Even as authorities move to return the schools to full strength operations and relax curbs on commercial activity in view of the receding tide of the Covid-19 global pandemic, Pakistan is in the pincer grip of a Covid-Dengue co-epidemic, bringing fresh pressure on the country’s derelict healthcare system.
The new challenge has arisen as the dengue virus has once again reared its ugly head in Islamabad, Punjab and Khyber-Pakhtunkhwa (KP) provinces. Currently, several parts of the country have been hit by the potentially devastating co-epidemic.
While the data predict that the mosquito-borne disease may strike with full force in the coming days, health experts are demanding of the federal and provincial governments to take necessary preventive steps to minimise the spread of the viral illness.
The latest statistics show that number of dengue virus cases is already on the rise in several parts of the country. For instance, in Rawalpindi, more than 500 patients have so far been treated at public-sector hospitals alone in just two weeks.
The protocols and preventive measures to avoid spread of dengue virus have been in place for the last many years. The most important among them is the prevention of mosquito infestations. Basically, the strategy involves draining stagnant water and ensuring regular fumigation especially in areas more susceptible to viral outbreaks.
Use of insect repellents, wearing long-sleeved garments and sleeping under mosquito nets are also advised to guard against mosquito bites. The recent history of the dengue virus revealed that Lahore was in the grip of the dengue epidemic in 2011.
The then Chief Minister of Punjab Shahbaz Sharif resolved to eliminate breeding grounds of mosquitoes by implementing advice from countries like Sri Lanka, which had been engaged in a running battle with dengue. The proven solutions were adopted and, resultantly, the number of cases came down from 21,000 in 2011 to 258 in 2012.
Coinfection
Coinfection of Covid-19 and dengue poses another challenge for accurate diagnosis and treatment of these viral diseases. The initial symptoms of co-infected patients such as fever, aches, and rash are seen to be similar; the distinction can be made as the disease progresses.
Thus, it is difficult to distinguish between dengue and Covid-19 at the initial stage because they manifest similar clinical and laboratory features. Further complications raise when Covid-19 infection gives false-positive results for dengue in the rapid serological tests.
The patients being first incorrectly diagnosed with dengue are later confirmed to be Covid-19. Thus, the new symptom of Covid-19 has been discovered where the patient is suspected of suffering from dengue fever.
The combination of Covid-19 and dengue is assumed as dangerous for health care system. In fact, coinfection may cause illness with overlapping signs and symptoms that make diagnosis and treatment difficult for health professionals.
Besides, highly accurate, rapid, sensitive, and accessible diagnostic tests are strongly recommended for both Covid-19 and dengue to avoid false-positive results. Continuous surveillance of Covid-19 and dengue patients either single or co-infected with clinical symptoms is also recommended for early and proper recognition of the infecting pathogen.
Covid by numbers
The total number of confirmed coronavirus cases is 1,252,656: Islamabad 105,802; Punjab 433,687; Sindh 460,748; KP 174,841; Balochistan 32,992; Azad Jammu and Kashmir (AJK) 34,253; and Gilgit-Baltistan (GB) 10,334.
The number of active cases is 45,826: Islamabad 2,268; Punjab 15,690; Sindh 22,801; KP 4,292; Balochistan 161; AJK 468; and GB 146.
In all, 1,178,883 patients have fully recovered from the disease: Islamabad 103,604; Punjab 405,287; Sindh 430,505; KP 164,596; Balochistan 32,482; AJK 33,047; and GB 10,002.
Unfortunately, 27,947 people have lost their lives across the country: Islamabad 929; Punjab 12,710; Sindh 7,442; KP 5,593; Balochistan 349; AJK 738; and GB 186.
A total of 61,538,995 people have got their first dose of the coronavirus vaccine while 31,020,211 are now fully vaccinat- ed in the country. The number of total doses administered in Pakistan is 86,630,655.
Dengue larvae
Official record shows the evidence of dengue larvae has been found in 71,000 households in the Punjab province, most of them in Lahore, Rawalpindi, and Islamabad. The number of dengue cases in Punjab has crossed the 2,000 mark after 173 more people tested positive for the virus on last day of first week of October.
Data shows on average three to five positive cases were emerging in Punjab every day last October. The number for this October is 150 cases. The reason is said to be a lack of surveillance activities and commitment to launch vigorous anti-dengue campaign in Punjab by the health authorities.
Multiple reports are emerging from hospitals that a number of dengue patients are reporting with low platelet counts.
Complications
Medical practitioners say a negative result of the diagnostic tests, either for Covid-19 or dengue fever, does not rule out infections when the clinical symptoms are suggestive, especially in early stages. In patients with several days of symptoms, the probability of finding RT-PCR for dengue positivity is low, since the sensitivity of the test decreases further along the course of illness, as observed in the second case.
It has been seen that RT-PCR tests for SARS CoV-2 can be positive for longer periods, which is an interesting difference compared with direct dengue tests. The dengue virus and Covid-19 coinfection are possible, and should be suspected in dengue endemic areas.
The diagnosis requires a combination of tools, tests for the direct detection of virus, and indirect tests that measure the immune response, in addition to an adequate interpretation of the results according to the clinical and epidemiological particularities of both infections.
Warning or dengue spike
The Pakistan Meteorological Department (PMD) recently warned of a spike in dengue cases in the country. Post-monsoon weather conditions are conducive to the spread of vector-borne illness.
The PMD also pointed out eight major cities – Karachi, Hyderabad, Peshawar, Islamabad, Lahore, Multan, Faisalabad and Rawalpindi – as likely hotspots that will be particularly vulnerable to the onslaught of Aedes aegypti, the mosquito species responsible for spreading dengue virus, from 10 October to 20 November.
New fake entries
Three more high-profile fake entries for coronavirus vaccination surfaced involving identity theft of former Prime Minister Nawaz Sharif, his deceased wife Kulsoom Nawaz, and former Finance Minister Ishaq Dar.
Another fake entry in the name of former Prime Minister Nawaz Sharif has been made at a vaccination centre in Narowal. The City’s Deputy Commissioner said the suspects entered Nawaz Sharif’s name in the database using his identity card.
The first fake coronavirus vaccine entry made using the former prime minister’s name was at the National Immunization Management System (NIMS) at the Government Kot Khawaja Saeed Hospital on 22 September.
The Punjab Primary and Secondary Healthcare Department moved the Federal Investigation Agency (FIA) to take action over fake entries made under the names of Kulsoom Nawaz and Ishaq Dar in the National Immunisation Management System (Nims) – the government’s online portal for the issuance of vaccination certificates.
Two health department officials have since been suspended from service and the relevant district health authority’s chief executive officer has asked the FIA to register a case against them.
Back to school
The educational activities across the country have finally regained a semblance of normalcy after almost two years of interruptions because of the multiple waves of the coronavirus pandemic.
The National Command and Operation Centre (NCOC), the nerve centre of the government’s unified efforts to stem the pandemic, took this decision in view of the decline in the Covid-19 cases and a stepped-up national vaccination campaign.
Educational activities were closed after coronavirus cases first emerged in the country in February 2020. The classes resumed briefly after some six months but had to be suspended again as the second wave of the disease surfaced towards the end of last year.
A steady decline in the prevalence of Covid-19 has been in evidence in recent weeks. For the past few days, the national Covid-19 positivity ratio has plummeted to below 3 percent.
Emerging challenges
The fourth wave of coronavirus pandemic is apparently heading towards its logical end but the dengue virus outbreak is likely to mount pressure on the healthcare system.
Many experts have pointed out that the Punjab government has not taken appropriate measures during pre-monsoon and monsoon season due to which the dengue virus has raised its head in many cities of the province.
Under the protocols laid down years ago, provincial governments are required to come up with their plans to control dengue virus by June every year. In next three months they implement their respec- tive plans to control the disease. It does not seem like the practice was followed this year. Now the emerging situation underlines the need for immediate measures that can ensure protection of the people from this disease.
