Rahul Tandon, Consultant at Global Health Strategies talks about managing COVID co-infection & seasonal vector borne diseases
The COVID impact
After weeks of battling the unrelenting onslaught of Covid-19 infections, India’s healthcare system finally received a respite when the second wave of COVID began to fade. Hospital beds are becoming available again, and vaccinations are being administered.
Other public health priorities, however, such as the battle against malaria, have been affected by the pandemic. A recent survey by Geneva-based The Global Fund on the impact of Covid-19 on malaria programs in seven Asian countries found that malaria diagnoses fell 56%, while malaria treatments dropped 59%[1].
In India, efforts to control vector borne diseases such spraying insecticides, IRS rounds to control Kala Azar, distribution of bed nets etc have taken a hit. This has led to millions being exposed to these diseases.
It’s critical that the government and the community work together to prevent mosquito breeding. To prevent mosquito infection, water bodies such as lakes and ponds must be cleaned and water should not be allowed to accumulate anywhere.
We must keep in mind that if India faces a third wave of COVID, the country’s healthcare infrastructure may not be able to cope with the combined surge in COVID and vector-borne disease cases.
The Co-Infection – COVID & Vector Borne Diseases
According to the World Health Organization (WHO), acute onset of fever and cough could be signs of COVID, or ANY THREE of the following signs or symptoms could indicate a person has COVID.
- fever
- cough
- general weakness/fatigue
- headache
- myalgia,
- sore throat
- coryza
- dyspnoea
- anorexia/nausea/ vomiting
- diarrhoea
- altered mental status
Seasonal epidemic prone diseases, such malaria, dengue, lymphatic filariases, Kala Azar etc, can all have symptoms like COVID-19. If there is a co-infection, there may be common signs and symptoms which might makes diagnosis difficult.
Symptoms for common vector borne diseases:
Malaria –fever either daily, or every alternate day, body ache, chills, sweating and shivering, along with diarrhoea, mental confusion, and a rapid heart rate.
Dengue – Sudden, high fever, along with nausea and vomiting, severe body ache, low platelet count, pain typically behind the eyes, muscle, joint, or bone pain, and rashes
Chikungunya: High fever and chills, along with severe body ache and fatigue, rashes, acute joint pain and pain in the abdomen, back of the eyes, joints, or muscles.
Clinical management & diagnostics
According to the Guidelines for management of co-infection of COVID-19 with other seasonal epidemic prone diseases issued by Ministry of Health and Family Welfare, Government of India:
- Tests recommended by ICMR (for COVID-19) and that recommended by the concerned programme divisions (NVBDCP for vector borne diseases [Malaria, Dengue, Chikungunya]) and NCDC (Seasonal Influenza, Leptospirosis, Scrub Typhus)] should be conducted.
- Availability of rapid diagnostic kits for malaria, dengue, scrub typhus should be ensured in such COVID treatment facilities.
- Co-infection should be ruled out when suspected with proper diagnostic method at the early stage to initiate proper specific management to reduce morbidity and mortality.
- Mild to moderate Dengue and COVID co-infected patient should be monitored closely preferably at hospital, as they may rapidly progress to a severe stage.
- Strengthening the primary health care level is the key to manage dengue through early clinical diagnosis and recognition of warning signs for severity of Dengue (such as abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleed, lethargy or restlessness, liver enlargement >2 cm, and increase in haematocrit).
- At the same time, all secondary and tertiary level hospitals should be prepared to manage severe dengue and COVID cases.
These measures will help prevent the progression of illness to severe dengue and deaths, which in turn will also help to reduce the number of patients that need to be referred to hospitals, thus avoiding saturation of these facilities as well as the intensive care units
COVID protocols – A boon this Monsoon
- Wearing a mask, social distancing, and hand sanitization/washing on a regular basis are all recommended.
- Wear clothing that covers most of your body to avoid mosquito bites while also protecting yourself from COVID infection. Keep your house clean and prevent it from mosquitoes as far as possible.
- Drink clean water that is ideally boiled or filtered, and carefully wash vegetables and fruits in it before cooking. Fresh vegetables should be consumed whenever possible.
- Make a conscious effort to keep your surroundings clean and avoiding water stagnation.
- While COVID-19 prevention involves improving ventilation, this provides an ideal opportunity for mosquitos to enter homes. As a result, it’s critical to use insecticide-lined bed nets, insect repellents, and meshes over windows and doors. To protect yourself from vector-borne infections, make sure the mattresses are not damp.
Collaboration
Malaria No More, a non-governmental organisation, formed a multi-disciplinary India Interagency Expert Committee on Malaria and Climate (IEC) with the India Meteorological Department (IMD) and the Indian Council of Medical Research (ICMR) to investigate and advance climate-based solutions for accelerating malaria elimination efforts in India. The committee aims to combine meteorological information with the information from the health sector, to examine micro-trends and predict malaria patterns, and accelerate national progress towards eliminating Malaria.[2]
Initiatives like these have the potential to improve understanding of mosquitoes’ lethal role and to learn new disease eradication/control techniques for diseases like dengue and other mosquito-borne diseases.
To detect new outbreaks, the government and private sector must work together to establish robust reporting systems. Investments should be made in strengthening the overall health infrastructure to ensure that the country is ready for any outbreak comparable to COVID while also being efficient enough to treat existing infections.
Health workers and the community
ASHAs, India’s first line of defence female health professionals, must spread prevention education for a variety of health issues, including dengue, malaria, and COVID-19, to ensure that the community is prepared to deal with such diseases. It’s also critical to develop communication and trust between the public health system and the community.
Households should play their part in ensuring that stagnant water does not accumulate in empty containers, where mosquitos can breed.
Role of Panchayati Raj Institution
The role of Panchayati Raj Institutions (PRI) is crucial this monsoon. It is critical to manage mosquito breeding at the start of the monsoon season. Local governments, municipalities, and Panchayats, must identify vector infestations such as ponds, lakes, pits etc and ensure insecticides are sprayed.
To reduce stress on the country’s health infrastructure, protecting rural areas from vector-borne diseases should be a priority in the coming months, especially with COVID ongoing.
As the adage goes, “Prevention is better than cure!”
[1]https://www.theglobalfund.org/media/10776/covid-19_2020-disruption-impact_report_en.pdf
[2] https://www.malarianomore.org/news/india-interagency-expert-committee-on-malaria-and-climate-launched-by-malaria-no-more-in-collaboration-with-the-india-meteorological-department-and-the-indian-council-of-medical-research-to-accelerate/