key: cord-259106-nrg1960d
authors: Vasquez-Chavesta, Angie Z.; Morán-Mariños, Cristian; Rodrigo-Gallardo, Paola K.; Toro-Huamanchumo, Carlos J.
title: COVID-19 and dengue: Pushing the peruvian health care system over the edge
date: 2020-06-26
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2020.101808
sha: 
doc_id: 259106
cord_uid: nrg1960d

nan

COVID-19 and dengue: Pushing the peruvian health care system over the edge Dear Editor, On February 25, 2020, the first case of Coronavirus Disease 2019 (COVID-19) was reported in Latin America (LA). Brazil was the first country. However, there was a rapid widespread throughout LA due to its high transmission efficiency, lack of travel restrictions, and, in some cases, the delay (or absence) of effective health-related policy decisions [1] .

In Peru, the first case of COVID-19 was confirmed on March 6, 2020, in a 25-year-old man with a recent travel history from Europe. Unfortunately, the country was already facing a nationwide state of emergency due to an outbreak of Dengue fever that started in October 2019. Thus, in early 2020, the Ministry of Health (MINSA) had already reported an incidence of 7.83 cases/100,000 inhabitants [2] , and, by the end of the first trimester, the confirmed cases were above 10,000 (Table 1) . Simultaneously, since the first reported case, COVID-19 has increased exponentially. At the end of the epidemiological week 24 (EW24), June 13, MINSA reported a total of 225,132 cases, 10,342 hospitalized patients, 1113 in Intensive Care Units (ICUs) and 6498 deaths. Additionally, several regions in northern Peru (Loreto, Lambayeque, Piura and La Libertad) not only have a considerable number of Dengue cases but are also in the Top 6 of COVID-19 cases.

It is important to mention that both diseases share some epidemiological characteristics, such as an increasing incidence and difficult control. Similarly, COVID-19 and dengue could be hard to distinguish because they also share some clinical and laboratory characteristics [3] . Therefore, the healthcare management of patients with any of these diseases represents a real challenge (and we cannot rule out that the Table 1 New and cumulative cases/deaths for dengue and COVID-19, according to epidemiological week. 0  8  877  0  6267  0  4  0  15  0  9  857  0  7124  0  7  0  22  0  10  1103  6  8227  6  6  0  28  0  11  819  37  9046  43  0  0  28  0  12  629  275  9675  318  0  5  28  5  13  549  353  10,224  671  0  11  28  16  14  570  1075  10, number of dengue-related deaths is underestimated). Additionally, although in Peru the case fatality rate of dengue is lower than that of COVID-19, some clinical manifestations such as dengue with alarm signs and severe dengue may need hospitalization and ICU admission (according to Peruvian guidelines [4] ). To make matters worse, the number of probable cases has followed a similar pattern to that of confirmed cases, with an approximate ratio of 2:1, which increases, even more, the demand for healthcare services and resources in the country. In Peru, drastic measures have been implemented in order to achieve the mitigation of the impact of COVID-19/Dengue. These included the publication of two supreme decrees (N � 044-2020-PCM and N � 004-2020-SA). However, different limitations have arisen, especially since the first case of COVID-19 was reported. For example, the lack of ICUs availability, ventilators, diagnostic and screening tests, personal protective equipment (PPE) and health workforce. Similar scenarios have been reported in other LA countries, such as Brasil [3] and Ecuador [5] .

Currently (16/06/20), the country is going through its fourteenth week of quarantine and COVID-19 continues spreading (237,156 cases and 7056 deaths to date). At the time of submission of this manuscript, the EW24 surveillance report for dengue was still not available. Although the number of deaths has not changed in the previous EW21 to EW23, the increase of Dengue cases is likely to become more evident in the next weeks or months. This could add more pressure on a health system that is already being pushed to the brink of collapse.

Peru has been making every effort to stop the spread and mortality rate of COVID-19 and we have to be optimistic. We still cannot be sure when this pandemic will end. However, when this happens, we should start by strengthening our health care system. As an old saying goes, "certain experiences mark the beginning of maturity."

Not applicable.

Not applicable.

All data and materials used in this manuscript were publicly available. Data sources included weekly and national surveillance reports from the Center for Disease Control and Prevention (Ministry of Health, Peru), and daily reports published in the Peruvian Digital Platform Gob. pe. Cumulative confirmed cases of dengue were obtained using the Virtual Dashboard of Health Situation (https://www.dge.gob.pe/salasit uacional/sala/index/salasit_dash/143). Mortality data (daily and cumulative) for COVID-19 was obtained using the Health Situation Dashboard: COVID-19 Perú (https://covid19.minsa.gob.pe/sala_situacional. asp).

This study was self-funded.

CJTH conceived the study. AZVC and PKRG collected the data independently, CMM and CJTH performed the cross-validation of the datasets and the quality control. All authors discussed the results, drafted the first manuscript, critically read and revised the manuscript, and gave their final approval for publication.

The authors declare that they have no competing interests.

COVID-19 in Latin America: the implications of the first confirmed case in Brazil

Perú a la SE 03-2020. Lima: CDC Perú

COVID-19 and dengue fever: a dangerous combination for the health system in Brazil

Guía de Pr� actica Clínica para la Atenci� on de Casos de Dengue en el Perú. Lima, Perú: MINSA

COVID-19 and dengue, co-epidemics in Ecuador and other countries in Latin America: pushing strained health care systems over the edge

Not applicable.
