Health System Resilience for a Concurrent Outbreak of Coronavirus Disease 2019 and Dengue: A Response From Bangladesh

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Brief description: Bangladesh, a tropical country, has been facing periodic outbreaks of dengue since 2000. The country suffered its largest outbreak last year, with >100 000 confirmed cases and 120 deaths. These outbreaks usually reach the peak during monsoon and last till December and cause a considerable burden on our low-budgeted health care delivery system in terms of increased bed occupancy, higher outdoor and indoor consultations, and increased workload on health service providers. Even the diagnostic kits might fall short, as evident from previous outbreaks.¹ Besides, this makes hospitals preoccupied with noncritical patients, which hampers the critical patients’ timely management. This year, 792 dengue cases were reported until November 11, 2020, with an expected spike in the number to follow.² On the other hand, the existing health care facilities are already overburdened with coronavirus disease 2019 (COVID-19) patients. A total of 393 000 confirmed COVID-19 cases and 5723 deaths had been identified so far. Historically, concurrent outbreaks are not uncommon. The coincidence of dengue with chikungunya as well as influenza A H1N1 pandemic were previously documented. Concurrent infections of COVID-19 and dengue was already reported in Bangladesh³ and also in few other dengue-endemic countries.⁴ Although COVID-19 shows a classic respiratory symptom, it shares some common characteristics and laboratory profile with dengue as both can elicit a similar immune response in the body.⁵ As a result, a concurrent infection may spread insidiously among the general population while the nation focuses on COVID-19 alone. The simultaneous presence of both diseases in a person might cause diagnostic and management difficulty leading to fatal consequences. The coincident outbreak of dengue on top of the COVID-19 pandemic may cause havoc on the health care delivery system of Bangladesh if the preparation is not carried out in advance. To prevent increased dengue incidence on top of the COVID-19 pandemic, Bangladesh needs to take immediate action. Policymakers should collaborate with epidemiologists, entomologists, virologists, infectious disease specialists, health care professionals, and nongovernmental organizations in this regard. Public health measures in reducing the spread of COVID-19, such as social distancing or lockdown strategy, have been ineffective in our setting. Prevention strategies involving mosquito control and bite reduction failed in the past. Hence, the health care facilities should be ready to tackle the concomitant surge in dengue and COVID-19 cases. An organized effort of both public and private health care is therefore warranted. Bangladesh’s health care authority has already recommended testing all patients with fever for both COVID-19 and dengue and opened the dedicated COVID-19 hotlines for receiving dengue-related calls at district and upazila levels. Despite those measures, the recent escalating number of patients causes fearful apprehension about the health system’s preparedness. Therefore, authorities should increase testing facilities, designate COVID plus wards in the hospitals, and increase the number of beds in critical and intensive care units as early as possible. Intensified surveillance should be prioritized. A combination of these extraordinary measures is expected to strengthen the existing health system against this dual outbreak and could be applied in other countries sharing a similar social context.