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Impact of COVID-19 preventive measures on other infectious and non-infectious respiratory diseases in Pakistan

Published:January 29, 2021DOI:https://doi.org/10.1016/j.jinf.2021.01.018
      Dear Editor,
      We read with immense interest the article entitled “The impact of COVID-19 preventive measures on airborne/droplet- transmitted infectious diseases in Taiwan” by Shey-Ying Chen et al.
      • Lai C.C.
      • Chen S.Y.
      • Yen M.Y.
      • Lee P.I.
      • Ko W.C.
      • Hsueh P.R.
      The impact of COVID-19 preventative measures on airborne/droplet-transmitted infectious diseases in Taiwan.
      Which reported the decline in other respiratory diseases in Taiwan and here we would like to present the unintended decline in communicable and non-communicable respiratory illnesses in Pakistan.
      COVID-19 pandemic is now becomes a worldwide public health disaster and as of January 22, 2021, there are more than 98 million confirmed coronavirus cases including over 2 million deaths have been reported across the globe.

      COVID-19 CORONAVIRUS PANDEMIC: Available at; https://www.worldometers.info/coronavirus/. 2021.

      In Pakistan as of 22 January 2021, the toll of confirmed SARS-COV-2 cases reached 528,891 including 11,204 deaths after its first laboratory confirmation on 26 February 2020.

      COVID-19 CORONAVIRUS PANDEMIC: Available at; https://www.worldometers.info/coronavirus/. 2021.

      The collateral damage due to co-infection of COVID-19 with other respiratory pathogens and collateral benefits due to the implementation of COVID-19 preventative measures has been reported in the recent studies.
      • de Lusignan S.
      • Joy M.
      • Oke J.
      • McGagh D.
      • Nicholson B.
      • Sheppard J.
      • Akinyemi O.
      • Amirthalingam G.
      • et al.
      Disparities in the excess risk of mortality in the first wave of COVID-19: Cross sectional study of the English sentinel network.
      • Lai C.-C.
      • Yu W.-L.
      The COVID-19 pandemic and tuberculosis in Taiwan.
      The present study was conducted to investigate the positive impact of COVID-19 preventative measures on other infectious and non-infectious respiratory diseases in Pakistan. The data source utilized for the present study is based on the surveillance records available at National Institute of Health (NIH) Islamabad, which is the national public health institute supporting disease surveillance and epidemiology programs across the country. For the non-infectious respiratory diseases the data was obtained from the chest care clinic Islamabad. For comparative analysis we extracted the number of cases reported between January to December 2019 and 2020. Twelve infectious diseases including Tuberculosis (TB), Measles, Rubella, Influenza, Respiratory Syncytial Virus (RSV), Pertussis, Diphtheria, Epstein bar virus (EBV), Pneumonia, Haemophilus influenzae, Varicella zoster virus (VZV) and Mumps are notifiable diseases in Pakistan, for which the case investigation and reporting is mandatory for all public and private hospitals.
      Overall the number of 12 infectious and 5 non-infectious respiratory diseases declined from 1,92,026 in 2019 to 91,576 in 2020, with the reduction of 52.3% (Table 1). Comparatively more than 80% decline in 8 infectious diseases including, Rubella, RSV, Pertussis, Diphtheria, EBV, Pneumonia, Haemophilus influenzae Mumps and 5 non-infectious respiratory diseases such as Bronchiolitis, Asthma, Cystic fibrosis, Bronchitis and Bronchiectasis was observed in Pakistan. According to the data of chest care clinic Islamabad, for non-infectious respiratory diseases no any critical case is reported during 2020 as compare to the multiple critical cases were reported during 2019.
      Table 1Number of cases of infectious and noninfectious respiratory diseases reported during January to December in 2019 and 2020.
      Diseases20192020% Change
      Communicable
       TB17876787358-51.1
       Measles65363253-50.2
       Rubella1488132-91.1
       Influenza41787-79.1
       RSV32021-93.4
       Pertussis62435-94.3
       Diphtheria832157-81.1
       EBV7311-84.9
       Pneumonia1302248-80.9
       Haemophilus Influenzae20937-82.2
       VZV523114-78.2
       Mumps25839-84.9
      Non-Communicable
       Bronchiolitis977-92.8
       Asthma41359-85.7
       Cystic Fibrosis413-92.7
       Bronchitis7913-83.5
       Bronchiectasis472-95.7
       Total19202691576-52.3
      TB: Tuberculosis, RSV: Respiratory syncytial virus, EBV: Epstein bar virus, VZV: Varicella zoster virus
      The similar trends of unintended decline in other respiratory infectious diseases has already been reported from other countries such as Taiwan, Singapore, and China.
      • Wu D.
      • Lu J.
      • Cao L.
      • Ma X.
      • Liu Q.
      • Liu Y.
      • Zhang Z.
      Positive effects of COVID-19 control measures on pneumonia prevention.
      • Tsai J.R.
      • Tsai J.R.
      • Yang C.J.
      • Huang W.L.
      • Chen Y.H.
      • et al.
      Decline in invasive pneumococcus diseases while combating the COVID‐19 pandemic in Taiwan.
      • Galvin C.J.
      • Galvin C.J.
      • Li Y.C.
      • Malwade S.
      • Syed-Abdul S.
      • et al.
      COVID-19 preventive measures showing an unintended decline in infectious diseases in Taiwan.
      • Chen C.-H.
      • Lai CC
      • Chao CM
      • Tang HJ.
      Zero measles after COVID-19 pandemic in Taiwan.
      • Fang J.-L.
      • Chao C.-M.
      • Tang H.-J.
      The impact of COVID-19 on the diagnosis of TB in Taiwan.
      • Soo R.J.J.
      • Chiew CJ
      • Ma S
      • Pung R
      • Lee V.
      Decreased influenza incidence under COVID-19 control measures, Singapore.
      Results of our study showed that the nationwide use of face mask, regular hand washing, use of sanitizers, social distancing, closure of Malls, schools, colleges, universities, bane on public gathering, massive temperature check, lockdown, extensive testing and quarantine, dramatically reduce the risk of other respiratory diseases. The use of mask is proved to be helpful not only for infectious but also for the prevention of non-infectious respiratory diseases.
      The government and health authorities should continue to motivate the general public to actively participate in COVID-19 control measures, which will be more helpful to contain COVID-19 and additionally reduce the overall burden of other communicable diseases.
      During the COVID-19 pandemic the unintended decline in other infectious diseases definitely provide more capacity to deal with COVID-19 containment. The under–reporting of other infectious diseases during the COVID-19 pandemic need further evaluation.

      Authors contributions

      MSR, AI, MMA, MU, MS and SSZZ conceived and designed the study. MSR, MU, MMA were responsible for data collection and analysis. MSR, MU and MMA wrote the manuscript draft.

      Declaration of Competing Interest

      All author declared that there is no conflict of interest

      Funding

      No funding source

      Acknowledgements

      The authors extend their gratitude to the diseases epidemiology and surveillance staff of National Institute of Health and medical and nursing staff of Chest care clinic Islamabad for their technical support.

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