Outbreak of Dengue Amid the COVID-19 Pandemic: An Emerged Crisis for Bangladesh

Dear Editor, Bangladesh has experienced a havoc coinfection, the simultaneous infection by two different viral strains, caused by SARS-CoV-2 and dengue virus (DENV) from mid-2021 onward. SARS-CoV-2 induced COVID-19 appeared in December 2019 in Wuhan and was declared a pandemic by World Health Organization (WHO) on March 11, 2020.1 Bangladesh confirmed its first COVID-19 case on March 9, 2020, by IEDCR (The Institute of Epidemiology, Disease Control and Research), the country’s epidemiology institute. As of November 17, 2021, Bangladesh has reported 27 934 deaths due to COVID-19 with total cases of 1.57 million, and the presence of a more transmissible delta variant (60% more than alpha variant) has been confirmed by ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh), the country’s leading health research institute.2 Concurrently, dengue, the mosquito-borne viral disease and concerning infectious disease for tropical and subtropical zone, has been a great concern as the DGHS, a wing of the Ministry of Health and Family Welfare in Bangladesh, outlined that a total of 25 065 patients have been infected by dengue as of November 17, 2021; with a total death of 96, the infection rate has remarked to be swelled up since July.3 Acceleration of population growth, climate change, and random urbanization propelled dengue cases by 30-fold from 1960 to 2010 worldwide, and the IEDCR reported 101 354 dengue cases in 2019 with 179 deaths, much higher than the previous records due to a new variant DENV-3 that emerged in Bangladesh in 2019.4 In this pandemic era, indistinguishable initial symptoms for both the COVID-19 and dengue such as headache and fever as directed by Center for Disease Control and Prevention (CDC) and patient overflow in the hospitals left the health care workers in a perplexing situation in Bangladesh along with other dengue-prevalent tropical and subtropical countries to manage both infections implicitly. An earlier study in Asia revealed five deaths due to COVID-19 and dengue coinfection manifested by stroke.5 Singapore, India, and Thailand also reported cases of coinfection. A leading newspaper in Bangladesh, the Daily Sun, reported on July 4, 2021, that a professor of Bangladesh Agricultural University (BAU) died due to coinfection. Meanwhile, the alarming COVID-19 situation compelled the concerned authority to implement lockdown in Bangladesh which further makes people suffer from lack of transportation leading to tough accessibility to the health care system. Moreover, many people in Bangladesh, living in a lowermiddle-income country, face financial crisis in the lockdown, especially those who live on day-to-day basis earnings such as rickshaw pullers, tea stall owners, and so on. On the contrary, Bangladesh has been ranked 162 among 180 countries in the Environmental Performance Index (EPI) in 2021 indicating poor sanitization, impure water, and poor hygiene, which are responsible for dengue. Moreover, poor health structures and health disparity throughout the country also are concerning factors in this perilous situation. Proper training and safety must be ensured for the health care workers as they are battling the coinfection without any prior experience. Policy makers should make necessary amendments and take short-term and long-term plans to alleviate the present situation as well as build a safe healthy future.