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      Concerns about COVID-19 and arboviral (chikungunya, dengue, zika) concurrent outbreaks

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          Abstract

          To the editor, A novel betacoronavirus that causes severe pneumonia was first described in December 2019, in Wuhan, the capital city of Hubei province, in China. 1 Denominated SARS-CoV-2, and the etiologic agent of Coronavirus Disease 2019 (COVID-19), this virus has since spread around the world. The outbreak achieved pandemic status on March 12, 2020. 2 As of July 28, 2020, a total of 16,341,920 cases and 650,805 deaths were confirmed worldwide, 3 while in Brazil there were 2,483,191 cases and 88,539 deaths. 4 In addition to concerns surrounding the COVID-19 pandemic, there has also been an upsurge in other viral epidemics in Brazil: the arboviral diseases chikungunya, dengue and zika. A recent epidemiological bulletin from the Brazilian Ministry of Health (July 2020) reported a rising incidence of dengue (874,093), chikungunya (48,316) and zika (4666) cases from January to July 2020. 5 In Bahia, a state located in northeastern Brazil, an even more expressive rise was seen: a total of 28,293 cases of chikungunya, 82,251 cases of dengue and 3721 cases of zika in this same period. Compared with the same period in 2019, the number of chikungunya cases has risen by 383,2%. 6 As fever, fatigue, chills, myalgia are symptoms shared by both COVID-19 disease and arboviral infection syndromes, the concomitant occurrence of both outbreaks may lead to misdiagnosis by healthcare professionals.1, 7 Social distancing and isolation have been shown to be effective measures for preventing the spread of COVID-19 in populations, mitigating the collapse of health systems. 8 However, in impoverished areas, access to basic sanitation services, such as piped water delivery systems, remains scarce. As an alternative, poorer populations opt to store water for basic hygiene needs, which can lead to increased vectors proliferation, such as Aedes aegypti, and, consequently, more arbovirus infections. 9 Arboviral infections can also have life-threatening presentations, such as severe dengue and dengue shock syndrome, which accounted for 415 deaths and 8729 hospitalizations from January to July 2020 in the country. 5 Neurological complications arising from chikungunya and zika infections, including Guillain-Barré syndrome (GBS), encephalitis, myelitis and others, can be present during both acute and convalescent phases of the disease. 7 During the 2015 zika outbreak in Brazil, the appearance of several cases of GBS raised concerns with regard to severity, as most cases required hospitalization in intensive care unit (ICU) facilities due to acute progressive muscle weakness, respiratory failure and severe dysautonomia.10, 11 Approximately 15% of COVID-19 patients will evolve to severe pulmonary disease (severe acute respiratory syndrome — SARS), necessitating support in an ICU. The overall mortality rate associated with this disease has been reported to be around 5%. 8 Recent increases in the incidence of arboviral infections, potentially increasing the number of GBS cases, as well as severe dengue and dengue shock syndrome, raise the possibility of a lack of ICU beds to accommodate these patients in face of a health care system potentially overwhelmed by SARS-Cov-2. 12 It is extremely important that health care professionals and governmental health authorities be aware of the risks associated with the concomitant occurrence of the aforementioned diseases, and implement plans to conduct epidemiological surveillance and take the necessary actions to mitigate pressure on health care units. Conflicts of interest The authors declare no conflicts of interest.

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

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              The arboviral burden of disease caused by co-circulation and co-infection of dengue, chikungunya and Zika in the Americas.

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                Author and article information

                Journal
                Braz J Infect Dis
                Braz J Infect Dis
                The Brazilian Journal of Infectious Diseases
                Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U.
                1413-8670
                1678-4391
                12 September 2020
                12 September 2020
                Affiliations
                [a ]Universidade do Estado da Bahia, Departamento de Ciências da Vida, Campus I, Salvador, BA, Brazil
                [b ]Ministério da Saúde, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
                Author notes
                [* ] Corresponding author.
                Article
                S1413-8670(20)30123-9
                10.1016/j.bjid.2020.08.008
                7486873
                32941807
                6c30234b-3081-4f5d-a61b-f3c3b9e44d6a
                © 2020 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 30 August 2020
                Categories
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