key: cord-0863133-asbg85f2
authors: Lorenz, Camila; Azevedo, Thiago S.; Chiaravalloti-Neto, Francisco
title: COVID-19 and dengue fever: A dangerous combination for the health system in Brazil
date: 2020-04-09
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2020.101659
sha: 33a07d16bc3c09ced316c3ca0c171d1a7fe6621f
doc_id: 863133
cord_uid: asbg85f2

nan

* Corresponding author: Camila Lorenz Tel: +55(11)30617920; E-mail: camilalorenz@usp.br

To the Editor,

The outbreak of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. The number of COVID-19 cases has been on a rapid rise in Brazil, with the first records of death [1] . Simultaneously, the country is facing the outbreak of dengue fever, a known tropical disease. According to the Ministry of Health, the number of probable dengue cases increased by almost 19%, from 79,131 between December 29 and February 01 in 2019 to 94,149 in the same period in 2020. In 2019, about 2.3 million dengue cases were registered nationwide. Even in south regions of the country where the outbreak of dengue fever had never occurred, the number of dengue cases has been increasing at an alarming rate, with several deaths being recorded [2] . The number of dengue cases is often observed to increase at the beginning of the year due to the rainy season and high temperatures and peak between March and April.

Meanwhile, the peak of the COVID-19 outbreak in Brazil is forecast to occur between late April and early May, when respiratory diseases are most commonly found. This temporal coincidence implies that the two outbreaks may happen at the same time. This would cause great damage to population and therefore require intensive attention from both the private health system and the public Unified Health System (SUS).

Dengue fever and COVID-19 are difficult to distinguish because they share clinical and laboratory features [3] . Some authors described cases who were wrongly diagnosed as dengue but later confirmed to be COVID-19 [4] . Besides, co-infections with arboviruses and SARS-CoV-2 have not been well studied. In the midst of this complex epidemiological scenario, the fragile healthcare system in Brazil is facing the risk of collapse and multiple socio-economic issues [5] . For example, Constitutional Amendment 95 established the public spending limits, and in 2019, the health budget reduced by R$ 9 billion. There may not be enough intensive care units to accommodate even 25% of hospitalized patients with COVID-19. The lack of specific diagnostic tests, especially the real-time RT-PCR, would also make it challenging to perform early detection of virus importation and prevent onward transmission [5] . Another concern lies in the costs of hospitalization due

to dengue fever. The Brazilian government paid R$ 31 million for the hospitalization of approximately

World Health Organization

Brazilian Ministry of Health

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Covert COVID-19 and false-positive dengue serology in Singapore

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

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)

As the two outbreaks have a high likelihood of coinciding in terms of time, the burden of diseases may boost, requiring the Unified Health System (SUS) to put their greatest efforts into the double-fight against the outbreaks. *The number of dengue cases is not proportional to that of COVID-19 cases