Lassa Fever and COVID-19– Two Deadly Diseases in Nigeria.

Infectious diseases ravaging countries around the world have witnessed undeniable shifts in attention in light of the COVID-19 global pandemic. COVID-19 is an infectious disease caused by a corona virus called SARS-Cov-2 and it is reported to be transmitted from person to person through respiratory droplets produced when an infected person coughs, sneezes or talks[1],[2].There are speculations that the virus is of an animal origin since it is a coronavirus, although studies are still underway to identify the source of the virus.

On 30th January 2020, WHO declared COVID-19 a public health emergency of international concern[3] after an outbreak was first reported in Wuhan China in December 2019.  As the number of cases surged, WHO went ahead to declare COVID-19 a global pandemic on 11th March 2020. Since this declaration, concerted efforts at global, regional, national and sub-national levels have been channeled towards the fight against the disease. As of 30th August 2020, there have been 24,854,140 total confirmed cases and 838,924 total deaths as a result of COVID-19 disease[4]. Nigeria has since reported 53, 865 confirmed cases and 1,013 deaths[5] as of 30th August 2020 after the country announced its index case on 27th February 2020.

In response to the pandemic, Nigeria has deployed substantial resources in the fight against COVID-19, shifting attention away from another deadly disease of public health importance that has resulted in mortalities in recent times – Lassa fever. While COVID-19 is novel, Lassa fever is endemic in Nigeria and many parts of West Africa. Lassa fever is an acute viral haemorrhagic illness caused by Lassa virus[6]. The reservoir of the virus is the multimammate rat of the genus Mastomys.  The Lassa virus is transmitted to humans commonly through ingestion or inhalation of food or drink contaminated with the urine or faeces of infected multimammate rats; through exposure to open cuts or sores; or by direct contact with infected rat [7],[8]. In healthcare settings, laboratory transmission and person-to-person infection can also occur. An estimated 300,000 -500,000 cases and 5,000 related deaths occur annually in West Africa[9]. Outbreaks of different sizes and severities have occurred in Guinea, Liberia, Sierra Leone and Nigeria.

As Nigeria tackles COVID-19, it is also battling an outbreak of Lassa fever. Between 1st January and 30th August 2020, there have been 5,201 suspected cases, 1,074 confirmed cases and 225 deaths. In comparison to 2018 when there was over 600 confirmed cases and over 170 deaths[10], this has been the largest outbreak of Lassa fever. Within the same period, the case fatality rate (CFR) for Lassa fever was 20.9% compared to 1.9% for COVID-19. On the basis of CFR, it may be argued that more attention should be given to Lassa fever response; COVID-19 has however had more negative impact on the economies of a lot of countries. Clearly, the increasing number of Lassa fever cases poses a possible comorbidity of fatal proportions in COVID-19 affected persons. This is a cause of concern which calls for more attention and response towards Lassa fever.

Lassa fever has an incubation period between 6-21 days and presents with fever, muscle aches, sore throat, nausea, vomiting, and chest and abdominal pain as symptoms[11]. The most common complications of Lassa fever include acute kidney injury (AKI), severe dehydration (from vomiting or diarrhoea), sepsis/septic shock, encephalopathy, acute respiratory failure and severe bleeding/anaemia[12]. COVID-19 on the other hand has an incubation period of 1- 14 days and presents with symptoms from nasal congestion to headache, conjunctivitis, sore throat, diarrhea, loss of taste or smell or a rash on skin or discoloration of fingers or toes, and most commonly, fever, dry cough, and tiredness[1].The two most common complications of COVID-19 are (i) hypoxaemic respiratory failure and acute respiratory distress syndrome and (ii) sepsis and septic shock[2].

While there is ongoing research, clinical management of COVID-19 in Nigeria is currently guided by general principles of management of respiratory illnesses[3]. Presently, there is no definitive and agreed treatment for COVID-19 but a general principle of treatment used in Nigeria are around supplemental oxygen therapy, cautious and conservative use of fluid, empiric antibiotics treatment and close monitoring of patients with signs of clinical deterioration. Lassa fever is treated with intravenous Ribavirin administered over a period of 10 days[4] by trained health workers. A practice common to both diseases is the treatment or management of patients in designated isolation centres under standard infection prevention control (IPC) measures.

Currently, almost all campaigns and efforts are put towards the containment and reduction in the spread of COVID-19. Good personal and community hygiene has been the focus of all the media campaigns and sensitizations for the prevention of COVID-19. These campaigns, while directed and focused towards the prevention of the COVID-19, also prevent the transmission of Lassa fever. It is important to note the similarities in the preventive approaches for both diseases. A common preventive measure cutting across the Lassa fever and COVID 19 is the frequent washing of hands, use of face masks and use of personal protective equipment especially by health workers.

Efforts are being made by the government to enlighten the public on the importance of personal hand washing hygiene which may explain the reduction in the rate of Lassa fever infections. The interventions implemented for the prevention of COVID-19 comprised media campaigns to sensitize the public and create awareness about the virus, its transmission and precautions to prevent its contraction. The use of alcohol-based sanitizers, gloves and face masks have become the new norm. Frequent washing of hands, practice of social distancing and personal/environmental hygiene were also part of the focus of media campaigns for the prevention of COVID-19.

While there are sustained efforts to curb the spread of COVID-19, the course of the disease is still not certain as many countries have started opening their air borders, thus making continuous transmission a possibility through traveling activities. Notwithstanding, news about development of vaccines for COVID-19 has given hope both to the scientific community and the public at large. Clearly, the two diseases are of significant public health importance and require appropriate health responses. Responses towards curbing COVID-19 indirectly and positively affect Lassa fever prevention, and such prevention strategies should be intensified.

References

[1] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses

[2] National Interim Guidelines for Clinical Management of COVID-19, Version 1. Nigeria Centre for Disease Control, 14 March 2020

[3] National Interim Guidelines for Clinical Management of COVID-19, Version 1. Nigeria Centre for Disease Control, 14 March 2020

[4] National Guideline for Lassa Fever Case Management. Nigeria Centre for Disease Control, November 2018

[1] https://www.cdc.gov/coronavirus/2019-ncov/faq.html

[2] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-coronaviruses

[3] https://www.who.int/data/gho/whs-2020-visual-summary

[4] Coronavirus disease (COVID-19) Weekly Epidemiological Update. World Health Organization, 30 August 2020

[5] Covid-19 Situation report, Situation report 184. Nigeria Centre for Disease Control, 30 August , 2020

[6] Lassa fever. World Health Organization

[7] https://www.who.int/health-topics/lassa-fever/#tab=tab_1

[8] https://www.cdc.gov/vhf/lassa/pdf/factsheet.pdf

[9] https://ncdc.gov.ng/diseases/factsheet/47

[10] https://ncdc.gov.ng/diseases/factsheet/47

[11] National Guideline for Lassa Fever Case Management. Nigeria Centre for Disease Control, November 2018

[12] National Guideline for Lassa Fever Case Management. Nigeria Centre for Disease Control, November 2018

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