Dear Editor,
On February 25, 2020, the first case of Coronavirus Disease 2019 (COVID-19) was reported in Latin America (LA). Brazil was the first country. However, there was a rapid widespread throughout LA due to its high transmission efficiency, lack of travel restrictions, and, in some cases, the delay (or absence) of effective health-related policy decisions [1].
In Peru, the first case of COVID-19 was confirmed on March 6, 2020, in a 25-year-old man with a recent travel history from Europe. Unfortunately, the country was already facing a nationwide state of emergency due to an outbreak of Dengue fever that started in October 2019. Thus, in early 2020, the Ministry of Health (MINSA) had already reported an incidence of 7.83 cases/100,000 inhabitants [2], and, by the end of the first trimester, the confirmed cases were above 10,000 (Table 1 ). Simultaneously, since the first reported case, COVID-19 has increased exponentially. At the end of the epidemiological week 24 (EW24), June 13, MINSA reported a total of 225,132 cases, 10,342 hospitalized patients, 1113 in Intensive Care Units (ICUs) and 6498 deaths. Additionally, several regions in northern Peru (Loreto, Lambayeque, Piura and La Libertad) not only have a considerable number of Dengue cases but are also in the Top 6 of COVID-19 cases.
Table 1.
New and cumulative cases/deaths for dengue and COVID-19, according to epidemiological week.
| EW | New casesb |
Cumulative cases by weekb |
New deathsb |
Cumulative deaths by weekb |
||||
|---|---|---|---|---|---|---|---|---|
| Dengue | COVID-19 | Dengue | COVID-19 | Dengue | COVID-19 | Dengue | COVID-19 | |
| 1 | 475 | 0 | 475 | 0 | 0 | 0 | 0 | 0 |
| 2 | 597 | 0 | 1072 | 0 | 6 | 0 | 6 | 0 |
| 3 | 663 | 0 | 1735 | 0 | 1 | 0 | 7 | 0 |
| 4 | 849 | 0 | 2584 | 0 | 2 | 0 | 9 | 0 |
| 5 | 929 | 0 | 3513 | 0 | 2 | 0 | 11 | 0 |
| 6 | 946 | 0 | 4459 | 0 | 0 | 0 | 11 | 0 |
| 7 | 931 | 0 | 5390 | 0 | 0 | 0 | 11 | 0 |
| 8 | 877 | 0 | 6267 | 0 | 4 | 0 | 15 | 0 |
| 9 | 857 | 0 | 7124 | 0 | 7 | 0 | 22 | 0 |
| 10 | 1103 | 6 | 8227 | 6 | 6 | 0 | 28 | 0 |
| 11 | 819 | 37 | 9046 | 43 | 0 | 0 | 28 | 0 |
| 12 | 629 | 275 | 9675 | 318 | 0 | 5 | 28 | 5 |
| 13 | 549 | 353 | 10,224 | 671 | 0 | 11 | 28 | 16 |
| 14 | 570 | 1075 | 10,794 | 1746 | -a | 57 | -a | 73 |
| 15 | 552 | 5102 | 11,346 | 6848 | -a | 108 | 33 | 181 |
| 16 | 787 | 7572 | 12,133 | 14,420 | 0 | 168 | 33 | 349 |
| 17 | 606 | 10,911 | 12,739 | 25,331 | 0 | 351 | 33 | 700 |
| 18 | 503 | 17,203 | 13,242 | 42,534 | 0 | 500 | 33 | 1200 |
| 19 | 415 | 22,481 | 13,657 | 65,015 | 2 | 614 | 35 | 1814 |
| 20 | 355 | 23,526 | 14,012 | 88,541 | 0 | 709 | 35 | 2523 |
| 21 | 244 | 27,213 | 14,256 | 115,754 | 1 | 850 | 36 | 3373 |
| 22 | 138 | 39,917 | 14,394 | 155,671 | 0 | 998 | 36 | 4371 |
| 23 | 23 | 36,087 | 14,417 | 191,758 | 0 | 930 | 36 | 5301 |
| 24 | -a | 33,374 | -a | 225,132 | -a | 1197 | -a | 6498 |
At the time of the last update of this manuscript (June 16, 2020), there was no data for dengue.
Only confirmed cases were included EW (d/m/y): EW1: 01/01/20 to January 04, 2020, EW2: January 05, 2020 to January 11, 2020, EW3: January 12, 2020 to January 18, 2020, EW4: January 19, 2020 to January 25, 2020, EW5: January 26, 2020 to February 01, 2020, EW6: February 02, 2020 to February 08, 2020, EW7: February 09, 2020 to February 15, 2020, EW8: February 16, 2020 to February 22, 2020, EW9: February 23, 2020 to February 29, 2020, EW10: March 01, 2020 to March 07, 2020, EW11: March 08, 2020 to March 14, 2020, EW12: March 15, 2020 to March 21, 2020, EW13: March 22, 2020 to March 28, 2020, EW14: March 29, 2020 to April 04, 2020, EW15: April 05, 2020 to April 11, 2020), EW16: April 12, 2020 to April 18, 2020), EW17: April 19, 2020 to April 25, 2020), EW18: April 26, 2020 to May 02, 2020), EW19: May 03, 2020 to May 09, 2020), EW20: May 10, 2020 to May 16, 2020), EW21: May 17, 2020 to May 23, 2020), EW22: May 24, 2020 to May 30, 2020), EW23: May 31, 2020 to June 06, 2020, EW24: 07/06/20 to 13/06/20).
It is important to mention that both diseases share some epidemiological characteristics, such as an increasing incidence and difficult control. Similarly, COVID-19 and dengue could be hard to distinguish because they also share some clinical and laboratory characteristics [3]. Therefore, the healthcare management of patients with any of these diseases represents a real challenge (and we cannot rule out that the number of dengue-related deaths is underestimated). Additionally, although in Peru the case fatality rate of dengue is lower than that of COVID-19, some clinical manifestations such as dengue with alarm signs and severe dengue may need hospitalization and ICU admission (according to Peruvian guidelines [4]). To make matters worse, the number of probable cases has followed a similar pattern to that of confirmed cases, with an approximate ratio of 2:1, which increases, even more, the demand for healthcare services and resources in the country.
In Peru, drastic measures have been implemented in order to achieve the mitigation of the impact of COVID-19/Dengue. These included the publication of two supreme decrees (N°044-2020-PCM and N°004-2020-SA). However, different limitations have arisen, especially since the first case of COVID-19 was reported. For example, the lack of ICUs availability, ventilators, diagnostic and screening tests, personal protective equipment (PPE) and health workforce. Similar scenarios have been reported in other LA countries, such as Brasil [3] and Ecuador [5].
Currently (16/06/20), the country is going through its fourteenth week of quarantine and COVID-19 continues spreading (237,156 cases and 7056 deaths to date). At the time of submission of this manuscript, the EW24 surveillance report for dengue was still not available. Although the number of deaths has not changed in the previous EW21 to EW23, the increase of Dengue cases is likely to become more evident in the next weeks or months. This could add more pressure on a health system that is already being pushed to the brink of collapse.
Peru has been making every effort to stop the spread and mortality rate of COVID-19 and we have to be optimistic. We still cannot be sure when this pandemic will end. However, when this happens, we should start by strengthening our health care system. As an old saying goes, “certain experiences mark the beginning of maturity."
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Availability of data and material
All data and materials used in this manuscript were publicly available. Data sources included weekly and national surveillance reports from the Center for Disease Control and Prevention (Ministry of Health, Peru), and daily reports published in the Peruvian Digital Platform Gob.pe. Cumulative confirmed cases of dengue were obtained using the Virtual Dashboard of Health Situation (https://www.dge.gob.pe/salasituacional/sala/index/salasit_dash/143). Mortality data (daily and cumulative) for COVID-19 was obtained using the Health Situation Dashboard: COVID-19 Perú (https://covid19.minsa.gob.pe/sala_situacional.asp).
Funding
This study was self-funded.
Authors' contributions
CJTH conceived the study. AZVC and PKRG collected the data independently, CMM and CJTH performed the cross-validation of the datasets and the quality control. All authors discussed the results, drafted the first manuscript, critically read and revised the manuscript, and gave their final approval for publication.
Declaration of competing interest
The authors declare that they have no competing interests.
Acknowledgment
Not applicable.
References
- 1.Rodriguez-Morales A.J., Gallego V., Escalera-Antezana J.P., Méndez C.A., Zambrano L.I., Franco-Paredes C. COVID-19 in Latin America: the implications of the first confirmed case in Brazil. Trav Med Infect Dis. 2020 doi: 10.1016/j.tmaid.2020.101613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Centro Nacional de Epidemiologia . CDC Perú; Lima: 2020. Prevención y Control de Enfermedades. Sala de situación de salud. Perú a la SE 03-2020.https://www.dge.gob.pe/portal/docs/vigilancia/sala/2020/SE03/dengue.pdf Disponible en. [Google Scholar]
- 3.Lorenz C., Azevedo T.S., Chiaravalloti-Neto F. COVID-19 and dengue fever: a dangerous combination for the health system in Brazil. Trav Med Infect Dis. 2020 doi: 10.1016/j.tmaid.2020.101659. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.de Salud Ministerio. MINSA; Lima, Perú: 2012. Guía de Práctica Clínica para la Atención de Casos de Dengue en el Perú.bvs.minsa.gob.pe/local/MINSA/2366.pdf Available from: [Google Scholar]
- 5.Navarro J.-C., Arrivillaga-Henríquez J., Salazar-Loor J., Rodriguez-Morales A.J. COVID-19 and dengue, co-epidemics in Ecuador and other countries in Latin America: pushing strained health care systems over the edge. Trav Med Infect Dis. 2020;5 doi: 10.1016/j.tmaid.2020.101656. de abril de. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
All data and materials used in this manuscript were publicly available. Data sources included weekly and national surveillance reports from the Center for Disease Control and Prevention (Ministry of Health, Peru), and daily reports published in the Peruvian Digital Platform Gob.pe. Cumulative confirmed cases of dengue were obtained using the Virtual Dashboard of Health Situation (https://www.dge.gob.pe/salasituacional/sala/index/salasit_dash/143). Mortality data (daily and cumulative) for COVID-19 was obtained using the Health Situation Dashboard: COVID-19 Perú (https://covid19.minsa.gob.pe/sala_situacional.asp).