COVID-19 Pandemic and Malaria

The clinical features of COVID-19 pandemic ranged from asymptomatic to severe symptoms. The symptoms include fever, cough, sputum production and fatigue. They may also include headache, arthralgia, myalgia, nausea and vomiting. Comparatively, malaria patients usually present with fever, headache, chills and sweating, other symptoms may include fatigue, arthralgia, myalgia, nausea, vomiting, and diarrhoea . Due to the similarity of symptoms between malaria and COVID-19, especially fever, difficulty in breathing, fatigue and headache of acute onset, a malaria patient may be misdiagnosed as COVID-19 and vice versa. Moreover, complications like acute respiratory distress syndrome (ARDS), septic shock, and multi-organ failure can also occur in both malaria and COVID-19. The first step to identify a COVID-19 patient is the symptomatic screening, which consists of shortness of breath, fever, dry cough, sore throat, headache and myalgia in a high-risk patient like healthcare workers or patients with a history of contact with a confirmed COVID-19 case. These screening approaches can fail to catch about 50% of the COVID-19 patients even in countries with excellent health systems. Malaria is a parasitic infection, caused by parasites of the genus Plasmodium and transmitted by Anopheles mosquitoes, that leads to an acute life-threatening disease and poses a notable global health threat. It’s typically transmitted through the bite of an infected Anopheles mosquito. Infected mosquitoes carry the Plasmodium parasite and when this mosquito bites a person, the parasite is released into bloodstream of a person. Once the parasites are inside the body of a person, they travel to the liver, where they mature. After several days, the mature parasites enter the bloodstream and begin to infect red blood cells. The parasites inside the red blood cells multiply within 48 to 72 hours, causing the infected cells to burst open. The parasites continue to infect red blood cells, resulting in symptoms that occur in cycles that last two to three days at a time. There are four kinds of malaria parasites that can infect humans: Plasmodium vivax, P. ovale, P. malariae, and P. falciparum. P. falciparum causes a more severe form of the disease and those who contract this form of malaria have a higher risk of death. An infected mother can also pass the disease to her baby at birth. This is known as congenital malaria. Malaria is transmitted by blood, so it can also be transmitted through an organ transplant, a transfusion and use of shared needles or syringes. The symptoms of malaria typically develop within 10 days to 4 weeks following the infection. In some cases, symptoms may not develop for several months. Some malarial parasites can enter the body but will be dormant for long periods of time. The common symptoms of malaria include: shaking chills that can range from moderate to severe, high fever, profuse sweating, headache, nausea, vomiting, abdominal pain, diarrhea, anemia, muscle pain, convulsions, coma and bloody stools. In case any one feel any symptom of malaria, he/she should approach to a doctor. The doctor will be able to diagnose malaria. The doctor will review health history, including any recent travel to tropical climates and a physical examination. The doctor will be able to determine if a person have an enlarged spleen or liver. If anyone have symptoms of malaria, the doctor may order additional blood tests to confirm diagnosis. These tests will show whether a person have malaria, what type of malaria a person have, if infection is caused by a parasite that’s resistant to certain types of drugs and if the disease has caused anemia. Malaria can cause a number of life-threatening complications such as swelling of the blood vessels of the brain, or cerebral malaria, an accumulation of fluid in the lungs that causes breathing problems, or pulmonary edema, organ failure of the kidneys, liver, or spleen, anemia due to the destruction of red blood cells and low blood sugar. As we are moving through the difficult face of the COVID-19 pandemic, time has returned to make us know that where we stand. Nearly hundreds of years ago, a pandemic of that time, malaria triggered widespread deaths and it was up to the world to draw a lesson from this pandemic, but the harsh reality is that we have not. The country’s health system had not been up to date, had it been uplifted then we would not have encountered such problems. Number of patients across the world has now risen to over 25 lakh, but we can’t get effective epidemic surveillance. World malaria theme for 2021 was “Zero malaria starts with me” it puts responsibility on our shoulders. “Zero malaria starts with me” is the rallying cry for World Malaria Day 2021. The slogan was designed to keep malaria initiatives on the political agenda, mobilize resources by making the message more personal, and impress on communities and individuals to take ownership of certain aspects of malaria prevention. Despite the challenges posed by the COVID-19 pandemic, a number of countries reported zero indigenous malaria cases in 2020, while others made impressive progress in their journey to becoming malaria-free. Our emphasis has never been on research but has been on other issues. Priority has never been healthcare nor research, and that is why we are not able to increase our frequency of testing. World Malaria Day held on 25 April is an annual event to increase consciousness of the worldwide initiative to monitor and effectively eliminate this dreadful disease. Malaria occurs in over 100 countries across the globe, and about 900,000 people suffer each year from the disease. However, malaria may be avoided using drugs and other precautionary steps, such as bed nets filled with insecticide and applying insecticide indoors. A plasmodium parasite-caused illness, spreading through the bite of contaminated mosquitoes is the malaria. Malaria incidence differs, depending on plasmodium types. Symptoms include chills, cough, and vomiting, which typically arise a few weeks after chewing. People traveling to places where malaria is frequent generally take preventive medicinal products before, during and after their journey. Treatment requires medications which are antimalarial. Malaria’s existence spans from its ancient roots as a zoonotic disorder of Africa’s primates up to the 21st century. The first proof of malaria parasites was discovered in mosquitoes that have been preserved in amber from the Paleocene era, around 30 million years ago. Around 10,000 years ago, malaria started to have a significant effect on human life, happens to coincide with the advent of Neolithic progressive cultivation a widespread and potentially lethal human infectious disease which at its peak infested every continent except Antarctic. Malaria prevention and care has been a subject of research and medicine for decades. Traditional herbal medicines have been used for the treatment of malaria for thousands of years. The first successful malaria cure originated from the bark of the cinchona tree which contains quinine. Following the discovery of the association with mosquitoes and their larvae in the early 20th century, mosquito protection measures such as widespread use of insecticide DDT, swamp drainage, covering or oiling the surface of accessible water bodies, indoor residual spraying and the use of insecticide-treated nets were introduced. Prophylactic quinine has been used in tropical regions of malaria, and modern medicinal medications such as chloroquine and artemisinine have been used to combat the scourge. Artemisinin today is found in any medicine used in malarial therapy. By using artemisinin in combination with other drugs, Africa’s mortality rate dropped by half. Malaria was the most serious health threat faced by U.S. forces in the South Pacific during World War II, infecting over 500,000 people. According to Joseph Patrick Byrne, “Sixty thousand American soldiers died of malaria during the African and South Pacific campaigns.
Several vaccines have been developed and several countries have initiated mass vaccination campaigns to control COVID-19 spread. In this global healthcare crisis and the ultimate test of our times, it is on all of us to be responsible. We need to encourage everyone to prepare, but not panic.
The COVID-19 pandemic has been a part of our daily lives since March 2020. Till date, more than 147,127,354 people have been infected, more than 3,114,272 people have died and more than 124,787,542 COVID-19 infected people have recovered till 25 April 2021. The US remains the worst-hit country with 32,789,653, followed by India (16,960,172), Brazil (14,308,215 ), France (5,473,579) and Russia (4,762,569). However, in the past seven days, India has added the highest number of fresh cases followed by the US and Brazil. India COVID-19 cases stand at 16,960,172. UP, Bengal, Kerala, Gujarat report biggest single-day surge. India on 25 March announced that a new “double mutant” variant of the coronavirus had been detected from samples collected from different states which makes virus more infectious. This is the first time any country country has recorded over 300,000 cases in just 24 hours. Amid oxygen shortage and faltering health system in the country, India saw 2,263 deaths in highest single-day spike. The death toll from the deadly infection stands at 192,311. The country now has more than 2.4 million active cases. Amid the unprecedented COVID situation in the country, Prime Minister Narendra Modi will hold a series of meetings on Friday, including one with chief ministers of states with high burden of coronavirus cases. The top US infectious disease official Dr Anthony Fauci has said vaccines’ impact on Covid-19 variants in India has not yet been determined. China has caused an outbreak with a continuous breach of borders involving 219 countries and territories worldwide and 2 international conveyances. The disease was designated 2019-nCoV on January 7th by the World Health Organisation (WHO). On 11 February 2020, the WHO modified its name to COVID-19 and the virus responsible for this epidemic was also called Serious Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) owing to the 2003 SARS epidemic genetic association with coronavirus. The clinical trials for the treatment are on cards but on ground it is true that there is no drug to cure this deadly disease. We cannot ignore the stuff that both the malaria and covid-19 are the pandemic and that the WHO has classified them as a health emergency. Time is to introspect that a pandemic that occurred at least before 100 years is still a nightmare for the world to be declared as malaria free, how much time it will take to be COVID-19 free. When almost all the globe has been influenced by this disease the dire need of the hour is again the pledge of the UN and the WHO for the provision of drugs, public health services and trained health staff. Health should be provided a priority because it has correctly been stated that health is wealth. In the face of a dual threat of antimalarial drug resistance and COVID-19, countries of the Greater Mekong subregion have also made major strides towards their shared goal of elimination by 2030. In the 6 countries of the subregion, the reported number of malaria cases fell by 97% between 2000 and 2020. Malaria deaths were reduced by more than 99% in the same period of time. Ahead of World Malaria Day, country leaders, frontline health workers and global partners will come together in a virtual forum to share experiences and reflections on efforts to reach the target of zero malaria. The event will be co-hosted by WHO and the RBM Partnership to End Malaria on 21 April. We have made tremendous strides in the battle against malaria over the last two decades, saving more than 7 million lives and avoiding more than 1 billion cases of malaria. However, as long as malaria remains, it affects the weakest and most endangered populations and has the ability to re-emerge in periods of public health disaster – like the COVID-19 challenge we are facing today. COVID-19 disturbs the continuity of the Population Services International and the Global Malaria Community, such as seasonal malaria chemoprevention (SMC) and insecticide-treated bed nets (ITNs) distribution. Malaria testing and treatment are also disturbed due to the risks faced by health workers who provide health care services during the pandemic. Decision-makers will need to make difficult choices to ensure that COVID-19 pandemic and other urgent, ongoing public health problems- including malaria endemics—are addressed while minimizing risks to health workers and communities. The community-based activities towards supporting the continuity of essential services, such as malaria prevention, diagnosis and treatment, with its distinctive capacities for health care delivery and social engagement, have a critical role to play in the response to COVID-19 pandemic and are essential to meet people’s ongoing health necessities, particularly for the most vulnerable population. The numbers of older populations and the pace of aging differ broadly between and within regions. Typically, the more developed regions have higher proportions of their populations in older age groups than do developing ones. Population age structure has its role in the remarkable variation in the COVID-19 vulnerability and fatalities across countries. The COVID-19 mortality risk is highly focused at older ages, especially those 80?+?years of age. It was reported that the young COVID-19 patients are usually asymptomatic or have mild symptoms that can be missed by targeted surveillance and testing. Scientists attribute the inverse relationship between COVID 19 and malaria to the wide use of hydroxychloroquine (HCQ), chloroquine (CQ) and other anti-malarial drugs in countries that are endemic for malaria. It is important to point out that HCQ and CQ efficacy in the treatment of coronavirus diseases has been studied since the first SARS epidemic. In conclusion, COVID-19 has a variable prevalence among countries which is lower than expected in malaria-endemic regions. In addition to the possible role of health infrastructure and mitigation tools adopted, the variable distribution of the ACEI/D and the ACE2 (C1173T substitution) polymorphisms could partly explain this variable prevalence. Also, malaria patients develop anti-GPI antibodies which could identify SARS-CoV-2 glycoproteins and consequently play a protective role against COVID-191 or inducing a milder disease pattern. Finally, the lockdown and restricting movements of health care providers due to the COVID-19 pandemic has disturbed the continuation of malaria control programs such as the distribution of seasonal malaria chemoprevention and insecticide-treated bed nets resulting in more malaria cases and deaths. The number of active covid-19 cases in India in the second wave of covid-19 are rising exponentially, in terms of mathematical modeling. Though the nationwide vaccination drive is being gradually extended to include all age groups, the emergence of several new mutants of the pathogen, which are far more infectious, poses a health emergency situation. Preventive measures for COVID-19 spread include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns to control COVID-19 spread. In this global healthcare crisis and the ultimate test of our times, it is on all of us to be responsible. We need to encourage everyone to prepare, but not panic.
( While Dr. Bilal A. Bhat is an Associate Professor at SKUAST-Kashmir, Sherub Ayoub Shalla Student at Central University of Kashmir. Views are their own)



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Confirmed: 21,077,410Deaths: 230,168