Saurabh Rambiharilal SHRIVASTAVA,Prateek Saurabh SHRIVASTAVA

Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth - Deemed to be University, Nellikuppam, Chengalpattu, Tamil Nadu, India

ABSTRACT

The emergence of the coronavirus disease-2019 (COVID-19) outbreak and its rapid transmission in different parts of the world has become a major public health challenge.Considering the consequences of malaria in the past, it is the need of the hour that in the process of containing COVID-19, we should not ignore the strategies aimed toward the prevention and control of malaria infection.There is no point in complaining about the developments that have already happened, the best strategy will be to consider the different facets of COVID-19 infection containment as opportunities and then act accordingly.In the process of fighting against the COVID-19 infection, we have ignored the delivery of essential services pertaining to malaria.This calls for the need to revisit the planned and implemented services for COVID-19 infection and use the existing mechanism for implementing the strategies required for malaria elimination.

Keywords: Community, coronavirus disease-2019 pandemic, malaria

INTRODUCTION

The emergence of the coronavirus disease-2019 (COVID-19)outbreak and its rapid transmission in different parts of the world has become a major public health challenge.[1]Owing to the magnitude of the disease and the attributed deaths,the novel viral infection has accounted for huge global interruptions, especially in the health sector and delivery of welfare measures.[1]In fact, the recent report depicts that as of December 7, 2021, in excess of 265 million cases and 5.2 million deaths have been attributed to the infection.[2]Even though the pandemic has affected all the nations, considering the weakness in the health-care delivery system, its impact is bound to be more in the case of low-and middle-income nations.[1,3]

Malaria is a parasitic infection, which predominantly affects the African region and other developing nations, and that close to 50% of the world’s population resides in malaria-endemic settings.[4]In 2020, more than 240 million cases and 0.63 million malarial deaths have been reported worldwide.We must note that in 2019 (pre-COVID-19 era), 227 million cases and 0.57 million deaths were reported.[4]One of the potential reasons for the reported rise in the incidence and the death rates could be due to the interruption of the basic services required for the containment of the malarial infection, as all the existing resources were redirected toward the prevention and control of COVID-19 infection.[4-6]

It is important to note that patients with malaria or COVID-19 infection can present with similar kinds of clinical features (such as fever, weakness, sudden onset headache,and breathing difficulties), which might account for a false diagnosis of COVID-19 for malaria and vice versa, especially when the physician depends on clinical features alone.[7]We have organized the content under the following subheadings,namely COVID-19 impact on health system, interruption of malaria services, and potential strategies to contain COVID-19 and malaria.

CORONAVIRUS DISEASE-2019 IMPACT ON HEALTH SYSTEM

On a positive note, in the period of 2000-2020, a total of 23 nations has accomplished elimination of malaria in their nations as they have reported zero indigenous malaria cases for 3 successive years.[4]As the battle against the novel infection continues, we must acknowledge that it is extremely difficult to mobilize resources, especially in those nations which have multiple other competing public health priorities.[6,8]The COVID-19 pandemic has imposed an immense strain on the health-care delivery system and the policymakers are in a state of dilemma, wherein they have to not only deal with the dual threat of COVID-19 and malaria but even ensure that the outreach workers involved in malaria prevention and control are safeguarded from the novel viral infection.[5,6,8]

INTERRUPTION OF MALARIA SERVICES

Considering the consequences of malaria in the past, it is the need of the hour that in the process of containing COVID-19, we should not ignore the strategies aimed toward the prevention and control of malaria infection.[9,10]In other words, the attention to COVID-19 does not mean that we fall short in our efforts to contain the vector population or ensure timely management of the parasitic infection.[9-11]The findings of different studies and reports have revealed that the ongoing pandemic has disrupted a wide range of activities at different levels, including the use of insecticide-treated bed nets, the process of indoor residual spraying in homes, administration of larvicides in breeding sites,diagnostic services, therapeutic modalities, chemoprophylaxis of the infection, and the active and passive surveillance activities.[10-12]Most of these interruptions resulted because of the lockdown which was imposed to contain the COVID-19 infection and due to the alterations in the production and supply of various essentials (viz.antimalarial drugs, diagnostic kits, insecticides, insecticide-treated nets, etc.).[9-13]

POTENTIAL STRATEGIES TO CONTAIN CORONAVIRUS DISEASE-2019 AND MALARIA

There is no point in complaining about the developments that have already happened, the best strategy will be to consider the different facets of COVID-19 infection containment as opportunities and then act accordingly.[14-18]This has to begin with proactive leadership, wherein the policymakers take decisions based on scientific evidence and mathematical modeling, and this should be reflected in all steps that are being taken for containing both the infections.[14,15]One of the most effective strategies to contain both the infections is through the strengthening of surveillance activities, and this calls for the need to employ the surveillance system established for COVID-19 to be simultaneously utilized for malaria as well.[16,17]The field workers, which are involved in either manual contact tracing or surveillance/case management/vector control of malaria should strictly adhere to the standard infection prevention and control measures.[14,19]

The next approach has to be an intensification of research and development activities, as this is very much required not only to add some life to the malaria elimination campaign but also for interrupting the chain of transmission of COVID-19 or its prompt management.[19,20]Any progress in terms of the development of new diagnostics, potential drugs, potent vaccines, or technical advancements, can prove to be of immense utility.[19-21]There is also a need to avoid duplication of actions and employ a multidisciplinary team (as is done in the case of COVID-19) to expedite the activities which can aid in malaria elimination.In the battle against COVID-19 infection, a number of digital applications (viz.digital proximity tracing, reporting cases in real-time, etc.) were introduced, which in turn significantly helped to contain the infection.[14]On a similar note, there is a definite need to employ digital technologies, which should cover reported cases, clinical outcomes, diagnostic tools, interventions,vector surveillance, etc., all in one application to streamline the overall activities.[14,20-22]

To contain the spread of the COVID-19 infection, all points of entry and exit were closely monitored and people were subjected to laboratory tests before their arrival or departure.[22,23]In fact, the positive people were isolated,while the contacts were quarantined, and that aided us in containing the spread of the infection.This aspect of screening at borders is missing in case of malaria, and there is an immense need to strengthen the same at all points of entry and exit.[23,24]On a similar note, even the migrant people should be screened for both COVID-19 and malaria infection, and based on the results, appropriate actions need to be taken.[23-25]Further, one of the very essential aspects of COVID-19 containment was the support that we received from the general population.[26]This could have not been possible if we would have failed to pass on the correct information to the community on a timely basis and taken care of the various prevailing myths and misconceptions.Even though we are still fighting against the misinformation,there is a definite need to empower the community with the desired information pertaining to malaria, so that people join the government movement and work together for malaria elimination.[25-27]

The next strategy which can aid in the containment of both COVID-19 and malaria infection is in terms of identification of the potential hotspots and taking intensified steps in these locations to eliminate the same.This will essentially require the support of diagnostic tools and any kind of digital tool employment will significantly aid the overall process.[16-20]Both these infections cannot be contained by the health sector alone, rather we will definitely need the support of different sectors in the efforts to ensure better implementation.The policymakers have to ensure that the available resources are allocated rationally and that all the essential services are offered free of cost to the general population.[21]

At this stage, we must realize that the governments alone cannot make sustained progress unless the local population also joins the campaign and work together.[17,26]Working together means the members of the community should adhere to the standard infection prevention and control measures in case of COVID-19 (viz.social distancing, using a face mask, practicing hand hygiene, avoiding unnecessary travels, getting vaccinated at their turn, coughing etiquettes,etc.) and malaria infection (such as not sleeping outdoors,avoiding the collection of water, and not interfering with insecticide residual spray).[17,18,22,24]Finally, in a long-term perspective, we have to enhance the preparedness level of the health-care delivery system and be ready with an action plan for any public health emergency, thereby continuing the ongoing activities by making them sustainable.[28]

CONCLUSION

In conclusion, in the process of fighting against the COVID-19 infection, we have ignored the delivery of essential services pertaining to malaria.This calls for the need to revisit the planned and implemented services for COVID-19 infection and use the existing mechanism for implementing the strategies required for malaria elimination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.