Second Wave of COVID-19 in Pakistan: Our Responsibilities and Challenges as A Nation

The Corona virus (SARS-CoV2) pandemic initiated in late December 2019 in Wuhan city of Hubei, China, which has rapidly progressedinvolving more than 215 countries of the world. It was caused by novel SARS-COV2 coronavirus with Huanan seafood wholesale market as the possible point of origin. In past two decades, coronaviruses epidemic of Middle East Respiratory Syndrome (MERS-COV) had 37% mortality rate and Severe Acute Respiratory Syndrome (SARS-COV) had 10% affecting more than 10,000 population together. World Health Organization (WHO) declared it as the sixth Public Health Emergency of International Concern (PHEIC) on January 30, 2020 and later on March 11, 2020, the WHO labeledit as a pandemic. The first case of COVID-19 from Pakistan was reported on 26th February, 2020 and has affected over 354,000 people with a mortality of over 7000 patients. Many countries of the world have seen second wave of this pandemic. Government ofPakistan has also declared a second waveon October 28, 2020, after the rise in cases from 500 to 750 per day. Now it has crossed 2000 cases. The data released by the National Command and Operation Centre (NCOC) shows that the current percent positivity rate is close to 3 compared to the previous figure of lesser than 2 making it a bigger challenge than first wave in Pakistan. The patients now presenting in hospitals are all in critical condition. Lack of a specific vaccine or antiviral drug and non-compliance to the standard preventive measures is the major reason of initiation of a second wave of this viral infection in Pakistan. Being a nation we need to be responsible. Our country may go into economic crisis & our health facilities may choke. We have to understand how to live with this virus till the availability of vaccine or Curative antiviral drug. TheGovernment of Pakistan is creating awareness in the public for the second wave as the situation of pandemic is getting worse. Smart lock downs are being implementedbut people are not following preventive measures that are leading to infection spread at a very alarming speed. At the moment preventive measures are the only way to stop the spread of disease. Preventive measures should be adopted to contain this deadly disease. Wearing masks, using hand sanitizers, washing hands with soap for 20 sec, keeping social distance of 6 feet are mandatory preventive strategies. Social, political, business, recreationaland religious gatherings, should be avoided. Educational institutesshould follow strict standard operating procedures. Most of the people in Pakistan are not considering this disease as a matter of serious concern due to unawareness, poverty, beliefs and lack of resources. People should ignore such disbeliefs and should start considering it as a great health concern. They should follow the preventive measures in true sense.

Prevalence of Significant Liver Fibrosis in Patients With Hiv Monoinfection Compared to Those With Hiv-Hepatitis B Coinfection As Assessed by Shear Wave Elastography

Background: Liver disease is an emerging management problem in human immunodeficiency virus (HIV) infected patients. The incidence of chronic Hepatitis B infection, which accelerates the progression of chronic liver disease and development of liver fibrosis, is ten times higher in patients with HIV than the general population. Staging of liver fibrosis provides essential information in management of these patients. Objective: To determine the prevalence of significant liver fibrosis in patients with HIV mono-infection versus those with HIV-HBV co-infection as assessed with shear wave elastography (SWE). Methods: This was a cross-sectional study whereby HIV infected patients attending the HIV clinic at AKUH, N were consecutively recruited into the study. A total of 105 patients, 70 with HIV mono-infection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for presence of significant fibrosis the cut-off of which was 5.6 kPa. The prevalence of significant liver fibrosis was compared between the two groups. Assessment of APRI score (a non-invasive serum biomarker of liver fibrosis) in these patients was also done. Results: The prevalence of advanced liver fibrosis was significantly higher (p <0.0001) in patients with HIV-HBV co-infection, 25.7%, compared to those with HIV mono-infection, 7.1%. APRI score was higher in patients with HIV-HBV co-infection than those with HIV mono-infection. Discussion: The prevalence of significant liver fibrosis observed in the two proportions in the current study is comparable to those reported in other studies. HIV co-infection with HBV accelerates progression to significant liver fibrosis. Association of low CD 4 count with advanced fibrosis supports earlier starting of antiretroviral therapy to prevent rapid progression of liver disease in HIV positive patients. Higher APRI scores in the HIV-HBV co-infected group was as a result of higher AST levels. Conclusion/recommendations: In view of the high prevalence of liver fibrosis in patients with HIV-HBV co-infection, regular monitoring of the disease progression is recommended. A study involving follow up of HIV-HBV co-infected patients to assess for effects of therapy is also recommended.