<scp>COVID</scp>‐19 situation in Pakistan: A broad overview

Imran, Muhammad; Khan, Sajjad Ahmad; Khan, Shahid Ullah; Uddin, Azhar; Khan, Muhammad Salman; Ambade, Preshit

doi:10.1111/resp.14093

Cited by 29 publications

(27 citation statements)

References 1 publication

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“…Following this, an appreciable number of positive cases were reported throughout the country in successive waves [ 1 , 2 ], which is similar to other countries [ 3 , 4 ]. The first wave of COVID-19 in Pakistan peaked on 14 June 2020, infecting more than 300,000 people [ 5 , 6 ]. However, due to strict lockdown activities, travel restrictions, enhanced capacity testing for COVID-19 as well as improved contact tracing and isolation, cases started to decline substantially, mirroring other countries [ 5 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

et al. 2022

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Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates. Methods: A retrospective review of patient records among five tertiary care hospitals during successive waves was conducted. Data were collected from confirmed COVID-19 patients during the first five waves. Results: 3221 patients were included. The majority were male (51.53%), residents from urban areas (56.35%) and aged >50 years (52.06%). Cough, fever and a sore throat were the clinical symptoms in 20.39%, 12.97% and 9.50% of patients, respectively. A total of 23.62% of COVID-19 patients presented with typically mild disease and 45.48% presented with moderate disease. A high prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite there only being 1.14% bacterial co-infections and 3.14% secondary infections, was found. Antibiotic use significantly increased with increasing severity, elevated WBCs and CRP levels, a need for oxygen and admittance to the ICU; however, this decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus an enzyme inhibitor (20.66%), azithromycin (17.37%) and meropenem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from the WHO’s “Watch” category. Conclusions: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reductions.

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Section: Introductionmentioning

confidence: 99%

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

et al. 2022

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“…The first wave of COVID-19 in Pakistan occurred between March and July 2020 1 , the second from October 2020 until January 2021, the third from March to May 2021 7 and the fourth from July until September 2021 3 . Testing capacity has been relatively limited and in January 2021, 40,000 SARS-CoV-2 PCR tests a day were conducted for approximately 200 million population (at 200 tests/million) 8 .…”

Section: Introductionmentioning

confidence: 99%

Upregulated type I interferon responses in asymptomatic COVID-19 infection are associated with improved clinical outcome

Masood

Yameen

Ashraf

et al. 2021

Sci Rep

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Understanding key host protective mechanisms against SARS-CoV-2 infection can help improve treatment modalities for COVID-19. We used a blood transcriptome approach to study biomarkers associated with differing severity of COVID-19, comparing severe and mild Symptomatic disease with Asymptomatic COVID-19 and uninfected Controls. There was suppression of antigen presentation but upregulation of inflammatory and viral mRNA translation associated pathways in Symptomatic as compared with Asymptomatic cases. In severe COVID-19, CD177 a neutrophil marker, was upregulated while interferon stimulated genes (ISGs) were downregulated. Asymptomatic COVID-19 cases displayed upregulation of ISGs and humoral response genes with downregulation of ICAM3 and TLR8. Compared across the COVID-19 disease spectrum, we found type I interferon (IFN) responses to be significantly upregulated (IFNAR2, IRF2BP1, IRF4, MAVS, SAMHD1, TRIM1), or downregulated (SOCS3, IRF2BP2, IRF2BPL) in Asymptomatic as compared with mild and severe COVID-19, with the dysregulation of an increasing number of ISGs associated with progressive disease. These data suggest that initial early responses against SARS-CoV-2 may be effectively controlled by ISGs. Therefore, we hypothesize that treatment with type I interferons in the early stage of COVID-19 may limit disease progression by limiting SARS-CoV-2 in the host.

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“…There was a decrease in cases with a low in early September followed by a resurgence of COVID-19 cases with a second wave from October 2020 until January 2021. There was a brief reprieve in February with a third wave of cases between March and May 2021 [ 10 ]. COVID-19 cases started to rise again in June and currently in July 2021, Pakistan is well into the fourth wave [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Higher entropy observed in SARS-CoV-2 genomes from the first COVID-19 wave in Pakistan

et al. 2021

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Background We investigated the genome diversity of SARS-CoV-2 associated with the early COVID-19 period to investigate evolution of the virus in Pakistan. Materials and methods We studied ninety SARS-CoV-2 strains isolated between March and October 2020. Whole genome sequences from our laboratory and available genomes were used to investigate phylogeny, genetic variantion and mutation rates of SARS-CoV-2 strains in Pakistan. Site specific entropy analysis compared mutation rates between strains isolated before and after June 2020. Results In March, strains belonging to L, S, V and GH clades were observed but by October, only L and GH strains were present. The highest diversity of clades was present in Sindh and Islamabad Capital Territory and the least in Punjab province. Initial introductions of SARS-CoV-2 GH (B.1.255, B.1) and S (A) clades were associated with overseas travelers. Additionally, GH (B.1.255, B.1, B.1.160, B.1.36), L (B, B.6, B.4), V (B.4) and S (A) clades were transmitted locally. SARS-CoV-2 genomes clustered with global strains except for ten which matched Pakistani isolates. RNA substitution rates were estimated at 5.86 x10−4. The most frequent mutations were 5’ UTR 241C > T, Spike glycoprotein D614G, RNA dependent RNA polymerase (RdRp) P4715L and Orf3a Q57H. Strains up until June 2020 exhibited an overall higher mean and site-specific entropy as compared with sequences after June. Relative entropy was higher across GH as compared with GR and L clades. More sites were under selection pressure in GH strains but this was not significant for any particular site. Conclusions The higher entropy and diversity observed in early pandemic as compared with later strains suggests increasing stability of the genomes in subsequent COVID-19 waves. This would likely lead to the selection of site-specific changes that are advantageous to the virus, as has been currently observed through the pandemic.

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COVID‐19 situation in Pakistan: A broad overview

Cited by 29 publications

References 1 publication

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications

Upregulated type I interferon responses in asymptomatic COVID-19 infection are associated with improved clinical outcome

Higher entropy observed in SARS-CoV-2 genomes from the first COVID-19 wave in Pakistan

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