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Lymphatic filariasis ignored during COVID-19

COVID-19 has brought considerable disruption to India’s health system. Efforts have been necessarily diverted to tackling the disease, though this has often come at the expense of treating other conditions. Lymphatic filariasis is one of these diseases.


Image credit: Kateryna Kon / 123rf
Wuchereria bancrofti, a roundworm nematode, one of the causative agents of lymphatic filariasis, 3D illustration showing presence of sheath around the worm and tail nuclei non-extending to tip. Image credit: Kateryna Kon / 123rf

Lymphatic filariasis, or elephantiasis, is a neglected tropical disease (NTD) that attacks the lymphatic system. It is caused by the transmission of filarial parasites, transmitted to humans via mosquitoes. Three parasites – Wuchereria bancrofti, Brugia malayi, and Brugia timori – cause lymphatic filariasis. The parasites are roundworms belonging to the Filarioidea family. Wuchereria bancrofti is responsible for ninety percent of lymphatic filariasis cases. 

Infection with the condition can be acute, asymptomatic, or chronic. The chronic condition of lymphatic filariasis witnesses the body’s tissue swelling (lymphoedema) or thickening (elephantiasis, hence the condition’s synonym). Tissue swelling and thickening often affects the breasts and genitals and can lead to physical deformity. The condition can also cause damage to the lymphatic system, kidneys, and immune system.

While some in rural locations previously received treatment for the condition for free, many now report only receiving basic painkillers to manage the disease. “We are poor people,” Sunita Kashyap told the Thomson Reuters Foundation by phone from her village in the northern state of Uttar Pradesh. “My husband works on daily wages of 200 rupees (US$2.75) in a shop, but each time the shop closes due to lockdowns, we don’t get that money.”

For two decades, India has deployed vast numbers of accredited social health activists (ASHAs) to remote rural areas to administer a two-drug regimen that has the capacity to prevent transmission of lymphatic filariasis. This formula for disease prevention allowed India to reduce the number of districts in which the disease is endemic to 159 from 257 in 2004, according to health officials.

A new three-drug combination against lymphatic filariasis was due to be made available this year. However, rollout has been limited to just a few districts due to the constraints of the COVID-19 pandemic. In addition to the limited rollout of new therapies, the fallback to simply administering painkillers for symptom management could allow for those previously treated with regimens that prevent the spread of the disease to become transmissible once again.

COVID-19 alone has a considerable death count, taking millions of lives across the globe. However, this may be simply the start of the issue. As health systems across the globe — particularly in developing nations — begin to cope with the additional burden, it is likely to be revealed that the diversion of funds and resources from other diseases has caused surges in many other disease cases and deaths due to loss of screening and diagnoses, and delayed treatment. Years of progress are being undone, and it could take decades to recover.

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