Pakistan's healthcare system is currently dealing with the worst Coronavirus pandemic, with 221K confirmed cases and 4551 deaths so far, while the country needs to prepare for another significant public health threat from the tropically neglected Crimean‐Congo Hemorrhagic Fever (CCHF).1, 2 With the Islamic festival of Eid‐Ul‐Adha approaching,3 there is an enormous threat of the CCHF outbreak in Pakistan.4

CCHF is a zoonotic disease caused by the Nairovirus , and humans are infected with Ixodidae tick bites (mainly Hyalomma spp.) or by contact with the blood or tissues of viremic patients or animals.5 CCHF is endemic in Pakistan, and most cases occur at and around the time of the Eid‐Ul‐Adha Islamic festival, which commemorates the sacrifice of livestock.4, 6 Before Eid‐Ul‐Adha in Pakistan, livestock is brought down to the urban areas from the rural parts of the country. Animals are housed in open spaces and private residences until they are slaughtered.7 This provides ample contact time between humans and animals for the transmission of the virus.

The comparison of trends of CCHF cases showed that 58% and 62% of CCHFV positive cases were found around the Eid‐Ul‐Adha season in 2013 and 2014, respectively.8 This trend may be exaggerated even further this year as the attention of our health sector is entirely focused on COVID‐19.

Two CCHF cases have recently been reported to the Jinnah Postgraduate Medical Center in Karachi,9 which shows that new cases have already started emerging in Pakistan. World Health Organization Eastern Mediterranean Regional Office has identified several risk factors responsible for the emergence of arboviral and zoonotic diseases in the background of COVID‐19. These include worsening climatic conditions, humanitarian emergencies, conflicts, fragile health systems, weak surveillance, and inadequate laboratory capabilities, domesticating, and slaughtering animals during religious festivals.10

The population of Pakistan is at a very high risk of developing CCHF due to several factors. First, the underdeveloped healthcare system is currently not prepared to face challenges of this nature, and healthcare professionals and medical institutions are not sufficiently equipped to diagnose, manage, and prevent CCHF11 accurately. Secondly, a significant proportion of the general public is unaware of the spread and control of the vector, and, finally, the lack of quarantine areas and policies to control infection add to the current health crisis.11, 12

The COVID‐19 pandemic has brutally exposed the under‐staffed and under‐funded, fragile nature of Pakistan's healthcare system, with insufficient specific diagnostic tests, and late detection making it difficult to stop the spread of infectious diseases, including both COVID‐19 and CCHF.13 According to the Economic Survey of Pakistan 2018 to 2019, there is one doctor available for 963 persons and one hospital bed for 1608 individuals, with a shallow scale of availability of intensive care units.14

There is a significant need to regulate the migration activities of people and animals from CCHF endemic areas and to set up a registry and monitoring network to monitor the movement of livestock across borders and different provinces in Pakistan. Media can play a crucial role in providing knowledge of the modes of transmission and symptoms of CCHF, providing information on the use of appropriate clothing to avoid contact with ticks during the washing and pesticide spraying of animals, while protecting them from tick attacks. The government must refocus its energies and provide sufficient funding to vaccinate agricultural livestock before it reaches the market for sale on the occasion of the Eid‐Ul Adha.15 There should be training programs for physicians and health workers to enhance their awareness regarding early diagnosis, management, and personal protection. Laboratory capacity should be strengthened at least in tertiary care and teaching hospitals. Integration between clinicians, microbiologists, and public health professionals is necessary to manage all aspects of the outbreak. Additionally, there should be an increased communication between human and animal health experts. Only intersectoral collaborative efforts, along with effective community participation, can help contain these two diseases together.

巴基斯坦的医疗保健系统目前正在应对最严重的冠状病毒大流行，迄今已有 221,000 例确诊病例和 4551 人死亡，而该国需要为热带地区被忽视的克里米亚-刚果出血热 (CCHF) 带来的另一个重大公共卫生威胁做好准备。1, 2随着伊斯兰宰牲节的临近，3 CCHF 在巴基斯坦爆发的威胁很大。4

CCHF 是一种由内罗病毒引起的人畜共患病，人类被硬蜱科蜱叮咬（主要是Hyalomma spp.）或通过接触病毒血症患者或动物的血液或组织而感染。5 CCHF 在巴基斯坦流行，大多数病例发生在宰牲节期间和前后，该节日是为了纪念牲畜的牺牲。4, 6在巴基斯坦的宰牲节之前，牲畜从该国农村地区被带到城市地区。动物被安置在开放空间和私人住宅中，直到被宰杀。7这为人类和动物之间的病毒传播提供了充足的接触时间。

CCHF 病例趋势比较显示，2013 年和 2014 年开斋节前后分别发现 58% 和 62% 的 CCHFV 阳性病例。8由于我们卫生部门的注意力完全集中在 COVID-19 上，今年这一趋势可能会被进一步夸大。

最近向卡拉奇真纳研究生医疗中心报告了两例 CCHF 病例，9这表明巴基斯坦已经开始出现新病例。世界卫生组织东地中海区域办事处已经确定了在 COVID-19 的背景下导致出现虫媒病毒和人畜共患病的几个风险因素。其中包括气候条件恶化、人道主义紧急情况、冲突、脆弱的卫生系统、监控薄弱和实验室能力不足、在宗教节日期间驯化和屠宰动物。10

由于多种因素，巴基斯坦人口患 CCHF 的风险非常高。首先，不发达的医疗保健系统目前还没有准备好面对这种性质的挑战，医疗保健专业人员和医疗机构没有足够的能力准确诊断、管理和预防 CCHF 11 。其次，很大一部分公众不知道媒介的传播和控制，最后，缺乏隔离区和控制感染的政策加剧了当前的健康危机。11、12

COVID-19 大流行残酷地暴露了巴基斯坦医疗系统人手不足、资金不足、脆弱的性质，缺乏特定的诊断测试，而且检测较晚，因此难以阻止包括 COVID-19 和 COVID-19 在内的传染病的传播。 CCHF。13根据 2018 年至 2019 年巴基斯坦经济调查，963 人有一名医生，1608 人有一张病床，重症监护病房的可用性规模较小。14

迫切需要规范来自 CCHF 流行地区的人和动物的迁徙活动，并建立一个登记和监测网络，以监测巴基斯坦境内牲畜跨界和不同省份的流动。媒体可以在提供有关 CCHF 的传播方式和症状的知识、提供有关在清洗动物和喷洒杀虫剂期间使用适当衣服以避免接触蜱虫以及保护它们免受蜱虫袭击方面发挥关键作用。政府必须重新集中精力并提供足够的资金来为农畜接种疫苗，然后才能在宰牲节之际上市销售。15应该为医生和卫生工作者制定培训计划，以提高他们对早期诊断、管理和个人防护的认识。至少应加强三级医院和教学医院的实验室能力。临床医生、微生物学家和公共卫生专业人员之间的整合对于管理疫情的各个方面是必要的。此外，人类和动物健康专家之间应该加强交流。只有跨部门的合作以及有效的社区参与，才能帮助共同遏制这两种疾病。