By Sarah Hannan As we approach the third week of May, the torrential rains that are experienced in the south-western region of Sri Lanka, coupled with thundershowers, signals the arrival of the south-western monsoon. Scattered showers have already started to cause flash floods in several areas as the reeds have started to take over the marshlands throttling the water flow in crucial places. Rains experienced in the upstream areas are also flushing out debris which is now accumulating in the waterways, barricading the water from flowing to the sea. The Sri Lanka Navy, a few days ago, cleared such a blockage under the Wakwella Bridge as the Gin River flows underneath it. The Disaster Management Centre (DMC), earlier this week, said that the water level of the Gin River is expected to rise in the forthcoming monsoon season. Therefore, the Navy, in an attempt to prevent possible floods, cleared large bamboo trees, branches of trees, and debris accumulated under the bridge. The DMC stated that 12 rivers including Kelani, Kalu, Gin, Nilwala, Bentara, Kukule, Mee Oya, Maha Oya, Attanagalu Oya, Deduru Oya, and several reservoirs under the Department of Irrigation were identified as high-risk catchment areas that would prompt flooding when the southwest monsoon intensifies. The DMC, over the past month, has been taking the necessary measures to prepare for potential displacement events which can be caused by the impending adverse weather conditions. DMC Director General Maj. Gen. (Retd.) Sudantha Ranasinghe told The Sunday Morning that the Ministry of Health, the Department of Irrigation, the National Building Research Organisation (NBRO), the National Disaster Relief Service Centre, and the Urban Development Authority (UDA), in collaboration with the DMC, will contribute towards mitigating any disaster-related event. “Each district has its own action plan devised, with safe locations and quarantine centres appointed as required, sheltering anyone that is displaced due to adverse weather. In addition to that, due to the risk of Covid-19 spreading, we will not encourage the displaced families to move in with their friends and family. So, everyone will need to take shelter at the designated safe locations,” Maj. Gen. Ranasinghe elaborated. The safe locations will have to follow the health guidelines issued by the Ministry of Health and the DMC is looking to provide cooked meals in most cases to avoid people being exposed to pathogens. The Puttalam, Colombo, Gampaha, Kalutara, Galle, Matara, Kegalle, and Ratnapura districts will potentially experience floods and landslides, according to the analysis of the DMC, the NBRO, and the Department of Irrigation. Increase in diseases According to the Epidemiology Unit’s disease surveillance statistics, so far, 1,623 cases of leptospirosis have been reported in Sri Lanka for 2020. Recently, a Navy officer succumbed to the illness whilst receiving treatment at the Intensive Care Unit of the Sri Lanka Navy General Hospital, Colombo. Meanwhile, 10 people from the Kurunegala District died due to leptospirosis in January. Epidemiology Unit Acting Chief Epidemiologist Dr. Samitha Ginige noted that an increase in leptospirosis cases are observed at the beginning of the paddy cultivation cycle and farmers are prone to this disease. In addition, the disease is prevalent during floods and may cause outbreaks. A person may get infected with leptospirosis if they are exposed to contaminated water, while working in the fields, construction sites, or mines; while cleaning drains or wells; or while bathing and washing in small streams, rivers, and lakes, and flood water. Contact with water contaminated with urine from an animal known to be a reservoir species, such as rats and other rodents, buffalo, cattle, dogs, and pigs, is the most notable risk in transmission. The presence of breached skin increases the risk of infection. Possible misdiagnosis The Lancet, a magazine published in Singapore, revealed that there could be possible misdiagnosis between a Covid-19 patient and dengue patient, especially in dengue endemic areas, as the virus infections share common symptoms. This could lead to misdiagnosis as observed in two cases. The first Singaporean patient came to a hospital with a fever, cough, and a decrease in thrombocytopenia. Since he had no contact with a Covid-19 patient or travel history concerning a high-risk country, he was discharged following the conducting of the NS1, IgM, and IgG tests. He relapsed with no sign of the cough reducing, decreasing platelets, and was hospitalised for lymphopenia. He was once again subjected to a dengue antibody test, which returned positive and was hospitalised for treatment. His continuing cough and shortness of breath prompted the doctors to get an X-ray of his chest and he was later subjected to a PCR test to determine whether he was infected by the Covid-19 virus, which turned out to be positive. Accordingly, his initial dengue-positive sample and additional urine and blood samples were placed under a PCR test for dengue, and the results were negative for dengue. A dengue NS1, IgM/IgG test was carried out on a new blood sample which also turned out negative. Thus, it was concluded that the anti-dengue antibodies were false positives and that the patient was positive for Covid-19. The second patient too had no Covid-19 patient contact history or travel history to high-risk areas. She came to the hospital with symptoms of muscle pain, a cough that lasted for four days, and mild fever that lasted for two days. She was diagnosed with thrombocytopenia and was tested positive for dengue by the IgM test. She was then sent home with a follow-up appointment scheduled for two days later. After two days, she was admitted to the hospital with no reduction in fever, a drop in platelet count, a drop in lymphocytes, and abnormalities in her liver enzymes. Her X-ray was normal and her blood tests were normal after being admitted to the hospital. But the fever did not diminish. After three days, she had difficulty in breathing. The PCR test for Covid-19 was positive. A dengue NS1, IgM/IgG test was repeated, which came out negative. The original blood sample was also negative after a PCR test for dengue. Thus, the original IgM antibody test for dengue was confirmed as a false positive. Accordingly, there is a possibility that Covid-19 patients in countries and regions where the dengue genome is prevalent could be mistakenly diagnosed with dengue when testing for antibodies. Similarly, if the disease spreads in an area where dengue is present, the World Health Organisation (WHO) points the health authorities of the countries concerned to the possibility of Covid-19 as a co-infection.