BACKGROUND:
Following the COVID-19 pandemic, during which facilities like the Peshawar Institute of Cardiology and others managed significant caseloads, there was a concern that specialized units might become redundant. However, Peshawar has faced a double burden of pandemic recovery and a resurgence of infectious diseases exacerbated by the 2022 floods and immunization gaps. This study evaluates the transition of healthcare services to manage a broad spectrum of diseases beyond COVID-19.

METHODS:
A retrospective observational study was conducted to analyze infectious disease trends from 2021 to 2024 in Peshawar, utilizing provincial surveillance data and hospital records. The study assesses the impact of environmental factors such as the 2022 floods on disease etiology and patient demographics.

RESULTS:
Analysis of 11,406 admissions across the transition period mirrors regional trends with significant peaks in specific etiologies: Following the 2022 floods, Dengue remained the most common condition (n=3,554), followed by Malaria (n=1,079) and Typhoid (n=1,069). A major resurgence in Measles was noted in 2023 (n=1,578), and Diphtheria in 2024 (n=309), primarily affecting children with mean ages of 5.3 and 12 years, respectively. The highest in-hospital mortality was observed in Diphtheria (24.6%), followed by Tuberculosis (21.2%) and Pneumonia (20.7%). Advanced HIV (n=261) and UTIs (n=572) predominantly affected older age groups, with mean ages ranging from 37 to 57 years.

CONCLUSIONS:
The findings underscore that specialized infectious disease units, initially pandemic-driven, are now critical for managing outbreaks fueled by climate change and disrupted healthcare services. For a sustainable future, Peshawar must institutionalize dedicated infectious disease facilities and strengthen "One Health" surveillance to ensure equitable health outcomes across borders