Apart from changing the game of survival around the world, the coronavirus has given rise to some peculiarities relating to the diagnosis and treatment of another deadly disease–dengue.
Experts say Covid-19 and dengue share many signs and symptoms. Even in pathogenesis, they share many mechanisms and pathways for the progression and severity.
What this means is that clinical diagnosis and management have become a challenging task, says a group of doctors from India who wrote a paper on the two diseases.
The study, ‘National guidelines for dengue case management during Covid-19 pandemic’, was done by the National Vector Borne Disease Control Programme (NVBDCP). It was approved by the Ministry of Health and Family Welfare in October 2020.
COVID-19 and dengue coinfection
Assam, Chandigarh, Daman & Diu, Delhi, Goa, Gujarat, Karnataka, Kerala, Maharashtra, Odisha, Punjab and Uttar Pradesh reported dengue cases with COVID-19 coinfection in 2020. Deaths due to COVID-19 and dengue coinfection were reported from Assam, Maharashtra, Punjab and Delhi in 2020. However, figures are not available.
The WHO suggested patients suffering from endemic infections like malaria, dengue and tuberculosis should be tested as per routine protocols. They should also be tested for Covid-19 — irrespective of the presence of respiratory signs and symptoms — to find out if coinfection exists.
Coinfection: A public health challenge
The NVBDCP study said that it was difficult to distinguish symptoms and signs between Covid-19 and dengue because of their overlapping initial clinical presentations and laboratory parameters. “Both the diseases have an unpredictable clinical course and both generally require in-hospital monitoring for management,” it said.
The study found that most hospitals were busy managing COVID-19 and thus only a little window was open to tackle another disease outbreak.
“Most of the cases of COVID-19 and dengue are asymptomatic (about 80 per cent),” it said. “In cases of coinfection, one might enhance the severity of the other.”
Treatment of coinfection
The study suggested that before starting the treatment, the severity of coinfection should be assessed by signs, symptoms and investigational parameters. The treatment should be planned as per the severity of infection — either dengue, COVID-19 or both.
Management of coinfection
The study stressed on the need to strengthen primary health care facilities to treat dengue patients. “The secondary and tertiary level hospitals should be prepared to manage severe dengue and COVID-19 cases,” it said. “Proper surveillance systems at the clinical level should be in place to report coinfection. India needs to work to achieve better vector control measures both at the personal and institutional levels.”
Epidemiology of dengue in India
Dengue, a vector-borne viral infection transmitted by Aedes aegypti mosquitoes, is both very infectious and deadly. Every year, thousands of dengue cases are reported from India, leading to a significant number of deaths. Moreover, the number of cases has been rising. In 2017, the country recorded 1,88,401 dengue cases — the highest in the recent past.
“Dengue patients play a significant role in spreading the virus as they move to various places,” said the study.
The WHO, which in 2019 listed dengue as one of the 10 threats to global health, warns that a vast majority of dengue cases are asymptomatic. Thus, the actual number of dengue cases are underreported and misclassified.
Epidemiology of COVID-19 in India
The coronavirus is a pathogen which mostly attacks the respiratory system of human beings.
In the past, the country had witnessed coronavirus outbreaks in the form of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
Since 2020, India has reported 4.25 crore infected cases and 5.07 lakh deaths due to Covid-19 (till February 2022).
Globally, over the past two years, the coronavirus has infected 40.3 crore people and killed 57.8 lakh people (till February 11, 2022).
Notes
NVBDCP’S ‘National guidelines for dengue case management during Covid-19 pandemic’ study was written together by Dr Ashutosh Biswas, professor of medicine, All India Institute of Medical Sciences, New Delhi (AIIMS) (team lead); Dr Suresh Kumar, director professor, department of medicine, Maulana Azad Medical College, LNH & GB Pant Hospital, New Delhi; Dr Ghanshyam Pangtey, professor of medicine, LHMC & Srimati SK Hospital, New Delhi; Dr Manish Soneja, additional professor of medicine, AIIMS, New Delhi; Dr Sameer Gulati, associate professor medicine, Vardhman Mahavir Medical College & associated Safdarjung Hospital, New Delhi; Dr Pankaj Jorwal, associate professor of medicine, AIIMS, New Delhi; Dr Arvind Kumar, associate professor of medicine, AIIMS, New Delhi; Dr Upendra Baitha, assistant professor of medicine, AIIMS, New Delhi; Dr Sayan Maharatna, department of medicine, AIIMS, New Delhi; and Dr Sunit Sikdar, department of medicine, AIIMS, New Delhi.
From the NVBDCP, director Dr Neeraj Dhingra, additional director-coordinator Dr Kalpana Baruah and consultant Dr Amit Katewa wrote the document.
