Fever seems to be buzzword in outpatient wards and even in emergency units of hospitals in the current monsoon season, thanks to a sudden upsurge in cases of dengue, influenza infections, flu with typical upper respiratory infection, along with some cases of Covid. The common factor in all these viral infections is fever.
Dr J Satyanarayana, senior general physician, Kamineni Hospitals, Hyderabad, told Happiest Health that dengue cases are also on rise, similar to the scenario in Mumbai and Bengaluru. “Dengue is a vector-borne infection spreading through Aedes egypti mosquito that breeds in fresh water. Viral infections also see a rise during rainy season when the temperature drops, as the viruses replicate faster,” said Dr Satyanarayana. He said overcrowding has further added to the rise in Covid and other respiratory viruses.
Dr Satyanarayana Mysore, HOD and consultant, pulmonology lung transplant, Manipal Hospitals, said cases of influenza A (flu cases) and H1N1 (influenza B) are on the rise even as Covid is still forging on. “We are now seeing that the influenza A virus is more virulent this year compared to previous years and there is a rise in the number of cases. The flu season has started. Untimely rain and surging crowd are also adding to the spread of viral infections,” said Dr Mysore.
While the H1N1 test is not being done on every suspected case, the extreme sick ones tested are turning positive, says Dr Farah Ingale, director, internal medicine, Fortis Hiranandani hospital, Vashi, Mumbai. Fever, cough, sore throat and breathlessness are the common symptoms seen. The Mumbai rains have also added to the gastroenteritis cases, said Dr Ingale.
Dr SN Aravinda, consultant, internal medicine specialist, Aster RV Hospital, Bengaluru, said that with the rise in fever cases, there have been cases of family clusters too. “We are seeing typical flu symptoms such as cold, cough, fever and loose motion. It could be Covid or non-Covid. H1N1 cases are typically seen with prolonged cough,” said Dr Aravinda.
While there have been reports that some people with high fever who rushed to private hospital OPDs were put on mandatory intravenous fluids as part of treatment because their temperature crossed 100 degree Fahrenheit, doctors told Happiest Health that there are no such parameters.
IV fluids for fever
In Bengaluru, a 45-year-old man running a high fever was put on IV medication at a private hospital. While some were surprised to the see the new protocol in some of the hospitals, not all healthcare providers have the same mandate. Hospitals in some Indian metropolitan cities said there were no such guidelines, and IV introduction is based on a person’s condition and not temperature alone.
Dr Aravinda said persons with fever over 102F are put on the IV fluids along with intravenous paracetamol (if they are unable to take the oral paracetamol). “If the oral paracetamol is not helping the person with high fever, and if it crosses 102F then we introduce IV fluids. It also depends on the other parameters such as dehydration,” said Dr Aravinda.
“There are no guidelines in India on when to admit a sick person, when to administer IV fluids,” said Dr Satyanarayana from Hyderabad. “It’s all left to the discretion of the treating doctor. There is no logic to say if the temperature shoots up to 100 and above, put them on IV. It is needed in case of severe dehydration. Ditto with the usage of antibiotics which should be given only when there are signs of sore throat and pneumonia.” Dr Satyanarayana added a person whose temperature has crossed 100 Fahrenheit should ideally visit a doctor.
“IV fluids are given when the fever is very high, followed by fluid loss and poor intake of liquid during in the infection,” said Dr Satynarayana.
Dr Ingale agreed that the introduction of intravenous drugs depends on how sick the person is and not only on the temperature. “Introducing medicines via IV is not done for mild cases that are treated in outpatient units where oral medicines are given. If they have very high fever, look toxic with acute dehydration and have difficulty in breathing, IV fluids would be recommended,” said Dr Ingale.
Apart from high fever and cough coming in the way of a person’s eating and sleeping, another vital caution is the oxygen saturation level, said Dr Satyanarayana. “If the oxygen saturation level is on the lower side of 90, then the person must immediately get in touch with the healthcare provider,” said Dr Mysore.