Don’t let COVID-19 overshadow the risk of dengue

The human race is currently going through a scourge of the COVID-19 pandemic, caused by a newly discovered coronavirus, SARS-CoV-2, which originated in Wuhan, China in December 2019. Since then, more than 200 countries have fallen victim to this virus. There are more than 4 million active cases across the world, and the death toll has reached more than 500,000. Nepal has also not been able to escape this global health emergency, ranking 61st in the infection record order, with more than 16,000 cases and a death toll of more than 40.

Amid the COVID-19 pandemic in Nepal, the possibility of a rise in dengue fever cases at various locations of Nepal, with the onset of the monsoon rains, poses a great threat. According to the Lancet report published in March, dengue and COVID-19 cases are difficult to distinguish because of their shared clinical and laboratory features. This has made researchers and health professionals sit up regarding the cure and management of the virus.

Moreover, there are factors that can undermine dengue infection over the corona. For example, dengue’s early flu-like symptoms can be confused for the coronavirus. Symptoms like fever, headache, diarrhoea, sore throat and seizures are common to both the diseases, making it difficult for the doctors and health works to distinguish between the two. If patients are found to have both, there are chances of their health condition worsening exponentially, with little chances of recovery. For example, a study done in Singapore with false-positive results from rapid serological testing for dengue was later confirmed to have the SARS-CoV-2 infection.

Similar is the case in Nepal. A 30-year-old man from Dhading with fever, headache and cough was forced to visit the Sukraraj Tropical and Infectious Disease Hospital (corona-dedicated hospital) in Kathmandu, as health workers in his district refused to examine him, saying that most of his symptoms matched those of COVID-19. No one there was ready to diagnose if he was suffering from corona or some other diseases. If such a situation continues, the condition of the patients may worsen. Not only dengue and corona, many patients will die of several viral and other similar diseases if they do not get care or appropriate prophylaxis at the right time. No one is aware about the complications that may result from a dengue-corona misdiagnosis. The fear of COVID-19 is found more threatening than the virus itself, which now covers all 77 districts of Nepal.

Till date, since early 2020, more than 150 cases of dengue have been reported in Nepal. According to last year’s report, there were a total of 14,662 cases of dengue and a death count of six. The first case that started in Sunsari district in May later covered 68 out of 77 districts in Nepal. It is likely that similar number of cases will develop this year also.

Similarly, corona infection has already shifted to the community level, and present data show that a large number of cases are concentrated in provinces 1 and 2. The provinces are high-risk areas of dengue as well. Many hospitals in Nepal have stopped regular check-up facilities due to the COVID-19 fear, and in such a situation, people suffering from dengue infection are likely to suffer for lack of treatment and proper care. As most of the hospitals are concerned about the coronavirus only, many patients will die without even undergoing a minor check-up. Nobody can predict the worst condition should a person infected with corona is also infected with dengue or vice versa. Eventually this will create a health emergency in Nepal.

At the moment, there are no specific vaccines or treatments available for dengue and COVID-19. However, there are many ongoing clinical trials evaluating potential treatments and vaccination. It is possible that those who are infected with COVID -19 face the risk of being infected with dengue as well. Having a dengue outbreak amid the COVID-19 outbreak complicates matters for doctors and health workers because they have to distinguish between a fever from COVID-19 infection and a fever from dengue.

Cutting down on dengue infection will help in the fight against COVID-19 as having two outbreaks simultaneously creates more problems in detection. For this, it is better to go for a dengue test along with the COVID-19 test if the patients share common symptoms of both the viruses. PCR is the ultimate test to distinguish between the two. Timely management is necessary, and the government should manage large numbers of beds and ventilators to tackle the problem. Besides corona and dengue, there are chances of other flu infections as well, which share common symptoms.

Awareness in people about the transmission of dengue and the coronavirus plays an important role in the management of the virus. The best way to prevent and slow down the transmission of viral infection is to be well informed about the pathogenesis, related transmission risks and the preventive measure to the risk group regarding the virus.

Social distancing is the most followed practice used to prevent COVID-19. To protect ourselves from dengue infection, we should keep away from the bite of infected mosquitoes by using mosquito nets and cleaning mosquito breeding places. We can protect ourselves and others from the coronavirus by washing hands or using an alcohol-based hand rub frequently and not touching the face. Enhancing healthcare facilities with easy access to health services may bring about the desired health standard in the people, making disease management efficient. As there is no specific treatment or cure for both the viral diseases, timely intervention can help, depending on how severe the disease is.

Lamsal is a researcher in virology at the Central Department of Biotechnology, Tribhuvan University