News
The terrible twins – dengue & COVID
Dr. Upul Dissanayake
It was the twin viral diseases of COVID-19 and dengue that Consultant Physician Dr. Upul Dissanayake of the National Hospital of Sri Lanka (NHSL) focused on.
A strong intimation that dengue is on the rise came from Dr. Dissanayake as he said that due to people’s attention being mainly on COVID-19, dengue has been pushed back in their minds. Once every four years, there is a sharp spike in the number of dengue cases. The last time it was in 2017 and now the country may be at the beginning of the next spike.
He talks of the ground situation in his ward:
Of the 40 beds, 10-15 are occupied by dengue patients. Of these 10-15 dengue patients, between 1/3rd and half go into Dengue Haemorrhagic Fever (DFH).
With regard to COVID-19, the number of admissions has dropped. Currently, there may be around 40 in the whole of NHSL compared to 800 a couple of months ago. Among them, between 1/3rd and half are oxygen-dependent. Most of them are either not vaccinated or vaccinated but their immune response is low because of inherent problems like chronic diseases.
On how to differentiate between COVID-19 and dengue, Dr. Dissanayake said:
COVID-19 – Fever, intense backache, headache and bone pain. There could also be a runny nose and cough, while there is a loss of taste and smell and loss of appetite. There could also be breathing difficulty.
Dengue – Similar symptoms as COVID-19 and under-eye pain, but no loss of taste and smell even though there could be a loss of appetite. There could also be a runny nose and cough even though they are not symptoms of dengue but maybe due to another infection. Breathing difficulty could also be experienced if the person goes into dengue shock.
He stressed that if a person is vomiting and unable to eat/drink, he/she needs to be admitted to hospital immediately, as also if the person is having pain on the right side of the stomach because it could mean severe dengue.
How to differentiate between these twin viral diseases?
“To diagnose whether it is dengue, we need to perform a full blood count (FBC) and a dengue NS1 antigen test. It is important to keep in mind that on Day 1 or 2 of fever, even if the NS1 antigen test is negative, it is not a confirmation that the person is dengue-free. This is because while the NS1 antigen test shows about 98% positivity in first-time dengue patients, about 40% of second-time patients don’t test positive,” he said, adding that an FBC is also important and the reports should be given in a few hours rather than a day, as this would delay diagnosis and treatment.
Some advice from Dr. Dissanayake to dengue patients:
A circular by the Health Ministry recommends that if a person’s platelets drop below 130,000, he/she should be admitted to hospital. This is because there have been instances where a patient’s platelet count has been 150,000 one day but dropped drastically to 80,000 the next day with him/her going into shock.
It is vital to do FBCs morning and evening and get the reports soon.
If there is a suspicion that a person is having dengue, it is very important to stay home, bed-rest and take adequate hydration (2500ml of liquids for adults and as advised by a doctor for a child).
Prevention
Dr. Dissanayake says that the environment, in the house and outside, should be cleaned thoroughly and mosquito breeding spots destroyed. The dengue mosquito is a day-biter and sleeping under a mosquito net at night will not help.
“Wear long-sleeved clothes when going out especially if there have been dengue patients in your area and use a mosquito repellent like citronella oil,” he suggests.
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