Co-infection of dengue, Covid-19 raises alarm in Bangladesh

Major dedicated Covid hospitals in Dhaka have seen a steady flow of patients also infected with dengue over the past week as Bangladesh’s resource-poor healthcare system encounters yet another health crisis.

Co-infection of Covid-19 and dengue can be very difficult to deal with, especially at a time when healthcare resources are exhausted tackling the Covid pandemic, with hospitals unable to take in any more patients unless the admitted ones recover or die.

Clinicians said that a prompt diagnosis could play a crucial role in tackling the emerging conifection challenge and that patients with fever complaints must be diagnosed for both Covid-19 and dengue and until the dengue season was over.

Similar symptoms make clinical differentiation between dengue and Covid-19, both viral diseases, difficult while rapid tests, warned researchers, could be misleading, producing false-positive results for Covid-19.

‘Battling two viral diseases as dangerous as dengue and Covid-19 at a time is very difficult for most of us,’ said virologist Nazrul Islam.

The co-infection may raise mortality or leave survivors with a vulnerable health condition for the rest of their lives.

The diseases spread in different ways, one borne by mosquitoes and the other through human droplets, but can simultaneously grow inside the body as one infects blood while the other the respiratory system, he explained.

‘Physicians need to be very careful with fever patients,’ he said, adding that wrong diagnosis and treatment could bear serious consequences.

For instance, Nazrul explained, blood thinners, used to prevent blood clotting in many Covid patients, can increase bleeding in patients with severe dengue symptoms.

Rising co-infection can especially put children at high risk, he said, for they are easy prey for mosquitoes.

Co-infection has caused deaths in dengue endemic countries like Thailand, Singapore, India, Pakistan, and Malaysia in recent times, following misdiagnosis or belated diagnosis in some cases.

Researchers in their works published in international medical journals noted that in many cases, clinical symptoms of dengue and Covid-19 were similar — fever, body aches and skin rash.

Bangladesh is dengue endemic too and the Institute of Epidemiology, Disease Control and Research said that the confirmed dengue cases were mostly secondary infections.

The secondary dengue infections tend to trigger severe symptoms in patients for they are having the disease for the second time but with a different strand of the virus causing dengue.

There are four strands of the virus responsible for causing dengue.

‘All dengue infections so far this year are confirmed to have been caused by DENV-3, the strand that triggered the 2019 outbreak,’ said IEDCR director Tahmina Shirin.

The 2019 outbreak was the worst dengue outbreak Bangladesh has ever seen with more than 1,00,000 confirmed cases and nearly 200 deaths.

The DENV-3 was first detected in 2017, the year the country recorded 3,000 cases, ending 16 years of dominance of DENV-1 and DENV-2 since the dengue disease first appeared in 2000.

In July, 2,286 dengue cases were confirmed, representing almost 90 per cent of all cases this year.

In 11 years since the emergence of the disease, the yearly case count was lower than this July.

Dengue cases are reported more or less round the year but start occurring in a greater number in July with its potential peak period extended until October.

‘The conifection cases received so far are mild and have not needed hospitalisation,’ said Dhaka North City Corporation Covid Hospital director Brigadier General AKM Nasir Uddin.

The DNCC hospital saw patients with co-infection on each of the past four days but the hospital authorities would not reveal the number.

‘We do not yet consider the number alarming but the bad news is that we are getting patients with co-infection daily,’ said Nasir.

The Mugda Medical College Hospital authorities reported 10 conifection cases confirmed over the past four days, said Asim Kumar Nath, the hospital’s director.

The authorities of Dhaka Medical College Hospital, BSMMU and 250-bed TB Hospital confirmed co-infection cases as well.

The confections of dengue and Covid-19 occurred in the past year too but in a small number, likely for a relatively low outbreak of dengue with less than 1,500 cases confirmed in the year.

With a chronic manpower shortage in hospitals, the dengue outbreak this year is likely to further worsen hospital management.

Hospitals now would have to watch out for potential Aedes mosquito breeding grounds and ensure that patients with co-infection are using mosquito curtains properly, round the clock.

‘The situation turns even more difficult for physicians already exhausted from caring for Covid patients and passing long hours in PPEs,’ said BSMMU respiratory medicine department associate professor Shamim Ahmed.

July also has accounted for a third of all Covid tolls since the disease first emerged with the overall infection of 12.5 lakh people and death of 20,500 others until Sunday.

The month ended with signs of a further increase in Covid infections.

The DGHS in its routine virtual press briefing has advised dual diagnosis of fever patients considering their symptoms.

The DGHS, however, has not released the data of confirmed co-infection cases.

‘We are analysing co-infection cases and will release the data later,’ said DGHS director Nazmul Islam, adding that they have enough dengue testing arrangements.

The reassurance about adequate dengue diagnosis measures has come when the Covid outbreak exposed the country’s poor health preparedness.

More than a year and a half after the emergence of the pandemic, which is at its worst fuelled by the highly infectious Delta variant of coronavirus, about a third of Bangladesh still lacks Covid diagnosis capacity and government hospitals in half the country do not have central oxygen supply.

New Age