The onset of monsoon increases the risk of transmission of tropical, vector-borne diseases like malaria and dengue. As we continue to live amid a pandemic, the risk has compounded with the infections caused by Covid-19 virus since many symptoms of dengue, malaria, and Covid-19 overlap, which can make treatment difficult and outcome dismal. “Preventing simultaneous infection of Covid-19 and malaria or/and dengue becomes a critical health intervention. Preventing co-infection will help to segregate and treat Covid patients more expeditiously while reducing chances of wrong treatment that may cause morbidity or death,” said Dr Maheshkumar M Lakhe, Consultant – Internal Medicine and Infectious Disease, Columbia Asia Hospital, Pune

“Last year,” he continued, “Delhi recorded a rise of 24 per cent cases of dengue, malaria, and chikungunya cases in a span of a week in August, taking the toll to 131 by September, while Gurgaon witnessed 36 cases of malaria and dengue by mid-October. Though Pune did not witness a single case between March and August last year, any complacency can exacerbate the challenging COVID situation in the city,” he said.

Common symptoms of dengue, malaria, and Covid-19

It is very difficult to differentiate between dengue fever, malaria, and Covid-19 since all three diseases share similar laboratory and clinical characteristics.

Dengue: Also called bone-breaking fever, dengue is a viral infectious disease caused by any of the four related dengue viruses – DEN-1, DEN-2, DEN-3, and DEN-4. The common symptoms of dengue include high fever with severe headache, muscle and joint pain coupled with nausea and vomiting and diarrhea.

Malaria: The life-threatening disease is caused by the parasite Plasmodium, which is transmitted to humans through an infected anopheles mosquito. Some common symptoms include fever with shivering, headaches, fever, and vomiting, and occasional seizures, sweats, followed by a return to normal with fatigue.

Coronavirus: The disease spreads from person-to-person through droplets emanating from an infected person when they cough, sneeze or talk without a guard or a mask. Some established symptoms are fever, dry cough aches and pains with tiredness, sore throat with headache, diarrhea, difficulty breathing or shortness of breath.

“Both malaria and dengue have a few common symptoms as both start with headaches and generalised weakness, symptoms seen in a Covid-19 infected person as well. Covid symptoms, like skin rash and fever, can be found in dengue as well. The initial clinical symptoms like fever, myalgia and headache are commonly seen in both dengue and Covid-19 infected patients. However, additional symptoms pertaining to the respiratory system like cough, loss of smell or taste, or sore throat may encourage further investigations for Covid-19. This coinfection of dengue, malaria and Covid-19 poses a big challenge for the precise and right diagnosis of these viral diseases as there have been reports of misdiagnosis due to false-positive results,” expressed Dr Lakhe.

Measures to avert a coinfection

Undoubtedly, the co-infection and co-occurrence of dengue, malaria and COVID-19 have created a great burden on the medical and public health agencies, raising concerns over limited resources at a time when the healthcare infrastructure is under tremendous pressure due to the pandemic. “Also, it is a challenge for diagnostic staff to come out with correct laboratory diagnosis of shared clinical symptoms shown by infected individuals. The main pillars to control the two major arthropod-borne infections in tropical areas have been preventive measures such as vector control, protective measures, and surveillance. But the pandemic has posed a challenge in terms of restricted availability and movement of human resources. This has adversely impacted the much-needed vector management activities. Keeping the situation in mind, the roadmap for the district and state authorities has been structured to ensure that scheduled activities to curb the outbreak of malaria and dengue are not hampered. However, the paucity of manpower on the ground remains a cause of worry,” he said.

In such a situation, the need of the hour is an affordable and rapid test that could precisely distinguish between dengue, malaria, SARS-COVID-19, he suggested. To avoid rising numbers of dengue and malaria cases at a time when the COVID situation in India remains volatile, it is necessary that the hospitals develop sufficient infrastructure to treat patients with co-infection. It is also important that patients must be diagnosed for all the infections since clinical diagnosis is not easy due to overlapping symptoms.

“It can be assumed that the cases of co-infection of Covid-19, dengue and malaria would peak during monsoon season. Hence, the government and the health agencies must be well-prepared with strong measures like effective mosquito vector control strategies and sufficient hospital and diagnostic facilities. At the same time, it is important that people follow COVID-appropriate behaviour as well as the general guideline for malaria and dengue prevention including, but not limited to preventing the accumulation of freshwater, wearing clothes covering arms and legs, using mosquito nets and repellents, and screen on windows and doors, and cover water containers tightly or use chemical larvicide to prevent breeding of mosquitoes,” he said.

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