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Fighting dengue while battling Covid-19

Amrita Kaur on 26 Jul 2020

The Straits Times


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SINGAPORE - Amid all the focus on the fight against the Covid-19 pandemic, the other battle against dengue is also a cause for concern as the number of cases continues to rise.


And while both are viral infections that are present with fever, doctors say there are several features that differentiate them.


Nineteen people have died from dengue fever this year, only eight fewer than the number of Covid-19 deaths.


There were 1,733 dengue cases reported from July 12 to 18 - the highest number of weekly cases recorded in Singapore, according to data from the National Environment Agency. It was also the sixth week running with more than 1,000 cases.


More than 18,900 people have been infected this year as of July 20.


Medical director at Parkway Shenton Edwin Chng said: "The public has mainly been riveted by the current Covid-19 pandemic for the last seven to eight months because, understandably, the virus is new and relatively unknown, hence it triggers fears and concerns.


"However, in view of the recent escalation of dengue cases and deaths, it is important that we pay attention to fighting dengue fever as well."


Unlike Covid-19, dengue cannot spread directly from person to person. It is transmitted to humans through the bite of an infected Aedes mosquito.


A mosquito becomes infected when it bites a dengue-infected person, and it spreads when the mosquito later transmits the virus to other people they bite.


Symptoms of dengue include a sudden onset of fever that lasts between two and seven days, severe headache and pain behind the eyes, nausea and vomiting, and joint and muscle ache.


Severe dengue develops three to seven days after the first signs of illness, with worsening symptoms, such as severe abdominal pain, persistent vomiting, bleeding gums, vomiting blood, rapid breathing, and fatigue or restlessness.


Severe dengue, also known as dengue haemorrhagic fever, can cause the number of platelets - tiny blood cells that help the body to form clots to stop bleeding - to fall dangerously low, leading to bleeding in the internal organs, a sudden drop in blood pressure and death.


Dr Leong Hoe Nam, infectious disease specialist at Mount Elizabeth Novena Hospital, wrote in online health and wellness Web resource Health Plus: "Rare but known complications of dengue include myocarditis (inflammation of the heart), resulting in severe and profound hypotension (low blood pressure), heart failure and damage to peripheral nerves."


In an advisory published by Farrer Park Hospital, infectious diseases specialist Nicholas Chew said that while Covid-19 and dengue fever are both viral infections that present with fever, there are several features that differentiate them.


"Most patients infected with Covid-19 would display an upper respiratory tract infection with symptoms such as sore throat, cough or runny nose. Dengue fever is different. There would be other symptoms such as fever, joint aches or pains. Sometimes, patients may also develop a rash."


He added: "When a patient does come in with non-specific symptoms such as fever, most doctors in Singapore would be quite wary because these are two common infections active at the moment and a thorough check-up is required."


Dr Chng said that it can be "quite difficult" to differentiate dengue and Covid-19.


"In general, muscle aches, fatigue, headache, joint pain, nausea and vomiting are usually more severe in dengue fever. In addition, bleeding is seen only in dengue fever but not Covid-19," he said.


Dengue can also be present with minimal or no symptoms at all, especially in children, he added.


The diagnosis is usually confirmed with a blood test, which typically takes a few hours for the results to be available.


There is no specific treatment for dengue, but doctors can provide support and ease pain. Most people can be treated at outpatient clinics.


People living or travelling in tropical and sub-tropical areas are at increased risk of exposure to dengue fever, noted Dr Chng.


These areas include South-east Asia, Western Pacific islands, Latin America and the Caribbean, where the primary carrier for dengue fever, the Aedes mosquito, is widely distributed.


They typically breed in or close to houses, laying eggs in both man-made and natural water containers.


Dr Raymond Ong, a general practitioner at Intemedical 24 Hour Clinic in Ang Mo Kio, said Aedes mosquitoes are more likely to bite during the day.


"They are most active during daylight, for approximately two hours after sunrise, and several hours before sunset," he said. The mosquito also often rests indoors, such as in closets and other dark places.


Most people recover from dengue within 14 days.


Dr Ong noted that the effects of the Covid-19 pandemic may have contributed to the spike in dengue cases here.


"It could possibly be due to more people staying at home, the increased public focus on Covid-19, resulting in people paying less attention to dengue and prevention, or a lot of puddles from wet weather or stagnant water across Singapore."


There could be more dengue case pick-ups as a result of mandatory temperature screenings and people seeking medical attention even for mild symptoms, he added.


Individuals aged between 12 and 45 years old can be vaccinated against dengue, in consultation with a doctor.


Dr Leong noted that the vaccine has been shown to be 70 per cent effective in preventing dengue fever, and up to 95 per cent in preventing severe, life-threatening dengue illness.


Dengue patients recovering at home should ensure they get adequate rest and hydration.


They should also be monitored for signs of dehydration, including a decrease in urination, dry mouth or lips, as well as sunken eyes, confusion, cold or clammy extremities, bleeding, and few or no tears in infants.


Dr Chng cautioned against taking non-steroidal anti-inflammatory drugs such as ibuprofen, voltaren, naproxen and aspirin-based products as these can increase bleeding complications.


He said that as low blood pressure is a possible complication of dengue fever, patients on high blood pressure medication must be monitored by a doctor regularly. The medication would have to be adjusted or stopped temporarily if there is a drop in the patient's blood pressure to prevent it from plunging further to dangerously low levels.


To reduce the risk of infection, he urged everyone to keep safe by taking steps such as using a mosquito repellent regularly, and checking for and actively eliminating mosquito breeding sites at home.


"While we continue our fight against Covid-19, it is important to remain vigilant towards dengue in our community, and do our best to prevent mosquito breeding in our surroundings to reduce transmission," he said.


Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.



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