Is it Dengue or is it COVID-19?

During the COVID-19 pandemic, healthcare providers in areas where dengue is endemic need to consider dengue and COVID-19 in the differential diagnosis of acute febrile illnesses.

Most people with dengue and COVID-19 have mild illness and can recover at home; symptoms usually last a few days, and people tend to feel better after a week.

However, both dengue and COVID-19 can cause severe illness that can result in death.

The clinical management for people who develop severe illness with either of these two diseases is quite different, often requiring hospital-based care.

Find out below the clinical differences in common clinical information.

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Dengue: Risk factors for severe illness

Viral characteristics

• Viral titer correlates with disease severity

• There may be strain and serotype differences in pathogenicity

Host factors

• Age (infant)

• Women, especially pregnant women

• Patients with chronic medical conditions, including diabetes, asthma, obesity, and heart disease

• Patients with secondary DENV infection

Level of neutralizing antibody

• Timing of infection relative to the previous DENV infection (the longer, the higher the risk)

• There are no tests or biomarkers to identify which patients will experience severe disease

COVID-19: Risk factors for severe illness

Some people are more likely than others to become severely ill. Severe illness means that a person with COVID-19 may need: hospitalization, intensive care, a ventilator to help them breathe or they may even die.

People at increased risk, and those who live or visit with them, need to take precautions to protect themselves from getting COVID-19.

· Older Adults

· People with Certain Medical Conditions

Cancer.

Chronic kidney disease.

Chronic lung diseases, including COPD (chronic obstructive pulmonary disease), asthma (moderate-to-severe), interstitial lung disease, cystic fibrosis, and pulmonary hypertension.

Dementia.

Diabetes (type 1 or type 2).

Heart conditions (such as heart failure, coronary artery disease, cardiomyopathies or hypertension).

Down syndrome.

Immunocompromised state.

HIV infection.

Liver disease.

Overweight and obesity.

Smoking.

Solid organ or blood stem cell transplant.

Stroke or cerebrovascular disease.

· Pregnant and Recently Pregnant People

What Healthcare Professionals should do?

Healthcare providers should perform appropriate tests (for Dengue; for COVID-19) and follow the patient closely for warning signs.

Dengue warning signs include persistent vomiting, mucosal bleeding, difficulty breathing, lethargy/restlessness, postural hypotension, liver enlargement and progressive increase in hematocrit.

COVID-19 warning signs include difficulty breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face. This list is not all possible symptoms.

Complications for both dengue and COVID-19 can develop before test results come back. Clinical management should be guided by clinical presentation.

Differentiation and Similarities of Dengue & Covid-19

Dengue	COVID-19
Transmission
Dengue, an illness caused by any of 4 dengue viruses, is mainly transmitted to people through the bites of infected Aedes species mosquitoes (primarily Ae. aegypti or Ae. albopictus species).	COVID-19, a respiratory illness caused by the virus SARS-CoV-2, is mainly transmitted from person to person through respiratory droplets that are spread when an infected person coughs, sneezes, or talks.
Incubation Period
The incubation period for dengue ranges between 3-10 days, typically 5-7 days.	The incubation period for COVID-19 is thought to extend to 14 days, with a median of 4-5 days from exposure to symptoms onset.
Clinical Course The clinical manifestations of both dengue and COVID-19 can range from mild to critical.

Dengue	COVID-19

Signs and Symptoms

Mild to moderate disease

Febrile phase

Fever
Headache with eye pain
Myalgia
Nausea
Vomiting
Rash
Leukopenia

Warning signs for severe illness: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, lethargy, restlessness, and liver enlargement.

Critical Phase

Warning signs may appear, and rapid clinical deterioration may occur within 48 hours after defervescence (3–7 days after fever onset).

Mild to moderate disease

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

NOTE:

These signs and symptoms of COVID-19 are the ones most persons with the illness have experienced. However, this list is not inclusive.

Severe Illness

Severe dengue is defined by dengue with any of the following symptoms and signs:

Plasma leakage leading to shock.
Fluid accumulation with respiratory distress.
Severe bleeding with thrombocytopenia.
Severe organ impairment such as liver disease with elevated transaminases, or meningoencephalitis with impaired consciousness.
Heart impairment.

Among patients who developed severe disease, the medium time to dyspnea ranged from 5 to 8 days, the median time to acute respiratory distress syndrome (ARDS) ranged from 8 to 12 days, and the median time to ICU admission ranged from 10 to 12 days.

Signs and symptoms for severe illness can include: