Experience of a Tertiary Hospital in Singapore with Management of a Dual Outbreak of COVID-19 and Dengue

Abstract

During the COVID-19 pandemic, distinguishing dengue from cases of COVID-19 in endemic areas can be difficult. In a tertiary hospital contending with COVID-19 during a dengue epidemic, a triage strategy of routine COVID-19 testing for febrile patients with viral prodromes was used. All febrile patients with viral prodromes and no epidemiologic risk for COVID-19 were first admitted to a designated ward for COVID-19 testing, where enhanced personal protective equipment was used by healthcare workers until COVID-19 was ruled out. From January to May 2020, 11,086 admissions were screened for COVID-19; 868 cases of COVID-19 were diagnosed in our institution, along with 380 cases of dengue. Only 8.5% (943/11,086) of suspected COVID-19 cases were concurrently tested for dengue serology due to a compatible overlapping clinical syndrome, and dengue was established as an alternative diagnosis in 2% (207/10,218) of suspected COVID-19 cases that tested negative. There were eight COVID-19 cases with likely false-positive dengue serology and one probable COVID-19/dengue coinfection. From April to May 2020, 251 admissions presenting as viral prodromes with no respiratory symptoms were screened; of those, 15 cases had COVID-19, and 2/15 had false-positive dengue IgM. Epidemiology investigations showed no healthcare-associated transmission. In a dengue epidemic season coinciding with a COVID-19 pandemic, dengue was established as an alternative diagnosis in a minority of COVID-19 suspects, likely due to early availability of basic diagnostics. Routine screening of patients with viral prodromes during a dual outbreak of COVID-19 and dengue enabled containment of COVID-19 cases masquerading as dengue with false-positive IgM.

Case Report: Dengue and COVID-19 Coinfection in Thailand

“…Some reports have revealed false-positive dengue antibody in COVID-19 patients who were misdiagnosed as dengue. 4 – 6 Serological cross-reactivity between dengue and COVID-19 has been reported. 18 Thus, either dengue NS1Ag or dengue RT-PCR should be performed to confirm the diagnosis if suspected.…”

“…Testing for both dengue and COVID-19 with accurate methods together with isolation of suspected cases while awaiting the results is ideal and a well-established practice in some institutes. 6 However, this approach might overwhelm a public health system in a resource-limited tropical setting during an outbreak. During the COVID-19 outbreak in Thailand, the national policy encouraged all hospitals to establish ARI clinic to isolate and facilitate patients presenting with fever or respiratory symptoms.…”

“… 3 Some reports have described COVID-19 cases that were initially misdiagnosed as dengue infection. 4 – 6 Thus, dengue and COVID-19 might be a hazardous combination, and physicians should have raised awareness of this, especially in tropical areas. We report a 50-year-old woman diagnosed with laboratory-confirmed dengue fever and COVID-19 during the COVID-19 outbreak in Bangkok, Thailand.…”

The Complexity of Co-Infections in the Era of COVID-19

“…There are citations of unique co-infections of SARS-CoV-2 with other systemic viral illnesses [101][102][103][104][105][106][107][108][109][110][111]. Such coinfection was particularly of interest in the context of chronic HIV infection where persistent immunocompromise or enhanced infection susceptibility otherwise might allow for either of the infections to be more severe than not [104][105][106]112].…”

One Year on: An Overview of Singapore’s Response to COVID-19—What We Did, How We Fared, How We Can Move Forward

“…Another few were about co-infection with other pathogens, such as the human immunodeficiency virus (HIV) [288,289] and mycoplasma pneumoniae [290]. The remaining articles were about the various other aspects of COVID-19 pathology not mentioned above [291][292][293][294][295][296], such as dealing with a dual outbreak of dengue and COVID-19 [292], and respiratory surveillance wards to detect COVID-19 early [296].…”