Beware of Covid-19 and Dengue Dual Infection

Prof. Tjandra Yoga Aditama
Professor of Lung FKUI, Former Director of WHO SEARO, and Former Director General of P2P & Head of Balitbangkes

WE has started to enter the rainy season. If we look at last year’s data, at the end of the year like this, it is possible that cases of dengue and dengue hemorrhagic fever (DHF) will increase. On the other hand, we are still facing the Covid-19 pandemic, whose cases and deaths are still happening. It is good if we anticipate the possibility of dengue fever at a time when we still have to concentrate on dealing with Covid-19. It should be noted that there are now more than 50 million cases of Covid-19 in the world, and on the other hand, each year it is estimated that there are around 105 million dengue infections in the world, some of course in Southeast Asia, including our country.

Multiple Infection
Since several months ago there have been several scientific papers from various countries about these two diseases at once. One of the reports in the first months of the pandemic was from Singapore which was published in the international scientific journal Lancet in March 2020. The two cases they reported were initially treated with serological laboratory results that showed positive dengue and symptoms consistent with dengue disease. It turned out that later the laboratory results were false positives (false-positive) and recently both of these cases showed positive Covid-19 results.

Another example, in August 2020 there was a case report that had both dengue and Covid-19. This happened on Reunion Island in the Indian Ocean which has a population of only 850,000 people. The patient presents with symptoms of prolonged fever, redness (erythema) in the skin, pain all over the body, pain behind the eyes, photophobia (insufficient light) and headache. He lives in an area where there is dengue disease, and just arrived by plane from the city of Strasbourg where it was later discovered that another passenger had Covid-19 (+).

The patient’s complaint was indeed fever, a characteristic symptom of these two diseases. We know that although not very often, skin disorders (erythema etc.) have also been reported in some Covid-19 patients, at least as reported in Italy, France and Thailand, while redness of the skin is also a feature of dengue symptoms. That is, from the point of view of the symptoms that arise it can be almost the same.

Apart from the problem of diagnosing the disease, there are also other things that are currently being faced. First, many patients now refrain from going to puskesmas, clinics and hospitals if there are health complaints for fear of contracting Covid-19. This may result in delays in the diagnosis of DHF with various problems. This is certainly not good. If it is necessary we still have to get checked out, of course with strict health protocols.

Second, public health workers who used to deal with dengue may also now shift their duties to dealing with Covid-19, so that vector control (in this case mainly mosquitoes) becomes relatively constrained. This can cause dengue fever mosquitoes to continue to spread and we will increasingly face dengue problems in the community. Indeed, there have also been scientific reports which say that dengue infection may provide some form of immunity to Covid-19, but the supporting data is still very limited and needs further research.

Another thing that is also interesting is policy lockdown on Covid-19, which closed workplaces and banned crowds so that more people were in their neighborhoods. Researchers from Singapore examined the possible impact of these policies on the occurrence of dengue in Singapore, Malaysia, and Thailand, the results of which were reported in scientific journals in October 2020. The results showed a marked increase in dengue cases in Thailand, but not in Singapore and Malaysia, despite continued data. suggests that there appears to be a pick-up in Singapore too. This research team argues that policy differences social distancing and differences in the structural patterns of homes and workplaces in these three countries make up for the different outcomes of the lockdown on the incidence of dengue in communities.

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