Growing evidence of Covid co-infection with dengue, malaria: Centre asks hospitals to be ready; issues guidelines

This poses challenges in clinical and laboratory diagnosis of Covid, and have a bearing on clinical management and patient outcomes, the ministry says

New Delhi, October 13

The government on Tuesday said Covid could co-exist with a range of seasonal diseases and asked hospitals to be geared to treat a potential high burden of severe dengue/malaria cases along with Covid.

Issuing guidelines for the community and physicians on how to deal with Covid co-infections, the Health Ministry said that given the seasonal pattern of epidemic-prone diseases observed every year in the country, diseases like dengue, malaria, seasonal influenza, leptospirosis, chikungunya, and enteric fever cannot only present a diagnostic dilemma but may co-exist in Covid cases.

“This poses challenges in clinical and laboratory diagnosis of Covid, and have a bearing on clinical management and patient outcomes,” the ministry said issuing the guidance document that seeks to provide guidelines on prevention and treatment of co-infections of Covid with diseases like dengue, malaria, seasonal influenza (H1N1), leptospirosis, chikungunya.

The government said malaria and dengue could co-exist with other infections, and thus confirmation of malaria and dengue infection does not rule out the possibility of the patient not suffering from Covid and a high index of suspicion of malaria and dengue must be there when a fever case is diagnosed as Covid, particularly during the rainy and post-rainy season in areas endemic for these diseases.

Both Covid and seasonal influenza can also present as influenza-like illness and so all such cases in areas reporting Covid cases must be evaluated and tested for both Covid and seasonal influenza, if both viruses are circulating in population under consideration.

The ministry says chikungunya leads to acute onset of moderate to high grade continuous fever and malaise followed by rash, myalgia and arthralgia. Respiratory failure may ensue in late stages. Co-infection with Covid may be suspected in chikungunya endemic areas, in the months of monsoon.

Leptospirosis apart from presenting as febrile illness also has the tendency to manifest as acute respiratory illness, leading to respiratory distress and shock. In areas where leptospirosis is known to cause outbreaks during monsoon and post monsoon, the possibility of co- infection should be considered, say the guidelines.

They add that scrub typhus prevalent in foothills of Himalayas in Jammu and Kashmir, Himachal Pradesh, Sikkim, Manipur, Nagaland, Meghalaya has in recent past also been seen in Delhi, Haryana, Rajasthan, Maharashtra, Uttarakhand, Chhattisgarh, Tamil Nadu and Kerala.

“The clinical picture consists of sudden high-grade fever, severe headache, apathy, myalgia and generalised lymphadenopathy. A maculopapular rash may appear first on the trunk and then on the extremities and blenches within a few days. The patients may develop complications that include interstitial pneumonia. Scrub typhus infection may co-exist with Covid, so can bacterial infection,” the ministry said recommending diagnostic and treatment techniques and asking all secondary- and tertiary-level hospitals to be prepared to manage severe dengue and Covid cases.

The government said a concerted effort is required in prevention, surveillance, behaviour change communication and management of co-infections.

Alert vigil, a high index of suspicion and constant awareness of the possibility of co-infections can help physicians avert the adverse outcome of cases with co-infection, it said.