There is “no standard protocol” for treatment of patients who have contracted a double infection of COVID-19 and dengue, and a very “finely balanced” approach is needed to tackle both the ailments at once, experts said. Delhi Deputy Chief Minister Manish Sisodia was shifted to LNJP Hospital on Wednesday for COVID-19 treatment and tested positive for dengue a day later. On Thursday evening, the 48-year-old AAP leader was shifted to the ICU of Max Hospital Saket here. He had tested positive for COVID-19 on September 14 and is perhaps the first prominent personality in the city to have been diagnosed with both infections. Medical Director of Rajiv Gandhi Super Speciality Hospital (RGSSH) B L Sherwal said both the diseases have no specific treatment, which makes it even difficult for treating doctors of such patients. “Both COVID-19 and dengue need symptomatic treatment and in some aspects the treatment is kind of contradictory and thus tricky. In COVID-19, we inject heparin drug subcutaneously which ultimately reaches the blood stream, and this is done to prevent embolism in these patients which can prove fatal,” he said. Embolism is sudden blocking of an artery which can obstruct flow of oxygen, and that is why some patients get complications even after treatment, the doctor said. RGSSH is a dedicated COVID-19 facility run by the Delhi government. “In dengue, on the other hand, platelets infusion is needed in cases where its count has fallen to dangerously low level. So, it’s kind of opposite. And, therefore, we can’t inject heparin if a COVID-19 patient has dengue too,” Sherwal said. So, for a treating doctor it is like “walking a tight rope” and a very “finely balanced approach” is needed, he said. Vikas Maurya, Director and Head of Department, Pulmonology, Fortis Hospital Shalimar Bagh, also feels a balanced approach is needed in tackling the “double infection” of COVID-19 and dengue. “One will have to also see which disease takes preponderance in such a patient, and the course of treatment will depend accordingly. Both are spread by virus, so it is quite an unusual scenario for a doctor as well as the patient,” he said on Friday. Maurya also referred to a “study done by a university in Brazil along with an American varsity”. “Though the study is yet to be peer-reviewed, one of its findings was that in patients who had suffered dengue infection earlier had developed anti-bodies, and in some patients, a false positive result was coming for COVID-19, even with RT-PCR test. But it is too early to say anything,” he added. Rajesh Rautela, Medical Superintendent of GTB Hospital, said a doctor “will have to be like a juggler, balancing two things at the same time”. “So, best way is to take precautions and preventive measures to avoid stagnation of water where mosquitoes can breed. No medicinal cure is there for either of the two ailments, just symptomatic treatment, so people should be alert,” he said. Mugdha Tapdiya, senior consultant, internal medicine at Fortis Hospital, Vasant Kunj said, “Diseases like malaria and dengue have overlapping symptoms with COVID-19, except where there are respiratory symptoms.” “If there is a co-infection with dengue in which there is a risk of hemorrhage, then management becomes very tricky. Similarly there is a capillary leak in dengue fever which is treated by intravenous fluids, whereas with co-infection of COVID-19, large intravenous fluid is a risk in the view of potential trial risk of ARDS and pulmonary oedema,” she cautioned Sources at LNJP Hospital on Thursday said “there is no standard protocol” for treatment of double infection of COVID-19 and dengue, and treatment is “patient-specific”. LNJP Hospital is the largest hospital under the Delhi government and a dedicated COVID-19 facility. “The patient’s age, condition, comorbidities and other factors are taken into account for treatment of both the ailments,” a source said. Asked if there are any side effects of treatments in cases of a “double infection”, the source said, “Any treatment can have a side effect, but the treating doctor decides the methodology for it”. A dengue patient, if his or her platelets level falls dangerously below the normal level, needs external platelets infusion. A normal platelets level is considered in the range of 1.5-4.5 lakh, according to doctors. “If a patient needs plasma for COVID-19 treatment, he can be administered that, and if he needs platelets that too can be infused. The treating doctor will decide the course of treatment,” the source said. Common symptoms of COVID-19 are high fever, breathlessness, cough, body fatigue and loss of sense of smell and taste. In dengue, a vector-born disease caused by aedes aegypti mosquito, a person runs high fever, suffers red rashes on skin, pain behind eye sockets, joint pain and in serious case internal bleeding which can prove fatal. “In about 10 per cent of dengue cases, a patient suffers haemorrhagic fever which leads to deaths. Internal bleeding can manifest through nose, gums and those are danger signs,” Sherwal said. Recently, Delhi Health Minister Satyendar Jain, himself a COVID-19 survivor, had told reporters that about 2-3 patients of COVID-19 in Delhi had shown dengue infection too. “We have managed to contain dengue this year. Our campaign ”10 Hafte 10 Baje 10 Minute” was very effective last year, and this year too dengue situation in Delhi is under control,” he had said.
