Written by Dr Atul Gogia
Several cities are reporting cases of not just Covid-19 but other viral fevers such as seasonal flu (H1N1) and dengue. In fact, with overlapping symptoms and sometimes simultaneous cases, people are wondering what they should do when they develop fever.
There was a surge in Covid-19 numbers in Delhi this month but there are also reports of viral infections like dengue and H1N1. This is happening in other cities too. What are you seeing in your clinics right now?
After a lull, there has been an increase in Covid-19 cases this month. And if anybody comes in for consultation with fever, it is more likely than not that they have Covid-19. Seven out of 10 patients have Covid-19. But increasingly, we are also seeing cases of flu and dengue. We are even reporting cases of malaria – maybe three or four cases a week. Then there are always some cases of typhoid.
Is it a challenge to distinguish between different infections?
It is very difficult to distinguish between flu and Covid-19 because both of them have upper respiratory tract involvement along with fever. And, we don’t really need to distinguish in most cases because the treatment remains the same. There is no specific treatment for either — of course, there is Tamiflu for H1N1that helps in people who are at risk of severe disease but it has to be given within two or three days of the onset of symptoms — we usually just ask the patient to take paracetamol.
If we look at dengue, on the other hand, the fever is usually high, say 102 or 103 degrees. There is also retro-orbital pain, meaning pain behind the eyes, headache, back pain and sometimes red rashes. The treatment for dengue is also symptomatic.
Malaria again results in high grade fever and this is the one we need to confirm because there are specific anti-malarial drugs.
Who should get tested for the infections?
There are several seasonal fevers; we cannot test everyone for each of them. It is not practical and it is not needed. Plus, the cost also adds up. COVID-19 tests are cheaper now, home tests are also available but the H1N1 test can still cost around Rs 4,500. Then if you add dengue antigen test and typhoid test, it adds up.
Also, most viral fevers are self-limiting and there is no need for antibiotics or any such. People can just continue to take Paracetamol, stay at home and recuperate. Cough syrups and home remedies can be taken to help with sore throat and cough. People can remain in isolation so that whatever be the infection, they do not spread it to others.
Now, who should definitely get tested? The elderly, people with co-morbidities and those with compromised immune systems. This is because there is a risk of them developing more severe forms of Covid-19. People must also get tested if their fever is high grade, persists after two or three days and they have breathlessness or bleeding.
Are you seeing complicated Covid-19 or dengue cases?
We are. In fact, after the January surge in cases, we hardly ever saw people with COVID-19 pneumonia, low oxygen saturation, or the need for oxygen support. We are seeing it again. I have some patients who are not very old, they just have normal diabetes or hypertension, they do not have any other severe co-morbidity, but they needed oxygen support.
If someone does have Covid-19, oxygen saturation can also be monitored if they have a pulse oximeter at home. Those with co-morbidities should stay in touch with their physicians but there is no need to panic.
It is essential that people do not forget that Covid-19 is still here and pandemic-appropriate behaviour should not be done away with. Masking up will also protect against other respiratory infections like flu.
As for dengue, again we have seen dipping platelet counts in some of the patients. It is best to prevent mosquito bites at this time. People should keep an eye out for stagnant water and mosquito breeding spots as the environment is conducive now.
Since all the infections are happening together, and people do self-prescribe antibiotics and pain medicines, what is your advice?
Antipyretics are the safest bet. Just take Paracetamol and relax. There is no need to take any antibiotics because they have no role in any of the diseases. They are all viral illnesses; malaria, too, has a specific drug and there is no role for antibiotics. That is what the doctors will prescribe as well. People have been consuming Vitamin C and other supplements as well. What can a five-day dose of Vitamin C do? There is no need for any of it.
(Why Dr Gogia? He is a well-known internal medicine specialist at one of Delhi’s biggest tertiary care centres, Sir Ganga Ram Hospital. Practising for over 24 years, his area of interest lies in diabetes and infectious diseases)