Covid-19 vs Dengue – Similarities & Differences

Covid-19 vs Dengue – Similarities & Differences

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Why many people easily confuse Dengue symptoms with Covid-19 symptoms

Dengue is one of the most dangerous ‘classic’ diseases.

Dengue caused by infection from one of the four types of Flavivirus RNA (DENV-1, DENV-2, DENV-3 and DENV-4) has spread to at least 150 countries.

About 40 percent of the world’s population is at risk of getting infected with 400 million cases reported each year.

Historically, the first case of dengue was reported in 1789 by Benjamin Rush after the outbreak became a universal disease in Asia, Africa including North America. In Malaysia, the first case occurred in 1902.

Below is an English translated version of an article originally published in Sinar Harian online in Bahasa Malaysia on 04-10-2020.

Original title and all images from: Bila demam, ramai keliru terkena virus Covid-19 atau denggi, pakar dari dalam dan luar negara beri penjelasan…

Imagine, after 231 years, until now no vaccine could be produced to treat the female aedes mosquito-borne disease.

Although small, aedes mosquitoes which are the cause of dengue fever can claim human life in the blink of an eye if no follow-up treatment is taken.

When the Covid-19 pandemic invaded China before spreading to 215 countries with more than 34 million people infected and 1,027,489 million dead (as of yesterday), the public’s focal point was more towards the virus regardless of dengue infection.

The fact is, unknowingly, despite the explosion of the number of patients suffering from the SARS-Cov-2 virus, the graph of dengue victims is rising in most endemic countries such as in South America including Asian countries such as Singapore, Indonesia, Bangladesh and even Malaysia itself .

According to the journal SN Comprehensive Clinical Medicine , in tropical countries, Covid-19 can easily be misdiagnosed with other infectious diseases such as dengue because its main symptom is fever.

Director-General of Health, Datuk Dr Noor Hisham Abdullah who was worried about the situation said, Malaysia has recorded a total of 50,511 cases of dengue outbreak with 88 deaths (January to 13 June). Covid-19 was 12,088 (as of yesterday).

In some Asian countries, from January to August last year, Singapore reported 21,834 cases of dengue while in Indonesia, 68,753 cases.

According to the Director of the World Mosquito Program, Prof Scott O’Neill , the Movement Control Order has caused people around the world not to clean the home area because it is too paranoid to get out.

A longer-than-normal rainy season in the Southeast Asian region is also said to be able to drive more cases, O’Neill said.

Looking at the scenario, epidemiologists and researchers around the world expressed concern over the link between the dengue epidemic and Covid-19.

Many experts are concerned about the increasing trend of Covid-19 infection cases in line with the dengue case graph. The situation is not only happening in Malaysia, but also abroad such as India, Singapore and Indonesia.

Cases that erupted in Singapore and Thailand recently are among the most debated cases.

Citing a report from The Straits Times Singapore , the two republics, one of whom is 57 years old, was allegedly suffering from Covid-19 and dengue simultaneously. The patient was not misdiagnosed. Symptoms and laboratory results are consistent with dengue. However, when the victim suffered from respiratory symptoms, he was asked to perform an examination and was later confirmed to be infected with Covid-19.
The same tragedy also happened in Thailand last March. The first death from the Covid-19 epidemic involved a 35-year-old man who also had dengue fever.

Similarities & Differences between Dengue & Covid-19

Further refining , Sunway Medical Center Velocity Consultant and Lung Physician, Dr Nurul Yaqeen Mohd Esa said, there is confusion between the dengue virus and Covid-19 at a time when the global health crisis is still acute.

To SinarPlus , she first explained the similarities (see Figure 1 ) and differences (see Figure 2 ) between the two viruses.

Figure 1 – similarities between Covid-19 & Dengue
Figure 2 – Differences between Covid-19 & Dengue

Continuing her explanation, Dr Nurul Yaqeen said, if an individual has a fever that exceeds the temperature of 37.5 degrees Celsius, the hospital will conduct a significant questionnaire.

Among them are asking about the history of illness, social, travel and family.

If the patient is just sitting at home, has no history of traveling anywhere, does not meet anyone who has just returned from a foreign country / state at risk, we turn to another question. If the patient’s residential area is known as the dengue zone or there are family members / neighbors who have just contracted dengue, then, the dengue test will be conducted first. 

If there are no problems such as coughing or shortness of breath, the diagnosis is more likely to lead to dengue. If otherwise, the Covid-19 test will be implemented. If, patients not only have a fever, but also cough and face respiratory problems, perhaps, they have got the corona virus, ” she explained.

Any test to be performed whether Covid-19 or dengue, experts will first ask about travel history, family, area of ​​residence and some significant things. Symptoms of fever, experts say, are not necessarily caused by a person being infected with a corona virus or dengue.

However, lung infections due to other germs are also more likely because any bacterial infection (in the lungs) caused by any type of virus or bacteria can cause symptoms of fever, cough and difficulty breathing.

“It is not only the corona virus that can give symptoms like this,” she explained.

Answering another question whether those who have ever had dengue will be more vulnerable or more susceptible to the Covid-19 virus? The expert said, to date, the statement has not been scientifically and firmly proven.

“It is too early to draw conclusions on the matter,” she said.

Dr Nurul Yaqeen also commented on the case that took place in Singapore which saw two patients get dengue and Covid-19 at the same time as stated at the beginning of this article…

“In my opinion, it is possible for patients to be infected with the two types of viruses simultaneously, however, most of them are isolated and rare cases,” she said.

Strengthening her argument, the expert stressed, it is impossible for the dengue virus to turn into a Covid-19 virus because they both come from different viral families and genetic structures. However, in the event of an unexpected mutation, various other possibilities can occur, he said.

Nevertheless, recent research by the University of Hyderabad in India found that the dengue virus and Covid-19 have a protein structure and are based on RNA.

The lead researchers of the study, Naresh Sepuri and M Venkatramana said, proteins encoded as SARS-CoV-2 virus also have a target sequence of mitochondria (cellular respiration) and have the potential to interfere with its main function (protein).

“Thus, the identification of the first mitochondrial matrix protein targeted from human viruses in dengue infection could enhance the ability to deal with viruses in humans including Covid-19,” the two researchers said in a journal.

They added that over the past 20 to 30 years, the viruses that caused Ebola, HIV / AIDS, Zika and H1N1 were derived from RNA.

“We checked to see if any of the corona virus proteins could enter the mitochondria and found that three of them could. This (can) cause shortness of breath or hypoxia which is suddenly reported in the case of COVID-19, “said the researcher who is still continuing further research on it.

Covid-19-resistant dengue patients?

SinarPlus then drew Dr Nurul Yaqeen’s attention to a study by Prof Miguel Nicolelis from Duke University, Brazil who found a link between the spread of Covid-19 virus and dengue fever.

Nicolelis’ hypothesis states that individuals who have had dengue will be immune from Covid-19 attacks. Among other things, he found that the statistics of Covid-19 patients are low at high dengue cases in Brazil. Brazil, the third highest country in the world in terms of number of infections with 4.81 million cases.

Prof Miguel Nicolelis from Duke University, Brazil claims that individuals who have had dengue will be immune from Covid-19 attacks. Brazil is struggling with the growing problem of Covid-19 infection.

Nicolelis said the findings increase the likelihood of immunological cross-reactivity between the dengue Flavivirus serotype and Sars-CoV-2.

Discussing the study, Dr Nurul Yaqeen said, it is too early to say it is a fact that can be applied (temporarily).

The study has not been formally published and Covid-19 is a new disease and the SARS-Cov2 virus is also a new virus. There is still much that is not known about it. So there are many possibilities that may occur. However, there is a probability that the results of Prof Miguel’s study are correct, there is also (probability) it is not accurate. For me, it is too early for us to confirm its authenticity, ” she said.

She also said that if one day, the dengue vaccine is discovered by scientists, the vaccine should not be used to treat coronary heart disease patients.

If the dengue vaccine is discovered by scientists one day, the vaccine is said not to be used to treat coronary heart disease patients. However, everything is possible due to the rapid development of technology today.

The scientific reason is that the two viruses come from different genes and genetic structures. However, with the advancement of science and technology, various possibilities can occur.

Meanwhile, IMU Healthcare Family Physician, Associate Prof Dr Verna Lee Kar Mun said, the average Malaysian may have been infected with dengue at least once in a lifetime.

“Like Covid-19, a person may have been infected without his knowledge because 80 percent of dengue infections show only very few signs or no (direct signs),” she said.

Currently, there is no vaccine that provides effective protection against the dengue virus. Therefore, Dr. Verna advises individuals who have fever and body aches to see a doctor.

“Currently, many people may be a little hesitant to go to the hospital or clinic for fear of being infected with Covid-19. However, regardless of whether it is dengue or Covid-19, if the disease has been severe, it can be fatal, ” she said.

He said the use of teleconferencing (patients and doctors communicate online) can help high-risk groups from Covid-19 infection.

However, said Dr Verna, individuals with fever reaching 38.5 to 39 degrees Celsius, doctors will not be able to confirm whether they have dengue or Covid-19 through that method.

“Go immediately to a private or government clinic on the first day you have a fever. Typically, those with dengue symptoms (without respiratory symptoms) are offered diagnostic tests for dengue (NS1 antigen).

Currently, patients with fever and respiratory symptoms such as cough, shortness of breath, sore throat and loss of sensation will be referred to a government clinic that offers the COVID-19 test. If the Covid-19 test is negative, the patient may be tested for dengue fever, ” she said, adding that the test results can be obtained in less than an hour.

According to Dr. Verna, patients who have had dengue fever should be more careful if these symptoms persist.

To patients who have a fever and continue to keep the perspective that themselves or those around them get Covid-19 in case of fever, throw the stigma away.

The Covid-19 case, which has risen to three figures this week, signals to us that the virus is still rampant and has never known its borders.

According to Dr Nurul Yaqeen, the symptoms of fever can be caused by many diseases, not just dengue and Covid-19. Infections of the lungs, brain, intestines, urinary tract may also cause fever.

Cancer, autoimmune diseases, tuberculosis can also contribute. So, see a doctor to check and do the relevant tests to determine what is the cause of your fever symptoms, then get the right treatment. Do not make your own decision about the diagnosis of fever symptoms because this can cause panic problems also cause us not to get treatment that coincides with our actual disease.” she suggested.

Remember, whether it is Covid-19 or dengue, it already teaches us that there is no limit to any virus attack.

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Dr. Nurul Yaqeen

Consultant Respiratory, Internal Medicine Physician, Sleep Disorders Specialist


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