COVID-19, dengue double infection treatment tricky, needs balanced approach: Doctors

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 on Thursday.

Delhi Deputy Chief Minister Manish Sisodia who was shifted to LNJP Hospital on Wednesday for COVID-19 treatment, has now tested positive for dengue, perhaps the first prominent personality in the city to have been diagnosed with both infections.

Medical Director of Rajiv Gandhi Super Speciality Hospital (RGSSH) Dr 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 this 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 told PTI.

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 or it is like "walking a tight rope" and a very "finely balanced approach" is needed, he said.

Sources at LNJP Hospital 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 Delhi government and a dedicated COVID-19 facility.

"The patient's age, condition, co-morbidities 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 agypti 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 the year. Our campaign '10 Hafte 10 Baje 10 Minute' was very effective last year, and this year too dengue situation in Delhi is in control," he had said.