Experience of a Tertiary Hospital in Singapore with Management of a Dual Outbreak of COVID-19 and Dengue

Am J Trop Med Hyg. 2020 Nov;103(5):2005-2011. doi: 10.4269/ajtmh.20-0703.

Abstract

During the COVID-19 pandemic, distinguishing dengue from cases of COVID-19 in endemic areas can be difficult. In a tertiary hospital contending with COVID-19 during a dengue epidemic, a triage strategy of routine COVID-19 testing for febrile patients with viral prodromes was used. All febrile patients with viral prodromes and no epidemiologic risk for COVID-19 were first admitted to a designated ward for COVID-19 testing, where enhanced personal protective equipment was used by healthcare workers until COVID-19 was ruled out. From January to May 2020, 11,086 admissions were screened for COVID-19; 868 cases of COVID-19 were diagnosed in our institution, along with 380 cases of dengue. Only 8.5% (943/11,086) of suspected COVID-19 cases were concurrently tested for dengue serology due to a compatible overlapping clinical syndrome, and dengue was established as an alternative diagnosis in 2% (207/10,218) of suspected COVID-19 cases that tested negative. There were eight COVID-19 cases with likely false-positive dengue serology and one probable COVID-19/dengue coinfection. From April to May 2020, 251 admissions presenting as viral prodromes with no respiratory symptoms were screened; of those, 15 cases had COVID-19, and 2/15 had false-positive dengue IgM. Epidemiology investigations showed no healthcare-associated transmission. In a dengue epidemic season coinciding with a COVID-19 pandemic, dengue was established as an alternative diagnosis in a minority of COVID-19 suspects, likely due to early availability of basic diagnostics. Routine screening of patients with viral prodromes during a dual outbreak of COVID-19 and dengue enabled containment of COVID-19 cases masquerading as dengue with false-positive IgM.

MeSH terms

  • Adult
  • Aged
  • COVID-19 / complications
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / therapy
  • COVID-19 Nucleic Acid Testing
  • Dengue / complications
  • Dengue / diagnosis
  • Dengue / drug therapy
  • Dengue / epidemiology*
  • Dengue Virus / immunology
  • Dengue Virus / isolation & purification
  • Diagnosis, Differential
  • Disease Outbreaks*
  • Female
  • Humans
  • Immunoglobulin M / blood
  • Male
  • Middle Aged
  • Oropharynx / virology
  • RNA, Viral / isolation & purification
  • SARS-CoV-2 / genetics
  • SARS-CoV-2 / isolation & purification*
  • Singapore / epidemiology
  • Tertiary Care Centers
  • Triage / standards

Substances

  • Immunoglobulin M
  • RNA, Viral