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Strong triage system helps manage dual outbreak of COVID-19, dengue

Tristan Manalac
09 Oct 2020

When dealing with a dual outbreak of dengue and the novel coronavirus disease (COVID-19), a strong triage system, including designated testing wards and diagnostic tests, can help minimize the risk of healthcare-associated transmission, according to a new Singapore study.

From January to May 2020, the Singapore General Hospital screened 11,086 admissions for COVID-19. Of these, only 8.5 percent also underwent dengue serology testing, as ordered by the physician, due to matching clinical profiles. Only 868 patients (7.8 percent) eventually tested positive for COVID-19. [Am Trop Med Hyg 2020;doi:10.4269/ajtmh.20-0703]

Dengue was the main differential diagnosis in only 2.0 percent of patients initially admitted due to suspected COVID-19. Of the 868 confirmed COVID-19 cases, 8.1 percent (n=70) were also tested for dengue serology, and nine patients were positive for COVID-19 and potentially infected with dengue. Removing all false positives, only one patient was co-infected with COVID-19 and dengue.

“[I]t appears that in practice, the potential overlap in clinical syndromes is not large, even in a dengue-endemic area. Although our institution had to contend with the emergence of a COVID-19 pandemic during a dengue epidemic season, primary physicians were only compelled to rule out dengue in less than one-tenth of patients with confirmed COVID-19 infection,” the researchers said.

“However, our institution’s experience also demonstrates that when grappling with a COVID-19 pandemic during a dengue epidemic season, a triage strategy is necessary to detect cases of COVID-19 that may potentially be misdiagnosed as dengue,” they added.

Starting in February 2020, to improve the containment of COVID-19 amid a dengue outbreak, the Singapore General Hospital moved to admit all patients with undifferentiated symptoms of early viral infections to their respiratory surveillance ward (RSW) even if there had been no documented epidemiologic risk for COVID-19.

The RSW saw 1,751 patients from April to May 2020, of whom only 15 were eventually diagnosed with COVID-19. Two of those patients had false-positive dengue immunoglobulin M test results.

“Our institution’s policy of screening patients presenting with viral prodromes and nursing such patients in a designated RSW with decreased bed density and full personal protective equipment enabled the containment of these two patients in our institution’s RSW and mitigated potential exposure,” the researchers said, pointing out that none of 21 healthcare workers who came into close contact with these two patients showed evidence of onward transmission.

While a strict and efficient triage algorithm to differentiate dengue and COVID-19 is indispensable in areas with overlapping epidemics, the researchers acknowledged that this strategy may be difficult to replicate universally. It requires high levels of investment and support to be able to deliver COVID-19 test results quickly to ensure that the surveillance wards do not clog up.

“In resource-poor settings with limited access to supportive diagnostic tools, differentiating between these infections based on clinical signs and symptoms alone would certainly be more challenging,” they said.

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Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 5 days ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
5 days ago
Use of thyroid hormone therapy does not seem to protect older adults with subclinical hypothyroidism against mortality, but it appears to confer survival benefits to those aged <65 years, results of a study have shown.