Kolkata: The complexities around Covid-19 are confounding doctors and governments across the world. But West Bengal is now facing a challenging albeit entirely predictable complication — Covid and dengue ‘co-infections’ amid the onset of the tropical disease’s season.
The state, which is in the midst of a worsening Covid outbreak, has now started to see these co-infections. While any official number of such patients is not available as of now, several hospitals said patients testing positive for Covid are later being diagnosed with dengue infection too, or vice-versa.
According to experts, this creates an extremely critical condition in patients as Covid causes blood to clump while dengue causes bleeding that does not allow blood to clot. This creates an extremely critical condition in a patient.
The Mamata Banerjee government last week issued guidelines and protocols to hospitals for treating such cases.
ThePrint spoke to five Covid-designated government hospitals in Kolkata, four of which admitted to co-infection incidences. They are the Infectious Diseases and Beliaghata General (ID&BG) Hospital, the Nil Ratan Sircar (NRS) Medical College, the SSKM Hospital, and the MR Bangur Hospital.
“We got a recent case of dengue-Covid co-infection. He was a middle-aged doctor. Initially, he was critical, but he was treated and discharged a few days back. The dengue symptoms were not severe. But we must remember that dengue season is just starting,” said Dr Anima Haldar, principal, ID&BG Hospital.
West Bengal was India’s worst affected state in terms of dengue infections last year, government data shows. In 2019, the state recorded 47,390 infections and 27 deaths until the end of the season in November, according to the state government data. This was nearly triple the caseload of the next most affected state, Karnataka, which saw 15,232 cases and 13 deaths.
However, Bengal didn’t report its dengue figures for 2019 and 2018 to the Centre-run National Vector Borne Disease Control Programme, according to sources.
As of Friday, West Bengal has recorded 86,794 Covid cases and 1,902 deaths.
A top government official told ThePrint that the situation is critical but hospitals have been instructed on how to handle Covid, dengue and the co-infection cases.
Symptoms and complications
Dr Subrata Pal, a senior doctor and faculty member (medicine) at NRS Medical College, said it is not unnatural or abnormal to get dengue infection at the same time as Covid.
“Co-infection is a possibility. But the treating doctors need to be very alert and look for symptoms. We are hearing about such cases happening and that is why the health department has suggested the treatment protocol,” said Pal, who is also a member of the state’s new Covid task force.
In its guidelines issued last week, the government said dengue fever and Covid are difficult to distinguish because they share clinical and laboratory features. According to the guidelines, though initial symptoms are similar, the distinctions can be made as the disease progresses.
Explaining the complications, Dr Saswati Sinha of privately-run AMRI Hospital in Kolkata said, “A lot of patients might have initial symptoms like fever, headache, severe body ache, fatigue and so on. They may not have the more prominent Covid symptoms like cough or breathlessness or dengue symptoms including rashes. So this is a little difficult for doctors to diagnose, and the situation is tricky given the opposite nature of these viruses.”
Moreover, the supportive treatment for both these infections is radically different from each other, she said.
“Covid causes blood clots and dengue triggers bleeding. Now, all of us first go for Covid test as our brain is attuned for the last few months. But we need to be very careful and keep looking for any manifestation of bleeding or hemorrhage in a patient,” she said.
“If we miss the dengue diagnosis, and apply blood thinner as we do in case of Covid infections, it may end in a disaster,” added Sinha.
Govt says situation ‘critical’ but action taken
Dr Amitabha Nandi, a senior virologist and epidemiologist, said the state now “needs to be very vigilant on handling dengue infections”.
“Juxtaposition of both these viruses may trigger a crisis as there is no vaccine for none of these infections. These infections affect different organs and in a way, a patient may end up having more affected organs. Covid affects lungs internally, dengue does it externally. It also triggers haemorrhage,” he said.
West Bengal Health Secretary N.S. Nigam called the situation “critical”.
He, however, said hospitals have been equipped to deal with this situation. “We have taken lots of advance action in this regard and in the current year, the number of dengue cases are lower than the previous year,” Nigam said.
The Kolkata Municipal Corporation, meanwhile, said awareness programmes are on to check spread of dengue.
Since the disease is vector-borne, transmitted by agents like mosquitoes, ticks, and fleas, the Kolkata Municipal Corporation has an important role to play.
“We have started all awareness programmes. There are some sporadic cases, but it is still not serious and under control,” said Deputy Mayor Atin Ghosh, who is in charge of health.
Worrying dengue statistics over the years
According to the Friday health bulletin, the positivity rate for Covid infection in West Bengal is at 8.44 per cent, just a few notches below India’s rate of 8.8 per cent.
On the dengue front, while this year’s data is not available yet, that from previous years show worrying trends.
In 2011, Bengal recorded 510 cases of dengue and no deaths. This jumped massively the following year to touch 6,456 cases and 11 deaths. In 2017, this had reached 37,746 cases and 46 deaths. The next year, the cases dipped to 23,301 before touching the peak in 2019.
Overall, the state’s dengue caseload rose a staggering 9,100 per cent between 2011 and 2019.
Virologist Nandi said there are “many things that were not handled scientifically in the state”.
“Dengue is a tropical disease and it is a seasonal infection, we all understand that. But there are ways to control the spread of infection since it is vector borne. It is a failure of the state that could not arrest the rise in dengue infection and called it an unknown fever. It is a man-made medical disaster,” he said.
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