In dengue endemic regions, it can be difficult to distinguish early COVID-19 infection from dengue fever.

Wee et al. report a triage strategy used at a tertiary hospital during a dual COVID-19 and dengue outbreak.

All patients with fever and viral prodromes and no epidemiologic COVID-19 risk were admitted to a designated ward and tested for COVID-19. All healthworkers wore enhanced protective equipment until a COVID-19 diagnosis was excluded.

In total, 868 cases of COVID-19 and 380 cases of dengue were diagnosed among 11,086 admissions from January to May 2020.

Concurrent testing for COVID-19 and dengue serology was undertaken in 8.5% (943 of 11,086) of admissions due to presentation with an overlapping clinical syndrome. An alternative diagnosis of dengue was established in 2% of suspected COVID-19 cases that had subsequently tested negative.

False-positive dengue serology was likely in eight COVID-19 cases, and there was one case of probable coinfection.

Of 251 patients with viral prodromes without respiratory symptoms screened between April and May 2020, 15 had COVID-19 and 2/15 had false-positive dengue serology. There was no healthcare-associated COVID-19 transmission.

In conclusion, a triage strategy mitigated the risk of healthcare-associated COVID-19 transmission and contained COVID-cases with false-positive dengue serology during the dual outbreak. Early chest imaging and diagnostic testing likely reduced cases of dengue as a differential diagnosis.

https://www.ajtmh.org/view/journals/tpmd/103/5/article-p2005.xml

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