PETALING JAYA, July 16 — Getting a fever these days can be a massive cause for concern as the world continues to battle the Covid-19 pandemic.

But how does one differentiate Covid-19 from dengue, another dangerous disease with similar hallmark symptoms like fever, fatigue, and muscle and joint pain?

International Medical University (IMU) healthcare family medicine specialist and associate professor Dr Verna Lee Kar Mun has offered some helpful tips to distinguish the two illnesses from another so Malaysians can be better informed about their health.

Dr Lee said it’s important to understand that Covid-19 is a disease of the respiratory system while dengue is a vector-borne, systemic febrile disease that may or may not have respiratory symptoms.

The method of transmission also differs as Covid-19 infects people with respiratory droplets via coughs, sneezes, and contact with contaminated surfaces while dengue is transmitted through being bitten by an infected female Aedes mosquito.

“Covid-19 is caused by the latest addition or seventh member of the coronavirus family that infects humans, which we now know as SARS-CoV-2. 

“Dengue, on the other hand, is an acute febrile illness, caused by infection with one of the four related single-stranded RNA Flavivirus, namely DENV-1, DENV-2, DENV-3, or DENV- 4,” said Dr Lee in a press release.

She explained how overlapping symptoms can often cause confusion when drawing the line between Covid-19 and dengue.

Covid-19 typically results in a mild to moderate fever of 37.5 to 39 degrees Celsius that can continue for several days.

Meanwhile, dengue fever can go up to 40 to 41 degrees Celsius from day one to day five or six followed by a break and relapse by day seven or eight, a symptom that is known as a biphasic fever pattern.

Fatigue is a common symptom for both Covid-19 and dengue, but only 15 per cent of Covid-19 patients have reported experiencing joint and muscle pain. 

Joint and muscle pain are very common amongst those suffering from dengue, hence its alternative name “breakbone fever.”

Dr Lee said she’s been seeing more dengue patients come into her clinic at the disease’s early stages thanks to health-related news dominating the headlines. — Picture courtesy of IMU
Dr Lee said she’s been seeing more dengue patients come into her clinic at the disease’s early stages thanks to health-related news dominating the headlines. — Picture courtesy of IMU

“What differentiates the two diseases is that in cases of dengue, in addition to fever, tiredness and bone pain, headache with pain around or behind the eyeballs is very common and the patient may have rashes on the lower limbs and chest (small islands of white in a sea of red), nausea, vomiting and some abdominal pain.

“Respiratory-related symptoms like dry cough, nasal congestion, difficulty in breathing, conjunctivitis and a loss of taste and smell, on the other hand, are more synonymous with Covid-19,” said Dr Lee.

One upside of the prevalence of health-related information on social media means more patients with dengue have been coming in at the disease’s early stages to get diagnosed.

“With the current recovery movement control order and rapid spread of health-related news and updates on social media, Malaysians are well-informed enough to be extremely worried when they have a fever.

“Regardless of whether it is dengue or Covid-19, a severe form of disease and complications from late presentation can be fatal.”

The Health Ministry recorded a worrying 130,101 cases of dengue in Malaysia in 2019, a 61.4 per cent increase from the 80,615 cases in 2018.

The country’s total cumulative dengue cases from December 29, 2019 to June 30, 2020 is already at 55,115 and 92 people have died from January to June this year because of severe dengue.

Dr Lee said that Aedes mosquitos thrive in Malaysia’s hot and humid weather, making it a pressing public health issue especially with regards to the disease’s rising fatality rate.

Dr Lee also told Malaysians to look out for symptoms of severe dengue as severe complications are common in those who experience a second bout of the illness. — Pictures via AFP and IMU
Dr Lee also told Malaysians to look out for symptoms of severe dengue as severe complications are common in those who experience a second bout of the illness. — Pictures via AFP and IMU

She advised those with a fever to visit their nearest private clinic or Klinik Kesihatan from day one of fever onset to get tested for Covid-19 and dengue.

“Patients with fever and respiratory symptoms such as cough, difficulty in breathing, sore throat, loss of smell, and so on would most likely be referred to labs or government clinics that offer Covid-19 tests. 

“If the Covid-19 test is negative, then a dengue test may be performed. When you arrive at the clinic, inform the triage staff at the entrance about your fever and the duration of it. 

“You will then be ushered to an isolation room and the doctor will most likely come in donning full personal protective equipment gear to take a thorough history. 

“Be truthful. The doctor will need sufficient information to differentiate dengue and Covid-19 infection.”

Dr Lee also told Malaysians to be aware of the warning signs of severe dengue, including persistent nausea and vomiting, upper abdominal pain (indicative of involvement of the liver), diarrhoea and spontaneous bleeding from the nose and gums on brushing or on the skin which may appear as minute red spots, usually from day five or six of fever onset.