With the aim of providing clear guidelines on prevention and treatment of co-infections of coronavirus with other diseases, the Ministry of Health and Family Welfare said, “As per the World Health Organisation (WHO) case definition, a Covid case may present with acute onset of fever and cough, or, acute onset of any three or more of the following signs or symptoms: fever, cough, general weakness or fatigue, headache, myalgia, sore throat, coryza, dyspnoea, anorexia, nausea, vomiting, diarrhoea, altered mental status.”
“This case definition, although sensitive, is not very specific. Seasonal epidemic prone diseases, as cited in the foregoing paragraphs may all present as febrile illness, with symptoms that mimic Covid-19. If there is a co-infection, then apart from the febrile illness there may be constellation of signs and symptoms that may lead to difficulty in diagnosis. A comparative analysis of disease onset, symptoms, signs, warning signs, complications and diagnosis is given at Annexure,” the ministry added.
The seasonal pattern of epidemic prone diseases observed each year includes diseases like Dengue, Malaria, Seasonal Influenza, Leptospirosis, Chikungunya and Enteric fever. They can co-exist with the current Covid-19 pandemic and can also pose clinical and laboratory diagnostic issues.
The Health Ministry has listed approaches to diagnose suspected co-infection which include, a high index of suspicion for epidemic prone diseases existing in specific regions during monsoon and post-monsoon seasons. Bacterial co-infections must also be suspected in moderate or severe cases of Covid-19 not responding to treatment.
“It should also be considered that malaria and dengue can coexist with other infections, and thus a diagnosis of either of these does not rule out the possibility of the patient not suffering from Covid-19. Similarly, a high index of suspicion of malaria and dengue must be there when a fever case is diagnosed as Covid-19, particularly during the rainy and post rainy season in areas endemic for these diseases,” the Ministry added.