KOCHI: With Kerala facing the threat of monsoon fevers even as it battles Covid-19, uppermost thoughts in the minds of doctors is how to distinguish between the different fevers which may have similar symptoms. The regular suspects are dengue, leptospirosis and malaria. Other fevers include typhoid, Hepatitis A and uncommon fevers. Symptoms like fever, sore throat and cough are common to both Covid-19 and dengue fever. So, what should be the protocol to admit fever cases in private hospitals?
For starters, every hospital must have two zones. One for suspected Covid cases. These patients must be examined only in PPE kit till swab tests are negative. People with high-grade fever, blue toes, hacking cough and chest pain, must be treated here. The second zone is for other fever cases. One sure way to distinguish between dengue and covid is to check for the platelet count -- dengue patients will have a low platelet count whereas in covid, the platelet count may be normal. As for leptospirosis, symptoms include red eyes and deranged renal function or even acute renal failure.
For malaria, the clue would be high-grade fever coupled with chills at night. Typhoid will have more of gastro-intestinal symptoms like fever with vomiting and loose stools. In case swab test is not possible, rapid antibody tests can be done to check for possibility of Covid-19. If positive, such cases can be sent to designated labs for RT-PCR test. Checking the travel history and clinical signs is the key to distinguish between fevers. But, all fever admissions must be discussed with the Covid-19 core team of the hospital. If a patient tests positive for Covid-19, the staff members (doctors and nurses) who came in contact with the patient must be sent into 14-day home isolation and tested after seven days.
Kerala is witnessing a second surge of Covid-19 infections as a large number of Malayalis are returning from abroad and other states. Doctors and nurses in private and government sectors need to be extremely vigilant as they run the risk of contraction. They must be subjected to the mass surveillance programme as per ICMR guidelines using antibody kits or PCR. This will prevent transmission from healthcare workers to general population.Dr Joseph K Joseph is a consultant of internal medicine and diabetology at VPS Lakeshore Hospital, Kochi