We are going through Covid 19 pandemic for the past 6 months. The winter and monsoon are here. Anyone presenting with fever, myalgia, headache, and general malaise should undergo a nasal swab test for RT PCR antigen to rule out Corona. CT scan of the chest may show ground-glass opacities, infiltrates, and consolidation features which suggest Viral pneumonia which in combination with a positive COVID test confirms it as Covid 19.
Covid 19 patients usually have upper respiratory symptoms like fever, body pain, headache and rhinorrhea, and sore throat. Some of them go on to develop lower respiratory symptoms like persistent dry cough and tachypnea and features of Acute respiratory distress syndrome (ARDS).
However all these can occur due to common cold, Influenza A and B ( Flu), Swine flu, and also allergic respiratory disorders. Therefore, if a patient tests negative for Covid 19, CT chest findings may be due to Influenza also. A throat swab for the viral panel should be sent to rule out Influenza A or B or Swine flu infection.
The difference in the treatment is that Corona infections are treated with Remdesivir, fevirapivir(14 days) anticoagulants, and steroids while Influenza is treated with Oseltamivir or even Fevirapivir for 5 days. Anticoagulants and steroids have no role in the management of Influenza cases.
Secondary bacterial complications ARDS and septic shock are common to both Corona, Influenza, and Swine flue.
So the most important factor is to do Covid 19 test and a throat swab for the viral panel.
On the other hand, if a patient presents with only fever, headache, and body pain without respiratory symptoms (dry fever) it could be due to Dengue fever or Chikungunya fever.
Dengue presents mainly with severe backache ( Breakbone fever) and joint pains. Dengue NS 1 antigen test, IgM and IgG antibodies, and thrombocytopenia may confirm Dengue fever. Treatment is mainly symptomatic with fluids and Paracetamol.
Respiratory symptoms develop only in the late stages of dengue due to capillary leak syndrome causing pulmonary congestion, hydrothorax, or ARDS.
If the patient has a dengue-like fever with joint pains or arthritis involving the hand and ankle joints, It can be Chikungunya fever. In this condition, fever may be there for only a few days but viral arthritis may persist for weeks or months crippling the antibody titres for chikungunya may be positive. We may suspect Chikungunya by the way patients walk with severe arthritis of the knee and ankle.
Acute respiratory symptoms can also occur due to allergy to walking in the cold or drugs or occupational allergy-like cotton dust( common in Tirupur). Some patients may have even chronic bronchitis, emphysema or even bronchiectasis. Finally, to be remembered is that Acute coronary syndromes with left ventricular failure, Heart failure, Acute exacerbations of COPD, Pulmonary embolism, Sepsis with Metabolic acidosis, and Diabetic ketoacidosis can also present with breathlessness.
