Comparing the Greater of Two Evils

No, this article will not be discussing the US presidential election. Instead, we return to the two names that have been plaguing our headlines the past month - COVID-19 and Dengue.

[Image Source: (left) Shutterstock, (right) Martin Sanchez on Unsplash]

By Jill Chang

No, this article will not be discussing the US presidential election. Instead, we return to the two names that have been plaguing our headlines the past month – COVID-19 and Dengue. The spike in dengue cases comes as just another batch of bad news this 2020 following Singapore’s steady decline in COVID community cases. And, while a common occurrence in our tropical climate, the staggering 22, 403 dengue cases as of the 5th August (the highest ever recorded in a single year since 2013) was an alarming wake-up call amidst the pandemic. 

However, when pitched against a global pandemic, dengue fever does seem as painful as a mosquito bite. Thus, in a battle of viruses, which should be the main priority of concern to Singaporeans? 

In collaboration with We Tell Stories (WTS), we investigate this question through three fronts – collateral damage, the severity of its transmission and our immunity responses to the virus. 

Comparing Cases

Singapore: Dengue VS COVID-19 Cases

As of 2020, Singapore has 30,814 dengue cases with 20 deaths (as of 9th October) which is the highest number of cases Singapore has faced since 2013 and 2014. While for COVID-19, this number is set at 57,859 cases with 27 deaths (as of 9th October). 

At a glance, statistically, COVID-19 would be a priority to Singapore in terms of the number of casualties. However, with the number of dengue cases being one of the highest in Singapore’s history and with the number of deaths within the year being pretty close to each other – dengue as a virus should still be a concern lurking in the back of our minds. 

Tracking Transmission 

COVID-19, as we are all aware, spreads through direct, indirect, or close contact with infected individuals via the mouth or nose. While there has been speculation that the virus is airborne, more research needs to be done to confirm this as true. And, according to the World Health Organisation, it usually takes around 5 to 6 days for symptoms to show. In some instances, this even can be up to 14 days.

Infographic by Sanford Health

As for dengue, this disease is transmitted to humans via the bite of an infected Aedes Mosquito. Fortunately, dengue fever is not contagious and cannot be spread from human contact. However, symptoms can only be seen from 3 to 14 days later, and of which 75% are asymptomatic – meaning that a majority of cases usually don’t produce any symptoms at all.

Infographic by Raffles Medical Centre

Analyzing Immunity

Just like the common cold, upon catching COVID-19, it is possible for one’s body to gain immunity against catching the virus a second time. However, this immunity only lasts for a limited amount of time. In this case, research by Lauren Rodda, a researcher at the University of Washington, has shown that one can have immunity to common-cold coronaviruses for a matter of months (More specifically three months, where her antibodies were maintained in isolation against the virus for this duration). Furthermore, a study done by Lia van der Hoek at the University of Amsterdam revealed that symptoms were reduced during the second infection, meaning that it’s likely to be a less painful process the second time around. 

As for dengue, it seems that there is still no real vaccine or treatment for it yet. Even in cases where one recovers from the virus, they can only gain life-long immunity against one particular serotype of dengue. Unfortunately, in most instances, research has shown that catching dengue the first time makes the second round of infection by dengue much more severe, especially amongst children, the elderly, and adults with existing illnesses. 

According to the National Centre of Infectious disease, Singapore seems especially in danger of dengue this year due to our low herd immunity to a less common type of dengue virus (known as DENV – 3). Herd immunity is the result of a majority of the population, usually 60% to 80%, being immune to an infectious disease. This ultimately helps to provide indirect protection to those not immune to the disease. To gain immunity, one would need to have caught the disease and, in an ironic twist of fate, NEA’s efficient fogging and mozzie checks may be what is preventing people from getting infected by this particular serotype of dengue and building this herd immunity.

Infographic by Bloomberg

Thus, a few mosquitos carrying this particular type of dengue could have caused a dengue outbreak in a short amount of time – explaining our sudden spike of cases this year. 

But what about COVID-19? If it is possible to build immunity against COVID-19, should Singapore be trying to accomplish this?

Unfortunately, while possible for larger countries, Singapore’s small labour force and ageing population are too much of a risk for us to simply let the virus take its natural course. Furthermore, Singapore has been having dengue epidemics since 2004, compared to a global pandemic with too many unknown variables – prevention is still a better option.

A Final Showdown

Out of the three factors we’ve taken into consideration, both diseases seem equally tied. However, reflecting on Singapore’s actions the past year, it would seem that Singapore’s priorities have been more focused on the pandemic. We’ve witnessed panic buying within the first week Singapore announced moving into DORSCON level orange, and the frequent distribution of free masks and sanitisers like it was the end of the world. Our focus has been dedicated solely to the new virus, so much so that we’ve neglected a problem with equal severity that has plagued Singapore for a much longer time.

New viruses come and go, and more often than not, they linger. The real threat lies in individual complacency which is what has caused us to be at the mercy of dengue in the first place. Even now, with the blatant violation of social distancing measures, we soon could see ourselves in the same precarious situation as we did in phase one. 

So, what can we do to better protect ourselves from dengue? 

WTS’s conversation with Dr Christina Liew, an expert on dengue, emphasizes the importance of community involvement and not being reliant on NEA for dengue checks and constantly clearing out mosquito breeding grounds within one’s home. This would involve clearing stagnant water in parts of your home and spraying insecticide in dark corners of your home. 

Go the extra mile and carry a small bottle of repellent to apply both outdoors and indoors and make sure to remind your friends and family as well. In the same video, WTS also speaks to a recent university graduate who documents her gut-wrenching experience of dealing with the horror of being caught between the two viruses.

Both viruses are a cause of worry, with equal amounts of impact in terms of severity. And while it may seem that there is more danger of one over the other, in reality, the most dangerous threat to Singapore right now could be our complacency in dealing with either virus. 

Check out WTS’ video here: