Before I contracted dengue fever, I had treated mosquito bites as part and parcel of Singapore life – perfectly normal and nothing to fret over. I consider myself quite lucky to have lived in a dengue hotspot in the east for seven years now, battled countless mozzie bites and never got dengue, until recently. After a two-week fight with dengue fever, which wrecked my healthy 32-year-old body (including my period), I’m now a lot more cautious.

I don’t want to risk getting even one bite, because any bite might be an infectious one.

A quick background about dengue: It is a mosquito-borne viral infection that has been a regular in Asian and Latin American countries. In Singapore, dengue typically peaks from June to October every year, partly due to dry-wet weather changes from the Southwest Monsoon. Every year, thousands of people here fall ill from dengue, and roughly 0.1 per cent of them die. This year has been a record year for dengue, partly due to Covid-19. The collective focus on the coronavirus has led us to conveniently overlook the prevalence and dangers of dengue, which has worsened with more people staying at home.

One major contributor to the spike in dengue cases: The circuit breaker and stay-home measures for Covid-19 led to less frequent checks on mosquito breeding sites, while the number of residential breeding sites increased, consequently raising the likelihood of getting bitten by female Aedes mosquitoes, the carriers of dengue virus.

Since the start of 2020, there has been more than 20,000 recorded dengue cases in Singapore. In the month of July alone, there were about 7,600 new dengue patients. And I was one of them.

For a viral outbreak that happens over five months every year, we sure aren’t talking about it enough. Before I had the infection, all I knew about dengue was that it gives you a high fever and affects something in your blood. Well, it’s called dengue fever, right? What I didn’t realise was just how debilitating and potentially life-threatening dengue is. It’s definitely more severe than just a fever.

These are the common dengue symptoms, according to the Ministry of Health.

  • Fever for two to seven days
  • Severe headache with pain behind the eyes
  • Joint and muscle pain
  • Skin rashes
  • Nausea and vomiting
  • Mild bleeding (eg. nose or gum bleed)

Dengue can’t be diagnosed without a blood test

At the early stage, I experienced just three of the six symptoms above: fever, body aches, and nausea and vomiting. While crouching over the bin throwing up last night’s dinner and later on, some bile, I was pretty convinced I had a case of food poisoning, not dengue. Honestly, those symptoms are far from unique. You could have fever, body aches and nausea with a stomach flu, or Covid-19 right? On day five of my symptoms, I decided to get tested for dengue upon my GP’s recommendation.

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Fact: You can have dengue and Covid-19 at the same time

Theoretically that’s possible, though there hasn’t been a reported case of that yet. When I was suffering those symptoms, what went through my mind was: “Do I have dengue? Or Covid-19? Or something else..?” I then learnt that it’s possible to contract both dengue and Covid-19 simultaneously since they are totally different viruses.

When I saw my doctor for the dengue test, I was nursing a mild cough and dry throat. He checked my throat, said it looked a bit inflamed, and recommended me to get tested for Covid-19 as well. Yup, that horrifying-looking swab test where an extra long stick gets shoved deep into your nostrils, one at a time. Since Covid-19 symptoms can be mild and easily go undetected, I went for the swab test.

Within 24 hours, my dengue test result came back positive. I was relieved, because that meant my chance of being Covid-positive was lower – at least that’s what I thought. Still, I was on the edge for the next 24 hours before receiving my Covid-19 test result, which was thankfully, negative.

Both illnesses are infectious, but honestly I’d rather be down with dengue simply because the people around me are less likely to catch it, compared to Covid-19. For dengue, the virus is transmitted through the bite of an infected mosquito, while Covid-19 is passed through respiratory droplets, which obviously spreads much more easily and would require self-isolation. The day before my symptoms, I shared food with my daughter, so I prayed really hard that I didn’t have the flu or Covid-19.

Essentially, it’s easier to prevent the transmission of dengue than Covid-19. To stop dengue from going around in the household, everyone (including the dengue patient) would just need to avoid getting bitten by mozzies – and a sure way to do so is to use repellent and cover up as much skin as possible.

The fever keeps coming back

Perhaps, the most telling sign that it wasn’t a case of food poisoning or stomach flu, was that my fever returned every four to six hours for the first three days, and didn’t really go away until a week later. My temperature was consistently in the range of 37.1 to 38.9 deg C. Even when it dropped below 37 deg C, I continued to feel chilly, weak and achy.

Throughout that week of fever, I had heart palpitations – my daytime resting heart rate went up from 65 to between 80 and 84, making me feel jittery all the time, even when I was lying in bed. Needless to say, caffeinated food and drinks were out of my diet.

Dengue sucked my appetite and energy

On a well-rested day, I pride myself on being fairly energetic. I don’t usually experience energy spikes and dips – my energy level is closer to a level, horizontal line if you were to plot a graph. But with the dengue virus in my body, all I wanted to do was curl up in bed and wake up when it was over. Moving every limb took a gargantuan effort.

During the week of on-off fever, I was basically knocked out for most of the day in a fixed position on the bed. With the ongoing nausea, my diet was reduced to water, an isotonic drink and some nibbles of rice, fish and veggies for energy. I had zero inclination to eat. Without taking anti-vomiting and gas-relieving meds, my stomach was churning and bloated.

Physically, I lost basic strength and stamina. Daily chores such as brushing my teeth and showering were difficult as I couldn’t stand for more than a minute without feeling tired.

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Dengue messed up my period too

If all of the above sounds bad, wait till you read this. On day three of my symptoms, I started having menstrual bleeding even though I was on day 15 of my cycle. This is probably the most unanticipated part about having dengue for me. Initially, I thought it was just spotting, but the bleeding lasted a good six days, almost like a regular period.

After some googling, I found that the virus has been known to induce menstrual bleeding. Also, the National University Hospital lists “increased menstrual bleeding” under signs and symptoms of dengue on its website. An alternative explanation would be that dengue, just like any other illness, caused hormonal imbalance which disrupted my cycle. But for now, I’m leaning towards the first possibility. Just like that, dengue reset my moon cycle and gave me a second period within a month. Dammit.

I took four blood tests thanks to dengue

If there’s one thing I absolutely hate about going to the clinic, is it’s needles. The thought of a syringe poking my skin makes me so squeamish that I could cry. But because of dengue, I let the needle pierce my arms four times. First, the dengue test which required two small tubes of blood. The next three – thankfully only requiring a tube of blood each – were to determine my platelet count daily, to make sure that it didn’t drop below a dangerous level that would require hospitalisation.

Thankfully, my platelet count didn’t decline drastically – it hit a low of 72,000 before shooting up to 137,000 a few days later. For the record, platelets are small fragments of cells in your blood that help you to form blood clots. A low platelet count means there’s a risk of excessive and internal bleeding, which can be fatal. An ideal platelet count range is 140,000 to 440,000 per microlitre of blood. Which brings me to the next point.

Papaya leaves are a (surprising) dengue remedy

Since I got diagnosed with dengue, people around me – from my well-meaning friends and relatives to the knowing clinic staff – have been advocating papaya leaves. Specifically, to boil papaya leaves or crush the leaves to extract the juice. Apparently, there’s evidence that drinking the juice of papaya leaves helps to improve platelet count, though more research is needed to support this.

Empirically, those who recommended me to drink papaya leaf juice knew someone firsthand who drank it and recovered from dengue soon after. Of course, it can be argued that drinking any form of fresh juice or naturally derived drink would go towards alleviating the dengue symptoms. After all, the blanket advice to dengue patients is to take lots of fluids and rest up. But with my platelet count doubling after two days of drinking papaya leaf juice (500ml a day), in addition to plenty of rest and water, I can’t discount papaya leaf juice’s contribution to my dengue recovery. Who knew papaya had such an effect? I love papaya even more now – never mind that papaya leaf juice tastes like “a mixture of bitter gourd and sewage water”, as a friend accurately described it.

Finally, dengue gave me the ugliest rashes

Just when I thought the worst of dengue was over after my fever and body aches passed, tiny red spots started appearing on my thighs and calves on day seven. Those spots – known as dengue rashes and reminding me of measles – darkened and intensified over the next few days, spreading all over my legs. They caused a burning, prickly sensation, and felt as though there were a million ants crawling under my skin.

Credit: Estelle Low

Luckily, the rashes lasted for just over a week, and didn’t travel up my body or to my face. That would have been catastrophic.

Life after dengue

Today is day 17 as I write this. I lost 2kg during two weeks of dengue, thanks to the loss of appetite. The good news is, I’m well on my way to regaining them.

[UPDATE on Day 27: Dengue has caused me hair loss, too. Over the last few days, I’ve noticed more hair fall than usual. They remind me of postpartum hair loss, when my bathroom’s floor trap is choked with hair after I shower, and I’d easily see two or three strands drop after running a hand through my hair. Hair loss after dengue is not uncommon, though it still sucks. Broadly, it’s due to inflammation and cell death – factors that explain hair loss after major illnesses and life events like childbirth and menopause. In the meantime, I’ll just have to ride this out while embracing anti-hair loss products. The hair loss period is said to last anywhere from three to six months.]

I’m about 90 per cent back to my usual self, and back to my usual activities except for exercise. I’m still feeling a bit weak – my average walking speed is slower than before, and I get physically tired more easily. I guess this is my body telling me to take my time to recover, and go easy with my workouts for now. Pre-dengue, I was running two or three times a week, and doing one strength workout and one yoga session weekly.

On the diet front, my gut and taste buds have reset. I’ve stopped craving caffeinated drinks the way I did before – partly because I want to keep my heart rate from spiking unnecessarily. Because I still have lingering feelings and memories of nausea, I’m careful not to overeat, and am more sensitive to sweet, salty and spicy foods. That can only be a good thing, I suppose. These changes have made me aware of the excessive, strong-tasting food and drinks I used to consume.

While I’m out of the woods, this dengue episode has made me rethink my lifestyle choices and outdoor behaviour, at least until the peak dengue season is over. After all, there are four strains of dengue. I may be immune to one strain of dengue, but there are still three other strains that I’m at risk of getting in this lifetime. Plus, there’s evidence suggesting that the second dengue infection tends to be more severe. Just ask ex-minister Khaw Boon Wan (who had his third bout of dengue recently), and you’ll know that dengue is really no joke. Currently, conventional dengue tests don’t reveal which strain you’ve got. The best thing to do is to play it safe and avoid getting bitten.

I’ve become a religious applicant of insect repellent, especially before heading out in the morning and evening, and am looking to drop my breezy shorts in favour of long tights for my outdoor runs. I’ll also stop being an easy target by taking my post-run stretching indoors. Mosquitos are known to be attracted to carbon dioxide. Cue panting and deep exhalations after a run.

Of course, I’ll also be doing my part at home to clear any potential mozzie breeding grounds, such as turning over pails, drying out trays and removing any source of stagnant water I can find. In case you need proof of just how resilient mosquito eggs are: they can lay dormant in a dry place for up to nine months, and hatch within a day of being in a coin-sized puddle!

Text: Estelle Low / Shape