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SL in ‘big’ trouble over dengue, warn experts
- Hit out at lack of commitment by politicians of all hues, who are not exposed to the dangers unlike ordinary citizens
- Need to question how the number of people affected rose so sharply, look for the cause rather than holding onto traditional thinking
- The ‘mild and low’ dengue season from January to May has seen a huge 47,000 people being struck down, with 125 deaths
Kirulapone: Experts have called on authorities to think 'out of the box' regarding the prevention of the disease as scores of people, mostly in the Western Province, have been afflicted by dengue. Pic by Athula Devapriya
Declare a state of ‘health emergency’ and use full force to battle dengue, is the urgent plea by experts as Sri Lanka slides further down the slippery slope, with this virus spread by a tiny mosquito rampaging at will.
As the country braces for the ‘higher’ dengue peak in June, it has in the ‘mild and low’ dengue season from January to May seen a huge 47,000 people being struck down, with 125 deaths so far. The dengue menace has taken a drastic turn for the worse coming close not only to last year’s full diseased numbers (61,000) but tragically also the death toll, in just five months this year.
While commending the exhaustive discussions held on Tuesday by the Presidential Task Force on Dengue Eradication presided by President Maithripala Sirisena, experts stressed that it is better late than never.
Pointing out that political will and commitment seem to have been lacking in dealing with dengue throughout, they strongly urge that Sri Lanka needs to look at “where we have gone wrong” and map-out short and long-term plans, at least to control dengue immediately and then put into place measures to prevent dengue.
These experts stress that the dengue issue should not be swept under the carpet, assuming that if it is exposed there would be a drop in tourism, because at the moment Sri Lanka is in “big” trouble. Ignore it and tourists will not come here, but accept that there is a dengue crisis and deal with it.
Why is it that politicians are not coming down with dengue, asked one expert, pointing out that they are in their posh air-conditioned offices at the peak biting-times of the dengue mosquito, while other citizens of the country do not have that luxury.
“This is why there is absolutely no commitment on the part of politicians of all hues and even professionals are organizing trade union action while the country is in crisis,” the irate expert said, pointing out that even though crucial institutions such as the National Cancer Institute at Maharagama and the Lady Ridgeway Hospital for Children in Colombo were kept out of strike action, no one thought it right to keep dengue treatment units bursting at the seams with critically-ill patients without being hit by strikes.
Requesting that everyone should think out of the box and take a fresh look with an open mind, other experts said immediate brainstorming should be done to analyse how and why the number of people with dengue have increased this year.
In recent times, before 2017, the highest number of cases of 35,000 and 346 deaths were in 2009. When comparing the situation between 2009 and 2017, with much improved clinical management the death toll has been kept down at 127, even with a caseload of 47,000, the Sunday Times learns. In 2009, there were 1.0% of deaths, while in these five months of 2017, it has been 0.26%.
With more than a 200% increase in the number of cases compared to previous years, what other factors have changed needs to be ascertained. Many experts are of the opinion that the weather patterns have not changed too much – so with the dry spell experienced there could not have been an increase in the collection of small amounts of clear water due to sporadic rain. When compared to last year, there has also not been seen a doubling of small containers such as yoghurt cups on the ground which would push up the number of breeding places.
“This is why we need to question how the number of people affected by dengue rose so sharply and look for the cause rather than holding onto traditional thinking,” said an expert who has tried to find some answers.
With a vast improvement in clinical management of patients which is keeping the death toll down, have those in the prevention sector become lax and lethargic, is the worry of many. If prevention is carried out stringently, overcrowding of medical facilities would be less and the over-stretched doctors and nurses would be able to prevent more deaths, was the view echoed, for dengue has to be tackled on multiple fronts not just clinically managed.
“Unlike privileged people including politicians, the common people have to go about their routines. Children have to go to school, tuition classes and sports activity and men and women have to go to their workplaces,” said another expert, suggesting that the authorities take a closer look at the dengue mosquitoes’ behaviour and adapt the people’s lives to prevent them from being bitten. “It’s tragic that so many lives have been lost,” he said.
If we are to keep dengue down, the community has to play a major role. Thus, people have to be constantly reminded and motivated about what they need to do by the government and the media throughout the year, it is stressed.
There are many questions and concerns relevant to dengue that the Sunday Times asked the experts:
Is there a change in the disease pattern? Yes. From 2009 to 2016, Sri Lanka has faced DENV1 and DENV4. Currently what is wreaking havoc is DENV2. Experts say that the sequence of people who have earlier been hit by DENV1, now being exposed to DENV2 has caused the virulence to get worse.
There are four dengue virus serotypes – DENV1, DENV2, DENV3 and DENV4. Usually after being infected with one serotype, the person becomes immune to that but if he/she contracts a different serotype the vulnerability to and virulence of the disease are greater. The prevalence of DENV2 currently has been determined by sample testing.
The symptoms which need to be taken seriously – In the progression of the disease currently with DENV2, it is learnt that the platelet count drops quicker in Day 2, rather than in Day 3 as in the other three serotypes of DENV1, DENV3 and DENV4.
Those suffering from Dengue Haemorrhagic Fever go into fluid leakage quicker too on Day 2 instead of the usual Days 4 & 5. Experts are unsure whether this is a feature of DENV2 alone or whether it comes about when DENV2 affects a patient who has had an earlier infection with a different serotype.
Many doctors requested the government to ensure price control of a full blood count (FBC) test at around Rs. 200, so that it would be affordable to a majority of people.
This is while some doctors said that to ensure smaller numbers seeking treatment for dengue at hospitals and better management by short-staffed as well as overworked and exhausted junior doctors and nurses, people should be encouraged to get the Dengue NS1 Rapid Antigen Test done if there is high fever (>100F) between 18 and 24 hours of the onset of the temperature. If the government waives the taxes off the antigen test kit or the authorities themselves import the kits, the price could be kept at around Rs. 500 to 600. Then the people will do the test at their own cost and would also not be fleeced by laboratories.
Pointing out that some of the antigen test-kits are not of good quality, they reiterated that stringent action should be taken to stop those without approval from the National Medicines Regulatory Authority from flooding the market.
Have breeding places of the dengue mosquito changed? Yes. With the current conundrum being “nethi karanna be, vanda karanna be”, experts are of the view that while ensuring that there are no breeding grounds in and around homes, workplaces, construction sites, schools, tuition classes etc., what should be kept in mind is that these insects will somehow find alternative breeding grounds.
Mosquitoes in different parts of the country seem to have “adapted” to keep on proliferating, experts said.
All across the country – Experts are advising people to check unused toilets including squatting pans and also cisterns with water for mosquito breeding.
Western Province which is overwhelmed by dengue – the breeding spots are discarded receptacles and containers but could also be anywhere there is clean water. In some countries, studies have shown that breeding takes place both inside and outside houses. Usually, those checking homes look at the exterior, therefore, the people should do thorough checks within their own homes to destroy breeding spots.
Eastern belt including Trincomalee and Batticaloa – the breeding is taking place in shallow wells.
So the plea is to keep the eyes open for new breeding sites, while also examining the ‘traditional’ spots.
Is there a vaccine for dengue? While one dengue vaccine has been produced, there are other vaccines undergoing clinical trials across the world. Currently, Sri Lanka is part of one such multi-centre trial.
There are issues with the one-and-only dengue vaccine registered so far, it is learnt, with this vaccination not providing significant protection against DENV2. The World Health Organization (WHO) has recommended that it should be administered only to those above nine years old and especially to those who already have a past history of dengue infections.
Can dengue be prevented? Many lament that in Sri Lanka, there seems to be only “zero-prevention”. However, experts stress that if a concerted effort is made by each and everyone – the people and all the official stakeholders, this will not be an impossible task.
Even if eradication of dengue and the dengue mosquito may not seem possible in the near future, simple but prompt action could bring down the numbers affected by dengue.
When there is a red signal of one dengue patient seeking treatment, immediate action in the form of a rapid deployment team with a SWAT-like reaction should take place – seeking out the house and neighbourhood from which the person has come and carrying out mopping up operations, before the dengue-bearing mosquito has left the area. This would also prevent other mosquitoes which have bitten the new patient and become carriers of dengue to be destroyed. Rapid deployment and a clean-up and fogging of the area would stop the spread of the disease.
“Let’s act now and let’s act fast,” said one expert, adding that otherwise there would be more weeping and mourning in homes across the country as many more succumb to dengue.
| Take precautions, learn the biting habits of this mosquito | |
| To prevent contracting dengue, experts suggest a few precautions that people themselves can take, learning from the special biting habits of this mosquito.Studies in other countries have indicated that the dengue mosquito bites usually (90%) outdoors in the morning and evening and rarely at night or during other times of the day and also very rarely inside a room in the house. If you or your child is engaging in work, study or play in the morning or evening, wear long-sleeves and try and cover as much of your body as possible to prevent bites, an expert said, adding that a mosquito-repellent of short duration could also be used. Unfortunately, the dry and humid conditions are making mothers take their hardly-clothed infants for walks or scantily-clad older children to play outdoors, right during such biting times, where the deadly dengue mosquito lurks.
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| ‘If you have fever, think dengue’-senior doctor | |
| There are two issues that the country is facing with regard to dengue when taking the medical aspect into consideration – the sky-rocketing of the number of people affected by the disease and patients coming late to hospital. “If you have fever, think it is dengue,” is the advice of a senior doctor. To reduce deaths, more and more hospitals should have units having specialized training in the care and management of dengue patients, the Sunday Times learns. This would take the load off special centres such as the National Institute of Infectious Diseases at Angoda and the Dengue Centre at Negombo. The Sunday Times understands that setting up of other dengue units in strategically important places would require only a strong commitment from the Health Ministry to assign adequate nurses and doctors. At Tuesday’s meeting of the Presidential Task Force a decision had been made to set up two such dedicated dengue units at the Colombo South (Kalubowila) and Colombo North (Ragama) Teaching Hospitals with training support for doctors and nurses forthcoming from Angoda’s National Institute of Infectious Diseases and Negombo’s Dengue Centre respectively. However, what the country awaits is how soon the Health Ministry will allocate staff and equipment. Thereafter, such units could be replicated in major hospitals around the country, while a rapid deployment team of doctors and nurses could also be set up to troubleshoot when and where necessary, is another good suggestion, it is understood. |