It seems Delhi is in the sickroom again in the monsoon as dengue is emerging as public health threat. Panic-ridden Delhi-ites have no clue as to how to face this dire situation. It seems the government and people did not learn anything from last year’s dreadful dengue outbreak.
On July 21, 2016, a 17-year-old girl from Jaffrabad, northeast Delhi, became the first victim of dengue at LNJP hospital after suffering from high fever, abdominal pain and vomiting — all dengue symptoms. Dr J C Passey, medical director of the hospital, said the girl’s blood samples were being tested to confirm if dengue indeed killed her. “Her platelet count was around 50,000 at the time of admission, which is not very low. Hence, we cannot rule out other causes of death,” he said. So far Delhi has witnessed more than 90 dengue cases, it is well predicated that cases will shoot up drastically as post-rains weather becomes conducive for mosquito breeding.
Delhi government, MCDs have totally failed to create public awareness on prevention. Dengue-causing mosquitoes breed within homes and offices but people continue to ignore and there’s little political will to spread the word. Also, there is no policy or punitive action for stagnation of work at construction sites. Large- scale construction work, for government projects such as Delhi Metro or construction of houses, allows stagnation of water, which is potential breeding grounds.
Dr KK Aggarwal, secretary general of Indian Medical Association, said, “Aedes aegypti, the mosquito not only carries dengue virus but also is the carrier of zika and chikungunya viruses. Just as in case of dengue, India will offer a fertile ground for zika, the deadly virus that deforms babies when it infects pregnant women. Hoardings and advertisements are not going to control Dengue spreading across dengue. Delhi indicates we did not work on cleanliness, sanitation, and now a dengue outbreak is bound to happen.”
“The eggs of mosquitoes survive the Delhi cold and heat, and when they get the right temperature and moist conditions in the monsoon, they hatch. Dengue will be on rise in the late September and early October. The larvae live in water tanks, drains, pots and planters all around us. Eggs laid by an infected female mosquito carry the infection. Soon the Delhi air will be thick with dengue-infected mosquitoes. Dengue cases will be on rise till October,” added Dr. KK Agrawal.
Delhi isn’t only a sufferer of dengue outbreak, with monsoon active in Odisha, dengue has spread all over the state with at least 225 people being affected. “As many as 225 people have tested positive for dengue across the state. Of the affected persons, 13 are undergoing treatment at various hospitals,” said Odisha’s Health and Family Welfare Minister Atanu Sabyasachi Nayak. Already with the infamous tag of a ‘malaria-endemic’ state, a more stinging fact is that only in a decade’s time Odisha has curiously raced hard to become the dengue hub in its neighborhood (Bihar, Jharkhand, Andhra Pradesh and Chhattisgarh). Odisha, moreover, last year figured as a dengue hub with more cases than the BIMARU (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) States after Rajasthan.
Odisha had reported a mere one dengue case in 2006. But by years 2013 and 2014, cases grew geometrically to touch respectively over 7,000 and 6,000, and the State became number one dengue-endemic State among the BIMARU States. Odisha was also number one dengue-infected cases in its neighbourhood, including Andhra Pradesh, till 2015. Even, in dengue deaths Odisha was also third among the BIMARU States.
Cleanliness, insecticide-laced mosquito nets and repellents are important but not enough to tackle the problem. In the dense urban communities, mosquitoes easily places to breed. The adult mosquitoes fly up to 400 meters. Every household cannot bear the cost of cleaning all containers and treating water tanks and coolers in its surrounding area. So advertisement and communication is often inadequate as a strategy. For instance, government issues ‘dos and don’ts’ where it is advised that all water tanks be emptied, cleaned and refilled every week. But most of the households don’t clean it regularly. If your neighbour does not kill the larvae in her tank, you can be infected with dengue. In other words, the prevention of dengue is a public good. Killing the larvae before they develop into mosquitoes is a good idea to prevention of disease.
According to health experts in the NVBDCP (National Vector Borne Disease Control Programme), late spraying (fogging) of insecticide to kill adult mosquito population in order to prevent spreading of the epidemic is the main reason of dengue. Late fogging is proving ineffective as adult mosquitoes are seen returning quickly after spraying. Problems in controlling larval population is proving challenging owing to no regular civic maintenance as its larvae are found to be remaining for more than a year in dry condition, and upon setting in of rains saw triggering them again to grow to an adult.
Undoubtedly, the government intervention is requisite. People’s participation is required, but preventing dengue cannot be left to communities. The government needs to have a strategy after studying the pattern of the disease and examining ways of attacking it.
Ila Patnaik, professor, National Institute of Public Finance and Policy says, “In India, prevention of dengue is left largely to households, while the government offers a cure, tests and hospital beds, a strategy that is not only insensitive when compared with the benefits of a public health prevention strategy, but also costly. A number of studies across the world have shown that intervention by the government through a strategy of prevention is cheaper compared to the government paying for the costs of tests and hospitalisation.” Indian government always give prime focus on healthcare. There is an attitude of letting people get sick, then think about healthcare facilities to treat the masses. But it is better to engage in public health innervations than emphasis on public healthcare. In this particular case, the critical public health interventions are focused on mosquitoes.
We wait newspaper stories to know about the epidemic outbreak, people dying of dengue, etc. And we will get a surge in October 2016. The time to act on this is now, and actions should be grounded in public health and not in healthcare. It was essential to work on comprehensive public health initiatives in June and July, instead of waiting till October and trying to deal with a surge of patients using a very creak public healthcare system. States spends around 10 to 20 per cent of expenditure on health, while healthcare accounts for 80 per cent to 90 per cent of such expenditure. Where healthcare is very inefficient when compared with public health,
the effectiveness of public expenditure is dramatically superior when money is spent on well-managed public health programmes as compared with spending money on well-managed healthcare.
Finally, the questions arise: why does the government’s massive effort fail to contain outbreak? How many will die due to awful healthcare? When will it get solved? The questions remain unanswered for decades, and are still continuing!
by Sanjay K Bissoyi