No treatment, no vote, is the battle cry from Jodhpur, about to go to polls in end-November. As the incidence of dengue fever rises, awareness and anger against the government is shooting up.
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The Dengue virus is a global citizen, but loves cities, especially India’s dirty towns. This year, it seems to be partial to urban Maharashtra, which reported 4,667 cases by September 30, 2018, according to the National Vector Borne Disease Control Programme (NVBDCP). This was followed by Odisha with 3,883 cases, Kerala (3,660), Andhra Pradesh (3,314), Himachal Pradesh (3,303) and Rajasthan (3,022). The virus also seems to like the southern urbanscape for its tropical climate, where it reportedly gets transmitted throughout the year, even as it spreads from April through November in north India.
While citizens impute the flourishing virus to faulty administration and poor waste management, officials defend themselves saying the rising figures are not about flawed management but detection, with studies revealing that the disease is endemic. Although it has been reported in almost every major city, according to NVBDCP, more cases and deaths have been ironically recorded in states with better public health infrastructure.
Reporting and documentation have their own set of problems. In Delhi, for instance, more cases have been brought to light due to the government’s sentinel surveillance hospitals, which take a week to submit reports, while deaths are revealed after a month. In 2017, a research paper by All India Institute of Medical Sciences (AIIMS) and Indian Council of Medical Research (ICMR) stated that only 0.35% of the clinically diagnosed dengue cases in India were captured by the NVBDCP. Yet another survey report released by a non-profit organization said that over one lakh cases of dengue and malaria were recorded by them during a door-to-door research project in the capital city through 2017-18. The figure was more than 20 times higher than the cases shown in the municipality reports.
But even from whatever has been reported and documented, it is evident that our cities are hardly gaining any ground in the war against dengue. The following picture from some of the largest cities in the country bear testimony.
Till July this year, Kolhapur, Nashik and Pune accounted for most of Maharashtra’s 2,134 dengue cases and six deaths, of which five were confirmed in Kolhapur and one in Nashik. The Kolhapur Municipal Corporation (KMC) claimed to have taken efficient action by creating door-to-door awareness campaigns and taking preventive methods. Still, people’s neglect of safe water storage has not been addressed.
Pune seems to bear a “high disease burden”, with 60,000 persons showing signs of exposure. On October 15, Pune reported 2,408 cases this year. The only good news, perhaps, is that the number of cases dropped from 682 cases in August to 535 in September and then further to 207 by mid-October.
Six cases with the fatal HLH Dengue strain were hospitalised, of which at least two succumbed. Doctors are baffled that even a month-old baby was hit, as infants below a year old usually enjoy the protection of antibodies from their mothers.
Puzzlingly, Pune seems to be affected more than hot, humid and crowded Mumbai. It is probably due to eco-climatic conditions and fluctuating daily weather, which helps the vector to thrive in the city, according to a senior scientist from the National Institute of Virology (NIV).
Causes of the illness are said to include monsoon showers, crazy fluctuations in day and night temperatures and stagnant water at construction sites or homes. Water scarcity has also led to breeding, as people tend to store water in containers, especially in fringe areas.
There are no reports of cases from the core but only fringe regions due to unseasonal showers, humidity and stagnation in construction sites. Lack of planning, poor hygiene and sanitation have led to the outbreak of 60% of known cases in the fringe areas of Dhankawdi-Sahakarnagar, Hadapsar-Mundhwa, Ahmednagar Road-Wadgaonsheri and Bhavani Peth. The municipal corporation is held responsible for tardy maintenance of hygiene and cleanliness.
The first dengue case in Pune was discovered in 1994 by Dr Rajesh Gadia, which immediately spurred his KEM Hospital to get onto a Dengue research project and conclude after treating 6,000 patients in 20 years that the fever in India has been known to shoot up 100%. However, awareness and preventive measures have increased. Dr Gadia adds that KEM has managed to keep the mortality rate of Dengue at 1%, significantly less than WHO’s mortality rate of 3% to 5%.
This ‘Smart City’ doesn’t seem to have tackled the dengue epidemic with remarkable smartness, as it has recorded the highest number of cases – 40 per cent of the total – in Odisha this year. Odisha, that was 13th in terms of dengue outbreak last year is now the 7th most dengue-affected state. The BDA Colony in Chandrasekharpur is the epicentre of the dengue onslaught, followed by Nayapalli and IRC.
Dengue positive cases in the state shot up by 137 per cent from July-end to mid-August. Interestingly, citizens say that “outsiders” are behind the evil act of “spreading the disease”! Last year’s dengue virus originally came from West Bengal, but it has now been followed by a virus from Vizag. These are mainly due to emigrant workers who came home when they fell ill, and ended up passing it on to other residents. The torrential rains also led to its increase, and it does look likely that the toll this year will surpass last year’s 4,158 cases and six mortalities.
Anita Patnaik, director of health services, explained that volunteers visit houses regularly to spread awareness.
October has turned out to be the cruellest month for the capital. Heavy rains, intense humidity and civic administrative failure has led to a sudden spike of 52%, with 539 cases in just the first three weeks of October. The total number of cases reported in 2018 has gone up to 1,020. A 12-year-old girl died, while five more deaths are suspected to be due to dengue. There is still some cause for cheer, perhaps, in that it is less than half the number of cases reported in the same period (2,884) in 2017, and 2,099 in 2016.
July to November, sometimes stretching up to December, seem to be the months that see maximum breeding. A few months ago, Delhi Lieutenant Governor Anil Baijal had directed local bodies and other agencies to step up measures to control the insects. He directed the district magistrates to meet stakeholders in order to review the situation periodically. People were advised to dry their water coolers when not in use, as they seemed to be the biggest breeding grounds for mosquitoes.
However,not much action on the ground seemed to follow. As Delhi was sinking under its own ’emergency’ waste crisis, the apex court rued that at this rate, no one would be “left alive”! Strict action should be taken against officials, if adequate precautions are not taken to prevent vector-borne diseases, said the courts.
Earlier this year, reports from the South Municipal Corporation of Delhi (SDMC) were hopeful. Most patients were said to have been bitten by the gentler and less “virulent” DEN 3 strain. Due to different weather patterns and heavy rainfall “dislodging mosquito eggs,” the trend of dengue-affected admissions showed a fall.
However, October seemed to be a time of catching up with the number of cases documented in 2017. More recent SDMC reports revealed that by October 20th, domestic breeding checkers had found mosquitos breeding in 2,10,241 houses. By November 10th, 1,875 dengue cases had been reported.
A dengue spike was noted at Hyderabad’s Fever Hospital this year, when the outpatient fever cases jumped from 300 cases in July to 900 in August 2018. Half of the cases in the state were from the city.
Most dengue cases in the city are reported between August and November. By October 2018, all four strains of dengue were reported to have attacked the city. The symptoms displayed included respiratory distress, Central Nervous System and bleeding problems in most patients. The dengue attack also increased the mortality rate of those affected to 6 per cent. They were felled by the most severe forms of dengue – Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS).
The government seems to have gotten into war mode, initiating measures such as observation of dry day in order to clear stagnant water in the districts, and creating a drive to explain the value of using mosquito nets. A defensive NVBDCP official confirmed that the rains had led to collection and stagnation of water in pits, vessels, tyres or other containers, but the cessation of rains would bring down the number of cases.
The municipal corporation here has been tardy in treating dengue patients, claim residents. While the government was basking in the fact that they had brought down the cases from last year, they did not seem to be prepared for the 250 positive dengue cases in Jammu city alone, out of the total 424 cases in the Jammu and Kathua region.
Due to lack of remedial measures and delay in providing tests for patients, patients were forced to search for private hospitals outside the city. They fumed that no remedial kits or treatments were available and hospitals lacked decent facilities.
Experts are just hoping that with the dip in the temperatures, the breeding season will come down and they can put a contingency plan in place to vanquish the illness. The efforts seem to be directed towards cleanliness, de-watering the coolers and heavy fogging.
November usually sees a dip in dengue cases along with the temperature in West Bengal. But this year, there has been a spurt, spurring sharp protests in Kolkata’s streets against chief minister Mamata Banerjee, who was also the state health minister. She said that garbage, private hospitals and path laboratories were spreading panic.
Critics say that there was a spurt in the dengue cases during the October Durga Puja season, mainly due to Cyclone Titli, which caused fluctuations in the temperature. Moreover, the mosquito seemed to be biting in well-lit areas, when the ‘day-biters’ got lured to come in at night too, due to the ‘fake’ brightness caused by festival lighting.
The city certainly does not seem to have learned much from history. Last year, there were 38 deaths in the city due to the failure of the state to utilise funds earmarked for dengue, according to the Centre. This year too, a bereaved man who lost his daughter to dengue lamented that he has not seen any signs of governmental improvement or civic measures to fight vector-borne diseases. The adequacy or efficacy of awareness campaigns and messaging in the city is questionable, given that people are not making enough use of protective devices or taking steps to control the disease, despite its virulent outbreak.
On November 12th, the Institute for Child Health (ICH) was overflowing with suspected and 51 confirmed dengue cases. The number of cases had already shot up so much that the hospital increased its bed strength from 30 at the end of September to 80 after the October 1st!
The reasons for the vector attack are clear. The city has has not managed waste efficiently enough; segregation is not followed in most areas. Water bodies are in pitiable shape. Villavakkam’s polluted canal near the railway station has in fact become a ‘dengue factory’ due to the clogged plastic and ceramic containers here. No action seems to have been taken either by the Corporation or the railways.
ICH and the Rajiv Gandhi Government General Hospital are the two dengue treatment centres in Chennai. Fever clinics that work round the clock have been set up in all government hospitals, 416 mobile medical units and 770 jeeps are in action. Tamiflu tablets have been stocked and officials have appealed to people to take steps to keep their surroundings clean, especially as the northeast rains are hovering over the city.
October to December are the dengue months for Kamrup (Metro) and Guwahati. Last year, 4,000 cases of dengue were reported in Assam. Although the health officials claim that this year seems to be better, due to awareness programmes and fogging practices taken by the health department, the reality is that 2,427 cases and two deaths were reported last month in Guwahati.
Cases are being reported from areas that did not report them previously, such as Chandmari and Bamunimaidan. Officials confirm that regular fogging, health and sensitisation camps are being conducted regularly, even though that does not explain why there is a hike in the number of dengue cases.
On the whole, there is no mystery about why, when or due to what the illness occurs. The mystery, really, is all about what it will take for our cities — authorities and citizens alike — to come together and wage an informed, systematic and effective war against the dengue terror.