Dengue: A crisis goes sour over govt inaction

Manzur H Maswood and Rashad Ahamad | Published: 02:33, Aug 02,2019


After the recent spike in dengue patients in Dhaka, the government finally acknowledges the severity of the outbreak. The photo was taken at Shaheed Suhrawardy hospital in the capital. — Abdullah Apu

Dengue has broken all records this year since its detection in Bangladesh in 2000, taking a sinister turn. If panic has gripped the countrymen over its rapid spread over the last few weeks, it has its roots in both the escalating number of patients situation across the country and government unwillingness to face the truth.

The aedes mosquito-borne viral disease spread over 64 districts, infecting so far 19,513 as of Thursday this year. In Dhaka, hospitals are now teeming with dengue patients.

However, since the beginning a sharp chasm appeared between government and non-government assessment of the severity of the disease across the country. The last unofficial report put the death toll at 54 while the government report says that so far 14 people died of dengue.

The dengue situation became bad to worse over the weeks and in the month of July alone, at least 15,614 were hospitalised with dengue.

Dengue made its appearance in capital Dhaka and spread from here across the country. The city authorities have miserably failed to control mosquitoes. And on top of that, they were in denial about the outbreak of the disease since the beginning till few days ago.  

Directorate General of Health Services director general Abul Kalam Azad told New Age that the number of dengue patients were abnormally high this year, though he did not comment when asked whether the dengue situation could now be dubbed as an ‘epidemic’.

Mahmudur Rahman, public health expert and former director of the Institute of Epidemiology, Disease Control and Research, told New Age that the dengue situation was alarming.

‘The government needs to officially admit that dengue has taken a serious turn and looks like an epidemic,’ he said.

Government leaders, including ministers and Dhaka city mayors, primarily attempted to whitewash the issue and said that the media was making things up and severity of the dengue situation was only a rumour. Their nonchalant attitude towards the phenomena, coupled with their failure to take timely actions, helped worsen the situation.

On July 25, Dhaka South City mayor Sayeed Khokon passed the dengue menace as a ‘rumour’. He said the media reports on dengue infections were ‘rumours — similar to those of child lifting,’ and he found a link between both rumours.

On the same day, health minister Zahid Maleque made light of the high number of dengue infections. He said, ‘Dengue infections are high in number because mosquitoes are high breeding insects. Mosquitoes are very productive like the Rohingyas,’ he said at a seminar on dengue at the Dhaka Medical College on Thursday.

The health minister also said, ‘The mosquitoes are very healthy and sophisticated in nature. They live in urban homes.’


Record rise of dengue:

The numbers of dengue patients hospitalised every day have broken the records of the last few dengue outbreaks in Bangladesh.

The first dengue case in Bangladesh was recorded in 2000.

The cases hospitalised with the infection crossed the 6,000 mark four times since 2000 — with 6,232 in 2002, 6,060 in 2016 and 10,148 in 2018.

Dr Edwin Salvador, acting representative of World Health Organization in Dhaka, has reckoned the dengue situation in Bangladesh dubbing it as ‘alarming’.

The WHO country representative made the comment after a meeting with the Dhaka South City Corporation (DSCC) Mayor Sayeed Khokon at the latter’s residence in the capital on July 20.

Salvador said, ‘There are two ways to evaluate the situation — first, the number of dengue patients and second, the number of dengue suspects. The number of dengue patients is increasing along with the suspects. And, till now, the situation is deteriorating.

He said it would turn into epidemic if such a trend continued.

WHO made an estimated figure of dengue infected patients that about 3.5 lakh people were now infected with dengue.

DGHS director general said the figure was not important, what was important was whether the people were getting treatment or not.

‘It is important how many people are getting admitted at hospitals and if they were getting treatment,’ he told New Age.


Ambiguity about death figures:

According to the Health Services, so far 14 people died this year, though unofficial reports said 54 people died of dengue, which created a confusion about actual death figures.

The government data said among the 14 deaths, 13 were from the private hospitals and one from Dhaka Shishu Hospital.

Dhaka Medical College Hospital authorities said at least 10 people died of dengue at the hospital alone including the death of a health ministry deputy secretary’s wife.

Habiganj civil surgeon Shahadat Hossain Hazra, three other doctors and two university students — one from Dhaka University and another from Jahangirnagar University — died of dengue, but those were not confirmed centrally by DGHS.

Institute of Epidemiology, Disease Control and Research director Meerjady Sabrina Flora said they were receiving reports of suspected dengue deaths but they only confirm those after thorough investigations.


Fear in the coming days:

Dengue, caused by aedes mosquito, usually appears with the advent of monsoon in May and continues throughout the post-monsoon month of October.

Usually, there is a sharp rise in dengue infected patients between August and mid-October. So, the current outbreak is yet to enter its peak months, therefore, the worse is still awaits the population that is already smarting under an increasing number of infected patients.

The Health Services chief has also said that the situation is likely to turn worse if the aedes mosquitoes cannot be controlled.


Fear during Eid holidays:

The dengue situation may turn worse across the country as people from the capital prepare to go home during Eid and with it the risk of transporting the mosquito-borne dengue virus to the villages looms large.

This would mean an increase in the number of infected people, especially in the rural areas where it was yet to make its incursion, officials said.

‘Bangladesh being a populous country is at risk of extensive spread of dengue,’ said Health Services director for communicable disease Sanya Tahmina.

Fear of widespread infections of dengue is growing as people carrying the dengue virus would go to their village homes from Dhaka during the Eid festival, she said at a press conference at the Health Services auditorium on July 29.

The health services already alerted the civil surgeons about the risks of spreading dengue in the coming days.

It has sent dengue testing kits on Monday and copies of dengue management guidelines would be sent on Tuesday to the districts to ensure better management of dengue if it becomes widespread across the country.

The civil surgeons and medical college hospitals were directed to alert their doctors for dengue.

With the dengue infections soaring, the government on July 30 cancelled the leaves of all officials of health ministry.

‘The leaves of officials involved in health services have been cancelled,’ said Cabinet Division’s acting secretary (coordination and reform) Sheikh Mujibur Rahman after a meeting at the secretariat.

Cabinet secretary Mohammad Shafiul Alam chaired the meeting on dengue and flood situations.

Later, the health ministry in a release said the leaves of all officials and staff under the ministry has been cancelled due to dengue and flood.

The ministry opened a dengue monitoring cell to monitor the dengue situation in the country and people were asked to send their complaints related to dengue to 01314-766069, 01314-166070, 02-47120556, 47120557 and to [email protected]

Dhaka South city mayor Sayeed Khokon also had to renounce his former position in the face of widespread news of patients crowding the hospitals. On Wednesday, he said the dengue situation turned worse and that everyone should act now work together to eradicate the mosquitoes.

‘We don’t want to trade blames since we need to work together to control aedes mosquitos,’ he said at a public awareness programme in old Dhaka.


City corporations alerted in March:

A survey conducted by the Disease Control Division of DGHS, revealed between March 3 and 12, that some areas under Dhaka North City Corporation and Dhaka South City Corporation are perfect breeding grounds for the aedes mosquito.

Tejgaon, Turag, Pallabi, Magbazar, Uttara, Gulshan, Banani, Kafrul, Khilgaon, Rampura, Mirpur, Pirerbagh, Mohammadpur, Shewrapara, Kazipara, Banani, Kazipara, Banani and Baridhara under the DNCC, have been identified as vulnerable.

Under DSCC’s jurisdiction, Dayaganj, Narinda, Swamibag, Gendaria, Dhakkin Mugdapara, Basabo, Maniknagar Biswa Road, She-e-Bangla Nagar, Hazaribag, Moghbazar, Ramna, Segunbagicha, Shahbag, Farashganj, Syampur, and Uttar Jatrabari, are dengue prone areas.

DGHS director for communicable dieses Sanya Tahmina said they alerted the city corporations in March that the dengue situation may turn worse if mosquitoes were not controlled.


Dengue changed patterns:

Dengue is usually suspected when a high fever accompanied by the symptoms of severe headache, pain behind the eyes, muscle and joints, nausea, vomiting, swollen glands or rash are present.

But this year, the dengue manifestations are different, doctors said.

‘Even with low fever and within 12 hours of catching the fever, dengue patients are developing shock syndrome or severe dengue,’ said Kinkar Ghosh, epidemiologist at Dhaka Shishu Hospital.

Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment.

Warning signs of severe dengue occur usually three to seven days after the first symptoms in conjunction with a decrease in temperature — below 100°F and include severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness and blood in vomit.

But these symptoms are being found much earlier this year.

Once a patient develop severe dengue, the next 24-48 hours are considered a critical stage which can be lethal and proper medical care is needed to avoid complications and risk of death.

The doctors explained that dengue is caused by a virus of the Flaviviridae family and there are four distinct, but closely related, serotypes of the virus that causes dengue (DEN-1, DEN-2, DEN-3 and DEN-4).

Recovery from infection by one provides lifelong immunity against that particular serotype.

However, cross-immunity to the other serotypes after recovery is only partial and temporary.

Subsequent infections by other serotypes increase the risk of developing severe dengue.

Dhaka Medical College principal Khan Abul Kalam Azad, a noted medicine specialist, said that the menace of DEN-1 and DEN-2 serotypes were more visible in Bangladesh in previous years.

‘But this year we are seeing DEN-3 and DEN-4 serotypes of dengue,’ he told New Age.

‘When the patients are getting infected with dengue for the second or the third time, the new patterns are found and they suffer from shock syndrome or severe dengue,’ he pointed out.

‘The risks are acute for the patients of severe dengue who have already kidney, heart, brain, liver and respiratory diseases,’ Azad said.

He said for severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives. Maintenance of the patient’s body fluid volume and prevention of plasma leakage are critical to severe dengue care.

Azad advised suspected dengue patients not to get panicked, but to consult doctors, especially at outpatient departments of the government’s medical college hospitals and other government hospitals.

Bangabandhu Sheikh Mujib Medical University virology department conducted a study on dengue recently.

On their findings, virology department chairman Saif Ullah Munshi said the hospital diagnosed 6129 suspected dengue patients and found 1278 of them to be dengue positive in between January and July 25 this year.

People of the 16-30 age group are more infected with dengue. The cases of NS1 positive were 26 per cent, 6 per cent were IgM positive and 5 per cent were IgM+IgG positive, he said.

Saif said the presence of all four serotypes of dengue were present in the dengue cases at the BSMMU hospital.

Another concern is that the study collected samples of 72 dengue infected patients randomly and 48 of them were found infected by more than one serotype of dengue, Saif said.

Among them, 13 were infected by DN2 and DN3 serotypes, 18 were infected by DN2 and DN4 and 18 were infected by DN1 and DN3.

Patients with several serotypes become critical. They suffer haemorrhage, plasma leakage and organ damage.


Hospitals grappling with the situation:

The hospitals in the capital are still grappling with the dengue patients surge. Different hospitals opened separate dengue wards.

Dhaka Medical College Hospital witnessed a high number of patients as at least 2387 dengue patients were admitted and 11 of them died at the hospital as of Wednesday.

Other hospitals including Mitford Hospital, Shaheed Suhrawardy Hospital, Mugda Medical College Hospital, Holy Family Red Crescent Hospital and Dhaka Shishu Hospital witnessed overcrowding of dengue patients.


Dengue test as a thriving business:

Private hospitals in the capital cashed in on the dengue scourge, charging exorbitant fees for dengue diagnosis and other associated tests for such patients.

The fee for the diagnosis of the disease alone varied from Tk 700 to Tk 4,000 at private hospitals and clinics while other necessary tests like blood counts also had no set fees. In the absence of government guideline on fees for the tests, some people are reaping a harvest.

The relevant government officials have viewed that the amount taken by private facilities for dengue tests are too high.

Later, the government fixed the maximum fees for dengue related tests.

The Directorate General of Health Services on July 28 fixed the maximum fees for dengue diagnosis test and other related examinations at the private hospitals, clinics and diagnostic centres.

The new maximum rate for any dengue diagnosis test, effective from July 28, is Tk 500 while the maximum charge for the complete blood count test is Tk 400, said DGHS director general Abul Kalam Azad at a press conference at his office in the capital.


Insecticide not working:

The majority of insecticides used by the two city corporations in the capital have proved ineffective against aedes aegypti, according to a recent study.

Mohammad Shafiul Alam, a researcher at the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b) that conducted the survey, said they found mosquitoes in Dhaka fully resistant to permethrin, the main insecticide used by Dhaka city corporations.

Sources at the two city corporations said they were aware of the study and were trying to switch insecticides, but bureaucratic procedures made the immediate switch difficult.

Sayeed Khokon also admitted that their insecticide was not working.

The High Court in several hearings recently has expressed concerns over the dengue menace and ordered the city authorities to take effective measures to control the mosquitoes.

On July 22, the HC summoned the chief health officers of the two city corporations of Dhaka to appear before it on July 25 to explain their failure in controlling mosquitoes in the city.

On July 22, a separate bench of Justice Tariq-ul-Hakim and Justice Md Shohrowardi gave four days to the two city corporations to submit reports about their simultaneous fumigation more than twice every day throughout the capital by augmenting the anti-mosquito insecticide dose.

The two city corporations had admitted that simultaneous fumigations were needed to prevent mosquitoes escaping from one place to another. 

The city corporation sought at least one month’s time for importing ‘effective insecticides’.


Crisis of blood for dengue patients:

Relatives of dengue patients are stressed over collecting blood from the voluntary organisations, relatives, friends and others as an acute crisis of blood intensified in the wake of outbreak of the viral disease.

They urged the people for donating blood on emergency basis, particularly on various social media platforms and using mobile applications.

Quantum Foundation, a voluntary organisation, has been providing blood support for 19 years in Dhaka. Its coordinator, Sheik Md Faisal, observed that an emergency situation had been prevailing as they were producing platelets for 90 to 95 patients a day now every day which was only 20 to 25 before the recent spike in number of dengue patients in the city.

He said that at present the relatives of some 600 to 700 patients a day were asking for blood while they could only manage blood for 500 patients.

‘Donors are hard to come by,’ he lamented.

Voluntary blood matching organisations Sandhani and Badhan were facing similar crisis while hundreds of applications were being posted on social media pages of Blood Donation Bangladesh, Bloodman Foundation and Blood Friends.

Transfusion medicine department chairman of Bangabandhu Sheikh Mujib Medical University, Ayesha Khatun, told New Age that demand for platelets concentrate was increasing day by day.

‘Average previous demand was 12 to 15, now it is 25 to30 units every day,’ she said.

A physician of the transfusion medicine department of Dhaka Medical College Hospital said that requisition for blood increased by at least 10 per cent though most of the patients were trying to source blood from their family members or relatives.

Blood donors said that other surgery patients who needed blood were facing the same crisis as people became extra-cautious about dengue and were constantly in search of blood.


Anti-mosquito repellents shortage:

Panic-stricken city residents are facing an acute crisis of mosquito repellents including anti-mosquito lotion, oil, gel, refill, electric rackets and aerosol spray to be used as a hedge against the aedes mosquito-borne disease.

They said mosquito repellents not available at shops and supershops while the prices of mosquito nets and coils have increased manifold and, on top of that, bellow standard products were dominating the market.

Wakil Hasan, a senior sells officer of Lazz Pharma at Mirpur said that they were not getting supply of Dabur Odomos, Naturals Mosquito Repellent Spray, Good Knight Fabric Roll and Purnava Mosquito Repellent, which are in high demand, for the last four days.

‘Demand increased many fold but supply stopped,’ he said.

Bangladesh Standards and Testing Institution director general Md. Muazzem Hossain told that the crisis arose due to a sudden increase in demand.

Abdul Jalil, a seasonal businessman was hawking mosquito nets at Paribag in the capital on Tuesday morning while he was seen selling umbrella last month.

Jalil, who hailed from Barishal, said that as the demand for mosquito net increased he changed his product and is now making high profits.

He was demanding Tk 800 to 1000 for a mosquito net which the local said was not more than Tk 600 a piece.

Ridoy Ahmed, a shopkeeper at Kathalbagan said that sells representative of well-known company’s mosquito repellents didn’t even receive his phone calls for last five days.

‘I am now selling non-brand mosquito coil under the pressure of customers,’ he said.

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