Dengue: The Dilemma and the Drama

By Dr. K. Javeed Nayeem, MD

There is no denying the fact that our city is facing the very real problem of thousands of people suffering from a very rampant wave of fevers that frequently end in much morbidity and even mortality. Almost every household has someone who has recently gone through or is going through a bout of fever and joint pains.

Every day we see and hear reports in the media of people dying of uncontrolled bleeding and respiratory failure following a febrile illness. The situation may be the same in many other cities too. All wards are full both in govt. and private hospitals and there are reports of people being turned away for want of beds. There is an acute shortage of blood and blood components like platelets that are required to contain blood loss.

Over the past two months sixty percent of the patients turning up at all doctors’ clinics are fever cases. The symptoms are uniformly the same: Sudden, unrelenting, high grade fever associated with nausea, severe body ache and crippling joint pains and sometimes a rash too. If the patient is lucky the fever passes off uneventfully, leaving behind the joint pains which can be dismissed as a not-so-serious nuisance unless they happen to be very severe and persistent.

In the not-so-lucky cases, things can take a turn for the worse and become life threatening. The patient can rapidly become moribund and require intensive life support, often for prolonged periods. This is due either to bleeding tendencies or respiratory distress followed by a persistent fall of blood pressure called Dengue Shock which is often unresponsive even to the most aggressive treatment. Recovery from this stage of the illness is difficult and the mortality rate is therefore very high.

This scenario leads most doctors with sufficiently good common sense and clinical acumen to conclude that these may be cases of Dengue Fever, a viral infection transmitted by the bite of a particular species of mosquito. While the diagnosis of many infectious diseases is confirmed by specific laboratory tests the diagnosis of Dengue Fever is not so easy despite many lab tests being available. The reason for this is that there are at least five strains of the Dengue virus and the available tests do not have a high enough specificity and sensitivity to give a clinching diagnosis in all cases.

Moreover, each type of test that can be done quickly and at reasonable cost becomes positive only over a particular stage of the disease and quickly reverts to normal soon after without being able to throw much light retrospectively. Most other confirmatory tests are very expensive and also so time consuming that by the time their results are received the patient has either made a complete recovery or has passed away. They are therefore only good to make a retrospective diagnosis and settle any diagnostic debates between treating doctors or legal disputes between doctors and patients’ relatives!

So the fact remains that even in a very real case of Dengue it is not easy to make a confirmed diagnosis although all symptoms point to the existence of the problem. In a rather strange and amusing development the government has very strictly ordered that no private hospital or laboratory, however well- equipped, should declare that a patient has Dengue infection, keeping for itself the exalted privilege of doing the honours. It has also mandated that blood samples of all patients clinically suspected to be suffering from Dengue should be sent to a government laboratory for confirmation of the diagnosis and its proclamation to the world.

This is despite the fact that there are many excellent private medical labs in almost all cities with state-of-the-art equipment and all the accreditation that is required to testify to the reliability of their reports. In doing so the government seems to have bitten off more than it can chew because we find that while blood samples only go into government laboratories the results never come out for days together. Our government simply does not have the equipment and the logistic means to handle this sample load. If someone in the corridors of power wishes to refute this observation and allegation they would do well to tell us how many blood samples have been sent to them by private agencies and how many reports they have issued along with the entry and exit dates.

This order that muffles the voice and legitimate liberty of private hospitals seems to be tailor-made to avoid embarrassment to the government because an admission that a mosquito-borne disease like Dengue exists also automatically means that the Government has not done enough to eradicate mosquitoes. This can potentially open the doors for loud claims for compensation for the morbidity and mortality suffered by citizens which can become a major embarrassment to the Government.

If my memory serves me right, claims for compensation were made for Dengue deaths not very long ago in a place close to the Chief Minister’s own constituency and the Government has also set a precedent by paying it. But the fact remains that mosquitoes have made a resurgence in all our towns and cities, thanks to our open gutters and drains. Instead of covering those up our civic bodies are spending astronomical amounts of money on erecting expensive and completely needless balustrades or digging up age-old and still durable stone sidewalks and replacing them with fragile, short-lived cement blocks.

Mosquito eradication which should be a year-round activity is taken up in cosmetic bursts only when people complain. Fogging in our city seems to be done on just one day every leap year and that too with just fuel oil sans any real insecticide! We have to accept the fact that our society is in the grip of a potentially deadly epidemic that needs to be faced and contained by all the knowledge and means that are at our disposal.

This is therefore not the time to bind uncomfortable realities with bureaucratic red tape and push them under the carpet of Government might. It makes no difference to the severity and seriousness of the problem if we refuse to acknowledge that it is Dengue. Let us accept that by any other name too it is just as real and just as deadly and let us not let the mosquito have the last laugh!

e-mail: kjnmysore@rediffmail.com