To fight dengue, we must come out of denial
For all the romanticism attached to the rain, Delhi doesn’t really get to enjoy the monsoon. It has become the season of flooded streets, traffic snarls and fever outbreaks.columns Updated: Sep 12, 2016 15:22 IST
For all the romanticism attached to the rain, Delhi doesn’t really get to enjoy the monsoon. It has become the season of flooded streets, traffic snarls and fever outbreaks.
Delhi’s clinics are overcrowded this time too. The viral fever is not a notified disease so the government doesn’t keep an official count of the patients. But for dengue fever and chikungunya, spread by the same Aedes Agypti mosquito, it has to. Till the last count on September 3, 771 cases of dengue including two fatalities and 560 cases of chikungunya had been reported to the authorities. Hindustan Times has independently confirmed seven deaths.
Delhi has seen massive outbreaks of dengue since 1967. In 2006, 56 lives were lost. Last year, it afflicted 16,000 people and killed 60. After living over five decades with the menace, one would expect Delhi to have a robust public health plan to tackle the viral infection. It doesn’t.
If the crowding at the hospitals and neighbourhood clinics are an indication, the number of cases is much higher than those reported. But official records always downplay the numbers, nitpicking over tests, case histories and the domicile status of the patients.
Getting the correct data is important not just to assess the magnitude of the problem but also for deployment of adequate resources. In the absence of this, dengue is already a big business in the unregulated healthcare market. Nursing homes admit anyone running a high temperature and anxious patients ask no questions.
A 2014 study by researchers from Brandeis University, USA, Centre for Research in Medical Entomology, Madurai, Delhi-based National Institute of Health and Family Welfare and the INCLEN Trust International concluded that the burden of dengue in India was the heaviest in the world. For every single officially reported dengue case at the national level, 282 went unreported in official records.
Donald Shepard who led the 2014 study told The Economist that India must start publishing official data of both confirmed and suspected cases of dengue, a practice followed in many countries including the US.
Shepard’s team estimated that the average medical cost of a dengue case in India in 2012 was $235 (`13,000) if hospitalised, $25.46 (`1,400) for outpatients, and $94.24 (`5,250) overall. The study estimated the total direct medical cost of dengue in India to be $548 million and found that as much as 80% of this cost was paid for through private sources, mainly households.
Since last year, the government has been providing extra beds to accommodate the increasing load of patients in Delhi. The Mohalla clinics are handling the primary care.
Since there is no vaccine for dengue, only early detection and good medical care can lower the damage and fatalities. But medical infrastructure alone cannot fight the disease. What Delhi needs is a prevention strategy.
It is cheaper to kill mosquitoes at the larvae stage. Aedes does not breed in dirty drains. It needs clear water. Due to stagnant water in desert coolers, overhead tanks, Feng Shui plants and water collecting from condensers of ACs and refrigerators, half of those infected are bitten in their own homes.
Tackling this requires door-to-door surveillance, which is the weakest in Delhi. The municipalities are grossly ill-equipped with 1,100 posts — around 20% — vacant in the health departments. The budgets just about cover the wages of the disease-control teams and limited operations.
If the state of sanitation in Delhi is any evidence, the municipal staff is not known for its efficiency. But they are not the only ones to blame. Most residents resist inspection and complain of harassment when they are fined `500. It seems to suit everybody that fewer households have been checked for mosquito breeding this year.
Fumigation, the standard practice for dengue prevention, is harmful for asthma patients and pregnant women and does not stop mosquito breeding. It only kills the adult mosquito. Worse, the municipal officials say they know that fogging is ineffective but still continue with it on popular demand. One has to be in denial mode to fight an outbreak with a placebo.