Mystery viruses strike and kill at random each year before microbiologists can put their slides together. Often, two or more viruses go on a rampage simultaneously, confusing microbiologists further by presenting them with different sets of DNAs and RNAs. By the time experts respond to an outbreak, hundreds are stricken and dozens are dead. And so is the disease-causing pathogen, which often dies a natural death because the weather gets unfavourable for it to thrive. And then there is the threat of the wider geographical spread of identified diseases. Few people in northern India had heard of dengue and chikungunya a decade ago, but regular outbreaks that afflict thousands and kill many hundreds have made the two mosquito-borne diseases synonymous with the monsoons. Chikungunya, which caused outbreaks in a handful of southern states till a few years ago, has crossed several state boundaries to infect more people than dengue in Delhi. Adding to the disease cauldron are the frequent outbreaks of other infections such as malaria, Japanese encephalitis, jaundice, filariasis, gastrointestinal infections and seasonal flu, including H1N1, popularly referred to as swine flu.
All sorts of disease-causing pathogens — virus, bacteria, protozoa and parasitic worms — found in the faeces of the infected, for example, spread to other people through contaminated soil and water, food and surfaces touched by infected people. Add to that mosquitoes breeding in stagnant water, algae and fungi in neglected surroundings, lack of safe running water and missing toilets and sewerage — we are juggling several triggers of outbreaks waiting to happen. Apart from the fever and malaise, what these diseases have in common is that they are all under-reported and spread because of poor sanitation and hygiene. Let’s take under-reporting. Close to 100,000 dengue cases were reported in India in 2015, which is just a fraction of the actual number of infections. Blood samples taken from more than a thousand people across 50 Chennai neighbourhoods revealed that nearly all had been exposed to the dengue virus and 44% to chikungunya. Yet almost none of the people had reported having been infected, either because they had a very mild form of the disease or never got diagnosed. Complicating containment is the systematic knee-jerk reaction of the health department and civic authorities to each outbreak. They begin by publically accusing each other of mismanagement, add beds in hospitals and start cleanliness drives to destroy the breeding grounds of mosquitoes and disease-causing pathogens, and stop everything once infections begin to fall because of unfavourable weather conditions. There is no sustained planning for the year ahead.
Clearing neighbourhoods of garbage and filling up uneven surfaces where rainwater collects and becomes a breeding ground for mosquitoes is a start, as is building toilets and encouraging people to use them through sustained social campaigns. Handwashing and sanitation can prevent more than two dozen infections and conditions, from typhoid and other enteric fevers to worm infestation, diarrhoea, malnutrition and anaemia, so school-based social campaigns become vital. These outbreaks are back with frightening regularity because we strike at the disease after it’s struck us down. Prevention is better than cure is a public health adage civic and health authorities must treat as a truism that can be ignored only at their peril.