Just when the national capital began to relax its Covid restrictions as cases have plummeted, another health challenge reared its ugly head—dengue. The city logged 1,537 dengue cases and six deaths till October 31, the figures have already surpassed the dengue toll of the past three years.
Reasons for surge
Experts point to several factors that have caused Delhi’s uptick in dengue cases. Dr Ashish Khattar, Senior Consultant, Internal Medicine at Venkateshwar Hospital, noted that the surge is owing to late monsoon departure and mosquito breeding. “Usually the breeding starts in July and mid-August, but this time due to climatic changes, breeding happened in September as we saw heavy downpour last month. There has been more water stagnation. Earlier by October, dengue season would end,” said Dr Khattar stated.
Dr Ashutosh Biswas, Professor, Medicine, AIIMS, noted that with the city opening up post lockdown, construction projects have started across the capital, and water easily gets stored at these sites, making them one of most favourable spots for mosquito breeding. “The labourers are directly exposed to dengue mosquitoes, as most of them stay at the sites overnight. They tend to ignore the initial symptoms and then end up at hospital when their health deteriorates,” he noted.
Fogging—a technique to kill mosquitoes using a fine pesticide spray which is directed by a blower—usually starts in the national capital in the early months of the year. This time, due to the second wave, fogging and breeding came to a halt as many of the domestic breeding checkers (DBC) staff succumbed in the period. “Last year, the whole focus was on Covid, and less importance was given to vector-borne diseases. This year, with Covid cases under control, we are effectively doing surveillance for stored water, in especially JJ clusters and slums,” said an official from the North civic body.
East, South and North Delhi civic bodies are authorised to collect data of infection cases, deaths, house checking, breeding identification spots, fogging, etc. The South Delhi Municipal Corporation (SDMC) is the nodal agency that releases the weekly data. From house visits for spraying and Gambusia fish breeding, the larger responsibility to tackle the menace of vector-borne diseases in Delhi is on the shoulders of these civic bodies.
Last week, the SDMC Mayor Mukesh Suryan alleged that AAP had been spending public money on party expansion activities in other states, while Delhiites were suffering. Suryan claimed that the state government had not released legitimate funds for corporations, which was a blow to public interest and the civic fight against dengue, even though “the south corporation was making all the efforts to control the spread of dengue, malaria and chikungunya,” claimed Suryan.
However, the government’s anti-dengue campaign ‘10 Hafte, 10 Baje, 10 Minute Har Sunday Dengue Par Vaar’, that started in 2019, rolled out this year as well. The campaign kicked off on September 19 this year and ended on November 7. The AAP-led government also undertook a ‘massive’ fogging drive in Delhi that involved all AAP workers including party’s councillors and 62 MLAs, who collectively worked to execute the drive.
Are hospitals equipped?
Just before Diwali, there was a sharp rise in dengue patients, and resultant increase in the demand for hospital beds. However, none of the hospitals acknowledged shortage of beds. Prominent hospitals such as Safdarjung, AIIMS, as well as state run facilities Lok Nayak, GTB, had noted they had ample beds to admit the heavy surge. To tide the surge, the Delhi government ordered one third of the beds allotted for Covid patients to be reserved for dengue and other vector-borne diseases’ patients.
“It is observed that cases of dengue, malaria, chikungunya are on rise, with increasing demand of beds for these patients. Many of the beds reserved for Covid cases are lying vacant due to the decline in Covid cases. Therefore, it is hereby directed that the MD/MS/Director of all the hospitals under GNCT Delhi may use one third of the beds reserved for treating Covid patients, including ICU beds, for treating patients of vector borne diseases, like dengue, malaria, chikungunya, if required,” said the government order.
“The OPD and casualty are still seeing fever cases. Out of the total turnout in OPDs every day, around 25-30 per cent are fever cases, of which 15-20 per cent get detected as dengue positives. In the last 1-2 weeks, there has been a surge in patient load. But we have enough beds here,” noted Dr Suman Kumari, MS, Deep Chand Bandhu hospital.
The state government this year claimed that many patients from outside Delhi are turning up at city hospitals. “But that number is not more than state’s own dengue patients,” said a senior doctor from AIIMS, on condition of anonymity. “We are not exactly calculating who is coming from which area, but we have admitted patients from NCR belt such as Meerut, Faridabad, Gurgaon,” said Dr Suresh Kumar, Medical Director, Lok Nayak Hospital.
Another official from the south civic body observed: “Western Uttar Pradesh in particular is heavily affected due to dengue and many patients from here are coming to Delhi for treatment.”
Ground reality
To gauge whether city hospitals are equipped to deal with the vector-borne disease, a TMS correspondent visited Safdarjung Hospital that runs a separate fever clinic to tackle dengue cases. While talking to the staff, they disclosed that till last week the hospital would receive 250-300 dengue patients per day, which has now reduced to 80-100 cases per day.
“The situation turned grim between September-October when dengue season began. Every day, hundreds of patients diagnosed with dengue, from elderly to children, would turn up. At times, due to the overwhelming number of patients, we had no space left in the ward. We had to adjust two patients in one bed and those who did not get a bed were laid on the ground. But, the doctors treated everyone equally,” said a staff member, on the condition of anonymity. This correspondent found many beds vacant here, and cumulatively just 100 beds occupied in both the male and female wards.
“The cases have reduced, and several beds are vacant now. Most of the dengue patients are stable and many are opting for home care. Also, with the winter coming, dengue will be under control in a couple of weeks,” another medical staff noted.
Abdul, who had to admit his son at Safdarjung hospital, said he had no problem in getting a bed at the facility. “My son was tested dengue positive on Saturday, and the hospital admitted him immediately. We moved to Delhi recently from West Bengal here and were worried about the availability of beds. Now, my son is receiving good care and treatment,” he added.
What to keep in mind
The predominant dengue variants this year are Type I and Type II; the first one causes classic dengue fever, but the second is more fatal as it causes haemorrhagic fever with shock. “There are a few dengue varieties. There is classical dengue fever which is not so severe, and platelets are recovered by Day 8. Then is dengue fever that can cause haemorrhage and skin rashes. Infected women might experience prolonged menstrual flow for long periods. There could be bleeding with stool, and nose bleeding while sneezing. Also, high chances of secondary infection such as acute respiratory syndrome. Around 80 per cent dengue patients experience acute liver hepatitis, which is why dengue is more critical than malaria,” said Dr Khattar.
“Dengue is caused by the Aedes mosquito that keeps multiplying if it finds an area suitable for further growth. Transovarian transmission is another factor – the mosquito when it comes out of its egg gets infected, and therefore can transfer the virus more easily,” added Dr Biswas.
Changes of getting infected with dengue again are higher as a new strain may attack the body and develop serious symptoms. “There are four variants/strains of dengue. This year, the serotype 2 strain is predominant in Delhi. If a new strain attacks a human body, it is called antibody dependent enhancement. However, it is unlikely the same person will be affected again by the same strain,” added Dr Biswas.
Common dengue symptoms include lack of appetite, headaches, backache, vomiting, nausea, and these persist for 3-4 days, visit a doctor. “Platelets start falling after five days of recurrent fever. Those having less than 150,000 platelets may need transfusion. The treatment is symptomatic, with infusion of platelets, haemoglobin concentration, hydration, maintaining oxygen levels, and watching out for
breathlessness, abdominal distension, gum or menstrual bleeding. People should not panic and consult a doctor before having goat milk, as unpasteurised milk is not good for health and may cause problems,” said Dr Rakesh Pandit, Senior Consultant & HOD-Internal Medicine, Aakash Healthcare, Dwarka.
AAP initiatives: Reserving beds, increased fogging
The state government ordered city hospitals that one third of the beds be allotted for Covid patients to be reserved for patients of dengue and other vector-borne diseases. They also undertook a ‘massive’ fogging drive involving AAP councillors and 62 MLAs
Difference between Dengue-Malaria-Chikungunya
Dengue fever is an infectious disease carried by the Aedes mosquito. DEN-1, DEN-2, DEN-3, and DEN-4 are the four main viruses that cause the illness.
Malaria is a life-threatening mosquito-borne infectious disease caused by a parasite called Plasmodium, transmitted to humans via infected female Anopheles mosquito bites.
The word ‘chikungunya’ means ‘to walk bent’. Fever and joint pain are significant symptoms of chikungunya. A bite predominantly transmits the chikungunya virus from an infected female, ‘Aedes aegypti’, commonly called the ‘yellow fever mosquito’.
Severe Dengue symptoms
A patient enters what is called the critical phase normally about 3-7 days after illness onset. It is at this time, when the fever is dropping 100°F in the patient, that warning signs associated with severe dengue can manifest. Severe dengue is a potentially fatal complication, due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment.
Warning signs that doctors Should look for
Malaria symptoms
Symptoms are similar to those of flu and usually appear 6 to 30 days after the mosquito bite, but it can sometimes take up to a year for symptoms to start.
Initial symptoms of malaria
These symptoms can initially be mild and may be difficult to identify as malaria
Chikungunya symptoms
Symptoms of chikungunya virus are similar to other vector-borne diseases such as dengue fever. These symptoms normally appear just a few days after a mosquito has bitten an individual.
Most common symptoms are
Less commonly, symptoms can be accompanied by a maculopapular rash (similar to measles or heat rash), conjunctivitis, nausea, and vomiting.
