That time of the year

Almost two hundred dengue cases have been recently reported in Lahore, in a second and more intense wave this year. The epidemic is expected to continue through September and October, monsoon months which are most conducive to mosquito breeding. The threat is higher in northern Lahore and walled city where water pools, leaking pipes and congested areas serve as safe havens for mosquito vectors.
Threatened areas include Chungi Amar Sadhu, Samanabad, Dharampura, Misri Shah, Kot Khawaja Saeed, Shadbagh, China Scheme, Engineering University and Gulshan-e-Ravi are the main clusters of dengue virus and other areas of northern Lahore.

However, dengue cases appeared throughout the year which means that the dengue virus is adapting and that mosquitoes are growing insecticide-resistant. Previously affected dengue patients are at an increased risk of contracting the more deadly Dengue Hemorrhagic Fever and Dengue Shock Syndrome.

The virus is transmitted to humans by specific mosquito specie which bites during morning hours. The mosquito transmits disease by biting an infected person and then biting someone else. The incubation period is 3 to 14 days. Symptoms of a classic dengue case usually include fever, head and joint ache, nausea, skin rash and bleeding from nose, gums or under the skin.

The Communicable Disease Control (CDC) Cell of the Health Department declared that 40 dengue fever positive patients were admitted this season in Lahore, three were in Mayo Hospital, 11 in Jinnah Hospital, 1 in Institute of Public Health, 5 in Services Hospital, three in Rescue 1122, 2 in Sir Ganga Ram Hospital and at least 15 more in private hospitals. At least one person was reported dead.

One problem impeding data collection is that many patients go to private hospital or family physicians, resulting in under-estimates of patient numbers. Many clinics are not registered or lack the equipment for treatment. Also, the diagnosis is sometimes ambiguous because the symptoms vary in intensity and the test (ELISA) is expensive. Health department claims the test is done for free, however, its outreach is very limited. A dengue test costs some Rs1175 when done privately.

However, by careful estimates, thousands have been tested positive for the virus in both public and private health facilities and dengue has claimed dozens of lives. A brief visit to any emergency will show how widespread the outbreak is. Either the health authorities want to ward off any pressure they might face in times of an epidemic or they desire to prevent any public fear and frenzy.

However, Lahore’s EDO, Dr Umer Farooq Baloch denied that there is an epidemic in the province and called for Health department, Wasa, Solid Waste Management, Horticulture Authority and the community to fight dengue collectively. He added that the Health Department has so far circulated 600,000 pamphlets among the citizens to educate them about dengue.

Punjab Health Secretary Muhammad Jehanzeb Khan has assigned health directors in ten towns across Lahore to supervise preventive arrangements for dengue fever, checking mosquito growth and sending a monitoring report daily. Banners to enhance dengue awareness are also being displayed in several Ramazan bazaars.

The Mayo Hospital administration has a 40-bed strong ward and emergency centre exclusively for dengue patients, blood testing facilities and mosquito nets. Director Emergency Dr. Sabir Ali has been appointed focal person for coordinating with the Health department.

Dr. Raza Hassan of Children’s Hospital said that two or three dengue cases have been reported there so far with no fatalities. “We have diagnostic kits and platelet kits plus special counters, rooms and beds have been set up.”

The City District Government has yet to carry out fumigation, fogging and spray in different areas to eliminate the threat. The main focus is fumigation in the affected areas which has a limited impact on mosquito control pertaining to the dilution of spray, wind and timing which can cause the mosquitoes to simply disperse and return later. The best spraying hours are two hours before sunset and sunrise when a mosquito bite is most likely. To kill the mosquitoes and the larvae, four cycles of fumigation should be done in the same area for four consecutive weeks. He added that doing routine fogging is not advisable because this might make the community complacent.

Second phase of anti-mosquitoes spray would begin on August 26. Health Department had also sought cooperation of the Town Municipal Administrations (TMAs) to drain waste and rain water. Indiscriminate fumigation may also be ineffective in combating the virus because mosquitoes can form resistance to insecticide.

The mosquito-killing effect is transitory, variable in its efficiency as the aerosol may not penetrate indoors to micro-habitats where adult mosquitoes are sequestered, and the procedure is costly and operationally difficult. Regular monitoring of the vectors’ vulnerability to insecticides is essential to switch to a more suitable alternative when required. Hence, active monitoring and surveillance of the natural mosquito population should escort control efforts to establish effectiveness. Small, mosquito-eating fish have also been used to reduce mosquitoes.

Fatima Jinnah Medical College, Lahore held a seminar for Dengue-awareness on August 16, in which Principal Dr. Rakhshanda Rehman suggested:

“Platelets should be injected only when the patient starts bleeding.” She said that 163 million people have been tested positive for dengue worldwide. Dr Zarfishan Tahir, also on the same seminar, said that at bacteriologist laboratory, IPH so far one thousand tests have been conducted out of which 68 percent were confirmed positive. She informed that IPH is providing diagnostic facilities free of cost to public as well as private sector.

The Health department needs to be more transparent and collect data more accurately regarding dengue cases. The civil society, NGOs and pressure groups need to exert organised pressure on the Health department. If effective policies are not implemented, hospitals will be swarmed with patients without adequate medical supplies. Lahore is also under pressure of patients from other cities. In Sir Ganga Ram Hospital, for instance, patients from Pindi Bhattian, Mianwali and Bhalwal were also present.

Dengue has no vaccine. Removing standing freshwater, not storing it in open containers, covering it with lids, scrubbing edges of containers to dislodge eggs, using mosquito nets and repellents and remaining fully covered will help in preventing dengue. People in Faisalabad have formed an organisation to tackle dengue collectively Lahorites should follow in their footsteps.
This piece was first published in the News on Sunday.