JOIN USAll it takes is just one mosquito
November 2012 saw 1,005 cases of dengue in the city. This is the highest for the month in many years, and at least since 2007. The number of cases this November surpassed even that in November 2010 — the year when dengue acquired epidemic proportions.
It seems that despite the increasing threat of dengue, government authorities are failing to curb the spread, owing to changing environment and administrative lacunae.
Health activists and doctors have repeatedly pointed out that the official numbers are far lower than the real number, and do not capture the entire picture.
“The total figure by the municipal corporations is just above 2,000. This is gross underestimation. Only the top four private hospitals have seen more cases,” says Dr Sanjeev Swasti, who runs an independent clinic in south Delhi, and is a consultant of medicine in several private hospitals.
Apollo, Max, Moolchand Medcity and different branches of Fortis Hospitals have registered over 500 cases each. Rockland and Sitaram Bhartiya Hospitals have had nearly 300 cases each.
“If hospitals in south Delhi alone had so many cases, then the situation of the entire city can be gauged from this,” adds Dr Swasti.
A doctor of medicine at Deen Dayal Upadhyay Hospital says the official figures were maintained within the range of thirty cases per day for almost one-and-a-half month.
“This is statistically impossible. Either dengue would have spread and the number of cases per day should have increased, or declined if there was a downward trend. The extent of dengue spread cannot be stagnated to this extent,” he says.
“Day after day, the figure was maintained at 39; not even once it became even 40. The figures are definitely fudged,” he says, adding that he feels the numbers from DDU were also underestimated.
No punitive action
Apart from the ‘fudging’ of the numbers received by municipal corporations, doctors say all cases are not reported to the authorities.
“Dengue is a notified disease, which means any health facility receiving a fresh case has to inform government authorities. But there is no provision of punitive action. Thus, it depends more on goodwill of the hospital or relation of its authorities with the government, rather than the need to track the disease,” says health activist Amitava Sastri.
Health facilities are supposed to give the name and address of the patient, in addition to the number of fresh cases. This helps in tracking the area of mosquito presence, and in fumigation and fogging efficiently. Local hospitals and small clinics do not bother to send the information.
“If a patient recovers after being administered intravenous fluids, then he or she will never get registered. Only if the platelet count falls beyond limit and the patient has to be sent to a bigger facility for blood transfusion, that the case will most likely be registered with government authorities,” says Sastri.
He says in the absence of correct sense of judgement about the extent of dengue spread and the affected area, operations to prevent it are far from adequate.
Dissatisfied employees
Operations for checking of mosquito breeding sites and spraying medicines in the city are carried out by dengue breeding checkers (DBCs). The first epidemic was seen in Delhi in 1996. That’s when DCBs were appointed, initially for five months a year, which was extended to eight months later.
From the coming year DBCs will work throughout the year. East and South Delhi Municipal Corporations have already passed proposals to this effect. However, the number of DBCs — 3,200 — has not changed.
“The population of Delhi has increased manifold since 1996. How can the same number of people guard against all vector-borne diseases?” says MCD union leader Ashok Choudhary.
He said dissatisfaction among DBCs is one reason for inefficient work. “We work as contract labour for a few months in a year. People have to look for another job for four months every year. Fifteen to 20 days are lost initially to adjust, losing crucial time,” he says.
He adds that salaries are not paid for months at a stretch, creating discomfort.
Environmental factors
Speculation is that November was bad this year due to changing environmental conditions, and the Aedes mosquito having acquired resistance.
“Research shows that the mosquito has acquired resistance against drugs used for fogging and fumigation. This has also helped it in resisting environmental changes,” says a senior faculty member of community medicine at All India Institute of Medical Sciences.
He says even where fumigation was done properly, cases were reported. The mosquito can probably bear more cold than earlier. “Thus, even after the temperatures dipped, it took long for dengue cases to come down,” he adds.
Fight the bite
* Operations for checking of mosquito breeding sites and spraying medicines in the city are carried out by dengue breeding checkers (DBCs)
* The first epidemic was seen in Delhi in 1996. That’s when DCBs were appointed, initially for five months a year, which was extended to eight months later
* From the coming year DBCs will work throughout the year. East and South Delhi Municipal
Corporations have already passed proposals to this effect
* But the number of DBCs — 3,200 — has not changed
* Health facilities are supposed to give the name and address of the patient, in addition to the number of fresh cases. This helps in tracking the area of mosquito presence, and in fumigation and fogging efficientl*