Doctors divided over debate on chikungunya deaths in Delhi

Amid debate over chikungunya deaths in the city, opinion of doctors seem to be divided with some asserting only 0.1 per cent people run the risk of dying due to its complications while other medical professionals attribute the fatalities to the vector-borne disease.

"1 out of 1,000 people, i.e., 0.1 per cent run the risk of dying due to chikungunya complications and that too if the patient has co-morbid conditions. Chikungunya is otherwise non-fatal," AIIMS Head of the Department of Medicine Dr S K Sharma said.

At least 15 fatalities due to chikungunya complications have been reported at various city hospitals, including one at AIIMS, while over 2,600 people have been affected by the mosquito-borne fever this season.

"If one analyses the deaths, attributed to chikungunya, being reported in Delhi, you would realise that most of them had co-morbid conditions, like hypertension or diabetes or kidney or other renal problems. Chikungunya as such cannot cause death," AIIMS Director Dr M C Misra said.

But doctors at the Sir Ganga Ram Hospital (SGRH), where nearly half of these deaths have been recorded, say it was chikungunya that precipitated the death.

"Yes, most of these patients were old and had co-morbidity, but why are people finding it hard to believe that chikungunya cannot cause death. There are six crore diabetic people in Delhi, nearly 15 lakh suffer from blood pressure problems, they weren't dying earlier.

"The seven persons, who died here, were elderly people and suffered complications triggered by chikungunya and succumbed. Why are we so embarrassed to admit that these deaths were due to chikungunya? As per WHO reports, chikungunya outbreak in France and the US and South America have caused deaths," Chairman of Department of Medicine at SGRH, Dr S P Byotra told PTI.

Among the remaining fatalities, five of them were reported at Apollo Hospital, one each at AIIMS, Hindu Rao Hospital and Pushpawati Singhania Research Institute.

Dr Suranjit Chatterjee, senior consultant in Department of Internal Medicine at Apollo Hospital, says, while a debate over the fatality issue is fine, "doctors should not get dogmatic that chikungunya cannot lead to death."

"Out of the five patients who died at Apollo, while four of them were old and had some kind of co-morbid conditions, a 31-year-old man from Noida, did not have it, and died within a day of admission. His death has puzzled all of us doctors here," he said.

Besides, a 22-year-old girl died of cardiac arrest triggered by chikungunya complications at Hindu Rao Hospital. Most of the deceased belong to Uttar Pradesh, including the one at AIIMS, who hailed from Muzaffarnagar, and died of multi-organ failure.

Gulab Chand Gupta (70) from Lajpat Nagar in south Delhi, had died on September 12 Pushpawati Singhania Research Institute (PSRI). His family members are still trying to come to terms with his death, as Gupta was "fit and had no medical history".

"We have been told chikungunya is non-fatal. And, that may lead to death in those cases where the patients has co-morbidity. But, he had no medical history, he was fit and never smoked a cigarette or consumed alcohol. And, he even practiced yoga everyday," his son-in-law Santosh Mangal said.

Doctors at PSRI in the report said, describing his death from chikungunya complications said, "he died of acute febrile illness with septic shock and multi-organ failure."

AIIMS Head of the Department of Medicine, Dr Sharma, when asked about this case said, "I will have to scrutinise this case, before commenting on it."

At AIIMS laboratories, at least 2,000 blood test samples have tested positive for chikungunya, and doctors there are also studying the viral strain that is in circulation.

Experts have conjectured that the outbreak of chikungunya this year could be due to "evolution" in the virus strain.

Chatterjee and Byotra, both say that there is a possibility of viral strain of chikungunya "having evolved" but only a scientific study can give us a real picture.

The national capital and several other parts of north India are witnessing an outbreak of chikungunya after nearly 10 years. In 2006, over 13 lakh suspected chikungunya cases were reported in Delhi.

Dr Lalit Dar of Department of Microbiology at AIIMS, however, says, the rising cases of chikungunya after the 2006 outbreak could be due to "Delhi having a lot of migrant population and generation born after 2006."

"Since they were not exposed to the viral strain in 2006 and hence not grown immune, so they are getting affected by it," he said.

According to Dar, AIIMS laboratories have "tested 3,500 cases of chikungunya samples out of which 2,000 have tested positive, nearly 58 per cent. And, for dengue, out of 8,500 samples only 474 have tested positive."

The committee set up by the Delhi government to review the death attributed to dengue and chikungunya, had earlier, "ruled out" chikungunya as the primary cause of fatality.

"Why is a debate about primary or secondary cause. Chikungunya complications have proved fatal in many of these patients, and it is better to acknowledge the deaths do a proper research of the virus, rather than seeing it as something to be embarrassed about," Byotra said.