Bengaluru: Dengue, battling a deadly surge

Is Bengaluru forever destined to be diseased at the first sign of rain? Aided by a thoroughly unprepared healthcare system, the deathly dance of Dengue has gripped the city yet again. Spiraling out of control, the virus has already struck hundreds, triggering chaos and panic.

Season after season, Dengue and other vector-borne diseases have plagued the city with renewed vigour. And yet, a robust mechanism to arrest their spread is still to take shape. Awareness campaigns remain sporadic, healthcare institutions are under-equipped and platelet shortage is getting disturbingly real.

Clogged drains, construction debris and garbage hotspots have left vast swathes of the city exposed to water stagnation. Water crisis has forced many to store the precious resource in open containers. If these are not an invitation for mosquito-breeding, what is? And to make it all worse, effective coordination remains a taxing issue between multiple civic agencies and the Health Department.

BBMP preparations

But the Bruhath Bengaluru Mahanagara Palike (BBMP) insists that its preparations are in order. In Mid-May, the Palike Commissioner had directed the Solid Waste Management department to focus on taking out disposed containers, coconut shells and items that aid water stagnation.

Yet, the action on the ground is missing. Silt-filled shoulder drains, a step away from houses, are all across the city. De-silting of the drains, big and small, is sporadic and inadequate. Fogging operations, virtually unseen for years, are being ordered only now. Vacant spots filled with weeds and puddles have turned perfect breeding grounds for mosquitoes.

Delayed fogging

Delayed fogging, particularly when the monsoon has already set in, could be largely ineffective. The rains quickly wash away the chemicals. BBMP officials themselves admit the fogging operation should have begun at least two months in advance.

The city is already in a twister over poor solid waste and storm water drain management, and combating the mosquito menace should have been a priority.

However, the Palike’s Health Department officials say that two link workers per ward have been posted to undertake Dengue source reduction and spread awareness. “Two to three personnel per health centre and Asha workers have been tasked with this. There are also three spraymen per ward to spray larvicide on stagnant water,” an official informs.

Intermittent rains

Intermittent rains have made their work tougher, as open containers –both dumped and in use--are all over the place. “People store water in small containers and leave them open for days. The life cycle of mosquitoes that carry the Dengue-causing virus is seven to 10 days,” notes the former BBMP Chief Health Officer (Public Health), Dr. Manoranjan Hegde.

Dengue, as the World Health Organisation (WHO) notes, is a mosquito-borne viral infection causing a severe flu-like illness. This could lead to a potentially lethal complication called severe dengue. Globally, Dengue’s incidence has increased 30-fold over the last 50 years.

WHO defines

The Aedes aegypti mosquito is the main vector that transmits the viruses that cause Dengue. “The viruses are passed on to humans through the bites of an infective female Aedes mosquito, which mainly acquires the virus while feeding on the blood of an infected person,” WHO makes it clear.

A dramatic drop in blood platelet count often sparks panic among the patients. Since patients are brought to the hospitals often at a stage when platelet infusion is inevitable, there is a frantic search for this critical blood component.

But in blood banks across the city, platelets are arranged only when required and this takes time. As the clock ticks and the count drops, relatives are in despair, arranging donors and taking them to the blood banks for extraction.

Single Donor Platelets

In their frantic search for platelets, people are often forced to ignore doctors’ advice to prefer Single Donor Platelets (SDP). Random Donor Pooled Platelets (RDP), sourced from multiple donors, are far cheaper but contains a large number of foreign bodies. RDP costs about Rs 650 a unit, while SDP can be as expensive as Rs 10,000 or more.

Commercial interests have found an opportunity to exploit this desperation for platelets. A senior doctor from a top government hospital in the city explains: “Shortage of platelets is an issue. But not all Dengue cases require platelet transfusion. By amplifying a myth linking Dengue with platelets, commercial interests get into the picture.”

Transfusion mark

WHO guidelines have clearly mandated transfusion of platelets only when the count falls below 10,000 / cu.mm in the absense of bleeding manifestations. Platelet transfusion above this mark is required only in case of Haemorrhage.

But often, panic sets in when the count is way above the 10,000 mark. Doctors say the search for donors should ideally start when the count is below 20,000. Transfusion does increase the count, but the process cannot be left to the last minute. By how much the count falls cannot be predicted in advance.

Mandatory tests

Before donation, the donors are required to clear all mandatory tests related to HIV, Hepatitis B and C, malaria and syphilis. Donors should not be diabetic on insulin. Nor should they be on any antibiotic or aspirin. Their Blood Pressure levels must be under control and hemoglobin levels under 12.5g/dL. Their own platelet count should be 1.5 lakh / cu.mm or more.

Platelet anxiety is bound to get worse as the number of cases rise. Last year, the city had recorded over 1,500 cases. But in 2017, the city had seen over 7,200 cases, dramatically exposing the inadequancies of an overstretched healthcare system. This year’s troubles are not going away in a hurry, and that is everyone’s worry.