JOIN USCholera in the time of the coronavirus
Stumped by the monsoon, the city’s healthcare infrastructure has always struggled against the collective onslaught of water -borne diseases. But this season, under the shadow of the COVID-19 pandemic, as dengue too spreads its deadly tentacles again, the spectre of an unprecedented health crisis looms.
The pandemic has had the Bruhath Bengaluru Mahanagara Palike (BBMP) divert its personnel for relief work. Inevitably, monsoon preparedness took a big hit. But even as the flooding risk increased with drains left to remain clogged, the prospect of water-logging has amplified the disease threat.
Deadly mix
Consider this deadly mix: COVID-19 containment zones with stretches of stagnant, water-logged streets; zero fogging, always a half-hearted attempt to stop mosquito-spread; and floods that could trigger widespread contamination of drinking water lines with sewage.
In the past, gastroenteritis, typhoid and cholera had left vast swathes of the city, particularly its slums, in dire straits. Yet, the avoidable deaths did not spark any revolutionary change in policy or infrastructure on the ground. This year, with all systems overstretched, will belated interventions prove to be too little and late?
Sliver of hope
There is a sliver of hope, though. As Dr Manohar K N, physician, internal medicine, articulates it, the precautions against COVID-19 could actually reduce the risk of contracting dengue, malaria and other mosquito-borne diseases. “People are not eating outside like before. They are not mixing much,” he says.
Unlike other Metro cities such as Delhi, Mumbai and Chennai, COVID-19 cases have so far remained within manageable numbers in the city. But this should not lead to complacency. “By June-end or July, COVID numbers could spike, and the dengue spike might come. If COVID cases also rise, then it can get challenging,” notes Dr Manohar.
Overlapping symptoms
Rise in water and mosquito-borne diseases can raise public anxiety over COVID, as the symptoms often send confusing signals. “It is very difficult to differentiate the diseases from the first two-three days of a viral fever. Diarrhea can be there for dengue too. Dengue can trigger body aches. You cannot categorically differentiate (in the beginning).”
The multiplicity of asymptomatic COVID-19 cases has only complicated matters. Besides, dengue, a hitherto seasonal disease is now being reported right through the year.
In general, the pandemic has affected regular monitoring of all non-COVID diseases. The utilization of scarce resources to battle the pandemic has made it tough for patients with non-COVID illnesses to get medical care, notes Dr H Sudarshan Ballal, Chairman, Manipal Health Enterprises Pvt Ltd.
This, he says, “includes the huge burden of NCD cases who require long-term care and also the communicable diseases like other respiratory viral illnesses, mosquito-borne viral diseases and food-borne infections. This is especially important now since these diseases spike in this season between May and November.”
Innovative strategies
To address the non-COVID and NCD (Non-Communicable Diseases) burden and the public’s safety concern, adopting innovative ways are critical. Dr Ballal elaborates, “This is already being done through encouraging tele-consults, special precautions of social distancing, screening, PPE for protection of healthcare givers and patients in hospitals. Many of us have taken measures to instill confidence in people that it is safe to visit hospitals.”
Public awareness is also of paramount importance. “We need to allay the fear and paranoia around Corona among the public and encourage them to seek healthcare either virtually or in person and make sure non-Corona illnesses are not ignored.”
Cholera cases
Water-borne diseases had struck the city even before COVID-19 spread its tentacles wider. By the first week of March, several Cholera cases were reported from Neelasandra, L R Nagar, Srinagar, Padmanabhanagar and Azad Nagar. Sewage contamination with drinking water was the usual suspect.
Cholera often shows up with diarrhea, acute dehydration, depleted electrolyte level and low potassium and sodium levels. If ignored, in some cases, doctors say cholera could also lead to renal failure. One to two days after infection, gastroenteritis manifests itself through nausea and vomiting, headache, muscle aches, fever or chills, sweating, abdominal cramps and loss of appetite.
Management of seasonal flu’s and water-borne diseases can get tricky during the season. The symptoms overlap, notes Dr Pragati Hebbar, an Assistant Director with the Institute of Public Health (IPH). It is critical for the patients not to delay seeking medical help. To address concerns of contracting the virus from a clinic, tele-consultations with the doctor can be a way out, she notes.
Apprehensions
Citing the Ebola virus experience, Dr Hebbar recalls that the patients tend to postpone the visit to a doctor. In a tricky situation where the pandemic overwhelms the system, greater emphasis should be on taking extreme precautions against water-borne diseases.
Dengue has been one of the most dreaded this season. Highlighting the lack of a vaccine yet, the National Health Portal stresses the need to avoid mosquito bites. The Portal suggests insect repellants, mosquito nets, long-sleeved clothes and long trousers while going outdoors.
Precautions
Here is what residents living in areas infested with Aedes aegypti mosquito are advised to do: “Clean places where the mosquito lays their eggs, primarily artificial containers that store water. Items that collect rainwater or are used to store water (for example, plastic containers, drums, buckets, or used automobile tires) should be cleaned or discarded.”
Another advice is “to empty pet-watering containers and flower vases, and scrub-dry them at least once a week. This will eliminate the mosquito eggs, larvae and reduce the number of mosquitoes present in these areas. Chemical larvicide such as Temephos can be safely used in potable water.”
But beyond this advisory, the ground reality in the city gives a different picture. Garbage dumps are lying around all across the city with single-use plastic containers, ready to beckon the mosquitoes in droves. Clearing them quickly might just slow down the onset of the next big outbreak.