- Are we prepared to control the increase in dengue cases during the economic crisis?
By Shailendree Wickrama Adittiya
The monsoon brings with it an abundance of rain, as well as floods, landslides, and strong winds. The Meteorology Department yesterday (17) stated that the south-west monsoon was gradually establishing over Sri Lanka. The rains also create more breeding grounds for mosquitoes, resulting in an increase in dengue patients.
While the increase in dengue cases during this time of the year is to be expected, this year in particular poses new issues due to the economic crisis. Health officials have already raised concerns about the spread of dengue, with public health inspectors (PHIs) also highlighting a shortage of chemicals used in dengue eradication.
Speaking to Brunch, National Dengue Control Unit (NDCU) Director Dr. Sudath Samaraweera said: “Dengue cases have increased, and we expect it to further increase in the future. The total number of suspected cases so far this year is 20,536.”
Current situation
A total of 20,536 suspected dengue cases have been detected so far this year, out of which 2,813 were detected in May. The highest number of suspected cases were detected in January (7,702 cases). In February, 2,962 suspected dengue cases were detected, a number that rose to 3,040 the following month. In April, 4,019 suspected dengue cases were detected.
According to data shared by Dr. Samaraweera, 22.1% of the suspect cases detected in May are from Colombo, while 11.6% are from Kalutara, and 9.4% are from Gampaha, which means that 43.1% of the total suspected cases this month are from the Western Province.
In comparison, Epidemiology Unit data shows that during the first five months of 2021, dengue detections totalled 10,471.
About the illness
According to the NDCU, dengue is a viral infection transmitted by the bite of an infected mosquito and the infection outcomes can range from asymptomatic to symptomatic. The latter includes undifferentiated fever (viral syndrome), dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue with unusual manifestations. Of these, dengue fever and dengue haemorrhagic fever are the most common.
The onset of dengue fever is marked by sudden high fever, severe headache, pain behind the eyes, and pain in muscles and joints. The NDCU adds that some may also develop a rash and varying degrees of bleeding from various parts of the body, including nose, mouth and gums, or skin bruising.
Dengue haemorrhagic fever is more severe and is characterised by three phases: Febrile phase, critical phase, and convalescence phase.
Early detection and management can minimise morbidity and mortality, but there is no specific treatment for dengue. Thus the medical crisis in the country has not had an impact on dengue patients, Dr. Samaraweera said.
With regard to the chemicals used for mosquito fogging, he said new stocks have not arrived, but that there are sufficient stocks for now.
Challenges faced by PHIs
However, PHI Union President Upul Rohana painted a different picture. He said that cases are highest in the Western, Southern, and North-Western Provinces.
“We are continuing our duties as usual, but with the ongoing situation, there have been several issues in the past few days when carrying out dengue surveillance,” he said.
According to Rohana, there have been certain difficulties in sending surveillance teams to inspect residences, due to safety concerns in the country. He added that the fuel shortage has disrupted the duties carried out by PHIs, as they cannot supply fuel to vehicles used by Medical Officer of Health (MOH) units, with some vehicles remaining unused for close to two weeks due to the lack of fuel.
“The work capacity of officers has also dropped significantly. PHIs mainly use motorbikes when carrying out field work. So regardless of a fuel allowance, even if they have money, there is no fuel. If they are in the field today, they have to stand in line for fuel tomorrow,” Rohana said.
This has resulted in a drop in the number of hours during which a PHI can carry out duties.
In addition to this, testing has dropped due to shortages, which in turn means that the number of confirmed patients reported is low.
“It is thus clear that there are more dengue cases than are reported, but with the ongoing issues, there have been serious difficulties controlling the situation,” he explained.
According to the PHI Union President, the usual protocol once a dengue case is reported is the cleaning of the premises and surrounding areas. Mosquito fogging is then carried out within a 500 m radius. “However, now the issue is that we do not have the chemicals for fogging, so we have stopped it entirely,” he revealed.
Allocations for public awareness programmes from local government bodies have also been affected, and PHIs do not receive the usual level of support from local government and other state institutions.
“On the part of the public, we do not see as much co-operation as there used to be, in keeping their houses and premises clean. This could be due to the other problems they are facing,” Rohana went on to say.
He added that various factors, including spells of rain, lead to a rapid increase in the mosquito population. However, there has been no assurance from health officials on the supply of fuel or chemicals, nor has a timeline been provided for when supply can be expected.
“If a solution is not presented to us soon, there is a risk of a disaster situation coming about due to dengue,” Rohana warned.
PHOTOS © NATIONAL DENGUE CONTROL UNIT