The BBMP's budget for fogging is Rs 8 crore! Yet, come the monsoons and even when hospitals and clinics are inundated with dengue victims, no fogging is done. The excuse - WHO guidelines that apparently ban fogging! Let us let you into a little secret, BBMP. Virtually all restaurants that are open to air, most five star hotels and now even neighbourhood committees are hiring private foggers to fumigate their homes and places of business every day. DC has learnt that city hospitals are treating an average of 20 dengue cases per day. Yet, the city's health authorities refuse to acknowledge that dengue is a killer, saying people are dying of multiple organ failure, not dengue. Err...dengue, causes multiple organ failure! Once again, with the BBMP unable or unwilling to help manage the crisis, it is the citizenry that steps in to curb the disease at the grass-root level.
The city’s dengue story is getting complicated. Only two days ago a 31- year- old woman died at a city hospital of dengue going by her family and friends, but neither her doctors nor the BBMP health officers are willing to confirm it.
Whether or not the authorities are willing to accept the gravity of the situation, hospitals are still seeing a large number of dengue patients every day.
“We are treating some 20 dengue cases and on an average do two or three blood transfusions every day. Any patient with a platelet count of 20,000 or less and who is bleeding, is admitted for transfusion,” said Dr Shankar Prasad, Medical Director, St. Philomena's Hospital.
Manipal Hospital too is treating five to 10 cases every day going by its head of the Department of Internal Medicine, Dr Pankaj Singhai. And the vector-borne disease continues to causes many families grief. Twenty-seven-year-old Ganesh's family was expectedly worried as he walked in to meet the doctor at CMH hospital in Indiranagar with a platelet count of 26000 recently. “He has fever and only yesterday his platelet count dropped from 29,000 to 26,000. Just two days ago he had a count of 45,000,” added his father.
Whether the BBMP will classify him as a dengue patient is, however, unclear as despite private hospitals claiming to be deluged by patients suffering from the disease, it is willing to acknowledge only 861 cases in 361 private health facilities since January in the city. “We add up cases that have been confirmed by NIV, Mac Elisa and NS1 Antigen tests from across hospitals in all the eight zones,” explained an epidemiologist with the civic agency’s Public Health Information and Epidemiological Cell.
Ask Dr M Udaya Kumar Maiya, Medical Director of Portea Medical and he says the test and symptoms are both important for diagnosis of dengue. “If the Igm Mac Elisa test is strongly positive and a patient, who has bleeding, is in a state of shock, is lethargic and has a very low platelet count , dies after admission, it would be safe to say that he or she has died of dengue complications. Otherwise it can be attributed to non-specific viral infection,” he explained.
While advising Bengalureans not to hit the panic button, Dr Pavan Mangalore, consultant, emergency medicine, Columbia Asia Referral Hospital, Yeshwanthpur, however, says they do need to be alert. “The period between the third and sixth day of the fever is the most critical when patients could suffer from abdominal pain, giddiness, extreme lethargy and tiredness. You need to be aware of these symptoms and keep the patient properly hydrated,” he said.
Although some patients do walk in with gums bleeding as a result of low platelet count, Dr Murali of CMH Hospital says there could be internal bleeding as well, which is more worrying. “The same bleeding can occur in the brain or kidney. If they are bleeding on the inside, patients will have complications involving many organs, which could lead to multiple organ failure and death,” he added.
Dr K K Aggarwal, president of the Heart Care Foundation of India (HCFI), believes community participation is vital to preventing and controlling the spread of diseases transmitted by the Aedes aegypti mosquito, which include zika, chikungunya and yellow fever besides dengue. “In community participation, individuals, families and communities are involved in the planning and conduct of local vector control activities. The government does not have enough staff to search every backyard to identify and destroy all mosquito breeding sites," he pointed out.
Doctors also continue to stress that the most effective way to prevent dengue is to control mosquito populations, which means getting rid of standing water in containers, pet dishes, flower pots, vases, buckets, tyres and cans in and around the house. Or at the very least these should be covered so mosquitoes don’t get an opportunity to lay eggs, they emphasise.
Fogging, spraying only in some pockets
Hardly any fogging or spraying happens across Bengaluru, except in few pockets and this has contributed in the alarming rise in dengue and other vector borne diseases. The residents have been blaming BBMP authorities for their laid back attitude and the civic agency continues to be in a denial mode and downplay the problem. BBMP officials claim that a larvae study is going on, wherein they have identified water collection points and are looking at areas of water stagnation, where both fogging and spraying is going on.
“Eastern Bangalore is where we are conducting fogging as number of cases in that area is very high,” said a BBMP official. As for disease control measures, another health official said, “Anti larval operation, anti fogging operation are being carried out, especially in eastern Bengaluru. BBMP alone cannot do much regarding this and people should also take initiatives to ensure that water does not accumulate in empty tanks or vessels. We can only mitigate and educate people,” he added.
Teams have been formed across all 198 wards to conduct larvae survey and spray chemicals. Since the larvae has a seven-day life cycle, our workers are visiting open places like bus stops, vacant plots and other places, identifying breeding zones at constituency level. The survey is an ongoing process and will continue till September, he said.
Ways to protect yourself from the bite of the Aedes Aegypti
- Use Environmental Protection Agency registered insect repellents that contain DEET, picaridin, oil of lemon eucalyptus or IR3535.
- Use insect repellent with 20% to 35% of DEET as more than this can irritate the skin.
- Make sure you apply it to all exposed skin
- Apply and let sunscreen dry before using insect repellent. You want the mosquito to land on the repellent, not your sunscreen.
- Minimise exposed skin Wear light coloured and long sleeved attire and keep legs covered too as the mosquitoes are drawn to dark colours, floral patterns and sweet perfumes.
- Wear clothing treated with permethrin, a chemical used as an insecticide.
- Treat your own clothes, shoes with a permethrin spray.
- Sleep under mosquito nets with windows and doors closed or securely screened if there is no air conditioning.
Symptoms
Dengue warning signs include severe abdominal pain or persistent vomiting, red spots or patches on the skin, bleeding from the nose or gums, vomiting of blood or blood in stools, drowsiness or irritability, pale, cold or clammy skin or difficulty breathing.
Diagnosis
Clinical diagnosis – is made by the health care professionals based on a constellation of symptoms and clinical laboratory findings (e.g., CBC, platelet count).
Laboratory diagnosis – is specific for dengue is made through testing of a blood sample.
CDC Guidelines for Prevention
- The most effective way to prevent dengue is to prevent mosquito bites and control mosquito populations.
- As only a few infected mosquitoes can cause large outbreaks of the disease, effective mosquito control requires community support
- Mosquito- proof your home, in and out, install or fix screens on windows and doors. Do not prop open doors, allowing mosquitoes to fly in. If you have air-conditioning, use it.
- Drain and dump standing water found in containers and other things in and around the house. Or at least cover them so mosquitoes don’t have an opportunity to lay eggs.
- Weekly wash out containers with a brush or sponge to remove mosquito eggs.
What to do when one has high fever
The monsoon season brings with it several kinds of viral infections and fevers. Most of them are largely harmless and abate after a week or so. But if the fever continues for more than three days and is accompanied by rashes on the body and intense headache, make sure to consult a doctor.
Prevention of dengue
At the Personal level: Do not wear half sleeves and shorts during the monsoon and use mosquito repellent creams or nets at home. Ensure there is no source of mosquito breeding in and around your home or workplace.
At the Community level: Don't let water stagnate in containers, coolers, tyres and broken pots or even half broken tender coconuts.
