Dengue: an added worry amidst the pandemic

Dengue cases in the country are on the rise again—since June, there has been a surge in the number of dengue patients seeking treatment in various hospitals. As of Monday, 796 people have been diagnosed with the virus so far, with 209 being treated in hospitals across the country, according to data shared by the Directorate General of Health Services (DGHS). A dengue-related death has also been reported by the media.

While the magnitude of the situation has not yet evolved to the scale of 2019, when according to official data, 101,354 individuals had been diagnosed with dengue with 179 deaths, the sudden increase in cases over the last few weeks indicate the possibility of dengue taking a dangerous shape in the coming months. This is in the midst of a surge in Covid-19 cases, which creates a whole new set of challenges.

There are various factors that are contributing to the increase in dengue cases. According to entomologist Professor Kabirul Bashar of Jahangirnagar University, there is usually a "zigzag pattern" in the rise and fall of dengue every alternative year. While one year, the number of cases may be very high, the next year the situation might not be as bad. And then the year after that, there might be another spike. We can see a similar pattern between 2019 and 2021.While in 2019 the scenario had been grim, in 2020 the spread of dengue had been significantly low, with 1,193 dengue cases and three deaths, as per DGHS data. In 2021, we are again seeing a sharp increase in dengue cases. In addition, there has been a good amount of rainfall this year, which has facilitated the accumulation of fresh water in various places, across public and private properties, turning them into the perfect breeding grounds for Aedes mosquitoes—the carrier of the dengue virus.

Brigadier General Mohammad Jobaidur Rahman, chief health officer of Dhaka North City Corporation (DNCC), listed the measures DNCC has taken to contain the spread of the disease—spraying larvicide and adulticide, raising public awareness, and cleanliness drives, among others. Mobile courts are also identifying private properties that are enabling the breeding of Aedes larvae and imposing fines. Similar measures have also been taken by Dhaka South City Corporation (DSCC). They are also working on multiple fronts to contain the breeding and spread of dengue. Both city corporations started these drives in April 2021.

So why, despite these measures, are dengue cases increasing? There could be multiple reasons, including the lack of an integrated approach towards vector management throughout the country. In Dhaka, for example, DNCC is working in its own way to contain the spread of dengue, and so is DSCC. But these efforts are not necessarily synced, at least by design. While both the city corporation bodies are taking steps, they are doing it in their own ways, and the same goes for all the other city corporations across the country. The lack of public engagement in containing the disease is another factor that is leading to its spike. While mobile courts are fining private properties, they cannot ensure proactive cooperation from the people through penalties.

However, all this could have been addressed had there been a Vector Control Policy in place, which could have been implemented in sync across the country, and throughout the year, to not only control the breeding of Aedes but also Culex mosquitoes, and other vectors. "There should be an integrated vector management mechanism in place. A vector management policy includes four major components: environmental control, biological control, chemical control, and community involvement," said Professor Kabirul Bashar. 

Environmental control ensures that throughout the year, certain environmental parameters are maintained that can control the population growth of these pesky insects, he said. Biological control ensures the elimination of mosquito breeds through natural mechanisms. For instance, copepods—small aquatic creatures—can be used to suppress the growth of the Aedes population. These small predators have been used in various countries to control the spread of Aedes mosquitoes. Similarly, guppy fish can be released in stagnant water bodies to control Culex population growth. Through chemical control (using effective chemicals and pesticides), adulticide and larvicide of mosquitoes are carried out, which both the city corporations are currently doing across Dhaka. Finally, community involvement relates to the proactive collaboration of the common people with the city corporations in fighting the spread of mosquito-borne diseases, which is especially needed to contain the spike of dengue.

This integrated vector management mechanism is missing in our country and as a result, while some measures are being taken by the various city corporations, these are not yielding the best possible results. For the last year and a half, the government has been sitting on a Vector Control Policy—the draft of which, according to LGRD minister Md Tazul Islam (as reported by this newspaper recently), is in its final stages. A Local Government Division official informed this daily that once the draft is finalised, it will be sent to the ministries of public administration and finance for vetting. But the question is, why is the government wasting so much time to finalise the draft of a policy which should be of high importance for it? Unless of course, dengue is no longer a priority for the government.

The country's healthcare system is scrambling and often failing—especially during the second and the ongoing extended Covid-19 wave—to support the people in fighting a global pandemic. In the midst of this, the outbreak of another disease would be disastrous for everyone, not least the common people who run the risk of being deprived of medical care due to a lack of adequate healthcare facilities. While why the government has not been able to strengthen its healthcare infrastructure in the last year and a half is a separate debate, why it did not take coordinated measures to prevent the rise of an old enemy—dengue—remains a big question.

Had the government been able to perceive the risk posed by dengue and taken proactive measures to control its spread, even before the season came, perhaps so many people may not have needed to be hospitalised for treatment today. The Vector Control Policy and an integrated vector management mechanism should have been in place by now to address this problem. But perhaps our government is reactive in nature and thus they take sporadic, stop-gap measures in reaction to certain situations. This has happened in the case of Covid-19 and is also happening in the case of dengue management. While 2019 should have been a lesson for the government, clearly it has not been so.

The government must immediately set in place the policy and its implementation mechanisms to salvage the situation. It is already late, but there is still time for a comprehensive and integrated approach involving the concerned ministries, the city corporations across the country, and the citizens of this nation to fight the spread of dengue. Covid-19 is already tearing our healthcare system apart. We must do everything we can to avoid an epidemic amidst a pandemic. 

Tasneem Tayeb is a columnist for The Daily Star. Her Twitter handle is: @tasneem_tayeb