Are we headed towards another dengue crisis?

Against all odds (read: the non-existent movement restrictions and the maintenance of health safety guidelines almost becoming a practice-as-you-please thing), it seems the rate of Covid-19 infections in Bangladesh is finally going down, and hopefully nearing the "safe" and much-desired mark of five percent or less. This is, without a doubt, a welcome development, given the phased reopening of schools and, soon, of universities. Lest we rest easy, though, the seasonal dengue menace has been making itself known in the country for the last few months.

In fact, the beginning of the "dengue season" this year can be traced back to May, when 43 people were reported to be infected by the virus. By the end of July, the number of dengue cases climbed to 2,098 in the country. As of the morning of September 19, this number stood at 15,701, with 5,345 people diagnosed this month alone.

Dengue has caused 59 deaths in the country so far this year, according to the Directorate General of Health Services (DGHS). While most of the cases of infections have been reported in Dhaka, dengue—as any other virus—has started spreading outwards. For instance, of the 307 cases reported between September 14 and 15, about 20.52 percent were cases reported outside the capital. This is significant when we consider the fact that, of all the dengue cases this year until September 15, only around 10.79 percent were detected outside Dhaka.

However, the question now is not how we can combat this dengue surge, but why we did not anticipate this situation in the first place. Did the 2020 outbreak of Covid-19 pandemic wash away all the memories of the horrid dengue crisis that the country suffered in 2019?

Two years ago, the worst dengue outbreak in Bangladesh since 2000 left 101,354 sick with the dangerous serotype-3 variant of the virus—the same one is at work in 2021 as well— and caused at least 179 deaths, according to the DGHS. While the monsoon months typically see bouts of dengue infections anyway, the current dengue situation could also have been handled better, with preparations based on the experts' observation that dengue outbreaks seem to be worse every other year.

So, what can we learn from the errors made in 2019 in order to save our citizens, and our already exhausted healthcare system, from the burden of another dengue epidemic?

One of the major ways in which city corporations attempt to kill Aedes mosquitoes (carriers of the dengue virus) and prevent their breeding is by fogging—that is, the spraying of mosquito repellents in public spaces using fogging machines. However, in 2019, a study by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) found that the insecticides sprayed by the city corporations in Dhaka had no effect on adult mosquitoes, as they became resistant to one of the major chemical components of the insecticides: permethrin. This study was presented by the icddr,b to both the city corporations in May 2019. One would presume this would have given the authorities enough time to buck up and use insecticides containing malathion and deltamethrin instead of permethrin, as recommended by the researchers. Or to start their dengue awareness campaign earlier on. But it was not until July 15, 2019 that the Dhaka North City Corporation (DNCC) held a meeting and decided to look into the effectiveness of its adulticides. Alas, the dengue epidemic of 2019 still happened.

When it comes to diseases like dengue, authorities such as the city corporations tend to put a lot of emphasis on the citizens' own responsibility to save themselves from being infected. But there comes a point where it stops being awareness-building and starts becoming blame-shifting. No doubt, the public must take up preventive measures, such as wearing clothes that cover most of their bodies, spraying insecticides in their own homes, and get rid of stagnant water so Aedes larvae don't get the chance to breed there. But it cannot be denied that the majority of places where mosquitoes can breed freely and undisturbed are public spaces, making them the responsibility of the authorities.

Conducting mobile drives and imposing fines on people whose private properties have been found to have Aedes larvae are all well and good. But equal vigilance is required to encourage people to keep their homes clean and to raise awareness about how dangerous the dengue virus—specifically the serotype-3 variant—can be. Additionally, bulking up our healthcare sector to deal with the increasing number of dengue patients, amid the still-dangerous Covid-19 situation, is also crucial. Back in July, when the Covid-19 numbers were at their worst, two of the dengue wards of Shaheed Suhrawardy Medical College Hospital in Dhaka had to be re-assigned to accommodate coronavirus patients.

It is important to remember, no matter what the disease, that prevention is more desirable—and certainly a more intelligent option—than cure. Viruses will likely never disappear and will only mutate and exist among us as different, more dangerous variants. While dengue is seasonal, it is not as discriminative as Covid-19, in that it can infect people of all ages—including children. We must all work together—the state and the people, to the best of our respective abilities—in order to prevent a situation as bad as what we experienced in 2019, in this year and in the coming ones.

Afia Jahin is a member of the editorial team at The Daily Star.