A losing battle against vector and virus

For five consecutive days more than 3,000 dengue patients got admitted to different hospitals of the country with the lowest death toll of seven recorded in 24 years by 8 a.m. on Tuesday and the highest 21 by 8 a.m. on Wednesday and Thursday. There has been a remarkable difference now in the pattern of this mosquito-borne viral disease's incidence. Dhaka City was the epicentre of the disease in the past but now more than double the number of patients is reported from rest of the country. Even the number of deaths is higher in the rest of the country than in the city. This is particularly concerning because it shows that the disease has spread all across the country as against its concentration in the densely populated urban conundrum. The vector aedes aegypti has got life-cycle colonies in locations beyond the capital with a large number of patients falling victim to it. Its import is grave because management and control of the mosquitoes and the disease the female of the species spread will now be nearly impossible.
In the past 20 days of this month, more than 50,000 people have fallen victim to the disease, of which 295 patients succumbed to it. The death toll rose to a record 888 this year by Wednesday last. Now a disease is considered an epidemic when it breaks out in a community far in excess of the usual or normal rate in a given time or season. It can be a localised epidemic or a regional or national epidemic. But the administrative definition of an epidemic is calculated on the basis of a weekly 400 plus patients among each 100,000 people living in a place. On that count, Bangladesh may not as yet have witnessed a dengue epidemic but when the daily death toll of the disease is close to 20 and more than 3,000 people get it, the nation can feel the health exigency is no less than an epidemic.
Although, villages have not been affected as severely as the urban centres all across the country, the unexpected profusion of rains in this Autumn provides for the perfect setting for dengue spread in rural areas. In that sense, what was once just a matter of health emergency for city corporations and municipalities has now become an issue of health concern for the Directorate General of Health Services (DGHS) and the Ministry of Health and Family Welfare.
Evidently, the monsoon seems to have shifted to the season next to it when against the backdrop of the azure, patches of white cotton-like clouds should have sailed lazily from south to north. Instead, the Autumn is more like the monsoon when dark clouds cover the sky from end to end or a few of those laden with rains suddenly descend fast to cause a shower or two or even heavy spells of rains several times a day. At the end of Aswin, Kartik in this part of the world is known more for viral fever and other water-borne diseases because it is the time when water that submerges plains of this delta loses its freshness to get contaminated with its recession. Water gets, moreover, stagnated in pockets and continues to stink. That may not be the ideal breeding ground for aedes but in cases where rains get accumulated may help this particular type of mosquitoes' proliferation. If anything, there is hardly any chance of the exposure to an increased army of this dreaded enemy culminating before the winter when no rainfall is expected.
When hospital occupancy is beyond capacity, fresh dengue patients with severe conditions can hardly expect timely care. This has been happening right now in far-flung areas. The authorities were forced to issue an instruction not to refer or send dengue patients to hospitals in the capital city from other areas. This might be one of the reasons why more deaths are now reported from outlying towns and villages.
The city corporations are primarily to blame for not unleashing effective and intensive action programmes for elimination of the breeding grounds of aedes mosquitoes in the city when virologists warned of the danger to come. Rather, the scam over import of bacillus thuringiensis isralelensis (BTI) by a fake company for the Dhaka North City Corporation (DNCC) cast a long shadow on the drive against the vector and the virus. When there was a real chance of containing the disease within a limited space of the capital city and a few other urban centres, the city fathers gave at best an impression of a lack of seriousness and at worst a helpless capitulation to the tiny mosquito. They could do better by following the methods the authorities in Kolkata with weather and other conditions similar to Dhaka have developed to fight the vector. The larvicide Marshal Agrovet imported may be fake but there are genuine companies elsewhere including the Best Chemical Co (S) Pte Ltd, of Singapore. But there was no further move to procure the genuine BTI.
Corona left many families devastated with the death of the only child or income earner in a family. Now dengue is doing the same. Loss of life/lives, livelihoods, money together with the trauma suffered by each family on account of dengue is more than enough to make it a dreaded epidemic.

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