Millennium Post

Caught napping by Dengue menace

When Narendra Kumar, a labourer who lives in a slum in Delhi’s Badarpur area, returned home from work on September 13, he found his mother burning with fever. He took Renu Devi, 63, to a nearby doctor, but her condition kept deteriorating. He then shifted her to a nursing home, where he was advised to take her to Safdarjang Hospital. At Safdarjung, she was diagnosed with dengue. Kumar says he spent Rs.15,000 on treatment in the three days before he came to Safdarjang. He had saved this money to visit his village in Bihar during the festival season. It will not be possible for him to make the trip now. He is, however, relieved about his mother’s health because the doctors have told him not to panic, and the treatment is free. Similar is the case of Balwant Ram, a Gurgaon resident. His wife, Vimal Devi, 40, was treated for four days in the city’s Metro Life Line Hospital at an expense of Rs.12,000. But her condition continued to deteriorate till she was taken to the All India Institute of Medical Sciences (AIIMS), New Delhi.

These patients were still fortunate to have received timely treatment, which is not always the case. Till September 21, a total of 22 patients, mostly children, had died of dengue in Delhi. In fact, the media took note of dengue in Delhi only after two children, Avinash and Aman, were denied admission to Safdarjang and Moolchand hospitals and died on September 8 and September 12 respectively. The city has witnessed over 3,194 cases till September 21, with nearly 1,000 cases reported between September 5 and September 15. This is the worst outbreak in the last six years. Caught unprepared, the health infrastructure in Delhi was unable to cope with the deluge of dengue patients. Despite having witnessed the first case in January—a time when dengue cases are usually not reported—the governments did not take adequate measures to deal with the problem. The dengue cases in January were a result of unseasonal rainfall, followed by a dry spell that created humid conditions and allowed the dengue-carrying mosquito, Aedes aegypti, to breed.

The helplessness of the Delhi government in dealing with dengue was mirrored by other states too. According to the Union Ministry of Health and Family Welfare, all the states of the country have reported dengue cases this year. There have been around 27,676 cases of dengue in India this year, and 60 deaths. Delhi and Karnataka have been the worst affected states. South India, in particular, has reported a large number of cases this time, with states like Kerala, Telangana, Andhra Pradesh, and even Maharashtra bearing the brunt of the dengue attack. Kerala has had the highest number of deaths (19) in the country. Even states like Arunachal Pradesh, which had no dengue cases until two years ago, has been hit by the disease this time.

So, is this year’s dengue virus more virulent? “No,” says <g data-gr-id="115">Rajeeva</g> Moger, senior consultant, Internal Medicine, Apollo Hospitals, Bengaluru. “In fact, the overall symptoms are easier to cure this year as compared to last year,” he says. But a few patients have shown “sudden” worsening of symptoms leading to death, he adds. Savio Pereira, the associate medical superintendent at St John’s Hospital, Bengaluru, too sees no increase in virulence in this year’s strain. Apollo Hospitals and the National Institute of Mental Health and Neurosciences (NIMHANS) are jointly doing a study to identify the strain of dengue virus in circulation in Karnataka this year. Blood samples are being collected, and tests will be done in November when the peak dengue season is over. More information on this year’s strain is expected by December. The same team worked on last year’s dengue virus and found it to be the “serotype 2”, says <g data-gr-id="116">Jayasree</g> Shivadasan, consultant microbiologist, Apollo Hospitals, Bengaluru.

Caught unprepared
Delhi’s administration should have been better prepared, after having witnessed dengue outbreaks since 1996 and fully aware of the post-monsoon peak dengue season. But even basic preemptive measures, such as fogging, were not undertaken in time.

Hospitals in the city were not able to deal with the sharp rise in cases and started to either refuse admission to patients or could not provide timely and adequate service. In almost all cases of dengue deaths, it was found that the doctors either did not provide emergency services or refused admission. When a Down To Earth team went to Safdarjang Hospital, one of the biggest in Delhi, on September 15 (more than a week after the dengue outbreak), the scene at the special ward created for dengue patients was that of utter chaos. There were around 90 people in the room—patients and their family members—vying for medical attention, and the six on-duty doctors present were finding the going difficult. There were two patients on every bed, and more waiting outside. Anil K Rai, a medical superintendent of Safdarjung Hospital and Vardhman Mahavir Medical College, says, “We are accommodating all the patients. There is a lack of beds, but this will be taken care of in the coming months.” When it finally woke up to the problem, the state government issued an order on September 12, asking all state-run hospitals to increase the number of beds by 1,000 within a week. Even private hospitals were asked to buy more beds and hire more doctors, nurses and paramedics. It also ordered that patients suffering from dengue should be admitted on priority and hospitals must defer elective surgeries, if necessary, to make space for dengue patients. The government also cancelled the leaves of all doctors and directed private hospitals to cap the rates of diagnostic tests—the cost of platelet count test has been capped at Rs.50 while the ELISA-based NS1-antigen and dengue antibody tests have been capped at Rs.600. But these measures are all curative while the need was of preventive steps. On September 17, taking note of the sharp rise in dengue cases, even the Delhi High Court asked the Union government, the state government and civic bodies to explain the steps they were taking to check the crisis.

Southward spread
The situation is equally bad in Karnataka. The official figure for dengue cases in the state is 3,674 while the number of dead is four. But there are doubts about the accuracy of government data. In Bengaluru, the official figure for dengue cases from January 1 to September 18 was 1,199. But this appears to be a gross underestimate because just one hospital— Apollo on Bannerghatta Road—has reported 1,679 dengue cases since January. Other districts hit by dengue are Dakshina Kannada, Udupi, Mysore, Kolar and Bellary.

Along with dengue, chikungunya—another disease spread by the mosquito—has hit Bengaluru. The department of health and family welfare’s latest records say that a total of 1,428 individuals have been affected by chikungunya this year in Karnataka, of which 409 are from Bengaluru city. Bruhat Bengaluru Mahanagara Palike, the city’s municipal body, has undertaken awareness campaigns, but the efforts still appear to be inadequate. A lot of localities have yet to witness door-to-door campaigns or fumigations.  The ongoing strike has also hit efforts to manage dengue in government hospitals by some 2,500 junior and resident doctors for an increase in pay.

The scenario in Karnataka’s neighbouring state, Tamil Nadu, is no better. In fact, here local bodies are not even willing to share information. In Chennai, for instance, officials at the Municipal Corporation and doctors at the government general hospital are not speaking to the media. There are no official figures for dengue cases in the city. The issue has not even been picked up by the media in Tamil Nadu, which, the Ministry of Health and Family Welfare says, is the third most severely dengue affected state in the country. It has seen 2,343 cases of dengue this year, including five deaths. The state government, however, appears to be in denial mode.

“Most of these 2,000 cases are from an outbreak that took place in Virudhunagar town at the beginning of the year,” says K Kulandaisamy, Director of Public Health, and Tamil Nadu. According to George Varghese, associate professor at the Department of Medicine & Infectious Disease at Christian Medical College, Vellore, availability of improved diagnostic tools, such as the NS1 antigen test and IgM and IgB tests, is probably the reason behind the increase in positive cases being identified and recorded.

Kulandaisamy says the government is in constant touch with local bodies to raise awareness and to implement control measures. There seems to be little public awareness of control measures. No public service messages have been seen in the print media or on television. “We are not using the media to spread awareness, rather focusing on local-level mobilisation and awareness campaigns. We are tying up with educational institutes to form student groups to spread awareness in their localities. Prevention of breeding is one part of this awareness. The other is to encourage people to consult a doctor if they develop a fever. All hospitals are keeping records of fever cases. This data is being used to prioritise our control measures,” Kulandaisamy says.

Exorbitant cost
Unable to bear the cost of dengue treatment, people have started to make insurance claims for their medical expenses. Bajaj Allianz General Insurance says that it has seen a spike in claims in the past fortnight. In 2014-15, the company received 1,400 dengue claims. The figure this year stands at 900. But the numbers could increase as we are still in the middle of the dengue season. In the past three years, Bajaj Allianz has received, on an average, 2,100 dengue-related claims every year. Most of these came from Maharashtra, followed by Delhi and Gujarat. Companies are also trying to make a fast buck by offering insurance schemes. The website of Apollo Health Care Insurance, for instance, says the company offers a scheme for dengue with a base premium of Rs.578. Though Bajaj Allianz does not have any dengue-specific scheme, its Health Ensure policy offers a comprehensive cover for several diseases, including dengue. In response to a Down To Earth mail, a representative of the company said, “If you are in the age group of 25 to 40 years, by paying as little as Rs.650 for a sum insured of Rs.50,000, you can not only get a cover for monsoon-specific diseases like dengue, malaria, cholera, typhoid or swine flu, but also insure yourself against hospitalisation expenses incurred in case of accidents.”

Patients have been found claiming to have paid lakhs of rupees for the treatment of their near and dear ones. This could be true, say, experts, because the cost depends on the severity of individual cases. But on an average, the figure is around Rs.50,000. “Nearly 30 percent of the treatment cost for dengue is towards room charges,” says Bajaj Allianz.
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