States in bafflement

With experts and scientists not yet being able to find the root cause of the deadly 'mysterious' fever among children below the age of 10 years, it seems the country is going through a serious health crisis, as a large number of kids have died due to high-fever in Uttar Pradesh, Bihar, Haryana, Madhya Pradesh, etc.

The continued enigma over the cause of 'high-fever' among children exposes the lacuna in medical research in the country. It may be the outcome of time-taking research practices that the 'mysterious fever' has turned into an epidemic in just a few weeks and gripped several states including Uttar Pradesh, Bihar, West Bengal, Haryana, Madhya Pradesh, Maharashtra, North-eastern states etc.

The scary scenes of parents crying after losing their children outside hospitals in different states tell the story of the government's apathy and its lethargic approach in providing quality healthcare services to the residents in the said states.

Highest number of casualties among children has been reported from Uttar Pradesh's Firozabad district where over 60 children have died due to 'high-fever' or 'dengue' and above 450 children are still admitted to the child ward of the medical college in the district.

Experts and health professionals are divided over the cause of the viral fever. They have opined that the reasons behind the fever vary across regions. The high-fever in Uttar Pradesh is seen as an outbreak of mutated strain of dengue, while doctors from Bihar, Delhi and Haryana claim that rise in cases of fever is due to seasonal influenza-like infections apart from dengue, malaria, swine flu and typhoid.

According to medical experts, the relieving factor of this new kind of illness is that well-nourished children are responding well to the available treatment, however, it is proving fatal for newly born children and kids with some critical health issues or malnourishment.

Explaining about the trend, Lokesh Tiwari, HoD (paediatrics), AIIMS Patna, said: "As of now, most of the cases that you are suspecting of viral respiratory illness are of influenza and flu types. As per OPD pattern, out of 100, about 15-20 such cases are reported in AIIMS. We are keeping a close eye and seeing the trend."

"We have not reported any severe cases yet. Some serious cases that have come to the notice are of bacterial pneumonia," Tiwari said, adding that the trend of concern is a large number of admissions, which generally don't happen in case of normal viral fever.

However, the AIIMS-Patna doctor has outrightly rejected the reports about the early stage of Covid-19 phase-III outbreak among children, saying that findings of all the RT-PCR tests are negative. It's an air-borne and water-borne disease and the high number of cases is an alarming signal for the health fraternity, he said, adding that on normal days, we see a footfall of 100-120 patients in OPD, which has escalated to about 170 patients a day.

When compared to other states, the situation is quite normal in Delhi. Despite a rise in positivity from two per cent to six per cent, the severity is almost zero in the national capital. Sharing his views on the ongoing trend, Chacha Nehru Bal Chikitsalaya Director, BL Sherwal, told the Millennium Post that the cases of fever among children have increased, but there is no need of admission in comparison to other affected states like Uttar Pradesh, Haryana, Bihar, etc.

As per Sherwal, the rise in fever cases is a normal trend, as cases of flu and influenza are reported in the months of September and October each year. Doctors at Chacha Nehru Bal Chikitsalaya, which is a dedicated hospital for children, prescribe symptomatic medicines for patients visiting the hospital with the complaints of fever, and they are getting recovered.

Contrary to the AIIMS-Patna doctor, Sherwal doesn't see any unusual trend, as fever is the prime symptom and admission is only required when the platelets count comes down to below 20,000. The child specialist recommends liquid diets to keep the body hydrated and protect it from mosquitos.

Describing the cases of fever in some districts of Uttar Pradesh as a mutated strain of dengue, Sherwal said: "Deaths are happening due to mutated versions of dengue strain in the districts of Firozabad, Agra, etc. There are four strains of dengue, and mutated strain is more fatal as platelets of patients dip very fast resulting in a casualty."

"Delhi is completely safe and the people of the city need not to worry. They just need to follow all the preventive measures to keep themselves protected from mosquitoes," he said, adding that dengue viruses are spread to people through the bite of an infected Aedes mosquito.

Rejecting the claims of fever being a mysterious one, noted paediatrician Kafeel Khan said: "In science, there is nothing called mysterious fever. There is a reason for every fever. In the case of high-fever in some districts of Uttar Pradesh such as Firozabad, Agra, Aligarh, Maharajganj, Gorakhpur, etc., the main reason might be the contaminated water as it's a vector-borne and water-borne disease."

"Of the total, just five to 10 per cent cases are Japanese encephalitis, while rest are scrub typhus, herpes viral encephalitis, enteric fever encephalitis i.e., typhoid, dengue encephalitis, leptospirosis encephalitis and others. The UP government should direct its civic bodies to maintain hygiene," Khan said, adding that spread of the illness is mainly due to the state government's largely ineffective anti-mosquito control programmes.

"Japanese encephalitis is a viral disease and is caused mainly due to mosquitos. Some AES like viral encephalitis do spread through contact but that's rare and not such a big cause for concern. Besides mosquitoes, even mite bite to kids can cause AES-like scrub typhus," he said, adding that "the government should conduct a comprehensive serosurvey to establish a proper diagnosis as, if we don't investigate properly, mystery will continue to prevail."

As per experts, scrub typhus is a bacterial infection and spreads through bites of infected mites, and due to monsoon rains, mites generally get housed in storerooms of villagers and contaminate groceries, utensils, etc. Children get infected with the bacterial infection after getting exposed to mites-infested groceries at home or while defecating in the open in the bushes infested with mites.

Presenting the government view, Indian Council of Medical Research (ICMR) director-general Dr Balram Bhargava has said that the majority of deaths in Mathura, Agra and Firozabad were due to dengue fever caused by the D2 strain and the strain is so lethal that it can cause fatal haemorrhaging.

In contrast to all experts, AIIMS-Delhi doctors are of the view that it's the initial stage of the third wave of Covid-19. In defence of his arguments, a senior doctor, who wished not to be named, said: "Immunity among children is much higher than any adult. Deaths are happening among those children who are either suffering from any critical illness or are malnourished, while all healthy children are getting recovered."

"Since the immunity is so high among children, the tests conducted to detect the presence of Covid-19 virus among infected give negative results. The symptoms of 'viral' or 'mysterious' fever is similar to that of Covid-19", he said, adding that until the diagnosis is established, it cannot be declared as Covid-19 and the 'enigma' about the illness would prevail.

However, NITI Aayog member (health) Dr VK Paul urged people to take protective measures against vector-borne diseases and noted that dengue can lead to complications and death.

"Protect yourself from vector-borne diseases by using mosquito nets, mosquito repellents, covering yourself to avoid mosquito bites, because dengue can lead to death. We do not even have a vaccine for dengue, so it is important to take dengue as a serious disease as it leads to complications. Malaria also has ill effects. We have to fight against the disease," Paul said.

Recently, a Central team visited Firozabad district and observed that the majority of cases are of dengue, while a few are of scrub typhus and leptospirosis. Vector Indices were found to be high with House Index and Container Index, both above 50 per cent.

The National Centre for Disease Control (NCDC) has deputed two EIS (Epidemic Intelligence Service) officers in the district for the next 14 days and they will assist the administration in strengthening its outbreak response.

The Uttar Pradesh government has rushed a team of 15 doctors to Firozabad district to investigate the reasons behind the rise in cases of dengue and viral fever. The team comprises 10 doctors and five specialists.

The team, which is led by Dr GS Vajpayee — a specialist in communicable diseases — will investigate the causes behind patients not getting proper treatment before they reach the government medical college and other primary health centres in the district.

The team has also been tasked to investigate the reasons behind the increasing cases despite efforts to stem them since last month, and suggest measures to control the spread of dengue and viral fever.

The worrying factor is that several parents have complained about their children feeling unwell again after discharge, and required readmission.

Narrating his horrific story, a father told that a day after his son was discharged, he started feeling unwell. After checking his platelets at a local diagnostic centre, it was found very low. There are several such cases of re-admission and parents are running from pillar to post to get their children re-admitted.

Expressing a sigh of relief, Firozabad Chief Medical Officer, Dinesh Premi, who took charge on September 1, said: "The situation is now 'under control'. The cases of fever in the city have significantly reduced. We have also ordered house-to-house surveys and setting up of health camps to understand the extent of the outbreak."

When the Covid-19 outbreak became a big political agenda and ruling and opposition parties crossed swords to hold each other responsible for the mismanagement of the pandemic, then how the 'viral' or 'mysterious' fever cannot become an agenda in the state where assembly election is due early next year.

While taking a dig at the BJP-ruled UP government, Congress leader Priyanka Gandhi Vadra alleged that the state government has failed to take concrete steps to improvise the healthcare infrastructure of the state.

"The news of the 'death of 100 people including children' due to fever in Firozabad, Mathura, Agra and many other places in Uttar Pradesh is very worrying. The state government has still not taken any concrete step to strengthen the health system," she said.

In Haryana, health officials are on high alert to diagnose the reason for the death of at least seven children within just three weeks in Chilli village of Palwal district. All the kids who died due to 'fever' were aged below 14 years.

Though the health officials are still clueless about the actual reason of the illness, they believe that deaths happened due to multiple factors such as dengue, pneumonia, gastroenteritis and vector-borne diseases, mainly due to lack of sanitation in the village, while villagers claimed that all the children have died due to dengue.

Views expressed are personal