Probably neither the prime minister nor the chief minister of Delhi including their mandarins in the health and urban ministries ever realized that the deadliest stalker on the planet is the mosquito. Mosquitoes kill more than 8 lakhs people in a year with man coming a distant second accounting for 5 lakh kills. The lion slaughters a mere 100 people, while snakes in a year send almost 50,000 to paradise. Astoundingly in all the din most anchors and panelists on television debates have been unable to pronounce Dengue correctly; the emphasis by the media has all along been (with some justification) on slinging as much mud as possible on Delhi hospitals; but not a whisper or murmur of the terrible ramifications of the horrendously dirty city we live in. There has not been the slightest hint suggesting removal of all those puddles of water or administering a vaccine.
To me it seems obvious that much like the Arabs, the Syrians, the Afghans, the Persians, the Mughals, the French, and of course the Brits….the mosquitoes figured quite a few decades ago that natives of this land form an easily corruptible and dirty cohort which makes invasions and occupation a cake walk. No wonder little children are slaughtered in times of peace while their distraught parents leap to their deaths in abject despair.
The mosquitoes or mozzies have exposed us for what we are. Yemen too is having an epidemic right now; but has the excuse of a civil war raging on within its boundaries. Our chaps in Nirman Bhawan have the luxury of fudging data; the maxim is minimize to the maximum the incidence and number of deaths; the Indian bureaucrat is stunningly identical to the SHO in the local police station who cringes when asked to record an FIR for manifest reasons. He can under no circumstance reveal the fact that he is unable or incapable to arrest or reduce crime on his beat. Astonishingly all health secretaries in the central and Delhi administration have gone underground; not a single utterance on TV or the print media. This is the time to get their pearls of wisdom and erudition.
Dengue is produced by a virus which has 4 serotypes (call them subtypes), DEN-1, DEN-2, DEN-3 and DEN-4. Apparently Delhi has been struck this time by DEN-4. It However it makes little clinical sense to know of the serotype causing an epidemic because there is no treatment. Management of a case is largely symptomatic and supportive. The disease comes on suddenly with high fever, head ache, muscle/joint aches and a rash.The head ache is peculiar in that it is localised behind the eyes. Because of the aches and pains Dengue is also called “Breakbone fever”. The fever should be tackled by cold compresses, a cold shower, or paracetamol . Aspirin or brufen should never be used because they will aggravate hemorrhagic tendencies. A lot of patients may be a symptomatic or may have mild symptoms. A few however, (1-5%) may develop hemmorhagic dengue fever (HDF).
Severe dengue fever is explained by a repeat infection with a different serotype. Let us presume the first episode was by DEN-2 and the next infection is caused by DEN-4. The body initially fails to recognise the new virus serotype and remains laid back; but eventually it does figure out that there is a new intruder and this time it reacts by storming the virus with humongous amounts of antibodies. This firestorm of antigen-antibody reaction results in massive reduction of platelet counts (anti-hemmorhagic cells that resemble dinner plates) and leakage of blood vessels. The walls of blood vessels are badly compromised leading to oozing of copious amounts of fluid into the extravascular space. This in turn leads to a threads pulse and shock. Mortality can be as high as 20% or more.
Dengue is clinically recognised by the triad of fever,headache and rash. It can be confirmed by a spot test that detects the antigen on the first day itself and by PCR assessment. The white cell numbers get lowered, liver enzymes increase, and platelets begun to fall. In most Indian cities malaria,typhoid and plain viral fever have always to be kept in mind.
Genetically modified mosquitoes to eliminate mosquitoes seem an attractive proposition but are yet to be tested in the field. One has to keep in mind social and environmental costs, which will be conveniently glossed over by the companies selling the technology. Pilot tests have been conducted in Brazil but here in India for now we have to take the clarion call of “Swach Bharat” in more sincerely. Tragically all those photo ops proved to be mere optical illusions. We were unable and unwilling to clean up the mess on the streets of the capital of the country, permitting the mozzies to multiply and occupy at will. One female mozzie can lay from 300-500 eggs and she does not mind clean or polluted water, as long as there is still water around. The water could be in a vase, a flower pot, an old tyre, water cooler and so on. Surprisingly despite the mozzies breeding within homes no fogging is attempted inside residences.
It is obviously imperative that we are better prepared for the next epidemic and give serious thought to immunising children with a recently developed vaccine boasting of 60% efficacy in children. Do not underestimate the intelligence of the female mozzie who strikes without any warning or humming, from behind or from the side, in broad daylight. Unlike her male partner who is a strict vegetarian the lady mozzie needs blood to lay her eggs. She injects an anti-coagulant when sucking human blood and in the process transfers the Dengue virus located in her salivary glands. It would be perilous to underestimate her fortitude and ability. She is doing her job with minimal fuss unlike our folks roaring away on epilepsy inducing TV programs. Let us face it, if matters do not change soon, any one of us could be sitting duck.