Dengue outbreak: Where we are failing
The country recorded 281 dengue deaths in 2022, the highest on record. The situation could become even worse this year
Thirty-year-old Jahangir Islam has been admitted on the ninth floor of Mugda Medical College Hospital after falling prey to dengue fever for the third time since May this year. But as all the beds were occupied, he found his place on the floor.
Jahangir's symptoms are no longer like the previous two times. This time, he is not feeling as much feverish. He had been suffering from diarrhoea, extreme pain in his stomach, vomiting and low pressure since 1 July before finally testing positive for dengue fever on 5 July and getting admitted to the hospital.
But even though his platelet count has been depleting since the last 24 hours, he complained that he wasn't receiving the proper treatment he deserves due to a shortage of doctors and nurses amid the overcrowding of patients.
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During our visit to the hospital on Thursday afternoon, we found that from newborn babies to senior citizens of 80 years, patients of all ages are there, with most of them suffering from dengue fever for the second or third time this season.
With patients and their relatives crowding every single ward, there is hardly any place left — even on the floor — for new admissions.
Mugda Medical College Hospital has the highest number of dengue patients in the capital, while Dhaka and Suhrawardy Medical College Hospitals, Mitford Hospital and Kurmitola General Hospital are also facing more or less the same situation, with every hospital having way more patients than they can handle.
Overall, 65 people have died from dengue this year, with 18 of the deaths occurring within the first seven days of July, according to the Directorate General of Health Services (DGHS).
A total of 2,165 dengue patients, including 1,528 in Dhaka, are now receiving treatment at hospitals across the country, DGHS further informed.
The country recorded 281 dengue deaths in 2022, the highest on record after the 179 deaths recorded in 2019. However, the situation could become even worse this year, warns entomologists.
In light of this ongoing dengue outbreak, The Business Standard reached out to the country's leading public health experts, entomologists and researchers. As things stand, Bangladesh failed in certain sectors to keep the outbreak under control, and now the country's flawed health management system may also find it extremely difficult to handle the situation.
What is causing the rise of dengue outbreaks?
Before 2000, there had only been sporadic, isolated outbreaks of dengue in Dhaka and a few other regions of the country since 1965. In 2000, an unexpected dengue outbreak led to 5,551 cases and 93 fatalities, posing a substantial threat to public health.
Since 2000, dengue had more or less remained a metropolitan disease for a long time. But in the last few years since 2019, it has spread its claws to other districts of the country as well, and the outbreak has further been intensified by climate change. According to experts, Bangladesh's climate is ideal for the year‐round spread of diseases carried by Aedes mosquitoes.
"Increasing temperatures contribute to the creation of optimal environmental circumstances that facilitate the proliferation and propagation of mosquitoes, thereby enhancing the transmission of the virus. Extreme weather events can result in a buildup of stagnant water, which creates favourable conditions for the proliferation of mosquitoes," said Dr Md Shamim Hayder Talukder, CEO of Eminence Associates for Social Development.
Besides, Aedes larvae are now found in drain water due to the effects of climate change, said entomologist Dr Kabirul Bashar, professor of Jahangirnagar University's Zoology Department. He added that due to the accumulation of water in the car parking areas in the buildings, in addition to the rain, Aedes mosquitoes are born all year round.
According to him, urbanisation throughout the country also contributes to the year-round dengue outbreak, that too all across the country. "Aedes mosquitoes grow in number wherever there is urbanisation," said Dr Bashar.
But foremost, dengue largely depends on the amount of rain and humidity. Last year, the monsoon lasted for a long time, causing the dengue outbreak to continue till December. Even this year, the monsoon began late, and hence it may once again last for a longer period.
Is Bangladesh doing enough to prevent dengue outbreak?
With the dengue outbreak rising at the moment, everyone is concerned, but prevention measures were never a priority during the pre-monsoon season, complained the Center for Governance Studies (CGS) Chairman Manjur A Chowdhury, also an entomologist.
"An integrated mosquito control plan and proper surveillance of the insect in time is of utmost importance, as evident from the models of many other countries. But every year, our higher authorities and local governments start their dengue-prevention programmes at a time when it is already too late," said Chowdhury, also a former president of the Zoological Society Bangladesh.
Physician and activist Dr Rakib Al Hasan also reiterated the same, mentioning that unlike developed countries, Bangladesh has no natural or artificial infrastructural preparation to prevent mosquito breeding.
Apart from unplanned buildings, stagnant water on rooftops and unplanned roof gardens are some other factors behind the country's ever-growing mosquito population, he mentioned.
According to Dr Hasan, exporting frog legs by killing them in the 1980s was a move which damaged the natural food cycle, while natural farming based on low, medium and high levels of aquatic food cycles have also been lost to the commercial model of fish farming.
"As a result, there are no fish, no frogs, no turtles and no birds to eat the mosquito eggs or larvae," said Dr Hasan.
Public health expert and a former DGHS director Dr Be-Nazir Ahmed also termed the prevention methods carried out by the authorities as "inadequate", adding that the lack of strategic planning is to be blamed for the dengue outbreak every year.
"You can say the dengue outbreak is under control when there are less than 50 cases a year. That cannot happen overnight. You can set a goal that you will achieve by 2030, and then act accordingly. But we don't see such goals in our country," said Dr Be-Nazir.
To combat mosquito breeding, Bangladeshi government mostly fogs adulticides throughout the vector season. However, Dr Be-Nazir does not think this is the right way to go about it.
"Fogging is not enough, nor are the general foggers educated enough. Only entomologists can determine which steps should be taken, and where. Larvicide needs to be used to kill larvae," he said, adding that though the city corporations have recently recruited some entomologists, local governments have yet to follow suit.
Is Bangladesh's healthcare system strong enough?
Interestingly, there is already a blame game going on in the country about the dengue outbreak.
While public health experts have condemned the lack of sincerity from city corporation administration and local governments to prevent the dengue outbreak, Dhaka South City Corporation Mayor Sheikh Fazle Noor Taposh has also blamed the health directorate for the rise in dengue-related deaths.
"The mortality rate due to dengue is on the rise. The health directorate must pay more attention to the matter," said Taposh on Wednesday, adding that results of surveys on the dengue issue from the health directorate need to come in earlier, based on which the city corporation can proceed with their work.
However, the country's healthcare system can be questioned in more ways than one.
"Certainly our current healthcare system is not adequate," said Dr M Mushtaq Hussain, adviser to the Institute of Epidemiology, Disease Control and Research (IEDCR). "We don't have enough manpower, proper equipment, and there is also the lack of coordination between ministries that is very much needed in times of emergency."
Dr Hussain also urged the government to acknowledge the severity of the situation by declaring the current dengue outbreak an "epidemic", and address it with topmost priority.
Dr Be-Nazir also lamented the fact that people from outside the city have to come to Dhaka for dengue treatment, asking why there wasn't any preparation at the local level beforehand as dengue outbreak has become a yearly affair in the country.
Dr Hasan said that people from outside Dhaka should be treated in their own districts or upazilas. "If everyone comes to the capital city, Dhaka's hospitals won't be able to handle the pressure if the outbreak becomes worse," he said.
Meanwhile, there have been talks about the possibility of introducing a dengue vaccine in the country, after Japan's pharmaceutical giant Takeda Pharmaceutical Company recently developed a dengue vaccine named "Qdenga" – offering hope for future generations.
However, health directorate officials had earlier told TBS that they were not yet considering approving the drug. Bangladeshi experts also echoed the same, calling for a "go-slow" approach and see how it works in other countries and what the World Health Organization (WHO) directs.
"If the vaccine is proven to be efficient, we can definitely take resort to it. But right now, we should focus on the current problems instead and try to eliminate them from the core," said Md Obaidullah, research assistant at the Centre for Advanced Social Research, Dhaka.
Can Bangladesh learn from other nations?
According to CGS Chairman Manjur A Chowdhury, if Bangladesh wants to learn from foreign models, it shouldn't look any further than the neighbouring country India.
In spite of the same geographic and biological characteristics as Bangladesh, the dengue outbreak is not as prevalent in Kolkata. According to a report published in Times of India on 30 June, only 40 dengue cases had been logged in the city in the previous three weeks.
Some other regions of India are also showing extraordinary improvement in tackling mosquito-borne diseases. According to another Times of India report, as compared to 2021, there was a 40% decrease in the number of cases detected in 2022 in Maharashtra.
Dengue deaths, too, dropped by 40% from 2021 to 2022. The incidence of chikungunya, a viral infection characterised by severe pain, dropped by 57% from 2021 to 2022 in the state.
"India has been showing notable improvements in recent years, because they are setting national goals and trying to achieve them. Also they are giving importance to people with technical expertise. I have seen entomologists being recruited in big cities like Kolkata and Delhi to prevent dengue outbreak. We don't see similar practices in Bangladesh," said Chowdhury.
Apart from that, other vulnerable Indian states are also launching special campaigns against mosquito-borne diseases, while initiatives are being taken up for community mobilisation and participation, mass awareness, timely surveillance and treatment.
"You can't say any country has so far become 100% successful in preventing the dengue outbreak. But you can take the United States for example. They identify hotspots of dengue infections, and target adult Aedes mosquitoes. This is the basic rule for every country, and we should also do the same," said Dr ABM Abdullah, emeritus professor and personal physician of the prime minister.
"Countries like Indonesia and Brazil have reduced the rate of symptomatic dengue infections by 70% with lab-grown mosquitoes infected with Wolbachia bacteria. Also the most successful trial with Wolbachia has been conducted in Cairns and surrounding locations in northern Queensland, Australia for eight years," said Dr Rakib Al Hasan.
Though the trial completely stopped dengue transmission in those locations, they were geographically very small. Besides, economists hinted that this project elsewhere would require $12 to $21 per person, informed Dr Hasan.
"Bangladesh is also trying to implement one such project, but will this be a realistic approach for Bangladesh? I don't think so," he concluded.
