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Vol. XXVII No. 14, November 1-15, 2017
There is a sense of concern, even panic, over the outbreak of Dengue in the City and in several parts of the State. From all over the State, 12,324 cases have been -reported with 75 days more to go for this year. Considering that an outbreak of similar -proportion occurred in 2012, when 12,826 persons were affected, this shows that system failure alarms have not been heeded and that we are content to take symptomatic action, reactively, after the disaster has occurred. A team from the Central Government, Ministry of Health, has toured the State to assess the epidemic, recommend remedial action and estimate the extent of central assistance that the State would need in terms of money and technical support. The Central team’s statement that the 40 deaths reported are minimal out of reported cases of over 12,000 is statistically correct, but hardly comforting.
The State has sought Rs. 256 crores from the Central Team. Political leaders have visited hospitals. The High Court has demanded a status report from the Government. The report has been submitted to the Court. Opposition leaders have placed the responsibility squarely on the present Government. The Chief Minister has admitted that the situation is serious and said that the Government is taking all possible action. Expressions of concern over loss of lives have poured in. Thus, everything has run according to script. But when it all subsides, we will go back to doing nothing to avert recurrence and have a lasting effect.
Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons, breeding in water-filled flower pots, plastic bags, and containers.
Poor sanitation at the household level and inadequate capacity of the public sanitation system provide ideal conditions for the vector to thrive. The dengue carrier mosquito breeds in stagnant clean water; it does not breed in dirty water. Urban crowding multiplies the breeding sites manifold. When population growth outstrips an already inadequate infrastructure, sanitation facilities are unable to cope with the increased refuse. Widespread neglect of elementary sanitation practices, by the educated and the illiterate alike, contributes to open water storages, water puddling and collection of rubbish, like used tyres and plastics, creating a perfect environment for disease-causing mosquitoes to breed in.
The problem with dengue is that both prevention and cure are fraught with difficulties. Prevention is currently limited to vector control measures, there being no effective vaccines. Likewise, when it strikes, there are no specific therapeutics according to WHO Dengue vaccine research. Typical medical therapy for dengue fever is supportive care with IV fluids and pain medications – there is no medicine to cure dengue fever. When the number of platelets falls below a safe minimum, transfusion becomes necessary. Thus, prevention is by vector control measures through minimisation of open water storages, avoiding water puddles, especially in rainy seasons and responsible garbage/waste disposal practices – all calling for behavioural change to improve environmental sanitation.
Eminent members of the medical profession conversant with public health issues are emphatic that an assured environmental sanitation is the answer and that it can be accomplished only by strong and sustained awareness programmes for a behavioural transformation. Reducing open collections of water is the preferred method of control, as spraying of insecticides and biological control agents also produces negative health effects. Introduction of a variety of fish that feed on larvae in lakes and ponds checks the spread of the vector. Campaigns should be continuous to bring about correct practices on water logging and waste disposal and reinforced ahead of the rainy season, as rain provides water puddles for the mosquito to breed.
Smart projects have been cleared (which includes repairing 5.5 km of broken links in the stormwater drains in T’Nagar at a cost of Rs. 9.37 crore) that would contribute to improving environmental sanitation. The Chennai Corporation has initiated a mass cleaning drive, forming 200 teams employing 331 fogging machines and comprising 16,000 workers. But that is a post occurrence effort to contain the problem.
The National Family Health Survey-4 shows that Tamil Nadu has 52.2 per cent of households with improved sanitation facilities in 2015-16, which is an improvement over 2005-06. But that is far behind what is needed and compared to Kerala’s 98 per cent and 70-80 per cent in Punjab-Haryana.
These examples show that Government action can be effective and give lasting protection only if it is (a) diagnostic, (b) precautionary and preventive and not reactive, (c) addressing the basic cause and not the symptom, (d) aimed at behaviour transformation towards establishing sound sanitation practices, and (e) raising institutional efficiency. Observance of safe sanitation practices is equally the duty of responsible citizens in the interests of their own health.
In sum, as pre-protection vaccines and post-occurrence therapeutics are not the easy options as in the case of other diseases, the only way to prevent the disease is to improve the environmental sanitation which, in turn, entails citizens’ cooperation and municipal mechanisms’ efficiencies.
Dengue was widespread in 2012 and it has come again. We are fighting it after it has occurred and assumed alarming proportions. The community should have been educated post-2012 into adopting healthy and safe practices for total environmental sanitation that would have avoided recurrence and would have given a lasting defence against dengue as well as other communicable diseases. We cannot afford a repeat of such negligence and suffer repetition of an epidemic of a disease that is difficult to manage.