This Article is From Sep 08, 2019

How Delhi Government Has Battled Dengue With Startling Success

Dengue is a mosquito-borne viral disease and a fast-emerging pandemic-prone viral disease across the world. Dengue virus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus. This mosquito also transmits Chikungunya, Yellow Fever and Zika infection. Dengue is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature and unplanned rapid urbanization.

A vast majority of cases are asymptomatic and hence the actual numbers of dengue cases are under reported and many cases are misclassified. 

Over 3.9 billion people, in 128 countries, are at risk of infection with dengue viruses. India remains vulnerable to these viruses. 

Delhi recorded the worst-ever outbreak of Dengue in 2015. With over 15,867 cases and 60 deaths, the task at hand for all the stakeholders was daunting.

While India as a whole and Tamil Nadu, Kerala, Karnataka, Punjab and West Bengal, in particular, saw a significant rise in number of dengue cases (99,913 in 2015, 1,29,166 in 2016 and 1,88,401 in 2017), Delhi, on the other hand has shown a steady decline with 80% reduction in the number of reported cases.

It is a known fact that Dengue requires only fluid resuscitation. For a Dengue patient, the platelet count drops and typically the blood should become thin. But if the opposite happens and blood becomes thick due to capillary leakage and intravascular dehydration, it becomes an emergency. Clinically it becomes evident as it is high haematocrit with low platelets. Treatment for this is rapid fluid intake.Also, Dengue becomes serious only when the fever is subsiding, and the patient develops vascular leakage leading to internal vascular dehydration.

Going back to Delhi, an unnerving number of cases were reported daily in the capital in 2015. The challenge at that time was two-pronged - checking the spread of dengue, and its prevention, with the latter being more about increasing awareness among the common people. 

A strong political will coupled with citizens' co-operation worked wonders to bring down the number of Dengue cases in the city even as the country faces an upward trend. From 4,431 cases in the capital in 2016 to 4,726 in 2017, and 2,798 in 2018, there has been around 80% reduction, and that's quite praiseworthy.

All the stakeholders led by the state government worked towards one goal - reducing the cases of Dengue in the city. The efforts of health and sanitary departments, hospitals, RWAs, and the general public, including school children, youth and women's groups, lowered the casualty figures to just one in Delhi in 2017.

However, the most significant initiatives were creating a robust primary healthcare infrastructure and relentless focus on citizen awareness for prevention and early detection. 

To make Delhi the launchpad for a world-class community primary healthcare hub, we also saw the birth of the first Mohalla clinic in 2015. Today, the number stands at 203 fully functional Mohalla Clinics. These air-conditioned clinics with a private hospital-like atmosphere distribute 109 essential medicines, conducts 212 diagnostic tests (including those for mosquito-borne diseases) are run by a panel of extremely well-qualified doctors.

The good governance and political will saw 1,000 beds earmarked for fever cases in Delhi's government hospitals. The government even issued circular relaxing norms for private hospitals to increase the bed strength for treating Dengue patients. The circular allowed private hospitals and nursing homes to increase their bed strength by 10-20%. 

Regarding prevention, it is a well-established fact that we need to stop the breeding of mosquitoes in clear and stagnant water. The state decision to form a dedicated Dengue control cell to conduct prevention-related activities across the capital helped in identifying high-risk areas (high house and container index) which were then shared with local bodies to take necessary preventive measures. Also, all establishments including government and private hospitals were directed to identify a Nodal Officer to ensure that there was no mosquito breeding in the premises. 

All the government hospitals (33), dispensaries (262) and local clinics (106) had dedicated fever corners with sensitized and trained medical and paramedical staff regarding the prevention and management of Dengue.

Workshops were organized to sensitize doctors regarding Dengue control and management. All Polio coordinators were also added to this pool. Hospitals were directed to arrange adequate quantity of logistics (beds, bed nets, IV fluids, medicines, etc.) to cater to Dengue patients on a priority basis so that no one is denied admission. 

Further, to check arbitrary pricing of tests, the government went a step ahead and issued orders to put a cap on the rates - Rs 50 for platelet count test and Rs 600 for NS1 Elisa test.

The war on Dengue continues and the government seems to be fully determined to fully eradicate the endemic from the National Capital.

The Delhi Government's "10 Hafte, 10 Baje, 10 Minute - Har Ravivar, Dengue Par Vaar" campaign is a well-timed call for action as this 10-week period post-monsoon makes citizens vulnerable to Dengue.

This year's protracted monsoon will likely provide the disease-carrying mosquitoes with more breeding grounds and putting hospitals and clinics under even greater pressure than usual for this time of year.

Dengue is preventable by adopting simple measures at the local level. All we need is an unrelenting political will and massive support from citizens. 

(The author is President of Confederation of Medical Association of Asia and Oceania, President of Heart Care Foundation of India and the former National President of Indian Medical Association)

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