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Dengue: Situation Report

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Dilina Amaruwan

Dilina Amaruwan

Staff Writer

Sri Lanka is currently facing a dengue crisis on an unprecedented scale. With the health sector overwhelmed by the crisis, fears that things can only get worse might come true.

The Current Situation

According to the Epidemiology Unit of the Ministry of Health, as of July 7, this year has recorded 80,732 cases of dengue, with over 200 deaths.

To put things into perspective, that’s over 25,000 cases more than what was recorded the whole of 2016. Hospitals across the country are reportedly overwhelmed by the sheer number of patients. Beds are being shared by two to three people and many patients are forced to take the floor in the absence of facilities.

The mosquito-borne disease has already claimed over 200 lives. Image courtesy yourgenome.org

Dr. Cyril de Silva, deputy director of the National Hospital, told Roar that “The country is in a crisis situation. In the National Hospital, there are 780 fever patients and 437 of those are dengue patients.”

IDH Hospital Senior Consultant Physician Dr. Ananda Wijewickrama recently told the Sunday Observer that the lack of space and a severe shortage of staff is making things very difficult. He said that even the separate dengue ward was overcrowded and that they were grateful to the Army for constructing a new ward for dengue patients as an emergency measure.

As it turns out, the current dengue situation has reached such heights that the Army has deployed 450 troops in a bid to help combat the spread of the disease. Army spokesperson Brigadier Roshan Seneviratne told CNN that they were “assisting health inspectors to search for dengue breeding areas and have also set up temporary wards at the Negombo Hospital on the outskirts of Colombo to tackle the issue.”

How Did It Get So Bad?

According to Dr. Preshila Samaraweera of the Dengue Control Unit, dengue epidemics of previous years were mainly due to the dengue strain DENV1, which the population has developed a ‘herd immunity’ to. However, this year, the dengue strain DENV2 is what is spreading. The public has yet to develop an immunity to this ‘naïve’ infection, which is why so many people are showing symptoms of dengue.

The ongoing garbage crisis is thought to be a contributing factor to the spread of dengue. Image credit: Roar/Thiva Arunagirinathan

Dr. Cyril de Silva of the National Hospital said that many factors play into the spread of dengue. “It could be the climate, it could be cleanliness, it could be the routine of the public,” he said.

Meanwhile, Health Minister Rajitha Senaratne has blamed the current garbage disposal issues for creating mosquito breeding grounds and aggravating the situation. The recent torrential rains and subsequent floods also contributed to a rise in mosquito breeding grounds.

Countermeasures

In accordance with a Health Ministry Action Plan, government bodies will act on dengue prevention through a thorough and exhaustive search and destruction of mosquito breeding grounds. Personnel from the Local Government Ministry and the Home Affairs Ministry will conduct the efforts, supervised by Medical officers of the Ministry of Health and Public Health Inspectors.

A Sri Lankan health worker sprays a neighborhood with a fog used to ward off mosquitos in January. Image credit AFP/Ishara S. Kodikara

An effort to control the breeding of dengue mosquitoes using carnivorous larvae is also underway. According to Dr. Sagarika Samarasinghe, Director of the Entomology and Parasitology Unit of the Medical Research Institute, larva called Toxorhynchites splendens has been released to the environment. They are expected to feed on the larvae of mosquitoes that spread the dengue virus, particularly Aedes aegypti. The resulting “Elephant mosquitoes” are herbivorous and pose no threat to humans.

More High Dependency Units (HDUs) are also being set up at hospitals. HDUs are special wards where patients are cared for more extensively than at a normal ward. Dr. Cyril de Silva told Roar that the National Hospital is using its HDUs to maximum capacity, and has further reserved eight beds at each of its sixteen wards for dengue care. Multi-para monitors, syringe pumps, and other necessary equipment and drugs have also been allocated.

Speaking to the Sunday Times, Dr. Hasitha Tissera of the National Dengue Control Unit explained that outpatient departments have been instructed to set up ‘fever rooms’. These fever rooms will act as triage areas where patients are evaluated to determine whether they need to hospitalised or if they can be sent home with instructions on how to manage their fever. This would reduce the strain on hospital admissions.

Diagnosis And Treatment

According to Dr. Cyril de Silva, high fever, strong headaches, and muscle pains are symptoms to watch out for. “What is most required in dengue care is proper monitoring,” he added.

If any symptoms that suggest fever are present, it is prudent to take a Dengue Rapid Test as soon as possible. But according to Dr. Lakkumar Fernando of the Negombo Dengue Centre, while a positive test indicates dengue, even a patient with a negative test could have dengue. Dengue patients are diagnosed using suggestive symptoms and a full blood count. A normal person’s platelet count is between 150,000 and 400,000. If the level drops below 130,000, the patient is hospitalised and monitored for complications. Ibuprofen, Diclofenac, and other non-steroid anti-inflammatory drugs could suppress the actual symptoms which leads to delays in treatment, so they must be avoided. Only Paracetamol is recommended.

Many hospitals are currently filled to capacity thanks to the spread of dengue. Image courtesy dailymirror.lk

With an infection of DENV1, not many patients would suffer from fluid leakage, and Dengue Haemorrhagic Fever would start on Day 2. In the current DENV2 dengue epidemic, fluid leakage can be present on the second day and not the third. And most patients with Dengue Hemorrhagic Fever experience fluid leakage for around 24–36 hours and not for 48 hours as previously seen.

Caregivers need to be careful not to give too much fluid to the patient. Any overload of fluid could send these patients into respiratory difficulty and result in serious consequences. Hospitalisation is important as it is far safer for trained medical professionals to handle patient care.

Dr. de Silva said that “This is not something that the Health Ministry can do alone. It is a group effort. If the public doesn’t come together in the spirit of cooperation, we will not be able to control this dengue epidemic.”

Featured image credit: AP/Eranga Jayawardena

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