Dengue days are here to stay

It is not called ‘breakbone fever’ for nothing. Every bone, every muscle, every joint throbs with searing pain, as my body burned with high fever. It was not just for a day or two, it lasted weeks. The fever has finally subsided, but I am too weak even to walk.

As a public health graduate myself, and someone who has covered health and environment for this publication, I am used to covering disease outbreaks. But my experience with Covid last year, and now being struck down by dengue, I became the story I was reporting on.

It has been two months since the first cases of dengue surfaced in Kathmandu Valley. There was  an outbreak in 2019, and everyone thought it would pass.

But this monsoon, there has been no letup. The virus has spread like wildfire, exposing just how woefully unprepared national and local governments are in preventing a disease that has no cure.

The fever has now spread to all 77 districts with 10,000 patients in hospitals, many thousands more are recovering at home. Doctors have reported Covid patients with dengue complications.

“We are at the peak of the dengue outbreak,” warns Sher Bahadur Pun, virologist at the Sukraraj Tropical & Infectious Disease Hospital in Kathmandu which is seeing 250 patients a day. “I wish I had better news, we are at the mercy of the virus, and will just have to wait for winter.”

But Kathmandu Mayor Balen Shah posted on Facebook asking the public not to wait for winter. He said money had been allocated for wards, many are carrying out  ineffective fumigation.

Roshan Pokhrel, Secretary at the Ministry of Health says: “There is no cure for this. The only way is to search and destroy mosquito breeding grounds.”

Read also: State of malaise, Sonia Awale

But that is easier said than done. Draining stagnant pools is too late, infected mosquitos are already inside homes. The female Aedes aegypti mosquito has ideal breeding areas during this wet monsoon, and climate change is letting the virus move to higher elevations.

A female mosquito can lay up to 700 eggs even in a small pool of water, and can pass on the virus to its offspring. The mosquitos then can fly and infect in a radius of 300m, and they bite mainly in the daytime so that mosquito nets while sleeping are not really a deterrent. When the pools dry up, the larvae lie dormant and carry the virus next summer.

“Preventing mosquito bites is still the priority, people need to know about effective repellents, especially the ones containing DEET (diethyltoluamide), recommended by WHO and CDC as the most active ingredient in insect repellents,” says Buddha Basnyat, a physician at Patan Academy of Health Sciences.

Also important is to assure patients that although painful, dengue is rarely fatal, Basnyat assured me this week as I tried to regain my strength after two weeks of high fever.

Last month, I was preparing a review of new studies about air pollution when I started feeling feverish. It got difficult to even sit at my desk. Wincing with pain, I barely met the deadline for page 1. At that point, air pollution seemed to be the least of my problems.

The next two weeks are a blur. Fever that reached and stayed at 103°F for days on end, even touching my skin was painful, my eye sockets hurt. Paracetamol was the only medicine, and I needed cold presses to keep the fever down.

One evening, the temperature hit 104°F and that was when I felt like I was hallucinating. With such high fever, sleep is impossible. I could not even toss and turn because of the pain.

Eating was out of the question, even drinking water took enormous effort. Aside from the pain was the nausea and retching, which made the pain worse.

Read also: The dangers of the dengue virus, Tom Robertson

I cannot explain in words just how unpleasant dengue is. God forbid, you have to experience it yourself.

The other experience of my convalescence was how the medical profession in Kathmandu from doctors to pharmacies are abusing this epidemic for unethical profit. There is no medicine for dengue, just paracetamol to numb the pain, water to replenish the body’s fluids, and rest – lots of it.

My neighbourhood in Patan is a dengue hotspot, every household has at least one person who is sick. Some neighbours have been prescribed antibiotics, even though they are harmful to dengue patients.

“Dengue is a viral infection, prescribing antibiotics does no good,” Buddha Basnyat told me. “They are prescribing Azithromycin used for typhoid and typhus. This misuse can actually lead to resistance against those diseases.” Virologist Pun at Teku Hospital says he is getting patients at his fever clinic with complications because of antibiotic intake. Patients buy antibiotics over the counter in the misguided notion that it will make the fever go down.

The only effective prevention is to remove mosquito breeding grounds, but with the city being in the state it is in with garbage piles, open drains and potholes, it will need a mass awareness campaign with enforcement and fines as is done in other tropical Asian cities.

Climate change means that mosquito vectors and their pathogens are moving up, and besides dengue we will also have to watch out for malaria or encephalitis in areas they were unheard of before.

“Vector insects are moving from the southern plains to the northern mountains and with them the diseases they carry,” explains Pun.

This means Nepalis may have to experience more deadly outbreaks before the most vulnerable people become a priority for the state.

Read also: Mosquitoes move up mountains as the earth warms, Sonia Awale

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Operation Search and Destroy

Dengue is a viral infection transmitted to humans through the bite of infected Aedes aegypti or Aedes albopictus mosquitos. Because there are four different serotypes, an individual previously affected can get even more severe dengue due to the body's auto-immunity.

There is no cure for dengue. A vaccine is available, but it is recommended only for those previously infected. Patients can be tested for dengue with RT-PCR or enzyme-linked immunosorbent assays (ELISA).

Prevention is better than cure, and this is most true for dengue. Some 80% of dengue cases are asymptomatic, but for the rest it could be a very painful experience for up to 2 weeks.

Painkillers are not advised, only paracetamol, up to 1,000mg at one time 3 times a day.

The only antidote to dengue is to deprive the mosquito of stagnant pools of water to breed. It can be a plastic bottle cap in a garbage dump or the inside of a discarded tyre, anything is suitable for the female mosquito to lay her eggs.

She can lay up to 700 eggs in their two-week lifetime. And if the mother is infected, all her offspring are born with the virus too. These mosquitos can fly and infect everyone in a 300m radius.

Dengue was first detected in Nepal in 2004 on a visitor. Since then there have been cases every year with the biggest outbreaks in 2019 and this year. Once present in the environment, the virus can remain for years since the infected mosquito larvae can carry it into next summer.

The only way to prevent dengue and other mosquito borne diseases like malaria and encephalitis is to declare Operaton Search and Destroy on their breeding grounds.

Read also: Climate-health emergency, Sonia Awale