<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238939c7e80680e0c7392jpeg.jpg" alt="" width="960" height="640"/><figcaption>VECTOR FOR VIRUS: Stagnant pools of water, an ideal breeding site for the dengue mosquito, outside the Sukraraj Tropical &amp; Infectious Diseases Hospital at Teku, which on Thursday saw 250 new dengue patients. Photo: SUMAN NEPALI</figcaption></figure>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 &amp; 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: <a href="https://www.nepalitimes.com/banner/state-of-malaise/">State of malaise</a>, Sonia AwaleBut 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: <a href="https://www.nepalitimes.com/opinion/the-dangers-of-the-dengue-virus/">The dangers of the dengue virus</a>, Tom RobertsonI 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: <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/">Mosquitoes move up mountains as the earth warms</a>, Sonia Awale-----------------------------<h2>Operation Search and Destroy</h2><figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238959c7e80680e0c7393jpeg.jpg" alt="" width="1000" height="699"><figcaption> </figcaption></figure>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: <a href="https://www.nepalitimes.com/here-now/climate-health-emergency/">Climate-health emergency</a>, Sonia Awale

Sonia Awale

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Dengue days are here to stay

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221114131144/637238919c7e80680e0c7391jpeg.jpg" alt="" width="960" height="640"/><figcaption>VECTOR FOR VIRUS: Stagnant pools of water, an ideal breeding site for the dengue mosquito, outside the Sukraraj Tropical &amp; Infectious Diseases Hospital at Teku, which on Thursday saw 250 new dengue patients. Photo: SUMAN NEPALI</figcaption></figure>Although debilitating, fatality from dengue is rare. But the epidemic raging across Nepal’s cities has killed at least 12 people. The latest is a 29-year-old Nepali PhD student.The current outbreak comes on top of the Covid pandemic, and is a reflection of everything that is wrong with Nepal: political negligence, governance failure, misplaced priorities, lack of accountability, state apathy. Dengue is the symptom, the disease is political.A wetter than usual monsoon and <a href="https://www.nepalitimes.com/banner/mosquitoes-move-up-mountains-as-the-earth-warms/" target="_blank" rel="noopener noreferrer">climate change</a> mean that dengue mosquitos have found ideal breeding grounds even in roadside pools outside the Sukraraj Tropical &amp; Infectious Diseases Hospital at Teku (above) which is seeing 250 new dengue patients every day.The virus-carrying female Aedes aegypti mosquito has a wide choice of places to lay her eggs: on water-filled bottle caps in garbage piles, inside discarded tyres, stagnant pools in open drains, and even balcony flowerpots. Kathmandu Valley is now a magnet for mosquitos.We could have learnt from the 2019 dengue outbreak when there were 17,000 hospital cases, and at least 6 fatalities. The monsoon is not over, and this year we have already  surpassed those numbers.Read also: <a href="https://www.nepalitimes.com/banner/dengue-days-are-here-to-stay/">Dengue days are here to stay</a>, Sonia Awale“Unfortunately we learned nothing from the 2019 outbreak, we allowed infected mosquitos to breed everywhere,” says Sher Bahadur Pun, a virologist at the Clinical Research Unit at Teku. “The problem has magnified this year. The mosquitoes are now inside our homes, offices, and schools making it difficult to avoid infection.”The fact that local and central governments are gearing up to deploy a ‘search and destroy larvae’ two months into this large-scale outbreak is proof of slow-motion response. Fumigation is ineffective, and it is too late to drain breeding pools.The dengue virus can remain in the larvae of infected mosquitos for several years. So, the only way to prevent next year’s outbreak is to search and destroy breeding grounds now. Next monsoon will be too late. As with the garbage crisis and the air pollution emergency, dengue is problem for which the only solution is political will.Removing local breeding ground for the mosquito vector and spreading mass awareness about prevention is the responsibility of local governments. Federalism is supposed to make elected mayors accountable. They can start draining the swamps.For now, physician Buddha Basnyat’s advice is: “Avoid mosquitos, particularly at dusk and dawn, use the most effective repellent and don’t take antibiotics.”Read also: <a href="https://www.nepalitimes.com/banner/as-covid-abates-nepal-sees-dengue-outbreak/">As Covid abates, Nepal sees dengue outbreak</a>, Anita Shrestha

State of malaise

<figure><img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141116/636a57619c7e80680e0547ddjpeg.jpg" alt="" width="1400" height="1129"/><figcaption>BAD BITER: The dengue-carrying female Aedes aegypti mosquito (above) can now survive in higher altitudes and latitudes where it could not before because of climate change.</figcaption></figure>With over 8,000 reported dengue cases and an estimated 80,000 infections in five months, Nepal’s viral fever epidemic this year has gone viral. So far six people have died, and dengue has spread to higher altitudes where mosquito-borne diseases were unheard of.In Kathmandu Valley it has struck ministers, politicians, businessmen, even doctors and their families, but it has also drawn attention to tropical diseases migrating to the mountains. Agriculture Minister Chakrapani Khanal, renowned ophthalmologist <a style="background-color: #ffffff; letter-spacing: 0.01em;" href="http://archive.nepalitimes.com/article/Nepali-Times%20Buzz/sanduk%C2%ADruit%C2%ADtilganga,2574" target="_blank" rel="noopener">Sanduk Ruit</a> and Nepal Communist Party leader Bamdev Gautam are all down with fever, but the government’s response has been inadequate.Read also: <a href="https://www.nepalitimes.com/latest/like-a-sunburn-on-your-lungs-how-does-the-climate-crisis-impact-health/" target="_blank" rel="noopener">'Like a sunburn on your lungs': how does the climate crisis impact health?</a>, Emily Holden“Vector insects are moving up the Himalaya as warming increases, and so are the diseases they carry. Climate change is leading to changes in the geographic pattern of diseases,” said Meghnath Dhimal of the Nepal Health Research Council. His research has shown that mosquitoes do not just travel to higher altitudes in vehicles, but increasingly complete their lifecycles in what used to be colder places.Read Also:<a href="https://www.nepalitimes.com/?p=32892&amp;preview=true" target="_blank" rel="noopener">Tree-mendous</a>, Peter Gill<a href="https://www.nepalitimes.com/?p=32877&amp;preview=true" target="_blank" rel="noopener">It's a jungle out there,</a> Ajaya Dixit“Not just dengue: at any moment you can also have outbreaks of <a href="http://archive.nepalitimes.com/news.php?id=19426#.XXolTC4zbIU" target="_blank" rel="noopener">Chikungunya,</a> Japanese encephalitis and Zika in the mountains of Nepal due to global warming,” Dhimal says.https://www.youtube.com/watch?v=tz31WHLpMBo&amp;feature=youtu.beThis year’s unusually wet monsoon in Kathmandu Valley provided suitable breeding grounds for mosquitoes. The increased mobility of Nepalis has helped spread diseases like malaria, dengue and encephalitis to higher valleys. But it is climate change that has made disease-carrying mosquitoes themselves migrate to higher altitudes and latitudes.While mosquitoes and the microorganisms they carry now thrive in places that used to be too cold for them, extreme heat in the plains is killing off the insects. Recent studies have shown that dengue, malaria and other vector-borne infections are now found in areas where they were not before, and have disappeared in places where they were common.Read Also:<a href="https://www.nepalitimes.com/?p=32887&amp;preview=true" target="_blank" rel="noopener">Trees, politics and greed</a>, Mukesh Pokharel<a href="https://www.nepalitimes.com/?p=32836&amp;preview=true" target="_blank" rel="noopener">Mustn't blame everything on Climate Change,</a> Editorial<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141116/636a57639c7e80680e0547dejpeg.jpg" alt="" width="200" height="200">In 2014, ecologists at the University of Michigan found the first hard evidence that malaria travels to higher altitudes during warmer years. Another study by the London School of Hygiene and Tropical Medicine confirmed that the movement of malaria is temperature dependent.Read Also:<a href="https://www.nepalitimes.com/?p=32864&amp;preview=true" target="_blank" rel="noopener">The Third Pole is warming faster than expected,</a> Kunda Dixit<a href="https://www.nepalitimes.com/?p=32805&amp;preview=true" target="_blank" rel="noopener">Climate-health emergency,</a> Sonia AwaleNepal has set a target to eliminate malaria by 2022, and the climate crisis adds to the challenge, while also stressing the need to expand existing health programs to districts previously unaffected by the disease.“We need a climate-relevant and sensitive health system so that we are prepared for more frequent outbreaks,” added Dhimal. “This means training healthcare personnel and ensuring a robust monitoring, evaluation and surveillance mechanism.”Ironically, the Kathmandu hospital that is supposed to control infectious diseases has become an epicentre for the spread of the virus because of overcrowding. When one 24-year-old banker based in Pokhara travelled to Teku to confirm her dengue status, she met many others like her from Dharan, Hetauda and Salyan.“Relatives waiting on their infected family members were also starting to get sick because the mosquitoes there were biting everyone,” she said.Read Also:<a href="https://www.nepalitimes.com/?p=32872&amp;preview=true" target="_blank" rel="noopener">Protecting Kathmandu’s historic roofscape,</a> Anne Feenstra<a href="https://www.nepalitimes.com/?p=32849&amp;preview=true" target="_blank" rel="noopener">Tourism, aviation, and carbon</a>, Sanghamitra Subba<img src="https://superdesk-pro-c.s3.amazonaws.com/sd-nepalitimes/20221108141116/636a57649c7e80680e0547dfjpeg.jpg" alt="" width="1400" height="644">Dengue is spread when a female Aedes aegypti mosquito bites an infected patient and then bites healthy people within the following week. The mosquito can bite up to 10 different people before she has had her fill, which is why multiple members of the same family are falling ill.“We are receiving more than 500 cases per day and more than 70% of those I oversee have been tested positive,” said Sher Bahadur Pun, Chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital in Teku. “Our response is not proportionate to the enormity of the crisis. We are risking our own health to treat infected patients.”A female Aedes mosquito lays from 500-1,000 eggs in her lifetime, and if infected, all her eggs are also infected from birth and the epidemic multiplies. The best strategy to stop this cycle is destroying mosquito habitat, experts say. Personal protective measures are equally important.“No one is safe since the mosquitoes are everywhere, from plains to the mountains,” said Prakash Prasad Shah of the Epidemiological Diseases Control Division. “Also, fogging is not effective — it only kills adult mosquitoes. We need search and destroy missions and this requires a collective effort.”After Dharan started an anti-dengue campaign by targeting the mosquito’s breeding spots, there has been a drop in the four-month outbreak there. Similarly, dengue cases in New Delhi fell 80% after 2015 due to a massive public awareness campaign.Read Also:<a href="https://www.nepalitimes.com/?p=32856&amp;preview=true" target="_blank" rel="noopener">Summit leads packed UN agenda,</a> Thalif DeenOnly 10% of those infected with the dengue virus show symptoms and need further treatment. Very few suffer from complications due to haemorrhage and internal bleeding. Of the four types of dengue viruses, most Nepalis seem to be afflicted with the milder forms, either type 1 or 2.There is no vaccine or definite treatment for dengue fever yet. Patients are kept under observation and given supportive treatment for fever and with a blood transfusion if there is a drop in blood platelet count.This story is part of <a style="letter-spacing: 0.15px; background-color: #ffffff;" href="https://www.nepalitimes.com/latest/world-joins-to-cover-climate/" target="_blank" rel="noopener">Covering Climate Now</a>, a global collaboration of more than 250 news outlets to strengthen coverage of the climate story.