As the current dengue epidemic, the worst in decades relentlessly surges towards its peak next month, as the South west monsoon readies itself to lash its fury countrywide, health officials are hurriedly putting in place several strategies to contain the further spread of the disease, which since the beginning of this year till the time of going to print, has a total of seventy thousand clinically positive cases identified from across the island.
The epidemic this year is unique for many reasons. Firstly, it has seen the emergence of a new virulent type 2 strain which has affected over 30 percent of persons between the ages of 15 to 45 years. Secondly, in order to rein in the spread of this new strain, health officials have resorted to non conventional methods of eliminating the dengue carrying vector including bio technology. Thirdly, in sheer numbers, the epidemic has overtaken recent dengue epidemics, with over 71,000 dengue patients identified countrywide since the beginning of this year, the majority of whom are in urban areas notably in the Colombo district. The Colombo Municipal council area has recorded 2684 dengue patients while other parts of Colombo recorded 12,215.
Mounting garbage attracting flies and mosquitoes as well as drastic changes in the weather pattern have further compounded the problem. So much so that just this week President Maithripala Sirisena has called for another round of discussion to focus on the issue of streamlining waste management and to urge local government authorities to take stern measures against those who deliberately pollute the streets with their garbage.
However all these interventions though a step forward, need support from the public at large starting from grassroots level. For this the initial change must be a change in people’s habits and behaviour- with awareness raising programmes on the benefits of using eco friendly material such as paper, leaves, cane baskets instead of non degradable plastics and Styrofoam boxes. Such a change cannot happen overnight. It must start when children are in school with school based practical eco friendly waste management education being a part of the curriculum for primary school children upwards.
The public too must be encouraged to separate their waste and take it to the nearest recycle plants which unfortunately are too few in our country. If not they should be taught to transform their dirt into black gold or compost, which they can use for their home gardens.
In this respect we are encouraged to read of various pilot projects, one at the Peradeniya University of turning the dengue carrying vector against itself to destroy itself. The National Dengue Control Unit is also currently in partnership with a private institute to produce a locally dengue control agent BIT (Bacillus Thurusingiensis aelensis) to cut down heavy costs of importing dengue spray from China.
“Following discussions with the President who asked us at a recent meeting what happened to the local BTI previously produced by the Industrial Technology Institute (ITI) BIO Power to whom the technology had been transferred but had stopped production after the Colombo Municipal Council (CMC) said it was not effective when a sample was returned by the MRI to that effect, to look into the possibility of restarting production. We also asked them to give us a time frame”, Community Consultant Physician National Dengue Control Unit Dr Preshilla Samaraweera told the Sunday Observer. She said the local agent was known as Wolbachia, a natural bacterium present in 60 % of all species of insects around us such as fruit flies. It is a procedure involving extracting it and injecting it to the mosquito and has shown good results in Australia. It is not easy. We hope to launch our first pilot project with Australian funding”. Asked when it would be launched she said, “The matter is still under discussion.”
Stressing the need for clean premises, she said the Aedes aegypti breeds wherever there are small collections of clean rainwater. “Please keep your premises and your neighbourhood clean without dumping small plastic containers like yoghurt cups and lunch sheets, clean your gutters, don’t leave disused tyres , coconut shells, ant traps and empty your vases daily”, she urged .
As uncleaned gutters in houses were a leading problem as they were increasingly attracting mosquitoes, she said. “We have had discussions with the building industry stakeholders and shared our ideas as to how they can minimise this risk. It is now up to them and the urban development authorities to follow it up”.
Scattered rains increases bak maha kunu
Chief Medical Officer of Health Colombo Municipal Council Dr Ruwan Wijemuni blamed the unusual weather conditions for the current epidemic. The weather patterns this year have changed drastically. Look at the scattered rains we’ve had from February and still not settling well so that even in April and May when we usually get Bak Maha wehi (rains) which wash away the breeding sites of the mosquitoes, these scattered rains that are invariably followed with short spells of sunshine, have simply made the problem worse, as they lead to a proliferation of breeding sites for the larvae. In addition it is very hot. The increase in temperature serves to facilitate the hatching of the larvae resulting in thousands of eggs.
So was this the reason why dengue has surged?
“Yes. It has been one reason we now have a huge mosquito population of the Aedes aegypti variety that spreads dengue, all over the country. For the whole of last year the number there were 3,819 suspected cases reported. But now although the numbers in Colombo have gone down minimally, islandwide it has leaped to a new high of over 70,000 in just six months of the year.” He said congestion of urban population with a 650,000 resident population and another five lakhs of floating population in the space of 37 square kilometres have also facilitated the spread of dengue.
Impact of new Type 2 strain
Responding to our question on the new type 2 dengue strain and how it could impact on the human population, Dr Wijemuni said, “It is a very virulent strain which is much worse than the previous strains commonly prevalent in Sri Lanka. This strain is one that Sri Lankans have not been exposed to, so they have not developed sufficient immunity to fight it. What is so dangerous is that patients can go into leaking stage very quickly into Dengue Haemorrhagic and Dengue shock syndrome. So they have to be immediately taken to the nearest hospital if there is the least suspicion. “He said that the majority of victims were Lankans and Chinese migrant workers who unlike Indian and Bangladesh workers in our country had never been exposed to this particular strain.
Strategies to prevent spread
To prevent the spread of this new strain, he said the CMC has from this week started deploying over 600 persons including the Tri Forces and environmental Police to clear all high risk places. “It will be for three days using 1,800 personnel. We will be continuing the same clearing of mosquito breeding sites operations the following week as a pre monsoon precaution as the epidemic is expected to peak in July”.
He said the CMC had also started early morning fogging from 5.30 till 7 a.m and again from 5.30 pm till 7.30 pm. “We are also doing open air fogging and indoor spraying to kill the adult female mosquitoes and thus interrupt transmission, as many infected mosquitoes hide in dark places inside houses and get trapped inside. This can pose a threat to the health of those inside these buildings... Our services are available for any private institution. Call us on 2674965 and contact the chief Pest Control Officer Mr Edirisinghe.” Dr Wijemuni said that a school cleaning programme had been initiated from 11 to 12 noon by the Health Ministry and Education Ministry and would continue for the next month and indefinitely till the risks of dengue spread are reduced.
The Health Ministry is also looking at the possibility of making lab services available in all state hospitals located in the 14 dengue affected districts for 24 hours with many hospitals already being provided with equipment.
Hospitals - how are they coping?
Meanwhile, despite the frequent strikes by medical officers, lack of beds, space and overcrowded wards, hospital authorities say they are managing as best as they can.
Director National Hospital Dr Anil Jasinghe said, that the number of fever admissions per day, was now between 135-150. “Not all are dengue patients but the vast majority are definitely dengue fever patients. Today (Wednesday) there were 379 fever patients admitted to our wards, of which 356 were clinically positive patients.”
More shocking still is the fact that 71 of them had haemorrhagic fever needing specialised care as they could rapidly go into Dengue Shock syndrome.
“Our lab and OPD which now has 15 stations to handle patients, have the capability of issuing the results of a dengue test within thirty minutes, so that we can begin treatment immediately.”
Asked if patients were sent to other hospitals for lack of room or sufficient nursing and medical staff, he said, “Our patients are never sent to any other hospital. Since most come from Colombo and adjacent areas, we treat the here as best as we can”, he said.
To overcome the problem of more than two or three patients sharing a bed and some eve sleeping under the bed, or corridors, he said the hospital was now purchasing foldable beds. Some of our wards have only 45 beds but there are over 70 patients at any time. So when I was on my ward round I decided the most practical solution would be to give these patients foldable beds free of charge”.
Asked if the hospital was ready to face the challenge of a further spike in the dengue spread, he said, “We are already in a full blown epidemic. But if the situation gets worse we will be ready as we have the expertise and staff.”
Head of the Emergency Response Unit of the Health Ministry Dr Hemantha Herath who along with the Deputy Director Generals of the Health Services were recently appointed to monitor the dengue affected districts, when contacted said that since June 15th to ease congestion at the IDH and Colombo south Teaching Hospital, patients had been sent to Thalangama Piliyandala, Wethara, and Minuwangoda and High Dependency Units at Colombo Hospital and Colombo South Teaching Hospital among others were also sent to these hospitals we, on the instructions of the Health Minister.
The Infectious Diseases Hospital (IDH) has always struck one as been eminently capable of facing any challenge. So we were not surprised when Consultant Physician Dr Ananda Wijewickrama’s response to our question was more one of practical solutions to the problem rather than lamenting about the hospital’s woes.
He did however admit when pressed that the hospital was, “more than full despite putting two or more patients on one bed. We are a small hospital with only 200 beds. But at present due mainly to the flood of dengue patients we have over 400 in-patients at present. To overcome any shortage in staff, the Health Ministry has also given us ten additional medical doctors. Paying a compliment to the staff, he said everyone was working overtime and with dedication, as saving lives was their first priority.
Offering solutions from his vast background of experience, Dr Wijewickrama said that while a systematic waste removal to waste manage is being worked out, it was not the sole solution to the problem of containing dengue spread. “People’s behaviour patterns must change. They must be constantly reminded that unless they manage their waste with responsibility, they will only be endangering their lives and that of their families by exposing them to the dengue vector. The media must play a role here to remind them daily that throwing plastic cups, lunch sheets, styro foam boxes and other non degradable material on roadsides, or not keeping their own neighbourhood clean will only harm them. It will also result in economic loss for the whole country as productivity levels will be affected with frequent absences from work.”
Referring to a recent experience he said, “At the recent outbreak at Hambantota, it was found that the mosquito breeding sites were mostly present in the water containers of the people. Since they had no access to tap water, many of them were using containers to store the water, but had forgotten one important thing: to close the vessel with a net or lid to prevent mosquitoes from entering the water container. So this simply reinforces my view that people’s BEHAVIOUR must change”.
He said fogging and other operations being carried out at present were necessary at this point, but stressed they must be sustained. “If not the epidemic will return with a vengeance come the next peak season”, he warned. He also said that while establishing High Dependency wards was a good step forward, it involved a big expense.“The more practical solution would be to close down surgical wards that are underutilised in leading government hospitals, and send away paying patients such as those in the Merchant Ward at the NHSL and use these wards to house dengue patients”, he said.
Dengue epidemics are by no means a novelty in Sri Lanka. But unless we as its citizens from a very young age start taking our responsibilities of keeping this city green and clean as it once was in days gone by, the chances of future epidemics which will only get worse with more new strains cropping up as the mosquito mutates, looms as a strong possibility. Over to our readers.
