With the nation's healthcare system still only recovering from the blow of the Coronavirus pandemic, many hospitals in the city including Dhaka Medical College Hospital are struggling to provide treatment to the rising number of dengue patients due to a shortage of beds.

In scenes reminiscent of the country's worst-ever dengue outbreak in 2019, many patients suffering from dengue fever were seen receiving treatment on floors and balconies as hospitals ran out of beds to accommodate them.

Visiting various areas in the city, UNB found a number of medical facilities including Holy Family Hospital, Mugda Medical College and Hospital, Bangladesh Shishu Hospital and Institute, Dhaka Medical College Hospital and Kurmitola General Hospital treating patients on the floor, as all the beds in the respective wards have been filled with patients being treated for the mosquito-borne disease.

Last Sunday (Oct. 23), the number of daily hospitalisations reported by the Directorate General of Health Services crossed 1000 for the first time this year, from 922 the day before. Hospitalisations did drop back down as the week progressed, to reach 750 on Wednesday.

The number of infections may start to fall in the first week of November, said Dr Nazmul Islam, Director of the Disease Control Department of DGHS.

Recently, the number of dengue patients has increased across the country. But the fatalities can be considerably reduced if patients go to the doctor at the right time, he said. He also said that dengue has increased due to climate change. Besides, the mosquito-borne disease has increased this time due to the lack of awareness also, he said.

A seasonal shift

The current surge in cases and deaths is indeed recent. Authorities reported the first death from dengue this year with nearly half of it gone, on June 21. After that there were 9 deaths in July, and 11 in August, but the situation really started exploding in September, that witnessed a spike in the number of deaths to 34.

October has been the second-deadliest month for dengue ever witnessed in Bangladesh, with 65 people dying from the disease in just the first 26 days of the month.

Public health expert Dr Mohammad Abdus Sabur Khan said that although dengue intensity usually decreases in September, this time the situation has reversed.

"It's October now, but dengue is showing no sign of retreating. It seems like dengue will prevail till mid-November this time," Khan said.

"Creating awareness among the public is a must to rein in the dengue menace. We've taken various steps in this regard," Health Minister Zahid Maleque told UNB.

He went on to name three hospitals - Dhaka North Corporation Hospital, a new unit of BSMMU, and Lalkuthi Hospital - that have been kept ready to deal with any emergency. Many might say the emergency is already here, especially in light of the kind of October we have witnessed.

A total of 120 people have died of dengue this year (as of October 26), making it easily the second-worst outbreak of the disease in the country's history after 2019, when a staggering 101,354 people were infected with the virus and 179 of them died.

Entrenched enemy

Following some sporadic cases in the 1960s, dengue became endemic in Bangladesh in the year 2000. Since then there have been yearly outbreaks.

Dengue is a mosquito-borne viral disease that has spread to over 100 countries around the world in recent years. There are four distinct, but closely related, serotypes of the virus that cause dengue (DENV-1, DENV-2, DENV-3 and DENV-4).

It is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Aedes albopictus - the same mosquitoes that are also the vectors of chikungunya, yellow fever and Zika viruses.

Health Minister Maleque said that the city corporations and municipalities have been urged to be vigilant about killing mosquitoes. If the number of mosquitoes is reduced, the number of patients will automatically decrease resulting in lower pressure of dengue patients in the hospital, he observed.

Dr. Kabirul Bashar, professor at Jahangirnagar University's Zoology Department, said that the under-construction buildings are the primary breeding grounds of Aedes mosquitoes and 40 percent of mosquitoes are bred from such locations.

In order to protect against dengue, people should be made more aware, alongside effective campaigns to eradicate mosquitoes by the city corporations, Dr Bashar added.

As the number of dengue patients is increasing every day, hospitals have been directed to give patients the proper treatment, Dr Ahmadul Kabir, additional director general of the health department, told UNB.

According to the DGHS, a total of 33,923 people have been affected with dengue till October 26 of this year - again, easily the second-highest on record after 2019. All but 6,181 of those cases have been recorded since September 1.

"Beds and logistic support will be provided if needed," Dr Kabir added.

No jabs for breakbone fever

Yet the truth is there is no specific treatment for dengue fever. Patients should rest, stay hydrated and seek medical advice, according to the WHO. Depending on the clinical manifestations and other circumstances, patients may be sent home, be referred for in-hospital management, or require emergency treatment and urgent referral.

The severe form of dengue causes a fever known as 'breakbone fever', so called because of the severity of muscle spasms and joint pain it causes. That will almost always require medical care by physicians and nurses experienced with the effects and progression of the disease.

Current vaccine options are also very limited. There is currently only one, Dengvaxia, which was developed by the French multinational Sanofi-Pasteur in 2015 and is marketed in 20 countries around the world. But its use is limited by the fact that, when administered to individuals who have never been infected with dengue, it actually increases the risk of developing the more severe version of the disease.

Because of this, it is only recommended for people between the ages of 9 and 45 who have had at least one previous instance of infection. An individual's first infection with dengue is almost always benign, going under the radar in the vast majority of cases. It is any subsequent infection by a different serotype that usually turns severe.

Speaking at a press conference in Dhaka on October 12, Institute of Epidemiology, Disease Control and Research (IEDCR) director Prof. Tahmina Shirin said that three serotypes - DEN 1, DEN 3 and DEN 4 - were dominating the outbreak this year, causing higher fatalities.

Even Dr ABM Abdullah, emeritus professor and the personal physician of Prime Minister Sheikh Hasina, was only able to provide the following as his 'guideline to fight dengue':

"First of all, if anyone is infected with dengue, he has to consult a doctor and start taking medicines according to the prescription. Some people tend to think that a mild fever won't do any harm. This line of thinking must be discarded. People suffering from fever must test themselves, and if dengue is identified in someone, he has to be admitted in hospitals immediately," Dr Abdullah said.

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