It is well-known that density of population and climatic conditions contribute to make Dhaka an ideal breeding ground for mosquitoes of the Aedes genus, which act as the natural vectors for some of the deadliest diseases in the world: Chikungunya, malaria, West Nile Fever. And of course, dengue.

Authorities in Bangladesh have 23 years of experience dealing with outbreaks of dengue, which became endemic to the country at the turn of the century. Yet it would seem their management of the disease keeps getting worse. How else would you explain a nearly 400% jump in fatalities from one year to the next, as Bangladesh has experienced in 2023?

Despite all forewarnings, the customary drives against the breeding of Aedes mosquitoes, undertaken by two city corporations in charge of the capital, never seemed to gather the kind of urgency required. Although DGHS clearly has the mandate to play a central role in the fight against dengue, its activities are confined only to diagnosis and treatment.

As a result, Bangladesh stands at number three in the world this year, for the number of dengue patients and also the death toll. As far back as June, with the year's fatalities still in the 100s, public health experts were urging the authorities to declare a public health emergency in the country for the dengue outbreak. That call still stands today, after 1350 deaths, only as ignored as before.

Apart from the record-shattering fatalities, coupled with an abnormal jump in the case fatality rate (aka known as death rate), two other worrying trends around the disease became well-established this year. Neither bodes well for the future. The first one is that dengue is now pretty much an all-year round concern. This is evidenced by the fact that we are now in November, and there is really no sign of the onslaught that started in June slowing down. The peak may be associated with the monsoon months, but you are never quite safe.

Similarly, despite dengue being confined to Dhaka city and its surrounding, eponymous district till 2019 (when the first cases outside the bustling capital were reported), in the space of just four years the disease has successfully established itself all over the country. By late September, only around 45% of the confirmed dengue cases in 2023 have been reported in Dhaka district, of which almost all the cases were recorded inside Dhaka city. Yet this is the first time that confirmed dengue cases outside Dhaka have outnumbered those inside. Next year, it means the task ahead for the authorities is set to get even tougher. But there is really no telling if they even let themselves get fazed by such a prospect.

Current trends indicate that the number of weekly confirmed cases outside Dhaka city is rising, increasing by around 1.5 times, namely from around 8,500 to around 13,000 over a 20-day period, between August 27 and September 16, 2023. Now again to reiterate, reports suggest that the presence of Aedes mosquitoes and larvae in rural areas of the country has significantly increased compared to previous years, and these areas lack adequate facilities for the testing and treatment of the virus, and a significant portion of rural dengue patients in critical conditions need to reach facilities in bigger cities, especially Dhaka city, to receive treatment. In this regard, the increasing spread of the dengue virus in rural areas can increase the rate of cases being left untreated, triggering a deadly downward spiral in the healthcare system's most vulnerable points.