For many years now, dengue fever has been endemic in Karachi. Epidemics have also occurred in other parts of the country, including the Punjab and Khyber Pakhtunkhawa, since 2011. Having caused a large number of deaths in the past decade, dengue fever remains a dynamic disease that can have severe clinical manifestations. Patients presenting with the viral disease often require supportive and symptomatic management.
Dengue fever is a serious health problem that continues to be a concern worldwide, more so in developing countries with already overburnt and ill-managed healthcare systems. In the past two years, the focus has shifted from dengue relief activities to Covid-19 management for Pakistan, leading to an increase in the number of patients presenting with dengue fever this year.
The News on Sunday spoke with Prof Dr Javed Akram, vice chancellor of the University of Health Sciences (UHS) Lahore, to understand what measures are needed to curtail the dengue virus spread and for disease management. Prof Akram specialises in infectious disease, diabetes and hypertension management. He has served in prominent clinical, academic and administrative positions. Excerpts follow:
The News on Sunday (TNS): Dengue fever continues to spread, and interventions appear ineffective. What can be done to remedy the situation?
Prof Dr Javed Akram (JA): Cleanliness is key here. If we ensure the cleanliness of our surroundings, waterbodies and households, we can not only prevent the dengue virus from spreading but also get rid of malaria. Dengue fever has had a stronghold in this region for decades. What we witnessed in 2013 opened our eyes to the severity of the issue.
Since then, each year we have battled to keep the number of cases down. However, this has not been possible always. The major culprit is the lack of cleanliness and ineffective management of stagnant water.
TNS: Dengue fever appears to favour this region. Is mismanagement the only culprit here?
JA: Dengue fever is not just Pakistan’s problem. It is a global concern. Countries worldwide have been unable to eradicate the virus. Climate conditions are an important factor in the disease’s spread. The dengue vector grows well in moderate-humid conditions; therefore, any place with favourable temperatures is a perfect breeding ground.
TNS: The ever-rising number of dengue fever patients is alarming. What can be done to reduce the burden on the local healthcare system?
JA: The disease severity is proportionally linked with symptoms and therapeutic management in healthcare units. No one needs to die of dengue fever. It is very treatable. Patients presenting with severe symptoms must also be able to walk out of the hospital instead of being carried out. That is only possible through timely management of the symptoms and supportive treatment.
Not all patients require hospitalisation, but our healthcare staff must be trained to assess the severity of the disease and take action accordingly.
After years of battling dengue fever, some of our staff – doctors, nurses, and paramedics – still lack training. Regular training and seminars can help better equip our healthcare staff to manage patient load and take the right steps towards effective management of the situation.
TNS: Dengue prevention is every person’s responsibility. However, individual action is not enough to prevent its spread. What must the government and other social stakeholders do to control the situation?
JA: The government must realise that dengue prevention is an year-round activity. If we take action only when patients start pouring into hospitals, it is a case of too-little-too-late. Such a policy is one of the major reasons why we continue to face dengue‘s wrath. Proper governance is essential to manage any epidemic or pandemic; through that, disease-caused devastation can be reduced. Inspection teams must regularly visit homes, schools and offices. Proper fumigation is crucial to control the viral spread. Source reduction is most important. Pits must be drained regularly and other open water sources properly managed.
School managements must work proactively to ensure their students’ safety. Mosquito repellents, long-sleeved uniforms, and clean school grounds are necessary for safety during the dengue season. Teachers can educate students, teach them safety measures and encourage them to keep their surroundings clean. All this is going to help keep dengue in check in the future.
Office managers can also take similar steps to protect their workers. Wherever there is a water tank on the roof – homes, schools, office-buildings, hospitals, malls – it should be regularly cleaned and inspected. The lid of the water tanks must always be kept on. The dengue larvae grow in such spaces; it is important to reduce space available for their growth.
Corporate social responsibility, individual action, good governance, timely response, regular management, proper health support and consistent efforts are the way to save lives and curtail dengue.
The interviewer is a staff member