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Mayor springs dengue solution

Calcutta, Sept. 2: Mayor Sovan Chatterjee today said the extent of dengue in Calcutta was being “blown out of proportion for the sake of business interests” and advised people “come to the CMC clinic and you won’t die”.

The advice came on a day at least two more deaths linked to dengue were reported in the city, taking the unofficial toll in Calcutta alone to at least seven, higher than that in the past three years. According to government estimates, three people have died of dengue in the city so far this year.

The unofficial toll is higher if Salt Lake is included.

“We are doing everything that needs to be done,” mayor Chatterjee told The Telegraph. “But some people are blowing the situation out of proportion for the sake of their own business interests. Come to the CMC clinic and you won’t die. Not a single dengue death has been recorded among patients treated at our clinics in the past 30 years.”

The mayor did not elaborate on what he meant by “business interests” but some private hospitals had reported dengue-related deaths — which account for most of the “unofficial” casualties.

The CMC has over 100 clinics across the city. But so far, their perceived expertise has not been advertised enough to inspire confidence among too many Calcuttans.

Public health experts cautioned that instead of quibbling over figures, rapid and concerted action should have been taken as soon as it became clear that the incidence of dengue this year was higher compared with the preceding two years. According to the state health department’s own figures, at least 394 people have tested positive in the confirmatory tests and another 1,100-odd are suspected to be down with the disease after rapid tests.

In order to formally term the situation an outbreak, the number of patients that year should be twice that of the average for the previous three years. Some officials said the number of deaths, not patients, was the deciding factor.

By both yardsticks, Calcutta appears to have crossed the threshold. (See chart)

However, the dangers of splitting hairs over numbers become apparent against the backdrop of the avenues of information. The government database itself lists contradictory figures. Two documents on the same website list the number of dengue cases in 2010 as 111 (based on the confirmatory MAC-ELISA IgM test) and 437 while the number of dead has been put at zero and 1.

“Health authorities have no reason to wait for case numbers to fit the definition of an outbreak before launching preventive and control action,” an infectious disease expert said.

Calcutta’s public health authorities should have initiated mosquito surveillance and control and launched a campaign after the first spurt in fever cases, experts said.

“Dengue can spread fairly rapidly — so outbreak prevention and control actions should begin early,” said Manish Kakkar, an infectious disease specialist with the Public Health Foundation of India, New Delhi.

Others suggested that civic officials probably downplay such situations as formal declaration of an outbreak would require them to take a series of steps. The lack of admission means there is no urgency to implement the guidelines set by health agencies.

The WHO, for example, has outlined a series of steps to be initiated when an outbreak is suspected. These include a campaign that urges people to protect themselves from mosquito bites, estimation of the number of people at risk and the requirements to manage an outbreak, and clinical training for dengue management.

“Public campaigns making people aware of how to avoid mosquito breeding and to avoid getting bitten are crucial,” said Syed Manzoor Kadri, chief epidemiologist and infectious disease specialist in Kashmir. “People need to be told the Aedes aegypti is a day biter. They should be encouraged to get rid of potential breeding spots,” Kadri said.

In Calcutta, Dipika Sur, head of epidemiology at the National Institute of Cholera and Enteric Diseases under the Indian Council of Medical Research, said: “Communication is the most crucial way of tackling a dengue outbreak.”

No such effort has been made in Calcutta. So, households across the city continue to store water in open containers and government construction sites teem with mosquito-breeding hubs.

The public health experts said the authorities should have taken the following steps:

Awareness

Make people aware of the disease, its symptoms and its causes in every possible way through the media, schools, colleges and billboards.

Conduct door-to-door campaigns and make people aware of the hazards of storing water in open spaces.

Involve people in destruction of breeding sites on their premises and in their neighbourhood.

Civic by-laws

Enforce civic by-laws and fine households or individuals for mosquito-breeding sites.

Ensure construction of appropriate overhead and underground tanks with proper covers through building by-laws.

Monitoring

Go door to door to gather information and prepare a geographical information system, mapping affected areas.

Deploy volunteers to locate areas where the most cases have been reported and conduct platelet-count tests even on people without symptoms.


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