Even as Kerala is engaged in a spirited fight against the Covid-19 pandemic, with the number of infections surging in recent weeks, a familiar, endemic disease that grows in leaps and bounds with the arrival of the southwest monsoon is threatening to pile pressure on a severely-strained health machinery.
Dengue fever, known to strike with impunity with a high mortality rate unless detected early, is showing alarming incidence across the state, heightening fears among health officials and workers who have been forced to mobilize a huge chunk of their resources towards battling Covid in the last few months. The viral disease, transmitted by the common Aedes mosquito, has been reported with over 5600 suspected cases and three deaths this year, with cases set to rise further by July when the monsoon takes hold. There’s another reason why experts are nervous about a potential outbreak this year. Epidemiological trends of the dengue fever have showed a cyclical pattern in outbreaks with cases rising every three years. Considering the last outbreak was reported in 2017 when over 19000 cases were found, this year could witness a repeat of the cycle.
Every year, ahead of the monsoon, Kerala undertakes large-scale desilting of the canals, removal of waste, house-to-house visits to check for stagnant water, elimination of mosquito breeding grounds in plantations and making people aware about the risk of communicable diseases like dengue, leptospirosis and H1N1. Thanks to a decentralised and well-oiled public health system aided by decisive local bodies, such cleaning activities have contributed, in large part, to breaking the chain of transmission and thus reduce mortality. This year however, the heightened focus on Covid, since the reporting of the first case in January, has meant that the health department, along with local bodies, have been strained for resources in completing pre-monsoon cleaning activities.
It was in late April, by when the state had begun to receive the first tranche of summer showers, that grassroot workers like ASHAs and health inspectors were given instructions to carry out vector surveys and source reduction programmes. Vector surveys can gauge the mosquito density in an area and thus predict if the area is prone to an outbreak. Higher the vector density, higher are the chances of an outbreak. Officials also look at data from previous years to map areas which are vulnerable to mosquito breeding.
Restrictions on accessing homes
For both vector surveys and source reduction (practice of eliminating breeding grounds of mosquitoes), a close interaction between the health workers and the public is required. And that’s where the Covid pandemic has worsened matters. Due to the lockdown and a large number of families in quarantine, there have been restrictions for health workers to access households and check for accumulation of stagnant water.
“It’s true. We are not able to intrude into homes like previous years,” said Pratibha Ansari, head of the standing committee on health at Cochin Corporation, one of the biggest municipal bodies in the state in-charge of the city of Kochi.
“We attempted to conduct medical camps too, but the response has been that it is difficult to hold such camps right now due to the prevailing Covid circumstances.”
In urban areas like Kochi, where dengue cases are routinely reported every year especially in dipalidated slum-like colonies, officials found a way out: roping in resident welfare associations in awareness and cleaning activities.
“For the last one week, we have been observing a ‘dry week’ where we called for cleaning of all residential premises in the city. We asked resident associatons to join in because they have much better leeway in accessing homes and compounds. For supervision, our workers will be present. We pointed the public to check accumulation of water atop terraces, sun-shades and trays below flower pots. If people cooperate with us, the process can be easier,” added Ansari.
Dr Nandini, a former surveillance officer with the health department and currently teaching at the MES College in Perinthalmanna, said, “These are people-centric initiatives. The mosquito is domestic and it is our responsibility to remove the vector habitats. Community involvement is instrumental in reducing the mosquito density. People shouldn’t wait for health workers to come.”
System is strained
Since the first week of May, when people began returning to Kerala from other states and abroad, there has been a sustained rise in Covid cases. From just 16 active cases on May 7, the number has surged to 1366 as of June 16. However, the relief among health workers is that a majority of the cases are ‘imported’ in nature with transmission through local contact generally under control. But that means, the disease surveillance system of the state has been on an overdrive since January with officials constantly engaged in contact-tracing exercises and monitoring people under quarantine. This has resulted in the system coming under severe strain with grassroot workers bombarded with responsibilities.
Dr Vinod Paulose, a health officer in Ernakulam district, agreed. “Summer is when we get a one-week break. This summer, we couldn’t take any break as we have been working 24×7 (on Covid). Health, revenue, police and local bodies are all under strain. We need more volunteer support at the local level.”
In Ernakulam district alone, over a 1000 suspected cases of dengue have been reported this year, with outbreaks mostly in the eastern fringes of the district like Kothamangalam, Varapetty and Paipra which have plantations and farmlands. Officials are now moving on a war-footing to control outbreaks in these areas through integrated campaigns with local self-governing bodies.
Dr Paulose added, “Early case detection is very important to prevent transmission and complications. Local health bodies are undertaking vector surveillance and fever surveillance through ASHA and Kudumbashree workers by getting source reduction done at the spot. Committees have been formed at the ward-level to initiate behavioral changes among the public too.”