Dengue fear chokes hospitals

The huge increase in the number of viral fever patients is overwhelming both public and private sector hospitals across the State, with outpatient clinics, wards and emergency wings taken over by fever cases.

Doctors said that media reports about fever deaths seem to have sent the panic bells ringing among the public and that most people tended to rush to the hospital demanding admission because their “count (platelets) was down.”

“This is turning out to be a stressful situation for us. A huge number of patients are being referred to us daily just because their platelet count went below one lakh. Dengue complications can develop suddenly, so we cannot blame the doctors in the periphery either for referring the patient. But the panic situation is unwarranted, ” a senior doctor at Thiruvananthapuram Medical College said.

The Health Department has issued clear dengue management protocols to be followed by doctors.

But neither patients nor doctors are willing to take any risks, he pointed out.

Not all these patients require hospital admission and they would do much better if they were to take rest at home and keep themselves well-hydrated through oral fluids, he pointed out.

Platelets transfusion has only a very limited role to play in the management of dengue fever.

There are very clear indications and WHO criteria as to when a patient needs to be transfused with platelets.

However, the scare about dengue and low platelet count among the public has led to the general assumption that platelets transfusion is the main or life-saving mode of treatment for dengue. So much so that there is a situation wherein the doctors are being questioned “for doing nothing,” MCH doctors said.

Intravenous fluids and platelets need to be administered judiciously. Platelets may need to be transfused if the count goes below 10,000 (WHO) and even then only if there are any signs of bleeding.

Serious complications due to dengue, requiring emergency medical management, seems to be the main feature in this year’s epidemic, especially since the past two weeks, a senior consultant at MCH said. “There is definitely a change in the pattern of dengue illness now than in the beginning of the season. Many patients develop cardiac complications – acute myocarditis – often with a fatal outcome even within a day. Pleural effusion (fluid collections occurring around lung), broncho pneumonia are the other dangerous complications. We are unable to convince people that we can only treat the complications as they develop and that there is no definitive treatment for dengue,” he said.

The State is hyperendemic for dengue and all four strains of the virus are circulating here. People who are infected a second time with a different type of the dengue virus may have a different immune response wherein the clinical symptoms of dengue might worsen and the person has a severe disease.

Vector control

Meanwhile, lack of community involvement in vector control activities continue to be the one of the primary reasons for the explosive growth in the vector population, Health department officials said.

“Health department alone cannot take charge of the vector control drive. The public should be vigilant about the possibility of mosquito breeding within homes or in their premises and take up source reduction in a major way. This is an activity the community should take up together because even if you are doing source reduction activities religiously, mosquito breeding in your neighbour’s compound can still give you dengue,” said K.J. Reena, Additional DHS (Public Health)

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