May 29, 2023

Two-front battle: The dengue challenge amidst the Covid-19 pandemic

The Covid-19 pandemic, following its first outbreak in December 2019, has plagued – quite literally – the world and its economies during the past two years, severely.

While the developed world has not fared much better, the third world’s feeble economies had it worse as high and dense populations, poor sanitation, and an overall dearth of healthcare facilities made the cost of the epidemic unbearable for most countries. Public lack of seriousness and ignorance, propelled by an already prevalent lack of education, compounded the negative effects of the epidemic, making it harder for the developing world to cope with the attack of the novel coronavirus.

Pakistan, despite being the 5th most densely populated country in the world and a developing nation, dealt with the pandemic better than expected, receiving praise for its curtailing efforts by the World Health Organization (WHO). The country has, as of December 11, experienced 1,288,366 cases, of which 28,812 resulted in deaths – a 2.2% mortality rate, which is only slightly higher than the current global mortality rate of 1.9%. What the pandemic did to the country’s economy is a story for another day, and another article – one 2020 study suggested that the country lost as much as one-third of its revenue and its “exports dropped by 50%” – however, as far as loss of life is concerned, the South Asian country safely avoided the ‘potential disaster’ that it was predicted to face.

However, as soon as life seemed to be returning back to normal, with most schools across the country reopening by mid-September, and conducting normal, in-person classes by early October, another known adversary hit. Dengue, a mosquito-borne viral infection, has many times before wreaked havoc in the country, once causing widespread devastation in the Pakistani province of Punjab in the year 2011. It is, for Pakistan, what is termed by the Directorate General of Health Services, Punjab, and the WHO as the ‘Dengue Epidemic’.

The WHO reports that the country had lost at least 317 lives to the epidemic since 2010, of which 257 had taken place in the Punjabi capital and metropolis of Lahore, alone. The National Institute of Health (NIH) Islamabad, reports the incurrence of 22,938, 3,200, 24,547, and 3,442 cases of dengue fever in the years 2017, 2018, 2019, and 2020, respectively. The same report, published in April 2021, estimates the total, cumulative number of cases of dengue fever in the country to amount to around 10,212,834 of which 14,778 succumbed to the disease. Much to the already Covid-plagued, resources-drained country’s dismay and disbelief, the new (but old) epidemic caught momentum with unprecedented speed, this time also hitting the Federal Capital, Islamabad, with never-before-seen severity.

Therefore, when late in September this year, a surge in the cases of dengue fever was observed, the country took it very, very seriously. A Dengue Response Emergency Plan of Action (EPoA) was quickly drafted and issued on October 21, only a couple of weeks after the epidemic was believed to hit the Federal Capital, in addition to the already in place Ministry of National Health Services Regulations and Coordination (NHSRC) plan for dealing with dengue and other vector-borne diseases (VBDs) from 2020 through 2024.

The EPoA was designed specifically to tackle the dengue outbreak in Islamabad, partly because the capital city was one of the hardest hit in the country, and also because Punjab – being much more experienced in dealing with dengue – was already managing well on its own. The EPoA report suggests that the capital, in dealing with the epidemic, was looking up to Punjab – specifically Lahore – for guidance. It mentions that in Lahore, the outbreak was being tackled by opening field hospitals, in order to facilitate more patients, but a different approach was to be taken in Islamabad and Rawalpindi. To subdue the epidemic in the twin cities, the plan was to conduct widespread fumigation – targeting especially the cities’ peripheral hotspots – and to undertake spot checks.

A DREF – Disaster Relief Emergency Fund – application, the report further states, was also submitted to the International Federation of Red Cross and Red Crescent Societies (IFRC), indicating the country’s desperate need for financial aid amidst a crisis during which it has even received a cold shoulder from the IMF (International Monetary Fund).

Despite the quick response – the meeting to draft the response to the dengue outbreak was called on October 12, just 4 days after the initiation of the outbreak in the federal capital, Islamabad – and detailed coping strategies, the dengue landslide is reported to be continuing nationwide, undeterred.  According to most recent estimates, Punjab is reported to have had 27,758 cases, Sindh, 12053, Khyber Pakhtunkhwa 10,547 cases, Islamabad Capital Territory 4,616 cases, and Balochistan 3,075 cases during the most recent outbreak.

Given the context, Pakistan might just be looking forward to the closure of the peak of the mosquito’s breeding season – which in Pakistan is estimated to last between 20th September and 5th December during the country’s ‘post-monsoon’ season – to experience some respite from the virus. Another feasible – in fact, much-needed alternative – that Prime Minister Imran Khan must consider is the import and distribution of the dengue vaccine. That, however, is an expensive plan, and added expenditures are something the country must be trying to avoid amidst the current state of economic crisis. Nevertheless, extensive administration of the dengue vaccine might be the only long-term solution to a problem that has plagued the country now for a decade, claiming thousands of lives thus far.

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