I live in one of the well-known villa communities in Hyderabad. Like most of you, I’d vaguely heard Dengue spoken about with a sense of panic a few years back; though hardly one or two cases within my circle of family and friends. The last couple of years have seen a sudden increase in the numbers affected and this year the onslaught has been worse – every person I meet or talk to in Hyderabad knows someone close who’s had Dengue. Almost 10-15 percent of homes in my community has had Dengue and this has been an alarming progression! And this seems to be a pan India and pan South Asian phenomenon this year too.
My elder daughter was one of those affected and it took 2 weeks for her to start recovering fully. It was not a severe manifestation and under our watchful care she’s back on her feet faster than most other cases. I took her to the hospital as soon as she complained about fever and body aches. I was lucky enough to land up with a good pediatrician and support system who gave us the right timely advice. When her blood reports came positive for Dengue, I panicked and was upset! I’d heard too many bad stories, time to recovery being too long and my daughter was missing all her crucial exams being an eleventh grader. I knew nothing about Dengue, how to take care of her, what to watch out for. That just added to the anxiety.
I realized a few things as I went through her care.
- My doctor obviously knew what to look out for when I took her for a check up, but I was worried sick all the days I wasn’t taking her because I could see the abnormal blood reports, pains/other issues and I wasn’t sure what warranted further care. How could I know if she’s okay or needs to be taken to hospital immediately?
- Lots of random information came through on how to deal with the disease – mostly these were home remedies which my doctor hadn’t mentioned anything about and nobody knew why it was important or what it really helped with!
- Every person I spoke to gave me the gyan on papaya leaf juice, but I was clueless about how to actually go about giving it. Some of the embedded messaging on papaya being a cure was downright irresponsible. Critical thinking people will discount those, but several might just pop a few pills assuming it cures them!
- As I heard of other cases from less privileged families and what instructions they received, it was clear they were clueless about what mattered the most!
My doctor clearly mentioned these – massive liquid diet, good urine output, stable means you can keep her at home. She told me about critical period (extremely dangerous period of 2-3 days when fever breaks) and how many litres she must be consuming per day. If platelets came below 1 lakh count, she’d admit her for close monitoring. I researched and came up with questions I could ask the doctor when I went to the check ups, because I had so many in my head. And I realized how privileged I am to be able to ask these questions and get answers to them (my ability to figure out right questions and my doctor’s ability to give quality answers). Not everyone is equally privileged. Moreover, the coping costs are quite high if there’s lack of fundamental awareness. Where buttermilk can solve things cheaper and better, what is the need for kiwi juice if family can’t afford it? Where does kiwi fit into the scheme of things? (Clue: my daughter didn’t even touch the kiwis I bought for her shelling out 40 rupees for a small fruit). Kiwi/pomegranate are all good, but not the most important.
Only 5% Dengue cases develop into severe Dengue needing hospitalization (1 out of 20 cases) – when infected for second time or after, the Dengue manifestation has high probability to be severe as well. Rest can be handled without the extra financial burden, but with regular doctor check up and getting the key basics right at home. I had a situation myself where I had to take a call at midnight – my daughter forcibly threw up the lunch that gave her terrible nausea around 11 pm and later developed severe pain in the throat that she couldn’t swallow even sips of water and it was as if it was blocked. And this happened during critical period when she was supposed to be orally hydrated a lot. I knew if I rushed her to ER, they’d just put her on drips. And because I knew IV is not ideal (leads to longer recovery phase due to fluid shifts), I decided to wait out a couple of hours to see if it’d subside. And indeed, after a couple of tense hours, the pain did subside and she could drink liquids. By morning all was fine! IV is really important for many Dengue cases where because of persistent vomiting or nausea or diarrhea or other issues, patient can’t consume liquids orally. But it’s overkill and in fact you could avoid chances of needless complications, if the same can be done orally.
So the take-away on Dengue management if you don’t remember anything else – it’s a complicated disease, don’t take chances and go to a good doctor when you have a fever during and after the monsoon season. Lots and lots of liquid diet, hydration checks – fever under control, urine output and blanch test (press finger till it becomes white and when you release it returns back to pink before you count 1-2-3), warning signs (see links below), critical period watchfulness are the most important things for you to do at home. The rest, doctor will handle based on clinical symptoms and patient condition. And platelets falling is not the real killer just one of the concerns – the silent killer is plasma leak!
About the prevention of Dengue
This brings us to the primary purpose of sharing this awareness on ADDA for gated communities. There are a few important facts to share on Dengue. We are all perhaps already aware of the fact that Dengue/Yellow Fever/Zika/Chikungunya are all transmitted by the same Dengue mosquito (Aedes Aegypti)
- Dengue mosquitoes can fly up to 400 meters from their breeding ground to bite humans. Which means even if your residence is maintained well, your immediate neighborhood can affect you!
- Only 1 in 4 infected by Dengue virus will show symptoms. Which means for every 1 subject showing Dengue symptoms, there are 3 others who are just carriers of the virus without any symptoms/explicit disease manifestations.
- Dengue mosquitoes, once infected, will continue to stay infected after the incubation of the virus until its whole lifetime (1-2 months)
- Dengue mosquitoes bite mostly during early day time and hours before dusk. So prevention can be possible only if you protect the person from being bitten anywhere – home, school, workplace, playground.
- Dengue mosquitoes fly to any height to bite humans and they are more prevalent amidst human populated areas – urban spaces. Their favorite biting spots are apparently below knees and below the elbows. They are nervous feeders, which means they could bite several humans during a single blood meal and hence transfer virus when infected.
The above gives you a very good idea why it’s important to target Dengue prevention at all levels – individual, home and community!
- Mosquito repellent on the person. Doctor recommended fabric roll-ons that are available – natural concoction of essential oils.
- Wearing fully covered clothes to reduce exposed skin area – both upper and lower body!
- Build natural immunity by eating healthy food.
- Immunity building techniques through alternative medicine/therapy, especially during the monsoons. Ayurveda (Giloy/Neem/Tulsi), Unani, Sidha (Nilavembu Kudineer), Acupressure (spleen, liver and lymph points activation), Homeopathy (Eupatorium Perfoliatum). These are not well proven scientifically and may need to be administered with expert advice or knowledge.
Prevention measures in home
- Avoid any stagnation of water — fresh or otherwise. This is both inside the premises and outside.
- Rooftops, terrace, balcony are places out of sight and out of mind. Sometimes people leave old junk, broken buckets, tyres, discarded cups on the rooftop/outside home which catches rain water and serves as a perfect breeding ground for Dengue mosquitoes.
- Dengue mosquitoes can breed even in water bottle cap left untouched with standing water! Make sure overhead tanks, storage drums, sumps and any and all water storage have lids.
- De-weed all unwanted shrubs/bushes to avoid mosquito resting. Do garden maintenance regularly especially during monsoons
- Plant marigold, lemongrass, citronella and other mosquito repelling plants
- Clean water coolers, containers, buckets once a week
- Unused bathrooms are a hazard too with standing water.
- It’s best to remove all decorative pieces with water content – vases, fountains. Or change water everyday.
- Segregate the waste in the house into wet and dry. Keep the wet waste tightly covered.
- Use mosquito nets, mosquito screens for doors/windows and mosquito bats!
- Can also use mosquito repellent at home – commercially available liquid vaporizer, essential oils, other natural concoctions, dhoop/sambrani.
Prevention measures in community
- Avoid any stagnating water on roads and other community areas; dysfunctional water harvesting pits too.
- De-weed unwanted shrubs/bushes in community green spaces.
- Plant marigold, lemongrass, citronella, neem trees and other mosquito repelling green cover
- Gated communities should do proper professional vector control — larvicide spray (both water and oil spray), fogging regularly
- Inform community if there is a Dengue positive case, so others can take more precautions and/or Association can take remedial steps
- Larvicide schedule is far more important than fogging. It kills the mosquitoes in the larval stage
- Fogging should be done at dusk when adult mosquitoes are active — around 6 pm. Any later, it’s highly ineffective.
- Association should also take on a few actions to survey and get residents to destroy the stagnation points, especially if there are multiple residences affected.
Refer to the video for details.
Community awareness and action is very important in preventing the spread of Dengue. And in the case of Dengue, prevention is really tough but very important to attempt than dealing with the disease!
Understand, care and share the above to help another! Together we can #DefeatDengue
About the Author:
Nithya Rajamani is a hands-on Software Research Engineer by profession and has had 14+ years of corporate experience. Her areas of research includes Smarter Cities, Data sciences, Information management and Distributed computing. Driven by her personal and community experiences, in this blog she shares her research on dengue and prevention and treatment of the deadly disease. Know more about her here.