As the mortality rate of the current dengue epidemic soars day by day, doctors feel that the government should equip hospitals in the periphery with more facilities and human resource and focus on improving the case management scenario.
Tertiary care centres were seeing a lot more dengue fever cases wherein the patient deteriorated rapidly with lowered blood pressure and complications like myocarditis, often with a fatal outcome within a day.
In fact, unnecessary referrals from the periphery are not just choking hospitals like medical colleges, it is also increasingly contributing to an increase in the death rate. Because in a crisis situation like the current one, the time lag involved in reaching the patient to a higher centre and for the doctors there to take over the patient’s management can often make the difference between life and death.
“The government should give more support to the doctors in the periphery and give them the confidence so that the referrals come down. The focus right now should be on identifying people with warning signs of dengue complications — abdominal pain, vomiting, low blood pressure, diarrhoea, bleeding tendencies — and giving them more attention so that the deaths can be reduced,” Arunkumar, head of the Manipal Centre for Virus Research, told The Hindu .
In the peak of an epidemic, even testing for dengue is not important, because what is required is symptomatic management. The daily testing of platelets is unnecessary and only serves to heighten panic among the people because platelets are bound to go down in any viral fever.
“People need to be told clearly that platelets going down is normal as long as the patient does not have any bleeding tendencies. The complications of dengue usually show up after the phase of high fever, when the patient begins to normalise. This is the time when people should rest at home and watch out for warning signs. Proper clinical assessment and constant monitoring of those with warning signs can bring down death,” a senior physician said.
Dr. Arunkumar said that given the high vector density and the fact that a significant percentage of the population was already infected, bringing down dengue case numbers would be a difficult task.
Dengue has been endemic in Kerala for a long time. All four sero types of the virus are in circulation, with disease transmission happening throughout the year.
A majority of dengue infections in the community presents as subclinical or mild viral fever and hence a significant population here is already exposed to dengue.
“People who are infected a second time with a different dengue virus strain may have a different immune response and present with a severe illness. In the coming years, one should expect more hospitalisation due to dengue and more complications. Which is why it is all the more important that the focus should shift to improving case management and bringing down the mortality,” Dr. Arunkumar said.
