IN CASE YOU MISSED IT

Time to get tougher in dengue fight

This story was first published in The Straits Times on March 20, 2013

DENGUE cases are on the rise, and the numbers are staggering.

Over 2,000 have been diagnosed with dengue fever this year, a spike from 600 in the same period last year.

Last week, 309 dengue cases were recorded. Since the middle of January, over 200 new cases have been reported every week. The weekly peak of 322 cases early last month was the highest in four years.

And if the numbers are not worrying enough, the timing of past epidemics should be.

The last major dengue epidemic was in 2005, when 14,200 fell ill from the disease. Of these, 25 died.

Before that, an outbreak in 1998 infected 5,300 people.

Dengue epidemics peak every six to seven years, with each new wave causing more people to fall ill than the last, when the dengue virus switches to a different predominant strain.

The time appears ripe for another outbreak right about now.

And the effects of dengue painfully hit home when my maid and I caught the disease two weeks ago. We fell ill at the same time. As it turned out, our home was right in the middle of an active dengue cluster, with two neighbours infected by dengue a week earlier.

For me, it started with fever, which the doctor diagnosed as a sore throat. He sent me home to rest with two days of medical leave, and I told my colleagues with optimism that I would be back to work in a couple of days.

I was wrong.

The fever persisted and I started vomiting. By day four, I lost my appetite and threw up each time I ate. I was down on my knees hugging the toilet bowl for support when I threw up. Blood tests that day confirmed that both my maid and I had dengue.

Our fever spiked on Day 5, and my wife rushed us to hospital. The doctor said the maid was well enough not to be hospitalised, but I was so severely dehydrated that the accident and emergency department pumped three packs of fluid into my veins in two hours.

It was then that I learnt that not all dengue illnesses are the same. There is dengue fever and there is dengue haemorrhagic fever, where there is risk of internal bleeding. I had the latter.

I spent the next two days lying in a daze on a hospital bed, wondering if I would live to see my children get married one day.

I remember my wife's eyes welling up when she saw how ill and incapacitated I was.

On Day 7, the continuous drips caused the veins on my left hand to swell, and the doctor started a new drip on my right hand.

I started to get better on Day 8. The blood test showed that my blood platelet count had dipped to its lowest point and then started climbing.

The drips came off on Day 9. On Day 10, I was discharged from hospital and sent my colleagues an e-mail message to say that I would live to write another day.

It took another two days before I regained my appetite. The doctor said I will take another week or so to fully recover.

The two weeks that I lost to dengue was a game changer. Before the illness, I did know the basic steps to prevent mosquito breeding at home, but I left the responsibility entirely to the maid and the wife.

After returning from the hospital, I chanced upon a National Environment Agency (NEA) website that provides weekly updates on dengue hot spots.

The website is also peppered with useful information on how to prevent dengue.

Besides the website, I also experienced how the NEA's dengue outbreak monitoring mechanism kicked in.

A day after the blood test confirmed that I had dengue - which I presumed the general practitioner duly reported to the Health Ministry - I received a phone call from the ministry asking me to spell out my whereabouts before I fell ill. The officer was trying to trace the source of infection.

On the same day, I also had a visit from an NEA inspector. I was half expecting a stern-looking mosquito inspector ready to slap a fine should he find breeding spots, but he turned out to be as concerned about my illness as he was looking for mosquitoes.

He even shared a homemade recipe of steamed frog's legs and bittergourd that purportedly boosts the blood platelet count.

But while the surveillance might have worked in the case of my household, I doubt whether it can prevent a full-blown epidemic. The NEA inspector said that he had visited all except one home in my neighbourhood. The neighbour had refused to open the door.

So all the effort to keep a neighbourhood free from dengue will come to naught if just one neighbour continues to breed mosquitoes.

In 2003, the Government amended the law to give public health officials powers to enter and search homes to investigate outbreaks of infectious diseases. Those who obstruct the officials can be charged in court and slapped with a $10,000 fine or six months' jail, or both.

There is no record of the Health Ministry having to charge anyone in court to force them to open their doors. An NEA source tells me that faced with the threat of punishment, even the most hardened home owners will open their doors, eventually.

While I can understand the Government's preference not to be draconian, I wonder if the NEA is being too nice to the uncooperative ones.

How many unsuccessful visits does it take before it decides to enter a home forcibly? When facing the threat of a massive dengue outbreak, NEA inspectors do not have the luxury of time to have doors slammed on them more than once or twice.

And if persuasion does not change bad habits that cause mosquito breeding, I am sure a stiff fine will.

So long as the weekly dengue numbers stay high and the possibility of a massive outbreak looms, it is better to be firmer and keep the neighbourhood safe, rather than be nice but sorry.

tohyc@sph.com.sg

This story was first published in The Straits Times on March 20, 2013

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