Dengue’s still here

Still up to its neck in fighting the coronavirus pandemic, the country’s heavily burdened health care system is bound to face another challenge with the onset of the rainy season: dengue fever, a seasonal scourge that killed more than 1,500 last year, prompting the Department of Health (DOH) to declare a national epidemic.

World Mosquito Program (WMP) director Scott O’Neill called the looming prospect a “perfect storm,” where fragile health systems especially in developing countries like the Philippines have to manage outbreaks of two diseases at once.

“Mandated lockdowns mean people are spending more time in the home, where most transmission of dengue from mosquitoes occurs. Many dengue control measures—such as removal of potential mosquito breeding sites by local residents—have also ceased. Health workers who usually promote this work in the community are working from home or many have been reassigned to their local COVID-19 response,” O’Neill said in a statement posted on the website of WMP, a nonprofit initiative that seeks to protect the global community from mosquito-borne diseases. Asia (particularly the south), Latin America, and the Caribbean are among the regions seen to be most affected by dengue this year.

Last May, Health Secretary Francisco Duque III already warned that the risk from dengue, which is transmitted to humans through the bite of an infected Aedes aegypti or yellow fever mosquito, “is a permanent one” because of the country’s tropical climate. He said any expected spike in dengue cases could stretch the country’s resources already struggling to contain COVID-19. “The confluence of the rainy season and the expected rise in dengue cases will certainly pose a burden to the health system’s capacity,” Duque said. What’s more, some symptoms of dengue, such as fever, and muscle and joint pain, can also be confused with COVID-19—just as colds and pneumonia, which are also common during the rainy season—and may result in increased paranoia among the public over the novel coronavirus that has already killed 1,660 as of Friday.

Last year, the Philippines faced its worst dengue outbreak since 2012, and was the hardest hit by the disease among Asean countries. The DOH declared a national epidemic in August 2019 following a 98-percent increase in cases. Regions that reported the highest number of dengue cases were Western Visayas, Calabarzon, Zamboanga Peninsula, Northern Mindanao, and Soccsksargen. But from January to May this year, DOH’s surveillance report has been encouraging, showing a 46-percent drop to 50,169 from 92,808 in dengue cases compared to the same period last year. There have been fewer deaths, too, with only 173 compared with 452 for the same period.

Health officials attributed this to increased awareness about the disease and how to prevent it. The DOH launched the Sabayang 4-O’clock Habit campaign in the midst of last year’s epidemic to encourage local communities to search and destroy mosquito breeding sites. They, however, have also warned that now is not the time to be complacent; with majority of the people at home due to COVID-19 lockdowns, families can use this opportunity to clean their homes and surroundings and observe the “4S” in fighting dengue: self-protection; search and destroy mosquito breeding places; seek early consultation; and support fogging or spraying in hotspot areas. The dengue mosquito breeds in stagnant water.

The government has also made available Dengue NS1, a rapid diagnostic test used in detecting the dengue virus in the blood, in rural health centers; and has established Dengue Centers of Excellence in level 3 government hospitals. National Dengue Prevention and Control Program manager Norielyn Evangelista advised the public to consult health professionals when they experience dengue fever symptoms that also include severe headaches, rashes, diarrhea, retro-orbital pain, anorexia, nausea, and bleeding gums and nose. She encouraged those who do not want to go to hospitals out of fear of contracting COVID-19 to opt for telemedicine or online consultations instead.

The lockdowns, as well as fear of contracting COVID-19, have prevented the public from seeking medical attention for other illnesses. In addition, many health care personnel have been reassigned to fighting the coronavirus, and services like outpatient care and surgery have been suspended. While necessary, this “covidization” of health care, as medical experts Gideon Lasco and Joshua San Pedro wrote last month in this paper, may also be “taking attention away from other health concerns, many of which are likewise a matter of life and death.”

With the onset of the rainy days, it is imperative that the government does not lose sight of other pressing health issues such as dengue, which, as WMP’s O’Neill said, will still be a serious global health issue even after the COVID-19 pandemic passes.