The sad demise of Bollywood veteran Yash Chopra from complications of dengue on Sunday is a loud wake-up-call that the plunging public health standards of India do not distinguish between the rich and the poor.
Modifying lifestyle, eating organic and flying off to Singapore and US hospitals can save the rich from many illnesses, but not infectious diseases. They penetrate high walls and class divides to drag the upper and middle classes into the conditions of thousands of destitute people in Dharavi or East Delhi.
There is no escape unless you have a hermetically sealed existence. Or a greenhouse in Australia as Olivia Newton Jones once tried while recovering from cancer.
Yash Chopra’s tragedy is what hundreds of people, both adult and children, are going through in India between August to January. What used to be sporadic and self-contained outbreaks has become a country-wide phenomenon. From Thiruvananthapuram to Delhi and Kolkata to Mumbai, dengue is now more or less a generalised epidemic.
Should one be worried?
Of course, because it can kill and does kill.
Even if it doesn’t kill, it “breaks your bones”: high fever, headache and severe pain of the muscles and joints, and gastric problems, including vomiting, are the typical symptoms of the illness.
It grounds you for one to two weeks. In an epidemic situation, it fills up hospitals beyond capacity and affects workplaces because of absenteeism.
A majority of people (some estimates say 80%) don’t even realise that they have had a dengue episode; they might just feel that they had an unusually severe fever. The slightly more informed ones and doctors might note that it was a viral fever because of the muscle and body pain, the tiredness and severity of the fever.
The dengue virus has four sub-types and you can be infected by any of them. If you are infected by one of them, it gives you immunity from that subtype. But if you are infected again by another subtype, your immunity itself becomes a problem and the new subtypes tricks the body’s immune response. Therefore, the second infection becomes more acute than the first one and can lead to more complications. For the same reasons, a third infection can be really more serious. Therefore, you should always avoid getting dengue and if you get it once, be extremely careful not to get it again.
Only in those cases where the doctor asks for a blood test or those which go out of hand, does one realise that one is infected. In the routine blood work-up, a low platelet count with associated symptoms is a tell-tale sign. Most doctors then ask for a dengue test.
The platelet count keeps falling during the course of the illness, hits a low and then starts rebounding. From a usual 250,000, the count falls steadily to, say 70,000, and lower. When it hits the 50,000 mark, it gets disconcerting. Usually, when it breaches the 30,000 mark, the doctors start infusing platelets into the patient’s blood.
If it falls below the critical level, the patient develop blood spots (hemorrhagic spots) on the skin indicating bleeding. It can soon get fatal. Some go into a dengue shock which is marked by dangerously low blood pressure, and die.
Most patients recover before reaching this level of complications by taking a lot of fluids, both orally and intravenously (drips). Once the platelet count starts rebounding and shows a progressive rise, patients are usually discharged. Even in critical conditions, with appropriate and timely hospital care, people recover from dangerous conditions as the wife a hotshot Bollywood director did a few years ago.
In medical terms things are a little more scientific and complex, but this is the general scene.
Anyway, don’t blame it on India and its pathetic civic conditions. According to WHO figures, India is even behind Sri Lanka among the 30 highly endemic countries. Brazil, with at least 40 times India’s patients, tops the list followed by Indonesia, Vietnam, Mexico, Venezuela and Thailand. WHO chief, Dr Margaret Chan calls it the “most important mosquito-borne viral disease in the world.”
“Everywhere, the human and economic costs are staggering,” she said.
So are there ways to stay safe and prevent one and one’s family from being infected?
Yes, but only if everybody wants to prevent the spread of the disease and be safe, because all it takes is a single bite by a female mosquito that breeds in fresh water not far away from your living space. Usually not more than 100 meters.
It may sound philosophical, but true – the answer truly lies within. Within your home and neighbourhood.
The villain mosquito (most commonly the Aedes Aegypti although three more species can transmit the virus) breeds in small collections of clean water such as rain water in coconut shells, small plastic containers, plastic bags thrown around, water collecting around potted plants, water leaking from air-conditioners and coolers etc.
For a change, it’s not the dirty water-logging that causes the problem, but the cup-full of water that collects around you. This is not to say that the mounting garbage in our cities is not an accelerator because it has several plastic bags/containers that can collect fresh water wen it rains.
The only way of prevention is to prevent mosquito-breeding and avoid being bitten by mosquitoes.
To prevent mosquito breeding, you should consciously look for such collections of water at and around your home. Not that it doesn’t happen in public places – in fact they are the ideal setting for mosquitoes to bite several people at one go.
The dengue carrying mosquitoes mostly bite at dawn and dusk – late mornings and early evenings to be precise. Therefore, it is not a bad idea to keep your doors and windows shut during morning and evening hours even if it means missing some fresh air. People who cannot avoid public places may apply mosquito repellants containing DEET, a World War II insect repellant. Look for creams or sprays containing at least 30% DEET. They are hard to find in India though.
Interestingly, this is one disease that should frighten the middle and upper classes.
In Delhi, most of the southern parts of the city where the rich live are now endemic and in Mumbai, reports indicate that 60% of the affected are upper class. This is just an indicator that you cannot push your problems to your neighbourhood and blame the civic authorities for all the ills that you face.
Dengue, although “bone breaker” is also a leveler. It makes you realise that you live in India and that you have your responsibilities as well. An incidence chart shows that it is prevalent in countries that have a lot of socio-economic inequality, whether it is Brazil, Indonesia or Thailand.
The exclusive behaviour of the rich, in fact, aggravates the situation. In many Indian cities, the civic authorities are unable to contain the epidemic because the rich households are not only irresponsible, but also do not allow inspections and fogging machines in their premises or yards. This is a peculiar situation in Delhi and Mumbai, where the incidence is soaring in posh neighbourhoods.
As in the case of most infectious diseases, dengue also cannot be controlled by a medical approach, but requires a multi-pronged strategy that cannot overlook the socio-economic inequality of our society. Fundamental to this is responsibility to your society.
Shun your exclusivity and be responsible before it consumes you and lands you in deathbed. For a change, this one hits you harder.