H1N1, dengue outbreak in Kerala: Sluggish state govt response, apathetic local bodies to blame for rising death toll

The joy of monsoon in Kerala is slowly giving way to the panic arising out of an ever increasing number of fever deaths and only the state government is to blame for the situation

Naveen Nair June 27, 2017 18:55:46 IST
H1N1, dengue outbreak in Kerala: Sluggish state govt response, apathetic local bodies to blame for rising death toll

For a state that has prided itself on providing basic healthcare that rivals even some of the developed nations, this is perhaps the lowest point. The joy of monsoon in Kerala is slowly giving way to the panic arising out of an ever increasing number of fever deaths and only the state government is to blame for the situation.

126 deaths in the first six months of a year is an all time high for the state. If the suspected cases are also taken into account, the death toll could cross well over 250.

The H1N1 is the biggest villain, which has claimed more than 57 lives, anywhere between 10 to 12 deaths a month. While the influenza is widespread across the state, Thiruvananthapuram's status as endemic to dengue continues. So far this year, out of 30 deaths, 14 have been because of dengue. The state capital has also been recording the maximum cases of patients with dengue.

H1N1 dengue outbreak in Kerala Sluggish state govt response apathetic local bodies to blame for rising death toll

Representational image. Reuters

Out of a staggering figure of 13.5 lakh people who have reported to various government hospitals across the state with fever, 8,171 cases have been of dengue and 886 cases were of H1N1. While the majority of the deaths have also taken place from these two, 2.17 lakh have been admitted with Acute Diarrheal Disease (ADD) and another 18,358 with chicken pox.

690 patients in the state have Leptospirosis at the moment and another 900 have various kinds of hepatitis. 235 are down with typhoid, 336 with measles and 1563 with mumps, adding to Kerala's sick list and the state government seems to be groping in the dark.

Although the state has the medicines and the personnel to take care of the situation, but the inflow of patients have been so overwhelming that the government is still trying to recover from the shock of it.

The Indian Medical Association has already called this a 'man-made disaster' that could have been prevented if the state government had acted on time.

"We could have prevented this and reduced the scale of the problem if we had started our preventive efforts well in advance. When the government knows that fever and vector-borne diseases will inevitably come with rain, it is difficult for us to believe that no one moved a finger till the month of May, which is just a few days before the monsoon struck. Unless we start preparing as early as February, we cannot do anything to salvage the situation,’’ Dr N Sulfi, Secretary of IMA told FirstPost.

Most government hospitals in the state are bursting at their seams with every corridor and verandahs occupied by people running high temperatures and those with other vector and virus borne diseases.

35-year-old Sujatha had come form Vithura in rural Thiruvananthapuram with her six-year-old daughter who had been running high fever for the last five days. On Tuesday, she was diagnosed with dengue but the hospital has no beds to spare. She is now being treated on a make-shift bed placed in a corridor of a hospital.

"The reason why I brought my daughter all the way to the General Hospital is for her to get the best treatment. Now if they also do not have a bed, where will poor people like us go?" asks Sujatha.

Both dengue and H1N1 can infect people of all age groups. The latest casualties had been that of a one-month-old baby who die due to H1N1 and a three-year-old girl. Apoorva, who lost her life due to dengue on Wednesday while this report was being filed.

"There is hardly anything that we can do at the moment. You cannot turn away any patients especially the little ones and the aged if they have fever. Some patients are even lying on the floor under the beds of other patients. Such is the condition," said a doctor at Thiruvananthapuram Medical College Hospital, the premier government hospital in the state.

With so much suffering all around, the Opposition led by the Congress party had been repeatedly urging the state government to declare a state of medical emergency. If one were to keep apart the attempts to win a few political brownie points, the Opposition's words actually reflect the situation on the ground.

That the demand of the Opposition was not far from the reality was reflected in the desperation shown by the chief minister himself when at a hurriedly called press briefing, Pinarayi Vijayan called up the entire medical fraternity in Kerala and asked them to pool in their resources to get the state out of the crisis.

"It is imperative that we need to pool in all our resources immediately to fight this menace. I am urging private hospitals to spare doctors to the government sector and also all the editors of media houses to run awareness campaigns against breeding of mosquitoes. We have to declare a war against mosquitoes. There is no other way. Everyone in the society needs to get involved," Vijayan told media persons.

Too little too late?

The state government then went on to declare 27, 28 and 29 June as 'Cleanliness Mission Days' where every government department, including government schools and other institutions and organisations, would engage in cleaning their surroundings.

Health activists are calling the bluff of the government and questioning the logic behind performing a cleanliness drive so late and into the middle of a big outbreak. They say that the complete apathy of the government and local bodies towards finding a solution for the proper disposal of waste in and around the cities is at the crux of the whole issue.

Almost every city and town in Kerala is fast becoming a dump yard for all types of waste and Thiruvananthapuram leads the show. No wonder the maximum number of sick people are in the state capital.

PK Raju is a health activist who had been closely monitoring the cleanliness operation the government has started. "Perhaps there is no use lamenting on the fact that you have lost precious time in red-tapism, sluggishness of government officials and other issues. But what are you still doing? A couple of ministers come and start cleaning just for a photo-op and then things are back to square one. You need officials who will take strong action against people who don't work without looking at the union to which they belong. This is regarding people's lives and you cannot play around with it like this," Raju told FirstPost.

Health officials are agreeing to the fact that there has been a shortfall in the awareness drive in the state. Both dengue and H1N1 could have been minimised if the information had reached the people at the right time. Sadly, that did not happen.

A new government in 2016 meant getting off the blocks was late, but once the race, began there had been a number of obstacles too.

While the health department says that all awareness campaigns had been in place well in time, most of the local bodies reacted late to the programmes. Therefore, an already late start was made even worse with campaigns not reaching a lot of places on time.

"See, we have been doing our best in terms of implementing the awareness campaigns against mosquito breeding, keeping your surrounding clean and all. But I guess there has been some lacking in terms of getting it to the people on time, which the local bodies need to do fast. We are not paying for their inaction," Dr R Reena KJ, additional director of health services told FirstPost.

While the health service alleged a laid back attitude, the local bodies say that considering their minimal staff, they have done the best job. "We have done the best we could with the resources we have. Moreover, the funds did not come on time this year, which meant that our activities started late," added a senior official from Thiruvananthapuram Corporation.

Swine flu back with a vengeance

The biggest villain in the state that claimed the maximum lives has been the swine flu. The H1N1 virus seems to have returned to the state with a vengeance.

57 deaths out of 886 confirmed cases in just six months of 2017 makes it one of the worst attacks of the influenza virus in years. The fact that this comes after a zero death situation in 2016 has also got the health officials worried. They, however, blame it on reduced immunity and characteristic change in the virus as the reason, something that is expected every two to three years.

Even in 2015 which was the other worst year reported for H1N1 in recent times, the death toll had not touched the 50 mark in the first six months.

According to the numbers released by the Directorate of Health Services till 19 February, the state had only reported 6 H1N1 deaths. However, by 19 May which is exactly three months after, the number of dead stood at 36, which meant an average of at least 10 deaths in a month for three consecutive months. Towards the end of six months, that is 27 June to be precise, the data shows 57 and still counting.

Health officials also added that the virus' pattern change explains why the illness is spreading at a fast rate.

"The influenza virus keep on changing their minor characteristics from time to time which explains the change in the symptoms of disease. So, our existing immunity might just not be enough and the virus will eventually spread faster. In 2016, we had no deaths because either the virus had not changed its pattern or our immunity could not be beaten. But this time, we have a serious concern that the virus might have changed its pattern of attack. It is not mutation but the kind of illness it will bring might have changed," Dr Amar Fettle, nodal officer, H1N1 told FirstPost.

How long and to what rate Kerala would be suffocated by the viral fever and its related deaths will depend on how long monsoon would last this year.

Health experts are of the strong opinion that unless the state envisages a comprehensive preventive and awareness programme involving school children, communities like residence associations, social clubs, student organisations and NGOs well in advance that runs as routine programme every year, getting Kerala out of the grip of fever and vector borne diseases would be a distant dream.

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