Explained: Mumbai experts on why dengue spikes during the monsoon; causes and emergency treatment

The monsoons have finally hit Mumbai with regularity but that also means the onset of the flu season. Even as people deal with the Covid-19 pandemic, there is a general trend of increase in the number of cases of diseases such as gastroenteritis, dengue and malaria among others. While people were mostly indoors in the last two years due to the pandemic-induced lockdown, more people are travelling to work and being exposed to new places, which may be a cause for worry, especially in the case of dengue and malaria. The fact that comorbidities have seen more people succumb to Covid is another reason why people should be careful.

At such times, experts suggest taking general precautions that could prevent the diseases. According to a recent Mid-day report, the data from Brihanmumbai Municipal Corporation's (BMC) epidemiology cell has revealed a rise in the number of cases from the same time last year in June. In the case of dengue, the city saw 12 cases in 2021 but has seen as many as 22 this time till June 19 this year.

As the cases are seeing an upward trend, there is a need to understand the severity of the disease. Dengue is a mosquito-borne disease caused by the Tiger Mosquito, medically known as the Aedes mosquitoes. It is also important to understand how this disease is different from malaria and why early diagnosis is necessary.

Mid-day Online spoke to Dr Umang Agrawal, infectious diseases consultant at PD Hinduja Hospital & MRC and Dr Aniket Mule, consultant internal medicine, Wockhardt Hospitals, Mira Road to shed light on the disease. Agrawal and Mule highlight the common symptoms that occur when a person is suffering from dengue and why seeking immediate medical help is necessary. They also share why the disease should be a cause for concern in people with low blood pressure, toddlers, elderly people and pregnant females.

What are the symptoms of dengue?

Agrawal says the presence of dengue can be seen when there are symptoms such as high-grade fever, severe body aches and can sometimes be a rash as well. He says, "The important warning is that people need to be aware of intense abdominal pain, nausea, vomiting and breathlessness. If you have such symptoms, you will need to come to a hospital setup."

The symptoms, adds Mule, begin to show three to four days after infection. Apart from the symptoms highlighted by Agrawal, the city-based expert says people can also experience headaches and skin itching. "These symptoms generally resolve in two to seven days. Few patients may land up in severe dengue hemorrhagic fever, resulting in bleeding, reduced platelets and blood plasma leakage, or into dengue shock syndrome," he adds.

When do the number of dengue cases generally increase and peak?

It is known that the cases of dengue generally increase duringmonsoons and Agrawal says that is simply because a lot of water puddles are seen during this season spanning July to September. "These puddles are the breeding ground for mosquitoes. Not only that, you will also see cases of malaria increased during this particular season," he adds.

Are you getting more patients currently suffering from dengue? What is the current status in Mumbai?

At the PD Hinduja Hospital & MRC, Agrawal says they have started seeing more patients suffering from dengue these days. "The protracted season of dengue has come due to the large number of breeding sites for mosquitoes as the number of construction sites and stagnant watery areas have increased," adds Mule, while informing that the monsoon cases of dengue are increasing at the Wockhardt Hospitals in Mira Road too.

What are the general steps for prevention of dengue?

First step to prevent dengue, Mule highlights is to simply prevent mosquito bites. He explains, "It can be achieved by avoiding going out of home after the evening, using full sleeves garments, applying mosquito repellents, using mosquito nets while sleeping. Secondly to prevent breeding of mosquitoes we need to eliminate their habitats. This is done by getting rid of open sources of water, or by adding insecticides or biological control agents to these areas."

While these can be done at the personal level within our homes and around us, Agrawal says it is also important to involve the authorities to treat it at the civic level. "If there is water collection nearby, try informing the BMC with whose help the collection can be taken care of," he adds.

What are the risks involved for a person suffering from dengue during the ongoing Covid-19 pandemic?

It is hard to ignore the ongoing Covid pandemic, which has seen a resurgence in recent times, when we talk about the monsoon and the possibility of comorbidities affecting people. However, Agrawal and Mule say there is no particular risk except that people need to keep their health in check. "The method of transmission for Covid-19 and dengue are very dissimilar. However, in the present pandemic, it's quite possible that both of these diseases might occur together. Just the presence of Covid-19 does not make a patient susceptible to dengue."

While there is no direct link between these two viral fevers and that people can get them both at the same time, Mule adds, "This may cause delay and confusion in diagnosis of either one. Combined infections have been seen in a few patients but we need larger studies to make a conclusive relationship between the two ."

Do the symptoms of dengue and Covid-19 overlap? Please suggest ways to detect dengue and tell it apart from Covid-19.

The symptoms of dengue and Covid-19 do overlap in more ways than one with symptoms such as fever, body pain, generalised weakness and low platelet count, which are common in both diseases, according to Mule. "To diagnose dengue, we do Dengue NS1 antigen test and Seum IgG or IgM tests along with other routine blood tests to look for any possible complications. For Covid-19, we do a rapid antigen test or RT- PCR of Nasal/throat swab," he adds.

At a simpler level, Agrawal says there are easier ways to differentiate dengue from Covid-19. He explains, "Covid-19 is presented with lots of nasal stuffiness with runny nose, loss of taste, etc, which is generally not seen in dengue. Dengue generally presents with an erythematous rash, which is not so common with Covid-19."

Why should people be concerned about suffering from dengue? What are the misconceptions about dengue?

Agrawal reiterates seeking medical help immediately if one is suffering from high grade fever. "An important concern about dengue is that if it is left untreated, it can really cause a lot of blood thickening, which eventually results in a lot of problems. It can lead to Dengue shock syndrome or Dengue hemorrhagic syndrome as well. So, the important warning signs are intense nausea, vomiting, abdominal pain and breathlessness." Last but not the least, he says it is important to make sure that one is hydrating themselves very well as that is also the main treatment for dengue.

However, Mule positively says that most people with dengue recover without any ongoing problems. He explains, "The risk of death among those with severe dengue is 0.8 per cent to 2.5 per cent, and with adequate treatment this is less than 1 per cent. That is why early diagnosis and treatment is very crucial. Patients who develop significantly low blood pressure may have a fatality rate of up to 30 per cent. This risk of death among children less than five years old is four times greater than among those over the age of 10. Elderly people and pregnant females are also at higher risk of developing complications. And this is why we should be concerned about dengue."

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