Panic grips Bangladesh as confusion lingers over dengue situation - but why?

Panic has gripped Bangladesh as the mosquito-borne dengue virus fever continues to spread all over the country with a public perception that the authorities are trying to downplay the risks of the menace.

A record 19,500-plus people have been inflicted with the virus so far. The media, citing different hospitals, has reported over 50 deaths.

But the health directorate confirmed only 14 fatalities so far with their review process under way. This has created confusions with the public perception being that the government is trying to hide the real situation.

Though the overall fatality is less than 0.5 percent, panicky people continue to rush to the diagnostic centres for the blood test.

“Jittery people are coming to the hospitals,” said Dr Alauddin Al Azad, an assistant director at the Dhaka Medical College Hospital on Thursday, in a briefing.

“Yesterday we tested blood of 465 persons, but only 16 tested positive for dengue. It means panic is running very high.”

A Dhaka University student having his lunch inside a mosquito net at the SM Hall as death of one of the students after contracting dengue has sparked panic on the campus. Photo: Asif Mahmud Ove

Analysts see it as a failure of the government to reach out to the public with a clear message.

The government’s disease monitoring arm, IEDCR, which played the spokesperson role in previous outbreak situation, remained tight-lipped at the beginning. There have been no workshops or briefing sessions for journalists like it used to hold ahead of the outbreak it foresees.

Health Minister Zahid Maleque, who has drawn flaks from both the public and his colleagues in parliament for his hush-hush Malaysia visit as the disease spread like a wild fire, avoided the press on Thursday on his return.

His press briefing has been cancelled citing unavoidable circumstances.

'Unprecedented development'

Nurul Islam Hasib

Public Health Correspondent, bdnews24.com

This is an unprecedented development in the recent memory when it comes to managing disease outbreaks in Bangladesh.

I have followed the emerging public health issues since 2003 when IEDCR was a dumping station for government doctors and samples of any new disease suspect used to be sent to CDC, Atlanta for confirmation.

But that situation has changed. Now IEDCR hosts WHO-accredited laboratories and they have all the facilities to generate credible evidence related to disease outbreak. So, they played the spokesperson role in such situation.

In risk communication, it is imperative to give the public real-time information – what is happening, what the authorities are doing, what the authorities cannot do, what can happen the next day…so that people can be prepared.

This year it is just the opposite.

Journalists are even seen returning from the IEDCR as the director did not give them time. Sources indicate that it was the top-level decision of the health ministry to keep journalists away.

 

But on top of all, the controversy surrounding the death toll has sent a message across that the government is trying to hide the real situation.

One wrote on Facebook that “everyday newspapers are reporting one or two more deaths, but the government is saying only 14. How did they (government) calculate?”

“We cannot say anything unless confirmed as a responsible institution,” IEDCR Director Meerjady Sabrina Flora told bdnews24.com.

She said a review committee of experts headed by her confirms the death after following some procedures.

Of the 14 deaths out of the 20 that they have reviewed, all are from private medical colleges.

“We follow three processes – first we assess all the clinical documentations and treatment and hospital stay records and then we conduct verbal autopsy and collect samples.

“When we find PCR (this type of test detects the genetic material of the dengue virus in blood) positive in the lab, we can directly confirm that case to be dengue positive.

“Others remain in the probable case category. We don’t put those on the list.

“Then our death review committee divides them in two categories – one is death due to dengue, exclusively for dengue, and the other is the underlining cause is different, but may have died of dengue.

“The whole decision is given by death review committee. IEDCR as an institute has nothing to do with it.”

Asked why all the deaths in government record are from private hospitals when Dhaka Medical College Hospital has confirmed over 10 deaths in the government facility, Dr Flora said the review is not complete.

“We cannot do verbal autopsy instantly. We have to think about the psychological aspect and give time to the relatives of the deceased,” she said.

When the hospitals sent them the number of admitted patients, they also send the list of “suspected death due to dengue”.

“We have a long list of suspect information. We also monitor Facebook.”

But why there had been no confusion over the number of deaths before?

“Last year we also followed the same process and I had faced similar questions. But last year the outbreak was not as big as it is now, that’s why there was no hue and cry.

“We started this death review system in 2017 during the chikungunya outbreak. In many countries, they have such mechanism to confirm deaths due to disease outbreak. We are following that." The IEDCR director said an eight-strong team of experts sit on the committee.

Health Minister Zahid Maleque and Dhaka mayors Atiqul Islam and Mohammad Sayeed Khokon holding a meeting with hospital authorities and experts on Wednesday. Analysts see it as a failure of the government to reach out to the public with a clear message on the dengue situation.

Epidemiologists say while reviewing, the government can still tell the number.

“Whatever you have you can tell the public. You can simply give the message – we get this number from hospitals and we are checking those for laboratory confirmation. This simple message could narrow down the trust gap prevailing at this moment,” one epidemiologist told bdnews24.com requesting not to be named.

The IEDCR director is, however, upbeat amid all the doom and gloom.

“If the current momentum of concerted efforts to control mosquito continues, we hope things will change (for the better) soon. Everything depends on the efforts and success of Aedes mosquito control.”