Dengue, death & the disconnect

Can someone who lived in tiny Juhu, worked in upscale suburban Andheri and could afford the best medical care die of a disease associated with stagnant pools of water, poor sanitation and mosquitoes? The question is being furiously debated across the country since Yash Chopra, Bollywood’s “King of Romance”, died due to dengue fever.

For Chopra, the end came in one of Mumbai’s top hospitals in circumstances that are as far removed from romance as can be. His death certificate says the octogenarian died due to “sepses with pneumonia, with multi-organ failure, with dengue”.
Out of the lot, only dengue has stirred the pot. The disease carried by the mosquito species Aedes aegypti is not new to Mumbai or other parts of India. Not are dengue deaths. Indeed, in recent years, dengue has made steady inroads into vast swathes of the country which were previously unaffected by it. Still, Chopra’s death has been greeted by disbelief across the country. The celebrity dengue death has shattered the sense of immunity that many middle class and affluent Indians have when it comes to diseases that are born in unsanitary conditions. One of the reasons why dengue is so dangerous is that it reduces the platelet count in the blood. Now there is a panic rush to hospitals by people with near-normal platelet count who insist on getting admitted.
It is not that dengue has not earlier affected people who have good living standards and the best healthcare. In Delhi, the posh colonies report dengue cases year after year for exactly the same reasons that afflict people in less posh parts of the city. Some years ago, Prime Minister Manmohan Singh’s two young grandsons and son-in-law were admitted to the All India Institute of Medical Sciences (AIIMS) with dengue. Fortunately, theirs was not a serious case but a doctor who worked in this premier institution died of dengue. Even this year, there are post-monsoon newspaper photographs showing stagnant pools of water in the AIIMS campus — ideal breeding ground for the dengue-carrying mosquito.
Everyone knows what causes dengue and everyone knows the preventive measures. And yet till Chopra’s death brought home the message with sledgehammer power, there has been little urgency to deal with the nuts and bolts of prevention or to accept that dengue deaths, be it in Delhi or Mumbai or anywhere else, reflect the inadequacy in basic services, poor sanitation and weak public health resources. For urban Indians, standing pools of water, poor sewage systems and garbage dumps where mosquitoes breed are normal day-to-day realities. Even upscale localities are not exempt from this problem.
What has been the standard response to this and the myriad other problems of contemporary life in Indian cities? More and more middle-class and rich Indians are taking refuge in gated communities. Many of them also have the sense to keep the area within the walls spick and span, free of stagnant pools of water. But it does not help if the larger area outside the walls remains as dirty as ever, or dirtier, providing an ideal breeding ground for mosquitoes. Walls and gates and barbed wire and armed guards do not deter mosquitoes.
Back to Chopra and the dengue scare it has triggered across the country. The tragic death does not make Mumbai look good and an official committee is now scrutinising the medical reports to ascertain the exact causes of his demise. It is entirely possible that old age along with other complications worsened the situation, leading to death. But there is no point wishing away the fact that Chopra contracted dengue fever and that despite numerous alerts in recent years, there is little urgency to deal with all the factors that create a happy breeding ground for the Aedes aegypti.
The Brihanmumbai Municipal Corporation (BMC) has now held several meetings and has announced that it will collate information about dengue cases reported from public and private hospitals; it will inspect building complex, offices, film studios. The Federation of Western India Cine Employees has written to the civic body and to the Film City authorities demanding immediate measures to curb the mosquito menace at studios in the city and suburbs. There is much talk about stepping up advocacy. Fumigation drives of film studios are starting. Mumbai’s abandoned textile mills and railway yards where mosquitoes breed unhindered will be cleaned up, say the civic authorities.
Why did these basic measures have to await Yash Chopra’s death? It is dumb to be dismissive towards dengue. According to the National Vector Borne Disease Control Programme, 17,104 people in the country have been affected by the disease in the first nine months of this year alone. Of them, 100 have died.
“In the early 2000s, dengue in India progressed from being predominantly restricted to a relatively small number of states in the southern (Maharashtra, Karnataka, Tamil Nadu and Pondicherry) and north-western regions surrounding Delhi (Rajasthan, Haryana, Punjab and Chandigarh) to a situation where it currently affects large parts of the country. Dengue outbreaks have been reported in most states and Union Territories, with the exception of a few dry or mountainous regions where conditions are unfavourable to the vector,” note Anita Chakravarti, Rohit Arora and Christine Luxemburger in a May 2012 report called Fifty Years of Dengue in India, published in the journal The Transactions of the Royal Society of Tropical Medicine and Hygiene.
Most people who get dengue do not die. But it can be lethal if untreated. Clearly, that risk is minimised in areas with a proper prevention programme, good healthcare facilities and sanitation services that wipe out stagnant water where mosquitoes breed. This is not rocket science. Nor are the preventive steps unknown. But as long as our cities continue to expand in this unplanned manner, with inadequate housing, inadequate water, sewage, and waste management, we are simply continuing to create ideal conditions for the mosquito that carries the dengue virus.
If the situation is bad in metropolitan cities, it is worse in the smaller towns, where municipalities routinely complain of not having enough money to clean drains or dispose of garbage in a proper manner. In the emerging India story, these are basic issues that we can ignore only at our own peril.

The writer focuses on development issues in India and emerging economies.