Dhaka, Bangladesh – Every time Mosammat Mayna enters the dengue ward of Mugda Hospital in the capital of Bangladesh, sadness and fear take over his mind.
The 23-year-old youth has been working as a cleaner in the hospital for just one month, and the reason he was able to work was because his sister, Maria Ratna, died of dengue last month while doing her duty as a cleaner in the hospital. same ward.
“My sister worked non-stop for months during the dengue outbreak this year and eventually contracted the disease. After his death, the hospital authority offered me his job,” Mayna told Al Jazeera.
“Our family is very sad about Ratna’s death, but since I don’t have a job, I accepted the offer even though I was very scared.”
Bangladesh is suffering its worst dengue outbreak in history, with hospitals filled to the brim and the death toll on the rise. On Wednesday, the country recorded 24 deaths – the highest in a single day – from the mosquito-borne disease.
While the disease does not spread from person to person, a mosquito that bites an infected patient then becomes a carrier, and can transmit dengue to others it bites. That makes places with high concentrations of dengue patients — like the hospital where Mayna works — especially dangerous for those who haven’t been infected.
Health experts are alarmed because dengue usually subsides in the South Asian region when the annual rains stop at the end of September.
As of Monday, at least 1,549 people – including 156 children, from newborns to 15-year-olds – have died of the disease in Bangladesh, which has recorded a total of 301,255 cases in dengue this year, according to the government’s Directorate General of Health Service. (DGHS).
The record death toll is nearly five times last year’s toll of 281 deaths – the highest in a single year in Bangladesh’s history – until this year’s outbreak. The previous highest number of cases in a year – 1,01,354 – was reported in 2019.
“I have never witnessed a dengue outbreak of this proportion,” Mugda Hospital director Dr Mohammed Niatuzzaman told Al Jazeera, adding that patients were pouring in from across the densely populated country. . “It is very unusual to see such a large number of dengue patients in November.”
Outbreak of ‘epidemic’ proportions
Earlier dengue epidemics were largely confined to densely populated urban centers such as the capital Dhaka, home to more than 23 million people. Experts say that the disease this year has reached every district, including rural areas.
DGHS data said 65 percent of the cases reported this year came from outside Dhaka – the first time the capital had fewer cases than the rest of the country.
Sohaila Begum came to Mugda Hospital from the southern district of Patuakhali with her 11-year-old daughter, who had a high fever for more than a week now. As there were no beds available, they stayed in the corridors of the hospital.
“When her fever worsened, the doctors at the district hospital told us to immediately take her to any good hospital in the cities,” he told Al Jazeera, adding that his daughter’s condition had improved.
“We came to Dhaka but now we have run out of money. Everything is very expensive here. We will be in trouble if we take too long.”
Public health expert and former DGHS director Dr ANM Nuruzzaman told Al Jazeera that this year’s outbreak was nothing less than an epidemic.
“The problem is that the severity of dengue is not on the radar of the public and the media because the country is going through a political turmoil before the next election,” he said.
Bangladesh is expected to hold general elections on January 7 amid political uncertainty and violence gripping the country, as the main opposition Bangladesh Nationalist Party (BNP) demands the removal of the ruling Awami League government and the put a manager administration to ensure free. and fair polls.
“Dengue is a serious crisis because the pattern and severity of the disease has changed and become worse. The government should have declared it a public emergency before,” said Nuruzzaman.
Government officials claim that they are doing everything to check the spread of dengue and that declaring it a public emergency or epidemic will not make much difference.
“All government hospitals across the country have been ordered to open special dengue wards at the beginning of August. The health ministry has also allocated an emergency budget to fight the outbreak,” Dr Mohammad Robed Amin, director of non-communicable diseases at DGHS, told Al Jazeera.
“The problem is the health care system in our country has severe limitations because we are a large population and it is almost impossible to ensure health care and treatment for everyone,” he said.
Amin noted that this year’s cases and deaths were “abnormally high” for several reasons. “The first and most important reason is the high prevalence of the Den-2 type strain of dengue among patients,” he said.
Dengue has four types: Den-1, Den-2, Den-3 and Den-4. A person becomes immune to one type of dengue after infection, but not to other types.
“In the last two years, Bangladesh mostly had Den-3 type strains and people developed resistance against it. But this year, more than 75 percent of patients were diagnosed with Den-2 and almost all patients who died were affected by this particular strain,” said Amin, adding that several studies have found that Den-2 outbreaks are more severe when they are followed by years of Den-3 prevalence.
Another factor behind the high death toll is the explosion in rural areas, he said.
“This year, the disease has spread throughout the country, and in rural areas, health facilities are very scarce. Besides, most people don’t know the severity of the disease. If you don’t get treatment in time, it can that’s deadly. And that’s happening in a lot of places.”
What caused the death of the record
Meanwhile, entomologists say they may have found a possible reason behind this year’s record outbreak.
Kabirul Bashar, professor of medical entomology at Jahangirnagar University in Bangladesh, told Al Jazeera that the pattern of dengue decline in September changed last year when the disease reached its peak in October and caused 86 deaths. A year before that in 2021, that number is 22.
“We sounded an alarm last year, saying that the pattern of the disease has changed. Now dengue is no longer a disease associated with the rainy season, it is a year-round thing,” said Bashar, who is also the only scientific expert of the National Anti-Dengue Committee in the country.
The scientist said that climate change is changing the patterns of temperature, rainfall and other natural phenomena.
“Today, we will see almost steady rain throughout October and early November. It changes the breeding and lifecycle of the Aedes mosquito populations,” he said, referring to the type of mosquito that carries dengue.
Dengue is most prevalent in South and Southeast Asia between June and September, when stagnant water provides a good habitat for the Aedes mosquito, which usually breeds in clean water and feeds during the day.
But in a groundbreaking discovery, Bashar, who has been studying mosquitoes for more than two decades, discovered that mosquitoes now breed even in dirty sewers and salty seawater.
“So, on the one hand, you have incredibly consistent rainfall during the off-season that provides an ideal soil for their breeding and, on the other hand, you have mosquitoes expanding their horizons for reproduction. It’s a double whammy,” he told Al Jazeera.
Entomologists have also discovered that the two most widely used insecticides, malathion and temephos, have become “useless” against Aedes mosquitoes in Bangladesh.
“These two insecticides have become sub-insecticides, losing their effectiveness against mosquitoes because they have developed resistance,” said Md Golam Sharower, professor at the National Institute of Preventive and Social Medicine.
“Unfortunately, most of our city corporations across the country still use these two insecticides, which do very little to control the mosquito population.”
Bashar said the government should make a comprehensive five-year plan to control the spread of dengue and eventually eradicate the population of the Aedes mosquito.
“The disease will only worsen in the coming years if such a plan is not activated immediately,” he said.
Back at Mugda Hospital in Dhaka, Mayna, overwhelmed by an unusually high dengue epidemic, begins to regret her decision to work as a cleaner.
“I thought dengue would subside when the rainy season ended, but patients keep coming in every day. Forget the beds in the ward, there is no space even in the corridors of the hospital,” he told Al Jazeera.
“I’m afraid that I might end up like my brother.”