Health authorities in Bangladesh are wrestling with a surge in dengue fever cases as monsoon rains batter the densely populated country.
According to a World Health Organization report issued this month, "The higher incidence of dengue is taking place in the context of an unusual episodic amount of rainfall, combined with high temperatures and high humidity, which have resulted in an increased mosquito population throughout Bangladesh."
Almost 90,000 cases of the mosquito-borne viral illness had been reported his year through Aug. 15, according to government figures.
Researchers and public health experts say the true numbers are much higher. By mid-August, at least 426 people – 81 of whom were age 18 or younger – had died of the fever, according to the Directorate General of Health Services, making this the deadliest year since the first recorded epidemic in 2000.
There are four strains of dengue, including the most life-threatening, hemorrhagic dengue. However, only patients with severe symptoms end up in hospitals, where the government collects data.
Last year, 62,098 dengue cases were recorded in Bangladesh, with 281 deaths.
The dengue virus is transmitted through the bite of infected female Aedes mosquitoes, which also transmit chikungunya, yellow fever and Zika infection and is a recurring problem in Bangladesh during the monsoon season. However, this year's outbreak has been particularly severe, with the number of cases skyrocketing across urban and rural areas alike.
"We have noticed the disease has changed its characteristics, and so do the mosquitos too. They’ve adapted and become more stronger and prevalent. And now we see that dengue is not an ‘urban,’ problem anymore, the government database now records cases from every corner of the country," Dr. M.H. Chowdhury Lenin, a physician and public health expert told VOA.
According to Lenin, "Dengue has been present in Bangladesh for over two decades now, and as we now know, dengue mosquitoes had mutations and they are now resistant to the usual insecticide or repellents that we use. So our existing measures are unable to curb the spread of the Aedes mosquitoes."
Lenin warned the situation could get worse in the coming weeks, as monsoons are likely to intensify, with more rainfall and dengue hospitalizations and deaths. Monsoons in Bangladesh usually surge in August and September, continuing through early October.
"We need to have orchestrated efforts to minimize the fatalities. Dengue is not new in Bangladesh, and as a tropical country, we have to live with such diseases. However, we failed to build a multisectoral approach to prevent this disease from becoming a big public health nightmare," Lenin added.
This year’s surge in cases has significantly strained Bangladesh's already fragile health care system, which is plagued by mismanagement and corruption. Hospitals are grappling with the influx of patients, many of whom are suffering severe symptoms of dengue, such as high fever, intense headache, joint and muscle pain, and in severe cases, internal bleeding.
"Health sector in Bangladesh is inundated under corruption and mismanagement. It was nakedly visible during the COVID-19 outbreak. Politicization and commercial interests are the most important causes behind the destruction to this sector," Sharif Jamil, a prominent Dhaka-based social and environmental activist, wrote in a WhatsApp message.
"The failure to manage dengue spreading across the country is evident now that it is causing casualties in the urban areas in the periphery beyond the city areas."
Government officials aim to apply the lessons learned from managing the COVID-19 pandemic, when state-run and private hospitals nationwide increased bed capacity, provision of intensive care, and emergency medical preparations.
Dr. Robed Amin, the Directorate General of Health Services line director in the noncommunicable disease control program, said the directorate is hopeful the COVID-era measures will improve the fight against dengue.
"As we have noticed, dengue isn’t just an urban problem anymore. It’s rampant in the entire country. And with the monsoon rain of August and September, the cases will likely to go up. During the COVID pandemic, we strengthened our entire health care network across the country, so I am hopeful most of the severe cases will be able to be managed locally, and not everyone will have to flock to Dhaka or other big cities with better hospitals," Amin told VOA.
As most of the cases are reported from urban and suburban areas, experts and activists also blame unplanned urbanization and lackluster response from the authorities for the dengue outbreak.
Kabirul Bashar, an entomologist at Dhaka’s Jahangirnagar University, told VOA unplanned construction and lack of awareness helped dengue to become widespread in every corner of the country.
"Climate change is definitely a factor, but there are other man-made factors that are driving the disease. Not only in Dhaka, but even outside the capital, city-centric economic developments drive the rapid construction of high-rise business centers, hotels, and apartments in the urban areas," he said.
"The entire country has become big construction zones marked by stagnant water on concrete surfaces after rainfall, and potentially breeding Aedes mosquito."
Bashar said official "anti-mosquito drives" during the monsoon are inadequate to fight the current dengue outbreak, especially because over time and with climate change the mosquitoes have evolved and adapted and have become immune to the repellents used against them.
Activist Jamil said he believes future dengue outbreaks are preventable with a timely and coordinated approach and proper urban planning, among other things.
"A proper urban planning will include people and experts in the planning and implementation processes. If we can engage and empower people meaningfully, community leaders will come forward to work with the local government representatives and administrators to make their own areas safe from dengue outbreaks," Jamil told VOA.
Bangladesh's best hope could be a cost-effective vaccine. The International Centre for Diarrhoeal Disease Research, Bangladesh, is leading a clinical trial in Bangladesh for a promising single-dose vaccine created by the U.S. National Institutes of Health, University of Vermont Vaccine Testing Center, and Johns Hopkins University, according to a recent article in the medical journal The Lancet.
Meanwhile, the suffering of the people affected by the disease is mounting.
Saleha, whose name was provided to VOA by her husband, is a 43-year-old patient in the dengue ward of the state-run Shaheed Suhrawardy Medical College and Hospital and was diagnosed with dengue fever almost a week ago. Her husband said the conditions require her to be put in intensive care, but the hospital is already at capacity, and the family is not able to afford private hospital expenses.
"Her platelets count dropped as low as 13,000," said the husband, who did not give his name. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. In addition, he said, her blood pressure fell to critically low levels.
"At this stage, doctors said she needs intensive care support, but there are no beds available in ICU," he said.