The outbreak of Dengue in New Delhi has claimed 12 lives at the time of writing this article. Around 1900 persons are alleged to have acquired the infection, and many more may follow.

It is a matter of public debate, and accusations are flying thick and fast in the media.

The larger issue seems to be of, ‘whom do we blame the outbreak on?’, rather than, ‘how do we deal with the issue at hand and prevent it from a) going out of hand; and b) occurring in the future?’.

Let’s evaluate where the responsibility and blame lies in the present outbreak:

Politicians in the government

They are responsible because:

1. they control the release of funds- a shrinking health budget does not help matters, nor does a misguided sense of priorities
2. they determine policy matters- short term and long term policy decisions are in their domain
3. they choose the appropriate course of action in crises such as the present one- they are briefed by experts, but the final decision rests with them. Case in point, the subsidization of serum platelet testing; instructions to hospitals to increase beds, etc.

Politicians in the opposition

They are responsible because:

1. they can choose to act responsibly and influence the government’s decisions for greater public good, but often choose to do otherwise for political gain
2. they often exaggerate the magnitude of the problem, creating public alarm
3. they are party to policy decisions-although they typically absolve themselves of any responsibility or blame,  and could lead by example

Media

The media is responsible because:

1. it selectively disseminates information/ news, often with a view to sensationalize and increase Television Rating Points (TRPs)
2. it highlights stories that exaggerate the magnitude of the problem and create a sense of alarm
3. it could actively engage in spreading health education messages and increasing awareness regarding preventative measures, but rarely does so
4. it could focus on doable solutions and what is working; what is being done; what needs to be done, rather than voicing alarmist headlines that do little to improve public morale
5. it is often not impartial or thorough in its research, doing more damage by spreading unscientific or baseless messages/ news

Doctors

They are responsible because:

1. they do not adequately educate patients about the disease, risk factors, potential complications, prognostic factors, etc. Although this is largely blamed upon the poor doctor-patient ratio in India, the situation provides a fertile ground for non-qualified persons/ media to assume that role
2. they over-emphasize the importance of curative services when they appear on talk-shows, highlighting the shortage of beds rather than use of mosquito bed-nets, for example.
3. they tend to neglect and downplay the role of public health experts and preventive medicine in the situation
4. they may omit mentioning preventive and control measures to the patient’s relatives- this may help reduce the burden on the doctors by preventing new cases from occurring

The Health System

It is responsible because:

1. health workers are responsible for health education, environmental modification, fogging, etc.
2. outbreak investigation, outbreak control and prevention are among the primary functions of any health system
3. it has done little to restore public morale and faith in the system
4. it over-emphasizes the importance and role of doctors in outbreak situations, reinforcing the public perception that doctors alone can alter the situation

The residents of New Delhi/ Delhi State

They are responsible because:

1. maintenance of good health is largely dependent upon individual behavior, not external influences. Choices made at the individual and family level influence health and disease. In the present situation, this includes the following behaviors:

• sleeping under a mosquito bed-net
• draining stagnant water, making minor environmental modifications in and around the house to prevent mosquito breeding
• responsibly disposing waste
• following instructions of doctors and other health personnel
• reporting changes in health condition promptly

2. avoidable acts like parents committing suicide following the demise of a child only fuel public agitation, but do nothing to help control the situation

Bottom line: The outbreak is a collective responsibility. 

What one must know about Dengue and the mosquito transmitting it:

Most persons with dengue do not develop serious life-threatening complications. The case fatality rate for the present outbreak is 0.63% ([12 deaths/ 1900 cases] * 100). This means that less than 1% of all dengue cases have died from it.

Those who are very young (children), very old, pregnant, and suffering from medical conditions like chronic kidney disease, diabetes are more vulnerable. Even in the present outbreak, many of those who succumbed to the illness are children.

It is not possible to predict who will develop serious complications early in the disease.

Treatment is supportive only, and is based upon the condition of the patient.

When serious complications occur, there may not be enough time to react adequately, and patients may deteriorate within hours.

Drinking adequate amounts of water is very important. Dehydration is to be avoided at all costs.

Aedes aegypti mosquitoes transmit the dengue virus. They prefer laying eggs in artificial containers with water- tyres, flower vases, coolers, bottles, cans, etc.

The mosquito does not travel very far- its flight range is 100 metres only. Therefore, if a case of dengue arises in a locality, the mosquito came from up to 100 metres (radius) of that location. All artificial containers should be emptied of water and covered to prevent water stagnation/ collection. Stagnant water should be drained, and puddles, ditches should be filled. Water should be changed every day or every alternate day.

Personal protection is probably the best approach–

• always sleep under a mosquito bed-net;
• use mosquito repellents when going outdoors, particularly during the day time as Aedes aegypti  bites during the day;
• wear long sleeved clothes to minimize the chance of being bitten.

Waste should be disposed responsibly- indiscriminate dumping of wastes increases the number of breeding sites for the mosquito.