With three South Indian states among those reporting the highest number of dengue cases in the country, Union Health Minister Mansukh Mandaviya held a top-level meeting to assess the situation. Of the three states, Kerala and Karnataka top the list with 9,770 and 9,185 cases, respectively.
Telangana, with 5,138 of cases, is also among the states reporting a high number of dengue cases.
Statistics from the National Centre for Vector Borne Disease Control show that India has reported over 94,000 dengue cases and 91 deaths, as of 17 September.
The health minister, at the meeting on Wednesday, 27 September, urged the states to adhere to the guidelines issued by the Union government for prevention and containment of dengue.
What to do if diagnosed with dengue fever?
Taking to social media platform X, public health doctor Dr Sylvia Karpagam said, “Most patients with dengue recover in 1-2 weeks with rest and some basic medication. About 4-5 percent can develop dengue haemorrhagic fever (DHF), which is life threatening, requiring emergency management and hospital admission.”
Noting that 91 people have died in the country due to dengue, Dr Karpagam said that around one percent of the infected population may die due to dengue fever.
“Usually platelet counts fall with any viral including dengue (normal 1-5-4 lakhs/cu ml). If it falls below 1 lakh doctor will suggest further management. Less than 50,000 requires hospital admission,” she said.
About 1% of patients with dengue can die. Some of the things that help with dengue are rest (avoid strenuous exertion), plenty of fluids (lime/orange juice, buttermilk), good protein diet, mild painkillers like paracetamol (not more than 2-3 tabs a day 4 hours apart). (2)
— Dr. Sylvia Karpagam (@sakie339) September 27, 2023
On the list of things that might help one recover from dengue are rest (avoid strenuous exertion), plenty of fluids (lime/orange juice, buttermilk), good protein diet, mild painkillers like paracetamol (not more than 2-3 tablets a day 4 hours apart), said Dr Karpagam.
Meanwhile, she added, “In case patient has bleeding from anywhere like nostril/gums/urine, severe pain abdomen, black motions/stools and/or difficulty breathing, excess tiredness, small blood spots on skin/mouth etc., then it is likely to be DHF [dengue haemorrhagic fever] and patient has to be taken urgently to hospital.”
Usually, platelet counts fall with any viral infection, including dengue (normal 1-5-4 lakhs/cu ml). If it falls below one lakh, doctors will suggest further management. Less than 50,000 requires hospital admission, she explained.
Demand of platelets
With the rising number of dengue case, there is an increased demand for platelets in hospitals, with several cities reporting shortages. Some are even resorting to social media platforms to request people to come forward and donate platelets.
Speaking to South First, Dr Padmakumar, a senior doctor from the Department of Critical Care Medicine at Fortis Hospital on Bannerghatta Road, Bengaluru, said, “Due to increasing number of dengue cases, there is more demand for platelets in hospitals.”
During dengue fever, there is a critical need for platelets because the virus can cause a significant drop in a patient’s platelet count. Platelets are crucial components of our blood that help with clotting and preventing excessive bleeding.
When the platelet count is too low, it can lead to a condition called thrombocytopaenia, which can result in serious bleeding complications.
This is especially concerning in the context of dengue fever, as the disease can lead to haemorrhagic manifestations, which means bleeding both externally and internally. Severe cases of dengue can lead to dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS), which can be life-threatening.
“Usually, for a dengue patient, platelet count starts to drop after the fever subsides. Common manifestation of low platelets is the tendency to bleed due to minor trauma or bruises (as brushing teeth). If there is any bleeding tendency, it is important to check for platelet count. If there is no bleeding, patients will tolerate platelet count as low as 10,000. In case of bleeding tendency, patients may need transfusions even with higher platelet counts,” Dr Padmakumar explained.
Meanwhile, demand for platelets is being reported in Telangana too. Several blood banks in the state are requesting people to come forward to donate blood.
Demand due to shortage?
“Many times, when individuals contract dengue fever, they initially mistake it for a typical seasonal viral flu and resort to over-the-counter remedies. It’s only when their platelet count plummets and the situation becomes grave that they seek medical attention at hospitals,” Dr Dashrath, Resident Medical Officer at Kondapur District Hospital told South First.
He added that upon conducting blood tests, roughly half of these patients are diagnosed with dengue and, of this group, approximately a quarter exhibit severely low platelet levels, below 30,000. “In such cases, our medical team evaluates various factors, including the duration of the fever and overall vital signs, to determine if platelet transfusion is necessary,” explained Dr Dashrath.
“The challenge arises when hospitals experience a high influx of patients, many of whom urgently require platelet transfusions, yet the platelet supplies are often insufficient. Individuals with severe dengue fever tend to turn to corporate hospitals for treatment, further straining the demand for blood platelets in these facilities,” Red Cross Society’s Hyderabad Director Dr K Pitchi Reddy told South First.
“There is demand for single-donor platelets during these times. Corporate hospitals are well-equipped with extracting platelets from single blood donors. So, you might observe that the calls for platelets are made over WhatsApp groups and social media as the people look for single donor,” said Dr Reddy.
He added that there is demand of platelets, though not a shortage.
How platelets donation works
Platelet donation is a vital part of providing care for dengue patients. Platelets are usually donated through a process called apheresis, which is different from whole blood donation.
Apheresis Procedure: Platelet donation is typically done using a machine called an apheresis machine. During the procedure, blood is drawn from the donor’s arm into the machine. The machine separates the blood components, collects the platelets, and returns the remaining blood components (such as red blood cells and plasma) back to the donor.
Single Donor: Platelets collected through apheresis are usually from a single donor. This is important because it minimises the risk of transfusion reactions and ensures that the recipient receives platelets with compatible characteristics.
Regular Donations: Platelets have a relatively short shelf life, so regular donations are often required, especially during disease outbreaks like dengue epidemics.
Qualified Donors: Platelet donors are typically screened for eligibility, just like whole blood donors. They need to meet specific health criteria to ensure the safety of both the donor and the recipient.
When the cases of dengue are high, then it becomes difficult to procure platelets and in some places, they are being sold at a high price.
“Those who can afford it may procure platelets valued at ₹13,000. However, for those who cannot afford them, particularly in government centres that may not operate around the clock, the situation becomes problematic. I believe we should find a solution for this,” Hyderabad-based paediatrician Madap Karuna told South First.
“If the poor are unable to access free platelets, it becomes exceedingly challenging for them to save their children’s lives. Hence, it is imperative that platelets are provided free of charge to every patient who cannot afford them. Why should anyone be denied the opportunity to save a life, simply because they cannot afford platelets?” she asked.
Of papaya leaves and exotic fruits
As soon as platelets begin to drop, many people start resorting to natural remedies, like consuming the juice of raw papaya leaves, papaya leaf extract tablets, kiwi, dragon fruit, etc. Several people even took to X to learn if any of these work.
Commenting on X, Dr Karpagam said, “Many people vouch by papaya leaf juice, some have mentioned kiwi but I don’t know enough about that. Have never heard of dragon fruit & for sure its an exotic fruit & very expensive. Wouldn’t recommend it over & above these other things.”
However, Cyriac Abby Philips — aka @TheLiverDoc — in the past has strictly said no to papaya juice/leaves and has said that it is “not beneficial”.
Agreeing with this, Dr Bharatashree VM from Bengaluru also took to X and said, “No fruits, no juice, no amount of papaya leaves can do miracles in dengue fever. All it needs is symptomatic management. No antibiotics no unnecessary tests no unnecessary panicking is needed here. Folks, don’t fall for such miracles, believe in science,” he posted.
No fruits no juice no amount of papaya leaves can do miracles in dengue fever..
All it needs is symptomatic management. No antibiotics no unnecessary tests no unnecessary panicking is needed here.
Folks , Don't fall for such miracles believe in science. Bcz it saves. https://t.co/LGqFS8ukD2
— Dr. Bharatashree V M🇮🇳 #DalitDoctor (@Bharatashree) September 27, 2023
Are state governments doing enough?
Speaking to South First, Dr Madap Karuna from Telangana said, “The state government needs to do more to control dengue cases. WHO advises visiting homes to check on dengue cases and remove larvae. Is the state doing this?” She also questioned whether fogging was conducted around the affected residences.
She emphasised the need for public education and awareness campaigns through various media outlets, theatre advertisements, involving public figures, and school awareness drives. Dr Karuna questioned if children’s schools actively participated in these awareness initiatives.
Addressing dengue prevention and education within the community, she stressed the importance of citizen responsibility and the involvement of dengue volunteer groups.
She emphasised the need to include dengue cases from villages and address their healthcare challenges, allocating resources to referral hospitals.
Minister says enough dengue medicines
On Tuesday, addressing the media, Telangana Health Minister Harish Rao stated that dengue medicines are available in government dawakhanas. However, several doctors took objection to this statement.
Dr Sivaranjani Santosh, renowned paediatrician from Telangana, told South First, “This statement is really going to make people think that there is actually a medicine for dengue and this, in turn, is going to delay hospitalisation and cause more complications.”
Clarifying that there is no specific medicine to cure dengue and only supportive care can help manage symptoms and complications, Dr Sivaranjani made a list of what the Health Ministry needs to do to create awareness amongst people.
She said the health ministry should inform public that:
1. There is no medicine available for dengue.
2. Only paracetamol is to be given for fever.
3. Hydration with the right liquids is most important.
4. Identification of warning signs and hospitalisation as needed, is important.
5. Those developing HLH (Hemophagocytic Lymphohistiocytosis) and severe dengue need to be taken care of, in well-equipped ICUs.
The Kerala government has stepped up dengue prevention activities.
In Kozhikode, which recently saw Nipah virus cases, District Medical Officer Dr Rajaram recently spoke to the media and said that a “waterlogged areas are being cleared in the state and requested people that a dry day should be observed once every week, where the home and the premises need to be properly cleaned. And if any symptoms of dengue is seen, they must seek immediate medical attention.”
In response to the escalating dengue cases in Karnataka, the state Health Department issued a comprehensive advisory last week. The advisory addresses key concerns such as proper solid waste management, prevention of mosquito breeding, and raising public awareness.
Karnataka Health Commissioner Randeep D outlined specific directives in the advisory. Civic bodies and health officials were instructed to prioritise the swift disposal of solid waste, discouraging its accumulation in landfills known to facilitate mosquito breeding.
Additionally, health officials were urged to proactively combat mosquito breeding by implementing various measures throughout the state. This initiative also emphasised the necessity of educating the public about how dengue spreads and the preventive actions they can take to safeguard themselves.
To ensure effective implementation of these measures, the advisory proposed the engagement of NGOs and resident welfare associations. Their involvement is seen as vital in curbing the spread of dengue.