Dengue strikes!

I am sorry it took quite some time to get back to you. I was so occupied with answering so many referrals of patients with dengue in several hospitals in Cebu. Yesterday was particularly difficult. A patient arrived at the ER with absent pulses and was obviously in shock. She had come from a district hospital, which, to their credit, had done everything in their capacity to manage the condition. However, she had bleeding episodes that required transfusion, and since blood products were unavailable, she had to be transferred. We lost her within 12 hours of arrival.” This recount came from a critical care colleague and friend.

Days prior to the exchange, a past president of the Philippine Pediatric Society (PPS) and a passionate advocate for dengue had given me a heads-up that she was flying to Bohol. Unknown to me and most of us in the National Capital Region, cases in the province had surpassed epidemic thresholds for dengue, and there had already been mortalities. The local government unit of Bohol had declared a dengue outbreak last Aug. 26, and the Philippine Pediatric Society Central Visayas Chapter (PPSCV) president had called upon its members to help out. In response, critical care colleagues from Cebu and members of the Dengue Integrated Program (DIP) offered to hold a seminar and a workshop, which was eventually held in the Governor Celestino Gallares Memorial Medical Center. She had taken time out from her hectic schedule to give her unwavering support.

To give a brief backgrounder, the DIP is an offshoot of the dengue caravan program initiated by the PPSCV in 2019 to address the unusually high number of cases and deaths during that period. Knowing that dengue would always be of public health importance and is unlikely to be eradicated, its main objective has always been to teach fellow health-care workers—physicians, nurses, midwives, and even medical students—its prompt recognition, management, and prevention. Through the years, they have conducted caravans not only in local district hospitals and barangay health centers but even in community gymnasiums to educate healthcare workers, representatives of the local government units, parents, and the public in general. This has now become one of the flagship programs of the PPS.

“Devastating and heartbreaking” are two words that any doctor can identify with when caring for a patient with complications that could have been prevented, even totally avoided, and resulted in death. The what-ifs, as any clinician knows, are the ones that always weigh heavily. While acknowledging that we can only do so much given our own human limitations, the questions still manage to linger. From his story, would things have changed if a consult was done earlier, or if the needed interventions—medical supplies or manpower—had been available?

From existing data that have been mostly provided by news agencies, the incidence of dengue cases compared to the same period last year is lower. This piece of information should be taken with extreme caution, and may be misleading, as it may be viewed by some sectors to be a result of effective national and community efforts from the programs that are already in place, and more alarmingly, as an excuse to loosen the grip in the fight against dengue. As a country, we are a long way from achieving the 2030 strategy of having zero deaths from dengue as envisioned by the World Health Organization, but we can have at least a semblance of control.

So how can we all help?

Mosquitoes have existed long before we did, and most probably will outlive us. Since they are the vectors, we should make sure that they do not thrive by keeping our surroundings clean.

For individuals experiencing nonspecific signs, such as fever, malaise, nausea, decrease in appetite, headache, eye pain, joint and muscle pains, or rash, please do not be quick to dismiss this as influenza or any systemic viral infection that will eventually resolve on its own. Early consult and testing can be lifesaving. We are an endemic country.

Key points to remember include: never take aspirin in place of paracetamol, increased fluid intake does not mean water alone but must include oral rehydration salts, as no sports drink or concentrated commercial juice can replace the fluids and electrolytes lost as a result of infection.

For those of you who might have experienced dengue, extreme fatigue and exhaustion are characteristic even from the first day of illness. Warning signs that herald severe infection include persistent vomiting, severe or increasing abdominal pain, and even mucosal bleeding. No one wants to reach the point where things can become irreversible.

From the story above, may I call on those who are eligible to be blood donors as well. And for those with the power to make national decisions, I encourage you to consider facilitating the introduction of the newer-generation dengue vaccine, as it has already been licensed and is in use in other endemic countries as part of their efforts to combat the disease. While having zero deaths may be an impossible dream, it wouldn’t hurt to try to save those we can, with whatever means we can place within our reach.