69,000 and Counting

Southeast Asia which includes the Philippines has been noted to be hyperendemic of the Dengue virus.  It is more common in the urban than in the rural areas.  This is probably because of the head count and the dirty surroundings which becomes appropriate for vectors which are active during the day to live and multiply.

Currently, most hospitals are crowded with febrile patients and almost all are getting screened for Dengue infection.  In the news today, children are occupying hospital beds at least two at a time.  And hospitals cannot anymore accommodate patients.  Only the urgent cases gets to share a bed with the rest of those already confined.

The local and national government hasn’t done anything drastic to address such problems despite the number of those affected.  The Department of Health is the only institution working on a national level.  The growing number of those affected and the hospital conditions people are experiencing right now (i.e. shared beds already situated in the hospital corridors) can make someone wonder if they are doing enough.

Dengue virus has been known to exist in the country since the 1950’s brought about by the mosquito species, Aedes.  A person can get Dengue virus four times and creates immunity to each one after each infection.  Infection of any of the four types of Dengue virus may manifest as Dengue fever, Dengue shock syndrome or Dengue Hemorrhagic Fever or may not manifest any signs or symptoms at all.  The manifestations worsens as you get infected by more than one type of Dengue virus.

Fever with chills and flushing is a significant set of symptoms for Dengue virus infection.  The virus affects dendritic cells, reticuloendothelial cells and hepatocytes therefore, it is affects almost all of the systems in the body.  As the infection progresses, we may see other signs such as bleeding tendencies or leaking of fluid out of the vascular system.  This may be seen as pleural effusion (fluid in the thorax which is also seen in pneumonia), ascites (fluid in the abdominal cavity which is also seen in those with beer bellies), menorrhagia (increased menstrual flow), melena (black stools due to blood in the gastrointestinal tract), hematemesis (vomiting of blood), purpuras and petechiae (rash-like because of leaking of blood vessels in the skin) and many others. 

Since there is loss of body fluids, body circulation needs to compensate.  Heart is trying to pump more blood hence there is tachycardia.  There is fast and weak pulse.  The body organs are compromised because it is not supplied by enough body fluids.  There is hypotension in severe cases. 

Laboratory findings will include high hematocrit levels but low platelet count.  Liver problems are also reflected by the low albumin levels, high AST and ALT levels and coagulopathies (deranged PT and PTT). 

The best thing to do before someone gets infected is make the environment less susceptible to further infect individuals.  Aedes doesn’t reside in cool environment.  Unfortunately, this is a tropical country and a damp, warm climate is perfect for the mosquito species.  Mosquito spray and lotions outweigh the harsh chemicals it may contain and may affect man’s health in these scenarios.  Mosquito nets at night time may have no use at all. 

Trying to minimize the clutter in the surroundings is also helpful – less eye sore in the environment, less likely mosquitos will live in that area.  The problem with most (of my fellow) Filipinos is they don’t want to throw anything away.  As much as possible, they keep what isn’t useful to them, hence, homes are more like a storage space.  If people are not able to throw things away, they have to make sure it’s inside a closed cabinet. 

Taking in Vitamin C may (or may not) also help prevent deadly manifestations of the infection.  Since Vitamin C is good for healing connective tissues, the effects of the virus in the body may be somewhat hindered by the vitamin C stored in the body. (Note: The body cannot create vitamin C hence, it should be taken daily.)  It is good to remember that vitamin C doesn’t cure or prevent infection. 

When someone gets infected, it is important to have visited the doctor to have the specific tests done to monitor someone’s level of infection.  There is no cure for the infection.  Once infected, the person will have to undergo the progression of the illness.  Physicians can only monitor and provide ways in which the manifestations may be addressed immediately before it permanently destroys organs in the body.

Proper types of fluids are given in the hospital.  IV fluids and blood components is administered in some cases.  There will be a lot of instances hospitals need to draw blood daily to monitor a patient’s progress.

It is no excuse that this is a tropical country that is why there is hyperendemic periods during the year.  The rural areas are also more tropical than Manila.  The difference lies in the overpopulation and the clutter each citizen makes.  Local government needs to address these problems or else, funds will be spent only for this single type of infection when there are still more problems in the country that also needs spending.