Dhaka, Bangladesh – Every time Mosamat Meina walks into the dengue ward of the Bangladeshi capital Mughda Hospital, sadness and fear take over her mind.
The 23-year-old has been working as a cleaner at the hospital for a month, the only reason she got the job was because her sister Maria Ratna died of dengue last month while working as a cleaner. Same room.
“My sister worked non-stop for months during this year’s dengue outbreak and finally contracted the disease. After she died, the hospital authority gave me her job,” Meyna told Al Jazeera.
“Our family was saddened by his death, but I took the gift even though I was scared because I was unemployed.”
Bangladesh is dealing with its worst dengue outbreak in history, with hospitals on the brink and the death toll rising. Last Wednesday, the country recorded 24 deaths – the highest in a single day – from the mosquito-borne disease.
Although the disease is not transmitted from person to person, a mosquito that bites an infected person then becomes a carrier, and transmits dengue to others. That makes places with high numbers of dengue patients — like the hospital where Meina works — even more dangerous for people who haven’t yet been infected.
Health experts are alarmed by the decline in dengue in the South Asian region when the annual rains stop at the end of September.
At least 1,549 people – including 156 children – have died of the disease in Bangladesh as of Monday, the state’s Directorate General of Health Services said. (DGHS)
The death toll from this year’s outbreak — the highest in a single year in Bangladesh’s history — was roughly five times last year’s 281 deaths. The highest number in one year – 1,01,354 – was returned in 2019.
“I have never seen so many cases of dengue,” Mughda Hospital director Dr. Mohammad Nyatuzaman told Al Jazeera. “It is very unusual to see such a large number of dengue patients in November.”
The incidence of epidemics
Previously, dengue outbreaks were confined to densely populated urban centers such as the capital Dhaka, home to more than 23 million people. Experts say that this year the disease has reached every district including rural areas.
According to DGHS data, 65 percent of the reported cases this year are outside Dhaka – the first time the capital has had fewer cases than the rest of the country.
Sohaila Begum came to Mugda Hospital from Patukali southern district where her 11-year-old daughter was suffering from high fever for more than a week now. Where there are no beds, they stay in the corridors of the hospital.
“When the fever worsened, the district hospital doctors told us to take her to a good hospital in the cities,” she told Al Jazeera, adding that her daughter’s condition had improved.
“We came to Dhaka but now we are running out of money. Everything here is very expensive. If we stay longer we will be in trouble.”
Public health expert and former DGHS director Dr ANM Nooruzaman told Al Jazeera that this year’s outbreak is nothing short of an epidemic.
“The problem is that when the country is in political turmoil ahead of the upcoming elections, the severity of dengue has gone off the public and media radar,” he said.
Bangladesh is expected to hold general elections on January 7 amid political instability and violence in the country, as the main opposition Bangladesh National Party (BNP) is demanding the ouster of the ruling Awami League government and the establishment of an interim administration to ensure independence and fair elections.
“Dengue is a serious crisis as the form and severity of the disease has changed and worsened. The government should have declared a public emergency long ago,” Nuruzaman said.
Government officials say they have done everything to check the spread of dengue and declaring a public emergency or an epidemic would have made little difference.
“All government hospitals in the country have been ordered to open special dengue units by early August. The Ministry of Health has also allocated an emergency budget to fight the epidemic,” Dr Mohammed Robed Amin, director of non-communicable diseases at DGHS, told Al Jazeera.
“The problem is that our country’s health care system has serious limitations, and since we are a large population, it is almost impossible to ensure health care and treatment for all,” he said.
Amin said the number of cases and deaths this year was “unusually high” for several reasons. “The first and foremost reason is the very high prevalence of dengue type 2 among patients,” he said.
Dengue has four types: Dengue-1, Dengue-2, Dengue-3 and Dengue-4. After the infection, a person becomes immune to the dengue type, but not to other types.
“In the last two years, Bangladesh has had mostly Den-3 strains and people have developed immunity to this disease. But this year, more than 75 percent of patients were infected with Den-2, and almost all of the patients who died were affected by this particular type,” said Amin. “Several studies have shown that the Den-2 epidemic is worse than the Den-3 epidemic years.
Another reason for the high death toll was the epidemic in the countryside, he said.
“This year, the disease has spread across the country and the health facilities are very few in the rural areas. Also, many people do not know the seriousness of the disease. If they do not get treatment in time, it can lead to death. This has happened in many areas,” he said.
What is the cause of record death
Meanwhile, entomologists say they have discovered the possible cause of this year’s record outbreak.
Kabirul Bashar, a professor of medical entomology at Bangladesh’s Jahangirnagar University, told Al Jazeera that the decline in dengue cases in September reversed last year’s peak in October, when 86 people died. A year ago, in 2021, this number was 22.
“Last year we sounded the alarm that the disease situation had changed. Now, dengue is not a rain-related disease but a year-round phenomenon,” said Bashar, the sole scientific expert of the country’s National Anti-Dengue Committee.
The scientist said that climate change is causing changes in temperature, rainfall and other natural phenomena.
“Right now, we see steady rain that looks like rain in October and early November. It changes the breeding and life cycle of Aedes mosquito populations,” he said, referring to the type of mosquito that carries dengue.
Dengue is most prevalent in South and Southeast Asia between June and September, and calm water is an ideal habitat for the Aedes mosquito, which is usually born in fresh water and feeds during the day.
But Bashar, who has studied mosquitoes for more than two decades, has shown with astonishing results that mosquitoes breed in sewage drains and even in salty seas.
“So, on the one hand, you have unseasonably consistent rains that provide favorable conditions for breeding, and on the other hand, mosquitoes expand their breeding horizons. It’s a double whammy,” he told Al Jazeera.
Entomologists also found that the two most commonly used insecticides, malathion and temephos, were “ineffective” against Aedes mosquitoes in Bangladesh.
“These two insecticides have changed, mosquitoes have become resistant, so they have lost their effectiveness,” said MD Golam Sharower, a professor at the National Institute of Prevention and Social Medicine.
Unfortunately, most of our city corporations across the country still use these two pesticides.
Bashar said the government should come up with a comprehensive five-year plan to control the spread of dengue and eventually eradicate the AIDS mosquito.
“If such a plan is not activated immediately, the disease will worsen in the coming years,” he said.
Arriving at Dhaka’s Mugda Hospital, Maina, struck down by an unusually long bout of dengue, begins to question her decision to work as a cleaner.
“I thought dengue would subside at the end of the rainy season, but patients are coming in every day. Forget ward beds, there is no space even in hospital corridors,” she told Al Jazeera.
“I’m afraid I might end up like my sister.”