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In the grip of dengue fever

The deadly insect may be best known globally as the yellow fever mosquito, but in India it is more noted for the transmission of the four types of viruses that cause dengue, which has become one of the world’s major mosquito-borne diseases.

Doctors are in no doubt that there is a dengue epidemic in the capital region. Most hospitals have no rooms available to admit patients. Almost everybody here knows someone who has been struck by the fever. But, as usual, the government has responded to the outbreak through denial and fogging. And by releasing statistics that make doctors laugh.

The latest figure from the Delhi government is that 1,355 people in the city have tested positive for dengue this season. But, in just the first half of September, one general practitioner, Dr. Nandita Chakraborty, treated 263 patients who tested positive for dengue. “Then I stopped counting,” she said.

The general medical opinion is that tens of thousands in New Delhi have been infected, and the figure could be in the millions in India.

All doctors have to report dengue cases to public health officials, but they get the hint from the government that they need not be so conscientious about contributing to data. Dr. Chakraborty said that health officials asked her “too many questions” and demanded excessive documentation to prove her diagnosis of dengue cases, until she concluded that they did not really want her to report the numbers.

Underreporting unpleasant figures is an old government habit. In all Indian languages, “official figure” means a fraction of the truth. Arvind Kejriwal, whose newly formed political party will contest the Delhi Assembly elections this year, told me that the government is terrified of the facts of the dengue epidemic for a very practical reason. “There is very serious underreporting of dengue cases because of the elections,” he said.

Dengue is debilitating and painful, but not fatal in most people who are infected by the virus. But it can become extremely dangerous if, at the same time or soon after the illness, the victim contracts other viral or bacterial diseases. What has spooked people in New Delhi, especially parents of young children, is that there are outbreaks other than dengue. Schools have issued circulars drawing attention to hand, foot and mouth disease, a contagious viral illness that chiefly affects children.

“There is a typhoid outbreak, there is a gastroenteritis outbreak, there is laryngitis,” said Dr. Chakraborty.

The doctor, whose clinic is situated in an upscale residential area, treated more than 200 cases of typhoid fever in the first week of September. Residents suspect their housemaids and cooks to be the carriers of the disease, which is transmitted through the ingestion of food or drink contaminated by the feces of an infected person.

A distraught father whose daughter contracted typhoid muttered in Dr. Chakraborty’s clinic, “The whole country eats excrement?”

The doctor weighed the question with more seriousness than he had expected, and said that that was probably true. On the brighter side, she said, it contributed to the eradication of polio in India. People with the best access to the oral polio vaccine discharged it in their stools, allowing the vaccine to reach the drinking water of those on the outer fringes of society.

But in the exchange of germs and maladies between the rich and the poor— a perpetual transaction in Indian society— there is a disturbing trend. The poor live in conditions that make them effective carriers and transmitters of diseases, which the rich then combat with excessive use of antibiotics that are easily available over the counter. This leaves the microbes increasingly resistant to the most powerful drugs of Western medicine, allowing them to transmit the enhanced diseases back to the poor.

In the case of dengue, the poor alone cannot be blamed. The predominance of the disease is, in a way, a result of a private-public partnership. As the Aedes aegypti mosquito needs fresh water to breed, it thrives in fancy homes and construction sites as well as in the slums.

There is not yet a cure or vaccine for dengue. But now, scientists from the New Delhi division of the International Center for Genetic Engineering and Biotechnology, a global research organisation, have reported that a vaccine they have developed has shown encouraging results on mice. Dr. Navin Khanna, who is leading the team of researchers, and whose daughter, by coincidence, recently tested positive for dengue, told me, “It will take at least another five years before the vaccine is ready, if everything goes according to plan.”

He is among the scientists who are unable to make sense of the Indian government’s poor investment in research on mosquito-borne diseases. “The push is coming from the West,” he said.

The most dramatic attempt to fight dengue has been undertaken by the British biotechnology company Oxford Insect Technologies, or Oxitec. The project, which is in the field trial stage, is audacious. Scientists create genetically modified Aedes aegypti mosquitoes, kill all the females, and release the males in the open. Wild females cannot tell the difference between the natural and the modified males. The offspring of the genetically altered male mosquitoes will die before they can fly. In a short video made by Oxitec, a scientist describes the ideas as “birth control for insects.”

Meanwhile, there is a rumour in New Delhi that the leaves of the papaya plant can cure dengue. There have been reports of a rise in demand for the leaves, and of their disappearance from branches.

Manu Joseph is editor of the Indian newsweekly Open and author of the novel “The Illicit Happiness of Other People.”