TWICE BIT­TEN, NOT YET SHY

Down to Earth - - EDITOR’S PAGE - @suni­ta­nar

UR­BAN IN­DIA is sick. Yes, that is right. Across our cities, dengue and chikun­gunya are tak­ing their toll—peo­ple are fight­ing high, even haem­or­rhagic, fever, ex­cru­ci­at­ing joint pain and acute fa­tigue. There is some mor­tal­ity, but what is worse, much worse, is mor­bid­ity—the num­ber of days that ill­ness-re­lated dis­abil­ity is forc­ing peo­ple out of jobs and reg­u­lar ac­tiv­i­ties. Re­mem­ber, this is even worse when peo­ple are em­ployed un­der daily wages and our cities have mil­lions of them. They can­not even take a day off; there is no sick leave avail­able to them. These vi­ral dis­eases, spread through mos­qui­toes, are de­bil­i­tat­ing. So let’s be clear and cer­tain, we are sick in our cities.

Let us also be cer­tain that gross mis­man­age­ment of our city’s environment is mak­ing us sick.

This, sim­ply put, is the re­sult of garbage, dirt and ne­glect that sur­rounds us in ur­ban In­dia. It is also a fact that dengue and chikun­gunya are ur­ban dis­eases. Un­like malaria, where the fe­male Anophe­les mos­qui­toes breed in flow­ing wa­ter, the Aedes ae­gypti mos­quito, the bite of which car­ries the dengue, chikun­gunya, yel­low fever and even Zika viruses, breeds in stag­nant wa­ter. Stud­ies have shown that ur­ban ar­eas have a much higher preva­lence of Aedes ae­gypti as com­pared to ru­ral ar­eas. This mos­quito has adapted to ur­ban ar­eas by mov­ing from nat­u­ral to ar­ti­fi­cial breed­ing habi­tats. The Aedes ae­gypti can breed inside an aban­doned tyre or even a bot­tle cap with a lit­tle wa­ter.

It can also spread the virus fast in ur­ban ar­eas. This is not be­cause the mos­quito moves over a large area. In fact, the range of the mos­quito is only some 100 me­tres. What moves is the per­son bit­ten and in­fected by the mos­quito. That per­son then trans­mits the virus to an­other mos­quito, bred at an­other place, when it bites him or her. And in ur­ban ar­eas hu­man den­sity is high and so is the rate of trans­mis­sion. This is the re­venge of the mos­quito. This much is clear.

Ev­ery­thing else is un­clear. Gov­ern­ments do not know how big the prob­lem is. It is well-ac­cepted that the data col­lated by the Na­tional Vec­tor Borne Dis­ease Con­trol Programme is grossly un­der-re­ported. Although dengue and chikun­gunya are no­ti­fi­able dis­eases in many states, only the cases con­firmed in lab­o­ra­to­ries are con­sid­ered in the fi­nal statis­tics—and we know that in most cases there are symp­toms but no con­fir­ma­tion. Then many do not get tested or even go to hos­pi­tals. So we just do not know the scale. We do not even know the cause of sick­ness. Even when pa­tients have ev­ery symp­tom of dengue or chikun­gunya, tests to con­firm the virus come back neg­a­tive. Doc­tors say this could be be­cause the tests are not sen­si­tive enough; or be­cause the virus has mu­tated; or it could be an­other virus al­to­gether. It is a mys­tery, they say.

We do not even know what makes Aedes ae­gypti tick. Con­ven­tional ev­i­dence shows it thrives only in clean wa­ter, so even to­day mu­nic­i­pal agen­cies tar­get over­head and other clean wa­ter tanks in house­holds. But this misses the fact that Aedes ae­gypti breeds wher­ever stag­nant wa­ter is rel­a­tively clean. The con­nec­tion with cli­mate change is also un­clear. The fact is cli­mate change is lead­ing to more in­tense rain and pe­ri­ods of more in­tense sun­light. This pro­vides the ideal con­di­tions for the mos­quito’s prop­a­ga­tion. Un­sea­sonal rain is also pro­long­ing the breed­ing pe­riod of mos­qui­toes.

So what do we do? In Delhi, now that the pub­lic health cri­sis is full-blown and deadly, politi­cians are vy­ing to get photo shoots with fog­ging machines spray­ing in­sec­ti­cides across colonies. But it is well known that this will not work. Even if the adult mos­quito is killed; lar­vae will survive. Breed­ing will con­tinue and re­sis­tance will grow. This is not the way to go.

To stop mos­quito breed­ing, all the con­di­tions con­ducive to its breed­ing will have to be re­moved. In cities, this means clean­ing up big time. There is no other op­tion. It is also clear that for too long we have al­lowed filth to grow in our vicin­ity. We have done this be­cause there does not seem to be any im­me­di­ate or ap­par­ent health cost to us. It looks bad, yes. But we have learnt to live with it. The only time ur­ban In­dia was shaken and stirred from its ap­a­thy to­wards filth was when plague hit the city of Su­rat in Gu­jarat. The city smartened up and has not looked back since. The ques­tion is: why do we not make this health con­nec­tion? That’s be­cause de­part­ments are dif­fer­ent, health and mu­nic­i­pal ser­vices; fo­cus is on dis­ease man­age­ment; fog­ging and push­ing in­sec­ti­cides are eas­ier; and the ev­i­dence on the con­nec­tion is never used for pol­icy-mak­ing. Even to­day, we do not com­pre­hend that mos­qui­toes do not move far and wide, hu­mans do. Dis­ease trans­mis­sion re­quires mos­qui­toes as car­ri­ers, so mos­qui­toes have to be our tar­get and ob­ses­sive clean­ing up, our only ob­jec­tive.

Dengue and chikun­gunya are ur­ban In­dia’s night­mare. They will haunt us. They will make us sick. So clean up, ob­ses­sively.

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