Pakistan is experiencing an unprecedented flooding crisis that has left nearly 33 million people displaced and homeless, with one-third of the entire country under water. With a death toll of over 1,300 people, and nearly $10 billion in damages, the worst is far from over. Experts are warning of a slew of flood related problems heading Pakistan's way, such as a looming food crisis that will see effects across Pakistan's immediate borders, as well as a sharp increase in the risk of diseases such as dengue, malaria and cholera.
According to World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus, the United Nations agency has classified Pakistan's current situation as a grade 3 emergency, which is the highest level. The UN has pledged support of $160 million in aid, while the WHO has separately released $10 million from a WHO emergency fund to assist in flood relief. While cholera vaccinations were already underway prior to the floods, due to an existing outbreak of the disease, efforts will have to be enhanced in the current situation, where there is higher risk of the spread of water-borne diseases such as diarrhea, cholera and dengue.
Sindh Health Minister Azra Pechuho has also spoken about the outbreak of these diseases in the worst-hit parts of Sindh, telling Dawn News "More than 134,000 cases of diarrhea and 44,000 cases of malaria have been reported in the province." Since July, the number of dengue cases in the province have jumped from 361 to 1,336 in September. Most recently, the number of cases doubled from 201 to 403 in the two day difference between September 14 and September 16.
Even Khyber-Pakhtunkhwa is reporting an uptick of cases in the flood-hit regions of the province, with 1,952 cases of dengue being recorded in September alone, as per a report by the Integrated Vector Control Programme. Additionally, the province had also seen 4,819 cases of malaria in just two days this past week. According to the report, most of the cases of both diseases came from Mardan, Peshawar, Shangla, Khyber, Bannu, Buner, Dera Ismail Khan, Tank, Charsadda, Nowshera, Mansehra and Malakand.
However, it is not just the flood-hit areas of the country that are experiencing a sharp increase in dengue cases, as the disease has been rampant in the twin cities as well. In the last 24 hours alone, hospitals in Rawalpindi have seen 77 new patients with dengue, bringing the total for the city up to 1,558 cases thus far. The News reported that the number of cases of dengue in the twin cities in the last 19 days is 500 times higher than from January 1 to September 1.
The question arises: if we know that Pakistan is susceptible to dengue outbreaks, were the relevant departments taking necessary precautions before the onset of the epidemic? Is there such a practice as regular spraying and fogging of areas with chemicals that prevent dengue, or if not, should there be? When The Friday Times (TFT) called the Lahore Cantonment Board to discern this, we were told by the complaint receiver Muntazir Mehdi that fogging and spraying is mostly done on the basis of complaints. "We send out our teams on the basis of complaints; if people call us and say 'please get this street, or this school or this neighbourhood sprayed', we'll send out a team," said Mehdi. When asked about the frequency of dengue related complaints, Mehdi said they get at least one or two calls requesting spraying every day.
The spread of dengue has been very quick. In the small tehsil of Kahuta, Irfan — an attendant of the local health department, tells TFT that the first case of dengue was registered on July 20. Since then, in almost two months, the number of dengue patients has risen to 36, which is not an insignificant number given the population density of Kahuta. Irfan said that the preventive spraying had been initiated before the first patient was received. "When the season starts, we begin the process of Indoor Residual Spraying (IRS). Before that, we spray the larvae, then we go towards patients, and then probable cases also get sprayed, as do confirmed patients," he outlined.
Some medical experts are of the opinion that this outbreak of the disease is deadlier than its previous iterations, although the exact cause for that remains unclear. Shoaib, an entomologist based at the Kahuta District Department of Health Office, told The Friday Times that dengue fever sees an intense season every three years. "This is basically a cycle; it first was very intense in 2016, then in 2019, and now once again in 2022 we are seeing an intense case of the disease, so it repeats every three years" he said. Last year, he tells TFT, Kahuta saw only nine dengue patients, whereas this year they have 36. He said that the reason for the three-year cycle remains unclear and is still being researched upon.
Shoaib says that fogging and spraying is being done daily in Kahuta as well as the greater Rawalpindi district. "In 2019 there were some fogging SOPs that were introduced, according to which we only fog areas where a case has been reported, or where larva has been detected, or in the 300-square-foot radius of the house where a confirmed patient resides," he said, adding that even the rules for the IRS spray had changed to only spraying the four houses around the house where larvae has been found. In the case of a probable patient, the surrounding 39 houses are sprayed with alpha cypermethrine.
While the recent floods, which have generated their own fair share of climate change discourse, may have exacerbated the dengue crisis in a lot of areas, there is reason to believe that the recent intensity of the disease may also well be attributed to climate change. Dr. Zaeem Zia, who is the District Health Officer of Islamabad, and heads all the dengue operations in the city says that the dengue outbreak of 2021 was far more intense than what we're seeing right now, with some districts reporting over 14,000 cases of the disease. "The multiplication of cases was so high last year, we would get 10 cases today, then 20 tomorrow, then 40 the next and so on and it went up to 300 cases a day," he explained, adding: "It is not happening right now."
He noted that the cyclical nature of dengue did not come into play this time around, as the outbreak 'blew out of proportion in 2021', commenting that this year, things were not as bad as last year. He said while it was too early to say if this year's outbreak was worse than before, dengue operation teams across the country are being very cautious and constantly monitoring patterns. "However, given the climate change, and the conducive environment created by the multiple rainfalls, this might add to the endemic," he said.
According to World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus, the United Nations agency has classified Pakistan's current situation as a grade 3 emergency, which is the highest level. The UN has pledged support of $160 million in aid, while the WHO has separately released $10 million from a WHO emergency fund to assist in flood relief. While cholera vaccinations were already underway prior to the floods, due to an existing outbreak of the disease, efforts will have to be enhanced in the current situation, where there is higher risk of the spread of water-borne diseases such as diarrhea, cholera and dengue.
Sindh Health Minister Azra Pechuho has also spoken about the outbreak of these diseases in the worst-hit parts of Sindh, telling Dawn News "More than 134,000 cases of diarrhea and 44,000 cases of malaria have been reported in the province." Since July, the number of dengue cases in the province have jumped from 361 to 1,336 in September. Most recently, the number of cases doubled from 201 to 403 in the two day difference between September 14 and September 16.
Even Khyber-Pakhtunkhwa is reporting an uptick of cases in the flood-hit regions of the province, with 1,952 cases of dengue being recorded in September alone, as per a report by the Integrated Vector Control Programme. Additionally, the province had also seen 4,819 cases of malaria in just two days this past week. According to the report, most of the cases of both diseases came from Mardan, Peshawar, Shangla, Khyber, Bannu, Buner, Dera Ismail Khan, Tank, Charsadda, Nowshera, Mansehra and Malakand.
However, it is not just the flood-hit areas of the country that are experiencing a sharp increase in dengue cases, as the disease has been rampant in the twin cities as well. In the last 24 hours alone, hospitals in Rawalpindi have seen 77 new patients with dengue, bringing the total for the city up to 1,558 cases thus far. The News reported that the number of cases of dengue in the twin cities in the last 19 days is 500 times higher than from January 1 to September 1.
The question arises: if we know that Pakistan is susceptible to dengue outbreaks, were the relevant departments taking necessary precautions before the onset of the epidemic? Is there such a practice as regular spraying and fogging of areas with chemicals that prevent dengue, or if not, should there be? When The Friday Times (TFT) called the Lahore Cantonment Board to discern this, we were told by the complaint receiver Muntazir Mehdi that fogging and spraying is mostly done on the basis of complaints. "We send out our teams on the basis of complaints; if people call us and say 'please get this street, or this school or this neighbourhood sprayed', we'll send out a team," said Mehdi. When asked about the frequency of dengue related complaints, Mehdi said they get at least one or two calls requesting spraying every day.
The spread of dengue has been very quick. In the small tehsil of Kahuta, Irfan — an attendant of the local health department, tells TFT that the first case of dengue was registered on July 20. Since then, in almost two months, the number of dengue patients has risen to 36, which is not an insignificant number given the population density of Kahuta. Irfan said that the preventive spraying had been initiated before the first patient was received. "When the season starts, we begin the process of Indoor Residual Spraying (IRS). Before that, we spray the larvae, then we go towards patients, and then probable cases also get sprayed, as do confirmed patients," he outlined.
Some medical experts are of the opinion that this outbreak of the disease is deadlier than its previous iterations, although the exact cause for that remains unclear. Shoaib, an entomologist based at the Kahuta District Department of Health Office, told The Friday Times that dengue fever sees an intense season every three years. "This is basically a cycle; it first was very intense in 2016, then in 2019, and now once again in 2022 we are seeing an intense case of the disease, so it repeats every three years" he said. Last year, he tells TFT, Kahuta saw only nine dengue patients, whereas this year they have 36. He said that the reason for the three-year cycle remains unclear and is still being researched upon.
Shoaib says that fogging and spraying is being done daily in Kahuta as well as the greater Rawalpindi district. "In 2019 there were some fogging SOPs that were introduced, according to which we only fog areas where a case has been reported, or where larva has been detected, or in the 300-square-foot radius of the house where a confirmed patient resides," he said, adding that even the rules for the IRS spray had changed to only spraying the four houses around the house where larvae has been found. In the case of a probable patient, the surrounding 39 houses are sprayed with alpha cypermethrine.
While the recent floods, which have generated their own fair share of climate change discourse, may have exacerbated the dengue crisis in a lot of areas, there is reason to believe that the recent intensity of the disease may also well be attributed to climate change. Dr. Zaeem Zia, who is the District Health Officer of Islamabad, and heads all the dengue operations in the city says that the dengue outbreak of 2021 was far more intense than what we're seeing right now, with some districts reporting over 14,000 cases of the disease. "The multiplication of cases was so high last year, we would get 10 cases today, then 20 tomorrow, then 40 the next and so on and it went up to 300 cases a day," he explained, adding: "It is not happening right now."
He noted that the cyclical nature of dengue did not come into play this time around, as the outbreak 'blew out of proportion in 2021', commenting that this year, things were not as bad as last year. He said while it was too early to say if this year's outbreak was worse than before, dengue operation teams across the country are being very cautious and constantly monitoring patterns. "However, given the climate change, and the conducive environment created by the multiple rainfalls, this might add to the endemic," he said.