There is a major Dengue fever outbreak in the city of Lahore. Several thousand patients have been documented, and many more have gone undiagnosed. In addition, there is a general sense of paranoia about this illness.

One of the important aspects in the care of Dengue fever patients is the establishment of the diagnosis. Since a large number of patients are non-affording, it is important to make arrangements to make these diagnostic facilities accessible to all. However, it must also be ensured that the diagnostic facilities and resources are not wasted.

One of the recent measures was the notification that set the rate for CBC at Rs 90. In spirit this is a good move as it allows all segments of society to get tested, but there has been an unexpected consequence. A large number of people have started getting their CBC test done simply because it is so cheap! Diagnostic facilities which were already working at full capacity are now faced with another tidal wave of blood samples. As a result, the following things are happening or are bound to happen:

1. Because of the rush of ‘normal’ patients seeking to get their test done, the actual Dengue patients are being overlooked.
2. As the workload increases beyond the capacity of the diagnostic facilities, the reporting time for the crucial CBC test is rising. Already the reporting time at most facilities has grown to more than 12 hours.
3. In the rush to test these thousands of CBC samples, patients who do not have Dengue fever but other illnesses such as malaria or leukemia are likely to be overlooked or ignored.
4. There is a finite supply of reagent needed to perform the CBC test. At current rates we are consuming the reagent far quicker than it can be imported. Heaven forbid if labs start to run out of the reagents needed to perform the CBC test. Then we will have taken a crisis and made it worse.

In this time of crisis, it is very important that collaborative and streamlined efforts are made by all those involved in caring for Dengue fever patients. We must focus our attention on actual Dengue fever patients instead of trying to cater to everyone who desires a CBC test. We must remember that not every patient with fever has Dengue fever. And we must all work together to educate the public about this illness.

A month ago I wrote about a storm that was headed our way. Well, in case you haven’t noticed, it’s here. And it is worse than any of us expected. Dengue fever has hit Lahore with even more ferocity than last year. There are hundreds of cases all over the city. Hospitals are filled to capacity. At our lab, we are reporting dozens of new cases every day. And I don’t think the outbreak has peaked yet.

 

There will be time later to look back upon who failed who. What public health measures were not taken. There will be ample time to make committees to examine what went wrong.