Amid a rash of fever cases and over 70 related fatalities, the robustness of the reporting mechanism and the truthfulness of the official account have been called into question. The primary casualty in this stand-off is public confidence

Pavithra Murali, 19, was admitted to a hospital on September 14 after she tested positive for dengue, and two days later, she was dead.

When she first fell sick, her parents, both daily wage labourers, took her to a private clinic, where she tested negative for dengue. Later, her condition worsened and another test was taken at a private hospital, which threw up a positive result. She was shifted to a government hospital, where she died. When the family was issued the death certificate, it listed the cause of death as suspected viral meningoencephilitis and epilepticus. There was no mention of dengue.

Similar was the case of Arulselvi Karona’s daughter Kenisha. On August 15, the 9-year-old was admitted to the Sri Ramachandra Medical College and Hospital (SRMCH) with high fever and other dengue symptoms. Despite treatment, her condition worsened. On August 23, she was transferred to the Children’s Hospital in Egmore, and two days later, she died. While the SRMC discharge summary stated she was suffering from severe dengue, the death certificate issued by the government hospital stated: “Viral Haemorrhaging and Multiple Organ Failure.”

Devil in the details

Director of Public Health (DPH) K. Kolandaisamy has the data of dengue cases recorded over the year. So far, 10,392 cases of dengue and 75 fever deaths, of which 27 were related to dengue, have been reported in Tamil Nadu. Many cases, however, don’t show up on the radar due to a technicality — a difference in the classification of the cause of death. Viral haemorrhaging, as in the case of Kenisha, and encephalitis cases go into a different box, according to the DPH. Viral haemorrhaging could result from many virus attacks, including Ebola, West Nile and Crimean Congo. The dengue virus is also part of this list. While other viruses like Ebola and West Nile are not prevalent in Tamil Nadu, dengue is widespread. Dengue is diagnosed with the help of two tests — the ELISA and the Rapid Diagnostic Test (RDT). The RDT, can, according to Elanchezhiyan Manickan, head of the Microbiology department at Madras University, throw up many false positives and negatives. The ELISA test is more reliable.

“So viral haemorrhaging is essentially dengue,” said Dr. Kolandaisamy. It is not as if Tamil Nadu, or India at large, is ill-equipped to diagnose it. But he added that it would be impossible to test every case of “viral haemorrhaging” in labs to confirm dengue, though he maintained that all cases of viral haemorrhaging in Tamil Nadu currently were of dengue. “There is no ill intention,” he claimed, “but if along with viral haemorrhaging, there is the term ‘multiple organ failure’, then it is a case of fudging.” This is what happened in Kenisha’s case. He said, “There is under-reporting, statistically, since we cannot capture sub-clinical cases and those from private clinics.”

Appropriate diagnosis

Abdul Ghafur, infectious diseases consultant at Apollo Hospitals, said the government was doing its best. “Appropriate diagnosis within the right period is important, and rapid tests are just not accurate except if done in the preliminary stage. Doctors must follow up on it with the ELISA test in a week,” he said.

The Corporation, which seems to be in an operational tussle with the DPH, employs officers in all the 15 zones to record data on breeding hotspots and orders fumigation there. Over 500 sanitary workers have been deployed to clean these hotspots and inform them of fever cases. The Corporation claims that there are zero dengue deaths in Chennai.

They deny any pressure to under-report. However, in October 2016, at a dengue review meeting , Health Minister C. Vijay Baskar and Health Secretary J. Radhakrishnan, were reportedly upset with Corporation officials for the handling of information when dengue death occurred at a hospital. According to a source, the Minister warned, “Stop hiding cases. Stop seeing it as a personal insult. We need to ensure transparency. Hiding cases from patients, the media and the public is not getting us anywhere”.

On September 13, at a press interaction, Mr. Vijay Baskar refused to put a number to the deaths due to dengue. “Recently, there has been a spurt in the number of dengue cases in Chennai. So, we are taking steps on a war footing to control it,” he said. “We are converting all out-patients to in-patients if they have fever.” He added, “Death cannot take place because of fever. If there are co-morbid conditions, that is, already existing illnesses, only then is there a possibility of death. We are taking fever very seriously and following WHO protocols.”

Dr. Radhakrishnan said, “The real issue is how the media can help in creating awareness to prevent these cases and ultimately, deaths. We cannot hide deaths. It could be a death due to a specific event like a heart attack or other attributal causes or on account of complications of fever.”

Divya Karthikeyan is a freelance journalist based in Chennai.