The New York Times has made the astounding revelation that not a single athlete or visitor got infected by the Zika virus in the recently concluded Rio Olympics. The Times quotes health specialists from the WHO, who of course do not provide any reliable piece of evidence as to how they came to the conclusion that no one has the Zika virus incubating inside him or her without the benefit of serological or PCR molecular tests. For al we know dozens or even hundreds must have got infected keeping in mind that almost 80% of people infected by the Zika virus do not show any symptoms but are quite capable of transmitting the disease.
The NYT report becomes even more bizarre because almost simultaneously the British medical journal Lancet, has reported that more than 2.5 billion people are at risk of Zika in Asia, Africa and elsewhere, Particularly Indians, Indonesians, Nigerians and Chinese, largely due to travel to and fro form Latin America and the Caribbean. Singapore and Malaysia are on high alert due to the emergence of more than 100 patients with confirmed Zika, and a substantial proportion of those sick are Indians.
Zika is a virus that is injected into humans by an infected Aedes aegypti female mosquito. The symptoms in the victim are quite similar to that observed with Dengue, Chikungunya and other viral fevers. The symptoms are in fact almost identical and impossible to distinguish in the real clinical scenario unlike what is described in classrooms and press conferences. Dengue and Chikungunya too break out with fever, headache, retro-orbital pain, body rash, muscle ache, muscle weakness and pain in joints. Serological tests that detect antibodies to these viruses largely overlap and do not therefore have the sensitivity to diagnose one from the other. The only reliable test is polymerase chain reaction.
But there are crucial differences; dengue (pronounced deng-gay) can lead to hemorrhage that can kill in less than 1% of patients. The hemorrhage is preceded by nausea, abdominal ache, enlargement of liver, fluid collection in pleura and pericardium, increase in hematocrit and drastic lowering of platelets.
Chikungunya apart from lingering joint pains can lead to temporary paralysis, which could be fatal in a few. It is therefore imperative that without putting the fear of God in the public it is the duty of health officials and medical personal that Guillain Barre is a distinct risk with Chikungunya.
Which brings us to Zika, which has the odious ability of damaging the nervous system both in adults and worse of the fetus too. Moreover it is still unclear as to whether it’s the first trimester that is crucial for infection or whether the fetus is susceptible through out pregnancy. Children infected during pregnancy could be born with small heads (microcephaly), blindness, seizures, paralysis and impaired intellectual growth.
Delhi is currently in the grip of Dengue, Chikungunya and unidentified viral fevers. True to form there will be shrill headlines for a handful of days that provide little or no information apart from some obvious mundane figures because there is manifestly little respect for human life in our setup. The cacophony would have been almost identical last July to October and will be reenacted yet again next year because nothing will change. Severe chikungunya may present with encephalopathy, encephalitis, myocarditis,hepatitis, and multi organ failure. The severe asthenia accompanying chikungunya can be debilitating. The virus can be picked up by reverse transcriptase polymerase chain reaction in the first 5-7 days, following which IGM antibodies to the chikungunya virus is likely to be detected after 5-7 days of onset of symptoms. In the current epidemic in Delhi the serological tests for chikungunya are turning out negative because they are being done too early and also sensitivity of the kits are not high.
The prime minister has no clue of the toxicity of viral fevers; some one must inform him that probably 30 to 100 million people died of the Great Flu epidemic a century ago. The G 20 summit is an extremely important huddle where we publicly acknowledge the aspirations of our Chinese neighbors but so also is the health of the citizens of Delhi NCR. In the same breath I would urge Mr. Rahul Gandhi to make a mental note of the lethality of these viral fevers occupying more and more territories in and around Delhi. He and his colleagues would do well to realise that in the blink of an eye a viral fever can transform into encephalitis or myocarditis, both of which can be fatal.
It is obvious that no one really cares about the filthy air in Delhi, which is saturated by a variety of toxic viruses. If the heath secretary had an iota of a sense of responsibility he would have by now ordered and given us the genetic makeup of the virus that is wrecking havoc in just about every nook and corner of Delhi. Is it a variant of the Spanish Flu virus? Is it a genetic shift in the Swine Flu virus? Is the filth spread all over the city incubating a deadlier virus? Have the rains and added muck compounded the problem? These questions have to be addressed at the earliest because it is a matter of life and death.
The disappointing spectacle of winning a mere 2 loser medals in the Rio Olympics by a 1.3 billion people has to be recognized albeit it has already been brushed under a gigantic soggy filthy virus infested rug. For a few days a few Indians will squeal like head less chicken about the horror and ignominy of it all before matters get settled as usual and we are back in the business of ogling lurid pictures from Bollywood splashed generously in all newspaper websites.
Viral fevers are a completely different ball game. Zika and Dengue cannot be brushed under any carpet made by man. The chief minister of Delhi must be warned that comorbidities such as diabetes, heart disease, hypertension and chronic pulmonary make one a sitting duck where the HN virus is concerned. The HN virus is not spread by mosquitoes but by sneezing and coughing. A single sneeze carries 500 million virus particles for spread. Moreover it’s every cardiologists nightmare to dance with the platelets of a patient with dengue and underlying stented coronary arteries. Coronary stents with dengue virus as guests can be lethal. There are 4 serotypes of dengue virus ( DEN-1, DEN-2, DEN-3, DEN-4). Dengue has the terrible trademark of being more virulent the second time around, the first infection creates antibodies that instead of forming a shield against a subsequent infection,actually facilitates the entry and toxicity of the virus. This is the reason why some advise that the (newly developed dengue vaccine be prescribed only in people who have previous dengue infection ascertained by serlology.
The mosquitoes on the other hand are content with their knowledge of the strange Indian mindset that is incapable of appreciating any talent beyond pretenders on the silver screen. No wonder not a single Indian boxer, wrestler, shooter, hockey player or an athlete came back with one medal from Rio. You don’t need money to make a champion, you need to learn how to marvel and applaud talent. The Delhi-wallah must know of the fastest man in the capital and the best long distance runner of the university of Delhi. Such appreciation and love for sport can only come from within and not from any amount of coercion or lucre.
Similarly, the desire to keep surroundings clean in order to keep diseases at bay is impossible to create from the outside. It has to be a part of the local DNA. In the meantime there should be serious attempts made at manufacturing effective vaccines against these viral infections, and elimination of mosquitoes by genetic modification.