Sindh fixes dengue test rate at Rs850 as hundreds falling sick daily

Following an unprecedented increase in the dengue fever cases with over 200 cases of the viral disease reportedly emerging in Karachi during the last 24 hours, the Sindh Healthcare Commission (SHCC) has asked the laboratories in the province not to charge more than Rs850 for the dengue NS1 antigen test.

Meanwhile, the Islamabad Healthcare Regulatory Authority (IHRA) has directed all the private hospitals not to charge more than Rs1, rupees for the NS1 Elisa test for dengue fever till December 31, 2022.

The SHCC chief executive officer (CEO), Dr Ahson Qavi, told The News that following a meeting with representatives of all the private labs in the province, it had been decided that labs and private hospitals would not charge more than Rs850 for the dengue NS1 antigen test.

He explained that as hundreds of patients were getting infected with dengue virus and many of them could not afford to spend Rs1,400 to Rs3,000 being charged by the labs for the dengue test, the SHCC decided to intervene, and after consultations with lab representatives, the cost of the test was fixed at Rs850.

Similarly, he said, the platelet count test or complete blood count (CBC) would cost Rs250 only while the ICT malaria test for the detection of malarial parasite would only cost Rs500 in the province.

Meanwhile, the Islamabad health authority said that after exercising powers conferred under the Islamabad Healthcare Regulations Act 2018, it had fixed the maximum cost of the NS1 Elisa test at Rs1,800.

In a notification issued by IHRA CEO Dr Quaid Saeed, the decision was taken in compliance with a decision taken in a consultative meeting with representatives of private laboratories and hospitals a few days back.

“Every laboratory conducting Elisa for dengue has to mention following details in its report: Machine used during the test (Elisa), Reagents / Kits with their certification and individual batch number. All private hospitals, laboratories and collection centers are directed to clearly display the dengue test rates and also that in case of any grievances, the patients can lodge a complaint to Islamabad Healthcare Regulatory Authority,” read the notification.

The IHRA also warned that those found non-compliant with the directives shall be penalised in accordance with the IHR Act 2018, and the penalty may include de-registration, sealing the premises, fine or imprisonment.

Need for platelet transfusion

Around 99 per cent patients of dengue do not need platelet transfusions if their platelets count drop to 10,000 or even below this number if there is no sign of bleeding from gums and nose, spots or bruising on the skin and blood in urine, senior infectious diseases experts and clinicians said on Wednesday.

Hundreds of people are getting infected with dengue in Karachi and the rest of Pakistan on a daily basis following unprecedented rains. According to the health authorities, the number of dengue cases was three to four times higher in Karachi in the first 14 days of September compared to the entire month of August.

The Sindh Blood Transfusion Authority (SBTA) said blood banks in Karachi provided 29,000 units of platelets in the month of August alone after hospitals had asked attendants of dengue patients to start arranging mega or single units of platelets.

The SBTA added that they were asking blood banks not to issue platelet units without the clinicians’ advice as several people were asking for the platelets without any medical reason.

“In dengue fever, platelets can be given to prevent bleeding before bleeding happens or to stop bleeding in patients who are bleeding. As far as prevention of bleeding is concerned, there is no cut off of platelets count. The World Health Organisation and we, the clinicians, believe that there is no reason to transfuse platelets to any dengue patient who is not bleeding,” infectious diseases expert Dr Faisal Mehmood said.

Dr Mehmood, who is the head of infectious diseases at the Aga Khan University Hospital Karachi, said that if a person was bleeding and his or her platelets count was below a hundred thousand, they should be given platelets, otherwise there was no need to transfuse platelets.

“Actually, the risk of bleeding in dengue patients is not related to the platelet count. If a patient has to bleed, he or she will bleed even at higher platelets counts while in many patients, they don’t bleed even if their platelets count drop below 10,000,” he added.

To a query, the expert maintained that very few patients required platelet transfusions among thousands of patients. He added that he had not even transfused platelets on single digits as the patients were not bleeding.

Another senior clinician and professor of medicine Dr Tahir Hussain said platelet transfusion was only required when there was a high risk of major bleeding in susceptible patients. He added that there was no absolute platelet count, against which the transfusion was necessary.

“Generally, if the patient with dengue has or is at risk for major bleeding in the judgment of physician, the platelet therapy is deemed necessary. In 99 per cent of otherwise healthy patients, it is not required,” Prof Hussain, who is a former head of medicine at Abbasi Shaheed Hopsital, added.

Head of Infectious Diseases at Indus Hospital Karachi Dr Naseem Salahuddin is of the same opinion. He said a doctor treating a dengue patient should start worrying when there is nose bleeding, gum bleeding, spots or bruises on the skin, bleeding in the conjunctiva of eyes, black stool or blood in urine along with falling platelets.

“Low platelets by itself does not mean they require transfusion. All physicians should be trained in recognising when to transfuse or when not to transfuse platelets. The most important advice is to replace balanced amount of fluid and ensure fever reduction,” Dr Salahuddin said.

“Of the thousands of patients with dengue that I have handled over the years, I must have transfused less than 20. Over 98 per cent of patients survive without complications and platelets return to normal within eight to 10 days. Of course, you always instruct patients about the warning signs and ask them to return immediately if any of these happens — bleeding, hypotension, decreased urine, abdominal pain, shortness of breath, etc.,” she added. Pakistan Society of Internal Medicine (PSIM) Secretary General Dr Somia Iqtidar said that in dengue fever, platelets and white blood cells count started decreasing but people believed that if a patient was given platelets, he could be cured, which was incorrect.

“People use many home remedies for increase in platelets including papaya leaf juice, and pomegranate and apple juices as well as platelets transfusion but they don’t prove beneficial for the patients because platelets are produced in the bone marrow and start increasing once the viral infection subsides on its own with the passage of time,” she remarked. She advised the patients and their attendants not to insist on the platelet transfusion and let their physicians decide about it.

Fumigation drive

To deal with the increasing cases of vector-borne diseases in the city, the Karachi Metropolitan Corporation (KMC) has been using 30 vehicles for fumigation in 246 union committees of the city, adds our correspondent. This is in addition to the fumigation vehicles owned by seven District Municipal Corporations (DMCs) of the city.

According to an official of the KMC, of their 60 fumigation vehicles, 30 were being used. He explained that this was not the case that the rest of the vehicles were out of order, but the reason for not utilising them was that the KMC did not have petrol money to run more than 30 vehicles.

The official shared that they had a staff of 60 people that was involved in the fumigation drive. Each vehicle was provided with 15 litres of petrol and those that ran on diesel were provided 40 litres of diesel. However, he conceded that a few of the vehicles were out of order since three years and the metropolitan corporation did not have funds to get them fixed.

The KMC official shared that they were carrying out fumigation spay in the Central, Keamari, Malir and West districts. He added that the drive in East, South and Korangi districts had been temporarily stopped due to rainfall.

Controlling the breeding of mosquitoes has been one of the functions of the KMC. The Sindh Solid Waste Management Board (SSWMB) has also been providing assistance to the KMC in the fumigation process.

SSWMB Executive Director Operations Tariq Nizami told The News that they were currently operating in six districts of the city and they had a better network due to which they were assisting the KMC and DMCs in fumigation. He added that providing fuel to the fumigation vehicles and supply of medicated spray was being carried out by their Chinese contractors.

In union committees where the KMC and DMCs were short of vehicles, the SSWMB was bringing in their fleet of vehicles, he said. The KMC’s head of fumigation campaign Mazhar Khan told The News how they were using their 30 vehicles for fumigation and seeking assistance of DMCs and SSWMB. “All municipal agencies are working with each other in full coordination.

KMC Administrator Murtaza Wahab told Geo News that the KMC and DMCs had been carrying out fumigation spray on a daily basis. He said they wanted to cover all the streets, markets and every nook and cranny of the city in the drive. He said they were trying to increase the number of vehicles involved in the fumigation drive, and cover more union committees in a single day. He also requested the citizens to keep water reservoirs covered and ensure that no water accumulated in their surroundings.