When I visited Sukraraj Tropical and Infectious Disease Hospital following the Dashain festival, the emergency department was overwhelmed with patients requesting healthcare workers to check their reports. Among them, the majority were tested positive for dengue virus. By 11am that day, nearly 40 samples had been confirmed dengue positive. Surprisingly, cases requiring admission to the intensive care unit (ICU) or other hospital wards were almost negligible.

So far, the ongoing dengue outbreak of 2024 appears to be less severe and fatal than the outbreak experienced in 2022. However, many individuals continue to commute to work despite being infected with the dengue virus. I refer to this phenomenon as "walking dengue." At present, dengue is significantly affecting not only Kathmandu but also other parts of the country. Recent reports of patient overload in the Tanahun district hospital point to the possibility of a dengue outbreak in any area where mosquito breeding is prevalent.

Since 2004, there has been a notable rise in dengue cases and fatality rates in Nepal. The capital witnessed an explosive dengue outbreak in 2019 for the first time. During that year, however, the residents of Kathmandu possessed limited knowledge about the virus. Many families isolated infected members in separate rooms, concerned that the virus might spread to other family members through touching, coughing or physical contact.

During that time, dengue was viewed as an infectious disease akin to Covid-19. Since then, there appears to have been increased information about the dengue virus, including an overview of dengue and its transmission routes, associated symptoms, and strategies to prevent it from spreading by destroying mosquito larvae. Regrettably, it appears that both the public and the government are not fully committed to eliminating mosquito larvae. As a result, every year, dengue seems to have a significant impact on the community. Despite the widespread presence of walking dengue, the practice of regular hospital check-ups is lacking. The main reason for this is the absence of a specific antiviral medication against dengue following infection.

The World Health Organisation has provided information regarding “warning signs” that could suggest the possibility of a severe form of dengue following infection. Dengue warning signs include persistent vomiting, bleeding from the nose or gums, severe abdominal pain and extreme weakness/lethargy. Doctors often warn or inform their patients about these symptoms if they are seeking care as outpatients. Moreover, an enlarged liver, fluid accumulation in the chest or abdomen, a rapid decrease in platelets in the blood, and an increase in hematocrit are additional indicators that could point to severe dengue. Nonetheless, there is no need to wait for the warning signs if the individuals are elderly and have underlying medical conditions.

Currently, there is a continuous influx of infected individuals, many of whom are experiencing recurrent dengue infections. Blood tests reveal that current patients have significantly lower platelet counts than those recorded in the past. Studies show re-infection with a different dengue serotype can cause more severe symptoms. Nevertheless, public information regarding dengue serotypes currently circulating is lacking. Therefore, any predictions regarding the potential impact of dengue on the community in the coming days will have to be based solely on speculation.

Many people have experienced fevers that last between one to three days, but they exhibit significant body pain and a strong aversion to food. Severe flu-like illness has also been observed in many dengue-infected individuals. Currently, flu and Covid-19 viruses are also circulating in Nepal. However, most people and healthcare providers do not pursue further testing following the confirmation of a dengue infection. Several studies have shown that both age (old age) and co-infection with dengue can contribute to an increased mortality rate. Nevertheless, information regarding co-infections remains scarce as dengue continues to spread more widely and aggressively in Nepal.

Interestingly, only two-thirds of those presenting symptoms similar to dengue are confirmed (by laboratory test) to have dengue virus, leaving the remaining cases uncertain. Almost a decade ago, there was a widespread incidence of severe fever with thrombocytopenia (a drop in platelet counts) in patients requiring hospitalisation. Until now, there has been a lack of research or analysis regarding this mysterious/unknown disease in Nepal.

To sum up, with every dengue outbreak, there has been a rise in the number of infected individuals. The virus has become more complex and dangerous, accelerating its pace in the country. While there is currently no miraculous answer to swiftly stopping the spread of dengue or controlling Aedes mosquitoes, attaining a zero-death toll could still be considered a remarkable success. Dengue warning signs should be widely disseminated at the community level to prevent its complications and deaths. Undoubtedly, walking dengue will be a significant concern in the days ahead if timely action is not taken.