Last week, Lalitpur Metropolitan City deployed Sanu Maiya Dangol and her team for a “dengue search and destroy drive” in various wards as dengue cases continued to rise.

Dangol, an auxiliary nurse midwife serving at the metropolitan city, however, had a bitter experience.

“It was a door-to-door campaign. First of all people would not open the door and let health workers and volunteers search breeding sites of dengue spreading mosquitoes in their houses,” said Dangol. “Secondly, they refuse to throw water stored in plastic drums and pots.”

Lalitpur is the most affected district by the dengue virus, which recorded 1,056 cases until Monday.

Due to an acute drinking water crisis, people in the Valley store water in jars and pots, which could provide ideal breeding ground for the mosquitoes that spread dengue.

Experts say search and destroy drives are the most effective means to eliminate breeding sites of mosquitoes, the vector, and raise awareness among the people about protection measures.

“There are households who after some explanation allow us in and let us check stored waters for mosquito eggs. But they won’t throw the water away,” said Dangol. “They instead asked for medicines for dengue. Most of the households reacted angrily when they were asked not to store water in jars and pots.”

For the security of health workers and volunteers, authorities in Lalitpur also deployed two city policemen with each team for the search and destroy drive.

Dengue is transmitted by female Aedes aegypti or Aedes albopictus mosquitoes, after they bite a person.

The same vector also transmits chikungunya, yellow fever, and Zika viruses, according to the World Health Organisation.

Mosquitoes that cause dengue breed in clean water and infect people in daylight. Uncovered water tanks and discarded plastic cups and bottles could also shelter dengue-carrying mosquitoes.

With the outbreak of dengue infection, Health Office Lalitpur carried out several search and destroy drives. Preparations are also underway to launch a similar drive in Mahalaxmi Municipality and Godawari Municipality, officials said.

“Without the cooperation of people and their active participation, it will be very hard to stop the spread of dengue virus infection,” said Satis Bista, chief of Health Office, Lalitpur. “But people in many places are refusing to cooperate with health workers and volunteers deployed in the search and destroy drive.”

New cases have been rising at an alarming rate of late.

So far, 2,827 cases of dengue infection have been reported from 72 districts throughout the country, according to officials at the Ministry of Health and Population.

With the spread of the virus in communities, major hospitals in the Valley have reported a surge in infected patients, with some forced to accommodate two patients in one bed.

“Over 70 people infected with dengue virus visited the emergency ward on Tuesday morning,” said Navaraj Gautam, information officer at the Sukraraj Tropical and Infectious Disease Hospital. “Over five dozen infected people had visited the outpatient department for dengue treatment.”

Patan Hospital said that at least 50 people infected with the dengue virus have been visiting the hospital every day.

“The number has risen significantly in the last 10 days,” said Dr Ravi Shakya, director at the hospital. “This year over 620 people infected with dengue virus have received treatment from our hospital.”

According to doctors, mild to high fever, severe muscle pain, rashes, severe headache, pain in eyes and vomiting are some of the symptoms of dengue.

Abdomen pain, vomiting, bleeding from gums and nose, vomiting blood and blood in stool, feeling tired and restlessness are symptoms of severe dengue.

Severe dengue is the leading cause of serious illness and death, doctors say.

Disposing of solid waste properly, covering or emptying water storage containers, using personal household protection such as window screens, and wearing long-sleeved clothes are some of measures to prevent the infection.

Health workers say that laboratory tests are being carried out to diagnose if someone is infected with the dengue virus. Earlier when there were not enough test kits, doctors were diagnosing the infection based on the symptoms.

Nepal has witnessed outbreaks of dengue in the pre-monsoon, monsoon, and post-monsoon seasons, although the post-monsoon period is considered a high transmission season for the virus.

As the monsoon is still continuing and the post-monsoon season is yet to start, officials at the Health Ministry say the dengue infection rate could go up in the coming days.

“It is not possible to predict how long it will take to contain the spread of the infection as past experience shows more cases in September and October,” said Dr Gokarna Dahal, chief of the Vector Control Section at the Epidemiology and Disease Control Division. “It is not possible to contain the spread overnight. The dengue-spreading mosquitoes survive up to 45 days and their entire generation gets infected with the virus, meaning that they can transmit the same virus.”

Of the total infections, over 70 percent cases are in 10 districts, including Lalitpur and Kathmandu, officials said. According to them, office-goers and school children have been infected in large numbers of late.

“Two of my staffers have been infected with dengue,” said Bista, chief of Health Office Lalitpur. “A lot of children have been also getting infected in schools, as the dengue-spreading mosquitoes bite in the daytime.”

In 2019, at least six people died and over 16,000 were hospitalised with dengue fever. The outbreak, which had started in the pre-monsoon period from Dharan, spread to 68 districts.

The UN health agency says that there is no specific treatment for severe dengue, but early detection and access to proper medical care can lower the fatality rate.

“A lot of people have already got infected with dengue virus and others are at risk of getting infected as the virus has been spread in almost all districts,” said Dr Sher Bahadur Pun. “Despite the rapid spread of the virus and thousands of people already infected, no effective measures have been taken to break the chain of infection, which is concerning.”