On Sunday, the Ministry of Health and Population called a meeting of elected local representatives from the Kathmandu Valley to discuss the growing risk of the dengue virus. But representatives, chiefs or deputy chiefs, from only six out of 18 local units in the Valley’s three districts—Kathmandu, Lalitpur and Bhaktapur—attended the meeting.

“The meeting was crucial, as the risk of a massive spread of the vectors and infection grows in July, August and September,” said Dr Roshan Pokhrel, secretary of the Health Ministry. “Unfortunately, very few chiefs and deputy chiefs attended.”

This is not the first time that elected representatives of the local governments have undermined meetings called by the Health Ministry to discuss vital public health issues.

During the second wave of the Covid-19 pandemic in 2021, the ministry invited local unit representatives to discuss the gravity of the situation and the role of the local bodies to enforce measures to mitigate risks of infections. But then too, only a few of them had appeared in the meeting.

Likewise, Sunday’s meeting, presided over by Minister for Health and Population Mohan Bahadur Basnet, was called to discuss the impending health risks with the local unit representatives.

“Health workers serving at the local levels work round the year,” Pokhrel said. “If elected chiefs and deputy chiefs take the issue seriously, control measures would be more effective.”

As the local governments get up to 90 percent of their health budgets from the federal government, their role is crucial to controlling any outbreaks. But most local bodies neither make their own policies on healthcare nor work seriously to implement those of the federal government.

At least one person has died and more than 1,300 people have been infected with the dengue virus since the start of 2023. Officials at the Epidemiology and Disease Control Division said that most of the cases were reported in June. The virus has so far spread to 66 of the 77 districts.

According to the Epidemiology and Disease Control Division, the federal agency responsible for containing outbreaks and epidemics in the country, a 30-year-old man from Dharan, who tested positive for dengue virus, died of complications last month.

According to the division, the real number of infections could be several times higher, as the government’s case reporting system is not very effective.

All three districts of the Valley have reported dengue cases.

Although the post-monsoon time is considered the peak season for dengue transmissions, the country has already witnessed outbreaks of the potentially deadly disease since the start of the year. Experts say the virus has become endemic with cases of dengue infection being reported throughout the year.

They say the reported dengue cases could be just the tip of the iceberg as around 90 percent of the infected people do not show any symptoms.

Last year, at least 88 people died and more than 54,000 were infected with the virus, which had spread to all 77 districts of the country. Hospitals in Kathmandu Valley were overwhelmed with dengue patients and many complained that they were deprived of treatment. At the time, pharmacies had run out of paracetamol, the most widely used medicine to treat fever.

The number of deaths from dengue infection in Nepal is considered very high.

Negligence in case management, lack of or delayed adoption of preventive measures, shortage of public awareness to the risks, and delays in seeking healthcare services after catching the infection are among the reasons for the high death rate from the virus, experts say. Dengue virus serotype DENV-1, DENV-2, and DENV-3 were found responsible for the dengue epidemic in the country.

In 2019, the disease had gripped 68 districts; six people had died, and more than 16,000 were hospitalised.

“We have asked all the agencies concerned to begin a ‘dengue search and destroy drive’ in their respective local levels,” said Sagar Ghimire, chief of the Health Office Kathmandu. “Along with local governments, the role of the general public will be crucial in the campaign.”

Dengue is a mosquito-borne disease transmitted by female Aedes aegypti and Aedes albopictus mosquitoes. The same vector also transmits chikungunya, yellow fever, and Zika, according to the World Health Organisation.

According to doctors, mild to high fever, severe muscle pain, rashes, severe headache and pain in the eyes are some symptoms of dengue. Doctors advise that those experiencing these symptoms should immediately seek treatment. While there is no specific cure for the disease, early detection and access to proper medical care can lower fatalities.

Dengue-transmitting mosquitoes breed in clean water and bite people in daylight. Uncovered water tanks and discarded plastic cups and bottles could be breeding grounds for dengue-carrying mosquitoes.

Entomologists warn that dengue spread could surge as no serious initiatives have been taken to destroy the eggs of infected mosquitoes.

“We have alerted all agencies in the districts about the outbreak of the dengue virus, and have urged them to begin a mosquito ‘search and destroy’ drive,” said Gokarna Dahal, chief of the Vector Control Section at the Epidemiology and Disease Control Division. “Testing kits have been supplied and orientation for health workers has been completed.”