With more dengue cases reported in 2016, the potential for hospitals to be overcrowded was very high, and likely contributed to the higher death toll due to the mosquito-borne disease, according to Department of Health Spokesman Dr Eric Tayag.

He admitted the Health agency was worried over the 1,019 dengue deaths reported in the previous year even as there was a decrease in the number of dengue cases from 2015. A total of 211,108 suspected dengue cases were recorded in the Philippines in 2016, down 1.3 percent.

Dr Tayag said with more dengue infections, health facilities especially public hospitals, would have accommodated more patients resulting in overcrowding.

“The cornerstone of dengue treatment in hospitals is monitoring,” the Health Assistant Secretary explained. “How can you monitor enough if you do not have the [proper] number of staff... who are all exhausted? Therefore, you lose patients.”

Another factor he attributed the higher mortality rate to is the inability of certain health facilities to detect or manage the infection.

“There are pockets where access to health facilities can be limited,” he pointed out. However, Dr Tayag added, “That should not be a problem if they had the capacity to detect dengue so they can immediately provide fluid resuscitation.”

He told MIMS that presently, dengue management no longer hinges on platelet transfusion. “We are now in the dengue generation where it is about fluid resuscitation and not blood transfusion. Platelet transfusion is a thing of the past. It’s now hydration, that’s very clear” he emphasized.

Unfortunately, there is still a divide where there are caregivers who still believe in platelet transfusion, who monitor that, Dr Tayag pointed out. “We have not reached a critical mass of caregivers who know about this [fluid resuscitation].”

Because they have been taught to monitor platelet count, the automatic response when there is a drop in the count is to give blood. And even textbooks will tell them that when the platelet count drops the risk of getting spontaneous bleeding increases. “So I cannot blame them,” the Health official said.

He explained that in dengue, the mechanics are different. A decreasing platelet count is an indication that the patient lacks fluids. The reduced count is likely a result of dehydration.

A change in mindset is crucial, and while the Health agency has been directing the change in management protocol, Dr Tayag said there are still some healthcare practitioners who are “hardheaded and close-minded.”

They are the ones who argue that platelet transfusion had helped save lives in the past, so why should management be changed when the results have borne them out, the Health official said.

Dengue management: Fluid resuscitation in; platelet transfusion out
Dengue management: Fluid resuscitation in; platelet transfusion out

And while blood transfusion may have helped improve the patient’s condition, Dr Tayag said “They did not know that coincidentally, fluids were being resuscitated.” So whatever is given to the patient, whether it is platelet transfusion, vitamins, or herbal supplements, the fact remains that fluids are returning.

So they will attribute to whatever they gave the patient as responsible for his improvement, he said, and next time that will be reinforced. “I saved a patient, so why should I change the management? I should do it again.”

The Department of Health is going around to ensure everyone in the healthcare system is aware about fluid resuscitation as the protocol for dengue management. It has also been assisted by the Pediatric Infectious Disease Society of the Philippines (PIDSP), which has drawn up guidelines for managing dengue.

The PIDSP recently held a forum where it gathered stakeholders to seek their opinion about this new protocol, and will soon finalize the guidelines based on the recommendations of attendees.

In this way, there will be a new standard of management that can clarify any confusion with regard to the type of fluids to be given, how to compute dosage, and frequency it should be administered.

“The guidelines will mandate one recipe for all, so we don’t get confused. That way, wherever the patient goes, the management will be the same,” Dr Tayag said. MIMS

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