Sabayang 4 o’clock Habit not enough
posted 28-Aug-2019  ·  
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Last early Monday morning, Rev. Fr. Rommel Arcilla begged off from his weekly Sacerdos et Aeternum column, citing fatigue from serving his flock in Metro Manila. In the column’s place is a boxed article containing the Department of Health’s treatment protocol for dengue patients, from the classification of cases to its phases and case management.

The Tribune management decided to publish the excerpt, which is available in the DOH website, for the information of the general public so that they may be informed on how health officials views and treats the disease that has now reached epidemic proportions nationwide.

One statement stands out: “Dengue has no treatment but the disease can be early managed.”

As often stressed by local health officials, there is no pill for the dengue virus and most victims survive as long as they are able to drink adequate volumes of liquid to prevent dehydration.

In most fatality cases, the eventual decline of the patient is heralded by increasing hematocrit and/or decreasing blood platelet count due to dehydration, severe bleeding and organ impairment.

Hematocrit is the ratio of the volume of red blood cells (RBC) to the total volume of blood. It is normally 40.7% to 50.3% for men and 36.1% to 44.3% for women, according to Wikipedia. A high RBC means your blood is too thick as there is not enough liquid in the blood and you will be prone to a stroke or heart attack.

Platelets, on the other hand, are tiny blood cells produced in the bone marrow that help the body form clots to stop bleeding. If one of our blood vessels gets damaged, it sends out signals to the platelets, which rush to the site of damage and forms a clot to fix the damage.

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia. The platelet number is determined through a routine blood test called a Complete Blood Count (CBC).

Aside from viral infections such as dengue, hepatitis C or HIV, a low platelet count can also be attributed to other factors such as leukemia, some types of anemia, chemotherapy drugs and heavy alcohol consumption.

Dangerous internal bleeding can occur when the platelet count falls below 10,000 platelets per microliter, which can cause bleeding into the brain and lead to death of the patient.

Why is understanding this so important at this time when the entire country is grappling with the dengue crisis?

Most of the deaths attributed to dengue is caused by severe internal bleeding and impairment of internal organs. But a vital contributory factor is the delay in recognizing the necessity to bring the stricken patient to the hospital for appropriate treatment, especially if the family does not have the means to pay for costly confinement that could last for days.

True, the availability of Dengue NS1 Rapid Diagnostic Tests in the district hospitals and Rural Health Units has resulted in a lower fatality count for Catanduanes when compared to the rest of the Bicol provinces. But one more death is one too many.

What is critical for patients with severe dengue is that none of the public and private health facilities capable of managing such cases has immediate access to platelets.

The local chapter of the Philippine Red Cross only keeps in stock several blood types, none of them platelets. And the nearest source of platelet is the Bicol Regional Teaching and Training Hospital (BRTTH).

One has to go to BRTTH to get the platelets, or order one from Metro Manila through the Red Cross, if the patient cannot be brought to the mainland. That takes at least a day, which is way too much precious time to waste.

In the absence of immediately available platelets on the island, a family does not have any recourse but to bring their loved one to the mainland regardless of the cost.

We can all observe the Sabayang 4’ o’clock Habit to the letter (very few actually did so last Friday, especially in the capital town), but eliminating entirely all Aedes aegypti and Aedes albopictus mosquitoes is an impossibility.

What is possible is ensuring the availability of platelets right here on the island, with no need of getting them from the mainland or bringing severe dengue patients to Albay or Metro Manila.

Whether local officials, health professionals and stakeholders will be able to do so would indicate how much they value the lives of their fellow islanders.

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