Dr Joseph Herbert on the pulse with dengue treatment 

There is no disputing the fact that over the last 13 months, COVID-19  took centre stage in all healthcare circles both public and private. 

It was perceived as an imminent threat to life, livelihoods, and the economy. 

Late last year and early this year, however, a more familiar virus was quietly wreaking havoc as it was passed from human to human from the deadly Aedes aegypti mosquito.   

Consultant Family Physician Dr Joseph Herbert, who is based at the Diagnostic Clinic,  was one of many private practitioners who accepted the challenge of tackling a massive dengue outbreak that peaked between late October last year and early January 2021. 

According to Dr Herbert, the latest dengue outbreak was as prevalent as he had ever seen in his over 10-year career. To put the situation in context, he explained that between himself and the other physician at the clinic, there were “multiple cases” every day, and at least one severe case every week that required immediate hospitalization. 

Adding insult to injury to the outbreak of dengue was the fact that it was unfolding alongside a troubling surge in the transmission of COVID-19. This is because many of the two deadly diseases share many of the same symptoms, ranging from a high fever to muscle/joint pain and nausea. 

“I guess what was hardest in this setting is that initially, you don’t have any way of being 100 per cent sure that somebody has dengue versus having COVID-19. There are some differences in what is most common when a patient comes to you, but the truth is that it’s always possible that something that looks a lot like dengue could be COVID-19 and vice versa,” Dr Herbert explained. 

“It was very tricky, and the problem with severe dengue is that people come with very low blood pressure. So they need urgent intervention or else they can deteriorate and die, and this is all taking place in a healthcare system that is overwhelmed with [cases of] COVID-19,” he added. 

Dr Herbert explained that after an initial assessment at the Diagnostic Clinic, persons with suspected dengue received attention in an isolated area from workers clad in full personal protective equipment (PPE). All other patients displaying symptoms of both diseases were referred to the Queen Elizabeth Hospital (QEH). Even with all the precautions in place that were sometimes guided by World Health Organisation (WHO) criteria, the doctor admits that it was a nerve-wracking period as his decisions could mean the difference between life and death. 

Much like with COVID-19, elderly persons and persons with underlying conditions are more susceptible to severe dengue and even death as a result. 

“But on the flip side, just like COVID, that doesn’t mean it can’t affect young people and perhaps because we are so used to dengue, sometimes we may be more casual about it and unfortunately because of things like COVID-19, it has been more difficult to access the doctor, not only for dengue but for all sorts of health problems. It’s therefore been a very challenging time for health professionals balancing the need to have infection prevention and control regarding COVID-19 and the epidemic and at the same time making sure that we maintain access to people when they need urgent healthcare. It’s a very difficult balancing act,” Herbert explained. 

Despite numerous stories in the public domain about people’s experiences with severe dengue and even death, the volume of the latest outbreak and the extent of the mortality rates are still quite unclear. 

According to Dr Herbert, this is largely the result of physicians failing to report illnesses like dengue to the Ministry of Health and Wellness.

“There was clearly a recognition within the medical fraternity that there was an increase in cases, and perhaps something that wasn’t recognised at the governmental level is that part of the problem is us not taking the time to report promptly. It’s difficult when you have a big workload, but it’s an important public health function and something I want to be better at,” the doctor explained. 

Drawing on suggestions from organisations like the Pan American Health Organisation (PAHO), Dr Herbert noted that the country’s health systems are well-suited to tackling dengue, but noted that the approach to monitoring with clearly specified algorithms may be below what PAHO recommends. 

“Using those algorithms can be helpful to better define patients who need to be monitored daily or every other day basis and perhaps have repeat blood tests. I think the biggest takeaway is being able to recognise which patients require special and intense care or referral to hospital,” said the Physician. 

He however suggested that with COVID-19 prompting a technological shift, now is a perfect opportunity to use technology to make health system reporting of illness easier as opposed to the “piece of paper” which they are currently required to fill out. 

Throughout the Dengue outbreak, Dr Herbert has been showered with praises, particularly on social media, for his approach to dealing with patients. This, he credits to his training at the University of the West Indies (UWI) where the focus has been on providing ‘patient-centred care’. 

“That means that we are not seeing ourselves as telling patients what to do but equal partners with patients recognising their suffering and recognising them as individuals and trying to put them at the forefront of all that we do in addressing both their medical condition, but also their suffering in a way that is in keeping with their values and wishes. 

“I am very grateful for that education and mentorship that I got in my training and I try to carry that forward. I feel that gives me great purpose and I feel that meets the gap in what has been missing in modern medicine that you hear from patients who believe that their doctors aren’t listening to them and don’t treat them like a person,” Dr Herbert concluded. 

This article appears in the April 1 edition of Focus on Dengue. Read the full publication here.