Episode Transcript
[00:00:01] Speaker A: The best insight, instant feedback, accountability. The all new talk radio Freedom 106.5.
[00:00:08] Speaker B: Doctor Ragbir is on with us. Let's welcome him to our program this morning. Good morning to you, Doctor Ragbar and welcome to our show.
[00:00:20] Speaker A: Good morning Satish and to your entire viewing audience.
[00:00:28] Speaker B: Go ahead.
[00:00:29] Speaker A: Yeah, yeah, yeah. I come not as a politician. I come as a man of God. And I come as a medical practitioner. Yeah. This morning that population trend we go.
[00:00:38] Speaker B: Yeah, that this morning's discussion is a very, very pertinent one because, you know, as Trinis, we don't take things seriously until it hit home, literally. And then we're running all over the place like headless chicken, asking, well, how this could happen or who we should blame. Dengue is not something unheard of. Dengue is not something that's new to us. It happens every year. We have a period where you have dengue infections. Sometimes it's not necessarily as bad. We've spoken to officials from the ministry that say that usually every year I think we get about 100 cases or somewhere around there. This year. This year we have a lot more. Let's begin by you telling us in your private practice and information that you may have. What's your summary evaluation of what's going on this time around with dengue?
[00:01:30] Speaker A: Well, first of all, if you will permit me to understand dengue, the adti muscular is a vector. And it's always been around. It's endemic. We just came out the Covid-19 pandemic. That means you have more than enough cases that we could be handling. So we become overwhelmed. Now, endemic means in this state that we always have the Eddie mosquito. So before we start, I think the public needs to understand a little bit about the life cycle mosquito. We learn in primary and secondary school, you have the adult. The adult lays eggs, the eggs turn to larva and to people. But here is the creation, all of this from the adult to the eggs. The eggs are laid in a receptacle with water in it. But it's laid above the water line. And usually the female mosquito or the Edes albopictus place about 100 eggs at a time with six egg bloop to the side of the container. Once there's rain or added water into that receptacle, then the eggs may hatch. Definitely. That egg can stay as much as days or months, especially during the dry season. So the rainy season is upon us. From that it goes to the larva stage.
[00:02:50] Speaker B: From.
[00:02:51] Speaker A: From days for the eggs to the larva stage. From the larva stage it takes five days to go to the pupil. Now the pupa, those are the wigglers you see moving all around with a sucker towards the surface of the water, absorbing oxygen. And within two to three days adult mosquito is born. Now the flight time, the flight distance for an adult mosquito is only about, give or take, 100ft. 100ft. Which works out to be probably about 30 meters or so. So it comes back down in terms of the life cycle of the mosquito. The mosquito is within breathing a wrong environment. Maybe your yard, your neighbor's yard. Now the mosquito lifespan is between two to three weeks. And what is significant here in that time they can lay three cents of eggs, 100 eggs at a time. That's a lot of mosquitoes. And clearly I think all of us are educated enough to know that, as you just said, is clean stagnant water. And everywhere from your saucers to your water bars not covered, your guttering, you name it, the tires, the abandoned vehicles, the pet dishes, the bamboo cottons. That's where this mosquito is breeding now. But the secret to this is that the adult mosquito, they are day biters from dawn to dusk. And I must say I have to get to the corrupted matter first of all. Yes, there has been a significant increase. I'm seeing four to six clinically diagnosed and lab confirmed. Lab confirm cases.
Now when I get these cases, the Ministry of health, the arm of the county medical officer at the surveillance department gets this information. This information, and this is in the id was supposed to be passed on to the IVCD insect vector control division. Now how does a corporation get involved? They lend a hand. Now everybody's saying they have no resources and whatnot. But what is important, and I saw in the newspaper yesterday that a woman wore a mask and spraying malatharine. I don't know if you saw that, right. Well, here's the thing. Malathion is an aguanophosphate pesticide. Very, very deadly. In 1976 I think there about United States ban that commercial you always still use in some areas. And that spree can be deadly for people. Because the persons in the IVCD, right. Everyone in Trinidad. And this is what Covid taught us. Hey, I could go to the chemical shop and buy this monotheist had sprayed my yard on a regular basis to protect myself and family. All goes well. But here is the problem.
If you are not trained one, if you are not protected, you yourself will get the adverse effects.
The effects of the malaria. So what I'm seeing now, yes, we will always have dengue cases. People will die, sadly. But the indiscriminate use of malatharine is what I'm really concerned about apart from the dengue. So we have another narrative there. The third narrative here is where people now are not taking this seriously by cleaning up their environment. Yes. According to the Ordinance act of 1979, when you reach that, you can be charged $3,500. Now, who does that?
It is actually those people who work together with the corporation, municipal police. These are called litter wardens, litter prevention wardens. So they give you a citation and they give you 14 days to clean up your app. If you don't, well, your charge will come before the court to pay $3,500. But we know that everyone has vacant land next to the property, and we can't ever seem to find the owners. And this is where people use it as dump site with the glass bottles, containers, and what are reading mosquitoes and satish. I will tell you and the audience, do you know as much as a cup full a cork. Right. A bottle cap. Can breathe. Filled with water. Can breathe. Significant amount of Aedes egyptian mosquito.
And it is sad that just a small volume of water can actually cause someone to get dengue and die.
But let me just finish this part. I do apologize.
What the population needs to know. Dengue has always been around. 80% of dengue have pursued track. Dengue have no symptoms. No symptoms. And we learned this word asymptomatic. During COVID During Covid-19 infection, 30% of people had no symptoms. 15% will have mild to moderate symptoms. And 5% cv's symptoms where they need hospitalization. And every single accident and emergency doctor's office are filled.
And they need to be lined up outside the a and e because they suspect they may have dengue. And that's it. You need to seek your healthcare provider. Go ahead, sadiq.
[00:08:17] Speaker B: Yeah, well, in the season that we're in the rainy season, it makes it all the more complicated because it's almost impossible to find every nook and cranny where water may be collected. That it's. That's just the reality. You could clean as much. You could clean as much as you want. There will be some little captured water somewhere that mosquitoes.
Yeah. And that's what we're dealing with. So then there needs to be a number of things, obviously, that need to happen hand in hand with people trying to clean up their surroundings as much as they can. You must have the relative spraying by insect vector and everything else to complete the. The assault on the Aedes egyptian mosquito.
[00:09:03] Speaker A: That's.
[00:09:04] Speaker B: That doesn't seem to be happening, but we'll deal with that in other discussions. The information may be there, but we need to probably just reinforce it for people as well. When it comes to dengue, how it's spread and all of these things. We know that the mosquito, the Aedes aegypti mosquito, is responsible for spreading dengue. Can persons. And I'm just asking for you to repeat the information. We should know it by now. But can dengue be spread person to person?
[00:09:30] Speaker A: No, it cannot be spread person to person. The female mosquito has to bite an infected person and thereby spread it that and then spread it to another person. Because that person has the virus in them.
Dengue is not unique to tran, Tobago, nor the Caribbean or the Americas. You saw the person from Carpa said it has increased 200 fold compared to the same time in 2023.
Volume six starts on 26 July. And France is inundated with the dengue virus as well. Because there's a free travel between Martinique and Guadalupe. So the United States from New York to all other states, it's the migrant population. And we all remember well, when we went into the aircraft, you remember that they used to spray, say, close your eyes and we're going to spray the aircraft.
But that has actually stopped. They used to spray something insecticide called permethrin, which is no longer required. But at the end is the main persons who have contracted this virus. And they travel and they will spread it. Because all over has the Edes aegypti. Now here's the thing I mentioned. Aedes albopictus is a vector agent. And it's also spread dengue. Now, they tend to thrive more in bamboo cottons, where water has settled in tires. And in this country, my gosh, we have so much of tires dumped all over. And it's strange enough. Thing is, when you go into port, a spin on your left hand side, opposite central market, you see thousands of tires being dumped. So you can imagine right there on the fringes of to spray in the city, how much mosquitoes might be breeding inside there.
[00:11:16] Speaker B: Yeah.
[00:11:17] Speaker A: And let's come back to the agent that IVCD has he malathion. The only person that's supposed to be spraying are very focal operators. Whether we have sufficient amount, which I know we don't, the fact of the matter, they must be adorned with the proper equipment. That is PPE, gloves, boots, the goggles and the respirators. Not a facial mask, not a handkerchief, not your piece of clothing over your face. Because inhalation, ingestion or on your skin, spraying with a tank once absorbing a leaky tank is. It causes same disastrous efforts where you'll get clinical symptoms of headache, dizziness. You may even get convulsions.
You may get excessive salivation, excessive sweating. It can also cause abnormal heart rhythms and you may die.
[00:12:13] Speaker B: Let's talk about.
[00:12:14] Speaker A: But when people sprain, they spray a little bit on its additive, satish.
[00:12:18] Speaker B: So, okay, telling people, well, don't use this is important. But is there anything that people can use? Because now you have a situation where people frightened and they're scared and they're buying tin spray by the, by the dozen and they have at home, and every two minutes they spray in the whole house and all of that kind of thing. But is there anything people can use or they can do?
[00:12:39] Speaker A: So let's go back to a previous statement. My master. The dengue mosquito is from dawn to dusk. So that mosquito is inside your house and bites you during the course of the day, the eighties. Other pictures tends to be me or more outside. So here is the thing. When people spraying outside, the majority of the muscular is egyptite. That's not outside. So that expensive chemical that you're buying, malathion and mixing it with water. That's what they mix it with water here. What? When you spray that, that goes about three to 4 meters from you because it has a high volatility. That means it evaporates very fast. So that means you within that zone and you inhale in that.
The second thing is when the insect vector uses ulv, the ultra low volume, which is called fogging, they mix the malachi in certain amounts with diesel oil because that would reduce the volatility. So that means it will stay longer in the homes. That's why they tell you, you smell this thing, you know the van is passing. So you have to open your doors, open your windows so you can percolate every day. It's not toxic for human beings, but it disappears very fast. But I come back to the flight distance of the mosquito. It's give or take about just 100ft. So you know when the mosquito is there, it's somewhere in your yard, to your neighbor's yard and this longshore. To your question, be it insecticides and other malathion, sadly, is one of the agents we need to use. But there's a lot of resistance now to the mosquito. The mosquito is laughing at you. That's not doing me anything. But how it works is a contact reagent. When it hits the mosquito, the malathion, they die.
Get other alternative things that you could use. As neem, we have read about that as well. Neem. Neem oil. When you spray that, however, the mosquitoes must ingest it.
So the male adhesive, thy mosquito, likes nectar and juices. The female adhesive muscle likes blood. So if they don't ingest any, it's neither here nor there. It will not really affect them. What about between a rock and a hard place? You had to clean up your environment. It comes back to that basic thing. There is no cure for dengue. The symptom of dengue is self limiting. And that's it. So it's rehydration. Rehydration, rehydration. And please, in this viruses and with dengue outbreak, do not take any non steroidal anti inflammatory drugs. If you have fever or any symptoms, that means any aspirin based drug, cataplan, advil, motrin, ibuprofen, you name it, constant. All those drugs like that because you could reduce damage your system because it makes the platelet, which drops during dengue, very low and you could have a bleeding disorder.
[00:15:48] Speaker B: Okay, let's not get too much into that because I want to ask you specifically about self medicating. And I want that discussion to stand out because I know real people who going on Google apparently now and googling what symptoms are dengue are and self diagnosing their self and all of that kind of thing, rather than going to the hospital, that very real thing. But I wanted to explain a bit as well about dengue fever and dengue hemorrhagic fever. Is there a difference? What are the two and how can people identify?
[00:16:18] Speaker A: Right, so you remember I said 80% of dengue pseudoscience with dengue were contracted dengue, 15% have mild to moderate symptoms. And you could manage that clinically even if they're at home and they take simple medication, non aspirin based paracetamol, even multi symptom and whatnot, they will do well, they will try well, but it's a severe ones where the platelets starts to drop. Now, to diagnose these patients, you need a blood test so you can clinically and you have lab confirmed. And the lab confirm is dengue igg, which means you had a past infection from three months onwards, igm from three days to three months. And then we also test for the, the antigen to dengue, which can be positive, satish as early as one day after the onset of a fever.
But even if it tests as negative, the dengue antigen, as I said, is one day after fever, you could still have dengue. So cakes come back. Not only to the lab, the clinical suspicion. So what I'm scared about one narrative again. The indiscriminate sprain and not being properly adorned and trained. Two is that you're staying home and hoping this is just a normal cola virus. We now break every life we lose. It's important to somebody. It's important to the country as well. We recently had all these neonatal deaths. We had Covid-19 deaths. Come on, this thing. Dengue has been around for a long while. And I said the cases five years ago.
Good. Thank God. The last influenza season which has terminated in me. We had no major deaths per se. But people drinking their papa leaf. Now I know you want to ask me on that, so I'll bring it out one time. The extract of the papaya leaves have some bioactive compounds that shown to increase platelets and reduce inflammation as much as it's done. And there is no cure for dengue. Whatever the persons can use in this instance, it augurs well. I have not heard people making the little concoctions. Which is not scientifically proven. That helps, whatever it could happen. Why? I think just stop spraying in the aircraft. It was more psychological. You feel that they're killing only muscles. Then who said it don't make sense again, because the person would have contracted in there. Because you have seen no data, the sub screen and whatnot. But I've come back down to your diet.
Your medication, water, simple medication. But here is your problem.
When you take medication, the virus deteriorates. Especially those with non communicable disease. Cardiac disease, asthma, the diabetes, high blood pressure, history of stroke, whatnot, cancer. Anybody who's immunocompromised. Your body can fight it like a regular person. Because as I said, it is self limiting. Your body fights it. And you can, yes, you can get dengue more than once. So many people, when we test, they would have had dengue before. But I didn't know I had dengue. And that would be a dengue igg immunoglobulin. But every time you get dengue, it's more severe. And there are four strains of dengue virus, strain 1234. And the ones that seem be serotype circulating now is dengue strain to Americas and the Caribbean. So it is pretty bad. And at the end of the day, I urge people, please, we have an outbreak. Seek a healthcare provider. And that's why I'm telling you that all the accidental and emergency health centers are inundated patients. Don't be brave and say, I know everything because I'm googling being Doctor Google. No, what we are concerned is about your platelets. Because I've had patients with platelets from the health facilities at 140 normally is above 150,000 per microliter. And in one day satish, that went from 140 to 25.
[00:20:20] Speaker B: I understand this.
No, I do. I understand the severity of it, because we've had these discussions every year. Every year you have a discussion about, engage in the ministry, come in and all that kind of thing, and they underscore how. How dangerous it is and how quickly you could go from hero to zero with this thing. And yet I was 24.
[00:20:38] Speaker A: Was that?
[00:20:38] Speaker B: Yeah.
[00:20:38] Speaker A: And yet from 140 to 25, you.
[00:20:42] Speaker B: Have people who, for whatever reason, are not taking steps to get treated as quickly as you need to be treated with a matter like this. And it takes us back again, um, to self medicating. And, well, if I boost my immune system, I go beat this thing. And me, I need to go by the doctor and. But from what you're saying, to be properly diagnosed and treated, you need to have a blood test, and. And the. The average individual can't test their own blood. You have to go into a facility to get it done and everything.
[00:21:13] Speaker A: Absolutely, absolutely. And if you don't get all over the world, is a clinical suspicion of dengue, because that's what the surveillance people from the county medical office have helped do you have clinical suspicion and you have lab confirmed. So, at the end of the day, in our outbreak, anyone with a fever and other symptoms of headache, body pains, eye pains, etcetera, or rash or anything like that, you want to prevent. As you asked before, dengue hemorrhagic fever, when you play this job very low, just stop clotting. So you could have nosebleed, bleeding by the eyes, bleeds under your skin, be then from all your orifices, for that matter, so they go into shock, dengue shock syndrome, and then you perish. And many, many people in the Caribbean and the Americas never realized that they had dengue before. And I will repeat, there are four strains of dengue. And if you get dengue more than once, and every time you get dengue because of the immune system, it gets worse in your system, because if you never know you had it unless your laboratory tested, you will know.
[00:22:17] Speaker B: Now, let's. We're almost at the time. Is this just like nine minutes before the top of the hour? And we have a couple messages to take us up to the top, but we need to end with some guidance for people.
Let's approach it by giving guidance to people who have what may be symptoms already and explain to them how important it is, what they need to do. And then generally, this thing about, well, here now, if I take my vitamin C and I boost my immune system, I have nothing to worry about. Deal with both of them.
[00:22:48] Speaker A: Well, first of all, once your symptoms are like what everyone knows it now, headache, fever, joint pains, abdominal pains, you get nausea, vomiting, you may get a rash. So once your symptoms start, do not take vena outbreak. Don't take any aspirin drugs. Right. And when I. When you realize you're taking your paracetamol or your paracodein on a regular basis and the symptoms are not abated when the medication wears up, see your healthcare provider. Don't be a judge and jury for your own self. Because you never know if it is dengue or if you had dengue before. That's one, two. Your family says, boy, here what?
You know, go and rest and drink fluids, and they need your support. But look, your family needs to look at the environment. Are there any breeding sites or mosquitoes? And as I said this, don't go and buy malathi and start spraying. Discriminatory perifocal operators have been trained. They have the proper equipment. And when we keep spraying, as it alluded to the aircraft at the article yesterday, the malathion doesn't seem to be working as before. So what I'm really scared about people in the country. They're spraying indiscriminately and harming themselves. There are other ways that we can use to fight the dengue. Apart from source reduction. In certain countries have used genetics as a way of testing. But we don't have that source of technology right now. How it goes from the surveillance nurse, it goes. The information passed. Insect vector control division is also the local government lens corporation. And I know right now, every corporation are having talks with all these stakeholders. So let's see how we could battle this. But it's come back down to resources of clearing your water courses, looking at your guttering, etcetera, where water is cooling and whatnot. Your health is your responsibility and your community. Health is part of your responsibility because you belong to a community. There is no cure for dengue. There's no treatment to eradicate the mosquito completely. It will always spread. It will always be there. That's why they use word endemic. But please, I implore people, do not take your health now casually. You have to be very serious if your symptoms continues without the onset of all these symptoms, or you may just have a high fever, and you have no other symptoms, like any respiratory tract symptoms, urinary tract symptoms, or any diarrhea. Right. That means be cautious because you could have a common cold, a bronchitis. You could have a urinary tract infection. You could have gastroenteritis. So you may not have dengue, but you could have other things. But always remember in life, you could have more than one disease. You could have dengue, you could have gastruli, same thing. So be wary. Seek care by a healthcare provider.
[00:25:48] Speaker B: That's why we're gonna have to leave it here this morning. Doc, thank you so much for being with us. This was really valuable information at a time when people are, people are scared. People really are, because there's mosquito all over the place and you get bite you into show what we know and symptoms. People trying to treat themselves.
[00:26:06] Speaker A: Take your health in your hands like that, casually.
[00:26:08] Speaker B: Yeah. Thank you.
[00:26:09] Speaker A: And remember, that same mosquito live seven to ten days.
[00:26:12] Speaker B: Thank you. Thank you once again.
[00:26:13] Speaker A: I'm sorry. Two to three weeks, but the incubation period is seven to ten days. That that life cycle, the egg, the adult, the egg, the lavender, back to school.
[00:26:24] Speaker B: That's. Thank you so much for being with us.
[00:26:26] Speaker A: The best insight, instant feedback, accountability. The all new talk radio Freedom 106.5.
