The study of a massive dengue-fever outbreak by immunologist Neelika Malavige is being hampered by fuel shortages and power outages.
Sri Lanka is in a state of emergency. With the country deeply in debt and inflation at an all-time high, the government lacks the funds to import fuel, exacerbating food shortages. Protesters marched into President Gotabaya Rajapaksa’s official residence last weekend, demanding his immediate resignation. Since then, he has fled the country.
According to the World Food Programme, more than six million Sri Lankans — three out of every ten households — are unsure where to get their next meal. After wave after wave of COVID-19, Sri Lanka is now experiencing a massive dengue fever outbreak.
Neelika Malavige, an immunologist at the University of Sri Jayewardenepura in Colombo, has been researching dengue fever for over a decade. She discussed the situation in Sri Lanka and how it is affecting her work with Nature.
What is life like in Sri Lanka right now?
Sri Lanka lacks sufficient foreign reserves to import fuel, affecting every sector. Schools are shut down indefinitely. Except for essential services, the government has declared Fridays a holiday for all public institutions. Patients, as well as doctors, nurses, and other medical personnel, are unable to reach hospitals. In addition, we are running out of essential medicines and are experiencing daily power outages lasting more than three hours.
There is also a scarcity of food, owing in part to the government’s decision in May 2021 to impose a nationwide ban on chemical fertilisers, which reduced agricultural production and raised the prices of staple foods like rice and vegetables. To catch fish, an important source of protein, fishing boats do not use diesel or kerosene. Inflation exceeds 50%, forcing many people to choose between eating three meals a day and going hungry.
We also have nearly 41,000 confirmed dengue cases this year, which is more than we had all of last year.
How are you looking into the dengue outbreak?
The majority of dengue patients have mild disease, but 15% of those admitted to hospitals develop dengue haemorrhagic fever, which causes severe bleeding and can be fatal. There is no way to predict whether someone will develop severe dengue in the early stages of an infection, so people must visit the hospital daily for blood tests and monitoring to detect symptoms as early as possible. That puts a significant strain on the health-care system.
We’re looking for biomarkers that can predict whether someone will develop severe dengue. We are also attempting to identify the immune response associated with protection from severe disease in dengue, which is still unknown.
In addition, my lab has completed several clinical trials in search of drugs that can be repurposed to treat dengue, for which there is no safe and effective vaccine. We are recruiting participants and collecting samples for a study with a Latin American group to compare the epidemiology and pathogenesis of dengue in the two regions. Simultaneously, we are attempting to sequence and isolate the dengue virus in order to determine what is causing the current outbreak.
Has the crisis in Sri Lanka had an impact on your research?
We are not doing many things that we could have done last year. Because of the lack of fuel, recruiting participants and collecting samples from the hospital, which is 16 kilometres from our lab, is especially difficult right now. Many people, including myself, have started cycling, but cycling between 8 a.m. and 4 p.m. in temperatures above 33 °C, with 80-90 percent humidity, and in direct sunlight is a nightmare.
Because of power outages and a lack of fuel for backup generators, we are unable to use equipment such as our Illumina genomic-sequencing machine, which must run continuously for at least 24 hours. Instead, we rely on nanopore sequencing, which can be powered by a large battery. Nanopore sequencing is simpler, less expensive, and provides greater coverage, but it has slightly lower accuracy rates. We were able to sequence a few SARS-CoV-2 samples last week. This month, there have been more and more cases, so we were able to do this.
We can’t buy reagents for some of our dengue experiments because of the foreign-reserve crisis, so we’re freezing a lot of samples for when we can get them. But in March, we had power outages that lasted up to 13 hours and caused us to lose samples that were stored in some of our freezers.
Some procedures, such as flow cytometry, require fresh samples, so we had to work around planned power outages and limited university hours to complete those experiments. It’s extremely difficult. The majority of my time is spent troubleshooting.
Has inflation had an effect on your work?
It has increased the cost of many essential laboratory items. A bottle of the cell-culture medium we use, for example, cost 4,000 Sri Lankan rupees (US $11 at current exchange rates) in 2021 and is now 36,000 rupees. I’m still scratching my head, unsure of how to solve this problem. Can we obtain the medium at a lower cost from Chinese manufacturers? Immune cells are extremely sensitive, so they may not thrive in the new medium.
The rising food prices have also had a significant impact on our employees. A single egg now costs 50 rupees, up from 17 rupees in 2020. Rice, lentils, and coconut oil have all increased in price. My research assistants and PhD students are having a difficult time making ends meet. and dengue pathogenesis in the two regions. We are trying to sequence and isolate the dengue virus at the same time so that we can figure out what is causing the current outbreak.
(Curtesy nature.com)
