I refer to the letter Dengue - doctors can diagnose but not contain . I would like to thank Dr TE Cheah on his tutorial on pathophysiology and his concise thoughts on how dengue should be diagnosed and managed. Suffice to say that the general lay public by and large already know that treatment is essentially supportive without really going into the benefits nor intricacies of Cheah's version of management principles.

Perhaps we will all remember to tell patients next time they come with platelet counts of less then 15,000/mm3 and bleeding from the nose and gums that there are 'dangers' regarding platelet transfusions and we will 'wait and see' if the patient really warrants it. Or maybe we will give him the choice as per Whittaker of either contracting transfusion-related infections and reactions or letting him leak into in his lungs and brain.

Or perhaps, while accepting a patient with acute respiratory syndrome to the ICU with a platelet count of 10,000/ mm3 with our physicians all locked into ward and blog rounds discussing if the cause could be any one of a number of viral illnesses including dengue and chikungunya, we should also forego tests for dengue serology which in any case is done only on a weekly batch basis at our general hospitals.

Of course, the test is not diagnostic and at best only indicative but together with clinical symptoms and history, dengue serology can yield a diagnosis which aids in management. Indeed with PCR, you can even confirm it if there is a need. Platelet transfusions have a recognised role in the management of hospitalised dengue patients although exact indications and situations in which these are to be transfused may vary. But in the Malaysian setting, they are a critical component in the armamentarium for the management of dengue.

Perhaps Cheah doesn't have the unpleasant task of having dengue shock syndromes admitted weekly to the ICU with virtually all of them having platelet counts of less then 10,000/ mm3 with the blood bank officer screaming back at you that he really doesn't have any more platelet to spare.

Lest the public gets away with the notion that all is dandy once they consume lots of fluid or have saline or Hartmann's poured into their system if they contract dengue fever, they should perhaps know that although dengue fever is an acute, self-limiting viral disease, what many of us are worried about is when patients slip into its consequent sequella of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) especially if there is reinfection. And this happens in our setting only because of poor early diagnosis, erratic surveillance or negligent healthcare preventive measures.

The assertion that Subang Jaya residents are to be blamed for not looking after their drains and are therefore responsible for their unfortunate fate is at best nave if not decidedly unfair.

The point is, to say doctors can diagnose but not contain the problem is irresponsible. Doctors just don't diagnose, they must provide the guidance so necessary in eradication in many types of infectious diseases be it vector borne, HIV, SARs, hepatitis or H5N1. Pointing a finger at the community who are your most important ally in this war could lead to tragic circumstances. This country has a powerful tradition in overcoming many tropical illnesses basically because of its strong initial foundations since pre-independence days.

Sadly we appear to have let slip this advantage and reading in the papers about children, golfers and lecturers dying of dengue, is, I am certain, not something our forefathers would have been proud of. The main reason dengue still kills is because we do not possess the medical leadership so critically required in surmounting it.