Patients in BrasÍlia remained fixed in the waiting room, moaning for assistance. Desperate search for an open hospital bed. Arguments in the emergency room about medication.
Brazil hasn’t seen such images since the darkest days of the COVID-19 outbreak when medical systems across the country collapsed under the weight of the sickness. This time, it’s not the coronavirus that has caused states to declare a state of emergency and even push the establishment of a field hospital in the capital, Brasília.
It’s dengue fever.
The disease is ravaging parts of South America, where experts think rising temperatures from climate change have expanded the geographical range of the mosquito that transmits dengue and accelerated its reproduction.
In the first two months of this year, Paraguay reported nearly 100,000 suspected cases, more than five times the normal incidence. Peru, which is dealing with its outbreak, has declared an emergency in many parts of the country. Argentina, too, has witnessed a surge in instances.
However, the disease has spread particularly rapidly in Brazil, where epidemiologists predict the number of dengue infections to reach the millions, more than double the previous record and likely killing thousands of people.
Epidemiologists believe the escalating public health problem serves as a warning to the world. The battle against the disease has entered an unforeseen and deadly new phase. Dengue fever is making its way into previously unexplored territory. And, as has been the case for some time, case numbers are skyrocketing.
Historically, the disease was only found in tropical areas. However, as cases have increased eightfold around the world since the turn of the millennium, the virus has progressively spread into previously unaffected areas.
Local transmission has been observed in America’s warmer, wetter states, where the disease’s vector, the Aedes aegypti mosquito, already lives. Last year, Florida recorded a record-breaking 178 cases of local transmission. California, Arizona, and Texas are also reporting local transmissions. A similar dynamic is seen in southern Europe, where doesn’t of cases of local transmission were reported last year.
“Cases of dengue fever are increasing at an alarming rate,” said Gabriela Paz-Bailey, a dengue specialist at the CDC. “It’s becoming a public health crisis and coming to places that have never had it before.”
Several factors, notably the frequency of screened windows, widespread air conditioning, and strict cleanliness procedures, reduce the number of stagnant pools where A. aegypti can breed.
However, epidemiologists say the hazard should not be ignored, particularly this year. In January and February alone, Brazil reported almost 1 million cases of dengue fever. By the end of the year, the country is predicted to have 4.2 million cases, more than the entire Americas had last year during its record dengue outbreak.
“There hasn’t been much transmission in the United States, but that could change,” said Albert Ko, an epidemiologist at Yale University. “We should be concerned that a large epidemic season in Brazil and the rest of South America will drive spread and transmission to places in the U.S.”
An unexpected spike in dengue fever
Dengue fever cases in Brazil have consistently increased over the last several years. They increased from a few hundred thousand per year in the early 2000s to more than 1.4 million in 2013, and again to about 1.7 million last year. This year, however, many factors came together to unleash an unprecedented pandemic.
A heat wave and El Niño, which generally correlates with higher dispersion of dengue, led to a larger proliferation of the Egypt mosquito and extended its life span.
“It’s not just how many there are, but that they live longer,” said Kleber Luz, who oversees research on A. aegypti-transmitted diseases for the Brazilian Society of Epidemiology. “Even if it is only for one or two days, this will affect.
The simultaneous circulation of all four kinds of dengue fever served as an additional accelerant. This weakened the immunological safeguards that people might have had in a place where dengue has long been prevalent. “I’ve been working with dengue since 1997,” says Luz, “and I’ve never seen another year when all four are circulating at the same time.”
According to Felipe Naveca, an epidemiologist with the Oswaldo Cruz Foundation, a Brazilian scientific research institution, situations like this one, where numerous dengue varieties are circulating, are very dangerous since people can contract the disease multiple times in a short amount of time. Cases are likely to remain high as each variety peaks in succession.
“The scenario isn’t good,” he admitted.
Brazil’s fight against dengue is complicated by a plethora of chronic socioeconomic maladies that the A. aegypti mosquito has long exploited: inequality, poverty, haphazard urban design, and a frequently failing public health system.
Millions of Brazilians live in densely populated, irregular neighborhoods known as favelas or “the periphery,” which are frequently isolated from government services and basic utilities. People with faulty plumbing frequently store water outside, resulting in a plethora of mosquito breeding places.
“If people do not use the water for a week, the mosquito breeds in it,” said Raman Velayudhan, a dengue expert at the World Health Organisation. “This is a disease of urban cities.”
Many of these dynamics are now clashing, particularly in Brazil’s Federal District, which by the end of last month had become the hub of the country’s dengue epidemic.
They didn’t have a bed for me.
The epidemic quickly spread to the district’s poorer areas, forming a ring around the rich core of Brasília. By the end of February, the disease was widespread, with approximately 120,000 suspected dengue cases in a population of 2.8 million people. The district’s hospital system, which had survived the coronavirus pandemic, began to falter. The hospital had run out of beds.
“The public and private health systems in the federal district have now collapsed,” district governor Ibaneis Rocha stated. “The moment is grave, and we still aren’t at the peak of the epidemic.”
“This year is different,” said Antonia Natane Lopes de Lima, 32, accompanying her ill son. “This year is worse than ever.”
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