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The disease is ravaging much of South America, where scientists say rising temperatures due to climate change have expanded the territorial reach of the mosquito that transmits dengue and increased its proliferation.
In the first two months of this year, Paraguay recorded almost 100,000 suspected cases, more than five times the typical rate. Peru, devastated by its own outbreak, has declared an emergency in much of the country. Argentina has also seen an explosion of cases.
But the disease has risen with particular virulence in Brazil, where epidemiologists expect the number of dengue cases to reach millions (more than double the previous record) and potentially kill thousands of people.
The deepening public health crisis, epidemiologists say, serves as a warning to the world. The fight against the disease has entered a new unpredictable and dangerous phase. Dengue is now infiltrating places it has never been before. And where it has been for a long time, the number of cases is skyrocketing to levels never seen before.
Historically, the disease has been limited to tropical climates. But in recent years, as cases have skyrocketed in much of the world… increasing eight times Since the turn of the millennium, the virus has increasingly spread to areas that were previously largely safe.
Local transmission is currently being reported in the warmest and most humid states of the United States, where the disease vector, the Aedes aegypti mosquito, it’s already wandering. Last year, Florida reported a record 178 locally transmitted cases. California, Arizona and Texas are also detecting local transmission. The same dynamic is also being seen in the south of Europewhere dozens of cases of local transmission were recorded last year.
Epidemiologists warn This is probably just the beginning. In the coming years, as climate change expands the range of A. aegypti mosquito, the disease could become increasingly prevalent, even endemic, in much of southern Europe and the southern United States.
“Dengue cases are increasing at an alarming rate,” said Gabriela Paz-Bailey, a dengue specialist at the Centers for Disease Control and Prevention. “It’s becoming a public health crisis and it’s reaching places that have never had it before.”
The risk in richer northern climates is mitigated by several factors, including the prevalence of screened windows, widespread air conditioning, and strong sanitation practices, which can reduce the number of standing water puddles, where Aedes aegypti can be reproduced.
But epidemiologists say the threat should not be discounted, especially this year. Brazil recorded more than 1 million cases of dengue in January and February alone. It is expected that by the end of the year the country will suffer 4.2 million, more than what was recorded in all of America last year during its record outbreak of dengue.
“There hasn’t been extensive transmission in the United States, but that may 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 United States”
An alarming increase in dengue
For years, dengue cases in Brazil have been steadily increasing. They jumped from a few hundred thousand per year earlier this year to more than 1.4 million in 2013, and then again to nearly 1.7 million last year. But this year, several forces combined to unleash an unprecedented outbreak.
An extraordinary heat wave collided with El Niño, which often coincides with greater spread of dengue, leading to greater proliferation of the Aedes aegypti mosquito and extending its useful life.
“It’s not just about how many there are, but whether they live longer,” said Kleber Luz, who coordinates dengue research at the Brazilian Society of Epidemiology. “Even if it is only one or two days, this will affect the number of dengue cases.”
Then came another accelerator: the simultaneous circulation of the four types of dengue. That reduced the immune protection people might have had in a country where dengue has been present for a long time. “I’ve been working with dengue since 1997,” Luz said, “and I’ve never seen another year where all four are circulating at the same time.”
Felipe Naveca, an epidemiologist at the Oswaldo Cruz Foundation, a Brazilian scientific research institution, said times like this, when multiple variants of dengue circulate, are particularly dangerous, because people can contract the disease several times in a short period. Cases will likely remain elevated as each variant successively peaks.
“The scenario is not good,” he said.
Further complicating Brazil’s fight against dengue are a number of chronic social ailments that the Aedes aegypti The mosquito has long exploded: inequality, poverty, disorganized urban planning and a frequently failing public health system.
Millions of Brazilians live in irregular, densely populated communities (called favelas or “the periphery”), often outside the reach of government services and basic public services. Because pipes are unreliable, people often resort to storing water outside, which creates countless breeding grounds for mosquitoes.
“If people don’t use the water for a week, the mosquito breeds in it,” said Raman Velayudhan, a dengue expert at the World Health Organization. “This is a disease of urban cities.”
Many of these forces are now clashing with particular force in Brazil’s Federal District, which, late last month, had become the epicenter of the country’s dengue outbreak.
‘They didn’t have a bed for me’
With invisible speed, the disease hurtled toward the poorest pockets of the district, which form a circle around the wealthy center, Brasilia. By the end of February, the disease was everywhere: almost 120,000 cases of dengue in a city of 2.8 million inhabitants. The district’s hospital system, which had withstood the onslaught of the coronavirus pandemic, began to falter. Hospital beds had been exhausted.
“The public and private health systems in the Federal District are now collapsed” saying governor of the Ibaneis Rocha district. “The moment is serious and we are not yet at the peak of the epidemic.”
When Loide Rocha dos Santos, 57, was taken to a packed hospital last month, she said the chaos was clear. Despite the severity of her condition (dengue had reduced her blood platelet count to a dangerous level), the health clinic in the Gama region could do little to care for her.
“The first two days I had to sit in a wheelchair,” he said. “They didn’t have a bed for me.”
She was one of the lucky ones. Patients were around her, she said, on the floor, receiving IVs. Others shouted angrily at the lack of attention, according to a video recorded by her daughter. A man screamed for painkillers so he could go home and die.
“None of us could go anywhere,” he said.
At the other end of the district, in the impoverished region of Ceilândia, another family scoured the city in search of a hospital bed. Mariana Torres Lima, 5 years old, clearly had a case of dengue with high fever, vomiting and severe pain. But when her relatives took her to the Ceilândia Regional Hospital, they were turned away, they said.
The family then traveled to a field hospital built to care for those suffering from dengue. After seven hours of waiting, Mariana was admitted. She curled up under a coarse wool blanket on a military cot and fell asleep.
Outside, her aunt Bruna Lira seethed with anger. “The government is not taking care of us,” she said. “There is garbage in the streets and there is no general cleaning in the schools. One thing leads to another.”
She sat down again. Around her, in the field hospital, more and more people were arriving. At noon, there were dozens. Many collapsed. Others were vomiting.
“This year is different,” said Antonia Natane Lopes de Lima, 32, accompanying her sick son. “This year is worse than ever.”