In Some Nations, Coronavirus Is Only One of Many Outbreaks

In Some Nations, Coronavirus Is Only One of Many Outbreaks


MEXICO CITY — A dengue epidemic ravaged Honduras last year, sickening over 100,000 people and leaving 180 dead. As this year began, officials braced for another surge in cases of the mosquito-borne disease and wondered how they would manage with their frail public health system and shortage of trained personnel.

Then along came the coronavirus, pitching the nation into a grueling, two-front public health battle.

“Horrible,” said Dr. Dinorah Nolasco, a top health official in northern Honduras, a region that has been particularly hard hit by both diseases. “These months have been tremendous.”

As the coronavirus pandemic stalks the globe, some nations, particularly in the developing world, find themselves under extraordinary strain as they simultaneously contend with other outbreaks, chronic public health problems and challenges posed by government mismanagement, poverty and armed conflict.

The all-consuming demands of the coronavirus, officials fear, could divert government focus and open the door to a possible resurgence of other illnesses.

In Latin America, where the number of coronavirus cases has been rising sharply, governments are trying to contend with new dengue outbreaks while holding onto gains in the fight against other infectious diseases. But at least nine countries in Latin America and the Caribbean have paused some of their immunization activities, officials said, threatening efforts to control diseases such as polio, tuberculosis and measles.

Dengue is also bedeviling nations in Southeast Asia, like Indonesia, another country hard hit by the coronavirus. And in Africa, health officials are concerned about recent outbreaks of yellow fever, cholera, measles and Ebola, among other diseases.

In one alarming measure of the extent of the coronavirus’s disruption to global health strategies, vaccination programs in at least 68 countries have been “substantially hindered,” according to a statement released last week by the World Health Organization, Unicef and Gavi, a public-private partnership that helps provide vaccines to developing countries.

The causes for the disruptions include lockdowns that have impeded the movement of health care workers and patients, fear of coronavirus transmission in mass vaccination gatherings, inadequate vaccine supplies due to transportation delays and insufficient protective gear for health care workers, the statement said.

In some places, health care workers assigned to vaccination campaigns have been redeployed to respond to the coronavirus, officials said.

The pandemic, coming on top of other immense public health challenges, “has showed the vulnerabilities of many countries in different manners,” said Dr. Richard Mihigo, coordinator in Africa for the World Health Organization’s immunization and vaccines development program.

“Countries have been almost on their knees, paralyzed,” he continued. “It becomes very clear that they need to have a much more resilient health system in place to control any outbreak or to prepare for any outbreak that may come.”

The coronavirus took hold in Latin America well after it had started pummeling most of the rest of the world. During the first few months of the year, health officials had more immediate problems to contend with, including dengue.

In 2019, the disease, transmitted by the Aedes aegypti mosquito, had ravaged Latin America, which suffered its worst dengue epidemic on record with more than 3 million cases and more than 1,500 deaths.

The outbreak hit Honduras particularly hard, overwhelming a public health system that had already been weakened by budget cuts and pervasive corruption and was barely equipped to meet usual demands, much less an epidemic of record size. By the end of 2019, Honduras had suffered about 61 percent of the dengue deaths in Central America.

The highest number of dengue cases occurred in the department of Cortés, where efforts to control its transmission were further hampered by a lack of trained personnel and by the region’s ubiquitous criminal gangs, which for months blocked government health care workers from gaining access to some of the hardest-hit neighborhoods.

Dengue remains a major concern in Latin America and the Caribbean this year. According to the latest statistics from the Pan American Health Organization, about 1,426,000 cases have been recorded in the region so far, fewer than during the same period last year. But regional health officials fear this may be an undercount caused by the focus on the coronavirus and the disease it causes, Covid-19.

“Covid has been able to sometimes deviate attention from other pressing problems,” said Dr. Marcos Espinal, director of the department of communicable diseases at the Pan American Health Organization, based in Washington, D.C.

On Tuesday, Dr. Carissa F. Etienne, the director of the Pan American Health Organization, said the Americas, with more than 2.4 million Covid-19 cases and more than 143,000 deaths, had become the epicenter of the pandemic.

In Honduras, the number of dengue cases this year is already outpacing last year’s tally — with the worst, perhaps, yet to come, officials said. The rainy season is just beginning, bringing more pooling and flooding and creating more potential breeding sites for mosquitoes.

“We’re expecting a much greater proliferation of the mosquito between July, August and September,” said Dr. Piedad Huerta, representative of the Pan American Health Organization in Honduras.

Health officials are now bracing for a repeat of last year’s crisis in Honduras, when the hospital systems in some regions were overflowing with gravely sick dengue patients, many of them children. Only this time, there is the additional problem of Covid-19.

“It puts a double burden on the health services,” Dr. Huerta said. “Without a doubt, I think it isn’t easy for the country to be able to manage both things in a very efficient manner. It’s a very big challenge.”

The Honduran government has put out a call to contract more health care workers to deal with the growing coronavirus threat, officials said, while imposing stringent measures to try to control its spread, including closing the country’s borders, mandating a blanket curfew and severely restricting the ability of people to leave their homes.

Dr. Nolasco, regional health director in the northern province of Cortés, said she has already been provided with more than 200 supplemental workers — doctors, nurses, microbiologists and others — to staff quick-response medical teams and conduct door-to-door education campaigns, cornerstones of her public health program to confront both the coronavirus and dengue.

But while she no longer has a problem with the criminal gangs, as she did last year, her teams are still having difficulty accessing some areas. Residents of certain neighborhoods have banded together to block the entrance of health care workers out of fear that they might be carrying the virus.

Dr. Nolasco said she and her staff members have been driven away by mobs wielding machetes and throwing stones. In one incident, workers trying to enter a neighborhood were doused with bleach, she said.

Some people afflicted by Covid-19 have been fearful of seeking out attention because they believe the disease is shameful and are embarrassed. Others are in denial that it is even a real phenomenon, she said.

Some patients, seriously sick with Covid-19, are seeking medical attention after it is too late. “People are arriving at the emergency room to die,” she said. “The fight now is education.”

Dr. Espinal said he worries about countries in Latin America and the Caribbean becoming overwhelmed by the coronavirus and “taking their eyes off” other health problems.

“Latin America has a great history of declining morbidity of infectious diseases,” Dr. Espinal said. “We don’t want to go back or to lose that achievement.”



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