the epidemics that threaten Latin America- ELESPECTADOR.COM

The coronavirus reached a continent that last year reported 20,554 confirmed measles cases, in at least 14 countries, and more than three million dengue infections.

The new coronavirus found in Latin America a panorama diametrically different from that of Europe or Asia. The socioeconomic characteristics of the region, the wait for the epidemiological peak in the coming weeks and the saturation of an already fragile health system these are just some of the South American challenges that have even forced us to rethink effective control and prevention dynamics in other parts of the world. One of them, perhaps the most latent, is the presence of other epidemics, such as measles or dengue, which were already on the continent. Infectious diseases that, like the coronavirus, threatened the lives of thousands of people and are now one more obstacle in times of crisis. (See here all the information about coronavirus)

The epidemiological situation living in Latin America is known to experts as a syndemic. A concept that is used when facing more than one epidemic. “Right now we have several epidemics simultaneously: dengue, measles and now COVID-19,” said Alfonso Rodríguez, vice president of the Colombian Association of Infectious Diseases. The coronavirus reached a continent that last year reported 20,554 confirmed measles cases, in at least 14 countries, and more than three million dengue infections, an increase of 20% from 2015, when the outbreak was experienced. highest in the history of the region.

For the specific case of Colombia, according to the infectologist Rodríguez, the epidemic that could increase sanitary saturation at this time would be dengue“We must take into account the case of dengue. In the country, in 2019, more than 127,000 cases were reported, of those about 14,000 evolved into severe dengue ”. Iván Darío Velez, director of the Program for the Study and Control of Tropical Diseases at the University of Antioquia, agrees with this opinion. “In Colombia we are in an epidemic that is simultaneously with COVID-19, and it is dengue. Until the end of April we were already in 50,000 cases in the country. ”

In Argentina, as reported in local media, cases also increased this year. So far the infections in Buenos Aires borders the 6,000 infected. The city’s health authorities indicated that 94.8% of cases did not travel to a place with viral circulation, that is, that the infection was local, something rare in the area. “The dengue outbreak started last year in November. It was an outbreak of as great magnitude as in 2016. Even in Buenos Aires there were neighborhoods with many cases and that is not so common, ”Angela Gentile, head of the Epidemiology Department of the Children’s Hospital Dr. Ricardo Gutiérrez of Argentina, told El Espectador.

When epidemics collide

With the outbreak of other epidemics in the region and with the saturation of the health system, figures could be registered for one disease when it really belongs to another. This situation, according to Josefina Coloma, a researcher at the University of California School of Public Health, consulted by BBC Mundo, could have occurred in Ecuador, the third country with the most cases of COVID-19 on the continent. “We do not have specific data, but we think it has to do with what is known as a double charge. In the epidemiological tables published by Ecuador, the dengue curve was very high (at the beginning of the year) and suddenly in March, when COVID-19 (dengue) started, it dropped to zero. And it is not that it has dropped to zero, but that the health system is saturated and nobody is really specifically following dengue cases, “he told the international media.

The term double burden epidemiology occurs in countries that “They still carry a very important weight of infectious diseases in different areas of the country, endemic diseases prevented by vaccines, ”said Alfonso Rodríguez. In places like Peru, the second country with the highest number of infections in the region, this situation is also occurring, and for Cristian Díaz, an epidemiologist in that country, it could be influenced by another of the medical challenges with the coronavirus: the detection of symptoms. “I know there should be dengue around, but having symptoms at a very similar start could be cases of mild dengue due to COVID-19,” he said. (You can read: After a month, Wuhan records COVID-19 case for the first time)

In a study, recently published in Travel Medicine and Infectious Disease, the issue was associated not only with confusion between two cases, but also with coinfection episodes: “We will have a high probability of coinfections of both viruses, with mixed symptoms, which can worsen the epidemiological situation in Latin America. (…) If we add the possibility of some false positives through rapid dengue tests, the lack of consideration of COVID-19 due to this will have serious implications not only for the patient, but also for public health. Hence the importance of developing rapid and reliable tests for SARS-CoV-2 / Dengue in the immediate future. “

The article also points out that this situation could not only be harmful for the epidemiological surveillance of each disease, but for the treatment used in each one of them. “The differentiated supply of drugs such as ibuprofen, with different severity-COVID19 in Italy and aspirin (contraindicated for dengue) will increase the complexity of medical care in simultaneous epidemics ”. However, for other experts this situation should not occur as frequently, since the case definition between dengue and coronavirus is distant, “I do not think there is confusion in practice because the clinical guidelines are very clear and clearly the COVID circuit is another because it points to a respiratory picture. So the circuits are different and the control measures are different, “added Argentine epidemiologist Gentile.

Whether due to coinfection or the presence of false positive cases due to saturation in the health system, the truth is that the most latent risk factor with the presence of other epidemics in the region is the cancellation of preventive measures to face them. Measure that affects especially at this time, in which cases have shown accelerated growth.
“With the arrival of the coronavirus, the reaction programs have been affected. Previously officials went out to look for mosquito breeding sites to prevent the spread of dengue, but they are no longer coming out by the other virus. Since the quarantine started we have seen that people are not going to hospitals. They are afraid to consult, even if they have symptoms of the disease. Perhaps the control measures for dengue have been diminished by the COVID-19 outbreak, ”added Iván Darío Velez, an expert in infectious diseases and tropical medicine. (It may interest you: Dengue cases in Colombia increased more than 93% compared to the previous year)

These types of diseases, also known as “neglected tropical diseases”, are frequent in regions where water is unhealthy, hygiene conditions are insufficient and housing structures are inadequate. According to Pan American Health Organization (PAHO), the most vulnerable populations are the poorest living in remote rural areas, slums of cities or conflict zones.

For Vélez, these types of epidemics are especially difficult to overcome due to the lack of investment in medicines or vaccines for protection, “dengue, leishmaniasis and malaria are called by the World Health Organization like neglected tropical diseases. In other words, they affect a large population and are not of interest to pharmaceutical companies because they are diseases of the poor, they are not good business. ”