Hidden Epidemics

A suspicious silence about dengue fever

puts over two billion people at risk. *

* See Writer’s note, September 17, 2003, at bottom.

keith harmon snow

Appeared first in Toward Freedom -- Vol. 46, No. 2, May 1997 – later picked up by several online journals.

With best-selling books and Hollywood movies,

the deadly ebola virus infected public consciousness in 1995, spreading like a plague through the media. Newspapers and TV screens were filled with the search for at phantom “patient zero,” first victim of “Africa’s latest scourge.” All told, this “vicious killer virus” killed 244 of 315 victims, a 79 percent death rate. In a few days, it seemed, ebola dropped them like flies. Yet, during the same period another “outbreak” was hardly mentioned: dengue (deng-hee) hemorrhagic fever.

Planning a trip to Rio de Janeiro, Jamaica, or the Bahamas? Is dengue circulating there? Quiz your travel agent about the unadvertised health risks which might come with your destination package. But remember that tourism in Costa Rica, for example, earned $622 million in 1994 and broke new records last year. Dengue fever, with at least 24,042 cases from 1993-96, ranks among the biggest of Costa Rica’s unreported stories. And contrary to myth, travelers aren’t immune.

“The dengue viruses certainly haven’t received the kind of coverage they should,” says microbiologist Dr. C.H. Hoke at the US Army’s Walter Reed Institute of Research, where he’s working on a vaccine.

Dengue comes in multiple strains and forms. Stressed in the few dengue articles that have appeared is the notion that “dengue in its classic form is rarely fatal.” This tidy summary ignores the “other world” masses for whom critical treatment may be economically or logistically unavailable. That is doubly true for the more lethal manifestations, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), in which the flu-like symptoms of “classic” dengue progress to hemorrhaging and infections of internal organs, circulatory collapse, seizures, and coma. Although an infection by one of the four historically recognized dengue strains leaves survivors immune to that strain, infection by another strain can lead to DHF/DSS.

DEADLY SILENCE

Back when ebola was as unexplored and unknown as Kikwit, Zaire, epidemics of dengue were raging in the Americas. In April 1994, “Dengue in the Western Hemisphere,” published in a prominent US medical journal, documented the emerging plague. Reporting on the global pandemic in April 1996, the Center for Disease Control (CDC) noted, “Each year tens of millions of cases of dengue fever occur and depending on the year, up to hundreds of thousands of cases of DHF.”

At Costa Rica’s Hospital San Juan de Dios in April 1995, I confirmed what travel agents and press wouldn’t. “There is an epidemic of dengue type I in Costa Rica today,” said microbiologist and medical epidemiologist Dr. Teresita Solano.

There were at least 6200 cases of classic dengue in 1993. By September 1994, the C.R. Ministry of Health recorded 10,926 cases, although University of Costa Rica researcher Dr. Leonardo Mata reported over 27,000. According to Dr. Solano, from October 1993 to June 1996 (when other strains began to appear), Costa Rica saw some 24,042 cases of classic dengue.

By 1995, all four resident strains were intermixing throughout Latin America and the Caribbean, and with the arrival of a new dengue -III strain, probably from Asia, unknown variations began to appear. In August 1995, El Salvador and Guatemala declared “states of nation emergency.” Venezuela saw 15,252 cases of dengue and 2934 cases of DHF. Brazil had 88,039 cases of dengue. According to the CDC’s San Juan Labs in Puerto Rico, 14 countries in the Americas had confirmed cases of DHF by 1995.

So, where were the New York Times, Newsweek, and Time? Ebola often captured the front page, with some 55 stories in four major newspapers in 1995 alone. From 1992 to 1996 dengue scored a measly eight articles, typically buried inside. With over 40 maps, charts and photos, ebola was the focus of 14 features in at least four issues of Time, Newsweek, and U.S. News & World Report. Meanwhile, the same magazines ran nothing on dengue.

On September 13, 1995 the New York Times published a column by medical journalist Robin Maratz Henig, who wrote, “A new virus is attacking thousands of people in our own hemisphere…less then 10 miles from our borders…Yet we greet this nearby epidemic with an eerie silence. Ten to 15 percent of those infected die…newspaper and [TV] news shows have completely ignored the outbreak…though it has been three months since reports of dengue began circulating on the Internet.”

Ten days later, the New York Times followed up with Larry Rohter’s “U.S. is Now Threatened by an Epidemic of Dengue,” in which dengue statistics were based on member country reports to the Pan American Health Organizations. Nothing that “health workers in some countries suspected underreporting by governments wary of scaring off tourists,” the New York Times reported on 3324 cases of classic dengue in Costa Rica (not the 10,000 to 27,000 cases reported by medical professionals there).

Supporting evidence that the dengue story was suppressed includes an unclassified alert issued by US commercial officer Maria Galindo form the US embassy in Costa Rica on November 12, 1993. Advising that 2000 cases were confirmed and that “public officials are obviously nervous about the effect on the tourist industry,” the memo noted that: “this was an epidemiologic catastrophe waiting to happen.” No travelers’ advisory was issued, however. This “alert report” was designed instead for “US companies specializing in health, sanitation and education” who “may find a market very receptive to assistance in eradicating this menacing and very dangerous disease.”

In Costa Rica, half the population has been squeezed onto less the 1.1 percent of the land by mining, industrial and resort development, and agribusiness with its pesticide plantations of fruits, coffee, spices and fast-growing pulp and paper trees. An acute water shortage and garbage crisis is compounded by erosion, declining agricultural productivity, and ongoing deforestation -- all under the banners of “ecotourism” and “sustainable development” widely advertised by the US travel and leisure media.

Has the dengue epidemic been intentionally obscured? Recent articles on the global resurgence of infectious diseases have certainly neglected it. One was the October 1996 U.S. News & World Report focus on “Fighting Global epidemics.” Another was the major New York Times two-part feature on January 1, 1997, which manipulatively addressed mosquitoes, malaria, water and health. Noting that: “the mosquito does not itself catch malaria, yellow fever, encephalitis or the many other ailments that it can carry,” the New York Times never mentioned dengue. Malaria is a mosquito-born parasite; dengue is a mosquito-born virus.

DIVERTING ATTENTION

Why was ebola given major coverage while devastating mass epidemics in the Americas went underreported or ignored? One reason may be that ebola is a “sexy,” easily contained virus which as affected a relative few and required no major outlay of funds. The response, however, legitimized government and media as public health “protectors,” even while diverting attention and obscuring the realities of pervasive, systemic diseases and root causes affecting millions of people beyond western borders.

Other equally deadly epidemics were underreported in 1995: In Colombia, equine encephalitis infected an estimated 45,000 and killed 270 in four months. Honduras saw 6300 cases of cholera, including 175 deaths. An “outbreak” of leptospirosis infected 2500 and killed 26 in less than a month in Nicaragua, where there were 7000 cases of cholera, 35,000 of malaria, 17,000 of dengue, and 2000 cases of DHF.

Coverage of ebola included personalized accounts of terror and tragedy, touching snapshots of tears, or ghastly images of death -- ever in keeping with the spectacle of death and disease in Africa. Dengue was meanwhile presented with institutional and scientific detachment -- and without personalized accounts. Dengue was sold as the result of rapid urban population growth, lax sanitation procedures, overcrowding, and poverty, as if these -- like “dictator’s disease” in Africa -- are inevitable.

In fact, the ebola outbreak may have offered a pretext for the US and its agents to draw attention to an economically neutered Zaire. It certainly helped put the public in mood for intervention. After 36 years, the institutionalized chaos created by President Mobutu and his western puppeteers is no longer necessary. More likely, shifts in the power structures and allegiances of capital dictated the replacement of the Mobutu; hence the war by competing (external) factions. In the age of large-scale “resource” plunder, global scarcities now dictate the need for an accessible Zaire, and Western interests are poised to penetrate and industrialize.

A focus on dengue, on the other hand, would draw attention to deforestation, arms sales, “low-intensity” conflict, refugee flows, poverty, garage crises, and water shortages -- all exacerbated by debilitating debt-service obligations (IMF & World Bank) that perpetually sap government funds for public health and public works, forcing liquidation of “natural resource” capital. In other words, coverage of dengue would draw attention to predatory capitalism, the chains of free-trade, and the US house of cards in Latin America.

In September 1993, I contracted dengue fever in the Philippines. In Costa Rica and Nicaragua in 1995, where all four strains of dengue were circulating, I faced the potential of a lethal hemorrhagic infection. Returning to the US, the evidence of unprecedented epidemics in hand, I sent out queries widely. Nobody was interested.

While the implications are broad and significant, they remain largely unaddressed and obscure. Why does DHF strike women harder then men, and healthy children harder than malnourished ones? What ‘s the status of dengue today? Has it been ignored perhaps because unchecked epidemics are part of a strategy of “other world” de-development? Does a vaccine exist, available to US troops but withheld from the rest of humanity?

Dengue has a global distribution comparable to malaria. An estimated 2.5 billion people form 100 countries are currently at risk. As global temperatures continue to rise and the mosquitoes that transmit dengue move north, the media’s neglect should at least be questioned. The problems are not intractable, but the chemical insecticides touted by industrial saviors aren’t the answer. In the meantime, the big question isn’t “if” or “when” dengue will penetrate the US. Indeed, it’s already here. end.

Writer’s note, September 17, 2003:

On April 30, 2003, the Op-Ed page of the New York Times carried a curious advertorial – a major eye-catching spread of mixed fonts, headlines and subtitles, and one that filled two-thirds of the page – delineating the different diseases that, for the most part, the people of the “third” world routinely live (and die) with.

The purpose of the advertorial appears to have been two-fold: [1] promote an upcoming book by Howard Markel, “professor of pediatrics and communicable diseases at the University of Michigan”, and [2] to downplay the threat of severe acute respiratory syndrome (SARS). Downplaying SARS – putting it in perspective next to other global pandemics like tuberculosis, malaria and diarrheal disease, probably served the interest (and assuaged the fears) of the travel industry, whose profits must have been falling off due to fear of global travel and infection by SARS.

The advertorial gives the following statistic for dengue fever: 24,000 deaths a year; 20 million new cases a year. This is the closest the New York Times or any other major news venue has come to admitting and/or advertising (which is what newspapers are all about) the specter of the dengue pandemic.