Dengue in full swing: What went wrong with Peru’s worst spike in recent years? A Collapsed Health System | Women’s Minister Rosa Gutierrez resigns Minsa | Spreading mosquito | Peru

When COVID-19 arrived in Peru, the virus had only been known for three months. Without a clear protocol, vaccines, or proper knowledge of the nature of the second SARS-CoV in history, International distribution It overwhelmed our healthcare system and killed more than 220 thousand people. He DengueLocal, circulating in the country for more than thirty years, with a clear pattern of seasons and clinical experience in its care, has surpassed us.

“I apologize for the mistake of announcing that we will eliminate dengue in 15 days. It was my self-request and belief that the joint work and equality of all concerned departments made me think so. The real thing is that this error has me here in front of you”, Rosa Gutierrez tendered her resignation as health minister to Congress last Thursday.

While his statements are unfortunate, the reality is that the industry’s belated response to a known and preventable disease was not limited to a single sentence. Only till Friday, official figures The death toll from dengue this year stands at 261 – more than triple what was achieved in 2017, the country’s previous worst year for the epidemic – with 1,146 hospitalizations and more than 152,000 infections.

This is an account of all that has failed, because even if cases decrease, the next health minister will at some point have to face the cyclical history of dengue in Peru.

is an arbitrary vector

“In April, we sent a document to Minsa that cases were already increasing. They replied to us after a month. The letter is crying, because they are asking us for an explanation about where it is, when the thing has already exploded “, says Juan Carlos Celis, infectious disease physician and president of the Peruvian Association of Infectious and Tropical Diseases. With first-hand experience of dengue in Loreto, Celis notes that the ministry acted too late and in part. “It is not quickly answered with what is already known. MINSA is connected and fails to gather areas of experience”. El Comercio says.

“A mistake [en el] The Prime Minister emphasized that [Alberto Otárola] And the Minister should compare the situation in the Amazon and the north coast, where the outbreak began after the Yaku. They are not comparable situations.”

Juan Carlos Celis, President of the Peruvian Society of Infectious and Tropical Diseases.

The starting point for this strategy is the vector-borne mosquito ‘Aedes aegypti’, which also transmits Zika virus, chikungunya and others. If fumigation to kill mosquitoes was carried out late – in the worst-affected region of Piura, an aggressive and systematic fumigation campaign began only in June, when hospitals were already overcrowded – control of larvae was very poor. “Hatcheries were supposed to be reduced initially, but that was not done because the budget was needed to hire hundreds of door-to-door workers.”, adds Celis.

The delay is especially questionable given months of warning that temperatures will be above normal this summer and fall, even if El Niño is not confirmed. Heat is important, explains public health physician and infectious disease researcher Valerie Bass Solden. “When it’s hotter and more humid, the vector has more places to lay eggs. The breeding time of mosquitoes also accelerates with the heat.Explain.

Poor communication

While there is ample information on how to treat dengue, Selis reminds us that it is a disease with no specific treatment. There are no anti-dengue or anti-viral pills like herpes or other viruses. That is why communication is needed to prevent it”. Dice.

As the contexts and timing of epidemics are different in each region, this communication should be differentiated. “In northern Lima, it was found that 80% of the growers do not have water storage indoors, in vases, for demand. In Loreto it is very different, here you don’t find bamboo ornaments like in Lima”, I said.Follow along.

There is insufficient information on symptoms and warning signs. Because there are four serotypes of dengue, there are only four possible infections. However, Boss Solden points out that there are investigations that indicate that there will be more complications in the second epidemic. The problem is that there are people who don’t know it’s dengue the first time because the symptoms of dengue aren’t usually severe.

“There isn’t even information about where the larvicides are sourced so that people can avoid cleaning hatcheries.” Adds the expert.

Not enough staff

For Celis, another problem that cannot be repeated is the enormous slowdown and lack of incentives to hire health workers added to bureaucratic locks to upgrade the equipment of hospitals and health centers. “It takes a month for the ministry to implement something, the emergency has not expedited it, there are delays in budget items,” he says.

However, the warnings are months old. In February, for example, Peru’s medical association denounced the lack of intensive care physicians and infectious disease specialists in all areas where dengue cases are frequent.

“The most important thing to prevent dengue is to control the breeding places. The second thing, when there are more mosquitoes, is to smoke. No one prioritizes prevention until people start dying. We must be vigilant. We live with this disease.”

Valerie Bass Solden, Public health physician and infectious disease researcher.

Amid staff shortages, the sudden deactivation of the Expert Group to Monitor Dengue Control Policies and Interventions, comprising eight experts in epidemiology and infectious diseases, which had been active for only three weeks, drew attention. . The members of the committee ad respect and others learned about the word through the ministerial resolution published on Monday night, June 5.

A non-repetitive integration

For Bas Solden, it is important to recognize that the instability in the health sector, with the changes of 11 ministers from 2020, does not allow maintaining the order of work that helps to reduce the gaps: “I am not releasing the minister, but there is no way ministers can work well if they are in office for an average of 162 days”.

In any case, strategic work with each region is required. In fact, the Comptroller General of the Republic warned this week that dangerous situations were detected in Piura, Tumbes, Lima, Loreto and Callao.

“In a recession regional governments have a huge responsibility, they are living their own epidemics. As happened with Covid-19, it takes a unit or company to consider buying and hiring more staff without going through ten administrative processes. The decision comes from the top,” says Celis.