Venezuela Seeks to Quell Fears of Disease Outbreak

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Government seeks doctor’s arrest for saying deaths could point to mosquito-borne disease, Juan Forero reports for The Wall Street Journal.

A string of deaths in a hospital here has sparked fears of a potent, mosquito-borne disease and led authorities to seek a doctor’s arrest for allegedly sowing panic, leaving residents wondering how to explain their symptoms.

Angel Sarmiento, president of the College of Doctors in Aragua state, told reporters on Sept. 11 that a virus or bacteria may have been responsible for the deaths of eight patients in quick succession at the Central Hospital of Maracay. A ninth patient died three days after Dr. Sarmiento’s comments.

Insisting there was no cause for general alarm, President Nicolás Maduro last week accused Dr. Sarmiento of “psychological terrorism.”

The confusion in Maracay over the deaths—and over who to believe on their cause—shows how difficult it has become to arrive at a rational approach to public health in Venezuela. Part of the problem, doctors here say, is that the silencing of independent media has squelched the flow of information.

“To dissent, to have a position different from the government, leads to a witch hunt,” Dr. Sarmiento said in a telephone interview on Friday. “I am not a terrorist. I am a doctor.” He said he was still in Venezuela but was in hiding because he worried he would face a politically motivated prosecution.

Much of the fear has been focused on Chikungunya, a viral disease transmitted by mosquito bites that has been present in Africa and Asia for decades but only recently spread to the Americas. Though there is no cure for the disease, its symptoms can be alleviated with medication. The disease has killed at least 113 people this year in the Caribbean region, according to the Pan American Health Organization, with the islands of Martinique and Guadaloupe hardest hit.

Health authorities from Mr. Maduro’s government and independent epidemiologists agree the disease arrived in Venezuela several months ago. The two sides, though, are at odds about practically everything else about the disease.

In this polarized country, some leading epidemiologists said they believed Chikungunya was spreading so fast that a health emergency needed to be declared. The government has rejected that idea and accused its critics of trying to score political points.

Luis López, the head of public health in Aragua state, said in an interview that the nine deaths at the hospital in a two-week period ended Sept. 14 weren’t caused by Chikungunya or any other mosquito-transmitted virus.

“All of the cases had important health difficulties,” he said, as a doctor, Gerardo Sánchez, read off details of the cause of the nine deaths from a hospital report. Independent doctors interviewed here say the information released by the government is incomplete and inconclusive and does not mean a tropical disease, like Chikungunya, didn’t play a role.

Mr. López added that the government—including the governor for whom he works, Tareck El Aissami, a leader of the ruling Socialist Party—see Dr. Sarmiento’s comments about the deaths as an attack “to sabotage health care in Aragua state and create alarm where it didn’t exist before, at the national and international level.”

Tropical diseases are a fact of life here, with dengue being a scourge in Venezuela for years. But according to the College of Doctors, government health authorities haven’t sought the help of independent epidemiologists and infectious disease specialists in setting a strategy against tropical diseases, as is the norm in neighboring countries when outbreaks take place.

Doctors say they are afraid to speak out after Mr. Maduro accused Dr. Sarmiento directly and promised severe punishment if he is caught.

“In Venezuela there is a problem, but the authorities act like nothing has happened,” said Edgar Capriles, who works at the Central Hospital and worked in the public-health system to contain diseases.

In some neighborhoods in this oven-hot city, whole families become infected with what they presume is Chikungunya or suffer from its presumed after-effects. Local health centers are packed with people with fevers seeking acetaminophen, which several ill people said has been impossible to find.

At one poor neighborhood on the city’s eastern fringe, Fanny Ramírez, 49 years old, arrived at a small health facility with her son, Elvis Morffe, 14, who complained of a high fever, joint pain, inflamed glands, rashes—all of which, doctors say, are associated with Chikungunya. “It is all over, this disease,” she said. “The majority of people have it.”

Those in the waiting room knew about the 2-year-old girl, Marielvis Gil, who awoke nearby with a fever on a recent day and was dead 13 hours later. At the girl’s home, her grieving mother, Yaniret Carmona, said she won’t know the results of tests to determine the cause of death for a month. She said she suspected Chikungunya because doctors have told other family members that they likely have the disease.

“I want to know what killed my daughter,” she said, “so we can avoid this happening to other people.”

Epidemiologists and the heads of medical associations in Maracay and elsewhere said the government has underestimated the impact of Chikungunya, while wondering if a more potent strain had hit the region. That requires a public health campaign and fumigation of neighborhoods, as well as kits to diagnose the disease and medication to treat it.

“They didn’t prepare for this because the government has been irresponsible in managing public health,” said Feder Alvarez of the College of Doctors.

In the interview, Mr. López, the public-health official, denied that charge. said that the government implemented a vigorous public health campaign. Authorities say about 400 people have Chikungunya nationwide and that three who had it have died.”We have fumigated 10 times more this year than last year,” he said. “We are acting in an absolutely professional manner.”

Hector Celis, an epidemiologist who accompanied Mr. López to the interview, said the concern over Chikungunya is being magnified because the symptoms of the virus, such as joint pain, can be felt even months after the virus has died off.

Public-health documents, though, show that cases of people reporting fever—a key symptom of Chikungunya and dengue—shot up to 18,000 a week in Aragua state recently, far above the rate of slightly more than 1,000 a week earlier this year. Though the documents don’t outline what caused the fever, doctors not associated with the state government here say they believe it is Chikungunya.

So does Edy Bueno, who sat in pain in the waiting room on a recent morning to see a doctor.

“This seems like the plague—there are so many sick people,” she said. “The people next door to me have it. Across the street they have it. They should fumigate.”

For the original report go to http://online.wsj.com/articles/venezuela-seeks-to-quell-fears-of-disease-outbreak-1411409327

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