A report by Kirk Semple for The New York Times.
Rising temperatures are increasing the range of disease-bearing mosquitoes globally. But in Honduras, the effects are compounded by government dysfunction and criminal gangs.
More than 400 people died this year as one of the worst dengue epidemics on record swept through Central America — a type of outbreak that some scientists and public health officials are warning is likely to become more frequent and more widespread because of climate change.
But while climate change is threatening to increase the spread of dengue worldwide by expanding the range of the mosquitoes that carry the virus, the disease has already found an especially fertile breeding ground in Honduras, for reasons that go beyond the environment.
In Honduras, which accounted for more than 40 percent of the dengue deaths in Central America this year, according to the Pan American Health Organization, the effects of climate change have been compounded by government dysfunction, political tumult and public apathy.
Dengue has hit the country hard. This year, it had more than 107,000 cases of the viral disease — more than 13 times the number recorded last year — and at least 175 deaths. In 2018, only three people in Honduras died from the disease, according to the Pan American Health Organization.
Honduras’s notorious criminality has worsened matters, too, as public health teams, already stretched thin by budget cuts and a lack of trained personnel, have been blocked by gangs from entering some of the most severely afflicted neighborhoods to educate residents and fumigate against mosquito infestations.
Dengue is transmitted to humans by a type of mosquito called Aedes, which thrives in urban areas of the world’s tropical and subtropical regions. Tens of millions of cases occur each year in more than 100 countries, and symptoms may include fever, internal bleeding and shock. Inadequately treated, the illness can quickly kill.
In Honduras, health officials trace the start of the current epidemic to the fall of 2018. The number of incidents then rose sharply during the first half of 2019, hitting a peak this summer before falling off as the year ended. A nationwide health emergency declared in July by the administration of President Juan Orlando Hernández remains in effect.
The outbreak struck during a time of political turbulence in Honduras, with violent street protests against Mr. Hernández and calls for his ouster. Some of the protests have been driven by fears the government planned to privatize the health and education sectors.
The nation also suffers from high murder rates and widespread poverty, which have combined to drive tens of thousands of Hondurans in recent years to emigrate, with many trying to make it to the United States.
The dengue outbreak has met little resistance from a public health system gutted by budget cuts and pervasive corruption, analysts and officials said.
“It’s a collapsed system, an inefficient system,” said Ismael Zepeda, an economist with Fosdeh, a research group in Tegucigalpa, the capital.
Surveillance programs intended to detect outbreaks of mosquito-borne diseases were feeble. The nation’s poorly supplied and understaffed medical facilities lacked the capacity to adequately handle even the nation’s normal demands, much less an epidemic of historic proportions requiring a fast, highly organized response.
“In another country there would be many sick but not as many deaths,” said Eduardo Ortíz, an adviser on sustainable development and environmental health for the Pan American Health Organization in Honduras. “The cure for dengue is political.”
The epidemic in Honduras has been particularly brutal in the northern department, or province, of Cortés, the industrial heartland of Honduras. It got started early in this region and spread quickly through its main cities, San Pedro Sula and Choloma.
Cortés then became a kind of engine for the national crisis, officials said, as its large migratory population of factory workers helped spread the disease to other regions on visits home, officials said.
The epidemic has had a particularly devastating impact on Cortés’s low-income neighborhoods, which suffer from overburdened and ill-equipped public services and poor health care resources.
The epidemic caught Wendy Carcamo and her family unaware early this year.
Though the outbreak had already begun to bedevil Honduras, Ms. Carcamo said she knew little about it. Then one day in February, her son, Jostin Pineda, 7, suddenly fell ill.
“All day he was happy,” Ms. Carcamo recalled of her son. But by nightfall he was suffering a brutal headache and a high fever.
In the ensuing days, Ms. Carcamo said, Jostin’s illness was misdiagnosed by doctors at three local, private health clinics in a poor sector of Choloma. The last doctor referred the boy to the main public hospital in San Pedro Sula. But by then the disease was too far along, and he died the following morning.
It’s a story of missed opportunities that has become remarkably common during this outbreak in Honduras.
“As a parent, I wasn’t well prepared,” Ms. Carcamo said. “And as doctors, they weren’t well-prepared.”
She added: “Everything happened too fast.”
Dr. Dinorah Nolasco, the regional health director in Cortés, acknowledged that one of the main factors contributing to the epidemic’s spread was the shortage of trained personnel focused on prevention, education and response.
“In the face of the virus and its speed, we weren’t prepared,” she said.
Dr. Nolasco said her teams also had difficulty getting access to certain neighborhoods where armed gangs hold sway and harbor a suspicion of outsiders, particularly from the government.
In the poor, violent neighborhood of López Arellano in Choloma, Dr. Nolasco’s teams were blocked for months by gang members from getting into certain areas and were unable to survey for mosquito breeding grounds, educate residents or fumigate.
Government personnel were able to secure regular access only after Dr. Nolasco held a series of meetings with community leaders, who then negotiated with gang leaders. By then, however, López Arellano had already become a dengue hot spot, with thousands of infections.
Access remains a fraught issue. One worker for the health ministry has had to pay bribes to gang members — in small amounts of cash or marijuana — to do her work.
While better governance and bigger budgets would have helped contain the Honduran epidemic, scientists and public health experts say, they also point to another factor that might have contributed to the intensity and scope of the outbreak: meteorological conditions that are beyond the ability of one country to mitigate.
Honduras this year endured a drought so severe that it merited an emergency declaration in September by the government. But the nation also suffered bouts of unexpectedly intense rainfall, part of a pattern of increasing weather variability that climate scientists say is most likely related to climate change.
Some of this variability has created conditions that, in the absence of a strong governmental program of disease control, has allowed dengue to flourish.
During periods of extreme drought, residents living in neighborhoods without a reliable public water supply — as is the case in much of Honduras — will sometimes store water in their homes, providing more potential mosquito breeding sites. And during heavy rainfall, flooding can provide more breeding environments, particularly in areas with poor drainage systems.
“With climate change, we have rainy periods where there were once dry periods, dry periods when there was rain,” Dr. Nolasco lamented. “Before we had three cycles of spraying. Now we have to spray year-round.”
But experts caution that no single epidemic can be attributed wholly to climate change.
“In general, climate change is one of the multitude of factors affecting dengue,” said Rachel Lowe, an associate professor at the London School of Hygiene & Tropical Medicine, who researches the connection between climate and the spread of diseases.
Honduran public health officials are particularly worried about apathy, an enduring problem throughout the epidemic, particularly among poor, vulnerable populations.
“People are thinking about other problems,” said Dr. Nolasco, the regional health director. “If I’m a mother and I have three children, four children, I’m going to be thinking about what I’m going to feed them, whether my son is running with the gangs. They’ll be thinking least of all about dengue.”
During a visit to López Arellano this month, Dr. Nolasco stopped by the home of one family that had lost a child to dengue. She inspected a basin where water was stored for washing clothes and found hundreds of mosquito larvae swimming around. She found the same thing at a house across the street.
“How do you educate the population?” she said later, frustration in her voice. “In what moment is the public going to help?”
Though the number of cases reported per day in Honduras has fallen sharply from the epidemic’s peak in July, Dr. Nolasco frets that scenes like this are part of the reason there may be a resurgence of cases in the new year.
“I don’t even know what’s coming in January, February, March,” she said, sounding exhausted. “It could get worse.”