10 Days of Dengue Fever

Postado em: 4th maio 2015 por Vanessa Barbara em New York Times, Reportagens
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The International New York Times
May 1, 2015

by Vanessa Barbara
Contributing Op-Ed Writer

SÃO PAULO, Brazil — In March, I spent 10 days in bed, mostly moaning and eating large quantities of pears — the only food I found remotely appetizing. I was one of the roughly 500,000 Brazilians infected with dengue fever in the first three months of 2015, over half of them in the state of São Paulo, according to the Ministry of Health. Here, a mosquito called Aedes aegypti spreads the tropical disease, which, in extreme cases, can lead to internal bleeding, organ failure and death. In those three months, 132 Brazilians died of dengue fever — more than one a day.

I had probably been infected at home, despite my maximum-security domestic measures.

I cover my legs with insect repellent. All of my windows and doors are equipped with mosquito nets, but I still keep two electric mosquito swatters inside the house. The swatters are shaped like tennis rackets and deliver an electric shock strong enough to kill bugs. One stays in the bedroom, where I work, and the other in the living room, where I watch movies while violently hitting insects as if for sport.

Despite the precautions, the bugs keep biting me without mercy. That first week of March was no different from the others, spent entirely working and roasting mosquitoes at home.

Then, on Sunday, I woke up tired and feverish, with a temperature of 102 degrees. I was exhausted and had an annoying headache. But no sore throat, no cough and no viscous substances running through my nose. So I reached Dr. Google and learned that a sudden fever not accompanied by typical flu symptoms is evidence of dengue (or chikungunya, another disease brought on by the same striped mosquito).

I promptly recalled all the public awareness ads on TV and in magazines urging people to seek immediate medical attention if they suspect they have dengue, and I felt almost a civic duty to report to a hospital. There is no cure for dengue, but timely treatment lowers the death rate below 1 percent. Also, I was taking a prescription anti-inflammatory drug called meloxicam to relieve neck pain and I needed to know, for sure, if I should keep taking it. (Every Brazilian knows that dengue patients shouldn’t take aspirin because it can aggravate bleeding.)

I spent more than three hours in the waiting room of a private hospital covered by my health insurance before the doctor could take a look at my blood count. He then said it was fine. He proceeded to tell me that specific tests for dengue fever could be performed only six days after the first symptoms. “Yes, it could be dengue,” he told me. “But honestly it could be anything.” He said it was fine to keep taking the meloxicam, and sent me home with a prescription to reduce my fever.

I was relieved, until I resorted again to Dr. Google. Apparently it is possible to test for dengue after the first day of fever, before antibodies appear. The NS1 antigen test is cheap and reliable. I also learned that it was definitely not advisable to continue to take meloxicam because, like aspirin, it could also raise the risk of bleeding; my orthopedist called the next day to forbid me from doing it.

I assume the doctor I saw at the hospital didn’t report me as having dengue, so I guess I’m not included in the Ministry of Health statistics. It took three weeks for me to find out for sure it was dengue, after a test at a private laboratory showed that my blood serum contained antibodies to the disease.

The situation is even worse within the public health system. Recently, a friend with symptoms of dengue fever waited more than four hours to be seen by a doctor in a community health care center. Because of the excess of patients, he was told he couldn’t get a blood count test for another day or two, and the results would take several more days to be processed. Blood serum tests were out of the question. “Patients who arrive after 4 p.m. are told to return the next day,” he told me. “My doctor advised me to return ‘if the dengue was hemorrhagic.’ ”

The São Paulo authorities are making an effort to fill in the gaps. The city recently set up medical tents to treat patients in high-risk areas and even called in the army to help.

Dengue is endemic to Brazil, and there are regular cycles of outbreaks, especially during the rainy season, from January to May. Some say that the main reason for the epidemic this year in São Paulo is the current water crisis. Outdated water infrastructure and a lack of investment have turned an ordinary drought into a serious shortage, and people have been forced to store water in open containers, which are perfect breeding grounds for mosquitoes.

But the same story plays out every year, with different excuses. According to the World Health Organization, the incidence of dengue worldwide has increased thirtyfold over the last 50 years. More than 40 percent of the world’s population is now at risk of being infected, including people in developed countries. The virus has at least four different strains, or serotypes, so even if you’ve had dengue once, you’re still vulnerable to the other types. Subsequent infections increase the risk of severe complications. So far, there’s no reliable vaccine against it.

My fever persisted for almost a week. I also developed a headache right behind my eyes — another classic symptom of dengue. I was dizzy and very weak, so much so that I couldn’t squeeze the toothpaste. The disease is also called “breakbone fever,” because of the intense muscle and joint pain it causes. All I could do was sleep, drink water and eat a little fruit.

By Friday evening, my fever had dropped, but so did my blood pressure. Every time I stood up, the world spun and I had to sit down — sometimes in the corridor or on the kitchen floor — so that I wouldn’t faint. I also broke out in a rash on my legs and arms. These symptoms could indicate a progression to dengue hemorrhagic fever, the severest form of the disease, with fatality rates as high as 20 percent.

But, this time, Dr. Google and I made the decision to wait. And, as the days passed, I got better and better. In the end, all that remained was some minor weakness — and three other subtypes of virus to catch.

Vanessa Barbara is a columnist for the Brazilian newspaper O Estado de São Paulo and the editor of the literary website A Hortaliça.