The epidemic of diseases transmitted by mosquitoes in Cuba against a backdrop of health collapse: “It looks like a city of zombies”

Sources interviewed by BBC News Mundo (Spanish service of the BBC) say they know of several close cases of people dying from the “virus” in recent months.

New chikungunya cases increased by 71% in just seven days, as the Cuban Ministry of Public Health reported last week, while the Pan American Health Organization (PAHO) put the total number of cases of the disease at 25,995.

However, most patients avoid seeing a doctor when they are not in serious condition, making the true number of infected people unknown.

In Brazil, dengue fever outbreaks have been recorded in the country since at least the 1980s. It is also becoming a concern in other parts of the world, including wealthy countries in Europe and North America.

The chikungunya virus, first identified in Tanzania in the 1950s, officially arrived in Brazil in 2013 and caused the first outbreak in mid-2015 and 2016. In a decade, the pathogen spread to 6 out of 10 Brazilian cities and caused seven major outbreaks.

The virus that causes oropouche fever was first identified in 1955 in a patient who lived in the village of Vega de Oropouche on the Caribbean island of Trinidad. Shortly after, in the 1960s, the infectious agent was also discovered in Brazil.

Between 1961 and 2000, more than 30 oropouche outbreaks were recorded in Brazil, notably in the states of Acre, Amapá, Amazonas, Goiás, Maranhão, Pará, Rondônia and Tocantins, according to a study by the University of Kansas (United States).

Increasing deforestation and climate change increase the risk that this disease will spread to other places and create new cycles of urban transmission of this virus – just as is already the case with dengue, zika and chikungunya.

BBC News Mundo spoke to several Cubans who reported from the island their experiences with the three types of viruses.

“I was working and I felt pain in my knee, as if I had a very heavy weight. When I went to get up from my chair, I couldn’t; walking became very difficult. That’s how it all started,” recalls Hansel, a 31-year-old engineer from Havana.

This happened about two months ago. The next day, the symptoms worsened.

“I woke up with pain all over my body: in my joints, in my feet, in my fingers, in both knees, in my lower back, in my shoulders, in my wrists, in my fingers…”

Hansel describes what he felt as “a kind of arthritis, like suddenly becoming an old person.”

Three days of high fever followed, reaching 39°C, combined with intense pain.

The pain persisted even after the fever subsided, and on the fifth day, he said, skin irritation appeared all over his body.

Silvia (not her real name, as she does not want to be identified) told BBC News Mundo that her mother and grandmother, in the province of Pinar del Río, in the far west of the island, are very ill, also because of the “virus”.

“It’s me who counts, because they are not in good condition,” he begins.

Silvia reports that both have tremors, a fever of up to 39.5°C and intense joint pain that prevents them from getting out of bed.

What do they have? It could be dengue, chikungunya, oropouche or another virus. Neither Hansel nor Silvia’s family knows for sure, because they have not consulted a doctor. They consider it a waste of time and the little energy the “virus” leaves them.

In Cuban hospitals, says Silvia, “there are no conditions for receiving people. Everything is collapsed, including the pediatric services. There is no diagnosis per se, they just recommend hydration, paracetamol, paracetamol for joint pain.”

“The truth is that the situation is very precarious. People are staying at home as best they can, practically without walking, because of the pain,” he said.

A 50-year-old Havana teacher, also on condition of anonymity, says “very few” seek medical attention after falling ill.

“Almost no one I know goes there. People choose not to go because in these institutions there is no way to get a reliable diagnosis and there are no medicines either. You have to buy them on the informal market, or ask a relative or friend to send them from abroad, or someone who lives here to donate them,” he says.

Cuba defines itself as a “medical power” because of certain advances made in recent decades that have not been made by other larger or wealthier countries, from training large numbers of doctors and sending international health missions to developing its own biotechnology industry, responsible for creating a national vaccine against Covid-19.

However, the worsening economic crisis that the country is facing today places the health system in extremely precarious conditions.

Most hospitals are completely short of equipment, materials and medicines, making it impossible to guarantee the minimum medical and hygienic conditions for treating patients.

Added to this is the fact that thousands of Cuban doctors have emigrated abroad in recent years, leaving on the island collapsed services, uncovered teams and a chronic overload of the professionals who remain, subject to strong pressure for salaries which are around 30 dollars per month (around R$150).

BBC News Mundo contacted the Cuban government to request an interview with a health authority, but received no response.

“National authorities have implemented surveillance and response measures, including strengthening epidemiological and laboratory surveillance, standardizing clinical management in health services, and adopting vector control interventions targeted to areas of highest transmission,” WHO/PAHO reported.

The extreme situation in Cuba not only affects the treatment of patients with dengue, chikungunya and oropouche, but also favors the spread of these diseases.

“Hygienic conditions in and around homes influence the proliferation of vectors that transmit these diseases,” PAHO responded when asked about the impact of factors such as power outages, water shortages and accumulation of garbage.

Others describe the problem more concretely.

“If there’s a power outage and you can’t use fans, air conditioning or other mosquito control equipment, they come in and bite,” Hansel laments.

Added to this, adds the engineer, “the problem of landfills at the corners of neighborhoods, which are sometimes numerous and which are not collected or accumulated, and all this also generates mosquitoes and problems.”

The Cuban government has recorded 47 deaths attributed to the “virus” to date, while the WHO/PAHO considers the official figures to be valid.

However, independent experts believe the true total could be higher, and several people interviewed by BBC News Mundo say they are aware of recent and upcoming deaths caused by the outbreak.

“I know of two people who died. Both aged around 80 years old. One of them was transported to the Sancti Spíritus Provincial Hospital and the other was kept in a small therapy room at the Fomento Hospital,” said the professor quoted above.

Another major concern concerns the consequences left by these viruses, the long-term scope of which is still unknown.

For now, many patients say they continue to experience pain and limitations of varying degrees of intensity weeks or even months after recovery.

“I still feel pain in my fingers; for example, when I close my hand and squeeze it, I have difficulty opening the jars. My shoulders and lower back also hurt a little. And it’s been more than a month,” laments Hansel.