SINGAPORE — The first of Yuli Irma’s children to fall ill with a fever was her 6-year-old girl. The next day it was her 13-year-old daughter, followed by her 12-year-old son.
Living on the outskirts of the Indonesian capital of Jakarta, Irma feared her children were stricken with the coronavirus. But blood tests revealed they had dengue fever, another viral disease that’s in the throes of an outbreak but has been overshadowed by COVID-19.
After a record number of cases last year, the illness is relentlessly spreading across Southeast Asia, a hot zone where the mosquitoes that transmit the virus flourish. The painful disease kills thousands each year and infects hundreds of millions within a band of tropical territory spanning the globe.
While the overwhelming majority of people infected never present symptoms, severe cases can result in bleeding, respiratory distress and organ failure. More common symptoms — a few that mirror the coronavirus — include high fevers, severe headaches and excruciating joint pain deserving of dengue’s sobriquet, “breakbone fever.”
The rise in dengue fever cases is further straining medical resources in countries such as Indonesia at a time when health care facilities are dealing with the crushing demands of a pandemic — a stark reminder of how the coronavirus’ impact on health is rippling far beyond just those it sickens.
People worldwide are delaying elective surgery. Noncoronavirus patients are competing for diminishing supplies of ventilators, antiviral drugs and sedatives. And countries with chronically low numbers of medical staff are being pushed to the brink.
It took days for Irma to find treatment for her children. A doctor drew blood samples at home because Irma feared exposing the youngsters to the coronavirus at a hospital. When the tests revealed dengue, it took several more days to find a facility that wasn’t designated for COVID-19 patients.
“The children were very weak and dizzy by then,” said Irma, 42, whose children were hospitalized for four days in April.
Dengue’s early flulike symptoms can be confused for the coronavirus. Some patients have been found to have both, exponentially worsening their chances of recovery. The first person with COVID-19 to die in Thailand was also infected by dengue (pronounced deng-ee). In February, two Singaporeans with COVID-19 were misdiagnosed as having dengue.
Like the coronavirus, there is no cure for the disease, though researchers have been trying for decades to develop a vaccine — a sobering prospect for those expecting a COVID-19 vaccine to be ready in less than two years.
Development has been complicated by the fact the dengue virus appears in four different forms, known as serotypes. Patients who recover from one serotype can develop an immunity, but they face severe illness if they’re later infected by another serotyope. A successful vaccine would have to target all four serotypes.
One promising vaccine ended up being marred by controversy. In 2016, the Philippines stopped a vaccination drive that used a drug sold by French pharmaceutical manufacturer Sanofi Pasteur after children began dying.
Sanofi Pasteur subsequently disclosed its vaccine was making children ill who had never had dengue. The World Health Organization now recommends the drug only for those who have had dengue in the past. The scandal resulted in indictments of government officials and medical researchers in the Philippines, and a public mistrust of inoculations that contributed to a major recurrence of measles last year.
“It’s sort of a cautionary tale while we’re searching for a COVID-19 vaccine,” said Dr. Leong Hoe Nam, an infectious diseases expert at Mount Elizabeth Novena Hospital in Singapore. “Vaccines don’t always behave the way we want them to.”
While dengue is also found in Africa and countries south of the United States, 70% of its occurrence is in Asia. Before 1970, only nine countries had severe dengue epidemics, according to the World Health Organization.
Since then, mass urbanization, explosive growth in travel and warming weather has propelled the spread of the disease, making it endemic in 128 countries. Dengue is considered a “neglected tropical disease,” a title given by health officials to describe illnesses that occur in mostly poorer countries that receive inadequate attention.
