Honduras' 2010 dengue epidemic (1 of 2)

Aedes aegypti mosquito,
very distinctive and easily recognized

The Honduran dengue epidemic I wrote about in June continues. At one point, there was even mention of it turning into a hyper-epidemic, though more recent reports seem to indicate that there is a reduction in numbers being admitted to hospitals, "a 25% reduction last week and 13% the week before", according to the Minister of Health, Arturo "Tuki" Bendaña last week. More on that statement below.

Bad numbers

The statistics are something hard to pin down as most people do not go to a doctor for dengue (there is no real treatment), and it's doubtful that private doctors report all of the cases that they treat. In fact, an August 14 La Prensa article flatly states that the private hospitals are not reporting dengue statistics at all because they say they "care for their prestige". [What the...??] Miraculously, even though those statistics are not reported, La Prensa says they are somehow "included in the total numbers reported by the Minister of Health". Disputed in that same article, a regional director admitted that they don't have accurate statistics.

(The same Aedes Aegypti mosquito, but this time engorged on human blood)

Providing further doubt of the validity of the statistics is the 'Honduran math' in which a decrease to 5,162 new cases in Week 32 from 5,253 new cases in Week 31 was announced on television as a big success, "a 25% decrease in cases this week" according to the Minister. It just doesn't compute.

In a later article on August 26, that was clarified to claim a 15% reduction from two weeks prior, not the week before and not 25%. Alas, it still doesn't compute! The math shows that the week 32 decrease was 1.7% and comparing it to two weeks prior results in a 13.7% decrease. Sadly, Honduran newspaper math is just as bad. They dutifully report what was said and they don't check the math or point out these errors of fact. Picking and choosing the comparative week just makes the Minister look bad, especially when he doesn't use the same week for the DH statistics.

The other day on the news a doctor said that the test kits that the hospitals were using were worthless, that they were resulting in a lot of false positives and a lot of false negatives. So once again, it seems the government has wasted money on poor quality. Also, if the tests aren't accurate, how can the statistics be relied upon?

The statistics are also hard to believe because we have seen playing with the numbers in the past. In 2007, the number of cases was compared to an arbitrarily selected high incidence year (2002) rather than the prior year in order to show the situation was under control, but reporters didn't catch on to that for several months. Other times, there were lengthy delays (weeks) in the reporting of confirmed cases of dengue hemorrágico. This year, at times the year-to-date numbers are reported and other times it is the June-to-date numbers. Confusing to say the least.

The red line in the chart is supposed to be actual cases in 2010. As best as I can tell, the green area signifies what would be considered "under control" while the orange area would be considered an ''alert" or epidemic. Like most data from the Minister of Health, it doesn't even make sense, since it only goes to 3,500 and as of week 26 (the supposed date of this chart), the count was already at 17,620 as shown earlier in this same report.

In July, anonymous doctors at the Tegucigalpa hospital with the highest incidence of cases in the country accused the Health Department of hiding figures, telling reporters that there had been 50 deaths from dengue, not 19 as had been officially reported at the time (July 8). They also said that the Minister had forbidden public health employees from giving accurate statistics on pain of firing. Two public health doctors who criticized the dengue eradication campaign were fired.

So...there isn't much reason to rely on the statistics, but it is all we have and there isn't much chance that they have been overstated.


Latest statistics

I started writing this article about two weeks ago and decided to wait for the latest statistics. Week 32 statistics weren't given until the end of week 33. Then, I really wanted to check the veracity of that "25% decrease" statement. Last week's statistics were finally reported yesterday.

Official statistics as of week 33 (August 26) show that country-wide 53,700 [suspiciously round number?] people have been diagnosed with dengue clásico, 1,796 with dengue hemorrágico (DH), and 60 have died from dengue. These numbers finally show a significant decrease in new classic dengue cases, 29% from the previous week, but show a 5% increase in new confirmed DH cases, or a 28% increase over two weeks ago (since the Minister likes to use two weeks prior when convenient). This might have more meaning if they also reported the statistics for the backlog of cases stuck in the confirmation process each week.

By comparison, the counts for the entire year of 2009 in Honduras were as follows: 14,528 dengue, 604 DH, and 12 deaths. To see how totally out of control this year's epidemic is, check out these 2007 and 2006 statistics from my article about this same time of year in 2007.

An important thing to know which is not usually made clear by the newspaper articles is that more than 50% of Honduran cases of both dengue clásico and dengue hemorrágico (the potentially deadly type) have occurred in the capital, Tegucigalpa. Another 10% have occurred in the San Pedro Sula metropolitan area.

Dengue Hemorrágico: 2010 cases in red;
2009 cases in blue; through week 26.

Even more interesting, in searching for the data, I ran across articles from January 2010 predicting the epidemic this year and indicating that the reported dengue cases in Tegucigalpa were already up 600% over the year before. So if the government knew it was coming, why didn't they do anything? Had appropriate actions been taken in that city earlier in the year, we might not have reached epidemic proportions.

Why Honduras?

Map of dengue hemorrágico in Central America
Yellow = number of cases; Red = number of deaths

As of week 31 (August 12), in all of Central America, 75% of the total deaths from dengue had occurred in Honduras, and 50% of the total deaths had occurred in Tegucigalpa. Comparing Honduras to its neighbors, Costa Rica has had only a little over 17,000 classic cases, the same as El Salvador. Guatemala, with almost double the population of Honduras, has had only about 7,500 cases of dengue clásico, 104 cases of DH and 15 deaths. Honduras represents about 18% of the Central American population.

Civic group Transformemos Honduras has quite a lot to say about the government's mishandling of the dengue epidemic this year. [This Google translation to English is worth reading.] This organization's well-documented article points out that not even basic steps were taken and places the blame squarely on the shoulders of the Health Minister, who among other things, placed a newly graduated doctor with no experience or specialization in the area of dengue or infectious diseases in charge of the program.

What is dengue?

Basically, classic dengue is like a very, very bad flu, with excruciating pains in the bones and joints and behind the eyes. If you aren't familiar with dengue, you could take a look at my 2007 article which gives lots of details and has some links to World Health Organization and US Center for Disease Control information. Only a certain type of mosquito carries the dengue virus and the only way the mosquito can contract it is by biting a human who has dengue. Dengue does not spread from person to person. While it is not easy, there are ways to control the proliferation of this mosquito, but instead, what we are seeing in Honduras is a spreading of dengue to areas which previously had very little incidence.

Why is Honduras being hit so much harder than other Central American countries?

See Part 2 tomorrow.

What is this??

We had a heavy rain the night before and when I went outside I found this bowl full of thick, white, slimy, foamy, something ....

What on earth?

This was a dog dish that I think someone took off the terraza to wash and left it on the grass by mistake. There was no dog food in it that might have grown moldy or anything like that. The bits of grass on top are only because someone was weedeating at the time. This is what the stuff looked like when I poured it out....

Gross!

Then I found this....


I think Arexy may have been giving the chickens water in this or maybe it was just from the rain. We feed the chickens in another area, so I don't think that it had chicken food in it. This is what it looked like when I poured it out...

The interesting thing is that none of this stuff soaked into the ground. It was thick and stayed there until I washed it away with a hose.

Then, going to check on some chicks in the chicken coop, I found this inside the coop where it couldn't possibly have been rained upon ...


The red stuff is wood shavings that the chickens had kicked on top of the .... whatever it is. This dish probably had rice and cracked corn in it, but how and why did it turn into this slop? This is what it looked like when I dumped it out...


This was thicker and less foamy than the other two. None of it had an odor, not that I got any closer to it than I had to to get rid of it!

I thought it would make a great horror movie, the foamy slime that took over the world.

Does anyone anywhere have a clue as to what this could possibly be?

La Gringa's Mocha Gelato

LG's Mocha Gelato The true color was darker,
but this night time photo with a flash doesn't show that

What is gelato? Gelato is Italian ice cream which is generally less high fat than American or French ice creams, often using a higher milk to cream ratio or even no cream at all. It is sometimes, though not always, made with no eggs. It is not made from gelatin, which is what you might initially think from the name. Gelato is a little denser than American-style ice cream because less air is introduced in the making. Ice cream cookbook author David Lebovitz has a good article that explains the different types of gelato from different parts of Italy in What is Gelato?

After reviewing many gelato recipes, I adapted this recipe primarily from a Gourmet Magazine Mocha Chip Gelato recipe which called for using 1% milk (bleech!). I used about 3 parts whole milk and to 1 part cream. Most gelato recipes called for whole milk, some that I viewed used 2% milk. Some of the reviewers skipped the cream completely in recipes, used half and half in place of cream, or even used skimmed milk. You're on your own there! Let your conscience be your guide. (I have no conscience when it comes to ice cream.)

I really changed the recipe a lot. Based on the reviews, I reduced the proportion of cornstarch and increased the coffee. I didn't have any chocolate so I upped the cocoa considerably. I used Penzey's Dutch Process High Fat Cocoa* which gives an amazingly good chocolate flavor without the harshness that some cocoa has. I prefer to use part cocoa and part melted chocolate when I have some. I also increased the recipe as it only called for 1 3/4 cups of milk. It seemed a lot of work to do for such a small quantity of ice cream.

*Yes, that is the name on the package: High Fat Cocoa. Pretty gutsy in this day and age, don't you think? ;-) Just a note for the tropics: Though refrigeration is not recommended for cocoa, I store cocoa in a plastic bag in the freezer. I have had cocoa go moldy in the pantry because of the high humidity.

Without telling El Jefe much about the recipe other than it was Italian ice cream and didn't have eggs, I asked what he thought of it. His review had me laughing, because it was exactly what I expected him to say:

"I was excited: "gelato"? I've never heard of that. Italian ice cream. Wow. But it wasn't as rich as you usually make. It was fine. But I would choose pineapple ... or caramel cappuccino or .... I wasn't excited. I think it needs eggs. It was okay but I think you have to make it a little richer."

He also said that he couldn't taste the coffee, so next time I think I'll use regular coffee steeped in part of the milk.

Not exactly a rave review, huh? The resulting ice cream was dense as gelato should be and it was very smooth, a really excellent texture. I thought it was good, but not fantastic. Though much lower in fat than most of my recipes (even as modified), I don't think it tasted like a lowfat ice cream.

Note that with the lack of eggs and less fat, this ice cream will freeze very hard by the next day. Taste and texture as well as scoopability will definitely improve with a few seconds (10-20) in the microwave at 50% power.

I think this ice cream could really benefit from some luscious add-ins, but then, of course, you'll be upping the calorie content, too. The next time, I'll have to try one or more of the variations that I dreamed of (below) but just didn't have the ingredients. I think some add-ins would give it enough kick that El Jefe wouldn't notice the lower fat content. But for those who have been clamoring for gelato and egg-free or lower fat recipes, here you go:


La Gringa's Mocha Gelato
Makes about 1 quart

3/4 cup sugar
3 1/2 cups milk (divided use)
3 tbsp. instant coffee
2 tbsp. plus 1 tsp. Dutch-process cocoa powder
3 tbsp. cornstarch
1 cup cream
1/8 tsp. salt
1 tsp. vanilla

1. Stir together 1/2 cup milk and cornstarch in a small bowl. Set aside.

2. Whisk together sugar, cocoa, coffee granules, and 3 cups milk in a medium saucepan. Bring to a boil, whisking often. Stir cornstarch to mix again and whisk into coffee-cocoa mixture. Return to a simmer, whisking for 2 minutes. Mixture should be thick.

3. Remove from heat. If you have any lumps, strain the mixture through a sieve. Stir in vanilla, salt, and cream.

4. Set saucepan in a large bowl of ice water to cool, whisking frequently so that a "skin" does not form. When room temperature, place in freezer for an hour or two until thoroughly cold, stirring occasionally.

5. Freeze according to your machine's directions.

Variations:

Cinnamon Mocha: Add 1 to 1 1/2 tsp. cinnamon with the vanilla.

Double Coffee Mocha: Add 3 tbsp. Kaluha or other coffee liquor during the last 5 minutes of freezing.

Double Chocolate Mocha: Chop finely 4-5 oz. of bittersweet or semi-sweet chocolate. Add half with the vanilla and stir until melted. Stir the other half into the finished ice cream.

Mocha Chip: Add 3/4 cup chocolate chips or broken chocolate chunks.

Toffee Mocha: Add 3/4 cup Heath bits, or better yet, real Heath bars broken into pieces. (The second night, I topped the gelato with Heath Bits and it was an improvement.)

Toppings: Sprinkle with sliced almonds, pecans pieces, or chocolate covered coffee beans.

Enjoy!


See also my ice cream making tips, the raw egg controversy and alternatives, and, if you are in the market for a machine, my ice cream maker reviews.