Four months on from when Hurricane Otis made landfall in Southern Mexico, the debris lingers, even as new threats to the local population emerge — notably a surge in dengue fever cases.

Like most natural disasters, Hurricane Otis grabbed headlines in late October as a Category 5 storm that produced record-setting wind gusts of 205 miles per hour. The storm killed at least 52 people, with dozens more missing, according to the official government count. Local outlets have placed the death toll at as high as 350 people.

Now, several months later, international media has moved on even as the deadliest phase of the storm is ongoing. In the hurricane’s immediate aftermath, lack of potable water, limited or no electricity, impassable roads and damaged infrastructure, and interruptions to local food and medicine supply chains were the most pressing issues. Today, the delayed progress in rebuilding efforts has created a breeding ground for mosquitoes.

Dengue fever, also known as break-bone fever, is a viral mosquito-borne infection that can lead to painful fevers, rashes, and low platelet counts, which reduces the ability of the body to stop bleeding. While there is no cure, many cases can be treated with over-the-counter medications and rest. However, more difficult cases require anti-hemorrhaging medication, platelet transfusion, and an array of interventions in an ICU. In the most severe cases, usually due to low platelet counts, which can lead to spontaneous blood loss, patients are transferred to hospitals in Mexico City.

The mortality rate is less than 1%, though the illness can quickly fill up hospital beds. This is reflected at a new field hospital in Acapulco, where most patients are being treated for dengue fever, according to Dr. Ivan Santana, Guerrero state’s director of medical emergencies.

Months after the storm, “there still is a lot of debris and garbage, including trees, wood, sheet metal, aluminum, mud, and dust in the hurricane-effected areas (Guerrero state). It has become a breeding ground for mosquitoes,” said Dr. Santana, who noted that some roads in poorer, more rural parts of the state remain blocked.

Santana said there were about 1,500 active dengue fever cases in Guerrero as of last week, with just about all of them concentrated in areas most impacted by Hurricane Otis. He said cases were on the rise prior to the storm — Ministry of Health figures show a case count increase of almost 340% through October 2023 compared to all of 2022 — but that the numbers in Guerrero jumped significantly post-Otis. “Dengue is also present in other Mexican states, but Guerrero has the highest number, and I believe this is due to the hurricane,” he said.  

Less than two weeks after the storm, Guerrero had 1,855 confirmed cases, representing a 50% year-over-year increase in the number of cases compared to the same period the previous year. Between January 1 and February 21 this year, Guerrero had 1,497 confirmed cases, part of more than 4,700 total suspected cases, according to PAHO. These case counts are more than the total number of dengue cases in the state from January 1 to October 23, just before Otis hit last year.

Overall, since the storm, Guerrero has seen a 237% increase in cases compared to the same period the previous year, according to Ministry of Health data. Nationwide, Guerrero has about 40% of all confirmed cases, which is down from the 75% of all Mexican cases it had at the end of January. Before the storm last year, Guerrero was not among the top five states in dengue case counts.

Assessing the current healthcare priorities in Guerrero, Santana said dengue fever is at the top, even as other maladies are present, such as other mosquito-borne diseases, including chikungunya and Zika, as well as diarrheal diseases. Santana also mentioned that people with cancer and chronic diseases, such as diabetes, chronic kidney disease, and hypertension, have faced interruptions to care due to a lack of access to their medicines and treatments at facilities. Violent crime has also persisted in Guerrero, which has also curtailed the number of physicians and other first responders willing to travel to the area, according to Santana and one additional doctor who asked to remain anonymous and who decided to suspend his medical missions to Guerrero.

“Hospital infrastructure was damaged, and services were cut. Pretty much every single medical facility was affected by the hurricane so that obviously creates some issues,” Santana said. He mentioned the lack of cold chain capacity as an example of why diabetics were unable to get insulin, for example. Other medications that require being kept at low temperatures, like some vaccines, also spoiled.

Addressing what led to the recovery effort delays, Santana said the scale of the disaster was simply too large to address quickly, given available resources.

“More than 500 trucks were moving rubble right after the storm. There was lots of heavy machinery, but the magnitude of the hurricane was so massive that you couldn’t quite do it fast enough,” he said. “It was too much for any quick response to mobilize. There was too much rubble and mud, and even now there’s mud, which is a breeding ground for mosquitos.”

In the past couple of weeks, Santana said that the outbreak has been somewhat curtailed because of favorable weather conditions, specifically meager amounts of rain, as well as more fumigation. Santana believes the situation will stabilize through the spring, but that cases will likely rise again during the rainy summer months, in addition to fumigation machinery needing to be returned to the other Mexican states from which they have been loaned.

Since Hurricane Otis made landfall in Oct. 2023, Direct Relief has shipped more than 67 tons of medical aid to support health services for those impacted by the storm.

Interview translation and additional reporting by Eduardo Mendoza