GRBV UNDEREPORTS H1N1, DENGUE AND MALARIA ON THE RISE

C O N F I D E N T I A L SECTION 01 OF 02 CARACAS 001591 SIPDIS HQ SOUTHCOM ALSO FOR POLAD TREASURY FOR MKACZMAREK NSC FOR DRESTREPO NSC FOR LROSSELLO USDOC FOR 4332 MAC/ITA/WH/JLAO AMEMBASSY BRIDGETOWN PASS TO AMEMBASSY GRENADA AMEMBASSY OTTAWA PASS TO AMCONSUL QUEBEC AMEMBASSY BRASILIA PASS TO AMCONSUL RECIFE E.O. 12958: DECL: 2019/12/23 TAGS: ECON VE KFLU KHIV AMED SUBJECT: GRBV UNDEREPORTS H1N1, DENGUE AND MALARIA ON THE RISE REF: CARACAS 1515; CARCAS 1367 CLASSIFIED BY: DUDDY, AMBASSADOR, DOS, AMB; REASON: 1.4(B),(D) ¶1. (C) SUMMARY: As of December 17, the Venezuelan Ministry of Health has reported 2,697 laboratory-confirmed cases of H1N1 and 117 deaths associated with the virus. Many medical experts claim that the Venezuelan Government (GBRV) has underreported the prevalence of H1N1, based on the mortality rate of H1N1 worldwide and the number of reported deaths. On December 18, the Director of the HEALTH Corporation of Miranda told Emboffs that the GBRV has no contingency plan for an H1N1 outbreak, no supply of H1N1 vaccine, and few intensive care units for patients with respiratory problems. In a related development, dengue and malaria are on the rise, and while the opposition media has blamed the GBRV's failed policies for the spread of these diseases, it is equally plausible that the increase is part of a wider regional phenomenon. END SUMMARY. GBRV UNDERREPORTS H1N1 ¶2. (C) On December 18, Emboffs met with Doctor Gustavo Villasmil (protect throughout),Director of the HEALTH Corporation of Miranda, the government entity responsible for managing the opposition-governed Miranda state's medical network. Villasmil said that while GBRV statistics on the number of H1N1-associated deaths were credible, the GBRV dramatically underestimated the prevalence of the virus (Note: According to the local press, eight Yanomamis who died from the virus have not been included in official statistics. End Note.). ¶3. (C) Villasmil estimated that there have been approximately 10,000 cases of H1N1-not 2,697 as reported by the GBRV. His calculation was based on a comparison of the H1N1 mortality rate worldwide and the number of reported deaths in Venezuela. According to Villasmil, the H1N1 mortality rate is between ONE percent and .5 percent worldwide. This mortality rate suggests that the number of cases of H1N1 in Venezuela should be much higher given the number of reported deaths (Note: Post's Regional Medical Officer said that the worldwide H1N1 mortality rate is almost certainly lower than .5 percent, but agreed that the GBRV has probably underestimated the incidence of H1N1 since the official GBRV statistics suggest that the mortality rate in Venezuela is 4.3 percent. End Note.). On September 28, the opposition daily "El Universal" cited an epidemiological report that concluded that the actual number of H1N1 cases could be seven times greater than the number reported by the GBRV, a charge that HEALTH Minister Carlos Rotondaro has repeatedly denied. ¶4. (C) Villasmil characterized GBRV preparations for an H1N1 epidemic inadequate. There are only 50 Intensive Care Units (ICUs) in Venezuela for patients with respiratory problems-who would be at great risk in the event of a pandemic-and the Ministry of HEALTH has no organized plan for using the units during a crisis. "This government has not written a single word to plan for a pandemic," Villasmil said. Clinics and hospitals have not been prepared for an outbreak and the GBRV has not organized emergency triage centers. At the moment, the GBRV has no supply of H1N1 vaccine. On December 4, the press reported that the GBRV had ordered 3 million doses of H1N1 vaccine that were scheduled to arrive in January 2010, but Villasmil said that the central government would "probably not" share the vaccine with opposition-led Miranda state. In preparation for a possible outbreak, Villasmil has made arrangements to buy generic Tamiflu from India, over the objections of Ministry of HEALTH officials who argue that the Ministry of Health is responsible for coordinating HEALTH policy throughout the country. CARACAS 00001591 002 OF 002 DENGUE AND MALARIA ON THE RISE, OPPOSITION MEDIA BLAMES GBRV ¶5. (C) As of December 5, the Ministry of HEALTH has confirmed 59,138 cases of dengue, including 4,485 cases of hemorrhagic dengue, a subtype with a higher mortality rate (Note: Post RMO said that for a variety of reasons dengue is often unreported, while hemorrhagic dengue is often over reported. As such, the GBRV's estimate for the number of cases of dengue is probably too low, while statistics for the number of cases of hemorrhagic dengue are probably too high. End Note.). According to Villasmil, the GBRV has facilitated the spread of dengue and malaria by allowing basic infrastructure to deteriorate and neglecting effective prevention programs. Delays in trash collection have left huge piles of garbage along the streets of Caracas and contributed to unsanitary conditions (Ref A). In response to government-imposed water rationing (Ref B),Venezuelans have collected water in large tanks, creating breeding grounds for mosquitoes (Note: Post RMO said that while an increase in standing water may have contributed to the spread of dengue, such a casual relationship is difficult to prove, and that the increase in Venezuela is more likely part of a wider regional phenomenon. End note.). The incidence of malaria, a disease that was all but eradicated by a government fumigation program in the 1940s, has increased to between 30,000 or 40,000 cases per year. ¶6. (C) COMMENT: Most medical experts accept the GBRV statistics on the number of H1N1-associated deaths in Venezuela, but the general consensus is that the Ministry of HEALTH has underreported the prevalence of H1N1 based on a comparison of the mortality rate of H1N1 and the number of deaths. HEALTH care professionals also seem to agree that the GBRV has taken few substantive measures to prepare for an H1N1 epidemic. Venezuela's medical infrastructure would be quickly overwhelmed in the event of an outbreak, with shortages of ICUs, H1N1 vaccines, and anti-viral medications particularly likely. Although opposition media outlets have blamed government inaction and ineptitude for the increase in dengue and malaria, it is not clear that the GBRV bears full responsibility for the spread of these diseases, which may be part of a wider regional phenomenon. END COMMENT. DUDDY