BOGOTA: As the coronavirus kills thousands and dominates government attention across Latin America, another deadly viral infection is quietly stalking the region.

Dengue - colloquially called breakbone fever for the severe joint pain it causes - is endemic in much of Latin America, but COVID-19's arrival has pulled crucial attention and resources away from the fight against it, doctors and officials say.

The Pan-American Health Organization (PAHO) expects 2020 to be marked by high rates of dengue, which can fill intensive care units and kill patients even absent the pressures of COVID-19, the respiratory disease caused by the novel coronavirus.

Around the world, COVID-19 has affected other diseases in different ways. Though in Europe measures to stop the coronavirus have banished seasonal flu, in Africa border closures have stopped transportation of measles vaccines and other supplies.

In Latin America, a dengue epidemic which started in late 2018 is still being felt. Dengue infections in the Americas surged to an all-time high of 3.1 million in 2019, with over 1,500 deaths in Latin America and the Caribbean, according to the PAHO.

Cases of the disease should begin to decline in the second half of the year, the organization said.

Spread by mosquitoes, dengue outbreaks typically occur three to five years after the previous epidemic.

And with four strains of dengue in circulation, people may catch it more than once, with second cases more likely to be severe.

"COVID is the star right now, so all of the attention is being put on COVID, but there are still problems with dengue," said Doctor Jaime Gomez, who works at a hospital in Floridablanca, in Colombia's Santander province.

Although dengue is not usually fatal and can be treated with painkillers, some sufferers deal with persistent symptoms like fatigue, weight loss, and depression that affect their ability to work. Severe dengue is treated with intravenous fluids and those who do not get tested are at risk of dangerous complications.

Such medical intervention cannot be given if patients stay home, worried about contracting the coronavirus, or if overcrowded hospitals have to turn them away.

With relatively few cases of COVID-19 in the province where he works, Gomez said his clinic had seen hospitalizations fall by half, as people were fearful of venturing outdoors.

'SYSTEM HAS COLLAPSED'

Paraguayan lawyer Sonia Fernandez avoided seeking care when she and her two daughters, ages 11 and 8, got sick with dengue at the beginning of April.

"All three of us had dengue, we had all the symptoms, the pain, the rash, but we didn't go to a clinic or a health center so as not to expose ourselves (to COVID-19)," Fernandez said.

All three have since recovered.

Dengue cases in Paraguay have exploded this year. In the first 18 weeks of 2020, the country reported 42,710 confirmed cases and 64 deaths, compared to 384 confirmed cases and six deaths in the year-earlier period.

In Ecuador, where the coronavirus outbreak has hit hard and hospitals in the largest city of Guayaquil been overwhelmed, an apparent fall in the number of dengue cases could mask other issues.

According to Ecuador's health ministry, dengue cases peaked at 888 in the week ending March 14, two weeks after the country confirmed its first case of COVID-19. For the week of April 4, they fell to 257.

"Very clearly dengue is being under-reported," said Esteban Ortiz, global health researcher at Quito's University of the Americas.

"Cases haven't decreased, the diagnosis of cases has decreased, which confirms the system has totally collapsed," he added.

Ecuador's health ministry said in a statement that the country was no more exposed to the double impact of COVID-19 and dengue than any other in the region, adding it has sufficient supplies to treat cases of the mosquito-borne disease.

Dengue has also spiked sharply in Central America. Cases in Costa Rica nearly tripled through May 1 compared with a year ago, to over 2,000.

"We are going through a difficult moment dealing with COVID-19 but unfortunately other diseases continue their cycle," Rodrigo Marin, director of Costa Rica's health surveillance agency, recently told journalists.

In Panama, where dengue has caused at least two deaths this year, Panama City health official Yamileth Lopez also sounded the alarm in an interview with Reuters.

"Dengue kills too," she said.