The number that tells the whole story is not this year's case count. The number is the comparison: from 2011 to the end of 2025, Macedonia registered a total of 54 laboratory-confirmed cases of West Nile fever. In 2026 alone, up to 8 September, it has registered 58.

So this year has produced more cases than the previous fifteen years combined. That figure comes from the Institute of Public Health's own report, not from an estimate.

Of those 58 cases, 54 are confirmed and four are recorded as probable. Eight people have died. All of the dead were men from Skopje, with an average age of 71.9, all had been hospitalised, and seven had other underlying conditions. By place of residence, 55 of the patients are from Skopje, with one each from Veles, Kumanovo and Sveti Nikole. Fifty-seven cases are autochthonous - the virus was caught here, not brought in.

What the virus does

Dr Fadil Cana, director of the Clinic for Infectious Diseases, explained that no specific drug exists - not here, and not anywhere in the world.

"The treatment process is supportive, the patient is supported and we respond if complications arise. Once the acute phase is over, great emphasis is placed on rehabilitation. If symptoms persist in a patient, that does not mean the infection is still active; these are sequelae from the acute phase that require neurological examinations and physical rehabilitation. In the most severe forms that process can last weeks, months, even years," Cana said.

All 56 patients with the neuroinvasive form were hospitalised. Two patients remain in serious condition on ventilators. Five more people are still being treated in hospital.

Cana added something worth repeating loudly: people who have had the illness should not be stigmatised, because the virus does not pass from person to person and patients are not contagious to those around them even during the acute phase.

Mosquitoes, spraying and timing

The government says the epidemic is subsiding. The opposition SDSM says it never had to get this big.

"The number of patients is rising and the death toll has reached eight. These are not just statistical figures - these are human lives. SDSM warned for weeks that the government was late with prevention against West Nile fever. Late with mosquito spraying, late with systemic measures and with timely protection of citizens," the party said.

Political attacks during a health crisis are a predictable genre. But this time there is an uncomfortable fact that stands regardless of who says it: 65.5 percent of patients developed their first symptoms in August, another 17 cases came in July, two in June and one in May. The virus was circulating for months before the numbers became news.

West Nile fever is transmitted by the bite of a Culex mosquito that has previously fed on an infected bird. Which means the fight against it is not waged in hospital - it is waged in May and June, with spraying, with clearing standing water, with screens on windows. By the time a patient is on a ventilator, prevention is already several months late.

The Institute of Public Health notes a significant increase in 2026 compared with previous years, in both cases and deaths. That is an accurate, calm, official sentence. The question it does not ask is why an increase like this surprised a system that has been tracking the same virus since 2011.