Macedonia has the highest rate of West Nile fever cases per million inhabitants in Europe. That is not a rhetorical flourish - it is what comes out when you divide the number of cases by the population.

So far 43 cases have been registered, 40 of them fully confirmed and three confirmed by a single test. Four people have died. Per head of population that works out at around 20.3 cases per million - against 15.1 in Greece and 5.3 in Italy. Almost four times more than Italy.

Why the number looks like this

The virus circulates in a natural cycle between birds and mosquitoes of the Culex genus. A confirmed case in a dead raven in Skopje showed the virus is actively circulating in the wild ecosystem, not only in people. In the Skopje region 34 risk locations have been mapped, 13 of them classified as high risk.

Between 70 and 80 percent of those infected have no symptoms at all. Severe cases progress to neuroinfection, and the highest risk is carried by older people and those with weakened immunity. The most recent victim is a 73-year-old from Dolno Lisice, with a severe clinical picture and underlying conditions.

What the municipalities are doing

On 19 August the City of Skopje held a coordination meeting with the mayors of Skopje's municipalities, reviewing competences and obligations. Karpos municipality also took part in a meeting with the Ministry of Health, where the situation with infected people, the presence of the virus in dead birds and potential hotspots in Skopje were reviewed.

Mosquito spraying has been running since May. That is the detail that stings most in this whole story: measures have been in place for months, and the rate is still the highest in Europe. So either the spraying is not enough, or it comes too late in the season, or the problem is somewhere else - in the standing water nobody removes.

The advice to citizens is simple: repellents and covering clothing, screens on windows and doors, and getting rid of every container of standing water - buckets, plant pots, old tyres. Dead birds should not be touched with bare hands but reported.

All of that is correct and worth doing. But a coordination meeting in the second half of August, when the mosquito season has been running for months and four people are already dead, can hardly be called prevention. It is a reaction - and a late one.