It’s coming this summer.
The Centers for Disease Control and Prevention gathered more than 300 local, state, and federal authorities and experts at its Atlanta headquarters Friday to prepare for clusters of mosquito-transmitted Zika infections on the US mainland.
“The mosquitoes that carry Zika virus are already active in US territories, hundreds of travelers with Zika have already returned to the continental US, and we could well see clusters of Zika virus in the continental US in the coming months,” CDC Director Tom Frieden said in a statement prior to today’s meeting. “Urgent action is needed, especially to minimize the risk of exposure during pregnancy.”
The virus that has already plagued South and Central America to the point where Olympic athletes are rethinking their attendance at the Rio Summer Games is coming not only to the southern United States, but according to a gestation map recently prepared by the CDC, as far north as New York City and San Francisco. While the Zika virus (“ZIKV”) causes only minor ailments such as rash, pinkeye and body aches in most people showing symptoms (80% of people infected with it are asymptomatic), for pregnant women it is a true horror, linked to microcephaly, a condition in which babies are born with tiny malformed heads and brains. Yesterday the World Health Organization confirmed the scientific consensus linking ZIKV to microcephaly, as well as Guillain Barre syndrome, a neurological disorder that can cause temporary paralysis.
Experts are now concerned that the health risks associated with the virus may go well beyond microcephaly, implicating “less obvious developmental and cognitive problems.” As the ArsTechnica article linked above points out, microcephaly may simply be the extreme manifestation of infection, as recent studies have found the virus actually kills brain cells.
But microcephaly is bad enough. The New England Journal of Medicine released a study this week which “followed” a pregnant woman infected with the virus with repeat ultrasonographic imaging of the fetus’ brain. The woman had been infected when she was three months pregnant:
With blood tests and magnetic resonance images (MRI), researchers watched as the baby’s brain essentially turned to liquid in the course of nine weeks. The woman aborted the fetus at week 21.
From the study:
The cerebral mantle appeared to be thin with increased extra-axial spaces. Both frontal horns were enlarged with heterogeneous, predominantly echogenic material present in the frontal horn and body of the left lateral ventricle, a finding that raised concern about intraventricular hemorrhage. Dilation and upward displacement of the third ventricle, dilation of the frontal horns of the lateral ventricles, concave medial borders of the lateral ventricles, and the absence of the cavum septum pellucidum suggested agenesis of the corpus callosum.
The CDC’s meeting in Atlanta on Friday is the largest yet convened in the US to coordinate a response to the threat ZIKV poses:
Friday’s one-day summit covered such breaking scientific data on the virus and provided training to authorities on how to prevent, treat, and talk with the public (particularly pregnant women) about Zika and its health effects. Experts also focused on coordinating efforts to stamp down mosquito populations.
Mosquito control has classically been a local task, usually handled by municipalities, with widely disparate techniques employed with equally varying levels of effectiveness. One of the biggest concerns repeatedly echoed yesterday is lack of funding for the degree of mosquito control measures necessary to effectively contain ZIKV. As usual, the Republican Party is responsible for the shortfall in available funds to combat the threat nationally:
[With local public health budgets still shrunken since the recession of 2008 and President Obama’s $1.8 billion Zika funding request stalled in Congress, health officials are starting to worry.
That concern pervaded a Zika Action Plan Summit meeting of several hundred local health officials organized by the C.D.C. on Friday in Atlanta. Their problems were different, but all had one in common: too little money.
“There is a broad pattern of decline, and that kind of places us in a handicapped position to start this race,” said E. Oscar Alleyne, the senior adviser for public health programs at the National Association of County and City Health Officials, which has calculated that local health departments — where some mosquito control departments reside — have lost about 12 percent of their staffs since 2008.
Many municipalities in the states most susceptible to the spread of ZIKV-- Mississippi, Alabama, and Georgia, for example-- lack the tax base necessary to implement effective mosquito control, a consequence of decades of Red-state policies that have bled towns and cities dry of funds that could be allocated to such an effort. As the Times article points out, traditional spraying is largely useless against Aedis aegypti, the primary vehicle for Zika transmission, because it gravitates toward urban areas and breeds in small pools of collected water--the kind of water that lies in trash cans for days after a rainfall, or water in unused kiddie-pools and flower pots. That requires house-to-house inspection, which in turn requires paying people to do the work.
The risk of a “runaway” outbreak of ZIKV infection in the U.S. remains small, according to most health officials, but there is little doubt that the virus will reach the southern part of the country by summer. Officials emphasize local outbreaks, which are expected and likely, will have to be quickly contained to avoid an even more contagious problem: panic.
“A woman could get bitten by a mosquito and have a child with a terrible malformation — and that could happen in Florida or Texas or Arizona, or anywhere this mosquito is,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention. “We don’t think the numbers will be large,” he said, “but the impact could be very large.”