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by Larry

April, 2016

Zika Freakin'

Not surprisingly, alarm over Zika disease is spreading fast in the Western Hemisphere. There is now a confirmed link between this virus and fetal deformities, with thousands of infected women having already delivered microcephalic babies, infants with tiny heads and severe brain damage. Embryos may also be born blind or with other birth deficits secondary to Zika. The Zika infection itself may cause fever, rash, and achiness. There are indications too that it is be responsible for increases in the autoimmune disorder, acute disseminated encephalomyelitis (ADEM), and for more frequent cases of Guillain-Barré syndrome (GBS).

ADEM is more common among children and adolescents, but can occur in older persons as well. It can result in loss of consciousness, coma, and death. Common symptoms include nausea, headaches, fever, confusion, vision difficulties, seizures, drowsiness, cranial nerve palsies, paraparesis, and hemiparesis. There is good recovery about 50-75% of the time.

GBS is a rapid onset infirmity that has widely divergent and individual symptoms. It may begin only with numbness of the feet but can progress upward and affect the body generally, occasionally resulting in paralysis and coma. Normally it is temporary. Often patients can later regain lost functioning. In extreme cases, though, even breathing is affected, and sufferers must be attached to machines to maintain their inhalations and exhalations.

To date, over a million people in Latin America are believed to have been infected with the Zika virus. Yet it was not even known in this region prior to 2015. Spread both by the sexual transmission of fluids, as from both kissing and intercourse, and by mosquitoes, its rise to recently pandemic proportions is due to a "perfect storm" of high human populations, modern rapid transportation, and the warming of the global climate, increasing conditions in which its insect vectors thrive.

While any incidence of infant microcephaly, severe acute disseminated encephalomyelitis, or Guillain-Barré syndrome is tragic, it is important to note that only a minority of people infected with Zika either develop significant symptoms themselves or pass them to unborn children. For example, despite quite large numbers of patients having gotten Zika, to date several thousand microcephalic infants have been born to women who were infected. Nonetheless, since these conditions are devastating and are now challenging local medical resources, even a relatively minor occurrence of Zika's worst implications is a huge problem.

Asian Tiger Mosquito (Aedes albopictus)
Further, as the embryos of pregnant women face the gravest potential threat from Zika, warnings must be given heed about limiting travel to Zika-infested areas by women who are pregnant or may become so. Such precautions naturally will have an economic impact beyond the Zika related illnesses themselves. Brazil, Mexico, Caribbean nations, and other countries where Zika is becoming prevalent are dependent on tourism. In some instances, these states have already been devastated by the loss of revenues linked to a drop in the price of oil. In others, foreign visitor spending has been essential for monetary health. Brazil may already be experiencing political instability from the combined effects of the oil slump, Zika, and a loss of tourist dollars. The 2016 Rio (Brazil) Summer Olympics will be unprofitable for its cash-strapped host city if thousands stay away due to Zika.

While the virus has not to date been a major factor in The Lower 48, the United States and her territories are not immune. Puerto Rico, the United States Virgin Islands, American Samoa, and up to thirty of our states are considered vulnerable. As I write (on 4/19/16), the first Zika case has shown up in RI. The disease's rapid rise just since last year in Latin America shows how it might soon be a big health factor here. Zika's spread through the hemisphere is estimated to include up to four million people by the end of 2016. Already in Puerto Rico the number of Zika cases is doubling every week and could reach hundreds of thousands. What is being or needs to be done? Hysteria and massive overkill, literally, such as the widespread use of DDT in earlier generations to deal with mosquitoes and protect crops from insect predators, must be avoided. In Brazil, there is a major anti-Zika operation underway, and millions of human dwellings have been inspected by close to half a million troops and health officials seeking to reduce mosquitoes' breeding sites. Folks are also being educated in how to cut the vector population and limit the number of people bitten.

Though criticized as inadequate given that the pandemic was apparent months ago, in the U.S. and its territories some measures are being ramped up, and more can be done by us as individuals:

  1. The Centers for Disease Control is announcing its findings about how significant a health hazard this is.

  2. Congress and the Administration are considering an authorization of nearly two billion dollars for efforts to combat Zika, yet are also treating this as another opportunity for dysfunctional politics.

  3. The Pentagon is monitoring bases most at risk from Zika.

  4. When more funds become available, additional research can commence to find a vaccine for Zika.

  5. Individuals who already have been infected should take precautions to avoid its being spread to others, both by protecting against mosquito bites and avoiding kissing or other sexual contact while still infectious.

  6. Local communities will be dealing with the health hazard as they deem appropriate. Such efforts will likely not be well coordinated or of equal effectiveness.

  7. Personally I believe the challenge warrants public service announcements and media attention equal to the coverage given to our more entertaining presidential campaign.

  8. As is true in Brazil, households in this country can assure that standing water is not available for the breeding of disease-vector mosquitoes.

  9. Even as the threat of their babies having severe birth defects is low as a percent of all mothers infected with this virus, if one is unlucky and her baby is among those damaged by the condition, it could be devastating for mother and child. Women of child-bearing age (and their parents or other responsible adults, in the case of young teenage girls) can decide how they want to address the health threats of Zika, both to themselves and their potential unborn children. In some instances, it may be wise to avoid pregnancy till the Zika risks are much better controlled than is the situation at present, for example till late autumn or early winter. In others, women may want to consider traveling for awhile to areas outside the Zika mosquito carrier ranges. Assuming there is no real problem since not much about it has been in the news yet could be a mistake. Once in this country too there are a lot of victims, it will certainly be treated as newsworthy, but by then the situation will obviously be too late for many.

  10. In general, when we go out during the day and if we live in one of the areas likely to be affected by Zika's spread, we can wear hats, shoes and socks, long sleeve shirts, and pants or jeans. We can as well help kids be better protected from biting mosquitoes.

  11. Good insect repellants applied before leaving the house in daylight hours can also cut down substantially on the number of Zika-bearing mosquito bites and hence the numbers of transmissions.

Chances are the Zika spread and its overall effects will be neither as mild as deniers may dismissively forecast nor as horrendous as Chicken Little's "sky is falling" warnings of the doom that it might be.

Common sense and practical measures are in order. Placing ourselves on a war type footing in response to the threat is not. On the other hand, especially as the threat has not been dealt with proactively, it is to be expected the current crisis will result in a number of sufferers, some the most defenseless among us. Perhaps my estimates of looming consequences of Zika in the U.S. are overblown. Hope so. If not, though, as after any natural disaster coping with Zika will then no doubt involve compassionately assisting those most decimated by its effects.

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