Given that the Zika virus<\/a> and the mosquitoes that carry it from one human to another have been advancing north from South America through the Caribbean and Mexico, and that parts of the USA share the same permissive semi-tropical environments necessary for the disease to spread, most public health scientists and officials have assumed that home-grown Zika disease and its sequela would show up in the course of time.\u00a0 Officials in North Miami, Florida believe that time has come<\/a>. Even with all the warning in the world, Congress could not be persuaded to act before leaving Washington for vacation.\u00a0 Imagine, public health being sacrificed at the altar of political control and the national shackling of anything having to do with women\u2019s health policy \u00a0to a self-defined pro-life lobby and the religious dogma\u00a0that supports it. \u00a0The failure to prepare now, as it has been in the past, is all about control of the levers of power that drives political life.<\/p>\n Background<\/strong>. What is the risk of Zika infection?<\/strong> The worst part.<\/strong> Advanced microcephaly is only the tip of the iceberg in terms of damage to the fetus. It is only manifest when the physical bulk of brain damage is so great that the growing skull does not have much brain tissue to enclose.\u00a0 We must assume that less extensive brain damage can occur that will not show up for months or years after an infected child is born. While obvious microcephaly or brain calcifications indicative of damage can be detected by maternal ultrasound or X-ray in the later stages of pregnancy, lesser degrees of brain damage will be undetectable at any<\/span> stage of pregnancy!\u00a0 This is the reason behind the current emphasis on prevention of pregnancy in areas where Zika virus is present.\u00a0 At least one child with microcephaly has already been born in the USA. \u00a0Others will undoubtedly follow with devastating effects on the children themselves and their families. An article in yesterday’s New York Times<\/a>\u00a0describes the the painful experiences now occurring in our own Puerto Rico where responses to the epidemic have faltered.<\/p>\n The way forward.<\/strong> You would think that our elected officials would be hot on the case to get the ball rolling.\u00a0 In my opinion, they have betrayed us, deciding in the best political tradition that trying to make the other guy look bad yields a safer, easier, and more profitable result than trying to do something good. \u00a0The first thing I learned in my education as a lobbyist was that it is easier to kill a bill than to pass one.\u00a0 And so it is in our current Congress which adjourned for the summer without passing a Zika bill that it has been kicking around for months. Want to bet they will not come back early for a fix<\/a>?<\/p>\n
\nPeople, including pregnant women who have contracted Zika virus, have been present in the USA for some time, having caught the disease while traveling abroad in endemic areas, or having acquired the disease sexually from partners who did the traveling for them. \u00a0(Yes, Zeka is also a sexually-transmitted disease.)\u00a0 Since the virus can linger for months in various places within the human body, we can assume that transfer of the disease by nonsexual intimate contact or exposure to body fluids is also possible. Blood donors in parts of Florida are already being told not to do so, and testing of donated blood for the virus more broadly is being advocated. It is likely that Zika is here to stay for a while, if not forever. “So what?” you may ask.<\/p>\n
\nMany if not most Zika infections are asymptomatic \u2013 a person does not realize that they have even been infected.\u00a0 This of course makes control of the disease even more difficult.\u00a0 For most of the rest of infected people, the disease runs a self-limited, if uncomfortable course with the fever, aches and pains, and rashes commonly found with other viral illnesses. For a very few people, the virus is associated acutely with significant and occasionally\u00a0fatal neurological syndromes of the auto-immune type. It is important to note however, that follow-up of people with Zika has not been long enough to be confident about the presence or absence of other longer-term sequela of the disease.<\/p>\n
\nThe very real and most apparent acute complication of Zika is its effect on the development of the fetal brain<\/a>. The virus has been shown in the laboratory and in human specimens of fetal tissue to have a special affinity for developing neurons, at least in the brain.\u00a0 In its more severe form, and especially if contracted in the early months of pregnancy, it results in the syndrome of microcephaly<\/a> in which the entire head of the fetus or delivered child is much smaller than normal. Microcephaly is associated with profound intellectual and functional disability.\u00a0 In the days of the circus sideshow, such people were displayed as “pinheads.”\u00a0 Hundreds of such children have been born in south America. Any remaining microcephaly-deniers are either frankly ignorant science-deniers in general, or perpetrating a cruel hoax on people whose lives they are trying to control.<\/p>\n
\nWe have time-tested if not guaranteed-effective paths to follow. There is currently no treatment for the primary Zika virus infection itself other than providing symptomatic relief. An effective vaccine to prevent the disease is at least a year and likely several years away. Even then there will be the same barriers to the universal immunization necessary to confront the disease that currently has allowed the reemergence of several childhood diseases in the USA. We will simultaneously have to continue our centuries-long battle of mosquito control, but do so without killing off every other living thing including ourselves. The operative word here is control, not elimination of Zeka \u2013 which may be impossible.\u00a0 Our medical, public health, and scientific communities know what they have to do, but they need resources and the cooperation of the public to proceed.<\/p>\n