Zika hits home, Congress yawns and passes the buck

With all due respect to T. S. Eliot, it may well come to pass that August emerges as the cruelest month for frontline healthcare workers. They are struggling with dwindling resources to keep America from becoming the next country in the Western Hemisphere to declare a full-fledged Zika epidemic within its borders.

The recent and evolving news from Florida points out clearly that in a global environment, no country or community can afford complacence. And while it’s true that the current count of 27 cases (and rising) of locally-acquired Zika infection in the Miami region don’t stack up numbers-wise against preventable illnesses like influenza, the key word difference here is preventable.

{mosads}As health care providers for women with high-risk pregnancies, the members of the Society for Maternal-Fetal Medicine (SMFM) work on a daily basis to prevent pregnancy complications before they happen, and help best manage those that can’t always be predicted.

We are frustrated that a disappointing percentage of pregnant women fail to get vaccinated against influenza every year, especially when a large body of evidence proves without question that women are at markedly higher risks of morbidity and even death if they get the flu during their pregnancy.

And, as comment writers to this blog have noted, from an absolute magnitude point of view, influenza is a larger public health risk than Zika, but that still presents the problem in a comparison of unequals.

Zika is unlike any mosquito-borne infection that has been encountered to date in that it has been conclusively associated, using established scientific criteria, with an increased risk of birth defects when an infected mother passes the virus on to the fetus.

Even for doctors who counsel women with problem pregnancies, however, the scope of the impact of this virus is devastating. While Zika-associated microcephaly was the first noticeable abnormality described as infected newborns came to the attention of pediatricians in Brazil, we now understand that this severe abnormality of brain development was only the tip of the iceberg.

Researchers in Latin America who saw the brunt of the emerging avalanche of cases have helped us understand that this is a broad developmental spectrum of disease in affected fetuses and newborns, with severe underdevelopment of critical brain areas occurring long before or even in the absence of a frank diagnosis of microcephaly.

And now, our pediatric and high-risk pregnancy colleagues are describing, in reports published just over the last month, sizable numbers of infected infants who look otherwise normal at birth, but who are showing signs of poor motor and other neurologic functional development as late as 6 months of age.

As this iceberg threatens to expand in this country, with plenty of warning of the devastation that could follow should a full-fledged epidemic occur here, Congress sits back and is content to simply rearrange the deck chairs on the Titanic. Funding for preventing Zika from taking hold in the United States is critical: While vaccine research is an important part of this process in terms of prevention, surveillance and mosquito control will need to be amped up as the first wave of preventive measures.

Many here in this country sat back and assumed that “we” would never face the scope of the problem being encountered in resource-poorer neighbor countries.

But the history of medicine is rife with the dangers of dividing infection risks into “us” versus “them”, an argument that has become much too common this election year in particular.

There are over 10,000 locally-transmitted cases of Zika in the United States, in Puerto Rico, including 1035 in pregnant women. As high-risk pregnancy doctors in SMFM, these are our patients, but if resources were allocated appropriately by Congress they might not need to be.

If our medical surveillance and vector control teams, not to mention our vaccine research specialists, were funded upfront, we might not be watching Florida right now and wondering where the next outbreak occurs, it still being just halfway through this cruel August.

It poorly serves all of our citizens when the President, in a morally and logistically appropriate measure, is forced to Solomonically divert existing limited healthcare dollars from other worthy projects to Zika efforts because Congress shirks its responsibility to establish a clean standing resource budget to address not just this emerging infection, but the next one we don’t yet know about.  

It is unacceptable to take the real and terrible fear in women coping with Zika infected pregnancies as an opportunity to posture and pander for an election about access to reproductive health options, rather than acknowledging the long-term catastrophe this diagnosis can be for an entire family.

It serves no purpose for either political party to call Zika an issue of interest only to their colleagues across the aisle. As doctors, we are trained to “do no harm”. If only the men and women we entrust the care of our families, our children, and our nation could do the same. It is time — it is past time.  

Dr. Silverman is a clinical professor of obstetrics and gynecology at UCLA School of medicine and has served on the Board of Directors of the Society for Maternal-Fetal Medicine. He is also the perinatal advisor on Zika to the California Dept. of Public Health.