Zika Update: Brace for Resurgence

Author: David R. Kotok, Post Date: November 1, 2017
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Back in 2013 a mild virus nobody paid much attention to underwent one small mutation: A single amino acid (serine) was replaced by another (asparagine), according to Chinese scientists who recently published their research in the journal Science (https://www.washingtonpost.com/news/speaking-of-science/wp/2017/09/28/zika-was-a-mild-bug-a-new-discovery-shows-how-it-turned-monstrous). With that one change, Zika began to deal horrific damage to developing human brains. Zika became the public health threat we know today, one that lurks everywhere that infected mosquitoes range.

Through the summer of 2017, we had gained an edge in the fight against Zika. As of October 11, US states have counted only 291 cases in 2017. Florida saw a 71% drop in the number of cases for the first half of the year; New York saw a 56% drop. Other states likewise saw a reduction. (https://www.usatoday.com/story/news/nation-now/2017/07/13/why-zika-virus-infections-way-down-u-s-summer/474312001/)

But the Zika threat hasn’t disappeared; in fact, it is now poised to make a comeback, along with other mosquito-borne diseases such as dengue and chikungunya. While a single recent case of mosquito-borne transmission in Florida is cause for concern (https://www.usnews.com/news/health-care-news/articles/2017-10-13/florida-confirms-its-first-locally-transmitted-zika-case-of-2017), a greater concern is the ultimate impact of devastating hurricanes Harvey in Texas and Maria in Puerto Rico and Florida.

When a powerful hurricane wreaks devastation, it very nearly wipes out mosquito populations. That’s good news that lasts for about a week – until mosquito eggs hatch and survive in much higher numbers than usual in areas impacted by flooding. In Texas, for example, surveillance teams are finding thousands of mosquitoes in traps where they’d normally see only 10 or 20 (http://www.contagionlive.com/news/zika-virus-news-update-three-new-things-you-should-know).

The situation is similar and worse in Puerto Rico: Reports indicate uncontrolled spikes in mosquito populations on an island that has endured the hardest Zika hit among any US state or territory, with 34,963 confirmed cases of Zika last year and 486 so far this year – until Maria (CDC). We can be sure that no accurate counting is possible now, given dire living conditions on the island and a healthcare system in shambles. Food, water, and shelter are more urgent concerns. It’s inevitable, then, that Puerto Rico will see a surge in mosquito-borne diseases, including Zika, just as areas impacted by Katrina in 2008 saw a doubling in the number of cases of West Nile virus (https://fivethirtyeight.com/features/one-more-thing-for-puerto-rico-to-worry-about-disease-ridden-mosquitoes).

Puerto Rico’s mosquito-borne disease surveillance system used to be one of the world’s best, according to network science professor Samuel Scarpino of Northeastern University. Now, however, the island is in survival mode. Mosquitoes breed unchecked in pools and storm debris; people live and sleep exposed to open air where they will be often bitten; and Puerto Rico’s model programs for mosquito control and capture, disease testing, and reporting have fallen apart with the infrastructure that supported them, destroyed by the storm (https://fivethirtyeight.com/features/one-more-thing-for-puerto-rico-to-worry-about-disease-ridden-mosquitoes).

We know, then, that cases of Zika (along with chikungunya and dengue) in Puerto Rico are destined to spike unchecked and uncounted for a time, and with them the number of Zika’s smallest victims, infants whose lifetime care will cost millions. Worse yet, Puerto Rico’s looming Zika woes are not Puerto Rico’s alone.

Zika is now much more likely to gain a significant foothold in the US mainland as tens of thousand of Puerto Rican–American citizens flee for the continental US (http://www.latimes.com/nation/la-na-puerto-rico-orlando-20171010-story.html). Life was hard in Puerto Rico before Maria swept through – the island faced dire financial straits. The population had already dropped from 3.8 million to 3.4 million over the last decade as some 400,000 Puerto Rican Americans sought a better life in the US mainland. Now, given the lack of power, adequate shelter, food, and clean water, leaving seems the only rational option in the minds of many (https://www.newyorker.com/news/news-desk/how-many-puerto-ricans-will-leave-home-after-hurricane-maria).

And so they come. NPR reports, “Thousands of Puerto Ricans have poured into Florida after Hurricane Maria. More than 27,000 have arrived through Port Everglades and the Miami and Orlando airports alone since Oct. 3, according to the governor’s office. Some will stay temporarily, until power and water are largely restored across the island; but many … are coming to the sunshine state to rebuild their lives” (http://www.npr.org/2017/10/13/557108484/-get-us-out-of-here-amid-broken-infrastructure-puerto-ricans-flee-to-florida).

The influx of people will bring with it an influx of Zika, upping the chances that the virus will make it into local mosquito populations in the continental US, and incidents of mosquito-borne transmission will rise. In short, this is no time to be complacent about Zika; instead, it is time to double down on surveillance, mosquito control, and prevention, and to budget for that challenge. There is no room for congressional incompetence and political gridlock on the funding front, where Zika and other matters are concerned. There is no time for the nonsense of voting no, as some have unwisely done in the past. Timely action against Zika in hurricane-impacted areas and beyond is critical to save children’s futures, billions of dollars in healthcare costs, and productivity hits later on.

Funding to address the Zika emergency – at last approved by Congress in early 2016 after lengthy delays – ended on September 29, 2017, and the CDC consequently had to deactivate its Zika Emergeny Operations Center (https://www.cdc.gov/media/releases/2017/p0929-eoc-deactivation-zika.html). The 2018 budget proposed by Donald Trump includes a 17% decrease in funding for the CDC overall, while the CDC has requested an additional $12.5 million to address vector-borne diseases. The CDC explains that request: “In FY 2018, the U.S. will remain vulnerable to existing and new vector-borne disease threats, like Zika. With increased funding, CDC will provide enhanced support to up to 9 states at the greatest risk for vector-borne disease outbreaks. These resources would allow for enhanced capacity in laboratory, case and outbreak investigation, and vector control.

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