The following is an editorial submitted by Dr. Jonathan M. Metsch, a health educator and the former CEO of Jersey City Medical Center who is also a Hoboken resident
Medical experts do not know if, or where, or how much, or on what trajectory the Zika virus may spread across the United States. Nor do they know how else Zika might spread besides by certain types of mosquitos and by some types of sexual activity. However, the risks to pregnant women are well documented.
In fact, on Tuesday, a Honduran woman with the Zika virus gave birth at Hackensack University Medical Center to a baby girl with birth defects, and one of her doctors said they appear to be caused by the mosquito-borne virus, according to a story in the New York Times.
Of the more than 500 Zika cases so far in the U.S., all involved people infected in outbreak areas in South America, Central America, or the Caribbean, or people who had sex with infected travelers, the Times reported. The story noted that mosquitoes aren’t yet spreading Zika in the continental U.S., but experts predict small outbreaks are possible as mosquito season heats up.
Yes, it’s true that Zika is different from Ebola. But there are lessons to be learned from the 2014 Ebola scare relevant to planning for Zika. For example, Zika should not be considered treatable at any or every hospital.
According to the federal Center for Disease Control (CDC), “There is no vaccine to prevent or medicine to treat (the) Zika virus.”
One might argue that any hospital can take care of a Zika patient. But since there is no treatment, there’s an elevated risk for microcephaly – a birth defect that leaves babies with malformed heads and brains – and serious possible sequela such as Guillain–Barré syndrome, and since we cannot predict the trajectory or volume of a Zika surge, patients should initially be aggregated to develop evidenced-based care protocols.
The federal government should immediately develop guidelines for Zika regional referral centers (ZRRC)s, followed quickly by the designation of ZRRCs.
If there is no surge as mosquito season spreads across the county and if the severity of index cases is minimal, where to admit Zika patients can be reconsidered. But it would be better to start with robust, focused preparation and adapt to the situation as it actually emerges.
Meeting the virus head-on
In 2014, I suggested several anchor principles for Ebola preparedness in New Jersey, as hospitals of all sizes and scope “marketed” their Ebola readiness, only to learn that it took well over 20/ 25 full time staff to care for one Ebola patient (and 50 in Dallas!).
These recommendations included that every hospital that certified its Emergency Room as ready for Ebola be subject to at least three separate drills using a standardized form, and then be subject to random “secret shopper” inspections; that anyone with a confirmed or suspected Ebola diagnosis be immediately transferred to a regional center hospital designated by national standardized criteria which could demonstrate that it has sufficient nursing staff “volunteers” to care for a least five patients round the clock; and that isolation hospitals be readied for instant activation, whether a closed hospital prepared for Ebola now and standing by, or a “virtual” hospital ready-to-go in military fashion.
Also there was a need to minimize Ebola patients walking into an ER unannounced, and suggested a statewide 800 number be established so patients can call ahead and be transported by a prepared ambulance team and taken to a regional center.
Similar organizing principles are urgently need to be established for tiered Zika hospital preparedness. Here are some thoughts.
1. There should not be an automatic default to just designating Ebola Centers as ZRRCs, although there is likely to be significant overlap.
2. Zika Centers should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and Zika-related “reading” expertise).
3. National leadership in clinical trials.
4. A track record of successful, large scale clinical Rapid Response.
5. Organizational wherewithal to address intensive resource absorption.
6. Start preliminary planning for Zika care out of the initial designated ZRRCs.
Zika protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as Chikungunya, MERS, and Dengue.
– Jonathan M. Metsch, Dr.P.H.
Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai