The ER clerk asked me “How do you spell Zika?

CDC’s revised Zika Interim Response Plan (July) states:  ”Neither vaccines nor proven clinical treatments are expected to be available to treat or prevent virus infections before local transmission begins within CONUS or Hawaii.”; “Scientific understanding of Zika virus continues to evolve, and new characteristics of the virus and how it is spread may arise.” (A)

“CDC director Tom Frieden has said that the mosquitoes carrying Zika in Miami could be developing resistance. Researchers can project what Zika infection rates will look like in multiple scenarios, but not what will happen if Zika is evolving at the DNA level or if its vectors multiply beyond sex and mosquitoes, both of which are real possibilities.” (B)

The New Jersey and New York Departments of Health Zika pages focus on community awareness, default to CDC, then stop at the door to the hospital ER. (C)

So we are not dealing with Zika “evidenced based medicine” but “best practices” aggregated and amended from Swine Flu, Ebola,  Dengue, and other mosquito transmitted viruses.

Examples of some recent news reports make it clear that Zika parameters are changing so quickly, that only medical school affiliated teaching hospitals should be caring for Zika patients.

  1. “Zika virus infection during pregnancy may be related to a severe birth defect called arthrogryposis, whereby the joints – particularly those in the arms or legs – are deformed. This is the finding of a new study published in The BMJ.” “Researchers focused on seven babies whose mothers were infected with Zika while pregnant. Six of the seven developed microcephaly—  the most widely publicized birth defect from Zika— but six also had trouble swallowing, six had clubfoot, five had eye abnormalities, and two needed breathing and feeding tubes.” (D)
  2. “NEW ORLEANS — Officials at the front lines of fighting the Zika virus are warning residents that mosquitos that carry the disease are already here.” (E)
  3. “Texas reported its first Zika-related death Tuesday after a baby girl whose mother traveled to El Salvador while pregnant died shortly after birth in a suburban Houston hospital. The girl, who died a few weeks ago, had microcephaly linked to the Zika virus….” (F)
  4. “In an effort to detect any local transmission of the Zika virus, the New York City Department of Health and Mental Hygiene said on Tuesday that it had expanded the guidelines on who should be tested for the disease to include anyone with its most-common symptoms.” (G)
  5. “Amid news of a Zika outbreak in the Miami area, the U.S. Food and Drug Administration’s Center for Veterinary Medicine (FDA-CVM) has cleared the experimental release of genetically modified (GMO) mosquitoes in the Florida Keys to help combat the virus. “ (H)
  6. “Suncoast Blood Bank announces they are testing all donated blood for the Zika virus. Effective immediately the blood bank will test all donors for the virus.” They say this is a proactive measure to protect the community blood supply.” (I)
  7. “I got Zika. The US health care system had no idea what to do with me. How do you spell Zika?”I stood at the front desk of a major Washington, DC, hospital last month. I had a head-to-toe rash that developed after I’d returned from the Dominican Republic, where Zika is much more common than it is stateside. The friend I’d traveled with was showing symptoms of the virus. I’d come to the emergency room to find out if I had it too.This was not a question I wanted to hear from the man who was checking me in.But ignorance of what Zika is, and uncertainty about how to deal with it, was common in my quest to get diagnosed — even from parts of the medical community that I expected would know what to do.” (J)
  8. “On Thursday, scientists described two cases in which the semen of men who contracted Zika in Haiti early this year continued to test positive for the virus, even though it has been six months since they were infected.The semen of one tested positive 188 days after he first experienced symptoms of the illness. Testing on day 181 came back positive for the other man. Both men are still being followed. Previously, the longest period in which evidence of virus was seen in the semen of a Zika-infected man was 93 days.” (K)
  9. “Until this week, there had been no reported cases of birth defects related to Zika in Canada.Public health officials are releasing no other information about the fetus, including whether or not he or she is alive. It represents the second confirmed case of maternal-to-fetal transmission of the Zika virus in Canada.” (L)
  10. “U.S. Sen. Bob Menendez can add a personal motivation to his efforts to get Congress to approve federal funding to combat the spread of the Zika virus. Menendez said this week his daughter is five months’ pregnant in Miami with his first grandchild.”(M)
  11. “Beyond Zika: How Congress Is Flirting With Medical Disaster. The dysfunctional response to the Zika virus lays bare a system that is increasingly ill-equipped to respond to outbreaks.” (N)
  12. “While the Zika virus has its moment, few people are discussing the problems underlying the worldwide increase in emerging infectious diseases.” (O)
  13. “Zika fits into the category of unforeseen emerging threats that migrate into new environments where they suddenly pose major hazards to unprepared populations — think severe acute respiratory syndrome (SARS) or Ebola, for instance. These required “urgent mobilization to protect and manage the introduction of these alien, and dangerous, pathogens,”….(P)

Soooooo……if you are concerned that you may have been exposed to Zika, until there are national protocols in place, bypass your community hospital ER, and go to the nearest medical school affiliated teaching hospital.

And…..remember:

EMERGENCY ROOMS are not all created equal! (Q)

Stop the name games! University hospitals and regional medical centers should live up to their billing. (R)

 

 

 

(A)   http://www.cdc.gov/zika/pdfs/zika-draft-interim-conus-plan.pdf

(B)   http://www.vogue.com/13464580/why-zika-is-scarier-than-donald-trump/

(C)   http://www.nj.gov/health/cd/zika/  https://www.health.ny.gov/diseases/zika_virus/

(D)   http://www.medicalnewstoday.com/articles/312229.php

(E)    http://www.wwltv.com/news/health/mosquitos-that-carry-zika-already-in-new-orleans/292487541

(F)    http://blackamericaweb.com/2016/08/10/infants-death-is-first-zika-related-fatality-in-texas/

(G)  http://www.nytimes.com/2016/08/10/nyregion/zika-testing-new-york-health-dept.html?_r=0

(H)   http://www.nationofchange.org/2016/08/08/fda-approves-genetically-modified-mosquitoes-combat-zika-florida/

(I)     http://www.snntv.com/2016/08/09/suncoast-blood-bank-begins-testing-zika/ 

(J)     http://www.vox.com/2016/8/11/12422314/zika-virus-united-states

(K)   https://www.statnews.com/2016/08/11/zika-virus-semen-sexual-activity/

(L)    http://ottawacitizen.com/news/national/only-a-matter-of-time-first-zika-related-birth-defects-reported-in-canada

(M) http://www.wftv.com/news/local/us-sen-bob-menendez-has-personal-stake-in-push-for-zika-funding/421039501

(N)  https://newrepublic.com/article/136022/beyond-zika-congress-flirting-medical-disaster

(O)  http://www.americanscientist.org/issues/pub/2016/5/zika-goes-viral

(P)   https://www.thecipherbrief.com/article/exclusive/north-america/zika-national-security-threat-1095

(Q)  http://doctordidyouwashyourhands.com/2016/04/emergency-rooms-are-not-all-created-equal/

(R)   http://doctordidyouwashyourhands.com/2016/07/stop-the-name-games-university-hospitals-and-regional-medical-centers-should-live-up-to-their-billing/

 

APPENDIX

Many of you might be familiar with my advocacy for designating Zika Regional Referral Centers. If not see links below.

We don’t know what we don’t know” – The challenge to emergency preparedness….. http://doctordidyouwashyourhands.com/2016/04/we-dont-know-what-we-dont-know-about-zika-1-the-challenge-to-emergency-preparedness/

Former hospital prez says: Designate local Zika centers now. “Medical experts do not know if, or where, or how much, or on what trajectory the Zika virus may spread across the United States.” http://doctordidyouwashyourhands.com/2016/06/former-hospital-prez-says-designate-local-zika-centers-now-medical-experts-do-not-know-if-or-where-or-how-much-or-on-what-trajectory-the-zika-virus-may-spread-across-the-united-states/

Suspending a chicken over your bed could protect against Zika virus and malaria (A)  http://doctordidyouwashyourhands.com/2016/07/suspending-a-chicken-over-your-bed-could-protect-against-zika-virus-and-malaria-a/

Zika “panic” – IS YOUR HOME TOWN READY FOR ZIKA?

http://doctordidyouwashyourhands.com/2016/08/zika-panic-is-your-home-town-ready-for-zika/

 

 

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

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