DOCTOR tracked ZIKA last year and proposed the designation of REGIONAL EMERGING VIRUSES REFERRAL CENTERS.
It seems that when it was an isolated mainland event in south Florida, public concern disappeared and public health authorities breathed a sigh of relief.
Even though we now know that more ZIKA outbreaks are likely and that the consequences for some babies will be catastrophic, authorities apparently are leaving every hospital to plan on its own.
Here’s one reason centralized planning is a necessity and Referral Centers need to be designated.
The New York Times story, by Catherine Saint Louis, noted:(A)
“Women who do not have any symptoms of Zika virus still may give birth to a baby with Zika-related birth defects, research has shown. The only way to catch those infections is to screen women because they may have been exposed to Zika-infected mosquitoes or may have had sexual contact with an infected partner.
In this new report, “The presence or absence of symptoms was not predictive of whether a baby would be damaged,” … “There were women who had asymptomatic Zika whose babies were damaged.”
Currently, only about 60 percent of babies born alive in United States territories had results of Zika laboratory testing reported to pregnancy and infant registries. It’s important that all babies who may have been affected are monitored, as early intervention can help.
For instance, some babies who appear normal at birth later develop an unusually shrunken head. Only with long-term tracking can health officials get an accurate estimate of the scope of the problem.”
Previous ZIKA related DOCTOR posts:
ZIKA UPDATE #1. EBOLA is back in Africa. Is ZIKA next? Are we prepared? (B)
All pregnant women with Zika diagnosed at community hospitals must be referred to academic medical centers for prenatal care! (C)
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.” (D)
(A) https://www.nytimes.com/2017/06/08/health/zika-birth-defects-cdc.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(B) https://doctordidyouwashyourhands.com/2017/05/ebola-is-back-in-africa-is-zika-next-are-we-prepared/
(C) https://doctordidyouwashyourhands.com/2016/09/all-pregnant-women-with-zika-diagnosed-at-community-hospitals-must-be-referred-to-academic-medical-centers-for-prenatal-care/
(D) https://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/
…according to Iowa Republican Congressman Raúl R. Labrador. *
But New York Democratic Congressman Sean Patrick Maloney got it right when he said “Any member of congress who voted for the bill should be obligated to join a high risk pool.” **
HIGH RISK HEALTH INSURANCE POOLS in Trump/ Ryan Care carve out individuals with pre-existing conditions but does not guarantee them access to affordable health care.
This is under-the-radar but that’s why we need to be vigilant. So here’s a nerdy HIGH RISK 101.
The House Trump/ Ryan Care bill… would allow states to apply for waivers for certain ObamaCare provisions, such as a ban on insurers charging premiums based on a customer’s health and the requirement that insurers’ basic health plans cover certain services, like prescription drugs and mental health.
How do we know this was a dodge?
An under-the-radar GOP amendment would have exempted members of Congress and their staffs to ensure that they will still be protected by those ObamaCare provisions. It was deleted after it was discovered. (A) When Congress tries to exempt itself, we know its shenanigans!
High-risk pools are private, self-funded health insurance plans organized by state to serve high-risk individuals who meet enrollment criteria and do not have access to group insurance. (B)
“High-risk pools are a key concept that helped House Republicans pass their replacement for the Affordable Care Act. That bill, the American Health Care Act…allows states to opt out of the requirement for insurers to cover people with preexisting conditions and set up high-risk pools for these people instead. A late amendment to the bill added $8 billion* in additional funding over five years for these potential pools, and that change garnered enough new Republican votes for AHCA to pass the House.” (C)
“In a nutshell, high-risk pools: are prohibitively expensive to administer, are prohibitively expensive for consumers to purchase, and offer much less than optimal coverage, often with annual and lifetime limits, coverage gaps, and very high premiums and deductibles.” (D)
There have been state high-risk pools for 35 years, prior to the ACA. A recent Kaiser Health Foundation report on the state programs noted: “These high-risk pools likely covered just a fraction of the number of people with pre-existing conditions who lacked insurance, due in part to design features that limited enrollment. State pools typically excluded coverage of services associated with pre-existing conditions for a period of time and charged premiums substantially in excess of what a typical person would pay in the non-group market.” (E)
“…unless high risk pools are adequately subsidized, high premium costs will mean all high need consumers will not be able to afford coverage. State policymakers will need to address those implications as more consumers may face personal bankruptcies and unmet needs, and as states witness an increase in the number of uninsured and more demand for uncompensated care.” (F)
“The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage — if they are able to obtain coverage at all.” (G)
WHAT OTHER DAMAGE TO ACCESS IS BURIED IN THE BILL THAT HOUSE MEMBERS DIDN’T READ BEFORE THEY VOTED FOR IT?
* https://www.washingtonpost.com/news/powerpost/wp/2017/05/06/nobody-dies-because-they-dont-have-access-to-health-care-gop-lawmaker-says-he-got-booed/?utm_term=.93a5e7087576
** WAMC public radio
(A) House GOP health bill changes exempt members of Congress by Peter Sullivan, The Hill, http://thehill.com/policy/healthcare/330592-house-gop-health-bill-changes-exempt-members-of-congress
(B) CONSUMER GUIDE TO HIGH-RISK HEALTH INSURANCE POOLS, NAHU, http://www.nahu.org/consumer/hrpguide.cfm
(C) Sounds Like A Good Idea? High-Risk Pools, by Julie Rovner and Francis Ying, KHN, http://khn.org/news/sounds-like-a-good-idea-high-risk-pools/
(D) Why High Risk Pools (Still) Won’t Work, by Jean P. Hall, Commonwealth Fund, http://www.commonwealthfund.org/publications/blog/2015/feb/why-high-risk-pools-still-will-not-work
(E) High-Risk Pools For Uninsurable Individuals, by Karen Pollitz, http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/
(F) High Risk Pools Deja Vu – Lessons from States, Questions for Policymakers, by Trish Riley and Anita Cardwell, NASHP, http://www.nashp.org/high-risk-pools-deja-vu-lessons-from-states-questions-for-policymakers/
(G) High-risk pools won’t match Obamacare’s protections for pre-existing conditions by Tami Luhby, CNN, http://money.cnn.com/2017/05/03/news/economy/high-risk-pools-obamacare-pre-existing
“No Surprise Charges” is one of the key Lessons Learned in Elisabeth Rosenthal’s fabulous new book AN AMERICAN SICKNESS (Penguin Press, 2017). “Hospitals in your network should also be required to guarantee that all doctors who treat you are in your insurance network.”
We have all harshly experienced or heard about under-the counter out-of-network hospital charges:
(A) “A Kaiser Family Foundation survey finds that among insured, non-elderly adults struggling with medical bill problems, charges from out-of-network providers were a contributing factor about one-third of the time. Further, nearly 7 in 10 of individuals with unaffordable out-of-network medical bills did not know the health care provider was not in their plan’s network at the time they received care.”
(B) A new study that looked at more than 2 million emergency department visits found that more than 1 in 5 patients who went to ERs within their health-insurance networks ended up being treated by an “out-of-network” doctor — and thus exposed to additional charges not covered by their insurance plan.”
Here is a brief case study:
“When Janet Wolfe was admitted to the hospital near Macon, Georgia, a few years ago, her lungs were functioning at just one-fifth their normal capacity. The problem: graft-versus-host disease, a complication from a stem cell transplant she received to treat lymphoma. Over the course of three days she saw three different doctors. Unbeknownst to Janet and her husband, Andrew, however, none of them was in her health plan’s network of providers. That led the insurer to pay a smaller fraction of those doctors’ bills, leaving the couple with some hefty charges.” (C)
So what can you do to avoid out-of-network charges? (D)
– Speak with a practice representative before being seen to understand the costs of seeing your doctor on an out-of-network or a cash basis. (DOCTOR note: maybe you need to leave and go to an in-network physician instead)
– If you need additional services, such as surgery, imaging or physical therapy, ask your doctor to refer you to an in-network facility to keep your costs down.
A New York law is a great start toward transparency to reduce out-of-network surprises.
Under a recent New York law, Hold Harmless Protections for Insured Patients, “… patients are generally protected from owing more than their in-network copayment, coinsurance or deductible on bills they receive for out-of-network emergency services or on surprise bills.
A bill is considered a surprise if consumers receive services without their knowledge from an out-of-network doctor at an in-network hospital or ambulatory surgical center, among other things. In addition, if consumers are referred to out-of-network providers but don’t sign a written consent form saying they understand the services will be out of network and may result in higher out-of-pocket costs, it’s considered a surprise bill. (E)
(A) Surprise Medical Bills by Karen Pollitz, kkf.org, http://kff.org/private-insurance/issue-brief/surprise-medical-bills/
(B) Many get hit with surprise ‘out-of-network’ bill after emergency rooms: Study” by Dan Mangan, CNBC, http://www.cnbc.com/2016/11/16/many-get-hit-with-surprise-out-of-network-bill-after-emergency-rooms-study.html
(C) When Out-Of-Network Charges Pop Up, Try An Appeal, by Michelle Andrews, NPR, http://www.npr.org/sections/health-shots/2011/06/21/137304710/when-out-of-network-charges-pop-up-try-an-appeal
(D) What It Means If Your Doctor is Out of Network, by Sergio Viroslav, Angie’s list, https://www.angieslist.com/articles/what-it-means-if-your-doctor-out-network.htm
(E) N.Y. Law Offers Model For Helping Consumers Avoid Surprise Out-Of-Network Charges by Michelle Andrews, KHN http://khn.org/news/n-y-law-offers-model-for-helping-consumers-avoid-surprise-out-of-network-charges/
Lesson Learned from recent EBOLA and ZIKA episodes. We need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
1. There should not be an automatic default to just designating Ebola Centers as REVRCs although there is likely to be significant overlap.
2. REVRCs 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 emerging viruses “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.
REVRC protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as Chikungunya, MERS, and Dengue.
Fast forward to this weekend: “There have been 17 suspected cases and two confirmed cases of Ebola in Congo’s Bas-Uele province,…. Of the 19, three deaths have been reported. …. health officials were trying to located 125 people believed to be linked to the cases.” (A)
What are we waiting for? DESIGNATE REVRCs NOW!
(A) EBOLA RETURNS: WHAT YOU NEED TO KNOW ABOUT THE OUTBREAK IN CONGO, by BY CONOR GAFFEY, Newsweek, http://www.newsweek.com/democratic-republic-congo-ebola-609143
Background posts:
EMERGENCY ROOMS are not all created equal! https://doctordidyouwashyourhands.com/2016/04/emergency-rooms-are-not-all-created-equal/
We don’t know what we don’t know” https://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. https://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/
“I got Zika. The US health care system had no idea what to do with me…” https://doctordidyouwashyourhands.com/2016/08/i-got-zika-the-us-health-care-system-had-no-idea-what-to-do-with-me/
“With little known about Zika virus, hospitals scramble to stay ahead.” https://doctordidyouwashyourhands.com/2016/08/with-little-known-about-zika-virus-hospitals-scramble-to-stay-ahead/
Hospitals are developing their own Zika preparedness models. Compare the Central Florida and Johns Hopkins approaches! Which template makes more sense? https://doctordidyouwashyourhands.com/2016/09/hospitals-are-developing-their-own-zika-preparedness-models-compare-the-central-florida-and-johns-hopkins-approaches-which-template-makes-more-sense/
Living in the rarified world of VIP access to health care maybe it’s time for a non-randomized clinical trial, with Congressman being in a study group where they have to pay out-of-pocket fee-for-service with no reimbursement, for prostate screening and treatment.
So they can experience what life was like for 20 million Americans before Obamacare.
Some specifics of the trial. They must get care in their districts. No “professional courtesy” from local physicians. No free PSA. Go to the ER if further tests are needed and become “self pay”, or apply for “charity care” and/ or work out a payment plan for the hospital charges, radiologist, urologist +++
THEN in a year come back to Washington and revise the Obamacare algorithms to assure its sustainability.
For which they might start be reading How to Build on Obamacare by Paul Krugman of the New York Times.
“Actually, though, health care isn’t all that complicated. Basically, you need to induce people who don’t currently need medical treatment to pay the bills for those who do, with the promise that the favor will be returned if necessary.
Unfortunately, Republicans have spent eight years angrily denying that simple proposition. And that refusal to think seriously about how health care works is the fundamental reason Mr. Trump and his allies in Congress now look like such losers.
But put politics aside for a minute, and ask, what could be done to make health care work better going forward?”
To see some solutions read the rest of the article by clicking on https://www.nytimes.com/2017/03/27/opinion/how-to-build-on-obamacare.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
To understand why “Repeal and Replace” was a flop click on LESSONS LEARNED: TrumpRyanCare Obits at https://doctordidyouwashyourhands.com/2017/03/lessons-learned-trumpryancare-obits/
And, worth reading:
Is Obamacare a Lifesaver? By Ross Douthat, New York Times https://www.nytimes.com/2017/03/29/opinion/is-obamacare-a-lifesaver.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
“Repeal and Replace” was a political play!
After eight years of whining, “there was no there there”, no Republican plan!
Following is a sequence of obituary snippets explaining what happened and why.
Ryan: ObamaCare will be law for ‘foreseeable future’
“GOP leadership and the White House had spent weeks attempting to bring skeptical Republicans on board. Conservatives argued the bill didn’t go far enough to repeal ObamaCare, while moderate lawmakers worried about backlash in their districts from those who came to rely on ObamaCare.”
http://thehill.com/policy/healthcare/325700-ryan-we-came-close-but-came-up-short-on-healthcare-bill
THE HILL. Ben Kamisar
Why Trumpcare Failed
“After making repeal of that law their top legislative priority for the past seven years, Republicans now join the much longer list of failures because, during all that time, they never reached a consensus. Rather than come up with a plan the party could unite behind, and with the ACA filling the space where bipartisan consensus could be had, they splintered and entrenched. You can’t bridge that divide. (For their own political sakes, they’re lucky they didn’t.)”
“Freedom Caucus members have a cold vision of health care reform, but a coherent one. They believe that the government being involved in health care, either through regulation or subsidies, is the factor driving up prices, and undoing all of that architecture is what’s necessary to allow market forces to drive down prices. Being coherent in this way on health care policy means accepting the trade-offs that your vision entails, and Freedom Caucus members accept that this approach would leave a lot of vulnerable people in the lurch, left to the care of charities and communities. They have an odd belief that a vast majority of the American public shares this vision despite representing only a small percentage of the House of Representatives.”
Slate. Jim Newell http://www.slate.com/articles/news_and_politics/politics/2017/03/all_of_the_reasons_why_trumpcare_failed.html
In Major Defeat for Trump, Push to Repeal Health Law Fails
“The Republican bill would have repealed tax penalties for people without health insurance, rolled back federal insurance standards, reduced subsidies for the purchase of private insurance and set new limits on spending for Medicaid, the federal-state program that covers more than 70 million low-income people. The bill would have repealed hundreds of billions of dollars in taxes imposed by the Affordable Care Act and would also have cut off federal funds to Planned Parenthood for one year.
Mr. Ryan had said the bill included “huge conservative wins.” But it never won over conservatives who wanted a more thorough eradication of the Affordable Care Act. Nor did it have the backing of more moderate Republicans who were anxiously aware of the Congressional Budget Office’s assessment that the bill would leave 24 million more Americans without insurance in 2024, compared with the number who would be uninsured under the current law.
The budget office also warned that in the short run, the Republicans’ legislation would drive insurance premiums higher. For older Americans approaching retirement, the cost of insurance could have risen sharply.”
New York Times. ROBERT PEAR, THOMAS KAPLAN and MAGGIE HABERMAN
Why Republicans failed to repeal Obamacare
“Let me briefly try to answer this question: How did Republicans fail to repeal and replace the Affordable Care Act? In no order, and off the top of my addled mind at the end of a crushing week:
— They hated Obamacare but they never understood the Affordable Care Act. This is the uber-explanation for much of what follows. Hating Obamacare became just what you did on the right. It didn’t mean you understood it, beyond maybe getting that it was a government program and thus paid for by taxes. It certainly (and this turned out to be very important) didn’t mean you had any ideas about what it did, how it worked or how many people were benefiting from it … or how to replace it.”
The Washington Post. Jared Bernstein
https://www.washingtonpost.com/posteverything/wp/2017/03/24/what-just-happened-explaining-the-republicans-big-health-care-fail/?utm_term=.15fbea5ab191
The Trumpcare Con Implodes
“Passing the bill would have also made a joke of Republican promises that, given the chance, they would replace Obamacare with something that would result in cheaper, better insurance for more people. Trump himself went much further, guaranteeing “insurance for everybody” at government expense. The American Health Care Act was diametrically opposed to those supposed goals.
And that’s what really matters, after all: The practical effects of huge changes to the health care system for those who actually need to use it, alongside the faith Americans can have that their elected officials are making promises they will at least attempt to keep.
Instead, the GOP, from Trump on down, spent years claiming they had a magic plan to make everyone’s health care better, and then tried to bang through a bill in just a few weeks that would have covered fewer people, who would have had to pay much more for whatever care they got, without even reducing the deficit conservatives pretend to care about by all that much. They didn’t even bother waiting for the Congressional Budget Office to assess the final product, so little did they care for the real-world effects it might have.”
U.S.News. Pat Garofalo
https://www.usnews.com/opinion/thomas-jefferson-street/articles/2017-03-24/trumpcare-con-ends-in-deserved-gop-failure
Three Real Reasons “TrumpCare” Failed
“Why was the bill so unpopular? First and foremost it’s because most people hate the underlying Republican philosophy pertaining to health care. And they hate it for good reason: it doesn’t work.
We tried the GOP philosophy of allowing the “competitive” market to provide the “most wonderful health care plan in the world” and it produced a system that resulted in per person health care costs twice as high as the rest of the industrial world and outcomes that were worse. That was the world of pre-ACA health care.
The “unfettered market” allowed insurance companies to discriminate against people with pre-existing conditions – and to define one of those “pre-existing conditions” as simply being a woman. It allowed them to enforce lifetime caps on coverage – so if you got really sick you were simply out of luck.”
The Huffington Post. Robert Creamer
http://www.huffingtonpost.com/entry/three-real-reasons-trumpcare-failed-gop-divisions_us_58d78074e4b0c0980ac0e701
The cruel double standard that may have saved Obamacare
“But others cite another factor: The face of Obamacare is now white.
More Americans now realize Obamacare helps millions of working class whites and that it’s not — as once portrayed by conservatives — a form of welfare pushed by the first black president to help people of color, historians and scholars say. The media landscape is filled with images of the furrowed brows of anxious white residents at congressional town halls who fear they will suffer if they lose Obamacare, says Judy Lubin, a sociologist and adjunct professor at Howard University in Washington.
“When you see white working-class Americans saying that I’m benefiting and my family is getting help from the Affordable Care Act, you start to hear ‘repair’ not ‘repeal,'” Lubin says. “Whites standing up in support of a policy changes the dynamics of the conversation.”
CNN. John Blake
http://www.cnn.com/2017/03/24/politics/obamacare-double-standard/
Trump’s Trainwreck
“For seven years — seven years — Republicans thundered about the evils of Obamacare, yearned for the day when they could bury it and vowed to do precisely that once the ball was in their hands.
Last week proved that this had all been an emotional and theatrical exercise, not a substantive one. The ball was in their hands, and they had no coherent playbook. No real play. They scurried around the Capitol with their chests deflated and their tails between their legs.
For the entirety of his campaign, Donald Trump crowed about his peerless ability to make deals, one of which, he assured us, was going to be a replacement for Obamacare that would cut costs without leaving any Americans in the lurch.
Last week proved that there was no such swap, that he hadn’t done an iota of work to devise one and that he was spectacularly unprepared to shepherd such legislation through Congress. As his promise lay in tatters at his feet, he gave a delusional interview to Time magazine about what an infallible soothsayer he is, then tried to shift the blame to Democrats, who, he said, would soon be the ones hankering for an Obamacare replacement.”
New York Times. Frank Bruni
Trump: I never said repeal and replace would come in 64 days
“Yet asked if he would talk to Democrats now that Republicans are moving on, Trump said no.
“I think we have to let Obamacare go its way for a little while, and we’ll see how things go. I’d love to see it do well, but it can’t. I mean, it can’t,” Trump said. “It’s not a question of, ‘Gee, I hope it does well.’ I would love it to do well. I want great health care for the people of this nation, but it can’t do well. It’s imploding and soon will explode, and it’s not gonna be pretty. So the Democrats don’t wanna see that so they’re gonna reach out when they’re ready. And whenever they’re ready, we’re ready.” “
POLITICO. Nolan D. McCaskill
http://www.politico.com/story/2017/03/trump-obamacare-statement-repeal-replace-236482
With GOP Plan Dead, Trump Weighs Other Ways to Reshape Health Care
Republicans have ability to make changes to Affordable Care Act but do so at their own risk
“With the collapse of Republicans’ health plan in the House on Friday, the Trump administration is set to ramp up its efforts to alter the Affordable Care Act in one of the few ways it has left—by making changes to the law through waivers and rule changes.”
Wall Street Journal. Stephanie Armour
https://www.wsj.com/articles/with-gop-plan-dead-trump-eyes-other-ways-to-reshape-health-care-1490434201
Most pregnant women with Zika will eventually wind up at academic medical centers for prenatal care and delivery by a perinatologist, with newborn care provided by a comprehensive team of pediatrician sub-specialists including neonatologists and pediatric neurologists. The earlier during the pregnancy the better!
Here’s why…..
Highlights from August’s Emergency Preparedness Coordinating Council
Kevin Chason, DO, of the Mount Sinai Health System, shared how his system uses the emergency management structure to coordinate preparedness and response to Zika virus. A multidisciplinary team co-led by representatives from the emergency management and infection control departments has been meeting regularly since May. Key focus areas are patient communication, provider guidance, tracking and monitoring of specimens, and staff safety.
http://gnyha.org/PressRoom/Publication/1e9f564d-eec3-4371-af75-31f0896b89e1/
Zika continues to infiltrate US, 20 babies born with Zika-related birth defects
Twenty babies in the U.S. have been born with Zika-related birth defects and 749 pregnant women have lab evidence of possible Zika infection as of Sept. 15, according to the CDC’s most recent update.
There are 3,358 people in the U.S. with the mosquito-born and sexually transmitted virus in the U.S. as of Sept. 21. Of those, 28 people were infected via sexual contact.
Additionally, the CDC reported 43 of the total cases were acquired from mosquitoes in Florida. However, the Florida Department of Health lists its number of locally acquired Zika cases at 92 as of Sept. 22.
http://www.beckershospitalreview.com/quality/zika-continues-to-infiltrate-us-20-babies-born-with-zika-related-birth-defects.html
Doctors Brace for Zika Babies
This month, the first group of babies in Puerto Rico known to have been exposed to the Zika virus in their first trimester are being born. Pediatricians do not know what to expect.
“This is not like any other outbreak or epidemic,” said Dr. Fernando Ysern, a pediatrician in Caguas, Puerto Rico, who is the president of the Puerto Rico chapter of the American Academy of Pediatrics.
In the pediatric field, Zika looms as a kind of developmental doomsday virus, attacking the vulnerability of early brain development, striking at the neurological basis of human potential. While Puerto Rico, a United States territory, will experience the first wave of children affected by Zika, the rest of the United States is bracing for the spread of the virus.
http://www.nytimes.com/2016/09/26/well/family/doctors-brace-for-zika-babies.html
