My patient had a slight fever, muscle pains, red eyes and a very slight rash. Nothing was exceedingly worrisome, until my next question.
“Any recent travel?”
The answer was “yes” and revealed travel less than two days prior to one of the countries included in the CDC warning for the Zika virus. That began a process that is now over four weeks old.
I contacted the director of the regional health department who called her director in Nashville. Within two hours we had the form and directions needed for collection of the blood and urine to test for the virus.
The state has to authorize any testing for the Zika virus and limits the testing to a person with symptoms who has traveled, or had direct contact with someone who has traveled to a country in most of Latin America or the Caribbean. The reason for this is there is one testing location available in the United States.
One. Only one.
The advice given to me by the director was to advise my patient to stay away from areas with mosquitos. As it was February and snowing a little outside, I assumed the mosquitos weren’t biting. She told it would be a while before the test came back. She wasn’t kidding.
Most people with Zika have a very limited illness that quickly goes away. The highly publicized concerns with this virus have been the strong, but not proven, suspected link to severe birth defects. The infected mothers in the first two trimesters of pregnancy have a much greater chance of a baby born with microcephaly, a condition where the brain literally does not grow beyond the brainstem. How, why, and how often this occurs is still unclear.
The patient was kind and understanding and has recovered nicely. It has been four weeks now and I just received the results of the test. Four weeks. The test was negative for Zika and positive for a paranoid doctor. I’ll take that anyday.
The other neurological condition seemingly associated with Zika is Guillain-Barré syndrome. This occurs in a patient who has recently had the virus and their immune system turns against its own body attacking the neurological system. Severe, temporary but potentially complete paralysis can occur lasting months and sometimes a lifetime.
Imagine being completely healthy and within one week of a mild virus unable to walk, talk or possibly breath on your own all while completely able to think clearly. That is Guillain-Barré. It is terrifying to ponder. I saw this condition twice in Georgia and vividly remember both patients.
The Zika virus is transmitted by mosquitos in Latin America and the Caribbean. There have been 200 cases of Zika in the US all associated with a person who had traveled to the areas of concern. There is a strong suspicion that Zika is sexually transmitted. It is unclear how long that can be a concern after the infection.
The virus is transmitted from an infected person to another by a mosquito biting the infected person then biting the next victim. This is the same pattern of other tropical diseases such as yellow fever, dengue and malaria.
Is Zika in tears, saliva and urine? It has been detected, but it is unclear if that means it can be transmitted.
How long is it possible to transmit Zika? That is unclear.
How big of a problem is this going to be this summer? That, also, is unclear. But from the sight of the mosquito bellying up to the buffet bar of my pasty white leg last weekend, we shall soon find out.
Put yourself in the shoes of a young mother excited about her pregnancy in the first twenty-four weeks or so. Then imagine Zika is being spread across your local region during the summer and that a simple mosquito bite might mean your baby is born with essentially no brain. The potential for profound fear and worry is tremendous.
Now imagine there is only one testing center in the United States and that is takes four weeks during the slow month of February to find out if a patient has Zika. That is a very large problem that is being addressed currently, although no clear information on how many centers will be available to test and who will perform it. Eventually a rapid test could possibly be developed.
We don’t have a treatment for Zika, yet, but it sure would be nice to know if it’s around.
Potential areas of combating this virus will be vaccines (years), killing mosquitoes (spraying of communities and ridding of standing water) and a very controversial genetically engineered male mosquito which has shown success in Brazil already. Genetically engineered anything is a controversial topic and the concern of unleashing a genetically altered mosquito versus the anxiety of having a child with a birth defect may make this a passionately debated topic in the news.
Well, at least passionately debated any other year when there isn’t a presidential election parade marching down the main street of the media coverage.
If a person is traveling to Latin America or the Caribbean, it is advisable to read the CDC travel warnings. Given the Summer Olympics are in Rio, Brazil this year, this could be a fascinating culmination of fear, freedom, public policy, personal independence, infection control, Olympic dreams, and genetic engineering all wrapped up into one summer story.
Stay tuned. There are many people from this region who travel regularly to areas of great need to perform wonderful ministries to people who love and appreciate it. In less than twenty four hours, that traveler may be standing next to you in the store.
(On a personal note, I want to wish a very fond farewell and express my deepest thanks to Jason Davis, Editor of The Mountain Press, who announced he is leaving the paper. I spent many years with Jason on the sidelines of Sevier County’s football games always enjoying his quick smile, great eye for a picture, ready facts of the game and a flowing story to sum it up. We had the unique privilege of being on the sidelines 11/11/2011 to witness the Herculean comeback win of Sevier County against Dobyns-Bennett from twenty eight points down in the second round of the playoffs. That column was one of his very best among a collection of many great sports and news pieces. Thank you, Jason, for giving me the opportunity to publish a column, something I never thought I would do. It’s been a pleasure to work with you.)
Eric J. Littleton, M.D. (@DrEricLittleton) is a Family Physician in Sevierville, TN. His office is in the UT Regional Health Center Sevierville at 1130 Middle Creek Road. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com
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