First Zika death on US territory as Congress delays funding

David Brown

Last week the Center for Disease Control (CDC) confirmed a death earlier this year as the first fatal, American case of Zika fever. A man in his 70s living in Puerto Rico’s capital of San Juan, fell ill with Zika in late February. A few days after recovering from the normal rash and fever, he died from internal bleeding from a resulting autoimmune disorder. His death was only recently reported after the CDC was able to confirm that it was caused by the Zika virus and not any other complications.

There are currently 700 confirmed cases of Zika in Puerto Rico, including 89 pregnant women, and CDC officials predict 700,000 cases by the end of the year as the epidemic spreads across the island. Puerto Rico is currently the only part of the United States where local transmission by mosquito is occurring.

In the face of this health crisis, the US Congress entered into a week-long recess this week without approving any funding to combat the Zika virus. The CDC is currently using $589 million in funding redirected from the efforts to contain the 2014 Ebola outbreak. To carry out sufficient preparations to combat Zika the CDC has requested $2 billion.

The money would be used to control the mosquito populations that spread the disease and ensure the profits of pharmaceutical companies developing tests and vaccines.

Without a significant boost to Puerto Rico’s health care system, the Zika outbreak could become a social catastrophe. Although the disease is normally asymptomatic in adults, it has caused a sharp spike in rare autoimmune and neurological disorders.

The Puerto Rican death was caused by immune thrombocytopenic purpura (ITP) where the body’s immune system begins targeting the platelets responsible for blood clotting. With low platelet counts, victims of ITP may begin bleeding from the gums, bruising easily, and in severe cases, bleeding internally.

In the current Zika outbreak, there have been three fatal cases of ITP in Colombia. Current CDC testing suggests that 1.3 percent of Zika cases show a subsequent decline in platelet levels. There are no reported cases yet in Brazil, but the symptoms of ITP are easily misdiagnosed as the much more common dengue hemorrhagic which is spread by the same mosquitoes as Zika.

ITP shares similarities with the neurological disorder Guillain-Barré syndrome that is also caused by Zika. In both cases, the Zika virus causes the body’s immune system to attack other cells; platelets in the case of ITP and nerves in Guillain-Barré. So far, 17 people have been hospitalized in Puerto Rico with Guillain-Barré syndrome, which usually entails temporary weakness that can transform into potentially fatal paralysis.

The majority of adults that are infected show no symptoms and most of those that do only suffer a fever and rash. This makes the Zika virus much harder to detect outbreaks in poverty stricken areas with poor health care systems. The current outbreak, which is centered in Brazil where over a million are believed to have been infected, was only noticed from the disease’s impact on fetal development.

Women infected with the disease while pregnant pass it on to their children in the womb, resulting in a sharp spike in children born with abnormally small heads, microcephaly. The Brazilian health ministry counts 4,908 suspected and confirmed cases of Zika-related microcephaly. The epidemic began in April 2014, a year when Brazil had only 150 cases of microcephaly, the normal rate. Seven other countries have reported Zika-related microcephaly cases in the single digits, including two in the US.

Like most epidemics, Zika is a disease of poverty. Basic infrastructure like garbage collection and piped water minimize the mosquito populations that spread the disease. Well-maintained housing keeps mosquitoes out during the night, and 50 cents a year in netting is all it takes to protect an adult where other measures are not possible. Regular access to health care and family planning would also eliminate the majority of sexual transmission of the disease.

It is no coincidence that in the United States, the territory that is experiencing a widespread outbreak of Zika is also one of the poorest. In Puerto Rico 45 percent of the population is below the poverty line, and the health care system is in crisis. The US territory is facing a $72 billion bankruptcy crisis and failed to deliver a $250 million payment to its hospitals last year.

When the US Congress began their weeklong recess Friday, they not only failed to allocate money to combat the Zika outbreak, they also tabled any resolution to Puerto Rico’s debt crisis, forcing the US territory to default on a $422 million debt payment on May 1.

Since 2009, the island has laid off tens of thousands of public employees, while the official unemployment rate sits at 11.8 percent. Since 2014, the administration of Governor Alejandro Padilla has closed 10 percent of the schools. Efforts by the government to pay the bankers through cuts to social services will only exacerbate the conditions that have allowed the Zika virus to spread on the island.