Zika and Medicaid

I want to focus on the probable consequences of a potential Zika outbreak on Medicaid as a continuation of the discussion that Anne started last night.

Zika could be a significant push to rejigger parts of the Legacy medicaid system away from state based funding to a national reinsurance model because of who has high cost persistent conditions, where Zika infections are more likely to be concentrated and who pays for a significant number of births.

Medicaid is a significant payer for maternity, labor and delivery care in the United States.  In 2010, Medicaid paid for 44% of the births in the country.  These births are paid for via Legacy Medicaid where the states are paying between 30% and 50% of the total cost of the service.  The Southern and Southwestern states are more likely to have higher than national average percentage of births paid for by Medicaid than cooler climate states.  This means that all else being equal, the impact of Zika will be borne by more Southern and Southwestern states than states that fought for the Union or in the Mountain West.

Southern states tend to have far skimpier Medicaid plans and more importantly, they are generally poorer with less public health capacity and less economic ability to absorb significant economic and medical shocks.

The most notable impact of Zika is microcephaly.  Children born with too small heads are extreme medical risks.  These children will have lifelong medical costs for additional surgeries, drugs, treatments and rehabilitation therarpy compared to kids.  Having a child with life long medical needs is a significant constraint on earnings for parents and caregivers.  I would project that Medicaid and CHIP will cover a disproportionate share of children who have Zika related birth defects.

So we would have very expensive cases concentrated on publicly provided insurance rolls in states that stingily fund their safety net.  A state that has several hundred covered lives with Zika related birth defects on their Legacy Medicaid plans will be in significant financial trouble.  They either can’t or won’t raise taxes enough to cover the cost of catastrophic illnesses that are outside the normal variance.

There is a viable policy tweak.  It would require Congressional action.  Zika related birth defects would be carved out as  as a separate eligibility category with a distinct federal funding stream.  We already do this with end state renal disease (dialysis) and three years of immunosuppressent payments for transplants.  People who have those diseases and conditions are enrolled into  Medicare and Medicare pays for them as either the primary public insurer or as a secondary insurer for people with private insurance.  Carving out Zika would be fairly straightforward and it distributes the risk nationally.  Alaska and Montana would pay their share for public health.

The other alternative would be to have Medicaid pay kick payments to the states on a capitation basis for individuals with Zika related birth defects.  The kick payment would act to bring the total cost of treatment onto the Federal books instead of the state’s books.  This would be a narrower intervention  as it would only nationalize Zika treatment costs for individuals on Medicaid.






78 replies
  1. 1
    I'mNotSureWhoIWantToBeYet says:

    It seems clear that it’s a question of when and how big the Zika outbreak in the mainland US will be, not if it happens. It’s in Puerto Rico now.

    It would be nice if we had a sensible Congress so that we didn’t have to do special carve-outs whenever some new pathogen causes severe problems. There will be new emergencies coming as the world gets smaller, especially with climate change driving the process.

    I assume it will take months to setup the Medicaid necessary changes. I would hope that any new program would be retroactive to cover anyone affected (and reimburse people who had to pay huge amounts before the program took effect).

    It would also be nice if there were no restrictions on abortion funding, so that women would have the option to terminate their pregnancy without worrying about the cost.

    All of these things are possible – we know how to do them. We don’t have to invent new physics, or create faster-than-light travel, or create perpetual motion machines. We just need to pull up our big-boy pants and vote for people who will make things better. When Democrats vote, Democrats win.

    (sigh)

    Thanks.

    Cheers,
    Scott.

  2. 2
    rikyrah says:

    Thanks for breaking it down, Mayhew. They anger me with their deliberate negligence.

    PS- did you read that Medicaid expansion probably won’t happen in Oklahoma after all?

  3. 3

    @I’mNotSureWhoIWantToBeYet: People would be covered. A baby born this morning with Zika related birth defects whose mother is on Medicaid would automatically qualify for Medicaid and get the appropriate early life treatment/surgeries needed paid for by a split between the state of residence and the Federal government. That is automatic. The issue will be if there are hundreds/thousands of babies with Zika related births in a single state, their state Medicaid system will fail without a massive cash infusion.

    That failure point is months out in the worst case scenario and it may never occur.

  4. 4

    @rikyrah: I saw that… and oh fucksticks

  5. 5
    Poopyman says:

    It would require Congressional action.

    Uhhhhh, I think I see a flaw in your plan….

  6. 6

    @Poopyman: Not really, shovel money to Southern Republican governors so they don’t have to raise taxes… that is one bill I think can pass without too much trouble.

  7. 7
    singfoom says:

    Dick Durbin tried to pass a bill to extend the 36 months until the transplant patient reaches Medicare age. It stalled in the 2011 Congress but maybe if Durbin takes over for Reid and the Senate turns blue it could get more movement. There are studies highlighting rejection after 3 years due to the expensive immunosuppressives. You have to pay Medicare B premiums anyway and its a small population relatively. Otherwise its $400 a month at least for the rest of your life.

    Hopefully any Zika legislation doesnt have the expiration date.

  8. 8
    MazeDancer says:

    The possible level of suffering is mind numbing. Didn’t the Catholic Church even ok Zika risk abortions? Birth control for free on every corner would make good sense.

    Also, did not know 44% of births are covered by Medicaid. That does not speak to a solid level of income to support way too many new babies. Maybe people are covered by Medicaid who do have solid income?

  9. 9
    gene108 says:

    @Richard Mayhew:

    Not really, shovel money to Southern Republican governors so they don’t have to raise taxes… that is one bill I think can pass without too much trouble.

    Republican governors are more than willing to turn down free Federal money for shits and giggles.

    They did this with infrastructure money in 2009 and 2010. They are doing this with PPACA Medicaid expansion.

    Historically Republicans have no problem letting Americans die, because it will require government being the solution and not the problem.

    Reagan showed the way, with his “response” to AIDS in the 1980’s.

    I am not hopeful.

    Mosquito repellent sales will be high. At this point it is repellent or bust.

  10. 10
    gene108 says:

    It would require Congressional action. Zika related birth defects would be carved out as as a separate eligibility category with a distinct federal funding stream. We already do this with end state renal disease (dialysis) and three years of immunosuppressent payments for transplants.

    As I am probably going to be on dialysis in a year or so, there’s a “hot potato” mindset between private insurance and Medicare about who pays for what and when. Each seems to want to toss your expenses onto the other group.

    It is not a clear cut or seamless process.

  11. 11

    @MazeDancer: Depending on the state you’re in, Legacy Medicaid had very wide eligibility bands for pregnant women. Almost all states IIRC included pregnant women who were at or below 138% FPL (the current Expansion limit) as part of Medicaid Legacy, and some states had that number in the 200’s

    Women who give birth have two big demographic strikes against them. First they are young so they are less likely to have great jobs with good benefits. Secondly, they are female so the patriarchy shits on them. (1 and 2 play together)

  12. 12
    Prescott Cactus says:

    Are South & Southwestern states more likely to be the first and most infected because the infected skeeters are moving Nothward ?

  13. 13

    @Prescott Cactus: Warmer weather, earlier breeding season and longer fall skeeter season in Florida/Georgia than in Maine or Wisconsin.

  14. 14
    Punchy says:

    Bet the house, car, and all 3 children on this happening: Just as LA (Texas?) passed a law outlawing abortion on the basis of a Down’s diagnosis, GOP leggys everywhere will be passing laws outlawing abortions due to conditions manifested by the Zika virus. They want this virus to cause havoc. They want people to fear this. It’ll get them the White House if they play it perfectly.

  15. 15
    Dork says:

    they are generally poorer with less public health capacity and less economic ability to absorb significant economic and medical shocks.

    Shorter: Redneck states are the Zika virus in this dynamic, infecting ordinarily reasonable people and turning them into vector pinheads who spend all day trying to infect others with their brand of ignorance and bigotry.

  16. 16
    Matt McIrvin says:

    @Punchy: This is the Trump landslide scenario, unless the Democrats can figure out a visceral, emotionally affecting message on this and get it out early and hard.

    Note, they’re already pivoting to blame Zika on environmentalist pesticide bans, and the Ebola-style demonization of foreigners (Puerto Rican US citizens included as necessary) should come shortly.

  17. 17
    Cermet says:

    @gene108: You should “google” these two terms: ‘dialysis’ and ‘activated Charcoal’; and then read some of the medical studies that are related. Might prove very useful for you.

  18. 18
    Rich2506 says:

    Technical problem: I tried to use the Facebook button to post last nights “Late Night Horrorshow” to my Facebook page and it posted this article instead. Also included pictures of cats (not that I have a problem with cats) instead of the usual Balloon pic. By going back to the usual method of copying the link and putting that up, it worked fine.

    Looking at the comments here, the problem with responding to Zika is the GOPs crazy-arse idea that government should be small and cheap. Getting extra money to Republicans Congress-people isn’t going to solve anything because the problem is an ideological one, not one of resources being short.

  19. 19
    amygdala says:

    How does Medicare eligibility work for children? I know with adults who aren’t on dialysis or 65+ that it requires full and long-term/permanent disability for a couple of years (and can take forever to qualify for). Is it dialysis or severe disability for children, too?

    As I mentioned in last night’s thread, I suspect that Zika-related microcephaly may turn out to be particularly bad neurologically. If that turns out to be true, would the Feds mostly wind up covering cost after a few years, because these poor kids will mostly be Medicare-eligible?

    It’s important as an access-to-care issue, as well. In some states, Medicaid is such poor coverage that it can be hard for patients to find specialty care.

    As an aside, it’s probably worth pointing out that even though this looks like Zika establishing itself in North America, as occurred with West Nile virus (WNV) New York in the late 90s, spread of WNV in subsequent summers was weirdly unpredictable. Bad outbreaks occurred some summers, but not others, stumping the folks who develop models for these kinds of things. There’s undoubtedly some useful info in the gap between what was predicted and what happened, but we haven’t figured it out yet.

    Problem is that if Zika doesn’t hit as hard as feared this summer, giving health departments more time to prepare, Republicans will say “I told you so.” The conundrum of public health: you’re an alarmist if you raise concern and things turn out well, or incompetent if widespread deaths or injury occurs (unless, of course, the cause is gun violence, in which case it’s none of your damn business).

  20. 20
    1,000 Flouncing Lurkers (was fidelioscabinet) says:

    It’s been a while since we had a really bad outbreak of mosquito-borne disease in the US.

    For some historical perspective, in the 1878 yellow fever epidemic in the Lower Mississippi Valley, from St. Louis on south, there were 120,000 estimated cases and 20,000 deaths. The city of Memphis was nearly depopulated as the result of people leaving town, and suffered around 5,000 deaths. The state of Mississippi, with few large cities, still managed to sustain over 3,000 deaths. With no effective methods of treatment, no vaccine, and no clue about cause and prevention, the best government could do to inhibit the spread of the disease was attempt to enforce quarantines and travel bans, which was much easier to do when there were only two means of mass transportation–the railroads and riverboats–and the road network was far less developed and there were no automobiles.

    For a look at what that shitshow was like, try Jeanette Keith’s Fever Season and Molly Caldwell Crosby’s The American Plague. Then stop and think about malaria, which is still a constant presence in many places and is an infection that can keep on giving and giving to survivors for many years. Dengue has not made the same inroads in the US, but it’s a serious concern in plenty of other places.

    Then call your elected representatives, at all levels of government–the city council, the state legislature and the governor’s office, and nationally, no matter what party they belong to.

    There’s a good reason my parents’ generation when apeshit with DDT in the 1940s and 1950s–they had seen the consequences of mosquito-borne illnesses, or heard about them growing up.

  21. 21
    Matt McIrvin says:

    @1,000 Flouncing Lurkers (was fidelioscabinet): Correct, though it’s also important to note that mass outdoor spraying would be pretty much ineffective against the mosquito that carries Zika. If people call their representatives and what they demand is showy but ineffective measures, it could cause more harm than good.

  22. 22
    Matt McIrvin says:

    I have a feeling there’s going to be as much anxiety about this as a sexually transmitted disease as anything else. Most people who get Zika are completely or mostly asymptomatic, but male partners can transmit it to women and cause microcephaly in a developing fetus.

  23. 23
    Capri says:

    @Prescott Cactus: It would follow the range of the species of mosquito. The Southwest will probably be spared because it’s too dry. I’d expect it to cover the gulf coast states then work its way north generally along the path of the Mississippi River.

    Fun fact – The West Nile Virus carrying mosquitos like to breed in small pools of stagnant water, very much like a puddle of water that might be in an old tire. They don’t like flowing water. So there’s more West Nile in drought years as compared to flood years, even though the overall mosquito population might be higher.

  24. 24
    manyakitty says:

    Maybe I missed the explanation for this, but why is there so much less wingnut panic about Zika than there was about Ebola? Where’s the Zika czar? Is it because this will actually be a problem, and as such require real solutions derived from a functioning government/public health infrastructure?

  25. 25
    Jack the Second says:

    @MazeDancer: I believe they OK’d contraceptions, not abortions.

    (Which is hilarious for the “contraceptions are really secretly abortifacients” crowd, but the Catholic Church has always had different stated reasons for opposing contraceptions and abortions.)

  26. 26
    Matt McIrvin says:

    @manyakitty: As Loomis pointed out on LGM, there’s a Republican bill in the House to loosen pesticide regulations in the name of Zika. Completely unnecessary and useless in this case for a variety of reasons, but it pins the blame firmly on those hippie environmentalists for taking away our DDT.

    The ideal situation for Republicans is for the epidemic to start raging here so they can ride to victory on the panic.

  27. 27
    🌷 Martin says:

    @Punchy:

    They want this virus to cause havoc. They want people to fear this. It’ll get them the White House if they play it perfectly.

    I don’t buy that. What’s the strategy – that Donald Trump will bomb the mosquitoes? There’s just no way to bluster through something like this.

    I think the problem the GOP has here is that they don’t want to pay the potential massive cost of treating Zika and supporting Zika children, and they don’t want to carve out a new exception for abortion on the issue. And that’s pretty much a binary choice. Zika drives a wedge between the drown it in a bathtub republicans and the godbotherers. They don’t see Zika as an offensive benefit, they see it as a defensive liability because Democrats can play an ‘all of the above’ solution – education, increased healthcare spending, access to abortion.

  28. 28
    🌷 Martin says:

    @manyakitty:

    Maybe I missed the explanation for this, but why is there so much less wingnut panic about Zika than there was about Ebola? Where’s the Zika czar? Is it because this will actually be a problem, and as such require real solutions derived from a functioning government/public health infrastructure?

    It’s because Ebola intersected with their desired outcomes on immigration and general white supremacy inclinations, where Zika is intersecting also with abortion, which they don’t want to see rise as a conversation.

    Put short, they don’t genuinely give a shit about the victims of either, they’re just using them as pawns in their culture war. They could spin Ebola toward positive ends (from their perspective) but Zika is much harder for them to come out ahead on – more likely the public will side with Democratic goals there.

  29. 29
    🌷 Martin says:

    @Capri:

    Fun fact – The West Nile Virus carrying mosquitos like to breed in small pools of stagnant water, very much like a puddle of water that might be in an old tire. They don’t like flowing water. So there’s more West Nile in drought years as compared to flood years, even though the overall mosquito population might be higher.

    My aunt contracted West Nile about 10 years ago here in SoCal. Almost no flowing water to be found.

  30. 30
    Poopyman says:

    Clearly, the only sure way to avoid Zika is to not get bitten. I’m waiting for some Republican to suggest that women not go out without being completely covered, head to toe. Perhaps there’s some name for such a garment ….

  31. 31
    Ramping Up says:

    Why BernieBros may vote for Trump!

    I still say Trump’s best option is to take a Rovian tact and make this election all about gender and a referendum on Third Wave Feminism. Turn Hillary’s gender card into her biggest liability. Make it a #HElection. Dog whistle with Redpill and etc terminology. Divide single vs married women, women with children vs Singl feminist harpy cat ladies.

  32. 32
    Matt McIrvin says:

    @🌷 Martin:

    I don’t buy that. What’s the strategy – that Donald Trump will bomb the mosquitoes?

    That he’ll keep out foreigners, just like with Ebola. That’s the obvious hook. The disease comes from outside the US, therefore we need to secure our borders, etc. etc. The fact that there are asymptomatic carriers makes it a perfect vehicle for paranoia.

  33. 33
    Barbara says:

    @Richard Mayhew: Medicaid expansion would have disproportionately shoveled money to Southern states. It didn’t seem to matter.

    I actually see Zika as posing a bigger threat to a state’s educational funding because of the number of these children with complex medical needs that will also have complex educational needs.

    I want to do something about Zika, it’s a travesty that we can’t or haven’t, but we should also keep in mind a number of things. First, Americans are somewhat less at risk because we do have screens and air conditioning and spend less time outside, proportionately, than people in some other countries. Second, even among pregnant women exposed to Zika, a minority of births seem to result in microcephaly, the worst complication documented thus far. Third, based on the experience of some other countries (in the South Pacific), for whatever reason, Zika outbreaks seem to have a wildfire quality, including burning out of their own accord. None of this means we shouldn’t do more public health and research because, among other reasons, microcephaly is a devastating, irreversible condition, but I think our concerns should be more on the people whose lives will be devastated and less on the public purse.

  34. 34
    Lee says:

    @Matt McIrvin:

    I thought I read a long while back that while DDT is bad, it is not nearly as bad as it was made out to be.

  35. 35
    trollhattan says:

    @🌷 Martin:
    We don’t even know how prevalent West Nile is, since a good portion of the infected are asymptomatic or get a mild flu. And yet, it claims quite a few lives and many birds.

  36. 36
    Capri says:

    @Ramping Up: How do you do that when over 50% of the electorate are female? Do you think folks haven’t noticed that Hilary is a woman? Is he going to call her out for wanting all those horrible feminist goals such as equal pay and support for families. Those positions aren’t exactly news.
    Every time he screams that Hilary “enabled” Bill, I think “My ex-husband is an alcoholic. Is that my fault now? Isn’t the male even a teensy tiny bit responsible for his own behavior?”

    I honestly see no upside to doing this

  37. 37
    Matt McIrvin says:

    @Lee: DDT has its uses when judiciously applied to control mosquito-borne epidemics, but you need to be careful when reading about it: anti-environmentalists have been vigorously spreading lies about how it was largely benign and Rachel Carson somehow murdered millions by causing it to be banned, with the aim of discrediting the environmental movement in general and the World Health Organization.

  38. 38
    trollhattan says:

    @Lee:
    That’s specifically disinformation started by the tobacco industry to discredit the WHO. See Merchants of Doubt for more.

    DDT is pernicious and importantly, mosquito populations quickly develop resistance if used in the traditional manner. It’s also extremely stable, lasting for decades. See the Palos Verde Shelf and Montrose Chemical Superfund sites for just how long.

  39. 39
    Jack the Second says:

    @Ramping Up: The problem with trying to “turn Hillary’s gender card into her biggest liability” is that her gender has always been her biggest liability.

  40. 40
    Matt McIrvin says:

    I’d guess they also want people to start agitating for mass outdoor spraying of pesticides, though this would accomplish little, because the specific mosquito that carries Zika prefers to live indoors.

  41. 41
    Steeplejack says:

    As I glaze over while reading, I keep wanting “Zika and the [something]” to be a band name. Maybe on a double bill with the Flouncing Lurkers. Does this make me a bad person?

  42. 42
    Barbara says:

    @Ramping Up: Because there are some people who have not yet noticed that Clinton is a woman. Those people probably need help getting their pants on in the morning and still let their mothers make their beds. Give it a rest.

  43. 43

    @Barbara: Yep, but educational problems from a state budget perspective are at least 24 to 36 months after birth for early intervention services… and 3 years is like forever on the political cycle. Medicaid funding hits within a year of a major epidemic.

  44. 44
    manyakitty says:

    @Matt McIrvin: So basically it’s an economic move and an opportunity to spread bad science wrapped into one? Gross.

  45. 45
    Matt McIrvin says:

    @Capri: These guys assume in PUA-like fashion that the subset of women who actually have anything like feminist attitudes and goals is a tiny minority, and the majority of women respond positively to bullying from big strong “alpha males”; or, at least, that the fraction of women you lose that way is small compared to the gains you’ll get among men. (Scott Adams’ statements on why Trump will win are a perfect example of the genre.)

    I suppose we’ll see if they’re right.

  46. 46
    Matt McIrvin says:

    @manyakitty: It’s amazing how much of this actually originally came from the tobacco industry, up to and including global-warming denialism. You might wonder why they’d get into things with little direct relevance to tobacco, but the whole point is to make people suspicious of regulatory bodies and international research and oversight organizations. (Also, tobacco companies are agricultural companies, so their interests extend further than muddying the health risks of tobacco.)

  47. 47
    Botsplainer, Cryptofascist Tool of the Oppressor Class says:

    @Lee:

    If it was up to me, I’d quickly do a UN authority on DDT application, supply to be limited and doled out on a three year run in order to get the mosquito infestation in Nader control. Roll it out again ale very 20 years or so. It is imperfect, but it is kind of an inoculation.

  48. 48
    Steeplejack says:

    @🌷 Martin:

    What’s the strategy—that Donald Trump will bomb the mosquitoes?

    There is no strategy. It’s a pure fear play. “You are in danger because Obama didn’t do [something]! Elect us!” And I don’t think they’re even attempting to “play it perfectly.” They’re just throwing stuff against the wall and hoping something sticks.

  49. 49
    Poopyman says:

    @Botsplainer, Cryptofascist Tool of the Oppressor Class:

    supply to be limited and doled out on a three year run in order to get the mosquito infestation in Nader control.

    Say what?

  50. 50

    I disagree with a lot of folks here. I hope moderation doesn’t eat me for links to their posts!

    First, Mayhew, do we have any information from experts on how virulent Zika is expected to be? That American mosquitoes can carry it and it is certainly going to come here doesn’t tell us whether there will be one hundred cases or one million. Malaria and Dengue could be rife in the South, but aren’t. We should prepare regardless, because goat help us if it’s the ‘one million’ answer.

    Which leads to… @gene108:
    This. Republicans have a long history of refusing money for their states if by refusing they can hurt people, and ramping up that tendency to hysterical levels has been a major part of the insane reaction to Obama.

    Which leads us to… @Punchy:

    It’ll get them the White House if they play it perfectly.

    I don’t believe this at all. First, they’re not that good at planning. Second, Zika isn’t Ebola. Which in turn leads us to…

    @🌷 Martin: and @Matt McIrvin: and @manyakitty:
    Here is the big difference between Zika and Ebola: Republicans associate Ebola with Africa, with everything their racist prejudices think of Africa. They’ve been indoctrinated in this since at LEAST the 80s. I grew up with this message. Ebola was some universally fatal disease that eats human flesh (I’m aware that’s not what it does, but that’s the message that came through) and causes hideous deaths, and it happens only in Africa and is the embodiment of all that is awful about Africa. Ebola was and is imprinted on their brains, deeply so, and they are both terrified of it and associate it with black people… like our president.

    @Matt McIrvin:
    DDT is so weird. It is one of the least mammal-toxic pesticides that exist. It’s less acutely deadly than WATER. You have to get a whole lot of it in circulation for it to affect anything but insects, which it wipes out. But then comes the bad side… it takes decades to biodegrade. It doesn’t just disappear into the ground like a lot of chemicals, either. It gets lodged in living creatures and passed between them. It builds up and builds up and builds up to the ‘whole lot of it in circulation’ in a way no other pesticide does. Just by virtue of how well and how long it accumulates, the least dangerous insecticide becomes an environmental nightmare.

  51. 51
    amygdala says:

    @🌷 Martin: Additionally, Ebola has significant person-to-person transmission with high acute mortality. Zika transmits to humans mostly from mosquitoes and causes serious illness in selected groups: some of the offspring of pregnant women and even fewer people who get GBS (or even rarer neurologic syndromes such as encephalitis or ADEM). Acute Zika infection causes minor symptoms in most people.

    There are estimated to be nearly 300 pregnant women in the US with Zika exposure. Even if some of those pregnancies are terminated and if many of the ones that are not result in a normal infant, the numbers of individuals with bad outcomes from Zika may well already exceed the number of Americans who got Ebola. And that doesn’t take into account Zika infections yet to come. But human beings are notably bad at assessing risk, even when they’re not reflexively anti-science, the way Congressional Republicans are these days.

  52. 52
    Steeplejack says:

    @Poopyman:

    “Under control,” presumably, before autocorrect got hold of it.

  53. 53
    Botsplainer, Cryptofascist Tool of the Oppressor Class says:

    @Poopyman:

    Typo – I meant “under”, nothing to do with St Ralph.

  54. 54
    Elie says:

    I am late to the thread but I don’t think its just children with microcephaly. Babies might have a range of neurological anomalies — not just microcephaly, which if profound enough, will cause death.

    The other negative consequence of Zika which is probably more rare but would be extremely costly is Gilliam Barre syndrome… a post acute immune reaction to the infectious agent that can cause severe, possibly life long paralysis of older children and adults. These are more rare but the only death in Puerto Rico was from complications due to Gilliam Barre….

  55. 55

    Thanks, Richard. Hadn’t considered this aspect. Good thread, everybody. Bring it in, good thread. *hugs*

  56. 56
    trollhattan says:

    @Botsplainer, Cryptofascist Tool of the Oppressor Class:
    DDT has been available all along because not every nation was a signer of the ban, India for one. IDK if it’s in production today but regardless, it’s not any kind of magic bullet in lieu of many other insecticides and other management practices.

  57. 57
    amygdala says:

    @Elie:

    I am late to the thread but I don’t think its just children with microcephaly. Babies might have a range of neurological anomalies — not just microcephaly, which if profound enough, will cause death.

    Yeah, it seems likely that microcephaly may be the tip of a very bad cerebral iceberg. Milder brain disorders will take years to characterize fully, though.

    The Zika death in Puerto Rico was, according to the NYT, from an immune-mediated platelet disorder, not GBS. The best data about Zika-related GBS comes from Reunion Island, which had a Zika outbreak a few years ago. Patients mostly did relatively well. Will have to hope the same will be true in PR, which has had a number of cases. It’s possible there are relevant differences in viral strains (or host factors) with GBS and Zika.

  58. 58
    Brachiator says:

    Zika could be a significant push to rejigger parts of the Legacy medicaid system away from state based funding to a national reinsurance model because of who has high cost persistent conditions, where Zika infections are more likely to be concentrated and who pays for a significant number of births.

    A Zika outbreak may also see an increase in abortions and in infanticide.

    What is the best case developmental outcome for a Zika child with microcephaly?

    Pope Francis has already suggested that condoms could be used as a response to Zika. Will anti-abortion absolutists stand their ground?

  59. 59
    Elie says:

    @amygdala:

    Similar pathophysiology in that its immune based reaction to Zika. All I am saying is that the dimension of the costs associated with ZIka may be higher than we realize and not just related to babies with neurologic problems. You might need sustained hospitalization and rehab with GB

  60. 60
    Barbara says:

    @Richard Mayhew: Well, the point is that for MOST people Zika isn’t even as bad as the flu. For SOME people — an infant exposed as a fetus in utero — it is devastating and the medical expenses will hit almost as soon as the births occur. Microcephaly is to Zika as quadraplegia is to car accidents: a low incidence, high acuity event. Honestly, I am not worried about the dollars of this. What is maddening is the lack of will to do something to avoid such horrible risks for such a vulnerable population.

  61. 61
    1,000 Flouncing Lurkers (was fidelioscabinet) says:

    @Matt McIrvin: This is true.

    It’s also worth noting that DDT, however much it was a godsend at one point, is not any longer an immensely effective agent, as in many places the bugs have developed a resistance to the stuff. There are other pesticides that are bones of contention with regulatory agencies, in this country and elsewhere–one of Tom Delay’s pet peeves was federal regulations that prevented the use of certain agents indoors, where humans, especially small, tender, young ones with more easily overwhelmed and damaged organs would be heavily exposed to them. I can’t recall everything that was on the list, but I do remember my uncle the exterminator saying–“Yeah, that stuff’s effective all right–but you spray it near my grandkids and I can promise you I’ll deliver you a lethal dose of something myself!”

    If you want to know where Zika will spread the fastest, look at the old yellow fever maps from the 19th century. Modern transportation will have some effect, as cases can fly in to anywhere in the US, and lengthening growing seasons mean that areas of infection will stretch farther north than they used to, but there’s a reason that pattern from the Gulf states north along the rivers was a classic,

    One of the points Keith noted in her book about the 1878 epidemic in Memphis was that the mosquitos laid their eggs in standing water–and they liked it as clean as possible. In Memphis at that time, many, if not most, residences, even those on higher, drier ground still had cisterns to store rain water for domestic use. Once Memphis installed a municipal water system, the cisterns stopped being used and this was a factor in limiting the spread of the disease in the city.

    So mass spraying might not be effective, but making people know to use repellents when they are outside and how to use them effectively, helping people install window screens, and letting them know that they need to watch for standing water issues and so on can make a difference.

  62. 62
    PurpleGirl says:

    @Brachiator:

    Will anti-abortion absolutists stand their ground?

    I think they will, based on our experience of their understanding of the need for late or third trimester abortions. Remember Dr. Tiller. He did late term abortions for women experiencing extreme problems with their pregnancies. Dr. Tiller was killed as he attended Sunday services at his church, which by the way was a liberal Lutheran congregation that officially supported him as doing good work for people in a severely stressful position.

  63. 63
    Ella in New Mexico says:

    I’ve had four healthy, beautiful children who had their share of problems growing up from a combination of nature and nurture. We spent a lot of money on all the “normal” medical and other costs to help them stay healthy and do well in life. What a blessing to have only had to deal with hospitalizing an infant with RSV, a head injury or two, missing teeth requiring $10K of dental/orthodontist interventions, ADD testing and coaching and repeat strep infections blocking airways. (Oh, and that one time the cops read the second kid his rights in my kitchen, but that’s another story….)

    I pray to God we find a way to intervene in this Zika thing fast, especially in early pregnancy. Because knowing what I have learned about how it permanently effects the neural and immune system of it’s tiniest victims, I really would opt to terminate a pregnancy if I found out I was infected with it before 14 weeks.

    Particularly when it comes to Medicaid recipients, the financial and emotional burden on families and the medical and education system costs should this outbreak become widespread will be horrible. I really wonder if Zika may effect Republicans “complete and total” opposition to first term abortions at some point…

  64. 64
    Matt McIrvin says:

    @Frankensteinbeck:

    Just by virtue of how well and how long it accumulates, the least dangerous insecticide becomes an environmental nightmare.

    In that sense, it resembles both ozone-destroying CFCs and carbon dioxide–both things that are relatively benign in terms of direct biological contact (CO2 is toxic in large quantities, but not as it occurs in outdoor air).

  65. 65
    Ella in New Mexico says:

    @Capri:

    The Southwest will probably be spared because it’s too dry.

    Mosquitos in New Mexico thrive in the summer because of agricultural irrigation and summer rains that leave behind pools of water for breeding. Seriously, I’ve had to fumigate my whole house after a forgotten soda can with some rainwater in it tipped over and a bajillion nasty baby bugs flew out and engulfed my backyard patio. They don’t need much water at all to breed like…well, mosquitos.

    Also, in a briefing the other day, we were told that we probably won’t be spared Zika here, only delayed in it’s arrival. Apparently we have a related species here that is also expected to be a carrier. We already have seen that being a “desert” environment won’t save us, as we have serious issues with West Nile and a few other mosquito-borne illnesses such as Equine encephalitis.

    Just what the poorest state in the nation needs: MORE neurologically impaired/disabled children of a bunch of already poor and unprepared young parents In a place that can’t handle the handful we have now.

  66. 66
    manyakitty says:

    @Matt McIrvin: Sadly, this explanation makes perfect sense.

  67. 67
    Trollhattan says:

    @Ella in New Mexico:
    Seems to me that vector control and testing/screening for zika are the best immediate actions but long-term, we require a vaccine. I’m sure Martin Shkreli will be all over that action, presuming the Republicans can keep the CDC’s big, fat, commie noses out of it.

  68. 68
    Matt McIrvin says:

    @Barbara: There’s also apparently some fraction of adults who can get Guillain-Barré syndrome from it. Not large, I think, but it happens.

  69. 69
    Brachiator says:

    @PurpleGirl:

    I think they will, based on our experience of their understanding of the need for late or third trimester abortions

    And this is what I fear, that obstacles and restrictions will push more women to have to consider late term abortions, and then further obstacles will force women to give birth when that is not the best option for them and their families.

    I also fear that conservatives will force women to be exposed to outright lies about the risks and negative outcomes of Zika, and will also appeal to religious fantasies about miraculous outcomes.

  70. 70
    Barbara says:

    @Matt McIrvin: Yes, if it were not for the possibility of GB Syndrome (which usually gets better although it can take a long time), people might actually be told to try to get the disease and develop immunity, before they try to get pregnant. GB is too big of a risk to give that advice.

  71. 71
    Ella in New Mexico says:

    @Trollhattan: Yes, Shkrelli will be in the forefront on this, no doubt. Fucker.

    @Brachiator:

    I also fear that conservatives will force women to be exposed to outright lies about the risks and negative outcomes of Zika, and will also appeal to religious fantasies about miraculous outcomes.

    Fuck! You’re right, of course. And of course there’s always “It’s God’s Will we suffer”.

    @Barbara: Actually, we’re not completely sure about all the long term effects of Zika on people who survive it. Some studies indicate that even if you had a relatively uneventful infection, you carry the potential to infect others with sperm or possibly even with blood donation. Also, there are studies indicating that it damages the special immune system protecting your nervous system, which could lead to a variety of neurological impairments later, not just Buillain Barre (which CAN have lifetime effects) but in terms of things like demyelinating or neuron destructing diseases over time. We could be seeing a whole lot of disability, from MS-like disorders to dementia.

    It’s really not a good virus.

  72. 72
    Mnemosyne says:

    @Matt McIrvin:

    And I’ll add in something else: EVEN IF African-American and Hispanic women respond positively to alpha-male machismo from men in their own ethnic groups, there’s zero evidence that they would respond positively to a white dude doing the same thing. And as I keep harping on, you can no longer win a national election without women of color.

  73. 73
    andy says:

    So, in other words, what will evolve in the deep south is the attitude that zika-afflicted kids are the judgement of god, and that they and their families will be shunned by the culture-of-life folk, and that succor will only come if grownups happen to win control of the Federal government.

  74. 74
    Barbara says:

    @Ella in New Mexico: Clearly, it has some kind of mechanism that makes it more likely to have neurological effects. Which is why there should be research. However, most people who have had it appear to recover normally.

  75. 75
    J R in WV says:

    @Lee:

    If it’s used indoors, it isn’t that bad, but if it’s used outdoors, as for bulk mosquito control, it kills off birds by reducing their egg shells to microscopic thickness – that’s why pelicans, eagles, hawks, and many others were going extinct until DDT was banned. If it’s allowed for indoor use, people WILL use it outdoors. Regardless of the dead eagle chicks.

  76. 76
    J R in WV says:

    @Capri:

    You are talking to a paid republican troll, which is a waste of breath. I do it too, their arguments are so transparently bad, you almost can’t help poking holes.

  77. 77
    Miss Bianca says:

    @Ella in New Mexico: I can’t wait to see how the mosquito control district in my old home town is going to handle this…mosquito control was a hugely political issue in the 00s, because of the advent of West Nile virus, and the propensity of the old guard to just spray the shit out of the towns and the rural areas, despite the overwhelming evidence to bear that it was not effective…we fought and fought to get actual scientists onto the board and get scientifically-vetted methodology in place…and a lot of re-education re not leaving standing water lying around – get rid of those old tires, folks! Check those birdbaths and ponds! Anti-larval agents, the works. Wonder if Zika’s arrival will change protocol or sweep some itchy old-timers back into power.

  78. 78
    amygdala says:

    For folks whose science-averse Congresscritters are being ridiculous about funding the government’s response to Zika, here’s some messaging guidance from the American Public Health Association.

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