Communicating the threat of Zika is a powerful tool in the fight, shaping public policies and attitudes that can slow transmission of the virus or hasten its spread.
But it hasn’t been easy getting people to care enough about Zika to wear insect repellent consistently, dump standing water where mosquitoes that spread the virus breed, and take other steps to protect the broader community and not just themselves, according to a panel of public health experts, medical ethicists and others gathered Thursday at the University of Miami.
“It is never easy communicating about something that is new and scary,” said state Surgeon General Celeste Philip, who oversees the Florida Department of Health, the state’s lead agency in responding to Zika.
Speaking at “Zika 2017: Where Do We Go Next,” a forum hosted by the UM Miller School of Medicine’s Institute for Bioethics, Philip said the state had learned a number of lessons from the first outbreak of Zika in the continental United States, which occurred in Miami’s Wynwood neighborhood last summer.
When the Centers for Disease Control and Prevention issued an unprecedented travel advisory telling pregnant women to avoid Miami-Dade County, Philip said that state and federal officials struggled to communicate the risks without sowing panic.
“So we struggled quite a bit,” she said, “with how do we tell pregnant women, ‘Don’t go there because of the risks.’ If you’re traveling, you have an option. But what do you say to women who don’t have the means to move?”
Another struggle for the health department, Philip said, was the decision by Florida Gov. Rick Scott to offer free Zika testing to all pregnant women in the state despite limited resources.
In the end, the policy triggered a crush of demand that contributed to delays in patients receiving timely results, with some waiting months. But Philip said it was the right move.
“This was an issue where the science did not outweigh the greater good of being able to provide the assurance and some options for women who didn’t have a whole lot of others,” she said.
Still, Philip acknowledged, there were areas the state could have handled better, such as reporting where infections were occurring, particularly in Miami-Dade where dozens of cases were “undetermined” due to an inability to pinpoint where people were exposed.
Other challenges included communicating new clinical guidelines to clinicians, and persuading mothers who had tested positive for Zika during pregnancy that follow-up care for their babies was imperative, even if their child had no apparent birth defect.
For physicians on the front lines in Miami, communicating with patients also was a challenge, said Christine Curry, an obstetrician and gynecologist with the UM Health System who helps lead its Zika response team. Patients were receiving fragmented information about Zika at the same time physicians were learning about the disease, which created tension, she said.
Curry noted that a recent CDC report found that one in three infants born to mothers who tested positive for Zika during pregnancy were never tested after delivery, and only about one in four received brain scans. Both are recommended by the CDC.
“These are huge misses in our system for reasons I cannot particularly account for,” she said.
Then there was the challenge of language in a multicultural community like Miami. “The majority of patients that we see with Zika are not speaking to me in English,” Curry said.
Last year about 1,700 patients, mostly women, were tested for Zika by UHealth and its partner institution, Jackson Health System, Miami-Dade’s public hospital network. Among patients who spoke English, Curry said, about 2 percent tested positive for the virus. Among Spanish-speakers, about 6 percent were positive. And among those who spoke Haitian Creole, about 6.5 percent were positive.