Zapping Zika fears during pregnancy
The front of Tracy Towle Humphrey’s home in Miami’s Upper Eastside neighborhood looks like a chemistry lab.
Two mosquito zappers cast an eerie green glow over the entrance, and just this week, her husband, Jeffrey, installed a device that hooks up to a propane gas tank and supposedly kills the pesky insects. In total, Humphrey estimates there’s about $700 worth of mosquito prevention equipment around their home, just two miles from Wynwood, the area identified this week as the first in the nation with Zika virus spread by mosquitoes.
Humphrey, 37, is six months into her second pregnancy, and news of a Zika outbreak near her home has made mosquito prevention an unexpected priority.
“It’s been disconcerting to have this stress and concern,” she said. “Last time, over four years ago, there was no concern over this and it was much smoother.”
No new Zika cases were reported in Florida on Wednesday.
Since health officials warned pregnant women to avoid the Wynwood area because of ongoing Zika transmission — and the Centers for Disease Control and Prevention urged those who had visited the district on or after June 15 to get tested for the virus — expectant mothers and women planning to conceive in South Florida are making a run on lab tests while others are freezing their eggs, delaying their pregnancies or, in the most extreme cases, planning to leave town to finish out their terms.
Florida Gov. Rick Scott has pledged that Zika tests will be provided free for all pregnant women statewide. But since testing supplies are limited, and not all the available tests are equally effective at detecting the virus, the explosion of demand has overwhelmed the public health agencies that Floridians are relying on for answers, said Ellen Schwartzbard, an OB/GYN at South Miami Hospital.
“I don’t feel the Department of Health is prepared for this right now,” she said.
Many expectant mothers and women planning to become pregnant are turning to private labs instead of the health department to get tested for Zika, and sometimes paying $150 to $500 out-of-pocket for a screening because coverage for those with health insurance varies.
Schwartzbard used her first shipment of Zika virus test equipment from a private lab on Wednesday. Another shipment of 20 kits — four times the size of the first one — was expected later that day.
Since last week’s announcement that Zika had hit Miami, she and the other two doctors in her office have fielded more than 30 phone calls and compiled a waiting list of at least 20 people.
“I haven’t experienced anything like this,” Schwartzbard said. “It’s definitely draining because you want to be able to give information to your patients, you want to be able to have them be cautious, but you don’t want excessive alarm.”
High demand is part of the reason why Schwartzbard decided to contract a private lab for Zika testing. She already struggled to get a test from the Department of Health for a pregnant patient from outside the country who had Zika symptoms — and that was before local cases were confirmed.
“That was one patient,” she said. “Now I have 20 patients who want to be tested.”
Lauren Allen, 30, who is six-months pregnant, said that she and her doctor called the state health department numerous times trying to find out whether she should get tested for Zika. Allen has visited Wynwood since June 15, and wanted to get tested.
But after failing to get help from the health department, Allen said, she had her doctor write an order for her to get tested at a private facility, LabCorp, which she did on Tuesday.
“I hate that it was so hard for me to get an answer,” she said. “The only reason I chose to get tested is because if I’m negative, my husband and I are considering the option of me leaving Miami.”
Zika poses the greatest threat to pregnant women and their unborn children because, the Centers for Disease Control and Prevention has concluded, the virus can cause microcephaly and other severe fetal brain defects. Zika also can lead to eye, ear and neurological problems, including Guillain-Barré syndrome.
“We know that a single child born with microcephaly represents a terrible tragedy for that family and also can cost $10 million or more in medical costs over the lifetime of that child,” CDC Director Tom Frieden said this week after health officials identified a Miami neighborhood with ongoing Zika transmission.
Emily Nostro, 28, who teaches blind children in Broward County, said she doesn’t believe society is prepared to care long-term for children impacted by the virus.
“They’re going to have drastically different lives, and they’re going to require extensive special needs services ” Nostro said. “And I don’t think we’re at the level to handle a sort of epidemic.”
Among the greatest challenges for doctors seeking approval for testing from the health department is dealing with the limited resources, said Kenneth Ratzan, a physician and chief of infectious diseases at Mount Sinai Medical Center in Miami Beach.
Ratzan said that if doctors were given funding and resources similar to what was provided during the Ebola outbreak, hospitals would be better prepared to deal with Zika. Congress recessed in July for a seven-week break that will last into early September without adopting a Zika funding package, which has been under debate since February when President Barack Obama requested $1.9 billion in emergency funding to help states combat the infectious disease.
“But those resources weren’t allocated because Congress failed to do so,” Ratzan said. “If Congress had acted, I would think that the testing would have been developed.”
As of now, blood and urine are the only fluids being tested for Zika virus. The more common test, known as the PCR test, looks for any presence of the virus in the last two weeks. The other test, called a Zika antibody test, looks for any immune system response to the virus dating back as far as 12 weeks from the test date, according to the CDC.
Sarah Revell, a spokeswoman for the Florida Department of Health, said the state has the capacity to test 1,985 people for Zika virus antibodies, and the ability to screen 6,526 people with PCR tests.
Despite limited supplies, Revell said Florida is committed to providing free testing to all pregnant women.
“We will make the resources available to make this happen,” she said.
The only other option for those looking to get tested for Zika virus is through a private lab. Allen said she was quoted prices ranging from $165 to $500. She ended up being charged $165, but is not sure if her insurance will cover it.
And she’s not even sure if it’s worth finding out if she has had Zika. “What am I going to do if I’m positive,” she said, “other than worry for the next three months. ... I'm too far along to terminate a pregnancy.”
Humphrey, despite the laboratory of mosquito prevention devices surrounding her home, said she will get the test at a private lab with her husband on Thursday. She said she was surprised that it was more difficult to get approval for her husband’s test than her own because he is a man.
Her husband Jeffrey, 48, said he didn’t understand why so many people questioned his decision to get tested.
“Zika is sexually transmitted,” he said. “And I’m worried about my wife.”
And the concern goes beyond the bedroom for some couples.
Armando Hernandez, a physician and infertility specialist at Conceptions Florida, a Coral Gables fertility clinic, said in 13 years of practice he has never seen his clients so concerned.
“Craziness,” he said, “it’s absolute craziness.”
In the past few weeks, the number of patients having their eggs frozen has doubled at his practice, Hernandez said. And some patients are postponing their fertility treatments until winter, when there are fewer mosquitoes. A same-sex couple from Hong Kong is holding off transferring embryos to their Miami surrogate, and another couple is hoping to synchronize their conception with a winter holiday in Boston.
But for Hernandez’s older patients, waiting until winter may not be an option.
“I can’t tell this 43-year-old woman, ‘You have to wait six months,’” Hernandez said. “She doesn’t have six months.”
Age is one of the factors Schwartzbard addresses with her patients. While caution is important for the pregnant women who have called her office with questions about the tests and the virus, she said, Schwartzbard doesn’t plan to recommend leaving Miami.
“I don’t feel at this time, with the volume of risk that we have presently, that people need to up and leave their jobs, and their families, and their support,” she said. “If that’s something they want to do, that’s their choice.”
Leaving Miami is an decision that has lingered in the back of Maggie Arias’s mind for the past few weeks after listening to a radio piece about Texas doctors suggesting their patients should move to higher elevations, farther from the Gulf of Mexico and a possible Zika outbreak.
It’s a suggestion that makes sense to Arias, who is six months pregnant, and she has in-laws in Massachusetts whom she can stay with until her first child is born in November. But that’s not a decision the Coconut Grove attorney plans on making anytime soon.
“At this point, if there’s any evidence that there are any cases outside of Wynwood, we probably go from ‘maybe’ to ‘likely’ shipping me off to the Northeast for the remainder of the pregnancy,” Arias said.
Instead, she’s trying to stay informed and take preventative steps around her home. County workers visited her home on Tuesday to spray for mosquitoes, and Arias said she has been applying repellent to her legs and feet before walking to the courthouse in the mornings.
“We’ve taken preventative measures that we probably wouldn’t have been concerned to do if it had not been for the Zika outbreaks in the tropics,” Arias said. “It could be panicking, but in reality, you have to be proactive and read about it.”
This article includes comments from the Public Insight Network, an online community of people who have agreed to share their insights with the Miami Herald and WLRN. Become a source at wlrn.org/topic/public-insight-network.
Who To Call
People who live in the area north of downtown and want to be tested for Zika should contact the Florida Department of Health in Miami-Dade County at 305-324-2400 for more information.