Zika, Cuba, American Politics

Zika, Cuba, American Politics
David R Kotok
Cumberland October 4, 2016

“Why is Zika so important that you write about it often?” I have gotten that question many times.

An update on the Zika situation follows. But first let me offer an explanation as to why I write about it.

I believe that health issues and disease threats offer us the chance to assess the functioning of a political system. SARS, Ebola, bird flu, and now Zika show whether or not the political system can be proactive. The quality of governance of a country is revealed, and its functionality or lack of same becomes measurable in statistics of suffering, illness, and death. Such is the case now in America as we clearly see that our elected political leaders utterly failed, at a critical juncture, to grasp the magnitude of this threat. Our elected Democrats and Republicans are at fault. They own the outcomes.

Health issues allow for demonstrations of leadership success or leadership failure. Success requires the government and the private sector to engage in a proactive joint effort. Consider the polio vaccine or measles or tuberculosis treatment. Think about pneumonia shots or the shingles vaccine. How did these things happen? How are they funded? Why are they now ubiquitous? Why are we older folks healthier and more protected against illness than we have ever been?

Then ask why we abandoned the Zika-impacted infant yet to be born.

We can also make comparisons with other governments, and I will be trying to do that in a few days. If all comes together, I will visit Cuba next week. Part of the trip will involve meetings and discussion in the healthcare arena. I will be trying to discuss Zika treatment, defense, and financial issues in Cuba with government officials and healthcare professionals there. I do not know how much will be revealed in confidence and how much I will be able to write about. I will share what I can on my return. Takeaways will be discussed where I can. And confidentiality of my sources will be fully protected as this visit to Cuba proceeds.

When we last updated you on Zika (on Sept. 7 – see www.cumber.com/zika-congress-and-damaged-lives/), the Senate had just failed, once again, to achieve cloture on the Zika bill. Finally, on Wednesday of last week, the Congress approved $1.1 billion to combat Zika, as part of a stopgap spending bill that keeps the government up and running through Dec. 9 (so our elected representatives can go home and focus on campaigning).

We would like to report that we are happy with that outcome, but consider the following. Zika funding and action would have passed quickly in a clean piece of Zika-only legislation. It never had that chance. The far right in the Republican House tried to use Zika to undermine Planned Parenthood. The Democrats tried to use Zika to fund a water project. The president used Zika to defend his legacy of Obamacare from a single little chink in the armor because the few dollars in Puerto Rico that will never be used for Obamacare were being reallocated. So the Senate and House and the White House succeeded in going nowhere, and the penalty will fall on many Americans who are our friends or and neighbors.

This month’s belated approval of funding comes only after the 2016 mosquito season has largely passed. Since Congress adjourned on July 15 without acting on Zika, the number of pregnant women with any laboratory evidence of Zika infection in the US and its territories has swollen from 649 to 2298, a 254% increase. (Figures here and below are as of Sept. 28.)

Researchers estimate that between 1% and 13 % of pregnant women infected with Zika in the first trimester will have microcephalic babies, but more could have children with other, more subtle problems.

The number of Zika-infected babies who have already been born with microcephaly or other deformities in the continental US has now climbed to 21. There is still just one such reported birth in Puerto Rico, even though the total number of cases in the Commonwealth stands at 22,069, six times more than the US total of 3625. If the numbers were proportional, we would have expected more than 120 births of deformed babies by now in Puerto Rico. Is there faulty reporting from Puerto Rico? We do know that this month the first large of wave of Puerto Rican babies known to have been exposed to Zika in the first trimester will be born, and doctors there do not know what to expect. (See Doctors Brace for Zika Babies.)

In addition to birth deformities, the Zika virus causes Guillain–Barré syndrome (GBS), a rapid-onset muscle weakness problem caused by the immune system damaging the peripheral nervous system. There are 8 reported Zika-associated cases of Guillain–Barré in the continental US and 37 in Puerto Rico.

Note that with all these figures we’re just talking about confirmed cases. Health officials fear that actual cases may be more than 50 times greater than the reported numbers, since the virus causes only a mild illness in most people, with few if any symptoms. In addition, most people must undergo a series of tests to determine whether they actually have the virus. So far, there is no one simple diagnostic test for Zika – the development of one has been delayed by a dearth of funding. Pregnant women may currently wait more than a month to learn whether they have been infected.

How many women in the early months of pregnancy have been bitten by Zika-carrying mosquitoes or infected by sexual partners? Due to the nine-month gap between conception and birth, and since summer is the peak season for mosquitoes, many cases won’t be confirmed until this fall or winter. And fetal abnormalities are generally not detected until six months after the initial Zika infection, according to WHO.

There are other unknowns. Researchers do yet know how long the virus persists in the body or whether patients develop immunity after initial exposure. The possible modes of transmission are not fully understood, either. Just last week there was a report in the New England Journal of Medicine of a Utah man who was apparently infected via sweat or tears exchanged with his father, who was subsequently killed by the virus. (See www.theguardian.com/world/2016/sep/29/mystery-zika-virus-utah-may-spread-through-sweat-tears.)

Adequate Zika funding needed to be provided a year ago, not just last week. A year of progress toward rapid detection and an effective Zika vaccine has been lost through political game playing. In that year, the number of American families whose lives have been irremediably damaged through inaction on Zika has likely grown from a handful to hundreds and maybe thousands.

Dear readers, each Zika-induced case of microcephaly stands to impose an estimated lifetime cost of $10 million on the United States, the state or states of residence, and the locale. The family support system faces a huge stress. Those that succumb to the stresses and lose family cohesion become the stories of the secondary impacts.

In my opinion, those Zika cases are a wake-up call to the American people, courtesy of partisan Democrats and Republicans. Those two political parties have become diseased themselves. They have combined to squander American lives and impose high costs. In my opinion the system is broken. The folks who lead the Democrats and Republicans care only about their own political ends. They are dangerous. Six months from now the national news will begin reporting the births of Zika babies who were infected on American soil. Think about these statistics as they are revealed over the next year. We have only begun to see the results of this failure in American governance.

We cannot know how many Zika cases there would have been  if the funding had been approved a year ago. That is a counterfactual. But we can surmise that there would be far fewer. 

Let’s think about that when we have to consider voting for Johnson-Weld or Clinton-Kaine or Trump-Pence. I haven’t heard a Johnson-Weld comment on Zika. Kaine voted with Harry Reid to block cloture on Zika only a few days before he became Hillary Clinton’s choice as her running mate. Clinton blames the Republicans for holding up the funding. Trump and his team haven’t mentioned this developing national tragedy and what they think could be done about it.

Meanwhile, the numbers of Zika cases and Zika pregnancies continue to grow. The recent news from Thailand adds to the evidence favoring political seriousness.

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David R Kotok
Chairman & Chief Investment Officer