January 31, 2017

Midyear 2017: Experts to examine Florida Zika response, offer lessons for future outbreaks

In November, the World Health Organization announced that the Zika virus was no longer a public health emergency.  That is both good news and bad news, according to public health professionals and local officials who expect a resurgence of Zika and other mosquito-borne diseases in the near future.

To discuss the impact of public health emergencies such as Zika and other mosquito-borne diseases, potential litigation and civil liberties considerations, and the overall need for emergency planning, outreach and education, the ABA Young Lawyers Division is sponsoring a panel, “The Zika Virus: The Legal Implications of a Public Health Emergency” during the Midyear Meeting on Friday, Feb. 3, from 10:30-11:30 a.m.

Panelists include Bob Eadie and Anna M Likos of the Florida Department of Health in Tallahassee, Fla., and Philip K. Stoddard, professor of biological science at Florida International University. The program will be moderated by Melodie Arian of Thakur Law Firm in Brea, Calif.

“We’re not done with mosquito-borne viruses,” said Stoddard who also serves as mayor of South Miami. “We have besides Zika, West Nile virus and Chikungunya. They’re adapting to come further north.”

“We were lucky to have a head start on preparations for Zika because we dealt with a 2009 outbreak of dengue fever,” said Eadie of Florida’s response. “It is caused by the same mosquito that causes Zika. As a result, we had a very active, mosquito control district in the Keyes. It is world class.”

But according to a Center for Disease Control and Prevention report, “Local Mosquito-Borne Transmission of Zika Virus — Miami-Dade and Broward Counties, Florida, June–August 2016,” which includes contributions from Likos, despite aggressive efforts to address disease-carrying mosquitoes, high numbers persist because of the large number of larval development sites, as well as the limited reach of truck-based spraying that fail to reach areas distant from roads and the presence of adult mosquitoes indoors.

“The biggest lesson to learn on a local level is you’ve got to be very judicious of the use of your public health policies because most people would be surprised that they could be incarcerated for refusing to cooperate,” said Eadie.  Eadie explained that if nine of 10 houses in an areas suspected of being mosquito infested and a danger to public health agreed to be sprayed and one refused, the public health service has to prove that the tenth house is a breeding ground.

 “It’s tough to balance individual rights and the public’s right to be safe,” said Eadie, noting that in the Keys, a health officer decided to use a chemical but a vocal minority opposed its use. 

Oxitec, a British company, developed a genetically modified mosquito that would mate with the mosquitos that carry the Zika virus and make them sterile, but Eadie said “the idea of the release on an upscale neighbor made that neighborhood go berserk.”   

Fortunately, the Zika crisis subsided.

Such roadblocks may not be sustained in the future, especially when it comes to people suspected of being carriers.  During the Ebola crisis, a handful of Americans were put in quarantine to protect the health of the general public.

On January 19, the CDC and the U.S. Department of Health and Human Services issued broad, new regulations for the quarantine of people who may be carrying disease. In addition, the new rules permit the federal government to restrict interstate travel during a health crisis. The government would also able to have in-house oversight of anyone detained, without providing a clear path to challenge the quarantine in federal court.

Prior to this new regulation, which becomes effective February 21, most quarantines were instituted by state and local governments.

Stoddard said that Brazil, where the Zika virus first showed up, was better prepared than the United States, noting that Miami-Dade County had no employees who were Ph.D. scientists or any entomologists with knowledge of mosquitos, critical to ensure that potential health scares are grounded in scientific evidence.

“You don’t want your public health measures to be causing other problems,” said Stoddard.

“What happens when city employees, public works people, and police, come down with Zika?  Is it the employees’ fault? In Miami Beach, they were given insect repellent, but it creates a gray area between employer and employee if the person comes down with Zika and the response is, ‘well, it’s not our responsibility, you missed a spot when you used repellent.’”

Further fallout is possible if spraying and prevention have unexpected consequences.  A 2016 study posed a correlation between aerial spraying of pesticides to kill mosquitoes and an increased risk of developmental delays and autism among kids.

Stoddard predicted another Zika outbreak next summer. “I don’t think we’re ready for it.

“The mosquitos are evolving to hang out in the winter in storm drains and heating ducts,” he said.  “I saw Asian tiger mosquitos in Georgetown in Washington, D.C., this summer.”  

The Asian tiger doesn’t carry the Zika virus but it does carry yellow fever virus, dengue fever, Chikungunya fever, West Nile virus and encephalitis.