Gochfeld's West Nile op-ed]

[Michael Gochfeld]

FYI----Since several people have asked me for my editorial on West Nile
Virus,  here is the first draft of my OP-ED piece. It was edited down to
600 words and published in the September 11, 2001 issue of the Newark
Star Ledger.   

That was remarkably poor timing. Apparently no one saw it and no one has
contacted me to complain about my callous treatment of this forlorn
virus.  Compared to the uncomprehensible events of that day, it's easy
to forget West Nile (and many other public health problems). 

Michael Gochfeld wrote:
>
> ==============================================================
> 
> THE NOT-SO-DEADLY WEST NILE VIRUS
> 
>         They sprayed Piscataway recently because a mosquito tested
> positive for West Nile Virus. There was no fanfare, and only a modicum
> of media coverage.  What a difference two years make.  West Nile Virus
> burst upon the Western Hemisphere  in 1999 with great fanfare, arousing
> incredible anxiety and fear.
>         A combination of political expediency and media
> hyperbole, captured and exploited this disease, before the public health
> establishment could develop a clear understanding of how to respond.
> This created  a horror flick environment----an alien that attacks the
> brain and can only be combated by airplanes spraying  chemicals.
>         In the fall of 1999, virtually all  media coverage referred to
> it as the "Deadly West Nile Virus", thereby perpetuating the fear and
> nullifying opposition to the aerial spray campaigns.  Although public
> health authorities soon issued advice to empower individuals to reduce
> their risk by eliminating breeding places and avoiding mosquito bites,
> media coverage focused instead on the body count and spray missions,
> imparting the message, "you are helpless, stay indoors, and close the
> windows."
>         There are indeed, deadly viruses, Ebola, is a well known
> example which kills the vast majority of people who become infected and
> spreads readily from person to person.  And, "deadly" might apply to
> Eastern Equine Encephalitis, which occurs sporadically in North America,
> including New Jersey, and kills more than a quarter of those infected,
> and may leave survivors permanently impaired.  West Nile, however, is
> better characterized as "a usually benign; very rarely fatal infection."
>         How do we know that West Nile does not deserve the name
> "deadly".  For one thing, there are many places in North Africa and the
> Middle East, where more than half the population has antibodies
> indicative of past infection with West Nile.  These are all survivors.
>         Epidemiologic studies are more compelling. The first
> well-studied European epidemic occurred in Romania in 1996; 352 people
> were identified with the encephalitis or meningitis forms of West Nile
> infection and 17 died (about 5%).  That seems pretty severe.  However, a
> survey of blood samples estimated that about 94,000 people had been
> infected.  In other words less than half of one percent of infected
> people got significantly sick, and few of those succumbed.   I don't
> mean to sound unsympathetic, but compared to many other public health
> problems, West Nile was a meagre contributor to the death toll.
>         The New York epidemic of 1999 was similar.  Of the 62 people
> identified with serious manifestations of West Nile infection 7 died.
> However, a serologic survey of people living in Queens and Staten Island
> (both of which had a lot of cases), showed that many people had been
> infected without even knowing it. In the main focus of disease in
> northern Queens, extrapolation from the serological survey for
> antibodies, yielded an estimate that 1288 out of about 46,000
> residents were infected, but only a tenth of one percent got severely
> ill.  Last year in Staten Island, the infection rate was about half of
> one percent, yet only 10 people required hospitalization .   This was
> also half of one percent of those infected. And, none of these died.
> Conclusion: very few were infected and very few of those who were
> infected got sick.
>         Moreover, encephalitis and meningitis are not particularly rare
> diseases in our area and there are many other causes besides West Nile.
>  But even in the last two years, West Nile has been responsible for only
> a handful of cases (4% of 583 encephalitis cases tested in Connecticut,
> New York, and New Jersey in 2000), Thus not only is West Nile rarely
> deadly, but it is a relatively rare cause of these serious illnesses
> which have been around for a long time.
>         Indeed, humans are not a normal host for West Nile virus and the
> vast majority of people who are infected by the virus, never realize
> that they are infected and have no symptoms at all.  Of the less than
> one percent of infected individuals who do get symptoms, only a small
> percentage get the severe central nervous system syndrome of
> encephalitis and/or meningitis.   Only the latter condition,
> West Nile Encephalitis, might warrant the designation of "deadly" since
> somewhere between 5 and 15% of those who reach that point will succumb.
>         If people die of the disease at all, why does it matter how many
> or what percent?  It matters because the seriousness of the threat
> determines the aggressiveness of the response.  The greater the risk of
> disease, the greater the risks we are willing to take to stop it.  Back
> in the dark ages of autumn 1999, the suggestion that aerial or broadcast
> spraying of pesticides against adult mosquitoes was not only undesirable
> but unnecessary was considered anaethema, a crackpot idea of the
> environmental fringe. After all, the virus was "deadly".
>         By spring of 2000, howeer, the climate had changed.  Public
> health officials both at the federal Centers for Disease Control and
> Prevention (CDC) and in state health departments,  had rallied and began
> delivering  a common message.  Spraying for adult mosquitoes was
> relegated to its deserved last place among control methods.
>         The overall public health practices of eliminating mosquito
> breeding places, treating standing water to kill larvae, and reducing
> behavior conducive to mosquito bites, has finally won out and the
> message is being gotten across. However, when NJDEP Commissioner Robert
> Shinn announced a statewide tire cleanup, it garnered scant mention in
> the press.
>         While all this debate over West Nile control goes on, about 2400
> people die each year of pneumonia and flu-like diseases in New Jersey,
> not to mention over 300 dying from firearms-related events.   The one
> West Nile death in New Jersey in 2000, though tragic,  doesn't begin to
> approach the magnitude of these traditional public health problems which
> rarely garner comparable media attention.
>         So what should we have learned from our misadventure with West
> Nile virus.  Health risks need to be understood in order to be balanced.
> The intervention must be warranted by the risk.  Despite reassurances
> from pesticide manufacturers and applicators, the pesticides (both
> active and inert ingredients) are not benign. Moreover, considering that
> children rarely develops symptoms of West Nile infection, should parents
> still be are urged to apply the neurotoxic repellant DEET to "protect"
> their children. Now that one rarely hears the word "deadly" associated
> with West Nile, it becomes much easier for individuals, health officials
> and communities to make thoughtful decisions.  
	West Nile Virus has now been detected over most of eastern North
America. There have been several human cases and even one death (in
Georgia) attributed to the virus. Its spread was predicted as early as
1999, yet health officials in Florida were beleagured by frantic calls
to stop the invader. Proposals included wholesale destruction of bird
populations, a draconian measure.  Florida did report one case of
Eastern Equine Encephalitis, a disease that warrants closer
surveillance. 
>         Individuals must feel empowered to control their own risk by
> reducing exposure to mosquitoes through a combination of activities.
> It's easier to make a house mosquito proof than spray proof.  Most
> mosquitoes that bite humans are not infected, and the vast majority of
> people who become infected won't get sick.  Spraying of adulticidal
> pesticides are the LAST rather than FIRST measure for preventing an
> outbreak of West Nile.  Whether it can be justified for Eastern Equine, depends on the circumstance.  Bird and mosquito surveillance are important and should cover multiple viruses. 
> Sound public health and effective risk communication remain important,
> and West Nile has reinforced that lesson.  All this is said while
> extending sympathy to the victims of West Nile and their families, as
> well as the victims of dozens of other more widespread, more serious and
> preventable public health problems.


Michael Gochfeld is a Professor of occupational medicine and
environmental toxicology in the Department of Environmental and
Community Medicine of UMDNJ's Robert Wood Johnson Medical School and a
member of the Environmental and Occupational Health Institute.

 
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