Zika virus may now have a second local outbreak zone in South Florida: the popular resort destination of Miami Beach, where two new cases appear to be the work of local mosquitoes.
Just across Biscayne Bay from the current outbreak in Miami’s Wynwood neighborhood, Miami Beach has half of the hotel rooms in Miami-Dade County. At present, local politicians are denying the presence of Zika in Miami Beach. They have a reason to be concerned: A significant number of cases in the city could have an adverse effect on the 24 billion dollar annual tourist economy.
Brazil, ground zero for the Zika epidemic, is at or near the top as the country of origin for Miami Beach international tourists.
The New York Times reports that an unidentified source said that health officials were considering an advisory recommending that visitors avoid Miami Beach due to the new cases. This would only be the second such advisory issued to advise Americans to avoid an area within the continental U.S. due to disease concerns.
There are now 35 cases of likely locally-transmitted Zika in Florida, but what you might not have heard is that 10 of them are not associated with the current local outbreak zone north of downtown Miami. Besides Miami Beach, all but one of the cases are being investigated in various other areas of Miami-Dade county. Including travel-related cases, 577 people in the state of Florida have been infected with Zika in 2016, including 63 pregnant women.
These numbers may represent the tip of the iceberg. 80% of Zika cases are totally asymptomatic, meaning that most people with Zika don’t know they were infected. There also exists the possibility that many Zika cases are missed due to lack of testing. Free Zika testing in Florida is only offered to pregnant women; other testing is done only at the discretion of the health department and physicians.
The Guardian, reports that Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor University, believes that other outbreaks may already have occurred. He said, “There is not active surveillance going on in the at-risk states in the United States… I think there’s not just Zika transmission going on in Miami, it’s going on all up and down the Gulf Coast and in Arizona, it’s just that nobody’s looking.”
Despite the concerns for outbreaks in the continental U.S., the real hotspot for Zika in America remains the U.S. territory of Puerto Rico. Cases are mounting so quickly there that statistics in print can’t keep up. Over 10,000 cases are thought to exist, and some suggest that a quarter of the island’s population may contract the infection before the epidemic subsides.
Are we missing outbreaks in warm-weather states like Texas and, perhaps, Louisiana, where recent floods will provide expanded breeding grounds for mosquitoes? We won’t know for months, when more babies might be born with brain abnormalities, like microcephaly. Indeed, we might not know for years; Zika-infected babies only sometimes show physical signs at birth. What if normal-appearing newborns start missing milestones for things like walking and talking?
Zika, being mild in its symptoms or without symptoms at all, doesn’t seem like a big deal to most. It can, however, mean quite a great deal to the next generation if we don’t give it the attention it deserves.
Joe Alton, MD