Pregnant in Miami With Zika on the Loose
Life is stressful enough when you’re expecting a baby.
It was early July when a rash spread over my chest like a bumpy butterfly. I have dealt with a variety of rashes throughout the five-and-a-half months of my first pregnancy. Some were caused by hormones, and others were due to the intense Miami heat. At my next appointment, my OB/GYN identified it as an allergic reaction. To what, she wasn’t sure. (To pregnancy perhaps? I wondered.) The prospect that it might be a symptom of Zika didn’t cross her mind. Only travelers to the tropics had thus far tested positive for the mosquito-borne illness. Besides, an ultrasound the week before had shown the baby to be “perfectly” intact. But ultrasounds don’t always detect microcephaly—a birth defect causing lower-than-average head size, and the main known complication of contracting Zika while pregnant.
Soon after, news reports announced four suspected local transmissions in Miami, the first such cases in the United States. The virus is currently being transmitted on the ground in 42 countries and territories according to the World Health Organization. Brazil has 1,749 confirmed cases of microcephaly with more suspected. In Puerto Rico, experts believe 50 pregnant women a day are becoming infected. It's hard to track cases, because 80 percent of people who get the virus are asymptomatic. If you experience symptoms, it’s usually a rash, fever, conjunctivitis, joint pain—basically a weird, intense flu. Very rarely, people can come down with an autoimmune disorder of the nervous system, Guillain-Barré Syndrome.
Pregnancy typically feels like a sci-fi flick. Your body is the locus of an alien experiment. Everything is warped, and your figure is cartoonish. You’re suddenly scared of things you used to enjoy, like the ingredients in a good anti-wrinkle cream or ceviche. Zika, however, turns these nine-and-a-half months into a horror movie with a monster that is almost impossible to locate and hard to avoid.
On Friday, July 29, officials confirmed that the locally acquired infections were confined to the Wynwood Arts District. Wynwood, a small, active neighborhood is the place where everybody knows your name. (Is Cheers still a universal reference?) After spending months indoors—in a city where outdoor activities are the norm—trying to avoid Zika, one evening a few weeks earlier, I decided to eat gourmet tacos on an outdoor bench in Wynwood, with a friend. I looked down at my bare ankles and asked, “Do you see any mosquitoes down there?” After dinner, my friend and I walked at a leisurely pace past the huge, colorful murals on 26th Street as it started to rain. At least one nest of Zika-transmitting Aedes aegypti mosquitoes was swarming just yards away.
Immediately after reading on Friday that the local transmissions were confirmed in the area near where I work, remembering that walk and my rash, I was determined to get tested. The nurse at my doctor’s office informed me with little interest that, “We don’t do that here.” I called a Zika hotline I saw somewhere in the flurry of articles I read that morning. After asking me to describe my rash, the guy on the phone flippantly diagnosed me over the phone, “Doesn’t sound like Zika.” He did give me the number for the Florida Department of Health. The woman at their epidemiology line was gentle and smart and couldn’t believe that my doctor’s office hadn’t read any of the advisories that the DOH sent to doctors' offices providing the procedure on how to test patients for Zika. She advised me to go to the emergency room or an urgent care center to get tested more quickly.
The urgent care center was just as blasé as the doctor’s office. After about 10 phone calls, someone said the center could order a testing kit for $160 that I could take three days later. I would have paid, but I didn’t want to wait. The DOH was again helpful in getting me tested for free that day at an independent testing center, Quest Diagnostics. A polymerase chain reaction test (PCR) would determine whether or not I had an active infection (the test is accurate for two to four weeks after initial infection). I took it and waited.
On Monday, August 1, 10 more locally-transmitted cases were confirmed—12 of which were in Wynwood—for a total of 14. The CDC advised pregnant women not to travel to the area, a 10-minute walk from where I work. Governor Rick Scott said that only 200 locals had been tested, many from a door-to-door collection of urine samples. That’s a seven percent rate of infection, just from that tiny sample. Spraying for mosquitoes in Wynwood had already begun, Scott said, but it was a day later before I saw friends on Facebook post images of their houses being treated.
Christina Frigo is 32 weeks pregnant and works as a freelance copywriter in Miami. Her doctor’s office told her that they needed approval from the DOH to test her blood, and that the agency was only approving those who live in the same zip code as Wynwood. She does live in that zip code, and given that I was provided this test courtesy of the DOH and do not live there, the information given by her doctor seems inaccurate. The next day, they sent her blood to another lab for a fee of $85.
Her father has been trying to convince her to move to the Midwest for months for fear of Zika. “It felt far away,” she remembers, “and now, all of a sudden, it’s in our zip code. I haven’t left my house except to go to the doctor’s office.” When we spoke, she was on her way back from an emergency ultrasound to make sure that things with her baby were okay. It’s unclear how much damage can be caused from an infection in the third trimester, but she’s not taking any chances.
She and her husband just made the decision to move to Chicago to live with her mother for the remainder of the pregnancy. Given her freelance job, they have the flexibility to go, though it wasn’t a decision they made lightly. “It seems crazy, but I don’t know,” she says.
With regard to the availability of testing, and the efforts of authorities to control the disease, she observes, “It just feels like too little too late… It’s crazy how much they could have done in advance and nothing was done. They’re all of a sudden taking these reactionary measures, and it’s not enough.” She says she’s concerned that there hasn’t been enough action because this is much more of a threat to pregnant women than it is to men.
Another local expectant mother, Sheela Dominguez, is the director of strategic operations at the Miami Clinical and Translational Science Institute at University of Miami. She says, “I've been acting as if this is an active pandemic since March, so the news that there is local transmission wasn't too shocking to me.” She has been taking extra preventative measures for a while now, including having her house sprayed by Terminix once a month for five months and putting a fan near her doorway to keep bugs out.
She’s concerned that her OB/GYN hasn’t spoken to her once about Zika in six-and half-months of pregnancy. She works in healthcare, but wonders, “How many people have no idea about this and are just now learning about it?” She believes that it should be standard practice that pregnant women all over the U.S. are tested for Zika because there are cases in almost every state. “I would like to know if I have or did have it, but you have to fight to get a blood test. And then, what if I test positive for Zika or antibodies? What is the next step?”
This is the real question for women who are pregnant and facing the possibility of Zika infection. She points out that most serious brain abnormalities can be detected with a fetal MRI. Would insurance even cover that, she wonders? In Florida, abortion is only legal up to 24 weeks. For women as far along in their pregnancy as Dominguez and I are, if a Zika infection terribly damaged the fetus, and we decided on having an abortion, those restrictive laws would pose an overwhelming emotional, practical, and financial challenge.
Morbid thoughts seem to be woven deeply into the fabric of the pregnancy experience. Suddenly, you’re a goth teen, exploring the darkest corners of your mind. The first three months, you’re basically just waiting to miscarry. Then, once the baby starts moving, if the fetus has a slow day, you’re certain it’s because the umbilical cord is wrapped tightly around its neck. There’s so much time to read about the medicalization of childbirth and fret over a natural birthing plan that will more than likely end up on the operating room floor. Doctors will scare you into believing that if you don’t have that C-section, the baby will certainly die as it emerges from the birth canal. But this is truly a time when life and death hang in the balance, and sometimes you have control over it, but sometimes you don’t.
Congress went on recess before passing a bill to fund Zika fighting measures. Republicans used the legislation as a platform to push a conservative agenda by adding provisions that would limit women’s access to birth control, keep money from public programs like Planned Parenthood, and weaken environmental protections related to pesticides. Those provisions would primarily hurt lower-income women and their unborn children. Especially considering Zika is also a sexually-transmitted disease—as if sex during pregnancy weren’t already enough of a challenge.
My mother, Mary Ellen Tracy, has taken it upon herself to get two things done: have someone spray my block for mosquitoes and have an agency create a hotline for pregnant women to get their streets sprayed. On her first of multiple calls to 311, which offers access to local governmental services, to lobby for someone to spray my block, the man on the line said he’d take a message but that it would be four to five days before anyone got it. They'd send an inspector in a week. The DOH was closed on Saturday and Sunday. “Are the mosquitoes sleeping on the weekend?” she asked. “Why don’t you have a hotline for pregnant women?” Three calls later, including one to the mayor’s office, it turns out that someone on a previous call should have given her a confirmation number, guaranteeing this service. None were provided and still, six days later, no one has come spraying down the street. The thing is, insecticide isn’t killing as many mosquitoes as the authorities expected. They started aerial spraying on August 4, but only in a limited 10-mile area. Zika is going to spread in Miami. A 15th case outside the one square mile of Wynwood in Southwest Ranches in Broward County about thirty miles away was announced on August 2.
My first test came back negative. No one bothered to call to tell me. I had to call them to ask. A more concerned doctor at the practice followed up by asking me to take the Zika IgM Antibody Capture Enzyme-Linked Immunosorbent Assay (Zika MAC-ELISA) test, which has a longer tail. It will show if I have been infected within the past 12 weeks. It’s something that, I feel, probably should have been recommended when I first had that rash.
I took the test today. I’m waiting with no clue when I will get the results. Official guidance on Zika comes in slowly, after the news breaks, and it feels like adequate precautions weren’t taken in time to protect South Floridians. Right now, it seems like all pregnant women in Miami can do is hide, and hope. We have to ensure that our entire bodies are covered at all times, despite the 95-degree weather. We must splash on DEET enthusiastically, even if we normally buy organic produce and natural cosmetics. But there’s no way to completely ensure that there won’t be one day when a hungry mosquito is waiting for us out of sight, under the bed, as we get out of the shower, as vulnerable as a newborn baby.