By Gustavo Arellano
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By Charles Lam
Photo by Geoff Du Feu/Getty ImagesState officials just added a 16th victim to the list of West Nile Virus deaths, almost all of them in Southern California. But public-health officials in Orange County are claiming that the mosquito-driven epidemic has peaked and shows signs of waning. Now another vector, the Asian tiger mosquito, has captured the front pages and for the moment replaced the West Nile epidemic as the latest peril de jour.
But even as West Nile deaths are relegated to boxed stories on the back pages next to the mattress ads and legal notices, the numbers of West Nile Virus (WNV) cases and deaths continue to rise across Southern California.
So before you hose off the DEET and resume your early-morning power walks, consider the possibility that your preeminent public-health agency—sentinels of public safety—may themselves have little more than a hazy picture of this epidemic still in our midst.
The Orange County Health Care Agency (HCA) is charged with identifying every WNV case that arises in the county. Along with the Orange County Vector Control District, HCA is the first and, in the case of this epidemic, the last line of defense against any vector-borne virus that enters the county.
So it's surprising and, sure, discomforting to talk to Dr. Hildy Meyers and learn HCA's head epidemiologist has no idea how widespread the virus is across the county, can't estimate how many people might be exposed thus far, and won't discuss the cases or how many of them may have been medically predisposed to the virus.
What we do know is this: HCA claims only 27 confirmed cases of WNV in Orange County out of a population of 3 million people. Compare that number with those of Los Angeles County—with more than seven times the number of cases (200) in a population three times Orange County's—and San Bernardino County—with a population slightly smaller than OC's, with 180 cases.
The numbers suggest that neighboring Orange County—with two major lowland marsh and flood plains—has managed to more or less dodge the mosquito bullet.
"That's a good question," admits HCA spokesman Howard Sutter. "There should be a commonality of numbers. It's not like we are separated by great distances or natural boundaries."
Sutter says it's possible that early abatement and public-awareness efforts slowed the vector's advance. Yet we know from OC Vector Control data that infected bird counts—a precursor to disease outbreak among humans—were just as high here in Orange County as in Los Angeles, San Bernardino and Riverside counties. The bird deaths indicated a broad distribution of the virus itself, setting off media alarms earlier in the spring, and let us know that yes, there was an epidemic and it was coming our way.
Then Sutter said something that piqued my curiosity: "Our low numbers may also be because we are really not as directly involved in patient care to the degree Los Angeles County is. Without a system of clinics and county hospitals . . . we just don't have the same data."
Could the epidemic's remarkably low profile in Orange County have something to do with the way county health officials identify potential victims?
The answer, it seems, is yes. It's the county Health Care Agency that establishes the criteria based on the severity of symptoms for who gets tested for WNV; the higher the bar—and the county's bar is very high—the fewer who will be tested. It's the HCA that refers patients to clinics or emergency rooms. And it's the HCA—the county's primary surveillance and assessment delivery system—that ultimately decides what information goes up the chain of command, information on which major county health policy is determined.
That delivery system broke down for a time last month when news of the first WNV-related death in the county, a 57-year-old Fullerton man, somehow failed to reach top county health authorities for three weeks. In that critical time, county officials were in the dark about the approaching WNV epidemic and when and where it would first turn up.
The delay troubled state Assemblyman Todd Spitzer (R-Fullerton) and prompted him to call a press conference. "It is time for the county to treat this as a very dangerous virus, and not like it's a common cold," he said. As a member of the Assembly West Nile Virus committee, he demanded that OC hospitals report WNV-related patient information to the Orange County HCA promptly, a practice already in effect in hospitals in Los Angeles and San Bernardino and which became an HCA requirement only after the lapse in reporting came to light.
But that doesn't mean that Spitzer is giving HCA a clean bill of health. He believes the cracks in the official response to WNV run deeper than mere delays in hospital notifications.
"This is not a new disease," he said. "It's a tornado we should have seen coming. And now that it's here, we're still not doing an adequate job of compiling data from all corners of the county. We are clearly underreporting—intentionally or unintentionally—and it is keeping us from getting a clear picture of this epidemic even now."