Why are county health officials in West Nile Denial?

West Nile Virus was carried around the Nile River valleys of East Africa in the bellies of mosquitoes, first appearing in the U.S. in New York in the summer of 1999 and in Washington, D.C., shortly after. The Centers for Disease Control has tracked the epidemic's westward migration every year since. It's a killer disease, but early reports suggested that only the elderly and the immune-compromised were at risk of serious illness. Now there's a different story. The average age of a confirmed WNV case in California is just over 50, and some have been as young as 18. Even here in Orange County, where the only statistical picture we can get is from an extremely small pool of confirmed cases, more than half of all victims are under the age of 55.

Unfortunately, public knowledge in Orange County stops there. The HCA does not make public specific or even general descriptions of patients' medical conditions. Nor does it state the health of the infected before exposure—preconditions that may have contributed to the illness that could shed some light for all of us on who gets sick and who doesn't.

There's disturbing evidence gleaned from Los Angeles and San Bernardino county records indicating that not only do confirmed cases appear to be getting younger, but that many of the confirmed WNV cases also had no particularly compromising preconditions before contracting WNV.

Why is that valuable public information not available to the public from our own county public-health agency? HCA officials cite privacy issues and say the agency has yet to sift through and "assess" all the cases to date.

All 27? San Bernardino County, with a smaller population, has nearly 10 times as many confirmed cases, yet it doesn't seem to have a problem assessing its caseload. And as for privacy, no one's asking for names.

Worse is that if you think you may have WNV—with the attendant headache, stiff neck, swollen glands or rash—you can't just call the HCA and expect them to test you. Dr. Meyers says her agency conducts no walk-in testing of its own.

"We are set up to test," Dr. Meyers confirmed, "but we basically work through physician referrals. There is no systematic testing of humans going on. . . . We just don't have those data sources."

Los Angeles County does. With 13 public hospitals and a well-established safety net of county-run, publicly funded, low-cost walk-in clinics accessible to all, Los Angeles County Health Services is able to take advantage of a broad sampling of WNV data from the general population, allowing officials there to connect the dots to form a picture of this newly arrived epidemic.

"Of course, we don't have a complete picture yet," said LA communicable-disease specialist Dr. Rachel Civen, "but we have acquired a lot of information, and we are beginning to see the scope of this epidemic more clearly."

For example, Civen says, there's preliminary evidence to show that the epidemic became more quickly and broadly dispersed geographically than expected. There's statistical evidence the virus has hit younger and healthier victims to a greater degree than documented elsewhere. Plus, Los Angeles County makes public the type and degree of WNV-related illness, revealing that nearly half of its confirmed cases developed acute meningitis or encephalitis (swelling of the brain).

Los Angeles County officials are also looking outside their own system of services to complete the picture. Recently, blood-donation banks were tested for WNV contamination, and health officials found that the percentage of WNV-infected donors was one in 1,000 in Los Angeles County and approximately one in 400 in San Bernardino County. That's consistent with the general assessment of Los Angeles County Director of Public Health Jonathan Fielding: "For every person with WNV, there are many, many more who are never reported. We estimate there are thousands of such cases in Los Angeles County."

Orange County HCA has yet to take a similar assist from the Red Cross in Orange County to help determine the extent of the WNV presence here. With technically no county hospital or publicly run clinics of its own, Orange County relies on a hit-and-miss system of physician referrals, overburdened and increasingly understaffed private ERs, and a reluctant string of private health-care clinics to piece together a picture of the current WNV epidemic.

If you, an Orange County resident, should be so unfortunate as to find yourself with a fever, headache, stiff neck, rash or swollen lymph glands, you can call the Orange County HCA. They won't test you, of course. They won't even see you. They will, however, in an engagingly professional manner, refer you to your nearest emergency room, where the chances are fair to poor they will test you—unless, of course, your symptoms are advanced enough with an acute meningeal infection or brain-swelling encephalitis.

And there's the catch. Each county establishes its own testing guidelines for WNV screening. In Los Angeles County, prolonged fever, swollen glands and a severe neck ache will get you in the door for a blood test at a county facility, hospital or qualified clinic. But to get a WNV blood test in Orange County, you've got to show up with full-blown encephalitis, aseptic meningitis, acute flaccid paralysis or a full seven days of spiking fever. In other words, you're already cooking brain cells, and you probably belong in an ER anyway.

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