Thanks to Liz Szabo for willing to chase down a number that we needed in yesterday’s Zika post:
@bjdickmayhew The CDC’s Tom Frieden says lifetime costs for microcephaly could be $10 million.
— Liz Szabo (@LizSzabo) May 26, 2016
From the CDC on 3/10/2016:
we know the cost of caring for one infant with a birth defect can be up to $10 million or more. Funding is crucially important and urgently needed. The rains are coming and with the rains will come mosquito season and with mosquito season will be the risk of explosive spread of Zika as well as dengue and other Chikungunya.
That works out to be $120,000 in incremental costs assuming an 85 year lifespan. If we assume a 50 year life span, we’re looking at $200,000 per year in incremental costs.
Depending on the life span assumptions, a Zika birth defect case ranges from the equivilent of an additional Hep-C treatment year to a Cystic Fibrosis treatment year. If there are widespread but low level infections and a low probability of significant birth defects from Zika, then state budgets can handle a few more catastrophic on-going claims. If there are concentrated areas of infection with significant birth defects then state budgets will blow up.
CONGRATULATIONS!
And the damned anti-choice contingent will be screaming that aborting a fetus without a brain is somehow a sin against Jesus and Western culture.
If they can’t have their theocracy then by God they will bankrupt us all.
Oh look, an idiot beat me to first post. Of course this won’t be a “pandemic”, fool, insect-transmitted diseases rarely work that way. But with costs at 10 million per occurrence, it doesn’t have to be a pandemic to be a fiscal catastrophe. Who do you think would pay for the cost of even a thousand cases, the parents?
MobiusKlein
@shomi: ‘Probably’ here is lifting a large part of your argument.
51% probably? 99%? Makes a big difference in terms of how much to spend for mitigating the risk.
Luthe
@srv: If you had done any reading on the subject at all (and yes, I know this presumes you would trouble your beautiful mind with such an effort), you would know the mosquito that spreads Zika does not live in locations that would be reached by mass sprayings of DDT. But nice try pushing your talking points!
CONGRATULATIONS!
@srv: Stuff doesn’t work on mosquitoes any more. Ask Africa. Like penicillin, it got used until the bugs got resistant.
Still does a hell of a job killing predatory birds, though. If Zika were transmitted through hawk bites I’m sure we’d be all over it.
Mike J
@srv: DDT use never stopped, it just hasn’t been sprayed over millions of acres multiple times per year like it used to be. If we still used it the way we used to, DDT would now be completely ineffective. If people hadn’t been so hung up on bringing bald eagles back from the edge of extinction, we would have lost a great tool for spot elimination of mosquitoes.
justawriter
I am a bit mystified by the Zika uproar in the U.S. I am not an epidemiologist, but I know enough about biology to know we have a pretty good handle on the dynamics of vector borne diseases. In the U.S. we have pretty good control of disease carrying mosquitoes and the chances of Zika becoming endemic outside of Puerto Rico are pretty slim. I predict that like dengue and malaria, there will be a few thousand cases in the U.S. every year, almost all of them coming in people who traveled to countries where these diseases are endemic.
Please note that these comments do not apply outside of the U.S. Vector borne diseases are a devastating problem in developing countries. The best result will be if the U.S. panic over Zika can be leveraged to make a real difference in the prevention and treatment of infectious diseases in developing countries, something that has been criminally underfunded for decades.
Humdog
Brazil has some 200 million people and in 1.5 years they have over 2000 micro encephalitic babies, ballpark numbers. We have over 300 million, so 2000 or so suffering children born per year here? If we talked about it as a 9/11 every year for poor little sick babies, can we find a few Republicans to care enough to fund a vaccine?
I think of what populations are at risk here and how G-Barre is under diagnosed and often blamed on the patient being “lazy”, as well as the care needed for the babies and the G-B sufferers and I can hardly deal with it. This can have multi generational devastating effects, like we are today considering painting the South with lead paint and asking for the known horrible consequences. My hair is in danger of catching fire. Shomi’s attitude up top seems so callous and head-in-the-sand, but I find myself wishing I had a dose of it.
Humdog
@justawriter: I hope you are correct. I don’t hear much of an uproar, a lot more, “meh.”
trollhattan
@justawriter:
It’s also transmitted by sex, and our ability to eliminate STDs has been spotty, to say the least.
daveNYC
It’s pretty much guaranteed that infected areas won’t be evenly distributed. Climate, birth control, and pre-natal care quality will all impact how many zika related birth defects will crop up; and all of those items vary on where you live.
amygdala
@justawriter: Uh, West Nile virus (WNV) arrived in the US in the late 90s, with human disease reported in nearly all of the lower 48 (as well as in Canada) since.
As with WNV, predicting the spread of Zika may turn out to be challenging. Because unlike WNV, Zika also can be sexually transmitted and (fresh off the press from yesterday’s New England Journal of Medicine) is estimated to cause microcephaly in 1-13% of infants born after first trimester infection, it is not something at-risk countries should ignore.
And yeah, the hope would be that wealthy countries will develop a vaccine that can also be used in resource-limited parts of the world. As TB, malaria, and HIV demonstrate, drug development for global scourges proceeds more quickly when high income countries are also at risk.
low-tech cyclist
@shomi:
I don’t know about maimed, but for deaths alone, you’re off by a couple orders of magnitude. In 2014, the most recent year we have the final tally for, 89 people per day were killed in motor vehicle accidents.
And while there may not be headlines about the highway accident epidemic, the highway death rate is down 61% from 1969. (26.42 traffic deaths per 100,000 Americans then, 10.25 per 100,000 in 2014.) IOW, we’ve been working at it, and as a result, we’ve made enormous progress.
We could make a lot more progress if we weren’t kinda stuck with a car-based transportation system, but the GOP has decided that mass transit of any sort is socialism, and they’re determined to kill it wherever they can. (Think of all the GOP-controlled states that turned down free stimulus money back in 2009-2010 for free high-speed rail construction.) But even still, we’ve done a great deal.
And unlike with cars, we can see Zika coming at us in time to do something about it before it gets here. So maybe it’s worth a couple billion to stop this thing in its tracks, because microcephaly ain’t pretty. And the amount of money Obama’s asked for is less than the possible lifetime cost of treating 200 babies with microcephaly. So it’ll pay for itself. (An ounce of prevention, and all that.)
Like what we’re doing with cars, if we work at this, we’ll get somewhere. If we don’t, we won’t.
amygdala
Regarding that $10 million estimate, it’s not clear to me from Frieden’s statement (and other searching around) whether that figure includes indirect costs.
For severe microcephaly, I’d be inclined to go with the 50 year (or so) lifespan. Extensive brain injury has all sorts of complications that shorten life expectancy.
Diana
@shomi: Did you even read the post? The point is not that *you* will be having problems with Zika, it’s that the poor children who are affected are going to cost taxpayers millions. That’s the problem, not your personal chance of catching the disease yourself.
TriassicSands
It looks like you should add the costs of Guillain–Barré syndrome to those of birth defects for the overall toll that Zika could take.
Ohio Mom
Snark warning:
Based on my almost two decade long experience being a mom of a child with a disability, I want to assure everyone that as a country, we will definitely not be spending that much money per child.
Much of the cost will be borne by the families, and if they can’t afford every thing that is needed, well you don’t fully understand the phrase “you’re on your own” until you’ve lived it.
As one small example, if the best place for my soon-to-be-adult child turns out to be a group home or other supervised living situation, he will have to wait (I’m guessing) another quarter of a century until both my husband and I are dead. The state of Ohio will not put him on the front of the waiting list for the needed subsidy until then.
This situation is making the non-profits that provide supervised living a little panicked. They have spaces they can’t fill because their potential clients do not have the required funding because the state cut it all back.
This is why Republicans are unswayed by arguments such as that made by the CDC. They know they never would have coughed up that much dough to begin with.
justawriter
@amygdala: West Nile kind of proves my point. It is a worst case scenario from a control perspective. It can be carried by something like 50 species of mosquito and has a widespread reservoir in birds that keeps it alive and happy when there are no skeeters around. As you noted, it has a nationwide distribution. Yet, in seven of the last 10 years there have been fewer than 2,500 reported cases, and a couple of those years there were fewer than 1,000. Compare that to blood borne diseases like HIV or hepatitis that causes 30,000 to 50,000 new cases a year. So far, Zika has only been found in just three species of mosquitoes and two of those have very limited ranges in the U.S. I don’t think the reservoir species has been identified for Zika, and it is possible that it is only transmitted from human to human via the mosquitoes. If there is an actual Zika outbreak in the U.S. (excepting, once again Puerto Rico) it will likely be discovered because of a dramatic increase in the other two tropical diseases carried by the same mosquitoes, dengue and chikungunya.
amygdala
@justawriter: No, it doesn’t prove your point. WNV became endemic in the US several years after its arrival. The burden of major illness related to it has to do with its protean clinical manifestations, specifically that most infections cause a mild to moderate viral prodrome and that neuroinvasive disease, which can be lethal, is rare. This is actually pretty common with a lot of viruses that cause encephalitis, but does not change the fact that WNV is now established in the US. Moreover, there are now studies with longer-term followup suggesting that patients with milder WNV infection have protracted disability.
The estimates–and they are estimates, it must be emphasized–are that 1-13% of first trimester Zika infections result in microcephaly. Microcephaly has a long differential diagnosis, but is associated most of the time with poor neurologic prognosis. Recent studies suggesting that Zika targets fetal neural progenitor cells likely portends that these infants will be on the down side of an already bad situation. Being born with fewer brain cells is not a good situation.
Until combination antiretroviral therapy, HIV was rapidly fatal to the vast majority of people who picked up the infection. That Zika seems less lethal–and it’s important to note that we’re still sorting out all of its clinical features–does not negate the horror that is microcephaly, even at a 1% attack rate in a third of pregnant women.
As I posted yesterday, public health is one of those fields where it’s hard to win. Prevent a catastrophe and get accused of alarmism. A catastrophe on one’s watch means you failed.