Anti-Zika graffiti signage on a wall in front of a housing project in San Juan, Puerto Rico, on August 7, 2016.
The signs were part of an island-wide effort organized by grassroots groups and local mayors to try to stop the spread of the Zika virus in Puerto Rico. ANGEL VALENTIN/GETTY IMAGES
TO TALK ABOUT Zika virus control is to talk about money.
Vaccine development, mosquito abatement, and even the distribution of DEET repellant takes (and currently lacks) major federal dollars. When, last week, the US Department of Health and Human Services declared Zika a public health emergency in Puerto Rico, it was in part a means to a better-funded end.
But the real price of Zika, and the reason the disease has gone from arboviral nobody to world-wide bugaboo, is the devastating birth defects that can appear in children born to infected women. While it’s hard to predict how many children will be born with Zika-related neurodevelopmental disorders, it is clear caring for these children will take a toll.
And experts are already calculating the cost of a generation of US babies impacted by Zika.
It starts with the price of being pregnant with Zika.
The cost of a regular, healthy pregnancy in the United States is already high, sometimes as much as $50,000 for those who deliver via C-section.
But in states with Zika outbreaks, that number will climb when you figure in the two rounds of Zika testing and monthly serial ultrasounds the CDC recommends for monitoring.
Right now, Zika is limited to southern states where the virus-spreading Aedes aegypti are most abundant, and that’s where monitoring will stay concentrated. “But it’s hard to say where Zika’s boundaries are, because you only really need that one mosquito,” says David Pigott, a spatial epidemiologist at the University of Washington.
That (expensive) vigilance is in the hopes of either avoiding Zika—or catching the infection soon enough that women have options for possibly terminating a pregnancy if they get it.
Prevention can’t be perfect, though. And many women won’t choose to terminate if they legally can in their state (which is a big if).
The Cost of Care For pregnancies carried during a Zika infection, researchers estimate anywhere from 1 to 13 percent will result in a birth defect.
The best-known is microcephaly, a condition in which a baby’s head size is two standard deviations below the norm. But that’s only part of the story.
“We have plenty of patients with microcephaly who are very healthy, with few neurological impairments,” says Nassim Zecavati, a pediatric neurologist at Georgetown University Hospital. “But with Zika, the brain is not only small, but underdeveloped and malformed.”
Some babies with congenital Zika virus infections show signs of fetal brain disruption sequence, in which the brain stops growing and then atrophies, causing the skull to collapse during development. “The neurological manifestations of Zika are catastrophic,” says Zecavati. “Children with Zika are going to require a very high level of care.” And that means money.
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