The Midwestern mystery virus

It looks like we’ve got a full-blown outbreak on our hands, spreading out from the Midwest, particularly Kansas City and Chicago.  Ten states have now requested assistance from the Centers for Disease Control for dealing with a surge in rare EV-D68 infections, including Colorado, Georgia, Illinois, Iowa, Kansas, Kentucky, Missouri, North Carolina, Ohio, and Oklahoma.  

EV-D68 is, essentially, a very severe case of the common cold.  The tides of the usual summer-cold season are doubtless helping to spread it, particularly kids returning to school and passing it around to each other.  Normal safety practices are the only way to slow it down: wash your hands, disinfect commonly touched surfaces, don’t share eating utensils, avoid close contact with infected people, etc.  

What’s different about this particular strain is that it has, until now, been very uncommon in the United States.  According to CNN, there were fewer than 100 total reported cases from the initial identification of the virus in the Sixties until this year… but suddenly it’s sent well over a hundred children to the hospital this year alone.  The Chicago Tribune writes of 70 patients reporting symptoms consistent with EV-D68 at a single hospital in Quincy, Illinois just over the Labor Day weekend.  An article at reports 475 cases at Children’s Mercy hospital in Kansas City, with at least 60 patients requiring intensive care.  900 children have reportedly ended up spending time in intensive-care wards in Colorado.

That’s astonishing growth for a previously obscure virus.  (Of course, we must make due allowance for the likelihood that EV-D68 has infected far more than a hundred people over the years, but most of the cases went unreported, because it’s not generally life-threatening, and like any other cold it clears up over time.)

As you might suspect from the large number of emergency-room visits, this is a really nasty little bug, especially when contracted by children who have asthma or other respiratory problems.  A troubling percentage of the cases reported thus far have ended up with the children in intensive care.  WGN in Chicago relates the harrowing story of one young man with asthma who contracted the virus:

Will Cornejo, 13, was among the children in intensive care at Rocky Mountain Hospital for Children after he came down with a cold last weekend and then woke up Tuesday night with an asthma attack that couldn’t be controlled with his medicine albuterol. His mother, Jennifer, called 911 when her son’s breathing became shallow, and her son was airlifted to the Denver hospital, she told KUSA.

Her son was put on a breathing tube for 24 hours.

“It was like nothing we’ve ever seen,” Jennifer Cornejo told KUSA. “He was unresponsive. He was laying on the couch. He couldn’t speak to me. He was turning white, and his lips turned blue.

“We’re having a hard time believing that it really happened,” she added. “We’re much better now because he is breathing on his own. We’re on the mend.”

The authorities sound duly concerned.  “We believe the unusual increases in Kansas City and Chicago might be occurring in other places in the weeks ahead,” warned Anne Schuchat of the CDC’s National Center for Immunization and Respiratory Diseases. “We’re in a stage where it’s difficult to say just how big this is, how long it will go on for, and how widespread it will be.” 

“It’s worse in terms of scope of critically ill children who require intensive care,” Dr. Mary Anne Jackson of Children’s Mercy Hospital told CNN. “I would call it unprecedented.  I’ve practiced for 30 years in pediatrics, and I’ve never seen anything quite like this.”

Now that the EV-D68 outbreak is making national news, there will be a tendency to believe it’s spreading faster than it actually is – a lot of concerned parents will naturally worry that every summer cold is a potential infection of this more serious strain.  It’s best to pay attention to the CDC and their tracking of confirmed cases, rather than rumors and assumptions.  For what it’s worth, while they’re puzzled by the origins of the outbreak and concerned by its rapid spread, they seem universally confident that it can be controlled, and there have not been any confirmed fatalities.

As to why this second-string virus is suddenly a heavy hitter in the summer of 2014, there has been speculation it has something to do with the influx of Central American children over the southern border.  I find that relationship unlikely for a simple reason: two of the states that have always received a heavy percentage of illegal immigrants, Texas and Florida, have not reported any significant instance of EV-D68.  There are lingering questions about exactly where the Administration sent all the border-crossing children, but it seems extremely improbable that their dispersal would correlate strongly with the Midwestern virus eruptions. 

Tracking down the initial patients for any viral outbreak is extremely difficult – these things spread quickly, and a virus that primarily hits children is obviously going to spread rapidly when they go back to school.  The puzzling thing about the current crisis is that these conditions have always existed.  Summer cold season is a fact of life for parents.  Everyone knows small children don’t follow disinfection procedures very carefully.  So why did this one particularly ugly strain suddenly experience… what, a thousand percent growth in reported cases?  More?  …in a single season?  It would seem improbable that the roughly simultaneous outbreaks in different cities could be traced to a single “patient zero.”  Was this just random chance?  If not, what changed?  It will be interesting to see what CDC comes up with.

Update: Cincinnati Children’s Hospital reported a “record number of children” were admitted over the weekend, with symptoms resembling EV-D68, although it hasn’t been established whether any of them were bona fide EV-D68 cases yet.  As mentioned above, this thing is in the news now, so it’s to be expected that more nervous parents will bring children sick with anything resembling its symptoms to the hospital.


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