Winged Migration
As West Nile season winds down, hard-hit Colorado takes stock of the virus outbreak and California braces for the next wave

By H. Cheever Griffin
October 20, 2003

Mona Faber, RN, said only one word describes what happened at Boulder (Colo.) Community Hospital this past summer: overwhelming. During the course of several months, the rooms on her floor filled up with patients young and old writhing in pain with severe headaches, nausea, fever and other symptoms.

"They were coming in one after the other," Faber said. "It got to the point where we would receive a new patient suffering from these symptoms and we'd know right away what it was."

The much-publicized and sometimes deadly mosquito-transmitted virus that was first detected in the United States in 1999 in New York continued its path westward this summer, hitting Nebraska, South Dakota and especially Colorado with a vengeance.

With mosquito season over, nurses and other health care professionals are taking stock of this latest round of the virus. Those who battled it on the frontlines have plenty of stories to tell, as well as a few suggestions to offer. Meanwhile, the larger medical community continues working to develop a vaccine against the virus and, in the months ahead, preparations of some kind most likely will begin in California-which some experts believe will be next summer's ground zero for West Nile.

The West Nile virus takes its name from the West Nile district of Uganda, where the virus was isolated in 1937 from the blood of a patient. Since then, it has made its way throughout Africa, West Asia, the Middle East and the United States. The virus invades a host population, most often birds, and is transmitted by mosquitoes to humans and animals. However, medical experts recently determined that the virus can be contracted through infected blood and organs. (They caution, however, that the virus remains in the bloodstream for only a short time and thus does not pose a great risk to blood supplies.)

No treatment or known vaccine has been developed yet for the virus, which usually passes after several days to a week. The best way to protect against it remains avoiding mosquito bites-which means plenty of bug spray and protective clothing. People infected with West Nile typically develop immunity to it and thus most likely will never have it again.

Most people afflicted with the West Nile virus either manifest no symptoms or develop mild, flulike difficulties such as fever, headache or body ache before fully recovering. For other patients, however, the symptoms may be more acute. They may endure swollen lymph nodes; a rash to the neck, trunk and extremities; high fever; stiff neck; loss of consciousness; muscle weakness; and severe abdominal pain, nausea and vomiting. For those already weakened by old age or unrelated health problems, the virus can be fatal.

As the West Nile virus moved west this summer out of the Midwest and into the Western Plain states, the total number of people victimized grew. In 2002, officials reported nearly 4,200 human cases of the virus. With the final numbers still being tallied for 2003, more than 7,000 human cases have been reported.

In what can be considered good news, however, it appears that the virus will not be as deadly this year as it was a year ago. The death toll from West Nile last year was 284, according to the CDC. The latest CDC figures for 2003 show 152 fatalities.

Front Range frontlines

Just as one state, Illinois, stood head and shoulders above all others in reported cases and deaths last year, Colorado was far and away this year's hot spot. Colorado reported nearly 2,100 cases, more than twice the number of the next closest state, along with 42 deaths.

"We got hit pretty hard with the outbreak," said John Pape, epidemiologist with the Colorado Department of Public Health and Environment. "It was a busy summer."

Pape stressed that Colorado's relatively large population as well as a break in the region's recent drought and the prominence of a particular mosquito species adept at transmitting the virus all helped to give the state a thrashing.

Such an explanation offers cold comfort to Helen Lutz, RN, who spent the better part of the summer tending to West Nile patients on her floor at Longmont (Colo.) United Hospital. "It was crazy," she said. "There were a lot of sick people with horrible headaches, nausea and weakness. Summer is normally a bit of a slow time for us, but not this year."

Lutz said that one of the difficulties in dealing with West Nile patients is that many of them require extra time and attention from the nursing staff. "Their limbs and extremities are extremely weak, and so they need help walking and doing most other things. It was a labor-intensive couple of months for us."

Another challenging aspect of the disease, Lutz added, is the lack of a known cure-which leaves nurses with little else to do but try to make patients as comfortable as possible and wait for the virus to run its course. "It's definitely frustrating," Lutz said, "but you do the best you can to help the patients get through it. Pain management becomes the main focus."

Faber agreed. She said that much of her work with West Nile patients revolved around easing pain and suffering. She added that the closest thing she found to a wonder drug was Toradol (ketorolac tromethamine), a quick-acting anti-inflammatory medication. reduced the swelling in a lot of patients, which really helped their situation," Faber said. "You can't use it for too long because it can cause stomach problems, but it works quickly."

In addition to addressing the obvious physical suffering exhibited by West Nile patients, Faber said that nurses also should be prepared to address the emotional and psychological symptoms that accompany such a notorious and panic-inducing disease.

"There was a lot of fear," Faber said, referring to the patients she treated this past summer. "A lot of people, particularly our elderly patients, thought they were going to die." She added, "You have to keep them calm and reassure them that they're most likely going to be OK. This virus really requires you to treat the whole patient."

Westward, ho

Signs are cropping up that a possible cure may be on the way. Last year, scientists developed an experimental vaccine for the virus-made from the existing yellow fever vaccine with West Nile genes spliced in. Scientists say the vaccine has proved effective in protecting laboratory animals from the disease.

Officials with the National Institutes of Health recently reported to Congress that a biotechnology company, Acambis, plans to begin tests on the vaccine with a small group of people to determine whether it is safe and effective for humans. If all goes well, officials said, the vaccine could be available for public use in about three years.

That, of course, means that West Nile will enjoy at least a few more seasons of unabated activity. Perhaps nowhere is this more of a concern than in California, where officials fear the virus will strike hardest next year. West Nile, experts said, is expected to continue its westward migration-and that leaves the Golden State directly in its path.

The telltale signs of a looming invasion are already there. State investigators detected infected mosquitoes for the first time in August, and since then, more dead birds have begun turning up. Health officials believe that human cases erupt one season after the virus first appears in the environment. (California officials reported the state's first human case of West Nile several weeks ago, erasing any doubts that the virus might bypass the state.)

"We're definitely bracing for next spring," said Liz Jacobs, RN, spokeswoman for the California Nurses Association.

In light of California's well-known budget crisis, Jacobs said she doubts there will be much funding for any kind of well-organized statewide campaign against the virus. She sees more of a grass-roots effort, with nurses and other frontline health care providers working to get the word out early and often about what in the end is still the only way to combat the virus: prevention.

"It all comes down to preventive measures," Jacobs said, "wearing long clothing and strong repellent, and for some, such as the elderly and sick, avoiding outdoor activity in the evening." She added, "The key to battling this disease remains educating the public on the ways to avoid it."

Contact H. Cheever Griffin at cgcommunications@ameritech.net