Florida providers worry they might not be ready to serve a potential influx of Zika-infected patients. The concerns come after four Floridians became the first known cases to be infected by mosquitoes in the U.S.
The news marks a shift in the spread of the virus within the U.S. As recently as Wednesday, all but 16 of the nation's more than 1,600 reported cases were acquired during travel outside the U.S., according to the Centers for Disease Control and Prevention. Of those cases that did not involved travel, 15 were the result of sexual transmission while one was caused by laboratory exposure.
That changed Friday.
CDC Director Dr. Tom Frieden said in a written statement that evidence indicates mosquito-borne transmissions had occurred several weeks ago within a few blocks in Miami. He advised everyone—especially pregnant women— residing in areas where Aedes aegypti mosquitoes are present to avoid mosquito bites.
If transmission within the U.S. spreads, providers serving populations that have been identified as being the most vulnerable — the poor living in urban areas with inadequate housing conditions and environments that host pools of stagnant water — say they might not be ready as they face reductions in disproportionate-share payments.
The CMS has been pushing back on DSH payments since it's believed states would see more patients covered through Medicaid expansion. But 19 states including many southern states where the Zika virus is most likely to take hold because of climate and breeding conditions have not expanded Medicaid. That could leave safety net hospitals in those regions without the necessary resources to deal with outbreaks.
Safety net hospitals “often are the first place patients turn during a public health crisis,” said Beth Feldpush, senior vice president of policy and advocacy for America's Essential Hospitals, which represents hospitals that serve vulnerable populations.
Congress left for its summer break without passing a bill to fund efforts to combat the virus, which has been linked to microcephaly, a neurological condition in which babies are born with abnormally small heads and underdeveloped brains.
“Sadly, we knew this outcome was probable with each passing day that Congress failed to fund Zika protection and response,” said American Public Health Association Executive Director Dr. Georges Benjamin in a written statement. “Public health is again being asked to do more with less to keep Americans safe.”
Public health experts have been stressing the importance of funding efforts to address often neglected diseases.
A 2014 study published in the journal PLOS found that infectious, vector-borne diseases like Zika were prevalent among the poorest populations living in the world's top 20 major economies.
For its part, the Safety Net Hospital Alliance of Florida released a statement stating it is committed to fighting the virus spread.
“(The Alliance) is ready to act quickly and deploy its experience and expertise in this fight against Zika,'' said Dr. Jonathan Ellen, incoming chair of SNHAF and president and vice dean of Johns Hopkins All Children's Hospital.
"We hope Congress and the administration can agree quickly on funding a Zika response and ensure underserved communities are prepared for this and other public health threats," Feldpush said.
Some groups have called for a permanent fund to combat this and other neglected diseases.
Meanwhile, people in Florida's Miami-Dade and Broward counties are being tested to learn whether there are more cases, said Gov. Rick Scott on Friday.
"This is not just a Florida issue. It's a national issue — we just happen to be at the forefront," he added.
