"How do you spell Zika?"
I stood at the front desk of a major Washington, DC, hospital last month. I had a head-to-toe rash that developed after I’d returned from the Dominican Republic, where Zika is much more common than it is stateside. The friend I’d traveled with was showing symptoms of the virus. I’d come to the emergency room to find out if I had it too.
This was not a question I wanted to hear from the man who was checking me in.
But ignorance of what Zika is, and uncertainty about how to deal with it, was common in my quest to get diagnosed — even from parts of the medical community that I expected would know what to do.
I found out a week after my trip to the ER that I had one of DC’s first 10 confirmed cases of the virus. Fortunately, I’m not pregnant and my symptoms were not severe. I’m fine. But my experience makes me wonder about what might be in store for the US. Would we be ready if we had a major outbreak of Zika? It sure didn't seem like DC was.
"Don’t bring Zika home with you"
This June, I took two weeks off of my job at a radio show for a reporting trip to the Dominican Republic. One of my college roommates had been in the country for nearly a year, volunteering at a school in Salcedo, outside of Santiago, and I’d be staying with her.
When I went to the doctor before I left, I found out that because I was going to a rural area and staying in a house instead of a resort, my risk for contracting a tropical disease was elevated.
But armed with a typhoid vaccine, an antimalarial medication, and an aggressive supply of sunscreen and bug spray, I wasn’t worried, even when my co-workers joked that they hoped I didn’t bring Zika back with me.
It makes sense that they were concerned: The American press, including the show I work on, has been running stories about the Zika threat since last year, when an outbreak of the virus spread from Brazil across Latin America. Zika’s link to birth defects and even miscarriages prompted the World Health Organization to declare it a public health emergency in February.
The virus has been spreading since then, most frequently through mosquitoes (which can eventually develop the virus after biting an infected person) but also between pregnant women and their fetuses and during sexual intercourse.
As Vox reported earlier this month, more than 60 countries and territories have reported mosquito transmission of the virus, and 11 countries have seen sexual transmission. Until late July, all US cases were "travel-associated," according to the Centers for Disease Control and Prevention, but at this point the virus seems to be circulating locally in South Florida.
The CDC has classified the Dominican Republic as a place with a relatively high-level threat for Zika, and urges travelers to "practice enhanced precautions" to make sure they don’t get infected. The danger isn’t simply that the travelers will get sick themselves — unless you’re pregnant or develop a rare condition, the symptoms aren’t severe. The problem is more that infected travelers can bring the virus back to the US and and potentially cause others to get sick.
In the Dominican Republic, my bug repellent was my perfume
For my two weeks in the DR, I was vigilant about protecting myself against mosquitoes: I wore pants or long skirts nearly every day, slept under a mosquito net, and reapplied Cutter Lemon Eucalyptus and Off Deep Woods so often that my friend’s roommates called it my "perfume."
At the beginning of my trip, I could feel myself looking closely at the head of every baby I saw, especially those in women’s arms on the backs of passing motos. But by the time I left, I wasn’t thinking too much about it: I met students and teachers who had been sick, and even a few who still had the telltale rash crisscrossing their arms and cheeks. In general, people didn’t seem too worried about the virus — there wasn’t a lot they could do about it.
Despite my best efforts to avoid mosquito bites, I couldn’t escape them entirely: I am the type of person who comes back from a bike ride with bug bites through the spandex of my leggings, and by the end of the two weeks I had quite a few. Still, when I left the country with no symptoms, I assumed I’d avoided Zika. I returned to work as usual, reapplying that same bug spray in the evenings.
At first, I ignored my Zika symptoms
Three days after I returned to the US, the friend I’d stayed with in the DR Snapchatted me a picture of her rash. This was alarming — we’d been together for nearly the whole time I was down there, so if she’d been bitten by an infected mosquito, it was very likely that I had been as well.
I still had no rash, though, so I figured I was fine. Sure, I was a little sleepy, and it seemed hard to focus, but I figured I was in a post-vacation lull. I started going to bed earlier.
On the Saturday before July 4, after nearly a week back, my symptoms started to mount — and so did my excuses: Yoga class was comically difficult (it involved quite a bit of child’s pose on my part), but I chalked up my achiness to a few weeks off. I had a headache, which I blamed on riding my bike around in the hot DC sun.
When I got out of the shower that day, though, I noticed a light covering of purple dots across my stomach. So, as you do, I sent an uneasy selfie to my mom.
She said not to stress — a lot of factors could be causing my rash. I put on a long-sleeved shirt and biked the 3 miles each way to my friend’s corn-themed barbecue, leaving a trail of bug spray behind me.
Over the next two days, I tried to live my life normally. I couldn’t actually be sick, I told myself, if I was able to do my thing on one Tylenol twice a day. And, for the most part, everything was normal: I went hiking, to another barbecue, to my cousin’s house.
But the rash was spreading. By Sunday night it traversed from my cheeks to my knees, and when I woke up Monday it was everywhere but my forehead and toes.
As it grew, I was getting increasingly anxious when I did leave my house — what if I got bitten by a mosquito that went on to bite a pregnant woman? Could the rash be a symptom of something more serious, like dengue fever or chikungunya, which are also mosquito-borne?
I wasn’t the only one concerned: My friends knew even less about the virus than I did, and they expressed worry for my safety, as well as their own. My supervisors (and their bosses) decided that before I could return to work, I needed to see a doctor, get tested, and ensure I wasn’t immediately contagious. My issue: Like many Americans, I don’t have a primary care practitioner.
I called the clinic I had gone to for my pre-trip shots to ask if they could look at me, but they said they didn’t have the test for Zika on hand and couldn’t help. Next, I called the closest urgent care clinic, who told me they also couldn’t help and that I should go to the emergency room. This, to me, felt silly; who bikes themselves to the ER?
I threw my wallet, a book, headphones, and my bike lock into a tote bag and rode down to the community clinic at the end of my street, where a friend was working at the time. Together, we called the George Washington University Hospital physician referral line, who transferred me to the CDC’s info line.
I explained my situation — recently back from traveling, showing symptoms of Zika, without a PCP — and asked what I should do. The operator’s response? "Do you mind if I place you on a brief one- to two-minute hold while I do some research?"
I would have thought if anyone knew the proper course of action, it would be the CDC. But when she called back, she transferred me to the DC Department of Health, who wanted to know more information about my condition. They would call me back about where I should go to see a doctor.
"You seem nervous," the man on the other end said to me — and by this point, it was true.
As I waited for a return call from the DC Health Department, I visited two more nearby walk-in clinics — at one, all doctors were occupied in a five-hour all-staff meeting. The other told me they had no wifi in their office, so they couldn’t download a necessary form from the health department website.
Frustrated, I called my mom again. She happened to be sitting next to my aunt, who is a nurse practitioner, and together we all decided that I would go to the ER, as overzealous as it seemed.
"How do you spell Zika?": My trip to the ER
By the time I was called up at the emergency room, an hour and a half after arriving, I had my spiel about my symptoms and my self-diagnosis down pat. The man at the desk’s eyes widened a little bit — and that’s when he asked me how to spell Zika.
I was led to a small room in the back corner of the ER, where I would spend the next three or four hours. At least I’d remembered to grab a book when I left my house that morning. A couple of hours in, the nurse poked her head in to apologize for the wait and to tell me I hadn’t been forgotten. "We’re trying to figure out what to do!" she said.
They were waiting for word from the top, she added, when she returned to take my blood. I told her that, based on my research, I just needed that form filled out, and a note from the doctor about whether I was still contagious, so I could go back to work.
Eventually, they brought me the form, which I filled out, and I spoke to two doctors. Everyone who saw me that day tried to convince me that it probably wasn’t Zika but instead a drug rash — despite the fact that I hadn’t taken any new medicines or changed my laundry detergent, and that my friend who I’d been traveling with had the same symptoms. Seven hours after I initially arrived at the ER, I finally checked out.
A week later, my test came back positive. My boss called Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases, a frequent guest on our show, to make sure I was safe to be at work. (I was.)
Why I’m concerned about America’s readiness for Zika
In a lot of ways I’m unreasonably lucky: I know I’m not pregnant (I promise, Mom); I did eventually get seen by a doctor; my work was supportive, even insistent, that I take a full day off to sit in the ER; and my parents still help with my medical bills. I never felt that sick, and as far as I know I haven’t had any complications.
But it’s been a month, and — whether due to the virus or the resulting stress — I still don’t quite feel like myself. One of the things that has kept the stress going is how little the people I’ve talked to know about Zika, from how it affects you to the ways it is, and isn’t, passed on.
At this point I’ve Googled Zika-related information often enough that the internet thinks I must be pregnant — and in every conversation I’ve had, I’ve corrected countless misconceptions. But there’s one worry we usually share: Even though I’m pretty sure I didn’t get bitten while I would have been contagious, and the CDC hasn’t recorded any new cases in DC since my diagnosis, I’ll never know if I spread the virus.
And I’m worried about our ability to respond as the virus moves into the US. Experts don’t expect Zika to affect the US anywhere near as much as it did Latin America. Nonetheless, there have been 1,400 travel-related Zika cases in the US so far, around 20 homegrown cases in Florida — a number that will probably grow, even if it doesn’t get out of control.
Congress did not approve funding for Zika prevention and preparedness this session, and a new study suggests that Zika will remain a threat to the US for "a few summers to come," according to NPR’s Goats and Soda.
Last weekend I happened to sit at a Brooklyn coffee shop’s community table next to a researcher who’s studying how Zika spreads. He called it a "smart virus" because of this fact: It’s estimated that 80 percent of those who contract Zika don’t show symptoms. I wore bug spray constantly most of the first three weeks I was back in the US, but part of that was because I thought I’d been infected — I felt a bit like a walking biohazard. If I hadn’t known I probably had Zika, I can’t say that I would have been so careful.
I’ve been working in journalism through a few international disease outbreaks now (which are, in fact, more common than in the past), and what I’ve noticed is there’s so much fear of the viruses, but not a lot of public knowledge. Zika is not Ebola — I barely felt sick while I had it. But the sense of fear, and a lack of control, remains. We need more information, and a system in place to identify cases in recent travelers — maybe even a reminder at the customs line to wear bug spray for two to three weeks. If Zika is smart, shouldn’t we aim to be smarter?
Gracie McKenzie is a journalist based in Washington, DC. Find her on Twitter @graciemckenzie.