The Not-So-Common Cold: Enterovirus D68

Cold-and-flu season is well under way in California, but this fall, young children in Southern California are being exposed to a different kind of runny nose. Enterovirus D68, also known as EV-D68, was first identified in the state of California in the winter of 1962, when four children were hospitalized with respiratory symptoms that imitated the likes of pneumonia and bronchitis. Since then there have been few cases throughout the United States. However, it has recently become a cause for concern as increasing numbers of children are contracting the virus and dying nationwide.

The sudden increase in cases of EV-D68 across the US is a cause for concern for parents nationwide.
The sudden increase in cases of EV-D68 across the US is a cause for concern for parents nationwide. Source: butterbin.com

This is especially worrisome because these otherwise healthy children have shown no previous signs of weak immune systems. Eli Waller, a four-year-old boy from New Jersey, has been the most recent death as confirmed by the Centers for Disease Control (CDC) on September 25, 2014. According to both medical practitioners and his family, Eli Waller was fully asymptomatic, meaning he lacked typical enterovirus symptoms, before he passed away in his sleep that night. Since his death, over 500 people in over 43 states and the District of Columbia have been diagnosed with the disease, and most of them have been young children. The disease is especially detrimental to children with asthma.

Also disquieting is the fact that Enterovirus D68 has mutated to exhibit polio-like symptoms, such as numbing and limb paralysis. Muscle weakness is also a common symptom of the mutated strain, and this symptom often remains with the affected individual if he or she survives. Often cases are being mistaken for the common cold or flu, since preliminary symptoms are extremely similar. Parents may not be taking their children to get tested because they do not realize the possible threat of EV-D68. Still, the threat is significant, as the viral infection is airborne and has the potential to rapidly proliferate through Californian youth through coughing, sneezing, and touching contaminated surfaces. While the CDC urges parents to seek out professional health care if their children have even basic cold symptoms, parents likely do not do so because they are unaware of the threat of lasting polio-like effects.

At the root of the problem is the uncertain source of this polio-like strain of EV-D86 and its sudden prevalence in southern California. The last case of polio in the United States was recorded over three decades ago, so the seemingly random surge of this mutated respiratory illness is a source of unease for many citizens. Others argue the spread of EV-D68 is no random coincidence and actually has much broader policy implications; this group contends that this strain of Enterovirus D68 is directly correlated to the influx of undocumented immigrant children from Central America.

An October 2013 study published in Virology Journal found that EV-D68 affected three percent of 3,375 young children infected with a respiratory illness in Central America. While there was no major geographic variation between Central American countries, El Salvador and Nicaragua stood out slightly above others. Although this study was published in 2013, there is no reason to believe the number of cases in Central America has decreased. This is a strain that even the advanced medical field in fully developed countries fails to completely comprehend, much less the health care professionals in lesser developed countries. The recent increase of cases in the United States was exposed shortly after the Obama administration allowed for 37,000 Central American undocumented immigrant children to cross over the border without any health screening, spurring outrage against President Obama’s alleged leniency on illegal immigration, but this time out of an ostensible concern for public health. Talk-radio host Michael Savage, a graduate of UC Berkeley with a degree in epidemiology, loudly opposed this act by the US government, claiming that “the American people are being lied to by the Centers for Disease Transmission. They used to be the CDC; they’re now the CDT.” Savage continued to criticize the Obama administration’s lack of “common sense” for essentially causing an epidemic due to a lack of health screening.

California is the third state with the most undocumented children relocated there by the federal government (a total of 3,909). Because families have not been told where exactly these children have been placed within California, critics have more ammunition. Conservative critics of Obama’s immigration policies vocalize their distrust for the federal government and its lack of transparency, while also project greater hostility onto undocumented immigrants. However, this conservative angst is misinformed and finds only a scapegoat in undocumented immigrant children. A majority of factors outside illegal immigration contribute to the surge of EV-D68 cases in the United States, such as defiance of hand hygiene, which children often do. EV-D68 is contracted through contaminated surfaces, just like the common cold, which could explain its prevalence in young children. Similarly, many conservatives associate the spread of EV-D68 with the allowance of undocumented children in public elementary schools, which they believe explains the rising trend of EV-D86 among children rather than adults. However, it must be noted that young children are generally more susceptible to diseases than adults due to their lack of immunity. EV-D68 is essentially a viral respiratory illness, which adults have a higher natural protection against, just from their age and previous contraction of similar infections. Although EV-D68 has evolved polio-like effects, the respiratory symptoms are preliminary, and since adult antibodies can more easily fight these symptoms, those affected may never experience the acute paralysis symptoms before the disease leaves the host.

Whether or not the spread of EV-D68 is actually related to the relocation of undocumented immigrant children remains unclear. Furthermore, health professionals simply do not understand the disease well enough to substantiate such bold claims. While the correlation may exist, heaping the full blame on illegal immigrant children is simply unjust. Many other factors could be at play as well; health professionals simply need to determine these factors to analyze the full extent of the problem. Regardless, many conservative voters have clung to this problem, and the spread of EV-D86 cases provides a convenient outlet for blame on both undocumented immigrants as well as on the Obama administration. Most conservatives are focusing on the disease as a political issue and should instead pay more attention to it as the public health threat that it really is.

Politics are overwhelming this issue of public health. The only conclusion to be drawn from the increase of EV-D68 cases in California and other states is that EV-D68 poses a potentially serious public health challenge to the United States. Although the correlation between EV-D68 cases and undocumented immigrants may exist, a slew of other factors may be similarly involved, and undocumented immigrants provide a convenient place for blame. However, the way to address the issue is through an approach concerned with sound public health responses, rather than political opportunism.