Editor's Note: (Laurie Garrett is a Senior Fellow for Global Health at the Council on Foreign Relations, and a Pulitzer Prize-winning writer. The opinions expressed in this commentary are hers.)
(CNN) Zika is here, in the USA. Fasten your seat belts because we're in for a bumpy ride.
Local mosquitoes in the Miami area are carrying the Zika virus, and have infected at least four Floridians. In announcing this alarming news during a press conference Friday morning, Gov. Rick Scott, a Republican, added a sharp warning: "This is not just a Florida issue. It's a national issue -- we just happen to be at the forefront."
Now all the falderal typical of American outbreaks will commence: Political posturing, hysteria versus naysaying, conspiracy theories, demands for safety and care and a daily mounting toll of identified cases. And this year the hoopla will unfold against the background of one of the ugliest, most deeply divided election years in modern history.
In Washington, House Republicans are likely gambling that the United States outbreak will be relatively mild, and GOP denunciation of the Obama administration's failure to swiftly juggle budgets to conjure funds for fighting the virus will garner public support. In the White House, the opposite is the case: Officials assume a severe outbreak is unfolding, and blame GOP refusal to allocate new money for the current vulnerability to the mosquito-borne disease across southern states.
But please, Mr. Trump and Secretary Clinton, do not add Zika to your list of crazy political talking points.
Four individuals in Florida's Miami-Dade and Broward Counties have come down with Zika infections, with no evidence of their having traveled to an area, such as Brazil, that has a florid epidemic, or of having sexual intercourse with a partner who so-traveled.
While Florida public health investigators scour the counties in search of infected local mosquitoes and other people showing Zika symptoms, the Food and Drug Administration is playing it safe, calling for a halt of blood donations collections in the area. The Zika virus can be spread by Aedes aegypti mosquito bites, sex and blood transfusion. Zika can also be found in human urine, semen and saliva, and Florida authorities are now collecting urine samples from family members and neighbors of the four identified cases, hoping to determine how widespread infection may already be in the area.
Skeptics will want scientists to capture infected mosquitoes, prove that they carry Zika and demonstrate that the insects caused the four identified cases of the disease: This is nonsense. For more than a year, scientists with Brazil's premier health sciences institute, Fiocruz have collected mosquitoes, smashed them up in the lab and studied DNA in search of Zika virus genes -- only days ago, on July 22, were they finally able to announce that of the 1,683 mosquitoes of various species captured in and around Rio during the city's huge epidemic fewer than three pools of aegypti (out of 198 pools of insects) contained Zika DNA.
If finding a virus-containing mosquito is the necessary proof for action, thousands of humans could get Zika disease before disease detectives identify the smoking guns. Florida's Gov. Scott acknowledged this, saying scientists are chasing mosquitoes, but tough public health action must go forward, regardless.
Zika symptoms of exhaustion, fever, skin rash and flu-like ailments don't occur in everyone -- indeed 80% are asymptomatically infected, meaning Florida could have many more human Zika cases caused by local biting mosquitoes. Florida has identified 386 Zika cases so far, all acquired overseas or via sexual intercourse with a partner who traveled to a Zika-epidemic location: 55 of them are pregnant women. Florida authorities are taking the situation seriously, warning pregnant women not to leave their homes without insect repellent, testing hundreds of urine samples, and hunting for mosquitoes to test for viral DNA.
Scott no doubt saw the threat coming: every health expert knew swampy, mosquito-infested Florida would get hit with Zika first. Like some dreadful slow-motion horror movie Scott and scientists at the Centers for Disease Control and Prevention have for months watched the Zika crisis unfold across Latin America, the Caribbean, Puerto Rico -- all the while expressing exasperation over the lack of congressional approval for federal funds to augment the state's $26 million emergency fund.
Scott said he found Washington's partisan disputes over Zika funding "profoundly disappointing," and his consternation only increased when Congress closed for summer recess, having reached no Zika funding agreement, thereby leaving states to muddle through the nation's peak mosquito season without hope of significant federal support until well after Labor Day.
"The federal government needs to show up and do their part," Scott said this week. By shuffling its budget around, putting other health programs on hold, the U.S. Centers for Disease Control and Prevention found $1.4 million this month for Florida, and is now trying to rob more of Peter to pay more to Paul in the form of another $5.6 million Zika grant.
Meanwhile, the National Institutes of Health is also taking funds from various other research pots to urgently fund pursuit of essential tools for the fight against Zika: a vaccine, treatment, a quick reliable diagnostic test, the clinical dimensions of Zika infection, and ways to determine in utero whether or not a fetus has been infected and/or damaged. Without hundreds of millions of dollars the NIH is executing the efforts on the fly, at the expense of valuable work on other diseases.
All of this is nuts. Think about it: This isn't a sudden surprising pandemic slamming America with no warning -- no, we have been watching it creep our way for months, public health officials have shouted from the rafters, yet Washington postured and shrugged. On Friday the CDC forecast that more than 10,000 pregnancies this year in Puerto Rico could be affected by Zika infections -- ten thousand. Whether you are inclined to support a right to life position or Planned Parenthood the prospect of idly bearing witness to thousands of pregnancies that result in miscarriages or birth defects should enrage.
Brazil's experience offers real lessons -- if any politicians care to pay attention. Though the first cases of Zika disease and babies born with severe birth defects and microcephaly skull malformations were seen in one part of the country in October 2015, the nation's epidemic didn't peak until March 2016, six months later, by then causing 8,000 symptomatic cases per week, spread out over much of the enormous country. (Brazil's epidemic is waning now, as the Olympics approach, with fewer than 200 new cases seen nationwide weekly, as winter sets in and mosquitoes retire into hibernation.)
And what began as a completely mosquito-spread disease morphed into an increasing burden of sexual transmission, accounting for much of the pregnancy tragedies in Brazil. It started as a handful of suspicious births of microcephaly cases in northeastern Brazil less than a year ago and has now spread to more than 50 countries and territories, basically circumnavigating the Southern Hemisphere of the planet.
Four of those countries have possible endemic transmission, meaning that, like Brazil, they are overrun by local mosquitoes that carry and spread the virus. As winter drives southern mosquitoes into hibernation, our northern hemispheric summer is getting hot and steamy.
The mosquitoes are coming. It's our turn now.
CDC Director Tom Frieden told Time that, "We have an unprecedented health threat, and we don't have the robust resources that would enable us to respond most effectively. Without additional resources, this is like fighting a fight with one hand tied behind our backs." Top officials in the Department of Health and Human Services (HHS) have shown me that activating money, transferring it between federal accounts or to state coffers takes months of federal bureaucratic work, as dictated by congressionally mandated accounting procedures.
In the absence of an emergency fund for health akin to special reserves held under FEMA, the CDC and their bosses at HHS cannot swiftly conjure funds for Florida.
But it isn't just Florida. It would be a grave mistake to imagine that Zika will confine itself to the seaside villas of Miami or the suburbs of Broward County. Look out, Texas, Louisiana, Mississippi, the Carolinas, and, yes, the District of Columbia. The pressure Floridians are now applying in pursuit of federal support will swiftly magnify, as counties from Cameron, Texas, to Monmouth, New Jersey, join the din, demanding help from Washington.
Yes, we all know Washington is dysfunctional these days, but this isn't about arguing and refusing to compromise about highway construction -- this is about the nation's babies.
So fasten your seat belts, America -- the curtain is just now raising, and Act One of "Zika Hits the USA" has begun. And hecklers up in the cheap seats will be shouting, "Hey Congress, we told you so!"