Opinion: Why I’m worried about malaria in the US

Editor’s Note: Arick Wierson is an Emmy Award-winning television producer and former senior media adviser to former New York Mayor Michael Bloomberg. He advises corporate clients on communications and political strategies in the United States, Africa and Latin America. Follow him on Twitter @ArickWierson. Read more opinion on CNN.

Last week, the US Centers for Disease Control and Prevention (CDC) announced a public health advisory that five cases of locally acquired malaria had been identified in Texas and Florida. The Florida Department of Health has since reported two more cases of locally acquired malaria. Although there are an estimated 2,000 cases of malaria in the US each year, mostly contracted during travel, the news from the CDC marks the first time in over 20 years that the deadly parasite has been found to be acquired locally.

What this means, in plain English, is that there are an unknown number of mosquitos in the US are carrying the potentially lethal Plasmodium vivax strain of malaria, enabling it to spread. 

Let’s not mince words: This is a big deal. I know firsthand what can happen when someone fails to recognize and get prompt treatment for the disease; a decade ago, I nearly succumbed to the Plasmodium falciparum strain of malaria while living in sub-Saharan Africa. In my case, which I chronicled in great detail in a blog post, it was my unfamiliarity with the disease and my inability to identify early on its telltale symptoms (which can include shaking chills, headache, muscle aches, tiredness, nausea, vomiting and diarrhea) that put me in a coma for over a week and led to my near renal and pulmonary failure. And it’s this same unfamiliarity with malaria shared by most Americans that worries me the most.

In Angola, where I was infected with the malarial parasite, nearly everyone is highly attuned to the disease and its symptoms. The challenges there are of a public health nature, namely, access to medications and doctors. In the US, however, one of the biggest challenges will be recognizing the disease early to enable it to be treated swiftly.

Fortunately, the country has been considered malaria-free since the 1950s. In effect, this means that several generations of Americans have no memory of what it’s like living in malarial zones and aren’t used to recognizing the disease’s symptoms.

The risk of someone infected with malaria, chalking up a nagging headache to the flu or hoping that the fever and chills he or she is experiencing will eventually pass, could easily become — as it did in my case — a recipe for death.

“Malaria symptoms can present much like many other illnesses, especially in the early stages,” said Kelly Searle, a professor of epidemiology and community health at the University of Minnesota School of Public Health. Searle studies how malaria impacts communities and how it can be eliminated when feasible. “The issue here stateside isn’t treatment per se, but one of awareness. It’s not really on the average American’s radar. The vast majority of Americans that come down with a headache or a fever will not immediately suspect that they have malaria. This delay in seeking medical attention could allow the disease to spread more aggressively both within the patient and, with mosquitos as the vector, within the community.”

But aside from Americans’ lack of familiarity with malaria, what makes the locally transmitted cases in Texas and Florida most worrisome is the risk of American doctors’ inattentiveness to the disease.

Dr. Glenn Wortmann, the director of infectious diseases at MedStar Washington Hospital Center in Washington, DC, with whom I recently spoke about the cases identified in Florida in Texas, indicated that, prior to this recent CDC advisory, doctors would almost never consider malaria as a possible diagnosis for patients who had not recently traveled abroad.

He said that usually, “99.9% of doctors don’t think about malaria as a local disease. We are very cognizant of ‘airport malaria’ — those who may be bringing the disease back with them from overseas travel. But once someone indicates that they haven’t recently traveled abroad, it’s pretty much off the list.”

But patient ignorance about the disease and the potential for some doctors — especially those practicing in places far away from Texas and Florida — to not be thinking about malaria when diagnosing patients may only be part of the problem, and both can be effectively addressed through continued communication and education. What can’t be solved so easily are the structural conditions — both economic and climate-related — which are making malaria’s reappearance in the US so much more worrisome this time around.

As global travel and commerce increases, coupled with an extended mosquito season and an expanding mosquito belt due to global warming, the odds of malaria reinstalling itself in the US are higher than they have ever been in recent decades, experts say.

According to Dr. John Roberts, a Los Angeles-based public health physician for emergency situations at the International Medical Corps with whom I spoke about the matter, “In the public health arena, we often say that the globalized economy has increased the exchange of goods, services … and bugs. But what’s different now is climate change. Rising temperatures are expanding the reach of the anopheles genus of mosquito which is the primary vector for malaria; coupled with increased global trade, the likelihood of malaria being reintroduced to the US is higher than it has been since it was fully eradicated half a century ago.”

“In the public health field, we have been anticipating the reappearance of malaria here at home for quite some time. The only question now is are these five reported cases pretty much it or are they the ‘tip of the iceberg?’ Because this strain of malaria can lay dormant within some humans for quite a while, it may be some time before we know the full extent of the challenge we are up against from a public health perspective,” added Roberts.

My bout with malaria changed my life in so many ways. My brush with death in Africa was a wake-up call to the ephemeral nature of our short time here on earth. For me, life is no longer about making long-term plans and looking ahead to what’s next; malaria showed me that tomorrow is far from certain, and that we should all invest in enjoying the present. Moreover, although I have been fortunate to not have any long-term health consequences, it opened my eyes to this global killer that infects nearly a quarter of a billion people on the planet each year and kills over half a million people. The CDC was wise to get ahead of the issue and alert the media and the medical community of this re-emerging public health threat.

Let’s hope more people are paying attention.

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