The deadly EV-D68 enterovirus epidemic, which struck thousands of kids this fall, was likely propelled through America by President Barack Obama’s decision to allow tens of thousands of Central Americans across the Texas border, according to a growing body of genetic and statistical evidence.
The evidence includes admissions from top health officials that the epidemic included multiple strains of the virus, and that it appeared simultaneously in multiple independent locations.
The question can be settled if federal researchers study the genetic fingerprint of the EV-D68 viruses that first hit kids in Colorado, Missouri and Illinois to see if they are close relatives to the EV-D68 viruses found in Central America.
Officials ”have to do the genetic analysis” to disprove or prove the link, Nora Chapman, an enterovirus scientist at the University of Nebraska, told The Daily Caller.
But there’s already more than enough statistical evidence for American citizens to demand that scientists test the viruses to see if Obama’s progressive border priorities spread the dangerous contagion throughout the country during 2014.
So far, that virus has been found in nine people — including at least three American kids — who died from illness. It has apparently inflicted unprecedented polio-like paralysis in roughly 50 kids, and it has put hundreds of young American kids into hospital emergency wards and intensive care units throughout more than 40 states. Most of the dead have not been publicly identified.
A series of government researchers, health experts and academics refused to comment, or else urged self-censorship, when they were pressed by TheDC for statistical and scientific data that would exonerate Obama and his deputies.
“I would just steer away from that— it is not helpful, so why bring it up,” said Lone Simonsen, a professor at George Washington University’s Department of Global Health and the research director of the university’s Global Epidemiology Program. “A better angle [is] ‘We’re just learning what this outbreak is all about,'” she told TheDC.
Columbia University researcher Rafal Tokarz, one of the nation’s top experts on the EV-D68 virus, declined to comment to TheDC about the impact of Obama’s border policies. “I cannot comment… and at this time it would not be appropriate for me to do so… I would really rather not comment,” he said in email conversations.
The issue is dangerous for scientists because it could spike existing public opposition to the unpopular effort by Obama, Democrats and business-backed Republicans to increase the migration of foreign nationals — including many foreign scientists — into the United States. That inflow is a top priority for the Democratic leaders, who have the power to make life difficult for grant-dependent American scientists who discover politically damaging information.
That sensitivity showed up Oct. 16, when a top staffer for Rep. Luis Gutierrez, a champion of increased immigration from Latin America, denounced the evidence for an Obama-disease link: “Rush [Limbaugh], don’t let facts dissuade you! Enterovirus outbreak likely not coming from immigrants,” Guttierez communications director Douglas Rivlin tweeted, while linking to an article that tried to stigmatize investigations into any possible link.
On Oct. 29, The New York Times produced a vague article about EV-D68’s possible role in the paralysis cases, headlined “Doctors Mystified by Paralysis in Dozens of Children.” The article quoted Mark Pallansch, who heads the viral diseases unit at the federal Centers for Disease Control and Prevention, saying “we don’t have a single clear hypothesis that’s the leading one at this point.” He also said that American kids have less than a one-in-a-million chance of being paralyzed. The Times ignored the possible link to Obama’s border policy.
But public trust in government would nudge upward if there is strong scientific evidence against the widespread concern that Obama recklessly loosed the EV-D68 epidemic. The Snopes.com site tried to debunk the idea, but could only reject it as “problematic.”
The EV-D68 controversy is a weaker version of the Ebola fight, where Obama has opposed stringent federal and state barriers to the arrival of foreign travelers who may be carrying Ebola. The EV-D68 virus is far, far less dangerous than Ebola, but it also may be harder to counter because it has now spread throughout the United States.
There is no vaccine for EV-D68, so health experts expect more victims.
EV-D68 is one of at least 100 types of enteroviruses, although it is considered more threatening than most others.
CDC officials estimate that all enteroviruses cause between 10 to 15 million infections in the United States each year. There are no visible symptoms in roughly 90 percent of enterovirus infections, so hospitals have rarely spent the time and money to actually test for the confirmed presence of particular enteroviruses. Moreover, testing has to be done early, because the viruses are killed as patients recover. The testing that has been done, however, showed that enteroviruses were found in 49,637 ill patients in the United States from 1970 to 2005.
But there were only 26 confirmed EV-D68 infections in the United States during the 1970 to 2005 period.
Overseas, EV-D68 outbreaks are also rare. Since 2008, there’s been a few small outbreaks— 120 people in Japan, and 21 in the Philippines, for example. The Netherlands saw 10 cases in 2012, three in 2013 and eight in 2014. The United Kingdom saw three cases in 2013 and two in 2014 in young kids.
The U.S. EV-D68 infection numbers jumped after 2008, producing 79 confirmed cases between 2009 and 2013, including 47 cases in 2011.
The California A-71 outbreak is suspected to have caused the polio-like paralyzation of 20 kids by February 2014, only a few of which have recovered. CDC researchers identified 23 paralysis cases from January 2012 to June 2014, with a median age of 10, according Dr. Daniel Feikin, chief of the epidemiology branch in the CDC’s viral respiratory diseases section.
But the early 2014 California cluster is likely not linked to EV-D68, Dr. Steve Oberste, chief of the polio and picornavirus laboratory branch in CDC’s Division of Viral Disease, said Oct. 3. “We didn’t see the upswing in [EV-D68-like] respiratory illness until August,” he said.
The big epidemic arrived in August 2014.
That coincides with the big inflow of roughly 40,000 young Central American migrants in the summer of 2014.
“By August 22, our bed capacity was [occupied] beyond 100 percent,” said Dr. Mary Anne Jackson, director of the Infectious Diseases Division of Children’s Mercy Hospital and Clinic, in Kansas City, Missouri. “We had a census of 308 [victims]; one of the very first times ever that we’ve seen a census that high,” she told CDC officials in a Sept. 16 conference call hosted by CDC officials.
By Sept. 3, Kansas City had treated 500 children, almost 100 of whom were treated in the intensive care ward.
In Chicago, “We had such a crush of patients that on September 9 we had to take the extraordinary step of closing our emergency room and putting it on bypass, so closing it to ambulance admissions,” Dr. Daniel Johnson, a pediatric infectious disease specialist at the University of Chicago Medicine Comer Children’s Hospital, said in a phone conference.
Few of the many sick kids were formally tested for EV-D68, partly because the test is slow, expensive and not useful for doctors. That’s because EV-D68 victims get the same general treatment as other enterovirus victims.
By Sept. 8, hospitals in 12 states were reporting cases of EV-D68-like infections.
By mid-September, more tests were being conducted, and 153 patients were fully confirmed as EV-D68 victims in 18 states, including California.
By October , the EV-D68 virus was confirmed in 538 victims in 43 states, said Dr. Daniel Feikin, chief of the epidemiology branch in the CDC’s viral respiratory diseases section. Most of the victims were young children.
On Oct. 24, the number of confirmed infections reached 998. That’s 300 times the infection rate seen in the 33-year period from 1970 to 2003.
But the scale of any outbreak doesn’t reveal its source or cause.
Epidemics happen when populations mix, or when viruses mutate and combine to overcome peoples’ evolved immune defenses, said Chapman, who is a board member of the Enterovirus Foundation.
Disease experts “assume there are many places in the world and in the U.S. where viruses are still contained” in partial isolation, she said.
The researchers collected virus samples and found 74 kids infected with enteroviruses, including 10 kids infected with EV-D68, according to the 2012 study, titled, “Human rhinoviruses and enteroviruses in influenza-like illness in Latin America.”
El Salvador had a disproportionately large share of the enterovirus infections.
The researchers also “identified two cases [in Peru] of EV-A71, an [enterovirus] agent traditionally associated with hand-foot-and-mouth disease, as well as severe neurological and cardiac complications.” The primary author of the paper, Josefina Garcia, works for the taxpayers’ National Institute of Health. She did not respond to emails from TheDC.
But populations don’t share a virus unless they mix.
Since 2011, Obama and his deputies have allowed 170,000 adults, children and youths from Guatemala, El Salvador and Honduras to cross the border and apply for green cards.
Under existing immigration law, Obama could have barred the migration and repatriated the first waves of migrants in 2010 and 2011. He did not block the flow, but instead directed federal agencies to let the growing number of migrants settle throughout the United States.
The migration was rational for Central Americans because it allows them to live, work and study in a peaceful society that provides financial support and opportunity to poor people. It can also be seen as a moral obligation for the Central American parents, because it allows their kids to attend American schools, which gives them a chance to earn a decent living in an increasingly high-tech world.
There’s also no evidence that any migrants knew they were carrying EV-D68, partly because the vast majority of adult carriers are symptom-free. That puts them in the same situation as the American adults who unknowingly carried the virus as the epidemic spread.
Under current practices, officials do not screen temporary visitors — tourists and guest-workers, mostly — for disease, said Jessica Vaughan, policy director for the Center for Immigration Studies. However, applicants for green cards are screened for a few dangerous diseases, such as tuberculosis, Ebola and some sexually-transmitted diseases, she said.
Immigration policy has been incorrectly blamed for previous epidemics. For example, a 2009 rise in pertussis cases was blamed by some people on migrants from Mexico. However, the disease was previously common in the U.S., and Mexican vaccination policies were considered good.
The majority of the 170,000 migrants are working-aged youths and adults, who are unlikely to spend much time with American kids.
But there was also a large number of migrants aged 12 and younger.
The inflow of young kids crossing the border with smugglers or with a parent rose from a few hundred in 2011 to roughly 40,000 in 2014, as more Central Americans recognized Obama’s welcoming policy.
The total inflow has to be calculated from two sets of incomplete federal data.
The first set of data shows the number of children, youths and adults who told federal officials they were unaccompanied children aged 17 or below.
In 2011, border officers “encountered” 993 of these so-called “unaccompanied minors,” said a federal report. Another 10,146 came over the border by October 2012; another 20,805 came over by October 2013; and another 51,705 came over by October 2014. That adds up to 86,049 children and youths.
But few of those migrants were kids. Nearly all were teenagers or young adults.
For example, in the 12 months up to October 2013, only 283 of the 37,759 “unaccompanied minors” were aged younger than six, according to data provided by Pew Research Center. During the same year, 3,162 kids aged 6 to 12 arrived, yielding 3,445 under-13s in one year. Another 7,465 kids aged under 12 arrived by May 31, said Pew.
But Pew’s data from 2013 and 2014 data includes roughly 17,000 “unaccompanied” people from Mexico, who were apparently repatriated.
Still, Pew’s data suggests that only one-eighth, or 10,910 of the 86,049 “unaccompanied’ migrants, were aged 12 or under.
An October government reports that 20,805 “unaccompanied” Central Americans arrived in 2013, and 51,705 “unaccompanied” people arrived in 2014. That’s 72,510 “unaccompanied” people in 2013 and 2014. If one-eighth were younger than aged 13, then roughly 2,500 under-13s arrived in 2013, and 6,500 under-13s arrived in 2014.
The inflow of roughly 9,000 under-13 children from Central America were guided by smugglers or relatives to the Texas border, and then handed over to U.S. border agencies. Obama’s agencies knowingly relayed most of these 9,000 “unaccompanied” kids to their parents or relatives living illegally in the United States.
But a second set of federal data shows that a much larger number of children arrived in so-called “family units” in 2013 and 2014.
These groups consist of at least one adult and at least one child. The vast majority of the “family units” consisted of one women and one or two young kids from Central America.
Roughly 14,855 people came over in 2013 in “family units,” and another 68,445 “family unit” people arrived in 2014, according to federal data. That’s a total of 83,300 “family unit” people, with roughly 40.000 under-13 kids in two years. Only a few hundred migrants were immediately sent home, even though the president has the authority to repatriate them. Instead, Obama’s deputies released nearly all of the parents and kids to travel where they wished, pending their eventual appearance in court.
When the two sets of data are combined, a back-of-the-envelope calculation suggests that 9,000 Central American kids aged 12 and younger arrived by September 2013, and 40,000 more arrived by August 2014.
The Office of Refugee Resettlement at the Department of Health and Human Services has released a list of states where it sent the unaccompanied children and youths. The states included Missouri, Colorado, Illinois and Iowa. But the federal government does not say where the much-larger number of people in “family units” decided to settle during 2013 and 2014.
Immigrants’ advocates said they settled in the many cities that already have resident populations of Central Americans.
The CDC does not provide a detailed breakdown of where the infections and deaths were recorded.
The spread of EV-D68 has been very different from the usual flu epidemics, in which new strains annually sweep across the country from coast to coast, or from north to south.
For example, the H1-NI strain of flu first emerged in Mexico in 2009, and swept through the United States from the south to the north, said Dr. Nelson, a professor at the Johns Hopkins university. The flu “often moves across the country [but] its doesn’t always move in the same direction,” he told TheDC.
But the EV-D68 outbreak is very different, and is compatible with the population-mix option described by Chapman.
On Sept. 12, CDC officials described the outbreaks as geographically separated. “To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced… [and] identified [EV-D68] in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago,” the CDC reported.
The European version of the CDC suggested in late September that the epidemic appeared independently in several locations. “An epidemiological link across the clusters reported in several U.S. states has not yet been established, and it cannot be ruled out that the virus is circulating independently in several locations,” said the European Centre for Disease Prevention and Control. That paper was reviewed by Susan Gerber, head of the CDC’s respiratory virus division in CDC’s viral disease office.
The CDC refused to provide TheDC with any details about the number of EV-D68 infections and deaths in each state.
But government and media reports show the EV-D68 epidemic suddenly appeared in Missouri, Colorado and Chicago in the second week of August, sometimes even before schools opened.
The schools opened Aug. 5 in the city surrounding the Colorado hospital. The outbreak was noticed Aug. 8, once a number of kids were hospitalized with enterovirus-like symptoms tripled, and some were paralyzed. “The majority of our cluster [of paralyzed kids] has shown minimal improvement at this point,” Dr. Kevin Messacar from Children’s Hospital of Colorado, said Oct. 3.
Just several days after schools opened Aug. 11 in Missouri’s Kansas City, the local children’s hospital saw a spike in enterovirus patients. The hospital notified the CDC on Aug. 19 about the problem, which it first noted on Aug. 8. Just after Aug. 21, the Children’s Mercy hospital put out an an alert asking if other hospitals were seeing the same crush of sick kids. “From the emergency medicine listserv, we got multiple [responses] — approximately 10 — that right off the bat said ‘Yes, we are seeing the same thing,’ and we similarly had responses from colleagues on the Emerging Infection Network,” said Dr. Jackson.
Chicago schools opened Sept. 20, but the infection had been noticed a month earlier. “On August 23, CDC was notified by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients similar to those seen in Kansas City,” according to a report by the CDC.
The epidemic quickly appeared at many other hospitals.
In Chicago for example, Loyola University Medical Center also had eight cases in the week starting Aug. 18, also before school opened. In the next week, Loyola had 25 cases and another 40 in the first week of September. “It’s the main problem of our pediatric floor right now,” Anne Dillon, a hospital spokeswoman told the Chicago Tribune in early September.
The outbreaks also appeared in many states, sometimes isolated from the first outbreaks.
By Sept. 8, EV-D68 was found in Utah alongside Colorado, and in Kansas and Oklahoma, between Missouri and Colorado. The disease was found in Iowa and Kentucky, alongside Illinois. But it was also found in Michigan and Ohio, due east of Illinois. And it was detected further south, in Alabama and Georgia.
“Kinley Galbreath, from Hamilton, has spent the past three weeks in intensive care at Children’s of Alabama, where she remains on a ventilator– paralyzed from her arms to her legs,” reads an Oct. 8 TV report from Alabama.
“Her mom, Kim Nichols, has remained by Kinley’s side since the [five-year-old] little girl was admitted to the hospital and diagnosed with the potentially fatal respiratory illness enterovirus D-68.”
Speaking exclusively to ABC 3340, the mother said: “As she was getting ready to doze off, she said ‘Mommy, my hands are going numb,’ and by that point she started to lose movement in her neck.”
“On the third day is when she lost movement from her legs down,” her mother continued. “The only thing she’s had control of has been her toes. And that’s what she wiggles to let me know something’s wrong. And she’ll blink her eyes for yes, and won’t blink her eyes for no.’”
There are three genetically distinct subtypes of EV-D68. These subtypes are technically called “clades” and all three are apparently contributing to the 2014 epidemic.
TheDC asked Oberste — the top CDC official — if all three clades are involved in the epidemic.
“In the current outbreak, there is one major group/clade which contains the vast majority of viruses, a minor group/clade that is related to the major group, and an outlier group/clade that has only a few viruses in it,” the CDC replied.
That’s critical information, because viral epidemics are usually powered by one new variety of a familiar virus. For example, the annual flu epidemics usually consist of a new mutation of an older flu virus. Because it is new, it bypasses immune responses that people acquired during prior flu waves, and then quickly jumps from person to person across the United States.
If confirmed, the presence of many strains would be further evidence that a population movement triggered the outbreaks, said Eden Wells, an assistant epidemiology professor at the University of Michigan’s School of Public Health.
The single-virus explanation was offered by Tokarz in the Oct. 2 issue of The New York Times. A “hypothesis of mine is that the strain that’s circulating now probably is a novel variant,” he said.
But Tokarz’s suggestion that the epidemic is powered by a single mutated strain is undermined by Oberste’s admission that the epidemic has three strains.
When CDC officials were asked by TheDC to explain this multi-city, multi-strain anomaly, they waffled: “There is no evidence that unaccompanied children brought EV-D68 to the United States; we are not aware of any of these children testing positive for the virus,” Oberste replied.
Oberste’s declaration that the CDC has not found a link is very different from saying that there is no link.
Chapman, of the Enterovirus Society, is agnostic. The epidemic may have been caused by a combination of population mixing and the emergence of a new mutation in a single strain of EV-D68, she said: “It is probably both.”
Viruses mutate at predictable rates, allowing scientists to track the virus’s changes, geographic movement and, sometimes, their precise origins.
This year, more than 50 American and African scientists tracked the movement of the Ebola virus from Guinea into Sierra Leone in May 2014. The study examined viruses from 78 patients in Sierra Leone, and determined that the virus arrived in the country among mourners who attended a funeral in neighboring Guinea. The virus samples from the dead were first killed, then fragmented into billions of pieces, then mixed together, and then reassembled and detailed by gene-sequencing machinery in Cambridge, Mass.
In 2009, CDC scientists used similar technology to trace the H1-N1 virus back into Mexico. “Of the Mexican cases, 18 have been laboratory confirmed… as Swine Influenza A/H1N1, while 12 of those are genetically identical to the Swine Influenza A/H1N1 viruses from California,” the World Health Organization reported in April 2009.
Tokarz has done similar work with the EV-D68 virus, and used a 2012 article to show the variety of strains within its three major clades. “The diversity within each of the three primary clades appears to have arisen only recently, with [origin dates] of 1997 and 1999 for clades A and C, respectively, and of 2007 for clade B,” he wrote in a 2012 article. Tokarz also looked to EV-68 outbreaks in Asia, Europe, Africa and North America — but not southern America —and reported that “based on the data currently available, the USA appears to have been a source for much of the [international] EV-D68 diversity that we have sampled,” he wrote.
Theoretically, scientists can use the same fingerprinting techniques to track the viruses in the 2014 epidemic back to their sources, said Chapman.
But the EV-D68 family of viruses mutates rapidly, and many strains are already widespread in the population, so it may be difficult to track the 2014 epidemic back to its origin, she said.
Finding the source via genetic fingerprinting may be difficult, said Wells: “Viruses do change often enough, so it it made be difficult to say what came first… I’m not certain we’ll find a smoking gun.”
So far, the CDC has mapped the complete genome of one EV-D68 virus taken from a U.S. victim, and has partial maps of viruses from several more U.S. patients, said Oberste, the CDC’s official. The gene maps are available at the CDC’s Genbank website.
“We are currently assembling all available EV-D68 sequences so we can analyze the relationships” among the various strains, Oberste told TheDC. “We are working on a comprehensive analysis for publication.”
But officials waffled when TheDC asked if they would compare the U.S. 2014 strains to the Latin American samples collected in the 2012 survey.
“The regions of the virus genome that were sequenced in the  Virology Journal paper are not the standard genome region for enteroviruses (and they are not regions that provide sufficient resolution to look at detailed relationships), so the Latin American viruses cannot be directly compared with our current data,” he said.
In prior outbreaks, when there was political consensus for an investigation, researchers actively looked for untested virus samples and reanalyzed older virus samples to complete the fingerprint matching.
So, Which Is It?
There’s plenty of evidence from government agencies and from doctors that the epidemic suddenly appeared in many places after the arrival of the 40,000 young migrants in the summer of 2014, and that it included many strains of EV-D68.
Scientists likely can use gene-sequencing technology to disprove or prove any genetic link with the EV-D68 samples found in Latin America, or differences to viruses found in the United States before 2009.
“It is early to draw conclusion or to make associations, certainty about causation…[although] I totally understand why people are trying to reach for associations,“ Wells said.
But that’s not a priority for the government-funded researchers. “The interest right now is to understand the behavior of the virus and whether or not this virus has changed its infectiousness or its virulence, its severity, since the previous years… that’s No. 1,” said Wells.
“Our issue is not to say ’It came from here or there or wherever.’”