Outbreak of West Nile virus grips Israelis, Palestinians


HOD HASHARON, Israel - In a land coveted over the centuries by numerous foreign powers, Israel constantly prepares itself for any present or future threat, from terrorists with pipe bombs to nuclear-tipped missiles.

But the nation now stands virtually defenseless against a deadly agent borne by nature.

From mid-August to November, hundreds of millions of birds cross Israel as they migrate from Europe to the warmer African climates. Some of them carry the West Nile virus.

The virus is picked up by mosquitoes and spreads quickly to humans, causing sickness ranging from a severe, flu-like symptoms to deadly encephalitis, or inflammation of the brain.

This year, Israel is in the grip of a particularly severe outbreak of the disease, triggering a health crisis that competes for headline space and talk-show time with political turmoil and the Israeli-Palestinian peace process.

As of yesterday, 120 cases had been identified, hundreds more are suspected, and eight people have died, enough to alarm Israel's ordinarily edgy population of 6 million and direct thousands of calls to government offices.

"By now, we're on the verge of an epidemic," said Dr. Moti Ravid, director of medicine at Meir Hospital in Kfar Sabaa, which has treated more than 20 cases, two of them fatal. "It's a hell of an outbreak."

No cases have so far been reported in the West Bank or Gaza, according to Palestinian authorities, who are nonetheless working to curb their mosquito population. Officials there were quick to blame Israel for the threat, saying water runoff from Jewish settlements draws mosquitoes.

Apparently originating in Africa, the disease was first identified in the blood of a patient in West Nile province, Uganda, in 1937. Outbreaks have since occurred in 17 countries, including a serious one in New York last year.

The elderly and weak and those with heart problems are at greatest risk of serious complications. Of those who died, seven were close to 80 years old.The latest victim, a 54-year-old woman, suffered from a disease that suppressed her immune system, officials say. Patients often become comatose before dying.

For the young and healthy, West Nile virus causes fever, head and muscle ache and a severe sore throat. One 33-year-old woman, Yifat Elyda, told Israel television she got such a bad case that she was hospitalized and is now in a wheelchair, but doctors give her good chances of recovery.

Beyond treating the symptoms with painkillers, anti-fever medication and fluids, doctors are at a loss. "There is no drug which can arrest the multiplication of this virus and there is no immunization to date," says Ravid.

The reason for this year's outbreak is still a mystery.

"We don't know exactly why the disease is appearing now," said Yossi Inbar, deputy director general of the Environment Ministry. One theory is that the migratory period began earlier than usual.

But Israel does not have more mosquitoes than normal, he said. Mosquitoes multiply in standing water, and this has been a dry year even by Israeli standards.

Still, in the absence of a medical form of prevention or cure, wiping out mosquitoes is the only way to fight the disease. And this has pulled the nation into an angry debate, pitting ministries against local authorities and environmentalists against health professionals.

"The effort to deal with the spread of the West Nile virus has in the past few days turned into a confused and uncoordinated campaign by various authorities, a situation that only heightens the public's fears," the newspaper Haaretz editorialized.

The main battlegrounds are towns such as Hod Hasharon, in central Israel, a patchwork of dense communities surrounded by irrigated agricultural land that feeds streams of waste water.

The Environment Ministry initially balked at the kind of spraying local authorities wanted to carry out, called "fogging," where insecticides are sprayed from cannon-like trolleys pulled through towns by jeeps.

The ministry said this method only killed adult mosquitoes and its effects would only last a few hours. The best way to combat mosquitoes is to spray breeding grounds to wipe out the larvae, its officials say. They noted pointedly that they alerted local authorities to the danger of the disease in May.

This town's municipal exterminator, Ofer Ben Zvi, was initially reluctant to defy the national government for fear of losing his license. But Mayor Ezra Binyamini told him, "You do it, and I'll be responsible."

By the time Ben Zvi got the town's old sprayer repaired, the government had relented. As of yesterday, 24 municipalities had received authority to spray, although even more want to do it.

The spraying, however, triggered a public panic worse than the disease itself.

Ben Zvi said it reminded him of the the 1991 gulf war, when Israel came under Iraqimissile attack.

Residents flooded his office with calls, asking if they should don gas masks or go into bomb shelters as they did in 1991. In the gulf crisis, 13 Israelis died: two from the missiles, seven from faulty use of gas masks and four from heart attacks.

Exterminators are taking note of people with particular health problems and steered clear of their immediate neighborhoods.

Two vehicles are used. One with a loudspeaker tells residents to stay indoors with their windows shut; the second pulls the sprayer. In Hod Hasharon, half the town was sprayed Wednesday night and the other half yesterday.

Ben Zvi says the spray "is not a thing I want my son or daughter to breathe all the time. It's not the healthiest thing."

He acknowledges that the town may have been too late this year in searching out heavy concentrations of mosquitoes, and says next year they will "start very early."

Ravid, at Meir Hospital in nearby Kfar Sabaa, says no one has been hospitalized from the effects of spraying. "We haven't even seen allergies," he said.

And he's all for aggressive eradication. "A modern country should get rid of its mosquitoes," Ravid said.

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