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3 reasons agents should care about adult Zika paralysis

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The Florida Department of Health today reported finding 15 new cases of state residents who dragged Zika infections into their communities from some other place, and one new travel-related case in Palm Beach County.

In other words: It’s possible that mosquitoes are spreading Zika within an easy drive of Palm Beach, a town where Republican presidential contender Donald Trump owns the Mar-a-Lago Club.

The health department has confirmed that mosquitoes really are spreading Zika from person to person only in Miami Beach and Wynwood in Dade County, Florida, but it has already found 43 “nontravel-related” cases of Zika. That seems to increase the odds that mosquitoes could carry Zika to the other warm, humid areas that are popular with mosquitoes by the end of the next summer.

Most media coverage has focused on the terrifying effects Zika can have on the fetuses of pregnant women who are exposed to Zika.

Related: Zika virus does cause birth defects

But researchers have found signs that Zika could also lead to memory and learning problems in adults, and temporary or permanent paralysis in adults, through a condition called Guillain-Barre Syndrome.

Related: Catastrophic disability coverage: What and who is it for?

When the body recovers from some infectious diseases, the immune system leads to the syndrome by going too far and starts attacking the nervous system. The patient may start by feeling tingly toes and, in extreme cases, suffer paralysis so severe that simply blinking an eyelid is impossible.

Last week, health officials in Puerto Rico reported that a patient has died there from Zika-related paralysis. Puerto Rico has already more than 10,000 laboratory-confirmed cases of Zika, and, especially in people who are not pregnant and not included in aggressive general testing programs, the ratio of people who have Zika to the number tested for Zika may be about 10 to 1. Officials have estimated that 25 percent of the commonwealth’s 3.5 million people could have had Zika by the end of the year.

If there are about 100,000 people in Puerto Rico who have already had Zika, 800,000 more people there get Zika by December, and the people who get Zika during the rest of the year are about as likely to develop Guillain-Barre Syndrome as the current patients, then Puerto Rico could record 240 additional patients with the syndrome by the end of the year, or about 1 case per 12,000 people. 

In the mainland United States, seven of the 2,517 people with confirmed cases of Zika infection reported to the U.S. Centers for Disease Control and Prevention have also had Guillain-Barre Syndrome. That means that about 1 in 360 the mainland U.S. patients with confirmed Zika infections have had Gullain-Barre Syndrome.

For a look at why that potentially paralyzing condition could be of interest to agents who sell health, disability, life or long-term care insurance, or some types of medically underwritten supplemental health products, read on:

Many working-age adults have posted YouTube videos about their experiences with Guillain-Barre Syndrome. Here’s a video posted by Jahmila Daniele, a woman who survived a battle with the condition in 2014. 

1. Zika-related Guillain-Barre Syndrome could affected working, insured adults.

Guillain-Barre Syndrome normally affects about one U.S. resident per 200,000 to four U.S. residents per 100,000 each year. Researchers have estimated that, in places like French Polynesia, the strain of Zika that appears to be causing the current outbreak in the Americas led to about one case of Guillain-Barre syndrome per 5,000 to 6,000 people.

Officials in Puerto Rico have not given details about the condition of the people with Guillain-Barre Syndrome there, but researchers in a community in Colombia said that, from December 2015 through March, 15 of the 19 patients with the Zika-related Guillain-Barre Syndrome they saw needed mechanical ventilators to breathe.

When the patients in the Colombia study were discharged from the hospital, 15 still needed help with breathing, were unable to walk at all, or suffered both from an inability to breathe unaided and an inability to walk.

In the past, U.S. adults who have recovered from cases of Guillain-Barre Syndrome resulting from causes other than the Zika virus have posted videos about being perfectly healthy one day and completely paralyzed a few days later. Many report having to go through many months of rehabilitation to get back to normal.

And the incidence of Zika-related adult and child paralysis could be comparable to the incidence of polio-related paralysis in the 1950s. In 1952, for example, a big polio epidemic led to temporary or permanent paralysis in about one in 6,000 people.

A 2014 research paper shows that the United States gets about one new spinal injury case per 25,000 people per year, and about one new case of multiple sclerosis per 30,000 people per year. Those figures suggest that even the kinds of Guillain-Barre Syndrome case numbers Puerto Rico is already experiencing might be high enough to get the attention of disability insurance issuers. 

Related: Zika and paralysis in adults 

In some cases, the existence of Zika-related Guillain-Barre Syndrome may make the application process a little slower. (Image: Thinkstock)

In some cases, the existence of Zika-related Guillain-Barre Syndrome may make the application process a little slower. (Image: Thinkstock)

2. Guillain-Barre Syndrome can complicate the sale of any product that involves thorough medical underwriting.

The Social Security Administration regards long-term impairments resulting from Guillain-Barre Syndrome as something that could qualify a worker to collect Social Security Disability Insurance benefits, but simply having Guillain-Barre Syndrome itself is not an automatically qualifying condition, according to an analysis by Disability Benefits Help, a Boston-based law firm.

Commercial insurers often look closely at any information about Guillain-Barre Syndrome, along with “post-polio syndrome,” when reviewing applications for medically underwritten products. Toronto-based Sun Life considers information about both conditions carefully when it’s reviewing an application for long-term care insurance, for example.

Having post-polio syndrome leads to an automatic decline, according to a copy of a field underwriting manual posted on the Web.

An applicant who had Guillain-Barre Syndrome once, recovered, has been stable for at least six months and has no lingering limitations on activities or neurological impairments can get coverage. Applicants who still have chronic or recurrent problems related to the syndrome cannot get coverage, according to the manual.

Even if the number of people who actually end up getting Zika-related Guillain-Barre Syndrome turns out to be small, increased insurer awareness of the syndrome could lead to more questions about the syndrome or requests for more documentation of good neurological health. 

Related: 10 ways to avoid the LTCI decline plague

Some people with Zika-related Guillain-Barre Syndrome may need months of rehab before they can regain the ability to walk. (Photo: Thinkstock)

Some people with Zika-related Guillain-Barre Syndrome may need months of rehab before they can regain the ability to walk. (Photo: Thinkstock)

3. The rise of Zika-related Guillain-Barre Syndrome could force health insurers, disability insurers and other issuers to think hard about skilled nursing facility and rehabilitation benefits.

Many health insurers and other types of insurers put patients who use inpatient hospital or rehabilitation services for long periods through extra layers of review, based on experiences with elderly patients who are unlikely to show much improvement after being treated for three months, and experiences with younger patients with spinal cord injuries who are unlikely ever to overcome injury-related paralysis with current medical technology.

People with severe cases of Guillain-Barre Syndrome, in contrast, may need many months of therapy to recover, and they often recover well enough to return to work.

Producers who help clients with policy service issues may find they get questions about whether plans are paying for the right kinds of rehabilitative care or return-to-work support.

Insurers have already started to wrestle with Guillain-Barre Syndrome coverage questions.

Hartford-based Aetna has developed a set of Guillain-Barre Syndrome treatment guidelines that’s up for review this week. Its guidelines focus mainly on recommendations for acute care but say exercise may help control pain.

Indianapolis-based Anthem, for example, says it will consider acute inpatient rehabilitation medically necessary for patients with disorders such as Guillain-Barre Syndrome that involve at least two extremities and significant impairment, as long as the weakness “is not limited to a qualitative difference since a prior inpatient admission.”


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