HIV and ID Observations

I received an email from someone who’s known me a very long time.

Hint:  She’s known me longer than anyone. Literally.

Here’s the email:

Baseball cancelled in Puerto Rico because of Zika. This story has you written all over it. (To use a cliche.)
Mom

I told you she knew me well!

For those not obsessed with this silly game to the same degree as I, here’s the story: Two games between the Pittsburgh Pirates and Miami Marlins were scheduled in San Juan, Puerto Rico on May 30-31 instead of in Miami.

This two-game series, of course, was planned before anyone had any idea that Zika would arrive and become a major health threat in Brazil, then move rapidly through Latin America and the Caribbean — including to Puerto Rico. Several hundred cases of Zika have been reported Puerto Rico (including one death), and some have estimated that 25% of the population will eventually become infected.

The players on the Pirates and Marlins raised significant concerns about traveling there, and two days ago it was announced that the series would be cancelled as a result. 

Puerto Rico officials were, predictably, highly critical of the decision.

So what was Major League Baseball supposed to do? I can see both sides of this issue.

In favor of cancellation:

• A player could contract the virus and transmit it to his partner. This is of greatest concern, of course, if the woman is pregnant or trying to conceive.
• There’s still no readily available test to see if infection has occurred. A large proportion of infections are asymptomatic. Are these players supposed to wait 6 months before trying to have children? Or have unprotected sex? Seems like a lot to ask.
• There’s a small (but not zero) chance that a player will get either severe clinical Zika (fever, myalgias, and rash) or, even worse, Guillan-Barre syndrome. Bad enough for anyone — baseball player or not — but imagine if this player were a star like Andrew McCutchen or Giancarlo Stanton. (Brief aside: Stanton hit a home run nearly 500 feet the other day. Wow. Watch here.)
• What do the players get out of it? The whole idea of these trips is to promote the game globally — so it’s good for “the game”.  But how about the players? They get paid the same regardless of where the games are played — why should they take this risk?

In favor of playing the games in Puerto Rico as originally scheduled:

• The CDC travel advisory on Zika is limited to women who are pregnant or trying to get pregnant. Not a single professional baseball player falls into this category. Didn’t even have to look that one up.
• The players will be mostly in settings where Zika transmission is highly unlikely. I don’t have their exact itinerary (they don’t typically share this with ID doctors), but it’s safe to assume they would stay at 5-star air conditioned hotels when they’re not playing. A comfortable air conditioned bus (at worst) would take them to and from the game. And though the stadium is old, it’s got to have an air conditioned locker room. Sure, the game itself is outdoors — but only for a few hours.
• They will only be there for three days. For such a short trip, the risk of getting Zika with the above conditions is incredibly small. Maybe almost as small as my chances of hitting a home run nearly 500 feet.
• How different is San Juan from Miami anyway? Virtually all public health officials are predicting Zika transmission in Southern Florida any day now. It might even be happening now — who knows about late May?
• Puerto Rico is the birthplace of several baseball superstars. Plenty of Hall of Famers and near Hall of Famers: Roberto Clemente. Roberto Alomar. (Hey — second time I’m writing about him!) Edgar Martinez. Ivan Rodriguez. Bernie Williams. This is an important pipeline for top baseball talent, we should support it.
• Zika didn’t stop hundreds of baseball scouts and other officials from recently visiting Puerto Rico to see a top prospect. The guy’s name, for the record, is Delvin Perez, a high school shortstop. I’d bet good money he never expected to see his name on this blog.
• They aren’t cancelling the Olympics in Brazil. If thousands of athletes from around the world can go to Rio, why can’t a couple of baseball teams go to Puerto Rico?
• Given what they’re being paid, the players should just do what they are told. The current average MLB salary is over 4 million dollars per year. The aforementioned Stanton has a 13-year, $325 million dollar contract. That will buy you plenty of DEET.

I don’t know whether baseball made the right decision on this one. But I do know that Zika is still so new, and so much is still unknown, that the decision is certainly understandable. With new threats of any sort — infectious or not — our risk assessment instincts are flawed, and typically biased toward fearing the worst.

So let’s give it a few years — Zika isn’t going anywhere, unfortunately. At that point we’ll know a lot more about how it causes disease, and in whom, and maybe even how to prevent it. We’ll certainly have better testing. There will be a “new normal” attitude about a world with Zika, just as there is now with West Nile virus, another mosquito borne virus which didn’t even exist in the Western hemisphere before 1999.

Once that new normal happens, I boldly predict that there will be professional baseball games played in San Juan.

Happy Mother’s Day!