You may be familiar with the idiom, “square peg into a round hole.” It is an expression that is often used to describe something that cannot fit, but yet every effort is made to try and force it to fit. That is the image that is emerging in the quest to find an answer to what is causing the mysterious polio-like condition known as acute flaccid myelitis (AFM)—also sometimes referred to as acute flaccid paralysis (AFP)—in the United States.
The media is now frequently reporting that a virus, specifically enterovirus D68 (EV-D68), is suspected as being the cause of AFM. Some doctors are also pushing the theory that AFM is likely caused by EV-D68. This trend was perhaps best highlighted by a major article last year in The Atlantic magazine titled “The Main Suspect Behind an Ominous Spike in a Polio-Like Illness.” The article’s subheading read, “A common virus seems to be behind a puzzling condition that’s paralyzing children, but uncertainties remain.”1 2 3 4 5
The author of the article in The Atlantic, Ed Yong, quoted Roberta DeBiasi, MD of Children’s National Health System in Washington, DC as saying, “It’s not too far of a jump” to suspect a virus. Then he went on to say that EV-D68 had “emerged as the lead suspect” of the cause of AFM.5
Neurologist Benjamin Greenberg, MD of UT Southwestern and Children’s Health in Dallas, Texas “suspects” EV-D68 as one of the more likely causes of AFMs and neurologist Kenneth Tyler, MD at the University of Colorado in Aurora believes that the “majority” of AFM cases are linked to EV-D68 and he seems to think the CDC has been “exceedingly cautious” in not coming to the same conclusion.6 7 8
Drs. Greenberg and Tyler, as well as other prominent physicians like Kevin Messacar, MD, assistant professor of pediatrics at Children’s Hospital Colorado in Aurora, want the Centers for Disease Control and Prevention (CDC) to settle on an enterovirus such as EV-D68 as the cause of AFM because then, “it could lead more quickly to a treatment or a vaccine.”6 7 8
“I agree that EV-D68 is probably the prime suspect, and the evidence is getting clearer and clearer, but it may be very difficult to prove… ” says infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security Amesh A. Adalja, MD.9
Listening to all of these physicians, one would think that all roads in the search for the cause of AFM lead to EV-D68. It looks like there is a strong likelihood that the CDC may eventually “settle” on EV-D68 or some other virus like EV-A71 or coxsackievirus A16 as the culprit behind AFM even though, currently, there is no compelling scientific evidence for doing that.
In a recent article in STAT, journalist Maggie Fox agreed on the lack of scientific evidence with regard to EV-D68. She wrote, “Doctors who have treated patients with AFM have long suspected that EV-D68 and perhaps other, similar viruses are causing the illness. But it’s been almost impossible to find the evidence they need to say so conclusively… “4
Then why is there a sense that EV-D68 may eventually be designated by the CDC as the culprit? Because there is growing pressure for the CDC to come up with a cause for AFM and viruses are always easy to blame for unexplained health problems. Public health officials and doctors must be getting tired of responding “we don’t know” or “it’s a mystery” when asked what is behind this perplexing paralytic condition that devastates the lives of children and adults who come down with it.
One of these days, when that first big headline is published in The New York Times or The Washington Post or TIME magazine stating that scientists have finally discovered the cause of AFM, remember to bear in mind the following June 2019 update by the CDC on its investigation into the cause of AFM:
We detected coxsackievirus A16, EV-A71, and EV-D68 in the spinal fluid of four of 570 confirmed cases of AFM since 2014, which points to the cause of those patients’ AFM. For all other patients, no pathogen (germ) has been detected in their spinal fluid to confirm a cause.10
More than 99 percent of the paralyzed individuals who have been diagnosed with AFM since 2014 did not have the EV-D68 virus or any other infectious microbe detected in their spinal fluid. Yet, CDC officials may be increasingly inclined to just go ahead and attribute AFM to a virus… even if it is highly improbable, at least with current scientific evidence, that a virus is the cause.
The square peg simply doesn’t fit.
1 EV-D68 cases spiked in 2018, new surveillance shows. Healio Mar. 28. 2019.
2 Cáceres M. Will AFM Quickly Go Viral Like Microcephaly? The Vaccine Reaction Oct. 31, 2018.
3 Carroll L. CDC report finds link between enterovirus D68 and polio-like condition. NBC News Mar. 28, 2019.
4 Fox M. New evidence points to possible cause of puzzling paralysis in kids. STAT June 14, 2019.
5 Yong E. The Main Suspect Behind an Ominous Spike in a Polio-Like Illness. The Atlantic Oct. 25, 2018.
6 Cáceres M. AFM Not Transmissible from Human to Human Says CDC. The Vaccine Reaction Nov. 7, 2018.
7 Ducharme J. Cases of Mysterious Polio-Like Illness Continue to Rise. And Experts Are Frustrated Over a Lack of Answers. TIME Oct. 31, 2018.
8 Karlmanga S. Children across U.S. are becoming inexplicably paralyzed. Some parents and experts say federal officials aren’t doing enough. Los Angeles Times Oct. 19, 2018.
9 Adalja AA. Q&A: Is the CDC’s delay in linking AFM to EV-D68 warranted? Healio Apr. 18, 2019.
10 Centers for Disease Control and Prevention. AFM Investigation. CDC.gov June 24, 2019.