Louisiana was close to a success story for the number of babies with syphilis. Then came the pandemic. | Coronavirus

On any given weekday, state health worker Kenneth Nash might spend hours driving across Rapides Parish, looking for women in apartment buildings, under I-49, in a Burger King or at the Salvation Army.

With every stop, Nash is trying to put a face to a name that’s been flagged for testing positive with syphilis while pregnant. Left untreated, syphilis can transfer to an unborn child, resulting in blood abnormalities, organ damage, bone deformities, blindness, stillbirth or death shortly after birth.

He’s part of a field team that tracks down every known pregnant syphilis case. In 2016, Louisiana had the highest rate of babies born with syphilis in the country. The Centers for Disease Control and Prevention gave the state a one-time supplemental fund of $550,000 to help combat the epidemic. The cash helped drive down the rates, moving the state’s ranking from worst to No. 7 in 2020, according to a CDC report released earlier this month.

But lately, despite the funding and renewed efforts, Louisiana’s rates have soared higher than ever before.

In 2021, syphilis cases among newborns rose 67% from the year prior, according to preliminary findings from the Louisiana Department of Health, from 63 cases in 2020 to 105 in 2021.

That’s a stark contrast to 2009, when there were just 11 babies born with syphilis in Louisiana, according to a Louisiana Department of Health report.

Every diagnosis of congenital syphilis is considered a “sentinel event,” an avoidable disease suggesting public health systems are failing. But what often awaits Nash – pregnant women who are struggling with lifelong poverty, mental illness, addiction and homelessness – is more than a budget bump can repair after the pandemic. In its wake, years of progress have been erased.

“When COVID hit, that’s when we started to see the spike in cases of congenital syphilis,” said Nash.

The increase represents an enormous backward slide for a state that had started chipping away at the issue through targeted efforts: field visits, massive education efforts, walk-in treatment, keeping the antibiotic treatment in stock and even providing the shots in a patient’s preferred location .

Louisiana’s rate of syphilis among babies in 2021 is now over 20 times the national average, the latest data show.

In Rapides Parish, where Dr. David Holcombe is health director, the number of babies born with syphilis increased from 9 to 23 between 2020 and 2021. Nearly all have something else in common.

“There’s almost always poverty,” said Holcombe. “Poverty is just there and it’s always there.”

Overdoses have also surged in the parish and have risen 35% in a year in Louisiana. Nationally, overdoses have risen about 12%, according to the CDC.

“It’s been a perfect storm of circumstances,” said Dr. David Holcombe, health director of the Alexandria area. “Drug use and overdose deaths have skyrocketed … Problems of medical care, clinical disruptions, problems associated with substance abuse have also contributed.”

If someone like Nash can get to a woman at least 30 days before her due date, it’s likely a lot of the complications the infant might face can be prevented with three weekly shots of penicillin. Otherwise, alarming fates await: Among pregnant women with active infections, there is a 25% risk of stillbirth, a 14% risk of neonatal death, a 41% risk of giving birth to a live but infected infant and only a 20% chance of giving birth to a healthy, uninfected infant.

Often, the women are facing challenges that are difficult to overcome.

In a study of Baton Rouge women and medical providers published last year by researchers at Tulane University and LSU Health Sciences Center, doctors indicated they were familiar with screening protocols and identifying syphilis. But the women, all of whom were identified as high risk based on factors like incarceration, poverty, substance abuse or homelessness and had also recently been pregnant, laid out a litany of challenges, even when they tried to pursue medical care.

Women would go months without Medicaid, even though they were applying and often already several months pregnant. Others said doctors wouldn’t take them as patients if they were past the first trimester.

All of the women – 42 in total – had some knowledge of syphilis, researchers found. But few understood how it might endanger their baby.

“I just know if you’re not pregnant, it can make you sterile or you won’t be pregnant because of the medications they give you,” a woman in a focus group said. “As far as pregnancy, no doctors have discussed … pretty much any STD with me.”

Louisiana does not have required sex education, and if it is taught, state law demands the emphasis be on abstinence. There are also fewer family planning clinics and public health clinics than there once were, a result of massive cuts to public health funding by Gov. Bobby Jindal’s administrationsaid Gloria Giarratano, a study author and professor of nursing at LSU Health who ran the focus groups.

A lot of the women, who were interviewed right before the pandemic, said their partners couldn’t get the same STD testing because it was only offered to pregnant women. That was a problem, because a person can be re-infected after treatment.

“It was just hard to believe sometimes, even though you’ve heard it – you’re in Louisiana and you know what the environment’s like – to hear that it takes a long time for a partner to be tested and treated even when we know something’s wrong?” Giarratano said.

The overall number of cases last year – 105 babies – might sound small, but congenital syphilis is like the “canary in the coal mine,” Giarratano said. It means there are more sexually transmitted infections lurking, and there will be a ripple effect in the population as a whole.

“There shouldn’t be any, is the thing,” Giarratano said. “It’s a preventable disease.”

National requirements stipulate three efforts – a letter, a phone call and a home visit – for women who test positive for syphilis while pregnant. That’s not nearly enough to find most people in Louisiana, said Nash, the disease intervention specialist.

He spent a recent Tuesday visiting four different addresses he found for a new case. At the last address, where he pulled in at 7:30 pm the night before a big storm blew through, the patient’s mother told him she was in jail. Nash estimates he’s spent thousands of hours trying to track people down.

“You just kind of have to work that case the best way you can work it,” said Nash. “We’re scheduled from 8:00 to 4:30, but if that means making a field visit at 7:30, you just have to do that, because we’re just trying to catch this patient.”