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REGINA — Isabel Barnsley doesn't know when it happened. It may have been while she was working in her garden in Abernethy, northeast of Regina, or playing with her grandkids in the yard.
But at some point last summer, a mosquito bit Ms. Barnsley and left behind a virus in her veins, one that ultimately placed her in the ranks of those afflicted with West Nile Neurological Syndrome, the most severe form of a disease that was unknown in Canada until 2002.
Today, Ms. Barnsley, 79, is a paraplegic and needs help from a ventilator to breathe. She communicates with a letter board, a maddeningly slow process for a woman who grew her own vegetables, took solo trips abroad and drove less-spry neighbours to church. And she is one of a small but growing number of Canadians struggling with the legacy of West Nile.
Since making its first appearance in Ontario, the virus has spread west, blipping on and off the public's radar screen according to the number of people affected. This week, both Manitoba and Ontario reported their first human cases of the year.
Isabel Barnsley seen here at a rehabilitation centre in Regina, was bitten last summer and contracted West Nile virus, becoming ill and is a quadriplegic. These days, she communicates with a letter board. John Lehmann/The Globe and Mail
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Last year was the worst in Canada since surveillance began in 2002, with more than 2,000 cases, including 12 deaths, reported to the Public Health Agency of Canada. All but a handful of cases were on the Prairies. Saskatchewan was hardest hit, with nearly 1,500 cases and seven deaths. In Manitoba, four people died and nearly 600 were infected.
“West Nile is here to stay,” says Phil Curry, Saskatchewan's point man on the virus. “It comes back every year to varying degrees. And the levels of immunity are … certainly not as high as we would like them to be.”
The virus was first isolated in Uganda in 1937 and has been present in North America since at least 1999, when the first recorded outbreak took place in New York. It is transmitted to humans by infected mosquitoes, which have fed on infected birds.
In the United States, infected mosquitoes, birds, humans or animals have been reported in every state but Hawaii, Alaska and Oregon. This month, California health officials warned of a spike in numbers of West Nile-infected birds and mosquitoes, saying the risk of humans being infected was the highest in the state since 2004, when more than 700 people were infected and 21 died.
It turns out mosquitoes love a housing crisis. “Green pools” – swimming pools left stagnant and untended as a result of mortgage foreclosures – are one factor in the increase. Mosquitoes lay their eggs in standing water and, for some species, the slimier the better.
Not all mosquitoes carry West Nile. Canada has 74 species of mosquitoes and West Nile has been detected in 10 of them. There is a West Nile vaccine for horses. But there is so far no commercially available human vaccine and no cure.
For researchers, West Nile is part of a bigger picture involving diseases spread by mosquitoes, fleas and ticks and the way that human influences – including deforestation, urbanization, world travel and climate change – affect how and where illnesses appear.
In Saskatchewan, authorities have noticed West Nile cases showing up farther north than ever, close to the edge of the boreal forest. Insects adapt to weather patterns, Mr. Curry says, citing the mountain pine beetles that have munched their way through vast tracts of B.C. forests, partly because the cold has been less prolonged in most winters over the past decade.
Such patterns may be involved in West Nile, as mosquitoes move into new areas or breed more successfully.
Climate change is also being linked to a global surge in cases of dengue, another mosquito-borne virus that can lead to potentially lethal dengue hemorrhagic fever and is a leading cause of death for children in Asia.
Research into vaccines, long-term effects and genetic factors involving West Nile could have implications for other diseases, says Mark Loeb, an infectious-disease specialist at Hamilton's McMaster University who is working on a two major research projects involving West Nile.
“Dengue may be making a resurgence in North America in the future,” Dr. Loeb says. “Anything we learn about West Nile virus might help our approach in studying dengue.”
He is investigating whether certain genes make people more susceptible to the most severe form of West Nile. He has also conducted a study, to be published this month, that looks at its long-term effects.
Because West Nile is relatively new to North America, little is known about its long-term effects. Research has been hampered by the small number of people affected by the disease and the fact that many of them live in rural areas – people such as Don Bell.
Mr. Bell, 58, is a rancher in Dubuc, Sask., a small town about 80 kilometres nearly straight east of Abernethy. Last summer, he used to think nothing of wrestling a halter onto a snorting, yearling bull. These days, he walks around his herd with canes.
Like Ms. Barnsley, he was bitten last summer, and he became so ill that he was paralyzed from the neck down and spent days in a fog of fever and pain.
Told he might not walk again, he dug into his exercises, starting with a routine that had him toppling over like a baby as he reached for oversized, brightly coloured balls. He eventually recovered the use of his legs and enough strength to do much of the work he used to do.
Now, he and his wife of nearly 40 years, Glenda, are preparing for a fall sale of some of their Angus cattle.
They had already struggled since 2003, when Canada's first case of bovine spongiform encephalopathy, or mad-cow disease, closed borders to Canadian beef and made their herd virtually worthless. But West Nile turned their world upside down. Family and neighbours looked after the farm while Ms. Bell moved into Regina to be close to her husband. When he got home in March, she dug out a wooden box he could use to haul himself up to the cab of his tractor. She would go in front of him, opening gates.
They say the risk of contracting West Nile, and the financial and human toll of the disease, is not well understood. Mr. Bell has come to feel so strongly about it that he asked the provincial health authority to release his medical documents: He wanted to know just how much his stay in the critical-care unit and in rehabilitation had cost his fellow taxpayers.
The authorities weren't crazy about giving him the information – they made him sign a waiver, he says – but eventually they turned it over. The tally was about $250,000. Multiply that by a few hundred and you've got yourself a problem, he says.
He knows researchers are working on a vaccine, but he wonders why it is taking so long. “If I can vaccinate my horses, this can be eliminated. And if someone says it's not serious, just look at a map.”
In her room in a Regina rehabilitation centre, Ms. Barnsley asks after Mr. Bell. Before her odyssey with West Nile, she was renowned as someone who took an intense interest in everyone she met. That hasn't changed.
Once caught up on the news, she answers a few questions about herself. She can't walk or talk or breathe on her own, she spells out on her board: “Some people would ask what's left.” But she has her friends and family and her characteristically fierce desire to be useful. She's eager to help spread the word about West Nile, if it can help even one person avoid what she has gone through.
“Can't look back,” she spells. “Keep going forward.”
Wendy Stueck is a reporter in The Globe and Mail's B.C. bureau.
