That smooth-brained baby might be more than comatose; maybe it could breathe, could blink, could digest, could live. But maybe that baby could not chew food, or see the spoon or the breast coming toward its mouth. Certainly it would never walk, probably would never crawl, or maybe would never do more than roll from side to side, unable to control its contorted arms and legs enough to even turn over.
Hospital hallways, doctors remembered in Brazil, were lined with mothers who resembled ghosts. They were in shock: mute, expressionless, bleak. Some were just teenagers. Some had ridden buses for hours and were too poor to buy food as the hours waiting to be seen stretched on. And there were so many of them. One doctor from southern Brazil, where there was no problem, recalled visiting a friend’s hospital in Salvador, not at all expecting what he found: 25 babies with microcephaly, all born in the previous 10 days. One mother looked up from her son’s face to ask, “Doctor? His head is going to grow, right?”
Those mother-and-baby pictures—normally records of happy occasions, now a series of postcards from hell—became the signature of Zika.
All over the world, pregnant women began to worry. So did everyone, man or woman, who hoped one day to have a child.
As well they might. Right now, at least 298 million people in the Americas live in areas “conducive to Zika transmission,” according to a recent study. Which is a conservative count, because, if you count everyone who lives between northern Argentina and southern Tennessee—roughly the range of the Aedes aegypti mosquito—you get over 400 million.
Over the next year, according to that conservative study, more than 5 million babies are due to be born.
How much damage Zika will ultimately do is not yet knowable. The aggressive spread outward from Brazil’s northeast began only in 2015, and most of the Western Hemisphere, including the United States, has not yet lived through even one full hot season with it.
What could happen if it spreads widely across Africa and Asia is a whole different level of disaster. About 130 million babies are born each year around the world.
Zika has been on those continents for decades, and many Africans and Asians may be immune to it. On the other hand, the African and Asian strains are different from each other; the Asian one has several substrains, and viruses constantly mutate. The flu virus mutates so fast that the vaccines against it must be reformulated each year. The Zika virus is not that mutable, but it may have shifted enough that immunity to the old strains does not confer protection against the new one.
One aspect is reassuring: more than 99 percent of all cases are mild. Most adults, teenagers, and even toddlers who get it appear to come though unharmed. So do most pregnant women—they themselves, that is.
The great threat is to unborn children. How great is not known as of this writing. French Polynesia’s experience suggested that mothers who had Zika while pregnant had a 1-in-100 chance of having a deformed child. A small study in Brazil suggested it was closer to 1 in 3. More research is being done.
After that, the greatest threat appears to be autoimmune reactions, the best-known of which is Guillain-Barré. As of this writing, it is thought to occur during Zika epidemics at 20 to 25 times its normal rate—that is, once in every 4,000 to 5,000 infections.
A very small number of people with other complicating illnesses, like sickle-cell anemia, have died while infected with Zika. But it is not believed that Zika inevitably hurts everyone with comorbidities. The sickle-cell trait comes from Africa—where it is a genetic defense against malaria—and is common in Brazil and the Caribbean, where many are descended from African slaves. But, as of this writing, deaths from it that are clearly related to Zika are very rare.
Also as of this writing, it is not thought that Zika particularly harms people whose immune system is suppressed, such as those with HIV, those taking antirejection drugs for organ transplants, or those whose bone marrow has been temporarily ablated to fight leukemia.
But the threat to babies is enough. The tiny virus, delivered by a mosquito that can be squashed with a finger, is rerouting cruise ships and Boeing 737s. It is canceling destination weddings and family vacations. It is threatening the 2016 Olympics, and has further shaken Brazil’s already shaky government. Failures of other presidents to fight it aggressively enough may yet topple other leaders.
For many people—certainly many Americans—the scare may be brief: a vacation canceled, a business trip replaced by a phone call. For some, living in tropical climates, it will mean months of worry: Worry that each mosquito might be the dangerous one. Worry that they have a silent infection. For women who are pregnant, that worry might be sheer terror: having to ask themselves every day for nine months, “Is my baby all right? Was it my fault? Did I do everything I could to protect it?”
For more than 1,400 women in Brazil and elsewhere in the hemisphere, that terror has already arrived. They know their babies are not all right. That if they survive, they will need a lifetime of care, will need watching night and day. Careers will be dropped, houses will be sold, bank accounts will be drained; in the United States, the cost of such care is estimated at $10 million per child. They know the guilt and exhaustion and anger of having a handicapped child and may fear that it will tear their family apart. Overwhelmed husbands abandon overwhelmed wives, resentful siblings will rebel.
And a mother’s worry does not end even on her deathbed: she may die wondering who will take care of the child for the rest of his or her life. Will those family caretakers have the money? Will they have the patience? Will they have the strength? And will they not hate her memory for leaving them the burden?
5
My First Brush
I FIRST HEARD the word “Zika” in September 2015, when a media rep for the University of Texas Medical Branch (UTMB) emailed me asking whether I wanted to interview Dr. Scott Weaver, scientific director of the school’s Galveston National Laboratory, about chikungunya, a mosquito-borne virus. I knew the disease; its name comes from the Makondo language spoken in Tanzania and Mozambique and means “bending-up fever,” for the way its victims twist miserably in pain. It doesn’t normally kill, but the pain it causes can last for months. It was invaliding many Latin Americans and making travel riskier for American tourists.
I replied apologetically that I knew it was high time I did a big story on chikungunya, but that I was too busy right then.
It was an honest excuse. As the New York Times’s main global health reporter, I’m supposed to track the world’s vital signs and cover every pestilence and plague that comes down the pike, so among my worries are AIDS, tuberculosis, malaria, Ebola, avian flu, swine flu, seasonal flu, SARS, MERS, polio, Guinea worm, diphtheria, pertussis, tetanus, measles, mumps, rubella, rotavirus, norovirus, respiratory syncytial virus, Hib, smallpox, cholera, the Black Death, Lyme disease, West Nile virus, yellow fever, Rocky Mountain spotted tick fever, erlichosis, babesiosis, cutaneous and visceral leishmaniasis, syphilis, gonorrhea, chlamydia, human papillomavirus, anthrax, ricin, cryptosporidium, Chagas, Buruli ulcers, Lassa fever, mycetoma, and the common cold—which is caused by nearly 100 different viruses. I may have forgotten some.
Also, because distrust in science among Americans is powerful, I cover some controversial diseases and persistent myths like Morgellons disease, delusional parasitosis, chronic Lyme, and the notion that vaccines cause autism.
The UTMB media guy tried again: Dr. Weaver was also an expert in something new that was “similar to West Nile virus and could make its way to the United States in the next few years.” It was called Zika virus. Would I like an interview about that?
Just the name had a certain zing to it. (I once interviewed a pharmaceutical executive who believed that putting the zee sound in the names of new medicines inspired a soothing credibility and sold more pills: Prozac, Zoloft, Xanax, and Zyrtec, for example. The vee sound, he thought, conveyed virility—hence, Viagra and Levitra. Their new rival,
Cialis, pronounced “see Alice,” he thought, was sure to be a damp squib.)
In early October, Dr. Weaver and I spoke for about 45 minutes.
He described the virus’s origins in Africa and its passage through Yap Island and French Polynesia, and he said very little work had been done on it thus far. The virus had arrived recently in Brazil and was worrisome because it was causing Guillain-Barré syndrome.
It might have spread even farther than Brazil, he said. No one knew. Only a few of the world’s top labs could test for it, including probably only one in Brazil, the Oswaldo Cruz Foundation.
It was particularly hard to test for in Latin America, he said, because many people had previously had dengue or had been given yellow fever shots as children. Since they were related diseases, they produced antibodies that cross-reacted with Zika antibody tests.
If the disease ever came to the United States, he noted, it would at least be easier to test for, since dengue hadn’t infected many Americans and only a tiny number had ever had yellow fever shots. (I was one, I reflected.)
Would it come? I asked.
It might, he said, but it would probably suffer the same fate as Florida dengue outbreaks, a cluster of a few cases that was crushed once it was detected.
“I don’t think we’ll see a major epidemic,” he said. “We stay inside our air-conditioned homes.”
He forwarded me a 2009 paper he had coauthored naming the viruses he thought were most likely to cross the ocean and hit the Americas. It was prescient: Zika was one of them. But it was among the also-rans. The two biggest threats he saw were Japanese encephalitis and African Rift Valley fever.
I thanked him, hung up, went through my notes to make sure I could read them in the future, scribbled his phone number and the date at the top, tore them off the legal pad, stapled them, and dropped them onto my head-scratcher pile. It’s about six inches tall and consists of stuff that strikes me as interesting enough to write a story about. Someday.
And, for the next couple of months, that was that.
I went back to writing about curing infant jaundice with sunlight and the long-term repercussions for China of the reality that its males smoked one-third of all the cigarettes in the world. I was also trying to arrange a difficult reporting trip: first to Bangladesh to see the world’s biggest diarrhea hospital, where crucial work had been done on a new cholera vaccine, and then to Vietnam to see whether it was true that communists are terrific at fighting tuberculosis, but would be able to declare victory only if they obtained more aid from the capitalists.
On Monday, December 28, 2015, recently back from that trip, I was in the office. It was the week after Christmas, and very quiet. No news was breaking, and half the editors were gone, anyway. My cholera and tuberculosis stories were coming along, but slowly.
I was poking through piles on my desk and wandering in infectious disease websites like ProMED and flutrackers.com. I had to dig up something to write for my Global Health column, which was due in a few hours. Along with full-length stories, I do something every week for the Tuesday Science Times section. It’s usually short, 300 words or so.
Cranking it out can be a pain, but it’s also a useful outlet: there are many events or studies that are not big news, but still intriguing. For example, a new vaccine against leishmaniasis made out of sand-fly saliva. (Leishmaniasis causes festering wounds and was obscure until U.S. service members in Iraq started getting “the Baghdad boil.”)
On Google News, I saw a small CNN story out of Brazil. It had “Zika” in the headline. Remembering the earlier conversation, I opened it—and read with growing horror.
Brazil had declared a state of emergency. Hospitals were seeing a wave of babies with microcephalic heads, more than 2,700 of them.
Zika was the suspected cause. The CNN piece mentioned the same facts Dr. Weaver had, but one line caught my eye: some of the country’s top obstetricians, it said, were recommending that women not get pregnant. Another article I found said a health ministry official had advised the same thing.
That was mind-boggling. Outside of China and its one-child policy, I’d never heard of any government—or any sane doctor, for that matter—recommending that women just stop conceiving. The idea was a betrayal of the whole idea of nationhood.
I looked at the CDC’s website. It had very little information: a paragraph stating that Zika virus was in Polynesia and South America, and that some cases had been reported in returning travelers. Nothing about microcephaly, nothing about Guillain-Barré. It did have one ominous line: “These imported cases may result in local spread of the virus in some areas of the United States.”
I called the one person I knew in Brazil, an Italian doctor named Marco Collovati, who ran a diagnostics company.
A few years earlier, I had written a front-page story about a new rapid test for leprosy, which is a big problem in Brazil. His company had created it. I had interviewed several leprosy experts for it, but not him. Nonetheless, soon afterwards, I found a box on my desk with a ceramic figurine of a Brazilian gypsy. Attached was a note full of exclamation points: it was a thank-you gift. I emailed him to say thanks, but New York Times rules didn’t let us accept gifts worth more than $25. When we spoke, he was effusive. “Dooooonald! You muuust take it! It is nothing! It is a souvenir! They sell them on the street! Your story has made me famous! I am a suuuuuper-hero in Brazil! You are a suuuuper-hero too! You are saving the world!”
Apparently, my story had been picked up by all the Brazilian media. Soon thereafter, he excitedly sent me a picture of himself on a dais with the very popular former president Luiz Inácio Lula da Silva, who was endorsing his test as an example of Brazilian ingenuity.
Marco was lots of fun, but that day he turned somber. I was incredulous. Was this story true? All these kids? From a mosquito disease? Yes, he said. His company was already working on a rapid test for Zika.
“It is a big, big mess, Donald. It is a tragedy. These babies do not recover. It is a very big El Niño this year, it is very hot. It is raining already, and it is only going to get hotter. The Olympics—they will be a disaster. Can you imagine people coming from the U.S., from France, into this?”
Yes, he confirmed, the health ministry had advised women not to have children. “What can they do? Abortion is illegal. So the only way to prevent this is to not get pregnant.”
And was it definitely Zika?
“It’s a big question,” he said. “We don’t know if it’s only that, or maybe it’s a combination. If a pregnant woman has had dengue a year before, gets an immunological reaction, and then gets Zika . . .”
I wrote a brief story with the basics, and after I filed it, I sent a long note to Tom Skinner, the chief spokesman for Dr. Thomas R. Frieden, the director of the CDC. It was headlined, apologetically, “Merry Christmas and let’s make Tom Skinner crazy during Xmas season.” If he had any days off, I was probably going to ruin them.
I had just written something brief about a new virus called Zika, I said. It was a huge problem in Brazil, suspected of causing a 20-fold increase in microcephaly, and women were being advised not to get pregnant. I was going to have to follow up with a major story, hopefully with help from the Times’s Brazil bureau.
When I do that, I said, I’ll need to include the CDC’s thoughts on how fearful Americans should be.
The agency’s website indicated that some American travelers were getting the disease and bringing it home, and there would likely be outbreaks in the United States.
Americans were going to want answers to some questions, I wrote, including these:
1.Should Americans be concerned that Zika could spread in the United States and cause brain damage in children?
2.Should Americans avoid going to Brazil now?
3.What other countries should they avoid?
4.Should Americans cancel plans to go to the Olympics?
5.Should American athletes avoid the Games? Or should some subset of the team, like pregnant athletes or female athletes?
Could he please, I asked, put me on the phone with someone as soon as possible?
His email auto-reply said he was off until January 4. But he wrote back within 20 minutes, saying, “We should be able to make this work. Let me see who is around. What is your drop-dead deadline?”
Depends on my editors, I replied, but by tomorrow afternoon, please.
Three hours later, another CDC spokesperson wrote back saying Dr. Erin Staples, an epidemiologist in vector-borne diseases, would be available early the next afternoon.
In those three hours, my editors had heard from the foreign desk. Simon Romero, our Rio bureau chief, had interrupted his own vacation to work on a piece about the emergency. It would be offered for page one, so I could file paragraphs about the American situation into it.
Dr. Staples and I spoke the next afternoon. She described the risk to the United States—that it was carried by the same “yellow fever mosquito,” Aedes aegypti, that carried dengue and chikungunya, so the agency expected the spread to be similar: Puerto Rico would be hit hard. There would probably be small clusters of cases in Florida, in Texas, and along the Gulf Coast—and possibly also in Hawaii. The CDC did not expect anywhere in the mainland to be hit as hard as Puerto Rico would be.
But, she warned, nothing was clear-cut: mosquito control budgets were set by states or counties, and they waxed and waned. They had gotten fatter when West Nile virus was a threat, but that was 15 years back, and West Nile was spread by different mosquitoes and had to be fought differently. The small dengue and chikungunya outbreaks since then hadn’t moved the budget needle. And there was very little money for surveillance—which meant trapping and typing mosquitoes regularly—so nobody really knew the true range of the yellow fever mosquito. The maps were old. And there was another wrinkle: a related mosquito, the “Asian tiger mosquito,” Aedes albopictus, could also transmit Zika. The tiger mosquito tolerated colder winters and survived much farther north.
Zika Page 4