Why Zika may be as tough to beat as Ebola

Child Neurologist Vanessa Van Der Linden observes the X-ray of a baby’s skull with microcephaly at the hospital Barao de Lucena in Recife, Brazil, January 26, 2016.  REUTERS/Ueslei Marcelino

By Peter Apps-

January 28, 2016

Taraneh Shirazian, obstetrician and gynecologist at New York University Langone medical center has been seeing some very worried women — those with pregnancies who have traveled through Latin America and the Caribbean in the last few months. As the scale of Zika virus outbreak becomes apparent, they are terrified that their unborn children may have been affected.

She struggles to know what to tell them about the risk they may face. The data is simply not available. What is clear, however, is that the Americas appear to be facing a health crisis on a scale and potential complexity that could be compared to West Africa’s 2014 Ebola outbreak.

So far, thousands of children have been born in Latin America in recent months suffering from microcephaly — smaller-than-normal heads with resulting brain damage and associated problems. Scientists believe the cases are almost certainly linked to the mosquito-borne virus. The World Health Organization warned this week that the Zika virus might well spread across the Americas, including much of the United States.

Just like Ebola in 2014, this Zika outbreak represents a sea change and step up from previous, much more limited, occurrences of the disease. Zika was first identified in 1947 but has only been seen in significant numbers in humans since 2007, with cases skyrocketing in the last year. As a result, it is outstripping both the capabilities of already stretched local health systems and much wider global scientific knowledge.

The differences with Ebola, though, are equally stark and may make it even harder for countries, individuals and families to handle.

For most of its sufferers, of course, Zika is a much less serious disease than Ebola. Symptoms are usually limited to a mild fever and rash with up to 80 percent of sufferers showing no external signs of the disease at all. On that level, it hardly bears comparison to Ebola, which is believed to have killed more than 11,000 people in 2014, almost all of them in Sierra Leone, Liberia and Guinea. Symptoms were singularly horrific, massive hemorrhaging that left victims covered in highly infectious sweat and blood that carried the disease to those closest to them.

Breaking the cycle of infection for a disease like Ebola is a relatively simple, but psychologically brutal process. Populations have to be educated to avoid direct physical contact with the sick or dying, interacting with them only through masks and gloves and making sure those suffering most were kept on isolation wards — provided enough are even available.

As a 23-year-old journalist, I covered the 2005 outbreak of the Ebola-like Marburg virus in the northern Angola. One anecdote in particular stands out — a story that told the infectious disease specialists they were finally winning the battle for hearts and minds.

In a remote village near the town of Uige, a pregnant woman began vomiting blood. Had this happened earlier in the outbreak, her husband would almost certainly have looked after her, infecting himself and the rest of the family. Instead, he took no chances, removing the other children from the house and locking his wife inside. It took several days for medics to reach the village — she died inside the house. 

The rest of the family lived — but the man, unsurprisingly, was apparently psychologically destroyed.

Zika, though, is a different kind of cruel. The only significant worry, it seems, is over unborn children. The problem is, because the symptoms are so mild, women living in affected areas — now spanning some 20 countries across an entire continent — simply do not know until far too late whether they have been infected.

Even when ultrasonic scans are available — and in most places they are not — microcephaly is not usually detectable until relatively late in the pregnancy, often the last three months. Even in countries where abortion is legal at all, it is often illegal at that late stage. In some cases, microcephaly can only be diagnosed at birth or even in the weeks and months following.

The effects, though, can be awful — intellectual and physical disability, shortened lifespan, huge requirements for ongoing care as long as they survive. For poor families and countries this will be incredibly difficult to manage.

For now, there remains a huge amount we do not know — what the incidence rate is likely to be, how severe the arising disabilities, how wide the geographic scope of spread. Hardly surprisingly, even before President Barack Obama’s call for increased research, estimates were already ramping up. But they will take time. And the statistics that are most crucial will only come in as the number of cases rise.

Under such circumstances, warnings for potentially pregnant women to avoid huge swathes of Latin America and the Caribbean make perfect sense. But that does little good for the millions living in those countries.

Earlier this week, El Salvador took the unprecedented step of advising its own population to put off pregnancy for two years, presumably in the hope that by then the situation might be somewhat resolved. 

How achievable that is in a country with high illiteracy rates, extremely limited sex education and access to contraception is another matter. It might prove impossible in any country. For one thing, women in their late 30s or older are unlikely to want to wait.

For now, researchers in Texas working on a vaccine say it could be 10 years away — although the more scientists who join the battle, the shorter that process might be. In the meantime, the brunt of the effort against the virus will have to be an industrial fight against the mosquitoes that carry Zika and their habitats.

Already, Brazil has mobilized several thousand troops for that effort. As in West Africa, it’s not hard to imagine the United States and other major powers also joining the effort.

Ultimately, as with Ebola, the worse the outbreak is — and the richer the countries actually and potentially affected — the more resources will be plowed into it. If the worst comes to the worst, the United States would probably spend almost whatever it took to make sure Americans could safely procreate.

If the World Health Organization is right in its predictions of the spread of the virus, it could yet come to that. In the meantime, however — just as with Ebola — we look set for another spell of almost impossible medical policy challenges and countless personal tragedies and traumas.