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article imageOp-Ed: Zika virus — 2700 cases in one year in Brazil, first U.S. cases

By Paul Wallis     Jan 10, 2016 in Health
New York - The Zika virus is causing a rash of birth defects in Brazil. Birth defects include microcephaly, infants born with small heads. Zika is so bad doctors are advising women to avoid pregnancy.
This disease has hit very suddenly, and most of the information available is a sort of half-finished basic chart of incidence of cases rather than applied research. There's also an issue with definitions. When a disease has a sudden surge in number of cases, the word “epidemic” needs to be used carefully. When “epidemic” and “endemic” are used together to describe an emerging disease, it’s a major problem. An epidemic means a sudden prevalence of a condition. Endemic means the diseases is entrenched in a region.
Zika definitely seems to be spreading, and the 2,700 cases of birth defects in Brazil in 2015, up from 150 in 2014, qualifies to be called a big 1800 percent spike in the number of cases.
The mystery of the spread of Zika has also become more complex with a German researcher’s theory that Zika can be transmitted by sex, as well as mosquitoes. That means prevention may have to cover multiple issues, and certainly doesn’t simplify either tracking or monitoring its spread. If true, the combination of sexual and mosquito-borne transmission makes Zika the only vector-borne virus in the world able to transmit these ways.
That’s another degree of difficulty, quite unprecedented and a possible distorting factor for epidemiologists trying to pin down areas of high incidence. If, for example, a lot of sex workers get Zika, its spread could be exponential, making it endemic in the human population, like HIV.
Nobody’s quite sure what’s caused this sudden change. A hot and wet year has definitely helped the mosquitoes. The Centers for Disease Control and Prevention (CDC) agency has charted a disturbing map of locally-acquired Zika transmission all the way up to Mexico.
Zika used to be relatively rare, and comparatively harmless. It’s believed that Zika evolved in Africa and spread during World War 2 through the South Pacific. There were very few notable cases of Zika after its discovery. The trail of the disease, however, is hardly straightforward.
According to The Conversation, Zika antibodies suddenly started spiking in South America and Africa in 2007. Then it showed up in the Philippines on the island of Yap, in the Pacific. In 2015, from 440,000 up to 1.3 million cases occurred in Brazil. If those figures seem a bit vague, there’s a reason for that. These are early numbers, and diagnoses may vary depending on the severity of cases. Accuracy of diagnoses for a new disease also has to be considered a factor in determining the actual number of cases of Zika.
The big deal here is that Zika wasn’t endemic in Brazil, and is believed to have evolved molecularly during its global travels, adapting to the Aedes mosquito vector, which possibly turned the virus in to a dangerous disease. The sudden huge spike in serious cases is a classic pointer to a virus gone feral in an environment where it was previously not an issue.
Viruses mutate. A harmless virus can become a killer, and a dangerous virus, ironically, may evolve in to a harmless virus over time. Resistance to disease also plays a part. The 1918 flu outbreak was one of the most destructive plagues in history since the Black Plague, but the flu is now much less dangerous than its original form, for example.
Epidemics, the war on the mosquito, and capacity for control
The biggest mass killer of humans on Earth is the mosquito. It’s a super-efficient transmitter of diseases and a logical vector for viruses. They’re the global vector for malaria, dengue, Yellow Fever, and many other very nasty diseases which kill and incapacitate hundreds of thousands of people every year and have killed millions since the beginning of recorded history.
After World War 2, DDT decimated the mosquito population around the world. The mosquitoes have since made a comeback, and they’re again usual suspects for any epidemic.
Brazil is using 18 tons of larvicide (larva-killers) to reduce the incidence of Zika by destroying mosquito larvae, but it’s pretty obvious that a coordinated global effort will be required to manage its spread. Many tropical region nations aren’t well-resourced to manage large scale prevention operations, and a consistent massive program of eradication is more of a dream than a working option.
The other issue is that they’re also severely under-resourced to manage large numbers of affected people and infants. Lack of resources, in this case, means the disease will inevitably spread.
Response? From whom, and more importantly, when?
It’s a sad fact that global governments seem to have completely lost the plot regarding management of epidemic disease transmissions. In combination with the other major global disease, the insane, irresponsible rises in health costs and bureaucracy which routinely taint and cripple management of every public health issue, it’s not a pretty picture.
Zika could be the straw that really tests the limits of global health systems. If this extraordinary spike in cases continues, the global health system culture is totally unprepared to manage it. How do you manage thousands or tens of thousands of cases of serious birth defects? How do you fund ongoing management of a disease where treatment and management of affected kids could cost billions per year? How do you administer prevention programs? How do you put in place effective, practical health policies?
This is yet another situation where “political solutions” are meaningless. Practical human realities beat politics any time. You can’t deport a disease, or beat it to death with rhetoric and empty slogans. You can’t shoot it, or lock it up. You can’t call a disease left wing or right wing.
Arguably, the worst problem about Zika isn’t the disease itself; it’s the dismal, mediocre, state of the global health system and health policies. The biggest obstacle to managing Zika is likely to be the sheer, well-proven, rabid incompetence of those supposed to be managing it.
In a sane world, a sane, competent response to a major outbreak of disease would be deliverable. In this world, it’s just a theory. The exponential spread of Zika, if it continues, could be a future nightmare for the world. To beat this sort of disease, the culture of health management will have to suddenly develop an uncharacteristic level of functionality and competence. Bets, anyone?
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
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