Zika (18 page)

An epidemic averted would be great news. It would be a victory for public health—and for risk communication and freedom of the press, since there is not much medically that can be done as of now.

Of course, if and when that happens, if the early fears are not realized and the dark clouds lift, many people will call it a false alarm. They'll say the media blew it out of proportion.

Fair enough, but the 2009 swine flu scare, which I covered—or contributed to the panic about, if you like—is now widely regarded as a false alarm. It arrived from Mexico in the spring, an unusual time for a flu outbreak, and it too caused a huge number of cases because no one was immune to the new gene mixture. Then it died out in the summer, as flu always does. But a council of White House science advisers predicted that, when it returned in the fall, it would kill up to 90,000 Americans. That document, released late in the day, set off panicky headlines. (Not in my newspaper. I didn't believe the estimate and held off writing until I could reach enough epidemiologists to debunk it. But by then it was too late.
USA Today
and virtually every TV station in the country had featured it prominently.) When the new flu did return, scientists realized it was actually milder than most seasonal flus. Ultimately
fewer
people died of the flu in 2009 than usually did.

But in late 2009, I met Aubrey Opdyke, a 27-year-old former waitress in West Palm Beach, Florida. When she caught the flu in June, she had weighed 135 pounds and had been healthy, except for one condition that put her at high risk in flu season: she was expecting. Nothing scary—she was in the middle of a typical, trouble-free pregnancy.

When I met her in October, she had been home from the hospital only three weeks. She had spent five weeks in a coma, suffered six collapsed lungs and a seizure that nearly killed her. She was still so weak that she needed a walker to get around her living room and could barely lift a one-pound weight during her daily sessions with a physical therapist. From her neck to her ankles, she was all stretch marks: the high-pressure ventilator that had kept her alive during the coma had forced so much air into her tissues that her husband said she'd looked like pictures of 400-pound women.

And she lost the baby. During one of the lung-collapse crises, the infant had to be delivered by Caesarean, and didn't survive. Aubrey was comatose, so she never saw the baby. But her husband named her Parker Christine and let a photographer's charity, “Now I Lay Me Down to Sleep,” take black-and-white pictures so that Aubrey would at least have a memory. Her mother bathed Parker and brushed her hair for the photographer—and then they buried her.

“Mild” diseases aren't mild for everyone, and one cynic's false alarm is another mother's disaster. Stay alert. And empathic.

13

Questions and Answers

(The information here is current as of June 1, 2016, and consistent with recommendations from public health authorities at that time. They could change. Please consult reliable websites like cdc.gov.)

Q. How dangerous is Zika?

A. For most people, it's mild. Four out of five people have no symptoms and don't realize they've had it. Most who get it recover in a week to 10 days. There is a small but unpredictable risk of Guillain-Barré paralysis and other dangerous complications. The biggest threat is to unborn children, for whom it can be devastating.

Q. If I'm bitten by a mosquito with Zika, how quickly will I show symptoms?

A. Usually within 3 to 6 days, although it can take as long as 14.

Q. What are the symptoms?

A. The most common are these: A low-grade fever (usually below 102 degrees). A flat reddish “maculopapular” rash on the trunk—bumpy but not with pustules like those of chicken pox. If you press on it, it disappears—you can even see a clear white handprint. Conjunctivitis—pink or red bloodshot eyes. Pain behind the eyes, especially in bright light. Pains in the back and joints. Not everyone who gets any symptoms gets all of them. The fever and back pain usually precede the rash, but if those are mild, the rash might be your first sign.

Q. If I've been to a Zika transmission area and have been bitten, or if I've noticed these symptoms, what should I do?

A. If you are pregnant, you should see a doctor and get tested as soon as possible. The most accurate tests can be done only in roughly the first 10 days after infection. Tests for antibodies can be done later but take days or weeks more and are less reliable.

Q. What does Zika do to unborn babies?

A. It can cause microcephaly—tiny heads and underdeveloped brains. But it can also kill babies in the womb outright. It may be able to do that at any time during a pregnancy. It may also cause milder damage to nerves in the growing brain that can lead to serious birth defects. Some newborns suffer fatal seizures. Some have spastic or frozen arms and legs. Some cry constantly in a high pitch. Some have difficulty feeding or swallowing. Without intensive care, some die in the first weeks of life.

Q. What is the future for these babies?

A. Most children affected by Zika are still very young, so doctors must guess on the basis of other viruses, like rubella and cytomegalovirus, that attack fetuses. Some babies appear to be blind or deaf. Some may never learn to stand, walk, or control their bowels. Some may have serious learning disabilities from childhood on. And experts fear that some who appear healthy in childhood may develop schizophrenia or bipolar disorder as adults.

Q. What about Guillain-Barré syndrome?

A. Zika can cause Guillain-Barré paralysis, but it's still very rare—in one outbreak the odds of getting it were calculated at about 1 out of every 4,000 Zika cases. You are at some risk of Guillain-Barré at all times; the world baseline rate is about 1 case in 100,000 people per year. It can be triggered by a cold, flu, stomach flu, or surgery.
Campylobacter
, the bacterium found in raw chicken, is a common cause. Vaccines are a rare cause.

Q. Exactly what is Guillain-Barré syndrome?

A. The immune system generates antibodies that attack your own nerve cells. That can cause ascending paralysis, which creeps in from limbs and face to the chest. If it reaches the breathing muscles, a victim can die if he or she is not quickly put on a ventilator. Most people recover within six months to a year. About 15 percent have persistent muscle weakness.

Q. How can I protect myself against Zika?

A. Stay away from areas where mosquitoes are transmitting it. If you cannot, avoid mosquito bites. Do not have unprotected sex with a man who has it or may have it. The CDC advises eight weeks of condom use or abstinence if the man has no symptoms, six months if he has any, and, if you are pregnant, for the length of the pregnancy.

Q. Is it safe for me to travel?

A. It is definitely
not
safe for pregnant women to visit areas with current Zika transmission. Check the websites of the CDC or the WHO for a list of countries with it. But to know whether mosquito activity is intense in a certain region, you may have to do your own research. Anywhere above 6,500 feet is considered safe, but also consider, for example, where you might change planes.

Q. Will it be safe for me to go to the Olympics?

A. The CDC definitely recommends that pregnant women avoid the Olympics. If a husband or boyfriend goes, it recommends no unprotected sex for the rest of the pregnancy. The real infection risk will not be clear until just before the Games, and will depend on how hot and rainy it is. August is Rio's winter, and rainfall is normally low, but “winter” in Rio means temperatures of 65 to 80, and mosquitoes can bite all year around. The Olympic Committee and city government say the venues will be safe, but that promise may prove hollow in a city of 13 million. Rio appears to have had a Zika outbreak in early 2015, and it had a big one from March to May of this year. The WHO has suggested that visitors avoid slums because garbage collects standing water. The CDC has a web page devoted entirely to the Olympics.

Q. What will happen if lots of Americans come back from the Olympics with Zika?

A. Even if that happens, hospitals are unlikely to be overwhelmed because most cases are mild. A bad flu season is probably a bigger threat to the hospital system. But cases of Guillain-Barré may be a problem. Also, travelers returning with Zika may seed outbreaks in their hometowns when local mosquitoes bite them.

Q. What kinds of mosquitoes carry the virus?

A. The most common vector is
Aedes aegypti
, “the yellow fever mosquito.” Although it has been found occasionally in 30 states, and in hot, wet years can range as far north as New York City, the threat is expected to be high only in Florida and along the Gulf Coast and in Hawaii.
Aedes albopictus
, “the Asian tiger mosquito,” can also carry Zika and is found well north of Chicago and New York in hot summers. But it is not known whether the tiger can spread Zika effectively. Brazil has reported the virus in
Culex
mosquitoes, which are all over the United States. But they've never been shown to transmit it.

Q. How can I tell which mosquitoes are around?

A. Mosquitoes are hard to tell apart.
Aedes
mosquitoes are usually slightly larger than
Culex
or
Anopheles
mosquitoes, which carry different diseases, and they are black with vivid white spots.
Aedes aegypti
, the yellow fever mosquito, has two curved “lyre-shaped” lines on its back. Females lay sticky eggs in clean water—even in pet dishes—and they slip into houses and hide in closets and under beds. They frequently bite ankles and are “sip feeders,” biting several people for each blood meal.
Aedes albopictus
, the Asian tiger mosquito, looks similar but can be even bigger and has a white line down its back. It tends to bite and hang on unless squashed. 

Q. How can I protect myself against Zika if I live in a transmission area?

A. If you are pregnant, you should avoid bites 24 hours a day. Close or screen all windows and use air-conditioning. Wear long sleeves and pants and repellent with DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-diol.

Q. Is DEET safe for pregnant women?

A. Yes, according to the CDC, especially in high-risk circumstances like this.

Q. Can I be bitten by a mosquito and still have a healthy baby? What are the chances?

A. Yes. Not every mosquito is an
Aedes
, and not every
Aedes
is infected. By some estimates, even in high-transmission zones only 1 mosquito in 1,000 has the virus. To put this in perspective: Brazil has had over 1,400 confirmed cases of microcephaly and more than 7,000 reported ones. But 3 million babies are normally born in Brazil each year.

Q. If I live in an area where it is being transmitted by mosquitoes, do I also have to protect myself against sexual transmission?

A. Yes. Your husband or boyfriend may get it and pass it on to you even before he has symptoms. You need to avoid unprotected sex—vaginal, anal, and oral.

Q. If I get Zika, and I recover, is it safe for me to have a baby later?

A. Yes, absolutely. A Zika infection is not for life. As with many other rash diseases—chicken pox, smallpox, and measles, for example—getting it once appears to provide lifelong immunity. No one is yet sure whether Zika immunity is lifelong, because it has been studied for only a few years. But doctors believe it is long-lasting.

Q. How long do I have to wait after being in a Zika area before I can have a baby?

A. You are probably safe within about three weeks, but out of caution, the CDC recommends that women wait eight weeks. (They took the estimated safe period and nearly tripled it.)

Q. Should I delay having a baby this year?

A. That is a difficult question that every woman has to answer for herself. Some leading doctors think women in areas where there is Zika transmission now—or may be soon—would be wise to delay pregnancy if they can. It is virtually impossible to protect yourself against mosquito bites for nine months. Epidemics are usually fiercest in their first year. And in a few years, a vaccine may be available.

Q. What about my husband? Can he give me Zika?

A. Yes. Doctors are still learning more about this risk. If a man has had no symptoms and no test after returning from an area with transmission, the CDC recommends avoiding any contact with his semen for eight weeks—meaning either abstain from vaginal, oral, and anal sex or use condoms. If he had symptoms or a positive Zika test, they recommend avoiding contact with his semen for six months.

Q. Six months? Why so long?

A. Live Zika virus has been found in semen as long as two months after symptoms disappear. Pregnant women should avoid contact with his semen for the entire pregnancy.

Q. Can my husband get Zika without ever knowing it?

A. Definitely. Eighty percent of all people infected with Zika never display symptoms.