Zika (5 page)

In 2015, when France's High Council on Public Health had held a meeting of experts to issue Zika recommendations, he wasn't invited, he said. “Frankly,” he commented, “the high authorities here never ask the opinion of people who've actually lived through the problems.”

As a result, he remarked, the recommendations, which applied to many French islands, including those in the Caribbean, yet to be in the virus's path, were naïve: the council recommended testing only symptomatic pregnant women. They should have recommended testing all of them, he said, since 80 percent will have no symptoms but could still suffer.

From Tahiti, the virus spread quickly to other Pacific island nations. New Caledonia, another set of French islands off the coast of Australia, was first. On March 5, 2014, Easter Island, home of the giant stone heads and also called Rapa Nui, reported a case in an 11-year-old boy who had never been off the island. Rapa Nui is Chilean territory but ethnically Polynesian, and a month earlier it had hosted the Tapati festival, the largest cultural event in the Pacific, which many French Polynesians attended. On March 11, the Cook Islands, next to Polynesia, confirmed a case.

But that was paid attention to only later. Outbreaks on remote islands rarely make headlines even in the unusual case in which they are truly scientifically investigated, as the ones in Yap and French Polynesia were. The virus effectively “disappeared” again.

One of the epidemic's great unanswered questions is how it made the leap from that scattered medley of oceanic nations to northeast Brazil, which juts far out into the Atlantic, has no overt cultural ties to Polynesia, and is geographically much closer to Africa.

On the map, the closest suspect is Easter Island. It's in the Western Hemisphere, directly due south of Salt Lake City. But its air connections are back to the Pacific and to Chile, which has not had a case yet and is not expected to, because its climate is too cold for
Aedes aegypti
mosquitoes.

Brazil didn't even realize it had Zika until May 2015. The first impulse of many Brazilians was to blame the soccer World Cup championship, which was held in June and July 2014. Stadiums in Recife, Natal, and Salvador, northeastern cities eventually at the epicenter, had all played host to games. But although the World Cup draws tourists from all over the world, no South Pacific nation had played in it.

Dr. Musso then published a letter suggesting that a more likely explanation was that it had arrived during the Va'a World Sprints, a set of outrigger canoe races held in Rio de Janeiro a month later, in August 2014. About 2,000 paddlers arrived for it, including teams from French Polynesia, New Caledonia, the Cook Islands, and Easter Island.

But in March 2016, genetic sequencing of the virus let scientists construct a “molecular clock” of how fast it had mutated as it spread. By “winding back the clock,” they estimated that it had been in Brazil since mid-to-late 2013.

Another discovery gave credence to that idea.

In April, researchers at the University of Florida went back and looked at a big batch of blood samples from an outbreak of chikungunya in Haiti. The samples were from school clinics, and the blood of three students, aged 6 to 14, tested positive for Zika. The researchers checked the dates—they had all been collected in December 2014, which meant the virus was also in Haiti well before it was identified in Brazil.

That didn't mean it was there first. It may have circulated under the radar in Brazil, Haiti, and perhaps elsewhere, for months before some unusual set of circumstances produced an explosion in northeast Brazil.

Now the prevailing theory is that it was introduced during the FIFA Confederations Cup, a prelude to the World Cup. It too was played in Brazil, but a year earlier, in June 2013. It included a team from Tahiti, which played one game in Recife. That theory is a bit of a stretch, for it would be four months before Tahiti's outbreak was detected, and a year and a half until Recife's was. But viruses are sly.

This was not the first or even second time that Zika victims had blamed their misery on soccer. When the virus swept French Polynesia, rumormongers pointed fingers at the World Cup of Beach Soccer, which had been held in Tahiti in September, just before their outbreak was detected. One of the 16 teams in it was from Senegal, they said, and Zika was an African virus, wasn't it? But the Senegalese were innocent, because genetic testing done later showed that the Polynesian outbreak was virtually identical to the one on Yap, and descended from the Asian lineage.

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The World Hears

T
HE WORLD HEARD
about the mystery virus when it leapt out of Brazil in headlines above pictures of grieving mothers holding babies with heads that didn't look right.

They looked like Cabbage Patch Kids or Trollz dolls—all chubby cheeks and big eyes, but with dark hair sprouting too closely behind their foreheads. They looked proportional, but somehow out of proportion, and it took the viewer a second to realize that what was wrong was that normal babies' heads look too big for their bodies. These babies looked more like old men with wrinkled brows.

But that was just cosmetics. Babies often look odd—scrunched or wizened or yellow or cross-eyed, or even born with elongated or oddly shaped heads—and yet they can be perfectly healthy. The struggle through the birth canal can be hard on an infant's soft plasticity.

The real and terrible consequence could be seen on CT scans, MRIs, and ultrasounds. Those tiny heads contained shrunken brains. Sometimes just the frontal lobes—the seat of decision-making, of speech, of intelligence, of humor—were atrophied, showing abnormally large dark ventricles, the hollow internal spaces that are supposed to appear smaller and smaller as the brain grows. Sometimes all that was left was the bulb above the brain stem, where the most basic functions, like breathing and digestion, reside. Around it would be blank space filled with cerebrospinal fluid. Usually the skull had not completely collapsed, but neither had it been pushed out to its full size by the growing brain. And the brain would be smooth, looking more like a small liver, with none of the deep folds and fissures—the sulci and gyri—that every growing brain should develop as it folds in upon itself to pack more thinking power into a small space.

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?

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