On Monday February 1st, the WHO declared the Zika virus a "public health emergency of international concern." This is a big deal. The designation has only been applied to three other illnesses in the past, most recently Ebola during the 2014-2015 outbreak in West Africa.
So given that this is such a huge outbreak, on a large scale with the Olympics rapidly approaching, it's time to grapple with the security politics.
Let's start with the science: Zika is actually about 50 years old, at least in terms of discovering it. It was long isolated in Africa and Asia, and the first cases in the Americas were detected in May of 2015. It's possible that it was brought to Brazil during the 2014 world cup. But let's get back to sports in a minute.
The virus is transmitted among humans by mosquito bites. Normally, if contracted, the virus presents no symptoms, or just mild symptoms. About 25% of people develop symptoms about 2 to 10 days after infection which can include a rash fever, infection, joint pain, red eyes, and head ache-- essentially flu like symptoms. Recovery is typically complete, and fatalities are very rare.
But in the last couple of months, something has changed with the Zika virus. There is growing evidence that the fetuses of pregnant women who get the Zika virus contract a condition called microcephaly which is a rare neurological condition in which the infant's head is significantly smaller than the heads of other children. It is often associated with neurological defects, seizures, and severely impacted development.
In Brazil, which is essentially ground zero for the Zika virus, nearly 4,200 cases with this typically rare disorder have emerged since October of 2015.
The good news is that the pool of people who seem to be severely impacted by the virus is relatively small-- it seems isolated to pregnant women. The bad news is that f they do contract it, it does appear that their babies have a horrible neurological disorder.
The WHO has not yet formalized the link between Zika and this disorder, it has just said that there is just strong evidence to suggest that there is a link. In some ways the WHO got ahead of the science and said simply 'this is now of international significance.'
For the United States, our response is going to be different than what's occurring in South America. In El Salvador, the government has advised women to delay getting pregnant until 2018. In the United States, we should expect there to be some cases. These mosquitos are common in many states. It's likely that we will see limited Ziki outbreaks in the United States, but we are buffeted by a strong public health system, less dense urban environments, and widely used air condition use. We also combat mosquito breeding grounds and pools.
What we need to be worried about is essentially our travel. The WHO did something interesting: they did not request travel restrictions. Right now, the Zika virus is in over 20 countries in the Americas. There have been 31 cases in the states, but in all those cases, the patients had recently traveled in Zika affected countries. There is no known vaccine or treatment.
The best way Americans can protect themselves and their neighbors against Zika is to not travel to those areas with ongoing virus transmission, especially if they are pregnant. Not because the science is clear, but because the science is unknown.
In terms long longterm strategies, we need to figure out how to control mosquitos. Only a larger scale, breeding grounds will be eliminated and mass use of insecticides is obviously helpful. There's also a technique called "fogging," that's used in tropical countries that just essentially wipes out whole areas infected.
But, like every other crisis, there is politics involved. We are talking about pregnant women, and we are also talking about predominantly catholic nations. The inequalities in prenatal healthcare are real, and they outbreaks in infectious diseases tend to reflect the social and racial inequalities that are experienced in all aspects of life.
When governments tell women to avoid pregnancy, it places the burden of the conditions on women. When of course the government has failed in terms of an inadequate response to Zika and just over all public health controls. Most of these women lack access to birth control and in some instances, abortion. Neglecting these communities has contributed to the birth defects we are seeing.
There is a final political aspect: The Olympics. Brazil is hosting the summer Olympics in 2016. The international olympic committee was getting worried-- quite publicly worried about whether Brazil can pull off the games prior to the news of the virus. To then invent millions of people to Brazil during a viral outbreak is a real concern.
The WHO's announcement this week is being criticized for not putting greater restrictions on travel to Brazil or on the obligations of Brazil in order to continue to host the Olympics. A lot of people are claiming that the WHO folded to pressure from the international community that they want people to still come to Brazil in a few months. The WHO should have ignored that pressure. If Zika is a virus that is out of control, maybe we should make an international statement and say not this year Brazil, not this Olympics.