'Zika: The Emerging Epidemic' Takes An In-Depth Look At The Virus

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The cover of "Zika: The Emerging Epidemic," by Donald G. McNeil Jr. (Courtesy of W.W. Norton & Company)
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New York Times science reporter Donald G. McNeil Jr. has been covering Zika since late 2015. Now he’s published “Zika: The Emerging Epidemic” on the origins of the virus, its effects and the issues that arise in covering the story.

McNeil talks with Here & Now‘s Robin Young about the book.

Interview Highlights: Donald G. McNeil Jr.

On why Zika stands out compared to other viruses

“It’s the first mosquito-borne virus that actually crosses the placenta and damages newborns, or fetuses. And it’s the first mosquito-borne virus that’s ever also been sexually transmitted, too, and both of these are just shockers for scientists. It changes everything about how you handle a virus.”

On why we weren’t seeing similar brain damage cases 60 years ago

“We might have actually seen them except nobody noticed. It’s not quite clear what happened, because nobody tracked the epidemics to know how many cases spread. But also there are other causes of microcephaly in the world. There’s rubella for which there weren’t shots in much of the poor parts of the world until a few years ago. There’s industrial poisons, there’s fetal alcohol syndrome and drug toxicity to babies. So it may have happened, just no one was paying attention.

It was when it hit those maternity wards in Brazil — in a place where a lot of people are giving birth in the hospital, which is crucial, because then you have, instead of people seeing it in their homes and hiding the baby, you have suddenly doctors notice five or six kids with the same problem, and that’s when you realize you have an epidemic on your hands.”

On the CDC’s reluctance to suggest delaying pregnancy

“I’m a journalist, so I don’t go out advocating more of an alarm, or something, my job is to cover the news. But I’m mystified as to why the CDC is so reluctant to suggest to women that they consider delaying pregnancy, because it’s clearly the only thing that will save those women, because mosquito control is not working, and also because the CDC is pushing contraception on women really hard, but doing it under the radar in places where it has some control, as in Puerto Rico.”

On using Zika to prevent Zika

“The best vaccine for Zika might be Zika itself for anyone who is not pregnant. The disease is a mild disease even for women of childbearing age. If they then go on to have a child a few months later, the virus probably disappears from their bloodstream within two weeks, and so obviously nobody suggests they get sick and then they try to get pregnant within two weeks, but after eight weeks or so even the CDC believes that it’s safe… As far as we know, it creates a long-lasting immunity. Nobody has studied the disease to know if the immunity is lifelong, but — as with chickenpox, as with measles, as with lots of infectious diseases — having the disease, recovering from it, and having immunity from it appears to long lasting.”

Book Excerpt: ‘Zika: The Emerging Epidemic’

By Donald G. McNeil Jr.

The 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 death- bed: 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?

Excerpted from Chapter 4 of the book ZIKA: THE EMERGING EPIDEMIC by Donald G. McNeil Jr. Copyright © 2016 by Donald G. McNeil Jr. Reprinted with permission of W.W. Norton & Company.

Guest

Donald G. McNeil Jr., health reporter for the New York Times and author of “Zika: The Emerging Epidemic.”

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