Friday, September 22, 2017

Putting the Zika Myth on Ice



By on June 24, 2017

SAN JUAN — Two weeks ago, the Puerto Rico Health Department declared the Zika epidemic, which had been affecting the island since December 2015, officially over after virus transmission reports dropped significantly in the past month.

A press release circulated by the agency stated the levels of Zika have dropped to some 10 confirmed reported cases for the four-week period since April 2017, which is much fewer than the 8,000-plus reported cases at the peak of the outbreak in August 2016.

But after almost a year and a half of what was characterized as a “relentless outbreak of a very serious disease” by health authorities, both at the local and federal government level, the people of Puerto Rico are still waiting for the announced scourge of the land by the Aedes Aegypti mosquito-borne virus that, so far, has yet to materialize.

(CB Photo)

As of June 8, the weekly report on arboviral diseases published by Health states only seven Zika cases had been reported for the 21st week of the year, thus continuing a downward trend in the number of cases reported since week No. 16. The total number of confirmed accumulated cases, since the beginning of the outbreak in December 2015 until the 21st week of 2017, is 40,398, of which 3,757 were pregnant women.

As impressive as these numbers are, they are far from what public health officials tried to get Puerto Ricans, and Americans, to believe.

In most cases, the symptoms of Zika are mild, if they are ever felt by the infected person. It has been said that only one in five infected people actually develop symptoms.

It is to pregnant mothers that the virus presents a serious risk to the developing fetus, since it is “neurotropic” (i.e., attacks the cells in the central nervous system of the developing fetus), with microcephaly (i.e., abnormally reduced head and underdeveloped brain) being the most evident consequence for Zika prenatal infection cases. Nevertheless, a series of other birth defects have been associated to the Zika virus including severe sight, hearing and learning impairments that in some cases may not be diagnosed until the child is 3 to 5 years old.

Numbers don’t match, big discrepancies

The June 8 Health report states under “Other Findings” that there have been 38 births, since the beginning of the epidemic, in which congenital defects associated to the Zika virus have been diagnosed. In contrast, the Pan American Health Organization (PAHO) seems to have obtained its data from a source different from the Puerto Rico Health Department’s published reports.

In its most recent report, dated May 25, 2017, PAHO states Puerto Rico reported only 12 cases of congenital syndrome associated with Zika have been diagnosed.

“As of EW 27 [Epidemic Week 27] of 2016, 65 infants were born to women with evidence of Zika virus infection in pregnancy, and two pregnancy losses were identified. Zika virus was identified in neural tissue by immunohistochemistry in one case of pregnancy loss. As of EW 5 of 2017, a total of 12 cases of congenital syndrome associated with Zika virus infection among live births in Puerto Rico have been identified,” reads the report under the section, “Congenital Syndrome Associated with Zika.”

Even though this data tends to confirm a seemingly direct relation between the Zika virus and certain birth defects, it is far from confirming the “health disaster” that public health authorities had anticipated the virus would cause. As a matter of fact, only 1% of all women infected with Zika gave birth to babies with congenital defects.

Discrepancies between the data itself and what public officials were communicating abound. If there are as many as 3,757 pregnant women infected with a neurotropic virus capable of doing serious damage to a fetus’ nervous system, why does PAHO report “65 infants were born to women with evidence of Zika virus infection in pregnancy,” while Health only reports 38 births have congenital defects? On the other hand, and even more significant, why did PAHO report only “12 cases of congenital syndrome associated with Zika virus infection among live births”?

Assuming the data provided by Health is correct, there are questions that beg to be answered: Is the Zika virus as harmful and dangerous as we have been led to believe? Could the government, through its alarming discourse, have given a false alarm about the scope and danger of the epidemic and the virus causing it? Why would the government insist on the widespread risk of congenital defects to children of mothers exposed to the Zika virus when there was no clear case evidence?

The year of living dangerously

In August 2016, Caribbean Business (CB) published an article detailing how the Zika epidemic had allegedly been used by the administration of then-Gov. Alejandro García Padilla in early 2016 as part of the “humanitarian crisis” discourse—the island’s economic and fiscal crisis included—in an effort to get the Puerto Rico Oversight, Management & Economic Stability Act (Promesa) to pass in Congress. That was when the administration thought Promesa could entail a significant bailout allocation for the island.

Back then, “the García Padilla administration went even further and presented an ‘overblown’ version of the crisis, apparently hoping to get some sort relief package/fund that would serve to mitigate not only the effects of the Zika virus crisis, but also those of the economic and fiscal crisis,” stated the CB article, particularly $1.9 billion in emergency financing to fight Zika.

Around that same time, both Dr. Anne Schuchat, acting director of the Centers for Disease Control, and then-Health secretary, Dr. Ana Rius, had raised an alarm about the biblical proportions of the Zika plague affecting Puerto Rico.

“We are quite concerned about Puerto Rico, where the virus is spreading throughout the island. We think there could be hundreds of thousands of cases of Zika virus in Puerto Rico and perhaps hundreds of affected babies,” Schuchat said in April 2016, without presenting any evidence to support her claims.

Rius, for her part, went on a media tour urging people, particularly women of reproductive age, to “abstain from having sexual relations” because of the imminent risk that any child resulting from such relations could suffer “serious congenital defects.”

By April 2016, Health reported 5,407 suspected cases since the beginning of the outbreak, of which 707 were confirmed cases, and 89 of those were pregnant women. No congenital defects were reported at the time.

Later that year, the García Padilla administration had a change of heart after realizing neither President Obama nor Congress was considering the possibility of bailing out Puerto Rico through a relief package within the Promesa bill. But it was too late, as García Padilla’s pitch of the “humanitarian crisis” was so good that Obama devoted his July 1, 2016, weekly address to the nation on Zika and Puerto Rico as a focus of the virus.

In the meantime, the Aedes Aegypti mosquito, the main carrier of the Zika virus, had even stung Major League Baseball, which cancelled two regular-season games in Puerto Rico and moved the World Baseball Classic games, originally slated for Puerto Rico—which had been a host for the previous three events—to a different venue. Concerns about the players’ health and safety on account of Zika were cited.

The negative impact of the virus on an already devastated economy translated into more than 60,000 room-nights cancelled and more than $56 million in lost revenues from tourism, according to Milton Segarra, the former chairman of Meet Puerto Rico, a destination marketing organization that promotes Puerto Rico as a premier meeting and convention destination.

Exaggerated risk admitted

Confronted with the unsupported statements from public officials and the data available, even at the peak of the Zika outbreak, state epidemiologist Dr. Carmen Deseda admitted to CB that the people had been misled into thinking the Zika epidemic was a more serious and dangerous health threat than it really was.

“I have to agree…. I have to agree with you [that the warnings of congenital syndrome following the Zika epidemic were blown out of proportion],” said Deseda, who, in a very apologetic tone, added “ay bendito, but you have to stand by them,” as if to say Health officials did not know better.

The number of confirmed Zika cases also has been under scrutiny mainly because of the definitions for confirmed cases and the similarities to the symptomatology of the dengue virus, among other reasons.

In a previous article published in April 2017 by CB, it was reported that PAHO’s Zika statistics for the United States contrast sharply with those for Puerto Rico. With a significantly fewer number of Zika cases, the U.S. had five times more the number of cases of congenital syndrome associated to Zika.

In its May 25 report on the U.S., PAHO states: “As of EW 6 of 2017, there has been laboratory evidence of possible Zika virus infection in 43 live born infants with birth defects and five pregnancy losses with birth defects. The reported birth defects include microcephaly, calcium deposits in the brain indicating possible brain damage; excess fluid in the brain cavities and surrounding the brain; absent or poorly formed brain structures; abnormal eye development; or other problems resulting from damage to the brain that affects nerves, muscles and bones, such as clubfoot or inflexible joints.”

By EW 6, PAHO reported there were 1,455 pregnant women in the U.S. who had been infected with the Zika virus, vis-à-vis the 3,156 women reported in the U.S. territories, presumably including Puerto Rico. However, Health reported 3,120 infected pregnant women for that same period—or more than twice the number of cases.

Possible causes of discrepancies

According to Deseda, the abysmal difference between the number of Zika cases in Puerto Rico and the U.S., particularly among pregnant women, is because in Puerto Rico, even asymptomatic women are tested for the virus.

“We are investigating if a laboratory situation is what is causing us to get more confirmed cases in Puerto Rico,” she said.

According to the epidemiologist, there are two types of tests being used to diagnose Zika exposure: the PCR and the IgM.

The PCR determines the presence of the antibodies associated with the Zika virus and it takes 48 hours to complete.

The IgM detects antibodies up to three months after the infection and takes two weeks to complete.

“If you have a woman who was exposed to the virus three months ago and has become pregnant now…she is going to test positive to Zika even though she had not been exposed to the virus during the pregnancy,” the doctor said.

Deseda also revealed that “many of the babies of asymptomatic mothers are going to be normal.”

However, she was cautious about saying that babies with congenital defects were exclusively born to symptomatic mothers, but noted there is “a greater probability” for babies born with congenital defects when the mother shows symptoms from the infection.

So, the type of test and the presence, or lack, of symptoms in the expectant mother has a significant impact on whether the baby is born with congenital defects. Reportedly, none of this information has been disclosed previously or publicly discussed.

Deseda mentioned that theories about why the number of estimated cases of congenital defects has been so low in Puerto Rico are currently being put to the test. One such theory points toward the possibility that other diseases transmitted by the same mosquito could be “shielding” the fetuses from Zika. No conclusion has been developed yet.

For the epidemiologist, the bottom line is that it was a good thing to have that many people infected with the Zika virus.

“I’m happy that many people got infected during the epidemic. I’m happy that more than 700,000 people got exposed [to the virus]…. Why? Because as more people get exposed now, [fewer will get sick in the future]…this doesn’t repeat. Therefore, if you get exposed to Zika, you can stay here [Puerto Rico] and you won’t transmit Zika because you are already immune. Zika does not repeat,” Deseda assured.

Nevertheless, she warned about the need to stay on guard. “Even though current levels of virus transmission via the mosquito are very low, it is very important to stay vigilant to keep those numbers low and support the families affected by Zika,” she said.

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