Zika
The Emerging Epidemic
Donald G McNeil Jr
W W Norton & Company
203 pages; $14.95
If a publisher had come to me four months ago and asked me to write a book about the Zika crisis in just 30 days, I'm not sure I would have had the courage to say yes, as Donald G McNeil Jr did. So many assumptions written in March or April could prove wrong by June or August that the challenge of quickly producing a book on Zika would seem too risky - given that there will also be sleep deprivation, speed writing, high-velocity editing and rewrite ahead.
And so, it is with considerable amazement that I find much to applaud in Mr McNeil's Zika: The Emerging Epidemic. Though slim, with just 174 pages of text and an 11-page question-and-answer section, Zika is dense with information. How Mr McNeil, a science and health reporter for The New York Times, managed to accomplish this so fast I cannot fathom.
Ten months ago, Brazilian health authorities sounded alarms about babies born with misshapen, squashed skulls and neurological problems. On February 1, the World Health Organization formally declared the outbreak of Zika - named after the Ugandan forest where it was discovered in 1947 - in the Americas a public health emergency of international concern. Since then, the toll of Zika has mounted, spreading to 49 countries.
In a no-nonsense, declarative writing style, Mr McNeil tells the history of humanity's relationship with the Zika virus, recounting how an equatorial African microbe surfaced in the Yap Islands in the Pacific in 2007, infecting 73 per cent of the population in just five months. Six years later, the virus, carried by Aedes aegypti mosquitoes, arose in Tahiti, or French Polynesia, where an estimated 66 per cent of the population was infected over roughly nine months. Polynesian athletes unwittingly carried the virus to Recife, Brazil, where they participated in the FIFA Confederations Cup soccer games. El Niño, which radically altered rainfall patterns across the Amazon region in 2015, is credited with causing a surge in mosquitoes across the area, fostering the Zika explosion.
The Brazilian epidemic peaked in March, when the government identified more than 8,000 new cases a week, now down to 200 a week. But at least 200,000 people in the Americas have suffered Zika illnesses, mostly mild. Far more are thought to have been infected, but have shown no symptoms.
Since Mr McNeil's book was finished on June 1, numerous new findings have offered further cause for concern about Zika's arrival in the United States.
For example, lacking a reliable, affordable method of diagnosing current and past infections, researchers must use sophisticated guesswork in the form of mathematical models to reckon the scale and trends of national outbreaks. New research shows that a woman can become infected with Zika, have no symptoms, yet give birth to a baby with microcephaly.
No tests administered during pregnancy, including sonograms and blood analyses, can tell would-be parents definitively whether their child has been infected, and identify damage to the fetus. This has forced awful choices, a soaring rate of abortions in some Latin American countries, and tough debate in the US.
It was established early this year that Zika could be spread through intercourse from man to woman and from man to man, and an asymptomatic man might harbour infectious virus in his semen for more than 93 days. Since Mr McNeil finished the book, we have learned that the virus can thrive in vaginal fluids, and a case of female-to-male sexual transmission has been reported in New York City.
Zika is spreading so rapidly now in Puerto Rico that US health officials predict 25 per cent of the population will be infected by early August. As Zika surfaces inside the continental US new puzzles are arising, including how the virus was transmitted from a man in Utah, who died of the disease, to his adult son, who had cared for him; presumably the virus spread via blood, saliva or urine. And authorities are investigating two cases of apparent mosquito transmission of Zika in Miami, the possible onset of North America's homegrown outbreak.
Mr McNeil is not a political reporter, so his beat did not give him room to cover the fight over Zika funding on Capitol Hill. So you will find nothing in this book about the deeply partisan battles over Zika funding, leading to the congressional summer recess with no agreement reached on the White House's February request for $1.9 billion for prevention and research on the virus.
Mr McNeil ends with simple words: "Stay alert. And empathetic." That's not a bad summary of how all of us - public health experts, politicians, ordinary citizens - should respond to outbreaks of contagious disease. Being alert is far superior to the alternatives of nonchalance and fearfulness. And empathy is clearly better than common reactions to disease: Stigmatisation of the afflicted, disdain toward those most at risk for infection and political dithering that leaves populations in peril with few facts and no financing to stop the microbes' spread.
©2016 The New York Times News Service
