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Rasheed's World > epidemic
Brazil struggles with Zika outbreak
By Rasheed Abou-Alsamh
Brazil is reeling from an unprecedented outbreak of the Zika virus, which in the worst cases affects the fetuses of pregnant woman, causing malformation of the babies’ brains.
The virus is spread by the Aedes aegypti mosquito and the first case here was only recorded in 2014. It is believed that the virus was imported into Brazil by a traveler or athlete from the Pacific islands during the World Cup.
There are already 3,718 cases of suspected microcephaly in Brazilian babies, which means that their heads measure only 32 centimeters or less at birth. The majority of reported cases have been in Northeastern Brazil, the hottest and poorest region of the country. This has caused the US government to warn pregnant American women from traveling to Brazil, and has worried some Brazilians that if the outbreak is not handled quickly it could scare off some of the hundreds of thousands of foreign tourists expected to arrive for the Rio de Janeiro Olympic Games in August.
But what is the Brazilian government to do? Brazil is a tropical country with a lot of heat and rain. The poorest Brazilians live in shacks in slums that have many places where garbage accumulates as well as pools of water and sewage, perfect breeding grounds for mosquitoes. As one American expert rather gloatingly noted recently, the Zika virus is not going to spread like fire in the US because most Americans have air-conditioning and screens on the windows in their homes that keep the mosquitos out. Poor Brazilians do not have that luxury.
So the Brazilian government has done as it always has: Launched a public relations campaign through ads on television, radio and newspapers, telling the population to fight the breeding grounds of mosquitoes by making sure they do not have pools of water lurking around their homes in old containers, under potted plants and in any junk they may have accumulated in their backyards. But this is the continuation of a long-term campaign in its battle against the equally mosquito-borne pestilence of dengue fever. Municipal officials and occasionally army troops are annually deployed across cities and towns in Brazil, going door-to-door to inspect homes for mosquito-breeding locations. If they do find stagnant water pools, they try to drain them, and if that is not possible they pour insecticide into the water to kill the larvae of the mosquitoes.
But, meanwhile, the numbers of Brazilians infected with dengue and Zika keep skyrocketing. According to the Ministry of Health, the number of dengue cases in the first 20 days of this year jumped 48 percent, reaching 73,000 cases. In 2015, there were an eye-popping 1.6 million cases of dengue in Brazil. In dengue fever, the symptoms are high fever and acute pain in the eyes and joints of patients. In the case of Zika infection, the victim also gets red blotches on their skin across his/her body. There is also a more dangerous version of dengue fever that apart from causing all of the aforementioned symptoms causes internal bleeding.
The Brazilian government has now said its priority is to help with the work being done to develop a vaccine for the Zika virus. They hope to have human trials for a vaccine 18 months from now.
The scary aspect of the Zika virus is that when a pregnant woman catches it in her first three months of pregnancy, she most times passes it on to her fetus. Unfortunately, tests can only detect whether a fetus has been infected with the virus from the 24th week of gestation and onward. Which means that a fetus will already be six months old when the Zika virus can be detected. That causes many complications in that it makes it harder for a woman to have an abortion at that late stage in the pregnancy. Brazil has been battling with this, since being a Catholic nation abortion is strictly banned except if the mother was raped or could die if she brought the pregnancy to gestation.
A Supreme Court justice said recently he believed that women with fetuses affected by the Zika virus should be allowed to have abortions, since these babies will most likely be born with malformed brains. But no one seems to be pushing this aspect of dealing with the crisis. As one Brazilian commentator quipped: “Rich Brazilian women are not affected too much by the restrictions because they can afford to pay the $1,800 to have an illegal abortion in a private clinic, while poor women who cannot afford that remain resigned to their fate.”
The panic that this has generated here in Brazil has caused many well-to-do pregnant women to move to Miami in the US for the duration of their pregnancies, returning to Brazil only after their babies are born. Poor women obviously do not have that option. So the Brazilian government should step up efforts to control the mosquito population in Brazil, while work is being done on a vaccine for Zika and dengue too. Fumigating areas with too many mosquitoes, encouraging Brazilians not to throw their trash everywhere, and handing out free insect-repellent in poorer areas would go a long way in controlling the ever growing number of dengue and Zika victims.
This column was printed in Arab News on Feb. 14, 2016: http://www.arabnews.com/columns/news/880281
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Rasheed's World > epidemic
Do more before Ebola reaches tipping point
This is my Arab News column published on October 12, 2014:
By Rasheed Abou-Alsamh
Watching a BBC report this week on a desperate family in Liberia that had a male member ill with the Ebola virus, driving from one emergency medical center to another, only to be turned away from them all, was heart-wrenching.
They were confused and in the tropical heat looked dazed and angry, a woman frantically fanning the sick man who looked too weak and feverish to walk, let alone stand up, as he sat slumped in the front passenger seat. The reporter bravely gave the family rubber gloves to use, the most she could do in such extreme conditions, where in a tiny and impoverished nation such as Liberia, this deadly virus has completely overwhelmed the public health system. The sick man died shortly thereafter.
With more than 4,000 deaths now from the Ebola virus, and more than 8,000 people in West Africa infected with it, according to the World Health Organization, we have an epidemic on our hands. And if more is not done quickly, such as more experimental drugs to treat Ebola victims, and vaccines invented to prevent infection, then we will soon have a global pandemic. For sure the Ebola virus is not that easily transmitted, but it is also not that difficult to become contaminated with it if you come into contact with the bodily fluids of infected patients, as we have seen with the various nurses and aid workers, who have come down with the disease. And the mortality rates are extremely high: 70 percent of Ebola patients in West Africa are dying from it, Robert Murphy, a professor of medicine at Northwestern University in Chicago, told USA Today.
Which brings us to how the disease is being fought, how patients are being treated or not, and why finding a cure still doesn’t seem to be a high priority for major pharmaceutical companies. The first three Americans exposed to the virus in West Africa were all flown home to the United States where they received the best medical treatment in the world, including the experimental drugs ZMapp and TKM-Ebola. They also received blood transfusions from Ebola survivors, in the hope that their antibodies would strengthen their immune system against the virus. All three survived and have recovered well.
Compare their treatment to that of the 42-year-old Liberian Thomas Eric Duncan who just died this week of the Ebola virus in a Dallas hospital. He was not offered ZMapp or TKM-Ebola. According to the Atlanta Blackstar news site, contradictory reasons were given for why Duncan did not get the drugs. Tom Frieden, the director of the Centers for Disease Control and Prevention, said that doctors treating Duncan feared the drug might worsen his condition. Dr. Anthony Fauci of the National Institutes of Health claimed that supplies of ZMapp were exhausted, and that it would take six to eight weeks before new supplies would be ready. Duncan was given brincidofovir, an experimental antiviral drug, more than one week after he was admitted to hospital, according to USA Today. Obviously, that was not enough to save his life. He was not offered blood transfusions or any other experimental drugs according to the paper.
The good news, if you can even call it that, is that the WHO has fast-tracked the development of experimental vaccines against Ebola, agreeing to skip the usual randomized controlled tests in which some participants get the vaccine and others a placebo. The WHO said that it was ethical to give Ebola patients untested vaccines, although the risks and benefits should be strictly evaluated and the results shared. Several experimental vaccines are being tested in Africa, and hopefully will be able to save lives once they are produced and used on larger scales.
The US government has already sent 400 US military personnel to Liberia to set-up blood screening centers that process blood samples from Ebola patients. The US House of Representatives has now approved a further $700 million in funding to deploy a further 4,000 American troops to West Africa to help in the fight against Ebola. Cuba too has sent 165 doctors to Sierra Leone and will send a further 296 doctors to Liberia and Guinea.
Big pharmaceutical companies are not beating down anyone’s door to develop Ebola vaccines or treatment drugs because so far the majority of the victims have been poor Africans, who could never afford to buy expensive medicines that these manufacturers would want to push them to do in order to recoup their research and development costs in bringing these Ebola drugs quickly to the market. But this is a global emergency and all governments involved — African, Western, and Asian — should get together and pool their resources to fast-track the development of an Ebola vaccine. They could do so by using government laboratories or in some sort of government-private sector partnership where they offered private pharmaceutical firms tax incentives to develop these drugs quickly and cheaply.
All of our lives are in danger if not enough is done now, and Ebola is allowed to become to a global scourge. We cannot continue to be complacent, as our future depends on it.