Municipal agents spray against at the Sambadrome in Rio de Janeiro on January 26. Brazil mobilized more than 200,000 troops to go "house to house" in the battle against Zika-carrying mosquitoes.

Municipal agents spray against at the Sambadrome in Rio de Janeiro on January 26. Brazil mobilized more than 200,000 troops to go "house to house" in the battle against Zika-carrying mosquitoes.

In the days since the WHO declared Zika a global health emergency, parts of the U.S. have been preparing to contend with the virus – and the mosquitos that can carry it. The Obama administration now says it will ask Congress for $1.8 billion to respond to the Zika virus abroad and to prepare for it here at home. While Zika has begun to draw comparisons to Ebola – in potential scope and the ways health organizations should address it – many experts want to get out the message that Zika is a dramatically different public health concern; one that shouldn’t cause panic, but that should be taken seriously. It has raised tough questions about women and reproductive rights, following calls for women to delay childbirth in countries where contraception and abortion are hard to access or even illegal. And with Brazil at the heart of the pandemic, calls for delaying the Olympics, set to be held in Rio de Janeiro this summer, are growing louder. A panel of guests joins guest host Tom Gjelten to explain the risks – and how experts are facing the global challenges – posed by the Zika virus.

Guests

  • Arthur Caplan Director, division of medical ethics, New York University Langone Medical Center
  • Dr. Michael Osterholm Regents professor and director, Center for Infectious Disease Research and Policy, University of Minnesota; frequent consultant to the WHO, NIH, CDC and FDA; member of both the National Academy of Medicine and the Council on Foreign Relations
  • Larry Gostin Director, O’Neill Institute for National & Global Health Law at Georgetown University Law School; and director, World Health Organization Collaborating Center on Public Health Law & Human Rights.
  • Dina Fine Maron Editor, Health & Medicine, Scientific American

Q&A On Zika Risks

A Panel Of Experts Answers Your Questions About The Zika Virus - The Diane Rehm Show

During our segment on the risks and spread of the Zika virus, we received many questions from listeners via phone calls, email and social media. We weren't able to get to all of them during the show, so we reached out to those panelists to answer a few more listener questions afterward.

Transcript

  • 10:06:54

    MR. TOM GJELTENThanks for joining us. I'm Tom Gjelten of NPR sitting in for Diane Rehm. She's on a book tour. In this weekend's GOP debate, Governor Chris Christie said he's support quarantining anyone returning from Brazil with Zika virus symptoms. That recalled debates over how to manage Ebola patients. One example of the ethical and logistical issues raised by Zika, which has been gaining attention since the WHO and CDC issues warnings about the virus.

  • 10:07:23

    MR. TOM GJELTENJoining me with some perspective on the risks from Zika and looking at some of these challenges, I have Larry Gostin of the O’Neill Institute for National & Global Health Law at Georgetown University Law School, Dina Fine Maron of Scientific American. They're both here with me in the studio. And joining us by phone from Ridgefield, Connecticut is Arthur Caplan, medical ethicist at New York University and from Minneapolis, Minnesota, Dr. Michael Osterholm of the Center for Infectious Disease Research and Policy at the University of Minnesota.

  • 10:07:56

    MR. TOM GJELTENI know a lot of you have questions about Zika. We'll bring you into our conversation. You can call us at 1-800-433-8850. You can send us an email, drshow@wamu.org. You can also send in questions via our website, our Facebook page or on Twitter. A good day to all of you.

  • 10:08:18

    MS. DINA FINE MARONHi.

  • 10:08:19

    MR. ARTHUR CAPLANHey, thanks for having us.

  • 10:08:20

    GJELTENGreat. Let's start with the news this morning that President Obama is asking Congress for $1.8 billion in emergency funding. Dina, what do we know about this request? That's sounds like a lot of money.

  • 10:08:35

    MARONHi, good morning. Yeah, it does sound like a lot of money. The majority of it would be used for domestic purposes, specifically for Zika virus, towards getting a better understanding of the virus, where it's occurring, its links with birth defects that cause small-headed abnormalities as well as to improve -- finding a vaccine. But another $335 million of that fund would go overseas to support countries that are affected by the virus.

  • 10:09:07

    GJELTENAnd Larry, what would be some of the sort of research needs that this money would go to most quickly? I mean, does the CDC need this much new funding in order to investigate this virus?

  • 10:09:20

    MR. LARRY GOSTINIt absolutely does and if you remember, right in the height of the Ebola epidemic, President Obama asked for an emergency allocation. It has a huge impact both in the region, but also here in the United States. I mean, we certainly need to ramp up research for a vaccine and also a diagnostic test that's reliable because now you have to send samples to a specialized lab. And we need to find out, quite urgently, whether or not the apparent link between microcephaly and Zika virus is causative.

  • 10:10:00

    MR. LARRY GOSTINWe don't know that for certain and I think we do need NIH's leadership to make that happen. And then, finally, to me, what's most important is what's going on in the Americas and, in particular, in Brazil because it's affecting the young, the poor women and it's really unconscionable.

  • 10:10:21

    GJELTENMichael Osterholm, how quickly can these questions that Larry raised be answered? I mean, he said it was urgent, but can you answer questions like that urgently, quickly?

  • 10:10:32

    DR. MICHAEL OSTERHOLMWell, first of all, let me just make a comment that I think that the funding is a very, very important step forward, but as we know with all vector control, mosquito control, it's all local. It's like politics. And so what we're going to be looking for is very rapid movement of resources from the federal and international level to the local areas. And that's going to be the important piece here is that what can we do there.

  • 10:10:55

    DR. MICHAEL OSTERHOLMI think the second thing is that in public health, many, many times, we actually find what we call associations or very strong evidence of something tied to something else without understanding the actual proof of how it happened. Many years ago, we took aspirin out of the pediatric recommendation regimen for a condition called Reye Syndrome and we dropped, literally, overnight, all the cases. We've had many examples of where we've been able to show the very close relationship.

  • 10:11:23

    DR. MICHAEL OSTERHOLMAnd I think here that the relationship is well established between both microcephaly and Guillain Barre Syndrome. So, to me, I think the real key message here is, yes, we need to understand it better, but we don’t need any more understanding to affect this situation. If we do good localized mosquito control, we are going to have not only an impact on Zika, but also on Dengue, which has killed over 3300 people in the Americas in the last three years and we're going to have an important impact in Chikungunya and other viral infections mosquitoes are carrying.

  • 10:11:52

    GJELTENSo would you say then that even though we don't know so much about the mechanism by which this virus might work that maybe that it's not so urgent that we answer those questions?

  • 10:12:05

    OSTERHOLMWell, actually, I think it is urgent that we answer it, in particular, because of the fact that we're all talking about a new vaccine. I worry about a new vaccine because of the tie with Guillain Barre Syndrome. I was very involved back in 1976 with the original swine flu Guillain Barre Syndrome relationship and we surely established that. I have been involved with several other disease entities that cause Guillain Barre Syndrome and I can tell you right now, regulators are not going to move forward quickly on a vaccine like this until we understand could the vaccine itself cause Guillain Barre Syndrome just like the actual viral infection does.

  • 10:12:37

    OSTERHOLMSo that we're going to have some real very important work to be done to understand how that happens and why that happens, which is at the very basic laboratory level. And that, to me, is most important. The issue with microcephaly, there's any number of causes for why that can happen. The key message, again, is I don't need to understand why it's happening to understand how to prevent it. How to prevent it is to get these mosquitoes out of the home environment, the community environment these people are living in, whether it's in the Americas or in the United States.

  • 10:13:07

    GJELTENMichael -- Arthur Caplan, as an expert on medical ethics, how do you see this issue, this kind of dichotomy between prevention and research, what do you think are the priorities from a medical ethical point of view?

  • 10:13:24

    CAPLANWell, the priorities, certainly, are finding that reliable diagnostic tests. We haven't mentioned something that worries me and that is transmission into the blood supply. I spend four years as the chair of the advisory committee on blood safety and availability and you don't want this virus getting into the world's blood supply or the U.S. blood supply that would make for obvious transmission issues that would be very, very problematic. So as Larry said, I think a good diagnostic test, reliable, quick, fast, that's very, very important in terms of control.

  • 10:14:02

    CAPLANAs Michael has been saying, controlling the mosquitoes, no matter what evidence is out there, it's pretty clear that one species is carrying a bunch of diseases that are nasty and we have to do what we can to get rid of them. I think that's another prevention step, whether it's public health education about using repellant or staying indoors or I don't think the species is a night-mover so much of mosquito, but maybe there's some use for bed nets. So you really have to get out there and educate people.

  • 10:14:35

    CAPLANThat's another priority about how to handle mosquitoes and make sure that we've got appropriate pesticide use. Maybe even start thinking about some genetic experiments with mosquitoes.

  • 10:14:45

    GJELTENDina, we've had many years of experience dealing with mosquito-borne diseases, Dengue, Malaria, et cetera. Are there new issues that we have to consider now as we look at the prospect of a global pandemic with the Zika virus?

  • 10:15:05

    MARONThat's a good question. Well, as you point out, though we do have a lot of experience with these other mosquito-borne diseases, we, in fact, do have a lot of experience with them so we know a lot more about the symptoms that we would see with them, ways to address them and though we have learned lessons that are applicable here about the mosquitoes themselves, the main vector, it is aegypti, we know it's a daytime biter. We know where it breeds so we know the type of methods that could help make an environment less hospitable for the mosquitoes, namely eliminating standing water in your yard, things like that.

  • 10:15:38

    MARONWhat we don't know is really how often, one, we could see this link between Zika virus and microcephaly, we don't know how often women who are pregnant go on to develop this and we also don't know a lot of questions about really whether or not this could pick up in the United States. What's really great to know is that we've seen, though, there have been pandemics of Dengue around the world, we know there haven't been large clusters of disease here in the United States.

  • 10:16:08

    MARONAnd that's a really important note to be thinking about here. Though, indeed, we have the mosquitoes that are biologically capable of passing on Zika virus here, that doesn't necessarily mean there'll be a large outbreak here. Now, the U.S. Centers for Disease Control and Prevention are expecting that there will be local transmission here in the United States via mosquito and we are seeing that it would likely maybe on the Gulf Coast, which is where we've seen Dengue and Chikungunya.

  • 10:16:32

    GJELTENLarry?

  • 10:16:33

    GOSTINYeah. I mean, while we're on the topic of really aggressive control of the mosquito population, I think we need to understand that mosquitoes are actually the most dangerous animal on earth.

  • 10:16:44

    GJELTENIsn't that something?

  • 10:16:44

    GOSTINBy far. And they cause any range of diseases. You've mentioned a number of them, Malaria, Dengue, Chikungunya and Zika among others. And I would create a war on the mosquito in terms of very, very aggressive spraying of habitats, getting rid of standing water, making sure that people wear DEET and other kinds of things and I would really focus my efforts in concentration with low and middle income countries in the Americas. They're the ones that are going to suffer.

  • 10:17:30

    GOSTINAnd one of the things that really, from an ethical point of view, just gets under my skin is that we can control it here so we should be able to control it there. We need to put the resources in.

  • 10:17:42

    GJELTENLarry Gostin is director of the O'Neill Institute For National And Global Health Law at Georgetown University Law School. He says mosquitoes are the most dangerous animal in the world and I can't disagree with that. We're gonna take a short break and then, we'll be back with all of your questions and my other guests, Dina Fine Maron from Scientific American, Arthur Caplan, a medical ethicist and Dr. Michael Osterholm. Stay tuned.

  • 10:20:02

    GJELTENWelcome back. I'm Tom Gjelten from NPR and I'm sitting in for Diane Rehm today. And we're talking about the alarming spread of the Zika virus, what to do about it, what to make of it, how serious is it, how to fight it. President Obama is asking Congress for $1.8 billion in emergency funding to do this. My guests here in the studio are: Larry Gostin from -- he's director of World Health Organization Collaborating Center on Public Health Law & Human Rights. He's from Georgetown University. Dina Fine Maron from -- Health & Medicine editor at Scientific American. Arthur Caplan, director of the division of medical ethics at New York University's Langone Medical Center. Did I get that right?

  • 10:20:45

    CAPLANLangone.

  • 10:20:46

    GJELTENLangone, okay. I didn't have a pronouncer on that. Sorry. And Dr. Michael Osterholm, regents professor and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Dr. Osterholm, before we go too much further, just give a sense right now about the spread of the Zika virus. Where is it? Where is it likely to spread? What do we know about the, you know, prospects of it spreading globally. Just give us a kind of a global update on where we stand with it right now.

  • 10:21:18

    OSTERHOLMWell, first of all, Zika virus will go anywhere in the world if the right mosquito is there to actually spread it. And the right mosquito right now is the Aedes aegypti mosquito that we've been talking about, basically the mosquito that lives with people. I liken it to the Norway rat…

  • 10:21:31

    GJELTENSo it's a very common mosquito.

  • 10:21:34

    OSTERHOLMWell, it's common only in the sense that it is common in the sense of living with people. That's why I call it the Norway rat. If you look at the mosquito that causes Malaria, for example, you might consider that more like a gazelle or a deer. It lives in a very different environment. The mosquito that we're worried about may live in your closet. In fact, in household surveys, they find that that's the most common place to find an Aedes aegypti in your house, it's in your closet. It's not one that basically lives out in the air. We've studied mosquitoes that spread disease that may fly 40 miles a night on winds, whereas the Aedes aegypti will be right on your block, it'll be right in your yard.

  • 10:22:11

    OSTERHOLMAnd so the point is, we have to tailor any kind of mosquito control programs that we do for this kind of mosquito. Now it is spread around the world. Originally it came to the Americas with the first ships bringing the slaves over from Africa. It spread throughout the Americas. In the 1970s, with very aggressive waste management activities and vector control programs, included insecticides and so forth, we almost eradicated it from the Americas. But as you may recall the movie "The Graduate," what did they tell Dustin Hoffman to go into? Plastics.

  • 10:22:41

    GJELTENMm-hmm.

  • 10:22:41

    OSTERHOLMAnd in the 1960s, we was the emergence of these non-biodegradable products -- plastics and rubbers -- that now predominate in all the solid waste of the developing world in particular. This is the primary breeding site areas. These are different than trying to deal with Malaria mosquitoes. This is different than trying to deal with West Nile type mosquitoes. And so one of the problems we've had has been, over the past several weeks, we've got a lot of people commenting on what to do about mosquitoes who didn't understand the difference between mosquitoes. And so these programs really need to be tailored to the mosquito that lives right with us in all of our garbage and junk.

  • 10:23:12

    OSTERHOLMAnd every community in the world could do a great deal about removing this risk if they could, in fact, clean up the solid waste just in their own environment. It doesn't take high-tech activity to do that.

  • 10:23:23

    GJELTENNow one of the issues that is raised by the problem of mosquito breeding is that it really impacts communities differentially, right? I mean, if you're talking about in Brazil, for example, or anywhere in the tropics -- I mean, the low-income, poverty-stricken communities are the ones where they probably have the most stagnant water and the most dangerous areas for breeding mosquitoes. Right, Dina?

  • 10:23:51

    MARONYeah, exactly so. CDC has said that one of the reasons we haven't seen such a spread -- not just of Zika virus, but also dengue and chikungunya here -- is because Americans are more often inside with air conditioning, with screens on their doors. We're not as outside as much. But also we're not as densely packed as some communities together in Central America and South America. And because we don't have that proximity to one another in the exact same way, it's not as appealing or as useful for mosquitoes who are biting maybe five mosquitoes in one -- pardon me, five people in one blood meal.

  • 10:24:24

    GJELTENAnd, Art Caplan, another interesting issue or sort of alarming aspect of this problem is the special impact it has on women, the issues it raises for women. Because we've got these authorities who are actually telling women they shouldn't get pregnant, which is, you know, how realistic is it for advice like that to be given?

  • 10:24:47

    CAPLANWell, it's certainly worth suggesting abstinence. I'm not sure there's lots of evidence that that works for a long time but it can be suggested. But I think it's important to realize that in some of these countries in Central, South America, there are religious values that oppose not just -- oppose, if you will, not allowing someone to terminate a pregnancy, but even have lukewarm values about condoms. And so, we haven't mentioned it yet, but there is, it looks like, some sexual transmission of the disease. I think this should bring pressure in these countries to say we've got to be preventative.

  • 10:25:28

    CAPLANYep, we can give the abstinence speech. Yes, we can certainly say avoid pregnancy. But people don't always do that and aren't always aware that this threat is out there. I think we've got to push for better condom availability. And I think it's fair to say we've got to push hard for the right of people to have access to safe abortion. By the way, my Ob-Gyn colleagues tell me that sometimes this disease, if there is a microcephalic infant, it isn't detected until relatively late in a pregnancy, which even raises an issue in the United States about third-trimester abortion.

  • 10:26:11

    GOSTINYeah. Larry, you wanted to jump in because I wanted to connect the two themes that you were just raising. One is about the injustice and the inequity.

  • 10:26:21

    GJELTENMm-hmm.

  • 10:26:22

    GOSTINAnd the other is about reproductive rights.

  • 10:26:25

    GJELTENYeah.

  • 10:26:25

    GOSTINBecause they really connect. The people who are at risk are the poor. And they're the poor not just between the United States and Latin America, but also within countries, say, within Brazil. The rich are relatively unscathed from this. But poor, very, very young, often uneducated women and, in Latin America, most countries have very restrictive laws on contraception and abortion. So we're telling them, don't get pregnant, in El Salvador's case, not until 2017. And we're not giving them the tools to do something about it. So I think this has got a deep, ethical, human rights...

  • 10:27:10

    GJELTENRight.

  • 10:27:10

    GOSTIN...reproductive rights overtone to it.

  • 10:27:14

    GJELTENDr. Osterholm, we're getting a lot of questions, not surprisingly. And here's an important one. This is an email from Curtis, who says, since Zika probably doesn't make you sick, does it leave something in the systems of males and females that can come into play after all sign of disease have disappeared? And for future pregnancies, is this something that is in your body? Is this a virus that is going to remain active in your body and can be a problem in future pregnancies?

  • 10:27:42

    OSTERHOLMAnd that is a really important question. We're hearing that from many, many people, particularly as so many have traveled to the other parts of the Americas where this virus is now present and have then returned. All the best scientific data we have at this time indicates that literally within several weeks the virus will clear completely from your system. Unlike what we're seeing with the Ebola virus right now, where we know people may recover from the illness but still be infectious potentially for months later, this is not the case here.

  • 10:28:09

    OSTERHOLMSo what we're making in terms of recommendations for the blood transfusion issue that Art mentioned earlier or for sexual contact is that, within 21 to 30 days, you should feel very comfortable that if you've left that region -- whether you were infected but didn't know it or whether you were not infected -- you shouldn't be a problem at all.

  • 10:28:28

    GJELTENDina.

  • 10:28:29

    MARONYeah. Just one thing to add to that. What the scientific evidence is right now is that the virus will clear from your blood in about a week. But we do have a lot of unanswered questions about how long it might stay in other bodily fluids, specifically with the most recent evidence of a couple of instances of sexual transmission from one individual to another via sexual contact. We don't know how long the virus might stay in the semen of men. And that's why CDC has issued new guidance last week saying that, if a man has traveled to a place where there's active transmission of Zika virus, that he should engage in condom use, especially if he has a pregnant partner.

  • 10:29:05

    GJELTENLarry...

  • 10:29:05

    OSTERHOLMRight. And can I just add to that?

  • 10:29:07

    GJELTENYes, please, Michael Osterholm.

  • 10:29:08

    OSTERHOLMEven the cases we have on that all occurred within the 21 days post return from one of these areas. And I think one of the things that we're concerned about is, is we have people who traveled to the Americas three years ago who are now questioning whether or not they should get pregnant as a couple. And at this point, we have no evidence that that kind of risk is there. So we will have to in a sense titrate: is it 20 days, 21 days, 30 days that you are potentially long-term infected afterwards? But we don't have evidence based on this type of virus, even with semen, saliva, vaginal secretions, whatever, that someone may be infectious for an extended period of time. There's just no model for this virus to do that.

  • 10:29:48

    GJELTENAnd just to clarify, Dr. Osterholm, are you -- it sounds like you're still really focused on the mosquito as the method of transmission, as opposed to sexual contact or saliva or anything else.

  • 10:30:00

    OSTERHOLMNo. No. No, let me be really clear about that.

  • 10:30:02

    GJELTENOkay.

  • 10:30:02

    OSTERHOLMThos other mechanisms may surely play a role. But, you know, it's the situation where if you had to look at the vast majority of transmission, what is really going to stop this outbreak is stopping the mosquito spread. This is something that will be rare, one-off kinds of experiences, where we can have that blood transfusion. Sure we could have more because of the magnification -- one unit of blood may be used in a number of different people. That surely could be a problem. But in a sense, if we take our eye off the ball, it's about mosquito control.

  • 10:30:32

    GJELTENRight.

  • 10:30:33

    OSTERHOLMAnd that's where it's really at. And the other ones will be the kind of one-off that, you know, it's unfortunate the media played such high, high, high attention to the one case in Dallas, as if, somehow, to make it seem like this was going to now become a major sexually transmitted disease. It's just not.

  • 10:30:47

    GJELTENLarry Gostin, we mentioned at the top of the program this issue of quarantining people who are returning from areas or -- and showing signs of the Zika virus. With all of these infectious diseases, there are broader implications, questions that come up. The CDC came out with a recommendation that, you know, warnings about travel to areas where Zika is active. Obviously there are industries that have huge -- there are countries with big vested interests in not scaring people away. I mean Brazil is having the -- scheduled for the Olympics this summer. What are some of the implications that this has for the tourism business for, you know, for some of these countries that really depend on travelers coming to visit?

  • 10:31:36

    GOSTINWell, you've raised really important questions. Let me just take them quickly, one at a time. First of all, the idea about quarantine that came up in the Republican debate is really quite absurd. It's unlawful to quarantine somebody unless, say, they have very active tuberculosis or some kind of an infectious, person-to-person transmission. This would be completely unacceptable. I think Chris Christie did it with Ebola and now he's suggesting he might do it here. So let's just take that off the table.

  • 10:32:10

    GOSTINIn terms of travel advisories, it was very interesting. The CDC recommends that pregnant women postpone travel to Zika-affected areas, whereas the WHO didn't make that recommendation.

  • 10:32:21

    GJELTENRight.

  • 10:32:22

    GOSTINI think the CDC is right. You know, if I had a daughter and she was pregnant, I would tell her to postpone pregnancy. And then, finally, you've got this question of tourism, trade, travel to the area. By historical numbers, we're likely to see up to 10 percent loss of GDP in places like Brazil. And that will be amplified in the Olympics. So this is a huge question.

  • 10:32:47

    GJELTENLarry Gostin is director of the O'Neill Institute for National & Global Health Law at Georgetown University Law School. I'm Tom Gjelten. You're listening to "The Diane Rehm Show." And remember, our phone number is 1-800-433-8850. And our email is drshow@wamu.org. Dr. Osterholm, we have an email here from Russ in Florida who says that we already have 25,000 cases of microcephaly in the U.S. every year. He's read that. He's wondering if that's true. He's also read that 4,000 -- the 4,000 cases in Brazil may be a gross exaggeration booster by media hype. It further suggests that it has not been proven that Zika causes microcephaly rather than occurring with it.

  • 10:33:36

    GJELTENBut as you have pointed out, all you really need to focus on at this point is the association of microcephaly with the Zika virus and the, you know, the details of its transmission can be dealt with in time.

  • 10:33:51

    OSTERHOLMWell, first of all, let me just frame this discussion by two words: climate change. You know, we're still having the debate, is this proven or not? Even though the abundance of data surely supports that it's happening and it's manmade. The situation with Zika is very similar in the sense that, yes, we always had microcephaly occurring in our communities, some from infectious disease causes, others from genetic causes. And that background will be there.

  • 10:34:15

    OSTERHOLMBut what those of us who have done outbreak investigations, who are trained to come in to look at something that's an unusual occurrence, we'll tell you that, first of all, the vast majority of Brazil has not yet been hit by this. It's only largely in the northern and central regions of the country in a much smaller population. What we're talking about are medical facilities that used to have three to five cases of microcephaly a year, who are now seeing anywhere upwards of 20 to 30 new cases a month. And so what's happened is, is that these case increases, both with microcephaly and Guillain-Barre syndrome have occurred coincidentally, exactly at the time Zika arrived. So dengue was already there. Chikungunya was already there.

  • 10:34:55

    OSTERHOLMIn addition, we had evidence from an outbreak in French Polynesia back in 2013 and '14, that the very same thing happened there. This virus basically caused a major increase in Guillain-Barre syndrome and microcephaly. We now have some evidence genetically that this virus has changed, that in fact it has now become what we call a neurotropic virus, where it actually has a predilection for the neurologic tissue of a human and fits perfectly well within that. So I am absolutely certain that one day we'll more fully understand the actual mechanism at a cellular level by which these occur.

  • 10:35:30

    OSTERHOLMBut in the meantime, from an epidemiologic standpoint, they're solid. And I really commend the CDC for taking the proactive position it did. I think the WHO should have taken it. I regret that they didn't. I think that the, you know, this idea, we'll be debating this probably for years to come, does it cause it or not? But I think the media and everybody has to just move on. The data are clear and compelling that this is associated.

  • 10:35:51

    GJELTENAnd, Dina, Dr. Osterholm mentioned the neurological, predilection of this to attack neurological tissue. And of course there is not -- it's not just the microcephaly, there's also the Guillain-Barre syndrome which could occur even, you know, in men who get this.

  • 10:36:11

    MARONSure. Yeah. So there's this association with this autoimmune disease that you just mentioned that can eventually lead to paralysis and that could occur in any individual. We saw an uptick of that in French Polynesia in 2014. During that outbreak, in the peer review literature, they talked about a 20-fold increase since Zika outbreaks had began there in the past couple years. But we haven't heard that many formal reports with that association yet.

  • 10:36:38

    MARONAnd just to address the questioner's question about the 4,000 cases of microcephaly in Brazil. What scientists are saying right now about that is -- unfortunately the definition of microcephaly is tiny bit loose, in the sense that it's categorized by measuring the circumference of a baby's head and comparing it to other babies who are of the same gestational age and gender, saying, okay, does this head look abnormally small to you? And so what's happening right now, according to CDC, is they're going back and looking at these documented microcephaly cases to ensure that these records are really accurate.

  • 10:37:12

    MARONAnd also there have been a number of cases, however, where there has been laboratory confirmation now that amongst these 4,000 babies, some of them -- unfortunately just a handful have been tested so far -- they've seen Zika virus in the brain of these individuals. So that link has been made.

  • 10:37:29

    GJELTENDina Fine Maron is health and medicine editor at Scientific American. We're talking about the Zika virus. There are a lot of questions. We're going to go, after this short break, we're going to go to the phone lines and give you a chance to comment. Stay tuned.

  • 10:40:01

    GJELTENWelcome back. I'm Tom Gjelten from NPR and I'm sitting in for Diane Rehm today for this discussion of Zika virus and we're getting a ton of questions as you can imagine. Lots of people are wondering what to do about this, how serious it is. My guests, here in the studio are Larry Gostin, from Georgetown University Law School. He's an expert on some of the legal issues around epidemics. Dina Fine Maron, Health and Medicine Editor at Scientific American. By phone, we have Dr. Michael Osterholm, who's an expert on infectious disease and Director of the Center for infectious disease research and policy at the University of Minnesota.

  • 10:40:43

    GJELTENAnd also on the phone is Arthur Caplan, who's director of the Division of Medical Ethics at New York University's Langone Medical Center. And Art, we have a tweet here from Lou. I mean, we're getting a lot of tweets and emails. Who says that I have tickets for myself and my son to visit Ecuador in late March. Should I consider cancelling my trip? We already heard from Larry, who thinks that these travel advisories are well considered. But the big issue is the Summer Olympics in Brazil, at the heart of the pandemic.

  • 10:41:20

    GJELTENWhat's your view of how -- whether these games should go forward and what precautions might be taken there if they do go forward?

  • 10:41:28

    CAPLANSo, my view is that we ought to think hard about a postponement. And it's not because the epidemic is raging out of control yet, but if you look at WHO projections, it could get pretty nasty even though August is not mosquito season. I looked it up. There have been a number of rainfalls there, though, during that period historically. So, can't guarantee that standing water won't be there during that time. But more to the point, I think Brazil, as Larry has pointed out, is trying to deal with a problem that's facing poor people in particular.

  • 10:42:05

    CAPLANAs has been said, they've got a big cleanup on their hands. They're in an economic downturn. They've got facilities they haven't finished, they've got sewage problems at many of the sites. Add Zika on top of this and I think they're looking at a disaster in terms of how the media's going to portray the country. So, if you've got your six month delay, let's say, you'd have your diagnostics test, hopefully, maybe you'd be making some progress toward the vaccine. Maybe you'd be able to screen the blood supply better. I don't want to take away the income, but I know they've made an investment.

  • 10:42:41

    CAPLANBut a postponement in the face of what will be I think horrible press coverage and a lot of athletic groups back out, the US Olympic Committee just said to its women athletes today, if you're nervous, don't go. It's a lot of trouble, I think, for this.

  • 10:42:59

    GJELTENWell, we have different views on this question. Larry, what's your sense of it?

  • 10:43:02

    GOSTINWell, I mean, I have very high level -- people in high level positions in Brazil. They're not going to postpone the Olympics.

  • 10:43:12

    GJELTENThey've already decided not to.

  • 10:43:12

    GOSTINThey've already decided not to. They're not going to. They've been working toward this for quite some time. The other problem, of course, if -- I think Art does make a good point about we might get more diagnostic and other kinds of tests, but it will -- six months will put us right in the middle of their summer, which I think will be more risky, right? This is a climactically, it's the best time. So, in answer to your question, what should we do? A very aggressive mosquito control in Rio.

  • 10:43:45

    GOSTINAnd then, and then to educate athletes to cover up -- the only real risk, I think, would be to any of our women athletes who are pregnant and that is a serious question.

  • 10:43:58

    GJELTENYou know, people have such a hard time figuring out what to do or what not to do. They get conflicting advice. It's got to be confusing. We had an email here from Trish, who's planning a trip to South Florida and she's wondering if she should have, you know, she should hesitate going to Florida. Yeah, I mean, if, you know.

  • 10:44:13

    GOSTINYeah, my daughter-in-law asked me exactly the same question. I'll tell you what I told her. I said, it's fine. South Florida's fine. There have been no local transmissions there yet. And as long as she's not pregnant, and if she were pregnant, I might give -- but if she's not pregnant, I think Mike pointed out that within 21 days, you've lost pretty much lost the ability -- the virus within your system. So I would say yes, but just be very careful. Use DEET, cover up, stay away from mosquitoes, that aggressive biters outdoors in the daytime.

  • 10:44:53

    GJELTENOkay, we have Skype connections with Art Caplan and Mike Osterholm. They're both waving their hands at me. They want to weigh in. First you Art, very quickly.

  • 10:45:02

    CAPLANSo, I'm just gonna say, I understand the Brazilian government's commitment to go on in the planning and the da, da da da. And I'm not saying hold this thing in the middle of next summer. We can postpone it to a reasonable time, but I'm saying again, part of the reason to do this is to bring tourists in, fans in. I think a lot of them will just stay home. I think they have to think hard about how the whole thing will be portrayed if they push ahead. This isn't just a question of epidemiology and risk and mosquito control.

  • 10:45:29

    GJELTENRight. Yeah.

  • 10:45:29

    GOSTINIt's image. And they could get clobbered with this thing.

  • 10:45:34

    GJELTENOkay, Mike, did you want to add something?

  • 10:45:35

    OSTERHOLMWell yeah, I would come back to the issue of risk. I mean, we live a risky life. It's just the way it is. You know, you could be killed in an automobile accident in southern Florida. Or in one of these countries. I think, right now, to put it into some perspective, and that's what we're trying to get, is better information about what is the risk of having a micro -- a child with microcephaly or (unintelligible) . The point to make though is if you're in the United States, we have had ongoing transmission in very limited areas for a very limited period of time of Chikungunya, this new virus.

  • 10:46:04

    OSTERHOLMAnd where that occurs, we're more likely to see issues with Zika. But it's very small numbers. We're talking about 10, 20, 30 people kind of thing in an entire population. So I would tell everyone in the Americas, you know, chill out, I mean, in terms of the United States, chill out, just keep doing what you're doing. But make sure that we have good mosquito control. It's a different situation if you're in the Americas. This is now spreading through this like a forest fire, because we have so many people who are susceptible, meaning they are not previously infected.

  • 10:46:32

    OSTERHOLMAnd so we're going to see lots of cases. Chikungunya, we're talking about millions of cases a year in these first months of emerging epidemic. So I think that's a very different situation, and I would hope we can continue to distinguish between the United States and the situation here and what's happening in some of these countries. I do want to add one other thing. This is less of a disease of poor and rich people. We actually see lots of cases of Chikungunya in very well-to-do people in the larger cities because again, the plastic garbage is everywhere.

  • 10:47:01

    OSTERHOLMIf you walk down the streets of Rio, you walk down the streets of San Paulo, you will see lots of plastic garbage that actually are breeding sites for this mosquito in some of the more affluent areas of the community. It's a different mindset about solid waste. And so, I would urge that we also realize that yes, the poor people are even less capable of handling this, but this is something that is going to happen, even to those who are well to do, because of this situation of solid waste in the developing world.

  • 10:47:28

    GJELTENYou know, we have a lot of questions, a lot of callers, and most of them at this point want to talk about mosquitoes. This is, one of our producers just pointed out, this is the way the discussion of this Zika virus has evolved in the last few days. Tracy is on the line from Michigan. Hello, Tracy. Sorry you had to wait so long.

  • 10:47:47

    STACYIt's Stacy. And I just want to thank you so much for everything that you guys do. I love this program. I listen to it every day. And thank you panel for everything that you've done. My comment is this. One of your panel members said we want to wage a war on mosquitoes and wipe them all out. And I get it. You know, and I understand that this is a scary thing to be confronting. But it's kind of our knee jerk reaction that we always do when there's something we don't understand completely. And I just think, we can't just wipe, you know, I think wipe out mosquitoes. They're part of our ecosystem.

  • 10:48:20

    STACYThere's a reason that they're here and, you know, just thinking of bats. We need mosquitoes for bats. And here in Michigan, we get bombarded by mosquitoes. So, I get mosquitoes, but I want to caution people that just not go that extreme route without thinking it through. You know, we have an ecosystem.

  • 10:48:39

    GJELTENRight.

  • 10:48:39

    TRACYWe have something that we need to understand. And then, just one other comment. When we do work with these mosquitoes and want to eliminate as many as possible, you know, all these pesticides, I'm a person who suffers from auto-immune diseases and it's toxic overload that's part of my problem. And that's an epidemic. Auto immune disease is an epidemic. So...

  • 10:49:00

    GJELTENOkay. Let me put these questions to Larry, because he's the one that says we should have a war on mosquitoes. Also, Larry, John emailed us from Missouri saying, could introducing a major mosquito predator like bats have an effect on mosquito control? And he also wonders about whether if you destroy mosquitoes, what effect you have on the birds, for example?

  • 10:49:19

    GOSTINYeah, of course. I mean, we do have to be conscious of ecology, but we also have to keep risks in balance. When I say war on mosquitoes, I don't mean completely eradicate them but I think you need to significantly control them. There have been lots of studies, you can get up to 90 percent reduction in mosquitoes and we've studied the ecological potential harms and we really don't find them. And I do find that this is a kind of a north/south issue, because, you know, it is relatively easy for us to say here in the north, oh well, let's think about the environment, ecology, but we're not dying in our thousands and our millions from Malaria, Dengue, Chikungunya and other things.

  • 10:50:07

    GJELTENRight.

  • 10:50:07

    GOSTINAnd so, I just think that we need to be sensitive and absolutely, the science shows us that significant mosquito control doesn't cause major ecological harms and can have very significant benefits.

  • 10:50:22

    GJELTENAnother mosquito question from Steven who's on the line from Miami, Florida. Hello, Steven.

  • 10:50:27

    STEVENHi. Good day. I'm getting really concerned about the coincidentiality of the Chikungunya and now the Zika after the mosquito was created -- a mosquito was created in a lab. And released into South America last year.

  • 10:50:51

    GJELTENYep.

  • 10:50:52

    STEVENThe Malaria mosquito and I'm wondering if it's not a Frankenstein.

  • 10:50:57

    CAPLANNo.

  • 10:50:57

    GJELTENIs, Mike.

  • 10:51:00

    OSTERHOLMYeah, this is absolutely not the case.

  • 10:51:02

    CAPLANIt's not.

  • 10:51:02

    OSTERHOLMThere's no evidence whatsoever that this is actually related to any kind of genetic manipulation. What's happened here is humans have created this on our own. First of all, we move these mosquitoes around the world in our transports. And so, what used to be only isolated mosquito populations somewhere now have moved around the world. Second of all, we've created the habitat. There were 4,000 different kinds of mosquitoes. There's only a few that cause us major harm. Here we're talking mainly about Aedes aegypti and maybe Aedes albopictis. That's it out of all these mosquitoes.

  • 10:51:30

    OSTERHOLMAnd they're very targeted locations where they grow. These mosquito populations wouldn't be what they are today but for the solid waste of the developing world. And that is a very different situation. From an ecological standpoint, it's not a big issue whatsoever. In terms of what it does to others, and in fact, in our country, one of the big killers of birds is actually a virus infection caused by mosquitoes when they feed on birds.

  • 10:51:54

    GJELTENYeah, West Nile.

  • 10:51:55

    OSTERHOLMYeah, so exactly. So I think that these are all important points to consider in terms of what might be the second or third off implication, but right now, we can handle this virus and mosquitoes.

  • 10:52:04

    GJELTENDr. Michael Osterholm from the University of Minnesota. I'm Tom Gjelten. This is The Diane Rehm Show. And once again, Arthur Caplan is waving his hand at me over Skype to say that he has something important to add to this discussion.

  • 10:52:17

    CAPLANSo, I do want to say, not only is there no evidence at all that genetic manipulation, releasing genetically altered insects has caused any of this, I think it's partly a longer term solution to battling diseases in parasites like mosquitoes. I think we do have new techniques emerging that can either sterilize some strains of mosquito or prevent them from carrying diseases like Zika or Chikungunya. So, I think this is a positive technology and one that we ought to start looking at. I don't think we're going to be able to invoke it right now for this outbreak. But down the road, having standing research on genetic modification of insects, even for Malaria, our best friend in the mosquito world, makes good moral sense to me.

  • 10:53:03

    GJELTENDina Fine Maron, have you written about this?

  • 10:53:05

    MARONWell, we really need to be thinking about here is there are two main reasons for the virus's spread here, both Zika virus and Chikungunya. And those are that the population of the Americas, the Western hemisphere, have not previously been exposed to either of these viruses. So we don't have any immunity to them, which again, helps them to spread more easily in our communities. Also, the Aedes mosquitoes, the main vector for Zika transmission, are present in all the regions' countries, except for Canada and continental Chile.

  • 10:53:30

    MARONAnd that's why the WHO is anticipating that we'll be seeing Zika virus everywhere in the Americas except those two locations.

  • 10:53:37

    GJELTENDr. Osterholm, you know, one country that has not been mentioned here, and I'm curious about this, is Cuba. And Cuba's right there. I understand that this mosquito is prevalent in Cuba. Cuba's had a lot of issues with Dengue. Do you have any knowledge about what's going on? Why is there this sort of black hole, you know, with respect to reports out of Cuba? What kinds of infections they may have there?

  • 10:53:59

    OSTERHOLMWell, first of all, it's just a matter of time before Cuba has this problem. It is spreading across the Caribbean. They have had cases of Chikungunya where Chikungunya's gone and Dengue's gone, you're going to see this. So, this is going to unfold, kind of like a forest fire for months and months to come. And so, at this point, I would say anywhere that you've had Chikungunya, which includes Cuba, you're going to see Zika show up. What we're worried about is it actually going back to Africa or other parts of Asia as a new virus. The original Zika virus came out of Africa.

  • 10:54:31

    OSTERHOLMBut at that time, it was not the same virus it is today. And you can see this kind of situation unfold, both in Asia in Africa, like we're seeing here as the new virus spreads in the population.

  • 10:54:41

    GJELTENAnd Larry, and Dr. Osterholm mentioned that this virus has been evolving, adapting.

  • 10:54:46

    GOSTINYeah, it's been evolving and adapting, and it did originally come out of Uganda. And I think it's only a matter of time before it goes back to Africa and Asia. But doesn't this tell us that we really need leadership from the World Health Organization? I mean, they did declare Zika a public health emergency of international concern. I pushed them to do that, and they did, and I'm very pleased. But we haven't seen any action plan. We've seen no mobilization of funding.

  • 10:55:16

    GJELTENThis is reminiscent of Ebola, isn't it?

  • 10:55:17

    GOSTINThis is reminiscent of Ebola, the Ebola commissions. I've been on several of them, were critical of WHO. We need to learn their lesson. They need to learn this lesson and they really need to just lead, because this is clearly a global issue.

  • 10:55:32

    GJELTENWe have another practical question from Pat, who's calling from Texas. Pat, you're on the Diane Rehm Show. Thanks for calling.

  • 10:55:39

    PATThanks for taking my call. Great discussion. Yes, my mother had West Nile. And she had it really bad and nearly passed away. And the virologist said that she would not be immune after she got (unintelligible) . I was wondering if you get this Zika virus, will you be immune, or could you have an immunity afterwards, once you're cured of it?

  • 10:56:00

    GJELTENDr. Osterholm, quickly.

  • 10:56:01

    OSTERHOLMYeah, well, first of all, I -- there is evidence of immunity after West Nile infection. So, that, I would be careful about concluding that that wouldn't have been the case. Second of all, we do assume that there will be immunity here just as we see with the other viruses in the same category of viruses. We know that if you've been infected, you are much, much, much more less likely to be infected again. Unless it's Dengue, which then, it's just a different strain. There's four different strains of the virus.

  • 10:56:26

    OSTERHOLMYou can get Dengue multiple times, and in fact, that's the real problem is when you get severe diseases on multiple infections. But that's a very unique kind of virus. So, I think that one of the things that will be the reactor in the rod, or the rod in the reactor here will be that after it spreads through the population, you'll actually see a dampening of the epidemic, not necessarily because of mosquito control, but because there just won't be other people to get bitten who are likely to be vulnerable.

  • 10:56:49

    GJELTENDina, one final question for you and a really quick answer is needed. What's the role of the media here going forward? On the one hand, you don't want to promote panic, on the other hand, you have to raise concern.

  • 10:56:59

    MARONYeah, the media's role here really just needs to be proper public health education. Getting the right message out about what we need to be concerned about going forward.

  • 10:57:07

    GJELTENDina Fine Maron is Health and Medicine Editor at Scientific American. My other guests were Larry Gostin, who's Director of the O'Neill Institute for Global Health Law at Georgetown University Law School. And he has collaborated with the WHO in the past. Also, Art Caplan, a Medical Ethicist from New York University's Langone Medical Center and Dr. Michael Osterholm from the University of Minnesota. Thanks to all of you. Thanks for listening. I'm Tom Gjelten. This is "The Diane Rehm Show."

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