On Beyond Zika

 In Preventive Medicine Column

On Beyond Zika

Like everyone else who has heard the news about it, I find the rapid spread of the Zika virus extremely alarming. The newly recognized capacity of this virus, which historically has caused mild, self-limited infections in adults, to induce microcephaly, a terrible birth defect, is nothing less than devastating.

This particular virus was originally identified in Uganda some 70 years ago, first in monkeys, then in people. For the past half century, Zika has generally been limited to Uganda and Tanzania, with isolated outbreaks seen occasionally in other parts of the world.

That there is no specific treatment for Zika, named after the forest in Uganda where it was first identified, and no vaccine, is because until now the virus has not inspired much global concern, partly because it was not all that serious, and partly no doubt because it was “over there.”

Exactly why this infection, in the same family with the viruses that cause yellow fever and dengue fever, and transmitted by mosquitoes as they are, is suddenly implicated in an epidemic of birth defects is a work in progress. One likely explanation, for which there is evidence, is an evolutionary change in the virus itself. That may be compounded by exposure of new human populations, with perhaps different genetic vulnerabilities; transmission at a new scale; or other factors yet to be determined. We are currently on the steep part of the learning curve, racing to catch up with current events.

That’s a familiar race. We ran it for Ebola, too; and SARS, and MERS. Whatever the next outbreak is, we will likely need to run it again. We keep getting left behind.

For now, practical advice about Zika is limited, and mostly of the “easier said than done” variety. Countries mired in the outbreak are advising against pregnancy. We are all encouraged to avoid mosquito bites. Travel advisories are being issued.

The implications of the Zika crisis are not confined to this particular pathogen, for there will be a next, and a next. I am reasonably confident that an acute concentration of resources and ingenuity on Zika will result in a vaccine. Welcome though that will be, perhaps even by some prone to misguided railing against vaccination, it will do nothing to resolve our basic vulnerability.

As the climate changes, and we are past the point of debating the fact of it, the distribution of pathogens is changing too. We have seen this many times already, and are thus forewarned: we will be seeing it again. Whether or not we are forearmed depends on how we react, and allocate resources.

There is, thankfully, ever more attention to how the more than 7 billion of us Homo sapiens are roughing up the planet’s remaining pristine places. There is less, however, to the ramifications of it. For one thing, more people in more places inevitably means more encounters with bugs formerly unencountered. For another, the disruptions of ecosystems often circle back to bite us.

Another issue, relevant to almost every major peril our species now faces, is the very fact that there are more than 7 billion of us, and rising fast. There aren’t just humans in ever more places, there are ever more humans in ever greater concentrations everywhere. Whatever else we may be, we are just one, vast Petri dish to our pathogens. Plagues are a product of dense populations and unprecedented population densities will predictably mean new plagues.

And then finally, there is our proclivity to disperse into our competing factions: nations, religions, political parties, and so on. The distinctions between “us” and “them” may matter enormously to us, and them, but to the Zika virus, we are all the same, accommodating host. From the bug’s eye view, there is no “over there.” In a world of increasing global travel, the bug is right.

In our fantasies, we acknowledge that. The usual scenario is a science fiction adventure in which humanity is attacked by a scourge from without- an extraterrestrial menace- and that common threat provides common cause, and unifies us. We overcome our differences to defend our home, and our shared humanity.

From what we know about the universe, the probability of extraterrestrial visitation, hostile or otherwise, seems vanishingly remote- for reasons entirely unrelated to the probability of life on other planets. If interested in the mind-boggling barriers to such inter-stellar concourse, I recommend Lawrence Krauss’ book, A Universe from Nothing, as a good place to start.

Threats to us all, threats blind to the borders of nations, and deaf to the distinctions of ideology, are already here. They have no need to traverse the distance between stars. Would that we rallied to defend our common humanity not just from imaginary dangers, but also from those clear, present, and all too real.

-fin Dr. David L. Katz;www.davidkatzmd.com; author, Disease Proof; founder, True Health Initiative

Dr. David L. Katz
DAVID L. KATZ MD, MPH, FACPM, FACP, FACLM, is the founding director (1998) of Yale University's Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both Preventive Medicine, and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.
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