Colombia notebook: How my assumptions about Zika got turned upside down

The spread of Zika recently took me to Colombia, where I tried to learn more about the response to the mosquito-borne virus, which is more widespread there than in any country outside of Brazil.

I’m not an anthropologist, entomologist, or epidemiologist, and had never been to Colombia before. But what I learned over eight days convinced me that a lot of preconceptions people have about Zika — and how local populations are dealing with it — are, well, not quite right. (And I certainly harbored some of the same thoughts before the trip.)

Here are a few assumptions that should be reconsidered.

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Everyone is anxious about Zika

In the state of Norte de Santander, which has seen more cases of Zika than any other in Colombia, everyone knew about the virus, but it didn’t seem to have created much worry. Most people — up to 80 percent — who contract the virus don’t actually show symptoms, and the ones who do experience a few days of aches, rash, fever, and conjunctivitis.

It’s not great, but related viruses like chikungunya and dengue fever, which are transmitted by the same mosquitoes, tend to make people feel much sicker. And to residents, Zika was just the latest mosquito-borne plague to arrive. A new year, a new virus — or at least something like a virus. “Last year was chikungunya, this year is Maduro,” joked Francisco Gutierrez, who works at a tire repair shop in a city called Los Patios. He was referring to Venezuelan President Nicolás Maduro, whom many in Colombia despise.

That being said, people did grow concerned when talking about Zika when contracted by pregnant women because of the fear — which scientists are still investigating — that the virus could cause babies to be born with abnormally small heads, a condition called microcephaly. I met Adriana Alvarez, 18 and seven months pregnant, at a clinic in a town called Villa del Rosario where she and her boyfriend were waiting to see a doctor. She had shown symptoms of Zika about a month and a half before we met, and was feeling ill again. When she was sick initially, the doctors did an ultrasound and told her the fetus appeared to be fine. But when I (perhaps stupidly) asked her if she was worried about her baby, she had one word for me: “Obviously.”

Few people have ever heard of Guillain-Barré syndrome

In some people, Zika is believed to increase the risk of Guillain-Barré syndrome, a paralysis that’s caused by the body’s immune response to a bacterial or viral infection. Ask people in the United States if they know about Guillain-Barré syndrome, or GBS, and it’s safe to assume the answer is usually no. But many people I spoke with in Colombia — average people, not just doctors and health officials — knew about GBS. It’s temporary in most cases, but can lead to death; Colombian officials have said they believe at least three people have died from Zika-associated GBS.

Hyacinth Empinado/STAT The disease, known for triggering temporary paralysis, has been linked to Zika virus infections.

As with microcephaly, scientists are still trying to determine definitively if Zika does increase the risk of the condition. They are also looking at whether other factors are needed for Zika to trigger GBS, such as a past dengue or chikungunya infection.

GBS is scary because it strikes so quickly: It can immobilize completely active people to the point they need to be put on a respirator in a matter of days. When I asked Elizabeth Zambrano what it was like to see her husband, Luis Molina, who was paralyzed in the hospital with suspected Zika-associated GBS, she immediately started crying. One word she used stuck out to me: It was “cruel” to see him that way.

Mosquitoes can be controlled with repellant and other measures

I had read plenty about how Aedes aegypti are perfectly suited to live and reproduce among suburban and urban communities in Latin America, but being there really made clear just how hard it can be to pare down the mosquito population. The mosquitoes need just a small amount of water to breed, which they can find in piles of trash that build up in certain areas of cities. The water tanks that people keep on their roofs or in their yards are necessary for families to have a water supply and to do laundry, but they are also potential mosquito breeding sites.

Imagine living in a place where it regularly reaches 95 degrees but where most people don’t have air conditioning — you’d have your doors and windows open too. But that brings these mosquitoes inside, where they like to stay and can thus avoid fumigating efforts. Some homes I visited had nets hanging in doorways to block mosquitoes from entering certain rooms, but most people don’t seem to bother with sleeping under a net because it doesn’t do any good in this case: Aedes aegypti bite during the day.

Alex Hogan/STAT Are you at risk for contracting Zika virus? Your level of risk depends in part on your living conditions.

Residents know to dump standing water and to clean and cover their water basins, but it just seems like there are so many places that can collect water that they face an uphill battle trying to halt mosquitoes from reproducing. As Heidi Brown, a scientist at the University of Arizona, told me, these mosquitoes thrive in urban areas and love to feed on people, meaning they’re “optimized for disease transmission.”

The biggest problem with these mosquitoes is Zika

I only got about four mosquito bites that I noticed during my reporting, which I considered a victory, given that mosquitoes typically tend to munch on me like they’re competitive eaters and I’m a stack of hot dogs. The hypochondriac who maintains a large piece of real estate in my imagination did stir with the thought that if I contracted Zika, I might possibly suffer from GBS. But after talking with many Colombians about the different mosquito-borne viruses, my main thought was, “I really hope I don’t get dengue.”

It’s sometimes called “breakbone fever” because of the deep body aches it causes. The virus can also cause a severe illness called dengue hemorrhagic fever, particularly when more than one strain is contracted.

US travelers are being watched for signs of illness

It’s true that the Centers for Disease Control and Prevention has urged women who are pregnant or are trying to get pregnant to avoid traveling to areas with Zika transmission. US officials have also issued guidance to reduce the chance of sexual transmission of the virus, thought to be much rarer than cases in which the virus is transmitted through mosquitoes.

Those guidelines aside, there isn’t a lot of public health surveillance going on, at least that I saw. To get back home to Boston, I flew through Houston, a hub for flights to and from Latin America and a city that has Aedes aegypti mosquitoes. I didn’t see any signs in the airport or questions asked about Zika, although I spotted one sign warning about Middle East respiratory syndrome.

I wouldn’t be surprised if that changed closer to summer, when mosquitoes are more active in the United States and local cases of Zika may pop up. (And even if local transmission occurs, experts think any outbreaks in the US will be small and contained.) But last week, at least, Zika was a much bigger deal on the evening news than at border control.

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