Zika virus. Humanity faced with a new test.

Virus zika. Čovječanstvo pred novim ispitom.

Aedes_aegypti_CDC-GathanyAs a civilization, we have reached today such a stage of interrelation of science, the media and collective (global) awareness that a mere speculation, derived from the scarce factual data, suffices to create an alert on a global scale – generated mainly by the media and accompanied by attempts of relativization of the value of human life.

Situation

We are now in the developed stage of a global concern over the epidemic of Zika virus. Following the outbreak of reported cases of microcephaly and Guillain-Barré syndrome in the countries of Southern America, the World Health Organization (WHO) declared February 1st a global emergency.[1] But even long before that, warnings and suggestions of various kinds started to emerge, often in a rather alarming tone. Since this is a highly delicate set of problems, it is likely that many crucial facts may be put aside, and it happens so in the enthusiastic attempt to deal with a problem in a shortest procedure possible. Thus, countries that have been struck with the epidemic witnessed a prompt transition from strict concern over the virus outbreak, to asking questions on accessibility of abortion – under excuse of a possible connection between the virus and microcephaly. At the same time it is noteworthy that abortion, in the majority of those countries, is either prohibited, or strictly regulated. This problem was recently amplified with some of the statements from the UN representatives – particularly UN spokeswoman, Cecile Pouilly, and High commissioner for human rights, ZeidaRa’ad Al Husseina – which, in the context of the Zika virus epidemic, openly suggested that abortion should also be treated as a means of resolving the sudden outbreak of Guillain-Barré syndrome and microcephaly cases.[2] Their statements were promptly interpreted by the media as the UN’s demand for the countries to make abortion (more) accessible.

Facts

Nevertheless, some of the key facts point to several things, in regard to the entire process of the situation and the formation of the collective awareness on the issues concerned, that happen to be quite unclear. This is a process in which the media plays a significant role. First of all, the main fact that even WHO doesn’t fail to mention, but that appears in the media (and thus in public opinion) only incidentally – or doesn’t appear at all – is that the causal relation between Zika virus and microcephaly has still not been confirmed. The same applies to a connection between the virus and any other neonatal disorder.[3] Researches that came closest to certain negative prognoses, among which is the work done by a research team from Ljubljana (Slovenia), managed to confirm, to a certain degree, the suspicion that the virus could be transmitted from mother to child during pregnancy.[4] More precisely, this particular research showed that the child diagnosed with microcephaly, and whose mother was infected with Zika virus, was also infected with the same virus. However, even though this case so far represents the biggest breakthrough in the virus research, the possibility that the virus could cause microcephaly still remains a matter of speculation.

Zika virus

It could be said that not much is actually known about the disease caused by the Zika virus. The virus was first reported in 1947. There have been no cases of death connected with it to date, including the epidemic which emerged at the end of 2015.[5] Most common transmitters are mosquitos, several kinds of them. Very few cases are known of transmitting the virus through blood infusion, through sexual intercourse, and, as mentioned above, during pregnancy. The disease usually manifests itself as a typical flu. Most people infected with the virus never actually develop any of the usual symptoms. With a relatively higher amount of certainty we know that the virus usually stays in the organism for two to seven days, as well as that there is no particular risk for a child during pregnancy which follows that period. Also, so far there have been no cases of the virus being transmitted from mother to child in the late stage of pregnancy. Therefore, not only that very few concrete data is available to us, but the data we have got so far indicates that speculations on causal relation between the virus and neonatal malformations are generally rushed and precarious.

Microcephaly

Microcephaly is a condition in which a child is born with a disproportionately small head and an underdeveloped brain, and it is related with other physical and cognitive disorders.[6]Although some argue that some symptoms of microcephaly can be detected through ultrasound already between 18th and 22th week of pregnancy, precise diagnosis is usually possible only near the end of second and the beginning of third trimester. It is important that we keep the following thing in mind. In nearly 50% of previous cases of suspected microcephaly, unrelated to Zika virus, prenatal diagnosis proved to be rather unreliable, in the sense that children were either born and developed without any symptoms of microcephaly and similar disorders,[7]or they had some of the symptoms at birth, but later on developed without any symptoms of any kind of disorder.[8] These facts as well indicate how dangerous it is that the fear of the virus’ epidemic got so easily related to abortion as a possible solution.

Furthermore, the actual cause of microcephaly usually remains unknown. There are some factors that are considered as most probable causes:

1) infections in uterus (herpes, syphilis, HIV, etc.),
2) exposure to harmful substances (various metals such as arsenic and mercury; radiation, alcohol, nicotine),
3) genetic abnormalities (as in Down syndrome), and

4) chronic malnutrition during pregnancy.[9]

Connection (?)

Shortly after the virus epidemic outbreak in Brazil at the end of last year, along came speculations on possible connection between the virus and microcephaly, Guillain-Barré syndrome and other cases of defect pregnancies and pregnancies with negative outcome.[10] These speculations lead to various alarming suggestions which often aim at the development of “strategies of preventing unwanted pregnancies” in countries struck with the epidemic.[11] Certainly, every measure of precaution, especially in the state of an epidemic such as this one, is reasonable. Taking into serious consideration all experts’ opinion is also reasonable, particularly if we have access to alarmingly little concrete data. However, this situation seems to attest the general rule that: the fewer facts known, the more opportunity there is to manipulate them. Precisely because professional’s and research’s circles so far have access to so little verified data – regarding both Zika virus and microcephaly – the public, primarily by virtue of the media, generated a vast space for all kinds of negative predictions and speculations, which happen to easily influence the formation of public awareness on this situation. A basic indicator of the latter is the fact that the media, in spite of all seriousness of the situation, frequently do not cite statements of responsible institutions, but rather their own variously intoned interpretations, or those of others.

Since 1) countries which are hit with the Zika virus epidemic had a relatively high number of microcephaly cases prior to the epidemic, 2) majority of those countries have relatively low standard of living, and 3) there are no concrete evidence for the causal relation between the virus and microcephaly, although the media invested a serious effort in oversimplifying the entire situation, it is somewhat confusing – to say the least – why there isn’t more word on some of the other suspected causal factors, rather than incessantly speculating about Zika virus. At least one thing is certain – even though serious, ongoing research has so far yielded very little concrete data on Zika virus, microcephaly and their connection, and even though not a single case has been reported so far confirming the speculation that the virus actually causes any known fetal malformations, there are already some serious indications which show that the public awareness on these issues has already been wrongly and somewhat dangerously formed, not without a substantial contribution of the media. Whether it is informative videos on Zika virus simultaneously presenting cases of newborn children with microcephaly[12] – thus implying causal relation between the two – or various other misinterpretations of scarce factual data, the impact of the media has proven to be a crucial component to the development of the situation in which we are now. It is almost impossible to find a report on the virus that doesn’t in any way imply or explicitly infer the causal relation between the virus and microcephaly.

Conclusion

This situation attests that, as a civilization, we have reached such a stage of interrelation of science, the media and collective (global) awareness that a mere speculation, derived from the scarce factual data, suffices to create an alert on a global scale – generated mainly by the media and accompanied by attempts of relativization of the value of human life. In that sense, although results of further research will be important, they could be considered as of secondary importance in relation to the way they could be interpreted. No research result should in any case have a decisive influence on our stance concerning our fundamental civilizational values, among which the right to life is the most important. And precisely this is exposed to a most serious, although latent threat. Even if further research would prove that the virus causes microcephaly, so what? Let us even put aside the fact that there are already serious indications that it will be impossible to prove all of the negative speculations,[13] and let us ask ourselves: Are microcephaly and similar conditions something that by itself puts the value of human life in question?

In conclusion, a large number of factors point to the real background of this situation which goes beyond mere concern over the virus epidemic. It doesn’t take much to realize that from the very beginning two concurrent phenomena, for whose relation we have no strong indications, are being used with purpose of creating space for various (potentially) troubling things: from radical scientific and technical procedures such as genetic modification of mosquitos with the aim of their extermination,[14] to liberalization of abortion in countries in which it is either prohibited or strictly regulated.[15] Before further development of the situation in the direction described above, it is necessary that responsible international and national institutions stand behind every person’s intrinsic dignity and right to life; that reasonable measures (i.e. in accordance with current data on the virus and without any influence of ungrounded speculations) in preventing further spread of the epidemic are found; and that, accordingly, the idea of abortion is dismissed: whether as a means of stopping the spread of the epidemic, or as a necessary outcome of pregnancies with diagnosed microcephaly.

[1] http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/
[2] http://www.reuters.com/article/health-zika-rights-idUSL8N15K248
[3] http://www.who.int/emergencies/zika-virus/en/
[4]http://www.nejm.org/doi/full/10.1056/NEJMoa1600651
[5] http://www.who.int/mediacentre/factsheets/zika/en/
[6] http://www.who.int/emergencies/zika-virus/microcephaly/en/
[7] http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html
[8] http://www.who.int/emergencies/zika-virus/microcephaly/en/
[9] http://www.who.int/emergencies/zika-virus/microcephaly/en/
[10] http://www.cdc.gov/zika/
[11] http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html
[12] http://www.washingtonpost.com/news/to-your-health/wp/2016/01/29/heres-how-gm-mosquitos-with-self-destruct-genes-could-save-us-from-zika-virus/
[13] http://www.nature.com/polopoly_fs/7.33594!/file/NS-724-2015_ECLAMC-ZIKA%20VIRUS_V-FINAL_012516.pdf
[14] http://www.telegraph.co.uk/news/worldnews/zika/12143563/Releasing-millions-of-GM-mosquitoes-could-solve-zika-crisis.html
[15] http://www.reuters.com/article/health-zika-rights-idUSL8N15K248; http://www.npr.org/2016/01/30/464995788/zika-virus-reignites-abortion-debate-in-brazil

Situacija

Nalazimo se u razvijenom stadiju globalne zabrinutosti epidemijom virusa zika. Svjetska zdravstvena organizacija (SZO) je, povodom značajnog porasta slučajeva mikrocefalije i Guillain-Barréova sindroma u zemljama srednje i južne Amerike, te istovremene pojave epidemije virusa zika, 1. veljače 2016. godine proglasila globalnu uzbunu.[1] No i puno prije toga počela su se pojavljivati različita upozorenja i sugestije u pogledu donošenja mjera protiv širenja virusa u pogođenim zemljama, nerijetko zabrinjavajućeg tona. Budući da se radi o iznimno osjetljivoj temi, vrlo lako se događa da, u zanosnom nastojanju da se problem riješi po što kraćem postupku, bitne činjenice ostanu po strani. Tako se u zemljama pogođenima virusnom epidemijom u vrlo kratkom periodu prešlo s problematiziranja virusa na otvaranje pitanja o dostupnosti pobačaja, pod izlikom moguće povezanosti virusa s mikrocefalijom. Pritom je važno imati na umu da je pobačaj u dobrom dijelu dotičnih zemalja ili zabranjen ili strogo reguliran. Ovaj problem pojačan je i nedavnim izjavama predstavnika UN-a – glasnogovornice Cecile Pouilly, te visokog povjerenika za ljudska prava, Zeida Ra’ad Al Husseina, u kojima se, u kontekstu epidemije virusa zika, pogođenim zemljama, između ostaloga, otvoreno poručuje kako bi i pobačaj trebao biti tretiran kao sredstvo rješenja naglog porasta slučajeva mikrocefalije i Guillain-Barréova sindroma.[2] Njihove izjave u medijima su interpretirane kao zahtjevi UN-a da se u dotičnim zemljama pobačaj učini dostupnim.

Činjenice

Pogled na ključne činjenice otkriva neke nejasnoće u pogledu razvoja situacije te izgradnje kolektivne svijesti o uključenim problemima, pri čemu nemalu zaslugu imaju mediji. Prije svega, činjenica koju ni SZO ne propušta istaknuti, ali koja se u medijima – te prema tome u javnosti – pojavljuje tek sporedno, ili nikako, jest to da uzročno-posljedična veza između virusa zika i mikrocefalije nije potvrđena, kao niti povezanost istog virusa s ikojim neonatalnim poremećajem.[3] Dosadašnja istraživanja koja su se najviše približila nekim negativnim predviđanjima, od kojih se ističe rad istraživačkog tima u Ljubljani, uspjela su donekle potvrditi sumnju o mogućnosti prijenosa virusa s majke na nerođeno dijete.[4] Točnije, dotično istraživanje pokazalo je da je nerođeno dijete, kojem je dijagnosticirana mikrocefalija te čija je majka bila zaražena virusom zika, za vrijeme trudnoće i samo bilo zaraženo istim virusom. No, iako se radi o do sada najvećem istraživačkom proboju, to da bi virus mogao uzrokovati mikrocefaliju i dalje ostaje predmetom spekulacije.

Virus zika

Možemo reći kako je relativno malo činjenica poznato o bolesti uzrokovanoj virusom zika. Sam virus otkriven je 1947. godine. Do danas, uključujući i epidemiju koja je u jeku od prosinca 2015., nije zabilježen niti jedan smrtni slučaj povezan s njime.[5] Redoviti prijenosnici su nekolicina vrsta komaraca. Poznati su jako rijetki slučajevi prenošenja virusa transfuzijom, putem spolnog odnosa te, kao što je spomenuto, s majke na dijete za vrijeme trudnoće. Bolest povezana s virusom obično se javlja kao prehlada. Većina ljudi zaraženih virusom ne razvije ni jedan od uobičajenih simptoma. S nešto većom sigurnošću znamo da virus u organizmu redovito ostaje dva do sedam dana, te da u trudnoći do koje dolazi nakon tog perioda ne postoji nikakva opasnost po plod. Također, nisu poznati slučajevi zaraze ploda virusom u završnom stadiju trudnoće. Prema tome, ne samo da raspolažemo s jako malo konkretnih podataka, nego oni upućuju na neutemeljenost i ishitrenost prejudiciranja uzročno-posljedične veze između virusa i neonatalnih malformacija.

Mikrocefalija

Mikrocefalija je stanje u kojem se dijete rađa s nesrazmjerno malom glavom, odnosno nerazvijenim mozgom, a povezano je s drugim tjelesnim i kognitivnim poremećajima.[6] Iako postoje spekulacije da je otkrivanje simptoma ultrazvukom moguće već između 18. i 22. tjedna trudnoće, precizna dijagnoza redovito je moguća tek krajem drugog i početkom trećeg trimestra trudnoće. No, važno je imati na umu sljedeće. U gotovo 50% dosadašnjih slučajeva, nepovezanih s virusom zika, prenatalno dijagnosticiranje mikrocefalije pokazalo se nepouzdanim, bilo da su se djeca rodila i razvijala bez simptoma mikrocefalije i srodnih poremećaja,[7] bilo da po porodu jesu imala simptome, ali su se ipak razvijala bez ikakvih stvarnih poremećaja.[8] Te činjenice dodatno upućuju na to koliko je opasno što se bojazan oko postojeće virusne epidemije povezuje s pobačajem kao mogućim rješenjem.

Nadalje, uzročnik mikrocefalije redovito ostaje nepoznat, no postoje neki čimbenici koji se smatraju najvjerojatnijim uzročnicima:

1) infekcije u maternici (herpes, sifilis, HIV, i dr.),
2) izloženost štetnim supstancama (metali poput arsena i žive, radijacija, alkohol, nikotin),
3) genetske abnormalnosti (poput Down sindroma), te
4) kronična pothranjenost za vrijeme trudnoće.[9]

Povezanost(?)

Ubrzo nakon pojave virusne epidemije u Brazilu krajem prošle godine, pojavile su se spekulacije o mogućoj povezanosti virusa s Guillain-Barréovim sindromom i drugim slučajevima “defektnih” trudnoća i trudnoća s negativnim ishodom.[10] Već duže vrijeme mogu se čuti svakojake alarmantne sugestije, koje redovito smjeraju razvijanju “strategija sprečavanja neželjenih trudnoća” u zemljama pogođenima epidemijom.[11] Činjenica je da je, posebno u prilikama epidemije ovakvih razmjera, svaka mjera opreza opravdana, kao i to da je svako stručno mišljenje potrebno ozbiljno uzeti u obzir. Posebno ako raspolažemo sa zabrinjavajuće malo konkretnih podataka. No ova situacija potvrđuje ustaljeno pravilo da što je manje činjenica poznato, to je više prostora za manipuliranje njima. Upravo stoga što stručni, znanstveno-istraživački krugovi za sada raspolažu s oskudnom količinom provjerenih podataka – kako po pitanju virusa zika, tako po pitanju mikrocefalije – u javnosti se, primarno posredstvom medija, stvorio ogroman prostor za razne negativne prognoze i spekulacije, koje zabrinjavajućom lakoćom formiraju kolektivnu svijest o ovom problemu. Osnovni pokazatelj toga je činjenica da mediji, unatoč svoj ozbiljnosti situacije, redovito ne donose direktne izjave nadležnih institucija, nego vlastite ili tuđe interesno intonirane interpretacije istih.

Budući da 1) zemlje pogođene visokim stupnjem epidemije virusa zika od ranije bilježe relativno velik broj slučajeva mikrocefalije, 2) da se pretežito radi o zemljama niskog životnog standarda, te 3) da nema konkretnih pokazatelja uzročno-posljedične veze između virusa zika i mikrocefalije, iako se u medijima problem nesputano nastoji pojednostaviti, u najmanju je ruku zbunjujuće zašto nema više riječi o spomenutim vjerojatnim uzročnicima, umjesto konstantnog spekuliranja o virusu zika. Jedno je jasno – iako su ozbiljna istraživanja koja se i dalje provode do sada polučila jako malo konkretnih podataka u vezi virusa zika, mikrocefalije, te njihove povezanosti, te iako ni u jednom slučaju do sada nije utvrđeno da je dotični virus uzročnik ikoje poznate malformacije ploda za vrijeme trudnoće, postoje naznake da je kolektivna svijest, ne bez bitnog utjecaja medija, već sada pogrešno i, potencijalno, opasno formirana. Očitih pokazatelja doprinosa medija krivom oblikovanju javne svijesti o ovom problemu ima napretek, a sežu od informativnih videa o virusu zika koji istovremeno prikazuju primjere mikrocefalije i sličnih stanja u novorođene djece[12] – sugerirajući tako uzročno-posljedičnu vezu između toga dvoga – do svakojakih pogrešnih, eksplicitnih interpretacija oskudnih činjeničnih podataka. Gotovo je nemoguće pronaći izvještaj o virusu zika koji na koji način ne implicira, ili pak eksplicitno sugerira uzročnu vezu između virusa i mikrocefalije.

Zaključak

Cijela situacija svjedoči da smo, gledano civilizacijski, dosegli takav stadij međuodnosa znanosti, medija te kolektivne (globalne) svijesti, da je za uzbunu globalnih razmjera, koja je u ovom slučaju popraćena novim relativiziranjem vrijednosti ljudskog života, dovoljna nepotpuna spekulacija – generirana i održavana od strane zabrinjavajuće nekritičkih medija. U tom smislu, iako su daljnji ishodi istraživanja bitni, oni mogu biti od sporedne važnosti u odnosu na način na koji ih se interpretira. Oni ni u kojem slučaju ne bi smjeli imati presudan utjecaj na naš stav o temeljnim civilizacijskim vrijednostima, među kojima je na prvome mjestu pravo svake osobe na život. A upravo je to ono što je u ovoj situaciji izloženo najozbiljnijoj, makar latentnoj prijetnji. Čak ako bi istraživanja doista dokazala da virus uzrokuje mikrocefaliju – što s tim? Na trenutak stavimo po strani to što već sad postoje naznake da će biti teško potvrditi sve dosadašnje negativne spekulacije,[13] i zapitajmo se: jesu li mikrocefalija i druga slična stanja nešto što po sebi govori o vrijednosti ljudskog života?

Sažeto, mnogi čimbenici upućuju na pravu pozadinu cijele situacije koja ide onkraj bojazni virusne epidemije. Bez puno napora moguće je uvidjeti kako se od samoga početka dvije podudarne pojave, za koje ne postoji snažan pokazatelj uzročne povezanosti, koriste u svrhu stvaranja prostora za razne (potencijalno) problematične stvari: od radikalnih znanstveno-tehničkih postupaka poput genetskog modificiranja komaraca u svrhu njihova istrebljenja,[14] do liberalizacije pobačaja u zemljama u kojima je isti strogo reguliran ili zabranjen.[15] Kakav god bio daljnji razvoj situacije, neophodno je da međunarodne i nadležne državne institucije stanu iza nepovredivog dostojanstva i prava na život svake osobe, da se iznađu razumne mjere za suzbijanje širenja virusne epidemije – u skladu s dostupnim činjenicama i bez utjecaja neutemeljenih spekulacija – te da se, sukladno tomu, odbaci ideja pobačaja: bilo kao metode sprečavanja širenja epidemije, bilo kao potrebnog ishoda za trudnoće s dijagnosticiranom mikrocefalijom.

[1] http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/
[2] http://www.reuters.com/article/health-zika-rights-idUSL8N15K248
[3] http://www.who.int/emergencies/zika-virus/en/
[4]http://www.nejm.org/doi/full/10.1056/NEJMoa1600651
[5] http://www.who.int/mediacentre/factsheets/zika/en/
[6] http://www.who.int/emergencies/zika-virus/microcephaly/en/
[7] http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html
[8] http://www.who.int/emergencies/zika-virus/microcephaly/en/
[9] http://www.who.int/emergencies/zika-virus/microcephaly/en/
[10] http://www.cdc.gov/zika/
[11] http://www.cdc.gov/zika/hc-providers/qa-pregnant-women.html
[12] http://www.washingtonpost.com/news/to-your-health/wp/2016/01/29/heres-how-gm-mosquitos-with-self-destruct-genes-could-save-us-from-zika-virus/
[13] http://www.nature.com/polopoly_fs/7.33594!/file/NS-724-2015_ECLAMC-ZIKA%20VIRUS_V-FINAL_012516.pdf
[14] http://www.telegraph.co.uk/news/worldnews/zika/12143563/Releasing-millions-of-GM-mosquitoes-could-solve-zika-crisis.html
[15] http://www.reuters.com/article/health-zika-rights-idUSL8N15K248; http://www.npr.org/2016/01/30/464995788/zika-virus-reignites-abortion-debate-in-brazil

 

Written by Valentino Findrik from WYA Croatia.