Zika-associated mental health burdens: is little knowledge a dangerous thing?

Today Infectious Diseases of Poverty has published an opinion piece on the recent Zika outbreak. Here, co-author of the article explains more about how little knowledge of the virus could be dangerous to those living in areas at risk.

During the last week of January, one of my colleagues, who is an academic but not from a biomedical background, joined me over coffee to express his absolute fear of the Zika epidemic, the coverage of which in that day’s online news came under the eye-catching banner “Brazil is badly losing the battle against Zika virus”.

My friend knew that I researched tropical infectious diseases and sought my insight. As we chatted, his concern was amplified when he noticed in the newspaper he was idly flicking through another headline entitled, “Brazil is sending more than 200,000 troops to fight Zika virus”.

The soldiers were being mobilized mainly to help with insecticide spraying – more hands to the pump, as it were. While the size of the deployment may be seen as an exaggerated knee-jerk response to counter an unknown enemy, especially in a war not fought with guns and bullets, what raised my eyebrow was the journalist’s turn of phrase.

By this point, any attempt I made to allay my friend’s fears by proffering a rational and considered scientific explanation of just what we do and do not know about Zika, and the threat that the current outbreak poses, was fast becoming futile – and this to a person in Australia, half way around the planet from South America.

The words ‘troops’, ‘fight’ and ‘virus’ in the same sentence are powerfully evocative on a visceral psychological level. Who needs a zombie apocalypse when you have Zika?

The shocking media

As the story has developed, most social and news media have monitored the outbreak and the public health authorities’ responses to it.

For the past few months Zika has been making headlines around the world. As the story has developed, most social and news media have monitored the outbreak and the public health authorities’ responses to it.

For the most part reporting of the real and potential spread of the epidemic, the clinical effects of infection and the risk and route(s) of transmission has been accurate, give or take a little journalistic licence.

However, some publically accessible articles have verged towards sensationalism, in so doing catastrophizing the ongoing situation with scientifically unsupported content that is fronted by a deliberately shocking heading.

The anxiety I observed in my colleague is just an anecdotal example of how ordinary people who are not involved in the medical field or healthcare disciplines, and thus have no reason to know about a previously obscure virus like Zika, could perceive such imprecise coverage.

Zika – the virus and the symptoms

Similarly to the globally established fellow flaviviruses dengue and yellow fever, Zika is a blood-borne disease transmitted by the bite of species of Aedes mosquitoes, including the widespread A. aegypti and A. albopictus, and so is not contagious through person to person contact.

Only around 20% of infected people show any symptoms of illness and which are usually mild in nature

Until very recently, Zika resided in an obscure backwater of virology and tropical medicine research, occurring at very low incidence in some parts of Africa, Asia and the Pacific islands.

Its recent emergence in an altogether new region of the world may have been facilitated by climate conditions favorable to the population growth of the vector mosquitoes over a widening geographical range, together with an ever increasing and rapid movement of people across the globe.

Only around 20% of infected people show any symptoms of illness and which are usually mild in nature, like a much dumbed-down version of flu. However, there is an exception to this rule – pregnant women are considered a high-risk group for Zika, as the infection is linked to a congenital condition called microcephaly which affects the unborn baby that the mother is carrying.

In Brazil, Zika is now associated with more than 4,000 cases of this hitherto rare disease that causes babies to be born with abnormally small heads and, usually, brain damage. Although the link remains to be proven, as a preliminary outcome Brazilian doctors have recently detected the virus in the brains of babies who have died from microcephaly, suggesting a possible association between the virus and the disease.

In Latin America, Zika infection is also being linked with another rare neurological disorder that interrupts nerve transmission, Guillain-Barré syndrome (GBS), an autoimmune muscle-weakening disease that may be triggered by an infectious episode, including with Zika.

After a large cluster of microcephaly and GBS was identified in areas where cases of Zika were newly reported, on February 1st 2016 the World Health Organization declared ZIKV as “a public health emergency of international concern” and highlighted the importance of aggressive measures to reduce infection, particularly among pregnant women and women of childbearing age.

Risks to pregnant women

In all the furore attending the present Zika epidemic an overlooked aspect is the development of anxiety among pregnant women and their spouse/families, as well as by travellers to, and residents of, affected regions.

Plenty of news stories have aroused a significant degree of public anxiety regarding Zika. The governments of several South and Central American countries where the virus is now prominent are advising women to delay any plans to have a baby for the next two years while they work to bring the virus under control.

Even after the crisis situation has abated people may retain the fear of having an unhealthy baby.

For some couples such a national directive will assuredly cause uncertainty, if not outright stress. Even after the crisis situation has abated people may retain the fear of having an unhealthy baby. Moreover, women with insufficient understanding of Zika infection, who are not pregnant but bitten by a mosquito during this outbreak, could also be apprehensive in future while trying to conceive or while carrying a child.

Individuals who have an irrational fear of infection or contamination may become more paranoid, thereby compounding their tendency to avoid contact with people and thus becoming further socially detached.

Others may show traits of obsessive compulsive disorder in repetitively cleaning items that they think are a potential source of disease. It is even possible that children who grow up with manifestations of microcephaly could become ostracised within local communities due to an unfounded fear of catching infection from them.

A collective responsibility

It is said that a little knowledge is a dangerous thing – ignorance and phobias surrounding Zika have the potential to impact negatively the lives of people in currently affected locations long after the current epidemic has subsided.

As a society, we have a collective responsibility to not spread misinformation over Zika

As a society, we have a collective responsibility to not spread misinformation over Zika, or for that matter the next re-emerging disease that makes an impact on the international stage, without regard to those people whom it may have a psychological effect, major or minor. We all have sympathy for those whose physical scars we can see but spare a thought for those who carry mental scars that are not so easily noticed.

…As for my friend, he has now calmed down. Erring on the side of caution, when we next met up for coffee I decided to not mention the slew of mosquito-transmitted viruses that are native to Australia and about which next to nothing is known. Some cause clinical infection. One could be the ‘next Zika’ waiting to happen, but then again, very probably not.

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