The Brazilian Doctors Who Sounded Alarm on Zika and Microcephaly – Wall Street Journal

On Thursday, the World Health Organization said it would convene an emergency committee Monday to decide if the Zika outbreak ought to be declared an international health emergency. WHO Director-General

Dr. Margaret Chan

said the virus was “spreading explosively.”

Experts at the Centers for Disease Control and Prevention and at U.S. university medical centers, along with the heads of Brazil’s leading medical research laboratories, now believe that evidence for a connection between Zika and microcephaly is strong. Brazilian Health Minister

Marcelo Castro

says he has “100% certainty” a link exists.

What remains uncertain are how the virus works its damage—and the number of victims. In 2014, the year Zika is believed to have arrived in Brazil, the country recorded 147 microcephaly cases. Since October, the country has reported 4,180 suspected cases and the death of 70 babies. Some of those suspected cases have been found not to be microcephaly, and very few have been positively linked to Zika. Most cases are still under investigation.

Dr. Artur Timerman,

 president of Brazil’s Society of Dengue and Arbovirus, made headlines when he predicted Brazil eventually could be dealing with 50,000 to 100,000 cases of Zika-related microcephaly by 2020.

Dr. Timerman said he based his estimate on the fertility index of Brazilian women, and by taking account of similar diseases such as rubella.

“I do not think that cases of microcephaly are overstated,” Dr. Timerman said. “Data in Brazil on this subject is still precarious, but I suspect that the data is being underestimated more than overestimated.”

In the U.S., numbers derived from state tracking systems of birth defects suggest that microcephaly afflicts between two and 12 babies per 10,000 live births, according to the CDC. If Dr. Timerman’s predictions hold, that would put Brazil in the range of 45 to 60 per 10,000.

Apart from the microcephaly scare, Brazil is suffering its worst public health crisis since yellow fever raged in the early 20th century. The country is struggling to contain a growing epidemic not only of Zika but of two similar viruses spread by the Aedes aegypti mosquito: dengue and chikungunya. Last year, Brazil had a record number of 1.6 million dengue cases.

The van der Lindens have found themselves plunged into the middle of the crisis. Descended on one side from Dutch-German immigrants who settled Brazil’s impoverished northeast, the family has produced five doctors, including the father,

Dr. Hélio van der Linden,

a neurosurgeon who is deceased.

His widow, Dr. Ana van der Linden, and 46-year-old daughter Vanessa, work as neuropediatricians in different public hospitals in Recife.

A woman pushes a baby past a canal filled with garbage in Recife, where Zika-carrying mosquitoes are flourishing.

A girl walks past a discarded toilet in an impoverished Recife neighborhood.

The metropolis of about 3.7 million had all the ingredients to hatch an epidemic. Recife’s sodden topography is interlaced with canals filled with raw sewage. Flooded streets and mounds of rain-soaked garbage are common during the rainy season.

Despite the faded grandeur of its downtown (part of which is a Unesco World Heritage site), and its gleaming $226 million soccer stadium built to host a total of five games during the 2014 World Cup tournament, Brazil’s fifth-largest city is dotted with sprawling shantytowns. Crumbling wooden shacks perch on stilts alongside riverbanks and estuaries.

Recife’s poorest residents, lacking reliable water, have taken to building cisterns and hoarding supplies in swimming pools and other containers where mosquitoes breed. Most cannot afford insect repellent.

CT scans of twin brothers born recently in Brazil. One is healthy while the other is afflicted with microcephaly.

For many poor families in Pernambuco, the only bright spot in this bleak picture are physicians like Dr. van der Linden Mota and her mother.

Dr. van der Linden Mota’s eureka moment took place last August, while she was tending to a woman who had given birth to twins, one with microcephaly, the other healthy. Testing for congenital defects turned out normal, the doctor said, “an indication that we were dealing with something new.”

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