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The Mysterious Case of Zika-Microcephaly’s Disappearance


In 2015, a viral pandemic from Northeast Brazil exploded into the news, supported by breathless public health alarms that Zika — a flavivirus acknowledged for decades as harmless — was now suddenly responsible for congenital microcephaly (babies with small heads; diminished intellect). WHO-aligned experts within Latin America recommended that women forgo childbirth indefinitely — possibly until a Zika vaccine’s fabrication (still unrealized). Massive panic predictably ensued.

Not a single case of human medical illness had previously been attributed to Zika — a near twin of the dengue virus (which itself brings a million South American “bone-break fever” cases, yearly) – – and never with any associated congenital microcephaly. Brazil’s medical research establishment treated the Zika- (and later microcephaly-) claims with initial skepticism — but were twice overwhelmed by vested parties’ self-serving media leaks – the latter of which spiraled into full-fledged national panic.

The upheavals from Zika-microcephaly included outsized public health overreactions: travel advisories; Brazilian soldiers on the streets; indelible fear; emergency injunctions proposed for abortion; the eternal absence of more than 100,000 “ghosted” Brazilian children (babies not conceived during the panic).

  • “Oh, it’s bordering on the panic state for pregnant women. Wealthier women moved further south. Here, women:

    • are worried whether they can get pregnant;

    • use additional (layers of clothing), hoping not to be affected;

    • (slather insect repellent) which … may generate another problem.”

Fortunately, the Zika pandemic has fizzled out inconspicuously and unceremoniously; never fulfilling the analysts’ predictions of an additional million microcephalic births yearly, worldwide. Nonetheless, its complete disappearance hasn’t resulted in a single scientist questioning the credibility of the underlying (likely false) premise: that receiving a Zika-carrying Aedes aegypti mosquito-bite early in pregnancy may irrevocably damage the cherished life within.

Zika, discovered in Uganda in 1947, had warranted literally only a baker’s dozen of scholarly articles in 60 years, none of which verified any human danger. In 2007, there was a bit of a “buzz” as certain dengue cases in the Pacific were relabeled by the CDC (after-the-fact and without clinical correlation) as Zika.

Zika in Bahia

In 2015, the Zika virus had heretofore never appeared in the Americas. Routine clinical Zika testing was nowhere available until many months after the announcement of the Brazilian pandemic. Most physicians and the entire public had never heard of it. Yet, despite (or perhaps because of) Zika’s void of prior significance, it became the unlikely prize within an ulteriorly-motivated medical treasure hunt. To physicians hunting, a priori, for a virus to affect social change Zika represented the clay — through wishes and partial perceptions molded into full-bore actionable fear.

In 2014, physicians Carlos Brito (of Recife) and Kleber Luz (of Natal) had formed a WhatsApp group with the literally expressed purpose of announcing a brand-new virus within Brazil; the discovery of which would address Brazil’s [poor North/wealthier South] societal inequities by bringing money and attention to Brazil’s Northeast equatorial areas. They called it “CHIKV, The Mission” – referencing both their target “chikungunya” (aka “CHIKV”, an African virus potentially making inroads into Feira de Santana, Bahia-Brazil at the time), and the 1986 movie, The Mission – in which the doctors’ anti-establishment heroes self-sacrificed in battle against the ills of European colonialism perpetrated upon indigenous populations. Ultimately, they pivoted to Zika — which served their original purpose of creating a crisis to drive increased funding even more grandly.

Dr. Luz lost the race for being the first to “unearth” Zika in Brazil, but not for lack of trying. He gave dengue patients’ serum to Dr. Claudia Duarte dos Santos, imploring her: “It’s Zika. Find Zika!” She couldn’t and didn’t – so his “Mission” was preempted in April 2015 by researchers Drs. Silvia Sardi and Gubio Soares Campos (“S&SC”) in Bahia instead.

Drs. S&SC, likely CHIKV- members themselves, similarly attributed Zika to mild dengue patients and others with achiness and rash. S&SC did so without clinical confirmation on any specific patient. The Zika PCR-test’s primer that S&SC used in their lab was a Senegalese researcher’s leftover, unverified by Brazil’s “FDA” or other researchers for efficacy. Zika and dengue are physically and genomically nearly identical, thus cross-reactive in the lab.

There was pushback to S&SC’s claim from institutional researchers who pointed out fatal flaws in S&SC’s Zika claims. S&SC responded not with the appropriate professional patience of transparently sharing their data, materials and methods for effective peer review, but by simply leaking their unsubstantiated claim directly to the popular press. This predictably created a Zika creation myth that took on its own life, independent of review, and generated a massive shockwave of panic.

Dr. Soares Campos justified his action: “We decided to benefit the public more, rather than immediately writing a scientific paper and publishing it– as if there had been some ongoing public health emergency, while undercutting his own rationale, acknowledging “Zika is not as serious as dengue or chikungunya. The treatment is Tylenol.” Absent any pressing health dangers, why subvert the scientific process?

Bahia-State’s health ministry (SESAB) contemporaneously and publicly contradicted S&SC with a statement that the diagnosis of Zika cases in Bahia may be wrong.” SESAB overturned half of S&SC’s results leaving only 12% of the 24 patients’ blood samples showing Zika (literally four individuals in a city of 300,000) — and any or all of those four may have been either dengue misdiagnosed, or nothing at all.

It’s debatable whether Dr. Soares Campos was able to “benefit the public more” than himself– given his professional advancement from Bahia to Buenos Aires as the self-proclaimed, “Discoverer of the Zika virus in Brazil.” His wife, Dr. Silvia, acknowledged, “We went from being two big nobodies to media stars.Meanwhile, SESAB’s counterclaims have fallen by the wayside– no surprise as falsehood flies, and truth comes limping after it.

Microcephaly in Recife

Completely independently, a few months later, microcephaly was declared by neuro-pediatricians in Recife to be “epidemic” in the total absence of institutional protocol or comparison to baseline data. Stipulating their motives as honorable, believing there were more such babies in their wards – nonetheless, their methods and pronouncements were precipitous and rash. Coordinating their own physician cohorts’ WhatsApp conversations and visits to the ten local public hospitals, Drs. Vanessa and Ana van der Linden aggregated around 20 apparent cases.

In 2015, Brazil had a lax way of determining which infant had microcephaly and which had not. Brazil declared microcephaly if the infant’s head circumference was two standard-deviations below the mean – which resulted in a microcephaly diagnosis for around one out of forty births, regardless of clinical correlation. This was 17 times looser than WHO’s cutoff of three standard deviations below the mean, which meant that microcephaly was an incredibly rare finding in countries that followed the WHO standard.

Inevitably, Brazil’s overly broad criteria led to a massive overcounting of babies with physically small heads, but who were intellectually normal, as being microcephalic. This fueled the Recife doctors’ perceptions. Directly as a result of the Recife doctors’ declared microcephaly epidemic, Brazil’s nonconforming standard was twice adjusted to become appropriately stringent, and ultimately aligned with international standards.

Metropolitan Recife’s population of 4 million yields ~40,000 births annually (~100 daily), from which the erstwhile standard defined 2.5% as “microcephaly,” around two such births per day. The normal neonate’s hospital stay in Brazil is two days, but longer for this diagnosis, therefore around ten such cases might at any moment reside in-hospital normally throughout Recife. This comports with the neuropediatricians’ observation and explains their alarm:

Dr. Ana van der Linden stated, “We have 3 wards (of ~7 beds each)… almost filled with children with microcephaly.” Debora Diniz continues, “The doctors had originally expected the clinic to receive ten infants [but got double; so, as a result…] Drs. Ana and Vanessa van der Linden were both certain that a new infectious disease was on the loose.”

The Zika-Microcephaly Connection

At this point, “the plot thickens.” To evaluate Recife’s microcephaly situation and the neuro-pediatricians’ premonitions, Brazil’s Ministry of Health decided on Dr. Brito, notably already invested in the notion of a newly-dangerous Zika virus:

“Dr. Brito tried to persuade his fellow epidemiologists that the microcephaly was not a product of previous underreporting or some genetic factor. He believed they were witnessing a change in an epidemiological pattern, and the cause was the Zika virus.”

With conclusion in hand, all that was needed was evidence.

Dr. Brito focused (only) on 26 mothers of microcephalic babies: asking each retroactively about rash, fever or ache 6-8 months prior. For him, an affirmative answer qualified that case as “Zika” — even with no serologic testing performed on the mothers or infants, and no control group of normal babies’ mothers given a “rash, fever, aches” questionnaire. This approach violated every basic principle of epidemiology.

Dr. Brito’s techniques, overall, were not consistent with the scientific method, involving

  • “selection bias” (querying only microcephalics’ and not normal babies’ mothers)

  • “lack of blinding” (eliminating the buffer layer between researcher and subject; influencing answers given to please the authoritative questioner);

  • “observer bias” (the researcher’s shading answers towards his own predilection); and,

  • “recall bias” (assuming accuracy of the mothers’ distant recollections)

Dr. Brito’s unsubstantiated conclusion of a novel Zika-microcephaly connection, which had been his predetermined outcome, was leaked directly to the press, subverting peer review and contemporaneous institutional replication or validation – very much redolent of S&SC’s modus operandi.

S&SC’s Zika-discovery leak garnered media attention, but absent public health ramifications soon died down. The Brito Zika-microcephaly press leak, on the other hand, communicated imminent danger and quickly cascaded into a regional, then national, then worldwide panic – the latter partially augmented by the coincidence of elites’ travel worries regarding the Rio Olympics.Confirmed cases of Zika-related microcephaly ultimately comprised fewer than 5% of the original panic-era claims. Brazil’s physicians vastly overdiagnosed neonates – from some combination of panic, overcaution, and Brazil’s incorrect and inconsistent microcephaly standards at the time. Microcephaly (as claimed) concentrated in and coincided with the location and timing of the news-generated panic (in Recife and Brazil’s Northeast) rather than with the vector-mosquito’s own range.

In short, dengue illness’ map overlaps with the Aedes aegypti mosquito’s distribution; while Zika-microcephaly claims were strongest where people were talking most about Zika-microcephaly.

The following year when microcephaly standards had been firmed up, and Zika diagnoses could be confirmed via proper laboratory tests, there was no further increase in microcephaly seen anywhere in Brazil including the “Ground Zero” of Recife.

Scientists are bewildered

Neither the Aedes aegypti mosquito nor its transported virus recognize national borders; yet there never was a microcephaly-rate explosion in Colombia.

“Zika has left a puzzling and distinctly uneven pattern of damage across the Americas. To the great bewilderment of scientists, the epidemic has not produced the wave of fetal deformities so widely feared when the images of misshapen infants first emerged from Brazil.

Should we be surprised that Zika-scientists were “bewildered” by this anomaly? Add in the skepticism and suspicion science ordinarily deserves (and undoubtedly this article will garner) and the “bewilderment” disappears.

Even in Recife itself, there were vastly differing rates of microcephaly occurrence, with certain neighborhoods at orders of magnitude more than others. Wealthy neighborhoods didn’t exhibit microcephaly even though there had been no prior reason to have been overly cautious regarding mosquitoes. Arguably, the wealthy have better mosquito nets and drier streets – but they also maintain better hygiene, on average, regarding microcephaly’s pre-existing associations.

Microcephaly — aside from one severe, rare, genetically recessive “primary” version had never had a predominantly identifiable individual cause. Rather it’s a physical and statistical quantification medically characterized causally as “multifactorial,” i.e. loosely connected to a myriad of potential agents (most of which [underlined] coincide with poverty).

Disruptive injuries; Infections: “TORCHES” (toxoplasmosis, rubella, cytomegalovirus, herpes varicella, syphilis) and HIV; Poorly controlled maternal diabetes; Deprivation; Maternal hypothyroidism; Maternal folate deficiency; Maternal malnutrition; Alcohol-overuse; Teratogens: hydantoin, radiation; Maternal phenylketonuria; Placental insufficiency; Death of a monozygous twin; Ischemic or Hemorrhagic stroke.

Compare this to rubella virus and its attendant congenital neurologic deformities (“rubella syndrome”) which comprise a defined cause-effect relationship. Rubella infection during a susceptible mother’s first trimester essentially always (80% -100%) brings on the syndrome; conversely the syndrome’s classic features have no other cause. Zika, once the dust had settled, was surmised to have brought (at its height) only a ~4% microcephaly-rate from its first-trimester infections.

The confluence of Zika’s low damage-rate with microcephaly’s rarity, lack of uniform presentation, and pre-existing ~twenty other loosely associative factors thwart statistical proof of causality. Imagine looking out on a field, presuming to fathom the reason for a few extra three-leaf clovers.

A Brazilian national fund began to award stipends to mothers of Zika-microcephalic babies. Even with this financial incentive newly on board, microcephaly cases associated with Zika disappeared!

In 2016 and 2017 with the advent of actual clinical Zika tests; corrected microcephaly standards; and maximal public awareness, Zika-attributed microcephaly immediately disappeared as a phenomenon. It didn’t recur in hotspot Northeast Brazil nor anywhere else on the globe. Zika showed up, for instance, in 2018 in Rajasthan India – but without attendant microcephaly.

Three Studies Reinforce Zika-Skepticism

The First:

Dr. da Silva Mattos’ “Microcephaly in north-east Brazil: a retrospective study on neonates born between 2012 and 2015” retroactively fills in the prior-year comparison data unavailable to the Recife neuropediatricians. Data-reconstruction casts doubt that there was any genuine increase in microcephaly in 2015, the year of the outbreak. The result is surprising:


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