Aedes aegypti. Flickr. Some rights reserved.

Zika weighs heavily on my mind. I spoke to a friend in Venezuela recently. This is terrible example at baseline of social and economic disruption for political reasons. Her daily life is made up of queues for daily essentials like toilet paper; there is no tylenol available for anything. A big upsurge in malaria had already happened last year!

Add Zika. In her neighborhood, about a dozen cases of active Zika (clinically, there are no diagnostics), and two of them are pregnant women. Upsurge in Guillan Barre syndrome, for which they have no therapy other than support when available. This has not been reported to the WHO. The thousands of babies affected in the Americas raise the contrast to the lack of options for those who hear that pregnant women from the north are being told not to travel to their country. This is being played out across the Americas where the Aedes mosquito is present. While the first documented case of sexual transmission for this rare virus was published 5 years ago, now documentation from Texas in the context of an important epidemic raises all sorts of new questions. Is that an important method for expansion of the infection? 

Every night, sleeping with the fear. Or not sleeping at all.

So many things unknown. Credible causality assessment of Zika to the CNS findings (microcephaly, Guillan Barre, retinal findings) is ongoing in Columbia and Brazil. The exact biology of the nervous system impact of Zika is unknown. Many important aspects of this viral infection are still to be understood. For example, how long is the risk of CNS effects?  What is the nature of immunity?

Zika, in contrast to the recent devastation that was clinical Ebola, is a relatively mild infection, but the consequences appear to be neurological post infection. This epidemic adds Zika to the classic TORCH infections we were trained to recognize: congenital Toxoplasmosis, Other, Rubella, CMV, and Herpes. It is now a big player in "other".

Then I wonder. Did that Ebola/emergency response money that was promised globally ever get to WHO? Or anywhere? Zika itself as the next epidemic was really not so predictable. However, that there will continue to be outbreaks and pandemics, yes, indeed. Look at the track record: H1N1, H5 re-emerges, MERS, Ebola, Zika...

The theme song goes: when will they ever learn?