As Zika spreads, Brazil deploys everything from local workers to troops

Early next month, Brazil's President Dilma Rousseff will deploy hundreds of thousands of troops to fight Brazil’s “No. 1 enemy": mosquitoes.

The Aedes mosquito species, which is known to carry viruses including Dengue and Chikungunya, has gained fresh notoriety as it has spread the Zika virus in the region.

The World Health Organization announced this week that Zika could reach as many as 4 million people across the Americas. But while the stakes are high – Zika is believed to cause birth defects and other possible neurological effects – the battle against mosquito-borne disease is one Brazil and the region have fought before. Now what's needed, experts say, is a renewed focus on extensive mosquito control and collaboration on further research to tackle the virus and its largely still unknown long-term effects.

“Most of the countries affected by Zika have been dealing with outbreaks of Dengue for decades,” says Justin Stoler, assistant professor of geography at the University of Miami College of Arts & Sciences.

That means fumigation and public education campaigns about removing stagnant water or wearing long-sleeves to fend off mosquito-related illnesses are familiar terrain for most governments. “But because we haven’t seen the explosiveness … of Zika until recently, there’s been complacency,” Mr. Stoler says. That includes reported decisions to cut mosquito reduction campaigns in Brazil by half last year compared with 2013, according to local news reports.

Part of Zika’s reach has to do with the fact that the virus is new in this part of the world: few people have built up immunity, which means that prevention and the eradication of mosquitoes is particularly important. 

Brazil was one of the first nations in the Western Hemisphere to identify Zika cases last May. Since then, it has ramped up efforts to halt the spread, boosting inspections and spraying insecticide in residential neighborhoods and popular gathering spots like public beaches and parks. It’s also regularly spraying the Sambadrome, which can hold roughly 70,000 people and will host the annual Carnival parade in Rio de Janeiro next month.

Medical and public health officials have teamed up at the Federal University of Rio de Janeiro to work on a potential vaccine, and Brazil is distributing mosquito repellent to thousands of pregnant women. Radio and televisions stations are overflowing with public service announcements, and some 220,000 troops are to be sent into communities across the country one day next month to educate the population about preventative measures.

Going door to door

In the southern Rio de Janeiro favela of Chapeu Mangueira, water that has pooled in potholes and along steep stairways from a heavy overnight rain taunts sanitation worker Maria Isabel Castro.

“Our duty is to remind every single resident to be actively vigilant. They simply can’t allow puddles,” Ms. Castro says, banging on doors and handing out informational pamphlets.

She reminds residents to clean their potted plants, clear out garbage, and make sure water tanks are securely covered.

Resident Carlos Alberto, who has lived here all his life, bristles at her advice.

“How you going to get rid of this virus? The very places we live in are full of holes and crevices” ready to fill up with water, Mr. Alberto says, shutting his door.

But door-to-door health and sanitation education, like what Castro has been doing here for the past four years, could offer a small but important leg up as Brazil takes on Zika. Networks of health volunteers have long gone into hard-to-reach, impoverished communities to educate about public health risks.

But there is certainly room for improvement in education and prevention. From the government of El Salvador putting the onus of protection squarely on the shoulders of citizens by advising women not to get pregnant for two years, to gaps in the delivery of eradication campaigns in hard-to-reach neighborhoods or due to high levels of violence, Zika remains a potent threat.  

Dr. Ana Paula Cavalcante, who works at an emergency care unit in the northeastern city of Recife, one of the regions where Zika has hit the hardest, says that she and her colleagues are overwhelmed – not only with the influx of patients who believe they might have Zika, but in their efforts to understand this new virus.

“While the government is investing in educating the population, we feel like we do not really know much about the disease,” Dr. Cavalcante says. “What we know we learn from each other, from our colleagues.”

Unknown links

The symptoms of Zika are mild, and some 80 percent of people infected show no signs at all, health officials say, adding to the difficulty of knowing when a mother and unborn child is at risk. But that is the issue that has raised the most concern: the potential link between Zika and microcephaly, a rare condition where babies are born with severe disabilities. Nearly 4,000 newborns in Brazil have been diagnosed with the birth defect thus far.

“I am increasingly worried about the lack of resources in our hospitals to help the mothers and babies affected by this illness,” says Adriana Melo, an obstetrician at the Elpidio de Almeida Health Institute maternity hospital in Paraiba State. She was one of the first health professionals in Brazil to find evidence of a link between Zika and microcephaly.

“I’m worried about the lack of testing and assistance being given. We don’t have the infrastructure in place to cope,” she says.

There have been reports of desperate families, concerned that they won’t be able to financially deal with their newborn’s health complications, abandoning their child.

In response, this week, the ministry for social development announced that poor families whose children are diagnosed can apply to receive government disability support.

Past successes

Earlier eradication programs to deal with the strain of mosquito that carries the virus had considerable success. “I tell my students that this is one of the greatest public health success stories and failures," says Mr. Stoler. "They were on the brink of eradication and then came back in full force.”

After a regional push in the 1950s and '60s to eradicate the Aedes mosquito, which carried the threat of Yellow Fever at the time, it had disappeared from almost the entire region, except for a few pockets in the Caribbean, the southern United States, and northern South America.

“But then other viruses emerged like HIV and resources shifted,” Stoler says. “That’s when it came roaring back, and to areas it hadn’t inhabited before.”

There are present-day lessons in this, he says.

“We have been able to get away with not thinking about these infections that are happening in other parts of the world,” says Stoler. “Then came [mosquito-born] Chikungunya crossing the Atlantic, and Ebola briefly arriving in the US and Europe. These tropical infections are the world’s problem.

“We have to decide: Will we work together, adopt better standards, and give resources where they are needed? Or wait until it’s on our doorstep?”

Rafaela Cruz contributed reporting from Recife.