Zika’s Legacy

Brazilian physicians and scientists work to answer urgent questions about the 2015 Zika epidemic — while waiting for the next one.

Occupational therapist Mayara Barata works with 2-year-old Nicolas, who has Zika congenital syndrome, in a photo of December 2017.

[This story was submitted in May 2018 in partial fulfillment of the degree of Master of Arts in Journalism. Columbia University Graduate School of Journalism. MA in Science, Environment, and Medicine]

Mayara Barata took off her shoes before stepping onto the blue foam mat. It was a Friday, just before Christmas, 2017. She was about to see her last patient of the week. The mat covered part of the floor in an improvised rehabilitation center at Oswaldo Cruz University Hospital in Recife, northeast Brazil, the region where the Zika epidemic had hit hardest two years before.

Two-year-old Nicolas entered the room in a small wheelchair pushed by his aunt. Wall stickers depicting fluffy clouds and rainbows made the case that this was a space dedicated to children. So did the toys, buckets, cubes, and Pilates balls spread over the floor.

Barata, who is an occupational therapist, placed Nicolas on the mat, cozied between the two legs of a pillow made from a stuffed pair of faded blue jeans. While holding his right arm stretched, she gently started rotating his wrist. The seemingly trivial movement encountered resistance, causing his whole arm to shake and his face to contort. Barata comforted him with a kiss on the forehead just in time to prevent tears from rolling down, but soon she resumed the painful stretching routine.

Babies infected by Zika while in their mother’s womb have rigid muscles. This stiffness, called hypertonia, makes it hard to move and was seen, in different degrees, in most patients with congenital Zika syndrome.

More than two years after identifying the first patients with the condition, scientists and physicians have many questions. Why hasn’t Brazil yet experienced a second wave of congenital Zika syndrome, even though there has been a second wave of Zika infections? Thousands of children have been diagnosed. How will they develop throughout childhood? Will they be able to walk, talk or go to school? Assuming that only the babies with the most severe symptoms were initially diagnosed, how many more children will turn out to have been affected?