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Matthew J. Edlund M.D.

Stop Having Kids?

Stopping sex won't stop Zika


Fear eats the soul and creates strange policies: witness how the Zika virus provokes national recommendations to stop pregnancy cold. If you are young and fertile and Salvadoran, the government wants you to shut down your reproductive capacity for two full years - you can think about having children in 2018. Colombia only suggests ending reproduction for six to eight months; Jamaica, yet to see a case, has also asked people to stop having kids at least a half year. Yet will stopping sex (in the U.S. half of pregnancies are “unintended;” it’s more common in Latin America and the Caribbean) lead to the end of the virus?

No more than building walls across Mexico or Canada will stop terrorism in the U.S.

The recommendations to “end pregnancy as we know it” smack more of government ineffectiveness and cowardice than sensible public health policy. If you get pregnant and your child is born with microcephaly, it’s not our fault, is it? We told you not to do it, bureaucrats can intone, even if we can’t provide free or cheap contraceptives or just plain ban them along with abortion, which in gang ridden El Salvador is illegal even when the mother’s life – and the fetus’s - is in direct danger.

Don’t be surprised if some politicians play similar cards here. For the “transmission” of uncontrolled fatality, whether its death by pneumonia from the SARS virus or death by Kalashnikov by ISIS, terrifies people in powerful ways that obscures how to effectively combat it. Fear does more than eat the soul; it also wins proponents and votes - and provokes wars.

When You Feel the Sky is Falling

The earth is economically richer than ever before. People are living longer than ever before. Sanitation, vaccination and education have improved, and are better globally than ever before.

Yet people, even in developed countries, feel less secure.

There’s enough to worry about. The bizarre rulers of North Korea, whose ideology combines fervent emperor worship with the purity of the Korean “race,” possess nuclear weapons they are attempting to put atop intercontinental missiles. Vladimir Putin, as he perfects his giant mafia state, regularly threatens his “enemies” with nuclear attack. Global climate change can potentially disappear many of the great cities of the world while sparking ferocious economic, social and political conflicts. The “Great Recession” throws tens of millions out of jobs and stunts the economic future of hundreds of millions. And a pair of home grown murderers attack an office party and kill public health workers in San Bernardino.

But since the era of AIDS we have seen multiple epidemics – SARS and MERS and Ebola, to name a few. All were thought to have the potential to kill millions.

That did not happen. Even horrible and horribly infectious Ebola, occurring in some of the remotest, most violent scarred and poor areas of the earth, was stopped through international public health actions. SARS and MERS were rapidly controlled by applying public health measures locally and worldwide. Zika will hopefully prove no different. You stop Zika not by stopping sex, but by stopping the Aedes aegypti mosquito, which also spreads Chikungunya and Dengue fever. Dengue alone, according to the CDC, infects 50-100 million people each year, killing at least 22,000 and maiming far more. So why does it get so much less press than Zika?

Because it is less “spectacular.” Dengue has been around for centuries. Babies with tiny heads scare people a lot more than feverish deaths of tens of thousands of children.

Stop the infective power of the aedes aegypti mosquito – by spraying, emptying water containers, using mosquito nets, wearing insect repellent and long sleeves, checking screen doors and, finally, considering genetic manipulation of the mosquito’s reproduction, and you should ultimately control Zika. Those actions work when there are functioning governmental institutions and basic levels of food and political security. And that should also suggest to us how other forms of international cooperation can control the spread and fear of "infective" terrorism.

Propping Up the Sky

Ostensibly comparing the spread of viruses with the spread of terrorism appears unworkable. Though “invisible,” viruses are generally spread by direct human contact and respiratory droplets; terrorist ideologies spread by human contact but also on the internet, which appears to have been the case in San Bernardino and many other instances.

Solving Middle Eastern problems, by comparison, appears impossibly daunting. There are perhaps 7000 Syrian opposition groups. Wars in Yemen, Syria, Iraq and Libya are heavily fueled by an ancient Shia-Sunni conflict now in its fourteenth century. Often extremist ideologies work best in states of chaos – or perceived chaos. When people don’t have enough food and fear for their lives every single minute, they may accept political overlords who promise a modicum of safety. And tens of millions of young men and women with no economic and social prospects, no belief they will ever get anywhere – an endemic problem throughout the Middle East and North Africa and even parts of the West – are more prone to join extremist groups, no matter how false the hopes they provide, or how deep their anti-human viciousness.

Combating epidemics, infectious or ideological, is a long, hard slog. As with Ebola, you need lots of educated workers, endless effort, much cooperation among strangers, all to engage people who don’t speak your language, don’t think the way you do, don't want to talk to you and frequently hate your guts. But when you start to provide potential security rather than fear – a sense of safety and belonging, a belief in an actual, preferable future – things may slowly progress. Often the simple solutions are false. “Making the sands gleam” will not solve ideological epidemics, though functioning institutions might. That means agreement and cooperation among leaders who detest each other – as ultimately occurred between the Soviet Union and the West.

Fear eats the soul. Fear creates more fear. Thoughtful consideration is far less media sexy and emotionally engaging. It may not be possible, as El Salvador’s rulers have proposed, to stop sex; but it’s sometimes possible – with great and sustained effort - to give people basic security, and begin the end of endless conflict.

About the Author

Matthew Edlund, M.D., researches rest, sleep, performance, and public health. He is the author of Healthy Without Health Insurance and The Power of Rest.