I'm still trying to process the report mentioned in the post just below, and if I had any sense I'd sit back and let wiser, cooler heads discuss its implications. But I don't, so I won't.
First, a little background: The report's corresponding author is Dr. Sandra da Silva Mattos, president of a Recife NGO called Círculo do Coração de Pernambuco; so I'll call it the Mattos Report. Others are personnel in the Health Secretariat of Paraíba state, so the findings come with a governmental endorsement.
Having now read the Mattos Report a couple of times, I have a sense of what the researchers were trying to do. They knew that since 2012 Paraíba had a database on pediatric cardiology including over 100,000 neonates. Not all the data recorded for those newborns was included in the database, but the researchers looked at a random 10% of the births over four years (up to the end of 2015) and retrieved data on head circumference based on three criteria.
From December 1 to December 31, 2015, the unpaid team collected this information on 16,208 neonates from 21 different public health centres in Paraíba state. They found that, depending on the criteria, "from 4% to 8% of kids born between 2012 and 2015 had microcephaly. Neonates fulfilling all three crtiera accounted for nearly 2% of the sample." The report explains what that means:
Projecting our findings to the total number of live births in Paraíba, in 2014 (n=58,147), the number of neonates born with microcephaly in that year would have been 4,652 by the Health Ministry proposed criteria, 2,442 by the Fenton curves and 2,907 by the proportionality criteria. Neonates classified with microcephaly by all three criteria would have been 1,105."
And this in just one Brazilian state with a population of about four million.
I've been fretting about the microcephaly baseline not just in Brazil but across Latin America—a region that's not exactly poor, but which generally impoverishes its public health sector. The Mattos Report, in an understated way, condemns the Brazilian government for sustaining that impoverishment and allowing a public health disaster to go unnoticed. The report points out that microcephaly cases were numerous (but fluctuating within global norms) right from 2012, two years before the earliest possible arrival of Zika.
Of course, Brazilian health surveillance also looks bad in this report; for all anyone knows, Zika may have been in Brazil years earlier, running camouflaged as dengue and then chikungunya. The Mattos Report points out that other causes of microcephaly need consideration:
Among them figures the possibility of boosting effects from associated infections, perhaps even viral infections, such as DENV and CHIKV, both carried by the same Aedes aegypti vector. Also to be considered is teratogens exposure, such as vaccines or drugs used in early pregnancy. Further, malnutrition, which has previously been associated to microcephaly, could have an intensifying effect when coupled with other aetiological factors. Indeed, most of the reported cases have occurred in low-income families.
That last sentence is like a nail gun pressed to the head of the Brazilian government, and the trigger pulled.
If the ultimate cause of Brazil's microcephaly is not some alien African virus but deliberate government policy that keeps millions poor, what does that say about the government and the Brazilians who support it?
And what does that say about countries around the world who adopt similar policies, countries who leave their poor to lose their babies to diarrhea and malaria or cholera—or who keep their babies as malnourished, uneducated, stunted parodies of the strong and healthy young people they could have been?
Very likely the Rousseff government will try to ignore the Mattos Report. What it should do is extend it to the whole vast country; if nothing else, it could establish a baseline not only on microcephaly but on the catastrophic consequences of centuries of robbing the poor to pay the rich.