W.H.O.’s Zika Guidelines Don’t Include Delaying Olympics

http://www.nytimes.com/2016/05/13/health/zika-brazil-olympics-who-guidelines.html

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The World Health Organization on Thursday urged athletes and travelers planning to attend the Olympics in Brazil, the epicenter of the Zika epidemic, to take a series of steps to guard against infection, but the agency made it clear that it was not calling for the Summer Games in August to be canceled or postponed.

The health organization’s guidance follows most of the current advice from public health authorities about Zika, although its recommendations for protecting against sexual transmission of the virus differ slightly from those of the American Centers for Disease Control and Prevention. The W.H.O. statement said that travelers should use condoms or abstain from sex during their stay and for at least four weeks after returning from a region within the epidemic zone; the C.D.C. suggests abstaining for eight weeks after returning.

The Zika virus is transmitted by mosquitoes. For many people it causes only a mild illness, but Zika has been linked to brain damage in babies born to mothers who contracted it during pregnancy. It has also been linked to a rare form of temporary paralysis.

Last week, concern over Zika led Major League Baseball and the players’ union to announce that two games between the Pittsburgh Pirates and the Miami Marlins would be moved to Florida instead of taking place in Puerto Rico, which has also been hit by the epidemic.

But the content and tone of the World Health Organization’s guidance for athletes and travelers indicated that the health authority was not advocating the cancellation, postponement or relocation of the Olympics, as a few prominent medical ethicists have urged.

Arthur Caplan, a bioethicist at New York University, wrote in February that holding the Olympics as scheduled was “senseless and irresponsible,” and recommended postponing it for six months to a year. Recently, Amir Attaran, a public health and law professor at the University of Ottawa, wrote that the Games should be postponed or moved to another country.

In his article in the Harvard Public Health Review, Dr. Attaran criticized the World Health Organization for not having issued an official statement on the Olympics and Zika. He said his arguments about the threat of the virus were not “meant to deny that the Games are a much-loved event. But where is the love for the possible victims of a foreseeable global catastrophe: the damaged or dead adults, and the babies for whom — and mark these coldly clinical words carefully — fetal brain disruption sequence is as terrible as it sounds, and extinguishes the hope of a normal life even before it has begun? With stakes like that, bluntly put, these Olympics are no game at all.”

In an interview on Thursday, Dr. Marcos Espinal, who directs the Zika response of the Pan American Health Organization, an arm of the W.H.O., strongly rejected the idea of postponing or relocating the events.

“I still think the Olympic Games should take place,” said Dr. Espinal, who added that he had just visited Brazil’s most at-risk areas. He noted that August would be “full winter in Brazil,” and said he expected “very little circulation of mosquitoes and virus in Brazil in August.”

Dr. Espinal said other viruses carried by the same Aedes aegypti mosquito, including dengue and chikungunya, had been shown to drop off significantly after the warm months, the first three months of the year in Brazil. As a result, he said, “W.H.O. and P.A.H.O. don’t think we should postpone the Olympics.”

Few Olympic athletes have publicly expressed concerns about Zika, and Olympic officials around the world have generally rejected the possibility that the conditions in Rio de Janeiro will be unsafe for competitors and spectators. There is no contingency plan if the health crisis escalates, they have said.

Several test events have been held in Rio in recent months, with no reports of athletes contracting the virus. The organizing committee for the Games has said that local authorities are trying to combat mosquito breeding by monitoring standing water.

The difference between the W.H.O. and the C.D.C. guidance on sexual transmission of Zika may reflect how little is known about the probability and conditions under which such transmission is possible. There have been a few cases of documented or suspected sexual transmission, and among the unanswered questions are how long the virus persists in semen, whether women can transmit the virus to sexual partners, and whether an infected person who never shows symptoms can transmit the virus sexually.

“I think four weeks could be sufficient,” Dr. Espinal said. “At the end of the day, the person should be cautious. The most important thing is safe sex.”

Two other recommendations in the World Health Organization guidelines could have economic consequences for some businesses and communities in Brazil. The guidelines suggest that Olympic visitors stay in air-conditioned accommodations and “avoid visiting impoverished and overcrowded areas in cities and towns with no piped water and poor sanitation (ideal breeding grounds of mosquitoes) where the risk of being bitten is higher.”

Asked about the possibility that the Zika epidemic may funnel Olympic spending away from poorer communities, Dr. Espinal said: “I don’t think it’s a matter of poor neighborhoods versus rich neighborhoods. I think it’s a matter of people taking precautions.”