How WhatsApp Provided Early Warning for the Zika Outbreak

Infectious disease doctors in Brazil — as well as mothers of infants born with microcephaly — are using WhatsApp to diagnose and cope with the Zika-caused illness.

WhatsApp, a free peer-to-peer messaging platform, is essential to communication in Brazil. It’s the most downloaded app in the country and is used by more than half the population to text and voice message one another. Globally, the app has almost a billion users. Many argue the reason for WhatsApp’s dominance in markets like Brazil, India, and parts of Africa is that “it provid[es] locals with the first truly viable way of quickly and cheaply communicating over the Internet.” So much so that infectious disease doctors in Brazil — as well as mothers of infants born with microcephaly — are using it to diagnose and cope with the Zika-caused illness.


Since last fall, over 4,000 suspected cases of microcephaly, a rare condition where newborns are born with abnormally small heads and brains, have been reported in Brazil. Most health authorities blame mosquitoes carrying the Zika virus for the outbreak. Zika is now present in most of South and Central America and the government of Brazil estimates that 1.5 million Brazilians may have it.

Using WhatsApp, a group of Brazilian doctors messaged late last March with one another, describing symptoms they were seeing in patients. “I think it’s Zika,” Dr. Kleber Luz posted to the group of doctors on WhatsApp. Another doctor, two states away, assessed the conditions reported by Luz. He then told his wife, “OK. I agree with Kleber. It’s Zika.”

This early work on identifying Zika stemmed from a WhatsApp group the doctors formed after they had traveled to Feira de Santana, Bahia, to investigate an outbreak of chikungunya. Dubbed “CHIKV: The Mission,” the doctors used the WhatsApp group to stay in touch. Little did they know, they’d be using the app to diagnose Zika. In August, doctors in northwestern Brazil began exchanging CT scans of patients over WhatsApp in an effort to diagnose microcephaly.

Unfortunately, these early investigations into the outbreak didn’t make it to Brazilian health authorities immediately. “The doctors say they started to notice more cases in August, but it was only reported to us around Oct. 15,” said Patricia Ismael de Carvalho, general director of information and strategic actions in epidemiological surveillance for the Pernambuco State Secretariat of Health.

Because the networks of doctors on WhatsApp don't always overlap with government officials, notifications of disease outbreak can be delayed. “If you’re an obstetrician, you’re talking to other obstetricians in your network, but you’re not talking to the Ministry of Health,” said Sonia Shah, science journalist and author of the book Pandemic: Tracking Contagions from Cholera to Ebola and Beyond. “You’re not going to text someone unless you know them personally and you know their phone number.”

While doctors are diagnosing and attempting to share information about the disease outbreak via the messaging app, mothers of infants born with microcephaly are using WhatsApp to form support networks. In Recife earlier this month, office administrator Germana Soares organized an event for dozens of mothers of suspected microcephaly-diagnosed infants. Over 60 of those parents use an enormous WhatsApp group for support. “These groups allow us to celebrate motherhood at a time we feel faced with lots of stigma,” Soares said.

Social media is an amazing thing. It can create connections to people that normally wouldn't occur. In this case, it allowed for the early recognition of a devastating disease and provides support for afflicted families. 

“We’re all in the same boat,” said Soares. “And the boat is full.”

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Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.

Still from John Stephenson's 1999 rendition of Animal Farm.
Surprising Science
  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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