The Great Zika Freak-Out: A Teaching Moment in the Psychology of Fear

An unfamiliar new threat that harms babies, that we can't protect ourselves from, that experts don't fully understand, and about which the media is blaring loud alarms; Zika virus has several powerful emotional characteristics that make any potential danger feel much more dangerous than it might actually be.

         A new disease with an exotic name, Zika virus, is spreading "explosively" around the world. It may be causing babies to be born with shrunken heads and brains. No one has immunity. Experts admit significant uncertainty about how the disease spreads, what symptoms it causes, or just which parts of the population face the greatest danger. And the media is going bonkers. There could not be a more perfect set of conditions for a full-blown freak-out about a threat that plenty of evidence also suggests may not be that great a threat at all. And that kind of risk reaction can be dangerous all by itself.


     I'm no expert in Zika virus or infectious diseases. For scientific particulars, one great source is Helen Branswell at STAT; Everything You Need to Know About Zika virus. There is also a solid backgrounder in The New York Times: Short Answers to Hard Questions About Zika Virus

The CDC has an information site. So does the World Health Organization (WHO).

But interestingly, the WHO information site is FAR more measured than the public statements by WHO head Dr. Margaret Chan, who spoke in much more dramatic terms.

“Last year the disease was detected in the Americas, where it is spreading explosively.”

“The level of alarm is extremely high. Arrival of the virus in some cases has been associated with a steep increase in the birth of babies with abnormally small heads.”

“The possible links have rapidly changed the risk profile of Zika from a mild threat to one of alarming proportions."

       Dr. Chan’s statements, which almost surely will be widely criticized as poor risk communication, set the world press into a Zika frenzy:

Zika Virus ‘Spreading Explosively’ in Americas, W.H.O. Says

Should Canadians Worry About Zika Virus?

Zika virus is here in New York

Zika virus may not be in South Florida yet, but it has the potential to be

Zika virus: Up to 4 million cases predicted

         But compare that scary headline with what the BBC story itself says in the second paragraph;

Most will not develop symptoms, but the virus, spread by mosquitoes, has been linked to brain defects in babies.

         And compare Dr. Chan’s alarmist language (speaking about a global threat) with the comments of Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, describing the risk for the United States, where there have been a grand total of 31 recorded cases of an infectious disease that has been around in many tropical areas (that breed the right species of mosquito) for at least eight years.

For the average American who is not traveling, this is not something they need to worry about. For people who are pregnant and considering travel to the affected areas, please take this seriously.

Dr. Schuchat also did a wise thing with her risk communication. She all but promised there would be more travel-related cases, rather than trying to over-reassure the public. But she said that conditions in the United States make it highly unlikely (not impossible, but highly unlikely) there will be a serious outbreak here.

Perhaps most importantly, compare Dr. Chan’s alarm with the actual numbers from Brazil, one of the first places where doctors noticed a spike in microcephaly, the condition of babies born with shrunken heads or malformed brains. Nature reported on an analysis of the actual numbers: Brazil's surge in small-headed babies questioned by report 

It is not known how common microcephaly has become in Brazil’s outbreak. About 3 million babies are born in Brazil each year. Normally, about 150 cases of microcephaly are reported, and Brazil says it is investigating nearly 4,000 cases.

From 150 to 4,000 in one year is a frightening spike on a percentage basis, and certainly cause for alarm. But how much alarm? A total of 4,000 cases of microcephaly out of 3 million babies comes to a risk rate of 0.0013. Tiny. And the study reported by Nature found that only 270 of the Brazil cases have been confirmed as microcephaly, and a tenth of the reported cases have been discounted as false diagnoses.

         So the basic facts about Zika virus at this point suggest that even if the worst case is real, the statistical risk, even where conditions are favorable for the spread of the disease, is probably tiny. But at this point facts are, well, equivocal, which is why public health authorities are responding with due caution, (even though some, like Dr. Chan, are responding with less-than-cautious language.) And the very fact that there is uncertainty is just one of several psychological characteristics that make the threat of Zika virus feel much more worrisome than the evidence alone suggests.

         New risks freak us out more than the ones we’re familiar with. The way we freaked out about West Nile virus, and then calmed down about it even though it’s still around, provides a good analogy. We are much more concerned about risks to babies than risks to adults. Zika scores high on that risk perception factor too. So does the fact that we have no immunity or vaccines, which means we are powerless — we have no sense of control. Not being able to protect ourselves makes any risk scarier. Uncertainty about the nature of the Zika threat adds to the sense of not knowing what we need to know to protect ourselves/powerlessness.

         And the media alarms play a huge magnifying role. The more readily available something is to our awareness, the more space it takes up on our limited radar screen of risk. No matter how measured the stories on Zika virus may be as you get down into the details, (and most are), blaring headlines of “spreading explosively” and “4 million possible victims” (thank you, Dr. Chan) are what we hear and read first and, cautious beings that we are, we tend to put too much weight on the worst-case possibilities of any threat and those reassuring caveats down in the story, if we even get that far, do little to disabuse us of our fears.

         Let’s be clear, and fair: Nobody is panicking. These worries, even if based more on feelings that an objective look at the evidence, are real, and valid, and entirely reasonable. Better-safe-than-sorry precaution is built into the psychology of how we keep ourselves safe. Given what isn’t known, only a fool would suggest there is no need to worry.

But we also have to worry about worrying too much, about this threat or any threat, because excessive fear can be risky too — from the choices it leads us to make, or just the harmful effects of chronic stress. So it’s worth observing how the Zika outbreak is demonstrating how we supposedly rational intelligent creatures often respond to potential danger with emotion and instinct as much as with objective analysis and reason. Understanding that can help us stay safe too.

image, GettyImages, Inti Ocon

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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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