Since being infected with the Zika virus a month ago, Wendy Johana Castillo has been experiencing pain all over her body, a recurring fever and a skin rash. But the 23-year-old Colombian is more concerned about her unborn baby.
Every 15 days, she has to undergo a scan to make sure her foetus isn’t developing microcephaly, a birth defect that has been linked to the mosquito-borne Zika virus. Babies with the congenital condition are born with abnormally small heads and often suffer from poor brain development.
"Doctors advised me not to move much and, if I don't feel my baby moving in the womb, to rush to the nearest ER," Castillo told IRIN over the phone from a bed in her cousin’s home in Soacha, on the outskirts of Colombia’s capital, Bogotá.
Castillo, who is 19 weeks pregnant, used to work as a janitor at a construction site in Girardot, a tourist town about two and a half hours’ drive from Bogotá. She said her workplace "was surrounded by puddles and infested with mosquitoes".
How to know if you have the virus?
Zika's most common symptoms are mild fever and a skin rash, usually accompanied by conjunctivitis and muscle or joint pain that begins a week or less after being bitten by an infected mosquito. Most people experience no symptoms at all, but the links between infections in pregnant women and an increase in the number of children born with microcephaly in neighbouring Brazil has caused alarm among experts. On Monday, the World Health Organization declared that the strong links between Zika infection during pregnancy and microcephaly should be treated as a global public health emergency.
So far, cases have been confirmed in 23 countries in Latin America and the Caribbean, but the WHO expects it to spread rapidly throughout tropical areas of the region, infecting up to four million people. Brazil has been hardest hit, with fears that as many as 4,000 babies may have been born with Zika-related microcephaly since October 2015. The country has declared a state of emergency and rushed 220,000 soldiers onto the streets to help eliminate mosquito breeding grounds.
Colombia is the second most affected country, with 20,297 confirmed cases, 2,100 of them among pregnant women, according to government figures released on Saturday.
So far, there are no reported cases of infected women in Colombia giving birth to babies with microcephaly, and last week the government denied rumors that a nine-year-old girl died after being infected with the virus. The government is nevertheless treating all pregnant women suspected of being infected with Zika as "high-risk pregnancies", and has advised women to avoid getting pregnant before mid-2016.
Living in Zika’s Ground Zero
In Girardot, Castillo´s hometown, there have been 1,437 reported Zika cases, according to figures from the municipality, which began keeping a record in November 2015 after being alerted by the Federal Health Authority.
The town has a year-round tropical climate and is densely populated, both factors that make it particularly susceptible to the spread of Zika. Although there have been no confirmed cases of the virus being transmitted from one person to another, a mosquito that bites an infected person can transit it to other people it bites.
"In emergency rooms, doctors have doubled their shifts, leaving other services uncovered," said Erika Lorena Ramirez, Girardot's public health chief. She told IRIN that medical clinics are overwhelmed by people worried they have the virus. Doctors at one hospital in the town have gone from seeing an average of six patients a day to 50.
Ramirez — herself infected with Zika — said her town is used to handling epidemics of dengue fever and chikungunya, both of which are carried by the same Aedes aegypti mosquito that spreads Zika. Last year, chikungunya infected some 76,000 people in Girardot, nearly half the town’s population.
How many unreported cases?
Juliana Quintero, an epidemiologist at Fundación Santa Fé, a hospital and research centre in Bogotá worries that many cases of Zika are going unreported. She said that many people who had negative experiences when visiting ill-equipped medical centres in Girardot during previous epidemics, probably preferred to stay at home and handle the problem themselves.
"People just think: why go to the hospital, wait for hours and, at the end, receive some acetaminophen (Aspirin)," she told IRIN.
This is currently no effective treatment for Zika and no rapid test for diagnosing the infection. Quintero explained that as the symptoms are similar to other diseases, cases can only be confirmed by a laboratory test. Small towns lack the expertise to conduct such tests and National Health Institute labs in major cities are clogged. For now, priority is being given to pregnant women and patients that show neurological symptoms. As well as links with microcephaly, Zika virus has also been associated with Guillain-Barré, a syndrome that can lead to paralysis. On Friday, Colombia’s deputy health minister said the country had recorded 41 cases of the syndrome that appear to be linked to Zika infections.
The Colombian government has estimated that at least 500 babies will be born with microcephaly before the virus can be contained, but some experts have said that the real number could be much higher.
The breeding grounds
Open water tanks with adjoining sinks called "albercas", which are used to do laundry and other household tasks and are a common feature of middle- and lower-income homes in the region, account for some 80 percent of breeding sites for the Aedes aegypti mosquito in Colombia, according to Quintero.
She is leading a pilot project to reduce populations of Aedes aegypti mosquitoes by simply covering the tanks with specially adapted nets. The technique, sponsored by the WHO is proving more effective than current measures, the most popular being to fill a woman’s stocking with a larvae-killing substance and hang it inside the tank. The method often fails when the water level inside the tank drops and there is no contact with the stocking, explained Quintero.
Fumigation campaigns have also had limited impact because they only kill the adult mosquitoes, which are replaced within a few days by a new generation of the insects that hatch from larvae, said Ramirez.
Because of its geographical location and tropical weather, 85 percent of Colombia is vulnerable to Zika, which is thought to have originated in Uganda in the 1940s before arriving in South America in 2015.
Castillo moved from Girardot to her cousin’s house in Soacha because she needed to be closer to her frequent medical appointments in the capital. She lost her job when she became too sick to work and now struggles to support her seven-year-old son and pay for the many vitamins and painkillers that her doctor prescribes. Her medical exams are covered by her public health insurance. She said her boyfriend left her when he learned she was pregnant.
"My fear is that my baby gets born with some kind of brain problem,” said Castillo. "No matter what, I will have my baby until God decides to take him away.”