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 I assumed it was irritation from the cigar I'd smoked on my deck
that afternoon in mid-June. But the sensation hung on. Within three
days, I had a 102-degree Fahrenheit (38.9 degrees Celsius) fever,
chills and bed-drenching night sweats.
For two weeks, symptoms came in waves. A skin rash. Joint pain. Then
a dull throbbing behind my eyes. There was pain and redness too, in
a certain exclusively male region, which ibuprofen didn't relieve.
Then, I felt better. But a week later, the symptoms staged a
comeback, with more eye pain and something new - small welts on my
eyelids and temples. I had sporadic headaches, was so exhausted I
slept 10 hours a night and even failed to wake up for a flight.
My mother was the first to suspect I was infected with the virus
that arrived in Puerto Rico in December 2015, four months after I'd
begun an assignment as Reuters' San Juan bureau chief.
Initially, I laughed off her internet diagnosis as the overwrought
worries of a long-distance mom. But I agreed to see my long-time
physician during a visit home in late June.
After listening to my symptoms and learning I'd been working in San
Juan, Dr. Kevin Wallace of Murray Hill Medical Group called the New
York City Health Department and arranged to have my blood sent for
screening. Eight days later, I got the news.
Mom was right. I had Zika.
EVOLVING KNOWLEDGE
Hundreds of thousands of people are estimated to have been infected
with Zika in the Americas since the virus was detected in Brazil
early last year. Most have no symptoms or experience only a mild
illness.
But it can penetrate the womb in pregnant women, causing a rare but
crippling birth defect known as microcephaly. In adults, it has been
linked to Guillain-Barre syndrome, a temporary paralysis. And it can
be passed on through sex, a unique characteristic among
mosquito-borne viruses. There is no vaccine or treatment.
Last month, the U.S. government declared a public health emergency
in Puerto Rico, the hardest hit among states and territories. More
than 17,800 infections have been reported on the island, including
more than 1,500 among pregnant women, and one case of microcephaly
in an aborted fetus.
As a journalist and a patient, I've had access to some of the
brightest minds studying Zika. But the virus has confounded experts
at the highest levels and launched a global race to understand its
risks.
Each month, new findings have led to changes in how the public is
advised to stay safe. Compared to what we know about other diseases,
such as flu and even Ebola, we are in new territory.
In my case, doctors were hard-pressed to explain why my symptoms
returned about three weeks after the initial infection. Nor could
they tell me how long I could be at risk for Guillain-Barre. Another
mystery: were condoms enough to protect against sexual transmission?
In the weeks since I've recovered, that is proving to be one of the
toughest questions to live with.
Both men and women can infect their sexual partners. In one case,
scientists identified Zika virus in semen six months after the man's
symptoms appeared, though it's not clear how long it can cause new
infections.
Public health officials have warned couples not to conceive for at
least six months after either a man or woman returns from a Zika
outbreak area, even if they show no symptoms.
My wife and I, both in our early 30s, have had to consider how
dangerous my bout with Zika could be to our plans to have children
some day.
Our most intimate decisions now are affected by the uncertainty
surrounding Zika: how long can I infect my partner? How likely is it
that my baby would become sick if I do? Given how rapidly the
expertise about Zika has evolved so far, how much faith should we
put in the current thinking?
SHRUGGING IT OFF
When I took the one-year post in Puerto Rico, I figured my biggest
health risk would be sunburn.
Even when Zika began circulating on the island, I didn't worry. My
wife Julie, a lawyer and publishing industry pro, had decided to
stay at home in Brooklyn during my assignment, and we weren't
planning to have kids for at least a couple of years. So we gave
Zika little more than a shoulder shrug.
I'm not sure when I was infected. I picked up more mosquito bites in
San Juan than Twitter followers. I didn't always use bug spray. I
worked from home, an apartment in a colonial building without window
screens, and kept the deck doors open to save money on air
conditioning.
Locals are used to mosquito-borne illnesses, including dengue and
chikungunya. Some, more concerned about pesticides than Zika,
successfully fought aerial spraying with Naled. Many also are
concerned about Zika's threat to tourism, which could compound the
island's vast economic challenges.
One friend grew indignant when I mentioned writing this piece.
"You're a journalist," she said. "You have a responsibility not to
perpetuate hysteria."
When I got sick, I didn't consider going to a doctor in Puerto Rico.
The economic crisis has made medical care unpredictable, and the
waits are long. When I sought treatment for allergic reactions
earlier in my stay, doctors refused my corporate health insurance
and demanded cash.
Instead, I waited a few days to see Dr. Wallace during my visit to
New York. I was his second potential Zika patient, though the first
ultimately tested negative for the virus.
Eight days after my blood sample was submitted, a woman from the
city health department called.
Have you heard from your doctor? she asked.
"No."
"Oh?" she said. "You haven't spoken to your doctor at all?"
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I broke a long pause, saying, "Feel free to let the cat out of the
bag."
"Well," she said, "you tested positive for Zika."
The way it is supposed to work, the results are sent to the
patient's doctor in time to break the news before the city
"interviewer" calls to address public health concerns. But Dr. Jay
Varma, deputy commissioner of the New York City Health Department,
acknowledged that doesn't always happen.
MIXED REACTIONS
Some friends in Puerto Rico teased me when they learned I had Zika.
Many of them had experienced chikungunya or dengue, and had stories
about months of muscle pain or weeks in bed. Friends from the
states, on the other hand, showed grave concern, offering thoughts,
prayers and condolences. Some kept their distance for weeks. A few
questioned whether it was safe for me to be around babies.
The evidence shows Zika clears the bloodstream quickly, and the
virus doesn't spread through casual interactions.
Julie and I weren't quite sure how to react. We didn't take it too
seriously at first. I posted a glamour-shot selfie on Facebook with
the caption: "This is the face of a man with Zika."
As the weeks passed, it became clear that Julie and I were also a
little rattled - and not fully on the same page. She canceled a
planned long weekend visit to Puerto Rico. She wanted to minimize
her exposure to Zika and arranged instead for us to meet in Florida.
This disappointed me. I had hoped to show her my new favorite places
on the island. I clung stubbornly to the view that Zika fears were
largely overblown. She reminded me that, given the unknowns about
Zika's impact on pregnancy, I was in no position to call the shots.
"Try to see it from a woman's perspective," she said.
We have heard a lot of different things about Zika, even from
doctors, and she doesn't totally trust the idea that the virus is
manageable with the current medical advice.
What if Zika poses a threat for months or years after infection? If
so, could that jeopardize our future plans to start a family? What
if we got pregnant before we planned to?
We've had to manage our different anxieties over the "what ifs" of
Zika.
FOR SCIENCE
There's plenty the experts are still figuring out, and that has been
reflected in the shifting opinions about my case.
Ingrid Rabe, an epidemiologist with the U.S. Centers for Disease
Control and Prevention, told me Zika generally lasts a few days.
While she couldn't address my specific case, she speculated that a
return of symptoms like mine could indicate the presence of a second
virus.
A few weeks later, Dr. Varma told me it was possible, in severe
cases, for symptoms to last longer or recur.
Of three acquaintances in Puerto Rico who developed Zika, all have
complained, like me, of lingering health problems, in one case for
longer than a month.
Two weeks into my infection, Dr. Wallace couldn't tell me whether I
remained at risk for Guillain-Barre. The city health interviewer,
after consulting with doctors, told me the paralyzing condition
would most likely have set in within days of Zika infection, so I
was probably out of the woods.
Again, the information shifted over time. The CDC's Rabe later told
me it could take "a few weeks" for Guillain-Barre to appear. So far,
I haven't had any symptoms consistent with Guillain-Barre, and
here's hoping it stays that way.
Guidance on sex lacked precision as well. The city health
interviewer recommended we "use condoms every time" for six months,
reflecting CDC guidelines.
When I asked whether Zika can spread via saliva or oral sex, the
city health interviewer didn't answer directly. She said it can
spread via "sexual activity," and that saliva is "currently not
being tested." Rabe later told me "there's been no evidence" that
saliva can spread Zika.
The city health interviewer asked if I would join a CDC study
gauging how long Zika can be spread through semen and urine. I'm one
of 140 participants, though protocol calls for up to 250.
The study is a bit awkward. But, as a writer always looking for a
good story, I could not pass it up.
Every two weeks, a study test kit arrives by FedEx in a box with
dauntingly detailed instructions on how to produce and package my
samples, then overnight them back to the center's Colorado lab. I
also answer a somewhat blush-inducing questionnaire about my recent
sexual activity.
The CDC staffer assigned to my case sends cheery emails to let me
know she has received my samples and sex report, an interaction that
feels slightly too intimate. But I endure it in exchange for a $50
Visa gift card for each sample, and, more importantly, for the
chance to learn and to contribute to science.
The downside: I don't learn my results until the study ends in
December.
(Reporting by Nick Brown; Editing by Michele Gershberg and Lisa
Girion)
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