O que é este blog?

Este blog trata basicamente de ideias, se possível inteligentes, para pessoas inteligentes. Ele também se ocupa de ideias aplicadas à política, em especial à política econômica. Ele constitui uma tentativa de manter um pensamento crítico e independente sobre livros, sobre questões culturais em geral, focando numa discussão bem informada sobre temas de relações internacionais e de política externa do Brasil. Para meus livros e ensaios ver o website: www.pralmeida.org. Para a maior parte de meus textos, ver minha página na plataforma Academia.edu, link: https://itamaraty.academia.edu/PauloRobertodeAlmeida.

terça-feira, 9 de fevereiro de 2016

Paulo R. Almeida na Amazon books: um abuso e um roubo...


Caindo na Amazon para ver o preço de um livro que me interessava (ainda estava muito caro, mesmo em Kindle edition, que em vários casos ficou mais cara do que o livro impresso), resolvi testar o meu nome para saber o que estava sendo oferecido (sem o meu consentimento) e a que preços.
Encontrei livros de que participei, outros dos quais sou indiscutivelmente o autor, vários que editei e outros que sequer desconfio por que estão sob o meu nome (um ou outro porque escrevi uma frase para a quarta capa, mas a maioria provavelmente porque sou apenas citado por algum autor).
Em todos os casos, com exceção dos que eu mesmo ofertei em formato digital, os livros estão muito caros, dificultando o acesso aos interessados.
Eliminei os homônimos (e a Amazon recupera mesmo os "quase homônimos", o que é errado), e os livros nos quais sou apenas citado, e deu isso que está abaixo:

1-12 of 85 results for Books :
"Paulo Roberto de Almeida"


Jun 16, 2009
by Michael Schiffer and David Shorr
$39.99Prime


Other Formats:Hardcover
Paulo Roberto de Almeida is Ph.D. in Social Sciences (University of Brussels, 1984) and Master in International Economy (University of Antwerp, 1977). He is also a career diplomat since 1977. Besides his professional duties, has engaged in academic activitiesMore about Paulo Roberto de Almeida

Sep 8, 2013
by Paulo Roberto Almeida and Pedro Paulo Palazzo de Almeida
Kindle edition: $4.35to buy
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Sep 26, 2014
by Ted Goertzel and Paulo Roberto de Almeida
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Sep 16, 2005
by Marshall C. Eakin and Paulo Roberto de Almeida
Kindle Edition: $21.95
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Nov 2, 2014
by Paulo Roberto de Almeida
Kindle Edition: $0.99to buy
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Sep 17, 2015
by de Almeida, Paulo Roberto
Paperback: $66.00Prime

Sep 2, 2015
by de Almeida, Paulo Roberto
Paperback: $47.00Prime



Oct 15, 2014
by Paulo Roberto de Almeida
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Nov 4, 2014
by Paulo Roberto de Almeida

Nov 4, 2014
by Paulo Roberto de Almeida
Kindle Edition: $0.99

Nov 30, 2015
by Paulo Roberto de Almeida

2006

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2010
by Paulo Roberto de Almeida
               
1605
by Paulo Roberto de Almeida (Contributor)

1993
Currently unavailable

Jan 6, 2009
by J. Love and W. Baer
Hardcover: $130.00Prime
Table of Contents : ... Global Strategies 167 Paulo Roberto de Almeida Part Four The Impact ...See a random page in this book.

2006
by Rubens Antonio Almeida Paulo Roberto De^Barbosa
Currently unavailable

Oct 1, 2008
by Andrew Fenton Cooper and Agata Antkiewicz

Table of Contents : ... Denise Gregory and Paulo Roberto de Almeida 137 7 South Africa ...See a random page in this book.



A era de "depressao" permanente, ou da Grande Estagnacao? - Robert Romano

Será?
Vamos ver...
Paulo Roberto de Almeida

Is the era of economic growth ending?
By Robert Romano
Americans for Limited Government, February 9, 2016

The economy of Japan has not grown nominally in 20 years, according to data published by the Statistics Bureau of Japan.

Nor has its population aged 15 to 64 —those in the prime working years of their lives — which has declined from 86.9 million in 1995 to 76.7 million today.

Inflation has barely budged, too, averaging just 1.1 percent a year the past 20 years, even with a torrent of monetary expansion by the Bank of Japan.

Interest rates have also declined on a long-term basis, from an average of 3.4 percent in 1995 to just 0.04 percent today. Those may even go negative in the near future, chief bond strategist at Tokai Tokyo Securities Co., Kazuhiko Sano, predicts. Sano accurately called the rate dropping below 0.5 percent, 0.25 percent and 0.1 percent.

Just imagine that. For the privilege of lending money to the Japanese government, it costs banks and investors money. The only way it might pay to buy the bonds is in an outright deflationary environment, prices declined even faster than the interest rates. But even then, keeping cash would seem to be a better deal.

It all coincides with the Bank of Japan charging banks for excess reserves with a negative interest rate.

Is the Bank of Japan forecasting deflation in Japan? Certainly wouldn't be the first time.

But in a broader context, do the rapidly falling interest rates project a no-growth, or slow-growth environment?

Certainly something to question over here in the U.S., where the economy has not grown above 4 percent since 2000, and not above 3 percent since 2005, according to the Bureau of Economic Analysis. As for 2015, it came in at a tepid 2.4 percent growth.

The average annual growth from 2006 to 2015 was 1.41 percent, the worst decade since the Great Depression.

U.S. 10-year treasuries stand at just 1.75 percent.

The consumer price index only increased 0.7 percent in 2015.

The working age population in the U.S. has certainly been slowing, and will be growing at an even slower pace for the next few decades.

The labor force participation rate for 16- to 64-year-olds has not been faring much better, according to data compiled by the Bureau of Labor Statistics. It peaked in 1997 at 77.37 percent and has dropped to 72.61 percent in 2015, accounting for 9.7 million people who otherwise might have been in the labor force since then but are not.

Note that excludes those of retirement age, correcting for drops in labor participation associated with Baby Boomers retiring. Yes, that has reduced the participation rate some, but so has the working age population exodus from the work force too.

What emerges is a spiral of slower growth, less asset price appreciation, lower interest rates and fewer jobs.

What's to like?

But worse still, could this point to a longer trend where the global economy itself is slowing down until, one day, it stops growing all together?

Is the era of growth ending? Never mind the degrowth movement.

Perhaps Japan and Europe, too, which is in a similar stagnation, are just windows into the future.

What is most alarming, however, may be the declines the U.S. is seeing in labor participation. Slower growth might be seen as a benign indicator if it still proportionately produced the same number of jobs.

But it is not, with the 16- to 64-year-old labor participation rate dropping to levels not seen since 1981 when women were still entering the work force. Slower growth has been toxic.

All this, after the U.S. has invested hundreds of billions of dollars in college educations with students with tens of thousands of dollars of debt predicated on the idea that there would be enough jobs for everyone. Well, there aren't, every year it keeps getting worse and we need to start asking ourselves why.

Robert Romano is the senior editor of Americans for Limited Government.

A Parceria Trans-Pacifica: uma analise do Congressional Research Service (2016)


The Trans-Pacific Partnership: Strategic Implications

Brock R. Williams, Coordinator, Analyst in International Trade and Finance
Ben Dolven, Coordinator, Specialist in Asian Affairs
Ian F. Fergusson, Specialist in International Trade and Finance
Mark E. Manyin, Specialist in Asian Affairs
Michael F. Martin, Specialist in Asian Affairs
Wayne M. Morrison, Specialist in Asian Trade and Finance

Congressional Research Service
February 3, 2016
7-5700
R44361


Summary
On October 5, 2015, Ministers of the 12 Trans Pacific Partnership (TPP) countries announced conclusion of their free trade agreement (FTA) negotiations.
The agreement is one of the Obama Administration’s signature trade policy initiatives, an effort to reduce and eliminate trade and investment barriers and establish new rules and disciplines to govern trade and investment among the 12 countries.
TPP proponents, including Administration officials, argue that the proposed TPP would have substantial strategic benefits for the United States in addition to its direct economic impact.
They argue that the agreement would enhance overall U.S. influence in the economically dynamic Asia-Pacific region and advance U.S. leadership in setting and modernizing the rules of commerce in the region and potentially in the multilateral trading system under the World Trade Organization (WTO).
Congress plays a key role in the TPP. Through U.S. trade negotiating objectives established in Trade Promotion Authority (TPA) legislation and informal consultations and oversight, Congress has guided the Administration’s negotiations.
Ultimately, Congress would need to pass implementing legislation if the concluded agreement is to take effect in the United States.
The geo-political arguments surrounding TPP are widely debated, as are the arguments about its potential economic impact. To some, the TPP is an important |litmus test of U.S. credibility in the Asia-Pacific region.
As the leading economic component of the Administration’s “strategic rebalancing” to the region, the TPP, proponents argue, would allow the United States to reaffirm existing alliances, expand U.S. soft power, spur countries to adopt a more U.S.-friendly foreign policy outlook, and enhance broader diplomatic and security relations.
Many Asian policymakers – correctly or not – could interpret a failure of TPP in the United States as a symbol of the United States’ declining interest in the region and inability to assert leadership.
Some critics argue that TPP backers often do not identify specific, concrete ways that a successful deal would invigorate U.S. security partnerships in the region, and that an agreement should be considered solely for its economic impact.
They maintain that past trade pacts have had a limited impact on broad foreign policy dynamics and that U.S. bilateral relations are based on each country’s broader national interests.
The Administration is also pursuing strategic economic goals in the TPP. Through the agreement, proponents argue, the United States can play a leading role in “writing the rules” for commerce with key trading partners, addressing gaps in current multilateral trade rules, and setting a precedent for future regional and bilateral FTA negotiations or multilateral trade talks at the World Trade Organization (WTO).
The core of this argument is the assertion that the TPP’s potential components – including tariff and non-tariff liberalization, strong intellectual property rights and investment protections, and labor and environmental provisions – would build upon the U.S.- led economic system that has expanded world trade and investment enormously
since the end of World War II.
Although most U.S. observers agree it is in the U.S. interest to lead in establishing global and regional trade rules, less consensus exists on what those rules should be, yielding some criticism on the strength and breadth of various TPP provisions.
In addition, some argue that crafting new rules through “mega-regional” agreements rather than the WTO could undermine the multilateral trading system, create competing trading blocs, lead to trade diversion, and marginalize the countries not participating in regional initiatives. China is not a TPP member, but features prominently in discussion of the agreement’s potential strategic effects.
Some argue that China is attempting to create a regional order that seeks to minimize U.S. presence and power. In this line of reasoning, the TPP serves as a counter to growing Chinese economic and political influence, implying that failure to conclude TPP could, in effect, allow China to shape regional rules of commerce and diplomacy through its own trade and investment initiatives.
Others, however, argue that TPP is complementary to other FTAs and trade agreements throughout the region, including those championed by China, and that new members –possibly including China –will be critical for the TPP to influence regional norms.
Trade agreements occur at the intersection of foreign and domestic policy, which can create tensions in balancing competing policy priorities. Key issues Congress faces as it continues its role regarding TPP include: (1) how strongly to weigh geo-political implications of TPP; (2) the potential impact of the TPP on the multilateral trading system and other trade and economic institutions; and (3) the possible expansion of the agreement to include additional members.

Energias verdes na America do Sul - Joana Castro Pereira (Lusiada)

Um artigo extremamente bem informado, descritivo, analítico, interpretativo, que recomendo sem hesitação:

Green Energy Integration in South America: a winding path
Joana Castro Pereira, Professora Auxiliar da Universidade Lusíada do Norte (Porto)
 in: Lusíada. Política Internacional e Segurança, n.º 12 (2015)
Neste link: 
http://revistas.lis.ulusiada.pt/index.php/lpis/article/viewFile/2265/2389


Abstract:
Economic and social development is inseparable from energy, therefore, since the second half of the twentieth century, some of the major South-American regional actors have been seeking to implement and strengthen projects regarding energy production and energy integration. Thus, energy is a common interest in the region. Furthermore, South America reveals a significant potential to move towards a low carbon economy and Brazil, as an important green pole in the region and the central figure in the process of energy integration, seemed to be in the position to foster cooperation around green energy integration. However, there are a number of challenges to the achievement of such an ambitious goal, especially those associated with the Pacific Alliance, which has been increasing Mexico’s influence over South America, and the Brazilian political, economic and social situations’ deterioration from 2013 until today.
Key-words: South-America; Brazil; regional integration; energy; low carbon economy; Pacific Alliance

Resumo:
O desenvolvimento económico e social é indissociável da questão energética, de modo que, desde a segunda metade do século XX, alguns dos principais atores regionais sul-americanos têm vindo a procurar implementar e fortalecer projetos no âmbito da produção e integração energéticas. A energia é, portanto, um interesse comum entre os países sul-americanos. Ademais, a região revela um potencial significativo para avançar rumo a uma economia de baixo carbono e o Brasil, enquanto importante polo verde na região e principal ator do processo de integração energética, poderia promover a cooperação em torno da integração regional verde. No entanto, existem vários obstáculos à concretização de um objetivo tão ambicioso, sobretudo os que se encontram relacionados com a criação da Aliança do Pacífico, que tem vindo a aumentar a influência do México na América do Sul, e a deterioração da situação política, económica e social brasileira desde 2013.
Palavras-chave: América do Sul; Brasil; integração regional; energia; economia de baixo carbono; Aliança do Pacífico

segunda-feira, 8 de fevereiro de 2016

Chilcote's book: interesting but too costly, even used...

Intellectuals and the Search for National Identity: Chilcote, Ronald H.
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Chilcote, Ronald H.
Published by Cambridge University Press
ISBN 10: 1107071623 ISBN 13: 9781107071629
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O Real vai continuar caindo, diz o Financial Times

Brazil's real: how low can it go?
Joe Leahy and John Paul Rathbone
Financial Times, February 8, 2016

Currency has further to fall given the state of the economy, analysts say
When Dilma Rousseff attended the 2016 opening session of Brazil's congress this week, she appealed to lawmakers to approve tax increases to tackle a widening gap in the country's public finances.
Most critically, the president called for the reintroduction of a tax on financial transactions, known as the CPMF, that was abandoned in 2007 after objections from business. Opposition congressmen booed her.
But with Brazil reporting a budget deficit last year that was the biggest among emerging economies except for Saudi Arabia at over 10 per cent, unpopular measures are needed to save the country from a deepening fiscal hole, analysts say.
Indeed, some economists argue that given Brazil's growing political and budget crises, its currency, the real, should be trading at closer to R$5 against the dollar than today's level of around R$4. Only intervention by the central bank with its large reserves and Brazil's high interest rates are keeping hedge funds at bay, they say.
"Most of us think that if it were just based on fundamentals, the real should be closer to R$5 to the dollar not R$4," said a senior banker with a foreign institution in São Paulo.
Ms Rousseff made a rare appearance in congress because she will need all the support she can get in 2016. Not only is the economy heading into its worst recession in more than a century but lawmakers will resume an impeachment process against her after the annual carnival festivities end next week.
A central bank survey of economists shows most predicting gross domestic product will contract by more than 3 per cent this year, compounding what is expected to have been a more than 3 per cent fall in 2015. They are also forecasting inflation of 7.3 per cent, above the central bank's target range of 4.5 per cent plus or minus 2 percentage points and carrying on from last year's blowout rise in prices of 10.7 per cent.
The survey also shows economists predicting the real will end the year at R$4.35 to the dollar compared with about R$3.90 on Wednesday.
However, even though a rate of R$4.35 would be a record nominal low for the currency, it could have much further to fall, economists say. In spite of the much more negative economic situation today, Brazil's currency remains stronger against the dollar in real terms than when it last hit record lows in 2002. At that time, the currency was struck by pessimism over the election of a leftwing firebrand president, Luiz Inácio Lula da Silva, who later turned out to be more market-friendly than expected.
On a real effective exchange rate basis, the real today is trading at about 15-25 per cent below its historical average while in 2002 it fell as much as 50 per cent below its average. Indeed, the currency's "equilibrium" - the level at which it would represent fair value in real terms - would be R$5.45 if it were allowed to float without intervention, said Marcos Casarin, economist with Oxford Economics.
"This [R$5.45 to the dollar] is where the model says OK now your external adjustment is done and now this rate will ensure you have some capacity for your export industry to be competitive in external markets," Mr Casarin said.
This fact has not been lost on hedge fund managers. Just before the Christmas break, Brazilian hedge fund, Verde Asset Management, led by Luis Stulhberger, known for his long history of market outperformance, said in a report it saw the currency as overvalued.
"The time will come to have much higher exposure in US dollars [versus the real]," Verde said. "We remain very attentive."
The obstacle facing hedge funds is the prospect of central bank intervention to defend the currency. Brazil has one of the largest foreign exchange reserves in the world at about $369bn. Betting against the real by going short is also expensive given Brazil's high interest rates, with the central bank's benchmark Selic rate at 14.25 per cent.
"I think it [the real] will be held back by central bank intervention and also by those fat interest rates they offer, which discourage shorting of the real," said Mr Casarin of Oxford Economics.
Another factor potentially helping the real is a collapse in trade, with imports contracting faster than exports in recent months. This has generated a positive trade balance - a factor that could curb depreciation of the Brazilian currency, Nomura said in a report.
However, most analysts say that even if the real can withstand Brazil's internal problems, it is extremely vulnerable to an external event, such as a significant devaluation of the renminbi. China is one of Brazil's most important trading partners. Such a shock could open the currency up for attack.
"There are a lot of mines along the way, external and internal, so the real, as much as it has moved down, probably hasn't seen its bottom yet," said Jorge Mariscal, emerging markets chief investment officer with UBS Wealth Management.

Zika virus: uma tragedia brasileira, e universal... - The New York Times

Matérias horripilantes na imprensa internacional para este Carnaval, que provavelmente vai ficar na história, como um equivalente brasileiro de pestes universais de tempos passados.
Nem a sociedade, nem as autoridades se deram ainda conta da extrema gravidade da situação.
Paulo Roberto de Almeida

Matérias do The New York Times, February 8, 2016

The Zika Virus and Brazilian Women's Right to Choose
Debora Diniz

Brazil is in a state of crisis. Since October, there have been more than 4,000 suspected cases of babies born with a neurological syndrome associated with the Zika virus. The Health Ministry has suggested that women avoid pregnancy until the epidemic has passed or more is known about it.
I am a Brazilian woman. My friends who are planning to have children soon are worried about Zika. But they don't need to be too concerned. In our well-to-do neighborhood in Brasília, the capital, there has not been a single case of a baby with the birth defects associated with the Zika epidemic. As far as I know, not one woman here has even been infected by the virus.
Lost in the panic about Zika is an important fact: The epidemic mirrors the social inequality of Brazilian society. It is concentrated among young, poor, black and brown women, a vast majority of them living in the country's least-developed regions. The women at greatest risk of contracting Zika live in places where the mosquito is part of their everyday lives, where mosquito-borne diseases like dengue andchikungunya were already endemic. They live in substandard, crowded housing in neighborhoods where stagnant water, the breeding ground for disease-carrying mosquitoes, is everywhere. These women can't avoid bites: They need to be outdoors from dawn until dusk to work, shop and take care of their children. And they are the same women who have the least access to sexual and reproductive health care.
The Zika epidemic has given Brazil a unique opportunity to look at inequality and reproductive rights, and to change how the country treats women. Asking women to avoid pregnancy without offering the necessary information, education, contraceptives or access to abortion is not a reasonable health policy. Sexual and reproductive rights for all women, poor and rich, must be taken seriously. The government should immediately offer a comprehensive package of sexual and reproductive health care to all Brazilian women, with a specific focus on those at most risk of Zika infection.
Brazil has some of the world's strictest abortion laws. The procedure is legal only in cases when the life of the woman is in danger of complications, or she was raped, or she is carrying an anencephalic fetus. Knowledge that a child will suffer from serious neurological problems is not grounds for legally terminating a pregnancy. That doesn't mean that abortion is uncommon, though.
In 2010, I conducted a national survey that found that by age 40, one in five Brazilian women had had at least one abortion. The overwhelming majority of these abortions were illegal and performed in unsafe conditions. According to Brazilian law, more than five million women should have spent time in prison. They would have amounted to almost 10 times our current prison population, which is the fourth largest in the world. In abortion, too, Brazil's economic inequality is a factor: Wealthy women can pay to secure safe abortions; most women can't.
The poor women who are most likely to contract Zika face tremendous barriers to getting safe abortions. They are forced to carry their pregnancies in fear. Public health clinics in poor communities rarely offer either the blood test that detects the presence of the virus or the ultrasound that can diagnose birth defects. We in Brazil need to know their stories to repair the harm inflicted by the government's negligence in controlling the outbreak.
Low-paid women and domestic workers are the true face of the Zika virus. In Brazil, it is usually women who are responsible for family planning and child care. They will also be the caregivers of disabled, dependent children. Some news reports have included accounts of women being abandoned by their partners after the birth of a baby with neurological problems. The state shouldn't abandon them, too. It needs to provide financial support and social services for the poor women and their children who are suffering from the effects of Zika.
The Health Ministry must help Brazil's women. In the short term, the government needs to control the mosquitoes by destroying their habitat and working with the international community to advance knowledge about how to stop the disease. But that's only a start. Women need to be given the power to manage their own pregnancies.
While family planning is a constitutional right, many women have trouble getting contraceptives because of poverty or inconvenience. This must change. And sexual and reproductive education must be a topic in Brazil's public schools.
The government must finally give women basic control over their reproductive lives - accessible and affordable contraception, and safe and legal abortion. The organization I founded, Anis - Institute of Bioethics, is preparing to present a case to the Supreme Court with these demands. Ever since we announced our plans, I have been receiving phone calls from women from all over the country; some have seen their childbearing dreams turned into nightmares because of the Zika virus. Others worry about how they will get health care for their disabled children. Many wonder how many more will have to suffer or die before abortion is a right.

Brazil Finds Zika Virus in Human Urine and Saliva, but Risk Is Unclear
Vinod Sreeharsha & Simon Romero

Scientists Find Zika in Saliva and Urine
A Brazilian health institute found traces of the Zika virus in certain bodily fluids of two patients, but said more research is needed to determine if the infection can be transmitted through the fluids.
Brazilian scientists said Friday that they had detected the presence of the Zika virus in samples of human saliva and urine, a first for Brazil.
The Brazilian researchers warned that the virus might have the potential to spread through kissing or urine, but they were quick to point out that this still remains to be proved. Nonetheless, the announcement amplified concern in Brazil with many people pointing out the possible impact to the annual Carnival celebration, which began on Friday.
"It is something we have to further investigate," said Dr. Myrna Bonaldo, the head of the Flavivirus Molecular Biology Laboratory at Fiocruz, a prominent research institute here. "We are not yet sure if Zika can be transmitted to others" through saliva or urine, she said.
The findings point to the frenetic efforts by researchers in Brazil and other countries to determine the risks posed by the mosquito-borne Zika virus as it spreads through more than two dozen countries in the Americas.
Brazilian doctors have already linked Zika to an increase in babies born with abnormally small heads, a condition known asmicrocephaly, though research teams are still trying to prove this connection.
French scientists had already published research last year in the Journal of Clinical Virology that located the Zika virus in human saliva following an outbreak of the virus in 2013 and 2014 in French Polynesia.
The Brazilian researchers at Fiocruz said that their studies had detected the virus in an active form in human saliva and urine samples.
Dr. Bonaldo and officials at the institute said that they had obtained the samples from two patients with Zika-like symptoms; one was found to have the virus in urine, the other had Zika in the saliva sample. It remained unclear whether the tiny sample size was enough to produce solid conclusions.
"The significance of the results is unclear," said Dr. Peter J. Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. "We know, for example, that dengue is only transmitted via Aedes mosquito bites, and yet we can find the dengue genome in urine and saliva. So more research would need to be done to determine if Zika can be transmitted via kissing."
"For now," Dr. Hotez added, "it still seems highly likely that the overwhelming number of cases of Zika are transmitted through mosquito bites."
The announcement at Fiocruz on Friday morning quickly spread on social media, sowing confusion among some in Brazil.
"I'm trying to remain calm, but this is really some troubling news," said Kalina de Andrade, 28, a cashier at a store in the seaside Botafogo neighborhood of Rio.
Ms. de Andrade, who is five months pregnant, said that it had become increasingly difficult to discern all the risks associated with Zika ever since the federal authorities declared an emergency after the outbreak of the virus several weeks ago.
"The government needs to get better at explaining to the population what this means," she said, emphasizing that annual Carnival celebrations officially got underway here on Friday. "With Carnival starting, people are going to be having sexual relations and exchanging saliva," she said. "That means the virus could spread even more."
The researchers at Fiocruz said that they had conducted tests to rule out the presence of dengue and chikungunya, viruses that are part of the same family and transmitted by the same mosquito, Aedes aegypti.
A potential upside to Friday's revelation could involve developing urine tests as a diagnostic tool to determine when patients in Brazil have Zika. Brazil still lacks widespread availability to tests for Zika, a virus that shows no symptoms in most of the people who get it.

How a Medical Mystery in Brazil Led Doctors to Zika
Donald G. Mcneil Jr., Simon Romero and Sabrina Tavernise

A sudden, sharp increase in babies with "no foreheads and very strange heads" was baffling doctors in Brazil. That set off a search for answers that led to a little-known pathogen, the Zika virus.
Something strange was happening last August in the maternity wards of Recife, a seaside city perched onBrazil's easternmost tip, where the country juts into the Atlantic.
"Doctors, pediatricians, neurologists, they started finding this thing we never had seen," said Dr. Celina M. Turchi, an infectious diseases researcher at the Oswaldo Cruz Foundation, a prominent scientific institute in Brazil.
"Children with normal faces up to the eyebrows, and then you have no foreheads and very strange heads," she recalled, referring to the condition known as microcephaly. "The doctors were saying, 'Well, I saw four today,' and, 'Oh that's strange, because I saw two.'"
Aside from their alarming appearance, many of the babies seemed healthy.
"They cried," Dr. Turchi said. "They breast-fed well. They just didn't seem to be ill."
Doctors were stumped.
They did not know it then, but they were seeing the first swell of a horrifying wave. A little-known pathogen - the Zika virus, carried by mosquitoes - had been circulating in Brazil for at least a year. It would later become the chief suspect in the hunt to work out what had happened to those newborns.
Since then, those tiny babies have led the World Health Organization to declare a public health emergency. They have prompted warnings to pregnant women to avoid countries where the virus is circulating, even to refrain from unprotected sex with men who have visited those countries, following a report of sexual transmission of the virus in Dallas last week.
They have led health ministers of five countries to say something so unthinkable that none had ever uttered it before: Women, please delay having children.
The virus now threatens the economies of fragile nations and the 2016 Summer Olympics in Rio de Janeiro. It has opened a new front in the debate in heavily Roman Catholic countries about a woman's right tobirth control and abortion.
And the children stricken with microcephaly, or abnormally small heads, have doctors everywhere asking: What is this virus? How could it have been around for almost 70 years without us realizing its power? What do we tell our patients about a bug that can hide in a mosquito's proboscis and a man's semen, even in human saliva or urine? What do we tell young women who ask if their unborn babies are safe?
 "This epidemic is an unfolding story," said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. "As with Ebola, this virus is something that could exist for years under the radar, and we don't know until we get thousands of cases what it really does."
"With Zika, we're seeing new twists and turns every week."
To doctors in Recife, whatever was striking the babies seemed to have fallen like a bolt from the blue.
In reality, it had been building for months. It had even been frequently discussed among clinicians - but no one had realized what was on the horizon.

Seeing the Same Symptoms
A year earlier, doctors say, the first patients had started trickling into public hospitals in Natal, capital of the state of Rio Grande do Norte, about 200 miles up the coast from Recife.
It was a few weeks after the 2014 World Cup, and Natal had been one of the host cities of the soccer championship, which draws fans from all over the world.
Many patients lived on the city's margins, others in settlements dotted across the sertão, northeast Brazil's arid hinterland.
Almost all had the same symptoms: a flat pinkish rash, bloodshot eyes,fever, joint pain and headaches. None were desperately ill, but the similarities were striking.
"That scared some patients and doctors, and my team," said Aline Bezerra, a nurse and the municipal epidemiologist. "We knew nothing other than that it might be some kind of light dengue."
Tests ruled that out, along with other common viruses, but the patients kept coming. One day in January 2015, 100 showed up at the state's hospitals.
"We alerted the federal authorities that we were dealing with something urgent and new," said Dr. Kleber Luz, an infectious diseases specialist at the Federal University of Rio Grande do Norte. "But their reaction was sluggish."
By last March, the spread of a "doença misteriosa" - the mystery disease - had become impossible to ignore. It appeared in two more states nearby. Then it reached Salvador, a city of 2.5 million.
Doctors speculated that it was an allergy; that it was roseola, a childhood illness; that it was a new variant of Fifth Disease, a facial rash that gives children a "slapped-cheek" look.
"People were claiming it was polluted water," said Dr. Gúbio Soares, a virologist at the Federal University of Bahia in Salvador. "I began thinking it was something transmitted by mosquitoes."
Working in his modest lab with a colleague, Dr. Silvia Sardi, Dr. Soares kept testing blood samples.
Other doctors were doing the same. Over 6,800 samples were tested, according to news reports, from victims ranging from 4 months to 98 years old. Parvovirus, dengue, chikungunya and other suspects were all ruled out.
Finally, in April, Dr. Soares and Dr. Sardi were sure: It was Zika.
"I actually felt a sense of relief," Dr. Soares said. "The literature said it was much less aggressive than viruses we already deal with in Brazil."
In the capital, Brasília, the health minister at the time, Dr. Arthur Chioro, felt the same way.
"Zika virus doesn't worry us," he told reporters in May, after the Oswaldo Cruz Foundation had confirmed Dr. Soares's findings. "It's a benign disease." Dengue hemorrhagic fever, on the other hand, killed hundreds of Brazilians each year.
But on ProMED Mail, an online service run by the International Society for Infectious Diseases, the reaction was not so sanguine.
"The arrival of Zika virus in Brazil is not good news," wrote Thomas M. Yuill, an emeritus professor of veterinary science and wildlife ecology at the University of Wisconsin-Madison.
Not only did Brazil have "abundant mosquitoes and a large population of susceptible people," he wrote, but so did much of the Americas.
Two weeks earlier, an American mosquito disease expert working in Rio de Janeiro had scoffed on ProMED about an unconfirmed report that it was Zika. The virus fit the symptoms, he wrote, but it was circulating only in Africa and Asia, and in the South Pacific, half a world away, in a different ocean.
He was right about where the virus had been, but not about where it was now.

An Island-Hopping Virus
For years, virus hunters on ProMED and other outbreak alert networks had been watching, fascinated, as Zika made long, slow and erratic progress eastward across the Pacific, island-hopping as American forces had done during World War II, albeit in reverse.
In 2007, it hit Yap Island, in Micronesia, east of the Philippines and north of Australia. It could have come to Yap from anywhere in Asia.
In October 2013, the Zika virus raced through the many islands of French Polynesia, including Tahiti and Bora Bora. In early 2014, it bounced to the Cook Islands, just to the west, and New Caledonia, close to Australia.
It also leapt to Easter Island, home of the giant stone heads, its official arrival in the Western Hemisphere.
It is still island-hopping. American Samoa and Tonga are having outbreaks now.
Scott C. Weaver, a virologist at the University of Texas Medical Branch in Galveston, wrote an article in 2009 warning that Zika was approaching the Americas. The virus was so obscure that, trying to be helpful in an interview, he explained: "Its closest relative is Spondweni" - a virus named for a place in South Africa that is no longer even on maps.
The Zika Forest in Uganda still is; the virus was discovered there in a monkey in 1947. Since then, the Zika virus had been considered mild compared to its killer cousins: yellow fever, dengue, West Nile and Japanese encephalitis. Until 2013, there was no evidence Zika had ever hospitalized anyone.

Tracking Its Path to Brazil
Back in Brazil, on May 14, it was definite. The mysterious outbreaks - by then in cities all over Brazil, including Rio de Janeiro - had all been caused by Zika.
Who had brought the virus to Brazil? There are two theories.
The first, offered by Brazilian scientists who analyzed airline flight patterns, was that it arrived in the crowds of soccer fans who had flocked to the 12 host cities in the 2014 World Cup. If the Natal outbreak was truly the first, that theory has credence.
A second, proposed by French scientists connected to the Pasteur Institute in Paris who had investigated the outbreak in Polynesia, was that it arrived a few weeks later, during the Va'a World Sprint, a canoe race in Rio that attracted teams from several Polynesian islands.
Since the virus is believed to persist in the blood for up to 10 days, it presumably came from an island then having an outbreak. But in a world as interconnected as ours has become, it may be spread not by a foreigner from faraway lands, but by any international traveler.
The first case of Zika infection detected in New York City was found in December 2013 - six months before the virus is thought to have reached Brazil - in a 48-year-old traveler who lives near Central Park but has asked to remain unidentified.
When he walked into Traveler's Medical Service on Madison Avenue, he had just returned from a long trek through Ecuador, Peru, Bolivia, Chile, Easter Island and Hawaii, with a stopover in French Polynesia.
Dyan J. Summers, the nurse practitioner who first saw him, said he pulled his shirt out of his bluejeans and peeled it off, exposing a pinkish rash he said he had had for 11 days.
"I took one look and said, 'Dengue fever,'" she recalled in an interview last week. "He said, 'I'm not so sure. I think it's Zika.'"
Ms. Summers was startled: "I'd heard of Zika, but nobody was thinking about Zika."
"But this is a very, very bright guy," she continued. "He travels a lot, he knows about safe water and safe altitudes for malaria. He was right on the money, that guy. In Polynesia, he had read articles in the local paper about Zika."
She took blood immediately and again 20 days later, and sent both samples to the Centers for Disease Control and Prevention in Atlanta. Their tests showed that he had antibodies to dengue, West Nile and Zika, but the count of Zika antibodies had shot up.
In researching Zika, Ms. Summers said, her very bright patient had found an article about a scientist in Colorado who had infected his wife with the virus after returning from Africa.
"Because of that paper, I advised him not to have unprotected sex with his common-law wife," she said.
"What's weirder," she added. "He knew there were cases of Guillain-Barré connected to it."
Their exchange was strangely prescient.
At the time, Polynesian and French doctors were just beginning to diagnose Guillain-Barré syndrome, a form of temporary paralysis that starts in the hands and feet. Along with infant microcephaly, the syndrome has turned out to be one of the Zika epidemic's chief fears.
It is an autoimmune attack on nerve cells that can be triggered by several viruses or bacteria. It is usually temporary, though it can last for weeks; but if the paralysis reaches the muscles powering the lungs, and the patient is not quickly put on a respirator, it can kill.
Ms. Summers's caution was right: Last week, the Centers for Disease Control and Prevention gave similar advice about unprotected sex to all Americans.
Hints a Virus Isn't Benign
In May, after it was confirmed that Zika was circulating in Brazil, it took only a few weeks for doctors to suspect that Dr. Chioro, the health minister, had been mistaken. There were hints that the virus was anything but benign.
In Maceió, Recife and other cities, cases of Guillain-Barré began to spike. Dr. María Lúcia Brito, a neurologist in Recife, saw 50 patients with it in 2015, up from 14 the year before.
"It was obvious - a shift occurred when Zika cases started to rise," she said.
Then, in July, a pair of twins were born in Recife. One was healthy; the other was microcephalic. Their parents took them in early August to be examined by Dr. Vanessa van der Linden, a prominent neurologist.
She diagnosed the cause as an infection that had reached one baby in the womb, and tested mother and baby for rubella, syphilis andtoxoplasmosis, three known causes of microcephaly.
The results were negative, so she started testing for genetic mutations like Down syndrome.
In September, the Hospital Barão de Lucena, the public hospital in Recife where she works, saw a surge in cases: five microcephalic babies were suddenly in her care.
The same thing was happening elsewhere. The hospital where her mother was a pediatric neurologist suddenly had seven cases.
"That's when I thought, 'Something is terribly wrong,' " Dr. van der Linden said.
She soon learned that several of the mothers remembered having the "mystery disease" - the Zika rash - early in their pregnancies.
But tests of the infants for the Zika infection were all negative. Their mothers had been ill months earlier, and in adults the virus usually disappears in 10 days or less. It is still unclear how long it persists in a fetus.
In early October, the national health ministry asked Dr. Turchi, the Oswaldo Cruz Foundation epidemiologist, to investigate. She went to hospitals, including those in Recife. Doctors were running tests for various viruses, but they were all coming up blank.
"The pediatricians were saying, 'We've never seen anything like this,' " she said. "These kids are different. This is something new."

Young Mothers in Shock
Dr. Kátia Petribu, a hospital psychiatrist in Recife, remembers the mothers. They were ghosts - mute, expressionless figures in corridors holding babies whose foreheads seemed to have vanished.
Many of the mothers were young, one just 14. "They were in a state of shock," she said. "They were unable to talk."
Dr. Petribu had trouble sleeping. She could not get them out of her mind.
Normally, she worked with patients with obsessive-compulsive disorder. But she decided to refocus on these women, who so clearly needed help.
"They come with nothing," she said. "No food. They travel by bus for hours, arrive at 7 a.m., and wait for hours to be seen."
Many were young rural women with no understanding of why their children looked so different. A 16-year-old showed up with her own mother, who was worried about missing a perfect day to sell cold drinks on the beach.
Dr. Mauricio L. Nogueira, a doctor from southern Brazil who had seen no cases in his region, which is as far from the tropical north as Quebec is from Miami, remembers visiting a hospital in the northern city of Salvador. He is still haunted by what he saw: 25 microcephalic children, all born in the previous 10 days.
That was "really shocking for me," he said. "Until then, I was just reading reports."
One mother, he said, looked up at him and asked, "Hey, doctor, his head is going to grow, right?"
"It was really painful," he said.
Frustration was growing, too, for Dr. Turchi, the epidemiologist. "If we had known what was going on, that would have been one thing," she said. "But there was no book to follow. We had no map."
She shelved her work on the dengue virus and skipped Christmas with her mother.
"I couldn't sleep for several weeks," she said. "It was the most important thing I have seen in my entire career. It was a tragedy, but it was like we were seeing history in front of us, day by day. It was a Zika's connection to microcephaly was suspected but very difficult to confirm. Dr. Turchi set up a quick "case control" study, the epidemiologist's classic tool, comparing babies born with the condition and those without it.
Dr. David L. Heymann, chairman of the World Health Organization committee that recommended the declaration of the public health emergency, said in an interview last week that very tool - a case control study following two sets of pregnant women, some who had Zika and some who did not - was what his committee needed to prove whether Zika causes microcephaly, and whether it does so alone or requires a cofactor like a prior infection with dengue.
"Sorting out a rare event will take a lot of women," he said, and they must be followed for months.

At Last, 'a Road to Follow'
But Dr. Turchi did not have months.
She called every scientist she knew, and they came from all over Brazil. One flew in from London. Dr. Turchi gave the group a name: MERG, the Microcephaly Epidemic Research Group.
 "It was like a house on fire - everyone grabs a bucket and does what they can," she said. Some scientists stayed in her apartment, talking late into the night. "It's like when you like something and you have people who like the same thing, you can talk for hours without feeling tired," she said. "It's like discussing football. You never stop talking. It's an obsession."
A turning point came in early November: Dr. Adriana Melo in Paraíba State, just north of Recife, had drawn amniotic fluid from a pregnant woman and found Zika virus in it. Then brain tissue from two stillbirths was tested. Again, Zika.
"At last we had a road to follow," Dr. Turchi said. "A map."
One of those who flew in to help in the detective work was Dr. Laura C. Rodrigues, an epidemiologist at the London School of Hygiene and Tropical Medicine on contract to the Pan American Health Organization.
"It was the kind of call where you dropped everything," she said. "There had never been a congenital malformation by mosquito before, not ever. It was totally outside our experience."
With the discovery of Zika in malformed fetuses, Dr. Turchi's team has been able to turn to the kind of task Dr. Heymann described. They have recruited about 1,000 pregnant women with Zika symptoms, and are following healthy and microcephalic newborns in the same areas. They work nights and weekends, eating sandwiches from the institute's shop or meals of rice, beans and chicken provided by a research assistant's mother.
There are now so many reported cases of microcephaly that a new problem has arisen: too many false alarms.
Anxious obstetricians across Brazil have reported babies who merely have small heads, or babies whose mothers had other problems, like severe alcoholism or family histories of malformations, conditions that should have excluded them from the research.
Brazil has already changed its definition of a small head, to 32 centimeters around from 33 centimeters, and may revise it again soon.
Dr. Turchi defends those decisions, saying a broad net had to be cast at first because so little was known.
"We didn't want to get just the severe cases; we wanted to look at the broadest possible spectrum of the disease," she said. "Then we can narrow it later."

'Perfect Epidemic Curve'
Loosed on a continent where no one is immune, Zika has the potential to infect tens of millions of people. It is now being transmitted in 33 countries with about 600 million inhabitants, the W.H.O. says. Health officials in Brazil are investigating thousands of reported cases of microcephaly that may be linked to the virus.
Now a bright spot has appeared.
In Recife, and Pernambuco State around it, microcephaly cases have been declining for about three weeks. It is unclear exactly why, but researchers are starting to wonder if the epidemic has peaked.
"It looks like a perfect epidemic curve," Dr. Turchi said. "You see where it started, then went up, and now it's going down."
But that decline, and the general sigh of relief it portends, is occurring only in the one spot in the hemisphere where transmission of the virus hit earliest and was most intense.
Zika was just getting started there a year before the microcephaly cases began. And now the virus is virtually everywhere south of Florida and Texas.
And Guillain-Barré, the harbinger of microcephaly, is being spotted farther from the epidemic's epicenter in Brazil.
Colombia, Venezuela, Suriname and El Salvador, where mosquitoes thrive year-round, all have reported Guillain-Barré cases. Colombia has "an explosion" of them, its health minister said, with three deaths.
There have also been dozens of confirmed Zika rashes and fevers in the United States, all so far in returning travelers, except for the person infected through sex in Texas by a traveler returning from Venezuela.
Air travel maps show the United States' potential to be a kind of viral pincushion; Zika may arrive from anywhere. Since four out of five victims never have any symptoms, there is no way to spot it at the border.
The C.D.C. thinks it is all but inevitable that there will be at least small outbreaks here. But how far they spread will depend on how aggressively mosquitoes are killed.
Now that the world is alert to the danger and is fighting back, and women are even contemplating delaying pregnancies, scientists say it is unlikely that Brazil's national nightmare will be repeated elsewhere on such a scale.
In Recife, Dr. Turchi was hopeful.
"I'm more comfortable now," she said. "I see so many people working as a team and so much international concern. Now it has become clear to the whole world."

The Wall Street Journal, February 8, 2016

Brazil Health Researchers Say Zika Virus Is Active in Saliva, UrinePaul Kiernan, Reed Johnson and Rogerio Jelmayer
Pregnant women advised to take precautions to avoid coming in contact with others' saliva; other researchers suggest such fears are overblown
As many as 1.5 million Brazilians may be infected by the mosquito-borne Zika virus. With Brazil at the forefront of the latest global health scare, and as the host of this year's Olympic Games, Dipti Kapadia explains three things Brazil is doing to combat the Zika virus. Photo: Getty Images
Brazilian health researchers said Friday the Zika virus is active in saliva and urine, sparking fears about possible new infection routes on the eve of the nation's sexually charged Carnival festivities.
Brazil's leading medical-research institute, the Rio-based Oswaldo Cruz Foundation, said researchers' tests showed that the "entire genetic sequence" of the virus was present and "replicating" in samples of saliva and urine that it examined.
Officials of the foundation, known as Fiocruz, recommended that pregnant women take precautions by staying away from large crowds and avoiding sharing cups and utensils with people who show symptoms of the virus.
Artur Timerman, president of Brazil's Society of Dengue and Arbovirus, criticized the institute for publicizing its findings at a news conference rather than through the time-consuming but professionally sanctioned route of peer-reviewed scientific journals.
"The irresponsible thing that has happened is that Fiocruz has released this through the press," Dr. Timerman said. "This is creating a panic, a fear, that in my view is disproportional."
Fiocruz officials said it hasn't yet been determined whether Zika can be transmitted through those fluids. Brazil's Health Ministry, which oversees the institute, said in a separate statement Friday that additional research would be needed to do so.
"The fact that you've got an active virus in saliva and urine isn't proof that transmission can occur. But there may be a possibility of infection of other people through those fluids," said Paulo Gadelha,Fiocruz's president.
Coming on the eve of Brazil's wild Carnival festivities, the announcement prompted a flurry of comments from hundreds of viewers watching the news conference live on a social-media platform. One of the biggest street parties in the world, Brazil's alcohol-fueled Carnival parades often involve revelers kissing total strangers. Public urination is also rampant.
"Carnival is over, guys," one viewer lamented.
The virus, which is thought to be transmitted mainly by mosquito bites, usually produces mild symptoms, if any. But it has become a major international concern since Brazilian authorities linked it to complications, including a rare birth defect called microcephaly in which babies are born with dangerously small skulls and underdeveloped brains. Earlier this week, the World Health Organization declared possible complications from Zika a global health emergency.
Speaking at a separate news conference on Friday, Tom Frieden, director of the Atlanta-based Centers for Disease Control and Prevention, said there was little data on the likelihood of Zika virus transmission through saliva or urine, and only three confirmed cases of transmission through sexual contact. "There are unknowns," Frieden said. "We're still learning more about how it works in the body."
When asked if the CDC concurred with Fiocruz's advisory, Frieden said the CDC is still gathering the data and would provide information when it becomes available so women can decide what is safe. "We have not issued guidance" on kissing, Frieden said.
Fiocruz's latest findings come on the back of a wave of recent evidence that mosquitoes aren't the Zika virus's only vector for spreading. Brazilian health officials in the city of Campinas this week reported two cases of Zika being transmitted through blood transfusions. The CDC said Wednesday that a person in Texas contracted the virus through sexual contact with a partner who had recently traveled to an area where Zika was circulating. On Friday it urged pregnant women to avoid unprotected sex with male partners who have traveled to such areas.
Much Zika research to date has been based on the assumption that the virus was transmitted primarily, or even exclusively, through mosquito bites, according to Joseph Conlon, technical adviser for the U.S.-based nonprofit American Mosquito Control Association. Friday's announcement could change that, he said.
"If it can be transmitted by any bodily fluid, that complicates matters considerably," Mr. Conlon said. "We're going to have to look beyond the mosquitoes and we're going to have to do a lot of case management."
Uncertainty has driven much of the Zika panic worldwide. Discovered in a monkey in Uganda's Zika Forest in 1947, the virus traveled through parts of Africa, Asia and the Pacific Islands before reaching Brazil a couple of years ago, researchers say. Symptoms don't appear in as many as four out of every five cases; when they do, they tend to be far milder than those of other mosquito-borne pathogens like dengue fever.
But that has made it hard for health officials to determine how prevalent the disease is and what, if any, relation it has to microcephaly.
Given the uncertainty, Fiocruz's recommendations to pregnant women were premature, said Marcio Fernandes, an epidemiologist at both the Federal University of Rio de Janeiro and the Rio state health authority.
"We shouldn't lose focus on combatting the main transmission pathway, which is the mosquito," Mr. Fernandes said. "Even the HIV virus has been isolated in saliva, but the quantity is so small that it isn't able to be transmitted through saliva."

Reuters, February 8, 2016

Doctors puzzle over severity of defects in some Brazilian babiesBill Berkrot & Anthony Boadle

Experts on microcephaly, the birth defect that has sparked alarm in the current Zika virus outbreak, say they are struck by the severity of a small number of cases they have reviewed from Brazil.
Consultations among doctors in Brazil and the United States have increased in the last two weeks, and some of the leading authorities on the condition are finding patterns of unusual devastation in scans of the newborns' malformed brains.
While it's not known how representative the scans are, the early observations of these doctors point to a tough road ahead for the babies, their families and their communities and heighten the concern surrounding Zika, which is suspected of causing microcephaly.
"We are in the process of very rapid information gathering on what has been seen," said Dr. William Dobyns, a geneticist at Seattle Children's Hospital. "The condition that I've been able to review, very preliminarily, is more severe than simple microcephaly."
The Zika virus is transmitted by mosquito, causing mild symptoms in about 20 percent of cases, and most people experience no illness at all. But a spike in reported microcephaly cases among babies in areas of Brazil with Zika outbreaks has triggered an international effort to determine whether the virus causes the condition. The suspected association moved the World Health Organization (WHO) on Monday to declare an international health emergency.
Dobyns has spent 30 years researching and treating microcephaly, a condition defined by abnormally small heads in newborns that can lead to developmental disabilities, from mild to severe. The U.S. Centers for Disease Control and Prevention (CDC) has sought out his expertise in understanding the unfolding epidemic.
With a small group of geneticists and other microcephaly specialists, he recently reviewed scans of a handful of babies sent by a colleague in Brazil. All the experts were struck by the scale of malformations, he said.
"These children have a very severe form of microcephaly," Dobyns said. "The brain is not just small, it's small with malformations of the cerebral cortex and calcifications. It has the appearance of a very severe, destructive injury to the brain."
Particularly alarming, Dobyns said, is the presence in the Brazilian cases of excess spinal fluid between the brain and skull of the babies.
"If the brain is growing and then suddenly shrinks, then you'll see fluid between the brain and skull," he said. "It has a pattern that suggests that the brain has actually decreased in size."
Dr. Leonardo Vedolin, a neuroradiologist and researcher at the Moinhos de Vento hospital in Porto Alegre, Brazil, shared with Dobyns scans of two more microcephalic babies this week. The doctors belong to a brain defects study group that convenes via videoconference each month. The group is now focused on Zika.
Neither Vedolin nor Brazil's Health Ministry were able to provide a breakdown on the severity of confirmed microcephaly cases. In general, Vedolin said, 5 percent of microcephaly cases are severe. But the proportion appears greater among the cases in Brazil, he said.

THE CASELOAD
Public health officials in Brazil are investigating more than 4,000 cases of suspected microcephaly, and have confirmed more than 400. Prior to the Zika outbreak, Brazil saw on average 163 cases annually of microcephaly over the past five years, according to WHO. In 17 of the new cases, the presence of Zika was identified in the mother or the baby.
A study of 35 Brazilian babies born with microcephaly during the Zika outbreak reported by the CDC Jan. 29 added strength to the suspected connection.
The mothers of all 35 infants had lived in or visited Zika virus-affected areas during pregnancy, the report said. Twenty-five infants had severe microcephaly, and 17 had at least one neurologic abnormality.
Dr. Frank Esper, an infectious disease expert from Rainbow Babies & Children's Hospital in Cleveland, said he expects a steady wave of studies on Zika and microcephaly that will provide a much clearer picture over the first half of 2016.
By the broadest definition, about 2.3 percent of all babies are microcephalic, Dobyns said. Some cases are so mild they involve no complications at all.
About one tenth of one percent of the cases are so severe that lifelong care is required, he said. There are many known causes, including a wide range of genetic disorders such as Down syndrome, as well as oxygen deprivation to the fetus, cytomegalovirus and severe fetal alcohol syndrome.
Lifespan in severe cases can be months or as long as 10 years, depending on proximity to good medical care, Dobyns said.
Dr. Dawn Nolt, a member of the American Association of Pediatrics' (AAP) Committee on Infectious Diseases, and other doctors, said more severely affected children often require treatment for epileptic seizures, as well as physical, respiratory and speech therapy. They may need help with everyday activities, such as eating or walking.
"It's crucial to go to a care center with good neurology and genetics teams that can evaluate the child comprehensively," said Dr. Ghayda Mirzaa, a pediatric neurologist and colleague of Dobyns at Seattle Children's.
Doctors in Recife, Brazil are sending mothers with afflicted babies for therapy to help stimulate eyesight, hearing and motor skills to minimize retardation in mental and physical development.
There are a handful of centers of microcephaly research and treatment in the U.S., including Dobyns' hospital in Seattle. The consultations of physicians like Dobyns in the Brazil cases is informal at this point but could form the basis for an organized exchange of expertise that will inform the ongoing care of the children of the epidemic.
"We need to get the message out that this is real, and coming, without getting everybody to panic," Dobyns said. "There will be a steep curve of new information coming in."

O Carnaval do Zika campeao: vai se espalhar pelo mundo - WashPost

In Zika-stricken Brazil, a Carnival of flesh and feasting - for the mosquitoes
Nick Miroff  & Dom Phillips
The Washington Post, February 8, 2016

For the next few nights, Tuane Rocha, a tall, radiant samba queen, will be dancing naked in the streets of this city, wearing only body paint.
Mind you, she will take precautions. "First I'm going to put on a layer of repellent," she said. "Then makeup. Then the paint."
Rocha dances fast - really fast. She figures she can keep the mosquitoes at bay if she keeps moving.
Because nothing stops Carnival in this country. Not the government, nor a lousy economy, nor the Zika pandemic.
Millions of Brazilians will be in the streets this coming week for one of the world's biggest bacchanals, a dancing and drinking binge that draws revelers from all over the world. No doubt some of them will go home with Zika and spread it even more. Huge crowds at Carnival celebrations across the Americas will give the virus new opportunities to propagate - by mosquito but also potentially through sexual contact.

The arrival of Carnival points to one of the inherent challenges in fighting the Zika outbreak. The World Health Organization has declared the outbreak a "global emergency." But it doesn't quite feel like one. At least not here, despite the terrifying possibility that it is bringing into the world a wave of babies born with small heads.
Pregnant women and their families are petrified. But unlike Ebola, cholera or AIDS at its advent, the Zika virus doesn't present an immediate, lethal threat to the broader population. As many as 80 percent of those infected have no symptoms. And the best - really the only - way to fight it is for people to do something that they should have been doing anyway: eliminating the mosquito breeding pools in their homes and yards.
The mosquitoes that carry Zika flourish, too, in places that belong to no one. Rio de Janeiro's spectacular urban rain forests and lush mountainsides teem with them. So do the city's vacant lots and roadsides, strewn with garbage where water collects. Carnival, which began Friday, will probably bring even more trash.
Just as authorities here have bristled at calls to cancel theSummer Olympics scheduled for August, there was never any question in Brazilian minds that Carnival would go on despite Zika. Canceling it would be similar to the U.S. government trying to cancel Christmas. It is the country's most sacred holiday, said Brazilian sociologist and columnist Luiz Simas. Its very purpose is to help people forget about their problems.
"People abroad might find this a little strange," he said. "But in the history of Rio, at the most difficult moments, Carnival is even more intense."
"You don't party at Carnival because life is good," Simas said. "You party at Carnival because life is difficult."
In addition to its main parade, a massive, corporate-sponsored procession with thousands of dancers gyrating in elaborate costumes, Carnival also consists of hundreds of neighborhood-level street parties known as "blocos," where the drumming and drinking last long into the hot nights of the Southern Hemisphere's summer. It's hard to think of a better place for mosquitoes and for promiscuity.
Images of Carnival revelry here may contribute to international perceptions that Brazil isn't doing enough to contain the outbreak or sound alarms, for fear of losing much-needed tourism revenue for Carnival and the Olympics.

This week, the country's Health Ministry also fired back at complaints from scientists and researchers in the United States and Europe who say they are unable to properly study Zika because Brazil isn't sharing enough test samples.
Authorities reject claims that they aren't taking the pandemic seriously or should cancel the Summer Games. President Dilma Rousseff has urged Brazilians to mobilize against the virus, and she promised expectant mothers that the government "will do everything, absolutely everything in our power to protect you."
In a speech this past week, Rousseff declared "war" onAedes aegypti, the mosquito that is the primary vector for the virus. She has ordered more than 220,000 soldiers to fan out across the country to hand out leaflets at 3 million homes. About 50,000 will hunt for pools of standing water where the insects breed.

But not until next week. After Carnival.
"People here expect the government to do a lot for them," said Leandro do Nascimiento, a city health worker passing out brochures and condoms ahead of Carnival. "We need them to take responsibility for this, too."
He joined a large group of health and sanitation workers dancing to samba music and passing out condoms and lubricant packets near commuter trains this week. They do the event every year ahead of the festivities to encourage HIV prevention, but this year, they added Zika materials, and a few dressed up in mosquito costumes, wearing plastic wings and rubbery proboscises.
Several residents said these were the first government workers they had seen talking to people about the virus. "We don't know much about Zika. Only what we've heard on television," said Alessandro Tavares, speaking at Rio's Central Station, alongside his wife, Vanessa Dos Santos, who is nine months pregnant. Anti-mosquito brigades that are supposedly fanning out across the city with larvicide have yet to show up in their neighborhood, he said.
"The city and the state government don't even have the money to keep the public hospitals open, but they still want to have the Olympic Games," said Tavares, who, like many Brazilians, expresses little faith in the ability of the country's recession-hobbled government to confront the crisis.
The couple live high up on a hillside in one of the city's favelas, where mosquitoes thrive. They keep their doors and windows closed, slather on bug repellent every day, and Dos Santos has not had Zika symptoms. But they worry about the baby they are expecting.
"It's in God's hands now," Tavares said.

A surge in cases

Brazil is investigating a possible Zika connection to more than 3,000 reported cases of babies born with underdeveloped heads and brains, the condition known as microcephaly.
The highest number of cases have been reported in northern Brazil's Pernambuco state. Now, more cases are appearing in Rio, said Alexandra Araujo, a pediatric neurologist at the federal university hospital here. "I have never seen so many in such a short time," said Araujo, who has been working at the hospital since 1983.
So far, Brazil is the only country in the Americas where authorities have seen a surge of infants born with microcephaly, and Araujo acknowledged that a direct link between Zika and the birth defect has not been proved. But she has seen "too much of a jump" in recent weeks, she said.
There are currently about 3,000 pregnant women in Rio state - which has a population of 16 million - who have reported Zika symptoms, she said. There were 171 newborns diagnosed with microcephaly statewide last month, after 66 in all of 2015.
One of them was Luiz Felipe, born Dec. 28. His mother, Pollyana Rebello, 27, was diagnosed with Zika during her eighth month of pregnancy. For her, it is not a time for Carnival celebrations.
"Only with time will we know if he will improve," Rebello said, cradling the boy in her suburban home on the outskirts of Niteroi, a town near Rio. "It could be that he's able to talk but not walk."
To her, Luiz Felipe is a normal boy, she said. "He just has a little head."
But she said others in the community have stigmatized the family. "People think that microcephaly is a contagious disease, and it's not."
Her cousin Stephani Moura, 24, who is four months pregnant, sat on the couch and fawned over Luiz Felipe. She said that she was trying to protect herself as best she could against mosquitoes."I have the fan on all day, the windows closed, and I put repellent on every two hours," Moura said. "And I wear long pants."
But not that day. In Rio's stifling humidity, she was wearing shorts and a vest. "In this heat, no one can stand it," she said.

Relembrar é viver? Ou seria sofrer? - Paulo Roberto de Almeida

Do programa de campanha dos aloprados econômicos em 2014:

“A política macroeconômica defendida nas campanhas eleitorais e executada nos governos do PT e dos partidos aliados é baseada na construção de condições para redução sustentável das taxas de juros; na flexibilidade da taxa de câmbio em patamares compatíveis com as condições estruturais do País; na inflação baixa e estável; no rigor da gestão fiscal; na ampliação do investimento público; no incentivo ao investimento privado e no fortalecimento das parcerias entre Estado e iniciativa privada.”

Mais um pouco:

“Um dos alicerces deste novo ciclo é o fortalecimento de uma política macroeconômica sólida, intransigente no combate à inflação e que proporcione um crescimento econômico e social robusto e sustentável. Crescimento econômico estimulado pelo aumento da taxa de investimento da economia e pela ampliação de um mercado doméstico sólido e dinâmico, e que ocorra sem obstáculos, graças à expansão dos investimentos em infraestrutura. Prosperidade social que seja acompanhada pela geração de oportunidades para todos, por meio dos programas de inclusão dos historicamente excluídos e da educação para elevar a formação e a qualificação científica e técnica de nosso povo.”

Pois é, parece que deu tudo ao contrário, não é mesmo? Ou será porque eles erraram em absolutamente tudo?
Vocês decidem...
Uma última pergunta: um bando de ineptos, que produziu tamanho desastre na economia brasileira e que roubou desbragadamente, merece continuar mandando no país?
Paulo Roberto de Almeida