Family Powers of Two

I have just come back from The Valley Hospital where I delivered a beautiful baby boy, a first baby, to a wonderful couple. The baby came out right onto the mothers chest and abdomen, and he was moving around, pink, and of course crying. He took his first 5 breaths, which are mostly in breaths, before he started crying from being born. I think that babies do not like being born. It is like getting evicted from a warm easy 98 degree bath that one has floated in for 9 months. I can't imaging getting evicted like that. And then babies have to do the hard work of actually breathing and digesting. It is called transition by the baby care staff. Transitioning is important, and it can be difficult for babies that are born in a stressful manner. Difficult or stressful births might be a premee or an infection. This could include influenza or strep sepsis, for instance, or a placental abruption. Transition is also sometimes a bit difficult for C Section babies that have not experienced labor. I think that the babies that don't get squished or compressed by uterine contractions have a harder time with transition. They breath harder and faster, and sometimes need oxygen, suctioning, and stimulation. They have more amniotic fluid in their lungs that needs to get expelled somehow. We call this transitioning difficulty "Transitional Tachypnea of the Newborn".  Here is the Wikipedia page as of 2 PM on December 7th. https://en.wikipedia.org/wiki/Transient_tachypnea_of_the_newborn. Notice that Wikipedia calls it transient tachypnea. That is another name.

But as a mathematician and a amateur philosopher I have been thinking about generational genetic math again. One of my patients has done the 23andMe genetics service and has found out some genetic history. This may be very valuable to someone who has no known family history. It can elucidate particular genetic risks, and will be valuable for the whole family, and her kids. (I can use the pronoun "her" because I only have female patients, as per my board certification rules, which disallow male patients under most circumstances).

Lets think about generational math. Realize that you have two parents. Your parents have two parents, meaning you have 4 grandparents. Your grandparents have two parents each. This means that you have 8 great grandparents. Notice that each generation has a power of two. Powers of two have very easy calculations, especially for a computer scientist as they deal with powers of two all the time. 2 to the 8th power is a byte, and there are 256 different bytes, starting at zero and ending at 255.

Anyway, lets continue. Two to the 16 is 65,536. This means you have 65,536 great great... 16th generation... grandparents. And so does everyone else.

Powers of two have an "exponential" growth rate. There is an astronomical amount of power in an exponential growth rate. Two to the 32 is 4, 294, 967,296.  

Here is the first kicker. 32 generations ago, was how long? If we allow 20-25 years per generation, we get 640 to 800 years. There was not 4 billion people on the planet back then. This was the European middle ages, the Ottoman empire, the Shogun's of Japan, the natives of the America's, which came over from Asia via multiple routes during the last Ice Age 10,000 or more years ago.

The Earth only got it's first 1 billion people as of the year 1800 or so. So how can you have 4 billion ancestors if there were much less than a billion people on the planet? The answer is that people share ancestors. This is another way of saying that we are all related.

Using this kind of math, we can show that in General, of the 8 billion people presently on the planet, we are no more than, maybe 64th cousins. This is a highly conservative estimate, because 2 to the 64th is 1.8 times 10 to the 20th power. This is trillions of times more than the number of people that have ever lived.

Or, another way to look at it, is that 2 to the 33 is about 8.6 billion. This is way more than the number of humans that existed 33 generations ago. Therefore, we all must share a lot of ancestors to get this high number.

How many generations of humans exist? Anthropologists and geneticists believe the humans evolved from a herd of homo sapiens consisting of about 40 woman, tracked through the mitochondrial genetics. This herd lived somewhere around 250,000 years ago, centered somewhere in Africa, and expanded from there. 250,000 years, divided by 20 years per generation, gives 12,500 generations. So your 12,500th grandfather, is most certainly the same as mine, no matter where you are in the world. The only way this could be different is if your family came from a different planet.

No matter how you do this math, the numbers will add up somewhere in the same ballpark.

We are likely no more than 35th cousin, and we are not possibly more than 12,000th cousin. No matter who you are in the world.

Can 12,000 generations evolve humans so differently? Pale skin was necessary in northern latitudes because humans would die of rickets without vitamin D. Pale skin was necessary to survive the low sunlight levels of northern latitudes.

Pale skin in equatorial Africa was similarly dangerous. A person like myself can get a sunburn in under 20 minutes of hot unmitigated sunshine. Everyday all day without coverage from the Sun and I would eventually get a tan, but I would be seriously challenged by the burn, the blisters, and the cancer that would likely ensue. A darker neighbor would most likely be healthier and have more successful reproduction. I believe that even a few generations like this would evolve humans to have different pigments. So yes, this many generations can evolve a lot of differences.

So, the bottom line, is that we are all related. All Europeans are no more than maybe 32nd cousins. All Asians similarly. All Africans similarly. But, assuming that the races of humans split up at the exact moment of creation of the species and didn't mix since, we can be no more than 12,000th cousin. I believe those conditions were not true, and that humans intermixed over history, so it would be difficult to find humans that are, say, more than a thousandth cousin.

We are all related. We are all one family.

Thanks for reading.

http://doctorjohnmarcus.blogspot.com 

Phone 201-447-0077

Fax 201-447-3560 

Member of: 

Lifeline Medical Associates at LMA_LLC.com 

Medical Society of New Jersey 

Past President of Bergen County Medical Society 

Member of Medical Justice 

Member of the U.S. Woman's Health Alliance at http://uswomenshealthalliance.com/index.php

Member of the American College of Ob/Gyn at www.acog.org 

Board Certified by American Board of Obstetrics and Gynecology at www.abog.org 

Member of The Valley Hospital Medical staff Department of Ob Gyn 

-ex Director, Associate Director, Secretary, Chief of Education, Chief of cancer committee. 

- present member of Ob Critical Care Committee 

Member of Hackensack UMC at Pascack Valley  Medical Staff at http://www.hackensackumcpv.com/

LISTERIA ALERT

Listeria is an infectious bacteria that is particularly dangerous to a pregnant woman's fetus.

Watching the news today I came across a story that all pregnant woman will have to know about. Listeria is once again in the news. 

Every once in awhile there will be a public health alert about some particular food that has become a danger to the public. The American Food and Drug Administration has the mandate to keep our food safe, identify the risks to the public, and eliminate or mitigate the risks somehow. Frequently that will mean recalls. Often the recalls will be some kind of vegetable. I can remember spinach, melons, packaged salad, and very frequently frozen hamburger meat. Once in the past it was Hummus. This time it is some kinds of Sabra hummus. Here is a link to the CNN article. I am sure this article will be updated as more information becomes available. 

http://www.cnn.com/2016/11/19/health/hummus-sabra-recalled/index.html 

Oddly, the article does not mention pregnant woman. In pregnancy the infection to the mother can be a relatively mild flu like illness, but the bacteria gets into the fetus and severely, permanently, or fatally injures the fetus. It is very difficult or impossible to identify the illness in the early stages. The most common diagnosis is on culture of the infected fetal tissues. By then, the damage is to late and many times irreversible. 

The best defense against listeria monocytogenes is avoidance. There are particular food rules that most pregnant woman are aware of to never eat certain foods. Like unpasteurized soft cheeses. This is a basic rule of pregnancy. I think I am going to survey my pregnant patients about this knowledge. And report the results here. Results to be announced. 

Here is the wikipedia page. I last looked at this on Sunday November 12th at 2:30 eastern standard time. (wikipedia pages can change all the time). 

https://en.wikipedia.org/wiki/Listeria_monocytogenes

Sabra is my favorite hummus. Hummus is vegan, extremely healthy, and really yummy. I will not stop buying it. But please throw away any of the listed versions. And for now, pregnant woman should avoid this Sabra hummus. 

It would be too easy to say that Sabra Hummus company is committing a malfeasance by producing hummus like this. I would ask all of you to consider an alternative view. My view, and your view should be, that Sabra is making an effort to keep their food safe, and doing this voluntarily. How many companies do quality control like this? It was not long ago that a peanut butter company did quality control but hid the results and shipped the infected food anyway. This led to unprecedented criminal charges against the leadership of that company. 

But worse, how many companies don't do quality control so effectively? How many don't do it at all? Large egg farms, for instance, have the hens living in poultry barns where there feces exist. This is utterly unavoidable as the birds cannot be potty trained. And keeping the birds on a grid to let the feces fall will only hurt their feet. 

And smaller companies (and restaurants) that make smaller batches or more "homemade" like food will have no quality control at all, other than the skills and cleanliness of the chefs and workers. There are many instances of Norovirus spreading from mildly infected workers. Workers should voluntarily stay away from work when they are ill, but that will be looked upon as a black mark on their occupational record, and might lower their paychecks. Alternatively, workers should be rewarded for due care to protect the food and their customers. I don't know how employers can commit to this. Personally, I don't come to work when I suspect that I might harbor an illness. And, don't be too surprised, physicians and nurses do get sick. I remember the look of shock once when a delivery man came to my house when I was sick and raised his eyebrows when he saw that I was on a sick day. He said "doctors don't get sick" in surprise. I laughed and said I wish that was so. 

So I believe that Sabra hummus is committing to quality control with vigor and commitment. This will make me more likely to buy Sabra, not less. 

Please let me know what you think in the comments below. 

Thanks for reading. 

http://doctorjohnmarcus.blogspot.com 

Phone 201-447-0077

Fax 201-447-3560 

Member of: 

Lifeline Medical Associates at LMA_LLC.com 

Medical Society of New Jersey 

Past President of Bergen County Medical Society 

Member of Medical Justice 

Member of the U.S. Woman's Health Alliance at http://uswomenshealthalliance.com/index.php

Member of the American College of Ob/Gyn at www.acog.org 

Board Certified by American Board of Obstetrics and Gynecology at www.abog.org 

Member of The Valley Hospital Medical staff Department of Ob Gyn 

-ex Director, Associate Director, Secretary, Chief of Education, Chief of cancer committee. 

- present member of Ob Critical Care Committee 

Member of Hackensack UMC at Pascack Valley  Medical Staff at http://www.hackensackumcpv.com/

Why do I ask people about their religion? 

To boil the answer down to a simple one, it is because I don't wish to put people and patients into a state of spiritual strife. Or spiritual danger. If I mistakenly give people a plan of action that they later come to regret, I will feel like an ass.

My medical decision making can be precisely correct, scientifically sound, and delivered in a clear, compassionate, and skillful manner. Yet still it is possible to wreck someones life. I don't want to wreck anyone's life. From professional point of view it would make me a bad doctor. From a personal point of view I would feel like a jerk. I don't want to feel like a jerk.

How could a doctor create spiritual danger? It is remarkably easy. And it is sad to say but physicians don't get any education about spiritual issues. I think that leaders in the medical sciences want to say that modern medicine is "evidence based". Medical leaders want to be scientifically sound. They want all medical decision making to be factual. They want to be able to cite actual scientific journal articles to support one decision over another.

The older generation of docs used to complain bitterly about  this turn towards science, towards checklists, and away from the art of medicine. Older docs called it "cookie cutter" medicine. Or "recipe" medicine, or something like that.

A arrogant young medical doctor might scoff at the notion that a person's religious belief would interfere with sound medical care. A self important doctor might tell a patient that "there is only one way to do this, and it is my way. Religion has nothing to do with it.". This is spiritually dangerous territory. Even for atheists.

Let's give an example:

A newly married Catholic woman comes to my office to ask about contraception. She has strong faith. During the consultation I find that she has no knowledge of the Catholic rules pertaining to conception and contraception. If I didn't care for her overall well being I might recommend the birth control pill or an IUD. If I did this deliberately it is even worse. Catholics have some simple and important rules to follow when it comes to contraception. Catholic rules prohibit ejaculation outside the vagina. And even more importantly Catholic rules prohibit interfering with an embryo. If an embryo gets created, then it must be allowed to implant and grow. No one can take any action that prevents embryo implantation. Since the birth control pill will allow rare ovulations, there will be embryos created. But the birth control pill also thins the uterine lining. When the uterine lining is thin the embryo has nowhere to implant. So the embryo menstruates out. The Catholic theology is that an embryo is a human, And obviously no one wants to hurt an innocent human.

Notice that this is simply an extension of the right to life movement all the way back to sperm and eggs.

Personally I don't adhere to the notion that an embryo isn't human yet. I think embryos are human. There is no magical point of time when an embryo ceases to be inanimate, and suddenly becomes human. The embryo is and always will be human. It is silly to point out an event and say, now, the baby is human. Before, not so much. Embryos are constantly growing. Whether a person is pro-life or pro-choice, people have to get rid of such misconceptions.

Discussing these issues is important. These issues are deadly. Of life and death importance, Many gynecologists have been shot or bombed because of disagreement over these beliefs. Many people have died over this issue.

So yes, spiritual competence is an important skill for a physician to have. And when I ask you about your genetic heritage, ethnicity, and religion, I am simply trying to be a good doctor, and avoid things that might harm you. And if you don't tell me your religion, then I might inadvertently give you bad advise. My advise might be scientifically sound but spiritually wrong.

As an interesting aside, there are many times during consultations when people claim to not have a religion. They might even get annoyed by the questions. Many people claim to be atheists. But, many times, they are not. They are wrong. They are not atheists. What they really are is agnostic. When a person claims "there is no God", then they are an atheist. That is not so common. Many people really want to say, "I don't know if there is a God". That makes them agnostic.

For another example of spiritual danger, consider the Jehovah's Witnesses. Jehovah's Witnesses believe that they cannot take another person's blood into their bodies. If they do, they will not get to go to heaven when they die. Many people are flabbergasted when they hear that someone would rather die then take a blood transfusion. It is only comprehensible when you understand that going to heaven is for eternity, and our life here on earth is only temporary and short. No one wants to make a mistake that would cost them an eternity of happiness. So Jehovah's Witnesses would rather die than take a blood transfusion. So the standard surgical consent form now has a Jehovah's Witness clause. It is an answer to the question, "Will you accept a blood transfusion if it is necessary to save your life?". The question must be asked and answered. Because I don't want to destroy someones long term plans of eternal happiness in Heaven.

Another example is Ramadan. Many Muslim women want to fast during Ramadan. I can help them. There is some theological controversy about the fast in pregnant women. But if my pregnant patient wanted to fast, I will try give her good advice about how to keep it safe. But I cannot give this advise if I don't know she is Muslim. Ramadan starts today.

In some religions woman cannot be touched by men. Not even to shake hands. For these women, you will put them in a bind if you offer to shake their hand. Nobody wants to be rude by refusing. But nobody wants to violate their own beliefs either. Again, if I didn't know someone was of that religion there would be uncomfortable moments. Medical care requires physical examination, but does not require a handshake. So there is unnecessary stress over a handshake.

If anyone asks about me, I am a theist. I am not an atheist.

Thank you sincerely for reading.

Dr John W Marcus
89 North Maple Ave
Ridgewood NJ 07450

Blog is at doctorjohnmarcus.blogspot.com.

Latest Zika News

Zika continues to be in the news. 

The country of Columbia has widespread Zika virus. But Columbia is claiming that they are not seeing the increase in microcephaly that is being found in Brazil. There is no known explanation for this discrepancy. The scientists in Columbia that are not absolutely convinced that Zika causes microcephaly. Columbian scientists think that this connection between Zika and microcephaly might be scientific misdirection based on bad statistics. What amounts to a correlation/causation fallacy. This kind of scientific fallacy has happened plenty of times in the past. As of yet I think that most people believe there is a link between Zika and microcephaly. 

Correlation/Causation fallacies are very easy to fall into. I remember when hairy ears were thought to be connected to heart disease. So people would trim their ears, as if that would help their heart. It was ridiculous. And in my field, it was thought that estrogen treatment for older women prevented heart disease. It required many years to correct this wrong idea. We now know that estrogen treatment is preferentially taken by fit women. This explained the fact that women on estrogen hormones had less heart disease. In a randomized trial, there was no protection from heart disease. This false conclusion took many years to correct. 

The estrogen link to breast cancer is still not understood at all. Even by very smart people. Estrogen is about as carcinogenic as a nose. It is a normal part of a woman's body. (Please note that noses do form cancer.) In the Woman's Health Initiative it was found that estrogen increased the breast cancer risk in women about 7 in 10,000 cases. But it similarly lowered the risk of colon cancer. So in the worst case scenario the cancer risk is a wash. Also note that changing 7 cases from colon cancer to breast cancer should save lives. In the WHI, after two years, the increased breast cancer risk was just about gone. The risk line was just about to cross over to lowered risk (consistent with many older studies) when the WHI was cancelled prematurely. I would invite anyone to go and read the WHI report and see that the risk for breast cancer was just about to cross over into protection. There is one graph that shows this. Cancelling the study early was a violation of the study protocol and wiser calmer heads should have kept the study going. 

The Aedes mosquito continues to spread. It is an invasive species anywhere in the Americas, so eliminating it should not damage the ecosystem in any way. Right now there are plenty of videos of insecticide trucks fogging entire cities, and workers with leaf blower sized backpack devices fogging inside homes. There appear to be an army of them working in South America. 

Even though removing Aedes mosquitoes will not hurt the environment, widespread insect fogging may have a detrimental effect on the environment or on human fetuses. It will certainly create resistant forms of other insects. 

There is no chance that insecticide is going to remove Aedes. There are just too many of these mosquitoes in too many places. Insecticide will reduce them, but it will not eliminate them. So humans are now seemingly committed to large scale long term continuous insecticide exposure everywhere there are Aedes mosquitoes. 

There is a much better strategy that has worked in the past. It is mosquito birth control. There is a British biotech firm, a small firm, that can create sterile Aedes male mosquitoes. These mosquitoes then go and mate with wild female Aedes. The offspring will not grow to adulthood. This British firm has also tagged their Aedes mosquitoes with a color that glows red in the presence of some kind of special light. Maybe a black light. This is a great way to follow the progress of their birth control measures. As a Gyne, I am familiar with birth control. Birth Control sometimes works. 

Here is a news story that is right now 3 hours old, at the Independent News in the UK: 

http://www.independent.co.uk/news/uk/home-news/zika-british-team-say-they-have-a-remedy-for-the-virus-a6859046.html

So if the sterile males go out into the wild and shoulder aside their more fertile cousins, then the Aedes mosquitoes will not successfully reproduce. 

So birth control can work. There are several theoretical problems here. According to the principle of natural selection, the more fertile members of a species should survive. So if there are some female Aedes out there that can smell out their nonfertile mates, and not mate with them, then this won't work for them. Also, fogging of insecticide will kill the Sterile males too, so those two methods will work against each other, not support each other. This exact birth control technique has been used in the past to remove pests from agriculture. It sounds a lot safer than insecticide to me. 

I tell my pregnant patients to avoid insecticide while pregnant. There are not enough studies to prove that these chemicals are safe for fetuses. It may be that fogging reduces Aedes, but that pregnant women exposed to insecticide have some other birth defects from the insecticides. Hopefully someone has figured out that risk. Eventually, the scientists will get to the bottom of this. 

Thanks for reading. 

Dr John Marcus 

blog at doctorjohnmarcus.blogspot.com 

89 North Maple Ave 

Ridgewood NJ 07450 

Comments are welcome. 

Surgical Skin Closure, Staples vs Sub-cu

Yesterday I posted about Zika virus and how it is dangerous to neural tissue, especially for a fetus. This Zika problem will be with us for a couple of years until we can get a handle on it. I've seen pictures of the "war room" at the CDC where the epidemiologists have their daily meetings. I think the CDC is in Atlanta but it might be located at least partially near Washington DC.

Today a patient came in for her PP visit and we discussed her surgical closing technique. I had a doctor covering my practice who is a very skillful and caring physician. The patient needed a C-Section and I wasn't on.

My covering doc closed her skin incision with cosmetic subcuticular dis-solvable stitches.  So my patient has had the skin closed both ways now. First with staples, second with sub-cu.  And she now has a strong preference.

I know that the staples are a bit more work, and patients are worried about the removal. The removal is usually almost painless as the staples slide ride out once they are unbent.

Why are the staples beneficial?

-They are completely removable.
-They are very smooth and shiny, so no germs can get a hold of them.
-They never break down and fail their job of holding the skin
-When they are gone, they are utterly gone, leaving nothing behind to dissolve.
-When they are gone there is skin touching skin and nothing else in between. This is far more comfortable, softer, and smoother.

Why don't people like staples?

They feel and look unsightly while they are in. And they have to be removed.

In my opinion staples just do a better job and are worth the extra work.

The science does not show a preference between between staples and subcu dissolvable sutures. There have been a number of randomized trials. Obviously the trial cannot be blinded because the doc doing the stitching can see what they are doing. I suppose the incision can be evaluated later by someone who is blinded as to the closing technique.

In any case the studies showed no difference in the quality of the skin incision outcome. Of note, though, the studies that I read were done in academic medical centers where the infection and complication rates were far higher than a private community hospital. The academic centers infection rates were about 8 times higher than my hospitals. This surgical complication rate is a reflection of the socio-economic stress of poverty, the higher workload of the staff, and the riskier patient mix. I doubt if the less experienced staff has anything to do with it, but it remains possible. It is possible that the older facilities have less modern infection control technologies, such us laminar flow air handling in the operating room.

I think that if that same study were done in a place like my hospital, there is possibly a different outcome.

In my experience the staples provide a better outcome. Once they are removed they provide a far more comfortable and smoother incision.

Every once in awhile a patient will pick a doctor based on their known closure technique. I would like everyone to know that I will do whatever technique they want. I will give them my advice and then honor their wishes. Hopefully that will satisfy the needs of those who don't like the idea of staples. I am perfectly qualified to do cosmetic sub cu. I studied 6 weeks of cosmetic surgery at the Cook County Hospital in Chicago Illinois. That was a great time for me. I learned a lot. And I have been doing surgery every since.

So if you don't want staples, then I will do the sub cu. But if you want the best, then ask your surgeon if they can do metal removable staples. (The dissolvable staples are more like the sub cu).

Zika Virus in Pregnancy. 

Zika Virus has been in the news quite a bit. It seems very bad. How bad is it? 

7 days ago there were very few cases known and published in the US. 

3 days ago there were 33 cases. All were cases caught outside the US, and brought here. 

Yesterday was the first case caught in the US, given from one person to another by sexual exposure. Sexual transmission seems to be a previously unknown method of transmission of Zika Virus. 

As of yet, there are no known mosquito transmissions in the mainland US. Although Puerto Rico, Guam, etc may be at higher risk, because of their tropical climates. 

It seems inevitable that there will be mosquito borne cases in the US. 

In Brazil, there are 4000 cases of microcephaly in newborns. This is a huge increase, and is thought to be possibly from Zika infections. Zika seems to have an outsize affect on neural tissue. Zika gives adults a case of Guillen Barre Syndrome: 

https://en.wikipedia.org/wiki/Guillain%E2%80%93Barr%C3%A9_syndrome 

Guillen Barre is a disorder of neural tissue. 

And in fetuses, it somehow affects the neural tissue of unborn children. Somehow the neural tissue is destroyed. I have seen the CT scan pictures, and the brains are seemly destroyed, at least partially. It is a real disaster for these children, families, and societies. I don't think anyone knows for sure how the neural tissue is destroyed but it is certainly possible that the virus gets into the cells, grows there, and kills the cells. Once the brains are destroyed, the head stops growing, and the child has a small head. This is called microcephaly.

There are no antizika antiviral medicines.

There is no Zika vaccine. 

The official position of the Brazilian Government is that women should put off being pregnant until something more is known about Zika Virus.   This will take some time. Delaying an entire countries childbearing has not been done in recent memory. Again, this is something new. 

As of this moment, there are far more questions than answers about Zika. 

Here are a few helpful links: 

http://www.cdc.gov/zika/pregnancy/question-answers.html

http://wwwnc.cdc.gov/travel/page/zika-information

http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html

http://www.cdc.gov/zika/pregnancy/index.html

http://mothertobaby.org/fact-sheets/deet-nn-ethyl-m-toluamide-pregnancy/pdf/

There are a few facts:

Eliminating mosquito bites will likely eliminate risk. How can we eliminate mosquito bites?
-Keep doors, windows, and screens closed.
-Don't travel to tropical climates right now, without precautions.
-Don't have unsafe sex with anyone who has been to a Zika prevalent area.
-When summer comes use air conditioning. Mosquites prefer the warmth. Cold keeps the mosquitoes out or inactive.
-If outside, use long tight pants, sleeves, socks, etc.
-Use special clothes that are permeated with permethrin. Personally, I have never seen such clothes for sale, but this is what the CDC says to do. I suppose if you can get Permethrin, you can spray your own clothes with it.
-Use highly effective insect repellent. DEET seems to be the best, in my opinion. Use it on all exposed skin, and even on your clothes. And use it even if pregnant. Use it copiously.
-Don't go outside when mosquitoes are active and present.
-Remove all standing water from the land. This is where mosquitoes breed.
-Treat standing water with insecticide or some other effective treatment.
-Use insect foggers outside, on a personal or municipal basis.

And finally, as a society, we need to control the Aedes Aegypti  mosquitoes.
https://en.wikipedia.org/wiki/Aedes_aegypti.
This is not the only nasty virus or disease transmitted by this mosquito.

There are some biological control mechanisms to control this mosquito. But we will have to get over our natural inclination to protect species. It is rare for humans to conduct deliberate annihilation of a species, but it has been done before. Smallpox has been destroyed. Some agricultural pests have been destroyed. Other infectious diseases are on their way out. If we can vaccinate everybody we can stop more infectious diseases. But vaccinating everyone requires some force, as there will always be selfish individuals who wish to take advantage of the herd immunity we provide them, while not simultaneously helping to provide that immunity. These individuals will need to be either convinced or coerced. Somehow. My personal politics preclude the use of force on people, but I would support some kind of strong coercion for this. Like keeping unvaccinated kids out of schools.

Worldwide, 140,000 people die of measles every year:
http://www.usatoday.com/story/news/2015/07/02/measles-death-washington-state/29624385/
These deaths are preventable with the vaccine. Everyone who declines the vaccine is part of the problem, not the solution. We all must accept the risk of the vaccine in order to benefit from the vaccine. And the risk of the vaccine is very very low. My children have been vaccinated as per the normal schedule. There was no doubt in my mind that it was a good idea. And now my kids cannot kill anyone by transmitting measles to someone. This, to me, is profoundly beneficial. And sensible.

So this Zika virus is going to infect a lot more people.

We can control it in the USA because we have measures to control mosquitoes that other nations don't have. Of note, living in a cold climate is not a protection. As anyone who has fished in Canada or Alaska knows, in the summer, there are tons of mosquitoes. And the mosquitoes come back every year. They survive the winter.

We have been down this road before. West Nile Virus was a similar kind of event. Ebola had a very high mortality, but was controlled with really heroic efforts by some people who deserve a Nobel Prize, like Doctors Without Borders. There are significant new epidemics every year or two.

And in fiction, I have read several doomsday novels about killer viruses. Mostly man made viruses.

Steven King wrote "The Stand". There is a very good movie as well.
More recently, Russel Blake wrote "Upon a Pale Horse".
Both are good books.

Here is a list of books about epidemics:

http://www.goodreads.com/list/show/19535.Best_Fiction_Books_About_Diseases_or_Viruses

Please use the links above. I hope to be able to give better answers in the future.

Thanks
Dr Marcus
Blog is at doctorjohnmarcus.blogspot.com

89 North Maple Ave
Ridgewood NJ USA 07450