The Last Word On Nothing

Last fall, Krista Hall and her fiancé decided on a destination wedding in the Dominican Republic. Planning a wedding can be a monumental task. Flowers must be chosen, food ordered, cakes tasted, dresses fitted, vows written, music selected . . . the list goes on and on and on. That’s why Hall hired a wedding planner. A couple of weeks ago, however, a problem arose that is beyond the purview of most wedding planners. On January 23^rd, the Dominican Republic reported its first cases of Zika infection. Hall had to think of her own health, of course, but also the health of the seventy or so family and friends she hoped would be there on the big day.

For those who haven’t been following the news closely, let me give you some background: Zika is a mosquito-borne virus first isolated in 1947 from the blood of a monkey living in Uganda’s Zika forest. Until 2007, the virus only caused sporadic human infections in Africa and Asia. But that year, the virus sparked an outbreak on Yap Island in the Pacific. The virus then spread to French Polynesia, New Caledonia, Cook Islands, and Easter Island.

Last spring, researchers reported that the virus had arrived in Brazil. The discovery didn’t prompt much alarm. For most people, Zika causes only mild flu-like symptoms. In November, however, Brazilian authorities reported that the Zika outbreak seemed to coincide with a sharp spike in the number of babies born with unusually small heads, a condition called microcephaly. They worried that Zika infection during pregnancy might be causing this birth defect. So terrifying was this prospect that the government of El Salvador advised women to stop getting pregnant altogether.

Concern about Zika began brewing among the Hall women about a month ago. Krista’s mom sent her a link to an article about Zika. Then Krista’s sister called. “We knew it was in Haiti, which is the same island. So, in my mind, there was no way it was going to be in Haiti and not in the DR,” Hall says.

Hall isn’t pregnant. She never considered canceling the wedding, or changing the location. But she did wonder what she should tell her guests. Some older family members were already resistant to the idea of a Caribbean destination wedding, and she didn’t want to fan the flames. But she also didn’t want to put anyone in harm’s way. So Hall recruited her sister to draft a memo, something that would provide accurate information without causing undue panic.

Risk communication is tricky business, and it’s especially tricky when the situation is fluid and the risks are unclear. Hall’s wedding guests might want to know 1. what is the likelihood that I’ll become infected? and 2. what will happen if I do? The real answers are 1. nobody knows, and 2. we’re not sure.

Peter Sandman, a risk communication expert, says you have to embrace this uncertainty, while also giving it boundaries. “Tell people what you know for sure, what you think is almost but not quite certain, what you think is probable, what you think is a toss-up, what you think is possible but unlikely, and what you think is almost inconceivable. Put bounds on the uncertainty: What range of possibilities is credible? Clarify that you are more certain about some things than others,” he writes.

And as the research progresses, the uncertainty will no doubt diminish. For example, several studies have come out in the past couple of weeks that bolster the link between Zika and microcephaly. The most convincing, according to virologist Vincent Racaniello, involves a European woman who got pregnant in February 2015 while volunteering in Brazil. Thirteen weeks into her pregnancy, she developed a high fever, body aches, and a rash. An ultrasound at 32 weeks revealed a variety of severe defects in the fetus, including microcephaly, and the woman chose to terminate the pregnancy. When researchers sequenced brain tissue from the fetus, they were able to pull out the entire Zika genome.

It is the link between Zika and birth defects that worries Hall. She could only think of one guest who might be trying to get pregnant, so she called and explained the situation.

And then she made a decision. Hall and her fiancé want to have a baby, and they had hoped to start trying on their honeymoon. But because the couple plans to honeymoon in the Dominican Republic, they decided to wait just a little longer. “We don’t want to take an unnecessary risk,” Hall says. “We’ll wait to pull the goalie until we get back.”

Image credits:

Heart via Sue Langford on Flickr

Risk via GotCredit on Flickr