Dear Olympic or Paralympic athlete:
Hi there. How's the training going? Feeling good about your chances for a podium finish or a personal best in Rio?
I'm sure the last few weeks before a once-every-four-years competition must be a pressure-filled time. And I know a really unwelcome turn of events may be adding to your stress: Brazil's Zika virus outbreak.
It makes perfect sense if Zika is weighing on your mind. This situation is new and scary, and the pictures of those babies in Brazil are heartbreaking.
If you've qualified for the Olympics or Paralympics, you've worked hard for the chance to compete for your country with the world's best in your sport. But with professional golfers withdrawing almost daily, you may be wondering whether you should rethink your decision to go.
I might be able to help. I'm not a medical professional, and if you're wrestling with what to do, you should absolutely consult your doctor. That said, I've been talking about Zika with health officials and other experts for months now, and I may be able to offer some perspective.
First off, you need to keep in mind the games are being held in Brazil's winter. No need to pack a parka; it's not remotely wintery. But there should be fewer mosquitoes than you'd experience in summer. Zika is spread by a type of mosquito that also transmits a related virus, dengue. August and September are low season for dengue, so the expectation is that will also be the case with Zika.
Still, some people may get infected. For most people, that shouldn't be a source of high anxiety -- though it would totally suck if you were sick while you were competing.
Zika infection is mild for most people. In fact, 4 out of 5 people infected don't even know, because they don't have symptoms. Those who do report symptoms typically have an illness that they get over quite quickly. There can be a pretty itchy rash, though.
There are very few deaths from Zika infection -- so few, in fact, that they tend to make news when they happen. And people who've died from a Zika infection have generally been folks who already have other illnesses. Zika is not Ebola.
Now it's true that some people who contract Zika go on to develop Guillain-Barré syndrome, a form of progressive paralysis that will normally reverse itself over time. Most people recover from GBS, but it's not pleasant; some people end up having to have a machine breathe for them for a time.
The best estimate at the moment is that about 1 in 4,000 or 5,000 people infected with Zika will develop GBS. It's known, though, from other illnesses that trigger GBS, that the risk of developing the condition rises with age. The risk is very low for people in their teens, 20s, and 30s.
So that's basically what's known about the danger Zika infection might pose to you. Now let's talk about the big problem with Zika.
Contact with this virus can be devastating for fetuses. If the virus gets into their systems, it can destroy parts of their developing brain, especially if the infection happens early in pregnancy.
Chances are you're not pregnant. Elite athletes know their bodies better than anyone, and it's hard to imagine the women among you would compete pregnant. If you are, though, you should give the Rio Games a pass. Both the World Health Organization and the Centers for Disease Control and Prevention strongly urge pregnant women not to travel to places where Zika is circulating.
What if you are the spouse or partner of a woman who is pregnant? American cyclist Tejay van Garderen, who competed at the London Olympics, has said he won't go to Rio. The reason: His wife, Jessica Phillips, is pregnant.
The Zika virus can be spread by sex, and van Garderen has good reason to be worried about contracting it and infecting his wife after the games. Plus Phillips, a former elite cyclist herself, wouldn't be able to go to Rio to cheer on her husband. Who wouldn't prefer to have their loved ones watching when they go for the gold?
Some other athletes, including golfers Rory McIlroy, Jason Day, and Lee-Anne Pace, have told their national teams they won't compete in Rio, even though golf is making its first appearance at the Olympics since 1904.
McIlroy recently became engaged and reportedly has talked about wanting to start a family. Pace cited concern for her "future family's health" as did Day, currently the world's top ranked male golfer. He and his wife have two children, but he has said they want more.
"The sole reason for my decision is my concerns about the possible transmission of the Zika virus and the potential risks that it may present to my wife's future pregnancies and to future members of our family," Day said in a statement.
But the idea of "future pregnancies" is a tricky one here. If you're planning to compete in the Olympics and want to start a family in a few years, should you reconsider travel to Brazil?
There's no reason to think infection will have a permanent or even long-lived impact on a woman's fertility or the health of any babies she might have down the road, Dr. Denise Jamieson, a senior member of the CDC's Zika response team, told STAT earlier this year.
In fact, people who've recovered from Zika likely can't catch it again, so they'd actually be protected during future pregnancies.
The Zika virus is thought to leave a woman's system fairly quickly, after a week or two. But with men, it can hang around longer. Some men who've contracted Zika emit the virus in their semen for a period of time after they have been infected.
I asked the CDC's Dr. John T. Brooks about this. He's a senior medical adviser in the division of HIV/AIDS prevention; he's working on the Zika response because it can be sexually transmitted.
Brooks said so far the longest anyone has been seen to be emitting live viruses -- viruses that presumably can infect a sexual partner -- is 24 days after symptoms first appeared, though experts are puzzling over a case in which a woman in France may have been infected through sex between 32 and 41 days after her partner developed Zika. The couple had vacationed in Martinique, which is also having an outbreak.
A type of test that can detect traces of virus has spotted Zika particles in semen out to 62 days after infection. But it's not clear, Brooks said, whether those men are still infectious.
Based on the existing evidence -- which Brooks acknowledged is limited -- the CDC is recommending that men who have had Zika hold off on fathering children for six months after their illness. He said that's erring on the side of caution. "Our intent is to be conservative," he said.
Men who have been to a place were Zika is spreading but didn't develop symptoms of the disease should practice safe sex for eight weeks after their return, Brooks said, pointing out many of them will not have contracted Zika in the first place.
So, should you stay or should you go? Only you can make that call.
If you are going, use mosquito repellent with DEET in it, and, if you're having sex, take advantage of the free condoms that are always on offer at the Olympics.
If you are agonizing over whether to go, get information from good, reliable sources. For starters, the CDC has lots of information here, and the WHO's explanation of why it isn't recommending delaying the Olympics is here.
As a journalist, I've covered three Olympics and I know how magical they are. If you do go, we at STAT wish you a happy, healthy, and successful games experience.
Citius, altius, fortius.
Helen Branswell