The World Health Organization announced Friday that it no longer considers the Zika epidemic a public health emergency of international concern.

But Zika’s threat to pregnant women and babies is not going away anytime soon, the agency says. Instead, the virus is now a chronic problem, says the WHO’s Dr. Pete Salama.

“It is really important that we communicate this very clearly: We are not downgrading the importance of Zika,” Salama says. “In fact, by placing this as a longer term program of work, we’re sending the message that Zika is here to stay. And WHO’s response is here to stay, in a robust manner.”

One thing is clear: Zika is still spreading. And microcephaly cases are still growing. Argentina reported its first potential case this week. And Florida continues to find people who caught Zika inside the state.

For these reasons, pregnant women — and their partners — still need to pay attention to where they travel, says Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

“Regardless of how WHO defines Zika, [the disease] is unprecedented, and it’s an extraordinary risk for pregnant women,” Frieden says. “That’s why it’s important that pregnant women not travel to places where Zika is spreading.”

Right now, those places include countries across Latin America, the Caribbean, parts of Southeast Asia — and neighborhoods in Miami.

WHO first declared Zika a public health emergency back in February. Back then, the situation looked dire.

Brazil was investigating more than 4,000 cases of microcephaly — a horrible birth defect where babies have brain damage and small heads. And health officials were predicting thousands of more cases, as Zika spread across the Western Hemisphere.

“If this pattern is confirmed beyond Latin America and the Caribbean, the world will face a severe public health crisis,” WHO’s director-general, Dr. Margaret Chan, said in February.

But so far, that pattern hasn’t repeated itself. Brazil has confirmed the most Zika-linked microcephaly cases, about 2,100. Other counties in Latin America have reported far fewer. Colombia has the second highest with 57 confirmed cases and the U.S. is third with 31, WHO said Thursday.

Such a vast difference between the situation in Brazil versus other countries has raised some eyebrows. Could some other factor in Brazil be increasing the risk of microcephaly there? Perhaps a pesticide or another virus?

“I think it’s too early to draw conclusions,” says Alessandro Vespignani, who models the spread of Zika virus at Northeastern University in Boston.

Colombia is still investigating more than 300 microcephaly cases to see if they’re linked to Zika. Several countries, such as Venezuela and Haiti, have not been vigilant about reporting cases. And countries that are on top of reporting, such as Mexico and Puerto Rico, aren’t expected to have microcephaly cases until next year — it takes around 9 months after a Zika outbreak strikes for the bulk of microcephaly cases to appear.

“We can’t rule out the possibility that something unique is happening in Brazil,” Vespignani says. “But, right now, we have to wait and see what happens elsewhere.”

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How do you get people to discuss diarrhea? Ask them to write poetry about it.

That’s the idea behind Poo Haiku, a competition created by Defeat DD, a campaign dedicated to the eradication of diarrheal disease.

Although everybody’s had the runs, it’s not something most folks talk about, says Hope Randall, digital communications officer for PATH’s Center for Vaccine Innovation and Access, which created DefeatDD to bring together resources on vaccines, nutrition, oral rehydration therapy, sanitation and more.

Silence is a problem because diarrheal disease is a problem. It’s the second-leading cause of death for children under the age of five. And it disproportionately affects kids in the developing world, where it’s tougher to access safe water and medical care.

Attention translates into more resources, Randall says, which is why Defeat DD wants to get people comfortable with words like “poo.” Hence, the call for “poo-ets” to write “poo-ems.”

Turns out there are plenty of potty mouths eager to show off their creativity. For the third Poo Haiku contest, which wrapped up on Nov. 4, Twitter was flush with submissions — a record 146 poo-ems, Randall boasts. The prize? Social media fame and the chance to be featured in DefeatDD’s 2017 calendar, which will be shaped like a toilet.

Most contributions came from the global health world. Take, for example, this winning entry from Kat Kelley of the Global Health Technologies Coalition, which references a recent study published in The Lancet:

Just six pathogens
But eighty percent of kids’
Diarrheal deaths.

Currently, there’s only a vaccine for one of these six pathogens — rotavirus, Randall notes. So DefeatDD is pushing for investment in vaccines to fight two more, ETEC, a type of E. coli bacteria, and Shigella.

The other pressing item on the DefeatDD agenda, Randall says, is the need to address the fact that even kids who survive diarrhea often deal with long-term consequences. Randall herself penned an entry on that topic:

A vicious cycle,
Gut damage, malnutrition
We can halt the churn.

Some Poo Haiku are more emotional than informational. Alanna Imbach, media relations manager for WaterAid, offers a good reminder that behind the stats, there are individual children out there facing hurdles to hygiene:

She is just a girl
Out looking for a toilet
Trying not to fear.

Other “poo-ems” will put a smile on your face, promises Randall, who’s partial to this one from a fifth grader who learned about Poo Haiku at school:

Go now, Mister Poo
Hurry, quick to the toilet,
When done wash your hands.

The ultimate winner, of course, is the fight against diarrheal disease. “As simple as it sounds, these kinds of words are so rarely used in polite discourse,” Randall says, noting that anything that helps poo become public makes the campaign a success.

Although the contest is now over, Randall would love to see people continue to share poo-ems through Saturday, which is World Toilet Day — the annual reminder that 2.4 billion people don’t have access to a toilet. Check out all of the poo-ems, including some videos, by searching for the hashtag #poohaiku on Twitter.

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When he was growing up in New York, All Things Considered host Robert Siegel always knew that Bellevue Hospital was a city institution.

But it wasn’t until he read David Oshinsky’s book Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital, that he realized the hospital was a pioneering institution for all of American medicine.

The hospital, which grew out of an almshouse founded in 1736, has been in the forefront of many innovations in medicine in the U.S. Advances that started at Bellevue included ambulances, a maternity ward, nursing school, a children’s clinic and forensic pathology.

Siegal talked with Oshinsky, a professor of history at New York University, about the hospital and how it reflects the advances and failures of medicine. The interview has been edited for length and clarity.

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In 1876, O.G. Mason, Bellevue’s official photographer, took a carefully staged photograph of a blood transfusion in progress. Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday hide caption

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Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday

On Bellevue’s origins in colonial New York

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Bellevue’s first class of interns, top, circa 1856. At bottom, America’s first professional nursing school opened at Bellevue in 1873. Preferring single, literate, religious women from cultivated families, it rejected most applicants on account of “bad breeding.” Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday; Courtesy of Bellevue Hospital Center Archive/Doubleday hide caption

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Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday; Courtesy of Bellevue Hospital Center Archive/Doubleday

Bellevue in the 18^th century was really both a poorhouse and a pest house. It was a place you came to die. It really began with the great yellow fever epidemics of the 1790s. At that time the Bel-Vue estate, which became the hospital, was located on the East River, about two miles away from where most of New York was located down by the Battery. And you would send people who really had no chance of recovering.

On hospitals not being very good at saving lives in the first half of Bellevue’s history

Most physicians at Bellevue and elsewhere believed in the miasma theory — that clouds of bad air caused all kinds of disease. They had no concept that an invisible organism could cause so much damage, and that was what germ theory was about. Belluevue physicians were really on the forefront, particiularly the younger physicians, in pushing germ theory forward.

You also had a hospital where there was no anesthesia until the 1840s, and once anesthesia comes, postoperative infections are still extraordinarily high. It’s only when you have professional nursing and germ care and the coming of X-ray machines and the kind of pathology where you can actually do lab work within a hospital that makes a hospital better at saving a person’s life.

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Applying the lessons he learned as a medical administrator in the Civil War, Edward Dalton organized the nation’s first civilian ambulance corps at Bellevue in 1869. Here, a Bellevue ambulance surgeon provides assistance to an injured New Yorker. Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday hide caption

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Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday

On Bellevue doctors treated two presidents — James Garfield and Grover Cleveland — with very different outcomes

Garfield was hit by two bullets, neither of which was fatal, but the lead surgeon was Frank Hamilton from Bellevue. And Hamilton came down to Washington and he put his finger into Garfield’s wound, and put dirty probes into Garfield’s wound. He didn’t die from the bullets, he died of the kind of infection was brought about by physicians who didn’t believe in germ theory.

About 15 or 20 years later, Grover Cleveland had a mass in his mouth which turned out to be cancerous. It was during the Great Panic of 1893, a serious economic depression. Cleveland did not want to alert his critics. So they hired a yacht with a number of Bellevue surgeons and physicians. They sailed up the East River to a very, very calm piece of water and they removed this mass from Cleveland’s mouth in a one and a half hour operation using every imaginable antiseptic technique available. Cleveland survived the operation and died of a heart attack many, many years later.

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During the 1918-19 influenza pandemic, which killed upwards of 50 million people worldwide, patients at Bellevue slept in corridors, closets, and on beds of straw on the floors. No one was turned away. Courtesy of Bellevue Hospital Center Archive/Doubleday hide caption

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Courtesy of Bellevue Hospital Center Archive/Doubleday

How Bellevue’s response to AIDS epitomizes its ethos

Because it was the place that turned no one away, it dealt with anything that came through New York City: cholera with the Irish in the 1930s, tuberculosis with the Jews and the Italians about the turn of the century, the great influenza epidemics. Bellevue treated more AIDS patients than any hospital in the country, and more AIDS patients died at Bellevue than at any hospital in the country. Bellevue was really in crisis mode at that time.

AIDS was one of the big issues at Bellevue and hospitals across the country. Doctors were wary. There were studies done where even a percentage of young interns thought they had the right to determine whether they would treat these patients or not. In the end, and this is the important point, Bellevue prevailed. The Bellevue message prevailed. The ethos that we treat everybody, regardless of their disease, regardless of their social standing. And they did. And I think that people look back at that era with great pride.

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