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Aug 6, 2016

From A to Zika

Co-produced with PRX Logo

The Zika virus already has spread swiftly across the island territory of Puerto Rico. And now, Miami is reporting its first cases in people infected by local mosquitoes. This week, Reveal takes us to the front lines of the battle against the disease.

In Puerto Rico, about 1,000 miles southeast of Miami, we tour one of the poorest neighborhoods in San Juan. It borders a polluted river that serves as an ideal breeding ground for the Aedes aegypti mosquito, carrier of the Zika virus. We meet a woman living next to the river who has lost all hope of attempting to keep the bugs out of her house. Down the street, an 18-year-old neighbor is pregnant and Zika positive. We learn about her journey, from her diagnosis to her new treatment at the Hospital Universitario, Puerto Rico’s public university hospital. There, one of the territory’s most renowned doctors describes a crisis that’s not just growing, but exploding.

Next, we head to a neighborhood called Wynwood, just north of downtown Miami, where more than a dozen people have been infected by local mosquitos. It’s the first time the virus has been transmitted by insects domestically, and now this community is ground zero for Zika at home. We talk with the head of mosquito control in Miami-Dade County, who’s doing his best to keep Zika from spreading, and a virologist with more troubling facts to share.

Reporter Amy Walters continues her Zika journey to one other high-risk area: Texas’ Lower Rio Grande Valley, one of the poorest regions in the country. She meets one pregnant woman who’s facing the possibility of Zika head on. The community clinics are ill-equipped to handle this crisis, and they aren’t alone – Texas is short on doctors. According to one study, Texas needs 12,000 more physicians to meet our per-capita national average. And about half the state has no OB-GYNs. It’s an ominous report. And Zika hasn’t even arrived in Texas – yet.

Dig Deeper

  • Read: Did our reporter get Zika?

Credits

Support for Reveal is provided by The Reva and David Logan Foundation, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation and Mary and Steven Swig.

Track list:

  • Camerado, “True Game (Reveal show theme)” (Cut-Off Man Records)
  • Dirty Three, “Rude (And Then Some Slight Return)” from “She Has No Strings Apollo” (Touch and Go Records)
  • SUBSET, “NLD2016 SIDE B” from “SUBSET meets Netlabel Day 2016 at The Dub Factory”
  • KILN, “Royal Peppermint Forest” from “Sunbox” (Ghostly International)
  • SUBSET, “Chiloe” from “Series 70” (cCommunity)
  • Shigeto, “Look At All the Smiling Faces” from “Full Circle” (Ghostly International)
  • Shigeto, “Look At All the Smiling Faces” from “Full Circle” (Ghostly International)
  • Dirty Three, “Indian Love Song” from “Dirty Three” (Touch and Go Records)
  • Shigeto, “Field Trip” from “Lineage” (Ghostly International)
  • SUBSET, “Taganga” from “Series 70” (cCommunity)
  • Blue Dot Sessions, “In the Back Room” from “Studio J” (Blue Dot Sessions)
  • KILN, “Hong” from “Sunbox” (Ghostly International)
  • Jideh High, “Melodica Time (Sound System Style)” from “Melodica Time” (Angel Dust Records)
  • Laszlo Harsanyi, “The Latin Lounge” from “Havana Heat” (Sound Tube)
  • Ketsa, “Tree Tops” from “Subconscious Communications” (Ketsa Music)
  • Minus, “Rooftops” from “Buzz.RO! 2011 [LCL11]” (Local Records)
  • Robert Fripp + Brian Eno, “The Heavenly Music Corporation” from “No Pussyfooting” (Polydor Records)
  • Cahill Locksmith, “Diamond Variety” from “Starter Kin” (Power Moves)
  • Cahill Locksmith, “Rail in Window Nights” from “Starter Kin” (Power Moves)
  • Cahill Locksmith, “Sentence Ends” from “Starter Kin” (Power Moves)
  • Cahill Locksmith, “Sentence Ends” from “Starter Kin” (Power Moves)
  • SUBSET, “NLD2016 SIDE B” from “SUBSET meets Netlabel Day 2016 at The Dub Factory” (The Dub Factory)

TRANSCRIPT:

Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal's radio stories is the audio.

Section 1 of 3          [00:00:00 - 00:14:05] (NOTE: speaker names may be different in each section)

Al:

From the Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson. Consider 2016 the summer of Zika, the mosquito born virus that can cause birth defects in babies has landed in the US.

Female:

For many Americans, the excitement over this weekend's unofficial start of summer is mixed with fears of that Zika virus.

Female:

Thousands of people may have contracted the Zika virus before returning to the US. That's from the CDC Tuesday.

Male:

The Zika virus is spreading out of Florida, where the governor has declared a state of emergency in 4 counties, and ground zero for the outbreak Brazil is struggling to contain it with prominent voices now calling for this summer's Rio Olympics to be cancelled.

Male:

Utah health officials say an elderly patient who was infected with the virus has died.

Female:

It's what health officials have been preparing for for months. Investigators say they may have discovered the first cases of Zika being spread within the US mainland.

Male:

This morning, we learned that 4 people in our state likely have the Zika virus as a result of a mosquito bite. This means Florida has become the first state in our nation to have local transmission of the Zika virus.

Al:

Zika has been threatening to invade the US all summer long. Now, it's finally happened. The numbers are growing. The CDC reports over a dozen people in the Miami area who caught the disease from domestic mosquitoes. This is a huge development, and could quicken Zika's spread. Until now, all the roughly 1600 Zika cases in the continental US could be traced to people who caught it while traveling or who had sex with someone who had traveled. Adults who are affected might not even know it. Some people don't get any symptoms, or the symptoms are common complaints, like fever, rash, joint pain, and pink eye. For unborn babies, the virus can have devastating consequences, including microcephaly. It's a serious birth defect that causes children to be born with abnormally small heads and brains. We're going to visit Miami where mosquitoes are spreading Zika, and ask, "Is the US prepared to stop the disease?" First, we turn to Puerto Rico, where the outbreak has already infected about 7300 people. About 800 of them are pregnant women. Reveal's Fernanda Camarena joins us with more on that. Fernanda, tell me about what you saw in Puerto Rico.

Fernanda:

I visited Puerto Rico in June, which is their rainy season. It's easy to see how it's a perfect storm for Zika. It's humid, it's crowded, its economy is suffering a massive debt crisis. Its poverty rate is 45%. Put this all together and it lacks the resources to fight the crisis. The CDC is actually there, and they are working to learn more about how Zika is transmitted.

Al:

While they are trying to figure out how it's transmitted, the virus is continuing to spread, correct?

Fernanda:

Yes. The CDC says 25% of the population could be infected with Zika by the end of this year. That would mean 875,000 of the island's 3.5 million people.

Al:

Fernanda, what's the government doing to stop Zika.

Fernanda:

Al, I took a ride along with a team called Emergency Zika Management, which was created by the local government, and they from time to time do what they called local impact to address the Zika crisis. It's lead by [Guespo 00:03:24], and he told me that they go all around Puerto Rico every week. They pump up the salsa music through giant speakers on the back of a pick up truck, and take off to the streets with about 30 people. [inaudible 00:03:42] is in charge, and he goes from house to house handing out Zika care packages. It's basically a Ziploc bag with larvicide, bug repellent, and some informational brochures.

Guespo (?):

[Spanish 00:03:54]

Fernanda:

He asks people if they know about Zika, then explains what it is. People listen to him but don't appear to be alarmed. Like most Puerto Ricans, they don't really see the threats.

Al:

Is that pretty much all these teams do?

Fernanda:

Well they spend a lot of their time collecting discarded tires, where water can pool and attract mosquitoes. They also clean out abandoned homes that attract the insects, and they spray, too. It's a huge problem. In the back of another open bed truck, a contraption that resembles a cannon fires pesticide fog called [inaudible 00:04:36]. Now, this substance is recommended by the CDC as the most effective right now. The gas is strong. I could hardly breathe and had to interrupt my interview to run out for a second. I can only imagine what it does for kids playing outside.

Al:

That sounds like some seriously heavy stuff. The question I have is, is all of it working?

Fernanda:

I don't think it's making much of a difference. [inaudible 00:05:04] says fumigations happen daily, but residents say they're not happening everywhere, or as often as they should. I caught the sense that the health department is overwhelmed by Zika. Here's how [inaudible 00:05:17] puts it.

Guespo (?):

It's like a boxer. You're in a fight and you have your guard high, but in the middle of the fight, you get tired and you put your guard down.

Al:

Fernanda, it seems like Puerto Rico is the perfect storm for Zika as you said.

Fernanda:

Yeah, it is. I spent most of my time in a barrio that many consider the eye of the storm. Deep in San Juan, the air is sweet. Tall sugar cane plants sway in the breeze. This is Gladys's backyard. Her hands are brown, wrinkled, and weathered, a testament to a life of labor. Gladys rips away leaves and snaps a thick stock of sugar cane and she offers it to me. The plant is fragrant and fresh but it's the only thing sweet here. The houses are tightly packed and falling apart. Chickens roam the streets. I'm in Barrio Obero, one of the poorest neighborhoods in San Juan. Right behind Gladys's sugar cane patch, I see the banks of the Martin Pena canal, a murky 4-mile channel that cuts through San Juan villages in gentle curves. It's shaped like the line on a heart monitor that's barely beating. It's one of Puerto Rico's most polluted streams. I see that it's stagnant, clogged by trash, sludge, and human waste, a perfect breeding grounds for the Aedes aegypti mosquito, carrier of the Zika virus. The water is deep brown and reeks of sewage. During heavy rains, the banks overflow and flood Gladys's yard, along with their neighbor's.

Gladys:

[Spanish 00:07:06]

Fernanda:

She remembers a particular night when the flooding was so intense she felt like she was drowning on the Titanic. This channel like the Titanic, may soon become synonymous with tragedy. Doctor Donald Ye, an associate professor of the Department of Biological Sciences at the University of Southern Mississippi thinks this river and more specifically the trash in and around it may hold important answers about Zika and the mosquitoes that spread it.

Donald:

The virus simply uses the mosquito in many cases, as a way to grow its numbers.

Fernanda:

In May, Doctor Ye and a team of scientists from the environmental protection agency set a mosquito trap in Gladys's backyard. They collected and froze more than 100 Aedes aegypti females from the Martin Pena canal. The water may hold high levels of nitrogen gas from the human raw sewage. Scientists want to know how that nitrogen may affect mosquito's immune system.

Donald:

Nitrogen is often times beneficial for the production of mosquitoes. In other words, if you put more nitrogen into the system, you often are able to grow more mosquitoes, and they're bigger too, which has a whole bunch of ramifications.

Fernanda:

It's like the stream could be breeding super mosquitoes. Those bugs then fly into homes in Barrio Obero. Many Puerto Ricans do not have window screens or air conditioning. The Aedes aegypti buzz right in and bite. They also lay eggs in tiny pools of standing water around the house. In Gladys's kitchen, small puddles of water collect on the counter and in dirty pots and pans. Next to me, the inside of a coffee mug is lined with mosquitoes. The health department has been trying to educate Puerto Ricans about the importance of eliminating all standing water inside their homes. This is exactly where mosquitoes like to reproduce, but that message hasn't resonated with Gladys.

Gladys:

[Spanish 00:09:13]

Fernanda:

"I can't be scared of Zika," she says. The most important thing here is [Spanish 00:09:20], keep on moving, and get out of poverty. Any fear Gladys has about Zika sails out the door with the mosquitoes. For one of her neighbors, the threat hits home. About 5 doors down from Gladys sits a pink house with a white fence. On the front porch, I notice a young woman spraying bug repellent all over her body. She has fair skin, hair that hangs down to her hips, and delicate features. Her prized possession dangles around her neck, a rosary made out of gold. It's her only jewelry. I notice she has a small stomach popping from her white tank top. She's 5 months pregnant.

Carla:

[Spanish 00:10:14] I went to a CVS and bought the pregnancy test. I came back and dropped it in a bag so no one would see it. I then went upstairs. I was really nervous. I took the test and it came out positive. I thought, "What will my family say?" I felt like I let them down.

Fernanda:

We're calling this 18 year old woman Carla. She wants us to protect her privacy because we're discussing private health issues. She found out she was pregnant in February. One month later, she felt sick after a huge storm flooded the banks of Martin Pena, trapping people inside their homes for a few days. A doctor from WIC, a federally run program that aids women and children, passed through her neighborhood. The doctor was testing for Zika. It took Carla a week to get her results. She was positive.

Carla:

[Spanish 00:11:06] I wanted to cry, but I was trying to listen to her. When she left, that's when I started crying. I said, "God, why? I'm not a bad person. Please make my baby be okay."

Fernanda:

Many women have to wait up to 2 months to get results from overburdened local clinics. If they are positive, their children may have birth defects. The delay creates a huge problem for women who may wish to have an abortion. As for Carla, she decided against an abortion. She's having a girl.

Carla:

It's like, I don't know, an instinct. I feel like everything is okay. There's nothing wrong with her.

Child:

[Spanish 00:11:54]

Fernanda:

She now lives with her boyfriend and his family, including his little niece. It's a big support system. Since Carla was diagnosed with Zika, she started going to the high risk pregnancy unit at the university's hospital. Her boyfriend regularly joins her for weekly prenatal sessions here. I wanted to see how doctors are advising pregnant women about Zika, so I went to a prenatal session. About 12 pregnant women and their partners sit in a circle. A nurse gives them the latest Zika information and they take turns sharing their stories. She passes out goodie bags that include a mosquito net for their beds, repellent, and a pamphlet with more information. Each woman gets a sonogram, and the Zika positive patients meet Doctor Alberto De La Vega. According to the health department, there are more than 700 pregnant women diagnoses with Zika in Puerto Rico. Half of them come here.

Alberto:

Most of them are very worried when they come to us.

Fernanda:

De La Vega's an OB/GYN and chief of the ultrasound unit. He says he's treating 4 to 5 new Zika cases every day. That number doubles every month. He's already seen 3 cases of birth defects including microcephaly.

Alberto:

What you see is a normal appearing child except for the fact that the head is much smaller than expected. The forehead may be slanting backwards because there is a smaller degree of brain matter.

Fernanda:

He says sonograms can only tell you so much, and worries the most for babies born who don't appear to have microcephaly.

Alberto:

Defining the problem based on finding or not finding microcephaly is ignoring the fact that this infection may be much more severe and serious than we can even imagine, because it could produce learning disabilities and neurological problems.

Section 1 of 3          [00:00:00 - 00:14:05]

Section 2 of 3          [00:14:00 - 00:28:05] (NOTE: speaker names may be different in each section)

De La Vega:

Learning disabilities and neurological problems that will only be manifested in the future. That's the real problem.

Fernanda:

De La Vega told Carla that her ultrasound as of now appears to be fine. It's not a crystal ball into whether the child will be healthy. Like many patients, Carla doesn't know if she contracted Zika through a mosquito or her partner. Zika is very unusual for a mosquito born illness, because it can also be passed on by unprotected sex.

Rullan:

This becomes very difficult human problem, because of the fact that you get initially infected by a mosquito, but then you amplify it tremendously by sex.

Fernanda:

That's Doctor Johnny Rullan, an epidemiologist and former health secretary of Puerto Rico. He came out of retirement to advise the current governor. Officially, Puerto Rico has about 7,300 cases of Zika. Doctor Rullan believes that number is much higher. He says 9,000 people are getting infected every day. He is pushing for a public campaign about safe sex, but he says historically, it's been hard to get people on the island to follow that advice.

Rullan:

Puerto Rico in the past, we're okay at knowledge. We're pretty okay in attitude. It doesn't always translate change in behavior.

Fernanda:

He also says Puerto Rico needs to eliminate the places where mosquitoes breed. He initially advocated aerial spraying, but there was a public backlash over health concerns, and he has now backed off that idea. Rullan believes that old cemeteries need to be drained of standing water. Thousands of abandoned tires need to be collected, and millions of mosquito traps need to be set. It's an enormous and expensive plan.

Rullan:

Science drives it, but then you need to get policy management, and you need to then follow up and get it done.

Fernanda:

Puerto Rico hasn't been able to get it done. A few weeks after I interviewed Doctor Rullan, he quit his post. He was frustrated with the island's response to the virus. In a statement, he said the outbreak was now out of control. After months of fighting Zika, Doctor Rullan decided to go on vacation to Spain.

Al:

That was Reveal's Fernanda Camaraina. Next, we head back to the mainland ...

Captain:

Flight attendants prepare doors for departure. Stand by for roll call.

Al:

... where an understaffed and underfunded mosquito control program is struggling to contain the first locally transmitted cases of Zika.

Captain:

Ladies and gentlemen, we'd like to welcome you to Miami International Airport, where the local time is 9:45.

Al:

That's next on Reveal.

David:

Hey podcast listeners, I'm David Rodriguez, and I've been interning at Reveal this summer. If you want a behind the scenes look at how this hour in Zika came together, go ahead and open up Instagram on your phone right now. I'll wait. Search for Reveal News. We've uploaded photos and videos from the front lines of the battle against Zika. Check them out and give us a follow.

Al:

From the Center for Investigative Reporting and PRX, this is Reveal. I'm Al Letson. Before the break, we were in Puerto Rico, where officials are failing to control a full blown outbreak of Zika. Now, we head to Miami where the spread of the virus is picking up pace. Right now, Florida is home to about 400 travel related cases of Zika. People who either caught the disease while traveling or had sex with someone who was, and for the first time ever in the continental US, more than a dozen people have been diagnosed with catching Zika from local mosquitoes. It's been traced to one neighborhood in Miami, Wynwood, an artsy touristy part of town. Now the Center for Disease Control and Prevention has done something extraordinary. They're advising women who visited Wynwood after June 15th to avoid getting pregnant for 2 months. Reveal's Amy Walters was in Miami earlier in June. The city is a gateway to the US where every day people arrive from countries where the Zika virus has taken hold.

Amy:

When I got to Miami, I did what a lot of people do, hit the clubs. Not to party exactly, but to ask people or rather shout questions at people about Zika.

 

[inaudible 00:18:56] Zika in Miami.

Female :

Oh no way.

Amy:

Can I ask? Do you mind?

Female :

I mean, I don't know anything about it. Sure.

Amy:

There's a bar, a dance floor, a bowling alley, and an ice rink here at Basement. You can see how not everybody has Zika on their mind.

 

Do you mind if I ask you if you're worried about it?

Male:

She just got here from Zika Land.

Amy:

I'm not sure you caught that, but that guy told me his date just flew in from Columbia, what he called Zika Land. Other partiers I met were from New York, even Greenland, and at least one couple I talked to were from Brazil, where this recent outbreak got going. There was one woman who was really worried.

Female:

Yeah, I'm worried about that. I'm freaking scared. The fact that mosquitoes could just bite you whenever. They are everywhere, so it's not like you can really know which mosquito is good or not. It's not cool.

Amy:

Are you trying to get pregnant?

Female:

No. Not anytime soon, no baby.

Amy:

Miami is ground zero for Zika in the continental US. At least that's what [Charlmars Baskas 00:20:05] says.

Charlmars:

I know the mosquitoes transmit Zika. It's the most highly [inaudible 00:20:10] mosquito in this county. It's everywhere.

Amy:

Charlmars has a pretty good grasp on the Zika situation here. He runs mosquito control for Miami Dade. His accent's from Nicaragua, where he grew up with mosquitoes, lots of them. He remembers the health department fighting them off when he was a kid.

Charlmars:

I remember this from malaria, and spraying the walls of the houses with DDT at the time.

Amy:

Inside the house?

Charlmars:

Inside it. [inaudible 00:20:39] inside homes.

Amy:

It may sound extreme but it was actually pretty effective. Back in the 1950s, health officials also used DDT to eradicate the Aedes aegypti mosquito from Nicaragua, Ecuador, Brazil, and other Latin American countries. At the time, they were trying to stop the spread of yellow fever. Because they didn't eradicate that mosquito everywhere, including here in the US, it eventually came back. Now, it spreads Zika and other tropical diseases like dengue which can be deadly, chikungunya which causes fever and joint pain.

Charlmars:

My home town, only half the population was infected with chikungunya. They do have Zika cases. They're reporting Zika cases in Nicaragua. Most of the Central American countries, Caribbean, and South America. It's all over. It's all over.

Amy:

Small world, right? Now, Charlmars is doing what he can to keep Zika from spreading here in the United States. In 1972, the environmental protection agency banned DDT here. Armed with chemicals that are a little less damaging to the environment, and less effective at killing mosquitoes, Charlmars' team of 12 mosquito inspectors, plus some contractors, try to keep Zika at bay. They say they're trying to hire up the 8 more, but it's a poultry team compared to nearby counties like Lee and Key West. Their staffs top 100, with a fraction of Miami's population. Each work day, Charlmars starts by pulling up facts from the health department.

Charlmars:

This is what we receive from the health department on a daily basis. This is Zika.

Amy:

This is a Zika case?

Charlmars:

This is a Zika case, all this. 1, 4, 5.

Amy:

These are 4 different addresses, 5 different addresses?

Charlmars:

4 different, 5 different addresses. We are not supposed to provide you with that.

Amy:

Right. He kept that list close to his chest. It has the addresses of people the Florida Health Department has identified as having Zika. Carlos Vargos, one of the inspectors, who goes out spraying.

Carlos:

The reason is that we need to eliminate the potential. You have mosquitoes around, and if a mosquito bites an infected person, or carrying the virus, that mosquito may be the carrier now.

Amy:

In early June, there was no evidence of that happening here. At the time, all confirmed cases were travel related. In addition to the list from the health department, Charlmars' team also responds to requests from the public. People can call in if they're worried about mosquitoes in their area. We ended up at one of those homes, a lovely Spanish style house in Coral Gables, a pretty upscale neighborhood.

Carlos:

As a matter of fact, the lady of this house, she called because she's now pregnant. She's kind of worried about the Zika virus, which is understandable. It's common, and it's something that is very worrisome, I would say.

Amy:

It rained the night before. There is puddles of water everywhere. Carlos drops granules of insecticide into the garden pots. You can actually see the bugs hovering. Then, Charlmars calls us over.

Charlmars:

Yeah, let me show you something across the street.

Amy:

The sound you're hearing is folks doing yard work at the neighbor's house next door. Charlmars takes me up to what seems to be the most innocent thing in the world, it's a child's tiny toy wheelbarrow with maybe a couple inches of water.

Charlmars:

Don't move. Let them start feeding. See how many there are flying around me?

Amy:

Just to let you know, mosquitoes are landing all over him. That toy has become a nursery for Aedes aegypti bugs.

 

He's just eating lunch.

Charlmars:

Yes. They're hungry.

Amy:

1, 2, 3, 4. You got another one on your hand right now. They're everywhere.

Charlmars:

Yeah, this is getting full with blood. You see he's engorging with blood. This one here on this side.

Amy:

Oh my gosh, do you have 7 on you now?

Charlmars:

Yep. Hopefully they're not carrying the virus.

Amy:

When I was there, there were no cases of locally acquired Zika in Miami yet.

Charlmars:

You see how bad it is? This is real bad now.

Amy:

This is how these guys count mosquitoes. More and more just keep landing, puncturing his skin and sucking his blood.

 

Are you going to get a Zika test?

Charlmars:

I should have, after I came back from Nicaragua, I should have been tested. I still have a chance you see?

Amy:

You actually don't know if you have Zika?

Charlmars:

Yep.

Amy:

Charlmars, the guy running mosquito control in Miami is telling me he could be infected himself. The thing is, even if Charlmars is infected right now, he probably wouldn't know it. Carlos explains.

Carlos:

One of the things that up to 80% of the people that may be infected with the virus, they don't show any symptoms.

Amy:

You don't know who has it.

Carlos:

Exactly.

Amy:

You don't know who is spreading it. Those mosquitoes that we saw, I mean, how do you know if they have it?

Carlos:

You don't.

Charlmars:

Well, we can ask them.

Amy:

We can ask them. That's it right now. All jokes aside, it really comes down to testing. Knowing which mosquitoes have the virus allows mosquito control to know where to spray. When I visited back in June, only 8 out of 67 counties in Florida were testing. Miami Dade wasn't one of them. Charlmars promised they'd start testing soon, and 2 weeks later, they did. Now 28 counties in Florida are testing, but back then when I was there, I thought, "Why don't I try to get some tested?" I was already noticing a couple of bites.

 

Can you save some of these guys for me?

Charlmars:

It's going to be hard.

Amy:

I ended up with 2. I put them in a bottle cap, wrapped them up in a piece of paper, and drove away in the car. The fight against Zika in Miami gives you an idea of just how unprepared the United States is for this disease. The thing that's so surprising? We already have a system that was designed to protect us from mosquito born diseases like Zika.

Jeffrey:

This is Jeffrey Engel, MD. I am the Executive Director of the Council of State and Territorial Epidemiologists.

Amy:

To explain how this system got started, he took me way back to 1999, when another mosquito born virus landed in the US.

Jeffrey:

When West Nile hit New York City in 1999, several people had already died and it was a public health emergency as it spread rapidly over the continental United States.

Amy:

The best got the attention of Capitol Hill. Federal funding was freed up to set up a pretty fancy computer program called Arbonet. Ar for arthropod, that's a kind of bug a mosquito is, Bo for ...

Section 2 of 3          [00:14:00 - 00:28:05]

Section 3 of 3          [00:28:00 - 00:52:00] (NOTE: speaker names may be different in each section)

Amy:

Ar for Arthropod, that's a kind of bug a mosquito is, Bo for Borne and Net for Network. It tracks vector borne illnesses transmitted by mosquitoes but it's only as good at the data it collects so a lot of the federal funding went to state and local mosquito surveillance.

Scott:

The states had no capacity to do vector borne work related to this threat. The fact is that the money for the West Nile virus epidemic was used to built infrastructure for all vector borne disease threats. We hadn't even heard about Zika at the time.

Amy:

You can actually pull up maps based on ArboNET data on your computer right now to follow the spread of viruses like Dengue, Chikungunya and West Nile throughout the United States. It was really successful. Once ArboNET ramped up, deaths from West Nile plummeted. That's when federal funding slowed. It went for 24 million in 2004 to 9 million in 2012. As funding for ArboNET has gone down the number of deaths from West Nile has climbed back up.

 

Her's where we are right now: With all these cut backs there are fewer people to monitor the mosquitoes, fewer people to test them for disease, and less overall mosquito control, so this ArboNET system that relies on data is handicapped and now has less data so it's harder to track mosquito borne diseases and squelch outbreaks before they take hold. Now with the spread of Zika one virologist, Sharon [Iscern 00:29:43], isn't willing to give up on collecting information.

Sharon:

If we could study how these disease outbreaks start and if we can get a better handle on how to control them as they're starting I think we could learn a lot of lessons on how we can handle this globally on a bigger scale.

Amy:

Sharon's volunteered to test Miami's mosquitoes for Zika for free.

Sharon:

It's just a small little sandbox and we can study it from the beginning.

Amy:

Sharon's a scientist at Florida Gulf Coast University and in 2010 she and her husband tested the mosquitoes from the first Dengue outbreak in Key West in half a century.

Sharon:

The mosquitoes come in and the first thing you've got to do is you have to grind them up. This is basically a blender that can take the mosquito bodies and puree them into a little sauce and we can then use ...

Amy:

With Zika, Miami hadn't [inaudible 00:30:33] any bugs yet, but remember those mosquitoes I got?

 

I brought something for you. I know that you said that you have a contract with Miami but they hadn't brought you any mosquitoes.

Sharon:

You actually brought us some?

Amy:

I did.

 

After rifling around in my purse for a minute I unfold the paper holding my mosquitoes.

 

There's 2 Aedes Egyptis in here.

Scott:

These may be the key.

Amy:

That's Scott Michael, Sharon's husband, who's also a virologist.

Sharon:

Look at that. In a little ...

Scott:

In a bottle cap.

Sharon:

In a water ...

Amy:

it was a water bottle cap. There's no soda in there.

Sharon:

No soda in there, so these ...

Amy:

I'm not the scientist. They said they'd send me the results soon.

 

The ArboNET system wasn't just set up to collect data about mosquitoes. It also gathers information on humans infected by them. It just so happened I noticed a couple of sizable welts swelling up on my left forearm. I got bitten by those mosquitoes the day before I Miami there were no local transmissions so it actually seemed unlikely that I had it, but just in case I called up Florida's Zika hotline to see how the system works.

 

Hi Stan. My name's Amy Walters.

 

Stan isn't a spokesperson so I only recorded my end of the conversation.

 

I'm a journalist.

 

Full disclosure.

 

I'm in Florida and I went out with the mosquito control this morning and I guess I got a couple bites from the Aedes Egypti mosquitoes. I wanted to check if I have Zika.

 

His response? You can't have Zika unless you've traveled outside the country. At that time in June there was no local transmission of Zika in Florida so they wouldn't test me.

 

Right, by mosquitoes.

 

But they don't test mosquitoes in Miami for Zika. The next week I got home to California and I wasn't feeling great. I had a fever, which is a symptom of Zika. Maybe I had Zika on the brain, but why take chances? I tried to get it checked out by calling my own health care provider.

 

I was traveling in Miami reporting a story on Zika and I got some mosquito bites and I did sort of come down with a cold and maybe a bit of a fever this week so I wanted to see if it was possible to get tested?

 

It wasn't. Again, unless I'd been out of the continental US, California wouldn't test me either. Until very recently, those were the guidelines from the CDC, so why did things change? What led the CDC to update it's guidelines? One proactive doctor who made the decision to test a patient who hadn't traveled. That's how the first locally acquired Zika cases were diagnosed. I asked Tom Skinner, the CDC spokesman how it happened. The interview was a little rushed. They're a bit busy now as you can imagine.

Tom:

They were sick, they actually had Zika virus so the went to their doctor and they were diagnosed.

Amy:

I've tried to call the hotline and they said unless I've traveled out of the country they can't test me.

Tom:

At the end of the day each doctor makes the call as to whether or not they're going to test somebody for Zika virus infection. We've put out our guidelines to who ought to be tested and the doctor makes a call on whether or not they're going to require a particular test be performed.

Amy:

Going beyond the CDC guidelines is what revealed that mosquitoes were already in the Wynwood neighborhood of Miami spreading the Zika virus and in less than a week the CDC uncovered more than a dozen cases of locally acquired Zika. That led the agency to issue a historic travel advisory warning pregnant women and their partners to avoid Wynwood. This is the first time the CDC has told people to avoid travel to a specific place inside the continental US.

 

The CDCs also recommending that anyone, male or female, who's been to Wynwood wait at least 8 weeks before trying to conceive.

Tom:

Literally, we're making these decisions on a day by day basis based on information that we're gathering each day.

Amy:

They are gathering information. So far, clinicians have tested over 23 hundred people in Florida and they're doing more mosquito testing too. The bugs I took to the lab ended up coming back negative, but Zika was soon found where I'd been in Miami. Skinner says they'd be able to track Zika better if the federal government fully funded ArboNET, the system created to stop the spread of mosquito borne diseases.

Tom:

Hopefully if we can get the money that we've asked for from congress that will help us even better improve our ability to check these outbreaks when they occur.

Amy:

When I asked him how bad this is going to get he just didn't know.

Tom:

We don't have a crystal ball. It's mosquito season and the states where we're likely to see more cases of Zika from locally transmitted mosquitoes are on the alert.

Al:

That story was from Reveal's, Amy Walters.

 

Month's ago, President Obama asked congress to approve 1.9 billion dollars to fight Zika but lawmakers were gridlocked and went on summer break without green-lighting new money to deal with the virus. Congress won't be back in DC until after labor day. As a stopgap measure, the CDC has freed up more than 40 million dollars to states fighting Zika.

 

One other note from the CDCs Tom Skinner: That area of heightened alert for Zika stretches along the southern border of the United States to Alabama, Mississippi, Louisiana and Texas.

Speaker 6:

Ladies and gentlemen, welcome to Harlingen. We're going to be taxing for a few minutes.

Al:

That is where Amy heads next, the Lone Star State, when we come back on Reveal from the Center of Investigative Reporting and PRX.

Julia:

Hey there. Reveal's Julia B. Chan here. I want to tell you about this new fellowship we just launched. It's for journalists of color, specifically working journalists already employed by another media outlet or currently freelancing full time. Throughout the year our staff will work with the fellow to help them produce and report an investigative story. Fellows will be hooked up with skills training, coaching, and editing from mentors here in the Reveals newsroom. This deadline for applications is September 12th so think about applying, or help us spread the word. Go to RevealNews.org/diversity to apply and find out more. That's RevealNews.org/diversity.

Al:

For the Center of Investigative Reporting and PRX, this is Reveal. I'm Al Letson. The sound you're hearing comes from mosquitoes that carry the Zika virus. They're called Aedes Egypti. These were plucked from standing water in the very southern tip of Texas, the Rio Grande Valley, on the border with Mexico.

Dr. Imperial:

Huge, fat mosquitoes.

Al:

That's Dr. Henry [Imperial 00:38:07].

Dr. Imperial:

I wouldn't be surprised if we have a case of Zika in Brownsville. We might not even know.

Al:

He's lead doctor at the Brownsville Community Health Center. This part of the nation is a high risk area for the disease and also one of the poorest in the country. One third of the population is uninsured and the women have limited access to healthcare. Amy Walters went there to continue her Zika journey and met one pregnant woman facing the possibility of contracting the virus.

Amy:

When I showed up here it was a nice hot day, actually really hot and wet and buggy, the perfect conditions to find someone who's worried about these bugs and about them carrying Zika.

Speaker 9:

Lemonade for 50 cents ... Oh, 25 cents, okay.

Amy:

I ran into Bella and Corina, 11 and 8 respectively, over some lemonade at their family's garage sale. I explained the story I was working on and they pointed me to their aunt, Carolina.

Carolina:

Carolina Rocha and I'm from McAllen, Texas.

Amy:

She's tall with dark hair and when I met her, her belly was pleasantly round.

 

How far along are you, do you know?

Carolina:

I am 5 months.

Amy:

Do you know if it's a boy or a girl yet?

Carolina:

Yes, it's a boy. Matthew.

Speaker 11:

I came home to show Daddy something.

Carolina:

That's Joshua.

Amy:

Joshua is 5 and getting used the idea of being an older brother. It turns out Carolina wasn't expecting to be expecting to be expecting either.

Carolina:

Since our oldest is already 5 we just thought it wasn't going to happen, but surprise, it happened.

Amy:

Pretty awesome, right?

Carolina:

I love kids.

Amy:

She works in a daycare, her life basically revolves around them and to have a second, she's thrilled, but she's also heard about Zika.

Carolina:

It's pretty scary, the fact that so many people come from South America and Mexico and into the United States, especially here in the Rio Grande Valley, not knowing of how at first how you could get it, but now that they say the mosquito carries it ... I love being outside. We like going to the beach, fishing. Now knowing that it might cause birth defects is even more scary and the mosquitoes down here are so huge.

Amy:

Have you had ultrasounds yet? Have you been tested?

Carolina:

I did have an ultrasound last month ...

Amy:

The ultrasound had her thinking about Zika. They saw some issues that are not likely Zika, but she just wants to be sure.

Carolina:

I think when I go I'm going to tell them to test me for it to be on the safe side.

Dr. Imperial:

We don't test. The state always says that we are ready to serve all women of Texas.

Amy:

That's Dr. Henry Imperial again, the Medical Director at the Brownsville Community Health Center. He says if a local outbreak gets going the clinic wouldn't be able to test all the pregnant women who have symptoms connected to Zika even thought that's what the CDC recommends. He said it would overwhelm the clinic.

Dr. Imperial:

It's just one of those, that sort of make the work that we do a lot more difficult and adding to already things that we do for pregnant women, you're going to have to add Zika among them.

Amy:

Many lower income women rely on these community clinics, but this system is starting to sound pretty fragile and Zika hasn't even arrived. Dr. Imperial's next available appointment is in January, next year, and that's normal.

 

Exceptional circumstances like the outbreak of a new virus would crash the system. During the swine flu epidemic, Dr. Imperial's clinic abandoned at least 10 thousand samples without testing them for the disease.

Dr. Imperial:

No point in doing it. We run out of protective masks during the swine flu epidemic.

Amy:

It's not just public health clinics that would be overwhelmed. Texas is short on doctors, way short. According to a federally funded study, Texas needs another 12 thousand physicians to come close to the national average and about half the state has no OBGYNs. For me it was startling. For Carolina, not so much.

Carolina:

I know a lot of doctors don't take care of the women very here in the Valley.

Amy:

Women like her older sister it turns out.

Carolina:

My sister was pregnant and her doctor did not inform her that her child had a stroke while in the womb which is something very rare. It took a year after he was born, after his first birthday, to realize that there was something wrong.

Amy:

Because of her nephew's stroke he has seizures now and no one in this part of Texas can help, so every couple of months they drive at least 5 hours from McAllen to Houston for care. Carolina thinks about families like hers who could be dealing with the long term effects of a disease like Zika.

Carolina:

If the women end up getting the Zika virus here and they have babies, it's just going to cost so much all around and I don't think the state of Texas is ready for that.

Amy:

It's a good point. What about the babies? I went back to the Brownsville Clinic to ask Paula Gomez, the director, how well prepared they are to cope with the potential of babies with Zika, babies that could be born with abnormally small heads and brains. Some Zika babies are even stillborn.

Paula:

I think if you ask about the finances, no, we're not equipped. You can never really be prepared.

Amy:

They've never dealt with the consequences of Zika, but the clinic's seen a similar condition, a baby born without a brain.

Paula:

We weren't prepared for that either. I remember the young woman coming and asking why she was told that her child was in a bottle someplace in the back of a hospital. She wanted that child so she could give it a burial. It created a lot of very, very serious issues for them emotionally and spiritually. The community gets scared, it effects a lot of things. Obviously, this is a little bit different, but I think the devastation of a family is the same.

Amy:

I wondered, what are doctors here telling woman who are thinking about getting pregnant?

Dr. Imperial:

I honestly don't know what to tell women who would like to have babies.

Amy:

That's Dr. Henry Imperial again, who's also at the Brownsville Clinic.

Dr. Imperial:

That's a tough question to answer in terms of asking women not to get pregnant. I was hoping we could get rid of mosquitoes first.

Amy:

The truth is, there's been a lot of different messages about what women should do in all the countries where there's Zika. Back in January, El Salvador asked women to delay pregnancy for 2 years. Columbia and Ecuador urged women to put off getting pregnant for several months and one representative of the World Health Organization was quoted saying, "Delaying pregnancy was sound advice," but WHO policy leaves that decision to the individual.

 

Here in the United States the Center for Disease Control and Prevention is not asking women to delay pregnancies across the board, only if they've traveled to places where mosquitoes are currently spreading Zika, but they are saying women should have access birth control. To be able to make that choice on their own.

Jose:

Responding to the Zika virus is going to take a new view of birth control because of Zika.

Amy:

Jose Camacho is the Executive Director of the Texas Association of Community Health Centers.

Jose:

We have to not only educate, but provide women the ability to prevent pregnancy.

Amy:

Maybe you remember the Texas legislature's fight with Planned Parenthood. In 2011 they restricted funding from clinics associated with abortion providers and shrank the state's family planning budget by 2 thirds. A New England Journal of Medicine study claimed that cutback led to more babies. A lot of that money has been restored, but bringing the system back on board takes time.

Jose:

Leave for just a second the issue of Planned Parenthood aside. There are fewer places where a woman can go to get birth control. When you go in and destroy capacity, it takes years to rebuild. We're still in a rebuilding mode that's showing up with preparedness on issues like Zika.

Amy:

According to John Hellerstedt, the Commissioner of the Texas Department of Health, there is a plan.

John:

Texas is ready. If we have local mosquito vector transmission of Zika in the state we have a plan. We're working with our partners at the national, state, regional and local level on how to respond.

Amy:

Back at the garage sale the heat won't let up. Carolina stands under the sun wearing shorts, not long pants and the long sleeve shirt like the CDC recommends. It's hot here, it's hard to blame her. She was already pregnant when she found out about Zika. She covers herself with repellent and stays inside, but apart from that, she doesn't really feel like there's a lot she can do, but she worries about other women here who are not pregnant yet.

Carolina:

It's kind of scary because the women here in the Valley can't get those birth control and I know my little sister, she's gone to Planned Parenthood and she wanted to get birth control but they were going to charge her 150 which I thought was nonsense.

Amy:

This is Carolina's younger sister, Christina.

Christina:

Why not just cross the border, go get birth control for 7 dollars which covers me for 3 months and I'm good?

Amy:

Did you do that?

Christina:

Yes.

Amy:

It's funny, we're so afraid of this virus coming across the border into the US and now Americans are going the other way into Mexico for birth control. Carolina picks up on that irony.

Carolina:

It would be better if the state of Texas could actually come up with a better system.

Al:

With 3 months of mosquito season left to go, it's not just Texas. The truth is, we could use a better system throughout the US and better funding of systems like ArboNET that we've already set up. The CDC is reporting more than 800 women are pregnant with Zika right now. There are likely more and there will definitely be more to come. It will take months, even years, before we know the effects on those babies, what we do know is the summer of Zika will stay with us long after this summer is gone.

 

Next week we'll have the story of one woman's decades long quest for justice. More on that in a minute. First, today's show was reported and produced by Amy Walters, Fernanda Camarena and Katharine Mieszkowski. Our program was edited by Taki Telonidis. Our sound design team is The Wonder Twins, my man, J Breezy, Mr. Jim Briggs and Claire C Note Mullen. Our Head of Studio is Christa Scharfenberg. Amy Pyle is our Editor in Chief. Susanne Reber is our Executive Editor and our Executive Producer is Kevin Sullivan. Our theme music is by Camarado, Lightning. Support for Reveal is provided by the Reva and David Logan Foundation, the Ford Foundation, the John D and Catherine T MacArthur Foundation, the John S and James L Knight Foundation and the Ethics and Excellence in Journalism Foundation.

 

Be sure to catch next weeks show. We bring you an incredibly intimate story of a woman who comes to terms with the abuse she suffered as a child at the hands of her gymnastics coach.

Speaker 16:

He had set up this mat, a floor mat, but that he could prop up, and he's explaining to me that because I had trouble concentrating and focusing and that he didn't want me to be distracted, that I had to stretch with him behind the mat.

Al:

We follow her story as she reports the crime to the police as a grown woman.

Amy:

At that moment did you feel uncomfortable at that age?

Speaker 16:

Yeah.

Amy:

You already felt like this was something that shouldn't have been happening.

Speaker 16:

Yeah, I remember having this sort of deeply shameful and, slash, sick feeling. Knowing it was wrong, not knowing exactly what to do.

Al:

We'll find out what happens when she tries to bring her abuser to justice. That's next week.

 

Reveal is a co-production of The Center for Investigative Reporting and PRX. I'm Al Letson, and remember, there is always more to the story.

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