About an hour after I first met Chalmers Vasquez, I saw him eaten alive.
It was a sweaty summer day in Coral Gables, one of Miami’s tonier suburbs, when Vasquez said he’d seen something he wanted to show me across the street.
He pointed out a small plastic wheelbarrow – a kid’s toy with a little rainwater inside, murky and stagnant. Moments later, the bugs from that tiny puddle swarmed Vasquez.
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“One, two, three, four,” I counted. “You got another one on your hand right now.”
“Yep,” he agreed. “And another one. Two! I got two there.”
Those bugs attached to Vasquez’s skin, dug their proboscises into his blood vessels and sucked out their meal. Mosquitoes generally rely on fruits and flowers for nutrition. Only the female mosquitoes go for blood, and only when they breed.
As the bugs feasted, Vasquez remained surprisingly calm. “This is getting full with blood.” he explained. “You see, it’s engorging.”
More insects landed. I couldn’t believe how many there were.
“Do you have seven on you right now?” I asked.
“Yeah,” he said. “So hopefully they don’t carry the virus.”
That virus is Zika. Miami’s situation indicates just how unprepared the United States is for this disease.
Right now, Florida is home to more than 460 travel-related cases of Zika – more than any state except New York. In Miami, it’s mosquito season, and every Aedes aegypti on Vasquez had the potential to carry the disease. Public health officials blame this bug for thousands of babies born with small heads and shrunken brains in Brazil. The condition, known as microcephaly, is tied to the Zika virus.
When I asked Vasquez, “Could they be infected?” he, in turn, asked the insects. He was making a grim joke, because he had no other way of knowing. In June, Miami-Dade County wasn’t testing mosquitoes for Zika. By August we would find out that mosquitoes exactly like these were spreading Zika just a few miles away.
Vasquez runs mosquito control for Miami-Dade County. He also grew up with the insects in his native Nicaragua.
When he was a kid, officials there sprayed the inside of his home with a pesticide called DDT as part of an effort to combat malaria. Each wall got a full treatment, top to bottom. By 1955, Nicaragua had eradicated the Aedes aegypti mosquito Vazquez sprays for now in Miami.
The species is a multipurpose biological weapon. At the end of the 19th century, Aedes aegypti mosquitoes carried yellow fever – a plague that ravaged low-lying cities like New Orleans and hindered U.S. troops in Cuba and the Philippines.
Aedes aegypti also carries potentially deadly dengue fever, joint pain-inducing Chikungunya virus and now Zika.
A century ago, workers building the Panama Canal fell sick with yellow fever. The construction of the new international shipping route increased fears about the disease’s spread. In 1915, the Rockefeller Foundation mounted an international fight against the fever and the bug behind it. In 1947, one of its research sites in Entebbe, Uganda, set out a sentinel rhesus monkey in a cage. That primate came down with the first documented case of Zika.
By the mid-1950s, Rockefeller-funded DDT spraying had eradicated the Aedes aegypti mosquito from Colombia, Brazil and Nicaragua, where Vasquez grew up.
But in countries including the United States, the bug continued to buzz. Once eradication efforts stopped in Central and South America, Aedes aegypti returned with a vengeance there, too. Now this tiny insect has added Zika to the arsenal of diseases it can spread.
Locally transmitted cases of the virus have just started to spread in the continental U.S., and public health officials expect to record many more. In 1972 the U.S. Environmental Protection Agency banned DDT because of its debilitating effects on other wildlife. Armed with chemicals that inflict less damage to the environment but kill mosquitoes less effectively, Vasquez’s team of a dozen inspectors and a few contractors try to keep Zika at bay.
Until fears about Zika surfaced, the team managed to do a lot with a little. Public mosquito control staffs in nearby Lee County and Key West, Florida, exceed 100 people and deploy airplanes and helicopters in their efforts. Tourism-dependent Key West, with about 30,000 full-time residents to protect, spends upward of $10 million a year to ward off mosquitoes. Miami-Dade County’s budget for the same task is under $2 million a year to protect 2.6 million people.
Miami’s location on the Atlantic coast used to minimize the number of nuisance mosquitoes in that region. But the game is different with Zika now. There is a lot more at stake.
“Aedes aegypti has a very short flight range,” Vasquez said. That fact delivers good and bad news. On one hand, the mosquitoes cannot spread disease very far by themselves. On the other, they aren’t flying all over the place where the insecticides can reach them.
Areawide pesticide application doesn’t easily kill these mosquitoes, Vasquez said. They’re often tucked away, in closets, under beds and inside homes, making them hard to catch.
The national system to protect us from mosquito-borne disease dates back to 1999, when West Nile caught this country off guard. Four people died in New York City, and word reached Capitol Hill. Federal money started to flow. In the decade that followed public health authorities had enacted a robust program, ArboNET, to stop mosquito-transmitted disease. “Ar” for arbovirus, a fancy word for viruses transmitted by mosquitoes, “bo” for borne and “NET” for network. The computer program still exists to track mosquito-borne viruses.
ArboNET was more than just software. The federal money that made it possible also supported state and local government eradication efforts. Dr. Jeff Engel, executive director of the Council of State and Territorial Epidemiologists, said that before West Nile, little to no support for combating mosquito-borne disease existed in the United States.
“The states had no capacity to do public health vector-borne work related to this threat.” Engel said. “The money for the West Nile virus epidemic was used to build infrastructure for all vector-borne disease threats. We hadn’t even heard about Zika at the time.”
Now, people can pull up computer maps based on ArboNET data to follow the spread of viruses throughout the United States.
These maps were really successful. Once ArboNET ramped up, West Nile fatalities plummeted. Interest in – and public spending on – mosquito-borne disease began to flag. The annual federal budget for ArboNET declined from $24 million in 2004 to $9 million in 2012. After that, deaths from West Nile started to increase again.
Some states dropped their epidemiology programs, Engel said, or shifted employees from full-time to part-time.
“The poor person who is doing influenza surveillance in the winter,” he said, “would put on a new hat and do vector-borne disease in the summer.”
These cutbacks mean fewer people in the United States to monitor the mosquitos, fewer people to test them for disease and less mosquito control overall.
While you can still pull up maps that track mosquito-borne disease, they are only as good as the data they hold. With less data, it’s harder to squelch outbreaks before they take hold.
Vasquez’s team at Miami-Dade County Mosquito Control sent Aedes aegypti specimens to a lab. Even with locally transmitted Zika, no mosquitoes in Miami or elsewhere in Florida have tested positive for the virus.
At the end of July 2016, doctors traced one, then two, then 14 people with Zika to the Wynwood neighborhood of North Miami. The doctor in the very first case took the unusual step of testing for the disease even though the patient had not traveled out of the country. At that point the Centers for Disease Control and Prevention had not advised testing people for Zika if they had not traveled outside the United States, but ultimately, the decision comes down to each doctor. This one took action.
The case was the first to offer evidence of locally transmitted Zika in the continental U.S., but it likely will not be the last. The mosquito that bit the patient could have been infected as early as June 15, a week after my visit with Vasquez.
Now, the CDC has issued a historic travel advisory that warns pregnant women and their partners to avoid Wynwood. It’s the first warning to avoid travel to a specific place within the continental U.S. The federal public health agency also recommends that anyone – male or female – who’s visited Wynwood wait at least eight weeks before trying to conceive a child.
“Literally we’re making these decisions on a day-by-day basis based on information that we’re gathering each day,” said CDC spokesman Tom Skinner.
Skinner concedes that tracking this disease could be easier if the federal government had continued to fully fund – and upgrade – ArboNET. But without more federal support, Skinner said, that does not seem likely.
Months ago, President Barack Obama asked Congress to approve $1.9 billion for the fight against Zika. Gridlocked lawmakers went on summer break without greenlighting new money to deal with the virus. Congress won’t be back in session until after Labor Day.
Florida, meanwhile, is investigating a new locally transmitted case of Zika in Palm Beach County – well beyond the other concentration of cases in Miami-Dade County.