Specter of Zika epidemic looms over a skeptical Puerto Rico
On a sweltering day in a popular shopping district near the campus of theUniversity of Puerto Rico , a young woman with light brown hair strolls past crumbling, grime-stained buildings and construction debris and into a cosmetics store.
She is dressed for tropical island heat in a pink tank top that exposes her arms and shoulders and accents her baby bump.
The woman, Tahiri Velez Rosario, 25, is seven months pregnant with boy and girl twins. She is also infected with Zika, a mosquito-borne virus linked to grievous birth defects.
In any other time, Rosario’s pregnancy would be routine, but nine months ago doctors in Puerto Rico diagnosed their first case of Zika. More than 10,000 people, including 1,035 pregnant women, in the U.S. territory now have it. Doctors worry that babies soon to be born to Rosario and hundreds of women like her will be the first wave of an epidemic of Zika-related birth defects including microcephaly, or incomplete brain development.
When Rosario, a nurse, tested positive for the Zika in her first trimester, she cried. Since then, normal test results tamped down her worry. Rosario suspects the government angst about Zika is overblown on an island that has weathered outbreaks of other mosquito-borne infections.
Zika symptoms are mild compared to mosquito-borne illnesses such as dengue or chikungunya. Rosario had a rash that didn’t itch and nausea she blamed on a plate of bad shrimp.
“I was bit by the mosquito that gives chikungunya and that was much worse. I couldn’t get out of bed,” Rosario said. “My gynecologist told me being pregnant with twins, there are more dangers than Zika.”
Rosario’s comments underscore Puerto Rico’s challenge: convincing a skeptical public to heed dire warnings about a common household pest on a tropical island.
To keep Zika from spreading, health authorities want people in Puerto Rico to cover their bare skin, douse themselves with mosquito repellant, clean up the standing water where mosquitoes breed and accept aerial spraying.
But health experts say it's an epic struggle to persuade Puerto Ricans to fear a creature they've tolerated for decades: the Aedes aegypti mosquito.
And how Puerto Rico responds may be a bellwether for the Gulf Coast, which is expected to become the center of the Zika epidemic on the U.S. mainland.
“I do not trust the government not even a bit,” Rosario said with a roll of her eyes. All the hype, she says, is a ploy. “They say they’re looking for a vaccine. They’re looking for more publicity to get more money.”
Rosario's skepticism is widespread, fed by a mistrust of government authorities who many Puerto Ricans believe bungled the island's finances, allowed corruption to fester and sent the country spiraling into debt.
Puerto Rico, mired in a 10-year recession, is broke. Nearly half the residents live below the poverty line. The island has a $700 million budget deficit and the highest sales tax – 11.5% – in the United States. And the commonwealth failed to make its $900 million bond payment in July.
Zika will actually give Puerto Rico an infusion of cash.
Emergency declarations, such as the public health emergency declared Friday by theObama administration , free up federal money and help keep the government afloat. The grants enable Puerto Rico to hire people during the crisis and whittle away at its 11.2% jobless rate, which is more than twice the national average.
Some of that money will go to Angel Crespo, the island's fire chief, and as of six months ago, the island's Zika czar.
In the next two weeks his office will distribute more than $400,000 in Zika prevention kits. An army of volunteers will go door-to-door handing out repellent, larvicide and brochures in three Puerto Rico cities: San Juan, Caguas and Ponce.
“If you can prevent a baby from coming with a birth defect you ought to do it,” Crespo said.
One of the people he'll have to persuade is Liam Rodriguez, 27.
Rodriguez, wearing a split-sleeve top that exposes her shoulders, sits on a bench in a shady city park flanked by tennis courts and swing sets. She is two months away from delivering twin girls.
“Some doctors want to alarm you,” she said. “I’m chilling. I don’t want people throwing me off my vibe.”
Rodriguez, a radio journalist, says she's wonders about the government's sudden motivation to rid Puerto Rico of a mosquito that has lived on the island as long as she can remember.
“ It’s never going to be gone. Why now do we have to have this massive fumigation?” Rodriguez said. “So when the government signed the emergency act that will provide a lot of federal funds towards Zika that’s when I was like – hmm, follow the money maybe? Is it something more about getting money?”
Such skepticism frustrates medical experts.
The U.S. Department of Health and Human Services has declared a public health emergency for Puerto Rico which will free up funding to help with the fight against the Zika virus. Kelly Jordan, USA TODAY
“Cover up! Use repellant! I tell them every day,” said Dr. Maria Rodriguez as she slaps her hand on a table to punctuate each word.
Rodriguez (no relation to Liam Rodriguez) directs Concilio de Salud integral de Loiza, a nonprofit health clinic an hour east of San Juan that serves 100,000 people in four communities.
More than 60% of the people in her service area live in extreme poverty -- on less than $7,200 for a family of four. The clinic gets nearly $4 million, mostly federal funds, to care for15,000 patients annually.
When asked whether Puerto Rico can afford to care for babies born with Zika-related birth defects, whose lifetime health care costs could top $10 million per child, Rodriguez searches for words.
The 52-year-old doctor explains fights to get medication. She tells of arguments with number crunchers over treatment plans. Finally, she concedes she can’t find the words in either English or Spanish to answer.
Very little with Zika is clear cut. At his fertility clinic in the heart of San Juan, Dr. Nabal Bracero struggles to explain to his patients the importance of prevention and the consequences for failing. Bracero, who leads the American College of Obstetricians and Gynecologists’ Puerto Rican Zika effort, says even doctors don't know which Zika-exposed patients will deliver healthy infants and which patients will not.
“ It’s not easy counseling for physicians,” Bracero said. “Communication is very, very difficult because we have a message that is without the depth and detail people would like to have.”
Only data and time will show what damage the Zika virus can do to fetal tissue, he says.
"There’s all the other damages that happens to the baby’s brain that we are not seeing at birth because it is under the surface," said Bracero, who counsels women to delay pregnancy until a Zika vaccine is available.
Through the Centers for Disease Control and private efforts, more than $15 million in contraceptive drugs and devices are available for free in this overwhelmingly Catholic territory. Bracero said 138,000 Puerto Rican women wanted but lacked access to contraceptives. He hopes the effort gives 40,000 women the birth control they need.
Bracero is waiting to see if the unprecedented availability of free birth control will reduce the number of babies with birth defects. Everyone else is waiting too. For November, when the first wave of Zika-exposed babies is born.
Expectant mothers Rodriguez and Rosario wait with hope, optimism and even a little humor.
“I don’t think being alarmed is going to help my pregnancy, but I will say 'OFF' is doing quite well here in Puerto Rico,” Rodriguez said, referencing a manufacturer of insect spray.
Rosario had a sonogram with a specialist who reassured her.
“I’m not saying everything is going to be right when they are born but now everything is normal,” Rosario said. “He said the girl is the one moving around, jumping up and down.”
James Call reports for the Tallahassee Democrat . San Juan-based journalist Laura Moscoso served as translator for this report.
James Call
Specter of Zika epidemic looms over a skeptical Puerto Rico
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