By Brenda Goodman, MA
WebMD Health News
Reviewed by Arefa Cassoobhoy, MD, MPH
March 11, 2016 (Humacao, Puerto Rico) -- Coasting through the streets in a white Jeep Cherokee, Jose Baez holds a cell phone up to his ear with one hand; with the other, he waves down a passing police cruiser.
He has just come from an auto shop, where dozens of tires sit piled up on the sidewalk. Mosquitoes buzz around them.
Baez shakes his head. He's the director of emergency management in this city of 80,000 people, nestled into a lush corner of Puerto Rico's eastern coast.
He's most often on call when weather disasters strike. But since February, when Puerto Rico's governor declared a public health emergency because of the Zika virus, it has been his job to try to reduce the local mosquito population.
He is trying, but this foe is coming at him on all fronts. It's proving to be a challenge more difficult than any storm he has weathered.
The people who own the tire shops, called gombas, are supposed to at least cover the tires so they don't get wet and provide breeding grounds for Zika-spreading mosquitos. But most don't bother. Baez warns them and then slaps them with a fine if they don't comply.
"This one is right around the corner from a gynecologist's office," he says, pointing to one of the worst offenders.
His men are at the business with a truck now to haul off the tires, but the owner of the shop has told him that it isn't a good time. They want him to come back.
"You see, they don't want to do anything," he says, exasperated.
He asks the cops to cite the owner of the tire shop.
Baez knows that pregnant women are at great risk from Zika. Mounting scientific evidence suggests that the virus can cause grave birth defects, damaging a developing baby's brain, eyes, and nervous system. The virus is transmitted primarily through mosquitoes.
Humacao is where the island's first locally transmitted Zika case was found. But when asked if he has known anyone who's gotten sick with Zika yet, Baez shakes his head. "My friends? My neighbors? No," he says. "I hope I never know anyone who has Zika."
Fighting Mosquitos Everywhere
Most of Humacao's buildings are squat, square, and concrete, ornamented by ironwork. Dwellings are stacked one on top of the other, tilting at odd angles up hills and tumbling into ravines. Bougainvillea spills over the edges of corrugated tin roofs.
Baez is the man who stands watch over it all. His staff of 60 work 24 hours a day in three shifts, answering calls for help from around the city.
The city has set up a new 311 line that people can call if they're having trouble with mosquitos. The phone rings constantly. Baez or an assistant always answers.
Today, he is taking us around the city.
With the island's economy in a tailspin, plenty of the homes here sit abandoned, with trash spilling out of their doorways. Dumped refrigerators hang open in empty lots, filling like bathtubs after heavy rains.
Baez's men are working diligently to clean up trash around the city. But when a bank forecloses on an abandoned home, it becomes private property, and he's not allowed to go in and clean it up.
In fact, anywhere water collects can be a problem. The mosquitos known to spread Zika are a species called Aedes aegypti. They are known as "clean water" mosquitos that like to breed in small amounts of rainwater than collect in garbage, in rain gutters, or even in the water in saucers under potted plants inside houses. But in Puerto Rico, the mosquitos have happily taken to breeding in sewage sitting in hundreds of septic tanks across the island -- opening up a whole new front in the battle to kill them. Many tanks need screens and repairs to keep them from becoming threats to people.
Baez pulls up to one of the three cemeteries he manages in the city. Nearly all the headstones have vases attached, so that the bereaved can leave flowers to honor the dead.
The vases fill with water when it rains. He's begun pouring gravel and sand in them to prevent them from collecting water. He also sprinkles granules of larvicide he hopes will fill the nooks and crannies that he can't reach.
He wants to be sure the dead can't visit fresh misery on the living.
He points up the hill from the cemetery. "There are houses up there," he says. "There's a school right over there."
Then there are the tires.
Problems Pile Up
About 5 years ago, Baez says, the Puerto Rican government ran out of money to pay a company contracted to haul old tires off the island.
The tires piled up. They sit in mounds outside schools, on street corners, in vacant lots. Tire stores sell new ones and then take the customers' old tires, which crowd the sidewalks in front of their stores. When it rains, the tires collect water and the mosquito eggs laid in them hatch, sending clouds of a flying menace into the air.
Baez has had crews going all over the city to collect the tires. Each week, he collects 300 to 350 tires. There's supposed to be some kind of machine coming from China, he says, that will compact them so they can be recycled. It was supposed to be here weeks ago. In the meantime, the tires are filling two old warehouses to at least get them under a roof and out of the rain.
He drives to one of the warehouses. It is stacked floor to ceiling with 200,000 tires -- the number of tires they've collected in about 1 month, he says. Mosquitos buzz everywhere inside.
Someone calls to Baez from outside the warehouse. They need him to come spray the tires down with insecticide again. Residents of the buff-colored condominiums that sit next to the tire warehouses are complaining about the mosquitos.
At night, he uses three trucks equipped with powerful fogging machines to spray an insecticide called permethrin out into the streets. Recent tests by scientists at the CDC have shown that mosquitos in Puerto Rico have become resistant to permethrin. It doesn't kill them anymore. Baez knows this. But he sprays anyway.
"We keep on going with that one because that's the one we have," he says.
Asked if his efforts have made a difference, he says, "We're doing what they've asked us to do."
"I have to get these cleaned up. There are people over there."
Close to Home
We've asked Baez to help us track down a resident of Humacao. Her name is Zulmarys Molina. She is 29 and a single mother to a 3-year-old son. She's one of 150 people with a confirmed Zika infection on the island, and she is 18 weeks pregnant with a girl.
"Molina? He says. "I think I know her."
He asks for the address again, and his face falls.
"It's right over there," he says, pointing to the condominiums on the other side of the tire warehouse --the ones that are swarming with mosquitoes.
We head over there. When we meet her, Baez smiles. He recognizes her. He gives her a big hug.
"I've known her since she was a little girl," he says. Her brother and his son are very close friends.
He didn't know she was pregnant, or that she'd been infected.
"That was when I got really scared," she says. "They told me to go to the emergency room so they could test to see what the symptoms were for."
She got pregnant in October, two months before the first case of locally transmitted Zika infection was announced in Puerto Rico. At the time, there were few news reports about Zika or its connection to birth defects. She didn't wear insect repellent, she says, because pregnancy had heightened her sense of smell and the odor of the spray made her nauseous.
Her pregnancy was unplanned, but she never thought of ending it.
Nine days after she had her blood taken in the emergency room, she got a call from her doctor. Her test results were in, but they wanted her to come to the doctor's office to get them. She was at work when she got word. It took her 30 minutes to drive there.
"I cried. I was shaking and all those thoughts going through my mind," she says. "But then I calmed down and said, 'Nothing is going to happen, God is with me."
"Maybe if I was going to react and be more anxious or more nervous, then it was going to affect my pregnancy, so I calmed down," she says.
Her new doctor, a specialist in high-risk pregnancies, is doing regular ultrasounds. So far, the baby, a girl that she will name Michaela, seems healthy. Zika is thought to be most dangerous in the first trimester of pregnancy when a baby's brain is still forming. Molina was in the second trimester when she was infected, but just barely. She was 14 weeks along.
"Anything could happen," she says.
She has held off having an amniocentesis, a test that could show whether the baby has been infected with the virus. If the result is positive , there isn't much they can do.
"With that information, we can't do nothing else," she says. "I don't want to know because that might make me depressed or maybe more worried with what's going on with my baby, but I prefer to be like this and keep thinking that nothing is going to happen."
Baez's face is filled with emotion as he listens.
"It's very sad," he says, as we're getting ready to leave. "She's close to me."
"But she's going to be a great thing for me, for us, for the Zika," he says. "Because I know I can call her and she can give the message to another woman," he says. "I'm going to be checking on her."
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