How Miami-Dade got outgunned in war on Zika

Despite early alarms, records show the county largely proceeded with business as usual as the summer mosquito season approached.

BY JENNY STALETOVICH
MIAMI HERALD/TNS

MIAMI – As the Zika virus spread across Miami-Dade County this summer, a tiny staff of 17 that handles mosquito control for nearly 2.7 million people was outgunned, overwhelmed and maybe even a victim of its own success: In 2009 and 2010, the county managed to dodge a dengue outbreak that infected more than 100 people in Key West and four years later evaded a rash of Chikungunya.

Miami-Dade County Mosquito Control inspector Sharon Nagel peers into a drain in Miami’s Wynwood district to detect any mosquito presence on July 30 in Miami.(GASTON DE CARDENAS/MIAMI HERALD/TNS)
Miami-Dade County Mosquito Control inspector Sharon Nagel peers into a drain in Miami’s Wynwood district to detect any mosquito presence on July 30 in Miami.
(GASTON DE CARDENAS/MIAMI HERALD/TNS)

But Zika was something different, a mosquito-borne virus with terrifying implications for expectant parents that had ravaged parts of South America.

As early as February, the county led the state in travel-related cases. In April, federal scientists issued dire predictions that ground zero for Zika in the U.S. would likely be Miami, a mecca for both Latin American tourists and the Aedes aegypti mosquitoes that transmit the virus.

The Centers for Disease Control and Prevention repeatedly warned it was a public health threat that called for serious advance planning.

Business as usual
Despite the early alarms, records show Miami-Dade largely proceeded with business as usual as the summer mosquito season approached.

Mosquito staff set up a network of monitoring traps along the coast and marshes — a seasonal strategy designed to track nuisance biters but do little to assess the urban, disease-carrying Zika mosquitoes.

A five-page action plan was drafted — with an initial prevention campaign focused on telling residents to dump and cover containers where mosquitoes breed, a strategy that almost never works.

Mayor Carlos Gimenez told staff to do what was needed and called for a $300,000 bump in the mosquito control division’s $1.7 million budget — a modest 18 percent boost that wouldn’t deliver more money until next year.

Other tactics, which better-financed mosquito control districts implemented, were not pursued. No additional surveys were done to scope out breeding grounds.

No special traps were distributed to track the presence of Aedes aegypti. No larvicide application, or neighborhood fogging outside the marsh mosquito zone in South Miami-Dade, was performed to knock down numbers in advance of the coming mosquito season.

More funds needed
The county plan, for the most part, was to step up measures if and when Zika got a local foothold.

Outside experts say Miami-Dade could have done more. Given the dense urban population, preventing Zika was probably impossible. More aggressive and expensive tactics might have helped limit public exposure, but would have busted the budget in Miami-Dade, which has cut mosquito control spending in half since 2007.

The county now spends about 64 cents each year for every resident. The Florida Keys, in contrast, spends about $208 per resident — far and away the state’s gold standard for mosquito control.

“When you consider the population of Miami-Dade and the area you’re dealing with, you can’t do anything of any consequence toward controlling mosquitoes with that little bit of money. It’s just not possible,” said Ed Fussell, who helped pioneer aerial larviciding as head of the Florida Keys Mosquito Control District between 1997 to 2011.

Borrowed traps
As the outbreak spread, the county juggled a fast-emerging public health crisis and public relations nightmare. The five-page plan posted on the division’s website was removed after Raquel Regalado, a mayoral candidate opposing Gimenez, complained in a televised debate that too little was done to prepare for the outbreak.

Officials discontinued compiling daily mosquito reports after the Miami Herald requested them, then resumed them in a new form that emphasized wider control efforts implemented after the local outbreak.

Throughout July, as travel-related cases mounted, trucks fogged just 10 locations countywide. Once health agencies confirmed local transmission in Wynwood on July 29, the small mosquito control division scrambled to confront the outbreak.

The daily reports show the division dispatched three to five inspectors with backpack foggers in the days that followed and deployed a truck fogger four times.

By the time a mosquito-fighting team from the Centers for Disease Control and Prevention arrived in early August, just six Aedes aegypti traps, some of them borrowed, were being monitored by the county in Wynwood, CDC officials said.

‘Something new’
The summer battle has shown the proposed $300,000 bump estimated to for expanded mosquito control was absurdly low. Gimenez now estimates that the county will spend about $10 million this year to fight Zika. The state has set aside, but not yet sent, another $5 million.

County officials defend the Zika campaign, rejecting the argument that more traps in different places would have made a difference. Chalmers Vasquez, chief of the mosquito control division, said it’s long been known that Zika mosquitoes infest much of the community.

“Miami-Dade County is a huge area. We have 300 square miles and we’re going to find these mosquitoes in the same number, maybe a little denser from block to bock, but in the same number all over,” he said. “We are learning. This situation is something new.”

And comparing what happens in Miami-Dade to other parts of the state is unfair, Gimenez said.

“Miami-Dade is different. Our demographics are different and our visitors are coming from around the world,” he said. “Money was never the object. My directions were very clear: Don’t worry about the money.”

Sluggish response
Within the tight confines of the Wynwood neighborhood, with its open-air restaurants and international travelers, preventing the virus would have been nearly impossible, he said.

“Monday-morning quarterbacking is really nice, but our experts did what they thought they had to do,” he said.

In fairness, Miami-Dade is not alone in getting caught flat-footed. The response of state and federal officials at times has also been sluggish or difficult to assess because of overlapping bureaucratic responsibilities and a lack of information.

Gov. Rick Scott has made numerous appearances to recap ongoing efforts, but the state has supplied few details about how it prepared in advance of the looming public health threat.

The Department of Agriculture usually oversees mosquito control but the state health department took over distributing money once Zika became a public health threat, a spokeswoman said. The health department did not respond to a request for what steps agency leadership took in advance of the outbreak.

Divvying up traps
The agriculture department also failed to distinguish the elevated risk in Miami-Dade when it distributed a tight supply of traps designed to monitor Zika mosquitoes.

After the German company that manufactures the traps, called BG Sentinel, ran out as demands soared over the spring, the state back-ordered 310. But when they arrived in June, the state sent only nine to Miami-Dade, bringing the county’s total to 21.

The well-funded East Volusia Mosquito Control District, which has an operating budget of about $25 million for the Daytona Beach area, wound up with 45 traps.

Spokeswoman Jennifer Meale said in an email that the department based its decision on how to divvy up the traps to ensure every county had enough.

“The primary method of identifying local transmission of Zika is through interviews of case patients; however, our goal in distributing traps and testing mosquitoes for Zika is to provide a secondary surveillance measure to detect the virus in mosquitoes,” she responded when asked why Miami received so few.

Weekly checks
It took until Sept. 6, well after two transmission zones were confirmed in Wynwood and Miami Beach, for Miami-Dade County to complete a surveillance network that will include 61 BG traps.

Those traps will be checked weekly, said Miami-Dade’s Public Works spokeswoman Gayle Love, with another 50 traps ordered and expected to be put out before the end of the season. In recent weeks the county also deployed 200 In2Care traps, which are used to kill mosquitoes, in a field test of the relatively new product.

The CDC has also failed to follow through on some promised help.

In April, the agency rolled out a draft preparation plane that promised to provide counties with risk models showing where Zika was likely to pop up. But the agency has yet to produce the models despite three requests.

By August, the agency revised the plan to instead work with local authorities to investigate factors that might lead to Zika spreading. The agency also created grants to help locals assess risks in May, but the money wasn’t approved until August, CDC entomologist Janet McAllister said.

Battle over funding
McAllister also conceded that while the federal health agency called for more surveillance to specifically track Aedes aegypti, “there really hasn’t been a lot of time for local jurisdictions to have the resources to do that.”

Meanwhile, the battle over federal Zika funding — $1.8 billion requested by the Obama administration in February — remains mired in Congress, with Republicans fighting to deny money to Planned Parenthood in Puerto Rico and Democrats demanding money for water problems in Flint, Mich.

Still, with all the early warnings pointed at South Florida, Miami-Dade’s poorly funded mosquito division stands out for its low-key response.

Collier survey
Other parts of the state, with far less risk, acted more aggressively when it became clear Zika was on the move.

At the start of the season, Collier County, for instance, conducted a survey using simple Ovitraps — small, inexpensive cups that mimic the containers where Zika mosquitoes breed, to map hot spots, said Mark Clifton, a research entomologist with the Collier Mosquito Control District.

“Ovitraps are cheaper and easier (than BG traps). All you have to do is remember where you put them,” he said. “The problem with Aedes aegypti is it’s so very localized that one house may have a bunch and the house next door may be nearly free.”

But Miami-Dade mosquito fighters were closing a decade of reduced spending even as an array of mosquito-borne disease threats increased.

Audit results
In 2006, the division had a budget of nearly $3.7 million for a staff of 29. By 2012, after the Key West dengue outbreak, it fell to $1.4 million for 19 employees.

An audit that year found fewer than five employees were conducting inspections to look for mosquitoes around houses — where the Aedes aegypti and other disease carrying species largely live.

The staff also tended to over-estimate the time it took to complete inspections and usually came up empty-handed, the report said.

Part of the problem stemmed from the way inspections were conducted: residents were not contacted in advance, making it difficult to find the pots, broken bird baths, yard toys and other containers where mosquitoes breed.

About 96 percent of the time no breeding sites were found, suggesting the inspections amounted to a total waste of time. Auditors also reported that during the off season, other districts took advantage of free time to conduct surveillance and training, something auditors suggested Miami-Dade start doing.

With the Zika threat looming last year, county commissioners did take one step to speed the property inspection process, passing an ordinance allowing the county’s 12 inspectors to gain quicker access to yards and sites where mosquitoes might be breeding.

New strategies
Another factor stacked against Miami-Dade. Attacking the urban Aedes aegypti requires a different set of strategies that are still not well understood, experts say, and Miami-Dade’s Zika battle may well provide a testing ground for weapons and tactics others areas will employ to combat mosquito-borne viruses in the future.

“It’s not like we go to a manual and say here’s how you control Aedes aegypti. It’s a field that’s emerging and techniques advancing all the time,” said Clifton, the research entomologist with the Collier Mosquito Control District.

Because of that, surveillance can be tougher in dense, urban areas, he said.

“You could have 9,000 (BG traps) and it probably wouldn’t be enough for Miami,” he said. “Every corner you could have a new trap and it would give you totally new information than the one next to it.”

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