In the Hot Seat
Emily Toth Martin, an assistant professor of epidemiology at the
University of Michigan School of Public Health, spoke with senior editor
Sarah Feldberg about how Zika spreads and why the mosquitoes that carry
it are so hard to combat. Read More
When the Centers for Disease Control and Prevention (CDC)
released its July 29 update on the state of Zika infection in Puerto Rico, the
news was not good for the island or its tourism industry.
For much of the time since the virus was discovered in Puerto
Rico last November, Zika infections had been relatively stable, though the
number gradually increased each month. That changed in April. Since then, week
after week, the number of new infections in Puerto Rico has grown
In February the official count of new confirmed and
presumptive cases of Zika on the island was 291. By June, that number had
jumped nearly eight-fold, to 2,612. As of July 7, a total of 5,582 confirmed and
presumptive Zika cases had been reported in Puerto Rico, including 672 pregnant
women. Between February and June, the number of pregnant women testing positive
increased almost six-fold.
The Puerto Rican government’s prevention campaign, which
emphasizes controlling the mosquitoes that carry the disease and educating
residents and visitors about how to protect themselves from bites, appears not
to be working. Based on previous patterns of similar outbreaks on the island,
the CDC reported that “the Zika virus outbreak exhibits no signs of abating.”
Puerto Rico is by no means the only destination dealing with
concerns about the spread of Zika. The CDC has issued travel notices regarding
Zika for 25 nations in the Caribbean, 12 countries in South America and in
Mexico, among other places.
In fact, in an unprecedented move last week, the agency
advised pregnant women to avoid Miami’s Wynwood neighborhood, where the first
locally transmitted cases of Zika in the U.S. mainland have been identified.
For public health officials, tracking and containing Zika is
difficult because while Zika infections in pregnant women have been associated
with microcephaly, a birth defect in which an infant is born with a
smaller-than-normal head, severe neurological damage and a range of long-term
problems, most people who contract the disease exhibit no symptoms at all.
Four out of five Zika patients are believed to be
asymptomatic, and among those who do display symptoms, it often manifests as a
mild illness that includes fever, rash, joint pain and conjunctivitis.
Emily Toth Martin, a professor of epidemiology at the
University of Michigan School of Public Health, said last week that when the
CDC reports a total of 5,582 Zika cases in Puerto Rico, “there are probably a
lot more asymptomatic cases than what is encompassed in that number.”
Another difficulty is fighting the Aedes aegypti mosquito,
which spreads the disease, along with other viruses like chikungunya and
dengue. They typically breed in standing water, and evidence suggests that they
might be resistant to some of the sprays being used to eradicate them. In
Puerto Rico, where the summer wet season brings nearly daily rains and standing
water collects in numerous places, battling Aedes aegypti has been particularly
Martin said the Florida Department of Health recommends
surveying the property to get rid of standing water: “It says even a bottle cap
with a couple drops of water needs to be taken care of.”
The final challenge is convincing both residents and
visitors that they must take the threat of Zika seriously and protect
themselves sufficiently by using mosquito repellent and wearing long sleeves or
Aedes aegypti are “day-biters,” Martin said, so some classic
techniques, like staying inside when dusk falls and using a bed net or window
screens, “don’t apply.”
In Puerto Rico last week, the CDC held a seminar for hotels
about how to eliminate mosquito breeding grounds around their properties, and tourism
officials have tried to layer their promotional campaigns with information on
how visitors can stay safe.
The Puerto Rico Tourism Company (PRTC) is giving
recommendations to hotels about informing guests on Zika prevention, including
signage, a letter from the PRTC for in-room distribution and providing bug
spray for sale or for free.
“We do want to make sure that the visitors come and are well
educated and they feel they are being informed about what Puerto Rico’s doing,”
said Ingrid Rivera Rocafort, the PRTC’s executive director.
Margie Hand, an agent and Caribbean specialist with Andavo
Travel, said, “For me, this has not been an issue with Puerto Rico in
particular. But it does continue to be a situation that I am asked about from
every honeymoon couple or babymoon couple. I can’t tell you how many people
say, ‘I want to go somewhere where they don’t have Zika.’”
Alyssa Scheppach, the call center director for
CheapCaribbean.com, said the company has seen a jump in calls from clients
concerned about the disease in Mexico and the Caribbean, as well as 850
cancellations due to Zika. “Every time it pops up in the news we’ve seen an
increase” in calls, she said.
She said CheapCaribbean.com tries to provide its agents with
the most up-to-date information, and it refers clients to the CDC or to their
primary care physician for further questions. So far, clients seem to be
continuing with their travel plans. Bookings across the site are up 17% in
2016, and Scheppach said Puerto Rico business mirrors that growth.
Puerto Rico tourism overall, however, has taken a hit. After
record growth in 2015, Rivera said the numbers have dropped following the Zika
“In January we had growth of 10.9% in hotel registrations,”
Rivera said. “In February we started seeing a bit of a softness versus February
of last year.” In the months that have followed, room tax collections have
dropped 6.5% year over year due to fewer visitors and to hotels dropping their
Rivera, however, doesn’t see Zika having a long-term impact.
She sees Zika following the chikungunya pattern, causing widespread concern at
first, then fading into a fact of life affecting fewer people as everyone
learns how to deal with it.
Jamie Biesiada contributed to this report.