Zika was worrying local health officials long before Florida announced the nation's first local transmission from an infected mosquito in late July.
Previously, the virus had already hit US territories, Puerto Rico in particular, and there were almost 1,700 cases in the US, most of them stemming from travelers who had visited a Caribbean or South American country.
But the news out of Florida ramped up concerns. It meant the mosquitoes infected with the virus had arrived in the US, and mosquitoes being far harder to corral and track than humans, concerns about Zika's spread shot to the forefront of many local health departments' agendas.
"If we do nothing, a lot of people will get Zika," wrote Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons in an op-ed this week. "Most will have no symptoms, and most of the rest will have a short, mild illness and become immune to future infections. The epidemic will die down when most prospective hosts are immune. But this is not the strategy we want to follow."
Many cities and counties along the coast and border know this and are preparing in sometimes creative ways. While the list of locales below is by no means exhaustive, it does represent a broad spectrum of efforts to combat Zika or its potential arrival.
Perhaps you can take a page from their books to help protect yourself and your family.
Not just Zika: Being on the Mexican border, home to all three mosquitoes that can carry the Zika virus, health officials here keep a keen eye on any vector, said Hector Gonzalez, director of the city health department. While Zika poses significant concern -- roughly a six or seven on a scale of 10, Gonzalez says -- it's just below drug-resistant tuberculosis, diabetes and dengue fever, of which there are about two dozen cases across the border in Nuevo Laredo, Tamaulipas, he said.
Little fishies help: Because those same mosquitoes can carry dengue, West Nile and the chikungunya virus, city health officials are educating the public on using repellant and ensuring there is no standing water in their yards, which allows mosquitoes to breed. They're also spraying larvacide and planting thousands of minnows in the waterways to gobble up the mosquito larvae before they can grow into dangerous adults.
Get checked out: Testing is important, on both mosquitoes and humans, Gonzalez said. Laredo has tested hundreds of mosquitoes (no carriers yet) and are encouraging residents -- especially women of child-bearing age, travelers to South America and the Caribbean and anyone displaying Zika symptoms -- to get tested.
Bye-bye tires: Also, an ordinance enacted last year has resulted in a 45% uptick in used tires being delivered to the landfill. Illegal tire dumping promotes mosquito breeding, Gonzalez said, because water collects inside, creating a "classic mosquito-breeding environment."
Tip 'n Toss: The Southeast coastal city, like many across the country, is asking residents to remove items from their yards that might collect water. Signs promoting the campaign have been posted in all surrounding counties. Residents are also asked to keep gutters clean, bag and discard leaves, and keep vegetation low. If you have a garden pool or birdbath that's too heavy to dump, try using larvacides, better known as mosquito dunks, doughnuts or torpedoes, said Coastal Health District Director Dr. Lawton Davis.
Bodyguards: Protect yourself, Davis said. That means using an EPA-registered repellant with 20% to 30% DEET, Picaridin, IR3535, or oil of lemon eucalyptus. Also -- and this is asking a lot in the sweltering Southern states most in danger -- wear light-colored clothes, long sleeves, pants and socks to fend off the bugs, he said.
Nothing new: Savannah and the surrounding area have been preparing for months, and the recent news that Zika was contracted in southern Florida "serves as a reminder that we need to be ready," Davis said. The health district has already been distributing letters to schools, government officials and other agencies, and in the event of local transmission of the virus, the city would evaluate the risk, reach out to residents, especially women of child-bearing age, and work with the appropriate counties to target the area with mosquito control measures, he said.
Trucks and planes: The city's Mosquito, Termite and Rodent Control Board has an annual budget of $3.5 million to control pest populations, and Mayor Mitch Landrieu announced this week that it will be getting an additional $500,000 to target the Yellow Fever and Asian tiger mosquitoes. The control board relies on several methods, including mosquito surveillance, education, eliminating breeding sites, biological control, pesticides, spray trucks and "airplane spraying," the city says.
What the heck is a codepod?: Like Laredo, New Orleans employs tiny fish -- specifically, the western mosquitofish -- that consume mosquito larvae in fountains, pools and other man-made bodies of water (the state forbids their deployment in natural bodies of water). And it has another biological tool: tiny crustaceans known as codepods. The aggressive species is found naturally in marine habitats and can eat more than 40 larvae a day and can be added to tires, barrels and cisterns, the city says.
Knocking on doors: In April, the mosquito control board and New Orleans Health Department teamed up with local partners and went home-to-home in the city's high-risk neighborhoods to educate the public. Residents were asked to help reduce mosquito populations by removing the clutter -- especially wading pools, buckets, trash cans and toys -- from their homes and businesses.
Tempered anxiety: Dr. David Persse, the Houston public health authority, says his anxiety level is about a seven on a scale of one to 10, somewhere below what he feels is a dearth of paramedic training in the community (another hat he wears is EMS physician director for the city). Zika "keeps me awake some nights but not all nights," he said.
Extra shift for garbagemen: In some of Houston's more impoverished neighborhoods, contractors illegally dump trash and construction materials in empty lots in the middle of the night. This complicates the city's efforts to combat Zika, as it creates "all kinds of tiny reservoirs for rainwater to collect," Persse said. Houston has thus added an extra Saturday shift for trash pickup in these neighborhoods, and since March, the city has already collected 3,000 tons more trash than it did over the same time span last year. Targeting these neighborhoods is especially important, Persse said, because they have a large population of women of childbearing age, fewer residents may have air conditioning (which mosquitoes tend to disdain) and they may lack the necessary funds to buy repellants and pesticides to protect themselves, Persse said.
3D: The city has come up with a catchy initiative to remind the public to protect itself: drain, dress, DEET, or 3D. Using signage in several languages to accommodate Houston's diverse population, they've also put up signs on buses, trains, and at its airports' international terminals. They've also established health alerts for physicians to keep them apprised of the latest information. There is only so much the government can do, so people need to learn to change their behavior in order to "take away (mosquitoes') food source, which is us," he said. It may not sound like much, but if a person averaged 10 mosquito bites a day, and after putting on long sleeves and applying repellant, they were only bitten twice, it represents an 80% drop, and "that's important," Persse said.
Balancing act: Los Angeles County health officials are "certainly concerned" about the possible transmission of Zika -- for a variety of reasons, including the number of travelers and the wealth of residents who hail from South and Central American countries where Zika has been a problem, said Dr. Ben Schwartz, acting director of the acute communicable disease control program for the county Department of Public Health. The trick, he said, is balancing concerns about Zika's spread -- which he said was "a relatively low-likelihood event, but it's a high-consequence event" -- against illnesses such as diabetes and infectious diseases such as West Nile, of which 24 people in the county died last year (out of 300 cases).
Remain nimble: As the situation has continued to evolve, so has the county, Schwartz said. One example is how officials work with clinicians to adjust their thinking on diagnoses. Earlier this year, the focus was on travel-related cases, but now the county wants doctors to think about the possibility of local transmission, he said. The county also recently expanded its lab capabilities to ensure faster results, he said.
Make folks care: Much like Persse in Houston, Schwartz said he believes knowledge is key to behavioral change. In Los Angeles County, officials have recently adopted a tactic of appealing to people's emotions, rather than relying solely on cognitive messaging. With West Nile, it involves emphasizing that residents' grandparents are at greater risk. With Zika, the emphasis needs to be on pregnant women to drive home "the importance of everyone working together to protect the community," he said. Also, county officials are working on messaging that makes behavior habitual. Southern California residents know to apply sunscreen when they go outside. It's habit. Applying repellant needs to become habitual, too, Schwartz said.
Quick, discreet response: Los Angeles County is a special case. At more than 4,000 square miles, it's massive, and with more than 10 million residents, it's the nation's most populous. The mosquitoes capable of carrying Zika live mostly in the San Gabriel Valley and the eastern portion of the county, Schwartz said. The aforementioned South and Central American communities, meanwhile, are not cloistered in a particular area. They live throughout the county. These factors complicate the risks. So when a case of Zika is suspected, Schwartz said, county heath officials reach out to "vector control agencies," whose teams rapidly and aggressively survey the neighborhood to ensure it's free of the pertinent mosquitoes and that residents are doing what they can to protect themselves. "They do it in a way that is sensitive but also very thorough," he said.
All five boroughs: In April, the city announced a three-year plan to combat the spread of Zika. Its Health Department already had an infrastructure in place to fight mosquitoes carrying the West Nile virus, and this plan "expands mosquito surveillance," increases capacity to test pregnant New Yorkers and launches an awareness campaign, Fight Back NYC, which can be found on buses, subways and on local radio and television. The city also had a "day of action" in June, in which teams handed out educational materials at 20 subway hubs during morning rush hour.
Big money: The $21 million plan creates 51 jobs -- inspectors, exterminators, disease inspectors and lab analysts -- and doubles the number of traps in the city to more than 120. The Yellow Fever mosquito, most often associated with Zika, has never been detected in New York, but the Asian tiger mosquito, which can carry the virus, does live there.
Neighborhood targeting: Areas with high populations of the Asian tiger mosquito are being targeted: the city is eliminating standing water that provides breeding grounds and applying pesticides to kill larvae and adults. If residents see standing water they can't handle themselves, they're asked to call 311. New York is also paying special attention to neighborhoods with immigrants hailing from countries affected by Zika.
Focus on the expecting: Across the city, the Health Department has placed more than 1,000 travel advisory posters in medical centers likely to be visited by pregnant women and is distributing insect repellant through clinicians. The city established a call center for physicians to process testing results and is working with federal authorities to create a national registry of Zika-infected pregnant women.
Charleston, South Carolina
Flooding exacerbates: Zika is "top of mind" for South Carolina, and the state is ahead of the game, said Department of Health and Environmental Control spokesman Robert Yanity. Because of the flooding in October, followed by a relatively warm winter, DHEC warned counties to begin tackling mosquito issues in February, weeks before breeding season.
Coordination: Counties without mosquito programs were encouraged to explore starting one, and though mosquito control is handled at the local level, DHEC helped educate county officials and connect them with counties that have "robust" mosquito abatement programs, such as coastal Charleston County and Buford County to its south, Yanity said. In Charleston County alone, there are 60-70 traps "in places they need to be," he said. Some are permanent, while others move based on data the state collects.
Task force, action plan: Educating the public and encouraging the counties to invest in mosquito prevention are just two prongs of the state's action plan. Another part of it is educating health care providers on what questions to ask when they suspect a patient has contracted Zika. The state also held a forum in April during which it educated officials on every aspect of the disease, from screening to epidemiology to prevention.
Corpus Christi, Texas
Been there, done that: Annette Rodriguez, health director for the Corpus Christi-Nueces County Health District in Texas, says her level of concern is about a two on a scale of 10, but only because mosquito-borne illnesses are nothing new to the area after battling swine flu, West Nile virus and St. Louis encephalitis in the past. "I feel like we've had ample time to prepare," she said.
Re-education: Despite the early initiation, Corpus Christi is looking at things a little differently. For instance, the Culex mosquito that carried West Nile was a nighttime mosquito, so previously, residents were warned to cover up and use repellant from dusk till dawn. The Yellow Fever and Asian tiger mosquitoes (which, pre-Zika, were considered mere nuisances, Rodriguez said) are aggressive daytime mosquitoes, so the county is adjusting its advisories accordingly. Be sure to have screens on open windows and close the door quickly when you go in and out of your home, the district warns.
Tracking: In the swine flu days, the district did it with hard-copy maps and tacks. Now, it has geographic information systems and computers. Mapping is important as health officials do their detective work. If Zika was locally transmitted to a resident in one zip code, officials would want to know if Zika-infected mosquitoes were present in the same zip code. If not, it's important to determine the correlation, even if the person just visited another area for lunch, Rodriguez said.
Never stop spraying: Obviously, every locale is asking residents to use insect repellant, but Rodriguez explained it isn't just for personal protection. Even if you were to contract Zika, officials would urge you to keep applying repellant because it kills any mosquito that bites you. If someone had Zika and wasn't wearing repellant when they were bit, "they've just infected the mosquito population of Corpus Christi," she said.
Odd response: In response to CNN's questions -- namely, how anxious county health officials were about the arrival of the virus and what preparations were under way -- San Diego County spokesman Michael Workman instructed his staff in an email to either ignore the queries or provide a "bland" answer, such as, "We are monitoring and preparing for the potential arrival of Zika." Later, Workman passed on a short statement from San Diego County Health Officer Dr. Wilma Wooten, but it provided few specifics.
Monitoring, communication: According to Wooten, the county is monitoring the situation closely and is working with state and federal health authorities to make recommendations to residents. "We have been working to educate the public, the medical community and our community partners about Zika, and ways to prevent contracting it."