Ed Slavin for Mosquito Control Board -- my response to WJCT/Jacksonville Today questionnaire

Here are my updated responses to the WJCT (NPR affiliate) and Jacksonville Today questions on my candidacy to be a Commissioner of the Anastasia Mosquito Control Commission of St. Johns County (AMCD), Seat 1:

Age

67

Background

A summary of the candidate's background

I've lived in St. Johns County since November 5, 1999 -- 25 years ago. First visited in 1992. Fell in love with St. Augustine, its history and nature. "We, the People" love this magical place and I have worked to preserve, protect and defend our democracy, our precious historic and environmental heritage. Let me use my problem-solving abilities to protect the people of St. Johns County. In 2006-2007, I helped persuade the five person board of our independent mosquito district to cancel an unwise, illegal, no-bid, supposedly "sole source" luxury $1.8 million helicopter contract with Bell Helicopter. It took nine months of effort. Finally, after replacing several attorneys, our mosquito control district commissioners listened. We, the People in St. Johns County were finally heard and heeded. AMCD won a full refund of our 10% deposit to the helicopter manufacturer. My dad told me, as JFK's dad told him, that you have to stand up to people with power, or else they walk all over you. At age 26, as Appalachian Observer Editor, I won Department of Energy declassification of our frail planet's largest-ever mercury pollution event (Oak Ridge, Tenn. Y-12 Nuclear Weapons Plant), a national scandal, triggering nationwide cleanups; our Appalachian Observer newspaper was recommended for a Pulitzer Prize by Anderson County DA. Clerked for USDOL Chief Administrative Law Judge Nahum Litt and Judge Charles Rippey. Intern and junior staffer for Senators Ted Kennedy, Gary Hart & Jim Sasser. B.S.F.S., Georgetown University.; J.D., Memphis State U. (now University of Memphis). Advocate for worker rights. Your watchdog, termed an "environmental hero" by FOLIO WEEKLY (after reporting City of St. Augustine's illegal dumping of 40,000 cubic yards of contaminated material from a landfill in a lake). Helped encourage state and federal governments to remedy the City's illegal dumping and illegal sewage effluent pollution in our saltwater marsh). Shall we ask questions, demand answers & expect democracy? It is up to us.

Campaign website

www.edslavin.com

Your plans

How do you believe the role on the Anastasia Mosquito Control District can best be used to benefit the residents of St. Johns County?

In 1943, my dad was infected with malaria when he was bitten by a mosquito in Sicily, as an 82nd ABN DIVN paratrooper: he recovered in Army hospitals, but suffered lifetime effects. The mosquito is the most dangerous animal on Earth, killing some 600,000 people annually. Controlling fatal disease-spreading mosquitoes requires both good government and good science -- asking questions, getting answers and expecting democracy. Let's help make our Anastasia Mosquito Control District of St. Johns County work wisely and safely. To protect our way of life, we must assure that AMCD will practice good science and safeguard our tax dollars, protecting public health, the environment and public funds, advancing research and education while protecting scientific integrity and employee whistleblower rights; We must safeguard the independence of AMCD, an independent scientific and technical organization. We must assure that "whistleblower" ethical employees are heard and heeded whenever they raise concerns. Let's resist any further effort by the St. Johns County Board of County Commissioners to take over independent AMCD, as was attempted by misguided leaders, misled by a longtime former SJC County Administrator, fired in 2019. I opposed hiring of any more AMCD lawyers without Florida Bar Journal ads and thorough statewide searches and vetting. I oppose evergreen audit contracts. I oppose arbitration clauses in AMCD contracts: the late Supreme Court Justice William Rehnquist said that the Seventh Amendment right to civil jury trial ia "bulwark against oppression." Yes, I've been a watchdog of mosquito control environmental protection and spending since December 2006.

Why?

Why should voters choose you?

I am the only child of well-read working class parents. My dad was an 82nd ABN DIVN paratrooper who helped liberate the first French town from Nazi oppression, taking it back before the sun rose on June 6, 1944. I am blessed that my parents, my teachers and my mentors taught me to ask questions, demand answers and expect democracy. I support strong effective mosquito control measures, advancing research and education while protecting scientific integrity and employee whistleblower rights; safeguarding the independence of AMCD. AMCD must remain an independent scientific and technical organization; protecting public health, the environment and public funds. Let's assure that "whistleblower" ethical employees are heard and heeded whenever they raise concerns. Let's resist any further effort by the St. Johns County Board of County Commissioners to take over independent AMCD, as attempted by a misguided former SJC County Administrator. I oppose allowing arbitration clauses in AMCD and other government contracts, Yes, I've been a watchdog of mosquito control environmental protection and spending since December 2006. Yes, it is up to us to do this right.

Biggest issue

What is the biggest issue the Mosquito Control District faces? How do you propose the district combat it?

Overdevelopment, flooding and climate change. The University of Florida's Institute on Emerging Pathogens identifies "development" as one of three (3) co-factors to the growth of mosquito-borne diseases in Florida. Mosquito control issues must be considered in St. Johns County's comprehensive plan and development application approvals. Is our St. Johns County government rubber-stamping overdevelopment? You tell me. Some 33 neighborhoods suffer from excessive flooding, much of it due to poor planning, with some approved by a titled County Engineer, who was not a licensed engineer. Mosquito control scientists must be heard and heeded on the effects on public health of sticking large subdivisions adjoining swamps. Too often, governments chill and retaliate against free speech. Too often, people in government are discouraged from speaking out and doing their jobs "too well." Let's base public policy on good science and protect our free speech rights as Americans.  As the late U.S. Attorney General Robert F. Kennedy said, "If our Constitution had followed the style of Saint Paul, the First Amendment might have concluded--"But the greatest of these is speech." In the darkness of tyranny, this is the key to the sunlight. If it is granted, all doors open. If it is withheld, none."  Mosquito control employee free speech rights must be protected and not neglected: no illegal gag orders.  We're protecting public health and  combatting deadly mosquito-borne diseases, using natural and chemical pesticides and three helicopters.  Let's do it right, with good science and sound management. I would be honored to have your vote. 

Thank you.

With kindest regards, I am,

Sincerely yours,

Ed Slavin

Box 3084

St. Augustine, Florida 32085-3084

www.edslavin.com

http://www.cleanupcityofstaugustine.blogspot.com

http://www.staugustgreen.com

(904) 377-4998

Ed Slavin for Mosquito Control Board: My response to WJXT (News4Jax questions)

My response to WJXT (News4Jax) questions re: my candidacy for Anastasia Mosquito Control Board of St. Johns County, Seatt 1: 

Ed Slavin

Occupation: Retired

Age: 67

Family: My parents, the late Ed and Mary Slavin, helped organize unions. Dad survived malaria in WWII (South Jersey Chapter of 82nd ABN DIVN ASSN named “CPL Edward A. Slavin Chapter” in his honor). My father got malaria in Sicily WWII as an 82nd ABN DIVN paratrooper. My parents taught me, as JFK’s parents taught him, that you have to stand up to people with power or they walk all over you. When AMCD bought a no-bid luxury $1.8 million Bell luxury jet helicopter in 2006, I counted on my mom’s advice as a former purchasing secretary at Camden County College in South Jersey. Our Mosquito Control District got a full refund of our deposit and we learned a valuable lesson about the need for frugality and competitive bidding.

Education: B.S.F.S., Georgetown University School of Foreign Service. J.D., Memphis State University Law School (now University of Memphis).

Political experience: Your watchdog, called an “environmental hero” by Folio Weekly. 

What do you see as the top three issues in this race, and how do you plan to address them?

Advancing research and education while protecting scientific integrity and free speech rights; safeguarding the independence of AMCD as an independent scientific and technical organization; protecting public health, the environment and wisely spending public funds. How? Asking questions and encouraging open, honest transparent government. 

How can you help voters in a way that others running for this office cannot? 

Long experience as a watchdog of mosquito control and environmental protection here in St. Johns County, including helping persuade AMCD Commissioners to vote 5-0 in 2007 to cancel contract for illegal, no-bid $1.8 million purchase of a luxury jet helicopter, resulting in a full refund. Longtime advocate for government accountability and protection of worker and citizen rights.

What would you hope to be remembered for accomplishing after serving in this office? 

Inspiring better informed decisionmaking on spending and on environmental, safety, health and scientific issues.

Campaign website: edslavin.com

Campaign social media: None given

Elect Ed Slavin to Anastasia Mosquito Control Board of St. Johns County, Seat 1

To St. Johns County voters: May I please have the honor of your vote -- either early, or on November 5, 2024 -- for a seat as Commissioner of the Anastasia Mosquito District of St. Johns County, Seat 1?

Here's my Q&A with the League of Women Voters:

What motivated you to run for office?

It's our money. I've been a watchdog on mosquito control since 2006. Mosquitoes could bring us the next global pandemic. We will be prepared with data, research, education, and environmentally-friendly, non-toxic natural pesticides. My dad was an 82nd Airborne Division paratrooper, infected with malaria in Sicily. Dad recovered in Army hospitals, but we saw dad suffer lifetime effects. LWV's Ms. Robin Nadeau asked me to help her investigate Anastasia Mosquito Control of St. Johns County, buying a $1.8 million no-bid, luxury Bell Jet Long Ranger helicopter incapable of killing a single skeeter, not unlike buying a Porsche to use with a snowplow. We persuaded AMCD to cancel illegal, no-bid helicopter contract, saving $1.8 million in 2007.  

What do you see as the most pressing issues for this office and how do you propose to address them?
Advancing research and education while protecting scientific integrity and employee whistleblower rights; safeguarding the independence of AMCD, an independent scientific and technical organization; protecting public health, the environment and public funds. Let's assure that "whistleblower" ethical employees are heard and heeded whenever they raise concerns. Let's resist any further effort by the St. Johns County Board of County Commissioners to take over independent AMCD, as attempted by former SJC County Administrator Michael Wanchick and County Commission Chairmen. I oppose allowing arbitration clauses in AMCD contracts, Yes, I've been a watchdog of mosquito control environmental protection and spending since December 2006.

What training, experience, and characteristics qualify you for this position?
Helped persuade our independent mosquito district to cancel unwise, no-bid luxury $1.8 million helicopter contract. Won declassification of our frail planet's largest-ever mercury pollution event (Oak Ridge, Tenn. Y-12 Nuclear Weapons Plant),triggering nationwide cleanups; recommended for Pulitzer Prize by DA. Clerked for USDOL Chief Administrative Law Judge Nahum Litt and Judge Charles Rippey. Staffer for Senators Ted Kennedy, Gary Hart & Jim Sasser. B.S.F.S., Georgetown U.; J.D., Memphis State U. Your watchdog, termed an "environmental hero" by FOLIO WEEKLY (after reporting City's illegal dumping of landfill in lake and illegal sewage effluent pollution of our saltwater marsh). Shall we ask questions, demand answers & expect democracy?

How important are environmental concerns when making decisions for the Anastasia Mosquito Control District?
Very important

Explain your answer.
Rachel Carson's "Silent Spring" informs good science and use of non-toxic natural pesticides as much as possible. Amid global climate change, the next pandemic could be a mosquito-borne disease. Let's protect AMCD independence, education and applied research to protect public health and our environment. I support AMCD's leadership on natural pesticides. I once reported FEMA and AMCD to federal environmental law officials when bald eagles were exposed to organophosphate pesticides. Support AMCD working with other mosquito control districts and officials to share scientific knowledge to protect all of us "non-target species": mosquito control workers, residents, tourists, pets, horses, livestock, bees and other pollinators, flora and fauna. 

St. Johns County is growing rapidly. How does this impact the management of mosquito control?
Overdevelopment increases the expense of mosquito control and increases exposure of families to mosquitoes from wetlands. St. Johns County Commissioners, developers and their big money clout decide way too many unwise development decisions. This requires our nimble small mosquito control special taxing district to innovate, with sensitive adaptation of mosquito control techniques to protect entire new neighborhoods, which seem to spring up overnight, adjoining wetlands. Public education, applied research, sound science-based policies and non-toxic mosquito control methods, are all essential to protecting public health from mosquito-borne diseases. AMCD exists to prevent any outbreaks of deadly mosquito-borne diseases. We must do it right!

Dengue fever is surging worldwide. A hotter planet will make it worse. (Lena Sun and Sarah Kaplan, WaPo, June 30, 2024

I would be honored to have your vote in November 5, 2024 General Election for Seat 1 Commissioner, Anastasia Mosquito Control District of St. Johns County. From The Washington Post:

Dengue fever is surging worldwide. A hotter planet will make it worse.

Climate change helped fuel an explosion of dengue cases in the Americas, including Puerto Rico, as mosquitoes multiply in warmer, wetter weather. 

By Lena H. Sun

 and 

Sarah Kaplan

June 30, 2024 at 9:00 a.m. EDT

Genesis Polanco Marte, 9, is treated by a doctor, Zurisadai Rivera Acosta, as a suspected dengue case at Hospital Auxilio Mutuo in San Juan, Puerto Rico, on May 30. (Erika P. Rodríguez for The Washington Post)

SAN JUAN, Puerto Rico — The curly-haired girl came to the emergency room with fever, aches and signs of dehydration, common indications of many childhood illnesses. But the 9-year-old — pale and listless beneath her Pokémon blanket — looked sicker than most children and exhibited no respiratory symptoms. She could only whimper as a pediatrician stroked her hair and softly questioned her in Spanish.

The sharp-eyed doctor suspected dengue, a disease that is often missed but is now exploding around the world.

The girl, Genesis Polanco Marte, is among a record 10 million peoplewho have fallen ill with dengue so far this year — an unprecedented surge that scientists say is fueled in part by climate change. Soaring global temperatures have accelerated the life cycles and expanded the ranges of the mosquitoes that carry dengue, helping spread the virus to roughly 1 in every 800 people on the planet in the past six months alone. An influx of patients has overwhelmed hospitals from Brazil to Bangladesh, recalling the worst days of the coronavirus pandemic. Puerto Rico declared a public health emergency this spring, with more dengue cases reported in the first five months of 2024 than all of last year. Public health officials are bracing for the virus to crop up in more temperate regions, including the southernmost portions of the United States.

“The storm’s comin’, folks,” Grayson Brown, executive director of the nonprofit Puerto Rico Vector Control Unit, advised a group of California officials in a recent webinar. “It’s here in Puerto Rico, but you guys are going to feel it pretty soon.”

Soaring global temperatures have accelerated the life cycles and expanded the ranges of the mosquitoes that carry dengue. (Video: Alisa Shodiyev Kaff, Drea Cornejo/The Washington Post, Photo: Erika P. Rodríguez/The Washington Post)

Last week, the Centers for Disease Control and Prevention warned of an increased risk of dengue infections in the United States, urging clinicians to stay on alert for the disease when treating feverish patients who have traveled to places with dengue transmission.

But even as human-made warming spurs cases to historic highs, dengue remains one of the world’s most neglected tropical diseases, according to the World Health Organization. Three out of four cases are mild or asymptomatic, making the illness difficult to track. And because the virus comes in four varieties, or serotypes, natural immunity after one illness does not protect against future infections with other types. What makes dengue unusual is that the risk of severe complications may actually increase with sequential infections of a different type.

There is no cure for the virus, which in severe cases can lead to plasma leaking from veins, internal bleeding, organ failure and, in rare instances, death. Unlike other illnesses, vaccination is complicated. Few options are available, and few people know about them. The only vaccine available in the United States is for children 9 to 16 years old who have already been infected with dengue — those most vulnerable to hospitalization. But it won’t be available after 2026.

The crisis in Puerto Rico is a warning sign for the rest of the United States. It shows how quickly an outbreak can metastasize in communities with fragile infrastructure, underfunded health systems and temperatures that get hotter with each passing year.

Without drastic action to control the virus and slow climate change, research suggests some 2 billion additional people across the globe could be at risk for dengue in the next 50 years.

Rising temperatures spur global dengue spread

It has been more than a decade since Puerto Rico saw its last dengue outbreak. Though the virus is endemic in the territory and typically recurs every five to seven years, that cycle was interrupted by the emergence of Zika — a closely related virus that tore through the island in 2016 and gave some cross protection against dengue — and the isolation measures necessitated by the coronavirus.

But the return of global travel — especially Caribbean cruises — brought thousands of tourists who had been exposed to dengue elsewhere, introducing strains that hadn’t been dominant in Puerto Rico. The virus spread swiftly through the population of susceptible people, reachingGenesis in late May.

The girl had been feverish for several days before she arrived at the hospital. Her doctor, Zurisadai Rivera Acosta, pressed on the girl’s fingertip and saw it took longer than normal for the color beneath to return to pink — a sign of dehydration. More concerning, the doctor noted, she had begun vomiting and her count of blood platelets was low. Rivera admitted the girl to the hospital amid signs her condition was deteriorating. Genesis was one of 91 dengue cases reported in Puerto Rico that week, health department data show.

Puerto Rico public health officials are bracing for case counts to soar as the island heads into the hot and rainy season. By mid-June, the territory had reported more than 1,500 cases. At least two people have died.

Sweltering and stormy is the preferred weather for Aedes aegypti, the mosquito that is the main vector for dengue in the Americas. It lays its eggs wherever there is standing water: in vent pipes of septic tanks, water meters, discarded tires and broken flower pots. A single bottle cap filled with rainwater can hold more than 100 eggs, said Sadie Ryan, a medical geographer at the University of Florida who specializes in insect-borne diseases.

“They’re tenacious, they’re pernicious,” Ryan said. “Really, they’re just good at being everywhere.”

Its eating habits further bolster the bug’s ability to wreak havoc. Unlike the mosquitoes that transmit malaria, which require only a single blood meal before laying their eggs, female Aedes aegypti are “sippers,” Ryan said. They behave like tiny vampires at a human buffet, flitting from person to person, potentially spreading disease with each bite.

In Puerto Rico’s crowded urban areas, most families cannot afford air conditioning so they keep cool by opening windows and doors, which lack screens to keep mosquitoes out.

Meanwhile, human-caused warming is spawning an explosion of mosquitoes here. Greenhouse gas emissions, mostly from burning fossil fuels, have raised average temperatures in the commonwealth by about 2 degrees Fahrenheit since 1950, according to the National Centers for Climate Information.

The change has been a boon to Aedes aegypti, which is able to transmit diseases at higher temperatures than other mosquito species. In laboratory experiments, researchers have found that warmer conditions can make the insect grow faster, bite more people and lay more eggs. Heat also makes the dengue virus more infectious and allows it to replicate faster inside its hosts.

Models and real-world data show that these mosquitoes can transmit dengue at temperatures ranging from 64 to 94.1 degrees Fahrenheit — conditions that are found in Puerto Rico every month of the year.

Though this species is found in several states, including Texas, Florida and even California, the mosquito’s predilection for heat has historically limited dengue’s reach. Even when the virus hitches a ride via travelers from tropical regions, low nighttime and winter temperatures prevent it from spreading very far.

But officials are increasingly concerned that rising temperatures could set the stage for more outbreaks in the United States. Florida has already reported eight cases from local spread this year, health department data show — and the state’s warmest months are yet to come.

“Even one case in an area that doesn’t usually see dengue can consume a large number of resources, as well as create considerable public concern,” said Gabriela Paz-Bailey, chief of the CDC’s dengue branch in Puerto Rico. “It means the mosquito has acquired the virus, and you have the potential for additional transmission happening.”

In tropical regions across Latin America, Africa and Asia, where dengue once circulated primarily during summer months, a lengthening warm season is turning the disease into a year-round phenomenon. Meanwhile, the shifting climate is allowing dengue to infiltrate temperate regions and high-altitude communities where it has never been found before.

Nepal, which hadn’t seen a dengue case before 2004, recorded more than 50,000 cases in each of the last two years. Mauritius and Chadhave experienced their first-ever significant outbreaks in the past 12 months. Meanwhile, Italy, France and Spain documented dozens of instances of local transmission of the virus in 2023 — suggesting the disease may be gaining a foothold in spots where winter cold once kept it at bay.

But it’s not just rising temperatures that contribute to disease spread, researchers say. Climate-induced droughts can prompt people to stockpile water, creating more mosquito habitat. Escalating hurricanes and floods also produce standing water while simultaneously forcing people from their homes and increasing their exposure to mosquitoes, said Mallory Harris, a disease ecologist at Stanford University.

By combining climate models with simulations of disease spread, Harris is developing techniques that can help link cases to climate disasters — and project how future storms and droughts could trigger new outbreaks. In an analysis of Cyclone Yaku, which ravaged Peru’s northern coast in March 2023, she found that the storm was responsible for 33,000 dengue cases. Nearly 400 people died of the virus.

Only U.S. dengue vaccine runs out in 2026

The fact that the dengue virus comes in multiple serotypes and has an unusual mechanism for causing severe illness in people makes it especially tricky to fight. An infection with one type generates disease-fighting antibodies that protect a person from future infection with that variety. But those same antibodies can bind to viruses of a different serotype, facilitating their entry and causing more severe illness.

Dengvaxia, developed by the French-based manufacturer Sanofi, is the only vaccine approved for use in the United States. It protects against all four dengue types and is approved for children 9 to 16 years old living in high-risk areas such as Puerto Rico. The shots are covered by most health insurance plans. But the three-dose regimen — administered six months apart over the course of a year to be fully protected — requires patients to have a laboratory-confirmed previous dengue infection. It’s the only vaccine with such a requirement, complicating rollout efforts in vulnerable communities.

In May, WHO expanded the use of a second vaccine, Qdenga, which is already approved in several hard-hit countries, including Argentina, Brazil, Colombia and Indonesia and throughout Europe. The vaccine, developed by the Japanese company Takeda and is recommended by WHO for children ages 6 to 16, requires only two shots and can be used regardless of prior infection. But the company withdrew its application from the Food and Drug Administration in July 2023 because of data collection issues.

A third vaccine being developed by the National Institutes of Health is still in clinical trials and won’t be available in the United States for at least a few years.

Meanwhile, health-care workers in Puerto Rico lament that few residents know about Dengvaxia.

At HealthProMed, Hector Villanueva, the community clinic’s senior adviser for dengue, urged Mayra Rivera to vaccinate her teenage nephews, whom Rivera took in this year after their parents died. The boys had been hospitalized with fever, vomiting and diarrhea from the virus in January. Villanueva warned they could become even more severely ill if they were to be infected again.

Rivera eagerly signed them up for shots. The 13-year-old, whose diabetes can make dengue more lethal, received his first dose in April. His older brother is scheduled to receive his shot in July.

But uptake among other children in Puerto Rico has been slow. Many parents aren’t aware of dengue’s dangers and after the pandemic, are tired of hearing about getting more vaccines, Villanueva said.

“Most of the cases, they didn’t know they have dengue or they may have mild to moderate symptoms, so there is low perception of risk,” Villanueva said. “Parents are saying, ‘What are you talking about? Dengue, does that still exist?’”

Only 145 children in Puerto Rico have started the vaccine series since it became available in 2022, according to CDC — a tiny fraction of the roughly 140,000 eligible.

And now access to the vaccine is closing. A few months before Puerto Rico declared its public health emergency in March, Sanofi informed U.S. officials that it has stopped producing Dengvaxia because of low demand. The last doses will expire in August 2026.

Adam Gluck, who leads Sanofi’s U.S. corporate affairs, said the company tried making the vaccine easy to access but the complexity of screening for a prior infection before administering the required three doses kept demand low. The decision to discontinue the vaccine “is not driven by quality, safety or efficacy concerns,” he said in a statement.

Rivera said she is grateful her nephews qualify to receive the shots but is dismayed other children will no longer have the chance to protect themselves against dengue. “If they stop making these vaccines,” she said, “a lot of people will die.”

Combating dengue in Puerto Rico

On a recent steamy morning, a mosquito-control technician from Puerto Rico’s Vector Control Unit peered into a trap outside a home, a plastic bucket filled with water and hay whose odor was designed to attract egg-laying females. Sure enough, when he opened the trap, a mosquito with white markings was stuck on the special adhesive paper.

With schools out for the summer, another group of technicians went from classroom to classroom at a nearby elementary school, trapping mosquitoes to identify locations that could have been super spreaders.Workers thrust vacuum-like machines along walls, in corners, under piles of papers to flush out the insects, then caught their quarry in butterfly nets.

Unlike many mosquitoes, Aedes aegypti tend to bite during the day and are resistant to the most commonly used insecticide. So officials must focus on identifying and destroying mosquito habitats in high-transmission areas to reduce spread.

Teams rely on low-tech traps placed outside homes to collect mosquitoes, then test them to determine what percentage carry the virus. In areas with high rates of dengue-carrying mosquitoes, field teams apply larvicide and go door-to-door urging residents to use repellent and get rid of breeding grounds, authorities said.

The ongoing explosion of cases presages a future in which dengue becomes one of the dominant mosquito-borne threats to humanity, experts said, in some countries even eclipsing malaria. As temperatures in tropical regions get too hot for other mosquito species, Aedes aegyptiis poised to take over.

Singapore, Brazil and Colombia have programs to infect mosquitoes with a bacteria called Wolbachia, which blocks offspring released into the wild from transmitting the dengue virus. But that expensive and labor-intensive strategy has not been approved in the United States.

In Puerto Rico, one big challenge remains awareness among clinicians, who seldom treat the disease. The CDC and Puerto Rico health department are training doctors to monitor for warning signs of severe dengue, including abdominal pain, persistent vomiting and bleeding from the gums or nose. Unlike other diseases, where fever reduction is often a sign someone is getting better, the reverse is true for dengue.

Rivera, the emergency room pediatrician who recently treated 9-year-old Genesis, said she recognized the dengue symptoms in the young patient only because her own aunt and cousin had contracted dengue during the coronavirus pandemic. When Rivera rushed them to a hospital, doctors insisted the two had covid, not dengue. Her aunt almost died, Rivera said.

“There’s no rapid test for dengue,” Rivera said. “We have to diagnose it clinically.”

Genesis received intravenous fluids in the hospital, and her platelet count gradually trended up. Three days later, she was allowed to go home. Despite her recovery, the girl remains vulnerable to a second infection.

The mosquitoes are out here, waiting to bite.

Laura M. Quintero contributed to this report.