Liz Szabo

USA TODAY

The Gulf Coast may know hurricanes, but this year the region of 60 million people could find itself unprepared and at ground zero for a different type of storm: a mosquito-borne Zika epidemic.

A look at the region's urban hubs, small towns and rural outposts shows a patchwork of preparedness. Cities such as Houston have robust plans in place, while smaller towns, such as Corpus Christi, Texas, struggle with fewer resources.

The Gulf Coast's steamy climate, abundant mosquitoes and international airports create an environment ripe for the mosquito-borne Zika virus, which has spread to 37 countries and territories in the Americas. The disease causes devastating birth defects and is linked to paralysis and other serious complications.

The Zika virus could arrive in the continental U.S. in the next few weeks, carried here by travelers and spread by local mosquitoes, said Scott Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch in Galveston. Doctors have already diagnosed 472 cases of Zika in travelers who carried the virus to the U.S. after visiting affected countries or territories. Twenty percent of these travel-related cases were in Florida.

Recent heavy rains, which caused dangerous flooding in Houston, could multiply the number of mosquitoes, including the species that carries the virus, the Aedes aegypti.

"It only takes one infected person to arrive in a location with Aedes aegypti and then the transmission cycle is off and running," Weaver said. "We want to do everything we can to reduce that risk."

Cities with large international airports and a constant stream of tourists, such as Miami and New Orleans, could be at greater risk, but also tend to have more resources to tamp down on an outbreak.

New Orleans, which has a long history of robust mosquito control programs, was one of the first cities in the country to create a Zika action plan. The 50-page document lays out prevention strategies and steps to take at each stage of an outbreak.

U.S. fight against Zika mosquito depends on local effort

If Zika spreads among local mosquitoes, for example, the city will dispatch "Zika Outreach Teams" to neighborhoods where the virus is detected. The teams will hang signs on doors and talk to residents about how to prevent mosquito bites and eliminate the standing water in backyard containers that can allow mosquitoes to breed. If needed, teams will remove standing water and report any sites where the insects are breeding to the mosquito-control department.

Houston formed a Zika response team in January. Mosquito-control teams test mosquitoes for Zika to gauge whether the virus has infiltrated the U.S., said Mustapha Debboun, director of mosquito control in Harris County, Texas, which includes Houston. Although there's no sign of the virus, Debboun's team takes every opportunity to educate people about ways to reduce their risk of Zika.

While no federal agency is monitoring the nation's progress against Zika, it's clear that many states are taking the threat seriously, said James Blumenstock of the Association of State and Territorial Health Officials.

"Remarkable progress has been made in the last several months," said Blumenstock. "In many states, it really has been an 'all hands on deck' response."

Even with plans in place, Blumenstock said he's especially worried about the possibility of "multiple simultaneous events," such as a hurricane or tornado in the middle of a Zika outbreak.

"I don't think any community is prepared to the degree that we need to be prepared," said Umair Shah, executive director of health and environmental services in Harris County.

Cuts to public health could hamper Zika preparation, response

Fighting alone

Smaller, more rural and "some poor communities in the region have virtually nothing available" in terms of mosquito control, Weaver said.

At times, Arturo Rodriguez said he feels like his town is going to battle alone. Rodriguez, the public health director of the border town Brownsville, Texas, with a population of 183,000, said he has had more contact with his counterparts in Mexico than with federal officials in the U.S.

"We literally have to fight this issue on our own," Rodriguez. said. "We have to bootstrap ourselves. We have a very limited budget" of $225,00 a year for fighting mosquitoes.

Rodriguez sees Zika's arrival as inevitable. Brownsville and its neighbor to the south, the Mexican town of Matamoros, experienced an outbreak of dengue, a viral disease spread by the Aedes aegypti, in 2005.

Thousands of people a day cross the border between Brownsville and Mexico every day, and any one of them could be infected with Zika, he said. Health officials detected Zika in Mexico in November.

Rodriguez said he's realistic about what his town can do. "We're not in a position to prevent it. But I want to minimize the risk," he said.

Brownsville collaborates with other health departments to run public service announcements about Zika on radio and in print, alerting people to the signs of Zika and advising people with symptoms to visit a doctor. None of the departments can afford the ads on their own. Workers also trap mosquitoes, test them for disease and then target neighborhoods with affected insects, Rodriguez said.

Corpus Christi, a coastal city of 320,000 in South Texas, has two mosquito control employees, 40 mosquito traps placed strategically around the city and Capt. Christopher White, who leads the animal care services and vector control at the city’s police department.

Confronted by the possibility of an outbreak, White made a quick study of the Zika mosquito and ginned up a paper, “Mosquito 101,” along with a plan that lays out the city’s policies for varying levels of mosquito risk.

Each week from April through November, city employees collected samples of mosquitoes caught in the 40 traps and sent them off to a state laboratory for testing for mosquito-borne viruses.

Although the city ordered six traps specifically made for the Aedes aegypti, they won’t arrive until the end of May, White said. If anyone is diagnosed with Zika, workers will mount an intensive mosquito-killing campaign in the area around the patient's home, spraying pesticides and depositing chemicals into standing water to kill any larvae.

Like many communities, Corpus Christi tries to educate residents about the need to regularly empty rain water from any containers in their yards.

“People breed their own mosquitoes,” said vector control officer Tony Pantoja. “Dump all your containers, tires, buckets, bird baths, flowerpots. If there’s a low area in your yard, fill it with dirt.”

Uncle Sam wants you to clean up your yard to fight Zika

A stressed system

For communities that are struggling, there is little help on the horizon. A recent report found that there are major gaps in the country's ability to prevent and respond to infectious diseases.

Gulf Coast states fared especially poorly, according to a December report from the Trust for America's Health and the Robert Wood Johnson Foundation. Alabama, Florida and Louisiana scored 4 out of 10; Mississippi and Texas scored 5.

Federal funding to help states and localities prepare for disasters — from infectious disease outbreaks to hurricanes — fell 30% in the past 14 years, declining from $940 million in fiscal year 2002 to $651 million in 2016, according to an April report from The Trust for America's Health. A federal program to help hospitals prepare for emergencies has been cut by more than half since the peak of its funding in fiscal year 2004, when it received $515 million. And the budget for the Centers for Disease Control and Prevention decreased from a high of $7.07 billion in fiscal year 2005 to $6.34 billion in 2016.

Public health staff are already stretched to the limit, said Scott Becker, executive director of the Association of Public Health Laboratories. Zika will only add to the strain, he said.

During a Zika outbreak, public health labs could be overwhelmed with requests for tests from pregnant women worried about every mosquito bite, Weaver said. That could lead to delays and increase the anxiety of women waiting for their results, he said.

U.S. fight against Zika mosquito depends on local effort

Although President Obama asked Congress for $1.9 billion in emergency funds in February, Congress has not yet approved the request. Obama transferred $510 million of money earmarked for Ebola to the Zika fight, but said it won't be enough. Some public health experts fear that any financial help will come too late to prevent the birth of babies with irreversible brain damage.

Shah, the public health director in Houston, worries that federal funding will arrive only after there's a crisis. By then, he said, it might be too late to help communities in need.

"Whatever happens at the federal level, we need to happen now and not later," he said.

Contributing: Julie Garcia, Corpus Christi (Texas) Caller-Times.