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Mutant mosquitoes could fight Zika in Florida, but misinformation spreads

KEY WEST — There are many scary stories that start with a dark and stormy night, but this isn't one of them. It is the third day of summer in this island city, with its feral chickens and lemon-hued houses and women woohoo-ing by on rented motorcycles. Every bicycle has a basket, every mailbox is a manatee.

"You can't be in a hurry if you're in Key West," the emcee of an outdoor restaurant tells passing tourists. "You're not doing it right if you're in a hurry."

And throughout the island, people are swatting away. They give it a moment's consideration, then turn back to their children, their conversations, their cocktails.

No, this story is not the stuff of campfires and nightmares. But it might be the scariest story of all. Because the little mosquito they live with has the power to kill them, to doom their children, to scare away their chief industry and scar their community.

And they're more afraid of the hero than the monster.

• • •

An hour away, in a small city called Marathon, is an industrial street you'd never turn onto until the day you do. It is storage units and warehouses, boat parts scattered across front yards. Then there's the building belonging to the Florida Keys Mosquito Control District, numbers stuck on its mailbox like letters on a ransom note.

Derric Nimmo walks outside and starts the engine on a silver Mustang convertible, a rental agency upgrade. Nimmo has been coming to the Keys for six years, his passport stamped more than 50 times with the United States oval. He is the senior scientist for the Keys project of Oxitec, a British biotechnology company that creates genetically modified mosquitoes to combat disease-carrying ones in the wild.

As a scientist, Nimmo knows things that escape the average Floridian.

For one thing, he knows the mosquito is the deadliest creature on earth, the No. 1 killer of humans. Every year sharks kill 10 people. Mosquitoes kill 725,000. The second-biggest killer is other humans, and still, they claim only 500,000 lives.

The primary mosquito that carries dengue fever, yellow fever viruses, the chikungunya virus and now the Zika virus is called Aedes aegypti, and it does not belong here. It likely hitched a ride from Africa on European ships as the New World was colonized, stowing away in shipping containers and laying eggs in troughs of drinking water.

Though closed eyes would picture this mosquito making a home in marshlands, Aedes aegypti is far too clever for that. It has evolved to follow humans, to live in human homes, to prefer the taste of human blood. If a person were to stand at the center of a herd of 100 buffalo, this mosquito would weave past all the buffalo and bite the human. It can smell us — the carbon dioxide we exhale, the lactic acid in our sweat, the ammonia in our intestines.

Aedes aegypti knows to stay out of our sight lines, flying low around our feet and ankles. When we swat, it is patient, returning to the cool, dark underbelly of the kitchen island to wait for another chance.

The mosquito that bites you is female — the males don't feed off blood, but nectar — and she is acting in a postcoital haze. Aedes aegypti mates face-to-face, the female drawn to the song created by the flapping of her lover's wings. The sex lasts less than a minute, but that's all it takes for the two to become so entwined that to get away, the male must sometimes leave his genitals behind.

The female then seeks out a human "blood meal" to get enough nourishment to lay eggs. So she bites, maybe one person, but typically five. She needs only seven-tenths of a second to take our blood and leave behind any disease she is carrying.

Then she seeks out so many ordinary things: a flower pot, a boat tarp, an old tire. She can lay hundreds of eggs in a plastic Coca-Cola bottle cap, as long as it can hold a bit of water. Because this is the last trick of the very clever Aedes aegypti: Her eggs, laid just above the water line, won't hatch until the water rises and submerges them, giving them enough nutrients to thrive. The eggs can wait a month, outlast a dry spell, for conditions to be just right.

A dark and stormy night isn't necessary. A sun-shower will do just fine.

And so Derric Nimmo gets into his rental car and drives south on U.S. 1, the skinny highway that connects the island chain. He passes strip-mall churches and a stand for boat gas, sandal outlet stores ("Why pay Key West prices?") and the Barracuda Grill ("Stop in for a 'bite!' ")

He needs to reach as many residents as possible before tonight, when they'll try to convince their elected officials to stop Nimmo's company from enacting a plan he knows can kill almost all the disease-carrying mosquitoes in their town.

Oxitec chose a suburb in Key West as the technology's U.S. testing ground, its geographic layout perfect for a scientific trial. The project is undergoing federal approval. Before scientists can use this weapon to kill mosquitoes anywhere in the country, they need to start here.

Nimmo needs to convince residents Zika is a real threat, that South Florida is poised to be ground zero for a mosquito-borne epidemic the likes of which America has not seen.

He passes the orange sign that reads "US-1 FLORIDA KEYS 10 FATALITIES THIS YEAR," the "10" set up like on a high school marquee, ready to change with each island death.

• • •

It is not a small number of times now that public health officials have stood before the people of Key West and warned that Zika — the disease they've seen on the evening news, with misshapen babies and their crying mothers — is coming.

The conditions in Key West are just right, says Bob Eadie, head of Monroe County's health department: the tropical climate, the staggering number of international visitors, the military base and its Naval officers traveling back and forth from Latin American countries.

"The Zika issue is one that concerns me, probably, more than any other in my life, in my public health career," he says.

The disease was discovered in Uganda's Zika Forest in 1947, when scientists studying yellow fever stumbled upon a Rhesus monkey with a fever.

For decades the virus was more a curiosity than a threat, mimicking flu symptoms as it infected humans. It moved to West Africa and Asia, and by the 1980s it could be found in India, Indonesia, Malaysia and Pakistan. The travel pattern was consistent with a virus, spreading and growing, surviving and thriving.

The first large Zika outbreak came in 2007, on Yap Island in the western Pacific Ocean. Three in four people on Yap got the disease. By 2014 it was widespread throughout the Pacific islands. In French Polynesia, scientists discovered a link between the mosquito-borne disease and newborns with birth defects. Then adults started to report neurological disorders, autoimmune diseases.

Scientists discovered that Zika was sexually transmitted as they passed it on to their wives.

In spring 2015, Brazil confirmed the first widespread Zika outbreak in the Americas. By July, dozens of the infected also had Guillain–Barré syndrome. Their immune systems were attacking their bodies. Their limbs started tingling. Then they were paralyzed.

By October — less than six months after the initial outbreak — their babies were born with microcephaly, their heads tiny, their brains rocklike.

Mexico gets Zika. Guatemala gets Zika. Venezuela, El Salvador, Paraguay.

Doctors detect Zika in the blood of an infant who dies within five minutes of birth. Adults start dying. Thousands more babies meet the world with heads too small for their bodies, with underdeveloped brains.

The World Health Organization declares a public health emergency.

More than 300 people in Florida contract Zika through travel. A Haitian woman comes to Florida and gives birth to a baby with microcephaly.

The most popular tourist destination in Key West is a dredged-up sewer junction painted like an oversized buoy. It reads "90 Miles To Cuba" and marks the "Southernmost Point" of the United States.

Zika is in Cuba. But that doesn't even matter. Tens of thousands of Brazilians travel to Key West every year, lining up to snap selfies right here.

Only one of those people, who may not know he or she is a disease carrier, needs to be bitten once by a local mosquito. After eight days or so, that mosquito has enough of the Zika virus to spread it by biting another person. This is how local transmission happens — just like that.

Within the month, 100 miles from Key West, doctors would confirm the first local transmission in Miami-Dade County's hip Wynwood neighborhood.

Not even Zika would stop the al-fresco dining.

Here in the Keys, Shelby Wilbert, 24, finally gets her turn for a photo with the buoy. Visiting from Volusia County, Wilbert is pregnant and showing as she and her husband pose with their 8-month-old daughter, Riley.

Wilbert is not eating lunch meat or drinking coffee, won't touch a Caesar salad or over-easy eggs. But she forgets to apply bug spray.

Zika, she says, "is not a main concern in my mind."

• • •

Despite its status as an international vacation destination, Key West in many ways is very much a small town. About 25,000 people live here year-round, outnumbered by tourists 3-to-1. They know their neighbors and take pride in an Earth-first, laid-back life: a culture of eating outdoors to live music, of smiling approvingly at the glacial pace their groceries are bagged.

It is said the island either accepts you or rejects you, and there is social currency in being a long-standing, generational insider.

Someone born here is a "Saltwater Conch." Someone who has lived here for at least seven years, a "Freshwater Conch." Derric Nimmo is British.

He parks his rental on the curb off the main road of Key Haven, a well-to-do suburb on the eastern edge of Key West. Everywhere, signs say:

NO CONSENT

TO RELEASE OF GENETICALLY

MODIFIED MOSQUITOES

In 2010, a former director of the Florida Keys Mosquito Control District invited Oxitec to Key West amid an outbreak of dengue. Current director Michael Doyle remembers that Oxitec's technology was the most promising for stopping the disease. "It was really the only option."

Oxitec spun out of a research lab at the University of Oxford and is one of many organizations across the world, private and public, that modifies mosquito DNA in hopes of slashing disease rates.

It's simplest to think about modification like building a car. You can use all kinds of parts from all kinds of places. You can take the engine from a four-door sedan and the tires from a coupe. If you want the car to be green, you can use green paint. Green paint is out of stock? You can buy blue and yellow, and mix them together.

Creating synthetic genes is quite a bit like that, with fractions of existing genes used to form new ones.

Under the eye of a microscope, Oxitec scientists use incredibly thin glass needles to inject two genes: a fluorescent marker for tracking the mosquitoes it releases into the wild and a "self-limiting" gene. The latter is essentially a death gene, and strangely simple. Oxitec releases nonbiting male mosquitoes with double copies of this gene, meaning they will pass the gene along to all their offspring, which will then die.

Oxitec has released more than 150 million of these mosquitoes in Brazil, Panama and the Cayman Islands. In each trial, it has wiped out more than 90 percent — and as much as 99 percent — of the Aedes aegypti population. The Florida Keys Mosquito Control District — which at any given time has eight to 10 inspectors in the field and helicopters dropping fine mists of insecticide, and spends $1 million a year on this specific mosquito — can control about only 30 to 60 percent.

Oxitec's program has received a preliminary "Finding of No Significant Impact" on humans and the environment from the U.S. Food & Drug Administration, working with the Centers for Disease Control and the Environmental Protection Agency. Pending a review of public comments, the FDA is expected to issue final approval of it in the coming months. An environmental assessment found no danger, the conclusions detailed in a 284-page draft report.

The Aedes aegypti mosquito keeps to itself in the Keys, meaning wiping it out wouldn't have ripple effects on the ecosystem.

And in none of its international releases has an Oxitec mosquito caused problems for people or their pets. Though a very small number of female mosquitoes are released, their bite is no different from that of a wild mosquito.

But this has all meant little to the people of Key Haven, who are not scientists, and happy to tell you that. They are worried that people will not want to buy houses in an area where genetically modified mosquitoes are released. They are concerned that tourists will not want to visit. They are convinced that the female mosquitoes will survive, and thrive, and form a mutant strain, a worse disease, and make their children sterile or glow fluorescent.

Though a scientist, Nimmo has become a communications officer by default. He goes on radio shows, organizes community "listen 'n' learns," knocks door-to-door.

If he can just give them the facts, he's sure they'll have to see reason.

• • •

Michael Doyle, director of the Florida Keys Mosquito Control District, tries to be sympathetic when residents come up to him after meetings, get in his face, jab their fingers on the table. In a former life, he was working for Colorado Mosquito Control when West Nile disease hit. "People were arm in arm, blocking gates, roads, so we couldn't get our trucks in," Doyle remembers. It was 2003, and they were against insecticides. "It's the fear of the unknown."

In the Keys, Doyle doesn't know what to do anymore. In 2011, when he moved here and took over the mosquito control district, he surveyed the residents of Key Haven. About two in three were in favor of Oxitec's technology, another 20 percent were unsure or wanted more information, and about 10 to 15 percent were opposed, he says.

But as soon as the district's board of commissioners moved to approve the Oxitec trial — to this day, it has signed off on 90 percent of the contract — what Doyle perceives as a small but vocal minority began railing against it.

"I want to say I understand and appreciate both the people's desire to protect each other and the environment; that's admirable. And in a democracy, their ability to voice their opinion about it, I fully defend those things," says Doyle, sitting by the window in his office. "It's just — what's disheartening is, when solid facts and reasoning are presented, that's not always successful in swaying people's intellect."

He is thinking about a special workshop held a few months earlier. On April 19, the mosquito control district brought in scientists and experts from across the country to discuss methods for using sterilized mosquitoes to bring down the Aedes aegypti population.

Nimmo stood beside a PowerPoint presentation and gave the speech he probably has given a few hundred times now, explaining every aspect of the science of Oxitec's genetically modified mosquitoes and fielding questions on everything from the mosquito death rate to sterilized children.

The workshop also heard from Jack Newman, a scientist working to eradicate malaria who helps govern BioBricks, a foundation dedicated to ensuring genetic science is done openly and ethically. Newman spoke about the gulfs in understanding that divide the science community and the public.

Global warming claims the second-biggest gap, in terms of knowledge and acceptance, between U.S. adults and scientists. About 50 percent of adults think global warming is real and humans contribute to the problem, Newman said, while 87 percent of scientists do.

The biggest gap, he said, is in the safety and usefulness of genetic modification. "And that's a failing, I believe, of my science community," he said.

After Nimmo spoke, one of the board members asked Newman, "Did you hear anything that concerned you?" About the Oxitec mosquito, about a small number of females slipping through, about the children?

"No," he said. "I have no concern whatsoever."

But herein lies the problem that Doyle, sitting in his office now, is thinking about: So few people were at the workshop. They had held this special meeting, flown in all these experts.

"We had maybe 50 people come to the board meeting to voice their displeasure about the project, but then when this meeting started, it dwindled down to two or three or four to see the actual facts," Doyle remembers.

So much misinformation is out there. He doesn't know what to do anymore, except keep telling people: Male mosquitoes don't bite. If female mosquitoes are modified and bite you, they can't transfer their DNA. Your children won't become sterile. There is no way for the mosquitoes to mutate. This is unnatural, but it is safe. So many natural things can kill you. The bubonic plague. AIDS. If only he could shake them awake to Zika.

And this is where Michael Doyle, a 51-year-old man with a mustache and children of his own, begins to cry.

"Unfortunately, in the United States, that has been the pattern with mosquito-borne diseases," he says. "Nothing happens until … " His voice catches, and he looks out the window, and he can't speak for nine, 10, 11 seconds.

"Until somebody dies."

• • •

Cars are in the driveway at the first house Derric Nimmo approaches, but when he rings the doorbell and waits, no one comes to see him. A large, fluffy Chow considers him from the window before barking. It has not rained in six days in Key West, and the temperature and humidity are racing toward 100 degrees and 100 percent. Nimmo gives up and moves on, sweat pasting his shirt to the small of his back.

He knocks next door, and out comes Marie Ohayon, who apologizes for her clothes, saying she's been cleaning. Her teenage son walks out with her, but when Nimmo asks if they have any questions about genetically modified mosquitoes, the boy says, "All you, Mom," and retreats.

She asks about any females that would be released (they would mate with the males and their offspring would die; their bite would be like any other mosquito bite, as DNA is not transferred through saliva).

Ohayon asks what would happen if a mosquito bit her dogs (the same) or if the mosquito bit a newborn (the same).

"But it is something created by us, humans," says Ohayon, leaning on a refrigerator set out on her porch. "And nothing is perfect there, too. How can you be sure?"

"I've been around the world, to Brazil, Panama, Cayman," Nimmo says, ticking off the countries with his fingers. "The threat from dengue, Zika, chikungunya, is very real. The threat from our technology is nonexistent …"

"But the timing is also interesting," Ohayon says, "as far as, there was no Zika until they started spreading your mosquito."

"That's not true. That's truly not true."

"Out of nowhere, Zika comes …"

"That's totally not true."

"I know it's not true," says Ohayon, in a tone that makes it clear she does not know this. "But the way I see it, I'd never heard of Zika."

Nimmo tells her the disease has been around since the 1940s. He stops short of saying that it is spreading north every day, that if she thinks this knock is disconcerting, she should see what Zika can do to a pregnant woman's womb.

But Ohayon just says, "Look at the big picture. Zika? Never heard of it until a few years ago. And isn't it the same time when they started spreading?"

Nimmo thanks her for her time.

Ohayon wants him to meet her neighbor a few houses down. This woman, she says, is much better informed than she is, someone Nimmo should really talk to. "I'm going to walk you over," she says.

She leads him down the street.

They knock at the home of Lorraine Phelps, a 62-year-old Freshwater Conch, who is not home.

If she had been, Nimmo might have heard her theory that the mosquito control district stopped regularly treating Key Haven to make the mosquito problem worse and to convince residents they need Oxitec.

Or her conflicting theory, that Key Haven doesn't have Aedes aegypti mosquitoes at all.

He might have had a good answer for why Oxitec won't just release dragonflies, which eat mosquitoes. Or vet information she has heard, that Brazil put something in its water and that's what really caused the microcephaly.

But Nimmo won't be able to catch Phelps before the meeting, which she plans to attend that night.

He looks at his watch.

• • •

"There's a lot of information out there — some misinformation — and I want to cover a number of things." This is Michael Doyle, opening the June 22 meeting of the Florida Keys Mosquito Control District board of commissioners.

The board typically meets in Marathon, but on this evening, given the topic, it's in the old city hall building in downtown Key West. When the doors open, you can hear the laughter from the bar on the corner, an old haunt of Ernest Hemingway's called Sloppy Joe's.

There is a full crowd, and Doyle plans to take advantage. He starts by reminding the people how deadly the mosquito is and how easy local transmission of Zika would be.

Doyle reminds his audience that DNA is not spread through a mosquito bite. When they eat hamburgers, they are exposed to billions of pieces of cow DNA. They do not become cows. Humans have been bitten by mosquitoes for all of history without taking on their genetic code.

He reminds them that he has a 12-year-old daughter. And that the trial isn't an experiment on humans. "It's how well can this mosquito crash the Aedes aegypti population," he says, reminding them that the FDA, CDC and EPA have found nothing dangerous to humans or the environment.

Then he turns the microphone over to the people.

"Arrogance," says Howard Hubbard.

"There hasn't been enough information," says Mike Tinnell.

"I just wish everybody would slow down a little bit," says Bill Spottswood.

"Experiments are done in a lab," says Gilda Niles.

"We need more boots on the ground," says Oliver Kofoid, and several other people, too.

"Zika is being used as a cover story and a smoke screen," says Diana Bolton.

"My childhood sweetheart didn't die in a war for us to be treated like this" says Jan Isherwood.

On and on and on. From their seats, Lorraine Phelps and her husband applaud.

The commissioners end up voting to let the people of Key West have their say on whether to proceed with Oxitec's technology in a referendum in November's election, the first time a matter of public health will be handed over to popular opinion.

Though the referendum is nonbinding, three of the five commissioners — the three up for election — have pledged to vote according to the people's will.

Derric Nimmo rises from his seat after the four-hour meeting, looking ahead to so much more work to do. Today his public relations mission was about goodwill. For the next four months, he will need to convince these people to keep Oxitec's trial alive.

And if he has learned anything in his time in the Keys, it's that misinformation spreads as easily as the disease.

• • •

The sun rises on the fourth day of summer, and everything moves forward. Tourists eat breakfast, walk the rocky beaches. Michael Doyle's helicopters go up, spray what they can. Aedes aegypti pupae transform into larvae, bubbling like black, boiling water in an old tire. Mosquito inspectors move through yards in search of standing water, mosquito breeding grounds. They turn over forgotten glasses and Tupperware, flower pots shaped like turtles and little Buddhas.

A Royal Caribbean cruise ship docks. Thousands of new people walk the streets. They pet the cats at the Hemingway House and climb the stairs of the old Lighthouse. From up there, they can see so much.

"There's the Southernmost House — over there, with the red roof," says John Davis, 60, pointing toward it. His wife, Linda, 51, makes a low sound in acknowledgement.

The Houston couple arrived with the ship. Neither John nor Linda says they are concerned about Zika. "The ship was very clean," John explains, detailing the hand-washing stations onboard. "The Bahamas were quite windy," adds his wife.

They move around the deck of the Lighthouse, looking at an old church, an historic hotel, the harbor. A wall of dark gray begins to move across the outer Keys.

There is so much they can't see from up here, too. Those flower pots, those tarps. The Coca-Cola bottle caps turned up outside a dumpster. Another generation of the monster, waiting to hatch.

Within minutes, the outer bands of the storm reach the Lighthouse. It starts to drizzle.

It's only a light rain.

That's all it takes.

Times photographer Loren Elliott contributed to this report. Contact Lisa Gartner at lgartner@tampabay.com. Follow @lisagartner.

Mutant mosquitoes could fight Zika in Florida, but misinformation spreads 08/03/16 [Last modified: Wednesday, August 3, 2016 12:30pm]
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