Since Florida officials declared that the Zika virus is circulating in the state, Miami-area resident Karla Maguire has avoided taking her toddler son to a playground where mosquitoes may be biting. She walks her dogs less frequently and vigilantly applies bug repellant when she must go outside.
An obstetrician and gynecologist who is herself pregnant, Maguire has become scrupulous about following the advice that she gives patients to protect against Zika, which can cause a rare but devastating birth defect. Maguire works near the city's Wynwood neighborhood identified on Friday as the first site of local Zika transmission in the continental United States.
"It is frustrating to spend a lot of time avoiding mosquitoes," said Maguire, a physician at the University of Miami Miller School of Medicine, noting the discomfort of wearing long sleeves during Florida's steamy summer. "You just end up being inside a lot."
Physicians in Miami and beyond have seen this week a spike in concerned calls from pregnant women, particularly after health officials advised them not to travel to Wynwood and said any expecting mothers who had done so since mid-June should be tested for Zika.
On Wednesday, Florida said it would provide Zika testing to pregnant women at county health departments at no cost, and make available additional lab services to handle "the expected increase in tests being administered."
The warnings raised anxiety in a city already on high alert for Zika's arrival from Latin America, where it has spread quickly since first being detected in Brazil last year. The threat to newborns aside, Zika is otherwise considered a mild illness, and up to 80 percent of people infected have no symptoms.
All summer, Florida health officials have issued daily notices tallying the rise in cases acquired through travel to countries where Zika is widespread and advised the public to protect against mosquito bites. Along with 15 local cases, Florida is monitoring 391 picked up through travel abroad, which include 55 cases involving pregnant women.
One baby born in the state to a woman infected in Haiti has been diagnosed with the birth defect microcephaly, a condition defined by small head size that can lead to developmental problems.
TAILORING THE MESSAGE
Health officials expect that southern U.S. states vulnerable to mosquito-borne disease will see smaller, localized Zika outbreaks, given widespread use of window screens and air conditioning, compared with Latin American countries.
In Miami's trendy Wynwood district, known as a place to hop between art galleries and tour outdoor murals, some doctors fear that a counterculture ethos may diminish the impact of medical recommendations to combat Zika.
Batsheva Stern, who is 28 weeks pregnant, sees no reason to avoid the district, where her husband, Zak, owns a popular bakery.
"I'm not so nervous," said Stern, 27, recounting the advice of her midwife: "Don't freak out, nothing is happening."
But Dr. Elizabeth Etkin-Kramer, a gynecologist in private practice nearby, worries about birth defects resulting from unplanned pregnancies in some of her Wynwood-area patients who eschew birth control pills, noting the community is also skeptical of vaccines and antibiotics.
On Tuesday, she met with a patient who is 18 weeks pregnant and working near the affected area. The patient questioned her recommendation to be tested for Zika infection.
"Her feeling is, if something is going on, there is nothing you can do about it, short of termination," said Etkin-Kramer, an officer in the Florida district of the American Congress of Obstetricians and Gynecologists. "I think it would be important to know, and if God forbid she is positive, then we can look closely by ultrasound and get a lot more information."
Beatriz Mendes Pereira Lopes, 26, an attorney who is five months pregnant, has moved twice trying to avoid Zika. She went to Miami in April, as the hot months in her home of Brazil spurred mosquito breeding.
Last month, she returned to Brazil, now in its cooler winter, anticipating its mosquitoes would be in hibernation. Now that Zika has begun circulating in Miami, she concedes that her future options may be limited until a vaccine is developed.
"It's impossible to get rid of all the world's mosquitoes," she said via email.