As we continue to worry about the spread of COVID-19, now we hear that positive West Nile Virus mosquito activity is at record high levels in Tarrant County.

It seems 2020 is not quite ready to give us a break any time soon.

Tarrant County Public Health issued a warning to the general public at the end of last month. In its latest report (Aug. 2-Aug. 8, 2020), TCPH reported 302 positive tests in the region this year.

“We are continuing to see rapid increases in mosquito infection rates in Tarrant County, which means we have more human risk for West Nile Virus,” said Tarrant County Public Health Director Vinny Taneja at the end of last month. “To prevent outbreaks of West Nile, it’s very important that people remember to always use an EPA-approved repellent and wear long sleeves and pants when they go outside,” he said.

Fox4 reports one death related to West Nile this summer and "recent tests of mosquito traps in the northeastern part of the county show a 60% positivity rate."

Adding to the anxiety are how similar the symptoms of the West Nile virus is to COVID-19. About 20% of infected people will develop a fever with other symptoms such as headache, body aches, joint pains, vomiting, diarrhea or rash.

These are symptoms common in many viruses including COVID-19 and the flu.

But there are differences in COVID-19 and West Nile, beginning with how you contract the viruses.

“COVID is a respiratory virus spread between people’s secretions,” said Nicholas Rister, M.D., an infectious disease pediatrician at Cook Children’s. “West Nile virus is a blood infection spread by mosquitos. People with COVID, have symptoms that are primarily respiratory symptoms. West Nile virus is more fever, rash and joint aches.”

Dr. Rister said less than 1% of West Nile virus cases can cause central nervous system infections (meningitis/encephalitis for example), which is a bit more common in adults than kids, but still rare.

West Nile virus can affect anyone, although people age 50 and older run a higher risk of developing a severe infection.

Most people with this type of the disease recover completely, but fatigue and weakness can last for weeks or months. Less than 1% of infected people develop inflammation of the brain or surrounding tissues. The symptoms of neurologic illness can include headache, high fever, neck stiffness, disorientation, coma, tremors, seizures or paralysis.

Most children who are infected with this virus do not develop symptoms. West Nile virus has been circulating in mosquitoes in the United States for many years and is not new.

With heightened concerns of mosquito-borne illness, Tarrant County Public Health and County officials are asking for help to protect their community from mosquitoes such as:

• Wearing long sleeves and pants
• Dumping standing water
• Using EPA-approved insect repellent
• Keeping vegetation trimmed

Here is a list of mosquito repellents endorsed by the FDA and CDC. Tarrant County Public Health also has more information about West Nile Virus and other preventive measures residents can take at Be Mosquito Free.

Cook Children's medical staff saw its own cluster of patients in 2016 and has seen sporadic cases since then, as have other hospitals across the nation.

Acute flaccid myelitis (AFM) presents similar to polio in that it causes an abrupt onset of limb weakness an decreased muscle tone, which can have associated problems with urination and, in the worst cases, cause respiratory failure if the muscles involved in the breathing become weak.

“This is a very rare illness and we’re still not sure what causes AFM,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “It is mostly like caused by a virus or a genetic disorder. At this point, we must treat each child on a case-by-case basis, but the earlier a diagnosis is made, the quicker a plan of action can take place.”

The Centers for Disease Control and Prevention (CDC) says most patients will have a sudden onset of limb weakness and loss of muscle tone and reflexes. Some patients will also experience:

• Facial droop/weakness
• Difficulty moving the eyes
• Drooping eyelids
• Difficulty with swallowing or slurred speech

If you notice any of these symptoms, please notify your doctor immediately. Through thorough testing of the nervous system, doctors will be able to diagnose AFM.

The CDC recommends the following as means of prevention:

• Up to date on all recommended vaccinations, including the poliovirus.
• Protect yourself from mosquito-borne viruses such as West Nile by using mosquito repellent and staying indoors at dusk and dawn.
• Remove standing or stagnant water from properties to minimize the number of mosquitoes in your area.
• Wash hands with soap and water.
• Avoid close contact with sick people.
• Clean surfaces with a disinfectant, especially those that a sick person has touched.

DEET gets a pretty bad rap. In a day and age where people are pushing for the more "natural" approaches to prevention and medical care, DEET seems to be the least natural thing out there, right?

You know what is natural? West Nile virus. Zika virus. Chikungunya virus. Powassan virus. Ugh. All nasty viruses which are passed from human to human thanks to mosquitoes.

Citronella hasn't been proven to last very long and has to be at high concentrations to have any effect. So it has to be used really frequently to make up for its lack in efficacy.

Wristbands have been proven time and again in studies not to work, regardless of ingredients.

Lemon eucalyptus oil actually can help - but studies have shown that it's about half as effective as DEET and hasn't been tested for safety in kids under 3.

"Various botanical oils other than those discussed previously, including sandalwood, geranium, soybean, and others, have been used alone or in combination for repelling mosquitoes and ticks. The majority of studies of these alternative plant-based repellents show that the protection they offer is far inferior to DEET" - straight from a peer-reviewed medical article (UpToDate). I had high hopes for my marigold and lavender plants but I don't think they will work (Insert your own frown emoticon here).

So what do I put on my kids? DEET. Because no other compound (natural or synthetic or otherwise) has been proven to be as effective at keeping away mosquitoes, ticks, fleas, and chiggers.

DEET comes in different percentages - 10 percent to 70 percent. Stick with the 10-30 percent range. Ten percent will get you about two hours. Twenty-four percent gets you about five hours of protection. If your children are older, you can use higher concentrations if you'll be outside longer than five hours. The higher the concentration, the longer the effect will last.

DEET can be used on kids as young as 2 months. I know, I know - the thought of putting a synthetic compound on a sweet baby makes me cringe too. But honestly - it's OK for a few hours at a time. Scary things like neurotoxicity have actually only occurred in giant, massive doses after prolonged exposure, and even then it's super rare. Fewer than 20 cases of this happening have been recorded WORLDWIDE since the beginning of time.

If you have aerosolized spray, do what I do - spray it on your hands, then rub it on their arms, legs, neck, ankles, torso. Don't spray it on them directly , and try to avoid inhalation. Don't put it on their hands (because if they're anything like my kids, their hands are in their mouths nonstop). Avoid the eyes. Give them a bath when you're done with outside time.

DEET really is the best way to keep the bites away. And with such a wet "winter" that we had this year - it sounds like we will all need some.

Hugs,

Dr. Diane

As we expected, both mosquito-borne illnesses have been reported in Tarrant County.

West Nile

On July 13, Tarrant County Public Health (TCPH) confirmed the first case of West Nile virus for the 2016 season. The case is from Bedford and is the severe form – West Nile Neuroinvasive Disease. More information is not being released to protect the patient’s identity.

Symptoms of the more severe form of West Nile include neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis. This form of the disease can be deadly.

The mild form of the disease is commonly referred to as West Nile Fever. Symptoms include headache, fever, muscle and joint aches, nausea and fatigue. People typically recover on their own, although symptoms may last for several weeks.

“West Nile Virus infection is found in local mosquitoes. It is acquired from mosquito bites and not from infected people," said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. "Most children who are infected with this virus do not develop symptoms. It has been circulating in mosquitoes in the United States for many years and is not new."

TCPH reminds us that we can protect ourselves from the West Nile virus through prevention and protection.

Reduce mosquito breeding sites:

• Dump mosquito breeding sites:
• Dump standing water
• Overturn containers
• Dispose of trash

Use dunks, bits and briquettes

Protect yourself:

• Use EPA-approved insect repellent
• Wear long sleeved shirts and pants

Zika

Tarrant County Public Health has identified two new imported cases of Zika, raising the total number to 11. There is still no local transmission in Texas.

The chance of a healthy child living in this area becoming ill with either of these viruses, West Nile or Zika, currently is "very, very, low," according to Dr. Whitworth. She said if Zika begins to circulate in local mosquitoes this may change, but it hasn’t yet. She adds that the best thing parents can do is help their children avoid mosquito bites. And if your child becomes ill and you have concerns, seek medical care. 

"Zika Virus is not currently circulating in local mosquitoes and so in this area it only occurs in returning travelers who are infected, their sexual partners, and, sadly sometimes their infants," Dr. Whitworth said. "Until this is circulating in local mosquitoes, the risk of infection here is very close to zero with this virus."

The chance of a healthy child living in this area becoming ill with either of these viruses currently is very, very, low. If Zika begins to circulate in local mosquitoes this may change, but it hasn’t yet. The best thing parents can do is help their children avoid mosquito bites. And if your child becomes ill and you have concerns, seek medical care. “

The first patient had traveled to Jamaica and the second patient to St. Lucia.

Harris County Public Health (HCPH) confirmed the first Zika related microcephaly case in the state of Texas. The mother had traveled from Latin America. The mother received inconclusive test results for Zika. The baby received a definitive positive lab result for Zika, which means the mom most likely carried the virus while pregnant and is thought to have been infected in Latin America.

Microcephaly, is a medical term for an abnormally small head. The causes of microcephaly can vary, but in this instance the small skull was directly related to abnormal fetal brain development.

The Centers for Disease Control and Prevention recommends “that all people, especially pregnant women, who are traveling to Brazil and other areas in Latin America, should take precautions to avoid mosquito bites to reduce their risk of infection with Zika virus and other mosquito-borne viruses such as dengue and chikungunya.”

The CDC asks that travelers protect themselves from mosquitoes by using insect repellent, wearing long sleeves and pants, and staying in places with air conditioning or that use window and door screens.

Related links:

• Tarrant County Public Health
• West Nile: What are the symptoms?
• How to fight and win against mosquitoes
• Will Zika affect your family?
• Zika: From nuisance to 'genuine threat to public health'
• Should we be afraid of Zika?
• Guillain-Barré syndrome: Are you at risk?
• 11 facts about the Zika virus
• The deets on DEET

That’s how I remembered this:

Blood, frogs, lice, flies, disease, boils, hail, locusts, darkness, death.

You might ask, why was I learning the order of the plagues? Obviously, for a bible quiz game we used to play in Sunday school. Because I’m ultra-competitive, even when it comes to Sunday school.

The recent weather in North Texas has many questioning if we are witnessing plagues or if the Apocalypse is upon us.

Fortunately, it looks like the worst of the drenching rain (and hopefully the flooding as well) are behind us. As the waters recede, the rising threat will be mosquitoes and mosquito borne illness.

What’s the big deal with standing water?

Standing water is the breeding ground for mosquitoes. There are four stages of life for mosquitoes. The adult flying stage is the only one that does not rely upon water for survival. The eggs, larva and pupal stages must live in standing water.

Any standing water - water in a bird bath, pond or standing water from improper drainage can be a place for mosquitoes to breed.

Why do mosquitoes bite?

Female mosquitoes bite because they need a source of protein before they can produce eggs. Otherwise, like males, they can feed on nectar or sap.

When females bite, their long mouthpart breaks through the skin and gets into the small blood vessels just underneath. They also inject a small amount of saliva into the wound to make entry easier and to keep the blood from clotting.

What harm do bites cause our children?

Local reaction - While not technically an allergy, some kids will have a large local reaction with swelling and redness at the site of mosquito bites. These can be itchy and cause distraction in school or lack of sleep when severe.

Local infection – It’s not uncommon to see local infection in kids who have scratched mosquito bites, leaving a gap in skin, which can lead to infection. If the swelling worsens after the first few days or if there is significant warmth from the site of the bites, you should see your pediatrician to see if antibiotics are necessary.

General infection - Because mosquitoes can carry diseases, bites from mosquitoes can transmit infection that can affect the entire body. Mosquito borne illnesses cause over one million deaths world wide, most commonly from malaria. Two other diseases that we have seen in Texas associated with mosquitos are West Nile Virus and Chikungunya.

Given the amount of rain and the season, mosquitoes will be inevitable this summer season. Read more here about the many different ways you can reduce your child’s risk of discomfort and serious illness: How to fight (and) win against mosquitoes.

Then you walk inside, feel your arm itching and see the familiar red bumps on your arms. Mosquitoes! In December?

Why are we still seeing mosquitoes three weeks from Christmas?

For the answer, we asked Michael Merchant, Ph.D., a professor and Extension Urban Entomologist at Texas A&M University.

Merchant noticed mosquitoes over the weekend while out in the garden. But he wasn’t too surprised. After all, understanding pest management and insects is something he’s been an expert at for nearly 30 years.

“When the temperature drops below about 55 degrees, mosquitoes stop flying,” Merchant said. “We’ve already seen a major decline in mosquitoes, but we are still seeing a few of the hardier folks persisting.”

Mosquitoes don’t all die off during cold weather, they often just hide in protected spots to avoid freezing.

Mosquitoes are cold-blooded and like temperatures best in the 80s or warmer. Once the temperature drops below 55, they go away – or at least stop moving around as much. Some mosquitoes find holes or places inside to hide in until warmer weather. Others lay their eggs before the freezing weather and then die. The eggs then hatch in warmer winter.

But the risk isn’t over entirely. Merchant said it’s not unusual to see a few West Nile Cases in the Dallas/Fort Worth area into December, and this year’s warm weather has kept the insects around longer than usual.

The last bites of the year may even occur indoors. “A few mosquitoes always make their way indoors, often coming in from your doorways,” Merchant said. “Mosquitoes often hide in protected home entryways to get away from the cold.” From there it’s a short flight inside when the doors open and close.

Merchant suggests sweeping and vacuuming the upper part of your doors and around the doorway, as well as applying insecticides.

“For most of us, the threat of mosquitoes is almost over,” Merchant said. “Hopefully, by next week we will have a blast of cold weather and we won’t see them for a while.

For more information

To learn more on mosquito control around the home, Michael Merchant's website:

• Mosquito Safari Website. Go on a mosquito safari with this interactive AgriLife website. Mosquito Safari takes you on a walk through both urban and semi-rural landscapes to learn more about mosquito risks, biology and control options.
• Mosquito videos. Learn more about practical ways to make your home and landscape safer from mosquitoes, and see mosquito larvae breeding in a backyard setting.

I remember last year as story after story reported our cities varying counter assaults against West Nile, I looked at my husband and said, “This is really going to freak people out.” My stepson, with his patented perfect timing, walked into the room scratching a red bump on his arm and announced, “Hey something bit me.”

My stomach dropped. While I went in search of an antihistamine in our medicine cabinet, I reminded myself that usually only a small percentage of mosquitos in any area where carrier mosquitos have been found are infected with the West Nile virus. According to the CDC, 80 percent of people bitten by a mosquito infected with West Nile virus never develop symptoms.

Among those who are bitten and infected 1 in 5 develop mild flu-like symptoms such as fever, headache, body aches sometimes skin rash. These symptoms may last for a few days and are easily managed with over the counter medications.

Less than 1 in 100 (that is less than 1 percent) of those infected develop a severe illness with West Nile meningitis or encephalitis (swelling of the brain and surrounding tissue.) Armed with the facts I breathed a sigh of relief and reassured my stepson he would be fine.

What can we do this summer to protect ourselves and our kids? We need to prevent the mosquitoes from biting and make sure we do not have areas around our homes that invite mosquito to breed. We need to use the Four Dʼs: Drain, Dress, Dusk, DEET.

1. Drain all free standing water. Mosquito LOVE free standing water. The murkier the better. It is their favorite breeding ground. Check flower pots, bird baths, swimming pools, gutters, drain pipes. Drain or clean out anywhere water collects.
2. Dress in long sleeves and long pants. Easier said than done in 100 degree Texas heat but the reality is mosquitos only bite skin they can reach. Maybe opt for longer shorts and wear socks and tennis shoes instead of sandals.
3. Dusk (and Dawn) is the mosquito's’ favorite time of day so take extra precautions if the kids go outside during these times of the day.
4. DEET Use insect repellant. DEET has been tested and approved by the Environmental Protection Agency (EPA). Remember you only want to apply repellants to exposed skin or clothing and avoid contact with your eyes and mouth. DEET concentrations vary from product to product from less than 10 to more than 30 percent. The higher the concentration the longer lasting the repellant.

Safety has not been related to concentration. We do not recommend DEET products under 2 months of age. Instead you could try mosquito netting over your infant carrier.

You can also use repellants with picaridin or biopesticide repellants like Oil of Lemon Eucalyptus (ages 3 and up). Regardless of the type of repellant used; remember to wash the product completely off your child’s skin once you are indoors.

If despite your best efforts your child does get a bite you can give him or her an over the counter oral antihistamine or apply topical 1 percent hydrocortisone cream to help relieve the itch. As with all medicines, if you are not sure about the dose check with your pharmacist or pediatrician. If your child develops high fever, body aches or headaches it is time for a visit to your pediatrician.

Remember severe West Nile virus infection is extremely rare and armed with the Four Dʼs we can fight back the terror and, hopefully, take the bite out of this summer.