Dallas Copes With Unpredictability of West Nile Virus - New York Times

DALLAS â€" Jay Wortham found it under the cabinet below the kitchen sink after his mother died in August â€" a blue bottle of insect repellent.

His mother, Margorie Wortham, 91, died of West Nile virus, the mosquito-borne illness that has spread across this city and other parts of the country, killing 118 people and sickening nearly 3,000 others nationwide.

Mr. Wortham believes that his mother was bitten by an infected mosquito one hot day in July while she sat on an old wooden bench under a pecan tree in her backyard. Though she had often used the bug repellent, she was not wearing any that day.

Here in Dallas County, the West Nile outbreak’s hardest-hit county in the United States, a few missed pumps of bug spray can haunt the relatives of those who die from the virus.

“I wish I had taken her this instead of a vodka and Coke,” said Mr. Wortham, 59, holding the bottle in his hands. “I ask that other people don’t make the same mistake.”

Ms. Wortham and 14 other people have died in Dallas County from the virus since July. Nine were men, and six were women. The youngest were in their 40s, and the oldest in their 90s.

Charles H. Pistor Jr., 81, was a well-known figure in Dallas â€" a retired banking executive, former vice chairman of the board of trustees at Southern Methodist University and past president of the Dallas Assembly civic group.

Dr. Tom M. McCrory, 92, a retired eye surgeon, died eight days after Mr. Pistor in July.

Dema Miller lived in the Dallas suburb of Irving and was one week shy of her 84th birthday when she died in August.

Local and federal health officials said the outbreak that has killed 57 people and sickened hundreds of others in Texas appeared to be waning, with Dallas County seeing a decrease in new cases in recent weeks. Still, the friends and relatives of the county’s fatal victims remain in a state of grief, coming to terms with the seeming randomness of healthy middle-aged people and active retirees cut down by ever-present insects.

County health leaders said that although some of the 15 people had pre-existing medical conditions like hypertension, kidney disease or a history of cancer, others did not have any conditions that put them at a higher risk of developing the most severe form of the illness, West Nile neuroinvasive disease. The disease affects the brain and spinal cord and can lead to brain damage, coma and death. The milder form, West Nile fever, can cause flulike symptoms.

“You cannot predict with certainty who is going to come down with more severe disease in a situation like this,” said Dr. Wendy Chung, the chief epidemiologist for Dallas County Health and Human Services.

“We don’t want people to have a false sense of security that they are somehow impervious to the disease because they don’t have an underlying medical condition,” Dr. Chung added. “People feel that West Nile is something that happens to somebody else in some other ZIP code, with some other set of health problems. I think that is counterproductive to what we’re trying to achieve on a public health level, which is an appreciation that risk can sometimes be very unpredictable.”

Many of those who died lived far from one another in the Dallas suburbs of Seagoville, Grand Prairie or Rowlett, in a county that at 871 square miles is nearly three times the size of New York City.

But 6 of the 15 victims lived in three adjacent ZIP codes a few miles north of downtown Dallas â€" 75205, 75225 and 75229. The area is a roughly 21-square-mile section of North Dallas and the Park Cities, which include the town of Highland Park and the city of University Park. It is made up of neighborhoods with manicured lawns and some of the wealthiest, most highly educated households in the Dallas area.

One residence in particular is the best known but least talked about, publicly at least â€" the house on Daria Place where former President George W. Bush and his wife, Laura, live. Their ZIP code is 75229, where two people bitten by infected mosquitoes died â€" Ms. Wortham and another resident.

The reasons the West Nile outbreak has been so intense in those three ZIP codes and throughout the county are unclear. Local, state and federal health officials said a variety of complex factors could be at play.

Because West Nile outbreaks are often associated with heat waves, the Dallas area’s hot weather this summer might have contributed, although many parts of the country that had high temperatures did not experience such severe outbreaks. Mosquitoes get the virus when they feed on infected birds, and officials believe that the population of susceptible birds, the infectiousness of the mosquitoes and the environmental conditions that might have changed the interactions between birds and mosquitoes might have also played a role.

“All of this is something that we’re going to try and sort out in the upcoming weeks and months, as we start to look at the data in more detail,” said Dr. Lyle R. Petersen, the director of the vector-borne infectious diseases division at the Centers for Disease Control and Prevention. He added that it appeared that ecological factors were responsible, not a change in the genetics of the virus.

Ms. Wortham and her husband, James Gregg Wortham, an engineer who died in 1980, had two children, and she enjoyed spending time gardening at the house they moved into in 1959. In later years, Ms. Wortham, a grandmother of two and great-grandmother of four, hung a framed passage from a poem by Dorothy Frances Gurney: One is nearer God’s heart in a garden/Than anywhere else on Earth.

Days after Ms. Wortham was bitten in July, she became increasingly ill and nauseated. She eventually collapsed and was rushed to the hospital. “She was exceedingly weak,” Mr. Wortham said. “She had tremors here, and I couldn’t take care of her in that condition, and that’s when I called 911.”

She died five days later.

On a recent afternoon, Mr. Wortham, who had moved home to take care of his mother, sprayed himself with her bottle of bug spray before going out into the backyard. On the coffee table in the living room, he left the medical document he received days ago. He said he was feeling fine, and was neither overly worried nor surprised: he, too, had tested positive for the virus.