In the rolling hills of southern Puerto Rico, in the 500-year-old village of Coamo, the music blares from the back of a pickup truck rolling through neighborhoods.
The song warns about the dangers of mosquitoes that carry Zika virus.
As the music gets the attention of residents, a small army of city workers, including the town’s mayor, goes door to door handing out kits with mosquito repellent. Insecticide is sprayed nearby.
U.S. & World
The scene in Coamo, a picturesque, mostly Catholic town miles from the beach, is playing out across Puerto Rico.
The prevention efforts are in response to startling numbers showing that Zika is spreading wildly all over the island.
"This is dangerous to our people, to the ladies, to the old people," said Coamo Mayor Juan Carlos "Tato" Garcia Padilla. "We need the help of our people."
Some 2,000 people a week are getting infected and, if current trends hold, a quarter of the island’s 3.5 million people could get Zika by the end of this year, according to the Centers for Disease Control and Prevention.
Even the many people who show no symptoms can become carriers without knowing it. Tourists can unknowingly carry the virus back to the mainland.
Health experts fear the real impact will be on babies born with life-long disabilities.
The spread of the Zika virus has prompted the World Health Organization to declare an international health emergency. Carried by the Aedes aegypti mosquito, Zika can cause microcephaly in babies, who have unusually small heads and brain damage. A recent study of brain scans of Brazilian babies showed other damage as well.
In adults, Zika virus is also linked with Guillain-Barre syndrome, a form of temporary paralysis, according to the CDC.
There is no vaccine or medicine for Zika.
Zika emerged in the Americas in mid-2015 and since then outbreaks have occurred in multiple South American and Caribbean countries, and now Florida, according to the CDC.
Dr. Judibelle Rivera, an obstetrician and gynecologist in Coamo, is telling patients to wait a year or two before getting pregnant.
She passes out free government-provided birth control, even though fewer pregnancies mean her practice will take a financial hit.
"It's worth it because having babies with something like a handicap for the rest of their lives, that's not good,” she said.
Dr. Nabal Bracero, who runs a fertility clinic in San Juan, echoed her concerns.
"It is a nightmare,” he said. “It is the worst situation you can have in terms of public health."
Some 1,314 pregnant women in Puerto Rico have tested positive for Zika, the CDC said. The numbers are climbing.
Dr. Brenda Rivera heads the fight against the epidemic for the Puerto Rico Health Department.
"I'm at the forefront of the response, so for me it's not just a number," she said. "When I see these numbers go up, it's not just a number, there's a family, there's an individual behind that number. And for me that's very real."
Emergency responders are fanning out across the island, led by Puerto Rico’s emergency management director Angel Crespo.
"It's kind of crazy stuff to deal with it,” said Crespo, who is also the island’s fire chief. "Right now we are incorporating artists. I’m a musician too."
He wrote the Zika prevention song they were playing in Coamo and even made a music video posted on YouTube.
“Ten cuidado del mosquito te pica,” the song starts. It means, “Be careful of the mosquito biting you.”
"We need to explain this seriously, loud and clear, so people can understand how serious is the Zika virus,” Crespo said.
The US government, including a team from the CDC, is helping organize the growing response.
Standing water, especially around houses, has become a target.
The effort reaches to places you might not expect -- even cemeteries. That's because the water in the vases for flowers are mosquito breeding grounds. Workers have turned many of the vases upside down.
But the challenges are monumental. The tropical climate in Puerto Rico means it rains frequently. Puddles form everywhere.
And there are other challenges.
Plans for aerial spraying got shelved amid a public outcry about chemicals being dropped from the air.
The Zika scare comes as Puerto Rico is in the middle of a financial crisis. It can’t pay billions of dollars in debt and tourism is one of the only bright spots in the economy.
Money from the federal government to fight Zika is slow to make it to the front lines.
Even with better funding, the kind of mosquitoes that carry Zika are especially hard to kill.
"There is one insecticide that is working better than the others, but still there is widespread resistance to it," said Dr. Roberto Barrera, chief of entomology for the CDC.
The CDC is advising pregnant women not to go to Puerto Rico and telling visitors to wait at least eight weeks before trying to get pregnant.
Despite the threat, the head of Puerto Rico’s Hotel and Tourism Association said the island is open for business.
“You have to look at the facts – facts versus the fear,” said Clarisa Jimenez.
She called estimates that a quarter of the island could become infected a “worst-case scenario,” but acknowledged pregnant women should stay away and urged everyone to wear repellent.
Many hotels remain busy and tourists still flock to Old San Juan to visit the fortified beach-front walls that have helped defend the island for generations.
Dallas/Fort Worth International Airport offers daily nonstop flights to the capital of San Juan.
As a U.S. territory, Puerto Rico is neither a state nor a country. Its 3.5 million residents are American citizens.
A New York man visiting a San Juan beach said he felt safe.
“You’re a little precautious, you know, but it’s not going to beat the vacation,” Diego Suiter said.
Back in Texas, through Aug. 29, there have been 133 confirmed cases of Zika virus this year. This count includes six pregnant women, two infants infected before birth, and one person who had sexual contact with a traveler. Harris County has had the most cases with 35, but is followed closely by Dallas County with 30. Elsewhere in North Texas, Tarrant County has reported 17 cases, Collin County three and Denton County four.