In it for the Money: Bed Bugs!

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We met our first bed bug while traveling in the spring of 2011. My wife had plucked the creature from a friend’s bedroom wall.

As tends to be the case in situations like this, the meeting began with a debate over whether the arthropod in question was in fact a bed bug. Because I’ve had the privilege of being born and gendered male, my initial response was a very confident declaration:

“That’s not a bed bug!” Then we Googled it.

It was totally a bed bug. It was, quite possibly, the exact some bed bug shown in the top result returned for “bed bugs.”

What followed was a complete and hysterical existential freak-out. We helped our friends tear apart their home, searching for signs of bed bugs with all the frantic compulsion of deeply addicted meth heads scouring the rug for that last lost shard.

Our findings were inconclusive – as lots of things look like bed bug carcasses when you are freaking out. So we elected to beat a hasty retreat – fleeing not just the house, but the city and state, and stopping only to spend an hour or two at a highway rest area tearing through our belongings in a disgusted search for bugs, nymphs, carcasses, or droppings.

Meanwhile, our four-year-old played in the grassy border unattended, attempting to coax robins into landing on a stick he held by pretending to be a tree.

In our defense, this was back in 2011 – in the wake of the terrible Year of the Bed Bug, when mass media outlets from the New York Times and USA Today to local TV news reports couldn’t go a week without reporting a new bed bug incursion: bed bugs in New York lofts and San Francisco apartments, bed bugs in homeless shelters and thrift shops, bed bugs infiltrating high-fashion clothiers, upscale movie theaters, and even the offices of the Wall Street Journal (who’d jumped the gun three years earlier, declaring 2007 the Year of the Bed Bug).

Bed bugs, as you’ll recall, have sucking mouthparts which they use to drink your blood! These bites leave enormous suppurating welts on white people [1]. After biting you and draining you of your vital bodily essence, a bed bug will lay up to 300 eggs and poop blood in your bed! If a bed bug looks at an item of furniture for more than 15 seconds, that furniture must be completely burned and the ashes sealed in a zinc cask and cast into Mt. Doom, lest the bed bugs use it as a portal to all other furniture created in the same factory! Bed bugs spread filth and dyspepsia and halitosis, they are the number one cause of out-of-wedlock gay marriages in Bible Belt states, they are responsible for any of the Star Wars movies you don’t like, and they shot Abraham Lincoln’s dog!

Am I going over the top? A little. But here’s a 100% real bed bug article lede from a legitimate news source picked almost at random:

The United States is currently experiencing a nightmarish epidemic of disgusting blood sucking parasites. There is a full blown bed bug epidemic happening all across America and it just seems to get worse with each passing year. [2]

Neither of those sentences is factually accurate. The first might be, provided “nightmarish epidemic” is taken to be a synonym for “probable increase.” As for the second sentence, once you remove the unverifiable histrionics, all that remains is “There is a … bed bug … [in] America.”

That, at least, is true. There’s no denying that bed bugs are making a comeback in the U.S. and Europe as a common-place traveller’s worry.

But are they dangerous?

No.

Are infestations very common across the U.S.?

No.

Are infestations even all that common in the cities most infested with bed bugs?

No.

If there’s an epidemic here at all, it’s one of unverified “press release reporting,” where otherwise well-intentioned “reporters” report directly from fear-mongering press releases without engaging a modicum of skepticism or meaningfully Doing the Job.

We aren’t suffering from bed bugs so much as we’re suffering from media-driven delusional parasitosis – and that, in fact, is dangerous.

Bed Bug Eradication

Part of what’s at work here is a general unfamiliarity with bed bugs – because few living Americans have anything other than faint childhood memories of them. As of the mid-20th century we’d almost entirely eradicated bed bugs in the U.S. and Europe, sorta by accident.

Starting during World War II, DDT was used extensively to control the spread of malaria, dengue fever, and typhus by eliminating their vectors: Malaria and dengue fever are transmitted via infected mosquitos, and typhus by lice, fleas, and ticks. DDT was remarkably effective against these pests – in fact, it’s remarkably good at killing most arthropods on contact – without seeming to be all that toxic to people, pets, or livestock.

After WWII this wonder insecticide was approved for agricultural and commercial use in the U.S., and America entered the Space Age with plentiful crops, healthy kids, and vermin-free homes – it was a great time to be an American! Heck, our country was so great that it didn’t even have commonplace annoyances like mosquitos, no-see-ums, fleas, lice, or bed bugs! American Exceptionalism! Brave New World! U-S-A! U-S-A!

But it turned out that DDT wasn’t so benign, and the canary in this coal mine was the very symbol of our independent spirit, the bald eagle. While it is indeed the case that mammals are largely unfazed by DDT [3], the pesticide is environmentally persistent and fat soluble, readily absorbed by fish. That fat-soluble DDT then accumulates in the bodies of the predators that eat the DDT-enriched seafood. For reasons still not fully understood, high concentrations of DDT cause birds to lay eggs with very thin shells. Birds of prey are especially hard-hit, as are songbirds (hence the title of Rachel Carson’s “Silent Spring,” which warned of the environmental impacts of overuse of pesticides, especially DDT). In case it isn’t suitably obvious, as birds sit on their eggs to incubate them, thin-shelled eggs aren’t viable. The combination of Carson’s writings and the DDT-driven near extinction of our national bird gave birth to the modern environmental movement, and led to the ban of DDT by the 1970s.

Yeah! Brave New World! Earth Day! U-S-A! U-S-A!

Of course, with DDT banned, bed bugs – which hadn’t really been on our minds in 20 years – also began to recover. So we turned to organophosphate pesticides, usually chlorpyrifos, to control them. While these are much less environmentally devastating than DDT – they breakdown rapidly when exposed to light and air and are water soluble, and therefore don’t bio-accumulate very readily – they’re also significantly more toxic.

Organophosphates are “quasi”-irreversible acetylcholinesterase inhibitors, which means the both intensify and prolong the action of the neurotransmitter acetylcholine. This action slows the heart-rate and triggers muscle contractions. Classically, folks suffering organophosphate poisoning die from suffocation, as they are unable to relax their diaphragms. Sarin and VX nerve gas are also organophosphates.

Organophosphate poisoning is an absolutely wretched way to die – so terrible that we don’t even wish it on our worst human enemies.

As bed bugs tend to congregate in bed rooms, treating infestations with nerve gas seemed a touch injudicious. Chlorpyrifos was largely banned by 2001. Between 2001 and 2007-ish, we were doing OK against bed bugs using pyrethroid insecticides/repellents, which are basically what we’d been stuck using in those benighted years prior to WWII, when “don’t let the bed bugs bite” wasn’t just a cutesy bedtime aphorism.

Pyrethroids are basically man-made versions of the pyrethrins naturally occurring in some varieties of chrysanthemums. [Confusingly – for me, as a non-gardener – the specific mums that bear the highest concentrations of pyrethrins are often called "daisies"]. At one time “Persian powder” – basically crushed, dried pyrethrum mums – was a popular part of any good housewife’s anti-bed bug regimen, as was mercury. Ah, for the good old days, before we’d synthesized all these terrible chemicals like DDT and organophosphates and instead used good, clean, all-natural mercury to seal up our baseboards against the big bad bed bugs!

At any rate, by 2007 most strains of bed bugs seemed to have developed immunity to pyrethroids, both naturally occurring and synthesized. So, today, we’re not even back to square one. Square one was in the 1800s, when we still had the benefit of Persian powder and were willing to sleep in rooms filled with kerosene and mercury fumes. Today we’re completely defenseless against bed bugs – a scourge so terrible that, for a time, it seemed more reasonable to spray nerve gas in our sleeping chambers than to risk the terrible bed bug’s bite.

All those reporters are right: Truly, it is time to freak the hell out.

Bedbugapocalypse!

Except that it isn’t time to freak out at all. First and foremost: Bed bugs bites aren’t that bad.

Washtenaw County Environmental Health Director Kristen Schweighoefer pointed me to this wonderfully informative WEMU interview from August 25, 2010, featuring Erik Foster, a medical entomologist with the Michigan Department of Community Health. As Foster points out, bed bug bites don’t transmit disease – heck, even in lab conditions we can’t make them transmit disease. Bed bugs are actually fairly polite to humans: Their saliva contains an anesthetic, which is why you don’t feel their little mandibles buzz-sawing through your flesh. Some folks have a bad reaction to the anesthetic, which is why they swell up and get itchy – just as most folks do with mosquito bites (although, in contrast to bed bugs, mosquitos do spread dangerous pathogens). Between 15% and 30% of the population doesn’t even react to bed bug bites – and thus will be none the wiser of they get bit.

For a bit of contrast, let’s consider these much less reported, and much more significant, public health risks:

• Mold: Complaints about mold outrank bed bugs in Washtenaw county, and mold is actually injurious.
• Food-borne illness: More than one out of every six of us will suffer from it this year [4]. For most folks that will just mean a very unpleasant day, but for some it can be life threatening.
• H1N1: The latest strain of H1N1 swine flu seems to target healthy adults – who are usually least susceptible to flu. It’s hospitalized more than 60 people in Washtenaw County since the New Year, and caused several deaths.
• Dust mites: All of our beds and bedding are chock full of them. They’re seriously implicated in chronic asthma and pulmonary health issues for folks with allergies, but dust mites aren’t even really on the public-health radar; they’re just a an unpleasant fact of life – like bed bugs once were.

On top of this, bed bugs are egalitarian. The stereotype is that bed bugs target the poor, the dirty, and the foreign. But as Schweighoefer mentioned when we spoke, this really isn’t the case: “There’s a lot of social stigma associated with bed bugs; people often have the misconception that bed bugs are associated with a poorer socioeconomic status or dirty environment, and we know that is absolutely not the case. Bed bugs feed on humans. They don’t care how much money you make, or the color of your skin, or where you live. They like people. All people.”

In other words – and in contrast to many parasites, such as lice, who are racist – bed bugs are actually walking the egalitarian walk, and not just talking the talk. That’s kind of charming, when you think about it, especially so close to MLK Day.

But I digress.

To summarize: Bed bug are more polite than lice, safer than mold or dust mites or eating at a buffet, and their bites are less vexing and less dangerous than mosquito bites.

The Epidemic That Wasn’t There

Still, bed bugs are gross. They are relatively large (and thus easier to notice than the hordes upon hordes of microscopic dust mites that populate your pillow). They actively parasitize you and your bedmates. They do in fact poop blood in your sheets. They reproduce exclusively via traumatic insemination – which is actually much, much worse than it sounds, and which they are also doing in your bed. And they are going to totally make you a pariah if people find out you’ve got them.

Rational folks totally acknowledge that bed bugs are innocuous, but they still don’t wanna shack up with them.

How bad is our pan-national bed bug infestation? There’s the rub: Solid numbers from disinterested parties are remarkably hard to come by. Most media reports of the “bed bug pandemic” turn out to be re-reporting of press releases from national pest control chains, namely Orkin and Terminix, who release annual lists of the “most infested cities” in the U.S. On the one hand, this sounds pretty definitive: Who knows bed bugs better than trained exterminators? And who better to speak to the nationwide impact of bed bugs than nationwide firms with outposts in every region serving Americans across all socio-economic classes in a broad cross-section of living arrangements and businesses?

But these press releases don’t inspire a ton of confidence. To start with, they don’t even agree on which cities are most infested. In 2011, Orkin pegged Cincinnati as the bed-bugginist burg in the Union, followed by Chicago, Columbus (OH), Denver, and Detroit – New York came in seventh place. But according to Terminix. NYC was the place to be for bed bugs (and has stayed in the top five ever since), followed by Cincinnati. Detroit jumped to third, Chicago was pushed to forth, and Philadelphia (which was ninth according to Orkin) came in fifth on the Terminix list.

According to Orkin “cities are ranked in order of the number of bed bug treatments Orkin performed.” Digging a little deeper into their website, you find that “Most bed bug control treatments by professionals in the U.S. and Europe take 3-4 treatments” – which isn’t surprising when you learn that most companies (including Orkin) are still relying on some limited chemical pesticides combined with what amounts to spot-treatment using handheld steamers and dry ice. This isn’t super effective in killing eggs, which is why you end up with multiple treatments [5]. Are multiple treatments of the same infestations factored in to the press release tally? Who knows. This isn’t a scientific study; it’s a press release.

According to Terminix, their tallies are based on “complaint calls from customers as well as confirmed cases by service professionals when creating the ranking.” This distinction – between “calls” and “confirmed infestations” – is very murky, and that murkiness (elided in the press releases) goes entirely unremarked by reporters.

As it turns out, few municipal or county health departments actually track confirmed bed bug infestations. For example, Washtenaw County collects “complaints,” but these aren’t generally verified. As Schweighoefer explains, this is because, when it comes to bed bugs, the county’s role is really to mediate disputes and make sure the interpersonal issue is resolved. It doesn’t really matter if those purported “bed bugs” turn out to be gnats or pill bugs or hallucinations. If everyone can ultimately get along, that’s what counts – because, remember, bed bugs are not themselves dangerous.

So, for example, when a media outlet prints something like “… from September 2011 to June 2012, there was a period of frenzied feasting with [Philadelphia] residents phoning in 236 complaints of sleep-killing insects” – that figure doesn’t represent actual confirmed cases of bed bugs, even though Atlantic.com treats it as though it does. I called Michael Z. Levy – one of the researchers on the study whose press release the Atlantic was reprinting – and he confirmed that the Philadelphia Department of Public Health’s Vector Control Services (the source of the data he and his colleagues used for what he stressed was a pilot study) tracks complaints, without confirmation. [6]

So, what we have is an epidemic of complaints and pricey treatments, not an epidemic of bona fide bed bugs.

Fortunately, the New York City Department of Health and Mental Hygiene records both complaints and confirmed infestations, giving us a glimpse at what the variance might be between these two numbers. For example, in 2011 – that fateful Year of the Bed Bug – NYCDHMH recorded more than 13,000 bed bug complaints, because OMFG New York is so gross. Call the Orkin Man!!

But of those 13,000 complaints, only 4,481 – or about one-third – actually turned out to be bed bugs. Still, 4,481 cases of harmless bed bugs is pretty gross, right? I mean, those 4,481 confirmed bed bug cases landed NYC at the top of Terminix’s list of “Most Bed Bug Infested Cities in the U.S.” for years. But when you adjust for population, NYC’s 4,481 confirmed cases of bed bugs in 2011 amounts to an “infection rate” of just 0.00054 infestations per New Yorker, or one infestation for every 1,851 New Yorkers.

But that doesn’t make for scary press releases, does it? That ain’t gonna sell newspapers, let alone get you to pay the Orkin Man to flood your house with nerve gas.

Incidentally, I spoke with Peter Logan, communications director for University of Michigan Housing, and in 2011 UM had almost exactly the same infection rate as NYC: Of their roughly 11,000 residents, they had six confirmed cases of bed bugs – or, as a press-release reporter might have put it in his article’s lede:

“This bucolic Big Ten university suffered a 500 percent increase in confirmed bed bug infestations in 2011, a bed-bug infestation rate as bad as those seen in the hardest-hit metropolitan centers.” [7]

That’s not an actual lede anyone’s ever used – but it is 100% factually accurate, unlike the real lede I quoted at the beginning of this column. And UM has never made anyone’s Bed Bug Ground Zero list, despite having bed bug infestation rates as high as those in the worst-hit cities. That’s because six cases of bed bugs is hardly worth reporting, or even press-releasing. But that doesn’t change the fact that the UM dorm 2011 bed bug explosion was just as bad as New York’s.

That was back in 2011, when bed bugs were at their worst. In the intervening years New York seems to have gotten a handle on controlling bed bug populations, and has pushed these rates down by about 40 percent. Nonetheless, it’s still among the “most bed bug infested cities in the U.S.” even though – when you actual adjust for population – it is significantly less bed bug infested than most major U.S. universities, including our own University of Michigan.

Press Release Reporting And Delusional Behavior

Publicists and marketers write press releases to “drive interest” – which is the step that precedes “Profit!” in the Underpants Gnome Business Plan. Even university press releases – like the one quoted by the Atlantic – are marketing pieces, intended to increase the public familiarity with a brand, and thus the likelihood that the public will support that brand. It always boils down to attention, with attention being a proxy for money [8]. And that means (1) everything is stated in the most extreme possible terms; and (2) all facts are held to account not against Occam’s Razor, but against the ironclad edict of “Attract Eyeballs!”

This is sorta-kinda OK in a press release, because none of us reads a press release or brochure or glossy magazine ad and thinks “Man, these scientists at Johnson & Johnson sure have thoroughly established that Listerine is an effective remedy for the terrible plight of chronic halitosis!” We know to take commercial messages with a grain of salt.

But when we read something in a newspaper, we tend to assume that some level of fact checking or meaningful analysis has gone into it. When a reporter simply re-reports a press release, we have real-life citogenesis: A spurious datum becomes an ironclad and oft-repeated fact.

And that “fact” – despite bearing only passing resemblance to reality – will form the bases of our decisions and actions, for better or worse.

The Power Of Delusional Thinking

I keep saying that bed bugs are harmless, and that’s true: Most folks only react mildly to bed bug bites and the bugs cannot carry human transmissible disease. But they are still a public health concern, because bed bugs exact a significant psychological toll, ranging from mild discomfort and disrupted sleep to prolonged anxiety, social isolation, negative self-image, and delusional reasoning.

About three weeks ago my family had our second bed bug run-in whilst traveling, this time on the coverlet of a bed in a crisp, clean, modern and by no means inexpensive business hotel. My wife and I knew a lot about bed bug biology and how essentially harmless they are – having successfully recovered from our previous “bed bug exposure” without becoming scabby hosts to the terrible things.

Nonetheless, my wife and I packed our bags, sealed them in garbage bags, and hustled our two young children away from that hotel, so that we could knowingly drive into a polar-vortex driven blizzard. Twelve hours in to what is normally a five- or six-hour drive, we were forced off the road by white-out conditions near Michigan City, Indiana – and nearly literally forced off the road by a heedless airport shuttle bus that couldn’t see us.

My wife and I both grew up around Lake Michigan.  We’re no strangers to the ferocity of lake effect weather. We’d even texted my sister – who lives in Chicago – before leaving the hotel, and she’d advised in no uncertain terms that we should stay put: The weather coming in off Lake Michigan was nuts.

So, to tally:

1. We knew bed bugs were harmless.
2. We knew how to properly search and treat our belongings so that we would not ultimately bring bugs or viable eggs into our home.
3. We were fully cognizant of how dangerous highway driving is in general, let alone winter driving, let alone winter driving near the southern end of Lake Michigan
4. We had specific and authoritative information categorically stating that this specific drive was especially dangerous
5. We fully understood that we were driving into an unprecedented weather phenomenon.

And yet we left a safe hotel – where we would have gotten an excellent rate – and headed into a deadly storm. What we did was, without any doubt, stupid and irresponsible. I cannot justify it.

But . . .

It was our second morning in the hotel when I found and captured the bug. I’d checked the mattresses when we’d arrived (albeit far less rigorously than I would have in the past – after all, it’d been years since we’d seen a single bed bug). None of us had suffered a bite, or anything at all like a bite.

But you find that one bed bug – or even just one carapace, a few specks of blood near the mattress’s rolled seam – and you begin to itch all over. You can feel them under your clothes and in your hair. If you stop moving even for an instant – stop packing, stop loading the car, stop bathing the children, searching the sheets, cleaning, sorting, washing, searching – and you will feel them on your ankles and neck, worming across your belly hair, getting tangled in your armpits. You check your hair, tie it back, wash your hands. Repeat. You get back to packing, to barking at your kids, to checking and rechecking stuffed animals and books and shoes and sippy cups, bagging bags in other bags. You dive to scrutinize every dark clump of lint nestled in the shaggy rug. You wash your hands. Untie your hair, check your hair, tie it back. Check the kids’ boots, their stuffed animals, their bags, wash their hands, check their hair, wash your hands, rinse, repeat.

Repeat.

Repeat.

This is what’s dangerous about bed bugs, this low-level delusional parasitosis, and it’s dangerous because it drives us to behave irrationally and make terrible, terrible decisions. [9]

If you’re tempted to dismiss such things as “all in your head,” then just remember this: An intelligent man – a man you respect enough to wade through 4,000 words of his thoughts on bed bugs – drove into the vortex, endangering the lives of his toddler and seven-year-old, because he was afraid of the bed bug’s bite.

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Notes

[1] Sorry if that seems like gratuitous race-carding, but when I typed “bed bug bites” into Google Image Search all of the returns were of white people. When I tried “bed bug bites on a black person” the response was still almost entirely pink-colored. [shakes head] Post-racial America, indeed.

[2] This was plucked from the generally non-hysterical International Business Times; it was the first news item returned when I Googled “bed bug pandemic” on January 19, 2014.

[3] This is a moderately controversial statement: DDT is implicated in increased rates of diabetes, as well as some developmental problems to those exposed in utero. There are indications that heavy exposure – like that endured by workers handling DDT regularly – may result in chronic neurological problems. It’s also possible that the rates of some cancers – including breast cancer – increase with DDT exposure, but the actual cause-effect relationships continue to be murky.

[4] Including your correspondent; this column is late because my son and I were down for several days, likely due to a dodgy hard salami.

[5] What does seem to work: “integrated pest management” and heat treatment. That basically boils down to: thoroughly cleaning the space and vacuuming, laundering everything and sending it through the dryer, limited chemical fumigation of items that cannot be heated, some freezing of items for which heating and fumigation are impractical, and then heating the entire dwelling to 120 degrees using industrial space heaters. Seal your mattress and box spring in an encapsulating bag – also best practice if you have dust mite sensitivity – and you’re done. Is this easy? No! It’s a shit-ton of work. Is it cheap? No! It’ll run you a grand, at least. Does it work?  Yup, it’ll kill all bugs and eggs, trap the remainder harmlessly in your mattress, and you aren’t filling your bedroom with nerve gas.

[6] In case you’re wondering how I performed this amazing feat of investigative journalism: Levy’s name is a link in the press-release, and that link takes you to his faculty web page, which lists his phone number. He answered on the first ring. The whole thing took me under two minutes. I ain’t no Bob Woodward.

[7] Hard numbers: UM had one bed bug incident in 2010-2011, six in 2011-2012, and seven in 2012-2013. There’s been one this year. Although there is no centralized tracking of bed bug statistics among universities, Logan’s sense was that most schools about UM’s size had similar rates of infestation, and followed similar treatment and prevention protocols to those used at the university. These guys take pest control really seriously.

[8] Disclosure: The bulk of my living is earned in marketing. I am not a journalistic pundit opining on the evils of commercial hacks; I’m a commercial hack taking a steep pay cut to speak to you candidly about journalism and punditry.

[9] In case you’re wondering what the right response was here – since fleeing into the Polar Vortex obviously wasn’t it – check out this related post I’ve written covering the appropriate traveler’s response to bed bugs.

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