Concern about the recent city-wide rise in bed bug infestations has led to the creation of a bed bug forum, coming to Etobicoke this Wednesday, April 2 at LAMP CHC.”You have a couple of generations who are not used to living with bed bugs,” Reg Ayre, manager with the Healthy Environment Program at Toronto Public Health, told The Guardian. “Before the Second World War bed bugs were fairly common and people knew how to live with them and how to deal with them. Now you’ve got the situation where folks are having to learn to deal with them all over again.”The forum will feature speakers from Toronto Public Health, South Etobicoke Legal Clinic and Sam Bryks, Manager, Environmental Health at Housing Services Inc.

According to the article,

The forum runs from 6:30 p.m. to 8:30 p.m. at LAMP CHC, 185 Fifth Street, Community Room. Light refreshments provided.

• Reg Ayre of Toronto Public Health: bed bugs a “health concern,” not a “health hazard”
• After a fire, bed bugs “rain down from ceilings” into other apartments
• bed bug news for 2007-11-16
• Toronto Councillor Paula Fletcher has some progressive ideas about bed bugs

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It’s worth noting that Wikipedia claims Seaton House is the largest homeless shelter in Toronto, housing at times as many as 700 men.

I found more information on this initiative in this PDF at the City of Toronto website. (”Bug and Scrub” is item #2.) They even have a great name, though if they are only dealing with bed bugs–and this is not clear from the description–they might have gone with “Bed Bug and Scrub” to make this clearer.

It sounds like the program provides full-service assistance with bed bugs (from detection, to cleaning and prep for treatment, pesticide application, and follow-ups):

Bug and Scrub is an all in one service that incorporates responsible and reliable measures to deal with the bed bug issue. Following an Integrated Pest Management protocol, full treatment is provided including assessment, prep work, spraying of the bed bugs, removal of belongings and follow up. The business has already proven successful and has provided many low-income, vulnerable individuals with this unique service.

Staff at Seaton House support clients during their training and employment phase. Anyone residing in the City of Toronto can receive the Bug and Scrub service. Fees operate on a sliding scale and can range from $250 -$800 based on the type of work required.

For more information please contact Richard Grotsch at 416-392-5572.

Remember, contrary to some misconceptions, IPM doesn’t mean no pesticides are used. It means fighting bed bugs on multiple fronts, trying to remove them as much as you can, and then treating to kill what’s left.

I have to say, the Bug and Scrub concept excites me: these men are getting training in what is unfortunately a growth field, they’re getting support as they make an educational/career transition, and Toronto residents are hopefully getting good, reasonably-priced pest control service.

• Toronto Public Health now has a Bed Bug Action Committee. Action, people.
• Bed bugs: what’s really working?
• bed bugs in Toronto; Vancouver; Billings, MT,
• Abbey the Bed Bug Dog: news report

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Reg Ayre tapped his computer keyboard and up popped a photo of a polka dot pillow on a lonesome bed; not polka dots. “Those specks are blood,” said Reg. “The blood is from bedbug bites. You can see the pillow has not been washed.”

He tapped the keyboard again and up popped a photo of sawdust on the floor in one corner of a lonesome room; not sawdust. “Bedbugs,” said Reg. They were so thick you could have scooped them up with your hands.

Ayre is the Manager of Healthy Environments for Toronto Public Health. His department has just tabled a report about bedbugs with the board of health.

The report is written in committee language and is not as graphic as the photos. But, Ayre said, “The report establishes a bedbug action committee. We don’t want another policy group. We want action.”

And action is just what is needed!

While I don’t think New York City has an, ahem, “Manager for Healthy Environments,” we need just this sort of activity to be taken by Reg Ayre’s counterparts in San Francisco, Boston, and everywhere else bed bugs are biting.

Some New York Bedbuggers are organizing a campaign you will be hearing more about very soon — a campaign to press our local officials to take this kind of action.

Fiorito asks Ayre just the right questions:

So who’s on the committee? “There will be landlord and tenant reps from across the GTA [Greater Toronto Area], from both private and community housing. Public Health will be on the committee, and licensing and standards, shelter support and housing, social services, community groups and reps from the Community Care Action Centres.

“I’m trying to work with other resources. We’ve got pilot projects going in St. James Town and in smaller buildings downtown. Seaton House is doing an amazing job for us.” Seaton House, a men’s shelter, has trained some of its residents as exterminators; they have been helping people move furniture and prepare for spraying; this is so practical it’s radical.

Ayre said, “The committee is going to meet on the 17th of the month with a facilitator to develop some hard objectives, to plan a way forward, to create a template we can apply throughout the city.” Because the problem is city-wide.

Bed bugs are a serious problem for people of all social classes and in all physical conditions. But the most severely hit are those who are poor, elderly, or disabled–especially if they do not have anyone to call on for help. Fiorito’s conversation with Ayre covered one such tragic example:

[Ayre said:] “There was a tragic case of a woman with a variety of disabilities.” She was alone and being eaten alive by bugs.

“She had a social worker but that link was broken. My worker is helping her deal with (the Ontario support program) to get new furniture, to get funds, to work with her landlord. We’re trying to get her linked back with her family.

“But my staff aren’t social workers. They don’t have that training. And one of these cases might take months to resolve.” Yet his staff do not turn away.

And then he said something I find shocking.

“It’s my impression that bedbugs are just a symptom. People in this community are living without the supports they need to lead a healthy life.”

Fiorito also reminds those in Toronto

If you have bedbugs and don’t know how to cope, call Public Health: 416-338-7600.

In an article published January 16th, Fiorito quoted Ayre at greater length:

“If you need help, call Toronto Public Health. If we can’t answer your questions, we’ll send someone out. Then, if you need assistance, we’ll try to bring all the resources we can. We’ll be an intermediary. There are people who are afraid to clean up: contact us. But you have to be prepared to accept help … whether it’s a health hazard or not is on the periphery of the discussion. This is a social problem with health implications. It’s the most vulnerable who are suffering.”

So Reg Ayre means it, if you are in Toronto and have bed bugs and need help, seriously, call TPH.

Although other health departments do not appear to be offering help, I think that’s good advice for anyone, anywhere–to call your local health department, I mean. They may not know what to do with you, they may not think dealing with bed bugs is part of their jurisdiction. They certainly are not offering to come out and help you clean, yet. But we need to make it their concern.

I spoke with one public health official in California, who said that at a conference of public health officers, others were saying they never got calls about bed bugs. If they do not hear from people about the problem, then they do not know it is happening in their jurisdiction. If you have bed bugs and don’t know how to cope, and your city has said nothing as to who you should call, then call the public health department in your city or county. Demand help.

You can read today’s article by Joe Fiorito in its entirety here. If you like this kind of journalism, you can also click the link from the article to send Joe Fiorito a fan letter. I did.

You can also read Bedbugger’s coverage of the recent Toronto Board of Health discussions on bed bugs here.

• Reg Ayre of Toronto Public Health: bed bugs a “health concern,” not a “health hazard”
• After a fire, bed bugs “rain down from ceilings” into other apartments
• bed bug news for 2007-11-11: Lexington, KY and Toronto, ON
• Toronto Board of Health gearing up to fight bed bugs

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Toronto has had a serious bed bug problem for some time, just like New York, London, San Francisco, Vancouver–I could go on and on, but you get the idea.

The Toronto Star also has a journalist called Joe Fiorito who wrote extensively and repeatedly about how serious a problem bed bugs were, for everyone who gets them, but especially for the poor, the elderly, the disabled. You can see links to just some of Fiorito’s articles on my del.icio.us page. I mention Fiorito because I do not doubt for a moment the effects that good (or bad) journalism can have on public perceptions of the bed bug problem. In Fiorito’s case, the journalism was very good.

Then in November 12, 2007, Toronto City Councillor Paula Fletcher asked the Board of Health (of which she is a member) to take action on bed bugs. This is a PDF of her letter.

Fletcher wrote,

Traditionally Public Health officials consider and have categorized bed bugs as a nuisance because they do not carry and spread communicable diseases. However, ailments stemming from a bed bug infestation can range from secondary infections due to scratching to anxiety, embarrassment, and loss of sleep.

Moreover, residents who experience infestations are faced with considerable financial costs associated with fumigations as well as replacing furniture deemed to be unsalvageable.

Here is a politician who understands the bed bug problem. Clearly, she’s been listening to her constituents.

In the letter, Fletcher specifically asked the Board of Health to

• Review and report on the current procedures for bed bug inspection and control, including changing categorization of bed bugs as a public health ‘hazard’ and the harmonizing pest control under Municipal Licensing which currently deals with pest control relating to mice, cockroaches and termites
• Investigate and report back on a Bed-Bug Furniture Pick-up program
• Investigate and report back on North American best practices, including by-laws relating to sale and disposal of used furniture and mattresses
• [To provide an] Expansion of public education initiatives on measures, particularly to tenants, occupants of multi-residential units and users of shelters
• Report on the City’s regulatory authority to require action from property Owners, Operators of Hotels and Other Multi-unit dwellings including
  o Requirements for control and prevention, including pest control management plans included as part of landlord licensing requirements
  o Requirements for responding to complaints
  o Procedures for reporting to City officials
  o Treatment and control of bedbugs in hotel rooms
  o Guidelines for pest control companies
  o Responsibilities of tenants and homeowners

Fletcher noted that even though property owners are responsible for bed bug eradication, there is a need due to the “resilient and migratory nature” of bed bugs, for government agencies to re-examine their practices regarding the pest.

In response, Dr. David McKeown, the Toronto Medical Officer, unveiled a proposal for dealing with bed bugs last month. He asked the Board of Health to take action, outlined in this PDF.

McKeown’s report opened with a brief introductory paragraph, followed by this statement:

Bed bug infestations occur in all neighbourhoods and communities in the City and most households deal with the problem without assistance from the Municipality. This is not the case with the most vulnerable populations in our community. In recent months, Toronto Public Health has devoted significant resources to deal with severe infestations impacting on the health of the elderly, those living with physical and mental health issues and people living in poverty. This report is intended to focus primarily on strategies to ensure that vulnerable people get the assistance they need to lead independent, pest free lives.

The Medical Officer of Health’s made a series of proposals to the Board of Health (outlined in the same PDF) to deal with bed bugs.

The Board of Health then met on 2/26, and (as outlined in this PDF):

1. requested the Medical Officer of Health to establish an action committee comprised of city divisions, housing providers, health care organizations, social services, community groups, representatives of landlords and tenants, and other appropriate stakeholders to develop a comprehensive action plan to reduce bed bug infestations in the City of
Toronto with particular emphasis on vulnerable populations;

2. requested the Medical Officer of Health to report on the progress of the action committee within six months;

3. requested the government of Ontario to incorporate the issue of bed bug infestations in their poverty reduction strategy; and

4. referred all communications/submissions, and the following motions to the new Action Committee described in Recommendation 1:

Motion by Valerie Sterling:
“That Recommendation 1 be amended by adding the words “and in addition, consider broader public education and social marketing strategy to address the stigma associated with having bed bugs.”

Motion by Councillor Fletcher:
“That the Medical Officer of Health and TorontoPublic Health be requested to educate the medical community in identification of bed bug bites.”

This CBC article which was written in advance of the meeting notes that Toronto’s public health department surveyed PCOs about the increase in bed bug cases. This is the easiest way to get a realistic picture of the number of cases in a city, though of course those who self-treat will be left out.

Toronto Public Health surveyed 12 pest control companies in December 2007 and received six responses. All six reported an increase in numbers of inquires and calls related to bedbugs from 2006 to 2007. The majority of calls were in apartment buildings.

This was an informal check with just 12 companies. Remember the study done in Toronto in 2003? That year, every PCO reported every case of bed bugs in the city (well, theoretically, anyway). Most cases then were in single family homes. That might sound strange to some, since bed bugs are now a much bigger problem in apartment buildings, but it’s fully plausible.

Anyway, the Toronto officials know that if you want to know who has bed bugs in your city, you don’t simply rely on tracking official housing violations (as the New York government is trying to do) or official complaints to the Toronto Public Health Department. You ask the PCOs. Obviously, in this case this is just an informal inqury, not an official study (like the one in 2003). But the principle is the same.

A Toronto Sun article last December noted that the Toronto Public Health Department had gotten 160 calls about bed bugs in the first nine months of 2006. But Reg Ayre, the city’s Healthy Environments manager, said back then that anecdotal evidence from PCOs showed much higher incidence of bed bugs. One PCO claimed to be treating 1200 cases a year, another claimed to treat 400-600 a month (more on that below). You can read more about this here. (Sadly, I cannot link to the original article, since the Toronto Sun is holding out on us, so you’ll have to make do with the report I did on it in December.)

There were other documents associated with the Board of Health meeting, including several fact sheets and this: a PDF of a Toronto Community Housing proposal for dealing with bed bugs in public housing. (The key components, not surprisingly, are educating staff about bed bugs, educating tenants about bed bugs, getting both to cooperate, and using only qualified pest control contractors).

Bed bugs are clearly a problem that is far more serious than current Toronto Public Health data. The officials in Toronto are smart to recognize this. Here in New York, city officials seem happy to cite the number of bed bug cases in NYCHA public housing, or the NYCHPD housing violations for bed bugs, though it is obvious to us that these are just the tip of the iceberg.

The action we’re seeing in Toronto seems to stem in part from

• a vocal and forward-thinking city councillor taking up the cause of bed bugs,
• a persistent and talented journalist taking up the cause of bed bugs,
• a Board of Health willing to re-consider the definition of a “health hazard,”
• a Medical Officer of Health looking deeper into available bed bug statistics, and prioritizing the issue.

Doubtless, there are many more factors I can’t yet see. In any case, I am grateful for all those working to solve this problem in Toronto, and anywhere else.

I can’t overestimate how significant it is that Fletcher and the Board of Health were willing to consider bed bugs as having a significant effect on health. On February 26, other issues the Board of Health was dealing with included the provision of dental care to people on low incomes, and a plan for dealing with an inflenza pandemic. Deadly possibilities like an infleunza pandemic must be planned for, but we also need to deal with bed bugs, even if the health effects are not deadly.

I hope that cities which have not yet taken action will use the work being done elsewhere as a starting point. McKeown’s report, for example, cited what was being done to deal with bed bugs in Vancouver, and Hamilton (Ontario). Problems may vary from place to place, but the bed bug enemy is the same, and cities would do well to use the best practices beginning to be developed elsewhere as a starting point.

I look forward to hearing more from Toronto.

Many thanks to hopelessnomo for helping me think about this issue and for providing the location of the Board of Health’s document stash.

• bed bug news for 2007-11-16
• Toronto Councillor Paula Fletcher has some progressive ideas about bed bugs
• Toronto Public Health now has a Bed Bug Action Committee. Action, people.
• New York vs. Bed Bugs: NYC is the underdog!

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Joe Fiorito of Toronto’s The Star spoke with Reg Ayre of Toronto Public Health about why that body can’t legally class bed bugs as a health “hazard”:

Ayre’s office is downtown. He is a good guy in a hard job. He got right to the point. “Can we talk about what a health hazard is?” Sure, why not?

“We’re talking about a legal definition, in terms of the Health Protection and Promotion Act. It has to be a condition that would affect everyone in the community.”

Like SARS?

He said, “Bedbugs aren’t, under the act, a hazard. But Public Health considers that they are a concern.”

I suspect the concept of concern offers little comfort to the woman in social housing whose arm swelled from bites and who had an epileptic seizure after treatment.

Nor is concern any help to the man who was so bothered by bites that he washed his body with gasoline – and do not even think that is a good thing to do.

Nor does concern ease the pain of the father who had to bring his young son to the emergency room one day last November, because the boy’s bites were so bad.

Ayre said, “All the definition does is allow us to serve orders. But bedbugs is an issue where we don’t go the legal route.”

I cannot count the people I know who wish we could go the legal route. Because I think Toronto is Vancouver waiting to happen.

At least beautiful, bedbugged Vancouver has the motivation of the coming Olympics to spark a cleanup. Our motivation?

Itch, scratch.

I think I understand TPH’s distinction between health hazards and health concerns. But is the assessment that bed bugs would not “affect everyone in the community” because they would never infest everyone at once? Or because some people will be bitten and show no reaction to bites (as many as 50%, some experts say)? Or because, unlike SARS, the effects would not be as dire in the vast majority of cases? (Some do die due to bed bug bites, but it appears to be a very rare to have such a serious allergic reaction.)

From where I sit in New York City, I’d love to have my own city’s officials even admit bed bugs were a health concern.

But Fiorito is correct that the problem needs to be classified in such a way that agencies take care of it. If public health agencies can’t “go the legal route” in fighting bed bugs, can housing departments? Some agency needs to have some muscle when it comes to eliminating this problem.

You can read the rest of the article from The Star here.

• bed bug news for 2007-11-16
• bed bug news for 2007-11-11: Lexington, KY and Toronto, ON
• Toronto Public Health now has a Bed Bug Action Committee. Action, people.
• After a fire, bed bugs “rain down from ceilings” into other apartments

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But this article in Friday’s Toronto Sun has some interesting statistics. On the one hand,

According to Reg Ayre, the city’s Healthy Environments manager, Toronto Public Health received 194 calls for bed bug inquiries in 2004, 147 calls in 2005 and 160 in the first nine months of 2006.

That’s just calls to the public health department, though.

The little insects are spreading their non-existent wings and once again showing up in beds, and homes, across Canada, making them a significant issue of public concern.

“We started receiving anecdotal reports that bed bugs were on the rise,” Ayre said. “Prior to 2003-04 it was a non-issue for us.”

Four years later, Ayre says they are constantly sending investigators out to bed bug calls around the city.

From surveys of pest control companies, Ayre said it’s clear all communities are seeing an increase in bed bugs this year.

Disturbingly, individual Toronto PCOs record much higher figures, with one PCO seeing as many as four times TPH’s yearly figure per month.

One company said it performs 1,200 bed bug treatments per year while another said it’s spraying 400-500 homes per month.

Readers will recall a similar discrepancy between official complaints and PCOs’ reports in New York City: six months after the HPD tallied around 4600 calls and 1190 actual bed bug cases reported to 311 in twelve months (summer 2005-summer 2006), one well-known PCO claimed to be getting 85 actual bed bug calls a day (and presumably another 15 false alarms). That’s 22,100 cases per year for one PCO alone, if numbers held steady. (And that was a year ago.)

Clearly someone needs to get data on the full number of homes–public and private rentals, owned homes, as well as institutions– treated every year. Data on bed bugs in hotels and other businesses needs to be collected too. Even if bed bugs have not been proven to transmit disease, they definitely cause stress and much loss of property and income. They hurt individuals and business owners.

I’ve long said we need actual data on bed bug cases in New York City, where the only official data on bed bug cases comes from renters’ calls to 311 (the city’s information line). How people are supposed to know to call 311 with a pest complaint, which everyone knows is something you call your landlord about, is a mystery.

However, why most people don’t call 311 in such circumstances is not a mystery: want to stay in your apartment and not piss off the landlord? Give him/her a chance to solve your pest problem before reporting the building to the housing department.

And that, my friends, means most cases are under the government’s radar, and NYC does not have any reliable data about how many people here have bed bugs. We need a bed bug study done in New York, and so does Toronto.

Read about the 2003 Toronto data here on the CDC website.

• bed bugs: incidence studies needed in NYC and elsewhere
• Roger Smith Hotel on Lexington in NYC: latest bed bug lawsuit
• Toronto Public Health now has a Bed Bug Action Committee. Action, people.
• Reg Ayre of Toronto Public Health: bed bugs a “health concern,” not a “health hazard”

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(The following is not really bed bug news, but a reminder of a time not long ago when encountering a bed bug in a place of business was a bit like finding a hair in your salad, but maybe more common.)

(These last two are not really bed bug stories, but they tell us something about how widely known bed bugs are becoming: they’re starting to mean something in popular parlance once again.)

• bed bugs in Milwaukee, Wisconsin, and at Cornell University dorms
• Bed bugs in casino and senior apartments in New Jersey, Binghamton University (again) and another dust mite photo in the news
• bed bug news for 2007-11-16
• Boston University’s bed bugs: if we don’t talk about them, they’ll go away

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