Sleep Tight

Let’s set the record straight. Time magazine did not call Cincinnati the bedbug capital of the nation last summer.

Jack Atherton did.

In August, Time.com wrote about Ohio’s efforts to put the brakes on an insect that, in the past few years, seems to have appeared out of nowhere. Channel 5 News picked up the story, and the next day über-earnest anchor Jack Atherton was ominously announcing that the newsmagazine had dubbed the city “America’s bedbug capital.”

Except that’s not really true. The title appears to have been conferred by the station itself in a classic moment of hyperbolic tele-journalism. But hyperbole loves company, and it was buoyed by the pest control companies Terminix and Orkin, both of which released lists of the cities in the United States where they were busiest with bedbug calls. Terminix pegged the Queen City as fourth most-infested; Orkin had us at number one.

Dr. Camille Jones, assistant director of the City of Cincinnati Health Department, attributes that distinction to the fact that the city puts out a lot of information about bedbugs for residents. “They say we have more calls to pest management companies than anyone else,” she says. “That’s because we’re telling them to call.” The Hamilton County Public Health Department has also taken a similarly proactive approach, which has made it the go-to source for cities and regions that are just now—eek!—uncovering their first bedbug infestations. Before the rest of the Midwest was introduced to the 21st century’s six-legged pestilence (which, it must be said, has had a starring pestilential role in human history for millenia), we got advance warning that the time had come to grapple with an insect that everyone thought had been effectively eradicated for a half-century. Simply put, the Queen City is on the cutting edge of a trend.

So here’s the thing about that “bedbug capital” remark: Time did not say it. But that doesn’t mean it isn’t true.

You can learn more than you ever wanted to know about Ohio’s bedbug woes by heading to the west campus of The Ohio State University, where a rutted farm road leads to a low-slung building marked by a sign that says “Rothenbuhler Honey Bee Lab.” The building no longer houses honey bee science but it provides a fine environment for Susan Jones to do her bug research. Jones is an urban entomologist, which means she’s all about bugs in buildings. “I don’t know about crop pests” is how she explains her field to me as we sit in her office—a quietly chaotic repository of papers, research projects, books, and entomological paraphernalia. The latter includes a fridge magnet decorated with a picture of a stink bug and a glass jar of what looks like instant coffee granules but is actually termites.

Jones’s first love is termites. Down the hall, there’s a storage closet as big as a Manhattan efficiency apartment, with floor-to-ceiling shelves supporting dozens of clear plastic boxes and bins filled with wood mulch and insects. The largest container looks like something you’d store blankets in off-season, and it houses a termite colony of 50,000, all descended from a single pair.

By contrast, Jones’s bedbug lab is a modest affair: a plastic dishpan filled with jars, each one screened with nylon cut from pantyhose to keep the contents from escaping. Inside, a folded piece of paper makes it easier to see the insects and “gives them someplace to hide,” Jones explains. Here they’re able to live out their lives much as they would in your home. They hatch from sticky, near-invisible, whitish eggs, emerging as tiny clear nymphs. They suck down a meal of blood, then go into hiding and grow until they’re bursting their skins. They molt, take another blood meal, hide and grow again, repeating the cycle five times before they reach adulthood. Jones picks up a jar and points to the contents: adult insects the size of apple seeds; partly-grown nymphs; whisper-thin bits of cast-off skin; and splotches of what seems to be dried blood. “Fecal material,” she explains.

The challenge in lab-raising bedbugs is feeding them. They’re “very finicky,” Jones says. Blood is all they want or need. They’ll take it from some animals, but they really prefer us. She uses a device developed for mosquito research—a metal container the size of a cash box that warms human blood and presents it for feeding through a membrane that mimics a person’s skin. If a colony seems lethargic at feeding time, Jones will breathe into the jar. “That makes them excited,” she says. CO2 is to bedbugs what a whiff of hot pizza is to you or me.

Written on each jar is an address. Jones collects her specimens from infestations—big ones, like the nightmare scene in Dayton, Ohio, in August 2009, in which the 18-story Biltmore apartment building was overrun by such resilient pests that the whole place had to be sealed off and fumigated. “I went to collect for my colonies,” she says. “There were literally bedbugs walking down the hallway; groups congregating at the doors; people in wheelchairs with bugs crawling all over them.” The point of cultivating offspring from this sort of fright night scene is to test insecticides and figure out what works best on the worst of the worst.

Jones is a 1987 Ph.D. from The University of Arizona, and for the better part of her career bedbugs were mostly a footnote in her work. But about eight years ago, she started hearing from people in Cincinnati who thought they had bedbugs and didn’t know what to do. At the time, “it was people in HUD housing,” she recalls. “One particular situation was a handicapped individual. The person in charge of her building was hiring the cheapest pest management company they could find. And she was describing how this company was coming in, spraying her baseboards, and walking out. That’s not how you do bedbug control work.” Jones believed she was seeing the tip of the iceberg, and that, in terms of prevention and eradication, the Buckeye state needed to step up its game.

Since then, she has thrown herself at Ohio’s bedbug problem—setting up her lab; writing material to educate the public; putting on seminars for agencies and communities; serving on task forces, panels, and committees; and pounding on the government at all levels to pay attention to the billion-legged tsunami. This year she’ll guest-edit a special issue of the scientific journal Insects devoted to the topic.

Susan Jones is “our bedbug rock star,” jokes one pest control pro. That’s not a gig she wanted. But then, who would?

Bright-eyed and feisty at 84, Marianne (not her real name) lives in an apartment in the suburbs northwest of the city—just one bedroom, a living room, and a compact kitchen; small, but cheerful and sunny with enough space for family photos and comfy chairs. Except that visitors are likely to steer clear of her few pieces of upholstered furniture. A year and a half ago, Marianne had just laid down for an afternoon nap when she saw two dark flecks marching across the bed toward her. Her daughter came over with an aerosol can of insecticide. They moved the mattress, and the box spring was crawling; they sprayed a wall outlet, and hundreds poured out. “I went hysterical,” Marianne says. “My daughter got sick.”

The common bedbug—Cimex lectularius—feeds on the blood of mammals, preferably you and me, preferably when it’s dark and we’re happily dozing. People don’t generally feel it when the attacker pierces their skin with its beak and sucks—the itchy allergic reaction comes later (though not everyone has a reaction). And after a couple of minutes of drinking your blood the fiend is finished, scurrying off to hide someplace: between the box spring and mattress, or inside of them; behind the headboard, or between the pages of the book on the nightstand; along the baseboards and door frame or deep in the thick plush carpet. Anyplace where it will be, as the saying goes, snug as a bug in a rug.

Marianne’s landlord called in an exterminator for the entire apartment building and re-treated her unit when she had a recurrence a few months later. Each time, she had to prep her apartment for the treatments. She emptied every drawer, cabinet, and closet, and washed her clothing and linens in hot water—120 degrees—to kill them. She bought new bedding and threw away bag after bag of non-essentials and random clutter.

“It was traumatic,” she says. She figures she spent $2,000 replacing furnishings and clothing, and she doesn’t want to go through it again. So she learned all she could about bedbugs and adjusted accordingly. She never puts her purse on the floor anywhere when she’s out and about—bedbugs love to hitch a ride in a pocketbook’s dark interior—and she hangs her coat in the bathtub when she returns. “I could bring ’em back,” she explains. There’s a mattress cover on her new bed; double-sided tape outlines the perimeter of each room and every wall socket, too. The tape won’t prevent the pests’ return, but one trapped bug will alert her that they’re back, so she can get help before the situation gets worse.

Marianne’s sister refuses to visit her because she had bedbugs. As Marianne sees it, her sister probably spends plenty of time with people who don’t know that they have them. “I said, ‘I’m safer than any of your other friends,’” she recalls.

Like Marianne and Susan Jones, State Representative Dale Mallory never intended to become a bedbug expert. When we sit down to discuss the issue that has marked his statehouse career, I mention that simply talking about the subject makes me itch.

“Welcome to the club,” he says dourly.

In 2007, new in office, Mallory was introduced to the problem by the Council on Aging of Southwestern Ohio, the agency that administers government-funded services for the elderly. Polly Doran, COA’s government relations manager, took him to visit seniors in infested public housing. Elderly housing—especially high-rise apartments—can become towering reservoirs of bedbug activity. Like college dorms, they are densely populated settings where bugs can easily travel from one residence to another through wall voids. And like college students, seniors may be living a clutter-crammed existence where clothing, stacks of papers, mementoes—all sorts of detritus creates a place for the infestation to grow undetected.

Mallory’s experience was quite possibly the ghastliest get-to-know-your-constituents tour ever. “The first stop was Ninth and Central—Uptown Towers,” Mallory says. “It was being cleaned; they showed me bedbugs crawling around on things. Over on Ezzard Charles there was a man who’d been bitten up. He told me when he went to sleep at night is was kind of like a horror movie; they start crawling up both sides of the bed.

“The Stanley Rowe Apartments: That was where we encountered Mr. Samuel Blackman. Mr. Blackman had a baseball cap that had fecal bloodspots around the forehead. I said, ‘Do these bedbugs crawl on you?’ And he said, ‘There’s one crawling on my back right now!’” In a video shot by Channel 5 News, Mallory sweeps the insect off the frail man’s torso and smacks it with a flyswatter, leaving a bloody smear. “I almost got sick,” he says.

Since then, bedbugs have become Mallory’s cause celebre. That year he held a series of town hall meetings and in 2008 formed the Joint Bed Bug Task Force, conscripting Susan Jones as well as county and city public health representatives, landlord reps, and staff from agencies such as COA. Last year he spearheaded Ohio’s (failed) efforts to get the insecticide propoxur relicensed by the Environmental Protection Agency, and he has proposed legislation to provide for “bedbug awareness” materials and services, such as a 1-800 number to report infestations. He has some more sweeping ideas, too, such as creating a one-stop shop where pest control specialists could be trained, landlords could learn about extermination options, citizens could have furniture fumigated, and on and on.

A heady vision for tough economic times. But at least it’s a vision. At the time Mallory got involved, “He was the only [politician] who would listen, much less go out and see,” says COA chief executive officer Suzanne Burke. But others have caught the bug, so to speak. Chris Monzel struggled to deal with the issue when he chaired city council’s Health, Education & Environment Committee. Now, as a Hamilton County Commissioner, he’s looking at “hopefully…leveraging the things that work somewhere else.” State Senator Eric Kearney brought forth a resolution about the use of propoxur, and U.S. Congresswoman Jean Schmidt has a bill in committee that would provide $1 million for a two-year pilot project focused on prevention and mitigation in Ohio’s poorest, most bug-ridden areas.

Talk to those who came early to the Cincinnati bedbug conversation and you’ll hear the same thing: Most everybody outside the I-275 loop thought they were nuts. Chris Eddy, now on the public health faculty at Wright State University, was director of environmental health for the Hamilton County Public Health Department until 2008. He recalls talking to colleagues in Columbus and Cleveland half a dozen years ago. “They’d say, ‘Sorry for your luck. We don’t have them.’” Even today, there are still Ohioans who feel, if not invincible, at least immune.

“Most of the population doesn’t understand,” says Representative Schmidt when I ask if anyone else on Capitol Hill is taking bedbugs seriously. Except, she adds, “my colleagues in New York City. They get it.”

New York City has been battling bedbugs for most of the 21st century, and what New Yorkers get is that the rising tide of nymph exoskeletons and fecal stains is not limited to subsidized housing and senior centers. In the Big Apple, bedbugs have shown up in stores and movie theatres; people get bit in high-rise condos and swanky hotels. And when there’s that level of bedbuggery, it’s really, really, hard to stop.

Freezing kills bedbugs. So does high heat. But the logistics of flash-freezing or super-heating every nook and cranny of a sprawling Queen Anne Victorian can be daunting. If you see a bedbug crawling around, you can kill it by spraying it with alcohol or kerosene or lighter fluid. But—setting aside the fact that you might immolate yourself and your home in the process—killing one does nothing to stop the scores in hiding.

Bedbugs have behaviors that make them hard to eradicate. For one thing, it’s a temporary parasite: they suck your blood then flee—until their next meal. Head lice and pubic lice stay on you, so you know where to treat. “You can’t get a dose of Kwell [a treatment used to kill body lice] on bedbugs long enough to make a difference,” says Susan Jones. Unlike a cockroach, a bedbug doesn’t need water and it doesn’t scuttle around looking for tasty crumbs; they only ingest blood, so poison bait that kills through the gut doesn’t work. They are prone to dehydration, so a desiccant dust such as diatomaceous earth (maybe you remember the stuff from high school chemistry) can be effective—if you put it down where the bugs will crawl through it. Foggers (a.k.a. bug bombs) are not useful, says Lonnie Alonso, a pest control business owner who sits on the National Pest Management Association’s Blue Ribbon Bed Bug Task Force. The limited concentration of a fogger, “doesn’t have the penetrating qualities,” he explains. Plus, he points out, “The bedbug would be hidden. If you put a bedbug in a cup and drenched it with the fogger,” it could succumb, he says. “But that’s not normal behavior for a bedbug.”

Even their reproductive method makes them hard to beat. They mate through a process called “traumatic insemination.” The male pierces the female’s body cavity and inseminates her through the wound. The act injures the female, and some entomologists theorize that bedbugs disperse because females are running from males. Jones doesn’t necessarily subscribe to that theory, but she points out that an inseminated female—terrorized or not—is a fecund machine; she’ll lay from one to 12 eggs a day “for her lifetime, which is anywhere from a year to a year and a half.” Ballpark that at 500 eggs per bug, per year, and it’s easy to see how things get out of hand.

A professional exterminator may combine several techniques to address an infestation, including traditional insecticide sprays that work by lingering toxically in your home and killing bugs when they stroll across a spot that has been treated. But he will expect you to be equally thorough about discarding clutter in sealed bags, laundering fabric in scalding suds, et cetera. That infested couch? Don’t just leave it on the curb: damage it so that no one else will want it. This is war, and you are on the front lines.

In the publication Pest Control Technology, University of Kentucky entomologist Michael Potter notes that bedbug fossils have been found in archeological sites that date back 3,500 years. They hitchhiked throughout Europe with the spread of civilization, arrived in the New World with the first explorers, and accompanied pioneers inland as the Americas were settled. The 20th century ushered in central heating, which allowed bedbugs to thrive year-round, setting off an epidemic that persisted until the development of DDT, a synthetic insecticide that disrupts an insect’s nervous system by penetrating its outer cuticle. DDT was cheap, and it was long-lived; a surface sprayed with DDT killed bugs even when they skittered across it long afterwards. Put into wide use in the 1940s, it was so effective that, for most of us, “Sleep tight, don’t let the bedbugs bite” was just a nursery rhyme; bedbugs barely existed when we were growing up. And even though DDT was banned in 1972, Cimex lectularius hasn’t come roaring back until now. So why has it returned? And why here?

“We never eliminated them in the U.S.” says Susan Jones. “There were still pockets of them here and there”—in the poultry industry, for example—“but they were effectively controlled by the chemistries that we had available.” Where they remained in abundance was underdeveloped countries. So increased global travel and immigration get some of the blame. Then there’s the tendency of bugs to become resistant to insecticides, rendering some products less effective against some strains. DDT wasn’t the only insecticide taken off the market because of health concerns. Dursban—a product of Dow Chemical that was used frequently for cockroach infestations—was banned for indoor use by the EPA in 2000. Since then, Jones says, “Tests have shown that it was very effective against bedbugs. So indirectly we were probably controlling bedbugs in the U.S. [when] we were putting the product out to control cockroaches.

“We’re trying to make sense of this,” Jones adds. “There’s not one single reason that we can pinpoint.”

And why southwest Ohio appeared when it did on the nation’s bedbug radar is equally confounding. Jones attributes it to factors such as the city’s level of poverty, its geographic position as a transportation nexus, and its abundance of old buildings. But that’s just an educated guess. “How Cincinnati became the first major city outside of the coast is beyond me,” says pest pro Lonnie Alonso. He notes that Cincinnati was facing a big problem when “here in Columbus we were just getting trickles.” That changed in central Ohio, and it changed fast, he says. “One over here and one over there and boom! They’re all over the place.”

Wright State’s Chris Eddy believes he has the distinction of getting the first 21st century bedbug complaint in Ohio. It was back in 2003, when he was director of environmental health for the Hamilton County Public Health Department. When his secretary took the call, “I told her it was bogus,” he remembers. “If it wasn’t for the fact that one of my inspectors went out and brought it back in a baby food jar, I wouldn’t have believed it.”

Here’s how things boomed in Hamilton County: In 2003, the health department got two bedbug calls; in 2004, two more calls. In 2005 there were 37, and then they doubled annually. The peak seems to have been in 2008 at 306; last year, the count was 264, and hopes are high that the downward trend will continue.

The upside to all this? Hamilton County is widely regarded as a model of bedbug responsiveness. “We take every claim we receive seriously,” says Greg Kesterman, assistant health commissioner and Eddy’s successor. Within five days, a staff member follows up to do a field assessment. “If it’s an infestation, a licensed exterminator is what we ask the landlord to provide for that tenant.” Tenants are told they have to prepare for the service—clearing out clutter, encasing mattresses, or whatever the exterminator requires. There will probably be multiple treatments spread over several weeks to take care of stray insects and freshly-hatched nymphs. When it’s finished, the landlord must file evidence that treatment has taken place. If there are still bugs, or if they return, a tenant calls the health department, there’s another field assessment, and the process begins again. “I can promise you,” says Kesterman, “they’re not afraid to call us.”

If a landlord doesn’t comply with the county’s request for treatment, legal action is possible. Compliance can be a huge burden for property owners. But typically, says Kesterman, landlords come to see that it’s in their best interest to cooperate. “We do a good job of selling the fact that if you don’t take care of the problem early you’re not going to have one apartment that’s infested, you’re going to have four and nobody’s going to want to live there.”

Hamilton County started responding to bedbugs before a lot of other regions saw the need to. (Which is, ironically, one reason some outsiders have come to think that southwest Ohio’s problems are worse than other places.) In 2008, State Rep. Dale Mallory’s Joint Bed Bug Task Force even developed a strategic plan to tackle the problem by establishing best practices for prevention and treatment in the city and county. Central to the plan was a recommendation that both the city and county health departments respond to complaints pretty much the way that Hamilton County already was: a field assessment followed by a warning to the landlord or owner and instructions to the tenant; a violation notice if extermination didn’t take place; and legal action if necessary.

From the beginning, the plan seems to have been fraught with problems. For one thing, Hamilton County put the onus on building owners to have the extermination done. But the city viewed it as a joint tenant-landlord responsibility, which made enforcement difficult. The larger issue was that it took a huge increase in effort for the city to respond to the cascade of complaints headed its way.

In 2007, the city health department got 737 complaints and inspected 70 of them; in 2008, the department rolled out a comprehensive inspection program, received 1,101 complaints, and did 757 inspections. “The requests increased ten-fold in a year,” says Dr. Camille Jones, assistant health commissioner. “More than [calls about] rats, roaches, and mice combined.” It was a tall order; too tall, as it turned out. In January 2009, when the health department’s budget was cut by $290,000, they simply ceased doing bedbug inspections. “We had no financial support and we didn’t want to take away from activities that we were doing to decrease disease,” Dr. Jones says. Today, the city health department puts its bedbug energy into educational resources—brochures, a DVD, material that encourages readers to seek out a licensed pest management operator.

It’s a source of frustration to many. COA’s Suzanne Burke says her clients know they have bedbugs. “They don’t need a DVD,” she says. “They need inspection and enforcement to get their landlords to treat the problem.” She understands that education is an important part of managing the problem but, she adds, “That’s not enough.”

How did our ancestors deal with the blight? In Michael Potter’s journal article “The History of Bed Bug Management,” he cites a publication from 1777 entitled The Compleat Vermin-Killer that suggests wiping out the pestilence by filling cracks and crevices with gunpowder and igniting it. Some 20th century treatments were only slightly less harrowing. Hydrogen cyanide, for example, was a highly effective—and incredibly dangerous—fumigant widely used before the advent of DDT, which reigned supreme until it was banned over concerns about its impact on wildlife, especially birds. Many insecticides used today are in the class of agents called pyrethroids—a material synthesized to replicate pyrethrum, a natural product made from chrysanthemums. But increasingly, bedbugs are becoming resistant to pyrethroids.

As bedbugs have flourished, so have the methods used to kill them. High heat, steam, and freezing all have the potential to knock off bugs. But most pest management professionals doing large-scale eradication still rely most heavily on insecticides in order to be thorough. And as Susan Jones sees it, “We are in a situation where we don’t have a lot of alternative classes of chemistry that are effective.”

In 2010, Rep. Mallory and others in Ohio—including the governor—petitioned the U.S. Environmental Protection Agency to grant an emergency exemption to the product propoxur, an insecticide that is still on the market but which has not been relicensed for residential indoor use. Propoxur has a residual effect, and it kills eggs as well as the bedbugs themselves—a tremendous advantage. But last summer the EPA declined the exemption, citing unacceptable risk to children who might inhale it when it’s sprayed or ingest toxic amounts by repeatedly contacting treated surfaces.

Jones is frustrated by the bar that the EPA has set for the compound. “They have a thousand-fold safety factor for children,” she says, “and the scientific community is saying that’s not a realistic scenario. Let’s have some common sense here. Allow us to use this product under emergency exemption to see if we can get bedbugs under control. Let us use it in households where there aren’t any children. They were not willing to do it.”

Rep. Jean Schmidt is another proponent. “I wasn’t swayed by [the EPA’s] arguments,” she says. “A lot of things are harmful to children. You have to keep children out of the way.”

“Everybody supported it but the EPA,” Mallory says. “It was like, come on. Who’s not listening?”

Not everyone is so enthusiastic about propoxur’s place in the pesticide arsenal. “I’m very ambivalent about it,” says Chris Eddy. Yes, he says, the hope of an entomological silver bullet is appealing; but the flip side is the possibility of propoxur being misused, over-applied, and harming children, especially kids from low-income families who live in dilapidated, hard-to-treat properties.

In Ohio, at this juncture, these pests are a socioeconomic issue. “It has become fashionable for health officials to say that bedbugs are equal opportunity parasites,” Eddy says. There is some truth to that. If you buy an antique armoire at an auction, it might bring bedbugs into your home. If a poor mother buys a used baby stroller at a yard sale, it could, too. But when the exterminator’s charges start rolling in—$200 to $500 for a treatment multiplied by however many attempts it takes to get the bugs and their eggs knocked out, plus the cost of replacing whatever can’t be treated—the person who can afford that armoire “can probably afford the cost of extermination,” Eddy says. The poor mother can’t.

Eddy and others get frustrated when public officials minimize bedbug dangers because these pests are not known to transmit disease the way, say, mosquitoes do. “For the past 30 years, we weren’t studying them,” Eddy says. His point: We don’t know that they don’t carry disease. And being heavily bug-bitten can certainly feel like a health issue. “I saw a woman a few months ago,” says Jones. “She had an anxiety disorder, and she had sores all over her body [from scratching her bites]. She had literally wrecked her skin. These situations break your heart.”

“You see people who are traumatized,” says Mallory. “This issue has probably affected me more than anything ever. And then I go run into a brick wall.”

As Eddy sees it, some public officials minimize the bedbug battle because they can minimize it: Most of the population is still unaffected. “I’m worried about it,” he says. “I think that right now, bedbugs are ‘somebody else’s problem.’ And I’m concerned that if public health officials don’t take a somewhat aggressive stance, we’re all going to have them in our homes someday.”

In 1916, a United States Department of Agriculture publication advocated the use of “eternal vigilance” against bedbugs. Apparently we need to return to that pre-DDT Code Red alertness. “When I travel—top priority—I do an inspection when I go into a hotel room,” Jones tells me. “I shake items out before I try them on. I launder brand new clothes when I bring them in the house.” It’s not being alarmist, she says, it’s taking personal responsibility. “Just like looking both ways when you cross the street.”

We’re sitting in her work-clotted office, looking at pictures she uses when she talks with community groups: a mattress with rusty fecal stains; a college kid’s suitcase with a tell-tale whitish smear along the zipper; a plush teddy bear with a dark bug deep in its fur. My mind races over a host of perfectly ordinary activities that now seem fraught with danger. Test driving a used car. Praying on a padded pew kneeler. Thrift-store shopping.

Jones predicts that industries will change the way they do business. “You know how they no longer allow the cart into the hotel room when maids are servicing it?” she says. “That’s because bedbugs are hitching a ride on the cart.” She’d like to see more adaptations: providing more luggage racks and dispensing with the plush items that make luxury hotels, well, luxurious. Thick carpeting, upholstered headboards, heavy drapes. “Bad, bad, bad,” she says.

Minimalism may be required of us all in this buggy new world. We are a nation of collectors, accumulators, hoarders. “We have to de-clutter our lives,” Jones says. Then she looks around her office. “I’m not a good one to talk.”

Originally published in the February 2011 issue.