The Toronto Bed Bug Project – Medical Officer of Health’s Report

The Toronto Board of Health meets on Monday, November 17—here are the agenda (PDF) and supplementary reports (PDF).

The Medical Officer of Health, Dr. David McKeown, will present a staff report on the Toronto Bed Bug Project (PDF). (We have briefly reviewed the Toronto Bed Bug Project here and here.)

Let’s mention something right at the outset before we discuss the report, when you visit the Toronto Public Health website, you see that bed bugs are on the front page. On the front page. This is exactly what is necessary and we commend TPH for this simple but effective move.

What you actually see when you click on “bed bugs” is a portal with information for the public, for professionals, a link to fact sheets, and a link to the Toronto Bed Bug Project.

Again, well done, and we need to point this out because disseminating information in an organized way that is only a couple of clicks away from the front page is extremely important and it’s something we want our own city agencies to consider.

The Toronto Board of Health will also consider the request from Councillor Howard Moscoe that bed bugs be declared a health hazard (PDF). The Councillor’s letter is remarkable. He is speaking on behalf of the residents of a Toronto City Housing building where some residents are refusing treatment and thereby making it impossible to eradicate bed bugs from the building:

Even after a unit is sprayed the infestation quickly migrates from infested units back into the treated units.

Recommendations of the Medical Officer of Health

The Medical Officer of Health’s Staff Report on the Toronto Bed Bug Project (PDF) makes the following recommendations:

1. City Council approve a request for one time emergency funding of $75,000 gross and net in the Toronto Public Health 2009 Operating Budget to assist vulnerable adults who do not qualify for Ontario Works (OW) and Ontario Disability Support Program (ODSP) support, to purchase services to prepare their residences for bed bug pesticide treatment;
2. the Board of Health request the General Manager, Shelter Support and Housing Administration, to request funding for the expansion of the Bug and Scrub initiative, as part of the 2009 Operating Budget process;
3. this report be referred to the Budget Committee for consideration during the 2009 operating budget process;
4. this report be referred to the Greater Toronto Apartment Association, Municipal Licensing and Standards, the Ontario Non-Profit Housing Association and Toronto Community Housing for information; and
5. the Board of Health reiterate its request to the government of Ontario to fund bed bug control initiatives for vulnerable populations as part of their poverty reduction strategy.

An emergency funding request in the amount of $75,000 and an expansion of Bug and Scrub.

The Medical Officer’s report describes Bug and Scrub as follows:

Bug and Scrub is a Social Purpose Enterprise that was created by the Seaton House Men’s Shelter within Shelter, Support and Housing Administration. The program is currently supported through Division’s operating budget and more recently funding has been secured through the United Way to further develop the business. Bug and Scrub provides responsible, reliable and cost effective assistance in the preparation of tenant households for bed bug treatment. The enterprise creates real employment opportunities for homeless individuals and assists them in overcoming the barriers that restrict their ability to gain employment and reintegrate successfully back into their community.

Bug and Scrub is currently the only bed bug treatment business of its kind in Toronto. It provides much needed support to those who are unable to prepare their units before effective pest control measures can take place. The support is above and beyond that provided by traditional pest management companies.

(Information on contacting Bug and Scrub is available here.)

Statistics and Tracking

According to the Medical Officer’s report, there have been 1,444 bed bug service calls logged by Toronto Public Health from March 1, 2008 to October 9, 2008. These are requests for general information, inspections, identification and presentations. The report acknowledges that even with this great increase in calls, “many infestations are not reported.”

A Tracking and Monitoring workgroup of The Toronto Bed Bug Project has developed a Bed Bug Survey (not yet posted on the Toronto Public Health website) to gather additional information (“types of buildings infested, control measures used, financial implications and the degree of knowledge about bed bugs”).

And then there is this intriguing initiative:

The workgroup is also investigating the feasibility of creating a secure website for the pest control industry which will enable pest control operators to report bed bug activities directly to Toronto Public Health. It is felt that the number and location of treatments by pest control operators in Toronto would be one of the most meaningful statistics in assessing the extent of infestations in the city.

Emphasis mine.

Pilot Projects!

Toronto now has five pilot projects—with the cooperation of tenants, property managers, community agencies and Bug and Scrub—to assess and develop control and prevention methods in five communities. They have chosen communities with specific challenges:

These issues and challenges include dealing with buildings where the tenants speak very little English and where there is an inherent mistrust of government, dealing with large numbers of tenants living with physical and mental health disabilities, and working with tenant groups where personal health and safety and drug use is a reality in their lives.

A preliminary assessment of the challenges is offered (see page 7) and as people who are well-versed in all manner of bed bug problems, we can see where these challenges can even be predicted in multi-unit housing. But we feel very strongly that it would be severe folly to believe that these problems only occur in buildings that house tenants who are vulnerable as indicated in the paragraph above. We see these very problems in our city in all types of buildings in all types of communities. I feel it’s important to quote these challenges in full as I think they are universal:

• Improper or lack of preparation by tenants due to physical limitations and mental health issues. In many cases the task of preparing a unit can be overwhelming for tenants.
• Improper disposal of furniture and belongings that are infested with bed bugs, thus causing spread to hallways and elevators.
• Premature disposal of furniture that is infested with bed bugs. Furniture or belongings are frequently discarded where instead, they could have been treated by vacuuming, steam cleaning or laundering. Where furniture needs to be discarded, it must be destroyed upon disposal to prevent it from being reused. Often this is not the case.
• Lack of cooperation and in some cases, poor communication between management and tenants.
• Lack of resources for tenants who do not have the funds to obtain mattress covers, and to launder all of their belongings.
• Units being sprayed several times without successful results.
• Lack of reporting infestations by tenants.
• Tenants performing their own incomplete pest control treatment and exposing themselves to hazardous levels of pesticide dusts and chemicals due to incorrect use.
• Not enough time given by property management to allow tenants to properly prepare for the application of pesticide.

Let’s turn to the strategies that are being evaluated in the pilot projects:

• Conducting a survey in each building to determine the true extent of the problem.
• Getting all stakeholders involved (i.e. family, friends, tenant groups, social workers and community health officers) to help engage tenants in creating a sense of community within the building and to develop a building specific control strategy.
• Providing a series of educational seminars on how to properly prepare your unit for bed bug treatment with the use of visual aids. Education needs to encompass prevention methods.
• Providing mattress encasements for both the mattress and the box spring to the tenants. Funding for this strategy is currently being sought outside of government.
• Providing free or subsidized laundry services.
• Providing plastic bags for transporting laundry to and from the laundering area.
• Providing vacuum cleaners and hand held steamers on loan with instructions on proper use.
• Pesticide treatment by professionals only, to ensure safe application and appropriate use of pesticides according to the standard protocols for treatment.
• Securing funding for the above initiatives.

Mattresses!

Sorry, no information in the report on the recycling pilot project beyond mentioning it! Will have to do some research on that and get back to you.

WoodGreen Community Services

The Medical Officer’s report rightly commends the Bed Bug Resource Manual (PDF) developed by WoodGreen Community Services with assistance from Toronto Public Health. It is a truly wonderful document that I’ve been reading the past couple of days and hope to discuss shortly.

The Future

The Toronto Bed Bug Project expects to:

• Expand educational outreach and support to those affected.
• Encourage citizens to report their infestations in a prompt manner to property management.
• Develop best practice protocols for businesses to prevent practices that may be contributing to the spreading of infestations such as selling used furniture and moving furniture.
• Document each of the pilot projects, including the successes, challenges and failures.
• Create templates from these projects that can be applied to other building locations.
• Work with the pesticide industry to lobby for more effective chemical options to treat bed bugs.
• Secure adequate sustainable funding for an integrated bud bug control strategy for Toronto including the Bug and Scrub program.

We will be watching—and learning. We wish the people of Toronto health and success in controlling this pest that is capable of such havoc.

If you live in New York City and you are reading this. Please. Please. Please call your City Council representative. These solutions will not come to New York City unless and until all of us ask for them in voices that do not take no for an answer.

These pages may be of related interest:

1. Linkages: a Q&A with Rima Zavys of WoodGreen Community Services and the Toronto Bed Bug Project
2. Reports from Toronto, including new Toronto Bed Bug Project updates
3. A brief update on Toronto
4. Toronto Public Health’s bed bug portal: a closer look
5. The Toronto Bed Bug Project is surveying residents about bed bugs