New York vs Bed Bugs » Cincinnati / Hamilton County Strategic Plan

Greater Cincinnati Survey: 14.5% of Cincinnati respondents (7.9%, Hamilton County) report a bed bug problem

Renee Corea — Mon, 22 Dec 2008 08:00:35 +0000

If you’ve read the Cincinnati/Hamilton County Joint Bed But Task Force Strategic Plan, you know it contemplated three areas for statistical research:

Research
There is a critical need to evaluate the current level of infestation in Southwest Ohio, Northern Kentucky, and Southeast Indiana, to determine the burden of this significant quality of life hazard on the population, and to have a baseline for analysis of future trends. We have identified several potential projects to address this issue. These include adding questions related to recent bed bug exposure to the Greater Cincinnati Health Survey and the state Behavioral Risk Factor Surveillance (BRFSS), as well as developing a survey of pest control operators in the Tri-State region. All of these projects would require additional resources.

Greater Cincinnati Health Survey
This survey would allow us to ask several focused questions about the recent household exposure to bed bugs and efforts to eradicate infestations, in citizens of Cincinnati and Hamilton County. The survey would include ~500 respondents in the City of Cincinnati and 500 respondents in Hamilton County, and would provide population based representative estimates of exposure to bed bugs in the past year.

Behavioral Risk Factor Surveillance System (BRFSS)
This annual survey would be used to obtain state-wide prevalence estimates of recent bed bug infestations, and would provide the baseline data for evaluating trends in bed bug infestations throughout the state. Based on discussions with ODH, expression of State Legislative interest and a legislative directive to add a question about bed bugs to the BRFSS would be very helpful in getting this question added to the BRFSS, at no direct cost. Robert Indian (ODS) and Patty Koss (BRFSS coordinator) are the contact persons for this study.

Survey of pest control operators
Based on list of licensed PCO’s provided by Ohio Department of Agriculture, we could design a survey to obtain information on the number of buildings being treated for bed bugs by pest control operations. Based on reported data from the city of Toronto, we believe that the majority of bed bug infestations are not being reported to the two Health Departments.

There is no press release that I could find on the website of the Cincinnati Department of Health, but the results from the University of Cincinnati Institute of Policy Research semiannual Greater Cincinnati Survey are in. And they’re extraordinary. And apparently, a non-event in Cincinnati.

I found the press release below at Outlook on Health, a Cincinnati web site dedicated to women’s health issues. The page is dated November 20.

I could not locate news reports or the press release itself anywhere else.

I am reproducing it in its entirety:

Joint Bed Bug Task Force Urges Effective Bed Bug Treatment Methods and More Resources

CINCINNATI – Once introduced to a geographic area, bed bugs are difficult to eradicate. The Joint Bed Bug Task Force (JBBTF) a collaborative effort comprised of City of Cincinnati, Hamilton County and State of Ohio officials was established early this year to better understand the extent of the bed bug problem in the region and to issue recommendations. The recently completed JBBTF Strategic Plan recommends that more resources be found to support a broad-based educational, preventive and consultation campaign to improve the effectiveness of bed bug treatment for citizens.

“Bed bugs are a problem that can affect anybody and everybody, regardless of income, occupation, ethnicity or neighborhood,” Dr. Noble Maseru, Cincinnati Health Commissioner said. “Aggressive and effective treatment is necessary and should be started at the first sign of a problem.” The JJBTF acknowledges that public awareness and education are important aspects of dealing with the bed bug problem, and urges residents to learn the facts about ways to prevent infestations and recommended treatment methods. “Hiring a professional pest management service is the most effective way to eliminate a bed bug infestation,” Tim Ingram, Hamilton County Health Commissioner said. “Do-it-yourself products may cause bed bugs to scatter and make the situation even worse.” It is wise to use a licensed pest management professional with considerable experience treating for bed bugs. Treating for bed bugs is time-intensive and labor-intensive. Customer cooperation is an important aspect as clutter needs to be removed. An in-depth inspection is essential to the process of targeting bed bugs.

“A team-approach is useful for locating and treating bed bugs – any active bed bug harborage should be treated immediately before the bugs scatter, with the in-depth inspection then continuing.” Dr. Susan Jones, Ohio State University Extension Entomologist said. As part of their work, the JBBTF sponsored a series of questions for inclusion in the Spring 2008 Greater Cincinnati Health Survey conducted by the University of Cincinnati Institute for Policy Research. The results of the survey show that overall 7.9% of Hamilton County respondents answered “YES” when asked: “In the past year, have you experienced a problem with bed bugs in your home or apartment?” Of those who had a bed bug problem, 31% chose to treat the problem with only an over-the-counter insect spray – a method that is ineffective in almost all cases.

Breaking the information down, 14.5% of City of Cincinnati residents responding to the survey had a problem with bed bugs. Of Hamilton County residents outside the City of Cincinnati questioned, 3.6% reported a problem. The survey indicated that bed bugs affect all age, race and income groups. The results confirmed that renters and students tend to experience more of a problem. “I personally would expect a much higher incidence of bed bugs in any metro area,” Dr. Jones said. “These areas tend to have more multi-family dwellings, higher concentrations of people, more mass transit, more population diversity and a wide range of socio-economic conditions.“

For more information about bed bugs: City of Cincinnati residents: Information regarding bed bugs, including an instructional video can be found online at www.cincinnati-oh.gov (click on the Health Department link) or by calling (513) 564-1751. Hamilton County residents living outside the cities of Cincinnati, Norwood, Sharonville and Springdale: Please visit Hamilton County Public Health at www.hamiltoncountyhealth.org or call (513) 946-7832.

Emphasis added.

Did you see that? Yes, I recommend that you read that again.

Cincinnati, population 332,252, received give or take 757 official bed bug complaints in 2007. Do we realize what this survey suggests about the likely underreporting rate? The official stats could account for less than 2% of the actual cases.

And is it possible that there could be ______ New Yorkers who have bed bugs? Why can’t we have this type of survey here?

The Cincinnati/Hamilton County Strategic Plan: getting the basics right

Renee Corea — Tue, 28 Oct 2008 05:48:46 +0000

What is most impressive about the Cincinnati/Hamilton County Joint Bed Bug Task Force Strategic Plan is the breadth and accuracy of the analysis. We can’t solve a problem that we don’t understand—and it’s clear that committed and intelligent people in Cincinnati and Hamilton County correctly analyzed the issues.

They obviously get the basic things right, like for example the simple fact that an infestations map, even one maintained by their public health departments, will be a flawed representation of the total number and location of infestations (p. 16):

While this map is somewhat informative, it is important to remember that not all bed bug infestations are reported to the health department in the city and county. In fact, based on data from other cities, it is expected that the majority of bed bug infestations will be treated by pest control operators without being reported to a health department. Therefore, these maps may merely show the distribution of bed bug infestations in lower income areas, rather than the true number and distribution of infestations in the city or county.

Emphasis added.

I assure you that something like this is not immediately obvious to many. I know we may look at the New York City bed bug statistics of HPD-tracked bed bug complaints, the breakdown by community districts, and we may think of our neighborhoods with corresponding relief or alarm.

Perhaps you remember the map published by the New York Times in 2006? You can see it here. It accompanied this article.

You can pretty much lose yourself in the color-coded risk calculation trap that is that map! If you were to make assumptions about bed bug-free neighborhoods, however, you’d be courting serious error.

New York vs Bed Bugs advocates the tracking of bed bug infestations in New York City. We believe that bed bug complaint statistics should be available to the public as part of Local Law 47 reports. Moreover, we believe there should be a non-adversarial reporting system for bed bug infestations in our city. We need a clear picture of the scope of the problem.

Hamilton County Public Health’s Jeremy Hessel: “We’re all in this together”

Renee Corea — Mon, 20 Oct 2008 03:56:49 +0000

The first thing you notice about the Hamilton County Public Health bed bug brochure is the simple direction to call for help (PDF):

If you rent a home or apartment within Hamilton County (excluding cities of Cincinnati, Norwood, Sharonville or Springdale) and you think you have bed bugs, please contact the Hamilton County General Health District at (513) 946-7832. Health District sanitarians will work with your landlord to eliminate the problem.

The four excepted cities operate their own health departments. To see if a city or community is served by Hamilton County Public Health, check this map.

Hamilton County is the other half of the Cincinnati/Hamilton County Joint Bed Bug Task Force. Unforgivably, we have virtually ignored them until now—this despite the fact that a Hamilton County public health official was the first to make us sit up and take notice of a critical perceptual shift in 2007 when he declared that bed bugs were a “public health crisis.”

The Joint Bed Bug Task Force’s recently released Strategic Plan notes several differences between Cincinnati and Hamilton County: 58% rental housing units in Cincinnati vs. 37% in Hamilton County, a higher proportion of old buildings in Cincinnati, 28% of the population living below the poverty line in Cincinnati vs. 15% in Hamilton County, and a greater density of “transient residential structures” in Cincinnati.

A public health nuisance

In the national hand-wringing debate about what to call bed bugs (are they merely nuisance pests or public health pests—and, perhaps, does the answer depend on political will and resources?), Hamilton County shows itself in command of the essential question.

“Bed bugs might not spread disease but we consider them to be vermin, and a public health nuisance,” says registered sanitarian Jeremy Hessel.

When I spoke to Jeremy Hessel, Hamilton County Public Health’s tally of bed bug complaints, at 180, had already surpassed the previous year’s count of 167.

Under Ohio Department of Agriculture pesticide rules, an owner of a building of three units or less is allowed to treat the building without an applicator license. Hessel considers this a significant challenge in Hamilton County. Nonetheless, building owners have started to come round to the idea of hiring competent pest management professionals to service bed bug complaints in their properties, and they’re starting to understand what is required for eradication.

Who pays for treatments in Hamilton County? When tenants were being charged for bed bug treatments, Hessel said, Hamilton County consulted Legal Aid attorneys on their behalf. Unless the landlord could prove that the tenant “brought them in” or that unreasonable destruction was caused by the tenant, the landlord was responsible.

While treatment failure is not yet a significant problem in Hamilton County, Hessel worries about it becoming more common in the future.

Asked about the distribution of bed bug cases in the county, he says that while there is a high concentration in apartment complexes and apartment homes, they’re not only in densely populated areas. “You’ll see them in smaller cities within the county. Suburb areas in the county.”

Frequent tenant turnover in apartments, however, is a perceived factor in the spread.

When I asked about single-family homeowners and the likelihood that their struggles with bed bugs do not come to their attention, Hessel surprised me by saying, “They’ll call us. We’ll try to give as much guidance as possible, and sometimes we even go to their homes.”

When I tell Hessel I’m impressed by this, he says they do it to try to help the public. “Because if they have a problem, and if they stay at a neighbor’s house or at a hotel until the problem’s gone, they can take them with them. So, we’ll try to give them as much advice and guidance as possible and even make a visit sometimes.”

If you see one bug, that’s all you need

What happens when a resident asks for help with a bed bug problem? According to the Joint Bed Bug Task Force Strategic Plan, bed bug complaints received by Hamilton County Public Health are entered into the Cincinnati Area Geographic Information System (CAGIS). A field sanitarian is then assigned to each complaint and conducts an inspection within 5 business days. If an infestation is found, a violation is written and the sanitarian follows-up with all parties (landlord, tenant and pest management professional) within 14 days to check on the progress of the case.

The following flow chart (see page 22 of the Strategic Plan) describes the complaint response process:

Bed Bug Complaint Response Flow Chart

Hessel explains that they have received guidance on inspection protocols. “Through this process of formulating guidelines, we learned from [Ohio State University entomologist] Susan Jones that ‘if you see one bug, that’s all you need.’”

The Strategic Plan recommends leaving the full, likely-two-hour inspections to the professionals.

If signs of bed bugs are found at the field evaluation, instructions are given to the owner and to the tenants about their responsibilities. Hessel says he asks the landlord to hire a pest control operator “tomorrow or the next day.”

“We follow up with the landlord to make sure that process has been done or that process has been initiated, and then we’ll have the tenants follow up with us on how the situation is going. We might do some follow-up field visits, upon request.”

I ask our favorite question, what about inspections of adjoining apartments?

“We usually recommend that they do that. It’s not mandatory, but it’s highly recommended because of the nature of the bed bugs, and how they maneuver through the walls and electric piping. So most of the applicators that we have encountered do that already. They go in and inspect upstairs, sides and below. It’s all about good pest management.”

What is on the horizon for their bed bug control efforts in Hamilton County? Hessel says they haven’t really looked at furniture movers and furniture stores and they may evaluate the problems in those businesses. He says they plan to do community outreach presentations to different groups, such as social workers and other workers who take care of adults with disabilities.

“One of the tougher issues is when nurses call from school.” They offer help to the affected families.

We’re all in this together

There is a fundamental decency to the approach to bed bug infestations in Hamilton County. And this was felt in our conversations with Jeremy Hessel. When we thanked him for talking to us, he said “We’re all in this together.” When we complimented the extraordinary work that they are doing, he said something I personally found moving in its simple statement of the facts.

He said, “We’re trying. We’re doing the best we can. I hope others will take the lead. If you try to forget about it, if you try to brush it aside, it’s going to catch up with you eventually and you’re going to be behind the eight ball at that point. You got to do something about it now. You can’t let it continue. You have to try to step in and do something for the residents.”

Yes, we must.

New York vs Bed Bugs advocates a comprehensive bed bug strategy for our own city. We’ll have what Cincinnati and Hamilton County are having, please! You can support our efforts.

The Cincinnati/Hamilton County Strategic Plan: the political frame

Renee Corea — Mon, 06 Oct 2008 05:13:32 +0000

This is the first of a planned series of excerpts and articles on The Cincinnati/Hamilton County Joint Bed Bug Task Force Strategic Plan.

The Joint Bed Bug Task Force is comprised of the Cincinnati Health Department, Hamilton County Public Health, and Ohio State University Extension Entomology (Dr. Susan C. Jones).

The Joint Bed Bug Task Force members who collaborated on the Strategic Plan are: Camille Jones, MD, MPH; Timothy Ingram, RS, MS; Susan Jones, PhD.; Antonio Young, RS; Chris Eddy RS, MPH; Thomas Hooper, RS; Robert Smith, RS; Bernadette Watson; and Mohammad Alam, PhD.

We’ve chosen to open our examination of the Strategic Plan (a document that we have anticipated all year) by simply citing the statements of the elected representatives and public health officials of Cincinnati and Hamilton County.

The statements of government and public health officials are always important. They are predictive. They frame the issues and define the challenges and the terms of success and accountability.

And policies will absolutely flow from those statements, as we have seen with regret in New York City.

In Cincinnati and Hamilton County, the following statements are quoted in the Joint Bed Bug Task Force Strategic Plan:

Ohio State Representative Dale Mallory stated “This infestation is a major social and economic issue that must be addressed. We are working hard at the state level to help address this issue. I have met with the Ohio Department of Health and the Ohio Department of Agriculture, and state elected officials. We are looking forward to helping resolve this problem.”

Cincinnati Councilman Chris Monzel said “The necessity of including the health department and other city and county departments as well as private and community organizations in this effort is clear.”

Dr. Noble Maseru, Cincinnati Health Commissioner stated “This bed bug problem is like a canary in the coal mine, alerting us to vulnerabilities of our social environment. The Task Force led by Dr. Camille Jones provides guidance to address bed bug infestation and the importance of establishing an essential multi agency network to solve this major nuisance in our social environment. I also commend our state, county and city legislative leadership in their quest to acquire resources which in the long term must be resolved through a citizen, public and private sector collaborative effort.”

Mr. Antonio Young, Supervising Sanitarian for the Technical Environmental Service of the City of Cincinnati Health Department said “We are committed to finding a way to minimize the impact of bed bugs on our community. The southwestern area of Ohio appears to be experiencing what the rest of the state may expect in the near future. The important work that the Task Force and political representatives do in this region, if carefully done, may serve as a model in addressing this formidable quality of life issue elsewhere”.

You know what else is interesting about Cincinnati/Hamilton County? When Ohio State Representative Dale Mallory convened an emergency meeting (yes, an emergency meeting) on January 18, 2008, following two previous town hall meetings, well, let’s quote in full:

Participants in the meeting included Representative Dale Mallory, Representative Michelle Schneider, Senator Bob Shuler, Cincinnati Councilman Chris Monzel, County Commissioner Todd Portune, Cincinnati Health Commissioner Dr. Noble Maseru, Hamilton County Health Commissioner Mr. Timothy Ingram, Dr. O’Dell Owens, Ms. Shirley Dunham representing Cincinnati Vice-Mayor David Crowley, Ms. Carolyn Edwards representing Cincinnati Councilman Cecil Thomas, Ohio State University Entomologist Dr. Susan Jones, Cincinnati Assistant Health Commissioner Dr. Camille Jones, Hamilton County Director of Environmental Health Chris Eddy, and Ms. Polly Doran from the Council on Aging of Southwestern Ohio. As a result of that meeting, the Joint Health Department Bed Bug Task Force was formed.

We hope that this will finally make clear why we have such a great interest in the genesis and in the work of the Cincinnati/Hamilton County Joint Bed Bug Task Force and why we are devoting special attention to the Strategic Plan. From the very beginning the issue of bed bugs had the attention of the Cincinnati and Hamilton County elected and civic leadership. I have to say that we are clearly in awe of their efforts. We congratulate them for an impressive undertaking. The specific challenges of combating bed bugs are certainly great but when there is a consensus from elected officials and public health officials that action must be taken, then there is actually hope of meeting the challenges and helping the people who are struggling.

Our next installment will explore the Task Force’s conception of these challenges.