I have been thinking about bed bugs lately. No, it is not because I just checked into a hotel. Recent press coverage of our bed bug infestation has got me thinking or re-thinking my take on bed bugs as a public health matter.
When I teach and talk about public health law, I introduce my students and listeners to public health analysis and to the triggering of the exercise of public health law authority through topical examples. I often start an introduction to public health law with what I hope will be a vivid example of local significance. I start small (no pun intended), building later to a look at the mass pandemics of our time.
I start with bed bugs.Bed bugs are ubiquitous and almost universely reviled. My students are disgusted by the bed bug specimens I bring to class. This revulsion goes a long way, I suspect, toward fueling press reports of a "bed bug epidemic." We, however, pause to consider whether bed bug infestation is a true epidemic and, if so, whether bed bug infestation merits activation of the full legal and regulatory force of public health law.
When I taught public health at Hastings, we looked at San Francisco's public health ordinance regarding bed bug infestation. We consider the personal cost, mental health implications, and economic cost of bed bug infestation in a city with a tourism-driven community. We can find the legal and regulatory system allocating rights and responsibilities all around the "epidemic."
Talking about bed bug infestation also introduces my students to the idea that public health crises often beget public health crises. In this case, the virtual ban on the use of certain insecticides plays a role in the U.S. resurgent bed bug population, though serious public health concerns put the brakes on routine mass use of these insecticides.
As anyone who has ever battled bed bugs will tell you, bed bugs are no laughing matter. Still, there are moments of levity in the public health analysis of this infestation. It is inevitable that discussions of current plans to use popular de-worming agents developed for animal use on humans (pet owners: think HeartGuard) provoke a smile.
But the most recent news on bed bugs over the last few months has been sobering. Even a well fed bed bug is quite small, often difficult to see given their nocturnal ways. Those who specialize in capturing them for dissection have begun to report the presence of community-acquired MRSA (Methicillin-resistant Staphylococcus aureus) in some communities of bed bugs.
Community-acquired MRSA may be one of our under-diagnosed epidemics. Even more troubling, our relatively lax approach to MRSA screening and reporting has begun to blur the line between health care facility-acquired and community-acquired MRSA. And, yes, bed bug infestations are not unknown in health care facilities.
Maybe a string of bed bug bites (hence the derivation of the old chant: breakfast, lunch, dinner) was always more than a nuisance. Now it is possibly much more than that.
Of course, much remains to be learned about all of this, particularly about the rate of MRSA infection in the general bed bug population and whether or not we can determine if bed bug to human MRSA transmission is a genuine threat. In the mean time, bed bugs as possible disease vectors frame one issue nicely: what role public health law ought play in allowing surveillance of and requiring treatment of potential disease pathways.
A marvelous guest speaker in a health law course once brought me up short with laughter when he advised the student listeners that the single most important requirement for a new attorney interested in health law was to have a strong stomach. Just in case that is not your calling, you can always check out reports of bed bug infestations in public accomodations online.
Cross-posted at prawfsblawg.blogs.com