The past ten years have seen a surge of bedbug infestations across North America, with many cities across Canada affected. 

Everyone hates bedbugs. But are they a health problem? The response to bedbugs often involves the health care system, along with housing authorities and pest control experts.

We went on the street to ask people who should be responsible for dealing with a bedbug infestation in a rental unit or apartment building. Click on the video below to see what they have to say.

In Ontario, landlords and property owners are responsible for ensuring that dwellings are free of pests like bedbugs, and tenants are required to cooperate with a landlord’s efforts to deal with infestations. However, efforts at eradicating bedbugs are often unsuccessful, leading to anxiety, escalating costs and discord between landlords and tenants.

Bedbugs – the health impact

Bedbugs do not transmit infections. Most people who are bitten by a bedbug suffer at most a minor skin reaction, similar in severity to the reaction from a mosquito bite. However, the health impact of a bedbug infestation goes beyond the skin. Stephen Hwang, a general internist at St. Michaels Hospital says that “although bedbugs do not spread disease, they cause physical and mental distress.” Tracy Leach, leader of the bedbug team for Toronto Public Health agrees, saying that “it’s not just the physical presence of bedbugs that people experience, but also the stigma and social isolation.”

While bedbugs affect people from all walks of life, they occur most often among people who live in lower income housing, high-density dwellings and shelters.

Infestations in high-density housing environments are particularly difficult and costly to eradicate, and require the combination of repeated pesticide treatments with environmental measures such as laundering of bed linens, frequent vacuuming and steam cleaning of mattresses and bedding. This is a costly, challenging undertaking and according to Leach “people who are vulnerable may have a reduced capacity to deal with this because of physical and mental health problems and addictions.” She adds that “services that people have [such as home care] may be reduced or eliminated because workers do not want to go into an infested home.”

Although harmful pesticides such as DDT were used to treat bedbugs in the early part of the 20th century, modern treatment methods use safer pesticides and protocols that minimize their use. Treatment involves careful inspection of a dwelling for bedbugs, their shells and eggs, manual methods (e.g., vacuuming, sealing of inaccessible spaces, etc.) and the application of steam or pesticides that break down quickly and are safe when used as directed.

Complex problem, no easy solutions 

Ray Copes, director of Occupational and Environmental Health for Public Health Ontario suggests that “the real public health problem is housing and the lack of social support for people who have mental illnesses and people who are socially disadvantaged and impoverished, which isn’t the same as bedbugs.” Copes says that “once bedbugs are seen as the problem, then the issue morphs into one where dealing with the bedbugs themselves is the focus.”

Arlene King, the Chief Medical Officer of Health of Ontario, describes bedbugs as a ”challenge which manifest themselves in the health sector, but the solution does not lie in the health sector.” King says “the solutions lie with other sectors, for example housing authorities and others who can deal with the problem of identification and management of bedbugs.” King notes that the recently implemented provincial bedbug strategy received input from a committee composed of representatives of eight different provincial ministries – including Community and Social Services, Health Promotion, and Municipal Affairs and Housing. The strategy included the creation of the website bedbugsinfo.ca and the provision of one-time funding to public health units across Ontario to support local bed bug initiatives for the period April 2011 to March 2012.

When asked about the next steps for the bedbug strategy, King responded that no decision has been made about continuing funding for bedbugs. She did however say that “we are continuing to collect data and information on those activities, and that information will inform next steps with respect to this issue.” She notes that “at a minimum, we will have to continue to provide information to the public on how to prevent, identify and control bedbugs.”

Intersectoral approaches

Tracy Leach’s team at Toronto Public Health received some of this one-time funding. Her team focuses on providing what she describes as “integrated pest management” with a team including 6 inspectors and 3 public health nurses. The public health nurse position is aimed at supporting bedbug control activities, including health assessments and support for vulnerable populations who are experiencing infestations or recurrent infestations. The bedbug inspection conducted by this team includes two or more professionals who “go in and examine the structure, space, and environment of a bedbug infestation” and provide guidance to tenants, property owners and landlords about appropriate treatment and control measures. Last year, the City of Toronto conducted 3500 inspections. Leach notes however that Toronto Public Health does not itself provide treatment or pest control.

Copes acknowledges that there is “debate, confusion and lack of consensus around the legal issues and ethics of responding to bedbugs” and that there are questions about “who is responsible and who pays.” The cost of eradicating bedbugs in a single apartment can climb into the thousands of dollars, with costs for pest control, dry cleaning and purchasing new furniture.

However, paying for pest control in one unit may not solve the bedbug problem for long, as bedbugs can travel between apartments. While property owners and landlords are responsible for dealing with a bedbug infestation, a tenant’s cooperation is vital. For example, a single individual can thwart a building-wide effort to manage bedbugs by not complying with requests to remove furniture or clean bedding.

Hwang, who has published a case report in the Canadian Medical Association Journal describing an unusual complication of a severe bedbug infestation, says that more commonly “there is nothing that a doctor or nurse can do on their own, as the problem is in the housing environment.”