Can a Penn epidemiologist prevent a bedbug-driven outbreak?

Epidemiologist Michael Z. Levy curbed a Chagas disease epidemic in Arequipa, Peru. Can he prevent an outbreak in Philadelphia?

After nearly 20 years researching the intersection of ecology, public health, and urban policy, Michael Z. Levy, an associate professor of epidemiology in the Perelman School of Medicine understands, better than most, how infectious disease outbreaks happen—and that we’re not doing enough to prevent them.

Road in the Chilean village of Arequipa.
Researchers from the Zoonotic Disease Research Center spent years surveilling Arequipa to find households where Chagas-infected insects were hiding, target those homes with insecticide, and then use data and epidemiological modeling to track where the next outbreak of disease might occur. (Image: Penn Medicine News)

“My big worry right now is that we’re going to have warehouses full of masks, and the next pandemic won’t be airborne—it’s going to be carried by a bug,” Levy says. “If we wait until bedbugs start spreading disease, then we are going to be in the same situation we are in now with COVID. We’ll have missed any opportunity to stop it.”

After graduating from Amherst College, Levy traveled to Chile, where his fear of contracting Chagas disease, which the chirimacha insect spreads, kept him awake at night, a flashlight in hand, scanning his sheets for the lethal insect. “I had this real phobia of the Chagas bugs. It’s a terrifying disease,” he says.

Years later, in 2001, Levy read that Chagas had killed a baby in Arequipa, Peru’s sprawling, second-largest city of one million people.“When an infant has an acute case of Chagas disease, that means there is usually another 1,000 cases that you’re not seeing,” Levy says.

The burgeoning epidemiologist knew he needed to go to Arequipa to battle the disease that had haunted and captivated him for years.

Once he arrived in Arequipa, Levy and a colleague from the Centers for Disease Control and Prevention met with representatives from the city’s Ministry of Health, who introduced them to Arequipa’s resident Chagas expert: the late Eleazar Córdova, then a microbiologist at the Universidad Nacional de San Agustín.

With funding from the Canadian government, the Ministry of Health embarked on a conventional door-to-door insecticidal treatment campaign, with methods dictated from afar by the Pan American Health Organization. Levy worked with Córdova to embed studies into the effort in order to understand the local epidemic—the largest ever in a city—and to tailor and recreate control strategies for other urban areas.

“There was a lot of press, and press gets politicians moving,” Levy says. “When there is political will, you can control a disease.”

By the fall of 2019, Levy had been back in Philadelphia for almost a decade, facing another nightmarish insect: He was confident that the city was finally ready to do something about bedbugs.

For the past four years, he had served on a city-commissioned Bedbug Task Force—composed of local scientists, pest management experts, and community activists—who worked diligently on a bill intended to stop the spread of the pests in a city that has been dubbed by Terminix as “the most bedbug-infested” in the country.

“What you need is smart policy that will encourage people to report the infestation, quickly … If you put the onus on the tenant to pay for treatment, they may not report it. I don’t care who is responsible—if they’re not reporting it, it’s going to spread.”

Read more at Penn Medicine News.