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Transcript: Mayor de Blasio Makes Announcement on Lyme Disease Prevention

July 23, 2018

Mayor Bill de Blasio: Thank you, Bob. I very much appreciate it. Bob, I want to thank you. I really appreciate you telling everyone your story. I really appreciate that you’ve gotten so involved to address this disease, to educate other people, and help make a difference for so many people. And it really— there’s something particularly admirable when someone has had a problem and instead of turning away, turn towards everyone else to help them. I know that you’re dealing with the challenge still. You look great, thank God, and I wish you continued good health and thank for all you were doing. Let’s give Bob a round of applause and thank him.

[Applause]

And we’re going to talk about, just how serious this disease is and all the things that we have to do to address it. And all the things that everyday people can do to protect themselves and their family. This is a problem all over our country – it’s a problem, increasingly, in this city, but nowhere more in the city than in Staten Island, and it needs a lot of attention, and we intend to give it the attention it deserves this is a very serious disease, with really lasting impact on people and we’ve got to take it seriously and we’ve got to fight it in every way we can.

I want to thank everyone who’s here. You’re going to hear from our Health Commissioner and from the Borough President and a Council member in a moment. Thank you to Senator Lanza for joining us as well. Thank you to the good people working in our parks and serve us, we really appreciate your good work, because Bob is right, our parks are so important to everyone in this city and in this borough and we want to enjoy them. We do not want to fear going out to take advantage of nature and enjoy nature, and enjoy athletic activity and all the things that matter to us, so we have to get this right for everybody.

So look, this is a very tough disease – one bite from one of these ticks can change someone’s life really for the worse. And we understand that, we don’t want to see anyone affected by this disease. We understand a lot of people are vulnerable and it’s going to take a lot of different pieces to make a difference here. You’re going to hear from our Health Commissioner about a number of the strategies we’re putting into place, and we also as Bob said, it’s so important that people are educated about what they can do to protect themselves and their families. That personal piece of the equation really, really matters because those ticks are out there, they’re on deer, they’re on mice, they’re on other small animals, and they’re going to be around for a while we figure out how to try to eradicate them once and for all, they’re going to be here for a while. We have to protect people in whole variety of ways. Our elected officials have been at the forefront. I particularly want to say to the borough president and the councilman and also Councilman Matteo is not here with us but he’s been part of this discussion, thank you for having sounded the alarm, thank you for having helped us all to understand that this was a growing problem that needed to be addressed.

Now, what we are putting together here is a new approach because this problem has been growing, again, all over and we see now some new aggressive approaches that we’re going to need to address it. For one thing, we will be announcing the most aggressive tick control policy in the history of New York City. So we’re ramping up on a variety of levels to go at this problem. We’re doubling the number of parks that we are surveying to be ahead of this problem, to know where the ticks are, so we can go at them and address them. We’re adding Department of Health staff to our Parks teams that are already on the front line addressing this issue. We’re deploying insecticide in parks where Lyme disease is more likely to occur – these are the bait boxes you’ve heard about, that we have a lot of hope for, we want to see if this strategy will work on a wider level. If it does, we’re going to use it aggressively all over to make sure we’re protecting people.

Obviously, this issue connects to the question of the deer population. It’s complex because again the ticks are carried by mice in large measure, other small animals, but the deer are a crucial piece of this equation too. What we know already, and this is some good news, is the deer population is down eight percent in the last year; we know half as many fawns have been born, and we know that as of March of this year 94 percent of male deer on this island were sterilized. That is real progress. We expect a substantial new reduction in the deer population in 2018. We want to keep driving down that population aggressively, so that’s a big part of the strategy. But I want to remind people, the other parts of the strategy are necessary because even without the deer, unfortunately the ticks are being carried by other animals as well.

There was, I thought, a really good article in the Staten Island Advance this morning, I was reading coming over on the ferry, about the different approaches being used. New York State is looking at an approach that’s very interesting in terms of trying to apply insecticide directly to deer. This is a new idea; we want to see if it’s something that can be used on a bigger level. So it’s not something we’re doing yet; we’re going to work with the state to see if that’s something we should implement here. Again, any strategy we think might work on a bigger level we’re going to put into play.

All of that matters, and then, I say to everyone, to all my fellow New Yorkers, to everyone who lives in Staten Island, protect yourself. That’s a big part of the equation. You’re going to hear some details from the Health Commissioner but protect yourself: you are your own best line of defense, you are your family’s own best line of defense, because you can identify this problem and act on it and the earlier you act on it the better. Use the bug spray, dress in clothing that helps protect you. I’m someone I can tell you – I love to go out in you know, sandals or flip flops and all but I have been schooled many of time, that’s something that unites what my mother used to tell me to what my wife now tells me, I’ve been told many a time in any area where it is a wooded area or there is tall grasses and I’ll put on socks, put on sneakers, those common sense things really make a difference. So as I conclude, I’m going to say a few words in Spanish before turning to the Commissioner and the elected officials. Looks the bottom line, Lyme disease is a serious disease, it is a life changing disease, it requires serious solutions, it requires urgent solutions and that’s what we are going to provide. Few words in Spanish.

[Mayor de Blasio speaks in Spanish]

With that I am going to turn to our Health Commissioner, she’s going to give you remarks now, I want to say to members of the media, if you have questions afterwards on the approach we are taking, or on the disease itself, how it manifests, you know details about the science around the disease, Doctor Bassett will stay after and be ready to answer those questions. But I want to thank her for being here, she’s one of the voices all New Yorkers listen for in terms of how to protect themselves and their families and she has really important information for us today. Our Commissioner, Dr. Mary Bassett.

Commissioner Mary Bassett, New York City Department of Health and Mental Hygiene: Thank you very much Mr. Mayor. I’m going to put  my props which will be recognized, I believe by the Borough President – we did an educational session at the Staten Island Borough Hall where actually somebody like you Sir, spoke who was a senior member of your staff, who lived with Lyme disease. So I want to say how excited I am to be here together with the elected officials and our Mayor, to announce this plan, this is a very important issue for Staten Island as you heard from the Mayor. The number of cases of tick borne diseases of which Lyme disease is the most important and the most common have been rising across our country, within our city, but it’s in Staten Island that we see the largest number of cases and Staten Island is a center for local transmission – meaning this is where we see people who have acquired their Lyme disease here in Staten Island. City wide, most people get it from traveling outside of the city but here in Staten Island between 50 and 60 percent of people get Lyme disease here. So while we want all New Yorkers and Staten Island is lucky to have so many beautiful parks and wooded areas, to enjoy the benefits of our parks, particularly in the summer months, now we really are going to be in the position to sound the alarm even louder about taking precautions to prevent tick borne infections and extend our ability to control tick borne illnesses in the city.

Just to give you an idea of the numbers – in the past five years, the number of cases of Lyme disease in people this is, increased from about 750 in 2013 to over a 1,000 in 2017. That’s a 44 percent increase, nearly 50 percent increase, and we also saw these other diseases that some of you may have heard of – Babesiosis, Anaplasmosis, go up. So these numbers tell us that we have to do more and that’s why we are so pleased to be able to talk about our efforts. We have a problem with our tick population. Not only have the number of cases in human beings gone up, we are seeing more and more ticks in our tick surveillance program and close to 20 percent of these ticks are ticks that have Lyme disease. So what we are going to do now with a new commitment from the Mayor is to increase our surveillance and control efforts. We are going to expand our ability to monitor the ticks, you heard we are going to be doubling our surveillance from 14 to 28 sites here in Staten Island and we also are going to be enhancing our ability to capture cases interview people who have Lyme disease and enhance our surveillance. We also are going to be adopting these novel strategies that you have heard about from the Mayor and these are strategies that tackle the field mice which are the maintained reservoir for Lyme disease and also explore opportunities to tackle the presence of ticks in the deer population. You know prevention is always the best medicine so I’m going to rake a moment to talk about what will really remain a mainstay of our efforts to control Lyme disease and that is to prevent the acquisition of ticks by taking precautions when you go outdoors to identify the presence of ticks on your bodies, and the bodies of our pets, because pets, dogs, and cats can also get Lyme disease, and then the importance of early diagnoses because, as you’ve heard, Lyme disease can be a very protracted and complex infection. It can affect our nervous system, our hearts, it can lead to very severe symptoms. It’s nearly always treatable but sometimes it’s not possible to treat. So early diagnoses and early initiation of antibiotic treatment is very important.

So let me begin with what it means to go outside in – these – on a day like today, it’s a little hard to tell people that you have to stay covered. You need wear socks and shoes, which the Mayor referenced, you not only need to do that, you need to tuck your long trousers into the top of your socks. The idea is to leave as little skin exposed for the tick to attach itself to if you happen to brush it in grass lands or as you go through wooded areas. It’s hot, so it’s hard for a lot of people to follow this advice, but it is the safe advice. Wear a hat, wear a bandanna, wear long sleeves, wear long trousers, wear socks, tuck your trousers in the socks, wear shoes.

The next step after you return from a wonderful escapade in a wooded area is to check for ticks. And you heard that they can be as small as poppy seeds. So feeling for them and that’s what Tick Check Harry is for, if anyone later wants to feel it, you’ll be able to see what it feels like to feel for a tick. We use this with children but I think adults can also learn from Tick Check Harry, and you need to feel for them. So you need to feel behind your ears, your neck line, your waist line, between your legs, and you have to check yourself with actually feeling for them, not just looking for them because sometimes they really are a speck and it’s only by feeling a little elevation.

Then if you find a tick you have to remove it safely and that means using a pair of fine tipped tweezers, pulling it out with gentle, continuous pressure, from the base where it attaches to the skin. Either flush it down the toilet or put it into alcohol. If you are not sure how long you’ve had that tick bite, then you should call your health care provider and talk with them about whether you should come in and discuss beginning antibiotic treatment. There are some places where so many of the tick bites are believed to carry Lyme disease that people just start individuals on antibiotics, so that’s a conversation you should have with your healthcare provider.

With luck, we’ll keep people from getting important tick bites, but if you get a tick bite, you have to very alert for a skin rash. And that is a characteristic rash. It looks literally like a bullseye, like a target legion, it’s red in the center, a circle that is not red, and then another circle that is red. Anybody who’s ever seen one will never forget what it looks like, it’s very characteristic, if you have that you have to see a doctor and begin treatment. Again, the earlier you start treatment, whether you saw a tick bite or not, if you see a legion like that you should seek care.

Other symptoms are much vaguer. That’s probably why, you sir, didn’t recognize that you had Lyme disease. It can be just a flu like symptom which can be lots of things. But if you’re in an area where there is a lot of ticks and Lyme disease, flu like symptoms in the summer months should prompt you to see your provider and mention to them that should consider Lyme disease. Again, very readily treated with common antibiotics, very important to diagnose it and treat it early. So I’ve finished being the doctor for you, but I want to just say how important it is that we will be able to expand all of these activities, our surveillance, our public education, and the initiation of the bate boxes and exploration of using pesticides on grasslands, there is a new fungal – fungus containing bio-pesticide that is biologically active but it doesn’t hurt people that we’re also looking at, as well as the possibility of treating the deer directly. We understand that people need protection and that people are not accustomed to being afraid of the outdoors. We want people to understand that they can take precautions, they can be alert to symptoms, and we want them to continue to go outside and enjoy the beautiful parks, thank you very much.

Mayor: Thank you very much doctor, appreciate it and I’m going to give you your dog back doctor. Pass along the dog, thank you.

Commissioner Bassett: I meant this was – this a very simple, everything you need to know about ticks that we use in our public education sessions and anybody who, we brought some with us, we’re happy to hand them out.

Mayor: Thank you very much, thank you doctor. I want to turn to the Borough President, and again thank him for always being a strong voice for the people of this borough and reminding us that we have to look under every stone for ways that we can serve people and address problems. This is a challenging problem but I know if we stay at we’re going to get it done. So, Mr. Borough President, thank you so much. 

[…]

Commissioner Bassett: Alright, alright I don’t know who is going to be fielding any questions, but I’ll do my best to answer them. Yes.

Question: My name is Dee Vandenburg and in August of 2017 the doctors of Staten Island University Hospital sat my husband down and said we don’t know if she’s going to make it. I had no tick bite, I had no rash that anybody knew about. I had spinal meningitis that went into the brain from May, they think I got bit in May, myself and the 13-year-old next to me. [Inaudible] ten people have Lyme disease. My spinal tap showed nine positive bands. CDC said anything over five [inaudible]. I only know one person on Staten Island that got a letter from the New York City Board of Health, I haven’t got one. The 13-year-old next door to me has seven positive bands on his spinal tap, he hasn’t gotten one either.

If the City of New York, whether it’s the hospital or the doctors because they are afraid of something are not reporting to you guys, you guys aren’t getting those letters out and it’s not going to the State of New York then turns it into the CDC, similar to Hurricane Sandy, if the feds don’t have numbers they won’t let anybody help us. My seven-year-old on the corner of my house when I was away on vacation this year just came down with Lyme disease again. Two days ago they took three nymph ticks off my neighbor’s wife. We’re in an epidemic here, if the feds don’t have the numbers. I will not question the procedure unless I know what that procedure is. I spoke to the CDC, they are not happy with New York, period. They are not getting the numbers in.

I have watched [inaudible] 13-year-old, the father had it twice, now the mother has it, and the cousin on the corner three houses away has it. Nine bands positive, that’s way over the five, I just got bitten again three weeks ago. I got bit on [inaudible] going to my [inaudible] doctor’s office. I almost died from this. I had no [inaudible].

The City of New York has got to, and I don’t know it’s the doctors are afraid to [inaudible] paid, because the feds are not allowing payment on certain things, I had to have – I had to pay $250 out of pocket, which I’m going to have to do again, to a lab in California for the testing, CDC won’t approve it. So the problem is the CDC is not going to change their format until they get the numbers. They need our numbers, and that’s going to get done [inaudible] so I’m begging you, get those numbers.

Commissioner Bassett: Thank you and I want just say your – I’m really glad that you’ve made such a good recovery, and it’s true that people can have Lyme disease with no characteristic rash. The percents that I’ve seen are 70 to 80 percent of people have the rash, but you know, that’s just from a textbook. The point here is that we have to improve our reporting, the Health Department receives reports. We are not the doctors that make the diagnoses. Our Bureau of Communicable Disease have tracked 73 different communicable diseases, all of which are subject to mandatory reporting to us, but we – your point is well taken to work more closely with the provider community to improve that reporting. Do you want to add any? I mean –

Staten Island Borough President James Oddo: No, no. That’s one of the points I made, that’s absolutely one of the focuses going forward. We got to get better at it.

Question: What exactly is new here today? I mean just reading the press release it said that you? One, what does that even mean? Are you like spies and surveillance –

[Laughter]

Commissioner Bassett:  No.

Question: What does that mean? And I assume the bait boxes are new too—

Commissioner Bassett:  That’s correct.

Question: That’s a brand new thing? And then, one last thing, you said 750 cases in 2014, but over a 1000 in 2017, are those citywide numbers?

Commissioner Bassett: Those are citywide numbers, yes that’s right. Let me – we can get you all the numbers on Staten Island, specific numbers. But the surveillance for ticks is what’s being expanded in parks. We collect ticks, as you’ve heard they don’t jump. Well I guess these special ticks jump, the lone star, but the deer – the black-legged, commonly called deer ticks, basically come on to human beings because you brush vegetation that has the ticks on it. And, we do surveillance by literally dragging clothes and looking for ticks and we’ve increased the amount of surveillance that we are doing two-fold. So that’s looking for ticks, then the ticks are tested to see what bacteria they have in the ticks. So we’ve had one comment on human surveillance and your question is about the tick surveillance. They’re both part of the equation of why Lyme disease is going up in the city. We’re both diagnosing it better but we have a rapid expansion in the tick population, and that’s where you get Lyme disease. Yes?

Borough President Oddo: They’ll drag, you’ll see them drag a piece of cloth in a particular location and then look at that cloth and then pick ticks off, so where going to move from – there was originally 13, we added a school that was near the woods, that’s 14—

Commissioner Bassett: Now it’s going to be 28. 14 to 28 sites, and then the bait boxes are – I think the Borough President described it as he has obviously become expert in this area these are aimed at the mice, which are referred to as the maintenance reservoir for the bacteria that causes Lyme disease. These mice can become infected with the bacteria, and if a nymph, a baby form of the tick, it starts out as an egg, then becomes a larva, then becomes a nymph, then becomes an adult, we’re sort of moving into adult tick season now. But if it goes on the mouse, and that mouse has Lyme disease, has the bacteria, then we get an infected tick, and when the tick goes on the mouse, it can give the mouse Lyme disease, so that’s a circular way in which the bacteria that causes Lyme disease is maintained in the mouse population. But the deer are, you can think of them as sort of the distribution agents. The deer are a much better source of blood meals for the developing tick, and without the deer we wouldn’t get the type of tick population that we have. The deer don’t get infected with Lyme disease; they just carry the ticks around on their bodies and feed them.

Question: How many bait boxes will there be and where?

Commissioner Bassett: That is still being worked out, but the idea, in other settings, and you’ve heard that there are various studies underway. They’ve been placed sort of under people’s garages and near their houses, and this is the thought of looking at wild areas and using bait boxes in parks.

Question: Could you elaborate Commissioner, on the lone star aggressive ticks, versus the normal ones that we –

Commissioner Bassett: Well my understanding of it is that in our city is that the black-legged tick is by far the most common form of tick that we see. The lone star tick can also carry diseases. The black-legged tick can carry different diseases than Lyme disease, I mentioned Babesiosis and there are other tick borne diseases that for which the black-legged tick is the vector. But the Borough President mentioned data on the lone star tick so I should I just ask him to give you those data

Borough President Oddo: Yes, and my apologies to the Commissioner, the data I use is not DOH data, we have Columbia University that’s doing studies on Staten Island and they came back and the preliminary study, just for an example – 2,674 black-legged nymph ticks and there were 1,532 lone star nymph ticks, and it was Columbia University’s assessment that that’s a surprisingly high number for lone star.

Commissioner Bassett: Right, so we also have surveillance data and I’ll take a look at that with the team, you should know, I hope you know Borough President that our team is familiar with the Columbia project, talks with them and exchanges information with them, yes. It’s a good collaboration.

Question: What does the Health Department think is the driver behind these locally acquired high cases of Lyme disease on Staten Island? What do you think is going on?

Commissioner Bassett: Well this is part of a global phenomenon and a national phenomenon that is undoubtedly related to climate change. I’m not sure that the federal government will be talking about that because of the federal government’s position on climate change but I don’t think that any thinking people would dismiss the fact that it’s getting warmer, that it’s easier for ticks to survive in this warm weather. It’s easy for mice to survive, the mouse population of these white-footed – white legged is it or white footed?

Borough President Oddo: White-footed mice, white tail deer.

Commissioner Bassett: Right, I got it. White-footed mice, their population is increasing, almost certainly because it’s easy for them to survive winters because of rising temperatures. So this phenomenon that’s being experienced here in Staten Island is one that other communities are confronting.

Question: You don’t think it has anything to do with the deer population?

Commissioner Bassett: I think maybe – I’d be happy to talk separately with you because this is part of the life cycle, I don’t know interested people in the whole audience are but the life cycle of the tick begins as an egg, moves on to a larvae and a nymph which is the baby poppy seed size tick. That’s what begins its blood meals on a mouse, on small animals, and possibly birds as well. And then they move on to the deer. The maintenance reservoir is the mouse population and that’s why this strategy with the bait boxes targets mice because that’s where you get the bacteria in the mice, giving it to the ticks, and the bacteria in the ticks, giving it to the mice so it becomes a circular pattern of infection and reintroduction of infection between the tick and mouse population. The deer carry it all over the place. They are bigger, they have a lot more blood and the ticks survive better and reproduce more effectively when they can get onto deer.

Question: How long do you guys have to invest the $600,000? How long do you [inaudible] invest this money? And when do you guys think you will bring on the, you know allow the bait boxes to be used on the deer and not just mice?

Commissioner Bassett: Well, we are in conversations with the State which is also in preliminary stages with the idea of trying to tackle directly putting pesticides on deer where I think you have heard from all of our electeds that they are eager to see novel methods explored. Thanks very much everybody.

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