TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. As you head out to summer barbecues, picnics, hikes and other great summer activities, you may already be vigilant about ticks because of lime disease, but there is a potentially more dangerous tick that you may not be aware of called the lone star. And unlike other ticks, it actively pursues its hosts. The lone star is spreading across vast regions of the U.S., and the illness it carries, the alpha-gal syndrome, is spreading in more than 30 countries on six continents, often spread by various other ticks. The alpha-gal syndrome is more difficult to diagnose and treat than lime disease, and the symptoms are more severe. In many cases, the victim develops an allergy to all red meat, including nearly microscopic particles of it. The allergy can become so extreme it can kill you. Milder cases can change your life if you're a meat eater or if you have cows or work on a cattle ranch or in the food industry, including restaurants. Pest control experts and medical research scientists have been confounded about what to do.
In an article in The New Yorker titled "The Tick That Hunts Down Its Hosts - Including Us," my guest, Burkhard Bilger, reports on what we know about how the tick operates, how it has multiplied and vastly extended its territory, how it afflicts the people it feeds on, and the latest ideas about how to limit the infestation and treat people with alpha-gal syndrome. Bilger is a staff writer for The New Yorker and author of the 2023 book "Fatherland," about his German grandfather who joined the Nazi Party but worked with the French Resistance.
Burkhard Bilger, welcome back to FRESH AIR. Your piece was fascinating, upsetting. And I'm really glad you wrote it, 'cause it's something we should really be vigilant about. So the first thing I want to do is let our listeners know how at risk they are by talking about where the ticks have spread and which places have the biggest infestations.
BURKHARD BILGER: Yeah. So this is a tick - the lone star tick - that used to be in the southeast, you know, and up through Virginia - up into the '50s, it rarely went north of Virginia. And it has now spread all the way north to Maine, to Michigan, as far west as Oklahoma. And if you look at maps of - I mean, the best data we have on where the syndrome is most common come from some military blood samples, 3,000 military recruits that were - in the early 2000s, when they looked at if they had alpha-gal antibodies in their blood. And if you look at those maps, the epicenter is kind of right where Arkansas, Missouri and Oklahoma meet. There's a stretch that kind of goes from Missouri down through southeastern Oklahoma where people - like 47% of the people who were tested had alpha-gal antibodies in their blood. On the East Coast, though, there's also kind of a mini epicenter, which is in eastern Long Island, around the Hamptons, and in Martha's Vineyard. Both those places have really high incidence of alpha-gal.
GROSS: So how do you know if you've been bitten by a lone star tick?
BILGER: Well, there's nothing like the bull's-eye rash that you get with deer ticks from Lyme disease. You really just have to see it and pick it off you or know you've been bitten. In some cases, too, people get bitten by these terrible things called tick bombs, colloquially. And that's basically these giant collections, clusters of lone star tick larvae, which can also bite you and also cause the disease. And sometimes people get hundreds of these things on their ankles or on their legs, and then they get multiple bites at the same time.
GROSS: Does that make the syndrome even worse?
BILGER: I mean, the more bites you get, the higher your antibody levels tend to be, and the greater your chances of getting the syndrome. It's a really weird cryptic disease because, you know, there are people who have very high antibody levels who don't get the syndrome. There are people who have pretty low antibody levels who do get it. There are people who have it for a long time, and then suddenly it flares up. It's a very kind of mysterious disease.
GROSS: So if you have to see the tick or see the bite, what are you looking for?
BILGER: I mean, you can identify the lone star tick by a little white dot on its back, and that's distinctive. But other than that, really, the only thing you can look for after that is some kind of symptoms. Sometimes you'll get a rash. You'll get hives. So you'll start to get shortness of breath. There's lots of different ways in which the syndrome can express itself.
GROSS: So you mentioned hives, rashes, difficulty breathing. The most infamous symptom of alpha-gal syndrome is an allergy to red meat, which seems crazy. How much exposure do you need? I guess this varies with the person. But give us a sense of the range of allergy to red meat that you might experience with alpha-gal syndrome.
BILGER: Well, early on, I think you could - just had one tick bite, and that - often it takes, you know, a substantial - and if you've got the syndrome, if you've got these allergy antibodies, you might eat a whole burger or a steak, and people then suddenly, a few hours later - and that's one of the things that's so befuddling about this allergy. Most allergies, you get a pretty quick reaction. If you eat peanuts and you have a peanut allergy, you'll get reactions within an hour, or even minutes in some cases. With alpha-gal, it can take six hours in some cases. But if you get more tick bites or if you just happen to be someone who is hypersensitive to these allergy antibodies, then you can start to get reactions to very small amounts. Often people then get allergic to dairy products. And then...
GROSS: Because it comes from cows.
BILGER: Because it comes from cows - I mean, anything essentially that contains the alpha-gal sugar molecule or carbohydrate. It's a molecule that all mammals contain, but not primates and not humans. And so most of us meat all the time. We eat this alpha-gal, and it doesn't cause a problem. But something about that tick bite, something in it. And we know that the tick bite itself has alpha-gal in the saliva, and that puts that into your system. But there must be something, people think, that is also triggering the sensitivities. It might be a virus, it might be another allergen, it might be something in the saliva that's just priming the system to respond to that.
So if you then become really sensitized to it, at some point, you know, you can start reacting to things like trace quantities of "natural flavorings," quote-unquote, in products that are really beef extracts or pork extracts. You can start reacting to just a tiny bit of dairy powder and a Doritos chip. You can start reacting to the tiny bit of beef tallow in the skin cream that you put on your hands. And all the way - to some people I spoke to in Missouri and in Virginia, if they just walked by someone frying bacon in a pan, the fumes from that, they said, made their throats seize up. And there's some debate if that's actually psychosomatic or not. You know, absolutely, the - your respiratory system is easily triggered by allergens. But there's so little in that fume. Is it really doing it? But one way or another, many, many people say that it does trigger them.
GROSS: Is beef used in any medications that you wouldn't think about, but if you had a really bad case of alpha-gal syndrome, you might end up being allergic to?
BILGER: Absolutely. I mean, I think one of the most common one is simply gelatin capsules. You know, if you get ibuprofen or acetaminophen from gelatin capsules, that often has collagen in it from beef or from pigs. And the same thing with a lot of dietary supplements. You know, if you're in the hospital, it gets really scary 'cause you don't really have time to tell - you may not have time to tell your doctor or your surgeon what's going on. But, like, heparin - it's a blood thin or a common blood thin. That's from - made from beef intestines. You have insulin that's made from pig pancreases - or can be - and you have estrogen that's made from pregnant mares' urine. You have vaccines and antivenoms that are used for snake bites that are often - are made with meat.
So, you know - and the problem when you're getting an injection, especially, is that the reaction is intense and immediate. It's not like the hours-delayed thing you get with meat ingestion. I mean, that was how alpha-gal was originally discovered. It was a cancer drug called cetuximab, which people who had been sensitized to alpha-gal - cetuximab had alpha-gal in it because it was used - made - it was produced with mouse DNA. So it had alpha-gal in it, and people in the South who were sensitized to alpha-gal by tick bites were having these terrible reactions in clinics all through the South. And in Arkansas, I mean, one patient died while it was being infused into their body. So that's the real danger, a lot of people are telling me - is the medical establishment hasn't caught up with the fact that a lot of their patients may be more and more sensitive to the drugs they're using.
GROSS: I guess we should add lanolin to this, too, 'cause that's in a lot of products.
BILGER: Sure. Yeah, yeah, lanolin and things from the sebaceous glands of sheep. There's always - you know, it's crazy. One woman who is a rancher in southern Missouri said, you know, I've had - my son has alpha-gal. But I - it's made me really proud of the beef industry 'cause we are just - we've infiltrated every single thing. And it makes you realize...
(LAUGHTER)
BILGER: It's just, like, the degree in which it has been incorporated. Even, like, drywall sometimes has, you know, cow hides in it. You know, it's just - it's all around us, and we don't even realize it.
GROSS: And if you look at the labels, will you know?
BILGER: Sometimes you will. I mean, there's a - there's an app called Fig that people are using who have alpha-gal that will give you, you know, a red, green or yellow light based on if it's safe or iffy or definitely not safe. But so many things - there's no - you know, there's no regulations on the - that kind of labeling. So the food industry will use natural flavorings all the time. And often those are - you know, they have alpha-gal in them. They're beef or meat extracts.
GROSS: Well, let me reintroduce you, and then we'll talk some more. If you're just joining us, my guest is Burkhard Bilger. His latest article in The New Yorker is titled "The Tick That Hunts Down Its Hosts - Including Us." It's part of The New Yorker's Body Issue. We'll be right back after a break. This is FRESH AIR.
(SOUNDBITE OF RUDY ROYSTON'S "BED BOBBIN'")
GROSS: This is FRESH AIR. Let's get back to my interview with Burkhard Bilger. His latest article in The New Yorker is titled "The Tick That Hunts Down Its Hosts - Including Us. And it's about the lone star tick and the illness it causes, which is called alpha-gal syndrome.
So has there ever been anything like a potentially lethal meat allergy before, spread by a tick or any other insect or anything?
BILGER: No. I mean, this really came out of nowhere. And the scientists I spoke to - they all had kind of the same story. Back in the early 2000s - 2006, 2007, when this was discovered - it was kind of somewhat simultaneously discovered by an allergist in Australia north of Sydney and by a group at the University of Virginia led by Thomas Platt-Mills - Platts-Mills and Scott Commins. And they all said, you know, when we first talked this to colleagues, they said, that's ridiculous. Allergies don't work that way. First of all, sugars don't usually trigger allergies. It's usually proteins. So why would the sugar do this? And second of all, food allergies don't take hours to manifest - don't take hours to cause a reaction.
So it - you know, there was a lot of skepticism. And even later, after it had been established as a disease that had certain parameters, and it was accepted, a lot of people in the stomach disease world didn't believe that it could cause stomach problems, but it absolutely does. And now we know that it can cause nausea and stomach knots and all kinds of problems on that level as well.
GROSS: So red meat is the problem. But, like, poultry, fish - they're OK?
BILGER: Yeah. Any other kind of meat is fine. You know, a lot of the people I spoke to who had it - there was, you know, a big alpha-gal support group in Martha's Vineyard that I sat in with for a couple hours. And they all talked about, you know, they're trying to get emu meat and ostrich meat because they're red meats, but they don't have alpha-gal in them. They were buying these xenotransplantation hogs that had been developed for organ transplants that were deliberately genetically engineered to not have alpha-gal, because alpha-gal's one of the reasons that pig organs tend to get rejected by the human body. So this company, Revivicor, designed this pig and then found, oh, boy. There's a whole market for the meat we didn't even realize. And a lot of people who have alpha-gal are trying to get hold of that meat as well.
GROSS: Do most doctors know how to identify alpha-gal syndrome or even know what it is?
BILGER: I think now it's gotten to the point where they do. You know, there was a study in 2017 that looked at, I think, a hundred or more doctors' visits and found that only one in 10 identified the syndrome correctly. And they found at the same time - that same study found - that the median time it took for the syndrome to be diagnosed was seven years. So you're living with this thing for seven years. It's giving you hives. It's giving you stomach cramps. It's giving you shortness of breath. It might even send you to the hospital in anaphylactic shock, and you just don't know.
I mean, and there was this one - I went to this restaurant in Springfield, Missouri, called The Safe Spoon that was entirely allergen-free, all the nine major allergens and no alpha-gal. And I talked to a guy who had been a salesman and started to have all kinds of - he went to the hospital two or three times with shock. He had two cardiac procedures because they misdiagnosed it and thought he had a heart problem, and before they realized it was a red-meat allergy. So it was really - part of the problem with this over the years has been that people are getting the wrong treatment for something that is actually quite simple. Don't eat meat. Don't drink milk.
GROSS: Is an EpiPen effective if you start developing symptoms?
BILGER: Yes. It is. I mean, and I think EpiPen is essential if you're - if you have anaphylaxis or if you start to get really severe symptoms. Especially in rural areas, it's really important to have EpiPen around just in case you go into a severe reaction.
GROSS: So Lyme disease, which is also tick-borne, can be controlled if you take the right antibiotic in a short period of time after being bit. So what about alpha-gal? Like, is - outside of, like, an EpiPen, which can end the episode, is there any kind of antibiotic treatment or other treatment that's effective?
BILGER: Well, there's certainly no cure. I mean, you can really get rid of Lyme disease with amoxicillin and doxycycline, but you can't do that with alpha-gal. One thing that's, I mean, a positive about it, I guess you could say, is that if you don't eat meat or drink dairy or get bitten by a tick for three or four years, often it'll subside to the point where you can eat meat again. But there's no cure.
The one treatment that seems to be effective is a drug called Xolair - X-O-L-A-I-R - that has been - it was originally approved for asthma and has since been approved for food allergies. And a lot of people who have had severe reactions to alpha-gal and want to prevent going into shock or having another scary reaction will take Xolair, and in some cases, they'll even take it regularly and start eating meat again. I mean, it has not been approved for that, you know, but certainly it can be effective.
GROSS: If you're bitten by a lone star tick, what is the first thing you should do?
BILGER: You know, there's not a lot you can do. You can certainly take it off. And there are procedures for taking ticks off. I mean, I think one thing that people should do when they get bitten is - there's a wonderful website called alphagalinformation.org that has a huge amount of instructions and research on that. And there's another one from Australia called tiara.org.au - T-I-A-R-A - and they have a lot about how to treat tick bites and what to do with it. But there's really nothing you can do in the meantime that - it's interesting, you know, with Lyme disease, only a percentage of the deer ticks carry Lyme disease. But in alpha-gal, all the ticks have alpha-gal in their saliva. So if it latches on and it feeds for a while - I mean, ideally, I think you would get rid of the tick as quickly as possible. And the sooner you can get rid of the tick, the less of the alpha-gal you'll get in your system, the less likely you're going to get antibodies to it. So that's the first thought.
But the thing with alpha-gal is all the ticks will have that alpha-gal. If they latch on, it will be in your system, but it's - you know, it's not clear yet whether you will develop antibodies and then it's not clear if you will react to those antibodies. I mean, I talked to this researcher, Jeffrey Wilson, at the University of Virginia, and he said, look, if I went to the mall right now in Virginia - which has fairly high rates - and I tested the blood on a hundred people, 20 of them would probably have alpha-gal antibodies, but only two of them would have the syndrome.
So, you know, if you get it, really the thing would be to monitor yourself, make sure you're not having any symptoms. If you have any symptoms, then you should go get tested by your doctors. Everybody's telling me, don't just get tested as soon as you get a tick because it kind of muddies the data in some ways because there's - you know, like I said, half the people in Missouri - in certain parts of Missouri - have those antibodies. It doesn't tell you that much. What we're really interested in is how many people who have the antibodies also have the syndrome.
GROSS: So if you get bitten by the lone star tick, you shouldn't go right to the emergency room?
BILGER: Absolutely not (laughter). No, no. You should try and get rid of the tick as quickly as possible and then, you know, have it in the back of your mind - horrible thing - but to - you know, to - if you're having any reactions, and just wait. And if you start to feel yourself having - getting hives or having stomach problems after eating meat, or any of the other possible reactions, then you - I would go to the doctor and have them do a blood test.
GROSS: Should you eat meat and test yourself or just, like...
BILGER: (Laughter).
GROSS: ...Avoid it out of fear? Like, what's - do you have any suggestions, any advice?
BILGER: Boy. You know, I feel like, from what I'm hearing now, if you look at those data from Virginia, you know, and from Missouri, it's becoming such a common thing that I think we don't want to be overcautious. I mean, a lot of ways, that mentality is what got us into this allergy epidemic we've had in this country already. You know, this fear of peanuts, for instance, and allergists started saying, don't give your kids peanuts because, you know, he could develop a peanut allergy. And then, lo and behold, we discover that actually the stomach is really good at kind of habituating itself to the allergens in peanuts, and if you eat peanuts as a child then it helps - actually helps you prevent having an allergy to it. And if you don't eat peanuts, you might get it through your skin or your breath. So there's a lot of unintended consequences, I think, from overcaution.
And the same thing with the hygiene hypothesis, which says if we're too clean we're, like, keeping our gut biome from developing, you know, good bacteria that can fend off allergies and diseases. So I think in a lot of ways, it's best not to freak out immediately as soon as you get a tick bite and just kind of wait and see.
GROSS: You make that sound easy.
(LAUGHTER)
GROSS: If you're just joining us, my guest is journalist Burkhard Bilger. His latest article in The New Yorker is titled "The Tick That Hunts Down Its Hosts - Including Us," and it's about the lone star tick and the illness it carries, which is called alpha-gal syndrome.
We'll be right back after a short break. I'm Terry Gross, and this is FRESH AIR.
(SOUNDBITE OF EMERSON STRING QUARTET'S PERFORMANCE OF BARTOK'S "ALLEGRETTO PIZZICATO FROM STRING QUARTET NO. 4")
GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Burkhard Bilger. His latest article in The New Yorker, where he's a staff writer, is titled "The Tick That Hunts Down Its Hosts - Including Us." The tick is the lone star tick. Its victims can develop alpha-gal syndrome, which is an allergy to all red meat so severe it can be lethal.
You say that the descriptions that you heard of people who have alpha-gal syndrome sound like scenes from horror films. I have to ask you to describe what you've heard.
BILGER: Yeah. I mean, they're like these - almost like horror films about bodily possession or contamination. You know, there's this one woman who was six months pregnant. She and her husband had actually met in a steakhouse where she was a waitress. And one night, she's sleeping, and he wakes her up. And in the dark, she sees him looming over her, and he says, something's wrong with me. Can you come to the bathroom with me? And she says, what's going on? And he says, something's wrong with my face. And they go into the bathroom, and she turns on the light. And the whole left side of his face is totally misshapen and swollen.
You know, I spoke to a sheep farmer in Oklahoma called Clark Giles. And he, you know, said that he got to the point when he was birthing sheep he had to, like, wear respirator masks like something out of "Blue Velvet" or something, you know, to be able to stand it. And then if he was driving by a restaurant and there was - and they were doing open grilling, he said it was like his head would start to ring like cicadas in summertime. And he would start to be shortness of breath, or all these kind of - to me, they felt like horror scenes because it's this unexplained attack coming from out of nowhere based on something that's totally normal and totally quotidian in your life. And suddenly, it's toxic to you.
GROSS: So how do the ticks travel? Do they travel on their hosts? Do they just kind of march across blades of grass like soldiers?
BILGER: I mean, the lone star tick is an interesting tick. I mean, it's funny talking to entomologists. I talked to a lot of entomologists in Georgia and Virginia and Martha's Vineyard and kind of all over the country. And kind of almost to a person, they hated lone star ticks. I mean, most entomologists have a certain love for their study subjects. But when it came to lone stars, they just hated them.
I mean, one woman, Holly Gaff in Virginia, told me, look, they are the bullies of the tick world. They will beat you up and take your lunch money. They're - they are a tick that doesn't just kind of quietly amble out onto a blade of grass and kind of wait for somebody to walk by and then latch on and get a little blood and then drop off. This is a tick that will hunt you down - that will actually try to seek out a blood meal, as they call it.
And they've been known to do things like - Patrick Roden-Reynolds in Martha's Vineyard, the biologist that I went tick collecting with - he told me, look, I've been hearing about these ticks crawling down from the dunes along the beach and getting onto the blankets of sunbathers and then biting them while they're sunbathing. This is a tick that is bold. It's resilient. And it's bloodthirsty. So they're particularly good at spreading the syndrome. And as I said, their numbers are increasing across a lot of states across the country.
GROSS: So before the 1970s, it was rare for lone star ticks to cross the Mason-Dixon line. And now they're as far north as Maine, as far west as Oklahoma. So what has caused the migration? Did - is it just, like, increasing populations or competition for food? Does climate change have anything to do with it?
BILGER: Yeah. I think climate change has had a big part of it. It's certainly - they like warmer temperatures. And they were - you know, originally, their home territory was the Southeast. When I talked to ecologists about that, they said, well, it's not as simple as simply warmth. I mean, it's actually they want wet, moist places. That's what they really need. And so part of what's going on is they're migrating into areas that have become warmer and wetter. So you get that.
I mean, a big part of it also has been, you know, the reforestation of the East Coast of America. It's - I mean, a lot of farms in the last 100 years and former farmlands have turned into forests now, and the - and lone stars can do well in those. And a lot of the kind of patchy suburbanized areas that used to be partly industrial or partly farmland and partly forests and now are kind of, you know, the houses with little trees around them or little patches of nature preserves - those are kind of ideal for a lone star tick. So it's kind of a combination of climate and land use that's really made a difference. And if you add deer on top of that, you get kind of a perfect storm of situations.
GROSS: But how have they migrated? How do they travel?
BILGER: I mean, they travel - they have lots of hosts. One of the things about ticks that makes them such a incredibly good disease vector in the modern world is they'll feed on anything that has blood. They'll be on white-footed mice. They'll be on shrews. They'll be on raccoons, on possums.
You know, their main host in this country is deer. We have 36 million deer wandering the country. And in the story, I describe them as a fleet of mobile blood banks, and it really seems that way. They just are all over the place, and these ticks can just, you know, hitch a ride. Often, they'll congregate on the head of the deer, and they'll just travel around and then drop off and find another host. So they're very mobile, and then deer themselves are mobile. I mean, one of the things about deer is they've been known to swim out to barrier islands - that some of the way they brought ticks to places like Martha's Vineyard and other islands along the coast is they swam out there.
GROSS: So they know - if people are around and they hunt down people to feed on them, how do they know that there are people around?
BILGER: I mean, like, a lot of these kind of insects - they can sense carbon dioxide. I think that's a telltale signature, and they will kind of hone in on - home in on that. So that's one thing. I think they also just go along paths and places where there's a lot of foot traffic. And they just know when there's a creature nearby, and they'll jump on it.
GROSS: So one of the places in the North with the greatest infestations is Martha's Vineyard. And, you know, that's the place where the Obamas summer. It's beautiful. It's scenic. I mean, the ticks don't appreciate all that. But...
BILGER: (Laughter).
GROSS: And it's an island, so it's, like, harder to get to. How did Martha's Vineyard become, like, a gathering place for so many of these ticks?
BILGER: Well, I think you get a lot of necessary conditions at once. I mean, you have a place that used to be farmland and - you know, in the 19th century and then gradually got more and more reforestation. People built their homes there. Then you have deer, which were not around at the turn of the last century and now have grown to - there's 5,000 deer on this little island. Eighty-eight square miles, and there's 5,000 deer, so it's infested with deer. And so - and then you have lots of other little mammals. You have white-footed mice, you have the short-tailed shrew. They have (ph) all these potential hosts for the lone star tick and other ticks. So Martha's Vineyard is just kind of a natural little - it's like a perfect little environment for these guys.
And it's an interesting thing. As I was looking into this pest research, you know, we often assume that these animals discriminate, or there's some sense of different social groups get them. You know, with bedbugs, for instance, there was this assumption that, oh, this is a symptom of poverty - that people are getting bedbugs because their houses aren't clean or something to that effect. And that turned out to be quite the opposite, in fact. That - people were getting bedbugs because they were coming in through luxury hotels, people who were traveling. And so the first infestations of bedbugs in New York City, for instance, were wealthier people, people who were well-to-do, and only later did it go on to subways and in movie theaters and spread to the poor.
GROSS: I'm going to have to end this interview right now.
BILGER: Sorry.
(LAUGHTER)
BILGER: But, I mean - and I feel like with ticks, it's a little bit the opposite prejudice because lyme disease, you know, was named after Lyme, Connecticut, which is a posh town in Connecticut, and the first people where you heard about having it were kind of wealthier people in their summer homes. And the same thing with Martha's Vineyard. We kind of assume there's a bias somehow (laughter) in this beast that's choosing the wealthy. And in fact, it's not true, of course. You know, a lot of people I visited who had this were in, you know, poor farms in - or working-class folks in Missouri and Arkansas and those kind of places.
But you can say that a place like Martha's Vineyard and the Hamptons, you know, a lot of these homes have a lot of land around them, and they have beautiful forests nearby and they make a point of kind of keeping a natural character. And those are the places that ticks love. They love these edge habitats. They love places that are transitions between grass and forest. And so in a way, what we think of as really posh, beautiful landscaping is a perfect tick habitat.
GROSS: Let me reintroduce you, and then we'll talk some more. If you're just joining us, my guest is Burkhard Bilger. His latest article in The New Yorker is titled "The Tick That Hunts Down Its Hosts - Including Us." It's part of The New Yorker's Body Issue.
We'll be right back after a break. This is FRESH AIR.
(SOUNDBITE OF MUSIC)
GROSS: This is FRESH AIR. Let's get back to my interview with Burkhard Bilger. His latest article in The New Yorker is titled "The Tick That Hunts Down Its Hosts - Including Us," and it's about the lone star tick and the illness it causes, which is called alpha-gal syndrome.
When you made your trip to Martha's Vineyard to learn more about the lone star tick, you went out with Patrick Roden-Reynolds, who is the island's public health biologist. How did you protect yourselves? I mean, the ticks were looking for you - human blood.
BILGER: (Laughter).
GROSS: But you were out looking for them.
BILGER: It's funny, I - you know, I've never been all that paranoid about ticks. You know, when I was growing up, I grew up in Oklahoma, and I remember the kind of primal horror of being an 8-year-old and putting your fingers through your hair and finding a giant, bloated tick in your hair. So I knew that feeling. But, you know, the only thing back then was Rocky Mountain spotted fever as a possibility, and we knew that was very rare and it - we weren't so worried about anything else. It was just gross to have a tick in your hair.
But all of a sudden, when I was on Martha's Vineyard, there was a sense of, wow, this could transform my life. I mean, the people I had spoken to who had alpha-gal syndrome, I mean, it really had changed everything they did, how they socialized. They couldn't go to barbecues anymore. They often couldn't go to parties. You know, they couldn't go to outdoor restaurants. And I suddenly had this sense of, wow, this could - you know, I love meat. (Laughter) I'm a very enthusiastic carnivore. And the idea of this illness striking me was pretty upsetting. So I did what Roden-Reynolds did, and what kind of everybody I spoke to who spends a lot of time in these areas does, and that is I wore permethrin-soaked clothes.
There's a company called Insect Shield that sells these, that's been doing it for the military for decades. But it's essentially ordinary-looking clothes, socks and pants and shirts that are kind of impregnated with this pesticide that's based on a toxin found in chrysanthemum flowers. That's pyrethrin in chrysanthemum. But this is - permethrin is kind of a synthetic version of that. And so my whole body was cloaked in this stuff, and Patrick's was, too. And if a tick were to crawl onto my pants, I mean, it could go maybe six or eight inches and then it would be poisoned to death.
GROSS: So you don't put the repellent on your skin, you wear clothes that are soaked in it?
BILGER: Yeah.
GROSS: Why is it done that way, as opposed to what's typically done, I think, which is put it on your skin?
BILGER: Well, I think a lot of the things that are good on your skin - the sprays like DEET and so forth - don't really work with ticks that well. They may put them off a little bit, but they're not really effective. I think permethrin is the one thing that they've found that absolutely will kill the tick and prevent it. So the - you know, the people like Patrick who are out there every day - I mean, he's done, I think, 450 yard checks in Martha's Vineyard looking for ticks - he doesn't take any chances. So he has socks, he has pants. He has his pants in his - in the cuffs of his socks. Everything is coated in this stuff except for his cheeks and his hands, basically.
GROSS: So you're talking about buying pre-soaked clothing. Can you, like, buy a big vat of this stuff and soak your own clothes in it?
BILGER: Yeah, yeah, yeah, you can do that. And also, I went to the Insect Shield factory in Greensboro, North Carolina, and in this warehouse, they just had giant piles of clothes. And I said, what is that? And they said, well, people all over the South and - in tick areas are sending us their clothes, and we soak their own clothes in permethrin for them and send them back to them. So that's another, you know, service that they have.
GROSS: Does it smell?
BILGER: No. And it's - you know, again, it's been used by the military for decades, so it's very safe. And I think they've done all kinds of crazy tests with high concentrations and still haven't had negative reactions. So it's - it doesn't smell. It doesn't really cause any irritation. I talked to one guy in Missouri - a hunter - who said that when it's, like, 90 degrees and highly humid and he's sweating into his Permethrin shirt, sometimes he'll get a little bit of a rash. I mean, that's about as bad as it gets, I think.
GROSS: So I'm going to spell Permethrin for anybody who wants to look it up and do more research. It's P-E-R-M-E-T-H-R-I-N - Permethrin.
BILGER: That's right.
GROSS: So what if we attack the ticks with it? What if we spread Permethrin, like, throughout a place with a major infestation?
BILGER: Yeah. I mean, everybody I spoke to said, look, that's a nonstarter. I mean, you can do that to a degree. Like, if you're about to have a lawn party, you could go out and, you know, spray Permethrin on your lawn.
And there was a woman - this - Holly Gaff that I talked about at Old Dominion University in Virginia. She developed this thing called the TickBot that's kind of a Roomba-type device that kind of goes around your lawn on its own and kind of drags a Permethrin-soaked sheet and kind of can gradually cover your lawn that way and get rid of the ticks. But it's a quick stopgap measure. It's not going to be long-term because, you know, there's millions of these ticks, and they're in the forests around you. They're in the yard next door. There's kind of no way to spread enough Permethrin to really kill all the ticks to a point where you can really protect yourselves from them.
GROSS: What are some of the proposals now for how to get these ticks under control? I mean, I'm not sure we'd ever completely eradicate them. That might be impossible. But we can try to minimize the infestations. So what have you been hearing about ways to do it?
BILGER: I mean, there's two basic avenues that I've seen, or maybe three. I mean, one is a - you know, like, the kind of magic bullet would be a vaccine, a human vaccine against tick-borne illness. And it could be that there's some common denominator of these tick-borne illnesses that a vaccine could treat, and I know there's some work going on to try to find something like that.
The other one is, you know, a vaccine for deer that you could widely give to deer. And then, when the ticks are on them, the ticks don't grow to full adulthood and don't multiply. You know, an example of that, a version of that that worked really well in this country is in the '50s and '60s when we had this terrible screwworm infestation. And screwworms are this awful, awful thing, worse than lone star ticks, if you can imagine - basically, blowfly maggots that burrow into flesh and kill animals. They killed millions of deer and cows in the United States.
And then in the '50s and '60s, this huge program happened where they bred literally billions of blowfly - sterile male blowflies - and airdropped them all over the southern United States. And eventually, the blowflies died out, and screwworms weren't a problem. And then they did that through Mexico, Central America, all the way to Panama. Lately, they've made their way back to Mexico, so screwworms are kind of a new problem. But that idea that you can kind of control the source of the ticks, you know, or the pest, is - I think that's a possibility with lone star ticks as well.
But probably the most practical, the most immediate solution to the problem in places like Martha's Vineyard, but really across the country, I think, is just killing deer. And it sounds brutal, but the truth is that we have such an overpopulation of deer. It's been true for decades. They're disastrous for the environment. They're beautiful, but they're actually eating a lot of native species. They - people call them ecosystem engineers because they really transform a landscape, but not necessarily in a good way.
So we have way too many deer. I mean, they've gone up from a - I think- a few hundred thousand at the turn of the last century to 36 million. So the idea is really to go through and get these down to a manageable level on an ecological level but also, in a place like Martha's Vineyard, to really reduce them to, you know, almost nothing or a fraction of what they are now. So there's the big campaign now to start to kill maybe three - or more - thousand deer on Martha's Vineyard.
GROSS: What would that look like? Like, who would be shooting them? And what would you be doing with all of those dead deer?
BILGER: Yeah. It's interesting. I mean, you know, the - I think the model on a very, very small - talking about microcosm, the smallest scale is Monhegan Island off the coast of Maine, where it's a much, much smaller island. And they had a deer tick problem and Lyme disease problem. And they brought in one professional sharpshooter who came in and basically killed all the deer on the island. But that was, I think, less than a hundred deer.
In Martha's Vineyard - on Martha's Vineyard, the idea is you would get local hunters to do the killing. Tick Free Martha's Vineyard, the group I was talking about, is already planning to build a new processing facility for the carcasses. And then you would take that processed meat, and you would give it to food pantries and other people. And you would just start this massive hunting campaign to try to rid the island of deer. It's kind of hard to imagine, but I think it's going to happen.
GROSS: Do you think there'll be objections to it - this, like, mass slaughter of deer?
BILGER: I feel like that's been a debate that's been ongoing for four decades. But it also feels like alpha-gal may finally be the thing that solves this or brings it to an end because on a place like Martha's Vineyard, people love their deer. They love the look of it. You know, they love having these animals around them. And yet they are just - as Lea Hamner, this epidemiologist I spoke to, said - this is an existential crisis. If we don't get this tick population under control, people will leave this island, and they won't come back. People were saying, you know, our grandkids aren't coming back now because - to visit us because they're afraid of getting bitten. So I think they've finally gotten to the point where the island there is on board, and I can imagine that same process happening in other parts of the country.
GROSS: Well, let's take another break here. If you're just joining us, my guest is Burkhard Bilger. His latest article in The New Yorker is titled "The Tick That Hunts Down Its Hosts - Including Us." We'll be right back. This is FRESH AIR.
(SOUNDBITE OF MICHAEL BISO QUARTET & RON SODERSTROM'S "A.M.")
GROSS: This is FRESH AIR. Let's get back to my interview with Burkhard Bilger. His latest article 0N The New Yorker is titled "The Tick That Hunts Down Its Hosts - Including Us." It's part of the magazine's Body Issue. And the tick we're talking about is the lone star tick, and the syndrome it's - it carries is called alpha-gal syndrome. And it often produces a very extreme allergy to meat.
Toward the end of your article, you write something I really identified with. You said that after going on this tick research, you thought it would be really good to be back in New York City. You'd feel relatively safe surrounded by brick and concrete. But as it turned out, there was a health alert from the city as you got back. What was the health alert?
BILGER: Well, it was a health alert I discovered. I mean, I was kind of suddenly worried. I thought, wait a second. And I did a search for lone star ticks in New York, and I found a health alert, I mean, from, I think, a year or two ago saying, yes, the lone star tick has settled in Staten Island. It's kind of pretty well established there. And it's in parts of the North Bronx. It's established there. It's all over eastern Long Island.
And there have been occasional lone stars found in Prospect Park and probably in Central Park. There is no established population in Prospect Park or in Manhattan. And there probably will never be a huge one because there aren't deer there. So I don't think the risk is super high, but essentially, I realized, no, this thing could be in Prospect Park. All it would take is a tick bomb or two tick bombs - you know, a bunch of larvae - and you could have the real risk of getting bitten by a tick in - three blocks from my house in Brooklyn. So the idea that somehow I'm perfectly protected from nature by being surrounded by stone is kind of a pipe dream.
GROSS: So you're not panicking yourself right now?
BILGER: No, I'm not. I'm not at all. You know, I do think it's scary. I mean, just being - it was interesting to be at The Safe Spoon restaurant in Springfield, Missouri, because it's a beef-growing area. You know, the owner told me, look, vegan is a dirty word around here. But it was just jam packed with people who had alpha-gal syndrome, who had other kinds of allergies. And it made me feel like, wow, we have somehow gotten to the point in this country where our bodies are not nearly as resilient as they used to be. And through a combination of diet and chemicals and land use changes, being out in nature and, you know, changing the ecology by letting deer go, we have made ourselves more and more vulnerable to things that we used to be more resistant to. So that - it gave me a sense of vulnerability that I hadn't had before.
GROSS: One more question. So I live in the city. There aren't deer in the urban part of the city where I live, but there's mice. And mice carry lone star ticks too, right?
BILGER: Yes.
GROSS: So how can you know if you're safe if there's, like, you know, mice all over?
BILGER: Well, to some degree, it's a question of density, right? Like, how many ticks are there? I mean, I think that's what they're coming up against in Martha's Vineyard, too, is, yeah, you can kill all these deer, but there's still all these mice and shrews and other, you know, little mammals around to carry the ticks. But the number of ticks they can carry is so much smaller. I mean, a deer can carry 500 to 1,000 ticks in a season. You know, a mouse may carry five or six, you know? And so it's a different level. And I think once you get to the point where the ticks are fairly rare, it's just - the risk goes down dramatically.
GROSS: Well, Burkhard Bilger, thank you so much for coming back to FRESH AIR.
BILGER: Oh, it's been a pleasure.
GROSS: And stay away from the ticks.
BILGER: I will. Thank you. You too.
GROSS: Burkhard Bilger is a staff writer at The New Yorker. His new article is titled "The Tick That Hunts Down Its Hosts - Including Us."
Tomorrow on FRESH AIR, our guest will be romance novelist Kennedy Ryan. Her stories focus on people the genre has often left out.
KENNEDY RYAN: The Black Girl, the fat girl, the sick girl, the disabled girl.
GROSS: She's the first Black author to win the RITA, romance's highest honor. I hope you'll join us.
(SOUNDBITE OF MILES DAVIS' "JUST SQUEEZE ME")
GROSS: To keep up with what's on the show and get highlights of our interviews, follow us on Instagram - @nprfreshair. FRESH AIR's executive producer is Sam Briger. Our technical director and engineer is Audrey Bentham. Our engineer today is Adam Staniszewski. Our interviews and reviews are produced and edited by Phyllis Myers, Ann Marie Baldonado, Lauren Krenzel, Therese Madden, Monique Nazareth, Thea Chaloner, Susan Nyakundi, Anna Bauman and Nico Gonzalez-Wisler. Our digital media producer is Molly Seavy-Nesper. Roberta Shorrock directs the show. Our cohost is Tonya Mosley. I'm Terry Gross.
(SOUNDBITE OF MILES DAVIS' "JUST SQUEEZE ME") Transcript provided by NPR, Copyright NPR.
NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
