From Egg To Epidemic: Controlling the New World Screwworm

Hello and welcome to Transmission Interrupted.

I am Jill Morgan.

I'm a nurse here at Emory University Hospital in Atlanta, Georgia.

For those of you not yet familiar with NETEC, our mission is to set the gold

standard for special pathogen preparedness and response across health systems in

the U.S. with the goals of driving best practices and closing knowledge gaps

and developing innovative resources.

NETEC works alongside and in cooperation with the CDC and is

funded by ASPR, the Administration for Strategic Preparedness and Response.

I am both excited and disgusted by the topic of today's podcast.

And I am really grateful to have Ashley Perry, who is the director of Hazardous

Waste Services for Daniel's Health.

And that's a big title to say she knows almost everything there is to know

about disgusting healthcare waste.

And she's actually the one that brought this story to my attention.

I admit to having heard about New World screwworm.

In the news, but had purposefully limited my willingness to, to read

or especially look at images of it.

Because I just have, despite having removed literal worms from people's bodies

over the course of my ED career, these are just things that really do skive me.

This is a parasite.

They can actually kill livestock.

That's how bad these infections can be.

So, First of all, let me start out by welcoming Ashley Perry, who I'm just

thrilled to have back with me today.

So Ashley, thank you for bringing this to me and for being willing to

talk more about this gross stuff.

Yeah, I'm happy to be here and sorry at the same time

that I have to share this with you.

Some burdens are better shared.

So, for those of you not familiar, and frankly I hope many of you

are not familiar, New World screwworm is a type of blow fly.

So it's a parasitic blow fly and it looks like any other fly, right?

Sort of a metallic looking and you know, maybe a little bigger

than a house fly, but not much.

The difference about this fly is that it lays its eggs in the eyes, nose, ears,

mouth, genitals, or wounds of animals.

And that includes people, it includes livestock.

And this is why it is such a huge concern.

It not only lays its eggs there, but as these eggs develop into the little

worm, which is the intermediate stage of this lifecycle, the worm itself

doesn't just feed on dead tissue, which many, many worms and some people may

even be familiar with using things like maggots to eat dead tissue, from wounds

that we do in the hospital, right?

And that's something that that happens, but these eat live tissue.

So that means they're not just feasting on dead stuff, they're actually destroying

the very animal they're living off of.

And so it can bring about the death of livestock and, pets and

can completely gross out humans.

So.

I really caution you.

We're gonna have some resources, look at images for the very large

livestock industry in the United States.

Especially across the Southwest, where we have lots and lots of cattle

herds and things like this, and New World Screwworm is actually endemic

in many places to the south of us.

So, Central America and across some of the Caribbean where it's

just a much more common problem.

And in the United States, we've done a pretty good job in the past of

controlling this in fascinating ways.

The U.S. has actually bred sterile flies so that they, can, mate with

these parasitic flies and limit their, ability to reproduce in an area.

So we've got all sorts of creative things, but that's how big a deal it

is because if this infection took place that took hold in the United States,

it could decimate, livestock and it could also impact both human health

and our pets that could be affected by this, in any warm-blooded animal.

So that's a gross introduction to what we're gonna talk about today.

And I wanna start with, I told y'all that Ashley brought this to me, but now I wanna

go sort of backwards and say, Ashley, how the heck did you get involved in this

parasitic blow fly larva thing coming from a healthcare waste vendor perspective?

It's so interesting because every time I think I've

seen just like all of it, right?

Like you think you've seen all the types of gross waste that you can

find, like something new kind of creeps out, and that's kind of how this went.

So, uh, we had a customer that was actually on the west coast, like

in the southwest United States, and they had a patient come in and

they did have these maggot worm looking things in an infected wound.

And so they were concerned, obviously just with their location to some of those like

southern areas like Mexico and Central America, that this could potentially

be a case of New World screwworm.

They had reached out, they're like, what do we do with this?

And I was like hold on a second, I need to learn more about what

New World screwworm actually is.

I'd heard it kind of in passing, but I'm the same way, Jill.

If it's creepy crawlies, I try to not, not let it come into my brain.

So, in going through this process, really learned about.

not only like the impact that these cases have on livestock and on the communities,

like where these cases come from, but there's also some unique guidance out

there around waste and how to handle this.

So thankfully.

this facility, like they sent in their worms, like there's a certain

number of larvae they have to collect.

They send it in, to like the CDC and their local State Department of Health.

And it came back that this thankfully was not a case of New World screwworm.

They still wanted to treat the waste as if it was, just to be safe, which

is what I would always recommend.

Thankfully it was not an actual case of New World screwworm and there has

not yet been a U.S. based case where it's generated from the U.S., but it

got me thinking that this is probably something, given the complexities

around some of the guidance that CDC has, as well as some things like

waste disposal related guidance, where maybe the CDC is forgetting that there

might be some EPA rules to some of the processes, which we can talk about,

where it could cause some confusion.

And so, what I did then is just got engaged internally

within our organization.

Worked with our customer to develop their policy around how they would handle

this and then started working on some resources for us as a vendor to be able

to provide out in the event that our customers have this kind of waste or have

suspected cases, so that way we don't end up in situations like we have in the

past when we get these new pathogens.

We've got a bunch of waste that went out to the wrong place, or it went out for

disposal, or things got thrown in the wrong container, and were not properly

disposed of to try to limit any kind of unintended spread of these cases.

So thankfully it was not a case that came to fruition.

Yeah, and I think, you know, your point about losing control

of this stuff is really important because we don't always think about.

You know, we discard something, right?

So, and I think in most cases, in an emergency department or a

healthcare clinic of any kind, if you remove something like this, you

might just throw it in the trash.

If you clean out a wound and have even the eggs, not even the worm stage,

but the eggs, you might irrigate that wound, capture that arrogant.

Which would include these live eggs, and it might just go into your regular

trash because in many hospitals that would not even be necessarily

considered red bag trash, right?

The problem with that is that if these things ended up in a landfill,

in a regular trash, dumpster, garbage thing, that can reproduce and then let

these flies be out in our environment.

So it's not just that it's gross, it's not just that it's a regulatory thing from the

CDC standpoint or human health, but that this is a big deal for, USDA and the, I'm

not gonna get this acronym right the first time, APHIS, which is agriculture, no.

Plants.

Ah, alright.

Hold on.

I gotta pull up aphis.

I thought

Animal Plant health inspection service.

Thank you.

All right.

So APHIS, the Animal Plant Health Inspection Service.

So for instance, you travel and you go through an airport, and they're concerned

with checking things to make sure that little bugs don't come in on your stuff.

This is part of why, because we don't want these things here.

So if we don't handle those things correctly in a healthcare environment,

we could in fact be contributing to the release of these parasitic flies.

It does sound a little like the theme of a bad sci-fi movie, right?

I mean, this is exactly what a bad sci-fi movie would be built upon.

Like this would be it.

Alright, so what is it that hospitals should do, or anybody, not just a

hospital, but a clinic, an urgent care, a dermatologist, anybody

could see these wounds in a human.

What should they do with what they take out of a wound or the trash

that is associated with this kind of wound care if they're worried it

might be a New World's screwworm?

Yeah.

So I think one of the key things is making sure that, it's kind of twofold, so if

you think that you have a case of New World Screwworm, first and foremost, you

wanna make sure that you are collecting the larvae that are generated from

this patient that you're taking on.

You're gonna want to send the CDC asks for at least 10.

If you've got fewer than 10, they want you to send all you've got.

But they want you to collect them in a leak proof container, and the statement

on the CDC guidance is they prefer 70% ethanol, or 70% isopropanol or higher.

So, whatever you have.

If you have, 85% IPA that works too.

They want you to get that in a leak proof container or really close it down

and then that's gonna be sent to CDC, for testing to validate whether or not

this is a case of New World Screwworm.

And then all the other larva and eggs, so if you have a patient that has a bad

infestation and there's more than the 10 that you're supposed to send to CDC,

you wanna make sure that you're taking all of those materials, specifically the

live larva, the eggs, and you're getting those also into a different leak proof

container with 70% ethanol, or alcohol.

They did say they will also allow formalin if there's not ethanol or alcohol

available, but the idea is to kill the larva and the eggs, but then also still

be able to preserve them for any testing or anything that needs to be done.

So, that's why we use that ethanol.

We wanna fix 'em so then they can be tested.

And the thing that's unique to this is once you've done that, so you've

sent your 10 to the CDC, it's gone for testing, and then you have

all the rest of this larvae waste.

This is where the CDC guidance, I have to be like, hold on, we gotta pull back

a little bit because they say throw it in the general trash or your regulated

medical waste, but ethanol and isopropyl alcohol are RCRA hazardous waste.

So they exhibit the ignitability characteristic.

And so what this now means is that we may have a very unique waste stream depending

on what state you're in and where you're sending it for treatment, you have to

make sure you're profiling it correctly, and working with your hazardous waste

vendor to make sure it's getting sent to the appropriate disposal methods.

So we don't wanna throw, the bottles of alcohol with the larva

and the eggs into your red bag waste.

We wanna make sure that we're collecting those, collecting them maybe in like

a five-gallon bucket or some kind of container that you can mark as hazardous

waste and can be held onto while you're working through the disposal

process with your vendor and then your PPE and stuff that you've been used

that's been contaminated with this, that could go into your red bag waste.

But it's, there's two distinct waste streams that get generated here, which

is a little bit different than like maybe some like category A infectious waste or

other types of pathogen waste where you're typically generating one waste stream.

Like it's all going out the same way.

And in this case, we've got two separate things that we wanna be mindful of

to make sure that not only are we not causing spread of New World screwworm,

but we're also not causing harm to human health or the environment by

inappropriately disposing of the waste.

Yep.

And I wanna go back to an acronym you use, which is RCRA, which is RCRA.

Can you just explain for folks, I know our EVS people will be intimately familiar

with RCRA, but other people may not be.

So just spend a second explaining what that is.

Yeah, so RCRA stands for the Resource Conservation and Recovery Act.

So this is the primary act around waste in the United States.

So it falls under the Environmental Protection Agency's purview.

And so when we talk about RCRA waste, we're talking about hazardous waste.

So these are things that are regulated.

The EPA breaks it down into a few different categories.

They will define things as having a characteristic of hazardous waste,

or they'll be considered a listed hazardous waste, which means they've

come from like a specific process or they contain some listed hazardous

chemical in the makeup of that material.

Specifically for the New World screwworm, when I mentioned the

ignitability characteristic, essentially the ethanol is flammable.

We wanna make sure it gets disposed of properly so that way we're not putting

something flammable into our compactors.

Or the worst thing to do would be put something flammable into our medical waste

that gets autoclave and goes through a big heat steam sterilization process.

So we wanna make sure we're not having risk down the line.

Yeah, and I think it's great to think about because of

course hospitals deal with small amounts of alcohol all the time.

We might use alcohol on something, we use a lot of chemicals, but

we're not typically packaging them in as liquids and sealing them up.

Right?

So that's, I think here where we get the difference.

And I wanna be clear that yes, we know you all use alcohol swabs.

You use maybe even bottles of alcohol that you might use to pour onto a four

by four or whatever you're doing, but you're not, you wouldn't just throw

away the bottle of alcohol, hopefully, in with your regular trash because it

will, again, as Ashley said, obviously we all know alcohol is flammable, right?

So that is fascinating that people would have to then separate this

trash if it's got this, bottle or, some sort of, cup of alcohol with

these larva eggs or, larva in it.

I wanna ask sort of a, what might be a dumb question?

Could I put them in that and let them die and then just let the alcohol evaporate?

Would that let me throw it away and not have to worry about like,

having it as my, you know, this other kind of hazardous waste?

I actually don't think that's a dumb question at all.

Because I do get questions of a similar nature related to like

just general waste disposal.

So because alcohol dissipates so quickly when exposed air, a lot of people

are like, if I just like open this or I let it evaporate, like then I can

just throw this away as general trash.

We wanna be really careful when we do that because the Environmental Protection

Agency would actually consider that to be a form of treatment on site.

And you cannot do hazardous waste treatment without a big

special permit from the EPA allowing you to treat on site.

So I always envision it as like a specimen cup.

Okay, I've got this specimen cup.

I've got my alcohol in the container.

I've put my larva and my eggs in and I'm screwing this down, and I'm just

gonna, I'm gonna keep it closed and sealed so it doesn't leak, and then

I'm going to put it in the container and send it off for disposal.

So we don't wanna let that evaporate.

Not only because of the EPA, looking at that from a treatment and a compliance

perspective, but also we don't wanna incidentally have like a spill.

Like we don't wanna knock over the alcohol.

Then you have to clean that up and then that spill cleanup material has

to be treated as hazardous waste.

So from a risk reduction and compliance perspective, we just wanna close them

up and send them on their way and, and say a happy goodbye to them on

that hazardous waste manifest and know that they'll be incinerated.

and destroyed, and you won't have to worry about 'em again.

Excellent.

That's exactly what I would like to do with these worms is not

have to think about them again.

One other question in, in that regard, so is there a volume of the alcohol

that crosses this threshold, right?

So like, is it five mils, 15 mils, 50 mils?

What constitutes the volume that we would have to do something with, in

this regard of separating it as a RCRA or hazardous waste different

from my regular hospital waste.

Yeah, that's another great question.

So, when it comes to characteristic wastes, which is what this would

be, we consider things that might be ignitable, or certain toxics, or like

different corrosive materials that exhibit a hazardous waste characteristic.

There are different criteria or definitions that the EPA is laid out.

So for some things, like mercury, there's gonna be a limit.

for what that PPM can be for you to be able to consider something general trash.

When it comes to the ignitability characteristic, there is

not a volume limit or level.

What the EPA states is if the flash point of the material is at 140

degrees Fahrenheit or less, it is considered to be an ignitable waste.

They do have some other criteria for things like oxidizers, but for the

sake of this conversation I won't go into the weeds because I could

talk about hazardous waste all day.

But, so when it comes to this, what we really wanna know is.

Would this flash?

And so there's a couple of ways that we typically will evaluate these things.

One is the safety data sheet for the ethanol you're using

or the IPA you're using.

The other thing you can do is run analytical and do like a flashpoint test.

Given that this material's not gonna be mixed with anything else, so we need

it to be the pure ethanol to do the job of killing the larva and fixing them.

So we're not gonna add any water, right?

We don't wanna like dilute it.

Given that the safety data sheet, when we look at it, it's gonna say,

if I had to throw out a random number, typically I think ethanol is in like

the 70 degrees Fahrenheit range for a flashpoint, so it's definitely

gonna be below that 140 degrees.

It's safe to say that because we wanna make sure we've covered all of the

larvae in there, that any amount that we collect, it's gonna be a best practice

to send that out as hazardous waste.

And the reason why is because it would be costly to test it.

You can absolutely have a situation where there's an inspector on site

that's asking you about, well, how did you make the determination to

throw this in the general trash?

And if you don't have any documentation or really strong evidence that you can

provide back to a regulator, they're probably not gonna be super thrilled

that you threw it in the trash and you could end up with like citations.

So my recommendation, and even in when we thought we had this suspected case.

My recommendation was even if we only have 5 mL or 15 mL in this

container, we wanna go ahead and treat this as hazardous waste.

It's likely going to exhibit the flashpoint if you were to test it.

So let's just make sure that we do that.

Hopefully we're not generating this waste frequently, it's not

something that's a recurring process.

And it also makes it very clear, in a situation like this, one of the

things I hate is having to have a bunch of decisions that need to be

made in the waste disposal process.

I am not a clinician, but I am sure, um, if I was dealing with a patient with this

material and also concerned about the infectious risk that it poses, the last

thing I wanna do is try to qualify how much alcohol I use and where it can go.

And so it makes it a little bit easier for clinicians just to know, okay,

you've sealed at these containers.

We're putting it in this container.

It's going out as hazardous waste to make it easy for them.

Yeah.

And I would suspect that, for most of us in the healthcare environment,

and probably even veterinary clinics and people like that, our labs are

probably already used to dealing with icky things in fluid, right?

Whether that's a body part or a specimen that was removed to go to pathology.

They have processes for this that will be compliant.

with the RCRA rules, which say that it has to be treated as a hazardous waste.

So this is just one of those things where maybe you're not used to that

situation in your emergency department, but your laboratory probably is.

So lean on the people in your facility.

They're already probably handling these things, know what to do.

And then of course EVS supervisors, I know the Healthcare Waste Institute

and your waste vendor are great resources for if you have a question,

what do I need to do with this?

Reach out.

The last thing we wanna do is pass risk downstream.

Y'all have heard me say that before.

We don't wanna ever knowingly pass risk onto other people.

It's not fair.

So talk with your lab, talk with your waste vendor, talk with EVS.

And really, if you are in a part of the country that has livestock, or is in, I

would say this whole swath of the south and the southwest of the United States.

This is a risk.

Ranchers and cattle people have probably heard about this.

There's a lot of resources out there, both from the CDC and from APHIS and the USDA.

Texas A&M has a bunch of resources out about this.

It's a really big concern.

I wanna just finish by asking Ashley, really is there anything else you

think that people should know if you are that veterinary clinic, if you

are a hospital or urgent care that you think that, that, last parting

wisdom from the maven of disgusting waste today you would wanna pass along.

Yeah, I would just say, when it comes to the guidance, and

I mentioned this before, but when it comes to the CDC guidance, like there's

a lot of amazing resources out there for what to do in this situation.

I always recommend just take heed when it comes to receiving guidance

on disposal from organizations that maybe don't deal with this disposal.

So again, I think CDC is doing their best effort, but there's a lot of

intricate rules that are at play.

If there's one thing that I can really reinforce outside of how gross this this

waste is, is just being mindful of that, if you have guidance and you, or you

think you have a suspected case, like I've said it before, engage your vendor early.

Make sure that your teams know within the organization, whether that's

environmental services, if you have an environmental health and safety

person, and just be mindful of the guidance that you're following.

So to any EH & S or EBS staff out there, like reach out to your waste vendor.

Just to validate that the guidance that you are seeing is how they would direct

you to, just to make sure that you are going to be in compliance for that.

And I think my second piece of advice would certainly be, similar

to what I say always, is if you are prepared then you don't have

to stress about it when it happens.

So, it's definitely worth considering evaluating your policies, having

conversations internally within the healthcare organizations to

determine whether or not anybody's even talked about New World screwworm.

Even if it's low risk, it's better to have something in place than trying

to figure out how you would handle it when you've got a patient that

actively has these larva and eggs and flies that are developing in wounds.

So we wanna make sure that we're prepared to deal with this and that it's not a

scramble on the backend, it's just how we prevent inadvertently spreading the

disease or inadvertently causing harm downstream because we haven't provided

proper guidance or we don't have a plan in place to manage this, and then the

waste going out for proper disposal.

Yeah, I think it's super important.

This is really timely right now because, we have a lot of people who

travel to the Caribbean and Mexico and, Central and South America.

We have a lot of people who will be coming from those areas into the United

States for the World Cup coming up.

We have folks that might already see, regular bot flies and other kinds of fly

larvae in wounds, and we don't expect you to be able to tell one worm from another.

Frankly, I don't wanna look at them long enough to tell which is which,

ever, but in this case, especially since we know this is such a risk, if you

are a healthcare provider and you are extracting, a larva from a wound, if you

are washing out an infected wound and it has eggs and or larvae in it, and the eggs

are gonna look like very small grains of rice, and this is gross folks, but it can

move from egg to larva in eight hours.

It doesn't take long to make this life change.

I mean, it took long for me to make many of my life changes, but it

doesn't take these larva long at all.

And the warmer it is, the faster this lifecycle happens.

So as we go into the summer months, it doesn't take a month for these

flies to go from a fly to a larva, it takes just a couple weeks for

the entire lifecycle to go around.

It's super important that people be aware of this.

So if you have people that are extracting these things, prepare them now as Ashley

said, 70% is a minimum of alcohol.

Seal it up.

You want to send the specimen to make sure that it's not this

particular New World screwworm.

Hopefully it won't be, but if it is, you will want to have taken care of

this waste correctly while you're waiting for the results from the

CDC about what kind of worm it is.

Wow.

Like I said, I both excited and disgusted by today's topic.

I know.

I was gonna say, I forgot to mention too, earlier there's something like

uniquely gross about this as well, which is that they, I think in most cases

from my research and understanding, is that larva tend to stay towards

the outer surface of the wound in most cases, but as New World screwworm, as

they develop and they go through their lifecycle, they actually burrow deeper.

So, a wound may not present itself with larva or eggs

that are very easily visible.

And so just being mindful too when you're doing wound cleaning, you

could find them deeper as they get into their further life stages.

The New World screwworm continues to burrow deeper into that

wound, which is wonderful.

A wonderful parting thought for everyone.

Yes.

And, and it's really sort of how they got their name right?

Because their bodies have this little screw thing that sort of

lets them get deeper into tissue.

And as we said, this is not just a superficial infection.

These infections, with this infestation, with these New World screwworms,

causes the death of livestock.

Which is just a horrible idea, that a fly can kill a cow, but

this is exactly how it happens.

So you've been warned.

Look at the pictures with, you know, one eye shot, but also really be on

the lookout and please help educate any of your providers who might

be handling these things, handling these wounds, doing wound care.

This is a great topic for your wound care team, and your EVS team to make

sure everybody's on the same page about what's happening with these.

So, Ashley, thank you so much.

It's such a pleasure to talk to you even when it's about a gross topic.

We are gonna be talking a lot about waste in the coming months, so

please, consider joining us again, and it's so nice to have you here

yeah.

Thank you so much for having me.

I love the opportunity to be able to just share and make sure that

these things are getting out to our clinicians and our healthcare facilities.

So I always love getting the opportunity to chat with you specifically, Jill, so

looking forward to who knows what the next thing will be that we'll be talking about.

So.

I really want to thank Ashley Perry for enlightening us about

this disgusting topic in healthcare waste and how we should be very, very

cautious if we encounter something that looks like it could be a New World

screwworm in a healthcare setting.

And remember, that could be in a lot of places.

Doctor's offices, urgent cares, or emergency departments.

And now I just want to change directions a little bit because the healthcare

setting is only one aspect of this, right?

When we're talking about a parasite that can affect livestock, and

we have a lot of folks across the country doing research about this.

And, I mentioned earlier that Texas A&M has really been leading on this and they

have a tremendous amount of information on- online if you're interested.

Again, I'm warning you guys about pictures.

I'm completely serious.

It's really gross.

But, I'm so happy to have Dr. Shawn Gibbs with me today, who is

the Dean in the School of Public Health at Texas A&M University.

So Shawn, welcome.

Thanks for joining us today.

Well, thank you for having me, Jill.

I appreciate being here.

Ashley was able to fill us in on the really highly regulated and

finicky side of healthcare waste when you're dealing with something like this.

But the reality for an awful lot of the risk in this is really that this is gonna

be out in the field where somebody's encountering a member of their livest-

is it a member of your livestock herd?

I don't know.

What's a singular of livestock?

I don't know.

Just animal in your herd.

There you go.

An animal in your herd, or let's hope it's not more than one animal

in your herd, with an infection.

What are people doing in that case, and what, from your best judgment, and

I guess there isn't a lot of guidance on this yet, but what would be your

best advice in these situations?

Well, the first thing is with the maggots associated with the New World

screwworm fly, don't leave them alive.

Don't leave them out in the environment.

You, you've got to contain it.

The recommendation is, of course, for 70% ethanol or 70%

isopropyl alcohol to kill them.

If you're out in the field, this can be done in essentially

buckets, or other containers.

As Ashley mentioned earlier, anytime you're using that level of

waste it is RCRA hazardous waste.

You got to be aware of that as well, but you do not want to

leave these alive in the field.

And you mentioned earlier, Texas A&M, and I want to highlight and

be clear, the portion of Texas A&M who's really leading the way on this

is Texas A&M AgriLife Extension.

They are in every county out here in the state of Texas, I think, and they

are doing a marvelous job of preparing for the entire state to encounter

this if and when it does occur.

Their information online is really good.

We mentioned there are some other resources out there, of course, because

there are a lot of federal agencies that are concerned with keeping this contained.

And if anybody's interested in sort of the history of this, it really is very,

very interesting how we were able to eradicate this in the 1960s by working

together with Mexico and other countries to release these sterile male flies.

So then because the New World screwworm females only mate once, if they mate

with these sterile males, they don't end up laying eggs everywhere, and

that, of course, then can really drop these sorts of disgusting infections

very quickly and effectively.

It was really a phenomenal example of scientific cooperation amongst

multiple countries and really taking the science into practice and into the field.

I love the idea that it wasn't like some new drug that we had

to spray on animals or that we're not spraying insecticides from the sky,

but this fairly, I guess, low impact to the rest of the environment, or the

rest of bugs, if you're only doing it with one specific kind of horrific fly.

And as a matter of fact, if you're using the sterile males,

you wanna be rather cautious with your use of insecticides because overuse

of insecticides while you're releasing the sterile males would actually be

counterproductive, because they would be as vulnerable to the insecticides as

the non-sterile males and the females.

Yeah, you actually wanna let them go for a while.

Oh my gosh.

It gets so complicated so fast.

In your past you've done a lot of work with like lab safety and risk

analysis and things like that.

And so we do know that there are researchers out there working on this

and other sort of dangerous bugs.

Is the disposal method, is the waste side of things different in the lab than it

is in the very complex hospital world?

I mean, you mentioned RCRA, which we've already defined for folks,

but you know, that obviously involves the alcohol itself.

But thinking about how people get rid of the creepy things

they're working on in a lab.

Well, you know, I think the lab environment is actually gonna be

fairly similar to what Ashley described in regards to the healthcare environment.

It's gonna be a very controlled environment where you're gonna

be able to identify things rather rapidly and realistically

dealing with a smaller number.

You're gonna be dealing with one patient, or in a lab environment, you're dealing

with something that you've created or that you've brought in for study.

So it's gonna be a lot more controlled.

I think one of the great things that Texas A&M Agricultural Extension has

been doing, and USDA and many of the others, is acknowledging and planning

for where we're gonna see a lot of this, is not gonna be in the lab.

It's not gonna be in the healthcare environment, it's gonna be in the field.

It's gonna be in the herds.

It's gonna be in the head of animals.

And you're gonna have to address it out on a dairy farm or out,

you know, in a pasture somewhere.

And that's a very different environment than a hospital or a laboratory structure.

You're gonna be dealing with weather.

You're gonna be dealing with the elements.

Anything that you're bringing in, you're driving in or you're hiking in.

So anything you bring in, you've also gotta take out.

So there's also the potential for a lot higher volume of these maggots

when it comes to the animals.

I know you don't like to hear that.

Jill, you've been a nurse for a year or two and generally, people will

notice something burrowing under their skin and they will go to a healthcare

provider, and people in the laboratory, the scientists will maintain the

maggots and they'll control the maggots.

The animals can't talk, so if they get hit even with great ranchers who are

paying attention a lot to their animals, there's a potential for one of these

maggot infestations to grow pretty robust.

Yeah.

And of course, that's how they get their name, is because they're literally

burrowing down as they go because of course they're eating live tissue.

And the fact that they can… it doesn't need a wound, that it can be

in like an animal's ears or whatever, it's just a horror- horrific idea.

Yeah.

Anywhere there's a mucus membrane it can get in.

And the truth of the matter is, with, all of our feed animals, just like

people, we constantly are dealing with scrapes, cuts, et cetera, right?

I mean, even under the greatest conditions, I've got like two

cuts on my hand today just from where I opened the car door wrong.

Yeah.

No, you're right.

I mean, obviously, people's skin is not 100% intact.

I would guess that, know, you've got herds of animals, many

of them have non-intact skin.

And then I guess I think about other ways, like I mentioned to

Ashley, "Well, couldn't I just let the alcohol evaporate?"

And she admonished me that that was still, not a great thing to do.

But I wonder, like, you know, if I'm out and I'm a rancher, could

I just make a little bonfire?

I will mention right now we're in the middle of some really bad drought

across many parts of the country, so fires are-- I'm not recommending fires.

But you know, something like that where you figure we could destroy this, and as

you mentioned at the very start, our goal is to not leave any of these where they

could then create an ongoing outbreak.

You know, I can see a number of scenarios where they're out in the

field, they're working with the herds, and just trying to get the material

that they've de-breeded back and use the volume of alcohol in order to kill

the worms may be very problematic.

I could see a number of scenarios where they potentially could use burn barrels

or other things like that and essentially char the flesh in the animals or the

maggots, the animal flesh in the maggots.

It's not necessarily something that's recommended, but I'll be

honest, I think it's something that people are likely to do.

Well, I think certainly another concern is this idea that in some

cases this gets, it goes unrecognized long enough that an animal succumbs.

And I had mentioned to Ashley, like the idea of this fly, you think about

the size of a fly, taking down a cow.

But that's all it takes, right?

Because these can just keep reproducing and burrowing in and eating live tissue.

And so, if you think about how you would then dispose of an entire

animal, then you'd almost have to use something like a burn pit.

Yeah.

I'm not worried

about it taking down a whole cow in regards to the vast majority of

animal feedlots in the United States.

Whether it's dairy or beef production, they're

gonna be paying attention to it.

They're gonna catch this pretty early on before it gets to the point

where it's taken down a whole animal.

And if it's dairy, they're monitoring milk production nonstop.

But, I think some smaller ranches, some smaller facilities, there is

that potential for, you know, a pasture-raised animal that doesn't get

checked on as much, that they've never had a problem with, and not expecting a

problem for something to go unchecked.

When you're talking about situations like this, a lot of times when an

animal passes away, they'll compost.

With this screwworm, that's not something they should do.

So at that point, when you're dealing with a whole animal carcass, you probably

are looking at, essentially burning it.

Yeah.

Wow.

Gosh, just when I thought my life couldn't get any grosser when it

comes to the kind of waste I've had to deal with at the hospital, and now

we're talking about how you get rid of a carcass teeming with maggots.

I just… I think I've had enough for today.

Jill, you and I have known each other long enough.

We've both done Ebola response and Lassa response and Nipah

and other things like that.

This grosses me out a little bit more.

Yes, I completely agree.

All right, well, we will definitely link people to the Texas A&M AgriLife Extension

resources, because I think they do a great job of really talking about, what you

should watch for and what actions to take.

We certainly appreciate folks being willing to do so much work on things

that are just creeping the rest of us out

And before we go, I'd like to really highlight that when you're

talking about something like this, that is a true One Health issue, It's gonna

impact the environment, it's gonna impact humans, it's gonna impact animals,

and it's gonna impact feed animals.

Agricultural extension, both the Texas A&M AgriLife Extension Agency,

as well as all the others across the country, they're key components to

public health communication on this.

They're embedded in their communities.

They're working with the ranchers.

They're working with the farmers.

They're working with the communities, and they've got trust in those communities.

So, getting that information to them so that they can disseminate it in a proper

way and get it through their channels and their networks is, absolutely instrumental

Yeah.

Fantastic, and it's a good plug because I do wanna end with this idea

that no matter who you are right now, whether you're a rancher or a farmer, a

veterinarian, a healthcare worker in a human healthcare facility, of any kind.

If somebody comes in, if an animal comes in or a pet comes in with something that

has this sort of appearance, you've got

maggots in a wound, something that seems to be burrowing deep, this

is definitely something we want to get ahold of, we want you to send

a specimen, as Ashley said, like 10 if you can,

so that they can be identified.

Hopefully, you will not be the people, ding, ding, ding, you know, winner,

winner to find the New World screwworm.

But it is something, especially as we get into the warmer summer months, when

this is so important that we stay on top of it, and really be aware, as

Dr. Gibbs said, you know, this idea of One Health really is so important here.

That we are all part of this living environment and, we have

to pay attention to these things.

So, I think it's great to give a shout-out to the extension services

across the state of Texas, but also across the rest of the country.

And really think about, how we can all have our -- at least somewhere in

our minds that this is a possibility.

Well, thank you Dr. Gibbs.

Such a pleasure to see you and, pick your brain about something disgusting

again, and come back any time!

Jill, it's a pleasure, and I think you only call me when you want

to talk about something disgusting.

It's true.

It's true.

I have a fairly large disgusting repertoire, frankly.

But yeah, thanks.

All right.

Thank you so much for joining us on Transmission Interrupted.

As usual, if you have ideas for future shows or questions about

today's episode, you can find us on the web at, info@netec.org, You can

also find us, of course, through any of the platforms for podcasts.

We hope you'll join us next time for, any other disgusting topic I can think

of, but also a lot about infectious diseases and personal protective

equipment and healthcare worker safety.

So thank you all for joining us we'll see you next time on Transmission Interrupted.