Dr. Timothy Lepore, a tick expert and Nantucket’s surgeon, removes ticks from deer that hunters have killed and sends them to researchers who test them for diseases.
Spotted in 1922 deer-paddling in the ocean, he was scooped up by a fishing sloop and brought to Nantucket, an island then without a single deer. And since the animal, nicknamed Old Buck, was single, Nantucket took pity on him. With help from a summer resident, a diplomat who had helped create the League of Nations, two does were imported from Michigan in 1926, greeted at the wharf by a cheering crowd.
Nantucket became so sweet on its deer that when Old Buck was killed by a car in 1932, a newspaper editorialized: "he deserved to live to a good old age, that he might see his grandchildren, great-grandchildren, great-great-grandchildren, and a lot more grand progeny, thrive happily in the swamps and moors of Nantucket."
Now that progeny, island-bound with no apparent swimmers among them, is the focus of Nantucket's attempt to grapple with diseases caused by ticks that feed on deer blood. Not just the familiar Lyme disease but also babesiosis and ehrlichiosis, which are less common, can be debilitating or fatal.
Last year, Nantucket had 411 laboratory-confirmed cases of tick diseases, up from 257 in 2007. And health officials say some cases are not reported, some Lyme disease diagnoses are made clinically, and some visitors' ailments are diagnosed off-island.
We recognize that it's a big problem here," said Michael Kopko, chairman of the Nantucket Board of Selectmen, whose wife and daughter have had tick illnesses. "Those of us who live here all know someone or are related to someone or have ourselves had a tick-borne disease."
After prodding from summer residents, Mr. Kopko said, the town appointed a committee, which will make recommendations this fall. It is looking at options including trimming brush in backyards and installing feeders that coat deer with insecticide.Most controversial is whether to allow more deer hunting.
"The numbers of tick-borne diseases are so off the graph, and it all comes back to the deer," said Richard Ray, Nantucket's health department director. Some tick experts believe that island-dwellers may more frequently encounter ticks infected with two or all three diseases. That could be because high numbers of ticks increase the odds of being bitten by co-infected ones or because the ticks' concentrated food supply increases their co-infection risk.
Michael Miller, a 52-year-old martial arts instructor, contracted Lyme disease and babesiosis simultaneously and was so weakened and feverish that doctors initially thought he had malaria or tuberculosis.
"In a place like Nantucket or any other island, there's less biodiversity, which can mean more intense transmission of infections," said Dr. Sam Telford III, a tick expert at Tufts University's school of veterinary medicine.
Houses built closer to deer habitat draw deer to tasty landscaping, and that brings ticks closer to people. Officials estimate that there are about 2,500 deer, about 60 per square mile - compared with 10 to 20 per square mile on the mainland.
Measuring the problem is difficult. Reporting criteria for tick diseases have changed, and per capita disease rates are inexact because Nantucket's population swings from about 10,000 off-season to about 40,000 in summer and because cases contracted on-island but diagnosed elsewhere are often not reported here. Numbers fluctuate for other reasons - this year, for example, the authorities expect fewer cases, saying tourism was down and rain kept people inside.
The Centers for Disease Control and Prevention has listed Nantucket among the top three Lyme disease counties since 1992. In a recent survey of about 220 homeowners in Nantucket's Tom Nevers section, 61 percent said one or more household members, including guests and renters, have had a tick disease.
"We see the tip of the iceberg, the people who get sick," Dr. Timothy Lepore, Nantucket's surgeon and tick expert, told the committee. "These diseases, while not necessarily the four horsemen of the apocalypse, have caused near-fatalities."
Tom Foley, 54, a summer resident, contracted babesiosis recently, which lacerated his spleen. He was one of many people who had to be airlifted off Nantucket for treatment because its hospital would be overstretched. "People are going to die from this," Mr. Foley said. "People don't want to talk about it - they're worried it will hurt property values - but something has to be done."
Laura Mueller, 73, a 40-year summer resident, barely survived babesiosis in 2007. "I'm dying," she kept telling doctors. Her condition proved too dire for airlifting; Dr. Lepore removed her ruptured spleen, exhausting most of the hospital's blood supply. Her recovery took 10 months. As the island considers solutions, the "February hunt" of 2005 looms large.
An extra hunting week, added because few other states have deer hunting then, attracted hundreds of hunters from as far as Florida and Texas. But Nantucket was blasted with three feet of snow, and hunters unfamiliar with the terrain could not get to the moors.
"They were showing up in bright orange where there were occupied houses, and people were going bananas thinking they were going to shoot," said Jim Lentowski, executive director of the Nantucket Conservation Foundation. A preschool even closed. In the end, 246 deer were killed, far exceeding scientists' expectations of 100.
"From our point of view it was great," said Rob Deblinger, deputy director of the Massachusetts Division of Fisheries and Wildlife. "But from some other points of view it was horrible."
After a public outcry, the extra hunt was canceled. Nobody advocates a February hunt again, and the committee will probably recommend several strategies, including public education and Damminix, which kills baby ticks feeding on the mice carrying the initial tick-disease bacteria.
Laura Simon, a wildlife ecologist for the Humane Society of the United States, told the committee that "killing deer will not work" because ticks would feed on other animals.
But several experts told the committee that more hunting is necessary, saying other methods, while potentially helpful, were insufficient and expensive.
"I think there are a lot more people who want to reduce deer numbers than want to snuggle with them," said one committee member, Dr. Tristram Dammin, son of the scientist for whom a deer tick, Ixodes dammini, was named.
But Beverly McLaughlin, another committee member, said: "I really love the deer, and I can't help it. My mother took me to see 'Bambi' when I was little."
Although her husband had Lyme disease and babesiosis, she said that even if Nantucket had 400 cases last year, "you know what? That's not an epidemic."
A hunter on the committee, Kevin Madden, said many hunters wanted only modest increases in hunting, so that bagging deer would remain easy.
"I don't want to see all the deer wiped out because some people get Lyme's disease," he said. "Let them live until I need them."
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