A 750-word memo hit Pennypacker's listserv today, announcing that the scabies infestation that forced the Harvard dorm's entire student population to bathe in medicated creams, call-of-shame all sex partners, and fumigate all clothing and sheets is most definitely gone... because it probably wasn't scabies, at all! The University Health Services-authored email explains,

It's difficult to say definitively whether the original three students ultimately had scabies or not. Our best diagnosis at the time was that they did, and, given this diagnosis, it would have been risky not to treat the entire dormitory. Four days later, Dr. Michael Alpert, an entomologist from the Harvard School of Public Health came to Pennypacker and talked to three symptomatic individuals and concluded that scabies was unlikely, given the rapid clearing. He speculated that the causative bug could have been mosquitoes.

It took four days for UHS to realize this, and twelve to make the information publicly available? Because it only took us two. And they say we don't care about the Crimsons!

Harvard officials' rambling explanation after the jump. 

From: [redacted]
Date: Oct 24, 2007 1:32 PM
Subject: Important Update on Scabies in Pennypacker
To: [redacted]

Dear Pennypacker Resident:

After reading the Crimson opinion piece from October 22, 2007, "I've
Got  an Itch", it seems worthwhile to review where things stand after
the incidents of skin complaints two weekends ago at Pennypacker.

At that time, three individuals came to university health services
(UHS)  with similar symptoms. After being evaluated by a physician at
After Hours Urgent Care, the possibility of scabies was considered.
Discussion with proctors at Pennypacker revealed that there were at
least 5 or 6 students at Pennypacker with itching skin and rash, though
only three of them wished to be examined.

Given the symptoms, also under consideration was the possibility of bed
bugs, though the skin findings were not classic for this diagnosis.    A
scraping from the skin of one student was done to look for mites, but
these were not seen.  It's important to note the presence of mites on a
skin scraping absolutely confirms the diagnosis of scabies; if they are
absent, though, the diagnosis is not excluded.  Frequently, the
diagnosis of scabies is difficult to make, and it takes several
examinations of a patient over time before other possibilities are
excluded.  This is because the rash associated with scabies can be
fairly non-specific, and the "burrows" are often not seen.

A team of pest control experts, brought in by Environmental Health and
Safety, examined the dormitory and did not find bed bugs.  The diagnosis
of scabies could not be excluded at that point.  The location of the
"bites" was consistent with the scabies diagnosis, and the number of
bites was inconsistent with other common insects.  The /presumptive/
diagnosis of scabies was therefore made---meaning that it was a
diagnosis of exclusion, and not a definitive diagnosis.

A Brigham and Women's Infectious Disease consult was called for advice
and, based on the /presumptive diagnosis/ of scabies, it was decided
that the most prudent course of action was to preventively treat the
whole dormitory, consistent with standard practice.  On Sunday October
14, UHS clinicians came to Pennypacker to dispense the treatment to all
residents and to provide information about laundering potentially
exposed clothing.

Thanks to your cooperation, in the days that followed, there were no new
cases at Pennypacker. It's difficult to say definitively whether the
original three students ultimately had scabies or not.  Our best
diagnosis at the time was that they did, and, given this diagnosis, it
would have been risky not to treat the entire dormitory.  Four days
later, Dr. Michael Alpert, an entomologist from the Harvard School of
Public Health came to Pennypacker and talked to three symptomatic
individuals and concluded that scabies was unlikely, given the rapid
clearing.  He speculated that the causative bug could have been
mosquitoes, though he never saw the bites when they were present.  The
physician who did see the bites, said that the appearance of the bites
was not consistent with mosquitoes, and that their locations on the skin
was more consistent with scabies. As is frequently the case with rashes,
the simple symptoms can lead to a variety of diagnosis, and it
is often difficult to tell, in the absence of definitive testing, which
one is correct.

At this point, if there was scabies in the dormitory, we can consider
scabies cleared from Pennypacker.  You may open the bags containing your
non-washable possessions.   If the diagnosis was not scabies, it is
possible that there was another insect involved, though it does not
appear to be bedbugs (because there are no ongoing symptoms and there
was no evidence for bed bugs when the pest control team evaluated the
dormitory), nor appear to be mosquitoes. Whatever the ultimate source,
it is now eradicated from Pennypacker thanks to your response and
cooperation.

A final word on scabies transmission:  scabies can be spread by physical
contact with clothes and bedding of an individual who has it.  Although
sexual contact is a possible mode of transmission, more commonly, it is
spread by other means.  Scabies spreads in schools and in families
frequently, and from person to person between whom there is no sexual
contact. Scabies is not considered to be a "sexually transmitted
disease", since it is not transmitted exclusively through sexual contact.

Incidents such as these can cause inconvenience and emotional stress.
Please feel free to contact us personally if you have any further
questions about this incident, or if you have any remaining clinical
concerns.

Soheyla D. Gharib, MD
Chief of Medicine
Harvard University Health Services
sgharib@uhs.harvard.edu

Dr. Gregory Johnson, MD
Medical Director
After Hours Urgent Care and Stillman Infirmary
Harvard University Health Services
gjohnson@uhs.harvard.edu