No one could blame you if you thought that the United States had narrowly averted a deadly tuberculosis epidemic in the past month, but you’d be wrong. You may also have thought in the past few years that we were on the brink of catastrophe from West Nile Virus, SARS, and Bird Flu, and you would have been, respectively, wrong, wrong, and wrong.
The unfortunate Andrew Speaker, now in isolation in Denver due to his drug resistant TB infection does NOT have TB illness, a case of TB, or active TB. What he has is an infection, just like anyone who has ever tested positive on a TB skin test. The difference between having an inactive, or latent, TB infection and having the disease is the difference between having a heart and having heart disease but with less risk. One-third of the world’s population is infected with a strain of TB, 10% will develop active disease and less than 1% of those will die from it.
The gulf between a TB infection and TB disease has been consistently lost in the media, aided and abetted, it appears, by the Centers for Disease Control which is now in CYA overdrive. There have been endless fear-based editorials and letters condemning the Speakers. All of this could have been avoided with an official, honest, clarification of the issues from CDC.
The reason that Mr. Speaker was told by CDC staff that he was not contagious was because – are you ready? - he was not contagious. No one with only a tuberculosis infection, without active tuberculosis, is a threat to anyone. That is the reason why all those people you know who had a positive TB skin test were not shuttled instantly into quarantine. It is also the reason why CDC should apologize, not only to the Speakers, but to those airline passengers who were scared witless with the prospect of impending doom, but will not test positive for Andrew Speaker’s strain of TB.Mr. Speaker’s prognosis? Although a drug resistant TB infection is nothing to mess with, the fact is that he may never have developed active disease or infected any one else. Those who progress from the infection to the illness are usually in their later years or have an immune system that is already compromised. If Mr. Speaker’s infection had not been accidentally discovered on an x-ray after an injury, he could easily have lived into old age and died without ever being the wiser. Instead, he was led to believe that he was doomed to a quick death if he didn’t comply with government directives.
A number of knowledgeable observers have commented in print that the CDC overreacted and several TV docs have come very close to saying the same.
The CDC’s reaction has been more CYA. As of today, they are instituting an investigation which will include Mr. Speaker’s new father-in-law, Dr. Robert Cooksey, the tuberculosis expert. CDC immediately informed the press.
The story has been much the same for bird flu, West Nile Virus, and SARS, other of CDC’s predicted public health catastrophes that came and went with dazzling speed. Sooner or later there will be a real public health emergency and the public health community may wish it hadn’t been so willing, so often, to trade certainty for headlines.
CDC’s director, Dr. Julie Gerberding, is a Bush loyalist in the mode of former FEMA director Mike Brown. If competence didn’t run a distant second to sucking up, she would probably have been sent packing when one of her first acts was to drive away all of the most experienced scientific leaders in the agency, paving the way for one high profile blunder after another. Remember those hundreds of thousands of nonexistent obesity deaths two years ago?
A sound public health system is a crucial first line defense not only against terrorist acts but also against foreign indifference and/or ability to maintain healthy export standards, against medical and health supplier vagaries and incompetence, and against malevolent, globablized pathogens that arrive with the speed of a jet liner.
We need better than public health professionals who can’t distinguish between an emergency and a photo op.
For what we pay them, we should be able to get it.
For what they might cost us, we should demand it.