The public debacle of a person traveling with a contagious and possibly deadly disease through the international transportation system raises many questions, most of them unanswered.
Mr. Speaker, the patient in question, violated medical advice to not travel, to get to his wedding in Greece. He accomplished his goal, and now he denies that anyone gave him a warning. His denial comes at the heels of a confirmatory letter telling him to not travel.
So what gives? The public may never know; however, Mr. Speaker has given a public apology to all he may have infected. Is this sufficient?
The government also apologizes for not stopping Mr. Speaker. There inability for not stopping Mr. Speaker can certainly not be from a lack of opportunity. Mr. Speakers used at least 4 different air flights, and crossed many international borders. So what is there excuse? As expected, the situation left no excuse uncovered. Not enough border guards; An overloaded health care system; Unwillingness to act like a ‘military state’; An outdated method for detecting TB; No International Guidelines in place to inform countries on what action to take; Minimizing the risk of communicability; thereby, the importance.
No matter what excuse offered, none of them seem to hold water. Outlined below are refutations for each excuse proffered.
Mr. Speaker’s TB had been diagnosed in January; surely enough time to place precautionary measures.
A military state would not exist due to using quarantines. Although quarantines may not have been used for over a half a century, they are still on the law books, and can be used to protect the health of others.
Ample border guards existed in this case; however, the border guard did not see the alert placed on Mr. Speaker’s passport and waved him past the crossing.
The World Health Organization issued guidelines last year, stating that anyone with multi-drug TB (which excludes his type, of extremely drug resistant) ‘must’ not travel by public transportation until proven non-infectious. XDR-TB stands for “Extensively Drug-Resistant Tuberculosis” (though some reports have “extreme drug-resistant”), a term that was coined in a report by the US Centers for Disease Control and the World Health Organization that was published on World TB Day in March 2006. It refers to an intensification of a severe medical problem that has been growing for two decades — the evolution of strains of TB resistant to the drugs available. The term for an earlier stage of the evolution of drug resistance was MDR-TB, “Multiple Drug Resistant Tuberculosis”. The difference between this and the new form is that sufferers from XDR-TB are resistant not only to the usual front-line drugs for the disease but also to three or more of the six second-level ones, making it extremely difficult to treat. If a patient has HIV and also catched XDR-TB; the mortality is 100%.
What about the low risk of catching Mr. Speaker’s TB. The CDC has stated that his smear was negative for any TB bacteria, indicating that risk for infection in others was minimal. However, minimal risk does not mean no risk. Additionally, 17% of people exposed to negative smears, ‘but positive cultures’ have caught TB. This hardly seems like a minimal risk!
So what does explain this international scandal?
Poor communication, as always, seems to be at the center of this hubris. Communication was late, not specific, directed to the wrong person, and just plain inadequate. At the center of this missed or no communication was the issue of money. Who should pay to transport Mr. Speaker? Who should treat Mr. Speaker once he was contained? Who would foot the bill for all of the mishaps?
And, once again, as with Katrina, Homeland Security seemed to play a huge role, but play the part inadequately and ineptly. As a spokesperson for the World Health Organization summed it up: “This problem is now, and will remain, very scary to all of us”
The New York Times, June 2, 2007
http://www.nytimes.com/2007/06/02/health/02tick.html?_r=1&th=&adxnnl=1&oref=slogin&emc=th&adxnnlx=1180797599-v9x6+SiSTsN0xZyRDEnGGQ&pagewanted=print
Centers for Disease Control
www.cdc.gov/tb/xdrtb
World Health Organization
www.who.int/tb/xdr/en/index.html
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