The Dreaded TB Patient

[Timbuk3]

I don't know how much you overseas guys have seen of this, but it's BIG NEWS in America. Seems a guy with drug-resistant TB flew on a commercial flight to Europe, then snuck back into the country. Inarguably, someone with an airborne communicable disease shouldn't be on a commercial flight, but there's a bit more to it than that. Seems he's not communicable.

No one else in his family, including his fiancee (who I'm presuming he kisses, on the lips, once in a while) has it, and no one told him to stay away from them.

So now, of course, the media's full of stories about how he snuck back into the country (OH MY GOD, THE BORDERS AREN'T SECURE!), but they just sorta mention that he's since been flown twice for medical treatment, and would have gotten back in regardless.

And, of course, "the authorities" are "frantically searching" for "the endangered passengers" (FOR THEIR OWN GOOD, OF COURSE!)

All of this hysteria, I'm predicting, will lead to calls that WE NEED MORE OPENNESS WITH MEDICAL RECORDS! Because, you see, this guy posed such a threat and all, it only makes sense that the Ministry of Fearthe Department of Homeland Security should have access to everyone's medical records. And just for good measure, don't forget that dreaded flu virus that never seems to materialize (but made some investors some serious dough.)

Hmmm...

The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.

Now who'd want to get around that particular right we all used to hold dear?

Oh, yeah...

Under fire from abortion-rights groups, Attorney General John Ashcroft insisted Thursday that doctor-patient privacy is not threatened by a government attempt to subpoena medical records...

Watch for it.

[fishnfla]

1. Watch for this too

Contact lens solutions are not the cause of severe eye infections.

While the CDC was letting TB invested lawyer guy fly around, the FDA took out the chlorine from the water supply, stopped testing for amoebas in the water, and people are going blind as we speak...

next weeks story

[BleedingHeartPatriot]

2. Latent TB is everywhere. Why this guy? He's not virulent.

:shrug: MKJ

[LisaL]

8. He actually has the disease.

The disease is deadly even if the man himself is not highly contagious.

[BleedingHeartPatriot]

20. Yet, this scenario plays out over and over. Latent TB patients are part of our general population.

Why did this non virulent guy get all the focus, when contagious TB patients have been exposing folks to TB for years? And, I would have rather sat next to him on a plane than next to someone in the virulent stages of a gastrointestinal virus.

:shrug: MKJ

[LisaL]

23. Because he has a strain of TB that no current antibiotic can

actually cure.

[BleedingHeartPatriot]

42. I wonder how it was identified....AFB smear?

:shrug: MKJ

[wildhorses]

3. smoke and mirrors

move along folks, nothing to see here.

[The Velveteen Ocelot]

4. The Four Horsemen of the Apocalypse... Bush has 'em covered.

War? Yep. Death? No problem. Famine? Got it. Pestilence? Hmmm... OK, we got the TB Guy!

[Kagemusha]

5. Words cannot suffice for what I feel as I read your post.

You think this is a joke? You think this is a game? You think the CDC wastes the time of state, federal and foreign national governments over something that is no threat whatsoever (and which you seem to think will never and can never be a threat)? You think they do this for kicks? Or you think they're just in on the giant government conspiracy?

And for that matter, where in the world did you get the idea that the CDC cannot get the medical records of an individual who they believe poses a severe health risk to the public? When did you get this idea and who encouraged you to hold it?

[Timbuk3]

7. Seems like I struck a nerve with you

I wonder if you can calm down, a bit?

I don't think this is a joke. Where did you get that?

I think that you should at least do me the courtesy of providing me with evidence that this guy infected ONE person to justify the media frenzy of the past few days.

I think they do this because they airwaves are no longer under the control of their legal owners, the people of America, and they put out "what sells", what "gains them access", and what advances the political agenda of their parent company.

Yes. I believe that.

And please don't presume that the CDC can get your medical records without probable cause, or lay that "the goverment can do anything they want until they get caught" stuff on me. I've heard it all before.

I think this is an over-hyped story, and I think it's reasonable to look for underlying motivation when a story is over-hyped.

I don't trust this government. Not one bit.

Do you?

[Kagemusha]

10. The CDC had a test that said the guy had this XDR TB.

You don't think that's probable cause? You don't think it's probable cause mixed in with the guy running away from the efforts made to keep him in one place until something could be done in a controlled manner?

And I do not think I owe you the courtesy of providing you with evidence that this guy infected one person. I will be blunt. I do not want the CDC to wait until a guy known to have this type of TB, who is not cooperating with health officials, starts infecting people. That is too late.

Tuberculosis is not a partisan issue.

[Timbuk3]

15. You're getting hysterical

You don't have to provide evidence of anything. You're afraid, and that's all the justification you need.

Read down the thread a bit. This guy didn't endanger anyone. Come back in a month and you STILL won't be able to provide me with the name of one person he infected.

Read the NPR link and get back to me.

http://www.npr.org/templates/story/story.php?storyId=10634346

There's a certain form of government that thrives when it's people are in constant fear, and it's not American democracy.

[Kagemusha]

22. Notice how I write this in complete sentences with proper punctuation.

Thanks to one of the recent replies on this thread, an issue has come up which I will attempt to explain in a very calm and very serious manner.

Infectious diseases spread via bacteria or viruses. Contagion is not a binary value (i.e. a 1, or a 0); it is more like the concept of critical mass in nuclear fission. In a normal, healthy person, a body's defense mechanisms will prevent a self-sustaining infection from occuring if the amount of bacteria or viruses is below a particular level. Even though diseases have what amounts to explosive growth, too low an initial level will still result in the body winning.

Now take an individual who has an immune deficiency, perhaps due to AIDS or similar diseases that attack the body's natural defenses. Here, a level of infectious matter far lower than that which would infect a normal person can produce a successful infection in the person with a weakened immune system. Consequently, a person who is non-infectious to healthy people can be a mortal danger to someone with a weak immune system. Also, this latter person may, in turn, become a far greater threat to othewise healthy people. It happens. It is a possibility that must be guarded against by health authorities.

This individual may not wind up killing anyone, or even infecting anyone, but that would be a result that could fairly be called a combination of good luck on behalf of the people this man came in contact with and the fact that health authorities acted quickly so that even despite this man's reckless behavior, the danger was minimized. However, the danger would then only have been minimized by rapid action. Mr. Speaker most definitely endangered people. He may not end up having infected and killed them, but he placed them in danger.

With all due respect, even constitutional republics have emergencies, situations where things must be done for the public good with little regard for individual rights. The threat of the spread of extreme drug resistant TB is one such circumstance. Even if there was no court issued warrant involved, no sane judge would rule that actions taken to prevent an epidemic involving a deadly and nearly untreatable disease are unreasonable.

I write this with little knowledge of the exact legal regime under which the CDC operates with regard to WHO treaties and its congressional mandate and so forth; I am no expert. However, and while I somewhat regret using the phrase, there is a strong body of constitutional scholarship that views the constitution as not being "a suicide pact". The constitution foresees that there are genuine emergencies and that the government must be allowed to act in these emergencies; not without oversight, and not without the possibility of consequences, but it must have the freedom to act for the general good.

Stopping the spread of a deadly infectious disease certainly qualifies.

The real problem is that even if your questionable statement that this man "is not contagious" is wholly literally correct, this is TB, a known disease with known stages and that is known to get worse and more infectious. If the CDC and the rest of the government had lost this man and was not able to find him while he became more infectious and dangerous, the threat to the public would be immense and deeply unacceptable to any moral and responsible public official. Waiting until it's too late is not an acceptable option when the stakes are this high - and the constitution in no way requires that.

[Timbuk3]

25. Cool!

Lotsa full, calm sentences.

Thanks!

Now then, I have some knowledge of biology. I'm not a doctor, but I've had some training. I know, and this is an accepted medical fact, that a single germ can infect a person with a disease. I suppose I could google a link for you, but I have no doubt I'd find one.

Your concern seems to be that someone with a compromised immune system could be at more risk. This brings up some fairly obvious questions, like "since the closed cabin of an airplane poses a known health risk, shouldn't those people who are more subject to infection be required to sign a liability release?", but I don't want to go down those paths.

You speak of the "fact" that Mr. Speaker endangered people. I dispute this, as I have pointed out more than once already, but will stipulate for now that he did endanger people. I could think of several questions, again: "Do you support taking away a woman's right to choose and abortion?" "Do you support not allowing driving priviledges to people who can't maintain their cars in perfect order?" "Do you support mandatory genetic testing to determine who should, and shouldn't, breed?"

Again, those would be unproductive paths. Instead, please allow me to point out that it's your absolute belief that the government acted in our best interests AFTER THE FACT, but not before, that still baffles me. EVERY report I have read tells me that Mr. Speaker was not told he couldn't travel, that he was not told to avoid people, that he had no reason to believe until after he left the country he posed any danger to anyone, or that he'd have any problem returning after a vacation.

SO here is the question I need you to answer: "Why did the government react so strongly AFTER THE FACT, when it could simply have told him not to fly?"

Or, perhaps, this is a better question: "WHY is the reaction, here, one of 'the borders are unsafe and we need to fix that', and 'we need to do WHATEVER IS NECESSARY to track down the other passengers on those planes', instead of "WE NEED TO DO A BETTER JOB OF WARNING PEOPLE NOT TO FLY WHEN THEY HAVE A CONTAGIOUS DISEASE"?

Seriously. Have you seen that second approach to this "problem" proposed by anyone in our government? I'd SERIOUSLY like a link to that report.

So, if you want to stop, as you put it, "the spread of a deadly infectious disease", which is a better way to do it? By scaring the crap out of people for days, or by instituting a better "warning system" to let individuals at risk know they shouldn't put themselves into this situation?

[Kagemusha]

32. In the absence of helpful amounts of evidence re: the warnings...

This man seems to have been told that he shouldn't travel. That he really, really shouldn't travel. That it's a really bad idea to travel. That he should stay put. Having been told this, he left before an ORDER not to travel came down. Now, what this order is, I do not know; if it is some kind of legal process, it may well be akin to the warrant example. So, it's like a police officer saying, don't leave town; it's a request, not an order. But, he left town while the warrant was enroute. At this point the problem is elementarily simple: the guy should be in custody, but is not. But, because he left town before the order came, he did not violate that order per se and therefore did not commit a *crime*.

But, he was a confirmed danger to the public so everything else flows from the assertion of the need to thwart that danger, not because this guy is a criminal. ...Per se.

Now, one report got my attention for a really simple reason... and it cited Speaker's concerns, perhaps via a lawyer, I can't recall exactly, but let's say it comes from "the Speaker camp". That concern was that he would be trapped in Italy in diplomatic limbo. So, he decided to head back to the US, to the point of driving across the border and not flying because if he flew he might be stopped. And a very stupid border guard who isn't familiar with the idea of carriers of infectious diseases not looking physically sick let him in at the border.

It sounds to me like legal concern for this man's human rights and freedom resulted in giving him warnings rather than enforceable orders and he ignored the warnings and thwarted the orders... and that he had an awful lot of denial too.

But let me be clear.

The entire anti-pandemic health structure failed. It failed badly. It failed catastrophcially badly. It is after that system having failed and failed very badly that every effort is being taken to go above and beyond the call of cost-effectiveness to guarantee that this disease has not spread further, and if it has, to stop it. The public's reaction is indeed part of the motivation to do so. Also, doing their job is a motivation, since this is their job. This is apparently the first person to be forcibly quarantined by the government in this manner since 1963. I do not have access to all the details but the balance of evidence seems to support that this man disregarded strong warnings because his convenience was more important than the public's health in his own mind. Well he was wrong.

I'm not saying you're wrong beyond all certainty. You're just assuming that this guy did all this because the warnings were insufficient. I don't know the legal hoops that the CDC has to go through to not just warn, but dictate, that a person not travel. (And get the cooperation of foreign governments in doing so through WHO treaties and whatever.) There's obviously a process involved and it's not open to full public scrutiny yet. But your assumption that this man was simply warned too lightly and therefore was completely reasonable in his reactions is a large assumption, one that could easily be wrong, one that is argued to be wrong by plenty of public officials, and the idea that the guy said, "I'm HEALTHY, I have no symptoms, I will not be stuck in Italy because of some screw-up, I'm an AMERICAN and I have the RIGHT to return to my country" and then went and acted on that belief, just seems instinctively correct to me. It isn't as if this hasn't happened in other cases in modern history.

I just don't see how you can selectively pick and choose from the public's horror and revulsion and say that the reaction has nothing to do with 'we need to do a better job of warning'. The whole system failed from start to finish: the voluntary parts, the involuntary parts, everything. And that border guard's abject stupidity was the coup de grace. This is not funny. This is bad stuff. A long, hard look needs to be taken at every aspect.

[Timbuk3]

40. Two in a row!

Thanks!

Seriously, it might seem like I'm being snarky, but after a "not so auspicious" start, we're actually having a dialog. That never fails to impress me.

A couple of points:

"But, he was a confirmed danger to the public..."

I don't believe that statement is an accurate description of him, before he left the country.

"...concern was that he would be trapped in Italy in diplomatic limbo."

I have heard this, as well, but wouldn't dispute it, anyway.

All I can say is, if I had a life-threatening illness, had been told that my only hope of survival was to go to a hospital in Denver, had NOT been warned not to travel, and after my arrival in a foreign county I was told "stay there", I might not react rationally, either. If it was my wife or child instead of me I can ASSURE you I wouldn't act rationally.

"This is apparently the first person to be forcibly quarantined by the government in this manner since 1963."

Someone on Kos just supplied me with this link: "Man with tuberculosis jailed as threat to health"

http://www.usatoday.com/news/nation/2007-04-11-tuberculosis-threat_N.htm

In this case, he's a "poor Russian immigrant" who was raised in America, and he just got his clock radio back. That wonderful jailer in Pheonix thought he should be treated as a criminal for not wearing his mask in public.

BTW, if I haven't been clear about this, I'm familiar with Typhoid Mary. I have no problem with quarantine, involuntary if necessary, of someone who poses a health threat. What I'm questioning is how he could have been under treatment for months, his father-in-law worked at CDC for crissakes, and not known he couldn't travel, yet once he DID travel it was national news for days. You're right about one thing. The system failed. It's where and why it failed I want to know.

"I don't know the legal hoops that the CDC has to go through to not just warn, but dictate, that a person not travel."

I don't either, but they seemed to have no problem jumping through them AFTER he left the country.

Have I mentioned I don't trust a government that, under Rove's guidance, has politicized EVERYTHING it has had the chance to?

"I just don't see how you can selectively pick and choose from the public's horror and revulsion and say that the reaction has nothing to do with 'we need to do a better job of warning'."

That's really, honestly, seriously NOT what I'm saying.

I'm saying there's going to be a "Homeland Security" meeting about this, next week. Watch it. That's all I intended to say.

I appreciate the turnaround in our conversation, but it's late here. I'm going to say good night. I'll check back for a "rebuttal" in the morning.

[Kagemusha]

41. I've heard nothing to suggest the CDC knew he had XDR TB before he was in Europe.

Okay, more exactly, I heard specific reporting claiming the opposite.

Until we know for sure either way there's really nothing to discuss. Even about your assertion which I objected to, that Stranger is *not* communicable. How would I know. I'm only reading the news.

[hedgehog]

24. Now you've got me wondering

It didn't make sense that the father-in-law wouldn't object vociferously to airline travel if he was contagious. The lack of bacteria in his sputum is the measure of contagiousness. If he's been under treatment since January and coming back with negative sputum rests, it would explain 1. why he felt it was OK to travel and 2.why he was so shocked to find out that he had a very resistant form of TB.

Now, what story is passing by under the radar while this one monopolizes all the news outlets?

[barb162]

16. You're damned right! This guy's utter disregard for other people

is disgusting. Think of the hotel workers, the restaurant workers, the plane passenger, cabin crew... and if any of them are immune compromised/ susceptible to this disease.

[Timbuk3]

18. May I ask what you do for a living?

You seem to have medical knowledge that I lack.

What danger did he pose to the hotel workers, etc?

Please be specific.

"He could have infected them" is not specific.

[barb162]

30. What danger did he pose to the hotel workers, etc? You're kidding, right?

Did he perhaps talk or cough in their presence or some time before they came to clean his room? Look at the second line below re "coughs, sneezes, speaks, or sings." The germs float in the air for hours ...so they are in his room cleaning it every day.


"snip
Drug-susceptible (regular) TB and XDR TB are spread the same way. TB germs are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs can float in the air for several hours, depending on the environment. Persons who breathe in the air containing these TB germs can become infected.
snip"
http://www.cdc.gov/tb/pubs/tbfactsheets/xdrtb.htm

[LisaL]

31. The TB is very dangerous, but from what has been reported, the

guy himself is not highly infectious because he is not actually secreting this bacteria. Sounds like he is in the early stages of the disease and hasn't really gone to the contagious stage yet.

[alittlelark]

6. I see it possibly as a positive.

(put on tin-foil hat)

Perhaps some CDC employees were disgusted by the shrubs cutting of $$$$.
Perhaps they wished to SHOW US why they need $$$.
Perhaps the only way it could be done was through the SENSATIONALISM that gets it "ON AIR"

....The top CDC scientists don't even warrant 15 seconds normally....booooooring....


Desperate people do desperate things for moral reasons.

Think about the ppl involved and the SENSATIONALISM.

[Kagemusha]

13. What do you people think, the TB test is fake?...

Or what here?

[alittlelark]

29. Those w/ regular immune systems will not be effected.

Even among those w/ weakened immune systems that odds are low of infection (over 4-8 hours).


We have been told that the odds of him transmitting it to someone else is very low (by the CDC). I do not purport to KNOW anything.... I'm just throwing out ideas.:evilgrin:

[Kagemusha]

35. k, thanks

Others on other threads seem to be suggesting a fake test though. ...Well whatever, it's an international embarassment and it seems we're collectively getting off much luckier than we have any right to.

[LisaL]

9. I don't think he has flown for his treatment on commercial flights.

I think special flights have been arranged for him, and his insurance company is paying for it (or so have been reported).

[Timbuk3]

11. That sounds right, to me

But in doing a little research I found this on NPR:

According to the World Health Organization, there have been no recorded cases of someone becoming sick with TB after merely sitting on an aircraft with an infected person. There are two cases of people on long flights becoming infected but never showing symptoms.

and:

On Good Morning America on Friday, Speaker said he didn't understand that he might infect others.

"I repeatedly asked my doctors, 'Is my family at risk? Is anybody at risk for this?' I turned up smear-negative on all my cultures. They told me I wasn't contagious, I wasn't dangerous," Speaker said.

Just for the record.

http://www.npr.org/templates/story/story.php?storyId=10634346

I also cross-posted this on Kos, and someone there is raising the possibility that this guys HIPAA rights have already been violated.

http://www.dailykos.com/comments/2007/6/1/231149/3448/21#c21

[LisaL]

14. Regarding no cases of TB due to someone merely sitting on the

airplane next to the infected person-how would anyone know? Mr. Speaker himself has no idea how he contracted TB. And so, I presume, many of other people that catch it.
How does anyone know where they got it?

[Timbuk3]

17. I can't answer your question

I'm not a doctor.

WHO says "there have been no recorded cases of someone becoming sick with TB after merely sitting on an aircraft with an infected person."

Given my lack of knowledge about Mr. Speaker's medical training, I'm going to have to go with the WHO on this one, although I noticed that he was told he didn't need to stay away from his family.

Doesn't it seem reasonable that someone in the mainstream media would have pointed this out a little more often in their multi-day frenzy of reporting on this?

[LisaL]

19. Again, just because there are no "recorded cases," doesn't mean

it actually can not happen, or did not happen already. Unless WHO knows how everyone who has TB contracted it. But you are not naive enough to think that, are you?

[Timbuk3]

21. Of course not

Only a fool would equate "no recorded cases" with "has never happened."

What I will say is that, to me, the mass hysteria exhibited by the media, the "frantic" calls for all of the passengers on those planes, presumably at the behest of our government (some of whom surely must have been able to look up the FACT that there are "no recorded cases") without tempering it with those facts points a different direction than "working to protect the public."

I'd substitute "manipulate" for "protect".

[barb162]

12. Agree with Kagemusha here. This is no joke. This TB strain

is resistant to 11 of 13 antibiotics and is fatal in more than 50% of cases. What's so fucking funny about that and the fact that this asshole decided to DISREGARD the lives of others by possibly infecting them with something really deadly. If this asshole turns out to be non- contagious, then many many people exposed to this creep will consider themselves very lucky. And since not everyone has been tested yet, we don't know at all if he really infected someone. How do you know if he came into contact with someone who has immunity problems?

[lligrd]

26. Nothing Scares Me More Than Watching The Public

over react to a public health scare. You would think we had learned nothing since the days of leper colonies. And yes, I find it quite conceivable that the current government would use something like this to both divert attention from real problems and use it as an excuse to do away with the little bit of privacy they haven't yet stolen from us. And no, before anybody asks, I don't trust the government. Why would anybody?

[Timbuk3]

28. I also don't trust that our current government...

...wouldn't turn TB into a "partisan issue."

I don't think anything is too low for them.

[Timbuk3]

27. I've made my prediction

I may be right.

I may be wrong.

The facts don't support the government's INaction prior to the event, or the loud REaction after the event.

But I have one final observation. Again, from the NPR link:

Next week in Washington, the House Homeland Security Committee will have a hearing to investigate how Speaker evaded federal officials' efforts to control his travel.

Believe what you choose to believe, but like I said, "just watch."

[lligrd]

33. Your Point Is Already Being Made

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=1022208&mesg_id=1022208

[Kagemusha]

34. They don't need a hearing for that. A border guard decided to play god.

And thanks to that, someone who shouldn't have been let in, but who was white and healthy looking, was let in.

And yes, the border guards fall under Homeland Security. Who do you think would be called in for a hearing - the Navy?

[LisaL]

36. I doubt Canada would have decided to keep the TB guy in anyway.

Considering how much his treatment is going to cost, and his disease has no cure, I doubt Canada would have decided to just keep a US citizen there.
I am not suggesting the border agent did the right thing, but I think eventually the TB patient would have ended up in US anyway.

[Kagemusha]

37. I'm getting deja vu. I'm sure this very situation has come up before.

Certainly not about this exact kind of TB but... I'm sure there has been a situation like this in the news, on DU, before, in terms of people saying Canada 'wouldn't have decided to keep the guy in anyway'.

...Regardless, it's not about ending up in the US, it's how. And the proper way would be to hold the guy in as safe a place as possible, take proper precautions, let the CDC pick him up (ASAP, of course) and take him to the most appropriate facility.

Letting him drive through a checkpoint and go anywhere he pleases is not something that should be treated as an acceptable alternative because "he would have ended up in the US anyway". IMHO, anyway.

At least it wasn't worse. Much worse.

[LisaL]

38. I didn't say it was acceptable. I am actually amazed that the

border agent just let him through because he "looked healthy."
Obviously there is a huge problem if the border agents just let people in who are on the list, if those people "look healthy."

[Kagemusha]

39. Agreed, huge problems indeed

Someone needs to thwap them upside the head and tell them the CDC does not casually issue these orders...

[kurth]

43. "I felt very abandoned," Andrew Speaker said

Yes, the CDC forced him to fly to Europe to get married and honeymoon, because he couldn't find anyplace within driving distance to get married.