Nature Medicine | Spoonful of Medicine

Good reason TB nervous

By now, you’ve all heard about Andrew Speaker, the man who brought extensively drug-resistant tuberculosis to full-blown US attention.

The case is undeniably bizarre. Man has deadly infection, health officials try in vain to get him to stop flying, he puts hundreds of passengers at risk despite being on a so-called “no-fly” list, a customs official lets him in because he doesn’t look sick… oh, and most bizarrely of all, his father-in-law is a researcher at the Centers for Disease Control and Prevention specializing in, wait for it, TB.

My first response was to think that the US was over-reacting. After all, XDR-TB has been found everywhere in the world. What’s so special about this one case? And it’s not as if the US is teeming with HIV-infected individuals, who are most at risk of catching TB. The reports all said too that his wife hadn’t become infected despite presumably spending lots of time with her husband.

But then the newspapers started detailing the many missteps that led to Speaker’s dangerous jaunts across the Atlantic. Now I, and no doubt every health official in the world, am wondering how we can ever hope to sucecssfully contain something like a flu pandemic, if we can’t get one guy to stay put. I’m not really for the idea of quarantining people. When SARS hit, some governments went a little 1984-ish nutso with nonstop surveillance and what-have-you. But I can’t argue that in the end, that’s what stopped SARS in its tracks, nor that most models show that containing the first few infections will be key in stopping a flu pandemic.

What I think we need is some updated quarantine laws, that make sense and take into account individual liberties. But even before that, I hope governments quickly learn how to stop infected people from putting everyone around them at risk.

Comments

  1. Report this comment

    The Gay Species said:

    Nice observations, but a deeper question has to be asked: Not whether to quarantine, but whether individuals can act prudently? Assuming “blame” can be shared in this case, the obvious first point to make: the infected individual is not a stupid or illiterate man. He just acted stupidly (if he knew he had TB). Most of us, I hope, know to confine ourselves to home, drink plenty of water, and get some rest when we come down with a COLD, and all of us do when we come down with the FLU. And neither is as serious to one’s health or the public’s welfare than TB. And, if, a big if, the TB was known to be of the drug-resistant kind, then where in the hell were his providers informing public health officials? (Not to mention their complicity by deference to stupidity.)

    Did the infected’s physician/provider offer any guidance to the infected? If not, why? (A first question.) If so, why did a contagiously-sick individual act so wrecklessly?

    Before resorting to quarantine, which I truly understand may be necessarily propitious (however undesirable), why is the infected not instructed in the benefits and features of confinement (and general harm avoidance)? And, if he was so instructed (it takes only a few seconds), why did he act so contemptuously of others?

    (For my own readers who think my “Do No Harm” is merely a limit, this is a perfect example of its use at a minimum not being minimally applied, maybe not even considered.) If we cannot get individuals to “comply” with a minimum standard of “do no harm,” all the other axiological concerns are extraneous and useless.

    Rather than expending resources on quarantine (solution of last resort), perhaps (just a thought) we might start with a public education program in (non-religious) ethics and morality of human conduct, of which “do no harm” is the elementary, primitive, and necessary start. (No one could fail that part of the course.)

    It may, just may, be more utilitarian than teaching Creationism, Abstinence, Cures of Homosexuality, and other forms of denial, and certainly it is more benevolent. It’s cost-benefits analysis should tip heavily in its favor. Since dissimulation seems so popular these days, we could even call the course “Public Safety and Health,” or even “Common Sense,” and make it a graduation requirement. Assuming teachers taught it, assuming students listened, assuming bureaucrats and government did not contravene, it’s a very simple solution to the otherwise complex and expensive alternatives, including quarantine.

    Assuming, of course, students applied what they learned in the art of life. Is that too much presumption?

  2. Report this comment

    jumpyd said:

    First of all, as you may have heard, his doctor, while advising against travel, specifically told Mr. Speaker that he was not contagious.

    Does this change the nature of this discussion? It would seem to me that the blame lies in the faulty diagnosis, not in Mr. Speaker’s actions. If I had been told that I was not contagious, why wouldn’t I go on a planned trip?

    But, honestly, there is a larger issue here that has been missed. This entire episode happened only because Mr. Speaker chose to visit a doctor for minor symptoms. What if he had chosen not to bother?

    Or, what if Mr. Speaker was not a successful attorney with health insurance and the ability to pay his co-pay at the doctor’s office? What if he was one of the 48 million uninsured, for whom visiting a doctor is not even a choice they can make?

    Our deplorable state of health care could have remained blissfully ignorant of this entire episode if that were the case.

    Makes me wonder…how many other cases of this TB are out there walking around without access to health care? And you’re worried about 200 people on a plane? How about worrying about the people any of those 48 million uninsured come into contact with? Based on sheer numbers, wouldn’t that be more important?

    How can you even begin to address how to contain a health care crisis (TB, flu pandemic, whatever) when fully 15% of the population does not even have the option of visiting a doctor?

    This entire discussion is a perfect example of trying to seal a window while the front door is wide open.

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    Apnea accessories said:

    I love your sarcasm, it makes reading your posts very enjoyable. Great article, the whole Speaker case is a nightmare. Luckily, he has now been “downgraded” (if you want to call it that) to a less severe case of TB.