Effect Measure

My defense of the TB guy has drawn a lot of traffic and some of the comments imply my view is colored by a case of misplaced compassion. Since I’m a physician I won’t shy away from being called compassionate. Whether true or not in my case, it is a desirable trait for a doctor and nothing to be ashamed of. However I don’t think my opinions about this case are due to sentiment. I would defend them on the grounds they are sound judgments of a public health professional. Since I am unlikely to convince the doubters by repeating my arguments (you can find them at these links), I will do something else. I’ll let other public health professionals repeat my arguments.

In particular, I’ll let the Center for Biosecurity at the University of Pittsburgh Medical Center do it. They do not reference this blog as one of their sources and despite the close similarity to my arguments I am quite confident they arrived at them independently. I am not always in agreement with the Center. In particular I do not always agree about the value of biodefense. One thing for sure, however. They cannot be accused of sentimentality. They are seasoned and hardheaded public health professionals who know this area well. Here’s some excerpts from what they think about the TB story, which you can compare with my version. The whole thing is here if you wish to satisfy yourself I haven’t taken things out of context (I have omitted their discussion of the need to invest in diagnosis, treatment and prevention of infectious diseases of global significance like TB):

Careful examination of government and public responses to the recent case of Extensively Drug-Resistant Tuberculosis (XDR-TB) is critical. However, in the course of this assessment, there has been so much focus on border control issues that the broader public health implications of this case and the associated events might be missed. Specifically, this case raises important questions about the nation’s ability to detect and respond not only to tuberculosis (TB) outbreaks, but also to other major outbreaks of serious infectious diseases, whether they are the result of a natural epidemic or a bioterrorist attack.

[section of background on TB prevalence, mortality and drug resistance omitted]

The fact that one person with XDR-TB flew on several commercial flights should not be as alarming as the fact that millions of contagious TB patients are intermixing with and potentially exposing uninfected people every day throughout the world. There can be little doubt that many TB patients (including those with MDR-TB and XDR-TB) have traveled many times locally by public transportation and over longer distances by airplane.

[snip]

According to news reports, the patient recently diagnosed with XDR-TB was first suspected of having TB in January 2007 on the basis of an incidental finding on a chest x-ray. It appears that he had an appropriate routine and methodical work-up that resulted in a diagnosis of XDR-TB 5 months later. This long path to diagnosis is a direct result of the current state of TB diagnostics.

[snip]

The patient with XDR-TB has said he decided to fly home from Europe against the direction of public health authorities because he was frightened that he would be confined to an Italian hospital, that he would never get home, and that he would never get well. This refrain is common in the history of epidemics. When people become so frightened by the possible government reaction or by the possible public reaction to their illness, they avoid medical attention and sometimes disappear. This has been documented in past U.S. smallpox outbreaks,in the HIV/AIDS epidemic, and in the 2003 SARS outbreak in Beijing and Hong Kong.

If infected individuals are made into public scapegoats, it may increase the likelihood that in the future people with highly contagious diseases will be reluctant to seek proper medical attention. It is in society’s great interest to avoid doing anything that makes it so frightening to get diagnosed and/or treated for infectious diseases that people decide not to seek diagnosis and care. Addressing this critical issue is not only a matter of common decency–it is also a matter of collective enlightened self-interest.

You may still disagree with me. But you will also be disagreeing with other public health professionals about a public health problem.

Update: Other posts here.

Comments

#1 Ex-drone
June 9, 2007

So let’s say an otherwise healthy Mr Speaker gets on a plane and buckles up. Just as he is taking off, his seat mate leans over and says, “I’ve just been told that I likely have multiple drug resistant tuberculosis, but my doctor says that I’m probably not infectious. So I thought, ‘What the hey. I’ll take a chance.’ Anyways, how’s your day going?” Tell me that old Andy is not going to shift away in his seat and hold his breath a lot during the flight, and tell me that he’s not going to stew about what right his neighbour has in taking a risk with other people’s lives. Acting socially responsible often requires accepting personal hardship to protect others and has nothing to do with splitting legalistic hairs.
#2 revere
June 9, 2007

Ex-drone: Yes, I agree it is not about splitting legalistic hairs. After all, he did nothing illegal, so if it were about that, we wouldn’t be discussing it. It is about public health, which is what my posts were about and what the CBN/UPMC piece was about.

In your example, let’s say the person doesn’t lean over and say that (why would they if they thought there was no risk to anyone else?). Or suppose you get on an airplane and lean over to your seat mate and say, “By the way, I was feeling somewhat achey when I got up this morning. I’m sure it’s nothing.” Or you send your child to school with the sniffles. You tell another parent, “Johnny was a bit off this morning and his nose is running, but I don’t think it’s anything serious.” But I’m sure you’ve never done that or gone to work feeling a bit sick. Right?
#3 M. Randolph Kruger
June 9, 2007

“In US law, endangerment comprises several types of crimes involving conduct that is wrongful and reckless or wanton, and likely to produce death or grievous bodily harm to another person.

The offense is intended to prohibit and therefore deter reckless or wanton conduct that wrongfully creates a substantial risk of death or serious injury to others.

The law specifies several types of endangerment:

* Child endangerment: placing a child in a potentially harmful situation, either through neglect or conduct.

* Reckless endangerment: A person commits the crime of reckless endangerment if the person recklessly engages in conduct which creates a substantial risk of serious physical injury to another person. �Reckless� conduct is conduct that exhibits a culpable disregard of foreseeable consequences to others from the act or omission involved. The accused need not intentionally cause a resulting harm or know that his conduct is substantially certain to cause that result. The ultimate question is whether, under all the circumstances, the accused�s conduct was of that heedless nature that made it actually or imminently dangerous to the rights or safety of others.

Endangerment can range from a misdemeanor to a felony.”

HIV/AIDS patients are tried for this often. Knowing and wilful act to have unprotected sex or deliberately doing it as an act of violence to get back at a gir/boyfriend or hiring someone with this to have sex with your husband/wife that has it. Its murder 1 if they develop it and die.

Same thing as speeding through a construction zone. You might not hit anyone, but you are guilty of speeding and because it was a wilful act you are guilty of endangerment.

I am far from giving this guy a pass. From the time he was informed by the people in GA and then CDC not to move he did in fact commit an act under every states laws regarding this. Not too sure about Italian/Czech Republic law but I am sure its there too. Even the Uniform Code of Military Justice and US Code its covered and this is what he did at the very least. Redundant though to prosecute him. With the possibility of a cure being about less than half he is already on death row.

So lets take a long look at the chain of events. First he is told that travel isnt what he should be doing by “public health officials” and he jumps a plane and is put on the no fly list. He makes it anyway to Santorini. Then he flies to Italy where he is chased down on the phone. Told again not to fly and report to the hospital. A lot of thrashing conversation took place. At the final communication between the public health officials he was in a foreign land and they told him not to move. It was a cognizant decision on his part not to follow medical officials advice. So we are to just accept that A. Speaker got onto a flight AMA, two in fact and then presented himself at the US border where he wasnt detained and he made it back in. When he hit US territory he was indeed a suspected bio-terrorist because of the acts he committed. I find nothing wrong with the law, only the enforcement. The fact that he was told not to go or not recommended and that he should seek treatment rather than get married is where things went south.

I find the supposition that this is like AIDs and HIV a little weak. Its not in Andrew Speakers purview to decide that he can take the public health into his hands in any country. He doesnt have the right and its not second hand smoke. The attitude of it was a small risk is in whose eyes? Its those public health officials we keep hearing about and they told him not to move. What if it was highly infectious smallpox, B. flu? You cant state that he has the right to fly or do any of these things that he did once he knows definitively that he is a threat. And they told him he was a threat. He didnt even put on a mask. The law is simple and besides that, he didnt take any precautions, nor for the more important issue…. HE DIDNT ASK FOR THE PEOPLE WHO HE MIGHT HAVE INFECTEDS PERMISSION! If he had I would have gotten onto the plane, with a mask for him and me and we would have flown back to the US together. He could have shown up at the Embassy in Rome and they would have been forced to fly him back at US expense. Hell, I wouldnt have left him in Italy. Far from it. I want him to have every chance at living and Italy wouldnt have been it.

He was also told before he left he needed to be in Colorado… So this stuff isnt happening in a vacuum and it seems that everyone is concerned about Andrews right to “possibly” infect others, or lack of it. This is where the courts always have found that it goes back to what they call “first act”. First act is when either in civil or criminal law that someone did something that was either questionable or actually known to be illegal. E.g. Scooter Libby rather than just not talking to the FBI or Grand Jury he opened his mouth and started a chain of events resulting in obstruction. Not convicted of outing anyone as Plame wasnt a spy. But he did commit an act that was illegal.

Back to Speaker. I am infectious maybe, but perhaps only slightly. So lets go to Santorini and deliberately change flights outbound so I cant be caught after being told not to fly. This is where the cognizant act comes into play and it is a misdemeanor first and then up to a class E felony in GA, TN, MI, MS, NY, PA, OH, KY, IL, VA, MD and those are the ones I looked it up in. It looks like its in every state except for a word change or two. It makes no distinction if he has AIDS or any other disease for that matter. If the person in question fails to follow medical instructions of the “public health officials” then he/she is considered to be a threat.

There is a big difference between an undiagnosed runny nose as to whether its a sinus infection, cold or flu on a kid or if you are acheing this morning. You can down to bottom it a bit if you want Revere, but the kid is not having a seizure in the playground either. They are telling someone to boot. Keep away from little Andrew this morning, he has XDR-TB but I am sure its nothing serious is the supposition. That stands in the way of good common sense and there was a lack of that on the part of both the “public health officials” and Speaker. All things being equal, Andrew would have been getting married in Colorado if I had been in charge, never to grace the shores of Greece or Italy.

Better get used to this folks, we are seeing the beginnings of Bird Flu in different ways and how we will react. Andrew Speaker very likely brought bio-defense to the forefront and while Congress aint the brightest bulbs in the sockets they do have oversight. This could result in new laws that make the A. Speakers in the world full blown criminals and I mean definitively rather than this ambiguous stuff. The states already have it on their books and its loosely worded by all and likely for just this reason. He could have been arrested now for suspicion of endangerment, and then indicted by at least GA or NY for the actual act. Criminals by condition if there was ever a case for it. Having a disease will put you in the governmental crosshairs. Me, I’ll take my BF to go.

Initially BF will be treated like someone has rights and that will last up until the time that the last bed, ventilator, food, water, blanket is taken when it breaks out.

May God or Revere help us all. I am not raising Revere to deity status but If the only voice you hear is……
#4 Ollock
June 9, 2007

I agreed with the original post and I still agree. Mr. Speaker might have been better not to go on any trips, but in his place I’m not sure that I wouldn’t do the same. I don’t think any one can know what they would do in situations like this until they actually experience it. I would hope I could do the right thing, but I honestly don’t know.
#5 PennyBright
June 9, 2007

Given the recent revelations that Mr. Speaker was directly told by an official of the Fulton Co. Health Department that he was “not contagious” and that “there was no reason for him to be sequestered” and that “you are not a threat to anyone right now”, I have considerably less antipathy towards him then I did initially.

The fact that he was cagy enough to tape the conversation in which he was told this leaves me a little cold…. it suggests he was well aware that some kind of situation like this might come up.

http://www.accessnorthga.com/news/ap_newfullstory.asp?ID=93456
#6 revere
June 9, 2007

Randy: You have a position. You’ve stated it. If you were a prosecutor, you would have to decide if you could bring charges. But no one brought any charges and no crime was committed (as in your example, there was no speeding). Nor could anyone have made a charge he endangered anyone stick because he clearly didn’t and was told he wouldn’t have. So you’d have been a runaway prosecutor. Bird flu is something else. It is not stoppable this way. Resistance is futile, if resistance means stopping a pandemic. But preparing for one is the only rational step, like buying insurance but better because you get pay off even if a pandemic doesn’t happen.

The real point of my post was to say this was how many, if not most, public health professionals appraise this situation. I am not an outlier but in the mainstream. That’s not to say there might not be some difference of opinion, but my views are what most of my colleagues think as far as I can tell, and I got emails and personal communication to that effect.
#7 revere
June 9, 2007

PB: Both Speakers are lawyers. When faced with an oral statement by an official they do what lawyers always do, they documented it. You wouldn’t do that and neither would I. That’s because we aren’t lawyers. If he hadn’t, no one would believe him and it is more than possible the Fulton County officials might remember it diffrerently, not lying, but making their memory conform to what everyone wanted it to be after events transpired as they did. The more important issue here is the public health appraisal, in general, not the specifics of this case. This case is probably repeated dozens of times a month around the world. We just don’t know about it because most people in Speaker’s position don’t hurt their ribs and get a chest x-ray.
#8 M. Randolph Kruger
June 9, 2007

Well Revere you are right, its my opinion. Penny is very Bright and hmmm…. How many conversations do you have with a recorder going? They planned this from the start as far as I can tell Revere. And they by Speakers own admission tell him NOT to leave Italy and that he was told he might be infectious at that point. This is the reason we have prosecutors and not medical people running the laws. At the point they told him not to move and he did, he became a bio-terrorist IMO. I rest my case.
#9 Lea
June 9, 2007

The whole point here may well come to rest in the fact(s) that he was basically hunted down in another country and told not to fly. After he was told it was o.k. to fly.
Come on, double standards, bull crap, mixed messages… . One minute it’s o.k. to fly, the next it’s not?
Too many holes in this story.

And revere, with all due respect, you would have probably done what Speaker did? I wouldn’t have, but then deep down inside I do consider responsible behavior a priority for anyone to even be called a human.
As MRK briefly stated: “Better get used to this folks, we are seeing the beginnings of Bird Flu in different ways and how we will react”. And the UPMC said: “When people become so frightened by the possible government reaction or by the possible public reaction to their illness, they avoid medical attention and sometimes disappear”.
The pandemic is going to be a regular circus with dozens of Speaker’s, ah clowns, running around doing “their thing”.
#10 revere
June 9, 2007

“deep down inside I do consider responsible behavior a priority for anyone to even be called a human.”

And of course you get to say what is responsible behavior, right? And therefore you get to say who is truly human? Do you really mean this?
#11 Lea
June 9, 2007

revere, dear one, your opinion is respected, never think otherwise.
Honestly, tell me what person on this planet does not judge another? And if there’s someone who says they don’t, they’re lying. (There’s only a hand full of people that I can come up with who don’t judge another).
We are all judged, one way or another, by our actions. Is this not truth?
#12 revere
June 9, 2007

Lea: Dunno. I think most of us just try to get by. I don’t do much judging and I don’t think I’m so unusual in that. I know lots of judgmental people. Tomorrow I will have been married to one for 35 years (yes, it’s our anniversary) and I think she’s a good one. But she’s different than me in the judgmental category. So I’m not too quick to say we are all judged or all judging. I do judge, on occasion, and often she doesn’t. It’s not a universal. But I will tell you truthfully, I mostly don’t judge others, although as Mrs. R. will be quick to tell you, I have lots of opinions. It is always a reflex to try to put myself in their shoes and that makes judging pretty difficult.
#13 Lea
June 9, 2007

Happy Anniversary. 35 years adds to your credibility. (Like you needed to add to it, geez).

Going cruising in the Volvo?!
#14 revere
June 9, 2007

LOL. Yes, in fact. Planning a day shopping trip to some outlet malls a couple of hours away. We just like to do things together. Doesn’t matter that much what it is.
#15 Paul Todd
June 9, 2007

Based on the CDC Directors recent comments that they plan to use this case to make it easier for local public health officials to prevent patients with infectious diseases from taking “overseas” flights, not to mention information that has come to light since the initial hysteria on his not being infectious, it is clear the motivation here had little to do with public health, but was manufactured to get the public support (and international support) for allowing government restrictions on travellers leaving the country or entering the country, which of course requires the government to share information on US passengers health with foreign countries, and receive the same information on foreign passengers from other governments. This is something which clearly needs to be discussed to prevent abuse, and Speakers treatment was clearly an abuse of power and infringed on his rights to travel.

A Doctor saying he prefers you not to travel while he sits face to face with you without wearing a mask is clearly not very convincing to anyone with travel plans that he would be a threat to passengers, especially as he would be a bigger threat to his wife and child, and received no instructions to avoid contact with them. Why? He was not infectious.

Before his overseas trip it was ok for Speaker to walk around in the US, go to work, play with his kid, take public transportation, watch a movie in a crowded theater, have face to face meetings with his doctors where none of the doctors bother wearing a mask, and continue to do so for another 4-6 weeks until he could get a bed in the Denver hospital, but it was not permissible for him to take a 6-8 hr flight home just 2 weeks after his Doctors told him he still was not infectious?.

CDC’s own web site says the risk of TB infection during air travel from passengers who are “infectious” is very low, and Speaker was not infectious.

But hey, this is a country where up to 40% of people believe in creationism and a sizeable percentage still believes Hussein had something to do with 9/11. If someone on CNN or Fox says it is bad, it has to be true.
#16 revere
June 9, 2007

Paul: I have been watching the same media reports. I’m not sure if this was planned and djinned up, a case of opportunism or Gerberding doing the bidding of the Administration. But it is dangerous.
#17 M. Randolph Kruger
June 9, 2007

THAT is exactly my point here. You get 25 A. Speakers running around the US or world with BF or XDR-TB and then those same prosecutors are not going to be asking them to stay home, they will tell them. With or without the law they can haul anyone in on suspicion for 72 hours. Georgia’s officials are pretty ticked off and already talking about amending their laws.
#18 revere
June 9, 2007

I’m not sure what your point was, given I had three options. But for bird flu, it is a non issue. You don’t stop it that way. If you have someone you know is already sick with it, then you have thousands of others. The horse is already out of the barn and closing the door is a waste of time. With TB, you already have dozens of A. Speakers traveling on airplanes around the world. They aren’t infecting people and you don’t know about them. That’s the public health part of it. Your point, whatever it might have been, wasn’t about public health.
#19 Lea
June 9, 2007

Therefore I am a bit confused too. What are we really discussing? The CDC, Speaker’s credibility, another clandestine movement by the government(s) to take away freedoms? Please, enlighten me.
#20 revere
June 9, 2007

I’m not much for conspiracies, but I do believe there are those in the government, particularly this administration, who wish to have more tools to control people. The hullaballoo over this case is an opportunity to get them, despite the fact that these tools are not indicated or required by public health. Yet public health will be the excuse.
#21 gilmore
June 10, 2007

Posted by: revere | June 9, 2007 07:10 PM
We just like to do things together. Doesn’t matter that much what it is.

*************************

That’s Love!!! Congrats.
#22 Jody Lanard
June 10, 2007

.
The unmentioned elephant in the room here is this: Fulton County, the State of Georgia, and other states already have rules they could have used if Speaker had demonstrated the more usual (but still infrequent) types of noncompliance by active TB patients: violating home isolation recommendations; failing to comply with directly observed therapy.

Some states and counties clearly spell out to newly-diagnosed active TB patients what the “advice” is — and the consequences of ignoring that advice. See for example the Montana Home Isolation Agreement, which includes this line before the patient’s signature line: “I understand that if I fail to comply with these conditions, legal action may be taken, possibly resulting in court ordered detainment. I have read the above information and understand it.”

There can be no “covenant of trust” without fully informed — or warned — consent.

Georgia’s guidelines for respiratory isolation of patients with smear-negative, culture-positive drug-resistant TB call for home isolation, if the patient has a stable home. (See pages 68-70 of the Georgia TB Reference Guide 2001)

None of this would have happened if officials had followed their own existing community public health policies.

That is what makes me suspicious about the knee-jerk calls for pre-emptive detention.

Part 2 of this story presents a much more complex problem: By the time CDC officials reached Speaker in Rome, he had very little reason to trust anything he was told, given the profoundly mixed messages he seems to have received before he left the U.S.
#23 M. Randolph Kruger
June 10, 2007

Jody-The laws are there already in just about every state. To close the holes in bio-terrorism that are actual or perceived they have to limit the freedoms of people. The world we were raised in is over. We still have a mindset in this country that we are dealing with a criminal element rather than one of state sponsor terrorists and armies. The enemy we face is two fold, the walking kind and the walking kind with a bug.The possibilities are endless for bio anything and everything, all of which relate to Speaker, but are not the issue right now.

Speaker flat did wrong. Revere’s opinion is that just because one third of the world has TB that we shouldnt have worried and that he wasnt infectious. Says who? He went from negative in a sputum test, to XDR-TB in what a week of discussion. Then they told him that he needed to be in Colorado before, during and after he left. But really the issue isnt so much that he has TB, only that AMA he traveled. In their opinion he should have been traveling to Colorado rather than out of the country. They couldnt detain him without governing law and without first commiting an act. When he did leave, the act was committed and the wheels went into motion. Regardless of whether Daddy in Law was the greatest TB researcher in the world, not wearing a mask or in the room with all of the Georgia health people and they were not wearing masks he left AMA. That is when he first affected the public, then the countries in question. Those countries in question have a little different read on this….They would have detained him permanently or until there was a resolution. Oh, Andrew was right when he knew he had to get out of the countries in question and back to….Colorado.
The fact is that he should have never left and regardless of what tests he had taken or whatever it isnt his right to run around with even a slightly contagious disease that MIGHT infect someone that could likely kill them.

There are varying degrees of this and this isnt the first time A. Speakers of the world have been running around and thats why we already have the laws. Greece–Detention, Italy–Detention, Czech–Detention. The US, well you know we have the courts and all and these guys are attorneys and well, I want to go and get married and well, the sputum tests are clear. Are you telling me NOT to go? They couldnt, they cant and Speaker knew they couldnt do anything unless he did leave.

We expect people to make rational decisions and I fear that because Speaker did something that was pretty dumb that those flights and travel in everyones future are going to be fraught with more than just the shoes coming off. I mean a full blown security check and no last minute travel without having to pay a premium to find out whether you have had contacts with terrorists, met with a foreign national, been plugged into a national medical computer and that last one bothers the shit out of me. There are going to be calls for this from both sides of the aisle because A. Speaker single handedly knocked bio-security on its ear. Its not so much he was sick, couldnt help that. But it showed what one determined person could do inside the system and the system failed, even when actually confronted by a human asset. That isnt escaping the smart guys, it willme another reduction in rights if they do something about it. But its the old rights of the one outweighed by the many thing. Speaker if he had been nabbed in Italy would have been in a hospital jail ward and returned likely in a pine box. He could have also not gone which is what was suggested. Next time out they will TELL the next one what he can and cant do. EOT
#24 crfullmoon
June 10, 2007

He moved his departure date up two days early
so they couldn’t write something “don’t fly” up
all legal and hand it to him.
(Which they should have done before he left the meeting;
they and he knew he had DR-TB and was still going to travel.)

He ran early. They was fugitive when they left early.

Stupid mistakes in not postponing or calling off a wedding
don’t usually involve public and international health,
(just personal consequences in later divorce)
but this situation did.
#25 revere
June 10, 2007

Randy: You have the science wrong. XDR and infectious are different things. He was (and as far as anyone knows, still is) non infectious. XDR only has to do with sensitivity of the bugs to drugs.

crf: You also have your facts wrong. If he had left as scheduled they still could not have issued a no fly. The realization he had XDR came when he was in Rome on May 24.

Neither of you appreciates the unintended consequences of what you are advocating. It will not stop the spread of XDR TB one iota. It will, according to all the experience we have had on this as set out by the UPMC/CBN folks, spread XDR faster and farther as people defer or refuse diagnosis or flee earlier and in ways they can’t be traced to avoid a public health policy that is useless in terms of its outcome and harmful in terms of the behavior it will induce in a predictably large proportion of people. The fact that each of you feels confident you wouldn’t act that way is not relevant. We know many (more) people will, when confronted with a futile and counterproductive public policy of coercive restraint irrespective of clinical status.
#26 Lea
June 10, 2007

Did not Jody say, in other words, the basically the same thing MRK and I have said revere? And yet you don’t address this? Englighten me again, please.
#27 gilmore
June 10, 2007

Revere,

I along with Randy and cfr (I beleive) aren’t really concerned about the science at this point, but more so about the actions of the individual and his evasive and most likely illegal travels.

You may look at the 1/2 filled glass (or petri dish) with a stethoscope around your neck and think not to bad. I look at the have filled glass (or petri dish) with a rope I want to throw around his neck for his reckless disregard for others.

Not filing charges because he’s pretty sick makes no sense to me. He, like Ms Hilton need to see the view from the inside so that we ALL may be detered from future stupidities we may want to consider.

When parents lose a couple of their kids in an accident because they didn’t have seat belts on, they rarely see jail time as they “suffered enough”. . . We need to think of the NEXT set of kids and their death, rather then the grieving parents whose lose was self inflicted.

In Arizona we have a gent who didn’t think needed to follow the rules either. He is sitting in a hospital cell. 24 hour surveilance camera and no lights off. They just gave him phone access and TV. He showed no remorse for his REPEATED public exposres until AFTER he got invided to incarceration. . .
#28 Thinlina
June 10, 2007

The TB guy won’t be healthty any time soon. So sooner or later he should have had to be transferred to US. Or would he have been restricted to come back to his home land? It’s better taht he came back when not infectious. Later he might have been infectious and also the curing might have been more difficult.
#29 crfullmoon
June 10, 2007

So the test results hadn’t come back yet; it’s a slow test.

Speaker said, they had stopped the second line drugs because they weren’t working; they had told him the only other option was the last-ditch stuff in Denver.
So; untreated MDR-TB and …?
What happend to “err on the side of caution”?

The infectious risk was not zero.
And they had no way to know when his risk of infecting others would increase.

The impact of getting this gets as bad as fatal,
(not to mention time-consuming and six-digit expensive).

Did a sense of entitlement, being a pushy lawyer, and CDC connections get things out of control? “Covenant of trust”? Doesn’t sound like a way to control disease.
Do doctors not wear masks so patients will not feel embarrased and will come back?
Do public health officials tell patients to not wear masks because other will discriminate against them; do they choose risk to the public rather than the public being able to see people who are wearing masks in public; “bad for morale”, bad for tourism; what?

Doctors not taking precautions doesn’t reassure me much; some are fatalistic, or, think they’re careful enough nothing can happen to them, or, just don’t think about things that make them too uncomfortable.
(Who besides me has asked their doctors about H5N1 and pandemic year preparedness – are they all over the map on “coping mechanisms” or what?)

The local systems don’t work, the national system doesn’t work,
and the international systems didn’t work. With terrorists, or deadly viruses, we have to do the right thing everytime. We’re screwed.
#30 Lea
June 10, 2007

crfullmoon asked: Who besides me has asked their doctors about H5N1 and pandemic year preparedness – are they all over the map on “coping mechanisms” or what?

I asked my doctor point blank his opinion and concerns about his health about H5N1 and a pandemic, know what I got? He shrugged his shoulders!
Fatalistic I’d say, where did his oath go? Out the window I suppose with his attitude.

Now where did I park my Volvo?!
#31 M. Randolph Kruger
June 10, 2007

This was sent to me from a contact in Colorado government.

http://www.cdc.gov/tb/xdrtb/HealthcareProvidersLetter.htm

Note that A. Speaker is now in a enclosed environment or wearing a mask. Might that be because they aint telling us everything?
#32 revere
June 10, 2007

Everybody is talking as if this guy violated a law. He didn’t. If you want this guy’s blood, you are welcome to it. I said what I had to say about him and I don’t have any more to add. I don’t know him or anyone connected with this case, even second hand. But I will repeat what I said. If you want to see lots more behavior like this, you are going about it the right way. As for everyone behaving so responsibly, I don’t believe it for a minute. I think all of you have gone to work sick or sent your kids to school sick or haven’t gotten a flu shot some years or only taken your antibiotics for 5 days instead of 10 and much else. This blog is read by people who are especially concerned with H5N1, as am I. But there are other blogs and communities where they think global warming is the big issue and where they think you folks behave irresponsbily because you don’t drive a hybrid. And when we faced the peril of nuclear war? How many of you worked to stop it? No? Because it wasn’t your priority? Welcome to the world of different viewpoints.

I’ll let Jody answer for herself. As far as I understand her, she and I are mostly on the same page with respect to the TB case. The only place where I am aware we differ is in what should be said about his infectiousness. But I won’t speak for her.

Meanwhile I am just back after a truly nice day with my bride of the last 35 years. I have been able to put this in a box and not think about it. Not even for one second. That’s my big accomplishment for the day. I will continue until tomorrow brings a new (work) day. G’night everyone.
#33 Jody Lanard
June 12, 2007

Re: Revere’s and my perceptions re: the patient’s infectiousness. I have learned enough now to think that Revere is right and I was wrong.

I owe an apology to various people, including people at Fulton County, for thinking I “knew” that Speaker should have been isolated much sooner.

Tonight we all learned, thanks to the Associated Press getting access to some of the emails between CDC officials, that the CDC doctor working in the Fulton County TB clinic (and who evaluated Speaker there on April 25, after it became known that his culture was positive)is quite an experienced TB researcher and CDC program administrator named Andrew Vernon.

A wide range of docs involved in decisions about Speaker, prior to May 10, all seem to have agreed that he was not infectious enough to require isolation.

It leaves me with lots of questions about how the “no fly recommendation” was explained to Speaker — and notions about how it could have been explained more candidly — but I am starting from a different position than the starting point in my earlier posts.
#34 M. Randolph Kruger
June 12, 2007

http://www.foxnews.com/wires/2007Jun12/0,4670,TuberculosisInfection,00.html

Call it what you want. But I would now call it conspiracy to endanger the public by a high ranking CDC official in charge of TB research, Speaker and Speakers father IMO. There is always more to the story. This is exactly the same story on CNN.com and FoxNews.com.

Daddy in law obviously thought he knew better than all of the people doing their jobs, right up until they told him that it was XDR. I am sorry for this kid, I really am but at what point could one say that a criminal act happened. If anyone turns up a positive on those tests on those planes is when. No prior symptoms could be argued, but if anyone of them end up with XDR the USGovt. is going to have to pay the claims. He was our national and we are responsible. I dont want the kids head. Its not worth anything to even try. But the tip level for state charges is much, much lower than the the federales. I wouldnt be surprised. Like I said the GA officials are six kinds of pissed off at the CDC people. State problem up until the time he got onto the plane, then it was an international one.