This was the kind of fallout from the TB case I was most concerned about:
States should have the power to restrict the movement of patients with contagious diseases even before they have the chance to disobey doctors’ orders, federal health officials say.
The need for such authority to order someone quarantined emerged as lesson No. 1 from the case of the Atlanta lawyer who went to Europe despite having a dangerous form of tuberculosis.
“First of all, up front, before the patient left the United States, we believe that we could strengthen our states’ ability to restrict the movement of patients before they demonstrate noncompliance with the medical order,” Gerberding told lawmakers. (Fox News)
We’ve discussed this here quite a bit. I don’t want to rehash the case of Andrew Speaker further. At this point we need more information than we have (or may get) about his specific case. More important is the policy fallout from a case where all sorts of people were quick to jump on their horses and ride madly off in all directions. Even people who should know better are drawing parallels between an apparent failure to restrict this person’s air travel and a supposed weakness in our defenses against pandemic influenza. We do have weaknesses, but failure to detain the TB isn’t evidence of one of them. Everyone who has looked at the question, including the Department of Homeland Security, CDC and its parent agency, the Department of Health and Human Services, not to mention independent experts, has concluded that trying to control the spread of influenza by controlling air travel is futile. This is not to say that a restriction in air travel won’t have a slowing effect. But it won’t be the result of intentional policies. The system will start to slow on its own as travelers stay home and air crews suffer absenteeism sufficient to cancel flights. The system is already very brittle and the shock of a pandemic will seriously affect it.
So forget about implications for pandemic influenza. The TB situation is more complicated. While there is no documented evidence anyone has contracted active TB from an exposure on an airplane, it is plausible it could happen. We rub shoulders with infectious TB all the time, unfortunately. Multiply drug resistant TB (MDR) is now common in the former Soviet Union and eastern Europe and there is a great deal of traffic between many places where MDR TB is endemic and North America. Andrew Speaker is an example, having reportedly traveled in such areas for the six years prior to his diagnosis. And that diagnosis was quite accidental, the result of a chest x-ray done to look at a rib he had injured. The moral of the story is there is a frightful amount of TB in the world, much of it infectious and undiagnosed, and we are riding the buses, subways and airplanes with these cases on a daily basis. There is nothing unusual about Andrew Speaker except that we know about him. We won’t make a dent by giving extraordinary police powers to a government that seems to have an unlimited appetite for police power.
I believe in the power of government to make people’s lives better. I am proudly a person of the Left. I am for universal health care (single payer) and effective regulation of industries who don’t care about the health and safety of their workers and the general public. I am not opposed to effective and robust public health powers. But I am also a libertarian when it comes to government interference with personal liberties. This is a case where the candle isn’t worth the game, and I am not the only one disturbed by the direction this is being taken:
Peter Jacobson, a health law professor, had concerns about Gerberding’s statement on two fronts.
“That’s not the federal government’s role and it’s far, far too broad a statement. There has to be a credible threat, a direct threat of harm before you restrict someone’s freedom to move, before you intrude on their individual liberties,” said Jacobson, director of the Center for Law and Ethics and Health at the University of Michigan.
“For her to say in such a broad manner that a state should restrict people before they’re noncompliant is extremely intrusive in my view,” he said.
Also, the District of Columbia-based association representing state health officials noted that it is now up to the states, not the federal government, to determine when to issue an isolation order.
The Bush administration never loses an opportunity to extend its coercive reach over the citizens of this country and Gerberding rarely loses an opportunity to ingratiate herself with her masters. But this isn’t just the right wing. Liberal Senator Tom Harkin from Iowa is solidly onboard:
Harkin, the chairman of the Senate Appropriations subcommittee that questioned Gerberding, said the agency was notified May 18 that Speaker had multiple drug resistant tuberculosis, but the Homeland Security Department was not told until four days later. Speaker was not placed on a no-fly list until May 24.
“Again, with the rapidity of world travel today, it seems to me that this time frame should have been collapsed to just a few hours,” Harkin said.
Said Gerberding: “I think we should have done it faster, and I think we’ll be able to accelerate this next time. In retrospect, that was a mistake and I wish we had done it differently.”
Twenty years ago we might have gone this route with HIV/AIDS. After all, is it so different to say we need to lock up HIV positive people because they might have unprotected sex and spread the disease? In fact some HIV positive people did just that. The next logical step, of course, would have been to lock up those at high risk of getting infected with HIV. You know where that would have gone. We didn’t do it. But that was before September 11.
TB? Lock ‘em up. Let’s start with the immigrants.
Update: Other posts here.