Friday, June 01, 2007

Mister TB Man

I just feel like I have to add my two cents' worth to this story. Reading quotes from this guy saying he's sorry he endangered people, he didn't know is really making me angry.

The Facts (As I Understand Them):

A lawyer from Atlanta was scheduled to get married in Greece. Shortly before boarding his plane, he was told he had drug-resistant tuberculosis. Apparently, he had been treated for TB before, and often travels to TB-endemic countries. His father apparently recorded a health official as saying that they preferred he not fly to cover themselves, not because he was a danger to anyone, as his risk of contagiousness was low. Since officials told him "we prefer you not fly", but never directly forbade him to fly, he decided that he would fly to Europe with his fiancee to get married.

After he left his apartment, CDC officials tried to contact him to say his diagnosis had changed from drug-resistant TB to extensively drug resistant TB, or XDR-TB. Apparently only 49 cases have been reported in the United States until this time. Thus far, the best treatments achieve only 20-30% cure rates for XDR-TB. It was too late--he was already on his way to Europe.

Once in Europe, where Greek officials are denying he ever filed marriage paperwork, CDC officials were able to reach the man and inform him of his condition. CDC claims they told him to stay put, as they would try to figure out a way to bring him back to the US safely. He claims he was told to turn himself in to Italian authorities, where he feared he'd never be released and would die. So, he and his new wife(?) hop the first plane from Prague to Canada, figuring they'd evade US Customs. Indeed, he drove safely across the border into New York, despite his passport being flagged. Fortunately, once in New York, he turned himself in, and has since been flown to Georgia and then Denver, where he can receive treatment for his TB.

My Interpretation of the Facts:

I'll come out and say it--I think this guy's an idiot.

Perhaps they never quite made it clear that TB is an infectious disease; perhaps he didn't understand that XDR-TB could be spread to other people--although how did he think he got it??? TB is a droplet-spread disease. Once an infected person coughs out bacteria, it's fairly easy to spread them to other people. Even though this man had "clean" sputum, up to 17% of people contract TB from patients with no red snappers in their sputum. Perhaps that wasn't made clear to this guy.

I can almost understand him leaving the US to get married. I would personally like to take care of my health first, but I'm sure this guy had dealt with TB before and didn't think it was a big deal. I also realize weddings aren't cheap and his fiancee would probably have killed him if he didn't go to Greece. Okay.

It's what happened in Europe that gets weird. This guy is saying he doesn't know what changed while he was on the flight--if he wasn't contagious before, he still shouldn't be. The problem was never that he was totally UNcontagious--nothing's 100%--but what changed was the threat he posed to others if he were contagious. It would be akin to having sex with a person with HIV and using a condom, but later finding out the person has multi-drug resistant HIV. It makes the risk of contracting the disease that much scarier. Actually, to continue my analogy, it would be like that person having sex with 400+ people, because there were that many people on one of the flights this guy took. Just because the chance of infection is very low doesn't make it zero, and statistically the more people you cough on the more likely one of them is to catch TB.

While I can almost understand him boarding the plane to Europe, I have a harder time understanding boarding the plane home, fully knowing his diagnosis and the danger (even if it was small!) he posed to his fellow passengers.

It's super creepy that Border Patrol didn't catch the guy, even though his passport was flagged.

Unfortunately, the whole thing has assumed a "he said, the CDC said" kind of air, and we may never fully know what actually happened. What is more unfortunate, however, is that so many people were endangered--some who don't even know it yet--who are now anxiously awaiting the results of a PPD.

It does bring an ethical question to mind: Did the CDC have the right to quarantine this guy and take away all his freedoms in order to treat his TB? The libertarian in me says perhaps not. The medical student in me says XDR-TB is a pretty serious thing--for the good of everyone else, we need to get this guy treated. (The geek who loves microbiology in me is simply saying 'Woo, bacteria!', but that's beside the point).

If I become one of the 20% of medical students* who convert their PPD to positive per year by working in the county hospital, you'd better believe I'm not getting on an airplane if I have a positive chest x-ray.

*An entirely made up number I heard somewhere from a cousin of a friend of an ex whose sister had hair.


Gauderio said...

Quarentine isn't a new thing, just new to this century. Libertarians (darn them!) may view it as restricting one person's right, but then again letting him spread a potentially lethal disease to hundreds, or thousands, or hundreds of thousands by his drive-by coughings kinda sorta restricts the abilities, rights, and lives of all those who ended up seroconverting.

You should just put on an N50 whenever you come within 50 yards of your and my favorite county hospital. It'd be the stylish thing to do.

Aggie Sarah said...

Great blog! I just thought I'd add that my friend that just finished up her first year in medical school was told that the majority of med students will come into medical school with a positive PPD if they've done any substantial amount of hospital work. Your numbers may not be so off after all :)