TB Scare: The Public-Health Slip-Ups

As federal airport screeners scan us for weapons and explosives, and confiscate our bottled water and makeup, who's looking out for serious potential health threats? And for that matter, could authorities stop terrorists seeking to import infectious diseases? Those questions were on Congress's mind Wednesday during two separate hearings about the circumstances of 31-year-old Andrew's Speaker's unchecked round-the-world TB tour.

The finger-pointing between the Centers for Disease Control, the Department of Homeland Security and Speaker himself—who spoke to lawmakers by phone Wednesday from his hospital room in Denver—underscores the troubling fact that as rates of deadly diseases like drug-resistant TB are on the rise, both public-health and national-security officials may be ill-equipped to stop their spread. While part of the problem may lie with individuals like Speaker who misunderstand or ignore medical advice, blame for the TB scare seems to be attributable in part to government missteps.

At a hearing before the Senate Appropriations Subcommittee, lawmakers hounded CDC Director Dr. Julie Gerberding for an apparent series of slip-ups. The first was in waiting, from May 18 when CDC officials first learned Speaker had extensively drug-resistant TB (XDR-TB) to May 22  before contacting Homeland Security. Gerberding argued that the CDC wanted to corroborate all the information on hand before potentially violating his civil liberties or causing undo concern to the public. "We can't just act on presumption," she testified. Later, however, Gerberding conceded that it was a "mistake" to not have alerted authorities much earlier—given Speaker's previous disregard for travel warnings. Also at question during the hearing was why the CDC failed to alert authorities in Italy, where Speaker was honeymooning. "We gave the patient the benefit of the doubt," said Gerberding, who indicated that U.S. officials wanted to give Speaker a chance to cooperate in arranging for his return to the States. "And in retrospect we made a mistake."

Another source of confusion for lawmakers was why the CDC failed to allow Speaker to use the CDC plane, a leased Gulfstream III jet available at all times to the agency in case of public-health emergencies. The Atlanta Journal-Constitution reported just last week that private jets leased by the CDC for emergencies are rarely used, despite their $7 million annual cost. In an interview on Friday Speaker told NEWSWEEK that a CDC official clearly told him the plane would not be sent to get him and that he would have to pay for his own private jet home. But when NEWSWEEK asked CDC spokesman Tom Skinner this week about the plane, he pointedly said that "all options were still being explored" when Speaker fled for the United States. "We were most interested in restricting his movements while we finalized these options to get him home."

It still boils down to "he said/he said" but what happened next is clear: Speaker and his bride made a mad dash for the United States through Canada on commercial airlines, sparking fears of a spread of the deadly XDR-TB among his fellow passengers. How contagious was Speaker? CDC's Gerberding said that they now know he is "smear negative but culture positive," which means there was no readily visible TB bacteria in his sputum, making his risk of infecting others much less. "But it's not zero," Gerberding added. Seventeen percent of TB cases in the United States, she pointed out, were contracted from people who were culture positive but smear negative. And more than eight hours in a plane would greatly increase the risk to others.

TB Mystery

For his part, Speaker reasserted his earlier claims: "I was repeatedly told I was not contagious, that I was not a threat to anyone. But Fulton County health official Dr. Steven R. Katkowsky told lawmakers the patient's medical chart says he was told "he was not highly contagious." Katkowsky emphasized that Speaker wasn't told that he wasn't contagious at all, just not highly contagious. Lawmakers on Wednesday did not press Speaker about why he felt he had the authority to self-diagnose, while in Rome, that he posed no risk to others despite being clearly told not to fly by a CDC official.

Another security hole was exposed when a single border agent waived Speaker through a Canadian/U.S. checkpoint because he didn't look sick. At a separate hearing in the House of Representatives, Homeland Security Committee Chairman Bennie Thompson argued, "We should have connected more dots. Better—or at least more complete—policies and procedures may have made a difference in preventing Andrew Speaker from coming across the border." Ralph Basham of the Department of Homeland Security said that the agent had a clear message on his computer to stop Speaker, but, "He chose to ignore it." Basham added that new procedures are being put in place to prevent a similar incident from happening again.

The slow pace of TB science also wasn't quick enough for public-health officials to keep pace with a young man intent on going overseas and marrying. Health officials warned Congress that the financing for TB research has flat-lined just as the risk of more drug-resistant strains of the bug is growing. "We have not graduated the science of TB into the 21st century," said Dr. Anthony Fauci, director of the National Institute of Health's Institute for Allergy and Infectious Diseases at the Senate hearing. Diagnostics are "antiquated and slow," explained Fauci, and drug regiments are complex and lengthy.

At the same hearing, Nils Daulaire, president of the Global Health Council, described the growth of multi-drug-resistant TB as a "moving train" that was warned about eight years ago. "I hope not to be sitting here eight years from now and talking about TDR-TB, totally drug-resistant TB," he warned. Already, about 50,000 people worldwide have what Speaker has—extensively drug-resistant TB. And, says, Daulaire, "This is certainly a national-security issue, but it's not about terrorists." Infected people, especially refugees and immigrants, are crossing borders all the time. And, as the CDC's Gerberding points out, there are quarantine officers at only 20 U.S. airports, yet there are more than 470 points of entry into the country. The only solution, argued Daulaire, is to assess the problem among the world's poor, where TB is rampant. That's because, he pointed out, "no walls we can build can possibly be high enough" to protect Americans from infectious disease.

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