From the Centers for Disease Control:
Florida ranked fourth in the nation with 1,707 tuberculosis cases reported in 1992 for a rate of 12.7 per 100,000 population. Thirteen percent of these patients had AIDS. Recent cases in prisons, shelters, hospitals and schools have stimulated interest and media coverage. Resurgence of strains of multiple-drug resistant tuberculosis is a serious concern. The Florida Department of Health and Rehabilitative Services, in collaboration with allied agencies, has utilized several initiatives in response. The most significant, Tuberculosis Epidemic Containment Plan, details intervention strategies needed to eliminate TB in the state by the year 2010. Successful implementation depends upon local TB prevention and control coalitions that include private and public sector providers.
The article above was published in 1994. So, Father Orthoduck is sure that the State of Florida took all due precautions and controlled TB, right? Well, you would be quite right! The State of Florida took its job seriously and cracked down on TB. Up until 2010, the rate of infection declined every year. But 2009, the CDC had to be invited into Duval County in order to help control a serious outbreak of TB. That turned out to be a warning. Their report said in part:
However, the full scope of the outbreak outside the facility could not be determined because of limited genotyping (approximately 25%) of culture-positive cases in Florida at the time and the lack of available records and reliable interviews of outbreak patients with mental illness that documented their whereabouts (e.g., homeless shelters).
In other words, the county did not take the necessary epidemiological steps to track and control the outbreak. Notice, “the lack of available records and reliable interviews.” Nevertheless, Duval County did manage to drop the total number of TB cases. But now the TB had begun to spread. By February of 2012 it was the State of Florida that called the CDC back in.
So, what did the CDC find?
BTW, the CDC 2012 data is only for TWO months. While the CDC did not overtly mention it, they hint that their studies show that the records for 2010 and before might have been a little lower than actual. Thus, while Duval was reporting a decline, the opposite might have been true. In fact, two people had died from TB because of “delayed” diagnosis and treatment. So far the count is 13 dead in total.
In 2010, the State of Florida reported an increase in TB from the previous year, 2009. This represented a break from the statistics since 1992. For well over 10 years the State of Florida has done an incredibly good job in controlling TB. In fact, the money that the State spent on prophylactic healthcare has been well spent and demonstrably successful. The fact that TB is going up is not a slam on the State of Florida. After all, outbreaks happen in every disease in an unpredictable manner. What you do is that you send in the “medical” troops, call for help from publicly funded places, like the CDC, and use your public funds to control the outbreak.
So, one expects that the governor and legislature would back this up. After all, who wants sick constituents? Well, there you would be wrong. The State of Florida’s publicly financed healthcare did its job. The CDC did its job. I am not so sure about Duval County, but at least they called in the troops once they realized they had a problem. But, the Department of Health was under a budgetary threat and was about to be “consolidated” which generally means diminished in today’s political climate. So, recently the Miami Herald reported:
In late March, Gov. Rick Scott signed a bill that consolidated the state’s Department of Health and required the closure of the A.G. Holley State Hospital in Lantana, where tuberculosis cases had been treated for more than 60 years.
Yep, the State’s only TB hospital is being closed in the midst of the worst outbreak in nearly 20 years. That hospital is/was one of only four hospitals in the country where people with intractable TB could be sent. Of course, the CDC has just released its reports and there are now angry people all over the place. The Governor has back-pedaled and claims he knew nothing. The legislature knew nothing. Some in the legislature are calling for an investigation.
Father Orthoduck will simply comment that this is what happens when you decide to cut prophylactic healthcare spending. For those of you who remember an old old TV show, let’s just say that the State of Florida wins the “Fickle Finger of Fate” award this week.
Speaking of TB, a related issue is the fact that no drug companies are interested in doing antibiotic research nowadays. Why? Basically it’s because we already have a bunch of antibiotics, and the current demand for antibiotics against drug resistant bacterial strains is not that great. Drug development costs billions of dollars and around a decade in time; therefore only drugs for common stuff gets researched by private firms. But the threat of multi-drug resistant “superbugs” is very real. And since research takes such a long time to bear fruit, it may be too late to start work on researching such after a superbug appears and becomes prevalent. It’s precisely the role of government and public entities to do the work on stuff that won’t be directly profitable, yet is necessary for societal well being.
Note that the REAL problem with TB lies in India. They are having tremendous outbreaks because of the antiobiotic phenom, “I felt better and I stopped taking the drug.” Costs money. More than that, you swallow it with water. Water is a problem there.
Do we have a problem? Yes. Is it worse than it used to be? Yes. How’s it compare? Not even close. But the superbug is coming from India and we know it. What I read is that TB has varieties. You have to use the right drug for the right variety of infection… otherwise no luck. But that takes observation before application. India has only one drug course, and doesn’t follow a course of delay at onset to determine a choice. There is none. Add to that the early quits of folks who feel better… and we have a toxic multiplier. When it hits our shores, this hospital closing seems short sighted. Poor + Aids + TB = 3 strikes. We can do better.