Tuesday, May 29, 2007

XDR-TB: Time to Listen

Just today, the Centers for Disease Control of the United States issued its first government-mandated quarantine of an individual since the early 1960's. According to reports and a CDC press conference this afternoon, a gentleman traveling on two separate trans-Atlantic flights was already infected with Extensively Drug Resistant Tuberculosis (aka: XDR-TB) when he boarded those two planes. Although the relative risk of infection is being characterized as low, the officials at the CDC are taking no chances and have quarantined the individual until further testing and treatment can be accomplished.

I have mixed feelings about today's events. On the one hand, I understand the need for quarantine, and when international travel is involved, the rapid spread of HIV in the early 1980's taught us how air travel can move a dangerous organism around the globe in a matter of hours. On the other hand, issues of individual liberties and freedoms are raised when the government begins issuing orders for quarantine, and it is not difficult to imagine scenarios like those portrayed in Albert Camus' novel The Plague. While Camus' story is more about existential angst, personal redemption, and the growth of Fascism in Europe than it is about infectious disease, it paints a picture of the loss of individual freedom under the guise of government control "for the public good". In these days of Guantanamo Bay and Abu Ghraib, it is not beyond imagination to picture a situation in which a fearful and power-hungry government imprisons political dissidents who are "diagnosed" with a dangerous new infectious organism. Camus' novel is a chilling read and could not be more timely.

In terms of more contemporary scientific literature, Laurie Garret wrote of the "newly emerging diseases in a world out of balance" in her equally chilling (and very non-fiction) tome The Coming Plague in the late 1990s. Ms. Garrett underscored the fact that rapidly spreading, drug-resistant diseases would begin to emerge and traverse the planet with greater frequency and virulence unless something was done to stem the tide. Consider her book a public health version of Al Gore's An Inconvenient Truth.

Many questions were raised today, and very few clear answers seem forthcoming. This one individual has been quarantined, and many passengers and crew from the affected flights will be tested and treated. But I believe today was a wake-up call for the public health community (not to mention the rest of us), and the ramifications of today's events will be enormous and perhaps vastly unforeseen.


Anonymous said...

In the headline of a Bob McCarty Writes™ post May 3, I raised this question: Will Liberals View Terrorism & TB in Similar Ways? Now, it seems we're getting the opportunity to find out. It's going to get interesting.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Thanks for your comment, Bob. As a nurse who works with people with infectious disease (and a so-called "liberal", if you feel the need to label me as such) I am very concerned about pandemics and the potential for worldwide death and illness, and I take the subject quite seriously.

However, our government can often be very reactionary, "shooting from the hip" in situations requiring more subtle evaluation. The concern I raise in this post has to do with the fact that the United States has used the War on Terror in ways which preclude any notion of civil liberties.

From reading your blog, I must differ from your opinion that everyone imprisoned at Guantanamo is "bent on the destruction of America". Yes, some of those folks are terrorists, and some are people who simply got caught up in a very wide and indiscriminate net.

In my post I describe a "nightmare scenario" in which the government overreacts and imprisons people without proper screening and identification of actual contagion. As we saw in New Orleans, communities of color and the poor could very well be warehoused indiscriminately and mistreated or forgotten in the process. As a member of the National Medical Reserve Corps, I count myself as one person who will work to assure that that process is transparent and clinically accurate, if the need for such measures should ever arise.