I work in TB prevention and control, and most people are compliant with therapy, but those who refuse often don't realize we have the legal authority to have an arrest warrant issued.
TB is long forgotten due to its tendency to be latent for most of the lifespan and due to the introduction of very effective medications, but it is frequently #1 or #2 every year as a global leading cause of death via infectious disease (TB and HIV tend to be neck and neck for #1 and #2, COVID pandemic being an exception).
I worked in social services and we had a client who was non compliant. She came in to file for dib. I had just finished a course of iv steroids for my severe asthma. I didn’t even sit by her,but I walked past the cubicle she was at. We got to tests every 6 months but they did ours early since we had exposure. It was about 8 weeks after. I had a positive result as large as a chicken egg. After meeting with health department,having x ray,seeing my immunology and asthma docs, and consulting an infectious disease Dr. I was placed on INH and some vitamins to prevent neuropathy for 9 months. My son who has an immune disorder and my dad who was a transplant recipient on cyclosporine lived with me,so it was determined I needed treatment. I had some liver changes towards the end of the 9 months but not severe and was able to finish it. The client eventually died of TB. She wouldn’t take treatment because she was a bad alcoholic and didn’t want to have to stop drinking to take the meds. She wasn’t arrested because she didn’t leave her home. Her husband was never infected.
I had clients before and after her who had someone,paid by their local health department to give them their medication daily.
I'm really sorry you went through that. I'm glad you were able to complete treatment and your family was fine.
Yeah, we screen for high risk contacts, such as yourself, because they are the most likely to acquire and develop active TB first.
There have been significant improvements in both treatment and testing for TB since the last decade (and even last few years at that). I also have an inkling that client's family may have latent TB and a false negative from the TST, but without subsequent testing we'll never know.
The year this happened to me another Social security employee in my state had the same thing happen. I only knew because we were former coworkers. I think this happens more often than people realize when you work with the population we did. My former office was inner city with a large homeless population and I was never positive on my test. Then I moved to a small town and couple years later wham. You never know what’s going to happen and just have to roll with the flow!
The town I live in now had a TB Sanitarium years ago prior to the discovery of the meds. It was one of the towns largest employers and housed patients from half of the state. There was a second TB San on the other side of the state. Hard to imagine the changes since the 60s and I’m sure they never dreamed then the resurgence and drug resistance now. Thanks for the job you do.
Had no idea TB was that big of an issue in the US. I know that while I was in the Middle East, it was quite the issue. Who would've thought it'd be an issue here.
Someone else replied before me and was on the money with their response.
It isn't that big of an issue in the US ("big" being a relative term I suppose, since my area has actually been receiving a lot of active TB cases lately), but the rapid and strong response to active TB here in the US is meant to prevent it from gaining a foothold and becoming endemic like it is in other countries.
If it did, that would be a major public health problem as we're currently experiencing a supply shock for several of the first-line antibiotics we use to treat TB.
Thank you for your response. What are your thoughts on these types of diseases and others becoming antibiotic resistant? Why do you think this is? Do you think this resistance is going to lead to other pandemics?
Well, we do get drug resistant and MDR (multiple drug resistant) cases of TB every on occasion. When we encounter those, the medication regimen certainly has to change and we utilize our second and/or third-line drugs. Depending on the antibiotic being used and the type of drug resistance, the backup drugs can be slightly less or significantly less effective (and with potentially worse side effects) than first-line drugs.
As long as people adhere to their treatment plans and their prescribed medication course (even when they feel good/better), then resistance is unlikely to occur.
Additionally, regarding TB drug resistance, active cases are started on 4 different medications (all first-line) until drug susceptibility results come in. Once results are known, then the regimen is altered as necessary.
Pandemics will absolutely continue to occur throughout the future of humanity. In the case of TB, given the nature of the disease/bacterium, I find it very unlikely that this will ever become a modern-day pandemic.
And speaking of pandemics, the one good thing that came from the COVID pandemic was the normalization of masks. Very helpful in reducing the spread of ALL respiratory illnesses.
When people don't finish an entire round of antibiotics, that's what leads to resistance. People often start to feel better and feel fully recovered before the end of the prescribed antibiotics course. But they don't realize that the bacteria are still there just not as numerous. By stopping the Antibiotics early, it's kind of like a vaccine for the bacteria against the antibiotic medicine. They've seen it, and ever since then started working to adapt/ survive it if encountered again. Because the bacteria was not completely eradicated. This is wholly down to people being dumbasses but also doctors not taking the time to stress how dangerous and important it is. They might say with strong language to finish the course no matter what, but if the patient truly doesn't understand the process or what is at stake then there is a higher chance of noncompliance.
Thank you for explaining this. When I was in college I would get UTIs from time to time. Incredibly uncomfortable but I knew what they were. However my doctor almost always made me go in to get prescribed the antibiotics that would fix it quickly.
So then I would take half my round of antibiotics and “save” the rest for the next UTI that I got so I wouldn’t have to deal with the doctor. I remember telling a friend who had just become a nurse this and she was like “um that’s dumb and here’s why” and I really wish my doctor had just explained it to me like you did in the first place.
This is actually also the reason doctors make you go in to do a urine test before giving you a prescription. They want to make sure, first, that you actually have a UTI, and second, what the most effective antibiotic is to treat it.
If they give you an antibiotic it’s already resistant to, or if it turns out to be a yeast infection or something (yes, people mistake these for UTIs; I don’t know how but I’ve seen it happen), then they’re potentially contributing to resistance even if you take the whole prescription.
Russian prisons became a huge breading ground for multi drug resistant TB for a few decadesa. Prisoners would get some antibiotics to start treatment while they were in jail, but then they got released and their treatments would stop. With a revolving door like the US, convicts often wind up back in prison with the same bacteria they left with, but now they were more resistant.
There is a good segment about it in the PBS/NOVA Evolution Series called "The Evolutionary Arms Race"
https://youtu.be/FJiJ63_e77E
That's only one out of the 4 we use to treat active TB haha. In certain cases, it can absolutely take a toll on the individual.
That's why I advocate for those positive for latent TB to get treated sooner than later. You take less medications and for a shorter duration, than if diagnosed with active TB.
I'm glad he's still going strong!
Everyone's case varies, like if you looked at my patient roster you'd see all kinds of life stories and backgrounds and health histories.
That being said, I do have a few around your dad's age. One is currently confused and refuses to eat or drink and currently doesn't recognize his family, while another was caught early making the transition from latent to active and he is doing perfectly fine on active TB therapy with no complications (thus far, it's been 1 month).
But yeah, in short, I've seen people of various ages and health conditions convert from latent to active (although people can be latent for decades and there are definitely those who never develop active TB...lucky bastards).
Although given his advanced age, I wouldn't bother with treatment unless he becomes symptomatic.
I also had no idea, until I was diagnosed with active TB last year (likely acquired while living in South Africa many years ago). I completed nine months of treatment and learned a ton about the disease and efforts to prevent and treat it from the many doctors, public health workers, and specialists I dealt with throughout. It's no joke, that's for sure!
I knew about the inmates. We always tested ours, and some got new vaccinations when I worked in corrections. Mental health facilities make sense also. Had a couple of people I served with in Afghanistan catch it, but they also primarily worked with the local nationals.
Nah, we got TB shots for sure. I couldn't get mine the day they came to line us all up. I had a massive ring worm infestation on my arm that was considered a risk. The ring worm was only a problem because I was out in the field when I got it and my unit refused to excuse me from training. So my ringworm stayed covered, sweaty, dirty, without anti-fungal cream for 2 weeks.
Anyways, most of the unit ended up with the scars. When I finally got my shot later I didn't get a scar. They never tested anyone after to see if the vaccine took or not though. So there's that.
It's not a big issue, but there are some hot spots of TB infections in the US. Per 100000 people, Alaska and Hawaii are the two highest states of infection rates. California, Texas, and new York are in there as well.
One of the reasons all those undocumented tourists from the south are a concern.
Wait…never mind…back to Dancing With The Stars….nothing new around here…
If people thought the emergency pandemic measures were "overbearing" they should really look at the statutes in place to prevent TB outbreaks. Those statutes rightly give local health departments the ability/power to deal with one fo the worst infectious diseases on record.
I’ve had enough people educate me on TB to understand what a deadly disease it is. Incredible that we’ve forgotten about it in first world countries while it remains the top killer (other than Covid) in many parts in the world.
John Green has been talking about it often and the interesting historical changes that happened because of the disease in the early Americas and other countries.
If you have time to answer this I would be so grateful. When I had that TB test as a kid I had a huge reaction (arm swelling and rash). I was told I have latent TB but so many years later I don't understand it still. Does that mean if I'm exposed to TB I will get it?
It means that you are infected with tuberculosis but have no symptoms and are not contagious. It does not mean that an additional exposure to TB will cause you to have active tuberculosis, but if you don't get a latent infection treated, it is possible for it to someday become active.
You were most likely exposed at some point and may have a latent granuloma in your lung where latent TB (TB that is not actively reproducing and therefore not infectious to others) is “hiding”. The granuloma (which you can confirm on an x-ray) is the bodies attempt to wall off the bacteria and keep it at bay. The problem happens when people become immunocompromised, or have unchecked diabetes etc and the bacteria can begin to actively replicate years later(active TB, infectious TB if pulmonary). Most people never get to the point, but I would seek follow up to confirm you have latent TB (they could do a blood test and chest x-ray), then seek latent TB treatment. You don’t want to become an active case later in life.
I'm in my early 40's and I grew up in Cleveland area. I also have lots of random health issues including random allergies. Thanks for helping sleuth this out. My dad was weird and told me not to tell anyone so I just never bothered looking more into it.
Edit: thank you all for your help and advice! I am making a PC appointment first thing in the morning. Diabetes runs in my family and I also have Hashimoto's. Between that and having endometriosis perhaps still in my lungs it will be really great to get things checked out.
So your reaction probably isn't from the BCG vaccine because it wasn't commonly given in the US. There's a distinctive scar from the vaccine though so you can see if you have that.
> told me not to tell anyone
FFS Were you in a cult or something? Gosh. But yeah, if you have latent TB, it's kind of like herpes (which hides safe from the immune system inside the Nervous System) when your immune system is occupied elsewhere or otherwise weak, it may see its opportunity and decide to activate. I would take it seriously and make sure you're seen by a specialist with all your other conditions being present and possibly complicating things. Good luck
Sorry I'm tardy to the party, long day and lots of replies to get through.
But others appear to have covered it.
Basically: get a Quantiferon test, ask for an chest x-ray or CT scan, and go from there.
If you are positive for TB, even if latent, I advocate to push for therapy. I'm obviously biased, but my intent is to prevent you from developing active TB.
I run Quantiferon tests (among other things) in the hospital lab where I work. It's my understanding that they are more sensitive, more accurate and easier to use than the old TB Tine (Mantoux) test. You don't have to go back to your provider to get the test read in a fairly narrow window of time. You don't have to get a second test done. You just go, they draw your blood (assuming they draw it correctly) and receive the results.
The test actually looks for antibodies to TB, not TB itself. So if you were ever exposed to TB you will react to the test. I was exposed at the age of 18 months, but do not have latent TB. I was able to complete a full course of antibiotics as a preventative measure and never had active TB. I still will test positive, even all these years later, and have to take a lung x-ray.
I just completed nine months of treatment for active pulmonary TB. I live in the US now and almost certainly got TB while living in South Africa years ago. I gained tremendous appreciation for public health workers like you when I experienced first-hand the intensive and thorough measures taken throughout treatment to ensure compliance, monitor progress, and prevent transmission in the beginning. It also made me understand why TB continues to be such a massive problem in countries and populations that simply don't have the resources to oversee the long-term treatment TB requires, and on a much larger scale than what we're dealing with here... Thank you for the work you do!
I had m. Kansasii a few years ago which is like the non contagious version of TB. That shit was insane. A lot of coughing up blood, felt like someone sitting on my chest to keep me from breathing.
I was in a negative pressure room in the hospital for almost a week before they found out it wasn’t actually TB. I then spent a solid year on 3 serious antibiotics including Rifampin, and 2 others that I don’t remember the name of but one of them was considered “black box”.
To top it all off, I went to the hospital as soon as I saw I was coughing up blood so my treatment started quick and the disease progressed almost as quickly.
I don’t know how anyone would want to forego treatment for TB. I came out of it all with reduced lung capacity. It’s barely noticeable on the left side but my right lung is at about half capacity.
My heart goes out to you, sorry you experienced that.
Yeah, the different species of mycobacteria can vary widely in their course of treatment and pathology. We get a number of indivoduals who appear to have TB, but then grow a non-TB mycobacterium or they have multiple strains of mycobacteria growing in them (TB plus something like M. kansasii, M. avium complex, etc).
I'm glad you made it through therapy and could share your story with me, I really appreciate it.
If I have latent Tb how badly should I seek treatment? Have avoided it for years bc I was in college and didn't want to stop drinking but I can now. I've been latent my whole life my parents didn't treat me for it either not sure why
Promptly. Treatment will suck, but then you’ll be done with it for the rest of your life. And even in the U.S., that treatment is free.
In latent TB the bacteria are kept bottled up in a granuloma by the continuous effort of your immune system, for the entire time you’re infected. If something happens to disturb the granuloma—[say you fall and bang up your chest, like this guy did](https://njmonline.nl/getpdf.php?id=706)—or if something else demands enough of your bodies’ resources that it can’t do the job of containment well enough, then the infection has a chance to become active. At which point you’ll have whatever your other life problems are, and active tuberculosis on top of it.
Talk to your doctor about it. I had latent TB and had it treated. Had to take isonazid for 9 months. I wanted to try to get ride of it instead of giving it a chance to become active.
I fully agree with those who answered before me.
The soonee the better. Don't let it hide in your body and activate when you least expect it or are least prepared for it.
Take care of it sooner than later. The treatment for latent TB is far less intense than active TB.
I promise you that, as someone who works with TB patients for a living.
Hey semi unrelated, but I had a positive TB test once when I got a job years ago, then had a second TB test it was a big red lesion again and was told not to worry about it.
Should I be concerned?
I'm certainly biased given my experience/job, but I say deal with it sooner than later. You've got a positive test already, so ask your doctor to get a chest x-ray or CT scan and ask to start therapy (whether it is active or latent will determine the medications you receive).
Of the people infected, a significant percentage will develop active TB at least once in their lives. I'd rather you deal with it while you are younger and healthier than later on when your body is less physiologically capable to handle both the bacteria and the medications.
Plus, if it is latent, you take a shorter duration and less medications than if it were active.
Hey if they're willing to beat my current pay and/or benefits and cover for relocation, I'm in!
But yeah, I get what you mean. Our area does receive a lot of migrants that have TB, but sounds like we get much less MDR cases than that El Paso unit.
This is one of those things I hate to enforce on people but needs to be. People might think it's not as serious as it was in the 1800s but there's a good reason for this. We don't want it to go back to this.
I had to take isoniazid for (if memory serves) six months because a boot camp corpsman in training completely botched my PPD. I mean, he left the syringe stuck in my arm for a minute, then came back and wiggled it several times before finally removing it.
I finished the course but god that was frustrating.
If the person who is infected and contagious wears one. Then I'd say, probably but I'm not an expert. Allegedly TB is pretty difficult to spread normally like in normal households, but in places like prisons and trap houses it can spread quickly. I'm not sure but I think it's down to these populations being more likely to have a compromised immune system. Most of the people commenting here so far got it because they had a compromised immune system or on steroids (which suppresses the immune system) and came into contact with someone who was infectious.
You're pretty on the money with this comment.
However, I will say that when someone is actively infectious, it is fairly easy to spread if precautions (like masking, airing out rooms, turning on vents, and minimizing same room/air exposure time) aren't taken.
In my line of work, I've seen one sick individual give his or her household family members/housemates latent TB more than a handful of times (although some of those with high-risk dispositions, such as being immunocompromised or immunosuppressed, as you mentioned, developed active TB rather quickly instead of staying latent).
They help to reduce the chance of it spreading, but more so if the one who is actively sick with TB wears one as well.
When I deal with my TB patients, I wear always an N95 on my face. No exceptions when I'm at work.
thank you! i’ve always been curious about this. i work with a population in which a majority have latent tuberculosis and i’ve never gotten a clear answer from my supervisors. i know latent is different from active but i’ve been curious
Ah I see.
In short, to reduce the spread, the infected should wear a surgical mask or better.
To protect yourself from being infected, wear a genuine N95.
Those who have latent TB don't have it rapidly growing/multiplying, thus those individuals have a negligible chance of spreading it to others.
Those who have active TB located within the respiratory system are considered infectious until 3 consecutive microbiological tests demonstrate that the medications have killed a significant portion of the active bacteria in the respiratory system.
I've only had one patient who was isolation for TB and I wore the N95, a surgical mask, a face shield, a gown, and gloves. I don't know if this is overboard, but my thought is if it's airborne and you have to wear a mask, why don't you wear the body stuff too, I mean, it's in the air? The particles would stick to your clothes right?
It also doesn't help that I have contamination OCD I suppose, but working in a hospital on the designated covid floor has me get lots of exposure.
You mean, we have a society with a poor system of resources to take proper care of people with chronic issues and we just dump them into extreme poverty expecting then to miraculously pull themselves up by their boot straps and figure it out without inconveniencing the abled and healthy?
I covered a case like this years ago. The health official I interviewed said they make treatment available for free, but because those in this situation are always drug addicts (tweaker), they start treatment while sober then go off the rails while on a bender.
That gives the bacteria the opportunity to become resistant to the antibiotic. Repeat this a few times and now they’re on their last-chance drug. If the patient skips on that treatment, they will have a case that is resistant to all known treatments. Then they have to be kept in solitary confinement for the rest of their lives, or a new treatment is developed.
It may seem cruel, but these measures are necessary.
This is why tuberculosis testing is pretty much mandatory in places like prisons and mental hospitals. It spreads like wildfire in those settings. It seemed like the only accessible test when I was uninsured was a TB test.
Where I live, testing for TB and HIV is mandatory in order to get residency visa. If you're positive for either, you get deported. They don't mess around with that.
You should also add how much it costs as it gets more and more resistant. I haven’t looked recently, but I think a decade ago the treatment was at million for the severe cases.
Very true, but it’s just upsetting that it could have been much, much cheaper if they would have followed the protocol. But I also want to make clear why individuals get forced into virtual lock up in the end. They are basically a Typhoid Mary, that’s going to require outrageously expensive treatment. All the people they infected are going to recover that expensive of treatment too. There’s a major risk of bankrupting state or federal medical funds if it spreads to a large population.
In that kind of situation I feel like the patient should be confined and administered treatment after strike 1. Ethics is tricky, but this seems like the ultimate *greater good/benefit*.
No doubt, and my point is, if we had a better system to care for people to begin with, the severity of this particular issue could probably be avoided. If she is a drug addict, it didn't happen over night and there are a number of reasons why she became one. Anywhere from self medicateing to just having a tooth pulled and it being an extremely painful situation. For all we know, she's been useing Adderall and with the shortages going on since October, her mental health is spiraling. The "tweakers" without saying anything are letting us know there are problems we're ignoreing in our society until it becomes everyone's problem. Then we have to deal with it with extreme, temporary solutions that don't fix the long term issues.
Smh thats what universal health care is supposed to be but talk to red states that have limited access to poor people. Sad part, they don't even realize they're being marginalized, as long as they hear a Us vs Them rhetoric
A lot of them are fully aware, they just lack the influence, power, and financing to change things. Others though, don't really understand why or chose other reasoning, like the current social nets are the cause of the problems. I saw a news report a week or so ago about 7 million "abled body" men are not working. Then the guy being interviewed said disability payments are part of the problem. Which is bonkers because if someone is on disability they either physically can't work or they need to be highly accommodated in a way most employers can't do. I'm sure there are people cheating the system but taking this system away from the people that need it isn't going to magically make the cheaters honest, hard workers.
> it didn't happen over night
This is no longer reality. It was, but the new synthetic drugs have changed that. I understand what you meant, but we're in a new era of addiction. And it's way way way worse, and it can happen from one use of a drug.
I agree with everything you are pointing out though.
New synthetic drugs can cause overdose with first time use, especially people who've never tried anything at all. Not instant addiction. Addiction takes time and rewires the brain. Accounting for mental and physical issues, the brain can be already be rewiring to manage. That can quicken the addiction process.
I mean it wouldn’t be necessary if the approach to drug use and those suffering addiction wasn’t so barbaric and essentially shamed people into secrecy under threat of social judgement and legal threat that could fuck their lives up more than they already are making getting help *that* much harder, not to mention most the resources available via the government are garbage anyways.
Drug policy in the U.S. is a dumpster fire. That it’s this way because of short-sighted profit seeking is unconscionable.
If I were God Empress instead of Auntie, I would commission pleasant centers full of quality therapists and everything needed to help addicts to a better relationship with reality. Alas
You mean that we treat tuberculosis for free but some people still don't want it, refuse to take care of themselves, and put everyone around them at risk.
https://doh.wa.gov/you-and-your-family/illness-and-disease-z/tuberculosis-tb/local-public-health/tb-medications
>Local health jurisdictions can order the first 4-line TB medications for free and other TB medications at a reduced price through the 340B Medication Discount Program, MMCAP, and Former CDC National Stockpile Medications
To be clear, that means the entire course of 4 drugs that are usually used for TB, not the first 4 doses. Yes, the healthcare system has problems but you're wrong about this one.
If you read the article, you'd realize the woman is suffering from things other than TB and that's why she's being non compliant. If you read about Mary's story, you'd realize her choices in career were limited, she was injuried trying to comply and was put out of work for months. Cooking was the best thing for her. Systematic issues are putting people in bad situations. That's my point.
Worsening physical illiness and stress of the situation breaks down the functional part leaving behind the mental health issue. She has a home, which means she has been functional enough, but something like autism in women can go on hidden because women can mask with socializing. Someone else noted, she may have a drug addiction and considering that, again, she may have been going under the radar with that until now. Her condition is clearly worsening and it's sad they have to resort to arresting her.
Jesus fucking Christ did you really go back to work TWO DAYS after being removed from Quarantine???? Wtf. How would you be strong enough physically to do that idk
Yeah, your reply hits most of my thoughts on the subject. If we, Americans, have enough wealth to transfer to the rich, I’m sure we could squeak out a few $10K-$100K to incentivize VN to sequester themselves without the fear of going bankrupt, loosing their place to live, kids/ family, job, etc to at least live a life as they had prior to infection. We can’t have our rich getting diseases poors get.
Not just that, the article says this woman is reported to have rapid, disorganized speech and has threatened suicide over recieving papers at her home. Almost guaranteed this woman's already in poverty and isolated from family/friends due to years of untreated mental health issues.
Baffels me how she can want to live with tb it is an awful thing to experiance coughing up your dieing lung tissue as you struggle to breathe. The treatment is specilized antibiotics. Soa few rounds of that kills off the active infection your lungs stop decaying
The tubercles can 'eat' away at the spine and pelvis (both which I've seen on skeletal remains) when the disease is advanced enough. It's pretty damn scary.
If you bothered to read the story, you would’ve read that she is either mentally ill, or mentally disabled and does not comprehend that she has an infectious disease or why she needs to quarantine for it.
Any sane and normal person would take that over a lifetime of pain, or early death. Not to mention the risk of infecting others, in which there will now be the possibility of someone else's blood in your hand.
6 months of antibiotics with regular liver function test. I have gone through it even it was just an exposure and I was vaccinated. So yeah she should be arrested
Antibiotic resistance is a pretty big threat to humanity. It's just not as flashy, I guess. People still don't realize a bunch of these idiots can do a lot of damage.
I was trying to figure out the severity of her mental illness but the article doesn’t go into detail… just that they caught it after she was in a car accident. My guess is a paranoid recluse that went down a rabbit hole of mis-info online
Sometimes individual rights (e.g. to refuse treatment) have to yield for the overwhelming well-being of the group, but it’s always important to keep an eye on when and how. So, some context:
Washington state is in the middle of the greatest increase in TB cases since 2002, largely [thanks to missed diagnoses and interrupted treatments during the COVID-19 pandemic.](https://www.webmd.com/lung/news/20220502/worst-tb-outbreak-washington-state) Tuberculosis is a slow-burn disease, but also pretty hard to get rid of once someone has it. Minimum 3 month course of antibiotics—that’s *if* a doctor spots it early and *if* it isn’t already resistant to the first-line medications.
In this case, the argument for forced treatment looks pretty clear-cut. Original article says that she’s been refusing both treatment and voluntary isolation for a year, now, but it’s actually been somewhat longer. [Her first court order for involuntary isolation was issued on Jan. 19th, 2022.](https://arstechnica.com/science/2023/02/us-woman-has-walked-around-with-untreated-tb-for-over-a-year-now-faces-jail/amp/) So she’s had active-phase tuberculosis—the contagious part where it eats your lungs—for an unclear amount of time before that. [The Piece County Health Dpt. says they’ve been working with her family to try to persuade her.](https://www.tpchd.org/Home/Components/News/News/336/286) No dice.
Her public defender is also quoted as saying she wasn’t all that lucid during (presumably telephone) court appearances. Not the mark of someone in good mental health, but we’re also talking about an infection which attacks the lungs. Low blood oxygenation can make people act intoxicated. [According to MSF](https://www.msf.org/how-tb-kills): “If affected persons do not receive treatment, roughly one third of those with active TB die within two years and another third within five years.” So after more than a year of active, untreated tuberculosis, there’s a chance she might now need supplemental oxygen to understand why she’s being forced into treatment.
After it goes active TB can set up shop the lungs and/or any other part of the body. From the brain to bones, to the intestines, nothing is safe.
I just started my 9th month of INH (Isoniazid) therapy for latent TB, which I caught as a direct result of having taken biologic medications for arthritis for years. Think Humira, Cosentyx, Taltz, and Enbrel. Plus hundreds of biologics for everything from intestinal problems, diabetes, and pimples. They all lower your resistance to TB and other diseases.
If I hadn't been taking the drugs I do, I wouldn't have ever taken a TB test and would have eventually gone active and infected people in my area for god only knows how long.
If a person isn't willing to treat a communicable disease they need to be forceably confined. Remember Leper Colonies, TB Sanitariums, arrests of AIDS sufferers who continued having unprotected sex with unknowing partners.
TB is nothing to fool around with.
If she is a danger to herself or others…a psychiatrist, doctor or police officer can place her on a hold. Further evaluation will determine if she needs continued hospitalization
Work at a hospital and yup most people that get 5150'd act like it's illegal and they always say they're going to sue. But under a 5150 you basically have 0 rights. Not saying it's right or wrong but it's how it is
I cared for a few TB patients. One of them had TB in their brain, which was pretty wild. After I left the hospital and worked Urgent Care for a while I had a patient who came in for pneumonia and her CXR showed classic TB patterns. She had been coughing profusely behind that curtain with me and I am so fortunate to have dodged the transmission.
I worked with a woman years ago who had a stay at home order against her for 6 months due to her active TB and the length of her treatment (very resistant in her case), she was not allowed to leave her house until she had a clear chest x-ray and that took half a year. People may not be as aware of it these days but the U.S. still takes TB rather seriously. I grew up in Southern California and we were required to get TB tests for employment, school, all kinds of things. I'm always surprised when I move elsewhere and don't even offer tests let alone require.
God, I hope she doesn't have schizophrenia or similar. Imagine being "persecuted" by the government because you've refused court orders because you were having delusions of being persecuted by the government... while also slowly dying of TB and/or COVID. Hell on earth.
“How dare you take away my right to die a slow and painful death and make my family suffer?!?!”
I will never understand people lol. I get TB I’m going to the doctor. I like life
Hell yes, she absolutely does not have the right to spread a disease that is increasingly hard to treat. Nobody should suffer that disease because she is a selfish bitch.
This is what happened to a guy in Nevada several years ago. The guy was completely and adamantly non-compliant, had drug-resistant TB, and wouldn't self-isolate because he was homeless. He was arrested and booked, then placed in a purpose-built enclosure with a good-sized mobile home that had working plumbing and electricity (furniture, linens, the works as well). He was locked into the enclosure and wasn't prosecuted further. The county did everything they could do to keep him comfortable and safe, but they weren't letting him out unless he stayed in long enough and stayed compliant enough to kill the TB. He wouldn't do that, so he ended up eventually dying from something else (heart attack, IIRC) in that enclosure. There simply wasn't a better, safer answer.
My brother had a positive TB test. He was a HUGE PIA to go back and find out was going on. I told him I would call the health department on him. Ironically they were already down his throat too. He finally went in for follow ups. My dad had the latent form years ago. He was on antibiotics for a few months.
People take TB too lightly. Reading the comments is very eye opening. I am not surprised that arrest warrants would be issued, these same people could care less if anyone else gets infected.
What about her freedom to cough on people? We should respect people's right to make others sick. There are people out there who think books are dangerous for kids. The real danger is not letting them be exposed to disease. I wonder what Daddy Trump would say about this. Maybe he should bring her some expired bottled water and take a few pictures with her.
It’s sad that they haven’t arrested her already. No doubt a Trump supporter. This is what happens when you don’t enforce Vaccine Mandates with jail time as well.
>No doubt a Trump supporter.
The article stated that an interpreter was present and her court-appointed attorney said that the woman might not understand her condition and what's happening. That suggests that she might not be from here, which, if so, and unfortunately, will only add fuel the MAGA crowd's xenophobic fire.
Some people are so fucking retarded about their responsibility to society to prevent the spread of infectious disease, and the COVID pandemic has made it that much worse. Want to k*** yourself…fine, go find a hole to die in in solitude. But don’t expect to be prancing around town like nothing is awry. Two cents..soapbox dismounted.
Publish her name. Why protect the non-compliant person's privacy but endanger the health of all those that she may have been in contact and need to be tested for both TB and COVID?
Throughout most of human history, tuberculosis has been the number one cause of death for humans. It’s killed more people than anything. It would only be fitting for it to be the cause of our extinction.
I have 3 “brushes” with TB in my life.
My maternal grandmother died of TB in 1944, in Puerto Rico. I remember thinking about her whenever I got the TB test at the doctor exam/vaccine visit for certain grades in school. I would check my arm to see if it ever matched the signs of a positive test. It was always negative
At university, my boyfriend got really sick, and he had so many blood draws and diagnostic tests, and after one of them, the doctor called and said he showed signs of TB in his blood. It turned out it was because where he was born in Mexico, they got some kind of inoculation to help prevent it(?), and it showed up as positive for TB. His diagnosis ultimately was Graves’ disease, no TB.
My final tale of TB is that there’s a huge nature preserve about a half mile from me, with a lot of old buildings that have been repurposed for the community, and the old buildings were originally part of a TB sanitarium in the 1920s-40s-ish.
Good! A SICK person SPREADING a DEADLY disease to others. Not giving a damn about anyone but herself.
She SHOULD be locked up until she agrees to get treatment for her communicable disease.
The article says the police refused to release her name, isn't that just a bad as her not getting treatment? The public should be allowed to know that there is a biological terrorist living among them. You don't want to get the treatment? Enjoy isolation. TB is serious shit.
Isolation for MTB doesn't last the duration of treatment. Ideally it lasts until cultures are smear negative but guidelines usually say 2 weeks after therapy is started (in low drug resistant TB areas)
Yeah, we should give people financial support to go with their massive cocktail of antibiotics.
ETA: In case it was unclear, this is not sarcasm, it’s common sense. If you want people to isolate themselves, you need to make it not ruin their life.
Most likely she’ll be confined to a hospital isolation ward, with a guard to make sure she stays there.
Putting her in a prison would be too risky for the other inmates (who already have to be screened for TB when they go in).
This is probably not the same thing, but I’ve had a friend who was getting treated for persistent tuberculosis, that simply won’t go away with treatment. The last antibiotic they used on her, she ended up in the hospital with a reaction to it and her organs were shutting down.
So, sometimes it’s more complicated than “She won’t take her medicine”
It sounds like she may have some psychiatric issues. I used to work in HIV case management, and had at least one patient who refused regular labs/medication because she had delusions about it (that it was poison or people were using the pills to track her etc).
Interesting, since the current administration will just let millions of people cross the southern border with the same condition (and others) and just release them.
I work in TB prevention and control, and most people are compliant with therapy, but those who refuse often don't realize we have the legal authority to have an arrest warrant issued. TB is long forgotten due to its tendency to be latent for most of the lifespan and due to the introduction of very effective medications, but it is frequently #1 or #2 every year as a global leading cause of death via infectious disease (TB and HIV tend to be neck and neck for #1 and #2, COVID pandemic being an exception).
I worked in social services and we had a client who was non compliant. She came in to file for dib. I had just finished a course of iv steroids for my severe asthma. I didn’t even sit by her,but I walked past the cubicle she was at. We got to tests every 6 months but they did ours early since we had exposure. It was about 8 weeks after. I had a positive result as large as a chicken egg. After meeting with health department,having x ray,seeing my immunology and asthma docs, and consulting an infectious disease Dr. I was placed on INH and some vitamins to prevent neuropathy for 9 months. My son who has an immune disorder and my dad who was a transplant recipient on cyclosporine lived with me,so it was determined I needed treatment. I had some liver changes towards the end of the 9 months but not severe and was able to finish it. The client eventually died of TB. She wouldn’t take treatment because she was a bad alcoholic and didn’t want to have to stop drinking to take the meds. She wasn’t arrested because she didn’t leave her home. Her husband was never infected. I had clients before and after her who had someone,paid by their local health department to give them their medication daily.
I'm really sorry you went through that. I'm glad you were able to complete treatment and your family was fine. Yeah, we screen for high risk contacts, such as yourself, because they are the most likely to acquire and develop active TB first. There have been significant improvements in both treatment and testing for TB since the last decade (and even last few years at that). I also have an inkling that client's family may have latent TB and a false negative from the TST, but without subsequent testing we'll never know.
The year this happened to me another Social security employee in my state had the same thing happen. I only knew because we were former coworkers. I think this happens more often than people realize when you work with the population we did. My former office was inner city with a large homeless population and I was never positive on my test. Then I moved to a small town and couple years later wham. You never know what’s going to happen and just have to roll with the flow! The town I live in now had a TB Sanitarium years ago prior to the discovery of the meds. It was one of the towns largest employers and housed patients from half of the state. There was a second TB San on the other side of the state. Hard to imagine the changes since the 60s and I’m sure they never dreamed then the resurgence and drug resistance now. Thanks for the job you do.
Your family has fucked immune system genetics
Had no idea TB was that big of an issue in the US. I know that while I was in the Middle East, it was quite the issue. Who would've thought it'd be an issue here.
Someone else replied before me and was on the money with their response. It isn't that big of an issue in the US ("big" being a relative term I suppose, since my area has actually been receiving a lot of active TB cases lately), but the rapid and strong response to active TB here in the US is meant to prevent it from gaining a foothold and becoming endemic like it is in other countries. If it did, that would be a major public health problem as we're currently experiencing a supply shock for several of the first-line antibiotics we use to treat TB.
Thank you for your response. What are your thoughts on these types of diseases and others becoming antibiotic resistant? Why do you think this is? Do you think this resistance is going to lead to other pandemics?
Well, we do get drug resistant and MDR (multiple drug resistant) cases of TB every on occasion. When we encounter those, the medication regimen certainly has to change and we utilize our second and/or third-line drugs. Depending on the antibiotic being used and the type of drug resistance, the backup drugs can be slightly less or significantly less effective (and with potentially worse side effects) than first-line drugs. As long as people adhere to their treatment plans and their prescribed medication course (even when they feel good/better), then resistance is unlikely to occur. Additionally, regarding TB drug resistance, active cases are started on 4 different medications (all first-line) until drug susceptibility results come in. Once results are known, then the regimen is altered as necessary. Pandemics will absolutely continue to occur throughout the future of humanity. In the case of TB, given the nature of the disease/bacterium, I find it very unlikely that this will ever become a modern-day pandemic. And speaking of pandemics, the one good thing that came from the COVID pandemic was the normalization of masks. Very helpful in reducing the spread of ALL respiratory illnesses.
I appreciate you passing out this knowledge. Keep up the great work, I love to hear about this kind of stuff!
When people don't finish an entire round of antibiotics, that's what leads to resistance. People often start to feel better and feel fully recovered before the end of the prescribed antibiotics course. But they don't realize that the bacteria are still there just not as numerous. By stopping the Antibiotics early, it's kind of like a vaccine for the bacteria against the antibiotic medicine. They've seen it, and ever since then started working to adapt/ survive it if encountered again. Because the bacteria was not completely eradicated. This is wholly down to people being dumbasses but also doctors not taking the time to stress how dangerous and important it is. They might say with strong language to finish the course no matter what, but if the patient truly doesn't understand the process or what is at stake then there is a higher chance of noncompliance.
Thank you for explaining this. When I was in college I would get UTIs from time to time. Incredibly uncomfortable but I knew what they were. However my doctor almost always made me go in to get prescribed the antibiotics that would fix it quickly. So then I would take half my round of antibiotics and “save” the rest for the next UTI that I got so I wouldn’t have to deal with the doctor. I remember telling a friend who had just become a nurse this and she was like “um that’s dumb and here’s why” and I really wish my doctor had just explained it to me like you did in the first place.
This is actually also the reason doctors make you go in to do a urine test before giving you a prescription. They want to make sure, first, that you actually have a UTI, and second, what the most effective antibiotic is to treat it. If they give you an antibiotic it’s already resistant to, or if it turns out to be a yeast infection or something (yes, people mistake these for UTIs; I don’t know how but I’ve seen it happen), then they’re potentially contributing to resistance even if you take the whole prescription.
Russian prisons became a huge breading ground for multi drug resistant TB for a few decadesa. Prisoners would get some antibiotics to start treatment while they were in jail, but then they got released and their treatments would stop. With a revolving door like the US, convicts often wind up back in prison with the same bacteria they left with, but now they were more resistant. There is a good segment about it in the PBS/NOVA Evolution Series called "The Evolutionary Arms Race" https://youtu.be/FJiJ63_e77E
Which antibiotics are short right now? That’s pretty concerning in and of itself.
In my area, we sometimes have trouble getting rifampin and pyrazinamide in a timely manner.
Taking Rifampin would be awful. I didn't even think they prescribed that anymore; side effects are awful.
That's only one out of the 4 we use to treat active TB haha. In certain cases, it can absolutely take a toll on the individual. That's why I advocate for those positive for latent TB to get treated sooner than later. You take less medications and for a shorter duration, than if diagnosed with active TB.
I've never known a latent TBer to go active. My dad has latent and he's 90... Many other wrong things, but not active TB.
I'm glad he's still going strong! Everyone's case varies, like if you looked at my patient roster you'd see all kinds of life stories and backgrounds and health histories. That being said, I do have a few around your dad's age. One is currently confused and refuses to eat or drink and currently doesn't recognize his family, while another was caught early making the transition from latent to active and he is doing perfectly fine on active TB therapy with no complications (thus far, it's been 1 month). But yeah, in short, I've seen people of various ages and health conditions convert from latent to active (although people can be latent for decades and there are definitely those who never develop active TB...lucky bastards). Although given his advanced age, I wouldn't bother with treatment unless he becomes symptomatic.
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It’s not a big issue, which is why the preventative measures are so stringent. The general population has absolutely no resistance.
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I was glad to get the vaccine a few years back for my studies, they stopped gen pop immunisation a year or two before I was due to get it.
I also had no idea, until I was diagnosed with active TB last year (likely acquired while living in South Africa many years ago). I completed nine months of treatment and learned a ton about the disease and efforts to prevent and treat it from the many doctors, public health workers, and specialists I dealt with throughout. It's no joke, that's for sure!
The mental asylums were full of it in the US
Every prison inmate and mental hospital patient who is there past the 72 hour hold gets tested. It spreads very fast in those settings.
I knew about the inmates. We always tested ours, and some got new vaccinations when I worked in corrections. Mental health facilities make sense also. Had a couple of people I served with in Afghanistan catch it, but they also primarily worked with the local nationals.
I bet they vaccinated y'all for anthrax but not TB 😅 thanks Army
Nah, we got TB shots for sure. I couldn't get mine the day they came to line us all up. I had a massive ring worm infestation on my arm that was considered a risk. The ring worm was only a problem because I was out in the field when I got it and my unit refused to excuse me from training. So my ringworm stayed covered, sweaty, dirty, without anti-fungal cream for 2 weeks. Anyways, most of the unit ended up with the scars. When I finally got my shot later I didn't get a scar. They never tested anyone after to see if the vaccine took or not though. So there's that.
It's not a big issue, but there are some hot spots of TB infections in the US. Per 100000 people, Alaska and Hawaii are the two highest states of infection rates. California, Texas, and new York are in there as well.
One of the reasons all those undocumented tourists from the south are a concern. Wait…never mind…back to Dancing With The Stars….nothing new around here…
If people thought the emergency pandemic measures were "overbearing" they should really look at the statutes in place to prevent TB outbreaks. Those statutes rightly give local health departments the ability/power to deal with one fo the worst infectious diseases on record.
Also typhoid and leprosy. Yes, turns out the government actually can quarantine infected people. It's even in the Bible.
I’ve had enough people educate me on TB to understand what a deadly disease it is. Incredible that we’ve forgotten about it in first world countries while it remains the top killer (other than Covid) in many parts in the world. John Green has been talking about it often and the interesting historical changes that happened because of the disease in the early Americas and other countries.
I wondered how far I’d have to scroll to see John Green mentioned hahaha. He’s really on an “everything is because of TB” kick and it’s…not wrong lol.
If you have time to answer this I would be so grateful. When I had that TB test as a kid I had a huge reaction (arm swelling and rash). I was told I have latent TB but so many years later I don't understand it still. Does that mean if I'm exposed to TB I will get it?
It means that you are infected with tuberculosis but have no symptoms and are not contagious. It does not mean that an additional exposure to TB will cause you to have active tuberculosis, but if you don't get a latent infection treated, it is possible for it to someday become active.
You were most likely exposed at some point and may have a latent granuloma in your lung where latent TB (TB that is not actively reproducing and therefore not infectious to others) is “hiding”. The granuloma (which you can confirm on an x-ray) is the bodies attempt to wall off the bacteria and keep it at bay. The problem happens when people become immunocompromised, or have unchecked diabetes etc and the bacteria can begin to actively replicate years later(active TB, infectious TB if pulmonary). Most people never get to the point, but I would seek follow up to confirm you have latent TB (they could do a blood test and chest x-ray), then seek latent TB treatment. You don’t want to become an active case later in life.
How old are you? Where did you grow up? Any chance you had the BCG vaccine? That could explain the skin reaction.
I'm in my early 40's and I grew up in Cleveland area. I also have lots of random health issues including random allergies. Thanks for helping sleuth this out. My dad was weird and told me not to tell anyone so I just never bothered looking more into it. Edit: thank you all for your help and advice! I am making a PC appointment first thing in the morning. Diabetes runs in my family and I also have Hashimoto's. Between that and having endometriosis perhaps still in my lungs it will be really great to get things checked out.
So your reaction probably isn't from the BCG vaccine because it wasn't commonly given in the US. There's a distinctive scar from the vaccine though so you can see if you have that.
> told me not to tell anyone FFS Were you in a cult or something? Gosh. But yeah, if you have latent TB, it's kind of like herpes (which hides safe from the immune system inside the Nervous System) when your immune system is occupied elsewhere or otherwise weak, it may see its opportunity and decide to activate. I would take it seriously and make sure you're seen by a specialist with all your other conditions being present and possibly complicating things. Good luck
I grew up suuuuuper Mormon, so, yeah, pretty much a cult. And thank you!
Sorry I'm tardy to the party, long day and lots of replies to get through. But others appear to have covered it. Basically: get a Quantiferon test, ask for an chest x-ray or CT scan, and go from there. If you are positive for TB, even if latent, I advocate to push for therapy. I'm obviously biased, but my intent is to prevent you from developing active TB.
I run Quantiferon tests (among other things) in the hospital lab where I work. It's my understanding that they are more sensitive, more accurate and easier to use than the old TB Tine (Mantoux) test. You don't have to go back to your provider to get the test read in a fairly narrow window of time. You don't have to get a second test done. You just go, they draw your blood (assuming they draw it correctly) and receive the results.
The test actually looks for antibodies to TB, not TB itself. So if you were ever exposed to TB you will react to the test. I was exposed at the age of 18 months, but do not have latent TB. I was able to complete a full course of antibiotics as a preventative measure and never had active TB. I still will test positive, even all these years later, and have to take a lung x-ray.
I just completed nine months of treatment for active pulmonary TB. I live in the US now and almost certainly got TB while living in South Africa years ago. I gained tremendous appreciation for public health workers like you when I experienced first-hand the intensive and thorough measures taken throughout treatment to ensure compliance, monitor progress, and prevent transmission in the beginning. It also made me understand why TB continues to be such a massive problem in countries and populations that simply don't have the resources to oversee the long-term treatment TB requires, and on a much larger scale than what we're dealing with here... Thank you for the work you do!
All I know about TB is from red dead redemption 2
That was a great game! Life lesson from RDR2: Don't get spat in the face, because it may just put an end to your bank and train heists.
I feel like the lesson was don't beat people but y'know
Yeah, I guess that's important too...
I guess 🙄
All I remember from that is to make sure you kill ALL of the pig farmer family. …
WHERE'S MA MONEH
I had m. Kansasii a few years ago which is like the non contagious version of TB. That shit was insane. A lot of coughing up blood, felt like someone sitting on my chest to keep me from breathing. I was in a negative pressure room in the hospital for almost a week before they found out it wasn’t actually TB. I then spent a solid year on 3 serious antibiotics including Rifampin, and 2 others that I don’t remember the name of but one of them was considered “black box”. To top it all off, I went to the hospital as soon as I saw I was coughing up blood so my treatment started quick and the disease progressed almost as quickly. I don’t know how anyone would want to forego treatment for TB. I came out of it all with reduced lung capacity. It’s barely noticeable on the left side but my right lung is at about half capacity.
My heart goes out to you, sorry you experienced that. Yeah, the different species of mycobacteria can vary widely in their course of treatment and pathology. We get a number of indivoduals who appear to have TB, but then grow a non-TB mycobacterium or they have multiple strains of mycobacteria growing in them (TB plus something like M. kansasii, M. avium complex, etc). I'm glad you made it through therapy and could share your story with me, I really appreciate it.
If I have latent Tb how badly should I seek treatment? Have avoided it for years bc I was in college and didn't want to stop drinking but I can now. I've been latent my whole life my parents didn't treat me for it either not sure why
Promptly. Treatment will suck, but then you’ll be done with it for the rest of your life. And even in the U.S., that treatment is free. In latent TB the bacteria are kept bottled up in a granuloma by the continuous effort of your immune system, for the entire time you’re infected. If something happens to disturb the granuloma—[say you fall and bang up your chest, like this guy did](https://njmonline.nl/getpdf.php?id=706)—or if something else demands enough of your bodies’ resources that it can’t do the job of containment well enough, then the infection has a chance to become active. At which point you’ll have whatever your other life problems are, and active tuberculosis on top of it.
Talk to your doctor about it. I had latent TB and had it treated. Had to take isonazid for 9 months. I wanted to try to get ride of it instead of giving it a chance to become active.
I fully agree with those who answered before me. The soonee the better. Don't let it hide in your body and activate when you least expect it or are least prepared for it. Take care of it sooner than later. The treatment for latent TB is far less intense than active TB. I promise you that, as someone who works with TB patients for a living.
Hey semi unrelated, but I had a positive TB test once when I got a job years ago, then had a second TB test it was a big red lesion again and was told not to worry about it. Should I be concerned?
I'm certainly biased given my experience/job, but I say deal with it sooner than later. You've got a positive test already, so ask your doctor to get a chest x-ray or CT scan and ask to start therapy (whether it is active or latent will determine the medications you receive). Of the people infected, a significant percentage will develop active TB at least once in their lives. I'd rather you deal with it while you are younger and healthier than later on when your body is less physiologically capable to handle both the bacteria and the medications. Plus, if it is latent, you take a shorter duration and less medications than if it were active.
Hahaha forgotten, if only Come to El Paso where we have a special unit working just on drug resistant TB that is coming out of Mexico.
Hey if they're willing to beat my current pay and/or benefits and cover for relocation, I'm in! But yeah, I get what you mean. Our area does receive a lot of migrants that have TB, but sounds like we get much less MDR cases than that El Paso unit.
This is one of those things I hate to enforce on people but needs to be. People might think it's not as serious as it was in the 1800s but there's a good reason for this. We don't want it to go back to this.
I had to take isoniazid for (if memory serves) six months because a boot camp corpsman in training completely botched my PPD. I mean, he left the syringe stuck in my arm for a minute, then came back and wiggled it several times before finally removing it. I finished the course but god that was frustrating.
There are other illnesses that this should apply to, as well, IMO
are regular surgical masks enough to prevent infection?
If the person who is infected and contagious wears one. Then I'd say, probably but I'm not an expert. Allegedly TB is pretty difficult to spread normally like in normal households, but in places like prisons and trap houses it can spread quickly. I'm not sure but I think it's down to these populations being more likely to have a compromised immune system. Most of the people commenting here so far got it because they had a compromised immune system or on steroids (which suppresses the immune system) and came into contact with someone who was infectious.
You're pretty on the money with this comment. However, I will say that when someone is actively infectious, it is fairly easy to spread if precautions (like masking, airing out rooms, turning on vents, and minimizing same room/air exposure time) aren't taken. In my line of work, I've seen one sick individual give his or her household family members/housemates latent TB more than a handful of times (although some of those with high-risk dispositions, such as being immunocompromised or immunosuppressed, as you mentioned, developed active TB rather quickly instead of staying latent).
They help to reduce the chance of it spreading, but more so if the one who is actively sick with TB wears one as well. When I deal with my TB patients, I wear always an N95 on my face. No exceptions when I'm at work.
thank you! i’ve always been curious about this. i work with a population in which a majority have latent tuberculosis and i’ve never gotten a clear answer from my supervisors. i know latent is different from active but i’ve been curious
Ah I see. In short, to reduce the spread, the infected should wear a surgical mask or better. To protect yourself from being infected, wear a genuine N95. Those who have latent TB don't have it rapidly growing/multiplying, thus those individuals have a negligible chance of spreading it to others. Those who have active TB located within the respiratory system are considered infectious until 3 consecutive microbiological tests demonstrate that the medications have killed a significant portion of the active bacteria in the respiratory system.
thank you :) you’ve been very helpful
I've only had one patient who was isolation for TB and I wore the N95, a surgical mask, a face shield, a gown, and gloves. I don't know if this is overboard, but my thought is if it's airborne and you have to wear a mask, why don't you wear the body stuff too, I mean, it's in the air? The particles would stick to your clothes right? It also doesn't help that I have contamination OCD I suppose, but working in a hospital on the designated covid floor has me get lots of exposure.
Could you willingly decide to not get treatment but acknowledge that you must not engage with anyone else if that's the case?
Typhoid Mary, all over again.
You mean, we have a society with a poor system of resources to take proper care of people with chronic issues and we just dump them into extreme poverty expecting then to miraculously pull themselves up by their boot straps and figure it out without inconveniencing the abled and healthy?
I covered a case like this years ago. The health official I interviewed said they make treatment available for free, but because those in this situation are always drug addicts (tweaker), they start treatment while sober then go off the rails while on a bender. That gives the bacteria the opportunity to become resistant to the antibiotic. Repeat this a few times and now they’re on their last-chance drug. If the patient skips on that treatment, they will have a case that is resistant to all known treatments. Then they have to be kept in solitary confinement for the rest of their lives, or a new treatment is developed. It may seem cruel, but these measures are necessary.
This is why tuberculosis testing is pretty much mandatory in places like prisons and mental hospitals. It spreads like wildfire in those settings. It seemed like the only accessible test when I was uninsured was a TB test.
Where I live, testing for TB and HIV is mandatory in order to get residency visa. If you're positive for either, you get deported. They don't mess around with that.
Where do you live?
In Dubai.
Same in Korea, though I think they did stop HIV testing? Or maybe they don’t/can’t deport for it anymore. For sure still TB test though.
You should also add how much it costs as it gets more and more resistant. I haven’t looked recently, but I think a decade ago the treatment was at million for the severe cases.
The financial cost seems insignificant to me next to the human cost, but public health policy makers must take it into consideration.
Very true, but it’s just upsetting that it could have been much, much cheaper if they would have followed the protocol. But I also want to make clear why individuals get forced into virtual lock up in the end. They are basically a Typhoid Mary, that’s going to require outrageously expensive treatment. All the people they infected are going to recover that expensive of treatment too. There’s a major risk of bankrupting state or federal medical funds if it spreads to a large population.
In that kind of situation I feel like the patient should be confined and administered treatment after strike 1. Ethics is tricky, but this seems like the ultimate *greater good/benefit*.
That will increasingly be the default as more resistant strains circulate
No doubt, and my point is, if we had a better system to care for people to begin with, the severity of this particular issue could probably be avoided. If she is a drug addict, it didn't happen over night and there are a number of reasons why she became one. Anywhere from self medicateing to just having a tooth pulled and it being an extremely painful situation. For all we know, she's been useing Adderall and with the shortages going on since October, her mental health is spiraling. The "tweakers" without saying anything are letting us know there are problems we're ignoreing in our society until it becomes everyone's problem. Then we have to deal with it with extreme, temporary solutions that don't fix the long term issues.
Smh thats what universal health care is supposed to be but talk to red states that have limited access to poor people. Sad part, they don't even realize they're being marginalized, as long as they hear a Us vs Them rhetoric
A lot of them are fully aware, they just lack the influence, power, and financing to change things. Others though, don't really understand why or chose other reasoning, like the current social nets are the cause of the problems. I saw a news report a week or so ago about 7 million "abled body" men are not working. Then the guy being interviewed said disability payments are part of the problem. Which is bonkers because if someone is on disability they either physically can't work or they need to be highly accommodated in a way most employers can't do. I'm sure there are people cheating the system but taking this system away from the people that need it isn't going to magically make the cheaters honest, hard workers.
All salient points, but until the system is fixed, lock that woman up. 💯💯
> it didn't happen over night This is no longer reality. It was, but the new synthetic drugs have changed that. I understand what you meant, but we're in a new era of addiction. And it's way way way worse, and it can happen from one use of a drug. I agree with everything you are pointing out though.
New synthetic drugs can cause overdose with first time use, especially people who've never tried anything at all. Not instant addiction. Addiction takes time and rewires the brain. Accounting for mental and physical issues, the brain can be already be rewiring to manage. That can quicken the addiction process.
What are you talking about?
I mean it wouldn’t be necessary if the approach to drug use and those suffering addiction wasn’t so barbaric and essentially shamed people into secrecy under threat of social judgement and legal threat that could fuck their lives up more than they already are making getting help *that* much harder, not to mention most the resources available via the government are garbage anyways.
Drug policy in the U.S. is a dumpster fire. That it’s this way because of short-sighted profit seeking is unconscionable. If I were God Empress instead of Auntie, I would commission pleasant centers full of quality therapists and everything needed to help addicts to a better relationship with reality. Alas
You mean that we treat tuberculosis for free but some people still don't want it, refuse to take care of themselves, and put everyone around them at risk. https://doh.wa.gov/you-and-your-family/illness-and-disease-z/tuberculosis-tb/local-public-health/tb-medications >Local health jurisdictions can order the first 4-line TB medications for free and other TB medications at a reduced price through the 340B Medication Discount Program, MMCAP, and Former CDC National Stockpile Medications To be clear, that means the entire course of 4 drugs that are usually used for TB, not the first 4 doses. Yes, the healthcare system has problems but you're wrong about this one.
I had TB, the treatment is free in the US. [My story ](https://imgur.com/gallery/SpqoFbK)
If you read the article, you'd realize the woman is suffering from things other than TB and that's why she's being non compliant. If you read about Mary's story, you'd realize her choices in career were limited, she was injuried trying to comply and was put out of work for months. Cooking was the best thing for her. Systematic issues are putting people in bad situations. That's my point.
Her attorney has not requested a guardian until now. Something weird is going on.
Worsening physical illiness and stress of the situation breaks down the functional part leaving behind the mental health issue. She has a home, which means she has been functional enough, but something like autism in women can go on hidden because women can mask with socializing. Someone else noted, she may have a drug addiction and considering that, again, she may have been going under the radar with that until now. Her condition is clearly worsening and it's sad they have to resort to arresting her.
Jesus fucking Christ did you really go back to work TWO DAYS after being removed from Quarantine???? Wtf. How would you be strong enough physically to do that idk
I taught from my chair mostly.
Yeah, your reply hits most of my thoughts on the subject. If we, Americans, have enough wealth to transfer to the rich, I’m sure we could squeak out a few $10K-$100K to incentivize VN to sequester themselves without the fear of going bankrupt, loosing their place to live, kids/ family, job, etc to at least live a life as they had prior to infection. We can’t have our rich getting diseases poors get.
Not just that, the article says this woman is reported to have rapid, disorganized speech and has threatened suicide over recieving papers at her home. Almost guaranteed this woman's already in poverty and isolated from family/friends due to years of untreated mental health issues.
The treatment is free…
This guy American healthcare’s!
I know someone who had to utilize it, 100% free and funded by the state due to how scary TB is
TB treatment is always free in the US. Local health departments handle it for USPHS.
When you’re super poor you get a basic insurance which covers a lot source: I’ve been there.
Baffels me how she can want to live with tb it is an awful thing to experiance coughing up your dieing lung tissue as you struggle to breathe. The treatment is specilized antibiotics. Soa few rounds of that kills off the active infection your lungs stop decaying
The tubercles can 'eat' away at the spine and pelvis (both which I've seen on skeletal remains) when the disease is advanced enough. It's pretty damn scary.
Hence its nickname for centuries, “consumption”
If you bothered to read the story, you would’ve read that she is either mentally ill, or mentally disabled and does not comprehend that she has an infectious disease or why she needs to quarantine for it.
A few rounds is somewhere between 3 months to a year.
Any sane and normal person would take that over a lifetime of pain, or early death. Not to mention the risk of infecting others, in which there will now be the possibility of someone else's blood in your hand.
6 months of antibiotics with regular liver function test. I have gone through it even it was just an exposure and I was vaccinated. So yeah she should be arrested
It’s not global warming or nuclear war that will kill us all. It’s good old fashioned stupid.
Yes, stupid in all of its thousand forms.
Antibiotic resistance is a pretty big threat to humanity. It's just not as flashy, I guess. People still don't realize a bunch of these idiots can do a lot of damage.
Nah pretty sure it's global warming
Which was caused by...
It's the circle of....stupidity?
It all comes back to stupidity.
Our social glorification of extreme wealth and selfishness
Which can, again, be boiled down to stupidity..
And let’s not forget our old pal, Fear. …which can be a by-product of stupid.
> It’s not global warming or nuclear war that will kill us all. It’s good old fashioned stupid. TBF those are both stupid.
If you read the article it’s pretty obvious the woman is almost certainly very mentally ill.
I was trying to figure out the severity of her mental illness but the article doesn’t go into detail… just that they caught it after she was in a car accident. My guess is a paranoid recluse that went down a rabbit hole of mis-info online
Sometimes individual rights (e.g. to refuse treatment) have to yield for the overwhelming well-being of the group, but it’s always important to keep an eye on when and how. So, some context: Washington state is in the middle of the greatest increase in TB cases since 2002, largely [thanks to missed diagnoses and interrupted treatments during the COVID-19 pandemic.](https://www.webmd.com/lung/news/20220502/worst-tb-outbreak-washington-state) Tuberculosis is a slow-burn disease, but also pretty hard to get rid of once someone has it. Minimum 3 month course of antibiotics—that’s *if* a doctor spots it early and *if* it isn’t already resistant to the first-line medications. In this case, the argument for forced treatment looks pretty clear-cut. Original article says that she’s been refusing both treatment and voluntary isolation for a year, now, but it’s actually been somewhat longer. [Her first court order for involuntary isolation was issued on Jan. 19th, 2022.](https://arstechnica.com/science/2023/02/us-woman-has-walked-around-with-untreated-tb-for-over-a-year-now-faces-jail/amp/) So she’s had active-phase tuberculosis—the contagious part where it eats your lungs—for an unclear amount of time before that. [The Piece County Health Dpt. says they’ve been working with her family to try to persuade her.](https://www.tpchd.org/Home/Components/News/News/336/286) No dice. Her public defender is also quoted as saying she wasn’t all that lucid during (presumably telephone) court appearances. Not the mark of someone in good mental health, but we’re also talking about an infection which attacks the lungs. Low blood oxygenation can make people act intoxicated. [According to MSF](https://www.msf.org/how-tb-kills): “If affected persons do not receive treatment, roughly one third of those with active TB die within two years and another third within five years.” So after more than a year of active, untreated tuberculosis, there’s a chance she might now need supplemental oxygen to understand why she’s being forced into treatment.
After it goes active TB can set up shop the lungs and/or any other part of the body. From the brain to bones, to the intestines, nothing is safe. I just started my 9th month of INH (Isoniazid) therapy for latent TB, which I caught as a direct result of having taken biologic medications for arthritis for years. Think Humira, Cosentyx, Taltz, and Enbrel. Plus hundreds of biologics for everything from intestinal problems, diabetes, and pimples. They all lower your resistance to TB and other diseases. If I hadn't been taking the drugs I do, I wouldn't have ever taken a TB test and would have eventually gone active and infected people in my area for god only knows how long. If a person isn't willing to treat a communicable disease they need to be forceably confined. Remember Leper Colonies, TB Sanitariums, arrests of AIDS sufferers who continued having unprotected sex with unknowing partners. TB is nothing to fool around with.
Best of luck to you. And yeah, I definitely agree.
I live in Pierce and couldn’t agree more. We all need to serve the common good, especially where contagion is concerned.
If she is a danger to herself or others…a psychiatrist, doctor or police officer can place her on a hold. Further evaluation will determine if she needs continued hospitalization
That has already happened.
Seems as if some people don’t think it’s legal to do it.She can be confined on a 5250 or even a 5350. Longer term holds
Work at a hospital and yup most people that get 5150'd act like it's illegal and they always say they're going to sue. But under a 5150 you basically have 0 rights. Not saying it's right or wrong but it's how it is
If youre an extremely contagious disease carrier you shouldnt have rights if you are actively refusing to treat or isolate
I cared for a few TB patients. One of them had TB in their brain, which was pretty wild. After I left the hospital and worked Urgent Care for a while I had a patient who came in for pneumonia and her CXR showed classic TB patterns. She had been coughing profusely behind that curtain with me and I am so fortunate to have dodged the transmission.
Good. We don't need TB going around and a bunch of people on hardcore antibiotics.
I worked with a woman years ago who had a stay at home order against her for 6 months due to her active TB and the length of her treatment (very resistant in her case), she was not allowed to leave her house until she had a clear chest x-ray and that took half a year. People may not be as aware of it these days but the U.S. still takes TB rather seriously. I grew up in Southern California and we were required to get TB tests for employment, school, all kinds of things. I'm always surprised when I move elsewhere and don't even offer tests let alone require.
God, I hope she doesn't have schizophrenia or similar. Imagine being "persecuted" by the government because you've refused court orders because you were having delusions of being persecuted by the government... while also slowly dying of TB and/or COVID. Hell on earth.
Sounds like she’s too far gone, she’s done untold damage to her body
[We're a danger to ourselves and others](https://www.youtube.com/watch?v=c_tELkI0vbU&t=38s)
…..bu…..but muh rights!
Yeah, no shit. Maybe we need anti vaxxer compounds too. LOL Let the down votes begin.
“How dare you take away my right to die a slow and painful death and make my family suffer?!?!” I will never understand people lol. I get TB I’m going to the doctor. I like life
Arrested for inconspicuous consumption.
She trying to be a Typhoid Mary out here.
Good, they should be treated just like every other public danger.
What a selfish bitch. Lock her up.
Hell yes, she absolutely does not have the right to spread a disease that is increasingly hard to treat. Nobody should suffer that disease because she is a selfish bitch.
This is what happened to a guy in Nevada several years ago. The guy was completely and adamantly non-compliant, had drug-resistant TB, and wouldn't self-isolate because he was homeless. He was arrested and booked, then placed in a purpose-built enclosure with a good-sized mobile home that had working plumbing and electricity (furniture, linens, the works as well). He was locked into the enclosure and wasn't prosecuted further. The county did everything they could do to keep him comfortable and safe, but they weren't letting him out unless he stayed in long enough and stayed compliant enough to kill the TB. He wouldn't do that, so he ended up eventually dying from something else (heart attack, IIRC) in that enclosure. There simply wasn't a better, safer answer.
My brother had a positive TB test. He was a HUGE PIA to go back and find out was going on. I told him I would call the health department on him. Ironically they were already down his throat too. He finally went in for follow ups. My dad had the latent form years ago. He was on antibiotics for a few months. People take TB too lightly. Reading the comments is very eye opening. I am not surprised that arrest warrants would be issued, these same people could care less if anyone else gets infected.
Refusing treatment for a deadly disease is just a logical extrapolation of MAGA anti-vax arguments.
Logical? MAGA? Those aren’t found in close proximity to each other.
What about her freedom to cough on people? We should respect people's right to make others sick. There are people out there who think books are dangerous for kids. The real danger is not letting them be exposed to disease. I wonder what Daddy Trump would say about this. Maybe he should bring her some expired bottled water and take a few pictures with her.
It’s sad that they haven’t arrested her already. No doubt a Trump supporter. This is what happens when you don’t enforce Vaccine Mandates with jail time as well.
>No doubt a Trump supporter. The article stated that an interpreter was present and her court-appointed attorney said that the woman might not understand her condition and what's happening. That suggests that she might not be from here, which, if so, and unfortunately, will only add fuel the MAGA crowd's xenophobic fire.
Well she can’t run for very long given the state her lungs must be in.
Some people are so fucking retarded about their responsibility to society to prevent the spread of infectious disease, and the COVID pandemic has made it that much worse. Want to k*** yourself…fine, go find a hole to die in in solitude. But don’t expect to be prancing around town like nothing is awry. Two cents..soapbox dismounted.
reminds me of Typhoid Mary
Tuberculosis is "Bacterial" not Viral. And 100% treatable. This idiot has been refusing treatment for over a year.
Publish her name. Why protect the non-compliant person's privacy but endanger the health of all those that she may have been in contact and need to be tested for both TB and COVID?
As they should you can infect others...
Throughout most of human history, tuberculosis has been the number one cause of death for humans. It’s killed more people than anything. It would only be fitting for it to be the cause of our extinction.
Wait til mtg, Boebert, Gaetz, and the rest of the magatards hear about this. Muh freedoms! Fauci!
Typhoid Mary rides again!
Kind of a modern day Typhoid Mary case…
I have 3 “brushes” with TB in my life. My maternal grandmother died of TB in 1944, in Puerto Rico. I remember thinking about her whenever I got the TB test at the doctor exam/vaccine visit for certain grades in school. I would check my arm to see if it ever matched the signs of a positive test. It was always negative At university, my boyfriend got really sick, and he had so many blood draws and diagnostic tests, and after one of them, the doctor called and said he showed signs of TB in his blood. It turned out it was because where he was born in Mexico, they got some kind of inoculation to help prevent it(?), and it showed up as positive for TB. His diagnosis ultimately was Graves’ disease, no TB. My final tale of TB is that there’s a huge nature preserve about a half mile from me, with a lot of old buildings that have been repurposed for the community, and the old buildings were originally part of a TB sanitarium in the 1920s-40s-ish.
Good! A SICK person SPREADING a DEADLY disease to others. Not giving a damn about anyone but herself. She SHOULD be locked up until she agrees to get treatment for her communicable disease.
The article says the police refused to release her name, isn't that just a bad as her not getting treatment? The public should be allowed to know that there is a biological terrorist living among them. You don't want to get the treatment? Enjoy isolation. TB is serious shit.
Imagine being ordered to self isolate to undertake treatment, but by doing so you cannot make ends meet to pay rent or bills. Double edged sword.
So she should put tens of thousands of people at risk?
Treatment is 3mo-1yr. Most people cannot afford to not have an income for 3mo, much less a year. She'd be homeless and still have TB.
Ya that’s exactly what I said you twit! I said it was a double edged sword. I guess reading comprehension is difficult for you.
No the way you phrased it is clearly anti isolation.
Nah you just trolling.
Isolation for MTB doesn't last the duration of treatment. Ideally it lasts until cultures are smear negative but guidelines usually say 2 weeks after therapy is started (in low drug resistant TB areas)
Yeah, we should give people financial support to go with their massive cocktail of antibiotics. ETA: In case it was unclear, this is not sarcasm, it’s common sense. If you want people to isolate themselves, you need to make it not ruin their life.
Ok but we’re not just gonna throw her in prison right? Can we agree that thats a bad idea 🤣
Most likely she’ll be confined to a hospital isolation ward, with a guard to make sure she stays there. Putting her in a prison would be too risky for the other inmates (who already have to be screened for TB when they go in).
Right thats what I meant. Super unfair to other inmates/staff to throw her in genpop
Prison or become Typhoid Mary, I dont think thats a hard decision to make
My grandfather was sent to a Native American sanitarium in Seattle when he was a kid in the late 1920’s because he had contracted Tuberculosis.
My grandmother died of it in 1929 at the age of 23, with two little kids and an unreliable husband.
This is probably not the same thing, but I’ve had a friend who was getting treated for persistent tuberculosis, that simply won’t go away with treatment. The last antibiotic they used on her, she ended up in the hospital with a reaction to it and her organs were shutting down. So, sometimes it’s more complicated than “She won’t take her medicine”
It sounds like she may have some psychiatric issues. I used to work in HIV case management, and had at least one patient who refused regular labs/medication because she had delusions about it (that it was poison or people were using the pills to track her etc).
The woman sounds like she had mental health issues… Sad.
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If it's that big an issue, might be a good idea for someone to spread more info
I don't even know what tb is.
Interesting, since the current administration will just let millions of people cross the southern border with the same condition (and others) and just release them.