Sunday, June 03, 2007

TB Double Standard?

Last week, I was only peripherally following the case of Andrew Speaker. He's the guy who flew to Greece to get married and it was found out that he had a form of drug-resistant tuberculosis. There was a lot of media coverage about who was exposed on the airplane, and the process of contacting all these people. Apparently, Friday, he went on national television to apologize.

Right now, Speaker is under US government quarantine (the first since 1963) while he is undergoing further evaluation and treatment. His medical plan is to stay in a Denver hospital for possibly two months to receive antibiotics and possibly surgery.

As I was reading this story, there were aspects of this that sounded kind of familiar to a previous post that I wrote. Then, it hit me. I wrote two months ago about Robert Daniels (pictured above - image credit) and his ordeal in Arizona.

Daniels moved from Russia to Arizona and it was found out that he has drug resistant tuberculosis. Reports state that he refused treatment or even to wear a mask. For these reasons Daniels ended up in jail and is still there to this day (Read TB patient in jail for more details and an interesting comment section).

I started asking myself: How can one guy be under federal quarantine and placed in a hospital, and another guy be under state/local quarantine and placed in jail? As I did more research, I found this article on MSNBC/Newsweek.
Robert Daniels has been confined to his small, cinder-block room for nine months so far and he doesn’t know when his confinement will end. He has one barred window that is frosted over so little light shines through, a metal toilet with a metal sink and he spends most of his day in bed. He hasn’t had a hot shower since his detention and has to bathe with sanitary wipes, since he has only been allowed out of his room once. But Daniels is not a criminal, and has not yet been charged with any crime. Instead he is a tuberculosis patient who was quarantined at the Maricopa County hospital in Phoenix last July after failing to wear his mask in public.

While tuberculosis patient Andrew Speaker, at the center of a media storm this week, was the first person since 1963 to be quarantined by the federal government, some others, like Daniels, are detained by local and state officials.

[A]fter Speaker's case went public, [ACLU attorney Linda] Cosme says she will be filing a motion to move Daniels' case to federal jurisdiction. "Speaker's treatment is much better," Cosme says. "While Robert acknowledges that he should be quarantined, he should be allowed out to exercise his legs and be in the sun." As long as he’s wearing that mask.
Is there a double standard here with one quarantine in a hospital and the other quarantine in a jail? Well, the ACLU is going to make an argument for this. Do I agree? If these cases where similar, then I would say, yes, there has to be consistency here.

But, I think there are more differences than similarities in these two cases. Daniels was pretty adamant about not wearing a mask in public, lied about not wearing a mask, and didn't follow other public health recommendations. These choices landed him in jail.

Meanwhile, Speaker was already in Europe when he learned of his disease state. Granted, he ignored health official recommendations not to take a long flight home, but I'm willing to give him a pass on this (I'm starting to hear the hypocrite chants) because the guy was scared and thought he was going to die. Plus, since getting home, he states he's been feeling guilty about taking those long flights and has been apologizing to anyone who will listen.

Is there a double standard going on here? Am I being a hypocrite here? Well, you be the judge (and I know you'll let me know). These cases will be more and more interesting as they continue to unfold.


~Mary said...

Speaker could have chartered a private plane home. Lawyers have the money. I don't fault him for wanting to get back to the states for treatment-I just think he could have done it in a more civic minded way.

Anonymous said...

Hmmm...maybe those passengers could be brought at San Lazaro Pavilion 10 here in the Philippines, then they'll know how it is to move in a place surrounded by hundreds of TB patients.

Anonymous said...

I'm not going to say that we shouldn't blame Speaker for what he did (boarding a plane when he knows he is ill with a dangerous strain of TB). But maybe it would be more compassionate if we don't discriminate him for having such a disease. After all, he had already ask for forgiveness and he seemed sincere. It should just serve as a lesson for those who do a lot of travelling. People should also try to seek education from their trusted health professionals (or try to educate themselves by reading more) about infectious diseases.

Anonymous said...

I DO think it's a double standard of some sort.
I'm not willing to let speaker off the hook so easily, Dr. A.
If he didn't want to disclose his TB status, he could have taken some sort of precautions--tell the airline he has an immune disorder and asks to be put in a front corner and/or alone or segregated seat(if the plane wasn't full).

Will you feel the same if it turns out he's infected any other passengers or airline crew?
Now that he's been caught, he's sorry and remorseful. BULL POOP I say. It's just another prime example of the entitled attitude Americans have, "I'll do whatever the hell I wantfor my own gain or good. Why should I care if some innocent bystander if adversely affected by my selfish, narcisistic behaviors? Are you old enough to remember about Patient Zero (the international flight attended) who single handedly (actually it wasn't his hand, but another appendage) was responsible for transmission of HIV in the early days? (If you haven't read "And the Band Played On", by Randy Shilts, I highly recommend it.)
Speaker gets no sympathy from me for having apologized after he got caught. Do you think we'd know about him/the TB at all otherwise? I'm not necessarily saying he should get jail time like the other guy who blantantly and defiantly REFUSED to act in a repsonsible manner. But who's going to end up paying the bill of all that Speaker has done? --YOu and me, as taxpayers.

Dr. A said...

I have read And The Band Played On. I agree - Great book.

I'm not trying to be argumentative, but I've read in the media and on other blogs people using the following example.

Since TB is infectious and contagious, does that mean that anyone with a infectious and contagious illness should freely disclose it for the reason of public safety?

How about the common cold? How about bronchitis or pneumonia? How about travelers diahrea? How about the bird flu? How about HIV and AIDS?

Don't throw anything at me, but this is the discussion that is taking place out there right now. Who has the power to deny Americans (or anyone else in the world) the ability to travel via plane, via boat, via car, etc? Do we want to give government or other entities this much power "for the public good?" Just some things to think about...

Anonymous said...

Dr. A,
Don't fret, I won't throw anything. I was a little league flunky, and besides, I throw like a sissy anyway. ;) (insert favorite stereotype here.) I'm not taking your comments as argumentative, but reinforcing your point. It takes a LOT to offend me.
You raise many valid points. The LAST thing I want is for the US to become more of a police state/Big(ger) Brother than it already is.
In a former full-time volunteer gig, I was a member & eventually chair of our State HIV planning group that wrote the proposals/RFP to the CDC for $$ for HIV prevention and education. In that role I fought hard (with many other activists) to keep the feds from creating the national data base of all infected people. In light of this, one arguement would be that HIV is not airborne. Other travelers aren't going to "catch" contract HIV unless there is exchanging of body fluids. As someone who get bronch infections at the drop of a pin, I wouldn't be adverse disclosing. But as a side note, I usually end up with a bronch infection AFTER having travelled by air, which has me leering of my upcoming trip to NYC. If I am in the midst of a bronch infect. when travelling, I do all that I can to keep to myself and practice universal cautions. But, I think I'm the exception and not the rule in this case.
For me, the biggest issue in this TB case is that TB is SO easily transmitted, and this guy has a drug resistant strain. As a person who is immune compromised (I have CVID), if I'd been on that plain, I'd be EXTREMELY pissed, as the way my luck runs, I could be at the complete opposite end of the plane from him, & I'd be the one passenger walking out infected. Even with my monthly IgG infusions, TB would win the battle against me.
The answer's not black and white, but a very muddy grey (as are most moral/ethical decisions and conversations.
Thanks for responding and the additional thoughts, Dr. A. I was beginning to think I was the death nell for posts.

ID Crossroads said...

I was horrified and disgusted at Andrew Speaker when I heard the case. I think the man should go to jail for exposing all these innocent people to a potentially deadly disease. From what I've heard, his primary care doc told him not to travel when he was diagnosed with TB. Speaker said he needs to go on his honeymoon. The CDC got involved when the TB was found to be XDR. By that time, Speaker was in Rome. The CDC found him by phone, and told him to stay put. He then proceded to come back to the US. He was apparently listed as "no fly", and flew to Canada and then drove into the U.S. Now he says he is sorry and he did not know he was contagious. I find it hard to believe that no one mentioned that to him. Besides, why does he think the CDC is making such a big deal if he wasn't contagious? This guy is a lawyer himself, and I think he is now doing double talk.