Tb @ MindSay

Tuberculosis and Minibuses

Sometimes some rumours become too interesting that even the most docile mind does not fail to comment on it. They become really interesting especially when they seem to originate from trusted sources and more importantly when they get reflected in events that follow them.

Of late we have read in papers about mosquitoes raging havoc in major cities of the country and at the same time we have also read about some people trying to ascribe the presence of TB in the country to the conduct of private minibus owners.  Not only have some authorities trusted and accepted this link, they have gone a step further to implement some countermeasures to allegedly stop the spread and it is rumoured they will continue to think of other countermeasures. The purpose of this article is not to trash these beliefs per se but to question whether scientifically we could indeed argue without doubt that there is a causal link between the conduct of minibus owners and the spread of TB throughout the country. This is important because minibus owners, just like most of us, sometimes can be viewed as helpless individuals whose businesses thrive only at the mercy of sometimes viewed as really ruthless but powerful individuals with hidden motives themselves.

The argument that TB in the country is spread by minibuses seems logical upon hearing it if we understand that TB is airborne and air tight environments may act as apt places for its spread. For example assuming that a minibus or any other car is loaded with people and one of them is having the TB bacterium, it might be spread through the air and some people may be affected. This can also be the case in hospitals, any public places without good ventilation and even in busy high streets like the Devil Street in the capital among others. While this is hypothetically possible the question is can this information suffice as evidence against minibuses? While ‘the air-tight places’ postulate may be hypothetically acceptable, in practice it does not exhaust the possible mechanisms through which TB spreads and unless we accounted for those omitted factors we would not be well placed to draw such damaging conclusions. Or do we have real data, empirical work or any statistics to support this claim?

With the modest knowledge of pathology, statistics and econometrics, I doubt very much if indeed we do have enough grounds to unequivocally ascribe TB spread to poorly ventilated minibuses. It is also questionable whether we can attribute it to the fact that minibuses take some number of people per chair. I mean it does not take rocket science to appreciate that TB has been there since the birth of our nation and over time it has visited many geographical areas and people of all statuses. TB is present in many areas regardless of each place’s level of urbanization, development and commercialization.  It exists in areas where some children have never seen any minibuses as well.

In a nutshell, my advice to law enforcers is that, while in theory the minibus-TB causal link may be possible, in practice it is not clearly so and if minibus owners are to applaud your conduct, do a good homework and decide on how best you would like to help reduce the spread of TB. This could even take the form of direct donations to TB reduction campaigns through the ministry of health among other possibilities. The decisions to punish minibus owners act as a tax on them and some taxes are bad for economic growth. of course these taxes are justfied but only when the rates are proportional to the probable harm that minibuses are thought may cause.

I do not doubt that poorly ventilated minibuses are a menance and that we need good minibuses. nevertheless, we need to be punishing businesses in a manner that does not suppress innovation and entrepreneureship

I wrote this short article in hopes of creating the importance of Bio Hazards. Generally the Police officer is the first responder to an emergency, like homicides, robbery or simple DUI offenses. In any scenario, the police officer must be alert to potential hazardous areas or people infected with a potentially infectious disease. These diseases can be Hepatitis B, HIV or TB, they are found in bodily fluids, blood, or on other items present.

Over 300,000 caretakers are infected each year from contact with infectious disease carriers or from improper handling procedures. Needle sticks is a major contributor to accidents and from drug interdictions. Needles should always be capped after use and destroyed properly. All needles should never be used twice. Proper hand wear, heavy duty gloves is a must when handling anything that may be potentially infectious or sharp, and protects against saturation and moisture of any kind.

http://www.police-writers.com/law_enforcement_bio_hazards.html

This article, which was on azcentral.com, was shocking.  I cannot believe the treatment this man is receiving; it is too harsh.  

I understand the importance of containment and isolation, for the safety of the general population.  Imagine if someone with this strain of TB decided to get on an airplane; how many people would contract the TB, and then, unknowingly, take it back home and spread it throughout their community?  The next influenza pandemic will most likely be spread by infected individuals travelling by airplane.  (For a Hollywood reference, rent the movie Outbreak with Dustin Hoffman and a young Dr. McDreamy).

Even though this man has a deadly, drug-resistant strain of TB, the fact that he is not allowed any contact with the outside world could constitute 'cruel and unusual' punishment.  I don't understand the reasoning behind the fact that he is not allowed at least a phone, television or a shower.  I'm not sure how watching televison would put anyone at risk for contracting TB.

While reading this keep in mind that he is an American (he has dual citizenhip) and has a wife and daughter in Russia, whom, according to this article, he can't communicate with because he isn't allowed a phone (I'm not sure if he can make calls, the article doesn't address that). 

Please let me know your thoughts...

Quarantine breach leaves TB patient locked in isolation

Man may serve life in hospital

Dennis Wagner
The Arizona Republic
Mar. 1, 2007 12:00 AM

He has been isolated here for eight months and is expected to remain much longer, perhaps until he dies.

But Robert Daniels is not charged with any crime. He has tuberculosis. And he is under court-ordered confinement because he violated the rules of voluntary quarantine, exposing others to a potentially deadly illness.

Daniels is afflicted with a TB strain so dangerous that he has never met his appointed lawyer, Robert Blecher, who describes the situation as "extremely unusual."

"Mr. Daniels' problems occurred - and he understands this - because of his own actions," Blecher said. "It does come down to a health issue for the entire community. He did go out in the public. He was exposing people."

Blecher acknowledged that his client's living conditions are unusual: Daniels is housed in Station 41, a room where air flows only in, not out. He is on a hospital floor supervised by the Sheriff's Office. There is no other facility in the Valley for medical lockdown.

Jack McIntyre, a sheriff's spokesman, said sympathetic nurses gave Daniels a computer, a phone and other items for a time, but those were confiscated for security reasons. "While he's there, we treat him as an incarcerated individual," McIntyre said. "It's a jail ward."

Daniels contracted TB while living in Russia, according to Superior Court filings. In July 2006, he was admitted to Scottsdale Healthcare Osborn hospital for respiratory illness. Lab tests revealed that he suffered from "extreme multi-drug-resistant tuberculosis," records show.

The disease is spread by airborne contact: If a patient coughs in public, others are endangered.

Robert England, Maricopa County tuberculosis control officer, said in court filings that Daniels was transferred from the hospital in July to Monroe House, an outpatient facility for indigent TB patients near downtown Phoenix. He was instructed to continue treatment and wear a mask whenever going out in public. England alleged that Daniels stopped taking his medication and went unprotected to a Jack in the Box, a Circle K and other stores. Daniels understood the rules, England said in his affidavit, but "merely refuses to follow them."

Based on that, the Maricopa County Department of Public Health obtained a court order for "compulsory detention," a legal tool used only about once a year in Arizona and usually only for a short time.

Daniels is a Russian-born 27-year-old with dual U.S. citizenship. During a hurried and rare phone conversation Tuesday, he admitted making a mistake eight months ago but said he did not understand the gravity of his disease at the time.

"I don't want to confuse people if I wear a mask," Daniels said, describing his thoughts. "What if they think I'm a robber? What if I get shot?

"Nobody talked to me about this thing. Nobody lectured me."

Daniels said face covers are not worn by tuberculosis patients in his homeland, which ranks 12th on the World Health Organization's list of most infected nations.

"In Moscow," he said, "when I went to clinics, even the doctors did not wear masks."

Russia, with 26,000 TB deaths annually, has more than 80 cases per 100,000 population, compared with five per 100,000 in Arizona.

Daniels said he has become depressed to the point of weeping.

"They're making a criminal out of me," he added. "I've been crying almost every day. . . . I'm all alone. No showers. No sunlight. It's the silence that's pushing down on me. . . . It's the worst you can get, even if you murdered somebody."

Daniels, who has an American father and lived in the United States during the 1990s, was diagnosed with TB two years ago in Moscow. He was told drugs were difficult to obtain and too expensive for a poor laborer. Daniels said he came to Arizona in January 2006 looking for work and hoping to get treatment.

His wife, Alla, who is in Russia with their 5-year-old son, said in a phone interview that the imprisonment seems inhumane.

"I know he has a very dangerous form of the disease," she said. "But he was not arrested. His rights are being violated."

Daniels said hospital workers became so upset with his plight recently that a series of county Superior Court hearings were conducted. Last week, Commissioner Randy Ellexson ordered that the patient be moved to new quarters. He then reversed that decision during an emergency session, which Daniels said he was not allowed to monitor by phone.

Daniels said he has been a model patient at Station 41 and would not violate quarantine again. He claimed recent tests of sputum from his lungs were negative for TB.

But prospects for freedom remain unclear. A medical assessment submitted to the court in August indicated the disease was still mutating in Daniels and may require treatment for years.

"There is certainly a high likelihood that the patient has developed additional drug resistant (sic) that may make cure impossible," the assessment said. "If this is the case, the patient must be detained in isolation until death or patient's own immune system contains it (50% chance of either possibility)."

A Feb. 20 entry in the file added that Daniels needs eight weeks of clear tests before he can be deemed non-infectious. Court records do not contain an updated prognosis, and medical authorities declined to comment.

When I watch My Fair Brady I see similarities between their relationship and that of me and my boyfriend. The age difference (ours is 12 years rather than 22 years), the moving in thing (keep talking about it on this end, but who knows if/when it will happen), and the whole wanting to get married and have kids thing. I love Adrianne so much. I totally see me as far as the marriage, kids, and sex thing goes. Granted, she's a 22 year old wanting to have kids with a guy that is 44 or so years old and I'm 20 years old wanting marriage and kids with a 32 year old. Anyways, that's my "I want" fit for now.

Did the first phase of my TB testing today. My arm is so sore and puffy right now. I think I am coming down with something too. I guess that's what happens when you work in the school system. I didn't get sick at all last year, well, except for the kidney infection, but that isn't exactly something you catch from someone. Anyways, time to crash.