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…to prevent the introduction, transmission, and spread of communicable diseases…

May 30, 2007

XDR TBThose of us who receive health alerts have been bombarded the last couple of days with CDC advisories and updates. I received alerts from Philadelphia, Pennsylvania, NYC and CDC – on two separate items, with one of them requiring an update.  Receiving twelve alerts in two days is something that scares the hell out of me, and I hope I never have to witness it again, for relatively small matters such as this week, or any other reason.

One of the items, while not of immediate interest to clinicians and providers, shows us the extent and force of public health response in this country, and is something we should all be aware of in the event of.  On 12 May, a man who has radiographic evidence of pulmonary TB, is culture-positive for XDR TB, but is sputum smear negative for acid fast bacilli and is relatively asymptomatic boards a plane bound for Paris.  The CDC (and presumably DHS) place this man’s name on a no-fly-list for flying while considered contagious.  He boards a flight from Prague to Montreal and re-enters the US by car on May 24.  He checks himself into a New York hospital and is taken into isolation by the CDC.

First of all, the ridiculousness of a man with an extremely deadly contagious airborne disease setting foot on an airline and crossing the border AFTER being identified is enough to call this whole DHS situation a farce.  If we were dealing with someone with ill intentions and a fatal cough, all of those millions upon millions in money spent on homeland security would have been better spent on football stadiums.

Secondly, and more on topic, we have now seen the public health response of last resort — isolation.  No one has been forcibly isolated in the US due to public health concerns for more than forty years.  And for good reason, this is the proverbial sledgehammer to catch a flea situation.  The issue of public health interests trumping individual liberties has been debated since public health interests were first asserted in the US.  Doing it in today’s hyper-communicative and activist environment is akin to waving a match at a stick of dynamite.  Already liberal bloggers have bemoaned the possibility of quarantine during a potential influenza pandemic.  Should this have been a situation where the infected put up a fight, we’d be having wide ranging discussions on the rights of American citizens right now.

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