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XDR-TB Is Coming, XDR-TB is Coming!

September 27, 2007

508682046_897156f638 Earlier this month, the House Committee on Homeland Security Majority Staff issued a report (pdf) regarding the fiasco that was Andrew Speaker’s wild and crazy ride. Following a detailed timeline of the events that lead to Mr. Speaker’s detainment in Colorado, the reader is treated to a veritable comedy of errors. The only thing that keeps it from being funny is that, well, it’s true.

By now, everyone’s heard at least parts of the story, but here’s the blow-by-blow. On May 10, Mr. Speaker was diagnosed as having MDR-TB, then alerted to that fact and told not to travel the next day. On May 12, Mr. Speaker hopped a flight to Paris, then another to Athens, then yet another to Thira Island on the 16th. On the 17th, the Georgia lab that diagnosed the MDR asked the CDC to test the samples for XDR-TB. On the 21st, Mr. Speaker hops a plane back to Athens, then another on to Rome, meanwhile, the CDC confirms the XDR designation. CDC works with Customs and Border Protection (CBP) to attach a note informing that Mrs. Mr. Speaker should be held in isolation onto his passport. They later find out that he is in Rome and contact Mr. Speaker to inform him of the diagnosis and to stop traveling. On May 24th, Mr. Speaker, after promising to stop traveling and having been made aware that he was placed on a “no-fly” list (he was placed on one later that night), jumps on a plane bound for Montreal. Mr. Speaker and his wife arrive at the Champlain, NY port of entry, and are cleared to enter the country by a CBP officer who notes the message attached to Mr. Speaker’s passport. The following day, Mr. Speaker admits himself to an isolation hospital in New York City, and is transferred to an Atlanta area hospital. Much ass covering ensues.

Now a quick catalog of the disastrous errors that enabled a public health risk to go globe-trotting and re-enter the our “homeland.”

  • Mr. Speaker was warned against travel, when he should, and very easily could, have been legally restricted from traveling
  • The state lab in Georgia waited seven days after a diagnosis of MDR to request additional testing by the CDC for XDR status, and no explanation was given for the delay
  • CDC directly contacted Mr. Speaker in Rome and expected him to follow their directive to stop traveling when they already knew his lack of compliance with health orders. International authorities were not notified of Mr. Speaker’s status and location until two days after CDC knew both
  • CDC depended on a former employee working for the Italian Ministry of Health to make personal contact with Mr. Speaker, instead of depending on Italian authorities who could have brought in law enforcement to ensure Mr. Speaker’s compliance
  • DHS Office of Health Affairs was notified of Mr. Speaker’s unauthorized flights and status on May 24, AFTER Mr. Speaker has boarded a flight bound for Canada. Not until after he lands does CDC contact TSA requesting that he be put on a no-fly list
  • HE DRIVES TO THE BORDER – AND THEY LET HIM IN!!!
  • TSA approves Mr. Speaker’s inclusion on the no-fly list at 7:30PM. Canadian officials place Mr. Speaker on their no-fly list at 8:00PM. American authorities don’t do the same until 8:31PM – nearly five hours after it was requested

Now, I don’t mean to be unduly harsh. This was the first time something like this popped up, and in retrospect, Mr. Speaker wasn’t contagious, so there was really no need to worry. In fact, I don’t think that the biggest problem was the CDC’s fault. I truly do believe that they did the best they could in a weird situation. I hope they do better next time.

No, my problem is with CBP. The message that was attached to Mr. Speaker’s passport said:

[P]lace mask on subject, place in isolation, well-ventilated room if possible.

And

[Subject] has multiple drug resistant TB and is a public health risk.

Seems pretty point blank for someone charged with protecting the “homeland.” What the hell kind of training are they getting over there? According to the report, the officer who (saw the note on Mr. Speaker’s passport, reviewed it, decided it wasn’t a very big deal, ignored the note, and then) let Mr. Speaker into the country has since retired, and says that while they’ve asked questions about the officer’s supervisor, they’ve not heard anything back yet.

Listen, I think we all know how ridiculous I think this whole Homeland Security business is. I just think I could find the stomach for it – maybe even support the idea – if the screw ups weren’t so outrageous.

Here’s to hoping things improve. <Gulp>

Photo credit: ONE/MILLION

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