When We Quarantine — And When We Don't
Thursday, November 06, 2014
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Mycobaterium tuberculosis is much less common than
it used to be, but it is still considered a threat to public health and
in some cases can be very difficult to treat.
(Microbe World/flickr)
Thirty-four-year-old Karim works long days as an investment
adviser, and when he doesn’t burn the midnight oil, he plays basketball
or goes to the gym, hangs out with friends, or heads to coffee shops.
You wouldn’t know he has an especially tough-to-treat illness: multiple
drug-resistant tuberculosis.
"It has been a very stressful treatment process and a lot to deal with, but thank god it’s all going really, really well," said Karim, who is not using his full name out of concern he could be stigmatized for being a carrier of a disease many people don’t understand. "At this point, I mostly don't think about it, other than during the three minutes a day when I take my medicine."
While Americans debate whether we should quarantine people who might have Ebola but clearly aren’t contagious, many people wander among us who are infected with another highly communicable disease. Close to 10,000 people in this country have tuberculosis, including around 650 in New York City.
During the first couple of weeks after the diagnosis in August of 2013, the city Health Department ordered Karim to stay home, and he did so. When tests confirmed the initial drugs had beaten back the TB bacteria in his lungs to a non-contagious level, he got the ‘all clear’ to move around the city freely. Today, he continues to take three very powerful antibiotics every morning. A Health Department official watches him take the pills, via smartphone video app. This is the city's standard practice for all TB patients.
"In the beginning, I was frustrated with having to report or show that I’m taking my treatment all the time, but at the end of the day this is something that could get out of hand," Karim said. "You just don’t want to risk it. It is a highly contagious disease, and if you’re not taking your meds, you’re just putting other people at risk."
New York state allows the city to impose a strict quarantine on TB patients, and some can even be detained in a lock-up at Bellevue Hospital. But those drastic steps only happen to highly infectious people who repeatedly don’t take their medications — a small handful of people each year, according to Dr. Joseph Burzynski, head of the City Health Department’s Bureau of Tuberculosis Control.
"Detention and quarantine are rare events, and most of our patients that get to that point have had significant substance abuse issues or mental health problems that are not being addressed," Burzynski said. "Those are the reasons they’re not being adherent."
Only about one percent of people with TB in the city have multi-drug-resistant TB. Their treatment involves more drugs — including initial ones with harsh side effects — for about 18 months, a period about two to three times longer than the typical TB regimen.
All the news about Ebola has made both Burzynski and Karim think about how people understand infectious diseases. Burzynski said it makes sense that people are afraid of Ebola, because it's so lethal a virus. He he said looking at the TB experience could ease some of those fears and dial back some of the popular insistence on quarantining those exposed to Ebola who show no symptoms of the disease.
"We know that patients with tuberculosis are not infectious, except when they have a high degree of disease that’s not being treated and they’re coughing, and we know that persons with Ebola disease are only infectious once they develop symptoms and transmit the disease through the spread bodily fluids," Burzynski said. "So there’s really no reason to quarantine somebody who’s not a high risk to the public."
Karim said he's concerned about stigmatizing people with communicable illness. Members of his own immigrant family have expressed shame about the illness, leading him to share his condition with almost no one outside his closest circle. But he believes the issue is larger than a small group's feelings and their being inconvenienced. Like Burzynski, he thinks it's bad science and fear-mongering to quarantine people who don't have enough virus or bacteria in their system to show symptoms and therefore can't transmit disease.
"Whether it's tuberculosis or Ebola," Karim said, "if you go from quarantining people with symptoms to quarantining people without symptoms, you're making [these illnesses] a lot scarier than they are."
"It has been a very stressful treatment process and a lot to deal with, but thank god it’s all going really, really well," said Karim, who is not using his full name out of concern he could be stigmatized for being a carrier of a disease many people don’t understand. "At this point, I mostly don't think about it, other than during the three minutes a day when I take my medicine."
While Americans debate whether we should quarantine people who might have Ebola but clearly aren’t contagious, many people wander among us who are infected with another highly communicable disease. Close to 10,000 people in this country have tuberculosis, including around 650 in New York City.
During the first couple of weeks after the diagnosis in August of 2013, the city Health Department ordered Karim to stay home, and he did so. When tests confirmed the initial drugs had beaten back the TB bacteria in his lungs to a non-contagious level, he got the ‘all clear’ to move around the city freely. Today, he continues to take three very powerful antibiotics every morning. A Health Department official watches him take the pills, via smartphone video app. This is the city's standard practice for all TB patients.
"In the beginning, I was frustrated with having to report or show that I’m taking my treatment all the time, but at the end of the day this is something that could get out of hand," Karim said. "You just don’t want to risk it. It is a highly contagious disease, and if you’re not taking your meds, you’re just putting other people at risk."
New York state allows the city to impose a strict quarantine on TB patients, and some can even be detained in a lock-up at Bellevue Hospital. But those drastic steps only happen to highly infectious people who repeatedly don’t take their medications — a small handful of people each year, according to Dr. Joseph Burzynski, head of the City Health Department’s Bureau of Tuberculosis Control.
"Detention and quarantine are rare events, and most of our patients that get to that point have had significant substance abuse issues or mental health problems that are not being addressed," Burzynski said. "Those are the reasons they’re not being adherent."
Only about one percent of people with TB in the city have multi-drug-resistant TB. Their treatment involves more drugs — including initial ones with harsh side effects — for about 18 months, a period about two to three times longer than the typical TB regimen.
All the news about Ebola has made both Burzynski and Karim think about how people understand infectious diseases. Burzynski said it makes sense that people are afraid of Ebola, because it's so lethal a virus. He he said looking at the TB experience could ease some of those fears and dial back some of the popular insistence on quarantining those exposed to Ebola who show no symptoms of the disease.
"We know that patients with tuberculosis are not infectious, except when they have a high degree of disease that’s not being treated and they’re coughing, and we know that persons with Ebola disease are only infectious once they develop symptoms and transmit the disease through the spread bodily fluids," Burzynski said. "So there’s really no reason to quarantine somebody who’s not a high risk to the public."
Karim said he's concerned about stigmatizing people with communicable illness. Members of his own immigrant family have expressed shame about the illness, leading him to share his condition with almost no one outside his closest circle. But he believes the issue is larger than a small group's feelings and their being inconvenienced. Like Burzynski, he thinks it's bad science and fear-mongering to quarantine people who don't have enough virus or bacteria in their system to show symptoms and therefore can't transmit disease.
"Whether it's tuberculosis or Ebola," Karim said, "if you go from quarantining people with symptoms to quarantining people without symptoms, you're making [these illnesses] a lot scarier than they are."
Editors:
Julianne WelbyMore in:
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Fred Mogul, Reporter, WNYC News
Fred Mogul has been covering healthcare and medicine for WNYC since 2002.
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