Did Public Health Officials Underreact, Overreact, or Both?

Jacob Sullum | June 8, 2007

An audio recording from Andrew Speaker's May 10 meeting with Fulton County, Georgia, public health officials backs up his claim that they told him he was not a threat to others, despite requiring treatment for tuberculosis:

The Speakers asked whether Andrew could expect to be restricted to a room once he arrived at a Denver hospital for specialized treatment.

"Now, that I don't know," responded Dr. Eric A. Benning, director of the county health department's communicable diseases branch. "But because of the fact that you actually are not contagious, there's no reason for you to be sequestered."

In another piece of the recording, Dr. Benning told Mr. Speaker, "As far as we can tell you, you're not a threat to anybody right now."

The recording, by the way, was made by Speaker's father, who "described himself as 'a little hard of hearing,'" and "said he taped conversations frequently and had wanted to be able to review any diagnosis offered in the meeting." If these excerpts accurately reflect what public health officials were saying, Andrew Speaker's decision to leave for his European wedding and honeymoon seems reasonable. As for his decision to fly back after the CDC called to tell him he had extensively drug-resistant TB, he claims he asked whether he was any more contagious than he had originally believed, and the CDC said no. If this account is accurate, the threat to others had increased in the sense that the outcome was worse but not in the sense that the likelihood of that outcome had increased. If the likelihood of transmitting the disease was significant, the news that he had XDR TB should have affected his decision about whether to travel. But if the likelihood was essentially zero (as his father-in-law, a CDC tuberculosis expert, apparently thought), the updated diagnosis really needn't have figured in his decision, except to the extent that it made him anxious to fly home for treatment.

So far it looks like Elizabeth Whelan, president of the American Council on Science and Health, was right in arguing that public health officials either underreacted at the beginning or overreacted later. Possibly they did both.

Comments

Richard|6.8.07 @ 4:44PM|#

The "possible outcome" was worse, indeed. If there's a 1% chance the person next to you might catch your cold, flying is reasonable. If there's a 1% chance the person next to you might catch your highly drug resistent and potentially fatal disease, stay off the damn flight. I'd like to shoot the SOB.

|6.8.07 @ 4:52PM|#

Despite Richard's opinion, I'm taking Speaker off the Big List of Assholes until further notice.

|6.8.07 @ 5:01PM|#

Where's officer Barbradey when you need him?

Paul|6.8.07 @ 5:11PM|#

That's because health officials are busy working on this.

Disease epidemics are so 1950's, it's the contextual health "dangers" which rule.

|6.8.07 @ 5:32PM|#

[" An audio recording from Andrew Speaker's May 10 meeting with Fulton County, Georgia, public health officials..." ]


...and just 'why' did Andrew Speaker meet with "public health officials" or have any involvement at all with them ??

Did he ever wonder why they might be so interested in him ?

Obviously, (..even to Andrew) his condition was a potentially serious threat to the public.

Lawyer Speaker certainly knew that... despite his claims that no one 'told' him he might present a serious risk to others now or in the near future.

Carefully selected (.. and totally unverified) excerpts from his lawyer-father's pocket voice recorder -- are far from persuasive evidence of anything.

The Georgia and CDC "health officials" behaved as normal government bureaucrats -- slow to decide & act, but quick to avoid responsibility.

Would an Atlanta cab-driver or retail clerk been treated the same as 'personal-injury lawyer Andrew Speaker' by government health officials ... in similar circumstances of TB diagnosis ??

|6.8.07 @ 5:47PM|#

The CDC seems to have dropped the ball. The solution is, obviously, the creation of a new Department of Homeland Health Security and a new Infectious diseases Czar.

Doc|6.8.07 @ 6:49PM|#

Speaker was most certainly infectious when he left ATL. The level of that infectiousness is probably very low but certainly not 'noninfectious'.

While the cells were not microscopically detected (so called 'smear negative') that does *not* mean TB cells aren't in the specimen. The TB culture from his sputum was positive for growth XDR TB. A report of 'No TB/acid-fast bacilli observed' does not mean the same as 'No TB/acid-fast bacilli present' (no lab issues a report like that).

Fulton Co.'s TB program is widely derided especially by the folks at the CDC. Kinda like a retarded cousin you make fun of but not infront of stangers.