Did Public Health Officials Underreact, Overreact, or Both?

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.