Tuesday, July 10, 2012

Florida Governor Rick Scott's Huge TB Outbreak

There is a huge outbreak of TB in the Jacksonville, Florida area. I offer these infection control suggestions to the CDC and others for dealing with Florida's "problem" along with a timeline of the events surrounding the outbreak:

1) Build a huge wall between Georgia/Alabama and Florida.  We can't allow people with TB to get out of Florida, since that would make healthcare interstate commerce.  We know interstate commerce of healthcare is no longer possible since the SCOTUS just told us so. Gosh, if only this was a Broccoli Mosaic Virus outbreak - oh, the irony...

2) Ban all flights out of Florida - see #1 above.

3) Don't send any EIS officers or others to help, because this is a state's rights issue. We also know that everything the Federal Government does is bad, especially healthcare. Plus, this help will be perceived as a play by the Federal Government to take over the entire State - the slippery slope.

TB Outbreak facts:

1) The current outbreak of a strain called FL 046 initially infected at least 15 mental health facility residents and three non-residents and killed two in 2008 per a recently published study in June's American Journal of Psychiatry. Per the report, one patient circulated among a hospital, correctional facility, homeless shelter and an assisted living facility with a horrible cough that was recorded but never treated. The good-natured CDC even sent $275K to deal with said outbreak.

2) February 2012: Duval County Health Department (Jacksonville) asks CDC for help given huge spike in TB cases. This is not typically done without first contacting the state health department, no?

2) March 2012: Governor Rick Scott signs an order to shrink the Department of Public Health and close Florida's only TB hospital, AG Holley State Hospital, which had treated TB in the state for 60 years. Duval County Health Department's budget fell from $61 million to $46 million just as the outbreak became known.

3) April 5, 2012: CDC's Dr. Robert Luo releases a 25-page report describing Jacksonville’s outbreak that potentially impacts 3,000 people. Of these only 253 people had been evaluated. There were 99 confirmed cases, 13 deaths. Of the cases contacted and evaluated, only two-thirds could be linked to exposure at homeless shelters and other high-risk settings, suggesting that the TB strain had spread to the general public.

4) April 13-16, 2012: SHEA holds it's spring conference in Jacksonville.

5) July 2, 2012: The AG Holley State TB Hospital officially closes

6) July 8, 2012: Word begins to leak out of a huge spike in Florida TB cases.

To sum things up: the CDC report is released nine days after the cuts and closure bill is signed by Governor Scott.  The report is ignored and then the hospital closes.  Word of the outbreak final spreads 6 days after the hospital closes. Interesting timing.

Sources: Palm Beach Post, July 8th and International Business Times, July 9th, 2012

Image source: the null hypothesis blog

Addendum: Infectious diseases are the great equalizer - i.e. they don't care if you are rich or poor.  If the poor cannot afford good medical and mental-health care, it's only a matter of time before our whole country suffers. The poor can't spread heart disease to the rich, but TB and other difficult to treat infectious pathogens are another matter.  Public health can't be made into a political football or we all suffer, as the residents of Florida now are.

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