'Virtually Untreatable' Form Of TB Emerges

The Wrap: A worm's eye view

Tuesday September 12, 2006
Guardian Unlimited


A new strain of incurable TB could kill the rich as well as the poor, says Andrew Brown

The thing that books don't tell you about tuberculosis is that it smells disgusting. I once had to carry the feet of a man who was dying of it down a flight of stairs and when he raised his head a bit he breathed on me. That's how I knew his lungs were really rotting. He died about a fortnight later, and in hippy Glastonbury, in 1972 or thereabouts, this was shocking. TB was one of the diseases no one died of. Actually, we didn't really believe in those days that there were still any diseases that killed people like us. We thought that they had all been conquered. Yet this immunity is very recent. In the nineteenth century the disease was responsible for a quarter of all the deaths in England. George Orwell died in 1948. One of his last letters mentions being tested with streptomycin, but it came too late for him.

Until antibiotics, the only cures involved rest and good hygiene, fresh air and hope. This meant, of course, that for most poor people, the disease was more or less incurable. You need bad luck or a weakened immune system to develop the full-blown disease, but it's very easy indeed to catch the bacillus, which is spread, like colds, by coughing. The news last week that a strain of TB is flourishing that will not be cured by any known combination of antibiotics might thus be a harbinger of a really nasty future. It is particularly dangerous in countries where Aids has taken root, because so many people there are living with weakened immune systems. Of 553 TB patients studied in rural South Africa recently, a tenth were found to have the incurable TB - and all but one of these 53 patients were dead within a month. With that kind of plague around, the extremely expensive and complex retroviral drugs developed to keep people alive till a cure for Aids is found just won't work. They will keep patients alive only until the TB catches them.

The disease was not first found in Africa. It had been reported from Latvia and Russia, and is suspected all over the world. But it was first identified in the US and may well become established there. This raises some interesting and unpleasant possibilities. By and large, America is the best place in the world to be ill if you're rich, and one of the worst if you're poor or insufficiently insured. A perfectly privatised health system like that made perfect sense for most of history, when no one knew how diseases were spread. Now that we understand that disease comes from pathogens and parasites, it makes sense only as long as there are no real plagues. So far, that's true. Dangerous infectious diseases are almost entirely confined to the poor. You may say that people of all classes get Aids but it is only a partial exception to this rule, because the rich, if they get it, can live with it: they have the drugs. Nor is it really terribly infectious. Nowadays it is hard to catch if you avoid sharing needles and bodily fluids.

Imagine, though, the social impact of a plague that rich people could get from poor people who just breathed on them. It's not just tube trains, nor even pavements, that would be dangerous then. In an age of mass air travel, a single drug-resistant TB patient sitting on a plane for eight hours is a threat to five or six hundred other passengers, even the ones in first class. At this point we are back to socialism as self-preservation. The health of the poor directly affects the health of the rich, since a patient whose immune system has overcome the disease is not infectious. But the NHS is not immune to the strain of plagues. It is financed by a different and more diverse insurance pool than the one available under the American system. But the political dynamic works the same way: those who pay expect to benefit, and they don't want non-payers benefiting at their expense. In both Europe and the US, there is an assumption that the age of plagues is over, and that diseases will respect political boundaries. For most of history, this hasn't been true at all.

Back in 1903, when the threat of pullulating aliens was Jewish, one witness told the parliamentary commission of enquiry that the mortality rate among children less than one year old in Whitechapel was 50% (in the slums of the native poor it was only 38%). The 1905 Aliens Commission urged that "in cases where an immigrant is found to be suffering from infectious or loathsome disease ... the medical officer to have the power to debar such immigrant from landing."

It may not be drug resistant TB that pushes us back to those days. But the next time that someone tells you that bird flu is an over-rated threat, remember what a really infectious, really deadly disease could do. The fear of terrorism is not so dreadful as the fear of plague. Sometimes the one per cent doctrine - that even small risks of catastrophe can't be tolerated - is quite right.

* Andrew Brown maintains a blog.

Drug-resistant TB gaining ground

September 23, 2006

BY JORDAN ROBERTSON

SAN FRANCISCO -- The worst forms of the killer tuberculosis bug have been gaining ground in the United States, alarming public health officials over imported drug-resistant strains of a disease that is mostly under control in this country.

Although the number of drug-resistant TB cases in the United States is small compared with developing nations, health officials here warn that visitors from other countries who are unaware of their infections are bringing over the deadliest mutations.

Most drug-resistant infections in the United States are brought in by legal visitors.

The only visitors to the United States who are screened for tuberculosis and other medical conditions are immigrant and refugee visa applicants.

Worldwide, TB kills 2 million each year, mostly in Africa and southeast Asia.

Of gravest concern is ''extensively drug-resistant'' TB, which recently killed more than 50 in South Africa. It has been found in limited numbers in the United States -- 74 reported cases since 1993.

The strain is almost impossible to cure because it's immune to the best first- and second-line TB drugs. It is as easily transmitted through the air as garden-variety TB.

Officials here also have been jolted by a spike in a milder but still lethal form called ''multidrug resistant'' TB. It responds to more treatments but can cost up to $250,000 and take two years to cure.

AP

Oh great! I'm turning 50 soon and all I need is one more reason to fear for my own mortality.

As my grandfather - who got to be 95 years old - used to say: "One shot
of Schnaps a day kills all the germs".

Salute!!