TB Outbreak in FL kept secret.

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madd0ct0r
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Re: TB Outbreak in FL kept secret.

Post by madd0ct0r »

Ralin wrote:
madd0ct0r wrote:So your preferred option is to let lots of homeless guys die slowly of coughing bits of their lungs out, because you're too busy 'protecting' them from a theoretical rabid mob?

fuck sakes man.
Dude, calm down. I said a few posts ago that they fucked up horribly. Like Losanti said, there were options in between tell no one and plastering "HOMELESS PLAGUE!!!" over the evening news.

I just think that keeping it somewhat quiet wasn't unjustified. It's a valid concern.
Both TB and homelessness have significance to me, but keeping it quiet? There's no need to phrase it as 'Hordes of Homeless people are trying to spread this disease.' More like, 'There's been a big TB outbreak, if you're a concerned member of the public, feel free to come in for testing.' That way you hoover up all of the easily dealt with cases quickly while you can work with Homeless charities to see how best to tackle people who are terrified of hospitals, of guys in white coats and feel uncomfortable even being inside for too long.

which is smilar to what you said, except you then went onto say keeping it quiet is justified. it isn't. it simply isn't.
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Alyrium Denryle
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Re: TB Outbreak in FL kept secret.

Post by Alyrium Denryle »

OK. I am going to be blunt here. From an epidemiological standpoint, not going public with an outbreak of a deadly contagious disease is a really bad move, especially because the earlier you catch it, the more easily it can be treated. The more people are exposed, the better the odds that the disease will mutate into something more difficult to combat, the more moving parts you have to deal with in order to keep people on their medications.

The CDC not going public with this on its own is bad enough, but the state government "Not knowing" about it despite the CDC informing them, and continuing to close the best facility in the state for treating TB? Continuing after they know, even? No. I am not buying it. Maybe someone hacks into state gov emails to determine if the higher ups in state government are lying through their teeth, as I suspect they are. I wonder if the state government officials knowingly burying this would be liable in either civil or criminal courts if they did so.
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Re: TB Outbreak in FL kept secret.

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madd0ct0r wrote:Both TB and homelessness have significance to me, but keeping it quiet? There's no need to phrase it as 'Hordes of Homeless people are trying to spread this disease.' More like, 'There's been a big TB outbreak, if you're a concerned member of the public, feel free to come in for testing.' That way you hoover up all of the easily dealt with cases quickly while you can work with Homeless charities to see how best to tackle people who are terrified of hospitals, of guys in white coats and feel uncomfortable even being inside for too long.
The point is that entrepreneuring article-writers will smell that there is something that will make them sell the article THE PEOPLE MUST KNOW NAO!!!1!!1!!, and will start asking questions around. It's not that hard to get to the real story and tweak it a bit to make it more "interesting" by usual means, and voilà you get Faux Noise and similar saying "Hordes of Obama-supporting gay black whatever Homeless people are trying to spread this disease." exactly to the people more likely to take torches and pitchforks.

Again, "keeping it quiet to the media" does not mean "keeping it quiet to the ones supposed to contain outbreaks" as well.
The latter is very close to homicide.
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Re: TB Outbreak in FL kept secret.

Post by Darth Wong »

Alyrium Denryle wrote:OK. I am going to be blunt here. From an epidemiological standpoint, not going public with an outbreak of a deadly contagious disease is a really bad move, especially because the earlier you catch it, the more easily it can be treated. The more people are exposed, the better the odds that the disease will mutate into something more difficult to combat, the more moving parts you have to deal with in order to keep people on their medications.

The CDC not going public with this on its own is bad enough, but the state government "Not knowing" about it despite the CDC informing them, and continuing to close the best facility in the state for treating TB? Continuing after they know, even? No. I am not buying it. Maybe someone hacks into state gov emails to determine if the higher ups in state government are lying through their teeth, as I suspect they are. I wonder if the state government officials knowingly burying this would be liable in either civil or criminal courts if they did so.
Why am I reminded of "Jaws", and the pin-headed officials who didn't want to go public with knowledge of the killings because they were afraid it would hurt tourism?
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Re: TB Outbreak in FL kept secret.

Post by Alyrium Denryle »

Darth Wong wrote:
Alyrium Denryle wrote:OK. I am going to be blunt here. From an epidemiological standpoint, not going public with an outbreak of a deadly contagious disease is a really bad move, especially because the earlier you catch it, the more easily it can be treated. The more people are exposed, the better the odds that the disease will mutate into something more difficult to combat, the more moving parts you have to deal with in order to keep people on their medications.

The CDC not going public with this on its own is bad enough, but the state government "Not knowing" about it despite the CDC informing them, and continuing to close the best facility in the state for treating TB? Continuing after they know, even? No. I am not buying it. Maybe someone hacks into state gov emails to determine if the higher ups in state government are lying through their teeth, as I suspect they are. I wonder if the state government officials knowingly burying this would be liable in either civil or criminal courts if they did so.
Why am I reminded of "Jaws", and the pin-headed officials who didn't want to go public with knowledge of the killings because they were afraid it would hurt tourism?
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Re: TB Outbreak in FL kept secret.

Post by Ralin »

madd0ct0r wrote:Both TB and homelessness have significance to me, but keeping it quiet? There's no need to phrase it as 'Hordes of Homeless people are trying to spread this disease.' More like, 'There's been a big TB outbreak, if you're a concerned member of the public, feel free to come in for testing.' That way you hoover up all of the easily dealt with cases quickly while you can work with Homeless charities to see how best to tackle people who are terrified of hospitals, of guys in white coats and feel uncomfortable even being inside for too long.

which is smilar to what you said, except you then went onto say keeping it quiet is justified. it isn't. it simply isn't.
I have a very good friend who's homeless at the moment, so yeah, it matters to me too. It just seems to me like something that could spiral and cause more problems for the people affected.

That said, I'm no biologist or doctor, so I'll defer to Alyrium's expertise.

EDIT:

Jesus fucking Christ, I just told the aforementioned friend about this story and apparently she came down with tuberculosis last year. So yeah, hits home with me too.
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Re: TB Outbreak in FL kept secret.

Post by Ahriman238 »

My paternal grandfather died of TB, and I grew up on the story of his suffering and final months in a dedicated ward. So this is something personal to myself as well.

That said, I can almost see what happened. Someone made a stupid choice without public discourse, and decided to dig in on the issue and cover up rather than hear about consequences or deal with people asking what he/she was thinking. That happens all the time.

But now people are dead, more are dying (very slowly, and if they get tested there's plenty of time to save most) and the people responsible are going to see exactly zero consequences for screwing up.
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Re: TB Outbreak in FL kept secret.

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Errr. someone correct me if I'm wrong. The article is essentially saying that somebody got TB and was undiscovered for 8 months in 2008, no alert was raised but just routine attempts made to contain it, in 2012, the CDC got called in to see why there was a spike in TB cases and their report wasn't noticed by politicians intending to close a TB hospital.

Right?
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Re: TB Outbreak in FL kept secret.

Post by Themightytom »

Sriad wrote:
Themightytom wrote:Big Brother should keep secrets from the public about things that might scare them.
I'm sorry to be "fixed that for you guy" but that is seriously fucked up.
Har har har

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I think we have different levels of confidence in our government's efficacy. The US government is not big brother, both because of it's level of competence, but more importantly, because of the complete lack of a cohesive agenda.

Let's talk about the context here for a second, because I think we're looking at this very differently.

Ideologically, you believe that people have the right to make informed decisions. We agree on that, but we do not agree that all people have the ABILITY to make informed decisions. I think you are inferring that this ability is derived from natural aptitude, I think it comes from a combination of socioeconomic factors. This is important because we are talking about FLORIDA, not anywhere else. Florida has demonstrated a conservative intolerance of the homeless, it exists in their policies and practices, policies which the public information office should be intimately familiar with.

I realize you might find the concept of a public information office distasteful, but it that more because you favor the right of people to make informed decisions, or because it's ridiculous to you that they wouldn't be able to.

People do stupid things, I'm looking at the ethics of disclosure and how it will affect the overall system at work. I'm looking at the decisions people will reasonably start to make, relative to their roles when introduced to information that pertains to situations beyond those roles. I think public officials have an ethical obligation not to put their constituents in a bad position by disclosing information they are entrusted to act on, inappropriately.

That's not big brother stealing liberty and freedom of thought, it's a public offical making appropriate decisions about disclosure. You tell people something when it will serve a purpose, or affects their role not because you don't want to take responsibility for developing an effective response.

I wouldn't expect a doctor to tell me my symptoms are consistent with tuberculosis unless that is all they are consistent with and there is enough evidence to suggest a TB test. Likewise, I wouldn't expect a public health advisory to the general population, if the public health risk was to a specific population. there was clearly some risk of exchange here, but the broader problem seems to be with a lack of resource allocation to deal with the outbreak in the population it was found in. I don't ever want to see a public health department that concludes every outbreak possibility needs to be publicized because there is likely no capability to contain it, that's just admitting the system is broken and refusing to try fixing it.
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Themightytom wrote:...mobilizing ignorance...
Funny, when I think of things that would "mobilise ignorance", creating an environment where the Health Department cannot be trusted because they value political correctness more than doing their damn jobs ranks significantly higher than allowing people to make informed decisions about their own health.
Do people trust the Health department when they warn about a bird flu scare and it never happens because they pushed inoculations and prevented it? That is consequential thinking. I think we disagree about roles and expectations here, beyond just the political aspects of what's going on, here's the role of the state department of public health,
The role of public health is to promote and protect the health and safety of all Floridians. This mission is accomplished by:

identifying health risks in the community;
maintaining a safe and healthful environment;
detecting, investigating, and preventing the spread of disease;
promoting healthy lifestyles;
providing primary care for individuals with limited access to such care from the private sector; and ensuring that health care practitioners meet the requirements for providing adequate care;
informing the public on health issues.
http://www.doh.state.fl.us/Planning_eva ... phmain.htm

That mission includes considering the role that panic and disinformation plays in dealing with an outbreak. Do you see that second method? Maintaining a safe and healthful environment? It includes not screaming fire in every crowded building on the block. You call the fire department, and you assess whether or not the fire is a threat to everyone in the area. The FIFTH method is a little hard to accomplish when you flood the system with panicking hypochondriacs, and push the homeless further and further out of outreach range because they are afraid of public backlash.

I have not been advocating for political correctness, I am advocating for a pragmatic dissemination of information. I want people to do their jobs professionally, and not shy away from exercising their responsibilities because retroactively someone might doubt their decision making. I think the role politics played here can certainly be inferred, and I am not supporting that at all. That was irresponsible and unprofessional. Decision makers should have been aware of this information, however, decision makers are not John Q Public. They CHOSE the decision makers. They find out how those decision makers do, they decide whether to choose them again.

So, the public should certainly know what their representatives decide, but you know, they were elected, appointed, whatever, there's a point where you can't armchair quarterback. Advocating for full and complete disclosure, telling the public EVERYTHING and relying on public opinion to inform or justify their response is just another way to absolve them of the responsibility of acting on it, and that's a problem for me, these people are trained, educated, selected and compensated relevant to that training, to do a job, why are we going to do all that and not expect them to do that job? Why are we going to throw away that whole system based on specific instances without confirming a reasonable pattern of incompetence first, that's just an emotional response satirized by my tin hat picture..

HOW the public learns is an important aspect of this, we can write a nice big story about how the health department dealt with an outbreak of TB among the homeless, after they have dealt with an outbreak of TB among the homeless. Most people will gloss over it, some people, like you, will probably read it and consider it for a few days, but at least no one will freak out an target the homeless unfairly. Half of the policy issues facing the homeless were never made for their benefit, but rather from getting people riled up enough to seek the protection of government policy. in this case, we wrote a story after they clearly did nothing, and that's fine, it will help the public recognize when decision makers AREN'T getting what they need to deal with this, it does NOT mean the public should ride herd on every issue of public health.

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Re: TB Outbreak in FL kept secret.

Post by PainRack »

Ok. I'm reading the CDC report that was sent to Durval County Health Department...... and it changes the context significantly.

The article actually gets the fundamental right and everything, what happens is that everybody is reading it wrong and focusing on the sensational.

1. There was a drop in TB cases, which prompted the governor to sign the bill closing the specialised TB hospital.(From the news article), since, you know, AUSTERITY!

2. The timing turns out to be bad, as the article pointed out. There was no spike in TB cases. What happened was that there was a spike in a strain with the same genotype, suggesting that earlier efforts to contain TB in the nursing home failed. 30 of the 71 cases were from the same strain, this while TB cases dropped from 80 to 71 over the last 3 years. The article failed to bring out hard numbers, which.... I guess caused the confusion.
The report was also only given nine days AFTER the bill had been signed.

3. DCHD didn't screw this up.
As part of the 2009 outbreak investigation, active case finding was conducted at the assisted living facility. In response to increasing number of cases among homeless persons during 2010-2011, DCHD conducted a total of 22 TB screenings at homeless shelters and other sites suspected of having potential TB transmission, including one active case finding activity at a homeless shelter. DCHD increased educational outreach to local homeless providers and shelter staff and convened a forum on TB and homelessness involving stakeholders in 2011.
So, they DID involve the stakeholders, to the extent of convening a forum on TB and homelessness. They did everything procedurally right. They did case finding, they did this and they stepped up monitoring, what happened was as a result of their monitoring, despite the lower number of TB cases, they found that it was from the same strain, suggesting that it was being spread. And probably amongst the homelessness, and they couldn't contain it. So, they called in the experts at the CDC.


4. What really made this frightening is this portion here.
Five cases did not have docuemented treatment completion for their active TB disease because the patients were lost to follow-up. Fourteen cases had a history of prior LTBI infection;however, documentation of treatment completion was only available for three of them.
Guess EMR isn't that well established, especially amongst the homeless in Florida.

Or that due to the transient nature of homelessness, which points out a huge social issue here. I note from my lessons in ethics that the US quarantine laws is supposed to be complicated and varies from state to state. Anyone can elaborate on what Florida views are?

I guess that Florida doesn't have the equivalent of Singapore Infectious Disease Act, where people who had violated DOTs repeatedly could be detained at the CDC for compulsory treatment. Well, that's assuming they're placed on DOTs in the first place.

I won't be able to parse more info from the report, as I'm not an epidemologist or a doctor by training but well, here's the report.
http://www.documentcloud.org/documents/ ... ocument/p1
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Re: TB Outbreak in FL kept secret.

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To be honest, I think this portion of the CDC report and the fact that Florida is practising austerity, AND that state revenue has dropped tremedously, limiting the county ability to implement anti TB measures is more important.
The second major factor is the large number of contacts who have not yet been evaluated, despite the continued dedication of DCHD to performing name-based contact investigations and location-based screenings. Only 253 of 3,222 recent contacts to infectious cases identified at homeless shelters during 2010-2012 have been evaluated through these screenings, raising the possibility that the 1,200 persons evaluated at location-based screenings might not have been contacts.....
Whoo wee.

It gets better. A lot of the recommendations doesn't sound cheap. I'm thinking the Democrats should comb through the ACA to see whether that would have helped, such as the Medicare expansion to states and the quality of care bits.Hell, considering some of the healthcare bills posters have posted over the past, that 500 dollars per patient sounds too good to be true. A CXR for all HIV patients who been in contact? Whoopee.
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Re: TB Outbreak in FL kept secret.

Post by PainRack »

Is there any follow up news on this? The only updates I find on a google news search is essentially a rebuttal by the state denying that they covered up the outbreak, using the same facts I posed earlier on.....
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