Worst TB outbreak in 20 years kept secret
As state rushes closure of its only TB hospital in Lantana



JACKSONVILLE — The CDC officer had a serious warning for Florida health
officials in April: A tuberculosis outbreak in Jacksonville was one of
the worst his group had investigated in 20 years. Linked to 13 deaths
and 99 illnesses, including six children, it would require concerted
action to stop.

That report had been penned on April 5, exactly nine days after Florida
Gov. Rick Scott signed the bill that shrank the Department of Health and
required the closure of the A.G. Holley State Hospital in Lantana, where
tough tuberculosis cases have been treated for more than 60 years.

As health officials in Tallahassee turned their focus to restructuring,
Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and
the measures needed to contain it – went unseen by key decision makers
around the state. At the health agency, an order went out that the TB
hospital must be closed six months ahead of schedule.

Had they seen the letter, decision makers would have learned that 3,000
people in the past two years may have had close contact with contagious
people at Jacksonville’s homeless shelters, an outpatient mental health
clinic and area jails. Yet only 253 people had been found and evaluated
for TB infection, meaning Florida’s outbreak was, and is, far from
contained.

The public was not to learn anything until early June, even though the
same strain was appearing in other parts of the state, including Miami.

Tuberculosis is a lung disease more associated with the 18th century
than the 21st, referred to as “consumption” in Dickensian times because
its victims would grow gaunt and wan as their lungs disintigrated and
they slowly died. The CDC investigator described a similar fate for 10
of the 13 people who died in Jacksonville.

They wasted away before ever getting treatment, or were too far gone by
the time it began. Most of the sick were poor black men.

“The high number of deaths in this outbreak emphasizes the need for
vigilant active case finding, improved education about TB, and ongoing
screening at all sites with outbreak cases,” Luo’s report states.

Today, three months after it was sent to Tallahassee, the CDC report
still has not been widely circulated.

Backer of closing hospital didn’t know

Meanwhile the champion of the health agency consolidation, Rep. Matt
Hudson, R-Naples, said he had not been informed of the Jacksonville
outbreak and the CDC’s role as of Friday.

Told the details, the chairman of the House Health Care Appropriations
Committee vowed that there would be money for TB treatment.

“There is every bit of understanding that we cannot not take care of
people who have a difficult case of TB,” Hudson said.

The governor’s office asked a reporter to foward a copy of the CDC
letter on Saturday, but did not comment by press time.

Treatment for TB can be an ordeal. A person with an uncomplicated,
active case of TB must take a cocktail of three to four antibiotics —
dozens of pills a day — for six months or more. The drugs can cause
serious side effects — stomach and liver problems chief among them. But
failure to stay on the drugs for the entire treatment period can and
often does cause drug resistance.

At that point, a disease that can cost $500 to overcome grows
exponentially more costly. The average cost to treat a drug-resistant
strain is more than $275,000, requiring up to two years on medications.
For this reason, the state pays for public health nurses to go to the
home of a person with TB every day to observe them taking their medications.

However, the itinerant homeless, drug-addicted, mentally ill people at
the core of the Jacksonville TB cluster are almost impossible to keep on
their medications. Last year, Duval County sent 11 patients to A.G.
Holley under court order. Last week, with A.G. Holley now closed, one
was sent to Jackson Memorial Hospital in Miami. The ones who will stay
put in Jacksonville are being put up in motels, to make it easier for
public health nurses to find them, Duval County health officials said.

They spoke about CDC’s report Friday, only after weeks of records
requests from The Palm Beach Post. The report was released late last
week only after a reporter traveled to Tallahassee to demand records in
person. The records should be open to inspection to anyone upon request
under Florida Statute 119, known as the Government in the Sunshine law.

TB strain spreads beyond homeless

In his report, the CDC’s Luo makes it clear that other health officials
throughout the state and nation have reason to be concerned: Of the
fraction of the sick people’s contacts reached, one-third tested
positive for TB exposure in areas like the homeless shelter.

Furthermore, only two-thirds of the active cases could be traced to
people and places in Jacksonville where the homeless and mentally ill
had congregated. That suggested the TB strain had spread beyond the
city’s underclass and into the general population. The Palm Beach Post
requested a database showing where every related case has appeared. That
database has not been released.

It was early February when Duval County Health Department officials felt
so overwhelmed by the sudden spike in tuberculosis that they asked the
U.S. Centers for Disease Control and Prevention to become involved.
Believing the outbreak affected only their underclass, the health
officials made a conscious decision not to not tell the public,
repeating a decision they had made in 2008, when the same strain had
appeared in an assisted living home for people with schizophrenia.

“What you don’t want is for anyone to have another reason why people
should turn their backs on the homeless,” said Charles Griggs, the
public information officer for the Duval County Health Department.

Even the CDC was not forthcoming about the outbreak. An agency
spokesperson declined requests from The Post when asked to make an
expert available to discuss a CDC-authored scholarly paper on the
possible origins of the Jacksonville outbreak, offering only general
fact sheets on TB.

“After checking in with the Division of TB Elimination about your
specific questions, they have suggested that you reach out to your
health department,” wrote Salina Cranor of the CDC’s TB prevention
office. . “They are really the best source for your questions.”

“With TB it’s a judgment call,” said Duval County Health Director Dr.
Bob Harmon in a telephone interview Friday, after the state’s new
surgeon general referred questions back to him.

“There have been TB outbreaks where we do alert the public, such as a
school or a college,” Harmon added.

For weeks, there had been a dissonant message coming from the Department
of Health press office in Tallahassee. It released overall numbers of
Florida tuberculosis cases showing a marked decline statewide,
supporting the argument that A.G. Holley had become irrelevant. Asked
whether she had been aware of the severity of Jacksonville’s outbreak
while delivering that message, she did not answer.

“Florida experienced a 10 percent decrease in cases for 2011 compared to
2010. For the period 2007—2011, there was a 24 percent decrease in
cases,” wrote agency spokeswoman Jessica Hammonds in an emailed response
to written questions on May 18. She declined, at the time, to make
agency experts available for interview.

In an article published in June’s American Journal of Psychiatry, CDC
experts Dr. Joseph Cavanaugh, Dr. Kiren Mitruka and colleagues described
the apparent origins of the current outbreak, when a TB strain called FL
046 came to claim two lives and sicken at least 15 mentally ill
residents of one assisted living facility in 2008.

A single schizophrenic patient had circulated from hospital to jail to
homeless shelter to assisted living facility, living in dorm housing in
many locations. Over and over, the patient’s cough was documented in his
chart, but not treated. It continued for eight months, until he finally
was sent under court order to A.G. Holley. That year, 2008-2009, a total
of 18 people in that community developed active tuberculosis from the
strain called FL 046 and two died. The CDC sent a $275,000 grant to help
pay for the staff needed to contain it.

After the money ran out, Harmon said, staff were redeployed to other
needs. But in 2011, suddenly, the number of active cases of FL 046
spiked, rising 16 percent to 30 cases of a specific genotype, the one
seen in 2008.

“We thought after 2008 that we had it contained,” Harmon said. “It was
not contained. In retrospect, it would have been better to inform the
general population then.”

Harmon said the Duval County Health Department will need more resources
if it is to contain the current TB outbreak. In 2008, when the TB
outbreak hit, his department employed 946 staff with revenues of $61
million. “Now we’re down to 700 staff and revenue is down to $46
million,” Harmon said. “It has affected most areas of the organization.”

If he can raise at least $300,000, he will use the money to hire teams
of experts — epidemiologists, nurses, outreach workers, to look under
bridges, in fields — in all the places where Jacksonville’s estimated
4,000 homeless congregate, to track down the people who may still be
infected unknowingly. Fortunately, only a few of the cases have
developed drug resistance so far. The vast majority respond to the
first-line antibiotics.

In downtown Jacksonville, in the homeless shelters and soup kitchens,
the TB strain called FL 046 continues to spread.

On a recent June morning, 60-year-old Lilla Charline Burkhalter joined
about 100 other poor and homeless guests being served a free hot meal of
scrambled eggs, grapes, potatoes and butterless bread by a local church
youth group.

The youth group was volunteering at the Clara White Mission, where a man
with active tuberculosis had been identified just three weeks earlier.

Looking weary but friendly, Burkhalter described her life of late,
sleeping in grassy fields and in shelter dormitories. She lived on a
small Social Security disability check, she said. It had enabled her to
pay for a room in an apartment, for a while. But her roommate had kicked
her out for making his girlfriend jealous, she said, and she hadn’t been
able to find any other accommodations. It had been a rough few months,
she acknowledged. But she had been through tough times before.

As she spoke, she coughed often. It was her emphysema acting up, she
explained.

Asked if she was fearful about the TB in the community, she shrugged.

“The health department tests me for TB once a year, so I know I don’t
have it,” she said. “I’m not worried.”

The Clara White Mission is now playing a key role in helping
Jacksonville fight TB. Its housing case manager, Ken Covington, had
spent most of his career helping bank branches assimilate after mergers.
Two months ago, he joined Clara White, charged with placing homeless
veterans and recently released jail inmates into homes. But the job has
became much larger.

Today, Covington is the new chairman of the Duval County TB Coalition.
In his hands he holds a massive binder with the intimidating title,
“Core Curriculum in Tuberculosis: What the Clinician Should Know.” It
was given to him by Vernard Green, the CDC’s visiting TB liaison.

Covington said he was a banker, not a clinician. But he had learned what
to watch for with TB – coughing up blood, night sweats, sudden weight
loss. The coalition members were looking at buying air filtration
equipment, drafting intake protocols, getting to know the TB experts in
the community, and educating shelter staff on what to watch for and what
to do if a client appeared ill.

“We’re trying to do what we can to rein it in, and stay in front of it,
and not let it get any worse,” Covington said. “I take it as a very
important role for the community.”

WHAT THE POST UNCOVERED

In 2008, a schizophrenic patient contracted TB but went untreated for
eight months, wandering among many places where the homeless congregate,
infecting at least 17 others.

In 2012, the CDC was invited to help with a sudden spike in cases of the
same rare strain the schizophrenic patient had. What they found is the
worst outbreak they have investigated in 20 years, and it is not contained.

ON THE TRAIL OF TB

Hard to track: Homeless and mentally ill people and those they have come
in contact with are especially hard to treat.

Long, tough treatment: Several pills a day of several virulent
antibiotics for a minimum of six months, often up to two years.

What’s at stake: If treatment regimen isn’t strictly followed,
antibiotic resistent strains emerge.

- - -

http://tinyurl.com/cohmc73

Governor Scott: Full Steam Backwards for Floridians

On 7/9/2012 3:53 PM, X ` Man wrote:
Worst TB outbreak in 20 years kept secret
As state rushes closure of its only TB hospital in Lantana



JACKSONVILLE — The CDC officer had a serious warning for Florida health
officials in April: A tuberculosis outbreak in Jacksonville was one of
the worst his group had investigated in 20 years. Linked to 13 deaths
and 99 illnesses, including six children, it would require concerted
action to stop.

That report had been penned on April 5, exactly nine days after Florida
Gov. Rick Scott signed the bill that shrank the Department of Health and
required the closure of the A.G. Holley State Hospital in Lantana, where
tough tuberculosis cases have been treated for more than 60 years.

As health officials in Tallahassee turned their focus to restructuring,
Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and
the measures needed to contain it – went unseen by key decision makers
around the state. At the health agency, an order went out that the TB
hospital must be closed six months ahead of schedule.

Had they seen the letter, decision makers would have learned that 3,000
people in the past two years may have had close contact with contagious
people at Jacksonville’s homeless shelters, an outpatient mental health
clinic and area jails. Yet only 253 people had been found and evaluated
for TB infection, meaning Florida’s outbreak was, and is, far from
contained.

The public was not to learn anything until early June, even though the
same strain was appearing in other parts of the state, including Miami.

Tuberculosis is a lung disease more associated with the 18th century
than the 21st, referred to as “consumption” in Dickensian times because
its victims would grow gaunt and wan as their lungs disintigrated and
they slowly died. The CDC investigator described a similar fate for 10
of the 13 people who died in Jacksonville.

They wasted away before ever getting treatment, or were too far gone by
the time it began. Most of the sick were poor black men.

“The high number of deaths in this outbreak emphasizes the need for
vigilant active case finding, improved education about TB, and ongoing
screening at all sites with outbreak cases,” Luo’s report states.

Today, three months after it was sent to Tallahassee, the CDC report
still has not been widely circulated.

Backer of closing hospital didn’t know

Meanwhile the champion of the health agency consolidation, Rep. Matt
Hudson, R-Naples, said he had not been informed of the Jacksonville
outbreak and the CDC’s role as of Friday.

Told the details, the chairman of the House Health Care Appropriations
Committee vowed that there would be money for TB treatment.

“There is every bit of understanding that we cannot not take care of
people who have a difficult case of TB,” Hudson said.

The governor’s office asked a reporter to foward a copy of the CDC
letter on Saturday, but did not comment by press time.

Treatment for TB can be an ordeal. A person with an uncomplicated,
active case of TB must take a cocktail of three to four antibiotics —
dozens of pills a day — for six months or more. The drugs can cause
serious side effects — stomach and liver problems chief among them. But
failure to stay on the drugs for the entire treatment period can and
often does cause drug resistance.

At that point, a disease that can cost $500 to overcome grows
exponentially more costly. The average cost to treat a drug-resistant
strain is more than $275,000, requiring up to two years on medications.
For this reason, the state pays for public health nurses to go to the
home of a person with TB every day to observe them taking their
medications.

However, the itinerant homeless, drug-addicted, mentally ill people at
the core of the Jacksonville TB cluster are almost impossible to keep on
their medications. Last year, Duval County sent 11 patients to A.G.
Holley under court order. Last week, with A.G. Holley now closed, one
was sent to Jackson Memorial Hospital in Miami. The ones who will stay
put in Jacksonville are being put up in motels, to make it easier for
public health nurses to find them, Duval County health officials said.

They spoke about CDC’s report Friday, only after weeks of records
requests from The Palm Beach Post. The report was released late last
week only after a reporter traveled to Tallahassee to demand records in
person. The records should be open to inspection to anyone upon request
under Florida Statute 119, known as the Government in the Sunshine law.

TB strain spreads beyond homeless

In his report, the CDC’s Luo makes it clear that other health officials
throughout the state and nation have reason to be concerned: Of the
fraction of the sick people’s contacts reached, one-third tested
positive for TB exposure in areas like the homeless shelter.

Furthermore, only two-thirds of the active cases could be traced to
people and places in Jacksonville where the homeless and mentally ill
had congregated. That suggested the TB strain had spread beyond the
city’s underclass and into the general population. The Palm Beach Post
requested a database showing where every related case has appeared. That
database has not been released.

It was early February when Duval County Health Department officials felt
so overwhelmed by the sudden spike in tuberculosis that they asked the
U.S. Centers for Disease Control and Prevention to become involved.
Believing the outbreak affected only their underclass, the health
officials made a conscious decision not to not tell the public,
repeating a decision they had made in 2008, when the same strain had
appeared in an assisted living home for people with schizophrenia.

“What you don’t want is for anyone to have another reason why people
should turn their backs on the homeless,” said Charles Griggs, the
public information officer for the Duval County Health Department.

Even the CDC was not forthcoming about the outbreak. An agency
spokesperson declined requests from The Post when asked to make an
expert available to discuss a CDC-authored scholarly paper on the
possible origins of the Jacksonville outbreak, offering only general
fact sheets on TB.

“After checking in with the Division of TB Elimination about your
specific questions, they have suggested that you reach out to your
health department,” wrote Salina Cranor of the CDC’s TB prevention
office. . “They are really the best source for your questions.”

“With TB it’s a judgment call,” said Duval County Health Director Dr.
Bob Harmon in a telephone interview Friday, after the state’s new
surgeon general referred questions back to him.

“There have been TB outbreaks where we do alert the public, such as a
school or a college,” Harmon added.

For weeks, there had been a dissonant message coming from the Department
of Health press office in Tallahassee. It released overall numbers of
Florida tuberculosis cases showing a marked decline statewide,
supporting the argument that A.G. Holley had become irrelevant. Asked
whether she had been aware of the severity of Jacksonville’s outbreak
while delivering that message, she did not answer.

“Florida experienced a 10 percent decrease in cases for 2011 compared to
2010. For the period 2007—2011, there was a 24 percent decrease in
cases,” wrote agency spokeswoman Jessica Hammonds in an emailed response
to written questions on May 18. She declined, at the time, to make
agency experts available for interview.

In an article published in June’s American Journal of Psychiatry, CDC
experts Dr. Joseph Cavanaugh, Dr. Kiren Mitruka and colleagues described
the apparent origins of the current outbreak, when a TB strain called FL
046 came to claim two lives and sicken at least 15 mentally ill
residents of one assisted living facility in 2008.

A single schizophrenic patient had circulated from hospital to jail to
homeless shelter to assisted living facility, living in dorm housing in
many locations. Over and over, the patient’s cough was documented in his
chart, but not treated. It continued for eight months, until he finally
was sent under court order to A.G. Holley. That year, 2008-2009, a total
of 18 people in that community developed active tuberculosis from the
strain called FL 046 and two died. The CDC sent a $275,000 grant to help
pay for the staff needed to contain it.

After the money ran out, Harmon said, staff were redeployed to other
needs. But in 2011, suddenly, the number of active cases of FL 046
spiked, rising 16 percent to 30 cases of a specific genotype, the one
seen in 2008.

“We thought after 2008 that we had it contained,” Harmon said. “It was
not contained. In retrospect, it would have been better to inform the
general population then.”

Harmon said the Duval County Health Department will need more resources
if it is to contain the current TB outbreak. In 2008, when the TB
outbreak hit, his department employed 946 staff with revenues of $61
million. “Now we’re down to 700 staff and revenue is down to $46
million,” Harmon said. “It has affected most areas of the organization.”

If he can raise at least $300,000, he will use the money to hire teams
of experts — epidemiologists, nurses, outreach workers, to look under
bridges, in fields — in all the places where Jacksonville’s estimated
4,000 homeless congregate, to track down the people who may still be
infected unknowingly. Fortunately, only a few of the cases have
developed drug resistance so far. The vast majority respond to the
first-line antibiotics.

In downtown Jacksonville, in the homeless shelters and soup kitchens,
the TB strain called FL 046 continues to spread.

On a recent June morning, 60-year-old Lilla Charline Burkhalter joined
about 100 other poor and homeless guests being served a free hot meal of
scrambled eggs, grapes, potatoes and butterless bread by a local church
youth group.

The youth group was volunteering at the Clara White Mission, where a man
with active tuberculosis had been identified just three weeks earlier.

Looking weary but friendly, Burkhalter described her life of late,
sleeping in grassy fields and in shelter dormitories. She lived on a
small Social Security disability check, she said. It had enabled her to
pay for a room in an apartment, for a while. But her roommate had kicked
her out for making his girlfriend jealous, she said, and she hadn’t been
able to find any other accommodations. It had been a rough few months,
she acknowledged. But she had been through tough times before.

As she spoke, she coughed often. It was her emphysema acting up, she
explained.

Asked if she was fearful about the TB in the community, she shrugged.

“The health department tests me for TB once a year, so I know I don’t
have it,” she said. “I’m not worried.”

The Clara White Mission is now playing a key role in helping
Jacksonville fight TB. Its housing case manager, Ken Covington, had
spent most of his career helping bank branches assimilate after mergers.
Two months ago, he joined Clara White, charged with placing homeless
veterans and recently released jail inmates into homes. But the job has
became much larger.

Today, Covington is the new chairman of the Duval County TB Coalition.
In his hands he holds a massive binder with the intimidating title,
“Core Curriculum in Tuberculosis: What the Clinician Should Know.” It
was given to him by Vernard Green, the CDC’s visiting TB liaison.

Covington said he was a banker, not a clinician. But he had learned what
to watch for with TB – coughing up blood, night sweats, sudden weight
loss. The coalition members were looking at buying air filtration
equipment, drafting intake protocols, getting to know the TB experts in
the community, and educating shelter staff on what to watch for and what
to do if a client appeared ill.

“We’re trying to do what we can to rein it in, and stay in front of it,
and not let it get any worse,” Covington said. “I take it as a very
important role for the community.”

WHAT THE POST UNCOVERED

In 2008, a schizophrenic patient contracted TB but went untreated for
eight months, wandering among many places where the homeless congregate,
infecting at least 17 others.

In 2012, the CDC was invited to help with a sudden spike in cases of the
same rare strain the schizophrenic patient had. What they found is the
worst outbreak they have investigated in 20 years, and it is not contained.

ON THE TRAIL OF TB

Hard to track: Homeless and mentally ill people and those they have come
in contact with are especially hard to treat.

Long, tough treatment: Several pills a day of several virulent
antibiotics for a minimum of six months, often up to two years.

What’s at stake: If treatment regimen isn’t strictly followed,
antibiotic resistent strains emerge.

- - -

http://tinyurl.com/cohmc73

Governor Scott: Full Steam Backwards for Floridians

Why did tou wait 3 months to post this important alert?

Meyer wrote:
On 7/9/2012 3:53 PM, X ` Man wrote:
Worst TB outbreak in 20 years kept secret
As state rushes closure of its only TB hospital in Lantana



JACKSONVILLE — The CDC officer had a serious warning for Florida health
officials in April: A tuberculosis outbreak in Jacksonville was one of
the worst his group had investigated in 20 years. Linked to 13 deaths
and 99 illnesses, including six children, it would require concerted
action to stop.

That report had been penned on April 5, exactly nine days after Florida
Gov. Rick Scott signed the bill that shrank the Department of Health and
required the closure of the A.G. Holley State Hospital in Lantana, where
tough tuberculosis cases have been treated for more than 60 years.

As health officials in Tallahassee turned their focus to restructuring,
Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and
the measures needed to contain it – went unseen by key decision makers
around the state. At the health agency, an order went out that the TB
hospital must be closed six months ahead of schedule.

Had they seen the letter, decision makers would have learned that 3,000
people in the past two years may have had close contact with contagious
people at Jacksonville’s homeless shelters, an outpatient mental health
clinic and area jails. Yet only 253 people had been found and evaluated
for TB infection, meaning Florida’s outbreak was, and is, far from
contained.

The public was not to learn anything until early June, even though the
same strain was appearing in other parts of the state, including Miami.

Tuberculosis is a lung disease more associated with the 18th century
than the 21st, referred to as “consumption” in Dickensian times because
its victims would grow gaunt and wan as their lungs disintigrated and
they slowly died. The CDC investigator described a similar fate for 10
of the 13 people who died in Jacksonville.

They wasted away before ever getting treatment, or were too far gone by
the time it began. Most of the sick were poor black men.

“The high number of deaths in this outbreak emphasizes the need for
vigilant active case finding, improved education about TB, and ongoing
screening at all sites with outbreak cases,” Luo’s report states.

Today, three months after it was sent to Tallahassee, the CDC report
still has not been widely circulated.

Backer of closing hospital didn’t know

Meanwhile the champion of the health agency consolidation, Rep. Matt
Hudson, R-Naples, said he had not been informed of the Jacksonville
outbreak and the CDC’s role as of Friday.

Told the details, the chairman of the House Health Care Appropriations
Committee vowed that there would be money for TB treatment.

“There is every bit of understanding that we cannot not take care of
people who have a difficult case of TB,” Hudson said.

The governor’s office asked a reporter to foward a copy of the CDC
letter on Saturday, but did not comment by press time.

Treatment for TB can be an ordeal. A person with an uncomplicated,
active case of TB must take a cocktail of three to four antibiotics —
dozens of pills a day — for six months or more. The drugs can cause
serious side effects — stomach and liver problems chief among them. But
failure to stay on the drugs for the entire treatment period can and
often does cause drug resistance.

At that point, a disease that can cost $500 to overcome grows
exponentially more costly. The average cost to treat a drug-resistant
strain is more than $275,000, requiring up to two years on medications.
For this reason, the state pays for public health nurses to go to the
home of a person with TB every day to observe them taking their
medications.

However, the itinerant homeless, drug-addicted, mentally ill people at
the core of the Jacksonville TB cluster are almost impossible to keep on
their medications. Last year, Duval County sent 11 patients to A.G.
Holley under court order. Last week, with A.G. Holley now closed, one
was sent to Jackson Memorial Hospital in Miami. The ones who will stay
put in Jacksonville are being put up in motels, to make it easier for
public health nurses to find them, Duval County health officials said.

They spoke about CDC’s report Friday, only after weeks of records
requests from The Palm Beach Post. The report was released late last
week only after a reporter traveled to Tallahassee to demand records in
person. The records should be open to inspection to anyone upon request
under Florida Statute 119, known as the Government in the Sunshine law.

TB strain spreads beyond homeless

In his report, the CDC’s Luo makes it clear that other health officials
throughout the state and nation have reason to be concerned: Of the
fraction of the sick people’s contacts reached, one-third tested
positive for TB exposure in areas like the homeless shelter.

Furthermore, only two-thirds of the active cases could be traced to
people and places in Jacksonville where the homeless and mentally ill
had congregated. That suggested the TB strain had spread beyond the
city’s underclass and into the general population. The Palm Beach Post
requested a database showing where every related case has appeared. That
database has not been released.

It was early February when Duval County Health Department officials felt
so overwhelmed by the sudden spike in tuberculosis that they asked the
U.S. Centers for Disease Control and Prevention to become involved.
Believing the outbreak affected only their underclass, the health
officials made a conscious decision not to not tell the public,
repeating a decision they had made in 2008, when the same strain had
appeared in an assisted living home for people with schizophrenia.

“What you don’t want is for anyone to have another reason why people
should turn their backs on the homeless,” said Charles Griggs, the
public information officer for the Duval County Health Department.

Even the CDC was not forthcoming about the outbreak. An agency
spokesperson declined requests from The Post when asked to make an
expert available to discuss a CDC-authored scholarly paper on the
possible origins of the Jacksonville outbreak, offering only general
fact sheets on TB.

“After checking in with the Division of TB Elimination about your
specific questions, they have suggested that you reach out to your
health department,” wrote Salina Cranor of the CDC’s TB prevention
office. . “They are really the best source for your questions.”

“With TB it’s a judgment call,” said Duval County Health Director Dr.
Bob Harmon in a telephone interview Friday, after the state’s new
surgeon general referred questions back to him.

“There have been TB outbreaks where we do alert the public, such as a
school or a college,” Harmon added.

For weeks, there had been a dissonant message coming from the Department
of Health press office in Tallahassee. It released overall numbers of
Florida tuberculosis cases showing a marked decline statewide,
supporting the argument that A.G. Holley had become irrelevant. Asked
whether she had been aware of the severity of Jacksonville’s outbreak
while delivering that message, she did not answer.

“Florida experienced a 10 percent decrease in cases for 2011 compared to
2010. For the period 2007—2011, there was a 24 percent decrease in
cases,” wrote agency spokeswoman Jessica Hammonds in an emailed response
to written questions on May 18. She declined, at the time, to make
agency experts available for interview.

In an article published in June’s American Journal of Psychiatry, CDC
experts Dr. Joseph Cavanaugh, Dr. Kiren Mitruka and colleagues described
the apparent origins of the current outbreak, when a TB strain called FL
046 came to claim two lives and sicken at least 15 mentally ill
residents of one assisted living facility in 2008.

A single schizophrenic patient had circulated from hospital to jail to
homeless shelter to assisted living facility, living in dorm housing in
many locations. Over and over, the patient’s cough was documented in his
chart, but not treated. It continued for eight months, until he finally
was sent under court order to A.G. Holley. That year, 2008-2009, a total
of 18 people in that community developed active tuberculosis from the
strain called FL 046 and two died. The CDC sent a $275,000 grant to help
pay for the staff needed to contain it.

After the money ran out, Harmon said, staff were redeployed to other
needs. But in 2011, suddenly, the number of active cases of FL 046
spiked, rising 16 percent to 30 cases of a specific genotype, the one
seen in 2008.

“We thought after 2008 that we had it contained,” Harmon said. “It was
not contained. In retrospect, it would have been better to inform the
general population then.”

Harmon said the Duval County Health Department will need more resources
if it is to contain the current TB outbreak. In 2008, when the TB
outbreak hit, his department employed 946 staff with revenues of $61
million. “Now we’re down to 700 staff and revenue is down to $46
million,” Harmon said. “It has affected most areas of the organization.”

If he can raise at least $300,000, he will use the money to hire teams
of experts — epidemiologists, nurses, outreach workers, to look under
bridges, in fields — in all the places where Jacksonville’s estimated
4,000 homeless congregate, to track down the people who may still be
infected unknowingly. Fortunately, only a few of the cases have
developed drug resistance so far. The vast majority respond to the
first-line antibiotics.

In downtown Jacksonville, in the homeless shelters and soup kitchens,
the TB strain called FL 046 continues to spread.

On a recent June morning, 60-year-old Lilla Charline Burkhalter joined
about 100 other poor and homeless guests being served a free hot meal of
scrambled eggs, grapes, potatoes and butterless bread by a local church
youth group.

The youth group was volunteering at the Clara White Mission, where a man
with active tuberculosis had been identified just three weeks earlier.

Looking weary but friendly, Burkhalter described her life of late,
sleeping in grassy fields and in shelter dormitories. She lived on a
small Social Security disability check, she said. It had enabled her to
pay for a room in an apartment, for a while. But her roommate had kicked
her out for making his girlfriend jealous, she said, and she hadn’t been
able to find any other accommodations. It had been a rough few months,
she acknowledged. But she had been through tough times before.

As she spoke, she coughed often. It was her emphysema acting up, she
explained.

Asked if she was fearful about the TB in the community, she shrugged.

“The health department tests me for TB once a year, so I know I don’t
have it,” she said. “I’m not worried.”

The Clara White Mission is now playing a key role in helping
Jacksonville fight TB. Its housing case manager, Ken Covington, had
spent most of his career helping bank branches assimilate after mergers.
Two months ago, he joined Clara White, charged with placing homeless
veterans and recently released jail inmates into homes. But the job has
became much larger.

Today, Covington is the new chairman of the Duval County TB Coalition.
In his hands he holds a massive binder with the intimidating title,
“Core Curriculum in Tuberculosis: What the Clinician Should Know.” It
was given to him by Vernard Green, the CDC’s visiting TB liaison.

Covington said he was a banker, not a clinician. But he had learned what
to watch for with TB – coughing up blood, night sweats, sudden weight
loss. The coalition members were looking at buying air filtration
equipment, drafting intake protocols, getting to know the TB experts in
the community, and educating shelter staff on what to watch for and what
to do if a client appeared ill.

“We’re trying to do what we can to rein it in, and stay in front of it,
and not let it get any worse,” Covington said. “I take it as a very
important role for the community.”

WHAT THE POST UNCOVERED

In 2008, a schizophrenic patient contracted TB but went untreated for
eight months, wandering among many places where the homeless congregate,
infecting at least 17 others.

In 2012, the CDC was invited to help with a sudden spike in cases of the
same rare strain the schizophrenic patient had. What they found is the
worst outbreak they have investigated in 20 years, and it is not
contained.

ON THE TRAIL OF TB

Hard to track: Homeless and mentally ill people and those they have come
in contact with are especially hard to treat.

Long, tough treatment: Several pills a day of several virulent
antibiotics for a minimum of six months, often up to two years.

What’s at stake: If treatment regimen isn’t strictly followed,
antibiotic resistent strains emerge.

- - -

http://tinyurl.com/cohmc73

Governor Scott: Full Steam Backwards for Floridians

Why did tou wait 3 months to post this important alert?

He has no boat and lives on Google.

On Mon, 09 Jul 2012 20:36:00 -0400, Earl
wrote:

He has no boat and lives on Google.

===

Heh, the ultimate homeless shelter.

I'm going to write a letter to Scott and demand that he immediately
reopen the hospital as soon as it has been relocated next door to
Huntington, MD's most famous resident.