Immigrant status, homelessness or prison ties to TB outbreak should be made public | Opinion
For more than a year, local, state and federal public health officials have been tracking one of the nation’s largest outbreaks of tuberculosis in decades. So far, 67 communicable active cases of the world’s deadliest airborne pathogen have been found in Kansas along with 79 of the less serious latent cases where the patient is infected, but not actively spreading the disease. We still don’t know anything about who is getting sick.
“Tuberculosis outbreaks are often indications of weakness in public health infrastructure,” says Dr. David Dowdy, a professor of epidemiology at the Johns Hopkins University’s Bloomberg School of Public Health. “When public health services weaken, one of the first things you will see is outbreaks of TB.”
I asked him what he meant by that and he told me that the “concern is there are other outbreaks we are missing. If it is happening in Kansas City, there could be outbreaks elsewhere that we don’t know about.”
This sounds to me like we should be at least a little alarmed.
However, the federal Centers for Disease Control and Prevention refused to answer my questions about who is getting sick in Kansas, referring questions to state officials. Jill Bronaugh, communications director at the Kansas Department of Health and Environment told me by email: “The Kansas Department of Health and Environment takes patient confidentiality seriously. To protect patient identity, the agency does not and will not publicly identify the communities impacted by the outbreak.”
That’s funny, because there is a similar-size outbreak of measles going on in Texas right now and there, public health officials have had no qualms about releasing what ties the cases together in that state, even though the outbreak is only days old. There, public health officials have said that all the cases are among those who are unvaccinated or whose vaccination status is unknown.
So why the double standard? Public health officials in Texas and Kansas operate under the same federal medical privacy law. Both diseases are rare in the United States, but much more common overseas in places where health care systems are weaker. Disease investigation is just as arduous in Texas as it is in Kansas.
After interviewing a number of former health officials and university epidemiologists, none wanted to explain the difference on the record, but all agreed, speaking off the record, that what ties the Kansas TB cases together is either homelessness, incarcerated populations or immigration status.
Staffers at the jail and homeless shelters in Wyandotte County, where the outbreak is centered, told me that public health officials have not traced the outbreak to them. That appears to leave us with immigrants.
Most TB cases in the United States come from immigrants, both legal and undocumented. When legal immigrants — often refugees who have lived in camps — are identified as having TB, they are reported to local health authorities so the county health department can supervise their care until they no longer have TB.
However, that proactive approach is not available for undocumented immigrants whose status is unknown.
Making the connection to immigration is not rocket science. In recent years, immigrants have made up seven in ten cases of TB in the United States. Just a couple of years ago, there was a smaller TB outbreak in Kansas. After the outbreak was contained, the CDC reported that the majority of those who came down with TB were immigrants and their U.S.-born children from four families that socialized and worked together.
And it matters to the broader community, when the CDC was addressing the previous outbreak of drug-resistant TB, investigators feared the disease could be spreading through schools and workplaces, both locations where the public comes into close contact with immigrants for sustained periods of time.
Public health officials in Texas are willing to talk about immunization status, but public health officials in Kansas won’t talk about immigration status or whatever factor connects the TB cases in the state. Though we don’t know how Kansas officials would have responded if the outbreak was caused by a specific group of unvaccinated people, it seems the Texas public health officials are fine stigmatizing people for not being vaccinated. Apparently, Kansas public health officials are not so keen on playing into the poisonous politics of immigration going on in the United States right now.
That’s a mistake. Taking politics into account can backfire as the government should have learned during COVID-19. People need to trust that they are getting the straight scoop from public health officials, but when they think they are getting half-truths filtered through political considerations, they lose that trust.
In a world where COVID is a daily reality, once-vanquished diseases such as TB and measles are gaining a new foothold, and vaccine skepticism is on the rise, Kansas public health officials can’t afford to undermine their credibility. We deserve an explanation now.
