TB Infected Man Foils Homeland Security

[Alt+F4]

He didn't fly once, he didn't fly twice.....he flew seven times! If someone gets the drug resistant tuberculosis he has (only a 30% cure rate) I don't think a attempted murder charge would be uncalled for. How can someone be so selfish?

Oh, and guess what happens when your name gets on a "no fly" list? You get to fly! Don't worry my fellow Americans, Congress is gonna investigate this!

While he was honeymooning in Rome, CDC officials asked him to agree to indefinite isolation in an Italian hospital. Instead he fled. Despite the CDC putting the man on airlines' "no fly" lists and having his passport flagged, the man and his bride were able to elude health authorities and sneak back into the United States by flying to Canada and driving across the border last week.

Linky: http://www.ajc.com/health/content/health/stories/2007/05/30/0531meshcdctb.html

[Darth Rotor]

He didn't fly once, he didn't fly twice.....he flew seven times! If someone gets the drug resistant tuberculosis he has (only a 30% cure rate) I don't think a attempted murder charge would be uncalled for.
Nope, at worst negligent homicide.
How can someone be so selfish?
Is this a rhetorical question? ;)

DR

[Charlie Monoxide]

According to the newscast last night, he didn't break any laws. Being inconsiderate of your fellow humans is not against the law.

Charlie (especially if you're a lawyer) Monoxide

[parrotslave]

If my future father-in-law was researching TB and I contracted a resistant strain of TB, I'd be more than a little suspicious that my future father-in-law didn't like me.

[Skeptic Guy]

Yeah, the guy was a real moron. Not that it excuses him in the least, but he wasn't aware that he had the XDR TB until the authorities got in touch with him in Italy. But they had already told him not to fly before he left for his trip (though he is disputing this) and were so concerned about his initial response that they were in the process of delivering the order not to travel to him in writing when they descovered he had already skipped the country.

He had to know that TB, even the non-drug resistant kind, is a highly contagious disease and that he shouldn't be running around the world with it. I wonder what his new wife thinks about his willingness to risk her life?

Though I am doubtful that Congress is going to investigate this.

[Alt+F4]

Though I am doubtful that Congress is going to investigate this.

From the link in the OP:

The House Homeland Security Committee announced Tuesday it will hold a June 6 hearing examining health officials' response in the case.

[BPSCG]

Gives me a warm fuzzy to know our borders are so secure. And Congress is trying to pass an immigration bill that, among other things,will supposedly keep illegals out. Why is my skeptic meter pinned in the red zone?

[Skeptic Guy]

Hmmm, missed that. Oh great, a chance for a bunch of politicians to pontificate and second guess.

A little google search shows that our dear Andrew Speaker is a partner in an Atlanta-based lawfirm (possibly with his father) that handles divorce cases. Wonder if he is going to need one, himself?

DR, note that he also attended the Naval Academy.... ;)

ETA: Yes, the article mentions the lawfirm too. I need to go home...

[Miss Anthrope]

I just read that an alert popped up at his border crossing from Canada into NY which said to don a mask and isolate the person. Yet, the border agent said "he looks healthy" and let him through.

And this jerk is a personal injury attorney to boot.

ETA: LINK (http://apnews.myway.com/article/20070531/D8PFL1P00.html)

Some quotes:

The unidentified inspector explained that he was no doctor but that the infected man seemed perfectly healthy and that he thought the warning was merely "discretionary," officials briefed on the case told The Associated Press. They spoke on condition of anonymity because the matter is still under investigation.


The disclosure that the patient is a lawyer - and specifically a personal injury lawyer - outraged many people on the Internet and elsewhere. Some travelers who flew on the same planes with Speaker angrily accused him of selfishly putting hundreds of people's lives in danger.


The inspector ran Speaker's passport through a computer, and a warning - including instructions to hold the traveler, don a protective mask in dealing with him, and telephone health authorities - popped up, officials said. About a minute later, Speaker was instead cleared to continue on his journey, according to officials familiar with the records.

[The Painter]

Makes you wonder how secure the airlines really are. The funny thing is, in 2 other threads a couple of people told me planes could never be compromised again. Oops, I gues they were wrong.

[strathmeyer]

According to the newscast last night, he didn't break any laws. Being inconsiderate of your fellow humans is not against the law.

It is when someone dies! (And the perpetrator had a reasonable expectation that death was likely.)

[Miss Anthrope]

According to the newscast last night, he didn't break any laws. Being inconsiderate of your fellow humans is not against the law.

Charlie (especially if you're a lawyer) Monoxide

Knowingly exposing people to TB, even if he did not know what strain it was, is a bit more than being inconsiderate.

Miss "I'm sorry I bled all over you, fellow passenger, it's not illegal to fly with Ebola" Anthrope

[Darth Rotor]

DR, note that he also attended the Naval Academy.... ;)


So did Jimmy Carter and Ollie North.

DR

[Charlie Monoxide]

Knowingly exposing people to TB, even if he did not know what strain it was, is a bit more than being inconsiderate.

Miss "I'm sorry I bled all over you, fellow passenger, it's not illegal to fly with Ebola" AnthropeBeing my typically waggish self, I was being sarcastic in my response. The guy is a douchebag. The fact he's a lawyer would somehow indicate that he has some smarts about himself. It was a profoundly selfish act, especially now that it has come to light, he was duly warned and chose to go flying (7 times!).

Charlie (drug resistant waggism) Monoxide

[Miss Anthrope]

Being my typically waggish self, I was being sarcastic in my response. The guy is a douchebag. The fact he's a lawyer would somehow indicate that he has some smarts about himself. It was a profoundly selfish act, especially now that it has come to light, he was duly warned and chose to go flying (7 times!).

Charlie (drug resistant waggism) Monoxide

I figured you were joshin', I should have added a smiley.

[Skeptic Ginger]

OK Skeptics, me thinks you are convicting this guy on exaggerated and somewhat false news reports which you all know typically blow this crap out of proportion.

Here's the story adding in my considerable knowledge of TB. Let me walk you through the actual evidence here.

First, the guy says it wasn't made that clear to him before he left that he was contagious. While the CDC officials are all over themselves to say they did make it clear, think about it.

He's had active TB since January!!!!! He's being treated and wasn't getting better as fast and/or as completely as he might have so they had to have done some additional tests. He's had negative sputum smears. Not to bore you with the details but when you have negative sputum smears you are RELEASED FROM ISOLATION.

They did a culture on the specimen. That is the normal procedure. The smears tell you if the patient is contagious, the culture tells you what you are infected with. At some point either back in January when he was diagnosed or with a preliminary result from the pending final culture, it was determined he had MDR TB. That means multi-drug resistant. [you can have TB; drug resistant TB: DR TB; MDR TB; and extremely drug resistant TB: XDR TB]

What the press and the health department officials covering their asses are conveniently leaving out of this story is this guy wasn't in isolation from some time after he was diagnosed with TB in January until now. He made those wedding plans and was in close contact with his fiance', his father-in-law (who went to the wedding, BTW) and probably everyone at his job and wherever else he's been hanging out the last 5 months. You would think the brain-dead reporters might have have the sense to ask, "What about before he left on that jet"? But no, they are too busy with this juicy story to bother thinking it through. Anyone want to start a pool betting when someone on the news is going to finally ask that question?

OK, back to the story. So here's a guy, not in isolation, who has his frikkin wedding planned and a day or so before he leaves he has some additional medical report saying the MDR TB is still growing on the cultures. Remember, he wasn't in isolation before the trip. Why? Because his sputum smears were negative and they have been telling him since some time ago he wasn't contagious.

So he doesn't want to cancel the big day. Who would? He has no reason to think he is contagious. If anyone did say he shouldn't go on the trip I have no doubt it wasn't made clear to him he could be contagious. Why? Because he wasn't. At least not according to the TB guidelines we all follow. Those guidelines come from the CDC!

Fast forward now the final culture comes back XDR TB. He gets a call in Italy on his cell phone with this devastating news. Now they are telling him he needs to be in isolation when just a few days before they told him he wasn't contagious. His sputum smears did not change. All that changed was the CDC wants overkill on isolation with XDR TB.

So what does the CDC news release say they told this guy? "Turn yourself in to the Italian Police!" Who in their right mind would risk turning yourself in to the police in a foreign country claiming you have something akin to the plague and the disease has a higher than 50% fatality rate even with the best of care? I wouldn't.

I would say, I'm not coughing, the sputum smears were negative, the CDC is overreacting and if I go to the Italian police, who knows what kind of jail cell I'd be lingering in until treatment became completely hopeless?

I doubt very much this guy infected a single person on his trip, there or back. He didn't put anyone in danger, the CDC only says he might have but they give spurious reasons, saying it is an unknown. But if it was so bad, then what about before he left when he was clearly told he wasn't contagious. I know what he would have been told because the CDC says in their press release he had negative sputum smears and he's had TB since January!

So the CDC has it's typical dilemma. They have to make a public announcement because that's the only way to find the airline passengers. They need baseline TB tests and 3 months later, follow up TB tests. Other wise there is no way to know who has this strain of TB until disease actually develops. And actual disease only develops in 10% of the people actually infected. If there were no airline passengers to track down, CDC would have just contacted people directly and never put this in the news.

Tracking down those passengers is overkill. But if the CDC didn't track them down, the CDC might later be faulted for that. So it's OK they made the announcement and are testing the passengers. I'll take overkill when it's needed. But it's a shame this guy is being vilified. All this happened fast. He had every reason to ignore the CDC telling him to turn himself in to the Italian police. There was even something about the CDC contacting Italian authorities to figure out what to do and no one knew.

Look at the interviews with the guy on TV. He has a mask on. That's it, reporters all around. All they had to do was tell him to put a mask on for the flight. But there was no plan in place for this contingency or if there was, no one bothered to look at it.

With all the pandemic flu planning and the well known fact XDR TB is showing up all over the world and getting worse, you would think the CDC could have had a contingency plan for this sort of thing: a US citizen with XDR TB who needs to get home. Apparently not.

The guy isn't a douchbag, Charlie. CDC did not make it very clear on the news how not contagious this guy actually was. CDC handled it poorly, this guy is paying the price.

And believe me, if I thought he just took some total self serving action and flew home knowing he was contagious, I would be calling him a douchebag too. But how can you expect him to see himself as a danger when for 5 months they've probably been telling him he wasn't contagious.


Weird coincidence with the father-in-law. Amazing.

[Skeptic Ginger]

Makes you wonder how secure the airlines really are. The funny thing is, in 2 other threads a couple of people told me planes could never be compromised again. Oops, I gues they were wrong.What? You don't think President 'security is job 1' Bush has made this country safe? Now why would you think that? :rolleyes:

[corplinx]

This is the last time I tongue kiss a random guy on a plane I tell you what.

[Skeptic Ginger]

This is the last time I tongue kiss a random guy on a plane I tell you what.You can't get TB from kissing. There's another disease in the mycobacterium family you can get from unpasteurized milk that is also called TB but it is actually a different organism.

A lot of airborne diseases only need get in your mouth to infect you. TB has to reach the alveoli of your lung to grow. Anywhere else in the respiratory tract and the conditions are not right. Thus you have to inhale the bacteria, and you have to inhale them in a high enough concentration so that they aren't picked off on the way down by your defense mechanisms like mucus, cilia, and your nasal turbinates.

So you can kiss, but it's better to breathe through your nose than your mouth. ;)

[The Great Hairy One]

This is the last time I tongue kiss a random guy on a plane I tell you what.


Are you cheating on me again, you swine?!?!?!

:p

Cheers,
TGHO

[Jaggy Bunnet]

OK Skeptics, me thinks you are convicting this guy on exaggerated and somewhat false news reports which you all know typically blow this crap out of proportion.

Thanks for posting this - it is always interesting to get a different perspective on the latest media health scare.

[Skeptic Ginger]

Thanks for posting this - it is always interesting to get a different perspective on the latest media health scare.:D You're welcome. I also forgot to mention there wasn't anytime during the news clips I saw of this guy where he even coughed. If you aren't coughing, with the exception of TB infection in your throat (a rare condition) you aren't contagious.

And I need to clarify my post about TB not growing anywhere but the alveoli of the lung. That is in the initial infection. Once the infection begins, TB can then grow in any number of places outside the lung.

It should be a clue to these reporters that the microbiologist TB researcher father-in-law would have been concerned if this guy had any signs or symptoms suggesting he was contagious.

[BPSCG]

I'm not so concerned that a sick guy flew; hell, who knows what the person sitting next to you may or may not be carrying?

My concern is that even though he was on the no-fly list, he was able to get on a plane.

[Miss Anthrope]

Thanks for the info Skeptigirl, it does add context to the story and why he was flying originally. I still have a huge issue with what the border agent did, and I still take issue with TB Guy over this aspect: (link) (http://news.yahoo.com/s/ap/20070601/ap_on_he_me/tuberculosis_infection_law_3)



Speaker flew to Europe for his wedding and honeymoon after being advised by health officials not to make the trip because he had TB. Then, while he was in Rome, U.S. health officials told him to stay put because further tests showed he had an even more dangerous, drug-resistant type of TB than previously thought.

The 31-year-old newlywed disregarded those instructions, taking commercial jets to Prague and then Montreal in an attempt to sneak back into the United States.


In an interview earlier this week with The Atlanta Journal-Constitution, Speaker said he declined to report to Italian health officials because he believed the only lifesaving care for his condition was available in the U.S.


"I'm a very well-educated, successful, intelligent person," he told the newspaper. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing."

[hgc]

Thanks for the info Skeptigirl, it does add context to the story and why he was flying originally. I still have a huge issue with what the border agent did, and I still take issue with TB Guy over this aspect: (link) (http://news.yahoo.com/s/ap/20070601/ap_on_he_me/tuberculosis_infection_law_3)


I agree with you on that. After they contacted him in Italy, it was monumentally assholish of him to flee from there to get on another plane just so he could get back into the U.S. He has no right to attempt to use his own judgement about how dangerous he is just because he doesn't want to be in the hands of Italian health authorities.

[strathmeyer]

http://en.wikipedia.org/wiki/Universal_health_care
Italy: second best health care system in the world, next to France

[Giz]

After they contacted him in Italy, it was monumentally assholish of him to flee from there to get on another plane just so he could get back into the U.S. He has no right to attempt to use his own judgement about how dangerous he is just because he doesn't want to be in the hands of Italian health authorities.

100% agreement.

[BPSCG]

http://en.wikipedia.org/wiki/Universal_health_care
Italy: second best health care system in the world, next to France[anecdotal evidence]
Not if the experience of my French relatives is any measure. :(
[/anecdotal evidence]

[Miss Anthrope]

http://en.wikipedia.org/wiki/Universal_health_care
Italy: second best health care system in the world, next to France

Having been up all night with my 3 year old and his stomach flu, I was too lazy to look this up, and was hoping someone would. Thanks!

I had been scratching my head about that. It might be more sympathetic if he were in a country with questionable health care. My guess was this was far from the case, and I'm glad someone pointed it out.

[PeekaBoo]

If his only concern was not getting stuck in an Italian hospital, why all the sneaking to get back into his own country?

That makes no sense.

[Skeptic Ginger]

I'm not so concerned that a sick guy flew; hell, who knows what the person sitting next to you may or may not be carrying?

My concern is that even though he was on the no-fly list, he was able to get on a plane.
I know and was not really trying to hijack the thread. I debated about starting a new one then saw those comments like, "He was a douchebag".

Do the mods want to split it? Or do others want me to start a new thread? I'll be happy to.

[Skeptic Ginger]

If his only concern was not getting stuck in an Italian hospital, why all the sneaking to get back into his own country?

That makes no sense.It's called panicking. I bet lots of people given the same circumstances would have acted then re-thought about it later.

You are told you have a very difficult to treat infection and you know the US has the best health care in the world for treating this infection. I'd want to get back to the US as fast as possible to avoid being detained in isolation somewhere.

We got a sound bite of his side today and he said just what I did, "Before all this they told me I wasn't a danger to anyone, so I asked them, what changed? You tell me what changed?" (As best as I remember the quote.)

Now CNN is finally reporting, "He walked around with this for 5 months before the trip."

[Skeptic Ginger]

... It might be more sympathetic if he were in a country with questionable health care. ....I wouldn't want to be anywhere but the US with XDR TB. You really aren't talking about just a country with modern medicine, you still die from this with the best care. The hospital he's now at is probably his best chance, literally.

Also, look how the CDC reacted when he wasn't contagious. They keep saying well we don't know but the guidelines on TB are very clear, no AFB in the sputum, no cough, TB not in the upper airway (which you cough like crazy with anyway), then you are not contagious. If the CDC reacted this way, what do you supposed is possible in other countries? How would you know what the Italians would have done? It's not like you have time to find out.

[Tailgater]

http://en.wikipedia.org/wiki/Universal_health_care
Italy: second best health care system in the world, next to France

I skimmed over that page and was too lazy to do further research, but isn't that ranking based on the fact that more people are covered and at a better price and not neccessarily the best at treating the disease?

[Skeptic Ginger]

Regardless of the outcome of treating XDR TB in Italy, the patient would have to know that information.

I know I would have done the same as this guy. I would have known I wasn't contagious and the CDC was over-reacting. I might have put a mask on in the plane is about all I can say I would have done differently.

This guy is not going to turn out to have infected anyone on those flights. I'm sure of it.

[Skeptic Ginger]

WHO TB infection control in air travel. (http://www.who.int/tb/publications/2006/who_htm_tb_2006_363.pdf)To date, no case of active TB has been identified as a result of exposure on a commercial aircraft. Furthermore, no evidence of TB disease has been reported among those known to have been infected with M. tuberculosis during air travel. From 1992 to 1994, the United States Centers for Disease Control and Prevention (CDC), together with state and local health departments, conducted seven contact investigations, one centred on a cabin crew member and six on passengers with infectious TB who had flown during this period. Concern was raised that the closed aircraft cabin environment may have enhanced transmission of M. tuberculosis (6–11). The number of potentially exposed passengers and cabin crew exceeded 2600 on a total of 191 flights involving nine different types of aircraft. All index patients were highly infectious, i.e. smears from spontaneous sputum specimens from all index cases were heavily positive for acid-fast bacilli (AFB) and all patients were culture-positive and had evidence of extensive pulmonary disease on chest radiography. One patient also had biopsyand culture-confirmed laryngeal TB, the most infectious form of TB. In two instances, strains of M. tuberculosis resistant to at least isoniazid and rifampicin were isolated, i.e. multidrug-resistant tuberculosis (MDR-TB) (7, 10). Organisms isolated from the other patients were sensitive to all anti-TB drugs. Two passengers, who were flying to the United States for medical care, knew that they had active TB at the time of their flights but did not inform the airline of their disease. In the other five cases, TB was diagnosed after the flights. In only two of the investigations was there evidence to suggest transmission of M. tuberculosis infection: one from a cabin crew member to other crew members, and another from a passenger to other passengers (6, 10). In the first report, evidence of transmission was limited to cabin crew with at least 12 hours' exposure to the infectious source. In the other, transmission of infection occurred to only a few passengers seated in the same section as and in close proximity to the passenger with infectious TB, and only on one flight lasting more than eight hours.Not a single case of TB resulted, only a couple of infections occurred and that was with patients who were smear positive.

Regarding the guidelines of when a person with active TB disease may fly, WHO does suggest a culture rather than a sputum smear be negative. Seems like overkill considering the number of cases transmitted with smear positive patients. The guideline suggests patients can fly with active TB but WHO defers to the countries involved to decide the specifics.

[strathmeyer]

I skimmed over that page and was too lazy to do further research, but isn't that ranking based on the fact that more people are covered and at a better price and not neccessarily the best at treating the disease?

Probably, but it's not like he was stuck in New Jersey.

[Skeptic Ginger]

http://en.wikipedia.org/wiki/Universal_health_care
Italy: second best health care system in the world, next to France

Short sidetrack:

There are hundreds of studies like these and hundreds more that found the same thing with practitioner's experience and outcome:

Hospital experience and nursing improve cancer surgery outcome (http://www.medicalnewstoday.com/medicalnews.php?newsid=28069)

Hospital experience improves bladder cancer outcome (http://www.healthandage.com/public/health-center/30/news/7362/Hospital-experience-improves-bladder-cancer-outcome.html)

Hospital Volume & Surgical Experience Key to Prostate Cancer Outcomes (http://www.mskcc.org/mskcc/html/8724.cfm)

According to the evidence, if you have something really bad or really complicated, going to the doctor and/or hospital with the most experience and expertise can make or break your 'life' in this case. No the care isn't the same no matter where you are treated.

Knowing a fair amount about the EMS prehospital care in this country, I would bet Princess Diana would have survived that same car crash were it in Seattle with our Medic 1 program and Harborview's incredible trauma care. In the French system they spent 30 minutes trying to stabilizer her in the field. You can't stabilize a ruptured major chest artery in the field. Not unless you can crack that chest open. In Seattle she would have either been in the OR by then or they would have literally opened her chest in the ED. I was really surprised to see such a different care system in France. Modern, yes, the same, no way.


Ooops! I've said too much. Quick, hide this from the CT crowd. :whistling

[Miss Anthrope]

Short sidetrack:

There are hundreds of studies like these and hundreds more that found the same thing with practitioner's experience and outcome:

Hospital experience and nursing improve cancer surgery outcome (http://www.medicalnewstoday.com/medicalnews.php?newsid=28069)

Hospital experience improves bladder cancer outcome (http://www.healthandage.com/public/health-center/30/news/7362/Hospital-experience-improves-bladder-cancer-outcome.html)

Hospital Volume & Surgical Experience Key to Prostate Cancer Outcomes (http://www.mskcc.org/mskcc/html/8724.cfm)

According to the evidence, if you have something really bad or really complicated, going to the doctor and/or hospital with the most experience and expertise can make or break your 'life' in this case. No the care isn't the same no matter where you are treated.

Knowing a fair amount about the EMS prehospital care in this country, I would bet Princess Diana would have survived that same car crash were it in Seattle with our Medic 1 program and Harborview's incredible trauma care. In the French system they spent 30 minutes trying to stabilizer her in the field. You can't stabilize a ruptured major chest artery in the field. Not unless you can crack that chest open. In Seattle she would have either been in the OR by then or they would have literally opened her chest in the ED. I was really surprised to see such a different care system in France. Modern, yes, the same, no way.

More sidetrack...are you in any way connected to King Co. EMS? Would be an incredibly small world if you are. I am well aware that if I want to survive a heart attack, I want to have it in King County over anywhere in the world, given what, the average 4-7% success rate versus our 46%. Ok, ending the derail, had to ask.

[Skeptic Ginger]

I provide the infectious disease exposure care for about 20 King County fire departments. Bellevue and Shoreline oversee their own King County Medics so I work with both those groups. Once in a great while I see the South King County Medics like giving them flu shots when there was no vaccine elsewhere. And I have regular contact with all the King County Medics for various other reasons.

So in short, yes. What's your connection? Are you a medic?

[Miss Anthrope]

I provide the infectious disease exposure care for about 20 King County fire departments. Bellevue and Shoreline oversee their own King County Medics so I work with both those groups. Once in a great while I see the South King County Medics like giving them flu shots when there was no vaccine elsewhere. And I have regular contact with all the King County Medics for various other reasons.

So in short, yes. What's your connection? Are you a medic?

Not a medic, but there's a connection! Small world indeed-PMing the longer answer.

[WildCat]

This guy is not going to turn out to have infected anyone on those flights. I'm sure of it.
I don't care. If I see anyone on a plane with TB, I'll kill them with my bare gloved full bio-hazard suited hands.

It's true! :)

[Skeptic Ginger]

I don't care. If I see anyone on a plane with TB, I'll kill them with my bare gloved full bio-hazard suited hands.

It's true! :)How would you know? You going after everything that coughs? :)

[Segnosaur]

Regardless of the outcome of treating XDR TB in Italy, the patient would have to know that information.

I know I would have done the same as this guy. I would have known I wasn't contagious and the CDC was over-reacting. I might have put a mask on in the plane is about all I can say I would have done differently.

A couple of points here...

- You may have done 'the same thing' as the TB guy, but you would be basing your actions on what looks like a substantial amount of knowledge. The TB guy was basing his actions on ignorance and selfishness. (Even if the CDC wasn't forthcoming with all of its information, should a lawyer be second guessing medical experts, even if they are being overly cautious?)

- In an earlier post, you said that he was right to get to the U.S. because he could get the best possible treatment for his disease. Yet he had had the same disease for months prior. If his condition had been so stable, why is treatment in the U.S. so critical? Even if the Italian medical system isn't quite as good as the U.S. system (a debatable point), there would have been plenty of time for doctors to 'get things right'.


This guy is not going to turn out to have infected anyone on those flights. I'm sure of it.

You're probably right. Wouldn't be the first time that people overreacted to diseases. But then, you ARE dealing with anti-biotic resistant germs, something that's a relatively new problem. It may not necessarily be more transmittable, but if you DO catch it, its a lot worse, so in my (admittedly non-expert opinion) a little more caution is warranted.

And even if the risk was very small, is it really the patient's job to determine acceptable risk to other people?

[BPSCG]

How would you know? You going after everything that coughs? :)Yes! There's no time to wait for the CDC! :)

[Miss Anthrope]

And even if the risk was very small, is it really the patient's job to determine acceptable risk to other people?

Great nutshell. And that is ultimately where I stand with this guy.

[Skeptic Ginger]

A couple of points here...

- You may have done 'the same thing' as the TB guy, but you would be basing your actions on what looks like a substantial amount of knowledge. The TB guy was basing his actions on ignorance and selfishness. (Even if the CDC wasn't forthcoming with all of its information, should a lawyer be second guessing medical experts, even if they are being overly cautious?)Do you accept expertise based on authority? I don't.

This guy was intelligent, I assume computer literate, he's had the disease since January, his father-in-law was an expert in the field. This conclusion, "was basing his actions on ignorance and selfishness" is unsupportable. You have no evidence of what the guy knew.

I do know he told the news people (because I saw the clip) that he had been told he was NOT contagious. Regardless of which strain of TB he was now being told he had, for several months he was assured he was NOT contagious. Also in his words (because I saw the clip) he drew the correct conclusion, "what changed?"

So, you are an intelligent person. You know you have MDR TB. You might read about it, your future father-in-law who you know is an expert and your doctors assure you for months, you are not contagious! Now you get a call by some "authorities" telling you you pose a risk to people on a plane. I would go by my knowledge. I would not go by the "authorities" unless I had reason to believe they knew something. In this case, they would have to give me a reasonable explanation of "what changed?" And they couldn't.

Your father-in-law (now) went on the plane with you there. Your father-in-law went to the wedding. Your father-in-law had no concerns you might infect his daughter on your honeymoon. Your father-in-law is an expert at the CDC and specializes in TB bacteria.

Not only was the "authority" on the phone unable to explain why you were now contagious when for months they assured you you weren't, that same "authority" told you to go get locked up in quarantine by the Italian "authorities". Only later did the CDC say they were looking at options for bringing this guy back. The CDC was bumbling at that time. And that's where I place the blame.

They could have simply told this guy to put on a mask. Like I said, look at the news interview. There he is with a mask on and all the reporters are right there in the room with him. The CDC has grossly over-reacted in this case. And they have likely ruined this guy's life because of their ridiculous incompetent reaction.

- In an earlier post, you said that he was right to get to the U.S. because he could get the best possible treatment for his disease. Yet he had had the same disease for months prior. If his condition had been so stable, why is treatment in the U.S. so critical? Even if the Italian medical system isn't quite as good as the U.S. system (a debatable point), there would have been plenty of time for doctors to 'get things right'.Multidrug resistant TB is easier to treat that extensively drug resistant TB. All TB requires months to treat. You actually can feel quite well and not be infectious in a short period of time. You still need months more time to finish the last of the buggers off.

Most of our current TB drugs and a lot of antibiotics kill dividing bacteria only. They have no effect on bacteria that are not actively dividing. The reason we have to treat TB for so long is the bacteria often live for years with very little cell growth. 5% of people with a positive TB skin test are infected with bacteria that can literally live 50 years without growing enough to produce symptoms or even what we consider active disease. They have what is called latent TB infection.

[Of the people who get infected with TB bacteria, 90% never develop disease, 5% develop it within 2 years and 5% develop TB disease at some time in their life]

TB is difficult to catch. There are only a couple cases of it ever spreading on an airline. In those cases it was only spread after prolonged contact and only to a couple people and only when the source case had enough bacteria to show up in the sputum smear. CDC spokesdoctor said "we don't know if XDR TB could be more contagious". Well I've been reading more given this case and found that wasn't true. There is more than sufficient evidence that XDR TB is no more infectious than any other TB.

The more I look at this whole affair, the more disgusted I am with the incompetent reaction of the CDC and the government when it comes to the safety of the no-fly policies and procedures.

You're probably right. Wouldn't be the first time that people overreacted to diseases. But then, you ARE dealing with anti-biotic resistant germs, something that's a relatively new problem. It may not necessarily be more transmittable, but if you DO catch it, its a lot worse, so in my (admittedly non-expert opinion) a little more caution is warranted.

And even if the risk was very small, is it really the patient's job to determine acceptable risk to other people?Ever been nicked by the clippers at the barber shop? Ever cut yourself on one of your buddies' tools?

Think those clippers or your friend's tools might have blood on them from the last guy they nicked? Just what is an acceptable risk? Want the government to require barbers to use new or sterilized clippers with every patron making the cost of a haircut about 4 times as much? Think it should be against the law to share tools? What if it is only one person's barber shop and that will drive them out of business? Do you or that barber have any individual rights?

If there was evidence people were getting HIV from the clippers at the barber shop, then sure, the regulations are needed. Same with the tools only maybe in the case of the tools it could be money spent on a public health campaign. But it's the evidence of actual risk, not the fear of how bad the disease is that we decide which actions are necessary.

Did everyone stop flying during the SARS outbreak? Did Toronto businesses need to be boycotted? They had enough drop in tourism to affect the incomes of some people. The city put on a campaign to tell people it was safe to visit.

Like I said, the more I see of this case, the more apparent it becomes, the CDC over-reacted. Now you have a public believing this guy actually put people at risk, not because he did, but because he had a legitimate concern for his life and because he went with having been told for months he wasn't contagious rather than with an "authority" who was now telling him not to get on a plane but couldn't explain, what changed.

[Skeptic Ginger]

Great nutshell. And that is ultimately where I stand with this guy.Well taking this a step further, should we put everyone with a positive PPD (TB skin test) in immediate isolation until they have a chest X-ray to rule out active disease?

10% of people with positive disease x 2% of TB was XDR in lab cultures world wide when surveyed a couple years ago = .002% lifetime risk that person has XDR TB that will be potentially active at some time. Let's isolate everyone with a positive PPD until the X-ray clears them.

If I was going to invest in preventing potentially fatal infectious diseases one person's actions puts others at risk by, I'd make it a federal law MMR vaccine was mandatory with only medical exemptions in all states. Right now several states have an opt out if you feel like it law. Measles is right up there with TB in terms of how many people it kills.

On the one hand I understand when the "authorities" are telling you not to fly a responsible person in most circumstances shouldn't. But I also understand what the fear a patient in this guy's shoes has and how it affects decision making. I'm still siding with the guy concluding correctly the person on the phone didn't have the answers of a knowledgeable expert.

The news media has everyone believing this is the plague. It's the news media version you are basing the guy's guilty verdict on, not the actual facts.

[Segnosaur]

Do you accept expertise based on authority? I don't.

Well, I do... to a certain extent. For example, if I'm sick, I'll accept the doctor's expertise on how to get better. If my house is burning, I'll accept the fireman's expertise on how to extinguish the fire.

We live in a complex world... nobody can be an 'expert' in everything.


This guy was intelligent...

Well, that was HIS claim... do you accept his statement on face value?


I assume computer literate, he's had the disease since January, his father-in-law was an expert in the field. This conclusion, "was basing his actions on ignorance and selfishness" is unsupportable. You have no evidence of what the guy knew.

I have not seen any of his actual interviews on the news... has he actually said "My father-in-law said it was safe", or "I went on line and read medical literature on the subject before I flew"?

By the way, has the father-in-law gone on record saying he supported his plan to fly? Has he said "I wasn't told about the CDC warnings"? Or has he remained silent?


I do know he told the news people (because I saw the clip) that he had been told he was NOT contagious. Regardless of which strain of TB he was now being told he had, for several months he was assured he was NOT contagious. Also in his words (because I saw the clip) he drew the correct conclusion, "what changed?"

Keep in mind that:
- Even if the CDC didn't tell him "what changed", that does not mean that their recommendations should be ignored. The CDC is a beauracracy; perhaps the 'reasons' were there but they were simply not passed on.

- Did you ever think his statement might be a little, well, self serving? Claiming the CDC was somehow at fault for not giving him details puts him in a little better light than saying "Yeah they told me but I ignored the information", or "They told me but I didn't understand the medical mumbo-jumbo".


So, you are an intelligent person. You know you have MDR TB. You might read about it, your future father-in-law who you know is an expert and your doctors assure you for months, you are not contagious! Now you get a call by some "authorities" telling you you pose a risk to people on a plane. I would go by my knowledge. I would not go by the "authorities" unless I had reason to believe they knew something. In this case, they would have to give me a reasonable explanation of "what changed?" And they couldn't.

You know, its that same type of thinking that leads to things like 9/11 and moon hoax conspiracies.

Yes, ultimately the CDC may have over-reacted. But how many 9/11 people think they are "intelligent people", and who get told by friends who are "experts" that the towers couldn't have collapsed in the way they did?


Not only was the "authority" on the phone unable to explain why you were now contagious when for months they assured you you weren't, that same "authority" told you to go get locked up in quarantine by the Italian "authorities".

Just wondering... who exactly was the 'authority' he was talking with on the phone? If it was some secretary who was given the task of tracking him down to contact him, you wouldn't expect them to be an expert in all the details.

As for the risk of getting locked in quarantine by the Italians... does he think Italy is some sort of 3rd world dictatorship? Why exactly do you think he'd be at any more significant risk being stuck in Italy than in the U.S.? (I asked that in my previous post, but the issue was never addressed.)


TB is difficult to catch.

I'm sure it is. But it wasn't so difficult that HE didn't catch it. (Has it ever been established where he got the disease from in the first place?)


There are only a couple cases of it ever spreading on an airline. In those cases it was only spread after prolonged contact and only to a couple people and only when the source case had enough bacteria to show up in the sputum smear.

Again, they're dealing with a relatively new problem (antibiotic resistant bacteria)... given that the amount of trouble that it can cause, some may feel that a little extra caution is not unwarranted.


Ever been nicked by the clippers at the barber shop? Ever cut yourself on one of your buddies' tools?

When I borrow my buddie's tools, I know the risks... I know that the tools are sharp and can cause injury and/or infections if I'm not careful.


Like I said, the more I see of this case, the more apparent it becomes, the CDC over-reacted. Now you have a public believing this guy actually put people at risk, not because he did, but because he had a legitimate concern for his life and because he went with having been told for months he wasn't contagious rather than with an "authority" who was now telling him not to get on a plane but couldn't explain, what changed.

Once again, please explain why he had a 'legitimate' concern for his life. Italy does have a modern health care system... not a perfect once, but I'm sure there have got to be a few doctors and/or hospitals capable of administering antibiotics. And given the fact that he had had his 'disease' for a while, why would he consider it necessary to rush back to the U.S. to get treatment?

[Segnosaur]

If I was going to invest in preventing potentially fatal infectious diseases one person's actions puts others at risk by, I'd make it a federal law MMR vaccine was mandatory with only medical exemptions in all states.

That sounds like an excellent idea. But why does it have to be an either/or situation? Why can't the government handle both widespread vaccinations AND the problem of people travelling with diseases?

Heck, I can think of a lot of diseases that should probably be given higher priority than the ones we concentrate on now...


On the one hand I understand when the "authorities" are telling you not to fly a responsible person in most circumstances shouldn't. But I also understand what the fear a patient in this guy's shoes has and how it affects decision making. I'm still siding with the guy concluding correctly the person on the phone didn't have the answers of a knowledgeable expert.



Wait a second... At one point you seem to say this guy was reasonable, rational, etc. (when you talked about how intelligent he was, etc.) at the time of his actions. Then, you seem to imply that his actions were based on panic and/or fear.

So which is it? Can't have it both ways now...

[Skeptic Ginger]

That sounds like an excellent idea. But why does it have to be an either/or situation? Why can't the government handle both widespread vaccinations AND the problem of people travelling with diseases?

Heck, I can think of a lot of diseases that should probably be given higher priority than the ones we concentrate on now...If we had infinite resources one should be addressing XDR TB at the source, people with TB who are too poor to get adequate treatment.

Want to know where some of MDR TB got worse? In grossly over crowed Russian jails. Prisoners were partially treated, then when released, had no way to continue treatment. You might as well be culturing drug resistance.

Shouldn't we invest in prevention at the source?

Wait a second... At one point you seem to say this guy was reasonable, rational, etc. (when you talked about how intelligent he was, etc.) at the time of his actions. Then, you seem to imply that his actions were based on panic and/or fear.

So which is it? Can't have it both ways now...Yes, you can. He was safe to travel, he was told not to. Were there no fear involved he could have pandered to the CDC spokesperson.

[Segnosaur]

If we had infinite resources one should be addressing XDR TB at the source, people with TB who are too poor to get adequate treatment.

If we had infinite resources, we would by definition be able to do both (that is, address the disease at the source AND at later on.)

Of course, then you also end up with a whole mess of other problems... like what do you do if people are actually given the required medicine but stop taking it early? Should we force them (at gunpoint) to finish their meds?


Yes, you can. He was safe to travel, he was told not to. Were there no fear involved he could have pandered to the CDC spokesperson.

But you implied (at least that's what I assumed) that his decision was not based on fear but on reason (when you talked about his intelligence, how he had access to all these resources, etc.)

[Skeptic Ginger]

Well, I do... to a certain extent. For example, if I'm sick, I'll accept the doctor's expertise on how to get better. If my house is burning, I'll accept the fireman's expertise on how to extinguish the fire.

We live in a complex world... nobody can be an 'expert' in everything. But Seg, you are changing the point I made to one that suits your answer. If you knew the authority was wrong or if you had more evidence they were wrong than they were right? If you blindly follow authority, that ain't so good.

Well, that was HIS claim... do you accept his statement on face value?He graduated from law school and passed the Bar Exam

I have not seen any of his actual interviews on the news... has he actually said "My father-in-law said it was safe", or "I went on line and read medical literature on the subject before I flew"?

By the way, has the father-in-law gone on record saying he supported his plan to fly? Has he said "I wasn't told about the CDC warnings"? Or has he remained silent? I was giving multiple possibilities re the lit review. I said you don't know but it was certainly possible.

As to the father-in-law, yes, both the father-in-law and the patient said the father-in-law said the man wasn't contagious. The father-in-law, however said he wasn't involved in the decision to fly back and that because of his job, he wouldn't say anymore.

Keep in mind that:
- Even if the CDC didn't tell him "what changed", that does not mean that their recommendations should be ignored. The CDC is a beauracracy; perhaps the 'reasons' were there but they were simply not passed on.

- Did you ever think his statement might be a little, well, self serving? Claiming the CDC was somehow at fault for not giving him details puts him in a little better light than saying "Yeah they told me but I ignored the information", or "They told me but I didn't understand the medical mumbo-jumbo".No, I'm sorry. The CDC was wrong, they did over-react and I have to judge the guy based on my sympathy for his right to ignore the CDC caller who was wrong and my empathy for him as a patient.


You know, its that same type of thinking that leads to things like 9/11 and moon hoax conspiracies. Now you are getting into absurd territory. I could say blind following of authority let Hitler come to power.

Yes, ultimately the CDC may have over-reacted. But how many 9/11 people think they are "intelligent people", and who get told by friends who are "experts" that the towers couldn't have collapsed in the way they did? We could go on all day discussing risks that were ignored.

You cannot avoid all risk. Avoiding risk is a value judgment. It's cheap to put in a smoke alarm, anyone not doing so is a fool. It's hard to eat a perfect diet. Every person who choses to eat a few strips of bacon now and then is not a fool because they might be increasing their risk of heart attack by a teeny fraction with each strip.

You need some perspective here!

Just wondering... who exactly was the 'authority' he was talking with on the phone? If it was some secretary who was given the task of tracking him down to contact him, you wouldn't expect them to be an expert in all the details.A clinician is the one who calls. I talk to them all the time in my business.

... Why exactly do you think he'd be at any more significant risk being stuck in Italy than in the U.S.? (I asked that in my previous post, but the issue was never addressed.)For the same reason everyone ignorant about the facts in the situation is freaking out about this guy here.

I'm sure it is. But it wasn't so difficult that HE didn't catch it. (Has it ever been established where he got the disease from in the first place?)Touring a hospital in Vietnam is the most likely place.


Again, they're dealing with a relatively new problem (antibiotic resistant bacteria)... given that the amount of trouble that it can cause, some may feel that a little extra caution is not unwarranted. Not if the patient isn't infectious.

When I borrow my buddie's tools, I know the risks... I know that the tools are sharp and can cause injury and/or infections if I'm not careful.Come on, could we keep the discussion real here? Is it risk free to walk out your door? Were the plane passengers even put at risk here? No, they weren't. Period. CDC over-reacted.

Once again, please explain why he had a 'legitimate' concern for his life. Italy does have a modern health care system... not a perfect once, but I'm sure there have got to be a few doctors and/or hospitals capable of administering antibiotics. And given the fact that he had had his 'disease' for a while, why would he consider it necessary to rush back to the U.S. to get treatment?I have already gone over this, see my previous posts.

[Skeptic Ginger]

From the parents and parents-in-law interview (http://news.yahoo.com/s/nm/20070604/hl_nm/tuberculosis_usa_dc_5;_ylt=ArUc6UAYLAfrAiVFaq70YUk E1vAI) today:

"Do you think that this man [the father in law], who is an expert in TB, do you think that this man, if he had thought that there was any danger whatsoever to his only child and his only grandchild, that he would have allowed this to happen?" she said.

"We were told that these induced sputum tests that he had had were negative to that point, and so by the guidelines, he was not considered infectious," Cooksey said.

Speaker's father, Ted Speaker, said a tape-recording of a pre-trip meeting with
CDC officials confirms the same conclusion. "They said on tape it is not contagious ... at least three times,"

[Segnosaur]

But Seg, you are changing the point I made to one that suits your answer. If you knew the authority was wrong or if you had more evidence they were wrong than they were right? If you blindly follow authority, that ain't so good.

No, but second-guessing people who are experts when you have no training in the field ain't so good either.

I acknowledge the fact that the CDC likely overreacted. But if he was unsure of what the CDC said, then he should have gotten a second opinion from a doctor their in Italy, and/or waited to get the situation cleared up.


He graduated from law school and passed the Bar Exam

And Judy Wood (of the 9/11 death star beam conspiricy theory) managed to graduate and get the qualifications to teach engineering. And Behe managed to get an advanced degree in biochemistry.

Sadly, holding any sort of advanced degree is no guarantee that the person holding the degree is actually intelligent.

A clinician is the one who calls. I talk to them all the time in my business.

But then, will that clinician have access to all the details about the decision to put him on the no-fly list, or will they just be repeating the basic instructions? If they're just parroting what they've been told then the argument he made about not being told the details is moot.


For the same reason everyone ignorant about the facts in the situation is freaking out about this guy here.

But this person would not be dealing with 'everyone' in Italy. He'd be dealing with doctors. I'd assume that in a country as large as Italy, he'd be able to find at least ONE doctor who would be able to correctly assess his situation and get him on the correct course of antibiotics without having him chained in a dungeon.


Once again, please explain why he had a 'legitimate' concern for his life. Italy does have a modern health care system... not a perfect once, but I'm sure there have got to be a few doctors and/or hospitals capable of administering antibiotics. And given the fact that he had had his 'disease' for a while, why would he consider it necessary to rush back to the U.S. to get treatment?
I have already gone over this, see my previous posts.

No, you haven't. What you've done is pointed out (probably correctly) that the CDC overreacted and the risks were over-emphasized. What you HAVEN'T done is justified why staying in Italy and receiving treatment there (where they have a relatively modern medical system and at least some measure of human rights), at least until he could legally return to the U.S., was somehow putting his life at risk, considering that his condition appears to have been stable for some time. The only arguments I've seen you make in that area were that 'people in Italy would panic' (not an issue since he'd be dealing with doctors, not average citizens) and that a person is better off being close to the 'best' source of treatment (again not an issue since his condition was stable.) At the very least he could stay put until they got the issue of "non-contagious but not allowed to fly" straightened out.

[Skeptic Ginger]

No, but second-guessing people who are experts when you have no training in the field ain't so good either. You have no evidence this is the case, none!

In fact, the guy was right, he wasn't contagious. Know what the hospital he's in now is about to do? Release him from isolation. Know why? Because they have collected 2 of 3 sputum smears. One more negative smear and guess what? He meets the same criteria he met before he went on the wedding trip. NOT CONTAGIOUS.

They are of course in deference to not embarrassing the CDC qualifying the release from isolation saying well he can't be in real close contact. Nonsense. The guidelines have not changed. No cough, negative sputum smears, no isolation. You can look it up on the CDC's own TB web pages.

....No, you haven't. What you've done is pointed out (probably correctly) that the CDC overreacted and the risks were over-emphasized. What you HAVEN'T done is justified why staying in Italy and receiving treatment there (where they have a relatively modern medical system and at least some measure of human rights), at least until he could legally return to the U.S., was somehow putting his life at risk, considering that his condition appears to have been stable for some time. The only arguments I've seen you make in that area were that 'people in Italy would panic' (not an issue since he'd be dealing with doctors, not average citizens) and that a person is better off being close to the 'best' source of treatment (again not an issue since his condition was stable.) At the very least he could stay put until they got the issue of "non-contagious but not allowed to fly" straightened out.I told you read what I already posted. I addressed this. He had no way of knowing this. After you are locked up in quarantine, you can't exactly change your course of action.

They are going to release this guy. When they do just remember, I told you so. I told you he never posed a risk to those air passengers. I would have had no qualms sitting right next to him.

[Gurdur]

...You are told you have a very difficult to treat infection and you know the US has the best health care in the world for treating this infection. I'd want to get back to the US as fast as possible to avoid being detained in isolation somewhere. Regardless of the outcome of treating XDR TB in Italy, the patient would have to know that information.

I know I would have done the same as this guy.
These are fatuous and dishonest statements.

For a start, just for example, the Netherlands has much better expertise and overall control in dealing with MDR infections than does the USA, a kind of fact you ignore in your ignorant insularism.

The next thing that you willfully ignore of course is that the topic is MDR TB and XDR TB; explain to us all just how actual treatment and outcome prognosis for both is supposed to differ between Italy and the USA. You're being very disingenuous indeed.

Since the treatment for both is rather standard in all Western countries, your whole argument is a pack of red herrings.
I know I would have done the same as this guy. I would have known I wasn't contagious and the CDC was over-reacting.
That is an extremely unprofessional statement of yours indeed. You are supposed to know, as a result of your training, that individual patients should not willy-nilly cast off quarantine measures to suit themselves; I suggest strongly you re-study medical ethics, assuming of course learning ethics is not something you would disparage as allegedly "theist", as you did the last time the subject came up.

[SteveGrenard]

http://www.medpagetoday.com/InfectiousDisease/Tuberculosis/tb/6083



Speaker Does Not Have XDR-TB


DENVER -- Andrew Speaker, the 31-year-old Atlanta lawyer whose apparent extensively drug-resistant tuberculosis (XDR-TB) sparked an international furor, does not have XDR-TB after all, said Charles Daley, M.D., his physician at the National Jewish Medical Center here. Instead, he has multiple drug-resistant TB (MDR-TB), which may be treatable by second-line antibiotics. Surgery, which had been planned, has been put on hold.


http://www.medpagetoday.com/

[Skeptic Ginger]

So I reviewed the literature on spreading TB from sputum negative sources. There were 4 studies. Sorry, I didn't save the links, but they were all on the net.
BMJ
TUBERCULOSIS
Transmission of tuberculosis from smear negative patients: a molecular epidemiology study
E Hernández-Garduño3, V Cook1,3, D Kunimoto2, R K Elwood1,3, W A Black1,3 and J M FitzGerald1,4

Results: In the total sample the mean (SD) age was 51 (21) years, 54.3% were male, and 17.0% of patients were clustered. Compared with smear negative patients, smear positive patients were more likely to be in a cluster (OR = 2.0, 95% CI 1.1 to 3.6) and to have had a history of ethanol abuse (OR = 2.7, 95% CI 1.0 to 6.7), diabetes mellitus (OR = 2.8, 95% CI 1.1 to 7.0), injection drug use (OR = 3.1, 95% CI 1.1 to 8.3), and to have had a previous hospital admission (OR = 8.5, 95% CI 5.1 to 14.0). The proportion of episodes of transmission from smear negative clustered patients ranged from 17.3% to 22.2% in group 1 and from 25% to 41% in group 2.
Conclusion: In Greater Vancouver, smear negative cases appear responsible for at least one sixth of culture positive episodes of TB transmission.

Lancet
Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli
Dr MA BehrMD a , SA WarrenBSc b, H SalamonPhD b, PC HopewellMD c, A Ponce de LeonMD d, CL DaleyMD c and PM SmallMD b

The relative transmission rate of smear-negative compared with smear-positive patients was calculated as 0•22 (95% CI 0•16–0•32). Sensitivity analyses and stratification for HIV-1 status had no impact on these estimates.

Chest
...smear-negative cases are still responsible for approximately 17% of recently transmitted TB. The latter observation lends support to the current Centers for Disease Control and Prevention recommendations stating that in order to discontinue airborne precautions, patients with pulmonary TB in addition to having three negative, consecutive, sputum smear results must be receiving efficacious therapy and show adequate clinical response.6 ...

...All cases had only negative AFB smear results during the infectious period and were categorized in two groups: group A consisted of cases with only one or two sputum specimens collected and processed, and group B consisted of cases with at least three sputum specimens or at least one bronchoscopic specimen...

Number of Negative Acid-Fast Smears Needed To Adequately Assess Infectivity of Patients With Pulmonary Tuberculosis*
George Mixides, MD, FCCP; Vasanti Shende, MD; Larry D. Teeter, PhD; Robert Awe, MD ; James M. Musser, MD, PhD and Edward A. Graviss, PhD, MPH

...Smear category of the index case (group A vs group B) was not independently associated with transmission. We also found that the first two sputum specimens in cases where three or more were performed yielded 90% of all positive culture results for Mycobacterium tuberculosis (MTB).

Conclusions: We conclude that two sputum specimens negative for AFB stain are adequate for both assessing infectivity and for isolating MTB from patients with pulmonary TB.

Int J Tuberc Lung Dis. 2005 Jan;9(1):49-55. Links
Risk of tuberculosis in children from smear-negative source cases.
Elwood RK, Cook VJ, Hernández-Garduño E.

RESULTS: Smear-negative source cases transmitted the disease to 10% of children (95%CI 5-17). My question is why did CDC wait until this guy was on a plane to tell the rest of the infection control practitioners? And are the exposure guidelines now changed?

In addition, since investigations of TB transmission on planes has shown only rare transmission, has anyone really determined what are the factors involved in this smear negative transmission?

This whole thing disgusts me.

But I will get to the bottom of it. I'm still on Speaker's side. No one acted like he was contagious until they thought it was XDRTB. His father-in-law, working for the CDC specifically on TB, for Pete's sake hadn't been advised about these smear negative risks. These guys are still covering their sorry a$$e$. And normally, I support the CDC not to act like that.

And the news media has gone with the scandal of TB on a plane over incompetency at CDC. I'll wager that's based on the reporter's own fear level.