A patient with extensively drug-resistant TB flew from Mumbai to Chicago, and the deadly disease could become an infamous export due to problems in India's public health system
[...] Now, difficult-to-kill TB is no longer just India's nightmare. In June U.S. health authorities confirmed that an Indian patient carried this extreme form of the infection, called XDR-TB, across the ocean to Chicago. The patient drove from there to visit relatives as far away as Tennessee and Missouri. Health officials in several states are tracking down everyone with whom the patient—who is now quarantined and being treated at the National Institutes of Health in Maryland—had prolonged contact. The disease can be cured in only 30 percent of patients and sometimes requires surgery to remove infected parts of lungs. Although TB's slow rate of infection makes explosive epidemics unlikely, the Chicago episode shows how easy it might be for the illness to become a worldwide export.
Yet until recently Indian public health officials remained reluctant to admit there's a problem, says Nerges Mistry, director of the Mumbai-based Foundation for Medical Research. "They were always trying to deny it [existed]," she says. (Neither the head of India's Revised National Tuberculosis Control Program (RNTCP) nor Mumbai's main tuberculosis control official—both of whom are new to their posts—responded to interview requests from Scientific American.)
[...] If there are indeed many people with resistant germs, it heightens the chances of those pathogens leaving the country for the rest of the world. Nearly a million Indians traveled to the U.S. in 2014, compared with less than three million from all of central Asia. More and more middle-class Indians are being diagnosed with TB, and although the patient who carried XDR-TB to the U.S. was immediately placed in isolation, India has no provisions for quarantines or travel restrictions.
http://www.cdc.gov/tb/publications/factsheets/drtb/xdrtb.htm
http://www.medicinenet.com/extensively_drug-resistant_tuberculosis_xdr_tb/article.htm
http://www.who.int/tb/challenges/xdr/faqs/en/
Yes, their headline is sensationalist - but there really IS a problem here, as evidenced by the CDC, WHO, and other organizations. Perhaps the problem wasn't created by India's restructured medical school system, but it has almost certainly been increased by it.
As reported by The Times of India last year:
The SN Medical College's trauma centre which became 'functional' in 2011 is yet to conduct a surgery. This came to UP chief minister Akhilesh Yadav's attention when he conducted a surprise inspection of the centre on Friday.
[...] "Not a single serious patient has ever been treated at the centre. Whenever a minister or a dignitary plans to pay a visit to the centre, a few are admitted in the intensive care unit (ICU) to 'show' them," said a doctor, who did not wish to be named. He added that a ward boy has been put on duty in the ICU just to keep an eye that no one steals anything from there.
Related Stories
University of Sheffield and Rutherford Appleton Laboratory (RAL) scientists have discovered several new related (dinuclear RuII) compounds which visualize and kill gram-negative bacteria, such as E. coli (note - no word on whether it works on synthetic E.coli)
Bacteria are classified generally by what type of staining works on them using a method developed in the 1800's by Hans Christian Gram. 'Gram-negative' bacteria retain a stain color that shows them as a pinkish red coloring, these bacteria have cell walls that make it difficult to get drugs into them and many gram-negative bacteria have become significantly or even completely resistant to available drug treatments.
A new drug in the difficult gram-negative space is particularly important. Drug resistant bacteria already cause the deaths of over 50 thousand people a year in the US and EU alone, and as many as 10 million people a year could die worldwide every year by 2050 due to antibiotic resistant infections.
Doctors have not had a new treatment for gram-negative bacteria in the last 50 years, and no potential drugs have entered clinical trials since 2010.
The new drug compound has a range of exciting opportunities. As Professor Jim Thomas explains: "As the compound is luminescent it glows when exposed to light. This means the uptake and effect on bacteria can be followed by the advanced microscope techniques available at RAL.
"This breakthrough could lead to vital new treatments to life-threatening superbugs and the growing risk posed by antimicrobial resistance."
The studies at Sheffield and RAL have shown the compound seems to have several modes of action, making it more difficult for resistance to emerge in the bacteria.
Better yet
Mammalian cell culture and animal model studies indicate that the complex is not toxic to eukaryotes, even at concentrations that are several orders of magnitude higher than its minimum inhibitory concentration (MIC).
The researchers plan to test the compounds against additional multi drug resistant bacteria next.
(Score: 1) by anubi on Tuesday July 07 2015, @12:57AM
This is a prime example of why I believe national healthcare in necessary.
Worldwide.
In the same vein that a fire department is necessary.
If someone becomes ill, its all of our problem - Unaddressed, an ill person will continue to spew forth infections like a fire that's not put out continues to spew forth ignitions.
Note India's public health system did not catch this. Now its a much bigger problem.
With international trade being what it is... this concerns me a lot. I often purchase electronic parts through AliExpress in China. All the stuff is made there anyway, and I can often get parts that are not available elsewhere. All it would take is one Chinese part-packer with some contagious disease to ship his problem over the entire world, and only hit the techie types like me.
"Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
(Score: 1) by Francis on Tuesday July 07 2015, @01:04AM
Unlikely, most, if not all, seriously infectious contagions wouldn't survive the trip. Between the time and the temperatures involved, the likelihood of anything contagious coming that way accidentally is rather remote. Most of the things that we contract really have to be transfered in a matter of minutes. There are, of course, some bacteria that will live longer, but for the most part as long as you don't put the parts in your mouth, you won't be contracting them.
The reason why TB is an issue is primarily because it takes months to show symptoms and every time you breath you put the pathogens in the air for other people to breathe in. Which reminds me, I'll need a TB screening in a couple months.
(Score: 1, Informative) by Anonymous Coward on Tuesday July 07 2015, @01:31AM
Those freighters aren't computer controlled yet. There are people on board every international shipment along with the cargo.
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @01:25AM
Because, really, who will set the standards for Worldwide Healthcare?
Vote for anubi for World Emperor. It's the only logical choice.
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @01:34AM
If (communicabledisease == true){
treatpatient();
}
Done in one.
(Score: 2) by MichaelDavidCrawford on Tuesday July 07 2015, @06:33AM
Filter error: Comment too short
Yes I Have No Bananas. [gofundme.com]
(Score: 1) by anubi on Thursday July 09 2015, @01:27AM
I do NOT want to be world emperor.
If somehow I was forced into such a thing, my first order will be to replace myself with a ballot box.
I flat do not possess the wisdom to run a decent household, much less a planet.
From observation, I have come to the conclusion no one else does either.
"Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
(Score: 1) by Eristone on Thursday July 09 2015, @09:05PM
First qualification for the job - you don't want it - congratulations! Plus, we wouldn't want to put someone in charge that *wanted* to be World Leader, they already have issues.
(Score: 4, Interesting) by gnuman on Tuesday July 07 2015, @03:35AM
This is a prime example of why I believe national healthcare in necessary.
Worldwide.
In the same vein that a fire department is necessary.
You certainly haven't been to Freedomland recently, where some fire departments do not offer universal coverage.
http://www.nbcnews.com/id/39516346/ns/us_news-life/t/no-pay-no-spray-firefighters-let-home-burn/ [nbcnews.com]
Firefighters in rural Tennessee let a home burn to the ground last week because the homeowner hadn't paid a $75 fee.
(Score: 2) by linuxrocks123 on Tuesday July 07 2015, @08:31AM
*shrug*, I see no problem with the fire department's policy. If you're stupid enough not to pay $75 a year to fund the fire department, yet you will be significantly damaged if your property catches fire, you deserve what's coming to you.
Of course, taxes are usually used to fund fire departments ... but extremely rural areas might not have enough of a tax base to do that. And, a lot of people who own property there might not really care if their vacant lots catch fire. So, a voluntary fee policy makes sense in circumstances like that.
Why do you think this article says anything bad about the US, other than that there are some idiots in the US, as there are everywhere?
(Score: 3, Insightful) by Phoenix666 on Tuesday July 07 2015, @10:39AM
What do they think will happen if the fire does not conveniently confine itself to the property of the shirker and becomes a general conflagration? I don't know if that's a big risk in rural Tennessee, but it certainly is out West where I grew up. Put the frickin' fire out, jackass fire department!
Washington DC delenda est.
(Score: 2) by linuxrocks123 on Tuesday July 07 2015, @11:47AM
Well, if you read the link, you would see that the fire department will respond if the fire spreads to a neighbor's property and that neighbor has paid the $75 fee. They will then contain the fire so it doesn't spread.
But they'll still let the would-be free-rider's house burn to the ground.
(Score: 1, Informative) by Anonymous Coward on Tuesday July 07 2015, @03:23PM
This is not humane. If you wonder why this is not humane, you certainly do not have the capacity to feel for another person. I would not wish to be associated or live anywhere near a human being such as you.
(Score: 3, Interesting) by linuxrocks123 on Tuesday July 07 2015, @04:56PM
There's no reason to resort to personal attacks here.
It's a difficult situation ... I'll grant you that. But here are the facts that led to this:
1. The county chose not to use its tax revenue to fund a fire department.
2. A "city" of ~2000 people in the county decided to fund a volunteer fire department -- probably very cash-strapped, but effective.
3. This city offered a fire protection subscription that rural land owners in the county but not the city could buy for $75 a year.
No one can force the people in the county to pay for fire protection, because the city can only tax within its limits. No one can force the city to provide fire protection outside of its city limits. So, if you want fire protection, you pay the $75 fee. If you don't, the fire department doesn't provide fire protection for you. Fire departments, even volunteer fire departments, cost money to run and a city of 2000 people can probably just barely afford to provide one. If they don't charge that fee to the county landowners who want fire service, they'd probably have to shut down. And, if it gets out that they'll put out a fire at your house even if you don't pay the fee, a lot of people will likely stop paying. And then there's no more fire department.
It's a shame his house burned down. But he was either trying to free-ride at the city's expense (most likely), or he thought he didn't need fire protection even though he was apparently intentionally burning his trash on his property (which btw isn't that uncommon in rural areas). In either case, he made a poor decision, and, unfortunately, there were consequences for it.
I may have been a little strong saying he "deserved" it, but I do think free-riding off of a volunteer fire department is pretty damn antisocial, so that's where that was coming from. If I were actually there at the scene of the fire, of course, I'd feel really bad for the guy regardless.
Still, if that city wants a fire department ... that's what they have to do. If it's "inhumane" to let one guy's house burn down, it's a lot more inhumane to not have a fire department and therefore let a lot of people's houses burn down.
The right solution, one might say, is to have the county provide the fire department instead of the city. But, well, like I said elsewhere, there might be land owners there with undeveloped land who don't want to pay the taxes to run a countywide fire department. There often aren't perfect solutions to problems such as these.
(Score: 2) by http on Tuesday July 07 2015, @07:58PM
If the fire department waits until it reaches the property line of the person who paid them, it's going to be harder to stop it from taking out the next house. Fire's like that. Also, you did say "you deserve what's coming to you." After letting that loose, you should hardly be surprised by a personal attack, even if you think you don't deserve it.
I browse at -1 when I have mod points. It's unsettling.
(Score: 2) by linuxrocks123 on Wednesday July 08 2015, @05:43AM
If the fire department waits until it reaches the property line of the person who paid them, it's going to be harder to stop it from taking out the next house.
That's sometimes true; in those cases, the firefighters use their professional judgment as to what the minimum they need to do to contain the fire is, and then do that minimum. Sometimes this might result in a free-loader's house getting put out; more often it just results in part of their lawn not getting burnt.
Also, you did say "you deserve what's coming to you."
English has a concept called the impersonal you: https://en.wikipedia.org/wiki/Impersonal_you [wikipedia.org]
That said, random personal attacks are par for the course on Slashdot/SoylentNews, so you're correct that it wasn't particularly surprising.
(Score: 1) by rcamera on Tuesday July 07 2015, @05:30PM
and
and
say it all. the family burned down their own trailer and were upset that they couldn't pay for fire department service after-the-fact. this is after the district voted to shutter their own fire department, if memory serves.
i recall reading back when this was actual news that it was the 2nd or 3rd time the fire department responded to garbage fires spread to the residence for this same lot, and the owner still refused to pay. i guess it's because the FD put the fire out the last time (or two) without being paid the annual fee - they figured they could get away with it again. not to mention the FD's insurance only covered injuries (of FD personnel) for in-district injuries OR on out-of-district lots they were paid to cover.
/* no comment */
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @08:35PM
Really stupid policy....IMHO government exists to better the society we live in. Just charge everybody the $75 as part of the Tax base and be done with it...How in the world is rural Tennessee society better off by allowing a few guys with vacant land to keep their $75.
(Score: 2) by MichaelDavidCrawford on Tuesday July 07 2015, @05:38AM
not public health care, public health. Stuff like finding ways to prevent what this story reports.
This according to Laurie Garrett, author of "The Coming Plague".
Yes I Have No Bananas. [gofundme.com]
(Score: 1, Flamebait) by Phoenix666 on Tuesday July 07 2015, @10:45AM
I generally file those people under the, "Bruce Jenner totally became a chick, dude! Trans-Pacific Partnership? Huh?" folder.
They are not the people who ought to drive public policy.
Washington DC delenda est.
(Score: 2) by MichaelDavidCrawford on Tuesday July 07 2015, @11:16AM
That those are the kinds of people who do, in fact, drive public policy.
I don't regard most elected officials as ignorant. They just act that way so they can win votes and financing.
Yes I Have No Bananas. [gofundme.com]
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @07:27AM
Google "phage therapy" and stop believing in Big Pharma's "sky is falling!!! need moar money!" soundbites.
Once there develops any real inconvenience to "valuable members of society", less profitable cures will be produced from under the rug and put to work. Until then - proles will suffer and die, and rich fatcats will use their deaths to demand more subsidies and less taxes. It is that simple.
(Score: 3, Insightful) by linuxrocks123 on Tuesday July 07 2015, @08:20AM
+1 for the link to an interesting experimental therapy.
-2 for the paranoid fantasy that the reason random experimental therapies aren't yet widely available is because THE MAN WANTS TO KEEP US DOWN!!!!
Protip: anyone who uses the phrase "it's that simple" when talking about a policy issue is usually himself simple.
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @08:46AM
Zealous disbelieving in "THE MAN" in 2015 is not exactly a mark of sophistication; Snowden, Wikileaks, etc. etc. etc. is for realsies.
Alas, Virginia (or Pollyanna?) teh world is not all sunshine and little ponies. :(
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @12:51PM
The granulomas that are characteristic of TB would probably not allow for bacteriophage penetration. The granulomas are surrounded by a dense layer of macrophages.
Conspiracy theories are not necessary to keep phage therapy from the clinic. Bacteriophage are too immunogenic to treat systemic bacterial infections and are incredibly narrow-spectrum. The technology has some niche uses but it isn't ready for prime time yet especially considering how amazingly effective, cheap, and well-tested broad-spectrum antibiotics are.
(Score: -1, Offtopic) by Anonymous Coward on Tuesday July 07 2015, @01:03AM
What the fuck is Chigaco?
(Score: 2) by Runaway1956 on Tuesday July 07 2015, @01:24AM
Editor's typo? Your own type? Chigaco doesn't appear anywhere on this page, nor does it appear on the page from which I copy/pasted it. Are you feeling well today?
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @01:28AM
The headline has been corrected.
(Score: 2) by krishnoid on Tuesday July 07 2015, @02:07AM
It's a Japanese word, roughly translating to "middle school" [wikia.com].
(Score: 2) by Phoenix666 on Tuesday July 07 2015, @10:36AM
It's the Hellmouth, whence all demons and evil in the world. It shall be sealed when a Slayer appears and casts it back into the depths.
Washington DC delenda est.
(Score: 3, Interesting) by MichaelDavidCrawford on Tuesday July 07 2015, @01:31AM
My concept of who to blame when somethi bad happens has evolved considerably over the years. Instead of blaming the perpetrator, I have come to regard people who do bad things as simply doing what comes natural.
These days I blame whoever was in a position to prevent the problem yet failed to take responsibility to actually do so.
Yes I Have No Bananas. [gofundme.com]
(Score: 3, Informative) by Runaway1956 on Tuesday July 07 2015, @02:14AM
Hmmmmm. US Customs isn't exactly tasked with checking the health of visitors and immigrants. Not that I've seen, anyway. Sure, they might stop an obviously ill person, but they don't do blood tests and such.
The latter part of the post refers to today's medical schools in India. Some years ago, a graduate from a medical school in India was highly regarded. Today, not so much. What has happened? Medical schools have been, at the same time, privatized, and subsidized. I've read a number of stories, like the one linked to, which show that a medical college might not see a patient for months, but when a scheduled inspection is about to take place, the staff runs out into the town to find "patients" to fill the beds. Consequently, the students are getting almost no medical training at all, and certainly no practical experience.
It's amazing what a little corruption can accomplish in just a few short years. Today, India has unqualified "doctors" prescribing random drugs for diseases they've never seen, let alone treated.
(Score: 4, Insightful) by c0lo on Tuesday July 07 2015, @02:49AM
Well, why so amazed? Corruption grows exponential* - the more corrupts, the easier it becomes to corrupt others - what you see may a the result of tens of years of "benign corruption"
---
* actually I suspect Lotka-Volterra equations may be a better model - pretty much like the evolution of an infectious disease, until the system either reaches an equilibrium under endemic corruption or collapses and drives the corrupt population down to atto-foxes.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 3, Informative) by MichaelDavidCrawford on Tuesday July 07 2015, @06:31AM
India provides a very basic food ration to its population - a few kilos of grain and beans each month. But it is estimated that only 15% of that food reaches those who it is intended for.
Many regard India, Mexico and other developing nations as desperately poor. In reality they are fabulously wealthy but that wealth is quite inequitably distributed, in large part due to corruption.
Yes I Have No Bananas. [gofundme.com]
(Score: 3, Insightful) by c0lo on Tuesday July 07 2015, @02:29AM
There are cases in which prevention is more costly than after-the-fact mitigation.
If you'd be a Windows user, you'd have known it: a bad infection may cost 1-2 days to remove reinstall/reconfigure everything and may happen once a year, the cost of running a realtime malware slows the computer down each and every second you use the computer - 1% of every year gets to 3 days worth of downtime.
Oh, well... seems like a natural law to see increased risk-adversity in a society along its progress: we are growing wimpy by the day. The Londoners lived for 3 decades of the trouble [wikipedia.org] and the political class wasn't as hysterical as today.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @08:05AM
You're doing it wrong. That's why you get the wrong results.
If your windoze gets a bad infection, all your customer data is compromized, all your "intellectual property" and business plans stolen. It's not just a question of doing a reinstall of a workstation... The right way to prevent in this example would be to run a GNU/Linux operating system where you're much much more unlikely to contact malware. And this is a very poor anyways analogy because resistent bacteria have the potential for a global pandemic we cannot treat. It's very serious stuff.
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @12:08PM
A compromised desktop computer cannot infect your child with a deadly disease.
(Score: 2) by frojack on Tuesday July 07 2015, @03:46AM
These days I blame whoever was in a position to prevent the problem yet failed to take responsibility to actually do so.
I think Hanlon's Razor is in order here:
Never attribute to malice that which is adequately explained by stupidity.
In this case you can substitute simile ignorance for stupidity. I don't believe Customs and Immigration officers in airports are trained to detect asymptomatic diseases. And if the disease was actually as "extensive" as the article mentions, the Indian authorities are still the ones who let her on the plane.
No, you are mistaken. I've always had this sig.
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @04:38AM
Doesn't that mean there are two classes of people, then? Those who are elite enough to be responsible for themselves and the rest who might as well be cattle?
(Score: 0) by Anonymous Coward on Tuesday July 07 2015, @06:06PM
India, rampant antibiotic use is common. Patients have access to any antibiotic so people do not use the drug properly without proper checking, leading to many people with drug resistant strains of any disease. TB is just one of them
(Score: 0) by Anonymous Coward on Wednesday July 08 2015, @09:31AM
Around 80% of antibiotics manufactured go to Big Agro where they're abused to make the animals grow a little bit faster. Nevermind that this will plunge us in the dark ages when resistent strains develop...