TB IS Down but Not Out

Public employees and health care workers cannot breathe easy — although tuberculosis cases are dropping.

NEW YORK CITY

After four hours cooped up in a small hospital room with a constantly coughing prisoner, New York State Corrections Officer Leo Dickerman wondered if he could catch whatever it was that was making the prisoner so sick.

A month later, Dickerman found he not only could catch the sickness — he had. A member of AFSCME Local 2691 (Council 82), Dickerman, now 44, tested positive for a tuberculosis infection.

Every year, TB kills about 3 million people worldwide, according to the federal Centers for Disease Control (CDC) in Atlanta, Ga. Corrections officers, public employees and health care professionals are particularly vulnerable to infection through their daily contact with individuals in poor health. When workers are exposed to TB, so are their families. And these days the disease is more dangerous than ever: Today’s tuberculosis is often a more dangerous strain that is resistant to the drugs commonly used to treat it.

That’s exactly the TB Dickerman contracted and passed along to his two children, 18-month-old Zachary and 5-year-old Amy. The standard TB-control medications didn’t help Dickerman overcome the disease: He felt worse, not better.

John Stanforth, occupational health and safety specialist for AFSCME Council 82, put Dickerman in touch with the National Jewish Medical and Research Center in Denver, one of the nation’s premier TB-treatment hospitals. Doctors removed half a lung and put Dickerman on a two-year program with advanced drugs. He and his children — who are taking the same drugs to ward off a full-blown case of the disease — have a 95 percent chance of staying TB-free for the rest of their lives.

Now working a desk job for the Applicant Investigative Unit of the New York State Department of Corrections, Dickerman no longer has any contact with prisoners. A 1995 CDC report says that the prevalence of TB infection in United States correctional facilities ranges from 14 to 25 percent.

"I don’t have to escort prisoners with active TB to hospitals anymore," Dickerman says with relief. "The doctors said if I get TB again, I probably won’t survive. Once you’ve taken the TB medications every day for two years, like I had to, the odds that they’ll work again to heal you aren’t very good."

HISTORICAL KILLER. "TB is a disease the middle class and rich incorrectly think is limited to the poor and minority population. It may start there, but it can infect anyone," warns Dr. Lee Reichman, executive director of the New Jersey Medical School’s National TB Center in Newark, N.J., and a past president of the American Lung Association.

Once a major cause of death in America, TB was all but defeated by the 1960s. In the late 1980s, however, public health funds were cut and tuberculosis came roaring back. An alarmed Congress restored funding and TB cases declined.

But experts warn that history may be about to repeat itself: Programs to combat TB may once again become inviting targets for federal and local budget cutters. These cutbacks could lead to yet another rise in the disease.

"The danger is, with the advent of multi-drug resistant TB, there is a real possibility that we could see a non-curable form of TB spread rapidly worldwide if funding is cut once again," Reichman warns.

The old adage of penny-wise, pound-foolish applies here, the doctor explains. "Before the budget cuts of the 1980s, it cost about $10 million a year to [fight] TB nationwide. In the early 1990s, in order to beat back the outbreaks in several areas of the country, Congress appropriated $150 million in emergency expenditures. Had they left well enough alone, we wouldn’t have been in that predicament."

BETTER PRECAUTIONS. The infusion of money to combat TB has helped licensed vocational nurse Sandra Alexander breathe a lot easier at work.

Alexander, vice president of AFSCME Local 839 (Council 57) works in a community health clinic south of San Francisco which has been equipped with new air purification systems that help to eliminate TB particles from the clinic’s isolation rooms and main lobby. The masks she now has at her disposal also provide a better shield against TB than those of a few years ago.

It is a good thing she is better protected, Alexander says, since the incidence of TB in San Mateo County is increasing: from 75 cases in 1994 to 93 in 1996.

"We have a lot of legal and illegal immigrants from the Philippines, El Salvador and Nicaragua who come here with active TB and infect many others," Alexander says.

According to the CDC, almost 2 billion people worldwide — one-third of the world’s population — are infected with TB. Each year there are 8 million new cases and 3 million TB deaths.

An increasing proportion of cases in the United States, some 37 percent, are among individuals born in areas where TB is common, such as Asia, Africa, Latin America and the Philippines. Public health officials point out that TB cannot fully be eliminated in the United States unless it is eliminated worldwide.

VIGILANCE REQUIRED. In Baltimore’s Eastern Chest Clinic, Registered Nurse George Brubach supervises another approach to preventing the spread of tuberculosis: a relatively new practice called Directly Observed Treatment.

"[In Directly Observed Treatment] we simply watch the patients take their medicine, either here at the clinic or at home, every day. It isn’t sexy, but it works," says Brubach, a member of AFSCME Local 558 (Council 67).

Directly Observed Treatment is effective — and expensive. Brubach worries that once politicians believe TB is beaten again they will cut funding. "Labor costs money. Build-ing state-of-the-art clinics with proper lighting and ventilation costs money. You can see why TB programs start to look like ideal candidates for budget cuts when TB levels fall," he says.

Brubach points out that drug companies have also scaled back their efforts to find new and more effective treatments for TB. "Because public health clinics are the biggest users of such drugs, there is little financial incentive for companies to keep funding expensive drug research programs," he charges.

"It’s only through collective efforts by public employees — through organized labor — that we can help keep the public aware of TB’s threat and the need to control it," the nurse explains. "If we don’t stay on top of this, who else will make the extra effort to protect our lives?"

THE FIGHT CONTINUES. AFSCME has long been concerned about TB exposure of its members, such as health care workers, COs and social service workers.

AFSCME was instrumental in successfully lobbying the CDC to update its TB guidelines to better protect workers in 1990. In 1993, AFSCME, along with more than 10 other unions, successfully petitioned the federal Occupational Safety and Health Administration for regulations requiring employers to protect workers from occupational exposure to TB.

As a result of the union’s diligence, OSHA will soon publish a proposed standard on TB. OSHA will conduct public hearings across the nation later this year to solicit comments from employers and workers on the proposed new regulations.

AFSCME intends to be an active participant in the OSHA hearings. Employees, including some of the prison workers who battle TB, are expected to testify.

"It is our hope that OSHA will require that employers implement the necessary protections to prevent more public employees from being infected with the scourge of TB," says AFSCME Pres. Gerald W. McEntee.

"If we’ve learned anything at all about TB it is that we cannot afford to ever let our guard down," he adds. "The minute we do, TB will come back nationwide and we’ll once again face a crisis."

By Daniel Guido