Quarantine Until Death: The Pandemic Policy Now on Trial in the Court of Public Opinion

In a test run promising to become the global model for pandemic response, South Africa is recommending that patients infected with drug-resistant tuberculosis (XDR-TB) be forcibly isolated until they die. "Forced isolation" is framed apologetically, as pitting individual rights against society's rights. However, the real issue is not about the individual versus society - it's about international corporate rights overriding the rights of individuals and society as a whole.

Scientists have long known that industrial activities - like factory farming and chemical pollution - cause micro-environmental changes, which in turn force microbes to mutate and create new diseases. But despite scientific knowledge and the overwhelming evidence, industrial practices known to create new diseases have not changed.

Why not?

Because corporate rights to profit override public health risks, and cancel out individuals' and society's rights. As a result, the world is facing a host of emerging untreatable, incurable and potentially deadly diseases.

Extensive Drug Resistant Tuberculosis (XDR-TB) is man-made - just like H5N1 bird flu, MRSA, E. coli and most other emerging diseases.

Positioned to go pandemic, XDR-TB is highly resistant to most antibiotics, almost incurable, and there are significant dangers associated with the drugs used for treatment. XDR-TB is airborne and usually fatal, especially in people with compromised immune systems, killing 98% of those infected within about two weeks. WHO's tuberculosis experts believe XDR-TB is just as serious a threat to global health as bird flu and SARS.

Some say the prevalence of HIV/AIDS in South Africa puts that nation especially at risk from XDR-TB. Disease surveillance, diagnostics and drugs are woefully inadequate, but a team of 3 doctors recommends forcible detainment of diagnosed XDR-TB patients who refuse the dangerous and ineffective treatment. Patients would be hospitalized until they die.

The recommendation parallels steps taken in New York City in the 1990's, when people who rejected TB treatment were forcibly detained in Bellevue and Goldwater hospitals. Some patients were held for as long as two years, and eventually, the number of TB cases diagnosed in NYC dipped.

The dilemma of a deadly disease: patients may be forcibly detained

South Africa is considering forcibly detaining people who carry a deadly strain of tuberculosis that has already claimed hundreds of lives. The strain threatens to cause a global pandemic, but the planned move pits public protection against human rights.

The country's health department says it has discussed with the World Health Organisation and South Africa's leading medical organisations the possibility of placing carriers of extreme drug resistant TB or XDR-TB under guard in isolation wards until they die, but has yet to reach a decision.

Pressure to take action has been growing since a woman diagnosed with the disease discharged herself from a hospital last September and probably spread the infection before she was finally coaxed back when she was threatened with a court order.

***

South Africa TB Patients May Be Detained

In their paper in the Public Library of Science Medicine journal, physicians Jerome Amir Singh, Ross Upshur and Nesri Padayatchi propose that XDR-TB patients who refuse treatment be involuntarily detained in hospitals or other health care facilities. Singh and Padayatchi are at the Centre for AIDS Programme of Research in South Africa, and Upshur is the director of the Joint Centre for Bioethics at the University of Toronto.

In the 1990s, New York City health authorities authorized the forcible detention of people who rejected TB treatment, some for as long as two years, ultimately leading to a significant dip in cases. The detainees were held in Bellevue or Goldwater hospitals.

Last September, the World Health Organization announced there were 53 confirmed XDR-TB cases in South Africa, of which 52 were fatal. Most of the patients were also HIV positive. To date, more than 300 cases have been identified, and at least 30 more are picked up each month.

Critics of the recommendation point out that steps should be taken before imprisoning patients.

Some public health experts say South Africa and the international community haven't taken basic outbreak response steps, such as drafting an emergency plan, conducting a proper investigation and reinforcing surveillance. WHO and its partners have held a flurry of international meetings since XDR-TB in South Africa was identified, but little has changed for patients in Africa.

"The government hasn't yet done the most obvious things to shut down transmission," said Mark Harrington, executive director of the Treatment Action Group, a health advocacy group. "Starting to imprison patients is a step very far downstream from where we are now."

Both critics and proponents are focusing on the issue of individual versus society's rights - a red herring that totally ignores corporate industry's role in creating virulent incurable diseases.

South African law also permits enforced isolation but some lawyers say it comes into conflict with the constitutional guarantees on individual rights. However, the constitution also guarantees communal rights, including protection from infection and the right to a safe environment.

So if the Constitution protects people from infection and ensures the right to a safe environment - then why aren't they going after the corporate industries that create and spread the disease, instead of planning to imprison the victims?

The issue is being "managed."

No one is acknowledging publicly that XDR-TB, like other emerging pandemics, is a man-made disease. Or that industrial practices - like dosing livestock with human antibiotics - are responsible for their creation. Or that it started in the USA - and could have been prevented. Or that the FDA recommended stopping the use of human antibiotics in livestock as far back as 1972.

Curtailing antibiotic use in agriculture. It is time for action: this use contributes to bacterial resistance in humans

One essential course of action is to minimize any and all causes and reservoirs of antibiotic resistance. Besides medical use in humans, there is the troubling issue of use in agriculture, specifically in livestock production. Antibiotics have long been routinely used not only for the treatment of infections, but also as a means of getting animals to market faster by growth promotion. Controversies about these practices have resulted in numerous reports, dating back decades, urging more caution or outright bans on the practice. The World Health Organization and other leading medical and public health bodies have advised that animals not be dosed with antibiotics used in humans - to little avail here in the United States to date, even though our own Food and Drug Administration (FDA) took this position as far back as 1972.

***

1978: Antibiotics in animal feeds--human and animal safety issues.

1978: Public health concerns relative to the use of subtherapeutic levels of antibiotics in animal feeds.

***

1995: Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic Drug resistance is a serious problem, especially in the United States. If worldwide control of tuberculosis does not improve, 90 million new cases and 30 million deaths are expected in the decade 1990 through 1999.

***

ANTIBIOTIC RESISTANCE: Superbugs on the Hoof?

Disturbing new findings have provided a key link in the chain of evidence connecting antibiotics used on livestock to outbreaks of disease caused by antibiotic-resistant human pathogens. Now agencies worldwide are beginning to clamp down on antibiotic use in agriculture. The moves have riled industry officials, who argue that antibiotics are essential to keeping animals healthy and the food supply safe, and that the most serious threat comes from indiscriminate use of antibiotics in people, not livestock.

In fact, public discussion about how factory farming, pollution and environmental change create disease is kept separate from dialogue about pandemic prevention and response - another kind of forced isolation, sometimes called censorship or "sanitization" of the issue.

Here is a quick general overview from the US Government's Environmental Health Perspectives, with a synopsis from Reuters.

Antibiotic Resistance in Livestock: More at Stake than Steak

Imagine, for a moment, this scenario: you, like millions of other people around the world, are lying in a hospital bed suffering from a bacterial infection. Your doctors have told you that your disease, which once would have been easily treated, no longer responds to available drugs. In addition to feeling shock and disbelief, you'd probably wonder how this could have happened.

You would not be alone. The specter of antibiotic resistance is considered by many to be one of the most pressing scientific questions today. With each passing year, former wonder drugs like penicillin, erythromycin, and tetracycline are less effective against strains of treatment-resistant "superbugs." By decreasing the number of effective drugs in the medical arsenal, antibiotic resistance is making bacterial infections and related conditions more difficult to treat. Scientists also worry that the spread of resistance genes among even unrelated strains of bacteria could turn what are now treatable illnesses into killers.

Where are these resistance traits coming from? Certainly overuse in human medicine is an important source. But agricultural uses, particularly in livestock, also contribute significantly toward the problem of antibiotic resistance, scientists say.

***

Infectious Disease: The Human Costs of Our Environmental Errors

For a few exhilarating decades in the middle of the twentieth century, it seemed the world might have a reprieve from some major infectious diseases. After coordinated worldwide efforts had virtually eliminated smallpox and made major inroads against other infectious diseases such as influenza, tuberculosis, and polio, some public health officials thought we had entered a new era in which infectious diseases would no longer be among the planet's worst killers. By the 1980s, though, those hopes were dashed, due in large part to the burgeoning AIDS epidemic.

...More than a dozen major factors have been pegged over the past 10-15 years as existing or potential contributors to infectious disease outbreaks. Microbes continue to evolve rapidly, and human susceptibility to infection is increasing due to malnutrition, weakening of immune systems through cancer treatments or chronic diseases, and aging of the population in some countries. Extensive poverty and population growth have spawned impacts such as poor basic public health infrastructure in megacities. Wars result in dislocation of peoples, destruction of public health systems, malnutrition, and introduction of new microbes by soldiers returning home; bioterrorism raises the possibility of infectious agents being released upon the population at large. Changing medical technology allows exchanges of microbes through blood transfusions and organ and tissue transplants, some of which come from animals. Increased international travel and exchange of goods--including animals, plants, and foods that can carry pathogens--both spread diseases rapidly. Many nations have seen reduced funding for safe water and sewer systems, vaccines, research, surveillance, prevention, and response, due in part to complacency.

...many environmental factors are playing major roles, including climate change, deforestation, global dust transport, and numerous agricultural practices. The links between these factors and millions of potential human deaths have often been overlooked or discounted as pollution and other more obvious concerns have typically drawn the limelight.

***

...the deadly H5N1 virus is just one of a plethora of diseases threatening animals and people around the world as global warming, intensive farming, increased travel and trade help dangerous microbes breed and spread.

"Almost every year there is a new disease appearing, and 75 percent of these emerging or re-emerging diseases are coming from animals; 80 percent of those have zoonotic potential," he said in an interview. ...Le Gall said such zoonoses -- animal diseases that humans can also catch -- included Rift Valley fever, rabies and anthrax. ..."These could come together to create what the experts are calling 'the perfect microbial storm',"...

The science is clear: Most emerging diseases are potentially virulent, deadly, incurable - and man-made. Factory farming, increased travel and trade, changing weather patterns and global warming all play a role in breeding and spreading these new diseases.

But authorities want us to misunderstand the issue - to measure individual rights against society's rights - and ignore the fact that international corporate rights override both individual and society's rights, and threaten our lives. The "debate" is totally phony - a red herring.

Tuberculosis has been pandemic for a decade or more, and multi-drug resistant tuberculosis was identified as "the norm" before 2002, and classified as a "global pandemic more deadly than AIDS."

2002: ON MULTI-DRUG RESISTANT TUBERCULOSIS

1) ...Tuberculosis ranks among the most important burdens on human health, not because the total number of cases is especially large (approximately 9 million per year worldwide), but because approximately one-quarter of sufferers die, most of them young adults. Untreated or untreatable disease would kill more, approximately half of all cases. Globally, the number of tuberculosis cases is rising at 2 percent per year, and the fear is that the number of cases resistant to antibiotics may be increasing much faster.

2) The perceived threat of drug-resistant tuberculosis is enormous. The biggest menace is multi-drug-resistant tuberculosis, caused by strains resistant to at least isoniazid and rifampcin, the two principal first-time drugs used in combination chemotherapy. Health warnings have been issued in correspondingly strong language, not just in the popular press, but also in principal scientific and medical journals. Among various readings of the evidence, the spread of multi-drug-resistant tuberculosis has been classified as a global pandemic more deadly than AIDS, with the potential to destabilize society. Drug-resistant mycobacteria are said to be on the rampage, and multi-drug-resistant tuberculosis is thought to have become the norm. In the year 2000, an estimated 273,000 of 8.7 million new tuberculosis cases were multi-drug resistant, with the highest proportion of multi-drug resistant new cases in Estonia (14 percent); Henan Province, China (11 percent); Latvia (9 percent); and the Ivanovo and Tomsk provinces in Russia (9 percent and 7 percent, respectively). Resistance is very unevenly distributed around the world: an estimated 70 percent of new multi-drug-resistant tuberculosis cases occur in just 10 countries.

So multi-drug resistant TB is not a new crisis; it was classified as a global pandemic around when Bush became President of the USA; and the emergence of XDR-TB was predicted, with warnings ad infinitem.

Obviously, the goal is NOT to deal with the crisis effectively - if that were the real goal, action would have been taken years ago.

Clearly, the primary objective is population control.

And the corporate strategy is unusually transparent:

The XDR-TB epidemic in South Africa - and the recommendation for forced isolation - is being manipulated to polarize discussion, and to focus the "court of public opinion" on individuals' versus society's rights. The public "debate" will proceed in fear, under threat of a deadly pandemic brewing in South Africa.

Most people participating in the global dialogue will support society's rights over individual rights - and the stage will be set.

The question of corporate rights will not be addressed in the global debate. Authorities will not acknowledge the fact that the corporate right to profit effectively promotes creating deadly diseases, and pits corporate rights against individual and society's rights.

The important questions will not be asked. The real issues will not be addressed. The impacts of "corporate rights to profit" on public health will not be evaluated.

Once the court of public opinion weighs in against individual rights, and for society's rights, a global precedent will be firmly established. Without ever considering the real choice.

Numerous diseases are set to go pandemic, not just XDR-TB and H5N1 bird flu. It's not a question of if a pandemic will happen, but when.

And when the pandemic does hit, if a policy of forced isolation until death has been enforced in South Africa for XDR-TB, then the same policy will be the pandemic response-of-choice worldwide. Already decided in the court of public opinion, and supported globally.


As a matter of interest, US legislation allows forced isolation and quarantine under a broad range of circumstances - thanks to a series of laws and executive orders decreed by President Bush.

Mr. Bush's order added pandemic influenza to the government's list of communicable diseases for which a quarantine is authorized...

The quarantine list was amended in 2003 to include SARS, or severe acute respiratory syndrome, which killed nearly 800 people in 2003. Other diseases on the list are cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever and viral hemorrhagic fevers.

Jennifer Morcone, a spokeswoman for the health centers, said Mr. Bush's executive order was intended to prepare for all options.

But, you say, it's just good common sense: Quarantine is proven to stop the spread of disease.

In fact, quarantine never works if you don't clean the barn, as any farmer can tell you. In this case, the barn is the whole planet. Many new and deadly diseases are now airborne, not just XDR-TB and H5N1 bird flu - and they can be spread around the world by atmospheric winds. Never mind international travel and trade.

So how do you quarantine the wind?

Rather than isolating and quarantining select human victims, it would be far more effective to change the industrial practices that create new diseases, and the trade systems that spread them.

Yet instead of tackling the most significant factors and looking at prevention - authorities are focusing solely on person-to-person transmission, and planning forced human isolation and quarantines. Which a) won't work, and b) will curtail civil liberties. One needs to wonder why.

Since 9/11, Americans have been conditioned to give up their rights and civil liberties for the illusion of safety. New measures - like the Patriot Act and the President's emergency powers granted to deal with the "war on terrorism" - all infringe on American civil liberties. More to the point, all these new measures effectively supplant the Constitution and Bill of Rights. The President's recently acquired powers to impose forced isolation and quarantine are part of the same package.

All that's missing is public support for already-existent laws allowing forced isolation and quarantine. It's just a political thing - it's easy to manipulate public opinion, and orchestrate public support. Just watch.

The truth is, H5N1 bird flu did not emerge in China, and XDR-TB did not emerge in South Africa; both diseases were created elsewhere, and imported. Our techno-industrial world promotes mutation in microbes, forces their evolution - creates deadly, untreatable, incurable diseases - helps them breed, and spreads them around the world. That's the problem.

It may seem logical to lock up infected people, and write them off as "unfit for survival." But it's not a solution to the larger continuing problem. If we do not change our industrial and agricultural practices, new diseases will keep emerging - and creating new pandemics that we cannot cure or treat.

Soon, we will all face imprisonment in leper colony gulags - where people with untreatable, incurable, man-made diseases are left to die. And the only "persons" living free on planet Earth will be the corporate variety.

The only way to change the debate's predictable outcome, and protect the future of human society, is to re-frame the question. Honestly.

We are NOT facing a choice between either the rights of society or individual rights. We are choosing whether or not to respect the corporate right to profit over individual rights and the rights of society as a whole.






Suggested Reading:

Bird Flu - A Virus of Our Own Hatching

You have voted soficrow for the Way Above Top Secret award.



SofiCrow, You just in that post got a Way Above vote for that piece you wrote.

As a health care professional, drug resistant TB scares the living hell out of me, it really does. here in the UK it is on the rise, and as you state it is so hard to treat it is not funny.

Vancomycin (antibiotic) is virtualy our last line of defence, and yet, and yet it some times seems to struggle fighting this nasty little disease.

With mass world wide immigration, mass world wide travel to very exotic areas of the world, drug resistant TB is going to become a very, very real threat to the worlds continueing health.

Couple travel with our utter stupidity in putting antiobiotics into the food chain so profits can go up and up........ well, we are in deep deep trouble indeed, as antibiotics were never intended by nature to be in the bloody food chain!

Originally posted by D4rk Kn1ght
You have voted soficrow for the Way Above Top Secret award.

Thanks D4rk Kn1ght.

As a health care professional, drug resistant TB scares the living hell out of me, it really does. ...drug resistant TB is going to become a very, very real threat to the worlds continueing health.

Couple travel with our utter stupidity in putting antiobiotics into the food chain so profits can go up and up........ well, we are in deep deep trouble indeed, as antibiotics were never intended by nature to be in the bloody food chain!

Unfortunately, drug-resistant TB is not the only drug-resistant disease we're facing - not by a long shot. ...Most new diseases are untreatable and incurable - and getting more virulent.

And no - antibiotics were never intended by nature to be in the bloody food chain.

But stupid us - we put them there. Along with about 100,000 synthetic chemicals previously unknown on earth, which are capable of coming together to create an infinite number of brand-new never-seen-before chemical compounds that we are not genetically equipped to handle.

Here's a bit that talks about chemical pollutants' effects on people and animals - but not on microbes, which mutate, adapt and evolve far more quickly than complex life forms.

Over the last two decades, there has been increasing scientific concern and public debate regarding the adverse effects of chemical pollutants in the environment that can interfere with the normal functioning of the endocrine system in wildlife and in humans (the so-called endocrine-disrupting chemicals, EDCs). These concerns have been fueled primarily by reports of disrupted reproductive function and development in certain wildlife--mammals, birds, fish, amphibians, and mollusks--and by the increased incidence of certain diseases of the endocrine system in humans.

...Most laboratory studies on chemical effects have been conducted on single chemicals, but in the wild, animals are often exposed to complex mixtures that potentially have interactive effects.

We have created a world that we are not equipped to survive in.

Clever, huh?

It will be interesting to see what happens next.

Thanks for raising the TB issue Sofi...

Here's a thorough article on the TB epidemic:
XDR-TB in South Africa: No Time for Denial or Complacency PLoS Medicine

Sadly, I don't see them driving away business by holding corporations responsible over the rights of poor or sick people. Our crass consumerism goes hand in hand with these reckless corporate practices that spread disease and contaminate the Earth, where as those on top rarely suffer for these destructive actions and those on bottom have been programmed to accept our burdens and sins.

The world's 3 richest people have wealth greater than the combined Gross Domestic Product (the value of all goods and services) of the world's 48 poorest nations. The world's richest 225 people have combined assets equal to the combined annual income of the world's 2.5 billion poorest people. source

Africa is showing us all what is to come for our decadence and complacency, as climate change, war and poverty continues to march across the globe to the drums of mindless consumption and irresponsible predatory capitalism. We only have one planet and many have yet to know what Gaia theory even is.



[edit on 23-1-2007 by Regenmacher]

Thanks for contributing Regenmacher.

The Lancet said it well last March:

The history of tuberculosis is one of scientific, medical, and political failure. Although modern short-course treatment for tuberculosis is among the most effective and inexpensive of treatments for life-threatening diseases, tuberculosis remains one of the leading causes of morbidity and mortality worldwide.

Two CBC news articles neatly illustrate yours and the Lancet's charge. The first was published in September of 2006, the second came out today, January 23, 2007:

September 6, 2006: 'Virtually untreatable' tuberculosis found worldwide: WHO

Now, extensive drug-resistant TB or XDR-TB is emerging, in which the bacteria resist not only front-line drugs, but also three of the more than six classes of second-line drugs. While more potent, these medications have more serious side-effects, are more expensive and may need to be taken for as long as two years.

...A survey of 18,000 TB samples by the U.S. Centers for Disease Control and WHO between November 2004 and November 2005 found XDR-TB in all regions of the world, including the United States.

The XDR-TB strains were found most frequently in the former Soviet Union and Asia. Cases are also on the rise in Africa.

***

January 23, 2007: Adopt tough isolation for drug-resistant TB patients: ethicists

"We're not saying confine people and leave them there to rot and die. We're saying confine people but ensure that their needs are taken care of," said Singh, a lawyer and ethicist who also works at U of T.

"We're not speaking of dropping them off in some sort of colony akin to a leper colony."

But. The drugs are expensive, and might need to be taken for 2 years.

What happens to people who can't afford treatment?

What happens if the disease is untreatable and incurable? What happens when the money isn't there to "ensure that their needs are taken care of"?

Do we move right along to compassionate euthanasia?

The WHO reports that 'virtually untreatable' tuberculosis is found worldwide, including in the United States.

So what about victims in other countries?

Should victims of untreatable, incurable and contagious diseases be imprisoned in South Africa, but not in other nations? Should all such victims be imprisoned, or only the poor ones?

And what about people with other untreatable, incurable and contagious diseases? What should be done with those victims?

How long will it take for "humane confinement" to degenerate into leper colony gulags? How long will it take for isolation facilities to be overwhelmed? How many victims? How many nasty diseases? How many epidemics?


Or does Singh foresee an efficient assembly line: in through the front, stop for a needle, out through the back? No bottlenecks, no pesky congestion?

Finally:

What about prevention?

Who says we must accept industrial practices that create virulent and deadly diseases? Who determined that prevention is no longer an option?

Why do corporate rights to profit override individuals' and society's rights?

It's all about the money. But. Does it really have to be that way?


.

[edit on 23-1-2007 by soficrow]

Ignorance and complacency have led us to this point in time--where we are on the threshold of truely global pandemics. Denial and finger pointing will occur once pandemics start. Budgetary priorities will delay responses until the entire human race is facing the threat of self-extinction and then finally, mayby, hopefully we'll start to fight back. Let us pray that not so common sense will finally prevail and save at least some of the human race while they are still human.

Great post Sofi.

I thought that this was perhaps the most salient feature.

In fact, quarantine never works if you don't clean the barn, as any farmer can tell you.

We can't 'clean the barn' without a serious paradigm shift in the GP, combined with a sudden attack of conscience on the part of the elite.

I think one big hurdle, when it comes to businesses and governments, is the liability. Look at the issue with cancer. Nobody wants to admit the biggest factors contributing to the problem, so steps can be taken to remedy the situation, because an admission of guilt would almost certainly spark huge amounts of anger and a great lashing out on the part of the duped masses. The last thing anybody in power wants is to relinquish power to the mob because they told the truth.

The drug pushers and chemical cartels, the oil barons and plastics pimps - they are on top of the heap. They are happy in that position. They will not relinquish it without a fight. They certainly won't go so far as to implicate themselves in this mess, just to save a few million or a few billion peasants. We're just not that important to them.

Originally posted by soficrow
Why do corporate rights to profit override individuals' and society's rights?

It's all about the money. But. Does it really have to be that way?

Until we can revise that money alone doesn't mean power and control over the masses, I don't have an answer for you Sofi. It's been that way since the dawn of civilization, where people give up control to others for temporary gains. Everyone is bought off, everyone has a price and everyone preys on the weak...call it Darwinism or the law of the jungle.

The poor are considered expendable and exploitable to most industries, and many of us that are well off don't see these epidemics as a threat. When it actually does become too much of a problem to our leaders, their answer is war.

How do we change this haunts my mind too...



[edit on 24-1-2007 by Regenmacher]

Thanks astronomere, WyrdeOne, Regenmacher.


But what about the quarantine policy? The recommendation that infected people be locked up until they die?

...Can anyone comment directly on the idea of quarantine until death?

Anyone think that's a good way to go? A good policy?

How can they possibly quarantine say up to a quarter of the population?

If to be done under humane and decent conditions it will cost substantial resources. But as efficient run death camps would be another thing.

BTW whatever conditions, such confinements must be perfect breeding grounds for even more malicious vira, gene pool exchange and new mutations in the course of evolution.

Most troublesome, there's an Auschwitz déjà vu in these informations Sofi bring forward.

Keep it up! Expose it.

I don't know if we have to accept this? ...stay fit, and you're less likely to get it, is all I can come up with.

Don't let'm buy this idea in the Court of Public Opinion.

Originally posted by khunmoon

...such confinements must be perfect breeding grounds for even more malicious vira, gene pool exchange and new mutations in the course of evolution.

Absolutely! ...And a key argument against keeping infected victims together in the same place.

Most troublesome, there's an Auschwitz déjà vu in these informations Sofi bring forward.

Uh huh.

And like the man said, "They hanged the wrong guy."

...if the Constitution "protects people from infection and ensures the right to a safe environment" - then why aren't they going after the corporate industries that create and spread the disease, instead of planning to imprison the victims?

Don't let'm buy this idea in the Court of Public Opinion.

Unfortunately, quarantine and forced isolation seem like the right response. And South Africa seems comfortably far enough away and culturally different.

It's not though.

South Africa is actually the least affected of areas identified with XDR-TB, and has fewer cases than other countries.

This really is a trial balloon to see how a "quarantine til death" policy will fly.




PS. Thanks khunmoon.






[edit on 25-1-2007 by soficrow]

Originally posted by soficrow
...Can anyone comment directly on the idea of quarantine until death?

I would assume SA officials and medicos see those infected with XDR-TB as a threat to society, much like a murderer is a threat. Thus, they will be have to be confined until they no longer pose a danger to the healthy. If they don't, then they run the risk of decimating the entire continent or worse. Reminds me of a forest fire, containment is key or the whole forest goes poof.

Keeping in mind their limited resources, I don't see an alternative.




[edit on 25-1-2007 by Regenmacher]

First off, very well done Sofi. You got my way above vote.

As for the forced isolation / quarantine until death, I think it is something that needs to be looked at a bit harder. IF this becomes the case, that means no one will go to the Dr.'s anymore. If no one knows they have TB they cant quarantine them. So, to me, that forced isolation idea is more dangerous than nuclear war (from a human loss standpoint). That could totaly wipe out a very large population. All because people will be too scared to seek out medical help. They would hide thier illnesses so long that they would infect God knows how many people.

Originally posted by Regenmacher

Originally posted by soficrow
...Can anyone comment directly on the idea of quarantine until death?

I would assume SA officials and medicos see those infected with XDR-TB as a threat to society, much like a murderer is a threat. Thus, they will be have to be confined until they no longer pose a danger to the healthy. If they don't, then they run the risk of decimating the entire continent or worse.

South Africa is being pressured by the international community.

...quarantine won't work because a) the conditions that created the disease have not changed, b) it's still in the environment, c) not just in South Africa, and d) XDR-TB is only one of the many untreatable, incurable diseases now threatening the world.

So why focus on XDR-TB and single out South Africa?

...Unless it is a trial balloon for an entirely misconceived global infectious disease policy.


FYI the first steps towards introducing forced detainment in the USA have already been taken:

Manual outlines when to isolate sick passengers

Airline crews are responsible for spotting and reporting sick passengers who might spread a dangerous illness, the manual noted, but health officials should decide whether to call police to help subdue those unwilling to be isolated.

The U.S. Centers for Disease Control and Prevention has the authority to decide whether to isolate or quarantine travelers who may have an infectious disease and those they have come into contact with.

It ...can do so in the case of nine diseases -- cholera, diphtheria, communicable tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fever, severe acute respiratory syndrome or SARS, and avian influenza with pandemic potential.

Given that numerous emerging diseases are untreatable, not just XDR-TB:

Where should the lines be drawn?

Geographically? Economically?

And how do you get the microbes to respect artificial boundaries?

MrsDudara

First off, very well done Sofi. You got my way above vote.

As for the forced isolation / quarantine until death, I think it is something that needs to be looked at a bit harder. IF this becomes the case, that means no one will go to the Dr.'s anymore. If no one knows they have TB they cant quarantine them. ....They would hide thier illnesses so long that they would infect God knows how many people.

Thanks.

You raise several good points. Especially...

The old "Don't test, don't find" strategy.

For example, the USA already has XDR-TB - and over 50 million Americans have no health insurance, and don't go to doctors until they qualify for emergency treatment. So how many cases remain undiagnosed and unreported?

And at what point will the USA institute mandatory testing? Where? How? Using what criteria?





Also FYI - testing on animals does NOT occur until they are falling down sick, as with TB, Mad Cow and bird flu, even though it is well known that these diseases are carried and spread by asymptomatic hosts.

So if animals aren't tested unless they are visibly very sick, do you think the same criteria should apply to people?

...Of course the cavalier testing policies for animals are what created the plagues in the first place...










[edit on 26-1-2007 by soficrow]

Sofi, what a well researched and well-written article.
I agree with the ethical viewpoints that you have stated and that it is in the interest of pharmaceutical companies to keep people dependent on drugs and antibiotics. I also agree with the stance about our attitudes to sick people in LEDC's. However, what do you mean by man-made diseases? If you mean that MRSA'a and invasive E. coli and H5N1 strains of influenza have been man-made, I would disagree. There is a huge body of evidence that suggests natural selection of microrganisms to external constraints such as nutrient shortage or exposure to antibiotic. There is a natural mutation rate in bacteria or viruses which will always throw up "genetic variants" which are resistant. In fact some cancer cells in vivo treated with anti-cancer drugs that are increased stepwise during conventional treatment selects for resistant cancer cells; apparently by genetic amplification of the gene for resistance to the drug. I would think that selective pressures and man-made practices in treatment of disease and in animal husbandry are far more to blame than the work of evil individuals. Keep up the good work though. Very interesting and detailed research.

Originally posted by soficrow
...quarantine won't work because a) the conditions that created the disease have not changed, b) it's still in the environment, c) not just in South Africa, and d) XDR-TB is only one of the many untreatable, incurable diseases now threatening the world.

Well then they are SOL, and should prepare for only damage control. They are facing genocide, just like native Americans during the 1800's were literally wiped out by smallpox and other euro diseases. Plus the climate is going to give them a knockout punch.

The world's teetering on a global depression, so as far as money and aid goes that's drying up and Bono went home empty handed.


Up in Smoke, the African Apocalypse ATS


[edit on 26-1-2007 by Regenmacher]

Originally posted by Regenmacher

Originally posted by soficrow
...quarantine won't work because a) the conditions that created the disease have not changed, b) it's still in the environment, c) not just in South Africa, and d) XDR-TB is only one of the many untreatable, incurable diseases now threatening the world.

Well then they are SOL, and should prepare for only damage control. They are facing genocide, just like native Americans during the 1800's were literally wiped out by smallpox and other euro diseases. Plus the climate is going to give them a knockout punch.

It's not just South Africa...


From the CDC fact sheet on XDR-TB:

XDR-TB Fact Sheet

In the industrialized nations in this survey (including the United States), XDR TB increased from 3 percent of MDR TB cases in 2000 to 11 percent in 2004.

The emergence of XDR TB is cause for concern because it is widely distributed geographically, including in the United States, and renders patients virtually untreatable with available drugs.

If the incidence of XDR-TB increased from 3% to 11% in industrialized nations, including the USA, in the 4 years between 2000 and 2004 - we can assume it has risen much higher in the past 3 years.

So why focus exclusively on South Africa? Unless that is just the first step towards a global policy of forced quarantine and isolation for emerging infectious diseases?

Which leads to the question:

"Will human quarantine work for zoonotic diseases?"

Answer: No.

And TB is a zoonotic disease.

Tuberculosis: a re-emerging zoonosis?

Tuberculosis is an infectious disease that is found throughout the world and which can have a dramatic impact on the economy and on human and animal health. In humans, the principal cause of infection is Mycobacterium tuberculosis, but the animal-specific pathogen, M. bovis, is arguably the most important zoonotic agent in human history. Despite the fact that several countries have implemented control programmes for M. bovis infection in animals, which has resulted in a reduction in the number of human cases as well, recent years have witnessed a re-emergence of tuberculosis. This is due to the appearance of strains that are resistant to the main antibiotics used to treat the infection in humans, the spread of the human immunodeficiency virus, the maintenance of wild reservoirs and the persistence of the infection in livestock, particularly in developing regions. Coordinated efforts by human and animal health services, the improvement of diagnostic techniques and the development of more effective vaccines to prevent the infection are the main strategies for controlling this disease.

***

Bovine Tuberculosis (PDF)

...reservoirs in wildlife make complete eradication difficult.

Species affected

Cattle and buffalo are considered to be the maintenance hosts for M. bovis. Infections have also been described in numerous other domestic and wild animals including sheep, goats, horses, pigs, deer, antelope, dogs, cats, ferrets, camels, foxes, mink, badgers, rats, primates, llamas, kudus, elands, tapirs, elk, elephants, sitatungas, oryxes, addaxes, rhinoceroses, opossums, ground squirrels, otters, seals, hares, moles, raccoons, coyotes, lions, tigers, leopards, and lynx. Most of these species are considered to be spill–over hosts; however, some can act as wildlife reservoirs. Known reservoir hosts include brush–tailed opossums in New Zealand, badgers in the United Kingdom and Ireland, deer in the United States, bison in Canada, and greater kudu, common duiker, African buffalo, warthogs, and Kafue lechwe in Africa.

***

Zoonotic TB in Humans

TB caused by M. bovis is clinically indistinguishable from TB caused by M. tuberculosis.

***

Mycobacterium bovis is the causative agent of tuberculosis in animals used for production of food and accounts for a very small proportion of human cases of tuberculosis in Ireland. Infection with these organisms is chronic and the infected human host may remain entirely asymptomatic or may have mild to moderate illness that does not come to medical attention for long periods. In a proportion of human or animal hosts infected with these microorganisms the infection may ultimately progress to severe systemic illness. (PDF)

The agricultural lobby would have us believe that drug-resistant TB arose exclusively in humans, and that routine dosing of cattle with human antiobiotics did not and could not play a role in creating drug-resistant zoonoses like XDR-TB.

Bull puckey.

And human quarantine will NOT work to contain zoonotic diseases.



.

Originally posted by soficrow
So why focus exclusively on South Africa? Unless that is just the first step towards a global policy of forced quarantine and isolation for emerging infectious diseases?

The focus is on Africa because it is the most likely to be the first continent to be wiped out by disease and climate change. So I suspect they will be used for a draconian test bed by outsiders bearing gifts with strings attached..

Originally posted by Regenmacher

Originally posted by soficrow
So why focus exclusively on South Africa? Unless that is just the first step towards a global policy of forced quarantine and isolation for emerging infectious diseases?

The focus is on Africa because it is the most likely to be the first continent to be wiped out by disease and climate change. So I suspect they will be used for a draconian test bed by outsiders bearing gifts with strings attached..

Aaahhh.

And one of the strings here, for untreatable TB, will involve forced participation in drug trials, no doubt.

From Doctors Without Borders:

October 30, 2006. XDR-TB Emergency Will Require New Strategies and New Tools: Business As Usual Would Be Fatal

Relying on the standard World Health Organization (WHO) TB strategies in the face of extensively drug resistant tuberculosis (XDR TB) will be fatal, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) warned today. To respond to the XDR-TB outbreak, WHO will need to get newer drugs to patients as soon as possible by ensuring accelerated development of new drugs already in clinical trials. Existing TB drugs and diagnostics are not adequate to combat the disease, and a new analysis being released by MSF as the 37th Union World Conference on Lung Health begins this week in Paris shows that none of the TB drugs currently in development, however promising, will be able to drastically improve TB treatment in the near future. WHO must take the lead in ensuring there is major reprioritisation and increased funding of TB research.

With 450,000 new cases of drug resistant TB globally each year, resistance to drugs is a problem that is growing at a rapid pace. People with XDR-TB are resistant to both of the first-line antibiotics used to treat TB as well as to two classes of second-line drugs, making treatment with existing drugs virtually impossible. XDR-TB is particularly alarming in the context of HIV, as people who are co-infected with HIV/AIDS could die before test results can confirm their drug resistance. Using standard drugs to treat XDR-TB without knowing whether there is drug resistance could effectively condemn a patient to death. MSF doctors have been struggling to treat TB with the tools available today, a matter which is exacerbated by the HIV pandemic.

"Business as usual would be a disaster when it comes to treating XDR-TB," said Dr. Françoise Louis, MSF TB and HIV/AIDS advisor. "XDR-TB has the potential to be devastating in places where HIV/AIDS is widespread. But trying to treat XDR-TB with the tools we have today would be like trying to put out a forest fire with a garden hose."

***

Increasing Human Toll Taken by Tuberculosis

Every year, TB kills nearly two million people while an estimated nine million develop the disease. An additional 450,000 new cases of multidrug-resistant (MDR) TB are seen every year.

While many people in the West consider tuberculosis (TB) a disease of a bygone era, the devastating human toll taken by the disease is increasing worldwide, particularly in developing countries with high HIV prevalence. Every year, TB kills nearly 2 million people while an estimated 9 million develop the disease. An additional 450,000 new cases of multidrug-resistant (MDR) TB are seen every year. This frightening situation became even worse in 2006 when a survey among 544 TB patients in Kwazulu Natal, South Africa, found 10percent had developed XDR TB, a strain of TB that is resistant to both first-line antibiotics as well as to two classes of second-line drugs. Almost all of these patients died, and the extent of the outbreak remains unknown.

Even so, the drugs in today's standard TB treatment were developed in the 1950s and 1960s, while the most commonly used TB test — sputum microscopy — was developed in 1882 and only detects TB in half of the cases. Existing TB treatments and diagnostics are even less adapted for use in people living with HIV/AIDS, even though TB is their number one killer. The years of neglect are underscored by the fact that of the 1,556 new chemical entities marketed worldwide between 1975 and 2004, only 3 were for TB. Even though some initiatives are underway, efforts need to be significantly increased in order to respond to the disastrous impact of TB. None of the drugs currently in development, however promising, will be able to drastically improve TB treatment in the near future. "That TB destroys millions of lives around the world every year shows that the current approach is just not working," said Dr. Tido von Schoen-Angerer, Director of MSF's Campaign for the Access to Essential Medicines. "The tools we have to treat and diagnose TB are woefully inadequate and outdated, and we're not seeing the necessary urgency to tackle the disease."

Soficrow, How brilliant - thanks for that article, very informative.

Governments know that XDR-TB poses a serious health threat, but even where there is universal health care in place, they will not be using the system effectively.

Here is Canada TB rates and resistant TB rates are highest in the poorest areas and on the reserves, however in many provinces - charges for TB scratch tests and results are no longer covered. Poor people don't have the nearly 100 dollars it takes to cover the cost of the test. For heaven's sake, they're giving away free viagra.