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The CDC, TB, and Andrew Speaker: The Plot Thickens
By Elizabeth M. Whelan, Sc.D., M.P.H.
There is more information coming in about attorney Andrew Speaker's case of tuberculosis, his decision to take international flights to and from his European wedding and honeymoon -- and exactly who knew what when. While there is still palpable contempt for Mr. Speaker's allegedly acting selfishly, putting the health of others at risk to get himself to a Denver hospital, there is a very strong possibility that the real culprit in this saga is not Mr. Speaker but the Centers for Disease Control. At the very least, CDC and local health officials are looking very bad indeed.
The Fulton County, GA health officials maintain that they told Andrew well before his planned trip to Greece that he was infectious and should not fly. But in an interview today on Good Morning America, Andrew's father, Ted Speaker, who attended a meeting with health officials before the wedding trip, said he was told "at least three times" that Andrew's TB was not contagious. CDC tuberculosis specialist Dr. Robert Cooksey, ironically the patient's new father-in-law, also attended the meeting with health officials, and he noted, "We were told that...sputum tests...were negative... and so, by the guidelines, he was not considered infectious."
Thus the two sets of parents and the bride and the groom (all highly intelligent, educated people) went off to Greece not worrying about Andrew's condition being infectious.
After the family met with the Fulton County Health Department -- and after the party left for Europe -- the Health Department apparently penned a letter instructing Andrew not to fly and put the letter in the U.S. mail. It was never received because the wedding group was already in Greece. One would think that if they did want the patient to receive an official written communication, they would have contacted his or his father's office to arrange to have the letter delivered in an expeditious manner.
It was only when the couple was in Rome that Andrew learned that his tuberculosis was highly drug-resistant. At that point, CDC ordered him not to take a commercial airline home. But CDC did absolutely nothing to assist him and his new wife in getting back to the United States other than, unhelpfully, suggesting they hire commercial aircraft at a cost of $100,000.
Nor did the CDC offer any new evidence that Andrew's TB had suddenly become contagious. Those who are highly critical of Andrew Speaker for being "selfish" might ask themselves: would you want to turn yourself over to Italian authorities and be quarantined indefinitely in a hospital of unknown quality? Or would you take matters in your own hands -- having never been given information that you were suddenly infectious -- and secure a flight home any way you could? What would a specialist in the field of tuberculosis do in such an instance? We have an answer here: Dr. Cooksey stated that given the same set of circumstances, he would likely take the same action that Andrew did to get home in an effort to get the medical attention he needed.
So it is beginning to look like it is the CDC and local health officials that slipped up, more than once, by failing to communicate their concerns about Andrew being infectious, failing to deliver their letter in a timely fashion, and giving Andrew and his wife no help whatsoever in returning to the United States. The interview on ABC this morning left one with the firm impression that these families were highly responsible, acted in a way most any of us would in that circumstance, and simply do not deserve the national wrath that is being directed toward them.
The incident also raises the question of whether CDC was not doing some grandstanding here, invoking the first federal quarantine order in over forty years (such a legal move requires the signature of the President of the United States). Was this not a case of using a cannon to kill a fly? Interestingly, the much-touted quarantine was quietly lifted over the weekend (yet I did not see any major publicity about that).
Mr. Speaker remains confined to a Denver hospital now under an isolation order from the state of Colorado. Given the repeated assertions of the "experts" at the CDC that he was non-infectious even before treatment, I wonder if this confinement is merely the continuation of the overkill approach that various public health officials have taken since this incident became public.
I said it before, and I'll say it again: Free Andrew. It's time for the honeymoon to continue.
Dr. Elizabeth M. Whelan is president of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com). See also: Whelan's New York Post piece, "Free Andrew!"
Lance Kaczorowski, BS Mechanical Engineeirng (June 5, 2007)
I agree wholeheartedly with Dr. Whelen's entire article above, only I am hesitant to accept the last statement, “Free Andrew.” I am missing relevant information: What are the odds that Speaker will become contagious unknowingly at some future time (giving Speaker the full benefit of the doubt that he would seek quarantine promptly if he knew he had become contagious), what are the odds of his infecting others at that time before he could be quarantined, and what would be the severity of the consequences if he infected others? Is the total risk reasonable? Perhaps it is, but what is the logical basis for asserting that it is a reasonable risk? I would feel perfectly at ease to have Andrew Speaker over to my house for dinner tonight, but I wouldn’t want to live in the same house with him. Knowing that he is not contagious right today does not equate to knowing that he will not be contagious tomorrow. The mishandling of Speaker’s case up to this point, by itself, does not answer the question, “What should be done now?” I agree that Andrew Speaker should not be denied freedom without just cause. Certainly no one should be denied their freedom only to suit another’s need for public posturing. How does the potential health risk Andrew Speaker poses to others stack up against other potential and present health risks the general public accepts with little concern? Is this situation comparable to being afraid to fly even though the odds are higher that one would die in a fatal car crash when covering the same distance?
(July 1, 2008)
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