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Science, Culture, & Humanities / Epidemics: Bird Flu, TB, AIDs, Superbugs, Ebola, etc
« on: January 23, 2007, 05:08:35 AM »
The dilemma of a deadly disease: patients may be forcibly detained
Doctors fear TB strain could cause a global pandemic if it is not controlled
Chris McGreal in Johannesburg and Sarah Boseley, health editor
Tuesday January 23, 2007
Guardian
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.
More than 300 cases of the highly infectious disease, which is spread by
airborne droplets and kills 98% of those infected within about two weeks,
have been identified in South Africa.
But doctors believe there have been hundreds, possibly thousands, more and
the numbers are growing among the millions of people with HIV, who are
particularly vulnerable to the disease. Their fear is that patients with
XDR-TB, told that there is little that can be done for them, will leave the
isolation wards and go home to die. But while they are still walking around
they risk spreading the infection.
Now a group of doctors has warned in a medical journal that if enforced
isolation is not introduced XDR-TB could swamp South Africa and spread far
beyond its borders. Regular TB is already the single largest killer of
people with Aids in South Africa.
Pandemic
Jerome Amir Singh of the Centre for Aids Programme of Research in South
Africa and two colleagues wrote in the peer-reviewed journal Public Library
of Science Medicine that the government must overcome its understandable
qualms over human rights in the interests of the majority. Without
exceptional control measures, including enforced isolation, XDR-TB "could
become a lethal global pandemic", they say.
"The containment of infectious patients with XDR-TB may arguably take
precedence over any other patients not infected with highly infectious and
deadly airborne diseases, including those with full-blown Aids. This is an
issue requiring urgent attention from the global community," they wrote.
"The South African government's initial lethargic response to the crisis and
uncertainty amongst South African health professionals concerning the
ethical, social and human rights implications of effectively tackling this
outbreak highlight the urgent need to address these issues lest doubt and
inaction spawn a full-blown XDR-TB epidemic in South Africa and beyond."
Mary Edginton of the Witwatersrand university's medical school endorses
enforced quarantining.
"You can look at it from two points of view. From the patient's point of
view, you are expected to stay in some awful place, you can't work and you
can't see your family. You will probably die there. From the community's
point of view such a person is infectious. If they go to the shops or wander
around their friends they can spread it, potentially to a large group of
people," she said.
Karin Weyer of the Medical Research Council has called for enforced
hospitalisation of high-risk TB patients on the grounds that the risks to
society outweigh individual rights. But she opposes forcible treatment
because of the dangers associated with the drugs.
Professor Edginton said that medical authorities in the US and other
countries can obtain a court order to detain a person with infectious TB or
someone who is non-infectious but has failed to adhere to treatment. "The
Americans are much better at enforcing their laws on this," she said.
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.
South Africa's health department yesterday said it has discussed the
possibility of enforced isolation with the country's Medical Research
Council and the World Health Organisation but has not reached a conclusion.
Poor housing
Ronnie Green-Thompson, a special adviser to the health department, said the
issue at stake is the human rights of the individual weighed against the
rights of the wider public. "The issue of holding the patient against their
will is not ideal but may have to be considered in the interest of the
public. Legal opinion and comment as well as sourcing the opinion of human
rights groups is important," he said.
"Also of importance is preventing those factors that lead to infectious TB
and these are poverty, poor housing, overcrowding and poor nutrition and any
other factors that weakens patients' resistance to acquiring infections."
Umesh Lalloo, of Durban's Nelson Mandela School of Medicine and head of the
research team into the first XDR-TB outbreak, said he is not persuaded that
detention is necessary.
"It's a very difficult call. Given our recent past with human rights
violations we need to be careful. I'm not dismissing such a move but it's a
very radical step. What we should be pushing for is a reinforcement of the
TB control programme which would contain the spread," he said. Professor
Lalloo said one consideration is that almost all infections appear to have
spread to patients in hospital.
The doctors and co-authors said that it is essential that patients were
detained in "humane and decent living conditions" and they urged the
government to change the rules so that those in hospital with TB continue to
receive welfare payments which are cut off if they are treated at the
state's expense.
Although cases of XDR-TB were discovered in South Africa a decade ago, the
disease started claiming dozens of lives at the small Tugela Ferry hospital
in rural KwaZulu-Natal two years ago. XDR-TB's origins are uncertain but the
WHO says the misuse of anti-tuberculosis drugs is the most likely cause.
Guardian Unlimited © Guardian News and Media Limited 2007
Doctors fear TB strain could cause a global pandemic if it is not controlled
Chris McGreal in Johannesburg and Sarah Boseley, health editor
Tuesday January 23, 2007
Guardian
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.
More than 300 cases of the highly infectious disease, which is spread by
airborne droplets and kills 98% of those infected within about two weeks,
have been identified in South Africa.
But doctors believe there have been hundreds, possibly thousands, more and
the numbers are growing among the millions of people with HIV, who are
particularly vulnerable to the disease. Their fear is that patients with
XDR-TB, told that there is little that can be done for them, will leave the
isolation wards and go home to die. But while they are still walking around
they risk spreading the infection.
Now a group of doctors has warned in a medical journal that if enforced
isolation is not introduced XDR-TB could swamp South Africa and spread far
beyond its borders. Regular TB is already the single largest killer of
people with Aids in South Africa.
Pandemic
Jerome Amir Singh of the Centre for Aids Programme of Research in South
Africa and two colleagues wrote in the peer-reviewed journal Public Library
of Science Medicine that the government must overcome its understandable
qualms over human rights in the interests of the majority. Without
exceptional control measures, including enforced isolation, XDR-TB "could
become a lethal global pandemic", they say.
"The containment of infectious patients with XDR-TB may arguably take
precedence over any other patients not infected with highly infectious and
deadly airborne diseases, including those with full-blown Aids. This is an
issue requiring urgent attention from the global community," they wrote.
"The South African government's initial lethargic response to the crisis and
uncertainty amongst South African health professionals concerning the
ethical, social and human rights implications of effectively tackling this
outbreak highlight the urgent need to address these issues lest doubt and
inaction spawn a full-blown XDR-TB epidemic in South Africa and beyond."
Mary Edginton of the Witwatersrand university's medical school endorses
enforced quarantining.
"You can look at it from two points of view. From the patient's point of
view, you are expected to stay in some awful place, you can't work and you
can't see your family. You will probably die there. From the community's
point of view such a person is infectious. If they go to the shops or wander
around their friends they can spread it, potentially to a large group of
people," she said.
Karin Weyer of the Medical Research Council has called for enforced
hospitalisation of high-risk TB patients on the grounds that the risks to
society outweigh individual rights. But she opposes forcible treatment
because of the dangers associated with the drugs.
Professor Edginton said that medical authorities in the US and other
countries can obtain a court order to detain a person with infectious TB or
someone who is non-infectious but has failed to adhere to treatment. "The
Americans are much better at enforcing their laws on this," she said.
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.
South Africa's health department yesterday said it has discussed the
possibility of enforced isolation with the country's Medical Research
Council and the World Health Organisation but has not reached a conclusion.
Poor housing
Ronnie Green-Thompson, a special adviser to the health department, said the
issue at stake is the human rights of the individual weighed against the
rights of the wider public. "The issue of holding the patient against their
will is not ideal but may have to be considered in the interest of the
public. Legal opinion and comment as well as sourcing the opinion of human
rights groups is important," he said.
"Also of importance is preventing those factors that lead to infectious TB
and these are poverty, poor housing, overcrowding and poor nutrition and any
other factors that weakens patients' resistance to acquiring infections."
Umesh Lalloo, of Durban's Nelson Mandela School of Medicine and head of the
research team into the first XDR-TB outbreak, said he is not persuaded that
detention is necessary.
"It's a very difficult call. Given our recent past with human rights
violations we need to be careful. I'm not dismissing such a move but it's a
very radical step. What we should be pushing for is a reinforcement of the
TB control programme which would contain the spread," he said. Professor
Lalloo said one consideration is that almost all infections appear to have
spread to patients in hospital.
The doctors and co-authors said that it is essential that patients were
detained in "humane and decent living conditions" and they urged the
government to change the rules so that those in hospital with TB continue to
receive welfare payments which are cut off if they are treated at the
state's expense.
Although cases of XDR-TB were discovered in South Africa a decade ago, the
disease started claiming dozens of lives at the small Tugela Ferry hospital
in rural KwaZulu-Natal two years ago. XDR-TB's origins are uncertain but the
WHO says the misuse of anti-tuberculosis drugs is the most likely cause.
Guardian Unlimited © Guardian News and Media Limited 2007