Pandemic TB

We have been talking about the untreatable super bacteria in India (link) and about the problem with super-tuberculosis problem in general (link 2). Now it is making the front page of the Wall Street Journal. If this were a typical pandemic-apocalypse novel, we would probably be at the point in the first chapter where they say something like "It was first reported in X."

India in Race to Contain Untreatable Tuberculosis
Geeta Annand, Wall Street Journal, 19 June 2012

In December, Dr. Udwadia reported in a medical journal that he had four tuberculosis patients resistant to all treatment. By January, he had a dozen cases, then 15.

A government backlash began immediately. Anonymous health-ministry officials denied the reports through media outlets. They accused Dr. Udwadia and his colleagues of starting a panic. A Mumbai city health official seized patient samples for verification in government labs.

Ashok Kumar, head of India's tuberculosis-control program, said the government was "seriously addressing" the widening drug-resistance problem. However, he refuted Dr. Udwadia's description of a "totally drug-resistant" TB strain—not because there is a treatment, but because the term isn't internationally recognized and a new cure could be discovered.

Tuberculosis has long been a global killer. Traces were found in the skeletons of Egyptian mummies. There are records of the disease from Hippocrates, the Indian Rig Veda and ancient Chinese texts. At the start of the 19th century, tuberculosis was the main cause of death in most of Europe.

India has the largest number of the world's cases—2.3 million of the nearly nine million people afflicted annually—and it is the country's most fatal infectious illness. Government authorities estimated about 100,000 of India's patients have drug-resistant strains, which researchers say can mutate into forms increasingly immune to more and more medicines.

Camilla Rodrigues, lab chief at Hinduja Hospital where most of India's cases have been found, said the strain's total drug resistance was indeed difficult to confirm in a lab. But, she said, it was easily confirmed in clinical practice: Four of 15 patients, whose lab tests showed the strain, have died, despite aggressive treatment. The hospital has since stopped publicly reporting its cases.

India's TB program for years focused on treating regular strains. Patients who didn't improve received the same treatment for longer but with one more antibiotic. The regimen had virtually no chance of defeating resistant strains, experts said.

"It serves merely to amplify resistance over a further eight months, allowing drug-resistant TB to spread,"

India is a destination point for low cost medical services.  It is a major source of foreign capital for the country.  The dollars act as a further incentive to the usual defensiveness of organizations having problems with their status quo working models.

The article notes that there is equipment that can be bought to test patients for drug-resistant TB - tests that take only hours versus months to get results, but at $70,000 a piece, the cost of the machines is prohibitive from the cold-eyed comparison of outputs of a typical Indian's per person share of national output (per capita GNP) of $1,389 (ranking 140 out of 183 countries listed, versus US at $48,387, ranked number 14).

Although the bird flue is the popular media choice for our next global pandemic, Cholera has been with us a long time, and has been there before.  As an airborne disease it has the potential to travel quickly.  If untreatable, it has the potential to become deadly on a grand scale.

What of course people are waiting to see is if the resistant cholera hits that hockey stick curve in the charts.  The hockey stick curve that all exponential trends eventually display if given enough time and resources to run.  To finish our quotes from the article.

Dr. Udwadia said he was worried they [the expensive equipment] would come too late: "We're chasing the snowball down the hill."