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Runaway Bridegroom: XDR-TB Comes (Back) to America

If it wasn't so tragic for everyone involved, the unfolding saga of runaway bridegroom Andrew Speaker would make a screenplay starring the late Peter Sellers. I try to avoid blogging about the more sensational health news stories, but I wrote XDR TB: Extremely Drug Resistant, Extremely Scary back in March of this year. I feel a surreal detachment about emerging diseases - are the microorganisms going be our undoing? In the case of Mr. Speaker, there are more questions than answers. While I do regret that any patient's anonymity has been so completely compromised, at this point I join the fray in examining the troubling questions posed by his case, in the hopes that public interests will be better protected in the future.

  • The big question is - how does an otherwise healthy young man from Atlanta Georgia get a tennis ball sized XDR-TB in his chest in the first place? We have MDR-TB in the US, and have had only 49 cases of XDR-TB cases since 1993.
    • He was first diagnosed with TB in January, 2007 after a chest X-ray to rule out a rib fracture following a fall
    • Tuberculosis is a Notifiable Disease/Condition in the State of Georgia. That means once the diagnosis was made by Mr. Speaker's health providers, authorities at the Georgia Division of Public Health would have been notified in January. Tuberculosis is a disease that must be reported IMMEDIATELY (others can be reported within 7 days, one month or 4-6 months).
    • Reportable diseases are then reported to the national CDC on a voluntary basis.
  • Mr. Speaker's father-in-law, Robert Cooksey, has worked at the Centers of Disease Control (CDC) for 32 years as a research microbiologist in the Division of Tuberculosis (TB) Elimination. Coincidence? Dr. Cooksey released this statement, "...I do not have, nor have I ever had, TB. My son-in-law's TB did not originate from myself or the CDC's labs, which operate under the highest levels of biosecurity." OoooK...
  • May 10, 2007: Mr. Speaker met with "local health officials" before planning his honeymoon to Greece. I'm sorry, maybe it's just me, but anytime you have to meet with local health officials before you do anything, maybe you need to just make other plans? An "official" said "Of course, I prefer you not travel." Mr. Speaker's father was present at this meeting and tape recorded it. Wow.
    • This is way beyond any wedding plans I, or any of my friends ever made. I never had my dad come and tape record meetings with anyone for anything. I'm really getting confused. Someone help me out here. Just because you own a tape recording in which health officials say you are not contagious does not exonerate you. The fact that you feel you need to tape a conversation about your health status before you engage in an activity where you will be coming into contact with many other people might tip you off that you just want to stay home.
    • Steven Katkowsky, MD, Director of Fulton County Department of Health and Wellness, said Mr. Speaker was told his traveling would be against medical advice. Dr. Katkowsky was NOT informed that the meeting was being tape-recorded by the elder Mr. Speaker. The beleaguered Dr. Katkowsky states there is a legal Catch-22 about restricting TB patients against their will. "A patient has to be non-compliant before you can intervene..."
    • Fulton County Department of Health officials notified the Georgia Division of Public Health who in turn notified the CDC.
  • May 12, 2007 Mr. Speaker flew from Atlanta, Georgia, USA to Paris, France
  • May 14, 2007 Mr. Speaker flew from Paris to Athens, Greece
  • May 16, 2007 Mr. Speaker flew from Athens, Greece to Thira Island, Greece. He claims to have gotten married there, but the Mayor of Santorini, Angelos Roussos, disputes this, stating the necessary paperwork for a civil ceremony was never obtained. Mr. Speaker did not contact the municipality prior to making his travel plans to get his paper work in order for his wedding...(hmmm...does he have issues with authority or something?)
  • May 17, 2007: Georgia State Public Health officials learned Mr. Speaker had flown overseas.
  • May 18, 2007: CDC learned Mr. Speaker was in Europe
  • May 21, 2007 Mr. Speaker flew from Mykonos, Island to Athens, Greece then onto Rome, Italy
ANYONE WHO TRAVELED ON THESE FLIGHTS CALL 1-800 CDC INFO. The link for the actual flight details is on the CDC Website.
  • At some point, a representative of the CDC in Rome called Mr. Speaker in Rome and told him he could not fly back to the US unless he chartered a plane ($100,000) and that he should check into a local hospital in Italy. He was told he would be placed on a no-fly list to restrict his movement. His parents say they "are not rich" and could not afford to charter a plane. Hmmm? Not rich? A month-long honeymoon in Europe...the dollar is so weak against the euro right now, my friends & I can't even consider a summer trip to "the continent".
  • May 22, 2007: CDC determined Mr. Speaker has XDR-TB, or XDBTB (extensively drug-resistant strain)
    • Question? How long does it take to test a sample of sputum to determine the strain of TB? I really do not know the answer and I am hoping some of our microbiologist readers can help us out.
    • Question? When did Georgia Public Health officials notify CDC that Mr. Speaker had TB? ( was it May, January or some time in between?)
    • Question? When did they begin testing the sample?
    • The CDC notified Homeland Security through the regional office of Customs and Border Patrol (CBP) in Atlanta vs. the Washington headquarters.
    • The CDC did not immediately inform Italian health officials, but waited for them to insist on the information.
  • May 24, 2007 Mr. Speaker flew from Rome, Italy to Prague, Czech Republic. He deliberately changed his departure date and destination to elude authorities, slipping into the US via rental car. Mr. Speaker told Diane Sawyer in a TV interview that he was afraid of getting stuck in Italy so he made a decision to fly back to North America.
    • The World Health Organization (WHO) and Italian Health authorities were notified that an XDR-TB infected US citizen had been at large in Europe.
    • CDC & CBP alerted the Transportation Security Administration and DHS to place Mr. Speaker on a no-fly list.
      • DHS wants to know why the alert was shared with field offices only
        • they want to know why CDC did not notify DHS's National Operations Center so that agencies from the TSA to the Coast Guard to state partners could be alerted.
    • Both the CDC and FBI resisted divulging Mr. Speaker's name and targeting an individual for public health reasons.
  • May 25, 2007: The Greek Health Ministry was notified that an XDR-TB infected US citizen had been at large in their country
  • An alert had been attached to his passport to warn customs agents to detain Mr. Speaker but the border guard waved him through. The warning was pretty explicit: "Hold traveler...don a protective health authorities....".
  • May 25, 2007 Mr. Speaker was ordered into quarantine in Atlanta, GA by health officials. This is the first federal isolation order in 34 years.
  • June 1, 2007 Mr. Speaker was flown to Denver from Atlanta under watch of federal marshals for specialized treatment.
  • June 2, 2007, the New York Times reported that "...opportunities to head international public health emergency were lost because of restrictive regulations, poor communication and questionable judgment..."
  • June 4, 2007: Homeland Security officials briefed Congress on how Mr. Speaker was able to elude CDC, border, transportation security and counterterrorism agencies despite the fact that they knew his name, passport number and whereabouts.
  • So now Dr. Cooksey is being investigated, the border guard is being investigated, how many other lives will be hurt in the fall-out? What about the maids, the porters in the hotels, restaurants where the honeymooners stayed? We have another international public relations disaster with another US public agency so everyone will hate us even more than they already do.
  • Per the CDC, this is the first investigation of a case of XDR-TB during air travel. The CDC urges all passengers on these flights to receive evaluation, testing, and follow-up. Your health provider can use this XDR-TB Investigation Form and contact your state TB officials.
My own personal tips for airline travel:
  1. Always travel with a large headscarf (yes, even guys) and don't be embarrassed to wrap it around your ears, over your mouth and nose.
  2. Take a mask and if someone near you is coughing or sneezing, put it on.
  3. Take some hand wipes and use them every time you touch anything public, especially the bathroom.
  4. Stay hydrated with bottled, non-alcoholic beverages.
  5. Walk around and stretch out frequently to prevent deep vein thrombosis.
Finally, use common sense, concern for others and compassion when making plans. If you have an illness that is contagious and may infect others, just stay home. One sneeze can infect anyone five rows in front of you and two rows back on an airplane.

Thank you, purevizhun for use of runaway_groom.
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