Sunday, January 28, 2007

The War Within Us(NYT)

January 28, 2007

Virulent TB in South Africa May Imperil Millions

JOHANNESBURG, Jan. 27 — More than a year after a virulent strain of tuberculosis killed 52 of 53 infected patients in a rural South African hospital, experts here and abroad say the disease has most likely spread to neighboring countries, and some say urgent action is essential to halt its advance.

Several expressed concern at what they called South Africa’s sluggish response to a health emergency that, left unchecked, could prove hugely expensive to contain and could threaten millions across sub-Saharan Africa.

The director of the government’s tuberculosis programs called those concerns unfounded and said officials were doing everything reasonable to combat the outbreak.

The form of TB, known as XDR for extensively drug-resistant, cannot be effectively treated with most first- and second-line tuberculosis drugs, and some doctors consider it incurable.

Since it was first detected last year in KwaZulu-Natal Province, bordering the Indian Ocean, additional cases have been found at 39 hospitals in South Africa’s other eight provinces. In interviews on Friday, several epidemiologists and TB experts said the disease had probably moved into Lesotho, Swaziland and Mozambique — countries that share borders and migrant work forces with South Africa — and perhaps to Zimbabwe, which sends hundreds of thousands of destitute refugees to and from South Africa each year.

But no one can say with certainty, because none of those countries have the laboratories and clinical experts necessary to diagnose and track the disease. Ominously, none have the money and skills that would be needed to contain it should it begin to spread.

Even in South Africa, where nearly 330 cases have been officially documented, evidence of the disease’s spread is mostly anecdotal, and epidemiological work needed to trace its progress is only now beginning.

“We don’t understand the extent of it, and whether it’s more widespread than anyone thinks,” Mario C. Raviglione, the director of the Stop TB Department of the World Health Organization in Geneva, said in a telephone interview. “And if we don’t know what has caused it, then we don’t know how to stop it.”

Cases of XDR TB exist elsewhere, in countries like Russia and China where inadequate treatment programs have allowed drug-resistant strains of the disease to emerge. The South African outbreak is considered far more alarming than those elsewhere, however, because it is not only far larger, but has surfaced at the center of the world’s H.I.V. pandemic.

Although one third of the world’s people, by W.H.O. estimates, are infected with dormant tuberculosis germs, the disease thrives when immune systems are weakened by H.I.V. At least two in three South African TB sufferers are H.I.V. positive. Should XDR TB gain a foothold in the H.I.V.-positive population, it could wreak havoc not only among the five million South Africans who carry the virus, but the tens of millions more throughout sub-Saharan Africa.

People without H.I.V. have a far smaller chance of contracting tuberculosis, even if they are infected with the bacillus that causes TB. But because tuberculosis is spread through the air, anyone in close contact with an active TB sufferer is at some risk of falling ill.

Most if not all of the 52 people who died in the initial outbreak of XDR TB, at the Church of Scotland Hospital in a KwaZulu-Natal hamlet called Tugela Ferry in 2005 and early 2006, had AIDS. Most died within weeks of being tested for drug-resistant tuberculosis, a mortality rate scientists called unprecedented.

Since then, South African health officials say, they have confirmed a total of 328 cases of XDR TB, all but 43 in KwaZulu-Natal. Slightly more than half the patients have died.

Those numbers are deceptive, however. The Tugela Ferry outbreak was reported in part because the hospital there was part of a Yale University research project involving H.I.V.-positive patients with tuberculosis. Because South Africa’s treatment and reporting programs for tuberculosis are notoriously poor — barely half of TB patients are cured — virtually all experts contend the true rate of infection is greater.

“We’re really concerned that there may be similar outbreaks to the one in Tugela Ferry that are currently going undetected because the patients die very quickly,” said Dr. Karin Weyer, who directs tuberculosis programs for South Africa’s Medical Research Council, a semiofficial research arm of the government.

Some other researchers and experts say they share Dr. Weyer’s concern. They say South African health officials have lagged badly in assembling the epidemiological studies, treatment programs and skilled clinicians needed to combat the outbreak, and say the government has responded slowly to international offers of help.

Dr. Weyer said the council “shares the concern that not enough is being done, quickly enough, to get on top of the problem.” In particular, she said, officials have yet to carry out epidemiological studies or address a “shocking” lack of infection controls in hospitals that could allow TB and other infections to spread freely among H.I.V.-positive patients

“It’s an emergency, and we’re not reacting as if it were an emergency,” said Dr. Nesri Padayatchi, an epidemiologist and expert on drug-resistant TB for Caprisa, a Durban-based consortium of South African and American AIDS researchers. “I think we have the financial resources to address the issue, and we’ve been told the Department of Health has allocated these resources.”

Although the government was first told of the outbreak 20 months ago, in May 2005, “to date, on the ground in clinics and hospitals, we are not seeing the effect,” she said.

In KwaZulu-Natal’s major city, Durban, the sole hospital capable of treating XDR TB patients has a waiting list of 70 such cases, she said.

Dr. Weyer said the waiting list indicates that “capacity is becoming a problem” in KwaZulu-Natal, the outbreak’s center. “I’m quite sure we may find a similar situation in other provinces,” she added.

A spokesman at the hospital said it could not easily determine how many patients were awaiting treatment.

But the manager of South Africa’s national tuberculosis program, Dr. Lindiwe Mvusi, said such complaints were misplaced. The Durban hospital in question, she said, is under renovation, and officials are “looking for accommodations in other hospitals” while construction proceeds.

Hospitals in other provinces have enough beds now for XDR TB patients, and some are expanding isolation wards to handle any spread of the disease, she said.

She said other responses to the outbreak were under way, including a rough assessment of TB cases in hospitals nationwide. A more comprehensive national survey of TB cases may be conducted late this year, she added, and health officials in KwaZulu-Natal have begun surveillance programs to detect new cases of drug-resistant TB in the province.

Dr. Mvusi also rejected the notion that the tuberculosis had moved beyond South Africa’s borders. But in interviews, a number of TB experts and epidemiologists raised that concern, including Mr. Raviglione at the world health organization, Dr. Padayatchi, Dr. Weyer and Dr. Gerald Friedland, director of the AIDS program at the Yale University School of Medicine.

Dr. Raviglione of W.H.O. said that South African health officials were cooperating on responses to the outbreak, and that an official of his organization would arrive in Pretoria within days to discuss placing a team of global TB experts in the country.

“W.H.O. is ready to come to South Africa and to help in any place, for anything, whether surveillance, or detection, or infection control,” he said. However, those arrangements have not been completed.

Dr. Mvusi, the government’s TB program head, said global health experts were welcome, but “in an advisory role, because we want the capacity locally.”


While we fight amongst each other, there are forces that would eliminate us from the inside, any number of diseases could do us in, some are incurable like this one.

This is where our focus should be.


Saladin said...

Good morning DEN! Today we are having our first snow here at 5000 ft! And boy did we need it. Almost 3 inches so far. WOO HOO!

Check out these photos, this is what the lunatic Israeli and US neocons are ready to nuke into the stoneage. Make sure the sound is on.

Peace Train Images of Tehran you will NEVER see on TV.

DEN said...

Sal, we a real dry up here too, no rain since Dec.

Cat Stevens! I used to have Teaser and the Firecat on vinyl,(70's).

Message is clear, these people are way too advanced a civilization and must be bombed back a few centuries in time.

Carey said...

I totally cherish Cat Steven's music. An interesting peace-loving Muslim nowadays.

I have read several times that tuberculosis is making a comeback. It must be because of this new drug-resistant strain. People have predicted a worldwide crisis.

Can you believe it? A sixth-grader from an outlying community came down with a serious lung disease while participating at sixth grade camp. They shut down the camps countywide and sent everyone home (Brandon had already been to camp this year.) Everyone was thinking tuberculosis. It was a severe staph infection and the young man has been in critical condition for two weeks now. Unbelievable.

Your concluding message, Den, that ravages from within could do away with our species may not be far off the mark. With global warming undoubtedly heading towards affecting every facet of life, this seems all too likely.

Glad to hear of your first snow, Sal. Send me pics, pleez? Is Bishop at 5000 feet? I can't remember. Yeah, I sorta remember. That was a long time ago, high school was.

Here's a nice petition promoting legislation entitled "Employee Freedom of Choice Act." It loosens the confines surrounding employees who would like to join a union or start one.


Saladin said...

Carey, I live about 17 miles North of Bishop, it is 5000 ft. here in "Paradise", the name of my little community. I will snap a couple pics and zap them over.
DEN, those uppity Persians are out of control, time for some action. Did you notice how those photos could have been taken in anywhere USA?

Carey said...

A nice post from one of my faves, John Nichols:

DC Marchers Challenge Congress to End War

While Bush and Vice President Cheney continue to peddle the fantasy they have the power to wage war as they choose, Congressman Dennis Kucinich corrected the latest lie from the White House. "It is time for George Bush to understand that Congress is a coequal branch of government," the Ohio Democrat said. "Congress has the power to end this war."

Kucinich is right on both counts. But he might have added a footnote: There are still a lot of representatives and senators who do not fully accept the responsibility that goes with being members of a coequal branch of government. Until they are reminded of that fact by their constituents, a cautious approach to Constitutionally-mandated duties will prevent Congress from ending the war -- or even seriously curtailing it.

Sean Penn's message was, indeed, the appropriate one: Those who marched on Saturday can and should be the deciders in a democracy.


After writing of my dismay at the course liberal blogs appear to be taking, protesting only the "surge", the nation is warmed at the sight of a real Peace March, or "Peace Train".

Carey said...

Those pictures of Tehran, that's the city my dear Persian friend remembers. I will send her this link. Her Mom still lives there.

Carey said...

Just read an amazing column by a man I highly respect, Tim Rutten, the media critic and analyst for the La Times.

Micki, I have you in mind particularly as one who would truly appreciate this analysis. Rutten has a wonderful way of zeroing in on the problem. I think you'll all like this one.

You can skim through the first part. We've been discussing this already. The meat comes just after Rutten quotes Dana Milbank of The Washington Post from an article Alan posted a day or so ago.

Cheney's Staff, and a Useful Press

It wasn't what anybody intended, but this week Vice President Dick Cheney and some of his former aides gave the rest of us a rather instructive seminar in the symbiotic contempt that links the Bush administration and self-serving members of the Washington press corps.


Speaking of utter contempt, when you think of Hitler, one thinks of the pure essense of evil.

Cheney embodies this.

David B. Benson said...

Not only new TB strains, but several climatologists think that the IPCC report due out Friday will understate the extent of sea stand raise at about 1/2 meter. These experts point to recent Greenland and Antartica data which suggests a substantially larger value by the year 2100.

This means substantial transhumanization, i.e., refugees...

Carey said...


Some of you might have already seen this:

Nuclear Plans in Chaos as Iran Leader Flounders

Boasts of a nuclear programme are just propaganda, say insiders, but the PR could be enough to provoke Israel into war.

Gerald said...

The wars we fight should be against diseases that affect our entire planet.

We should not fight wars to make the elitists feel good and line their pockets with money.


Gerald said...

Here Is Our Future

Dear Posters:

I am going to share with you our future. You can believe or disbelieve our future.

We are a nation of hypocrites. Americans are very fickle people. Americans are also selfish, into immediate gratification, with short memories, the world centers around them and no one else matters.

America faces serious problems. We have psychos in the White House, Congress, and the Supreme Court. Corporations rule the world and the MSM is irresponsible in doing their work. Religions sides with money and they are involved in politics. Talk show hosts unleash incessant hatred and lies and the majority of Americans will believe what is given to them. The monetary gap will only widen between the classes and the middle class will diminish to the point of borderline poverty. Medicare and Social Security will be eliminated by the ruling class. More and more Americans will be without health care. As Americans die, they will be placed in communal graves. We are people consumed by corruption, decadence, and greed. Our soldiers are only cannon fodder to be used as pawns and ninety percent of Americans are mushrooms. We are kept in the dark and fed crap.

Our country will be involved in endless wars where we are glorified by torture, war crimes, and murders. We face huge economic deficits that will cause great instability among the people. We have a population deficit and so hundreds of millions of immigrants will come into our country to fight our wars, work for cheap labor, and become part of the enslavement of our citizens. Americans also have an attention deficit disorder. Americans are confused by what is right and by what is wrong. We think that we can change the world and the people in the world by force. It is our way and no other way because we claim to know what is best for everyone. We also possess an insatiable appetite for all of the natural resources in the world. If it means that we must kill large human populations to control these natural resources, then we must kill them. As more pollution takes hold in our world, water will be a precious natural resource that will be necessary for life. Americans have to pay a great price for their water as will most of the world population.

I see a banana republic for our people with a despotic ruler in control over our enslaved people. I also see tremendous pain and suffering for you and me. We are a damned nation to continuously reside in hell.



Carey said...

Absolutely Gerald. The successful 2008 presidential candidate will be antiwar.

Here's another side of the media coin. It's short, by Joe Conanson of Salon and the last paragraphs are the winning elements showing just what the media can be capable of.

By the way, if you get a chance, do see that Cheney interview with Blitzer (probably at Crooks and Liars). For all the disgust we spew at Wolf, he's a deinite victim in this one.

Ghosts of Dirty Tricks Past

The right-wing smear campaign against Barack Obama, with its telltale twist of linking Hillary Clinton to the attack, is classic Watergate.

Gerald said...

Nazi America and Nazi Israel foreign policy in the Middle East is death, destruction, and genocide of the Muslims and Arabs.

Carey said...

Joe Conason.

Gerald said...

On Eagle's Wings

This hymn is song at the end of requiem masses.

I dedicate the hymn to the Iranian people who will soon have Nazi Americna nuclear bombs and missiles destroying their beautiful people and beautiful country.

Gerald said...

Saladin, thank you for those beautiful pictures!!! Beautiful people in a beautiful country!!! They are our brothers and sisters in God.

Saladin that is why America will nuke Iran!!! America craves death, destruction, and genocide in the Middle East that is our foreign policy in one word-"HATRED" FOR THE MUSLIMS AND THE ARABS.

I truly believe that God will punish Nazi America for her evil ways!!!!!

We are a nation and a people that will eternally reside in hell under a despotic ruler!!!!!!!!!!

Gerald said...

For the Iranian people: Please accept an apology from an American! Nazi America has numbered your days! I cannot prevent the slaughter and horror that will soon unfold in your country from our nuclear bombs and missiles! All I can say as one American that I consider you my brothers and sisters in God and may God lift you up On Eagle's Wings and welcome you into His Kingdom of Heaven!

May God have mercy on the souls of Americans for this barbaric and dastardly act!!!!!

Iran and Nazi America will never be the same!!!!!


David B. Benson said...

A quick check of news regrading Iran shows that, no, the Iranians are not in fact installing more centrifuges. (I will guess tthat they do not have such.) Also, Iran wants a bit of time to study the latest UN-sponored plan.

Further, it seems that many Iranians do not much care for their president and his overly outspoken ways...

Gerald said...

God will command His angels to lift you up and bring to the palm of His hand!!!

David B. Benson said...

Tomorrow is National Call-in Day on Iraq. Please remember to express your opinion regarding Iraq by calling the offices of your representative and senators.

Saladin said...

Gerald, I think God can determine who is good hearted and who is not. We must leave those decisions in His hands. An entire nation cannot be punished for the decisions of the few, not by a just entity, if it exists anyway. Remember what was said, gold must be refined in the fire, could this be the fire? Maybe? Are we the wheat or the chaff?

DEN said...

David, thanks for the reminder!

Sal, those pics are of good areas and very similar to us. Bombing them is beyond stupid.

Carey,funny how the repugs screw up everything when they are in power and when removed because of that whine and snivel like children.

They can't handle the job, make way for somebody that can, don't sit there and undermine the solutions they try to apply to fix things.

Gerald, looks to me like Christian America is trying to eliminate Muslims or at least control them as a lesser variety of people. Blackwater is run by a right wing Christian wacko.

There is more here than meets the eye.

Carey said...

There's alot more than meets the eye when it comes to Christian right wackos. They've infiltrated everywhere. It is completely scary.

Thanks Dr. B for the reminder on national call-in Day on Iraq.


I'm cutting and pasting Williams' column from yesterday and sending it off to family members. It's so good.

see y'all tomorrow

David B. Benson said...

Repugs --- No, not 'right-wingers', wrong-wingers. Not conservatives, flaming radicals.

Flaming radical wrong-wingers.

Other things too...

David B. Benson said...

Carey --- That should read un-Christian wrong wackos!

Jeanne said...

I loved the pictures of Tehran. Not much different than a lot of cities in the US.

Jeanne said...

Great article on the post. It always amazes me that in this day and age we choose to ignore such a terrible problem.

Jeanne said...

Oh I am so happy to bring you this article. I wait for it every year.

The BEAST 50 Most Loathsome People in America, 2006

Micki said...

I don't know Jeanne...cheney is #6??????? Well, maybe the list isn't weighted...Harry Whittington might put him closer to the top.

6. Dick Cheney

Charges: The dark master of the White House, Cheney strikes fear into the blackest of hearts. Only surfaces occasionally to nod and grunt at a reporter from Fox News, the only station he ever sees, before returning to the White House boiler room to continue planning the apocalypse. Almost certainly ignores everything Bush says. Vindictive and secretive to the point of absurdity, Cheney has his heart set on total global hegemony, and doesn't really care if you know it.

Exhibit A: How evil does a guy have to be for his buddy to apologize for getting shot in the face by him?

Sentence: A 30-year vacation at Gitmo.

Micki said...

Similar to cities all around the world. Including Israel. People being people.

Micki said...

Carey, thanks for pointing me to Tim Rutten's LAT piece.

Gerald said...

Saladin, I have an email address for one of my Nazi sister-in-laws and her husband. I sent her your pictures.

Micki said...

Though a couple of hammers are involved, this glock has never been lethal

Gerald said...

The placing of Jesus Christ on this list is blasphemy, the eternal sin that cannot never be forgiven. The sin relegates the author to hell for all eternity. Jesus Christ is not the problem. The problem is the people who misrepresent our Savior.

Jesus Christ is PERFECT LOVE. His life was the embodiment of PERFECT LOVE.

Gerald said...

Crossing the Line

Gerald said...

Crossing the Line

Saladin said...

Israel, like America, needs a change of leadership, otherwise both will go down and take all, good and bad alike, with them. It's time for the good people to stand up and do battle with evil, it is here, at our doorstep, in every country. We outnumber them, we CAN prevail! Unless we don't try.

Gerald said...

The main job of the corporate media with regard to war-related reporting is to decontaminate stories such as these so that their explosive political potential can be neutralized. These stories will normally only be reported if it is somehow forced into public attention by an individual act of courage, as in the case of Haditha or Abu Ghraib. If there is an accidental spill of this kind, the news media acts as clean-up crew to reverse its potential effects by recontextualizing it, often by emphasizing minor legalistic issues so as to obscure the major thrust. The same applies to stories such as the Libby trial, which will be formatted as much as possible toward its entertainment possibilities, while serious issues will invariably be reduced to legal quibbles so as to divert the thrust of moral outrage into a dry dispute.

As Christians, we should begin our penance in reparation for these crimes as soon as we hear about them.

Saladin said...

Or, if we are divided.

Gerald said...

An Army of Principles

Gerald said...

From Gandhi:

"Kings will always use their kingly weapons. To use force is bred in them. They want to command, but those who have to obey commands do not want guns: and these are in a majority throughout the world. They have to learn either body-force or soul-force. Where they learn the former, both the rulers and the ruled become like so many mad men; but where they learn soul-force, the commands of the rulers do not go beyond the point of their swords, for true men disregard unjust commands."

The last word goes to Chanan Suarez Diaz, a Navy corpsman who was deployed to Iraq in September 2005: "So they keep a lot of news about combat refusals or resistance internal, so people don’t hear about it. Because they know if word got out, this kind of behavior will spread like wildfire within the ranks."

Give all the support you can to these troops by ending the violence that lives in our hearts and hands, that a rebellion of love may infect the Christian world.


Alan said...

haha Jeanne, that 'toon of Mann Coulter is worth the trip by itself. The "–-and Adam's apple removed with a backhoe." cracked me up too.
So, I'm halfway thru the list and still reading.

Gerald said...

Pictures of Iran Before Bush

Gerald said...

Pictures of Iraq After Bush

This fate awaits Iran between now and April 30, 2007.