Shot or Mugged? Wrong, the biggest danger is from TB

LA DAYS

It was supposed to be a routine check-up at which the worst possibility was to be asked to cough by a doctor with chilly hands. So it was surprising to hear the note of urgency in the nurse's voice. "Could Mr Reeves come this way at once?"

I had been looking forward to reading my Glendale News-Press (headline: "Glendale Agog Over Marcia Clark's New Hair-do"). The room was full of bandaged, bored people. Why pick on me?

"Let's have a look at your forearm," she said. She peered at the same red blot that I had casually shown the receptionist when I arrived. "Yup," she said, "She was right. TB positive."

When I moved to Los Angeles more than three years ago, I brought certain expectations, mostly the consequence of watching bad television. I knew people could be shot at random, especially if they strayed into gang- occupied areas; I should not have been surprised to be mugged, or burgled.

What I had not anticipated was encountering a disease which (in my ill-informed view) was largely the preserve of 19th-century Romantic poets and, in the US at least, 20th-century down-and-outs. It was my fault: for too long I had tempted fate by scoffing at Californian friends for worrying obsessively about their iron intake, their personal training regimes ...

The nurse was quick to put matters in proportion. "You don't actually have TB," she said, "It's an airborne disease, and this skin test just means you have been exposed to it, that it's somewhere in your system, and that there's an outside chance you could develop it."

There was a choice: it could be treated by a drug, but this could damage the liver and had even, in rare cases, led to death. More to the point, the course took at least six months, during which all alcohol was banned. Or one could do nothing, and hope to be among the 90-95 per cent who test "TB positive" but never get the disease. After a chest x-ray, which found nothing, the latter course was adopted.

No one knows precisely how many in the US are "TB positive". Not everyone is screened and the test is not always accurate (especially among those who have had the BCG vaccination in Britain). But a tentative estimate is about 10 per cent - a figure that rises to 50 per cent among the homeless, the incarcerated, and some immigrant groups. TB is everywhere.

Until the past two years, it has been spreading like wildfire, particularly among the homeless and impoverished in metropolitan areas such as Los Angeles and New York. Latest figures (for 1993) from the Centre for Disease Control and Prevention show there were 25,287 full-blown TB cases in America - a figure that has risen by 20 per cent in the past decade, after a long period of steady decline.

Medical experts cite many reasons - the emergence of the HIV virus, global air travel, the growth of a deprived underclass, drug abuse, and immigration.

But health authorities have a still greater reason for concern. While most TB cases can usually be cured (except among Aids sufferers), these do not include emerging drug resistant varieties.

Some of these can conquer as many as 11 types of drugs, either killing their victims or dooming them to life in isolation. So far only 1.6 per cent of California cases have been classified multi-drug resistant.

Just now Americans are particularly attuned to the risk of large-scale epidemics. Two years ago, an intestinal parasite, cryptosporidium, infected 403,000 people in Milwaukee, the largest attack of waterborne illness in US history. Americans have watched with horror as cholera has re-established itself among their Hispanic neighbours.

The topic, the subject of a forthcoming White House conference, is high on the national agenda - The Hot Zone, Richard Preston's book about the spread of a deadly African virus is a best-seller. Even Hollywood has taken it up, with Dustin Hoffman's The Outbreak.

But it is serious. At a panel on infectious diseases in Washington last month, the Nobel-prize winning biologist Joshua Lederberg asked: "Will we get them, before the bugs get us?" He was in deadly earnest.

Start your day with The Independent, sign up for daily news emails
Have you tried new the Independent Digital Edition apps?
News
ebooksAn unforgettable anthology of contemporary reportage
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Recruitment Genius: Customer Accounts Executive

£14000 - £18000 per annum: Recruitment Genius: This is an opportunity for the ...

Recruitment Genius: Team Administrator / Secretary - South East

£14000 - £17000 per annum: Recruitment Genius: Full time Administrator/Secreta...

Recruitment Genius: Parts Advisor

£16500 - £18500 per annum: Recruitment Genius: One of the leading Mercedes-Ben...

Recruitment Genius: Software Developer

£27500 - £35000 per annum: Recruitment Genius: This is an exciting opportunity...

Day In a Page

Fifa corruption: The 161-page dossier that exposes the organisation's dark heart

The 161-page dossier that exposes Fifa's dark heart

How did a group of corrupt officials turn football’s governing body into what was, in essence, a criminal enterprise? Chris Green and David Connett reveal all
Mediterranean migrant crisis: 'If Europe thinks bombing boats will stop smuggling, it will not. We will defend ourselves,' says Tripoli PM

Exclusive interview with Tripoli PM Khalifa al-Ghweil

'If Europe thinks bombing boats will stop smuggling, it will not. We will defend ourselves'
Raymond Chandler's Los Angeles: How the author foretold the Californian water crisis

Raymond Chandler's Los Angeles

How the author foretold the Californian water crisis
Chinese artist who posted funny image of President Xi Jinping facing five years in prison as authorities crackdown on dissent in the arts

Art attack

Chinese artist who posted funny image of President Xi Jinping facing five years in prison
Marc Jacobs is putting Cher in the limelight as the face of his latest campaign

Cher is the new face of Marc Jacobs

Alexander Fury explains why designers are turning to august stars to front their lines
Parents of six-year-old who beat leukaemia plan to climb Ben Nevis for cancer charity

'I'm climbing Ben Nevis for my daughter'

Karen Attwood's young daughter Yasmin beat cancer. Now her family is about to take on a new challenge - scaling Ben Nevis to help other children
10 best wedding gift ideas

It's that time of year again... 10 best wedding gift ideas

Forget that fancy toaster, we've gone off-list to find memorable gifts that will last a lifetime
Paul Scholes column: With the Premier League over for another year, here are my end of season awards

Paul Scholes column

With the Premier League over for another year, here are my end of season awards
Heysel disaster 30th anniversary: Liverpool have seen too much tragedy to forget fateful day in Belgium

Liverpool have seen too much tragedy to forget Heysel

Thirty years ago, 39 fans waiting to watch a European Cup final died as a result of a fatal cocktail of circumstances. Ian Herbert looks at how a club dealt with this tragedy
Amir Khan vs Chris Algieri: Khan’s audition for Floyd Mayweather may turn into a no-win situation, says Frank Warren

Khan’s audition for Mayweather may turn into a no-win situation

The Bolton fighter could be damned if he dazzles and damned if he doesn’t against Algieri, the man last seen being decked six times by Pacquiao, says Frank Warren
Blundering Tony Blair quits as Middle East peace envoy – only Israel will miss him

Blundering Blair quits as Middle East peace envoy – only Israel will miss him

For Arabs – and for Britons who lost their loved ones in his shambolic war in Iraq – his appointment was an insult, says Robert Fisk
Fifa corruption arrests: All hail the Feds for riding to football's rescue

Fifa corruption arrests

All hail the Feds for riding to football's rescue, says Ian Herbert
Isis in Syria: The Kurdish enclave still resisting the tyranny of President Assad and militant fighters

The Kurdish enclave still resisting the tyranny of Assad and Isis

In Syrian Kurdish cantons along the Turkish border, the progressive aims of the 2011 uprising are being enacted despite the war. Patrick Cockburn returns to Amuda
How I survived Cambodia's Killing Fields: Acclaimed surgeon SreyRam Kuy celebrates her mother's determination to escape the US

How I survived Cambodia's Killing Fields

Acclaimed surgeon SreyRam Kuy celebrates her mother's determination to escape to the US
Stephen Mangan interview: From posh buffoon to pregnant dad, the actor has quite a range

How Stephen Mangan got his range

Posh buffoon, hapless writer, pregnant dad - Mangan is certainly a versatile actor