While health officials search for at least 107 airline passengers and crew members who may have been exposed to a potentially deadly form of tuberculosis, experts on Wednesday questioned how an Atlanta-area man was able to jet off on his honeymoon with the knowledge of government officials.
The case, which has spawned an international health incident involving investigations in several countries, raises difficult questions about balancing the rights of an individual with the needs to protect the public, they said.
And while the man's current confinement in isolation at Grady Memorial Hospital shows how the system worked --- in the end, the experts questioned whether more could have been done before he ever left Atlanta.
"I think this is going to be a lesson learned nationwide of the importance of local and county health departments being the front line of protection for the rest of the population," said Michael Greenberger, a law professor and director of the University of Maryland Center for Health and Homeland Security.
A congressional committee, the House Homeland Security Committee, announced Tuesday it will hold a June 6 hearing examining health officials' response in the case.
The TB patient, who is being confined at Grady under a federal isolation order --- with an armed guard outside his hospital room --- has told The Atlanta Journal-Constitution that he specifically told Fulton County health officials he was planning to leave for his wedding in Greece, then a honeymoon tour of Europe. He says they only told him they "preferred" he not travel. When pressed on what that meant, the man said they didn't say he couldn't travel.
The man, whose name is not being published by the AJC at his request, was diagnosed with multidrug resistant TB prior to leaving the country. While that's serious, an even more serious diagnosis of extensively drug-resistant TB, also called XDR TB, was made after he was in Europe.
While the man was honeymooning in Rome, CDC officials asked him to agree to indefinite isolation in an Italian hospital. Instead he fled.
The CDC put the man on airlines' "no fly" lists and had his passport flagged, but the man and his bride were able to elude health authorities and sneak back into the United States by flying to Canada and driving across the border last week.
Fulton County and Georgia state health officials said they believe he was clearly informed that he shouldn't travel. But they also acknowledge that despite their conversations, as of May 10 they knew he intended to leave the country for his wedding. They also discussed with CDC officials the man's intent to fly for at least two days before his planned May 12 Atlanta-to-Paris flight, according to CDC spokesman Tom Skinner and Georgia's state epidemiologist Susan Lance.
Skinner said Fulton County health officials contacted CDC on May 10 and May 11 to talk about the man, who had told them he planned fly aboard airlines. "We discussed with them several options to prohibit him from flying," Skinner said, all of which needed to be taken by local authorities.
Skinner said CDC never heard back from local health officials until May 18 --- after the man had already left the United States.
While Georgia health officials can obtain a court order to restrict the actions of a person or to even involuntarily commit them for treatment, Lance said the individual first needs to be served with a medical order telling them what they can and cannot do. Fulton health officials have said they tried to hand-deliver the man a medical order not to travel, but couldn't find him on May 11.
Lance said state and county health officials thought the man was departing at a later date, not on May 12, when he flew from Atlanta to Paris. It was the first in a series of flights that now has health authorities in several countries working to contact passengers to be tested for TB.
Out of about 500 general TB cases in Georgia each year, Lance said only about four will require court orders for involuntary comittment to treatment and a few others for other reasons.
"I think the Fulton County Department of Health and Wellness did their job to the best of their ability," Lance said, but she added that "there probably needs to be a review" of the state's laws.
At a press conference Wednesday, Dr. Martin Cetron, director of CDC's Division of Global Migration and Quarantine, said health officials are focused on the evolving investigation, tracing the man's movements and identifying what passengers were closest to him on long flights --- those over 8 hours in duration --- to identify those who may be at risk.
Cetron said CDC officials do not believe the man was highly contagious. However, the consequences would be dire if the disease were to spread, because treatments are so limited, he said.
The man's wife was tested and the initial result was negative, Cetron said.
The CDC is trying to locate approximately 80 passengers and 27 crew members who were on the two transatlantic flights and may have been near the infected passenger, Cetron said.
Passengers who are at highest risk on those flights were sitting within two rows of the man. They are urged to call 1-800-CDC INFO so they can receive a TB test.
The infected man was on Air France flight 385 from Atlanta to Paris on May 12 and on Czech Air flight 0104 from Prague to Montreal on May 24.
On the Air France flight departing Atlanta, he sat in row 30, Skinner said. On the Czech Air flight he was sitting in 12C.
CDC officials said Wednesday they have not yet received a passenger manifest from Air France, and that pinpointing the man's seat takes time. "This is a cumbersome and challenging process to locate passengers," Cetron said.
The agency also released details of several short flights within Europe taken by the couple, but said that they were all of short duration and involved less risk.
"This contact investigation is going on in several countries."
On the May 12 Air France flight, 18 crew members and approximately 50 of the total 433 passengers are being contacted by authorities, Cetron said.
On the May 24 Czech Air flight, nine crew members and about 30 passengers out of 191 total passengers are considered high priorities for contact, Cetron said.
The patient, who remained in isolation Wednesday at Grady, appears well.
Cetron did not say how long the patient would be at Grady before being transferred to National Jewish Medical and Research Center in Denver, which treats the most highly resistant forms of TB. But, he said, CDC will be involved in his transport.
"We're working on plan to ensure the patient can move safely across state lines," he said.
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