Ah, the joys of air travel, sitting crammed between two people in seats a bit too narrow, so you have elbows in your soup.

I prefer the old days, when the twelve hour trips to Manila were half empty, and if your feet got cramped, you could walk back to the smoking section and play poker with the smokers and off duty stewardesses.

Oh well, the good thing about the “non smoking” rules is that I can breathe better (try sitting two rows in front of the smoking section for twelve hours two weeks after being treated for “walking pneumonia).

The point of the “no smoking” rules is the recognition that smoke and other “particulate matter” tends to concentrate in closed rooms, and are a health hazard.

Nor is this health problem limited to smoking.

An airline passenger is now in quarrantine, and all those on his flight notified to get checked for TB…and not just simple TB, but multidrug resistant TB. He also traveled in Europe, so may have endangered more people there.

Tuberculosis kills a million people worldwide each year, but the good news is that most people in contact with the germ never come down with it. Instead, they develop immunity, and a positive skin test. And the other good news is that not all TB is very infectious: depends if you have open cavities and lots of germs in the sputum, or merely an early case or chronic infection where you don’t cough a lot of germs out.
It is spread via cough. The laws against “spitting” were originally because those with Chronic TB would cough and spit, spreading the germs to those nearby. So usually now we see it spread in families and roommates and other close contacts. Worry about TB from homeless people on subways is mainly a worry, but the real danger is in hospitals, where sick people get infected easily. Obviously, in an airplane, he may have spread the disease to quite a few passengers.
The treatment is usually a combination of antibiotics. After you take the antibiotic for two weeks or so, your germ count in the sputum goes down and we don’t need to isolate you anymore.
But for Multi drug resistant TB, there is a possibility of the laws requiring quarantine from the public will again be used. I haven’t seen it used in civilians, but on the Indian reservations, we were able to threaten forced hospitalization for those who refused medical treatment. But even that case was 30 years ago: the Indian Health service now sends public health nurses to the home three times a week to supervise taking the complicated medical treatment (lots of pills) and take the blood test to make sure there are no liver problems from the medicine.
This gentleman is now in isolation, but for how long? Will the ACLU get involved?

I suspect that he may end up in home isolation, and required to use a mask in public if he remains infectious.

But it’s just one more thing to worry about if you travel in airplanes.


Nancy Reyes is a retired physician living in the Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays on HeyDoc Xanga Blog 



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