An American woman diagnosed with tuberculosis, a highly contagious bacterial infection, has been found in civil contempt after repeatedly refusing to follow treatment orders.
According to a Press release by the Tacoma-Pierce County Health Department in Washington, a warrant has been issued for the arrest of the unidentified 42-year-old woman, who will be taken to “a specially designated facility at the Pierce County Jail for isolation, testing and treatment.”
“In every case like this, we are constantly balancing the risks to the public and the civil liberties of the patient. We always hope that a patient will choose to voluntarily comply,” said Health Department spokesman Nigel Turner.
“Seeking to enforce a court order through a civil arrest warrant is always our last resort.
This “last resort” came after a year of working with family and community members to encourage the woman to comply with therapies targeting the disease.
Heading to court for the 16th time, the woman was finally given three options: take the drugs, stay home or go to jail.
As extreme as the result may seem, tuberculosis is a serious threat to public health. Thanks to careful management of surveillance, testing and treatment, the disease is now relatively rare in the United States.
Again in the world it continues to infect more than 10 million people each year, with 1.6 million deaths recorded in 2021, making it the 13th leading cause of death worldwide.
The disease is caused by bacteria Mycobacterium tuberculosiswhich likes nothing more than to nestle in the white blood cells inside the air sacs of the lungs.
Ready to destroy invaders like Mr. tuberculosisthe white blood cells seal the microbe inside the membranes and flood them with destructive agents in an attempt to break them down.
That would be the end of the bacteria, if not for a thick layer that keeps it safe and sound, allowing it to replicate inside the very cells responsible for keeping our bodies safe.
Eventually, the white blood cell dies, though the immune system continues to do its best to destroy the invader, throwing more killer cells and protective tissue at the encapsulated bacteria in an attempt to seal it off and get rid of it.
The carnage of dead cells and protective growth culminates in a tiny granuloma called a tubercle, giving the disease its name and providing pathologists with a visible means of detecting the microscopic invader using X-rays.
If these tiny beads of infection spread through the body, they can occupy just about any tissue, greatly increasing the risk of death. Coughed into the air inside microscopic droplets of liquid, they can easily spread to the lungs of others nearby, posing a serious health risk to the community at large.
Treatment for the active form of pulmonary tuberculosis usually takes the form of a six-month course of antibiotics, although an increasing number of strains are develop resistance to the most common antibacterial drugs.
In many cases, the infections are silent, only to flare up periodically throughout a person’s life. To reduce the risk of drug resistance in populations, these latent cases are usually not treated with antibiotics, but are closely monitored for continued risk.
The exact reason the Tacoma woman declined treatment of her own active case is unclear. It is alleged by the health department that despite starting the treatment for several months, she refused to continue until the end.
Symptoms of active TB can go away a few weeks after starting treatment, leading some to believe they are no longer at risk.
In January 2022, the woman received a court order to remain isolated at home until her condition was no longer considered active. Repeated court orders were disobeyed, including an occasion when she put hospital staff at risk by not disclosing her infection following a car accident.
This is only the third time in the past two decades that Tacoma-Pierce County health officials have called for such extreme civil action to force adherence to TB treatment.
Yet history is replete with examples where authorities have faced similar decisions between individual freedom and the risk of a public health crisis.
Perhaps the most famous is the case of ‘Typhoid Mary’ Mallonan Irish-American who is believed to have infected more than a hundred people at the turn of the last century with the pathogen Salmonella enterica serovar Typhi (Typhi S), which she carried in her guts and spread in her role as a cook.
While she herself was asymptomatic, infections in others would lead to several deaths. Forced into quarantine by the authorities, Mallon died after nearly 30 years in solitary confinement.
Today, this highly contagious disease is just as easily treated with antibiotics, although it too could one day pose a more serious risk because he develops new ways to avoid first-line drugs.
With the rise of drug resistance, health misinformationand the ubiquitous risk of new epidemicssuch cases will increasingly become examples of lost freedom or reluctant last-resort protective measures.