In a message dated 4/20/08 7:23:01 P.M. Central Daylight Time, News@JobDestruction.info writes:
<<<<< JOB DESTRUCTION NEWSLETTER No. 1856 -- 4/20/2008 >>>>>
Alameda County TB control officer Dr. Robert Benjamin warned that
tuberculosis among H-1B visa holders has dramatically increased.
"During the dot-com boom, we in Alameda County and I know other
Bay Area counties saw a dramatic increase in tuberculosis among
the (H-1B) visa immigrants," said Benjamin, the Alameda County
TB control officer.
Dr. Benjamin laments the fact that H-1Bs aren't screened for TB.
"I don't know how or why, but at some point a decision was made by
the State Department that if a U.S. company sponsors a highly
educated, highly skilled worker, that they don't need screening
. . . . I think that just because they are highly educated and
have a job doesn't mean they can't have TB."
Dr. Benjamin is correct that H-1Bs aren't required to be screened for TB,
but he is wrong that the State Dept. changed their policy -- H-1B
nonimmigrants have never been required to be screened for infectious
diseases, although some employers may ask that their H-1Bs be tested.
Believe it or not, there is a rationale to justify the avoidance of
screening H-1Bs for TB. To understand the reasoning, however flawed it may
be, it has to be understood that nonimmigrants, on temporary visas, and
immigrants, who seek permanent residency, are considered very differently.
H-1B visas are nonimmigrant, which in theory means that they come to this
country temporarily and therefore are considered a lower risk of being a
disease vector than a permanent immigrant.
H-1Bs are unlikely to ever get tested for TB unless they apply for a change
of status to a green card. Once they apply for a green card they must get a
TB test. Even if they test positive for TB they won't necessarily be
rejected because they can apply for a waiver by filing "I-601, Application
for Waiver of Grounds of Inadmissibility".
All of this means that H-1B visas holders can be here for six years without
ever being tested for tuberculosis. So, if in the period of six years the
H-1B coughs, sneezes, or shouts the germs will spray into the air. Anyone
who breathes their aerosol can be infected with the disease.
Image of TB infected H-1B coughing
\\\\\\//
\\\ \
\\ <oo)
\\C \
\\ __\
jgs / _\':.
/ _\'..:. :.
/ ': : : : :.
: ' :: : :. <---- phlegm aerosol
. : ' .
You may be wondering what kind of idiot politician would allow this to
happen. I gotta surprise for you -- it's not politicians, it's the AMA!
Many of their politically correct physicians decided that the risk of
tuberculosis is outweighed by the advantages of open border politics.
http://www.ncbi.nlm.nih.gov/pubmed/11176758
Overseas TB screening of nonimmigrant visitors, who are unlikely to
have active TB and even less likely to transmit it, will be of
extremely low yield, would significantly deviate from the US
"open-door" policy for nonimmigrants, and would have great
logistical and political implications.
Of course medical researchers and doctors wouldn't rely on crass politics
to fully justify this non testing policy. They did a cost vs. benefit
analysis to figure out that testing nonimmigrants is just too dang
expensive.
Screening and monitoring the nonimmigrant foreign-born population
would divert valuable resources from now established, successful
TB control programs for foreign-born immigrants.
NOTE: Google doesn't allow access to the entire medical study, so I wasn't
able to see which group of shameless corporations paid for the study.
+++++++++++++++++++++++++++++++++++++++++++++++++++
http://www.mercurynews.com/ci_8975501?source=most_emailed
New TB threat: Global ties bring an ancient disease to Silicon Valley
By Mike Swift
Mercury News
Article Launched: 04/18/2008 04:11:10 PM PDT
New TB threat: Doctors worry about powerful strains resistant to drugsNew
TB threat: Health worker fights disease, patient by patientIn a beautiful
home filled with mementos of world travel, a 44-year-old Silicon Valley
executive reluctantly picks up the telephone to tell several business
contacts that he might have infected them with tuberculosis.
In a one-bedroom apartment in Oakland, a new mother feels her life slipping
away. She is losing her hearing, her feet are going numb and her face
carries a rash from the toxic drugs being used to fight the drug-resistant
bacteria in her lungs. Her body has dwindled to 87 pounds and she wonders:
Would my husband and infant son be better off if I was dead?
In Helena, Mont., the state's tuberculosis official takes an urgent call
from the laboratory and feels her stomach knot. She has a patient with a
potentially infectious, dangerous TB strain - a case her state lacks the
money and the medical resources to treat.
Those three small snapshots are all part of a global tuberculosis epidemic
that threatens the Bay Area - with its web of international connections -
like few places in the nation.
Call it one price of globalism.
Last year, tuberculosis increased in four of the Bay Area's five largest
counties, and the San Jose area in 2006 had the highest TB rate of any
large American metro area, according to data from the U.S. Centers for
Disease Control and Prevention and the California Department of Public
Health. San Francisco, after an outbreak of TB among Latino day workers in
the Mission district, has the highest TB rate of any county in California -
quadruple the U.S. rate.
From the bodies of Peruvian mummies to 21st-century tech workers,
tuberculosis has been mankind's dark partner for centuries - a highly
infectious disease that never followed the path to eradication of smallpox
and polio. One in three people worldwide are infected, and 1.7 million died
last year, mostly in poor countries where people lack the access to
detection and treatment available in the United States.
No case of TB is easy. The waxy-sheathed, rod-shaped, slow-growing
bacteria, if untreated, colonizes the lungs, creating such dense cavities
of disease that pieces must sometimes be excised. TB spreads through the
air; untreated, one person infects 10 to 15 people a year, according to the
World Health Organization.
But among public health officials, nothing is more worrisome than the
relative handful of drug-resistant TB cases. WHO and U.S. experts are
warily watching the record level of such cases - found from former Soviet
prisons to remote provinces in China - as hints of something even scarier
on the horizon.
"It worries me that we're going to have increased cases of multi-drug
resistance because we have no control over the rest of the world," said Dr.
Marty Fenstersheib, the public health officer for Santa Clara County, which
has had a 21 percent jump in TB cases since 2005. "The person on the
street, when you go up to them and say, 'Do you know what one of our major
problems is?' and they guess everything else and you go, 'Tuberculosis,'
and they go, 'No. We still have TB? We have that?' "
Treating one drug-resistant case can easily cost several hundred thousand
dollars or more - the bill often ends up with the county health department
if a patient lacks insurance. And in a growing number of extremely
resistant cases - including a few in the Bay Area - there are no drugs that
can cure the disease, raising the specter of an infectious, incurable,
potentially fatal infection.
With California in a budget crisis - and the state's total number of TB
cases declining - a disaster which hasn't happened yet is not a high
priority for politicians. But that is precisely what worries Bay Area TB
officials. They say emerging drug resistance, global travel connections,
and Gov. Arnold Schwarzenegger's plans to cut TB spending will all handicap
California's ability to protect residents from dangerous drug-resistant TB.
"It drops our pants around our ankles," Alameda County TB control officer
Dr. Robert Benjamin said of the budget cuts. "And we can't run like that."
Demographics
Valley's strong links to other countries If affluent, modern Silicon Valley
seems an unlikely hunting ground for a disease often presumed a medieval
scourge, nothing could be more wrong. This region has intimate ties to
countries with the world's highest TB burdens, countries where the lack of
access to antibiotics and basic health care has allowed the disease to
flourish in the 21st century.
Ninety percent of Santa Clara County's 241 TB cases in 2007 were in
students, immigrants, temporary workers, tourists and others born in other
countries. At the same time, the number of multi-drug-resistant cases in
the county - bacteria resistant to isoniazid and rifampin, the first-line
TB antibiotics - jumped from two to seven.
The top five countries of origin for foreign-born people with TB are
Mexico, the Philippines, Vietnam, India and China, according to the CDC.
Those nationalities are also Santa Clara County's largest five foreign-born
populations. At 430,000 people, they are one-quarter of the county's total
population.
"Our TB reflects the countries of origin that our patients come from, and
it's the Philippines and Vietnam and India where there is a lot of drug
resistance," said Dr. Sundari Mase, Santa Clara County's former TB control
officer, now with the CDC.
Many are not recent immigrants - two-thirds of Santa Clara County's
foreign-born cases have been in the United States for at least five years.
In that sense, TB is a public health issue, not an immigration issue, heath
officials say.
State health officials estimate there are 2 million foreign-born residents
of California infected with latent TB. The great majority will never get
sick, but if their immune systems weaken - by way of HIV infection,
diabetes, aging or immune-suppressing drugs - their TB could multiply, and
they could transmit the disease.
In 2005, soon after she gave birth to a son, a young immigrant wife was
hospitalized with TB. In her native Mongolia, she had nursed an older
sister, who ultimately died of TB, just before she immigrated to the United
States and got married.
Soon something was ominously clear - Battsengel, who asked that her last
name not be used because of her embarrassment at having TB - had a
drug-resistant case. It forced doctors to use second-line drugs that can
cost 100 times more than standard antibiotics. And they can produce
terrible side effects.
Drug-induced nausea chopped her weight from 110 to 87 pounds. She had
ringing in her ears and her feet became numb because of nerve myopathy - a
common side effect of second-line TB drugs. And the beautiful skin on the
young mother's face was covered by a rash.
"I was very depressed. There was no happiness, no smile," she said.
"Because of my depression, sometimes I would get so angry - sometimes I
would try to jump out of home, not try, but I say if I die, it will be
better."
Loopholes
Screening isn't always effective The United States screens legal immigrants
and refugees for TB before they are allowed to enter the country, by
checking medical histories and requiring a chest X-ray for those at risk.
But Bay Area health officials say there are loopholes in the nation's
defenses, and that budget cuts will only make the gaps bigger.
Denise Ingman, who heads Montana's TB program, learned about one of those
loopholes firsthand in summer 2006. Ingman used a new genetic test
developed by the California Department of Public Health to confirm a
20-year-old at the University of Montana had potentially infectious
drug-resistant TB.
But the student, who was from Mongolia, probably never would have been able
to enter the United States if the country, like Canada, had a system to
screen students, temporary workers on H-1B visas or other visitors who may
live here for years on non-immigrant visas.
Once she had the confirmation, Ingman contacted county health authorities
who were tracking the student.
"They said, 'Oh. We just gave her permission to go on a little trip,' "
Ingman recalled.
For three tense days, Montana officials searched for the student, who was
on a driving tour of the Pacific Northwest. Her family had their cell
phones off. Ingman contacted the Seattle airport, issuing a "do not board"
order, because she was worried the student was trying to return home.
Ingman and the TB control officers in Santa Clara, San Mateo, San Francisco
and Alameda counties, as well as the executive director of the National
Tuberculosis Controllers Association, agree the United States should screen
all long-term visitors.
Canada prevents an estimated 600 TB cases a year by screening everyone who
plans to stay in the country permanently, for longer than six months if
they are coming from a country with a high incidence of TB, or for any
length of time if they will be working in health care, education, child
care or domestic work, said Dr. Edward Ellis, manager of TB control for the
Public Health Agency of Canada.
"During the dot-com boom, we in Alameda County and I know other Bay Area
counties saw a dramatic increase in tuberculosis among the (H-1B) visa
immigrants," said Benjamin, the Alameda County TB control officer. "I don't
know how or why, but at some point a decision was made by the State
Department that if a U.S. company sponsors a highly educated, highly
skilled worker, that they don't need screening. . . . I think that just
because they are highly educated and have a job doesn't mean they can't
have TB."
The cost of every TB case to local taxpayers is significant.
Santa Clara County spent an average of $18,000 a case in 2007 - about $4.3
million total - for drugs, testing and for the labor-intensive contact
investigation required for families, co-workers or schoolmates who have
contact with an infectious person.
With state and local funding in doubt, Fenstersheib, the county health
officer, went to Washington in March to lobby Silicon Valley's
congressional representatives to have Santa Clara County join the dozen
U.S. cities and counties that get direct federal TB funding.
"I think we deserve it," Fenstersheib said. "We have more cases than half
the cities that have direct funding."
Emotional toll
S.F. executive's unexpected fight Scott Halstead is an optimistic, athletic
person - the kind of guy who would bike several hundred miles a week - a
Silicon Valley executive and venture investor.
In January, five months before his wife was due to deliver their first
child, Halstead, the former chief executive of WageWorks in San Mateo,
learned he had TB. He didn't have a drug-resistant case, but for 3 1/2
weeks, he was required to stay in his Noe Valley home, going outside only
in a surgical mask.
Instead of business meetings and dinners with his wife, his schedule was
tied to the daily arrival of a San Francisco health worker, who would
deliver his medicine and watch him take it - a public health requirement to
make sure he took all his doses to prevent the survival of drug-resistant
bacterial in his body. The drugs fogged his mind to the point he couldn't
work.
And he had to call several business contacts and the relatives he shared
Thanksgiving with, and tell them that they all needed to get tested for TB.
"It's hard to even connect to what it was like to be well," he said.
Halstead probably was infected on his honeymoon in Africa last year, and
immune-suppressing arthritis drugs allowed his TB to multiply. He expects
to be in good health by the time his wife delivers later this spring.
For patients with a multi-drug-resistant case, however, the medical odyssey
can be much, much longer.
Battsengel survived hers. After two years, two months and 15 days of
medication, she is healthy, her TB cured after two years of treatment.
"I feel great," said Battsengel, who is studying to become a nurse. "I have
a smile on my face. I have a future."
One TB patient who spent most of the past three months in Stanford
University Hospital - a 30-year-old Sunnyvale woman who flew from New Delhi
to San Francisco International Airport with a contagious case of
multi-drug-resistant TB in December - faces a similar trial. The case
triggered a national hunt by the CDC for 44 other passengers sitting
nearby.
At least one person on the flight might have been infected, although it's
impossible to definitively confirm that the infection came from the airline
exposure at this point, the CDC reported Wednesday. The Sunnyvale woman,
who declined an interview request and whose identity is being withheld by
public health officials, is enduring what Fenstersheib said could be a
two-year regimen of drugs with potential side effects including hearing and
liver damage.
TB experts say she won't be the last person to bring a dangerous strain of
drug-resistant disease to the Bay Area.
International hubs are at "very, very serious risk," said Dr. Marcos
Espinal, who heads the Stop-TB Partnership, an international health
partnership housed at the WHO in Geneva.
"TB is endemic in many countries that have a strong relationship with the
U.S., in trade, exchanges in the arts, in sports," Espinal said. "Many
people from those countries meet in the U.S. It's very serious in my view."
Contact Mike Swift at mswift@mercurynews.com or (408) 271-3648. Mercury
News Staff Writer Saqib Rahim contributed to this report.
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