Wednesday, February 11, 2015

The Union Gospel Mission (and, likely, other shelters, too) are adjusting their procedures to better protect against the spread of TB

Special note: This blogpost is NOT meant as a criticism of the Union Gospel Mission. The mission is just the example of issues regarding TB that was related to me by homeless guys I know. The same issues or similar issues are being dealt with by shelter programs elsewhere in Sacramento and throughout the country. If anything, UGM is to be lauded for its upgraded effort to better protect homeless people from contracting TB who come to its facilities for overnight stays and myriad other services.
A change in procedures has been implemented at Union Gospel Mission with regard to newly homeless fellows seeking a one-week stay in the mission's dorm.

Until recently, if a new fellow sought a bed and didn't as yet have a current county TB Card -- indicating that the guy had been tested at Mercy Clinic and showed an absence of evidence of having tuberculosis -- the guy could get a bed so long as he agreed to take the steps in getting his card, acting as expeditiously as was possible.

Often, it might take no fewer than five days for a fellow to get his card. If he came to the mission on a Friday evening, he would be expected to go to Mercy Clinic at Loaves & Fishes the next Monday morning to get a skin test (aka, prick test) [see video] when sterilized "tuberculin units" are injected within layers of skin on the fellow's forearm and to then return to Mercy Clinic on Wednesday to have the skin reaction to the tuberculin test 'read' by a technician. If there is no improper skin reaction -- indicating presence of TB antibodies -- then the fellow would be issued a TB card that is valid for one year.

The Mission's new policy, requiring that all men staying in the dorm have a valid TB card from the start of their stay, is better for an important reason: it better protects homeless men using the mission's services from contracting tuberculosis. But, for a newly homeless guy, it makes life difficult. The Mission is the entryway for such a new guy to begin to receive homeless services. With the new policy, new guys -- who most often don't have bedrolls or blankets -- have to figure out for themselves how to survive until they can get their vital TB card.

According to the website "Pulmonary TB (in the lungs) is contagious. It spreads when a person who has active TB breathes out air that has the TB bacteria in it and then another person breathes in the bacteria from the air. An infected person releases even more bacteria when he or she does things like cough or laugh."

Surprisingly (to me), TB bacteria CANNOT BE SPREAD by sharing drinking containers or eating utensils OR by sharing cigarettes with others OR from kissing. As well, TB is NOT spread through shaking someone’s hand, sharing food, touching bed linens or toilet seats, or sharing toothbrushes. [This information comes from page 6 of the Center for Disease Control booklet found here,]

While homeless men I've spoken with are happy to now be better protected from the spread of TB in the Mission dorm, they expressed concern about a continuing possibility of being infected in the Mission chapel and meal room, both of which are crowded when utilized every evening. People coming just for the chapel service, and who would be welcomed to eat a meal, do not need to have proof of having been tested for the TB infection. But, of course, people going to restaurants and regular church services don't have to be tested for TB either.

According to a report at the Center for Disease Control website, homelessness is a risk factor for contracting tuberculosis:
In 2011 ... Among those affected, disproportionately higher rates of TB occur among high-risk populations, especially homeless persons. In the United States, 1% of the population experiences homelessness in a given year, but 5.8% of persons with TB reported being homeless within the past year. These findings are not surprising, as persons who are homeless have a high prevalence of conditions that increase the risk of TB, including substance abuse, HIV infection, and residence in crowded shelters. This combination of conditions is conducive to transmission of TB. Persons who are homeless often lack ready access to the medical care required to make an early diagnosis of TB.
From information in the quoted paragraph above, homeless people have a nearly six times greater chance of catching TB than the general population.

It is difficult for doctors to diagnose TB just from symptoms because the symptoms from a case of TB vary greatly dependent on what part of the body is infected. A good list of the varieties of TB and symptoms most typical at each common body location can be found here, at the TB website.
I have made inquiries about any new TB requirements relating to Sacramento homeless folk coming from the Sacramento county Tuberculosis Control Program. I am hopeful to hear back in the next few days. When I know more, I will post a follow-up blogpost.

Recent events, beginning with the spread of measles at Disneyland on December 28, have made the contagion of virulent disease a hot topic in California. The measles epidemic spread quickly from a woman in her twenties who came to the amusement park. Seven people at the park contracted the disease. In a matter of days, 26 people in four states had the disease, all emanating from the same young infected woman. Today, there is report of people in Canada having measles linked to the Disneyland outbreak.

While TB bacteria is most always transmitted by becoming airborne, from the exhalation of a carrier of the disease followed by the inhalation by an unlucky person who then gets infected, measles is transmitted in that manner, too, but also can be transmitted by shared wet contamination of body fluid -- thus from kissing, shared cigarettes, touching a wet toilet seat, that kind of thing.

Earlier this month, sixteen students at Florin High School, here in Sacramento, tested positive for having tuberculosis out of 155 students and staff at the school who were tested. [An Elk Grove Citizen article on the outbreak can be found here: "Sixteen test positive for tuberculosis at Florin High"]


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