The ongoing yearlong outbreak of tuberculosis (TB) in the Kansas City, Kansas, area continues to perplex health authorities, a full year after it began. The TB outbreak has led to 67 active cases that are being treated with a combination of antibiotics that must be taken under supervision of health officials for several months to ensure completion of therapy.
There are also 79 people with latent TB, and two have died from their infection. Latent TB is asymptomatic and considered non-contagious, but without treatment it can become active and develop into full-blown TB.
The outbreak has centered around the working class Wyandotte County, which includes Kansas City, Kansas (smaller than neighboring Kansas City, Missouri), and the more affluent suburban Johnson County. While a dozen or so cases would be expected in such an outbreak, according to Dr. Dana Hawkinson, an infectious disease specialist at the University of Kansas Health System, the comparatively high case count over the past year comes as a “stark warning.”
As has been the case since the COVID-19 pandemic, health officials in Kansas have downplayed the threat to the local population despite TB being a contagious respiratory disease. This means that the bacterium, Mycobacterium tuberculosis, which causes TB, is transmitted through airborne aerosol particles.
Jill Bronaugh, spokesperson for the Kansas Department of Health and Environment (KDHE), told the media, “TB is an infectious disease that most often affects the lungs and is caused by a type of bacteria. It spreads through the air when infected people cough, speak or sing. While there is a very low risk of infection to the general public in these communities, KDHE is working to ensure that patients are receiving appropriate treatment, which will limit the ability to spread this disease and prevent additional cases from occurring.” The cause of the outbreak remains unknown. However, health officials said that contact tracing was underway to identify presumed close contacts, and free testing was being offered.
Although health authorities had indicated that the Kansas City, Kansas, outbreak was the largest in US history since records began in 1950, an official from the Centers for Disease Control and Prevention (CDC) told the media that an outbreak of TB cases at homeless shelters in Georgia from 2015 to 2017 led to more than 170 cases of active TB and 400 latent cases. Among US-born patients with TB, being homeless raises a person’s risk of contracting TB ten-fold. The homeless are also more often hospitalized and experience worse outcomes.
Homelessness, affecting 653,104 people in 2023, has been on the rise since 2016, when Trump first took office. It is also a record-high tally and 12 percent above 2022 figures. Analysis for why homelessness exists in one of the richest countries in the world indicates widespread economic disparities, which have worsened in the “post-COVID recovery.”
Skyrocketing housing costs, including both rents and mortgages, are pricing more and more people out of the market. The ending of the COVID-era assistance in 2023 has impoverished an untold number of people. Additionally, limited access to healthcare means more and more people are thrown into the chronic cycle of poverty, depression, substance abuse and mental health crisis, which aggravates their circumstances.
In short, TB, like COVID-19 and every other communicable disease, is a social disease, exacerbated by the inequitable distribution of social resources, including the defunding of public health and healthcare services.
According to the latest data from the CDC on reported cases of TB in the US, there were 9,633 active TB cases for 2023, 15.6 percent more than the 8,320 cases in 2022, and 8.3 percent higher than the 8,895 documented in 2019, the year before the COVID-19 pandemic. While California had the highest number of cases in 2023 with 2,133, Alaska had the highest per capita rate at 10.6 cases per 100,000, a figure 3.65 times higher than the annual case rate for the entire US.
Despite the assurances made by public health officials, the current TB trajectory appears to have wiped out all the gains made from a decade ago, as cases since 2020 are climbing steadily, with 2023 showing the largest uptick in cases in the COVID-19 era. The concerns moving forward also take into account the seismic shift under way against public health, both through the anti-science personnel appointed by Trump and the massive defunding of federal health programs.
The year 2023 also marked TB’s recognition as the leading cause of death globally from a single infectious agent, following COVID-19’s three-year reign in this category. More than 1.25 million people died from TB in 2023, including 161,000 who also had HIV. Overall, 10.8 million had active TB in 2023, up from 10 million in 2020. Given the immune dysregulation caused by COVID-19 infections, one must assume that the ongoing COVID-19 pandemic is, in part, contributing to the global rise of TB.
As the authors of a 2023 study looking at the association between COVID-19 and TB noted, “Clinical evidence suggests that COVID-19 may predispose patients to TB disease or reactivation of latent TB infection through severe depletion and dysfunction of T-cells and uncontrolled production of pro-inflammatory cytokines.”
Although the disease is curable and preventable, multidrug-resistant TB (MDR-TB) continues to pose as a serious health crisis and security threat. According to the World Health Organization, only 40 percent of those with drug-resistant TB accessed treatment in 2023. While a mere $22 billion is needed annually for global TB prevention, diagnosis and treatment to achieve stated 2027 targets, the current political climate raises significant concerns about the trajectory for TB and other communicable diseases.
In the first 10 days of the Trump administration, it has become clearly evident that public health and all social programs are to be gutted and federal resources directed to the buttressing of the military and the enhancement of the police state apparatus. TB is but one example of the ongoing crisis in public health, along with the continuing COVID-19 pandemic and the danger of the eruption of a deadly bird flu pandemic that could rapidly kill millions.