New York City’s tuberculosis monitoring office is understaffed, making it difficult to respond to instances, causing concern that the disease could make a comeback decades after it was thought to be eradicated in the United States.
According to early internal statistics examined by AWN, the city has verified around 500 cases of active tuberculosis so far this year, an increase of roughly 20% from the same period last year. At that rate, it would be the worst year in at least ten years.
Three officials from the city’s Department of Health’s Bureau of Tuberculosis Control have expressed concern over the length of time patients must wait for treatment at city-run TB clinics. As the temperature drops, the risk of tuberculosis and other respiratory infections spreading rises.
“When there are particularly high spikes in TB and other infectious diseases in New York City, that tends to be kind of a bellwether for the rest of the country,” said Elizabeth Lovinger, health policy director at Treatment Action Group, a public health advocacy group with a focus on TB.
The widespread underinvestment in attempts to manage and eliminate tuberculosis since instances last surged in the early 1990s has led to a worrying scenario in New York City, but some tuberculosis experts say it’s not surprising. As a result of years of budget cuts and numerous vacancies, the Bureau of Tuberculosis Control is ill-equipped to control the disease’s spread.
Despite the widespread belief that tuberculosis is no longer a concern in the United States, health officials have repeatedly cautioned that this phenomena could lead to yet another increase.
However, the scenario in the nation’s largest metropolis portends a probable revival of the disease, which is still a leading killer internationally but has been on the decline in the United States since the height of the AIDS pandemic decades ago. Bacterial in origin, airborne transmission, high mortality rate if untreated.
After the Covid-19 pandemic hampered efforts to diagnose and treat tuberculosis infections, experts projected a rise in the number of cases.
That was exacerbated by the fact that over 100,000 migrants have settled in New York City since spring of 2022. Since tuberculosis spreads rapidly in communal settings like those where the city is lodging migrants, such people have a higher chance of becoming infected with the disease.
Staff members from the TB bureau, who requested anonymity because they were not authorised to speak publicly, claim that preliminary data for the year 2023 has exceeded expectations in the city.
The city has one of the highest rates in the country, with 6.1 instances per 100,000 residents, according to internal data, and is on track to surpass that number this year. This year’s case count in the city could be the highest since 2013 if the current trend continues.
Lovinger characterised the upswing as “more dramatic” than anyone could have predicted.
While incidents have been on the rise, the city has kept silent.
Increased TB incidence is cause for alarm.
Neither Ashwin Vasan, the city’s health commissioner, nor Joseph Burzynski, the director of the health department’s tuberculosis control programme, were accessible for interviews. According to the copied email sent to the bureau, Burzynski instructed staff to ignore AWN’s requests for comment on the city’s tuberculosis control initiatives.
The department’s chest centre in Washington Heights, one of four municipal-run clinics in the city that provide free TB testing and care, has closed, making the situation even worse.
Depending on the feasibility of modernising the facilities, the Washington Heights clinic may reopen, as stated by City Health Department spokesperson Patrick Gallahue, however he did not specify a date. The clinic was temporarily repurposed to aid with the Covid response.
Actively infected individuals might expect to wait two or three days for an appointment at one of the city’s three remaining TB clinics, he added.
However, two workers claimed that wait times are getting significantly longer than that, with one worker citing an instance from earlier this year in which a patient with actively infectious tuberculosis waited more than a week for a medical evaluation. The third worker mentioned that active TB patients are sometimes double-booked so they can be seen as soon as possible.
Patients who are actively infectious should be assessed within three days, as recommended by the TB bureau’s practise handbook. The longer they wait to get treatment, the more likely it is that the disease will spread and the more challenging it will be to treat.
Getting an appointment isn’t the only problem. Patients may have to wait even longer to have a chest X-ray to determine if they have active TB due to a lack of technicians. Due to a serious lack of personnel, the department has recently contracted with the private firm Lenox Hill Radiology for up to $500,000 to conduct chest X-rays.
Gallahue would not comment on the alleged understaffing or the internal data.
He stated in a statement, “The health of our city is our core mission, and we’ll do whatever we can to ensure that no one goes without care.”
New York City previously had a significant uptick in tuberculosis cases in the late 1980s, and the combination of escalating illnesses and a resource-starved bureau is eerily reminiscent of that time.
After reaching its height in the 1960s, the city’s Bureau of Tuberculosis Control had shrunk to just 140 employees and eight clinics by the early 2000s. With the advent of HIV, which weakens the immune system and makes people more susceptible to active TB infection, the lack of investment produced the ideal conditions for a revival.
New York City had become the national hub of the tuberculosis pandemic by the early 1990s. With over 3,000 new cases of tuberculosis diagnosed each year, the city spent $1 billion expanding its TB control programme and staffing the bureau with over 600 workers. City and federal governments reduced financing when the number of local cases dropped into the hundreds.
The city’s budget for tuberculosis control had been cut by more than half by 2014, when it stood at roughly $23 million. A total of 240 positions were allotted for the bureau.
According to Dr. Jay Varma, an epidemiologist who served as the Health Department’s deputy commissioner for disease control under former Mayor Bill de Blasio, “it seems paradoxical, but many disease control programmes struggle harder during the elimination phase than they do during a surge,” because the level of staffing and political commitment declines more rapidly than the case numbers.
Since then, funding has decreased, with only three clinics funded out of the $14.3 million allocated to tuberculosis control in the city’s current budget. That amounts to 151 workers, which is a decrease from last year’s budget of 170 workers, plus a few roles paid by grants. Gallahue, the spokeswoman, refused to disclose information about the number of open positions.
Three workers told AWN that there isn’t enough help on hand. They detailed a wide range of positions reporting staffing issues, from doctors and radiographers to case managers and epidemiologists. Because of the urgency and length of the tuberculosis treatment process, employees have been overburdened.
The Health Department’s TB bureau manages a patient’s care throughout the months-long treatment regimen and often handles follow-up visits, despite the fact that most patients are diagnosed in an emergency room and begin treatment in the hospital. Gallahue estimated that the agency was treating around 1,000 persons with TB at any given time.
The city health worker continued, “We’re all just doing triage all the time.”