Orange County Voices : COMMENTARY ON HEALTH : Fighting TB Will Require Both Short-, Long-Term Solutions : Apathy allowed the disease to resurface. Doctors, public agencies need a comprehensive plan of action.

In the past few years we have fallen prey to earthquakes, firestorms, floods and violence. Our judicial system seems to be in turmoil. Guns, knives and iron rods seem to rule. Graffiti and gangs add to the feeling of fear of what the future holds for Orange County. We have been caught up in the “tabloiding” of the United States, the personalities in the press, the violence of nature and man (excuse me, humans).

In a quiet way, another killer has re-emerged, not with a bang or a flash, but insidiously moving into areas where we weren’t looking.

The areas we chose to ignore: Our deteriorating infrastructure, our underfunded public health system and our substandard living conditions created breeding grounds for an invisible, sneaky disease that we thought had been conquered--tuberculosis.

We became satisfied when tuberculosis rates dropped dramatically in the ‘60s and ‘70s. With improved living conditions and effective medications, tuberculosis was under control. The Tuberculosis Society even changed its name to the American Lung Assn.

Perhaps it slipped people’s notice that, over the past year in three different Orange County cities--in two high schools and a preschool--we had a number of cases of tuberculosis. If your town or school district was not affected, you may have not been aware.

Did you know that in 1993 tuberculosis increased 7% in Orange County?

Did you know that in 1990 we had 258 cases, and in 1993 we almost doubled that number to 440 cases?

Did you know that 12% of the cases are in children under 14 and 18% are in young people between the ages of 15 and 24?

A year ago, the American Lung Assn. of Orange County, the Orange County Health Care Agency and a diverse group of community leaders got together to form a coalition to address this problem. As part of our education plan we feel it is critical that the public be alerted to our concerns.

Although federal emergency funds totaling $360,000 were allocated to Orange County, much more is needed to combat this insidious disease.

We know the county budget is limited, and competing priorities make it difficult to find the funds to meet the increasing needs. The Orange County Health Care Agency is working long hours to follow up the cases in schools; care and treatment must be provided for the increasing caseload.

At the same time, education and prevention efforts are required for the community at large. But additional work needs to be done, and funding is needed.

For example, schools would be hard pressed to screen all children for tuberculosis unless adequate staffing is provided. It is not a requirement to screen children before entering school, and it is at the discretion of the health officer to require this.

A lack of resources has resulted in a recent change in services available to the community. Preventive therapy will no longer be provided to individuals between the ages of 21 and 35 who skin-test positive for tuberculosis but have no other risk factors.

This is not the time for cost-cutting measures. We can learn from the New York experience that declining resources can be linked with the emergence of communicable, drug-resistant tuberculosis that is extremely difficult and expensive to treat and poses an increased risk to health care providers.

I understand that the Health Care Agency will request additional funds to help control tuberculosis. I urge the Board of Supervisors to approve those funds. We must face our dilemma and avoid future costly problems by providing adequate resources now.

We are at the stage where we can stop this disease from becoming what it is throughout the world: The disease that kills more people--more than 3 million a year--than all other infectious diseases combined.

This disease does not discriminate; it delights in finding a place to live in the homeless, the overcrowded, the immune-deficient, the young and the elderly. It is not easily transmitted. It is spread through the air and requires prolonged close contact to be spread. Symptoms to look for include a cough, coughing up blood, weight loss, tiredness, weakness, fever and night sweats.

I urge physicians to “think TB” and to do the appropriate diagnostic tests. I urge pharmacists and other dispensers of herbs and medicines to refer clients to their doctor or the Health Care Agency if they have symptoms of tuberculosis. I encourage teachers to be alert for symptomatic children, and I urge community leaders to be knowledgeable and to ask what they can do.

We need to look for long-term solutions to this problem, including places where homeless, infectious individuals can be treated and followed for as long as needed to cure their disease. We need to look at the impact that health care reform and managed care will have on diseases such as tuberculosis.

Just as all the other issues that confront us today--natural disasters, crime, and racial disharmony--tuberculosis will only be defeated if we educate, plan for the future and provide essential services for the less fortunate.