L.A. County’s Fiscal Demands vs. TB : Budget cuts must not be allowed to compromise the war on the contagious disease

Tuberculosis, that age-old nemesis of humankind, is in Southern California. We’ve known that for years. Most of the new cases are found among AIDS patients, immigrants and the homeless. We know that. What we may be about to learn, the hard way, is that deep cuts in the Los Angeles County health budget could drastically weaken the ability of health officials to respond to this insidious killer.

TB is an airborne disease that can kill by attacking the lungs. An estimated 2 billion people throughout the world have been infected by TB, and each of these can spread the disease simply through coughing or sneezing. A single carrier, on average, infects three to four other people.

Presently, less than 1% of the world’s TB cases are to be found in the U.S. population, and declines in the number of American cases were recorded in 1993 and 1994. But if recent history is any guide, failure to concentrate attention and resources on the problem could easily lead to a resurgence.

Indeed, that’s what happened in the mid-1980s when, after a decades-long decline, TB cases crept back upward. Los Angeles County mirrored the national trend, registering a jump in cases from 1985 to 1993.

Public health officials have learned they can’t successfully play catch-up with TB. They realize this disease must be attacked aggressively and continuously. They know that means programs such as mobile screening, monitoring of patients in the field and health education, particularly for at-risk immigrant and homeless populations.

Now this pressing demand is face to face with Los Angeles County’s need to cut its budget. Tentative plans call for the county to slash the number of health centers and clinics from 39 to 10.

Treating tuberculosis requires that health facilities have separate waiting, examination and interview rooms to keep infected people from mixing with non-infected patients. That’s standard practice. But according to county health officials, only two of the 10 remaining facilities could do that.

Here’s the dilemma. The county has fiscal obligations but it also is required by law to do everything in its power to monitor and control illnesses that pose a serious threat to the public. That can’t be properly done if the proposed reductions fail to take into account the special threat of TB. If the disease is not contained now, it will cost more down the line. TB is a killer.