The incidence of tuberculosis is growing in New York: it has reached a record high in 10 years

The understaffed agency responsible for monitoring tuberculosis in New York is struggling to respond to new cases of the disease, fueling fears of a resurgence of tuberculosis decades after it was brought under control. Writes about this Politico.

About 500 cases of active tuberculosis have been confirmed in the city this year, up about 20% from the same period last year. This figure will be the worst in the last decade.

There are alarmingly long wait times for treatment at municipal TB clinics, according to three officials from the city's health department's TB Bureau. And the situation may worsen as cold weather sets in, increasing the likelihood of the spread of tuberculosis and other respiratory diseases.

“When New York City has particularly high rates of tuberculosis and other infectious diseases, it tends to send a message to the rest of the country,” said Elizabeth Lovinger, director of health policy at Treatment Action Group, an advocacy group. public health, specializing in the fight against tuberculosis.

The situation in New York is concerning but not surprising to some tuberculosis experts, given the widespread decline in investment in efforts to control and eliminate the infectious disease since its last peak in the early 1990s. The TB Bureau has been weakened by years of budget cuts and large vacancies, leaving its ability to fight the spread of the disease limited.

It's a phenomenon that health officials have repeatedly warned could lead to another surge in cases, despite widespread misconception that tuberculosis is no longer a threat to the United States.

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Tuberculosis has been a relatively minor disease in the United States since the AIDS epidemic decades ago, but the situation in the nation's largest city heralds a possible resurgence of the disease, which remains one of the world's leading killers. The disease, caused by bacteria, spreads through the air and can be deadly if left untreated.

Experts predicted a rise in tuberculosis cases after the COVID-19 pandemic disrupted diagnosis and treatment of patients.

This has been fueled by the arrival of more than 2022 migrants in New York since the spring of 100. They are at increased risk of developing active TB infection because the disease can spread especially quickly in the crowded settings where they live.

Preliminary data for the city for 2023 exceeded expectations, according to employees of the tuberculosis bureau.

According to internal data, city authorities are aware of an increase from last year's rate of 536 newly diagnosed patients, or 6,1 cases per 100 thousand people, which is already one of the highest rates in the country. If this figure continues, this year it will be the highest in the city since 2013.

“This is certainly a sharper recovery than we might have expected,” Lovinger said.

At the same time, city authorities are still silent about the increase in the number of cases of the disease.

Rising incidence of tuberculosis raises concerns

The city health department declined to make Commissioner Ashwin Vasan or tuberculosis program director Joseph Burzynski available for an interview. Burzynski told staff not to respond to inquiries about the city's TB efforts.

The situation is exacerbated by the closure of a center in Washington Heights, one of four city clinics offering free tuberculosis testing and treatment, and the only such center in Manhattan.

City Health Department spokesman Patrick Gallahue said the Washington Heights clinic has been repurposed to help respond to COVID-19 and is being considered for renovations. According to him, the resumption of its work depends on the feasibility of modernizing the premises, but he did not give a time frame.

The average wait time for an appointment at one of the city's three remaining TB clinics is two to three days for actively infected patients, Gallahue said.

However, wait times are increasingly exceeding this figure, according to two staff, with one citing an example of a patient with active tuberculosis waiting more than a week for testing earlier this year. According to another employee, in order to quickly see patients with active tuberculosis, it is sometimes necessary to keep double records.

The TB Bureau's practice guidance states that active infectious cases should be assessed within three days to minimize the threat to public health. The longer they go untreated, the higher the risk of the disease spreading and the more difficult it is to treat.

The problem is not just getting an appointment. Because of a shortage of specialists, patients may wait even longer for a chest X-ray to determine whether they have active TB. The staffing shortage is so severe that the department recently hired private company Lenox Hill Radiology to perform chest X-rays under a $500 contract.

“The health of our city's residents is our top priority, and we will do everything we can to ensure no one is left without medical care,” Gallahue said in a statement.

Problems with financing

The combination of rising TB cases and the bureau's lack of resources is reminiscent of the late 1980s, the last time New York City saw a major surge in cases.

After its peak in the 1960s, the city's Bureau of Tuberculosis Control dwindled to 140 employees and eight clinics. The advent of HIV, which suppresses the immune system and makes people more vulnerable to active tuberculosis infection, has created the perfect environment for a resurgence of the disease.

By the early 1990s, New York City had become the epicenter of a nationwide tuberculosis epidemic. The city spent $1 billion to expand its tuberculosis program, staffing the bureau with more than 600 employees to treat more than 3000 cases a year. As local cases dropped into the hundreds, city and federal officials cut funding again.

By 2014, funding for the city's tuberculosis program had been cut by more than 50% to about $23 million. The bureau was budgeted for 240 positions.

“It seems counterintuitive, but many disease control programs struggle more during the eradication phase than during a surge because staffing levels and political commitment decline faster than the number of cases,” noted Dr. Jay Varma, an epidemiologist who served as serving as the Department of Health's deputy commissioner for disease control under former Mayor Bill de Blasio.

Since then, resources have dwindled further: the city's current budget allocates $14,3 million to fight tuberculosis with just three clinics. These efforts account for 151 employees (up from 170 in last year's budget) and several grant-funded positions. It is unclear how many positions are vacant.

The staffing level is insufficient, according to three employees who spoke to Politico. They described staffing shortages in positions ranging from doctors and radiologists to case managers and epidemiologists. As a result, employees are under great strain due to the time and effort required to treat tuberculosis.

Most patients are diagnosed in the emergency room and treated in the hospital, but the Department of Health's TB Bureau monitors the patient's condition over the course of months of treatment and makes frequent follow-up visits. At any given time, the bureau treats about 1000 people with active or suspected tuberculosis, Gallahue said.

One city health official emphasized: “We are all constantly triaging patients.”