[AnIInWon]

Girl, 16, kicked off plane for coughing

March 30, 2007

A 16-year-old girl who caught a cold during a school trip to New York was kicked off her flight home because she was coughing.

Rachel Collier was removed from the Continental Airlines plane as it was about to leave Newark, N.J., for Honolulu earlier this week. She had fallen asleep after boarding the plane with about three dozen classmates and woke up coughing and gasping for breath as it was about to take off.

"Everyone was looking at me," she said. "I couldn't talk because I lost my voice coughing so much. I was panicking."

The flight attendants gave her water, and a doctor on the flight said she would be OK to make the 10-hour flight. But the captain returned the aircraft to the gate to drop off the girl and one of her teachers.

Rachel said she started crying when the captain told her to leave. She and the teacher finally made it home the next day.

Teacher Maile Kawamura, a chaperone for the spring break trip to New York and Washington, D.C., said she was shocked. The two didn't know what to do or where to stay, she said. They finally found accommodations in New York and bought clothes and toiletries.

Continental said in a statement that Collier was coughing "uncontrollably" on the plane Tuesday and that "the captain felt he was acting in the best interest of the passenger and other passengers on the flight."

Rachel's mother, Stephanie Collier, said Continental has agreed to reimburse her daughter's expenses incurred during the extra day, including the cost of the hotel.

"I felt it was really extreme for a coughing fit," she said. "We've all had coughing fits."

Copyright © 2007 The Associated Press. All rights reserved.
http://news.yahoo.com/s/ap/20070330/...ng_passenger_1


Detained air passengers had seasonal flu

March 27, 2007

Passengers on a flight from Hong Kong were allowed to get off a plane at Newark Liberty International Airport Monday afternoon after being held for two hours because some passengers reported feeling ill, officials said.

The Continental flight arrived in New Jersey at 2 p.m. Monday, and passengers disembarked about 4 p.m. after officials from the Centers for Disease Control and Prevention allowed them off, said Marc La Vorgna, a spokesman for the Port Authority of New York and New Jersey, which operates the airport.

Continental Flight 98 departed Hong Kong with 272 passengers.

During the flight, the cabin crew noticed that several passengers appeared ill, and airline officials notified health authorities in the U.S., said Dave Messing, a spokesman for Houston-based Continental Airlines.

CDC spokeswoman Karen Hunter said seven passengers boarded the plane with flu-like symptoms and during the 15-hour flight, other passengers began to exhibit the symptoms as well. She did not have an exact number.

Emergency services personnel who were sent to the plane to interview the passengers about their symptoms passed on the information to a CDC Global Migration and Quarantine representative at John F. Kennedy International Airport, Hunter said.

"It was determined the symptoms were consistent with possible seasonal influenza and there was no reason to believe it was more serious," said CDC spokesman Glen Nowak. Nowak said the seven passengers who boarded the plane already sick had visited a hospital outpatient center and were diagnosed with the flu, but it wasn't clear whether that visit took place in Hong Kong or the U.S.

The airline and the CDC believe the ill passengers were part of a group of more than 80 tourists who sailed together on a river cruise in Asia.

The final destination of the group, after switching planes in Newark, was Montreal, Canada.

Copyright © 2007 The Associated Press. All rights reserved.
http://news.yahoo.com/s/ap_travel/20...e_passengers_1

[sirmzereigMix]

Could have been worse!

http://www.timesonline.co.uk/tol/new...cle1530572.ece

[Louthcoombutt]

Frankly, CB, I would rather be seated a few seats down from a corpse than from somebody who may be contagious with the flu. Especially if the flight is from Hong Kong... you know, the Avian flu!

~~~~~~~~~

I started this topic in the hope that it would lead to a discussion about where the airlines should draw the line about a passenger who has sympoms of an ailment. Usually strong opinionated, I have mixed feelings about this issue. Pulling passengers off planes for ailments they may or may not have is opening a legal can of worms; then again, who wants to fly next to someone who is incessantly coughing?

Sign me,
Divided Heart

[jamisi]

The New York Times
May 30, 2007

TB Patient Is Isolated After Taking Two Flights

By LAWRENCE K. ALTMAN

Federal and international officials are tracking down passengers and crew members on two trans-Atlantic flights earlier this month who may have been exposed to a man infected with an exceptionally dangerous form of tuberculosis.

The male passenger flew to Paris from his home in Atlanta on May 12 on Air France 385 and arrived in Paris on May 13. He returned to the United States on May 24 after taking Czech Air 104 to Montreal from Prague. The man drove into the United States that day and entered a hospital in New York City on May 25.

The man is now in an Atlanta hospital under federally enforced isolation after he was flown there from New York City on Monday in a plane owned by the Centers for Disease Control and Prevention in Atlanta.

Dr. Martin S. Cetron , an agency official, said he reached the man on his cellphone while he was in Italy to inform him that tests performed before he left for Europe showed that he had a form of tuberculosis that was extremely resistant to standard antibiotics. Dr. Cetron said that he advised the man not to take commercial flights home from Europe and that a United States Embassy would provide assistance, including examination by a tuberculosis expert.

While the agency began to explore ways to bring the man home, he flew to Montreal and drove into the United States. Then, after agency officials made contact with him, he followed their instructions to drive safely into New York without risk to the public.

The New York City health department said the man spent 72 hours in a hospital in isolation and did not interact with anyone other than trained medical workers.

The disease control agency said that because it was the first airline contact investigation for extremely drug resistant tuberculosis, it was not sure that current recommendations were adequate to determine the possible range and risk of transmission on infection.

Dr. Julie L. Gerberding, director of the C.D.C., said her agency was advising passengers on the commercial flights to be tested for tuberculosis even though they are believed to have a low risk of infection.

That appraisal was based on tests showing that the number of tuberculosis bacteria in the man’s sputum were too low to be detected but still enough to infect others. Dr. Gerberding said her agency was erring on the side of caution because the form of tuberculosis, known as XDR TB, was often fatal and a growing public health threat in many countries.

The advisory applies only to the crew members on the man’s flight and to his fellow passengers, particularly those who were seated next to him and in the two rows behind him and the two rows in front of him.

“We’re not concerned about a generic threat to travelers,” Dr. Gerberding said.

Drug-susceptible, or regular, TB and XDR TB are thought to be spread the same way. The TB bacteria become aerosols when a person coughs, sneezes, speaks or sings. The bacteria can float in the air for several hours, depending on the environment. People who breathe air containing these bacteria can become infected.

The risk of acquiring any type of TB appears to depend on several factors, such as the extent of disease in the person who is the source of the bacteria, the duration of exposure and ventilation.

People who become infected have usually been exposed for several hours or days in poorly ventilated or crowded environments. An important way to prevent the spread and transmission is by limiting an infectious person’s contact with other people. People who have a confirmed diagnosis of TB or XDR TB are placed on treatment and kept isolated until they are no longer infectious.

Contact passengers will be advised to undergo a medical evaluation and testing and then have follow-up tests 8 to 10 weeks later.

Dr. Gerberding said doctors had not determined the source of the man’s infection. Molecular fingerprints used to distinguish among bacterial strains so far do not match that of any other known case, she said. People who think they may have been exposed to TB or XDR TB can call (800) CDC-INFO for more information.

Copyright 2007 The New York Times Company

http://www.nytimes.com/2007/05/30/us/30tb.html

[ulnanVti]

The New York Times
June 2, 2007

A Tangle of Conflicting Accounts in TB Patient’s Odyssey



“Good Morning America”/ABC
Andrew and Sarah Speaker on “Good Morning America.”

By JOHN SCHWARTZ

As the Atlanta lawyer with a dangerous form of tuberculosis began treatment yesterday in Denver, the patient and government officials here and abroad provided sharply divergent accounts of his 12 days of world travel. The accounts seemed to agree only in the missed opportunities to head off what has become an international public health scandal.

The patient, Andrew Speaker, has said that public health officials in Fulton County, Ga., told him a trip would not be risky. But those officials said that he had been clearly warned of the dangers. In interviews, public health officials at the county, state and federal levels all said he should not have traveled and defended their handling of the case.

The finger-pointing extended to Canada, Greece and Italy, where officials said they had received no word of Mr. Speaker’s presence in their countries in time to take action. Italian officials said they were first informed unofficially of an American with a dangerous tuberculosis case while Mr. Speaker was still in Rome, but had to take the initiative in calling the Centers for Disease Control and Prevention in Atlanta to ask for details. That information did not come until after Mr. Speaker had left Italy.

The likelihood that Mr. Speaker might have infected other passengers is low, tuberculosis experts say, because the disease is not as contagious as illnesses like influenza. In any case, Mr. Speaker has not been coughing, and may not have enough TB bacteria in his sputum to spread the disease if he did, health officials said.

But the risk was still real, and the bizarre case calls into question preparations to deal with medical crises like influenza pandemics and even bioterror attacks.

In the sharpest contradiction in the accounts, Mr. Speaker said yesterday on “Good Morning America” that county health officials who met with him all but wished him bon voyage. Although they urged him not to travel to his wedding in Greece because of his tuberculosis, he recalled, they backed off under his father’s lawyerly prodding, saying, “Well, we have to say that to cover ourself, but he’s not a risk.”

Steven R. Katkowsky, director of the Fulton County Department of Health and Wellness, said in an interview that the county had little power to detain Mr. Speaker, but insisted that they could not have made their warning more clear. “We told him that if you travel, you’re putting people at risk,” Dr. Katkowsky said.

County officials said Mr. Speaker did change his travel plans after the meeting. But instead of canceling his reservations for a wedding and monthlong honeymoon, he moved up the departure date to May 12 from May 14 — too soon to get the follow-up letter from the county stating, “it is imperative that you are aware that you are traveling against medical advice.”

Dr. Katkowsky said, “We are talking about a person who both had the intent and the means to escape the jurisdiction.”

Lingering Questions

Meanwhile, some of the most intriguing questions still remain unresolved.

Why would a well-informed person aware of medical concerns get on an airplane after receiving a diagnosis of a disease that could be fatal to others? Why would he flee from health authorities once the diagnosis became even more grave? How could the man’s father-in-law, an expert in tuberculosis at the C.D.C., accede to the trip?

Laney Wiggins, a passenger who sat near Mr. Speaker on the Air France Flight 385 from Atlanta to Paris has been tested for tuberculosis and said she expected to learn that she was not infected. But that was small comfort, Ms. Wiggins added. “How many other people can do this or will do this?” she asked. “It’s hard to think about what this means for the future of air travel.”

The story continued to unfold on Friday. In Denver, doctors treating Mr. Speaker said they had started him on medications, and that he would probably be treated for at least two years and may need surgery to remove the infected sixth of one of his lungs.

Dr. Gwen A. Huitt, who is treating Mr. Speaker at National Jewish Medical and Research Center, announced that tests there suggested that it was unlikely he had infected anyone on the flights. “It is our opinion that he is of low communicability,” Dr. Huitt said, as the C.D.C. had also said.

But low does not mean zero, and the basic rules of public health state clearly that people like Mr. Speaker should not fly. Guidelines issued last year by the World Health Organization say that patients with multidrug-resistant TB (a category that includes his type, XDR) “must not travel by public air transportation” until they have proved to be noninfectious.

Though Mr. Speaker has said repeatedly that he believed he was not a risk to others because he was “smear negative” — that is, the bacterium did not show up in his sputum — studies show that 17 percent of tuberculosis cases are traced back to a source whose smear is negative.

In Atlanta, officials at the Centers for Disease Control and Prevention said they had reached 74 passengers out of 310 from the United States, including all 26 people who were in the rows closest to Mr. Speaker on the flight to Paris. The agency is focusing only on American citizens, said Julie L. Gerberding, the director of the centers; she said other nations should be contacting their own citizens. The passengers are being advised to have tuberculosis tests immediately, and to have follow-up tests in several weeks.

When asked why the health organization could not move more quickly and catch up with Mr. Speaker before he took more flights, Dr. Gerberding said in the press conference that much of the previous week’s activity had been spent debating issues concerning the laws and regulations that govern isolation and quarantine in the United States and internationally.

The World Health Organization regulations, she said, are “wonderful statements of principles” that do not provide “operational details of things like who should pay to move a patient, or who should care for a patient.” She said, “I think a central question that we will be grappling with is, whose patient is it?”

For his part, Mr. Speaker apologized to his fellow passengers yesterday on “Good Morning America” on ABC. From his hospital room in Denver he said:

“I don’t expect those people to ever forgive me. I just hope they understand that I truly never meant them any harm.”

He said that when he was contacted by a representative of the Centers for Disease Control in Rome, he was told that he could not fly home unless he chartered a plane — at a cost of $100,000 — and that he should check into a local hospital. “I felt very abandoned,” he said, emphasizing that he firmly believed he could not infect others. He said he feared he might end up “stuck in an Italian hospital indefinitely, where I could die.” But when pressed by the interviewer, Diane Sawyer, he said, “In hindsight, maybe it wasn’t the best decision.”

Missed Opportunities

In that, however, Mr. Speaker appeared to be in good company. At every step in the case, opportunities to head off what became an international public health emergency were lost because of restrictive regulations, poor communication and questionable judgment, those involved with the case said.

Though their accounts differ, the county health authorities and Mr. Speaker agree that the officials did not try to forcibly restrict Mr. Speaker’s movement. Dr. Katkowsky, the county official, said that the law presented “kind of a Catch-22” when it comes to restricting the activities of tuberculosis patients against their will. “A patient has to be noncompliant before you can intervene,” he said. “There’s no precedent for a court stepping in before a patient has proven himself to be non-compliant.”

It would have been an extraordinary step that, while not unheard of in tuberculosis cases, would evoke a centuries-old struggle to balance public health and individual liberty. The term “quarantine” comes from the Italian phrase “quaranta giorni,” or “40 days,” the amount of time Venetians isolated those coming into port in the plague years of the 14th century, said Robert Klitzman, a co-founder of the Columbia University Center for Bioethics and an associate professor of clinical psychiatry at the university’s College of Physicians and Surgeons.

The specter of tuberculosis, the disease called “consumption,” loomed large in the United States, and hospitals devoted to treating the condition sprung up in the American West for those seeking treatment; those who refused treatment, like Mary Mallon, who infected nearly 50 people with typhoid as a cook and domestic servant at the turn of the 20th century, were forced into isolation.

In this century, quarantine and isolation have become less important thanks to vaccines and antibiotics, and civil liberties issues have tended to come to the forefront. Dr. Klitzman said that these days, quarantine and forced medical isolation “have a uniformly bad name to the more liberally-minded people,” raising the notion of “the state violating individual autonomy.”

Mr. Speaker first received a diagnosis of tuberculosis in January after a chest X-ray to see if he had broken a rib in a fall. Yet it would be months before the matter became a priority of county health officials.

The day of the meeting with Mr. Speaker, May 10, the county health officials called the Georgia Division of Public Health, said Dena Smith, the state public health press secretary. That office made a call to the Centers for Disease Control. Ms. Smith said the call from the county left officials in her office with the impression that the problem was largely hypothetical.

“They had no idea at that time that the patient was thinking about leaving the country,” she said. Her office did not receive word that Mr. Speaker had flown overseas until May 17, she said.

When federal health officials tracked him down in Rome, they offered what Mr. Speaker said was a very poor set of options, and let him know that he would be placed on a no-fly list to restrict his movement, officials at the disease centers said yesterday.

Once again, Mr. Speaker changed his travel plans, moving up his departure date and slipping out of the country on a roundabout path that would take him to Prague and Montreal, where he rented a car to return to the United States.

The disease centers learned on May 22 that Mr. Speaker had XDR tuberculosis, but they did not immediately contact Italian health authorities or the World Health Organization, Italian officials said.

Instead, on May 23, C.D.C. officials contacted a doctor who had worked at the disease centers in the past, but is now working in Italy. Dr. Martin S. Cetron of the disease centers said the doctor worked with the Italian Health Ministry, but Italian officials said the doctor was not with their agency. On the same day, Italian officials said, this doctor contacted the Italian Health Ministry to let them know about a tuberculosis case and tell them the disease centers would be in touch.

On May 24, when the Italian Health Ministry still had not received anything, Dr. Maria Grazia Pompa, who leads Italy’s tuberculosis surveillance program, said she “contacted the C.D.C and said, ‘Weren’t you supposed to contact us?’ ”

Dr. Pompa added, “At that time, the disease centers confirmed that there was a case, but did not provide details.” Those came in an e-mail message to Dr. Pompa on the afternoon of May 25, a day after Mr. Speaker drove back into the United States from Canada. United States officials did not get word to Canadian authorities that Mr. Speaker was in their country until after he left, Dr. Gerberding said. She defended that, by saying: “We didn’t know where he was. For all we knew, he was anywhere in the world.”

Still, by the time Mr. Speaker made his way to the United States border, an alert had been attached to his passport that warned customs agents to detain him. But the guard waved him through — a matter that is now under investigation.

On Friday, Homeland Security officials promised to examine anew their systems for detaining sickened travelers, but they acknowledged that there would always be holes in the system.

“We don’t have doctors at all the borders,” said Dr. Jeff Runge, assistant secretary and chief medical officer of the Department of Homeland Security. Indeed, the Division of Global Migration and Quarantine at the disease centers has only about 80 medical officers who can staff only 20 of the nation’s 326 border crossings, Dr. Runge said.

“We will do the best we can with the people we have,” he said.
Security Concerns

Senator Charles E. Schumer, Democrat of New York, said the mistake at the border was a sign that the Customs and Border Protection bureau was stretched too thin, with just 4,000 agents along a northern border that is required by law to have 5,000.

“The agents of the Customs and Border Control bureau are our first line of defense,” Mr. Schumer said. “We cannot afford even one mistake in an incident such as this.”

Other lawmakers called for strong and clear legal authority to deal with public health emergencies. Senator Richard M. Burr, Republican of North Carolina, issued a statement on Friday calling for “strong state and local public health authorities, tools to rapidly detect and track disease, and robust investment in the development of medical countermeasures,” along with “improved coordination between health officials and law enforcement.”

Ultimately, however, the idea of an all-seeing public health and enforcement network that could spot and stop a traveling patient could raise worries of its own, said Michael Osterholm, an epidemiologist who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. “Short of a military state where you have 24/7 surveillance on someone,” Dr. Osterholm said, “you have to count on the good will of the individual.”

He called this a fact of life in an open society, one that could lead to major problems in an outbreak of pandemic influenza, in which many people would probably be boarding planes knowing they were sick to get away from an epidemic. “They would say, ‘I want to make sure I get out,’ ” whatever the risk to others. In that kind of situation, he said, the public health system would inevitably be unable to keep up.

As they sorted through the incidents of the past weeks, officials at the disease centers were left with what might be the biggest question from the case: Is it possible that their tactics, by the time Mr. Speaker was in Rome, inadvertently spurred him to escape? This was, after all, a patient who had already flown away from one set of public health officials who had tried to ground him.

Tom Skinner, a spokesman for the centers, did not address that question directly, but said, “There are going to be many lessons learned from this whole particular incident.”

Reporting was contributed by Lawrence K. Altman and Denise Grady from New York; Brenda Goodman and Rachel Pomerance from Atlanta; Gardiner Harris from Washington; Niki Kitsantonis from Athens; Christopher Mason from Toronto; and Betta Povoledo and Elisabeth Rosenthal from Rome.

http://www.nytimes.com/2007/06/02/he...QZMV/Ty/gcAKUg


I, Rapunzel, declare that this patient is not only physically ill, but also mentally ill for having behaved so irrationally.

[Lotyqnag]

[quote=Rapunzel;156832]Frankly, CB, I would rather be seated a few seats down from a corpse than from somebody who may be contagious with the flu. Especially if the flight is from Hong Kong... you know, the Avian flu!

Well that's really what i wanted to hear! I'm flying to Hong Kong on the 2nd July, so now not only am i going to worry about the flight (i have a real fear of flying), but now i'll be running the risk of catching flu

[MaigicyuNinia]

Don't worry- probability-wise, the chances of your catching it is almost nill.

Also, I suspect that flight crews are looking over the passengers more before the plane takes off. They don't want to catch it either!

Does anybody have a good list of precautions Meerkat can take? Preferably something published by an expert on the subject?

(Aside from, "If somebody near you is visibly very ill, and it's not plane turbulence sickness, try to have your seat moved.")

[PharmaDrMan]

Don't worry- probability-wise, the chances of your catching it is almost nill.

Also, I suspect that flight crews are looking over the passengers more before the plane takes off. They don't want to catch it either!

Does anybody have a good list of precautions Meerkat can take? Preferably something published by an expert on the subject?

(Aside from, "If somebody near you is visibly very ill, and it's not plane turbulence sickness, try to have your seat moved.")

Its ok, i was only joking about the flu - its pretty unlikely i'd catch anything, unless i'm sat next to someone with a cold of course. I don't think there are any precautions i could take really, apart from drinking plenty of fluids and getting up and having a walk periodically. In my job i'm exposed to all sorts of germs / infections etc (i'm a nurse) so i should have a good level of immunity if someone near me has an infection of some sort (well, i hope anyway). God 14 hours in a plane, i'm dreading it.

[jdynwa]

It's the 14-hour plane ride!