Tuberculosis in North Carolina (Feb 9, 2025)
And in Kansas, Michigan, a few other sites…
https://www.the-independent.com/news/health/tuberculosis-outbreak-north-carolina-symptoms-b2692889.html
North Carolina is currently reporting one of the worst tuberculosis outbreaks in many years. Please click on link above for full story. Tuberculosis is a disease that we’ve never fully eliminated (in the USA) and there are usually very few cases every year. Consider my medical school experience: Despite seeing thousands of patients (in the early 2000s btw, before our society began collapsing), I had only one TB case in my training and this was from someone who had traveled from an area abroad known to have abundant TB.
What does this all mean? Why are we seeing so many TB cases spread over such a wide geographic area? It’s hard to know exactly why this is occurring but I will put forth a couple of hypotheses:
The extreme dismissal of regular ‘infection prevention’ techniques as a result of the politicization of infectious disease. There has been a drastic change in the way approximately 40% of the US population view infectious disease—that we really shouldn’t worry because our immune systems are good enough. This is disastrous when you consider that in a fatal infectious disease it is often the work of the immune system that results in so much of the damage. The best strategy is to not get sick at all, if possible. And TB is not one of those diseases you want to challenge your immune system with because it’s very good at evading it as part of its pathologic process.
Mass immune dysfunction as a result of Covid-19 infections. I truly hope this sentence isn’t where you are just now finding out that C19 infection can have an immunosuppressive effect (with some scientists actually referring to it as ‘airborne HIV’). This is why so many people got COVID then in the weeks and months after the infection, got sick again and again. That didn’t happen to everyone, but it happened to enough people that this was a well-known phenomenon. If repeated COVID infections harmed the immune system, then it is possible that exposure to TB may have allowed more infections to settle in than would have otherwise.
Random chance? I have my doubts on this one, but I have to consider that infectious disease ebbs and flows and this could just be an “up cycle” statistically. I keep a very close eye on TB reports and have for many years and I don’t ever remember it popping up in so many places at around the same time.
New strain? That has yet to be determined. Could a more infectious version of TB be out there right now and that’s why we are seeing more of it? We certainly have to consider that but we won’t know until these cases are looked at from a molecular /genetic perspective to see if there are any genes upregulated that promote immune system evasive or overall pathogenicity of the organism Mycobacterium tuberculosis.
So what should you do? As always, just be aware of your communities. Look for local statistics (if available) and see if you can get a sense for the burden of disease. The number one technique I use is that if I see/hear anyone coughing excessively (a primary symptom of TB and other respiratory disease), I will avoid that area/space if possible. I’ve even been known to walk into a store, observe someone coughing their head off, then turn around and leave without conducting my business. Hey, laugh all you want but I’ve only been sick 1 time in the last six years.
Lastly, what about masking? I’m only going to tell you to wear one based on your circumstances. I for one have gone back to wearing a mask from the moment I walk into the hospital until the moment I leave (aside from taking it off when I am in an office with the door closed). Furthermore, I tend to use a KN95 or N95 in most spaces. Cloth masks and loose fitting surgical masks really aren’t great for stopping a disease like TB or others. I also try to minimize my time in crowded indoor spaces (grocery, big box stores etc). And of course you can never go wrong with frequent hand sanitizer / hand washing. If I am in a particularly crowded space with anyone who seems to be sick, I also wash my face when I get home (in particular around the eyelids, nose, mouth).
If you’ve followed me for a while you’ve heard me say these things over and over. But that’s only because we’ve known for a century that these techniques work!
Also, be vigilant against the thought terminating cliche such as “you’re just living in fear” or “trust your immune system”. Neither one of those incantations are going to stop what’s coming, so advocate for yourselves and your families!
—DLW
As a school nurse, I mask when I go into classrooms and when children come into the nurse's office. There is a reason for my blog's name, hands on nursing in a germ factory.
So nice to hear an authority on the matter of infectious diseases. Too many contrary and unprofessional voices out there telling us to let down our guard. If you listen to them, it will be too late.