Tuberculosis Outbreak Declared in San Francisco

At least fifty cases of tuberculosis have been confirmed among the student body of Archbishop Riordan High School, San Francisco. Yes, tuberculosis—one of those old-timey illnesses of yore, now back in the zeitgeist once again in RFK’s America. Meanwhile, a measles outbreak in South Carolina shows no signs of waning with nearly 900 cases confirmed there. Tuberculosis, once known as “consumption,” has surpassed HIV as the leading cause of death by infectious disease worldwide. 

This isn’t a virus like COVID. Though it spreads the same way, that is where similarities end. This debilitating and potentially fatal illness is the result of infection by Mycobacterium tuberculosis, a worryingly potent bacteria. Research shows it takes as few as ten individual bacilli to trigger the illness in humans. Tuberculosis, or TB, is not your average infection. TB is known for damaging the lungs, but it can also infect the brain, spine, lymph nodes, kidneys and skin. In fact, if the skin does get involved, survivors can develop extensive scarring wherever tubercles bloomed. Worse, the bacteria may lie dormant in the body for years without symptoms, then wake at any time.

TB’s incubation rate is astoundingly long for bacteria, taking around three weeks to culture in lab settings. Dormant, a.k.a. inactive TB, is not contagious—but it is a ticking time bomb. Once it activates, unpredictably so, the germs become communicable. Infected people may present with tolerable, mild symptoms (fatigue, persistent cough), unknowingly spreading the bacteria for weeks, even months. M. Tuberculosis is also particularly robust. It lingers in sneeze droplets, spitwads, dried sputum etc., and survives outside the body alarmingly well. It even defies certain disinfectants, and can survive on countertops and hardwood floors for up to 88 days.  

With a strict, months-long antibiotic regimen, the mortality rate for active TB drops to about 10%. Around one in ten sick people may still die even with treatment. Without medical intervention, the fatality rate soars to 50%. 

A vast majority (50+) of students at Archbishop Riordan High School tested positive for inactive M. Tuberculosis. Given the bacteria’s lengthy incubation period, it is likely this outbreak took root weeks, maybe months ago. TB turns symptomatic when the immune system can no longer hold back the multiplying bacteria. Active TB’s symptoms: Fever, chest pain, night sweats, persistent, sometimes bloody cough. Weight loss, or wasting, is also common, and associated with later or severe stages of TB. Three Riordan High students are currently battling the illness. 

“We now have an outbreak here in San Francisco,” UCSF infectious disease expert Dr. Monica Gandhi told SFGATE. “With 3 active TB cases at Riordan and a new report of 50 latent TB infections…the school has rightly gone to virtual learning while additional testing is being conducted…This seems to be a much more widespread outbreak than originally thought.”

The good news is, a vaccine for TB exists. The bad news, it is only effective for small children. If you have kids ages 5 and under, get them vaccinated!

Remember the R-naught? Basically, it’s the number of people a sick person is expected to infect within a population that has no immunity to the specified pathogen. The R-naught (R₀) for TB is tricky, scaling from 0.26 to over 4. M. Tuberculosis thrives in enclosed environments (classrooms, city buses, ER waiting rooms). It really doesn’t want you to wash your hands. Soap and warm water are too good at breaking down the germ’s protective lipid shells, killing it. This deadly infectious disease just wants to snuggle. Jokes aside, in this failed experiment of a country, curtailing a TB outbreak really does come down to us. 

Consider masking up again, at least in crowded spaces. TB is nothing to fuck with. You could get infected in February and come down with a cough in July. Unlike last time however, there is no miracle vaccine on the horizon.