March 31, 2026 • 18 mins
In this episode of Wellness Unmasked, Dr. Nicole Saphier breaks down the alarming headlines surrounding the so-called “white plague”—and reveals the truth behind the rising cases of tuberculosis in the United States.
After decades of decline, TB cases are climbing again, with over 10,000 reported annually—the highest levels in more than a decade. But what’s really driving this trend, and should Americans be concerned?
Dr. Saphier explains:
- What tuberculosis is and why it’s being called the “white plague”
- Why TB cases are rising again after years of progress
- The difference between latent and active tuberculosis
- How COVID-era disruptions impacted public health tracking and treatment
- The role of global migration and screening challenges
- Why early detection, treatment completion, and public health infrastructure matter more than ever
Plus, a look at the history of TB—from its devastating impact in the 18th and 19th centuries to modern-day prevention strategies—and what needs to happen now to stop its resurgence.
See omnystudio.com/listener for privacy information.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to willness A mass I'm doctor Nicole Sapphire, and
we're going to talk about something that's a little funny
this week because I got a couple of radio requests,
and you know, usually I get an email or a
text message or a phone call saying, hey, doctor Sapphire,
are you available to talk about this? And in the
subject line it said what they wanted to talk about?
(00:26):
They're like, are you available to talk about the white plague?
And I just found myself sitting there, I'm like, white plague?
What the heck is the white plague? Am I really
that out of touch with reality that there's a plague
going around and I don't even know about it. Maybe
you've seen these headlines, maybe you haven't. They're definitely out there,
(00:46):
and they sound dramatic. Certainly grabs attention. That's what these
headlines are for. And yes, it's definitely a bit of
a scare factor baked into that language. But good news,
here's the reality. Okay, So, first of all, they're not
entirely wrong. There are cases of white plague going on
about that around here. But white plague is not some
(01:09):
new emergent bacteria parasite virus that we don't know about.
We're talking about tuberculosis. Apparently it's called the white plague.
I had no idea. I'd actually never heard it before.
Maybe you have. Maybe I'm the only one who's never
heard that tuberculosis was called the white plague. I didn't
learn that in medical school. I haven't seen it in
the hospital. But you know, maybe it's a thing. The
(01:33):
truth is, when we talk about tuberculosis cases are in
fact they're actually rising. So since there are headlines out
there about this, I thought maybe we talk about it
a little bit. So after decades of steady decline, the
United States has now seen multiple consecutive years of rising
(01:53):
tuberculosis cases. In twenty twenty three alone, there were nearly
ten thousand, ten thousand reported cases. That's a fifteen percent
jump from the year prior, one of the largest increases
really in recent years. And looking at the data, it
suggests that unfortunately that wasn't a fluke, that the trend
(02:17):
of rising cases it's continuing. With over ten thousand cases
in twenty twenty four, that was the highest levels we've
seen in more than a decade. So it does seem
that higher cases are here to stay. At least for
right now. It's a trend. So, yes, the White plague.
The headlines may sound sensational, but underneath that language there's
(02:40):
real public health story unfolding. So let's unpack that a
bit today. That's what I want to talk about. In
the eighteenth and nineteenth centuries. That's right, We're going to
go way back. Tuberculosis. It wasn't just a disease. It
was a defining force of life and death. At its peak,
tuberculosis accounted for up to twenty five percent of all
(03:02):
deaths in Europe, one in four deaths because of TV
in Europe. It was called then the white plague. I
guess I didn't read that in my history novels, but
it was called the white plague then because of how
it made people look. They looked pale, gaunt, they were
wasting away. You've heard the term consumption. That all came
(03:23):
from that time. It came from how slowly it just
consumed the body. This wasn't a fast illness. It was
a slow decline months, sometimes years. It's still that way today.
By the way, it wasn't until eighteen eighty two that
it was discovered the bacterium was responsible for it a
(03:45):
certain bacteria. It's called michael Bacterium tuberculosis. So when you
hear TV or tuberculosis, it's caused by a bacteria. It's
a very specific kind of bacteria. It's called an acid
fast bacteria. I learned all about this when I studied
microbiology and undergraduate degree. It was kind of hard to isolate.
(04:06):
It requires a very specific environment to grow. That's why
it took a while to identify what it was. But
they were able to prove back then that this was
in fact an infectious disease. It wasn't a virus, but
it was a bacteria. Remind you, this is before antibiotics,
so bacterium were scary because they didn't have a way
(04:26):
to treat them. Patients were isolated in santoriums. They literally
took patients who were infected with this bacterium and just
said here, you go go live in isolation because we
have no way to rid you of this infection. So
just go live and die out here, please, and don't
give it to the rest of the community. People were
(04:48):
sent there for months or even years. For most people.
Wasn't necessarily a treatment, It was just a place to wait.
Some recovered, many died, But even today you kind of
see some of that echoing of that history from over
a century ago. I remember early in my training, I mean,
(05:10):
we had TV isolation rooms. We still have rooms that
we have. We put patients in if they're suspected of
having tuberculosis negative pressure mass required limited contact, because yeah,
this is not something you want to come in contact with.
It's not easily treated. It's not like, oh, I'm just
going to have a five day course of antibiotic and
(05:32):
I'm going to rid myself of this. No, no, no treatment
for tuberculosis. It's not like that. But you know, it's
just it's interesting to see that these headlines that these
cases are increasing, because well, you know, when I was
in training and early on in my career, we talked
a lot about it. You don't hear much about it
these days. You know, inside of these isolation room it's
(05:54):
usually a patient who's thin, not doing so well, coffee,
they're exhausted, they probably haven't been feeling well for months.
And so when I would see these patients, and what
struck me the most, it wasn't just the illness, it
was the isolation. What we did to these people It
really took us back, you know, way before modern medicine.
(06:18):
Is what it felt like, you know, meals left at
the door, no visitors care, delivered at a distance. Does
the sound familiar? It kind of reminds me of COVID.
We did the same thing during COVID. COVID has kind
of come and gone, we don't do the same thing anymore.
But tuberculosis we still do. We understand why tuberculosis it's airborne,
(06:39):
similar to COVID, similar to other infectious diseases like smallpox
travels in the air, measles travels in the air, very
contagious because all you have to do is be in
the general vicinity of someone who's positive. You breathe the
air they're breathing, and you have the potential to be infected.
But the humans of that experience, you know, the separation,
(07:02):
the stigma. I guess that hasn't really changed nearly as
much as we think. But here's the part that we
don't talk enough about tuberculosis. It didn't decline because of
one singular breakthrough, one singular modern medicine. Sure, yes, antibiotics helped,
(07:23):
but it really declined because of layered public health measures. First,
and foremost yes, antibiotics an amazing discovery. Obviously saves a
lot of lives. It's also wreaked a lot of havoc.
We've talked about what it's done to our gut health
and antibiotic resistance bacterian stuff, but that's an entirely different episode.
(07:45):
Talking about tuberculosis. The layered public health measures that have
led to the decline of cases. Antibiotics for sure, improving
of just housing and nutrition screening programs, making sure people
who are higher risk we are able to to ask
some questions about their symptoms, their lifestyle, and detect early cases,
(08:06):
contact tracing, isolation protocols, and really just directly observed therapy
to ensure that patients are completing their treatment. All of
these systems they worked. In the United States, tuberculosis cases
felled dramatically over decades, from tens of thousands every single
year to under ten thousand, and globally, TB efforts since
(08:30):
two thousand, so about a quarter century have saved tens
of millions of lives. This is one of the greatest
public health successes stories that we rarely highlight. But here's
the concern we're now seeing. I mean, mind you. It's
you know, it's slight, but we are seeing a reversal
of some of that progress. In the United States, cases
(08:53):
have been rising since twenty twenty one. So let's talk
about that for a second. You had decrease of like
flu in twenty twenty, a decrease in most other public
health infections early twenty twenty twenty twenty one because people
were kind of sheltering in place because of COVID. But
(09:14):
all of a sudden, we started seeing tuberculosis cases rising.
There has been a fifteen percent increase in twenty twenty
three alone, and now we're up, as I mentioned, ten
thousand cases annually. And now if you look around here
in the United States, there are about thirteen million people
who have what's called latent TB, meaning they have tuberculosis.
(09:38):
They may not be symptomatic, they may not be active.
It's not an active infection, but it's still kind of
brewing inside of them. And you know, during COVID, to
be honest, we lost momentum when it came to tuberculosis.
We had fewer screenings, we had delayed diagnosis, people were
interrupted in their treatments, and let's be honest, people only
cared about COVID during that time. They didn't care about cancer,
(10:00):
they didn't care about heart attacks, and they certainly didn't
care about tuberculosis. But let's talk about what else happened
during that time. Now, during that time early on in
the pandemic, people just stopped moving altogether across the globe.
You didn't have a lot of travel. There wasn't a
lot of migratory efforts whatsoever, because well there are travel restrictions,
(10:22):
but people were really just staying put. In the United States, specifically,
in about twenty twenty one, you started seeing a lot
more traffic happening at the southwest border. Most TB cases,
the reality is occur in individuals who are born outside
of the country to now migrate into the United States.
(10:45):
This isn't about blame. I'm not trying to point fingers
at anybody. I'm just talking about facts. When it comes
to epidemiology, that's what happens. TB is more common in
certain regions globally. Many individuals are exposed earlier in life,
and the infection it truly can just remain in their
system for years, decades. They may not even have symptoms.
(11:08):
That's latent. TB like I talked about later on, as
the immune system weakens. It happens to all of us
as we get older, or another illness develops and you
take some sort of medication whatever it is. For whatever reason,
your immunity decreases during time. At that point the infection
(11:30):
can become active. So this bacteria is kind of like
living inside of you, but they're silent, they're sneaky. It's
just waiting for your immunity to drop. For whatever reason
it can drop, maybe you're not eating enough fruits and vegetables.
Maybe you have the flu one year and it kind
of just wipes you out. Maybe you're taking biologics for
(11:51):
an autoimmune disease. Whatever happens, all of a sudden, your
immune system decreases your ability to fight off infection. You
have this latent or sneaky bacterium tuberculosis just hanging out waiting,
waiting for the right opportunity to activate. And so that's
what happened. And so once the infection becomes active, it
(12:15):
can be detrimental. And importantly, many cases occur years many
years after the arrival, meaning after the person has been infected.
Highlighting that this is a latent disease management issue. It's
not just simply border control, because people who are coming
across the border, if you're screening them solely for symptoms,
(12:38):
the majority of people who are crossing probably don't have
active tuberculosis because active tuberculosis makes you very sick and
you probably can't make that arduous journey across the Southwest
border in the desert and with all the other obstacles
you face. Doesn't mean that they don't have latent tuberculosis
that once they come into the United States, whether they
(13:00):
acclimate or don't, whatever it is, it can then activate.
Now the United States, they already have pre immigration screening,
targeted testing, and very small pockets of public health follow up,
but huge gaps remain. As I mentioned latent TB, it's
often silent. The treatments requires months of adherence. So even
(13:24):
if you identify someone who has either latent or active TB,
it's not that they're going to take that five or
seven day course of antibiotics. Oftentimes they need to be
on it for I mean really like six months. They
need to be actively monitored. So the real focus at
the border anywhere else should be better screening, stronger follow up,
(13:48):
and ensuring treatment completion, because that's what's important. It's one
thing to diagnose it. It's one thing to give someone
a prescription, but it's another thing to make sure that
they have completed that in higher course and it has
done the trick and has gotten rid of the infection.
Because infectious disease they don't respect borders, but strong public
(14:09):
health systems can certainly contain them. So the pathboard it's
not really that complicated, but it does require commitment first
and foremost, it truly does rely on early detection, expands
straining in high risk populations, and that includes anyone who
is crossing our borders coming to the United States, because
(14:32):
they're significantly higher rates of latent and active TB everywhere
else other than our country. You also see them in
prison populations, in homeless shelters, anywhere where you have people congregating,
and it's important to be screening these individuals. Second, we
need to be treating latent TB. This is where most
(14:54):
cases originate here in the United States. Just because someone
doesn't have symptoms, that does I mean we don't treat them.
We need to be doing blood tests, we need to
be doing X rays, we need to be doing everything
we possibly can to ensuring someone doesn't just have latent
B that will be reactivated later in their life and
(15:14):
then they're able to spread it. And as I mentioned,
ensuring treatment completion but also making sure that the treatment
is accessible and affordable is equally vital. But making sure
someone completes their treatment, whether it is a weekly check in,
whether there is some sort of incentive to making sure
that they complete it, whatever it needs to be, that's
(15:37):
really important, and we have to reinvest in our public
health infrastructure. We see a lot of cuts when it
comes to public health, and I understand that there's a
lot of hostility when it comes to our public health
infrastructure ever since COVID specifically, But the reality is this
is the health of the nation that we're talking about.
(15:58):
I'm talking about contact tracing, community outreach, and any sort
of follow up systems. Public health nurses, social workers, and
those who are really making sure that people who have
been identified as high risk for TB or even having TB,
that they are followed continuously and we are ensuring that
not only they're healthy, they're family healthy, but everyone around
(16:21):
them is also healthy. Obviously, we want to talk about
global investments. You have the World Health Organization and some
other nonprofits, Doctors Without Borders and so forth, who are
in charge of that. I'm not really going to get
into the weeds of that, but it is more than
just a local problem. As I mentioned, the majority of
(16:42):
cases here in the United States originating people who came
from elsewhere in the world. So it would be with
us to make sure that we are working with our
global partners to decrease tuberculosis cases. And I guess again,
tuberculosis was once the don't quote white plague. White plague
does sound scary. It was a nice little history lesson
(17:06):
for myself to learn this new verbiage. The reality is,
I don't want to call it a plague today because
that makes me think of those plague mass and a
horrible time in our global history when it comes to
public health. But the reality is tuberculosis is alive and well.
It is a disease that we associate with history. But
if we look at data, walk through a hospital isolation unit,
(17:29):
we just zoom out globally and you'll realize it certainly
has not been eliminated. Yes, it's been controlled, but the
control requires vigilance because in medicine success isn't permanent. It
is maintained, and it's only maintained if we keep up
on our public health efforts. We have lagged a little
(17:50):
bit when it comes to tuberculosis, so we need to
get back to it. Thank you so much for joining
me on Wellness Unmass. I'm doctor Nicole Sapphire. Sure to
listen to Wellness on Mass on iHeartRadio, Apple Podcasts and
wherever you get your podcasts, and I'll see you next time.
Welcome to willness A mass I'm doctor Nicole Sapphire, and
we're going to talk about something that's a little funny
this week because I got a couple of radio requests,
and you know, usually I get an email or a
text message or a phone call saying, hey, doctor Sapphire,
are you available to talk about this? And in the
subject line it said what they wanted to talk about?
(00:26):
They're like, are you available to talk about the white plague?
And I just found myself sitting there, I'm like, white plague?
What the heck is the white plague? Am I really
that out of touch with reality that there's a plague
going around and I don't even know about it. Maybe
you've seen these headlines, maybe you haven't. They're definitely out there,
(00:46):
and they sound dramatic. Certainly grabs attention. That's what these
headlines are for. And yes, it's definitely a bit of
a scare factor baked into that language. But good news,
here's the reality. Okay, So, first of all, they're not
entirely wrong. There are cases of white plague going on
about that around here. But white plague is not some
(01:09):
new emergent bacteria parasite virus that we don't know about.
We're talking about tuberculosis. Apparently it's called the white plague.
I had no idea. I'd actually never heard it before.
Maybe you have. Maybe I'm the only one who's never
heard that tuberculosis was called the white plague. I didn't
learn that in medical school. I haven't seen it in
the hospital. But you know, maybe it's a thing. The
(01:33):
truth is, when we talk about tuberculosis cases are in
fact they're actually rising. So since there are headlines out
there about this, I thought maybe we talk about it
a little bit. So after decades of steady decline, the
United States has now seen multiple consecutive years of rising
(01:53):
tuberculosis cases. In twenty twenty three alone, there were nearly
ten thousand, ten thousand reported cases. That's a fifteen percent
jump from the year prior, one of the largest increases
really in recent years. And looking at the data, it
suggests that unfortunately that wasn't a fluke, that the trend
(02:17):
of rising cases it's continuing. With over ten thousand cases
in twenty twenty four, that was the highest levels we've
seen in more than a decade. So it does seem
that higher cases are here to stay. At least for
right now. It's a trend. So, yes, the White plague.
The headlines may sound sensational, but underneath that language there's
(02:40):
real public health story unfolding. So let's unpack that a
bit today. That's what I want to talk about. In
the eighteenth and nineteenth centuries. That's right, We're going to
go way back. Tuberculosis. It wasn't just a disease. It
was a defining force of life and death. At its peak,
tuberculosis accounted for up to twenty five percent of all
(03:02):
deaths in Europe, one in four deaths because of TV
in Europe. It was called then the white plague. I
guess I didn't read that in my history novels, but
it was called the white plague then because of how
it made people look. They looked pale, gaunt, they were
wasting away. You've heard the term consumption. That all came
(03:23):
from that time. It came from how slowly it just
consumed the body. This wasn't a fast illness. It was
a slow decline months, sometimes years. It's still that way today.
By the way, it wasn't until eighteen eighty two that
it was discovered the bacterium was responsible for it a
(03:45):
certain bacteria. It's called michael Bacterium tuberculosis. So when you
hear TV or tuberculosis, it's caused by a bacteria. It's
a very specific kind of bacteria. It's called an acid
fast bacteria. I learned all about this when I studied
microbiology and undergraduate degree. It was kind of hard to isolate.
(04:06):
It requires a very specific environment to grow. That's why
it took a while to identify what it was. But
they were able to prove back then that this was
in fact an infectious disease. It wasn't a virus, but
it was a bacteria. Remind you, this is before antibiotics,
so bacterium were scary because they didn't have a way
(04:26):
to treat them. Patients were isolated in santoriums. They literally
took patients who were infected with this bacterium and just
said here, you go go live in isolation because we
have no way to rid you of this infection. So
just go live and die out here, please, and don't
give it to the rest of the community. People were
(04:48):
sent there for months or even years. For most people.
Wasn't necessarily a treatment, It was just a place to wait.
Some recovered, many died, But even today you kind of
see some of that echoing of that history from over
a century ago. I remember early in my training, I mean,
(05:10):
we had TV isolation rooms. We still have rooms that
we have. We put patients in if they're suspected of
having tuberculosis negative pressure mass required limited contact, because yeah,
this is not something you want to come in contact with.
It's not easily treated. It's not like, oh, I'm just
going to have a five day course of antibiotic and
(05:32):
I'm going to rid myself of this. No, no, no treatment
for tuberculosis. It's not like that. But you know, it's
just it's interesting to see that these headlines that these
cases are increasing, because well, you know, when I was
in training and early on in my career, we talked
a lot about it. You don't hear much about it
these days. You know, inside of these isolation room it's
(05:54):
usually a patient who's thin, not doing so well, coffee,
they're exhausted, they probably haven't been feeling well for months.
And so when I would see these patients, and what
struck me the most, it wasn't just the illness, it
was the isolation. What we did to these people It
really took us back, you know, way before modern medicine.
(06:18):
Is what it felt like, you know, meals left at
the door, no visitors care, delivered at a distance. Does
the sound familiar? It kind of reminds me of COVID.
We did the same thing during COVID. COVID has kind
of come and gone, we don't do the same thing anymore.
But tuberculosis we still do. We understand why tuberculosis it's airborne,
(06:39):
similar to COVID, similar to other infectious diseases like smallpox
travels in the air, measles travels in the air, very
contagious because all you have to do is be in
the general vicinity of someone who's positive. You breathe the
air they're breathing, and you have the potential to be infected.
But the humans of that experience, you know, the separation,
(07:02):
the stigma. I guess that hasn't really changed nearly as
much as we think. But here's the part that we
don't talk enough about tuberculosis. It didn't decline because of
one singular breakthrough, one singular modern medicine. Sure, yes, antibiotics helped,
(07:23):
but it really declined because of layered public health measures. First,
and foremost yes, antibiotics an amazing discovery. Obviously saves a
lot of lives. It's also wreaked a lot of havoc.
We've talked about what it's done to our gut health
and antibiotic resistance bacterian stuff, but that's an entirely different episode.
(07:45):
Talking about tuberculosis. The layered public health measures that have
led to the decline of cases. Antibiotics for sure, improving
of just housing and nutrition screening programs, making sure people
who are higher risk we are able to to ask
some questions about their symptoms, their lifestyle, and detect early cases,
(08:06):
contact tracing, isolation protocols, and really just directly observed therapy
to ensure that patients are completing their treatment. All of
these systems they worked. In the United States, tuberculosis cases
felled dramatically over decades, from tens of thousands every single
year to under ten thousand, and globally, TB efforts since
(08:30):
two thousand, so about a quarter century have saved tens
of millions of lives. This is one of the greatest
public health successes stories that we rarely highlight. But here's
the concern we're now seeing. I mean, mind you. It's
you know, it's slight, but we are seeing a reversal
of some of that progress. In the United States, cases
(08:53):
have been rising since twenty twenty one. So let's talk
about that for a second. You had decrease of like
flu in twenty twenty, a decrease in most other public
health infections early twenty twenty twenty twenty one because people
were kind of sheltering in place because of COVID. But
(09:14):
all of a sudden, we started seeing tuberculosis cases rising.
There has been a fifteen percent increase in twenty twenty
three alone, and now we're up, as I mentioned, ten
thousand cases annually. And now if you look around here
in the United States, there are about thirteen million people
who have what's called latent TB, meaning they have tuberculosis.
(09:38):
They may not be symptomatic, they may not be active.
It's not an active infection, but it's still kind of
brewing inside of them. And you know, during COVID, to
be honest, we lost momentum when it came to tuberculosis.
We had fewer screenings, we had delayed diagnosis, people were
interrupted in their treatments, and let's be honest, people only
cared about COVID during that time. They didn't care about cancer,
(10:00):
they didn't care about heart attacks, and they certainly didn't
care about tuberculosis. But let's talk about what else happened
during that time. Now, during that time early on in
the pandemic, people just stopped moving altogether across the globe.
You didn't have a lot of travel. There wasn't a
lot of migratory efforts whatsoever, because well there are travel restrictions,
(10:22):
but people were really just staying put. In the United States, specifically,
in about twenty twenty one, you started seeing a lot
more traffic happening at the southwest border. Most TB cases,
the reality is occur in individuals who are born outside
of the country to now migrate into the United States.
(10:45):
This isn't about blame. I'm not trying to point fingers
at anybody. I'm just talking about facts. When it comes
to epidemiology, that's what happens. TB is more common in
certain regions globally. Many individuals are exposed earlier in life,
and the infection it truly can just remain in their
system for years, decades. They may not even have symptoms.
(11:08):
That's latent. TB like I talked about later on, as
the immune system weakens. It happens to all of us
as we get older, or another illness develops and you
take some sort of medication whatever it is. For whatever reason,
your immunity decreases during time. At that point the infection
(11:30):
can become active. So this bacteria is kind of like
living inside of you, but they're silent, they're sneaky. It's
just waiting for your immunity to drop. For whatever reason
it can drop, maybe you're not eating enough fruits and vegetables.
Maybe you have the flu one year and it kind
of just wipes you out. Maybe you're taking biologics for
(11:51):
an autoimmune disease. Whatever happens, all of a sudden, your
immune system decreases your ability to fight off infection. You
have this latent or sneaky bacterium tuberculosis just hanging out waiting,
waiting for the right opportunity to activate. And so that's
what happened. And so once the infection becomes active, it
(12:15):
can be detrimental. And importantly, many cases occur years many
years after the arrival, meaning after the person has been infected.
Highlighting that this is a latent disease management issue. It's
not just simply border control, because people who are coming
across the border, if you're screening them solely for symptoms,
(12:38):
the majority of people who are crossing probably don't have
active tuberculosis because active tuberculosis makes you very sick and
you probably can't make that arduous journey across the Southwest
border in the desert and with all the other obstacles
you face. Doesn't mean that they don't have latent tuberculosis
that once they come into the United States, whether they
(13:00):
acclimate or don't, whatever it is, it can then activate.
Now the United States, they already have pre immigration screening,
targeted testing, and very small pockets of public health follow up,
but huge gaps remain. As I mentioned latent TB, it's
often silent. The treatments requires months of adherence. So even
(13:24):
if you identify someone who has either latent or active TB,
it's not that they're going to take that five or
seven day course of antibiotics. Oftentimes they need to be
on it for I mean really like six months. They
need to be actively monitored. So the real focus at
the border anywhere else should be better screening, stronger follow up,
(13:48):
and ensuring treatment completion, because that's what's important. It's one
thing to diagnose it. It's one thing to give someone
a prescription, but it's another thing to make sure that
they have completed that in higher course and it has
done the trick and has gotten rid of the infection.
Because infectious disease they don't respect borders, but strong public
(14:09):
health systems can certainly contain them. So the pathboard it's
not really that complicated, but it does require commitment first
and foremost, it truly does rely on early detection, expands
straining in high risk populations, and that includes anyone who
is crossing our borders coming to the United States, because
(14:32):
they're significantly higher rates of latent and active TB everywhere
else other than our country. You also see them in
prison populations, in homeless shelters, anywhere where you have people congregating,
and it's important to be screening these individuals. Second, we
need to be treating latent TB. This is where most
(14:54):
cases originate here in the United States. Just because someone
doesn't have symptoms, that does I mean we don't treat them.
We need to be doing blood tests, we need to
be doing X rays, we need to be doing everything
we possibly can to ensuring someone doesn't just have latent
B that will be reactivated later in their life and
(15:14):
then they're able to spread it. And as I mentioned,
ensuring treatment completion but also making sure that the treatment
is accessible and affordable is equally vital. But making sure
someone completes their treatment, whether it is a weekly check in,
whether there is some sort of incentive to making sure
that they complete it, whatever it needs to be, that's
(15:37):
really important, and we have to reinvest in our public
health infrastructure. We see a lot of cuts when it
comes to public health, and I understand that there's a
lot of hostility when it comes to our public health
infrastructure ever since COVID specifically, But the reality is this
is the health of the nation that we're talking about.
(15:58):
I'm talking about contact tracing, community outreach, and any sort
of follow up systems. Public health nurses, social workers, and
those who are really making sure that people who have
been identified as high risk for TB or even having TB,
that they are followed continuously and we are ensuring that
not only they're healthy, they're family healthy, but everyone around
(16:21):
them is also healthy. Obviously, we want to talk about
global investments. You have the World Health Organization and some
other nonprofits, Doctors Without Borders and so forth, who are
in charge of that. I'm not really going to get
into the weeds of that, but it is more than
just a local problem. As I mentioned, the majority of
(16:42):
cases here in the United States originating people who came
from elsewhere in the world. So it would be with
us to make sure that we are working with our
global partners to decrease tuberculosis cases. And I guess again,
tuberculosis was once the don't quote white plague. White plague
does sound scary. It was a nice little history lesson
(17:06):
for myself to learn this new verbiage. The reality is,
I don't want to call it a plague today because
that makes me think of those plague mass and a
horrible time in our global history when it comes to
public health. But the reality is tuberculosis is alive and well.
It is a disease that we associate with history. But
if we look at data, walk through a hospital isolation unit,
(17:29):
we just zoom out globally and you'll realize it certainly
has not been eliminated. Yes, it's been controlled, but the
control requires vigilance because in medicine success isn't permanent. It
is maintained, and it's only maintained if we keep up
on our public health efforts. We have lagged a little
(17:50):
bit when it comes to tuberculosis, so we need to
get back to it. Thank you so much for joining
me on Wellness Unmass. I'm doctor Nicole Sapphire. Sure to
listen to Wellness on Mass on iHeartRadio, Apple Podcasts and
wherever you get your podcasts, and I'll see you next time.
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