TB still out there

Apr. 14—Less prevalent than in poorer countries, tuberculosis is still around in the U.S. and Permian Basin.

TB is a bacterial infection that is an airborne particle. Anyone can get it, but it tends to affect people that may have other health conditions or their immune system is compromised.

"It tends to be more common in third-world countries because they don't have as many treatment options," Midland College respiratory care Clinical Director Holly Baker said.

"People get sick with it and it gets spread, because the people that get sick with it don't have the availability to get treatment so it is fairly widespread. We still have quite a few cases here in the U.S. every year. But there are treatments. It's six or nine month treatment regimens, certain medications that they have to take, and so you can't get rid of it," Baker said.

When people were wearing masks, there was a downturn in flu and other viruses and when mask wearing stopped there was a small uptick, she said.

Masks did prevent people from getting the flu during COVID, but to prevent TB, you'd have to wear a fitted N95 mask. Even then health providers say you can still get it because it lingers in the air.

Baker said there is more interest in respiratory therapy now because it became better known.

"Beforehand, not everybody knew about us or knew what we did, so there's been a lot more interest," she added.

Odessa College is starting its respiratory therapy program again, but Baker said they never stopped at MC.

The two-year program has about 24 students between the first and second years. It lasts all year and it's all in person.

Respiratory therapists are now in demand.

"When I graduated, it was hard to find a job. I went to Fort Worth. I grew up in Fort Worth, so I went to school there and I couldn't find a job just because the hospitals had plenty of staff. The area was saturated, so that's why I ended up moving out here," Baker said.

"But now when these kids graduate, they're going be able to go wherever they want to go, because the hospitals are all hurting," she added. "COVID kind of changed the face of health care. So many people left and got out and so hospitals are still really hurting."

In general, respiratory therapists do a wide variety of things, but Baker said it varies a little bit from hospital to hospital.

"We're used in the ER; we're used on the floors; we're used in critical care. General care, we'll give breathing treatments to COPD (patients), asthmatics. We'll do things called chest physiotherapy where we help to move the secretions up and out for those patients that have really thick sputum," Baker said.

"ER, ICU, we'll either put the artificial airway down for the patient to breathe or will assist the physician in that and then we run the machine that keeps them breathing. That's just kind of a flyover overview ... We're at every code, so our job is to manage that airway," Baker added.

They are also brought in for consults so doctors can figure out what therapies or protocols need to be ordered. Respiratory therapists also work with cystic fibrosis patients.

The MC respiratory therapy faculty has two full-time, two part-time and a couple of PRNs or as needed staff. Baker said the program has grown staff and student wise since she arrived.

The classes the past couple of years have had four or seven students. The group that just started in the fall has 15 and there are more than 30 applicants for the fall.

Clinical sites are in Odessa, Midland, Monahans and UMC and Covenant in Lubbock.

Kisha Rasband, an instructor in Odessa College's vocational nursing program in Monahans, is an associate degree registered nurse. She earned her nursing degree from OC in 2010.

"Tuberculosis is kind of a weird disease because it can be dormant for so long. You can have a latent case of tuberculosis that you got from a time when you were a young adult and it did not present as an active disease process until you're an older adult," Rasband said.

Active TB is what most people associate with tuberculosis because that's when you're seeing coughing, fatigue, low iron and anemia, for example.

"But if you look at our statistics, the CDC actually says there's 13 million people in the U.S. that have latent tuberculosis that don't know about. There are times that we'll actually see more active cases through this area, especially because we are close to the border we do see cases pick up occasionally. Our health department tracks those, so we do see more cases than our inlander friends. But it's not a disease that we typically think of in the U.S. as being a big plague because we almost eradicated tuberculosis in our country," Rasband said.

Some employers still want you to take a TB test in the healthcare industry, especially because tuberculosis is thought of as a silent killer that's just waiting.

Healthcare professionals are constantly being tested for TB.

Rasband said the first time there was an increase in the TB disease process was 2019 when COVID occurred.

Prevention is quarantine of people with active TB, the symptomatic type.

"But the thing that stands us and other developed countries apart is the active treatment of TB. We treat it before it's symptomatic. The other thing that happens is we're able to, because we have standardized medicine, we actively go to the doctor when we have health concerns. So all those comorbidities that cause TB to be so concerning we're getting treatment for. Because we have a better healthcare system, we have less risk of that high incidence of TB. Our bodies are more effectively able to fight against it," Rasband said.

Prevention is difficult because vaccines are only 20 percent effective, which is one of the reasons they aren't used here.

Dr. Jorge Fleisher said the disease is more common in people that come from Mexico, Central America or the former Soviet Union.

They never had control, so it's endemic there so the prevalence of people in those countries that have been exposed to TB is more than 50 percent.

"Having uncontrolled diabetes, having malnourishment, having disease processes that you're not taking care of decreases your immunity and so you're not able to fight against that disease process. Really living a healthy lifestyle is the only combat we have against tuberculosis," Rasband said.

TB also mimics other diseases. Some people will go without treatment for a long time because they think it's a cold. Unless they start seeing blood in their coughs, they won't get treatment.

"It's a really interesting disease. It has killed over 1 billion people over the last 200 years which is more than any other disease process. It's been around forever," Rasband said.

In 2008, some skeletons that were 9,000 years old had tuberculosis in the bones.

"Whenever it talks about consumption in our old textbooks it's talking about tuberculosis. This disease has been around for a long time and we're still fighting it; not so much in our developed countries but in our poverty countries; our areas where things like malaria and HIV are prevalent. You're seeing TB as well where malnutrition is prevalent," Rasband said.

You're starting to see eradication in developed countries, but not in underdeveloped countries.

Fleisher, who is affiliated with Steward Hospitals, said if someone has latent TB they have about 10 percent chance of getting active TB in their lifetime.

"Fifty percent of them get TB in the first two years. Then as time goes by the risk of getting active TB is lower. Medications that we use to treat many illness also bring down the immune system in a way that increase risk of TB," Fleisher said.

"I'm seeing a lot of cases of latent TB and those patients should be treated to prevent them from flaring in the future. But now we're a mix of problems because we have a lot of people who decided not to get treated in the past. We could not force everyone to get treated. Now with these new medications and people living longer we're seeing an increase in active TB," he added.

TB is diagnosed through a blood test.

Once it is activated it lasts for many weeks. People present with fever, chronic cough; some patients start to cough up specks of blood. They have night sweats and fever usually at night. They start losing weight.

The main problem is when people cough now, they think of COVID rather than TB.

The disease is treated with antibiotics, but it is very resistant to antibiotics. People are treated anywhere from six to eight months, depending when they clear the infection.