A tuberculosis patient in a hospital for chest diseases in the Indian region of Kashmir.
Drug resistant tuberculosis is expected to increase globally over the next two decades.
New research predicts a steady rise in TB cases that can’t be cured with conventional, first-line antibiotics in four countries.
Researchers from the Centers for Disease Control and Prevention forecast that these complicated — and potentially deadly — cases of TB will become far more common in Russia, India, the Philippines and South Africa by the year 2040.
“Multi-drug resistant TB is going to increase to about 30 percent of cases in Russia,” says Peter Cegielski with the CDC’s Global TB Branch and the senior author of the new report. “It [drug resistant TB] will get to about 10 percent in India and the Philippines and probably about 5 percent in South Africa.”
These four countries already have the bulk of the world’s drug resistant tuberculosis. Because the disease is highly contagious, things look like they’re going to get worse before they get better, even with major efforts to curtail the spread. Last year according to the World Health Organization, there were more than 10 million new cases of TB (both drug-resistant and regular) globally and nearly 2 million TB-related deaths.
Even the simplest cases are difficult to treat.
“Plain TB is curable with six to nine months of treatment,” says Cegielski at the CDC. “Treatment rates for multidrug resistant TB and extensively drug resistant TB are far worse. Mortality rates for MDR are around 30 percent and as high as 80 percent for XDR. That’s worse than most cancers.”
Treatment for drug resistant TB can take up to two years, involve daily injections of highly toxic drugs and can come with severe side effects including psychosis and hearing loss.
Some new strains have emerged that aren’t treatable at all. These cases are labeled “totally drug resistant” because the infections don’t respond to any available antibiotics. The fatality rate is 100 percent.
Part of what’s terrifying about tuberculosis — and particularly drug-resistant TB — is that the bacteria spread through the air. Someone with TB can cough in a room and potentially infect many other people.
“It’s airborne [and] bacilli can remain suspended in the room for hours depending on the ventilation,” says Cegielski. “So anybody in the room can be exposed and infected. And it doesn’t have to be a room, it can be any enclosed environment — a store, a bus, any place like that.”
Because treatment is so complicated Cegielski says there needs to a lot more attention to preventing new infections in the first place.
“Airborne infection control in most countries, particularly in hospitals and clinics, is rudimentary at best or even non-existent,” he says. “It’s really only practiced in affluent countries.”
People attending Rep. Rod Blum’s town hall event in Dubuque, Iowa, this week held up red sheets of paper to show disagreement with what the Republican congressman was saying, and green to show they concurred. The GOP health care bill was a major concern of many.
Scott Olson/Getty Images
Scott Olson/Getty Images
Town hall meetings got loud for some Republican members of Congress this week, as they defended the passage of the American Health Care Act by the House of Representatives. Constituents have been asking a lot of questions, and we’ve been fact-checking the answers given by some leading GOP lawmakers.
Tom Reed, R-N.Y., at a town hall meeting in his district:
“The pre-existing reform is not repealed by this legislation.”
Fact check: That’s not the whole truth
Reed was responding to a constituent who was concerned about a child with severe allergies: “His co-pays and deductibles will be through the roof,” the parent told Reed, “because he’s going to be in a high-risk pool — because he has a pre-existing condition.”
“No, no, no,” Reed told the parent.
The bill does have language that says insurers cannot deny people coverage or charge them more just because they have a pre-existing condition.
However, the GOP bill also has an enormous loophole in that regard. The plan allows states to apply for waivers from the federal government that gets them out of many of the regulations put in place under the Affordable Care Act – including one that bans insurance companies from charging people with pre-existing conditions more for a health plan. A waiver would allow insurance companies to consider a person’s health status when determining what to charge for coverage. And that means that although someone with a pre-existing condition who lives in a state that got a waiver would have to be offered a policy, it could be very expensive.
Steve Scalise, R-La., on Fox News this week:
“No matter what kind of plan you have today,” Scalise told Fox News, “if you have a pre-existing condition, under our bill, you cannot be denied coverage and you cannot be charged more than anybody else.”
Fact check: Not exactly true
Scalise, like Reed, is pointing to the language in the bill that retains the Obamacare rules that prohibit insurers from charging people with expensive medical conditions more than their neighbors of the same age for an insurance policy.
But the state waivers allow insurers a way around that guarantee.
Before the Affordable Care Act, insurance companies denied coverage or charged more if the person who wanted insurance had any of a long list of conditions — including arthritis, diabetes heart disease, muscular dystrophy, obesity and sleep apnea, according to a list compiled by the Kaiser Family Foundation from insurers’ underwriting guidelines.
Insurers also could refuse to cover many medications, including drugs that treat cancer, diabetes, AIDS or arthritis, according to Kaiser.
If you have cancer and buy insurance that doesn’t pay for your cancer treatment, your pre-existing condition is effectively excluded.
Rod Blum, R-Iowa, at a town hall in Dubuque:
“If you’re getting your insurance through the group health care marketplace — your employer — nothing changes,” Blum told constituents this week. “If you’re getting your health insurance through Medicare, nothing’s going to change. If you’re currently getting your health insurance through Medicaid, nothing’s going to change.”
Fact check: Partly false
Blum’s statement refers to a couple of big things — employer coverage and Medicaid.
As to employer coverage, whether your insurance would change under the GOP bill depends on whether your company is based — and buys its insurance — in a state that gets a waiver.
In “waiver states,” employers’ insurance policies might no longer be subject to Obamacare regulations around so-called essential health benefits — the minimal benefits that must be included in a policy.
They also might no longer be subject to restrictions on annual and lifetime spending caps.
That means, in those states, your employer-sponsored health insurance policy could deny coverage for some categories of care, such as mental health care or maternity coverage. And the health plan could impose annual or lifetime limits on insurance benefits. So workers with very expensive conditions, or their family members with such conditions, could see their costs pile up — even if they have health coverage through work.
Before Obamacare, about 60 percent of employers had lifetime limits on their health plans.
Blum’s second statement – the one in regards to Medicaid — is false. The GOP health bill makes major changes to Medicaid, first by rolling back the expansion of the program over time.
The bill allows people to keep their expanded Medicaid as long as they remain eligible. But people at or near the poverty level often see their incomes fluctuate, making them temporarily ineligible for the health care program. Under the GOP bill, once they leave the Medicaid rolls, they would not be able to return, even if their income declines.
In addition, the bill fundamentally changes how the U.S. government finances Medicaid. States would receive a fixed amount of money from the federal government for each beneficiary, rather than an amount that varies according to the numbers of Medicaid beneficiaries and their health care needs.
Most analysts say that, over time, the level of services Medicaid could provide would decline if the GOP health bill becomes law, and the states would have to cut back on services. That forecast is borne out by the Congressional Budget Office, which said the changes to Medicaid would cut the costs of the program by $880 billion over 10 years.
Many services provided by Medicaid today, including home health care and services for people with disabilities, are considered “optional” under the GOP health bill. Those are also the services that help keep people out of hospitals and nursing homes.
This is a skull of Homo naledi from the Rising Star Cave system in South Africa.
Wits University/John Hawks
Wits University/John Hawks
The bones of a human-like creature have puzzled scientists since they were found in a South African cave in 2013.
Homo naledi is primitive in some ways, with a small brain and other physical features reminiscent of our early ancestors. But it also walked upright, and had hands that may have been capable of making tools.
This perplexing combination of features raised questions about when the animal walked the Earth. But in new research published today in eLife, scientists have come to the conclusion that it lived between 335,000-236,000 years ago. That’s only about a tenth of the age some experts previously predicted.
It suggests that this human-life creature may have lived alongside early humans, or Homo sapiens. “It’s a much more complex picture of human evolution that is rising,” lead author Paul Dirks of James Cook University and the University of Witwatersrand tells The Two-Way.
Dirks says that the research team wanted to be absolutely certain about the surprising finding before releasing it. “So we took our time, I must say,” he says. “We did six different techniques side-by-side to make sure that things were consistent. For the most important techniques, we did double-blind dating, so we had independent labs dating the same materials twice, sometimes three times to make sure the things could be reproduced and corroborated between different labs.”
Richard Potts, the director of Smithsonian’s Human Origins Program who was not involved in the research, tells NPR that he finds the dating methodology to be sound and describes the conclusion as “reasonable and cautious.”
The research team also announced today that they have discovered a new chamber containing additional Homo naledi fossils in the Rising Star cave system, where the first specimens were found four years ago.
A schematic of the Rising Star cave system, where the Homo naledi fossils were found.
Marina Elliott/Wits University
Marina Elliott/Wits University
Homo naledi‘s age and other recent discoveries complicate previous ideas of how humans evolved. “Traditionally, not all that long ago, human evolution was pretty much viewed as a linear sort of progression towards larger-brained animals,” Dirks says.
But the finding that this creature is young enough to have lived alongside early humans means “the whole evolutionary process may have happened slightly differently than a simply linear process,” he says. “There may have been a number of different species evolving side by side.”
This raises interesting questions about how the two species may have interacted, and whether tools previously attributed to early humans may have actually been created by Homo naledi, Dirks says:
“On the African landscape, there’s lots of stone tools and stone tool industries. And the time period that we’ve now dated the Homo naledi fossils at coincides more or less with the start of the Middle Stone Age, which is a more advanced stone tool industry. Now traditionally, Middle Stone age tools have all been attributed to … the immediate ancestors of Homo sapiens.”
That conclusion is “less clear and less certain now,” he says.
It’s a controversial suggestion. Potts calls it a “non-starter,” pointing out that no evidence of tools has been found with the Homo naledi remains. “There’s nothing about naledi that implies it was the originator of that novel way of life.” He says that he thinks a likely explanation for the creature is that it actually “evolved and persisted isolated” from other relatives of humans.
And yet another mystery: How did the bones end up in these caves at all, and why? One extremely controversial suggestion is that it was part of a burial ritual. “There are other possibilities as well,” says Dirks, and he says sorting out the history of these caves will be a “formidable task.”