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COVER STORY : The Invisible Foe : Urban Ills Combine to Make Tuberculosis Tough to Beat


Judy was recovering from a car accident, but doctors couldn't figure out why she kept running a fever. Jennifer went to bed most nights feeling fine, then woke up with a hacking cough. Fernando was just weary all the time, and the rest of the family began feeling the same way.

Until a few years ago, many doctors might have prescribed lots of orange juice and rest, writing off this collection of symptoms as just another virus.

But after four years of drumbeating by the Long Beach Department of Health and Human Services, just about everybody--from local physicians to the City Council; from social service agencies to homeless people camped out in city parks--is finally becoming aware of an insidious, growing presence in the city.

Judy, Jennifer and Fernando--not their real names--didn't have colds. Like hundreds of others in this city of 430,000, they had tuberculosis, the debilitating lung disease that has been afflicting humans since the Stone Age.

The disease, thought to have gone the way of polio and scarlet fever, is back in a big way in Long Beach and other urban areas. New TB cases in the city jumped more than 30% last year to 148, an eight-year peak, while the number of cases throughout Los Angeles County was dropping about 12%.

In 1992, the last year for which statewide records were available, Long Beach was fifth in new tuberculosis cases per capita among California cities, after San Francisco, Oakland, Los Angeles and Santa Ana. In that year, there were 25.8 new cases for every 100,000 people in Long Beach, and last year the number jumped to 33.8.

Health authorities have watched with alarm the return of tuberculosis to Long Beach like a haunting specter from the past. In April, 1990, the City Council declared a local tuberculosis emergency, making the city eligible for special state and federal funds.

"We were concerned that there might be a lot more cases unless we dealt with the disease aggressively," said Diana Bonta, director of the city's Department of Health and Human Services.

Bonta's department beefed up the city's tuberculosis clinic, sent city workers into the field to attack the disease at its sources and notified local physicians that they had to report new cases to the city. With help from the state and federal government grants, Long Beach is now pouring more than $1 million a year into the prevention and cure of tuberculosis.

The disease came as a big shock to some of its victims. "I was absolutely dumbfounded when they told me," said one man, the son of a Midwest contractor. "I remember when there were TB sanatoriums. My father used to remodel them, turning them into college campuses."

It wasn't as if tuberculosis were anything new. Scientists have found evidence of the disease in 4,000-year-old Egyptian mummies.

For centuries, tuberculosis patients were relegated to remote sanatoriums, often in mountain or desert locations, where afflicted lungs could presumably breathe cleaner air. The big medical breakthrough came with the discovery in 1943 of streptomycin, the first drug to prove effective against the tuberculosis germ.

By the 1960s, after even more effective drugs had been discovered, tuberculosis was in full retreat in America. In 1985, the United States recorded its lowest number of new tuberculosis cases, 22,201, since the Centers for Disease Control began to keep track in 1917.

But homelessness, immigration from foreign disease centers, grinding poverty and AIDS have primed urban America for the return of tuberculosis as a major public health problem, authorities say. The disease has been sweeping the country, increasing 20% from 1985 to 1992. The number of cases dropped about 5% last year, according to preliminary figures released this week by the Centers for Disease Control.

Tuberculosis follows a slow, unswerving course, traveling between drug users, AIDS patients, children and down-and-outers--all with limited means to fight back.

It rarely affects perfectly healthy individuals who happen to come into contact with a carrier, doctors say. For instance, none of the city's tuberculosis clinic workers, who deal with infected patients every day, have tested positive for the disease.

"It's not an easy bug to catch," says Barbara Lindsay, a public health nurse who coordinates the tuberculosis program for the city. "It usually takes quite a lot of exposure to someone who's sick."

But if a patient fails to take his medicine, which can render him non-infectious within a couple of weeks, he can spread the germs to other vulnerable individuals. The disease travels on droplets of moisture from coughs or sneezes, or even from singing, in crowded, poorly ventilated rooms.

Tuberculosis saps victims' energy and eats "holes" in their lungs, where protective cells called macrophages attack the germs, forming spongy clumps. In advanced cases, the germs move into blood vessels and attach themselves to bones, the brain or kidneys, causing blindness and skin lesions--even sending victims into a coma.

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