Years of budget cuts and staffing shortages have left the New York City Department of Health too hobbled to contain a sharp rise in local cases of tuberculosis, according to a bombshell new report.
“TB is the top killer of people worldwide among infectious diseases,” Dr. Bruce Hirsch, infectious disease specialist at North Shore University Hospital in Manhasset, N.Y., told The Post.
And there have been about 500 active cases of TB in NYC so far in 2023.
That’s an increase of about 20% over the same time last year, according to “internal preliminary data” reported by Politico, making 2023 the worst year for TB infections in a decade.
“This is definitely a more dramatic resurgence than we would have probably expected,” said Elizabeth Lovinger of Treatment Action Group, a NYC public health advocacy group. “When there are particularly high spikes in TB and other infectious diseases in New York City, that tends to be kind of a bellwether for the rest of the country.”
NYC is an epicenter
Hirsch and other medical experts agree: “Everything in the world comes to New York City,” he said.
“When COVID started in the US, it started in New York. It was an explosion,” Hirsch added, noting that housing shortages and a decline in our public health infrastructure are partly to blame for TB’s resurgence.
“Everything is becoming crowded, with [health care] staffing shortages. Things are much worse in the public health clinic space,” Hirsch said.
“The quality of health care for people in prisons is often superior to the health care on the outside,” he added. “TB is sneaky and it’s persistent — and it’s well adapted to human beings.”
The spike in NYC tuberculosis cases has also been partly attributed to the COVID-19 pandemic — and vaccine fatigue — hindering efforts to diagnose and treat cases, and to the arrival in the city since spring 2022 of over 100,000 migrants, who are at a heightened risk of developing active tuberculosis infections.
Meanwhile, TB cases have recently been reported in Olathe, Kansas, and in Brockton, Massachusetts. Last month, the United Nations held a high-level meeting to discuss strategies for controlling the global spread of the disease.
Despite the concerning new data, NYC Health Department spokesperson Patrick Gallahue told The Post, “This city is a leader in TB care.”
NYC is woefully unprepared
Cases of the flu, TB and other infectious diseases dropped during the COVID-19 pandemic emergency, as public health efforts kept people masked or isolated at home.
“During the pandemic … COVID-19 prevention efforts reduced tuberculosis cases,” Dr. Carlos Franco-Paredes, associate professor of medicine at the University of Colorado School of Medicine, wrote in The Conversation.
“But tuberculosis numbers have quickly climbed back up to pre-pandemic levels, marking the first time in decades that cases and deaths have risen globally,” he added.
And New York City is woefully unprepared for a widespread tuberculosis outbreak.
Long waits of up to a week for testing and treatment are the norm at the city’s three TB clinics, according to employees of the NYC Department of Health’s Bureau of Tuberculosis Control, who spoke anonymously because they weren’t authorized to comment on the issue.
And the longer an infected person waits for treatment, the harder the disease is to treat — and it’s more likely the infection will spread to others.
Manhattan TB clinic closed
A TB clinic in Washington Heights — one of only four NYC-run clinics that offer free testing and care for TB, and the only TB clinic in Manhattan — was recently closed for renovation.
The Washington Heights clinic had been closed to TB patients because it was needed to assist in the COVID-19 response. It might be renovated or upgraded at some point in the future, according to Gallahue.
“We have pioneered treatments and therapies in New York City,” he told The Post. “We also launched a new latent tuberculosis infection provider outreach campaign to increase screening, diagnosis and treatment among at-risk New Yorkers.
“Additionally, we have a contract with a local provider that is worth up to $500,000 to ensure that New Yorkers receive care and that we have additional capacity in place should anyone need services,” Gallahue added.
Migrants, vaccine fatigue worsen problem
But the problem has been exacerbated by the challenge of finding housing for newly arrived migrants.
Migrants are at increased risk of developing a TB infection because they are often located in crowded, poorly-ventilated settings in which the disease spreads easily.
“TB could not design a better environment to maximize its spread,” said Hirsch. “It’s extremely unfortunate.”
And experts are concerned that matters could get worse as the weather turns cold and people huddle indoors, helping to spread TB and other respiratory illnesses like the flu, respiratory syncytial virus and COVID-19.
Moreover, vaccine hesitancy and years of “COVID fatigue” could make the upcoming virus season especially severe by overwhelming health care facilities.
Tuberculosis symptoms
Tuberculosis is a respiratory disease caused by a bacteria that spreads through airborne droplets when an infected person coughs, sneezes, talks or sings, according to the Mayo Clinic.
TB symptoms — which may start mildly, then worsen over time — include coughing (or coughing up blood or mucus), chest pain, fever, chills, night sweats and weight loss.
If caught early, the disease can usually be treated with drugs; some infections may require several months of consistent drug treatment. But if left untreated, TB can result in death — it kills about 1.5 million people each year.
Alarmingly, some strains of the TB bacteria (Mycobacterium tuberculosis) have developed resistance to many drugs, making the deadly disease almost incurable.
The city’s problems with TB screening and treatment are extensive: Staffing shortages run to doctors, X-ray technicians, case managers and public health experts. Remaining staff are burdened with heavy workloads caused by the time-sensitive and monthslong treatment needed for TB cases.
But many of the problems we’re now facing with TB could have been avoided: “We have experience with stemming rises in TB from the 1990s, with the explosion in HIV in New York City,” said Hirsch, noting that TB is a common infection among people with HIV/AIDS.
“Our public health infrastructure was dialed up. The recipe is pretty well established,” Hirsch said. “It’s a matter of getting care, like getting rapid chest X-rays.
“What we’re seeing now is kind of heartbreaking,” Hirsch added, “I hope that things get better before they get too much worse.”
