Patients With Drug Resistant TB at Large

By CLARE NULLIS

CAPE TOWN, South Africa – South African authorities have threatened to use police in door-to-door searches to compel 23 patients with highly infectious, drug resistant tuberculosis to return to the hospital they escaped from last week.

The patients had complained that they wanted to spend Christmas with their families. Some had been in the hospital for more than 18 months.

Eastern Cape health department spokesman Siyanda Manana said Wednesday that court orders would be delivered to the patients’ homes Thursday.

"If they do not return immediately, department officials will be accompanied by members of the South African Police Service in a door-to-door search," he said.

In all, 49 patients fled from the Jose Pearson hospital near the coastal city of Port Elizabeth last week by cutting a gap through the wire fence surrounding the isolation unit.

In the interim, 26 have returned to the hospital of their own accord.

"I think that those who returned are aware that they are putting themselves and their families at risk," said Manana, according to the South African Press Association.

The mass escape highlighted the problems faced by South Africa as it struggles to cope with an epidemic of virtually incurable TB that feeds off the AIDS virus and kills most of its victims. South Africa has an estimated 5.4 million people living with the AIDS virus.

There have been around 400 confirmed cases of the incurable strain known as XDR-TB, or extremely drug resistant TB. But activists say the actual number is probably much larger, because testing methods are not sophisticated enough to detect the new strain and many people die before they can be diagnosed.

Several provinces in South Africa have been forced to take legal action to force drug resistant TB patients to stay in the hospital. Earlier this year in Cape Town, for instance, authorities had to confine a minibus taxi driver – who was a potential risk to hundreds of people every day – after he insisted he could not afford the loss of wages by committing himself to a hospital.

Although forced confinement of patients violates most medical ethics, authorities say they have no choice but to put the wider public good above individual rights. Confinement for XDR-TB is at least six months.

Some patients have been at the Jose Pearson institution for more than a year while others have been there more than 18 months.

Tension started mounting early in December when patients insisted they be released to spend the holiday season with their families.

As a compromise, the hospital agreed to release those considered slightly less infectious for a limited period under strict supervision. Patients not released were promised a function with their families at the hospital.

It was unclear what prompted the patients to break out. The hospital has since changed its security firm and increased the number of watchmen.

South African authorities say they do not have the resources to enforce isolation and treatment, as in the United States, because the number of patients is far too high.