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Here's why the state didn't notify the public about the Bayhealth tuberculosis exposure

DelawareOnline.com (Wilmington, DE) logo DelawareOnline.com (Wilmington, DE) 11/27/2019 Meredith Newman, Delaware News Journal
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Since 2018, there have been at least three cases of large numbers of people being potentially exposed to tuberculosis in Delaware.

They came at ManorCare health services in Wilmington, Georgetown Elementary in Sussex County and, most recently, at Bayhealth's Kent Campus. 

They told the public about two, but not about the third case, which may have exposed 200 people at Bayhealth's Kent Campus.

"Not everyone at the location was a risk," Dr. Rick Hong, state medical director, said about the Bayhealth exposure. "We don't want to create public fear."

"Although that 200 number seems very large," he added, "it is very accurate."

BACKGROUND: 200 people 'potentially exposed' to tuberculosis at Bayhealth in Dover

According to the Centers for Disease Control and Prevention's guidelines for handling tuberculosis cases, states are not obligated to inform the public in all situations.

Every investigation of an infectious disease is handled differently, state officials said, and sometimes it can take months to identify and contact those who might have been exposed.

In recent cases, the state has chosen to notify the public depending on the demographics of those potentially exposed and if they have enough information to contact those people. 

Tuberculosis is a potentially serious bacterial disease that attacks the lungs. It is easily spread by coughing, sneezing or laughing. It can affect any bodily organ, but it is infectious when it occurs in the lungs or voice box.

Symptoms include a cough that lasts more than two weeks, fatigue, weakness, weight loss, fever and chills. Only people with symptoms can spread the disease. The disease is treatable and curable, typically by taking medication for several months.

The state had 22 cases in 2018, 15 cases in 2017 and 16 cases in 2016, according to the state's website. So far this year, there have been 16 confirmed cases of tuberculosis in Delaware.

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During an investigation of tuberculosis case in August, health officials realized it was related to seven others. They all had the same genetic content.

In the following weeks, the state discovered there was a possible exposure at Bayhealth's Kent Campus in Dover. Through its investigation — and conducting many interviews — the state came to the conclusion that about 200 people may have been exposed, Hong said. 

Tuberculosis is very hard to transmit, he said, which means it would only affect people who were in close contact with the person with the disease. Much of the investigation consisted of narrowing down who at the hospital was at a higher risk for exposure. 

Even though many people walk in and out of a hospital every day, the state investigators, with the help of Bayhealth officials, pinpointed who might have been at risk, Hong said. 

Delaware Online/The News Journal learned about the incident from a Smyrna woman, who received a letter on Nov. 18, telling her that she has been "directly exposed."

Hong said the state notifies those who might have been exposed in a "tiered approach." This resident was likely in the first round of people who have been notified by the state, Hong said. 

"Most people don't realize how long the investigation takes," Hong said.

The Division of Public Health officials said last week there is no "evidence of uncontrolled spread of the bacteria" at Bayhealth and there is "no risk to current patients at the hospital as a result of this exposure." It defined the risk to the general public as "minimal."

If people do not receive a letter from the state regarding the exposure, they are not considered to be at risk, officials said. 

The CDC guidelines say that while alerting the media can educate the public about the disease, it can also lead to "potential drawbacks" like increased public anxiety.

Releasing a press release ahead of other media coverage is "is recommended so as to provide clear, accurate messages from the start," the guidelines stated.  

"Waiting until a story reaches the media through other sources leaves the health department reacting to inaccuracies in the story and could lend credence to a perception that information is being withheld from the public," according to the guidelines. 

In May 2018, the Delaware Division of Public Health alerted the public about a tuberculosis outbreak in which more than 600 people at ManorCare Health Services' Wilmington facility may have been exposed to someone who had active tuberculosis for most of 2017. 

Hong said the state notified the public in this situation because, unlike at Bayhealth, it did not have all of the contact information of the people who might have been exposed. 

Months later, in September 2018, health officials released information about how 50 individuals at Georgetown Elementary may have been exposed to someone with tuberculosis.

Hong said the public was likely notified in this case because it involved children in a school setting.

"Not all investigations are the same," Hong said. "They will vary based on the situation."

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Contact Meredith Newman at (302) 324-2386 or at mnewman@delawareonline.com. Follow her on Twitter at @merenewman.

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This article originally appeared on Delaware News Journal: Here's why the state didn't notify the public about the Bayhealth tuberculosis exposure

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