TB or Not TB

BY LLOYD GORMAN

Every day more than 30,000 people catch it and 4,000 die from it, but this disease rarely - if ever - hits the headlines, possibly because most of its victims are in developing and poorer nations. But there was a time, within living memory, when Tuberculosis (TB) - one of the deadliest killers the world has ever known - caused havoc, dread and death across Ireland. Some 7,000 people a year became infected and until specific drugs were developed in the early 1950’s to fight it, with infection seen as a death sentence. The death rate was appalling. Between 1950 and 1960 about 10,000 people - men, women and children - a year lost their lives to TB. TB is now a preventable and largely curable disease, caused by a bacterium (germ) called Mycobacterium tuberculosis. It usually affects the lungs, but it can also affect other parts of the body, including the glands, the bones and rarely the brain. It spreads by an infected person coughing, sneezing or spitting. Children, people with poor health, weak immune systems or already suffering from another disease are at greater risk of becoming ill from TB (not everyone who becomes infected develops TB). Poor housing and overcrowded conditions also put people at risk. Another type of TB that may have been a factor at play in 1950’s rural Ireland was called Mycobacterium bovis, which can arise from drinking contaminated milk, but this form of TB is now rare as pasteurisation of milk removes the risk.

The fight against TB was led by Dr Noël Browne. Browne worked in various ‘sanatoriums’ as a young doctor and saw its withering effects. He also saw hospital buildings in terrible condition and an antiquated and inflexible system that was not centred on the patients needs. On a personal level, a nine year old Noël lost both his parents to TB within a short period of time, and he himself suffered from it. In order to achieve social and medical change, Browne went into politics and would have one of the most incredible political careers of any modern day parliamentarian. His Mother and Child Scheme for example, collapsed the first inter party government in 1951*. As minister for health, he spared no time or effort in confronting the TB problem. Amongst other things he introduced a mass radiography scheme which allowed many more patients to have their chest and lungs x-rayed, and created more than 5,000 extra hospital beds. The measures and improvements slashed the death rate, sparked a decline in the number of cases and increased the recovery rate of patients. The scourge of Tuberculosis

In 2018 some 315 TB cases were notified to the Irish health authorities and according to the Irish Thoracic Society: "With appropriate antibiotic treatment, TB can be cured in more than nine out of 10 patients". In the same year there were 136 notifications of Tuberculosis in Western Australia. According to the Western Australian Tuberculosis Control Program this number was “very similar to the previous four years”. As with Ireland, the majority of reported TB cases can be traced back to people who have come into the country/state from other countries. While the TB situation in Ireland, Australia and most developed nations is one that the health systems can easily deal with, unfortunately there are other parts of the world where it is still claiming many lives. As it happens, World Tuberculosis Day fell on March 24, but this year would have gone by almost completely unnoticed. On that date in 1882, German physician and scientist Robert Koch, identified the causal agent of the disease for the first time. Since the centenary of that discovery in 1982, World Tuberculosis Day has been held annually. *I had the privilege of meeting Dr Noel Browne. His achievements and impact on Irish society were taught as part of Irish history at secondary school and my late maternal grandmother, who was a young mother in Dublin at the time of his achievements, spoke of him with great admiration. When I discovered that this inspiring man was still alive, the aspiring journalist in me wanted to interview him. I had read his hard hitting biography ‘Against The Tide’ and knew he lived in the West of Ireland but not where, so I wrote him a letter and posted the letter with “Dr Noel Browne, West of Ireland” on the envelope and hoped for the best. Thanks to the nature of Irish society at the time and the efforts of An Post, it reached him and he called me and we arranged to meet soon after, at the Great Southern Hotel on Eyre Square. We spoke for at least an hour. He responded to my questions in detail. He was elderly at that point (this was in the early 1990’s) and withered by a lifetime of battling the big institutions of Irish society such as the Catholic Church, and what he saw as injustices. But Browne was still a man with a blend of fierceness, honesty and intelligence that must have been the trademark of his professional life. Certainly he was an impressive if not slightly embittered figure. But above all he was a hero of the Irish people. My good friend and flatmate at the time Tommy Farrell - who came with me from Dublin for that weekend - and my now wife Imelda joined me at the hotel and also met him briefly. He signed a copy of his biography for me and we parted ways. A few years later, in May 1997, Dr Browne passed away, aged 81. He left his country in much better shape than he found it.

TB vaccine tested against COVID-19

Hundreds of front line healthcare workers in Perth hospitals are taking part in a trial that will test a theory that an existing vaccine for tuberculosis can reduce their chance of becoming infected by COVID-19. In all, some 2,000 doctors and nurses from Fiona Stanley, Sir Charles Gairdner and Perth Children’s Hospitals will participate in the ‘BRACE’ research trial with colleagues from other hospitals in Melbourne. When these volunteering medics go to get their standard flu shot, half of them will also get a shot of the BCG (Bacille Calmette-Guérin) vaccine. “It seeks to establish whether the BCG vaccine, which is known to boost immunity against a range of infections, has a similar effect on COVID-19,” WA Health Minister Roger Cook said. Telethon Kids Institute Director Professor Jonathan Carapetis said the Institute - which normally focuses on diseases in children - was ready to roll out new research against COVID-19. “We know from other studies that the BCG vaccine provides protection against a diverse range of pathogens and has reduced the impact of respiratory tract infections,” Dr Carapetis said. “It also has been shown to boost the effects of the flu

vaccine, which will be given to these study volunteers at the same time. This effect alone could be very important.” Interestingly this trial was announced on April 14 and even has the blessing of the Director-General of the World Health Organisation, Dr. Tedros Adhanom Ghebreyesus. A scientific brief on an official WHO site - dated April 12 - stated: “There is no evidence that the Bacille Calmette-Guérin vaccine (BCG) protects people against infection with COVID-19 virus. Two clinical trials addressing this question are underway, and WHO will evaluate the evidence when it is available. In the absence of evidence, WHO does not recommend BCG vaccination for the prevention of COVID-19.”