Connect with us

Science

Tuberculosis cases rising in California, and state officials are sounding the alarm

Published

on

Tuberculosis cases rising in California, and state officials are sounding the alarm

Tuberculosis cases are rising again in California, and health officials are urging those at higher risk, as well as doctors, to be alert for the disease, which can lurk in people’s bodies for years before becoming potentially deadly.

The number of tuberculosis cases in 2023 rose by 15% in California compared with the previous year, the state Department of Public Health said. That’s the highest year-over-year increase since 1989, when it was tied to people co-infected with HIV.

There were 2,113 cases across California last year; that’s about the same amount reported in 2019, before the COVID-19 pandemic. Seniors 65 and older had the highest percentage increase in cases from 2022 to 2023.

Tuberculosis rates also are rising nationally, up 16% in 2023 compared with the previous year, the U.S. Centers for Disease Control and Prevention said Thursday. The 9,615 cases provisionally reported last year were the highest since 2013 and were 8% higher than the tally of 8,895 cases reported in 2019.

Those at major risk for tuberculosis include people who have lived outside the U.S. where the TB rate is high, including most nations in Asia, the Middle East, Africa, Eastern Europe and Latin America.

Advertisement

Nationally in 2023, TB cases increased among all age groups and those born inside or outside the U.S., the CDC said.

Caused by bacteria Mycobacterium tuberculosis, tuberculosis disease is spread through the air. Unlike COVID-19 — in which infection can occur in minutes — a person would typically need to be exposed for hours to inhale enough TB bacteria to get infected, said Dr. Julie Higashi, director of the L.A. County tuberculosis control program.

Most active cases in California are from people with latent TB who picked up the bacteria decades ago but weren’t contagious or showing symptoms. “Then something happens. Either they age … and their immune system actually becomes weaker … and then they progress” to acute TB, Higashi said.

On the flip side, an estimated 18% of TB cases in L.A. County occur from recent transmission.

California officials said that 13% of people with tuberculosis died in 2020. That’s up from 8% in 2010. Generally, more than 200 Californians die from tuberculosis every year, state officials say.

Advertisement

TB has afflicted humanity since before the dawn of recorded history, and at one point in the 17th and 18th centuries, caused one-quarter of all deaths in Europe.

It was only on March 24, 1882 — 142 years ago Sunday — that a scientist announced the discovery of the bacteria that causes TB. (Decades earlier, TB was thought to be hereditary, and in New England, inspired “vampire panics” because people thought the first family member to die of TB would come back as a vampire to infect the rest of them, according to the CDC.)

By the start of the 20th century, tuberculosis was one of the leading causes of death in the United States.

Governments in the early part of the last century began making serious progress in preventing infectious diseases. According to the CDC, housing improvements reduced overcrowding — a risk factor for TB spread — and programs were launched to control TB. By 1940, the TB death rate was one-fourth what it had been at the turn of the century. Further progress was made with the discovery of TB treatments in the middle of the 20th century.

TB cases have generally been declining in California since the early 1990s but continue to take a significant toll, a tragedy given the disease is detectable and treatable.

Advertisement

“Not only can you treat the active disease, you can also treat the latent disease, which is much easier to treat — fewer drugs, much shorter time — and then prevent that progression to the active form of disease,” Higashi said.

The CDC estimates 13 million people in the U.S. have a latent tuberculosis infection — meaning they have no symptoms and can’t spread the bacteria. Without treatment, 5% to 10% will develop active disease that can turn contagious and potentially deadly later in life.

Outbreaks can happen locally. In Contra Costa County last year, 11 confirmed cases were linked to staff and customers of the California Grand Casino in Pacheco. At least 10 cases were genetically linked.

According to the most recent data, California counties with the highest per capita rates of tuberculosis are generally along populous coastal areas. In Southern California, those with the highest rates were Los Angeles, San Diego, Orange and Imperial counties. In Northern California, they were Santa Clara, Alameda, Sacramento, Contra Costa, San Francisco, San Mateo, San Joaquin, Solano, Monterey and Napa counties.

Officials noticed a substantial drop in TB cases in 2020, tied to stay-at-home orders and reduced travel during the early phase of the pandemic. Since then, case rates have increased 4% to 5% each year before jumping by 15% in 2023.

Advertisement

The rise in TB cases in Orange County, California’s third most populous, has been especially pronounced, jumping 20% between 2022 and 2023; in L.A. County, cases rose by about 4% over the same time, according to local data.

According to state data, Orange County’s per capita TB case rate is 10% higher than L.A. County’s.

“We have a lot of people who travel, and also have family members who come from other countries with higher rates of TB,” Dr. Regina Chinsio-Kwong, Orange County’s health officer, said.

Cities in Orange County with TB case rates higher than the overall county rate are Laguna Hills, Westminster, Garden Grove, Buena Park, Santa Ana, Fountain Valley, Anaheim, Costa Mesa and Lake Forest, according to county data.

Those at highest risk in Orange County are people born outside the U.S., Asian Americans, males, and seniors age 65 and up. Having diabetes, HIV or smoking cigarettes increases the risk of having latent TB develop into full-blown TB, Chinsio-Kwong said.

Advertisement

With “latent TB, when someone’s immune system is nice and strong, you have no symptoms, it doesn’t affect your organs,” Chinsio-Kwong said. “But it can develop into active TB when you’re immunosuppressed. So that’s where diabetes, smoking or any infectious disease, like HIV, can really put you at higher risk of developing an active TB case.”

Routine testing for higher-risk people, such as healthcare workers, can be helpful. Chinsio-Kwong said she was diagnosed with a case of latent TB earlier in her career, prompting her to take a nine-month regimen of treatment.

“If we can appropriately treat all the latent TB cases, we can really reduce the number of active TB cases,” she said. “The hope is that you detect latent TB before you develop symptoms — because by the time you have symptoms, you’re an active TB case, spreading your germs and possibly even spreading the infection to others.”

In Los Angeles County, 91% of tuberculosis cases were among Latino or Asian American residents. The top seven countries of birth of people with TB were Mexico, the Philippines, Guatemala, China, Vietnam, El Salvador and South Korea.

Areas with the highest tuberculosis case rates in regions monitored by the L.A. County Department of Public Health were in central L.A., which the agency defines as including downtown, Echo Park, Silver Lake and the Hollywood Hills; South L.A.; and an area of the western San Gabriel Valley that includes Alhambra, Monterey Park and San Gabriel.

Advertisement

Other areas with TB rates above the L.A. County average include the neighborhoods covering Hollywood, northeast L.A., El Monte, East L.A., Inglewood, Torrance and Bellflower.

Of the regions with L.A. County’s highest TB cases, those with the highest mortality rates were in the Alhambra-Monterey Park-San Gabriel area, where 15.4% of tuberculosis cases resulted in death; and Central L.A., where 20.5% of cases resulted in death.

A large problem with TB is that it’s possible for doctors to miss a diagnosis, as TB is relatively rare. The California Department of Public Health last month urged healthcare providers to consider tuberculosis as a potential cause of respiratory illness among higher-risk people.

There are situations in which doctors can misdiagnose people with TB. While the disease typically grows in the lungs — leading to symptoms such as chronic cough, chest pain and coughing up blood — the bacteria also can grow in other areas of the body, including the gastrointestinal tract or the nervous system, and doctors might miss a TB diagnosis in that atypical presentation.

Instances of misdiagnosed TB cases previously documented by The Times include a San Fernando Valley businessman, who was raised in Chile and suffered for 11 years until a TB diagnosis was made; and a Shanghai-born UC Berkeley Mandarin lecturer who was misdiagnosed with Crohn’s disease and given a steroid to suppress her immune system, allowing her TB to spread. It was only when she lay gravely ill in a hospital that a doctor seriously considered TB.

Advertisement

One prominent misdiagnosis occurred in 2004, when Dr. Claudia Lacson — pregnant with her first child — fell into a coma in Georgia after complaining of severe headaches and a persistent fever. Doctors initially suspected bacterial meningitis, but by the time doctors began TB treatment, it was too late, and she died at age 38, weeks after giving birth to a daughter, who also did not survive.

“What we want providers to know is that when any individual comes to them presenting with respiratory symptoms, they need to start thinking about is: Is this potentially a person who is at risk of having TB?” Chinsio-Kwong said. “Even if you weren’t born [in] another country, if you’re in close proximity to those who are coming from out of the United States, there’s a risk.”

Science

Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

Published

on

Cancer survival rates soar nationwide, but L.A. doctors warn cultural and educational barriers leave some behind

The American Cancer Society’s 2026 Cancer Statistics report, released Tuesday, marks a major milestone for U.S. cancer survival rates. For the first time, the annual report shows that 70% of Americans diagnosed with cancer can expect to live at least five years, compared with just 49% in the mid-1970s.

The new findings, based on data from national cancer records and death statistics from 2015 to 2021, also show promising progress in survival rates for people with the deadliest, most advanced and hardest-to-treat cancers when compared with rates from the mid-1990s. The five-year survival rate for myeloma, for example, nearly doubled (from 32% to 62%). The survival rate for liver cancer tripled (from 7% to 22%), for late-stage lung cancer nearly doubled (from 20% to 37%), and for both melanoma and rectal cancer more than doubled (from 16% to 35% and from 8% to 18%, respectively).

For all cancers, the five-year survival rate more than doubled since the mid-1990s, rising from 17% to 35%.

This also signals a 34% drop in cancer mortality since 1991, translating to an estimated 4.8 million fewer cancer deaths between 1991 and 2023. These significant public health advances result from years of public investment in research, early detection and prevention, and improved cancer treatment, according to the report.

“This stunning victory is largely the result of decades of cancer research that provided clinicians with the tools to treat the disease more effectively, turning many cancers from a death sentence into a chronic disease,” said Rebecca Siegel, senior scientific director at the American Cancer Society and lead author of the report.

Advertisement

As more people survive cancer, there is also a growing focus on the quality of life after treatment. Patients, families and caregivers face physical, financial and emotional challenges. Dr. William Dahut, the American Cancer Society’s chief scientific officer, said that ongoing innovation must go hand in hand with better support services and policies, so all survivors — not just the privileged — can have “not only more days, but better days.”

Indeed, the report also shows that not everyone has benefited equally from the advances of the last few decades. American Indian and Alaska Native people now have the highest cancer death rates in the country, with deaths from kidney, liver, stomach and cervical cancers about double that of white Americans.

Additionally, Black women are more likely to die from breast and uterine cancers than non-Black women — and Black men have the highest cancer rates of any American demographic. The report connects these disparities in survival to long-standing issues such as income inequity and the effects of past discrimination, such as redlining, affecting where people live — forcing historically marginalized populations to be disproportionately exposed to environmental carcinogens.

Dr. René Javier Sotelo, a urologic oncologist at Keck Medicine of USC, notes that the fight against cancer in Southern California, amid long-standing disparities facing vulnerable communities, is very much about overcoming educational, cultural and socioeconomic barriers.

While access to care and insurance options in Los Angeles are relatively robust, many disparities persist because community members often lack crucial information about risk factors, screening and early warning signs. “We need to insist on the importance of education and screening,” Sotelo said. He emphasized that making resources, helplines and culturally tailored materials readily available to everyone is crucial.

Advertisement

He cites penile cancer as a stark example: rates are higher among Latino men in L.A., not necessarily due to lack of access, but because of gaps in awareness and education around HPV vaccination and hygiene.

Despite these persisting inequities, the dramatic nationwide improvement in cancer survival is unquestionably good news, bringing renewed hope to many individuals and families. However, the report also gives a clear warning: Proposed federal cuts to cancer research and health insurance could stop or even undo these important gains.

“We can’t stop now,” warned Shane Jacobson, the American Cancer Society’s chief executive.

“We need to understand that we are not yet there,” Sotelo concurred. ”Cancer is still an issue.”

Advertisement
Continue Reading

Science

Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

Published

on

Clashing with the state, L.A. City moves to adopt lenient wildfire ‘Zone Zero’ regulations

As the state continues multiyear marathon discussions on rules for what residents in wildfire hazard zones must do to make the first five feet from their houses — an area dubbed “Zone Zero” — ember-resistant, the Los Angeles City Council voted Tuesday to start creating its own version of the regulations that is more lenient than most proposals currently favored in Sacramento.

Critics of Zone Zero, who are worried about the financial burden and labor required to comply as well as the detrimental impacts to urban ecosystems, have been particularly vocal in Los Angeles. However, wildfire safety advocates worry the measures endorsed by L.A.’s City Council will do little to prevent homes from burning.

“My motion is to get advice from local experts, from the Fire Department, to actually put something in place that makes sense, that’s rooted in science,” said City Councilmember John Lee, who put forth the motion. “Sacramento, unfortunately, doesn’t consult with the largest city in the state — the largest area that deals with wildfires — and so, this is our way of sending a message.”

Tony Andersen — executive officer of the state’s Board of Forestry and Fire Protection, which is in charge of creating the regulations — has repeatedly stressed the board’s commitment to incorporating L.A.’s feedback. Over the last year, the board hosted a contentious public meeting in Pasadena, walking tours with L.A. residents and numerous virtual workshops and hearings.

Advertisement
  • Share via

Advertisement

Some L.A. residents are championing a proposed fire-safety rule, referred to as “Zone Zero,” requiring the clearance of flammable material within the first five feet of homes. Others are skeptical of its value.

With the state long past its original Jan. 1, 2023, deadline to complete the regulations, several cities around the state have taken the matter into their own hands and adopted regulations ahead of the state, including Berkeley and San Diego.

“With the lack of guidance from the State Board of Forestry and Fire Protection, the City is left in a precarious position as it strives to protect residents, property, and the landscape that creates the City of Los Angeles,” the L.A. City Council motion states.

Advertisement

However, unlike San Diego and Berkeley, whose regulations more or less match the strictest options the state Board of Forestry is considering, Los Angeles is pushing for a more lenient approach.

The statewide regulations, once adopted, are expected to override any local versions that are significantly more lenient.

The Zone Zero regulations apply only to rural areas where the California Department of Forestry and Fire Protection responds to fires and urban areas that Cal Fire has determined have “very high” fire hazard. In L.A., that includes significant portions of Silver Lake, Echo Park, Brentwood and Pacific Palisades.

Fire experts and L.A. residents are generally fine with many of the measures within the state’s Zone Zero draft regulations, such as the requirement that there be no wooden or combustible fences or outbuildings within the first five feet of a home. Then there are some measures already required under previous wildfire regulations — such as removing dead vegetation like twigs and leaves, from the ground, roof and gutters — that are not under debate.

However, other new measures introduced by the state have generated controversy, especially in Los Angeles. The disputes have mainly centered around what to do about trees and other living vegetation, like shrubs and grass.

Advertisement

The state is considering two options for trees: One would require residents to trim branches within five feet of a house’s walls and roof; the other does not. Both require keeping trees well-maintained and at least 10 feet from chimneys.

On vegetation, the state is considering options for Zone Zero ranging from banning virtually all vegetation beyond small potted plants to just maintaining the regulations already on the books, which allow nearly all healthy vegetation.

Lee’s motion instructs the Los Angeles Fire Department to create regulations in line with the most lenient options that allow healthy vegetation and do not require the removal of tree limbs within five feet of a house. It is unclear whether LAFD will complete the process before the Board of Forestry considers finalized statewide regulations, which it expects to do midyear.

The motion follows a pointed report from LAFD and the city’s Community Forest Advisory Committee that argued the Board of Forestry’s draft regulations stepped beyond the intentions of the 2020 law creating Zone Zero, would undermine the city’s biodiversity goals and could result in the loss of up to 18% of the urban tree canopy in some neighborhoods.

The board has not decided which approach it will adopt statewide, but fire safety advocates worry that the lenient options championed by L.A. do little to protect vulnerable homes from wildfire.

Advertisement

Recent studies into fire mechanics have generally found that the intense heat from wildfire can quickly dry out these plants, making them susceptible to ignition from embers, flames and radiant heat. And anything next to a house that can burn risks taking the house with it.

Another recent study that looked at five major wildfires in California from the last decade, not including the 2025 Eaton and Palisades fires, found that 20% of homes with significant vegetation in Zone Zero survived, compared to 37% of homes that had cleared the vegetation.

Continue Reading

Science

At 89, he’s heard six decades of L.A.’s secrets and is ready to talk about what he’s learned

Published

on

At 89, he’s heard six decades of L.A.’s secrets and is ready to talk about what he’s learned

Dr. Arnold Gilberg’s sunny consultation room sits just off Wilshire Boulevard. Natural light spills onto a wooden floor, his houndstooth-upholstered armchair, the low-slung couch draped with a colorful Guatemalan blanket.

The Beverly Hills psychiatrist has been seeing patients for more than 60 years, both in rooms like this and at Cedars-Sinai Medical Center, where he has been an attending physician since the 1960s.

He treats wildly famous celebrities and people with no fame at all. He sees patients without much money and some who could probably buy his whole office building and not miss the cash.

Gilberg, 89, has treated enough people in Hollywood, and advised so many directors and actors on character psychology, that his likeness shows up in films the way people float through one another’s dreams.

The Nancy Meyers film “It’s Complicated” briefly features a psychiatrist character with an Airedale terrier — a doppelganger of Belle, Gilberg’s dog who sat in on sessions until her death in 2018, looking back and forth between doctor and patient like a Wimbledon spectator.

Advertisement

“If you were making a movie, he would be central casting for a Philip Roth‑esque kind of psychiatrist,” said John Burnham, a longtime Hollywood talent agent who was Gilberg’s patient for decades starting in his 20s. “He’s always curious and interested. He gave good advice.”

Since Gilberg opened his practice in 1965, psychiatry and psychotherapy have gone from highly stigmatized secrets to something people acknowledge in award show acceptance speeches. His longtime prescriptions of fresh food, sunshine, regular exercise and meditation are now widely accepted building blocks of health, and are no longer the sole province of ditzy L.A. hippies.

Beverly Hills psychiatrist Dr. Arnold Gilberg, 89, is the last living person to have trained under Franz Alexander, a disciple of Sigmund Freud.

(Robert Gauthier / Los Angeles Times)

Advertisement

He’s watched people, himself included, grow wiser and more accepting of the many ways there are to live. He’s also watched people grow lonelier and more rigid in their political beliefs.

On a recent afternoon, Gilbert sat for a conversation with The Times at the glass-topped desk in his consultation room, framed by a wall full of degrees. At his elbow was a stack of copies of his first book, “The Myth of Aging: A Prescription for Emotional and Physical Well-Being,” which comes out Tuesday.

In just more than 200 pages, the book contains everything Gilberg wishes he could tell the many people who will never make it into his office. After a lifetime of listening, the doctor is ready to talk.

Gilberg moved to Los Angeles in 1961 for an internship at what is now Los Angeles General Medical Center. He did his residency at Mount Sinai Hospital (later Cedars-Sinai) with the famed Hungarian American psychoanalyst Dr. Franz Alexander.

Among his fellow disciples of Sigmund Freud, Alexander was a bit of an outlier. He balked at Freud’s insistence that patients needed years of near-daily sessions on an analyst’s couch, arguing that an hour or two a week in a comfortable chair could do just as much good. He believed patients’ psychological problems stemmed more often from difficulties in their current personal relationships than from dark twists in their sexual development.

Advertisement

Not all of Alexander’s theories have aged well, Gilberg said — repressed emotions do not cause asthma, to name one since-debunked idea. But Gilberg is the last living person to have trained with Alexander directly and has retained some of his mentor’s willingness to go against the herd.

If you walk into Gilberg’s office demanding an antidepressant prescription, for example, he will suggest you go elsewhere. Psychiatric medication is appropriate for some mental conditions, he said, but he prefers that patients first try to fix any depressing situations in their lives.

He has counseled patients to care for their bodies long before “wellness” was a cultural buzzword. It’s not that he forces them to adopt regimens of exercise and healthy eating, exactly, but if they don’t, they’re going to hear about it.

“They know how I feel about all this stuff,” he said.

He tells many new patients to start with a 10-session limit. If they haven’t made any progress after 10 visits, he reasons, there’s a good chance he’s not the right doctor for them. If he is, he’ll see them as long as they need.

Advertisement

One patient first came to see him at 19 and returned regularly until her death a few years ago at the age of 79.

“He’s had patients that he’s taken care of over the span, and families that have come back to him over time,” said Dr. Itai Danovitch, who chairs the psychiatry department at Cedars-Sinai. “It’s one of the benefits of being an incredibly thoughtful clinician.”

Not long after opening his private practice in 1965, Gilberg was contacted by a prominent Beverly Hills couple seeking care for their son. The treatment went well, Gilberg said, and the satisfied family passed his name to several well-connected friends.

As a result, over the years his practice has included many names you’d recognize right away (no, he will not tell you who) alongside people who live quite regular lives.

They all have the same concerns, Gilberg says: Their relationships. Their children. Their purpose in life and their place in the world. Whatever you achieve in life, it appears, your worries remain largely the same.

Advertisement

When it’s appropriate, Gilberg is willing to share that his own life has had bumps and detours.

He was born in Chicago in 1936, the middle of three boys. His mother was a homemaker and his father worked in scrap metal. Money was always tight. Gilberg spent a lot of time with his paternal grandparents, who lived nearby with their adult daughter, Belle.

The house was a formative place for Gilberg. He was especially close to his grandfather — a rabbi in Poland who built a successful career in waste management after immigrating to the U.S. — and to his Aunt Belle.

Disabled after a childhood accident, Belle spent most of her time indoors, radiating a sadness that even at the age of 4 made Gilberg worry for her safety.

“It’s one of the things that brought me into medicine, and then ultimately psychiatry,” Gilberg said. “I felt very, very close to her.”

Advertisement

He and his first wife raised two children in Beverly Hills. Jay Gilberg is now a real estate developer and Dr. Susanne Gilberg-Lenz is an obstetrician-gynecologist (and the other half of the only father-daughter pair of physicians at Cedars-Sinai).

The marriage ended when he was in his 40s, and though the split was painful, he said, it helped him better understand the kind of losses his patients experienced.

He found love again in his 70s with Gloria Lushing-Gilberg. The couple share 16 grandchildren and seven great-grandchildren. They married four years ago, after nearly two decades together.

“As a psychoanalyst or psychiatrist ages, we have the ability, through our own life experiences, to be more understanding and more aware,” he said.

It’s part of what keeps him going. Though he has reduced his hours considerably, he isn’t ready to retire. He has stayed as active as he advises his patients to be, both personally (he was ordained as a rabbi several years ago) and professionally.

Advertisement

For all the strides society has made during the course of his career toward acceptance and inclusivity, he also sees that patients are lonelier than they used to be. They spend less time with friends and family, have a harder time finding partners.

We’re isolated and suffering for it, he said, as individuals and as a society. People still need care.

Unlike a lot of titles on the self-help shelves, Gilberg’s book promises no sly little hack to happiness, no “you’ve-been-thinking-about-this-all-wrong” twist.

Psychiatrist Dr. Arnold Gilberg, 89, authored "The Myth of Aging: A Prescription for Emotional and Physical Well-Being."

After 60 years working with Hollywood stars and regular Angelenos, Gilberg is ready to share what he’s learned with the world.

(Robert Gauthier / Los Angeles Times)

Advertisement

His prescriptions run along deceptively simple lines: Care for your health. Say thank you. Choose to let go of harmless slights and petty conflicts. Find people you belong with, and stop holding yourself and others to impossibly high standards.

“People have the capacity to self-heal, and I have become a firm believer in that. Not everyone needs to be in therapy for 10 years to figure it out,” he said. “A lot of this is inside yourself. You have an opportunity to overcome the things and obstacles that are in you, and you can do it.”

So what is “it”? What does it mean to live a good life?

Gilberg considered the question, hands clasped beneath his chin, the traffic outside humming expectantly.

“It means that the person has been able to look at themselves,” he said, “and feel somewhat happy about their existence.”

Advertisement

The best any of us can hope for is to be … somewhat happy?

Correct, Gilberg said. “A somewhat happy existence, off and on, which is normal. And hopefully, if the person wants to pursue that, some kind of a personal relationship.”

As it turns out, there is no housing in happiness. You can visit, but nobody really lives there. The happiest people know that. They live in OK neighborhoods that are not perfect but could be worse. They try to be nice to the neighbors. The house is a mess a lot of the time. They still let people in.

Somewhat happy, sometimes, with someone else to talk to.

It is that simple. It is that hard.

Advertisement
Continue Reading
Advertisement

Trending