Science
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.
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.
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.
“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.
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.
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.
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.
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
Cluster of farmworkers diagnosed with rare animal-borne disease in Ventura County
A cluster of workers at Ventura County berry farms have been diagnosed with a rare disease often transmitted through sick animals’ urine, according to a public health advisory distributed to local doctors by county health officials Tuesday.
The bacterial infection, leptospirosis, has resulted in severe symptoms for some workers, including meningitis, an inflammation of the brain lining and spinal cord. Symptoms for mild cases included headaches and fevers.
The disease, which can be fatal, rarely spreads from human to human, according to the U.S. Centers for Disease Control and Prevention.
Ventura County Public Health has not given an official case count but said it had not identified any cases outside of the agriculture sector. The county’s agriculture commissioner was aware of 18 cases, the Ventura County Star reported.
The health department said it was first contacted by a local physician in October, who reported an unusual trend in symptoms among hospital patients.
After launching an investigation, the department identified leptospirosis as a probable cause of the illness and found most patients worked on caneberry farms that utilize hoop houses — greenhouse structures to shelter the crops.
As the investigation to identify any additional cases and the exact sources of exposure continues, Ventura County Public Health has asked healthcare providers to consider a leptospirosis diagnosis for sick agricultural workers, particularly berry harvesters.
Rodents are a common source and transmitter of disease, though other mammals — including livestock, cats and dogs — can transmit it as well.
The disease is spread through bodily fluids, such as urine, and is often contracted through cuts and abrasions that contact contaminated water and soil, where the bacteria can survive for months.
Humans can also contract the illness through contaminated food; however, the county health agency has found no known health risks to the general public, including through the contact or consumption of caneberries such as raspberries and blackberries.
Symptom onset typically occurs between two and 30 days after exposure, and symptoms can last for months if untreated, according to the CDC.
The illness often begins with mild symptoms, with fevers, chills, vomiting and headaches. Some cases can then enter a second, more severe phase that can result in kidney or liver failure.
Ventura County Public Health recommends agriculture and berry harvesters regularly rinse any cuts with soap and water and cover them with bandages. They also recommend wearing waterproof clothing and protection while working outdoors, including gloves and long-sleeve shirts and pants.
While there is no evidence of spread to the larger community, according to the department, residents should wash hands frequently and work to control rodents around their property if possible.
Pet owners can consult a veterinarian about leptospirosis vaccinations and should keep pets away from ponds, lakes and other natural bodies of water.
Science
Political stress: Can you stay engaged without sacrificing your mental health?
It’s been two weeks since Donald Trump won the presidential election, but Stacey Lamirand’s brain hasn’t stopped churning.
“I still think about the election all the time,” said the 60-year-old Bay Area resident, who wanted a Kamala Harris victory so badly that she flew to Pennsylvania and knocked on voters’ doors in the final days of the campaign. “I honestly don’t know what to do about that.”
Neither do the psychologists and political scientists who have been tracking the country’s slide toward toxic levels of partisanship.
Fully 69% of U.S. adults found the presidential election a significant source of stress in their lives, the American Psychological Assn. said in its latest Stress in America report.
The distress was present across the political spectrum, with 80% of Republicans, 79% of Democrats and 73% of independents surveyed saying they were stressed about the country’s future.
That’s unhealthy for the body politic — and for voters themselves. Stress can cause muscle tension, headaches, sleep problems and loss of appetite. Chronic stress can inflict more serious damage to the immune system and make people more vulnerable to heart attacks, strokes, diabetes, infertility, clinical anxiety, depression and other ailments.
In most circumstances, the sound medical advice is to disengage from the source of stress, therapists said. But when stress is coming from politics, that prescription pits the health of the individual against the health of the nation.
“I’m worried about people totally withdrawing from politics because it’s unpleasant,” said Aaron Weinschenk, a political scientist at the University of Wisconsin–Green Bay who studies political behavior and elections. “We don’t want them to do that. But we also don’t want them to feel sick.”
Modern life is full of stressors of all kinds: paying bills, pleasing difficult bosses, getting along with frenemies, caring for children or aging parents (or both).
The stress that stems from politics isn’t fundamentally different from other kinds of stress. What’s unique about it is the way it encompasses and enhances other sources of stress, said Brett Ford, a social psychologist at the University of Toronto who studies the link between emotions and political engagement.
For instance, she said, elections have the potential to make everyday stressors like money and health concerns more difficult to manage as candidates debate policies that could raise the price of gas or cut off access to certain kinds of medical care.
Layered on top of that is the fact that political disagreements have morphed into moral conflicts that are perceived as pitting good against evil.
“When someone comes into power who is not on the same page as you morally, that can hit very deeply,” Ford said.
Partisanship and polarization have raised the stakes as well. Voters who feel a strong connection to a political party become more invested in its success. That can make a loss at the ballot box feel like a personal defeat, she said.
There’s also the fact that we have limited control over the outcome of an election. A patient with heart disease can improve their prognosis by taking medicine, changing their diet, getting more exercise or quitting smoking. But a person with political stress is largely at the mercy of others.
“Politics is many forms of stress all rolled into one,” Ford said.
Weinschenk observed this firsthand the day after the election.
“I could feel it when I went into my classroom,” said the professor, whose research has found that people with political anxiety aren’t necessarily anxious in general. “I have a student who’s transgender and a couple of students who are gay. Their emotional state was so closed down.”
That’s almost to be expected in a place like Wisconsin, whose swing-state status caused residents to be bombarded with political messages. The more campaign ads a person is exposed to, the greater the risk of being diagnosed with anxiety, depression or another psychological ailment, according to a 2022 study in the journal PLOS One.
Political messages seem designed to keep voters “emotionally on edge,” said Vaile Wright, a licensed psychologist in Villa Park, Ill., and a member of the APA’s Stress in America team.
“It encourages emotion to drive our decision-making behavior, as opposed to logic,” Wright said. “When we’re really emotionally stimulated, it makes it so much more challenging to have civil conversation. For politicians, I think that’s powerful, because emotions can be very easily manipulated.”
Making voters feel anxious is a tried-and-true way to grab their attention, said Christopher Ojeda, a political scientist at UC Merced who studies mental health and politics.
“Feelings of anxiety can be mobilizing, definitely,” he said. “That’s why politicians make fear appeals — they want people to get engaged.”
On the other hand, “feelings of depression are demobilizing and take you out of the political system,” said Ojeda, author of “The Sad Citizen: How Politics is Depressing and Why it Matters.”
“What [these feelings] can tell you is, ‘Things aren’t going the way I want them to. Maybe I need to step back,’” he said.
Genessa Krasnow has been seeing a lot of that since the election.
The Seattle entrepreneur, who also campaigned for Harris, said it grates on her to see people laughing in restaurants “as if nothing had happened.” At a recent book club meeting, her fellow group members were willing to let her vent about politics for five minutes, but they weren’t interested in discussing ways they could counteract the incoming president.
“They’re in a state of disengagement,” said Krasnow, who is 56. She, meanwhile, is looking for new ways to reach young voters.
“I am exhausted. I am so sad,” she said. “But I don’t believe that disengaging is the answer.”
That’s the fundamental trade-off, Ojeda said, and there’s no one-size-fits-all solution.
“Everyone has to make a decision about how much engagement they can tolerate without undermining their psychological well-being,” he said.
Lamirand took steps to protect her mental health by cutting social media ties with people whose values aren’t aligned with hers. But she will remain politically active and expects to volunteer for phone-banking duty soon.
“Doing something is the only thing that allows me to feel better,” Lamirand said. “It allows me to feel some level of control.”
Ideally, Ford said, people would not have to choose between being politically active and preserving their mental health. She is investigating ways to help people feel hopeful, inspired and compassionate about political challenges, since these emotions can motivate action without triggering stress and anxiety.
“We want to counteract this pattern where the more involved you are, the worse you are,” Ford said.
The benefits would be felt across the political spectrum. In the APA survey, similar shares of Democrats, Republicans and independents agreed with statements like, “It causes me stress that politicians aren’t talking about the things that are most important to me,” and, “The political climate has caused strain between my family members and me.”
“Both sides are very invested in this country, and that is a good thing,” Wright said. “Antipathy and hopelessness really doesn’t serve us in the long run.”
Science
Video: SpaceX Unable to Recover Booster Stage During Sixth Test Flight
President-elect Donald Trump joined Elon Musk in Texas and watched the launch from a nearby location on Tuesday. While the Starship’s giant booster stage was unable to repeat a “chopsticks” landing, the vehicle’s upper stage successfully splashed down in the Indian Ocean.
-
Business1 week ago
Column: Molly White's message for journalists going freelance — be ready for the pitfalls
-
Science5 days ago
Trump nominates Dr. Oz to head Medicare and Medicaid and help take on 'illness industrial complex'
-
Politics1 week ago
Trump taps FCC member Brendan Carr to lead agency: 'Warrior for Free Speech'
-
Technology7 days ago
Inside Elon Musk’s messy breakup with OpenAI
-
Lifestyle1 week ago
Some in the U.S. farm industry are alarmed by Trump's embrace of RFK Jr. and tariffs
-
World1 week ago
Protesters in Slovakia rally against Robert Fico’s populist government
-
News1 week ago
They disagree about a lot, but these singers figure out how to stay in harmony
-
News1 week ago
Gaetz-gate: Navigating the President-elect's most baffling Cabinet pick