Peachtree-Pine, Fulton tussle over TB

CDC in 2009 called city’s largest shelter breeding ground for tuberculosis

In recent years, the Metro Atlanta Task Force for the Homeless has weathered criticism from neighboring homeowners, the loss of millions in federal grants and attempts by City Hall to shut off its water. Now, a recently surfaced report by the Centers for Disease Control and Prevention indicates that between early 2008 and mid-2009, the embattled men’s shelter at the corner of Peachtree and Pine streets also was a breeding ground for a drug-resistant strain of tuberculosis.

Although Fulton County health officials now say the TB outbreak — which the CDC report labeled an “urgent public health problem” — is under control and shelter residents are receiving treatment, they concede they have no proof that the Task Force has followed the county’s recommended protocol for preventing and containing future incidents.

“They may very well be in compliance, but they just haven’t shown us any evidence,” explains Dr. Patrice Harris, director of the Department of Health Services, which oversees public health for Georgia’s largest county.

The Peachtree-Pine shelter has been under observation by the CDC at least since 2002, when Fulton officials asked the agency to investigate reports of TB among the shelter’s homeless residents. At that time, the report says, a team of epidemiologists visited the shelter, but poor cooperation from residents resulted in inconclusive findings. Still, the Task Force was given a list of recommendations, from opening windows to improve air circulation to keeping daily logs of shelter occupants.

The CDC sent another team in February 2009, again at the request of the county, which had noted a dozen reported cases of a particular drug-resistant strain of TB during the previous year — all of which had been traced back to Peachtree-Pine.

According to the June 2009 report, little seemed to have changed in the shelter’s protocols since the CDC’s previous visit nearly seven years earlier. Every night, several hundred homeless men slept on cots in a crowded room, with a few others camped out in chairs in a garage overflow area. Apart from a 7 p.m. curfew, residents were largely allowed to come and go without checking in, so few records were kept, much less daily logs. Windows were mostly kept closed and the building lacked bacteria-killing UV lights, the report notes.

“The shelter staff acknowledged that the recommendations from the previous investigation in 2002 had not been implemented,” the report says.

Of the nearly 300 shelter occupants who underwent testing by the CDC team, 40 percent tested positive for TB exposure. However, nearly half of the men with positive results failed to return for follow-up testing or treatment, according to the report.

Dr. Henry Blumberg, an infectious disease specialist at Grady Memorial Hospital and professor with the Emory University School of Medicine, says it’s important to distinguish between latent and active TB. After being exposed to TB, a healthy person’s immune system is typically able to kill off the bacterium before symptoms appear. At this stage, the person would test positive for latent TB, but could not infect others.

Among the homeless, whose immune systems are often compromised by drug use, alcoholism or other diseases, the chance of developing active TB — which is contagious — is much higher.

But even active, full-blown TB is not easy to catch. Stopping to give a quarter to a coughing panhandler, for instance, would likely not be enough. “Usually, prolonged exposure in close quarters is needed,” explains Blumberg, adding that some large cities restrict the size of homeless shelters because of the danger of TB transmission.

In addition to the 12 confirmed active TB cases at Peachtree-Pine, the CDC team identified six probable cases and one suspected case.

“That’s an indication that there was some level of transmission going on there,” notes Dr. Matthew McKenna, medical director for the Fulton Health Department, indicating the likelihood that Peachtree-Pine residents passed the airborne infection between themselves.

So, if Peachtree-Pine was effectively an incubator for a prolonged TB outbreak, why didn’t county officials close the shelter down?

According to Fulton Health Department Director Harris, it’s not that simple. “That’s private property and we only have so much authority,” she says.

Harris explains that the county can’t cordon off an entire building, but it can quarantine infectious TB carriers who refuse treatment. All of the homeless men identified with active TB were sent to Grady for isolation, then provided with ongoing treatment, she says, adding that county health workers visit the shelter daily to administer medicine and perform screenings on new residents.

“We haven’t seen a new case in the past six months,” says McKenna. “We wouldn’t say it’s unsafe to come into the building.”

Typically, Blumberg says, it takes several weeks of treatment before a TB patient is no longer contagious and about six months to be cured.

The Peachtree-Pine outbreak stands in contrast to other Atlanta homeless shelters, where there have been “very few cases of active TB,” McKenna says. Most of the larger shelters, including the city-run Gateway and the private Atlanta Union Mission, require TB screenings for anyone entering one of their programs.

County spokeswoman Ericka Davis says health officials have asked the Task Force to require “mandatory screening for long-term residents, separation of residents who have been screened for TB from clients who have not been screened, and maintenance of accurate logs of residents in order to allow efficient follow-up of persons exposed to Tuberculosis.

“To our knowledge, these procedures have never been implemented,” Davis says.

But Task Force officials say that’s not true.

“I refuse to accept under any circumstances that they’d allow a little nonprofit organization to be here for nine years, blatantly disobeying their recommendations,” says Joe Beasley, vice chairman of the Task Force board of directors. “We cooperated with the CDC and with the health department. If there was a danger to this city, this would’ve been stopped.”

Beasley questioned the timing of the appearance of the CDC report. In an ongoing federal lawsuit against Atlanta, the Task Force alleges that the city, working with the downtown business community, has conspired to shut down the facility. Last week, a day before CL was given a copy of the report by a tipster, Task Force Director Anita Beaty was deposed by city attorneys.

Beasley says the 2009 TB outbreak is no longer an issue. “This is 2011,” he says. “As God would have it, He watched over and kept the people. And He’ll keep on keeping the people. And all the imps in hell can’t close this place down.”