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The Clay Travis and Buck Sexton Show
Wellness Unmasked: “White Plague” Explained — Why Tuberculosis Cases Are Rising Again
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Dr. Nicole Safire
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Martha Stewart
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- [03:55]
Dr. Nicole Safire
Welcome to Wellness and Mass. I'm Dr. Nicole Safire, and we're going to talk about something that's a little funny this week because I got a couple of radio requests and, you know, usually I get an email or a text message or a phone call saying, hey, Dr. Safire, are you available to talk about this? And in the subject line, it said what they wanted to talk about. They're like, are you available to talk about the white plague? And. And I just found myself sitting there. I'm like, white plague? What the heck is the white plague? Am I really that out of touch with reality that there's a plague going around and I don't even know about it? Maybe you've seen these headlines, maybe you haven't. They're definitely out there, and they sound dramatic. Certainly grabs attention. That's what these headlines are for. And yes, it's definitely a bit of a scare factor baked into that language. But good news, here's the reality. Okay, so first of all, they're not entirely wrong. There are cases of white plague going on about that around here. But white plague is not some new emergent bacteria parasite virus that we don't know about. We're talking about tuberculosis. Apparently, it's called the white plague. I had no idea. I'd actually never heard it before. Maybe you have. Maybe I'm the only one who's never heard that tuberculosis was called the white Plague. I didn't learn that in medical school. I haven't seen it in the hospital. But, you know, maybe it's a thing. The truth is, when we talk about tuberculosis, cases are, in fact, they're actually rising. So since there are headlines out there about this, I thought maybe we talk about it a little bit. So after decades of steady decline, the United States has now seen multiple consecutive years of rising tuberculosis cases. In 2023 alone, there were nearly 10,000, 10,000 reported cases. Now, that's a 15% jump from the year prior, one of the largest increases, really, in recent years. And looking at the data, it suggests that, unfortunately, that wasn't a fluke, that the trend of rising cases, it's continuing. With over 10,000 cases in 2024. That was the highest levels we've seen in more than a decade. So it does seem that higher cases are here to stay, at least for right now. It's a trend. So, yes, the white plague. The headlines may sound sensational, but underneath that language, there's real public health story unfolding. So let's unpack that a bit. Today. That's what I want to talk about. In the 18th and 19th centuries. That's right. We're gonna go way back. Tuberculosis, it wasn't just a disease. It was a defining force of life and death. At its peak, tuberculosis accounted for up to 25% of all deaths in Europe. 1 in 4 deaths because of TB in Europe. It was called then the white plague. I guess I didn't read that in my history novels, but it was called the white plague then because of how it made people look. They looked pale, gaunt. They were wasting away. You've heard the term consumption. That all came from that time. It came from how slowly it just consumed the body. This wasn't a fast illness. It was a slow decline. Months, sometimes years. It's still that way today. By the way. It wasn't until 1882 that it was discovered the bacterium was responsible for it. A certain bacteria, it's called Mycobacterium tuberculosis. So when you hear TB or tuberculosis, it's caused by a bacteria. It's a very specific kind of bacteria. It's called an acid fast bacteria. I learned all about this when I studied microbiology and undergraduate degree. It was kind of hard to isolate. It requires a very specific environment to grow. That's why it took a while to identify what it was. But they were able to prove back then that this was, in fact, an infectious disease. It wasn't a virus, but it was a bacteria. But remind you, this is before antibiotics. So bacterium were scary because they didn't have a way to treat them. Patients were isolated in santoriums. They literally took patients who were infected with this bacterium and just said, here you go, go live in isolation because we have no way to rid you of this infection. So just go live and die out here, please, and don't give it to the rest of the people were sent there for months or even years. For most people, it wasn't necessarily a treatment, it was just a place to wait. Some recovered, many died. But even today you kind of see some of that echoing of that history from over a century ago. I remember early in my training, I mean, we had TB isolation rooms. We still have rooms that we put patients in if they're suspected of having tuberculosis. Negative pressure mass required limited contact because, yeah, this is not something you want to come in contact with. It's not easily treated. It's not like, oh, I'm just going to have a five day course of antibiotic and I'm going to rid myself of this. No, no, no. Treatment for tuberculosis. It's not like that. But, you know, it's just, it's interesting to see that these headlines, that these cases are increasing because while, you know, when I was in training and early on in my career, we talked a lot about it, you don't hear much about it. You know, inside of these isolation room, it's usually a patient who's thin, not doing so well, coughing, they're exhausted, they probably haven't been feeling well for months. And so when I would see these patients and what struck me the most, it wasn't just the illness, it was the isolation. What we did to these people, it really took us back, you know, way before modern medicine is what it felt like. You know, meals left at the door, no visitors, care delivered at a distance. Does this sound familiar? It kind of reminds me of COVID We did the same thing during COVID Covid has kind of come and gone. We don't do the same thing anymore. But tuberculosis, we still do. We understand why Tuberculosis, it's airborne, similar to Covid, similar to other infectious diseases like smallpox. It travels in the air, measles, travels in the air, very contagious, because all you have to do is be the general vicinity of someone who's positive. You breathe the air they're breathing and you have the potential to be infected. But the human side of that experience, you know, the separation, the stigma, I guess that hasn't really changed nearly as much as we think but here's the part that we don't talk enough about tuberculosis. It didn't decline because of one singular breakthrough, one singular modern medicine. Sure, yes, antibiotics helped, but it really declined because of layered public health measures, first and foremost. Yes, antibiotics, an amazing discovery, obviously saves
- [11:24]
Tuberculosis Expert / Guest Speaker
a lot of lives.
- [11:25]
Dr. Nicole Safire
It's also wreaked a lot of havoc. We've talked about what it's done to our gut health and antibiotic resistance, bacteria and stuff, but that's an entirely different episode. Talking about tuberculosis, the layered public health measures that have led to the decline of cases. Antibiotics for sure, Improving of just housing and nutrition, screening programs, making sure people who are higher risk, we are able to ask them questions about their symptoms, their lifestyle, and detect early cases. Contact tracing, isolation protocols, and really just directly observed therapy to ensure that patients are completing their treatment. All of these systems, they worked. In the United States, tuberculosis cases fell dramatically over decades, from tens of thousands every single year to under 10,000. And globally, TB efforts since 2000, so about a quarter century, have saved tens of millions of lives. This is one of the greatest public health successes stories that we rarely highlight. But here's the concern we're now seeing. I mean, mind you, it's, you know, it's slight, but we are seeing a reversal of some of that progress. In the United States, cases have been rising since 2021. So let's talk about that for a second. You had a decrease of, like, flu in 2020, a decrease in most other
- [12:56]
Tuberculosis Expert / Guest Speaker
public health infections early 2020, 2021, because people were kind of sheltering in place because of COVID But all of a sudden, we started seeing tuberculosis cases rising.
- [13:10]
Dr. Nicole Safire
There has been a 15% increase in 2023 alone.
- [13:15]
Tuberculosis Expert / Guest Speaker
And now we're up, as I mentioned, 10,000 cases annually. And now if you look around here
- [13:20]
Dr. Nicole Safire
in the United States, There are about
- [13:22]
Tuberculosis Expert / Guest Speaker
13 million people who have what's called latent TB, meaning they have tuberculosis. They may not be symptomatic, they may not be active. It's not an active infection, but it's still kind of brewing inside of them. Know, during COVID to be honest, we lost momentum when it came to tuberculosis. We had fewer screenings, we had delayed diagnosis. People were interrupted in their treatments. And let's be honest, people only cared about COVID during that time.
- [13:50]
Dr. Nicole Safire
They didn't care about cancer, they didn't care about heart attacks, and they certainly
- [13:53]
Tuberculosis Expert / Guest Speaker
didn't care about tuberculosis. But let's talk about what else happened during that time. Now, during that time, early on in the pandemic, people just stopped Moving altogether across the globe. You didn't have a lot of travel. There wasn't a lot of migratory efforts whatsoever because, well, there are travel restrictions, but people were really just staying put. In the United States Specifically, in about 2021, you started seeing a lot more traffic happening at the southwest border. And most TB cases, the reality is, occur in individuals who are born outside of the country who now migrate into the United. This isn't about blame. I'm not trying to point fingers at anybody.
- [14:39]
Dr. Nicole Safire
I'm just talking about facts. When it comes to epidemiology, that's what happens.
- [14:44]
Tuberculosis Expert / Guest Speaker
TB is more common in certain regions. Globally, many individuals are exposed earlier in life. And the infection, it truly can just remain in their system for years, decades.
- [14:56]
Dr. Nicole Safire
They may not even have symptoms that was, that's latent tb like I talked
- [15:01]
Tuberculosis Expert / Guest Speaker
about later on, as the immune system weakens, it happens to all of us as we get older or another illness develops and you take some sort of medication, whatever it is, for whatever reason, your immunity decreases during time. At that point, the infection can become active. So this bacteria is kind of like living inside of you, but they're silent, they're sneaky. It's just waiting for your immunity to drop. For whatever reason it can drop. Maybe you're not eating enough fruits and vegetables. Maybe you have the flu one year and it kind of just wipes you out. Maybe you're taking biologics for an autoimmune disease. Whatever happens, all of a sudden, your immune system decreases your ability to fight off infections. You have this latent or sneaky bacterium tuberculosis, just hanging out, waiting, waiting for the right opportunity to activate. And so that's what happened. And so once the infection becomes active, it can be detrimental. And importantly, many cases occur years, many years after the arrival, meaning after the person has been infected. Highlighting that this is a latent disease management issue. It's not just simply border control, because people who are coming across the border, if you're screening them solely for symptoms, the majority of people who are crossing probably don't have active tuberculosis because active tuberculosis makes you very sick. And you probably can't make that arduous journey across the southwest border in the desert and with all the other obstacles you face, doesn't mean that they don't have latent tuberculosis, that once they come into the United States, whether they acclimate or don't, whatever it is, it can then activate. Now, the United States, they already have pre immigration screening, targeted testing, and very small pockets of public health follow up. But huge gaps remain as I mentioned latent tb. It's often silent. The treatments requires months of adherence. So even if you identify someone who has either latent or active tb, it's not that they're gonna take that five or seven day course of antibiotics. Oftentimes they need to be on it for, I mean really like six months. They need to be actively monitored. So the real focus at the border and anywhere else should be better screening, stronger follow up and ensuring treatment completion, because that's what's important. It's one thing to diagnose it, it's one thing to give someone a prescription, but it's another thing to make sure that they have completed that entire course and it has done the trick and has gotten rid of the infection. Because infectious disease, they don't respect borders, but strong public health systems can certainly contain them. So the path forward, it's not, it's not really that complicated, but it does require commitment first and foremost. It truly does rely on early detection, expand screening in high risk populations, and that includes anyone who is crossing our borders coming to the United States because there are significantly higher rates of latent and active TB everywhere else other than our country. You also see them in prison populations, in homeless shelters, anywhere where you have people congregating. And it's important to be screening these individuals. Second, we need to be treating latent tb. This is where most cases originate here in the United States. Just because someone doesn't have symptoms, that doesn't mean we don't treat them. We need to be doing blood tests, we need to be doing X rays, we need to be doing everything we possibly can to ensuring someone doesn't just have latent TB that will be reactivated later in their life and then they're able to spread it. And as I mentioned, ensuring treatment completion, but also making sure that the treatment is accessible and affordable is equally vital. But making sure someone completes their treatment, whether it is a weekly check in, whether there is some sort of incentive to making sure that they complete it, whatever it needs to be, that's really important. And we have to reinvest in our public health infrastructure. We see a lot of cuts when it comes to public health. And I understand that there is a lot of hostility when it comes to, you know, our public health infrastructure ever since COVID specifically. But the reality is this is the health of the nation that we're talking about. I'm talking about contact tracing, community outreach, and any sort of follow up systems. Public health nurses, social workers, and those who are really making sure that people who have been identified as high risk for TB or even having tb that they they are followed continuously. And we are ensuring that not only they're healthy, their family healthy, but everyone around them is also healthy. Obviously we want to talk about global investments. You have the World Health Organization and some other nonprofits, Doctors Without Borders and so forth, who are in charge of that. I'm not really going to get into the weeds of that, but it is more than just a local problem. As I mentioned, the majority of cases here in the United States originate in people who came from elsewhere in the world. So it would behoove us to make sure that we are working with our global partners to decrease tuberculosis cases. And I guess again, tuberculosis was once the quote unquote white plague. White plague does sound scary. It was a nice little history lesson for myself to learn this new verbiage. The reality is I don't want to call it a plague today because that makes me think of those plague mass and a horrible time in our global history when it comes to public health. But the reality is tuberculosis is alive and well. It is a disease that we associate with history. But if we look at data, walk through a hospital isolation unit, we just zoom out globally and you'll realize it certainly has not been eliminated. Yes, it's been controlled, but the control requires vigilance. Because in medicine, success isn't permanent, it is maintained. And it's only maintained if we keep up on our public health efforts. We have lagged a little bit when it comes to tuberculosis, so we need to get get back to it. Thank you so much for joining me on Wellness on Mass. I'm Dr. Nicole Safire. Be sure to listen to Wellness on Mass on iHeartRadio, Apple Podcasts and wherever
- [21:55]
Dr. Nicole Safire
you get your podcasts. And I'll see you next time.
- [21:58]
Public Investing / HomeServe Announcer
Hey, it's Kavino and Rich struggling to see up close. Make it visible with viz. VIZ is a once daily prescription eye drop to treat blurry near vision for up to 10 hours. The most common side effects that may be experienced while using VIZ include eye irritation, temporary dim or dark vision, headaches, and eye redness. Talk to an eye doctor to learn if VIZ is right for you.
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Redfin Announcer
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Martha Stewart
how to make hosting look effortless? Here's a secret when prepping for cooking and baking, get ahead of the mess with new Reynolds Kitchens countertop prep paper. Just lightly wet the counter so the paper grips. Lay it down and drips and spills stay on the paper, not on your counter. Cleanup is as simple as lifting it away to reveal clean counters. Effortless it is thanks to Reynolds Kitchen's countertop prep paper. Wet it, set it, prep it, done. Available in the Reynolds wrap aisle at
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