The state of Florida has been struggling for months with what the Centers for Disease Control describe as the worst tuberculosis outbreak in the United States in twenty years.

Although a CDC report went out to state health officials in April encouraging them to take concerted action, the warning went largely unnoticed and nothing has been done. The public did not even learn of the outbreak until June, after a man with an active case of TB was spotted in a Jacksonville soup kitchen.

The Palm Beach Post has managed to obtain records on the outbreak and the CDC report, though only after weeks of repeated requests. These documents should have been freely available under Florida's Sunshine Law.

According to the Post, the coverup began as early as last February, "when Duval County Health Department officials felt so overwhelmed by the sudden spike in tuberculosis that they asked the U.S. Centers for Disease Control and Prevention to become involved. Believing the outbreak affected only their underclass, the health officials made a conscious decision not to not tell the public, repeating a decision they had made in 2008, when the same strain had appeared in an assisted living home for people with schizophrenia."

That decision now appears to have gone terribly awry, partly because the disease appears to have already spread into the general population but also because just nine days before the CDC warning was issued, Florida Governor Rick Scott had signed a bill downsizing the state's Department of Health and closing the A.G. Holley State Hospital that had treated the most difficult tuberculosis cases for over 60 years.

With health officials preoccupied by the challenge of restructuring, the CDC report went unseen, and an order even went out for the hospital to be closed immediately, six months ahead of schedule.

According to the Post, by April the outbreak had been linked to thirteen deaths, with 99 individuals infected, including six children. Most of those affected were poor black men, ten of whom simply wasted away from the disease before getting treatment or were not treated in time to stop its progression.

Now it is estimated that as many as 3000 people may have been exposed to the strain over the past two years, mainly in Jacksonville's homeless shelters, jails, and a mental health clinic. Only 253 of those have been found, of whom one-third have tested positive for TB exposure.

“The high number of deaths in this outbreak emphasizes the need for vigilant active case finding, improved education about TB, and ongoing screening at all sites with outbreak cases,” the CDC report urged.

Now the strain has not only spread beyond the underclass but has started appearing in other parts of the state, including Miami.

The Republican legislator who was the motive force behind the health department consolidation, Rep. Matt Hudson, told the Post on Friday that he was unaware of both the outbreak and the CDC warning. When filled in by a reporter, he promised that as chairman of the House Health Care Appropriations Committee he would see to it that there was funding for TB treatment.

That treatment will not come cheap. The drugs to treat a simple case of TB cost only $500, but if a patient does not take them regularly and the strain becomes drug-resistant, the cost skyrockets to $275,000. And, as the Post notes, "the itinerant homeless, drug-addicted, mentally ill people at the core of the Jacksonville TB cluster are almost impossible to keep on their medications."

Image by WPA Federal Art Project, Dis. 4 [Public domain], via Wikimedia Commons