PATIENT'S CHRONOLOGY


The Atlanta Journal-Constitution
Published on: 06/01/07

Here is a timeline of the activities of Andrew Speaker, the Atlanta attorney who has an extremely dangerous strain of tuberculosis and is now being treated in Denver.

April 23: Speaker was referred to the Fulton County Department of Health and Wellness by "someone outside of the health department," presumably a physician, for having tuberculosis, said Steven R. Katkowsky, director of the department. It was not known at that time how serious the disease was, only that Speaker had tested positive for TB.

April 25: Speaker visited the Fulton health department, was interviewed and asked about people with whom he had come in contact. He was started on first-line antibiotic medications. Skin and other tests were done to determine the severity of his illness. He also was X-rayed.

May 10: The Fulton health authorities determined that Speaker had a multidrug-resistant strain of tuberculosis, or MDR. He was notified and revisited the health department the same day. "At that point, he met with our physicians and [was] advised of his status," Katkowsky said. "They talked about the possibilities for treatment, what he should and shouldn't do, and the thing he was told he shouldn't do was travel [to Greece]. ... We told him not to travel. We didn't ask him. There were two reasons, his health, and the possibility he could spread the drug-resistant contagious disease to other people." Also, state officials were notified of a case of drug-resistant TB.

May 11: Follow-up letters were mailed to the TB victim confirming what he had been told in person on May 10. Letters were sent to his addresses of record at home and at work.

May 12: He left Atlanta on Air France 385 for Paris.

May 12: The health department sent a disease investigator to Speaker's addresses but was not able to deliver the notices because he was not at either location, Katkowsky said. At that point, Fulton officials were advised that the TB victim was out of the country.

May 17: Fulton officials, after viewing and examining a growing culture, learned Speaker did not just have the multidrug-resistant (MDR) strain, but that he had the extremely drug-resistant (XDR) variety. "That meant he was resistant to both the first-line and second-line antibiotics," Katkowsky said. He said the CDC was notified that day. Dr. Stuart Brown, director of the Georgia Division of Public Health, said: "We got the CDC involved because they have interactions with all other countries' health officials and have access to border security systems in order to flag or identify people."

May 22: The CDC said it informed Homeland Security that Speaker had an infectious disease. Homeland Security issued an alert to its personnel at Customs locations and the Border Patrol was alerted.

May 23: Speaker was telephoned in Italy by CDC officials and given instructions as to what to do next, said Tom Skinner of the CDC.

May 24: The CDC recommended he be put on a "no-fly" list, Skinner said. The Department of Homeland Security issued a no-fly order, not knowing he was then on his way back to North America. Speaker arrived in Montreal in the early hours of the day. He was logged as having crossed the Canadian border by automobile at 6:18 p.m. At that point, Canadian officials had not been notified by the CDC that the man with TB had arrived on a Czech Air Lines flight and had no reason to question him, said Patti Robson of the Public Health Agency of Canada.

May 25: The man entered a New York hospital.

May 28: He was taken to Atlanta's Grady Memorial Hospital and placed under guard in respiratory isolation.

May 31: He was flown to Denver's National Jewish Medical and Research Center for treatment.


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