Terri Bishop sees a lot of down-and-out types checking into the Community for Creative Nonviolence (CCNV) homeless shelter at 2nd and D Streets NW. As president of CCNV, Bishop is responsible for finding them a place to sleep and keeping them from hurting one another.
Now the feds may be adding another duty: TB screening. An initiative proposed by the Occupational Safety and Health Administration (OSHA) would require all shelters to furnish isolation rooms for anyone “suspected or confirmed” of having TB.
On a recent spring day, Bishop stands outside the shelter and hears the coughs and hacks of residents playing chess and touch football. One man smoking a cigarette is coughing up vicious yellow lung fragments, but it’s hard to tell if he has TB or the consumptive croak of common smoker’s hack. The early stages of TB often produce none of the symptoms common to all forms of the disease in the advanced stagesfever, fatigue, sweating, loss of appetite, loss of weight, and, in pulmonary cases, respiratory disturbances such as coughing, chest pains, and blood-stained saliva.
“A third of the residents are HIV-positive, and many others are in poor health,” says Bishop, explaining the difficulties of complying with the proposal.
Once known as “the white plague,” TB was on the decline following the development of successful drug treatments in the 1940s. However, a new and deadly form of the disease is raising concerns among health officials. The contagious disease, which is most prevalent in areas of overcrowding and poverty, is caught by inhaling airborne particles carrying Mycobacterium tuberculosis. If the infection is left untreated, the bacterium multiplies and destroys the affected tissues, leading to serious illness or death.
The TB isolation proposal comes on the heels of a nationwide enforcement program orchestrated two years ago by OSHA to adhere to guidelines issued by the Centers for Disease Control and Prevention (CDC). OSHA and CDC are counting on identification and isolation as a one-two punch against the spread of the dreaded disease.
Bishop, who testified before OSHA on April 16 on the proposal, said the requirements of the rule would only strain the resources of homeless shelters, making homelessness and TB itself more prevalent. OSHA’s proposed TB rule goes overboard, she says, because it would require the early identification of anyone even suspected of having contracted the disease. At her shelter, she says, everyone meets that criterion.
The most onerous provision of the initiative would force shelters to furnish temporary isolation rooms with direct exhaust or high-efficiency particulate air filters for possible TB sufferers who could not be transferred within five hours. Every homeless shelter is strapped for funds, and few have space available for isolation rooms. “I know we couldn’t do it, and we’re the largest shelter in the country, so the smaller ones would really have problems,” says Bishop.
“What was not taken into consideration [in proposing the rule] is the in-and-out nature of a shelter. Who at 1 o’clock in the morning is going to do a TB test? And if they [the homeless] knew they needed one, they would not bother coming in at all. They’d freeze to death on the street instead.”
Bishop says that instead of adopting new OSHA “panic requirements,” homeless shelters should simply continue to do what they are have been doingmaking sure that volunteers and staff are treated regularly and that equipment is sterilized. CCNV already requires residents and staff to have a TB test every six months. And if you don’t get tested within seven days of checking in, you are asked to leave.
By OSHA estimates, implementing the rule would cost CCNV about $2,450 a year, but Bishop figures she’d have to cough up much more than that. “I can’t imagine having an isolation room without major renovations, equipment, maintenance, and repair,” she says.CP