On Thursday I shared a post about leprosy being endemic in Florida. While the 159 cases reported in 2020 are noteworthy, this news is just information. The research/announcement shared last week does NOT mean you should cancel your trip to Florida or fear flying through an airport in Florida.
While there is no new news about leprosy today, comments regarding leprosy from two friends prompted this post…
First, Christian commented —
“Maybe it is not something to freak out about. But, I think this is indicative of some failures in our overall healthcare system.”
EXACTLY!
Leprosy spreads when it is NOT diagnosed and treated as soon as symptoms begin.
Previously (a decade or so ago) leprosy affected people (in the US) who immigrated from leprosy-endemic areas. However, between 2015-2020, more than one-third of all leprosy cases were acquired locally in the US.
Preventing locally-acquired leprosy in the United States will require healthcare providers to improve their ability to diagnose cases in the early stages of the disease, provide timely treatment (aimed at curing the disease), and eliminate sources of infection.
Preventing locally-acquired leprosy will also require that we address the following risk factors associated with the spread of the disease —
Poor housing conditions, including sharing of small spaces (including beds)
Poor/substandard sanitation
Poverty
According to Dr. Marc Siegel —
“Although leprosy is not particularly contagious, the combination of poor hygiene, a lack of shelter, and inaccessible medical treatment among the homeless creates a 'perfect cauldron' for the disease.”
Individuals living in poverty — who are often also unemployed or under-employed — do not have adequate access to healthcare services (necessary for diagnosis and treatment), and cannot pay for their care (the average out-of-pocket cost for a physician’s visit is $171) or treatment for the disease (which costs upwards of $430). Additionally, individuals living in poverty tend to have poor nutrition, which is associated with decreased immune function and an increased risk of developing disease).
Increasing rates of leprosy — and the declaration that leprosy is endemic in Florida — are indicative of unhealthy communities.
When homeless shelters are full…
When families cannot afford food or shelter…
When we allow families to live in substandard and overcrowded homes/shelters…
When we tie health insurance to employment…
When we say you have to pay upwards of $600 out-of-pocket to receive care for an infectious disease…
When we say all of these things are true in our communities… leprosy will spread.
Endemic leprosy in the United States is an indicator that our healthcare system is failing; that public health is failing; and that our communities are unhealthy.
We need reform.
We need a healthcare system that provides care and treatment for all.
We need a public health system that is well-funded and staffed to address the root causes of so many of our community health problems — poverty, poor housing, poor nutrition, poor sanitation/hygiene, and unequal access to the medical system.
And if you are sitting there thinking — this isn’t really true. Leprosy is just “tied to expanding armadillo populations since armadillos can carry the disease…” as my friend, Anne, asked about — please know that armadillos can transmit leprosy to humans (and to each other). HOWEVER, the increasing spread of leprosy in the southeastern United States is NOT tied to armadillos. The report from CDC last week (naming leprosy as endemic in Florida) specifically states and describes cases that are NOT zoonotic (meaning — the disease did NOT spread from an animal/armadillo to a human).
Given that many of the cases in Florida did not report close contact with an armadillo — handling or eating them), we need to think about this as a disease spread from human to human through close, sustained contact.
Endemic leprosy in the United States is an indicator that our healthcare system is failing; that public health is failing; and that our communities are unhealthy.
We need reform.
We need a healthcare system that provides care and treatment for all.
We need a public health system that is funded and staffed to address the root causes of so many of our community health problems — poverty, poor housing, poor nutrition, poor sanitation/hygiene, and unequal access to the medical system.
Questions?
Be sure to share this with your friends and family.
We need to reform our healthcare and public health systems.
We need to work to eradicate poverty.
And we can only do this if we work together…
Excellent commentary on the issue. Bravo!
Hi Becky, Just in case you are not aware, there is a Hansen's Institute in New Orleans I think. I had a patient that acquired Hansen's Disease in Mexico before immigrating to the US and we were able to obtain his medication, and treatment guidelines from this Institute, for no cost to the patient.