Let’s improve public-health monitoring of infectious diseases

Ebola has shined a critical light on the role of public health in controlling infectious diseases. The media is flooded with reports about public-health officials attempting to protect the public’s health while respecting individual rights.

Tuberculosis (TB) is an exponentially more common infectious disease than Ebola with similar ethical and legal implications. According to the Minnesota Department of Health, there are approximately 150 TB cases yearly in Minnesota. The gold standard for TB is directly observed therapy (DOT), where a professional watches the patient take every dose of medication. The medication regimen must be taken completely. If it is if not, the risk of treatment failure is greatly increased.

Treatment failure can lead to infection of others and contributes to the development of drug-resistant TB, which is more deadly and more expensive to treat. It is critical to effectively treat each case, and DOT assures this. However, DOT monitoring can be invasive for the individual: Imagine having someone come into your house at the same time every day for months to watch you take pills.

This moment of attention to public health’s role is a perfect time to revisit how we control and treat infectious diseases. Other states have begun to explore alternative DOT practices for TB, including video-DOT, which allows for monitoring of medication via video without the invasive practice of routine visits from outside professionals.

Application of video-DOT in Minnesota would alleviate some of the ethical implications of traditional DOT while assuring the effective control of TB. As a public health nurse with experience treating TB, I know well the need to intervene to control and treat TB. With video-DOT, we can make public health monitoring better while building trust, which is sorely needed in our current sociopolitical environment.

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