Return of the White Death: TB is once again a serious threat to the nation’s health

Infection rates in parts of London are higher than in Rwanda, Eritrea or Iraq

News & Analysis

18th February 2016

In-association-with-Benenden
 
What do you think of when someone mentions TB? Literature offers us visions of writers and artists dying picturesque deaths from consumption, or the White Death as it was romantically known. Or perhaps you think of mountain sanatoriums, with pale patients sitting on verandas in the 1920s and ’30s, bundled up to enjoy the clear Alpine air. What you almost certainly won’t think of is a disease that is causing a health crisis in the UK today.

TB is much more common than most of us realise, with 6,520 new cases diagnosed in 2014, and an increasing number of people presenting with a drug-resistant form of the disease. Around the world it kills 1.5 million people every year — more than HIV/Aids. And yet it rarely makes the headlines. At current rates of infection, the UK will soon have more TB cases than the whole of the USA. TB clinics in London already tackle more cases each year than in all the other European capitals put together, and in October last year it was announced that TB infection rates were higher in parts of London than in Rwanda, Eritrea and Iraq.

Other conurbations, including Leicester, Birmingham, Manchester, Luton and Coventry, are at the top of the infection charts. Around 5,000 of the cases reported each year are among people not born in the UK, but few of those are recent migrants. Because of improved screening, fewer people with TB are coming here from abroad. With a World Health Organisation campaign to find better vaccines and tackle TB worldwide, it’s hoped that this will have a beneficial effect on our rates as well. However, the rate of infection among UK-born residents is not going down at all.

A hundred years ago TB was a frightening, usually deadly, disease that everyone was aware of. At the turn of the 19th century, 300,000 people had TB in the UK, with just 500 free hospital beds to treat them. It was particularly common in industrial cities where workers spent long hours close together.

In 1905, decades before the creation of the NHS, Benenden was established as a mutual society to provide affordable treatment for postal workers suffering from tuberculosis. Its first sanatorium, which gave the organisation its name, was opened at Benenden in Kent in 1907. Workers who had paid a modest subscription went there and were able to benefit from rest and fresh air. Today Benenden still provides affordable healthcare services to a membership of almost 900,000 people.

TB is commonly thought of as a disease of the lungs, but there are actually many forms, which can affect every part of your body, including the glands and nervous system. It can even cause meningitis. Most forms are treatable with a six-to-nine-month course of antibiotics. But for sufferers who don’t receive treatment, TB can be deadly.

Capsules

Although it was in decline throughout most of the 20th century thanks to new treatments and the discovery of antibiotics in the 1950s, infection rates began to increase again as early as the 1980s, and they carried on going up until the mid-2000s, by which time the UK had the second highest rate in western Europe.

Countrywide, there are 13 new cases per 100,000 people, which means we trail behind not just Germany and Italy, but also the Czech Republic, Slovenia and Slovakia, according to the World Health Organisation. This may not sound that bad, and if you live in a rural area you have very little chance of coming into contact with the disease. But in some areas it’s a much more common, and often hidden, menace.

So what’s to be done? In January last year NHS England announced a £11.5 million project to eradicate tuberculosis from the UK through better screening and earlier identification and diagnosis. At the time Professor Paul Cosford, Director for Health Protection at Public Health England, said: ‘TB should be consigned to the past and yet it is occurring in England at higher rates than most of Western Europe. This situation must be reversed.’

One of the problems with treating TB is that it can take up to two years for symptoms to appear and then months for them to be recognised and treated. If asked to name a symptom, most people would probably say coughing up blood, but this is usually preceded by several weeks of a persistent cough, symptomatic of a lot of other problems, along with several other multi-diagnosable traits such as weight loss, lack of appetite, night sweats, tiredness and running a high temperature.

For many of us, TB is still something that was ‘cured’ years ago, so it doesn’t occur to us that our nagging cough and fever could be anything more than an annoying cold that won’t go away. TB is all too easy to overlook because it’s not the obvious diagnosis. People now think of it as a third-world disease if they think of it at all. But it’s out there in our towns and cities in the 21st century, and despite our best efforts, the number of sufferers in the UK is still increasing year by year.

Globally, TB has been recognised by the World Health Organisation as a massive threat, and one that can travel the world as populations migrate. While it is unlikely ever again to reach the levels of infection that prompted the founding of organisations like Benenden to provide affordable private sanatoriums for afflicted workers, TB remains a danger. And it is all the more dangerous if we continue to think of it as someone else’s problem, or a disease that couldn’t affect us or those we love.