Skid Row's Tuberculosis Outbreak: 'Immiseration' Grows More Deadly

The deaths of 12 Skid Row residents from tuberculosis in the past five years is a grim statistic, but only a fraction of the deaths by "immiseration" among the homeless from one decade to another.

Because the number of reported TB cases since 2007 -- about 80 -- is relatively large, because the strain of TB is unique to downtown's street population, and because the Centers for Disease Control and Prevention has seen the emergence of drug resistant forms of the disease, the count of the sick, treated, and dead was reported with care to avoid panic.

"There is no danger to the general public," federal and county health workers said in March, who seemed to be speaking mostly to the public that does not live at the edges of Skid Row or work there. It was suggested that they get an annual TB test.

Despite the reassurance -- TB requires frequent and close contact with an active case, the course of treatment is simple, and those treated soon become non-infectious -- the CDC still considers Skid Row "a public health crisis" not just because of TB's increase but also for the HIV, hepatitis (A, B, and C), and the opportunistic infections that come from chronic ill health and filth.

Life on the street is an obvious "public health crisis," but it's also a "moral crisis" for a city and a county health care system under stress, as well as for a national policy that underfunds street-level public health in favor of bioterrorism defense. Sequestering, budget cutting, and militarizing public health only worsen the condition of the most marginalized among us.

For all our sophistication, we're poor at judging risks and even worse at evaluating how risks are reported. The tubercular homeless are an extreme risk to other homeless men and women, less so to the heroic workers and volunteers who minister to them, and almost no risk to you and me. The hazard that confronts us doesn't come from bacilli, but from the contagions of indifference, disregard, and arid hearts.

Immiseration is complimentary. It works both ways. From increasing misery, the homeless are reduced to disease vectors. By increasing our distance, we're reduced to being merely comfortable.