Kansas tuberculosis outbreak reminds us of long battle for public health — and importance of trust – Kansas Reflector
This medical illustration shows the drug-resistant Mycobacterium tuberculosis bacteria. A Kansas City, Kansas, outbreak of TB has made national news. (Centers for Disease Control and Prevention)
“Don’t spit on sidewalk.”That’s some of the best advice ever, and I first read it on a paving brick in my hometown of Baxter Springs. I have since found the message repeated on sidewalks across Kansas, as the bricks were produced by the thousands. Artifacts of an early 20th century public health campaign to combat tuberculosis and other communicable diseases, the bricks were the brainchild of former frontier doctor and early public health advocate Samuel J. Crumbine.From 1904 to 1923, Crumbine was head of the Kansas State Board of Health and promoted public hygiene as the first defense against disease. In addition to his brick campaign, he became a promoter of the flyswatter, urged a ban on public drinking cups and helped the state through its first pandemic.I’ve been thinking about Crumbine and those bricks because of the current tuberculosis outbreak in the Kansas City metro area, which is among the largest in U.S. history. The outbreak has killed two and resulted in 67 confirmed active cases, according to state health officials.In the 1880s, when Crumbine started practicing medicine in Dodge City, TB killed 1 of 7 people in the United States, according to the Centers for Disease Control and Prevention. For decades, the treatment for tuberculosis — also known as “consumption” — was fresh air, cod liver oil and isolating infected individuals in tent camps. Public education about how the disease spreads, widespread testing and the discovery of the antibiotic streptomycin in 1943 contributed to the containment of the disease in the United States.While there were many factors in the successful campaign against tuberculosis, including the Christmas Seals fund drives, Crumbine set the standard for how public health officials should act, with an emphasis on education, clear messaging and trust.I’ve written about Crumbine before, in November 2020, while we were searching for answers and hope during COVID-19. That pandemic, in addition to scaring the jam out of us, was a reminder that public health is a continuing battle between ignorance and science. Back then, I was optimistic that science and reason would win.Now, I’m not so sure.As I write, the U.S. Senate is holding confirmation hearings for a secretary of Health and Human Services nominee who has spread debunked vaccine claims, said COVID-19 was targeted to attack Caucasians and Black people, and has called fluoride in drinking water dangerous “industrial waste.”The nominee, Robert F. Kennedy Jr., is also an advocate for drinking raw, unpasteurized milk. The Food and Drug Administration and the CDC — both agencies of Health and Human Services — have warned that drinking raw milk risks exposure to germs such as E. coli, listeria, and other pathogens.RFK Jr. has also engaged in a number of questionable activities, including dumping a dead bear in Central Park and using a chainsaw to cut off the head of a deceased whale and strapping it to the top of the family minivan. Any of this would be enough to disqualify a nominee during sane times, but as he is President Donald Trump’s nominee, there probably aren’t enough GOP senators with the integrity to block the confirmation.Hours after his inauguration, Trump signed an executive order withdrawing the United States from the World Health Organization, an action that would isolate America from the global exchange of health information. The Trump administration also ordered federal health agencies to pause all health advisories, website updates and other domestic communication. In addition Trump has improperly fired 17 inspectors general, including the watchdog responsible for HHS.Such moves are extraordinarily risky.Whenever those who make public health policy are more committed to an anti-scientific political agenda than they are to the health and welfare of Americans, it is a prescription for catastrophe. Of all the chaos of the first days of the second Trump administration, the monkey-wrenching of federal health services may be the most damaging.Take the danger posed by the tuberculosis outbreak in northeast Kansas.If you’ve followed this in the news, you might have been distracted about whether the outbreak is the largest since the country began keeping track of such things in the 1950s. Put that aside for a moment, because no matter how you slice it, the outbreak is historic.What we should be most concerned about is the grave risk tuberculosis still poses to the public health. Worldwide, it kills 11 million people a year, according to the World Health Organization’s most recent report. In the United States, there are fewer than 600 deaths per year, according to the CDC. Those Americans who succumb to tuberculosis are typically poor, live in overcrowded conditions and have limited access to health care.But we don’t know the situation with the Kansas outbreak.Damned little information has come from the Kansas Department of Health and Environment. The public has been told nothing about the origin of the ongoing outbreak, which has lasted more than a year, or the ages of the victims.There are 67 active cases in Wyandotte and Johnson counties, with another 79 dormant cases, according to the KDHE. The disease is transmitted by air, through close interaction with a person coughing, talking, or singing. Those with dormant tuberculosis, also called latent cases, aren’t capable of spreading it, but they may develop an active case if untreated, according to the CDC. The infections can remain dormant for years.Jill Bronaugh, KDHE communications director, told me recently the department had no one available for an interview. She forwarded a statement from KDHE that stressed that the “risk remains low” for the general public. It is “the largest outbreak in the U.S.” when counted over the span of one year since the CDC began reporting cases in the 1950s, the statement said.“We are taking comprehensive steps to address the situation and prevent further spread,” the statement said. “We are also working with schools and businesses to help prevent the spread of TB by supporting efforts to monitor symptoms and provide education.”Four CDC employees are in Kansas to help with contact investigation, testing and screening, according to the New York Times. Local health departments are also involved.“KDHE is currently managing a total of 384 individuals associated with this outbreak who are all at various different stages of TB testing, diagnostics, and treatment,” the department statement said. “We continue to update these case counts weekly.”There is no reason to panic over the Kansas outbreak, but there is cause for concern. More information about the origin of the outbreak would help us understand the challenges facing health officials. It is important to protect the identities of the sick, both to protect privacy and to avoid stigma, but it’s also important for public understanding to provide context. It might also underscore what health experts already understand, that tuberculosis disproportionately affects the poor.Lee Norman, a physician who led the state through the worst of the COVID pandemic as Kansas Health secretary, told me that public health crises are often created by a lack of funding and guiding policy to reach at-risk individuals.“TB outbreaks don’t occur in wealthy suburban neighborhoods,” he said. “They occur where residents are in crowded housing, and where they don’t have access to medical care. From a public policy perspective, we aren’t (embracing) Medicaid and funding the underlying health care infrastructure well enough for the poor.”The outspoken Norman was forced to resign in 2021 as state health secretary for reasons he says he still doesn’t clearly understand. Norman, who stood beside Gov. Laura Kelly during news briefings early in the pandemic, clashed with her chief of staff. At issue was Norman’s bluntness about pandemic measures. He is now chief medical officer for the Midwest of Optum, a health care company.“Overall, the public is not at great risk,” Norman said. “I have great faith in the Wyandotte and Johnson county health departments.”He said he did not know if KDHE was underfunded, because he doesn’t have access to its budget and finances. But he said that in public health, underfunding often leads to outbreaks.“The reason funding is required is to do the groundwork,” Norman said. “Finding the active and latent cases. We’re talking very much about pockets (of individuals) that are at risk, and it takes granular work to reach these populations and help them be treated and identified.”More information is better than no information, he said.“One of my lessons from the pandemic was, when we do the best we can, with the understanding that the information might change from day to day, the public will roll with it,” Norman said. “That’s the best way to handle it. You have to be trusted as a public health official.”Unfortunately, trust has been a casualty of American politics.It would be easy to dismiss the nomination of RFK Jr. as a needed disruption of the status quo. But his chainsaw and roadkill burn-it-all-down approach is a clear danger to the public health. His lack of qualifications may be attractive to those who mistrust government, embrace conspiracy theories, and take their medical advice from social media. He’s suited to be a guest on a podcast, but not much else.This crisis of trust threatens to undo a century of progress in public health.The advances we’ve made as a nation against tuberculosis and other diseases have come incrementally, one state or one community or one patient at a time.Let me give you an example of how Crumbine inspired trust.One morning in 1908, a burly Shawnee County farmer walked into the state board of health in Topeka, his 17-year-old son in tow, to confront Crumbine, the state’s top public health officer.Crumbine listened as the farmer complained that a school in Lawrence wouldn’t allow the son to return to school because he had been diagnosed as “tubercular.”“My son ain’t sick,” the farmer said, according to a Topeka State Journal reporter who witnessed the meeting. “I want to know how to make those people admit him to school.”In his hand, the farmer had an envelope with the results of a test administered by a doctor in Rossville. Crumbine examined the results and told the farmer his son had tuberculosis.“That settles it,” Crumbine said. “There isn’t any ground for dispute after this test is made.”But, the farmer protested, his son wasn’t sick.“The coughing and spitting (of blood) will come later, all right, if you don’t do something,” Crumbine told him. The boy was well now, but once the coughing started, it would be too late.Shaken, the farmer mumbled his thanks and left.“I gave it to them straight,” Crumbine told the reporter. “It seemed rather hard to talk that way before the boy, but it’s the only way you can convince some people of danger.”It still is.While the current Kansas outbreak is unlikely to pose much of a threat to most of us, it is a reminder that public health is fragile. It demands funding, diligence, and compassion. From the top of the government to the bottom, it requires public servants who are expert, dedicated, and willing to engage in straight talk.What we don’t need is more people, like RFK Jr., spitting on the sidewalk.Max McCoy is an award-winning author and journalist. Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.by Max McCoy, Kansas Reflector February 2, 2025by Max McCoy, Kansas Reflector February 2, 2025“Don’t spit on sidewalk.”That’s some of the best advice ever, and I first read it on a paving brick in my hometown of Baxter Springs. I have since found the message repeated on sidewalks across Kansas, as the bricks were produced by the thousands. Artifacts of an early 20th century public health campaign to combat tuberculosis and other communicable diseases, the bricks were the brainchild of former frontier doctor and early public health advocate Samuel J. Crumbine.From 1904 to 1923, Crumbine was head of the Kansas State Board of Health and promoted public hygiene as the first defense against disease. In addition to his brick campaign, he became a promoter of the flyswatter, urged a ban on public drinking cups and helped the state through its first pandemic.I’ve been thinking about Crumbine and those bricks because of the current tuberculosis outbreak in the Kansas City metro area, which is among the largest in U.S. history. The outbreak has killed two and resulted in 67 confirmed active cases, according to state health officials.In the 1880s, when Crumbine started practicing medicine in Dodge City, TB killed 1 of 7 people in the United States, according to the Centers for Disease Control and Prevention. For decades, the treatment for tuberculosis — also known as “consumption” — was fresh air, cod liver oil and isolating infected individuals in tent camps. Public education about how the disease spreads, widespread testing and the discovery of the antibiotic streptomycin in 1943 contributed to the containment of the disease in the United States.While there were many factors in the successful campaign against tuberculosis, including the Christmas Seals fund drives, Crumbine set the standard for how public health officials should act, with an emphasis on education, clear messaging and trust.I’ve written about Crumbine before, in November 2020, while we were searching for answers and hope during COVID-19. That pandemic, in addition to scaring the jam out of us, was a reminder that public health is a continuing battle between ignorance and science. Back then, I was optimistic that science and reason would win.Now, I’m not so sure.As I write, the U.S. Senate is holding confirmation hearings for a secretary of Health and Human Services nominee who has spread debunked vaccine claims, said COVID-19 was targeted to attack Caucasians and Black people, and has called fluoride in drinking water dangerous “industrial waste.”The nominee, Robert F. Kennedy Jr., is also an advocate for drinking raw, unpasteurized milk. The Food and Drug Administration and the CDC — both agencies of Health and Human Services — have warned that drinking raw milk risks exposure to germs such as E. coli, listeria, and other pathogens.RFK Jr. has also engaged in a number of questionable activities, including dumping a dead bear in Central Park and using a chainsaw to cut off the head of a deceased whale and strapping it to the top of the family minivan. Any of this would be enough to disqualify a nominee during sane times, but as he is President Donald Trump’s nominee, there probably aren’t enough GOP senators with the integrity to block the confirmation.Hours after his inauguration, Trump signed an executive order withdrawing the United States from the World Health Organization, an action that would isolate America from the global exchange of health information. The Trump administration also ordered federal health agencies to pause all health advisories, website updates and other domestic communication. In addition Trump has improperly fired 17 inspectors general, including the watchdog responsible for HHS.Such moves are extraordinarily risky.Whenever those who make public health policy are more committed to an anti-scientific political agenda than they are to the health and welfare of Americans, it is a prescription for catastrophe. Of all the chaos of the first days of the second Trump administration, the monkey-wrenching of federal health services may be the most damaging.Take the danger posed by the tuberculosis outbreak in northeast Kansas.If you’ve followed this in the news, you might have been distracted about whether the outbreak is the largest since the country began keeping track of such things in the 1950s. Put that aside for a moment, because no matter how you slice it, the outbreak is historic.What we should be most concerned about is the grave risk tuberculosis still poses to the public health. Worldwide, it kills 11 million people a year, according to the World Health Organization’s most recent report. In the United States, there are fewer than 600 deaths per year, according to the CDC. Those Americans who succumb to tuberculosis are typically poor, live in overcrowded conditions and have limited access to health care.But we don’t know the situation with the Kansas outbreak.Damned little information has come from the Kansas Department of Health and Environment. The public has been told nothing about the origin of the ongoing outbreak, which has lasted more than a year, or the ages of the victims.There are 67 active cases in Wyandotte and Johnson counties, with another 79 dormant cases, according to the KDHE. The disease is transmitted by air, through close interaction with a person coughing, talking, or singing. Those with dormant tuberculosis, also called latent cases, aren’t capable of spreading it, but they may develop an active case if untreated, according to the CDC. The infections can remain dormant for years.Jill Bronaugh, KDHE communications director, told me recently the department had no one available for an interview. She forwarded a statement from KDHE that stressed that the “risk remains low” for the general public. It is “the largest outbreak in the U.S.” when counted over the span of one year since the CDC began reporting cases in the 1950s, the statement said.“We are taking comprehensive steps to address the situation and prevent further spread,” the statement said. “We are also working with schools and businesses to help prevent the spread of TB by supporting efforts to monitor symptoms and provide education.”Four CDC employees are in Kansas to help with contact investigation, testing and screening, according to the New York Times. Local health departments are also involved.“KDHE is currently managing a total of 384 individuals associated with this outbreak who are all at various different stages of TB testing, diagnostics, and treatment,” the department statement said. “We continue to update these case counts weekly.”There is no reason to panic over the Kansas outbreak, but there is cause for concern. More information about the origin of the outbreak would help us understand the challenges facing health officials. It is important to protect the identities of the sick, both to protect privacy and to avoid stigma, but it’s also important for public understanding to provide context. It might also underscore what health experts already understand, that tuberculosis disproportionately affects the poor.Lee Norman, a physician who led the state through the worst of the COVID pandemic as Kansas Health secretary, told me that public health crises are often created by a lack of funding and guiding policy to reach at-risk individuals.“TB outbreaks don’t occur in wealthy suburban neighborhoods,” he said. “They occur where residents are in crowded housing, and where they don’t have access to medical care. From a public policy perspective, we aren’t (embracing) Medicaid and funding the underlying health care infrastructure well enough for the poor.”The outspoken Norman was forced to resign in 2021 as state health secretary for reasons he says he still doesn’t clearly understand. Norman, who stood beside Gov. Laura Kelly during news briefings early in the pandemic, clashed with her chief of staff. At issue was Norman’s bluntness about pandemic measures. He is now chief medical officer for the Midwest of Optum, a health care company.“Overall, the public is not at great risk,” Norman said. “I have great faith in the Wyandotte and Johnson county health departments.”He said he did not know if KDHE was underfunded, because he doesn’t have access to its budget and finances. But he said that in public health, underfunding often leads to outbreaks.“The reason funding is required is to do the groundwork,” Norman said. “Finding the active and latent cases. We’re talking very much about pockets (of individuals) that are at risk, and it takes granular work to reach these populations and help them be treated and identified.”More information is better than no information, he said.“One of my lessons from the pandemic was, when we do the best we can, with the understanding that the information might change from day to day, the public will roll with it,” Norman said. “That’s the best way to handle it. You have to be trusted as a public health official.”Unfortunately, trust has been a casualty of American politics.It would be easy to dismiss the nomination of RFK Jr. as a needed disruption of the status quo. But his chainsaw and roadkill burn-it-all-down approach is a clear danger to the public health. His lack of qualifications may be attractive to those who mistrust government, embrace conspiracy theories, and take their medical advice from social media. He’s suited to be a guest on a podcast, but not much else.This crisis of trust threatens to undo a century of progress in public health.The advances we’ve made as a nation against tuberculosis and other diseases have come incrementally, one state or one community or one patient at a time.Let me give you an example of how Crumbine inspired trust.One morning in 1908, a burly Shawnee County farmer walked into the state board of health in Topeka, his 17-year-old son in tow, to confront Crumbine, the state’s top public health officer.Crumbine listened as the farmer complained that a school in Lawrence wouldn’t allow the son to return to school because he had been diagnosed as “tubercular.”“My son ain’t sick,” the farmer said, according to a Topeka State Journal reporter who witnessed the meeting. “I want to know how to make those people admit him to school.”In his hand, the farmer had an envelope with the results of a test administered by a doctor in Rossville. Crumbine examined the results and told the farmer his son had tuberculosis.“That settles it,” Crumbine said. “There isn’t any ground for dispute after this test is made.”But, the farmer protested, his son wasn’t sick.“The coughing and spitting (of blood) will come later, all right, if you don’t do something,” Crumbine told him. The boy was well now, but once the coughing started, it would be too late.Shaken, the farmer mumbled his thanks and left.“I gave it to them straight,” Crumbine told the reporter. “It seemed rather hard to talk that way before the boy, but it’s the only way you can convince some people of danger.”It still is.While the current Kansas outbreak is unlikely to pose much of a threat to most of us, it is a reminder that public health is fragile. It demands funding, diligence, and compassion. From the top of the government to the bottom, it requires public servants who are expert, dedicated, and willing to engage in straight talk.What we don’t need is more people, like RFK Jr., spitting on the sidewalk.Max McCoy is an award-winning author and journalist. Through its opinion section, the Kansas Reflector works to amplify the voices of people who are affected by public policies or excluded from public debate. Find information, including how to submit your own commentary, here.Kansas Reflector is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Kansas Reflector maintains editorial independence. Contact Editor Sherman Smith for questions: info@kansasreflector.com.Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our website. AP and Getty images may not be republished. Please see our republishing guidelines for use of any other photos and graphics.Max McCoy is an award-winning author and journalist. A Kansan, he started his career at the Pittsburg Morning Sun and was soon writing for national magazines. His investigative stories on unsolved murders, serial killers and hate groups earned him first-place awards from the Associated Press Managing Editors and other organizations. McCoy has also written more than 20 books, the most recent of which is “Elevations: A Personal Exploration of the Arkansas River,” named a Kansas Notable Book by the state library. “Elevations” also won the National Outdoor Book Award, in the history/biography category.DEMOCRACY TOOLKIT© Kansas Reflector, 2025v1.72.2Kansas Reflector is a nonprofit news operation providing in-depth reporting, diverse opinions and daily coverage of state government and politics. This public service is free to readers and other news outlets. We’re part of States Newsroom, the nation’s largest state-focused nonprofit news organization. DEIJ Policy | Ethics Policy | Privacy PolicyOur stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our website. (See full republishing guidelines.)© Kansas Reflector, 2025
