Anyone in need of a little extra anxiety can go online and type one word into a search engine: tuberculosis.
While many might think TB is a disease on the run, it doesn’t take long to learn what Peggy Cooley has known for decades: It is a worldwide pandemic with which a third of the population is infected. Last year, there were 9.6 million new cases diagnosed around the globe.
Roughly 1,500,000 people died from the disease in 2014.
In Pierce County for the last two decades, much of the defense against the spread of tuberculosis has rested on the shoulders of Peggy Cooley, a nurse with the Tacoma-Pierce County Health Department.
“I have a team: one outreach worker, a refugee coordinator and me,” Cooley said.
Over the last 20 years, Cooley has ensured the treatment of 495 TB patients in the county — men, women and children who, without treatment, would have spread the disease.
How easily is it spread? As easy as breathing.
“It’s airborne, and if someone with the disease is in a confined space — and office, a home, a schoolroom — it doesn’t take much to be infected,” Cooley said.
Health care workers like her don’t mess around when it comes to TB.
“I’m never cavalier about wearing my mask,” she added. “It’s a N-95 respirator, the kind first responders wear.”
Knowledgeable about TB when she began running the health department program to combat it in 1996, Cooley hasn’t stopped expanding her information base.
“I learn something new about it daily,” Cooley said. “It’s a complicated disease.
“Tuberculosis can infect you, then lie dormant for a lifetime if it is walled up by scar tissue in the lungs,” Cooley said. “The disease can wait 90 years or three months before it shows itself. That latency makes it unique. When it’s latent, a patient not only may not know they have it, they’re not infectious.”
Perhaps the most frustrating aspect of TB is that it’s curable, if only people know they carry it.
“Treatment usually consists of the patient taking four different antibiotics — the dose is dependent upon their weight — five to seven days a week for six months, minimum,” Cooley said.
“Now we’re finding out it can be resistant to multidrug combinations. In those cases, we use different drugs, and the treatment goes from six months to two years.”
To make things more complicated, treatment must be monitored to ensure each patient is taking the prescribed medication.
“We bring them the packet of meds, watch them take it,” Cooley said. “We also use Skype. Now we can observe using a camera on their computer or telephone. We still have to watch them count out their pills and take them.”
TB patients aren’t quarantined, but they are isolated.
“They can go outside, but they can’t go to work, school, the homes of family or neighbors,” Cooley said. “Not as long as they’re in treatment, and that’s over a period of months. One of the hardest parts of this job is telling someone they won’t be able to go to work.”
How do patients and families get by if they can’t work? The answer isn’t likely to calm anyone.
“Ask their family and friends for help,” Cooley said. “There is no social program that helps TB patients. If they ask, I’ll talk to their landlord, explain the situation. We can’t make someone hold a job for a patient or relax the rent. We can only talk to them.”
Cooley and her team investigate each case to determine how the patient was infected. Many are immigrants, and in some cases, Cooley said, the infection source is never known.
At 62, Cooley is the mother of two grown children; she has one grandchild and another on the way. Working with tuberculosis patients can be dangerous, though she doesn’t see it that way.
“One or two times I’ve been concerned about TB infection. The truth is, I’m not afraid of it. I’ve seen patients cured, seen them get their lives back.”
That is the joy in Cooley’s work. The responsibility?
“Keep the citizens of Pierce County healthy,” she said.
Cooley has done her job so well that this month the Washington State Department of Health’s Tuberculosis Program gave her a lifetime achievement award. It’s work she plans on continuing.
And it’s somewhat personal. A hobby genealogist, she began looking at her father’s side of the family not long ago.
“The first person I found was my paternal grandfather,” Cooley said. “He died of tuberculosis.”