Thousands of Ukrainians seeking asylum are trickling into the U.S., displaced by war with Russia. As more Ukrainians enter Los Angeles, testing and treatment for an insidious disease has quietly spooled up, as health workers search for a contagious bacteria that still poses a threat.
“We did TB testing with Afghan refugees, and now we’re doing it with Ukrainians,” said Dr. Julie Higashi, director of L.A. County’s Tuberculosis Control Program.
Tuberculosis may seem like a relic of the past in wealthy countries, yet it still kills more people worldwide than any other infectious disease besides COVID-19 — with about 1.6 million people dying from TB annually.
“It’s the No. 1 infectious disease killer in the world. And a fourth of the world’s population is infected,” Higashi said.
The temporary Uniting for Ukraine program, put in place by the Biden administration, allows Ukrainian citizens and their families to live in the U.S. for up to two years. Under the streamlined program, anyone 2 years of age or older must meet vaccination requirements and infectious disease screenings — including a blood test for tuberculosis.
To meet the requirement, Dimitri Loboda went to a county-run health clinic in Van Nuys. The 35-year-old arrived in L.A. from Ukraine a few weeks ago to escape Russian bombs and military enlistment.
“For me, I don’t want [to] kill people,” he said.
In Ukraine, he owned a small delivery company. But when the borders to other European Union countries closed, his business crumbled.
“I have before [the war a] logistical company, but [it’s] not possible now. Is really catastrophic for me,” he said.
Loboda said he doesn’t mind getting his blood drawn and tested. He studied dentistry at university, and though he didn’t pursue it as a career, he said he understands the importance of testing for diseases and getting treatment. He laughed when asked if he knew anyone in Ukraine with tuberculosis.
“No, no. No one I know,” he said.
According to the World Health Organization, Ukraine has the fourth highest incidence of tuberculosis in Europe and one of the highest rates of multi-drug-resistant TB anywhere in the world.
But not everyone infected with TB bacteria becomes sick or even knows they have it. Higashi said most of the people who test positive in L.A., whether they be asylum seekers or residents, have latent tuberculosis. That’s where the bacteria lives in the body without making the person sick, and they are not contagious.
But one in 10 develop active tuberculosis, with symptoms people might associate with tuberculosis patients in movies, such as hacking, bloody coughs, wheezing breaths and a pale complexion. They can spread the bacteria by coughing, talking or even laughing.
“It is still a deadly disease. If you look at the percents, it’s 10 times deadlier than COVID,” Higashi said.
For people whose immune systems are weak, especially those with HIV infection, the risk of developing TB disease is much higher than for people with normal immune systems.
“In Los Angeles County, we have high rates of TB here. We report almost the highest number of TB incidents on average per year [in the United States] second only to New York City,” Higashi said.
To explain the high numbers, Higashi pointed to L.A. County’s gigantic population of more than 10 million as well as being an immigration center for people coming to the country.
“We have a lot of people traveling internationally, coming in and out of the country. We have a large population of people experiencing homelessness, a large incarcerated population,” she said.
“It’s a disease of humanity,” Higashi said. “TB is referenced in operas. It’s in the Bible. It’s been with us for thousands of years.”
The battle against the deadly bacteria has long shaped Los Angeles. It started in the 1840s, said Tamara Venit-Shelton, a history professor at Claremont McKenna College. While tuberculosis plagued the nation, cities like Los Angeles swelled as health-seekers traveled west to climates that promised to cure.
“Especially after the Transcontinental Railroad connected California to the rest of the country, health tourism became a more reliable source of income for Californians,” she said. ”It didn't take a lot of capital to set up a place that middle- and upper-class tourists could come to rest and recuperate.”
Until the discovery of antibiotics, treatment for TB was limited. Doctors advised patients to stay warm, rest and eat good food.
“In the first half of the 19th century, there really weren't many ways of treating people with tuberculosis or other respiratory ailments. And so one of the really common treatments was travel,” Venit-Shelton said. “The idea that if you left your environment, your urban environment most of all, and went to the countryside, that the fresh air, maybe the journey itself, too, would cure you of your respiratory issues.”
As L.A. swelled with migrants, so did poverty, overcrowding and tuberculosis. Fear of infection was used to justify racist policies from elected California officials, culminating in mass deportations in the 1930s.
“When Mexican Americans and Mexicans were forcibly removed from their homes and sent to tuberculosis wards [they became] a place for immigration officials to come and find them, put them on buses and trains, and send them back to Mexico,” she said.
After World War II, antibiotics became widely available, and wealthy Western countries had the resources to pay for them, and cure and control tuberculosis. Developing countries didn’t, and the inequality remains.
Today, for every one person in the U.S. who has tuberculosis, about 35 people in Ukraine have the disease.
Now, instead of putting themselves at risk of deportation, asylum seekers who show up for testing are offered help.
“Everybody today is going to get a call with their results,” said Higashi, the county’s TB control program director. “If it’s a negative test they are all done and they can proceed with their health attestation. If it’s a positive result then we will link that person to one of our clinics where they will get a chest X-ray, and then depending on those results they’ll get the appropriate treatment.”
Local health workers took out bus ads and billboards in Ukrainian and Armenian, and spread the word among leaders in those communities to come and get tested.
“It was really hard, trying to figure out how to reach them,” Higashi said. “It’s been really gratifying to us that we put up our shingle, and figured out how to get to the population and we’re seeing them come.”
