PACHECO — Now that tuberculosis has been linked genetically to a gambling casino in Contra Costa County, health officials said the next step is to make sure that those who were exposed to it get checked out.
That may be easier said than done.
“Honestly, there’s still a lot of stigma and misinformation out there about TB that hinders people from coming in for testing and treatment,” Dr. Nahid Payam, a professor of Medicine and director for the UC San Francisco Center for Tuberculosis, said Friday. “People tend not to seek out care, and that’s the worst way to handle this. Unfortunately, TB runs parallel with HIV in our need to reduce the stigma, and in fact, TB now has a greater stigma attached to it than HIV.”
The tuberculosis presence in Contra Costa County came to light Thursday when health officials said anyone who has spent time since 2018 in the California Grand Casino may have been exposed to the bacteria, which attacks the lungs. The casino is located in the unincorporated community of Pacheco, which is bordered by Martinez, Concord and Pleasant Hill.
In a statement, Contra Costa Health Services officials said recent genetic testing revealed several related cases since 2018 among staff and customers. Ten of 11 confirmed TB cases were linked genetically, and officials were waiting for testing on the last case.
Paul Leung, the county’s program chief for communicable diseases, emphasized that the most recent case came back in the past few weeks but that it’s virtually impossible to know when and how the bacteria was transmitted. He said the county follows up on every recorded TB case and that all of the cases were investigated at the time they were reported.
“Unlike other diseases that spread, when you get exposed to TB, you don’t get it right away,” Leung said. “So we don’t know how long they were initially infected.”
Additionally, Leung said there was no inherent danger of being in the casino, because the disease is spread through sharing indoor space with a contagious patient. It cannot be caught from touching gaming chips or doorknobs, officials said.
A call for comment left for the casino Friday was not returned.
The reason the period when customers may have been exposed to TB ran for such a long period was because of the difficulty tracking how it is tracked, experts said. When doctors interviewed the most recent patients, Leung said one of the activities they all mentioned was at the casino.
Newly refined genetic testing also narrowed down the possible vectors, he said.
“The game-changer was the Whole Genome Sequencing,” Leung said. “That data, which is a fairly new feature, was able to find in these cluster of cases an identical TB strain. That was the extra evidence that the casino might be a connection as a place where people were exposed.”
Health experts Friday emphasized that a person exposed to tuberculosis may not develop obvious symptoms.
“TB outbreaks can vary in duration,” Payam said. “They can be latent several months to several months. … The reality is that it’s a worldwide pandemic. It’s the leading infectious disease killer worldwide, more than HIV, more than malaria, more than COVID-19.”
The disease also is very curable with treatment, he said.
“That is why it’s important to take a test, even if you do not feel sick,” Dr. Meera Sreenivasan said in a statement Thursday. Sreenivasan, Contra Costa County’s deupty health officer, added that “TB can cause serious illness, but it is treatable and curable with medicine, especially when caught early.”
Doctors use skin and blood tests to determine if a person has the bacteria. It is spread through the air and most often attacks a person’s lungs, according to the World Health Organization. It takes only a few germs to be inhaled to cause infection.
The symptoms can include a persistent or bloody cough, fever, unexpected weight loss, night sweats and fatigue.
