From what I can gather, the hubbub is for two reasons: 1) XDR-TB is a great public health threat, and 2) This guy was an idiot for hopping on planes and travelling from place to place.

It seems that his case wasn't considered particularly infectious, as reported by Dr Martin Cetron, director of the CDC's Division of Global Migration and Quarantine, so there's very little chance than anyone else on this honeymoon trip was infected. That's the good news for all those unwitting fellow passengers.

What worried authorities was this guy's blatantly selfish behavior that kept putting more people and more countries in potential jeopordy. Probably you don't hear about most other XDR-TB cases--well, except for Mr Daniels in Arizona--is because these people stay put, get treated, and don't put other people at risk. After doing a bit more reading, it seems that when Andrew Speaker was contacted in Rome that his TB was actually XDR-TB by the CDC, he was told that he could not fly and that he would be banned from flying. That's when he and his wife went on the lam, flying from country to country in a desperate bid to get home before the health authorities could find him. They weren't just "touring Europe" on their honeymoon. They were in escape and evasion mode. I guess that's why he ended up flying to Canada and then trying to sneak across the border by car back into the US to avoid entering through a US airport.

How incredibly selfish of him. I don't know, people say he's a great guy in these news stories, but this makes me question his ethics and character, particularly being a personal injury attorney who should know better.

As far as his fear of not getting the best treatment in Europe goes, this guy has Kaiser Permanente HMO insurance. I say this as a Kaiser member myself, but when it comes to a very expensive, complicated treatment regime like for XDR-TB, seriously, he might've been better off in Italy! OK, half in jest, but half not. Besides, in all likelihood, he would've been transported back to the US for treatment. If he were a penniless illegal alien from Africa who snuck into Italy, that's one thing, but I think an American attorney and the son-in-law of a career CDC scientist has little to fear going to the health authorities in Italy.

Arrogance does seem to have a role in his decision making. He put his wants above the health needs of many/any others. You can make an argument that his travels up until he was notified of the severe TB strain was okay because he wasn't in a contagious stage. . .I wouldn't make that argument. Once the XDR TB strain was identified however, he was obligated to comply with CDC and do whatever he could to minimize the spread of the strain -- he didn't.

That said, whoever told him to turn himself in to the Italian health establishment was an idiot. They should have had the paperwork to take him into custody in Rome and transport his ass back to the U.S. ensuring further spread of the disease was minimized. The interview indicated that option was there; it shouldn't have been an option, it should have been Plan A.

Hopefully, his low risk of being contagious will give us a pass, but as a practice run I'd have to say that patient zero acted very typically and the CDC didn't do enough to contain the problem.

As far as I can figure, he is noncontagious. The joy of being a medical librarian's kid- the summary I've got from my mother, she of the medical intell, is that this a hard strain to catch, and almost as hard to give away if you nonsymptomatic.

That being said, I think he should have turned himself over to the nearest embassy or consulate, or at least to the Italians (look, people can be as jingoistic as they want, but Italy has a decent medical system- what he needs is isolation in a low pressure room and all but the poorest hospitals in the US have those so Rome should have a couple) as soon as he was told which strain he has. My understanding is that he was told he had a possitive for TB but was noncontagious, then they IDed the strain after he left the country but I could be wrong on that one.

What bothers me is his route. I haven't had a chance to look at airline times, but there should have been something that didn't involve him flying into Montreal, that's just screwy.

On the media side, it's interesting. The nationals are all reporting that the boarder agent who passed him has been "reassigned", but he crossed not too far west of where I am and our local news was reporting that the agent is on "administrative leave" or "administrative suspension" pending evaluation. I find that kind of funny, in a sad kind of way.

The other funny thing... At work, we have two TVs that are tuned to the news all the time, one FoxNews, one CNN, just becuase. They were both talking to the what looked like same young lady who had been on the flight to Paris at the same time, and both were running it with the "live" banner. This was about 1pm Eastern. We have the sound down, but I'm pretty sure it was the same girl "live" on both stations, solo on one and with a class mate on the other, but the same hair, build and hideous shirt. "Live". HA!!!

Morally obligated, yes. Legally obligated, not in the least.

In the US, unless a judge has ordered you to receive medical attention, there is no way to force someone to consent to medical treatment. You can't force someone who is bi-polar to take lithium, can't force someone who needs glasses to wear them, can't force someone who is a high heart attack risk to get his blood pressure and cholesterol down. And you can't, as the law stands now (and there are a number of Constitutional issues at play) force someone to go into a quarantine unless a judge decides they are a clear and present danger to the population as a whole.

Don't be surprised if that changes soon. It will be the law of the land for a few years while it percolates upstream in the federal court system.

They weren't in the U.S. Seems to me the CDC could have requested the Italians take him into custody and send him back to the U.S. on that aircraft CDC had as an option. I'm sure the Italians would have been more than happy to cooperate with his deportation.

Instead he was allowed to fly from Rome to Prague to Montreal. Then the Border agent thought the flag on his passport was discretionary. WTF? Whatever.

As I said, something looks screwy with his return trip and I hope they have that border agent is out of a job. People dropped the ball.

As for telling the Italians, I haven't seen anything to indicate that they hadn't, but I can think of good reasons not to. Not the least of which is they didn't know where he was. Going down the list, if it is an official government to government request, things sometimes spiral out of control and lots of people get quarantined; if he voluntarily turns himself in, maybe no one other than his blushing bride joins him.

As for a deportation, that means that the various foreign ministries get involved. Paperwork galore, people who don't need to be quarantined are, it gets political. After you find him, in a country with free internal movement and open borders with it's neighbors. Not as easy as it sounds, even if you can get a track on credit cards.

You're right, easier said than done even if it's legal. Apparently even the Italian Health Ministry couldn't do much without his consent.

I'm just a bit surprised that they didn't offer him the free ride home as a first option rather than trying the turn yourself in to Italy first.

What is your source for this information? Everything I have seen says he is being treated with antibiotics in the Denver hospital. Nothing has indicated his case was so severe that he needed to have a lung removed.

Here's the way I see it. This guy is intelligent enough to know that any TB is contagious, even if he is in the early stages. Prior to finding out it was the worst form of TB, he had already decided deliberately to expose other passengers to the disease, however slight, on his trip to Europe and abroad, without letting any of them know. That, in Tort law, is negligence. When he found out he had the resistant strain, he deliberately concealed that knowledge and successfully attempted to fraud our domestic security, along with again exposing additional passengers to his infection; more negligence. That he is a personal injury claims attorney who knowingly jeopardized the public in general and all those passengers in particular and attempted to conceal the fact makes him extremely culpable.

In addition to paying all costs associated with the investigation, testing, any subsequent treatment of those exposed, sanitization of all facilities he encountered, transportation to Denver, and associated court costs, he should also be permanently disbarred, and tried for criminal negligence, since there is no known cure for his disease (treat it like an HIV positive person exposing others through intimate contact). He should remain in complete isolation, save for properly attired medical staff, which would preclude any further contact with his new wife or family, until he is free of the disease, while continuing to incur liability for treatment costs.

I love how his family portrays him as this really nice, magnanimous person. He is a monster that is so self centered and callous to the needs of others, I would almost characterize his actions as psychopathic.

Well put...