People have been hounding us for weeks to write more extensively on a recent outbreak of tuberculosis (TB) in Greenwood, S.C.
For those of you keeping score at home, seventy-four people have tested positive for the disease – an airborne strain of mycobacteria which attacks the lungs. Of those, twelve have shown abnormal chest X-ray readings – signifying an active infection. All seventy-four cases are linked to the Ninety Six Primary School, which hired a janitor who was infected with the disease.
This “index patient” – who was uncooperative with regional health inspectors – was removed from the school on March 8 via a public health order. However it took more than two months for the extent of the infection to become public knowledge. This delay has prompted a flood of criticism – most of it directed at S.C. Department of Health and Environmental Control (SCDHEC) director Catherine Templeton.
That strikes us as curious considering Templeton was the one who blew up this story in the first place – and who, to use her term, “called in the cavalry” as soon as she was made aware of the outbreak.
Which leads us to the fundamental question: Why did it take so long for Templeton to find out?
Several Democratic State Senators – Joel Lourie (D-Richland), Brad Hutto (D-Orangeburg) and Vincent Sheheen (D-Camden) – are holding hearings into the outbreak this week. Meanwhile The (Columbia, S.C.) State newspaper has devoted dozens of barrels of ink to the story. Of course these “investigations” are driven more by political gamesmanship and newspaper subscriptions than a desire to uncover the truth.
In response to several requests from our readers, we’ve begun to collect information on what actually happened at the Ninety Six Primary School. We’ve conducted interviews with several of Templeton’s most aggressive detractors – and we’ve offered Templeton’s agency an opportunity to respond to those critics.
We’ve also been talking with people on the ground in Greenwood – most of whom want to know what the school district was doing to protect its children during the critical early stages of the outbreak.
“It is my understanding Mr. Clarence Winans, Director of Student Services, is over the nurses employed at the schools,” Ninety-Six resident Amy Hilley wrote in an email to state Senators last week. “I would think you would want to interview him at your hearing to see what his involvement was during this whole mess. Was he even included in any of the decisions made on behalf of the students? I am sure since he is over the nurses he must be aware of the policies and procedures which were in place at the time all of this happened. I am sure he would also be able to confirm what kind of training has taken place regarding infectious disease control. If Mr. Winans was not included in any of these discussions, why not?”
Those are excellent questions.
In fact we wouldn’t be surprised to learn that Lourie, Hutto and Sheheen – three of the most aggressive defenders of South Carolina’s failed government-run school system – were looking to shield its incompetent employees from bearing the brunt of the blame in this case. After all, these are the same people who love to criticize the lack of “accountability” in private and parochial schools.
Anyway, in addition to our interviews we’ve filed several information requests with various state agencies seeking documents related to the outbreak.
Stay tuned for what we uncover …
59 comments
What does this mean: “This
“index patient” – who was uncooperative with regional health
inspectors…”? Uncooperative how? Does the State have no
power to enforce cooperation in a public health crisis?
They do and did. He was ordered into a TB treatment facility and will be confined there until he is no longer contagious or disease free.
From what I read, I don’t know if this man understood the implications or seriousness of what he was dealing with. One story talked with his neighbors. He was not unfriendly, but a stand-offish kind of guy and no family was mentioned.
What does this mean: “This
“index patient” – who was uncooperative with regional health
inspectors…”? Uncooperative how? Does the State have no
power to enforce cooperation in a public health crisis?
They do and did. He was ordered into a TB treatment facility and will be confined there until he is no longer contagious or disease free.
From what I read, I don’t know if this man understood the implications or seriousness of what he was dealing with. One story talked with his neighbors. He was not unfriendly, but a stand-offish kind of guy and no family was mentioned.
I’m sure you’re aware that three of the lower-level DHEC employees in Greenwood were fired by DHEC as a result of their involvement in the case. And they have retained an attorney from Spartanburg and have filed a wrongful termination lawsuit against DHEC, alleging that two of the higher-level DHEC administrators incorporated a “TB consulting business” around the time of the outbreak. They’re suggesting that these two upper-level administrators were attempting to profit from the outbreak and obstructing DHEC’s response to the event.
One of those upper level administrators has now filed a lawsuit against DHEC accusing Templeton of slander.
Believe it or not, Fox Carolina has pretty comprehensive coverage of this:
http://www.foxcarolina.com/topics/health-hierarchy/health/tuberculosis.htm?&mc_Text=28&mc_Video=20&mediatype=Text
Wow, lotsa good stuff at that link. Looks like they’ve been all over this story, while other local media was silent. Thanks for posting.
The State and SCRN have been covering this for quite a while.
I’m sure you’re aware that three of the lower-level DHEC employees in Greenwood were fired by DHEC as a result of their involvement in the case. And they have retained an attorney from Spartanburg and have filed a wrongful termination lawsuit against DHEC, alleging that two of the higher-level DHEC administrators incorporated a “TB consulting business” around the time of the outbreak. They’re suggesting that these two upper-level administrators were attempting to profit from the outbreak and obstructing DHEC’s response to the event.
One of those upper level administrators has now filed a lawsuit against DHEC accusing Templeton of slander.
Believe it or not, Fox Carolina has pretty comprehensive coverage of this:
http://www.foxcarolina.com/topics/health-hierarchy/health/tuberculosis.htm?&mc_Text=28&mc_Video=20&mediatype=Text
Wow, lotsa good stuff at that link. Looks like they’ve been all over this story, while other local media was silent. Thanks for posting.
The State and SCRN have been covering this for quite a while.
With no professional epidemiologist on the DHEC payroll for more than a year, you’re surprised about a contagious disease outbreak, poor management and poor communication. You wouldn’t be so calm if these were your children. Believe me the outbreak might be in your child’s school or day care. Or you grandmother’s assisted living home. Starving public health staffing for years has consequences. Who do you think the public is in public health! It’s all of us, we’re all at risk.
This isn’t the first incident of where DHEC executive staff bungled a threat to SC citizen’s public health. Check your facts if you can find them on the NECC contamination in the Lowcountry and how poorly DHEC responded because of the rigid management style Catherine Templeton employs. But them I’m sure your services have been retained to polish her image. And we know what you know about management, Willie.
What happened to the epidemiologist and has there always been just one at DHEC?
He left to work for the CDC. Whether he was encouraged to leave I don’t know. But the position is vacant.
Let me see if I understand your argument:
You are saying that “starving public health staffing” is responsible for the following:
1. 38 school employees being tested for TB in March, none of which bothered to ask the results (sure!), not telling anyone they were even tested.
2. The Principle, who DHEC told there was an outbreak to in March, and didn’t notify parents until May 28th.
3. The entire DHEC staff surrounding the direct testing, including the two nurses fired after they formed a TB consulting firm in mid May, once again not telling anyone.
4. The regional TB program manager, who claims DHEC told her NOT to test anyone AFTER being fired.
So it was “starving public health staffing” that caused this outbreak(or at least made it worse)?!? LMAO!
You know what all of the above have in common? They are “public health staffing” or have responsibilities directly in the area and interact with them.
So your argument in essence, is that despite the 40+ gov’t employees, of which, ONLY 1 of which had to have a conscience and simply SPEAK UP, if there were more public funds to hire MORE of them, or just 1 specific one even….then the TB outbreak wouldn’t have happened, or at least been contained?
Do you realize how moronic this sounds? I don’t care if you got 100 “thumbs up”, it’s pure stupidity.
You’re aware of privacy laws regarding health information, no? And you should check your facts on the one person who actually had the conscience to speak up. It wasn’t Templeton – she was just covering her ass.
“You’re aware of privacy laws regarding health information, no?”
And what pray tell, does “privacy laws” have to do with informing parents their kids have been exposed to TB and continue to be exposed on an ongoing basis?
Are you telling me there’s a law no allowing someone with a conscience and/or brain to tell another that their children are in danger?
Doubtful.
edit: “law not”
Btw, I’m not impressed that 1 person tried to tell someone out of 40, nor do I care..nor does it affect my point made above.
Yep. State and federal laws and DHEC regs based on those laws. IF DHEC nurses violate those laws, they get fired. Oh, wait, they didn’t violate them, but they still got fired when Templeton needed a scapegoat. Hmmmm.
Yea, sorry, I don’t by that.
If you want to link further stuff that says they aren’t allowed to tell parents when their kids are being exposed to TB on a daily basis I look forward to being proven wrong.
That said, if you actually find some law saying that in effect, then the law is stupid and the gov’t workers immoral for abiding by it to the detriment of the children.
No one’s job is more important then the life of a kid…especially when your chosen profession is supposed to be protecting said kids.
You’re welcome to look it up for yourself on the DHEC website and the SC code of laws. For the fed stuff, look to HIPPA. Can’t disagree about the immorality of it all in this case, but if I was a nurse who needed my job, I’d be put in pretty bad position wouldn’t I?
I’m not looking it up, the burden is on you to prove such a law exists, you made the claim.
I think government is tremendously stupid in many aspects…but if it is so stupid as to write laws that prevent its workers from notifying parents that their kids either have or are continually exposed to TB….well then it’s downright evil.
“but if I was a nurse who needed my job, I’d be put in pretty bad position wouldn’t I”
No, you are not. You do your duty and protect the children, “suffer” the consequences of doing the moral thing and happily get a job someplace where they appreciate you prioritizing the welfare of children over following a stupid law.
I suspect there are a great number of employers that value that outside of the government.
Adolf Eichmann- “just following orders”(obeying the law)
Wait – you don’t know what HIPPA is? That’s not something you should have to look up. It’s not as simple as “getting a job somewhere else.” You may think the law is stupid, but if you break it, you face real penalties. It’s all well and good to be self-righteous when it isn’t you who suffers. Also, Godwin’s Law at the end there (or pretty close to it) doesn’t help your argument, bro.
Sure it does, I’m familiar with HIPPA. Since when does it not allow for the warning of parents in the case of their kids and exposure to TB?
Are you claiming that janitor should be protected via HIPPA? He still could have been by simply stating the presence of TB to the parents without revealing his identity.
That is a joke. I hope someone/lawyer isn’t trying to use that defense…and “Godwin’s law” is completely relevant and definitely states my case quite clearly in this instance.
“Following the law” in a way that causes death is reprehensible. Call me “self righteous”, but that is exactly what Nazi’s were put to death for.
I’d glad wear the “self righteous” label if my disobeying the law caused me to lose my job yet saved a kid from harm. Seriously, what the hell are you thinking?
Are you actually saying you might let the kid get infected if you were in a similar situation?
With no professional epidemiologist on the DHEC payroll for more than a year, you’re surprised about a contagious disease outbreak, poor management and poor communication. You wouldn’t be so calm if these were your children. Believe me the outbreak might be in your child’s school or day care. Or you grandmother’s assisted living home. Starving public health staffing for years has consequences. Who do you think the public is in public health! It’s all of us, we’re all at risk.
This isn’t the first incident of where DHEC executive staff bungled a threat to SC citizen’s public health. Check your facts if you can find them on the NECC contamination in the Lowcountry and how poorly DHEC responded because of the rigid management style Catherine Templeton employs. But them I’m sure your services have been retained to polish her image. And we know what you know about management, Willie.
What happened to the epidemiologist and has there always been just one at DHEC?
He left to work for the CDC. Whether he was encouraged to leave I don’t know. But the position is vacant.
Let me see if I understand your argument:
You are saying that “starving public health staffing” is responsible for the following:
1. 38 school employees being tested for TB in March, none of which bothered to ask the results (sure!), not telling anyone they were even tested.
2. The Principle, who DHEC told there was an outbreak to in March, and didn’t notify parents until May 28th.
3. The entire DHEC staff surrounding the direct testing, including the two nurses fired after they formed a TB consulting firm in mid May, once again not telling anyone.
4. The regional TB program manager, who claims DHEC told her NOT to test anyone AFTER being fired.
So it was “starving public health staffing” that caused this outbreak(or at least made it worse)?!? LMAO!
You know what all of the above have in common? They are “public health staffing” or have responsibilities directly in the area and interact with them.
So your argument in essence, is that despite the 40+ gov’t employees, of which, ONLY 1 of which had to have a conscience and simply SPEAK UP, if there were more public funds to hire MORE of them, or just 1 specific one even….then the TB outbreak wouldn’t have happened, or at least been contained?
Do you realize how moronic this sounds? I don’t care if you got 100 “thumbs up”, it’s pure stupidity.
You’re aware of privacy laws regarding health information, no? And you should check your facts on the one person who actually had the conscience to speak up. It wasn’t Templeton – she was just covering her ass.
“You’re aware of privacy laws regarding health information, no?”
And what pray tell, does “privacy laws” have to do with informing parents their kids have been exposed to TB and continue to be exposed on an ongoing basis?
Are you telling me there’s a law no allowing someone with a conscience and/or brain to tell another that their children are in danger?
Doubtful.
edit: “law not”
Btw, I’m not impressed that 1 person tried to tell someone out of 40, nor do I care..nor does it affect my point made above.
Yep. State and federal laws and DHEC regs based on those laws. IF DHEC nurses violate those laws, they get fired. Oh, wait, they didn’t violate them, but they still got fired when Templeton needed a scapegoat. Hmmmm.
Yea, sorry, I don’t by that.
If you want to link further stuff that says they aren’t allowed to tell parents when their kids are being exposed to TB on a daily basis I look forward to being proven wrong.
That said, if you actually find some law saying that in effect, then the law is stupid and the gov’t workers immoral for abiding by it to the detriment of the children.
No one’s job is more important then the life of a kid…especially when your chosen profession is supposed to be protecting said kids.
You’re welcome to look it up for yourself on the DHEC website and the SC code of laws. For the fed stuff, look to HIPPA. Can’t disagree about the immorality of it all in this case, but if I was a nurse who needed my job, I’d be put in pretty bad position wouldn’t I?
I’m not looking it up, the burden is on you to prove such a law exists, you made the claim.
I think government is tremendously stupid in many aspects…but if it is so stupid as to write laws that prevent its workers from notifying parents that their kids either have or are continually exposed to TB….well then it’s downright evil.
“but if I was a nurse who needed my job, I’d be put in pretty bad position wouldn’t I”
No, you are not. You do your duty and protect the children, “suffer” the consequences of doing the moral thing and happily get a job someplace where they appreciate you prioritizing the welfare of children over following a stupid law.
I suspect there are a great number of employers that value that outside of the government.
Adolf Eichmann- “just following orders”(obeying the law)
Wait – you don’t know what HIPPA is? That’s not something you should have to look up. It’s not as simple as “getting a job somewhere else.” You may think the law is stupid, but if you break it, you face real penalties. It’s all well and good to be self-righteous when it isn’t you who suffers. Also, Godwin’s Law at the end there (or pretty close to it) doesn’t help your argument, bro.
Sure it does, I’m familiar with HIPPA. Since when does it not allow for the warning of parents in the case of their kids and exposure to TB?
Are you claiming that janitor should be protected via HIPPA? He still could have been by simply stating the presence of TB to the parents without revealing his identity.
That is a joke. I hope someone/lawyer isn’t trying to use that defense…and “Godwin’s law” is completely relevant and definitely states my case quite clearly in this instance.
“Following the law” in a way that causes death is reprehensible. Call me “self righteous”, but that is exactly what Nazi’s were put to death for.
I’d glad wear the “self righteous” label if my disobeying the law caused me to lose my job yet saved a kid from harm. Seriously, what the hell are you thinking?
Are you actually saying you might let the kid get infected if you were in a similar situation?
The children there should have ALL been x-rayed and ALL put on immediate therapy as soon as the infectious patient was discovered. Children and the old and others with lowered immune systems are especially vulnerable. Bloodborne TB–very deadly–can develop very quickly in infected children. If proper procedures were not followed, there’s no excuse. This should be standard operating procedure. The TB management program of DHEC should have been all over this from the very beginning as part of their standard operating procedure and calling in personnel from other parts of the state to back them up if necessary to make sure every child was screened and put on therapy. Talk to TB management personnel in other states if no one here will talk to you about it.
That’s not the protocol and shouldn’t be. X-rays, CT scans are not something that should be done, particularly to children, at the drop of an hat. There is discussion going on in the medical community right now about how over-exposed little kids are to radiation.
As someone who was exposed to a person with TB because his doctor didn’t bother to notify DHEC, when he was hospitalized and we in his office were finally informed, we were sent to DHEC for the skin test and that’s the appropriate step 1.
It’s handled differently when younger children are involved. I’ve talked to someone who knows and has handled a high school outbreak several years ago which is serious but not as bad as cases that she handled with younger children. Classmates at the school were exposed to a VERY contagious case and, as things developed, some students who weren’t even in class with him but came into the classroom after he’d been coughing out germs were infected from breathing the same air. Every student with a positive TB skin test was tested and x-rayed. Students determined to be close contacts had negative TB skin tests were also X-rayed as an extra precaution that is usually not taken with adults.
Younger children who were close contacts to any active case were routinely X-rayed immediately and put on medication until a second negative skin test a few weeks later cleared them. Of course, medication continued if a second skin test showed positive (when the first skin test was negative-it takes a few weeks to develop the antibody that the test detects) and if an X-ray showed active disease, chemotherapy was increased and continued for several months of directly observed therapy.
Depending on a determination of how contagious the TB case is and what pool of children were considered close contacts-and that could potentially be the entire population of the school-children involved should have been X-rayed which is more than justifiable considering the relative risks of active TB disease in children vs. a small amount of radiation.
Protocols may vary from state to state and, sometimes, from one state public health area to another depending on who is in charge. When elementary age children are involved, however, the consequences can be very serious and a few weeks can make a lot of difference in their treatment and, in some cases, their survival.
The children there should have ALL been x-rayed and ALL put on immediate therapy as soon as the infectious patient was discovered. Children and the old and others with lowered immune systems are especially vulnerable. Bloodborne TB–very deadly–can develop very quickly in infected children. If proper procedures were not followed, there’s no excuse. This should be standard operating procedure. The TB management program of DHEC should have been all over this from the very beginning as part of their standard operating procedure and calling in personnel from other parts of the state to back them up if necessary to make sure every child was screened and put on therapy. Talk to TB management personnel in other states if no one here will talk to you about it.
That’s not the protocol and shouldn’t be. X-rays, CT scans are not something that should be done, particularly to children, at the drop of an hat. There is discussion going on in the medical community right now about how over-exposed little kids are to radiation.
As someone who was exposed to a person with TB because his doctor didn’t bother to notify DHEC, when he was hospitalized and we in his office were finally informed, we were sent to DHEC for the skin test and that’s the appropriate step 1.
It’s handled differently when younger children are involved. I’ve talked to someone who knows and has handled a high school outbreak several years ago which is serious but not as bad as cases that she handled with younger children. Classmates at the school were exposed to a VERY contagious case and, as things developed, some students who weren’t even in class with him but came into the classroom after he’d been coughing out germs were infected from breathing the same air. Every student with a positive TB skin test was tested and x-rayed. Students determined to be close contacts had negative TB skin tests were also X-rayed as an extra precaution that is usually not taken with adults.
Younger children who were close contacts to any active case were routinely X-rayed immediately and put on medication until a second negative skin test a few weeks later cleared them. Of course, medication continued if a second skin test showed positive (when the first skin test was negative-it takes a few weeks to develop the antibody that the test detects) and if an X-ray showed active disease, chemotherapy was increased and continued for several months of directly observed therapy.
Depending on a determination of how contagious the TB case is and what pool of children were considered close contacts-and that could potentially be the entire population of the school-children involved should have been X-rayed which is more than justifiable considering the relative risks of active TB disease in children vs. a small amount of radiation.
Protocols may vary from state to state and, sometimes, from one state public health area to another depending on who is in charge. When elementary age children are involved, however, the consequences can be very serious and a few weeks can make a lot of difference in their treatment and, in some cases, their survival.
Templeton is the main reason this issue is before us now. Period. She and her hired hands have bungled, fired, mismanaged funds and directly put the public’s health at risk. Any other assumption is purely bunk. They face a record number of legal actions and could possibly be looking at federal prosecution if not careful.
do tell, Sam. And how might you know this? What is your involvement in DHEC and any legal liability?
DHEC and Templeton personally are facing four legal actions related to this case (that the media has told us about – maybe there will be more, from the parents down the road). Wonder how much it costs to defend her when she fucks up, because we’re paying that bill.
DHEC has been bungling for years. Maybe not the heath side, but the environmental side has a good many mounded rugs and bone-filled closets.
Templeton is the main reason this issue is before us now. Period. She and her hired hands have bungled, fired, mismanaged funds and directly put the public’s health at risk. Any other assumption is purely bunk. They face a record number of legal actions and could possibly be looking at federal prosecution if not careful.
do tell, Sam. And how might you know this? What is your involvement in DHEC and any legal liability?
DHEC and Templeton personally are facing four legal actions related to this case (that the media has told us about – maybe there will be more, from the parents down the road). Wonder how much it costs to defend her when she fucks up, because we’re paying that bill.
DHEC has been bungling for years. Maybe not the heath side, but the environmental side has a good many mounded rugs and bone-filled closets.
A slow-progressing disease, of relatively low contagion, with effective treatment readily available, but a fairly slow means of testing reliably (a few weeks, not a day or two) and the high-confidence but low-comprehension know-nothings in the howling mob want heads on pikes for the delay in notification. What more would the parents have done, take their kids to faith healers or naturopaths? They would rather have had panic than a steady, if somewhat sluggish, methodical response. Should we base, say, bridge design by a show of public hands too?
How about find out what CDC or NIH recommends and see how closely it was reached? Then, if necessary, look for the tar and feathers.
I’d say over 63 kids infected in a small town school of around 400 merits some panic, aside from 24 associated with the school also infected.
The testing in early March should still yields results by your claim of “a few weeks” either at the end of March or early April.
IT TOOK TWO MORE MONTHS FOR NOTIFICATION!
Holy cow, I hope you aren’t running anything of importance.
Oh, and casting further doubt on your claim, since you referenced the “CDC”, they claim a skin test only takes 2-3 days:
http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm
Even if you want to avoid panic, you could “two step” test and still be under 1 week.
It’s incredible mass incompetence.
I think it likely that you confuse an exposure test with the far more important contagious test. I claim no special knowledge at all but a medical article on TB in the news today claimed ONE-THIRD OF THE WORLD’S POPULATION has been exposed to TB and shows antibodies. If so, that test cannot be all that useful in guiding action other than triggering more testing..
Given your high state of certainty with very little hard information, I do trust that your job is fairly simple.
“I think it likely that you confuse an exposure test with the far more important contagious test.”
That’s the first test, followed by an X-Ray to confirm, you who “claim no special knowledge”. How long does an X-ray take?
Also, your “exposure” rates are highly misleading:
http://www.cdc.gov/tb/publications/factsheets/statistics/TBTrends.htm
Like I said, I hope you aren’t running anything of importance, because if a simpleton like myself can see a clear and responsible path for handling such an emergency and you can’t, well, then let us hope you responsibilities reflect your ability.
A slow-progressing disease, of relatively low contagion, with effective treatment readily available, but a fairly slow means of testing reliably (a few weeks, not a day or two) and the high-confidence but low-comprehension know-nothings in the howling mob want heads on pikes for the delay in notification. What more would the parents have done, take their kids to faith healers or naturopaths? They would rather have had panic than a steady, if somewhat sluggish, methodical response. Should we base, say, bridge design by a show of public hands too?
How about find out what CDC or NIH recommends and see how closely it was reached? Then, if necessary, look for the tar and feathers.
I’d say over 63 kids infected in a small town school of around 400 merits some panic, aside from 24 associated with the school also infected.
The testing in early March should still yields results by your claim of “a few weeks” either at the end of March or early April.
IT TOOK TWO MORE MONTHS FOR NOTIFICATION!
Holy cow, I hope you aren’t running anything of importance.
Oh, and casting further doubt on your claim, since you referenced the “CDC”, they claim a skin test only takes 2-3 days:
http://www.cdc.gov/tb/publications/factsheets/testing/skintesting.htm
Even if you want to avoid panic, you could “two step” test and still be under 1 week.
It’s incredible mass incompetence.
I think it likely that you confuse an exposure test with the far more important contagious test. I claim no special knowledge at all but a medical article on TB in the news today claimed ONE-THIRD OF THE WORLD’S POPULATION has been exposed to TB and shows antibodies. If so, that test cannot be all that useful in guiding action other than triggering more testing..
Given your high state of certainty with very little hard information, I do trust that your job is fairly simple.
“I think it likely that you confuse an exposure test with the far more important contagious test.”
That’s the first test, followed by an X-Ray to confirm, you who “claim no special knowledge”. How long does an X-ray take?
Also, your “exposure” rates are highly misleading:
http://www.cdc.gov/tb/publications/factsheets/statistics/TBTrends.htm
Like I said, I hope you aren’t running anything of importance, because if a simpleton like myself can see a clear and responsible path for handling such an emergency and you can’t, well, then let us hope you responsibilities reflect your ability.
Any citizen can call CDC. Get the phone number and call them. A person from CDC will talk to you. Go ahead they are friendly.