A single schizophrenic patient had circulated from hospital to jail to homeless shelter to assisted living facility, living in dorm housing in many locations. Over and over, the patient’s cough was documented in his chart, but not treated. It continued for eight months, until he finally was sent under court order to A.G. Holley. That year, 2008-2009, a total of 18 people in that community developed active tuberculosis from the strain called FL 046 and two died. The CDC sent a $275,000 grant to help pay for the staff needed to contain it.

After the money ran out, Harmon said, staff were redeployed to other needs. But in 2011, suddenly, the number of active cases of FL 046 spiked, rising 16 percent to 30 cases of a specific genotype, the one seen in 2008.

“We thought after 2008 that we had it contained,” Harmon said. “It was not contained. In retrospect, it would have been better to inform the general population then.”