Thursday, October 30, 2014

So Damned Mean



From comments on Because Science post today:
the danger of Ebola eventually showing up in the US in large numbers has MUCH MORE to do with stopping it in Africa than it does with fear driven (rather than data driven) reactions here in the US over quarantines.
No, it has nothing to do with that at all. It has to do with not letting them fly in here every damn day, and checking for symptoms now that might not show up for 21 days. How's about we put them in a room for 21 days, and THEN see if they have symptoms?
99.9999% success rate. How's that for data? Next problem.
If we save 10 or 20 near future contact cases here in the US but the cost of that is an outbreak that spreads through-out the 3rd world when we might have had a better chance of stopping it in West Africa by not making it harder for medical staff to volunteer, do you think that would be a good trade?
No. I wouldn't trade you one US doctor or one US nurse for their whole country. If someone chooses to go on their own, that's their decision. But their choice doesn't obligate me or any other American to be exposed to the risk of the disease just because it inconveniences them to have to sit in a tent for 21 days waiting to see if they screwed up while out do-gooding.
There's a way that we could handle our near term concerns in the US while at the same time enhancing our response to the greater threat in West Africa by simply paying people.
Let's say we need 2,000 doctors and 8,000 nurses to serve in West Africa for the next six months to get this under control.
Offer to pay those doctors $100,000 per month and those nurses $25,000 per month with a contractual obligation to self-isolate for 21 days upon return.
The cost? 2.4 billion plus infrastructure, transportation, and consumables costs. So let's say 5 billion, all in.
That's about $20 per US taxpayer, or about half of what the government spends in a day. You could probably even crowd source it.
This would be a smarter way to speed up wiping out this ebola outbreak than reacting from fear and failing to adequately adress the bigger problem.
No, it wouldn't. If the federal budget has a spare $5B, it's that much too big already. You want to start a charity and do that yourself, knock yourself out. I'll send you the $20. But keep Uncle Sam's (and your) hands out of my pockets, and off my back. I'm already carrying the 47% Free Shit Army, 11-20M illegal aliens, and now you want me to piggyback 21M African tribesmen? No thanks, my back hurts now.

And next year, some guy would decide he wants BBQ bat, his wife would prepare it, she'd give Ebola to the baby, and we'll be off to the races again.
And again.
And again.

You want to help them? Teach them to stop eating bats, kissing dead people, and maybe get them to wash their hands after they crap, and before they eat.

At some point, they're going to need to start figuring this stuff out for themselves, and in the meantime, there's no requirement to import them here daily. We're already carrying the lion's share of the load on relief there. They've had famines and epidemics there for millennia. The "civilized" countries have figured this out.

Stop throwing life preservers to the ones who put 400 people on a 50 passenger ferry and then look shocked when it flips over.
So you think you can escape it if it spreads in the third world?
That's ridiculous.
Once it's in Latin America, it's here.
There is no way to stop it here without stopping it there, and even if it takes 500 billion dollars, that's still a preferable outcome to the existential alternative.
No, but we can sure as hell slow it down overseas, and block it off from getting here as long as possible. MAYBE even long enough to figure out effective treatments or a vaccine.
 Aesop, it sounds like you WANT this to spread.
No, I want it to go away. I also want a Ferrari, the winning Powerball ticket, and the phone number of the Playmate of the Year. But the reality is, I'm not going to get any of those things in my Christmas stocking, and nothing we've done, will do, or could do, will make any difference in stopping Ebola in Guinea, Sierra Leone, or Liberia, anytime soon. And they don't have much more time left beyond "soon".
I think it is possible to stop it because other countries in Africa have done just that.
But even if I took your view that a vaccine is the only hope, and we're just playing for time here, then that's even MORE reason to work on slowing it down over there.
They stopped it at one case, or one vector. So stop wasting time, money, and effort on the three countries that are going to burn to the ground no matter what, and instead start dumping everything into beefing up medical response and capabilities in Cote d'Ivoire, Mali, Senegal, and Guinea Bissau, so they can KEEP catching this at 1 or 2 patients. And start by buying their border guards as much ammo as you can get. Because when one/all of the currently infested countries collapses, people are going to flow outwards in all directions, and if Ebola ever gets out and in case numbers of 20 or 50, it'll bury them, and we'll be off to the races again, except this time with countries with 54M people, instead of 20M. And it'll devastate them, just like it will us, in any city here that gets a cluster of 20+ cases overnight.
None of your logic makes any sense.
If you think we can stop it, then stopping it over there makes sense.
If you think we can't, then slowing it down over there (where it's currently growing at the fastest rate) makes sense.
I'm certain we can't stop it in any of the current three most afflicted countries, based on over 10 months of unmitigated failure, and a growth rate that would be a Wall St. mutual fund manager's wet dream.
I don't even think we can slow it down there.
But we might could slow it down by containing it where it is, and doing everything possible to slow it down if/when it hits the next tier of victims. The farther from here, the better, and the longer before it gets to us, better still.

As to stopping it, or developing a vaccine, I am hopeful. But only because that's all there is.
I'm certainly not confident. I expect we'll fail at stopping it, gradually lose at slowing it down, and eventually have to face it here, and not in isolated single-case events. All we're waiting on for that is Thomas Duncan v2.0, taking his infected self to some immigrant flophouse, infecting 10-20 guys who didn't travel to Africa, and they come down with it, maybe during the holidays, when ERs are at their annual hopelessly overcrowded census, and flu season is in full swing, and somebody goes back home without being seen, or gets misdiagnosed, or whatever.
Then a week or so later, 5, 10, 20 cases all present within a couple of days, and any city is immediately overwhelmed, because they don't know where it started, why they've got it, and they have no chance in hell of contact-tracing the 50,000 people they'll have been with, or around, in the prior 21 days.
And on that day, American City X is now Monrovia.

Sorry if Reality hurts your feelings, or leaves a mark. Get used to it.

(And no, I don't mind such comments. It gives me something to sharpen my claws on.)

31 comments:

Ex-Dissident said...

Yup. If this happens in NYC, 1/2 the hospital staff will flee. The hospitals are already overcrowded and the ones with heart attacks, strokes, and cancer will be left behind. While the chronically ill will suffer from this aspect of Ebola hitting a large city, the financial impact will be felt by everyone, including the young and the healthy.

Anonymous said...

Sheeple prepare for FEMA camps!!!!!

Rob Crawford said...

In 1665 the Black Death made its last appearance in London. Granted, there was little they could do, given the state of technology, but what they DID do should be instructive:

Quarantined THE CITY. Sure, some people got out. But ships weren't allowed to leave, people were mostly kept inside the city walls. Supplies were shipped in and left inside the city gates.

The calculation was that it was better to risk losing the city of London(!) than the entire British Isles.

You want doctors and nurses to be able to volunteer to help in Africa? Fine -- but don't expect they'll be able to come back until the outbreak's OVER. None of this "I needed a break, so I came over, went bowling, rode around town and, oh yeah, came down with Ebola". This was the practice in the years before airfare became cheap, and it had the advantage of helping contain the outbreak, so there's no reason we can't do it again.

But I'd rather lose the entirety of West Africa than risk even a small outbreak in the US. Call me all the names you want, I don't care.

Anonymous said...

You missed the most important part on the 1665 outbreak, in London, of the black death.
The great fire of London in 1666
finally rid London of the plague after sporadic outbreaks in the previous 300 years.
Sam Pepys ,in his diary,believed the fire had been set deliberately by the English nobility, who luckily were out of town when it raged.

Yojimbo said...

AESOP,

Thought you might be interested in this story about a possible asymptomatic carrier of Ebola in West Africa...

http://www.thedailybeast.com/articles/2014/10/30/this-man-lost-35-relatives-to-ebola-and-his-community-wants-him-gone.html

A typhoid mary?

Anonymous said...

"They" told us the economy was improving. "They" told us we had nothing to fear from terrorists. "They" told us they had Ebola under control. We live paycheck to paycheck. We've seen terrorists attack for years on our own soil. We've seen people in this country with ebola.
Next comes martial law. Then the mandatory quarantine. Then the round up for the FEMA camps...
Three percent of us will "decline to participate", and will choose option 3...
"We tried to tell you, but you weren't listening. You're not listening still."
Now, we express our displeasure in a more direct, and louder way. And once it goes loud... s f

Anonymous said...

Liking the fact you used a Marine D.I. there. Not known for excessive worry about hurting feelings. :)

Continue, please, with the "So Damned Mean!"

Anonymous said...

This isn't a question of mean or nice, it's a question of efficacy.

If we do expend resources to contain it over there, then we reduce (but don't eliminate) the chance we will need to spend vastly greater resources to defend against it here later.

Is there a risk that by doing that we will speed up the spread over here? Sure there is, but the current data shows that risk is relatively small, and if the data change, we can always reevaluate the risks.

But if you think that sticking your head in the sand, doing nothing, and just hoping that someone invents a vaccine in time is the equivalent of "sharpening your claws," please continue to think so.

I'll just continue to think you're wrong.

Aesop said...

There is no amount of resources we could expend to contain it there. It's pissing on a forest fire.

That isn't going to speed up the spread over here, it's simply wasted effort, coupled with a guaranteed Ebola import rate when workers there get infected, and want to come home. There are a total of 23 BL4 beds here, but they're only staffed to handle 8-11 patients, and 3 of those beds are permanently reserved for their primary mission - caring for workers at the BL4 research labs. So there are thus 5-8 slots left for infected people. At one point, we were down to two spaces. So if we get 10 docs/nurses infected over there, and we have no BL4 isolation treatment beds left, we're back to the THP-Dallas clown show, which turned out so well the last time we tried it. Most of their ER and ICU staff not already exposed walked out.

The only person putting their head in the sand is you if you think there's anything you can "do" in the already-effected countries. They're toast.

Like I said, you want to invest in bulking up the four surrounding countries' medical response, rock on with yer bad self. That might buy some extra time, and enable them to keep fighting off the onesie-twosie outbreaks better, and longer.

Except Mali's president, it being a land-locked country, has already indicated they'll keep their borders open. That's a death sentence for his country eventually, since they border both Guinea and Liberia. But if they can play whack-a-mole for longer, it buys more time for research. And that's the best you can do.

For 38 years, official international policy with Ebola has been to isolate, and let it burn itself out. At the cost of entire villages and districts that were inside the hot zone.

Now entire nations including million-person cities are the hot zone, and it's still all we've got, except we're stupidly allowing people out from the hot zone all the time. Including our own do-gooders, both sick and healthy, and we can't tell one from the other for 21 days, as Dr. Spencer illustrated. He also illustrated that highly trained medical professionals will live in denial, do stupid things, and lie to the authorities afterwards, because they're human, not machines.

Acting otherwise is another form of sticking heads in sand.

You can believe whatever you want.
But if you can't recognize obvious facts from open public sources and current events, the problem isn't what you believe. It's what you don't know you don't know about what you think you know.

You're entitled to your own opinion; but you don't get to create your own reality out of strawberry-scented unicorn farts.

And the reality is this is going to get worse, not better, for a long time.

So far, every three weeks, the size of the problem doubles. We're building 20 beds a day, and Ebola is infecting 200 people a day. In 3 weeks, we'll have built all the beds we can, and Ebola will be making 400 patients a day.

There's no effort to anywhere from anywhere that can keep up with that growth rate until it either runs out of people, or we can stave it off medically.

Anonymous said...

You keep trying to claim with certainty that there's no way to stop these outbreaks in the three most effected countries in West Africa, and that's nonsense.

You don't know that for sure, just as I don't know for sure that doing more will help.

There may be eventual patterns of response in these countries that slow the spread even without our help (or maybe not). We just don't know, because we have never seen outbreaks like these before.

But early and committed efforts over there are the cheaper option to try first, and we can always course correct to a more isolationist strategy later, so dismissing that effort makes no sense, because you can not be certain that these outbreaks aren't containable.

By claiming that you do, you just sound short-sighted and afraid to me.

Anonymous said...

When you're dealing with a potential ELE, you don't pick belt OR suspenders, you pick both.

What we need here is Ben Affleck, Bruce Willis, a bunch of public health resources, and some Aerosmith tunes. A full-on disaster movie level of response.

What has America become? Cringing and hiding in the face of threats? That's sad.

Aesop said...

The time for early and committed efforts was last May. We started paying attention in late September. If we hadn't had one case come here then, we'd still be wondering and pondering.

All you're doing now is pure gainsaying based on fantasy.

I'm pointing to the facts on the ground, going back months, and getting bleaker by the day.

NGOs already wrote Sierra Leone off the first week in October. They started passing out home health care kits (AKA "Guaranteed Family Ebola Spreaders") because they knew, and admitted publicly "we can never catch up to this outbreak". And Liberia is worse off than that, already, and has been for months.

There's no number you could name that's reality-based that could ever make any difference: no number of workers, doctors, treatment beds, nothing. The answer doesn't exist in the real world, and any answer that does exist is not enough. This battle was lost last spring, and WHO and CDC know it.

Nothing I'm telling you is unavailable online; you simply have to look, and do the math.

Positing some other way out of thin air is simply magical thinking.

Anonymous said...

There is a site called Public Intelligence that posts the US Military operations reports regarding Africa Command and their Ebola efforts on site. Contains other very interesting reports as well from other .mil and .gov sources. You might want to check it out. -SemperFido

gamegetter II said...

"I'm pointing to the facts on the ground, going back months, and getting bleaker by the day."

Yup. And facts is all you've been "reporting on" here for months.

No one who has had passing grades in middle school math can deny the fact that no mater how many beds the U.S. Army,Marines and whoever else helps builds-it can never,ever catch up with the number of new cases-until the virus runs out of hosts.

There is only one way to prevent an outbreak here-and that is to not allow anyone from the hot zone (s) into the U.S. unless they have been quarantined for a minimum of 21 days. 45 days would be a much safer length of quarantine-because there may be cases that don't produce symptoms until 40+ days-and we know that some people who are infected never present with a fever.

Nurse MiMi being a CDC infectious disease outbreak"intelligence" specialist,her lawyer having been to the White House a few times-then just suddenly showing up out of nowhere to represent MiMi whiny bitch seems just a bit too convenient.
All part of TPTB's media campaign to convince the masses that we can treat Ebola cases here-and that Ebola is really,really hard to catch.

Anonymous said...

What some of you don't seem to understand is how interconnected the global economy is.

This doesn't have to spread to the US in order to collapse our society - all it has to do is cause enough disruption in a major foreign economy to trigger enough CDO's to render our banks insolvent.

And just a few tens of thousands of cases in India or China might well be enough to do that. Or a new war, in one of several countries, if the virus spreads there.

Who is going to develop your vaccine when the global economy shuts down because supply chains freeze due to lack of credit?

If this isn't stopped at the source, then the chances for stopping it later are poorer, not better.

Aesop said...

Then we're already totally screwed, because it can't be "stopped at the source".

We don't even know what the source is.
And we've been looking for 38 years.

So when you pull that stuff out like it somehow creates a necessity for action, you aren't helping the "over there" case, you're just pointing out that it's like having a duel inside a burning house to even attempt it.

Also, hard as it is to believe, we're the most self-sufficient nation on earth compared to every other one, so even granting some worldwide financial meltdown, we're likely the only country that could possibly regroup enough to continue such research.

Additionally, knowing Asia's vulnerability, already two nations in the region have completely closed their doors to any W. African travelers from the affected nations: North Korea, and Australia.
When the most repressive regime on the planet and one of the most open and laid back both agree on the same policy, maybe stop trying to sell your Magic Beans, and pay attention.

Double fail.

Capitalist Eric said...

Aesop, I stumbled across your blog (via WRSA) a few weeks ago. My doctorate was in Information Systems, i.e. data analysis. So while I'm not medically trained, the facts that you provide appear solid.

Terrifyingly so...

Given the lack of knowledge as to transmission mechanisms, much less an effective treatment/"cure," this very much appears to be (in my eyes) a civilization-ending event. I therefore worry about my family, my kids... and know there is nothing to be done except watch, and perhaps prepare with those I trust. And that's very likely not going to be enough...

I'm reminded of the first half of The Stand; life imitates art. The pace is slower, the mortality rate 90% instead of 99.7 (in the book), but the cold feel of inevitably remains.

Keep up your work, keep putting out the facts. Better to SEE than to be blind.

Remember, though, that there will always be a group of people too weak to face facts, even when reality- or Death- is staring them in the face.

Aesop said...

Thanks.

I started following this closely in early July, and I started crunching open-source numbers myself shortly afterwards. It is simply and unceasingly grim.

I'd love to be wrong, it'd make a lot of things cheerier every day, but there's no sign of things getting better.

The only rational answer to me is plan to be somewhere where it isn't coming in the door, and you aren't going out of yours, and you have enough of life's necessities put by to ride it out.

Anonymous said...

By "the source" I meant the sources of human replication for the current outbreak - not the animal source.

I don't believe that current case counts are unmanageable if enough resources are applied soon and, even better, if the population at risk starts to learn how to avoid becoming infected.

You may think that's a long shot, or impossible, but the alternatives are another long shot - quickly developing a vaccine for a rapidly mutating virus (ask the HIV boys how easy that is), or ELE.

Anonymous said...

I said about six months into Obozos term he's too much of a narcissistic sociopath to ever leave the office of the POS willingly his derilliction of duty, blundering incompetence and downright deliberence to spread Ebola just goes to prove my point; unfortunately. I agree that mandatory camp assignments and culling the herd is in our future. A former FDA official is already priming the pump for such events.

Anonymous said...

Thank you guys for this civil debate representing both sides of the aisle for what appears to be the most important issue we have faced in my 39yrs on this planet. It is a rare thing to find on the Internet these days and it causes both sides to think of things they might not have on their own. My personal feelings are that the 21 day cycle of this methodical monster will be our undoing. Who in our mouse click overnight delivery society has the patience and attention span for 21 days, much less the slow march over the next month and years. It's slow enough that the vast majority of us do not have the resources isolate ourselves if it does hit our shores in significant numbers and long enough that most of us would go insane if we tried. Keep it up Aesop, we are listening.

Alien said...

There is no solution humans can implement that will fix Ebola in the African Big Three. Africa absolutely, positively, will not create its own vaccine, that will come from Advanced Western Civilization (eg., "probably the U.S.").

And, when the AWC does create a vaccine, first, it won't be perfect because the incredible variety of human DNA variations will ensure it won't work for every person, and second, a significant portion of Africa's culture won't trust it because, well, just "because." It's the culture, stupid.

The best that can be achieved will be Ebola becomes like the flu - killing a certain number each year, based on location and individual susceptability, but within manageable numbers. Containment will be, despite the lefties' desire for it to not be so, THE integral part of Ebola management. Unless someone finds a way to eliminate the virus itself from the planet - which we haven't done with any virus we've learned to manage - we'll still see a certain number of cases annually.

Much of Africa is a stone age civilization with TVs and Toyotas (the same can be said of Milwaukee, Kabul and Detroit, with a few caveats).

Leftists are incapable of providing any degree of solution to the problem, righties barely more so; neither have deep foundations in reality, and when the Real SHTF both will respond similarly.

I'm afraid this thing must run its course, and our only hopes are that enough of the smart ones survive to resurrect civilization and we have enoughtime to discover means to spread humanity into the other parts of the universe, preferably without bringing "the stupid" with us.

Limbaugh mentioned t'other day that the last two years of the Obama Kingdom will be challenging; I fear that he is right, for reasons that have little to do with Obama.

Anonymous said...

Excellent, point-by-point dismantling of an idiot's "reasoning" process.

Once again, I must ask: what about Duncan's family? I've seen NOTHING from them, other than a "somebody said" report that they want "privacy." No interviews, none at all. Not one? No one wants their fifteen minutes of fame on GMA?

Until I find such, I'm going to file this under hmmm…

Percy said...

It surely is like pissing into a forest fire unless they are beginning to catch on over there (stay away from them -- stay far, far away), and it is unutterably offensive that they are doing it with my soldiers,sent to build things or something over there rather than killing enemies. (Soldiers? My soldiers? This is what they are for?) And that they are spending my dollars to do the mindless pissing.

For what? Who are we trying to please or make feel better here by doing this? Would those please stand up so I can move farther way from you -- keep my children from your company?

Be sure to vote for your candidate next week if he or she has sense enough to say to this "Stop! Stop now!" But those seem few and far between -- if there are any at all. Vote the others out. Might leave a lot of empty places in the halls of our brain-dead rulers.

Oh. And another thing. That truculent, mad nurse and the Governor of Maine. WTF? Can't file a simple brief in support of a restraining and quarantine order and find a judge to issue it? Not yet? Why not? What the hell's wrong with you and your staff?

Wyoming Bound said...

It has always blown my mind how rational, intelligent human beings can do such stupid things.
We have a potential epidemic and nurses and doctors with contact are gallivanting around as if they're invincible.
I can't help but think this is natures law culling the herd.

Frank Ch. Eigler said...

"I don't believe that current case counts are unmanageable if enough resources are applied soon"

What are "enough resources" (and please avoid True Scotsman or circular reasoning). Where could those come from?

"and, even better, if the population at risk starts to learn how to avoid becoming infected."

Please inform us of your assessment of the probability of this happening, given any possible assistance.



"You may think that's a long shot, or impossible, but the alternatives are another long shot"

There is no "but" there. Both are long shots.

Rob Crawford said...

"I don't believe that current case counts are unmanageable if enough resources are applied soon and, even better, if the population at risk starts to learn how to avoid becoming infected."

And how many of the doctors and nurses you want to send there will die, and how many Americans will die because we've drained our resources providing hospice care for Africa?

They've had centuries to learn how to avoid these diseases, and haven't. They don't want to, because they believe it's magic, not a virus.

Anonymous said...

Napalm the entire area in Africa where this shit is!!

Anonymous said...

But if you think that sticking your head in the sand, doing nothing, and just hoping that someone invents a vaccine in time is the equivalent of "sharpening your claws," please continue to think so.
"Doing nothing?" You're a liar, since nobody is suggesting doing nothing. Pretty dumb and dishonest of you to characterize reasonable actions as "nothing."

Invent a vaccine? You mean in addition to the ones that have ALREADY been invented, shown preliminary success, and are simply awaiting mass production?

Or how about the other treatments like ZMapp et al that have ALREADY been invented, shown preliminary success, and are simply awaiting mass production?

Mass production is EASY.

Anonymous said...

"You keep trying to claim with certainty that there's no way to stop these outbreaks in the three most effected countries in West Africa, and that's nonsense.

You don't know that for sure, just as I don't know for sure that doing more will help."


Yes, it's technically true that we don't know "for sure" one way or the other.

But living in the real world isn't about knowing "for sure," it's about playing odds.

I would estimate that there's less than a 1% chance that we can 'save' West Africa. It's like being down 50-0 with 2 minutes left in the Super Bowl: sure there's a nonzero chance we can come back and win, but it's wildly improbable.

On the other hand, I estimate that there's around a 99% chance that the U.S. could save itself (and by so doing, be able to save the world) if we take some rather simple preventive steps.

The current strategy (i.e. 'screw taking the totally doable preventive steps to obviate problems here, let's just put all our eggs in the piss-on-the-forest-fire basket') is the worst possible strategy. It bets our own safety on the miniscule odds of stopping the problem in West Africa. That's a ridiculously bad bet, and is completely irresponsible.

Anonymous said...

"What some of you don't seem to understand is how interconnected the global economy is.

This doesn't have to spread to the US in order to collapse our society - all it has to do is cause enough disruption in a major foreign economy to trigger enough CDO's to render our banks insolvent.

...

If this isn't stopped at the source, then the chances for stopping it later are poorer, not better."


And what you don't seem to understand is how easy that problem is to solve. Is finance your religion or something? Do you submit to daily banking brainwashings?

It's beyond ridiculous to claim that Americans would no longer produce vaccines/treatments for themselves if there were an international banking freeze/collapse. GET REAL. We'd create our own independent financial system very quickly if need be. And even if the financial system were in total upheaval, people would still do the work. Very few people would say, "Screw going into work to mass produce vaccines/treatments for this imminent threat, I'm not working again until the banks are happy again!"

It's like you don't realize that the "We must keep the banks happy or the world will end" meme is just bs propaganda by the banking industry meant to scare you into doing whatever they want (like giving them trillions of dollars for free).