Friday, October 3, 2014

You Can't Handle The Truth

From time to time here, and on a couple of forums where the whole Ebola topic has predictably mushroomed in the last few days, a number of Internet aficionados have pulled out their expert creds, and/or subtly (and not-so-) hinted that things aren't that bad, "because the government sez different."

A number of repetitive strains of this malfunction keep showing up, and I'm not above some examination and self-criticism, in case I missed something, so let's have a look at what we know, shall we?

#1) "Ebola is hard to catch."

Well played. So, I can either believe that, or my lying eyes.
Strike one.

#2) "Ebola is fragile, and can't last long outside the host."
"We know how it's transmitted."
"We have the resources to contain it."
CNN Happygas from 8/5/2014

Well, it seems that since then, the CDC keeps changing the press release on that.

One of the key phrases excised from later editions:
"Because we still do not know exactly how people are infected with Ebola, few primary prevention measures have been established..." .
Pay attention to the fact that the science underlining that statement hasn't changed since then. Only the party line. That fact was undermining soothing platitudes, so it had to go. So every time you hear some talking head tell you "Ebola does this, or Ebola does that", remember that the considered medical wisdom until three weeks ago was that
"we still do not know exactly how people are infected with Ebola".

We also know that Ebola can survive for weeks outside the host, and that cold is actually more helpful, not less.
Under actual conditions, entire hospitals are contaminated, and remain a potent source of re-infection for days and days until decontaminated or destroyed.

#3) We can handle this, because first-world medicine!"
Yes, unlilke Liberia, we have flush toilets and running water anywhere and time we want it. Which only means you won't get Ebola from your own hands and dirty dishes or toilet seats. It means two things with regard to first-world medical care: Jack, and Shit.
The reality is, most hospitals have few negative airflow rooms to place a patient into strict isolation. For instance, the ones I've worked in had between 2 and 6 such rooms in the ER.
But the entire distance from the parking lot to those rooms is open community space. So just the act of bringing someone in to put into those rooms can expose other people along the way.
Think it over yourself: Grandma has chest pain, or your son breaks his arm. So you go to the ER. How are you feeling about sitting next to Mr. Headache Fever, visiting here from Pestilentia, and recent arrival on United Airlines' Ebola Express, while he coughs/pukes/craps himself?
And if he arrives after the 1/2/6/whatever isolation beds are full, where do you think he's going to be sitting?

All of that goes away, as long as you're willing to do only Ebola someplace, and tell anybody seeking care for heart attacks, strokes, seizures, and so on, to just go away someplace else. Because the ERs everywhere have so much extra space and staff that most of us just do crosswords and surf the 'net every shift, 24/7/365, and wait times don't exist. (Said no ER doctor, nurse, tech, or hospital administrator anywhere in the US, ever.)
And hey, good luck recruiting people to work at Ebola General Hospital, or ever getting anyone to come in the doors again, unless you first burn the place down and rebuild it from the dirt up, for a few hundred million dollars. FYI, THP, the Dallas hospital in question is a paltry 968-bed primary acute-care hospital that's a key to the region's medical system. Good luck dealing with the everyday anywhere in 20 miles if it becomes the Dallas Ebola Magnet Hospital of Excellence. Especially when salaries climb to $200/hr for janitors just to get any kind of staffing.

There are, in fact, four infectious disease ward around the country, in MD, GA, MT, and NE.
(Nota bene  there aren't any in NYC, L.A., Chicago, San Diego, Philadelphia, Dallas, Houston, Miami, Boston, or a host of other cities with international airports and millions of residents.) The one (of those four) in Missoula MT has 3...T-H-R-E-E...whole beds.  Emory U.'s Serious Communicable Disease Unit has three also. The NIH's Special Clinical Studies Unit has 7 beds, three doubles and a single. The biggest one of the four is the Biocontainment Unit at U. of Nebraska in Omaha, and it has a total of 10 beds. That's it.(You should also know that they're sited where they are because Emory, in Atlanta, is down the road from the BL4 lab at CDC, the one in MD is co-located just outside Ft. Detrick and the BL4 lab at USAMRIID, where we study bio-weapons and defense of same, the MT site is near the NIAID/NIH BL4 lab in Hamilton, the NE site is near the under-construction BL4 ward at the DHS/NBAF in Manhattan, and it and the MT site are roughly convenient for the US Army's Dugway Proving Grounds biowarfare test site, our nuclear missile wings, and the HQ for NORAD and America's strategic defenses. The problems of 300M other Americans are not on the radar so much.) They're constructed with separate physical entry/airlocks, and a host of things too expensive to include on every hospital ward everywhere, but vital to successfully treating a BL4 pathogen without making matters worse.

And while treating Brantly and Writebol under BL4 conditions at Emory was the right thing to do, virtually zero risk to anyone in the entire country, and undoubtedly saved their lives, those two patients generated 40 bags of deadly infectious waste hazmat. And the company that normally processes their medical waste refused, until virtually ordered to deal with it by CDC. And that was for just two patients, for a bare couple of weeks.

No hospital anywhere is currently configured to comply with the necessary hazmat regs on a ongoing basis, certainly not for multiple simultaneous patients, the waste companies will refuse to deal with it, and you can't send in troops to force them to do so at gunpoint. So you basically cut corners, and risk safety, and further spread of the disease. Like Ebola needed the help.

How bad is it?
As far back as August, the government and White House had no idea what they were dealing with, no strategy to cope with it, and no future protocols if things got worse there or here.

Rep. Frank Wolf (R-Va.) serves on the State and Foreign Operations Appropriations Subcommittee, which funds the State Department and foreign aid programs, yet was allowed to sit in on today’s special hearing of the House Foreign Affairs Subcommittee on Africa, Global Health, Global Human Rights and International Organizations. "For the first part of the epidemic, the international community simply let three of the most impoverished countries in the world deal with the Ebola threat essentially on their own,” the congressman continued. “It should be no surprise that the health systems in Liberia, Guinea, and Sierra Leone do not have the resources or the capacity to deal with this epidemic on their own. Despite early warnings from those NGOs working on the ground, there was little action taken to get out in front of this problem, and now we are seeing the consequences.”Wolf said he spent much of Monday last week on the phone with the White House, State Department, Centers for Disease Control and Prevention, and Department of Health and Human Services “trying to understand just what, if anything, the U.S. was doing both to help contain the outbreak and prevent the spread of Ebola to the U.S.”
“I was concerned that no one could tell me who was in charge within the administration on this issue. No one could explain what actions would be taken to ensure the U.S. was prepared to respond,” he said. “Although more progress has been made over the last week since these conversations, it’s clear that the government is still trying to catch up.”
CDC Director Tom Frieden eventually took Wolf’s call.
“It soon became apparent that there were significant gaps in existing procedures for dealing with this. The CDC had no available registry of medical facilities capable of treating Ebola patients in the United States,” Wolf said. “There are no quarantines or travel restrictions in place. And there was concern that these gaps in the protocols and how do you deal with them.”

Those were conversations in late July, over two months ago, and as one single patient here has proven, they're still in over their heads, a day late, and a dollar short, as

yesterday's post, showing unprotected and untrained flunkies aerosolizing deadly hazardous Ebola biowaste in a public parking lot demonstrates, beyond any shred of gainsaying and government/media happygas, farted out by unicorns fed on Magic Beans.

Please, please, get it through your heads:

Ebola is robust.
The contagion is virulent.
We don't know basic Epidemiology 101 information about its spread, or absolute prevention of same. (And testing deadly pathogens on people to get it is unethical, and gruesome.)
We don't have anything like the resources, nor planning and forethought on tap to combat this if it moves beyond a patient or two, in any city in the land. No one does, at this point.
The government couldn't find its collective ass with both hands, a map, and a mirror.

Remember that whenever someone cheerfully urges you "Remain calm! All is well!"

And if this title doesn't apply to you, let it roll off you like water from a duck's back, and rock on with your bad selves. Ignore the Soothsayers of Stupidity. This is going to get worse before it gets better, and we need people with a grip to deal with it. Which, so far, is almost no one actually in charge.


Historian said...

Amen. Ebola does indeed have some airborne potential, and we in fact don't have a handle on this yet. However, I do know that a lot of people are scrambling to catch up, not on the gvt side but on the health care side.

Anonymous said...

Ice cold water poured right down your back. Excellent, sir. Thank you.

Anonymous said...

The BSL 4 in Montana is because of the Rocky Mountain Labs, a NIH facility in Hamilton, Montana

Aesop said...

Thanks for the tip.

That information was actually buried in the bottom of the very article I linked; I was more concerned about how the ward was set up, but the reporter actually included that lab as the "why" they are where they are.
Otherwise, I didn't know about NIAID per se, nor that NIH had put a BL4 facility there, and Missoula is reasonably contiguous. So that's a clear connection in three out of four cases with exactly that level of research.

So I did some further digging, and came up with the NBAF, the National Bio and Agro-Defense Facility, a big new BL4 lab facility under construction in Manhattan Kansas, to be run by DHS, scheduled to open in 2015.
The nearby ward in in Omaha NE. Four out of four, plus the military/strategic reasons I previously cited.

Thanks for the nudge.

Phil said...

Looking at the facts, this has the potential of turning into the New Smallpox.

Thanks for the sobering info, I linked to this from The Vulgar Curmudgeon.

Aesop said...

Thanks for the link.

Smallpox was easier to transmit, but lethality varied from 1-100% based on type, with an average of about 30%.

Ebola is slightly harder to transmit, but lethality varies from 40-ish% (treated) to 90% (untreated).
And we have no vaccine for it yet.

Dan said...

Realistically we have only two possible avenues to prevent a world changing pandemic from this. Either we develop a reasonably effective that isn't as dangerous as the disease OR some genius pulls a rabbit out of his ass and finds an effective AND affordable AND relatively easy to manufacture treatment. Without either of these we are SOOOOOOO screwed.

Aesop said...

Total number of viruses we can treat primarily, dawn of time until now:

If the virus isn't as mutation-slippery as HIV/AIDS, a vaccine at some point is a possibility.

The open question is whether a worldwide pandemic beats us to the punch.

The project has been a worldwide orphan for decades, because a few thousand starving Africans were never going to make the development and drug roll out worth the costs of the research.

The sudden prospect of this going worldwide just a few plane trips away seems to have concentrated everyone's thinking wonderfully, and bumped this up a few rungs on the research and funding priorities ladders.

Whether we'll be in time remains to be seen.

The next milestone is whether they get any sort of handle on this, or whether the governments of Liberia/Guinea/Sierra Leone collapse, and the infected are suddenly unconstrained from heading outward via feet, canoes, and jet planes at the speed of utter panic.
Looking at the numbers, my money is on such a collapse, though I hope and pray I'm proven wrong.

Because at that point, the party's in full swing, and we're all on the guest list.

Dan said...

While to date an effective HIV vaccine has not been found that doesn't mean that a Filovirus cannot be protected against. Polio is a viral disease and we have VERY effective vaccines against it. The real problem is that while we have known about and played with Ebola for years it was always from the governments "how can I make this a weapon" perspective. Efforts to develop vaccines and treatments weren't very important. Now that they've let the horse out of the barn they are trying to play catch up. Sometimes you get the time to do so.....sometimes you don't.