Sunday, November 2, 2014
Fear Mongering: Not So Much
In his cultural landmark paper in 1993, the late great Sen. Daniel Patrick Moynihan coined the brilliant phrase Defining Deviancy Down. In that scholarly work (which you should read sometime, if you're intellectually curious) he wasn't describing anything like a rising tide of prurient perversions, but rather, speaking in sociological terms consistent with his long scholarly affiliation, speaking to the near-timeless tendency of the altruistic engineers of society to cope with the burgeoning growth of the problems their do-gooding inflicts, to make what was once "outside the norm" AKA a statistical deviant, into "the new Normal".
As proof of the genius of the last great honest political liberal of modern times, we see exactly that phenomenon now with regard to our recent close brush with Ebola. We've had precisely two unexpected deliveries of that virulent pathogen arrive here so far (plus five deliberate imports, and two unfortunate hospital-acquired infections). For a grand total of nine patients. Of these, every American has survived (and those infected now are likely to fully recover as well), while the one unfortunate Liberian who came here died the expected horrible death via multisystem organ failure, as his insides turned to jelly and squirted out his orifices.
This statistical hiccup, which anyone familiar with numbers let alone disease would entirely disregard, is treated with hosannas by both the media and the architects of the insane policy of importing more such Index Patients, whereas in comparison to the thousands of African Ebola victims would be treated as nothing more important than a rounding error in tabulating the daily horrific toll of the infected and dead.
Because that's all this is.
Does it tell us anything about Ebola? Yes.
It tells us that if we get a single case at a time, or at worst, a bare few, and no closer than several days apart, and if we detect the new-onset cases immediately, and throw astronomical amounts of American medical care and attention at them from the start, damn the cost, we can drastically decrease the mortality of this disease. The honest historical death rate is up to 90%; the fudged rate from WHO in this outbreak is over 70%; the current American mortality rate, as it stands now, is 11%.
So what's wrong with that? Everything.
Let's start with the "Ifs":
If we're looking for it
If they had recent African travel or contact with Ebola patients
If their temperatures are checked
If they self-monitor
If they don't live in denial
If they don't traipse hither and yon about the greater community
If they seek immediate care
If they get rapidly diagnosed
If we can identify, locate, and monitor or isolate their contacts
If we have the level of hospital care and treatment required
Assigning each of those "IFs" a bare 50/50 probability, that's a chain of intention vs. coincidence of 0.0976% in any random patient.
In other words, if we get patients one at a time, like Dr. Spencer, or nurse Nina Pham, and everything goes right, they have a better than 89% shot at making a full recovery.
If not, they end up like Thomas Duncan. And if we get 1000 Duncans, one might be expected to fully recover, and possibly 100-300 would survive the disease (the exact same survival rate in Africa with no essentially no medical care whatsoever.)
A minimum of 700 would be expected to die.
Then there's the re-infection rate:
Duncan, exactly like in Africa, produced two additional patients within 21 days of symptomatic infection.
Pham, Vinson, and Spencer have produced none.
Because they were rapidly placed in isolation (Pham within literally minutes, Vinson and Spencer less rapidly, but still fairly early in the course of the disease, when the amounts of viral load in their systems was relatively small.)
To date, and likely permanently, none of the hundreds of people Vinson and Spencer exposed have become infected.
Out of two, rapidly isolated cases among 13,000+ Ebola victims.
How many more times are we going to keep rolling those dice with airliners full of people?
Say there's only a 1% chance of passing it on early.
After 100 patients, that becomes a statistical probability of happening.
And what can we expect?
A study in the UK medical journal Lancet says we can expect 2-8 more Duncans per month, worldwide, at least 1-2 of whom will come to the US.
In the next few months, the US can expect 1 to 8 such patients, with a cluster of up to 20 patients, and perhaps as many as 130 by the end of December, according to the latest study done for the AP.
Excuse me? "Perhaps" 130 patients? A cluster of 20?!?
Remain calm. All is well.
A cluster of 20 patients would sink the abilities of even NYFC to cope with, right this minute. For any city or town smaller and less provided with care options, it would be a calamity.
We saw how well Dallas responded to one case (and everyone - not working for the CDC that is - now concedes THP-Dallas' response is the norm to expect, not an aberration).
Now imagine it breaking out in picturesque and quaint Fort Kent ME.
Or think about the extreme likelihood of an asymptomatic carrier going to a flophouse or garage full of people precisely least likely to self-monitor, assess the implications, and seek immediate care and treatment upon initial fever: like say a household of illegal immigrants from West Africa who've overstayed their visas, hiding in plain sight.
What happens when they don't rush to the ER at the first fever, instead waiting until everyone in the house has it? The kids go to school at the local public education warehouse: free lunch. Mom keeps showing up sick for work at Burger King, because they need the money. Dad does the same with his night shift job stocking Wal-Mart shelves. Neither of them with medical insurance. And our import Index Patient goes to his bachelor flat dive, gets sick, and dies alone at home without alerting the authorities to his immediate predicament.
And then a week or two later, like a zombie horror movie, the infected 5-10-20 all show up with well-advanced cases of Ebola, bleeding out the eyes, and squirting their internal organs out of both ends in streams of bloody vomit and diarrhea, at the local ER?
Howzat going to play, do you suppose?
Twitter, anyone? E-mail? TMZ?
Remain calm. All is well.
And the next day, it becomes known that the number of contacts to trace is 5,000, 10,000, or more. They think.
All the kids at a couple of schools. All the teachers. All the families of both. Everybody who ate at Burger King #XXXX since a week ago Tuesday. Everyone who shopped at Wal-Mart for the same period. Everyone who rode in his neighbor Joe's taxicab. All the people his girlfriend Mary served at the local greasy spoon diner.
Remain calm. All is well.
You tell me how long you're staying put when that info gets out.
What store shelves will look like an hour later.
How many hospital staff will call off sick that night, and the next morning.
What the interstates outbound will resemble.
And what will happen the first time someone on a plane infects a member of cabin staff, who then flew on 20 flights with 3000 passengers and crew members before becoming ragingly symptomatic, and finally correctly diagnosed with more than just seasonal flu.
And all that, just based on what we can expect to come here in the next few months.
Because the flights keep coming.
After that, the likelihood "depends on further developments in West Africa".
Word to your mother, Sherlock:
West Africa is going to complete shit, day by day, at 100 MPH.
The government has assigned Top. Men.
Remain calm. All is well.
So far, I'm the calm, rational one in this discussion.
So, how's your supply of canned good looking, folks?