One of our most thoughtful and respected commenters, in response to the last post, wrote the following:
"My thought is that Ebola kills too quickly to ever be a major problem in a country where the medical system is advanced past the 19th century.Let's be clear: Ebola in Kivu, right now, is nowhere near as bad as it was in West Africa in 2014.
Once the symptoms of Ebola take effect, the infected are as easily spotted as an extra on The Walking Dead, and just as easy to avoid.
We in the first world also understand quaratine, and we tend to follow those guidlines.
No one in America is going to be raiding hospitals to grab bloody Ebola laden bandages like the tribal folks did in Africa last time there was a major outbreak.
Healthcare workers in the first world have access to real PPE and they know how to use it.
My level of concern about Ebola is minimal at this point.
That said, it couldn't happen to a better continent."
Now, that said, and with all due respect to the commenter, my reply to that:
I was like that once, too. Right up until I started digging, out of curiosity, in early 2014.
Springtime, IIRC. Then Reality, with a predictability like sunrise, did its thing.
You ought to know better than that, and I refer you to the very articles I wrote on the topic at the time.
TL;DR? Let me help you out with a quick summary.
CDC: We understand this disease and everything about how to deal with it.
Aesop: You know so little about this disease, even the most basic info, that it would be comical if it wasn't life and death tragedy.
Aesop 1, CDC 0.
CDC: Ebola will never get here.
Aesop: Ebola's gonna get here.
Aesop 2, CDC 0.
CDC: Our screenings will stop it before it gets here.
Aesop: Our screenings are kabuki theatre and boob bait for the Bubbas.
Aesop 3, CDC 0.
CDC:We have protocols in place in case there is a case.
Aesop: We have Jack and Shit, and Jack left town.
Aesop 4, CDC 0.
CDC: We have first-world healthcare.
Aesop: We have our collective pants around our ankles.
Aesop 5, CDC 0.
CDC: We know how to handle this.
Aesop: We haven't the first clue about any of this.
Aesop 6, CDC 0.
CDC: We'll nip it in the bud, and overwhelm it with our superior capabilities.
Aesop: It will be a total fustercluck, and it will spread around the country before you've got your pants on the correct legs, once you get you head out of your tailpipe.
Aesop 7, CDC 0.
Clever readers will spot a trend there.
Multiply that times about four-five months, multiple times daily, and you get the idea.
1) The modern system is exactly the problem with Ebola. One infected reference patient, Patient Zero, walks into your ER lobby with what looks like just another set of flu symptoms. During flu season. (How helpful for you.) After an hour (or as little as ten minutes, as numerous dead former cab drivers in Guinea, Liberia, and Sierra Leone could attest, if only we could dig up their ashes and re-animate them before their former owners died of Ebola infections from giving patients rides to the hospital) in the same lobby as ten other people, you have eight more Ebola patients, and you won't know it for 5-21 days. And they'll infect the triage nurse, the doctor, and the treating RN, unless you have everyone in Ebola-proof gear 24/7/365 pro-actively...
What? Of course neither you nor anyone else does that? Ever? Sux to be you, man.
Then, if you're really lucky, and Triage is on that, they ask the magic questions:
"Have you been exposed to Ebola?" "Oh, no sir."
"Have you been to Africa recently?" "Oh, no sir."
Why do they do that? Because patients lie. I've gotten a knowing laugh from more than a few cops, by pointing out to them that the only places history changes before your eyes is in the ER, and on the witness stand. Why do they lie? Because the enemy gets a vote. Because Ebola in Africa is a death sentence. It means exclusions, quarantines, and slow, agonizing death. So of course they don't have that. Doesn't everybody with the flu bleed out their ass and eyeballs?? And why are they lying little shits at the precise moment the truth matters most to you (and the ER staff, and everybody in the waiting room, and 300M of all your closest friends and neighbors)?
Sorry if letting that cat out of the bag shattered your illusions. It's one of my Super Powers.
2) Once the symptoms of Ebola pop up, they've already exposed people for 1-3 weeks, so it's the 500 contacts you didn't know about that are going to be the next casualties. And they expose 50,000 more contacts you don't know about. And they expose 5,000,000 contacts you didn't know about. And they expose virtually everyone in the continent, and you're still waiting for the first patient's diagnosis to come back from the lab. How does America with a few million to a few hundred million dead sound to you? Another 10% of that crippled for life, and carrying the disease in their own bodies? Wildlife becoming a native virus reservoir on this continent, forever? Coyotes, rats, skunks, bats, whatever.
We still don't even know where in hell it lives in Africa, after looking for decades.
3) Quarantine? You're kidding me, right?
Look up Kaci Hickox.
Then Dr. Craig Spencer.
Then Dr. Nancy Snyderman.
4) Look up how Ebola was handled at Texas Health Presbyterian Hospital.
One case infected two nurses (for life, it appears) despite them scrupulously following the CDC "guidelines" (instead of the actual field-tested MSF/DWB protective gear guidelines), they generated tons of medical waste, lost their ICU and ER wholesale for months, and nearly bankrupted the hospital.
For one case. Then three cases.
Then, they shipped the two surviving nurses to Emory in Atlanta ricky-tick, one of the actual BL-IV hospitals, and virtually shuttered their hospital for months, until the stigma and the story finally went away. Think about that: a cornerstone regional acute care hospital, 968-beds, turned into a virtual ghost town for three people. (Oh, and about a gazillion dollars in indefensible liability suits.)
Their entire ER staff basically told management, "Either close the ER, now, or we all walk forever." The hospital closed that week. They had to; their patient census that week dropped literally to single digits. It was costing them more to turn the lights and AC on for a day than they were making in a month of that.
5) Hospitals here, outside the four BL-IV hospitals actually trained and sort-of staffed to care for a grand continent-wide total of - wait for it - eleven Ebola patients, maximum, are utterly, completely, and massively unprepared to deal with this , as the Dallas example proved in about 21 days, and neither they nor the CDC wants to talk honestly about this.
Neither you, I, nor 2M other RNs nor 1M doctors has the slightest effing CLUE about dealing with this (unless they volunteered in West Africa in 2014) and come the day, they're going to make simple mistakes that'll get them dead, along with thousands to millions of their patients.
The suiting up and decon process takes half an hour each coming and going, requires scrupulous attention to detail at every step, unless you want to die, the gear is hot, a lot hotter than most people can work in for more than a couple of hours, and a "simple" pee break requires the entire 30 minute decon, then another 30 minutes to re-suit. It takes two people who do nothing but suit you up, and another who does nothing but monitor you peeling out of it without effing up and killing yourself. So imagine with me a staffing ratio of four people for every one person who can actually render bedside treatment. And you think the nursing shortage is bad now?
Bear in mind the age of the average nurse in the US is something like 50 years old, not 21 or 22. So you'll have people old enough to be retirees in the military, in the equivalent of MOPP Level IV, which is hotter than hell even in an air-conditioned room, sweating like a pigs, and doing everything through a fogged up facepiece and two layers of gloves, in a rubber suit, with a virus that only has to get lucky once, with delirious feverish patients oozing blood from every orifice onto everything, and coughing a miasma of bloody sputum into the air. Yeah, that should work.
And then, tell me how many CNAs, EMTs, and PCTs are going to risk their lives for $10-15/hr.?
In someone's effing dreams, baby; hospitals will become ghost towns, just like Texas Health in Dallas did. In minutes and hours, not days. You'll have patients and staff going out the fire escapes and jumping down laundry chutes, mark my words.
In Africa, they make Ebola survivors unpaid help with patient care. They have to help anyways, since they get stoned and shunned in town when they come out afterwards, and it's the only place they can get fed. And anyways, most of the victims are the very people they infected, and who infected them: family, friends, and neighbors. Good luck pulling that off here.
And it requires literal fuck-tons of gear, that your hospital and mine don't have and never will, dedicated facilities that they don't have, HEPA-filtered air- and waste-handling facilities they've never had, and generates even more fuck-tons of BL-IV HazMat waste that no one on the entire continent knows how to or is willing to deal with. The pyres burning it are going to look like Kuwait in 1991, people downwind fleeing the ashes are going to look like villagers fleeing Mongol hordes, and if you try to ship it across state lines, the trucks and trains will be met by smiling national guardsmen, with bayonet-mounted locked-and-loaded rifles and battle-ready tanks, and a serious dose of the ass with you for trying to transship it.
You might get the idea that this is wee bit more important to me.
I repeat, go back to about August 2014, and read through the Ebola posts chronologically through the end of the year. The real liftoff was late September/early October, once Deadly Duncan from Liberia staggered into a Dallas ER. Hilarity ensued. If you think almost jumpstarting a pandemic is funny.
6) Canada has zero BL-IV beds, AFAIK. But hey, free health care! Just like in Ebola clinics in the African bush. Should work out great for them.
Mexico has...wait, you're shitting me, right? Mexico has what you'd expect Mexico to have: a corrupt government, and an overabundance of expendable and illiterate peones. No points for guessing who'll handle clean-up there. Then take the disease home to papi y los niños, Tío Juan and Tía Julietta, y los viejos. Who will cheerfully and unknowingly spread it to all their friends, and pretty soon, you solved the immigration problem by erasing everyone from Tijuana to Tierra del Fuego, except maybe some lucky isolated Indians in the deep Amazon rainforest. ¡Viva!
So, in between those two, there are actually 23 BL-IV hospital beds, but cleverly, only 11 are actually staffed to operate anytime, and you can't just call Joe's Nursing Registry in Missoula or Baltimore or Omaha or Atlanta and whistle up more BL-IV-qualified nurses to pick up the open shifts. Bummer.
Oh, and one to three of those 11 beds are reserved by law for the potential military casualties at their neighboring state-of-the-art Infectious Disease (and chem-bio warfare, which of course we swear we don't do ;) military research center(s) in UT and MT, so there are really, actually only 8 beds.
We have 8 beds for 453,000,000 people (those poor Caribbean islanders from Cuba around to Trinidad can just suck it, like they always do).
Bermuda is looking pretty good, but only if they shoot down incoming aircraft, and sink cruise liners off the continental shelf at the merest suspicion of a pandemic.
So Twelve Ebola cases flood and overflow every available BL-IV treatment bed extant in North America.
Twenty actual Ebola cases will shut down any city in America. Overnight. For months.
Fifty cases, and the USA is Liberia in 2014. Times 1,000.
That's not a guesstimate, those are the hard numbers.
There are 52 active cases in Congo right now, who haven't died. Yet. 80% of them will.
And the survivors will carry virus reservoirs in their bodies functionally forever.
And probably go blind from retinal damage due to disease-related coagulopathy.
(That includes the two nurses from Dallas who contracted it, BTW. You'll notice a deafening silence on that, since 2014.)
God help those people, every one of them.
IMHO, it's a dice roll whether living with Ebola or dying from it are worse.
This disease is from Hell.
In 2014, we had TEN cases here.
We were two Ebola patients away from swamping the lifeboats, and turning any other hospital into Texas Health Presbyterian, which was Tier One disasterpiece theater. They exposed thousands of people, unwittingly. They had the infected guy in once, misdiagnosed it totally, and sent him home. They didn't catch on until he was brought in again in total collapse, and after throwing the entire best the first world had to offer at him, he died anyways. And infected a perfect R-naught of 2 additional victims. Only fate, or a benevolent deity, kept that incident from turning Dallas into Freetown, Liberia in about two weeks, and wiping out their whole ER shift staff that night. Poorly protected clean-up crews in Dallas were pressure-washing the guy's vomit - live, active virus - onto everything within yards of his apartment in suburban Dallas, the day after it happened. Because illegal aliens with a fourth-grade education are the front line in that clean-up, hired by companies with no more sense than God gave a jackass about Hazmat gear, or proper Ebola precautions. In NYFC, they were handling stuff with no PPE whatsoever. Hand to God on that.
Sleep tight, America.
Anyone in health care who isn't concerned whenever Ebola crops up, simply and respectfully doesn't know what the hell they're talking about.
Let's talk turkey on my streetcorner: At the time, in 2014, a busy day on this site was maybe 1K hits/day. (It's now closer to 5-6K. Thanks, folks, sincerely. That and $5 and I can get iced coffee at Starbuck's).
When I warned, after looking at what was happening, that Ebola was going to hit us, I was getting maybe 1500.
The heads of the CDC and Infectious Disease, with five more degrees than I have, nine more letters after their titles, and 87 research papers between them, assured us all most sincerely that that could never happen.
Then the late Mr. Duncan showed up, almost on cue.
After it did get here, I was suddenly getting 5K hits an hour.
I yell because I care.
I want a head of the CDC who's a goddam DOCTOR, not an idiot with a medical license giving the retarded president and his fucktarded staff of sycophants a tongue bath every day.
I want the liaison and advisory person at the White House to be someone who groks hard science, not a damage control PR flak who couldn't find his ass with both hands, a map, and a rearview mirror.
I want a president with the wits to order a halt on all flights and travelers in and out of any country with an active outbreak, except mercy shipments and returns to an affected area, and I want them to innundate that affected area with every possible resource, early, when it will work and do some good, not half-ass this until it fails and Ebola gets here. And I want him arm-twisting every other first-world country for the same damned thing until they either yield, or their shoulders pop out of joint, if necessary. (In Trump's case, I think he'd literally do that, and relish the screams. Whereas Obozo was actually rooting for a pandemic, to kill Whitey.)
I want anyone returning from such an area to expect a mandatory medical quarantine, enforceable at gunpoint if necessary, in actual total isolation, until they're medically cleared. That's an actual 40 days with Ebola, just like the meaning of the historical root of the word, not just 7 days, or 14, or 21. And sure as hell not a mere ear-temp check by a fat stupid TSA bastard who dropped out in the 4th grade. That rule is written in the blood of dead medical people in Spain. It's been around since the Middle Ages and bubonic plague, and anyone waving their civil rights about that reality should be not just smacked in the mouth, they should be taken out and shot as a danger to civilization and for crimes against humanity.
And that's not hyperbole for grins, I mean that absolutely literally, and the execution should be televised worldwide, on live TV, mandatorily carried on every broadcast and cable channel we can compel including Cartoon Network and the Disney Channel. This is THAT fucking serious.
I want guidelines based on what actually works, drawing on MSF's work in fighting the disease there, not on some asshole bureaucrat's ideas in a D.C. swivel chair here, and without one single minute in hazmat gear.
I want hospitals to not just paper this over with a page in their bullshit contingency manual for JCAHO certification, but to designate, by mutual agreement, which hospital will be the one, sole receiving facility in a given major county or state. That would be one hospital in each state, and one more hospital in any city with over 1M inhabitants. I don't think that's asking for too much.
I want no-bullshit, come-to-Jesus full dress rehearsals in full gear, for 72 hours non-stop, annually at every one of those designated hospitals, and the primary EMS agencies, including every ward and floor from the ER to the hospital morgue, so that when they get a real Ebola victim, they don't all loose their collective shit, kill half their staff and the surrounding city, and slaughter millions of people because this was all "too hard". I want those procedures vetted and supervised initially and audited annually by the experts at CDC and the four actual BL-IV hospitals who actually do it right, 24/7/365, because they have to do so if they want to stay alive. Disseminate that expertise to where it will save lives, instead of just look good on a resume.
That's the difference between medicine, and marketing.
And while it's happening at the designated hospitals, I want mandatory screening at every other hospital in the country required to be doing it too, by triaging every patient and every visitor in full gear, and segregating anyone who would meet Ebola criteria outside, in dedicated quarantine tents, so as not to unwittingly infect and expose the entire staff, hospital, and every visitor before they know whether you've got Ebola or the flu.
If that's too hard, I'd tell them that a license to operate a hospital is a grant, not a guarantee, and they can always go into the hotel business instead. Dealer's choice: they either staff it, fund it, and practice it out of their own pocket, every damned year, or they can close and completely shut down for those three days, and eat the loss of revenue. I'd also tell them they won't be reimbursed for any federally insured patients ever again, like veterans or Medicare, just to drive the point well home. Welcome to capitalism, baby. Play ball with us, or get the bat up your back end.
I'm hoping maybe this time people will pull their collective heads out of their asses, step it up, and we won't have to deal with it in Dallas, because we wiped it out in Kivu.
Otherwise, just like in 2014, Ebola walks in the ER door hereabouts, and I walk out.
Same effing day. (See if I'm not the only one, either.)
I like my job, and I'm damned good at it, but it's not a suicide pact with Florence Nightengale, and I can't spend the money if I'm dead, or infected for life, or left blind, or twenty other side effects.
I'll take my chances behind barbed wire that I control, at that point.
I know what we can handle, and how we can handle it.
And what we cannot.
And Ebola, here, frankly scares the shit out of me.
Because we can't handle it.
Not in 2014, and not now.
And Hope ain't a plan.
But that, and the soapbox, is all I've got at the moment.
I hope not having an incompetent America-hating illegal alien muslim in the White House will be enough this time to turn the rudder before we hit the iceberg.
We can stop 2014 from happening again, or God forbid, happening worse this time around.
But the first step to doing that, is wanting to.
It's four years later, and apart from a few government staff changes, the only difference now is it's four years later.
I repeat for emphasis, 2018 isn't 2014, yet.
I hope it never gets there, or anywhere close. ("Hear me, God!")
I said then, and repeated recently, I don't want to be doing the sportscast blog on the end of humanity, or even "only" a few million dead people in a "small" pandemic. I really, really, don't.
But if we can't face the truth, we can't begin to deal with it.
So now you know different.
What you do with that knowledge is your business.
This is what won me the Fucking Ray Of Sunshine Award for 2014.
I'd really rather not add a cluster to that ribbon.
And hey, score one for Serendipity:
Look who made the papers today! JUSTICE!!!!!!!!!!!
This I take as proof that God listens, and watches. He almost never answers back, but every so often, He gives the world a little surreptitious wink.