Sunday, June 16, 2019

Dunning-Kruger: Why The Dumbass Next Door Will Get You Killed

Despite this meme, and the posted Comments policy
on the right sidebar, today's post was brought to you
by the letters "M", "O", "R", and "N", and the IQ "40".

[I was saving this post for tomorrow, but I finished my appointed rounds early, and maybe I'll take tomorrow off, and just leave this up instead.- A.]

Generally, I appreciate Comments to posts I make. Otherwise I'd just sit in the den and mumble to myself. Good ones add to the discussion, on the theory that None Of Us Is Smarter Than All Of Us, editorial accountability, etc.

On the other side of the scale is the boot camp wisdom delivered by one of my drill instructors:

Truer words have never been uttered.

There's also the 24K gold assessment by Mssrs. Dunning, and Kruger, regarding the regrettable human failing where the less people actually understand about something, the smarter they think they are on that topic.

I tell you plainly, all I know about Ebola is what I've read.
Which is everything I can get my hands on.

Other people read one blog post, can't grasp the basics of even that, and conclude they must therefore be the Smartest Guy In The Room.

Which brings us directly to today's example of That Guy:
Anonymous said...
350,000,000 people live in the U.S.
We have, perhaps, 15 beds available to treat Ebola patients safely. As many as 50% of whom would live and survive the infection. 75% if you're really lucky.
So your best odds in an Ebola outbreak if you become infected, are a 1 in 35,000,000 chance of survival.

I'm to sure [sic] how you did the math there, but it's very very suspect.

We tried, patiently, to explain where the wheels went off his tricycle.
Then you're suffering from dyscalculia, but I'll explain it anyways.

There are 350,000,000 people in the U.S., give or take.
There are 15 staffed BL-IV beds.

15 people will get those beds.
Everyone else will get Jack, and Shit.
(That would be 349,999,985 people, if you're keeping a tally, who will be told "Best wishes" along with such sage medical advice as "Wash your hands" and "Cover your cough".)

Once you get into a BL-IV bed, historically you have a 50-75% chance of survival.
Let's split the difference and call it 66%.
66% of 15 is 10. (But it could range from 7-12, historically.)
You thus have 10 chances out of 350,000,000, which reduces to a 1 in 35,000,000 chance of getting into one of those beds, and surviving.

This is called fractions.
It's generally covered for most people in third or fourth grade.

Unprotected and untreated, 80-90% of Ebola victims die.
"Surviving" for the other 10-20% isn't anything to write home about either.
Read up on [post-]Ebola Virus Syndrome.

Short answer, don't get infected.
Stock up, and bunker in.

Because if you get it, and you're Case #16 or higher, you're not going to be treated, just farmed out to a death center, where you will die, and then incinerated.
Being dead already, you won't mind that last part.


One might think that such a painstaking explanation might have soothed the confusion in the mind of such a mentally challenged chowder-head, but no. He had yet to spread his wings to full peacock-fan proportions.
Anonymous said...
So the bush people in subsaharan Africa somehow manage a fifty percent survival rate, but if it makes it to the US we're looking at a survival rate of essentially zero. If everyone in the US is infected, only ten people will remain on the continent.
That sound about right to you?

15 people will get those beds.
Everyone else will get Jack, and Shit.

I have a magical formula that will double the number of those beds. Roll more into the isolation rooms.
There are also things called tents...marvelous inventions.
Good grief.

That, gentle readers, is bag-of-hammers breathtaking stupidity of such epic proportions as to raise a blister on boot leather.
So yet again, we remonstrated, albeit less generously in Round Two.
Fucking brilliant!

And can you also squat and shit out double the number of trained personnel to care for them? Doctors, nurses, ancillary staff, lab techs, clean up crew, everyone? And also shit out twice the supplies necessary to care for them? Another eight tons worth of exposure suits alone, just for 15 more patients? Not to mention medicines, IV fluids, tubing, bedding and linen, and so on?

No...? Can't do that?

Did you figure they were going to treat themselves?
Or that the isolation room magically cures people?

So much for that great idea.

Bush people in sub-Saharan Africa infected with the virus manage a 10-20% survival rate, not 50%. So will we, with similar levels of medical treatment options for the other 349+M people.

So if it infected everyone, only 280,000,000-315,000,000 people here would die outright.

The rest of the survivors, all 35,000,000-70,000,000 or so, would only have [post-]Ebola Virus Syndrome, which side affects include eventual blindness, along with perpetual headaches, joint pain, and a host of other debilitating problems.

And they'll have 280,000,000+ corpses to dispose of.
But highway traffic will be lighter, so there's that.

Ebola will also probably become endemic to wildlife species on this continent as well, so we could look forward to additional regular outbreaks, forever, without having to wait for another batch to get imported from Africa.

You're going to fix that with tents?

Genius, pal. Call the Pentagon, and tell 'em you've cracked the whole problem, all by yourself, because all we needed to do was pitch more tents all along.

I've only posted somewhere in the neighborhood of 200+ blog posts on this problem in the last 6 years.
You've skimmed one, and hurt yourself trying to digest it.

Stop thinking now, before you sprain your head.
That was really the most embarrassingly stupid pair of posts anyone has ever put up here, in the history of this blog.

No, really.

Walk tall.
And please, keep your thoughts to yourself.
Entertaining as it will be to people for days afterwards, I really don't like kicking the retarded kids; it just looks bad.

Now we come to a conundrum: Duelling Anonymous @$$tards.
Because the wonders of Blogger, and the similar low double-digit IQs involved make it hard to tell if we now have two retards, or one, posting twice.
 Anonymous said...
If you look at the population charts of countries hit by ebola in Africa, ebola was barely a blip.
So asserting the odds of living on if the US is struck by the virus are 1 in 35,000,000 just undermines your own credibility.
The problem with such absurd assertions about the sky falling and world ending is...the next time people take them less seriously. And the next even less.
Until they stop worrying and become cavalier.
Your information, though largely correct (like: isolation precautions in medical facilities leave a lot to be desired, and ebola is very very very bad), is filled with half truths and hyperbole that push it into the land of the absurd.

@$$tard #1: Reading comprehension for everyone but you is still a thing.
Nota bene that at no time did we assert that "the odds of living on if the US is struck by the virus are 1 in 35,000,000". (Scroll up, if you doubt this.)
We said, and in carefully italicized language (Common Core grads, do not dive for a translator; italicized means we did this, it doesn't mean we spoke in the language of the Popes and Caesars.), that
"if it infected everyone, only 280,000,000-315,000,000 people here would die outright."
For those, like Anonymous here, who are manifestly too stupid to comprehend basic English grammar, logic, and rhetoric, I cannot help you. That wisdom represents the Trivium, considered by the ancients to be 3/7ths of a proper education, and a lack of which I cannot remedy in mere blog posts. I urge you to return to the grade school that passed you on to middle school, punch the teachers who failed you in the face, and demand an immediate refund.

And alas for Anonymous #1, I'm not too very troubled that my credibility with demonstrated morons is undermined. I write for reasonably intelligent people, and leave the rest to the tender embraces of Mother Nature and Darwinian selection.

Since I made therefore no such absurd assertions, half truths, nor hyperbole, your pejorative-laden gainsaying is an entirely gratuitous, worthless, unsupported, and putrescent load of horseshit.

Had you any substantiation, you might have attempted to illustrate your point, but as you have nothing like, it's merely the carping of the ignorant demonstrating their mental defects.
Thanks for playing, and we have some lovely parting gifts for you.
Now we return to another contribution certainly from the original Anonymous, who not only sticks up for his rank ignorance, but doubles down on it.
 Anonymous said...
You're going to fix that with tents?
It isn't a panacea, but it will offer more than your asserted 15 total beds in the entire CONUS capable of handling ebola patients.

Genius, pal. Call the Pentagon, and tell 'em you've cracked the whole problem, all by yourself, because all we needed to do was pitch more tents all along.
They already know. People have been handling deadly chemicals in airtight tents and hazmat suits for decades, on a regular basis (sometimes 12 hour shifts....unlike Africa they have access to cooling suits).
Anyway, done here.
I won't post again, don't worry.

Worry? You misunderstand me.
My sides hurt.
Look, Dipshiticus Maximus, the problem isn't the lack of beds, you ignorant simpleton fuckwit.
They sell beds online by the gross.
What makes BL-IV beds special isn't how many of them there are, it's how many of them come with an attached building with the capacity to provide negative airflow, BL-IV filtration and flawless virucidal handling of every cubic centimeter of atmosphere inside without contaminating the entire surrounding countryside with deadly pathogens for which there is no cure; and incineration of the metric fucktons of BL-IV waste products, from gloves to mattresses; and airlock decontamination of the practitioners; and having metric fucktons of all those supplies already on hand right effing now, oh, and like I wasn't absolutely clear on the concept, having enough goddam practitioners - doctors, nurses, techs, and ancillary staff, who take years of learning and months of BL-IV specific training to be able to competently and safely care for patients in such a hazardous and alien practice environment without spreading the disease, like the amateurs did in a Dallas ICU.
So if you really think just popping up a few tents fixes that, you're really too stupid to waste any further discussion on, and you probably need the following diagram in a big way.

All part of the service, moron.

But even someone stupid enough to try another bite at that apple can serve as a negative example for those less stupid, so for their sake, we'll finish driving this home.

Because, Gentle Readers, they already use tents now. In Africa. Because "Ebola Treatment Center" is another misnomer, whereby TPTB have been lying to you, me, and most especially, thousands of doomed Africans with Ebola.

Because they don't do much of any "treatment" in Africa. They do "palliative care".
The centers should be called "Ebola Hospice Centers". They wipe fevered foreheads, they offer a cup of cool water, and they mop up Ebola-laden diarrhea and vomitus, until the virus kills its usual 75-90% tally.
The survivors, they send home. Or draft to work in the Ebola Treatment Centers, since
a) they're now immune, and
b) no-effing-body else wants anything to do with them, and their families are probably all dead already; and
c) everybody's working for free anyways, so it doesn't cost them anything.
Curiously, health care workers over here have this quaint notion that they should be paid for their labors, so that's not going to work here. Until everybody with a license to practice has left skidmarks in the parking lot. (Like by Day Two.)
Call me crazy, but it seems to me getting taken care of by the dumbshits stupid enough to contract Ebola to begin with, and trusting them not to spread it, is like taking your effed up car back to the guys who effed it up the first time, and then expecting they'll get it right the second time, i'n'it??
And, when the outbreak is over, they burn the tent and the whole treatment center to the ground.
With napalm.
Just to be sure.
And with only 15 actual (not "alleged", shit-for-brains; I posted the documentation, so maybe try reading for comprehension, just for the novelty) BL-IV beds available here, for actual treatment, which gets us to 50-75% chance of recovery instead of 10-20%, if they get you in early enough, everyone else infected is going to get the same African palliative care model, and die at exactly the same 80% slate-wiping genocidal rate as in Africa. There's your potential millions of deaths, because we saw how good the amateur Ebola care models worked in Dallas, five years ago.
(And trust me, by three cases outside of BL-IV, the staffs everywhere are going home, and they won't be back until long after this is over. Or they'll die, stupidly, listening to the same official happygas horsesh*t that infected the two nurses in Dallas. And in the course of that dying, spread the outbreak even farther.)
So you either get the lotto-unlikely 1 BL-IV bed out of 15; or you get Ebola, and probably (80% or worse) die; or you bunker in someplace until it's over, which wee point I may have been a bit shy about pounding across in the last five or six posts since the beginning of the month. Or maybe some Anonymous jackhole commenters have cement-heads, and sh*t for brains.
I could give you good odds on which is likelier.
And now, I'm going to hand it over to frequent commenter Nick, just in time for him to climb up the ropes, and come down with an Atomic Elbow smash on our Fucktard Of the Day.
Take it home, Nick:
In Africa, they don't have 3 million people counting on truck drivers to deliver tomorrow's groceries. Or 9 million. They don't have a large percentage who would die without daily or weekly meds, which aren't stocked locally, and can't be stockpiled by individuals. Their supply chain looks completely different.

They don't riot if their favorite sports team wins, let alone if the stores are closed for a week.

Since you sound like you work for the CDC, the patronizing attitude that the people need to be kept from panicking annoys the HELL out of those of us with better than room temperature IQ and the motivation to take care of ourselves. I suggest reading your own CDC guidelines on Business Continuity and Pandemic Flu. Ask yourself the same questions they ask, like, can your business survive with only 50 of people coming to work? Then ask if modern western society can survive if only 50% of people go to work.

Having been thru civil collapse (Rodney King riots in LA), terror attack (I was 8 miles from ground zero on 9-11), and a variety of natural disasters (Rita, Ike, Harvey)- the thread that holds our society together is thin and strained.

Airline pilots for some airlines can rightly be fired for lying to passengers about the severity of any issue. This is the way it should be. Treat people as adults. Don't lie to me. The pushback when your lies are exposed, and the CDC DID NOT COVER ITSELF WITH GLORY IN 2014, will be worse than the truth.


Also, nit picking over one idea (where the reservoir is) is a great but tired tactic to distract from the bigger issue. If this gets here, we are not prepared and people will die. Let them panic! What do you expect them to do? Run out and stock up on food? Close the border? Quarantine arriving flights??? HOW IS ANY OF THAT A BAD THING?

How, indeed?
The odds point to this arriving here.
We've all but thrown the gates open and rolled out a red carpet for Ebola this time.

In 2014, we were two BL-IV patients away from being West Africa.

Idiots, get that through your thick skull.
The smart people have already grasped the significance of that fact.
If Duncan had infected two more people, it would have gotten out loose in the wild.
We had no vaccine at all then.

And we have nowhere near enough now; perhaps a few tens of thousands of doses.
I've seen nothing anywhere that indicates they can ramp that up to hundreds of millions (let alone billions) of doses in even the next year. They've been vaccinating like crazy in DRC, and it's still doubling reliably, blowing right past all those mythical 'containment rings" of vaccinated people, and has now spread to a second poverty-stricken Turd World Sh*thole.
It's within a bus ride of two or three megapolii, with international airports in each.

Which means it could be anywhere in 24 hours from yesterday.

Or, mirabile dictu, it might flame out in Africa.

To this day, no one in authority, anywhere, can explain why it burned out in West Africa after only 2 years, because they never met any of their posted goals for contact tracing, containment, number of facilities, safe burials, or anything else. Not one.

I wouldn't bet the farm on that square this time around, thanks anyways.

But if it does get here, a la a 2019 version of Duncan, you won't know for two weeks, when someone shows up at your local ER, with blood shooting out of all orifices.

It'll be a wee bit late to "make a plan" then.

No doubt Anonymous Simpleton will be trying to pitch a tent, and telling you everything's gonna be okay. And the morons at CDC will be telling you, yet again, "We can handle this! We're ready for it! First World health care! Magic beans!"

Best Wishes with that plan.

I hope my readers will understand if I choose to approach things with a bit more realistic viewpoint.

But thanks, Anonymous Simpleton(s) for providing the usual Comedy Relief.

Rules For Life

If this is news to you, how unfortunate.

Sunday Music: Walk On By

This week, a long, black woman in a cool dress.
For over a decade, the definition of popular musical perfection was anything written by Burt Bacharach and Hal David, and sung by Dionne Warwick.

This is but one example among many, many others.

Saturday, June 15, 2019

Rules For Life

It may not always be working-in-a-coal-mine hard.
But if it's as easy as falling off a log, you're about to.

Where The Problem Is

Frequent commenter Nick asks:

"Aesop, you know I'm with you on this topic, and I've been adding to my long term bulk food storage every two weeks...

But, the MSF guys are all volunteers, and they not only go to work, but do so at a loss financially.

Most africans are not particularly diligent or methodical but they seem to manage the deconn, donning and doffing reasonably well.

Given the conditions on the ground in this and the last outbreak, how can we reconcile what you (and I for that matter) expect, with the lived experience of the medical teams in africa? After all, there are LOTS of Drs and staff involved, and no or few reported deaths among staff, and none among the Drs.

I don't think the vaccine is the difference because we didn't have widespread losses among the foreign Drs and staff last time around either. (the one nurse iirc, and that from a social engagement not work)

I agree that it's the knock on effects that would be so devastating here or other first world countries due to the dependence on infrastructure and Just In Time delivery.

We also have the experience in Dallas of the guys POWER WASHING the index patient's effluvia off the walk, and the patient's own family who were closeted with him in the apartment, yet none of them got sick.

Is it possible that it's harder to spread this than we think? It can't be luck every time...."

Serious questions deserve thoughtful answers.
My response:

1) They manage donning and doffing pretty well, because they have five times the staff we'll allocate, because none of them are drawing paychecks. From 2014:
The Ebola epidemic caused an increasing demand for protective clothing. A full set of protective clothing includes a suit, goggles, a mask, socks and boots, and an apron. Boots and aprons can be disinfected and reused, but everything else must be destroyed after use. Health workers change garments frequently, discarding gear that has barely been used. This not only takes a great deal of time but also exposes them to the virus because, for those wearing protective clothing, one of the most dangerous moments for contracting Ebola is while suits are being removed.
The protective clothing sets that MSF uses cost about $75 apiece. Staff who have returned from deployments to Western Africa say the clothing is so heavy that it can be worn for only about 40 minutes at a stretch. A physician working in Sierra Leone has said: "After about 30 or 40 minutes, your goggles have fogged up; your socks are completely drenched in sweat. You're just walking in water in your boots. And at that point, you have to exit for your own safety ... Here it takes 20–25 minutes to take off a protective suit and must be done with two trained supervisors who watch every step in a military manner to ensure no mistakes are made, because a slip up can easily occur and of course can be fatal." Link
Do that math: $75 x 24 hrs/day, x 30 days, per patient. Times 6-10 staff members. At minimums, that's $324,000 per Ebola patient, just for the protective ensemble. and that's 4320 protective gear ensembles. For each patient. 25-75% of whom will die anyways.

Generating, if each suit only weighs 2 pounds, some eight tons of highly infectious medical waste, which no one in this country wants or knows how to handle, short of open pit gasoline fires.

Asking for a friend:
Which way do the prevailing winds blow from the nearest hospital?
How are the people living downwind in the Ash Zone going to feel about that?
Just curious.

2) "Pretty well" is a relative term:

In August 2014 (two years before the outbreak was over!), healthcare workers represented nearly 10 percent of cases and fatalities—significantly impairing the capacity to respond to an outbreak in an area already facing severe shortages. By 1 July 2015, the WHO reported that a total of 874 health workers had been infected, of which 509 had died. Link

As of 30 April 2019, there have been 92 health care workers in the Democratic Republic of the Congo infected with EVD, of which 33 have died. Link
 And MSF's precautions are done in a no-sh*t Hot Zone. An unknown number of those helping are "survivors" of the current outbreak, each time, with obvious immunity going forward (with all the caveats about EVSyndrome for such "survivors").

We are not being trained in their MSF protocols here, we're trained to CDC protocols.
You know, the ones that got two nurses here infected within 21 days, despite doing everything the CDC thought was sufficient. Which is exactly how well Ebola spreads in the wild, with zero precautions.

BLUF: The CDC guidelines are the same as slam-dancing naked with Ebola-riddled corpses.

The same CDC that gave an infectious nurse permission (WTF?) to take commercial air home, knowing someone with a fever (which she had) was infectious to everyone at the airport and flight she came into contact with, including the guys that handled her baggage.

( "Hey, we're the Government, rules of Nature, like physics and epidemiology, don't apply to us, Because we say so.")

It isn't that Ebola is less effective at transmission than we thought, it's that early, before you're literally coughing out your lungs, vomiting out your esophageal tract, and sh*tting your intestinal walls out, it's a somewhat (but unknown amount) less infectious than the final stages.

That's a pretty fine razor to skate on barefoot.
That was the luck we were living on with Duncan, with both nurses he infected, with Dr. Dumbass in NYFC, and with exposed-but-not-infected-roommate-of-Ebola-victim Nurse Mimi Crybabypants.

[The later two, failing actual 40-day-lockdown-hard-isolation quarantine, should by rights have been shot on sight for breaking quarantine, gross professional negligence, and 20,000 counts of attempted murder.(I.e., if you point a gun at someone and pull the trigger because you thought it might be loaded, but it wasn't, you're still fully legally culpable in 50 states and 7 territories for the attempt.)
If somebody capped them both tomorrow, on their own, it would still be justifiable homicide IMHO.]

And if/when this gets here, some medical professionals will decide they're Special Snowflakes, and don't need to follow all the rules, and don't have to be quarantined, because it violates their rights or harshes their mellow, and exactly like the family from DRC that sneaked into Uganda, they'll transplant the outbreak to others. And we won't find out for another 3-21 days, on average, and some not for longer, by which point it's already an epidemic shitshow here.

That should be a shoot-on-sight situation, followed by burning the corpses immediately, after obtaining a blood sample under BL-IV precautions.

But this is America, and we're too squeamish to do that, and we'll end up killing people with kindness by not doing it. (Like letting infectious nurses travel commercial air, rather than sending a BL-IV jet to whisk her and her stuff into full containment. Like your government did in 2014.)

Also, the people working with Ebola in Africa for MSF are only providing palliative care, i.e. assistance for the 80-90% who're going to die, to do so less uncomfortably than they would in a rut by a dirt road.

They aren't taking blood samples, starting IVs, or 57 other things. Their height of care is a cool cloth for the forehead, a cup of water (which becomes the next bout of projectile vomitus), and trying to contain the piles of bloody diarrhea being launched into bedding and over at the patient on either side.

And they burn the entire treatment center when they're done, down to the concrete pad (unless, like in DRC, the locals don't wait until its over, as they've already done over 40 times during this outbreak, and killing or injuring over 80 health workers there, which is why 25% of the affected areas in DRC have zero MSF or WHO presence). Now, think of your local ghetto 'hood or barrio. Think it will be better here??

It isn't just HIPPA concerns that keep TPTB from showing you that bloody reality in each and every outbreak. People would be at the White House fence line with AR-15s and Molotovs in earnest, clamoring for POTUS to nuke Africa if they knew that and saw it on the Nightly Snooze on the major networks. You're being lied to daily, including by massive omission, and have been since forever. I post what I post because I figure people can handle the reality with the bark on. But in 2014, I had to drop it, because by Presidential Fiat Decree, the news media were told Not To Talk About Ebola Anymore. Leaving us with just the happygas from foreign sources (who largely also complied with the gag order) and the lying African nations' self-serving press releases that under-reported the breadth and depth of things, on purpose, by a minimum of 300%. Even the UN/WHO admitted that, during the outbreak, openly. "It'll be different this time." Sh'yeah, as if. Neither there, nor here.

And one of those factoids is that once it's more patients than our BL-IV beds can handle, the care and protocols and training become so sketchy as to constitute gross professional negligence on the part of all hands participating, from POTUS and the CDC director, down to the sloppy housekeeping person with a GED who'll be sent in to mop up after patients #16 to #Infinity, with half-assed don/doff training, protocols, faulty equipment, and insufficient staff.

Ebola's always going to find the weak links in any chain of infection.

In the West in general, the weak links are the chain itself.

Instead of screening this stuff and keeping it at arm's length, because of ignorance, deliberate stupidity, negligence, malpractice, and malign indifference to all of the above, the very people who stay and play with it are going to be the same ones who insure that everyone else gets it, mostly through accidental exposures like the two nurses in Dallas, along with the selfish and stupid infectees who won't seek treatment, and will keep sending sick kids to school and going to work until either one collapses shooting blood out their eyeballs.

That's before we even talk about the open borders and lackadaisical attitude towards quarantine that's been rampant non-stop from 2014 until now. This is deliberately engineering Ebola's arrival and release among the population, which we've already seem with measles, TB, Chikungunya virus, West Nile virus, and a witches' brew of other diseases we had formerly whipped here.

Verstehen sie?

We aren't set up for this, and we're doing nothing to stop it getting here (rather the opposite in fact).
And when it does, after those first 15 beds are occupied, we've done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we've done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can't bullshit me or countless other doctors, nurses, and ancillary staff who'll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we're standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can't collect paychecks at Forest Lawn, and I won't be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you'll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly - by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO's lackadaisical clipboard commandos - we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.
There's just death.

I'll do my damnedest to save your life if you come into my ER.
But I won't kill myself to do it, and I won't die for you because TPTB at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain't in my contract, and unlike joining the Marines, I took no such oath, and it isn't part of the deal.

I don't know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Unless you're one of the original few cases in the outbreak, before anyone knew it was here, so you didn't have the sense to self-quarantine while you were uninfected, if you come to the hospital with Ebola, you're de facto part of the problem, not the solution.

And you're probably going to die, and there's a better than even chance you had it coming.

To All Concerned:
Get. Your. Sh*t. Together.

Nobody else is going to save you if this gets here. Save yourself. Don't get it.
Because if you catch it, you're getting a Viking funeral, about a minute after you're dead.

Just like they do Over There.

Friday, June 14, 2019

You'll Never Need A Knife In Combat

h/t Daily Timewaster

Then 28 y.o. squad leader SSGT Bellavia, in Iraq, circa 2004.

Which is absolutely true...until you do:

From Army Times
"Bellavia grabbed the wounded insurgent and put him in a choke hold to keep him from giving away their position.
“The wounded Jihadist then bit Sergeant Bellavia on the arm and smacked him in the face with the butt of his AK-47. In the wild scuffle that followed, Sergeant Bellavia took out his knife and slit the Jihadist’s throat,” the Silver Star citation reads. "Two other insurgents who were trying to come to their comrade’s rescue, fired at Bellavia, but he had slipped out of the room, which was now full of smoke and fire."
Bellavia's Silver Star for the action in 2004, upon review, was upgraded to a Medal of Honor. When President Trump puts it around his neck on June 25th, it will make him the Army's only living recipient of that award from OIF, out of seven total awards.

And a certified badass.


Why Ontario Knives, KaBar, or whoever's product he was carrying hasn't already signed him to a lifetime contract as their cutlery spokesperson is a mystery.
Oughta be a slam dunk.

Do The Math, 2019 version

My Inner 12-year-old loves that the placement of the filtration units
on the German hazmat suits means your farts are immediately
vented into the infected patient's room.

The title may be familiar to long-time readers of this blog. If you want, you can peruse the original 2014 version, which according to Blogger is one of my Top Five Greatest Hits, feel free. (Go read it. Take it to heart. It's five years later, and US hospitals are still as unprepared now as they were then. Worse even. Because now, they've pen-whipped imaginary policies into place, but with zero training, and no/inadequate supplies, so now they think they know what they're doing. But they don't. And TPTB, locally, and nationally, know it, and they don't care. Sleep tight. Pleasant dreams.)

But Anonymous poster in Comments to the last post thoughtfully sent along the following info, and the link to it:

Thanks for all the (terrifying) information. I researched and found some information on BL-IV beds here. Apparently they call them "High-Level Isolation Units" in the EU.

London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 6
Madrid, Hospital La Paz - 5
Berlin, Charity University Medicine - 4
Hamburg, unnamed hospital - 6
Rome, Lazzaro Spallanzani - 8
Unnamed other center in Italy - ?

Most don't have the staff to care for that many patients at once.

This information is from the following blog by a NHS nurse at the Newcastle facility who won a grant to tour the BL-IV beds of US and Germany, Italy and Spain in 2018:
Since I do the slogging so you don't have to, I read that grant recipient's blog report.
I recommend it. For general information.

The information shows Europe, in its entirety, could handle perhaps 31 BL-IV/HLIU patients, per that research/blog.

So how many could they really handle?

London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 2
Madrid, Hospital La Paz - 2
Berlin, Charity University Medicine - 2
Hamburg, unnamed hospital - 3
Rome, Lazzaro Spallanzani - 2
Unnamed other center in Italy - 1
So in actuality, they can only deal with 13 Ebola or other HLIU patients out of 31 beds.
(Presumably, Eastern Europe and Russia could do something similar, or perhaps to a lesser degree.)

Not bad, for tiny outbreaks locally, like in 2014.

Recall, for those who don't, the US/N.A. numbers were 23 notional beds, and staffed for only 11 actual BL-IV level patients.  With the addition of U Iowa and Bellevue in NYFC, we get 4 more actual BL-IV beds in the US, maybe another dozen notional but unstaffed beds.
So let's guesstimate it now up to 15 beds. (And 3 of those beds are nominally "reserved" for military cases from ASAMRIID, and the associated network of .MIL facilities in MD, UT, MT, and CO, we have working on chem/bio weapons which we aren't creating, merely defending against. And I have a bridge for sale, cheap.)

That's with Canada and Mexico providing 0 beds apiece.
For reality, let's assume in a crunch, Canada could cobble up perhaps 1-2 beds, and Mexico would still be zero, because they can't, and would recognize that futility with brilliant Latin fatalismo, so they likely wouldn't even make the effort. They're predictable like that.

So 50 beds so far, maybe 100 all in, if Australia, Japan, Switzerland, France, and everyone else pitches in, but staffed, on the best day, for between a quarter and half that many actual patients.

350,000,000 people live in the U.S.
We have, perhaps, 15 beds available to treat Ebola patients safely. As many as 50% of whom would live and survive the infection. 75% if you're really lucky.
So your best odds in an Ebola outbreak if you become infected, are a 1 in 35,000,000 chance of survival. I'd have to check, but I think winning the Powerball lottery is generally about that level.

In short, a dozen or two active cases, and everyone's screwed.
Which means local hospitals and ICUs are trying to bootstrap their way to bare competency in handling BL-IV/HLIU cases. We saw the consequences of having untrained amateurs try that at Texas Health Presbyterian in Dallas in 2014. It infected two people exactly 21 days after trying it, and shut down an entire 875-bed major tertiary care facility that was key to medical capability in that region, and within a month. (The entire staff threatened a mass walk-out if they didn't shut the whole effing thing down. The ER and ICU were closed for months afterwards. And let's be serious: would you go to the Ebola ER or Ebola ICU the week after they infected two nurses?? Neither would people in Dallas. Double bonus: That hospital is 93 beds smaller (a 10% shrinkage) now than it was in 2014 (968 beds to 875). I'm sure hundreds of millions of dollars of liability and lost revenue from their 2014 escapades had nothing to do with that downsizing.)
I get trained in this nonsense every year, and exactly like military MOPP level training, it reinforces the reality: GTFO of the Hot Zone ASAP, and don't play there, or you're all going to die. The training is only to reduce panic, not save any lives, and keep people from running, screaming, for the hills. The issued gear is a joke, and will be criminally ineffective, and anyone who tries this on the cheap, which is how every hospital in 50 states and 7 territories rolls, is going to infect and kill staff and the public, in about a month.
You read that right, and here, first. Take it to the bank.

Your chances, without even those clown-car levels of resources, of "surviving" fulminant Ebola, only to suffer EVSyndrome for life, are about 1 in 4 during an actual outbreak. 3 chances out of 4, with "palliative" (i.e. helping you die inside your skin a wee bit more comfortably) care, you simply die.

If you read the blog linked, she toured US and European Infectious Disease suites.
I'm here to tell you, looking at the procedures required, those are not going to operate well under higher pressure of actual patients, they will be degraded. Mistakes will happen. Staff members will screw up, and may die as a result. They will, in a short amount of time, realize this, and the people willing to suit up will not increase, it will dwindle, and the units will fail. Ditto for transport, laboratory, and ancillary staff. Most people don't enter any medical occupations, including doctors, thinking they ought to risk their lives to treat patients. The whole point, in fact, is that the only person rolling the dice in any situation is the patient. Your heart attack isn't going to kill me. Nor your gunshot wound, nor your stabbing. Even your HIV is defeatable with $0.03 worth of nitrile gloves.

But your Ebola?
The period in any sentence on this page would be a ball of 100,000,000 Ebola viruses in a patient fully involved and infectious. Enough to wipe out everyone east of the Mississippi.
The number of those viruses from that period-sized ball necessary to infect a medical caregiver, transport person, lab worker, and kill them just as horribly?


With a patient convulsing, explosively sh*tting out their guts, literally coughing out their lungs, and blood running from their eyes, nose, and mouth, all rife with fatally infectious blood-borne pathogens.

Go back to that linked blog, and imagine someone with a couple of gallon jugs of red gloppy dye, and tell them, amidst everyone in their shiny hazmat suits, to randomly squirt out a turkey baster of it up, out, and down, while the staff walks and works in the room. Say once every couple of minutes. Splatter face shields, plop out a juicy glob or three on the floor, and let a constant amount dribble off the edge of the bed.

Some of the staff members will probably start to freak out, even knowing it's just a drill, which is why we never do that even in drills, so as not to let the cat out of the bag.
Ask me how I know this.

Then, after 3-4 hours in those hot, claustrophobic suits, now dripping with deadly simulated goo on the outside, the masks fogged over with sweat and condensed breath on the inside, and not able to hear anything but the powered respirator blower whooshing loudly past your ears for every minute of those same 3-4 hours, and the inhabitants thereof dehydrated, tired, woozy, sensory-deprived, and hopefully not panicky, see how crisp and precise their procedures are. Like starting a simple IV, or drawing blood from the patient. Like we do 10-50 times a shift. (How many hospitals' staff operate in diving gear at depths of >100'? None?? Why d'ya suppose that is, hmmm?)

Sh'yeah, that'll happen.

And with truncated operating times, you'll need 3-6x the number of staff you need for ordinary patients. {Hint: We can't get adequate staffing in any hospital, anywhere, right effing NOW. Do you really think we'll be inundated with 6X as many when Ebola hits?? Sh'yeah, as IF.}

Those people will do one or two shifts like that, and then they're
Called out sick.
Didn't answer their phones.
Never heard from again.

Reality: left skidmarks in the driveway, after mailing in their resignations, loading up the family and gear, and pointing the car towards Bumfuck, Egypt, 500 miles from the next living soul out in the Great American Outback, beyond the black stump.

If they're smart.

We make minor mistakes in clinical care every day, now.
In just scrubs, and comfortable and competent at our jobs.

Put people in unfamiliar environments, in uncomfortable working conditions, with nothing but the prospect of endless more, times months to years, and with the added prospect that the slightest error could result in slow, agonizing nightmarish death? And take out their family and friends as well?

Game. Over.

Throw in vaccination with a highly experimental and clinically untested Ebola vaccine (even one with >98% efficacy like RVSV-ZEBOV, but no idea of long term consequences to recipients; ask the Gulf War I vets how that experimental Anthrax shot worked out), which you don't have enough right effing now of to cover even 10% of the health workers in only the U.S., let alone anyplace else, and you might get 1-5% compliance with hanging around a month or two. By which time, the outbreak will have doubled or quadrupled, for any value of Wherever You're Talking About.
"Best wishes with that plan. 
Love and kisses.
Wish you were here."

Now get your stuff together to either shelter in place in self-quarantine, or GTFO to your Happy Place, and do the same thing. For weeks to months, perhaps as long as a year or two. (The West African outbreak, in a population smaller - yes, also dumber, but not by much - than that of the U.S., lasted from December 2013-January 2016, 25 months, before it was officially declared Ebola-free.)
Think about that one long and hard.
BONUS: That will also come in handy for twenty-seven other potential crises. Win-win.

That's what you could be dealing with, if/when it gets here again, and if it overwhelms our ability to adequately deal with it. The margin for error in such an outbreak is zero.
And if it never happens, you've wasted your time, and are now only prepared for a couple of dozen other major problems. How sad for you.

That sharp stinging sensation in the back of your head is Reality bitchslapping you back to itself, once the Official Partyline Happy Gas wears off.

[Blog note: We'll return to blogposts on other regular topics as the Muse moves us, if it ever stops being SS;DD. Just saying.]