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.