Tuesday, April 28, 2020

How Not To Do This



Morons in action. This is the cover pic for my upcoming book, Pandemic
Prevention For Dummies. It's like looking for a gas leak with a lit road
flare, or looking for a tiger with a bloody dripping side of beef. 
















As businesses  grope for ways to re-open without doing it using Gilligan Logic, they're searching for ways to limit the exposure of their employees and customers to Kung Flu.

The brighter lights out there are actually putting some thought into what they do, and don't do. In that light, recently, another blogger PM'ed me about using temperature checks.

It's a poor choice, other than being the only non-invasive non-test-dependent indicator.
That last is the only thing in its favor.

1) The TSA uses it. That alone should tell you all you need to know, but we'll continue.

2) When checking temperatures, rectal is most accurate, axillary (armpit) is least, and oral is problematic (for instance, if you're sipping iced tea or hot coffee - which I used to get a doctor's note during college, and almost bought myself an ICU sepsis admission, because I overdid it). At any rate, you're trying to determine body core temperature, with reasonably close accuracy.

3) My hospital is using thermal sensors like A/C and heating techs use. Worst method of all, because it's measuring skin temp, not core temp. (That goes for forehead strips too, btw.) And we're a hospital, FFS. It's pure kabuki theater. And can be defeated simply by pressing an ice pack against your forehead for a minute before entering, even if you had a fever of 104° F. (And no, don't pull that dumbass trick either. If you have a fever, stay your @$$ at home.)

4) Ear temps run the risk of poor circulation, ear infections, and cerumen impaction, so false readings, both ways.
 
5) Killer app problem: asymptomatic carriers with NO fever. That was the problem with the last strain/outbreak of Ebola, BTW: 50% of those infected showed no fever spike.
Kung Flu may be as high as 90%. Any percentage at all means using temperature as a screening method pretty much guarantees you're letting foxes into the chicken coop, every day, and rolling the dice on outcomes. Just like the actual Typhoid Mary, asymptomatic carriers have been driving the bus on the Kung Flu outbreak in every country, since Day One to right this minute. That's what makes this disease such a royal flaming pain in the @$$. So using temperature as a screening tool is World-Class Stupid, in the same league as trying to catch flies with a hula hoop, and no net. Or issuing your minefield clearing parties sledge hammers and pogo sticks. Only not quite as smart as that.

 
Like the TSA and Customs and Immigration has been doing with air travel during this pandemic, for a virus that may not show symptoms for 11-21 days, if ever, not to put too fine a point on it.

TL;DR: Temp checks: Better than nothing, but not by much.
 
BTW: The book-standard average range is 97.6°F to 99.6°F = normal.
I.e. 98.6°F, ±1°F either way, for oral.
-1°F for axillary range.
+1°F for rectal range.
(not that you're going to ever do rectal temps at work or anything, just for completeness).

If your business is planning to do temperature checks, and you can get away with it, beat them cheerfully about the head and shoulders with a large 2x4. What they're telling you, as an employee, is that they're using you for live bait in the mosquito trap, and your bosses are too stupid to work for.

So, knowing that, why would the TSA use temperature to screen out arriving passengers for Kung Flu?

"Because we're from the government, and we're here to help..."


 

28 comments:

RandyGC said...

State VFW sent our post direction about having "a plan" to reopen (once the state allows bars and eat-in restaurants to reopen).

One of the first things we are supposed to do for anyone entering the post (member/staff or customer?). You guessed it.

I'm going to see if I can have it removed from our post's plan, but I think there is already agreement among staff that if forced to do it we will do so in the tradition of TSA's form over substance operating procedures.

Great Scott said...

I completely agree with the TSA comment.

JNorth said...

Are the electronic ones you just press against your temple (mines from Walgreens) the same as the ones they pass over your forehead and behind your ear (IIRC thats what they did with it last time I was in the hospital)?

elysianfield said...

Aesop


I am inclined to be skeptical regarding the various antibody tests that purport to show that 15% of the target demographic has been infected, antibodies produced and mostly without symptoms. Ending the quarantine has become intensely political, the Republicans pushing for relief, the Democrats...not so much (The Democratic lead House of Reps will not open on schedule...Too soon into the pandemic, they say).

The prison system does not show the same phenomena...Several states tested thousands of their prisoners...over 3500 tested positive with symptoms...89 positive but asymptomatic. Anecdotal, I know, but the 15% who insensibly contracted the disease seems improbable. Military has tested ships at sea... most with no cases, symptomatic or otherwise.

Full disclosure; I have been branded a fear-monger, a Jerk and a lurker on sites morally suspect. It will, perhaps, soon be suggested that my parents were not married (They were, but not necessarily to each other).

We really do not know much about the Novel Virus...many opinions, conflicting studies...not much otherwise.


Malcolm said...

Excellent video

https://www.youtube.com/watch?v=ZDglEj3WoNM&feature=emb_title

Unknown said...

You opened up the comments again?
Good.
Here's something I would like your opinion on, Aesop...
https://theconservativetreehouse.com/2020/04/26/an-alarming-message-about-healthcare-and-covid-19-in-new-york-city/

Night driver said...

ef, DEAD NUTS ON!!!

The list of things we DON'T know bout this bug is several times longer than the frickin list of things we DO know for FACTS with it.

There have been Metric TONNES of "information" that have turned out to be crap as we have gone farther into this wave.

And while we study the genome as sequenced in a BILLION places, we STILL won't have that long list much shorter. Because we really CAN'T translate GENOME SEQUENCED into EFFECTS and capabilities. THOSE answers have to come from our IN VIVO study. And its DANG hard to study someone while yer trying to save his or her damn life!

Which translates into Pathologists doing Posts and GP's and Infectious Disease (unknowns under pressure) doing post survival investigations/serological studies/spinal taps/EMG's and a whole bunch of other investigative tests, some of which are DAMN uncomfortable but the only way to even be PART WAY to being ready for Round 2 in about September-October.

Aesop, you and any docs you talk to who LISTEN can be instrumental in having PLANS in PLACE for what (if H1N1 Flu AKA 1918-1919 Flu is a predictor) is going to be a REAL Barn Burner. Because if H1N1 IS a predictor, what we have had to deal with these last 8 weeks will be "The Good Old Days".

And, no, I don't do well at parties, either. We should be starting our plans NOW. Because the enemies of the Union are certainly starting THEIRS.

Think starting my prayers tonight ain't ANY too soon.

Cederq said...

I actually insisted on one place I started to go into, I also told them the infrared thermometers only recorded skin temp. If they were going to be thorough I wanted a rectal... that the only true body core temp is rectal. I was turned down, I still went in

. said...



https://kpel965.com/alan-seabaugh-gov-lied-to-lawmakers-about-stay-at-home-extension-video/

Case numbers are dropping in urban areas. Case numbers are increasing in a few rural areas, as testing becomes more available. Well DUH....color me shocked. Some Louisiana counties are so rural and poor, it hurts.

But instead of a phased, county by county re-opening, John Bell is insisting on an all-together-now deal. So some barbers/hair salons are quietly doing one person at a time haircuts/coloring. Via the rear door.
And the Legislature is rumbling about overriding JBE. Hopefully he will see the handwriting on the wall, and act accordingly.

And Sunday 2 state troopers told me they are "imitating Sgt Schultz" regarding anything other than traffic issues.

Termite

RSR said...

Aesop -- curious about your thoughts about this vid: https://www.patreon.com/posts/apparent-nurse-i-36460864

Michael Yon confirms he's heard similar report of NYC nurses doing the bare minimum, refusing a lot of treatment options, and effectively murdering patients. Yon titled: "Apparent Nurse Blowing Whistle: I cannot verify but is consistent with a private report to me"

Tina said...

Glad to see the comments back. :-)

Another reason temperature checks are faulty diagnostics: since my thyroid went haywire at age 60, my temperature now runs about 96.5 to 97.3, consistently. It's been as low as 95. My whole life, my oral temp was 98.6. But no longer. If I have a low-grade fever, it looks like the rest of the world's normal. :-(

I'm no expert, but if that is true of all people with underactive thyroid, that is a lot of people with normally low temps who won't show up even if they are running a fever.

Aesop said...

@Malcolm:
The correct link is:

https://www.youtube.com/watch?v=ZDglEj3WoNM

That said, Dr. Fucktard is another innumerate shit-for-brains.
Kern County has 6% infection from those they've tested. They aren't doing widespread testing; they're testing symptomatic sick people. that skews the positive rate up YUUUUGELY. If Dr. Fucktard didn't know this, I know which half of his medical school class he graduated in (hint: it's not the top half). He then repeats that stupidity when he talks about CA's numbers. We aren't doing drive-by testing here. Mainly, it's only those who're symptomatic and sick.
So what he's noting is a high rate of infection among the 1.5% of the state tested, who already show obvious symptoms. Duh. That means among everyone else, he has no fucking clue what the infection rate is, because he's too fucking stupid to differentiate between testing the sick, versus testing a valid, RANDOM, age/sex/race/geographically corrected SAMPLE of the state's population, using an accurate test.

I can tell you this based on watching 5 minutes so far, of a 68 minute video.
I'm not in favor of YouTube censoring this.
But Dr. Shit-For-Brains probably shouldn't go on the internet to advertise being this fucking stupid, because patients will be able to see what a non-scientific moron he is, for years to come.

And if he can't set the problem up correctly from the get-go, nor understand basic statistical analysis, he clearly can have no wild idea WTF "science" is, nor what it means, and any conclusions he draws in the rest of this talking abortion are going to be First Class Gilligan Logic.

He should have taken Will Rogers' advice, and not passed up a good opportunity to STFU.

If you meant to illustrate why just because someone has "Dr." in their title, it doesn't mean they're not still idiots, you get 5 stars *****.

If, OTOH, his babble sounded good, I urge you to dig deeper.
This was like watching a gun "expert" who shoots himself in the foot in the beginning minute of his lecture.

https://www.youtube.com/watch?v=vfONckOPyaI

Toirdhealbheach Beucail said...

I believe this is in place at my current job for those that are still working on site. All the problems listed are there. Per our HR and Legal team, this is 100% within their rights to do.

But now the cat is out of the bag. I would expect some level of corporate technology to make the same sort of thing as a metal detector/door that one has to walk through to almost everywhere (mostly to cut down on the labor cost). This will likely become ubiquitous because at some point, businesses that do not do it will not want the liability.

Hawkin'Gal said...

I have hot flashes at least twice an hour. I wonder how long before these retards figure out that an outsized percentage of those scanning "feverish" are middle-aged women?

ThatWouldBeTelling said...

Just like the actual Typhoid Mary, asymptomatic carriers have been driving the bus on the Kung Flu outbreak in every country, since Day One to right this minute. That's what makes this disease such a royal flaming pain in the @$$.

I'm inclined to believe this is true, although I'd like to see hard evidence for it, which I'm pretty sure we can't have yet, e.g. good serological (antibody) studies would be better than trying to tease this out of infection patterns when we aren't testing hardly enough people for current infections.

If so, I note Saint Fauci laid down a very strong marker saying the reverse at the end of January:

To just add one thing that seems to get lost in that question: we would really like to see the [PRC] data because if there is asymptomatic transmission it impacts certain policies regarding screening etcetera. But the one thing historically people need to realize, even if there is some asymptomatic transmission - in all the history of respiratory borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks, even if there’s a rare asymptomatic person that might transit, an epidemic is not driven by asymptomatic carriers.

ThatWouldBeTelling said...

And while we study the genome as sequenced in a BILLION places, we STILL won't have that long list much shorter. Because we really CAN'T translate GENOME SEQUENCED into EFFECTS and capabilities. THOSE answers have to come from our IN VIVO study. And its DANG hard to study someone while yer trying to save his or her damn life!

That turns out not to be the case. Particularly when it comes to going from the gene sequence to the proteins that come out of the mixmaster of a virus like this hijacking a cell's machinery. And you can figure out various details about the proteins from how they effect cells in vitro, the major thing you're lacking is immune system responses.

Plus you have to be careful that the virus doesn't adapt itself to the cells in your culture compared to wild type cells, this has already been noted as a problem. To get a general idea of how messy this can be, see how HeLa cells have contaminated other cell culture lines.

In the meanwhile Night driver, maybe you should cut down the all caps shouting and show a little humility about what you're so sure you know to be true?

Aesop said...

So evidently Fauci was sick the day in medical school when they discussed Typhoid Mary being an actual person.

ThatWouldBeTelling said...

Unknown, in reply to your previous posting of this link (plus I think now two others), I too would be interested in his opinion, but in the meanwhile to repeat my reply:

This is consistent with for instance the 90% fatality rate of people on ventilators in NYC, which is as far as we know worse than the already very bad US standard. And I previously linked to this article about the terrible level of nursing in NYC.

ADS said...

What do you call the guy who finishes at the bottom of his class in med school?
Every field in which I have expertise is chock full of schooled-but-uneducated blowhards who are only good enough to be convincing to lay people. Gell-mann amnesia is a specific case of a very general problem.

ThatWouldBeTelling said...

Typhoid Mary didn't drive an outbreak like this one, probably because typhoid isn't a respiratory borne virus (it's a bacteria with a fecal-oral infection route). But the potential is there, and it would seem he should have been more cautious about a novel (corona)virus with a transmission pattern then known to be very different from SARS-Cov and MERS-CoV.

Reminds me of the saying about flu, "if you've seen one flu season/epidemic/pandemic, you've seen one flu season/epidemic/pandemic." And we know a lot more about influenza.

Bee Ess said...

How is it, with ALL of the data available, that people ... ALL eFFing people ... don't understand wtf ASYMPTOMATIC means? Doubly, triply, infinitibbbbbbbly for TPTB and general "health care" people in charge?
WTaF?

Knightsofnee said...

What if kung flu is....
Synthetic not zoonotic
Weak antibody response
Little herd immunity

Sarin said...

"It's pure kabuki theater."
This. Right Here.

Along with Aesop's observations about the efficacy of forehead scanning, it's a move designed to placate the masses and make them feel better about going into said location. It's the "but we have to do SOMETHING" mentality that pervades society. People are all too happy to give up rights in order to feel safe.

Reminds me of the Santa Fe school shooting, which took place a few miles from our home. DW was about to yank our kid from school, indefinitely, because "it wasn't safe" and "We (they) have to do SOMETHING to keep our kids safe." Took a long while to talk her off the ledge and explain that the school district (not Santa Fe) had policies and procedures in place. That at some point, it changes from being a school to a prison. At what point are the masses going to understand what's happening? Never. Given the copious amounts of misinformation and bullshit masquerading as "educated experts" out there, combined with the near monopolistic censorship of "big data", it's impossible. Even face-to-face conversations are met with snorts and derision at best and bullshit is trotted out. When clearly refuted with logic and proof, it invariably returns to the emotional argument of doing SOMETHING and the histrionics and accusations of being Fascist or (x)-phobic.

Side-note. Literally listening to our Chief Economist talk about economic recovery (Top 10 on the Forbes list). He's stating that economic recovery won't happen until around Q2 2021. I asked about a secondary wave and took him off his thought track. My question was promptly ignored. When wave 2 hits, it's going to be way beyond a Shit Mardi Gras. Aesop's most recent Gunny Highway meme will be prescient. Let's hope folks sack-up between now and then.

ThatWouldBeTelling said...

What if kung flu is....
Synthetic not zoonotic
Weak antibody response
Little herd immunity


What if aliens invade the Earth tomorrow?

Such fearmonging does no one any good, and what I take your to say is not even credible, why would anyone create a bioweapon they can't defend their own population against with a vaccine?

OK, it might have been a work in progress, but more like it's the result of gain of function research by idiots who didn't know what they were doing. Much if not most of the "science" done in the PRC is of the cargo cult variety, and Mad Scientists around the world have been doing extraordinarily dangerous gain of function research for many years, first with bird flu, and the Feds shut this down in the US with two funding moratoriums. Including the Bat Woman's research so far as it was done in cooperation with US institutions and dollars.

On the other hand, severe cases are clearly getting antibody responses, reported to be strong ones, as you'd expect, plus of course that's what serological population tests look for (but maybe not well). So if substantial populations are getting weak antibody responses, in alignment with plenty of reports of uncertain quality, including old ones on "common cold" coronaviruses, we'll need vaccines that produce that level of response. Some "synthetic" work might be required for this.

ThatWouldBeTelling said...

Bee Ess: do you mean the consequences of asymptomatic cases? Because that's the sort of thing that requires real research, which takes time we haven't yet had much of. We do expect that the truly asymptomatic don't spread it like the symptomatic who cough, but we don't know, either at the micro level, or the macro level where too many asymptomatic cases with lower R0s could infect more people than the small number of symptomatic ones, at least some of whom take measures to limit their danger of infecting others. And of course this research would be complicated by taking measures to decrease the spread by any type of patient.

I'm of course assuming a situation like in the US where our liberalism has outlawed effective public health measures. We could have stopped this cold like some other countries with harsh travel, quarantine, and boarder measures, but we're too soft to do that.

So it's not illegitimate to worry as Nassim "Black Swan" Taleb does, along with I think Night driver, that if we continue to respond poorly to the epidemics the world's globalism makes inevitable, sooner or later we might have a Black Swan pandemic that's much worse than the Black Death, which will wipe out almost all of humanity. And at one time long ago we believe our population was squeezed down to about 40,000 individuals.

But I think we have sufficient troubles to worry about today, this something for after we gain some control over Corona-chan. And will be very hard to do unless it hits us really hard, perhaps through 2nd etc. order effects, note Trump's action about meatpackers. Or perhaps more likely, we either have to take vaccine booster shots very frequently, or if we can't develop one, and SARS-CoV-2 doesn't mutate into something gentler, it permanently and significantly raises the baseline of infectious death. Returning us to the harsher days when for example polio roamed the earth, or earlier and worse (polio has a fecal-oral route, so I suspect basic sanitation measures had a substantial effect on it, or see why most of us didn't get Hepatitis A before there were vaccines for it starting in the 1990s).

Night driver said...

TWBT -=- Copy.

Will work on pulling emotion out of responses.

Fair point. I should know better.

Joseph said...

Skin temp test is required daily before entering the plant I work at. In South Texas. In summer. Usually after you have walked anywhere from 50-200 yds, while wearing a hard hat, or wearing a reinforced "bump cap" and often wearing a nylon safety vest. I don't hold out much hope for accuracy here.

Knightsofnee said...

I never said it was a bioweapon.
Synthetic means someone was playing around with stuff.
That is all.