Monday, December 22, 2014

Paradise, Bitchez

For the first time in two decades, I got the holidays off for personal vacation. (Seniority, or the gods of random fortune, thank you).

Consequently, by the time this goes up, I'm sitting on a beach much like this one.
Just because.

Happy Holidays, &c.

Back after New Year's.

Tuesday, December 16, 2014

@$$Clown Of The Ides: Chuck U Very Much, Senator...

The real motivation for all that Ebola preparedness comes out:
(PORKVILLE) - Senator Chuck Schumer on Monday called on U.S. secretary of health and human services Sylvia Mathews Burwell to recognize the enormous amount New York hospitals have spent preparing for and treating the Ebola virus, and use some of the money she was given by Congress to reimburse hospitals for their expenses.
Burwell has 30 days to come up with a spending plan for the $733 million her agency received from the latest continuing resolution, a $1.1 trillion spending package that allotted a total of $5.4 billion to combat Ebola.
Most of that money is headed to West Africa, where the epidemic continues to claim thousands of lives, but some can be used domestically.
Schumer said he would like New York hospitals to receive roughly $50 million
         “I am urging secretary Burwell to make sure all of New York's institutions are completely reimbursed for their funding,” Schumer said at a press conference today outside Bellevue Hospital. “That was the purpose of the fund when we push for it and created it.”
Mayor Bill de Blasio has already reimbursed Bellevue, a part of the city's Health and Hospitals Corporation, $20 million for the expenses it incurred when treating Dr. Craig Spencer, the physician who contracted Ebola while working with Doctors Without Borders in West Africa.
But other hospitals have spent tens of millions of dollars preparing for the virus, Schumer said.
Montefiore has spent approximately $7.5 million building a biocontainment unit and training staff, Mount Sinai has spent between $7 and $8 million, and New York Presbyterian has spent roughly $3.3 million, according to Schumer's office.
Ken Raske, president of the Greater New York Hospital Association, estimated the ten Ebola-designated hospitals in New York have collectively spent between $50 million and $75 million on capital construction, the purchase of protective gear and training.
Try and look surprised at the prospect of a Democrat senator trying to shove both arms armpit deep into the taxpayers' pockets and keep everything he can get his hands on.

Webster's Dictionary could save space by consolidating the entry for Chuck and the entry for chutzpah. Or at least using the same picture.

Like Getting Ebola Wasn't Bad Enough

Kenema, Sierra Leone (Al Jazeera )- Massah Kamara sat patiently with her brother Momoh, her haunted eyes focused somewhere in the middle distance beyond the walls of the post-Ebola clinic.
Three months earlier, doctors gave her the good news - after weeks of fighting the disease, she had finally beaten Ebola. She would live.

Back in her home neighbourhood of Nyandeyama, a quiet suburb of sandy streets and mango trees, she found out 22 members of her family were dead, including her parents. She had no money, so was unable to go back to her tailoring business, and many of her possessions had been burned by terrified neighbours.

Then, just when she thought things couldn't get worse, she began to lose her eyesight.
"My eyes are dark," she said sadly. "Even when the sun is shining, my eyes are dark." Kamara said she was happy to have survived Ebola, but fear and misery were etched onto her face.
Kamara is one of 40 percent of Ebola survivors to have gone on to develop eye problems, according to a recent study carried out by the World Health Organisation and Kenema's District Health Management Team. It has been more than a month since the district saw it's last case of Ebola, and attention is turning to the plight of survivors.
The results of the survey, a copy of which was seen by Al Jazeera, outline a raft of physical, social and psychological problems the survivors are experiencing.
Seventy-nine percent, for example, now suffer from joint pain; 42 percent have problems sleeping, while more than one-third of those surveyed experienced peeling of the skin. Many others reported problems with their reproductive system.
Post-survival effects 
"There is so little written about post-Ebola problems," said Maggie Nanyonga, a WHO consultant working with Ebola survivors in Kenema district. "We don't know if it's the drugs that are causing it, or the disease, or just stress."
In a small room at the government hospital in Kenema, now known simply as "Psychosocial", volunteers busily transcribed forms with survivors' complaints. "Serious backbone pain. Difficulty breathing. Properties burned but not replaced," reads one.

"Ear and joint pains. Poor health with red eyes," reads another. 
 "Tired legs and weakness. Cannot see clearly," reads a third.Health education officer Michael Vandi said the eye problems are of particular concern. "We just weren't expecting this. A lot of them are experiencing it, often combined with headaches," he said.The head of the hospital's eye department, Ernest Challey, said he believes he has found the cause - a condition called Uveitis that occurs when the innermost coating of the eye becomes inflamed.
It is triggered by problems with the immune system, a viral infection, and sometimes trauma, he explained. It leaves patients with dim and blurred vision, and pain when they're in bright light. If left untreated, said Challey, it can lead to blindness.

But the physical symptoms are just a part of the immense challenge many Ebola survivors face. "Sometimes I cry when they tell me their stories," said one nurse after writing down Kamara's details in the post-Ebola clinic, the first of its kind.
And it gets worse, according to the rest of the story: the locals treat survivors like pariahs, having burned their few belongings, and shun them afterwards, so they're left with no place to live and no job, as all the health problems pile on.

There's never been a post-Ebola clinic, because historically, the Ebola Survivors Clubs have usually been able to meet in a phone booth.

But with a few thousand survivors this time out of at least 20,000 victims, medical science is getting a new chapter in Ebola treatment: follow-up prognosis for survivors. And it isn't pretty.

Not least of which because what little assistance is going there is aimed at trying to curb the actual outbreak, not deal with the aftermath.

We never had to do much of that before...

Monday, December 15, 2014

Some People Don't Know When The Music Is Over

"Can I just get five more seconds in the spotlight? How about four? Okay then...three...?

Speaking of Slow Learners, today's NPR blast of woulda-coulda-shoulda:
Speed. That's key to ending the Ebola epidemic, says the director of the U.S. Centers for Disease Control and Prevention.
Dr. Thomas Frieden is visiting West Africa this week to figure out how to reduce the time it takes to find new Ebola cases and isolate them.
Otherwise, Ebola could become a permanent disease in West Africa.
               "That's exactly the risk we face now. That Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come," Frieden tells NPR. "That is what I fear most."
Frieden plans to spend several days in each country where the virus is still out of control — Guinea, Liberia and Sierra Leone.
The biggest challenge right now is in Sierra Leone, he says, where the epidemic shows no signs of slowing down. New cases continue to rise exponentially. Last week, the country reported nearly 400 cases, or more than three times the number of cases reported by Guinea and Liberia combined.
Since February, there have been nearly 18,000 reported Ebola cases globally, the World Health Organization says, with more than 6,000 deaths.
               But Frieden is still confident that the three countries can eventually reach zero new cases and end the epidemic.
Because the world has stopped every Ebola outbreak before, Frieden says. "Even in this epidemic, we are stopping individual outbreaks. The challenge is doing it at a scale and with a speed that we've never done before."
When Frieden visited West Africa last time, in August and September, the disease was "raging out of control in Monrovia," he says.
Since then, the epidemic has slowed down in Liberia. "But we haven't been able to get it under control," he says.
               "As the weeks have gone by, we have been able to intervene faster [in Liberia]," Frieden says. "We've found that we can stop outbreaks in weeks instead of months."
So a hot spot in one town or county ends up having only a handful of cases instead of hundreds, he says.
Now the CDC and international aid groups need to figure out how to do that in Sierra Leone.
But even then, the response may not be fast enough. All it takes is one sick person to travel to a vulnerable town and ignite a new hot spot. That's been happening in Guinea for months.
"It's not like a forest fire, so much," Frieden says, "as a country full of bush fires in different places."

Tom, check your spam filter: President Obola sh*t-canned you back in October, when he appointed Flounder to be the new Invisible Disinformation On Ebola Czar. The memo you missed is probably in there.
So, a few pointers:

* If you've noticed a lot of space on your Day Planner lately, it's because you're officially dead in D.C.
* The first hurdle to tracking Ebola contacts in West Africa, is getting the countries involved to admit that they have them. When everybody admits that there's a "fudge factor" of between 2 and 200 to multiply official reports by, going back to, oh...forever in this outbreak, that's how many cases you'll never track, times the 10-100 contacts they create.
* The second hurdle would be teaching 20,000,000 people there how to count. If the illiteracy rate there was the growth rate of GDP, they'd all be driving Beemers and flying in Gulfstreams. As it is, they wear sandals in case they have to make change for a quarter.
* Ain't nothing happening there on a Western "right now" time frame. They make "island time" look like a FedEx Distribution Hub. "Just in time" in West Africa means "order three years in advance, double the needed amount, and keep a slush fund handy for last minute bribes, and there's a 60% chance we'll have this no later than a month after you need it."
Seriously, dude, try talking to any of your own people there about this.
* Once you tackle those paltry problems, you only have to get past two or three other minor details:
The cultural hurdles of a grabby/touchy/feely society
The religious hurdles of inshallah and the associated local burial rites and customs
The scientific hurdles of taking a country to accepting scientific germ theory accepted here since Pasteur, in one where this month 50-75% of the peoples there are more likely to believe that what's killing people is curses and witchcraft than "Ebola".

If you look closely Tommy, you might notice how curiously similar all that sounds to the phrase "nation-building". Something Britain and France couldn't do there in centuries. Maybe there's no TV in your lab or office, or you're more of a theatres-and-symphony kind of guy, but that phrase doesn't have quite the cachet now that it might have had in, say, 2003.

So why don't you respond to one of the 47 e-mails that career recruiter has been sending you for the last 8-10 weeks, and see about updating your resume.

You've "solved" quite enough geo-political epidemics for one lifetime, I think, and maybe you should get a new hobby to fill your golden years.

Oh, and nota bene, careful readers, that NPR and Frieden himself are still describing this outbreak as "out-of-control" in no uncertain terms, in all three countries.

Slow Learners Pay The Price

GENEVA (Reuters) - The failure of Sierra Leone's strategy for fighting Ebola may be down to a missing ingredient: a big shock that could change people's behaviour and finally prevent further infection.
Bruce Aylward, the head of Ebola response at the World Health Organisation, said Sierra Leone was well placed to contain the disease -- its worst outbreak on record -- with infrastructure, organisation and aid. The problem is that its people have yet to be shocked out of behaviour that is helping the disease to spread, still keeping infected loved ones close and touching the bodies of the dead. "Every new place that gets infected goes through that same terrible learning curve where a lot of people have to die ... before those behaviours start to change," Aylward told Reuters.The WHO's death toll from outbreak has climbed to 6,583 but the actual figure is likely to be far higher due to under-reporting of cases. The flare-up in Sierra Leone's capital Freetown and the country's more heavily populated western areas resemble the massive infections suffered in August by Liberia's capital Monrovia. "In Monrovia you had bodies on the streets, you had a riot, you had someone shot - awareness went through the roof in a very, very short time as a result," said Aylward.             "You don’t want to see that kind of thing drive public awareness but it has an impact very, very fast. People changed behaviours in Monrovia - bang! Like that." Mali also learned through a shock. Just as it seemed nobody had been infected by its first Ebola patient in October, another cluster of deaths sprang up the following month. Aylward said he told Malian officials that the only way to stop the outbreak was to trace anyone who may be at risk. "That’s when the contact tracing... took a jump from around 60-70 percent completion to 98 percent," he said.Denial and ignorance are part of the problem but a weak healthcare system and logistics also play a part. Officials in Kono - where an explosion of infections was discovered this week - said the eastern district of 350,000 inhabitants had only one ambulance and no Ebola treatment centre."The forest area of these three countries has got some really special and concerning practices, where they share meals with the corpse, where they sleep with the corpse," he said.Some areas of eastern Sierra Leone that were hit hardest early in the epidemic -- around the towns of Kenema and Kailahun -- have seen a massive reduction in case numbers as people change behaviour. "The areas that are now doing badly are the areas that were affected last. They are still on the learning curve."

Amazing to hear the UN official in charge of the entire WHO response wistfully longing for the more resposible parties to shoot few stupid people to get their attention, but there it is, and in print.

And short of that or massive die-offs, currently in progress, about the only thing likely to wake them up.

And as noted by commentor geoffb, the lesson fades from view overnight:
ABUJA Nigeria (Leadership) -The declaration of Nigeria as an Ebola-free country by the World Health Organisation (WHO) in October has prompted many Nigerians to discontinue the practice of maintaining a good level of hygiene as a measure of containing the Ebola Virus Disease.
From schools to banks and other public places, the strict measures of screening for signs of the disease put in place while the outbreak lasted between July and October, have fizzled out in most places. Most Nigerians are now living a care-free life because, according to them, Nigeria has been certified Ebola-free by the WHO, which means there is no cause for alarm.

Hopefully Ebola got the same memo, or the remedial course is going to be a bitch there.

Sunday, December 14, 2014

Another Ebola Round-Up

Given the all but predictable info-dumps on the weekends, the latest:

(Reuters) Liberia's elections have gone from on to off and back to on, currently for Dec. 20th.

(WaPo) Johns Hopkins has designed a vastly-improved next-gen moonsuit for Ebola caregivers to wear.
Takeaways: it's months from production and distribution (if that even occurs), so currently it's total vaporware this side of next summer. Or perhaps ever.
It's also exactly the isolation spacesuit all the naysayers said we didn't need to use to keep health care workers from getting infected. It's amazing what a dose - or 20,000 of them - of reality does to all those cheery "We can handle this stuff" bull$#!^ assertions. Remarkably, you can't find those people opening their yaps about things now. How curious.

(CTV) Sierra Leone reports the 12th doctor there now infected with Ebola. At this rate, they won't have any doctors left at all in a couple more months, other than outsiders come to help. They've gone 1 for 11, with the other 10 dead, on previous MDs infected. Interns have gone on prolonged and repeated strikes demanding actual protective gear, and almost all the doctors who have been infected had it happen while treating patients in other non-Ebola areas, indicating the Ebola-infected are going to other (non-screened) treatment areas, and cross-infection has already or will soon wipe out the entire minimal health system in the country unless everyone everywhere is treated as an Ebola patient 24/7/365.

And the best of the bunch, from (NPR) : What Happens When You Let Illiterate Retards Run  A Crisis (quoted in its entirety, as it was just too good to chop up)
As part of Sierra Leone's broader effort to contain the deadly Ebola virus, the country opened a new ambulance dispatch center in September in the capital, Freetown. Along with a new Ebola hotline, the center is considered an important step forward in the war on Ebola.
But on the center's second day of operation, a series of errors put the life of an apparently healthy 14-year-old boy at risk.
The dispatch center is situated in a meeting room at the Cline Town hospital just north of downtown Freetown. Inside the room, a group of men and women are huddled around a table full of laptops. Safa Koruma, a technician, points at a message on a screen. It describes a possible Ebola patient, reported through the hotline, with the words "vomiting and very pale."
Koruma forwards this message — along with hundreds of others — to the nearest health official. A community health worker is then supposed to evaluate the patient and assess the likelihood of Ebola.
"Probable" Ebola cases end up on a large whiteboard on the other side of the meeting room. It's the master list for ambulance pickups.
Victoria Parkinson, of the Tony Blair African Governance Initiative, is one of the directors of the center. She points at a name on the board with the number five written next to it, indicating the number of cohabiting family members.
"We want to get that [person] quickly, because there's many people in the home that could be infected by," she says.
One of Parkinson's colleagues, Ama Deepkabos, writes down an address and hands it to an ambulance driver. "It's 7 Hannah Street, 555 Junction. Do you understand?" she says, imitating the local Krio accent. "Go directly to the patient. No other stops!"
The driver nods and hustles out to the dirt parking lot, along with a nurse. I attempt to speak with the driver and nurse, but neither speaks good English. They step into a white Toyota SUV with the word "Ambulance" in large red letters, and pull out of the parking lot.
Sierra Leone is in the midst of a three-day national lockdown, intended to slow the spread of Ebola, so the roads are clear. The ambulance speeds across town and is waved through multiple police checkpoints.
After two wrong turns and several stops for directions, it eventually bounces down a long dirt road in Waterloo, a rural suburb 15 miles southeast of Freetown.
The driver and nurse spot the person they believe to be the patient: a 14-year-old boy in a blue T-shirt slouched on a white lawn chair.
They get out and put on glimmering white protective suits, surgical masks and rubber gloves. They walk over and escort the boy, who is able to walk on his own, into the back of the ambulance without touching him. They kick the door closed behind him.
The boy's guardian, Suleiman Espangura, is the principal of a nearby high school. He recently took the boy, Ngaima, into his custody because his family was moving to a rural part of Sierra Leone, and Ngaima wanted to stay at his current high school near Freetown.
"He likes to play football," Espangura says of the boy. "And he's very clever. We [teachers] like children who are clever."
Espangura says he's unclear why Ngaima is being taken away in an Ebola ambulance. He says the boy doesn't have any signs of Ebola — no fever, no vomiting, no diarrhea. He just has a headache and a slight loss of appetite.
But because Espangura had heard multiple public service announcements encouraging people to report any signs of illness, he contacted a health official and was told a community health worker would come to evaluate Ngaima. Instead, an Ebola ambulance showed up.
Espangura says the ambulance driver and nurse asked him if Ngaima was "the patient." Espangura said yes, thinking the men were here to evaluate him. Instead, they ushered the boy into the ambulance and whisked him away.
The ambulance rushes across town to a military hospital with an Ebola isolation unit set up outside — a series of white plastic tents with a blue tarp stretched around the perimeter.
The hospital guards, in military fatigues, tell the ambulance driver and nurse that Ngaima is not on their list of expected patients. A heated argument ensues. The driver insists that he is merely following instructions, and that this is the correct patient.
One of the guards eventually calls the head of the hospital, who consents to admitting Ngaima. The driver and nurse spray the back of the ambulance with chlorine and open the door to let him out. Ngaima steps out of the vehicle and disappears behind the blue tarp fence, into the Ebola ward.
A few minutes later, another Ebola ambulance arrives. The military guards are expecting this patient. But they say the beds beds are now completely full — Ngaima has taken the last one. The new patient is admitted anyway.
It's not clear exactly what went wrong here. But now, a 14-year-old boy with a headache is sitting inside an Ebola isolation center.

It's really heartwarming that Sierra Leone's Ebola response is being administered with the same tenderness and regard for common sense and patient outcomes as our own Veteran's Administration, by people that put the Keystone Kops' sketches to shame. And don't worry, if little Ngaima didn't have Ebola when he arrived in the treatment center, he soon will. 

Saturday, December 13, 2014

And As A Reminder

Here's the YouTubed home vid of a doc coming out of PPE isolation in W. Africa (in this case, for his last time). Note the process, and the fact that despite doing this one or more times a day while working there, the second safety monitor catches him a couple of times; also note the numerous times where he washes and re-washes and re-washes his gloved hands before touching the next item(s). The apron, goggles, and boots are re-used; everything else is toast after a single use, including both pairs of gloves, suit, and hood.

This is TIME's Person Of The Year, #30014. Now you have a taste for why.

Stupid Is As Stupid Does

Surprise! Surprise!
Shortly after re-opening their border with Guinea(?!), closed since mid-August, the nation of Guinea Bissau let someone through with a high fever. Someone of surpassing intellect amongst the assorted rent-seekers belatedly realized that was a bad thing, and they subsequently located and pulled the next potential Index patient (and 8 others in close contact) off of a bus preparing to head from their border straight to the regional teeming capitol. (Stop me if you're heard this one.) He was several miles away from the border when finally located.The nine individuals are all now in isolation pending test results on Mister Potential Ebola.

Kudos to whatever semi-literate suddenly had an attack of intelligence; he probably saved his country joining the Ebola tally in 2-21 days.

And whatever Customs and Immigration @$$hole (or whatever passes for it in Guinea Bissau) decided opening their border to an endemically-infected Ebola nation was a good idea should be the next recipient of the "Up Against The Wall!" African Retirement Ceremony usually reserved for deposed dictators.

(French-language link in the local press)

This is why Ebola isn't going away in the retarded part of the world anytime in the foreseeable future, sports fans. This was one IQ point away from becoming next week's newest outbreak, and 5-50 more cases. And remember, according to our government, we aren't safe here until they wipe it out over there.

Friday, December 12, 2014

When Hyperbole Isn't Enough

In past, I have rhetorically used the phrase "cancel Christmas" to describe things when/if the Ebola situation gets bad. Now, Sierra Leone has done exactly that:
(AU News) SIERRA LEONE is banning public Christmas celebrations as the spiralling caseload of Ebola infections continues to spread alarm. Soldiers are to be deployed throughout the festive period to force people venturing onto the streets back indoors, the government’s Ebola response unit announced on Friday.
Palo Conteh, head of the department, told reporters in the capital Freetown there would be “no Christmas and New Year celebrations this year”.

Thursday, December 11, 2014

Number Crunching Reported Cases

Courtesy of Reddit and user c0mputar, here are the 4-day daily case totals of reported Ebola cases going back to late August:

  • Dec 4th-7th: 102/day
  • Nov 30th-3rd: 128/day
  • Nov 26th-29th: 129/day
  • Nov 22nd-25th: 129/day
  • Nov 18th-21st: 120/day
  • Nov 14th-17th: 122/day
  • Nov 10th-13th: 165/day
  • Nov 6th-9th: 185/day
  • Nov 2nd-5th: 115/day
  • Oct 29th-1st: 115/day
  • Oct 25th-28th: 146/day
  • Oct 21st-24th: 107/day
  • Oct 17th-20th: 168/day
  • Oct 13th-16th: 127/day
  • Oct 9th-12th: 130/day
  • Oct 5th-8th: 132/day
  • Oct 1st-4th: 124/day
  • Sept 27th-30th: 138/day
  • Sept 23rd-26th: 129/day
  • Sept 19th-22nd: 137/day
  • Sept 15th-18th: 130/day
  • Sept 11th-14th: 124/day
  • Sept 7th-10th: 127/day
  • Sept 3rd-6th: 105/day
  • Aug 30th-2nd: 104/day
  • Aug 26th-29th: 101/day
  • Aug 22nd-25th: 101/day

  • With all the caveats regarding "official" reported numbers vs. actual cases, and noting that this includes periods where nations added - and subtracted - thousand-plus numbers into short periods, what's notable is that since late August, this outbreak hasn't been below 100/new cases day. It's also never gotten as high as 200 cases/day.

    IMHO, that points to this range being the maximum number of tests that can be run in one day, and/or the maximum number of people who come forward for testing, versus any approximation of the actual number of people infected in any place or period.

    Which explains everything else about supposed flattening of the growth curve.
    The fact that it isn't going anywhere, up or down, is proof that there are always (for the last nearly 4 months) at least 100 people so sick with Ebola that they'll finally drag themselves to an ETU - or collapse in the street - for isolation and testing. (It's more than that, but a notable number of them die before testing, which opts them out of the process with some finality, while simultaneously letting those nations elect to not count them in the death stats, since the cause of death is thus "unknown". How convenient. Shovel, shut up, and keep the news cheerful. QED)

    So what this tells us is more like a tachometer than a speedometer of the infection: it tells us how fast the labs are cycling tests.
    It doesn't tell us what gear the infection is in, if you will.

    It might be fair to think things were winding down, except for recent note that burials are humming along everywhere, while stacks of unburied bodies are being discovered all over Sierra Leone, while in Guinea, the spread of the disease simply refuses to taper off. Liberia seems mainly to have mastered the use of pencil erasers to solve their statistical problems.

    And Now, The Serious Lying Starts

    (Reuters) - An American nurse who was exposed to Ebola while volunteering in an Ebola treatment unit in Sierra Leone will be admitted to the National Institutes of Health's Clinical Center in Maryland on Thursday, NIH announced.NIH did not release any further information on the nurse, including when he or she might have been exposed to the virus, current medical condition or affiliation.
    It is thus apparent that we're not meant to know where she's arriving from, whether and how many people she may have already exposed here or anywhere else, or anything further about the case.

    And she's being taken to the one facility (out of four) completely under the control and purview of the U.S. government, from top to bottom. Make of that what you will.

    If you aren't continuing to get your personal quarantine ducks in a row, you aren't paying attention.

    UPDATE: NBC local affiliate is reporting that the nurse has tested negative for Ebola. So whether she's actually infected is an open question, and/or will accidentally leak out the truism that a negative initial Ebola test doesn't mean you're not infected.
    Disinformation Czar Klain will not be pleased.

    Wednesday, December 10, 2014

    Lid Blows Off WHO's Operation Happygas


    WHO notices horses are gone, Sierra Leone rushes to lock barn:
    (AP/ABC) Health workers sent to Sierra Leone to investigate an alarming spike in deaths from Ebola have uncovered a grim scene: piles of bodies, overwhelmed medical personnel and exhausted burial teams.
    The World Health Organization says the health workers from several local and international agencies are racing to the latest Ebola hotspot, a diamond-mining area that Sierra Leone put on "lockdown" Wednesday.
    "In 11 days, two teams buried 87 bodies, including a nurse, an ambulance driver, and a janitor who had been drafted into removing bodies piled up at the only area hospital," the WHO said in a statement Wednesday night.
    "Our team met heroic doctors and nurses at their wits end, exhausted burial teams and lab techs, all doing the best they could, but they simply ran out of resources and were overrun with gravely ill people," said Dr. Olu Olushayo, an official in WHO's response Ebola team.
    In the five days before its members arrived, 25 people had died in a makeshift, cordoned-off section of the hospital in Sierra Leone's eastern Kono district. The Ebola virus carries its heaviest load right after death, with bodies being a frightening source of contagion.
    Sierra Leone authorities said they ordered a two-week "lockdown" there until Dec. 23, in hope of containing transmission of the virus, which was confirmed in seven people Tuesday.
    People will be able to move within the district, but no one will be allowed to enter or leave, said Emmanuel Lebbie, a local official of the Independent Media Commission.
     Oopsie. Guess the celebrations were still a bit premature...

    Lying With Statistics

    US Airports Screened 2000 Travelers For Ebola, But Found No Cases  
    Nearly 2,000 travelers from West Africa who arrived at five U.S. airports over a recent one-month period were screened for Ebola, but the screenings did not reveal any of these people to actually have the disease, according to a new report. The report from the Centers for Disease Control and Prevention is the first to look at how the heightened airport screening of all travelers arriving from Guinea, Sierra Leone and Liberia has proceeded since it began, in October.
    One traveler included in the report was health care worker Dr. Craig Spencer, who developed symptoms of Ebola later, and was diagnosed with the disease six days after he arrived in the U.S. (Spencer has since recovered from the disease and has been released from the hospital.)
    Under the heightened screening procedures, travelers from the three Ebola-affected countries have their temperatures checked, and are asked questions aimed at determining if they have Ebola symptoms or were exposed to the disease. Between Oct. 11 and Nov. 10, there were 1,993 travelers screened, according to the report. Of these, 86 people — all health care workers — were referred to the CDC for more evaluation.
    Seven of these travelers required a medical evaluation because they had some symptoms, but these evaluations revealed that none had Ebola.
    The most common final destinations for travelers arriving in the U.S. from Ebola-stricken countries were New York (19 percent), Maryland (12 percent), Pennsylvania (11 percent), Georgia (9 percent) and Virginia (7 percent), the report found.
    The airport screenings allowed the public health departments to get contact information from travelers so they could be monitored, "and provided an added layer of protection for the U.S. public," the report said.
    The U.S. began this screening after the first person to be diagnosed with Ebola in the United States, Thomas Eric Duncan, traveled from Liberia to Dallas in September, and developed symptoms of Ebola after arriving in the U.S. Duncan died of the disease on Oct. 8.
    Airports in Guinea, Liberia and Sierra Leone have been screening departing passengers with temperature checks since August. Between August and October, about 80,000 people traveled by plane out of those countries, including 12,000 on their way to the United States, the report said.
    None of these passengers on international flights developed symptoms of Ebola while they were traveling, the report said.

    The factual way to look at that is that screening confirmed that 1992 travelers who didn't have Ebola were screened, but that screening procedures failed in 100% of the infected cases to actually point them out or prevent them from arriving here, which is the whole point of doing a screening.

    (Other than that, Mrs. Lincoln, how was the play?)

    And that only pure happenstance and luck prevented that one infected lying jackass from infecting any one of hundreds of people while he was gallivanting around Manhattan and Brooklyn symptomatic for three days and in full denial about his condition, and only secondary investigation of his credit cards and subway pass led authorities to conclude he was absolutely lying about his wanderings while infectious.

    IOW, airport security theatre screenings are as effective as putting signs up in Central Park forbidding elephants to nest in the trees. Or posting a sign in Vegas telling people they aren't allowed to win at blackjack.

    The only thing the study documents accurately is that we've had nearly 12000 tosses of the dice since August, and only hit snake eyes two times (which were both epic fusterclucks).

    Thanks for nothing, CDC geniuses.

    Tuesday, December 9, 2014

    Sierra Leone: Caught You, You Lying Mofos!

    (click to embiggen)

    FREETOWN (UK Guardian) - They send in surveillance officers to investigate homes where there have been deaths. They don’t get too close. “They do a clinical assessment from afar,” says Parkinson. It’s all run with military precision by the Sierra Leonean army. Grim scorecards on whiteboards are positioned around the room – the cases, the treatment beds available and the bodies.
    Burials of Ebola victims recorded week-by-week.
    Burials of Ebola victims recorded week-by-week. Photograph: Sarah Boseley
    “For the last five weeks we have buried every body reported to us the same day,” says Parkinson. “But yesterday we left 43 bodies because the burial teams had not been paid.”
    It keeps happening. Sometimes it’s the burial teams, sometimes the nurses and sometimes the ambulance workers. All are supposed to get extra danger money. Nobody seems to know whether the government can’t pay, won’t pay or is just bureaucratically bogged down. Whichever, it causes deadly delays. Two weeks ago, burial teams dumped highly infectious bodies – local people claimed as many as 15 – in the street outside a hospital gate in Kenema in the east of the country to make their point.

    Nota bene that from Oct 24 - present, Sierra Leone has reported less than 600 Ebola victim deaths to WHO, as reflected in their stats column on the bottom of this Wikipedia page .
    But as this snapshot from Sarah Boseley, author of the diary linked here recorded, Sierra Leone's Ebola crisis center recorded over 2600 burials by their own burial team members during this exact same time frame.
    And, the story goes on to note, people are reportedly wandering off into the jungle to die, which persons aren't reflected in the burial numbers anywhere.
    "People are afraid to report their numbers to the government. They are afraid to call the helpline. They are afraid they will be taken away to treatment centres and never see their families again. There are reports of people disappearing into the forest because they’d rather die with their family than be taken into a treatment site.”“It is a puzzle. We don’t know what it is. It is not a low death rate. It is probably the labs aren’t able to get swabs for all the dead bodies,” he says. That means they can’t be sure Ebola was the cause of death.
    And there are many hidden deaths. “We have evidence that less than two-thirds of burials are being reported,” he said.
    So they don't test the dead bodies, they simply cart them away post haste and shovel them under, same day.

    Liberia is "solving" their crisis with a pencil eraser.
    Sierra Leone is "solving" theirs with shovels.

    Neither approach will do anything about Ebola, except insure it continues to spread in wider and wider circles.

    So those 600-odd deaths? We have photographic evidence that the number of reported burials are 5-6X that many, and half as many again aren't being reported at all.

    If we change Sierra Leone's death report numbers in accordance with that knowledge, we get an additional 4000 dead people, which brings their numbers much closer to reality as observed elsewhere. Then factor in the number of people who just wander out and die in the jungle (which ensures that the virus reservoir in the wild will be well-stocked for decades once various critters tear into the corpses).

    And the lying m******f*****s sitting in those centers, their Western accomplices, and the morons in the media stand right in front of the tally boards they know to be lies, and just stare at them like deer in headlights, and can't seem to figure out what's going on.

    Yeah, it's a real poser, you jackholes.

    UN's Newest Fabulism

    GENEVA ( Reuters) - Ebola is still spreading quickly in western Sierra Leone and deep in Guinea’s forested region, a senior UN official said on Tuesday.
    “We know the outbreak is still flaming strongly in western Sierra Leone and some parts of the interior of Guinea. We can't rest, we still have to push on,” Nabarro told a news briefing in Geneva.
    More foreign health workers are needed to combat the epidemic, especially in Sierra Leone where treatment centres are still opening and need expert staff, said David Nabarro, the UN Secretary General’s special envoy for Ebola.
    So to recap from last Monday:
    : the WHO hit all their targets for containing the outbreak
    : except they didn't, because the numbers are ca-ca
    : so the war is over, but they need more soldiers.

    Got that?
    And the minute our troops leave Liberia, they lose rapid lab turnaround, and even the official infection rate there skyrockets, and they still haven't figured out, in either Sierra Leone or Liberia, how to lure people into the ETUs now that everyone knows they're simply death houses (except for the 11% who survive despite zero medical intervention, just as they would at home). The only thing the ETUs stop is further spread by the infected, and the governments there are so mistrusted, the people would rather take their chances with Ebola than with what passes for government help there.


    Monday, December 8, 2014

    WHO Admits They Were Talking Out Their

    LONDON (AP) — As health officials struggle to contain the world’s biggest-ever Ebola outbreak, their efforts are being complicated by another problem: bad data.
    Having accurate numbers about an outbreak is essential not only to provide a realistic picture of the epidemic, but to determine effective control strategies. Dr. Bruce Aylward, who is leading the World Health Organization’s Ebola response, said it’s crucial to track every single Ebola patient in West Africa to stop the outbreak and that serious gaps remain in their data.
    “As we move into the stage of hunting down the virus instead of just slowing the exponential growth, having good data is going to be at the heart of this,” Aylward said. “We are not there yet and this is something we definitely need to fix.”
    “Decisions about prevention and treatment should be data-driven, but we really don’t have the data,” agreed Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University.
    A week ago, the World Health Organization insisted at a media briefing it had mostly met targets to isolate 70 percent of Ebola patients and bury 70 percent of victims safely in Guinea, Liberia and Sierra Leone. But two days later, WHO backtracked and said that data inconsistencies meant they really didn’t know how many patients were being isolated. Then the U.N. health agency also conceded that many of the safe burials were of people not actually killed by Ebola.
    Aylward said not knowing exactly how many Ebola patients there are in hotspots like western Sierra Leone means health officials might miss potential contacts who could unknowingly cause a surge of cases. Compared to other epidemics like malaria, which is more seasonal and can fade away without huge control efforts, ending the Ebola outbreak will require extraordinary attention to detail.
    “This outbreak started with one case and it will end with one case,” Aylward said. “If we can’t get 100 percent of the contacts of cases, we will not be on track to shut it down. Unfortunately at the moment, the data right now is not enough for us to get to zero.”
    In West Africa, where health systems were already broken before Ebola struck, collecting data amid a raging outbreak has been challenging. 
     IOW, any resemblance between the press releases WHO has been shoveling out, and reality, is purely coincidental and entirely unintentional.
    Notably, they waited until after their celebratory "We hit all our goals" party to announce they were completely full of it, and have been since about last April.

    Africa Wins Again

    (NYTimes) KERRY TOWN, Sierra Leone — On a freshly cleared hillside outside the capital, where the trees have been chopped down and replaced with acres of smooth gravel, the new Ebola treatment center seems to have everything. There are racks of clean pink scrubs and white latex boots, bathrooms that smell like Ajax, solar-powered lights, a pharmacy tent, even a thatch-roofed hut to relax in.
    But one piece is missing: staff. The facility opened recently with a skeleton crew. Now, in an especially hard-hit area where people are dying every day because they cannot get into an Ebola clinic, 60 of the 80 beds at the Kerry Town Ebola clinic are not being used.
    It is like this with a lot here: good intentions, bad planning. Aid officials in Sierra Leone say poor coordination among aid groups, government mismanagement and some glaring inefficiencies are costing countless lives.
    Ambulances, for example, are being used to ferry blood samples, sometimes just one test tube at a time, while many patients die at home after waiting days for an ambulance to come.
    Half of the patients in some front-line Ebola clinics do not even have Ebola, but their test results take so long that they end up lingering for days, taking beds from people whose lives hang in the balance and greatly increasing their own chances of catching the virus in such close quarters.
    Even after patients recover, many treatment centers delay releasing them for more than a week until there are enough other survivors, sometimes dozens, to hold one huge goodbye ceremony for everyone — again, keeping desperately needed beds occupied. “I just wanted to get home and see my wife,” said Suliman Wafta, a recent Ebola survivor treated nearby. “But I had to wait eight extra days.”
    The latest Ebola numbers are ominous. This past week, Sierra Leone reported almost 100 new cases in a single day, nearly double the number just 10 days before — and those are only the confirmed cases, which health experts say may be a third of the total. At this rate, the swelling roster of the gravely ill will far outstrip even the most optimistic projections for new hospital beds.
    Many aid officials in Sierra Leone said they crave a more effective command structure. The government runs a national emergency center, but aid officials said that with scores of foreign experts, government delegations and private charities flocking here, coordination was still messy, with many gaps and overlaps. It is extremely difficult, they said, to get even the most basic information, including how many treatment centers exist.
    There are also growing questions about corruption, with the government announcing recently that it had found 6,000 “ghost medical workers” on its payroll, even as real Ebola burial teams and front-line health officers say they have not been paid in weeks.

    Nice to know that with thousands dying there, no one is in actually in charge, the government is still massively corrupt, the former colonial power is still inept, and the legacy of their hapless former charges continues to exacerbate the crisis and prolong it beyond any explanation other than widespread massive stupidity of biblical proportions.

    In short, because this is Africa we're talking about. But don't worry, whipping Ebola there is the key to not seeing it here, which is apparently one reason why Klown Klain is bailing out totally by March 1st,  just about the time things there should totally go to hell. Nice work, Klowny.

    Tuesday, December 2, 2014

    A Reminder: The Seven Stages Of Ebola Reporting

    1. What Ebola?
    3. Don't Worry, the Government has TOP. MEN. on the case.
    4. The TOP. MEN. Are Idiots! RUN FOR YOUR LIVES!
    5. Ebola is killing everyone handy in droves, but they're mostly "just Africans".
    6. Continued Ebola Stories upset the editorial bias and the entrenched bureaucracy.
    7. What Ebola?

    Remember that governing paradigm as the stories on this outbreak wax and wane, while the number of infected and dead climbs inexorably, and right on track with any number of estimates.

    There are only two or three pending milestones worthy of note:
    1) Collapse of one or more of the three affected counties' governments;
    2) Widespread outbreak outside the current 3 (or 4) affected countries;
    (note that #1 leads inexorably to #2)
    {nota bene that Mali is overripe for this, since their current mode is to assume that no one who dies or has died there anytime since September has Ebola until they're literally shitting their guts out, AND someone official deigns to take notice. Which worked out so well with Imam Ebola the Magnificent. :roll: }
    3) Any cluster of multiple cases here (or elsewhere in the "first" world) >10 cases nearly simultaneously (because that's my ballpark guess on what would overwhelm anyone's management capability, unless they revert to the West African "no actual treatment" modality, in which case 80+% die) because that's the point when the previous rosy outlook all goes to shit, and reality probably starts to kick in at the level of the average person on the street.

    Any one of those takes this up another DefCon level IMHO.
    The rest is merely the outbreak continuing to chew its way to one of those eventualities.

    Monday, December 1, 2014

    Lies, Damned Lies, Statistics...and Pure Ebola Bull$#!^

    (AP)Liberia and Guinea have met a Dec. 1 target for isolating 70 percent of people infected with Ebola and safely burying 70 percent of those who die, the World Health Organization said Monday.
    Only last week, the U.N. health agency had said only Guinea was on track to meet the targets for getting the deadly Ebola outbreak under control in the three hardest-hit West African countries.
    But at a news conference in Geneva, WHO's Dr. Bruce Aylward said the organization had revised its conclusion based on more analysis of its data. Sierra Leone also probably met the targets in the west of the country, he said, and likely will improve to the 70 percent target nationwide "in the coming weeks."
    Aylward also told reporters that WHO's ambitious plan to stop the deadly Ebola outbreak in West Africa has shown it possible to quickly reduce the "yawning gap" between disease levels and the capacity to respond.
    "You can catch up with Ebola even on this scale," he said.
    However, he added that it "doesn't mean you're automatically going to get to zero" cases and eliminate unsafe burials without more cooperation among organizations, communities, citizens and country leaders.
    It is also important for people who have changed their behavior to reduce the disease risks to avoid becoming complacent, he said.
    WHO launched its Ebola plan two months ago to isolate 70 percent of the sick and safely bury 70 percent of the victims in Guinea, Liberia and Sierra Leone by December 1.
    But the U.N. and others have predicted that Ebola will continue to sicken people in West Africa and possibly elsewhere until sometime next year.

    Sure they did. Except for the part about only having 20% of the infected in treatment beds.

    Or maybe WHO, and the AP, think that overcome by some tryptophan rush since Turkey Day, we forgot all about this little gem issued only last week, as folks rushed home to stock up on stuffing and cranberry sauce, and start marinating the bird:
     In its release of the latest figures on Wednesday, the World Health Organization said both Sierra Leone and Liberia appeared to be far behind the U.N.-set goal of isolating 70 percent of patients by Dec. 1, with only about 20 percent isolated in each country.
    Seriously, Assclowns, do you really figure we all have the attention span of methed-out gnats?? A 50% increase in only the last four days?!? Mirabile dictu, and magically and purely coincidentally, just in time for the Dec. 1st deadline??!!??

    Apparently, the only doctors still practicing in Liberia are SPIN DOCTORS.
    This is worse than watching a naked guy trying to pull rabbits out of a hat.
    This is watching a retarded naked guy trying to pull rabbits out of a hat.

    We see the bunny, you jackasses.
    Don't quit your day jobs.

    Related news:
    Those 1000 Liberian deaths they "forgot" to include in their Ebola totals until last week?
    Apparently, Liberia realized that Something Else must have actually killed them, but they're absolutely POSITIVE it couldn't have been the Ebola, nosiree Bob, not a chance, honest, we swear.
    Dec 1 (Reuters) - A surge in Ebola deaths reported by the World Health Organization at the weekend was due to about 1,000 Liberian deaths wrongly ascribed to the disease that would be removed, WHO assistant director general Bruce Aylward said on Monday."Liberia's figures came in but they've since said these were actually non-Ebola deaths that were reported as part of our Ebola deaths and we will be taking them off. So the whole world went up and the whole world will come down again," he told reporters.
    Data published at the weekend put Liberia's death toll at 4,181, up from 3,016 two days earlier.
    Call Ripley's.
    Apparently this here's the first reported casualties of the Giant Liberian People Eater.
    And the Liberian government officials who sacked other Liberian government officials for misreporting Ebola deaths, have just been sacked by NEW Liberian government officials.
    So you can believe these figures. Would Liberia lie to you?
    This is comedy gold, and it writes itself, I swear.

    Kerry Town - A Sierra Leone Slice Of Life

    (BBC) KERRY TOWN Sierra Leone -- On a sweltering afternoon, an ambulance crawled slowly along the fresh gravel path behind Kerry Town - the centrepiece of Britain's contribution to the fight against Ebola here in Sierra Leone.
    The vehicle parked at the back gate and a team of white-suited medics carried out the first of four confirmed Ebola patients onboard.
    One - a 40-year-old man - would die minutes later.
    "You never know what you'll find when you open those doors," said Irish doctor Carrie Garavan, adjusting the protective headgear on a Sierra Leonean medic.
    Only 14 of Kerry Town's 80 beds are currently occupied
    It will take time for staff at Kerry Town to adjust to what experts there say is a very dangerous environment.
    The ambulance's arrival coincided with a shift change at Kerry Town - a huge logistical operation.
    It takes 20 minutes for each health worker to put on the elaborate protective clothing required to enter the Ebola red-zone and its 80 beds.
    "It takes time. You can't rush. You can't be complacent. The safety of our staff is of paramount importance," said Dr Garavan, who is overseeing a large team of British, Cuban, Sierra Leonean and other international staff at the green-field site about one hour's drive outside the capital, Freetown.
    But almost four weeks after Kerry Town opened, there is growing concern - expressed vocally by some Sierra Leoneans, and more privately by foreign humanitarian experts - that the facility is seriously behind schedule and lacking a sense of urgency.
    So far, a total of 44 patients have been admitted. Fourteen of Kerry Town's 80 beds are currently occupied.
    Kerry Town is being run by Save the Children - a British charitable organisation that acknowledges it has stepped into profoundly unfamiliar territory.
    We said at the outset we didn't have the right level of experience but we'd acquire it and we've hired an awful lot of really competent people and put it together," said Michael Von Bertele, Save the Children International's Humanitarian Director.
    "I make no excuses. Many of the staff we've got are very inexperienced and we've got to move very slowly.
    "[The French medical charity] MSF for example - they've got years and years of experience... and they make it look easy and I sincerely hope that in six weeks time we'll make it look easy. Our plan was always to scale up slowly," he said.
    In the meantime, staff at Kerry Town say the criticism is taking a toll.
    "A lot of the team are upset. I think it's terribly unfair and unfounded and I do hope people stop," said Dr Garavan.
    But there were smiles and songs a few minutes later, when staff gathered to say goodbye to 21-year-old student Kadiatu Sesay, who was being discharged after beating Ebola. She is only the third patient to be sent home so far.
    "I feel so happy. This is the happiest day of my life," said Ms Sesay, who admitted she'd been sceptical about the virus before she caught it, and now plans to convince her friends and neighbours to take every precaution.
    If you're keeping score at home, that equates to a 90% fatality rate for Ebola in the field.
    (3 survivors out of 30 prior patients, and 14 currently admitted = 44 patients, this facility's total).
    Not 50%, not 72%. That's actual real world data there - so far.

    And it explains why they're slowly taking on more of the burden, and why they haven't opened the other 66 beds, yet.

    Unfortunately, someone infected with Ebola can't wait for centers like this to get their poop in a group, and so they try to find a facility with an open bed (spreading Ebola everywhere as they go, as like the mentioned example who died "within minutes", those patients are not newly diagnosed, they're in the end stages of the disease, shedding virus literally by the bucket-load).

    And it's exactly the same in Guinea and Liberia, it's just the folks there have realized there's no care to be had at the ETUs, and/or no beds to find, so they're not looking, simply dying in place, unnoticed, uncounted, but still horribly infectious.

    That's the real answer to how Liberia "finds" 1000 more dead people amidst a virus that continues to spread throughout the country. When they feel like noting it.

    And for those who'd decry the lack of care there, bear in mind Sierra Leone has had 68,000% more actual Ebola cases than the US has in the last year, and they currently have 5000% more actual dedicated Ebola care beds than the entire US has available. (Those are the current numbers based on reports, not typos.)

    Sunday, November 30, 2014

    Ebola Care: Pulling the Plug

    From comments on one of yesterday's threads:

    Has anyone performed a study or reviewed the Ebola cases to determine if heroic measures like dialysis and ventilators are effective in curing people?

    If dialysis and ventilators are not effective, wouldn't it be better to let the poor suffering victim die sooner? I do not want my life extended if I am suffering and in pain, if I am likely to die anyway. I would not want someone to catch Ebola, trying to fruitlessly prolong my life. At a certain point, maybe an OD of morphine would be a pleasant release.

    Great question.
    Short answer: No, no one's done that study.

    Bear in mind that prior to last December, when this outbreak began, the total number of Ebola cases worldwide, ever, was something like 2400-ish. Given where they were infected and treated, neither dialysis nor mechanical ventilation was an available treatment option, AFAIK.

    The entire US experience to date is limited to the ten or so cases we've seen here, and only two have died despite all efforts, whereas the rest survived with far lesser interventions.

    Thus, in that extremely limited dataset, the key seems to be catching the infection early (or not), along with actually giving care .Which, in case it isn't clear, is not what happens at the plastic ETUs in Africa - no IVs, no fluids thereby, no other major treatment. They don't have the supplies, the staff to do it, nor the wish to attempt it on such a large scale, not least of which would include the risk of trying to jab a vein on someone delirious, vomiting, and febrile while the caregiver starting the IV is wearing a hazmat spacesuit. One miss/needlestick, and both patient and caregiver die. Not to mention that their cases typically present far later in the course of infection in the first place, coupled with the lag - up to days - waiting for confirmatory lab work to make the diagnosis. Thus most of their cases are in the too late to save category before they even get them, some of them only diagnosed at all because they totally collapsed on the street before they were brought to hospital in the first place.

    Almost all of ours, just the opposite.

    So no one here is going to base entire treatment protocols or prognosis off of our entire two applicable cases, especially when we're talking about terminating or limiting response efforts.

    That day may come, but only if/when there's a lot more empirical data (God spare us that knowledge!) at which point I suspect the determining factors will be too many cases and not enough hospital space, care staff, medical equipment, or all three.

    As long as we're seeing single cases, and there's a chance of saving someone, we're going to try it if we can, absent advanced patient directives.

    If we get to the point where we have so many cases as to make a study possible, we'll have much bigger fish to fry. Which, frankly, is good, because the last thing anyone wants to have to do is play God with other people's lives if they don't have to.

    The burden on individuals is far too high at that point. It's tough enough unless people come in already dead with CPR in progress. Those of us "in the biz" have all seen 97-year-old grandpa come in with 12 co-morbid conditions including metastatic cancer, in full arrest, and a "full code" either expressly requested, or left by default from lack of prior thought. Even then, we make an effort. (If the family or patient had made sensible decisions beforehand, those patients wouldn't have been dragged to the emergency department in the first place.
    PSA: If you or yours are anywhere in life where you ought to think about this, discuss it, and put some advanced directives in place, please, for everyone's sake, do it now, and pass around copies to all next of kin so literally everyone is on the same page regarding how you want things to go when your time comes. 5000 ER and ICU staffs thank you.)

    Change that patient to a 40-year-old husband or wife with kids at home, and cutting off efforts will be immensely hard, unless you already have 50 other cases. And even then, you aren't going to be the Morphine OD Fairy dispensing terminal doses. You'll be too busy with the ones you can save, and let Death collect his own. He does just fine wrangling patients without any help from any of us.

    So I understand where the question is coming from, but either way, it isn't going to happen like that. And anyone in healthcare who wants things to get there, for this outbreak or any other reason, is a ghoul, IMHO.

    Killing people used to be my job. But since leaving the military and getting into health care, the institutional priorities are a bit different, as I'm sure you can understand.

    Saturday, November 29, 2014

    And The "Official" Numbers Are STILL Bull$#!^

    (Guardian UK) - The number of people with Ebola in west Africa has risen above 16,000, with the death toll from the outbreak reaching almost 7,000, the WHO says.
    The number of deaths is more than 1,000 higher than the figure issued by the WHO just two days ago, but it is thought to include deaths that have gone unreported in the weeks or months since the outbreak began. Most of the new deaths were recorded in Liberia.
    The WHO has warned that its figures could be a significant underestimation of the number of infections and deaths. Data from the outbreak has been patchy and the totals often rise considerably when backlogs of information are cleared. The latest confirmed data shows that almost half those known to have been infected with Ebola have died.
    ...And most of the other half only just got Ebola in the last three weeks, as always.

    What the hell, it's only 1000 dead people (1165, actually) Liberia "forgot to" get around to reporting, which explains why the infections numbers continued to skyrocket while the death rate went backwards at one point recently. So apparently rumors of non-lethal Ebola didn't pan out.
    And those are just the ones they actually tested for Ebola at some point before they were buried or set on fire.

    Just remember every time you see these reports, that they're tabulated by governments in countries with literacy/numeracy rates of 50% give or take. All WHO does is collect them.
    Doubtless witchcraft played some part.

    (h/t to commentor geoffb for the direct link)

    Why No One Wants To Play With The Ebola Kids

    Apparently the Washington Post was able to sneak out an Ebola story when Ebola Czar Klain was busy in the men's room:
    (WaPo) - U.S. officials trying to set up a network of hospitals in this country to care for Ebola patients are running into reluctance from facilities worried about steep costs, unwanted attention and the possibility of scaring away other patients.
    “They’re saying, ‘Look, we might be willing to do this, but we don’t want to be called an Ebola hospital. We don’t want people to be cancelling appointments left and right,’ ” said Michael Bell, director of laboratory safety at the Centers for Disease Control and Prevention. 
    The handful of U.S. hospitals that have treated Ebola patients have discovered that doing so can be costly, requiring around-the-clock care involving scores of nurses and other health workers. That would be a big challenge for many hospitals, where staffing is often stretched thin.
    TL;DR Highlights:
    * No one with any sense wants to play with Ebola

    * Remember that when you hear about a hospital that does.

    * Since Thomas Duncan's diagnosis, the CDC has barely managed to visit 1 hospital per day to evaluate as potential Ebola treatment destinations. (We won't ask WTF they were doing for the last 40 years since Ebola was discovered.)

    * "Airport screening" is touted as having prevented outbreaks so far; in reality, they haven't successfully screened out anyone here, as evidenced by all the US Ebola cases to date.

    * THP-Dallas was gutted by the consequences of treating Duncan.

    * The cost to each dedicated facility, like Emory and U NE, for treating a single Ebola patient, is between $600K-$900K PER PATIENT.

    * TWO MONTHS INTO THIS, most hospitals STILL have no idea how to deal with the basics, like training employees, segregating potentially infected persons, or how to deal with the mountains of medical HAZMAT waste generated by even a single patient.

    * At this point, hospitals and private insurers (if there are any) will have to eat the costs of treating an Ebola patient, and any opportunity costs of closing departments or the entire facility. There is ZERO financial incentive to do that, and most hospitals nationwide struggle to break even or stay in-budget year to year - particularly the teaching facilities that the CDC would like to use for this, who tend to serve the poorest strata of patients, on city and county budgets already being raped by the long-term recession and staggering unemployment.