Friday, October 31, 2014

Hell No, eh?

So much for playing PC nonsense games:
TORONTO - Canada is following in Australia's footsteps and has closed its doors, effectively immediately, to people from the West African countries battling Ebola.
In a move that puts Canada at odds with the World Health Organization, the federal government said Friday it is suspending the issuance of visas for residents and nationals of countries with "widespread and persistent-intense transmission" of Ebola virus disease. As well, work on permanent residence applications for people from the affected countries is also being suspended.
The stress on countries with widespread transmission provides an out for the United States, which currently still has at least one active Ebola case within its borders. At present only three countries meet the definition of widespread and persistent Ebola transmission: Guinea, Sierra Leone and Liberia."The precautionary measures announced today build on actions we have taken to protect the health and safety of Canadians here at home," the news release quoted Immigration Minister Alexander as saying.

Ebola Growth Rate

New cases per day, October 2014 (WHO numbers via Wikipedia)
Oct. 5= 135
Oct. 7= 149
Oct. 12= 137
Oct. 17= 138
Oct.19= 136
Oct. 24= 196
Oct. 27=239

(With the usual caveat that those are based purely on the "official" numbers, which are probably only 1/3 of the actual numbers, which means we could be getting 700 new cases/day, right now.)

So, tell me...anybody...what Imaginary Ebola Medical Strike Force is ANYONE going to conjure, and with what magic wand waving and incantations, that can deal with 239 to 700 new cases PER DAY, and increasing daily at a similar rate. Nota bene that it was 239/day four days ago, so it's probably 250-750 cases/day today.

If the key to solving the US Ebola problem is by solving it in West Africa, we should all kill ourselves now, because that's never, ever going to happen until this thing has killed somewhere between millions and hundreds of millions of Africans.

Wrap your head around that, as our troops work on creating the equivalent of 24 additional treatment beds/day (1700 beds ./. by 10 weeks work to early December, call it 70 days).
And tell me again why it was ever anything but a futile PR gesture, and a reckless risk of American troops lives on a hopeless mission.

(And BTW, if you're any of those troops' commanders above the rank of colonel, you're a gutless careerist sonofabitch who cares more about his pension than about protecting America or taking care of your troops - every goddamn last one of you, all the way to the 4 service chiefs and the JCS, for not resigning your star(s) if necessary and speaking out on this publicly long before now. Walk tall, you spineless wonders.
The writing is on the wall: Mene mene tekel uparsin.)

Anything we do in West Africa is one of two things: PR pablum, or a holding action, trying desperately to keep an orderly failure and retreat from turning into a full-blown rout.

And that includes all the do-gooder volunteers for every organization there now.
On a humanitarian scale, their individual work is selfless and commendable.
But from a practical standpoint based on results, they're simply pissing on a forest fire, and there aren't enough resources in the world available to make a dent in the problem, and never can or will be. We missed that opportunity somewhere around last May.

So spare me any more delusional rants about how quarantines of returning workers will adversely affect what happens there to any notable degree.
The obvious question is, How could you even tell?

No Public Contact - Updated! Twice!!

Kaci Hickox, the nurse who insists she is Ebola-free after a stint in West Africa helping people suffering from the deadly disease, can probably continue to ride her bike and go outside, but movies, shopping and riding the bus are out under a court order issued Friday by a judge in Maine.
Hickox had said she will defy the state's effort to impose a 21-day quarantine on her, prompting state officials to go to district court, where Judge Charles LaVerdiere ruled Friday that the nurse must face some restrictions. But the judge's order bars her from using "long distance commercial conveyances or local public conveyances," forbids her from showing up at shopping centers or movie theaters and mandates she maintains a three-foot distance from others when outside.
"This decision has critical implications for {Hickox's} freedom, as guaranteed by the U.S. and Maine Constitutions, as well as the public's right to be protected from the potential severe harm posed by transmission of this devastating disease," LaVerdiere wrote in the two-page decision.
Violate that one, MiMi Crybaby, and your next stop is the Graybar Motel.
Hopefully this gets the whiny self-entitled little jackass off the front page, and back in the oblivion she so richly deserves. Then maybe the media will start asking what her bosses knew, and when they knew it about her little crusade against common sense.

And in an epic move, the judge reversed HIMSELF.
I'm sure bending the entire stet over for the unelected minions of the CDC will sit real well at the State House and higher courts in Maine. Not.
So now Round Seven, at Tuesday's hearing.

Details, details:
Update II: Oh, BTW, MiMi Crybaby's roommate in Africa developed Ebola, from unknown contamination source. So maybe that explains the big pissy hurry for her to scurry back home to the USA and go hide out at the farmhouse.

Oopsie! Pres. Obola's Sticky Fingerprints Found

h/t WRSA and Daily Caller
I'm shocked! Shocked, I say, to find out a FEDERAL EMPLOYEE of the CDC is being used to browbeat state perogatives to protect public health, and advance the White house's case in full stealth mode:
Ebola health care worker Kaci Hickox, who was released from quarantine with the support of the White House, is a Centers For Disease Control and Prevention employee, records reveal. The lawyer who helped earn her release is a recent White House state dinner guest.Hickox was released from Ebola quarantine in Newark, N.J., Monday afternoon after the White House pressured New Jersey Gov. Chris Christie to release the nurse that was working in Sierra Leone with Doctors Without Borders. Hickox’s case for release was also bolstered by New York civil rights attorney Norman Siegel, who took on Hickox’s case.

Here’s an overlooked factor that could have contributed to her White House-backed release: Hickox is an official CDC Epidemic Intelligence Service (EIS) officer who performed work for the CDC in recent months.
Hickox was a Class of 2012 member of CDC’s two-year EIS officer training program, according to the official program for CDC’s 2014 EIS Conference (p. 98), which was held from April 28 to May 1, 2014. Hickox was featured in a photograph in the program.
Hickox was listed as an “EIS officer” for the CDC in program materials for a CDC course she taught in July 2014. She was specifically listed as an active “EIS officer” as recently as July 18, 2014, according to CDC documents.

In Crybaby's case, that means her normal gig isn't caring for anyone; she performs a clerical function for the .gov during outbreak data collection. She is thus about as vital to the actual treatment of disease in that role as teats on a bull. Which also explains her tenuous attachment to the common sense realities of outbreak nursing. She's what military people refer to as a clipboard commando.
Whether she did that, or actual patient care nursing in Africa is an open question.
So she's not some poor, down-trodden oppressed worker whose "civil rights" have been violated. She's a federal government employee, who knows precisely the impact of the state directives and oversight she's challenging, with the help and support of long-time government operatives, and doubtless the direction and assistance of the White House. Which explains why Pres. Obola, unlike his photo op hug of recovered nurse Nina Pham, has no plans to come within a country mile of Nurse Crybaby: someone might ask about the direct connection, since he's ultimately her boss.
Pres. Barack Obama was in Maine on Thursday to campaign for Democrats, including the one trying to unseat LePage next week. A spokesman knew of no plans for Obama and LePage to meet. The president had no plans to meet Hickox.

Well done, @$$clowns, you're disregard for the "science" and total lack of concern for the rights and safety of the citizens of Maine, New Jersey, and any other state, are now a matter of public record.

And the same jackass who told you "Ebola is highly unlikely to come here" and "Any hospital can handle Ebola patients" and "We have long-standing protocols in place" and about 200 other lies, half-truths, and gross distortions, is her boss.

Thanks, Tom Frieden, and welcome back to the limelight. it's been almost a week since you've been caught stepping on your dick in public, so we were wondering where you'd gotten and what you were up to. Now we know.

Thursday, October 30, 2014

So Damned Mean

From comments on Because Science post today:
the danger of Ebola eventually showing up in the US in large numbers has MUCH MORE to do with stopping it in Africa than it does with fear driven (rather than data driven) reactions here in the US over quarantines.
No, it has nothing to do with that at all. It has to do with not letting them fly in here every damn day, and checking for symptoms now that might not show up for 21 days. How's about we put them in a room for 21 days, and THEN see if they have symptoms?
99.9999% success rate. How's that for data? Next problem.
If we save 10 or 20 near future contact cases here in the US but the cost of that is an outbreak that spreads through-out the 3rd world when we might have had a better chance of stopping it in West Africa by not making it harder for medical staff to volunteer, do you think that would be a good trade?
No. I wouldn't trade you one US doctor or one US nurse for their whole country. If someone chooses to go on their own, that's their decision. But their choice doesn't obligate me or any other American to be exposed to the risk of the disease just because it inconveniences them to have to sit in a tent for 21 days waiting to see if they screwed up while out do-gooding.
There's a way that we could handle our near term concerns in the US while at the same time enhancing our response to the greater threat in West Africa by simply paying people.
Let's say we need 2,000 doctors and 8,000 nurses to serve in West Africa for the next six months to get this under control.
Offer to pay those doctors $100,000 per month and those nurses $25,000 per month with a contractual obligation to self-isolate for 21 days upon return.
The cost? 2.4 billion plus infrastructure, transportation, and consumables costs. So let's say 5 billion, all in.
That's about $20 per US taxpayer, or about half of what the government spends in a day. You could probably even crowd source it.
This would be a smarter way to speed up wiping out this ebola outbreak than reacting from fear and failing to adequately adress the bigger problem.
No, it wouldn't. If the federal budget has a spare $5B, it's that much too big already. You want to start a charity and do that yourself, knock yourself out. I'll send you the $20. But keep Uncle Sam's (and your) hands out of my pockets, and off my back. I'm already carrying the 47% Free Shit Army, 11-20M illegal aliens, and now you want me to piggyback 21M African tribesmen? No thanks, my back hurts now.

And next year, some guy would decide he wants BBQ bat, his wife would prepare it, she'd give Ebola to the baby, and we'll be off to the races again.
And again.
And again.

You want to help them? Teach them to stop eating bats, kissing dead people, and maybe get them to wash their hands after they crap, and before they eat.

At some point, they're going to need to start figuring this stuff out for themselves, and in the meantime, there's no requirement to import them here daily. We're already carrying the lion's share of the load on relief there. They've had famines and epidemics there for millennia. The "civilized" countries have figured this out.

Stop throwing life preservers to the ones who put 400 people on a 50 passenger ferry and then look shocked when it flips over.
So you think you can escape it if it spreads in the third world?
That's ridiculous.
Once it's in Latin America, it's here.
There is no way to stop it here without stopping it there, and even if it takes 500 billion dollars, that's still a preferable outcome to the existential alternative.
No, but we can sure as hell slow it down overseas, and block it off from getting here as long as possible. MAYBE even long enough to figure out effective treatments or a vaccine.
 Aesop, it sounds like you WANT this to spread.
No, I want it to go away. I also want a Ferrari, the winning Powerball ticket, and the phone number of the Playmate of the Year. But the reality is, I'm not going to get any of those things in my Christmas stocking, and nothing we've done, will do, or could do, will make any difference in stopping Ebola in Guinea, Sierra Leone, or Liberia, anytime soon. And they don't have much more time left beyond "soon".
I think it is possible to stop it because other countries in Africa have done just that.
But even if I took your view that a vaccine is the only hope, and we're just playing for time here, then that's even MORE reason to work on slowing it down over there.
They stopped it at one case, or one vector. So stop wasting time, money, and effort on the three countries that are going to burn to the ground no matter what, and instead start dumping everything into beefing up medical response and capabilities in Cote d'Ivoire, Mali, Senegal, and Guinea Bissau, so they can KEEP catching this at 1 or 2 patients. And start by buying their border guards as much ammo as you can get. Because when one/all of the currently infested countries collapses, people are going to flow outwards in all directions, and if Ebola ever gets out and in case numbers of 20 or 50, it'll bury them, and we'll be off to the races again, except this time with countries with 54M people, instead of 20M. And it'll devastate them, just like it will us, in any city here that gets a cluster of 20+ cases overnight.
None of your logic makes any sense.
If you think we can stop it, then stopping it over there makes sense.
If you think we can't, then slowing it down over there (where it's currently growing at the fastest rate) makes sense.
I'm certain we can't stop it in any of the current three most afflicted countries, based on over 10 months of unmitigated failure, and a growth rate that would be a Wall St. mutual fund manager's wet dream.
I don't even think we can slow it down there.
But we might could slow it down by containing it where it is, and doing everything possible to slow it down if/when it hits the next tier of victims. The farther from here, the better, and the longer before it gets to us, better still.

As to stopping it, or developing a vaccine, I am hopeful. But only because that's all there is.
I'm certainly not confident. I expect we'll fail at stopping it, gradually lose at slowing it down, and eventually have to face it here, and not in isolated single-case events. All we're waiting on for that is Thomas Duncan v2.0, taking his infected self to some immigrant flophouse, infecting 10-20 guys who didn't travel to Africa, and they come down with it, maybe during the holidays, when ERs are at their annual hopelessly overcrowded census, and flu season is in full swing, and somebody goes back home without being seen, or gets misdiagnosed, or whatever.
Then a week or so later, 5, 10, 20 cases all present within a couple of days, and any city is immediately overwhelmed, because they don't know where it started, why they've got it, and they have no chance in hell of contact-tracing the 50,000 people they'll have been with, or around, in the prior 21 days.
And on that day, American City X is now Monrovia.

Sorry if Reality hurts your feelings, or leaves a mark. Get used to it.

(And no, I don't mind such comments. It gives me something to sharpen my claws on.)

Irrelevant Clown Is Irrelevant

(Reuters) - President Barack Obama said on Wednesday that Americans may continue to see individual cases of Ebola in the United States until the outbreak in West Africa is contained.[1]
Obama said it was essential the United States and other countries work to stop the Ebola outbreak at its source in Africa.[2]
Until the outbreak is stopped, he said, "we may still continue to see individual cases in America in the weeks and months ahead."[3] 
"We can't hermetically seal ourselves off," he said at the White House.[4]  
He said the U.S. healthcare system is proving to be well capable of handling those Americans who have contracted Ebola.[5]
[1] Because of the continued policy to use a known and proven ineffective procedure to screen patients, coupled with the blind pig-headed insistence on continuing to import more potential cases every day, forever.
[2] Because this is impossible and unreachable, as all efforts by everyone in the world, combined, to date have proven utterly futile and totally ineffective to even make so much as the smallest dent in the outbreak.
[3] Ibid. See Note 1.
[4] Because we refuse to try. See note 1.
[5] As demonstrated by spending $500,000 to not save Thomas Duncan, infect two additional nurses at unknown additional costs, have one nurse who was febrile (just not quite to the arbitrary temperature level set by the CDC) take two airline flights cross-country and expose hundreds of people nationwide to the disease, a doctor symptomatic for Ebola ride all over NY city and then lie about the fact to police and health authorities, another doctor under "voluntary" quarantine decide that going to the fast food drive-thru trumped science, a lab worker taking a cruise to Cancun, and now a nurse and her friend-boy nursing student flouting voluntary quarantine requests because the public's safety are less important to them than their own comfort and convenience, and all this while the two most prominent doctors in the country, at CDC and NIAID, have repeatedly misinformed and outright lied to the American public about what we know, what we can do, and how we should react -- O yeah, American health care has shown the world what we're "well capable" of doing when it counts. Represent, mofos.

An Inconvenient Truth

Another at-bat for Common Sense:
TRENTON — After days of blistering criticism from the ACLU, the CDC and even the United Nations secretary general over Gov. Chris Christie’s new, 21-day mandatory quarantine policy for all healthcare workers exposed to Ebola, the New Jersey governor has gotten a much-needed vote of support from a heavyweight name in the medical community: Nobel Prize-winning doctor and medical researcher, Dr. Bruce Beutler.

Dr. Beutler, an American medical doctor and researcher, won the Nobel Prize for Medicine and Physiology in 2011 for his work researching the cellular subsystem of the body’s overall immune system — the part of it that defends the body from infection by other organisms, like Ebola.

He is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Medical Center in Dallas — the first U.S. city to treat an Ebola patient and also the first to watch one die from the virus. In an exclusive interview with NJ Advance Media, Beutler reviewed Christie’s new policy of mandatory quarantine for all health care workers exposed to Ebola, and declared: “I favor it.”

Unfortunately, while the doctor’s support might provide much-needed credibility for Christie as he threatens to quarantine ever more healthcare workers returning from the Ebola fight in West Africa, it also comes with some chilling words.
“I favor it, because it’s not entirely clear that they can’t transmit the disease,” Beutler said, referring to asymptomatic healthcare workers like Kaci Hickox, a Doctors Without Borders nurse returning from treating Ebola patients in Sierra Leone who was quarantined in New Jersey for 65 hours before being transported to her home state of Maine on Monday afternoon.

“It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up,” said Beutler, “It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.”
In fact, in a study published online in late September by the New England Journal of Medicine and backed by the World Health Organization, 3,343 confirmed and 667 probable cases of Ebola were analyzed, and nearly 13 percent of the time, those infected with Ebola exhibited no fever at all.
Why, then, does he think the CDC would so emphasize Ebola is not communicable in patients without symptoms?
“There’s some imperative to prevent panic among the public,” says Dr. Beutler, “But to be honest, people have not examined that with transmissibility in mind. I don’t completely trust people who’d say that as dogma.”

As such, allowing home confinement for medical workers exposed to Ebola but currently without symptoms was, as Beutler put it, “a move away from goodness,’ as an engineer might say.”

The U.S. Centers for Disease Control and Prevention changed direction and called for voluntary home quarantine for workers with the highest risk for Ebola infection. However, it also specified that most medical personnel returning from Sierra Leone, Liberia and Guinea would not need to be kept in isolation, as Hickox had been ever since she arrived at Newark International Airport on Friday up until her release and transfer to home quarantine in Maine early Monday afternoon.

“Even if someone is asymptomatic you cannot rely on people to report themselves if they get a fever,” said Dr. Beutler, adding, “You can’t just depend on the goodwill of people to confine the disease like that – even healthcare workers. They behave very irresponsibly.”

Christie has repeatedly pointed to the fact that NBC’s chief medical editor, Dr. Nancy Snyderman, after returning from Ebola besieged West Africa, was spotted violating her voluntary quarantine to get takeout from a Princeton eatery last week.

Despite her forced detainment by the New Jersey health department, Hickox insisted hat she was “feeling physically healthy” and except for a single, non-contact thermometer reading that registered her as having a 101 Fahrenheit fever, has had normal 98.6 F temperatures ever since her quarantine began.

“These are no arguments at all,” said Beutler. “Anyone could say that about any disease. It doesn’t matter that she was afebrile – she should be quarantined for 21 days.”

Hickox has complained that “her basic human rights were violated” and has since retained a civil rights attorney, but Beutner says he is puzzled by the argument.

“These people act like they are returning as conquering heroes — and they should be treated as conquering heroes, but part of being a conquering hero means making sure no one gets infected by you. Just look at the the foolish quarantine where astronauts came back from the moon [where there were no germs] and in this case, we know there is an infection.”

From a global perspective, it’s unlikely that the virus will take hold as an epidemic in the U.S., but in Africa, Beutler says it already “has gone ballistic – way, way beyond the past epidemics. One could project that maybe millions could be infected. It may be that it won’t spread like wildfire in the United States but even if one or two more people die, it will be too many.”

So, does Gov. Chris Christie have it right?

“I’d be a little bit more strict than he is being,” said Beutner, “I realize this would be inconvenient, but I don’t think it would prevent treating the disease.”

Christie has not been willing to publicly explain how home quarantine would work in cases like, for example, where a healthcare worker also had children at home.

“You’re in your home,” Christie deadpanned to the question when asked it was asked of him in Groton, Connecticut Monday night, “and you’re quarantined.”

“I know at times that you all would like to make things a heck of a lot more complicated than they are,” said Christie, “In home quarantine means: In-home. Quarantine. If they are asymptomatic, they can be quarantined in their home.”

Beutler disagrees with this, saying “the ideal scenario is where a patient is isolated from all family members,” preferably in an specialized hospital ward, not in a home.

The thought of an afebrile parent passing Ebola on to a child – as ostensibly can happen 13 percent of the time, “would disturb me. The point of quarantine of is to make sure they [Ebola viruses] are not carried elsewhere. It’s a little bit frustrating. Some of the things that are being done are not completely motivated by safety. For some reason, there’s an imperative to maintain open borders no matter what – to err on the side of total individual freedom rather than on the side of public health,” he said, adding, “If you really want to isolate a disease, then you have to isolate the people who carry it.”

SCIENCE, bitchez.

Because Science

FORT KENT – Kaci Hickox and her boyfriend, Ted Wilbur, left their house Thursday morning, got on bicycles and headed down the road, with two state troopers following them.
Hickox and Wilbur pulled onto a snowmobile or bike trail. The troopers drove behind them but did not attempt to stop them.Hickox, who treated Ebola patients in West Africa, vowed Wednesday to wage a legal battle against Maine’s intention to enforce a 21-day quarantine with a court order.
Hickox and Wilbur addressed the media outside his house here Wednesday night, as local and state police watched from across the street.
“We have been in negotiations all day with the state of Maine and tried to resolve this amicably, but they are not allowing me to leave my house and interact with the public even though I am completely healthy and symptom-free,” Hickox said Wednesday. “I am frustrated by this fact, and I have been told that it is the attorney general’s intention to file legal action against me. And if this does occur, I will challenge the legal actions.”
Stephen Hyman, Hickox’s attorney, said Thursday morning that he had heard Hickox and Wilbur had left the house, and reiterated that she has every right to leave and the state has no legal authority to force her to stay in her house.

MiMi Crybaby's argument: Yes, I was exposed to rampant Ebola patients.
Yes, the disease can be contracted, and not manifest itself for 21 days.
No, it hasn't been 21 days since my last exposure yet.
Therefore, because science works differently for me, I should be at liberty to expose the entire area, because Constitution, bitchez!

State of Maine's argument: get your ass back in the house, until we're reasonably certain you aren't going to spread your cooties to the whole county. That would be a whole 'nuther 11 days, Dipshit. Qwitcherbitchin', put on your Big Girl pants, and stop acting like a farking moron.

If whatever state she allegedly holds a nursing license from doesn't take action to suspend or revoke hers, for demonstrated reckless disregard for the public's safety, and demonstrated inability to perform critical thinking skills materially related to the practice of nursing, they should show cause right now why they themselves shouldn't be removed from their positions immediately.

This is beyond mollycoddling this jackhole, it's gotten to criminal dereliction of duty.
It doesn't matter if she ends up not infected. The state is asking for and has the right to pro-actively quarantine someone based on reasonable potential for spreading a disease, in this case a deadly incurable pathogen. Crybaby meets that criteria, as Dr. Spencer's case from NYC demonstrates amply and beyond argument.

Friend-boy, not even a nurse yet, ought to be dropped from his nursing program for the same reasons, for the good of the entire profession. Neither one of them, nor even both combined, has the brains God gave a jackass.

And even odds somebody in Maine is going to start taking pot shots at them, quarantine or no.

Wednesday, October 29, 2014

Logarithmic Growth 101

Riffing off a scenario at WRSA, the concept of logarithmic growth came up.
If you're RainMan with math, go watch Wapner, and skip the following.
If not, let me, as a non-mathematician, take a whack at it, as it relates to Ebola, and why you should know or care.

(And for those who'll bitch at me in Comments with degrees from MIT and CalTech, I feel your pain. After suffering through four, yes four math-incompetent nursing professors trying to teach Medication dosage calculations(!!), I noted aloud that having nurses teach math was like asking garbagemen to teach physics. Especially when the same university had perfectly adequate math professors already on staff. But I digress. Suffice it to say, you're stuck with a nurse teaching math here. If it makes you feel better, I never bounce a check.)

Quick and dirty: the earthquake Richter scale is base-10 logarithmic.
I.e., A 5.0 is 10 times bigger than a 4.0, a 6.0 is 100 times bigger than a 4.0, etc.
If you tried to straight line plot a logarithmic event, either the right side would require a piece of paper 20 feet tall, or the left side increases will be nearly flat unless examined under a microscope.
Like Mercator for maps, it's a good (not perfect) way to make things fit on a flat square/rectangular piece of paper small enough to hold in your hand.

The actual Wikipedia page for this Ebola outbreak has log scales for reference: instead of the rocket launch reverse parabola on the straight-line scales, the trend line seen is almost exactly 45 degrees up and right, indicating an almost perfect logarithmic R-naught of 2.
(Any departures owe more to shoddy math and stat collection than to any flaws in the disease's ability to spread. Nota bene the graph at top is an old one for this very outbreak, as we now have nearly triple that number of cases, and triple that again of likely official ones, i.e. pushing 40,000 cases.
To see a more current graph, with projections to the bitter end, Frozen Patriot has done one here:
I'd post it pictorially , but Blogger won't read the image. Go look for yourself.
h/t to Frozen Patriot for the work!)

100 new cases a week of something isn't that big a deal; we have 100 homicides in this country every few days, with no danger of running out of people. But if the homicide rate went logarithmic every month, in a year's time we'd be looking at 400,000 homicides a month. By mid-October of Year Two the homicide rate is larger than the population of the US, i.e. everyone's dead.

Ebola, playing with the entire planet, gets 33 doublings to get from 1 case to the 7.7B people on earth, less 10-25% or so survivors. Which would take the world's population back to where it was around 1700, more or less. It would take US population back to the 31M we had in 1860, except now those 31M would be distributed  thinly in all 50 states. Move your state's population decimal one place to the left, and that's where it'll be if Ebola keeps on marching at logarithmic growth worldwide. If we keep it out, we stop that from ever getting a toehold to start. That's why travel bans and quarantines matter!

People wonder why they should believe the graph. Fair enough. As far as suspicion, the graphists above has done the same thing the editors at Wikipedia did: plotted the numbers, and literally connected the dots. The graph is only as good as the data.

If the doublings speed up, the line goes farther to the right, faster. If we slow the speed of spread, it doesn't. Currently, Ebola is doubling every 2-4 weeks, depending on the country we're talking about. The average overall is every three weeks. If we even slowed that rate down to every four weeks, we'd add a year to the planetary "Game Over" date. It was at every four weeks in July/August, for reference.

It doesn't flatten until we get the R-naught to less than 2.
It doesn't turn downward at all until we have a treatment(s) or vaccine that starts cutting the R-number to less than 1.
For smallpox and polio, that took 5900 years or so of human history.
We don't have to replicate that, but it gives you an idea of what has to be accomplished.
We've been trying to do it with HIV/AIDS for decades, with zero success, because it mutates rapidly and becomes resistant to our efforts.
Hopefully Ebola doesn't mutate as fast as we come up with something to kill it, and a vaccine will work on it for more than five minutes. If not, we're boned.

What that means for our chances at getting ahead of this disease:
If aggressive fluid therapy in the initial day or two pulls the fangs out this disease, that would be HUGE. We're still learning. In the US, we only have an insignificant number of cases, with a lot of other variables in play, so we still don't know.
And we wouldn't know that before now, because they've never done that in Africa (no capabilities or resources) and still don't, and most people died before anyone could do much of anything, including the medical staffs.

Math teachers may leave red pencil marks in Comments now.

Thought For The Day


Ebola is like the Lottery:
They're both punishment for people who suck at math.

California Says "Me Eleven!"

LOS ANGELES (Reuters) - California health officials on Wednesday ordered any recent travelers to the state from an Ebola affected country who have had contact with an infected patient to be quarantined for 21 days.
Sorry, President Obola, but when you've lost Governor Moonbeam and the leadership of Califrutopia, you've lost the ball game.
"Quarantine" is the new black.
Suck it, @$$clowns.

AP: Welcome To Reality, $#!^heads!

CLUEVILLE (AP) --- The U.S. health care apparatus is so unprepared and short on resources to deal with the deadly Ebola virus that even small clusters of cases could overwhelm parts of the system, according to an Associated Press review of readiness at hospitals and other components of the emergency medical network.

Read The Whole Thing

TL;DR Highlights:
* Supplies, training, and funds are limited
* Health care workers may refuse to treat Ebola victims
* Smaller hospitals will be least-prepared
* Everyday demands on the emergency care system for years have been at near-crisis levels 24/7/365/forever
* As of 2008, 1/3 of hospital ERs had to divert ambulances because they were full
* 20% of normal ER visits are for Ebola-like symptoms
* Staff surveyed report 100% of their facilities unable to quarantine large numbers of possible Ebola patients
* 66% of administrators, 75% of ER docs, and 80% of infectious disease specialists say their own facilities unprepared to deal with Ebola patients
(nota bene that the greater the expertise, the greater the certainty that we can't handle this)
* "Nearly all" emergency nurses said that ER overcrowding will make dealing with Ebola well unlikely
* Less than 1% of surveyed personnel at acute care hospitals said their facility could handle even 10 Ebola patients at once, and less than 25% of major teaching hospitals thought they could
* Average hospital has 10 protective suits and PAPR respirators for staff, and only six mechanical ventilators for patients
* CDC spent $6.2B on "Strategic Supply Stockpile" which includes NO waterproof gowns, surgical hoods, full face shields, boot covers, or any of the other gear the CDC itself recommends for treating Ebola patients
* Over half of nurses have received no emergency training during the previous year;
of those who did, 44% felt poorly prepared or totally unprepared
* 1/3 of hospitals have no emergency plan for alternate care areas, staffing, beds, or equipment, morgues, or staff absences/shortages
* less than 1/3 of local health departments even had a full-scale preparedness drill
* Only 25% of teaching hospitals had such a drill
* only 4% of medium hospitals had one
* 0% of small hospitals had one
* 14% of isolation staff, 25% emergency and critical staff plan to call in sick if Ebola becomes a reality, and 17% and 50%, respectively, would refuse to work near Ebola patients

No really! They actually found that after um, you know, asking. I am not making this up!
Gosh, I almost wish I'd been saying the exact same damned thing for months and years...

Kind of puts all that nonstop crapola for the past month or two from the White House and the CDC into something like perspective.

Light At The End Of the Tunnel

The Ebola epidemic in west Africa may have reached a turning point, according to the director of the Wellcome Trust, which is funding an unprecedented series of fast-tracked trials of vaccines and drugs against the disease.
Writing in the Guardian, Dr. Jeremy Farrar says that although there are several bleak months ahead, “it is finally becoming possible to see some light. In the past 10 days, the international community has belatedly begun to take the actions necessary to start turning Ebola’s tide.
“The progress made is preliminary and uncertain; even if ultimately successful it will not reduce mortality or stop transmission for some time. We are not close to seeing the beginning of the end of the epidemic but [several] developments offer hope that we may have reached the end of the beginning.”
Farrar’s comments come as the WHO confirmed that the number of Ebola cases in Liberia has started to decline, with fewer burials and some empty hospital beds. But the WHO warned against any assumption that the outbreak there was ending.
“I’m terrified that the information will be misinterpreted,” said Dr Bruce Aylward, assistant director-general in charge of the Ebola operational response. “This is like saying your pet tiger is under control. This is a very, very dangerous disease. Any transmission change could result in many, many more deaths.”
Data appears to show that the number of burials and lab tests requested for the virus are down and the numbers of empty beds in treatment centres are up - there have been reports of as many as a hundred. Aylward said huge efforts to educate and inform the community on the risks of Ebola and how to avoid infection and bringing in safe burial practices may have made the difference.
But infections could shoot up again, as they did in Guinea. “The danger is that instead of a trend that takes us down to zero, we end up with an oscillating pattern,” he said. Getting to zero will involve grindingly hard work, identifying every Ebola case and tracing all the contacts. Without that effort, Ebola will remain at a lower but still dangerous level.
There have now been 13,703 cases, said Aylward, and he expected there would have been over 5,000 officially recorded deaths, although that number is not yet confirmed. Many cases and deaths are unrecorded. The death rate is 70%, although slightly better in treatment centres.

I'd like to be optimistic, but telling people that things are looking up as the tally skyrockets to nearly 14000 cases sounds to me like whistling past the graveyard.

I suspect any empty treatment beds have more to do with people finally giving up on going to them at all, as it's a known death sentence, and electing instead to simply die in place at home, thus condemning their families and neighborhoods to more Ebola, indefinitely.

More new Ebola cases in the last 30 days than the total of all cases in the prior 9 months, and spreading it to 3 more countries for the first time, doesn't strike me as an epidemic that anyone's getting any sort of handle on.


Mandatory Isolation For U.S. Troops Ordered

PENTAGON (AP) --- Defense Secretary Chuck Hagel on Wednesday approved a recommendation by military leaders that all U.S. troops returning from Ebola response missions in West Africa be kept in supervised isolation for 21 days.
The move goes beyond precautions recommended by the Obama administration for civilians.

Note that no tantrums nor crying have been observed as a result.
We've quarantined actual heroes before, and that's just how they roll.


Stupid Leaves A Mark

Apparently in all her time in nursing school and the CDC, no one ever mentioned the concept that the state decides who gets quarantined, not the patients. That sting is reality smacking you in your stupid face, MiMi. Not STFU, call J. Noble Daggett, and see what your chances are in court of telling the state where to get off.
And as for your future professional career?
Sh'yeah, as if.
I hope you can survive on those no-salary volunteer gigs, because your next nursing job will be coming around somewhere close to 2078.
Attorneys for a nurse released from isolation in New Jersey after returning to the U.S. from West Africa say she will not comply with Maine health officials’ requirements that she remain under quarantine at home for 21 days.
“She doesn’t want to agree to continue to be confined to a residence beyond the two days,” Hyman said.
Maine health officials have said they expect Hickox to agree to be quarantined at her home until 21 days have passed since her last potential exposure to the virus. Twenty-one days is the maximum incubation period for the Ebola virus.
Early Tuesday evening, Maine Department of Health and Human Services Commissioner Mary Mayhew noted at a hastily called news conference that the state has the authority to seek a court order to compel quarantine for individuals deemed a public health risk.
She did not address Hickox’s case directly, saying the state has not filed a court order.
Another attorney representing Hickox, New York civil rights lawyer Norman Siegel, said she would contest any potential court order requiring her quarantine at home.
Hickox’s boyfriend, Ted Wilbur, a University of Maine at Fort Kent nursing student, plans to join her and will not return to campus for the next 21 days, according to Raymond Phinney, associate dean of student life and development at the university.
Mayhew reinforced the state’s intent to prevent people who have been exposed to Ebola from contact with others during the news conference at the department’s offices in Bangor late Tuesday afternoon.
“The way that goes right now is that anybody who remains at home with an individual that is placed at risk, who’s had exposure, if that patient does become symptomatic, all family members must agree to go into quarantine for a 21-day period,” Mayhew said.
She acknowledged that the state’s protocols “may go slightly beyond the federal guidelines,” but described them as a common-sense approach to guard against a public health crisis.
“As we’ve indicated, the intent is to minimize public contact if they have family members who have become exposed to them and they later develop symptoms, those individuals would be subject to the 21-day quarantine.”
“If they had visitors, those visitors would be subject to the quarantine if the individual under quarantine develops symptoms,” Mayhew said.
“We will proceed with a court order to seek legal authority as provided under Maine law,” Mayhew said. “We expected that the Maine attorney general’s office will represent the Department of Health and Human Services in this avenue of pursuing a court order,” she said,.
“And I do want to comment a little bit on the science here,” Pinette said, referring to reports that the nurse had not tested positive for Ebola.
“The problem we’re faced with here is that this is a blood-borne pathogen,” Pinette said. “We don’t know a lot about this virus but we do know from the experiences learned in Texas that they had some equivocal tests within the first 72 hours of testing their health care workers and we need to go based on the facts.
“The fact of the matter is that it has a 21-day incubation period. This individual was tested within the first 24 to 48 hours and the federal CDC was in agreement with retesting the patient should she develop symptomatology,” she said, adding, “But they wanted to wait 72 hours and they wanted to continue to keep the individual under 21-day incubation period for monitoring because as the viral load increases, that is how you can develop a positive Ebola test.
“So we believe that she may have been tested too early and therefore that is the reason why we continue to monitor this individual. So I have to say, in my own clinical opinion, to protect the health and safety of even one Mainer, it is extremely important for us to be very, very cautious,” Pinette said.
And reverting to her base intelligence level (4 years old), Crybaby now has her very own Maine State Trooper contingent to help explain the facts of life to her, and friend boy won't be continuing in his nursing program. Those two developments alone should be no small comfort to lovers of sanity in this difficult crisis.

And when she has her ass legally handed to her and ends up with the choice between jail, or her cabin in Port Kent, the lightbulb may finally snap on over her head, and she might realize that "public" is the keyword in "public health nursing".

What an ever-loving embarrassment to an entire profession.


When asked about the documented plans to bring large numbers of infected foreign nationals here for Ebola treatment, White house and other government spokesmen went straight to the Pinocchio Strategy, followed by non-sequiturs, and then random incoherent word salad, and holding faked seizures in reserve in case of any future questions on the subject.

Press Secretary Josh Earnest (chosen for the job after a comprehensive search of birth certificates revealed there was no one in the country named Total Bullshitter) was quoted as saying "Many people difficulty strategy Ebola when nations highly unlikely, but never World Series help leadership seriousness."

White House Press Office assistants later issued a clarification, and stated that Earnest wasn't actually speaking on the record, he was just reading from a "Mad-Libs" pad he was buying for his nephew, and denied rumors that he'd hit his head with a hammer several times, and declared "totally categorically false" all suggestions that he might be having a stroke.

As the above link makes clear, you can believe the White House, or your lying eyes.

After the commercial, State Dept. announces their Workplace Ebonics Training was a success.

MIA - Day 8

LAST SEEN OCT 21, 2014
PLEASE CALL 1-202-456-1414 WITH INFO

Tuesday, October 28, 2014

WHO Comes To Jesus; We have LIFTOFF!

{h/t to Vinny (Ex-Dissident) @ Vinny's Rants for catching this...}

I have referred to the Wikipedia Ebola virus epidemic in West Africa page for numbers since mid-July, because they've been maintaining it circumspectly, it's accessible, and I'm lazy.
They generally post the WHO .pdf updates that come out every 2-5 days, and usually with a day or so, so I don't have to wade through .pdf hell trying to get the simple info.

I  fact, I was using the posted number there when I was writing the "Number Crunching" post yesterday, and I hadn't looked at it today.

Apparently, someone seems to have found whatever was keeping the needle stuck.
To wit:
24 Oct 2014 12,008 cases  5,078 deaths
19 Oct 2014   9,936 cases   4,877 deaths
17 Oct 2014   9,693 cases   4,811 deaths

2000 new cases in the last FIVE days?!! 
Sweet blazing hell! If you're in Africa, RUN FOR YOUR LIFE!

Look at the chart on the page; it hasn't increased by 2000 cases in the last 3 weeks.
Earlier today, I was about to note that I missed a WaPo news report a couple weeks back that related the Pentagon has revised their timetable for completing the 1700 beds; it's now going to take until early December, rather than mid-November, i.e. another 2-3 weeks.

I was going to note how far behind they'd be when they finally get to December.
But now, that whole post is pointless.
Those 1700 beds just became obsolete between last Sunday and last Friday morning.
And it's taking us 9 weeks to make 1700 beds' worth of facilities.
Ebola is making 400 new patients per day.

For the love of God, get our troops the hell out of there right fucking now!
Just tell them to drop their shit where it is, grab their duffel bag, and be on the runway ready to go in 5 minutes, fly in, pick them up, and just GO!

I have no clue what caused the uptick: they got religion, they found a box full of casualty reports next to Hillary Clinton's Whitewater files, somebody passed 4th grade, whatever...I dunno.

But those numbers are a nuclear launch of this epidemic, and it's going to eat everything in its path at this point if they're even the usual 1/3 of legit they've supposedly been.
If we're actually at triple those numbers, we just went from Double #13 to #15 (out of 33), meaning we're now 18 doubles away from worldwide pandemic, and we're there a month earlier than my guesstimates indicated (forget CDC and WHO projections, they're barely close to where we thought we were).

And people there, starting with the ones in the know, are going to start getting the hell out of there any way they can, and going any place they can get.

Personally, I feel like Steve McQueen at the end of The Sand Pebbles:
"What happened? What the hell HAPPENED?"

Titanic sinking; Captain concerned.

If only I'd said this already. Oh, wait, I did say all this yesterday. So we've established that the AP and UN are only about a day behind me. Guess I'm slipping.
KAMPALA, Uganda (AP) — Authorities are having trouble figuring out how many more people are getting Ebola in Liberia and Sierra Leone and where the hot spots are in those countries, harming efforts to get control of the raging, deadly outbreak, said  Anthony Banbury, the U.N.'s top Ebola official in West Africa said Tuesday. "The challenge is good information, because information helps tell us where the disease is, how it's spreading and where we need to target our resources," Banbury said by phone from the Ghanaian capital of Accra, where the U.N. Mission for Ebola Emergency Response, or UNMEER, is based. Health experts say the key to stopping Ebola is breaking the chain of transmission by tracing and isolating those who have had contact with Ebola patients or victims. Health care workers can't do that if they don't know where new cases are emerging.  
The president of the World Bank, Jim Yong Kim, meanwhile, said the three countries need at least 5,000 more health workers to effectively fight the epidemic. Kim said Tuesday that he is worried about where those health workers can be found given the widespread fear of Ebola. Quarantining health workers returning to their home countries could also hurt recruitment efforts.  
The U.N.'s target is to have 70 percent of Ebola cases getting access to a treatment center and to achieve a similar percentage for safe Ebola burials. "They are extremely ambitious (goals), given the geographical spread of the disease, the numbers of people infected, the very poor information on exactly where those infected are and what the transmission patterns are," Banbury said. "The three things we need the most are people, supplies and money. The most critical right now are people, health workers in particular, trained health care workers . But also people who can manage these Ebola treatment facilities." Ban said the transmission of the virus continues to outpace the international community's response. He appealed to the AU's 54 member states not to impose Ebola-related travel restrictions or close their borders. Some already have. Dlamini-Zuma said African Union states have pledged to send more than 2,000 health care workers to West Africa. She did not say when the workers would arrive.
So everything I said yesterday is spot-on.
The only thing missing to get ahead of this is people, supplies, and money:
  which is, in short, EVERYTHING.
It's like trying to make a hamburger without meat, condiments, and a bun.
They need 5000 more health workers, when articles BACK IN SEPTEMBER quoted UN officials as having trouble coming up with so many as 10.
And the other countries in the region have pledged more health workers than the total number they probably even have.
Promises are cheap, and in this outbreak, as cheap as Zimbabwean dollars.

Kids, Don't Try This At Home!

{h/t to Doc Grouch for the source material for this one.}

NEJM has just published a clinical case study of the course of treatment provided to a man sent to Germany with fulminant Ebola virus infection.

1) It's exhaustive, and fascinating.
2) If you're any medical clinician interested, or likely to see/treat Ebola in any context, go there now and read it.
3) If you're non-medical but a quick study, it's still worthwhile.
4) If you're not either, it will be worse than trying to follow Chinese opera.

I have gotten, and still see on the Internet (I see those links to my site, and I visit them from time to time, so I see you people out there!) folks who still cling to the doomed fantasy that they're going to stock up on supplies, and care for family/friends/fellow tribesmen, out of love, humanity, or simply pigheaded ignorance of the futility of the gesture. Allow me to lovingly smash that foolish dumbshittery to bitsy pieces with my 18# surgical steel sledgehammer of reality, just one more time. Remember, I yell because I care.

So with apologies to any clinicians who will quibble or object to the following summation, in hopes of making this clear to people, I present another foray into explaining in laymen's terms that even someone perplexed by the plotlines of Dumb And Dumber and Dude, Where's My Car? will be able to grasp. What follows is entirely my summary. If you want the actual case, RTWT from NEJM. (And thank them for posting it all where anyone can get it. This is what the Internet should be for, not just pR0n and kitten videos.)

The patient was a 36 y.o. male epidemiologist who became infected in Sierra Leone, probably by a colleague with whom he shared an office and bathroom. Said colleague contracted Ebola and died.
Patient was treated for malaria at first, by quickly became symptomatic of and tested positive for Ebola. On Day Ten after initial symptoms, he was transferred to Germany for intensive treatment.
Day 1: malaise, headache, bodyaches
Day 2: Fever of 101.2 F
Day 6: Positive Ebola blood test
Day 7: abdominal pain, nausea, vomiting, diarrhea
Day 8: Beginning of IV fluids and single-dose antibiotics
Day 10: Transfer to German hospital ICU isolation ward in Hamburg
Blood tests: suggestive of massive dehydration, lab values totally fucked up (that's a clinical term)
Ultrasound of inferior vena cava (the route blood from the body takes to get back to the heart) showed that it was flat. In other words, circulation was upgefuchten (German clinical term).
Patient shitting out more than 2 gallons of diarrhea per day for 3 days straight, and digestive tract blocked. Given 10 liters of IV fluid/daily, plus potassium supplements
Ebola blood concentration begins to decrease
Day 11: feeding tube placed
Day 13: vomiting stopped; Fever and general secondary infection noted, more antibiotics started
Day 15: central venous line placed; diarrhea decreased to less than 1 quart/day
Day 17: Ebola absent from blood concentration
Day 18: altered mental status and respiratory failure; placed on external ventilation
Day 20-25: hallucinations and delirium
Day 26: respiratory and mental recovery
Day 30: Ebola no longer detected in urine
Day 40: Ebola no longer detectable in sweat
Day 60: Patient discharged to return home to Senegal.

Truly, read the whole thing. This guy nearly died at least twice and perhaps three times; once when the Ebola nearly killed him, and again when the complications of Ebola caused bacteria from his digestive tract to leak out of it and into his body, causing a massive infection, and finally when the monstrous amount of fluid to stave off the Ebola, plus aspiration of blood caused lung and breathing problems, almost drowning him in his own fluids, and caused his brain to swell to the point of impinging on normal respiratory function.

By any standard, that medical team are rock stars.


1) The study was co-authored by 12 board-certified critical care specialist MDs, all of whom were directly involved in treating this one patient.
2) The patient was in the ICU, certainly what we call a 1:1, and probably more like a 4:1, i.e. at least one, and probably four nurses (two for care, and two to make sure the first two were sterile and safe) for his course of care, for at least 26-30 days of his care, if not the entire time.
3) 10 liters of saline/day times 10-18 days: $5/bag, 180 bags minimum=$900, and it's all Rx.
(BTW, there's been a national IV Saline shortage for months, to the point that hospitals are having trouble getting enough, just FYI)
4) New IV tubing every 3 days, probably two sets, $3@, figure another $100, all Rx.
5) The associated supplies to start the IV, another $300
6) rare and exotic antibiotics, including the big guns for the drug-resistant infection he developed from what leaked out of his guts and into his body because of the Ebola
Probably $5-10K worth, if you could get them
7) the full-body positive pressure hazmat suits and HEPA powered respirators that prevented one single reverse infection during the patient's treatment - $2K@
8) the x-ray, ultrasound, and CT scanners, roughly $1M worth, and all the techs to run them
9) the 24 hour lab, equipment, and specific tests to detect his various infections and run his blood tests
10) the sterile BL4 facility to house and care for the patient.

If you have a spare $10M to build that, and another $3+M/yr payroll to keep 15 doctors, including a pharmacist, radiologist, and pathologist, plus 24 ICU nurses to cover those shifts 24/7/365, and keep them all standing by for your family/friend/whatever, and all the ancillary staff as well, ROWYBS.

Of course, for a lot less, you could have bought and fully stocked one of those old missile silos or obsolete commo bunkers, and skipped the problem entirely, being instead watching your collection of every DVD movie known to man, playing ping pong, and eating steak and lobster off the BBQ 7 days a week for the next ten years, right now.

But if you have that kind of money, you could open a for-profit hospital now, and fund  making movies, and be raking in money hand over fist 24/7/forever, in which case you're likely too busy to read this blog.

You're sure as hell not going to pull it off clipping coupons and holding down any middle class job (or twenty) anywhere in North America.

And as for "But I've GOT to try!" let me help you with that:
"But I've GOT to DIE!" There, fixed if for ya.
And you're going to not only get sick, but give it to your whole family and anyone else nearby. Do them and yourself a favor: kill yourself now, and save Ebola the trouble.
Or at least, stop thinking there's anything you can do that isn't going to be throwing gasoline on the fire.

There's one correct answer where Ebola and similar pathogens are concerned:
Don't Catch Them.
Don't Let Those You Care About Catch Them.

*(And nota bene that Our Victim in this was infected by a trained ace medical colleague, who worked - until he collapsed - while infected until a mere four days before he died of Ebola, certainly coming to work with a raging Ebola virus infection for days beforehand, and spreading it to this poor guy and an unknown number of other medical colleagues.
That is why smart medical people will GTFO when Case One comes to their hospital, in most cases, and nearly everywhere. This is not something anyone without massive clinical support and brilliant co-workers and supervisors should ever play with.
Do you work in health care? If so, how bright are your colleagues and management?)

Princess MiMi Crybaby About To Get Second Spanking

A nurse who treated Ebola patients in West Africa before being briefly and controversially quarantined in New Jersey could be the focus of a new battle over state health policy as she returns to her home state of Maine.
Kaci Hickox left a Newark hospital on Monday and was expected to arrive in the northern Maine town of Fort Kent early Tuesday. Maine health officials have already announced that Hickox is expected to comply with a 21-day voluntary in-home quarantine put in place by the state's governor, Paul LePage.
However, one of Hickox's lawyers, Steve Hyman, said he expected her to remain in seclusion for only the "next day or so" while he works with Maine health officials. He said he believes the state should follow the Centers for Disease Control and Prevention guidelines that require only monitoring, not quarantine, for health care workers who show no symptoms after treating Ebola patients.

LePage defended the quarantine in a news release Monday, saying that state officials must be "vigilant in our duty to protect the health and safety of all Mainers." Adrienne Bennett, a spokeswoman for the governor, told the Portland Press Herald that authorities would take "appropriate action" if Hickox does not comply with the quarantine, though she did not specify what that action might be.
Word to your mother, MiMi: Maine isn't Joisy. That governor doesn't sound like you're getting his lunch money, and is about to jump on your stupid ass with both feet. And this time, it sounds like they won't send a spokeshole, they'll send armed deputies, and your ass will be nailed inside the damn house.
STFU and take your medicine, or your next quarantine may well be the new isolation bed in the county lockup.
State nursing licensure boards tend to view those sorts of legal entanglements as the sort of thing that has a direct bearing on your ongoing fitness and suitably for "the continued practice of nursing", in a professionally influential way.

And if friend-boy cohabitates with Hickox during her enforced quarantine, U. Maine-Fort Kent, where he's a nursing student, has announced they will refuse him access to campus, which will have a teensy affect on his continued nursing school education there. Like get him suspended and then dropped from the program, and have to ask for re-admission next semester, typically. He may not get back in for some time, given how impacted such programs are.
Play stupid games, win stupid prizes, kids.
And nota bene that despite screwing up the execution, the tally is now 9 states using the Q-word, while D.C. has dithered.