Monday, October 20, 2014

And Now, Back To Our Sponsor

After our health care and political leadership from local to federal has not missed any opportunities to miss any opportunities, the Duncan Ebola outbreak appears largely to have run its course.
Duncan is dead.
After $100K in costs to the state of TX, his family's vacated apartment is clean.
18 100 48 114 people on lockdown because of exposure to Duncan or one of the second tier of people he exposed, are finished with or soon will be, a 21-day mostly self-imposed quarantine.
Two of the 76 people who cared for Duncan acquired Ebola, and are under treatment in BL4 isolation beds, at a treatment cost of thousands per day.
THP-Dallas' ER has been closed since Nina Pham's arrival, and their ICU has been severely impacted by staff who went from self-monitoring to home lockdown, not to mention staff walking out or threatening to over any possibility of further care for Ebola patients.
Two jacktards pressure-washed infectious material all over the parking lot of Duncan's family's former apartment, potentially exposing dozens of people to a deadly pathogen.
Four schools were closed for days, and thousands of students missed days of school, while each school was extensively and expensively scrubbed down to remove any future risk from those children, at unknown direct and indirect costs, while their families were left to wonder whether their children were at risk of the disease.
Amber Vinson, possibly symptomatic for several days, directly exposed two planeloads of fliers and aircrew, and indirectly exposed as many as 25-30 more, because it was days before her infection became public knowledge. All those passengers and flightcrews continue to sweat out the next days and weeks.
So do store owners and visitors to a bridal shop, school employees, and the teachers and students of two Cleveland schools also exposed by Vinson's travels.
An entire cruise ship spent several days confined with another employee, ruining vacations, necessitating a thorough cleaning of that ship, and precipitating an international crisis when both Belize and Mexico showed more common sense than the US government, and refused any docking rights to the ship, passengers, or crew. Carnival Cruise Lines will eventually be out tens of thousands to millions.
A three person sheriff's team who entered the Duncan apartment afterwards had to deal with false-alarm fears of being directly exposed. Along with the ambulance crew that transported Duncan, and multiple other patients transported in the same un-decontaminated ambulance afterwards, including a homeless man doing what homeless people do, wandering around the greater Dallas area unnoticed until finally tracked down and put on a mental health hold because he couldn't grasp the potential seriousness of his exposure, or agree not to share his possibly infected self with all of downtown.
THP-Dallas, and the doctors and staff involved in the direct care of Duncan, now face years of costly lawsuits over all this, nearly all of which they'll either settle, or lose in court, for a total sum running probably to tens of millions of dollars, when one includes direct settlement payments, court and legal costs, malpractice premiums, and indirect costs like tying up the legal system, plus lost work for depositions, hearings, and trials for every employee directly and indirectly involved.
THP-Dallas has been unavailable to treat emergency patients or most other ICU cases due to all of this, robbing the greater community of that resource, forcing longer trips for emergency patients, and more patients funneled into the remaining Dallas-area ERs, resulting in greater workload, longer waiting room times, more frustration for patients, staff, and visitors, and an unknown risk of decreased outcomes for arriving ambulance patients forced to travel to more distant ERs. And on top of that, there's the long-term irreparable harm to the reputation of a first-rank hospital that in all other respects is a top hospital in the area. And all of this just in time for flu season.
Travelers face additional anxiety and screening delays, airlines face loss of revenue from fears leading to passengers' flight cancellations, not to mention Frontier Airlines having to ground multiple air crews and decon two planes, while associated travel, lodging, and restaurant revenues decrease in response.
And multiple times per week, every time anyone says the word "Africa" and concurrently coughs, sneezes, or pukes in public, it triggers an enormous three-alarm hazmat fire/police/hospital/isolation/flying monkey response to an ongoing string of false alarms, because not to do so would risk the onset of everything above in what would be Duncan v2.0.
Then there are the costs associated with dispatching the administration's army of flying monkeys hither and yon in multiple cases, and the opportunity cost to an administration arguably pretty incompetent with a dizzying array of world crises already, now having to face the latest thing they don't understand, aren't prepared for, and have absolutely no coherent plan for dealing with, which sends allies to reel in flights of full headless-chicken panic, and helped send the Dow into near freefall, which costs real people real money, including the state and private employee pension funds, and individual retirees who depend on mutual fund performance to pay their way through retirement.

And all of that from just one unemployed sociopath douchebag who lied to get here, and brought the new chief export of his homeland: a deadly 3nm filovirus, with only 7 genes, named Ebola.

And just for icing on the cake, all the kabuki show "screenings" we've added wouldn't have intercepted Duncan, and won't intercept the next 10 just like him, because they cannot, and weren't designed to, they're merely safety theatre designed to simulate "doing something" while actually doing precisely nothing.
So 316 million Americans are held hostage to the god of not making life inconvenient for less than 150 travelers per day from the three squalid little hellholes that have incubated and delivered this pestilence to the world's shores, on the ridiculous notion that we can't adequately screen them or track them (after they helpfully start Outbreak 2.0) if we simply refuse to let them come here. In other words, you have to eat the shit sandwich to tell what's inside the shit sandwich.

So how are things going on that account?
Since Duncan arrived here, the outbreak went from 6000 cases and 2800 deaths, to 9000 cases and 4500 deaths. There are more people dead from Ebola right now in Liberia, that the total number who had it worldwide less than two months ago. it continues to spread on a perfect 45-degree exponential-graph trajectory, with R-naught of 2, i.e. two new infectees for every initial victim. (Incidentally, exactly as it's behaved in the US - so far.) On a straight-line graph, the reverse parabola climb looks like a rocket launch to Mars, with no end in sight, despite everything done by everyone, since Day One.
Our efforts worldwide are so insignificant that if we'd done absolutely nothing, it wouldn't be appreciably any bit worse right now.

One of the discoverers of Ebola had this to say:
Prof. Piot is convinced that the world could have brought the disease rapidly under control months ago if prompt action had been taken. The World Health Organization reacted too late, he says, and by the time the seriousness of the outbreak was fully realized it was heading out of control. According to one estimate, it will cost around £1 billion a month to build and staff the treatment centers needed to isolate a notional 100,000 patients, quarantine their contacts and prevent the disease from spreading. So far, despite vague pledges, the international community has given nothing like enough. “The problem with Ebola is that it is not over until the last patient is either dead or has recovered,” Prof Piot says.
The spread of Ebola is, of course, fuelled by the fact that the nations affected have no health systems to speak of (in 2010 there were only 51 doctors in the whole of Liberia) and that traditional funeral practices involve the touching and kissing of the deceased.
“Can it be stopped? It will be a bumpy ride. I am worried for West Africa. We will see a decline in cases eventually, but without a vaccine I am not sure we can stop it.”

 And how is that vaccine progress coming?
Several companies are fast-tracking vaccines: two in particular, one being developed in Canada and one by GlaxoSmithKline in Britain, hold promise. But yesterday GSK said their vaccine would be “too late” for this outbreak and probably not available until late 2015.

So another year from now. Maybe. We hope. And what's that do for those countries in the meantime?
“Ebola has literally destroyed the health services in these countries,” Prof Piot says. As a result, it is quite possible that more people have died as a result of the lack of treatment for other diseases, such as malaria, than of Ebola itself.
Liberia's president, Ellen Johnson Sirleaf, says Ebola has killed more than 2,000 people in her country and brought it to "a standstill."Prolonged war over the course of years had already left emergency, medical and military services weakened when the outbreak began in Liberia and two other West African countries," she said. Now, "a generation of young people risk being lost to an economic catastrophe as harvests are missed, markets are shut and borders are closed."
Sirleaf made an appeal for help in a "Letter to the World" broadcast Sunday by the BBC.
In neighboring Sierra Leone, the U.N. World Food Program is distributing emergency food rations, providing a nutritional lifeline to 260,000 residents of an Ebola-stricken community on the outskirts of the capital, Freetown, the Associated Press reported.
And those devastated countries are the very ones we're hoping can hold the disease in check within their own borders, the ones our own president and his administration are telling us are the key to protecting America from more Ebola outbreak and the resultant panic, chaos, and death, and the ones we're risking American lives to prop up further.

If that's the case, the first thing I'd like to do is swap presidents with Liberia.


Anonymous said...

Well, now we get to see which one of them falls into the 4% that presents in 42 days, and which one never shows symptoms....

I'm glad that it appears to be hard to catch during the initial day or 2 of symptoms. This is really good news.

That doesn't change the underlying math though. We are still F'd.

BTW, does it seem to anyone else that the SecDef's strike teams sound like the adults in charge starting to act? Not one reference to CDC, the administration or how they fit into a greater plan. Just action.


TFA303 said...

So his family, who were with him in immediate contact, using zero PPE, had no infections, but two nurses, who (however imperfectly) were gloved, masked and Tyvek'ed from head to toe, did get infected?

How does that work?

Grouch, MD said...

Can't wait until whatever ISIS wannabe douchbag terrorist group gets the obvious clue and sends a few of their crew over to West Africa to get their freak on with whatever Ebola contaminated chap they can find, then cross the southern border and spend the remainder of their days going to the mall, the grocery store, and finally to a large sporting event and barfing all over everyone, then blowing themselves up with a charge small enough to ensure there will be bloody bits strewn about the crowd.
Things are sure to get sporty then.

Percy said...

Good news for a change (if believable):

"The lines on the tabular situation reports, sent to WHO each day by its country office in Nigeria, have now been full of zeros for 42 days.

"WHO officially declares that Nigeria is now free of Ebola virus transmission."

Tucanae Services said...


You don't think nefarious enough. If I were an ebola infected terrorists I would have made arrangements to get work in a meat packing plant and been giving plasma down at the blood bank all along.

Anonymous said...

Just wanted you to know that this blog has been a great resource for me and my family as we follow this outbreak. Please do keep up the good work and thank you for the time you spend putting these articles together. I would imagine my thoughts echo those of all your readers.