Tuesday, October 28, 2014

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?)


A Texan said...

In every field of endeavor, there's a Bell Curve. Some people are on the left side, most in the middle, some on the right. The assclown doc (now) in NYC and Nurse Crybaby are definitely on the left side, as was the doc who infected the patient who's course of treatment was dealt with here.

Stupidity kills, and all the more so when you have people in authority or responsibility that everyone looks to for the correct answer(s), and they give you answer(s) that are not merely wrong, but DEAD wrong.

All these government and media morons (left side of Bell Curve, for those not paying attention) who say that Ebola isn't a problem for the US, we have the "world's best medical system," there have only been 4 cases here, etc. - these are people not the least bit schooled in medicine OR mathematics, because simple common sense, history and a $5 calculator should inform ANYONE with a functioning brain that Ebola is potentially a BIG problem. How to avoid that big problem is mind-numbingly simple - keep new cases OUT of the US.

Again, stupidity kills (of which political correctness is merely a a subcategory). That and selfishness (of which political advantage is a subcategory). Between those 2, and our wonderfully modern transportation system, we're likely to have dozens of cases by the end of the year, or if not by that time, by no later than January 31. Again, reference common sense, history and your handy-dandy $5 calculator (if you're too fucking stupid or lazy to understand what a geometric progression is, and how it works with a communicable disease).

And yet, despite Aesop's warnings, many who read him and thousands of others will attempt to treat loved ones with Ebola, and will catch it themselves. THIS is how you go from a controllable problem to a pandemic. Pray that our society and our civilization survive the next 2 years.

Emily Disraeli said...

So I'm thinking everyone but Index "Duncan" did not or does not actually have Ebola. It's all just performance art, right?

Anonymous said...

What difference,at this point, does it make Ms. Disraeli.
If you have not been paying attention to the 'elites' plans, then I suggest you start looking now.
They have made no secret of them: A sustainable world population of
500 million to serve their needs.
Whether they get there from ebola, or via extermination camps matters not.Survive the coming panic, or ebola, or die from other causes, they are working their plan.

Emily Disraeli said...

I believe there are much more efficient means to kill off the population then a virus. What Ebola gives them "TPTB" is a terrifying means to control us. We stop thinking and start stampeding when they have frighten us enough.

Aesop said...

What would possibly make you think it's "performance art".

This is the medico-political version of 5 jackasses beating a hammer on the nose of a buried IED, waiting for the BOOM.


GamegetterII said...

Avoiding contact with anyone who was maybe possibly exposed to Ebola is the only way for anyone to survive an Ebola outbreak-unless you are one of the few people who is going to be able to go to one of the very few BL4 beds available.

I haven't seen anyone suggest caring for family members with Ebola is a good idea- yet.
That may be because I don't read a whole lot of the tripe that's on the 'net.

This site has been the voice of sanity in the Ebola area from the beginning of Ebolamania.

I'l stick with what I read here-it also appears Dr. Grouch may be a similar voice of sanity.

I'll just keep buying more food and supplies-and hope we don't end up being stuck in our home for months and months-since we do not have the $$$ to relocate.
I figure I'm more prepared to ride out an outbreak than 90+ % of the population-so maybe we'll make it through to the end of the outbreak.

Tucanae Services said...

Texan has a interesting point. A great many doctors develop the `God complex` pretty early in their career. They figure that since they can pull off doing 70hr shifts and only kill a few patients that nothing can get to them.

That kind of attitude with this virus could kill thousands.

Anonymous said...

It isn't just docs - normalcy bias will kill many folks.




Think for yourselves. Stay alive.

Aesop, thanks for all you do.


Emily Disraeli said...

My definition of performance art. Well, they are discharging the second Texas nurse from the hospital, what has it been 20 days and she's cured of Ebola. Now she will go and hug the president to show that Ebola is not such a bad thing. I do not believe she had it.

IvyMikeCafe said...

Critical care medic checking in. Your cost analysis and resource planning were exactly the things clicking around in my head after reading Doc Grouch's recommended article. The logistics are a bitch alone and we couldn't clone clinicians fast enough if this thing takes off.

To anyone with a single functioning brain cell, closing up the portals to Ebolaland and quarantining the fuck out of everyone AT THE SOURCE should have been done long ago.

The arrogance of the jackholes in DC and associated state cesspits of stupidity guarantees that more zombies are going come here and kill a lot of people.

Glad I'm rural and on a well and septic system.

Great analysis on all of this Aesop. You have been knocking it out of the park.

Anonymous said...

Waste disposal. How do you even begin to do cleanup and waste disposal with a patient producing gallons of highly infectious liquid waste every single day?

Shrimp said...

Only thing I can think of that you missed was:
11) Bio-hazard clean-up. All that crap (literally and figuratively) has to go somewhere. And it's all infectious. One mistake in doing so safely means a very likely new infection. If you have your own bio-hazard sanitation dept, awesome.

I'll take the avoid, evade and dodge the bullet method, thanks.

Anonymous said...

Normalcy bias is a real thing, and a real threat:


You can also overreact, but I do not believe that a quarantine in the face of anything as deadly and painful as Ebola, with a Reproductive Number of at least 2 is an overreaction.

If anything, I'm seeing a LOT of potential future "walkers" around. Hope they don't come to my family (up here in the sticks) if SHTF, because there won't be a really warm welcome after all of the ridicule and idiocy I'm witnessing.

Aesop said...

I didn't miss biohazard clean up guys, I just didn't feel like piling on any further.

I've pointed out more than once that Brantley and Writebol created 20 bags of hazamt @ at Emory from way back.

Ebola is not to "played with".
It is to be avoided wholesale.

Preferably with a measuring unit of continents.

And when this one completely escapes the small area it's in now, they aren't even thinking about what to do after that, as it engulfs the entirety of Africa.

Anonymous said...

Aesop, I'm not arguing your point, that it is better not to get it, but the case cited is the western approach. As is painfully clear, we won't have the resources for that approach either as a society or as individuals.

So I'm offering this counterpoint:



She was basically alone, to care for herself with minimal support. Clearly there is something at work here that is not fully understood, as some people seem to get a less severe case, and DO survive. Even in shittiest africa 1 in 10 survive.

Yes caregivers are at extremely high risk of getting sick. Yes, in many or most cases care has little effect and a huge risk.

It still seems reasonable to me, that an adult can self quarantine, and have ORS and antibiotics available. Or that one parent can self isolate and care for a child even at the risk of his/her own life. Especially given that a family may be contaminated before identifying the onset of symptoms anyway.

So any chance is better than none.

And often our preps have multiple uses anyway, so ORS, antibiotics, and isolation supplies are worth having on hand for after the fall when cholera, etc make their return.


I'm still finding it strange that we've heard nothing more out of Chicago where 2 passengers were hospitalized, an adult and child.

Able said...

Thanks for this one Aesop and double thanks to Dr. Grouch!!!

Forwarded it to our (local, regional hospital) ITU, Virology and Medical directorate team leaders - so far the swearing hasn't stopped. (unofficial, watercooler, polls show we'll have less than 3% of our normal staffing if/when with sudden onset I'mnotsuicidalistis).

Of particular interest were the findings of continued, post apparent recovery, viral load in urine and sweat. Isn't that a kicker? Be one of the rare survivors, stagger out of your self-isolation ... then still infect family/friends weeks later.

(I 'do' see where Emily is going too - just a bit too convenient that nurse Pham got better so quickly - and the O hugging when she was still excreting virus in her sweat? I think not somehow.

My cynicism is leaking again so I'll just put my in-foil beanie back on shall I?)

Anonymous said...

So if self treating isn't an option then we should um, head to our local hospital death corral?

The optics of this fucklest have been dismal to say the least. I'm not sure if we're watching psyop crap or the real thing.

Regardless appreciate Aesop's efforts to bring clarity.

Our media all need to go. Willingly or with toe tags.

Historian said...

If an effective travel ban from Africa can be established, the only way off the continent is across the Med. I doubt that many people will walk across the Sahara.

Anonymous said...

(oh geez, Grandpa's awake...) 1) .gov will not do anything to 'save' you or anyone else. 2) 'they' won't close the borders, and it ain't worth talking about why. 3) no matter where you are, your resources at this time are best utilized in preparation to stay, and stay inside and keep others away from you and your family/tribe. Talk with your family, friends, and neighbors TODAY about a rational as possible plan to do the above, with an implementation time frame of approximately yesterday. "It" isn't 'on it's way here' - it's here. Please don't believe President Openliar who just spoke to us regarding the "only 2 cases in the U.S.". It's here AND in your heart and mind you know it. Do not fail to plan unless you plan to fail. Seek understanding and truthful, factual information and knowledge. (thank you Aesop and Doc) (and ca @ wrsa...) Do NOT rely on what the msm or gov tell you, they lie.
We as humanity are grinding this out inexorably to... yes, here it comes... napalm.
There are liars with skin in this game, big liars. They are not now and likely never have been 'on our side' or concerned about... any of us.
But numbers don't lie. I am proud of many in the medical community, I would be unable to walk if not for you. I would have only one eye if not for you. But brave and wise as you are, you are outnumbered against this virus - and those who have ability to make the odds better for you (us all, actually) have shown complete disregard for us. Again.
Our founding fathers would already be shooting, and tossing ropes over streetlamps...
Don't get wrapped around the axle. Prepare yourself and those you care about and are close to. We must survive if for no other reason than to be at their reckoning in the aftermath. I pray that you all should live as long as Grandpa has... and hopefully longer.
I pray for you, for many of us. Be "ready" in every meaning of that word. Ready to live, as well as to meet your Maker; because at this point it can go either way...
Because... napalm. s f .

Anonymous said...


From day 17 on to day 60!

WHAT do you make of the miraculously abbreviated recoveries reported in recent US cases?

Grouch, MD said...

Part 2:

And yet...

I am not certain I could walk away from treating my kids or wife, regardless of the consequences. Your kids or wife? probably. My own? not so much. I still struggle with that, with the relative wisdom of doing so, vs the relative wisdom of not doing so. I have vastly more resources than she would have; it's always smart to be buddy-buddy with the pharmacist. I have a better grasp of what to do, and adequate fear to make me cautious. Do I take Aesop's advice? Walk away and let them die? Could I live with myself afterwards? I don't know. I'm sure Aesop will harass me mercilessly for this; can't say as I would blame him…but yet…

Do I really have the resources? have I sat down with the list of things that MSF uses, and compared against my own stores? Do I have 100 bags of IV fluid ready to go? Or the means to make some? What is the recipe for oral rehydration therapy? What antibiotics can I give? Do I even remember how to start a regular IV, instead of a central line? How would I deal, at home, with 3 kids, with 20 bags per person of soiled waste? How many changes of PPE do I have? Do I even own a raincoat or rain boots (as per the article cited above)? what about masks? What kind of help could I get from family? (That last one is easy, the Mrs. Grouch also sports MD after her name, and her dad, who lives close, was a Special Forces Medic for 20 years). Do I really have what I need? Or am I just as full of it as the random dude on the street? Remember: Das wesentlilche ist die Tat.

Able @ 11:11: the virus has been found in semen up to 100 days after clinical course has cleared..so no celebratory sex for you!

Grouch, MD said...

So many thoughts on this one: part 1.

Aesop is correct, in spades. Modern medicine, especially BSL4 medicine, doesn't come cheap. It is impossible without massive logistics. It reminds me of all the threads I have seen on the internet regarding setting up trauma bays, & etc, for the brave resistance fighters battling .gov's minions. Ain't gonna happen.

See my comment down toward the bottom of this post:


Over at CA's place, where someone pointed out that Bellvue is transferring out ICU patients as they do not have the staff to take care of them, as well as the Ebola patient. If a hospital with millions per year can't do it, you will not be able to provide the full court press, either.

Emily @8:49 am, the others did have Ebola. For reasons that are not clear (perhaps having to do with the type of care delivered here) the death rate is not as bad. There is also some evidence that, like most diseases, Ebola presents a spectrum of severity, and the nurse just released was on the low end of that spectrum. No performance art, she tested positive; you can't fake a PCR test.

I will comment on CA's post over at his site.

Anon @ 10:56 am:
I read the linked article, certainly interesting. I should point out that had they known the patient had Ebola the would not have treated her; there are no known survivors of Ebola who were pregnant while they had the disease. But here I thought you were going to link to this article:


There is a CNN article describing the same thing as well. In brief, this is a nurse in training, with a fair amount of logistical help, that took care of her family at home with a 75% survival rate--kudos to her. She had improvised a fairly complete set of PPE, she had antibiotics and other drugs available, and had IV fluids to give to her family. Still it was touch and go.

So can Ebola be treated successfully at home? Well, methinks it could be, but one would prefer to prevent it from getting to your house. If it does then it would be wise to exhaust all other options before choosing to treat at home. Every other option. Then double check to make sure there are not some options you have missed. Then slip a fat wad of cash under the table and see if other options arise. Get my point?

And yet...

Grouch, MD said...

Not sure why the two comments came out in the wrong order. Sorry.

Mrs. teresa said...

Nurse Crybaby is currently on her way to a remote, rural area approx. 50 miles from my door.
The area in which her boyfriend lives is the big wilderness destination in New England. The local economy is dependent upon tourism from hunting and fishing and canoe tripping.
Her presence here will decimate that economy.
The local hospital has 49 beds, and as you can imagine, does not attract the cream of the crop physician-wise.
The volunteer ambulance service is staffed by a really nice elderly couple(a pastor and his wife) who along with others are on-call 24/7 for their community. They are both EMTs. Cell phone coverage is non-existent, and when the phone lines go out, their communication with the base hospital is very limited. They do not have biohazard suits or hoods or filtering respirators, just paper gowns and N-95 masks, standard gloves. I know this because I just spoke to them about a month ago about this very subject. The consensus was "We're not likely to get a case here, but we need to prepare" Hopefully they are better prepared now.
People who are not rural do not understand rural medicine. The designated Ebola center is 6 hours away over rough roads, heavily crossed by moose and deer. Snow will be flying soon, probably within the week, and can severely restrict travel. The closest airport to that area is 50 miles to the northeast.
If she needed to be transported, it would be at least a 25 mile run to the hospital. A 25 mile run in a wobbling,weaving ambulance with someone projectile vomiting would be horrendous. Droplets everywhere.
They are not qualified to give any medications, and most times cannot contact their base due to comm. limitations so could not give anything for vomiting.
I am trying very hard not to loathe the evil woman who does not deserve to be called a nurse. I call many of the people who live there my brothers and sisters and all whom I know would give you - someone they don't even know - the shirt off their back and take you home and feed you if you were cold and hungry.

I'm hoping that she is seriously shunned due to her actions, which are selfish and downright evil, but there are some who drop off food to her, I'm sure.
Her and her boyfriend aren't even from Maine.

Retired Spook said...

Back to my original conundrum: Who can you walk away from?

Neighbors? Sure, I'll leave supplies I can spare where they can come out and pick them up.

Others? Not a chance in Hell!

Wife, kids, grandkids? I'll go down swinging, if all else fails.

Grouch, MD said...

Part 1 has apparently disappeared into the ether. Blast. and it was the good part too.

Aesop said...

FWIW, I think a big difference was the case study and Duncan were both several days into the course of the disease before they hit Western medicine; Pham was there within minutes of the first fever, and Vinson within hours.

HUGE difference in outcome, because they could (and did) establish IV access and flush virus out before the patients were debilitated.
Ditto for the Vox story (I read that one several days ago): se is a doctor who began slamming ORS early and often.
Also, both Pham and Vinson got antibody-laced plasma from Brantley.
And we can't overlook the possibility that the Dr. in Africa was just that 1 in 10 patient.

Bottom line, we have a bare handful of patients to judge by.
9 total in the US to date.
Which is statistically insignificant.

If it turns out that this thing can be cut back to "only" 30 or 50% mortality with early and aggressive fluid therapy, that would be great. It won't help in Africa, but it could make it a lot less scary here.

But that's still a huge if.
It could also turn out that without that antibody-rich plasma, the normal course more closely resembals the Senegalese doctor in the NEJM case study, which means that we'll use thou$and$ or dollar$ in re$ource$ and still lose a lot of people.

Looking at the case write-up, the guy was lucky to survive. had he not been an MD, they wouldn't even have tried, but in Senegal, he's scarcer than gold.

So far, we've only lost Duncan, whom many (including this writer) regard as largely a waste of skin and oxygen, when the scales are balanced.

I suspect that when we start to see patient body bags piling up here, the enthusiasm for treating people at great expense, and the toleration for importing further victims, will wane precipitously.

Like to the point of people doing everything short of shooting the incoming planes down from the highways adjacent to those 5 airports. people will only be pushed so far, and then the fringe folks start to go sideways.
Then it's a party.

Grouch, MD said...

Will try to recreate part 1. It won't be as good.

Lots of thoughts.

Disraeli: Everyone that tested positive for ebola by PCR had ebola. Can't fake that.

Gamegetter II: preps are always good, will never discourage that.

Left my comment on CA's post, on his blog.

Anon, I read the Vox post, but thought for sure you would recommend this one:


In short, this is a nurse in training, with fair logistical support, that nursed 3 out of 4 family members back to health. She had a decent homemade PPE setup, and IV fluids, antibiotics, and support from a doctor in the area.

So, can you treat ebola at home? Uh, I guess. If it has managed to slip past your preventative defenses. And those had better be in depth. Then if there is any other option you take that one. Then if you can't, you double check for other options, maybe offer up some cash under the table or a fine set of slightly used cows, or whatever passes for barter post SHTF. Get my point?

And yet…

ron8072 said...

And while we are focused on the "ebola" crisis, we are not paying attention to our southern border where the flow of sick 26 yr old children and younger, has not stopped. No telling where they are all housed now! This administration is adept at slight of hand especially using the shiny and glittery stuff from the right hand while the left hand tightens the screws on what is left of the freedoms we used to fight so hard to protect.
If I can borrow an oft used thought, "Has anyone contacted Lee Greenwood?"

Anonymous said...

What scares me is the avoidance of mention of the possibility of transmital of Ebola by sneezes and coughs, both of which spray body fluids (saliva, mucous, etc.) into the air. That would be coming from a Ebola subject and infecting the air space around them. Medical authorities stress covering your sneeze or cough into your elbow bend to avoid infecting those around you.

Anonymous said...

Nothing scares me more during an outbreak than religious zealots who think they're "helping". E.g., this idiot, already linked.

He writes: "My daughter has always loved being in the thick of things and has been fascinated with Ebola since childhood. Now, in just a matter of days, she will walk into a room filled with sick and dying Ebola patients, and all her training, grit, and compassion will be tested. She will eventually come home on a rotation and be under medical isolation here, in our home, for three weeks until she is cleared."

...yeah. The IQ is just bursting at the seems there, struggling to get out and solve a Rubick's Cube.

He ends his missive with a prayer to Our Lord.

Fucking idiot.

Robin Datta said...

Dr. Grouch:
Please type those commemts into "Notepad", "Notes" or some such and "Copy All" and "Paste". Save the comment to drive, cloud or self email until they show up AND STAY.

Unknown said...

After 43 years of passing gas and dragging my stool around the operating room (retired anesthesiologist), I know a little bit about sterile technique and a few other things. Aesop, you are dead on. I admire your guts. I wasn't sure what the proximate cause of death for ebola is, but according to a research paper published in the Journal of Infectious Diseases, 2003, in non human primates it is disseminated intravascular coagulation, also known as consumptive coagulopathy or defibrination. This condition is due to a "dysregulaton" of the clotting cascade, starting with the inappropriate release of tissue factor. I saw this condition frequently in humans with septic shock, or massive hemmorrage from trauma or ruptured abdominal aortic aneurysm. The only treatment in my experience consisted of platelet transfusions,fresh human plasma, and or fresh whole blood. A very small number of patients survivived this condition.

I noticed that the NEJM article did not mention major bleeding in the patient. Perhaps this is why he survived. Could this be an area where effective treatment might be directed, as well as vaccine development? Couldn't hurt.

Aesop.. Keep up the great work! I'm recommending you to all my friends and neighbors.

Robin Datta said...

"there's still virus being excreted in urine and sweat for up to 40 days after the disease manifests"

Any chance President Hussein acquired the Pham-Vinson disease?

Percy said...

The details provided here are priceless and not available elsewhere (at least not conveniently). Nevertheless, the blog threatens to become an “It’s The End Of The World!” thread. That would be a mistake.

There’s a political twist: Is Washington really terminally stupid and deceitful (and even is there some sort of conspiracy at work here)? A humanist element: What will you do if and when your wife or daughter gets the disease? A disaster element: Say my worst fears are reality and everything goes to shit, what do I do then? And a science/health element: How has it been with this disease here and elsewhere, how does it work, and how do we keep it away from us? Only the last of these four is essential information, however interesting all the rest is. The first three threaten now to overwhelm this very valuable thread. I pray they do not. All this is too important for that.

Speaking personally, I hope our resources here in the USA (including basic smarts) are sufficient to hold the thing at bay, including the ability to be heartless when to be otherwise is a near self-death decision. Those resources could well be sufficient, if frighteningly fragile. Or not. Have we or have or we not screwed the pooch already? Impeding the answer to this is misinformation from the government, due to ignorance and uncertainty (forgivable mostly) or worse (politics — irrelevant and terribly dangerous), terrible high-level decisions (e.g., sending armed forces to West Africa for some inexplicable reason to build irrelevantly small places for Ebola patients), and simple lack of experience with a plague of this kind. Say this is so — that is, that, as of now, we are still pretty safe. If so, what factors determine whether this will continue to be so? What do we need to do but have not yet done to be sure of this? How much time do we have within which to do it?

What else is relevant? Not much.

My guess is that we will do diddley about Ebola in West Africa, that we already know that we will not and cannot, that tens of thousands of cases will arise, go untreated there, and that such a number will die of it there. Second guess: in the end, it will burn itself out and go into retreat in West Africa. Third guess: it will be contained here and not be a big deal in the USA (or in Europe or Asia).

Just guesses, of course.

Thanks, Aesop, for all this, and for your understandably unforgiving vitriol. Keep it up.

Anonymous said...

Immediate evacuation to quarantine on a barren rock at sea for Americans in affected zones. With service comes delay and boredom.

Flamethrowers. Ring-fence affected areas, crater runways, delay ships for weeks, nothing leaves, mercy supply drops on pallets with crews aware of non-rescue policy.

Do we want to live, or what?

Lt. Greyman, NVA said...
This comment has been removed by a blog administrator.
Anonymous said...

There is word here in the Philippines of a potential treatment for Ebola. Not a vaccine, and expensive as hell.

They have developed a drug cocktail for treating hemmoragic dengue here that has proven effective. I'll get the doctors name and post here.

It has not been tried with Ebola patients yet but more than likely will be used here when they pop up.

Nightmare scenario is ships with infected crews land here at the port, and plane arrivals.

The government is recalling and evacuating over 2000 people from Sierra Leone and Liberia. That is 2000+ from each country and considering recalling the Filipino UN peacekeeping troops in Africa.

They are working on a plan to mobilize everybody they can here not if it gets here but rather when. They will even mobilize the bureau of jail management, along with all police forces, military, and any other group they can think of.

The search is on right now for a suitable quarantine location here. Several locations are being tossed about including Corregidor which is a tourist area and has facilities plus is logistically good, a former leper colony island in Palawan, and some of the other small islands.

Dieter said...

Nurse suing? What nurse has the time or money to sue the government for something essential as frivolous as in his case. THIS IS NOT A NURSE. THIS IS A CDC EMPLOYEE CARRYING OUT GOVERNMENT POLICY. There! I've said it! Another whacko conspiracy nut joins the clan.

Aesop said...

I don't that's whacko; nor do I think she's part of a conspiracy, per se. I think she being happily and consentually used by Hopey Dopey et al out of convenience to their desires.

I think she's personally an entitled whiny jackass, whose personal whims conjoin serendipitously with the wishes of her employer(s), and of the Usual Suspects (whence cometh the sudden pro bono ACLU ambulance chasers, fresh from a White House visit).

Anonymous said...

What is up with giving antibiotics for a viral disease? is it a matter of "we've got it laying around, so let's see if amoxicillin helps" or opportunistic infections or what?