Saturday, October 11, 2014

Surfing USA

One fine sunny morning in California, the San Andres Fault finally rips loose, there's an 8.5 earthquake, followed by a couple of 6.4 aftershocks just a few miles off the coast. Within minutes, the Santa Monica Pier is sitting 40 feet above the waterline, with a few fish flopping around on the glistening sand and kelp puddles that were in twenty to thirty feet of water just a few minutes earlier. Standing on the beach, you look offshore, and see a slight bulge in the waterline, not very high, but it seems to be moving fast inbound. It's 200 yards to the parking lot, and there's a downed streetlight sitting across the hood of your car anyways.
So how do you catch the incoming tsunami and ride it safely home?

You and the family are enjoying a nice vacation to Hawaii at Volcano National Park. Your only son, ignoring repeated stern warnings, climbs up on top of the boundary fence near an open crater, and before your horror-stricken eyes, slips and tumbles into a pool of glowing red lava. How do you dive in and save him?

You're an hour out of Miami headed for London, the plane is humming along, the co-pilot's doing everything like a pro, you're at 35,000' in clear skies, when suddenly there's a loud thump, all the alarms and lights in the cockpit go off at once, and as you're struggling to assess your problems and options, you can hear the fight attendant screaming through the cockpit door that apparently the tail and both wings, including all your engines, just fell off. How do you glide in for a landing?

The answer to all three questions is the exact same:
Don't be there. Be someplace else, far, far away. Period.

In comments to recent posts, several times, I've been asked to please tell folks what medical supplies to stock to care for family members if they become infected with Ebola. It's a serious subject, a serious question, and to all appearances, asked by serious people. So let me give you a serious answer to

"How do I care for family/friends with Ebola?"


"But Aesop, you don't understand, I love my wife/husband/son/daughter/brother/sister/aunt/cousin/grandpa/parents/pet giraffe, and I HAVE to help them!"

No problem.
1) Make out your will.
2) Do whatever you like. Don't bother with PPE. Treat their symptoms.
Result: They're (90% odds) going to die, you'll get infected, and then (90%) you're going to die too. Scatter any others under the same roof in there randomly as individually appropriate.

And there's absolutely nothing you're going to "stock up" on that will help, or change that reality.

Let me break it down, so that it's obvious I'm not just being a fatalistic dick about this.
Working in an Ebola Treatment center requires meticulously donning an impervious coverall, gloves, booties, hood, high-efficiency bio-hazard mask or powered respirator, goggles, apron, and more gloves. It typically takes two attendants to dress one person, to make sure everything's on right, tied closed, zipped up, and all the pieces in place, including places you can't see, like in front of your face and behind your back.

This all requires a clean, infection-free dressing area. Then they enter the patient treatment area through a door or doors that keep the infection locked in. The patient area needs to have everything the patient or caregiver needs stored within, because once you go in, you can't come out until you're decon'ed and all contaminated garments are removed.
So you have to have all medical supplies there, plus a bathroom area for the patient(s), and all sealed off from any outside contact.

Then you need another area to be decon'ed, and strip off the PPE, layer by layer, slowly and flawlessly, without contaminating yourself in the process, which requires more attendants to spray you with bleach solution, plus drains, disposal bins, showers, sinks, incinerators, etc.

Then you need a means to incinerate the waste, and a handy supply of ever-fresh new disposable supplies, for every time you suit up, and a crew to decon the re-usable stuff, with flawless precision each and every time.

And if you screw it up, you go into quarantine for 21 days. If you really screw it up, you move to the patient ward yourself, because you are one. To date nearly 400 healthcare workers in Africa have made that last transition, and most of them are dead now.

The easiest thing to do in this outbreak is get Ebola and die, as over 4000 people could tell you now themselves, if we'd only reconstitute their charcoal incinerated atoms and resurrect them to chat with us.

Setting up such a facility is such a royal PITA, most major hospitals don't even attempt it for training without weeks of meetings and prep, and they usually screw it up royally even then, despite hordes of trained professionals, thoughtful planning, and budgets any of us would envy.

So, what part of that could you reproduce, when failure = slow lingering death by liquification of your internal organs (while you're still using them)?

"But...but...IT"S MY WIFE!SON!BABY!MOTHER! I LOVE them!"

Noted. Of course you do. So be a hero, dive into the lava pool, and see how far you get.
After all, I could be wrong.

But on the theory I'm not, realize this:
Healthcare authorities yesterday threw in the towel with respect to Sierra Leone.
All of Sierra Leone.
They're going to start distributing home healthcare supplies there.
That stuff is going to enable family members to care for each other. And as a result, one infected family member will kill their fellow family members, with a 70-90% efficiency.
The charities involved have come to the conclusion that Sierra Leone's 5.7M people need to be cut loose, and they'll give them what they need to do minimal comfort care for family members, for whom there are simply no beds, and the disease will run rampant until it runs out of people to kill there. Probably nearly all of them, unless someone has the means and supplies to stay inside unexposed until 5.2M of their friends and neighbors have died, and the virus runs out of hosts or growth media, like decaying corpses. To the tune, potentially, of about half the entire Nazi holocaust, in total size.

The entire country has just been put on hospice, because we simply can't catch this virus.
It'll take weeks to burn out, thousands, perhaps millions more will die, and the people running the medical relief groups know all this right now.

What you can do:

You aren't going to be going out with a mask and such here if Ebola becomes more "than that one guy in Dallas". If you're riding on planes and busses with a mask on, you're an idiot. In short order, you'll be an infected idiot. And shortly after that, an ex-idiot. Don't be that guy.

You don't need masks, gowns, gloves, etc.

You need WATER. A source, not just a faucet. Barrels, bathtub, well, rain collection. Hell, pull your cars out of the garage, and put an above-ground pool up, and fill it with water.
Get a water purification filter, unscented bleach, etc., to keep drinking water clean.

You'll need FOOD. Not 3 days, but more like 3 WEEKS, and more likely 3 MONTHS worth. Ebola started in March in Africa. By next May, as things look now and with no change, it will be well on the way to wiping those nations off the planet, with 70-90% efficiency. So, have you got a year's food? Canned goods keep from 2-5 years. Dried/dehydrated for longer, but it's a lot pricier.

You're going to need a way to cook food, stay warm in the winter, etc. So power/electricity/fire. More ways is better.

If you have stored water, food, and means to purify/prepare both, you don't need to go out into the contagion.

You're going to need basic medical/first aid supplies, because going to the hospital during that time for a cut or broken bone isn't going to be an option.

You're going to need a way to be your own 911 - medical, fire, and police, because those folks may not be there to pick up when you call. Assuming calling is even an option at that point. Can you fix your own boo-boos? Put out a fire? Be your own cop? Get cracking.

The likeliest decontamination supplies will rarely be bleach (mixed in water), and more often than not a gallon of unleaded and a road flare, for the bodies that drop too near, or don't get picked up right away. If you think you want to gown up and play with them, drag them around, and/or give them a Christian burial, best wishes. We'll all split your gear after you're gone.
If I have to deal with any bodies, they're getting a Viking funeral, and an "Amen" by way of services.
If they aren't within throwing distance of a road flare from the property line, they're not my problem, nor within my jurisdiction.

If this outbreak gets contained where it is, great. Hallelujah.

If it doesn't, it isn't something you're going to get through.
It's going to change life as we know it, for years.
You're either going to totally avoid it, or it's going to weed you and your family out of the gene pool permanently and painfully.

And anybody who tells you anything different is either afraid to tell you the awful truth of that, woefully under-informed, or selling you a bill of goods. Or all of the above.

The only way to take care of family members with Ebola is not to have to.

The only possible exception is if you have a big enough tribe/family/group/whatever that you really do have a compound, buttloads of supplies, dedicated clinic space, and enough people to care for one or two persons who get infected (knowing that 50-90% of them will die anyway, and with the mental and physical preparation and means to deal with the disposal problem if that happens too). And if you're that well-prepared, you don't me to tell you how to handle things.

Personally, I'm betting outside of publicly funded entities, the number of groups to whom that would apply could be counted on your thumbs.

I hope anyone considering the future in the case that this becomes an epidemic here will recognize this as the definitive answer to this question, and not press for more. It simply doesn't exist.

I can't tell you anything more, because there's essentially no way to accomplish what some of you are thinking about, and it would be immoral and unethical for anyone to suggest otherwise. I certainly will not.

The best way to prepare for this getting worse is not by going to the drug store.
It's by going to the supermarket.

I understand what a rude shock that may be right now to a lot of folks.
Imagine what it's going to be like for people who don't get the lightbulb-over-the-head moment until after it's too late to get ready.


CATP said...

Ok that was sobering.

What about using supplements to at least improve resistance to getting it in the first place?

Emily Disraeli said...

I have not read anything about whether or not if you survive Ebola can you become reinfected?

Aesop said...

Resistance to getting it is conferred infallibly by distance. AFAIK, nothing else is known.

Current Ebola survivors are used to care for other sufferers in the Africa wards now.

The survival pool of such is too small to date for there to be any meaningful data on the possibility of reinfection. Theoretically, once you've had it, your immune system should take care of it afterwards. Whether that's true on different strains is an unknown, again, because the survivor pool is such a small sample, and testing deadly pathogens on humans isn't ethical. Any evidence would thus be almost completely anecdotal.

Anonymous said...

Lauric acid has antiviral properties, coconut oil is a great source of Lauric acid. Not saying it's a magic bullet but it surely can't hurt.

Aesop said...

@Anon 9:08PM

Great link!

Retired Spook said...

Yeah, I'd pretty much figured out that in order to not get EVD, you need to stay away from people with EVD. But there's the ones I can't walk away from.

Guess you're tougher than I am.

Anonymous said...

Yes, tough stuff indeed. The article of the woman doc in Nigeria was good as well.

For anyone who like the poster above have ones they can not leave:

I'm thinking the dry solution can be mixed, air vac packed and stored.

Aesop, thanks for the sobering assessment.

William said...

...50 to 90 percent...ok

William said...

In the "end" it comes down to a binary or zero...yes, no.There is no middle ground. Until there is a solid way to inoculate against this in a human host, this will kill or it will not. And as we have an historical record of the illness it has a very high mortality rate. NO preventative measures exist. The way that "our" government is dealing with the problem It will kill many of us, before this plague is halted.

Anonymous said...

Why isn't the CDC following its own rule book, that is the question...BMBL 5th ed, search filovirus or Ebola...

karol said...

Thank you for such a complete honest review of what we may face in the coming days. I would like to recommend visiting for help with building immune systems and also very good advice on preparing. But first I would like to recommend everyone take some very sound advise from our Founders and "pray". Our Creator is our "first responder" and all things are possible thru HIM. Faith in HIM as small as a mustard seed can move mountains. We have over 300 million people in America, not all are believers, however, there is 83% of this nation that believes in our Creator, HE does set amounts or limits on those HE loves and answers prayers for. What we should be doing is praying for ourselves, family, friends, government and the nation. Whatever Satan throws at the world, HE is able to stop. "Greater is HE that is in me, than he who is in the world". HE can and will cleanse us of this virus, if we will just humbly bend our knees, ask HIM to forgive our sins, to protect us and cleanse this virus from the land. In 2 Chronicles 7:14, he said exactly that: 2 Chronicles 7:14King James Version (KJV)

14 If my people, which are called by my name, shall humble themselves, and pray, and seek my face, and turn from their wicked ways; then will I hear from heaven, and will forgive their sin, and will heal their land.

Please, give it a try, at this point we have no other recourse, but every reason to believe HIS word.

Anonymous said...

Serious question:

What is the "pivot point" of lethality with this thing. I mean, we hear the 50-90% chance of death, but what does "making a recovery" look like versus "past the point of hope"? Beyond that, what sort of recovery can be reasonably expected for the lucky ones? Liquified organs don't just grow back, right? I guess what I am getting at is that it would be nice to know what signs to look for to identify the threshold of certain, painful death, where mercy might be more appropriate than false hope.

I haven't been able to find anything on this, but being as how SOME are surviving (right??), the circumstances should be documented somewhere, I would hope.

Very respectfully,

TFA303 said...


I greatly appreciate your expertise and clarity of reasoning. Please know that your blogging is helping in a very real way.

Keep them coming, as long as you can.

Dr. Strangelove said...

If I my respectfully disagree with some posters. It has a 50% to 90% death rate WITH Optimum CARE. In a first class med center with IV and anti-fever drugs and anti-virals and organ support, etc.

I would say the death rate in a homespun "medical" facility is near 100%. The ones worth your respect would suicide.

The only known vaccine grows in the tobacco plant (irony!) at too slow a rate to mass produce and already at some of these places their have been "accidents".

Home care is not going to fix this. This is as bad as a bite from a Walker.

Aesop said...

50% is best case, full support, top-tier first world care.
73% is the average officially confirmed death rate in W. Africa now.
90% is the maximum death rate anywhere, anytime, with home- or no care.
That's why I selected those numbers.
It's not likely to drop below 50% without a vaccine or treatment, and it isn't going to top 90% unless we do something idiotic like start euthanizing people.

Home care is a recipe for killing off entire family units.

Anonymous said...


I hear you on the home care = family doom time, but once the hospitals break down, there aren't a lot of options. Anyway, regarding my earlier question, I guess what I was hoping to learn about was the progression of the disease among survivors, particularly in no-care circumstances. I am especially interested in what will be damaged (organs), and to what degree. Are we talking a lifetime of kidney dialysis (or the need for liver transplant) as best case? If the organs are not completely destroyed (which I am assuming would be the case if they were to survive at all under W. Africa conditions), what would be the biggest danger (dehydration, fever, etc)?

On the flip side, if that glob of shit that you just slopped out IS your kidney, is it a safe assumption that the death is inevitable and just around the very painful corner?

I hope you follow my line of questioning here.

I'm just looking to understand the best case timeline under no-care circumstances, and on the other side, to be able to understand what markers to expect when the threshold of fatality has been passed.

Thanks again.

Very respectfully,

Bryan said...

Art Bell just linked your article.. Expect LOTS of hits

Anonymous said...

Terrific article. This is an exponential disaster, unlike anything that we have ever seen.

70+ health care workers in Dallas went shopping, their kids went to school. Those people went back home went shopping and their kids went to school. You do the math.

In 1918, there were no planes or means of rapid transit.

This is a global disaster, and the economics are not pretty. The airlines are going to go broke. Just watch the holiday season. You would have to be a complete idiot to board any plane. The close proximity to others and recirculated air is a recipe for disaster.

Prepper Time. Time to stock up on everything that you need to limit shopping trips. Hunker down as much as possible to limit your exposure to others. Cook your own food (no restaurants), you know the last time you washed your hands or sneezed.

Better to be prepared and not need it rather than to need stuff and not have it.

Aesop said...

The best thing I've read recently was the link from another Anonymous on 10/11:

As for timelines, either you're going to recover in two weeks, or not in two weeks, generally.

That patient's tale seems to indicate that a big help is staying hydrated enough, which means lots of ORS/Pedialyte/water.

The problem is that if uninfected people choose to care for infected people, they're just adding to the toll without flawless protection available.

And as I noted, it's extremely unlikely anyone will be able to provide that.

The best solution is not to get infected in the first place. Ebola doesn't come up the driveway, knock on the door, and mug you.
If you're in the house, and your loved ones are in the house, and Ebola's not, it's just a question of self-imposed isolation.

If one waits until infected individuals are running rampant before they shut the door, they've already waited too long.

And when to make that call is an individual decision.

Anonymous said...


Thanks to you and the commenter for that. The article confirmed what I had been expecting regarding hydration, and led me to do a little google search for the ORS oral therapy that she mentioned. Here is a link for the WHO publication on production of the stuff.

It looks like along with salt and glucose, the only other ingredients needed are Potassium Chloride and Trisodium Citrate Dihydrate, both of which are available on amazon in bulk for a few dozen bucks.

It goes without saying that home treatment is the last thing that I would want, but from everything you have been saying, once this thing really takes off locally (and the medical system goes truly tits up), what alternative is there.

I hate to keep coming with questions, but what are your thoughts of insects as a vector? Houseflies do what they do, and correct me if I am wrong but, wouldn't little bug legs be capable of transferring a few million strands of this stuff from random puke pile to random high traffic surface. How about mosquitoes? I know the cold season is coming, but the last few days in PA, I have been noticing a hell of a lot of the bloodsuckers still out and about. I have seen rodents and dogs mentioned, but do you have any thoughts on what other potential vectors other than humans? Are we going to have to redefine "bushmeats" for the whole North American experience?

Thanks a million for what you are doing, sir. Stay safe and good luck.

Very Respectfully,


Aesop said...

The experience of Duncan's family is instructive:
Decon would be costly, and depending on the seriousness of symptoms, might necessitate gutting a given living space, including carpet, mattresses, etc.

As for the 50 days claim, believe it. Here's the MSDS for Ebola from the Canadian Public Heath Agency, which has been online months before this outbreak became a news item:

Section IV, "Survival outside host" is what you want. It also lists inactivation/decontamination methods.

Your family situation is a bigger problem. But I wouldn't worry about bugging out at the point one becomes infected. You'd be quarantined within hours.

The whole point of bugging out is to go before that becomes an issue. Once someone gets it, your destiny is in the hands of the local health authorities.