Sunday, November 30, 2014

Ebola Care: Pulling the Plug

From comments on one of yesterday's threads:

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

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

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

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

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

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

Almost all of ours, just the opposite.

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

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

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

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

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

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

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

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

Saturday, November 29, 2014

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

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

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

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

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

Why No One Wants To Play With The Ebola Kids

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

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

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

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

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

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

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

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

Mali Ebola Free - For The Moment

Nov 29 (Reuters) - Mali has no more confirmed cases of Ebola after the last patient known to be suffering from the virus was cured, President Ibrahim Boubacar Keita said on Saturday.Mali has registered eight cases of Ebola - seven of them confirmed and one probable - after the virus spread from neighbouring Guinea, the World Health Organization (WHO) said this week.
Six of these people infected have died, the WHO said. A further 285 people who came into contact with them are being monitored but have shown no sign of the disease.
"At this moment, there are no cases of infection (in Mali)," Keita told a summit of francophone nations in Senegal.
"The suspected case turned out to be negative and the day before yesterday we had the good news of the first cured case of Ebola so I can now say zero cases in Mali," he said.

...except for those 285 people still under surveillance for the next week or two.

And the next infected carrier from across the border who plops a case there.

Graveyards Filling, Hospital Stays Empty

(UK Telegraph) - The British government’s flagship hospital in Sierra Leone is caring for only eleven Ebola victims, it has emerged.
The Department for International Development has put £230million towards helping Sierra Leone fight Ebola, but only 28 people have been treated in the new facility since it opened several weeks ago.
Another hospital a few miles away is having to turn Ebola victims away from its doors, meaning that they return to their homes and risk further infection in the community.
The British response to the Ebola crisis is facing serious criticism locally for its management, and has been called a “complete mess”, by aid workers in Sierra Leone.
Questions have been raised about DFID's decision to hand the management of the new facility in Kerry Town, near the capital of Freetown, to the charity Save the Children.
Sir Edward Garnier, a Conservative MP, said he was concerned about how few Ebola victims were being seen by the medics at Kerry Town.
"What strikes me is that this is not a good use of public money and it is not achieving its aims," he said. "The Connaught hospital in Freetown is overflowing and turning people away, back into the community, although they are infected with Ebola. This hospital has 92 beds, and they are almost all empty. It seems to be going very slowly."
DFID and Save The Children insisted that the plan had always been to scale up the new facility over time, despite the urgent demands by the World Health Organisation that there was an immediate response to the Ebola crisis.
 The Kerry Town complex includes an 80 bed treatment centre and a 12 bed centre staffed by British Army medics specifically for health care workers and international staff responding to the Ebola crisis. However, dozens of beds are lying empty. 
The construction of the treatment facility was overseen by British Army Royal Engineers.
The site also hosts an Ebola testing laboratory run by British scientists to accurately diagnose patients.
The £230 million Ebola response package from Britain includes funding for supplies such as chlorine and protective clothing, burial teams to increase capacity and work with communities on new burial practices. The roll out of community care centres is also planned.
"Britain is today providing 211 Ebola beds in facilities that the UK has built, expanded or kept open - including 23 beds rolled out so far at Kerry Town - and 232 beds and places in community care centres where Ebola sufferers are going for initial care and diagnosis,” said a DFID spokesman.
"Save The Children, a major global NGO which includes the international health charity Merlin, was available and keen to take on the management of Kerry Town at a time when other NGOs were stretched and unable to do so."
A spokesman for Save The Children said:  In answer to questions about patients, I can confirm that as of this morning, 28 people have been treated for Ebola at the [centre]. This is a cumulative figure of those treated since opening."

I got nothing. There's no attempt to explain this, or make any sense of it, because it's simply insane.
But with 100 cases a day popping up in Sierra Leone, this should keep those burial teams busy well into the new year.

Friday, November 28, 2014

Play Stupid Games, Win Stupid Prizes

(WaPo) EBOLAVILLE - The doctor who treated Martin Salia, the Sierra Leonean physician who died of Ebola last week after being transported to Omaha, has contracted the disease himself.
Komba Songu M’Briwa cared for Salia, his colleague and former professor, at Freetown’s Hastings Ebola Treatment Center before Salia, whose family lives in New Carrollton, was transported to the United States.
After Salia’s initial Ebola test came back negative, M’Briwa said employees “were celebrating” by embracing him. Salia’s subsequent test came back positive, meaning they had been unknowingly exposed to the virus.
It’s not certain that was how M’Briwa contracted Ebola.
M’Briwa is the ninth Sierra Leonean doctor to be diagnosed with the disease. He was a top physician at Hastings, one of the country’s largest Ebola treatment centers, with 120 beds.
In an interview with the Post earlier this month, he expressed frustration at Salia’s first negative test, which he said might have endangered his colleagues, who then assumed it was safe to touch him.
“If the test says you are Ebola-free, we assume you are Ebola-free,” he said.
In many cases, a negative test at that stage means nothing because “there aren’t enough copies of the virus in the blood for the test to pick up,” said Ermias Belay, the head of the CDC’s Ebola response team in Sierra Leone.
This is what happens when you ASSUME.
I'ma go out on a limb, and opine that he contracted Ebola from the infected doctor. Call me reckless.

Speaking of reckless, Nurse Crybaby Strippername, call your office immediately!

This is why your initial "negative" tests meant two things to people who didn't sleep through their nursing schools: Jack, and Shit. It's also why your lying ignorant ass should have been thrown right back into an unheated Ebola quarantine tent, and held there at gunpoint behind barbed wire for the full 21 days, you selfish jackass.

Please, kill yourself - really, I mean this, go actually do it - before you do any more harm to either the profession you allegedly practice, or the community you disserve and endanger, both here, where we pay you, and over there, where your selfish ignorance and personal example, or both, may have directly led to people dying.
If that's too much to ask of such a flaming narcissist sociopath, burn your license, quit the profession, and go back to whatever you did before someone clearly incompetent to evaluate you foolishly told you that you could do nursing.

In a just universe, they'd be tying you to a stake and piling up bundles of straw at your feet already, preparatory to a good incineration, not only for your own crimes, but pour encourager les autres.

No Rosy Goggles Here

From the UK Telegraph:
 A few months ago I read a blog of an MSF volunteer who found himself shouting over the beautiful jungled canopy of Sierra Leone “Where is everybody”?
Today, four months after the World Health Organization declared an international emergency, I did the same thing.

I had gritted teeth and clenched fists and it came out as more of a squeak than a war cry but still, my fury and incomprehension echoed his.

I always knew I would find it frustrating being unable to provide care as sophisticated as I would like for patients suffering, but this isn’t only about the unavailability of intensive care units and swishy machines that beep.
This isn’t only about watching young people die in a terrible way and being able to offer nothing but time-honored words of comfort in badly accented Krio.     This is about people dying in triage tents with no access to any kind of medical therapy as there are no beds available. 
This is about having to put desperately sick people in ambulances for five hours as that is how long it takes to get to the nearest treatment center with space.
This is about laboratory turn-around times that mean that people negative for the disease sit in beds next to patients with profuse vomiting, diarrhea and bleeding for up to eight days, waiting for their test results.
This is about how the world knew that a nightmarish plague had hit west Africa and the world waited over six months and then sang a song about it.
Of course, I know that many agencies are contributing and working as fast as they can, and that there are some on the ground who have been advocating and campaigning for action for months.
I only arrived a fortnight ago so I can’t imagine how much more furious and frustrated they must be. Perhaps during my time here progress will be made and there will be improvement.
There are many dreadful things about the Ebola epidemic - the suffering, the squalor, and the undercurrent of fear that you could be next. For me at this point, by far the most terrifying is that nothing will change and the status quo of international turpitude will continue.

The pitifully few "treatment" facilities in Sierra Leone are overwhelmed.
They provide exactly no "treatment".
The labs are slow, overwhelmed, and help to ensure those uninfected on arrival are infected in short order, thus "treatment" = infection.

Given all of that, and the fact that health care workers certainly talk to people too, is it really that surprising that the epidemic continues unabated, while the infected or merely suspected infected stay away in droves from such medieval levels of "medical care"?
This is the kind of medical malpractice that put Florence Nightingale on the map in the Crimea, and the same for Clara Barton in the Civil War.

Of course the "official" numbers most places are dropping.
People in West Arica are illiterate, perhaps even backwards and stupid.
But they aren't all barking mad.

Faced with those prospects, anyone with a lick of common sense, who heard the ominous tones of "We're from the government, and we're here to help" would

Amazing how that lesson crops in in history pretty much universally.

I Guess This Means Liberia Can Cancel Christmas

(Liberian Observer) EBOLAVILLE - Dr. Atai Omurutu, head doctor at the Island Clinic Ebola treatment unit, has raised an alarm over the disturbing incidents of male Ebola survivors infecting their partners and putting entire families at risk.
Dr. Omurutu said wives of male survivors are being admitted to the facility because they have contracted the disease from their partners.
She appealed to the Ministry of Health for condoms to be given to male survivors in order to stop this mode of transmission of the Ebola virus.
She disclosed this new wave of infection to President Ellen Johnson Sirleaf when the President toured Ebola Treatment Units.
Dr. Omurutu, a Ugandan doctor, stated that once a person survives Ebola, they still have the virus in their semen for up to three months, therefore it is extremely important that male survivors abstain from sex during that period or use a condom to avoid infecting their partner.
I'm shocked! Shocked, I say, to find out that Ebola will continue to blossom for months longer in Liberia for the same reason that AIDS is endemic to Africa: lack of basic common sense or scientific reasoning skills among the population.

So much for Liberia's presidential hopes for "A Christmas without Ebola" in 2014.
But Ebola does have one small silver lining: it keeps the stupid people from breeding.
(With the unfortunate side effect of infecting and killing their spouses, and then by extension the rest of the family.)

Happy holidays from another disease that's a gift that just keeps on giving.

Thursday, November 27, 2014

Mali: Ripples Continue Outward

(WHO) - Mali’s Ministry of Health has confirmed an additional 2 new cases of Ebola virus disease. The first, confirmed on 22 November, occurred in the 23-year-old fiancée of the 25-year-old nurse who attended the Grand Imam from Guinea (the index case in this outbreak) and died of Ebola on 11 November.The young woman developed symptoms on 19 November and, on 20 November, was hospitalized in isolation at Bamako’s Ebola treatment centre, a new facility which opened last week.
Because of her association with the nurse, most of her close contacts were already under surveillance. Her case was detected early in the disease course. Her quick isolation has further reduced opportunities for community exposures.
The second new case is part of a family of previously confirmed and deceased patients. The 27-year-old man lost his mother and half-brother to Ebola.
He developed symptoms on 19 November and was admitted for treatment at the new facility on 24 November.

So they're now on tier three of infections, and the second new case was wandering around loose and symptomatic in Bamako for five additional days.

That will work out well.

Operation Dumbass Drop II

(Reuters) BOHICA - Sierra Leone appealed to the United States on Wednesday to send military aid to help it battle Ebola as it falls behind its West African neighbors Guinea and Liberia in the fight against the virus.While the outbreak appears to be coming under control in Liberia, thanks partly to a health operation run by U.S. troops, infection rates have accelerated in Sierra Leone.
The rate of transmission is also beginning to slow in neighboring Guinea, the first country to report an Ebola case, although case numbers are rising in Mali.
"I believe now that the cases are reducing in Liberia, he (President Barack Obama) will ask the Department of Defense and the State Department also to turn attention to helping the efforts in Sierra Leone," said Alpha Kanu, Sierra Leone's minister of information and communication.
He also appealed to the United States to help Guinea, and urged Britain to provide more assistance to Sierra Leone.
Guinea's President Alpha Condé said on Wednesday he is ready to authorize the use of force if necessary if anyone refuses to let doctors check Ebola suspects for signs of the disease.
"We have an agenda, which is to get rid of this disease as quickly as possible," he told a news conference.
Britain, the former colonial power, has sent military personnel to establish treatment centers in Sierra Leone, as well as three helicopters and a 100-bed naval hospital.
The U.S. response in Liberia involves 3,000 troops.
"The difference between Liberia and Sierra Leone is that the American response was faster and stronger and more robust in the beginning, using technology that was easier to put up than what the British are doing in Sierra Leone," he told reporters.
The deputy commanding general of U.S. Operation United Assistance said this week the country had the capacity to help other Ebola-hit countries but denied there were immediate plans to do so.
Sierra Leone's President Ernest Bai Koroma has introduced emergency Ebola measures. He said it might be necessary to call another three-day lockdown to remove the sick from communities and transfer them to newly built treatment centers.

Putting 3000 troops into Liberia accomplished nothing, as they notably constructed nothing for over 8 weeks, and by the time they did, people had elected to die at home instead of going into quarantine.

So Sierra Leone wants some of that, and some General Fuckdup says "Why sure, let me drop my trousers and bend over for you, sir!"

So if you're in the military, below the O-7 grade, you know what's coming next.
"The good news is, a lot of them speak English, and they're not shooting at you.
The bad news is, they'll be bleeding out the ass, there's no cure, and we won't be issuing any of you any protective gear."

But notably, things are going so well in Guinea that they're willing to "use force" on anyone refusing treatment or quarantine.
Wait, I thought Ebola was "under control" in Guinea...?
So, apparently, "under control" means everyone there as well has decided to say "Eff that!" whenever the suggestion is made that they get in the van and go to the Quarantine Death Center for their ration of NoCare and a plastic shroud.

The sheep, having noticed no one comes out of the abattoir, are declining to go inside.
"Thank you for your kind invitation to the BBQ.
Before we RSVP, we'd like to know who's on the menu?"

Wednesday, November 26, 2014

Ebola: Melodrama Descends To Farce

H/t to commentor geoffb for this one. We needed some comedy for the holiday weekend.

FREETOWN, Sierra Leone (AP) — The Ebola outbreak in Sierra Leone, which has been surging in recent weeks, may have reached its peak and could be on the verge of slowing down, Sierra Leone's information minister said Wednesday.

But in a reminder of how serious the situation is in Sierra Leone, a ninth doctor became infected Wednesday and the World Health Organization said the country accounted for more than half of the new cases in the hardest-hit countries in the past week. By contrast, infections appear to be either stabilizing or declining in Guinea and Liberia. The case total includes 600 new cases in Guinea, Liberia and Sierra Leone in just the past week, according to the WHO.
Dr. Songo Mbriwa, a top military doctor who was working at a treatment center in the capital, tested positive for Ebola on Wednesday, according to Abass Kamara, a Health Ministry spokesman.
Nearly 600 health workers have become infected in the West African outbreak, many in the hardest-hit countries of Guinea, Liberia and Sierra Leone — all of which had too few of the workers to begin with.
Still, Alpha Kanu, Sierra Leone's minister of information, told journalists in an online press conference that with the imminent completion of two British-built treatment centers, the worst could be over for the country.
"We believe that now that those treatment centers are ready, the transmission of new cases will start reducing," he said. "I don't think we can get any higher than we are now — we are at the plateau of the curve and very soon we will have a downward trend, once we have somewhere to take people."
Sierra Leone has nearly 6,600 of the reported Ebola cases, with about 1,400 deaths, and the infections are increasing swiftly here.
In its release of the latest figures on Wednesday, the World Health Organization said both Sierra Leone and Liberia appeared to be far behind the U.N.-set goal of isolating 70 percent of patients by Dec. 1, with only about 20 percent isolated in each country. Guinea, by contrast, appears to have already passed that target. The agency warned that data is poor and slow to come in, so firm conclusions are difficult.
Kanu, the information minister, agreed that finding beds for patients had been a challenge in the country and predicted that the new centers would expand the country's Ebola treatment capacity to 1,000 beds and would help get the infected out of the community.
He also said that Sierra Leone would repeat its September shutdown when people across the country had to remain at home while medical teams went door to door.

Meanwhile, back in the Land Of Reality, Sierra Leone has chalked up 100 or so fresh Ebola cases per day for each of the 18 days of November for which figures are available, and less than 20% of those are isolated at Ebola Treatment Centers.

So you can believe this version of happygas from the currently most truth-challenged governments on the  planet, or believe your lying eyes.

Guinea and Liberia report 21 and 33 cases/day respectively during the same time span, but Liberia's numbers always seem to take a couple extra days to come out, suggesting that someone "massages" the data each week to fit the narrative, rather than releasing the known numbers, and their death toll is actually marching backward over time.
So all you have to do is wrap your head around the idea that suddenly, in those two countries, Ebola has become essentially non-lethal.

Or that the "official" numbers are such utter bullshit, that they are the product of monkeys flinging darts at a target.

Notably, none of these reports are being generated by anyone actually on the ground in Guinea or Sierra Leone, and no one is outside the capitols of any of those countries, while WHO, Medecins Sans Frontieres, and US CDC and DoD spokesholes are completely silent on what's being observed.

So if you want to sell the family cow for some Magic Beans, go right on ahead. But it won't be a giant that falls on you afterwards, nor golden eggs that goose leaves on your floor.

Monday, November 24, 2014

Denial In Mali, Not Just A River In Egypt

BAMAKO (Reuters) - Mali said on Monday that another person had tested positive for the Ebola virus, bringing the total number of cases in the West African nation to eight.
The Malian government did not provide further details about the new case and how the person contracted the disease, but it came after another case was confirmed on Saturday.
It said both cases were at an Ebola treatment center.
If you're keeping score at home, it's doubled there three times in 6 weeks. True to form, mostly among health care workers, which their nation doesn't have a plethora of to begin with. And those are just the exposures they think they know about. And their borders are still wide open to Guinea and Liberia, because they're a land-locked nation.

That works both ways, which must be a great comfort to those in the additional 5 countries they border on with no Ebola outbreak - yet.
"Wait, you're coming from WHERE?"


And The Sky In Your World Is...?

ACCRA (Reuters) - The U.N. Ebola Emergency Response Mission will not fully meet its Dec. 1 target for containing the virus due to escalating numbers of cases in Sierra Leone, Anthony Banbury, the head of UNMEER, said on Monday.
The mission set the goal in September of having 70 percent of Ebola patients under treatment and 70 percent of victims safely buried. That target will be achieved in some areas, Banbury told Reuters, citing progress in Liberia.
"We are going to exceed the Dec 1 targets in some areas.

This is like blaming 9/11 on some guy using his cellphone and causing the airplanes to hit the WTC.
It's ludicrous.

As noted here Saturday, even the NYTimes has WHO admitting that they're so far from their goal they don't expect to come close until the middle of next year (at which point they'll probably tell us a new fairytale story).

Baghdad Banbury obviously hasn't been paying attention.
Which probably has more to do with why this outbreak hasn't been and won't be controlled than the number of Quarantine Death Centers they have or haven't built in Ebolaville.
The bloom is off that rose, and the people aren't going to them. They're sitting in their hovels and passing Ebola around the neighborhood, because they realize can do nothing just as well as the governments can, except that doing it at home takes out their whole family, and the one next door.

Even illiterates in Monrovia aren't lining up to go die alone in a government plastic-sheet hospital for the good of humanity.

The WHO and UNMEER missed their goals because to little too late, and there probably aren't enough available resources in the entire world to catch this outbreak there now.

And we expected blithering idiots like this clown to know what they were doing.
"Hey, you fucked up: you trusted us. I'd advise you to start drinking heavily."

Top. Men.

Remember these @$$clowns, doing the clean-up on Doctor Dickhead's digs after he went bowling?

(Buzzfeed, via Fox News) New York City paid a con man who defrauded distressed homeowners out of millions of dollars during the housing crisis nearly $50,000 dollars to decontaminate the apartment of its first Ebola patient, BuzzFeed News is reporting.
The city awarded Sal Pane and his Bio-Recovery the emergency contract to disinfect Dr. Craig Spencer’s Harlem apartment after the physician was diagnosed with the deadly disease in October.
But Pane’s clean-up truck bore permit numbers that belonged to a dead man, Buzzfeed said Thursday in a lengthy report. The website said the dead man’s grieving sister was duped by Pane into selling him the truck and the company’s name.
The dead man, Ron Gospodarski, ran a reputable company that had years of experience cleaning up anthrax sites and other danger zones. Buzzfeed said its investigation showed that at the height of the Ebola scare in New York, Pane went on TV claiming that experience as his own.
“Twenty-seven years” of experience he told one radio station. “Not my first rodeo.”
Buzzfeed said that 27 years ago Pane was 4 years old.

In 2008, Pane ran a Long Island company that took upfront fees to obtain mortgage loan modifications for homeowners seeking to avoid foreclosure. He was sued by then-New York Attorney General Andrew Cuomo, who accused Pane of running off with fees without helping any homeowners. A judge ordered him to pay $12.5 million in fines and restitution to his victims. He’s only paid back $62,000.
Buzzfeed said Pane also did a nine-month stretch in prison three years ago after a jury on Long Island found him guilty of driving drunk and impersonating a prosecutor.
Pane’s contract with the city to clean Dr. Spencer’s Harlem apartment reportedly paid him and his company $48,000.
The city Health Department said it was unaware of Pane’s background but defended Bio-Recovery’s work.
Buzzfeed said in a brief phone interview Pane denied running Bio-Recovery.  He also told the website, “Enjoy your smear campaign."

$50K from the NYFC Health Department to a bunch of shmoes with a truck and some blue barrels.

So, the obvious follow-up question is where sociopath Pane took the stuff his henchmen removed from Doctor Dickhead's apartment, and what they did with it.

NYFC officials haven't asked, and nobody's telling.

Splendiferous. If you thought pressure-washing the vomit was good, how about looting the doc's apartment, tossing the stuff in some vacant lot, and probably hocking the good stuff at local pawn shops, and then collecting a city check for burglary in plain sight?

I couldn't make this kind of stuff up if I tried. But I think I've seen it somewhere before...

Sunday, November 23, 2014

Why Ebola Is Different

(Reuters) - An outbreak of the plague has killed 40 people out of 119 confirmed cases in Madagascar since late August and there is a risk of the disease spreading rapidly in the capital, the World Health Organization (WHO) said on Friday.So far two cases and one death have been recorded in the capital Antananarivo but those figures could climb quickly due to "the city's high population density and the weakness of the healthcare system", the WHO warned.
"The situation is further complicated by the high level of resistance to deltamethrin (an insecticide used to control fleas) that has been observed in the country," it added.
Plague, a bacterial disease, is mainly spread from one rodent to another by fleas. Humans bitten by an infected flea usually develop a bubonic form of plague, which swells the lymph node and can be treated with antibiotics, the WHO said.
If the bacteria reach the lungs, the patient develops pneumonia (pneumonic plague), which is transmissible from person to person through infected droplets spread by coughing. It is "one of the most deadly infectious diseases" and can kill people within 24 hours. Two percent of the cases reported in Madagascar so far have been pneumonic, it added.
Which, on the surface, would appear almost 10 times worse than Ebola in Mali.

And it would be, except for one thing:

You can hand somebody with bubonic plague about $25 worth of doxycycline, and send them home, (presuming they're not already on death's doorstep) and they'll be fine in about 10 days or so.
Problem solved.

Ebola, OTOH, requires a bit more in terms of resources for maybe 4 chances out of 5 to survive.

$500,000 and up/patient

This is why the US has saved 8 out of 10 Ebola patients (and will, as long as we don't get more than a paltry few at a time) and why West African nations lose about 75% of theirs, which is just about how many would live and die if they did absolutely nothing.

Because absolutely nothing is the amount of resources they have there 24/7/365/forever.

That's how Liberia, with a population half the size of NYC, has already lost more people to Ebola this year than the total casualties we suffered in 10 years of war in Iraq and Afghanistan combined.

And if the number of our victims ever starts to cut into the resources we can devote to their care, our death toll is going to start looking a lot more like the ones in Africa.

Saturday, November 22, 2014

Taking Out The Trash

As any good fan of shows like The West Wing knows, every White House administration has a desire to spin the news in a favorable light, and one of the ways they can do this is by letting information out in certain ways. When there are stories they have to talk about, however little the y wish to do so, they simply lump that information into the weekend information dump, downplaying it by burying it amongst a ton of other garbage released Fridays and over the weekend, in a process that became known on that series, as in real life, as "taking out the trash". Reporters like weekends too, and no one watches the news on the weekends.

So with that background, imagine my surprise, after the second solid week of essentially nothing but fluff regarding the ongoing Ebola outbreak, when the NYTimes elected to burp out this latest coverage late on Friday afternoon:
The leaders of the United Nations and the World Health Organization expressed renewed alarm on Friday about Ebola’s tenacity in Africa and, in particular, its potential to ravage a fourth country, Mali, where they said hundreds of people had been exposed to an infected cleric who died last month.
At a webcast news conference from the World Bank offices in Washington, the United Nations’ secretary general, Ban Ki-moon, and the W.H.O.’s director general, Dr. Margaret Chan, also appeared to reset their schedules for containing the Ebola virus, which has sickened at least 15,351 people and killed 5,459, according to a W.H.O. update posted earlier Friday.
Mr. Ban said nothing about the goal of safely burying 70 percent of the dead and treating 70 percent of the sick by Dec. 1, and instead expressed hope that the outbreak could be contained by the middle of next year.
Mr. Ban’s special envoy on the Ebola crisis, David Nabarro, also expressed doubts about achieving the Dec. 1 treatment goal in comments at the United Nations. “Confident? No,” he told reporters outside the Security Council, which was holding a meeting on the Ebola crisis.
While the effort to halt the virus has made progress, with strong indications that the worst-case outcomes might be avoided, the tone of the remarks by Mr. Ban and Dr. Chan was cautious.
“The international response is outpaced by this Ebola spread,” Mr. Ban said.
Warning against any complacency, Dr. Chan added, “We must not forget: Ebola is a formidable enemy.”
Most of the cases have been in the three most afflicted countries: Liberia, Guinea and Sierra Leone.
Yet the focus of the message of Mr. Ban and Dr. Chan was their concern about Mali, a vast country where the government does not have full control and where a United Nations peacekeeping force is deployed. At least six people in Mali have died of Ebola.
A successful effort to halt Ebola infections in Mali last month, prompted by an infected 2-year-old from Guinea, has now been overshadowed by a second and far more serious source of infection, from an imam who also had come from Guinea. His symptoms had been misdiagnosed as a kidney problem after he traveled to Bamako, the capital, to seek treatment.
Dr. Chan said nearly 500 people in Mali and Guinea had come into contact with the imam.
Mr. Ban said that a team led by Dr. Chan was headed to Mali and that a new support center would be established there. Dr. Chan was blunt about the potential for a worsening situation in Mali.
“We are scaling up our action,” she told reporters, adding, “We must smother this little fire, little smoke, before it gets out of control.”
The W.H.O.’s own figures tell a worrying story about the progress in containing the virus. Only 26 percent of the necessary Ebola treatment centers were up and running this week, and barely a fraction of the smaller community care centers that health experts now say are more needed. Fewer than one-fourth of reported cases were isolated, with Sierra Leone reporting only 13 percent. At the Security Council meeting on Friday afternoon, it became clear that two months after the world promised to rally to help the affected countries of West Africa, there remained significant shortfalls, even as diplomats said international aid had made a difference.
“It would be reckless to think that just because we hit some of our benchmarks, we have contained the virus’s deadly spread,” said Samantha Power, the United States ambassador.
Thomas Mauget, an aid worker speaking by video link from Conakry, the capital of Guinea, raised the alarm about new hot spots emerging in the country, saying “international mobilization must be intensified.”
The Security Council nudged the United Nations Ebola response mission to more quickly expand its operations.

TL;DR summary:
*>  The UN wishful thinking Dec. 1st 70% containment date has been pushed to the middle of next year.
IOW, they see no hope in hell that this thing is anywhere close to being controlled for months and months, at which time they'll probably conclude that mid-2015 was a pipe dream as well.
*> The number of exposures in Mali is no longer 327, it's now "over 500".
IOW, Ebola is officially off to the races in Mali (they're already isolating the third tier of infectees from the second Index Patient), and probably about to leap to where things were in Guinea, Liberia, and Sierra Leone last May, and it will make the jump in Mali in one great leap forward. The UN and NGOs are scrambling to pitch in, but it's probably far too late for that, and they don't have any reserve capacity to deal with this latest front. Look for the next report to tell you that they're now tracking "over 1000" exposures, and the latest confirmed case has exposed other people as well, as Ebola just keeps doubling apace ahead of all efforts to stop it in Mali, just like it did in the first three countries of outbreak. And Mali is more populous, medically under-served, and generally illiterate than any of them.
*> The prior "Ebola is slacking off, we're winning" happygas has been replaced by the cold hard realization that they are so far from screwed they can no longer see it receding into the distance.
They have nowhere near the number of centers they think they need, they cannot even isolate 25% of confirmed cases (which means they're isolating precisely 0% of unsuspected cases), but they're absolutely certain that they've succeeded in scaring people enough that they'll no longer report their infections nor arrive at Ebola Treatment Centers (AKA Quarantine Death Camps), which is the only way you have that many opening beds even as the disease spreads unrestrained.
In short, their entire efforts thus far, precisely like everything they've done prior, remain a complete, unmitigated, and unvarnished failure when they admit the truth to themselves, and look at their own available data.

In WWII, there was a brief period known as the "Phony War", when things seemed hopeful, as the conflict failed to catch fire after war was declared, mainly because the Germans took pause to consolidate their gains, and re-deploy their forces for the next round of attacks, mostly during the quiet winter months when campaigning wasn't so favorable anyways.

That's where this lull is now, especially when the press and government here have belatedly decided, for mostly partisan reasons, coupled with the sincere desire not to look like the clueless bunch of lackwits they've both demonstrated themselves to be on crisis after crisis, have co-operated (if not outright conspired) to underplay, downgrade, and simply ignore the common sense implications of this crisis, spike the stories about it, and refuse to cover or comment about it.

It's bad enough when you catch a government spokeshole lying.
But when the "journalists" covering them give them a stage wink as they do it, expecting either of them to tell you anything useful, let alone truthful, is a forlorn hope.

That isn't going to change on this story unless or until people start dropping in the streets in NYFC, if then.

You have from now until that time - which could be any amount of time at all - to get yourselves and your preparations together. You can plan ahead, or you can go shopping after Thanksgiving, and imagine everything is just fine, and this Ebola thing isn't coming to us anytime soon, even as we make plans for rotating thousands of troops into and out of the hot zone there, while the disease spreads across four countries unchecked.

Use your time wisely.

Friday, November 21, 2014

Ebola Update 11/21/2014

Looking at the latest WHO data (such as it is, with Liberia as usual electing to someday get around to coughing up some made-up numbers), what you can definitely say is this:

Sierra Leone has new cases in 100% (12/12) provinces in the last 21 days;
Liberia has new cases in 75% (10 out of 15) provinces in that same period;
Guinea has new cases in 50% (16 out of 33) provinces.

Mali's fatalities are all 6 of the confirmed cases, while they are following 327 exposure contacts in the capitol.

Of the confirmed and admitted cases worldwide, there are 100+ fresh confirmed cases per day, every day, and the most intense number of new cases in every instance is in the capitols of the respective countries, in each case among cities of around 1M persons.

In short, none of this points to outbreaks being any sort of controlled, nor even slackening much. The only thing that is certain is that people aren't coming to official treatment centers, thus not getting tested and confirmed as official cases, which seems to suit the respective governments just fine, and feed their penchant for minimizing the degree of infection, which their general illiteracy and innumeracy tends to support as well.

The only actual good news is that no one new - yet - has managed to drag their infected asses into London, Paris, the U.S., or apparently anywhere else, largely due to the recent travel bans and mandatory returnee quarantines, even as international aid to those countries has increased, and thus totally undermining any and all of the specious arguments against adopting those travel sanctions from the outset.

And even that thin reed breaks the minute there's one solid cluster of cases anywhere outside the now four affected/infected countries.

How much worse reality is than the cooked "official" numbers is would be anyone's guess, since the governments involved have notably cracked down on any reporting that doesn't accord with their own rosy figures, and outsider journalism worthy of the name has essentially departed, with most "reporting" done second- or third-hand, via telephone, fly-by, or from the bar outside the relevant agencies' briefing rooms, and a none-too-subtle deliberate spiking of reports and squelching of anything resembling actual reporting here in the US. Note, for example, finding out how many febrile symptomatic travelers have been intercepted is like asking for the nuclear weapon launch codes, or getting a confirmed sighting of Ebola Czar Klain, who surfaced precisely once in the last month for about 15 minutes, then submerged again to points unknown. (The chief benefit of which has been to stop rubbing the entire nation's noses in the limitless and studied assclownery of Drs. Frieden and Fauci, by throwing a shepherd hook around them both, and dragging them out of press briefing rooms non-stop since mid-October. This administration may still not have the first effing clue about handling Ebola, but they at least understand how to control the lazy and stupid bastards in the media, starve them of easy stories, and make further Ebola outbreak coverage resemble a sportscast of submarine races. Mission accomplished.)

The only other mildly cheery observation is that none of the hubris and happygas of officialdom so wall-to-wall prevalent two months ago is in evidence anywhere, so the one thing you can remain assured of is that there's nothing good to report whatsoever, else the gas-passers, and their media lickspittles would be only too cheerfully passing it along by the shovel-load.

So consider this a momentary respite, to continue to get your own stuff together, and hope that things continue in this vein for as long as possible, if not actually improve. If or when things begin to fall apart in W. Africa, or a solid cluster of cases appears outside it, it will become rather hard to cover up, and the sudden panic will bubble a bit higher in each succeeding wave, and become harder to whitewash.

Thursday, November 20, 2014

Walls and F**kheads

So, apparently, according to this enormous jackass, putting up a border wall, and telling people they can't just come here any effing time they want, is bad.

No, not just bad, it's the exact moral equivalent - he says this - of the East German VoPos putting up a wall to keep people in and shooting people for trying to leave communist East Germany and get to free West Germany.

Really, he says this in public, on the Internet. It beggars belief in literacy and common sense, if not history.

But I'll play along, arguendo:

1) How much pot, heroin, meth, and cocaine were the good people of East Germany humping into West Germany daily across that wall, by the 20-Fritz human mule train, back in the day?

How many of them were a plague on West German hospitals, schools, courts, prisons, and the social safety net?
How many times did they hold rallies and wave the East German flag, and demand to be given full rights, beyond what even the West Germans enjoyed?
Anyone? Beuller? Beuller...?
I ask because apparently, this news has yet to reach pundit Marko, or at last far enough up his back end to get to his head.

2) So explain to me when Mexico, and the rest of the goddam teeming Third World who would merrily come here, was partitioned off from the USA like East Germany was from West Germany in 1961? I'll wait while you explain that one.

3) Exactly where in the Constitution did we give the right to come here, flout our laws, bilk our treasury, destroy our educational system, and rob, rape, and kill our citizens to anyone who manages to hop, skip, jump, or tunnel their way here? Take your time looking it up; I've got a copy of the whole thing right here if you need help finding that section.

4) What's your home address, Marko?
It's only fair, because about 8:02 PM EST tonight, I want to publish it on the Internet, and invite the first 1000 swinging Ricardos to come camp on your lawn in perpetuity, sit on your couch, and drink your beer. Because if you want to stop them, you're the effing SS. (Not so funny when the armband is on the other bicep, is it, dickweed?)

I'm sure it feels nice to bootstrap yourself some unearned moral superiority about being so free with everything else in this country that you didn't build (but which you don't seem too shy to have adopted) but it kind of pales into insignificance when we note that you have a front door, with a locking latch, a deadbolt,  maybe a dog, and no doubt the desire to defend the same with a weapon (and if not that then certainly the hair-trigger response to scream for the local constables to do for you what you're probably too chickenshit to do for yourself).

And if you aren't willing to cough up your sustenance, and give until it bleeds, you're just another socialist in sheep's clothing, loudly proclaiming about "the rule of law for thee, but not for me."
"I’ll never be a fan of walls and fences, no matter which way the barbed wire on top is pointed."
I'm calling bullshit on all of that festering pile of self-righteous dung.

Prove me wrong:
Take your front door off its hinges.
Leave the keys in your car.
Open your business' front door, and leave it open and unattended all night while you sleep. Go down to the local constabulary and demand that the cops empty the jail and let your people go.
Take a bulldozer and tear a new gate at the local prison.
How about it, there, you hypocritical lying bastard? I'll bet you're a big fan of those walls and fences, aren't you, you sniveling socialist scum?
Anything else you've said or would say on the subject from now until Hell froze over is belied by your two-faced, four-flushing, mealy-mouthed crap-spewing on this topic.
(Ask Marco Rubio how that ploy works; or maybe Sen. McCain. They could tell you stories...)

I'll wager any amount you could name that none of that will happen, because you're so full of shit on this your eyes must be brown.

I live in a state where, because of precisely your sentiments, 33% of the prison inmates, 40-50% of the court cases, 66% of the babies, the loss of 100 hospitals, and the entire collapse of the educational system from 1st to 49th place has been because of the unrestrained influx of the tsunami of illiterate peasants and criminals you'd happily make not just legal, but mandatory. One would think that reality might have given you pause, long before wages stalled, unemployment skyrocketed, and the average family's purchasing power has slipped backwards for going on two generations now, ever since Teddy Kennedy opened the gates in 1965.

But all that's news to you, Baby Duck. Because while you were staring mesmerized at the Berlin Wall coming down, you were too bumfuzzled to draw intelligent conclusions from the event. Like the one, for instance, where you note that people were fleeing the side of the fence where all their shit belonged to the government to give away to everyone else. And since it's evidently escaped your hawk-like gaze and manifest perspicacity, that's exactly the result you'd like to see inflicted upon us HERE by your brainless position NOW. So hey, thanks, because there was somehow a pressing shortage of liberal asstardian socialism on the Intarwebz. So thanks for pitching in to help us out!

You could crap stupid non-stop for a year of Sundays, and still not boost your IQ to the point where you'd be worth pissing on you to save if you were on fire.
So please, pull your NIMBY head out of your ass, suck in some oxygen, and come back to this when you can figure out which way is up.
In the meantime, either start your charity at home, with your house, and your money, out of your wallet, or STFU.
Who is going to machine-gun unarmed men, women, and children trying to cross that river and climb those fences?
That'd be me. I'll even work week-ends at straight-time rate.
You want to see an ammo shortage, give me one Ma Deuce, and I'll stop all illegal immigration to the limit of range and traverse.
You put 2000 of them on the southern border, and there won't be any illegal immigration north of Brownsville.

But there's no need to go that far. 
I'm all for easy and bloodless: what say we start by rounding up the first 20M we catch here, and shipping them the fuck back to wherever? 
Tell them not shooting them this time is what we call "Amnesty".
Next time, the gloves are off.
(If you want to first have them helpfully shovel snow for six months in the winter, and spread hot asphalt for six months in the summer, while living in tents - just like Ebola quarnatinees, and US serving troops! - while wearing pink boxers, and feeding them nothing but green bologna sandwiches, just to drive the point home, we can talk.)

Try it my way for six months, (which would be the first six months it'd have been tried since the 1950's) and let's see how it works out down the road. You start raiding the business that start with "A" on Monday, "B" on Tuesday, and by Wednesday noon, you wouldn't be able to get on I-5 southbound south of Seattle or I-35 southbound south of St. Paul, and the delay to cross the Mexico border would be measured in days, for a month.
Unemployment here would drop to functionally zero, wages would rise, the US economy would be booming, and Mexico would be in revolution by the end of the month: I call that a grand slam.

If 80M Mexicans (or anyone anywhere else) loves America so much they want it too, here's a nifty idea: they kick their own bastards out, adopt the U.S. Constitution's provision in their country, and rock on with their bad selves! I'm spit-balling here, but I'm pretty sure even John Effing Kerry would leave skid marks to the Western Union office to congratulate and welcome any such country to the ranks of freedom in about 0.2 seconds, and we'd probably set records in granting them the best trading terms and defense treaties in existence for as long as they lived like that. We love the idea so much, we didn't even copyright the Constitution. I'm pretty sure there are enough people who could translate who ALREADY live in those countries, if that's what they wanted. Anybody could copy it and adopt it, anywhere, anytime! (As a matter of fact, from time to time there's occasionally even some chance of some of it breaking out in this country, when TPTB aren't looking!)

But throw open the borders?? That's ludicrous and asinine.

Maybe they didn't explain this clearly enough at your mail-order immigration green card school, but being left alone starts with leaving them on their side of the fence, unless they want to get a visa, visit, and then go back before it expires, like people do in hundreds of other countries going back to time out of mind.

Not letting everyone come rummage around here, loot the place, and ship it home, like they'd do in your fantasy from time out-of-your-mind.

I am reminded of nothing so much as this apropos benediction from Martin Luther:
Your words are so foolishly and ignorantly composed I cannot believe that you understand them.