Sunday, November 2, 2014

Fear Mongering: Not So Much

In his cultural landmark paper in 1993, the late great Sen. Daniel Patrick Moynihan coined the brilliant phrase Defining Deviancy Down. In that scholarly work (which you should read sometime, if you're intellectually curious) he wasn't describing anything like a rising tide of prurient perversions, but rather, speaking in sociological terms consistent with his long scholarly affiliation, speaking to the near-timeless tendency of the altruistic engineers of society to cope with the burgeoning growth of the problems their do-gooding inflicts, to make what was once "outside the norm" AKA a statistical deviant, into "the new Normal".

As proof of the genius of the last great honest political liberal of modern times, we see exactly that phenomenon now with regard to our recent close brush with Ebola. We've had precisely two unexpected deliveries of that virulent pathogen arrive here so far (plus five deliberate imports, and two unfortunate hospital-acquired infections). For a grand total of nine patients. Of these, every American has survived (and those infected now are likely to fully recover as well), while the one unfortunate Liberian who came here died the expected horrible death via multisystem organ failure, as his insides turned to jelly and squirted out his orifices.

This statistical hiccup, which anyone familiar with numbers let alone disease would entirely disregard, is treated with hosannas by both the media and the architects of the insane policy of importing more such Index Patients, whereas in comparison to the thousands of African Ebola victims would be treated as nothing more important than a rounding error in tabulating the daily horrific toll of the infected and dead.

Because that's all this is.

Does it tell us anything about Ebola? Yes.
It tells us that if we get a single case at a time, or at worst, a bare few, and no closer than several days apart, and if we detect the new-onset cases immediately, and throw astronomical amounts of American medical care and attention at them from the start, damn the cost, we can drastically decrease the mortality of this disease. The honest historical death rate is up to 90%; the fudged rate from WHO in this outbreak is over 70%; the current American mortality rate, as it stands now, is 11%.
So what's wrong with that? Everything.

Let's start with the "Ifs":
If we're looking for it
If they had recent African travel or contact with Ebola patients
If their temperatures are checked
If they self-monitor
If they don't live in denial
If they don't traipse hither and yon about the greater community
If they seek immediate care
If they get rapidly diagnosed
If we can identify, locate, and monitor or isolate their contacts
If we have the level of hospital care and treatment required
Assigning each of those "IFs" a bare 50/50 probability, that's a chain of intention vs. coincidence of 0.0976% in any random patient.
In other words, if we get patients one at a time, like Dr. Spencer, or nurse Nina Pham, and everything goes right, they have a better than 89% shot at making a full recovery.
If not, they end up like Thomas Duncan. And if we get 1000 Duncans, one might be expected to fully recover, and possibly 100-300 would survive the disease (the exact same survival rate in Africa with no essentially no medical care whatsoever.)
A minimum of 700 would be expected to die.

Then there's the re-infection rate:
Duncan, exactly like in Africa, produced two additional patients within 21 days of symptomatic infection.
Pham, Vinson, and Spencer have produced none.
Because they were rapidly placed in isolation (Pham within literally minutes, Vinson and Spencer less rapidly, but still fairly early in the course of the disease, when the amounts of viral load in their systems was relatively small.)
To date, and likely permanently, none of the hundreds of people Vinson and Spencer exposed have become infected.
Out of two, rapidly isolated cases among 13,000+ Ebola victims.

How many more times are we going to keep rolling those dice with airliners full of people?
Say there's only a 1% chance of passing it on early.
After 100 patients, that becomes a statistical probability of happening.

And what can we expect?
A study in the UK medical journal Lancet says we can expect 2-8 more Duncans per month, worldwide, at least 1-2 of whom will come to the US.
In the next few months, the US can expect 1 to 8 such patients, with a cluster of up to 20 patients, and perhaps as many as 130 by the end of December, according to the latest study done for the AP.

Excuse me? "Perhaps" 130 patients? A cluster of 20?!?

Remain calm. All is well.

My ass.

A cluster of 20 patients would sink the abilities of even NYFC to cope with, right this minute. For any city or town smaller and less provided with care options, it would be a calamity.
We saw how well Dallas responded to one case (and everyone - not working for the CDC that is - now concedes THP-Dallas' response is the norm to expect, not an aberration).
Now imagine it breaking out in picturesque and quaint Fort Kent ME.

Or think about the extreme likelihood of an asymptomatic carrier going to a flophouse or garage full of people precisely least likely to self-monitor, assess the implications, and seek immediate care and treatment upon initial fever: like say a household of illegal immigrants from West Africa who've overstayed their visas, hiding in plain sight.

What happens when they don't rush to the ER at the first fever, instead waiting until everyone in the house has it? The kids go to school at the local public education warehouse: free lunch. Mom keeps showing up sick for work at Burger King, because they need the money. Dad does the same with his night shift job stocking Wal-Mart shelves. Neither of them with medical insurance. And our import Index Patient goes to his bachelor flat dive, gets sick, and dies alone at home without alerting the authorities to his immediate predicament.

And then a week or two later, like a zombie horror movie, the infected 5-10-20 all show up with well-advanced cases of Ebola, bleeding out the eyes, and squirting their internal organs out of both ends in streams of bloody vomit and diarrhea, at the local ER?
Howzat going to play, do you suppose?
Twitter, anyone? E-mail? TMZ?

Remain calm. All is well.

And the next day, it becomes known that the number of contacts to trace is 5,000, 10,000, or more. They think.
All the kids at a couple of schools. All the teachers. All the families of both. Everybody who ate at Burger King #XXXX since a week ago Tuesday. Everyone who shopped at Wal-Mart for the same period. Everyone who rode in his neighbor Joe's taxicab. All the people his girlfriend Mary served at the local greasy spoon diner.

Remain calm. All is well.

You tell me how long you're staying put when that info gets out.
What store shelves will look like an hour later.
How many hospital staff will call off sick that night, and the next morning.
What the interstates outbound will resemble.
And what will happen the first time someone on a plane infects a member of cabin staff, who then flew on 20 flights with 3000 passengers and crew members before becoming ragingly symptomatic, and finally correctly diagnosed with more than just seasonal flu.

And all that, just based on what we can expect to come here in the next few months.
Because the flights keep coming.
After that, the likelihood "depends on further developments in West Africa".

Word to your mother, Sherlock:
West Africa is going to complete shit, day by day, at 100 MPH.

Fear mongering?
The government has assigned Top. Men.

Remain calm. All is well.

So far, I'm the calm, rational one in this discussion.

So, how's your supply of canned good looking, folks?


Emily Disraeli said...

I shutter to thing of all the possibilities. I use to manage a Hotel. Housekeeping cleaned as best they could but it's was very hard to control all the vermin people brought with them. We like all the other Hotels served a free breakfast, just imagine what an infected person could communicate to the food. I believe so far we have lived off borrowed time, there are just too many vectors.

Anonymous said...

Hi Aesop,

I've been reading you for a while. I am wondering at what point you think Joe Sixpack, en masse, will decide to stop watching football and instead go buy cans of Spaghettios and bottled water? In other words, what will be our hundredth monkey?

Are people ignorant because of the media, or is the media just providing the drivel that people want? In either case, should a cluster or two of ebola wind up here in the USA, eventually people will find out about it.

So I am wondering what you think a few possible triggering events might be that could cause the bulk of Americans to suddenly think that stocking up and hunkering down is worth their time and money.

I know you don't have a crystal ball (nor does your buddy at WRSA, from the Math Just Is post a few days ago, though he makes a damn compelling case), but it would be interesting to hear your speculations about how the slothful, distracted, self-absorbed American people might, if ever, be convinced to address this as a serious issue.

Hell, I can't even get my parents to sock away two weeks of canned goods and they are both double-degree smartypants. I am not hopeful...

Grouch, MD said...

Also, please enjoy the follow up article in the NEJM. Their n was just over 100.
Although part of the reason their mortality was so high involves, in the words of the corresponding author, "problems with aggressive fluid therapy".
We can pin our hopes on one of three things: a vaccine, development of a means of providing care that dramatically reduces the mortality AND COST of Ebola patients, or the discovery that there really is a Diagon Alley, wherein we can purchase real magic wand. I'm still thinking the latter is most likely.

Aesop said...

Most people wise up momentarily after a true close call, but the bulk revert to fat, dumb, and happy in short order.

Road to hell. Good intentions. Some assembly required.

Smart people have already made or are making the right preparations, and the stupid never will until their pants are on fire. That's only inconvenient when they're our own relatives or friends; otherwise it's mainly comedy, and object lessons.

All I'm worried about are the ones in between smart and stupid, who've been getting a steady diet of unicorn-farted happy gas from the White House, their shills over at CDC, and the media carrying water for the first two. Life is busy, and if you aren't paying attention, you can miss this stuff without trying too hard.

The actual information is out there and open-sourced easily (I'm bringing nothing special to the picnic but collating it, my personal experience in health care, and hopefully the occasional apt or pithy phrase), but as I noted in comments yesterday, you have to strain through a lot of derp, mostly deliberate and official, to get the informational nuggets.

I live in a state (and a country) where people ignore earthquakes until they happen, don't leave when a Cat V hurricane is coming, build their homes with wooden shake rooves in brushfire-prone hills, erect vacation mansions at the high tide line, don't wear their seatbelts, and leave their kids in hot cars on summer days while they shop. It's impossible to measure the base level of obliviousness and willful ignorance of the average person with existing instrumentation, but you can predict with near-certitude that an hour after it's too late, mobs of people will strip store shelves, jump on the freeway, and suddenly start looking for real estate in rural areas.
Not counting the smaller percentage who'll think they can either camp in the forest and hunt deer, or the ones who'll carry on regardless, and be found eating a bucket of fried chicken at the seawall when the hurricane storm surge hits.

Natural selection will have its culls, no matter what we do, and for them, oft-times the best action is none at all. If we'd stop throwing life preservers to the obviously stupid people, society would probably be better off in the long run, but that's cruel and non-PC, so no one brings it up.

Except the Darwin Awards website.

Aesop said...

Thanks for the link!
I'll tackle it after lunch.

Thought stolen, and posted.

GamegetterII said...

"in a state (and a country) where people ignore earthquakes until they happen, don't leave when a Cat V hurricane is coming, build their homes with wooden shake rooves in brushfire-prone hills, erect vacation mansions at the high tide line"

People also build in flood plains,and don't bother to buy flood insurance.

Far too many people believe the fertilizer being fed to them by CDC,NIH,Obola,et al.

You and doc Grouch seem to be the only voices of logic and sanity during Ebolamania.

You are right about those with busy lives who do not have the time-or don't take the time to find out what's really going on with Ebola,and what the likely end result is going to be here.

I think what will happen is a whole lot of people are going to suddenly decide that they really need to stock up on groceries-and store shelves will be emptied in hours.
The stores wil look just like they do when the cat 5 hurricane is 25 miles offshore-and all those who have nothing in their homes to survive the aftermath all decide to go shopping at once.
I've seen fistfights over a case of bottled water,or the last package of batteries.
That was when I lived on the NC Outer Banks-building those beachfront homes at the high tide line-it's probably worse in other more hurricane prone areas.

The result of millions of people suddenly deciding that the smart thing to do is stock up on groceries-and finding out there's nothing left on store shelves is going to be a disaster in and of itself.

Anonymous said...

Beautifully put. If it wakes up one person, just one, it'll have been worth the effort, because if they change THEIR minds, then their friends might start thinking about putting in some canned goods too.

Like you, I lived in a VERY hazardous earthquake zone most of my life, in between 2 fault lines that have the potential to blow off at a 7.0 or higher any second. Even Loma Prieta was't enough of a wake up call for a lot of people (and that was NOTHING like what's coming), or a lot of new people moved in who just have no clue.

I would talk about a months' supply of canned goods and water, of how to shut off gas mains - I'd refer people out to official websites about earthquake preparation, and inevitably people put it on the back burner and paid no mind. I didn't know anyone but my parents, in-laws, and us who were prepared - everyone thought that FEMA was gonna fly in to the rescue (like Katrina, right?).

We followed a geologist's and my father's advice and moved the hell away as soon as possible. Happy we did, now we're as prepped as we can be really for what's coming, and I KNOW any warnings are gonna fall on a lot of deaf ears.

If people can see footage of Loma Prieta and know what's coming in terms of earthquakes is worse and do NOTHING, then all I ask is that they stay the hell away from us when THIS hits. I don't want stupid of that magnitude around us at any time, and especially not in a life-or-death situation.

So well put Aesop, thank you.

Unknown said...

But, but, but the government LUVS me and just wants the best for me. And all the LAWS (wear your seatbelt or go to jail, wear clean underwear or go to jail, don't have a toilet that uses more than a gallon per flush or go to jail) are just to MAKE SURE I am healthy and happy and pay taxes so the PO' can keep living for free.

Yojimbo said...


I posted "Fear Mongering - Not So Much" on blog.

I hope you that's OK with you.

It's a very well respected blog that has a very large readership.

I think it will bring a huge number of readers to your site. Also, your article could get picked up by ZeroHedge and spread further. Do you know about ZeroHedge?

If you would like to reply there to comments on your article, please do. It is very easy, like here.

You can also publicly rip me a new one for taking your work and reposting it if you like.

My intent is to inform about the threat from Ebola, and to bring people to your site.

No offense intended.

Aesop said...

Not a problem, Yojimbo.

I'm already getting quite a number of daily hits from TBP and ZH here.

If I didn't want anyone to read this stuff, I wouldn't be putting it on the Internet.

Anonymous said...

I love reading your entries here--you add humor and make me laugh to something deadly serious; well, to us anyway.


Anonymous said...

Aesop is right, there is a lot to be concerned about.

As he said, there are a few bright spots. Duncan's family was not infected. Neither was that idiot Dallas County Commissioner or his flunkies. Nor the idiot power washing the vomit nor any of the apartment dwellers. The secondary infections ended with just the two health care workers. Two more than should have happened though.

It is a lot better result than I thought would happen. I was sure we were going to lose a handful of people. I was sure that Duncan was patient zero and we would have 3-4 copycats by Halloween.

I am not going to stop stocking up though. It is going to be a real cold winter here.

KC said...

Capitalism requires efficiency and redundancy is not efficient. Thus cost cutting is not only in the materials section but also in the workforce (including in hospitals). Any major hits to our infrastructure workforce will magnify the problems. The average age of an electrical lineman is now about 50, as retiring lineman are not being replaced at the same rate as they retire because who needs redundancy eh? Lowers profit.

Nuclear power plants are a double whammy. Not only would a hit to their workforce impact safe functioning - but so would a hit to the electric grid workforce. Nuclear power plants and their spent fuel pools must be cooled. This requires electricity. For reasons not entirely clear to me they cannot do this with their own produced electricity and thus when an grid outage happens they shut down. They have on hand fuel to run diesels to run the cooling pumps for 1 week. They are not required to have backup cooling for the spent fuel pools. So any outage more than 1 week will start the spent fuel pools overheating and unless more diesel is supplied will start the reactors heating. This scenario is described in the article 400 Chernobyls by Matthew Stein. He envisions this happening with a massive solar flare or an EMP attack, but anything that causes the grid to fail will do just fine. A pandemic could do that....

We have no idea how interconnected everything is until it fails. When a volcano in Iceland shut of air traffic in Europe it among other things affected farmers in Africa who grew the cut flowers sent daily to Europe. While the people in Europe could do without their cut flowers, the people in Africa needed that income.....

It gets more interesting from here on out.

KC said...

URGENT: Feds Delete Document to Hide Major Ebola Fact
The U.S. Centers for Disease Control and Prevention removed an Ebola poster from its website on Thursday after a media report that its information conflicted with other statements made by the CDC.

The poster revealed that Ebola can be spread by contaminated water droplets — as from a sneeze — despite claims from the CDC that no transmission of Ebola through the air is possible.

The New York Post reported on this poster Wednesday — and by Thursday, the poster had mysteriously disappeared. Thus, the CDC becomes the latest group of government drones to learn that everything is permanent on the WorldWideWeb, courtesy of the Daily Mail:

Anonymous said...


URL accessed: Category: Malicious Sources/Malnets

Aesop said...

The CDC had known droplet precautions were necessary years ago, and no one's taken those FAQ answers down, now, or any other time.

The "Sneeeze Poster" kerfluffle was just Oblivious Media hyperventilating about things they don't know about, and getting all a-twitter because they haven't been paying attention. Like with ozone holes, polar ice pack, and "glowbull warming".

The CDC made no new admissions, nor did they redact the basic information, at any point in time. Playing games with a .pdf poster was a non-event.

Not black helicopters circling for the kill.

Tucanae Services said...

Damn, don't sugar coat it.... Fair to say that is a very likely scenario.

Now (at least internally, since they pulled the info poster.) that CDC admits that the virus can be spread by aersols, there is even one epidemiologist who says that one need not be symptomatic to spread ebola the issue is even worse than you paint.

Aircraft being the worst of the bunch. In aerosol form the inside of a plane is nothing more than a multi hour ride in a petri dish. Nor can you decon a plane without stripping it down to the hull. Which I am sure the airlines would be willing to do -- NOT.


Tucanae Services said...

"...but you can predict with near-certitude that an hour after it's too late, mobs of people will strip store shelves, jump on the freeway, and suddenly start looking for real estate in rural areas." -- Aesop

I was a kid in Sarasota FL when the Cuban Missile Crisis hit. You don't have to guess, I experienced it. JFK was on the TV that night. By Noon the following day, the shelves were bare. This in a time when most markets had not instituted JIT delivery. Meat, dairy, canned goods and edible dry goods just wiped out.

It will happen, I saw it.