Friday, August 24, 2018

You don't LIKE a Fustercluck? This is how you GET a fustercluck.

One of our most thoughtful and respected commenters, in response to the last post, wrote the following:

"My thought is that Ebola kills too quickly to ever be a major problem in a country where the medical system is advanced past the 19th century.

Once the symptoms of Ebola take effect, the infected are as easily spotted as an extra on The Walking Dead, and just as easy to avoid.

We in the first world also understand quaratine, and we tend to follow those guidlines.

No one in America is going to be raiding hospitals to grab bloody Ebola laden bandages like the tribal folks did in Africa last time there was a major outbreak.

Healthcare workers in the first world have access to real PPE and they know how to use it.

My level of concern about Ebola is minimal at this point.

That said, it couldn't happen to a better continent."
Let's be clear: Ebola in Kivu, right now, is nowhere near as bad as it was in West Africa in 2014.


Now, that said, and with all due respect to the commenter, my reply to that:

I was like that once, too. Right up until I started digging, out of curiosity, in early 2014.
Springtime, IIRC. Then Reality, with a predictability like sunrise, did its thing.

You ought to know better than that, and I refer you to the very articles I wrote on the topic at the time.

TL;DR? Let me help you out with a quick summary.

CDC: We understand this disease and everything about how to deal with it.
Aesop: You know so little about this disease, even the most basic info, that it would be comical if it wasn't life and death tragedy.
Aesop 1, CDC 0.

CDC: Ebola will never get here.
Aesop: Ebola's gonna get here. 
Aesop 2, CDC 0.

CDC: Our screenings will stop it before it gets here.
Aesop: Our screenings are kabuki theatre and boob bait for the Bubbas.
Aesop 3, CDC 0.

CDC:We have protocols in place in case there is a case.
Aesop: We have Jack and Shit, and Jack left town.
Aesop 4, CDC 0.

CDC: We have first-world healthcare.
Aesop: We have our collective pants around our ankles.
Aesop 5, CDC 0.

CDC: We know how to handle this.
Aesop: We haven't the first clue about any of this.
Aesop 6, CDC 0.

CDC: We'll nip it in the bud, and overwhelm it with our superior capabilities.
Aesop: It will be a total fustercluck, and it will spread around the country before you've got your pants on the correct legs, once you get you head out of your tailpipe.
Aesop 7, CDC 0.

Clever readers will spot a trend there.

Multiply that times about four-five months, multiple times daily, and you get the idea.

1) The modern system is exactly the problem with Ebola. One infected reference patient, Patient Zero, walks into your ER lobby with what looks like just another set of flu symptoms.  During flu season. (How helpful for you.) After an hour (or as little as ten minutes, as numerous dead former cab drivers in Guinea, Liberia, and Sierra Leone could attest, if only we could dig up their ashes and re-animate them before their former owners died of Ebola infections from giving patients rides to the hospital) in the same lobby as ten other people, you have eight more Ebola patients, and you won't know it for 5-21 days. And they'll infect the triage nurse, the doctor, and the treating RN, unless you have everyone in Ebola-proof gear 24/7/365 pro-actively...
What? Of course neither you nor anyone else does that? Ever? Sux to be you, man.

Then, if you're really lucky, and Triage is on that, they ask the magic questions:
"Have you been exposed to Ebola?" "Oh, no sir."
"Have you been to Africa recently?" "Oh, no sir."

Why do they do that? Because patients lie. I've gotten a knowing laugh from more than a few cops, by pointing out to them that the only places history changes before your eyes is in the ER, and on the witness stand. Why do they lie? Because the enemy gets a vote. Because Ebola in Africa is a death sentence. It means exclusions, quarantines, and slow, agonizing death. So of course they don't have that. Doesn't everybody with the flu bleed out their ass and eyeballs?? And why are they lying little shits at the precise moment the truth matters most to you (and the ER staff, and everybody in the waiting room, and 300M of all your closest friends and neighbors)?

Sorry if letting that cat out of the bag shattered your illusions. It's one of my Super Powers.

2) Once the symptoms of Ebola pop up, they've already exposed people for 1-3 weeks, so it's the 500 contacts you didn't know about that are going to be the next casualties. And they expose 50,000 more contacts you don't know about. And they expose 5,000,000 contacts you didn't know about. And they expose virtually everyone in the continent, and you're still waiting for the first patient's diagnosis to come back from the lab. How does America with a few million to a few hundred million dead sound to you? Another 10% of that crippled for life, and carrying the disease in their own bodies? Wildlife becoming a native virus reservoir on this continent, forever? Coyotes, rats, skunks, bats, whatever.
We still don't even know where in hell it lives in Africa, after looking for decades.

3) Quarantine? You're kidding me, right?
Look up Kaci Hickox.
Then Dr. Craig Spencer.
Then Dr. Nancy Snyderman.

4) Look up how Ebola was handled at Texas Health Presbyterian Hospital.
One case infected two nurses (for life, it appears) despite them scrupulously following the CDC "guidelines" (instead of the actual field-tested MSF/DWB protective gear guidelines), they generated tons of medical waste, lost their ICU and ER wholesale for months, and nearly bankrupted the hospital.
For one case. Then three cases.
Then, they shipped the two surviving nurses to Emory in Atlanta ricky-tick, one of the actual BL-IV hospitals, and virtually shuttered their hospital for months, until the stigma and the story finally went away. Think about that: a cornerstone regional acute care hospital, 968-beds, turned into a virtual ghost town for three people. (Oh, and about a gazillion dollars in indefensible liability suits.)
Their entire ER staff basically told management, "Either close the ER, now, or we all walk forever." The hospital closed that week. They had to; their patient census that week dropped literally to single digits. It was costing them more to turn the lights and AC on for a day than they were making in a month of that.

5) Hospitals here, outside the four BL-IV hospitals actually trained and sort-of staffed to care for a grand continent-wide total of - wait for it - eleven Ebola patients, maximum, are utterly, completely, and massively unprepared to deal with this , as the Dallas example proved in about 21 days, and neither they nor the CDC wants to talk honestly about this.

Neither you, I, nor 2M other RNs nor 1M doctors has the slightest effing CLUE about dealing with this (unless they volunteered in West Africa in 2014) and come the day, they're going to make simple mistakes that'll get them dead, along with thousands to millions of their patients.
The suiting up and decon process takes half an hour each coming and going, requires scrupulous attention to detail at every step, unless you want to die, the gear is hot, a lot hotter than most people can work in for more than a couple of hours, and a "simple" pee break requires the entire 30 minute decon, then another 30 minutes to re-suit. It takes two people who do nothing but suit you up, and another who does nothing but monitor you peeling out of it without effing up and killing yourself. So imagine with me a staffing ratio of four people for every one person who can actually render bedside treatment. And you think the nursing shortage is bad now?
Bear in mind the age of the average nurse in the US is something like 50 years old, not 21 or 22. So you'll have people old enough to be retirees in the military, in the equivalent of MOPP Level IV, which is hotter than hell even in an air-conditioned room,  sweating like a pigs, and doing everything through a fogged up facepiece and two layers of gloves, in a rubber suit, with a virus that only has to get lucky once, with delirious feverish patients oozing blood from every orifice onto everything, and coughing a miasma of bloody sputum into the air. Yeah, that should work.

And then, tell me how many CNAs, EMTs, and PCTs are going to risk their lives for $10-15/hr.?
In someone's effing dreams, baby; hospitals will become ghost towns, just like Texas Health in Dallas did. In minutes and hours, not days. You'll have patients and staff going out the fire escapes and jumping down laundry chutes, mark my words.
In Africa, they make Ebola survivors unpaid help with patient care. They have to help anyways, since they get stoned and shunned in town when they come out afterwards, and it's the only place they can get fed. And anyways, most of the victims are the very people they infected, and who infected them: family, friends, and neighbors. Good luck pulling that off here.

And it requires literal fuck-tons of gear, that your hospital and mine don't have and never will, dedicated facilities that they don't have, HEPA-filtered air- and waste-handling facilities they've never had, and generates even more fuck-tons of BL-IV HazMat waste that no one on the entire continent knows how to or is willing to deal with. The pyres burning it are going to look like Kuwait in 1991, people downwind fleeing the ashes are going to look like villagers fleeing Mongol hordes, and if you try to ship it across state lines, the trucks and trains will be met by smiling national guardsmen, with bayonet-mounted locked-and-loaded rifles and battle-ready tanks, and a serious dose of the ass with you for trying to transship it.

You might get the idea that this is wee bit more important to me.
I repeat, go back to about August 2014, and read through the Ebola posts chronologically through the end of the year. The real liftoff was late September/early October, once Deadly Duncan from Liberia staggered into a Dallas ER. Hilarity ensued. If you think almost jumpstarting a pandemic is funny.

6) Canada has zero BL-IV beds, AFAIK. But hey, free health care! Just like in Ebola clinics in the African bush. Should work out great for them.
Mexico has...wait, you're shitting me, right? Mexico has what you'd expect Mexico to have: a corrupt government, and an overabundance of expendable and illiterate peones. No points for guessing who'll handle clean-up there. Then take the disease home to papi y los niños, Tío Juan and Tía Julietta, y los viejos. Who will cheerfully and unknowingly spread it to all their friends, and pretty soon, you solved the immigration problem by erasing everyone from Tijuana to Tierra del Fuego, except maybe some lucky isolated Indians in the deep Amazon rainforest. ¡Viva!

So, in between those two, there are actually 23 BL-IV hospital beds, but cleverly, only 11 are actually staffed to operate anytime, and you can't just call Joe's Nursing Registry in Missoula or Baltimore or Omaha or Atlanta and whistle up more BL-IV-qualified nurses to pick up the open shifts. Bummer.

Oh, and one to three of those 11 beds are reserved by law for the potential military casualties at their neighboring state-of-the-art Infectious Disease (and chem-bio warfare, which of course we swear we don't do ;)  military research center(s) in UT and MT, so there are really, actually only 8 beds.
We have 8 beds for 453,000,000 people (those poor Caribbean islanders from Cuba around to Trinidad can just suck it, like they always do).

Bermuda is looking pretty good, but only if they shoot down incoming aircraft, and sink cruise liners off the continental shelf at the merest suspicion of a pandemic.

So Twelve Ebola cases flood and overflow every available BL-IV treatment bed extant in North America.
Twenty actual Ebola cases will shut down any city in America. Overnight. For months.
Fifty cases, and the USA is Liberia in 2014. Times 1,000.
That's not a guesstimate, those are the hard numbers.

There are 52 active cases in Congo right now, who haven't died. Yet. 80% of them will.
And the survivors will carry virus reservoirs in their bodies functionally forever.
And probably go blind from retinal damage due to disease-related coagulopathy.
(That includes the two nurses from Dallas who contracted it, BTW. You'll notice a deafening silence on that, since 2014.)
God help those people, every one of them.
IMHO, it's a dice roll whether living with Ebola or dying from it are worse.
This disease is from Hell.

In 2014, we had TEN cases here.
We were two Ebola patients away from swamping the lifeboats, and turning any other hospital into Texas Health Presbyterian, which was Tier One disasterpiece theater. They exposed thousands of people, unwittingly. They had the infected guy in once, misdiagnosed it totally, and sent him home. They didn't catch on until he was brought in again in total collapse, and after throwing the entire best the first world had to offer at him, he died anyways. And infected a perfect R-naught of 2 additional victims. Only fate, or a benevolent deity, kept that incident from turning Dallas into Freetown, Liberia in about two weeks, and wiping out their whole ER shift staff that night. Poorly protected clean-up crews in Dallas were pressure-washing the guy's vomit - live, active virus - onto everything within yards of his apartment in suburban Dallas, the day after it happened. Because illegal aliens with a fourth-grade education are the front line in that clean-up, hired by companies with no more sense than God gave a jackass about Hazmat gear, or proper Ebola precautions. In NYFC, they were handling stuff with no PPE whatsoever. Hand to God on that.
Sleep tight, America.

Anyone in health care who isn't concerned whenever Ebola crops up, simply and respectfully doesn't know what the hell they're talking about.

Let's talk turkey on my streetcorner: At the time, in 2014, a busy day on this site was maybe 1K hits/day. (It's now closer to 5-6K. Thanks, folks, sincerely. That and $5 and I can get iced coffee at Starbuck's).
When I warned, after looking at what was happening, that Ebola was going to hit us, I was getting maybe 1500.
The heads of the CDC and Infectious Disease, with five more degrees than I have, nine more letters after their titles, and 87 research papers between them, assured us all most sincerely that that could never happen.
Then the late Mr. Duncan showed up, almost on cue.
After it did get here, I was suddenly getting 5K hits an hour.
I yell because I care.

I want a head of the CDC who's a goddam DOCTOR, not an idiot with a medical license giving the retarded president and his fucktarded staff of sycophants a tongue bath every day.

I want the liaison and advisory person at the White House to be someone who groks hard science, not a damage control PR flak who couldn't find his ass with both hands, a map, and a rearview mirror.

I want a president with the wits to order a halt on all flights and travelers in and out of any country with an active outbreak, except mercy shipments and returns to an affected area, and I want them to innundate that affected area with every possible resource, early, when it will work and do some good, not half-ass this until it fails and Ebola gets here. And I want him arm-twisting every other first-world country for the same damned thing until they either yield, or their shoulders pop out of joint, if necessary. (In Trump's case, I think he'd literally do that, and relish the screams. Whereas Obozo was actually rooting for a pandemic, to kill Whitey.)

I want anyone returning from such an area to expect a mandatory medical quarantine, enforceable at gunpoint if necessary, in actual total isolation, until they're medically cleared. That's an actual 40 days with Ebola, just like the meaning of the historical root of the word, not just 7 days, or 14, or 21. And sure as hell not a mere ear-temp check by a fat stupid TSA bastard who dropped out in the 4th grade. That rule is written in the blood of dead medical people in Spain. It's been around since the Middle Ages and bubonic plague, and anyone waving their civil rights about that reality should be not just smacked in the mouth, they should be taken out and shot as a danger to civilization and for crimes against humanity.

And that's not hyperbole for grins, I mean that absolutely literally, and the execution should be televised worldwide, on live TV, mandatorily carried on every broadcast and cable channel we can compel including Cartoon Network and the Disney Channel. This is THAT fucking serious.

I want guidelines based on what actually works, drawing on MSF's work in fighting the disease there, not on some asshole bureaucrat's ideas in a D.C. swivel chair here, and without one single minute in hazmat gear.

I want hospitals to not just paper this over with a page in their bullshit contingency manual for JCAHO certification, but to designate, by mutual agreement, which hospital will be the one, sole receiving facility in a given major county or state. That would be one hospital in each state, and one more hospital in any city with over 1M inhabitants. I don't think that's asking for too much.

I want no-bullshit, come-to-Jesus full dress rehearsals in full gear, for 72 hours non-stop, annually at every one of those designated hospitals, and the primary EMS agencies, including every ward and floor from the ER to the hospital morgue, so that when they get a real Ebola victim, they don't all loose their collective shit, kill half their staff and the surrounding city, and slaughter millions of people because this was all "too hard". I want those procedures vetted and supervised initially and audited annually by the experts at CDC and the four actual BL-IV hospitals who actually do it right, 24/7/365, because they have to do so if they want to stay alive. Disseminate that expertise to where it will save lives, instead of just look good on a resume.
That's the difference between medicine, and marketing.

And while it's happening at the designated hospitals, I want mandatory screening at every other hospital in the country required to be doing it too, by triaging every patient and every visitor in full gear, and segregating anyone who would meet Ebola criteria outside, in dedicated quarantine tents, so as not to unwittingly infect and expose the entire staff, hospital, and every visitor before they know whether you've got Ebola or the flu.

If that's too hard, I'd tell them that a license to operate a hospital is a grant, not a guarantee, and they can always go into the hotel business instead. Dealer's choice: they either staff it, fund it, and practice it out of their own pocket, every damned year, or they can close and completely shut down for those three days, and eat the loss of revenue. I'd also tell them they won't be reimbursed for any federally insured patients ever again, like veterans or Medicare, just to drive the point well home. Welcome to capitalism, baby. Play ball with us, or get the bat up your back end.

I'm hoping maybe this time people will pull their collective heads out of their asses, step it up, and we won't have to deal with it in Dallas, because we wiped it out in Kivu.

Otherwise, just like in 2014, Ebola walks in the ER door hereabouts, and I walk out.
Same effing day. (See if I'm not the only one, either.)
I like my job, and I'm damned good at it, but it's not a suicide pact with Florence Nightengale, and I can't spend the money if I'm dead, or infected for life, or left blind, or twenty other side effects.
Fuck. That.
I'll take my chances behind barbed wire that I control, at that point.

I know what we can handle, and how we can handle it.
And what we cannot.
And Ebola, here, frankly scares the shit out of me.

Because we can't handle it.
Not in 2014, and not now.
And Hope ain't a plan.
But that, and the soapbox, is all I've got at the moment.

I hope not having an incompetent America-hating illegal alien muslim in the White House will be enough this time to turn the rudder before we hit the iceberg.

We can stop 2014 from happening again, or God forbid, happening worse this time around.
But the first step to doing that, is wanting to.
It's four years later, and apart from a few government staff changes, the only difference now is it's four years later.

I repeat for emphasis, 2018 isn't 2014, yet.
I hope it never gets there, or anywhere close. ("Hear me, God!")
I said then, and repeated recently, I don't want to be doing the sportscast blog on the end of humanity, or even "only" a few million dead people in a "small" pandemic. I really, really, don't.

But if we can't face the truth, we can't begin to deal with it.
So now you know different.
What you do with that knowledge is your business.

This is what won me the Fucking Ray Of Sunshine Award for 2014.
I'd really rather not add a cluster to that ribbon.

And hey, score one for Serendipity:
Look who made the papers today! JUSTICE!!!!!!!!!!!
This I take as proof that God listens, and watches. He almost never answers back, but every so often, He gives the world a little surreptitious wink.


FiftycalTX said...

Thank you.

Cederq said...

I saw the writing on the wall back in 95 and tried talking with the hospital and corporate that owned 5 hospitals in the Portland area and no one wanted to listen and I was told to shut up or lose my job and license. I lasted another 3 years and then told them to shove this job. Back then it was antibiotic resistant TB, dysentery, cholera, typhoid coming from South of the border.

Anonymous said...

My wife is a medical assistant at a small town (10k) hospital/clinic. Last year when influenza was bad it burned through the staff and their families like wildfire. We've had discussions. If something like Ebola shows up or an 1918 version of influenza she's not going in. They're not equipped or trained to handle something like that and I'm not going to let her risk her life for 15 bucks an hour.

T-Rav said...

I might have believed the "it can't happen here because we're a first-world country with X" at one time. But I worked in a gas station long enough to become a firm partisan of the mantra that the only thing keeping us from total chaos is 6 hours of EBT cards not working.

So yeah, I'll be jumping in a hole if there's ever an Ebola epidemic round here.

Beans said...

Considering the horrid way we've handled the AIDS epidemic, when Ebola returns here we're forked. Totally. Done. Game over, man.

Same way with anything. Resistant Measles is attacking Europe right now, spread by the anti-vaccination crowds. As Cederq said, TB and all the old childhood friends except Polio (thank God) have returned, and outbreaks are kept hidden and not spoken about. More virulent killers, Hanta, the Plague, and so forth, periodically pop up in the American Southwest, especially on the Reservations, and only burn themselves out because the residents don't trust the government or modern health care and self-quarantine until the mini-epidemic burns itself out. Again, not something being reported.

Bio-Warfare manuals from the Cold War state to contain, burn everything, kill infected if necessary, in order to cut a protective 'berm' against the outbreak. Seriously. Kill potential infected, from a distance, gunfire if necessary but again fire is preferred, hot and long enough to cook the bones.

We, as a nation, used to be able to do this. We used to have the huevos to quarantine or reject infected travelers. We need to set up some island poop-hole as a clearinghouse-staging area. Johnston Atoll in the Pacific is a good start on the West Coast, or Wake Island (been used before for quarantining illegal aliens, so has Guantanamo.)

But we need to have planned 20 years ago. Now? Now is almost too late. At least we finally have a President with fortitude, hopefully.

MMinWA said...

That was sobering

When I clicked on your link to Friedman and read the story, I sure don't remember 11,000! people dying in Africa.

Bill Burr notes one of the symptoms of ebola is the apparent unstoppable urge to catch a flight.

Aesop said...


Try more like anywhere from 35,000-50,000.

As was well-known to WHO, the CDC, MSF, and the UN, the countries involved were outright lying about the official numbers, and the official fudge factor the WHO was using was to multiply everything reported by at least 3X to get grip on the reality.

People with Ebola, with hospitals and Ebola clinics stuffed to the rafters, were simply walking off into the jungle to die, and never counted in official tallies.
Entire villages in all three afflicted countries simply disappeared without explanation.

The official number is far less than a third of the actual count, in both number of cases and number of dead, and certainly represents on 25-33%, best case, of the actual casualties acknowledged by everyone with any knowledge of the situation on the ground.

On days they gave "official" death counts, just using B-roll newspaper photographs, I caught TPTB lying the daily death count, and blogged it right here on this blog.
Guinea, Liberia, and Sierra Leone had tons of relief supplies sitting on Atlantic Ocean docks while people were dying up-country, because no one would pay to bribe the port officials to let the stuff get taken to where it was needed.

Just as in DRC now, you had people lying because the whole concept of truth is not a cultural value. People who were illiterate and innumerate were doing the counting, and I'm not exaggerating when I remind people they were taking off their shoes to count above ten, and lastly and most egregious, you had government officials lying to downplay the numbers because it made them look as incompetent as they were, and they depend on tourist dollars, so with people literally dropping in the streets by the scores, they were claiming everything was fine, and standing there like Baghdad Bob claiming no deaths, while people behind them, spewing blood from every body orifice, were being hauled by anything with wheels to the nearest Ebola death clinic, just to keep trucks in the street from running over them.

Figure that something like 35,000-50,000 people died, and that's still a very conservative estimate.

The still-extant "official" numbers are a farcical hoax.

The actual number will never be known to anyone on earth, and anyone respectable would read those numbers with a stage wink and make "scare quotes" in the air, and then indicate to you either openly or in an aside exactly what I just wrote was the reality on the ground.

Aesop said...

And Bill Burr, being similarly unconstrained by SJW bullshit, and wicked observant, is also funny as hell.

MMinWA said...

That's even more sobering.

I wonder at what point your recommendation of halting any flights originating from that area would kick in. If as you point out, you can be infecting others for a week or longer before it's obvious you have more then the flu, there could already be carriers here. I have a habit of simply turning around when I'm out & about if I see someone ahead cough or sneeze-got a feeling that's not gonna be very effective with ebola.

And because of TDS, Europe is sure to join in with the chorus of REgressives here who would label the flight ban as another "moslim(or brown/black)ban" and refuse.

I know you like movie references and I had Dead Man's Walk on yesterday in my studio while I was working. Near the end, the Harry Dean Stanton character is killed by a guy who just had his eyeballs popped out by Apaches, which causes Keith Carradine to remark that Harry had been shot at for years by the best marksmen and here he was, lying dead, shot by a blind man.

And here we are, got lots of preventative measures we should take but PC could kill us.

Aesop said...

When to halt flights?


Mercy flights and medical/relief personnel only, in or out.
20:1 those flights should be military, anyways.
Any country that continues to accept flights goes on the same list, same day.
If that cuts off all air travel to/from your country, you're the sane one.
This is World War Z, less the zombies.

You either choke an epidemic off at the origin, or you're wasting your time, and playing epidemic roulette with 8B people's lives as chips.

Doing that should be answered with trials at the Hague for crimes against humanity, followed by a fine public hanging. It's depraved indifference to reality, and there's no earthly excuse for it. Not anywhere, nor at any time.

Aesop said...

And I refer you to this excerpt from the Wikipedia page on the 2014 outbreak in West Africa:

"As of 8 May 2016, the World Health Organization (WHO) and respective governments reported a total of 28,616 suspected cases and 11,310 deaths[21] (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak.[22][23]

On 29 March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak.[24][25][26] Subsequent flare-ups occurred; the last was declared over on 9 June 2016, 42 days after the last case tested negative on 28 April 2016 in Monrovia.[27]

The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner.[28]

Basic napkin math: if they have 17,000 survivors, it killed 3-4X that number, because the survival rate is 20% or worse in Africa.

That would be 51,000-68,000 dead, numbers that are as good as gold, and probably as good as you'll ever get.

Nota bene that the epidemic lasted there for another 18 months after HopeyDopey got the networks and media drones to agree to literally "stop talking about Ebola", at which point further record-keeping and body counts, no longer subject to outside scrutiny of even the most cursory kind, went right the hell out the window.

And everything I told you about the virus living inside the surviving lifelong hosts is exactly true as well, thus guaranteeing the virus will just keep coming back again and again. We don't know what the native species host is, but we do know it lives in "survivors" for as long as we keep testing them, so far. Functionally, probably until they die.

Ole Grump said...

Follow Ole Remus's advice. Avoid crowds and have a goodly supply of non perishable food.

smoken said...

When you say it lives in the survivors, are the infectious? Is exposure to saliva or blood from a survivor enough to pass it on?

Anonymous said...

Here in Albuquerque, New LaRaza-Land, some twink from the Crystal Corridor ( Taos - Santa Fe - UNM ) walked into UNMHER and sashayed around for a couple hours before being evaled, and failing to mention they'd been to Ground Zero Afreaka. They were discharged. Then came back. Repeat uncontrolled contact. During the Ebola scare !

Oceans, jungles and deserts used to be stop-checks against infectious spread. Now ? Ha ! Some bushman is gonna kite into London, or Paris, or Rome, or Barcelona, or LaGuardia, or and it's off to the races

Scariest book ever ? Laurie Garret 'The Coming Plague.' If folks knew about the SHV outbreak in Reston VA decades back they'd be hanging CDC personnel. The only pros are USAMRIID. End story. And let's not forget the genie released by former Sov-block researchers. Akantjian Alebeckhov becomes Kent Alibeck after he defects from BioPreparat director's post and casually mentions that they'd combined the infectivity of smallpox (ID = 5 virons)with the lethality of the hemorrhagic fevers ... "we called it BlackPox" Sweet. Just tweak the incubation period and a dedictade group of psycho-yeehadis could take down al-AmeriKwa in a month. They'd care not about the spread round the globe as long as the Great Satan is pooched.

UNM had a "Bioterrorism Panel Discussion" in '07. The panel was one practicing infectious specialist, one LANL researcher, and THREE lawyers. The proposed plan allowed Billy Richaerdson (Hero of Pyongyang)to violate the Constitution and forcibly evac folks to centers for forced vaccinations. The then state PubHealth director was NOT invited to the panel.

Trust the FedStateCounty PubHealth dweebs to fuck it all up.

Our NM state 'epidemiologist' once got on TV to state that Haanta couldn't be found below 6000' because the vector (deer mouse) wasn't found below that altitude ... just before they quarantined an outbuilding at the Petroglyph Center due to ... Haanta! Elevation 53 and change. We know that roadrunners, coyote and hawk would never ever grab a mousetidbit and move around, right ?

It's ineptitude and CYA all the way up, and down. Yes, Ol' Remus is correct. Prepare Accordingly


Aesop said...

They are infectious because it lives in semen samples from surviving males.
(Presumably in women too, but I haven't bothered to read up on the latest minutiae.)
We don't know for how long, because until 2014, the survivor pool could be counted on your fingers.
Now they have 17K or so of them to follow.
But every time they do another check, every 6 months or a year later, Ebola virus is still right there. The carriers are asymptomatic.
And can apparently pass live virus on through sexual contact.

So Mr. Obongo, widowed, finds him a new girlfriend a few months after the outbreak is supposedly over, she gets Ebola, and it's a fresh outbreak.

Lather, rinse, repeat.


Anonymous said...

One of your best rants! Consider Al Qaeda operatives self-infecting in Africa and then entering the US from our porous Southern border, or Canada. Consider spending their remaining days on public transport in Detroit, Baltimore, Atlanta or other such roiling fleshpots...God is Great!

Anonymous said...

Tragically funny story: Back in 2014 I had an appt to see my cardiologist at the local VA clinic. Part of the procedure before seeing the Dr. is have my vitals etc. reviewed by his nurse. Nurse: (upon me sitting down in her office) Have you been to any countries in Africa recently? Me: (laughing maniacally) Well, if I had and I had Ebola, you're already dead along with everyone in the waiting room and every person I've come in contact with since I entered the building. Nurse: I know kind of a ridiculous question at this point. Me: Why haven't they set up a triage station, out side the building, to check before anyone enters? Nurse: (smiling) That's too sensible.

I maybe wouldn't have responded thus without reading your timely, cogent reporting on the situation back then.


Aesop said...

Exactly the point.

When they told us to add those questions to triage, I refused to waste my time.

THEM: "What's wrong with you? Don't you think it's a good idea to find out if someone might have been exposed to Ebola?"
ME: "If it was that important, why aren't I asking them that question outside, in full PAPR and encapsulating suit, if you think it's a possibility at all?"
THEM: "Shit!"
ME: "I have a nursing license and a brain, and neither of them is two hours old."
I took a leave of absence the following week.

"Preparations" like that are CYA kabuki theater and happy gas, so TPTB can tell themselves they're "doing something".

Unknown said...
This comment has been removed by the author.
Aesop said...

1) Yes, you can set up your house to slightly positively pressurized.
2) As to setting up remotely maintainable filtration, I plead technological ignorance.
3) None of that is necessary.

To paraphrase my drill instructor "Ebola isn't going to low crawl up the driveway and butt-f**k you."

Ebola, at his point is transmitted by direct contact with blood, or aerosolized droplets of it.
That gives it a maximum range of maybe as much as twenty yards from a good sneeze.
unless you anticipate people strapping helium weather balloons to lawn chairs, drifting over your home, and venting their bloody bowels on you via aerial assault, a chain link fence and 50' of distance from the boundary line would solve the whole Ebola problem.

And a positive pressure domicile won't keep it out if you go out among the infected and bring it back on your shoes, clothes, or simply contract it yourself and then sneeze and cough it on your family a few days later.

All you need is a fence, a gate, and a lock, plus sufficient food and water.
And you stay in, and everyone else stays out.
Unless somebody fills a cropduster's spray tanks with Ebola-rich infected blood, and aerosolizes a mist of it onto your home, you're good to go with nothing more than a gate and a loaded shotgun.

It's not that hard to avoid.

It also means no human contact or travel or commerce whatsoever in infected areas until 42 days after the disease burns itself out, and then disposing of the remains left behind with gasoline and a flare, and/or spraying everything else down with tanker truckloads of concentrated chlorine bleach, and funereal pyres that would make a respectable Aggie pep rally bonfire.

If this becomes an everything everywhere pandemic, you can't go out among it, unless you're suicidal.

RandyB said...

"When to halt flights?


Odds this president will take my suggestion to shell the ports and crater the runways?

kurt9 said...

It seems to me that the scenario you describe would be accurate for an airborne pathogen. My understanding is that Ebola is not airborne transmissible and that is the only reason why the scenario you sketch did not happen in '14. I suspect your scenario is 100% spot on with regards to the incompetence of CDC and the medical centers in question. There is another issue that I'm certain you are very aware of that you do not present. That is the issue that, until they get the actual diagnosis of Ebola, they will take it seriously and instead will treat it as a billing event. They certainly did with the guy who showed up at the Dallas ER, where I heard 79 (Yes, I actually heard this figure) doctors, nurses, and medical technicians of various sort showed up in the guy's room until they figured out it was Ebola.

June J said...

CDC says “we know how to handle Ebola” yet a Dallas nurse who treated the patient is allowed to board a commercial flight.
This is the kind of stupidity that kills millions while assholes like Obama swear there’s nothing to worry about.

Aesop said...

Ebola demonstrates droplet transmission.
Droplets are de facto airborne transmission for anyone within 30' or so.
Hence infection via proximity without any physical contact to victims who are actively infected, coughing, sneezing, etc.
They are not true airborne transmission, like pneumonic plague or TB, simply because droplets are heavy enough that they do not continuously float around.

To this day, they don't know where the 2014 outbreak originated from, nor why it stopped.
Not a single one of the parameters outlined by MSF and WHO to contain the outbreak there was ever met.
Not a single one.

Ebola is never taken seriously here until it's confirmed.
That's precisely the silliness that would have to change if we were serious about halting the spread of an outbreak.
We weren't then, and we aren't now, and that delusional silliness in the face of a ravening plague will ensure that the next time will be as bad, or worse, than the last one.

If instead of just Duncan, there had ben ten or twenty victims in Dallas, or anywhere else, it probably would have wiped out hundreds of thousands to millions, and nothing would have stopped it but bayonets and napalm, and the total collapse of society. Worse, there's the very real possibility that it would have found an indigenous host species on this continent, and then it would keep coming back, just like in Africa, and "first-world" medicine would be as effective as a screen door on a submarine in trying to stop it.
You, I, and the entire populace on this continent were two active Ebola victims away from that in 2014.

If Duncan had infected just two family members in his apartment before coming in, everything you hold dear would likely have been wiped away, like a cow swishing flies with its tail, and the dead would have been stacked in heaps.

Just like in West Africa.

And I see no apprehension of that basic truth to this day, where it matters.

BTL said...

I just read the entire story and all of the comments about it.

The one thing I gather from it all is this: We are fucked.

There will be no precautions taken, no stopped flights until it's too late, no beds made ready to treat Ebola or any other outbreak.

Just chalk this one up there with a major financial crisis, nuclear war, terrorist attack, etc...

Prepare your home for whatever crisis you think might happen and do the best with what you have, but just expect that you are going to have to kiss your ass goodbye if one of a myriad of potential crises happen.

This planet is a dangerous place.

Oh, and please, everyone put some grip tape on your shower floor.

The Gray Man said...

Really? She's making big money for a MA.

Anonymous said...

Wow. Alarmist much?

The key things that will contain an Ebola outbreak in Europe, North America, etc., is communications.

Where rural level Africans are very hard to convince about the dangers of spreading disease, there won't be much such issue in Europe, North American, Most of Asia, Most of South America. People are educated (enough) to know what is right and wrong. (Recall the SARS and H1N1 outbreaks - hygiene went up 4 notches).

Get the word out, and people will avoid people. People will up their hygiene game. Etc. Can't spread w/o bodily fluid contact.

So there will possibly be other Texas Health Presbyterian Hospital events. That did not result in a pandemic. At all.

Of course it's not the CDC saying "we got this". It's people with information who will say, "Stay the f--- away from me, dude!" that will burn out a pandemic quickly. (Indeed, the CDC will probably say, "Tell people to stay away.").

In that sense, planning and preparing now (true prepping, not the arm myself to the rafters with AR-15 prepping) is a much better tool than alarmist articles as above. (And you don't need to repeat "bleeding from the (orifice of choice)" so often to make a point).

J6Z, signing off.

mtnforge said...

Never for one second did I take what you went to all the work to warn us about Ebola anything but the most gruesome deadly Armeggedon literally waiting for the mathematics of all the worst series of things for it to go world wide end of days.
And except for my wife, not a soul I know worked with or bumped into gave a hoot if I talked with them about the dire possibilities. In its own way that is worse than the Ebola.
It sure made things easy to decide what my wif and I decided our course of action would be, and that was if we where to survive such an event it was literally screw you. You scoffed at us, and treated the discussion like an unwanted embarrassing family member.
I figured it was a situation where as we lived in about rural an area as you can find at least we had the advantages of enforcing that seclusion from population to a better degree than most, that once it went pandemic a non contact shoot on sight policy would go into effect. Or literally bug out our back door head into the almost uninhabited hundreds of square miles of rugged mountain terrain and live it out in a dugout like two possums hibernating.

This shit is merciless. It is evolved to kill all in its way. It is cunning and enemy. There is no defense but total isolation from it and how is that possible in the world we have?
Only possible if your just as heartless cunning and have only total survival as your only prerogative.

I’m saying how can people without that modern technology work together fighting it? It seems it is not possible. And brutal and ugly as it is the only way to survive it in a pandemic stage is to be absolutely cold blooded ruthless. Like Ebola.

Or am I totally missing something?

Anonymous said...

Oops, left out a detail.

Vaccinations are now available for Ebola and one is in use in Africa following the "ring vaccination" protocol (vaccinate highest risk people). It is (apparently) effective (if not 100%) even on patients who have contracted Ebola.

J6Z, signing off. Really. I mean it.

June J said...

J6Z- wake up and smell the reality brewing. Communication? When the government seems more interested in covering their ass and not alarming the people exactly when they should be alarming the people? When the “professionals” in charge of hospitals put profits before preparation, ignoring the warnings that have been provided?
Perhaps travel here to Dallas and talk to people who were on the front lines, who lived in the neighborhoods around the outbreak area and try to understand the absolute clusterf**k the situation was.
If you have conclusive documentation of your effective vaccination claims then post the links.
Anyone paying attention the last dozen years or so can see the ineptitude of the medical leadership, most of whom are unworthy to wipe the butts of the hardworking nurses and doctors who strive under the thumbs of corporate lawyers and the vey government stupidity you think is communicating wisdom. Then add in the progressive socialists who resist any common sense measures because they cannot be bothered with facts and reality.
If a majority of our nurses are going to opt out of stupidity when the next outbreak occurs we’re all screwed.

15Fixer said...

Other than that, Mrs. Kennedy, how did you like Dallas?

Aesop said...

Relax, folks.
I've got this.


And people wonder why I put up with an hour+ drive to work every day. I live on a dead-end street that is hard to find by just wandering around. For a reason. Not just THIS reason, mind you, but this is definitely on the list.

Anonymous said...

@June J.

Your reply is a spray of rants against the government. Fine.

You can go to Wikipedia for info on the Ebola vaccination and find out about its effectiveness and limits. (There are over a half dozen versions in various states of testing; one has been deployed in Africa so far and is deemed effective (for some undefined value of effective).

You echo alarmism. Better just to plan and prepare. Again, those who can and will isolate themselves are the ones with the greatest chances of survival. Communications as we have today (and did not have during the Spanish Flu pandemic) will certainly make a huge difference.

I agree that the worst thing one could hear is "Hi, I'm from the government and I'm here to help you."

When you hear: "Ebola has landed" you put your plan into action. You will hear that via one or more of many forms of communication. If you happen to be in the wrong place at the wrong time, well, you may be screwed. Statistically the rest won't be.

Recall SARS? H1N1? They didn't become big things because of communication first, effective isolation and increased hygiene next.

I don't want to downplay Ebola - that would be silly. But it's had several turns at bat over the past few decades and has not managed to break out in any significant way. Yes, yes, Texas, blah blah.

But then there's these two lists (outbreaks and isolated events):

You've got some 30,000 known cases there, over time. And yet The Walking Dead is still just a somewhat repetitive show on television ...


Aesop said...


Look, the vaccine sounds very promising, all we could hope for.
So, we get another Duncan (or ten) here, how fast can they whistle up 350M doses...?

And what happens, everywhere, if we, let alone large swaths of humanity, have to go into self-imposed house arrest for weeks, months, or years?

A wee bit more appreciation for those realities wouldn't go amiss.

Nor a bit of reality about what happened last time: two doctors and a nurse exposed to Ebola decided they were too special to self-quarantine. Two more nurses turned themselves in for treatment the moment they spiked a fever. (A lot of that is the difference between actual bedside clinical practitioners and bureaucratic prima donnas, but still...)

Not counting the returnees who contracted Ebola overseas, we had three fulminant US cases, and one died. The two survivors will never have the life they did before the disease. The point isn't how little happened, it's how close to the edge of catastrophe we skated. Two more patients, anywhere, and every hospital where a subsequent victim showed up would become THP. I work at the pointy end of that, and I'm telling you first-hand, screwing it up by the numbers and turning an outbreak into a pandemic is exactly how it's going to go.

Four years after that experience, we're still in pants-around-our-ankles-and-head-up-our-@$$ mode, nationwide, top to bottom, from the CDC to the Podunk Community Clinic and Beauty Salon.

The "It's never been a problem before..." line has the uncannily same ring to it as
"Mayor Vaughn wants the Amity beaches open by the 4th of July..."

Maybe you've invested in a mutual fund, and heard the line "Past behavior is not a guarantee of future performance".

Spanish flu, far less virulent than Ebola, killed 675,000 Americans, when our national population was 103M.
So that with Ebola would be 2M people dead of Ebola.
That's why H1N1 and SARS aren't what to look at; apples are not oranges.

We get a good Ebola initial outbreak, like 10 or 20 people here, and we'll get those 2M Ebola deaths here. Maybe worse, and even with a vaccine.

2014 in West Africa was 4 steps out of 20 from 1M Ebola victims.
At the speed of spread, that's three months, max.

Here, from scratch, that's a year.
We'd need 50M doses of rVSV-ZEBOV within that year to stop that sort of outbreak from getting out of control.
Which is only 49,990,000 doses more than the total produced worldwide everywhere since 2003.

The only thing that kept in Africa is poverty, because 99.9% of the country can't afford a plane ticket out. The per capita GDP in Liberia is US$14/wk.

But if Ebola gets to a major city there, like Kinshasa, Nairobi, Cairo, Capetown, etc., then that flimsy protection goes out the window, and the virus gets disseminated worldwide at 550MPH.
And the customs inspector there is a guy making maybe US $100/wk, maybe 1/4 that, and is someone for whom a bribe is a perk, not an insult or a criminal offense.

"It never happened before" at that point isn't even a good epitaph.


The book THE HOT ZONE predicted this - it was a scary read.

Most people, especially in the cities, do not have a week of food, let alone the 40+ days needed to self-quarantine.

AB.Prosper said...

Anyone saying the US has a 1st world health care system is full of it. Huge parts have no health care other than an emergency room and some not even that. Many areas are quite second tier and none of them prepared for 1917 flu much less Ebola

We also have up to 114K homeless in California alone , even if some of these are just "staying with friends" or the like there is vast pool of potential carriers with substandard health care (better than none Cali has socialized medicine of a sort) It takes only a few of them getting infected of them to create a nightmare scenario


@AB Prosper:

Many years ago I lived in a teeny-tiny town with a hospital. I was told by more than one person that if I were having a heart attack, flip a coin going there or trying to make it to the BIG hospital an hour away.

The Gray Man said...

Thanks for the response, and no, I don't take it personally, because I'm one of those people who likes to be disagreed with because that's how we all get smarter and better at, well, actual intelligent thought?

Anyway, I do agree with a lot of what you're saying and I guess it really almost comes down to logistics more so than actual capabilities of medical staff and whatever protocols we think we have in place. And then of course it comes down to whether or not our "betters" deem it necessary to DO what's necessary to prevent this mess from spreading to our airports.

I fully agree that when Ebola pops up in some African ancient history lesson of a "country", we should stop incoming persons from within a thousand miles of that location. Same for other bugs even less deadly than Ebola. Hell, do the same for common cold for all I care.

The last time this country of our's actually NEEDED people from other countries, was probably around the year 1900, MAYBE. If your country has a problem with warlords, Ebola, socialists, bird flu, swine flu, cockroach flu, opium addiction, Muslim self-detonators, drug cartels, etc., then I think the airports and seaports and border crossings should be closed off to you.

Really, I just think that we as a nation, really we as an American medical community, would absolutely definitely do a better job containing and dealing with an Ebola outbreak, if for no other reason than we might actually have a statistically significant portion of the citizenry who'll attempt to assist, rather than steal bloody bandages to perform witching ceremonies with.

I could be wrong though. My wife and I have done RN work and have experience in hospitals as great as Shands at UF, or as shitty as, well, shitty hospitals. I guess this is just one more topic in a million where I come to realize that "the United States" is just too big, populated, spread out and diverse to be considered a single place anymore. We talk about the outbreaks in Congo and in Sierra Leone and Guinea and Liberia, and then we talk about a possible future outbreak in... The massive US of A! The experience of Ebola, if we are subjected to one, will be different in the various regions of America.

LA, NYC, parts of Texas, South Florida, New England... Avoid. Shit, can you imagine if Ebola got into Mexico City, Rio DJ, Bogota, Caracas, Haiti...


@The Gray Man:

Your last paragraph. *shudder* Hell, just in NYC.

I was in China this summer (on business). The factories I visited were rat-warrens of close contact, with companies having - onsite - apartments for their workers who are crammed in 6-8 per apartment (doubtless small, I didn't seem them).