Saturday, June 15, 2019

Where The Problem Is

Frequent commenter Nick asks:

"Aesop, you know I'm with you on this topic, and I've been adding to my long term bulk food storage every two weeks...

But, the MSF guys are all volunteers, and they not only go to work, but do so at a loss financially.

Most africans are not particularly diligent or methodical but they seem to manage the deconn, donning and doffing reasonably well.

Given the conditions on the ground in this and the last outbreak, how can we reconcile what you (and I for that matter) expect, with the lived experience of the medical teams in africa? After all, there are LOTS of Drs and staff involved, and no or few reported deaths among staff, and none among the Drs.

I don't think the vaccine is the difference because we didn't have widespread losses among the foreign Drs and staff last time around either. (the one nurse iirc, and that from a social engagement not work)

I agree that it's the knock on effects that would be so devastating here or other first world countries due to the dependence on infrastructure and Just In Time delivery.

We also have the experience in Dallas of the guys POWER WASHING the index patient's effluvia off the walk, and the patient's own family who were closeted with him in the apartment, yet none of them got sick.

Is it possible that it's harder to spread this than we think? It can't be luck every time...."

Serious questions deserve thoughtful answers.
My response:

1) They manage donning and doffing pretty well, because they have five times the staff we'll allocate, because none of them are drawing paychecks. From 2014:
The Ebola epidemic caused an increasing demand for protective clothing. A full set of protective clothing includes a suit, goggles, a mask, socks and boots, and an apron. Boots and aprons can be disinfected and reused, but everything else must be destroyed after use. Health workers change garments frequently, discarding gear that has barely been used. This not only takes a great deal of time but also exposes them to the virus because, for those wearing protective clothing, one of the most dangerous moments for contracting Ebola is while suits are being removed.
The protective clothing sets that MSF uses cost about $75 apiece. Staff who have returned from deployments to Western Africa say the clothing is so heavy that it can be worn for only about 40 minutes at a stretch. A physician working in Sierra Leone has said: "After about 30 or 40 minutes, your goggles have fogged up; your socks are completely drenched in sweat. You're just walking in water in your boots. And at that point, you have to exit for your own safety ... Here it takes 20–25 minutes to take off a protective suit and must be done with two trained supervisors who watch every step in a military manner to ensure no mistakes are made, because a slip up can easily occur and of course can be fatal." Link
Do that math: $75 x 24 hrs/day, x 30 days, per patient. Times 6-10 staff members. At minimums, that's $324,000 per Ebola patient, just for the protective ensemble. and that's 4320 protective gear ensembles. For each patient. 25-75% of whom will die anyways.

Generating, if each suit only weighs 2 pounds, some eight tons of highly infectious medical waste, which no one in this country wants or knows how to handle, short of open pit gasoline fires.

Asking for a friend:
Which way do the prevailing winds blow from the nearest hospital?
How are the people living downwind in the Ash Zone going to feel about that?
Just curious.

2) "Pretty well" is a relative term:

In August 2014 (two years before the outbreak was over!), healthcare workers represented nearly 10 percent of cases and fatalities—significantly impairing the capacity to respond to an outbreak in an area already facing severe shortages. By 1 July 2015, the WHO reported that a total of 874 health workers had been infected, of which 509 had died. Link

As of 30 April 2019, there have been 92 health care workers in the Democratic Republic of the Congo infected with EVD, of which 33 have died. Link
 And MSF's precautions are done in a no-sh*t Hot Zone. An unknown number of those helping are "survivors" of the current outbreak, each time, with obvious immunity going forward (with all the caveats about EVSyndrome for such "survivors").

We are not being trained in their MSF protocols here, we're trained to CDC protocols.
You know, the ones that got two nurses here infected within 21 days, despite doing everything the CDC thought was sufficient. Which is exactly how well Ebola spreads in the wild, with zero precautions.

BLUF: The CDC guidelines are the same as slam-dancing naked with Ebola-riddled corpses.

The same CDC that gave an infectious nurse permission (WTF?) to take commercial air home, knowing someone with a fever (which she had) was infectious to everyone at the airport and flight she came into contact with, including the guys that handled her baggage.

( "Hey, we're the Government, rules of Nature, like physics and epidemiology, don't apply to us, Because we say so.")

It isn't that Ebola is less effective at transmission than we thought, it's that early, before you're literally coughing out your lungs, vomiting out your esophageal tract, and sh*tting your intestinal walls out, it's a somewhat (but unknown amount) less infectious than the final stages.

That's a pretty fine razor to skate on barefoot.
That was the luck we were living on with Duncan, with both nurses he infected, with Dr. Dumbass in NYFC, and with exposed-but-not-infected-roommate-of-Ebola-victim Nurse Mimi Crybabypants.

[The later two, failing actual 40-day-lockdown-hard-isolation quarantine, should by rights have been shot on sight for breaking quarantine, gross professional negligence, and 20,000 counts of attempted murder.(I.e., if you point a gun at someone and pull the trigger because you thought it might be loaded, but it wasn't, you're still fully legally culpable in 50 states and 7 territories for the attempt.)
If somebody capped them both tomorrow, on their own, it would still be justifiable homicide IMHO.]

And if/when this gets here, some medical professionals will decide they're Special Snowflakes, and don't need to follow all the rules, and don't have to be quarantined, because it violates their rights or harshes their mellow, and exactly like the family from DRC that sneaked into Uganda, they'll transplant the outbreak to others. And we won't find out for another 3-21 days, on average, and some not for longer, by which point it's already an epidemic shitshow here.

That should be a shoot-on-sight situation, followed by burning the corpses immediately, after obtaining a blood sample under BL-IV precautions.

But this is America, and we're too squeamish to do that, and we'll end up killing people with kindness by not doing it. (Like letting infectious nurses travel commercial air, rather than sending a BL-IV jet to whisk her and her stuff into full containment. Like your government did in 2014.)

Also, the people working with Ebola in Africa for MSF are only providing palliative care, i.e. assistance for the 80-90% who're going to die, to do so less uncomfortably than they would in a rut by a dirt road.

They aren't taking blood samples, starting IVs, or 57 other things. Their height of care is a cool cloth for the forehead, a cup of water (which becomes the next bout of projectile vomitus), and trying to contain the piles of bloody diarrhea being launched into bedding and over at the patient on either side.

And they burn the entire treatment center when they're done, down to the concrete pad (unless, like in DRC, the locals don't wait until its over, as they've already done over 40 times during this outbreak, and killing or injuring over 80 health workers there, which is why 25% of the affected areas in DRC have zero MSF or WHO presence). Now, think of your local ghetto 'hood or barrio. Think it will be better here??

It isn't just HIPPA concerns that keep TPTB from showing you that bloody reality in each and every outbreak. People would be at the White House fence line with AR-15s and Molotovs in earnest, clamoring for POTUS to nuke Africa if they knew that and saw it on the Nightly Snooze on the major networks. You're being lied to daily, including by massive omission, and have been since forever. I post what I post because I figure people can handle the reality with the bark on. But in 2014, I had to drop it, because by Presidential Fiat Decree, the news media were told Not To Talk About Ebola Anymore. Leaving us with just the happygas from foreign sources (who largely also complied with the gag order) and the lying African nations' self-serving press releases that under-reported the breadth and depth of things, on purpose, by a minimum of 300%. Even the UN/WHO admitted that, during the outbreak, openly. "It'll be different this time." Sh'yeah, as if. Neither there, nor here.

And one of those factoids is that once it's more patients than our BL-IV beds can handle, the care and protocols and training become so sketchy as to constitute gross professional negligence on the part of all hands participating, from POTUS and the CDC director, down to the sloppy housekeeping person with a GED who'll be sent in to mop up after patients #16 to #Infinity, with half-assed don/doff training, protocols, faulty equipment, and insufficient staff.

Ebola's always going to find the weak links in any chain of infection.

In the West in general, the weak links are the chain itself.

Instead of screening this stuff and keeping it at arm's length, because of ignorance, deliberate stupidity, negligence, malpractice, and malign indifference to all of the above, the very people who stay and play with it are going to be the same ones who insure that everyone else gets it, mostly through accidental exposures like the two nurses in Dallas, along with the selfish and stupid infectees who won't seek treatment, and will keep sending sick kids to school and going to work until either one collapses shooting blood out their eyeballs.

That's before we even talk about the open borders and lackadaisical attitude towards quarantine that's been rampant non-stop from 2014 until now. This is deliberately engineering Ebola's arrival and release among the population, which we've already seem with measles, TB, Chikungunya virus, West Nile virus, and a witches' brew of other diseases we had formerly whipped here.

Verstehen sie?

We aren't set up for this, and we're doing nothing to stop it getting here (rather the opposite in fact).
And when it does, after those first 15 beds are occupied, we've done nothing anywhere close to adequate to handle things properly and nip it in the bud.

But everyone in charge pretends we've done exactly that, when nothing could be further from the truth.

Maybe you can bullshit the Low Information Viewers in flyover country, but you can't bullshit me or countless other doctors, nurses, and ancillary staff who'll be on the frontlines (for about 20 seconds, in my case) before we drop our clipboards where we're standing, and head for the parking lot.

I may make a bullshit excuse about not feeling well, I may pass off report on my patients to someone else who stays, but go I will, and I mean within minutes.

I can't collect paychecks at Forest Lawn, and I won't be helping anyone shitting my intestines into my scrub pants, and both of those are slam-dunk outcomes with the present (and perpetual) half-assed level of preparedness for Ebola or any one of 27 other pandemic-worthy infections at every hospital (but for a small part of a bare few) from Anchorage to Miami, and Maine to Hawaii.

Anyone wants to go to medical or nursing school, and go work on the frontlines of Ebola with WHO or the CDC, rolling the dice you'll live to retirement every time you scrub in or out, operators are standing by. (When every hospital has an actual 24/7 BL-IV capability, and staffs and supplies and trains for its use regularly - by which I mean more than once a year or three to salve their own charred consciences and pen-whip JCAHO's lackadaisical clipboard commandos - we can talk. Otherwise: F**K that noise. Sideways, with a rusty chainsaw.)

In such an epidemic, there is no such thing as a valiant death.
There's just death.

I'll do my damnedest to save your life if you come into my ER.
But I won't kill myself to do it, and I won't die for you because TPTB at every level are too half-assed and cheapskate to prepare for this as if it was Really A Thing, too stupid to know that, and too evil to care. That ain't in my contract, and unlike joining the Marines, I took no such oath, and it isn't part of the deal.

I don't know how many out of 4,000,000 medical practitioners will be that honest and tell you that up front.

I just did.

Unless you're one of the original few cases in the outbreak, before anyone knew it was here, so you didn't have the sense to self-quarantine while you were uninfected, if you come to the hospital with Ebola, you're de facto part of the problem, not the solution.

And you're probably going to die, and there's a better than even chance you had it coming.

To All Concerned:
Get. Your. Sh*t. Together.

Nobody else is going to save you if this gets here. Save yourself. Don't get it.
Because if you catch it, you're getting a Viking funeral, about a minute after you're dead.

Just like they do Over There.


Anonymous said...

Here's some more local info and reflections from Europe.

The Rome hospital with BL-IV beds, Lazzaro Spallanzani, is surrounded by typical European city-scape, nothing but five- or six- story apartment buildings in every direction. There are probably 200,000 people living within a mile of the hospital. It's also adjacent to a much bigger hospital, San Camillo-Forlanini. Those two hospitals accounted for 15% of the hospital visits for the entire province that includes Rome in the most recent information I could find, February 2015. They're probably ~20% of the hospital capacity for Rome proper.

If the virus were to break out of the BL-IV section of Lazzaro Spallanzani, it would shut down 20% of the hospital capacity of Rome and would probably run rampant through the city anyway. From the capital it would probably spread to most of Italy.

I live a mile from Lazzaro Spallanzani. By prevailing winds from March to October, I'm downwind. I can actually see a smokestack from my balcony which I'm pretty sure is the smokestack for the medical complex. I'm suddenly much more interested in verifying that guess.


Anonymous said...

Aesop, sorry to hog your comments box but I'm thinking about this topic a lot at the moment.

You've stated repeatedly that self-quarantine is the best (or only) survival option for individuals, whether in one's regular residence or at a rural retreat. You've given advice on how to make self-quarantine possible for those who are not prepared. Some of your readers are prepared and able to do so. It seems it would be very helpful for their odds of surviving for them to have decided in advance exactly when they're going to make the big decision to go into self-quarantine. It's a very tricky practical question. Do it late, and they multiply the chances of self or loved ones getting infected before you act. Do it over a false alarm and they'll have major expenses and career and family repercussions.

It would be great to have a post and discussion about the criteria.

You've said the ideal time is two weeks before the first case is identified in your area. That's not a clear criterion. Maybe we could think collectively about likely patterns of spread in the case of breakout into urban, industrialized society and produce some suggestions on identifiable criteria for the right moment to initiate the self-quarantine.

For example, what are the relative merits of a decision, "I will self-quarantine the moment Ebola is identified:
(1) anywhere in the industrialized world.
(2) anywhere in my country.
(3) anywhere in my city.
(4) at my workplace."


Anonymous said...

Or (2.5) "I will self-quarantine the moment the number of identified Ebola cases exceeds the number of BL-IV beds in my country"?


Anonymous said...

My wife is an APRN with more than 32 years practice. She has worked Serge. Med Serge. Wound care. CCU. ICU. NNICU. Trauma, and now works in a high risk pregnancy clinic. She used to "POO-POO" me about prepping UNTILL....She attended a CDC infection control seminar. She came home. Looked me in the eye and said: How long did you say we had to stockpile for?, And what kind of barb wire were you going on about? I said: Why? Did you learn something scary at this seminar? She Said: YES! The CDC are clueless idiots. They couldn't handle a code brown on a non infectious unit. If Ebola gets in to America we are "F"ed, with them in charge. It will be martial law in a week. Even then the only "plan" they have sounds like it was made by a kinder garden class with crayons. At her request I'll leave my name out. She says "Those people are both ruthless and stupid. They scare the crap out of me"

Anonymous said...

For those sheltering in place in the suburbs (like myself - sigh), without the means to buy/build a rural retreat in the next 2 months, the odds don't seem great. I am not particularly worried about getting ebola. I am worried about the knock-on effects of no power, no city water and sewage, marauding bands of what-not. . . time to google urban prepping.

Anonymous said...

I'm a primary care physician with the VA where the middle management bloat of clip-board commandos rules the roost. I saw the kits prepared for the previous E-scare and they met my expectation which was a bar so low that a cockroach couldnt slip under. Fortunately my clinic was about a kilometer from the ER. When I told my friend who was distributing the less than adequate kits that if I heard of a suspected case of Ebola in the ER, I would grab my kit and throw it in the air and try to be in the parking lot before it hit the floor and halfway home before it stopped rolling. He said he wouldnt waste the time throwing it. There's food and water in the garage at my home for my possible 3 week isolation from my family. The woods are 187 yards away where I plan to bleed out if it comes to that. Perhaps I would see the 8 pointer I spied once from deck 187 yards distant during hunting season. On a Sunday.

In any event, your assessment of middle management and up, HIPPA hitler's et al who go through motions they know are not only meaningless, but hinder the delivery of routine medical care let alone in a disaster, is spot on. Hey, they got a family to feed.

I just have the overwhelming urge to buy a few more cases of answers in 308 and 5.56; much more storable than concertina wire.

I'm just left wondering if my dogs would become a vector after they motivated an infectee to get off my lawn.

Anonymous said...

Absent some infected patient from the DRC getting on a plane and flying directly to Chicago, what is the best guess as to timing?

If the spread of the virus follows the same path in 2014, I assume it will reach a large African city in the next 4 - 6 weeks, and then a larger African city in 6-8 weeks, and then go international in about 10 weeks. Which means it gets "Spicy" in the U.S. some time in mid-September. Does that seem accurate?

Archived Pages said...

I appreciate all the hard work you do in getting this Ebola information to us.

The links are good. They help us in our own research. Could you also do them as links so that the information is still available if the pages are removed.

Thank you.

jstark said...

Gents, honest question.

Why isn't it worse yet?

Last time, effective action was countered poverty+incompetence+ignorance (like those denying the virus exists).

This time, it's all that plus moronic Bad Guys actively killing medical staff.

You'd think we'd have cases all over the world by now...

Matt Bracken said...

Thanks, Aesop.
Reposting where I can.
HT/WRSA for the linkage.

Historian said...

re anonymous 6/15/19 at 4:32:

With Aesop's points above well in mind, here are my thoughts on what will happen when this disease comes to these presently united States, followed by some timing thoughts. All of this is predicated upon the virus not evolving and becoming fully airborne, and the political situation here in these presently united States as it presently exists continuing. Establishment of serious quarantine measures would change matters for the better, as will triage/separation of ED patients and emergency funding for adequate PPE from the Federal Government. All of this is vanishingly unlikely until it is too late. If Ebola become fully airborne, that would be much worse.

It is less than 50/50 that an infected person will be identified as a suspect Ebola case upon arrival, probably much less likely, as bureaucratic inertia means that the list of possible infection source cities will lag the reality. It is more likely that the infected will be able to enter the US without being identified as possibly infected, (per Dallas) and will enter the general population, spreading infection among their families and contacts until they get sick enough that they show fever as well as the other characteristic symptoms.

At that point, they will go to their local hospital, likely infecting some of the under-trained and unaware doctors and nurses in the ED. When identified as an Ebola patient, current protocol is supposed to have such cases relocated within 24 hours to one of the designated regional Ebola treatment hospitals. Note that this only works if the person presenting is one of the few early cases. Once we have over 10 cases at such places, they will likely refuse to accept further patients, at which point the local hospital will have the choice of either ejecting the patient or trying to come up with an Ebola ward on the fly. Neither are likely, which means that this patient will stay where they are in a suboptimal containment location until they die or recover.

Those healthcare workers left behind at the original hospital will incubate Ebola for 3-40 days, depending on whether they got a large dose of the initial infection, or whether they got just a few virions, (minimum infectious dose is ONE viral particle) and after just a few days, will be spreading it to all those around them whenever they go (work, home, shopping, public events, etc.) every time they cough, or sneeze, or sweat on a common surface (door handles, counter tops, toilet seats, computer terminals, telephones, EMS radios, non-absorbent chair seats, etc.) even before the bleeding, projectile vomiting and diarrhea and other really unpleasant and obvious symptoms start. The other folks they are in contact with who are unlucky enough to ingest at least one viral particle will in turn start to spread this disease among their co-workers, contacts, friends and family, who in turn will take from 3-40 days to show prompt symptoms.

Meantime, this will be going on where-ever the other folks that got infected on the ride over have wound up.

Now as regards timing, I am not aware of any really good data on this, but based on the 2nd SD being about 21 days, I expect that the median time from infection to prompt symptoms is going to be between 7 and 14 days; much depends on how big an infectious dose is intially absorbed, but the stochastic nature of such an outbreak means that we could see the first case here in the USA, well, NOW.


Historian said...

I was somewhat surprised that the spread to Uganda happened so quickly; that speaks to the large number of unreported and unknown cases and the inadequacy of current screening measures. With all of that said, the probability of seeing one or more cases in the US grows week by week. I would be surprised to see a case here before the 4th of July, and I would be surprised if we did not see a case by the New Year, but either is possible. My best guess is that we'll probably see a first world case sometime in the 4th quarter and here in the US by the end of the year. What happens after that is anyone's guess, but keep in mind the slow progression and lack of fever of this variety of Ebola, which means it is harder to spot. This in turn means it is more likely to become endemic in North America.

Frankly, as much as I hope that Ebola NEVER comes to these presently united States, it might be a wakeup call to have some solo well-to-do person get exposed, slip through CBP, enter the US and then get sick, a la Dallas. That might be enough of a wake-up call to TPTB to break the present denial and actually enact quarantine regulations and get emergency production of PPE started in time to actually do something. That, too, is something of a forlorn hope.

The less exposure to the general public and to public areas, the better. I would absolutely avoid any public transportation, especially airliners from now on, and if I did have to use such, I would assume that the entire vehicle was contaminated, and would protect myself accordingly.

With regard to all who seek the Light,

robins111 said...

Isn't it remarkable that the same crowd who enthusiastically support euthanasia and full term abortion will be horrified that we don't spend billions on these terminal walking dead, and further will demand we allow anyone who is in contact with them to walk free.

Retired cop said...

As I read the comments, the news ticker on tv announces that CBP has quarantined 5,200 illegal immigrants for exposure to mumps and chicken pox. Makes you wonder if that press release was modified by concerns of panic conscious officials.

Your hard work in keeping the issues in our consciousness is greatly appreciated. I would join others in asking you to post an article about specifically when to self quarantine. I've read your posts about dropping the clipboard and heading out when the first case presents in your ED, and frankly, I think you will have made that decision much earlier than that, based on your remarks about "two weeks before the first case is symptomatic."
Any more specific guidance would be appreciated.

Anonymous said...

Aesop, thanks for the answers. I wasn't making the connection between early in the onset and late in the onset.

WRT why it's not spreading faster, WHO puts that down to the success of their ring vaccination program. They've vaccinated over 100,000 primary contacts and the vaccine is reported to have some therapeutic value even if you've already been exposed.

That said, I'm not taking anything WHO, MSF, or the local health ministers say on face value.

The US case in Dallas was only 6 hours by vehicle or 20 minutes by air from me. There is a lot of legitimate air travel between Dallas/Houston and africa due to the Oil and Gas industry. Someone is almost guaranteed to come into DFW or IAH. Dallas in 2014 was when my prepping emphasis shifted from short duration local or regional events like hurricanes, to long term events like self quarantine or social collapse. Much of that change was driven by Aesop's comments and analysis.

I'll add that just because 2014 didn't become a brushfire here, doesn't mean this one won't. The illegal immigration angle makes the whole scenario MUCH more likely. After all, if you are here illegally, will you run to the ER with a sniffle?

The homeless situation is worse than 2014 too, with ordinary medieval diseases making a comeback. If Ebola gets into that population, we'll have a wildfire...

To the commenter above who said "time to google urban prepping" I hope that was dark humor, but if not, YES IT IS TIME AND PAST TIME. There are good sites and money grubbing exploitative sites. Read for tone, with emphasis on practical and affordable advice. There are a lot of con men out there taking advantage of the rise in preparedness. Lots of good archives got lost when certain sites sold out.

I've been doing this for a few years now. Prepping doesn't have to be expensive. It doesn't have to entail irrevocable changes to your lifestyle. If you think time is short, you can trade money for time and bulk up quite quickly. But following some online advice you can also bulk up quite well without spending money on a packaged solution.

The topic of getting started in prepping is too big for a comments section, and most of the links I'd have given a year ago have vanished, but there is still good info out there. Start with the LDS church guidelines. Substitute flour for wheat. Flour is cheap and will last long enough, and you don't need a grinder. Double or triple the amount of water anyone recommends. Don't just read about it, get started.

Prepping is fractal. The closer you get to it the more there is to do. Don't let that discourage you.


Anonymous said...

WRT self quarantine, I'm currently leaning toward when the first case in the US without a known connection to the index patient happens. That would mean it's out in the wild here. It might be too late at that point but there are real world consequences to pulling the trigger too early too.


Aesop said...

There are absolutely consequences to bailing out, early or late.
By the time TPTB in your world are willing to give you a Mulligan for bailing out, because general catastrophe, it's already far too late.

As for going too early, that can leave you with bad options as well.

But if you aren't prepared to ride something out in the first place, you've already made your choice, and will have to live (and possibly die) from it.

No, I probably won't wait until the first case walks into my ER, unless it's the first case period.
If there are already cases in my county or the ones next door, it's probably going to be time to start unplugging.

Everyone in the country is entitled to 12 weeks of unpaid Family & Medical Leave, for any reason or no reason. Merely stating a "family emergency". Ebola a couple of zip codes away strikes me as the time I'll be taking that leave.

If it's better, and not worse, three months later, well and good.
If it's going sideways and pear-shaped, even better.

But if you haven't got the financial and survival resources in place, you don't even have the option except to become a refugee.

Do you have water for weeks to months?
A porta-john and sawdust to compost waste, or a number of large bags of kitty litter?
And enough actual food to avoid going out? And a way to prepare or cook it?
Along with whatever $$ you need to mail in checks for rent, power, water, &c.?
Can you be your own 9-11, for fire, medical, and police concerns?
What about your own water and power company?

It's not complicated, but the earlier you start, the less you still have to do.

And if you think the government will be there to help you, at any point in the process, I have a bridge for sale, cheap.

We were fat, dumb, and happy in August of 2014, and I'd already posted two or three warnings on things in Africa getting out of hand.

Come end of September, and it was wild and on the loose in Dallas, and suddenly shit got real.

Don't be the last guy to notice this.

Like I said a couple of posts back, the preps for this also come in handy for 27 other problems.

Anonymous said...

Aesop, just wanted to say THANK YOU for the continued intel. I love your style of writing, it certainly gets the point across! Keep up the great work, and be sure to let us know when you bug out.

My wife works in the local hospital, yay for us. I need to have a very serious conversation with her about when to run for the hills. I am leaning towards right after the 1st case is identified in the US. But bills, right?

Exciting times.


LM said...

Aesop, I totally agree that if Ebola gets loose in the US it will be a real disaster. But the more I think about prepping, the more difficult it appears to me. Ensuring some basic 1800s lifestyle for a year really shouldn't be so very hard assuming one has some surplus time and money.

The problem is that if things get out of hand, the food and energy supply of our cities will break down, and they will all come out to the country to take my shit. Let's say I am a good shot with various firearms and have a dog. Do I really like my chances against 15 desperate city dwellers armed with kitchen knives in the middle of the night? Do I have the balls to throw a grenade at a starving family on my driveway? And of course, there is a reasonable chance they all have Ebola! If I hit one with a shotgun from 10 feet and blood gets everywhere, what do I do? God forbid that happens inside my house near my food.

And then we have the geopolitical problems. Any country that isn't infected is going to have a huge incentive to take our land once the outbreak dies down if our military is completely vaporized, and that seems fairly likely. Even if we have nuclear weapons remaining and personnel to run them, who would make these decisions?

I don't want to seem like too much of a devil's advocate, because I would much rather be the man with the gun and the food and a fighting chance than the city dwellers who will suffer 90% casualties. But it seems extraordinarily difficult to really prepare for this. I wonder if the best strategy might be relocating to someplace more remote, say the Cayman Islands.

P.S. have you read Dr Robert Rowen's paper on fighting Ebola with ozone?

Aesop said...

I encourage Dr. Rowen to go to DRC, contract Ebola, and use ozone on himself, and write back with how that works out for him.
Failing that level of absolute confidence in his "cure", and its success, he's full of shit.

As a rule, nobody with Ebola is coming to take anything, they're generally collapsing and sh*tting their guts out in convulsions right where they are.

Anybody else is just an opportunist, and should be terminated with extreme prejudice the second they cross the property line.

If there are 15 of them, I only hope you're not using a bolt-action.
And not trusting to single-pane window glass and honesty locks to stop people.

As for "starving families in the driveway" I defer to the wisdom of an instructor in basic training some decades prior:

"Some guys see a baby in de trail, dey go over and look, and dey get killed. F**k dat.

I see a a baby on de trail, I'ma throw a grenade on dat baby.
If de baby blow up twice, da baby wuz booby-trapped.

That's a verbatim quote.

I have seen nothing in a long life to argue with the wisdom of that course of action.

Concertina at the property line, with a skull & crossbones.
And a red flag on the flagpole: "no prisoners taken, no quarter given."

Do what seems best to you.

The Termite said...

A ranch in the Andes Mountains in Chile is sounding better and better....

The Gray Man said...

Here you go, Aesop.

The Gray Man said...

Concertina wire is not expensive.

Anonymous said...

PS: Sorry if the formatting looks wonky.

Ebola in the West (USA and UK)
Name Got it here Sent here for treatment
• Dr Martin Salia (died) Sierra Leone Ne Omaha UNMC
• Mr Thomas Duncan (died) Liberia Tx Dallas THP
• Nurse Amber Vinson Tx Dallas THP Ga Atlanta Emory
• Nurse Nina Pham Tx Dallas THP Md Bethesda NIH
• Dr Kent Brantly Liberia SIM/ELWA* Ga Atlanta Emory
• Nurse Nancy Writebol Liberia SIM/ELWA* Ga Atlanta Emory
• Dr Richard Sacra Liberia SIM/ELWA* Ne Omaha UNMC
• Dr Craig Spencer Guinea NY NYC Bellvue
• Mr Ashoka Mukpo Liberia Ne Omaha UNMC
*SIM/ELWA = Serving in Mission, Eternal Love Winning Africa – a religious charity

• Nurse Pauline Cafferkey Sierra Leone Ln Royal Free Hosp

Breaches of Quarantine or Screening Protocol in the West (USA and UK)
• Dr Nancy Snyderman NBC reporter Liberia left self-quarantine in NJ
• Nurse Kaci Hickox Nurse in Sierra Leone refused quarantine in NJ and Me
• Nurse Pauline Cafferkey Heathrow Arpt lied to leave quarantine
• Dr Hannah Ryan Heathrow Arpt lied to help Cafferkey leave quarantine
• Nurse Donna Wood Heathrow Arpt lied to help Cafferkey leave quarantine
• 1st anon medic Heathrow Arpt lied to help Cafferkey leave quarantine
• 2nd anon medic Heathrow Arpt lied to help Cafferkey leave quarantine
• There are 16 separate names on this page.
• 2 (ie. 12.5% of the 16) were civilians who contracted the disease.
• 14 (i.e 87.5% of the 16) were medical professionals who contracted, or were suspected of contracting the disease, or contributed to the risk of spreading it.
• 14 were medical professionals who should not have contracted the disease because they should have been protected by their own actions and the protocols in place.
• 7 were medical professionals (ie. half of the 14 medical staff) who breached quarantine or screening protocols.
• 100% of those who breached rules were medical professionals.
• 87.% of cases were contracted in hospitals by staff.
• 12.5% were contracted outside a hospital by civilians.
My Conclusion
If ebola comes to the west it’ll be brought here and spread here by a medical professional in the first instance. My guess is that all the medical professionals got it when they used a toilet facility in the isolation unit while on shift and failed to doff or don their PPE correctly. It would be easy to do that.
100% of the avoidable errors or illegal/stupid actions were made by medical staff.

oldanddecrepit said...

If one wanted to distribute a bio weapon, one would be hard-pressed to think of a better methodology for minimum cost.

Retired cop said...

Thanks for the clarification. The only comments i would make are to set up electronic (remote) banking. This lets you pay bills without personal contact. It reduces personal contact and might keep things running longer. That starts with the electronic deposit of your paycheck and setting up your utilities to be paid electronically.

I'm thinking that by the time we hear of a U.S. case of Ebola, it will already be in the wild here. With the 2 week asymptomatic infectious period, that makes for very bad news. I'd suggest moving much sooner than waiting for known cases to get within a zip code or two. Part of your decision should depend on whether your employers know you as Aesop.

I am much luckier. Already retired, most preps in place. For me it's when do I stop the community activities, (church, volunteer work, card games, etc.) and drag barbed wire across the driveway.

Thanks again to Aesop and several clear headed anonymous commenters.

Anonymous said...

I don't see the Vice cameraman who got it showing ABC or CBS around the Ebola zone.... I though they sent him to Nebraska.

WRT prepping and surviving being hard, well YES. Most things worth doing are hard. Do it the same way you eat an elephant or start a journey of a thousand miles.

Aim for 3 days (the woefully inadequate FEMA disaster prep recommendation)
7 days (FEMAs new reco)
14 days (should cover almost any local or regional disaster)
30 days (big regional disaster, sick spouse, death of a loved one, loss of job)
45 days (same as above, plus self quarantine for flu or ebola)
6 months (economic depression, loss of job, death in the family, ease the long slide toward collapse)
1 year (Venezuela, Argentina, fUSA when the money collapses, ease the long slide)
2 years (F you and this shitty job, long slide, get thru ebola or other SHTF collapse)
5 years (until the rapture, or whatever the LDS church is expecting after SHTF)

Realistically, your time goal will probably be shortened by extra people on your doorstep, spoilage, charity, stone soup, etc.

Watch out for prepackaged freeze dried "kits". They usually grossly under provide calories for the amount of "days" they provide. Most of the food is pasta, and TVP which some people can't eat. You will be doing a lot more physical activity, you need more calories and water than "survival rations." WAY more water. Food and personal hygiene will require water. You don't want to start shitting yourself from food poisoning while everyone else has ebola.


The Termite said...


I don't have your email, so I thought I would leave this here.

Anonymous said...

For those of you anywhere near Virginia, I K Supply has Concertina wire for sale: 20 rolls for $200. They are 50 ft rolls.

LM said...

Thanks for the reply Aesop. I guess I need to get a bit emotionally tougher! I wonder how I would accomplish that.

Also, I did not phrase this very well, but ozone has actually cured people of Ebola. Rowen trained some Sierra Leone physicians in ozone. 7 of them contracted Ebola; all four of those who got ozone recovered more or less instantly and all three of those who did not get ozone died, including one who was denied treatment by the government. I wouldn't treat it as gospel, but neither would I instantly write it off.

Anyway, I appreciate the posts which have definitely ratcheted up my concern several notches.

Aesop said...

Maybe it works.
There was an Australian doctor who was sure ulcers were caused by bacteria.
But he had the balls to infect himself, then cure himself, to make his point.
Now he has a Nobel Prize in medicine to show for his determination.
So absent that level of commitment, you can understand my skepticism of Rowen's claims.

All he has to do is get his story published in the NEJM, JAMA, or the Lancet, and I'd give it a look. When anyone can replicate it (the acid test of actual science), even once, I might even believe it.
You'd think that wouldn't be hard amidst an outbreak of 2000 and counting, would you?

His own word, confirming his own claims, on an unsubstantiated internet blog post is worth absolutely nada.
Otherwise that Nigerian gold investment scheme would have made me a gazillionaire, just like Solomon Ondonkoh promised.

The fact that he's hawking his cure on the internet from Santa Rosa CA, and not taking it to the Hot Zone to demonstrate its efficacy tells people everything they need to know about the likelihood of veracity.

But as P.T. Barnum observed, "There's one born every minute."

Retired cop said...

So, what happened to the Dallas nurses, Amber Vinson and Nina Pham? I thought they tested positive. We're they cured? Are they now carriers? Dead?

Anonymous said...

Makes me wonder if Vinson and Pham actually had the virus.

Anonymous said...

For those that want to prep but are short of disposable income yet believe that time is of the essence go no further than Bison Prepper

You want the PDF "The Frugal Survivalist" found at

His blog

Unknown said...

I just glad to find where all the action is. It is here. I only found Bracken's War room appearance in a YT video uploaded by Baked Blunts. There was only 7 views. There he clearly explained why he believes it is the Iranians. It would be good if Bracken could, if is not already, posting his Infowars appearances here, or on another of his websites. I do my best to hunt him down, but it is not easy, and I'd hate to miss a vid.

With Ebola and all the other deadly antibiotic resistant TB, Typhoid etc, it is time to stock up with both hands and prepare to self quarantine for at least 30 days and longer. Prepare a remote location if you do not already live there. I'm in the mountains of Montana. When the country collapses, Cholera, guardia, cryptosporidium, water born diseases will be common as well as Typhoid, and TB. We could also see other deadly disease. I have the gear, but will not use it unless forced,because the decontamination process is too risky for Ebola. Get the book by Dr. Joe Alton, Alton's Antibiotics and Infectious Diseases. The book explains in simple laymen terms where,and what to buy, how to diagnois, and how to use antibiotics. Buy antibiotics a without prescription. We need to keep highly motivated patriots alive and well. There are so few.

I'm an old broken down man living on nearly nothing for income and I do not accept assistance from the goobermint. If I can do it you can do it, because if there is a will, there is a way. If there is no will, then there is no way. We must also get right with God.

Check out, run by James Wesley Rawles, author of Patriots, Surviving the Coming Collapse.

Tunnel Rabbit

Aesop said...

@Retired cop,

After virtually not a peep on her condition any time in the five years since 2014, there was recently a media story (just a wild coincidence, I'm sure) claiming she's virus-free. Mirabile dictu.

Of course, since they probably didn't pull the aqueous humor fluid from her eyeballs, or the CSF her spine and brain float in, where they've found Ebola virus in other formerly infected persons, my skepticism of that claim knows no bounds.

So far, for every survivor, per all accounts, when they really look for Ebola in prior victims, they find it. Functionally, forever.

The fact that it's five-plus years after her infection and they're only now announcing she's clear of it should give you pause.

Notably, they've released no such claim on Amber Vinson, Dallas nurse #2.

Draw your own conclusions there as well.

Then Google Ebola Virus Syndrome.

TL;DR: The best way to survive Ebola is to never get it. Period.

Matt Bracken said...

Aesop, just FYI: So I went to post the CR link above to Facebook (where I'm not currently on a 30-day ban).

“550 African migrants were just caught in Texas. DHS head says they aren’t being screened for Ebola”

And immediately, this dire warning popped up on my screen over the story before I could post it. I posted it anyway, despite the warning.

Matt Bracken said...

The CR story never said "migrants with Ebola are being dumped in San Antonio." The "politifact" re-direct is bogus, based on a lie. But Z-book sure is freaked out about Ebola reporting.


For your amusement:

Unknown said...

Aesop, I just started reading the following - Epidemic: Ebola and the Global Scramble to Prevent the Next Killer Outbreak 1st Edition
by Reid Wilson - and the opening chapters give a brief history of ebola and the response to 2014 outbreak.

All I can say is, if anything, you're UNDERSTATING the cluster f*ck that was the response by the WHO, MSF, et al...and the depth of ignorance of natives in the region is beyond staggering.

When it comes here, and I have no doubts now that it will, we are, simply put, well and truly f*cked.

daniel_day said...

Here's the Laura Ingraham report on Friday about Congolese "entrants":

Aesop said...

@Matt Bracken:

How dare you try to post un-pre-digested news where anyone can see it!

That one made my day.
Capitalism FTW.

lineman said...

You need to be building Community so you will have some help when it goes south...I'm in the Bitterroot if your close coffee is on me...

Domo said...

"This time, it's all that plus moronic Bad Guys actively killing medical staff."

Overseas medical staff being the people with easiest access to trucks, helicopters and jets.

Anonymous said...

was watching this ( about an ebola patient being delivered to Nebraska containiment unit, it brings home Aesop's point of the amount of effort to properly care for 1 person not to mention a horde.

What really caught my attention was at the 15:50 minute mark, it mentions a doctor (Dr Daniel Johnson) newly hired, was suited up (without ever going through the years of training) and put in contact with this first patient 'because he has necessary skills', his quote in the clip - " i was getting put into a suit that I had only seen on the news or in the movies", followed by one of the assistant director saying "I helped him get this gear on, we had a little talk right before he walked into the containment unit, I just said go in there and do what you do every day and just be extra careful ( nervous smile)"

Maybe its me but why have a team that has trained together for 10 years and on game day you introduce someone who is being told the rules of the game as he is being shoved onto main stage, sounds like amateur hour multiplied 10^10.

From a risk mitigation and potentially screwing up a protocol that has been trained and rehearsed for years -- that sounds like pure madness, have the protocols and entrance criteria been tightened?

lineman said...

Hey if you can risk someone else's life because they are the new man well then what do you think the senior guys are going to do...

Anonymous said...

FNG gets point, amirite?


Anonymous said...

Aesop, my wife and my daughter are both nurses at hospitals, one on the east coast the other in the midwest. If this stuff were to appear at your hospital, what would you do?

Anonymous said...

Aesop has been very clear that he'd drop the clipboard and head out the back door...

anyone with sense would.

The fact that some will try to help and end up like the Dallas nurses, or dead, is amazing, but I think few and far between.