Tuesday, September 30, 2014

Welcome To My World

Ebola is here.

I told ya so. (Seven weeks ago, in fact.)

Nota bene he made it past the airport/airline screenings.
Then became symptomatic (i.e. contagious).
Which means everyone he contacted, hugged, kissed, shook hands with, worked next to, etc., has been exposed.
Then, after two days shedding virus like a cat shedding hair, he seeks medical treatment. Exposing all those people.
And GOT SENT HOME, because of course, he just had the flu, right?
Then went to the ER again, and exposed all those people too, plus everyone he saw after the first check-up, including the people who took him to the ER, and everybody between the hospital door and the isolation ward.

Of course, effective tonight, Dallas County and the contiguous counties are being put on a one-day shutdown quarantine, so they can find and escort all those potential infectees to a 21-day mandatory quarantine isolation ward.
And because it obviously isn't going to work, they're shutting off all flights to the US from Africa, if not everywhere.

What's that, you say?
They're NOT doing that?
And even though the CDC sent out a "Holy shit, it's coming!" memo  two weeks ago, the hospital staff screening the guy weren't wearing hazmat suits, hoods, gloves, booties, goggles, and masks?
And neither is the staff at any other hospital in the country, not even the ones nearest to international airports?

Brilliant! That will end well.

I'm betting airline/airport and hospital sick calls tomorrow in DFW set a small record.

I took an indefinite leave of absence.

Good luck, and hope that fingers-in-their-ears-going-La!-La!-La! Strategy works out for the White House, the CDC, every hospital in the country, and you all.

Best wishes.

Sunday, September 21, 2014

Ebola Update - UPDATED! - TWICE!!

You may have noticed last week that the CDC blasted out a info-bomb to your hospital (and every other one in the U.S.) noting that it's not a question with Ebola about if it gets here, as much as when.

So, are all your triage nurses working every day in goggles, gloves, exposure suits, and N95 or better respirators? or did management decide better to let their staff die in the first wave, rather than risk scaring away patient$?

Yeah. Thought so.

New numbers posted today, dated from the WHO report on the 17th.

Good news: Senegal and Nigeria have pretty much stopped their infections in their tracks, and have no new cases. They are almost completely out of the woods for the moment, and barring any new patient vectors, should cease to be areas of contagion within a week or so.
Congo's separate strain continues to grow and spread on its own in the backcountry, albeit slowly. They may manage to contain it small, as in previous instances. 

Bad news: Liberia has more than picked up the slack, now having gone from late arriver to the party to the main event, all by itself.
The disease pool remains on pathway to double in size about every 21 days, which points to 100K or so cases in Liberia alone by Christmas, or twenty times the size of the current level of infection, which has already completely overwhelmed all three countries even now.
In a country of 4M, Liberia virtually ceases to exist by about next Easter. 

Worse news: Guinea and Sierra Leone are showing lower growth rate, which points not to control but being unable to confirm accurate numbers, unless the spread and the virus there is miraculously half as virulent as it is in Liberia. Unlikely.
Also, there are only treatment beds for something like 20% of affected victims in any of those three countries, which means the virus is still walking around in society re-infecting more people day over day, as 4 out of 5 contagious victims are not in a treatment center.
Sierra Leone is also enforcing a 3-day total curfew to attempt to slow the spread down, so their next numbers will be low, because of no counting going on, but the infected people on the loose, trapped at home with others caring for them, mean that instead of helping, the quarantine will virtually guarantee a subsequent spike once the curfew is lifted, and the fresh cases can flock for treatment, and the bodies in the streets can be rounded up.

And just for real fun, the freshest outbreaks in Liberia are in the south, which was untouched by Ebola until recently, in the region directly bordering Ivory Coast, a nation hitherto unaffected by Ebola thus far. This points to people with infection travelling there, unable to leave, and spreading the infection within. So Ivory Coast et al are about to be gifted with Liberian visitors, and the resultant outbreak, unless they can maintain a flawless isolation (i.e. enforced at gunpoint), and the government of Liberia, including their border guards, remains intact and functional.

And CDC has quietly revised the prior rosy bullshit estimates from WHO, which was spouting numbers of 20,000 total cases; CDC now estimates things could get into the hundreds of thousands, a number much more in touch with current realities on the ground, and still probably dreadfully low. And to think, I could have saved them the money they spent to get to that brilliant deduction, since weeks ago, just by reading the news to them.

Other notable news:

The U.S. is intensifying its effort, planning to deploy about 3,000 U.S. military personnel to the region to assist with shipping and distributing medical supplies and building treatment centers.

Major General Darryl Williams, U.S. Army-Africa commander, arrived in Monrovia on Sept. 17 with a 12-person team to assess the situation there, Rear Admiral John Kirby, a Pentagon spokesman, said yesterday at a news conference. That includes deciding where to build treatment sites and what else will be needed from the U.S. military.

One C-17 transport plane has already arrived, and two more are scheduled for next week, bringing 45 personnel and helping to set up a command headquarters, Kirby said.

More from the AP report that news is based on:

The military units expected to deploy have not been identified.
Some equipment has already arrived, including a forklift and generator, and two more aircraft are expected this weekend with 45 more military troops.
U.S. troops will not be involved in the direct treatment of patients.
They'd better have a robust security element, and a bombproof exit plan, like say an LHA, with embarked Marine Corps Battalion Landing Team-SOC, and full vertical-lift contingent on 24-hour standby, or one good riot and they're all going to die in place, when the zombie hordes bite the hand that feeds them.
Here's my revised doubling timetable, based on current infection data:

Now >5K
10/11 10K
11/1 20K
11/22 40K
12/13 80K
1/3/15 160K
1/24 320K
2/14 640K
3/7 1.25M
3/28 2.5M
4/18 5M
5/9 10M
5/30 20M
6/20 40M
7/11 80M
8/1 160M
8/22 320M
9/12 640M
10/23 1.2B
10/24 2.4B
11/14 4.8B
12/4/2015 Game over, planetary reset to the 10% or so of 7 billion still alive (assuming no one decides to start a war or launch nukes, just because, in the downward spiral of civilization).

Nota bene that the CDC projection is right down the middle of the fairway, not the worst case at all, but pretty much an absolute certainty, and all I needed for my projection was a 2014/2015 calendar page, and (literally) the back of an envelope, not 50 math geniuses.
Also be aware that we lost an entire year to "Game Over" in the last 50 days, because the rate of spread has sped up.
If it does that again in the next few weeks, and we go to 14-day doubles, we would reach "Game Over" by next Fourth of July or so.

I figure Liberia collapses by New Year's if not far sooner, all of West Africa shortly afterwards, and by late spring, the black hole spreads outward at the speed of transmission.

Important caveat: If the infection spread is halted by literal draconian gunpoint quarantine, the timeline may be extended. Understand this will require triaging most or substantial swaths of Africa to certain death by disease and/or starvation, and ruthlessly exterminating and preventing any spread of the disease beyond that continent, something never accomplished in recorded history. So I don't give that option a lot of hope, on either moral or logistical grounds, take your pick.
Once it gets to any other continent, we're right back on track. Asia, in particular, would pretty much guarantee a global meltdown, and all that takes is one pilgrimage to Mecca, or one latent-infected health worker going back to, say, India.

Hoping for a medical intervention is on a par with hoping for the appearance of Mary Poppins. It's theoretically possible, but highly statistically unlikely, unless you're looking for proof of the existence of a benevolent deity who loves us and wants us to prosper.

And you can probably bump those dates one place or two sooner, if the current outbreak is as under-reported as I suspect.
And of course, if the rate accelerates as the spread widens, the doubles happen even faster.

Either way, the 2016 presidential races just got a lot less interesting.
From the NYTimes  and WHO, a day or two after this was first posted here:
"The epidemiologic outlook is bleak,” the report said.
If control does not improve now, there will be more than 20,000 cases by Nov. 2, and the numbers of cases and deaths will continue increasing from hundreds to thousands per week for months to come, according to the report.

As Casey Stengel said, "You could look it up."
Either they finally found someone at WHO who can count. Or the WHO/NYTimes poaches my blogfodder.
It's not hard to be smarter than the UN and the Fishwrap of Record when you aren't hampered by peddling BS and the "Remain clam. All is well!" brand of happygas they've been full of on this topic.
Now let's hope someone in charge pays attention, and stops mollycoddling the response to this, before the bottom end of my projections becomes as correct as the top end.

Oh, look, the CDC has just noticed that the WHO numbers might be a wee bit optimistic:
"The U.S. Centers for Disease Control and Prevention (CDC) released a report Tuesday [9/23/14] predicting as many as 550,000 to 1.4 million cases of the Ebola virus in Liberia and Sierra Leone alone, by the end of January. "
I'm impressed. It's almost like someone at the CDC Press Office has learned to read, and count, in the same week. I hope they do epidemiology better than they do media relations and basic statistics. But better late than never, I suppose.

Welcome to the party, guys.

Monday, September 15, 2014

Things That Make you Go "Hmmmmmmm" - Updated

Totally aside from the march of Ebola unchecked or even constructively hindered by anything done so far, as documented multiple places, a couple of things we know, and a couple of more things I'd like to:

FACT: We were told that Nancy Writebol and Dr. Brantly were infected with Ebola.
FACT: Both were medically evacuated to Emory U. Hospital for treatment.
FACT: Beating the not inconsiderable odds, they both survived, and have been discharged as EVD infection-free.
FACT: Discounting WHO's cooked numbers, if you look at the number of cases and the number of deaths, the rough number of deaths now for any point in time, is the same as the number of cases 21 days prior to now (the incubation period of Ebola) if you multiply that number by 90% (the standard prior Ebola max death rate).

> This strain of Ebola is behaving exactly as every other strain did with regard to speed of progression, and fatality.
> The spread is different, precisely because it got out of the boonies, and into large urban populations, which it's never done before.
> If Writebol and Brantley were truly infected with Ebola, the safest place for them right now is working with the sick in West Africa, because they're both presumably bulletproof as far as Ebola virus is concerned. For life.
> Their combined survival, assuming both had Ebola, is a 1% absolute likelihood on a probability scale. (10% of 10% = 1%).
> If they didn't have Ebola, their dual survival in a BL4 hospital ICU under round-the-clock medical care and observation is a 99.9999999% certainty.

FACT: Neither of them is in West Africa now, despite being so dedicated prior that they were willing to work among a deadly pestilence with sub-par protective gear, and even none, to bring what help they could, and ease suffering; not particularly bright, but on a moral level if not an intelligence one, commendable.

FACT: Either they had Ebola, or they didn't.
FACT: They either knew the truth of their status, or they didn't.

Tinfoil fringe decision matrix in line with the known facts:

If they were infected with Ebola, why aren't they back in action on the ground?
They could now go there without any protective gear, and give unprotected mouth-to-mouth, with no further risk of contracting Ebola. (They wouldn't do it because of any number of other infection risks, but it makes the greater point.)
Since they aren't back nor champing to try to get back, either their prior commitment is suspect, or their immunity is, and they know the truth of both those things at this point.

If they didn't have Ebola, either they knew that, or they didn't. Either way, the CDC knows the truth.
If they didn't have Ebola, why say they did?

If they didn't have Ebola and knew that, why consent to be evacuated and held for treatment?

I could spin any number of wild suppositions. I won't because that's what Daily Kos and Facebook is for.
But all I know at this point is that the undisputable facts don't add up.
2 + 2 = 9 and 11/3rds.
And it's nagging the hell out of me.

When I couple that lack of coherence of what we know with what we've been told and what we may reasonably and logically assume, with CDC today issuing a "Prepare to Shit Kittens" Warning Order to every hospital in the US, I'm even less comforted.

UPDATE (9/30): I saw Brantly's testimony before Congress today. Based on his description of symptoms, I'm as certain as I can be (without running his bloodwork myself) that he had Ebola. He also noted that he was one of only two doctors in all of Southern Liberia treating Ebola patients when he got sick with it. He further noted that the Ebola wards use the few survivors who recover to help care for the others, because they can do so without needing the foofaraw of all the hazmat gear. Which, given his healthy and robust appearance now, and decided lack of any effort to return, means that he is an Altruism fail: the Ebola equivalent of a liberal who's been mugged.

So when a man who'd travel 8,000 miles to treat strangers doesn't want to go back, ponder the diligence of those here, now, tracking down contacts and caring for victims, now that the CDC guidelines that ensured Ebola could get here, have succeeded in accomplishing precisely that result.

Thursday, September 4, 2014

EBOLA: Why You Need To Wake The Eff Up

In case my last missive on the subject didn't get your attention, here's another crosspost.
Just a little more sunshine for your fund of How Bad It Really Is:


The hospital in Liberia where three American aid workers got sick with Ebola has been overwhelmed by a surge in patients and doesn't have enough hazard suits and other supplies to keep doctors and nurses safe, a missionary couple told The Associated Press on Wednesday.

The latest infection -- of Rick Sacra, a doctor who wasn't even working in the hospital's Ebola unit -- shows just how critical protective gear is to containing the deadly epidemic, and how charities alone can't handle the response, they said.

About 250 staffers at the hospital use thousands of disposable protective suits each week, but that's not enough to fully protect the doctors and nurses who must screen people entering the emergency room or treat patients outside the 50-bed Ebola isolation unit, they said.

"We don't have enough personal protective safety equipment to adequately be able to safely diagnose if a patient has Ebola. So they are putting themselves at risk," David Writebol said.

Sacra, 51, a doctor from suburban Boston who spent 15 years working at the hospital, felt compelled to return despite these challenges. As soon as he heard that Dr. Kent Brantly and Nancy Writebol were sick, Sacra called and said "I'm ready to go," SIM President Bruce Johnson said.

Sacra's job was to deliver babies and care for patients who were not infected with Ebola. He helped write the protocols for handling Ebola, his brother Doug said, and he followed all the protections, said Will Elthick, the group's operations director in Liberia.

But Sacra got infected nonetheless by the virus that has killed more than 1,900 people and sickened 3,500 in five West African nations.

The disease is spreading faster than the response for lack of protective gear and caregivers, said Tom Kenyon of the U.S. Centers for Disease Control and Prevention. At least $600 million is urgently needed to provide these tools and extra hazard pay so that more doctors and nurses are willing to risk their lives, the World Health Organization said Wednesday.

Health care workers at other West African hospitals have gone on strike demanding more protections, the Writebols said.

"They see colleagues who have fallen. They don't want that to happen to them. But they are saying, 'I can't go to work safely until there is personal protective equipment available -- the right gear, the right procedures in place. And then, if they don't go to work, are they going to get paid?" David Writebol said.

The Writebols left Charlotte for Africa several years ago; David helped with the hospital's technology while Nancy helped dress and disinfect people entering and leaving the Ebola unit at ELWA, which stands for Eternal Love Winning Africa.

Liberians were already struggling to survive when they got there, but with Ebola it's chaos — the number of patients is surging, finding food and supplies is more costly, schools are closed and people with common injuries or even mothers in childbirth can't get care.

Ebola has "overwhelmed the supply chain," David Writebol said. "They can't get equipment in because there aren't any regular flights coming in. Same thing with aid workers from the international community. There are only a limited number of seats available to come into Liberia. ... That's one of the biggest problems -- getting medicine, protective gear and supplies for health care workers who are there."

Nancy Writebol said people who showed up at the emergency room with symptoms were ushered into triage. But health workers were sometimes exposed as they screened patients who may not have known or advertised that they were carrying the virus.

And sometimes, the sick would leave before finding out if they had Ebola. "Those are the people you really worry about going back into the community, because if they are sick with Ebola, it will ultimately spread," she said.

Sacra immediately got tested for Ebola after coming down with a temperature, and like his colleagues, went into isolation to avoid spreading the virus, his brother Doug Sacra told the AP.
Some other doctors haven't been so rigorous.

The WHO announced today that a doctor in southern Nigeria was exposed by a man who evaded surveillance efforts, and then in turn exposed dozens of others by continuing to treat patients after he became ill. Before he died, his family and church members laid their hands on his body in a healing ritual.

Now his widow and sister are sick and about 60 others in the city of Port Harcourt are under surveillance, the agency said.

Sacra, who left his family at home for this latest trip to Africa, was in good spirits Wednesday and able to send emails, Elthick said. That could mean he's physically well enough to be evacuated.
His wife, Debbie, said in a statement that she's focusing on her husband, but she said "Rick would want me to urge you to remember that there are many people in Liberia who are suffering in this epidemic and others who are not receiving standard health care because clinics and hospitals have been forced to close.

"West Africa is on the verge of a humanitarian crisis, and the world needs to respond compassionately and generously," she said.

It's not clear where Sacra would be treated in the U.S. Experts say any fully-equipped hospital that follows safety protocols could prevent an American outbreak while caring for an Ebola patient. But there are four high-level isolation units designed especially to handle dreaded infectious diseases.

The largest is at the Nebraska Medical Center in Omaha, which was told to prepare to receive a patient, but they were told the same thing before Brantly and Writebol were evacuated instead to Emory University Hospital in Atlanta, medical center spokesman Taylor Wilson said Wednesday.
 The other two units are National Institutes of Health facilities in Maryland and Montana.

So to recap:

* one facility, with but a modest patient capacity, goes through "thousands" of those suits weekly
* the hospitals are out of the suits, routinely, to provide basic protection in order to limit the further spread of the disease and keep staff alive
* the staff at those hospitals are bright enough to say "F--k no!" when asked to work without the suits
* the do-gooders coming in from outside the countries affected aren't quite that bright
* some staff members, after becoming infected, are becoming Typhoid Marys and actually propagating the spread themselves by wanton indifference to reality
* patients leave before diagnosis and quarantine, guaranteeing further spread indefinitely
* there are a total of four facilities in the entire US capable of properly handling Ebola patients without spreading the disease and making it worse

Which I've far from vaguely hinted at for a few weeks now, despite the "it can't happen here" BS being spewed from the White House, CDC, WHO, and every media jackass in creation.

(BTW, nota bene that the NSC adviser for this crisis, Gayle Smith, is precisely such a medically ignorant media jackass, and Special Adviser To The President, and who has noted that contrary to the requests from actual doctors from Medicins Sans Frontieres, who've been on the scene, and requested bio-incident response teams, Ms. Smith's extensive experience from a lifetime background of journalism school, reporting from African hotels, and poverty pimping on Africa through successive Democrat administrations and multinational boards and such, has led to the recommendation that we ignore the requests of medical professionals, and not risk testing our capabilities by sending our people to the hot zone, but rather just send them more boxes of those disposable suits. Either because our precautions are suspected of being ineffective as well, or because she knows we'll be needing those teams in NYC and Atlanta all too soon, and helping to guarantee that reality by waiting to face the problem until it walks onto our own front porch.

(I can count on the fingers of my third hand the number of times, when some serious question arose, anyone intelligent replied, "Quick, let's get a news reporter to tell us what's really happening."
But the current administration actually puts them in charge of that. What could possibly go wrong?)

But hey, cheer up:
New numbers  are up, as of September 3rd:

3500+ cases, 1900+ deaths

Note the official transition to the "plus" sign, to scientifically indicate "we have no fucking idea anymore", along with the notably sharper-than-expected upward trend of both categories since the tally on 8/26/2014. It's transitioning from an upward curve to a more vertical spike.

If this still isn't on your dashboard of things to consider yet, the next step is when lights start flashing on the instrument panel, and strange noises and smoke begin to emanate from under the hood.

"Farewell and adieu to you fair Spanish ladies..."