Thursday, October 30, 2014

So Damned Mean



From comments on Because Science post today:
the danger of Ebola eventually showing up in the US in large numbers has MUCH MORE to do with stopping it in Africa than it does with fear driven (rather than data driven) reactions here in the US over quarantines.
No, it has nothing to do with that at all. It has to do with not letting them fly in here every damn day, and checking for symptoms now that might not show up for 21 days. How's about we put them in a room for 21 days, and THEN see if they have symptoms?
99.9999% success rate. How's that for data? Next problem.
If we save 10 or 20 near future contact cases here in the US but the cost of that is an outbreak that spreads through-out the 3rd world when we might have had a better chance of stopping it in West Africa by not making it harder for medical staff to volunteer, do you think that would be a good trade?
No. I wouldn't trade you one US doctor or one US nurse for their whole country. If someone chooses to go on their own, that's their decision. But their choice doesn't obligate me or any other American to be exposed to the risk of the disease just because it inconveniences them to have to sit in a tent for 21 days waiting to see if they screwed up while out do-gooding.
There's a way that we could handle our near term concerns in the US while at the same time enhancing our response to the greater threat in West Africa by simply paying people.
Let's say we need 2,000 doctors and 8,000 nurses to serve in West Africa for the next six months to get this under control.
Offer to pay those doctors $100,000 per month and those nurses $25,000 per month with a contractual obligation to self-isolate for 21 days upon return.
The cost? 2.4 billion plus infrastructure, transportation, and consumables costs. So let's say 5 billion, all in.
That's about $20 per US taxpayer, or about half of what the government spends in a day. You could probably even crowd source it.
This would be a smarter way to speed up wiping out this ebola outbreak than reacting from fear and failing to adequately adress the bigger problem.
No, it wouldn't. If the federal budget has a spare $5B, it's that much too big already. You want to start a charity and do that yourself, knock yourself out. I'll send you the $20. But keep Uncle Sam's (and your) hands out of my pockets, and off my back. I'm already carrying the 47% Free Shit Army, 11-20M illegal aliens, and now you want me to piggyback 21M African tribesmen? No thanks, my back hurts now.

And next year, some guy would decide he wants BBQ bat, his wife would prepare it, she'd give Ebola to the baby, and we'll be off to the races again.
And again.
And again.

You want to help them? Teach them to stop eating bats, kissing dead people, and maybe get them to wash their hands after they crap, and before they eat.

At some point, they're going to need to start figuring this stuff out for themselves, and in the meantime, there's no requirement to import them here daily. We're already carrying the lion's share of the load on relief there. They've had famines and epidemics there for millennia. The "civilized" countries have figured this out.

Stop throwing life preservers to the ones who put 400 people on a 50 passenger ferry and then look shocked when it flips over.
So you think you can escape it if it spreads in the third world?
That's ridiculous.
Once it's in Latin America, it's here.
There is no way to stop it here without stopping it there, and even if it takes 500 billion dollars, that's still a preferable outcome to the existential alternative.
No, but we can sure as hell slow it down overseas, and block it off from getting here as long as possible. MAYBE even long enough to figure out effective treatments or a vaccine.
 Aesop, it sounds like you WANT this to spread.
No, I want it to go away. I also want a Ferrari, the winning Powerball ticket, and the phone number of the Playmate of the Year. But the reality is, I'm not going to get any of those things in my Christmas stocking, and nothing we've done, will do, or could do, will make any difference in stopping Ebola in Guinea, Sierra Leone, or Liberia, anytime soon. And they don't have much more time left beyond "soon".
I think it is possible to stop it because other countries in Africa have done just that.
But even if I took your view that a vaccine is the only hope, and we're just playing for time here, then that's even MORE reason to work on slowing it down over there.
They stopped it at one case, or one vector. So stop wasting time, money, and effort on the three countries that are going to burn to the ground no matter what, and instead start dumping everything into beefing up medical response and capabilities in Cote d'Ivoire, Mali, Senegal, and Guinea Bissau, so they can KEEP catching this at 1 or 2 patients. And start by buying their border guards as much ammo as you can get. Because when one/all of the currently infested countries collapses, people are going to flow outwards in all directions, and if Ebola ever gets out and in case numbers of 20 or 50, it'll bury them, and we'll be off to the races again, except this time with countries with 54M people, instead of 20M. And it'll devastate them, just like it will us, in any city here that gets a cluster of 20+ cases overnight.
None of your logic makes any sense.
If you think we can stop it, then stopping it over there makes sense.
If you think we can't, then slowing it down over there (where it's currently growing at the fastest rate) makes sense.
I'm certain we can't stop it in any of the current three most afflicted countries, based on over 10 months of unmitigated failure, and a growth rate that would be a Wall St. mutual fund manager's wet dream.
I don't even think we can slow it down there.
But we might could slow it down by containing it where it is, and doing everything possible to slow it down if/when it hits the next tier of victims. The farther from here, the better, and the longer before it gets to us, better still.

As to stopping it, or developing a vaccine, I am hopeful. But only because that's all there is.
I'm certainly not confident. I expect we'll fail at stopping it, gradually lose at slowing it down, and eventually have to face it here, and not in isolated single-case events. All we're waiting on for that is Thomas Duncan v2.0, taking his infected self to some immigrant flophouse, infecting 10-20 guys who didn't travel to Africa, and they come down with it, maybe during the holidays, when ERs are at their annual hopelessly overcrowded census, and flu season is in full swing, and somebody goes back home without being seen, or gets misdiagnosed, or whatever.
Then a week or so later, 5, 10, 20 cases all present within a couple of days, and any city is immediately overwhelmed, because they don't know where it started, why they've got it, and they have no chance in hell of contact-tracing the 50,000 people they'll have been with, or around, in the prior 21 days.
And on that day, American City X is now Monrovia.

Sorry if Reality hurts your feelings, or leaves a mark. Get used to it.

(And no, I don't mind such comments. It gives me something to sharpen my claws on.)

4 comments:

  1. @ They stopped it at one case, or one vector. So stop wasting time, money, and effort on the three countries that are going to burn to the ground no matter what, and instead start dumping everything into beefing up medical response and capabilities in Cote d'Ivoire, Mali, Senegal, and Guinea Bissau, so they can KEEP catching this at 1 or 2 patients. And start by buying their border guards as much ammo as you can get. @

    I totally agree, it is time to think about a total blockade of the infected countries, an air, sea and ground blockade. Nobody gets out, nobody gets in, under penalty of death. I don’t think a vaccine will be ready in time without a blockade to buy us time. Maybe a vaccine will never be available: *hoping* for a vaccine is not a viable strategy.

    A policy of containment will buy us time for developing a vaccine but, if done right, it will allow the epidemic to burn itself out in the affected countries even without a vaccine. We need to stop thinking of the infected people as patients and instead we need to think of them as bio-weapons. When you start thinking this way, then you see that total containment is possible: the bio-weapons are not particularly stealthy or fast. They cannot travel far if roads are closed, bridges blown up, ships and boats sunk. Stopping air travel is very easy: just bomb the airports. Jet planes carried all known Ebola cases to this country, so stop the jet planes at the point of origin.

    Medical intervention is not effective and, in fact, it may be part of the problem. In the first Ebola outbreak, back in 1976 it was found that hospitals were the main cause of the infections: once travel between villages was stopped and people were encouraged to stay at home, the epidemic stopped by itself.

    The “ebola tourists,” like “liar” Spencer and “crybaby” Hickox are not helping: discouraging them from going there is part of any viable plan to stop the epidemic.

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  2. Aesop, you should be Ebola czar.

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  3. Won't happen. Aesop makes too much sense, so is too intelligent for government work.

    Meanwhile I'm going to go straight to the default position of that Zebra guy who keeps bringing up napalm a lot.

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  4. "Medical intervention is not effective and, in fact, it may be part of the problem. In the first Ebola outbreak, back in 1976 it was found that hospitals were the main cause of the infections: once travel between villages was stopped and people were encouraged to stay at home, the epidemic stopped by itself."

    I think the people may be figuring this out in Liberia. Bruce Aylward (WHO official) said in his comments to the press the other day that there are lots of empty beds in Ebola treatment units in Liberia now, which he attributed to the disease magically going away by itself (I'm paraphrasing). More likely, resistance to treatment among the populace is hardening as people realize that being dragged off to an ETU is a death sentence: if you don't yet have Ebola (say, flu or malaria instead), you'll likely get it from being confined there with actual Ebola patients, and even if you do already have it, the treatment they have available there (i.e. fluids-- no ZMapp in Africa) is unlikely to improve your odds enough to be worth it. This is especially the case for older people-- a newly published study says (not surprisingly) that Ebola impacts different age groups differently. People under 21 have almost even odds of surviving while Ebola-infected folks over 45 have a 94% fatality rate according to this: http://www.cbsnews.com/news/one-age-group-much-more-likely-to-die-from-ebola/

    This is an old article but gives an idea of what Ebola "hospitals" are really like: http://www.nytimes.com/2014/10/02/world/africa/ebola-spreading-in-west-africa.html?_r=0

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