Tuesday, October 21, 2014

The Ebola Farce

Originally published at woodpilereport.com 
Prediction. Our institutional defenses against epidemics assume 1950s-style civic support. Those days are gone. Even so, it'll work for a while, not perfectly, but well enough. For a while. Ebola will go exponential when it gets into our Liberia-like art-link-symbol-tiny-grey-arrow-only-rev01.gif urban areas and separatist enclaves. Necessary but inconvenient countermeasures will be widely evaded, denounced as genocide in disguise. Those who demand drastic action in defense of the nation will be slandered as paleo-rednecks.

From then on events will be decided by doddering civil rights agitators, the gullible morons who support them and the usual lunatic opportunists in DC. Naturally those who are actually stricken will demand priority on a "Poor, Minorities Hit Hardest" basis. The irony will go unnoticed. Worthwhile results will be either accidental or unavoidable. Ebola will burn its way through the populace all but unimpeded, and when the last victim collapses in a mushy pile of its own bloody excretions, victory will be declared. Heroes will be acclaimed and every faction in the country will have made new, enduring enemies. This is easy. It's like predicting the past. But—details. We want details.

Our farce thus far. How competent are our medical institutions with their world-class facilities and internationally renown experts, the same experts who tell us our fears are unfounded? Apparently word hadn't gotten to them that people coming from Ebola-infested pest holes in Africa may have Ebola, duh, including one who exhibited advanced symptoms and offered himself up to anyone who would listen:
Thomas Eric Duncan [art-link-symbol-tiny-grey-arrow-only-rev01.gif photo] told a nurse at a Dallas emergency room that he had recently visited Liberia, which has been ravaged by the Ebola outbreak. But an executive at Texas Health Presbyterian hospital told a news conference that the information was not widely enough shared with the medical team treating Duncan, and he was diagnosed as suffering from a “low-grade common viral disease”.
Gambino and Dart at theguardian.com
As a result of this lapse, Thomas Duncan was able to leave the hospital and interact with more people while experiencing symptoms, which is when the virus becomes contagious.
Mark Berman at washingtonpost.com
He didn't go to some first aid outfit in a backwater burg. He went to Texas Health Presbyterian, one of those outfits with nice corporate graphics which "raises awareness" and gives itself awards. Top shelf, in other words. Here's how obvious it had to be before he they admitted and isolated him:
“When the ambulance came his whole family were all screaming, he got outside and he was throwing up all over the place … when he was throwing up he was trying to walk and he couldn’t walk.”
Mesud Osmanovic, neighbor, to Gambino and Dart at theguardian.com
Which means from the 24th to the 28th of September he was stumbling around loose among the people of Dallas with infectious Ebola art-link-symbol-tiny-grey-arrow-only-rev01.gif, and he did so until his nephew called CDC directly—which, incidentally, suggests the reason for his trip here in the first place. He all but handed them a signed affidavit with "I HAVE EBOLA" across the top in all caps, yet Texas hospital says:
Regretfully, that information was not fully communicated throughout the full teams. As a result, the full import of that information wasn’t factored into the full decision making.
Mark Lester, Texas hospital, via news.yahoo.com
We fully understand. He wasn't coughing up lung tissue or spurting blood from his eyeballs so hoo cudda fully node. But just a few days before Mr. Duncan arrived, none other than President Obama assured us:
art-link-symbol-tiny-grey-arrow-only-rev01.gif We've been taking the necessary precautions, including working with countries in West Africa to increase screening at airports so that someone with the virus doesn't get on a plane for the United States. In the unlikely event that someone with Ebola does reach our shores, we've taken new measures so that we're prepared here at home.
In Obama's defense, he's a liar. His core supporters believe him, who can ask for better evidence? No sense in getting all worked up about it. Some people are left handed, some people are short and others tall, some people stutter. Obama lies. It's just his way. He can't help it so let it be.

Cynics say Duncan was knowingly set loose, that this is a trial run for a Club of Rome-style population reduction. How else does a driver for FedEx in Monrovia come up with airfare—about $3,500 one way—and a visa, apparently on short notice, they ask. Others say it's a psy-op calculated to prod the populace into demanding a national lock down under martial law.

Look what we have on the other side. Texas Health Presbyterian "regrets" their incompetence. They'll take even newer measures so that we're even more prepared here at home. Measures like a seminar, say. Off site. Nassau perhaps. Signup is by the door. Not a compelling counter argument. Denying entry to travelers with West African passports is a compelling counter argument. So is defending our borders and controlling immigration. DC is proudly and emphatically doing none of these so "oops" is their only counter argument.
We will stop Ebola in its tracks in the U.S... I have no doubt that we will control this importation or this case of the Ebola so that it does not spread widely in this country. It is certainly possible that someone who had contact with this individual, a family member, or other individual, could develop Ebola in the coming weeks, but there is no doubt in my mind that we will stop it here.
CDC Director Dr. Thomas Frieden via Frank Heinz at nbcwashington.com
Officials from the Centers for Disease Control and Prevention took to the airwaves to assure the public that there is no risk of widespread infection. The reason: The United States has a strong health system and trained health workers who can efficiently and effectively contain Ebola.
Ashley Judd at cnn.com
From farce to tragedy. Let's look at CDC's and Obama's claim American medical facilities are so sophisticated "the chances of an Ebola outbreak here in the United States are extremely low". Assume each suspected Ebola patient in high-level isolation requires eight medical professionals per shift. That's twenty-four per day. Should there be, say, one hundred high-risk patients admitted to isolation, that's 2,400 medical professionals, and all the necessary equipment and supplies for one hundred containment accommodations. It's already unrealistic. No hospital could function with that many diverted assets. Perhaps efficiency measures could bring these numbers down. Or perhaps these numbers are too low to begin with. What if there are not one hundred high-risk patients, but five hundred? Or a thousand.

Use CDC's "RO"—reinfection rate per 21-day cycle—and say one out of every ten high-risk patients is a confirmed case of Ebola. Every person they've been in close contact with is now another high-risk patient. Use twenty each per 21 days. Multiply these new numbers by twenty-four medical professionals each—plus or minus. To put it plainly, a hundred cases of Ebola in any one city would implode its health services. The city's alternatives would be to lower the standard of care to third world levels or concede outright defeat and sprint to the executive bunkers. Numbers are numbers, here or in Africa.

And oh by the way, it's game over if they start missing one or two infected contacts here and there. Think they won't? There's also an infection rate for the medical professionals we haven't considered. And don't bet against asymptomatic carriers, animal or human.
It has been shown that dogs may become infected with EBOV and remain asymptomatic. Dogs in some parts of Africa scavenge for their food and it is known that they sometimes eat infected animals and the corpses of humans. Although they remain asymptomatic, a 2005 survey of dogs during an EBOV outbreak found that over 31.8% showed a seroprevalence for EBOV closest to an outbreak versus 9% a farther distance away.
Then there's this:
The Texas health commissioner, Dr. David Lakey, told reporters during an afternoon news conference that health workers should have moved more swiftly to clean the apartment but that they had had trouble finding an outside medical team to do the work. They encountered “a little bit of hesitancy,” he said.
Sack and Marc Santoraoct at nytimes.com
There's an old comeback to the professional who says he's dedicated to 'serving mankind': would you still do it if you weren't getting paid? Now we have to ask if they'll still do it at a substantial risk to themselves of a ugly death. The realist says the occupancy rates at exclusive resorts will rise. Further down the ranks, when suited-up MDs and RNs are dying, how many EMTs will stay on the job? How many ambulance crew? Would firemen respond to a call on the Ebola floor? How understaffed can a medical facility get before it's a barracks for the doomed? You see where this goes even without a general panic. Safety is not in numbers. Rule One for survival is the new common sense: stay away from crowds.

The bottom line. A realistic mortality estimate has to include secondary effects, which includes a drastic reduction in ordinary medical services, disrupted transportation of food, fuel and other necessities, much diminished commercial activity, breakdown of civil order and the like. If we discount "perfect storm" doomer scenarios and stay within the likely, a mortality of 25% in the US is a reasonable estimate, with a burnout time of about three years. That's about 77 million. Our population is unevenly distributed and the country is large, look for it to advance in waves like the pandemic of 1918-1919. Again, mortality means deaths from Ebola and secondary effects.

In small, densely populated third-world countries, a single sweep of the scythe will suffice. 50% mortality may be too low a number. In sub-Saharan Africa, with its sketchy infrastructure, its "impaired to severely impaired" average intelligence, it's knack for making lemons out of lemonade and its near-total dependence on world charity, mortality may overtop 75%. Secondary effects need only a nudge to go full catastrophic, and its default 'prevention' is ritual and denial.

Long before it's over our failure to deny visas to west African nationals, or defend our borders and control immigration at all, will be seen for the unconscionable dereliction of duty it is. Alas, the opportunity is largely foreclosed even now. The mother of all buyer's regret is just now setting in. Too late. The dark side of globalism is about to have its way with us.
Meanwhile, the bad news just keeps rolling in:
art-link-symbol-tiny-grey-arrow-only-rev01.gif Doomsday warning: UN Ebola chief raises 'nightmare' prospect that virus could mutate and become airborne, by Charlton and Crossley at Mail Online 
art-link-symbol-tiny-grey-arrow-only-rev01.gif CDC is lying! If they’re not lying, they are grossly incompetent. For them to say last week that the likelihood of importing an Ebola case was extremely small was a real bad call. Once this disease consumes every third world country, as surely it will, because they lack the same basic infrastructure as Sierra Leone and Liberia, at that point, we will be importing clusters of Ebola on a daily basis. That will overwhelm any advanced country’s ability to contain the clusters in isolation and quarantine. 
Dr. Gil Mobley, via Morris and Spink at ajc.com/news
On September 28, when he returned to Presbyterian, this time deathly ill in an ambulance, the ER staff immediately suspected Ebola, Presbyterian told reporters, and called in the infectious disease team. How then did the ambulance drivers and the ambulance itself continue in circulation, unquarantined, for the next 48 hours.
Ford Vox at cnn.com
art-link-symbol-tiny-grey-arrow-only-rev01.gif Being at first skeptical that Ebola virus could be an aerosol-transmissible disease, we are now persuaded by a review of experimental and epidemiologic data that this might be an important feature of disease transmission, particularly in healthcare settings... The potential for transmission via inhalation of aerosols, therefore, cannot be ruled out by the observed risk factors or our knowledge of the infection process. Many body fluids, such as vomit, diarrhea, blood, and saliva, are capable of creating inhalable aerosol particles in the immediate vicinity of an infected person.
Brosseau and Jones at cidrap.umn.edu/news
Ms Greening said the stark prediction by the US Centers for Disease Control and Prevention that Ebola cases could reach 1.4 million by January highlighted the need for rapid action. The official number of people infected currently stands at 7,178 – of which 3,338 have died. But the US health institute suggested in a report last week that the true scale of the outbreak may have been hugely underestimated due to under-reporting... The number of people infected with Ebola is doubling every 20 to 30 days, and aid agencies said that the situation on the ground was dire.
Green and Cooper at independent.co.uk
The White House said Wednesday [1 Oct 2014] it will not impose travel restrictions or introduce new airport screenings to prevent additional cases of Ebola from entering the United States. Spokesman Josh Earnest said that current anti-Ebola measures, which include screenings in West African airports and observation of passengers in the United States, will be sufficient to prevent the “wide spread” of the virus.
Elise Viebeck at thehill.com/policy/healthcare
Officials confirmed that roughly 100 people are being questioned about possible exposure to the virus — up from reports of more than 80 earlier in the day. Only a "handful" likely could have caught the virus, they said, and no one but the patient is showing symptoms.
Elise Viebeck at thehill.com
The Dallas Fire Department left the ambulance that transported Ebola patient Thomas Duncan to the hospital in service for at least 48 hours before putting it in quarantine on Wednesday. The ambulance was exposed to the Ebola virus when Duncan was transported on September 28th.
Bob Price at breitbart.com
For months, doctors in my community have been convinced that the United States will be importing clusters regularly. Right now, on the continent of West Africa, there are a million people in isolation, in quarantine, because of Ebola, and ten thousand passengers leave West Africa every single day. It’s just a matter of time before this disease is carried to every corner of the world.
Gil Mobley, Missouri MD, via Dom Giordano at philadelphia.cbslocal.com