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Topic: Ebola (Read 2400 times)
October 15, 2014, 12:28:34 PM »
Giving Ebola its' own thread. Prior posts can be found on the Epidemics thread:
Reply #1 on:
October 15, 2014, 02:52:18 PM »
Can't see whole article
Reply #2 on:
October 15, 2014, 08:31:52 PM »
I cannot get the whole article.
Have to login.
Freidan is a perfect example of a liberal fool. Of course we should try to close our borders. At least we should try.
Trickle up poverty and trickle around the world disease.
In any case the politics of the AIDs epidemic seems to be when we started treating infectious disease differently.
Make us all suffer why don't chya.
Reply #3 on:
October 15, 2014, 09:02:23 PM »
Here ya go:
(For the record, I'm not sure I agree 100%, but I offer it here for conversation)
How the U.S. Made the Ebola Crisis Worse
The total number of Liberian doctors in America is about two-thirds the total now working in their homeland.
E. Fuller Torrey
Oct. 14, 2014 7:19 p.m. ET
Amid discussions of quarantines, lockdowns and doomsday death scenarios about Ebola, little has been said about the exodus of Africa’s health-care professionals and how it has contributed to the outbreak. For 50 years, the U.S. and other Western nations have admitted health professionals—especially doctors and nurses—from poor countries, including Liberia, Sierra Leone and Guinea, three nations at the heart of the Ebola epidemic.
The loss of these men and women is now reflected in reports about severe medical-manpower shortages in these countries, an absence of local medical leadership so critical for responding to the crisis, and a collapse or near-collapse of their health-care systems.
Although Africa bears 24% of the global disease burden, it is home to just 3% of the world’s health workforce. A 2010 World Health Organization assessment of doctors, nurses and midwives per population listed Liberia, Sierra Leone and Guinea in the bottom nine nations in the world in medical manpower.
In Liberia, a nation of four million people, the number of Ebola cases is said to be doubling every 15-20 days. Based on news reports, I’ve estimated that there were about 120 Liberian physicians in the country prior to the outbreak.
According to an American Medical Association database, in 2010 there were 56 Liberian-trained physicians practicing in the U.S. This number does not include other Liberian physicians who emigrated to this country, were unable to pass state licensing exams, and are employed as technicians, administrators, or in other jobs. Older studies suggest that the number failing such exams is about half of those licensed.
Thus the total number of Liberian physicians in the U.S. is probably about two-thirds the number in Liberia. In addition, Liberian-trained physicians live in Canada, Great Britain and Australia.
The Liberian situation is not exceptional. Altogether in 2010 the U.S. had 265,851 licensed physicians trained in other countries, constituting 32% of our physician workforce, according to the AMA. Among these, 128,729 came from countries categorized by the World Bank as being from low- or lower-middle income countries. These physicians tend to work disproportionately in rural and inner-city jobs less favored by American medical graduates. West Virginia, for example, has the highest proportion of foreign-trained physicians from poorer countries to U.S.-trained physicians.
The U.S. has always welcomed health professionals from other countries. However in 1965, responding to a perceived shortage of physicians for the growing U.S. population, Congress passed landmark immigration legislation giving preference to health professionals. Subsequent legislation in 1968, 1970 and 1994 further opened the door, especially for physicians from poorer countries. The percentage of foreign-trained physicians has steadily increased from 10% of the workforce in 1965 to its current 32%.
Many objections to this policy have been raised over the years. In 1967 Walter Mondale, then a senator from Minnesota, called it a disgrace. It was “inexcusable,” he wrote in the Saturday Review, that the U.S. should “need doctors from countries where thousands die daily of disease to relieve our shortage of medical manpower.”
A 1974 report on the “Brain Drain” for the House Foreign Affairs Committee noted that the current policy was widening the gap between rich and poor nations, and warned that the policy “has a great potential for mischief in the Nation’s future relations with the LDC [less developed countries].”
Despite such complaints, U.S. policy has continued to encourage the immigration of physicians and other health workers from poorer countries. “There’s nothing wrong with a foreign-trained doctor,” Casper Weinberger, then secretary of the Department of Health, Education and Welfare, said on TV in 1973. “Of course we’re using a lot of them, and will use a lot more.”
The consequences of this policy may be more than “mischief.” Ebola may be merely the first of many prices to be paid for our long-standing but shortsighted health manpower policy. Surely the wealthiest country in the world should be able to produce sufficient health workers for its own needs and not take them from the poorest countries.
Dr. Torrey is associate director of the Stanley Medical Research Institute and author of “American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System” (Oxford, 2013).
Scapeghoat as usual from the Self Chosen One
Reply #4 on:
October 15, 2014, 09:11:27 PM »
I wonder if this is what he was rushing back was for. To make the hospital CEO apologize. Make him the scapeghoat.
The only one who should apologize is the Self Chosen One who will not secure the borders:
Top Texas hospital official to tell lawmakers 'we made mistakes' on Ebola
Published October 15, 2014·
top official for the parent company of the Texas hospital where two nurses contracted Ebola from a dying patient plans to tell lawmakers he is “deeply sorry” that “mistakes” were made at the facility, and will vow to determine how the errors occurred.
Dr. Daniel Varga, the chief clinical officer and senior vice president for Texas Health Resources, which runs Texas Health Presbyterian Hospital, will testify before a House subcommittee Thursday along with CDC Director Dr. Thomas Frieden, the director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci and others.
According to prepared testimony, Varga will apologize to the subcommittee for how the hospital handled the treatment of Thomas Eric Duncan, a Liberian national who became the first person diagnosed with Ebola in the U.S. He died Oct. 8.
“Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes,” the prepared testimony reads. “We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.”
Varga will say the team of medical professionals was “devastated” when Duncan succumbed to the disease, adding it is “hard to put into words” the sorrow the team felt.
Varga also plans to mention the two nurses, both of whom contracted the deadly virus after caring for Duncan. He will say the team is “hopeful” about the progress of Nina Pham, the first nurse diagnosed and also will mention the second patient.
“A lot is being said about what may or may not have occurred to cause Ms. Pham to contract Ebola,” he will say. “She is known as an extremely skilled nurse, and she was using full protective measures under the CDC protocols, so we don’t yet know precisely how or when she was infected. But it’s clear there was an exposure somewhere, sometime. We are poring over records and observations, and doing all we can to find the answers.”
Varga will tell lawmakers the hospital group has made changes since its first encounter with Ebola, saying that the hospital was prepared to treat Ebola but fell short on diagnosing it.
“As a result, following Mr. Duncan’s initial admission, we have changed our screening process in the (emergency department) to capture the patient’s travel history at the first point of contact with (emergency department) staff,” he will say.
Varga will also say the hospital system is also conducting further training sessions with its staff and communicating and collaborating with federal, state and local agencies
Fauci will also testify before lawmakers on the federal government’s response to the crisis. According to prepared testimony, Fauci will say that although his agency is an “active participant” in attempting to stop the outbreak, it is still in the “early stages” of determining how best to treat and prevent Ebola.
“As we continue to expedite research while enforcing high safety and efficacy standards, the implementation of the public health measures already known to contain prior Ebola virus outbreaks and the implementation of treatment strategies such as fluid and electrolyte replacement are essential to preventing additional infections, treating those already infected, protecting health care providers, and ultimately bringing this epidemic to an end,” he will say.
Coulter on Ebola
Reply #5 on:
October 17, 2014, 07:29:58 AM »
Reply #6 on:
October 17, 2014, 08:02:47 AM »
Six Reasons to Panic
Reply #7 on:
October 17, 2014, 10:01:59 AM »
Six Reasons to Panic
Jonathan V. Last - The Weekly Standard
October 27, 2014, Vol. 20, No. 07
As a rule, one should not panic at whatever crisis has momentarily fixed the attention of cable news producers. But the Ebola outbreak in West Africa, which has migrated to both Europe and America, may be the exception that proves the rule. There are at least six reasons that a controlled, informed panic might be in order.
(1) Start with what we know, and don’t know, about the virus. Officials from the Centers for Disease Control (CDC) and other government agencies claim that contracting Ebola is relatively difficult because the virus is only transmittable by direct contact with bodily fluids from an infected person who has become symptomatic. Which means that, in theory, you can’t get Ebola by riding in the elevator with someone who is carrying the virus, because Ebola is not airborne.
This sounds reassuring. Except that it might not be true. There are four strains of the Ebola virus that have caused outbreaks in human populations. According to the New England Journal of Medicine, the current outbreak (known as Guinean EBOV, because it originated in Meliandou, Guinea, in late November 2013) is a separate clade “in a sister relationship with other known EBOV strains.” Meaning that this Ebola is related to, but genetically distinct from, previous known strains, and thus may have distinct mechanisms of transmission.
Not everyone is convinced that this Ebola isn’t airborne. Last month, the University of Minnesota’s Center for Infectious Disease Research and Policy published an article arguing that the current Ebola has “unclear modes of transmission” and that “there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.”
And even if this Ebola isn’t airborne right now, it might become so in the future. Viruses mutate and evolve in the wild, and the population of infected Ebola carriers is now bigger than it has been at any point in history—meaning that the pool for potential mutations is larger than it has ever been. As Dr. Philip K. Russell, a virologist who oversaw Ebola research while heading the U.S. Army’s Medical Research and Development Command, explained to the Los Angeles Times last week,
I see the reasons to dampen down public fears. But scientifically, we’re in the middle of the first experiment of multiple, serial passages of Ebola virus in man. . . . God knows what this virus is going to look like. I don’t.
In August, Science magazine published a survey conducted by 58 medical professionals working in African epidemiology. They traced the origin and spread of the virus with remarkable precision—for instance, they discovered that it crossed the border from Guinea into Sierra Leone at the funeral of a “traditional healer” who had treated Ebola victims. In just the first six months of tracking the virus, the team identified more than 100 mutated forms of it.
Yet what’s really scary is how robust the already-established transmission mechanisms are. Have you ever wondered why Ebola protocols call for washing down infected surfaces with chlorine? Because the virus can survive for up to three weeks on a dry surface.
How robust is transmission? Look at the health care workers who have contracted it. When Nina Pham, the Dallas nurse who was part of the team caring for Liberian national Thomas Duncan, contracted Ebola, the CDC quickly blamed her for “breaching protocol.” But to the extent that we have effective protocols for shielding people from Ebola, they’re so complex that even trained professionals, who are keenly aware that their lives are on the line, can make mistakes.
By the by, that Science article written by 58 medical professionals tracing the emergence of Ebola—5 of them died from Ebola before it was published.
(2) General infection rates are terrifying, too. In epidemiology, you measure the “R0,” or “reproduction number” of a virus; that is, how many new infections each infected person causes. When R0 is greater than 1, the virus is spreading through a population. When it’s below 1, the contamination is receding. In September the World Health Organization’s Ebola Response Team estimated the R0 to be at 1.71 in Guinea and 2.02 in Sierra Leone. Since then, it seems to have risen so that the average in West Africa is about 2.0. In September the WHO estimated that by October 20, there would be 3,000 total cases in Guinea, Liberia, and Sierra Leone. As of October 7, the count was 8,376.
In other words, rather than catching up with Ebola, we’re falling further behind. And we’re likely to continue falling behind, because physical and human resources do not scale virally. In order to stop the spread of Ebola, the reproduction number needs to be more than halved from its current rate. Yet reducing the reproduction number only gets harder as the total number of cases increases, because each case requires resources—facilities, beds, doctors, nurses, decontamination, and secure burials—which are already lagging well behind need. The latest WHO projections suggest that by December 1 we are likely to see 10,000 new cases in West Africa per week, at which point the virus could begin spreading geographically within the continent as it nears the border with Ivory Coast.
Thus far, officials have insisted that it will be different in America. On September 30, CDC director Thomas Frieden confirmed the first case of Ebola in the United States, the aforementioned Thomas Duncan. Frieden then declared, “We will stop Ebola in its tracks in the U.S. . . . The bottom line here is that I have no doubt that we will control this importation, or this case of Ebola, so that it does not spread widely in this country.”
The word “widely” is key. Because despite the fact that Duncan was a lone man under scrupulous, first-world care, with the eyes of the entire nation on him, his R0 was 2, just like that of your average Liberian Ebola victim. One carrier; two infections. He passed the virus to nurse Pham and to another hospital worker, Amber Joy Vinson, who flew from Cleveland to Dallas with a low-grade fever before being diagnosed.
(3) Do you really want to be scared? What’s to stop a jihadist from going to Liberia, getting himself infected, and then flying to New York and riding the subway until he keels over? This is just the biological warfare version of a suicide bomb. Can you imagine the consequences if someone with Ebola vomited in a New York City subway car? A flight from Roberts International in Monrovia to JFK in New York is less than $2,000, meaning that the planning and infrastructure needed for such an attack is relatively trivial. This scenario may be highly unlikely. But so were the September 11 attacks and the Richard Reid attempted shoe bombing, both of which resulted in the creation of a permanent security apparatus around airports. We take drastic precautions all the time, if the potential losses are serious enough, so long as officials are paying attention to the threat.
(4) Let’s put aside the Ebola-as-weapon scenario—some things are too depressing to contemplate at length—and look at the range of scenarios for what we have in front of us, from best-case to worst-case. The epidemiological protocols for containing Ebola rest on four pillars: contact tracing, case isolation, safe burial, and effective public information. On October 14, the New York Times reported that in Liberia, with “only” 4,000 cases, “Schools have shut down, elections have been postponed, mining and logging companies have withdrawn, farmers have abandoned their fields.” Which means that the baseline for “best-case” is already awful.
In September, the CDC ran a series of models on the spread of the virus and came up with a best-case scenario in which, by January 2015, Liberia alone would have a cumulative 11,000 to 27,000 cases. That’s in a world where all of the aid and personnel gets where it needs to be, the resident population behaves rationally, and everything breaks their way. The worst-case scenario envisioned by the model is anywhere from 537,000 to 1,367,000 cases by January. Just in Liberia. With the fever still raging out of control.
By which point, all might well be lost. Anthony Banbury is coordinating the response from the United Nations, which, whatever its many shortcomings, is probably the ideal organization to take the lead on Ebola. Banbury’s view is chilling: “The WHO advises within 60 days we must ensure 70 percent of infected people are in a care facility and 70 percent of burials are done without causing further infection. . . . We either stop Ebola now or we face an entirely unprecedented situation for which we do not have a plan [emphasis added]”.
What’s terrifying about the worst-case scenario isn’t just the scale of human devastation and misery. It’s that the various state actors and the official health establishment have already been overwhelmed with infections in only the four-digit range. And if the four pillars—contact tracing, case isolation, safe burial, and effective public information—fail, no one seems to have even a theoretical plan for what to do.
(5) And by the way, things could get worse. All of those worst-case projections assume that the virus stays contained in a relatively small area of West Africa, which, with a million people infected, would be highly unlikely. What happens if and when the virus starts leaking out to other parts of the world?
Marine Corps General John F. Kelly talked about Ebola at the National Defense University two weeks ago and mused about what would happen if Ebola reached Haiti or Central America, which have relatively easy access to America. “If it breaks out, it’s literally ‘Katie bar the door,’ and there will be mass migration into the United States,” Kelly said. “They will run away from Ebola, or if they suspect they are infected, they will try to get to the United States for treatment.”
It isn’t crazy to see how a health crisis could beget all sorts of other crises, from humanitarian, to economic, to political, to existential. If you think about Ebola and mutation and aerosolization and R0 for too long, you start to get visions of Mad Max cruising the postapocalyptic landscape with Katniss Everdeen at his side.
(6) While we’re on the subject of political crisis, it’s worth noting that the politics of Ebola are uncertain and dangerous to everyone involved. Thus far, there’s been only one serious political clash over Ebola, and that’s concerning the banning of flights to and from the infected countries in West Africa. The Obama administration refuses to countenance such a move, with the CDC’s Frieden flatly calling it “wrong”:
A travel ban is not the right answer. It’s simply not feasible to build a wall—virtual or real—around a community, city, or country. A travel ban would essentially quarantine the more than 22 million people that make up the combined populations of Liberia, Sierra Leone, and Guinea.
When a wildfire breaks out we don’t fence it off. We go in to extinguish it before one of the random sparks sets off another outbreak somewhere else.
We don’t want to isolate parts of the world, or people who aren’t sick, because that’s going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak. . . .
Importantly, isolating countries won’t keep Ebola contained and away from American shores. Paradoxically, it will increase the risk that Ebola will spread in those countries and to other countries, and that we will have more patients who develop Ebola in the U.S.
Not terribly convincing, is it? Wildfires, in fact, are often fought by using controlled burns and trench digging to establish perimeters. And it’s a straw-man argument to say that a flight ban wouldn’t keep Ebola fully contained. No one says it would. But by definition, it would help slow the spread of the virus. If there had been a travel ban in place, Thomas Duncan would have likely reached the same sad fate—but without infecting two Americans and setting the virus loose in North America. And it’s difficult to follow the logic by which banning travel from infected countries would create more infections in the United States, as Frieden insists. This is not a paradox; it’s magical thinking.
Frieden’s entire argument is so strange—and so at odds with what other epidemiologists prescribe—that it can only be explained by one of two causes: catastrophic incompetence or a prior ideological commitment. The latter, in this case, might well be the larger issue of immigration.
Ebola has the potential to reshuffle American attitudes to immigration. If you agree to seal the borders to mitigate the risks from Ebola, you’re implicitly rejecting the “open borders” mindset and admitting that there are cases in which government has a duty to protect citizens from outsiders. Some people on the left admit to seeing this as the thin end of the wedge. Writing in the New Yorker, Michael Specter lamented, “Several politicians, like Governor Bobby Jindal, of Louisiana, have turned the epidemic into fodder for their campaign to halt immigration.” And that sort of thing just can’t be allowed.
What would happen in the event of an Ebola outbreak in Latin America? Then America would have to worry about masses of uninfected immigrants surging across the border—not to mention carriers of the virus. And if we had decided it was okay to cut off flights from West Africa, would we decide it was okay to try to seal the Southern border too? You can see how the entire immigration project might start to come apart.
So for now, the Obama administration will insist on keeping travel open between infected countries and the West and hope that they, and we, get lucky.
At a deeper level, the Ebola outbreak is a crisis not for Obama and his administration, but for elite institutions. Because once more they have been exposed as either corrupt, incompetent, or both. On September 16, as he was trying to downplay the threat posed by Ebola, President Obama insisted that “the chances of an Ebola outbreak here in the United States are extremely low.” Less then two weeks later, there was an Ebola outbreak in the United States.
The CDC’s Frieden—who is an Obama appointee—has been almost comically oafish. On September 30, -Frieden declared, “We’re stopping it in its tracks in this country.” On October 13, he said, “We’re concerned, and unfortunately would not be surprised if we did see additional cases.” The next day he admitted that the CDC hadn’t taken the first infection seriously enough: “I wish we had put a team like this on the ground the day the patient, the first patient, was diagnosed,” he said. “That might have prevented this infection. But we will do that from today onward with any case, anywhere in the U.S. . . . We could have sent a more robust hospital infection-control team and been more hands-on with the hospital from Day One.”
The day after that Frieden was asked during a press conference if you could contract Ebola by sitting next to someone on a bus—a question prompted by a statement from President Obama the week before, when he declared that you can’t get Ebola “through casual contact, like sitting next to someone on a bus.”
Frieden answered: “I think there are two different parts of that equation. The first is, if you’re a member of the traveling public and are healthy, should you be worried that you might have gotten it by sitting next to someone? And the answer is no. Second, if you are sick and you may have Ebola, should you get on a bus? And the answer to that is also no. You might become ill, you might have a problem that exposes someone around you.”
Go ahead and read that again.
We have arrived at a moment with our elite institutions where it is impossible to distinguish incompetence from willful misdirection. This can only compound an already dangerous situation.
Reply #8 on:
October 19, 2014, 11:31:43 AM »
She makes some good points but I don't agree with her by and large about the larger issues.
She describes in detail how difficult it is too deal with such a deadly communicable virus in a safe way. But than proceeds to describe how our system has failed us in dealing with it to perfection.
Why is it always someone else's fault? I do agree with at least trying to stop Ebola in Africa. That is my big beef with the liberals on this issue. I think it is really because stopping immigration from these countries would conflict with their narrative that immigration is not a threat to us. Like the adenovirus that just coincidently becomes an epidemic for the first time ever in the US but is found endemically in S America.
******I'm a Hazmat-Trained Hospital Worker: Here's What No One Is Telling You About Ebola
Posted: 10/17/2014 10:18 am EDT Updated: 10/18/2014 12:59 pm EDT
Ebola is brilliant.
It is a superior virus that has evolved and fine-tuned its mechanism of transmission to be near-perfect. That's why we're all so terrified. We know we can't destroy it. All we can do is try to divert it, outrun it.
I've worked in health care for a few years now. One of the first things I took advantage of was training to become FEMA-certified for hazmat ops in a hospital setting. My rationale for this was that, in my home state of Maine, natural disasters are almost a given. We're also, though you may not know it, a state that has many major ports that receive hazardous liquids from ships and transport them inland. In the back of my mind, of course, I was aware that any hospital in the world could potentially find itself at the epicenter of a scene from The Hot Zone. That was several years ago. Today I'm thinking, by God, I might actually have to use this training. Mostly, though, I'm aware of just that -- that I did receive training. Lots of it. Because you can't just expect any nurse or any doctor or any health care worker or layperson to understand the deconning procedures by way of some kind of pamphlet or 10-minute training video. Not only is it mentally rigorous, but it's physically exhausting.
PPE, or, personal protective equipment, is sort of a catch-all phrase for the suits, booties, gloves, hoods and in many cases respirators worn by individuals who are entering a hot zone. These suits are incredibly difficult to move in. You are wearing several layers of gloves, which limits your dexterity to basically nil, the hoods limit the scope of your vision -- especially your peripheral vision, which all but disappears. The suits are hot -- almost unbearably so. The respirator gives you clean air, but not cool air. These suits are for protection, not comfort. Before you even suit up, your vitals need to be taken. You can't perform in the suit for more than about a half hour at a time -- if you make it that long. Heat stroke is almost a given at that point. You have to be fully hydrated and calm before you even step into the suit. By the time you come out of it, and your vitals are taken again, you're likely to be feeling the impact -- you may not have taken more than a few steps in the suit, but you'll feel like you've run a marathon on a 90-degree day.
Getting the suit on is easy enough, but it requires team work. Your gloves, all layers of them, are taped to your suit. This provides an extra layer of protection and also limits your movement. There is a very specific way to tape all the way around so that there are no gaps or "tenting" of the tape. If you don't do this properly, there ends up being more than enough open pockets for contamination to seep in.
If you're wearing a respirator, it needs to be tested prior to donning to make sure it is in good condition and that the filter has been changed recently, so that it will do its job. Ebola is not airborne. It is not like influenza, which spreads on particles that you sneeze or cough. However, Ebola lives in vomit, diarrhea and saliva -- and these avenues for infection can travel. Projectile vomiting is called so for a reason. Particles that are in vomit may aerosolize at the moment the patient vomits. This is why if the nurses in Dallas were in the room when the first patient, Thomas Duncan, was actively vomiting, it would be fairly easy for them to become infected. Especially if they were not utilizing their PPE correctly.
The other consideration is this: The "doffing" procedure, that is, the removal of PPE, is the most crucial part. It is also the point at which the majority of mistakes are made, and my guess is that this is what happened in Dallas.
The PPE, if worn correctly, does an excellent job of protecting you while you are wearing it. But eventually you'll need to take it off. Before you begin, you need to decon the outside of the PPE. That's the first thing. This is often done in the field with hoses or mobile showers/tents. Once this crucial step has occurred, the removal of PPE needs to be done in pairs. You cannot safely remove it by yourself. One reason you are wearing several sets of gloves is so that you have sterile gloves beneath your exterior gloves that will help you to get out of your suit. The procedure for this is taught in FEMA courses, and you run drills with a buddy over and over again until you get it right. You remove the tape and discard it. You throw it away from you. You step out of your boots -- careful not to let your body touch the sides. Your partner helps you to slither out of the suit, again, not touching the outside of it. This is difficult, and it cannot be rushed. The respirators need to be deconned, batteries changed, filters changed. The hoods, once deconnned, need to be stored properly. If the suits are disposable, they need to be disposed of properly. If not, they need to be thoroughly deconned and stored safely. And they always need to be checked for rips, tears, holes, punctures or any other even tiny, practically invisible openings that could make the suit vulnerable.
Can anyone tell me if this happened in Dallas?
We run at least an annual drill at my hospital each year. We are a small hospital and thus are a small emergency response team. But because we make a point to review our protocols, train our staff (actually practice donning/doffing gear), I realized this week that this puts us ahead at some much larger and more notable hospitals in the United States. Every hospital should be running these types of emergency response drills yearly, at least. To hear that the nurses in Dallas reported that there were no protocols at their hospital broke my heart. Their health care system failed them. In the United States we always talk about how the health care system is failing patients, but the truth is, it has failed its employees too. Not just doctors and nurses, but allied health professionals as well. The presence of Ebola on American soil has drawn out the true vulnerabilities in the health care system, and they are not fiscally based. We spend trillions of dollars on health care in this country -- yet the allocation of those funds are grossly disproportionate to how other countries spend their health care expenditures. We aren't focused on population health. Now, with Ebola threatening our population, the truth is out.
The truth is, in terms of virology, Ebola should not be a threat to American citizens. We have clean water. We have information. We have the means to educate ourselves, practice proper hand-washing procedures, protect ourselves with hazmat suits. The CDC Disease Detectives were dispatched to Dallas almost immediately to work on the front lines to identify those who might be at risk, who could have been exposed. We have the technology, and we certainly have the money to keep Ebola at bay. What we don't have is communication. What we don't have is a health care system that values preventative care. What we don't have is an equal playing field between nurses and physicians and allied health professionals and patients. What we don't have is a culture of health where we work symbiotically with one another and with the technology that was created specifically to bridge communication gaps, but has in so many ways failed. What we don't have is the social culture of transparency, what we don't have is a stopgap against mounting hysteria and hypochondria, what we don't have is nation of health literate individuals. We don't even have health-literate professionals. Most doctors are specialists and are well versed only in their field. Ask your orthopedist a general question about your health -- see if they can comfortably answer it.
Health care operates in silos -- we can't properly isolate our patients, but we sure as hell can isolate ourselves as health care workers.
As we slide now into flu season, into a time of year when we are normally braced for winter diseases, colds, flus, sick days and cancelled plans, the American people has also now been truly exposed to another disease entirely: the excruciating truth about our health care system's dysfunction -- and the prognosis doesn't look good.
Note: In response to some comments, I would like to clarify that I am FEMA-trained in level 3 hazmat in a hospital setting. I am a student, health guide and writer, but I am not a nurse.*******
Stratfor: Evaluating Ebola as a weapon
Reply #9 on:
October 23, 2014, 10:16:20 PM »
Evaluating Ebola as a Biological Weapon
Thursday, October 23, 2014 - 03:00 Print Text Size
By Scott Stewart
Over the past few weeks, I've had people at speaking engagements ask me if I thought the Islamic State or some other militant group is using Ebola as a biological weapon, or if such a group could do so in the future. Such questions and concerns are not surprising given the intense media hype that surrounds the disease, even though only one person has died from Ebola out of the three confirmed cases in the United States. The media hype about the threat posed by the Islamic State to the United States and the West is almost as bad. Both subjects of all this hype were combined into a tidy package on Oct. 20, when the Washington Post published an editorial by columnist Mark Thiessen in which he claimed it would be easy for a group such as the Islamic State to use Ebola in a terrorist attack. Despite Thiessen's claims, using Ebola as a biological warfare agent is much more difficult than it might appear at first blush.
The 2014 Outbreak
In the past, there have been several outbreaks of Ebola in Africa. Countries included Sudan, Uganda, the Republic of the Congo and the Democratic Republic of the Congo, and several comparatively small outbreaks occurred in Gabon as well. In most cases, people who handled or ate animals infected with the disease started the outbreaks. "Bushmeat," or portions of roasted meat from a variety of wild animals, is considered by many to be a delicacy in Africa, and in a continent where hunger is widespread, it is also a necessity for many hungry people. After several months of medical investigations, epidemiologists believe the current outbreak most likely began when a two-year-old child in Guinea touched or perhaps ate part of an infected animal such as a bat or monkey.
The source of the disease means it is highly unlikely that some malevolent actor intentionally caused the latest outbreak. Besides the fact that the current outbreak's cause has been identified as a natural one, even if a transnational militant group such as the Islamic State was able to somehow develop an Ebola weapon, it would have chosen to deploy the weapon against a far more desirable target than a small village in Guinea. We would have seen the militants use their weapon in a location such as New York, Paris or London, or against their local enemies in Syria and Iraq.
As far as intent goes, there is very little doubt that such a group would employ a biological weapon. As we noted last month when there was increased talk about the Islamic State possibly weaponizing plague for a biological attack, terrorist attacks are intended to have a psychological impact that outweighs the physical damage they cause. The Islamic State itself has a long history of conducting brutal actions to foster panic.
In 2006 and 2007, the Islamic State's predecessor, al Qaeda in Iraq, included large quantities of chlorine in vehicle bombs deployed against U.S. and Iraqi troops in an attempt to produce mass casualties. The explosives in the vehicle bombs killed more people than the chlorine did, and after several unsuccessful attempts, al Qaeda in Iraq gave up on its chlorine bombings because the results were not worth the effort. Al Qaeda in Iraq also included chemical artillery rounds in improvised explosive devices used in attacks against American troops in Iraq on several occasions. Again, these attacks failed to produce mass casualties. Finally, according to human rights organizations, the Islamic State appears to have recently used some artillery rounds containing mustard gas against its enemies in Syria; the group presumably recovered the rounds from a former Saddam-era chemical weapons facility in Iraq or from Syrian stockpiles.
The problem, then, lies not with the Islamic State's intent but instead with its capability to obtain and weaponize the Ebola virus. Creating a biological weapon is far more difficult than using a chemical such as chlorine or manufactured chemical munitions. Contrary to how the media frequently portrays them, biological weapons are not easy to obtain, they are not easy to deploy effectively and they do not always cause mass casualties.
The Difficulty of Weaponization
Ebola and terrorism are not new. Nor is the possibility of terrorist groups using the Ebola virus in an attack. As we have previously noted, the Japanese cult Aum Shinrikyo attempted to obtain the Ebola virus as part of its biological warfare program. The group sent a medical team to Africa under the pretext of being aid workers with the intent of obtaining samples of the virus. It failed in that mission, but even if it had succeeded, the group would have faced the challenge of getting the sample back to its biological warfare laboratory in Japan. The Ebola virus is relatively fragile. Its lifetime on dry surfaces outside of a host is only a couple of hours, and while some studies have shown that the virus can survive on surfaces for days when still in bodily fluids, this requires ideal conditions that would be difficult to replicate during transport.
If the group had been able to get the virus back to its laboratory, it would have then faced the challenge of reproducing the Ebola virus with enough volume to be used in a large-scale biological warfare attack, similar to its failed attacks on Tokyo and other Japanese cities in which the group sprayed thousands of gallons of botulinum toxin and Anthrax spores. Reproducing the Ebola virus would present additional challenges because it is an extremely dangerous virus to work with. It has infected researchers, even when they were working in laboratories with advanced biosafety measures in place. Although Aum Shinrikyo had a large staff of trained scientists and a state-of-the-art biological weapons laboratory, it was still unable to effectively weaponize the virus.
The challenges Aum Shinrikyo's biological weapons program faced would be multiplied for the Islamic State. Aum Shinrikyo operatives were given a great deal of operational freedom until their plans were discovered after the 1995 sarin attacks on the Tokyo subway. (The group's previous biological weapons attacks were so unsuccessful that nobody knew they had been carried out until after its members were arrested and its chemical and biological weapons factories were raided.) Unlike the Japanese cult, the Islamic State's every move is under heavy scrutiny by most of the world's intelligence and security agencies. This means jihadist operatives would have far more difficulty assembling the personnel and equipment needed to construct a biological weapons laboratory. Since randomly encountering an infected Ebola patient would be unreliable, the group would have to travel to a country impacted by the outbreak. This would be a difficult task for the group to complete without drawing attention to itself. Furthermore, once group members reached the infected countries, they would have to enter quarantined areas of medical facilities, retrieve the samples and then escape the country unnoticed, since they could not count on randomly encountering an infected Ebola patient.
Even if Islamic State operatives were somehow able to accomplish all of this -- without killing themselves in the process -- Ebola is not an ideal biological warfare vector. The virus is hard to pass from person to person. In fact, on average, its basic reproductive rate (the average amount of people that are infected by an Ebola patient) is only between one and two people. There are far more infectious diseases such as measles, which has a basic reproductive rate of 12-18, or smallpox, which has a basic reproductive rate of five to seven. Even HIV, which is only passed via sexual contact or intravenous blood transmission, has a basic reproductive rate of two to five.
Ebola's Weakness as a Weapon
The Ebola disease is also somewhat slow to take effect, and infected individuals do not become symptomatic and contagious for an average of 8-10 days. The disease's full incubation period can last anywhere from two to 21 days. As a comparison, influenza, which can be transmitted as quickly as three days after being contracted, can be spread before symptoms begin showing. This means that an Ebola attack would take longer to spread and would be easier to contain because infected people would be easier to identify.
Besides the fact that Ebola can only be passed through the bodily fluids of a person showing symptoms at the time, the virus in those bodily fluids must also somehow bypass the protection of a person's skin. The infectious fluid must enter the body through a cut or abrasion, or come into contact with the mucus membranes in the eyes, nose or mouth. This is different from more contagious viruses like measles and smallpox, which are airborne viruses and do not require any direct contact or transfer of bodily fluids. Additionally, the Ebola virus is quite fragile and sensitive to light, heat and low-humidity environments, and bleach and other common disinfectants can kill it. This means it is difficult to spread the virus by contaminating surfaces with it. The only way to infect a large amount of people with Ebola would be to spray them with a fluid containing the virus, something that would be difficult to do and easily detectable.
Thiessen's piece suggested that the Islamic State might implement an attack strategy of infecting suicide operatives with Ebola and then having them blow themselves up in a crowded place, spraying people with infected bodily fluids. One problem with this scenario is that it would be extremely difficult to get an infected operative from the group's laboratory to the United States without being detected. As we have discussed elsewhere, jihadist groups have struggled to get operatives to the West to conduct conventional terrorist attacks using guns and bombs, a constraint that would also affect their ability to deploy a biological weapon.
Even if a hostile group did mange to get an operative in place, it would still face several important obstacles. By the time Ebola patients are highly contagious, they are normally very ill and bedridden with high fever, fatigue, vomiting and diarrhea, meaning they are not strong enough to walk into a crowded area. The heat and shock of the suicide device's explosion would likely kill most of the virus. Anyone close enough to be exposed to the virus would also likely be injured by the blast and taken to a hospital, where they would then be quarantined and treated for the virus.
Biological weapons look great in the movies, but they are difficult and expensive to develop in real life. That is why we have rarely seen them used in terrorist attacks. As we have noted for a decade now, jihadists can kill far more people with far less expense and effort by utilizing traditional terrorist tactics, which makes the threat of a successful attack using the Ebola virus extremely unlikely.
Read more: Evaluating Ebola as a Biological Weapon | Stratfor
New Yorder: Inside the Ebola Wars
Reply #10 on:
October 27, 2014, 02:34:01 PM »
WSJ: Doctors without Scruples
Reply #11 on:
October 29, 2014, 04:32:26 PM »
Doctors Without Scruples
And why are soldiers being quarantined?
October 29, 2014
Kaci Hickox, the nurse who was briefly quarantined at a Newark, N.J., hospital after flying into the state en route from Ebola-ravaged Sierra Leone, now says she won’t comply with the three-week home-quarantine requirements in her home state of Maine. “She doesn’t want to agree to continue to be confined to a residence beyond the two days,” her New York-based lawyer, Steven Hyman, tells the Bangor Daily News.The Associated Press quotes Hyman as saying: “She’s a very good person who did very good work and deserves to be honored, not detained, for it.”
At least two other medical professionals have acted as if public-health rules don’t apply to them. The New York Post reports that physician Craig Spencer—like Hickox a volunteer for Doctors Without Borders, in his case in Guinea—“lied to authorities about his travels around the city . . ., law-enforcement sources said”:
Spencer at first told officials that he isolated himself in his Harlem apartment—and didn’t admit he rode the subways, dined out and went bowling until cops looked at his MetroCard the sources said.
“He told the authorities that he self-quarantined. Detectives then reviewed his credit-card statement and MetroCard and found that he went over here, over there, up and down and all around,” a source said.
And let’s not forget Nancy Snyderman, a Princeton, N.J., physician who entered voluntary quarantine after a fellow traveler to Liberia was diagnosed with Ebola. On Oct. 9 the Planet Princeton website reported that “Snyderman allegedly was seen sitting in her car outside of the Peasant Grill in Hopewell Boro this afternoon. A reader reported that a man who was with her got out of the car and went inside the restaurant to pick up a take-out order. Another man was in the back seat of her black Mercedes. Snyderman had sunglasses on and had her hair pulled back, the reader said.”
The state issued a mandatory quarantine order, and on Oct. 13 Snyderman “issued an apology to the public . . . but did not indicate that she had violated the voluntary confinement agreement . . . or take personal responsibility for the violation.”
At least Doctors Without Borders is off the hook for Snyderman. She works for NBC as chief medical correspondent.
Meanwhile, the Defense Department has announced that all U.S. servicemen “returning from areas affected by Ebola in West Africa” will be subjected to “a 21-day monitoring period.” As noted here yesterday, that has already been the de facto policy. The Pentagon press release doesn’t use the word “quarantine,” but every media report we’ve seen does.
The statement quotes a Pentagon spokesman as saying Secretary Chuck Hagel “believes these initial steps are prudent, given the large number of military personnel transiting from their home base and West Africa and the unique logistical demands and impact this deployment has on the force.” It’s hard to disagree, though one might add: and the irresponsible, if not downright dishonest, behavior of various civilian medics.
But of course Hagel’s announcement means that the Obama administration has two directly opposite policies on Americans returning from Ebola lands: quarantine for those in uniform, laissez-faire for civilians. And “laissez-faire” doesn’t quite capture it: The administration not only is not imposing a quarantine on civilians but is actively pressuring states to refrain from doing so. Hickox was released after—and possibly because of—that campaign.
What accounts for the double standard? Or, as a reporter put it to President Obama yesterday: “Are you concerned, sir, that there might be some confusion between the quarantine rules used by the military and used by health care workers and by some states?”
Let’s go through the president’s response point by point.
“Well, the military is a different situation, obviously, because they are, first of all, not treating patients.”
According to the Washington Post, some of them will “test samples for presence of the virus,” but if they are not going to have direct contact with Ebola sufferers, that would seem to militate against quarantining them upon return.
“Second of all, they are not there voluntarily, it’s part of their mission that’s been assigned to them by their commanders and ultimately by me, the commander in chief.”
Perhaps the president is unaware that the U.S. does not have military conscription. Which we suppose would be understandable, since Obama was 11 when the last draftee reported for duty.
“So we don’t expect to have similar rules for our military as we do for civilians. They are already, by definition, if they’re in the military, under more circumscribed conditions.”
Press secretary Josh Earnest had developed that argument further at a briefing two hours earlier:
There are a wide range of sacrifices that our men and women in uniform make for the sake of efficiency and for the sake of uniformity and for the success of our military.
So to take a more pedestrian example than the medical one that we’re talking about, there might be some members of the military who think that the haircut that’s required may not be their best, but that’s a haircut that they get every couple of weeks because it is in the best interest of their unit and it maintains unit cohesion.
We’ll return to the point, but let’s note here that taking servicemen out of circulation for three weeks obviously does not promote efficiency, and that instituting a policy that applies only to the relatively small number of servicemen stationed in Ebola lands obviously does not promote uniformity. That leaves only the catchall “success of our military” category to justify the quarantine.
Back to Obama:
“When we have volunteers who are taking time out from their families, from their loved ones and so forth, to go over there because they have a very particular expertise to tackle a very difficult job, we want to make sure that when they come back that we are prudent, that we are making sure that they are not at risk themselves or at risk of spreading the disease . . .”
It sounds here as if the president is continuing his justification of the military quarantine, but it turns out the “volunteers” he means here are the Doctors Without Borders types, who, he said in his prepared statement “are doing God’s work over there.” (Maybe, but didn’t God say something about bearing false witness?) The sentence continues:
“. . . but we don’t want to do things that aren’t based on science and best practices. Because if we do, then we’re just putting another barrier on somebody who’s already doing really important work on our behalf. And that’s not something that I think any of us should want to see happen.”
All of which leaves unanswered the central question: If a policy of quarantining returning personnel runs counter to “science and best practices,” how does it promote, in Earnest’s phrase, “the success of our military”?
Absent a satisfactory answer to that question, the answer to the question “Why are you quarantining servicemen?” seems to boil down to: “Because we can.” Because it is in the nature of military service to demand a considerable sacrifice of personal freedom. But if the administration viewed that as sufficient justification, it would not have pressed for legislation abolishing restrictions on service by homosexuals.
Anyway, we know of no one who denies that Hagel had the authority to establish the quarantine policy, absent a contrary order from the commander in chief. But the White House also concedes that states have the authority to order quarantines for civilians.
At his Monday press briefing, Josh Earnest answered a reporter’s question about the absence of “an overarching federal policy that rules” by saying this: “You can sort of take this up with James Madison, right? We have a federal system in this country in which states are given significant authority for governing their constituents. That is certainly true when it comes to public safety and public health.”
What is at issue, then, is the administration’s purely discretionary decisions to order quarantines for servicemen and lean on states not to order them for civilians—a contradiction with no obvious basis, and no basis the World’s Greatest Orator and his spokesman have managed to articulate, in philosophy, law or science.
Either servicemen are being subjected to burdens with no basis in “science or best practices,” or the administration is risking public health by prioritizing the personal comfort of civilian medical workers. Why in the world are they doing this?
Odd as it to say about this administration—especially with an election less than a week away—it’s hard to imagine the motive is political. CBS News reports that 80% of respondents in a new poll “think U.S. citizens and legal residents returning from West Africa should be quarantined upon their arrival in the U.S. until it is certain they don’t have Ebola”; just 17% disagree. (Though to be sure, that 17% is almost double the proportion describing themselves in another recent poll as “enthusiastic” about Obama.)
Let us suggest two practical distinctions, either or both of which may explain the disjunction in policy. The first is that forestalling the military quarantine order would have required Obama to overrule a recommendation of the Joint Chiefs of Staff—that is to say, to make a decision. Pressuring the governors, by contrast, involves only behind-the-scenes kibitzing and public bloviation.
The second is snobbery. Recall that quote from Nurse Hickox’s lawyer: “She’s a very good person.” She and others like her, according to the president, are doing God’s work, and—in pointed if inaccurate contrast to military servicemen—are “experts.” The logic would go something like this: You can’t quarantine her. She’s one of us.
Reply #12 on:
October 30, 2014, 05:43:53 AM »
As usual, the rules don't apply to the anointed of the left.
From the nurse in Maine
Reply #13 on:
October 30, 2014, 10:18:43 AM »
Who refuses quarantine:
"You could hug me, you could shake my hand [and] I would not give you Ebola," she said.
My response: How many nurses and doctors have died of Ebola?
Hero? "Liberal" is more like it.
That said I predict the whole Ebola thing will die (no pun intended) down in a couple of months. The peak of the epidemic was when we start reading WHO predict there could be 1.7 million cases by January. The WHO always makes wild predictions that herald the peak of epidemics. OTOH fear mongering is better then poo pawing the real dangers.
Ebola in Sierra Leone
Reply #14 on:
November 28, 2014, 07:51:29 PM »
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