Ebola and fragility

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jennypenny
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Re: Ebola and fragility

Post by jennypenny » Tue Oct 21, 2014 8:55 pm

At the hospital today, they were taping up "What is Ebola?" posters. Nothing like getting out in front of an issue. :roll:

I heard a related story on Marketplace tonight, talking about healthcare workers possibly not showing up for work during a pandemic. Absenteeism is a huge threat during a health crisis, and I think the CDC's performance over the last month has intensified the fear many have that the government won't be forthcoming or proactive during such a crisis.

From the Marketplace story...
The guidelines released by the CDC are aimed at many of these workers. But you can have all the protocols you want, a room stuffed with gear and Johns Hopkins' Dr. Daniel Barnett says you still may have staff scared stiff. He says he worries hospitals right now are making the same assumption he made about a decade ago.

“That people would be willing to come to work, regardless of scenario, regardless of context, regardless of personal and professional obligations given,” he says.

But his work in the field he calls psychological preparedness proved him wrong.

“We found that a third of hospital workers indicated they would be unwilling to show up in a severe pandemic. You can think of a severe influenza pandemic in terms of the fear in some ways as a proxy for what we are talking about with regards to Ebola,” he says.


Dr. Barnett's research article

Chad
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Re: Ebola and fragility

Post by Chad » Wed Oct 22, 2014 5:31 am

jennypenny wrote:
From the Marketplace story...
The guidelines released by the CDC are aimed at many of these workers. But you can have all the protocols you want, a room stuffed with gear and Johns Hopkins' Dr. Daniel Barnett says you still may have staff scared stiff. He says he worries hospitals right now are making the same assumption he made about a decade ago.

“That people would be willing to come to work, regardless of scenario, regardless of context, regardless of personal and professional obligations given,” he says.

But his work in the field he calls psychological preparedness proved him wrong.

“We found that a third of hospital workers indicated they would be unwilling to show up in a severe pandemic. You can think of a severe influenza pandemic in terms of the fear in some ways as a proxy for what we are talking about with regards to Ebola,” he says.


Dr. Barnett's research article
Interesting article. Though, I'm not sure a survey can accurately predict what these people would do. They might not show up, but I would bet the desire to have someone telling them what to do brings most of the sheep in. Unless it was World War Z level.

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Re: Ebola and fragility

Post by Ego » Wed Oct 22, 2014 10:12 am

People say they wouldn't show up. Tell them they'll lose their job if they have an unexcused absence during the crisis and that it will go on their permanent record, and they'll show. Mortgages and car payments are powerful motivators for the paycheck-to-paycheck crowd.

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Re: Ebola and fragility

Post by Chad » Wed Oct 22, 2014 11:17 am

This is rather amusing.
More Americans have been married to Kim Kardashian than have died from Ebola.
http://www.bloombergview.com/articles/2 ... ong-things

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Re: Ebola and fragility

Post by Ego » Wed Oct 22, 2014 12:17 pm

Along those same lines... more people showed up to protest the fact that the Spanish government put down the ebola-nurse's dog than those who showed up to demand the resignation of the minister of health for the supposedly poor ebola response.

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Re: Ebola and fragility

Post by Chad » Wed Oct 22, 2014 2:07 pm

Ego wrote:Along those same lines... more people showed up to protest the fact that the Spanish government put down the ebola-nurse's dog than those who showed up to demand the resignation of the minister of health for the supposedly poor ebola response.
Yeah, unfortunately the emotional response trumps the rational response.

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Re: Ebola and fragility

Post by jacob » Wed Oct 22, 2014 5:56 pm

However, exponential growth also trumps linear growth. Kim Kardashian can't marry an exponentially growing number of men. She can at most marry a linearly growing number of men. Same with traffic deaths and gunshots.

Once/if ebola overwhelms the medical resources, that is, the ability to effectively mobilize, of a country to do contract tracing and quarantine, the number of cases grow exponentially. The problem in West Africa is currently twice as large as it was three weeks ago. It's four times larger than it was a month and a half a go. It's 32 times larger than it was 6 months months ago. Similarly, without a fix, it'll be 32 times bigger half a year from now.

(These are forecasts which depend on the growth rate which seems to be around 1.7%/day. Predicting exact future numbers is a fools game since the projection varies widely by the rate the further we get out.)

This also means that discounting this epidemic by comparisons to the flu are kinda silly. It's not the quantitative aspects we should worry about. It's the qualitatively difference that's concerning. The reason is that GIVEN continued exponential growth the ebola numbers would overwhelm the flu numbers after a few months. Also, the mortality rate of flu is about 0.1% and it's endemic. That's much different from a 50% fatal epidemic.

Currently, in Liberia, 0.1% of the population has been affected. That's 1 in 1000. Half are dead. That's 1 in 2000. However, 3 weeks from now (mid Nov), it'll be 1 in 500. Then 1 in 250 (early Dec). Then 1 in 125 (end of year). Then 1 in 62 (late Jan). Then 1 in 31 (mid Feb). And so on.

For practical purposes, though, there's no need to worry about it locally unless the authorities lose the capacity to contain it (by contacting the nearest neighbors of each new case). For political "purposes", this is a big concern that requires an immediate and overwhelming response due to its exponential nature. However, such responses aren't exactly a strength of capitalist democracies.

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Re: Ebola and fragility

Post by jennypenny » Wed Oct 22, 2014 6:26 pm

jacob wrote:However, exponential growth also trumps linear growth. Kim Kardashian can't marry an exponentially growing number of men.
I wouldn't underestimate the Kardashians.

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Re: Ebola and fragility

Post by jennypenny » Thu Oct 23, 2014 6:48 am

Drugmakers may need indemnity for fast-tracked Ebola vaccines

Drugmakers are looking for some kind of indemnity from governments or multilateral agencies for the widespread emergency use of new Ebola vaccines in Africa. ...

GlaxoSmithKline Chief Executive Andrew Witty said a system of indemnity made sense given the unique situation in which companies are being urged by the WHO to fast-track the supply of novel vaccines in a matter of months rather than years.


^^This is the stuff that bugs me the most in all of this. How long has Ebola been around? Decades? And now we're going to risk further problems by rushing something to market.

Watching the complete mismanagement of the situation and learning that we're much less prepared for such things than I assumed has made me even more paranoid about pandemics.

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Re: Ebola and fragility

Post by jacob » Thu Oct 23, 2014 7:09 am

This is why I was interested in the fragility of the system when it comes to dealing with a "public" disease with a time-scale that's much faster than systemic/political change. I am curious about the difference in response wrt the types of patients treated (rich/poor/insured/uninsured), detected in the private and decentralized for-profit systems in the US and the public centralized non-profit systems in Europe and what the ultimate response is.

You can learn a lot about anything/anyone by seeing how they respond to a crisis.

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Re: Ebola and fragility

Post by Pronoid » Thu Oct 23, 2014 9:03 am

Related -

Hospitals weigh withholding Ebola care

The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

U.S. hospitals have over the years come under criticism for undertaking measures that prolong dying rather than improve patients' quality of life.

But the care of the first Ebola patient diagnosed in the United States, who received dialysis and intubation and infected two nurses caring for him, is spurring hospitals and medical associations to develop the first guidelines for what can reasonably be done and what should be withheld.

Officials from at least three hospital systems interviewed by Reuters said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed.

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Re: Ebola and fragility

Post by Chad » Thu Oct 23, 2014 10:25 am

IwantLess wrote:Related -

Hospitals weigh withholding Ebola care

The Ebola crisis is forcing the American healthcare system to consider the previously unthinkable: withholding some medical interventions because they are too dangerous to doctors and nurses and unlikely to help a patient.

U.S. hospitals have over the years come under criticism for undertaking measures that prolong dying rather than improve patients' quality of life.

But the care of the first Ebola patient diagnosed in the United States, who received dialysis and intubation and infected two nurses caring for him, is spurring hospitals and medical associations to develop the first guidelines for what can reasonably be done and what should be withheld.

Officials from at least three hospital systems interviewed by Reuters said they were considering whether to withhold individual procedures or leave it up to individual doctors to determine whether an intervention would be performed.
This shouldn't cause any alarm. Of course, that is the exact opposite emotion the article is trying to convey. This is actually a good question every hospital system should ask. There are many in this country that do not have facilities or training to handle ebola. The vast majority of the rural ones won't have the facilities or training to handle it properly, while it wouldn't be surprising to see some urban underfunded hospitals not have the facilities/training either. The more interesting question would be the plan put in place to mitigate these issues. This is what the reporter should focus on, but they won't.

As a side note, just discussing it at executive level by no means indicates the hospital will decide not to treat it. I don't like how we have become fearful of just discussing problems.
Last edited by Chad on Thu Oct 23, 2014 12:31 pm, edited 1 time in total.

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Re: Ebola and fragility

Post by jennypenny » Thu Oct 23, 2014 12:23 pm

@Chad--I think why that post from Iwantless is alarming is that it could significantly lower the quality of the healthcare provided. I'm not saying they're wrong to consider the risk/reward of any procedure, but it's another chink in the armor of our 'advanced modern healthcare system', which is the oft-touted antidote to the possibility of a pandemic.

jacob wrote:You can learn a lot about anything/anyone by seeing how they respond to a crisis.
Did you read the Archdruid Report yesterday? (A Pink Slip for the Progress Fairy)

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Re: Ebola and fragility

Post by Chad » Thu Oct 23, 2014 1:00 pm

jennypenny wrote:
jacob wrote:You can learn a lot about anything/anyone by seeing how they respond to a crisis.
Did you read the Archdruid Report yesterday? (A Pink Slip for the Progress Fairy)
You should know my thoughts on stuff like this by now. From my perspective it's kind of disaster porn.
If you’ve ever wondered just how powerfully collective thinking grips most members of our species—including, by and large, those who most forcefully insist on the originality of their thinking—I have an experiment to recommend: go out in public and advocate an idea about the future that isn’t part of the conventional wisdom, and see what kind of reaction you field. If your experience is anything like mine, you’ll get some anger, some argument, and some blank stares, but the most telling reaction will come from people who try to force what you’re saying into the Procrustean bed of the conventional wisdom, no matter how thoroughly they have to stretch and chop what you’ve said to make it fit.
David Brin would get the exact same reaction if he showed up and spoke at one of this guys meetings (etc.).

The Archdruid is a good story teller, and it's not implausible. Civilizations have always risen and fallen. Sometimes it's a mere hiccup, like Venice or the Soviet Union, and sometimes it's the Mongols destroying the Middle Easts Renaissance, but we know which one the Druid is going to pick every time based on the books that line the right side of his blog.

I think both Ferguson with Civilization: The West and the Rest and Diamond with Collapse have very valid points. I don't think either of them are completely correct, as they are at opposing extremes of thought.

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Re: Ebola and fragility

Post by jacob » Thu Oct 23, 2014 1:09 pm

@jp - No, haven't gotten to it yet. Watching stress responses is my main evaluation tool for ... everything/one.

Here it is anyway:

http://thearchdruidreport.blogspot.com/ ... fairy.html

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Re: Ebola and fragility

Post by jennypenny » Thu Oct 23, 2014 1:20 pm

jacob wrote:@jp - No, haven't gotten to it yet. Watching stress responses is my main evaluation tool for ... everything/one.

Here it is anyway:

http://thearchdruidreport.blogspot.com/ ... fairy.html
Did I post the wrong link again? That's three times this week. :x

Chad wrote:You should know my thoughts on stuff like this by now. From my perspective it's kind of disaster porn.
You say that like it's a bad thing. ;)

Greer's posts all string together into a long, loose narrative. I hesitate posting the link to any particular post because if someone hasn't read the previous few posts, the meaning can get lost. I find the current it-can't-happen-here meme about ebola similar to the this-time-it's-different meme Greer harps on in his posts.

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Re: Ebola and fragility

Post by Ego » Thu Oct 23, 2014 1:52 pm

jennypenny wrote:I find the current it-can't-happen-here meme about ebola similar to the this-time-it's-different meme Greer harps on in his posts.
Nah. It's not that it can't happen or that this time it's different, it's that it is about as useful to be terrified about it as it is to be terrified about the hegemonic South American Union of 2122. I like Sixbears comment. But then I would, wouldn't I?

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Re: Ebola and fragility

Post by Chad » Thu Oct 23, 2014 2:09 pm

jennypenny wrote:
Chad wrote:You should know my thoughts on stuff like this by now. From my perspective it's kind of disaster porn.
You say that like it's a bad thing. ;)
Not a bad thing at all! :D I love Mad Max as much as anyone. I don't actually think it's a bad thing until that disaster scenario becomes THE scenario in that person's mind.

What really bothers me is my reading comprehension. I completely missed that the Archdruid report was directed at Jacob and not me. Of course, I was at work, so my mind was probably only operating at half capacity.

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Re: Ebola and fragility

Post by Riggerjack » Thu Oct 23, 2014 2:49 pm

@jp
What made you think we are/should be prepared for Ebola? the CDC has shown its true colors. More money doesn't fix an entrenched bureaucracy, so funding ain't the issue.
Ebola is one of several hemoragic fevers. It got all the funding and attention that an exotic, rare, and deadly disease deserves. It is the easily pronounced, scary disease du jour.
Throwing more money at it is the american way. But Ebola was exotic, so it ain't going to get much private money, and the CDC already gave it its best. Who did you think should have handled this?
We have no effective defense against pandemic. Never have. Probably never will. Yeah, that's a tough sell for the government to make, but it is true.
I said I bought gloves/masks/bleach/ethyl alcohol. I did, because I use those regularly, anyway, and I for saw supply issues. And I don't want to face Ebola anymore than the next guy.
But the only solution to pandemic has been to let it burn out. Look at what it actually took to wipe out polio and small pox. This was in a time when there was no antivacination movement. A stronger trust in government, and a culture of "getting things done."
The only way to prevent pandemic, is isolation. And even that is hit or miss. You covered this in your public health posting. Folks will handle this as a public health issue. Masks, etc, when necessary. We could take the option of using the information available to us, to quarantine early, but that has been declared unPC. So it will do what it will do.
FWIW, I expect to odds of an Ebola case even coming to Washington state are slim. But I prepared anyway. Others will, too. It just seems the population most at risk is determined to be least prepared. See the comment above about living in NYC.

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Re: Ebola and fragility

Post by Riggerjack » Thu Oct 23, 2014 2:54 pm

BTW, for the entrepreneurs out there: Costco business centers are selling nitrile gloves for less than half the price of boxes on eBay...

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