Ebola and fragility

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Re: Ebola and fragility

Post by jacob » Sun Oct 12, 2014 9:56 am

Second confirmed US case. (A health care worker who treated the first case.)

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Re: Ebola and fragility

Post by almostthere » Sun Oct 12, 2014 2:56 pm

@ George, I considered your question for a couple days. I think if you wanted to donate, then donate to MSF(Doctors without Borders). They seem to have the in logistics in place already and seem to be attracting the most patients, at least in Liberia. They also seem to have the most experience in Ebola. From my experience, they also seem to be a low overhead organization (my subjective assessment). Liberia is a tough place to be getting started for any new organizations without logistics in place especially at the end of the rainy season. Just ask the US Army ;-)

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Re: Ebola and fragility

Post by george » Sun Oct 12, 2014 3:17 pm

almost there

it really is a small world. I know someone who is a doctor in this organisation. One day I was watching the BBC and they showed the very first aid workers entering a war zone, and there she was. its an amazing organisation and the people who work there are one of a kind. definately worth their donations.

Once this person said to me, I envy you, you have a mortgage, you can settle down, i'm not meant to do that. I would like to, but I can't. When we were at school she was the political one, school council etc, standing up for what she believed was right. She's spending her life doing this. She has a child now and works behind a desk, but her work is benefiting refugees etc. I always wonder what the stories are behind people who make such sacrifices, this is just one story.

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Re: Ebola and fragility

Post by workathome » Mon Oct 13, 2014 11:10 am

Imagine that, quarantining the disease work. Providing monetary relief for people who are hurt by the measures helps too.

http://www.washingtonpost.com/news/stor ... rra-leone/

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Re: Ebola and fragility

Post by jennypenny » Mon Oct 13, 2014 11:21 am

I was in the hospital for a couple of days, and I was dismayed to see a lack on concern amongst the staff. When I asked different people if there was talk of implementing new protocols, most would laugh or joke that it wasn't anything to worry about. I was asked if I had a fever, but no one actually took my temp until after I was admitted, and again after I entered pre-op.

A doctor was filling a personal prescription (he said it was) in the hospital pharmacy. This is only half of what he ordered. The pharmacy tech said the rest would come the next day. The tech asked him why he needed so much stuff. He shrugged his shoulders, and said "Well, you know, with everything going on, just in case I need it." Nothing like seeing a doctor stock up on medical supplies "just in case" to send my prepper paranoia into overdrive.

Image

(Sorry about the pic--DH was trying to be discreet about taking it)

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Re: Ebola and fragility

Post by jacob » Mon Oct 13, 2014 1:23 pm

Fragility revealed ... in terms of birds, think ostrich, not black swan.

http://www.bloomberg.com/news/2014-10-1 ... sight.html

Primary problem, the disconnect between belief and reality:
"Hospital administrators “are like ostriches with their heads in the sand, they keep telling our nurses there is a plan and the nurses say there is no plan,” Burger said in a telephone interview."

Lesson: Advanced techmology, a lackadaisical attitude towards risk control, or a 'procedure' does not compensate for lack of education.

Secondary problem, a private solution to a public problem:
"“Infection control budgets have been slashed,” said Judy Stone, an infectious disease expert who works at various hospitals in Pennsylvania." (and so on)

Lesson: A just-in-time focus on the bottom line makes for just about the tightest system imaginable. The short-term profit that is realized by not buying the education above is eventually paid back with [unknown] risk.

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Re: Ebola and fragility

Post by Chad » Mon Oct 13, 2014 1:33 pm

jacob wrote: Lesson: A just-in-time focus on the bottom line makes for just about the tightest system imaginable. The short-term profit that is realized by not buying the education above is eventually paid back with [unknown] risk.
Just replace education with investment and a lot of areas of our country/economy are in the same situation.

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Re: Ebola and fragility

Post by jacob » Mon Oct 13, 2014 3:16 pm

Via ZeroHedge ...

http://www.cidrap.umn.edu/news-perspect ... tion-ebola

Takeaway: The difference between airborne and aerosol is a quantitative measure in droplet size rather than it being the case of either one or the other. Aerosols are loosely defined as "larger droplets" (think sneezing, powerwashing puke, flushing a toilet, ...) the largest of which can remain suspended in the air for up to an hour. Airborne are classified "smaller droplets" and they stay longer. However, one hour is quite a long time.

The half-life [outside the body] of Ebola is about 20 minutes!

Frankly, this seems to be to be more than just an educational error. It's an error of thinking to take a continuum variable, split the continuum into two parts (big and small), classify observations as either one or the other, and the conclude that half of the observations are irrelevant. In a general sense, this is what happens if a understanding is abstracted, then simplified, and then reabstracted again [and typically made part of some procedure, classification, department, ...]. We end up with people thinking and talking about [re-]abstractions not realizing that their reality-perception is erroneous. This problem really IS endemic. It's highly frustrating to observe this in so many places of human activity. It's a peculiar form of dogmatism leading to the assumption of "facts" when the underlying [and often wildly simplifying] assumptions are forgotten or ignored. Yeah, education and investing too ...

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Re: Ebola and fragility

Post by jacob » Tue Oct 14, 2014 9:24 am

http://www.theglobeandmail.com/news/wor ... e21085134/

Outsourcing and jurisdiction problems [in the first Dallas case] when private contractors or local authorities simply refuse to do business ...

"As doctors and nurses there worked to keep desperately ill patients alive in August, the county threatened to disconnect Emory from the sewer lines if Ebola wastes went down the drain. The company that hauled medical trash to the incinerator refused to take anything used on an Ebola patient unless it was sterilized first. Couriers would not drive the patients’ blood samples a few blocks away for testing at the Centers for Disease Control and Prevention. And pizza places would not even deliver to staff members in any part of the hospital."

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Re: Ebola and fragility

Post by jennypenny » Tue Oct 14, 2014 3:09 pm

It was nice to see Dr. Nancy Snyderman and her colleague broke quarantine last week so they could get some good eats. Bonus points for picking a restaurant 10 miles from my house. :roll:

I'm not sitting my basement waiting for an outbreak in my area now. I just think the incident shows the futility of relying on quarantines as a way to control outbreaks. She's a doctor and has seen first-hand what the disease does to people, and yet even she couldn't manage to get through the 3-week quarantine period. The only quarantines that are truly effective are forced quarantines, but they are only realistic in small numbers. With Ebola, I think there are too many people who might need to be quarantined with each diagnosis, and too few people properly equipped to do the enforcing.

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Re: Ebola and fragility

Post by theanimal » Tue Oct 14, 2014 3:56 pm

Jacob- I think you may have linked the wrong article. I believe you are referring to this one? http://www.nytimes.com/2014/10/14/us/qu ... tcore-ipad

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Re: Ebola and fragility

Post by jacob » Wed Oct 15, 2014 7:24 am

US Case #3: Another nurse from the first case.

Edit: Who was also on a plane yesterday.

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Re: Ebola and fragility

Post by jacob » Wed Oct 15, 2014 11:54 am

http://www.theonion.com/articles/what-y ... ola,37137/

Okay, it's all covered here. I don't think I have anything to add ;-P

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Re: Ebola and fragility

Post by chenda » Wed Oct 15, 2014 12:45 pm

To put things in perspective/cause further alarm:

''The 1918 flu pandemic (January 1918 – December 1920) was an unusually deadly influenza pandemic, the first of the two pandemics involving H1N1 influenza virus. It infected 500 million people across the world, including remote Pacific islands and the Arctic, and killed 50 to 100 million of them—three to five percent of the world's population making it one of the deadliest natural disasters in human history. Most influenza outbreaks disproportionately kill juvenile, elderly, or already weakened patients; in contrast the 1918 pandemic predominantly killed previously healthy young adults.''

''The disease killed in every corner of the globe. As many as 17 million died in India, about 5% of the population. The death toll in India's British-ruled districts alone was 13.88 million. In Japan, 23 million people were affected, and 390,000 died. In the Dutch East Indies (now Indonesia), 1.5 million were assumed to have died from 30 million inhabitants. In Tahiti, 14% of the population died during only two months. Similarly, in Samoa in November 1918, 20% of the population of 38,000 died within two months. In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died. Native American tribes were particularly hard hit. In the Four Corners area alone, 3,293 deaths were registered among Native Americans. Entire villages perished in Alaska. In Canada 50,000 died. In Brazil 300,000 died, including president Rodrigues Alves.''

http://en.m.wikipedia.org/wiki/1918_flu_pandemic

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Re: Ebola and fragility

Post by jacob » Wed Oct 15, 2014 2:58 pm

http://www.washingtonpost.com/wp-srv/sp ... a-spreads/

Considering pandemics, in terms of speed (quite slow) and deadliness (very), it's better to compare ebola to smallpox (somewhat slow/quite) than the flu (fast/not very).

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Re: Ebola and fragility

Post by jennypenny » Wed Oct 15, 2014 4:11 pm

The comments in the WaPo article are pretty good. My favorite was "Dear CDC, You had one job."

-----

And from another article ...
Dr. Tom Frieden, director for the Center for Disease Control and Prevention (CDC), said during a telephone press briefing Wednesday that you cannot get Ebola by sitting next to someone on a bus, but that infected or exposed persons should not ride public transportation because they could transmit the disease to someone else.

I honestly can't tell if he's in over his head, or they really have no idea how it's spreading at this point and who is at risk.

-----

How many people are they realistically expecting to monitor with each infection? There are over a hundred from that flight alone. I assume dozens more that the person had contact with on the ground. How many people would end up quarantined if there were a few hundred people diagnosed?

What does "monitor" mean, anyway? I'm not sure if I would call that number or volunteer for monitoring. What about a person who lives paycheck to paycheck and is afraid they would make them stay home from work--would they call and self-report?

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Re: Ebola and fragility

Post by jacob » Wed Oct 15, 2014 6:30 pm

This brings me to the main fragility where the US sets itself apart from the rest of the first world. Its health care system. Given co-pays and other ways of sticking it to the consumer with excess(!?) care, consider the risk of reporting a flu symptom (which will more than likely just turn out to be a flu) and end up with a 3-6 figure medical bill as a result. FWIW, cleaning Duncan's apartment cost $100k. It's a huge incentive for people w/o Cadillac plans to hide, ignore, or wait-and-see-until-it's-too-late symptoms.

I think "over their heads" is the best explanation although that's not exactly the words I'd choose. It's more of a disconnect between the myth of "we're the bestest because techmology" and reality. I'm currently seeing a disconnect between the "clueless" (in Gervais terms) who are giving admin-speak excuses (e.g. "Our mission is to provide the best care in the world using the most advanced procedures available...") or simply repeating authority speak (e.g. "There's is no risk to the public [yeah, unless you personally sat next to that nurse on the plane and maybe passed the coffee cup over]") and the "losers" who are the boots on the ground (e.g. "WTF do you mean about procedures? I've never SEEN those procedures and I'm not risking my life over this. I quit!"). These groups need to sit down together, soon.

In Taleb terms this is actually a good example of how you don't need a theory to decide how to behave. Just see what people do in Liberia. Then do the same thing. You don't need to understand why. There's plenty of experience to draw on already. Unfortunately, the first "defense" here was "hand-out procedures". And that was penetrated. I think the "clueless" admins on the top are going to stick to theory for a while yet though.

PS: In case any "clueless" admins read this. It's nothing personal. Please go and read ribbonfarm's series on the Gervais principle and tell me if it fits this systemic problem.

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Re: Ebola and fragility

Post by theanimal » Wed Oct 15, 2014 10:28 pm

http://www.zerohedge.com/news/2014-10-1 ... bola-fears

Dallas set to declare state of disaster tomorrow.

Also, the second nurse flew to Cleveland and back the day before showing symptoms. Not only that, but she was granted to permission to fly by the CDC with an elevated temperature!


This says it all for me-
http://youtu.be/d8XhiaUE9xg?t=14s

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Re: Ebola and fragility

Post by Chad » Thu Oct 16, 2014 6:05 am

jennypenny wrote: And from another article ...
Dr. Tom Frieden, director for the Center for Disease Control and Prevention (CDC), said during a telephone press briefing Wednesday that you cannot get Ebola by sitting next to someone on a bus, but that infected or exposed persons should not ride public transportation because they could transmit the disease to someone else.
Stunningly unbelievable. Kind of like the idiot healthcare workers putting on 3 pairs of gloves.

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Re: Ebola and fragility

Post by prosaic » Thu Oct 16, 2014 2:50 pm

So much more...no PPE for the first 3 days for healthcare workers dealing with Duncan: http://thescoopblog.dallasnews.com/2014 ... 2773012ff1

and CDC officials possibly "contaminating hallways" in those early days at Texas Presbyterian: http://www.newyorker.com/news/amy-david ... l_facebook

I just...what.the.&^%$?

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