Ebola In The Big Apple: Trump Goes Insane

Unless you’ve been held hostage by ISIS for the last month, living in a shotgun shack in Montana with no electricity or cell coverage, or simply holding your hands over your eyes and ears and vowing not to stop until this whole thing blows over, you know that Ebola made it’s first visit to NYC yesterday, via another brave, if perhaps somewhat misguided young physician who donated his time and skills to help the pitiful patients in West Africa, and then returned with a souvenir way more dangerous than a fake shrunken head.  There was a whole range of responses to this new development, and at polar opposite sides of the spectrum, there were two famous billionaires.  Over there at batshit crazy on the dial was The Donald, who wasted no time in issuing these tweets from the Batcave of Batshit Lunacy atop one of the many skyscrapers with his name emblazoned in five story golden gothic script  on the side:

If this doctor, who so recklessly flew into New York from West Africa,has Ebola,then Obama should apologize to the American people & resign!

Ebola has been confirmed in N.Y.C., with officials frantically trying to find all of the people and things he had contact with.Obama’s fault

I have been saying for weeks for President Obama to stop the flights from West Africa. So simple, but he refused. A TOTAL incompetent!

Ok, so who’s surprised that Trump and the rest of the loonies over there at the FOX directorate of misinformation have come up with the shocking revelation that it’s OBAMA’S FAULT?  There is so much wrong with Trump’s comments, it’s hard to know where to start, but just as an example, maybe Trump should take some remedial geography or take note of the fact that normal human beings do not have a private jet at their disposal day and night.  The infected doc didn’t fly into JFK from Africa…virtually no one does…his flight was from Belgium.  Maybe Trump thinks we should ban all flights from Belgium…maybe we ought to block imports of chocolate while we’re at it.  Moron.

At the other side of the great divide, we find Microsoft co-founder Paul Allen, who is neither afflicted with verbal diarrhea nor in the business of blaming the people who are trying to help the problem with causing it.  Allen didn’t get on Twitter and feed his ego with self-agrandizement.  He simply quietly issued a statement that he would be donating $100 million (on top of the $9 million he’d already given) to various causes directly involved with the fight against Ebola.  Genius.

BW

 

Potpourri Of Good News And Bad News

I find myself with journalistic ADDH.  There is so much going on in so many different areas, some of it mildly encouraging and most of it ranging from moderately depressing to utterly terrifying, that I’m having difficulty deciding on any particular topic worthy of extended focus.  Aside from that, my primary concern, as always, emanates from the known center of the universe…me.  Since I’m heading to New York in a few days, I’m increasingly wary of the many dangers of the big city.  NYC isn’t just any big city.  It’s the veritable center of civilization as we know it, and along with that concentration of commerce, entertainment, education, transportation, technology, politics, and diversity comes a commensurate volume of corruption, crime, intrigue, and illness.  NYC isn’t just a destination, it’s a target.

When ISIS talks about bringing the jihad to the US, they mean to start in NYC.  When there are threats of attacks on subways and infrastructure, it’s New York that’s in the crosshairs.  ISIS is having a hard time keeping themselves at the forefront of the 24 hour news cycle.  It’s not their fault.  They’ve got plenty of hostages to behead, and the next in line is sadly a Hoosier, Peter Kassig, who was kidnapped while acting as an aid worker in Syria.  His parents posted a three minute video begging for his release, including the mother wearing a modest head scarf, which to me seems like a pointless capitulation to the religious fanatics.  The plea will almost certainly fail, and when it does, Kassig’s demise will be relegated to a relative footnote…because truth be told, there are more terrifying international fish to fry.  Even as our “coalition” continues to rain death from the skies over Iraq and Syria, the national consciousness has moved on.  We no more consider the ongoing air war over Syria and Iraq than we do the “non-fighting” in Afghanistan and Iraq.  It’s all “over there” and all being done by someone who isn’t “us”, thank you very much.

No, ISIS lost the terror franchise when Ebola came along.  Guys in black balaclavas with serrated combat knives in hand are nothing but pussies when compared to a curly ten micron virus that will have blood pouring out your asshole ten days after you rub the sweat from your eyes.  Make no mistake.  Ebola is getting worse, and it’s going to get worse still before it gets better.  Eric Duncan, the Liberian who brought Ebola to Dallas, is in critical condition.  A Spanish nursing assistant who cared for an Ebola patient in Madrid has now come down with the disease.   Officials at the World Health Organization are quietly admitting that there will inevitably be more cases in Western Europe, but just as in the case of the CDC declarations here in the US, they are maintaining that they are well prepared to contain and control the disease.  I’m unconvinced.  The people so far who have been most prone to contracting Ebola, outside of West African villagers, are the health care workers caring for Ebola patients…the experts who are sealed into high tech biohazard gear and exercise every caution in maintaining sterile protocol.  That doesn’t provide a lot of comfort or confidence to ordinary civilians, who might encounter this virus on any surface that might have been touched by someone with the disease.

Which brings me back to New York…where airports at JFK, La Guardia, and Newark unload tens of thousands of international travelers every day, including untold numbers from Africa.  It’s only a matter of time before a case lands in NYC…and as I said before, gets on the subway, goes to a restaurant and a show, and when he gets sick, just figures he got a bad falafel from a street vendor.  There’s more to worry about in New York than pickpockets and muggers, although those are pretty scary even without the added threat of global pandemic.

But listen, it’s not all bad news.  We might all end up barricaded in our homes with the windows sealed with duct tape and the bottled water running low, but we’ll at least know that if we want to get a same sex marriage, we can do it.  With so many of our freedoms being eroded and outright reversed, this is a big win, at least for now.  This is one of the few instances where our government’s proclivity for doing nothing resulted in a benefit.  The Supreme Court declined to consider five state’s challenges to lower courts’ injunctions against the states unconstitutional bans on gay unions, and by doing so, essentially made gay marriage legal in those states…including Indiana!  The only part of this more fun than seeing the smiles on the faces of all these folks getting their licenses at the county court houses is the red-faced-about-to-rupture-an-aneurysm outrage of all the bible-thumpers who can’t quite believe they’ve once again been thwarted from legislating how the rest of us blasphemers are to live our lives.  Priceless.

The federal courts gave us one other glimmer of hope in an otherwise bleak tableau.  A US Chief District Judge in Missouri ruled that the police in Ferguson violated the constitutional protections in the First and Fourth Amendments when they arrested protesters for failing to keep moving rather than standing still.  I was wondering when some jurist would come to this inevitable conclusion, and it’s about damned time.  Just for your review, here’s the oft-quoted text of the First Amendment:  Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances. When they talk about the right of the people to peaceably assemble, it doesn’t say anything about having to be in motion.  So there’s that.

Like I said, good news and bad news.  “May you live in interesting times.”

BW

Last Ebola Article Of The Week: I Call Bullshit!

I know everyone is tired of this, and I promise I’ve got lighter fare in the future, but I just had to say one more thing:  Texas Health Presbyterian Hospital in Dallas claims that Eric Duncan was mistakenly released from their emergency department on September 26 because of a “flaw in the electronic medical record”.  Specifically, although the triage nurse inquired as to the patient’s travel history and noted that he had, in fact, just arrived from Liberia, and that information was promptly entered on the ubiquitous laptop carried by every medical professional everywhere in 2014, that part of the medical record did not automatically appear on the ER physician’s similar laptop when he actually examined the patient.  My response: 1-Utter complete undiluted total BULLSHIT.  2-This is everything that is wrong with medicine in America in 2014.

Here’s what should have happened: That triage nurse should have run, not walked, immediately to the nearest person in scrubs with an actual M.D. and screamed in his face, “Oh my fucking god!  We’ve got a feverish man in room 2 who just got back from Liberia two days ago!   Put on a mask and gloves and come with me right now!”  Flaw in the electronic medical record, my ass.

BW

Ebola: Get Ahead Of The Curve And Worry Now

It turns out that the Dallas patient had at least 18 contacts once he became symptomatic, four of them schoolchildren.  That’s more than worrisome enough, given that there could always be a nineteenth person who was overlooked, and knowing further that each of the eighteen known contacts might have had ten or twenty or thirty contacts of their own, and so on.  Beyond that, we have no way of knowing if some other traveler from West Africa has arrived somewhere besides Dallas, or will tomorrow or the day after, and then might start showing symptoms in a day or a week or three weeks, since the incubation period for Ebola is anywhere from 2 days to 21 days.  It’s not just in the US.  The same possible scenario applies to every country on the planet.  It’s not a matter of if Ebola will spread beyond Africa, it’s a matter of when.

All the reassuring infectious disease specialists employed by CNN and the major networks will be telling you just how difficult it is to contract Ebola…while you’re watching the health care workers in Africa and in our own ICU’s prancing around in biohazard suits that rival anything NASA puts on astronauts before they venture outside the International Space Station.  Nothing to see here…move along.  Here’s the facts as we know them now: Ebola is spread by contact with bodily fluids from a symptomatic patient, with bodily fluids being basically anything wet or moist that comes out of a human being.  Ebola is not transmissible before a patient is feverish, but once he is, those bodily fluids are as deadly as a bath in the retention pond at Chernobyl.  The fluids need to enter your bloodstream before you can be infected, and that’s why every inch of health care worker’s bodies are covered with waterproof materials…skin is not itself always intact, and Ebola can enter the body through tiny micro-lacerations and micro-abrasions.  As we’ve already seen in at least half a dozen cases, even the most stringent precautions aren’t 100% effective if one is exposed to Ebola patients enough times.  So yeah, Ebola isn’t easy to contract, but it’s not as tough as winning the lottery either.

But here’s a little sidebar you won’t see trumpeted by the national media: There are some scientists who worry out loud that Ebola could mutate and become transmissible by air…just a cough or a sneeze.  Every time this little RNA virus replicates within a new host, there are a few tiny mutations.  There is nothing to say that one of those won’t be THE mutation, and then we’re in Stephen King/The Stand/The Last Ship territory.

That’s all I’ve got.  Have a pleasant evening.

BW

Plenty Of Outrages, Not Enough Time

The clock just ran out on me today.  And I think I exhuasted my well of creativity with yesterday’s rant.  I’ll get back on the keyboard tomorrow, but for the time being, very briefly,  here’s a topic I’ve been meaning to address since I first saw the story on Monday:

Global Commission on Drug Policy (GCDP) Recommends Drug Decriminalization

This is not a bunch of stoner yahoos.  This is guys like Kofi Anan, Richard Branson, and ex-presidents of eight major nations, and they are not the first scientists and statesmen to come to the same rational conclusion.  And they’re not just talking about about legalizing marijuana, which ought to be a forgone conclusion by this time, but stopping the drug war on cocaine and heroin too.  Here’s just a part of what the commission’s report said:

“Overwhelming evidence points to not just the failure of the drug control regime to attain its stated goals but also the horrific unintended consequences of punitive and prohibitionist laws and policies. A new and improved global drug control regime is needed that better protects the health and safety of individuals and communities around the world,” the report says. “Harsh measures grounded in repressive ideologies must be replaced by more humane and effective policies shaped by scientific evidence, public health principles and human rights standards.”

What do you suppose the chances are for a rational, humane, scientifically sound drug policy here in the US?  About the same as that we’ll stop taking Iraq advice from Dick Cheney.

I promise more content tomorrow.

BW

Can We Talk?: Eulogies, Death Panels, And Root Canals

It’s hard to maintain a positive outlook when you’re staring down the barrel of a root canal, but I’m doing my best.  After posting just a short explanation of my temporary absence from cyberspace on Friday, readership plummeted, with just one page view so far today, so for all I know, I’m basically writing for my personal journal this morning.  Not encouraging, but the upside is that anyone who checks in gets to glimpse inside my diary…pretty exciting, no?

Scanning the national headlines, there’s not a hell of a lot to smile about on this Monday morning (and smiling would be a challenge anyway, what with the aching molar and all).  The various polls have been retabulated, and the mathematical conclusion is that the GOP stands a 61% chance of retaking the Senate.  If you had any hopes about health care, abortion rights, a decent minimum wage, equal pay for equal work, immigration reform beyond walls and troops, or a return to a marginally functional legislative branch, you might want to stock up on Xanax and lay in supplies for a long winter.  The only good news is that it still takes a two-thirds majority in the Senate to validate an impeachment…but that doesn’t mean that these ideological fools won’t still waste most of the next two years giving it their best effort, while at the same time giving us all a lesson in constitutional fatalism.

Not that Obama hasn’t done his part.  My old blogmate related to me in private emails that he’s come to the conclusion that Obama has been the worst president of the modern era, a conclusion I fear is shared by virtually all of the Right, and is sadly being conceded even by some of Obama’s staunchest supporters on the Left.  This Sunday found the president yet again apologizing for one of his supposed gaffes.  He says he misjudged the “optics” when he was seen golfing shortly after issuing his statement of shock and anger over the beheading of American journalist Steven Foley.  I honestly don’t know if it was such a big deal what he did after issuing that statement, but the manufacturers of hyperbolic outrage on the Right certainly did, and jumped on it with even more vehemence than the disgust displayed over the president’s sartorial choices of the week before (the tan suit incident).  What I do know is that acknowledging these ridiculous slights with apologies and explanations just adds fuel to the fire.

Which brings me to the topic of Joan Rivers.  Mrs. Left and I grew up with her from her earliest days breaking ground on the Johnny Carson show to her epic one-liners on Fashion Police.  We’re old enough that we can remember when she actually had her own face.  Too soon?  Nah.  And that’s the thing I loved most about Joan Rivers.  She made an explicit policy of never apologizing for the things she said.  She epitomized the sentiments contained on a  plaque I had on the shelf in my office for over 25 years: Fuck ‘Em If They Can’t Take A Joke.  Joan believed that no one was exempt and no topic was off limits.  Like Mel Brooks, she had no problem making jokes about Hitler or the Holocaust, and there was no politician or celebrity, up to and including the Queen of England, who was too important or sacrosanct to be immune from Joan’s barbs.

I’d heard Joan interviewed several times on the Howard Stern Show, and it’s no surprise that Stern was chosen to deliver the eulogy at her funeral yesterday.  In some way from beyond the grave, I think it was Joan’s way of delivering a final “fuck you very much” to anyone who just doesn’t get it.

But River’s death made me think of another issue.  At age 81, and with a known cardiac dysrhythmia, she underwent an EGD (esophagogastroduodenoscopy) at a prestigious outpatient clinic in NYC.  During the procedure she suffered some type of cardiopulmonary arrest (they’ve never really been clear on the details) and subsequently died.  It reminds me of my late mother-in-law, who underwent a similar procedure at a similar age, and had a biopsy which resulted in a GI bleed that ultimately led to her death.  I have no idea what symptoms from which Joan Rivers may have been suffering that led to the recommendation for that endoscopy, but I do know that in my mother-in-law’s case, it was a non-urgent and probably completely unnecessary procedure.  The point here is that not everyone needs everything, medically speaking.  Particularly in the geriatric population, we need to much more carefully weigh the risks of any given procedure against the possible benefits.  Those risks accelerate with every passing year, and the benefits commensurately decline.  As it turns out, Joan Rivers’ death very well might have been prevented by a “death panel”.  If someone had said, “Joan, I don’t think you really need this expensive procedure right now.  Let’s be conservative, see what happens, and re-evaluate in a few months” she might still be talking about Miley Cyrus’ latest fashion faux pas instead of watching the black dresses on the red carpet of her own funeral from the other side of the veil.

BW

 

 

It’s A Whole New Pissing Match

We used to teach our children that it wasn’t whether you won or lost, but how you played the game.  Little guys would hand Mean Joe Green a coke after a tough loss and the bruiser in pads would toss him a jersey, and we’d all feel a little better about the human race.  But it’s questionable whether any of us ever took the lesson seriously.  We might take junior out for ice cream cones after his soccer team left the field down 17-0, but somewhere along the way we might growl at him for failing to be within the same county as the ball at any time during the match (I’m remembering at least two of my sons who treated a soccer ball as if it possessed a force field stronger than a Federation starship) or note that soccer is not usually a walking sport, but involves a little running.

We preach that it’s all about doing the best you can and that giving a good effort is a form of winning in itself, but we also routinely quote Vince Lombardi, who noted that “if winning doesn’t matter, then why do they keep score?” and that “Winning isn’t everything, it’s the only thing”.  We embrace self-empowerment and self-esteem, while still knowing that “second place is just the first loser”.

Competitiveness is not necessarily a bad thing.  Arguably, it’s what won us WWII, racing to develop the atom bomb before the Nazi scientists built one of their own, and then employing those same Nazi scientists to hurry us to the moon in 1969 before a couple of cosmonauts could plant their own flag in the Sea of Tranquility.  But there is a toxic and dangerous side to competition as well.  Testosterone overload has caved in plenty of skulls in bar fights, and the precursor to those sometimes fatal encounters is the schoolyard brawl.  The constant refrain of “My god is bigger than your god” has filled a couple of billion graves over ten thousand years of human history.  We’re all addicted to biggest, fastest, and strongest, even if we don’t always pay much attention to smartest.

In the early years of the new century, we’ve taken our obsession with objective measures of personal and team superiority to new levels of digital perfection, accurate to the third decimal place.  Thirty years ago, when I was still running 10K’s and marathons, I’d train on the country roads just outside our neighborhood in Champaign, Illinois.  It was easy to know how far I’d gone, since each of those roads bordering corn fields was one mile corner to corner, and it was equally easy to know how fast I’d run, since I could use the stopwatch on my handy dandy Casio watch (with the blue light…I had to have the light) to find out how long each of those miles took to complete.  None of that is good enough in 2014.  Now the shelves at Dick’s and Finish Line and Foot Locker are filled with wrist mounted “activity trackers” that monitor heart rate, respiratory rate, steps taken, distance travelled, wakefulness, hours slept, calories consumed, and probably the frequency and quality of your bowel movements for all I know.  These gadgets use GPS to know to the foot how long your run or ride was and then interface with your tablet, desktop, or cell phone to record and graph your progress or lack thereof on a daily, weekly, or lifetime basis.  You can program some devices to give you an “attaboy!” for your best efforts and to chide you for times you are lagging.  I used to make these judgements based on how much sweat I had to wring out of my t-shirt before throwing it in the washing machine.  Those days are gone.

For every societal trend, there is a bell curve.  We wish we could predict the start of things, but we rarely catch on until a thing reaches the plateau portion of the curve, but there is often a fairly distinct marker of when a given curve is tailing off…when the trend or product or activity has finally “jumped the shark”.  I think I’ve discovered the shark jumping point of digital activity tracking.  Ladies and gentlemen, I give you…wait for it…the “SexFit”, a vibrating cock ring that tracks thrusts per minute and calories burned during sex, and downloads it to your Android phone, where you can graph your progress, plan future exercises, and presumably share your results on Facebook.

This sounds like a completely horrifying idea to me.  I don’t know about you, but I prefer to keep my various inadequacies in the subjective realm.  The SexFit comes right on the heels of the husband who posted a spreadsheet of his wife’s excuses for declining sex for a month, the wife who retaliated by documenting her husband’s explanations for deferring intimacy for the same thirty-day interval, and the Duke coed who in 2010 posted a list of all her sexual partners, including details of size, stamina, skill, and inventiveness.

At my house, we don’t even have a working bathroom scale, and we have no intention of getting one.  Here’s my advice: If you walk into some woman’s bedroom and she has a tape measure, a stopwatch, and a SexFit resting on the night stand…RUN!

BW

First, The Bad News

The shit hasn’t just hit the fan.  Now we’re shipping in the shit and posing downwind of the fan.

They’re flying those two missionary aid workers who contracted Ebola back to the USA.  Dr. Kent Brantley and Nancy Writebol will arrive in Atlanta (where the CDC is headquartered) on a specially equipped hospital plane and be transported to Emory University Medical Center, where they will be held in isolation and treated for their almost always fatal condition.  There are a couple of things right with this plan and a whole host of things wrong.  Bringing these courageous Americans back to home soil is a nice symbolic gesture, like the Navy SEAL credo of never leaving a soldier, dead or alive, behind on a foreign battlefield.  And the facilities at a tertiary care center like Emory are undoubtedly superior to anything available in Africa.  Those are the only upsides I can see.  The downside is that Brantley and Writebol could be treated at Emory or Mass General or Cedars Sinai or a secret research facility on the moon, and there is simply no therapy available here that isn’t available where they were in Africa.  There is no vaccine and no anti-viral and no magic bullet for Ebola.  Patients are simply given supportive care, mainly IV fluids, and then it’s a matter of chance and luck.  Most die no matter what you do, some survive against all odds.  Meanwhile, there’s the danger of someone else catching the disease.  Granted, every high-tech protective measure will be employed, from full-body barrier protection to respirators to negative-pressure isolation suites to decontamination showers, but no such protective measure is perfect.  All it takes is one torn glove or inadvertent swipe of a needle or careless handling of a bag of biological waste.  Brantley and Writebol, were, in fact, festidiously employing the very same protective measures when they contracted the disease in the first place.  Basically, if there is no one already infected with Ebola in the US, the chances of getting Ebola in the US are zero.  If there is someone in the US already infected with Ebola, the chances of someone else contracting it are greater than zero, even if only one in a million (better odds than winning the lottery, and everyone figures they might be the one to do that).

Then there’s the clusterfuck in Gaza.  The Israelis offered a 72 hour truce.  Two hours later, Israeli shelling claimed another at least 35 Palestinian lives and an Israeli officer was captured and hauled away.  Both sides, of course, claimed that the other had provoked the truce violation.  The Israelis claim their officer was “kidnapped” or “abducted”.  The Palestinians have not commented, but would undoubtedly maintain that the officer was captured as a POW.  No matter what, it looks as if this tragedy being played out before the eyes of the world is only going to get worse.  The only way for it to stop is for someone to step away and stop shooting.  I’d like to see Hamas do that, but it is extremely unlikely.  Can Israel be the bigger man?  Can they create the space for a dialogue, even as their Iron Dome repels the mostly harmless rockets emerging from Gaza?  Or will they continue to follow the biblical precept of an eye for an eye…or in this case a hundred eyes for an eye?  My guess is that the riptide in this river of blood is only going to accelerate to a maelstrom, dragging ever more souls to their death.  Scary times.

BW

 

 

Low Risk, High Anxiety

Ok, let’s begin with my whining: I thought yesterday’s post was one of my best…impassioned, compelling, articulate, poetic in places.  I might be blowing my own horn, but I can also tell you that there are plenty of other pieces of which I’m not nearly so proud (some of them just plain suck).  But good or bad, it hardly matters, since I had a grand total of 7 readers yesterday.  Mrs. Left keeps telling me I need to get off the blog page with my two million or so competitors and get myself into glossy print, which seems like a great idea.  If one of yesterday’s readers happens to be an editor at Vanity Fair, could you please drop me a note?  It’s nextact2013@outlook.com, and I check my email frequently.

In other matters of interest, I ran up the distress flag over the Ebola epidemic in yesterday’s blog, and I freely admit that I’m a pessimist, sometimes an alarmist, and a longtime devote’ of the post-apocalyptic genre in literature.  Hopefully, I’m not also a prophet, but little by little, the terror quotient on this particular end-of-the-world scenario is incrementally creeping from “Not my problem” to “Holy shit!”.  First, I noted the headline on the front page of today’s USA Today that announced that the risk of an Ebola outbreak in the US was “low”…not nonexistent or remote, but low.  Next, in this morning’s email, as a licensed American physician, I was privileged to receive this little love-note from the CDC (Centers for Disease Control and Prevention):

This is an official

CDC HEALTH ADVISORY

 

Distributed via the CDC Health Alert Network

July 28, 2014, 16:30 ET (4:30 PM ET)

CDCHAN-00363

Ebola Virus Disease Confirmed in a Traveler to Nigeria, Two U.S. Healthcare Workers in Liberia

 

 

Summary

 

Nigerian health authorities have confirmed a diagnosis of Ebola Virus Disease (EVD) in a patient who died on Friday in a hospital in Lagos, Nigeria, after traveling from Liberia on July 20, 2014. The report marks the first Ebola case in Nigeria linked to the current outbreak in the West African countries of Guinea, Sierra Leone, and Liberia. Health authorities also reported this weekend that two U.S. citizens working in a hospital in Monrovia, Liberia, have confirmed Ebola virus infection. These recent cases, together with the continued increase in the number of Ebola cases in West Africa, underscore the potential for travel-associated spread of the disease and the risks of EVD to healthcare workers. While the possibility of infected persons entering the U.S. remains low, the Centers for Disease Control and Prevention (CDC) advises that healthcare providers in the U.S. should consider EVD in the differential diagnosis of febrile illness, with compatible symptoms, in any person with recent (within 21 days) travel history in the affected countries and consider isolation of those patients meeting these criteria, pending diagnostic testing.

 

Background

 

CDC is working with the World Health Organization (WHO), the ministries of health of Guinea, Liberia, and Sierra Leone, and other international organizations in response to an outbreak of EVD in West Africa, which was first reported in late March 2014.  As of July 23, 2014, according to WHO, a total of 1,201 cases and 672 deaths (case fatality 55-60%) had been reported in Guinea, Liberia, and Sierra Leone.  This is the largest outbreak of EVD ever documented and the first recorded in West Africa.

 

EVD is characterized by sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting, and diarrhea.  Patients with severe forms of the disease may develop multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death.

 

In outbreak settings, Ebola virus is typically first spread to humans after contact with infected wildlife and is then spread person-to-person through direct contact with bodily fluids such as, but not limited to, blood, urine, sweat, semen, and breast milk. The incubation period is usually 8–10 days (rarely ranging from  2–21 days). Patients can transmit the virus while febrile and through later stages of disease, as well as postmortem, when persons contact the body during funeral preparations.

 

On July 25, the Nigerian Ministry of Health confirmed a diagnosis of EVD in a man who died in a hospital in the country’s capital of Lagos (population ~21 million).  The man had been in isolation in the hospital since arriving at the Lagos airport from Liberia, where he apparently contracted the infection.  Health authorities are investigating whether passengers or crew on the plane or other persons who had contact with the ill traveler are at risk for infection.

 

In addition, health authorities have reported that two U.S. healthcare workers at ELWA hospital in Monrovia, Liberia, have confirmed Ebola virus infection.  One of the healthcare workers, a physician who worked with Ebola patients in the hospital, is symptomatic and in isolation.  The other healthcare worker, a hygienist, developed fever but is showing no other signs of illness.  The physician is an employee of Samaritan’s Purse, a North Carolina-based aid organization that has provided extensive assistance in Liberia since the beginning of the current outbreak.   The other healthcare worker works with Soudan Interior Mission (SIM) in Liberia and was helping the joint SIM/Samaritan’s Purse team.

 

The recent cases in a traveler and in healthcare workers demonstrate the risk for spread of EVD in these populations. While no EVD cases have been reported in the United States, a human case, caused by a related virus, Marburg virus, occurred in Denver, Colorado in 2008. Successful implementation of standard precautions was sufficient to limit onward transmission. Other imported cases of viral hemorrhagic fever disease were also successfully managed through effective barrier methods, including a recent Lassa fever case in Minnesota.

 

Recommendations

EVD poses little risk to the U.S. general population at this time. However, U.S. healthcare workers are advised to be alert for signs and symptoms of EVD in patients with compatible illness who have a recent (within 21 days) travel history to countries where the outbreak is occurring, and should consider isolation of those patients meeting these criteria, pending diagnostic testing.

So the CDC is telling us that there’s nothing to worry about…but just in case, we ought to be ready to seal the doors and filter the air for anyone showing up with fever, chills, muscle aches and an African passport.  Move along, nothing to see here.

Then there’s the update on the missionary physician from IU Medical School who contracted Ebola while treating Ebola patients in Liberia.  He’s reportedly in grave condition.  Which tells you that neither US citizenship, nor a medical degree, nor an abiding love for Jesus is protective against a disease that routinely kills over half the individuals who contract it.

Trust me.  This story is still in the prologue.  We’re many chapters away from the conclusion.

BW

 

 

 

 

 

This Retired Doctor Has No Fun As A Retired Patient

Seven months ago I was still a medical provider.  I occasionally also became a medical consumer, but I still had some perks that eased the overall pain and frustration of participating in that demographic.  If I needed a CT scan or an X-ray, I could just ask one of my techs to take the images.  Of course, I still suffered the disadvantage of having to interpret my own studies, and I knew how my radiologist had spent his idle hours during medical school and residency.  Not particularly reassuring.  And if I needed a three-month supply of some esoteric medication, I just wrote a prescription, dropped it off at the hospital pharmacy, picked it up the next morning, and waited for the bill, which was theoretically at the discounted wholesale price of whatever drug it was.  At the same time, if I’d had a particular test or procedure, and wanted to know the result, I’d have my receptionist call the receptionist of the doctor I needed to speak with, and usually had that doctor on the phone within a very short time.

Those days are gone.  Now I’m just patient #5312-2014, like any other schlep off the street…and it’s something of a rude awakening.  When I need something like a CT scan now, I’ve run into a little obstacle called “prior authorization”.  When I was in practice, I didn’t take prior authorization nearly as seriously as I should have, but it’s something I regularly heard my front desk personnel bitching about as I strolled through on my way to the coffee machine.  It turns out that all the folks denigrating countries with universal health care because of the long waits for routine services haven’t learned yet that American insurance companies have figured out how to do exactly the same thing with the requirement for prior authorizations.  Having an acute symptom and feel like hell?  Need some imaging test to find out why?  No problem, just as soon as your insurance carrier says that you’re sick enough, we’ll fit you in…maybe in nine or ten days.  If you happen to die in the meantime, well, that’s just another cost saver for the insurer.

And no one is exactly sure who is supposed to talk to the insurance company to find out just what they will and won’t reimburse.  Being of a certain age (over 60), my doctor (otherwise known as my PCP) wanted me to have a shingles vaccine.  Fine by me.  But they hesitated to administer the injection because they weren’t certain it was covered my my handy dandy ACA (Obamacare) policy.  So I said, “Well, can’t you check on that?” and they told me, “No, you need to call and ask if you’re covered.”  So, I figured, what the heck, I’ve got nothing but time these days…and I used about an hour of it that I can never get back listening to heinous hold music on the MDWise “patient care” line.  Finally some nice young man, who surprisingly spoke clear unaccented English, answered, and after asking me half a dozen questions he should already have had the answers to in front of him on his computer screen, put me on hold for another five minutes, then shuffled through some actual papers, and pronounced, “Well, I’m pretty sure it’s covered like any other preventative measures.”  Fast forward to today at my PCP office, where I told them I’d checked and that the vaccine was, in fact, a covered service, then signed some releases, and spent another half an hour waiting for the nurse to get the stuff out of the refrigerator and stick it in my arm…only to have the receptionist come back and tell me that they had been through this before and my insurance company had always refused to pay in the past.  Which would have been nice to know in the first place.  I was given the option of paying for the vaccine out-of-pocket, which I was just about ready to do…until they told me it would be $273!

I could go on and on, but here’s the point: The system is clearly designed to defer and delay.  Insurance companies may eventually pay, but they make money by holding onto money, and the longer they hold it, the more money they make.  That was always going to be the inherent problem with Obamacare, that health care remained in the control of insurance companies, rather than being a government entity.  It’s profit motive trumping patient care.  And it’s me learning as I go along.

BW