I Hope I’m Not Coming Down With Ebola: Worried When I Find Myself Agreeing With Ann Coulter And Donald Trump

It’s been a hell of a week.  I’ve managed to piss off more people than I usually do in a year, and this from a guy who has a god-given talent for being irritating.  Mrs. Left does not refer to me as “Shrek” for no reason (although my ears are similar and I do have an unusual fondness for donkeys).  But perhaps being a pain in the ass has hidden benefits.  I was overjoyed when last Friday’s Celebrities Behaving Badly garnered 68 hits, but yesterday Kibbitz Corner almost broke triple digits with 98 page views…and I didn’t include a single full frontal Kim Kardashian Istagram nude shot, so maybe folks are actually reading me (I like using “folks” ever since Obama admitted out loud that “We’ve tortured some folks“…the whole homey vibe makes waterboarding a lot easier to swallow, don’t you think?)

Before I directly address the topics in the title, let me cover an island of good news in what is otherwise a sea of sorrow: It was revealed today that billionaire author J.K. Rowling did one of the kindest and most selfless things I’ve heard of in a long time.  Rowling sent a hand-written note in purple ink from Albus Dumbledore, a wand, an acceptance to Hogwarts, a list of school supplies and an autographed Harry Potter book to Cassidy Stay, the fifteen year-old girl who survived a home invasion gun attack in Texas that left her entire family dead last month.  In a public appearance in Houston on July 12, Cassidy quoted Dumbledore from his speech at the opening of “Harry Potter and the Prisoner of Azkaban”: Happiness can be found even in the darkest times, if one only remembers to turn on the light.  I, for one, found it refreshing to hear the victim of a recent tragedy drawing emotional and spiritual support from a more recent mythical character than the two millenia-old one usually invoked.  Dumbledore has a lot of wisdom to impart, and he doesn’t threaten an eternity of torment from Dementors if you fail to believe in him.

About Ebola: Let me preface my remarks today by noting that I’m not a virologist or a microbiologist.  When I was in med school, there was no course in epidemiology offered, and if they did have any electives in public health, I didn’t take them.  Global epidemics originating out of African jungles, transmitted from primates to fruit bats and on to humans weren’t even a blip on the horizon in 1975, although Michael Crichton’s 1969 “Andromeda Strain” may have been a prescient foretelling of woes to come.  No one had ever seen a case of AIDS, even if some may have gone undetected long before public awareness peaked in the 80’s.  We were so innocent back then that when I was doing a third year med school rotation in the ER at Evanston Hospital and a patient came in with some strange sores on his penis, we had to pull out our textbooks and call in the dermatologist…we’d never before personally witnessed a case of genital herpes.  In 2014 most sophomores at IU could make the diagnosis (sadly).

My point is that I’m no expert, I’m just an old doc with half a glass full of common sense…and I probably should be reassuring everyone about the skill of the CDC and the technological superiority of American medicine and the infinitesimally small statistical chance of any of us personally contracting Ebola.  All of those things are true, and you can probably Google a Youtube video of Sanjay Gupta telling you exactly those things on CNN.  Meanwhile, I also know that the CDC has raised its alert level for Ebola to “level 1 activation”, which, if it were Dubya’s old color code homeland security system, would be somewhere in the red area.

Two individuals I typically detest and revile have made some public statements for which they are receiving massive grief.  Ann Coulter, writing about the missionary medical inclinations of Kent Brantley, questioned why he felt compelled to work with Ebola patients in Africa when he could have done just as much good staying here in the USA:  “If he had provided health care for the uninsured editors, writers, videographers and pundits in Gotham and managed to open one set of eyes, he would have done more good than marinating himself in medieval diseases of the Third World.”  In a similar fashion, Trump tweeted last week:  “The U.S. cannot allow EBOLA infected people back. People that go to far away places to help out are great-but must suffer the consequences!”  Heartless?  Selfish?  Callous?  Perhaps, but as my good friend Marcey likes to say, “Stop me when I’m lyin’.”

Here’s the truth of the matter.  Kent Brantley and Nancy Writebol probably pose no risk to the general population.  They truly are in the most secure isolation wing of any hospital anywhere on the planet.  The isolation facilities at Emory University Hospital are specifically designed to house scientists who may have been exposed to smallpox or anthrax or Ebola or bugs being researched in the deepest bowels of the CDC that we’ve never heard of.  And both Brantley and Writebol have been treated with the only vials in the world of some magic bullet that might actually have some effect on the deadly virus.  It’s the people we haven’t heard of that should worry us.  The fellow stopped at the airport in NYC ultimately tested negative for Ebola.  But what about the next guy, the one who isn’t even feverish yet, the one whose plane lands in Baltimore or Bangor, and he goes on for the welcome home dinner in Little Rock?  Could that happen?  Yep.

BW

The Countdown To The Apocalypse Just Added A Couple Of Seconds

But the clock is still ticking.

First let’s consider the Ebola epidemic, and more specifically, the puzzling admittance of two Ebola patients to North America.  I wrote last week that I couldn’t conceive of any rational explanation for bringing Dr. Kent Brantley and nurse Nancy Writebol back to the US for treatment in a specially equipped tertiary care center.  I noted that if there are no Ebola infected individuals on American soil, there is zero chance of contracting Ebola in America, and that if there is even one Ebola patient here, the chance is something greater than zero, no matter how small.  That statement is still true.  I also pointed out that there is no treatment for Ebola available here that is not also available in Africa.  As it turns out, that contention is only partially true.  I also said that there is no “magic bullet” for curing Ebola.  That might turn out to be completely false.  It’s now been revealed that Dr. Kent Brantley was, in fact, treated with a new experimental drug, ZMapp (as we all know, the efficacy of any modern medication is directly proportional the number of Q’s, X’s, and Z’s in its name…see under XELJANZ).  Zmapp was developed by Mapp Biopharmaceuticals and is a mix of monoclonal antibodies from mice infected with the Ebola virus.  The frozen ZMapp serum was flown to Liberia and given to Brantley as his symptoms critically worsened.  After administration, he began to visibly improve within an hour, and as we all saw, he was strong enough to walk into the hospital in his isolation suit and attached oxygen tank.

Brantley’s response to treatment is encouraging, Mapp Biopharmaceutical’s development is laudable, and the CDC’s involvement is evidence of a government agency actually doing what it’s paid to do, but there are still a host of unanswered questions.  First, why the SECRET drug?  I can’t help but be reminded of one of many famous lines from “Dr. Strangelove”:

“Yes, but the whole point of the doomsday machine is lost if you keep it a secret! Why didn’t you tell the world?”
“It was to be announced at the Party Congress on Monday. As you know, the Premier loves surprises.”
        – Dr Strangelove & Russian Ambassador

Second, if the drug was administered in Africa, and it was working on Dr. Brantley, why was it necessary to return him or Writebol to the US?  And last, but not least, if we have something, anything, that seems to help, when is it going to be made available to those several thousand other patients in Africa?

Then we have the ongoing crisis in Gaza, which up until this point had all the elements of a bomb with a very long fuse, ending at a barrel of hydrogen warheads.  Maybe, just maybe, someone has stepped on the fuse before everything goes boom.  It was announced today that Israel has witdrawn most of its ground troops from Gaza.  That constitutes encouraging news.  The withdrawal comes close on the heels of Israel shelling a UN-run school in Gaza, resulting in another 17 deaths and over 90 injuries…one of the many atrocities in this conflict that seems almost inexplicably cruel and unnecessary.  That tells you that the fuel for this fire is hardly exhausted, and even it it returns to its perpetual low simmer, it’s only a matter of time before another spark results in flames blotting out the sun.

Finally, there was the vastly underreported and underappreciated crisis in Northwest Ohio.  500,000 Ohioans hadn’t had a shower or bath or washed their dishes or taken a sip of tap water since last Thursday.  An algae bloom in Lake Erie resulted in levels of toxicity in the water that would have resulted in sickness or death if the water was consumed…or even touched your body for more than a few seconds…unless it was washed off with water…of which there was none, except for the poisonous muck that touched you in the first place.  The crisis is past now.  Toledo’s mayor announced that the water is safe to drink and that tests show that the toxin level has dropped to acceptable levels.  You’ve got to wonder what acceptable levels of any particular toxin are.  Just how much arsenic or lead or strychnine or strontium 90 or plutonium or rat poison is ok?  One part in a billion is fine but one part in a million is a  bit over the line?  Good to know.  Feeling better already.  Drop a couple more cubes of ice in my tea, thank you very much.

Meanwhile, the situation in Toledo should act as some kind of warning for the rest of us.  In the first place, water may very well turn out to be the most precious commodity of the 21st century.  Two thirds of the earth’s surface is covered in water, but only 3% is fresh water, and of that, nearly two thirds is trapped in glaciers.  Most of us here take clean clear fresh drinking water for granted.  We bitch about it when we don’t have an extra thirty or forty gallons to extend that nice relaxing hot shower.  But look what happened in Toledo.  Our infrastructure is so much more fragile than we want to consider.  It takes very little to eliminate a water supply…a toxin, an infestation, or a breakdown in the water treatment facility is enough.  If worries over natural disasters and terrorist threats aren’t sufficiently attention-grabbing, there’s the small matter of drought, common to huge areas of the third world, but now equally frightening in California and Texas and parts of the Plains.  Toledo stepped back from the brink, but one has to wonder what the story might have become in another week, if the temperatures had soared, and tempers shortened, and the taps had remained dry.

Yep, the apocalypse clock had a few seconds added, but it hasn’t stopped ticking.

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

 

 

 

 

 

Sarah Palin Wants Obama Impeached! (Yawn…)

Yeah, I know, what else is new?  Palin says she’s mad as hell and isn’t going to take it anymore.  She’s buying into the bizarre Rick Perry conspiracy theory that says Obama is deliberately leaving our borders porous, presumably to allow more Kenyan socialist terrorist infiltrators to foist their obvious homosexual agenda on our innocent children.  Rick Perry isn’t just delusional.  He’s a petty disrespectful douchebag.  Obama is coming to Texas to have a face-to-face discussion with Perry about the crisis at Texas’ Rio Grande border.  Obama doesn’t have to do this.  He could talk to Perry on the phone, or he could tell the governor to kiss his skinny black ass, but the president is a mensch, and he’s heading to Austin to see what he can work out…and Perry has declined Obama’s invitation to meet him on the Tarmac for a ceremonial handshake.  That’s just small and impolite and rude and tasteless…and douchey.

The Republicans have wanted Obama impeached since the morning after his election victory in 2008.  All their denials to the contrary, I suspect that number one on their list of high crimes and misdemeanors is BPWB (being president while black), but their actual list is a long litany of commissions and omissions which are mostly of their own doing, including failure to improve the economy (which is much improved since nearly being destroyed by Bush), failure to achieve immigration reform (repeatedly blocked by the do-nothing Congress), instituting the Affordable Care Act (which has already improved the health access of millions of Americans), engineering the release of the last American POW (which would have resulted in a new face being carved on Mt. Rushmore had the president been anyone else), and failure to start new wars in Libya, Egypt, Syria, and the Ukraine (and there was also that Nobel Peace Prize thing, the fucking Swedes…).

You’d think they’d just be exhausted by now just from maintaining a solid facade of fake outrage for six years, if nothing else.  Give it a rest.  I know the Congress is a little bored and stricken with cabin fever after basically hibernating since 2008, and they need something to do, but after wasting three trillion bucks on Iraq and Afghanistan, it seems like they could find some more productive use of their time and tax dollars than impeachment hearings.  That being said, if the lunatics regain the Senate in November, you can pretty much count on a Congressionally sanctioned coup commencing before Thanksgiving.

If the GOP wants to, there are a couple of real problems they could add to the list, but like all their pseudo-issues, these have little or nothing to do with the president.  First was the small matter of half a dozen vials of smallpox showing up in some broom closet at the CDC.  Given that smallpox killed something like 300-500 million people during the twentieth century alone, and given that it was declared cured in 1980, and given that the only samples of it are supposed to be in vaults in level 4 biocontainment facilities at the CDC, the find of six test-tubes full in somebody’s shoebox is perhaps cause for concern.  Second is the business of several hundred Minuteman missiles with enough nuclear firepower to incinerate the whole planet several times over sitting under blast doors that no one has oiled since around 1957, run by computers that still have vacuum tubes, watched over by officers who are bored to the point of coma, and guarded by a helicopter force that was last upgraded during the evacuation of Saigon.  These are the maladies of any huge bureaucracy, not the stuff of impeachments, but hey, if Boehner and the boys want to pile a little more manure on the mountain of bullshit, I’m here to help.  Knock yourselves out.

BW