Friday, October 24, 2014

More Insanity from CDC

Yesterday they posted guidelines that deal with providing high level support for a patient with Ebola. Such patients who have advanced disease develop renal shutdown and their blood vessels become very leaky. That is why this disease is known as viral hemorrhagic fever. When the kidneys no longer work, we start patients on dialysis but how do you safely do it while caring for a patient with Ebola. The answer is you don't.

The only facilities that could attempt something like this are BL4 isolation wards where the staff practice such techniques while wearing spacesuits. They have dedicated machines that are separated from the other hospital patients. There are only 4 such facilities in the country and the number of such beds is around 20; that is all there is, for the entire country.

The details of what took place in Houston are not known but now I wonder if they were crazy enough to try dialysis on Duncan, as he was near-dead.  Anyway, aside from the 4 BL4 labs in the country, any other place would be insane to try doing this in their own workplace. Rest assured, there are enough crazies within the medical community to give this a go.  The doctors insane enough to go jetting to West Africa so that they can see Ebola patients are not concerned with their own lives or those who are close to them. For proof, look at the recent antics by NBC news team doctor and most recently, Spencer.

Don't expect common sense out of anyone in the city, state, or federal administration.  They could have stopped the flights or at the very least instituted mandatory quarantine for all travelers from the Ebola hot zone. They didn't.

When Ebola takes root in the U.S.,  don't expect common sense from a doctor that sees you in the emergency room, hears your story about fever and diarrhea, and doesn't immediately leave the room. When one no longer needs to travel to West Africa to be exposed to this disease, making it far enough to be seen by a doctor while complaining of a fever and upset stomach, and not sitting in an isolation ward being tended to by people in space suits, means that you are in a place where other potential Ebola carriers are not being isolated. Even if you don't have this disease, you are now much more likely to have been exposed to it in that emergency room. That means, you're in the wrong place, stupid.

What we're all witnessing is a group of morons slowly driving a bus off the cliff, and the passengers mumbling softly to each other about how terrible this all is. Some of my friends tell me, you are a doctor and you must stand up and do something. "This is crazy, you must do something" they tell me.... OK, smarty. What should I do? Protest against city hall, protest against the federal government? How? Should I put on a Hazmat suit, write the government is lying to us, and show up to work dressed this way?  Someone did that, and he was laughed at.  No, I will not waste time arguing with a crowd that should really be locked up in an insane asylum.

The only thing anyone of us can do, when this spreads, is to isolate ourselves from the crazies. You still have some time to prepare for it, but it may be a very very small amount of time. Tic-toc.

And if anyone really wants to ask me what is our plan for dealing with this emergency, I will tell you. The plan is to hope that it all blows over. That is our emergency management protocol. It doesn't matter what the facts are, the talking heads will stick to that plan. This why you keep hearing, "This is very unlikely to happen here."


Thursday, October 23, 2014

Ebola in NYC (Updated)

I said to a colleague last Friday - I bet there is someone infected with Ebola walking around NYC right now. I was right. He agreed with me then.  Like I said about Duncan, I worry less about the discovered carrier, than about the undiscovered ones.  Spencer will not be the last person to carry Ebola into the U.S. There will be others and at this time there are probably over 20,000 people infected with Ebola in West Africa. Many of them cannot get to a medical facility and over 1/2 of them will die.  Those with the means, will try anything and everything to get medical help. While other countries are closing the roads leading to them, the U.S. doors remain open.

This is maddening and it is madness. This doctor Spencer should have known better and kept himself in isolation after arriving here. I bet he didn't.  The economic impact to Houston was likely over 1 billion dollars from Duncan's trip of a lifetime. The impact to NY and the rest of the country will likely be even greater. As soon as there is a dozen Duncans and Spencers walking around this city, riding on subways and buses, and checking themselves into the city's emergency rooms...this city will fall.  People won't go to shows, avoid large market places, and avoid public transportation.

I hope I am wrong about all of the above, but I fear that I am not.  I so wish that we still had Giuliani as our mayor.

Update:
A few minutes ago I posted my doubts about this doctor having the wisdom to self quarantine after arriving here from Guinea. I just read that the idiot bastard went bowling last night in Brooklyn. By tomorrow, that business will be closed.

Update #2

It just keeps getting better and better. He also rode the subway last night.  BTW, that business where he went bowling, known as The Gutter, is now closed. I wish them luck attracting customers in the next year. I think it may remain closed permanently. Economy to crash next week.

Tuesday, October 21, 2014

Appearances





I have been checking Ebola case counts on the CDC and WHO websites, daily over the past month. By mid September, Liberia was reporting close to 100 new cases per day and the outbreak was perfectly following a logarithmic graph. The rate of increase in new cases was expected to first increase and eventually as the number of potential new victims declines, that rate would also decrease.  Since October, the number of new cases coming out of Liberia has been reported with either an asterisk or a symbol for approximately, because those doing the counting realized that these numbers were unreliable.  The latest report from October 14th, Liberia doesn't even have a confirmed number next to the asterisk; there is just an asterisk in that slot, so it is anyone's guess.

We are sending our troops armed with a pair of gloves and a mask into an Ebola hot zone, directing them to sleep inside Liberian hotels and evacuated government buildings. No one knows the percentage of Liberians now infected but a fair guesstimate would likely be between 1/800 and 1/100, realistically this being closer to the 1/100.  Their mission goal remains elusive and when a general presiding over these troops was asked what will you do about infected American soldiers, he essentially said to the reporter that he would have to get back to us on that question.  He did acknowledge that he is not aware of any facility that has been designated accept infected soldiers. For a full transcript of the dizzying acrobatics  our general performed read this American Thinker post.

I don't think that Liberia is a functional country any longer, although people might argue that it wasn't functional for a very long time. I think that their ability to deliver healthcare is practically non-existent and when we send our troops there, they will be swamped by ailing natives. They will be expected to provide food and protection for these natives.  It is probably worth noting that the neighboring countries have a listed average IQ in the mid 60's with Equatorial Guinea being listed at 59 and Liberia not even listed on the chart.  



Welcome to Idiocracy headed by Prez Obola the 1st. Soon we'll all jokingly say to one another -  we're all Liberians now. Also don't forget that this joker is trying to pick a fight with Russia at this moment. Even though Russia is not on sound ground financially, I find it hard to believe that their administration is staffed by as many idiots as ours. England is. 

So, my advice to you as a doctor of medicine- get incoherently drunk and think happy thoughts.




Friday, October 3, 2014

More on Ebola

For some reason, the people who travel outside of the Ebola hot zone, that is Liberia, Sierra Leone, and Guinea, are complete assholes. Duncan who fled to the US, slept with his girlfriend here even though he was sick and knew what he probably had. When he was finally admitted to the hospital, his "family" here refused to remain under quarantine until the sheriff arrived and pointed a gun at these crazies. Also, consider the account of Patrick Sawyer, the man who went to Nigeria and led to the deaths of many people including the doctor who cared for him. This lunatic laid on the floor of the airport squirming in pain, and collapsed when he got into Nigeria. There he acted like a madman after being told that he may have Ebola, took off his pants and started urinating on the medical staff.  Meanwhile crazy Liberians tried to get him out of the hospital for God only knows what reasons. Furthermore, there is an account of some prominent Liberian doctor strolling into an Ebola treatment center without any protection and proclaiming that there is no such thing as Ebola. He died several days later of it.

Perhaps there is something about this virus that turns people into dangerous madmen, or perhaps we are just hearing about the dangers of Ebola stricken madmen because the normal victims of this illness die in peace and isolation. We will be hearing a lot about such cases in the coming weeks and months. 

On the home-front, we are totally unprepared for this illness. I am certain that at this point someone is walking about NYC with this virus and spreading it to others.  Duncan is not the only jerk in this country with this illness.  Doctors are scarred, especially ED docs because there is no proper screening and no place for isolation in the emergency rooms. In the first several days with symptoms, it is impossible to distinguish Ebola from any other virus causing gastroenteritis. If we do suspect someone as having Ebola, how do we isolate him from the rest of the hospital? Sure we have isolation rooms, but we have never dealt with such a deadly virus before. The bio-hazard suits are nice but they need to be put on somewhere safe and removed someplace safe. I don't know of any hospital in NYC that has a decontamination area set up in a ward. In most circumstances, people will put on protective clothing and remove them in a busy hallway, following which foot traffic will spread whatever was on the floor of the isolation room to the rest of the hospital ward floor. 

The center of our inadequate response is that many people are simply going through the motions of doing something that is needed to protect us. That happens at the level of ill trained hospital workers, and it happens at multiple levels of the administration. The talking heads from Washington, the CDC and other government agencies are speaking nonsense because for much of their lives all they ever had to do is pretend.  The truth is that they do not know what they are doing, and if you ask one to do something, they will only posture.  That is all they are capable of. The people they have surrounded themselves with are often times no better. That is why Obamacare was such a fiasco, our economy is failing, and even the secret service has become a joke.  And yet, we depend on these people for our lives and our livelihood. 

All in all, sad and frightening.

Ebola in America

In my last post I said, that people will run from the highly infected regions such as Liberia. The first such known runner is Thomas Eric Duncan.  He knew that he was at high risk for developing this disease as he just handled a person dying from Ebola and others where he lived died from it. Attempts to get a dying Ebola patient to a medical center proved futile in Liberia because all treatment centers are full, so he needed an escape plan. He got on a plane and went to his family in Texas, and several days later tried to get himself checked into a medical center, just as he was beginning to develop symptoms. When he was turned away, family came up with a plan to get him into that center, they called the CDC. It turned out that his fears were well founded as testing confirmed his infection with the Ebola virus. The man and his family must have known about his potentially deadly illness or else they wouldn't have made such an effort to bring him here and and get him into a hospital.

I am not surprised that a runner was found in the U.S.  I am not sure that it is appropriate to call him patient zero because he is likely to be one of many such zeroes we will soon hear about. That is what most concerns me. How many other such runners will emerge since we haven't done a thing to quarantine the infected population in West Africa.

I am also not sure why Americans and American companies are waiting for Obama to call for suspension of travel to and from these areas? Why does it all depend on Zero?

Sunday, September 28, 2014

Ebola Updates.

From a September 23rd publication of this article in NEJM, there are a number of graphs and tables that track current Ebola cases. The last observed data points are from end of August and projections for September are far below the numbers recently cited by CDC. The upper limits within the projected curves appear to be about 1/2 of the actual reported numbers. Therefore disease spread appears to be accelerating and while the last reported total case count is 6,263 with half of them dead, the number of cases by mid October will likely be much higher than the 14,000 predicted earlier. I think it will be closer to 30,000.  Medical delivery systems also seem to be breaking down in Liberia, Sierra Leone, and Guinea. These are the countries most affected by this epidemic. To make matters even scarier, today I read that Congo , I think the Democratic Republic of..., just reported an outbreak. While Liberia has about 4 million people with latest reported number just above 3,000 infections (that's one infected person per thousand), Congo has 77 million people.
So please consider what these projections mean for the above mentioned countries. While 1/1000 people are currently infected, the CDC expects the epidemic to reach one of 1/100 people by January and if nothing changes, one in 10 will be infected there in the Spring of 2015. One half of them will die.

People are going to run...

Run where?

Another important note to consider: If the disease spread really continues according to these predictions, then I don't think it is being spread by solely through the exposure to fluids of an infected person. If it really is that infectious, then airborne spread is likely and people hanging around the sick should be wearing their own air supply.  N95 masks may not be enough considering only a few viral particles are enough to transmit the infection.

On a final note, consider the panic that will hit NYC when a infected person with Ebola is diagnosed there and someone starts coughing on the subway. Consider what will happen if this epidemic reaches Mexico City.  this may prove to be a very volatile winter.

Saturday, September 27, 2014

Why it is wrong to call the Oklahoma murderer a lone wolf.

The vicious murder of a Christian woman was not an isolated incident or one perpetrated by an uncontrolled schizophrenic. Every day, Muslims attack the rest of us and those that actually commit these murders, are surrounded by cheerleaders in their community. How often do we hear about recent converts into this religion, that "suddenly" wage violent jihad? How often do we see evidence of agitation for such murders that take place in their mosques? Are their cheerleaders and spiritual guides really blameless?

One solution would be to demolish the mosque that he attended and deport his imam and everyone else that urged this jackass to commit this barbarity.  If there is no place to deport them, then I would send them to prison until they learn to behave themselves like descent people. On a concluding note, this really is a war against the American people, our society, and our choice of government. In a war, killing the enemy is the long established norm. Otherwise you are destined to lose the war.