Thursday, October 30, 2014

Prophetic

This was posted by Sultan Knish in July of 2012.






We have bits and pieces of that system in place already, but there are countries that have the whole awful shebang. World powers where patients die pleading for a drink of water and modern socialist utopias battling a disease whose name they dare not speak.

The article Daniel posted 2 years ago concerned itself with the dangers of Obamacare but, just like in every prophecy that has ever been analyzed, there are certain passages and elements that seem tailor made for our current time.



Tuesday, October 28, 2014

When Doctors Call In Sick.

When it comes to treating injured people after a plane crash, an earthquake, or a terrorist attack...the doctors and nurses will run to the hospital and help. I know this from experience because I was a first responder to the World Trade Center bombing.  It will be an entirely different response when those who come to work, must place their own and their loved ones lives at risk.


I also read a few moments ago that chief Obola plans to bring all the infected medics from Western Africa, here.  Don't be surprised when the hospitals here can't find anyone to work in them.

Obama has gone postal and he needs to be locked up in an insane asylum. Who will put a straight jacket on him and lock him up?

On a bright note, if Obola keeps this up, Jews and Muslims will soon find common ground. This, I also know from personal experience, because I am a Jew and I work with Muslim doctors.

Ebola, Then and Now.


This is what it means to go viral, and I don't have anything else to add to the above image. The image was taken from the Wikipedia page on Ebola outbreak in West Africa.

Some Descent Academic Work on Ebola

A recent entry at WRSA referenced several important articles that should be used to direct our clinical policies. One is a study that focused on rapid diagnosis of Ebola and it is available for review through NIH portal.

Rapid Diagnosis of Ebola Hemorrhagic Fever by Reverse Transcription-PCR in an Outbreak Setting and Assessment of Patient Viral Load as a Predictor of Outcome (2004)

This study was conducted on the previous largest Ebola outbreak and that virus was slightly different from the one now wreaking havoc on the world. Still, this study reveals some very useful information regarding the testing methods we currently use to determine if one is affected by Ebola or not. According to this study, PCR testing had a significant number of false negatives early in the course of the infection. In fact the tests may remain falsely negative, even several days after the onset of symptoms.   Another test to see if someone is positive is called the ELISA assay and it tests for antibodies to a particular virus, rather than the actual viral particles. It is a very sensitive test, but it takes time for your body to develop antibodies and therefore it will remain negative well into the symptomatic period of the illness.

All this means is that the nurse initially placed in isolation near the Newark airport has no business exiting isolation at this time. In fact, she should remain in isolation for at least 21 days and failure to do so should result in immediate suspension of her nursing privileges, her professional license, as well as continued enforced isolation.  Furthermore, when you read that the 5 year old boy is being kept for several additional days in isolation, despite initial testing showing a negative result, that means that whoever made this decision is likely aware of what literature states. It is not being overly cautious as the government talking head stated, rather it is being appropriately cautious. 

This patient developed severe diarrhea, similar in amount to cholera,  where up to 10 liters of fluid needed to be replaced per day. Following the onset of severe diarrhea, the patient developed multiple organ failures, needed ventilator support, his brain became encephalopathic, and he became septic with bacterial super-infections needing multiple courses of antibiotics.  Fortunate for him, he was in a biosafety level 4 (BL4) isolation area where the people who took care of him could perform all these risky procedures because they were sufficiently trained to do so. He survived, but discharge was delayed because various body fluids remained positive for over 1 month. This is a very important finding mentioned in this study and it it worth repeating:  different body fluids became negative as the person recovered from Ebola, at different times. After the viral particles were cleared from the patient's blood, sweat continued to show viral particles on day 40.

Elsewhere I've read that semen may remain positive for virions, for months. Therefore, when is it safe to release someone from Ebola quarantine? That depends on how irresponsible the individual is. If it is someone who plans on going clubbing, then keep that joker in isolation until his semen becomes clear of the virus, even if it takes 6 months.  That photo of Obama hugging one of the nurses -  this is the same nut largely responsible for the fact that this disease is starting to appear on this continent. Also keep in mind that the treatment given to one of the 1st evacuees from West Africa, is not available for us but is held in reserve for Obama and his staff.

At election time, just think: all this could have been avoided if our elected ones just kept appropriate travel restrictions and instituted appropriate quarantine measures.  In fact, there is a 2003 directive that provides for such quarantines, and Obama has not revoked this. If you read his amendment, it only concerns itself with the handling of SARS cases, and Ebola is still covered as a quarantine worthy disease under that 2003 directive.  For whatever reasons, they chose to ignore being reasonable.  You shouldn't.

Monday, October 27, 2014

Safe Zones

One can learn a lot from Wikipedia and this evening I decided to look up Liberian population in America. Surprise, surprise, Houston is listed as a city with a sizable population of Liberian-Americans and so it is no wonder that the first Liberian carrier of Ebola was discovered there. Another location in the US with a very large population of Liberians is Minnesota. I guess it would make sense to avoid Minneapolis, if things turn hairy in NYC. Most frightening number in that Wikipedia entry: 250,000 - 500,000 Liberians now live in the United States. If those with the means to run, flee Liberia, their relatives will be the first place they will turn to.

The following is a quote from Wikipedia: 

"The metropolitan areas with the largest Liberian immigrant populations are New York and Washington, D.C.; other cities with significant numbers of Liberians include AtlantaBostonChicagoDetroitHouston and Fort Worth (Texas)Hartford (Connecticut)Los Angelesand Oakland (California), MiamiMinneapolis and Philadelphia. So, as states such as Rhode Island and New Jersey.[6]"


Places not mentioned above should be safer. Please read the whole Wiki entry and familiarize yourself with it. It may save your life.

Politics and Medicine

I went away this weekend, and for a moment forgot about all of the latest craziness Americans and especially New Yorkers are being drowned in.  I was happy to read that New Jersey and New York announced a plan to quarantine those returning medics from West Africa. It would be far more effective to quarantine everyone coming here from the 3 countries most hard hit by Ebola, but that would be too logical and our government has a very short supply of common sense.  These logical steps were reversed as soon as chief Obola inserted his medical opinion.

The nurse who was inconvenienced at Newark airport found willing media outlets to carry the CDC message that quarantines and travel bans are not needed. There is a story in AP praising doc Spencer for running a marathon and traveling all over the world to see sick people.  I guess all of us should feel privileged to risk our lives because this Spencer is such a great guy and now we can all share in his dangerous adventures.

This afternoon, I read a NYCDOE notice.  "New York City is collaborating closely with its state and federal partners to protect New York children and families.  The risk of infection in New York is extremely small, and we hope this information will ease any concerns that you might have:
- All NYCDOE school nurses and medical providers in New York City have been prepared by the Health Department to look for signs of Ebola and take immediate steps to isolate those who may be infected..."

Wow, now I am really, really, reassured and at ease. The school nurses are being trained on how to recognize Ebola?  No one can tell the difference between Ebola and the Flu, or even the common gastroenteritis, in the beginning.  By the time you see the bleeding component of this illness, it is too late to do anything. However, I am not the school nurse. I am just a doctor who works at a city hospital. The only method we had to figure out who was at risk, was the travel history. After our hero-doc Spencer went bowling and rode the subway, that bit of useful information will soon become useless. I predict in about 1 month. Personally, I believe his medical license should be taken away for putting a whole city at risk and acting irresponsibly.  On the other hand, his behavior will probably be irrelevant because our borders are wide open and potential carriers are flying in daily.

My own hospital-wide updates sound schizophrenic and change almost daily about how to handle potential Ebola patients. Like I said in previous posts, the NYC hospitals are not equipped to treat such patients and they will not be anytime soon. We have no decontamination areas and no one I work with has any experience using these hazmat suits, that is if one can find such a suit.  I think my hospital has about 6 of them and very few people know where they are being kept.

Soon we shall see if the nurses and doctors at Bellevue are any luckier than the staff in Texas were. If they don't become infected, it will be through pure luck and little else. Some of the hospital staff who didn't feel so lucky apparently called in sick, in record numbers.  The ones who are being sent in to care for Spencer, have a very reasonable "Why me?" attitude. If Spencer lives, then he might be of use taking care of those sick and dying in this city due to a disease that he helped spread through NYC. If it spreads, and at this point it is really more of when than if, there will be a severe shortage of medical staff here.

Quarantine is the only effective weapon we have at this point, and the feds are not letting us use it.  It makes one wonder if politicians have always been this bad for our health. I don't think so because if we had such brilliant leaders 97 years ago, then the Spanish Flu would have taken 70% of humanity rather than a mere 1/3.

Just as it was before I left the city for the weekend, our only plan is to hope this pandemic blows over and to keep reassuring the public that all is well. I don't think anyone has even called it a pandemic yet even though it has already spread to 3 continents. It could have been only an epidemic, if we instituted proper quarantine measures, but we didn't because such measures were not appropriate politically.

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."