Immigration Reform.

The million immigrants a year are not entering booming industries, but serving as cheap labor in declining ones. And they’re doing it in a country where declining industries and poor workers are already being subsidized by taxpayers in a dozen different ways. Why then should taxpayers also be subsidizing the replacement of American workers with Somali and Honduran workers?
-Sultan Knish

Why have the patients treated for Ebola in the U.S. done so well?

The truth is, we don't know.  There is a scarcity of quality information on this outbreak because the governments in the 3 hardest hit countries don't want negative publicity. The reporters from developed Western countries have returned to their countries after some of them contracted the disease, and I have not heard of any news crews returning to West Africa.

Recently, there was a study published in NEJM by Schieffelin et al, which reported observations made at the Kenema hospital in Sierra Leone. There, they found 57 percent mortality among those younger than 21, and 94 percent mortality among those aged 45 and older. Overall fatality from Ebola was 74 percent. These are some pretty scary numbers and they simply do not compare with what has been reported in the case updates provided by WHO and the CDC. In the latest situation update from WHO, Sierra Leone reports a total of 6190 cases, with 5150 of them being confirmed and only 1267 fatalities. If you calculate the mortality from this report, you get only 20% using total cases or 24% if you only use confirmed cases number. The most likely explanation is that the numbers reported in WHO and CDC surveys are bogus.

Here in USA, everyone who received treatment early during the course of their illness, including the 2 nurses from Texas and the irresponsible doctor treated in NYC, survived. So how do you square the remarkable survival rates we've seen in the few people treated here at the US, with the survival rates reported in that study cited above? One possibility is that the people who were treated at the Kenema hospital were much sicker than the typical person who contracts this strain of Ebola. Perhaps those with only mild symptoms never show up at treatment centers in Sierra Leone and are able to weather this disease at home. Another possibility is that the folks treated in the U.S. were given medications unavailable in West Africa, such as Zmapp, early during the course of their disease, and such medications proved very effective. To repeat what I said in my opening sentence, we just don't know.

Some Hopeful News on Ebola

First I would like to state that this epidemic, in all likelihood, is still raging out of control in West Africa. The numbers being reported by WHO and CDC are likely nonsensical and the motivation for under-reporting is that the 3 hardest hit countries are under tremendous financial pressures. In many villages there are no signs of life and many people are struggling to find food. The fact that the number of dead in Liberia keeps going down, offers ample proof that this number is bogus.  Our best solution to keep our own country stable is to institute strict quarantine on travel from West Africa and do everything we can to prevent this disease from reaching our shores.

Furthermore, as this disease spreads beyond Liberia, Sierra Leone, and Guinea, the number of infected travelers to the U.S. will briskly increase once there is a significant outbreak in Nigeria and the Ivory Coast. The reason for my statement is partly anecdotal as, in my 8 years of working for a city hospital, I don't recall treating anyone from these 3 countries but I have had several patients from the Ivory Coast and numerous patients from Nigeria. The population of Ivory Coast is about 23 million and Nigerian Population is 174 million, while the combined population of Sierra Leone, Guinea, and Liberia was around 15 million.  Obviously we have many more commuters to the U.S. from these 2 larger populations.

I predicted that people would run from there, once the threat of Ebola became bad enough, and obviously some people like Duncan did run. Perhaps these countries are so destitute that most people simply don't have the means to travel outside their area and so far, the rapid transit of Ebola stricken people to the rest of the world hasn't been as severe as I feared. For the reasons stated above, I believe all this can change once these other countries, that border the 3 currently affected, become heavily infected.

By this point, you are probably wondering where is the hopeful aspect of my post. The hopeful aspect has to do with the ability to survive this infection inside the U.S. or other first world countries. While we haven't had tons of experience dealing with this virus here, thank God, we have had some. The early case named Duncan didn't make it, no matter what we threw at this illness, but several others have. What we can offer here that is unavailable in West Africa is appropriate management of kidney failure and appropriate fluid management. It appears that the early period of a severe Ebola illness is marked by profound diarrhea, to the tune of 6 litters per day and inability to drink enough fluid - probably due to vomiting. They can set up an IV in West Africa, but they are unlikely to get quick lab results back and manage the associated electrolyte disturbances as well as we can here. This has to do with having a good lab in your facility that can give you results within an hour or 2.  Another item they don't have as good an access to is dialysis, which seems to have played a role in stabilizing several Ebola patients who were treated successfully with 1st world medicine.  Duncan did receive dialysis, which was a very risky procedure for the staff, but he still died. However others lived, and consequently Ebola mortality here hasn't reached the 70-90% range seen elsewhere. As the illness progressed further and complications of bacterial sepsis occurred in the severely ill man treated in Germany, he had access to effective and powerful antibiotics and mechanical ventilation. These things are also not widely available in West Africa. Bottom line, he lived because of his access to such medical treatments whereas, if he had stayed in Africa, he would have died.

So in this hopeful part of my post, I have reason to believe that mortality from Ebola in the U.S. will not be as severe as it is in Africa. If I had to guess based on known survival patterns for sepsis and organ failure, I would guess it will be somewhere in the 25% range. Still, you should take such assessment with a grain of salt because it is impossible to do good statistics on so few cases as we have treated here, and often times theory based predictions turn out to be poor predictors of reality.

Another important point to make is that our ability to deliver such high level of care to someone infected with such a deadly pathogen is very limited. Outside the 20 or so BL4 beds available in this country, the other hospitals attempting to treat such patients will place themselves and their other patients in great risk. In terms of financial risk, the hospital that treated Duncan in Texas lost millions, even before they settled with Duncan's family. This was a 900 bed hospital and patients continue to avoid it like the plague, and therefore much of it remains empty. I would not be surprised if it goes belly up soon. Just imagine such financial impact hitting multiple hospitals throughout the U.S. The key to avoiding this devastating burden on our already severely stressed medical system here, is to send all such infected patients to the few operational BL4 beds we have. The best way to keep a manageable low census of such patients remains through effective quarantine.  I sure hope our politicians will take this threat seriously and not become fooled by the obviously false estimates coming out of West Africa.

Oh, The Places You Can Go...

UN encourages travel to 'vibrant and alive' Ebola-hit West Africa, as death toll tops 5,000.

UNITED NATIONS, United States (AFP) - The UN's Ebola czar on Wednesday encouraged tourists to visit West Africa, saying Liberia, Sierra Leone and Guinea were "vibrant and alive" and that contact with infected people was largely avoidable.

"I want to encourage everybody to maintain travel, tourism even to places that have Ebola. There is just no reason not to go to Freetown, Monrovia, Conakry," David Nabarro, the UN coordinator on Ebola, told the UN Economic and Social Council.

"These are cities which have got fabulous places for tourism. They are unfortunately not very full at the moment."

His push came as the death toll from the Ebola outbreak in West Africa's three hardest-hit countries, Guinea, Liberia and Sierra Leone, rose to 5,147 out of 14,068 cases as of Nov 9 end, according to the the World Health Organisation (WHO) on Wednesday.

H/T to the Anonymous commenter at Raconteur Report. 

Meet David Nabarro, who is the senior coordinator for UN's international response to Ebola, and must be the absolute worst travel guide, ever.

Back to Ebola News

I found this information from a comment on Raconteur Report.  Some imam arrived in Mali from Guinea and died at a clinic in Mali. There, he infected at least one person, whose infection is now lab confirmed, while other medical staff also appear to be ill and the number of infected will rise, if any honest reporting will occur. As a reminder of what we should expect, the man in a Nigerian hospital infected 20 staff and 8 of them eventually died. For unclear reasons, this second Mali case was never considered to have Ebola and so it is unknown what precautions the clinic staff took while treating him.  Obviously, he was contagious in that clinic and his body remained contagious while it was transported back to Guinea.  It is unlikely that appropriate precautions were taken during this transport. Also, it won't be surprising if others infected by this man will delude themselves and those around them about what they are infected with.

I am glad that Hajj is over for this year, and I am glad about the reported ban for West Africa that seemed to have been in effect for hopeful travelers to Saudi Arabia.  I just hope no one infected with Ebola reached that market of potential new infections, because it would accelerate the global spread and we need time.We need time to develop drugs and we need time to develop vaccines. We need at least a year and I am not so sure that we have it.

Despite a lack of reliable reporting about the spread of Ebola in West Africa, this disease remains a very serious global threat. Serious people should be working on how to contain it, but our leadership in DC is anything but serious.  In what should not surprise anyone whose brain function remains above moronic, our president has spent time at the Asian conference working on climate change agreements, further undermining our economy while chasing some opium pipe dream. In the picture this link leads to, the Chinese leader appears annoyed while Obola is flashing an idiot's smile.

Driving and Parking in NYC

I went shopping today near avenue J and Coney Island. It is a very busy area and I was fortunate to find a parking spot only one block away from my intended stores. After returning from one store and leaving several bags in the car, I started walking towards my other destination. As I walked 2 steps away from my car, a driver pulled up and with hopeful eyes asked me if I was leaving. I said no, and he replied "Why not?" I smiled and kept walking. A few more steps and another car slowed down near me and the driver screamed out - "Are you leaving?"...I again said no. He asked again either from deafness or, more likely, still hoping to hear the answer he wanted to hear. I again said no. This driver also followed up his queries with a "why?" and I really felt like answering - "out of spite", but just smiled and kept walking.

 New Yorkers are crazy and sometimes in a very funny way.

The new city-wide, 25 miles/h speed limit is now in effect but all the lights are still set up to accommodate a faster speed; previously it was 30 but everyone drives near 35 if they actually want to reach their destination within reason.  I saw a cop car flashing his lights while double parked and everyone slowed down to 25 or under. This meant that every street light turned red by the time I reached it and what used to take me 5 minutes to drive now took over 10.

I would like to see city officials and the police follow the laws they impose on the rest of us. If they don't, then someone should sue the city for discrimination and failure to uphold the equal protection under the law clause in our constitution.

Staying Alive in a World Dominated by Muslims.

"There are only so many second chances when someone wants to kill you. And if you are a non-Muslim in the Muslim world, then someone always wants to kill you." -Daniel Greenfield

Another reason to move out of NYC. 

Interesting Accounting of Ebola Cases on WHO Website

Last week, we saw a report of 13,700 cumulative cases of Ebola. This report included an adjustment from Liberia, which over the prior several updates failed to report their new cases and deaths. Surprisingly, the next follow up report saw a decrease in total number of cases from Liberia, but now included over 1,000 new cases from Sierra Leone. Friday went by with no further news, as did Monday, and then I noticed several hopeful accounts, claiming of this epidemic slowing down in Liberia.  The rationale for decrease in Liberian transmission seemed dubious as it referenced new facilities being built with international help, while such beds are yet to be filled and the number of health care staff in the worst off countries has actually decreased., Other amazing interventions mentioned include texting...
Seriously, the typical Liberian is sitting somewhere in the middle of a forest, reading health alerts through their smart phone. So I would be a fool to take such reporting seriously.

Today, a new account of cases was published on the WHO website, which again notes a decrease in total number of recorded cases; here both Liberia and Sierra Leone decreased their cumulative case numbers, and miraculously their number of dead also decreased.  I hope this doesn't mean that hundreds of undead are roaming West Africa.

So what does one make of these reports. It is possible that prior reports overestimated the number sick and dead, however this would also contradict prior WHO assertions that official numbers are under-reporting those affected by a factor of 2-3. There is a strong incentive to not report Ebola in the community, as this will adversely affect their ability to do commerce.  Bottom line.., we don't really know what is going on in West Africa and at what stage this Ebola epidemic is currently.  We do know that the situation is pretty chaotic, and that is good reason to remain very concerned.

Swinging at Windmills

I realize that my voting NYC is a quixotic endeavor. I still did it.

The voting place was largely empty, as compared to prior years.  You never know...

Could be this:

Or this:

I still feel better simply for doing it.

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. Nations 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.

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.

This is a worthy read from an ER doc in a Midwestern US city.

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. 

Another article worth discussing is a recent report, published at New England Journal of Medicine last week, that describes the successful treatment of a severely sick patient with Ebola in Europe.

A Case of Severe Ebola Virus Infection Complicated by Gram-Negative Septicemia

Benno Kreuels, M.D., Dominic Wichmann, M.D., Petra Emmerich, Ph.D., Jonas Schmidt-Chanasit, M.D., Geraldine de Heer, M.D., Stefan Kluge, M.D., Abdourahmane Sow, M.D., Thomas Renné, M.D., Ph.D., Stephan Günther, M.D., Ansgar W. Lohse, M.D., Marylyn M. Addo, M.D., Ph.D., and Stefan Schmiedel, M.D.

October 22, 2014DOI: 10.1056/NEJMoa1411677

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.

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 Atlanta, Boston, Chicago, Detroit, Houston and Fort Worth (Texas), Hartford (Connecticut), Los Angelesand Oakland (California), Miami, Minneapolis 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.

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."

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.

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.

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?

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.

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.

How We Lose Wars.

I was home watching TV today and on the History channel, shows about the Vietnam war played much of the day. The news stories of were uniformly opposed to American involvement. At one point they showed how crossing into Cambodia, allowed American forces to capture huge arms depots from the North Vietnamese. Essentially Cambodia was a safe zone where North Vietnamese would hide their forces and equipment. This move into Cambodia should have been hailed as a military victory, but instead it led to non-stop student protests and condemnation from MSM news sources. According to History channel, Americans were treated to a non-stop barrage of pictures of disfigured American soldiers; 90 percent of all news shows were devoted to this narrative every day.  When you think of Communist infiltrators affecting political decisions within our government, a much more successful infiltration affected our news culture and Hollywood.  No wonder we pulled out of Vietnam in defeat.

In recent conflicts, we went into Iraq and quickly succeeded in most of our military goals. At the time this war began, most of the American public were solidly behind this action and news stories were also largely supportive of our armed forces but, in time, this changed.  Obama achieved the destruction of all American achievements from the Bush era and under the current barrage of defeatist propaganda I don't see how we can defeat anyone.

We have a divisive leadership in the White House, MSM works towards same goal of weakening our country, and the culture permeating colleges and entertainment is also one of defeatism.  Under present conditions, we can only lose.  We must change our situation at home, if we are to survive as a nation and if we are to save our civilization.

Ebola Concerns.

Two good articles address this topic at today's American Thinker web site. It appears that there is a reasonable concern for possible airborne transmission of this virus and the medical staff working with the 2 returned American patients are appropriately dressed. This also explains London's actions regarding cancelling flights to parts of West Africa dealing with this epidemic.  Read for yourself here and here.

On the other hand, is the attention being given to Ebola another distraction? The border crisis in the US and a whole host of other problems caused by the Obama administration, aren't receiving as much news coverage now.  This administration certainly excels at taking us from one crisis to another.

Interesting Headlines at Breitbart Today.

OBAMA STRESSES OPENNESS, FAIRNESS AS TRIGGERS OF PROGRESS AT US-AFRICA SUMMIT

.

.

.

EBOLA TESTED ACROSS THE NATION; GOVERNMENT SUPPRESSES INFO

Oh, Oh, Part Two.

A Blaze post from today mentioned that 6 New Yorkers are being tested for Ebola and an Ohio woman. All of them apparently recently traveled here from a place where many are sick with Ebola, and all of them displayed some of the symptoms common to such an infection.  Unfortunately, these symptoms are not specific; they are fever, nausea, vomiting, and diarrhea. Just wait till the Flu season is here.  Same symptoms but, at this point, influenza is infinitely more common. Since we won't be able to isolate everyone with these symptoms, coming from West Africa, when so many will display them...we won't isolate them and someone sick with Ebola will arrive here and make others sick.  It is only a matter of time.

Oh, Oh.

A traveler from West Africa lands in NY and is hospitalized with high fever and diarrhea...Mount Sinai Hospital says "All is well"; we're testing him for ebola but we don't think he has it because he still lives.  Ahm... the 2 confirmed Ebola infected patients are still alive after being evacuated from Liberia. While it kills almost uniformly in poor African villages, one cannot say that it will remain as individually lethal in the USA. Instead of 90% lethality it may be only 50% or less. That is not necessarily a good thing as it may lead to greater number of infections and consequently more dead. Also the reassurance about Ebola only being spread by such fluids as blood and urine is misleading; I doubt the volunteers in Liberia that became infected were being peed on by the locals infected with Ebola and I also doubt they were sharing needles with them. I am certain that it is more easily transmitted than HIV, and what has kept this bug at bay was the fact that a small village would get infected and wiped out, and that was the end of a local outbreak. This particular strain doesn't kill as fast and hence greater spread.  If it establishes a local reservoir in the good old USA, then oh, oh.... and the we'll stop caring about Obama's criminal activities and those illegals might start moving back to South America. By then, it will be a pandemic.

Libya, Israel and the Obama Doctrine.

“The Citizens Commission on Benghazi, a self-selected group of former top military officers, CIA insiders and think-tankers, declared Tuesday in Washington that a seven-month review of the deadly 2012 terrorist attack has determined that it could have been prevented -- if the U.S. hadn't been helping to arm al-Qaeda militias throughout Libya a year earlier.

'The United States switched sides in the war on terror with what we did in Libya, knowingly facilitating the provision of weapons to known al-Qaeda militias and figures,' Clare Lopez, a member of the commission and a former CIA officer, told MailOnline.

She blamed the Obama administration for tacitly approving the diversion of half of a billion dollars of Qatari arms shipment to al-Qaeda-linked militants.” - quote recycled from American Thinker article by James Lewis.

This administration is helping the Muslim terrorists, has been since its first day in power, and will continue until their last day.  Today we have terrorists armed with enough nuclear fuel to make a dirty bomb and enough money to set it off in a city near you, or your city.  I am not sure why the media tries their best to cover this up; his mask has already come off and pretending that evil doesn't live next door will not spare anyone.  I agree with Lewis, that the above passage should be shouted far and wide.

Economic Sanctions and We're Number One...

Read a story today titled "Obama Declares Economic Sanctions on Russia", and thought to myself - Obama declared economic sanctions on Americans long ago.  When it comes to economic hardships orchestrated by this administration, "We're number one!". Of course, some have it worse than others - black Americans are more out of work than any other group. The young, who voted overwhelmingly for that jackass, are also more out of work than any other age group. Honestly  I don't know if it is better to be considered a friend or an enemy of this man. Perhaps it would have been best to not know him at all.

5 Trillion Civilian Deaths This Week Alone in Gaza.

If one is going to make up numbers, make them big.  I am so sick of the constant lies from "news" feeds.

Trying to make sense of the information about Ukraine

While I've lived most of my life in the US, and see myself 1st as an American, the crisis unfolding in Ukraine carries great emotional effect on me. I feel weighed down by it.  I have friends from Moscow, Kiev, and Odessa. If I looked for them, I would probably find distant relatives living in all 3 cities.

What's being written about this online is predominately propaganda, and it's hard to know who to believe. Kyivpost writes one version of events and RT.com writes a very different one. However, some things both mention and therefore such events are undisputed. There are large numbers of refugees fleeing to Russia from Slavyansk.  This tells me that there is danger and killing going on in Slavyansk. It also tells me that the people there are turning to Russia for safety and that means that the aggressor here is Kiev.

There are reports that 5,000 - 7,000 refugees, almost all of them women and children, have fled to Russia.  The men must be staying behind to fight. A recent report mentions plans by the Ukrainian army to place mines along its border with Russia. Why would they do such a dangerous thing. It's because they fear that the Russian army will enter the region, possibly to protect the civilians in Slavyansk.  Another news item that is undisputed is the shelling of Slavyansk by artillery and planes.  That likely means that attempts to enter the city by Ukrainian troops have been repelled. How many died in the process, on both sides, is unknown.

Who do we back in this fight, and should we back anyone here is a fair question.  For the time being, I would favor staying out of this fight. Unfortunately Obama and Kerry has already thrown our forces into supporting the new Kiev regime and that makes me very nervous. Elsewhere in the world they've backed the worst groups in the area; look at Egypt, Syria, Libya, and now they are working with the Taliban in Afghanistan.

Insanity and Evil are loose in this world.

The terrorist trade.

Why did Obama just release 5 top Taliban terrorists from our prison? Because we are now working with the Taliban.  Nothing more complicated.

A few words about Holder, Lerner, and other criminals including Obama.

"What a creature must sit on the throne, who lets a man like you deal out his justice."

Spoken by Dr. Peter Blood in an old movie -  Captain Blood.

Seizure of Foreign Nationals' Property..,Giving Away American Assets to the UN...

Will the real communist please stand up.  Even Carter wasn't this bad.

The world is upside down.
What is the endgame here? To destroy the US?

What is the worth of a non-aggression pact?

In recent memory, you can ask the Czechs, the Slovaks, and the Georgians. Most recently, ask the Ukrainians.  If you want to go back a little in history, ask the original inhabitants of Mecca, Medina, and just about any land on our planet. They are worthless pieces of paper.

The only solution to security of your own people, is to remain militarily strong. So strong, that no one will dare to mess with you.   This applies to American citizens who are now at the mercy of their own government too.  Once you become weakened, you can kiss your freedom goodbye.

Lastly, a word about Israel. With the most recent history lessons, they have to be nuts to depend on any agreement with their neighbors or the Arabs within their borders.

A few words about Ukraine, Russia, and the U.S.

"The world belonged to men with guns."  - Lucifer's Hammer by Larry Niven and Jerry Pournelle.

It has always been so, and will always remain so. Anyone telling you differently is lying to you, and perhaps, to themselves. Now ponder this, when you consider that politicians ask you to be unarmed and therefore defenseless.  In contrast, they will keep their weapons and rule over you.

What does the United States of America mean to you?

Why Ukraine Matters.

It is another global flash-point between a corrupt establishment and their miserable populace. Will it become another Egypt, where a popular movement was overtaken by the worst group on the scene? In every recent uprising that I can think of, the anti-state movement turned violent against the minority citizens.  I don't know enough details about the makeup of the opposition, but on you-tube I've seen videos of fascist nuts spouting antisemitic hatred - this is typical of the region and why my family left the USSR so many years ago.  My bet is that once the opposition movement obtains more power, more violence will come to the locals and both of the Jews left in Ukraine will become popular scapegoats.

On the other hand, my heart does go out to those miserable wretches railing against their corrupt politicians. I too am tired of being fleeced at every opportunity by thieves in government offices. After all, that was the reason for TEA rallies here, and I am proud to have participated in them.   

As our own economic prospects worsen, and it will get much worse here, similar protests will form. It will not be the Soros fueled useful idiots that called themselves OWS, and it will not be the polite TEA protesters.  We should all be prepared, because only those who are better organized will direct this parade.