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And, Then, There Were Two . . .
You know that things are getting really serious when Barack Obama cancels a fundraiser for any reason — especially when he cancels two fundraisers and actually calls a cabinet meeting.
The fact that he did so today suggests that he is really worried about something of genuinely vital importance — that he thinks that the news that a second nurse working at the Texas Presbyterian Hospital in Dallas has tested positive for Ebola might have an impact on the midterm elections three weeks from now. In his judgment, no doubt, It makes things even worse that, on the day before she tested positive, after her temperature rose well above normal, the lady in question contacted the CDC, and those who answered her call sanctioned her flying home on a commercial jet from Cleveland.
It was all too predictable that our current President would think that an empty gesture — a promise to dispatch “SWAT teams” from the feckless CDC — would get him off the hook. Empty gestures are his forte, and they have nearly always served him well. My guess, however, is that, before this is over, the President will have to bow to the inevitable and do the obvious — which is to institute a ban on travel to the United States from the countries where Ebola is now widespread. Barack Obama is a bit like the little boy who cried wolf. Nobody with half a brain believes him any more.
Such a ban is, in my opinion, long past due. Nothing that I have read in the interim has caused me to have second thoughts concerning what I wrote on Monday:
There is only one way to prevent the spread of an epidemic, and that is quarantine. No medical professional with any sense would suggest that we should admit individuals from Liberia to the United States at this time, and no medical professional worth his or her salt would say that we can test for the disease when the prospective visitor arrives at Immigration and Passport Control. Like most diseases, Ebola has an incubation period. Early on, there are no symptoms: none at all. There is no reliable way to tell whether those arriving at our ports of entry have contracted the disease or not. If we do not want it coming here, for a time, we have to keep everyone out who has been in that neck of the woods.
One could, of course, argue that such a travel ban is unnecessary and that our medical system is more than adequate to deal with an outbreak here, as did more than one of those who commented on my original post. But I do not believe it for a second. Consider what appears to have happened at the Texas Presbyterian.
When Thomas Duncan first showed up, a nurse took down the appropriate information, entered it into the system, and either the system or the medical personnel dropped the ball and he was sent home. Then, when he came in a second time, desperately ill, the following reportedly took place:
A Liberian Ebola patient was left in an open area of a Dallas emergency room for hours, and the nurses treating him worked for days without proper protective gear and faced constantly changing protocols . . . . Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their necks and heads were exposed as they cared for a patient with explosive diarrhea and projectile vomiting, said Deborah Burger of National Nurses United.
It is no wonder that two nurses have come down with Ebola. It would, in fact, be surprising if there were not more. Concerning that, of course, time will tell. What is clear already, however, is that the folks at the Texas Presbyterian Hospital were not prepared to cope with even a single case.
It is conceivable that this particular hospital is a shambles and that, if Thomas Duncan had shown up on the doorstep of any other Dallas hospital, things would have been handled without a hitch. I doubt it, however.
Think about it this way. How many hospitals in this country are equipped to handle, say, twenty such cases? Or ten? Or five? What is required is an isolation unit large enough to accommodate those who have come down with the disease, a staff trained to cope with it, and the requisite equipment. Ten years ago, as I noted in an earlier post, Congress provided the Department of Health and Human Services with some something like five billion dollars to prepare for just such a eventuality, which is a nice piece of change. But, at least at Texas Presbyterian Hospital, the requisite equipment was unavailable, and no one was properly trained and prepared.
I know a little something about isolation units. I was once to consigned to one. Two summers ago, as some of you may remember, I was operated on at the National Institutes of Health for prostate cancer. In the aftermath, there were complications. I developed a lymphocele near my left kidney, and I returned to NIH where a series of futile attempts was made to drain the cavity and dry up the flow of liquid from my lymph nodes. While there, I came down with pneumonia, and there was reason to fear that I had contracted the superbug. Someone else who had checked in the day in which I returned really did turn out to have it. So, until they found out that I had a run-of-the-mill strain, they isolated me and treated me with exceedingly caustic antibiotics.
But here is the point. At NIH, which is as well equipped for emergencies of this sort as is any hospital in the world, there were not a lot of rooms designed for the requisite level of isolation. What, I ask myself, is it like at the ordinary American hospital? What would happen if we had a thousand cases of Ebola in this country?
One of those commenting on my original post who was critical of my position argued that the American medical establishment should be our first line of defense. I would prefer to give them a backup position. My bet is that, if they were faced with a real epidemic of this sort on any scale in this country, they would be overwhelmed. You can be fabulous at what you do and incompetent when faced with the unexpected on a scale unexpected. If you think that there is anything special about the Texas Presbyterian Hospital, I suspect that you are dreaming. After all, that outfit is not much worse than the CDC.
Published in General
All you did was add a comma.
[EDIT:two commas ]
http://ricochet.com/and-then-there-were-two/
So the argument here is that if something unexpected occurs, something might go wrong, as it did. Hence…
Hence what?
Again, this whole argument centers around the fact that nothing can ever bee 100% guaranteed when it comes to this matters, and if it ends up not being so, therefore, some people, start accusing those responsible of being “incompetent”, “irresponsible”, “liars” etc. As your original post did.
Of course, it’s the premise that somehow these things could have been prevented 100%, or should be expected to do so in 100% of the cases, that is flawed. Not achieving 100% safety isn’t the same thing as…incompetence or irresponsibility.
PS: No, the $5 billion thing you’re talking about had nothing to do with “this eventuality”. That was for vaccine stockpiles.
PPS: So again, the main criticism here seems to be that this hospital was not prepared for an “eventuality”that had close to a 0% chance of happening. Of course, if they had spend all that money preparing for things that have a 0% chance of happening, you’d complain that they were wasting money on useless projects.
PPPS: So again, no one is actually arguing on whether travel bans are a good idea or bad idea. Simply that perhaps, there’s other things to consider, and perhaps, better ways. In either case, it’s not a critical part of the multiple pieces you have written on this. The critical part is the argument that somehow…they did not achieve a 100% safety record on an event which had a close to 0% chance of happening. That’s not a…reasonable criticism.
How could Obama claim to be a Citizen of the World if he instituted a travel ban? If his malignant narcissism is not the driver in this matter, I’ll eat a sombrero smuggled over the southern border.
The crux of the matter is, once again, trust. Emory and the CDC are using protocols different than those they publish for use at ordinary hospitals like the one in Dallas. My wife is the infection prevention manager at a local small regional rural hospital, and her head is about to explode due to the lying and malfeasance of CDC and their abettors.
AIG, get a grip. The CDC and their political and professional administration colleagues are quite busy whizzing away our taxes and debt and don’t need another apologist or seer. Quarantine is the ONLY effective defense in the early stages of an epidemic or pandemic. It’s not about politics or logical perambulations. At some point, reality intrudes. When you have a victim with a 70% chance of death in a health facility a half mile from your home, with transmission methods still being debated at the highest levels, I’ll bet you get serious.
The election coming up will kill how many? To keep Harry in power? Christ save us. Close the borders! Reveal the truth of our situation! Enact policy to protect us instead of Obama’s friends. Our government is itself infected with lying bastards, a condition analogous to a fatal deadly viral infection.
I dare AIG or any of my Ricochet friends to argue or refute my statements. Triple dog dare.
Well Dr. Rahe, I for one am paying attention to you and there are plenty of others that agree with you.
http://www.inquisitr.com/1541821/ebola-is-airborne-university-of-minnesota-cidrap-researchers-claim/
Sorry, Paul! I meant to add thanks for addressing this powerful issue. Well spoken.
If we can just get ebola and Obama in a room together, let ebola baste in the glow of Obama ‘s superior intellect, empathy and coolness. Maybe have the President give a speech about how great ebola is, how it punches above it weight and how the United States is sorry about it past treatment of viruses like Ebola. Then maybe Obama and Ebola can reach a meeting of the minds an some reasonable accommodation can be made where billions of taxpayer dollars are given to Ebola and Obama’s cronies and the virus stops killing people, especially Americans. If we are really, really lucky Ebola will infect Obama and his staff, kill them off then maybe some f’ing adults can get in control that will take this problem seriously and realize that this PC BS has got to go and start handling like the serious situation it is becoming.
I just wish there were a decision: Either we spend the money for the training and equipment to handle a minor epidemic of Ebola, or we close the borders and restrict air travel. We can’t do both. And I fear it may already be too late to do the latter.
I don’t think you get it. BECAUSE the system will inevitably be flawed it is negligent – negligent – to introduce Ebola into the US of A. The justification for doing it was exactly what you are so sarcastic about – that the system would deal with it perfectly.
I also had the feeling that the rubber had really hit the road for the president to actually cancel a fundraising trip, and for two fundraisers! Obviously the exposure of the American public to a wholly avoidable disease did not even more the needle. What must have happened was that a poll showed this was affecting Obama’s standing. Some impact on the Democratic Party might catch the president’s attention, but I doubt it.
As I have written elsewhere, quarantine of the pandemic countries is the first and necessary step–Public Health 101. Quarantine should not be controversial, and would not be under any previous president. You simply do not facilitate the importation of a readily transmissible infectious disease with a 50-90% acute mortality rate. You first isolate the virus and then work within the affected countries to treat the afflicted and arrest local spread.
Arguments to the contrary from the president and the CDC director are completely nonsensical.
I’m all for calling out the CDC and those who are supposed to be in charge of handling our readiness and response to ebola. But I have a hard time getting past this idiotic f***ing NURSE, you know, someone with MEDICAL TRAINING, for not quarantining herself. This stupid, selfish moron KNEW she had been exposed to ebola, KNEW her hospital had failed to diagnose the disease originally and needlessly exposed others to this disease, and KNEW she was starting to exhibit symptoms consistent with ebola. At that point doesn’t just a modicum of common sense tell you that you should get to hospital, tell them that you need to be quarantined and immediately get yourself tested for ebola???????? DON’T YOU????
No, I guess you don’t. I guess you call the CDC and let them diagnose you OVER THE PHONE!!!! Sweet Jesus, it’s not that our first responders aren’t prepared or are overwhelmed, it’s that far too many of them are f****ing IDIOTS! This problem is deeper than our bureaucracy being inadequate and our government leadership being shortsighted and feckless. The quality of our nurses and average hospital workers is abysmal. Our health professionals are not driven by concern for their patients or concern for the common good. They are worried about the amount of hours they work, getting seniority for better shifts, when their next break is, avoiding lawsuits, and far too many other things well before “do no harm.”
This problem is not simply a failure of Obama or the CDC. This problem simply exposes the systemic dysfunction of our entire health care system.
She’s just an ordinary nurse WHO DID EXACTLY AS SHE WAS INSTRUCTED CALLED THE EXPERTS THAT SO MANY HERE AND AROUND THE NATION KOWTOW TO, WHO THEN SCREWED THE POOCH.
Relax, a few more of these incidents and you wont have to worry about the quality of the doctors and nurses taking care of Ebola patients or anyone else, they will all be much happier doing just about anything else to make a living. Besides risking death and bringing the Plague to your family, you can look forward to being on perpetual quarantine.
Apparently the new standard is US healthcare worker who cared for an Ebola patient? LOCKDOWN. No fly, no public transportation.
West African from an epidemic plagued area? WELCOME ABOARD ENJOY YOUR VISIT TO THE US.
I notice the second nurse has been transported to the special isolation unit at Emory. Congratulations CDC you just instituted a new Standard of Care for Ebola in the US. Too bad we have only 4 hospitals and about 20 beds in the entire United States with that capacity. Better hope we don’t get a rush of infected Liberians or Guineans because it’s going to get tight. I’m sure Jesse and Al won’t settle for anything less then the best for our “guests”.
Lets recap here.
1 infected Liberian travels to US.
2 infected nurses (so far)
70 health care workers on quarantine.
About 300 people total on quarantine
500,000 in uncompensated health care ( so far)
ER of Hospital shut down.
Unknown Hundreds of people from 4 airline flights being monitored.
Airline stocks pummeled
Millions in lost economic activity.
Oh yeah, we got this. No problem.
“So who’s handling the Ebola issue in the US?”
“We have top men working on it right now”.
“Who?”
“TOP… MEN”.
> Dr. Rahe: One of those commenting on my original post who was critical of my position argued that the American medical establishment should be our first line of defense. I would prefer to give them a backup position.
—
This reminds me of my opposition to the criminal justice system having anything to do with non-citizen terrorists. By absorbing responsiblity from the military tribunal system, or civil/criminal courts must also absorb protocols and authorities.
Now who could possibly want that? Well perhaps the same sort of people who would rather have a large crisis instead of a small one, in order to have large opportunities rather than small ones.
There is a good deal of competence and diligence, mixed with incompetence and apathy, mixed with flat-out malice. I do not wish to paint with a broad brush. But just as in counterinsurgency, an assumption that most in a population are decent does not relieve you of the duty to defend against the presence of the indecent.
We have very bad people in our government, in part no doubt because that is the only place where bad actors can be truly effective. They would naturally gravitate there. Perhaps some of them are involved in policy regarding our quarantines. Our borders. Our wars.
Just because we are prepared to deal with a finite number of high-intensity outbreak cases, this does not mean that our vanilla medical system should be the front line in that fight. Our medical system should be shielded from that fight, a defense in depth.
John Wilson, this might sound odd coming from me, but if you wish to shout at the CDC, they have a website. While I do enjoy a good knock-down. drag-out, one of the things I appreciate about Ricochet is the absence of folks hollering in a barn. There are barns for that. Facebook seems to be one of them.
Just sayin’
No dawg, you a’ight.
Memos were written, meetings were held, studies were conducted, conclusions were reached. Five billion dollars only buys so much. This is government we are talking about.
To fight Ebola in Africa, their must be completely unrestricted air travel. If leisure travelers can’t go, then that means doctors and nurse can’t go either. It’s not like the government has any control of which planes are allowed to fly, or which passengers are allowed to fly. Do you suppose there’s someone checking every person before he gets on a plane, like some kind of crazy airplane bouncer? Do you think there’s some kind of wizard in a tower tracking where all the planes are going? It just isn’t possible to selectively allow some people or some planes to fly to Africa and stop the rest. Yes, that series of words I just typed makes complete sense.
Motion to recommend that the ratio of Paul Rahe posts per US ebola cases falls to 1:10, instead of the current 1:1. Do I have a second?
I was a member of a regional EMS system after 9/11. One of the things that came about was a big chunk of change for bioterrorism surveillance and response. What ended up happening was the money was used to improve the regional Trauma system. Which had virtually NOTHING to do with bioterrorism. We needed some system put in place that could track unusual patterns of illness presenting to doctors offices, clinics and ER’s, and respond quickly 24/7 to any outbreaks. It would have been very unsexy. But the money was there and a pseudo government agency was there to sop up all the cash….
Okay if this “Clipboard Guy” (and there’s NOTHING we clinicians loathe more then the clipboard people, except for personal injury lawyers) is CDC we are doomed.
http://www.dailymail.co.uk/news/article-2794854/what-thinking-mystery-man-without-hazmat-suit-seen-helping-2nd-ebola-nurse-board-plane-atlanta-joining-them.html
Pay special attention to where he handles the INFECTIOUS WASTE BAG OF A CONFIRMED EBOLA PATIENT without PPE, and I am guessing without gloves. Any hospital janitor knows better….
I should have checked the Members’ Feed.
It strikes me that the justice of the charge of incompetence is obvious. Just look at the details.
As for the question of whether Ebola would reach the US, I think that the likelihood was closer to 100% than to 0%. It is highly contagious, and it has reached a whole slew of countries in Europe. If one wants to minimize transmission in this country, one must do everything one can to prevent those who have it from coming here — and that can only be done through a travel ban.
Here is a little something to warm the cockles of your hearts:
To be fair to Frieden, I should perhaps add that he was in this instance doing “damage control” for Barack Obama, who had himself said that no one should worry about sitting on a bus next to someone with Ebola. Dr. Frieden is a man who knows where his bread is buttered.
It’s not that the folks from West Africa shouldn’t be coming here. It is that the folks in West Africa shouldn’t be going anywhere until this thing dies out.
To quote Niven and Pournelle: “Just think of it as evolution in action.”
Seawriter
This ebola incident clearly shows that the CDC is not the medical equivalent of the Navy SEAL’s, that TV and Movies potray them. Is there a CDC response team on the ground in Texas?
If Texas is lucky there is not.
I am beginning to believe Texas would be better off relying on the the “hot disease” center at UTMB in Galveston than on the CDC.
Seawriter