Michael Kennedy

Treatment of the Ebola contact.

by

The early information of the Ebola patients in Dallas seems to suggest that competence has not been high on the list of priorities. First, the patent seems to have known about his illness before he got on the plane to the US. He lied to the authorities in Liberia but that is not that unusual. All it takes is ibuprofen to evade the screening at the airport.

Second the treatment of the relatives Has finally become humane after days of cruel treatment including quarantine in a contaminated apartment.

The initial treatment was not a model of infectious disease protocol. Why he was sent home with a GI illness and a history of travel to Liberia is still not explained. My medical students are all told to take a history of travel with any GI illness symptom. It’s not clear who he saw but many ERs use Nurse practitioners or PAs to see ER patients.

He is not doing well and he seems to be declining. We will see how he does but his relatives are still in serious trouble. We are still in trouble.

The promised treatment program is still inadequate. Tomorrow will bring more bad news.

A CDC official said the agency realized that many hospitals remain confused and unsure about how they are supposed to react when a suspected patient shows up. The agency sent additional guidance to health-care facilities around the country this week, just as it has numerous times in recent months, on everything from training personnel to spot the symptoms of Ebola to using protective gear.

This is only the first case.

UPDATE: More news from Bookworm.

Ebola can transmit through people’s skin. It’s not enough to keep your hands away from your nose and mouth. If someone’s infected blood, vomit, fecal matter, semen, spit, or sweat just touches you, you can become infected. Even picking up a stained sheet can pass the infection. Additionally, scientists do not know how long the virus will survive on a surface once it’s become dehydrated. The current guess is that Ebola, unlike other viruses, can survive for quite a while away from its original host.

Oh oh. This explains the infection of hospital workers in Nigeria from urine.

The good news, if any, is this:

If patients get Western medicine that treats the symptoms — drugs to reduce fever and to control vomiting and diarrhea, proper treatment if the body goes into shock, and blood transfusions — the mortality rate is “only” 25% — which is still high, but is significantly lower than the 70%-90% morality in Africa, where patients get little to no treatment.

I will update this as news becomes available.

UPDATE #2

Now we have a possible case #2

A patient with Ebola-like symptoms is being treated at Howard University Hospital in Washington, D.C., a hospital spokesperson confirmed late Friday morning.

The patient had traveled to Nigeria recently.

That person has been admitted to the hospital in stable condition, and is being isolated. The medical team is working with the CDC and other authorities to monitor the patient’s condition.

“In an abundance of caution, we have activated the appropriate infection control protocols, including isolating the patient,” said hospital spokesperson Kerry-Ann Hamilton in a statement. “Our medical team continues to evaluate and monitor progress in close collaboration with the CDC and the Department of Health.”

No final word yet. Then, of course, we have the NBC case.

Thursday, news broke that a freelance NBC cameraman covering the outbreak in Monrovia, Liberia had tested positive for Ebola after experiencing symptoms of the disease.

The cameraman, Ashoka Mukpo, had been working with chief medical correspondent Dr. Nancy Snyderman. NBC News is flying Mukpo and the entire team back to the U.S. so Mukpo can be treated and the team can be quarantined for 21 days.

The Kurds and the Israelis are our only allies in the middle east.

by

The growth of the terrorist state ISIS has taken all the attention lately. This is just a resurgence of al Qeada in the vacuum left by Obama’s withdrawal of all US troops. Maybe, if we had kept a significant force in Iraq, something could be saved of all we bought at such terrible cost. Now, it is too late.

We do have allies worth helping but they are not in the Iraqi government. It is Shia dominated and dependent on Iran for support. They have alienated the Sunnis and the growth of ISIS is the result. We still have the Kurds as allies and they know we were their only hope in 1993. Jay Garner did a great job working with them once we decided to protect them after the First Gulf War. I have never understood why he was dismissed by George W Bush.

The Kurds have been an embarrassment for us for decades in the middle east because they occupy parts of three nations, two of which were at one time our allies.

contemporarykurdistanmap2005

Kurdistan includes parts of Iraq, Turkey and Iran. They have never had a modern nation and the neighbors are enemies. Only the mountains have protected them. Now, it is time we did something. Iran is certainly no friend. Iraq has dissolved and it is time to allow it to be broken up into the Sunni, Shia and Kurdish provinces it should be. Turkey is increasingly Islamist and has not been an ally at least since 2003 when they blocked our 4th Infantry Division from invading Iraq from the north.

The 4th was initially ordered to deploy in January 2003 before the war began, but did not arrive in Kuwait until late March. The delay was caused by the inability of the United States and Turkey to reach an agreement over using Turkish military bases to gain access to northern Iraq, where the division was originally planned to be located. Units from the division began crossing into Iraq on April 12, 2003.

The Kurds know this is their opportunity and Dexter Filkins’ piece in the New Yorker makes this clear.

The incursion of ISIS presents the Kurds with both opportunity and risk. In June, the ISIS army swept out of the Syrian desert and into Mosul, Iraq’s second-largest city. As the Islamist forces took control, Iraqi Army soldiers fled, setting off a military collapse through the region. The Kurds, taking advantage of the chaos, seized huge tracts of territory that had been claimed by both Kurdistan and the government in Baghdad. With the newly acquired land, the political climate for independence seemed promising. The region was also finding new economic strength; vast reserves of oil have been discovered there in the past decade. In July, President Barzani asked the Kurdish parliament to begin preparations for a vote on self-rule. “The time has come to decide our fate, and we should not wait for other people to decide it for us,” Barzani said.

The Kurds were surprised and routed by ISIS mostly due to limited weapons and ammunition. We could supply the deficit but Obama seems to be oblivious to the true situation. The Iraqi Army will not fight, a characteristic of all Arab armies. To the degree that the Iraqi army is Shia led, the Sunni Arabs will not cooperate or will join the enemy.

The present situation in Kurdistan is desperate.

Erbil has changed a lot since I was there last. In early 2013, on my way into Syrian Kurdistan, I had stopped off in the city for a few days to make preparations. Then, the city had the feel of a boom town shopping malls springing up across the skyline, brand new SUVs on the road, Exxon Mobil and Total were coming to town. It was the safest part of Iraq, an official of the Kurdish Regional Government had told me proudly over dinner in a garden restaurant.

A new kind of Middle East city.

What a difference a year makes. Now, Erbil is a city under siege. The closest lines of the Islamic State (IS) forces are 45 kilometers away. At the distant frontlines, IS (formerly ISIS) is dug in, its vehicles visible, waiting and glowering in the desert heat. The Kurdish Peshmerga forces are a few hundred meters away in positions hastily cut out of the sand to face the advancing jihadi fighters.

The problem and a solution are both clear. Obama is not serious about doing anything in Iraq or Syria and the Kurds may have to fend for themselves. Interesting enough, there are Jewish Kurds. Israel may have more at stake here than we do.

The phrase “Kurds have no friends but the mountains” was coined by Mullah Mustafa Barzani, the great and undisputed leader of the Kurdish people who fought all his life for Kurdish independence, and who was the first leader of the Kurdish autonomous region. His son, Massoud Barzani, is the current president of Iraqi Kurdistan. Other family members hold key positions in the government.

Barzani1Barzani

Perhaps the Israelis and Kurds can work out an alliance. The US, under Obama, is untrustworthy. We will see what happens.

The Yazidi minority we hear about in the news is not the only Kurdish minority. The Jews of Kurdistan, for example, maintained the traditions of ancient Judaism from the days of the Babylonian exile and the First Temple: they carried on the tradition of teaching the Oral Torah, and Aramaic remained the principal tongue of some in the Jewish Kurdish community since the Talmudic period. They preserved the legacy of the last prophets — whose grave markers constituted a significant part of community life — including the tomb of the prophet Jonah in Mosul, the prophet Nahum in Elkosh and the prophet Daniel in Kirkuk. When the vast majority of Kurdish Jews immigrated to Israel and adopted Hebrew as their first language, Aramaic ceased to exist as a living, spoken language. Although our grandparents’ generation still speaks it, along with a few Christian communities in Kurdistan, Aramaic has been declared a dead language by the academic world.

Israel might be an answer to the Kurds’ dilemma. I don’t think we are, except for supplying materials which we should have been doing all along.

Is Ebola airborne ?

by

Ebola has become an uncontrolled epidemic in Africa. I have previously posted on Ebola.

UPDATE: A new CDC report has now been provided on precautions. Somebody is worried. The document, itself, is here (pdf)

Now, we are going to send 3,000 military personnel to Africa to help. I sure hope none of these US people are infected. They did not volunteer for this and the training to protect themselves will take time.

Now the German epidemiology community has concluded that Liberia and Sierra Leone are lost.

Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine in Hamburg told DW that he is losing hope, that Sierra Leone and Liberia will receive the neccessary aid in time. Those are two of the countries worst hit by the recent Ebola epidemic.

“The right time to get this epidemic under control in these countries has been missed,” he said. That time was May and June. “Now it will be much more difficult.”
Schmidt-Chanasit expects the virus will “become endemic” in this part of the world, if no massive assistence arrives.

With other words: It could more or less infect everybody and many people could die.

This, of course, is from a German site and our own CDC is unwilling to say it.

For Sierra Leone and Liberia, though, he thinks “it is very difficult to bring enough help there to get a grip on the epidemic.”

According to the virologist, the most important thing to do now is to prevent the virus from spreading to other countries, “and to help where it is still possible, in Nigeria and Senegal for example.”

Of course, it is already in Nigeria.

In the balance therefore, the probability is that the virus is not airborne — yet — but it is more dangerous than its predecessors. This would account for its ability to slip through the protocols designed for less deadly strains of the disease. It’s not World War E time, but it’s time to worry.

And: This may be a new strain with more virulence.

The results of full genetic sequencing suggest that the outbreak in Guinea isn’t related to others that have occurred elsewhere in Africa, according to an international team that published its findings online in the New England Journal of Medicine (NEJM). That report was from April 2014.

Now, we have more news. From 2012, we know transmission in animals may be airborne.

While primates develop systemic infection associated with immune dysregulation resulting in severe hemorrhagic fever, the EBOV infection in swine affects mainly respiratory tract, implicating a potential for airborne transmission of ZEBOV2, 6. Contact exposure is considered to be the most important route of infection with EBOV in primates7, although there are reports suggesting or suspecting aerosol transmission of EBOV from NHP to NHP8, 9, 10, or in humans based on epidemiological observations11. The present study was design to evaluate EBOV transmission from experimentally infected piglets to NHPs without direct contact.

The study of this potential explosive development showed:

The present study provides evidence that infected pigs can efficiently transmit ZEBOV to NHPs in conditions resembling farm setting. Our findings support the hypothesis that airborne transmission may contribute to ZEBOV spread, specifically from pigs to primates, and may need to be considered in assessing transmission from animals to humans in general.

Now we have more articles appearing about this.

The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person may be genetically different from the virus entering the next. The current Ebola virus’s hyper-evolution is unprecedented; there has been more human-to-human transmission in the past four months than most likely occurred in the last 500 to 1,000 years. Each new infection represents trillions of throws of the genetic dice.

If the New York Times is publishing this, somebody is worried.

Read more

The Future of the Middle East

by

The rise of ISIS seems to have caught the attention of hitherto oblivious segments of the US public. Cutting off the heads of western journalists seems to do that. What we are seeing is the total collapse of civilization in that part of the world.

That is what civilizational decline looks like in real time. The roots of the crisis were visible four years ago before the so-called Arab Spring beguiled the foreign policy wonks. Hundreds of thousands of displaced Syrian farmers already were living in tent camps around Syrian cities before the Syrian civil war began in April 2011. Israeli analysts knew this. In March 2011 Paul Rivlin of Tel Aviv University released a study of the collapse of Syrian agriculture, widely cited in Arab media but unmentioned in the English language press (except my essay on the topic).

The Syrian food crisis had a lot to do with the collapse of Syria.

In response to the Tunisian and Egyptian uprisings, President Assad reduced taxes on oil and sugar, and cut import tariffs on basic foodstuffs. This action had unintended consequences. A blogger on the Syrian website sy-weather.com reports, “I spent fifteen days on formalities to reduce customs duties on some basic food items, but I have not seen a glimmer of hope on the horizon. This was supposed to reduce the prices of the targeted goods. On the contrary, a liter of oil that sold for 65 Syrian pounds [US$1.38] now sells for 85 pounds.” That’s an increase of 30% over the month. Other bloggers report that the prices of basic foodstuffs have risen by 25% to 30%.

This has resulted in the presence of 14 million refugees with no hope of relief.

When I wrote in 2011 that Islam was dying, this was precisely what I forecast. You can’t unscramble this egg. The international organizations, Bill Clinton, George Soros and other people of that ilk will draw up plans, propose funding, hold conferences and publish studies, to no avail. The raw despair of millions of people ripped out of the cocoon of traditional society, bereft of ties of kinship and custom, will feed the meatgrinder. Terrorist organizations that were hitherto less flamboyant (“moderate” is a misdesignation), e.g. the Muslim Brotherhood (and its Palestine branch Hamas), will compete with the caliphate for the loyalties of enraged young people. The delusion about Muslim democracy that afflicted utopians of both parties is now inoperative. War will end when the pool of prospective fighters has been exhausted.

Read more

The revolution we need might be starting in Britain.

by

A “Seismic Shock is coming to the British political system.

Douglas Carswell, a prominent Conservative MP has announced he is switching to UKIP. a new political party that has been attacked as “racist” and has been attracting a larger constituency from the British traditional voters.

A new political party has appeared in Britain called UK Independent Party. It has been called racist and a number of other things that might sound familiar to Tea Party members here.

For example:

News reports about the rising primary school population in England fail to mention the ‘elephant in the room’, said MEP Paul Nuttall.

“It is accepted that primary schools have increasing numbers of pupils, which causes all manner of problems, but what is frequently not referred to is why we have such a boom in numbers.

“And the answer is unlimited immigration into this country. It hits some areas harder than others but there cannot be many primary schools in the country which have not been affected at all,” said Mr Nuttall, UKIP Education spokesman.

Why is this controversial ? In the 1990s, the Labour Party opened the floodgates of immigration from Pakistan. The Conservatives have mentioned reducing this but have done little about it.

Steven Woolfe, UKIP Migration spokesman, attacks Conservatives for ‘lying to electorate’ on promises to cut migration, adding that ‘it is no wonder their own MPs are losing faith in them and they are haemorrhaging support to UKIP.’

“These shocking figures today show that the Government does not have a handle on immigration. The Conservative Party promised to cut net migration to tens of thousands and yet it has shot up by a staggering 68,000 in just one year. It is quite simple. They lie to the electorate. They lie to try to keep votes. Well they are being found out.

This is one reason why UKIP is hated. For example, of the 1400 young girls made sex slaves by “Asian” men, several were taken from foster parents because they had voted for UKIP.

A couple had their three foster children taken away by a council on the grounds that their membership of the UK Independence Party meant that they supported “racist” policies. The husband and wife, who have been fostering for nearly seven years, said they were made to feel like criminals when a social worker told them that their views on immigration made them unsuitable carers.

Sounds like the Tea Party to me.

Read more