Don’t Panic: A Continuing Series – Ebola or Black Heva?

[Readers needing background may refer to the earlier members of this series, Don’t Panic: Against the Spirit of the Age, and Don’t Panic: A Continuing Series.]

Time is running out, the man explains, speaking calmly and confidently, in the manner of a university professor. A deadly disease, spread by primitive tribespeople through dead bodies, will kill vast numbers of Americans unless the Federal government uses its powers to stop it.

The man is Russell Eugene Weston Jr., a paranoid schizophrenic who murdered two policemen inside the Capitol building in the summer of 1998. He has been institutionalized ever since.

As I write this, the most widely-read individual blog in the English-speaking world, written by a genuine university professor, is infested with (invariably pseudonymous) commenters not readily distinguishable from Weston; we can only hope that none of them will act on their impulses as he did.

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Don’t Panic: A Continuing Series

[Readers needing background may refer to the first member of this series, Don’t Panic: Against the Spirit of the Age, posted last month. This post, unlike that one, was hastily written due to time constraints involving, perhaps ironically, international travel to a Third World country.]

Constructive foreword: suggested case studies in disruption are the Chicago blizzard of 1/13-14/1979 (~3 million commuters immobilized) and the Milwaukee Cryptosporidiosis outbreak of 3/23-4/8/1993 (~400k residents sickened simultaneously).

Thesis: I argue that, at least with Ebola, inept and overwrought responses pose far greater risks to American society than the disease itself. With regard to managing the risks associated with Ebola in the US, it is vital that we identify easily disrupted institutions and design our processes intelligently to avoid creating bottlenecks, mostly by resisting the urge to overreact; likely candidates include …

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2nd Ebola Case in Dallas Texas

One of the health care workers (HCW) that treated Thomas Eric Duncan on in Dallas during the period of 28th thru 30th of September has tested positive for Ebola after coming down with a fever Friday night. Heath care workers at Texas Health Presbyterian Hospital intubated and placed Duncan on dialysis as a part of his palliative treatment schedule. The HCW were in personal protective equipment (PPE) level two or “droplet level” protection at the time.

It is notable that in the laboratory environment that Ebola is treated as a full bio-hazard level four or “inhalation” threat. Especially when you see circular thinking in public by CDC .


“I think the fact that we don’t know of a breach in protocol is concerning because clearly there was a breach in protocol. We have the ability to prevent the spread of Ebola by caring safely for patients.”

The statement said the CDC had NO IDEA how the protocol was breached, but protocol must have been breached because there was a an infection.

There was no mention as to why there was a two tier PPE protection level structure with widely different infection rates by routes other than Ebola virus injection accidents.

There is a huge no confidence vote in the CDc coming. One that will take the form we are seeing in Spain — HCW no-shows for hospitals caring for Ebola outbreaks.

An Update on healthcare reform.

Cash medical practice or, in the phrase favored by leftists critics, “Concierge Medicine,” seems to be growing.

Becker is shifting to a new style of practice, sometimes called concierge or retainer medicine. With the help of a company that has been helping physicians make such shifts for over 13 years, he will cease caring for a total of 2,500 patients and instead cut back to about 600. These patients will pay an annual fee of $1,650. In exchange, they will receive a two-hour annual visit with a complete physical exam, same-day appointments, 24-hour physician phone access, and personalized, web-based resources to promote wellness.

The article suggest that all these doctors choosing to drop insurance and Medicare are primary care. Many are but I know orthopedists and even general surgeons who are dropping all insurance.

The concierge model of practice is growing, and it is estimated that more than 4,000 U.S. physicians have adopted some variation of it. Most are general internists, with family practitioners second. It is attractive to physicians because they are relieved of much of the pressure to move patients through quickly, and they can devote more time to prevention and wellness.

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America’s Impending Tuberculosis Epidemic

(NOTE — Update at the End of the Column)

One of the things that changes you, when you become a parent, is the body of knowledge you acquire to protect your spouse and children including things like knowledge of infectious diseases in public schools. In my case that meant looking at the NY Times saying the following: “…the administration has begun to send the expected 240,000 migrants and 52,000 unaccompanied minors who have crossed the border illegally in recent months in the Rio Grande Valley to cities around the county.” And at headlines for the open border crisis like this by Todd Starnes titled “Immigration crisis: Tuberculosis spreading at camps” which caused me to immediately free associate them with a pair of “Tuberculosis in Public School”, headlines, one local to North Texas in 2011 and the other very recently in California. See this 2011 Consumer Health Daily article from Denton Texas “TB Outbreaks in Texas Schools Show Disease Still a Threat – At least 100 people have tested positive for the respiratory ailment” and this 1 July 2014 article from the Sacramento Bee “Four more students test positive for tuberculosis at Grant High.

As a Texas parent, this idea of TB positive illegal alien children released to illegal immigrant parents scares the heck out of me from the point of view of epidemiology. In the 1920s TB was the eighth leading cause of death for children 1-to-4 years old. Since then American public health has been so effective in preventing it that the USA no longer has any “herd immunity” to TB.

This “catch and release” illegal alien policy is horrible from the infectious disease point of view in that phlegm or aerosolized sputum that are contaminated with Mycobacterium tuberculosis are active biohazards that have long latent infection periods. This makes “exposure” very easy. The clinical definition of TB Exposure — which I found in a University of Vanderbilt student medical file PDF — is the following:

“A person is considered to be exposed if there is shared breathing space with someone with infectious pulmonary or laryngeal tuberculosis at a time when the infectious person is not wearing a mask and the other person is not wearing an N95 respirator. Usually a person has to be in close contact with someone with infectious tuberculosis for a long period of time to become infected; however, some people do become infected after short periods, especially if the contact is in a closed or poorly ventilated space.”

The Federal Government Hazmat protocol for dealing with suspected active TB cases is as follows:

1. Administrative controls
”¢ “Develop policies and protocols to ensure the rapid identification, isolation, diagnostic evaluation and treatment of persons likely to have TB.”
 
2. Engineering controls
Ӣ Isolation and
Ӣ Negative pressure room ventilation
 
3.Personal protective equipment controls
Ӣ N95 personal respirator protection

Questions people and reporters need to be asking their local, state and federal elected officials regards the so-called “unattended child immigration crisis” include:

1. How many Border Patrol Agents, health workers or other support staff at these immigration processing centers have worn N95 respirators in treating symptomatic TB sufferers?
 
2. How many TB sufferers were also wearing masks?
 
3. Have those Border Patrol Agents, health workers or other support staff followed a rigorous TB decontamination protocol?

Whether people ask those questions or not, we are going to find out the answers soon, and not just in Texas. Testable anti-bodies to TB infection appear in two to 12 weeks for skin and blood tests and the incubation period for full blown active TB is six months to two(+) years.

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