Health Care

Why Ebola will not stay in Africa.

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Today’s Belmont Club has a good explanation of why Ebola will not stay in Africa.

UPDATE: Patrick Sawyer was planning to visit Minnesota when he got sick.

UPDATE #2: More from Belmont Club.

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.

His wife, Decontee Sawyer, said that she had spoken to him a week earlier and that he had made plans to be stateside in early August to celebrate the birthdays of two of his three young daughters. She said the couple had been separated.

He is believed to be the first American to have died from the current outbreak, which has killed 672 people since March, according to World Health Organization figures.

He was American, not African.

The man who brought the Ebola virus to Nigeria probably knew he was infected. Surveillance video of Patrick Sawyer before boarding his flight at Liberia’s James Sprigg Payne’s Airport showed “Mr. Sawyer lying flat on his stomach on the floor in the corridor of the airport and seemed to be in ‘excruciating pain.’ The footage showed Mr. Sawyer preventing people from touching him.”

He collapsed upon arrival in Nigeria, after a layover in Togo and was rushed to a Nigerian hospital. Upon being told he had Ebola, he acted with what the Nigerians called “indiscipline”; a burst of rage and despair against the world and everyone in it.

Upon being told he had Ebola, Mr. Sawyer went into a rage, denying and objecting to the opinion of the medical experts. “He was so adamant and difficult that he took the tubes from his body and took off his pants and urinated on the health workers, forcing them to flee.

Amazingly, he was even then in the process of being sprung by his political connections before death intervened. Had he lived Sawyer might have gotten out and protected by the juju of expensive watches and status symbols, mingled among the muckety-mucks of ECOWAS.

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Medicine as a government benefit.

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Obamacare is having serious trouble as I have discussed. The success stories, like California, are an example of what I have called Medicaid for All.

“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Most of the new enrollees are Medicaid members and those enrolled in “private insurance” learn that they have severely restricted choice of doctor or hospital.

Now we have a new development.

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What next for health reform ?

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It looks to me that the Supreme Court will have little justification for continuing the Obamacare program as it exists. The Halbig decision should kill it off. It is clear that the IRS subsidies to federal exchange subscribers are illegal.

The only statement anyone has found in the legislative history that addresses this point comes from the Act’s lead author, who affirmed that Congress did intend to withhold tax credits in federal Exchanges. During a September 23, 2009, mark-up of his bill, which ultimately became the PPACA, Senate Finance Committee chairman Max Baucus (D-MT) refused to consider a Republican amendment regarding medical malpractice on the grounds it fell outside the Committee’s jurisdiction. Sen. John Ensign (R-NV) protested, asking how Baucus’ bill could do other things that lie outside the Committee’s jurisdiction, like direct states to create Exchanges. Baucus responded the bill creates tax credits, which are within its jurisdiction, and makes eligibility for those tax credits conditional on states creating Exchanges. Conditional necessarily means that Baucus intended to withhold tax credits in states that did not create their own Exchanges.

I just don’t see how the Court can ignore that history. The political left has been on a rant about Congressional intent since the decision was announced.

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An Update on healthcare reform.

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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

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(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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