China Syndrome comes home to roost.

Two viruses are making the news these days. One, Ebola hemorrhagic fever has infected two in the United States with no deaths yet. It has created wide spread concern bordering on panic. The other, Non-Polio Enterovirus D 68, appears to have infected 825 this year and been directly responsible for at least one death and indirectly responsible for many others, primarily among children. It has generated comparatively little media attention and very little panic. Why the difference?

First the victims of D 68 are primarily children, Ebola also strikes adults. As a culture we no longer value children as much as we once did. Children are an option, almost a luxury. They have become more expensive than most luxuries we consume. Perhaps it is because the high cost to rear a child is reflective of the damage we humans are doing to the planet Or because so few of them die at an early age as compared to the past. And I suspect that childlessness is far more prevalent among our media elite opinion makers. In any case, few children vote and so they don’t really matter to policy makers.

Second, D 68 generally kills indirectly by weakening the child so that pneumonia or some other respiratory illness can be the cause of death. Ebola eats you alive! I’ve seen it on TV! And it is a terrible new way to die unlike ways we’ve died before.

Finally, WE’RE ALL GOING TO DIE. D 68 is poorly understood and we have no idea how prevalent it is in the population or how many childhood deaths it has contributed to. And it’s non-Polio. But we know Ebola has a 50-70% fatality rate among those who contract it in African third world countries. After all it’s hemorrhagic fever. We’re going to bleed to death. So, if it gets loose here we could have millions of deaths like that! But we actually have all the tools we need in our public health system to prevent it from spreading widely, once we get the Bozos out of power. So it’s highly unlikely that this outbreak will spread among the general population.

It’s a very small probability of a terribly frightening event. And some folks have used the propensity of people to exaggerate the possibility of catastrophic outcomes to further their political goals. I’m thinking of nuclear power, an energy source that has killed no one in the US. Compared to the coal industry, which routinely contributes to the death of both its producers and consumers, nuclear power is harmless. However, some used Three Mile Island to shut down the development of power plants that could have cushioned us from the effects of the OPEC cartel. Or how about the Anthropogenic Global Warming (AGW) fraud? Or the reaction to a terrible but unrepeated terror bombing? The public has been taught to fear by leaders who want to harness public opinion to support their political goals.

Now comes Ebola. True, a threat. But a highly improbable one. Except when the incompetence of our elite leaders is made abundantly clear for all to see. And then those leaders have the audacity to be surprised when a formerly courageous people are reduced to trembling? The chickens are coming home to roost.

Treatment of the Ebola contact.

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.

Worthwhile Reading & Viewing

The festival of lights in Thailand

Three Irish girls win the Google Science Fair  with an approach to bacteria-enhanced crop growth

Two versions of “Oklahoma” at Bookworm, with discussion

10 Disney cartoons from the 1930s, with link to an article on the evolution of Disney’s cartoons over several decades

The lost art of political persuasion.  This piece at Ricochet argues that politicians are now less about converting the opposition and persuading the undecided, and more about activating those who are already members of their choir.

Bill Whittle thinks  it’s time to talk about some good news  (video)

A recent study suggests that empathy can lead to scapegoating

Book giveaways during WWII contributed greatly to the popularization of reading and the subsequent growth of the publishing industry.

This article by a Wharton professor argues that “emotional intelligence is overrated” and, specifically, that it is overrated in sales.  He cites a study in which hundreds of sales people were tested both for emotional intelligence and cognitive ability, and their sales performance subsequently tracked…with the conclusion that cognitive ability was more than 5X as powerful as emotional intelligence in predicting sales performance.  (Actually, I’m pretty sure that the importance of cognitive ability and the importance of emotional intelligence both vary greatly depending on what you’re selling and who you’re selling it to, and also on what kind of resources the salesman needs to leverage within his own organization.)

Don’t Panic: Against the Spirit of the Age

Cold and misty morning, I heard a warning borne in the air
About an age of power where no one had an hour to spare …
Emerson, Lake & Palmer, “Karn Evil 9, 1st Impression, Part 1”

Imagine that you just stepped out of a time machine into the mid-1930s with a case of partial historical amnesia. From your reading of history, you can still remember that the nation has been beset with economic difficulties for several years that will continue for several more. You also clearly remember that this is followed by participation in a global war, but you cannot recall just when it starts or who it’s with. A few days of newspapers and radio broadcasts, however, apprise you of obvious precursors to that conflict and various candidates for both allies and enemies.

As mentioned several times in this forum, I adhere to a historical model, consisting either of a four-part cycle of generational temperaments (Strauss and Howe), or a related but simpler system dynamic/generational flow (Xenakis). That model posits the above scenario as a description of our current situation and a prediction of its near future: a tremendous national trial, currently consisting mostly of failing domestic institutions, is underway. It will somehow transform into a geopolitical military phase and reach a crescendo early in the next decade. It cannot be avoided, only confronted.

Nor will it be a low-intensity conflict like the so-called “wars” of recent decades, which have had US casualty counts comparable to those of ordinary garrison duty a generation ago. Xenakis has coined the descriptive, and thoroughly alarming, term genocidal crisis war for these events. Some earlier instances in American history have killed >1% of the entire population and much larger portions of easily identifiable subsets of it. Any early-21st-century event of this type is overwhelmingly likely to kill millions of people in this country, many if not most of them noncombatants. And besides its stupendous quantitative aspect, the psychological effect will be such that the survivors (including young children) remain dedicated, for the rest of their lives, to preventing such a thing from ever happening again.

I will nonetheless argue that no matter how firmly convinced we may be that an utterly desperate struggle, with plenty of attendant disasters, is inevitable and imminent, we must avoid both individual panic and collective overreaction.

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Is Ebola airborne ?

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.

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