Roundup on Ebola
There are so many articles of interest on the subject of Ebola that I think I’ll just do a roundup:
My guess is that the suspected Ebola case in DC will turn out to be a false alarm, if the information that the patient’s exposure may have occurred in Nigeria is correct. Nigeria is not one of the countries presently involved in the epidemic; it had a small outbreak this summer, but apparently no cases since then.
If you want to know why Liberian Thomas Duncan may not have gotten any special attention from the Dallas hospital, it could be because Dallas has a substantial Liberian (I keep wanting to type “Libertarian”) community, between 5,000 and 10,000 people.
J. Christian Adams at PJ on Obama’s power to stop travelers from West Africa during the epidemic. Where’s that phone and pen when you need them?
But of course, that would be RACIST!
5,000 is substantial for such a small community, but out of 1.2 million in Dallas is less than one-half of one percent. Suppose that the Liberian population uses ER rooms at double the rate of the general population. That’s still under 1%.
The DailyMail is reporting a vomiting passenger from Liberia on a UA flight from Brussels. Over 200 passengers on board. *sigh*
http://www.dailymail.co.uk/news/article-2780696/BREAKING-NEWS-CDC-officials-rush-Newark-Airport-meet-Liberian-passenger-flying-Brussels-showed-symptoms-Ebola.html
Irene:
I meant that seeing a Liberian in the ER would hardly be an extraordinary event in Dallas.
Thanks for the roundup, Neo. I have a question, if you don’t mind, did the weekly totals report on new cases and deaths get overlooked this week?
I’ve been watching the (CDC’s) weekly graph-laden report complete with parabolic curves to get as close to hard info on the numbers as is available but I haven’t seen it this week? Anyone here tracking and charting?
mike f:
I don’t know, and don’t have time to check right now, but I think I read that it’s following general the pattern of increase that’s been set so far. In West Africa, that is.
Fair enough, Neo. It still seems strange to me, however, that no one involved didn’t put Liberian + ebola symptoms together or that they weren’t specifically instructed to take special note of patients from the ebola-stricken countries of Africa like Liberia – especially if there is a large community of Liberians nearby. In addition, ERs often ask if you’ve recently traveled in or out of the country for all sorts of problems.
addendum: the 3rd period in the above post apparently sprouted an Ebola-like viral twist.
Strangely, it now resembles a question mark. Do not be fooled! It is just a period!.
Irene:
I’m in complete agreement with you on that. It’s part of why I consider the hospital to have been negligent. They should have been hyper-aware—especially since Dallas does have a substantial Liberian community—of the dangers, and on the lookout for them, considering there is still a lot of back-and-forth travel between this country and Liberia.
That’s not just 20/20 hindsight, either. It should have been obvious before Mr. Duncan got ebola, that there was a big risk of someone arriving with the disease from Liberia.
Once there is a confirmed case in DC or NYC, then the travel ban starts.
The deadly Ebola virus has been ruled out for a patient hospitalized in Washington, D.C., authorities announced Saturday.
That’s great news.
Two passengers removed from plane that landed in Newark by CDC people in full Hazemat gear.
Plane was from Liberia.
Why? What’s the danger? Send them straight to Omaha. We will care for them, free of charge, at UNMC.
This Obola disaster and ISIS is Barack’s Waterloo.
Dems get swept.
Neo:
Hospital lawyers already shifting liability to software company.
And no real damages yet as no other infections.
Two parts to every case: liability and damages.
Sign petition at http://www.whitehouse.gov in the “We the People” section.
5,400 signatures now.
I’ve not seen any discussion of the resources, man hours, equipment, facilities, and costs associated with only one man coming into the country with ebola. It would not take much to overload the system. Why would we not stop all travel from west Africa? Who is picking up the tab?
100 signatures in about ten minutes.
Cornhead:
How about damages to Duncan, if he dies, when his disease could have been caught earlier (which I’m assuming they give some evidence could have made a difference in the outcome—catching it early)?
How about pain and suffering for the relatives and the other exposed people, even if they are fortunate enough to not come down with it?
How about expense for the cleanup?
Etc., etc…
Damages are iffy.
Cure rate for Ebola is low and this new territory even in the US.
Also big contributory negligence problem as this guy knew he had the disease and didn’t either quarantine himself and also was not more insistent in asking for treatment given what he had seen in Liberia.
Very unsympathetic plaintiff.
Trust me. These Liberians are not getting a dime. ( And I doubt they paid for the cleanup.)
Looks as if Duncan may not make it — his condition has now been downgraded to “critical”.
There’s also the airlines. The cost of decontaminating a plane? People afraid to fly because of bad publicity and fear. UA and AA both got hit hard financially after 9/11. Something like this could be the final nail in the coffin for an airline.
Cornhead:
As I have written in other posts and comments, there is no evidence (so far, anyway) that Duncan knew he’d been exposed to Ebola. If that continues to be the case, there would be no contributory negligence.
I have not been thinking that cleanup costs had been borne by the family. But someone bore them. Don’t know who that was: the city? The apartment complex? The CDC? It is was the CDC, I doubt they’d sue, of course.
I’m not saying anyone would win, either. I’m just saying there are possible plaintiffs, even if no one else caught Ebola from Duncan.
Ann:
And if he does die, an awful lot of people will blame him for his own demise and that of anyone else who might have caught Ebola from him, although it is not at all clear that he was guilty of any wrongdoing at all.
The Obama administration has quietly scrapped plans to enact sweeping new federal quarantine regulations that the Centers for Disease Control and Prevention touted four years ago as critical to protecting Americans from dangerous diseases spread by travelers.
The regulations, proposed in 2005 during the Bush administration amid fears of avian flu, would have given the federal government additional powers to detain sick airline passengers and those exposed to certain diseases. They also would have expanded requirements for airlines to report ill passengers to the CDC and mandated that airlines collect and maintain contact information for fliers in case they later needed to be traced as part of an investigation into an outbreak. …
phone post..here is the url
http://usatoday30.usatoday.com/news/washington/2010-04-01-quarantine_N.htm
Cornhead…
To hold down the signature counts, the White House is ginning up countless parallel petitions all asking for the same thing.
In this way, no-one can point to any SINGLE petition number that astounds. They all look like fringe sentiments.
Hence, the sobriquet: Digital Tyrant.
7300 now
The pen and phone have been used… let your infected children flock across our border and infect our middle and lower class children in our public schools; I welcome your ebola zombies to spread death across the amber waves of grain because ittheir deaths will not stop me from golf and fund raisers as I am immune due to my protected status. That is the dear leader’s message to the world.
We live in a victim-laden, litigous cesspool, where everything bad is alwaays someone or something else’s fault.
We live in a land where association has become causation.
We live in a land where civil decisions are determined by a preponderance of the evidence, not by the beyond a reasonable doubt criterion of the criminal court.
We live in a land where OJ is acquitted of two first-degree murders, but is convicted for monetary awards to the murdereds’ families in civil court. Assets which he hides successfully.
We live in a land where plaintiffs and defendants are coached in how to say and what to say, but swear to “Tell the truth, the whole truth, and nothing but the truth”.
We live in a land where pain and suffering, which can be highly subjective and often exxagerated complaints, are treated with large sums of money. And where plaintiff’s attorney(s) get a large retainer up front plus all expenses and a defined percentage of the adjudicated winnings, usually 40%.
So let’s get on with it. Hospitals have deep pockets, and they are there to serve. For the indigent it’s a winning lottery ticket which plaintiffs will piss away on booze, drugs and sex and be back to their beginnings in a couple of years. It’s the lawyers who hang on to their share of the loot.
So first, let’s kill all the lawyers. (hat tip, Shakespeare)
here i sit reading an “article” by linda stasi at the ny daily news. lstasi@nydailynews.com
Stasi: It’s easier to get into Texas with Ebola than to cross the border without carrying a plague
http://www.nydailynews.com/news/national/stasi-easier-texas-ebola-cross-border-article-1.1963802
the woman has promoted obama and democrats, and in her article tries to connect that the tea party is halting starving kids from sout america, and complaining that the borders are open to someone like duncan, who she compares to a person with aids having sex withotu telling others.
its amazing, that she starts off hitting the tea party who wants immigration laws enforced, then later in the ariticle points out that we did it better when ellis island was open.
someon or many someones should write and tell her that duncan is not to blame, but that she is and other ilk like her are to blame because they promote politicians who open the borders, and have let children wo are not innoculated into the US and shipped them all over and are putting them next to healthy children when some have lice, others have bedbugs, several have been found with tuberculosis, and a host of other deaseases.
she also complains that duncan is being treated on our dime, but it was people like her who promoted socialist medicine and the laws that say you have to treat someone no matter what turning our emergiency rooms in to dr offices for the poor.
who would want to sugget closing a border before ebola is here? she would have called them names and equated them with starving children. why would they then do the right thing when the person that sohuld be at least telling the truth is lying about them, hurting them, and preventing them from acting. if i wasnt a decent person i wold wish that she cought enterovirus68 and was told it came from south america…
she is as responsbiel as walter duranty was for the starvation of 8 million people at holodomar, adn the similar lies he told for similar reasons…
sadl, these same press people want it both ways, they want the door left open and believe no flies will enter, until they do then complain that the flies are here, but still want the door open
she is incredibley short sighted, and other than such things affecting her family, she tows the party line of popen borders, racist if you close them, and admires the people who used to. those people used to have press support so that they could do thier job.
its amazingly frustrating to read such and i have decided that once my subscription runs out, i will no longer bother buying pravda or its knockoffs as there is no reason to do this. if i want fiction, i might as well look for entertaining fiction, rather than fiction that is helping create pandemics and not realizing their part in it all!!!
Don Carlos i guess wants a soviet state…
figure out which side your on cause only in a soviet state do hospitals not need money, and only socialists believe that they have deep pockets (which is why so many have closed), and that lawyers should work for free.. .
yes.. lets get rid of lawyers… that way, we get rid of habeous corpus… right don? we can go back to the soviet style trials, which did not need lawyers as the outcome was decided way before there was a court presentation!! we can just stand up before a commttee or king and plea for our lives, and have no legal representation…
sometimes the solution is worse than the desease.
and those that want the desease fixed, never offer better
they just complan and offer worse..
which is what leftism has brought this great country.
people who hate what they have, dont have a better fix but wose ideas, and all want utopia rather than realize otherwise.
you let me know don carlos if seaching your home twice a year would be a good way tofight crime, regardless of wherher or not one has a warrant? after all, its lawyers adn their ilk that make that too expensive a propostition to do.
and dont forget, without lawyers you might be driving a car that is a death trap… because without lawyers, why would they fix it as there is no liability…
and the list and idiocy goes on and on…
18 Hospitals That Closed in 2013
Throughout 2013, 18 acute-care hospitals closed their doors, and there are many others – such as Interfaith Medical Center in Brooklyn, N.Y., Vidant Pungo Hospital in Belhaven, N.C., Lake Shore Health Care Center in Irving, N.Y., and Williamson (W.Va.) Memorial Hospital, to name a few – that could follow suit this year.
they were too wealthy to stay open
Hospitals continue to shut down in rural America
without turning lawyers and docs into slaves, how can you keep them open? i know… come up with single payer ACA and its all good… right?
https://www.youtube.com/watch?v=w-bC6pfzxxo
A first rate video on virology. ^^^
It has particular emphasis on Marburg and ebola viruses.
It, the video, also illustrates why the protocols for the Marburg virus are wholly inappropriate for ebola.
Ebola has bloomed so large that the entire (multi-nation) community has to thwart ebola.
The first steps must include the Red Chinese practice of wearing face masks as a matter of routine.
Decontamination squads are also required on short notice — almost like Fahrenheit 451 — to wash down and burn up ebola.
The totally witless Dallas scenario being the ultimate counter-example of correct procedure.
Ebola spreads a lot easier than HIV.
&&&&
The video does note that a slew of brutal viruses originate in the Victoria lake region.
One might suspect that they’re jumping over from primates native to that area.
IIRC, Mountain Gorillas hail from that neck of the African continent. They would also explain why researchers can’t find the animal host for these viruses. Who is going to be actively sampling gorillas?
They are both rare and hard to deal with. (Group defense)
It may come to pass that we’re going to have to inoculate African primates if there is to be any end in viral outbreaks.
Alternately, hunting and eating gorillas, etc, is going to have to become truly taboo.
It’s the kind of bush meat that can kill you, your family, and all of your kin!
Bats that feed off of the insects that hover over lake Victoria are another suspect animal reservoir for disease.
They also figure to be a prominent source of bush meat.
The face of r-selection reproduction is very evident during the video footage of the village devastated by HIV. It parallels my nephew’s tales.
All the men are gone. This is what a true matriarchy looks like.
It should give any Feminist pause.
We live in a world where doctors like DC think they know everything about the human body.
Here’s what I got on that.
BTW, Ymar, scientists in aggregate understand a tremendous amount about the human body. It is regrettable that Ymar has put on his nihilist, know-nothing hat. He is simply unable to comprehend Occam’s micro-lecture.
Occam is blessedly 100% right-again, as always-and always lucid, which I am not.-DC
Here comes a scientist to defend the flock. But such things are not my concern and were never going to propel human progress a single step forward. It’s simply tribal loyalty. Of what worth is that to me?-Ymar
You live in a world that you don’t understand a damn thing, Das Capital.
It’s a huge mistake to focus on blaming either the hospital or Duncan for the Dallas case. In terms of securing the nation against Ebola, our focus ought to be on understanding what happened, not on assigning blame for it with words like “egregious” or “criminal.”
Mistakes will always be made in health care, so long as it’s delivered by fallible human beings. They should be used to learn for the future. I mentioned Atul Gawande before and I’m mentioning him again, a physician and author of several fascinating books on how to improve medical care (and pretty much all other fields of endeavor) by avoiding human error (among other things) — and I think he’d be the first to tell you that blaming the perpetrators is not a particularly useful way of preventing future errors.
If you ask me, we obsess about who’s at fault and just how bad they are for being at fault as a way of avoiding the underlying fearful truth that we can’t control the universe. An assignment of fault is an assignment of responsibility, which is in itself a means of believing that somebody is always responsible and that we can control frightening situations. The truth is, sometimes we can’t. Human error will occur, so long as human beings are human. Aviation safety and health care safety experts long ago recognized that understanding that things WILL go wrong and people WILL make mistakes is the first step in designing systems that, as much as possible, help identify and avoid the circumstances that facilitate error in the first place. Blaming and outrage make us feel better, but that’s the illusion of control. In fact, those reactions are counterproductive: they do nothing to prevent future errors except to drive mistake-makers underground and make it harder to find out what went wrong and how to protect it next time.
I am not saying that we should not find out what went wrong. Of course we must do so. But the focus should not be on blaming. It ought to be on figuring out how to do this better.
Mrs Whatsit:
To figure out how to do something better, you have to take a look at what went wrong and analyze it. There’s nothing wrong with blame, IMHO. It’s not an either/or proposition. I agree that it’s more important to figure out what should be done from here on. But figuring out how and why something has gone wrong is a necessary first step.
Yes, I agree that we must figure out what went wrong, and I said so at the end of my comment. But that’s not the same thing at all as getting distracted by arguments about whether the mistakes should have been made and how bad the mistakes were to such a degree that we are focusing on the particulars of this specific situation rather than on the future — which it seems to me has happened to some extent in this blog’s recent discussion of what happened in Dallas.
You say there’s nothing wrong with blame, but I say that depends on your objective in a given situation. If your objective is to assign responsibility and determine consequences for one incident as a solitary matter (a medical malpractice lawsuit, a licensing disciplinary proceeding, a criminal trial) of course there’s nothing wrong with blame. That’s what you’re there to do. But if your objective is to fix the system so that it will do a better job in future, and identify system issues that make human errors more likely or easier to make (as for instance may have happened with the EMR workflow problem that the Dallas hospital said at one point had caused the miscommunication), then blame can absolutely be counter-productive. It can polarize, distract, make people defensive and less open to identifying what went wrong or even make them dishonest so that what went wrong cannot be discovered and fixed. Look how the hospital keeps changing its story and/or clamming up as to what, exactly, happened in Dallas. Doesn’t the chorus of blame have to do with that?
My brother is an airline pilot who’s also actively involved in crash investigations and aviation safety. He tells the story of two US airports located very near one another, that were originally lighted and laid out in such a way that it was very easy for pilots who meant to land at one of them to accidentally aim the plane at the other one. However, one was a much smaller airport with a shorter runway, so an aircraft headed for the bigger one might not be able to land safely at the smaller one. It was especially dangerous at night, when a pilot could not see the actual airports and runways and had to rely on the lights. Many near misses took place in which pilots realized in time that they were headed for the wrong airport, pulled up and corrected course — but the problem persisted for years before it was identified and fixed. Under the old system, a pilot who almost landed at the wrong airport would have been disciplined and punished — that is, blamed — for reporting his/her almost-error. Human nature being what it is, the pilots who caught themselves in time had an incentive not to tell anyone what had almost happened. They didn’t want to be punished. Also, they had no way of knowing that other pilots before them had made the same mistake, so they thought it was their own dumb fault and blamed themselves rather than the actual layout issue that had set up the problem for the near-miss. So, for a long time, nobody knew that there was a fixable problem waiting to cause a terrible accident. I can’t remember whether my brother’s story ends with an actual accident or not. What I do remember is that he said that after this problem and others like it were discovered and fixed, the system was changed to create an error-reporting system in aviation safety that is based on incentives to report errors so that error patterns can be spotted and causative problems can be solved — rather than the former disincentive of blame and discipline targeted at individual pilots rather than overall systems.
It would be lovely to think that people can be perfected so that they will never ever make a single mistake — the pilot flying your plane, the nurse admitting you to the ER, the surgeon amputating your right foot rather than the left (but oops, it was the left one that had gangrene . . . ) But in fact, people are fallible and WILL make mistakes, even the very best and most competent and careful. The challenge is in finding the stress points where the errors occur and wherever possible, adjusting them to prevent the errors before they happen (the checklist that requires magic-marker writing on the skin in advance, THIS IS THE FOOT TO AMPUTATE, NOT THAT OTHER ONE that ordinarily won’t be necessary — until, some day, it is.)
In the case of the discussion here, we aren’t going to be able to fix the reporting system in any case — that has to be left to the hospitals and the CDC. But I still think we distract ourselves with over-blaming the ER personnel who didn’t catch Duncan’s Ebola for being the dumb fallible human beings whom they are are rather than focusing on what we might do to protect all of ourselves from the terrifying fact — which I submit we’d rather not admit to ourselves — that every single person charged with stopping Ebola from spreading is a dumb fallible human being who’s capable of doing it wrong, if given the chance.
For instance: our current policy of letting Liberian nationals enter the US puts our already over-stressed hospitals on the front lines and increases the chance that they’ll miss more arriving Ebola patients. If we stopped letting people who’ve been in Liberia enter this country at all unless they have a darned good reason to be here (American citizens, returning aid workers) that would sharply decrease the chance of a health care professional — fallible or not — missing another Duncan. I have yet to hear a single good reason from anyone in authority as to why we should not do that. As long as we, the citizens, go on hollering at the ER folks in Dallas for missing Mr. Duncan, that takes the focus off the government people who should be explaining to us why he was allowed to enter and other Duncans are still being allowed to enter, so that they can keep on allowing it — even though doing so appears (to me, at least) to be a huge and indefensible system error.
Really, Neo, consider reading some of Atul Gawande’s work. Mind-expanding and fascinating even for somebody like me who does not work in health care.
Mrs Whatsit:
Actually, I have read some of his work, in the New Yorker.
I disagree with some of the rest of what you wrote, for the reasons I stated earlier. My beef with the Dallas hospital has little to do with some desire to sue them or take revenge on them or even criticize them, especially. It is that I think the problems there are hardly unique to that particular hospital; I fear that the communication, and other problems (particularly with integrating guidelines into actual practice) are widespread in the healthcare field, and can be fatal.
My original statement that they may possibly (not definitely) have been criminally liable was based on initial reports that they had the information that Duncan had been to Liberia, and failed to inform the doctor. That report turned out to have been incorrect—but that report was given out by the hospital itself!
I repeat that I don’t think blame is counterproductive in the search for answers. Blame indicates outrage, which I feel. I don’t think people in hospitals who make errors that are extremely serious in both their nature and their implications should escape blame, especially when it appears from the facts that they should have known better. Lawsuits I leave to the potential litigants; I don’t think they care much what I have to say either way.
I don’t hold medical people to standards of perfection. If I did, I’d have sued them many times over, but I’ve never sued anyone.
You and I obviously differ on this. That’s okay; we don’t have to be opinion clones.
By the way, I haven’t hollered at Mr. Duncan. I’ve actually defended him. And I have made it clear (for example, here) that I believe Obama should halt flights from these countries.
We probably don’t disagree all that much; I think it’s mostly a question of emphasis. As it happens, I’m not all that outraged by the fact that one of the first hospitals in this country ever to see an Ebola case missed it — I certainly wish they hadn’t, but I have family members who are or have been health professionals in various ERs, and it may be that I sympathize a little more than some with what their working conditions are and what they’re up against. On the other hand, I am practically transfixed with outrage by our government’s performance so far — not just the failure to limit arrivals from the affected countries while blandly refusing to explain why or even acknowledge that the possibility exists (if I have to read one more bland nonexplanation that we must not close our borders to travelers from there to here because that would somehow hamper our ability to deliver help from here to there, I will scream — in fact, Mr W will tell you that I already have) but also the bland insistence that we’ve got this, we’ll be able to control the spread, everything’s okay, mouthed right over the simultaneous circus of failures at every level in Dallas, such asking the duncan family to stay put without getting them food (at first) or removing the contaminated bedding for days, because — as they admitted — they had no one to do it and didn’t know where to put it — while simultaneously insisting that they know Exactly How to Do This, You Peasants, So Shut Up. Now, about that, I’m outraged, all right. As for the specific Dallas error we’ve been discussing, I’d rather point outrage at those charged with helping hospitals develop systems to avoid just this problem — public health agencies — than at this particular hospital that got their system wrong, or used it wrong, or whatever it turns out to be.
But I have to stop talking about this. As it happens, I have done almost nothing at work today except make mistakes and fix them again. Luckily for me, this neither kills anyone nor spreads disease. And now, I must go redesign one of the systems that caused me to make some of those mistakes so that next time around, I won’t make quite so many!