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Saturday, October 25, 2014

What would Thucydides do? How to create negative atmospheric pressure in the Ebola hot-zone



(Crossposted at Watts Up With That)
To keep pathogens from escaping, contagious disease laboratories and isolation rooms use negative atmospheric pressure (or negative relative air pressure) that pulls air in through all doors and cracks. Barriers are not enough. At the inevitable openings in the barriers, the movement of the pathogen must be inward, not outward. The same logic applies to the Ebola hot-zone countries of West Africa. Barriers in the form of travel restrictions and quarantines can help keep the contagion from spreading, but they cannot do the job by themselves. There has to be "negative air pressure," where it is safer for Ebola hot zone residents to stay put than to flee. 
That requires greatly reducing the rate of transmission within the hot zone, and the only way to achieve that is by using immune survivors to separate and treat the sick, a strategy developed by the Greeks 2400 years ago. The special challenge with ebola is how contagious it is to anyone who tries to provide care. By systematically hiring and developing a survivor-based treatment system that hurdle can be overcome. They can give aid without themselves becoming a vector of transmission, allowing the epidemic within the hot zone to be rolled back, reducing pressure to flee. 
 At present our national policies are working ever more powerfully in the opposite direction, creating strong incentives for infected and possibly infected people to flee to the United States from West Africa. An example of a policy that is creating an undesirable “positive atmospheric pressure” in the Ebola hot-zone (or equivalently, a negative relative pressure in the United States) is the promise that CDC Director Tom Frieden issued last week, telling the world that if anyone arrives at a major American airport with history or symptoms that indicate possible Ebola infection they will be whisked straight to the hospital, providing the strongest possible incentive for people who think they might be infected to come here for treatment.
At the same time, Frieden insists that travel from Liberia, Guinea and Sierra Leone to the United States should remain unrestricted, providing opportunity as well as incentive for hot-zone residents to flee here. From Frieden’s October 9thinterview on Fox News:
Staff from CDC and the Department of Homeland Security’s Customers & Border Protection will begin new layers of entry screening, first at John F. Kennedy International Airport in New York this Saturday, and in the following week at four additional airports … [which] … receive almost 95 percent of the American-bound travelers from the Ebola-affected countries.
Travelers from those countries will be escorted to an area of the airport set aside for screening. There they will be observed for signs of illness, asked a series of health and exposure questions, and given information on Ebola and information on monitoring themselves for symptoms for 21 days. Their temperature will be checked, and if there’s any concern about their health, they’ll be referred to the local public health authority for further evaluation or monitoring.
This funneling of hot-zone travelers through screening here in the U.S. was just made mandatory, guaranteeing care to the possibly infected. The resulting outward pressure—motivating infected people to move to a previously uninfected continent—will spread the infection, not contain it. Set aside that the CDC is supposed to give priority to American lives and should first and foremost work to keep Ebola from coming here, intercontinental spread of Ebola is a disaster for the whole world. Each breach of containment endangers everyone everywhere. 
Broad screening by it self would be fine. We have always tried to stop contagion from entering our borders. But screening together with a refusal to apply travel restrictions is an invitation to disaster, creating an obvious and powerful negative pressure on our side of the Atlantic that will suck Ebola here in volume. 
Creating negative pressure in the hot zone is not so easy
So long as the contagion keeps expanding within the hot-zone itself the pressure on residents to flee will keep increasing. But fighting transmission inside the hot zone is a labor intensive enterprise. Health care workers have to first diagnose who is infected and who is not, then isolate and treat the sick, all of which presents a high risk of transmission to the people doing this work. 
Ebola is perhaps the most infectious pathogen ever encountered, transmissible by a single particle. The repeated assurances that Ebola is not highly contagious apply only while patients remain asymptomatic. Once they start explosively erupting at both ends, protection for anyone in attendance must be perfect, which is very difficult to achieve, a factor that the CDC and our news media has been slow to acknowledge.
Three weeks ago NPR ran a happy talk segment on how easy it is to stop the spread of Ebola that completely ignored the problem of transmission through health care workers:
So to stop the chain of transmission, all health workers in Texas have to do is get the people possibly infected by the sick man into isolation before these people show signs of Ebola.
Then R0 drops to zero. And Texas is free of Ebola.
Then we all found out how difficult it is to keep health workers from getting the disease. The transmission rate, R-naught, does not drop to zero. With enough training and equipment transmission might be lowered dramatically, but only at impossible cost. Here a hospital director reacts to the CDC’s prep call (via Brian Preston):
Ebola Preparation “will bankrupt my hospital!” “Treating one Ebola patient requires, full time, 20 medical staff. Mostly ICU (intensive care unit) people. So that would wipe out an ICU in an average-sized hospital.”
At extreme expense we might be able to protect medical workers from contamination in a very limited number of Ebola cases. In Africa, forget it. But immune survivors do not need to be protected from contamination and this is a resource that Africa has in rapidly growing numbers. 
Immune survivors can make it both safer and more remunerative for hot-zone residents to stay put
Survivors have full immunity only to the Ebola strain they were infected with, but if they provide care in their local area they should be okay. Dr. Bruce Ribner onPBS:
Ebola virus is a new infection on this continent, but our colleagues across the ocean have been dealing with it for 40 years now, and so there is strong epidemiologic evidence that, once an individual has resolved Ebola virus infection, they are immune to that strain, recognizing that there are five different strains of Ebola virus.
Designate local isolation compounds for triage and treatment, drop off people and supplies, and no one comes out without a clean bill of health, bleached clothes, and a nice chlorinated shower. The immunity (in most cases) of the survivors means they could provide care without transmitting the disease, allowing the contagion to be rolled back, and the income they receive (this is where aid money comes in) would prop up the local economy, all of which would work to keep hot-zone residents in place.
If coming to America is off the table then flight from the Ebola hot-zones is a very daunting proposition. Africa is not a thriving land of opportunity and travel is more of a way to catch disease than avoid it. Thus if transmission within the hot-zone can be drastically reduced, negative atmospheric pressure is readily attainable, and this is what the use of immune survivors allows. Not being vectors, they can intercede to stop transmission in the cases under their care.
Some of these survivor health-workers will get infected with different strains and despite some cross immunity some of these re-infected health workers will surely die, but the fact that they are largely immune will allow the work of isolation and treatment to continue, which is simply not possible otherwise on any major scale.
The immune-survivor treatment strategy was implemented by the Greeks 2400 years ago
When I started advocating the immune-survivor strategy six weeks ago, I sent my post to Stanford health economist Jay Bhattacharya and he said, hey that’s what the Greeks did, sending me the following citation from Thucydides:
But whatever instances there may have been of such devotion, more often the sick and the dying were tended by the pitying care of those who had recovered, because they knew the course of the disease and were themselves free from apprehension. For no one was ever attacked a second time, or not with a fatal result. All men congratulated them, and they themselves, in the excess of their joy at the moment, had an innocent fancy that they could not die of any other sickness.
According to a report published by the CDC (back when they knew stuff) the Athenian plague could well have been Ebola. 

I am not the only one to advocate the deployment of immune survivors today. The day after I published my post Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, wrote the following in The New York Times:
The United Nations … should also coordinate the recruitment and training around the world of medical and nursing staff, in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection.
We have one immune survivor here in the United States, Dr. Kent Brantly, and with luck and prayers he may soon be joined by Nina Pham and Amber Vinson, but West Africa has a few thousand, and with the infection rate expected to soon reach 10,000 per week, that will become another 3000 survivors a week. The resource is there, we just have to use it, but the rationalizations provided by CDC Director Frieden show that he is looking in the opposite direction.
Frieden wants non-immune aid workers to go to Africa
That’s what he keeps saying whenever he tries to explain why he is against travel restrictions, that restrictions will make it harder for aid workers to travel to Africa:
One strategy that won’t stop this epidemic is isolating affected countries or sealing borders. When countries are isolated, it is harder to get medical supplies and personnel deployed to stop the spread of Ebola.
As one of the authors of whatever restrictions would be imposed, Frieden would have a chance to attach whatever exceptions he deems necessary for getting aid workers in and out, but set that aside. His premise to begin with is that outsiders should be going in and providing treatment. Like the happy talkers at NPR (who were trying to explain why Frieden is so confident that Ebola will not spread in the United States), Frieden ignores the problem of health care workers as a disease vector. About people who are being tracked and monitored he says:
The moment if they have any symptoms, if they have fever, they will be isolated. That is how you break the chain of transmission.
Yeah, not really. For a very small number of Ebola patients, at huge expense,maybe, if levels of protection and training are vastly improved. For Africa? Send in supplies and a small number of organizers at most, but no one from the outside should be sent in to deal with possibly infected subjects. They will just become disease vectors, both within Africa, and if they return without first undergoing a full period of quarantine they will bring it back here. 
Certainly don't send our military, or theNational Guard, and unexposed natives should not be recruited either. Turn the job over to the immune survivors. That is the only way to stop the contagion, and this critical resource is not here in America. It only exists in Africa, so stop bringing Ebola patients here!
Frieden keeps insisting that efforts to contain Ebola geographically will cause it to spread geographically
It is a bizarre contention. All non-government commentators regard isolation and treatment as complimentary strategies but Frieden insists they are either/or:
Restricting travel or trade to and from a community makes it harder to control in the isolated area, eventually putting the rest of the country at even greater risk. Isolating communities also increases people’s distrust of government, making them less likely to co-operate to help stop the spread of Ebola.
He is equating isolation with abandonment, which is a non sequitur. Does a patient placed in an isolation room become harder to control? Does being cared for in isolation make him more distrustful, and make observers distrustful, or does it make every one thankful? Frieden’s strained efforts to support this weak narrative are illogical to the point of dishonesty:
When a wildfire breaks out we don’t fence it off. We go in to extinguish it before one of the random sparks sets off another outbreak somewhere else.
Really, the guy’s never heard of a firebreak? We actually set fires, sacrificing part of the tree population to save the rest. Not that we should do that in Africa, but c’mon dude. Don’t just lie about stuff!
Travel restrictions may indeed have some downsides, but they also have a most important upside: they stop sick people from traveling around the world spreading disease. The question, which Frieden never even attempts to address, is whether the downsides he puts forward outweigh the upside in terms of disease transmission. Indeed, it is perfectly clear that Frieden is not accounting the upside at all, since he implicitly assumes it would be outweighed by the flimsiest of hypothesized downsides.
In reality, it is hard to think of any downside to travel restrictions that could begin to compare to the importance of keeping the Ebola-infected from freely carrying the disease wherever they want. The first imperative is to stop Ebola from making its way around the world and as director of the CDC it is Frieden’s first responsibility to make sure it doesn’t travel here. If other countries are also self-protective that is good. It will limit the spread of Ebola which makes everyone safer.
Is Frieden (and/or Obama) trying to reduce outward pressure by holing the containment vessel?
As meteorologists know, relative atmospheric pressure can be a tricky concept. Because air pushes in different places, distinguishing cause and effect can take some care, and this applies to the disease transmission analogy as well.
To achieve negative pressure in the Ebola hot-zone containment is obviously not enough. Transmission within the hot zone must be greatly reduced or else pressure to flee will build and build until it inevitably explodes. Could Frieden be looking at this looming build-up of pressure and getting the causality backwards? Is he proceeding on the idea that, if we never have containment in the first place, then the pressure cannot build enough to have an explosion?
Actions suggest that he and others may actually be trying to reduce outward pressure by getting rid of containment up front and even encouraging people to flee. Witness the “Ebola Outbreak-related Immigration Relief Measures” issued by the U.S. immigration service in mid-August, which the CDC would surely have had input on.
Some of the measures are reasonable, allowing “Nationals of Guinea, Liberia and Sierra Leone Currently in the United States” to stay here for now instead of forcing them to go back to the hot zone when their visas expire, but the measures gratuitously go much further, providing extreme incentive for residents of these countries to get themselves into the United States ASAP.
The really damaging relief measure (pressure relief measure?) is the first, which offers an opportunity for, “[c]hange or extension of nonimmigrant status for an individual currently in the United States, even if the request is filed after the authorized period of admission has expired.”
A change of status means a change from non-immigrant to immigrant status, thus any West African who is here on a tourist visa is eligible to be immediately switched to permanent resident status, leading to citizenship, and here’s the kicker: as Doug Ross noticed, there is no cut-off date for who is eligible for this change of status.
Instead of applying only to West Africans who were already here in mid-August, any Ebola-zone citizens who can get themselves over here on a tourist visa are immediately eligible to switch to permanent resident status, providing huge incentive for immediate mass outflow from West Africa to the United States. Obama/Frieden are offering them a once-in-a-lifetime jump-to-the-head-of-the-line opportunity to become American citizens.
We know Obama’s motivation, but why is the CDC going along?
President Obama, being a politician, can of course have political motivations for incentivizing West Africans to come here for citizenship. His intentional collapse of our southern border suggests that one of the ways that he wants to “fundamentally transform America” is by importing a new electorate, more to his liking. (DHS let a huge contract for the internal transport of unaccompanied illegal alien minors months before the vast wave of “unaccompanied minors” arrived, proving that the entire crisis was engineered by Obama.)
But CDC Director Frieden is supposed to be non-partisan, guided only by the objective requirements for keeping his countrymen safe from disease. How can a medical doctor be supportive of a ramped-up influx of immigrants from West Africa that is highly incentivized to carry Ebola?
Friedan’s big career-making achievement was dramatic reductions of tuberculosis in New York City and India, accomplished by systematic tracking, isolation and treatment of the infected. His oft-repeated mantra on Ebola is the same. “We know how to stop Ebola,” he says, by tracking, isolating, and treating infected individuals. Could he be fixated on tracking as a means?
Frieden wants people who could be infected with Ebola to fly so that they won’t travel “over land”
Note the particular language Frieden uses to explain why he thinks travel restrictions will be counter-productive. He keeps saying he wants the possibly infected to travel by means that enable tracking. That points directly to a preference for airline travel:
FRIEDEN: Right now, we know who’s coming in. If we try to eliminate travel, the possibility that some will travel over land, will come from other places, and we don’t know that they’re coming in, will mean that we won’t be able to do multiple things. … Borders can be porous — may I finish? – especially in this part of the world. We won’t be able to check them for fever when they leave, we won’t be able to check them for fever when they arrive. We won’t be able, as we do currently, to take a detailed history to see if they were exposed when they arrive.
When they arrive, we wouldn’t be able to impose (ph) quarantine as we now can if they have high-risk contact. We wouldn’t be able to obtain detailed locating information, which we do now, including not only name and date of birth, but e-mail addresses, cell phone numbers, address, addresses of friends, so that we could identify and locate them.
We wouldn’t be able to provide all of that information, as we do now, to state and local health departments, so that they can monitor them under supervision. We wouldn’t be able to impose controlled release, conditional release on them, or active monitoring, if they’re exposed, or to, in other ways…
The whole point of tracking is to stop further transmission so that we don’t have to do more tracking. The fact that a mode of travel enables tracking isn’t a plus if it also multiplies the need to track, as around the world commercial jet travel obviously does. In Frieden’s accounting the smallest amount of un-tracked contagion is more dangerous than a wide open and highly incentivized avenue of tracked contagion, because this is what we are talking about here.
The “overland” spread of Ebola that is Frieden’s sole concern would be extremely difficult under a travel ban. Even if frightened people could make their way out of Liberia and Guinea and Sierra Leone by ground travel (very difficult, snce many neighboring countries have closed their borders) they would still need to fly to reach the United States, which requires a visa, which requires a passport, which would still identify them as coming from a hot-zone country. The other possibility is that they fly to Mexico or Canada and travel overland at this end, but a) these crossings are within in our power to control, and b) if we impose a travel ban then Mexico and Canada will surely follow suit.
Frieden focuses entirely on the relatively tiny number of cases where a few West Africans might still get in by these untracked routes (a number that might well be decreased, not increased, by travel restrictions), and he completely ignores ignores the vast majority of cases where travel restrictions would keep the possibly Ebola-infected out. This selective accounting is not legitimate. It is basic economics and basic epidemiology that all impacts have to be fully accounted. Only looking at untracked flow is like buying merchandise for $100 a pop, selling it for $1 a pop, and thinking you are making money because you are only counting the flow of $1 receipts.
NIAID head directly mis-states travel requirements
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, does not seem to be aware of how travel documentation works. On Sunday he claimed that:
“If you say, ‘Nobody comes in from Sierra Leone, Liberia or Guinea,’ there are so many other ways to get into the country. You can go to one of the other countries and then get back in [to the United States].”
Wrong. Escapees from the hot-zone would only be able to get here via “other countries” if those other countries start issuing them passports that hide their true origin. Frieden and Fauci are doctors, not travel agents, but the entire USCIS knows that their claim about border hoppers being able to fly to the United States is wrong.
Regardless of Fauci’s confusion, the underlying error is still the same. Even if travel restrictions did somehow lead to an increase in un-tracked travel across the Atlantic (highly dubious), this increased avenue for Ebola transmission would still be tiny compared to the vast wide-open “above ground” highway for Ebola transmission that a travel ban would close off.
These supposed experts are acting as if there is no danger so long as we can track transmission, ignoring what a desperate game it is try to smother every outracing tendril from each outbreak. It’s like trying to stamp out an intrusion of cockroaches before any can escape through a crack.
Learning the wrong lesson from Nigeria’s close call
With heroic effort Nigeria just pulled off the squash-all-the-cockroaches feat, dedicating thousands of man hours of urgent detective work to successfully run down and isolate each multiplying pathway of Ebola exposure before they could multiply out of reach and consume a city of 21 million.
It was a very near thing and Frieden and Fauci are clearly learning the wrong lesson from it. They view it as confirmation that tracking works and can “stop Ebola in its tracks,” but the real lesson of Nigeria is the tremendous danger that just one infected airline passenger can pose. Realizing how lucky they were, Nigeria learned its lesson and stopped its hot-zone flights.
Much better not to let possibly infected people enter in the first place. Once an Ebola-infected person arrives a country might be quick enough to stop the contagion by tracking, monitoring and isolating individuals, but if the contagion gets away from them they will have to stop it the old fashioned way, the Greek way, by making use of the immune survivors as they emerge one by one from the spreading catastrophe.
Every nation has to be prepared for those same three stages of Ebola prevention and response. First we try to keep it from entering. If that fails then we try to contain the outbreak with tracking, monitoring and isolation of exposed individuals, and if that fails and there is an epidemic, only immune survivors can roll it back. Frieden and Fauci are fixated only on the middle third of this puzzle, the tracking. They aren’t concerned with keeping Ebola from getting here and they aren’t looking at how to fight it if it breaks out. Neither are they merely absent from these other battlefields but their fixation on tracking has them aggressively bringing Ebola here when the only people who can safely treat the disease are in Africa.
A perfect storm of illogic
Put Frieden’s apparent belief that tracking is a panacea together with his apparent confusion about cause and effect and they support each other. This seems to be his actual thinking: that if we let the infected out of the hot zone (while carefully tracking) then there won’t be an explosion because the pressure won’t have a chance to build up.
Could it be that simple, that he just doesn’t understand atmospheric pressure, where the whole point of creating negative pressure is to stop the outflow of the pathogen, so if pressure is reduced by the outflow of the pathogen that means we failed? Is the guy just that stupid? Or does he have some horrific political agenda like President Obama? (Definitely possible, since untracked TB and other infectious diseases pouring over our unenforced southern border elicit no protest from him.)
Either way, Congress better provide some countervailing force and quickly because the CDC is working hard to bring the negative pressure to our side of the Atlantic, sucking Ebola in. It is clear what we should be doing: imposing travel restrictions and using hot-zone Ebola survivors to separate and treat the newly infected. Then the problem won’t just stay in West Africa, it will be solved there.
The alternative, if Obama and Frieden can’t be stopped, is that we suffer our own Ebola epidemic, where the only way to avoid decimation or worse will be to deploy our own rapidly growing army of immune survivors. It’s either Thucydides in Africa or Thucydides in America, our choice.

UPDATE: Spencer case shows that we do NOT want free travel for returning aid workers, and it shows how quickly the tracking-hope could disappear

Spencer had been working with ebola infected people in Africa, came  back to America, started feeling weak, and the next day used several subway lines to go on an across-the-city bowling trip. But this was still a best-case-scenario because when his symptoms started to get worse Spencer knew it was probably ebola, isolated himself, and let everyone know.

The Dallas case was a similar best-case-scenario. Duncan knew he had recent physical contact with a person who died of Ebola. That's why he initially went to the hospital when he only had a mild fever, and when the ambulance later came to get him at his apartment his daughter told the EMTs that he likely had Ebola, so everybody was on alert. They still made mistakes, but nothing compared to what would have happened if they had no idea what was the matter with him.

The nightmare scenario is what happens when some ignorant person comes down with Ebola and has no idea he has Ebola. Suppose an out-of-it druggie were to pick up Ebola from Dr. Spencer's long trek through the subway system--maybe Spencer coughed on somebody, who knows, the guy was full of Ebola at that point--so a week or two from now this hapless druggie spends a couple of days on the streets and in the subway while he is in the massive shedding stage of Ebola infection, bleeding, puking and crapping in public rest-rooms and alleys and tracking his mess through public places.

Then it's goodbye to any hope for tracing the pathways of possible exposure. If it gets on the seats, grab-rails and hand straps of a handful of subway cars it will pass hand to hand, doorknob to doorknob, far beyond the subway system in a matter of hours. A single germ is infective, the tiniest drop of blood contains millions of germs, and we'd have this disintegrating person slathering infectious fluids everywhere he goes. If this just goes on for one day there will be a rampant epidemic starting in NYC but not stopping there.

The danger is EXTREME, yet not only are Frieden and Obama still adamant against travel restrictions, but they are at the same time providing huge incentives for possibly Ebola-exposed people to make use of that allowance to come here, both in the form of promises of first-rate care and through a once-in-a-lifetime offer of U.S. citizenship for anyone who can himself here from the Ebola hot zone, creating massive positive pressure for Ebola to flow out of the hot zone and into the United States. These policies are horrific, and the consequences will be too.

Monday, October 06, 2014

CDC Director Tom Friedan is a dishonest political hack

My "how to stop Ebola" post is about how to keep possible carriers from fleeing hot zones but the Obama administration is a million miles from even beginning to address such basic issues. Instead, Obama's CDC Director Tom Friedan is in full demagogue mode, pretending that a ban on travel from the Ebola hot-zone countries would block aid workers from traveling to those countries, as if it isn't in the administration's power to set up whatever restrictions, with whatever exemptions, are seen to make the most sense:
The approach of isolating a country is that it’s going to make it harder to get help into that country.
He is effectively declaring that any travel restrictions the Obama administration implements will be intentionally obstructionist so that they will have an excuse for not imposing any travel restrictions. Even the headline of the linked Puffington Host report contains the answer to the supposed problem with a travel ban:
Travel Ban From Ebola-Hit Countries Would Be 'Quick, Simple And Wrong,' CDC Director Says
A ban only on travel from Ebola-hit countries is outside the grasp of our CDC director, but obvious to a random Huff-Po headline writer.  Yeah, it's not really beyond Friedan's grasp. He's just a political hack intentionally blowing smoke.

Another infectious disease expert, Phenelle Segal, rides easily over Friedan's proclaimed stumbling block:
“I think as soon as we started seeing West Africa go out of control with Ebola, that was the time” to halt air travel from the region, said Segal, who supports exceptions for relief workers and aid missions.
Friedan is obviously aware of the possibility of exemptions for aid workers too. He's just a typical Obamaton, lying about anything at the slightest perceived rationale. It's what they do.

Establishing appropriate restrictions with appropriate exemptions would take some doing but that is the only hurdle: Friedan would have to actually do his job and implement appropriate rules. Of course such rules would impose some costs which, like all the other costs of mounting an effective medical response, would have to be met by the governments and NGOs that are seeking to mount an effective response. In particular, airlines will have to charge more if they are not allowed to take passengers back out of the hot-zone countries and if they are required to provide isolation for their crew members when they are on the ground in-country, but again, those costs only block aid if Friedan doesn't do his job.

As Director of the CDC he is supposed to design and implement our medical response to the health threat. Just as a matter of already-existing contingency planning he should have quarantine plans on the shelf that include all necessary exemptions, yet here he is making blatantly phony assertion that he can't impose a ban on travel from Ebola hot zones without blocking the flow of aid to Ebola hot zones.

Friedan also pretends that the Dallas contact-tracking example is confidence inspiring

The Duncan case demonstrates clearly the extreme outlay of highly competent manpower that is required to contain even one of the easiest  to contain cases, but instead of using this as an example of how easy it would be for containment to get away from us Friedan spins it as reason not to worry:
[W]e have no doubt that we will stop [Ebola] in its tracks in Texas. It's worth stepping back and saying how Ebola spreads. Ebola only spreads by direct contact with someone who's sick or with their body fluids. So the core of control is identifying everyone who might have had contact with them and making sure they're monitored for 21 days and if they develop symptoms to immediately isolate them to break the chain of transmission. ... [T]he work of the state and local departments with CDC assistance has been terrific. They have been able to assess all 114 individuals who might possibly have had contact. They were able to rule out that 66 did not have contact. They identified ten who appeared to have had contact with the individual when he might possibly have been infectious. Of those ten, seven are health care workers and three are family or community contacts. In addition, there are about 38 other people in whom we could not rule out that they had contact. So all of those 48 people will be tracked for 21 days to determine whether they have fever and if any developed fever, they will be immediately isolated, tested and if they have Ebola, given appropriate care and determine whether there were any additional contacts to their case. That's how we have stopped every outbreak in Ebola in the world until this one in West Africa. That's how we stopped it in Lagos, Nigeria and how we will stop it in Texas.
And what if just one infected contact slips through, say a drug user who vomits up a crack house, and Ebola starts passing from crack house to crack house? Enough with the idiotic "hope." The dire "changes" that are immediately possible need to be war-gamed and effective responses readied.

The first layer of protection is the border, which Obama has been working systematically to bring down. Now Friedan is lying that we can't restrict people from coming in without blocking them from going out.

Democrat lying is a fundamentally ingrained cognitive style

These a$$holes are going to get a lot of us killed. In Barack Hussein Obama's case that is very likely his intention, having been taught by his mentor the "ex-Muslim" Jeremiah Wright that Muslims living in infidel countries are supposed to lie about their religion, and for Muslims who follow this instruction, we know what kind of Muslims they are: they are followers of orthodox Islam, the religion that attacked us on 9/11, the religion of al Qaeda and the Muslim Brotherhood and ISIS and Khomeini too (Sunni and Shiite are the same on this).

But what is Friedan's motivation? I think it is just the habitual dishonesty of Democrat half of our political spectrum, the same habitual dishonesty that has allowed them for seven years to cover up Obama's mature racism (again under the tutelage of the out-and-proud anti-white racist Jeremiah Wright), along with his history as a paid professional Alinsky communist, to say nothing of his strongly evidenced Islamofascism.

Democrats control all of our information industries and they use that control constantly, habitually, and without exception, to advance Democratic party talking points. Their objective is never to tell the truth, it is always to support their partisan narratives, and anyone who lives within that Democrat-controlled information bubble comes to operate in the same backwards-thinking way, starting with preferred conclusions. It is a cognitive style.

This is what the term RINO refers to: Republicans who get their information from the Democrat-controlled media and are not even aware that there is a whole different alternate media available that doesn't edit information in support of an agenda but thinks frontwards, following reason and evidence. They don't even know what conservatism is. Their minds are controlled by the backwards-thinking Democrat opposition.

Friedan, being an Obamaton himself, is even more deeply a creature of the backwards thinking cognitive style and examples the extremity of its hold. Even as he confronts the facts about the extreme danger Ebola poses he is trying to spin them away in support of Obama's open borders agenda, pretending with complete dishonesty that we can't formulate travel restrictions that would still allow aid to flow to Ebola-hit African countries. Would a doctor really suppress medical necessity in favor of a political agenda? The answer is clearly yes, if he is a Democrat.

It's just like with the global warming scare where a whole cohort of Democratic Party voting scientists, receiving 100% of their funding from the climate bureaucracy set up by Vice President Al Gore, have promulgated blatantly a phony "science." Anyone who makes any effort to look at the facts for themselves quickly discovers that there virtually no evidence that CO2 causes more than a very small amount of warming. To account for late 20th century warming the small forcing effect of CO2 would have to be multiplied up several times by water vapor feedback effects, but there is no evidence that water vapor feedbacks are even positive.

Even the lowest IPCC-based assessments of the feedback effect are based on the assumption that late 20th century warming was caused by CO2, but the evidence actually points overwhelmingly to solar-magnetic activity. The IPCC dismisses this evidence on the anti-scientific grounds that we don't understand the mechanism by which solar-magnetic activity drives climate. The CO2-alarmists are using theory (their dislike of available theories of how solar-magnetic activity drives climate) to dismiss evidence, the exact opposite of the very definition of science, which demands that evidence trumps theory.

Our Democrat "scientists" are engaged in pure definitional anti-science on the grandest scale imaginable, demonstrating that once the backwards-thinking cognitive style takes hold there is no subject on which it cannot operate. Science and medicine are no barriers and this habitual dishonesty now defines our Democratic Party, leaving us without any effective leadership on anything, including Ebola, where Friedan is not even looking in the right direction.

What the African countries need is not outside personnel (who just end up getting infected) but strategy. We should be creating "negative atmospheric pressure" by paying the now-immune survivors to isolate and treat the sick and possibly sick (the subject of my first post), and we'd better get it figured out quick because the same imperatives are only a plane ride away from the United States itself. Thanks to the malignancy of Obama and the fecklessness of minions like Friedan there is a good chance we will not be able to keep our own Ebola outbreaks contained and will need to rely here at home on "negative atmospheric pressure" to limit the damage.


Crazy update

Story today from the U.K. Mail:
Dallas Ebola victim's stepdaughter - who took him to hospital as he was 'vomiting wildly' - is given all clear to return to work as nursing assistant
They are ignoring the 21 day quarantine period for people with known risk of exposure! The stepdaughter herself knows this isn't right and is insisting she will not go back to work yet. What the hell is wrong with the CDC?

Are they saying that there is no reason even for a person who had close contact with an infected person not to mingle with the general population unless and until they develop actual Ebola symptoms? "Don't worry about it, you're not communicable yet"? That's insane.

It means they are making no distinctions at all between different levels of "contact" with an infected person. Someone who directly attended to an externally hemorrhaging hemorragic fever victim only has to be monitored for fever for 21 days, the same as someone who only crossed the victim's path when he was beginning to show symptoms. No way.

If this woman comes down with Ebola they are going to have to do a whole new round of tracking. Who did she have contact with after they released her? Imagine if she really did go back to physical contact with numerous sick people every day, half of whom probably already have fevers from other causes. There would be no way to tell whether they were reacting to Ebola or not. They'd all have to be kept in isolation.

All for what? To give the impression that there is nothing to worry about? Look how lightly we are treating his, so you should too? On the contrary, they give us more to worry about every day.


More madness

West African family travels from Ebola hot-zone to Miami for family vacation, teenager quarantined with fever. Sure, we don't need no travel restrictions. What could go wrong.

3 weeks ago Obama said it was "unlikely" that someone with Ebola would reach our shores and that the chances of an outbreak here was "extremely low," all while following policies that make it all but certain that Ebola-infected people will be showing up here with substantial regularity.

The aggressive dishonesty and malignancy of this racist communist Islamofacist a$$hole of a president is astounding to behold.










Thursday, September 11, 2014

How to stop Ebola: create negative "atmospheric pressure" by paying Ebola survivors to treat the sick

Ebola rising, from Drudge today:
STUDY: Millions more at risk in Ebola outbreak... 
'Spreading like wildfire'... 
'Terrifying evolution' of virus...
The key to an effective response lies in the survivors, who are immune to re-infection (at least by the same Ebola strain, which is what would be circulating in their area). For those survivors who are undamaged enough for work, train and pay as many as are willing to tend to the sick, the dying and the dead. Non-immune people cannot do this work on a large scale. They are terribly encumbered and they still get sick, turning them into part of the problem.

Because treating the sick is so dangerous they are now receiving minimal if any care, causing mortality rates to be higher than they need to be. Using survivors to treat the sick would greatly increase the survivor rate, increasing the pool of survivors available to treat the sick. It is a self-reinforcing amelioration.

The immune would have to for the most part remain in isolation along with the sick. They couldn't touch stuff that other people touch, but supplies could be left for them and so long as they undergo rigorous disinfection before leaving isolation the sick under their care would would cease to be a source of infection.

Ditto for those who only might be sick with Ebola. These too could be tended to by Ebola survivors, whose first job would be to find out if they do have Ebola. Survivors, if they are make sure that the outsides of their bodies are as non-contagious as the insides of their bodies, can examine those with ambiguous symptoms and determine whether they need to be kept in quarantine or can be released to non-Ebola medical care.

Negative movement-pressure is critical

Most importantly, an army of survivors working to separate and treat the sick would drastically reduce transmission, which is the only way to keep the uninfected from fleeing hot zones and propelling further spread of the disease. That's the problem now. There is tremendous pressure to flee the hot zones, causing the disease to explode outwards.

No larger quarantine zone can hold under these conditions. The greater the external efforts at containment the more the pressure has to build before it explodes outwards but it will explode. Quarantine has to at least begin at the level of the individual patient. Stop local transmission from individual patients and then larger quarantine zones might work, if they are needed at all.

With an army of immune survivors to isolate and tend to the sick at the local level it becomes safer for uninfected people within the hot zones to stay where they are. Travel is dangerous because it exposes travelers to massed humanity, where contagion is amplified. Thus it would not be hard to make it safer not to flee, if a growing army of the immune were used to provide treatment-in-isolation for the sick.

Add people's interest in not losing their established homes and livelihoods the abnormal outward pressure of the infection would be eliminated. Economic devastation could also cause pressure to flee but this too would be reduced by paying survivors to care for the sick. There would be an inflow of disposable income that would keep the local economy propped up. Care for the sick would be a new industry, subsidized from outside. Somebody has to care for the caregivers, and the money would be there to do it.

Just as it takes negative atmospheric pressure to isolate an isolation room, so too if we want hot zones to remain isolated, whether or not they are quarantined, the motivational pressure for people inside to leave must be negative. Now the pressure to leave is strongly positive. Effective use of the immune-survivor resource can change that by isolating and treating the sick, stopping transmission and creating more immune survivors. Then even without formal larger scale quarantine movement would be greatly reduced.

The alternative is continued high rates of disease transmission, in which case no quarantine zone will be able to contain the epidemic. It will inevitably explode outwards, first across Africa, then anywhere else where Ebola is not dealt with rationally.


Addendum on the immunity of Ebola survivors to re-infection

From  Dr. Bruce Ribner, director of Emory University Hospital's infectious disease unit (via PBS interview):
DR. BRUCE RIBNER: The medical staff here at Emory is confident that the discharge from the hospital of both of these patients poses no public health threat. Ebola virus is a new infection on this continent, but our colleagues across the ocean have been dealing with it for 40 years now, and so there is strong epidemiologic evidence that, once an individual has resolved Ebola virus infection, they are immune to that strain, recognizing that there are five different strains of Ebola virus.

UPDATE:  The day after put up this post there is an Op-Ed in the NYT warning about mutation and spread of Ebola and calling, among other things, for using survivors to tend to the sick. From Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota:
The United Nations should provide whatever number of beds are needed; the World Health Organization has recommended 1,500, but we may need thousands more. It should also coordinate the recruitment and training around the world of medical and nursing staff, in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection. Many countries are pledging medical resources, but donations will not result in an effective treatment system if no single group is responsible for coordinating them.
I would leave the U.N. completely out of it. The U.N. is nothing but corruption. It is a well developed machine for siphoning off all monies that are channeled through it, maximally diverting every Dollar and Euro through its vast networks of sycophants, sinecures and profiteers. The U.N. is one gigantic "french drain," where pouring a flood in achieves at best a trickle out. Instead use the same Christian organizations that have been instrumental in fighting AIDS.

PEPFAR, the successful AIDS-fighting project that President Bush established in 2003, did not partner only with Christian organizations, but it did not discriminate against them, and in some ways favored them, because part of PEPFAR's mission was moral education, emphasizing that there would be no sexual transmission of AIDS at all if people were not having sex outside of marriage.

The resulting distribution of funding can be gleaned from PEPFAR's partner pages. Here, for instance, is the page for Nigeria in 2007. Maybe half of the partners, receiving half of the funding, are Christian (hard to tell because much of the money that went to secular organizations was distributed by them to Christian sub-partners). These groups actually try to deliver as much AIDS-fighting effect per dollar as they can. Similarly for the secular aid groups, which should also be employed, but U.N. is the worst. Maybe they will have to be paid off in some instances where they would otherwise use their reach to block aid, but there is unlikely to be any role in which the U.N. can do more good than harm.


UPDATES 9/20/14:  As predicted above, attempts at quarantine are motivating people inside the hot zones to flee. Instead of negative "atmospheric pressure," the attempt to impose quarantine on an out-of-control hot-zone is causing a powerful positive "atmospheric pressure" that will only get stronger until it explodes outwards like pressure-bursting pustule.

Also predictable, Obama is jumping on the chance to kill some U.S. troops and possibly bring Ebola to America by sending U.S. troops to the Ebola outbreak sites where there is nothing useful that they can do. Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, explains:
“What African troops are doing is shooting people who cross borders or violate quarantine,” Orient told WND, reacting to news of the U.S. troop deployment. “Is that what we plan to support?” 
She added, “Africans are already very suspicious of us. How will they react to an army setting up hospitals?” 
Orient called the planned U.S. deployment a “dubious mission,” warning that the nightmarish scenario could bring Ebola to America. 
“There is definitely a risk,” she said. “It seems irresponsible to send more people there when the ones already there are having trouble leaving. Probably anyone who has been exposed should be quarantined for 25 days since the last exposure.”
No, our troops will not shoot fleeing residents. They will instead deal with them up close and personal, and become vectors themselves:
“You can see that these doctors, who are highly trained people, got themselves infected,” said Dr. Lee Hieb, former president of the Association of American Physicians and Surgeons. “So sending troops into an area, if they’re dealing one-on-one with a patient, they’re not going to be able to protect themselves very well. It’s not easy to [prevent transmission], because you get tired and you get careless and you make some simple mistakes. All it takes is one virus particle.”
The only way to stop the spread is to mobilize the Ebola survivors. Pay them to isolate and treat the sick in the hot zones so that transmission within the hot zones can be extinguished, making it safer to stay put than to flee, creating the necessary negative "atmospheric pressure" and saving a lot of lives inside the hot zones as well as outside.

If any quarantine enforcement is to be applied, Ebola survivors should be used for this to, unless the quarantine is to be enforced the African way: by shooting anyone who tries to approach the quarantine boundary. That leaves no role for the U.S. military, never mind that, in the words of Lt. Gen. William G. Boykin Ret., this mission would in any case be “an absolute misuse of the U.S. military.” But then Obama wants to find any mission for U.S. troops that will keep them away from the "new Caliphate" he has spent five-plus years creating.



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