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e_moon60

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Ebola: Lessons Learned the Hard Way [Oct. 14th, 2014|12:36 pm]
e_moon60
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We could start with the worst: those who rouse panic largely for their own gain: to make money, to get elected to or stay in public office, to get their faces on the front pages or a chance at being a talking head on TV, to raise the ratings of their network, TV station, radio station, blogsite, Twitter feed, etc, etc, etc.  But that bunch don't learn lessons--they simply take any problem, magnify it, and declare that it's someone else's fault (for the past six years, Obama's fault) and add it to their repertoire to bring up when they move on to the next problem they can get a little publicity out of.   So I restrain myself from adding my personal "Worst of the Panic-Raisers" list and move on to the lessons.   They're more important, and so are the reasons we're learning them the hard way instead of easier ways.


Lesson One: A stitch in time saves nine.  If you want to get classical about it, the "stitch in time" is a subset of that hoary old virtue called Prudence, the foresight virtue.  It's noticing early stages of something, thinking out the "What if this goes on?" and how the problem might be alleviated and future worse outcomes prevented--and then doing something about it.  It's one of the least common virtues, because it requires expending time and energy and resources on something that hasn't happened yet.  That's not something we humans are good at, especially if the time, energy, and resources involved are our own, and not someone else's.

Ebola is not a new health threat; sporadic small outbreaks have taught those who worked where it was that a) it could be contained and b) how to contain it.  Its mode of transmission and its potential to spread from nation to nation have been under discussion for decades.  The ability of people incubating a serious disease to move globally before their disease becomes evident, thanks to the speed of modern travel,  is not new and has been under discussion for even more decades.  Ebola specifically has been talked about in medical journals as a one of a number of serious health threats.  But...Ebola was "over there" in Africa, the outbreaks were small, and the proposed costs of preparing for its arrival "here" (meaning outside Africa) seemed far too high to spend much time, energy, or money on actual preparedness.

Individuals, medical centers, and governments all chose to ignore the loose stitches in the fabric of global health (inclding a lot more than Ebola)  in favor of saving time, energy, and money for other problems.  Hospitals did not review their admittance procedures.  They did not train staff.  They did not stockpile the supplies needed.  They did not foresee the need for special handling of Ebola-contaminated trash.  Governments did not ensure that clear guidelines were issued, nor did they fund additional research into what it might take to mitigate the threats.  Nor did they send assistance to the affected countries the current outbreak occurred, to help contain it.   The medical staff who did go were volunteers, not representing their governments, and thus without a clear pipeline to the medical and political establishments back home.  Their experience--crucial to setting up protocols to deal safely with the same disease elsewhere--was not transmitted clearly.

In the U.S., states were alloted "disaster" funds after 9/11, and four high-containment treatment units for especially dangerous diseases were in fact set up, one in each of four states (Maryland, Georgia, Missouri, Nebraska), but the use of funds was up to the states themselves and no provision was made to assign all patients  with a particular disease to one of them.  Two--in Georgia and Nebraska--have been used so far for Ebola patients.  One of those, in Nebraska, was considered an unnecessary waste of taxpayer money until they had an Ebola case.

Lesson Two: Hubris kills.   The countries remote (they thought) from Africa that also had "modern" medical systems felt secure and comfortable in their medical superiority:  their hospitals full of equipment, their staffs well-trained to Western standards, their generally well-fed and healthy patient populations, their reliance on someone else to screen arrivals for signs of any dread disease.  Maybe "those people" couldn't deal with Ebola outbreaks--after all, these were poor countries, patients already had compromised health, medical personnel were few and they lacked all the medical  bells and whistles a richer country takes for graned.  If an Ebola patient showed up out of Africa, the superior medical skills, equipment, and supplies of the receiving hospital would instantly recognize and abate the threat to others, and probably the patient would survive, thanks to advanced care.   There was no need to seek out and learn from those who cared for Ebola in Africa, because the greater resources in wealthier countries made their experience irrelevant.

Secure in their assumption of superiority, politicians evaded  the need to fund forward-thinking ways to deal with what was (as the best medical advice said) the inevitable arrival of new, serious diseases from overseas and instead bragged on having a wonderful health care system.  Secure in their assumption of superiority, government agencies assured themselves (and the public) that their country's existing medical structures would respond promptly and correctly should Ebola appear...without running any checks to see if that was true.  Secure in their assumption of superiority, and pressured to cut costs, hospitals shaved preparedness activities to the bone, or simply eliminated them.   Public education on unfamiliar diseases (like Ebola) was left to sensationalist media with agendas not based on the public welfare: movies, television programs, talk radio, etc. with the result that most of the public knew only that it was a scary African disease and could kill a lot of people really quickly.

We know now how well that worked.  In spite of the fact that the current outbreak has been in the medical news since early last spring, and in the regular news at least since July,  hospitals did not immediately leap into action to train staff on the techniques needed for dealing with an Ebola patient.   Nor did most of them update their admissions and triage protocols to make detection of Ebola more likely and contamination of other patients and staff less likely.   Certainly they were not paying attention to the exact ways volunteer staff in the affected outbreak area went about their work, and why.  So when an actual Ebola patient showed up, the systems supposedly in place turned out to have large gaping holes.  In Texas Health Presbyterian Hospital, where Mr. Duncan died, his initial ER diagnosis was "sinusitis" and he was deemed "not sick enough" to be admitted.

In both the US and UK,  the shock of finding out that superiority wasn't as superior as had been thought shook public confidence in medical systems, and medical staffers' confidence in themselves.  In a few clinics where someone showed up stating he or she might have Ebola, staff refused to come near them and clearly did not know what to do.  Some clinics and hospitals experienced staff shortages due to staff concerns.  Nursing organizations complained that they hadn't had proper training and the protective gear now shown wasn't even available where they worked...yet nursing organizations, just like medical societies, had access to information about Ebola years before.  With no automatic referral of Ebola patients to the specialty units, including safe transport from their current location to such a unit, Ebola patients could--as Mr. Duncan did--appear at hospitals completely unprepared to recognize or care for someone with Ebola.   When hubris is shown up as hubris, when those smugly certain they had a situation under control find they didn't--the resulting shock can render existing systems unstable--individuals no longer know what they know, since they've just found out it wasn't as much as they thought.  And in that situation, individuals may perform worse than they did before, not better.  Any chaotic situation means people at risk.  THPH closed its Emergency Department (reasons not stated)--so where will sick people in its area go now?   Ebola is not the only killer: where will people with malaria, heart attacks, strokes, TB, and trauma go?

Lesson Three:  Privatisation is no guarantee of quality performance.  Despite claims by conservative politicians that the United States has the best health care system in the world,  this crisis (and others ) have shown that the health care system here is deficient in the main goal of any health care system:  enabling a healthier populace.  At enormous cost, the U.S. has accepted a health care system that enriches insurance companies, pharmaceutical companies, for-profit hospital groups, medical equipment manufacturers, etc,  while failing to provide adequate basic health care to large segments of the population.  We have all the shiny--all the machines, all the specialists, all the big hospitals, all the extras--anyone could hope for, but we do not have a sound basis for a good health care system: access for every citizen, regardless of income, to swift, accurate diagnosis and treatment, and to the underlying necessities of a healthy life: access to clean air, clean water, sufficient healthy and uncontaminated foods, decent housing, space for children and adults to exercise safely, quality education, and meaningful work.   That's why the basic health statistics in the U.S. have slipped year by year so the only thing we're #1 in is the cost of health care.

Lack of universal access results in the early stages of both communicable and so-called "lifestyle" diseases going undiagnosed and untreated because many people do not have the money to pay for discovery and treatment.   When Mr. Duncan appeared in the Emergency Room of Texas Health Presbyterian Hospital--a black, foreign, uninsured person--staff saw that, not the possibility that he had Ebola.  Emergency Departments in most hospitals lose money--it's where poor people go, who don't have insurance or money for illnesses that people with resources go to doctors' offices for.   The ER is a drain on other hospital resources and thus there's pressure from hospital administrations to get the non-payers out of there fast.   THPH, like all privately owned hospitals, had a bottom-line responsibility, and bottom-line priority is always a risk to quality patient care.  A hasty misdiagnosis of Mr. Duncan led to endangering not only his life, but the lives of staff, other patients, and those who contacted him outside the hospital, including his own family.   THPH isn't a monster:  It is an average hospital, representative of how many hospitals are run, in a national health care "system" that does not put public health or the health of individuals (if they're poor, especially) first.  Privatisation privileges profit, the bottom line, over patient welfare.  In any nation that values private enterprises, the tension between private and public agendas must be monitored with care.

Lesson Four:   Fear is faster than facts.  Biology makes us sensitive to threats--if you don't notice the lion, you get eaten.  But away from the very plain threats of lion, tiger, flood, fire, humans are generally bad at analyzing the relative danger of threats.   Which is more dangerous, your forty-minute commute,  or Ebola in your state?  Which is more likely to kill you within the next 12 months?  The commute, of course.  But you're a good driver--you're sure of that--and it's a familiar route, and it's not scary.  Ebola is scary...your imagination, faster than a speeding bullet, leaps the tall buildings of likelihood in a single bound and you are convinced that Ebola is the big bad lion crouched to spring.  If you have certain personality traits, anyone trying to give you the facts about Ebola will strike you as a fool or a tool of some conspiracy (involving the government, of course) and you will reject the facts in favor of nursing your own particular fear.   You will be helped in this by the ignorant and ambitious fear-mongers who are eager to push you towards other actions or opinions for their own reasons.   If you're detached from the fear, it's easier to see them work---they use Ebola as a tool in their argument for "closing the border" or "ending waste in Washington" or  any other political or economic end.

It's hard not to react to the efforts of others to engender fear--we're social animals, and we are affected by others' emotions.  But panic is not a good basis for action.  It's impossible to think when panicking, and hard to think when scared at all.  Yet when a threat is not imminent (the lion is two miles away, not about to spring at you)  taking the time to ascertain the facts (that lion is two miles away and there's not another lion any closer)  and act on facts, not fear, produces better results.  Most of us know that, when nothing scary is going on.  But the requirement of rational action--stopping to learn the facts, to think clearly, to act accordingly--takes time, and can feel as if "nothing's being done" and something should be.  Learning not to panic, but think--that takes training (and it helps if it starts in childhood.)   In most situations (there are exceptions and learning to tell the difference is important), slowing down to think improves the chance of a better outcome.  Is this threat immediate?   Is it a day away?   A week?  A month?   Next door?  Down the street?  Across town?  Hundreds of miles away?   If it's a threat you know little about, if it's really a new threat, something no one anticipated, then accept that the facts won't be known for awhile (nobody has all the facts) and ignore those who want to throw their favorite conspiracy theory onto the new emergency.

Two more ancient virtues help: temperance, the habit of, and ability to, control your emotions and desires, and courage/fortitude, the habit of not giving in to fear and panic.

Lesson Five:  Change takes time.   A system cannot change in an instant.  Either you take the time to notice that your pants have a few stitches gone in the seam, and take the time then to fix it, or when it's an obvious and embarrassing split, you take more time to fix it then.  Medical care systems are made up of "paper" as well as people, drugs, machine, and buildings: they are made of protocols, routines, habits.  I have read a clear description of the protocols used in one hospital in Liberia for treating Ebola patients: that does not mean I could perform it, put on and take off the protective clothing without contaminating myself.  I don't have the right habits; I don't have the right background of training and experience that builds the right habits.  (Six years in EMS wasn't enough, and that was thirty years ago anyway.)  Moreover a systerm reacts to any change with other changes--some of them difficult to predict, and discovered in practice.   Systems that work tend to stabilize and then to protect that stability (whether it's what you wanted or not.)  To change an existing system's way of working requires careful analysis and firm goals--and the willingness to put in the time, energy, and money necessary to overcome the system's inertia.   Behind one missed diagnosis--or one successful diagnosis--lies a whole system.  If making critical diagnoses of rare conditions is a priority, then time, energy, and money must be spent to make that one rare diagnosis possible.

Time:  Staff must be educated, and a single half hour to three hour training session with someone talking, a handout, and some slides is not enough.  Where behaviors need to be changed, only practice works...and the practice cannot be just rote, but intelligent, responsive practice.  Variations on the presentation of an emergency build a depth of skill in personnel that repeating the same exercise over and over does not.   If the behaviors are rarely used, then they must be practiced frequently enough to maintain the skills, which takes time from other duties.

Effort:  Planning and executing change is not easy, and exercises to break one habit and make another are difficult and often frustrating.  As the change begins to take hold, the unanticipated consequences show up, and must be dealt with.  People experienced in systems design and management in real-life systems are often hard to find (not everyone who claims that skill has it.)

Money:  To institute and maintain change in a system requires money--both to initiate it and to maintain it, as it requires staff time beyond existing duties.  In the case of medicine, it also requires maintaining an inventory of supplies that may not be needed except at long intervals.  Changes in protocols may also require money--if, for instance, it become standard to transfer patients with a given disease to a specialty center, then some entity must pay for that transport.

Is it possible to ensure that every hospital in the world will be able to recognize and handle a case of Ebola without transmission to a staff member or other patient?   Probably not.   Is it possible to ensure that every hospital in the United States will be able to do so?  Maybe, but unlikely.  Is it possible to ensure that every 300+ bed hospital in the United States can follow a simple protocol that identifies the probability that someone has Ebola, and take the correct steps to protect staff and other patients from contamination while awaiting more expert assistance?   Probably...but not by next week, or next month.   Too many hospitals, too many different organizations involved, and no central authority to enforce a common standard.  CDC can give advice, but has no power to compel compliance with its advice, besides being underfunded and understaffed.    Political forces in the US--anti-science, anti-regulation, anti-government--mitigate against any effective national policy.

The light bulb has to want to change.  Does this lightbulb?  Too early to tell.

Lesson Six:  Everything  is connected to everything else.   A disease outbreak in one country affects people in distant countries--even before someone with a disease arrives, it spreads panic,  it changes individual goals, it impacts governments' policies.

A hospital's desire for a business award affects its policies and procedures in its Emergency Department.   Fear affects whether an apartment complex will provide space for someone related to a patient with a certain disease.

Some connections are unreasonable, but they still have an effect--they're still "real" in a psychological sense: they change behaviors.  When a Texas politician wants to spend money "closing the Mexican border" instead of improving hospitals' response to sick people--that's not smart, but it is a connection in his mind between "foreigners" and "disease."  (His grasp of the overall disease burden in this state and where it comes from is...minimal.)

There is no bunker deep enough, no ivory tower high enough, no wall stout enough, or weapons system powerful enough to keep what happens "there" from affecting life "here."   We are part of a larger system, like it or not:  we are being changed even as we attempt to create change.  That's how systems work.  This is not the same world--physically, socially, psychologically, scientifically--that I was born into and grew up in, and it won't be the same as it is now when I am a decade older, when my son is the age I am now.

Because everything is connected to everything else, every person is connected to every other person, and what one group does, another reacts to.  To reach the best possible future requires understanding that, and accepting that reality, and then trying to act in ways that make things better for the system as a whole.  Knowing that good intentions don't ensure good outcomes.  Knowing that these outcomes are definitely not desirable, but uncertain about which good ones are even remotely possible.  This is a very hard lesson, since so much is not known abourt the best route to the best outcome even in one field.  It's not as simple as "wash your hands before eating and after using the toilet, eat five or more servings of vegetables a day,  get x minutes of exercise daily."   But it is possible (though not easy) to learn to think past one's own net worth in dollars, past one's own social or professional standing, past where to go on vacation next time, or how to afford the tuition at the community college while raising your kid on minimum wage.  It is possible to be aware of the connections and of being part of something more than one household or town or county or state.

Our choir director often says, when we're slightly out of synch, "WILL it to be together."   And then we are.  Because, I think, we're aware then, for sure, that we can't just read the music and sing the notes in the right order for the right duration...each interpreting that individually.  We have to sing together.  We have to be willing to sing together, more than insisting on our individual "rightness."   If we are willing to admit the connections, willing to "sing it together," better outcomes are possible.
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Comments:
[User Picture]From: fair_witness
2014-10-14 05:53 pm (UTC)
In the 1990s, aka "back when I was still working on site in a hospital environment," I remember we had a decent amount of time every year spent on inservices. Training sessions where we were required to learn various and sundry useful things, geared towards our role in the hospital.

By the time I left to move to Texas and get married, they were already cutting down on inservices. It was an easy way to decrease costs, in the short term, at least.

What's scary to me is that this blase attitude towards employee education isn't just found in hospitals. There's less and less emphasis on improving the skills of employees. Why spend money on that, when you can tell your employees that they have to work harder/smarter, to take up the slack for their co-workers who've been fired or managed out of the company?

Too much short-term thinking. Too many administrators scoffing at the idea that they should solve problems by "throwing money at them" (or, as we used to call it, funding and otherwise supporting the solution).
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[User Picture]From: thewayne
2014-10-15 03:14 pm (UTC)
Short-term profits almost always override long-term viability, and now we're finding that those short-term profits may cost some lives. Wheee! Money uber alles, including human life!
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[User Picture]From: chris_gerrib
2014-10-14 09:03 pm (UTC)
Thank you for this cogent and useful analysis.
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[User Picture]From: e_moon60
2014-10-15 03:26 am (UTC)
I'm glad you found it useful.
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From: sheff_dogs
2014-10-14 11:51 pm (UTC)
Thank you for a nother cogent analysis.
The practising of skills rarely used seems particularly pertinent given that the affected Spanish nurse thinks she probably infected herself by touching her face with her gloved and contaminated hand.


Thinking for the long term in whatever field is a skill that many people find extremely hard. My husband was asked to run a series of workshops looking at where transport in Manchester should be in ten, twenty and fifty years time for the organisation that manages transport planning and supervises public transport for the area. Most could manage to think ahead ten years, far fewer twenty and virtually none of them fifty years. This was not about a lack of knowledge of what technologies might be in play by then, it was a total inablility to apply what they did know and what they could reasonably exptrapolate. Despite being intelligent professionals most of them were too wrapped up in today to think about what kind of future they wanted to set in motion despite the fact that their actions today are already quite literally causing concrete to be poured that will limit the possibilities available tomorrow. The organisation knew it should do this sort of work, it had set staff time and resources aside for it, but even so it wasn't successful. He found it a very frustrating experience.
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[User Picture]From: e_moon60
2014-10-15 03:26 am (UTC)
True long-term planning is indeed difficult. And yet it's been done in the past, by some specific groups, and is possible--just at the functional margins maybe. I think of the medieval people who planted trees they knew would take over a hundred years to grow to useful size, to replace structural members that would someday need replacement.

I think in our age the focus on technological advances, on growth and constant change, has obscured some of the continuities and made it harder for people to plan for them. It still boggles my mind that politicians do not see the worth of infrastructure maintenance as a regular commitment.
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From: 6_penny
2014-10-15 07:23 pm (UTC)
It was either at Oxford or Cambridge where when they had to replace centuries old oak beams in one of their halls someone remembered the Oak woods that had been set aside to replace the medieval beams!
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From: sheff_dogs
2014-10-15 09:49 pm (UTC)
Not just a hundred years, my father was an Oxford University professor and told me the tale of one of the older colleges which found they needed to replace the roof of their great hall. They found on one of their many properties a wood with four hundred year old oaks suitable for the purpose that had been planted at the time of the hall's construction as the builders knew the ceiling would need replacing eventually. The story says so many things about the college and the people who cared for it down the years.

But yes I agree the relentless focus on technological advancement, and in particular small advances that let manufactureres trumpet the latest model as must have not only obsures, but directly undermines peoples understanding of the continuities.
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[User Picture]From: blueeowyn
2014-10-15 08:14 pm (UTC)
I was just in a talk (business planning) where the person was talking about Leaders who focus on the future and that so many of us are so wrapped up in the present that we can't think about the future but that you have to.

Not unlike the analogy of fitting life into your day after work and chores.
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[User Picture]From: talvinm
2014-10-15 12:01 am (UTC)
Distance from the actual problem seems to correlate to fear. I know people who live in parts of Tennessee where they are unlikely to meet anyone who has ever been to West Africa, and they are on Facebook quoting Bible verses that they say relate to Ebola and the end-times and discussing ways to survive this crisis.

Me? I live in a neighborhood where people line up down the block for Liberian Election Day (absentee voting of some sort, I have not inquired). (Let me digress and say I wish we could have turnout like that for OUR Election Day. Fie on us.) Some degree of caution is in order, and certainly they are worried about friends and relatives back home, but there is no sense of panic.
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[User Picture]From: e_moon60
2014-10-15 03:13 am (UTC)
I think the fear factor is in part cultural. Certain religious leaders have been talking about Ebola as a sign of the end-times since the summer, when it first really hit the standard news outlets. People who follow these leaders, and believe what they say, are already primed to believe that this and that are a sign of the end times, and to consider how to survive (nearly always involving guns, ammunition, etc.) In addition, some media outlets deliberately play up the dangers, to get more audience.

I would mention that I know people in eastern Tennessee who regularly travel to Atlanta and back--and Atlanta's Hartsfield airport is one of the four or so where most people coming from West Africa arrive in the US, so chances are that people in any part of Tennessee--particularly the eastern half--might indeed meet someone who had been there. Additionally, we're generally mobile--and even the stay-at-homes come in contact with people who do travel.

But culture--what you're taught to fear and how you're taught to react to fear--is more important than actual physical distance in terms of how people react. Until Mr. Duncan was diagnosed in Dallas, Texas was farther from West Africa than Tennessee, but only some were talking about the end of human civilization. The GOP politicians running for office are using Ebola as another threat (to blame on Obama and Democrats, of course--even to the point of claiming that Obama infected Central American children with Ebola and sent them north through Mexico and into Texas to bring Ebola here) and to bolster their claim that the border must be secured. But that's not all Texans (and I'm sure not all Tennesseeans, or all Georgians.)
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[User Picture]From: dyvan
2014-10-15 06:23 am (UTC)

So much of what is the issue here is down to complacency, to hubris....to a generational shift in disease thinking going back to WW2 and penicillin, a belief we can "science" our way out of anything.

Except for the science to work you need time, and our failure to safeguard those strongpoints - to provide an organised reasoned response - is where the greatest loss is likely to occur. Why should we expect nurses, and doctors, to sacrifice their lives for ours, if the funds to train them have never been made available?

Ebola kills, it waits for mistakes, carelessness, and just being right, or fair, or decent, or religious, isn't enough you have to be professional and trained and aware.

Ebola may not be the pandemic we wait on, it could be the next outbreak of particularly virulent flu, or a virus jumping from horses to people.....or something we haven't heard of yet.

We continue to create the conditions, provide a population of under-health supported persons for a disease to incubate in....it isn't a question of if, rather of when - history can show us that.

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[User Picture]From: e_moon60
2014-10-15 02:53 pm (UTC)
There are plenty of candidates already around--multi-drug-resistant TB, MERS, tropical insect-vectored diseases, resurgent polio, a new gut-bug virus that's caused deaths or paralysis in some victims, good old influenza...plus, as you say, the ones not yet known at all that may mutate to a form that can use humans as well.

Like other friends whose mothers trained as nurses before WWII, I've heard all my life about the dangers of over-dependence on antibiotics--which only ever worked on bacterial diseases anyway--and the lack of training "modern" hospital staff get in serious precautions against contamination. The move to make hospitals more homey and appealing increases the opportunity for germs to escape cleaning efforts.

But more dangerous, to me, is that this complacency has spread to encompass much of the public health thinking of those in power, both locally and internationally. Lessons learned about the importance of infrastructure in both disease prevention and management, for instance.
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[User Picture]From: thewayne
2014-10-15 03:31 pm (UTC)
I have an unusual medical condition, hypogammaglobulinemia. My body does not produce immuneglobin, so my adaptive immunity system is pretty much not there. There's 50,000ish or more of us in the country. As it happens, a friend of mine nearby has the exact same condition, but ended up with it through a different chain -- I'm genetic, she was exposed to nasty chemicals from being a jet engine mechanic in the USAF. We were talking recently (she has a Masters in Public Health Administration) and naturally talked about ebola, and basically if we get it, we're dead. Our body cannot build immunities to it, so if we can't get Zwhatever (of which there are no doses remaining) or a transfusion from a survivor, we're dead.

Period. Death, no saving throw. Most people have a 50/50 chance of surviving, probably somewhat better in the USA. But us people with CVID? We're toast.

To top things off, we're flying through Dallas to DC and back in two weeks, so it's nibbling at the back of my mind. I know my chance of infection is almost nil as I understand the infection vectors, but my condition leads to a bit of hypochondria. My wife is much more concerned with measles in Texas and flying.

I found it quite interesting that Mark Zuckerberg, Facebook zillionaire, gave $25,000,000 to the CDC. It's a drop in the bucket, but it is a pretty big drop.
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[User Picture]From: e_moon60
2014-10-15 04:34 pm (UTC)
Scary indeed. I don't know much (but what you told me) about your condition, but I do remember that pre-polio vaccine, gamma globulin from the blood of healthy donors was sometimes given to kids exposed to polio. When the second grade teacher at my school got polio, every child in the school who'd been in contact with her was given it (a BIG shot with a FAT needle, from my child perspective) and I did not get polio. I don't know if this is still available, or would work for you when you have to travel, and you probably already know about it...but if not, it might be worth asking your doctor. My best wishes for you to have an uncomplicated trip where you don't catch anything.
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[User Picture]From: blueeowyn
2014-10-15 08:31 pm (UTC)
The gamma globulin shot I got as a young adult (19?) was a BIG shot with what felt like a BIG needle and the stuff was thick so it stuck around (rabies exposure ... 8.5 CC split between the 2 glutes).

I think that gathering plasma from the people who have survived is a worthy thing to do and start sharing that plasma with people who have been exposed. Granted, I would start in the countries where it is so pervasive in an attempt to start to contain it before treating here.
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[User Picture]From: e_moon60
2014-10-15 04:37 pm (UTC)
Good for Zuckerberg.

I hope the day comes when people who can--including corporations--will donate sewage treatment plants instead of sports stadiums to get their name on something important. I have nothing against sports stadiums, but it would be a better world if there were more sewage treatment plants, more water purification plants, more basic public health measures--and see no reason why they shouldn't be named after those who donated to build them.
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[User Picture]From: grassrose
2014-10-16 07:25 pm (UTC)
If you want to see something really scary, take a look at the outbreaks page on the Global Incidents site. They track things I had never heard of, at least one of which is moving inexorably into the US (Chikungunya - a mosquito-spread disease).

http://outbreaks.globalincidentmap.com/home.php
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[User Picture]From: e_moon60
2014-10-16 08:31 pm (UTC)
Oh, chikungunya's a known Thing. Once we got the first confirmation of an exotic mosquito species in the US, husband and I made a list of what would eventually show up. We also keep track of outbreaks via medical journals.
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[User Picture]From: grassrose
2014-10-17 09:16 pm (UTC)

Chikungunya - A Known Thing

Yes, but you are educated on matters of which I was ignorant - and on some of which I'm still ignorant, I'm sure.

The site amazed me. H1N1 is all over the U.S., plus the occasional anthrax and the aforementioned chikungunya. Meanwhile, dengue fever is very common everywhere else, along with random cholera and the occasional fever I've never heard of. There's also polio, waiting to reenter our country as soon as Jenny McCarthy can get our herd immunity down low enough.


dengue fever, cholera, typhoid fever;
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