Tuesday, December 16, 2014

@$$Clown Of The Ides: Chuck U Very Much, Senator...

The real motivation for all that Ebola preparedness comes out:
(PORKVILLE) -Senator Chuck Schumer on Monday called on U.S. secretary of health and human services Sylvia Mathews Burwell to recognize the enormous amount New York hospitals have spent preparing for and treating the Ebola virus, and use some of the money she was given by Congress to reimburse hospitals for their expenses.
Burwell has 30 days to come up with a spending plan for the $733 million her agency received from the latest continuing resolution, a $1.1 trillion spending package that allotted a total of $5.4 billion to combat Ebola.
Most of that money is headed to West Africa, where the epidemic continues to claim thousands of lives, but some can be used domestically.
Schumer said he would like New York hospitals to receive roughly $50 million
         “I am urging secretary Burwell to make sure all of New York's institutions are completely reimbursed for their funding,” Schumer said at a press conference today outside Bellevue Hospital. “That was the purpose of the fund when we push for it and created it.”
Mayor Bill de Blasio has already reimbursed Bellevue, a part of the city's Health and Hospitals Corporation, $20 million for the expenses it incurred when treating Dr. Craig Spencer, the physician who contracted Ebola while working with Doctors Without Borders in West Africa.
But other hospitals have spent tens of millions of dollars preparing for the virus, Schumer said.
Montefiore has spent approximately $7.5 million building a biocontainment unit and training staff, Mount Sinai has spent between $7 and $8 million, and New York Presbyterian has spent roughly $3.3 million, according to Schumer's office.
Ken Raske, president of the Greater New York Hospital Association, estimated the ten Ebola-designated hospitals in New York have collectively spent between $50 million and $75 million on capital construction, the purchase of protective gear and training.
Try and look surprised at the prospect of a Democrat senator trying to shove both arms armpit deep into the taxpayers' pockets and keep everything he can get his hands on.

Webster's Dictionary could save space by consolidating the entry for Chuck and the entry for chutzpah. Or at least using the same picture.

Like Getting Ebola Wasn't Bad Enough

Kenema, Sierra Leone (Al Jazeera )- Massah Kamara sat patiently with her brother Momoh, her haunted eyes focused somewhere in the middle distance beyond the walls of the post-Ebola clinic.
Three months earlier, doctors gave her the good news - after weeks of fighting the disease, she had finally beaten Ebola. She would live.

Back in her home neighbourhood of Nyandeyama, a quiet suburb of sandy streets and mango trees, she found out 22 members of her family were dead, including her parents. She had no money, so was unable to go back to her tailoring business, and many of her possessions had been burned by terrified neighbours.

Then, just when she thought things couldn't get worse, she began to lose her eyesight.
"My eyes are dark," she said sadly. "Even when the sun is shining, my eyes are dark." Kamara said she was happy to have survived Ebola, but fear and misery were etched onto her face.
Kamara is one of 40 percent of Ebola survivors to have gone on to develop eye problems, according to a recent study carried out by the World Health Organisation and Kenema's District Health Management Team. It has been more than a month since the district saw it's last case of Ebola, and attention is turning to the plight of survivors.
The results of the survey, a copy of which was seen by Al Jazeera, outline a raft of physical, social and psychological problems the survivors are experiencing.
Seventy-nine percent, for example, now suffer from joint pain; 42 percent have problems sleeping, while more than one-third of those surveyed experienced peeling of the skin. Many others reported problems with their reproductive system.
Post-survival effects 
"There is so little written about post-Ebola problems," said Maggie Nanyonga, a WHO consultant working with Ebola survivors in Kenema district. "We don't know if it's the drugs that are causing it, or the disease, or just stress."
In a small room at the government hospital in Kenema, now known simply as "Psychosocial", volunteers busily transcribed forms with survivors' complaints. "Serious backbone pain. Difficulty breathing. Properties burned but not replaced," reads one.

"Ear and joint pains. Poor health with red eyes," reads another. 
 "Tired legs and weakness. Cannot see clearly," reads a third.Health education officer Michael Vandi said the eye problems are of particular concern. "We just weren't expecting this. A lot of them are experiencing it, often combined with headaches," he said.The head of the hospital's eye department, Ernest Challey, said he believes he has found the cause - a condition called Uveitis that occurs when the innermost coating of the eye becomes inflamed.
It is triggered by problems with the immune system, a viral infection, and sometimes trauma, he explained. It leaves patients with dim and blurred vision, and pain when they're in bright light. If left untreated, said Challey, it can lead to blindness.

But the physical symptoms are just a part of the immense challenge many Ebola survivors face. "Sometimes I cry when they tell me their stories," said one nurse after writing down Kamara's details in the post-Ebola clinic, the first of its kind.
And it gets worse, according to the rest of the story: the locals treat survivors like pariahs, having burned their few belongings, and shun them afterwards, so they're left with no place to live and no job, as all the health problems pile on.

There's never been a post-Ebola clinic, because historically, the Ebola Survivors Clubs have usually been able to meet in a phone booth.

But with a few thousand survivors this time out of at least 20,000 victims, medical science is getting a new chapter in Ebola treatment: follow-up prognosis for survivors. And it isn't pretty.

Not least of which because what little assistance is going there is aimed at trying to curb the actual outbreak, not deal with the aftermath.

We never had to do much of that before...

Monday, December 15, 2014

Some People Don't Know When The Music is Over

"Can I just get five more seconds in the spotlight? How about four? Okay then...three...?

Speaking of Slow Learners, today's NPR blast of woulda-coulda-shoulda:
Speed. That's key to ending the Ebola epidemic, says the director of the U.S. Centers for Disease Control and Prevention.
Dr. Thomas Frieden is visiting West Africa this week to figure out how to reduce the time it takes to find new Ebola cases and isolate them.
Otherwise, Ebola could become a permanent disease in West Africa.
               "That's exactly the risk we face now. That Ebola will simmer along, become endemic and be a problem for Africa and the world, for years to come," Frieden tells NPR. "That is what I fear most."
Frieden plans to spend several days in each country where the virus is still out of control — Guinea, Liberia and Sierra Leone.
The biggest challenge right now is in Sierra Leone, he says, where the epidemic shows no signs of slowing down. New cases continue to rise exponentially. Last week, the country reported nearly 400 cases, or more than three times the number of cases reported by Guinea and Liberia combined.
Since February, there have been nearly 18,000 reported Ebola cases globally, the World Health Organization says, with more than 6,000 deaths.
               But Frieden is still confident that the three countries can eventually reach zero new cases and end the epidemic.
Because the world has stopped every Ebola outbreak before, Frieden says. "Even in this epidemic, we are stopping individual outbreaks. The challenge is doing it at a scale and with a speed that we've never done before."
When Frieden visited West Africa last time, in August and September, the disease was "raging out of control in Monrovia," he says.
Since then, the epidemic has slowed down in Liberia. "But we haven't been able to get it under control," he says.
               "As the weeks have gone by, we have been able to intervene faster [in Liberia]," Frieden says. "We've found that we can stop outbreaks in weeks instead of months."
So a hot spot in one town or county ends up having only a handful of cases instead of hundreds, he says.
Now the CDC and international aid groups need to figure out how to do that in Sierra Leone.
But even then, the response may not be fast enough. All it takes is one sick person to travel to a vulnerable town and ignite a new hot spot. That's been happening in Guinea for months.
"It's not like a forest fire, so much," Frieden says, "as a country full of bush fires in different places."

Tom, check your spam filter: President Obola sh*t-canned you back in October, when he appointed Flounder to be the new Invisible Disinformation On Ebola Czar. The memo you missed is probably in  there.
So, a few pointers:

* If you've noticed a lot of space on your Day Planner lately, it's because you're officially dead in D.C.
* The first hurdle to tracking Ebola contacts in West Africa, is getting the countries involved to admit that they have them. When everybody admits that there's a "fudge factor" of between 2 and 200 to multiply official reports by, going back to, oh...forever in this outbreak, that's how many cases you'll never track, times the 10-100 contacts they create.
* The second hurdle would be teaching 20,000,000 people there how to count. If the illiteracy rate there was the growth rate of GDP, they'd all be driving Beemers and flying in Gulfstreams. As it is, they wear sandals in case they have to make change for a quarter.
* Ain't nothing happening there on a Western "right now" time frame. They make "island time" look like a FedEx Distribution Hub. "Just in time" in West Africa means "order three years in advance, double the needed amount, and keep a slush fund handy for last minute bribes, and there's a 60% chance we'll have this no later than a month after you need it."
Seriously, dude, try talking to any of your own people there about this.
* Once you tackle those paltry problems, you only have to get past two or three other minor details:
The cultural hurdles of a grabby/touchy/feely society
The religious hurdles of inshallah and the associated local burial rites and customs
The scientific hurdles of taking a country to accepting scientific germ theory accepted here since Pasteur, in one where this month 50-75% of the peoples there are more likely to believe that what's killing people is curses and witchcraft than "Ebola".

If you look closely Tommy, you might notice how curiously similar all that sounds to the phrase "nation-building". Something Britain and France couldn't do there in centuries. Maybe there's no TV in your lab or office, or you're more of a theatres-and-symphony kind of guy, but that phrase doesn't have quite the cachet now that it might have had in, say, 2003.

So why don't you respond to one of the 47 e-mails that career recruiter has been sending you for the last 8-10 weeks, and see about updating your resume.

You've "solved" quite enough geo-political epidemics for one lifetime, I think, and maybe you should get a new hobby to fill your golden years.

Oh, and nota bene, careful readers, that NPR and Frieden himself are still describing this outbreak as "out-of-control" in no uncertain terms, in all three countries.

Slow Learners Pay The Price

GENEVA (Reuters) - The failure of Sierra Leone's strategy for fighting Ebola may be down to a missing ingredient: a big shock that could change people's behaviour and finally prevent further infection.
Bruce Aylward, the head of Ebola response at the World Health Organisation, said Sierra Leone was well placed to contain the disease -- its worst outbreak on record -- with infrastructure, organisation and aid. The problem is that its people have yet to be shocked out of behaviour that is helping the disease to spread, still keeping infected loved ones close and touching the bodies of the dead. "Every new place that gets infected goes through that same terrible learning curve where a lot of people have to die ... before those behaviours start to change," Aylward told Reuters.The WHO's death toll from outbreak has climbed to 6,583 but the actual figure is likely to be far higher due to under-reporting of cases. The flare-up in Sierra Leone's capital Freetown and the country's more heavily populated western areas resemble the massive infections suffered in August by Liberia's capital Monrovia. "In Monrovia you had bodies on the streets, you had a riot, you had someone shot - awareness went through the roof in a very, very short time as a result," said Aylward.             "You don’t want to see that kind of thing drive public awareness but it has an impact very, very fast. People changed behaviours in Monrovia - bang! Like that." Mali also learned through a shock. Just as it seemed nobody had been infected by its first Ebola patient in October, another cluster of deaths sprang up the following month. Aylward said he told Malian officials that the only way to stop the outbreak was to trace anyone who may be at risk. "That’s when the contact tracing... took a jump from around 60-70 percent completion to 98 percent," he said.Denial and ignorance are part of the problem but a weak healthcare system and logistics also play a part. Officials in Kono - where an explosion of infections was discovered this week - said the eastern district of 350,000 inhabitants had only one ambulance and no Ebola treatment centre."The forest area of these three countries has got some really special and concerning practices, where they share meals with the corpse, where they sleep with the corpse," he said.Some areas of eastern Sierra Leone that were hit hardest early in the epidemic -- around the towns of Kenema and Kailahun -- have seen a massive reduction in case numbers as people change behaviour. "The areas that are now doing badly are the areas that were affected last. They are still on the learning curve."

Amazing to hear the UN official in charge of the entire WHO response wistfully longing for the more resposible parties to shoot few stupid people to get their attention, but there it is, and in print.

And short of that or massive die-offs, currently in progress, about the only thing likely to wake them up.

And as noted by commentor geoffb, the lesson fades from view overnight:
ABUJA Nigeria (Leadership) -The declaration of Nigeria as an Ebola-free country by the World Health Organisation (WHO) in October has prompted many Nigerians to discontinue the practice of maintaining a good level of hygiene as a measure of containing the Ebola Virus Disease.
From schools to banks and other public places, the strict measures of screening for signs of the disease put in place while the outbreak lasted between July and October, have fizzled out in most places. Most Nigerians are now living a care-free life because, according to them, Nigeria has been certified Ebola-free by the WHO, which means there is no cause for alarm.

Hopefully Ebola got the same memo, or the remedial course is going to be a bitch there.

Sunday, December 14, 2014

Another Ebola Round-Up

Given the all but predictable info-dumps on the weekends, the latest:

(Reuters) Liberia's elections have gone from on to off and back to on, currently for Dec. 20th.

(WaPo) Johns Hopkins has designed a vastly-improved next-gen moonsuit for Ebola caregivers to wear.
Takeaways: it's months from production and distribution (if that even occurs), so currently it's total vaporware this side of next summer. Or perhaps ever.
It's also exactly the isolation spacesuit all the naysayers said we didn't need to use to keep health care workers from getting infected. It's amazing what a dose - or 20,000 of them - of reality does to all those cheery "We can handle this stuff" bull$#!^ assertions. Remarkably, you can't find those people opening their yaps about things now. How curious.

(CTV) Sierra Leone reports the 12th doctor there now infected with Ebola. At this rate, they won't have any doctors left at all in a couple more months, other than outsiders come to help. They've gone 1 for 11, with the other 10 dead, on previous MDs infected. Interns have gone on prolonged and repeated strikes demanding actual protective gear, and almost all the doctors who have been infected had it happen while treating patients in other non-Ebola areas, indicating the Ebola-infected are going to other (non-screened) treatment areas, and cross-infection has already or will soon wipe out the entire minimal health system in the country unless everyone everywhere is treated as an Ebola patient 24/7/365.

And the best of the bunch, from (NPR) : What Happens When You Let Illiterate Retards Run  A Crisis (quoted in its entirety, as it was just too good to chop up)
As part of Sierra Leone's broader effort to contain the deadly Ebola virus, the country opened a new ambulance dispatch center in September in the capital, Freetown. Along with a new Ebola hotline, the center is considered an important step forward in the war on Ebola.
But on the center's second day of operation, a series of errors put the life of an apparently healthy 14-year-old boy at risk.
The dispatch center is situated in a meeting room at the Cline Town hospital just north of downtown Freetown. Inside the room, a group of men and women are huddled around a table full of laptops. Safa Koruma, a technician, points at a message on a screen. It describes a possible Ebola patient, reported through the hotline, with the words "vomiting and very pale."
Koruma forwards this message — along with hundreds of others — to the nearest health official. A community health worker is then supposed to evaluate the patient and assess the likelihood of Ebola.
"Probable" Ebola cases end up on a large whiteboard on the other side of the meeting room. It's the master list for ambulance pickups.
Victoria Parkinson, of the Tony Blair African Governance Initiative, is one of the directors of the center. She points at a name on the board with the number five written next to it, indicating the number of cohabiting family members.
"We want to get that [person] quickly, because there's many people in the home that could be infected by," she says.
One of Parkinson's colleagues, Ama Deepkabos, writes down an address and hands it to an ambulance driver. "It's 7 Hannah Street, 555 Junction. Do you understand?" she says, imitating the local Krio accent. "Go directly to the patient. No other stops!"
The driver nods and hustles out to the dirt parking lot, along with a nurse. I attempt to speak with the driver and nurse, but neither speaks good English. They step into a white Toyota SUV with the word "Ambulance" in large red letters, and pull out of the parking lot.
Sierra Leone is in the midst of a three-day national lockdown, intended to slow the spread of Ebola, so the roads are clear. The ambulance speeds across town and is waved through multiple police checkpoints.
After two wrong turns and several stops for directions, it eventually bounces down a long dirt road in Waterloo, a rural suburb 15 miles southeast of Freetown.
The driver and nurse spot the person they believe to be the patient: a 14-year-old boy in a blue T-shirt slouched on a white lawn chair.
They get out and put on glimmering white protective suits, surgical masks and rubber gloves. They walk over and escort the boy, who is able to walk on his own, into the back of the ambulance without touching him. They kick the door closed behind him.
The boy's guardian, Suleiman Espangura, is the principal of a nearby high school. He recently took the boy, Ngaima, into his custody because his family was moving to a rural part of Sierra Leone, and Ngaima wanted to stay at his current high school near Freetown.
"He likes to play football," Espangura says of the boy. "And he's very clever. We [teachers] like children who are clever."
Espangura says he's unclear why Ngaima is being taken away in an Ebola ambulance. He says the boy doesn't have any signs of Ebola — no fever, no vomiting, no diarrhea. He just has a headache and a slight loss of appetite.
But because Espangura had heard multiple public service announcements encouraging people to report any signs of illness, he contacted a health official and was told a community health worker would come to evaluate Ngaima. Instead, an Ebola ambulance showed up.
Espangura says the ambulance driver and nurse asked him if Ngaima was "the patient." Espangura said yes, thinking the men were here to evaluate him. Instead, they ushered the boy into the ambulance and whisked him away.
The ambulance rushes across town to a military hospital with an Ebola isolation unit set up outside — a series of white plastic tents with a blue tarp stretched around the perimeter.
The hospital guards, in military fatigues, tell the ambulance driver and nurse that Ngaima is not on their list of expected patients. A heated argument ensues. The driver insists that he is merely following instructions, and that this is the correct patient.
One of the guards eventually calls the head of the hospital, who consents to admitting Ngaima. The driver and nurse spray the back of the ambulance with chlorine and open the door to let him out. Ngaima steps out of the vehicle and disappears behind the blue tarp fence, into the Ebola ward.
A few minutes later, another Ebola ambulance arrives. The military guards are expecting this patient. But they say the beds beds are now completely full — Ngaima has taken the last one. The new patient is admitted anyway.
It's not clear exactly what went wrong here. But now, a 14-year-old boy with a headache is sitting inside an Ebola isolation center.

It's really heartwarming that Sierra Leone's Ebola response is being administered with the same tenderness and regard for common sense and patient outcomes as our own Veteran's Administration, by people that put the Keystone Kops' sketches to shame. And don't worry, if little Ngaima didn't have Ebola when he arrived in the treatment center, he soon will. 

Saturday, December 13, 2014

And As A Reminder

Here's the YouTubed home vid of a doc coming out of PPE isolation in W. Africa (in this case, for his last time). Note the process, and the fact that despite doing this one or more times a day while working there, the second safety monitor catches him a couple of times; also note the numerous times where he washes and re-washes and re-washes his gloved hands before touching the next item(s). The apron, goggles, and boots are re-used; everything else is toast after a single use, including both pairs of gloves, suit, and hood.

This is TIME's Person Of The Year, #30014. Now you have a taste for why.

Stupid Is As Stupid Does

Surprise! Surprise!
Shortly after re-opening their border with Guinea(?!), closed since mid-August, the nation of Guinea Bissau let someone through with a high fever. Someone of surpassing intellect amongst the assorted rent-seekers belatedly realized that was a bad thing, and they subsequently located and pulled the next potential Index patient (and 8 others in close contact) off of a bus preparing to head from their border straight to the regional teeming capitol. (Stop me if you're heard this one.) He was several miles away from the border when finally located.The nine individuals are all now in isolation pending test results on Mister Potential Ebola.

Kudos to whatever semi-literate(s) suddenly had an attack of intelligence; he probably saved his country joining the Ebola tally in 2-21 days.

And whatever Customs and Immigration @$$hole (or whatever passes for it in Guinea Bissau) decided opening their border to an endemically-infected Ebola nation was a good idea should be the next recipient of the "Up Against The Wall!" African Retirement Ceremony usually reserved for deposed dictators.

(French-language link in the local press)

This is why Ebola isn't going away in the retarded part of the world anytime in the foreseeable future, sports fans. This was one IQ point away from becoming next week's newest outbreak, and 5-50 more cases. And remember, according to our government, we aren't safe here until they wipe it out over there.

Friday, December 12, 2014

When Hyperbole Isn't Enough

In past, I have rhetorically used the phrase "cancel Christmas" to describe things when/if the Ebola situation gets bad. Now, Sierra Leone has done exactly that:
(AU News) SIERRA LEONE is banning public Christmas celebrations as the spiralling caseload of Ebola infections continues to spread alarm. Soldiers are to be deployed throughout the festive period to force people venturing onto the streets back indoors, the government’s Ebola response unit announced on Friday.
Palo Conteh, head of the department, told reporters in the capital Freetown there would be “no Christmas and New Year celebrations this year”.

Thursday, December 11, 2014

Number Crunching Reported Cases

Courtesy of Reddit and user c0mputar, here are the 4-day daily case totals of reported Ebola cases going back to late August:

  • Dec 4th-7th: 102/day
  • Nov 30th-3rd: 128/day
  • Nov 26th-29th: 129/day
  • Nov 22nd-25th: 129/day
  • Nov 18th-21st: 120/day
  • Nov 14th-17th: 122/day
  • Nov 10th-13th: 165/day
  • Nov 6th-9th: 185/day
  • Nov 2nd-5th: 115/day
  • Oct 29th-1st: 115/day
  • Oct 25th-28th: 146/day
  • Oct 21st-24th: 107/day
  • Oct 17th-20th: 168/day
  • Oct 13th-16th: 127/day
  • Oct 9th-12th: 130/day
  • Oct 5th-8th: 132/day
  • Oct 1st-4th: 124/day
  • Sept 27th-30th: 138/day
  • Sept 23rd-26th: 129/day
  • Sept 19th-22nd: 137/day
  • Sept 15th-18th: 130/day
  • Sept 11th-14th: 124/day
  • Sept 7th-10th: 127/day
  • Sept 3rd-6th: 105/day
  • Aug 30th-2nd: 104/day
  • Aug 26th-29th: 101/day
  • Aug 22nd-25th: 101/day

  • With all the caveats regarding "official" reported numbers vs. actual cases, and noting that this includes periods where nations added - and subtracted - thousand-plus numbers into short periods, what's notable is that since late August, this outbreak hasn't been below 100/new cases day. It's also never gotten as high as 200 cases/day.

    IMHO, that points to this range being the maximum number of tests that can be run in one day, and/or the maximum number of people who come forward for testing, versus any approximation of the actual number of people infected in any place or period.

    Which explains everything else about supposed flattening of the growth curve.
    The fact that it isn't going anywhere, up or down, is proof that there are always (for the last nearly 4 months) at least 100 people so sick with Ebola that they'll finally drag themselves to an ETU - or collapse in the street - for isolation and testing. (It's more than that, but a notable number of them die before testing, which opts them out of the process with some finality, while simultaneously letting those nations elect to not count them in the death stats, since the cause of death is thus "unknown". How convenient. Shovel, shut up, and keep the news cheerful. QED)

    So what this tells us is more like a tachometer than a speedometer of the infection: it tells us how fast the labs are cycling tests.
    It doesn't tell us what gear the infection is in, if you will.

    It might be fair to think things were winding down, except for recent note that burials are humming along everywhere, while stacks of unburied bodies are being discovered all over Sierra Leone, while in Guinea, the spread of the disease simply refuses to taper off. Liberia seems mainly to have mastered the use of pencil erasers to solve their statistical problems.

    And Now, The Serious Lying Starts

    (Reuters) - An American nurse who was exposed to Ebola while volunteering in an Ebola treatment unit in Sierra Leone will be admitted to the National Institutes of Health's Clinical Center in Maryland on Thursday, NIH announced.NIH did not release any further information on the nurse, including when he or she might have been exposed to the virus, current medical condition or affiliation.
    It is thus apparent that we're not meant to know where she's arriving from, whether and how many people she may have already exposed here or anywhere else, or anything further about the case.

    And she's being taken to the one facility (out of four) completely under the control and purview of the U.S. government, from top to bottom. Make of that what you will.

    If you aren't continuing to get your personal quarantine ducks in a row, you aren't paying attention.

    UPDATE: NBC local affiliate is reporting that the nurse has tested negative for Ebola. So whether she's actually infected is an open question, and/or will accidentally leak out the truism that a negative initial Ebola test doesn't mean you're not infected.
    Disinformation Czar Klain will not be pleased.