EBOLA IN THE U. S.: An Abundance of Caution Can Prompt Excessive Fear

No doubt you’ve heard that an Ebola case has developed in New York City, that of Dr.  Craig Spencer, who had worked with Ebola victims in Africa.  Of course, that has prompted another media frenzy (“first Ebola case reported in New York!”) that is supposed to calm our nerves but makes us more nervous (think of the teeming million of potential victims).

But not me.   So far, here is what the Ebola crisis has added up to in this country, one Ebola death of a man who came to the U. S. with the disease and two infections of nurses who treated him after he had full blown symptoms, and they did so in a hospital that was not prepared to deal with a surprise visit of that virus (which seemed true of most of our hospitals at the time).

The good news is that was a wake up call.

From articles I’ve read, training for dealing with a walk in Ebola case has sky rocketed since then, with Belleview Hospital where Spencer has been treated, an excellent example.  In my previous post, I pointed out that only four hospitals were considered specialists in dealing with an Ebola case, but prompted by the Dallas debacle Belleview seems to have upped it s preparedness enough to become a “designated Ebola Center”.

I have read about three Maryland hospitals  that have attained the same status, and are “listed as second options for the treatment of Ebola patients who are unable to go to one of the federal health facilities.”   I suspect a number of hospitals in other states have followed suit.

To me, that is the big news as to what is going on with Ebola, not a doctor who has been monitoring himself twice daily and finds he has a fever (100.3, not the 103 initially reported) and is taken into Belleview for treatment immediately.    From what I can tell, his chances of infecting anyone prior to having that fever are virtually nil (note, despite even his having a fever no one close to Thomas Eric Duncan in Dallas, including his fiancee, caught Ebola and all are now cleared of quarantine).

The problem is that with each case of Ebola we go into maximum response mode with quarantines and watch lists of anyone who might have had some contact with the victim, implying a sense of wide spread danger when really it is the hospital workers who deal with vomit and diarrhea who are much, much, much, much more likely than anyone else to catch the virus.  The doctors who wind up on TV say as much, or at least imply it.

The reason they don’t stress it more adamantly is that no matter how unlikely, it is theoretically possible the disease could spread through casual contact, so they tout the value of an “abundance of caution”, while simultaneously producing an excess of fear fueled by the media’s always implying they will share special insights and news just after the next commercial, which is seldom more than a rehash of what they have repeatedly covered.

There is an element of c.y.a. in all of this, of course, as a doctor who criticized all the attention paid to the wrong things would be crucified if someone did happen to get Ebola in a surprising way.   So, from this self-protective angle too, better to show an excessive amount of caution.

Ashoka Mukpo, a free lancer from  NBC and another who caught Ebola in Africa and is now cured, is no doctor, but I think he got to the nub of this issue better than most doctors in a recent tweet:  “People get Ebola by being around very very sick people.  Not people who felt a little funny and then became symptomatic later that night.”

Again, the only two people who have caught Ebola in this country fit that bill.

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(1)  The national CDC offers a guideline for the possible transmission of the Ebola virus, located here.    If you read the page you can see how it is conceivable that someone could catch Ebola from touching the same surface as did an Ebola victim, but from what I can tell that victim would have had full blown symptoms for this to possibly happen.

By the way, some of the fear regarding Dr. Spencer’s case stems from that initial report that he had a temperature of 103 when contacting the hospital, implying that he might have had a temperature well before that.   Now it seems it was 100.3, a big difference because by all reports the chances of contracting the virus get much greater as symptoms worsen.

EBOLA in the U. S.: What is Most Worrisome?

Move over ISIS, you are being scooped by the U. S. Ebola problem today.  It is not a crisis, but it may have the makings.

Most of the cable news this morning has been focused on the fact that Amber Vinson, a second nurse from Texas Health Presbyterian. has contracted Ebola.   The first was Nina Pham.

Worrisome is that Vinson was allowed to fly back to Dallas following a trip to Cleveland despite her reporting to the CDC that she had a fever of 99.5.  She was told not to worry about it because their guideline is 100.4.

Ah….  shouldn’t it matter that she had treated Thomas Eric Duncan, the Ebola patient who died in Dallas?  Rules are made to be broken in special cases.

It sounds like they will lower that bar now, but it is one more reason to be nervous as to the preparedness of  our health care system for handling Ebola cases.   Texas Health has issued a statement that they followed CDC procedures and staff had the recommended protective gear in treating Duncan, but that seems the product of a legal team and nurses there report differently, one very publicly on TV this morning.   Basically, when confronted with an Ebola case, the response was chaotic.

But here’s what’s most worrisome to me.   We have only four hospitals that are expert at handling infectious diseases like Ebola, one of them Emory where Vinson now resides.  More importantly, they are estimated at being able to handle only 19 patients max. 

As described in Time:

“There are four hospitals in the U.S. with special isolation units designed to contain biohazards like Ebola. In addition to Emory, they are the National Institutes of Health Clinical Center, in Bethesda, Md., a hospital at the University of Nebraska in Omaha and St. Patrick Hospital in Missoula, Mt. The facilities in Atlanta and Omaha have successfully treated Americans infected with Ebola overseas without any healthcare workers contracting the virus.

Though transporting future cases to these facilities may be prudent, they have limited beds: only 19 between them, according to CNN. Exclusively using specialized hospitals to treat Ebola is only an option so long as the number of cases in the U.S. remains extremely low.”

From what I’ve heard on TV from experts, we could easily have over thirty cases break out (and that seems a total guess to me) and I don’t know if that includes 3,000 military in West Africa, some of whom seem bound to contract the disease.

And it seems we are only completely confident that we can handle 20 or so.  I would worry less if I believed that we are doing whatever it takes to expand that capacity as quickly as possible.

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P. S. – After writing the above I saw Rachel Madow on TV focus on the same issue of all too few beds available for Ebola patients, but her count is even less:  She says nine beds in those four best facilities, four of which are now in use.   Whatever the exact count it seems way too few.

THE ISIS CRISIS: The American Dilemma of Involvement

I have been slow to post because my mind keeps spinning around trying to grasp how President Obama’s strategy to degrade and destroy ISIS will actually work.   The phrase “many moving parts” is often associated with the plan, but what makes me particularly uneasy is the feeling no one knows how these parts will assemble and then reassemble in the months and probably years to come.

One key problem with the grand strategy is that while many nations have pledged support, the degree of support or each remains largely nebulous or not all that much.   ISIS looks like it doesn’t have a chance on paper, but their fanatical warriors continue to capture ground in both Syria and Iraq.  The generally shared belief is that degrading and destroying ISIS will require “boots on the ground” to go along with air strikes, but other than the Kurds and the Iraqi government, no nation seems willing to provide those boots.

Bernie Sanders, U.S. Senator from Vermont

Bernie Sanders, U.S. Senator from Vermont (Photo credit: Wikipedia)

In the case of the Iraqi army, their boots have been largely useless, this despite years of training.   Now I hear talk of them needing more training.  Maybe, but they most need the will to fight against enemies quite willing to die for their beliefs, while my guess is most of the Iraqi army is largely fighting for a pay check.

So, we’re back to counting on the Kurds for the most part to supply boots that actually want to charge the enemy rather than run away from them.   And what I think 0f as a fantasy plan of training carefully vetted folks from the Free Syrian Army required to take a break from the action to get real good at fighting and then be inserted back into, well, who knows what and where by then?

Because we cannot  count on the fighting forces of other nations in this fight, there is a call by Senator John McCain and others  for more American boots on the ground as forward observers for the air strikes and as special forces, as well as more air strikes and a couple of other steps aimed at weakening Syria’s President Assad so he can’t take advantage of our weakening ISIS in Syria.

McCain argues that we are not doing enough to win right now, which may be true, but what is left unstated is  this very important question:  What do we do if his more robust plan doesn’t work, either?   Do we just pack up and go home?  More likely we get more and more deeply involved just as we did in Vietnam.   Talk of winning a war implies a willingness to do whatever it takes to succeed.

Senator Bernie Sanders, on the far left on the Democratic spectrum, shares McCain’s belief we should fight ISIS and is open to doing a little more than we are presently in this fight, but he is most concerned about us becoming bogged down in an endless war.  He makes the very sensible point: The more we are willing to do, the less the nations in the area feel they have to do?

Where are the troops from Egypt or Saudi Arabia or Turkey?  Where are their boots on the ground?  Do you realize Saudi Arabia ranks fourth in spending on arms world wide?   Behind only the U. S., China and Russia?    The Saudis have shown some support for the coalition in air strikes on ISIS and perhaps there has been money promised or more.  I don’t know.   But I recently saw photos of some of their pilots who are also Saudi princes and their involvement so far seems more likely a family photo shoot than a strong military commitment.  They don’t seem to be doing a lot in proportion to the danger ISIS poses to them.

But again as Sander points out, why should Saudi Arabia, Egypt or Turkey do more as long as we seem willing to do more than our share?

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P. S. – Each of those three nations has other concerns that often trump our desire for them to do more versus ISIS.   In future posts I will expand on their agendas that only partially harmonize with our goal of degrading and destroying ISIS.