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Ebola!

How worried should you be?
Wednesday, October 15, 2014, 9:35 AM

The current Ebola outbreak, unlike others throughout history, is lasting a very long time; with cases now being reported on a variety of continents well outside of its equatorial African origin.

I'm not especially worried about Ebola striking me or my loved ones, for reasons I'll explain in a moment. But I'm growing increasingly concerned about government response to the outbreak.

So let's spend some time understanding the nature of Ebola, specifically, and viral contagion, more generally. At the very least, Ebola can serve as an instructive reminder about how our society's responses to a viral outbreak could prove to be at least as disruptive and damaging as the virus itself.

Ebola

While very often cited as being 90% fatal once contracted, Ebola is rarely that lethal. In fact it was only that lethal in a single isolated outbreak. A 50% to 70% mortality rate is more common. As of Oct 10 2014, the latest outbreak had afflicted 8,376 and killed 4,024 -- a mortality rate of 48%.

This places the Ebola strain responsible for the latest outbreak on the lower end of the Ebola lethality scale. Don't misunderstand me: this is still a very deadly virus, to be sure. But it's not a guaranteed death sentence, either.

Viruses come in a wide variety of types and shapes. But the general structure they all share is that they have some form of nuclear material, either DNA itself or RNA, housed inside of a protein capsule. Think of a peanut M&M, where the peanut is the genetic payload and the outer coatings serve both a protective purpose (while the virus is seeking a new host) and as the means of docking with a host's cell.

That’s really all a virus is. A few proteins and some genetic material. No membranes, no sexual merging of genetic material, and no ability to replicate themselves all on their own. There are debates still ongoing today as to whether a virus should even be considered a living thing.

The life cycle of a virus is very simple. A virus particle will dock with a target host cell (most viruses are highly specific for the precise sorts of cells they will and won’t bind to), insert its genetic payload which hijacks the host’s replicative machinery, replicate the genetic payload wildly which codes for both new genetic material and protein capsule subunits, and then reassemble lots of intact virus particles which then escape the host cell to go and find other cells to infect.

Within a mammalian host, once a virus attack is recognized, an antibody response is mounted and the fight is on. As the virus particles escape the host cell (which is usually damaged or killed as a consequence of having been hijacked) it is vulnerable to being identified by a host antibody, itself a highly-specialized protein that will 'dock' with a virus particle more or less permanently (they bind together very tightly) and thereby incapacitate the virus’ ability to dock to a new host cell.

With lethal viruses, something goes wrong with this process. Either the virus replicates too quickly for the host to counter effectively, or the virus tricks the immune response into either too little or too much activity -- both conditions which can end poorly for the host.

For example, the Spanish flu epidemic of 1918 preferentially killed those between the ages of 20 and 40. This was unusual because it's exactly opposite the flu mortality patterns we normally expect, where the very young and the very old are the most susceptible.

The best prevailing explanation for this is that it was the very health and vigor of the patients that did them in. The Spanish flu (and other avian flu strains) cause the host body to unleash a 'cytokine storm' which is a very unhealthy, and sometimes lethal, positive feedback loop between immune cells and a class of attractor signaling molecules called cytokines. As more cytokines are released, say into the lung tissue, immune cells are attracted and can then release more cytokines, which attracts more immune cells, and so on. The place to which they are attracted becomes damaged by this overly-aggressive response of the immune cells and for the Spanish flu victims, this happened in the lungs, critically impairing respiration. Hence, the 'healthier' a host was, the more damage the Spanish flu virus caused.

In the case of Ebola, the virus preferentially targets the cells that line the inner walls of blood vessels (a.k.a. endothelial cells) as well as white blood cells, a fact which helps to spread the virus throughout the body fairly rapidly, as white blood cells actively migrate system-wide.

Through a variety of mechanisms, the Ebola virus causes the endothelial cells to detach from the blood vessels and die, which compromises blood vessel integrity. This targeting of the blood vessels is why the Ebola virus is classified as a hemorrhagic fever. The patient's blood vessels literally break down. That leads to the many visible symptoms of an Ebola victim, not the least of which is various burst blood vessels all throughout the body.

(Source)

Currently, it's thought that once exposed, an Ebola victim will incubate the virus for a period of up to 21 days before symptoms express. It's only once the victim is symptomatic that they themselves can transmit the virus and infect others.

This characteristic of Ebola, more than any other, is why I don’t fear it overly much as a pandemic risk. A far more worrisome virus would be one that's infective during asymptomatic stages of its host cycle, as is the case with HIV.

Early symptoms of Ebola include the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. Unfortunately, that pretty much describes any reasonably intense flu, which complicates screening procedures and causes unnecessary worry among those who merely have the flu but worry about the possibility of Ebola.

Nonetheless, authorities have no choice but to take every traveling passenger with these very ordinary flu symptoms as a possible Ebola case. It's a safe bet we’ll hear plenty in the coming days and weeks about Hazmat-suited response teams escorting sickly passengers off of planes.

A tip: if you have a fever, don’t travel. You'll worry a lot of people unnecessarily. And you may end up in quarantine, really throwing your travel plans off the rails.

The Short-Term Risk

While gruesome and heartbreaking, the actual number of deaths by Ebola as well as the total number of people infected is very, very low compared to other hazards out there.

Are you more worried about Ebola than driving to work? If so, you have those risks entirely inverted.

(Source)

In the above chart, there are 27 years worth of data contained in each data point. That means that if the chart reads 2,700 for a given day, then an average of 100 people died on US roads on that day each year out of 27.

For the US, the above chart translates into ~33,000 vehicle deaths per year. Even in Africa where some 4,000 people have died from Ebola so far in 2014, America's vehicle fatalities dwarf that current statistic.

Other communicable diseases such as HIV, tuberculosis, malaria, and diarrheal disease cause some 9 million deaths worldwide each year.

This is why I'm personally not that worried about Ebola striking me or my family here in the eastern US at this time. Nor would I be overly worried in Dallas, where the first two US-soil cases of Ebola command national attention. The odds of getting infected at this point are very low at the individual level.

The Longer-Term Risk

However, I do think that the reaction to Ebola, which could include ex- and inter-US travel bans and other economically and socially disruptive practices could be another matter altogether at this moment in time. While there is a small, but non-zero, chance that this Ebola strain could morph into something more virulent, there is a very good chance of a more Draconian government response developing.

In Part 2: Prudent Precautions To Take Now, we dive into not only what damage to our civil liberties and livelihood these heavy-handed and poorly executed government responses are likely to be, but we also address the actions that individuals can take today on important questions like:

  • Who is at risk of infection in the current ebola outbreak?
  • What's the likelihood the current strain will morph into a more virulent form?
  • What are the best steps to take today to reduce your vulnerability to a pandemic?

What Ebola reminds us of is that when a true pandemic arrives it will travel much faster than those in the past (thanks to air travel being an order of magnitude faster than dawning recognition) and that our complex, highly leveraged, just-in-time global economy is utterly unprepared for even a minor glitch in the flow of goods let alone the virtual lockdown that a true pandemic would require.

A small amount of preparing can make you much less vulnerable should (when?) that comes to pass.

Click here to access Part 2 of this report (free executive summary; enrollment required for full access)

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67 Comments

wmarsden's picture
wmarsden
Status: Bronze Member (Offline)
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Posts: 38
Mortality rate

There's some reason to believe that actual mortality rate is closer to 70%.  It's lower right now because the spread is mushrooming and many people are sick who have no yet died - but will.  

 

http://news.sciencemag.org/africa/2014/09/how-deadly-ebola-statistical-c...

AndyR's picture
AndyR
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Auto accidents

We are not seeing an exponential increase in auto accidents, so how can that be a valid comparison?  The risks are known and understood, and not doubling every 3 weeks. 

The plan such as it is, seems to be to let this pandemic burn out, which occurs as the sloppy replication of the virus causes it to lose its lethality in favor of transmission.  Spanish flu had a mortality rate of 2.5% and managed to span the globe before it burnt out.

A bit of fear, would be helpful in slowing the spread of ebola. 

timwoodsman67's picture
timwoodsman67
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not convincing

You sound very disingenuous when comparing ebola against car accidents. Car accidents do not grow exponentially! I worry more that the government will downplay the risks and tell us what we want to hear. Indeed, they are already doing so. You heard the CDC director stating there was a breach of protocol before even evaluating whether the protocols are sufficient or consistent. My impression is that you are using this to grind a familiar axe.

cmartenson's picture
cmartenson
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Let's use numbers, shall we?

I regularly like to keep things in proportion.  Ebola is still not yet anywhere on my personal worry list in terms of the disease potentially striking me.

Even if it is growing exponentially, the base is so small that it will take many doublings from here before any concern registers in my brain.

That's because I am versed in statistics and do not spend any time ingesting whatever fear du jour the media is peddling.

So far, what are your chances of dying in America from Ebola contracted here?  Exactly zero.

What are your chances of contracting Ebola at all?  So far one in 160,000,000.

What are your chances of contracting Ebola if you were not on the front lines treating a sick Ebola patient?  Exactly zero.

With all the things to actually worry about, why worry about something with almost zero chance of hitting you?  that's not an 'apologist's' stance, it is just by the numbers.

Here are some more numbers.

All unintentional injury deaths Number of deaths: 126,438  

Unintentional fall deaths Number of deaths: 27,483 

Motor vehicle traffic deaths Number of deaths: 33,783

Unintentional poisoning deaths Number of deaths: 36,280

kmaher's picture
kmaher
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Posts: 84
I also have no concern about

I also have no concern about catching Ebola here today.  I'm much less sanguine about Ebola than you overall.  My concern is that Ebola is not being brought under control yet and the longer this continues the greater the risk of Ebola establishing itself elsewhere say India, Egypt, Brazil or any other number of highly populated places with weaker medical systems than ours.  That potential greatly raises the risk that we see significant numbers of infections here which would seem to have the potential to overwhelm our medical system and would certainly have significant economic impacts.

Until recently, the Fed was pumping $85 billion dollars a month into the financial system.  I think it would be worth it to provide whatever resources are needed to those countries that are currently trying to get this under control.  It would seem a true bargain to guarantee a good annual salary to any Liberian Ebola survivor for example who was willing to be trained to take care of the sick and dead to get this under control.  Allowing this to rage on and spread to other areas risks inviting the black swans I'd say.  The risks aren't where the situation stands today it's where it could go in 6 months.

Another thought, I know a woman who grew up in Africa and swears that her immune system is strong enough for her to travel anywhere and drink the water eat the food and never worry about being sick.  How would American immune systems fare having never been exposed to the stressors of the average African, better or worse?  Also, I imaging in Liberia the people are accustomed to being more self sufficient and wonder if our efficient market and transportation systems would prepare us to cope better or worse than them?

Kevin

 

A. M.'s picture
A. M.
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Beware the CDC

The early responses are exactly why I'm more concerned about fear of Ebola than I am of Ebola, itself. 

The CDC's role in disseminating information, as Chris has said, is dubious - to put things conservatively.
Nearly all their statements have been inflamed by the media, and now people everywhere are expecting millions of cases by this time next year, if not billions. 

The modeling that's been done is literally taking place in a "worst case" vacuum. We can't expect the rate of doubling in Africa to adequately represent the doubling time anywhere else. If Ebola were revealed to have a much higher rate of transmission than previously thought, that would be concerning, and, not particularly surprising. 

At present, however, we're left with the official channels assessment, the MSM's spin machine on 'full-tilt boogie' and our wild imaginations. It's worth remembering that the Bubonic Plague was less deadly than the fear it created.

Cheers,
Aaron

rmurfster's picture
rmurfster
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Putting it in perspective...

If 8,000 cases seems statistically insignificant, how's 10,000 per WEEK? http://www.nytimes.com/2014/10/15/world/africa/ebola-epidemic-who-west-a...

 

Luke Moffat's picture
Luke Moffat
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%'s

Number of Ebola deaths this year = 4,447

Number of people on planet Earth = 7,000,000,000 (roughly)

4,447 / 7,000,000,000 x 100 = 0.0000635% mortality rate of Earth dwelling humans

Panic over

My more immediate threats are muggers, car users and alcohol poisoning

Now back to our regularly scheduled program

Time2help's picture
Time2help
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%'s

"The greatest shortcoming of the human race is our inability to understand the exponential function."

- Prof. Al Bartlett

dryam2000's picture
dryam2000
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Luke Moffat wrote: Number of
Luke Moffat wrote:

Number of Ebola deaths this year = 4,447

Number of people on planet Earth = 7,000,000,000 (roughly)

4,447 / 7,000,000,000 x 100 = 0.0000635% mortality rate of Earth dwelling humans

Panic over

My more immediate threats are muggers, car users and alcohol poisoning

Now back to our regularly scheduled program

You would refer you to the late Dr. Albert Bartlett's excellent youtube videos explaining exponential growth in layman's terms, or Dr. Martenson's excellent Crash Course video explaining exponential growth.

Time2help's picture
Time2help
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%'s
dryam2000 wrote:

You would refer you to the late Dr. Albert Bartlett's excellent youtube videos explaining exponential growth in layman's terms, or Dr. Martenson's excellent Crash Course video explaining exponential growth.

Both.

Luke Moffat's picture
Luke Moffat
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Haven't we been here before?

Swine Flu, Bird Flu, SARS

To Paraphrase;

Swine Flu

Based only on lab-confirmed cases, the WHO official figures report that just under 18,500 people died in the 2009 flupandemic.

A new study by over 60 researchers from 26 countries suggests that the number of people who died in the 2009 global H1N1 "swine flu" outbreak is much higher than official figures show.

Writing in PLOS Medicine, they estimate the total respiratory deaths worldwide to be up to 203,000, some 10 times higher than the World Health Organization (WHO) official total, which is based on lab-confirmed cases.

Bird Flu

Since 2003, 650 human infections with highly pathogenic H5N1 viruses have been reported to the World  Health Orgranization (WHO) by 15 countries. About 60% of these people died from their illness.

In 2011, 62 human H5N1 cases and 34 deaths were reported from five countries—Bangladesh, Cambodia, China, Egypt, and Indonesia.  Six countries— Bangladesh, China, Egypt, India, Indonesia, and Vietnam—have widespread and ongoing infections in their poultry. Poultry outbreaks have occurred in other countries recently as well.

 

SARS

The SARS outbreak of 2003

According to the World Health Organization (WHO), a total of 8,098 people worldwide became sick with SARS during the 2003 outbreak. Of these, 774 died. In the United States, only eight people had laboratory evidence of SARS-CoV infection. All of these people had traveled to other parts of the world with SARS. SARS did not spread more widely in the community in the United States. See an update onSARS cases in the United States and worldwide as of December 2003.

 

NOTICE

Since 2004, there have not been any known cases of SARS reported anywhere in the world. The content in this Web site was developed for the 2003 SARS epidemic. But, some guidelines are still being used. Any new SARS updates will be posted on this Web site.

Paraphrase Ends.

"Fears are nothing more than a state of mind" - Napolean Hill

VeganDB12's picture
VeganDB12
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Who is panicking?

I really don't see it in my little circle. My doctors seem like they are a bit scared because they are front line but I have yet to witness panic.  Even my friends who work in ER's haven't been panicking.  MSM is getting their ratings though.

I am sorry to be nitpicky but it is unfair to accuse people of panicking when they are just trying to find out what is going on.....

Very helpful writeup on the nuts and bolts of the virus.  Thank you as always Dr. M.

Luke Moffat's picture
Luke Moffat
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VeganD wrote: I am sorry to
VeganD wrote:

I am sorry to be nitpicky but it is unfair to accuse people of panicking when they are just trying to find out what is going on.....

 

Inference on my part. Sorry, my apologies

Dwig's picture
Dwig
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Ebola: the view from the front lines

The perspective I tend to trust is from those who are on the front lines of dealing with infectious disease, in particular nurses who deal every day with the good and bad practices in hospitals that deal with infectious diseases.  Mary Odum, at the Prosperous Way Down blog, is a professor of nursing with practical experience.  She has written some trenchant posts on the way the outbreak is being handled; here's her latest.  She's far less sanguine than Chris or most of the commenters here.  One of her main points is the disconnect between the doctors and nurses who are in the system, and the MBAs who run the hospitals and make the official pronouncements.

As to statistics, it seems to me that the most important one at this point is the rate of growth (deaths), which was still exponential last I saw, with a doubling time around 20 days (recent update from a commenter on Odum's site: "The case doubling time for Ebola appears to be close to its incubation time, about 21 days. With today's case load, we have about 27 doublings to reach over 7,000,000,000. That's about eighteen months.").

Certainly panic isn't called for, but neither is complacency.  We've been seeing lately how poorly our national-level systems deal with systemic issues (Iraq, anyone? Ferguson? Deepwater Horizon? Katrina? Peak oil?) -- it looks like public health may be another example.

larrythelogger's picture
larrythelogger
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Ebola: from Dallas

My wife is an ER nurse in the med center catty corner to Texas Health Presby Dallas (Ebola central).  Although her ER patient load has increased fivefold due to Presby being basically empty, she's not plussed about the virus at all.  However, she is concerned about having the correct protocol, training, buddy systems, etc if it does go nuts. Since Presby Dallas is pretty much a very large yet for all intents and purposes, closed facility, Med City and even Parkland (about ten miles away) are refusing ambulance patients; walk-ins only (Parkland is accepting ambulance delivered burns since they're a major burn hospital but that's all).  Texas Health Presby faced a mass exodus of staff when they drastically cut back hours.  So, because of the fear of losing most of their employees, they have been paying full component to their entire staff even though there are NO patients and it's a pretty huge facility.  How long they'll be able to keep that up is anyone's guess.  My guess is, not for much longer.  They make money by fixing broken people stuff, not by paying a few thousand people to watch their Facebook page all day.  So far, Dallas hasn't lit its hair on fire quite yet.  I asked my wife last weekend how many infected people will cause statewide severe sphincter muscle contraction.  She said, 30 and it's all over but the crying.  That's for Texas.  If you're in a state like Connecticut, where somebody who knows somebody who called somebody in Liberia who might have been infected, they might establish martial law. What's weird is that Ivory Coast, after closing its borders next to Sierra Leone and Liberia have had zero cases.  I wonder why that is.

debu's picture
debu
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Mary Odum/Properous Way Down Blog

Couldn't agree more with Dwig that Mary Odum's writing on the Ebola situation is very sobering stuff.

Essential reading, surely.

kmaher's picture
kmaher
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Another way of looking at the numbers.

What are the chances that Ebola is not contained and becomes a true global pandemic?  What would the expectation be for the number of deaths if this were to run amok?

If there is a .0001 chance of this escaping to become a true global pandemic, you'd have an expectation of 7,000,000,000 x .0001=700,000 x .5(mortality rate)=350,000 deaths.  Maybe you think the odds are it would only impact half the population, so you'd have an expectation of 175,000 deaths.  Or maybe our odds of it being contained are much better than one in a million.  You can use your own judgment as to what is likely and I'm not sure how best to quantify that.

However you want to look at it, the consequence of not fully containing this is so large it should be addressed much more aggressively by the world community.  Even if the chance of it happening is low.

Kevin

Michael_Rudmin's picture
Michael_Rudmin
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worse than exponential growth

If you do the numbers, it looks like the doubling period for African Ebola is 23 days, not 20 as the media states. Do it for the US diagnoses, it's 11+/- days.

Wait, you may say... the small sample size invalidates the estimate.

On the contrary, it brings out a worse point: that the exponential growth is not valid for early growth. Why? Because you aren't just getting exponential caseload growth. You are getting exponential growth of the number of paths of transmission.

First, it was ebola patients coming in by jet: first one, then two moreg then two more again... Then, it was transmission by protocol-less hospital. But that transmission was actually three paths: skin-skin contact with patients, poor wast management with vomit-soaked rags piled up to the ceiling, and a problem with the cafeteria that they decline to describe.

Next it was transmission-by-jet, with a feverish patient knowingly taking a jet trip to and from Fort Worth.

As each path causes groups to be overwhelmed, transmissions within that path approach exponential growth, and then tail off.

But that's not the worst. I'm going to posit that the number of available paths of transmission is a function of the size of the economy.

Liberia's GDP is small; they have a few paths of transmission; so they quickly moved from an exponentially growing exponent constant, to a fixed exponential constant.

But the US GDP is large. So the number of ways people interact is huge. Therefore, our 11 days could become 8 days, then 5.3, then 4 days to double the case load.

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sand_puppy
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All the talk is Ebola, tonight

The doctors and nurses in our Emergency Department don't have a real high opinion of the CDC.  They point out that it is a political post that sets social policy.  They are the shepherds, and we are the sheep.  Big Pharm, Big Medicine and all kinds of secret political dealings influence their "science."

1.  Not even one health care worker in our ED tonight thought that the paper gowns recommended by the CDC (and purchased by the hospital) would stop a splash of virus ladened diarrhea from penetrating to the skin of the HCW.  And since Ebola patients produce about 2.5 gallons of diarrhea a day, this is a big issue.

A couple of the nurses are Military Reserve Officers and one is in the chemical and biological weapons response unit at the USAMRIID.  So we had some insider viewpoints tonight.   The recommendation was "Watch what they do not what they say."  Here is picture of a CDC BSL-3:  battery powered HEPA ventilator (air is drawn from the room, filtered and delivered to the head/face piece), head cover, face shield, impermeable suit, work done behind a splash shield, chemical shower on exiting.  [This BSL-3 set up is much more rigorous than the recommendations they have provided to community hospital HCWs.]

And here is BSL-4.  Room air is NOT breathed but is pumped in from the outside filling the suit.  A 7 minute chemical decontamination shower while wearing the suit is required, then passage through multiple air pressure locks, then when stripped naked, another decontamination shower, then another air lock, then redress in street clothes.  Not one item of personal clothing enters or leaves.  This is how Ebola is treated by the CDC. (Thanks Claire)

2.   Even if our paper gown were to actually be impermeable, no one thinks that the act of doffing (removing) the PPE can be done consistently and perfectly everytime by every nurse.  Errors will occur.  People will be infected.  Several specific steps seemed likely to cause contamination.  Absolutely not one doctor or nurse thought it was reasonable to assume that each and every HCW was sterile after doffing.  And no one was willing to be touched by a HCW who had just left the Ebola room.

http://www.cdc.gov/HAI/pdfs/ppe/ppeposter148.pdf

3.   Absolutely no one, no one single doctor or nurse, would return home to spouse or children after caring for an Ebola patient.  Everyone planned on checking into a motel and "avoiding humanity" for the duration of the epidemic.  Yet it is the official position of the CDC that once you have removed your PPE you pose no infection risk at all and you may return to normal patient care activities and go home to your family.  Absolutely no-one believes that that is true.  [And tonight the CDC back tracks and says that the "Dallas number 2 infected nurse" should not have traveled after Ebola care....].

 

 

 

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LesPhelps
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Numbers aside, I thought the article was instructive

I have two daughters within 90 miles of Dallas.  I'm not even concerned for them, at this point.

What I don't understand is this.  A man, knowingly, directly exposed to the virus, without any form of protection chooses to fly half way around the world and no one is offended.  With a virus like Ebola, that sort of behavior should be criminal, carrying the heaviest penalty on the books, yet, not a peep out of anyone, that I've seen.

 

 

Michael_Rudmin's picture
Michael_Rudmin
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worse than exponential growth

so then, Sand Puppy, protocols need to be developed that incorporate those things into the response. The protocols need to be instilled now, and practiced now and TESTED now.

I would advise mobile concrete pads the size of parking spaces, raised as high as necessary, and with a steel drain pipe coming out its middle, and coil rod around the edges. using pallets and greenhouse technology, you build disposable tent units, and install space heaters. Each tent becomes a triage unit, or a place for a HCW to sleep... and if occupied by an ebola patient, gets incinerated. incineration can be accomplished by dropping a modified con-x over top of it, and burning everything with gas fire, superheating the exhaust and sending it through a catalytic converter (auto exhaust pipe).

The HCWs need to be faced with ebola symptom complaints, and need to be tested to see where their response fails proper protocol.

The ambulance crews need to get some Uhaul-style box trucks, and outfit them with plastic sheeting, Air Force 3 style, and have them ready to transport probable patients -- and then be thoroughly decontaminated. That system too needs to be tested.

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AKGrannyWGrit
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Ebolas Lessons

Dr Martenson's article was well written and no doubt reassuring to many.

I keep thinking that epidemics and pandemics happen for a (or many) reasons.  Mother Nature is teaching us, if only we are aware and willing to learn from the situations.  Something is out of balance, we are being sloppy, we are not paying attention.  Fear and death should be our wake up call. Fear, in my opinion, isn't such a bad thing, it prompts us to act, to pay attention, to make changes so we can survive.

I agree most of us are not currently in harms way but there may be a tipping point for this virus to be truly out of control and we won't know when that happens.  Plus the main stream media talks about "confirmed" cases.  So some official has to "confirm" a case before it's actually counted.  The question that begs to be asked is, are there two sets of numbers, "confirmed" cases and "actual" cases? Kind of like real inflation or jobs numbers or unemployment and the "official" numbers?

We learned that the virus originated in bats and that it can affect, humans, pigs, and monkeys.  The affected nurses dog is being quarantined so the virus could affect dogs as well.  The point here is that we might want to be concerned and aware that this virus can move to additional hosts.  This potential is a wild card and not statistically quantifiable, but a possibility.  

Human nature favors self preservation so if someone has a choice of getting sick and being treated in a clinic in a 3rd world country or traveling to the US to be treated in a state if the art, high tech hospital than I would think planes would be full of people opting to leave infected countries in order to be here in case they needed our healthcare. For this reason I think we will see many more cases in the future.

We are upping are preps and watching this situation like a hawk. 

My 2 cents, AK Granny

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cmartenson
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Living in fear vs. being motivated by fear
AkGrannyWGrit wrote:

Dr Martenson's article was well written and no doubt reassuring to many.

I keep thinking that epidemics and pandemics happen for a (or many) reasons.  Mother Nature is teaching us, if only we are aware and willing to learn from the situations.  Something is out of balance, we are being sloppy, we are not paying attention.  Fear and death should be our wake up call. Fear, in my opinion, isn't such a bad thing, it prompts us to act, to pay attention, to make changes so we can survive.

My sincere hope is the Ebola is a wake-up call for many, and that they use it to deepen their preparations, and as a means for observing how their government (the CDC) actually functions, or fails to, in the face of a very real threat, no matter how small it happens to currently be.

The much larger threat in my mind is the eventual arrival of a real pandemic threat that spreads rapidly and easily and causes enough mortality that it massively overwhelms the healthcare system (which actually isn't that hard to do...just add up the hospital beds in your city or town, and then divide that by the total population of your area and see what happens).

Somewhat jarringly, when this article was posted to ZeroHedge in the comments beneath I detected the distinct flavor of disappointment from some folks that my stance was not appropriately doomish enough, not enough fear based, and not pointing to the imminent demise of society as we know it.

That gave me some pause and I had to sleep on it because I have to carefully consider my own role in fueling the desires of those who long for change so much that it has become a belief system.  One that you either support or refute.  If supported, your views and data are met with glee and happiness.  If refuted, then it's anger and derision.

In both cases it is the emotional tone that reveals what is actually at work, and that is a belief system invested in certain outcome.

While I carry my own beliefs, so I'm neither elevating myself nor lowering others here, I work hard to assure that these beliefs do not prevent me from taking action.

I honestly care not whether someone shares my own limited concern about Ebola or has a highly elevated state of fear around the matter, but I do care, a lot, about whether that person (in either state) is taking prudent actions to become more resilient.

My assessment is that a majority of people at ZH who dumped on the article because it was not doomerish enough were also not doing anything new about becoming more resilient.  If they were in a dispassionate state around the materials, the responses would have been different and along the lines of, I disagree with the author's assessment and here's fact X and fact Y to support my case.  Accordingly, because of the view I hold, I have done this, bought that, and am increasing my own level of readiness along these lines, and I think others should consider the same...

All of that is perfectly reasonable to me.

But for anyone who found themselves angry at my views on the matter but has also not taken any concrete steps towards greater resilience and preparation I would offer up the idea that there's something there to be looked at because living in fear without action is the very definition of being a victim.

We are all responsible for ourselves, our reactions, and what we choose to allow to enter our minds and control our emotional state.  More regularly I choose to live calmly, and without fear, which means I filter out an enormous amount of popular culture and news.  

Said more directly, I choose not to be a victim.

Finally, I reserve the right to change my views on Ebola, or anything, as more data becomes available, and I hope you all know that.  :)

nickbert's picture
nickbert
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Hospital managers/administrators dropping the ball

My wife is an RN at a Denver hospital, and she says the hospital hasn’t done ANYTHING AT ALL in preparation or training for the possibility of encountering a suspected Ebola case.  Not so much as a 5-minute briefing regarding the possibility of needing to isolate or treat a suspected Ebola infection.  I’m less concerned about a widespread, devastating pandemic and more concerned about the hospital’s lack of timely preparedness and foresight exposing her and other nurses & doctors & patients (and their families) to possible infection.  I understand the risks of encountering such an infected individual are low (so far anyway) but the seriousness of the impact should it happen surely merits some response.  I don't expect them to turn the hospital upside-down and inside-out, but even a couple hours of briefing the staff on clues to look for and proper procedures to follow would at least be a step towards something.  It is criminal to not offer reasonable protection and training to the employees that through the course of their job are susceptible to substantially increased risk.  My wife says she frequently has to deal with patients who cough and sneeze on her with no thought to cover their mouths or turn their heads or anything.  And that's just the people who are mildly-to-moderately sick.... how bad will it be when said patients are seriously or deathly sick?

I've said it before, but all I can say is I’m glad this isn’t something equivalent to the Spanish Flu around 100 years ago.  If it was I’d be begging her to quit.

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Snydeman
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An important reminder, Chris, thanks!

"That gave me some pause and I had to sleep on it because I have to carefully consider my own role in fueling the desires of those who long for change so much that it has become a belief system.  One that you either support or refute.  If supported, your views and data are met with glee and happiness.  If refuted, then it's anger and derision.

In both cases it is the emotional tone that reveals what is actually at work, and that is a belief system invested in certain outcome."

 

It is a very, very important point you make there, and I had not considered how my own burning hatred of the "system" that we live in would merge with my fear/knowledge that Big Change is Upon Us and create a paradigm that I myself am having trouble seeing beyond. I definitely find myself gravitating to anything that speaks doom and gloom now, almost with a morbid glee that finally the corrupt edifice of civilization will crumble, and the true freedom of anarchy will prevail once again (a rosy view of what collapse would bring, no doubt). I will need to ponder this, greatly, because it is hard to act rationally and logically in preparing for the future if I am wearing blinders of any kind. In any case, thanks for the reminder.

 

My wife and I continue to try to maintain some semblance of a balance in the struggle to prepare and the struggle remain optimistic and sane.

 

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Jbarney
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I read your article yesterday

I read your article yesterday Chris, and I wasn't disappointed with your assessment, although it was not what I was expecting.  I have been reading your work for years, and while I have not read the responses over at ZH, I find it odd that some people would react with anger to your calm, "take a breath" approach.

With respect to the threat level of ebola, your perception about people needing to look at the numbers, be aware, and go on with preps AND their regular lives came across loud and clear.  I wouldn't take too much from those who seemingly get too caught up in the moment.

That said, I think what is happening in Dallas should be a major cause for concern.   From Duncan being able to get into the U.S., to his being turned away from the hospital, the nurses not having the proper equipment, to American health care workers getting ill....and now the story about the 2nd nurse actually flying while having an elevated temperature....it all speaks to how ill prepared our institutions are to rapidly changing events. 

The percentages are small.  These events, right now, are only hitting a small number of people.  However, I can't help but think about how much worse this could get.

Time2help's picture
Time2help
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Silver Lining(?)

Some Fear Ebola Outbreak Could Make Nation Turn to Science

NEW YORK (The Borowitz Report)—There is a deep-seated fear among some Americans that an Ebola outbreak could make the country turn to science.

In interviews conducted across the nation, leading anti-science activists expressed their concern that the American people, wracked with anxiety over the possible spread of the virus, might desperately look to science to save the day.

“It’s a very human reaction,” said Harland Dorrinson, a prominent anti-science activist from Springfield, Missouri. “If you put them under enough stress, perfectly rational people will panic and start believing in science.”

Additionally, he worries about a “slippery slope” situation, “in which a belief in science leads to a belief in math, which in turn fosters a dangerous dependence on facts.”

At the end of the day, though, Dorrinson hopes that such a doomsday scenario will not come to pass. “Time and time again through history, Americans have been exposed to science and refused to accept it,” he said. “I pray that this time will be no different.”

Wendy S. Delmater's picture
Wendy S. Delmater
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Highway patrol analogy

I loved the nice, scientific tone of your article above, Chris, and wanted to thank you for a cool head and sticking to the facts, especially since those facts may change and you've stated that you're open to changing any stances based on facts.

Facts are the difference between rational debate and irrational demagoguery.

Those of us who have done the best we can to get ready for the coming shift remind me of motorists reacting to a highway patrolman. If you're speeding, or have no auto insurance, or have a violation like a badly cracked windshield or missing headlight you are going to respond differently than if you are doing the speed limit in an insured, physically-sound car. It does not matter if you are driving an expensive car or a cheap one; you will not be caught out if you are doing the right thing.

When we're doing the right thing, although various crises pop up we probably have the skills and tools to play whack-a-mole with these crises if they intersect our lives. And the level of preparedness does not have to be perfect, it just has to be "the best you can do." Then you can be calm, and take a rational stance.

In our case our daily routine has not altered much. We pay attention to the news, and watch and listen. The political/societal/economic impact of this ebola outbreak may very well be damaging than the disease itself. Does anyone want to take bets that the way our government is "handling" this crisis is not impacting faith in the dollar, for example?

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Dwig
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Suggestion: interview Mary Odum

Ebola aside, Chris, I'd like to see you do an interview with Mary Odum.  She's the daughter, and "intellectual heir" to Howard Odum, who spent a lifetime doing ground-breaking work on an energy-based approach to ecology (which for him included all human activities).  The title of her blog, A Prosperous Way Down, is also the title of her father's last book, in which he summarizes his theories, and applies them to create recommendations for "policies appropriate to descent".  You can find much of his work in articles on the blog.  (For one thing, given your background, I think you'd enjoy learning about Odum's concepts of "emergy basis" (not a misspelling) and transformity, as well as his "pulsing paradigm" that puts our current situation into a larger context.

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Gaborzol
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Experience in Pathology AND Economy

One of the things I appreciate about this site is the wide variety of people with experience and actual knowledge, rather than just information. This article from Chris is a prime example: clear on both the background on the infectuousness and danger of Ebola, as well as what it may mean inserted into our current political and economic environment. Much more interesting that to figure out about all these apocaliptic stories and possibilities from the media or other discussion sites. But maybe it is like watching a documentary instead of a thriller, and that turns some people off, I imagine. For me the world is complex and entertaining enough already, I don't need the extra stimulation, and Peak Prosperity has a tendency to explain things on my level (the good old laymen's terms), without hyping it up to make it interesting and entertaining. Thank you for that! 

A. M.'s picture
A. M.
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Disaster Bias

It's interesting how we are used to seeing people with the Normalcy Bias who figure since something different hasn't happened yet, it probably won't. But this disaster bias seems to be working its way into our society more and more. 

Snydeman candidly summed it up - people who are just sick of our current "business as usual" policy towards political scandal, a valueless social system, a economic policy that promises gratification at the cost of satisfaction and legions of deeply rooted ponzi ticks out to screw you out of your money (I'm looking at you, local traffic courts) in the most absurd ways possible, are ready to just watch it burn. 

I would love to see our 'leadership' take notice of this and say "holy smokes, we should probably fix this rtfn". But, like Friden, we will probably see dialog more like "Well, it's YOUR fault! You didn't wear enough PPE!" And then a couple days later say "It's your fault! You wore TOO MUCH PPE."

It's the modern language of "Let them eat cake", and as with the Roman Empire, I have no doubt that Ebola is straw on an morbidly overloaded, weary camel with shaking knees and mange.

From that perspective, I thought this article illustrated the point nicely.
Cheers,
Aaron

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Time2help
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gallantfarms's picture
gallantfarms
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Ebola and Vitamin C

I also am not too concerned about Ebola in the US at this point, although it looks like it may be pretty devastating in Africa before it's over, and I think we will very likely see increasing "scare" cases here.  I would not want to be a Health Care worker never knowing if that "flu" patient I'm treating might have ebola.  It is reassuring that the close contacts of Duncan in Texas do not seem to have caught it, so it seems not super contagious until the later stages with very close contact.  

However, in the interest of "preps"  I thought I would share a link to an article that explains how to use Vitamin C to fight viruses.  Taking normal amounts of C will not do much, there is a specific dosing protocol that needs to be understood if you want it to work.   A virus replicates exponentially, like a fire, so it is extremely important to begin dosing at the very first signs of illness.  The great thing about vitamin c is that you don't need to know what it is you are sick with, it will help with a cold, flu or ebola, but only if you get the dosing right.

Here is the link:  http://orthomolecular.org/resources/omns/v10n13.shtml

Quote:  "The mechanism of action of high dose vitamin C is known and understood. In normal healthy tissues it acts as an antioxidant. In other tissues, it generates hydrogen peroxide, the chemical that platinum blondes use to bleach their hair. This happens in sick and inflamed tissues, for example in a malignant tumour. The process is typically a form of Fenton reaction, generating free radicals. The oxidation and free radicals arising from the hydrogen peroxide kill bacteria and inactivate viruses. In other words, vitamin C acts as a targeted bleach and antiseptic.

Vitamin C is unique, because it has low toxicity and can be taken safely in massive amounts. Other antioxidants and supplements will not have a similar effect." 

agitating prop's picture
agitating prop
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Seriously

...worry more about anti-biotic resistant strains of bacteria, like C. difficile.  How about necrotizing fasciitis? The only explosive diahrea I worry about is irresponsible journalism scaring the sh** out of everybody. 

Ebola is only a very small potential hazard to those on the front lines.   Sure it could become a problem.  Lots of things could become problems. Many viruses come and go without ever becoming a significant problem because their  numbers remain small enough that they never gain enough traction to cause a serious epidemic. 

Ebola is a disease of filthy conditions.  Feel for the people who live on a continent so beleaguered and beset with so many problems it can't deal with something as simple as basic hygiene.  That is the real tragedy.  Africa, as a continent, is the disease.  

mikkel's picture
mikkel
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Destruction of trust in the system

I apologize if this is addressed in the subscription only part, but the most likely catastrophic effect from ebola will be further rejection of the system.

Simply read the comments on this post at Naked Capitalism to get a gist of what I mean. The most noteworthy is

While it was sinking, could anyone have been said to be any trustworthy leaders on the Titanic? Regardless of status and position, those who were not only out for themselves were delusional and clueless. Add in a generous helping of incompetence and you have the Titanic in a nutshell. This analogy effectively describes not just the Dallas Presbyterian Hospital, but also America as a whole. Today, the best bet for self/family/group-preservation is to view everything with extreme cynicism and trust no one you don’t personally know. The alternative is empty life boats while people drown in freezing water.

Almost everyone has lost faith completely in the financial system, politics, journalists and statesmen; many have lost it in the police and educational system; and Fukushima/Deep Horizon contributed to putting scientists and engineers on the list, while all the abuse scandals are severely damaging religious institutions. About the only thing that has general support left is the medical system (and military), which is still considered good even though it is outrageously expensive.

Except of course it's not. The people within those systems know that they suffer from all the problems that the rest of society is facing. They are plagued by incompetent leadership focused on image and profits at the expense of service. They mistreat their core workers physically and emotionally, while lavishing rewards on hyper-educated but widely varying (in both skill and decency) technical workers. They arguably exist primarily to extract resources rather than benefit the public good.

As the Mary Odum post says:

Spanish nurses are defecting from the fight in Madrid, citing poor pay and inadequate PPE...hospitals these days are run by MBAs in suits, who know more about profitability than healthcare. What would stop me from quitting, and saving my ammo to care for my family, if I knew that a deadly pandemic was coming, and my hospital would not listen? Those journalists who promote headlines blaming the spread of EVD on nurses need to reconsider the slant they are promoting. And the MBAs running hospitals had better give nurses a seat at the table to manage these issues, now, before this pandemic heats up and we go into crisis mode

Similarily, from a Naked Capitalism comment "when a man with suspected Ebola arrived at Lewisham Hospital (South London, UK) recently, staff panicked and ran off, leaving the man untreated and unquarantined. One of the reasons why trained medical staff behaved this way, it was claimed, was that the business managers who run the UK National Health Service allocate protective gear in line with the perceived risk; that is, if someone turns up in A&E with a 10% chance of Ebola, staff only get low grade (ie “10%”) protective equipment."

Even a small pandemic has the potential to be the straw that breaks the camel's back, with widespread strikes and revolts. Of course, incompetent authoritarianism will only fuel that fire.

While most likely nothing extreme will happen, this will further cement distrust in not only authority, but society itself. Once people learn they can't even trust their doctors, who knows what will happen.

From this perspective, I find it foolish not to worry about ebola, regardless of its medical potential. But instead of that worry leading to passivity or further entrenchment, it should inspire peak-oriented people to capitalize and rebuild local trust by utilizing our worldviews.

vitger's picture
vitger
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More bad news

The CIDRAP says Ebola should be treated as airborne/aerosol driven disease:

http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

 

“We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.1

 

I do not think we can yet grasp the potential enormity and consequences of this problem.

Wendy S. Delmater's picture
Wendy S. Delmater
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Michael_Rudmin's picture
Michael_Rudmin
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Posts: 838
worse than exponential growth

Chris, your whole website is based on 'what's more scary than exponential growth?' And ebola is IN exponential growth, with only twenty doublings until worldwide infection totality.

But I tell you what's more scary than exponential growth: when you look at a log-linear graph, and see the hockey stick. n=a^BT become n=a^(b^cT).

Now go over to the wikipedia article on the African ebola outbreak, and go down to the 'time progression' part of the article. Look at the graph of total ebola infections. you'll see that each country has two curves: the second curve is the straight line on the log-linear graph. That's scary. But the first curve is before the country mounts a serious response to the various transmission paths: that's the j-hook on our log-linear graph.

That's terrifying.

Now all the news is about our government downplaying the risk and SPREADING the disease.

if you start at our current 11-day doubling, then by 5 months we will have 131 000 cases. if you cut that to 5 3/4 days, then that 131000 US cases occurs by Christmas.

Nigeria's non-response curve had 3-day doublings. Nominally, they've beaten the disease. If they're not lying.

http://nypost.com/2014/10/16/alarm-after-vomiting-passenger-dies-on-flig...

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cmartenson
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And the new Ebola czar is...a *lawyer* and political operative

From the you have TF be kidding me files:

 *OBAMA SAID TO APPOINT RON KLAIN AS EBOLA CZAR, CNN TWEETS +

Forget medical experience, what the USA needs to conbat the worst Ebola pandemic ever is "an American lawyer and political operative best known for serving as Chief of Staff to two Vice Presidents - Al Gore (1995–1999) and Joseph Biden (2009–2011)."

The Washington DC crowd is so infected with itself, that it sees everything thorough the political lens.

Ebola pandemic starting?  Quick! Get our best political operative on the job!  That should fix it!!

He should consult right away with the three well-connected DC lawyers currently serving on the Federal reserve FOMC panel, and then check in with the DC lawyers/operatives/resume padders to be found stuffed into various embassies all over the globe.

Then with the 128 lawyers in the House and the 45 in the Senate.

After that, I should think he will have a good handle on exactly what to do next....

 

 

Jim H's picture
Jim H
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A failure of spin...

Ebola problem being viewed by our political elites as a failure of spin.. too many folks actually becoming fearful, which is bad for the economy (stupid).  I am sure fear is readily apparent in real time international air bookings data.  How about a cruise?  You never know who you are being trapped in a floating bubble with;

  http://www.zerohedge.com/news/2014-10-17/ebola-handling-healthcare-worke...

What do you think the real time cruise cancelation data looks like?  I am sure the real time data is telling a chilling story of recession to come.      

Another answer is just to up the volume on the positive spin megaphone;

http://www.zerohedge.com/news/2014-10-17/umich-consumer-confidence-surge...

Yeah, right. 

AKGrannyWGrit's picture
AKGrannyWGrit
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Ebola Czar

Interesting choice for a title. Czar meaning a person of authority, autocrat, and tyrant.  Suggests control rather than prevention and cure.

My father used to say, "yeah when pigs fly" well I am watching for them because it's a crazy world out there and some shannagan's are hard to believe.

AK GrannyWGrit

A. M.'s picture
A. M.
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Posts: 2368
RE: Ebola Czar

AK GrannyWGrit,

Regarding the Ebola Czar, I'm thrilled! We haven't had a new Czar in months, if not years. When Obama got elected, we had Czars everywhere, and now it takes a fake crisis to get a new one. 

I feel safer already, knowing there's a legal authority overseeing the process of getting around the red tape... that the legal authorities that have destroyed hospital administration put into place to begin with. (Please read this as a heavy dose of sarcasm - which I generally don't like)

If lawyers were the damn problem, what're the odds that more lawyers are the solution? 

This is a dizzyingly stupid response, using equally stupid language. I wish all of D.C. would just go get massages and sit this one out so the people who know what's going on could step up on their own. Natural leadership would go a lot farther in these instances than elected leadership.

Sigh...

Aaron

Barnbuilder's picture
Barnbuilder
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Posts: 77
New Czar

About ten years ago as I was becoming aware of the peak oil story I sent Jim Kunstler an e-mail asking his advice on how we could get our government to get off it's dead behind and get in front of the pending crisis. His response then was that to rely on the government was folly and that any real change and prudent preparation would have to come from individuals and communities of aware and educated members of our society.  This is even more apparent now. The spin and total concentration on political effect versus what is accurate and effective is mind boggling. For Obama to appoint a political operative attorney starkly underscores that fact.

       Thank goodness for the work you and Adam have done here.  As I continually strengthen my family's resilience and resourcefulness it is more than helpful to come here and find like minded folks.  I agree with your assessment of the personal risk of this virus being very small.  However if any institution can snafu a manageable situation into an outright crisis our government at the federal, state and local levels is eminently qualified to do so. I guess the bottom line for all of us "peons" is to control what you can in your daily life, build resilience on a daily basis, and try to build community with like minded people.

Time2help's picture
Time2help
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Posts: 2833
Oh well...

...at least they are getting us used to have a "Czar" running things. USSR redux? SMH.

Time2help's picture
Time2help
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Posts: 2833
Morebola

Possible Ebola Case at the Pentagon

This whole thing stinks to high heaven.

Time2help's picture
Time2help
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Joined: Jun 9 2011
Posts: 2833
Possible Ebola Case in a Steel Frame Building

Bankers Slave's picture
Bankers Slave
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Posts: 523
Ebola transmitted from the twin towers

weakened the steel framed structure and it caused a global pandemic via column 79. Said the well informed  NIST spokesman. "We did not find any evidence of the use of explosives because we did not look."

Now go away and leave us alone!

sand_puppy's picture
sand_puppy
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Posts: 1894
Once more: The Pentagon

This signals that "we are under attack"  (Scary music)

"a tipster with knowledge of the emergency response" is about as good as "a white house insider whose name cannot be released."    Pictures of ambulances, hazmat suits.  Planting images and ideas in the news and psyche.

This is the way the propaganda arm of TPTB work.  We have a ring side seat.

cmartenson's picture
cmartenson
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Posts: 5733
About those exponentials...
Michael_Rudmin wrote:

(...) if you start at our current 11-day doubling, then by 5 months we will have 131 000 cases. if you cut that to 5 3/4 days, then that 131000 US cases occurs by Christmas. Nigeria's non-response curve had 3-day doublings. Nominally, they've beaten the disease. (...)

Hey, you know me...I'm about as concerned by exponential behavior as the anybody, but not (yet) in the case of Ebola.

I'm pretty confident that this incident will burn out and blow over, just like those before, mainly because of the low rate of host-to-host transmission and the low rate of mutation.

Note that there have been zero cases reported among patient zero's friends and contacts.  Nobody from the plane rides.  Nobody else at all.

Note also  that Nigeria seems to have beaten the disease, as you note.

But mainly I am confident that we cannot simply extrapolate this virus' rates of infection out through many more doublings because people will change their behavior, like they did in Nigeria, well before things got to "5 months, 131,000 cases" stage.

I certainly would.  

I have travel on my schedule right now and I have almost no worries about going on those trips.  I'll be a bit more vigilant watching for ill passengers, but I'm usually very careful in high density situations to contain my incidental face touching during flu season anyways so this will be a slight add to my existing awareness patterns.

But if suddenly Ebola was striking all over the place, I would not even travel.

And I would not be alone.  People are people, and they usually don't want to die.

Remember SARS?  

Here's how people are in the face of a deadly contagious illness:

Mall nearly empty after false SARS rumor spreads

Apr 24, 2003

KENT -- No one at the Great Wall Shopping Mall has died from the illness known as SARS. No one at the Asian-themed shopping mall, located where Kent and Renton meet, is suffering from SARS.

There isn't a single "probable" case of SARS in King County, according to the Public Health -- Seattle King County.

Now have some dim sum, please, because business at this indoor mall has dropped as much as 50 percent, business owners estimate, since rumors began circulating that the place has been infested with the severe respiratory illness that's infected more than 4,400 people worldwide, about half in China.

According to one rumor, an employee at the mall died from the disease. According to another, two employees at the Ranch 99 grocery store have been diagnosed with it. And, rumor has it, Christine Lee -- who along with husband, Omar Lee, owns the shopping mall and part of the Imperial Gardens Seafood restaurant there -- was in the hospital for a week with SARS.

She was vacationing in Florida with her children. "This is totally ridiculous," said Henry Ku, who owns two restaurants -- Taiwan Restaurant and Shanghai Restaurant -- at opposite ends of the mall.

He waved his arm at the 20-or-so tables at Taiwan, checking his watch. It read 12:11 p.m. "Usually it's a full house at lunch. Today, only one table."

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