Sunday, October 12, 2014

Ebola update: Don't panic!!11

So, imagine you're an anthropologist, and you're watching a Rain Man. He kills a rabbit and examines its entrails and says that it looks like he can make it rain tomorrow. So he builds a fire and shakes a painted stick and repeats every single syllable of the long chant his dad taught him, as seriously as you can imagine.

It doesn't rain the next day.

The Rain Man isn't upset, though. He says that maybe the rabbit had a blemish on its hide he didn't see, or maybe the fire wasn't big enough, or maybe he didn't chant quite the right syllables, at the end there, with sufficient intensity.

Or imagine you're reading this in the Wall Street Journal's blog:

Top U.S. health officials said news of a Texas health worker who has preliminarily tested positive for Ebola shows there was a breach in safety protocol at the hospital that treated an Ebola patient who died last week.
“I think the fact that we don’t know of a breach in protocol is concerning because clearly there was a breach in protocol,” said Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, on CBS’s “Face the Nation” on Sunday. “We have the ability to prevent the spread of Ebola by caring safely for patients.”
Yeah, must have been a "breach in protocol", because there isn't any possible way our understanding of how rain happens Ebola spreads can possibly be wrong.

A nurse in Dallas has caught Ebola, just like the nurse in Spain. People who are laying their lives on the line aren't normally careless, so there's two likely possibilities: Ebola can be spread without skin contacting infectious body fluids, or the "protocols" are too difficult to carry out repeatedly.

For the sake of not panicking, I'll ignore the first possibility (apart from my Rain Man analogy above).  What's up with the protocols? There's plenty of "opportunity for improvement" as we used to call errors when I worked in healthcare.  The hospital is not one of the CDC's favored containment centers and it's possible the staff are just ill-trained. It's more than likely that the airlock is too small for the nurse to doff her protective gear without getting twisted up.  It's certainly too small for someone to watch the nurse's every move, which would be a sensible precaution, and I doubt the airlock has antiseptic showers or UV irradiation to reduce the risk of viable viruses on the clothes before they are removed. But all in all it's easier to blame the nurses for being fuck-ups, though I have to think it's the least likely explanation.

All through this outbreak, we've had the borderline racist - or maybe just full-on racist - narrative about, "Yeah, three thousand people have died of it in Africa, but they're AFRICANS. We are Americans, and never forget it! We have the  best health care in the world, and it can't happen here!"

Well, it's not the best health care in the world - so far from it, in fact, that it's likely to encourage the spread of diseases by discouraging visits to primary health care providers and encouraging lying around vomiting for hours in emergency rooms - and it has happened here, obvs. Ask the nurse.

Other infectious diseases are raging unchecked here and the CDC, NIAID and other august bodies are not managing to contain them either. Enterovirus 68 is killing children in the US right now. Respiratory Syncytial Virus is so prevalent that it's said that EVERYBODY in the US has had it, and it leads to 100,000 hospitalizations of children under 1 year old every year (and as many again in older children). TB, Gonorrhea, syphilis and HIV are also doing very well, thank you.

As an anecdote, when it was my job to ensure that new HIV infections found by the laboratory I worked for were reported to the Public Health system, we continued to report them to the California counties on 3.5 inch floppies. This was way back in ...let's see... it was 2013.  A couple of years ago we polled our Public Health contacts there to see what they were doing with the floppies. Some, as you may suspect, had no idea what they were and only wanted them because they 'd always gotten them. Other counties seemed to actually be using them, goodness knows how. The consensus was they wanted to continue getting 3.5" floppies in the mail with HIV data.[1]

So what's next? Nigeria managed to contain Ebola a couple of weeks ago. Let's see how the US health care system stacks up against Nigeria.

[1] All is not necessarily lost as the counties probably throw away the floppies and get the information from CA state, who have a live link to testing laboratories.  However the fact that they want the floppies is problematic to me. I assume they want them because somebody in their organization once asked for them and communication is so obfuscated that they can't be sure that this most-likely-long-vanished person no longer reads them. The other explanation - that their PCs are more than ten years old - is even more worrying. 

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