This week in books part 2 - authors vs critics electric boogaloo

While I was finishing research for the blog post "This Week In Books" on Monday, I came across a reference to the "Benevolent Stalker".  I had too much material already, and passed over it. I refreshed the pages I was looking at on Wednesday, and saw that the "Benevolent Stalker" is now facing charges after allegedly belting a critic of his book with a wine bottle. 

When the informal internet rules state you shouldn't engage with your critics about your book, I'm pretty sure this advice tacitly includes not trying to kill them.

To start at the beginning:

On 23rd September, a writer and winner of a British TV quiz show, whom I'll refer to as RB in order to cut down Google search results - he is named in full in some of the links - wrote a blog post entitled "The Benevolent Stalker" in which he details at length how he stalked a woman who had no interest in him for months, hoping to get her to run away with him after he faked her kidnapping. But not creepy in the slightest, because he was totally going to get her permission, even though she obviously wanted nothing to do with him, which he acknowledged in every word of his blog post but which didn't seem to quite penetrate his skull.  He took the blog post down after everybody who had come within fifty feet of it pronounced it weird, chilling and inappropriate. However, Jezebel has extensive quotes from it here,  It ends:

I was going to tell her that if she came with me, and we faked a kidnapping, we would both become famous. We would go into the hills and camp out for a few days while the nation searched. I had brought the necessary supplies. 

I would like to reiterate that I was not plotting to kidnap her. I was planning on asking her if she would be interested in pretending to be kidnapped, so that we would make the news and people would learn about our story. 

Yesterday, I saw her on the street and approached her, and called her name, but she freaked out. 

"How?" she said. "How are you here?" She turned and snapped me on her phone before hurrying away. 

I didn't even get to tell her about my plan. I didn't want to make a scene because people were staring. I also realised that I didn't have the heart to ask her if she would like to be kidnapped. 

I left Glasgow, and I think our relationship is finished now. I gave it my best shot. I really thought that we would both become famous. We would have disappeared for a few days, people would have read my book, and she could have played the lead role when The World Rose is made into a movie. But alas; I'll have to find another way.

On October 20th, RB wrote a blog post called A Re-evaluation of Romance, in which he claimed to have realized his error.  It says in small part (because he does tend to go on a bit):

I have re-evaluated my stance on many things. My blogpost entitled “The Benevolent Stalker” made international news and was roundly condemned. For every supportive comment I received, I had about a hundred negative ones. This level of response was helpful because 99% of people cannot be wrong. At the time, I didn't realise just how terrible my behaviour was. I did have benevolent intentions but I now realise that there was nothing remotely benevolent about what I was doing. Stalking in any form is horrible and it is unacceptable to attempt to justify it.

In much of the discussion, I noticed women saying things like ‘Romance is evil’. I then remembered a former flat-mate called Gabrielle who had mentioned that she didn't like romance because it seemed ‘sort-of selfish’. Back then, I wrote her off as anomalous, but I am now willing to accept the possibility that the majority of women share that view. Romance is generally cast in a positive light in movies and literature, but when I thought about it, I realised that most of those stories are written by men. We're not seeing things from the female perspective. What I also realise now is that if you act the way that those characters do, in real life, you may end up in jail.

There is a danger here. This problem clearly doesn’t affect the majority of men, but it does affect those of us who are borderline-psychotic and easily carried away by epic ideas. I really thought that what I was doing – writing a book about my love and pursuing her despite repeated rejections – was part of a grand narrative which would end in happy matrimony. 

I now recognise that my behaviour was vile, selfish and deluded.

And it ends:

It is unforgivable that I continued to pursue her, and I have learnt a great deal and hope that others do not make similar mistakes. I've felt a bit like Bruce Willis in The Sixth Sense recently, when he realises that he is a dead person. That is how self-revelatory the last week has been for me. I wish I had found this peace of mind earlier, because it would have saved others from harm.

Others from harm? Why, yes.

In September, someone I'll call PR wrote a Goodreads review of RB's book, The World Rose.  It's a pretty scathing review. Not personal, though, just critical. A sample:

"But the bulldog merely yawned, slumped lazily in his basket with a sullen frown on his face." Adverbs: check. Redundancy: check. Slumping is a lazy action. Frowns are usually sullen. From the context, we know this. I just... 

Urgh, I can't. Even if there WAS more on Wattpad to read, I wouldn't. This is painful. Everything is written through telling and purple prose which is just about the worst combination there is as both a reader and writer. You can have the most fantastic plot in the world, but if you can't write it well, it won't sell. At least concerning self-publishing. And bad writing usually equals bad characters.

The review must have gotten his goat. In an addendum to the review she writes:

[EDIT] - The writer of the World Rose is arrogant. SO arrogant, in fact, that my review hit him where it hurts a little to hard. In return, he found out where I worked through Facebook, came from LONDON to where I live in the east of Scotland, and attacked me by hitting me over the head with a wine bottle from behind. Not a word or a sound. And then he left. I had to be taken to hospital to receive medical treatment for it, which included several stitches in my head.

I have to stress that this is currently an alleged attack - he has, according to her, been charged, but the case has not yet come to trial. However, the pictures of the split in her head certainly look legit.  There's a full write-up here and pictures here.  To summarize, RB traveled 350 miles (at least $250 in transportation costs) just to sneak up behind a petite 18 year old girl and smash her over the head with a wine bottle. Because of a one star review on Goodreads.

I'm not sure what these past few events- first Kathleen Hale, author, stalking her critic and now RB, author, bottling his own critic - portend. Has the world changed, and authors have decided that dead gophers in the mail are no longer sufficient; only direct confrontation will do? Are these a couple of terrorist-novelists, intended to chill the speech of reviewers on behalf of other authors?  Is novel-writing correlated with poor impulse control?

This makes the Stephan J Harper incontinent-comments-left-on-review episode look even more hilarious in retrospect. If only today's authors were as fully-hinged as Harper was way back, ooh, way back in May 2014. We laughed about the Streisand effect and so forth but at least we didn't fear for the critic's life.

Everybody calm down.

Land planarians in So Cal

To my intense disgust, we have these things in the garden.



They are a type of parasitic land flatworm that preys on earthworms. Don't know which species this is, but it is probably of the genus Bipalium. They capture an earthworm and evert their esophagus to digest the poor creature. Looking through the intertubes, it appears that an infestation of these things can clear out a compost worm-bin in just a few days. On one hand, we're lucky as we don't have a compost worm-bin. On the other hand, it looks like we'll never be able to have one now.

We see them because they come up out of the damp soil and on to the tiles when the sprinklers run. They make good speed, leaving a bit of a slime trail like a slug. They can be almost a foot long, and the distinguishing features are the hammer head and longitudinal stripes. Originally from Asia, they've made their way all over the place in the pots of nursery plants. Luckily they are quite stupid, and most of them die on the tiles without ever getting back to the damp earth. Apparently there's no point in chopping them up, as like other planarians, they regenerate whole bodies from chopped bits.

All in all they're disgusting and any ideas on how to get rid of them would be appreciated.

Cross Bones Graveyard feels the love at last

Peromyscus's law: The nearer it is to October 31st, the probability that a link you click will lead to skeletons begins to approach 1.

This is of particular interest to me as I don't actually like Halloween. Brought up a long time ago in England, we didn't have Halloween in the American sense. We had Mischievous Night, where the bolder children went smashing windows and setting fire to things. At the end of October and before Bonfire Night many of us carved faces into either rutabagas or turnips, depending on which ones are the big, grey wrinkly ones in your dialect. I think one year, in a fit of superstrength, I managed to hollow out enough turnip (or rutabaga) flesh to actually put the stub of a candle inside, but that was the one and only time. I have no idea why we did that, though. And nobody had any candy.

But the world wibe wed is no respecter of county traditions, and leans heavily Halloween.  Even though today is the first day of Diwali, I think I've only heard that on the radio. Everything on the 'tubes is geared towards skeletons. From Twitter, I clicked this link at the Smithsonian, and came across a sprawling write up of a cemetery in Southwark that borders on an area of London that has housed prostitutes for 1900 years. (Which is a whole lot of years. I'm not convinced we know for a fact that Roman soldiers were visiting ladies of the night in Southwark during the first century but the article seems to think we do.)


History Cold Case. Crossbones Girl by thegrantuk--

Crossbones Girl - a 'cold case' investigation of one of the skeletons found
at the cemetery.

The article gives a necessarily brief history of the area, and dwells on the cemetery, the Cross Bones Graveyard. Although the Bishop had the local licensing rights for prostitutes, for some reason they were still considered outside the church, and so were buried in unconsecrated land. There were a lot of them (and local poor, along with their children, who were also apparently buried here) and the later burials were shallow, leading to a bit of NIMBYism from the locals, who thought this might not be very sanitary. Still, the article says the burial ground was eventually "more or less forgotten" until the London transport authority needed the land to build a substation in the 1990s. Historians were given a brief window to check the ground, and then all hell broke loose. Not so much in terms of the corpses springing up and haunting South London, which would have been cool, but more in the sense of the living suddenly deciding that Cross Bones was Important And Must Be Commemorated.

The article says that "[t]he International Union of Sex Workers has even called for Cross Bones to be the first World Heritage site dedicated to those in the sex trade"; a local 'poet' called John Constable Had A Vision and wrote extensively about the site - and, in a less likely conclusion, was actually published and his work put on as a play; and lots of those New Agey/ Old Hippy folks who seem to lurk in the brick walls and cobbled mews in London like the Boneless in last week's Doctor Who sprang from the brick walls, as they do, and formed The Friends of Cross Bones. They have made a "wild garden" in the graveyard and festooned the gates with ribbons, and they aim to preserve "the garden as a more permanent place of reflection and remembrance".


A short doc on the Cross Bones cemetery.

This is the sort of story that presses all my buttons, despite being a little too Halloweeny to be really real.  Two thousand years of illicit sex, presided over variously by the original world authority, the Romans, and then their successors, the Christian Bishops; haphazard burials in unconsecrated ground, syphilis and miasma; a strange mass forgetfulness; the graveyard's revelation by the London Underground's mechanical backhoes; and the subsequent flume of psychogeography-related hysteria by those still remaining alive above ground, like the screaming mass hive panic in Quatermass and the Pit.

The spokeswoman from the local council is called Ms. Dark.

And, when the article declares...

An 1832 letter from parish authorities had noted the ground was “so very full of coffins that it is necessary to bury within two feet of the surface,” and that “the effluviem is so very offensive that we fear the consequences may be very injurious to the surrounding neighborhood.” [...] The land was sold for development 30 years later, but the sale declared void under the Disused Burial Grounds Act of 1884. Locals resisted further attempts at development, although the land was briefly used as a fairground, until complaints about the showmen’s “steam organs and noisy music” became overwhelming.

 ...it led me to believe, just for a moment, that it was the dead who had complained about the steam organs and noisy music. If the fairground featured a Ghost Train ride, I bet that was more than usually exciting.




Notes: Southwark is pronounced Sutheck. Quatermass and the Pit is pronounced Five Million Years From Earth.

This week in books - critics vs authors, and vice versa

As I've said before, I'm an inveterate reader of internet comments. So much so, that reading compendiums of internet comments is actually fun. I mourn the demise of Speak You're bRanes, and I'm a little dismayed at the long, slow cooling of Fandom Wank. The former quoted comments from the BBC's Have Your Say site, which tended towards the Little England, racist and small-minded, and took them apart with much creative swearing. Fandom Wank found those little outcrops of mass rage (otherwise known as wank) in various fandoms and summarized the best bits of Bronies losing their minds over criticism of My Little Pony, or Anne Rice throwing yet another fit about how fans are Doing It Wrong.

This week has been a banner week for fandom wank, in the lowercase, I'm not nearly as patient as either Nelson or the Fandom Wank writers, but if they're not on the job I suppose I should at least point at it. One kerfuffle is a about an author who went after a critic, and the other is about an abusive critic who became an author.

The first stirrings were the publication in the Grauniad of an essay by an author named Kathleen Hale. It's called 'Am I being catfished?' An author confronts her number one online critic' and she sure does.  Using an unusual definition of 'catfished', Hale is sure that a Goodreads book critic who gives her a one-star review that reads "Fuck this" is not simply reviewing her book, but beginning to orchestrate a vendetta against her. Hale fails to heed the advice of everybody in her life (and everybody I've ever read online), which is "Ignore it. Don't respond."

She gets drunk and engages, backs away, engages again and finally gets the critic's 'real name' and address. Then she does what everybody would do, which is think, "I have gone off the deep end and need to lie down", and tear up the background check she had done on the critic, right? No, she doesn't. She goes to the person's house.

This has stirred up a lot of interest on the interwebs, because unhinged author behavior is quite rare and always very telegenic - like watching a train wreck except fluffier and with more adjectives.

Smart Bitches Trashy Books has an interesting write up (and the comments, as always, are even more interesting). The Passive Voice, a lawyer's site on literature, has a couple of incisive looks at this, with even more comments: The Choices of Kathleen Hale and Am I Being Catfished?

The second hullabaloo coalesces around a blogger/critic whose pen name, Requires Hate, may give you some idea how she approached literary criticism.  Since the behavior went on for several years it's difficult to summarize, and since I lack the patience of Fandom Wank, I'm not even going to begin. Suffice to say she hounded and excoriated certain writers in long term, focused campaigns that couldn't be waved away as being by somebody who had a bit of a problem knowing where the do-not-cross line lay. (Though to give her credit, there's no evidence that she ever turned up at somebody's house with a view to carrying on the conversation.) Here is just one author's account of how this made her feel - and there are others like her.

Recently, there was a rumor that new science fiction writer Benjanun Sriduangkaew was the same person as Requires Hate, which started a backlash. Just because two people are Thai, and female, does not mean they are the same person, mocked the interwebs. Well, apparently they are the same person. Famous editor and internet eminence grise Nick Mamatas 'outed' her a week or so ago on Ello and the response was loud and immediate (James Nicoll's Live Journal).

Today (although the post is dated the 15th), Requires Hate apologized quite fulsomely for her previous behavior, once on her blog and again as Sriduangkaew. The response has been mixed, to say the least. Has she reformed, or does she have a book to sell?  Once again at James' Live Journal, the debate is on.  Azarias is one fan who is not convinced the apology is enough, and the write up there is very informative and full of historical information I was not detail-oriented enough to look up myself.

Ultimately, I think Kathleen Hale thought her critic was of the Requires Hate kind.  If she has the same experience of the insta-mobs that form around a thought-leader as I have, I can see why she felt she needed to stay on top of the message. Unfortunately her reaction was disproportional and deluded. Authors should just stay away from the places critics gather and let them play in their own sandbox. They may even apologize later if they went over the top.

Jimmy Page by Jimmy Page - the affordable edition review (Book, 2014)

A couple of days ago I was dithering about whether to buy the new "affordable" edition of Jimmy Page's photoautobiography, Jimmy Page by Jimmy Page.

Well, obviously, dear reader, I bought it.  The retail price is set at $60, slightly less than the limited, signed edition's $650, and it's being discounted to $37.95 plus tax here and there. (And I got free shipping.) Is it worth it? Yes!

First of all, it's huge. It's the same size as the limited edition, 12.4 x 10.1 x 1.5 inches, and weighs over six pounds. It's hardback, and sewn in signatures; the pages are not just glued to the spine. There are 509 pages, not counting the various endpapers, many of which are full-page photographs and many of which are in color. Most of these pictures I'd seen before, but that's because I'm a Zeppelin obsessive who has trawled the various Led Zeppelin message boards for more than seven years, and even curated the photo gallery for one of them (now sadly defunct). Chances are you haven't seen most of them - and you haven't seen them full-size and print quality. Fuzzy, artefacted jpegs don't do justice to them.

The book is set up as an autobiography, but Jimmy Page is a man of few words - his introduction is just three paragraphs long - and many photographs. They start with a photo of him as an angelic choirboy [1] and go through his early bands, like Carter-Lewis and the Southerners, Neil Christian and the Crusaders, Red E Lewis and the Redcaps, Mickey Finn and the Blue Men [2], through the Yardbirds and Led Zeppelin to his post-Zep bands and collaborations including the Black Crowes, Page and Plant, and even Puff Daddy. There's a section updated after the limited edition was published in 2010 to take us up to 2014.  It's literally all there, in photos.



This photo of the Crusaders and their chick magnet ambulance is not in the book. A slightly different one from 
the same photoshoot is in the book

Although a photo may be worth a thousand words, the sense of journey doesn't come through very strongly in this tome - due to familiarity with the material, my mind supplied enough supplementary commentary to fill it all in, but if you haven't had the pleasure of reading the many books on the evolution of Led Zeppelin, it may all be a bit mystifying.  On the other hand, if you haven't, why are you thinking of buying this one? Then again, one of the very first pictures is Jimmy playing his Grazioso guitar in front of a typical sixties British fireplace - there's a brass plate in the unused fire grate and in front of it, two electric one-bar fires. Two of the last pictures are Jimmy playing the Beijing Olympics with an audience of literally a billion, and him receiving an honorary doctorate. He has indeed come a long way from Heston.

Between the photographs are pictures of Jimmy's passports and visa stamps, along with tour dates. The passports give Jimmy's eye color as green, which interestingly is not borne out by the color photographs - his eyes may be hazel, i.e. green in certain lighting conditions, but they look coal-black in many photographs. The photos have the date and city on them - for example, a very fetching picture of Jimmy exiting a small sea plane that I've seen around for years is labeled August 23, 1966, Catalina Island, USA. Many arguments over what Dragon Suit or Poppy Suit was worn when can be won by referring to this volume.  Other photos come into focus, so to speak, with the sparse captions. One of Jimmy with a feathery dried-flower arrangement over his head is labeled as being in Ahmet Ertegun's house, so given that information, I can date other photos of Led Zeppelin with the same plant (no Plant pun intended).  The photo set that I'd always seen labeled as "Sol Studios" (but did not match the date for Sol) are labeled here as being taken in Jimmy's home studio at Plumpton House, and were apparently part of an idea for Jimmy's fantasy sequence in the film The Song Remains the Same, before he decided to go with the Hermit idea to be filmed at Boleskine House.

Although there are not many words in the captions, Jimmy is dryly funny throughout. A shot of him guarding a wicket from a cricket ball with a semi-acoustic guitar is captioned "My contribution to sport". It's actually a photo taken for a giveaway competition where readers could write in to win the guitar. I know that because I entered the competition; Jimmy doesn't mention it here. The famous shot of Jimmy tipping a bottle of Jack Daniels down his upturned gullet is captioned "homeopathic remedy".


Homeopathic remedy

A rare shot of the legendary "stormtrooper's uniform" of Chicago, 1977 is laconically captioned "Here I'm wearing Hugo Boss".


Hugo Boss design. This photo is not in the book; similar ones are.

A shot of Jimmy with an injured hand shows him with a man whose back is turned to the camera, and whose hand is lifted towards Jimmy's back. The caption is "Et tu, Brutus? (sic)" The caption does not name the man as Bill Graham, with whom Led Zeppelin had some serious troubles, but I'm pretty sure it is.

And man, are there a lot of duck-faces. If you thought Instagram selfie-girls invented that, you were wrong. There are lots of guitars with too many necks and weird numbers of strings.

What Jimmy has chosen to leave out of the book is quite interesting.  There's a Knebworth field group shot, but not the one taken a few minutes later when Robert Plant pulled his pants down to 'salute' the strippers the photographer had brought along to cheer the group up. (For this was the seventies...) There are no pictures of the Chislehurst Caves stripping nuns. The pictures taken in the Swedish live sex club are unsurprisingly missing. (Click on the picture for the full shot; warning NSFW.) The book is more or less silent on the final days of Led Zeppelin. There are no pictures of family members at all - one photo of Jimmy arriving at Knebworth in a helicopter has Charlotte in shot, but she is not named in the caption - unless you count Jackie DeShannon, who is in one picture but there is no mention of a relationship with Jimmy other than mutual songwriters and musicians. No kids. No dads. No revealing shots of life at home.

The book has had to downgrade slightly from the limited edition. The paper is lighter, so the photos are noticeably softer. I doubt if most people would care, but if you want to say, rip the photos to put on the interwebs, you'd need the glossier limited edition. It also doesn't lie completely flat, so double-page spreads have that annoying curve in the center, unless you carefully unpick the stitches and press it flat. And mind you, it's cheap enough you could do that - one to open up and paper your bedroom wall like it's 1975 again, and one to keep on the coffee table.

Five stars.

[1]My fingers typed "angelic cowboy" there the first time. What does that mean, Dr. Freud?
[2] Sensing a pattern to these names somehow

Jimmy Page, by Jimmy Page (Affordable Edition) out today

Three years ago, I bought a copy of the limited edition of Jimmy Page's "autobiography", a book of photographs detailing his entire career, from teenager to honorary doctorate and OBE holder.  I wrote about it here.  It's a fantastic book, but at $650 it's not something I leave open on the kitchen table in order to gawp at the pictures every day while whipping up a souffle or two.

Today, the affordable edition is released, by the same publisher, Genesis.  Details are kind of sparse, but Genesis call it an "edition" of the same book, so I have to assume the photo selection is the same and the difference is in the craftmanship that went into it.  I'm currently swinging between irritation that "Led Wallet" (as the road crew apparently called Jimmy Page on account of his thriftiness) would go for the money by releasing an unlimited edition and a strange desire to own it as it is a book I could paw through without damaging it.

Jimmy Page's website has a slideshow of some of the pages in the book and a "buy" button, but you can also buy from Amazon, which as usual looks to be the cheapest option - it is $37.95, with free shipping because I'm a Prime member.

10/20/14 Edit to add: I did buy it, of course. I review it here.

US Ebola protective gear protocols "being rethought"

I wrote a piece yesterday about "the protocols" used in doffing protective gear after caring for Ebola patients.  I said it was more likely that they were not adequate than the nurse had made a mistake in following them.

Today I learned what the protocols actually are.  They're here, with full instructions and pictures at the CDC website.  The poster made me heave a sigh. I realize that my 15 or so years on the laboratory bench dealing with Hepatitis B and C, HIV and so forth is not worth a single minute actually caring for a patient, but from my position of partially-informed inexperience, I must say you wouldn't catch me trying to work with a living being while wearing only the specified protective gear in that poster. A tray of open viral-positive serum tubes might be slightly scary to the uninitiated but at least they're not going to cough on the back of your neck or projectile vomit on your shoes.

Yesterday I speculated that the nurses weren't being watched as they donned and doffed the gear, and that there might be no showers of bleach in the airlock. Too right. There's no airlock, no observer, no bleach and not even any booties (overshoes) or back of the neck protection. There's only one set of gloves, so removing the gloves first means your bare skin touches your outer protective gear at the back of the neck when you undo the mask. It's like the CDC has never even seen one of those Medecins Sans Frontieres videos...

(Picture from MSF website credited to Sylvain Cherkaoui/Cosmos)

Today, the CDC, according to the New York Times, are changing their "protocols".

And they [the CDC] are now watching hospital personnel as they put on and take off their protective garb, retraining the staff and evaluating the type of protective equipment being used. They were considering using cleaning products that kill the virus to spray down workers who come out of the isolation unit where the nurse is being treated. 

“There are a series of things that are already implemented in the past 24 hours,” Dr. Frieden said. “If this one individual was infected, and we don’t know how within the isolation unit, then it is possible that other individuals could have been infected as well.”

My very best wishes to the poor nurse, and let's hope that's the last transmission in the US.

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. 

Beautiful Dumbo Octopus video from Okeanos

From: September 27: Okeanos Explorer Atlantic Canyons and Seamounts 2014



Previously:

Here
Here
And here

More Dallas Ebola response fun

HD Chopper 8 caught crews cleaning the sidewalk outside the Ivy Apartments where the #Ebola patient stayed. pic.twitter.com/Tl7CVVzVvH
— WFAA TV (@wfaachannel8) October 2, 2014

The tweet above claims to show the sidewalk being cleaned outside the Ebola patient's Dallas apartment. As I mentioned before, he had vomited there after showing symptoms of infection but being discharged from the hospital with antibiotics.

Two men are power-spraying the sidewalk. They are not wearing any protective gear, and a passerby is in shot, apparently unaware what they are doing. I've used a power-washer - it kicks up a fine spray inches and probably feet into the air. I can't think of a better way to aerosolize an infectious liquid.

For what it's worth, Ebola is hard to catch, in the sense that it is not very contagious. Since you have to touch the liquids from the body of an infected person, it usually requires you to touch his or her body or belongings. On average, one Ebola-carrying person will infect two others. For something like Measles or Mumps, one carrier can infect ten or more people, so these spread very rapidly compared to Ebola.

Ebola is, however, very infectious, which is different. For some viruses to "take" inside your body, you have to breathe in, or get in a skin cut, thousands of viral particles. For Ebola, one to ten viral particles is sufficient to give you the disease.

So a not-very-good thing to do with virus-containing body fluid is blow it up into the air in a fine spray.

I'm not an Ebola expert, but generally speaking, if you have to do a clean up of something like infected vomitus, put a spill boom around it, cloth on top of it and flood it with 10% household bleach solution. Leave it there for ten to twenty minutes and then soak it into cloths or use a spill-kit, Put all the material into biohazard bags and have a properly licensed* hazardous waste contractor haul it away for incineration. Remember to wear full protective clothing.  Here are full details from the CDC ( see in particular 5n and 5o) and it's a good idea to read them before you try it at home. Remember household bleach loses potency over a few months and diluted household bleach loses potency over a few days.

*The clean up crew who worked on the Dallas patient's apartment interior did not have all the permits needed. To be fair to them, it's quite likely the permits needed had not been invented yet. I really don't think anyone expected Ebola to happen!


Oh, and as I said before, best do this before dogs eat it. Endemic Ebola is not a good idea.

eBola? In my day we had to make do with Bola

(Not my joke, but I don't remember where I heard it.)


This is a follow up to the last post on the CDC's comedy attempt to stop Ebola from spreading in the US.  USA Today has a nice summary which I've excerpted here.

The apartment of the Ebola patient is finally being cleaned, so his partner does not have to continue to live with possibly infectious linen and other soiled items. (In case you've forgotten, she's cooped up in there because she's at gunpoint. You could argue that it would be more humane to take her to a nice clean quarantined hospital room, but no such luck. This is the USA.)

County officials say they had trouble finding a cleaning crew willing to sanitize the residence, but late Thursday night, a crew was seen entering the apartment.

One of the kids went to school on Wednesday, but the county has issued an "order" and the armed guard outside is enforcing it, so no more school until October 19th. No more visitors, either.

If someone else falls ill with a suspected case of Ebola, officials confirm they will likely be taken to Texas Health Presbyterian Hospital in Dallas by ambulance. Protocols have been put in place, though health officials declined to elaborate on the specifics of the protocols.

Let's see. If I remember HIPAA correctly, health officials aren't allowed to talk about general public health....No, wait, they ARE allowed to talk about public health protocols. It's individual patients' health records they are forbidden to discuss. Silence on this subject suggests they don't have any "protocols", or that they are so threadbare that they daren't expose them to scrutiny.

In the last blog entry, I wondered why the nurse had not flagged up the fact the patient had been to Liberia. Apparently the nurse did flag it, but there was a "flaw" and the information was not passed to doctors.

In their electronic records, physician and nursing workflows were kept separate, and the documentation of travel history was located only in the nursing workflow portion of the records. Since the flaw was discovered, the travel history documentation was relocated to a portion of the records that appears in both workflows, and has also been modified to specifically reference Ebola-endemic regions in Africa, hospital spokesman Wendell Watson said.

Sadly, I've worked in healthcare most of my working life, and I can totally believe this "flaw". It's entirely likely that some portion of the initial exam didn't get to the doctors.

Since nearly every hospital in the US has a different home-grown (and mostly incompatible with others) IT system, and they all have similar but interestingly different "flaws", good luck in not getting Ebola!



Update 10/04/14: There was no "flaw" in the IT system. The nurse didn't think to tell the doctor and the doctor didn't think to ask or to look in the IT system.

http://time.com/3465993/ebola-dallas-hospital/

I've worked with infectious disease people, public health people and the CDC (a bit) for years and this is just hopeless behavior. I despair.

Summer of Death and Derp

Well, this has been an interesting summer. Usually summer is the Silly Season, when New Yorkers fry eggs on the sidewalk, the British tabloids present pictures of "fruity" schoolgirls in short skirts waving their A-Level results, and stories abound about cuddly hippos called Hilly. This year's been different though. As Private Eye called it, satirically, in a headline, it's been the "Killy Season".

The American police-force has taken to shooting men (mostly black ones) in cold blood, beating up black women, tasering pregnant women in the back and generally acting like asshats.

Jumping the White House fence and seeing how many doors deep inside you can get is now the national sport. The Secret Service men also let Obama ride in an elevator with an armed felon, and one of them apparently sold the President's secret itinerary to Republican supporters, allowing them to get countering ads in place before the visit.

America has been attempting to start a proxy war with Russia in Ukraine and is doing remarkably well. Almost everyone thinks the Russians shot down a passenger craft over Ukraine, and Russian claims over Ukraine territory have been dismissed with the usual cry of "But Freeedomm! Ukraine must be free!" It's a bit more complicated than that, but shout "Freedom!" loud enough and Americans always join in. They were cheering along with Mel Gibson as William Wallace over the Scots getting their "Freedom!" this summer, but it turned out the Scots actually wanted cooperation and peaceful union. How un-American.

Then America had a big hit with bombing Syria after last year's disastrous flop – bombing Syria. It's surprising what a simple chord change – from bombing Assad to bombing his enemies – can do in terms of the kids buying the tune, even though it doesn't make any logical sense. The UK looked over the wall and said, "Are you having a war, Mr. Obama? Can we come?" and Barry said sure, pay the military industrial complex at the booth over there and get stuck in. There's room for everyone to bomb in the Middle East!

Best picture of Ebola I could fake up in Photoshop in a hurry.

And the biggest show of the late summer is the Ebola virus. After watching it rage in Africa with mild interest, and eventually sending troops who, I assume, are there to ensure people stay quarantined or get shot, (since troops are not generally used for things other than shooting people) the government twiddled its thumbs until Ebola made its way over to the US. Since Capitalism relies on open borders, I guess it would have been too disruptive to disallow flights from Liberia on the off-chance that someone would come over here with the virus. 

But someone did. After he carried a dying girl, bleeding from the mouth, to a doctor (she died the next day), the patient's family says he had no idea she had Ebola. He thought it was a complication of her pregnancy, because, you know, that's where you bleed from if you have a complication of pregnancy. Liberia says it's going to prosecute him for lying on his departure forms, but he says he didn't, so whatcha gonna do? Particularly as US health care is much more likely to help him than the Liberian system so he had no incentive to do whatever he had to do to get on that flight…wait!

Anyway, he didn't have a fever when checked at the airport. The Centers for Derp Concentration (CDC) have no protocols to recheck people from Hot Zones after a few days to make sure they're uninfected, so he hung around in an apartment in Dallas with his partner and his family, coming into contact with several children among other people, until he did have a fever, and then he went to a hospital.

Who promptly kicked him out. He said he'd been in Liberia within the right time frame, but I guess they didn't want to deal with a feverish foreigner who probably has no health insurance, so they kicked him out with antibiotics, telling him it was a low-grade virus.

Yep, they gave someone with a virus antibiotics, even though I'm pretty sure that at least some doctors are faintly acquainted with the concept that viruses are not affected by antibiotics. Oh, and in case you're thinking the nurse probs thought, "Travelled to Liberia? Isn't that near Washington? Why is he running a temperature, sweating on my shoes and telling me he's been to Liberia?" Well, the CDC has been holding outreaches to medical practitioners for months now telling them to ask about travel to West Africa and consider that low-grade viral symptoms from travellers may be early Ebola, so he or she knew, all right.

Anyway, they gave him his placebo antibiotics and he went home, vomited in the street, then suffered another two days before he was finally brought into hospital and diagnosed with Ebola. This was apparently prompted by his family calling the CDC and telling them he had Ebola, and he should be taken seriously. It sounds like it wasn't, as the ambulance crew is now being kept in isolation, so it sounds like they weren't properly prepared.

The CDC went on TV telling everyone not to panic and how they were on top of things and it can't happen here and we have the best medical care in the world and we're not Liberia, we're actually good at what we do and it isn't airborne you know, you have to touch body fluids yadda yadda.

The CDC has traced the contacts, or at least they say they have, though at this point one is beginning not to trust them. They've quarantined his partner in their apartment, where according to one article, she's been stuck with his sweaty bed sheets and towels from Sunday to Thursday, the disinfection crew not having turned up yet. You think she likes being in an apartment with some soiled linens when suited-up spacemen armed with bleach sprays barely dare to get near a body in Liberia? The apartment has "some hygiene issues", an official said.

They also told the rest of the family in the apartment to stay home, check their temperatures and report back. Naturally some of them left at the first opportunity, and had to be herded back, and are now guarded by police. A food truck is supplying meals. I bet they're a happy bunch! Oh, and the children have been taken out of school. Let's hope that wasn't too late.

The conspiracy theorist in me always wonders at this point (as I did during the civilian lockdown in Boston over the manhunt for the marathon bombers) whether it's somebody's plan to get us used to being told to stay in our houses for fear of our lives, and learn we'll be shot at by policemen if we don't agree.

It's possible the CDC (along with the armed policemen as their enforcement wing) are as clever as they think they are and it stops here. Based on the Keystone Kops routine above, I have my doubts.

Also - remember the patient vomiting in the street? What's the odds a dog or a rat got to that before anyone hosed it away? Some animals can get Ebola and not die from it. Bats are the animals most often implicated, but I'm sure there are others. Wouldn't it be fun if a sparse plume of infected bats slowly spread out from Dallas over the next ten or so years? Endemic Ebola. Lovely.


Update here.
Even more mind blowing update here.

http://www.dailymail.co.uk/news/article-2776965/Schoolchildren-exposed-US-Ebola-scare-patient-named-Thomas-Eric-Duncan.html

http://gawker.com/texas-ebola-patient-was-originally-just-sent-home-with-1641415368/all

http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-patient-thomas-eric-duncan-vomited-outdoors-witness-tells-reuters-n216426

http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-patient-thomas-eric-duncans-nephew-i-had-call-cdc-n216326

http://www.bbc.co.uk/news/world-africa-29467489

http://www.nbcnews.com/storyline/ebola-virus-outbreak/she-was-helpless-taxi-driver-describes-ebola-patients-fateful-ride-n217011

http://www.dailykos.com/story/2014/03/27/1287696/-Bats-discovered-to-be-transmission-vector-in-largest-outbreak-of-Ebola-in-Africa-in-seven-years-64

http://news.discovery.com/human/health/facts-about-the-ebola-virus-140918.htm

http://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=11336236

http://www.cnn.com/2014/10/02/us/texas-woman-quarantine-ebola-thomas-duncan/