Dr. Michael Osterholm from CIDRAP on Uncertainty and Ebola

Dr. Michael Osterholm is one of the few infectious disease experts speaking out and warning that we may not know everything about Ebola. It’s a convincing argument because it’s always a possibility – we may learn something new about Ebola.

What to do?

  • Uncertainty is the norm; don’t fear it. We don’t know what we don’t know and we live with that every day. Our culture tells us to run for cover when uncertainty is nearby so certainty is what the shepherds in Washington D.C. spew when uncertainty is near.
  • Prepare for uncertainty. This is why we put on our seat belts and lock our doors at night. We don’t know what might happen when we drive in our cars or go to sleep at night; but we don’t fear it – we build a hedge against the risk.
  • Remain vigilant. It’s not paranoid to have your head up when the herd has their heads down. It gives you an edge. Running for cover every time something spooks you is paranoid, avoid it.

 

Day 21 of Ebola in the USA: Living & Learning

Forty-three people who had contact with Thomas Eric Duncan, the first person diagnosed with the disease in the United States, were cleared overnight of twice-daily monitoring after 21 days of showing no symptoms, the state health department said, while another 120 were still on watch lists…

A top U.S. health official said on Sunday the United States would issue strict new guidelines telling American health workers to cover their skin and hair when dealing with Ebola patients after two Dallas nurses who treated Duncan contracted the virus. He died on Oct. 8.” – Reuters.

This news brings more hope that we can beat this thing. Two nurses who cared for Duncan are still in the hospital but 43 folks who also had contact with Duncan are not showing signs of infection.

The healthcare experts also seem to be closing the gaps in their PPE (personal protective equipment) set-up. It’s also reassuring to know that the spread of Ebola can be slowed dramatically by using the right gear and procedures.

More good news from across the Atlantic:

The World Health Organisation (WHO) declared Nigeria Ebola free on Monday, after a 42 day period with no new cases elapsed. “Nigeria is now free of Ebola,” WHO representative Rui Gama Vaz told a news conference in the capital Abuja.” – F. World

Nigeria had 20 cases of Ebola from a single incident in an airport. They responded quickly and had prepared ahead of time. They declared an emergency early and built an international task force to focus on the problem. They also did not close the borders to avoid creating a sense of panic and to avoid encouraging people to cross borders illegally. Nigeria knows the fight is not over either, and is standing watch for more cases. Read more about what Nigeria did right at TIME.

But the reports at TIME missed the fact that Nigeria tightened their borders.

Nigeria has procured vehicles to beef up patrols at the nation’s borders in an attempt to fend off further spread of Ebola virus, officials said on Saturday.

Minister of State for Health Khalliru Alhassan told a news conference in northern state of Sokoto that the government has formed a specialized rapid response team to effectively deal with the epidemic.

The team is comprised of doctors, medical laboratory scientists and other professionals, and also includes experts from the Centers for Disease Control (CDC) of the United States and Medicins Sans Frontiers, an international humanitarian organization.” – Xinhua

It’s funny that TIME missed this point all together, and pushed the ‘didn’t close borders’ piece. It seems like an important precaution to enforce existing legal borders crossings to allow aid and commerce while still effectively containing the spread of the disease. I think that’s exactly what some people in Congress are asking the CDC and White House to do.

 

Day 20: Life in Voluntary Quarantine for Some

While most neighbors understood there was scant risk that Mr. Mann, 41, had carried the disease home, rumors nevertheless coursed around town that he had tested positive for Ebola and would soon be medically evacuated. Mr. Mann said an anonymous commentator on a local news website had suggested burning down his house. “People had this lynch-mob mentality,” he said.” – NYTimes.com

Disheartening potential data point illustrated here. Voluntary quarantine may bring danger to those suspected of contracting disease. This must be part of the powder keg the White House is hoping to avoid detonating.

Opinion: White House in Full Spin Control Mode

In this week’s address President Obama attempts to reassure the American people that Ebola is contained, well understood, and will not be a problem. He covers a few basic facts in his weekly address:

  1. Only 3 cases of Ebola in USA;
  2. Ebola is a difficult disease to catch… the only way to contract Ebola is to come into contact with the bodily fluids of somebody already showing symptoms;
  3. We know how to fight the disease and we’re stepping up our response;
  4. We can’t cut ourselves off from Africa, so we can stop it at its source.

Here are my responses to these facts:

  1. True. But two of those people are healthcare workers who thought they were doing what was needed to protect themselves. So, in partial response to his third point, we obviously don’t know how to fight this disease. He also later states that this fight will take a long time and the surfacing of more cases are on the table. So while this point is true, it’s pointless. This is just the beginning of a bigger problem.
  2. Disputed. In a recent report from CIDRAP, (The Center for Infectious Disease Research and Policy at the University of Minnesota), another set of infectious disease experts say:

    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 face masks.

    The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10. A powered air-purifying respirator (PAPR) with a hood or helmet offers many advantages over an N95 filtering facepiece or similar respirator, being more protective, comfortable, and cost-effective in the long run.

    In other words, some experts say it may be possible to contract Ebola if bodily fluids from an infected person are aerosolized in a tight space.

  3. Disputed. In a recent Congressional Hearing aired on C-SPAN we witness many times over the doubts of some of our elected representatives on the adequacy of the White House and CDC’s response to the Ebola problem. Clearly there are many people in Washington DC that believe we should be doing much more, and that the CDC doesn’t have a firm grasp of the problem.
  4. True, but this is not a black & white situation – no pun intended. We can secure our borders and restrict air travel without shutting down efforts to stop Ebola at it’s source.  This idea was suggested repeated by several politicians during the recent Congressional Hearing.

The Conclusion I Draw

I think the White House is in full spin control mode as a national security precaution. If the White House were to issue any other message, especially one that sparked more concern, people might panic and that could collapse efforts to control the disease.

So while their motives may be well-intentioned they have no legs to run a long race. You can’t dismiss a growing problem with spin indefinitely. In fact when you do this you increase the backlash when the public wakes-up or is leveled-with.

My Recommendations


I think the Obama Administration should take a different path, and in this week’s address he laid the groundwork for this alternative by saying that every American citizen will have a role to play.

This is an opportunity to kick-off a health-centric civil defense program, which might even help promote and support Obamacare indirectly.

The primary core message for jump-starting this program would be confronting Ebola head-on with an overwhelming force. It’s not an over-reaction to fear but a calculated asymmetrical assault on the disease that confronts every possible avenue this enemy could take. It’s not a war on Ebola, which would be too cliche, but an strategically overwhelming response that closes all gaps for this disease to spread.

Such a bold move could also earn President Obama serious kudos. Instead of attempting to downplay the risk, which the public sees as weakness and avoidance, he could use the appointment of Ron Klain as the catalyst for this shift in approach.

Immediate actions for a health-centric civil defense program could be:

  1. Encourage people to build-up their immune systems. Make it widely known that eating less gluten, dairy, fast food, manufactured food, etc, weakened the immune system and increases an individuals chance of beating any bug. Strengthened immune systems start with a healthy gut. When your gut is clogged with cheese, gluten, and empty calories they become a breeding ground for bad gut flora, and your health deteriorates.
  2. Develop and distribute a Home Ebola Early Detection Kit along with the necessary personal protective (PPE) gear and information to help people isolate households where Ebola is discovered. This should be as easy to use as a home pregnancy kit and come in easy safe disposal packaging.
  3. Encourage people to wear PPE gear as soon as they feel sick or travel in public – even if Ebola has not reached their area. Gloves and an N95 mask, plus good safe handling measures (avoid touching face, or unnecessarily touching surfaces) can give someone an edge over any contagious disease including the flu.
  4. Be ready to distribute supplies and care information to households where Ebola emerges. This will help folks voluntarily shelter in place for long time periods. At some point hospitals may not have space or adequate numbers of healthcare workers to handle a growing number of Ebola patients. If this happens we will need a back-up plan ready to roll. The most obvious next step would be to empower people to shelter in place and care for themselves.
  5. Provide people with assurances that they will not loose their jobs or income if their household needs to be quarantined. I realize this could get very expensive financially, but giving people the security to isolate themselves should help eliminate the pressure to leave their quarantine.
  6. Build a robust plan to keep public utilities operational like the power grid, water system, teach pickup, and sewer. Work immediately to decentralize the power grid to eliminate key points of failure and improve the overall robustness of the grid.
  7. Immediately ramp-up the manufacture of PAPR (Powered Air Purifying Respirator) forced air breathing units and other necessary PPE gear. While the current message from the WHO and CDC says that Ebola is not airborne, others suggest that it can be under certain situations. So as an informed precaution give healthcare workers and emergency responders the best PPE possible. This will also help keep people on the job longer.
  8. Until the danger has passed, improve control at the borders. Require waiting periods of up to several days to monitor for signs of infection. Use disaster relief housing units at the borders as temporary housing.

Consider making this kind of civil defense program international since the problem can travel everywhere. Then, like the powers-that-be are already suggesting, ramp up the international response in Africa. Heading off the disease at its source should be the top priority.

So just to recap… where I disagree with the White House is in the domestic approach, not the efforts in Africa.

What to Do?

I’m skeptical that our government is capable of implementing anything like this, or inclined to do so, we should consider these kinds of measures for ourselves.  This you can do right now are:

  1. Learn how to improve your own immune system and make those changes now.
  2. Acquire basic PPE gear now (N95 masks, gloves, etc), and learn how to use it in an emergency.
  3. Be ready to shelter in place for an extended time.
  4. Reduce your exposure to all pathogens by limiting travel and unnecessary activities outside the home.
  5. Prepare back-up plans for electricity, water, and sewer.

An Ebola epidemic in America is on the table. We must not give into fear and respond stupidly, but we should not cling to the idea that everything is under control until the American people themselves feel empowered to defend themselves against this enemy.

 

 

Dangers of Fluoride from Dr. Mercola

99% of the fluoride added to U.S. drinking water never touches a tooth. It’s no conspiracy, 98% of Europe doesn’t fluoridate their water. So if they can do it, why are American’s asleep at the wheel and continue to allow this toxic chemical in our water?

Did you know that not all communities in the U.S. fluoridate their water? I live in one of them, Fair Oaks, CA, a suburb of Sacramento, CA. It’s not widely advertised, or easy to find, but can be confirmed in the Fair Oaks Water District Consumer Confidence Report. The only fluoride in our water comes from erosion of natural deposits.  Check your local water district’s website for a similar report to learn if your water has fluoride in it.

Data Point: Obama Says He ‘hugged and kissed’ Ebola Nurses

“I shook hands with, hugged and kissed not the doctors, but a couple of the nurses at Emory, because of the valiant work they did in treating one of the patients. They followed the protocols, they knew what they were doing, and I felt perfectly safe doing so…” – President Obama via story at RT USA

This could be bad if the healthcare authorities are wrong about how Ebola is transmitted. I guess we’ll just wait and see if the President and his entourage show signs of Ebola. I can’t even imagine the government’s response if The President gets Ebola so early in this (likely) pandemic.

ISIS Capable of Making Dirty Bombs with Chemical Weapons

A former commander of the British Army’s chemical and nuclear weapons protection forces has warned that the Islamic State in Iraq and Al-Sham ISIS has the capability of making battlefield dirty bombs.It emerged that hundred of shells filled with poison gas are stored unguarded in areas controlled by the jihadists.” – National Post

Could the world go to hell any better? It’s like a bad movie.

Data Point: Texas Ebola Hospital Cafeteria Becomes Ghost Town

DALLAS, Texas — The cafeteria, where employees and patients at Texas Health Presbyterian Hospital normally take a meal break, is looking more like a ghost town since the outbreak of Ebola. A cafeteria worker said their business had taken a major hit in the wake of Nina Pham’s becoming symptomatic after treating Thomas Eric Duncan while he was ill at this hospital.” – Breitbart.com

This is how the free market works. People make choices based on perceived risks versus potential rewards. Clearly eating food in a hospital that has failed to protect at least two of its staff members is not enough reward for the perceived risk.

Now take this up a few notches and see how if this trend line grows we will need to be ready to fend for ourselves. Nobody is coming to the rescue but ourselves. Those who can make the transition to increasing self-reliance, will better adapt during hard times.

Who Will Care for Ebola Patients?

The prospect of a pandemic is on the table, and hospitals are training their staff to treat Ebola. But we could already see the writing on the wall after hearing the news that a nurse, Nina Pham, became infected with Ebola while caring for Thomas Eric Duncan, the first Ebola victim in the U.S. Now a second healthcare worker that cared for Duncan has been diagnosed with Ebola.

Lets take a step back and consider how the confusion and fear will affect health workers. They now face the reality that Ebola is here in the U.S. and is not easily recognized. Every day these folks work with the sick. One day soon they may be treating an Ebola patient unknowingly. If they had a good level of certainty that the procedures and PPE (personal protection equipment) were sufficient for protecting them, there should be little fear. Unfortunately this recent news of healthcare workers becoming infected must be terrifying some.

“We’ve been asking for training for protocols and we have not gotten it,” said Katy Roemer, RN, a nurse at Kaiser Oakland and a member of National Nurses United. “Pieces of paper are being handed to us with minimal instructions on it, and it’s not adequate to deal with a virus like Ebola.”

Roemer’s experience is reflected thousands of times over in a survey conducted by NNU, which asks more than 2,000 nurses if their hospital has adequately prepared for Ebola. Seventy-six percent say their hospital hasn’t told them about any admission policy for Ebola patients. Eighty-five percent say their hospitals haven’t provided a forum for nurses to ask questions about their Ebola protocols.” –  Huffington Post: Nurses Say U.S. Hospitals Aren’t Adequately Prepared To Handle Ebola Patients.

So when do they stop showing up for work? I think that depends on how fast Ebola spreads and how quickly healthcare experts can determine what set of procedures and PPE is adequate for protecting healthcare workers from Ebola.

So in the mean time, it may be wise to learn all we can on how to prevent Ebola exposure and how to treat Ebola patients ourselves. If healthcare workers walk off the job to save their own lives – or the hospitals become overwhelmed – we will be on our own for treatment. The CDC may be the best place to start learning, even though they seem to be figuring this out as they go.

Photo via Breitbart.

Day 16 of Ebola in the USA: Mixed Messages

Today is Day 15 of Ebola in the U.S.A. and we’re continuing to get mixed messages from the authorities. One one hand they say we shouldn’t panic (good idea, I agree), then they tell hospitals to “think ebola”, and continue to say this is the worst health emergency of modern times.

From the CDC:

The government is telling the nations hospitals to “think Ebola.”… Every hospital must know how to diagnose Ebola in people who have been in West Africa and be ready to isolate a suspected case, Tom Frieden, director of the Centers for Disease Control and Prevention, said Monday.” – Yahoo News

From WHO:

World Health Organization Director-General Margaret Chan issued a statement Monday at a conference in Manila, calling the outbreak “the most severe, acute health emergency seen in modern times.”…

She said the outbreak is disrupting economies and societies around the world. She said 90% of economic costs of any outbreak “come from irrational and disorganized efforts of the public to avoid infection.”

Adequately educating the public should allow governments to curb those disruptions, Chan said. Fear, she said, spreads faster than any virus.

The clear message I’m hearing is:

  1. Worst case scenario is on the table; and is aided by open borders and long incubation time of the virus.
  2. Authorities overwhelmed and loosing control of the situation. The example of Nina Pham, the Dallas nurse who contracted Ebola while on the job, is clear evidence that the authorities don’t really know all there is to know about how Ebola spreads.
  3. Public is beginning to show signs of panic. The market impact on travel & leisure may be a trigger signal that the public’s behavior is changing as a result of the Ebola outbreak.

What to do?

  1. Stay calm. Panic only puts you at risk. Others will panic if Ebola begins to spread, so keeping your wits about you could give you an edge.
  2. Learn how to take care of Ebola patients in case someone in your household is infected. Start by reading the information the CDC publishes on Ebola for healthcare workers.
  3. Obtain the necessary gear. This is PPE (personal protection equipment) as well as plastic sheeting and tape for constructing make-shift isolation/clean rooms & grey rooms (rooms where you can wash down and change clothes.
  4. Know that 30% of the people that get Ebola survive. If you can build-up your immune system now you’ll improve the odds of survival.
  5. Know your own blood type and the blood types of the people in your household. It seems that one of the successful treatments is to receive a blood transfusion from Ebola survivors, so knowing your blood type could speed treatment.

Is this preparation overkill? Right now, yes, maybe. But if you think this could get out of hand a little bit of education and preparation might be cheap insurance. One thing is for sure, if the government declares an emergency, the store shelves will go bare of PPE gear – so you can choose to sit tight or front-run Ebola by gearing up now.

Video from CNN.