4 ms·

This is just dandy. We believe the risk of transmission in such a circumstance are low, but that low risk is counterbalanced by awful consequences if that beli

by hga 12y ago

This is just dandy. We believe the risk of transmission in such a circumstance are low, but that low risk is counterbalanced by awful consequences if that belief is wrong or there's bad luck. Note also that it appears to have been determined that Texas Health Presbyterian Hospital is not going to become the "Dallas Ebola Magnet Hospital of Excellence", she's being sent to Emory, which has 3 of the 23 hospital beds in the country that are truly equipped and prepared for Ebola. ADDED: more joy, although one should be very careful about early reports of data that's in this case 2nd or worst hand: However, Dr. Margo Erme from the Summit County Public Health said in an Akron press conference later in the afternoon that they’re not sure about the timeline. “We have gotten conflicting dates too, so we are actually looking at getting the manifest from the airline to actually confirm that because we have actually heard both.” She said her department is in the process of interviewing family members in Tallmadge, where they believe Vinson spent time. According to Erme, Vinson was “quite ill” when she went to the hospital and may be having trouble remembering details about her movements before she began to exhibit symptoms. From http://pjmedia.com/tatler/2014/10/15/conflicting-timelines-and-details-for-new-ebola-case/ http://pjmedia.com/tatler/2014/10/15/conflicting-timelines-a... Unfortunately believable given the reported fever, although what "quite sick" really means is extremely vague.

anigbrowl 12y ago
While not very impressed with the administration/CDC's leadership in response to this crisis (insofar as public oommunication could be a lot better), I'm downright astonished at how badly THPH has dropped the ball, and how often. Sending an Ebola-infected patient home, lying about why they did so (blaming a glitch in their IT system before coming clean), allegedly issuing staff with paper gowns, and having 76 different people treating their 'patient zero'...it's just one bad decision after another - some of which seem to be local to the hospital, some which are culturally ingrained in the medical profession (eg patients being treated by large numbers of medical staff seems to be the norm in the US). For a variety of reasons the Obama administration has zero political capital to make any significant changes in the healthcare landscape in its remaining 2.25 years, but I hope that one or more serious contenders for the presidency in 2016 makes reform of the US medical industry central to their political agenda. The market model for health care simply does not work because participants in a healthcare market are not voluntary actors (with a free choice of when to enter/exit the market), there is massive information asymmetry between actors which makes rating providers virtually impossible, and because there are noneconomic feedback mechanisms - eg irrational actors who choose not to get vaccinated can end up as epidemic vectors and completely upend the supply/demand equations for everyone else.
- crpatino 12y ago
  > (eg patients being treated by large numbers of medical staff seems to be the norm in the US). Treating knowledge workers as assembly line workers might be great for the bottom line, but at the cost of making the organization impossible to adapt to changing conditions. In this case, it's practically equivalent to sending your troops marching ahead in neat lines (Napoleon style) against a bunch of machine gun nests. ...oh well, I guess I am preaching to the choir here.
  - hga 12y ago
    Don't forget the quick firing canon. The speed of ones like the French 75 mm, ~ 15 rounds per minute, made as much of a difference in WWI, and per my current reading on that war---and in terms of near universal insufficient competence, it's totally topical, but I didn't exactly plan starting that a few weeks ago---that more than the machine guns required serious trench-works or the like. But you're going way too far in claiming that this organization found it "impossible to adapt to changing conditions". Read the accounts, they continually improved and stepped up their game, we Americans are good at that (in our warfare, Vietnam is the classic counterexample of micromanagement at all levels short circuiting that classic fantastic advantage of US soldiers). But this process wasn't fast enough when potentially fatal isolation errors started the second the EMT crew arrived at his apartment complex. But I'm certain we'll get better, just as I'm certain it'll take quite an infection and death toll to get "good enough". Assuming we don't get overwhelmed before then, this is way too path dependent to predict.
    - crpatino 12y ago
      At risk of going tremendously off-topic here... yes, people learn from their mistakes, if the consequences are hard enough. This was true in war, as it's probably going to be true in this epidemic. Little consolation for the poor souls at the first lines.
      - hga 12y ago
        The thing is, that's not necessarily true in war. Little of it happened in Vietnam, to the USArmy's eternal shame, LBJ and McNamara showed little if any signs of learning, etc. etc. At this point in my detailed WWI study I think I can say little happened in the French army, which mutinied with justification after several years of horror and was then useless for offense for a long time. The Japanese in WWII didn't particularly learn in critical areas when, e.g., they used up their air power in the futile for them South Pacific campaign (the one that started with Guadalcanal). They didn't learn that disdain of non-combatant specialties is fatal in modern war. Their admirals never lost their taste for insanely complicated battle plans that depended on the other side doing what they expected, or at least that's a lesson to be learned from Midway and the much latter just about final action in the Philippines. How much learning went on in the 30 Years War? Heck, I gather it's generally accepted that the lessons of Gustavus Adolphous were not properly learned until Napoleon applied them a century and a half later (!!!). I can go on and on and on ^_^. I mention this in part because the US has a tradition, if you can call it that, of starting out very green and shaky, and then getting really good. We're seeing the "very green and shaky" in Dallas right now; I'm hoping it and the rest of the country that's not ultra prepared (i.e. everyone but those four specialist wards) will follow a similar pattern.
hga 12y ago
CORRECTION: It turns out the nation has only 11 "Ebola beds": the Omaha and NIH wards can only treat 1-2 and 2 patients with something this bad out of the 10 and 7 total beds they have. Which leaves 7 free at the moment.
hga 12y ago
CORRECTION #4: It turns out the nation has only 11 "Ebola beds": the Omaha and NIH wards can only treat 1-2 and 2 patients with something this bad out of the 10 and 7 total beds they have. Which leaves 7 free at the moment.

by hga 12y ago

anigbrowl 12y ago

While not very impressed with the administration/CDC's leadership in response to this crisis (insofar as public oommunication could be a lot better), I'm downright astonished at how badly THPH has dropped the ball, and how often. Sending an Ebola-infected patient home, lying about why they did so (blaming a glitch in their IT system before coming clean), allegedly issuing staff with paper gowns, and having 76 different people treating their 'patient zero'...it's just one bad decision after another - some of which seem to be local to the hospital, some which are culturally ingrained in the medical profession (eg patients being treated by large numbers of medical staff seems to be the norm in the US). For a variety of reasons the Obama administration has zero political capital to make any significant changes in the healthcare landscape in its remaining 2.25 years, but I hope that one or more serious contenders for the presidency in 2016 makes reform of the US medical industry central to their political agenda. The market model for health care simply does not work because participants in a healthcare market are not voluntary actors (with a free choice of when to enter/exit the market), there is massive information asymmetry between actors which makes rating providers virtually impossible, and because there are noneconomic feedback mechanisms - eg irrational actors who choose not to get vaccinated can end up as epidemic vectors and completely upend the supply/demand equations for everyone else.

crpatino 12y ago
> (eg patients being treated by large numbers of medical staff seems to be the norm in the US). Treating knowledge workers as assembly line workers might be great for the bottom line, but at the cost of making the organization impossible to adapt to changing conditions. In this case, it's practically equivalent to sending your troops marching ahead in neat lines (Napoleon style) against a bunch of machine gun nests. ...oh well, I guess I am preaching to the choir here.
- hga 12y ago
  Don't forget the quick firing canon. The speed of ones like the French 75 mm, ~ 15 rounds per minute, made as much of a difference in WWI, and per my current reading on that war---and in terms of near universal insufficient competence, it's totally topical, but I didn't exactly plan starting that a few weeks ago---that more than the machine guns required serious trench-works or the like. But you're going way too far in claiming that this organization found it "impossible to adapt to changing conditions". Read the accounts, they continually improved and stepped up their game, we Americans are good at that (in our warfare, Vietnam is the classic counterexample of micromanagement at all levels short circuiting that classic fantastic advantage of US soldiers). But this process wasn't fast enough when potentially fatal isolation errors started the second the EMT crew arrived at his apartment complex. But I'm certain we'll get better, just as I'm certain it'll take quite an infection and death toll to get "good enough". Assuming we don't get overwhelmed before then, this is way too path dependent to predict.
  - crpatino 12y ago
    At risk of going tremendously off-topic here... yes, people learn from their mistakes, if the consequences are hard enough. This was true in war, as it's probably going to be true in this epidemic. Little consolation for the poor souls at the first lines.
    - hga 12y ago
      The thing is, that's not necessarily true in war. Little of it happened in Vietnam, to the USArmy's eternal shame, LBJ and McNamara showed little if any signs of learning, etc. etc. At this point in my detailed WWI study I think I can say little happened in the French army, which mutinied with justification after several years of horror and was then useless for offense for a long time. The Japanese in WWII didn't particularly learn in critical areas when, e.g., they used up their air power in the futile for them South Pacific campaign (the one that started with Guadalcanal). They didn't learn that disdain of non-combatant specialties is fatal in modern war. Their admirals never lost their taste for insanely complicated battle plans that depended on the other side doing what they expected, or at least that's a lesson to be learned from Midway and the much latter just about final action in the Philippines. How much learning went on in the 30 Years War? Heck, I gather it's generally accepted that the lessons of Gustavus Adolphous were not properly learned until Napoleon applied them a century and a half later (!!!). I can go on and on and on ^_^. I mention this in part because the US has a tradition, if you can call it that, of starting out very green and shaky, and then getting really good. We're seeing the "very green and shaky" in Dallas right now; I'm hoping it and the rest of the country that's not ultra prepared (i.e. everyone but those four specialist wards) will follow a similar pattern.

hga 12y ago

CORRECTION: It turns out the nation has only 11 "Ebola beds": the Omaha and NIH wards can only treat 1-2 and 2 patients with something this bad out of the 10 and 7 total beds they have. Which leaves 7 free at the moment.

hga 12y ago

CORRECTION #4: It turns out the nation has only 11 "Ebola beds": the Omaha and NIH wards can only treat 1-2 and 2 patients with something this bad out of the 10 and 7 total beds they have. Which leaves 7 free at the moment.