3 ms·

Who gives a damn about an 100% effective system? Perfect is the enemy of "good enough", or in this case significantly better. Worse, it's pretty clear that to

by hga 12y ago

Who gives a damn about an 100% effective system? Perfect is the enemy of "good enough", or in this case significantly better. Worse, it's pretty clear that too many cases in the US will use up various finite resources, from those 23 beds really able to handle this well, to healthcare workers outside of them willing to work on Ebola patients, unless future outbreaks turn out a lot better, to PPE supplies. Not to mention the extreme expense of dealing with each patient added to already financially strained hospitals, who's ability to provide services once an Ebola patient shows up gets degraded (is the Dallas hospital ER back in operation?) There's going to be leakers. The idea is to minimize them, and the human and economic costs they impose on us.

maxerickson 12y ago
I didn't mean to imply that Duncan was a known or managed case (it ended up in a managed state, it didn't start there), I was describing the situation today, where the patients are admitted for appropriate care and high quality contract tracing has been done. Anyway, as I said to you a few days ago, unless you are at least willing to revisit this in a few months or a year and consider whether the system in place was "good enough", rather than us getting lucky, there isn't much more to discuss (yes, I'm implying that my read is that you would maybe dismiss a positive outcome as luck; I don't mean to do so sneakily, nor do I intend it as an attack). I'm at least ambivalent about whether the U.S. is prepared for the situation, the repeated mishandling of things in Dallas was not encouraging.
- hga 12y ago
  Oh, I'll most certainly revisit this later. I didn't reply to your question 8 days ago in part because at this point I simply cannot envision only ~2 deaths in America (not counting the medevaced from a hotspot, 4 patients so far). But this is fantastically path dependent. I think we discussed that just before news of Duncan's death was released; in strict terms of impact on foreign importation, that obviously decreased "Ebola tourism". Not that Duncan, or Nigeria's index case were precisely examples of that; I've just started reading Camus' 1948 The Plague because at every level in these situations a lot of human behavior seems to be universal. Moving on, suppose the 2 nurses who who were infected by Duncan die, that'll change things in directions making it less likely others will die in the future (for the most part; there are results that could increase the death rate). We don't yet know if Dallas missed a contact who contracts it. And I can't imagine we won't get more Duncans until a travel ban significantly cuts the potential of them. Unless, of course, we don't get any more Duncans, in which your hope likely becomes true and we don't implement a travel ban. But I don't think that's the way to bet right now.
  - maxerickson 12y ago
    I don't understand what Ebola tourism is supposed to be. Are you talking about aid workers? Expats looking to leave the affected countries? Citizens of the effected countries looking to leave? High minded global concern says you probably let qualified medical workers travel out of the country, because it's probably a net positive to let them in, and letting them out is sensible in that case. I guess most of those folks would already be doing sensible quarantines. For the U.S., I don't think there is much of a legal framework for preventing expats from traveling back to the US (but maybe somebody should just make an order anyway and face the consequences later?). I think other countries tend to treat citizens similarly. For citizens of the effected countries, if they can get a Visa to travel to another country, I don't see the majority of them waiting until after they have a likely exposure to make their travel plans. So they would leave seeking refuge, not treatment.
    - hga 12y ago
      "Ebola tourism" is "Citizens of the effected countries looking to leave?", Mr. Duncan being the current example. The other types ought to go into 21+ day isolation/quarantine; while the risk might be low, the consequences are grave, and enough doctors have been irresponsible that I'd like it to be mandatory. Those who already have Ebola go straight to one of our 23 beds for that, as we've done with 3 people. ADDED: Now both of the nurses are going to those, the 2nd is already at Emory, the 1st is now said to be going to the NIH in Bethesda. Leaving only Montana's 3 beds untested (they've never treated a case). This vote of no confidence in a perfectly fine major hospital for "normal" problems is telling (and another strike against our idiot CDC director), as will the lawsuits that will almost certainly bankrupt it. Who wants to be next? As I understand it, public health law allows us to temporarily quarantine incoming expats and citizens, I'm not talking about a simple ban for them. When you say "I don't see the majority of them" we get to one of our fundamental disagreements, going back to https://news.ycombinator.com/item?id=8464603 https://news.ycombinator.com/item?id=8464603 up in this subthread. I just don't believe it's responsible to think about this like that; in this case your language admits that a non-majority will be seeking treatment.
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 #3: 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.
- deleted 12y ago
  [deleted]

by hga 12y ago

maxerickson 12y ago

I didn't mean to imply that Duncan was a known or managed case (it ended up in a managed state, it didn't start there), I was describing the situation today, where the patients are admitted for appropriate care and high quality contract tracing has been done. Anyway, as I said to you a few days ago, unless you are at least willing to revisit this in a few months or a year and consider whether the system in place was "good enough", rather than us getting lucky, there isn't much more to discuss (yes, I'm implying that my read is that you would maybe dismiss a positive outcome as luck; I don't mean to do so sneakily, nor do I intend it as an attack). I'm at least ambivalent about whether the U.S. is prepared for the situation, the repeated mishandling of things in Dallas was not encouraging.

hga 12y ago
Oh, I'll most certainly revisit this later. I didn't reply to your question 8 days ago in part because at this point I simply cannot envision only ~2 deaths in America (not counting the medevaced from a hotspot, 4 patients so far). But this is fantastically path dependent. I think we discussed that just before news of Duncan's death was released; in strict terms of impact on foreign importation, that obviously decreased "Ebola tourism". Not that Duncan, or Nigeria's index case were precisely examples of that; I've just started reading Camus' 1948 The Plague because at every level in these situations a lot of human behavior seems to be universal. Moving on, suppose the 2 nurses who who were infected by Duncan die, that'll change things in directions making it less likely others will die in the future (for the most part; there are results that could increase the death rate). We don't yet know if Dallas missed a contact who contracts it. And I can't imagine we won't get more Duncans until a travel ban significantly cuts the potential of them. Unless, of course, we don't get any more Duncans, in which your hope likely becomes true and we don't implement a travel ban. But I don't think that's the way to bet right now.
- maxerickson 12y ago
  I don't understand what Ebola tourism is supposed to be. Are you talking about aid workers? Expats looking to leave the affected countries? Citizens of the effected countries looking to leave? High minded global concern says you probably let qualified medical workers travel out of the country, because it's probably a net positive to let them in, and letting them out is sensible in that case. I guess most of those folks would already be doing sensible quarantines. For the U.S., I don't think there is much of a legal framework for preventing expats from traveling back to the US (but maybe somebody should just make an order anyway and face the consequences later?). I think other countries tend to treat citizens similarly. For citizens of the effected countries, if they can get a Visa to travel to another country, I don't see the majority of them waiting until after they have a likely exposure to make their travel plans. So they would leave seeking refuge, not treatment.
  - hga 12y ago
    "Ebola tourism" is "Citizens of the effected countries looking to leave?", Mr. Duncan being the current example. The other types ought to go into 21+ day isolation/quarantine; while the risk might be low, the consequences are grave, and enough doctors have been irresponsible that I'd like it to be mandatory. Those who already have Ebola go straight to one of our 23 beds for that, as we've done with 3 people. ADDED: Now both of the nurses are going to those, the 2nd is already at Emory, the 1st is now said to be going to the NIH in Bethesda. Leaving only Montana's 3 beds untested (they've never treated a case). This vote of no confidence in a perfectly fine major hospital for "normal" problems is telling (and another strike against our idiot CDC director), as will the lawsuits that will almost certainly bankrupt it. Who wants to be next? As I understand it, public health law allows us to temporarily quarantine incoming expats and citizens, I'm not talking about a simple ban for them. When you say "I don't see the majority of them" we get to one of our fundamental disagreements, going back to https://news.ycombinator.com/item?id=8464603 https://news.ycombinator.com/item?id=8464603 up in this subthread. I just don't believe it's responsible to think about this like that; in this case your language admits that a non-majority will be seeking treatment.

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 #3: 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.

deleted 12y ago
[deleted]