Saturday, October 11, 2014

Texas: Red State Fighting Ebola on the Cheap

In a cold, statistical way we can see why the social cultural conditions in West Africa were so "perfectly tuned" to make the ebola epidemic grow into the monster it is currently. 

First -- and possibly most consequential -- the ebola viral outbreaks are exclusively African. They have been isolated to sub-Saharan African regions in every [recorded] instance when epidemics have occurred for as long as such things have been scientifically tracked. Although many of the same "social cultural conditions" exist on other parts of the planet, the specific "primary" condition present in West Africa is that this is the "home" of the virus.

On a "microscopic level" the virus enjoys a certain collection of "organic" advantages found almost exclusively in the African environment. However, having said that, we can also begin to list a litany of other complications arising from human behavior which are contributing to the current epidemic.

1. There is a fairly plausible current theory that the virus has entered the human population through the eating of various game meat -- especially monkeys. Regional populations have done this traditionally.

2. The populations in the region are, over all, less educated and more superstitious than in more developed countries. These factors have gravely complicated efforts to teach methods which can prevent the virus from spreading.

3. The West African countries lack the resources to build modern health care infrastructure. It is very difficult for average citizens to access a doctor, especially in the rural areas, but to some extent, even in urban areas.

4. Cultural traditions and social habits "play into" the spread of the viral contagion. For example, it is the social tradition to wash the bodies of the dead in preparation for burial, and in the case of victims of ebola, this can amount to a fatal exposure. In another example an aid worker helped a man carry his wife, already sick with ebola and in a contagious stage, to a hospital. The husband and wife died, and the man who helped carry to sick woman became the ebola patient who was being being treated in Dallas.

As this specific account unfolds further, some of the impact of the conditions surrounding [4 - above] this part of the epidemic becomes clearer. This man was asked in routine screening at the Monrovia airport whether or not he had been in physical contact with anyone who had ebola, and he answered -- somewhat less than truthfully -- "no."

It is not hard to understand his motivation in providing this answer. He had no detectable symptoms of the disease, and he really wanted to board the plane to leave Liberia. We have to assume that this man had also been familiarized with the typical symptoms of the infection by the extensive educational campaigns being conducted by the Liberian government and aid workers.

We will pick up the following part of this story "at the Dallas end" later in this post.

5. Although not directly involved in spreading the viral contagion, the region is also just now emerging from a long, violent period of civil war. While not every one of the affected countries was involved in this, even having a civil war unfold "next door" has further aggravated the situation elsewhere.

With just this very abbreviated glimpse of conditions in West Africa in general and this specific case in hand we can turn to consider what happened in Texas and the implications of those events for the rest of the US.

Handling Contagious Viral Libertarianism
 Texas Style
This couldn't happen in America, right?
Hmmm. Texas HAS threatened to secede.

All of this "lurches" itself into a position of an unsettling, immediate relevance in the context of everything that has "happened" in the health care field in the United States recently. In this case, Texas presents an unavoidable example of exactly what we've "debated" ourselves into "health care and epidemic-wise."

For background we can begin with the fact that Texas currently has the largest percentage of uninsured citizens of any state in the country -- roughly 30%. Governor Perry refused to allow the Federal Medicaid expansion program into the state for ideological reasons. He considered it to be "creeping socialism."

Perry's GOP base in red Texas loved this opportunity to trump health care with wing nut ideology -- plus, most of them assumed that those left uninsured were primarily illegal immigrants, anyway, although this turned out to not be the case. [For fairly recent statistics TEXMED - Uninsured in Texas
and  TEXMED - Statistical Breakdown of Uninsured]

While Perry deserves plenty of the blame for the situation we find in this unfortunate place at the moment, the judicial "foundation" which provided him the opportunity to refuse these ACA benefits can be found deeply embedded in the Roberts Court's slimy decision determining that the ACA was 1. Constitutional, and 2. supported by a legal tax under the Interstate Commerce laws. [Read More here: MeanMesa - The Supreme "Bait and Switch"]

So, where does this leave Texas?

This leaves Texas with roughly "just a little more" of the same vulnerability to epidemic as a found in most red states currently. There are millions of Texans who will delay going to a doctor -- one who might provide the early detection of ebola, for example -- as long as possible because they 1. don't have any spare money, any health insurance or even a doctor or 2. are too sick to sit in a hospital ER waiting room for hours.

And, if they weren't "too sick to wait for an emergency room," rolling into a public ER waiting room coughing, vomiting, sneezing and bleeding for a nice three or four hour wait, Texas would likely be "blessed" with even more ebola patients in a few days.

The low unemployment paradise of Governor Perry's libertarian "Texas miracle" has left millions of Texans in this predicament. These Texans have no employee health benefits, no access to expanded Medicaid and little prospect for improving their situation because they have no money and very little prospect of ever getting any. The "plentiful jobs" which comprise the "Texas miracle" are jobs in the libertarian ideal model, that is, jobs with no unions, minimum wage pay rates and no benefits.

And, as Texas-style Libertarian wing nuts go, there's always the even more remotely "out there" lunatic fringe. Just think of this bunch as the ones eating lunch all by themselves in the far corner of the cafeteria lunch room of a locked down ward of a libertarian insane asylum.

Here is a sample. NEWS WEEK How Libertarians Would Handle an Ebola Outbreak in Texas

Texas Ebola Bungling in the News

Next, let's have a look at some examples of US domestic media coverage of how the Dallas hospital system handled this case. The first article is from Huffington Post [Visit site here.]

Huffington Post
 On Reason For Releasing
 Ebola Patient
 By Amanda L. Chan
Oct. 4, 2014
Texas Health Presbyterian Hospital Dallas, which is currently treating patient Thomas Eric Duncan for the Ebola virus, has revised the explanation it offered earlier this week as to why it had initially released Duncan after his first visit to the hospital on Sept. 25. Duncan later had to be brought back to the hospital by ambulance on Sept. 28. 

In a statement released Thursday, the hospital said that Duncan had told a nurse that he had traveled to Africa within the last four weeks, and that the nurse followed protocols by entering that information into the hospital's electronic health records system.

According to the hospital's statement, the lapse was due to "a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case. In our electronic health records, there are separate physician and nursing workflows." The statement went on to say that, "As designed, the travel history would not automatically appear in the physician's standard workflow."

However, in a "clarification" released on Friday, the hospital said that there was in fact "no flaw" in the interactions between the physician and nursing portions of the record systems.

The hospital's reversal on its previous statement leaves the public with no clear explanation for why Duncan was initially released on Sept. 25.
The hospital's full statement can be seen here: 

We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient's travel history was documented and available to the full care team in the electronic health record (EHR), including within the physician's workflow.

There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.

Texas Health Presbyterian did not immediately respond to a request for further information Saturday.

UPDATE: 12:55 -- During a press conference Saturday, city and U.S. health officials said they did not have any additional information regarding the hospital's latest statement.

Centers for Disease Control and Prevention Director Tom Frieden said that the broader issue is the need to ensure that careful travel histories are taken for all potential patients, and that such information is shared across health care teams.

The second example of media coverage is Dr. Maddow's typically insightful reporting. The material quoted is courtesy of RAW STORY. [A link to the original article follows the quoted material.]
Rachel Maddow dissects multiple ‘unsettling’ missteps
 in handling of first US Ebola case
David Ferguson
03 Oct 2014      

On Thursday night, MSNBC’s Rachel Maddow welcomed immunologist Dr. Anthony Fauci to her show to discuss the multiple instances in which doctors and health officials in the state of Texas mishandled the nation’s first Ebola case. 

“Obviously, this is very much in its early days,” Maddow said, “We do not yet know how Texas is going to handle this as a whole, but Texas’ early missteps, including ones we are still learning about today, are unsettling.”

The patient — a man named Thomas Duncan — showed up at Texas Health Presbyterian Hospital last Thursday night with early signs of Ebola infection. The hospital, Maddow pointed out, had just gone through an Ebola preparedness drill.

Duncan explained that he had just traveled to Liberia, one of three West African nations hit hardest by the Ebola outbreak. Nonetheless, the hospital sent him back home with antibiotics.

The infected man got sicker and sicker in the apartment he shares with his family, until finally on Sunday his relatives called an ambulance and he was taken back to Presbyterian Hospital.

As of Thursday night, Maddow noted, all of the sick man’s soiled clothing, bedding and towels remain in the residence. The family — including children — are all still living in the apartment, although health officials have asked them to remain isolated.

“Ebola does not spread through the air,” she said. “The only way to contract it is from somebody else who is symptomatic and for you to come into contact with their bodily fluids.”

“If somebody who is very sick with the disease has had their body fluids on sheets and towels and bedding, then those materials do need to be handled with extreme care,” she continued.

Because of the virus’ long incubation period — anywhere from two to 21 days — it is impossible now for the hospital to simply test everyone who was in the Emergency Room last Thursday or who might have come into contact with the Ebola patient. The virus may not yet be abundant enough in their blood to cause symptoms or to be detected by clinical test.

Texas health officials have bungled their press response, leaving local media with more questions than answers.

“Seriously, is this transparency?” one reporter asked. “If you get us all here and then walk away after a half-dozen questions?”

Texas health officials have bungled their press response, leaving local media with more questions than answers.

“Seriously, is this transparency?” one reporter asked. “If you get us all here and then walk away after a half-dozen questions?”

Dr. Antony Fauci — director of the National Institute of Allergy and Infectious Diseases (NIAID) — reiterated that people who aren’t showing symptoms can’t transmit Ebola, so everyone who Duncan encountered on his trip back to the U.S. is safe.

There are about 20 people, Fauci said, who Texas health officials should be following, once all contacts are thoroughly vetted. That task is made infinitely harder by the way Texas has handled the situation so far.

“The only positive thing I can take out of those missteps,” Fauci said, “is that this will now be a really hard lesson learned. So that people seeing this unfold in the United States and in other countries that might have an imported patient with Ebola to realize the important things to do.”

[Visit the original article here. It includes a video of Maddow's interview with Dr. Fauci.]
 Even Rich People Can Die From Ebola
It just doesn't seem fair.
It's probably just a glitch in the paper work.

Dark Humor [image - Mrs. Betty Bowers - fB]

The first and only ebola case with an onset of symptoms in the United States has died from the virus. So far the United States medical system is batting "one for one."

Notably, this man's story paints a bleak picture for the "relationship" between the US and ebola:

The Red Death [image source]
1. He was not diagnosed accurately in the emergency room when he first visited.
2. He was sent home where his now contagious condition deteriorated for three more days.
3. On his initial visit to the ER he reported that he had been in Liberia to the ER staff.
4. The doctors never accessed the information about the "Liberian connection."

This rather unsettling story has already been reported in great detail, there is little prospect of MeanMesa adding much to it now. However, when the details have been considered, the "big picture" still remains, waiting to be ominously illuminated in the chilling shadow of its own light.

If we were to overlook this possibility, that is, the possibility that such a "big picture" might hold important ideas about the course we take from here, we could very likely be "snatching defeat from the jaws of victory."

So, let's switch our focus to a few "big picture" conclusions.

1. Epidemic Hysteria

It is essentially inevitable that there will be additional cases of ebola in the US. Some of them will be introduced to the health care system immediately, but some of them, just as inevitably, will languish in uninsured households until the symptoms finally prompt a visit to the nearest emergency room.

In the latter cases the more and more people will be exposed to the viral contagion. This is the way such an epidemic will spread.

While the number of infected cases may, at least theoretically, remain small enough to manage, the public hysteria won't.

Further aggravating the situation, the currently uninsured populations in the US are predominately in red states which have refused Medicaid expansion under the ACA -- states with populations which are already 1. traditionally educationally challenged and religiously superstitious, 2. groomed to a crippling mistrust of the government and 3. heavily propagandized with ideological and class themes for local political purposes.

Considered this way, the cultural conditions in these red states are now beginning to look discouragingly similar to those in Liberia.

2. Class System Health Care

An unavoidable picture of a class based, "tiered" health care system emerged when the ACA debate was still raging in the Congress. As the Democrats patiently "sold out" one feature after another of the original design, one of the predictable consequences was the stark "class vulnerability" we can foresee as the ebola challenge unfolds now.

Thanks to the slimy Roberts Court decision, there are vast communities of Americans remaining without affordable access to health care. Ironically, before ebola arrived in Dallas there were vast communities of Americans who thought that these economic and ideological class divisions were "roses, simply roses."

Now, even this privileged [or, at least, ideologically duped...] population is rethinking their stalwart resistance to features such as "universal coverage," "a single payer system" and all the other potentially effective features of the original plan which were Congressionally amputated under the direction of the wing nut PAC think tanks and the Fox pundits.

3. Reassessing US Health Care Capacity

Hardly anyone has missed the "message" which accompanied the implementation of the ACA. Today's US health care system lacks the physical, material capacity to deliver the "quantity" of health care required to meet the care needs of all the newly insured people. The "list of missing pieces" is growing every day -- clinics, doctors, nurses, labs, and so on.

However, this was already the situation before the system was ever challenged by the frightening and ugly possibility of an explosive ebola epidemic. This deficiency is now further illuminated by the fact that for facing this particular health challenge, education, preventative intervention and access -- in an unanticipated greater scope than ever -- have all moved from the "nice" to the "necessary" as far as priorities go.

4. Money, Authority and Speed

The Congressional time line of the ACA "story" -- along with plenty of others -- reveals how frustratingly, irresolutely and slowly the US democracy handles conflicts between ideology and necessity. This traditionally languid speed decreases even further when huge piles of money are "on the table" during the respective "deliberations."

However, in the event of even a few more cases of ebola in the US will these previously "slothful" legislators become unexpectedly "motivated" to more rationally face the problems confronting us? We could be moving into a position where Congressional "response speed" will mark the difference between something fairly horrible and a full fledged nightmare.

Remember, this is the Congress that went on a 54 day "political vacation" the day after the last war started.

Interestingly, some of the more stable members of the Republican Party may actually feel something like "obstruction remorse." After installing every possible sort of political sabotage into the new health care system, they may come to wish that they had been just a little less thorough in the face of an epidemic.

Additionally, should the ebola epidemic materialize, all manner of currently abhorrent "non-libertarian restrictions of freedom" may well become necessary. Citizens will need to be quarantined against their will, or testing at transportation hubs may need to be greatly expanded. One doesn't require "too many glasses of tepid Merlot" to even imagine the necessity of issues such as forced vaccinations and screening or even regional martial law -- perhaps even as actions imposed by Federal authority.

 Finally, the "Big Picture" Question

Can the presently sitting Congress be expected to rise to such an occasion?

With a well deserved 9% public approval rating and perhaps the lowest public confidence in the nation's history,  MeanMesa worries that we may be looking at a Congress which is a "weak link" even "weaker" than the "weak links" in the health care system.

You can't make a broken tool work simply because you need it to work -- no matter how great the need.

Keep washing your hands. Vote November 4.

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