night driver
ESFP adrift in INTJ sea
AESOP--"Do the Math, 2019"
https://raconteurreport.blogspot.com/2019/06/do-math-2019-version.html
(Hint- go to https://raconteurreport.blogspot.com/ for access to his recent fulminations, seriously, it's a good idea)
Do The Math, 2019 version
My Inner 12-year-old loves that the placement of the filtration units
on the German hazmat suits means your farts are immediately
vented into the infected patient's room.
the title may be familiar to long-time readers of this blog. If you want, you can peruse the original 2014 version, which according to Blogger
is one of my Top Five Greatest Hits, feel free. (Go read it. Take it to heart. It's five years later, and US hospitals are still as unprepared now
as they were then. Worse even. Because now, they've pen-whipped imaginary policies into place, but with zero training, and no/inadequate
supplies, so now they think they know what they're doing. But they don't. And TPTB, locally, and nationally, know it, and they don't care. Sleep tight. Pleasant dreams.)
But Anonymous poster in Comments to the last post thoughtfully sent along the following info, and the link to it:
Thanks for all the (terrifying) information. I researched and found some information on BL-IV beds here. Apparently
they call them "High-Level Isolation Units" in the EU.
London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 6
Madrid, Hospital La Paz - 5
Berlin, Charity University Medicine - 4
Hamburg, unnamed hospital - 6
Rome, Lazzaro Spallanzani - 8
Unnamed other center in Italy - ?
Most don't have the staff to care for that many patients at once.
This information is from the following blog by a NHS nurse at the Newcastle facility who won a grant to tour the BL-IV beds
of US and Germany, Italy and Spain in 2018:
http://www.nhshighlevelisolation.com
Since I do the slogging so you don't have to, I read that grant recipient's blog report.
I recommend it. For general information.
The information shows Europe, in its entirety, could handle perhaps 31 BL-IV/HLIU patients, per that research/blog.
So how many could they really handle?
London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 2
Madrid, Hospital La Paz - 2
Berlin, Charity University Medicine - 2
Hamburg, unnamed hospital - 3
Rome, Lazzaro Spallanzani - 2
Unnamed other center in Italy - 1
So in actuality, they can only deal with 13 Ebola or other HLIU patients out of 31 beds.
(Presumably, Eastern Europe and Russia could do something similar, or perhaps to a lesser degree.)
Not bad, for tiny outbreaks locally, like in 2014.
Recall, for those who don't, the US/N.A. numbers were 23 notional beds, and staffed for only 11 actual BL-IV level patients.
With the addition of U Iowa and Bellevue in NYFC, we get 4 more actual BL-IV beds in the US, maybe another dozen notional but unstaffed beds.
So let's guesstimate it now up to 15 beds. (And 3 of those beds are nominally "reserved" for military cases from ASAMRIID,
and the associated network of .MIL facilities in MD, UT, MT, and CO, we have working on chem/bio weapons which we aren't
creating, merely defending against. And I have a bridge for sale, cheap.)
That's with Canada and Mexico providing 0 beds apiece.
For reality, let's assume in a crunch, Canada could cobble up perhaps 1-2 beds, and Mexico would still be zero, because they can't,
and would recognize that futility with brilliant Latin fatalismo, so they likely wouldn't even make the effort. They're predictable like that.
So 50 beds so far, maybe 100 all in, if Australia, Japan, Switzerland, France, and everyone else pitches in, but staffed, on the best day,
for between a quarter and half that many actual patients.
350,000,000 people live in the U.S.
We have, perhaps, 15 beds available to treat Ebola patients safely. As many as 50% of whom would live and survive the infection.
75% if you're really lucky.
So your best odds in an Ebola outbreak if you become infected, are a 1 in 35,000,000 chance of survival. I'd have to check, but I
think winning the Powerball lottery is generally about that level.
In short, a dozen or two active cases, and everyone's screwed.
Which means local hospitals and ICUs are trying to bootstrap their way to bare competency in handling BL-IV/HLIU cases. We saw the
consequences of having untrained amateurs try that at Texas Health Presbyterian in Dallas in 2014. It infected two people exactly 21
days after trying it, and shut down an entire 875-bed major tertiary care facility that was key to medical capability in that region, and
within a month. (The entire staff threatened a mass walk-out if they didn't shut the whole effing thing down. The ER and ICU were
closed for months afterwards. And let's be serious: would you go to the Ebola ER or Ebola ICU the week after they infected two nurses??
Neither would people in Dallas. Double bonus: That hospital is 93 beds smaller (a 10% shrinkage) now than it was in 2014 (968 beds to 875).
I'm sure hundreds of millions of dollars of liability and lost revenue from their 2014 escapades had nothing to do with that downsizing.)
I get trained in this nonsense every year, and exactly like military MOPP level training, it reinforces the reality: GTFO of the Hot Zone ASAP,
and don't play there, or you're all going to die. The training is only to reduce panic, not save any lives, and keep people from running,
screaming, for the hills. The issued gear is a joke, and will be criminally ineffective, and anyone who tries this on the cheap, which is
how every hospital in 50 states and 7 territories rolls, is going to infect and kill staff and the public, in about a month.
You read that right, and here, first. Take it to the bank. {Emphasis mine--CR}
Your chances, without even those clown-car levels of resources, of "surviving" fulminant Ebola, only to suffer EVSyndrome for life,
are about 1 in 4 during an actual outbreak. 3 chances out of 4, with "palliative" (i.e. helping you die inside your skin a wee bit more comfortably) care, you simply die.
If you read the blog linked, she toured US and European Infectious Disease suites.
I'm here to tell you, looking at the procedures required, those are not going to operate well under higher pressure of actual patients, they will be degraded.
Mistakes will happen. Staff members will screw up, and may die as a result. They will, in a short amount of time, realize this, and the people willing to suit
up will not increase, it will dwindle, and the units will fail. Ditto for transport, laboratory, and ancillary staff. Most people don't enter any medical occupations,
including doctors, thinking they ought to risk their lives to treat patients. The whole point, in fact, is that the only person rolling the dice in any situation is the patient.
Your heart attack isn't going to kill me. Nor your gunshot wound, nor your stabbing. Even your HIV is defeatable with $0.03 worth of nitrile gloves.
But your Ebola?
The period in any sentence on this page would be a ball of 100,000,000 Ebola viruses in a patient fully involved and infectious. Enough to wipe out everyone east of the Mississippi.
The number of those viruses from that period-sized ball necessary to infect a medical caregiver, transport person, lab worker, and kill them just as horribly?
One.
With a patient convulsing, explosively sh*tting out their guts, literally coughing out their lungs, and blood running from their eyes, nose, and mouth,
all rife with fatally infectious blood-borne pathogens.
Go back to that linked blog, and imagine someone with a couple of gallon jugs of red gloppy dye, and tell them, amidst everyone in their shiny hazmat
suits, to randomly squirt out a turkey baster of it up, out, and down, while the staff walks and works in the room. Say once every couple of minutes.
Splatter face shields, plop out a juicy glob or three on the floor, and let a constant amount dribble off the edge of the bed.
Some of the staff members will probably start to freak out, even knowing it's just a drill, which is why we never do that even in drills, so as not to let the cat out of the bag.
Ask me how I know this.
Then, after 3-4 hours in those hot, claustrophobic suits, now dripping with deadly simulated goo on the outside, the masks fogged over with sweat and condensed breath on the inside,
and not able to hear anything but the powered respirator blower whooshing loudly past your ears for every minute of those same 3-4 hours, and the inhabitants thereof dehydrated,
tired, woozy, sensory-deprived, and hopefully not panicky, see how crisp and precise their procedures are. Like starting a simple IV, or drawing blood from the patient. Like we do
10-50 times a shift. (How many hospitals' staff operate in diving gear at depths of >100'? None?? Why d'ya suppose that is, hmmm?)
Sh'yeah, that'll happen.
And with truncated operating times, you'll need 3-6x the number of staff you need for ordinary patients. {Hint: We can't get adequate staffing in any hospital, anywhere, right effing NOW.
Do you really think we'll be inundated with 6X as many when Ebola hits?? Sh'yeah, as IF.}
Those people will do one or two shifts like that, and then they're
g-o-n-e.
Called out sick.
Didn't answer their phones.
Never heard from again.
Reality: left skidmarks in the driveway, after mailing in their resignations, loading up the family and gear, and pointing the car towards Bum****,
Egypt, 500 miles from the next living soul out in the Great American Outback, beyond the black stump.
If they're smart.
We make minor mistakes in clinical care every day, now.
In just scrubs, and comfortable and competent at our jobs.
Put people in unfamiliar environments, in uncomfortable working conditions, with nothing but the prospect of endless more, times months to years,
and with the added prospect that the slightest error could result in slow, agonizing nightmarish death? And take out their family and friends as well?
Game. Over.
Throw in vaccination with a highly experimental and clinically untested Ebola vaccine (even one with >98% efficacy like RVSV-ZEBOV,
but no idea of long term consequences to recipients; ask the Gulf War I vets how that experimental Anthrax shot worked out),
which you don't have enough right effing now of to cover even 10% of the health workers in only the U.S., let alone anyplace else,
and you might get 1-5% compliance with hanging around a month or two. By which time, the outbreak will have doubled or quadrupled,
for any value of Wherever You're Talking About.
"Best wishes with that plan.
Love and kisses.
Wish you were here."
-Aesop
BF,E
Now get your stuff together to either shelter in place in self-quarantine, or GTFO to your Happy Place, and do the same thing.
For weeks to months, perhaps as long as a year or two. (The West African outbreak, in a population smaller - yes, also dumber,
but not by much - than that of the U.S., lasted from December 2013-January 2016, 25 months, before it was officially declared Ebola-free.)
Think about that one long and hard.
BONUS: That will also come in handy for twenty-seven other potential crises. Win-win.
That's what you could be dealing with, if/when it gets here again, and if it overwhelms our ability to adequately deal with it. The margin for error in such an outbreak is zero.
And if it never happens, you've wasted your time, and are now only prepared for a couple of dozen other major problems. How sad for you.
That sharp stinging sensation in the back of your head is Reality bitchslapping you back to itself, once the Official Partyline Happy Gas wears off.
[Blog note: We'll return to blogposts on other regular topics as the Muse moves us, if it ever stops being SS;DD. Just saying.]
Posted by Aesop at 2:44 AM
Labels: Ebola, follow-up story
8 comments:
McChuck said...
So, the outbreak protocol should be something like: Test for ebola. If ebola is found present in patient,
interview to find contacts. Then execute the patient, burn the body, and quarantine the contacts together someplace you can safely (for everybody else) fill with kerosene.
June 14, 2019 at 3:49 AM
Karl said...
I appreciate your informative posts on this subject. Thanks.
June 14, 2019 at 3:57 AM
Aesop said...
D'ya remember the scoops in Soylent Green?
There ya go.
https://www.youtube.com/watch?v=geol8k3rsLM
June 14, 2019 at 3:59 AM
Anonymous said...
Doesn't it seem odd that in the first picture there are four people in haz-mat suits and two in scrubs?
Almost as silly as the picture from last time of one person in a full-on suit and the other in a raincoat with goggles.....
Mark D
June 14, 2019 at 4:35 AM
Aesop said...
It's training; they're observers.
The NY idiots from 2014, OTOH, actually thought Option B was going to work.
Then Dallas happened.
June 14, 2019 at 4:41 AM
Anonymous said...
Ah, makes sense.
Glad I moved away from major metro areas six weeks ago.
Now to ramp up the preps.
Mark D
June 14, 2019 at 4:50 AM
Anonymous said...
"only to suffer EVSyndrome for life" But, but, but the NIH declared Nina Pham VIRUS FREE on June 14, 2019 and we should believe that because NIH and they would NEVER lie because .gov.
https://www.baltimoresun.com/health/bs-md-ebola-nurse-discharge-20141024-story.html
Nemo
June 14, 2019 at 4:52 AM
Aesop said...
Yeah, Nemo.
Extremely curious timing for that story, seeing as they've been silent as the grave on her and the other victims since 2014.
Just a coincidence, I'm sure.
And I'm sure they tapped her spine for CSF, and extracted fluid from the vitreous humor of her eyes, where they've found Ebola long after it's gone from blood tests, just to be thorough.
What's that? They didn't do any of that?
This is my shocked face.
June 14, 2019 at 5:07 AM
https://raconteurreport.blogspot.com/2019/06/do-math-2019-version.html
(Hint- go to https://raconteurreport.blogspot.com/ for access to his recent fulminations, seriously, it's a good idea)
Do The Math, 2019 version
My Inner 12-year-old loves that the placement of the filtration units
on the German hazmat suits means your farts are immediately
vented into the infected patient's room.
the title may be familiar to long-time readers of this blog. If you want, you can peruse the original 2014 version, which according to Blogger
is one of my Top Five Greatest Hits, feel free. (Go read it. Take it to heart. It's five years later, and US hospitals are still as unprepared now
as they were then. Worse even. Because now, they've pen-whipped imaginary policies into place, but with zero training, and no/inadequate
supplies, so now they think they know what they're doing. But they don't. And TPTB, locally, and nationally, know it, and they don't care. Sleep tight. Pleasant dreams.)
But Anonymous poster in Comments to the last post thoughtfully sent along the following info, and the link to it:
Thanks for all the (terrifying) information. I researched and found some information on BL-IV beds here. Apparently
they call them "High-Level Isolation Units" in the EU.
London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 6
Madrid, Hospital La Paz - 5
Berlin, Charity University Medicine - 4
Hamburg, unnamed hospital - 6
Rome, Lazzaro Spallanzani - 8
Unnamed other center in Italy - ?
Most don't have the staff to care for that many patients at once.
This information is from the following blog by a NHS nurse at the Newcastle facility who won a grant to tour the BL-IV beds
of US and Germany, Italy and Spain in 2018:
http://www.nhshighlevelisolation.com
Since I do the slogging so you don't have to, I read that grant recipient's blog report.
I recommend it. For general information.
The information shows Europe, in its entirety, could handle perhaps 31 BL-IV/HLIU patients, per that research/blog.
So how many could they really handle?
London, Royal Free Hospital - 1
Newcastle, Royal Victoria Infirmary - 2
Madrid, Hospital La Paz - 2
Berlin, Charity University Medicine - 2
Hamburg, unnamed hospital - 3
Rome, Lazzaro Spallanzani - 2
Unnamed other center in Italy - 1
So in actuality, they can only deal with 13 Ebola or other HLIU patients out of 31 beds.
(Presumably, Eastern Europe and Russia could do something similar, or perhaps to a lesser degree.)
Not bad, for tiny outbreaks locally, like in 2014.
Recall, for those who don't, the US/N.A. numbers were 23 notional beds, and staffed for only 11 actual BL-IV level patients.
With the addition of U Iowa and Bellevue in NYFC, we get 4 more actual BL-IV beds in the US, maybe another dozen notional but unstaffed beds.
So let's guesstimate it now up to 15 beds. (And 3 of those beds are nominally "reserved" for military cases from ASAMRIID,
and the associated network of .MIL facilities in MD, UT, MT, and CO, we have working on chem/bio weapons which we aren't
creating, merely defending against. And I have a bridge for sale, cheap.)
That's with Canada and Mexico providing 0 beds apiece.
For reality, let's assume in a crunch, Canada could cobble up perhaps 1-2 beds, and Mexico would still be zero, because they can't,
and would recognize that futility with brilliant Latin fatalismo, so they likely wouldn't even make the effort. They're predictable like that.
So 50 beds so far, maybe 100 all in, if Australia, Japan, Switzerland, France, and everyone else pitches in, but staffed, on the best day,
for between a quarter and half that many actual patients.
350,000,000 people live in the U.S.
We have, perhaps, 15 beds available to treat Ebola patients safely. As many as 50% of whom would live and survive the infection.
75% if you're really lucky.
So your best odds in an Ebola outbreak if you become infected, are a 1 in 35,000,000 chance of survival. I'd have to check, but I
think winning the Powerball lottery is generally about that level.
In short, a dozen or two active cases, and everyone's screwed.
Which means local hospitals and ICUs are trying to bootstrap their way to bare competency in handling BL-IV/HLIU cases. We saw the
consequences of having untrained amateurs try that at Texas Health Presbyterian in Dallas in 2014. It infected two people exactly 21
days after trying it, and shut down an entire 875-bed major tertiary care facility that was key to medical capability in that region, and
within a month. (The entire staff threatened a mass walk-out if they didn't shut the whole effing thing down. The ER and ICU were
closed for months afterwards. And let's be serious: would you go to the Ebola ER or Ebola ICU the week after they infected two nurses??
Neither would people in Dallas. Double bonus: That hospital is 93 beds smaller (a 10% shrinkage) now than it was in 2014 (968 beds to 875).
I'm sure hundreds of millions of dollars of liability and lost revenue from their 2014 escapades had nothing to do with that downsizing.)
I get trained in this nonsense every year, and exactly like military MOPP level training, it reinforces the reality: GTFO of the Hot Zone ASAP,
and don't play there, or you're all going to die. The training is only to reduce panic, not save any lives, and keep people from running,
screaming, for the hills. The issued gear is a joke, and will be criminally ineffective, and anyone who tries this on the cheap, which is
how every hospital in 50 states and 7 territories rolls, is going to infect and kill staff and the public, in about a month.
You read that right, and here, first. Take it to the bank. {Emphasis mine--CR}
Your chances, without even those clown-car levels of resources, of "surviving" fulminant Ebola, only to suffer EVSyndrome for life,
are about 1 in 4 during an actual outbreak. 3 chances out of 4, with "palliative" (i.e. helping you die inside your skin a wee bit more comfortably) care, you simply die.
If you read the blog linked, she toured US and European Infectious Disease suites.
I'm here to tell you, looking at the procedures required, those are not going to operate well under higher pressure of actual patients, they will be degraded.
Mistakes will happen. Staff members will screw up, and may die as a result. They will, in a short amount of time, realize this, and the people willing to suit
up will not increase, it will dwindle, and the units will fail. Ditto for transport, laboratory, and ancillary staff. Most people don't enter any medical occupations,
including doctors, thinking they ought to risk their lives to treat patients. The whole point, in fact, is that the only person rolling the dice in any situation is the patient.
Your heart attack isn't going to kill me. Nor your gunshot wound, nor your stabbing. Even your HIV is defeatable with $0.03 worth of nitrile gloves.
But your Ebola?
The period in any sentence on this page would be a ball of 100,000,000 Ebola viruses in a patient fully involved and infectious. Enough to wipe out everyone east of the Mississippi.
The number of those viruses from that period-sized ball necessary to infect a medical caregiver, transport person, lab worker, and kill them just as horribly?
One.
With a patient convulsing, explosively sh*tting out their guts, literally coughing out their lungs, and blood running from their eyes, nose, and mouth,
all rife with fatally infectious blood-borne pathogens.
Go back to that linked blog, and imagine someone with a couple of gallon jugs of red gloppy dye, and tell them, amidst everyone in their shiny hazmat
suits, to randomly squirt out a turkey baster of it up, out, and down, while the staff walks and works in the room. Say once every couple of minutes.
Splatter face shields, plop out a juicy glob or three on the floor, and let a constant amount dribble off the edge of the bed.
Some of the staff members will probably start to freak out, even knowing it's just a drill, which is why we never do that even in drills, so as not to let the cat out of the bag.
Ask me how I know this.
Then, after 3-4 hours in those hot, claustrophobic suits, now dripping with deadly simulated goo on the outside, the masks fogged over with sweat and condensed breath on the inside,
and not able to hear anything but the powered respirator blower whooshing loudly past your ears for every minute of those same 3-4 hours, and the inhabitants thereof dehydrated,
tired, woozy, sensory-deprived, and hopefully not panicky, see how crisp and precise their procedures are. Like starting a simple IV, or drawing blood from the patient. Like we do
10-50 times a shift. (How many hospitals' staff operate in diving gear at depths of >100'? None?? Why d'ya suppose that is, hmmm?)
Sh'yeah, that'll happen.
And with truncated operating times, you'll need 3-6x the number of staff you need for ordinary patients. {Hint: We can't get adequate staffing in any hospital, anywhere, right effing NOW.
Do you really think we'll be inundated with 6X as many when Ebola hits?? Sh'yeah, as IF.}
Those people will do one or two shifts like that, and then they're
g-o-n-e.
Called out sick.
Didn't answer their phones.
Never heard from again.
Reality: left skidmarks in the driveway, after mailing in their resignations, loading up the family and gear, and pointing the car towards Bum****,
Egypt, 500 miles from the next living soul out in the Great American Outback, beyond the black stump.
If they're smart.
We make minor mistakes in clinical care every day, now.
In just scrubs, and comfortable and competent at our jobs.
Put people in unfamiliar environments, in uncomfortable working conditions, with nothing but the prospect of endless more, times months to years,
and with the added prospect that the slightest error could result in slow, agonizing nightmarish death? And take out their family and friends as well?
Game. Over.
Throw in vaccination with a highly experimental and clinically untested Ebola vaccine (even one with >98% efficacy like RVSV-ZEBOV,
but no idea of long term consequences to recipients; ask the Gulf War I vets how that experimental Anthrax shot worked out),
which you don't have enough right effing now of to cover even 10% of the health workers in only the U.S., let alone anyplace else,
and you might get 1-5% compliance with hanging around a month or two. By which time, the outbreak will have doubled or quadrupled,
for any value of Wherever You're Talking About.
"Best wishes with that plan.
Love and kisses.
Wish you were here."
-Aesop
BF,E
Now get your stuff together to either shelter in place in self-quarantine, or GTFO to your Happy Place, and do the same thing.
For weeks to months, perhaps as long as a year or two. (The West African outbreak, in a population smaller - yes, also dumber,
but not by much - than that of the U.S., lasted from December 2013-January 2016, 25 months, before it was officially declared Ebola-free.)
Think about that one long and hard.
BONUS: That will also come in handy for twenty-seven other potential crises. Win-win.
That's what you could be dealing with, if/when it gets here again, and if it overwhelms our ability to adequately deal with it. The margin for error in such an outbreak is zero.
And if it never happens, you've wasted your time, and are now only prepared for a couple of dozen other major problems. How sad for you.
That sharp stinging sensation in the back of your head is Reality bitchslapping you back to itself, once the Official Partyline Happy Gas wears off.
[Blog note: We'll return to blogposts on other regular topics as the Muse moves us, if it ever stops being SS;DD. Just saying.]
Posted by Aesop at 2:44 AM
Labels: Ebola, follow-up story
8 comments:
McChuck said...
So, the outbreak protocol should be something like: Test for ebola. If ebola is found present in patient,
interview to find contacts. Then execute the patient, burn the body, and quarantine the contacts together someplace you can safely (for everybody else) fill with kerosene.
June 14, 2019 at 3:49 AM
Karl said...
I appreciate your informative posts on this subject. Thanks.
June 14, 2019 at 3:57 AM
Aesop said...
D'ya remember the scoops in Soylent Green?
There ya go.
https://www.youtube.com/watch?v=geol8k3rsLM
June 14, 2019 at 3:59 AM
Anonymous said...
Doesn't it seem odd that in the first picture there are four people in haz-mat suits and two in scrubs?
Almost as silly as the picture from last time of one person in a full-on suit and the other in a raincoat with goggles.....
Mark D
June 14, 2019 at 4:35 AM
Aesop said...
It's training; they're observers.
The NY idiots from 2014, OTOH, actually thought Option B was going to work.
Then Dallas happened.
June 14, 2019 at 4:41 AM
Anonymous said...
Ah, makes sense.
Glad I moved away from major metro areas six weeks ago.
Now to ramp up the preps.
Mark D
June 14, 2019 at 4:50 AM
Anonymous said...
"only to suffer EVSyndrome for life" But, but, but the NIH declared Nina Pham VIRUS FREE on June 14, 2019 and we should believe that because NIH and they would NEVER lie because .gov.
https://www.baltimoresun.com/health/bs-md-ebola-nurse-discharge-20141024-story.html
Nemo
June 14, 2019 at 4:52 AM
Aesop said...
Yeah, Nemo.
Extremely curious timing for that story, seeing as they've been silent as the grave on her and the other victims since 2014.
Just a coincidence, I'm sure.
And I'm sure they tapped her spine for CSF, and extracted fluid from the vitreous humor of her eyes, where they've found Ebola long after it's gone from blood tests, just to be thorough.
What's that? They didn't do any of that?
This is my shocked face.
June 14, 2019 at 5:07 AM
Last edited:
