Friday, October 31, 2014

Lower marriage rates have varied consequences and explanations


Robert J. Samuelson’s op-ed in the Washington Post on Oct. 27, “The Family Deficit” (link), is certainly worth noting. He stresses that the percentage of adults in almost all age groups who have never married (including me) has risen sharply since 1960, to astounding levels.

He is rightly critical of people having kids without marriage.  And, as some readers point out, he never got around to mentioning gay marriage, and the idea of gay adoptive parents.
  
For most of my adult life, however, my topological “singleton-ness” was, in practical terms, equivalent to a lack of sustainable heterosexual passion, enough to start and sustain a marriage (usually with children).  I made my own separate peace with society (almost along the lines of the John Knowles novel and movie), largely becoming an individual content creator.  But I did not offer “myself” in intimate situations the way some people would want, and the “example I set” doesn’t lead to sustainability.  

But a discussion of lower marriage rates has several, widely differing implications.   One of these might include lower birth rates, as much as children raised by single parents.  

Tuesday, October 28, 2014

UNC scandal far reaching, but not unprecedented; school and students must "move on" from this


Apparently, highly regarded universities, such as the University of North Carolina at Chapel Hill (“UNC”), where it is an honor for out-of-state students to get on, are not immune to academic integrity scandals related to athletic programs, this time having “athletes” take “paper classes”.   My first reaction would be to wonder how “real students” (for want of a better term) feel about being ambushed this way.  Forbes has a perspective which relates the problem that the question of paying athletes, link to story by Brian Goff here.  Strand has a film on atheltics and academic integrity, "Schooled: The Price of College Sports" reviewed on my movies blog Nov. 13, 2013.  But it’s worse than that: The Washington Post has a story by Nick Anderson Oct. 23, “UNC scandal not just about athletes; many who took ‘paper classes’ were not in sports”, link here.  Certain departments, like African-American studies, were affected from 1993-2011. 


CNN also weighs in on the 18-year scandal, here and there are reports that it is very unlikely that degrees will be revoked.

Other schools have come under suspicion in the past.  I recall a problem at the University of Maryland back in the 1960s.

When I started at William and Mary in the lost semester of 1961, the school had an honor system and an honor committee.  In fact, all state schools in Virginia had honor systems.  But when I wound up going to GWU and then the University of Kansas for graduate school, I found people mistrusted the idea.  When I was teaching algebra as a graduate assistant instructor in 1966, I caught one student cheating and gave him an F in the course.  This was in a time when course failures could mean getting drafted to fight in Vietnam.   People were surprised that cheating could mean course failure, but schools with honor systems would expel on a single honor offence.


That sort of idealism has been lost, as teachers and professors use “turnitin” to check papers for plagiarism.  In fact, my own postings and book materials have been plagiarized a few times.
Let’s hope that UNC can redeem itself now and its genuine students move on quickly. 

I used to wonder if there was a dichotomy.  Can one really be good at sports and be a great student at the same time?  That was part of my own "upward affiliation" complex.  Sometimes Clark Kent really exists.  These scandals show a lack of faith. 
Wikipedia attribution link for picture of Old Well on UNC campus. 

Sunday, October 26, 2014

Nurse, having volunteered in Africa, rails her unnecessary quarantine in New Jersey, but the public comments show little empathy


The web is bouncing with an existential debate on the extended quarantine order by the governors of New York and New Jersey, to apply to all health care workers.  University of Texas at Arlington graduate nurse Kaci Hickox was caught in the net as she explained in her op-ed in the Dallas Morning News today here. She says she is allowed to have absolutely nothing, although then one wonders how she got the LTE out. The quarantines, applying to travelers who land at JFK, Newark and now O’Hare, apply to any one with contact overseas with an infected person, which by definition includes all health workers in at least the three hard-hit West African nations.

The tone of comments on the web is rather startling.  Many visitors, maybe two-thirds of them, do not appreciate the idea that nurses and doctors who work with Doctors Without Borders are taking personal risks already to help some of the world’s neediest people.  The “take care of your own” mentality seems to stop at bridging beyond your own family and country with these people (as Charles Murray would say, bonding capital is there but bridge capital is not), with a majority of people who comment, at least in Texas.   One far right wing comment in the Dallas Morning News  (replying to the Hickox letter) called Obama (with regard to leadership of the military and the CDC) a “gay muslim”, almost an oxymoron. Maybe the comment has been removed by now, but it was rather stunning.   A number of comments suggest that Americans have no business going to Africa, coming back, and putting the "rest of us" in danger.  No wonder it is hard to recruit volunteers, and the epidemic gets out of control in Africa even more quickly, endangering us all through possible eventual mutation.  I haven’t even checked Breitbart for this issue yet. 

The measures by the three governors seem politically motivated, with fall elections approaching.
     
It seems mandatory that when organizations send people overseas, that the people be paid for their additional time in isolation upon returning, and that support of various kinds be paid for.  Maybe that could be set up in advance, but it would still reduce the number of volunteers. Most charities don’t have the money for this now.  Maybe the governors will fund the three weeks’ pay and amenities for this?  Are people supposed to do “gofundme” for people caught in situations created by politicians?  I could say I don’t get involved in other people’s lives that way, and resent the ideas – but I can see it coming with the asylum issue anyway. 

The Dallas Morning News reports that the friends of deceased Charles Duncan need a new place to live and new possessions.  If I were a member of that church, would I be expected to get involved in something like this?  Again, imagine the moral analogy to the political asylum issue (for gays from Russia and some African countries).
  
Let’s home that Dr. Spencer turns the corner on his own course with Ebola and starts improving quickly, as did several other patients.  He is reported to be approaching the most critical time in fighting the virus right now at Bellevue in NYC.


Update:  Oct. 28

Gov. Christie, under public pressure, un-quarantined Hickox, who now returns home to Maine, but her boyfriend, a nursing student, now has complications, according to this local story.


Update: Oct. 29 

Ryan Boyko is in quarantine in Connecticut, having returned from West Africa but not having had any contact with Ebola patients.  He discusses his situation with Anderson Cooper on AC360 here


Friday, October 24, 2014

Vaccine development for Ebola will accelerate for 2015; treated early, most patients in US seem to improve quickly


A vaccine known to protect monkeys from Ebola sat unused for ten years, according to a New York Times story today by Denise Grady, link here. The main reason, of course, is that Ebola outbreaks have always been sporadic and tended to die off, until this one, and pharmaceutical companies didn’t find it profitable to invest in them.
   
While I believe companies should make profits from their medications (and I probably have some of these companies in my IRA and depend on them for retirement) we need to make sure we are getting prepared (with vaccines) for everything we can – including SARS/MERS and “bird flu”, all of which have their own quirks in epidemiology and pathology, and in how the viruses actually “work”.  We simply can’t put people’s lives on hold this way over uncertainty over incidental contact, as has happened to hundreds from the Ebola “mini-outbreak” in the US.
   
   
AP has the report above on the vaccine, but there are some YouTube videos out there by “vaccine deniers”.
   
The experience so far is that patients identified at the first signs and treated properly  (with fluids and antivirals) are recovering promptly.  We don’t have the clinical details for any of the cases (Pham, Vinson, Mukpo) but it seems that they did not have severe symptoms for long, or even at all.  Mukpo was tweeting soon from his isolation room and seemed to recover very quickly.  Pham was in “fair” condition briefly, however, before going back to “good” and then rapid disappearance of the virus.
  
Hopefully, Craig Spencer will show rapid improvement as treatment starts.  Bellevue in NYC appears to be as able to treat Ebola as NIH or CDC-Emory. Only New Yorkers in very close contact with him (the girl friend, etc) should have to be restricted, monitored or quarantined.  
      
In February 2002 (at age 58), I had a bizarre respiratory illness while in California.  It hit suddenly with a dry cough and high fever, even though I had a flu shot.  It backed off, and then came back a second time, before going away for good, although it left a deep productive cough that lingered for weeks.  Loss of appetite and some diarrhea also occurred.  I finished the trip and even had a meeting at UCSB about my book, but was pretty washed out a couple nights.  There are reasons that I think this was more like a kinds of SARS.  I think a lot of people normally get over coronavirus infections on their own, and that they don’t get reported to the CDC.  I’m probably immune to it now;  it would be interesting to look for SARS-like antibodies.   


Thursday, October 23, 2014

Wealth inequality and "family values" seem connected


Matt O’Brien’s Wonkblog entry on p. A14 of the Washington Post on Thursday, October 23, 2014 puts an important perspective on wealth inequality (as maybe more critical than income inequality).  Appearing on p. A14, the title is “The bottom 90 percent are poorer today than they were in 1987”.  The link is here. The fundamental reason is that the middle class had invested most of its wealth in housing, which tanked in 2007/2008.  Wealthier people could invest in stocks and bonds, which also tanked but have recovered stronger than ever (even despite recent volatility over international instability – war, terror and epidemics).  
  
People invested in housing partly out of “family values”.  Buy as much space as possible for the kids.  (When you see a house with an attic made into a third story, you know that means – “teenagers”.)  Also, particularly in earlier times, it meant moving away from the cities.  In many areas (like Loudoun County VA, or areas way north of Dallas and even Plano) the corporations followed.   Server farms – employing lots of people and supporting exurban life styles – dot the beginning Piedmont areas of northern Virginia, as well as a lot of areas in North Carolina some distance from Charlotte or from Raleight-Durham – or, for that matter, Atlanta.  There has always been some tension between “taking care of family and your own” and “taking care of others” – something Charles Murray called “bonding capital” vs. “bridge capital” as parts of social capital in his book “Coming Apart” (Books, March 2012).
  
In an earlier article (Oct. 18) O’Brien criticized the way “meritocracy” (one of John Stossel’s favorite words) was unraveling, as rich kids do the “opportunity hoarding”, so poor kids who do everything right don’t come up to bat.  (The analogy happened in grade school:  someone batting in front of me just before lunch hit into a triple play!)   Everybody needs his “ups”.   My own personal observation, around some churches I go to, is that this really doesn’t happen:  the “better off kids” and young adults have gone to missions in Belize and Nicaragua (even Kenya), where interaction with others gets quite personal;  but that gets ever more dangerous now.
     
Stanley McChrystal is on to something.  Without some sense of potential fairness, a lot of people wonder why “only they” have to play by the rules.   

Wednesday, October 22, 2014

Employers push low-wage workers onto Medicaid and "skinny plans" under Obamacare, quite legally


Some employers are putting low-wage employees on Medicaid to avoid Obamacare penalties, according to a front-page story in the Wall Street Journal Wednesday by Anna Wilde Mathews and Julie Jargon, link here.  This practice obviously makes the companies a political flash point with both conservatives and liberals.  It may also increase the use of state-run MMIS systems, and require more systems development to support the practice.

  

Companies are offering “skinny plans”, that may not offer meaningful hospitalization coverage.  And companies that offer plans risk some fines based on employees who receive subsidies for signing up for full Obamacare plans on their own.  Major insurance companies are aggressively selling these plans because they have an incentive to do so.  

Monday, October 20, 2014

Crop Walk, then "Chess for Charity" events give a look into how this kind of "giving" and volunteerism work


On the Crop Walk in Arlington VA (link) I asked one of the organizers just how dependent food banks (whether like the Arlington Food Bank, or preparation and delivery like Food and Friends) are on volunteers.  I also had a conversation like this with an organizer at a brunch at Freddie’s Beach Bar in September.   Would people simply not get food if there weren’t enough volunteer hours available?  I’ve noticed that most of these charities tend to be bureaucratic and make a lot of volunteer management.


Neither knew, or would say.  The general impression I get is that they need maybe fewer people who are more dedicated than just a lot of bodies rarely. 


We also talked about the asylum crisis.  Again, the administration (and most especially conservatives in Congress) don’t want to pimp the idea of people taking in refugees because that would be seen as “encouraging” illegal immigration. Yet, as the walker said on the Crop Walk, politicians and pundits (most of all, conservatives in the GOP) don’t want to “live the life” or “walk in their shoes”.  Morality comes down to the individual.


WJLA promoted the Crop Walk on Twitter and asked or pictures.  When I shared a picture of the pumpkin sale, someone there tweeted back, “Did you buy a pumpkin?” 
  


I played in a “Chess for Charity” (link) tournament in Vienna, VA at a Catholic School Sunday afternoon. Again, at the even there was time taken for raffles and a lot of publicity about the fund racing itself (for kids with cancer).  I was glad to play in an informal chess tournament (there as even Japanese Chess upstairs) where the entry fee goes to charity.  I bought a T-shirt.  But I’m not one to push others into giving money, the self-projection of which seems to “cost me something”. But "the safety net" (and social stability)  needs the social capital that this kind of self-giving feeds.   

Saturday, October 18, 2014

Some researchers at Universities of Minnesota and Illinois note that Ebola might be spread by air for very short distances (CNN); more concerns about incubation


A site called “Opposing Views” (there is also a book series by this name, in my Book reviews blog, Sept. 19, 2006) ran an article reporting work from the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) indicating that Ebola might actually be spread through the air for very short distances and might actually produce infection through the lungs as well as in breaches in the skin, mouth or other external surfaces.  The CIDRAP report is here  and the Opposing Views article is here.  Lisa Brousseau, from the University of Illinois at Chicago, spoke about this study Saturday morning on CNN.  She said that in Stage 4 containment centers, health care workers wear respirators;  surgical masks are not sufficient. She also indicated some of the data came from West Africa.

  

The other concern is what happens with very small Ebola exposures.  There is a concern that the virus can “hide” for a while inside monocytes or certain blood cells.  Does the person overcome the virus naturally without illness or very minimal symptoms and become immune (as is common for garden variety infectious disease)?  Could the virus hide for months and we don’t realize this yet?  Could we have unexplained "crash" cases months from now? 

CNN has a new link, "The most outrageous statements about Ebola," here



Update:  Oct. 19

What happens with passengers who had flown from Cleveland to Dallas on Monday, Oct. 13 but who live in Cleveland and need to return home.  Are they kept from flying back?  Who pays for this?  Important policy and legal question.  This could happen to me with a later situation. 


Update: Oct. 20

There is some analysis claiming that the incubation period for Ebola behaves asymptotically, with possibly 5% of cases occurring after 21 days, because they had started with low exposures.  The link (quoting a WHO study) is here.  It refers to a WHO study.  CNN reported it today, but has softpedaled it.  Thoretically, those already released in Dallas could be re-quarantined if this report held up.  It could also mean, theoretically, that people could be trapped out of town for 42 days, in the worst case scenarios.  Again, who pays for it?   The link for the story is here
   
I think we need to be more reasonable, though, about extremely casual exposures, which really have no chance of transmission.  Most of those under observation had trivial exposures with no chance of illness.  That would be true of the bridal shop in Ohio.   
  
We really need a different kind of test, that could detect infected monocytes by some kind of external molecular negativity before there are symptoms.  We need to be able to test an clear people within 72 hours of very incidental exposure.  Is some sort of "Andraka Test" for early testing based on electronegativity concepts possible?  

Thursday, October 16, 2014

Should medical personnel who treat Ebola patients be "federalized" and inducted into the military?; in Ohio, some "indirect contacts" are reported as quarantined; more on transmission, incubation


Vox Media, in its “one sentence” summary feature, offers an article from The Washington Post, “What it’s like to clean airplane cabins during an airplane scare”, link here.  The article emphasizes the low wage of the workers and the need to turn around the plane in a half hour.   And now, with the Ebola scare and CDC misstep earlier this week, an article like this takes on a whole new urgency.
   
CDC, as of the latest news, talks about putting health care workers who treat Ebola patients on no-fly lists.  Is that “only” those workers at Texas Presbyterian, or at any of the four treatment centers or any other future hospital?

Are “indirect” contacts going to be put on no-fly lists, even if the likelihood of contact is so remote?  (What about the 130+ passengers on the Frontier plane.)  What about trains, buses, subways?  (The TSA doesn't operate there now.) Where does this stop?  So far the information isn’t clear.
  
Would travel insurance policies be honored in these cases?  If the government grounds you, are you entitled to a refund on a ticket or hotel reservation?  (More and more hotel reservations these days are not cancellable.)   It seems like industry practices around this new issue need to be standardized quickly to be “fair” to consumers caught in the middle. Could Texas Presbyterian be held liable for all of this since it was its own negligence that started all of this?
  
It also sounds rather frightening for the government to forbid people to fly just based on the work they do (latest on CNN)  here ).  It would sound as if nurses and doctors who treat Ebola patients should be treated as military personnel.  The Public Health Service has always been a “quasi military” service, a point that was sometimes made by SLDN during the days of debate over “don’t ask don’t tell”.  (Yes, here I go, connecting the distantly separately dots again, by putting up new “strings” or dimensions to see them in.)
  
Since the military draft, while no longer active, is still “constitutional” (as of a 1981 Supreme Court decision), the idea of federalizing and “conscripting” some health care workers might hold water.  I can recall in 1996, while on a trip in Ohio, reading a specific news article that Bill Clinton didn’t want to do away with Selective Service (even in the DADT world) because of the possibility of a sudden, hard-to-foresee for military medicine, after some calamity, maybe like this.
  

In fact, the Washington Post has a stunning story today by Tina Griego, “America may never have a draft again. But we’re still punishing low-income men for not registering”, link here

The Ebola crisis, which could well be followed by other pandemics (bird flu being the most obvious risk) also mixes into the debate on national service, as Gen. Stanley McChrystal discussed about a month ago.   Health care service (in the developing world) could turn out to be as taxing as military service (or the two can mix, as US Army medical troops are deployed to West Africa and medical reserves are suddenly called up).  Is this a gauntlet (like a hajj) everyone should run between 18 and 28 to pay his dues? (No more teen stars in sports like Bryce Harper or RGIII?)

Maybe the best news in all this speculative gloom is from NIH, which seems to report progress on an Ebola vaccine which may actually also be useful if given after exposure, before severe symptoms develop.  The link is here. Medically, Ebola seems diabolical because it can hide from the immune system in the early stages (as does HIV, although with a different mechanism) and symptoms can be mild for a few days until the patient suddenly crashes.  It would be important to know if any of the cases now recovering actually avoided the most severe symptoms.  We don’t have a lot of detail yet, but it sounds as if this is true of the NBC cameraman Ashoka Mukpo  (NBC video here ).


Update:  4:;45 PM, Thursday Oct. 14

A television station in Akron Ohio reports that six persons in Summit County OH and two in Cuyahoga County (Cleveland) are quarantined after very remote contact with Amber Vinson over the weekend.  A bridal shop that she visited has closed as a precaution.  I hope that the shop owner can collect damages from the Texas Presbyterian Hospital or the CDC for loss of business.  The liability lawyers for the hospital must be busy.  The link is here.  The store "Coming Attractions" is reported to have closed voluntarily after talking to the CDC.  The CDC also seems to want to talk to other people in the store.  (No, if I had been there and had no real contact with anyone, I wouldn't call in, because I can't afford to be isolated for what someone else did -- unless I really thought there was a problem, which there isn't).  It seems that the only "secondary contacts" that can present a real risk to the public are the health care workers themselves -- so far.



Update:  later Oct. 14

The Denver Post reports the rollout of business interruption insurance, from a company in California called NAS, story here.  The article uses a bit of hyperbole, though, in suggesting that a hospital, airport or hotel could be closed because a single person who had been on the premises tests positive for Ebola.  Bars, restaurants and discos, however, should worry that local health departments could shut them down for good, for little good reason.

AC360 reports that authorities in Texas a requiring all hospital employees (besides the close contacts already mentioned before) who had contact with Thomas Duncan not to go into public places, here.  But the 21 day period for them may be coming to an end for them soon.
David Sanders of Purdue University suggests that Ebola can go into the lungs so it could some day mutate to become airborne.  However it has not as of yet.  But the great number of cases multiplying in Africa increases the odds that this could happen.  Other authorities dispute his speculations, however.  Fox and Breitbart have covered the speculation, but Gupta interviewed him on CNN.

As if all of this were not enough bad news, Yahoo! reports a study indicating that a 21 day incubation maximum may not be enough, and than maybe 31 days is more appropriate. However, a look at Wikipedia shows that Thomas Eric Duncan's incubation period was only nine days (Sept. 15 in Liberia to Sept. 24, when first symptoms appeared, to become explosive on Sept. 28).  A short incubation may indicate greater initial exposure, which appears likely in Duncan's history.  Putting  this all together, there is the imaginable or speculative possibility that an extremely small exposure (airborne?  household?) might result in the virus's hiding in the body for many months, making the scope of an outbreak here much more than we have imagined, if in fact a normal immune system can't neutralize tiny amounts of the virus on its own because it hides.  There might be a "geometric progression" in the way it multiplies in the body (even starting with one particle) until it blasts out and causes symptoms.  In such a case stricter quarantines could be necessary.  


Wednesday, October 15, 2014

CDC now eyes passengers on domestic flight after second Dallas health care worker tests for Ebola the next day with minimal symptoms; what about isolation, quarantine reach?


In a startling new development, a second health care worker in Dallas from Texas Presbyterian Hospital has tested positive for Ebola after showing fever.  The patient was on a Frontier Airlines Flight from Cleveland to Dallas the day before, Monday, October 13, 2014, Columbus Day. 
  
The Centers for Disease Control has asked all passengers who were on that flight to be interviewed, in an announcement here

 Apparently the CDC will work with the airline to contact the passengers. 
  
The statement does NOT say that the other passengers will be isolated.  CDC characterizes this as “Passenger Notification underway”.
  
However, given the way health departments in Texas and New Jersey have handled other contact tracing situation, it’s not sure that the passengers would be allowed freedom of movement as long as they don’t show symptoms.  The only passengers at any risk at all would be those seated immediately next to the passenger, and this would be an issue only if another passenger came into some kind of contact with the patient or fluids.  The patient did not show symptoms during the flight.
  
It’s easy to imagine other situations where CDC could want to contact a lot of people.  If someone went to a sold-out concert, where seats are reserved, and then became symptomatic the next day (or even during the event), the CDC could want to interview everyone in the hall, or at least in the proximity of the patient. 
   
If a situation like this happened with Amtrak, it would be even more ambiguous.  Amtrak (at least on regular regional trains, I’m not sure about Acela) sells reserved coach seats, but doesn’t make seat assignments.  Trains in the NE corridor are crowded, but the probability of coming into contact with any person in a situation like this is extremely low. 
   
Right now, screening of passengers from three West African countries (including indirectly) happens at five US airports (or will start soon), but the implication of this story is that even domestic passengers can be at a theoretical risk.
    
CNN has a story here which contains links to others stories where nurses at Texas Presbyterian are pointing out to horrible gaffes during the first exposures of Duncan at the hospital during the first two visits.  It is becoming more apparent that regular hospitals are not was well prepared to handle Ebola as the specific level 4 containment hospitals.  A strategy would be to build containment facilities in many cities, including Dallas.  This hospital (in the NE part of Dallas, off 175)  is very large in area, and would be a logical place to build one.
   
I am concerned about the possibility  of severe disruption myself by being caught in a CDC “dragnet” (or local health department one) when there is no real risk.  If there is a particular fact (like sitting next to someone who vomited) that is another matter.  Until it is clearer what the “rules of conduct” when in “minor isolation” are going to be, I won’t make any plane reservations at all, not even domestically. 
 

Update:  

CNN reports that CDC refers to people under monitoring as allowed "controlled movements", which allows driving in a car, but not flying (or probably going to a packed concert).  CNN says that the second health care worker had been told she should not fly, but did so anyway.  

Further Update:

CNN is broadcasting allegations by nurses of misconduct at the hospital.  The nurses would not be identified because they fear "retaliation".  This is really getting ugly.  



Monday, October 13, 2014

Speculation about future infection control and social distancing mounts after new Dallas case, and breakdown of "voluntary isolation" in New Jersey; insurance companies stew on this


Today, I enjoyed a leisurely and tasty breakfast in the cafeteria at the Virginia Hospital Center in Arlington – even some bacon and eggs, not so healthful, unless you believe in Atkins – and I overheard what sounded like an informal job interval.  I heard a candidate being told, “they always have to care for patients”.

No, there are no reported Ebola cases there as of this writing, but hospital employees have to be wondering everywhere if it will show up next.

Of course, there is a lot of talk about proper care protocol today, training of personnel, and whether all hospitals should treat Ebola patients.  But any emergency room could have to handle a potential Ebola patient without warning.
  
The Dallas Morning News has a story on how the decontamination efforts can affect a neighborhood around where a diagnosed Ebola patient lives, here.  Many people in Dallas got “reverse 911” calls and knocks on the door. 
  
In New Jersey, a whole cohort of people were placed in formal quarantine because one person broke the rules of voluntary cooperation.   According to the New York Daily News, the “guilty party” was NBC’s Dr. Nancy Snyderman, link here. This group had minimal contact with NBC cameraman Ashoka Mukpo.
  
And Natalie DiBlasio writes in USA Today (I read the print story during breakfast) about business insurance in relation to Ebola, especially travel insurance, link here(Yes, travel insurers won’t pay for “fear”.) So far the travel issue is only about travel to certain West African countries.  But “what if”, say, a passenger from Brussels who sat next to a passenger from Liberia somehow touches something and develops it.  Will this turn into a concern about all international travel?  This can get out of hand quickly.
  
As for the mutation risk, Ebola is more likely to develop the ability to transmit infection before symptoms appear, than become airborne (because viruses that affect blood vessel linings don’t usually invade respiratory tract cells).  A more relevant question is how to control the next SARS outbreak or avian Influenza  SARS has a mortality rate of close to 10% -- but perhaps of only the worst cases. 
  
Again, we wonder how social distancing strategies could play out.  Will bars and discos have to ban “dirty dancing” some day?   The fact is, with most common viruses, adults build immunity over lifetimes, and probably benefit from some “dirty” contact.  It is the few that can be so deadly that provide the “exception that swallows the rule”.  HIV was the least contagious of all, but also the most universally deadly at first.  In the 1980s, we saw the baths closed as a result (starting in San Francisco).  Ebola is much more contagious, but still not spread through the air, but “intimate contact” with a person (including heterosexual) is risky – but, unlike HIV, the person has to show symptoms – which can be mild, and this fact may not always be the case in the future.   Airborne respiratory viruses are the most contagious of all, and can install great fear – but the fact is that the real death rate from them is probably much lower than reported, because most respiratory virus infections of any kind produce relatively mild symptoms, usually unreported, in most healthy adults – who gradually build beneficial antibodies and “herd immunity” from incidental contacts (including those in bars). 
  
In nature, the best defense against infectious disease is gradual exposure, allowing immunity to develop.  We don’t have time with something like Ebola, or perhaps bird flu or the next SARS.  We need to be much more aggressive with developing and deploying vaccines and prophylactic antiviral treatments.  By the way, we should start smallpox vaccinations again, too.   And don’t forget Meningitis (especially Type B) but that is bacterial.  

Update: Oct. 14 

Dr. Sanjay Gupta has explained the difference between "infectiousness" and "transmissibility".

The New York Times article explains the enormous viral load on the individual, which tends to increase for at least a week after symptoms appear. Unlike many viral diseases, this tends to get worse after several days of mild symptoms.  

Sunday, October 12, 2014

Experts still see last week's market turmoil as a healthy correction, despite international turmoil


CNN Money is saying that investors, even long term, are probably better sitting tight during current market turmoil, in a piece today “Is it time to exit stocks?” by Heather long, link here
  
Yet, experts say, we are overdue for a “correction”, the last one in 2011. No, we’re not near another major recession.
   
But international turmoil, with ISIS and various terror threats, and now the idea that Ebola or some other pathogen could create unprecedented disruption in normal lives, could rattle some investors. 
    
The Dow had taken a 360+ point drop on Thursday and slid again toward the end of the day Friday.   

Nurse who cared for Duncan appears to have Ebola; if so, first ever transmission of Ebola within the US


A second person, a female nurse who had worked with Thomas Eric Duncan at Texas Presbyterian Hospital, has been reported as testing positive for Ebola, after reporting a low-grade fever Friday (monitoring herself).  The story on ABCNews Sunday morning is here

This is the first-ever case transmitted within the United States.  ABC says “This is not over.”
    
CNN has a similar story here.  The test result will be checked by the CDC in Atlanta today.
  
The second patient’s history suggest that Ebola virus may show up in a test very early in symptoms.  
   
It is certainly desirable to have a “Western Blot” type test that could show infection before there are any symptoms at all.    
  
The patient was reported to be in stable condition early Sunday. It is possible that symptoms would not progress, particularly if the patient got supportive care, and particularly antiviral drugs or monoclonal antibodies immediately.  There is a tendency for the symptoms to become more severe over several days in almost all patients, but it is possible early intervention could change this.  The NBC cameraman being treated in Nebraska is apparently in good condition, still, although this is not clear.
  
The nurse was said to be properly geared and attired when treating Duncan on his second visit. 
   
Commentators are saying that not every hospital is equipped to handle Ebola properly, which is difficult to do.  But any emergency room would have to be able to put a patient in isolation with symptoms and a history of contact with other Ebola patients. 
     
Contacts of the nurse will be watched, and possibly isolated.
  
I live one very long block from a hospital.  So far, neighbors (not household members) of a patient have not been isolated in these cases (in Dallas or any city).  Could this change?   The concern is that if I ever were, the disruption could be extreme, and no one is entitled to compensation because of enforced isolation, even if cause by the negligence of others.  This wouldn’t be limited to Ebola; it might become a concern with a future outbreak of a more transmissible disease like a SARS-like disease, or avian influenza. 
  
Remember, Ebola is still hard to catch under ordinary circumstances. 
  
Some screening of passengers on international flights, at least based on connections from West Africa, has started today at JFK in New York, and will be added to Dulles, Atlanta, and O’Hare Chicago.  It would seem that Dallas DFW ought to be added.   

Friday, October 10, 2014

Woman in Texas needs to have negligent homicide conviction caused by Saturn ignition switch defect overturned


The case of Candice Anderson, who accepted a plea deal of “criminal negligent homicide” after a car crash in 2004 in Canton Texas where her fiancé, Mikale Erickson was killed when she lost control, deserves a re-hearing indeed.  Her Saturn Ion had the ignition switch defect that very likely led to the crash, as in this news story widely discussed in the media, especially CNN.


General Motors CEO said that the company would cooperate with the investigation but would not necessarily take the blame for the accident.

Anderson, who was also severely injured, faces trying to have her felony conviction expunged.  She did not have alcohol or drugs at the accident, and only a trace of medication, according to news stories.  

Mr. Erickson’s mother was informed by the National Highway Safety Administration that her son’s death was one thirteen blamed on GM’s faulty ignition switch.
  
Then why is it so hard to get this conviction overturned?  Could this happen to anyone?
    
A former prosecutor has asked the Texas Board of Pardons and Paroles to dismiss the case. 


Monday, October 06, 2014

When does the need to control infectious disease (with "quarantine" or "isolation") trump civil liberties?


Danny Cevallos, legal reporter for CNN (along with Jeffrey Toobin) has an alarming op-ed on CNN, “Protecting against Ebola trumps personal liberty”, link here
   

Cevallos explains the difference between quarantine, which can apply to a person exposed but not showing symptoms, and isolation, which applies to a person already ill.  The state’s due process responsibilities seem surprisingly limited.  An individual is not guaranteed he can recover income or property lost to quarantine, although in Texas it seems as though some of the employers are willing to pay quarantined or monitored individuals.  (I’m not sure if being told not to leave town or got to work and to report for temperature checks twice a day but being allowed out locally falls within the legal definition of quarantine, but the practical effect is similar. )

The passengers on a flight arriving in Newark from Brussels were briefly quarantined upon arrival before being allowed to go.  

Cevallos makes a rather over-the-top analogy to zombie movies, where “infected” individuals are immediately terminated, in posing whether the state could take an infected person’s life if a circumstance were extreme enough.  I am reminded of the movie “28 Days Later” and sequels.
     
Really – there are other things in life where this is true, often having to do with warfare or enemy action.  

In previous posts, I've gone into the panic over AIDS in the 1980s, and the hypothetical theories that led to proposal of a draconian anti-gay bill in in 1983 (when I lived in Dallas), as well as proposals to "quarantine AIDS patients" which technically would have been isolation.  One of the worst homophobes, Paul Cameron, was quoted in the 80s as saying "Civil liberties do no good if everybody's dead." 

Gov. Rick Perry (R-TX) has formed a task force to examine screening protocols (story ) but the White House doesn’t think a West Africa travel bam is necessary. Charles Schumer (D-NY) has called for more extensive questioning of people from international flights (CBS NY story ) but the CDC or local health departments would have to provide the manpower.  
    
I put off all plans to travel to Europe until at least next spring because of all of these crises and threats.  This can’t be good news for airlines or the economy,   Body temperatures can vary within a degree all the time normally;  there's such a great threat of disruption.  

Update: Oct. 7

NPR has an important story by Linda Poon and Opheibea Quist-Arcton, "How a person can recover from Ebola," link here


Update: Oct. 8

Many news organizations report that Thomas Eric Duncan passed away at 7:50 AM Wednesday, October 8.  Generally, doctors say that the two-day delay in getting treatment (often common with patients with no health insurance) may have proved fatal.  One or two other patients seem to have less severe symptoms and we're waiting to see if milder cases are possible,    

Update: Oct. 28

Vox Media also offers a legal explanation of the concept "quarantine" and "isolation" in a piece by Julai Belluz here


Sunday, October 05, 2014

Protests based on Ferguson police behavior disrupt St. Louis Symphony concert, "Which side are you on?"


A group of protestors (called a "flash mob" by CNN here)  disrupted a concert of the Saint Louis Symphony Saturday night with a chant, “Which side are you on?”  The protestors left peacefully later. The protestors obviously referred to the recent uproar in Ferguson. MO over police behavior, particularly the shooting of Michael Brown when apparently he was unarmed and trying to cooperate.  There is a story in the St. Louis Post Dispatch here
  
  
The incident, however, underscores the polarizing nature of activism.  A lot of times, I find myself resisting “taking sides” when there seems to be no critical thinking. And then others get mad at me over my apparent indifference to their needs, what they see as insularity.  How I remember the People’s Party of New Jersey, and the threats made at a covert meeting one night in Newark, NJ in late 1972.    
  
There’s a lot of video on YouTube; I selected one of them;  one of the more radical videos (which I did not select) says “we need to short back.”
  
Back in 1992, presidential candidate Ross Perot sometimes would say, "We're on different sides." 
   
Wikipedia attribution link for picture of St. Louis.   My most recent visits were in Nov. 1998 and Jan. 2000.