Doc Grouch: Should We Shut The Borders?

Screen shot 2014-10-28 at 12.00.49 AM
The latest:

Should we shut the borders?

Well, obviously. But that little bit of common sense predates Ebola by a considerable margin. Like, the entirety of human history.

So let’s ask the question, in regards to quarantine for Ebola.

What are our goals with this infection?
1. Prevent Ebola from infecting those in the US, and/or
2. Prevent folks infected with Ebola from arriving in the US
3. Chose #1 or #2, but accomplish that goal without giving .gov power that you will regret giving, later.

Allow me to point out the underlying assumptions between Goal #1 and Goal #2. Goal #1 is less stringent, and assumes that there is some low-level amount of Ebola that is acceptable in the US. It furthermore assumes that Ebola, while deadly, is not The Pestilence That Will End The World, and that we can successfully treat patients who get it, with acceptable mortality. There is also an undercurrent of hubris and/or normalcy bias inherent in this viewpoint.

Goal #2 makes none of those assumptions.

And the real deal, folks, is that no one knows. No one has any idea if this will turn out badly or not. The best current method to start an argument in the doctor’s lounge is to assert either that Ebola is a nothing virus that will cause no harm, or that Ebola is the next Black Plague that will kill us all. We all have our beliefs and guesses, but absent the gift of prophesy, no one knows.

Currently, .gov has chosen goal #1, and the protocol is:
1. If you have symptoms, you are isolated and tested.
2. If you do not have symptoms, they don’t waste money on testing* but instead asses your risk. Assumes truthful travelers.
—Low risk: observation by state dept of health, voluntary home quarantine
—High risk: observation by state dept of health, home quarantine, but voluntary or mandatory depends on various factors.
(at this time, there is no medium risk category)

*The virus is undetectable by standard testing until at least the time of symptoms, and in some patients not until 3 days after testing. Which is why the NJ nurse’s claim that she should be released because her “ebola test is negative” demonstrates a profound ignorance of reality.

The specific changes to the protocol above depend on whether you have selected Goal #1 or Goal #2.

Some changes being considered for Goal #1 are to enforce mandatory home quarantine on any non symptomatic patient, who is from or has traveled to the most infected area.

For Goal #2, some changes being considered are to 1) either enforce mandatory quarantine on everyone who is from, or has traveled through, the most infected areas, or 2) shut down flights from that area completely. There is some noise that the quarantine should be held at some as-yet-undefined location, not at home.

Those who can think of additional changes to the above protocol are welcome to chime in, down in the comments section. Having MD after your name does not make you a Certified Galactic Intellect. That honor is reserved for old computer programmers.

I am all in favor of enforcing mandatory home quarantine on folks who are from or who have visited the affected area, at a MINIMUM; but let’s face it: this is merely a slightly gilded version of what we are already doing, with a suboptimal track record. The points of breakdown in this strategy are well known: the patient skips down and cannot be found for the health department to follow, they do not follow the quarantine rules (Ebowling!), and when the patient finally goes to the hospital, they infect other folks. The second and third degree effects cannot be predicted.

The liberal argument that folks will fly from west Africa to Europe, rest up a few days, then come to the US on a flight not obviously connected to west Africa is stupid. This implies that Europe, as a whole, would not act in the same fashion to block flights from that area. In fact, it has; only Belgium accepts flights from that area. It can’t be that hard to track all passengers from that area for the last 21 days.

If you want to enforce Goal #2 by isolation in the US, then we have a big logistical problem. Every state–or perhaps just the 5 where all those travelers will be routed–will need to set up an MSF-style isolation wing. It will need to be of sufficient quality that those monitoring the patients won’t get sick, and the patients won’t infect each other. Each camp will have to be able to accept at least 30 (that is, 150 people per day divided by the 5 different camps) patients per day, and hold them for 21 days, which works out to 630 people. And the wherewithal to feed, clothe, wash, and test them all. And survive the inevitable lawsuits and crybaby BS by entitled jerks. And it almost certainly will have to be actual brick-and-mortar buildings, not just tents, given the approaching winter. And it has to be in place, starting yesterday. And let’s face it, folks–they will put FEMA in charge of this. Or perhaps the DHS. Pick your poison.

This looks like an easy way to screw up Goal #3.

So let’s turn to Method #2, Goal #2. There will be shouts of outrage from the Left. Weeping and wailing, and gnashing of teeth. “It will make the outbreak in Africa worse!” (compared to what?) “We need to take care of the problem over there!” (most assuredly, but it does not follow that we have to import cases here.) “It will be difficult to implement, and people will slip through!” (True, true, and neither are related to whether or not we should try.)

There is an argument out there, exemplified here, that states that if we implement a travel ban, then our risk is still relatively high. This may or may not be true, but it misses the key fact: It gives us time to catch up with the OODA loop of the virus.

We need time!

Time to sort out the PPE issues and get trained. Time to determine which hospitals will take these patients. Time to set up the logistics of developing a crew of at least 18 (if not more) ICU nurses to take care of a single patient on a long term basis. Time to report on what has been done with the patients, worldwide, who have been treated with first world medicine, and try to come up with a game plan for treating them. Time, folks. Time to get the monstrous leviathan aroused.

That’s why we should shut down the border. Protection is nice but will eventually fail. The time it gives us, if used well, will be critical.

And let me leave you with this final thought, dedicated to those politicians and boot lickers that have botched everything so far:

Folly, thou conquerest, and I must yield!
Against stupidity the very gods
Themselves contend in vain. Exalted reason,
Resplendent daughter of the head divine,
Wise foundress of the system of the world,
Guide of the stars, who art thou then if thou,
Bound to the tail of folly’s uncurbed steed,
Must, vainly shrieking with the drunken crowd,
Eyes open, plunge down headlong in the abyss.
Accursed, who striveth after noble ends,
And with deliberate wisdom forms his plans!
To the fool-king belongs the world.

——–Friedrich Schiller

nyny

21 responses to “Doc Grouch: Should We Shut The Borders?

  1. Alfred E. Neuman

    Reblogged this on The Lynler Report.

  2. This…

    “2. Prevent folks infected with Ebola from arriving in the US”

    Is what sane,logical people would do.

    It is what should be done,it does not mater what the left thinks,feels,or whines and gnashes their teeth about-simply refuse entry into the U.S. for any person who has been to W.Africa until the Ebola outbreak is declared over by MSF.
    Ebola has been around since the mid 1970’s,it has had a very high mortality rate since then-it’s not like this is the flu-or even the swine flu-it’s a deadly filovirus,about which little is known.
    What is known is that it is fatal to a hell of a lot of those who come into contact with it.
    Common sense dictates that to prevent large numbers of American citizens from contracting Ebola-no one who has been to the hot zones is allowed entry into the non-Ebola infected( kinda sorta) USA-period-no entry for anyone who has been to or is from W. Africa no exceptions-until the outbreak is over.
    Banning all entry into the U.S. for anyone who has been to or is from the hot zone until the outbreak is over solves the whole where to put people while in quarantine issue-except for one class of health care workers…

    All whiny leftist nurses who do not comprehend how tests for ebola are conducted,and what results mean for asymptomatic twits-are to be quarantined outdoors,in winter,in a tent,with nothing more than paper scrubs-the twits can blame the conditions on Bush-because their messiah would never be so mean to them.

  3. Current screening for anyone presenting symptoms is ‘fever and travel in a hot zone.’ This is doomed to fail at the first secondary infection (think of a homeless person picking up an infection from the good doctor’s ride on the subway in NYC), or a terrorist spread of body fluids in a public area like a mall.

    “What? You have a fever but you haven’t been to Africa? Take a couple of aspirin and get some rest.”

    • ^^^THIS!!! A THOUSAND TIMES THIS!!!^^^
      That’s when this goes from “one case” to “twenty cases” virtually overnight, and crashes the entire medical abilities of even a city like NY.

      The choice becomes treat the 20 Ebola patients, and let every other ICU patient die, or half-ass it, and spread it to 200 people, with levels of care exactly like what they get in W. Africa, i.e. plant care: feed them water them, and turn them towards the light.
      Whereupon without IV fluids etc., they die in the 90% droves for historical Ebola outbreaks, and we have a full-blown epidemic here.

      Known colloquially in the medical and epidemiological trade as
      “How Not To Manage An Ebola Outbreak 101”.

      That’s why the “Hope For The Best” strategy has got to be thrown under the bus with all dispatch. If we can tie it around the necks of Tom Frieden and Anthony Fauci, et al, and eliminate multiple birdbrains with one stone, so much the better.

      • And then every single person who gets an inkling of a sniffle runs to the hospital screaming “Ah’ve got da Ebola!” Which sets off panic on another level, as well as one, exposing even more people, and two, overwhelming the triage line who are fighting to keep everyone who doesn’t have it from getting it. And then when people start getting turned away because they’re not actually sick, we start attacking healthcare workers here because they’re mean and racist and stuff.

        I’ve come to accept a middle ground–Ebola isn’t going to kill nearly as many people here as a lot of people think, but it really is the end of the world as we know it.

    • Absolutely true and one of the worst nightmares I can have. Even if only a few people show up in this situation, the entire medical system would crash; the flu and the ebola have identical symptoms for the first 5 days or so, we would have no way of distinguishing the differences. Currently only the CDC can test for the virus; it takes a 3 day turnaround, etc. etc. It could get very ugly.

      There has to be some terrorist sitting in a cave right now, salivating over the possibilities.

      • I have been told plague death rates historically level off after a while–once people start dying, they’re not usually running around infecting others. True/reasonable? When would it start with Ebola?

    • I saw the video; I disagree, it’s clear how they get it. This particular virus is merciless when dealing with inadvertent slips in protocol; only the BSL4 “space suits” are truly safe, all the others represent some form of compromise. And even those may not be safe, we just haven’t treated enough cases to tell.
      Even though the CDC claims that this is contact with fluids only, they sure act like it’s at least droplet, if not airborne. I personally treat it like droplet; I am not convinced that airborne spread has been demonstrated outside of contrived lab situations.

  4. Sorry, the virus is undetectable with standard testing until folks are symptomatic, and in some people not until 3 days after symptoms. Just to clarify.

  5. stupidity it isn’t. Globalization/Agenda 21 requires (except for Israel) universal open borders. Pandemic is the Plan

  6. Summary of Ebola Developments:

    CT policies for travelers from West Africa detailed: ‘Erring on the side of caution’
    By Shelton Herald on October 27, 2014 in Lead News, News · 0 Comments
    State officials have outlined how the state is monitoring the health of any individual returning to Connecticut after traveling from one of the three West African countries affected by the current Ebola outbreak.

    State officials said Connecticut’s policies are more stringent than U.S. Centers for Disease Control and Prevention requirements and involve mandatory active monitoring for all travelers from three countries, and possible quarantine for individuals based on risk factors.

    Final determinations will be reviewed on a case-by-case basis, Connecticut officials said.

    Eight people in quarantine in CT
    Earlier this month, Gov. Dannel P. Malloy announced the state was utilizing its authority under the order signed by Malloy granting the state Department of Public Health (DPH) commissioner the discretion to quarantine people who have met the threshold for such action.

    Shelton-Dph-Health-LogoAs of last week, the department has issued four quarantine orders in the state involving nine people.

    An order involving one person has been rescinded based on a review of additional information related to travel activities. So currently there are eight people in quarantine in Connecticut.

    Malloy: ‘Err on the side of caution’
    Gov. Dannel P. Malloy
    Gov. Dannel P. Malloy
    “With the news of a recent traveler with Ebola in neighboring New York, it is critical that we look at each case on an individual basis,” Malloy said.

    “The protocols outlined here will ensure that we have the ability to take preventative action that will protect public health, utilizing the best information we have and the expertise of our public health officials,” he said. “DPH will continue to err on the side of caution in each and every circumstance.”

    Mandatory monitoring for 21 days
    Under these protocols, DPH is working with federal authorities and is being notified of travelers arriving in Connecticut from the three West African countries impacted by the Ebola virus: Liberia, Guinea and Sierra Leone.

    All such travelers will be subject to 21 days of active mandatory monitoring, and DPH will review each case and determine if additional steps beyond monitoring are necessary based upon a review of the person’s travel history and potential exposure.

    Under active monitoring, local health directors contact individuals daily to obtain their temperatures and determine whether they have developed any symptoms of illness.

    Travelers interviewed by staff
    Dr. Jewel Mullen
    Dr. Jewel Mullen
    Discussing the state’s procedures, DPH Commissioner Jewel Mullen said, “Once the traveler has arrived in Connecticut, they are interviewed by local health department staff or by an epidemiologist from the Connecticut DPH.

    Detailed information is obtained by these public health officials about the person’s travel and whether they potentially could have been exposed to Ebola.

    “Epidemiological experts at DPH assess this information, including the quality of the information collected,” Dr. Mullen said. “We then discuss, and decide on the appropriate steps to protect the public’s health — erring always on the side of caution.”

    Kept away from other people
    If Mullen deems it necessary based on information gathered during the screening process, a quarantine will be required.

    Under these guidelines, an individual held under quarantine is not sick, but is kept away from other people because they may have been exposed to an infectious or contagious disease.
    The state’s isolation procedure will be implemented once a person is exhibiting symptoms, so that further infection of other people can be prevented.

    For more information, go to the state’s Ebola website, http://www.ct.gov/ebola.

    — as edited by Brad Durrell for the Shelton Herald

  7. This isn’t 1805, or 1860 or even 1960. Close the damn borders already and we should know who comes in, why and where they go and for how long. The Feds brag and boast about all that they can accomplish well let’s accomplish a deportation of all non-citizens who are here ILLEGALLY. Bus them, train them or plane them and fine all those who EMPLOY them. KISS…keep it simple stupid.

  8. There is another goal that no one is talking about that is just as serious.

    We need to be sure that ebola does not become embedded in some other resident native wildlife. Lacking some consideration, once embedded in that species they will always be a carrier and we will forever be playing whack-a-mole with the virus. That is part of the problem in West Africa. The virus is resident in bats which are now a safe have for the disease.

  9. Dr. Grouch’s emphasis on taking action that earns us a bit of time deserves further emphasis.

    I’m being sloppy here: the infection models documented by Aesop suggest that we are somewhere between the fifteenth and eighteenth iteration of three-week-doubling globally.

    If we (hypothetically) only have eight infected individuals on ground on US soil, we bump ourselves back to the 4th iteration… provided we were to meaningfully keep Patients 9,10, 11, etc. off national soil, and earn ourselves six months before we’re in the same condition as West Africa.

    Presuming this action was taken yesterday, and if things were to proceed conveniently and mathematically (admittedly, an absurd supposition) we would have bought months of time to implement whatever course of action is appropriate for containing and controlling this issue on our soil.

    If the modeling Aesop has documented is even reasonably predictive, we are hopelessly behind the curve in West Africa. We have the opportunity to corral our resources, entrench ourselves, and then from a position of strength extend charity to West Africa.

    If we continue to bring in new Patient Not-Zeros every day, however, well… the math changes pretty quick.

  10. Very useful information provided by Doc Grouch. I don’t know who he is but I will assume that he is reading the comments here…so THANK YOU Doc.

    I also reviewed the 2 medical articles you referenced and posted my thoughts on them at my site.

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  12. Marlo Stanfield

    Since the Gov and big Pharma control the hundreds of Bio Warfare Test Centers here and overseas, border means nothing. More people need to wake up to the fact that the Ebola got released on purpose. And that this Gov is going to take over those countries because they want the oil and all those minerals. And all these countries with paper money and no assets don’t want to see an African Central Bank with all that oil and other natural resources to back it up. We don’t need OPEC any more. We have all we need here, controlling Africa would give us more reserves to sit on. Why pretend no one here cares about Africa, never have. But sooner than later more countries will do business with Africa and an African Central Bank is just a matter of time. Its all about control.