Tuesday, October 21, 2014

How do you solve a problem like Ebola....

(Maria is not the problem we need to solve at the moment, and in all reality was she ever really a problem?! I mean she was a dream of a nanny who ended up loving those children like her own.  Have I mentioned The Sound of Music is my favorite movie OF.All.TIME?)

I am not a doctor.  I don't play one on TV.  Hell, I don't even want to cut my husband's toenails. Okay, maybe when we are octogenarians I will, but even then it will be reluctantly. Additionally, my only forays into politics, outside of being President of my high school class (have I mentioned there were only around 50 of us so even that wasn't too difficult to achieve) are two failed attempts at running for the Site Based Decision Making Council at my son's elementary school.  So I guess what I am saying is the chances that I will be appointed the next Ebola Czarina are remote. 

Having said all that, my degree is in Economics & Sociology and everything I learned while pursuing my relatively inexpensive University of Kentucky college education (compared to what it would cost in 2014...by the way, in Econ, we call this secondary education hyper-inflation) tells me we are getting this Ebola thing all wrong.

But majoring in Econ and Sociology is a bit like living in two worlds at the same time; the world of studying supply vs. demand, rational vs. irrational behavior, correlation vs. causality, & nature vs. nurture. Where these two disciplines intersect is the study of when the chickens come home to roost, so to speak. So on my diploma it should really read:

Lucy Jett Waterbury

(yes, I was married before I graduated!)

Summa Cumme Laude

Bachelors of Arts

When The Chickens Come Home To Roost

Even if you are not the fear mongering type (Fox News viewers among us, stay with me here), this virus should be on your radar screen, but perhaps not for reasons that you may think.  Although there are those in our society that choose to live life in fear, I am not a card carrying member of this crowd. (Have I mentioned I have experienced a statistically significant number of frightening life experiences including watching my mother and brother die around age 40 from fatal brain tumors and living in the familial aftermath of the murder of my uncle in a random convenient store robbery?  I am only 39 folks.) Obviously the brains tumors are in my DNA, and my uncle was murdered by random evil that existed in 1986 and still exists in this world.  So yeah, fear could be something that defines me, but I simply don't let it.  But let's be real, if you aren't the slightest bit concerned about a horrific virus with a 50% mortality rate, that has already reached our shores, I am sure I can find a good suicide hotline phone number for you, as this is serious business.

Fortunately, we are now at the end of the quarantine period of those nearest and dearest to the first victim of Ebola in America, Thomas Eric Duncan, and his medical support team.  And for the most part, we can breathe a sigh of relief but it is now are duty to investigate "WTF just happened?!" and how do we respond when it happens again, because it will.

As I mentioned, this strain of Ebola, Ebola-Zaire, has a mortality rate of 50%.  Yep, you have a 1 in 2 chance of meeting Jesus if you become a card carrying member of this group.  Medically, we seem to THINK that we understand how it is transmitted (we will revisit this point later). But this assumes it does not mutate as viruses have a propensity to do (I hate it when that happens!).  We also seem to think that we know how to contain it but we have a major, modern medical facility and the CDC that cannot adequately explain how two nurses, using the proper protocols and wearing haz mat suits, contracted it. 

For those who have been living in a cave over the last couple of months or so, let's do a little Ebola 101.  According to the World Health Organization (WHO):

"First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools)."

What that WHO fact sheet fails to do a very good job of explaining, is what dying of Ebola really looks like.  Our own National Institute of Health (NIH) does a better job of explaining this in bullet points (Americans are all about their bullets so this not surprising...)
  • Bleeding from eyes, ears, and nose
  • Bleeding from the mouth and rectum (gastrointestinal bleeding)
  • Eye swelling (conjunctivitis)
  • Genital swelling (labia and scrotum)
  • Increased feeling of pain in the skin
  • Rash over the entire body that often contains blood (hemorrhagic)
  • Roof of mouth looks red
Sounds fantastic, doesn't it? Bleeding from your eyes makes pink eye look appealing, huh?

(Have I mentioned that according to the CDC, the budget cuts from "The Sequestration" hampered the NIH's development of a vaccine for Ebola?  How do you like the Sequestration now?  How does that thought process go exactly, "Hmmm, wow, I am really glad we cut government spending to a point where it may have put millions of tax payers lives at risk for the most deadly epidemic since the 1918 Spanish Flu outbreak. After all, we handled the 1977 Mexican Hot Sauce Botulism Outbreak just fine. History will treat us kindly, don't ya think?") Chickens roosting folks, chickens roosting!  If you are a geek to the level that I am, you can check out the Bipartisan Policy Center's "The Sequestration Explained" fact sheet here.  But how we got here is somewhat irrelevant, what counts now is what are we going to do about it and what have we learned, right? 

Let's talk about the continent that has been hosting this plague of 2014, Africa. But let's get more specific, shall we?  The countries that are currently cesspools of Ebola are Sierra Lione, Guinea, & Liberia. 

Source: www.vox.com

Most of my readers would not be surprised if I suggested that Africa has issues...lots of them. But when you consider Africa in the context of a deadly virus outbreak it has some things going for it. Intuitively this may seem awful that I am calling these positives but compared to the complexities of containing a deadly virus in the US, these are positives. Many times these outbreaks are contained in small, remote villages. And let's just say that most Africans do not have the means or method to leave the cesspool village. Sadly, it takes years for the village to raise a child but in Africa, they can unintentionally kill that same child in a matter of days.  Secondly, protecting basic human rights isn't exactly priority #1 in these countries so to be a human there is pretty awful and you are at the mercy or abuse of whomever dictates your quality of life, or lack there of.  Just as the politics of famine are complicated in Africa, so are the politics of disease. When competent to do so, the local folks will do what it takes to try and contain the disease but alas, even with limited mobility, denial of human rights, and governmental attempts to regulate travel, Ebola-Zaire landed in Dallas, TX on September 20th.

How does this happen?  Well, you show up at the airport without a fever, tell security what they want to hear and then board the plane for the promised land.  Can you really blame him?  After all, your fiance'  is in Dallas, you have other family in the States, you already quit your job, and basically YOU CAN. This post is not intended to demonize anyone and evidently Thomas Eric Duncan was a pretty darn good example of a kind, compassionate human as his willingness to transport a dying pregnant Ebola victim earned him his own ticket to meet Jesus.

To say that any of us would act differently is a self serving stretch.  Now many of us would have NEVER answered the call for help to move the dying Ebola patient, that is a given.  But most Americans, when afforded the opportunity to better his life and see his loved ones, would do what he did and the same would happen here. You would get on that plane to go "home" to see your loved ones and choose a better life, whatever that means in your circumstances and locale. If you say you would not, you are lying to yourself.  He acted rationally.

Did you know that the person responsible for the Nigeria outbreak was a Liberian-American (yep, those pesky Americans who think they can travel the world as they please) who traveled to Nigeria and infected 19 people. Nigeria has since been declared Ebola free but it was an American who brought it there.  Does that make you think about things differently?

The key to containing this virus here in the United States is controlling it before it reaches anywhere near what we call in Econ, the tipping point, which is a mind boggling low number of infections.  Because if you let it reach the tipping point, containing this virus here will be far more difficult.  I don't care what epidemiologists say, I don't care what the CDC says, when you have a critical mass of Americans exposed to this virus, the cows are out of the barn folks.  Why, you ask? Because the devil is in the details, as they say.

Here are some details:
1. Most regional hospitals and small community hospitals are not prepared adequately, nor is their staff trained to handle even a single highly contagious Ebola victim that stumbles into the closest ER, bleeding from every orifice.  What are most going to do with them once they have them?  They will assess them for disease and do what medical professionals do every.single.day, put their own lives at risk to save others (This assumes that at this point in the epidemic that enough doctors and nurses have decided it is worth it to keep coming to work...a big assumption for some that went into medicine for the wrong reasons).

2. If this virus reaches anywhere close to a tipping point, people will have no idea they even have the virus or were exposed to anyone with it, as they may think they just have the flu, decide to work anyway or send their sick children to school anyway.  Remember the onset of Ebola is very much like that of the flu.  In a country where medical costs are outrageous, the working poor will do what is rational which is continue working and sending their infected kids to school.  It doesn't matter what they should do, or would like to do, they like to eat and put a roof over their head and there is no back up child care available to them.  When the going gets really rough, like bleeding from the eyes, rough, they will eventually seek medical treatment, but far too late to prevent a potential public health nightmare created by their rational behavior.

3. We do not have sufficient ways to contain the virus in a population where human rights are at least in the top 10 priorities of our Constitution (okay, let's be real it is not #1 and if you believe that I can guess your race and socio-economic status in 1.5 seconds flat, remember, I am an Economist and Sociologist by training).  On any given day, I can jump in my car in Kentucky and I can put my foot down on the soil of most of the 48 contiguous states within 3 days, 5 of them within 3 HOURS!.  I don't have to ask for permission, I don't have to be screened by anyone, I just CAN. 

4. Quarantines work when people cooperate, choose honesty when facing unknown repercussions, and make their medical condition known to authorities.  We can quarantine citizens but by then, how many have already been put at risk.  These numbers start to get out of control quickly. 

5. Dogs can become infected with Ebola-Zaire and produce antibodies and excrete the virus in their stool and urine.  Can they transmit it to humans?  Are you ready....WE.DON'T.KNOW!  In a country where you are far more worried about where your own next meal is coming from,having a canine mouth to feed is highly unlikely and completely irrational.  How about in America where dogs are members of the family that sleep in the same beds with their owners?!

6. Tens of thousands of American lives are lost to the flu every year, and we have a vaccine for it that many people refuse to take (albeit for many and varied rational reasons)!  You could say that many would more willingly take a vaccine for a disease that has a 50% mortality rate but remember we still have hundreds of millions of Americans to vaccinate which is a logistics challenge, in an ideal set of circumstances, much less during mass chaos and hysteria.  

So what do we do now?  We can rejoice that it seems we dodged the bullet this time. We can dig deep, talk to professionals in many and varied disciplines outside of the medical profession and we can make sound public policy decisions and allocate adequate resources.  Some of these policy decisions will test our resolve and make us feel very uncomfortable.  But being uncomfortable beats being dead.

Any when BioProcessing, the company located in Kentucky, has produced enough Ebola fighting compound, a suspected cure for Ebola ,made from....(wait for it)...tobacco, we can all breath easier, both literally and figuratively.  Fortunately, the land of my birth and where I choose to call home, is exceptionally good at growing tobacco and we could really use the jobs.  (And if you are registered to vote in the land of my birth, for the love and anything and everything, please Ditch Mitch & vote for Alison!) 

Perhaps now that the potential cure to this horrific virus can be found in a previous delivery mechanism of death, we will think differently about a lot of things.  Maybe we have just been using tobacco wrong all of these years?! In an ironic twist of fate, perhaps it took the deaths of millions of Americans from tobacco smoke, and a potential epidemic to realize the life saving mechanism of tobacco was under our nose, literally and figuratively, all along.

So when Sequestration rears its ugly head again, and it will, just think of all the potential medicinal uses of Kentucky Bourbon we might be missing?! Okay, and in all seriousness, as the 101st Airborne Division out of Ft. Campbell, Kentucky is mobilized in a last ditch effort to try and keep Ebola-Zaire in Western Africa, ask yourself why bullets are funded more often and freely than the National Institute of Health.  One funds death re-actively, the other funds life proactively.

And according to Maria, the Reverend Mother said, "When the Lord closes a door, somewhere he opens a window".  It is our job to look for that window and not break the damn thing with our efforts.