Five days ago, on October 18th, I posted a controversial blog that expressed my alarm at the way the U.S. was approaching Ebola. This was right after the contagion in Dallas was really hitting its stride. I resisted as long as I was able, because I try to avoid discussing religious or politically charged topics – they never go anywhere good.
I got a lot of comments on Facebook along the lines that a travel ban for travelers from West Africa could never work, well, you know, because the President, who lied about the likelihood of Ebola hitting American shores, said it would never work. Because, well, it just wouldn’t, you know?
Tonight, a physician who was treating Ebola patients in West Africa and who returned to the U.S. about the mid-point of the average incubation period was diagnosed with the disease in New York, after presenting with a 103 fever this morning. Two days ago he began feeling sluggish and unwell, but not so much that he didn’t go to restaurants, use the subways, go bowling (bowling?!?), take taxis, etc.
Now, let me be the first to commend him for his altruism in going to unfortunate places and devoting his time, and yes, risking his life, to treat others suffering from a modern plague with a 70% mortality rate in those countries.
Let me also be the first to condemn his idiotic behavior in putting his fellow citizens at risk by traveling around more than I do on a three day binge, after returning to New York from Africa, knowing with his medical training that he was well within the incubation period of the disease, and could not only have it, but spread it. To call it irresponsible is to be charitable.
If I wrote this in a novel I’d get terrible reviews, because nobody would believe that a doctor could willfully expose people as this one did. Three people have been immediately quarantined. How many more come down with Ebola from this exposure is anyone’s guess at this moment.
But it highlights one glaring fact. Actually, two. First is that if this is what a well-trained healthcare professional would do after returning from a plague area where an incurable disease is spreading like wildfire, what can we honestly expect from laymen? And yet the US’ approach has been to allow West African travelers to enter its borders, and relied on “screening” and “self-monitoring.” How’s that going so far? That looks like 0 for 2 to me. And now the most important city in the US (the financial system is situated there) is an Ebola hot zone. But we “shouldn’t worry” per the authorities. You know, because Science! And we’re ready for this! And if we stop consuming the terrorists, er, the virus, wins!
Um, really? We won’t know how much more spread we have from Dallas for another couple of weeks, in spite of the hyperbole from the media. And we’re just getting started on this one. Tomorrow there’s nothing preventing another one of these horror stories. And another, and another, and another. Because the administration thinks it’s a good idea to bring potential carriers of this nightmare plague into the nation’s borders. You know, because otherwise the sky will fall, or people will think we’re racist hatemongers.
The doctor in New York is a white male. I’m not being racist. Death knows no color or creed, and the risk to fellow humans is the same regardless of skin color, eye shape, hair texture, etc. I’m also not a trained medical professional. But I do know that if people are traveling from the place where everyone’s dying of the incurable disease? Might be a bad idea to say, “come on in, make sure you behave responsibly, you little dickens, and if you don’t, well, you’re still not going to be blamed for the deaths you cause and the countless millions that are spent trying to clean up after you and stop the spread before the US becomes the first world version of Mad Max.” Because to me it’s a bad idea. How about, “You can’t come in until you prove you’re not Typhoid Mary?” Is that too much of a stretch?
What will the financial cost of this be? How likely are people to be to want to get on a plane when the person who sat in the seat before them could have been another altruistic physician returning from Liberia, or flying to visit someone after feeling sluggish and tired? How many of these outbreaks do we have to see before we figure it out? Let’s take Dallas as an example. The hospital there will probably go BK. Patients are canceling their surgeries, avoiding the place. This is one of the most revered hospitals in Dallas, and it’s going to likely be a casualty of Mr. Thompson’s decision to lie on his questionnaire after being exposed to Ebola and fly to Texas. And there’s the cost of tracking hundreds, or thousands, of the exposed. The cost to people when their health insurance goes through the roof as insurers back away. The cost of treating the afflicted. The cost to the airlines, Dallas hotels, restaurants, etc. It’s a big number, and that’s from only one patient slipping in. Multiply that by however many more you think likely as travelers pour in from the hot zones. It’s not pretty.
And how about the guy who touched the good doctor’s fork and knife and napkin at the restaurant? Because he or she undoubtedly is cringing right now. How about the cab driver? You know who has the highest mortality rate in Africa, after those caring for Ebola victims? Cab drivers. Because they invariably get stuck driving the victim to the hospital. I could go on and on, but then this blog would be a novella, not a blog.
For everyone who is going to say, “but he self-monitored, so that works,” I’d say, really? The professionals who are treating this are dying like flies, so they aren’t that sure their protocols are all that great (I still don’t see how a BSL-4 pathogen, which requires a closed breathing system and pretty much a full on hazmat suit, can be safely handled with some tape on gloves, some goggles, and hope – but then again, I’m not one of the 400+ who have given their lives to discover that may not be a great idea). And nobody’s sure exactly at what point in the curve the patient becomes aggressively contagious – the viral load in his sweat, saliva, other bodily fluids builds to critical mass and he goes full blown, but at what point is he close enough to full blown to infect? One hour before he takes his temperature and goes, holy shit? Three? Six? Twelve? Twenty? Nobody’s sure. Everyone’s making educated, and in some cases, fatally incorrect, guesses.
Politicians and administration mouthpieces who aren’t doctors are saying he posed almost no risk to those he was around on the subway, but they have no idea. Just as nobody really knows whether the new CDC protocols are adequate to keep it from spreading to healthcare workers. I mean, again, politicians and people with no medical training are saying they are, but they aren’t donning their little CDC protocol suits and going in to wipe an Ebola patient’s ass, so to them it’s another, “mistakes were made” oops if they’re wrong, or another “mysterious breach of protocols” when the nurses start dropping. Anyone see the moral hazard here? It’s pretty much the same as letting Congressmen not be subject to the same health insurance or financial constraints as those for whom they’re mandating those items. Huge moral hazard because they aren’t at personal risk. In business, you’d say they have no skin in the game. And that’s always a bad thing.
In Africa, the average Ebola carrier infects two more. And those two infect two more. And so on. The WHO estimates have the total infection at 1.5 million or so by the end of January, the number doubling every 12 days. How is that not scary as shit for a virus that is deadlier than bubonic plague (bubonic plague is 60%, Ebola 70%, although in these early cases it’s lower in the U.S. – but it’s still extremely early in the curve to be able to know what it actually will turn out to be here, because not everyone’s going to have the same immune response, the same level of care, the same overall health when it started, and, yes, the same luck).
Now, I know this is going to be unpopular, but I’ve even seen some articles trumpeting that the Dallas carrier’s family has been cleared, with no contagion. But you know my bet? He knew he’d been exposed, lied about it, and then when he started to present with it, told his family to avoid all contact with him, because he’d seen what it does. That’s about the only explanation I can come up with that makes sense. They avoided him, so they’re alive. Good for them. But that doesn’t mean it’s not all that contagious, because about 5K dead in Africa would beg to differ, as would every doctor on the planet, as would 400+ medical workers. Of course it’s contagious enough you should worry. It’s worse than the frigging plague.
And yet we’re being told not to give in to “hysteria.” Not to panic. Okay. I’m not panicked at all. I’m 1000 miles from the U.S. Couldn’t be calmer. Here’s a truth: It’s not panic or hysteria when you do a risk calculation that says things are doomed to get far worse at this rate. It’s being realistic. Sure, there have “only” been four cases of Ebola here so far, so it’s statistically irrelevant. But it’s also only the first few minutes of the first inning. And we’re dealing with a BSL-4 pathogen for which there’s no cure. If you don’t find that worrisome, you aren’t paying attention.
I get kind of testy when I see the mainstream media trying to spin Ebola as worse than a cold, but certainly not something Americans shouldn’t expect to walk away from, based on the stats so far from a tiny sampling. There’s simply no basis for that conviction. If there are 1000 cases here, and the death toll is “only” 200, well, then we can extrapolate and say it’s a 20% mortality rate in a first world country. But with eight and God knows how many more to come (the US is processing 150 expedited visas a day from West Africa, so you can expect more – a lot more), we’ll all get to find out.
The other part of this I’m offended by is that the U.S. is putting the entire continent at risk, because if and when this spreads into clusters of outbreaks, if and when it spreads to Mexico and points south, they don’t have hundreds of millions to throw at cleaning up for the administration’s decision to keep the U.S. as destination number one for Ebola-exposed carriers. So you can expect the mortality rates in those countries to be more in line with good ol 70%. And for the spread to be much more severe.
I know the flu kills 250K to 500K a year. But how many billions are exposed to it a year and contract it? Or put simply, how many Americans have to die before the U.S. figures out it might not be a good decision to refuse a travel ban? My fear is that it will soon be a moot point, because it can all turn sideways on us pretty quickly.
I’ll make some predictions. If this doesn’t get handled competently over the next few weeks the market will be a smoking crater, there will be new horror stories on a daily basis, and the U.S. will be a pariah to all its neighbors. The dollar will suffer and the government will have a difficult time borrowing to fund the debt-based lifestyle it enjoys but can’t afford, industries like tourism, airlines, restaurants, health care will go into the toilet, and the financial impact of this decision to keep the borders open will be one of the most costly in American history.
For once I’m so upset I don’t even care if you buy my crap or not. I mean, I’d hope you would to show solidarity, but if you don’t I’ll understand. And please, save the “Ebola has only hit a few people, it’s not a big deal” comments. Just because you can’t do exponential math or predict accurately past the end of your nose, kindly don’t parade that defect with pride. I can count. I know at the start of all epidemics in history it’s been only a few cases. I get it. But let’s all agree you know about as much about how many cases there will be in the U.S. within sixty days as you know what the price of Amazon will be in sixty days, which is to say, not at all, so any argument from that position is simply your unfounded opinion. It’s okay to have those, as I’ve just expressed mine, but if you think I’m in error, go write your own blog about why I’m way off base. I can write it for you. “Don’t panic. The Titanic’s engineers assure us that it’s unsinkable. The engineers of the mortgage backed securities markets assure us that the real estate market can never crash so badly as to take the whole world right to the brink. And right now a whole bunch of non-scientist, non-doctor politicians and their mouthpieces are saying you don’t have to worry about Ebola.”
See, the problem is that’s like saying, “the odds of dying of Ebola in the U.S. are less than you being attacked by a tiger walking out your front door!” Which I get. I also get that if you have hundreds, or thousands, of people flying into the country with tigers every week, that glib assurance goes out the window pretty fast.
To me that always sounds like, “Don’t worry, I’ve driven for years without a safety belt – you don’t need em!”
Until you do, Sweetie, until you do.
But by then it’s always too late.