Patterico's Pontifications

10/2/2014

People Possibly in Contact with Ebola Patient Goes from 12 to 18 to 80 to . . . 100

Filed under: General — Patterico @ 6:46 pm



The numbers keep growing:

Health officials are reaching out to as many as 100 people who may have had contact with Duncan, a spokeswoman with the Texas Department of State Health Services said Thursday. These are people who are still being questioned because they may have crossed paths with the patient either at the hospital, at his apartment complex or in the community.

“Out of an abundance of caution, we’re starting with this very wide net, including people who have had even brief encounters with the patient or the patient’s home,” spokeswoman Carrie Williams said. “The number will drop as we focus in on those whose contact may represent a potential risk of infection.”

The number of direct contacts who have been identified and are being monitored right now is “more than 12,” a federal official told CNN on Thursday. “By the end of the day, we should have a pretty good idea of how many contacts there are,” the official said.

Mr. Wentworth just told me to come and say there was trouble at the hospital.

Our chief weapon is surprise…surprise and fear…fear and surprise…. Our two weapons are fear and surprise…and ruthless efficiency…. Our three weapons are fear, surprise, and ruthless efficiency…and an almost fanatical devotion to the Pope…. Our four…no… Amongst our weapons…. Amongst our weaponry…are such elements as fear, surprise…. I’ll come in again.

66 Responses to “People Possibly in Contact with Ebola Patient Goes from 12 to 18 to 80 to . . . 100”

  1. United contacting those who flew with Ebola victim

    my understanding though is they’re washing the whole plane down with Spring Fresh Scented Fabuloso with Bleach Alternative

    this will make sure no trace of the pesky virus remains and leave the plane smelling fresh (like spring) not fresh like fresh ebola lesions

    happyfeet (a785d5)

  2. I think Tom Clancy’s Jack Ryan (no relation to Obama’s Jack Ryan) closed down all air travel and international borders, then ordered state authorities to close internal road borders for the duration of a weaponized Ebola attack.

    I don’t know that this would be a good idea, but I will take bets against Obama having a better one.

    Kevin M (b357ee)

  3. Close the border. It’s not that hard if you have good leadership.Oh…about that….

    Bugg (f0dbc7)

  4. @2– mentioned in comments in an earlier post on this topic.. “Executive Orders” was the book, and probably would be good reading for those who have not already done so.

    Gramps, the original (7adb80)

  5. FWIW, CNN is reporting Duncan was vomiting on first visit to hospital.

    With no care the mortality rate was running 70%. Let’s see what replacing fluids will do.

    Otherwise a lot of people are dead for the Dhimmi base vote.

    gary gulrud (46ca75)

  6. Ima going way, way out on a flimsy limb and say this outbreak in the making is not yet contained.

    http://www.thegatewaypundit.com/2014/10/what-ebola-quarantine-photo-shows-person-delivering-food-to-texas-ebola-victims-family/

    gary gulrud (46ca75)

  7. Of course the number of contacts and possible contacts is higher than 12 or 18, but the ones they don’t know about are likely to have far less contact, and if the ones they do know about don’t come down with ebola, you can be pretty sure the ones they don’t know about won’t. And the ones they do know about almost certainly won’t come down with ebola.

    The family of Duncan was asked to not go out – they wouldn’t agree, and they got a court order against them, telling them to stay indoors until October 21 (or else they’ll take them to a jail?? A few people you could lock up in isolation, I guess.)

    A doctor saw them today – no signs of illness.

    Twenty one days is probably far too long to give for the incubation period – md in Philly I think
    said that number of days was what they used to use for chickenpox. It is really a worst case scenario, and then who knows if 21 days is the longest incubation period possible? Maybe it is less, or if you want the one in a million case, maybe it is more.

    If his family doesn’t get sick, probably nobody else will, unless it is somebody very very vulnerable, like a 6-month old baby, an 85-year or more old person, or someone with HIV – who could then pass it on maybe to somebody else. This whole epidemic started from a small baby. Everybody else must have had a sub-clinical infection, although maybe some people were dying in the back woods or whatever they have like that in Africa.

    Sammy Finkelman (c2ea77)

  8. gary gulrud (46ca75) — 10/2/2014 @ 8:50 pm

    With no care the mortality rate was running 70%. Let’s see what replacing fluids will do.

    It greatly reduces the death rate for cholera.

    Interesting tidbit about cholera: People with type AB blood don’t get sick.

    Sammy Finkelman (c2ea77)

  9. I have been scanning the other Ebola threads, and I don’t think this has yet been mentioned. My apologies if it has. In any case, Powerline has a post up telling us that the Obama Administration back in 2010 suspended some Bush-era quarantine proposals and never bothered to replace them with an updated policy. So yeah, I’m not feeling too good that these are the folks in charge.

    JVW (638245)

  10. National Soros Radio says it’s totally no fair

    the ebola dude LIED his ass off and so the security measures never had a chance to work right

    now we have to redo everything and take into account the fact that ebola people are big fat LIARS

    happyfeet (a785d5)

  11. quarantine-photo-shows-person

    That illustrates how very casual or nonchalant the average person is about even basic hygiene.

    Various studies through the years have shown that people in no less than hospitals, including doctors and nurses, can be surprisingly casual or lazy about washing their hands.

    In a way, it’s surprising there are not far more cases of people becoming very ill after eating in restaurants (where much of the kitchen staff is “undocumented,” or merely one step beyond that supposed bit of legalese), or interfacing with any number of environments. For example, locations where cleaning crews use the exact same rag to clean both the toilet and other surface areas. I’ve witnessed janitors or maids doing that exact thing in office buildings or hotels I’ve been in.

    Mark (c160ec)

  12. JVW,

    The US has contingency plans for everything. Puerto Rico invading, asteroid strikes on De Moines, etc. They have a plan for a hemorrhagic fever outbreak, too. But I’ll bet a hundred dollars against a jelly donut that President Smartypants is gonna ignore it and roll his own. Again.

    Kevin M (b357ee)

  13. des moines.

    Kevin M (b357ee)

  14. happyfeet, that’s just not true. He told them he had been in Liberia and that he thought he might have been exposed to Ebola. He knew it when he left Liberia and lied to get on the plane (Liberia is pissed). Why? Because he wanted to go to a real hospital and get real medicine. So WHY WOULD HE LIE when he got to the US hospital?

    The hospital says he told them everything and they still sent him home. In their defense I imagine they’ve been inundated with everyone with sniffles thinking they have Ebola. Something that will now get worse.

    Kevin M (b357ee)

  15. National Soros Radio says it right there in the headline Mr. M

    he’s a big LIAR and a DECEIVER

    and it sucks cause the government has all their top people trying to keep us safe and then we get this LIAR messing up the whole system and putting regular non-ebola people in danger

    happyfeet (a785d5)

  16. Texas republicans led by doofus gov. peary cut spending to texas dept. of public health to give even more tax breaks to the rich. so the cut funding to hospitals. you get what you pay for! Hospital sent ebola carrier home as non emergency case hoping he would die at home so they wouldn’t have to foot the bill for his treatment. hospitals excuse just because he said he was from liberia and might have ebola well it got lost in transmission so call amco to fix the transmission!

    death star (8f392f)

  17. JVW (638245) — 10/2/2014 @ 9:20 pm

    Powerline has a post up telling us that the Obama Administration back in 2010 suspended some Bush-era quarantine proposals and never bothered to replace them with an updated policy.

    If only they didn’t quarantine places that experienced natural disasters and let people bring help on their own.

    There are civil liberties considerations with quarantine, and it was probably too easy to implement..they’d do it even for non-contagious diseases and prevent people from seeking medical help.

    Also, it would cause people to lie and hide the disease in question.

    Sammy Finkelman (c2ea77)

  18. There are civil liberties considerations with quarantine, and it was probably too easy to implement..they’d do it even for non-contagious diseases and prevent people from seeking medical help.

    Fine and well, Sammy, and the Powerline post mentions that civil libertarians didn’t like the Bush quarantine proposal, but the whole point is that Obama suspended the Bush proposal without ever bothering to substitute his own, so that when this hit there was no playbook for the government to follow and, as we are getting so used to, the Obama folks are just making it up as we go along. That’s not effective leadership.

    JVW (638245)

  19. death star rides in on his Soros horse to inform all of us rubes that this is all the fault of Rick Perry. If only Texas bureaucrats sitting in cubicles in an office building in Austin had been given more money, this whole thing would have been taken care of. The naiveté of liberals is so precious.

    JVW (638245)

  20. Texas republicans led by doofus gov. peary cut spending to texas dept. of public health to give even more tax breaks to the rich. so the cut funding to hospitals. you get what you pay for! Hospital sent ebola carrier home as non emergency case hoping he would die at home so they wouldn’t have to foot the bill for his treatment. hospitals excuse just because he said he was from liberia and might have ebola well it got lost in transmission so call amco to fix the transmission!

    death star (8f392f) — 10/2/2014 @ 9:45 pm

    Dude, step back for a second and realize something. When Happyfeet at his most whimsical makes more sense than you do now, you might want to a) loosen the tin-foil a turn or two and b) review your post before you actually hit “submit comment”.

    Bill H (f9e4cd)

  21. Here is something else: (showing non challance)

    The Guardian Saturday 27 August 2011:

    Ebola: the solution may be in sight

    You know what the sub-headline is?

    Research in the US suggests that a treatment for the deadly Ebola virus may be less than a decade away

    Less than a decade. That’s supposed to be super fast. !!!

    If you’re on that kind of timetable, you’re never going to cure anything.

    Ebola didn’t wait that long to become a pressing concern..

    Sammy Finkelman (c2ea77)

  22. Also, this discovery doesn’t seem to lead anywhere, unless you are proposing maybe to develop a genetic test to discover people who can’t be harmed by ebola, like there are people who can’t get the black death, or even AIDS, or cholera (for cholera, anyone with type AB blood)

    A grant proposal writer could claim a greater use, but I don’t see it.

    There is a protein, discovered in 2005!, that might have a protective effect but nobody seemed to be no great hurry to try to test it out, or to see, or to speculate, based on known information, whether or not using it would cause serious harmful effects. (in the case of ebola, the harmful effects have to be serious.)

    Besides who needs it? (whatever they could develop.)

    Statins work too: (and a number of other existing drugs)

    http://www.nytimes.com/2014/08/16/opinion/can-statins-help-treat-ebola.html?_r=0

    More than a decade ago, clinicians noted striking similarities between patients with Ebola and those with bacterial sepsis. Both diseases involve severe dysfunction of the endothelial cells that line blood vessels throughout the body. This dysfunction in turn precipitates major abnormalities in blood coagulation. Both can eventually lead to the failure of internal organs, primarily the liver and kidneys, and organ failure often leads to death. Something similar is seen in many patients with other forms of acute critical illness, including pneumonia and influenza.

    Researchers have since discovered that abnormalities of endothelial function and coagulation can be modified or reversed by treatment with drugs such as statins, angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), which were developed to treat patients with cardiovascular diseases and diabetes. Known as immunomodulatory drugs, they also have the ability to modify the body’s response to infection. While they don’t prevent infection itself, they can prevent complications like organ failure. A clinical trial published in the journal Critical Care in 2012 demonstrated, for example, that early treatment of sepsis patients with a statin reduced the occurrence of organ failure (a complication that often kills Ebola patients) by 83 percent.

    Of course, this is too original an idea to use. It is no longer the 19th or early 20th century.

    And they’ve come up with fantastic objections to trying this out: (remember, statins are pretty safe for short term use)

    Representatives from the World Health Organization have expressed reservations about what we are proposing. They have suggested, for instance, that the use of such drugs could increase viral replication and worsen the disease. But several studies have shown that statins actually reduce viral replication in human diseases like hepatitis C and improve clinical outcomes.

    Never mind. We’ll stick to the long, slow, decades long research projects.

    Sammy Finkelman (c2ea77)

  23. death star (8f392f) — 10/2/2014 @ 9:45 pm

    Hospital sent ebola carrier home as non emergency case hoping he would die at home so they wouldn’t have to foot the bill for his treatment.

    No, the same thing happened with some of the anthrax victims in 2001 – and they didn’t even get antibiotics.

    It doesn’t really cost the hospital anything. What they charge has little to do with the marginal cost of one more case. It’s that there are regulations and pressure from Medicare and insurance companies against having too many patients admitted.

    Sammy Finkelman (c2ea77)

  24. 23 It is not one case they send home all they can to save money when texas cut reimbursement for indigent health care so hospital doesn’t go bankrupt!

    death star (8f392f)

  25. Um…Sammy?

    You wrote:

    “…like there are people who can’t get the black death, or even AIDS, or cholera (for cholera, anyone with type AB blood)…”

    Are you seriously making the claim that people with type AB blood are immune to cholera?

    Do you have any peer reviewed article that says that, other than fringe science websites (like the “Blood Type Diet”)?

    There are indeed differences in susceptibility to the bacterium and its pathogenesis (with Type O having the most susceptibility).

    But ABs being immune?

    I know you are an odd cat, but please.

    Just curious.

    Simon Jester (52d023)

  26. Texas republicans led by doofus gov. peary cut spending to texas dept. of public health to give even more tax breaks to the rich. so the cut funding to hospitals. you get what you pay for! Hospital sent ebola carrier home as non emergency case hoping he would die at home so they wouldn’t have to foot the bill for his treatment. hospitals excuse just because he said he was from liberia and might have ebola well it got lost in transmission so call amco to fix the transmission!

    death star (8f392f) — 10/2/2014 @ 9:45 pm

    8/10

    Good effort

    Dustin (2c6c8b)

  27. “…like there are people who can’t get the black death, or even AIDS, or cholera (for cholera, anyone with type AB blood)…”

    Simon Jester (52d023) — 10/2/2014 @ 10:20 pm

    Are you seriously making the claim that people with type AB blood are immune to cholera?

    Do you have any peer reviewed article that says that, other than fringe science websites (like the “Blood Type Diet”)?

    Well, they can get infected, but they don’t come down with what is known as cholera – no
    diarrhea.

    This is what Matt Ridley wrote in his book “Genome”

    Page 140: “They are virtually immune to cholera”

    https://www.google.com/search?q=%22virtually+immune+to+cholera%22&btnG=Search+Books&tbm=bks&tbo=1&gws_rd=ssl

    and/or

    http://books.google.com/books?id=UIcvAQAAIAAJ&q=%22virtually+immune+to+cholera%22&dq=%22virtually+immune+to+cholera%22&hl=en&sa=X&ei=lDYuVMSpFcWLyASv34HACg&ved=0CCoQ6AEwAg

    The most resistant people are those with the AB genotype, followed by A, followed by B. All of these are much more resistant than those with O. So powerful is this resistance in AB people that they are virtually immune to cholera. It would be irresponsible to say that people with type AB blood can safely drink from a Calcutta sewer – they might get another disease – but it is true that even if these people did pick up the Vibrio bacterium that causes cholera and it settled in their gut, they would not get diarrhoea.

    Quoted here:

    http://m.delphiforums.com/chromosome/messages/55

    There are indeed differences in susceptibility to the bacterium and its pathogenesis (with Type O having the most susceptibility).

    But ABs being immune?

    I know you are an odd cat, but please.

    Just curious.

    Sammy Finkelman (0a978b)

  28. 8/10

    Good effort

    See Dustin, I have a problem scoring that high when death star failed to mention both GW Bush and the Koch Brothers. To me, death star’s submission rates no higher than a 6.

    JVW (638245)

  29. I’m only grading for effort here. It’s a brave new world now.

    Dustin (2c6c8b)

  30. Sammy….did you, you know, read any journal articles? By, oh, I don’t know…people who work in the field?

    I am very family with Matt Ridley’s work. He is a swell guy, as well as being the “5th Viscount Ridley.”

    But I recommend you speak to an epidemiologist. Or an infectious disease doc.

    Now you are saying that people with AB blood types who contract cholera don’t even get diarrhea.

    Please read this:

    http://iai.asm.org/content/73/11/7422.long

    Note that type Os do indeed suffer from increased symptoms. But ABs do indeed get cholera, complete with diarrhea, Sammy.

    I shouldn’t be surprised. You find some factoid you love emotionally and cling to it tenaciously.

    This is a classic case of Ridley overstating a situation for effect, and irresponsibly so.

    We don’t need this kind of thinking in a world with Ebola, thank you very much.

    Simon Jester (52d023)

  31. Simon – Sammy already cured TB, now he’s curing ebola. He’s on a roll!

    daleyrocks (bf33e9)

  32. halloween tricks and halloween treats ebola stalks the homeland’s streets but food stamp he’ll protect us all for he is big – ebola’s small!

    so as the witching hour draws near splash bleach on all those you hold dear and venture out into the night enjoy a gasp enjoy a fright!

    then scurry home your candy packing nevermind your children yacking it’s halloween and bloody hell you can’t let fear your fun dispel!

    happyfeet (a785d5)

  33. More than 12, as many as 100+….
    Top..People!

    askeptic (efcf22)

  34. Matt Ridley’s book looks well researched.

    I assume he may also have been relying on word of mouth.

    I don’t find anything quite as strong as what he said, so he may have been going a bit further than others, probably justifiably, though.

    I found this:

    http://n-equals-one.com/blogs/2010/11/11/drugs-and-blood-types-in-the-time-of-cholera/

    A follow-up study of family contacts of cholera patients, carried out between September 1980 and July 1982, indicated that blood group did not affect an individual’s risk of having a culture-proven infection with V. cholerae but was directly related to the severity of disease. Individuals with the most severe diarrhea compared with those with asymptomatic infection were more often of blood group O (68% versus 36%, p less than 0.01) and less often of AB (0% versus 7%, p less than 0.01). The constant selective pressure of cholera against people of O blood group may account in part for the extremely low prevalence of O group genes and the high prevalence of B group genes found among the people living in the Gangetic Delta.

    Individuals with Ab blood with the most severe diarrhea compared with those with asymptomatic infection:

    0% versus 7%

    0% = none. [on second thought maybe 0% could equal as much as 3, but probably doesn’t.]

    No patients who had severe diarrhea had AB blood. While 7% of those with an asymptomatic infection had Type AB blood.

    Some people with type AB blood can become cholera patients although the ratio is still one ninth of that in the general population.

    This might be the study referenced in the n-equals-one blog: (The abstract has the same statistics)

    http://aje.oxfordjournals.org/content/121/6/791

    I don’t have access to more than the abstract, but there is comment and description of it elsewhere.

    Altogether the blood type of 1346 patients was determined of whom 682 had a diarrheal illness that could be associated with a specific pathogen, and the remaining 664 were controls. Whatever the number of those 682 who had severe cholera, 0% had type AB blood. 7% of 682 means you should have expected that 48 of those with a diarrheal illness should have had type AB blood. There wasn’t a difference for other diarrheal diseases, and I don’t know how many of the 682 were cholera and how many of the cholera cases were severe. So whether n = 0 or 1 or 2 or even 3 I don’t know, but 3 would be very hard to round down to 0% as that would have made almost all of those cases cholera and not e-coli or anything that was tested.

    That web page contains a list of articles citing that 1985 study.

    In general, the writers seem mostly to distinguish between Type O and non-O, and are most interested or maybe only interested in this in the context of explaining the different ratios of the different blood groups in different regions..

    Sammy Finkelman (0a978b)

  35. @10, 15– Liar? When did that mean anything? Its a way of life for the Demmies. “If you like your doctor, you can keep….” comes immediately to mind, there might be more examples.

    Gramps, the original (7adb80)

  36. 33. askeptic (efcf22) — 10/2/2014 @ 11:30 pm

    More than 12, as many as 100+….

    That’s really as accurate as they can get, and they should have been more careful with giving out numbers.

    Twelve was maybe the number of people being followed up at the time the number was given out, or as of the time somebody checked.

    That was not all they would eventually check up on, as more interviewing and investigation brought forth more names, and was not expected to be, except by the people gung ho to issue an announcement.

    And whoever they followed up on, that was not actually every person who had some contact. They don’t know who else was in the emergency room, for instance.

    Or if they do (at least have names of the patients seen there) most were nowhere near Duncan, and the disease is not spread that easily – or else this (and previous outbreaks) would be and have been a much bigger, more rapidly expanding epidemic.

    So it’s followup…

    (which means only:

    1) check temperature daily.
    2) consider ebola if they get a temperature.
    and
    3) tell them to be a bit more careful than usual about spreading a possible infection)

    ….on those they can easily follow-up on, and no follow-up on those they don’t know about or who would be too hard or too many to track down.

    Now it does take maybe a few paragraphs to explain that.

    Sammy Finkelman (0a978b)

  37. http://www.npr.org/blogs/thetwo-way/2014/10/02/353274722/liberia-to-prosecute-u-s-ebola-patient-for-lying-on-questionnaire

    The hospital also said that the nurse who interviewed Duncan on his Sept. 20 arrival at the hospital correctly entered into the system his recent travel to West Africa, but that a flaw in the electronic health records system prevented physicians from receiving that information.

    What kind of flaw?

    How do people tolerate themselves writing articles like that?

    Maybe it was asked, but wasn’t tagged as medical information? What?

    Sammy Finkelman (0a978b)

  38. Binyah Kesselly, chairman of the board of directors of the Liberia Airport Authority, said Duncan had answered “no” to a question asking whether he had cared for an Ebola patient or touched the body of anyone who had died in an Ebola-affected area. If that was the wording of the questions, he might have answered both questions honestly.

    1) Since she never saw a doctor, she never was a ebola patient. And furthermore, and more to the point, he hadn’t cared for her, just helped carry her once or twice. That’s not caring for a patient, or sick person.

    2) He never touched her after she died.

    So where is the LIE?

    Sammy Finkelman (0a978b)

  39. 38. Try 2 this time formatted correctly:

    Binyah Kesselly, chairman of the board of directors of the Liberia Airport Authority, said Duncan had answered “no” to a question asking whether he had cared for an Ebola patient or touched the body of anyone who had died in an Ebola-affected area.

    If that was the wording of the questions, he might have answered both questions honestly.

    1) Since she never saw a doctor, she never was a ebola patient. And furthermore, and more to the point, he hadn’t cared for her, just helped carry her once or twice. That’s not caring for a patient, or sick person.

    2) He never touched her after she died.

    So where is the LIE?

    Sammy Finkelman (0a978b)

  40. 30. http://iai.asm.org/content/73/11/7422.long

    There is nothinng there about Type AB blood The news there is:

    Additionally, we made the new observation that individuals in Bangladesh with blood group O are protected from infection with V. cholerae O1, despite the increased severity of disease once infected.

    They don’t seem to have an explanation for it, other than that severity of disease and getting infected in the first place are two different things.

    They don’t seem to have any good ideas as to why people with Type O blood, who get a more severe disease, should be less likely to get it in the first place!!

    I thought of an answer:

    Since they lack protection from the consequences of the disease, selection will work to favor genes that prevent infection much more so than for people with other types of blood.

    And this is India, which has and had a caste system, with many sub-castes, so there would be sub-populations with extremely high Type O blood percentages who wouldn’t mix with other people who did not have Type O blood.

    Sammy Finkelman (efc0ed)

  41. I’m only grading for effort here. It’s a brave new world now.

    Dustin (2c6c8b) — 10/2/2014 @ 10:53 pm

    Ah, yes, Common Core.

    Bill H (f9e4cd)

  42. 8. Seriously, Sam, it is evident to everyone you have no formal training in science whatsoever.

    You are completely lost.

    gary gulrud (46ca75)

  43. > Besides who needs it? (whatever they could develop.)

    The question wasn’t “who needs it”, the question was “who would pay for it?”

    As long as the disease remained a highly exotic unusual disease which popped up every decade or so in poor African villages, a company putting money into developing a vaccine or treatment would be at high risk of losing money on the project because the prospective customers couldn’t repay the development costs.

    aphrael (af3e66)

  44. Just more evidence that this is the most transparent Administration in history.

    Joe (33fd9a)

  45. in regards to:
    http://news.yahoo.com/texas-hospital-reveals-how-ebola-patient-was-missed-032028517.html

    From Kevin M (b357ee) — 10/2/2014 @ 9:38 pm
    So WHY WOULD HE LIE when he got to the US hospital?

    I actually addressed this already more than once, but there have been many posts on several threads so it could have been missed.
    People may have reasons for everything they do, that may even have a train of “logic” given various presuppositions and emotional factors, but that does not make what we do to be always “rational”.
    Fear is a great motivator and leads to denial. It would be perfectly possible for someone to go to a doctor with a specific concern in mind, “Do I have cancer?”, “Do I have AIDS?”, “Do I have Ebola?”, but never mention it to the doctor. Apparently the idea/hope is that if the doctor can’t “figure it out own his/her own”, then maybe they don’t really have it after all and are just worrying too much.
    From one perspective it is irrational and crazy, if you’re sick, find out sooner than later if something can be done, but if the person is so fearful that they think nothing worthwhile can be done, then they don’t think that way. There was more stigma attached with AIDS early on, but it was common for a person to deny all rick factors but have PCP pneumonia upon evaluation, a telltale finding in AIDS (but also in people on chemo, with leukemia).

    The hospital says he told them everything and they still sent him home. In their defense I imagine they’ve been inundated with everyone with sniffles thinking they have Ebola. Something that will now get worse.

    Apparently the hospital wasn’t told everything, and what they were told, that he had been to West Africa, was entered into part of the electronic medical record that the doctor didn’t see.
    Three things that seem as obvious as night and day that it seems the world routinely ignores:
    1) The interface of computer systems ought to designed by people who use them, not computer experts, not administrators and business consultants
    2) Too often in a “system” people think of “doing there job” as “putting nut A onto bolt B” and do not think of the big picture. The job of people taking care of a patient is to communicate information to each other, not simply fill in boxes on a computerized form and then move on.
    3) People think technology is the answer. Never. Technology is only a tool that can be used.

    I once tried to make a career shift getting involved in computerized medical records, as I had experience trying to make my own for my own unique niche in the world, and thought I had something to offer as an end-user who had thought about the problem, but never found a foothold.

    A few weeks ago I was double billed on my charge card by a lumber yard because they couldn’t manage their computerized billing system. Two days ago it took me 10 minutes to check out of a paint store even though I was the only customer there at the time, again because it took them that long to work their computerized check out procedure. Both trivial compared to missing a case of Ebola, but the same general point.

    MD in Philly (f9371b)

  46. 45. “I once tried to make a career shift getting involved in computerized medical records”.

    Yeah, I kinda sorta tried that too. Probably fell apart before you tho.

    gary gulrud (46ca75)

  47. gary, just think, had they listened to us…
    The health system where my parents have their doc is now toiling with its second system, having given up after who knows how much money on their first.

    MD in Philly (f9371b)

  48. Duncan was actually asked 5 questions on the form. He should have checked off yes to the 4th one:

    Did you stay in a house with or have other casual contact with an ebola patient?

    Now it wasn’t 100% that she had ebola, but it was very very likely.

    There was a follow-up to the 5th question, which asked about care:

    If your answer was yes, did you always use a mask and gloves, an other protection?

    Sammy Finkelman (efc0ed)

  49. MD in Philly, it really bothers me that computerized medical systems have been so unsuccessful. From a *data tracking and aggregating* standpoint, it seems like they’re ideal – they solve a real problem, and they do it well.

    But the implementations have mostly been disastrous. :{

    aphrael (001863)

  50. well, aphrael, they do multiple things wrong

    First of all, as I said, nobody seems to bother to get MD and nurse input on how to structure the interface. You should have the doctors and nurses say, “I want this, this, and this, and then the computer guy makes it happen.
    This should have started by using a tablet interface with double touch, pen digitizer and finger touch capability with a complete MS OS, like Marshfield Clinic in WI did in-house.

    Second, administrators are always totally underestimating the time and effort overhead to implement a system.

    Put gary and me in charge of it and we’ll make it work, for a lot cheaper than many others have charged.

    MD in Philly (f9371b)

  51. The freelance cameraman reporter who has contrated ebola was being discussed here or on one of the other ebola threads. He is an American, son of a doctor from Rhode Island. He is described as a committed devout converted Buddist.

    http://www.nbcnews.com/storyline/ebola-virus-outbreak/committed-nbc-news-freelancer-returned-liberia-despite-ebola-risk-n217791

    elissa (a3eca3)

  52. thanks elissa,
    a little different than the previous report that he had “been in Liberia about 3 years”, but I still think with his previous history there that he probably had travelled “off of the beaten path” compared to the rest of the American crew.

    MD in Philly (f9371b)

  53. aphrael (001863) — 10/3/2014 @ 9:52 am

    Have they been ‘unsuccessful’, or are there untold numbers of ‘libertarian’ techies who have installed they tiniest of flaws in them in seeking to protect the privacy of individuals?

    askeptic (efcf22)

  54. MD in Philly (f9371b) — 10/3/2014 @ 10:02 am

    But, do we really want to be in a world where everyone’s medical data is open to even the simplest hack?
    We created an entire body of law to preserve the patient/doctor confidentiality, and now we’re just going to hand it over to the unchecked Apparat?

    askeptic (efcf22)

  55. askeptic (efcf22) — 10/3/2014 @ 3:01 pm

    perfectly valid question
    In my mind I’m thinking of the utility of a doctor in a practice with limited access to the data, not huge institutions or web based data.
    Now, in an institution there can be safeguards that monitor who accesses a person’s record, and if it is not somebody with a valid reason to, they are caught and tracked down.

    The issue of computerization of a chart for medical care and the issue of access to computer records are two related but different things. I think I’d rather carry a data card in my wallet rather than have my records in “the cloud”.

    HIPPA had nothing to do with the real issues of privacy ion the computer age, it had to do with telling companies and institutions how they could data-mine legally.

    MD in Philly (f9371b)

  56. aphrael (af3e66) — 10/3/2014 @ 4:31 am

    The other reality is that it is very difficult to do research on a pathogen that needs a class 4 containment facility, and human volunteers for vaccine testing.

    Sammy, the error is this, the nurses go into one computer screen and then click into certain screens from there,
    the doctors start out in one computer screen and do one from there,
    to switch back and forth between computer screens is harder for a doc than putting a finger in one part of a paper chart and looking at the nurses notes

    more info can be stored in the computerized chart, but so much so and poorly organized that it is unwieldy.
    gary and I would never have done it that way, never.

    MD in Philly (f9371b)

  57. If you can’t have fun with Ebola, what can you have fun with ?

    UnitedHealthCares (UHC) of Dekalb County has informed hospital officials at Emory University that Ebola patient Dr. Kent Brantley does not meet inpatient criteria. UHC’s commission based claims reviewer, Sven Tweeny, CNA, has recommended 24 hours of observation care instead. “If we paid inpatient for every viral syndrome, we’d run out of money before New Year’s Eve.”

    Mike K (90dfdc)

  58. So a claims reviewer dies and is standing in front of St. Peter. St. Peter opens his book and says, “Oh yes, you’re approved for a three-day stay”. The claim reviewer says, “Three days? What happens after that?” And St. Peter says, “Then you can go to ….”

    nk (dbc370)

  59. “Do not dwell in the past, do not dream of the future, concentrate the mind on the ridding yourself of the goddam Ebola.”

    – Buddha

    Colonel Haiku (2601c0)

  60. He is described as a committed devout converted Buddist.

    what he actually is is a self-absorbed idiot who has not only put his own life in danger, which is his business, but now is jeopardizing dozens, if not more, people who will have deal with the results of his stupidity.

    if it was me, there would be a total embargo on travel from that whole area to the US.

    redc1c4 (abd49e)

  61. anyone got a valid link for #57?

    redc1c4 (abd49e)

  62. Sorry about that. Try this this one.

    The blog is here and doctor humor can be a bit sick, as Milton Wolf learned to his cost this year.

    Mike K (90dfdc)

  63. And now down again to 9, but they are following up to 40 more.

    Sammy Finkelman (31cdef)

  64. MD in Philly (f9371b) — 10/4/2014 @ 10:59 am

    Sammy, the error is this, the nurses go into one computer screen and then click into certain screens from there, the doctors start out in one computer screen and do one from there,
    to switch back and forth between computer screens is harder for a doc than putting a finger in one part of a paper chart and looking at the nurses notes

    But now they say it was in both sets of records.

    So maybe the problem was it wasn’t flagged. Maybe what’s needed is on-the-fly alteration of flagging.

    Incidentally the NYT has the obituary today of the founder of computerized medical recordkeeping. He died at the age of 100 after working for 70 years for Kaiser.

    His birthday was 11/12/13.

    He died of cancer.

    Sammy Finkelman (31cdef)

  65. Some of what’s going on makes as much sense as quarantining the astronauts who came from the moon.

    Sammy Finkelman (31cdef)


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