Monday, October 27, 2014

Ebola, quarantine, and medical staffing

I find it interesting (not to mention depressing) that the most accurate, insightful and helpful comments on the current situation w.r.t. Ebola come from individual doctors and medical professionals, not from the CDC or hospitals or politicians or anyone else involved in supposedly "managing" the crisis.

There's an excellent and insightful commentary on the quarantine question by a veterinary surgeon.  Here's an excerpt.

The United States (and virtually all other countries) require a myriad of tests and often quarantine prior to bringing in a foreign animal.

I can’t legally cross state lines in the United States with a horse or cow without a health certificate signed by a USDA accredited veterinarian stating that the animal has been inspected and found free of infectious disease. In most cases blood tests are also required.

. . .

If I am a resident of Liberia incubating Ebola, to enter the United States all I need to do is present a valid visa, and lie when asked if I have been exposed to Ebola. Within hours (no quarantine required) I can be walking the streets of any city in the United States.

I feel very fortunate to live in a country that values our animals so highly.

There's more at the link.  Go read it all - then ask yourself why the authorities are willing to make animal owners jump through such regulatory hoops, but not potential carriers of Ebola.  Makes you think, doesn't it?

Then there's the question of whether or not medical staff are willing to put their lives on the line to care for Ebola patients if things get out of hand.  That's a serious question.  Dr. Louis M. Profeta is an emergency room (ER) physician in Indianapolis, and author of the book 'The Patient in Room Nine Says He's God' (which I highly recommend).  Here's what he had to say about that recently.

If an investigator for Joint Commissions or some other oversight agency, a member of the press or a committee trying to ensure CDC compliance were to pull me aside to spot check my Ebola acumen, they’d be satisfied with my answers and I’d leave them feeling like they had done due diligence as an administrator.

“Dr. Profeta, do we have enough protective stuff and does everyone know how to use it?”
“Are the screening plans in place?”
“Yeah, ya betcha.”
“Is the staff versed in transmission and spread of Ebola?”
“Darn tooten.”
“Has everyone read all the CDC and hospital communiqués regarding Ebola?”
“Sure have.”
“Have you practiced the drills in the ER in case we have someone show up with a possible exposure?”
“More times than Lois Lerner has hit her hard drive with a hammer.”

But if they were to ask me if there are any other issues they should be aware of, I’ll just stare with round blank eyes and keep my mouth shut until the right question is asked; the question they will pretend does not exist.

“Dr. Profeta, will they – the staff, you, your partners – show up? “
“That, I don’t know.”

. . .

Simply put, some of us in the trenches in damn near every ER in America will almost certainly die. It could be me, it could be any one of my partners, colleagues and co-workers and it could be one of our children or a spouse who gets infected when one of us comes home thinking the headache and fatigue they are feeling is simply exhaustion from the workload of the day. Can you picture it?

Now imagine that huge numbers of hospital staff – from doctors to housekeepers, from food services to registration, from security and parking to transportation will decide not show up. They will call in sick or simply just say: “No, I’m not coming to work today.” In just a few days, human waste, debris, soiled linens, the sick, the dying and the bodies will pile up. We will be overwhelmed and unable to offer much in the way of assistance because the labor-intensive protocols that allow us to safely care for even one patient are just too exhausting. These procedures are barely repeatable more than once or twice of day, and fraught with so many steps and potential for mistake that it becomes too physically and emotionally taxing for the staff to do … so they simply wont show up.

And I am not sure I will, either.

I love emergency medicine. I love helping people and saving lives and I think I’m pretty good at it, but I am also a person and I have a wife and three children that I love and want to see grow up.

Again, more at the link, and well worth your time to read in full.

Aesop, author of the Raconteur Report and Shepherd of the Gurneys blogs (whom we've met in these pages before), has already taken extended leave of absence from his job in the ER in a Texas hospital.  I don't blame him.  Today he crunched the numbers on the Ebola situation, and also discussed the lack of quarantine and the medical staffing situation if Ebola gets out of hand.  He shares Dr. Profeta's perspective (albeit somewhat more profanely).

... if we keep juggling the lit road flares while standing in the gasoline-filled wading pool, we're going to get another imported Index Patient here who infects 10 or 20 people, and quietly expires in his flophouse without running to the ER, because he can't, or won't. And those people are going to float around thinking they have the flu, because flu season, and they won't be African, or have made any recent African journeys, and they'll get the Duncan Protocol.

So when, two-eight days later they come back in, bleeding out of everywhere from their eyes to their asses, all the shit-eating grins at CDC, the White House, and the hairdo news programs won't help them, or you, or anyone else. There won't be any BL4 beds for 10 or 20 people, because we don't have them. There won't be any isolation at the local hospital.

And the smart people who work there will GTFO, because they're not all the same dumbshits as Doctor Ebolawalker Spencer, or Nurse Typhoid Mary Hickox. So they'll clock out, and the people left behind will be the least bright, not the most bright. Every occupation has that ten percent at the bottom of the gene pool, including healthcare. Just ask a malpractice attorney.

The administrators and spokesholes who've lied to everyone about "handling this problem" won't have anything to point to that explains how they can take care of people when their clinical staff elects to say "Hell no" and heads for the employee parking lot. (And if you think there's going to be loyalty to those institutions after the last few years of belt-tightening and having ObamaCare shoved down their throats, let me offer you a dose of reality: they're going to trample people on the way to their cars, and with smiles on their faces.)

More at the link.

Color me unhappy.  Extremely.



Rev. Paul said...

"And if you think there's going to be loyalty to those institutions after the last few years of belt-tightening and having ObamaCare shoved down their throats, let me offer you a dose of reality: they're going to trample people on the way to their cars, and with smiles on their faces."

Yeah, that. I manage a building full of doctors and nurses, and - you can trust me on this - he's exactly on the money. They're all about done.

Anonymous said...

Well said. We can't cross fruit or anything with a seed across the Mexican / U.S. border, but the person coming across with a I.D. - no problem!

That vet isn't exaggerating - we have a tick and fruit fly quarantine requiring the paperwork listed above.

dave said...

While I understand your point, there's a distinction between animals (and fruit) and humans that is critical to the discussion: people have rights.

Imposing a quarantine is a significant infringement upon one's liberty, and the sort of thing that requires due process of law. I understand the public health need to keep sick people from spreading infection, but there's a certain balancing that must be done to prevent the government from effectively imprisoning people arbitrarily.

Eric Wilner said...

Dave @ 12:04: partly agree. Of note, though: foreign nationals, as a rule, do not have the right to come to the U.S.
As for U.S. nationals, well: medical quarantine is one of those regrettably necessary powers of government. Alas, it's also one which may be readily abused, and has been, in sundry times and places. Now, if only we could trust our government not to abuse this power, nor to exercise it in a fickle way... yeah. Lotsa luck with that.

JohninMd.(HELP?!??) said...

Three points to remember - 1.) governments always lie; 2.) Complex systems fail under stress (health care); 3.) YOYO Your On Your Own. Better to have food and water for 30 days for all hands, plus means of defence, and hole up; self quarantine if epidemic occurs to stay AWAY from disease.

Anonymous said...

Yes. Well said. Particularly the article by the Veterinarian.

I am so sick of being told by 'our' government that we are 'panicked' that we are 'scared'. Basically that we are whiney little children.

WE ARE ANGRY. I AM ANGRY at the incompetence shown by not only the politicians but by the CDC (in fact, actually a political body).

Sigh... I don't want Ebola. I am not, however 'scared'. That seems to be the reaction that most of the people I've spoken with have.

Fair Winds,

Cap'n Jan