Friday, October 3, 2014

Incompetence in Disease Management


I've been following the Ebola fiasco. It would be a comedy of errors if it were not so deadly serious.

As I understand the story, infected patient Duncan visited a Dallas ER where he was mis-diagnosed and sent home with antibiotics because the hospital's automated workflow process disallowed doctors from seeing nurses' patient notes, including travel details. Apparently face-to-face communication is unlikely between doctors and nurses, even on the most important of patient matters, such as travel to Liberia during an Ebola outbreak.

Who knows how long he sat in the emergency room. Sitting in close proximity to someone with the disease has been found in some circumstances to be enough contact for disease transmission.

Two days later Duncan heads back to the ER in an ambulance after vomiting outside the apartment complex.

During the second visit, he was diagnosed with Ebola and isolated. Its not clear how long he sat in the ER waiting room.

Meanwhile, no health authorities are willing to enter the apartment Duncan was staying in to remove potentially contaminated bedding, increasing the likelihood that Duncan's relatives will contract the disease:
Delay in Dallas Ebola Cleanup as Workers Balk at Task. The New York Times http://www.nytimes.com/2014/10/03/us/dallas-ebola-case-thomas-duncan-contacts.html?emc=edit_th_20141003&nl=todaysheadlines&nlid=32962000&_r=0

[Excerpted] The officials said it had been difficult to find a contractor willing to enter the apartment to clean it and remove bedding and clothes, which they said had been bagged in plastic. They said they now had hired a firm that would do the work soon....

....The delay came amid reports that as many as 100 people could have had contact with the victim, Thomas E. Duncan. And it came a day after the hospital acknowledged it had misdiagnosed him when he first visited....
Anyone who has spent time in a hospital emergency room will not be surprised. ERs are chronically understaffed by well-intentioned (under the best of conditions), but almost always harried health workers. I personally have had all kinds of problems in ERs, including having typhoid diagnosed as "gas" despite me telling the hospital I was diagnosed with typhoid in Indonesia (normalcy bias plus plain old sexism and arrogance). The hospital was in Scottsdale AZ (but it was not Shae north).

Handling of the Duncan case reveals gross incapacity to deal with sudden and severe health risks.

It is unlikely that Ebola will spread in the US as in Africa because of important differences in climate, cultural practices, sanitation, and population density.

That said, I am truly concerned about the potential impact of mutating viruses after widespread fallout in the US from the Fukushima disaster.

Data from actual fallout samples indicate that the Fukushima produced a plume of cesium that was two to three MAGNITUDES higher GLOBALLY than the background levels caused by routine emissions, atmospheric testing, Chernobyl, etc:
Masson, et al (2011) Tracking of Airborne Radionuclides from the Damaged Fukushima Dai-Ichi Nuclear Reactors by European Networks. Environ. Sci. Technol, 45 (18), 7670−7677.

I cringe to think how high contamination levels must be in north east Japan and, to a lesser extent, in US and Canada, especially on the west coast through Colorado in areas west of mountains. The mountains trap radionuclides and other particulates, as I've documented in my 2011, 2012, and 2013 analyses of Radnet data. [I no longer look at the charts because I don't trust Radnet to post raw data given their documented tendency to withhold data for beta spikes]

I know from the US Geological Survey data that areas of the US had contamination levels that exceeded the IAEA's standard of contamination.

Viruses, as everyone knows, MUTATE and radiation increases the rate of mutation. I checked with a friend who is a microbiologist and yes, more mutations increases the likelihood of a more virulent variety. This should be obvious but some people contest it, no doubt for political reasons.

What scares me about the Ebola crisis is that the northern hemisphere is radioactively "hot" right now and many people may have reduced immunity because of bio-accumulation of radionuclides, among other toxins, coupled with ongoing atmospheric exposures.

We have already seen in the US unusual viral mutation in the form of Enterovirus 68. The enterovirus has caused severe respiratory distress for children across the US yet scientists don't understand why this usually innocuous virus is creating so much severe illness:
Outbreak of a Respiratory Illness Escalates Among Children and Mystifies Scientists http://www.nytimes.com/2014/09/26/health/outbreak-of-a-respiratory-illness-escalates-among-children.html?emc=edit_th_20140926&nl=todaysheadlines&nlid=32962000&_r=
I recommend that you read a "Question and Answer" session published by The New York Times with Rafal Tokarz of the Center for Infection and Immunity at the Mailman School of Public Health at Columbia University. Dr. Tokarz is an enterovirus expert:

Enterovirus 68: What You Need to Know. (2014, October 2) The New York Times. 
http://well.blogs.nytimes.com/2014/10/02/enterovirus-68-what-you-need-to-know/

Q. Until recently a lot of people had never heard of enterovirus 68. Is this outbreak — or the scope of it — unusual?
A.  I think the most surprising aspect of it is how severe it is, particularly the symptoms in kids. Because that hasn’t really been seen before.

Q. What is different about the symptoms seen in this outbreak compared to previous clusters?
A.  In most cases it manifests itself as a cold or maybe a mild case of the flu, and it probably got diagnosed as such. I believe in a lot of cases it’s still no different than a severe cold or the flu, even during this outbreak. But in certain individuals the symptoms are more severe, and that hasn’t been seen before....

Q.Why is this outbreak so different than others? Is the virus evolving?
A.  Absolutely. It is evolving. A hypothesis of mine is that the strain that’s circulating now probably is a novel variant. It may have mutated into something that’s more easily transmissible and more pathogenic. The virus is mutating, and there are a lot of different variants circulating around the globe....

The virus is mutating and many variants circulate. We are increasing their rate of mutation while we simultaneously undermine our biological and social capacities for responding.

It really is time for a gestalt shift away from our current path or we will not be around much longer.

P.S. Fukushima emissions were quite visible over the last two days, as illustrated by screenshots from yesterday:



7 comments:

  1. Excellent matter. Confirms my hunches. Now for the present my search for info ends! I have myself experienced infection (probably due to accidental dropping of rice on the floor which I immediately picked up and continued with lunch(I will not repeat this one off instance agine) or ear infection caused by removing suspected wax by fingers) and with cough and cold so resistant just weeks ago that I opted for an antibiotic (I am an anti antibiotic tick!) and cured myself(thru a physician of course). So far AFTABS, the homeopathic drug for antiflu- had worked miracles till this event. Thanks for writing about the aggravating of virus problems by the Fukushima connection. Yes docs are unable to diagnose and they grope in the dark trying various routes! Lucky people I know have responded and are alive. Your blog brings out into the open again the possibility of a billion infant mortalities for India alone due to Fukushima-23 million due to nuclear activities till 1989 from 1945.

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  2. It is my belief that the enterovirus 68 epidemic is the first major wave of radiation-caused illness in the US and Canada. Enteroviruses, herpes viruses, and Epstein-Barr viruses tend to suppress cellular immunity, and the body requires a robust immune response to clear them out. Radioactive contamination of the body suppresses this immune response. These infections are causing polio-like paralysis and neurological symptoms in many children, and many will develop neurological and connective tissue diseases like transverse myelitis, acute disseminated encephalomyelitis, multiple sclerosis, systemic sclerosis, and especially myalgic encephalomyelitis which will occur at a rate greater than the rest of these diseases put together.

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    1. I wouldn't be at all surprised if this were true....

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  3. America is more penetrated by incompetence than we can easily imagine. If we did have an epidemic now it would only be after many deaths that people would wake up and do the practical things.

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  4. Washington Post reported that 5 days later family finally moved out of contaminated apartment. They should have been moved immediately.
    http://www.washingtonpost.com/national/health-science/dallas-home-cleared-of-items-used-by-ebola-patient-who-arrived-from-liberia/2014/10/03/f4f3a184-4b42-11e4-a046-120a8a855cca_story.html?wpisrc=nl-headlines&wpmm=1


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  5. Majia -- I watch the Fuku cams daily and thought you'd be interested that on the Futaba Cams, if you change the last 3 numbers you get a different camera view each time. Of course I don't know where they are all at but it's very interesting to look at the area around Futaba. The observation point I usually look at is 173 but try 175 to get a view of traffic or 183 view -- very interesting. Most of them pan around if you wait. Have fun!

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    1. Thank you very much for the tip. I'll check it out!

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