RANGER AGAINST WAR: Ebola: The Plague II, or, "Don't Panic" <

Saturday, October 11, 2014

Ebola: The Plague II, or, "Don't Panic"

  
[Humans are]
just an advanced breed of monkey
 on a minor planet of a very average star
--Stephen Hawking 

“Were such things here as we do speak about? 
Or have we eaten on the insane root 
That takes the reason prisoner?”
--Macbeth, Shakespeare

apathetic bloody planet,
I've no sympathy at all. 
--Hitchhiker's Guide to the Planet, 
Douglas Adams
_________________

Funny the response to my previous piece on Ebola. Most suggested I calm down my measured and rational argument for full disclosure of medical failures so professionals and the rest of us can formulate a reasonable protocol to address inevitable threats like Ebola. Perhaps this is the human animal soothing itself in the face of a threat. Projection, denial, and all of that.

Most shocking, however, is the blithe way in which medical professionals have confronted those patients demonstrating symptoms who had clearly declared proximity to Ebola -- recently-deceased Texas patient Thomas Eric Duncan and Spanish nurse Teresa Romero Ramos.

Nurse Ramos had contacted health facilities three times with health concerns before being admitted to the hospital with a diagnosis of Ebola, this despite her declaration of having been on the team that treated Ebola missionaries a couple of weeks before the onset of her symptoms.

The Guardian reports,

"On arrival at the hospital, Romera Ramos warned staff that she feared she had contracted Ebola. Despite the warning, she remained in a bed in the emergency room while she waited for her test results. She was separated from other patients only by curtains, hospital staff said on Tuesday."

Romero Ramos was sent home with OTC fever-reducer Paracetemol, much as Mr. Duncan had been sent home with a bottle of antibiotics, this despite his declaration to hospital staff that he had recently traveled from Liberia, an Ebola hot spot.

Houston Chronicle Online ran an opaque Op-Ed regarding Mr. Duncan's treatment, which, without actually saying it, hinted that race may be a factor in terms of treatment received in a hospital ER. I would suggest the problem transcends race, and is possibly lodged at the level of the economic status of the patient, at least here in the States where medicine is big business. Those fortunate enough to possess Cadillac health insurance probably don't have too many worries, people like our Congressmen.

Unfortunately, the rest of us don't look too impressive sniffling in a metropolitan ER. I was one of those people in 2012.

After waiting in the ER for 6 hours with a registered fever of 102 and extreme body stiffness (which meant I had to be delivered to the reception area in a wheelchair) my total care consisted of two Tylenols in a paper cup, delivered only at my friend's inquiry regarding any forthcoming care. The only patient taken back (unescorted by police) was a man across from me who vomited and then keeled over, who was then wheeled into a separate room, and who knows how long he languished there.

As the evening wore on and the ER filled, it became clear that my best bet was to return home and wait until dawn, when I might schedule with my regular doctor. (My insurance was billed $300 for those two Tylenols, and the privilege of sitting in a roomful of very sick people.)

My M.D., a former Navy doctor, failed miserably in his diagnosis. He confidently concluded that I had H1N1 virus -- Bird Flu -- after viewing my presenting symptoms: 102 degree fever, spiking to 105 cyclically (every six hours), extreme shaking (to the point of almost falling off of the examination table) and malaise and heavy feeling in my limbs. To all of this, he smiled: 

 "You have a very strong immune system -- that's what going on here. Your body is trying to fight it. Here's a prescription for Tamiflu. Go to the CDC website and read up on Bird Flu."

Like Charles Eric Duncan, I was dismissed with the wrong prescription, and told to take double the amount of Tylenol recommended, in increments half the suggested dosing time (every 2-3 hours) and to mix that with aspirin, if necessary, as my fever would be high.

I trusted him, even though my symptoms didn't seem to be those of Bird Flu and did not abate; maybe he knew about some local variety. He gave me a paper mask which he instructed me to wear, which inhibited my already labored breathing.

Meanwhile, after the bout of fever in the exam room, I again found myself unable to walk, and waited while the office (housed in a large building of medical practices) found a rickety wheelchair to unceremoniously dump me at the front door while I waited for a ride.

By day three on Tamiflu, the relentless fever spikes every six hours were taking a toll. Never feeling so ill in my life, I called the office and requested an antibiotic, on the gut feeling that this was a bacterial infection. The doctor never returned my call.

There is more, but the upshot is: this was a bacterial infection which had gone blood-borne -- not Bird Flu. On the fifth day of suffering after his misdiagnosis and my demanding simple tests (at the behest of a friend) which revealed the infection, he then prescribed the most powerful antibiotic available short of the intravenous route; the fever began to recede soon thereafter. Recovery took months.

"I don't like to prescribe anitbiotics, but when I do, I go big," he proudly stated.

I was fortunate; I survived. The doctor later sent me a registered letter saying that he recognized I had lost faith in him, and that he was resigning as my physician. 

Looking back shocks me anew. If this were Bird Flu, should my case not have been reported to some CDC database? Should I not have been hospitalized? How could putting a paper mask on my mouth have prevented any infection from spreading at that point? The entire scenario is horribly absurd to contemplate. In retrospect, the high fever and extreme malaise robbed me of the ability to be logical, against a doctor who was not. 

That is an example of healthcare in America. There are other such bad stories, but few successes. Practicing medicine follows the bell curve, as do most endeavors. The bell hits the mark frequently enough -- or the body heals on its own with or despite palliative measures --and when they are wrong, they try again (or the patient dies.) The thin tails are inhabited by practitioners who will kill you outright or heal you.

On the basis of what I have read and my own experiences, I do fear for our ability to confront any full-fledged epidemic.

If such an eventuality occurs, the fortunate few among us may be left to follow Giovanni Boccaccio's advice in his The Decameron. The pastorale recalls the experiences of a mythical group of wealthy Italians who escaped into nature to avoid contact with the Black Death which was then ravaging mid-14th century Europe. It is a primitive answer to a rather grim prospect.

Now you may call me alarmist, but based on current medical practice, if a plague were to come, the tack of Boccaccio's privileged in the face of doctors practicing medicine may look like a good option.
_________________________

UPDATE (NYT, 28 OCT 2014):


Officials have emphasized that there is no risk of transmission from people who have been exposed to the virus but are not yet showing symptoms. Ebola spreads through direct contact with bodily fluids. A cough from a sick person could infect someone who has been sprayed with saliva. Specialists at Emory University Hospital in Atlanta have also found that the virus is present on a patient’s skin after symptoms develop, underlining how contagious the disease is once symptoms set in.
According to the C.D.C., the virus can survive for a few hours on dry surfaces like doorknobs and countertops and can survive for several days in puddles or other collections of body fluid. Bleach solutions can kill it.

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5 Comments:

Anonymous Anonymous said...

well, since your last ebola post we now have 1 dead in the US and at least one case contracted in the US ( a healthcare worker that attended the dead guy).

It seems that today someone with a history of travel to Liberia has presented with symptoms in Boston. So here we go?

I have thinking, the US really hasn't been presented with an immediate threat in years. The government has been able to enjoy the facade of being in charge because nothing has challenged the facade - the economy, sure, but it's complicated and lots of buck passing, finger pointing and phony statistics obfuscates the lack of leadership. The exception was Katrina and look how that went.

Now we have two immediate threats where success - or failure - to meet the challenge will be obvious and buck passing won't work. 1. Ebola 2. ISIS. Already it is clear that Washington it much like a chicken with its head cut off with regards to both.

No one is in charge of anything and no one knows what they're doing, despite all the tax dollars we poor into the beast. The sham will be exposed.

avedis

Sunday, October 12, 2014 at 4:53:00 PM GMT-5  
Anonymous Anonymous said...

Meanwhile, they've nearly defeated Ebola in Nigeria:
http://www.independent.co.uk/life-style/health-and-families/health-news/ebola-outbreak-nigeria-a-week-away-from-beating-virus-9794269.html
--bks

Tuesday, October 14, 2014 at 10:13:00 AM GMT-5  
Blogger Lisa said...

bks,

I don't know who pays you to try and stupidify Americans with your rosy outlook, but your half-truths constitute a whole lie. Now that your zero-for-zero card won't work, you've shifted tack.


From today's news:


[T]he World Health Organization projected that West Africa could see up to 10,000 new Ebola cases a week within two months and confirmed the death rate in the current outbreak has risen to 70 percent.

Dr. Gives Blood for Ebola Infected Nurse

That is how you define an epidemic.

Tuesday, October 14, 2014 at 4:41:00 PM GMT-5  
Anonymous Anonymous said...

Another Dallas healthcare worker has tested positive for Ebola (as of this morning).

BTW, Lisa your story of the less than stellar interaction with the healthcare system is appalling, but all to typical.

We in the insurance biz are implementing a more robust pay for performance (PforP) program across most of our products. We create metrics that tease out the quality and efficiency of care, based on claims, and provider (physicians, hospitals, clinics) reimbursement is on a carrots and sticks platform based on what the claims data is telling us. We want members of our plan to be treated well/treated right because we believe that not only develops loyalty to us and our networks, but saves costs in the long wrong.

So based on your diagnoses, we better see the right treatments and we better not see re-admissions, wasteful procedures, worsening conditions, etc. where those are clinically avoidable.

It's not perfect by a long shot, but we're trying.

cheers!

avedis

Wednesday, October 15, 2014 at 9:15:00 AM GMT-5  
Blogger Lisa said...

Thank you for your sympathy, avedis. It was one of the more appalling experiences I've had with healthcare in the U.S.

It sounds like the work you do can help make a positive difference, so you can feel good about that.

Wednesday, October 15, 2014 at 7:21:00 PM GMT-5  

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