Valued commenter Loneoak has a front-page post up at TPM that shares a front-line perspective on medical crisis preparedness:
I have a perspective tying together today’s big news brouhahas. My wife is an ER nurse at a major urban hospital owned by the Hospital Corporation of America, the hospital chain once run by Rick Scott. It’s the largest for-profit medical system in the world, and is of course also notable for its ‘creative billing’ practices in the largest Medicare fraud settlement in history. Scott was booted from the CEO position following that fraud investigation, so he’s not directly responsible for current conditions in those hospitals.
But it is obvious to those who work there that the combination of lax training and toxic labor relations ‘leaders’ like him have brought to the company are emblematic of a big problem for US hospitals if a major outbreak of ebola or other infectious disease occurs. My wife’s ER has an ‘ebola cart’ with some lightweight protective gear and written instructions for putting on a PPE, but the instructions are a loose bundle of papers and the pictures don’t match the gear in the cart and has inaccuracies that put them at serious risk. It’s an object of gallows humor for the staff. That’s the totality of their training or preparedness so far. As we all now know, PPEs are not easy to put on and take off correctly. Even though nurses all have experience with standard droplet control (they see TB and HIV all the time), ebola is a special case. They have gone months and months without a nurse education director because no one wants to deal with their management and take the position. Her coworkers are clear that they will refuse to treat an ebola patient because they have woefully inadequate training in the correct procedures and lack proper gear.
And yet the head of infectious disease at this hospital went on the local news to proclaim the hospital was ready to receive ebola patients safely. They obviously didn’t bother to speak to a single nurse on the front lines. I’m not particularly panic-y about ebola, even though obviously the family members of ER personnel have a lot at stake in ebola preparedness. But I think that this situation will be the weak link in any major national response. So many of our hospitals are run by lunatics like Rick Scott who seek only the highest profit margin. They do not invest in training, they build charting mechanisms that are good for billing but not treating patients, they constantly fight with their unionized employees, they lie to the public, etc, etc. We like to imagine that competent, highly-skilled medical institutions like Emory will save us, but we have way more Dallas Presbyterians in this country than we have Emorys. You can see exactly this managerial incompetence—and toxic labor relations—woven through the statement released by the nurses at Dallas Presbyterian today. Also see the head of National Nurses United on All In With Chris Hayes for a similar perspective.
To put it bluntly: we’ve entrusted our national medical system to the managerial competence and goodwill of the Rick Scotts of the world, and that is much scarier than a podium fan.
Emphasis mine, where Loneoak nails the crux of the problem. Rapacious knaves like Scott and like-minded armies of MBAs have hollowed out our national institutions across the board. As alarming as it is to get a glimpse of the true state of our “first world” healthcare system, that just scratches the surface of the rot.
We all had a ringside seat when the geniuses who run our financial institutions were revealed to be bumbling thieves several years ago. And before that, we were treated to the sight of our political class wielding the world’s most fearsome military like a brain-damaged spider monkey with an AK-47.
One of my great-uncles, a World War II vet, public health official and endlessly curious and intelligent man, surprised my then-high school kid self by telling me that this country was on the express bus to Banana Republicanstan back when Reagan was sworn in.
By god, you were right, Uncle Billy. You were right.
ice weasel
So well said.
SatanicPanic
Nonsense, everyone knows we have the best healthcare system in the world. Or we did, until Obama broke it.
Loneoak
Here are the links that got cut out:
National Nurses United statement.
Head of NNU on Chris Hayes. I really appreciated Hayes’ concluding statement: sometimes the employees know best.
Mnemosyne
I think Ella in New Mexico and I were violently agreeing on this same point yesterday — the US could have a great Ebola response because we have the knowledge and we have the educated personnel, but no hospital administrator wants to spend the money it would take for nurses, pathologists, and orderlies (to do the cleaning/incinerating), much less spend the money on training and supplies.
There is a woman in West Africa who built her own Ebola protection suit from garbage bags and rubber gloves — maybe our hospital staffs need to download her instructions to try and protect themselves, because their hospital administrators sure as shit aren’t going to do it until we’re in a full-blown epidemic. If then.
Violet
Really great piece. Thanks for writing it, loanoak. And thanks for FPing it, Betty. At some point I really hope people figure out that cutting funds everywhere and making 1%ers richer doesn’t make things better for the majority of people. I know, I’m living in la la land.
Loneoak
@Mnemosyne:
Yeah, I followed your conversation and chimed in very late on it. In total agreement with you two. Ella’s story was almost identical to my wife’s, which is part of what prompted me to write it.
And seriously, watch that Chris Hayes segment.
Betty Cracker
@Loneoak: Links added. Thanks — for writing it, and also for permission to repost! Many of my relatives are nurses, and I’m hearing similar rumblings from them.
Mr.Twister
I’m beginning to think we live in a third world country.
WereBear
It’s all fun and games until
someone goes home with Ebola.
Loneoak
One concrete example of the buffoonery that puts them at risk is the recommendation that they use medical tape to secure their gloves to their wrists. But *medical tape is permeable*. Duct tape would be wiser.
So imagine changing an adult diaper full of incredibly infectious bloody diarrhea with permeable tape protecting your wrists. And then ask yourselves how much training you would need to get out of your gear correctly. And then imagine the room full of infectious materials that the hospital management can’t figure out how to incinerate. And then imagine a physician or hospital CEO doing that work … lol.
Honestly, I’m not paranoid about this and there is a really slim chance of an outbreak. But the 1%ers that run our medical system are going to chew through nurses and their families if it happens.
d58826
Silliness and panic are running neck and neck. On the panic side Obama has authorized the use of the National Guard if need be. On the silly side after a long meeting the Dallas commissioners have decided not to invoke a state of emergency to deal with the now departed epidemic of Ebola. And where silliness intersects with panic two schools have been closed in Ohio because a parent may have been in the same areas the second nurse.
And Betty I think your Uncle was wrong, no self-respecting banana would want to be caught in the company of what this country has become.
pluege
the fatal fallacy in the devolution of “the American system” is that its central and inviolable tenant is that everything, and I do mean EVERYTHING can be distilled to a profit motive. Hence education, prisons, healthcare, justice, and everything else in which success SHOULD measured in something other than money is gutted so the 1% can make money providing values-based services.
Shorter modern republican/conservative American value system: Money is everything.
Trollhattan
Sobering, that, Have gone through HAZWOPER training and refreshers and the comments on proper donning, use and removal and disposal of PPE are spot on. It’s incredibly important to have training with the actual gear, staging and decon areas, and personnel to run both. For anybody working with active ebola patients it will be surprisingly easy to screw up and expose yourself–or for somebody else to do it for you–if you do not follow protocols from the moment you enter until you are physically off the premises. You have to do each thing correctly every time and there are no mulligans.
Violet
@Loneoak:
Can we also imagine Dick Cheney doing that work? I think I might need a cigarette.
balconesfault
It should never be forgotten – every time some system fails, this creates huge profit opportunities for certain large corporations.
JPL
One of thing that was mentioned today during the House hearing on Ebola, was restricting the dogs coming from Africa. I’m not sure how many dogs come from Africa a day, but I’d be willing it’s a small number.
Gindy51
@Loneoak: But the 1%ers that run our medical system are going to chew through nurses and their families if it happens.
I don’t know about that. I can easily see whole nursing staffs just leaving to protect their own families. What do they have to lose? A job? Screw that when you could be killing your own family by going to work.
JPL
There is not doubt that nurses need to be properly trained. The two nurses followed the protocol that they were told. They were also told that if they followed proper protocol, they were not at risk.
Health care workers are on the front line and we as a nation need to appreciate what they do.
Mnemosyne
@Trollhattan:
Well, you can’t have them train with the actual equipment they would be using — that stuff is expensive!
/hospital beancounter
Jude
I’m sure Cole can show up and tell us all again about how one nurse should be arrested for the whole problem.
SatanicPanic
@JPL: I was going to make a joke about how the right made a big deal about Obama allegedly eating dog while he was a child in Indonesia, but then I became depressed with myself for knowing that and I just can’t do it.
SWMBO
Please, please, please Baby Jeebus, could you make sure the Kochs get ebola and have to go to some libertarian hospital with minimal regulation? I would give up asking for a unicorn for Christmas if you would do this…
Corner Stone
@Jude:
I wish I could bet on when he’s going to issue a contrite apology for that stupid bullshit.
Somebody put up a clock!
The Dangerman
@d58826:
How does that work? There’s, what, a 3 week incubation period for Ebola? Are they really going to close schools for 3 weeks to be 100% sure? As it is, they can be 99.99999999% sure that there could be no transmission.
Also, since it appears that the nurses involved were treating Duncan for at least 2 days without adequate protection, some Hospital Bureaucrats need to answer for what appears to be reckless endangerment.
greennotGreen
I work in the research arm of a teaching medical center, and I have also been a patient here. I DO have faith in my medical center to correctly handle an Ebola patient or any other highly infectious case in which the mode of transmission is known because our nurses are awesome. In general, the doctors and all frontline staff care deeply about their mission and would work really hard to do everything right. Our hospital has in place procedures in which any time a chemo drug is administered IV there are two nurses present, one to check the other. I have never seen anything other than the most efficient and professional behavior from them.
That being said, mistakes do happen, but I would expect them to be rare and any slip-up monitored. Of course, we are not-for-profit, so that may make all the difference.
Violet
@JPL: @SatanicPanic: Well I was going to make a worse comment about thinly veiled racism: dogs = black Africans. Didn’t see the hearing but figured if it was a hearing in the House that there’d be plenty of dog whistling (see what I did there!) from Republicans.
Corner Stone
No! Oh NO! Somehow this is all some poor nurses fault!
She was exposed because her hospital doesn’t give a shit about her.
She was exposed because her employer cares more about bottom line pennies than it does human life.
She was exposed because beancounters run the provision of healthcare in this country.
Let’s regrip, people. Nationalize healthcare, just like all the damn dirty hippies have been saying.
Corner Stone
@JPL:
The wingnut asked about dogs eating the feces of infected dogs. Then asked the CDC Director if we knew anything about dogs transmitting Ebola.
No, I’m not sure how I watched any of it.
JPL
@Violet: It does give dog whistles new meaning. The hearing would be what you would expect. Don’t let folks from the infected area in our country. Seal the border because you know ebola is coming across.
The scary border stuff is odd because 9/11 didn’t happen because of porous borders.
@Corner Stone: Hopefully Cole sees your comment.
JPL
@Corner Stone: I didn’t know that african dogs arriving on our soil for freedom were a problem, until that hearing.
MomSense
Just noticed a headline on huffington puffington that 27% of Americans fear Ebola as a major threat.
The Dangerman
I’ll pinch hit for Cole (batter up!)…
…the nurse really shouldn’t have been traveling by plane (either outbound or inbound). Doesn’t matter what some (I presume former) CDC staffer might have told her on her inbound leg.
Yes, she was the victim of the Hospitals mistakes … but she compounded it.
Loneoak
@greennotGreen:
I have a lot more faith in research and/or university hospitals. Even some for-profit systems are great. I even have faith in my wife’s hospital if the nurses are in charge and have the right tools.
Botsplainer
@Corner Stone:
He should’ve declined the honor with a short letter release stating “fuck off, you useless fucks. I have real stuff to fucking do. Like fight Ebola.”
Origuy
The nurse in Spain who had Ebola had a dog which was killed by the authorities. Why they didn’t quarantine it to see if it could be contagious, I don’t know. It seems like a good opportunity to find out if dogs can get Ebola.
Trollhattan
@Mnemosyne:
Oww, ya got me! [clutches chest, keels ovah from shattered budget.]
Got morbid humor from standing in a kiddie pool (princess themes are nice) while being hosed down with decon solution.
Anoniminous
@JPL:
There is no evidence whatsoever of dogs contracting Ebola. It is highly unlikely they can even contract Ebola.
Jesus Christ, what WILL it take to get these idiots to read a High School Biology textbook?
Edited to direct comment to proper person.
Elie
So, all agreement on the evils of corporate health care aside, what is to be done?
Realistically, if the epidemic in Africa is not stopped, we will have other cases here and Lord knows where they will show up. Remember, flu season is just starting.
Don’t know about you, but LoneOak, your wife and her compadres in the ER should perhaps come up with a better suit than what they have based on the premise that they are going to be at full on risk some day. The other option is to strike — walk off until they get the satisfactory changes (PPE,training, equipment) to do their jobs to save themselves and their patients. There is no other choice. Just passively sitting and bitching about corporate healthcare but not doing anything is not going to give us anything or solve anything.. they, their families, patients and community will remain extremely vulnerable. Since they are in the situation now, it has to be on them to get the wheels going.
If someone has some other solution, I am all ears. We can’t observe this sort of dangerous deficiency and not act to correct it.
Corner Stone
@JPL: He’d rather yell at someone who was just doing her best and trying to live her life, instead of turning off all the lights and hiding under her blankie.
From what we know, she asked questions and told people she needed help to understand what was going on.
The fact of the matter is if that hospital had put Duncan in isolation and put every care giver in actual gear, neither of these people would be sick right now.
Don’t fucking tell me she’s going to die naked mopping or walking a dog on an icy sidewalk or some shit, even if she survives this infection. She’s NOT THE PROBLEM. Asshole.
Southern Beale
HCA is notorious for dicking people around on their billing, too. I was forced to go there for an annual mammo and to deal with them calling me “inviting” me to pay upfront, even though it’s covered by my insurance. About a month later I talked to a neighbor who went to the same place for a colonoscopy and had the same thing happen. It’s all about the money with those people. I refuse to go to another HCA hospital. Here in Nashville our options are HCA, the damn Catholics, or Vanderbilt. Vanderbilt has its own problems, though.
Trollhattan
@JPL:
They’ve had jetpacks nearly a decade now and they hate our freedoms. Opportunity, motive, checkmate, African doggie!
Trollhattan
@Anoniminous:
Just to be safe I’m laying off the fruit bats for awhile.
BGinCHI
Hey Loneoak, if you are lurking, HELLO!
How’s things?
Send me a pic of your lad, please.
Corner Stone
@JPL:
Only Cubans are coming here for freedom. Hispanics, blacks and dogs are all trying to transmit some form of terror to der Homeland.
Corner Stone
@Anoniminous: I’m feeling kind of lonely now.
Thanks.
SatanicPanic
@Corner Stone: Investigating this sounds like a job for Rick Santorum.
danielx
@MomSense:
Sweet jeebus in a tar pit, there’s that number again.
John Rogers didn’t know how prescient he was.
Anoniminous
@Trollhattan:
Since fruit bats are a vector … good idea. It’s a hardship – who doesn’t like tucking into a BBQ’ed fruit bat ere now & again? – but ya gotta do what ya gotta do.
d58826
@The Dangerman: How does that work? There’s, what, a 3 week incubation period for Ebola? Are they really going to close schools for 3 weeks to be 100% sure? As it is, they can be 99.99999999% sure that there could be no transmission.
Loneoak
@BGinCHI:
Dude, I’ve missed you like 20 times on threads. I don’t have much time to lurk these days, and it seems I always hit threads after you. Pics inbound!
Trollhattan
@Anoniminous:
Like getting that flu shot, I consider it my little contribution to the safety of the herd.
JPL
@Corner Stone: I know. Initially before knowing all the facts, I didn’t think she should fly but at least I said I was wrong last night. John sometimes just buckles down.
Dr. Brantly is pretty amazing trying to help those infected with blood transfusions.
Corner Stone
@The Dangerman: Hey, I don’t want her to be sick, nor cause anyone else to be sick either. Let’s agree on that.
But my ex, and mother of my child, is an RN. She leads a full life and interacts with not only her work situation, but her extended family as well as myself and our child, every few days.
I’d rather her employer give two fucking shits about her, and invest in the right things, than ask her to give up her life for 21 days every so often. Should we be extra cautious, and selfish to some degree, and expect health care professionals to do this for us?
How about we ask and expect people on the frontline to first get the best care and the best consideration? How about we start there.
Elie
I don’t think that it is absolutely clear about the risk of Ebola and dogs… not sure I would want to take the chance of being wrong in the absence of conclusive information. This is not about sentiment. I love animals and I can see why for now, the Mayor is protecting her dog. However, longer term, is he going to feel comfortable letting the dog out of its confinement? For how long should the dog be observed? Can we really risk this without knowledge to back it up?
BGinCHI
@Loneoak: Oh, man, sorry about that. I have been very hit & miss around here. Just way too much going on. All good though.
Hope you guys are doing well. Have you moved or are you still up in the mtns?
srv
I’m sorry Betty, but your Uncle Billy did a disservice to Banana Republics.
Anoniminous
@Elie:
Of course the dog should be held for examination and observation. As I said above it’s highly unlikely that dogs can even contract Ebola but “Don’t Know” means “Don’t Know.” Ebola could be one of the rare, non-parasitic, zoognosis diseases that can pass from dogs to humans.
SiubhanDuinne
@MomSense:
Is HuffPuff just fucking with us now?*
*(Well, any more than they ever did?)
The Dangerman
@Corner Stone:
No disagreement; the Hospital Exec’s fucked up royally (and, of course, it had to be Dallas). They need to be hammered to the full extent of the law.
As for the nurse traveling, simple common sense and basic precautions should be enough to stay off a plane.
Anoniminous
@Corner Stone:
I be a’thinking “You’re Welcome” isn’t the desired response.
@Trollhattan:
moo
greennotGreen
@Corner Stone: Someone, and I don’t remember who, made the connection between the six degrees of Kevin Bacon game and epidemiology to posit that some people – like Kevin Bacon – are highly connected socially, and therefore, efficiently controlling a pandemic would require treating those people first. The first examples of those highly-connected people would be healthcare workers.
Tree With Water
I’ve maintained the same poise during this recent ebola plague that I displayed during the Cuban Missile crisis, when I was 7 years old. I’d tend to look at any Americans who might do otherwise with a pronounced condescension. I definitely look at politicos and their corporate media allies that whip up hysteria about the plague with a contemptuous hatred, one that burns like hell itself.
SiubhanDuinne
@Origuy:
That’s exactly what I wondered at the time. Since they didn’t fucking KNOW whether the dog (read: DOGS) might or might not be able to transmit Ebola, why not seize this heaven-sent opportunity to find out?
Mnemosyne
@Elie:
Although we’re all against animal testing (I assume …) this does seem like a pretty good opportunity to figure out if dogs can be carriers. If nothing else, having the virus turn up in blood tests would be useful information, especially if it can be safely monitored for a few months.
If the dog does get sick, the compassionate thing to do would be to put it down, but we probably need the are dogs carriers? question answered anyway, so why not quarantine the dog for a while to find out?
Elie
@Anoniminous:
The problem is that there is insufficient data on how long to isolate them if isolation works at all. Hell, they can’t even test for it in dos. Yes, the transmission might be rare or not happen, but the problem is that they have an immune response, meaning, they did get at least some infection. Its clear that they don’t get sick, but it is unclear whether they can transmit it because there is no research on it. Bats dont get sick but transmit it. Do we keep the dog locked up until there some research completed on it or just wing it with letting the dog free? Frankly, I am not comfortable with that. Not sure what the best solution is but locking the dog up indefinitely is not a good option either.
Mike J
@Elie:
Rabies quarantine for the UK used to be six months. For US dogs, it’s down to 21 days. For other non-EU dogs it’s 1) vaccinate on entry 2) take a blood sample 30 days after start of quarantine 3) check that sample after 90 days.
JPL
The local news tried to tamp down concerns about ebola. It’s about time! They did mention that they didn’t know why they moved the first nurse to the NIH facilities because she was doing good. That was covered in the hearing today. Presby is overloaded trying to keep track of the health care workers that might have been exposed to ebola and the CDC felt like that was enough.
So all those folks that sat in the emergency room with Duncan, appear to be okay. The news will report that sometime in the future.
d58826
@Anoniminous: One thing to keep in mind if looking to Liberia as an example for dogs transmitting the disease. In Liberia there are dead bodies in the streets and hungry dogs eating them. Therefore if they would bit a human then the virus might be in and around the dogs mouth as opposed to being in the blood stream. This is a scenario that is extremely unlikely to happen in the US. We should still find out what we can but the African experiernce migfht not be a good example to look at
Davis X. Machina
@The Dangerman:
There’s a 0.00000001% chance you’ll lose an election, you’ll do it.
Seth Owen
@Mnemosyne: excellent point. There’s a real rot consuming this country where form trumps substance, especially if there is money involved — and substance ALWAYS involves money.
JR in WV
@Anoniminous:
I hear there’s a great recipe for fruit bat soup in Guinea – or one of the countries in question.
Yum!
Nothing finer
in the diner
Than Mom’s
Fruit Bat Soup
Burma Shave!
That’s a really old joke, from at least the 50s, and I think it was abandoned already and just lingered because the Burma Shave signs took a long time to all fall down.
elftx
And yet the CCO of Tx Presbyterian would have us believe they made sure the nurses had everything they needed and the fucker actually gave the following testimony:
“A lot is being said about what may or may not have occurred to cause Ms. Pham to contract Ebola. She is known as an extremely skilled nurse, and she was using full protective measures
under the CDC protocols, so we don’t yet know precisely how or when she was infected. But it’s
clear there was an exposure somewhere, sometime. We are poring over records and observations, and doing all we can to find the answers. “
Anoniminous
@Elie: @d58826:
This is a case of.
It’s a straight-forward epidemiological investigation. Am I happy the dogs may have to be put down? No. But neither am I willing to let a Known possible vector go unexamined.
JPL
@elftx: I was surprised the CDC didn’t throw him under the bus. CDC guidelines suggest hazmat suits for those with symptoms i. e. vomiting and instead they gave them double outer wear which is more difficult to remove. Then they were sent home and told good job, you should be fine.
polyorchnid octopunch
@Loneoak: I can tell you that the SARS outbreak in Toronto chewed its way through some nurses. I know one that worked at Scarborough; some of her colleagues died and she was a mess for quite a while afterwards.
Anoniminous
@JR in WV:
Old enough to remember the Burma Shave ads by the side of the road. (sigh)
And now … back to work.
Mnemosyne
@Anoniminous:
Again, it sounds bad because Animal Testing Is Bad (™ PETA), but if we have a potentially infected animal that can be observed and tested, why not observe and test it as safely as possible? The human incubation period seems to be 21 days — maybe keep it under observation for three times that long with weekly blood tests and euthanize it if it seems to be showing symptoms of illness.
(Note: IANA scientist, but I can see the value of testing and observation over immediate euthanization when the answer is currently unknown.)
Elie
@Anoniminous:
Yep– whoa there son with that science thing of yours!
The Snarxist Formerly Known as Kryptik
Mostly OT, but tangentally related. Despite the incompetence in action on display by the GOP in just about every place they have power (at least, incompetence in everything but remaining IN power), the GOP continues to convince most of America that they are the smartest most competent people in the room. Dems have the serious edge on the empathy factor, but apparently despite thinking that the Dems actually understand their shit, they think GOP will fix fucking everything because reasons and Obama apparently.
Fuck’s sake.
greennotGreen
@Mnemosyne: Useful link on this topic.
Elie
@Mnemosyne:
You keep saying ” watch them until they get sick. THEY DON’T GET SICK
They have an immune reaction to the virus that lets us know that their body saw the invader and made some antibodies to it. Question: is the invader still there lurking (like the herpes virus in humans) and therefore could potential infect some other thing if they are exposed to it through the dogs saliva, blood, poop, pee or whatever. Again, no one knows because that science hasnt been done. Good science isnt done on just this one dog. They would have to test many dogs exposed to the same dose of virus, chech them periodically over months and also if they show an immune response, try to take saliva, blood, etc and inject into another test animal to see if they can infect it. They would also try to culture the virus to see if live virus is still around.
This is not a one dog thing. I guess they can keep it locked up indefinitely, but there is no defensible science to be made from this to answer the question.
WereBear
@SWMBO: Dang I hate to
Go to the dark side.
But yeah.
That will leave a mark.
Botsplainer
Count me as unsurprised that Varga’s testimony was dissembling bullshit.
So I wonder how badly Texas’ legendarily awful Workers Comp system is going to fuck these nurses over on billing, or should they just pre-file bankruptcy to get it over with?
AlladinsLamp
FYI –
@Loneoak:
Emory is a private, “for profit” entity.
The research division I worked in (Cancer Biology) was a part of the Emory Clinic, an Emory Healthcare unit. It is an oddly put together place.
It was a nice gig, and then the grant money ran out. I got a nice raise every year, and a $50 Target gift card at Christmas paid for out of profits.
Corner Stone
This is what I keep saying. Dallas is full of assholes.
Fly this infected guy into Houston and our thespian mayor would’ve met him at the airport, gave him warm wet towels to clean up with, and escorted him into a nice, comfy, isolation unit.
g
@SWMBO:
One of the main factors in contracting Ebola is compassion – it’s caregivers, family members, and people who tend to the dead who are most at risk.
The Koch brothers will never be at risk, they haven’t a compassionate bone in their bodies.
Another Holocene Human
I completely agree with this, Loneoak. Especially as more info has come out. Thank you, NNU. Of course the MSM and the House will try to obscure this as much as possible and blame the very healthcare workers who are on the front line bearing the brunt of this crap.
LAX TRAINING (for peons because that costs money now, better to fight in court later) + TOXIC ATTITUDES TOWARDS LABOR
The public beware!
Violet
@g: Doesn’t mean the Ebola-infected limo driver can’t throw up on them.
Ripley
@Jude: John Cole Apology Watch Day 2: The Avoidancing
gbear
MN Public Radio aired an intereview with a nurse yesterday about how hospitals are preparing ‘action plans’ for dealing with ebola, but then not bothering to get that info to the ER employees. I thought it was a great story and it fits in well with this discussion.
Another Holocene Human
Another takeaway for me is that no matter how rich Texas gets you can’t spell Tex without ass. Fucking Georgia acquitted itself better. It’s funny because if you look at voting patterns and law and development measures you know Georgia sucks, it’s no Alabama or Mississippi and it’s clawed its way past South Cackalacky but it’s rife with intergenerational white haters, it’s stuffed with reactionaries, it’s crawling with kooky kristians who want a theocracy, but it is not, and this is key, even close to being as dysfunctional as fucking Texas. I mean wow.
Stupid is as stupid does and even though people in Georgia will cop to way stupider shit in aggregated than Texans they seem to have more functional institutions.
I think it’s the oil. Oil barons fuck everything up.
Mnemosyne
@greennotGreen:
Really interesting — thanks! It looks like most of the risk of non-primate animals spreading Ebola would be the same way it’s normally spread (i.e. the animal gets bodily fluids on it and moves those fluids around).
The scientific question is whether or not pets are reservoirs for the disease. There doesn’t seem to be any evidence of that so far, which you’d think there would be since Ebola’s been known for 20 years or so.
@Elie:
You have to start somewhere. At a minimum, put the animal under observation for a few months and test its blood several times before putting it down. You’re never going to be able to wait around for the perfect test animal to show up.
Another Holocene Human
@gbear:
If the rank and file are interchangeable replaceable peasants then this makes perfect sense. The only reason the peons in my industry get any training at all is because the state mandates it and actually comes around doing inspections and harasses the fuck out of management until they comply just to get the monkey off their back. When stuff comes up between mandatory training they try to communicate with the stupid losers who work for an hourly wage as little as possible.
If they had to do training they have to pay us to sit our butts in chairs and that would be putting us above our station.
ETA: both the payment to do such a thing part and the treating us like equal partners in the success of the enterprise since obviously we contribute nothing and are replaceable cogs
Another Holocene Human
@Corner Stone:
Given that the Bush Crime Family Favored Son branch felt comfortable enough to make their home there, you may have a point.
Calouste
@Tree With Water: The Cuban Missile Crisis was before my time, but I remember how SARS was going to kill us all, and H5N1, and swine flu, and….
Corner Stone
@Another Holocene Human: Fuck off, douchebag.
Another Holocene Human
@Botsplainer:
The bright side is that WC isn’t mandatory and if there isn’t WC they can sue for damages. If they are in WC … ugh.
We need a national worker’s compensation system. Just make it a tax like unemployment compensation, and integrate the regulations with the disability and medicaid systems, and then make some sort of beefed up OSHA/fine/liability/compliance arm that forces changes at businesses where there are excessive WC claims. OSHA as it stands is severely underfunded, the fines insufficient, and there are too many exempt industries. And their regs are too fucking lax. Like the bathroom regs. So a company can comply and actually be causing disease in employees. If OSHA and WC were combined then they would have to basically force employers to a standard where you don’t end up with people on dialysis who get thrown into the Medicaid system.
Another Holocene Human
@Corner Stone: Truth hurts.
I live in Flori-duh and we still have Texas beat on like every measure. Now if you want to look at culture and football teams and weather and shit like that, you know, that’s all a matter of taste. But I’m talking about institutions and institutional failure. You know who’s even worse than Texas?
Louisiana.
You know who could be worse but banned off-shore drilling? Florida.
It’s the oil. Just look at Alberta dumbshittery versus normal Canadian dumbshittery. Kinda dramatic.
mai naem
Okay, I know I shouldn’t find this funny but apparently somebody put up graffiti last week in a Scottsdale neighborhood(the snooty suburb of Phoenix). The graffitti was ” EBOLA QUARANTINE ZONE” The news blurb didn’t mention what neighborhood, just that the residents weren’t happy. I just hope it was on the outside walls of some 1 % gated community.
Mike G
This. There’s a whole Lords and Peasants mentality with MBA culture that flies in the face of cost efficiency and certainly in the face of organizational effectiveness. Treating the frontline workforce with anything but contempt would make them think they’re entitled to decent treatment and decent pay, and might interfere with their royal prerogative to treat people like shit for any reason or no reason at all. It might also suggest that management aren’t the center of the universe and perhaps not worth vast pay differentials over their staff.
I’m in the middle of such a miserable corporatization transformation right now at a public university. It blows for everyone, especially the customers, with the exception of upper management.
Elie
@Mnemosyne:
You can’t do it with one dog.
It will be extremely expensive to “make up a test” or tests to see if the dog has an immune response since a standardized test for dogs and Ebola has not been designed yet so it will have to be made. Why? This hasn’t been an issue until now. Remember, the world is just adapting to the scope of this outbreak in humans, much less whether pets in rich western countries can spread it from their owners. We don’t even have a rapid test for humans for chrissakes, M-! It takes several hours for the first test and that has to be confirmed a day later! But snap, jes like that we are going to make that up for one dog outside of a serious research effort? Please. Get real.
Unfortunately, a hard decision is going to have to be made at some point.
MomSense
@Ripley:
Apologizing is not his strong suit.
Betty Cracker
@Calouste: I think there’s almost no chance of a widespread Ebola outbreak in the US, despite the fact that at least some of our hospitals are ill-prepared to deal with it. However, the breakdowns in containment there should give us pause about how our healthcare system might deal with another deadly, more highly contagious threat. Not a comforting thought.
Also, the media hysteria whipped around the Ebola cases here might make it harder for the US to help West Africa deal with the genuine public emergency underway there. And if things spiral out of control there, well, I don’t even want to think about how that might play out.
Calouste
@Another Holocene Human: Norway has a lot of oil. They’re not bonkers.
Corner Stone
@Another Holocene Human: You want to start ranking states on your opinion please proceed, douchebag.
Why don’t you go back to being a Masshole if you hate FL so much? Personally, I think we should cut off America’s Wang if we could get rid of nonsensical douchebags such as yourself.
Botsplainer
@Another Holocene Human:
I would imagine that in the event an employee sued for damages in a case with no WC, you’d have a giggling, grinning, cackling judge ready and happy to grant summary judgment on an assumption of risk defense because “freedom”. Followed shortly, of course, by an appropriate sanction order against her for having the gall to sue noble job creators when she picked a healthcare job.
Loneoak
@Calouste: Have you seen their curling uniforms? My eyes beg to differ with your opinion.
Betty Cracker
@Corner Stone: Hey, man! Not cool!
shelley
I truely wish both the cable and local news shows would stop with the headline, “Ebola OUTBREAK!” It’s a little early to feel like we’re stuck ina movie with Matt Damon and Gwyneth Paltrow.
Suffern ACE
Ugh. I’m about to lose my partner to Ebola preparedness. He’s convinced that it will be at his hospital next week. Once its there, he won’t be coming home. Trials of being involved with a nurse.
shelley
I think I have more danger of picking up poison ivy from my dog, then Ebola.
Mike J
@MomSense: Cole has very little to apologize for in this case. He never said it was the nurse’s fault because she got herself infected. He said it was her fault she got on an airplane.
He said it before we had heard she asked for permission to go. NBC’s “doctor” had promised to stay at home and then broke her word. We had been told this nurse had been told to stay at home, and Cole and others (like me) assumed she ignored that request.
Since she got permission from the CDC to fly, that changes things. I still don’t think Cole is guilty of the sin he’s accused of.People are accusing him of blaming the nurse for getting sick, and he simply never did that. Hell, I think Cole is a moron about 75% of the time (especially about droooooooooones), but he was right on this with the info he had. He, I, and pretty much everyone was wrong about her not being cleared to fly. Some people thought it didn’t matter. Those people are still wrong.
satby
@Corner Stone: Yeah, that’s not what he said. And that the nurse called the CDC multiple times seem to me to indicate she suspected that she was infected and knew she was starting to run an elevated temp, and as a health professional, should NOT have gotten on the plane. Even though the chances for her to infect anyone else were really low. Cole said that was an asshole move, he didn’t blame her for getting sick.
And I happen to agree that was a reckless move by someone who knew better.
Full disclosure, I’m not a nurse, but I trained to be one in college.
MomSense
@Mike J:
It was a general comment.
He was right on this with the info he had.
When new information comes to light there is no harm in issuing an update or correction. Nurses especially serve a vital function in our world and deserve the benefit of the doubt. They are often overworked and placed in situations where they are expected to offer perfect service without adequate staffing or support.
Elizabelle
Balloon Juice gluttons for punishment: C-Span 1: Iowa Senate debate tonight at 8 p.
Bruce Braley (D) vs. Joni Ernst (Whacko).
I’m interested to see how Ernst comes across.
C-Span ran 3 ads from the race: 2 by Braley: one on Ernst’s support of personhood amendment and opposition to abortion and (allegedly) birth control pills; one on her pledge to defund the EPA; ends with photos of Ernst, Palin and the Koch brothers. Who does Ernst really work for?
The Ernst ad was a long one with rotating clip of Braley talking about the House gym and doing laundry. Tag line was roughly Bruce Braley says the oddest things, but if they can’t find anything beyond laundry and exercise? No policy mentioned at all.
Interesting that C-Span ran two clearly issues ads by Democrats, and a very odd personal attack of sorts by the Republicans.
Elizabelle
Tomorrow night, C-Span 8:00 p has Scott Walker vs. Mary Burke, the Wisconsin governor’s race.
How are we to keep our dinners down?
Mnemosyne
@Elie:
Right now, there is no — zero — evidence that dogs act as reservoirs for the Ebola virus. I am not comfortable saying that we have to immediately kill people’s dogs just in case there happens to be a connection that wasn’t spotted in the previous 20 years of studying it.
It’s not like dogs as pets or scavengers are unknown in Liberia or other parts of West Africa. I think that insisting on putting patients’ dogs to sleep is hysteria and doesn’t have any science behind it. I know they’ll justify anything as a “precautionary measure” since you won’t be able to prove them wrong once the dog is dead, so that’s why I’m uncomfortable saying, Yes, let’s euthanize all of the patients’ dogs just in case they haven’t been sufficiently studied yet.
aimai
@greennotGreen: Very good point.
Botsplainer
@Suffern ACE:
Guy from my office is married to a PA/NP, they have a one-year old. She advised him today that their ER received a patient today with a real recent travel hx involving Liberia, fever, aches, coughs, etc. The good part is that this facility is competently equipped and run, mainly because we regulate and train to the nth degree here. They basically cleared the ER and went into some sort of clampdown. I guess they’re testing and doing a great job on keeping the news leakage down at the moment.
My friend and his wife are planning a short term apartment rental for her if it is the big E, figuring they want to keep their child safe.
Corner Stone
@Elizabelle:
My guess? Quite badly. She spooks me right the fuck out.
Corner Stone
@satby: I read what he said, multiple times. What he said was bullshit and completely unfounded.
I’m not in the medical profession industry, either, but he has no clue what he’s talking about.
Corner Stone
@Betty Cracker: Sorry but I can’t condone you having non-consensual sex with the rest of the nation any longer.
I’ll thank you to take your SYG, your medicare fraud gov and bid you good day. I said Good Day, Sir!
cckids
My son has had, at various points, MRSA and antibiotic-resistant pseudomonas. I’ve been in hospitals/ER’s & ICU’s while dealing with them. And the degree to which doctors and nurses didn’t follow protocols while treating him is just staggering. Doctors are far, FAR worse than nurses.
When he first got a tracheostomy & respirator & we had to go through the training for using it, it was quite the eye opener as to what slides by in hospitals. When you have to be mindful & conscious of each movement & touch after you put your gloves on, it is a different world.
I realize that MRSA does not equal Ebola, but still, it takes practice, it takes the buddy system, it takes time & money for training & supplies. It takes changing the PROFIT BEFORE ALL mindset that runs hospitals today (yes, even the Catholic non-profit ones).
tybee
@Another Holocene Human:
texas. it’s like a whole other third world country.
Corner Stone
@cckids:
Seconded to the changing profit before all. In this connected world, health care decisions are too important to be left to private CEOs.
greennotGreen
@Loneoak: I think the Norwegian curling uniforms are not evidence of bonker-ness; they’re evidence of a serious competitive spirit. If you were playing against opponents wearing those outfits, would you even be able to remember what game you were playing?
Corner Stone
@tybee: Georgia’s really kicking ass, I guess. See you in a couple years when you’re asking for the rest of us to pay for your island being flooded.
tybee
@Corner Stone:
sorry, loser. i’m way above sea level on my island. houston will drown (as it should) before i do.
Corner Stone
@tybee: Island, you say? Good luck rebuilding that bridge chump.
Elie
@Mnemosyne:
At this point, without hard evidence, we are talking “risk assessment”. Risk has always error associated with it. How do you want to make that error when you are assessing the risk of a population for catching this lethal disease from any source?
Yours is that without evidence that dogs are a reservoir they should be allowed to live and presumably be set free to go about their business with their owners. You, apparently are prepared to accept an Ebola infection of someone if you are wrong.
First,you are wrong. Dogs CAN be reservoirs. We just don’t know if this dog was exposed enough to show signs of the infection and become a reservoir. Once a reservoir we also don’t know if dogs can transmit active Ebola disease.
I come at what is acceptable risk differently. To me, Ebola is such a horrendous outcome with so much cost to life and resources, I cannot tolerate the small risk of any positive dog being able to transmit Ebola, absent any confirming research results that assure me that they absolutely can’t.
You are saying, in essence, people keeping their pets is a more important value than minimizing the risk of transmitting that horrible disease in any possible way in the middle of a massive outbreak of unprecedented proportion. Somehow the horror of that disease is less important than the pets. (I really can’t believe you would think that, but this is what you would be willing to tolerate if the dog lives)
Sorry – just can’t agree in any way. My guess is that the Texas public health department will weigh in eventually and that will be that. The Mayor is a kind man but he actually made this tougher. If they had gone on to do the euthanasia, we could take it out of controversy. Now its going to be A BIG DEAL that will get everyone upset and in the end they are going to euthanize that dog anyway or he will have to be kept in quarantine the rest of his life. I guess someone could pay to develop a test for him to see if he had antibodies or not, but that would have to be done multiple times to be sure.
Mnemosyne
@Elie:
Actually, what I said is that the dogs with potential exposure should be quarantined and monitored to see if they either get ill or they show no symptoms but build up enough of a virus load in their systems that could potentially be transmissible. But you are not willing to do any studies on the dog(s) at all — you want to immediately euthanize them without even studying them to see if your hypothesis is right.
That’s not science. That’s hysteria. We have an opportunity to study this dog and you are unwilling to do it.
ETA: Also, we don’t have an epidemic in the US. We have one (1) dead patient and two (2) potential transmissions with the two nurses. Why wait until there’s an actual epidemic before we try and find out the answer to this question?
Sad_Dem
@ice weasel: Agreed.
Betty Cracker
@Mnemosyne: I thought it was established that dogs don’t get sick with Ebola? Is that not the case?
amk
May be cole should read his own blog instead of listening to the stupid and corrupt msm hacks. His hit piece on the infected nurse was truly pathetic.
Well done, Loneoak (and BC)
Elie
Oy
Ok – I give up. I was not being hysterical but forget it. You clearly can’t understand what I am trying to say.
Betty – Dogs DONT get sick but their bodies recognize the virus as an invader and make antibodies to it. It is not known whether they become reservoirs to the virus also when they make the antibodies. They also don’t know, if they are indeed reservoirs, if they then can transmit the disease to humans in their saliva, blood poop or whatever
But never mind. According to M its not important and we should just let the dogs and their owners be. Its just hysterical to worry about the uncertainty of their being able to transmit the virus in the middle of an outbreak.
And oh by the way, the virus is definitely transmitted in convelescent patients in their semen and breastmilk. We definitely know that so precautions for that needs to be addressed in populations that are coming back from this. Dr Brantley and the other male docs will have to wear “pro” for a while.
tybee
@Corner Stone:
certainly none of you tex-ass folks will be helping as you’re already on the federal dole.
leeches, all of you.
Procopius
@greennotGreen: Many years ago I worked on the audit of a not-for-profit hospital. It was an interesting experience, and one thing I learned was that “not-for-profit” just means they don’t pay dividends. In order to avoid building up too much undistributed capital, the executives may pay themselves high salaries. Not saying that is common among non-profits, but it sure does happen.
Ella in New Mexico
@Loneoak:
I can’t tell you how great it is to have read that post. Hit so close to home. I’m finding that often, it’s our spouses that are able to speak out for us in ways we cannot, and it’s been refreshing. Thank you, thank you, thank you!
Something I’ve been noting the past few days is that the “Great Ebola Fail of 2014” is bringing out the whole issue of Management vs. Labor. Nurses, CNA’s, Respiratory and Lab Techs, shit the poor housekeeping and janitorial staff– and anyone who has first person contact with sick patients and who is drawing an hourly paycheck in a hospital needs to be represented by a union, pronto. (Now if I can only get my scared coworkers to understand this.)
At my hospital, the people that were wrong from day one ALL tended to be supervisory or administrative level, even if they were RN’s. Management not only doesn’t get it, they have a financial incentive to not give a shit. They already are great at ignoring complaints and rationalizing short-staffing units and cutting the food services and janitorial staff to the bone so nurses can take up their slack. It’s gonna take some fear to break through that wall. And for some reason, these people’s biggest fear is a union coming in.
The first few days of the Ebola story, the word was “don’t be hysterical, universal precautions and hand washing take care of it and if you’re not just lazy and don’t follow them, you won’t catch it. ” Which I spent a lot of time debunking because I had the unfortunate opportunity to have taken upper div. bio classes on emerging infectious disease that scared the shit out of me.
“Yellow paper gowns and chemo gloves with plastic face shields and N95 masks. That’s all you need!!!” Ok, what about the fact that my ankles and neck will still be exposed? How about the fact that our reverse ventilation rooms are not sealed, and have cracks between the sliding doors I can put two fingers in? I mean, seriously, do we have a plan for the logistics of actually caring for these patients? How do we make sure every nook and cranny of the portable xray machine is sanitized after it’s use? Who’s job will it be to maintain a room full of bloody vomit and diarrhea in a somewhat hygienic manner? Who takes out the damn trash or the food trays? Nothing. No plan.
When Nina Pham got sick, my old ICU/ED teammate turned AOD blamed it on her not watching what she did. I suggested she probably did not have the proper PPE in the first place, based on what I was reading they used. As if he has totally forgotten what it’s like to actually work on the floor he flatly stated “This is Ebola- you know damn well that hospital made sure that those guys had 100% of what they needed to take care of that patient, they’d have to be insane otherwise. Oh, yeah. She fucked up.” I’m not sure why getting a salary seems to turn even the most reality based person into a corporate apologist, but there’s a sad story in that.
Well, in any case, he was right about the fact that she fucked up, but not about HOW she fucked up. She fucked up by being “Nurse 0” in the “Great Ebola Fail of 2014”. So did her coworker, the “Notorious Asshole Who Believed the Experts and Flew.” Here’s hoping that on a daily basis and over time, this turns into the best thing to ever happen to the American hospital system.