Our ethical bankruptcy is going to kill us, not a virus.
The United States has the most capable health infrastructure and the most capable doctors in the world, bar none,” Lisa Monaco, President Obama’s senior counter-terrorism adviser, said at a White House briefing. (“US Ebola outbreak ‘extraordinarily unlikely’, White House officials insist.” The Guardian)
You might wonder what a ‘counter-terrorism’ adviser is doing vouching for the quality of the US health system. It is an indication of just how badly this issue has been framed since the first report of the latest Ebola outbreak, which began in March of this year. Nor is it helpful that the current head of the CDC keeps insisting that an Ebola outbreak couldn’t happen in the US. And even more laughably, there’s a DA in Texas who looking into pressing charges against Thomas Eric Duncan, the Liberian who fell sick in Dallas. Let’s hope he lives long enough for that to be a worry to him.
All these absurd statements and assurances have one thing in common: they are aimed at pleasing the public, not at informing them of realities or doing anything constructive to stop what might turn into a global pandemic. The level of magical thinking, parochial smugness, ass-covering and spin-doctoring has been staggering.
Peter, Piot, the scientist who identified the Ebola virus, recently interviewed in the Guardian had something interesting to say about why, for instance, the WHO did not alert the world to the seriousness of the outbreak earlier: “their African regional office isn’t staffed with the most capable people but with political appointees. And the headquarters in Geneva suffered large budget cuts […] The department for haemorrhagic fever and the one responsible for the management of epidemic emergencies were hit hard.” (“‘In 1976 I discovered Ebola, now I fear an unimaginable tragedy‘,” The Guardian)
We appoint incompetents, we cut budgets in the wrong places (and I’m not defending the WHO at all – they’ve been worse than useless. One intelligent person in an office with a telephone would have been more effective.) But Medecins Sans Frontieres told everyone who would listen, including news networks and the US that there was a disaster looming, and that it had reached its limit to cope in June. (“Ebola in West Africa: ‘The epidemic is out of control‘” MSF.org, June 24, 2014).
Once this disease hit urban slums, places with high concentrations of people, this was always going to be our problem. And if you think culture or ignorance had anything to do with it, let me remind you that a hospital in the most medically sophisticated nation in the world turned Mr. Duncan back out onto the street, sick, knowing he had been to Liberia. I suspect they didn’t want the cost of treating him for anything – he had no insurance and no social security number. After all the bullshit from the hospital about computer system flaws, it appears they ‘just fucked up.” Call me a cynic: I think it’s a problem with for-profit medicine. No medical care facility that is run for profit can be expected to put the welfare of a community before its profits unless it has to – legally. And even then, it will do only what will satisfy the law, not what is best for the community.
Then we discover that the family Mr. Duncan was staying with, who have been exposed, have been told not to leave the apartment. They have to live in the space with infected sheets and towels for a week. There is no one to counsel them. No one comes to help them with the clean-up. There is no provision made to bring them food, or diapers (there’s a baby) or anything. The best this vastly superior system can do for them is to send someone along to take their temperatures. And when the Dallas authorities are taken to task for this, they blame the federal government.
Yeah — really. Never mind all this ‘African cultural behavior risk’ crap. We’re just as capable of at putting ourselves at risk by just being callous and stupid.
It’s greed, self-interest, and bureaucratically hidden incompetence that will kill us, not a virus.
I would like you to indulge in a little imaginative exercise: you are living in a city where people around you are dropping dead on the sidewalks of an awful disease with a 50%+ mortality rate. The hospitals, clinics and treatment centers are so overwhelmed, they are turning people away. You know this because you’ve just tried to take a friend to the hospital and had to take her home, and carry her back into her house, probably to die eventually, in your own arms.
(There were about 1000 doctors in the whole of Liberia at the beginning of the year, and many have now died of the disease while attempting to treat others. The Chief Medical Officer of Liberia has just quarantined herself and her entire staff after one of her assistants died of it.)
You, unlike most of the population, have the money to fly out. Are you going to hang around? When you know you can gain entry into a first world country with first world medical facilities (after all, you don’t KNOW you’ve been infected, but you know you might be)?
Right now, everyone who has the money and the connections to get out of Liberia, Guinea or Sierra Leone, has either done so, or is considering doing so. This is what happened during the outbreaks of the Plague in the Middle Ages. This is what happened during the Spanish Flu epidemic. People flee to places they think are safer.
What I’m trying to make clear is that these people are just like you. They don’t think they should hang around in a hot zone and get sick anymore than you would. And no, I am not advocating the grounding of all flights to the affected countries, because it does impede people coming in to help and fight the pandemic. And it’s blatantly unethical to strand people in a place we have allowed, by our stupidity, our selfishness, and, frankly, our racism, to go to shit.
So all those talking heads saying that we couldn’t know this would happen? That all the previous Ebola outbreaks have been small and burned themselves out? Either they are lying to cover their reputations and their asses, or their history education has been for shit. I suspect a little of both.
We have a very deadly disease that has been allowed to spread because we didn’t care enough about those people ‘over there.’
It will come here, wherever here is — I’ll lay odds on it. There will be cases in most major cities in the world. Our ability to cope with it and stop it will depend on the competence, the integrity, and the ethics of people at all levels – and that’s the scary part.
We live in a culture that encourages the appearance of process, diligence, expertise, and concern for the community, but beneath the layers of filled out forms, checklists and the apparent following of procedure, is increasingly less effective, less diligent, less expert and less caring. This, more than anything else, is what I think puts us at risk.
The ‘missteps’ at the Dallas Health Presbyterian Hospital in treating the Ebola patient in the US reveal exactly how wide the gaps is between having ‘processes in place’ and actual, effective responses. At some point, it becomes clear that all the ‘Ebola checklists’ and ‘red flag travel statuses’ in the world will do us no good unless we, as individuals, as organizations, as institutions stop burning energy on spin, on administration, on the appearance of competence and JUST DO OUR JOBS well. Not because there is a procedure, but because we have a duty. Not because it will be financially better for us in the long run, but because we genuinely CARE about our communities.
That’s the bottom line. It’s our ethical bankruptcy that is going to kill us. Not a virus.
P.S. Did I leave you feeling helpless? There’s something you can do. Go along to the MSF site in your country and give them some money. They’re almost wholly run on private donations and they’ve been working at the mine face of this tragedy, risking their lives to do it, since the beginning.
I don’t want to be nitpicking (but I’ll obviously do it anyway), the doctor who discovered ebola is called “Peter Piot”. Other than that, another thought-provoking read!
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GAH Typos. *smacks head on keyboard* Thank you, corrected.
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I do appreciate your examination of how spin exacerbates the problem of how best to respond to plagues. However, the fact remains that an epidemic of ebola is unlikely here, simply because the disease kills so quickly that an epidemic is unlikely ANYWHERE. It’s also not as easy to catch as a number of other diseases, despite the high risk of death if you get it. Ebola is a wildfire in Africa because they don’t have enough of anything needed to fight it – running water, gloves, masks and gowns and IV fluids, let alone doctors and nurses. We may not have enough of the courage and honesty necessary to be most effective, but at least we have the supplies!
Speaking as a clinical health care worker, the thing that’s most likely to kill you is a disease or condition you won’t see coming, one with few or no symptoms. Usually it’s a heart attack or stroke brought on by atherosclerosis. If you dodge that one, it will be that pesky cold that turns into pneumonia and overwhelms your organs because you have an immune system compromised by age or other problems. Failing those two, it will be trauma from some unanticipated accident, like falling out of your chair once you are old enough to have bones that break like china. Or hitting your head performing a normal activity (being on a ladder, driving, football). Sure there’s cancer and a host of other icky, painful things you could die from, but your statistical chances are quite small compared to the ones I listed above.
The plague situation we should look back to and remember was the original outbreak of AIDS in the 1980s. There was lots of denial, misinformation and discrimination against the victims based on fear and ignorance. And it’s a very similar disease to ebola in terms of how you can get it, even though the hemrorrhagic fever viruses kill more quickly and dramatically. Before we developed enough treatments and medicines, AIDS was more lethal than ebola. No one gained a natural immunity by surviving. Half of those who get ebola survive even in places where they get no treatment besides quarantine.
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“the disease kills so quickly that an epidemic is unlikely ANYWHERE”
20 day incubation period? Hmmm. Not so sure about that. These days, we travel fast. The Spanish Flu was 7 days, and that spread pretty fast. Admittedly, it was airborne and that changes things, but you are at no risk of getting anything if it isn’t in your vicinity, regardless of how it’s spread.
Meanwhile, I agree that a lack of resources and infrastructure has played a major part in the intensity of this epidemic. My point is that some of the behaviours that have become entrenched within our organizational structures are also dangerous, as the Dallas ‘missteps’ show. Many more people were exposed, and those who were initially exposed had that exposure prolonged because of incompetence, callousness and blame-tossing.
I don’t debate that there are much more quotidian things we are all likely to die from. It was not my intention to sound alarmist, and you are perfectly right to bring up the realities of HIV, but I would remind you that AIDS made its way very successfully around the world and, admittedly, the incubation period might be longer, but 20 days is more than enough for a person to travel from an infected area to a non-infected area and have numerous contacts in the same way as AIDS spread (by sexual contact, blood transfer, etc) and others – like saliva, vomit, sweat, tears – by virtue of Ebola’s symptoms. It is my understanding that the viral load required for infection with Ebola is tiny. As far as I understand, there was little cause to worry about an HIV infected person’s sweat.
My purpose in this post was to underscore that, technically and resource-wise, we DO have the capability to stop a global pandemic of Ebola, but those techniques and those resources require a will to apply. A genuine will. Not spin, and good sound-bites for the masses.
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I think the thousands of people dying in Africa from this disease would be considered an epidemic.
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Agreed, but not a global one
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Global = pandemic, not epidemic
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The US certainly has some very competent people in health care, and some ‘facilities’ are first class. But there is no sense of a ‘system’, there is no over-arching organisation; many people aren’t insured, and illness can bankrupt others. You’re not being cynical in your criticism of for-profit healthcare; it can provide world-class treatment for the ‘elite’, but not for the many.
Big Pharma works on the with-profit formula as well. There’s no immunisation against Ebola, nor is there much in the way of treatment; up to now there was no profit to be made from it—and it was a disease of poor countries, far away. To be effective, an immunisation programme needs to be organised and controlled by a competent authority; who, when a vaccine becomes available, can do this in W Africa. It also takes government action to get such a vaccine developed and tested.
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When we consider how contagious a disease is, we often tend to forget that the virus responsible for is something living, something dynamic , not dead and static. Ebola is mutating really fast now, than ever before. These mutations can make it a superbug. Also one must remember that many people in africa don’t know the symptoms of disease and they are not reporting it. This is leading to wider spread of disease and is also giving wider exposure to ebola virus which will definitely make it much more lethal.
For the time being let’s pray that it doesn’t become an air transferred disease.
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First, there is absolutely no proof that ebola is mutating fast. They’ve been looking at its mutations during this current outbreak in infectious disease labs in the US, the UK and in Germany, and they are not seeing any significant levels of mutation.
I’d also remind you that ‘Africa’ is a huge continent of many countries. They know as much about the symptoms as the rest of us. The problem in West Africa is a desperate lack of isolation and treatment facilities. It is spreading so fast because many, many people are having to nurse members of their families at home, due to lack of medical facilities.
Please read http://www.theatlantic.com/health/archive/2014/10/clarity-in-ebola-transmission-science/382026/
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It is funny to even think that ebola virus is not mutating. Every virus mutates at some stage whenever it attaches itself to a cell. A virus is noting but a genetic material strand and it propogates by entering into the cells of a host. Some are able to mutate faster and some slower. but all of them definitely mutate. Why do you think we are changing cough and cold formulations and doses after few years.
And about ebola in particular plz check :
http://news.nationalgeographic.com/news/2014/10/141015-ebola-virus-outbreak-pandemic-zoonotic-contagion/
Also plz check this too…
http://www.nature.com/news/ebola-virus-mutating-rapidly-as-it-spreads-1.15777
They are saying what i wrote. more the number of cases, more learnings for the virus. And regarding these so called ‘GOVERNMENT’ expert, they never expected swine flu, bird flu to mutate enough to attack humans. these were never supposed to attack humans previously.
Ebola getting mutated to be air spread is very difficult but it is not impossible. The increasing number of cases are only increasing this possibility.
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They’ve been looking at the genome of this virus over and over, as it is sampled from generations of infection. Of course, all viruses mutate, but this particular strain is not highly mutagenic
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Yes , I agree. This particular strain available with the labs is not that mutating. I hope it remains so like the HIV virus. But still , the exposure of virus is very small and we really don’t know what shape it will take if it spreads beyond african continent. Viruses don’t mutate at same rate all the time. Sometimes a particular kind of offspring generation mutates very fast which results in uncontrolable outbreaks.
I hope that it comes under control much faster.
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1) A virus is not a living thing.
2) Ebola is not mutating rapidly
3) Outside of western medical staff, Africans probably know the symptoms of Ebola far more than the general public here, who most likely had never even heard of Ebola until a few months ago
4) There is no point in comparing the common cold; a disease caused by a wide range of viruses, with one strain of Ebola with evidently lower rates of mutation.
5) Your national geographic source widely disagrees with the opinion you put forward. You may be being ironic here.
6) And the best until last-“Yes , I agree. This particular strain available with the labs is not that mutating. I hope it remains so like the HIV virus.” Holy shit. The HIV Virus doesn’t mutate that much? Best tell all those researchers searching for viral targets for drugs to give up. We can just have one drug, because HIV doesn’t mutate. I hope you realise this is sarcasm. HIV replicates so fast and so badly that even one HIV patient mathematically has at least one viral particle in their body that is resistant to a drug we could synthesise to some degree. Let that sink in for a second. We can’t cure it, because every one of them is different.
Now away with you,there’s a “rabies will start the zombie apocalypse” forum somewhere with science you’d like more.
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Whether a virus is a living thing or not depends on how you define “life”. Since it is probably impossible to define, claims to a virus being “alive” or “not alive” are not really relevant.
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Noted. But if it was a gun to your head and it was alive or not I think I know which way the majority of the scientific community would be leaning to
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Don’t see your point here. Could you explain what you mean?
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Basically the majority of scientists don’t classify viruses as living things and so calling them that (and to be honest the comment nearly seemed to imply they had an order higher than that) isn’t right. We don’t count them as life.
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I don’t know who is “we” who do not count viruses as life. I also am not aware that the majority of scientists don’t classify viruses as living things, if you have a credible source I would be interested to read more. As far as I know, the scientific debate is not over, and most people are quite comfortable not caring whether viruses are “alive” or “not alive”. I guess they are probably “not not alive” but also “not quite alive” – “undead” is the best definition I found. But all this is rather academic, and however interesting, has taken us rather off topic here.
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Well any text book from junior level to college graduate will emphasize we are leaning towards not alive. But it’s debateable as you say. they would certainly never be called “alive” however, rather not alive I suppose. Anyway, I think this article should be going academic. It’s a problem in need of a solution based on academic research. We can put as much of a humanist spin on it as we like, or not and call ourselves “cold”, but at the end of the day it’s public health and pharmaceutical solutions we need
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Mutations are not observed enough in labs but in real life. The original swine flu virus have not mutated enough in labs, they are stored in many labs across the world. I hope you know how many people swine flu kileed. That’s nature my freind, it’s always a step ahead.
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It’s nice that you expressed yourself in this article in a good way, saying the truth and giving to the readers a good lection to reflection. I think the spirit of surveillance it’s bigger than other thing, so if the Ebola reach first class world countries, the reaction would be the same, no matter what.
After all, we are animal that think, but animals at last. Hoping the people responsible for it show the face up and clean the mess. Our hope is in Organizations and Countries that really care about the problem, no matter what.
Greetings.
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I understand that Médecins Sans Frontières/Doctors Without Borders is the same group that Dr. Craig Spencer, New York’s first Ebola patient, worked for. Thank you for making others aware of MSF and the wonderful things this establishment does for others to stop a global pandemic of Ebola.
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Reblogged this on justasking and commented:
I think this pretty much hits the nail on the head.
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Reblogged this on pennymhook.
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excellent article on the current situation. thanks
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…@”My purpose in this post was to underscore that, technically and resource-wise, we DO have the capability to stop a global pandemic of Ebola, but those techniques and those resources require a will to apply. A genuine will. Not spin, and good sound-bites for the masses..”
Mission accomplished! Well written, well expressed on all accounts..Special thanks for mentioning MSF! As much as I’ve read to stay informed on this situation, I wasn’t aware about MSF. Will spread the word..
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People can be so selfish, it’s really sad! 😦 Fantastic article – very though-provoking
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Great write! Hopefully people will start to show some compassion and do something.
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Reblogged this on zobop republic and commented:
Africa is not poor. Just poorly managed. 😦
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great write
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Oh well, they both may.
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Very well said. I felt from the start that the reason the epidemic was so out of control in Africa is because the world at large doesn’t give a crap about Africans. They think that it’s “their” problem and never thought a step ahead to the fact that globalization could easily lead to the virus’ spread. Truly horrifying.
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Excellent.
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Could be correlated to the outbreak of swineflu and dengue towards the east…! The saturation point was reached and the shortage seemed to be manipulative in all respects. Agree with the views of few of the readers above..
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Reblogged this on Jarome Morrow and commented:
America is dying, from ebola. Except it’s not Ebola the disease. It’s the years of corruption from politicians who only do the will of those who funded their campaign. That’s the real Ebola in America !
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Thank you, thank you, thank you – for this smart, insightful piece. And especially for the shout out to MSF! Exactly. They are the best. I worked ‘in the field’ with another organization back in the 90s and MSF was the best back then and still are. That’s where I send my money.
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Reblogged this on The Awkward Moment and commented:
“We live in a culture that encourages the appearance of process, diligence, expertise, and concern for the community, but beneath the layers of filled out forms, checklists and the apparent following of procedure, is increasingly less effective, less diligent, less expert and less caring. ”
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Reblogged this on donkkku and commented:
Hit the nail on its head. The world is to see this as an ‘everyone’s problem’ and takle it as though it were here with us, and not go round blaming Africans for their mediocre health control systems.
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Reblogged this on Descriptions of the Nondescript and commented:
One thing science fiction does is imagine a future where large technical advances have brought change. We as a community rarely address the real issues of change at a societal level other than to pick some random event like a nuclear war over oil or environmentalism or something and run with it.
Maybe it’s time someone extrapolated the effects of the problem this article is showing so starkly. Maybe I’ll add it to my bucket of story ideas…
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Reblogged this on RidicuRyder and commented:
I’ve been a bedside RN for over 20 years. Incompetence is regularly appointed because the existing bureaucracy likes company (it also makes sense to surround yourself with a thick layer of scapegoats).
A sweeping correction is needed.
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Reblogged this on J. orphée Osako and commented:
That’s a real interesting write.
What could be done to save them?
Many countries around the world are collaborating to provide some assistance, however it’s not enough. According to some sources this virus is unsteady and is mutating really fast, currently there is any verification of this statement. To some extent we could think, those who could really help those people are waiting the increase of auctions…
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Hooked. Officially now stalking your every piece of writing.
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Some of it is…um… Not safe for work.
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Haha perfect! 😉
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can you now expose the unethical use of fear to stir the masses? I would like to see about 3.2 million politicians squirm uncomfortably. 🙂
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Great analysis. Our government seems intent upon offering the illusion of competence and security rather than the reality. It’s morally bankrupt.
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true
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