Again with the low-grade fever

The New Neo Posted on by

I’ve written that it seems that ebola can start with a low-grade fever for a while, and that the criteria for diagnosis should note that fact and not exclude people with other symptoms and risk factors because their fevers haven’t quite reached the 101.5 level yet.

Here’s even more evidence for that:

The CDC carried out further blood tests on Sunday that confirmed the [Dallas] healthcare worker’s preliminary positive result. Health officials said she had “mild” Ebola symptoms, including a “low-grade fever”.

Seems pretty clear at this point.

In other US-ebola-related news, the Dallas healthcare worker’s dog will be spared, unlike the Spanish one.

First case of ebola transmission in US is a Dallas health care worker…

The New Neo Posted on by

…who treated Thomas Eric Duncan.

I was wondering when the first US transmission would occur. I was hoping against hope it would not occur, but thinking that transmission was almost inevitable.

It is of interest that the first person to exhibit symptoms from US transmission is a health care worker who treated Duncan rather than a family member or friend who encountered him prior to his admission to the hospital. Of course, that doesn’t mean the latter group is out of the woods, not by a long shot. But it does suggest, if this pattern holds, that caring for an ebola patient in the later stages of the illness, even with protective gear, may be more dangerous than being around such a patient in the earlier stages—even though the delay in Duncan’s diagnosis meant that his family was around him, unprotected, as his symptoms become quite bad.

But the pattern of transmission here matches the pattern of transmission in Spain, which is that it occurred in the hospital under conditions that were supposedly in accord with recommended ebola-treatment protocol. And in each case, authorities have assumed there was a breach, and that this is what accounts for the transmission.

You may recall that the Spanish nurse’s assistant who got the disease had treated the Spanish priest (who’d been transferred to the hospital in the later stages of the illness, with authorities knowing full well what he had and employing the supposedly proper techniques to prevent transmission) very briefly, towards the end of his life, and then helped clean up his room after death. She is supposed to have breached protocol in the removal of her gloves, by touching her face. In the case of the Dallas transmission, it is also being blamed on a breach, this time an assumed one:

…[Dr. Daniel Varga,] a top federal health official said the health care worker’s Ebola diagnosis shows there was a clear breach of safety protocol and all those who treated Thomas Eric Duncan are now considered to be potentially exposed.

In addition [emphasis mine]:

…Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, on Sunday raised concerns about a possible breach of safety protocol and told CBS’ “Face the Nation” that among the things CDC will investigate is how the workers took off that gear ”” because removing it incorrectly can lead to a contamination.

“I think the fact that we don’t know of a breach in protocol is concerning, because clearly there was a breach in protocol,” Frieden said. “We have the ability to prevent the spread of Ebola by caring safely for patients … We’ll conduct a full investigation of what happens before health workers go in, what happens when they’re there, and what happens in the taking out, taking off their protective equipment because infections only occur when there’s a breach in protocol.”

Maybe yes. Maybe no. Maybe we just like to think that “infections only occur when there’s a breach in protocol,” because it’s even more frightening to consider that the current protocol may be inadequate. But one of the hallmarks of this particular outbreak has been that transmission to health care workers has been more frequent than in previous ones, and that sometimes the people who have been infected in this manner swear they’ve followed the rules. Officials have assumed the workers have breached protocol without realizing it, especially in Africa where conditions include heat and overwork, and sometimes poorly-trained personnel. But some of those who were infected there have been the top doctors working on the disease.

The fact that there have been two transmissions in the west, and both have involved health care workers who supposedly were in proper gear, is extremely troubling. But this entire thing is extremely troubling; we are in a heap of trouble. It is also very troubling (at least to me, although not very surprising) that officials don’t seem to take into consideration the fact that they may have to go back to the drawing board on protective gear.

And yet, what are the odds of seeing a West Africa travel ban here? I think they are very very low, unfortunately.

[NOTE: The article I linked to above is a model of how I believe reporters should be writing about Duncan and what he knew about his own exposure:

Duncan arrived in Dallas in late September, realizing a long-held ambition to join relatives. He came to attend the high-school graduation of his son, who was born in a refugee camp in Ivory Coast and was brought to the U.S. as a toddler when the boy’s mother successfully applied for resettlement.

The trip was the culmination of decades of effort, friends and family members said. But when Duncan arrived in Dallas, though he showed no symptoms, he had already been exposed to Ebola. His neighbors in Liberia believe Duncan become infected when he helped a pregnant neighbor who later died from it. It was unclear if he knew about her diagnosis before traveling.

Which of course doesn’t stop some people in the comments section there from blaming him.]

[ADDENDUM: One more thing—anyone who is involved in the treatment of this new case had better be extra careful. And each and every one of them deserves a medal, and combat pay. If you’re the praying sort, you might want to pray for them.

And for all of us.]

The wheels of justice…

The New Neo Posted on by

…grind slow, but they grind exceedingly fine.

Another story of a person falsely convicted of murder on flimsy evidence (in this case, testimony about a confession) that should never have been considered credible.

What an awful story.

Here are some more details on how it was that Susan Mellen was convicted of murder and sentenced to life without parole, and the efforts it took to free her.

One observation of mine: if a person is convicted, especially of a serious crime like murder, on the story of someone who says that person had confessed to them, and on almost nothing else, then that witness’s credibility is of the utmost importance. And yet in Mellen’s case, prosecutors appeared to have ignored the fact that the informant was a well-known serial liar.

We know that Republicans are the stupid party…

The New Neo Posted on by

But apparently they’ve gotten a tad better at countering the “war on women” this election cycle. Good.

My personal observation is that in 2012 the “war on women” caught Republicans flat-footed (what doesn’t?), and it really mattered. Quite a few of my friends/acquaintances seemed to swallow it hook, line, and sinker.

Of course, they were always going to vote Democratic anyway.

The decline of political rhetorical style

The New Neo Posted on by

The folks here decided to do an analysis of presidential speeches over time:

Using the Flesch-Kincaid readability test””the most well-known reading comprehension algorithm””Vocativ analyzed over 600 presidential speeches, going back to George Washington. We measured syllables along with word and sentence counts, and gave each speech a numerical grade. For instance, a grade of four means the content is accessible to a fourth-grader, while a grade of 12 corresponds to that of a high school graduate, a 15 to that of a college graduate and a 21 or higher to that of a PhD.

They found that speeches have grown less sophisticated over time, and that “despite President George W. Bush’s reputation as a poor speaker, Obama’s speeches are only slightly more sophisticated.”

I think that, although the language of Obama’s speeches may (accent on the “may”) be a bit more sophisticated and—er—nuanced—than that of Bush’s, the thoughts expressed in Obama’s speeches are less sophisticated, really remarkably so.

The study didn’t mention frequency of lies, either. We’re talking style here.

I found this comment very interesting:

It’s tempting to read this [trend over time] as a dumbing down of the bully pulpit,” Shesol explains. “But it’s actually a sign of democratization. In the early Republic, presidents could assume that they were speaking to audiences made up mostly of men like themselves: educated, civic-minded landowners. These, of course, were the only Americans with the right to vote. But over time, the franchise expanded and presidential appeals had to reach a broader audience.”

Maybe. But if that’s true, it’s definitely not just due to that. I’ve noticed that the level of discourse in general—not just of educated, civic-minded landowner men—used to be much higher. Look at letters, including letters from women, from the past. Look at plays, such as the plays of Shakespeare, which were meant to be understood and enjoyed not just by the educated but by the groundlings. Nowadays, most people can’t follow them, even with the CliffsNotes.

On the matter of Duncan’s temperature on his initial ER visit

The New Neo Posted on by

It was reported by the Dallas hospital that treated Thomas Eric Duncan that his temperature was only 100.1 degrees on his first visit to the ER, and this was part of the reason they didn’t red-flag him at that point. It was also reported that the nurse’s assistant in Spain called medical authorities for the first time at a point when her temperature was in that same range, and they dismissed her. For those reasons it seemed to me that the ebola protocols saying a temperature had to be 101.5 and above were incorrect and should be lowered when a patient had been exposed to the virus (as was the Spanish nurse) or was an arrival from an ebola country (as was Duncan).

I still think so, based on the evidence about the nurse.

But as far as Duncan goes—well, the hospital seems to have misinformed us again, if this report turns out to be correct:

Thomas Eric Duncan’s temperature spiked to 103 degrees during the hours of his initial visit to an emergency room – a fever that was flagged with an exclamation point in the hospital’s record-keeping system, his medical records show.

Despite telling a nurse that he had recently been in Africa and displaying other symptoms that could indicate Ebola, the man who would become the only person to die from the disease in the U.S. underwent a battery of tests and was eventually sent home.

Duncan’s family provided his medical records to The Associated Press – more than 1,400 pages in all. They encompass his time in the ER, his urgent return to the hospital two days later and his steep decline as his organs began to fail.

In a statement issued Friday, Texas Health Presbyterian Hospital said it had made procedural changes and continues to “review and evaluate” the decisions surrounding Duncan’s care.

It goes without saying that, if true, this would constitute a very good argument for negligence on the part of the hospital. Something—many things—seem to have gone extraordinarily wrong here.

No wonder the hospital is reviewing and evaluating.

Josephus Weeks, Duncan’s nephew, said the care his uncle received was “either incompetence or negligence.”

If the report is correct, I don’t see how anyone can argue with Josephus Weeks on that score. This is a much bigger error than any that have been alleged before on the part of the hospital in this case, particularly if the fever was flagged with that exclamation point. And (again with the caveat “if this is correct”), why did Dallas Presbyterian previously tell us Duncan’s temperature on that first visit was 100.1, if it was easily demonstrable that it was untrue? Did they expect to get away with that, or did they not even know how to access their own records?

This is truly awful.

Texas voter ID law struck down; Wisconsin’s halted

The New Neo Posted on by

This is one of the ways in which Democrats in power perpetuate more Democrats in power; the judge deciding this case was appointed by Barack Obama in 2011:

Less than a month before Election Day, a federal judge from Corpus Christi ruled late Thursday that Texas’ voter identification law is unconstitutional.

U.S. District Judge Nelva Gonzales Ramos equated the law, which passed the Texas Legislature in 2011 and has been in effect since last year, to the poll taxes of the Jim Crow-era South that were used to hinder minorities’ ability to cast ballots.

“The Court holds that S.B. 14 creates an unconstitutional burden on the right to vote, has an impermissible discriminatory effect against Hispanics and African-Americans, and was imposed with an unconstitutional discriminatory purpose,” Ramos’ opinion said. “The Court further holds that SB 14 constitutes an unconstitutional poll tax.”

The law required picture IDs.

This general subject of voter ID laws, pro and con, has been discussed in some depth previously on this blog several times (see this). IMHO, the Texas voter ID law did not constitute an unfair burden on any group, nor was it intended to, and it was passed to address an actual and/or potential problem that comes under a state’s power to deal with, and which is important to remedy and/or prevent.

Same for the Wisconsin ID law, which was blocked (although not decided) by SCOTUS today:

The court gave no reason for its action, as is routine for such emergency orders. But Justices Samuel Alito, Antonin Scalia and Clarence Thomas dissented, arguing that the court cannot block an appeals court ruling unless the lower court “clearly and demonstrably erred in its application of accepted standards.”

A victory for Democrats. Texas and Wisconsin are both important states, and the election is soon.

Texas will appeal the decision.

[NOTE: I’ve not read it, but this book by PJ’s J. Christian Adams on voter fraud sounds awfully timely. From a review by Andrew McCarthy:

A community-organizer president now has in his arsenal a politicized Justice Department that is every bit as much committed to fundamentally transforming the United States of America. The intrepid J. Christian Adams sounds the alarm on the systematic voter fraud that is changing our electoral landscape. Will we listen?

We are listening. But if the liberal courts overturn laws the people pass, it certainly makes it more difficult.

Adams’ book can be downloaded for free until the election.]

Spain: it was the nurse’s fault

The New Neo Posted on by

It doesn’t look good for the Spanish nurse in Madrid who contracted ebola while caring for an infected priest who’d been brought back from Africa. And, in today’s current climate of passing the buck, the Spanish authorities are passing it to her:

The health of a Spanish nurse with Ebola worsened on Thursday and four other people were put into isolation in Madrid, while the government rejected claims that its methods for dealing with the disease weren’t working, and blamed human error.

Not their human error. Hers:

Ruben Moreno, health spokesman for the ruling People’s Party, said Romero had told another doctor at the hospital that she had touched her face with her protective gloves.

“It’s obvious that the patient herself has recognized that she did not strictly follow the protocol,” he said in a television interview.

I don’t know exactly how these suits are supposed to work, but I would think it’s a poor design whose protective value can be thwarted by such a simple—and almost reflexive—move. Why do I see goggles and face masks in most of the photos of ebola hazmat suits? Did Spain not provide them? How was the nurse’s face left so exposed? If the face touching happened as she was taking the face mask off, I could understand it a little better, but surely there must be some protocol to avoid the almost inevitable problem a person would face during that required maneuver?

And what’s up with this with touching her “face” business? I thought the official word was that a person had to touch his/her eyes or mucus membranes to contract the disease; simple unbroken skin just wouldn’t do. But, as with much of the official word we’ve heard so far, perhaps that’s wrong.

Then there’s this:

Health workers — whose unions have called for Health Minister Ana Mato to resign — said the training and protective suits provided to hospital staff had been inadequate…

Another doctor, who cared for Romero and was among those now in isolation, said the sleeves on the protective suit he wore while handling her had been too short.

In a letter to healthcare authorities, published by national newspaper El Pais, the doctor detailed treating Romero while on a grueling 16-hour shift during which he was not told she had the Ebola virus. He said he only learned of this via the press

Talk about informed consent!

It’s not as though this happened in an understaffed, overburdened hospital in some poor area of Africa, where they lack the money for proper protective gear, and the number of ebola patients is overwhelming the already-inadequate system. This is a major hospital in Madrid—and, what’s more, the ebola-stricken priest was one of only two ebola victims in the country (at the time, anyway), who were brought back for special treatment in a unit one would think had received state-of-the-art training and equipment.

One would think.

If a situation had been specifically designed to undermine faith in our ability to deal with a disease such as ebola, it would be hard to imagine a better one than this.

[NOTE: By the way, it may or may not be relevant to this particular incident (although I think it probably is relevant), but Spain has socialized medicine.]

What did they know…

The New Neo Posted on by

…and when did they known it?:

As nearly two dozen Secret Service agents and members of the military were punished or fired following a 2012 prostitution scandal in Colombia, Obama administration officials repeatedly denied that anyone from the White House was involved.

But new details drawn from government documents and interviews show that senior White House aides were given information at the time suggesting that a prostitute was an overnight guest in the hotel room of a presidential advance-team member ”” yet that information was never thoroughly investigated or publicly acknowledged…

The lead investigator later told Senate staffers that he felt pressure from his superiors in the office of Charles K. Edwards, who was then the acting inspector general, to withhold evidence ”” and that, in the heat of an election year, decisions were being made with political considerations in mind.

“We were directed at the time .”‰.”‰. to delay the report of the investigation until after the 2012 election,” David Nieland, the lead investigator on the Colombia case for the DHS inspector general’s office, told Senate staffers, according to three people with knowledge of his statement.

Nieland added that his superiors told him “to withhold and alter certain information in the report of investigation because it was potentially embarrassing to the administration.”…

Whether the White House volunteer, Jonathan Dach, was involved in wrongdoing in Cartagena, Colombia, remains unclear. Dach, then a 25-year-old Yale University law student, declined to be interviewed, but through his attorney he denied hiring a prostitute or bringing anyone to his hotel room. Dach has long made the same denials to White House officials.

This is the way they roll. This is the way they’ve always rolled.

It’s not really about whether Dach was actually guilty or not, although of course that’s relevant. But as is often said, it’s not the crime, it’s the coverup:

Former and current Secret Service agents said they are angry at the White House’s public insistence that none of its team members were involved and its private decision to not fully investigate one of its own ”” while their colleagues had their careers ruined or hampered.

Ten members of the Secret Service ”” ranging from younger, lower-level officers assigned to rope-line security to seasoned members of a counterassault team ”” lost their jobs because of their actions in Cartagena. The agents were told that they jeopardized national security by drinking excessively and having contact with foreign nationals.

They were treated “radically differently by different parts of the same executive branch,” said Larry Berger, a lawyer who represented many of the agents, who were union members of the Federal Law Enforcement Officers Association.

Given the renewed focus on the Secret Service after recent reports of a series of security lapses, Rep. Jason Chaffetz (R-Utah) wrote to White House chief of staff Denis McDonough last week voicing concerns that “steps were taken by the Administration to cover-up or deflect” White House involvement in the scandal.

I’m not surprised…

The New Neo Posted on by

…that this is happening.

I’m surprised that it’s happening in Nebraska:

A Nebraska school district has instructed its teachers to stop referring to students by “gendered expressions” such as “boys and girls,” and use “gender inclusive” ones such as “purple penguins” instead.

“Don’t use phrases such as ”˜boys and girls,’ ”˜you guys,’ ”˜ladies and gentlemen,’ and similarly gendered expressions to get kids’ attention,” instructs a training document given to middle-school teachers at the Lincoln Public Schools.

“Create classroom names and then ask all of the ”˜purple penguins’ to meet on the rug,” it advises.

Come to think of it—“purple penguins”? In middle school? These people will be laughed out of the classroom—although it’s really not that funny (I wonder if laughter will get a student sent to the re-education camps).

More:

The instructions were part of a list called “12 steps on the way to gender inclusiveness” developed by Gender Spectrum, an organization that “provides education, training and support to help create a gender sensitive and inclusive environment for children of all ages.”

Other items on the list include asking all students about their preferred pronouns and decorating the classroom with “all genders welcome” door hangers.

If teachers still find it “necessary” to mention that genders exist at all, the document states, they must list them as “boy, girl, both or neither.”

Furthermore, it instructs teachers to interfere and interrupt if they ever hear a student talking about gender in terms of “boys and girls” so the student can learn that this is wrong.

“Point out and inquire when you hear others referencing gender in a binary manner,” it states. “Ask things like . . . ”˜What makes you say that?…”

I can imagine a middle school student patiently explaining “well, you see, boys have penises and girls have…”

Once again, the re-education camps.

[NOTE: These people, described in a previous post, were the vanguard. Actually, all campaigns for gender-neutral language—even ones that may have seemed innocuous at first (“firefighter” for “fireman,” for example)—were the vanguard.]