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.]

Followup: yes, the fever criterion for ebola definitely needs revising downward

The New Neo Posted on by

And that’s not the only thing that needs revising.

When I first heard the story about the Spanish nurse who has ebola, and compared it with that of Thomas Duncan, one thing leapt out at me: both of them reported to medical authorities initially with fevers of around 100 degrees, quite a bit less than the criterion of 101.5 for an ebola diagnosis. This was part of the reason their diagnoses were missed at first, and they were sent back into the community to put others at risk.

Obviously, everyone with a temperature of 100 can’t be screened for ebola, much less isolated. But if a person has a history of exposure to an ebola patient (as the Spanish nurse did), or has recently come from an area where the disease runs rampant and has other symptoms as well (Duncan fit that description), then a fever as low as 100 ought to qualify as another symptom of ebola.

More details of the Spanish nurse’s story only serve to solidify my impression and to underscore how the reliance on the criterion of a higher fever led the Spanish health care professionals astray.

Badly astray:

When Teresa Romero Ramos, the Spanish nurse now afflicted with the deadly Ebola virus first felt feverish on September 30, she reportedly called her family doctor and told him she had been working with Ebola patients just like Thomas Eric Duncan who died today in Dallas. Her fever was low-grade, just 38 degrees Celsius (100 degrees Fahrenheit), far enough below the 38.6-degree Ebola red alert temperature to not cause alarm. Her doctor told her to take two aspirin, keep an eye on her fever and keep in touch, according to Spanish press reports quoting Romero’s husband Javier Limé³n Romero…

…Romero discussed her slight fever and how she was feeling sick with friends and colleagues.

According to [the newspaper] El Paé­s, she talked incessantly about what the Ebola threshold was and, since she was far below it, they assured her not to worry””advice she apparently wanted to hear.

But even when she finally hit the ebola fever threshold days later, hospital workers didn’t seem alarmed. That is even more disturbing:

According to Spanish press reports quoting the Spanish nurses’ union, Romero called Carlos III hospital several times between September 30 and October 2 when her fever finally hit the 38.6 threshold. Still, it took until October 6 when she had become so deathly ill she was begging for an Ebola test before anyone at the hospital where she worked reportedly reacted. Then, rather than immediately isolating her and rushing her to the special ward used to treat the previous Ebola patients, they told her to go to the nearby emergency room at Alcorcé³n, where press reports say she sat in the public waiting room for several hours absent of any protective gear. “I think I have Ebola,” she reportedly told anyone who would listen. But no one took notice until her first test came back positive. By then, dripping with fevered sweat, she would have been inarguably contagious.

What was going on? Stupidity, denial, hubris, failure of public health authorities to communicate to hospital staff what ebola is about, all of the above?

At least they’ve learned—a little—from their errors:

Now a third nurse who also worked with the same Ebola patients who infected Romero is exhibiting the same low-grade fever. This time, authorities acted quickly to isolate her.

The blame game goes on:

Carlos III director Yolanda Fuentes told El Paé­s that the biohazard suits they provided did indeed conform with safety protocols established by the World Health Organization and the Spanish Ministry of Health. On Wednesday, German Ramfrez from the Chief Medical Internal Hospital in La Paz said it was Romero who erred when she touched her face with her infected glove as she undressed. Ramfrez told reporters at a news conference meant to quell panic that it was Romero’s “oversight”””not the Spanish medical community that has been blamed for its preparation for fighting the virus.

But the Spanish press report that the hospital was underequipped to handle cases and that rather than the Level IV suits they require, the Carlos III hospital only had Level II gear.

A horror story.

The Panetta interview with Bill O’Reilly

The New Neo Posted on by

I watched most of the Panetta interview on the O’Reilly show last night. Panetta tried to pull his punches in the sense that he kept offering tepid excuses for Obama that didn’t sound as though even he was convinced of their veracity. But much of what he said was a condemnation of the president he’d worked for—his judgment, and his personality.

Panetta actually seemed sincerely frightened or at least concerned about the situation, and I’ve seen quite a few other people around the blogosphere state the same impression of his demeanor. Of course, if he’d been that concerned, why didn’t he resign in protest back when the whole thing was happening, when his quitting might have actually done some good?

You can judge for yourself; here’s the full interview:

And this piece by David Ignatius is—unintentionally—funny. Ignatius says a “talent infusion” may be in the works for the Obama administration in its last two years. Ha! Even if that were true, it would merely be replacing one person Obama doesn’t listen to with another person he doesn’t listen to.

Unless it were Valerie Jarrett being replaced. And it won’t be.

[NOTE: Now none other than Jimmy Carter has joined the pile on.]

[ADDENDUM: Panetta also said he knew immediately that Benghazi was a terrorist attack. His reasoning was the common sense one given by a lot of people on the right: the weaponry used (see, for example, my first “Addendum” to this post written on September 12, 2012.)]

Thomas Eric Duncan has died of Ebola

The New Neo Posted on by

I was hoping he’d live, for many reasons. But despite being cared for in Dallas rather than Liberia, Thomas Eric Duncan becomes not just the first person to be diagnosed in this country, but the first person to die of the disease in this country.

RIP.

His death illustrates the fact that the disease can come here, and that treatment in this country (at least if begun in its later stages, which unfortunately was true for Duncan) is no panacea. The question of whether an earlier diagnosis would have mattered in his case remains open, but I’ve read that in general it can.

We have one of the better health care systems in the world. But if this thing is as contagious as some fear, or our response is as inadequate as some fear, the bell that tolled for Duncan could toll for many others. If an epidemic occurs and enough people are affected, even the best health care system in the world could be utterly overwhelmed by sheer numbers.

I’ve dealt before, briefly, with the question of whether Duncan was guilty of lying to authorities about his Ebola exposure, as has been claimed by Liberian authorities. I have notes for a longer piece on the subject, which I may or may not ever write. But the gist of it is that, the more I researched the question, the more convinced I became that the answer to it was “no.” Without going into a lot of detail in this post, I’ll just add that it’s based on things such as when he applied for his visa and purchased his plane ticket (way before his Ebola exposure), and that no one in his hometown knew that the woman they’d helped had actually died of Ebola until many days after Duncan had already left the country and come here. In addition, unless he was suicidal when he visited that Dallas ER room that first time, why would he not have shouted out to them that he’d been exposed to the disease, if in fact he knew it at the time?

Those questions are now moot in the sense that Duncan has died, although false accusations are still disturbing.

But now we turn to the very important question of the living. The wait continues for those who were exposed to the disease through him. Perhaps Duncan’s death can function as a wakeup call to those sanguine enough to have thought it couldn’t happen here, or that modern medicine could see Ebola victims through. Perhaps the end result of all of this will be a better response both by public health authorities, the government, and the medical profession.

One can hope, anyway.

Does this make sense?

The New Neo Posted on by

Now they want to kill the Spanish nurse’s dog as an Ebola precaution.

I like dogs, but I’m not a PETA-esque fanatic. However, I’m with the nurse’s husband on this—why not quarantine the dog for a while?:

In a letter posted to posted to Facebook by Villa Pepa Protective Association, an animal rights group, Javier Limon Romero, the husband of the infected nurse, Teresa Romeo, says an official with the Madrid health department told him “that they have to sacrifice my dog.”

“I was asked to give them my consent, but I obviously refused,” Javier wrote. “He said he was going to ask for a court order to forcibly enter my home and sacrifice Excalibur.”…

According to the Associated Press, “Madrid’s regional government obtained a court order to euthanize and incinerate their pet,” saying “available scientific knowledge suggests a risk that the mixed-breed dog could transmit the virus to humans.” It’s unclear whether they carried out the order.

“It seems unfair,” Javier wrote of the euthanasia order. “If you are really worried about this problem I think you can find another type of alternative solution, such as putting the dog in quarantine and observation as it has me. Or maybe you will have to sacrifice me just in case. But of course, with a dog it’s easier, it doesn’t matter as much.”

Authorities seem to careen wildly between not enough caution and too much. This seems like too much. After all, isn’t it sometimes the case that, if you want to bring a dog into a foreign country, it’s placed in quarantine for a while? (Answer: yes). Is that so incredibly difficult? After all, we’re not talking about thousands of dogs here. There’s only one involved.

And dogs are not known reservoirs for Ebola:

While some dogs in West Africa have tested positive for the Ebola virus, they showed no signs of being infected, Michael San Filippo, senior media relations specialist for the American Veterinary Medical Association, told the Pittsburgh Post-Gazette last month.

“There is more concern about fruit bats and nonhuman primates,” San Filippo said.

Isn’t this couple undergoing enough stress? Do they have to lose their pet, too?

Idiocracy.

Stunning disloyalty

The New Neo Posted on by

Dana Milbank writes an article parsing the recent spate of books by former Obama advisors (Gates, H. Clinton, and now Panetta) critical of his policies, especially his foreign policies. But in the entire piece he treats their motives as merely political and self-serving.

Now, I’d be the last person to say that self-serving politics—being miffed at Obama’s rejection of their advice, wanting to protect their own reputations and say “don’t blame me” in order to make sure they get the future kudos and positions they deserve, plus of course the need to sell books though the stirring up of controversy—isn’t very prominently in the mix. But isn’t it also possible that the “disloyalty” to the president that Milbank refers to as “stunning” is also motivated by some degree of loyalty to the US, the world, and its people? After all, if Islamist terrorism starts winning (forgive the outdated Bushian language) the War on Terror, wouldn’t that be a bad thing for all of us?

My guess is that people such as Milbank, who’s lived in Washington DC and written about the White House and other DC doings for umpteen years for the WaPo and other publications, and whose lives have come to center around politics, have stopped seeing anything but politics as the motivation for anything a politician may do. But although politics is a big, big thing, it’s not the only thing.

At least, let’s hope not. Let’s hope there are some patriots left.

Middle East: the world is watching…

The New Neo Posted on by

…and doing next to nothing as ISIS prepares to slaughter many of the remaining inhabitants of Kobani, a mostly Kurdish town on the border of Syria and Turkey:

…which is crammed with refugees””Kurdish, Turkmen, Christian, and Arab””from other parts of the Syrian charnel house. As many as 50,000 civilians remain in the town.

It’s not clear how many civilian residents are still in Kobani, however. This report indicates the above figure of 50K may be an overestimate, and only about 3,000 remain. Let’s hope the lower figure is correct.

It also describes Obama’s “strategy of containing the Islamic militants in Iraq and Syria” as now being “in ruins.”

I’m not sure you can dignify Obama’s response to ISIS as a “strategy” to “contain” ISIS, although that’s consistent with the way he describes it. It’s more like a tactic in the strategy of placating the American people with reassuring words so he can get through the 2014 midterm elections. And indeed, it may not be working.

But how on earth could anything like the following ever contain ISIS, or even a fighting group less determined than they, for that matter?:

There have been reports of airstrikes on ISIS vehicles, but so far, Bahjat [a Kurdish intelligence official] said that these strikes have been modest in scope and notably ineffective.

So we’re still bombing vehicles, when there are reportedly “9,000 ISIS terrorists armed with tanks and rocket launchers” assaulting the town.

But we’re not the only ones preparing to merely observe the slaughter:

Bahjat said he is receiving reports that Turkey is pulling its troops back, rather than risk armed confrontation with ISIS. “It’s unbelievable””Turkey is in NATO, so you literally have NATO watching what is happening in this town. Everyone can see it””the TV cameras are there, watching. It’s terrible.”

It’s not as though an ISIS victory wouldn’t affect the West, either, although that same West seems to have lost the will to act to prevent it. This is not just a humanitarian crisis, either, although it is certainly that. But in addition, the stronger ISIS gets, the closer to achieving its goal of a caliphate and the spread of sharia, the more money and weaponry it gains, the more recruits it attracts, the more likely it is to successfully pull off major terrorists attacks here.

We talk about leadership and how important it is. But never since Neville Chamberlain has it been so glaringly apparent that without it we flounder*. England was fortunate enough to have Churchill ready and waiting in the wings. We have two more years of President Obama.

[*I wrote “we flounder.” I hope it’s not the case that we founder.]

[ADDENDUM: More here.]