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17 October 2014

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shepherd

Thanks for reminding me about that strange book. The thing that always struck me about it is its journalistic verisimilitude. Of course, it's fiction, written more than fifty years after the events described. Defoe was one of the masters.

Dr K

"Others frightened into idiotism"
Sounds like the American people.

Fred

Dr. K,

Given the state of leadership from the Administration, particularly the Dr. of political correctness at CDC and the latest political insider lawyer appointed at Ebola fall guy, ah, Ebola Czar, the public should be frightened. Especially if they see a John Yoo sytle memo approving agregious conduct a few weeks from now.

William R. Cumming

Historical note: The FIRE SERVICE in the USA declined to be involved in radiological detection and protection policy and issues after WWII! This led to establishment of an independent civil defense effort.

Perhaps the perceived or actual failure of the for profit medical community to pull part or all of the EBOLA load will lead to better PUBLIC HEALTH PREPAREDNESS AND RESPONSE AND RECOVERY! Perhaps not!

Apparently no detailed study of EBOLA preparedness in the USA exists.

And now we have an EBOLA CZAR! Oops not called a CZAR!

rjj

The earlier term for this czar was point person. That appointment would make sense if his job is to be press/political pinata -- so somebody capable can do the heavy lifting behind the scenes in comfortable obscurity.

[/polyanna]

VietnamVet

RS

For clarity the Black Plague is caused by enterobacteria, Yersinia pestis, not a virus like Ebola. There is a vaccine and treatment with antibiotics. The reservoir is rat fleas and is transmitted to humans by flea bites or by direct and indirect contact or airborne transmission.
http://en.wikipedia.org/wiki/Plague_%28disease%29

Ebola has some of the characteristics of the Black Plague in the 14th Century. We do not know its reservoir nor have a vaccine or any treatment other experimental, palliative care, and isolation once infected.

We do know how to quarantine and prevent transmission of the virus. This costs a great deal of money and inconvenience. Full scale blood work to detect the Ebola virus has to be conducted on all contacts. All contacts have to be isolated. All persons traveling from West Africa have to be quarantined for 21 days until a blood test proves the person is free of the virus.


The deciders simply do not comprehend that to halt this epidemic they must make the hard decision that risk the economy and reduce their skimming of the profits. We may luck out and have only two cases in Dallas but until the epidemic is halted there will be more and more infected persons kicked out of America’s ERs because they have no health insurance.

Mali is right next door to the Ebola epidemic; soon one of God’s Warriors will carry the virus on his Jihad to the “Holy War”.

The Ebola Plague will show up in London. History rhymes.

toto

Using human carriers for an Ebola attack is not impossible, but it seems inefficient. You would need direct contact to infect people.

Now on the other hand, discreetly spraying bodily fluids over a large crowd (e.g. from the top of a building on a busy avenue)...

PeterHug

We do have a few advantages over 17th century Londoners in dealing with this. At the very least, we understand how transmission happens, what needs to be done to cut that down, and (in the US and EU at least) the resources to do a pretty good job at it. (Although as can be seen, the effort required balloons VERY rapidly if you want to be effective.)

The two problems I see going forward aside from the primary West African catastrophe are, (i) the very real possibility that someone will travel from West Africa to Karachi, Mumbai, Delhi, or some other similar megacity and become a new locus of uncontrolled infection there; and (ii) the unfortunate reality that for some time to come, anyone in the US suddenly afflicted with vomiting or diarrhea will need to be tested for Ebola, with accompanying disruptive and expensive disinfection of the locale, and quarantine of their contacts at least for a while. (This may become a significant issue in college towns, particularly on weekend nights...)

richard sale

I would agree. The bulk of the public seems timid and full of fear, qualities which help nothing.

Richard Sale

richard sale

You are absolutely right and I should have been more clear.

Richard

bth

An online reference to the book can be found here http://www.gutenberg.org/files/376/376-h/376-h.htm

It is a fascinating read I undertook last winter cover to cover. It is probably based on his uncle’s eye-witness account and converted into a composite fiction.
A couple of notes from this wonderful account. First people were driven initially by superstition for amulets and other potions but these peddlers of hope quickly vanished when the plague arrived for real. Is the arrival of charlatans an early indictors of trouble? When the plague seemed to stop at a parish line or skip a parish it was believed that they must be more righteous only to have the plague circle back with devastation striking wicked and righteous down without regard. Second, while panic often set it, I was stuck by the heroic attempts by families, churches and pubic administrators to maintain order and care and by the high fatality rates among these Samaritans. Third, I was impressed by the often rational reasoning conducted as to causes, actions and possible patterns of infection and early statistical efforts (though not called that by Defoe). People knew it spread by contact, the disease was tracked by parish and early quarantines were established with watchmen on the houses. Speculation about fleas, dogs and cats and places of animal butchery were being correlated. At markets people put their coins into jars of vinegar so merchants could avoid direct contact and some midwives survive by washing in vinegar. International merchants that had seen the plague in other countries either bugged out early or held up on ships in the Thames avoiding contact.
Several takeaways for the current crisis. First, almost right off the bat the rich folks bug out and with them they take the horses, wagons and money. There is not a housing shortage, there is a transportation crisis. Second, with the rich folks gone and the quarantines setting in, the poor starved and the economy collapsed. This only aggravated the bad situation and made the poor particularly vulnerable to disease and desperate. Law and order break down due to depravation not revolt. Timely charitable contributions from the church and the crown were critical to survival as the economy simply stopped functioning. This may very well be happening in Africa. Third, roaming bands of survivors try to make their way from the city on foot to the country where they might find food reach barricaded towns and roads. Now, we have sent troops into Africa without full protective gear on the promise they will not come into direct contact with the infected. But what happens when people stagger up to the front gates of the American military compounds carrying their dying children and when denied entry collapse in despair and disease on the ground around the compound entrances, or worse riot when they realize that soldiers attempt to avoid the locals? Direct contact is inevitable because the locals scared and sick will seek out the Americans in hope of salvation whether the US generals provide protective gear or not. Fourth, the author concludes there are two basic strategies for survival; one is to leave immediately when the plague shows up and get ahead of the crisis or barricade yourself up with supplies and ride it out by hiding out in residential compounds or on ships.
The TV series the Walking Dead has nothing on Defoe.

Cortes

In keeping with protocols used in the Gulf War, Iraq 2003 and Afghanistan I presume we can look forward to walkabouts and visits to troops deployed in Conakry, Monrovia, Freetown etc by inter alia Obama, Cameron and Hollande to reassure us all?

Cee

Richard,

so did the number of street astrologers, wizards and quack doctors.

Heh. This is happening now.

Something that strikes me concerns what should be done on a GLOBAL scaled with our trading partners. Everyone that we trade with should have a decent standard of health care. Without this in the age of globalization re: trade and travel, there is no controlling these kinds of things from being spread.

I also wish people were more selfless and would think about the consequences of their actions. The nurse traveled, another hospital worker who handled blood from the deceased Liberian got on a cruise ship. What is wrong with people?

optimax

With flu season almost here, people will become even more fearful when they see someone in public coughing and sneezing, and when they become sick will rush to the emergency room convinced they have Ebola.

The good news is it looks like Ebola is only highly infectious when the victim is near death or dead, spewing fluids like Linda Blair in The Exorcist.

An Ebola Czar seems absurd when we haven't had a Surgeon General for a year. Obama's appointee has been held up because of his anti-gun stance. but Obama should appoint someone less controversial at a time when it would be good for the country to have a single, trusted voice to assure the public everything is under control. To do that Obama would have to think outside his ideological box.

Cee

bth,

Ah thanks for the freak out. This sort of reminds me of Mel Gibson in The Road Warrior and a bit of the Book of Eli.

ex-PFC Chuck

VietnamVet: "For clarity the Black Plague is caused by enterobacteria, Yersinia pestis, not a virus like Ebola."

The authors of the book "Biology of Plagues: Evidence from Historical Populations," published nearly ten years ago, might take issue with your statement. At least that's what I get from the wheeze pitching the book at its website. I just recently ran across the publisher's web page and haven't read the book yet. Nor do I have any idea how well the argument was received by the relevant niches of the scientific community. But the fact that it has the imprimatur of the Cambridge University Press as opposed to, say, The National Enquirer suggests that it's based on serious scholarship.

ex-PFC Chuck

I intended to drop the URL of the Cambridge Press page in my comment but hit the "Post" button too soon. So, here it is:
http://bit.ly/1p7jywG

ex-PFC Chuck

Another pertinent piece from way back, albeit fiction: Edgar Allen Poe's "The Masque of the Red Death:"
http://www.online-literature.com/poe/36/

From the opening paragraph:
"No pestilence had ever been so fatal, or so hideous. Blood was its Avatar and its seal -- the redness and the horror of blood. There were sharp pains, and sudden dizziness, and then profuse bleeding at the pores, with dissolution. The scarlet stains upon the body and especially upon the face of the victim, were the pest ban which shut him out from the aid and from the sympathy of his fellow-men."

Poe was one prescient dude!

Walrus

Thank you for this work Mr. Sale, it is indeed timely.

What concerns me is the assumption that just because we know what causes the disease, how to stop it and have massive resources automatically means that we will escape the fate of Liberia et al. I disagree for one simple reason. Our economy and society is infinitely more complex and fragile than Liberia.

Consider the fact that at any given time, New York has approximately twelve hours food supplies in its stores. We have fully embraced "just in time" logistics philosophies. I would argue that while Liberia is "primitive" in comparison, as a result it is far more resilient. To put that another way, what proportion of Americans grow their own food, hew their own firewood and haul their own water compared to Liberians? WHat happens when our trucks stop moving?

Our very complexity should give us concern, A Dallas nurse flies across the country within days of treating a patient. Another is now on a cruise ship. The Liberians don't have our mobility which is perhaps why African epidemics have burned themselves out in the past.

To put that another way, what happens Ten days after a sick New Yorker takes the subway?

VietnamVet

Ex-PFC Chuck

The current Ebola Outbreak is a lot like the Black Plague due to our human responses to arrival of pestilence in our community. We are dependent on the government doing its job correctly. We cannot fight it alone. If the Shysters commandeer the response to make money and ignore science and mathematics, we are doomed.

ABC has a report on the controversy over the organism causing the Black Plague
http://abcnews.go.com/Health/story?id=117310
But, the following comment to this report is pretty convincing to me.
“Plague pits from the time of the Black Death have been uncovered recently, here in the UK, and DNA from Yersinia pestis, the bubonic plague pathogen, recovered from the teeth of the remains.”

Nature has a news report verifying Yersinia pestis was found in the remains.
http://www.nature.com/news/2011/111025/full/478444a.html

Aka

All,
I really don't think anyone who lives in a developed country with good medical facilities have to worry much about Ebola being a epidemic.

However anyone who's living in asia ( india for example with a large nos of expatriates in all over the world, including west africa ) should care very much about this causing real pandemic.

Babak Makkinejad

You wrote:

" Everyone that we trade with should have a decent standard of health care".

In case of Liberia, I think roughly half to two-thirds of their physicians live and work in the United States.

Over the last 30 years, US Government has passed legislation that, in fact, encourages foreign-educated physicians and nurses to re-locate to the United States.

rjj

Plutocrat spokesmodels with inclinations to think outside the box may not be inclined or allowed to take action.

By way of literature, Camus.

bth

An important take away i wanted to communicate in an earlier post is that in the Defoe book, the London economy stopped functioning for months. The poor quickly starved without money. They then began to migrate in great numbers to wherever they thought they could find relief. If a person were a member of a parish then there was some support and the orphans funds were raided which saved many. If we take the W. African current situation, we know that investment has been fleeing Nigeria and is probably nonexistent in Liberia. We need to be factoring temporary economic support into our military plans there immediately. Pay locals generously to clean up their communities, improve sanitation, make sure food supplies are delivered and that fuel is locally available. Sell soap and disinfectant at near give away prices through local merchants. Pay locals to build clinic facilities instead of using western military contractors.

nick b

I am surprised no one had mentioned "La Peste" or "The Plague" by Camus. Also an excellent novel about plague and the human condition. It was required reading for my brother prior to his beginning medical school. I snagged his copy, and despite the grim nature of the story, found it a very enjoyable read.

Here is a link to a first hand account of London's 1665 plague written by Nathaniel Hodges in 1672. This was a likely influence, among others, for Dafoe's work.
http://www.gutenberg.org/files/40106/40106-h/40106-h.htm

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