Simple Minded Man

To the Tune of "Simple Man" by Lynyrd Skynyrd

Mama told me when I was young
Don't touch that stove, my only son
And try to understand what I say.    
And if you do this
You'll get it some sunny day.
Take your time... Don't think too fast,
Exams will come but you won't pass.

Good luck with women, brains you're void of,
And don't forget son,
Her, you're surely unworthy of!

[Chorus:]
And be a simple mind-ed man.
Be someone who cannot understand.
Baby, be a simple minded man.
I know you'll do this for me son,
'ts-All you can.

Forget your lust for the rich man's gold
It's out of reach for your dumb soul,
You couldn't get rich if you tried.
All I can hope for you my son,
Is to be cookin' fried.

[Chorus]

You need to worry.
You'll lose yourself.
You've got no brains,
And no prospects.
You can't do this,
If you try.
All I can hope for you my son,
Is to be cookin' fried.

[Chorus]

Baby, be a simple, be a simple man
Oh, be someone who cannot understand
Baby, be a simple mind-ed man 

What if Ebola Spirals Out of Control in the US? (Part 4)

Table of contents, so far

• Part 1
• Part 2
• Part 3

October 23, 2014 11:10 am, Dallas, TX

John Thomas could not believe what he was watching on TV right now. Erin Burnett was describing on CNN how the CDC were looking for a man in security footage obtained from Lone Star X-Fit. The footage, which they were playing on repeat, showed a man described as about 5 ft 11, 210 pounds, grabbing a short girl, throwing her to the ground, and walking out the door.

The girl in the video was Melissa McElroy, the receptionist at Lone Star X-Fit, and was being touted as a hero for saving the life of Denise Weinstein, who moments before had tried to enter the fitness establishment where some thirty people were exposed to the Ebola virus. Seven of those thirty, including Miss McElroy and a volunteer firefighter, Billy Blount, were admitted to Texas Presbyterian last night - all within an hour of each other, which was described as being much more synchronized than they would've expected. There was an eighth patient, too - but they said she had no known connection to Steve Thomas.

John grabbed some more chips out of the bowl and used them to shovel salsa into his mouth. This was insane. He could not believe the authorities had video of him throwing that girl on the ground. But what was he supposed to do? Just stay there? With Ebola-boy puking all over the place? He felt bad for throwing her out of the way, but he had to get out of there, and frankly, so did all of those other people. If he hadn't done that, It would've been a whole hell of a lot more than seven people who got it.

"So what the hell do I do? Turn myself in? Everybody's gonna call me a jerk because I pushed her out of my way. Or a coward. Hell, they might press charges! Fuck fuck fuck. What do I do?" He thought to himself as he plopped another chip into his mouth.

"Jesus, John! Leave a little for the rest of us, huh? What's with you, anyway? You seem like you're somewhere else!"

"Wha? Oh, sorry guys. I'm just preoccupied with all the craziness."

"What - you think you might have Ebooooola? Hey, Jimmy - John thinks he's got Eeeebooooooolaaaa!"

"Nah - I don't think that. It's just freaky, ya know?"

"Ha! Look - even with all the people who have it here, it's still nothing compared to the flu. Quit worrying."

At this moment, CNN changed the video they were playing from the crappy indoor security camera, to an outdoor shoot of John walking out of Lone Star X-Fit and getting in his BMW. A few seconds later, he backs out and drives off. CNN then repeated the entire shot; as he was walking to his car, he looked up - almost directly into the camera, and CNN froze the shot on his face. They zoomed in, showing a grainy, highly pixelized, but still very recognizable picture of John.

He stared choking on his chip. He grabbed his water and started trying to wash out his mouth, but his reflexes kicked in, and he started coughing.

"Hey, John - this guy on TV looks a bit like you. He even drives the same car. Ain't that some shit, huh?"

John, still coughing, tried to look nonchalant. He shook his head.

"John, hey - is that you?"

John started sweating. "Oh crap - they know." He couldn't control his coughing now, and it included a scratch at the back of his throat. He watched as a particle he coughed out of his mouth flew across the table and landed on Mike's hand.

"John - seriously. Is that fucking guy you? Were you there on Monday?"

John realized there was no denying it now. Not really. He nodded. In between coughs, he pleaded his case, "but look - I'm not sick. Everybody else got sick yesterday. I'm fine!" "You have no idea how scary that was. I was right there! That guy, Steve - he was just out. I saw him jogging just a few minutes before. I had to get the fuck out of there!"

Mike was already calling the CDC. "Dude, this isn't cool. I can't believe you did this! And you still came to lunch, too! What the fuck?"

John started to feel like he needed to leave. He stood up. Mike got up, too. "John - you can't go anywhere."

"Yeah. You're right." John made a motion like he was going to sit down, but at the last moment, he bolted for the door. Mike ran after him, but John was fast. A waiter was in his way, so John pushed the waiter onto the table, making him spill three orders of scalding hot fajitas on the unlucky patrons seated next to the door. A second later, and John had made it outside.

Freedom. But now what? John fumbled in his pocket for his keys, and got in his car. He thought for a moment about the fact that he was stranding his friends at the restaurant, but then suppressed the guilt, and drove off.

"Yeah - CDC? My name is Mike Goldberg. I know who the guy at the gym was. Yeah, the guy who knocked that girl down trying to get out the door. I'm 100% certain. His name is John Thomas. He's a lawyer at my firm, and he just left us at La Cucaracha Mexican Grill over here at the corner of Alamo and Broom. Yeah - we'll wait here. He's driving a 2014 BMW 740i. Midnight Blue."

What if Ebola Spirals Out of Control in the US? (Part 3)

Table of contents, so far

• Part 1
• Part 2

Forward

Since yesterday's installment, there have been 7 Ebola scare incidents. Two of them, both in Spain, resulted in the quarantine of a total of six individuals. One, in New York, involved an elderly man on a flight from Nigeria. He reportedly vomited mid-flight, and expired before the plane could land at JFK — one of the busiest airports in the world.

In what I regard as a stunning display of the hubris I talked about in part 1, the CDC boarded the plane (leaving the door from the jetway to the terminal wide open), gave a "cursory" inspection of the body, declared that it was not Ebola, and allowed everybody to leave.

When Patrick Sawyer flew to Lagos, Nigeria on the 8th of September, he brought Ebola with him. In fact, he went to Nigeria against the wishes of the medical staff at the hospital he was leaving in Liberia. Doctors in Nigeria treated him, at first, for malaria, because he claimed he had not come into contact with Ebola. Malaria does not communicate directly between humans, so the use of protective gear would have been minimal. Sure enough, Sawyer's hubris cost the lives of 19 Nigerians who perished because they tried to save Sawyer's life.

With those grim thoughts in mind, I present part 3:

October 22, 2014 7:45 pm

Steve bolted up from sleep. He'd been having a nightmare, and he was soaked in sweat. The room was dark, and something was beeping next to the head of the bed. As he looked around, the first thing he noticed was a window on the door, with small wires embedded in it. That was odd, because Patty's bedroom didn't have anything like that. "Where am I?" he thought to himself.

He turned his head the other way, and found the source of the beeping. "Oh - I'm in a hospital." His head started pounding. "What the hell happened? Was I in a wreck?" He felt nauseous, and rolled onto his side. Before he could piece any more of the puzzle together, his mouth opened and a stream of vomit came forth. "Jesus!" He frantically searched for the call button. The beeping's pace increased. There it is. He repeatedly tapped the button.

When the door opened, he was confused to see the Michelin Man in the doorway.

"What the hell is going on?"

"Mr Thomas, you've been unconscious for 2 days. You're in Emory hospital, in Atlanta, Georgia. You were transferred here because you've contracted Ebola. Your girlfriend, Ms Klein, is in the next room."

Steve stared in disbelief. He turned his head towards the vomit, and recoiled when he realized it was mostly blood. "Holy shit! Am I going to die?"

The Michelin Man did not have great bedside manner. "Probably. There's a good 80% chance of that, given your lack of response to the infusion of Dr Brantley's blood serum we gave you. If you make it through the night, your odds improve."

"Oh..." Steve laid his body back down, fighting the urge to cry. He wasn't sure why, but he didn't want the Michelin Man to think him any less of a man.

As he sat there, confused and alone - except for this stack-of-tires which was now using a shovel to scoop up his vomit - he tried to remember what had led up to this. He had a sense that he had flown recently, and a vague recollection of fluorescent lights passing overhead, while... aliens? No, that made no sense. "It must have been people wearing haz-mat suits," he thought to himself. "Oh... that's what's going on! That's not the Michelin Man. It's a guy in a haz-mat suit. This one's puffy, though. Why?" That last word suddenly became something to focus on for Steve, and his mind repeated it: "Why? Why? Why?" It became a mental mantra, which he synchronized to the beeping of the heart monitor.

October 22, 2014 8:30 pm, Decatur, Georgia

"Shit. Guess he wasn't that strong, after all. Okay - start writing the press release. Steve Thomas fought valiantly, but finally succumbed to Ebola Virus Disease at 8:!5 pm. His girlfriend, Patty Klein, remains in critical condition. Amber Vinson is in stable condition, and only being kept here at this point out of an abundance of caution."

Doctor Ravi Kumar had no accent; he had been born and raised in Atlanta, Georgia. Despite what television would have us believe, most urban dwellers in the South don't actually have "Southern Drawls," let alone that exaggerated Red Scarlett accent that so many Hollywood productions portray. Doctor Kumar actually sounded a lot like Tom Brokaw. He had been working long hours since it was first announced that Vinson would be transferred to his isolation ward. He wanted to be damn sure that Emory continued to live up to its name and not make any of the mistakes which Texas Presbyterian had made.

So far, things were going fairly well, despite Mr. Thomas's expiration. Although Ms. Klein was in critical condition, she showed signs of heading toward convalescence - her breathing had calmed and her fever had come down a half a degree. She hadn't thrown up in over a day, too, so it looked like she'd turned the corner. If he had to guess, he'd put her odds at 50% right now. Which was pretty good, considering yesterday he thought she was a goner. But then, this morning, he thought that Mr. Thomas had a pretty good chance of surviving. That guy was in peak shape - a real athlete.

Dr Kumar went to the doctor's lounge, and sprawled out on the sofa. He turned on the TV. "Oh man, the news is going to go ballistic when they hear about Mr Thomas," he muttered to himself. "Okay, Megyn Kelly, what are you talking about today? Still whining about the lack of a travel ban?" He tuned the TV to Fox News.

BONNNNNG! "And we have a Fox News Alert with breaking news now that Texas Presbyterian hospital in Dallas has taken in a total of EIGHT patients in the past hour, all with suspected Ebola," Julie Banderas reported. "This as New York City's Mount Sinai isolates three patients, and Denver's Porter Adventist admits two patients."

Dr Kumar sat up. He had been expecting inconsequential talking head nonsense, not synchronized suspected Ebola cases. There had been a ridiculous number of suspected Ebola cases since the beginning of the outbreak, and 95% had turned out to be false alarms. On one day, October 16, there had been ten suspected patients, and all had been negative - even that guy who flew into JFK. He felt a bit uneasy, though. This was thirteen patients in one day, and as far as he could tell, they were all at the same time. What the fuck was going on?

October 22, 2014 9:00 pm, New York, New York

"All three? That can't be right. Test them again. Your samples or your equipment are contaminated. Sterilize everything"

October 23, 2014 10:35 am, Dallas, TX

Gertrude O'Reilly could not understand where she had gotten Ebola from. She was in Texas Presbyterian's isolation ward, and was surprised to see that the nurses treating her were covered, head-to-toe, in garbage bags. "We're out of hazmat suits," they told her. "We're having to improvise, again."

The CDC investigator, though, was in a full haz-mat suit. He had a hood over his head that made it a little difficult to understand him unless he yelled. He had been interviewing patients since 7:00 this morning. "You're sure you've had no contact with Patricia Klein, Steven Thomas, Amber Vinson, Nina Pham, or Thomas Duncan? You're positive?"

"I may be old, but I'm not senile yet. Hell, if it wasn't for this Eloba, or whatever it's called, I'd probably live another 20 years! Look: I've got a daily routine: I get up, I get dressed, I go to IHop for eggs and bacon, I go to the senior center for a few hours, I go home. Sometimes my grandkids come to visit, but it's been weeks since they've been by. Their mother is such a germophobe. Would you believe she took her kids out of school the day that Thomas Duncan was announced to be sick? She's been homeschooling her kids and staying inside for almost a month now! It's crazy - she's got about as much risk as I do of catching Eloba."

"Ma'am, was there any break in your routine in the past few weeks? Anything out of the ordinary?"

"I don't think so. The other day, Beatrice told me that the senior center had hired a new gardener. Manuel, I think his name is. She said she wanted to seduce him. That Beatrice - she's a bit of a whore, you know. You think she could've had the sex with Manuel and caught the Eloba from him? Given it to me? That little old bitch!"

"No, ma'am. That doesn't sound very likely..."

"Well, you know, she told me that back in the sixties, she caught gonorrhea twice. From TWO different men! It's a wonder she didn't get that AIDS stuff and die decades ago. And now she's gone and given me Eloba."

"Ma'am, we really don't think Beatrice transferred Ebola to you from the gardener..."

"Well, how do you suppose I got it, then?"

"Okay... Let's come back to that. What sort of medications are you taking?"

"Medications? Well, that's a pretty long list. Can't you just look on my chart? It's all in there, I'm sure. Maybe it was that Kelly. You know, she's an 'Artiste.' Always making clay pots and stuff. Why, I'll bet you she got some dirty African clay to spin, and then she touched me. That damned Kelly. I never liked her. She's so pretentious. 'Oooh, look at my pot I made! Isn't it just delightful, with these little smiley faces and flowers I carved in the side? I'm going to the farrrrmer's market this weekend, and I'll bet I can sell it for five dollars!' You know, that would barely cover the Fiber-One I bought the other day. Can you believe that stuff costs FOUR dollars and sixty eight cents? Before that Obama took office it was Three dollars and twenty-two cents. I tell you, inflation's going to ruin this country before Eloba does."

"Ma'am?"

"Kelly. That little bitch. I tell you what - after I get out of here, I'm gonna give her a piece of my mind."

"Ma'am! You said you bought some Fiber-One the other day?"

"Yes - yes I did. I had exact change, too. There was a damned brat behind me. Didn't even want to wait for me to fish out three pennies from my purse. You know, he sneezed on me! Little bastard. I hope he's got Eloba. That was... When was that? Oh - three days ago. That's right. I was late heading to the senior center and almost missed out on the first round of Gin Rummy."

The CDC investigator suspected this was Steven Thomas, and that he not only had Ebola, but he was dead.

"Ma'am, was this him?"

He fumbled through the manilla folder to retrieve a printing of a photo of Mr Thomas. The gloves did not make this easy.

"I don't know. Could be. Yeah. I think so. That bastard. He was tapping his feet while I counted my change. The nerve."

"Ma'am, this is Steven Thomas. He died last night at about 8:15pm, from Ebola in Atlanta."

"Atlanta? I haven't been to Atlanta in years! You know, the last time I was there was with my grand-kids. We had a layover coming back from Disney. Six hours in that airport. With my grand-kids! Can you imagine?"

The investigator got up, relieved to figure out that she had caught Ebola from patient four, and not an as-yet unknown patient. There was still a chance of nipping this thing. He hadn't gotten any news about the patients in Denver yet - he was hopeful that was just hysteria, which was way more contagious than Ebola. He was trying to figure out how the three in New York had caught it. Maybe they just flew in? He didn't really know much about them.

It took him 35 minutes to remove his haz-mat suit. He'd taken to wearing adult diapers whenever he put on the suit, because sometimes you just have to go. He sent an email on his iPad to the head investigator with his findings: all eight of the patients had contact with Mr Thomas, even the little old lady. He would have to come back and begin tracing all of their contacts after lunch.

He got into the rental car, and asked Siri where he could get some sushi. Sushi in Dallas - seemed kind of odd, but he really had a yen for it today. He asked Siri for directions, and started driving off. He turned onto Walnut Hill Lane, and turned on the radio.

"Four patients were admitted to Baylor University Medical center this morning, when a single mother and three children — one of them an infant — came in to the emergency room. All four were presenting with Ebola-like symptoms. Baylor says it's likely just the flu, but they have been put in isolation out of an abundance of caution..."

What if Ebola Spirals Out of Control in the US? (Part 2)

Forward

Since I wrote yesterday's installment, we've learned the name of the second Dallas nurse, Amber Vinson. We've also learned that during the observation period, she flew to Cleveland, Ohio, and amazingly was given the all-clear by the CDc to get on an airplane despite having a 99.5º fever. The number of exposed people is now easily in the hundreds. Not just health-care workers, but also:

• anybody on that flight
• anybody who subsequently boarded that plane before it was grounded
• anybody in either of the two airports
• her family and fiancé in Ohio
• any friends she visited in Ohio
• The seamstress who worked on her dress (I'm assuming she underwent that ritual while she was in town).

It sounds like she was asymptomatic, and therefore not contagious, until she got to the airport on October 13, so her family, friends, and other people she visited in Ohio are probably okay, but you've got to figure all of the people I just listed are pretty freaked out right now.

If you haven't read it yet, you may want to go read part 1 before proceeding. So, without further ado, here's part 2.

October 20, 9:15 am

Steve Thomas woke up in a haze, but he could tell that there was quite a commotion going on around him. "What happened?"

"Sir, I'm with the Dallas metro fire department. Name's Billy. You passed out, you've got a nose bleed, and you're showing a fever of 100°. It looks like you need to get some rest and... Aw, shit."

Steve had turned his head to the side and vomited. He could see the eggs he'd eaten, as well as small chunks of bacon and nasty tufts of what he assumed had been bread. He'd gotten it all over the fireman's lap. He noticed that the consistency of the puke didn't seem quite the same as other times he'd been sick. It seemed almost... bloody.

"Well, that's pretty nasty," the fireman joked. "Gee, I don't suppose you just got back from Liberia or something?"

"No, but..." and Steve threw up again, this time into a towel that Melissa had brought over for him. His phone started to ring again. "... never been to Africa, but..." and he passed out a second time.

Melissa dropped the towel in disgust as she grabbed another to wipe the vomit off of her hands. She heard Steve's phone and looked at it on the ground next to him. It was Steve's girlfriend, Patty, calling. She looked back at Steve, who was passed out again. By now, a crowd had formed around them. One guy had his cell phone out, filming the whole episode. She picked up the phone, and swiped the "answer" slider over.

"Hey, Patty, it's Melissa. Steve's passed out. Yeah, out cold. He threw up all over the paramedic, or fireman - whatever. Yeah... Yeah... What? He never mentioned that to me. Holy SHIT. You're serious? Fuck fuck fuck. Uh... What do I do? Hey, uh... firefighter?"

The fireman looked over at her, "Name's Billy. What is it?"

"His girlfriend Patty is heading to the hospital right now. She's been throwing up, too. She's a nurse over at Texas Presbyterian, and..." she hesitated, knowing this last bit would cause some commotion.

"And?" Billy prompted.

"And she worked on Thomas Duncan."

"Oh, fuck." Billy had been really professional prior to letting that f-bomb slip. "Uhh... okay. Everybody, step back, but DON'T LEAVE. We don't want anybody to track any of this puke out of here, willy-nilly. Uh... what's your name, miss?"

"Melissa."

"Great. Melissa, can you lock the doors?" She began running to the doors. Another customer was heading in for a morning workout. She motioned for them to turn around, and locked the door.

Denise Weinstein couldn't believe the audacity of that girl from the gym. Why the hell would she be locking the door at this hour? It made no sense. Denise marched right up to the door, and started knocking on the glass. "What gives, missy? I'm paying damned good money to work out here! Open these doors right now! I have to finish my workout early - I'm meeting my friends for lunch and can't be late!"

Melissa pointed at at Steve. Denise, dumbfounded, screamed through the glass, "So fucking what?" Melissa looked her in the eye, a tear running out of her own eye, and screamed, at the top of her lungs, "YOU DUMB FUCK! HE'S GOT EBOLA!"

Apparently, Lone Star X-Fit's customer base weren't the sharpest knives in the drawer, because they had not put together the implication of the name Thomas Duncan. Only now did they start to understand the fact that they were, at this moment, being exposed to the Ebola virus which only three weeks prior had never been transmitted on the North American continent.

The crowd backed away from Steve, like oil in a sink when a drop of Dawn is dropped in. The guy with the cell phone grabbed his backpack and began heading for the door. Melissa, between him and the door, said, "Hey, uh - where do you think you're going?"

"As far away from Ebola-boy over there as I can get. Get out of my way."

"Look, I'm no doctor or anything, but if you inhaled any of that puke, you've already got it, right?"

"Yeah, and if I didn't, then every second I'm still here is more of a risk. Now. Get the fuck out of my way."

"Sir, if you've got any on you, you could contaminate the outside world."

"Look. I'm leaving. You can try and stop me." He grabbed her by the shoulders, not realizing that she had Steve's vomit all over her, and threw her to the ground. He grabbed the lock mechanism on the door, turned it clockwise, and pushed his way through the door. Denise stepped to the side, and watched as cell-phone guy wiped his nose, undid the carabiner holding his keys on his backpack, and got in his BMW. Melissa got up and watched as cell-phone guy pulled his phone out again and placed a call. He put the phone to his ear, the key in the ignition, and backed out of the parking spot.

She started to head to the door to lock it again. Denise was already returning to her Escalade. Melissa heard a commotion behind her, and turned around. All of the other customers had decided that cell-phone guy was right; they needed to get out of there, immediately, and were walking to the exit.

"Everybody, you've got to stay calm and don't leave! You're going to spread this thing to your friends and families!" It was useless, though. They were already pushing her out of the way and there was nothing she could do. She sat on the bench that Steve, just moments before, was trying to get to. She felt the tears welling up, and as the last customer left, she began sobbing, and looked at her hands. They still had a film of Steve's vomit despite having been wiped.

As she was crying, another man came to the door, saw the man on the ground, and asked, "what the hell's going on?"

She looked up and said, "Ebola." As the man turned around, she got up and locked the door again. Billy was on his radio, talking with dispatch to try and figure out what the hell to do. "Melissa, you guys have records of who's been here? Video, maybe?"

Melissa was entering a weird, robotic state of shock. "Uh... yeah. There's a sign-in sheet, but the regulars don't usually bother with it. There's security cameras. I don't really know where the recorders are, though. You'll have to call my boss, Bob. His number's on the little sheet of paper taped to the inside of the desk over there."

"Hey, Billy? You've got more help coming, right?"

"Yeah. I'm just a volunteer fireman and paramedic. I just happened to be coming out of the Jiffy Lube when the call went out. There should be an ambulance here any second."

"Can you tell them to bring some clothes? I'm going to go take about fifty showers."

"That's actually a pretty good idea. I'll be right behind you."

Part 3

What if Ebola Spirals Out of Control in the US?

Forward

We're told there's no risk of it happening, that we know how to stop it. Yet, we're incapable of stopping it in West Africa, and expect to see tens of thousands of new cases there per week by next month. If there's one thing that precedes any calamity, it's hubris. When the Titanic set sail, it was proclaimed to be unsinkable. Subprime mortgages and their derivative investments were thought to be unstoppable.

I sincerely hope that the administration is correct when they tell us they know how to stop it and that it will not spread beyond its current confines in Dallas, TX; Madrid, Spain; and West Africa.

On the other hand, I have a morbid fascination for this outbreak, and cannot help but wonder how things will pan out if the administration is wrong. How could that play out? What follows is fiction. Let's hope that it stays that way.

October 20, 2014, 6:00 am

For five days, the media had been feasting on the fact that a second of Thomas Duncan's nurses had become infected with Ebola. There were continued scares around the world of new cases popping up in the most unlikely of places, including the small island nation of Mauritius. The CDC was beating their standard drum, with Thomas Frieden proclaiming, "contact tracing has worked - it's been 5 days and the Dallas Outbreak has no new patients. There have been no patients in Cleveland, even though the second patient traveled there. We've got this under control."

Patricia Klein was looking forward to sleeping in on this morning; she had been working double shifts as a nurse because her daughter had just started her career at Texas A&M, and college textbooks are ridiculously expensive. She could not believe that one book could cost $150. She was down to a few hundred dollars before her last credit card was paid off, too. The Dave Ramsey "financial peace" was so close, she could taste it, but her daughter's college plans had thrown a wrench into the works.

Patricia's boyfriend, Steve, was not suffering from being overworked, and he woke up on his usual schedule. It was 6:00 am that morning, and he had to be to work by 8:00. As a personal trainer at an upscale gym, his clients would not tolerate anything less than pristine punctuality. He cooked his usual breakfast: one egg, scrambled, with two slices of bacon, and one slice of toast for some carbohydrates. After breakfast, he went to the restroom to shave and get a shower. It was 6:45 now; he did the math: a quick shower, throw some clothes on, and he would make it to work by 7:45, even if traffic was heavy. Monday was shaping up to be pretty good.

In the shower, Steve felt a bit light-headed - like there was a bit of a throbbing behind his left eye. He thought to himself that he'd need to take some aspirin on his way out the door. As he finished up, he let a small sneeze escape his nose.

He threw on a pair of gym shorts and the official T-Shirt of the gym where he worked, Lone Star X-Fit. As he came out of the master bath, he saw Patty turning over in bed. He crawled across his side and gave her a quick kiss on the forehead, before grabbing his keys and jogging through the house to the garage. He didn't notice that her forehead was sweaty and feverish.

It was now 7:20, and he was about halfway to work when the throbbing behind his left eye returned. "Damn!" he thought to himself, "I forgot to take some aspirin before I left. Oh well, it's still early. I've got plenty of time to stop off at Walgreens for some." He pulled into the parking lot, where he parked the car and proceeded in to pick up some aspirin. He noticed a newspaper by the door with the hyperbolic headline, "WHAT THIS DOCTOR SAYS ABOUT EBOLA WILL TERRIFY YOU." "Give it a rest," he thought to himself, "Patty worked on Duncan, and she's fine. It's under control." He jogged to the back wall of the store, quickly locating the analgesics, and grabbed a bottle of Bayer. When he got back to the counter, he grabbed a bottle of water so he'd have something to wash it down.

While he was waiting in line - now it was 7:25 - he felt his noze itch and realized he needed to sneeze. Steve started to put the bottle down so he could sneeze into his hand, but it was too late; his nose exploded, spewing a stream of saliva into a cloud in front of him. "I'm so sorry," he muttered to the small, elderly woman in front of him, who was aghast at his lack of consideration, "It's my allergies. They always get me this time of year. I used to take Sudafed, but now you need a prescription because of those damned meth cookers. Sorry." He wiped his nose with the back of his right hand. She turned to the cashier and slowly pulled four singles out of her purse, which she placed on the counter, one at a time. She then pulled a coin purse out of her purse, announcing that she was pretty sure she had exact change.

Steve checked his phone for the time. It was now 7:30. The elderly woman was still pulling nickels out of her coin purse, "sixty, sixty-five, seventy. Wait - I think I've got three pennies somewhere in here. Oh, yes. Sixty-six. Sixty-seven. And one more makes Sixty-Eight cents." The cashier reminded her to have a nice day. She grabbed her bags, and tied them to her walker. As Steve was starting to tap his feet, she began pushing her walker towards the door, muttering to herself about how disrespectful today's youth were.

Steve turned to the cashier, who had already scanned the aspirin and was presently scanning the bottle of water. "Hi. That'll be $5.32.". Steve reached into his right back pocket and pulled out his wallet. He quickly flipped it open and retrieved the card with his left hand, and held the card out for the cashier. She looked at him with a combination of pity and aggravation, and pointed to the Ingenico card reader directly in front of him. "Oh, sorry." Steve muttered, and swiped his card. He put the card back in his wallet, and his wallet in his pants. By this time, the receipt had been printed, and the cashier held it out for him. He grabbed it with his right hand, sliding his finger along hers for a brief moment. He crumpled the receipt and threw it into the garbage can by the door as he walked outside into the unseasonably hot Dallas morning.

While opening his car door, Steve had to sneeze again. He casually turned his head to the side as he did so. He didn't notice the car next to him had the windows down, or that there was a baby in the car seat. He sat down and pulled his new bottle of aspirin out of the bag. It was now 7:35, and he had to get moving if he wanted to get to work and get warmed up ahead of his clients. He pulled the cotton balls out of the bottle with his left hand and threw them out of his window. He reached inside the bottle, fished out two pills, and placed them on his tongue. The water's top came off without any difficulty, and Steve took a gulp to wash down the aspirin.

A few minutes later, Steve pulled in to the parking lot at Lone Star X-Fit, and was relieved to see that it was only 7:50. His stop at Walgreens hadn't cost him as much time as he thought. He parked on the opposite side of the lot, exited his car, and jogged over to the door. He pulled it open with his left hand, and strolled inside. The receptionist, Melissa, smiled when she saw him come in.

"Hey, Steve! You ready for your first appointment? I know how you like Mr. Billings!" This was a bit of an inside joke. Steve had complained to Melissa many times about how John Billings wasn't taking his fitness regiment very seriously. But recently, John had a doctor visit which had given him a renewed focus. Apparently, his cholesterol was atrociously high, and his doctor had given him the speech about how he needs to correct his eating habits and exercise, or he would have a heart attack within the next three years.

Steve chuckled, "ah - he's okay these days. I'm gonna hit the treadmill." He walked over to the third treadmill from the reception desk, and turned the machine on. He selected a mild pace - he just wanted to warm up - and began jogging.

Five minutes later, and Steve had produced a little sweat just in time for Mr. Billings to arrive. As he walked in, Steve hit the "STOP" button on the treadmill and let it slowly push him off the back of the machine. He jogged over to John, wiping his brow with his right hand.

"Hey, John!" He extended his right hand, which John accepted in a firm grasp. "I figured today we'd work on the arms and back, then tomorrow we'll focus on the legs, take Wednesday off, then Thursday it'll be crunch day, and we'll round out Friday with some cross-training, just kinda hit everything at once. Sound good?"

"Yeah, actually it does. Let's get to it."

Steve led John over to the barbells and handed him a 20 lb bell. "Okay, let's get a few curls in. Nothing too heavy." John actually felt like the 20 lb was pushing his abilities, but didn't want to seem weak, so he grabbed it and started lifting. By the eighth repetition, he was struggling. Steve gave him a quick slap on the back, "C'mon, John! You got this. It's no problem for you!" Steve pushed through and let the barbell drop. He was panting now. "John - you wanna have that heart attack your doctor's always warning you about? Come on!" Steve put his hand under John's and gave a light push to encourage Mr. Billings to pick up the barbell on his own. John's face grimaced, and he slowly bent his arm, swinging the barbell up to his shoulder. "NINE!" Steve proclaimed as John let the weight fall again. "Just one more, and we can move on to bench presses. You got this! Just one more!" As John began to lift the weight again, he held his breath. "Breathe, John." John exhaled and took another deep breath. He now had the barbell about halfway up, and Steve was just about to offer a word of encouragement when he heard his phone ring.

"Come on, John! Pull! You got this!" ...ring... "You can do it!" ...ring... "TEN!" John let the weight drop. "Excuse me for a minute."

When Steve got to his phone, he saw that the call was from Patty. He answered it, "Hey babe, I'm with a client."

"Steve, I don't feel so good. Can you pick up some soup or something at lunch?"

"Sure thing, babe. Love you."

Steve hung up the phone and put it back down. He turned to go back to work, but John had a disturbed expression on his face.

"You okay, Steve?"

"Yeah. Why?"

"Well, your nose is bleeding, and you're pale as a ghost..."

Steve put his hand to his nose and pulled it away. He saw the blood on his fingers, and realized that he actually didn't feel okay. The throbbing behind his left eye had returned with a vengeance. "You know, actually, I think I need to get some rest." He stood up to walk over to the bench in the lobby. Melissa looked over at him, and their eyes locked. A moment later, he heard John calling his name as the world turned sideways and everything he could see collapsed into a dark tunnel around him.

PART 2

Thoughts on Travel Restrictions To Curb The Spread of Ebola

There is some controversy regarding whether or not the US, the WHO, or some other body should impose travel restrictions, or even an outright ban, to curb the spread of Ebola. In the "nay" column sit:

• CDC chief Thomas Frieden, MD - specialist in public health
• National Geographic correspondent Karen Weintraub
• The Week editorialist Shikha Dalmia, reprinted at Reason.com
• Texas governor Rick Perry

In the "yay" column, we find:

• Yale Trained Epidemiologist, David Dausey, MD
• Louisiana Governer Bobby Jindal
• Entrepreneur Donald Trump
• Conservative Talk Show Host Rush Limbaugh

Surprisingly, the week/reason.com article is the least reasoned on the "nay" side, invoking ad hominem attacks against the GOP for being "dumb," accusing Donald Trump of "threatening" the country with a Presidential run, and implying that because Rick Perry is somehow inferior, his presence in the "nay" column is particularly damning to the rest of the GOP:

(The lone voice of sanity questioning this burgeoning conservative narrative is Texas Gov. Rick Perry, which in itself speaks volumes about the state of the GOP.)

Come on, Reason! You're better than to reprint an article stuffed with ad hominem attacks and invective.

So what should be done? Should an all-out ban be implemented? Is that even possible?

Before I answer this, I want to step back and examine my principles. I consider myself a libertarian - that is, a person who believes in individual liberty and that government should be limited to protecting life and liberty by enforcing the nonaggression principle. The nonaggression principle, simply put, is the notion that aggression is inherently invalid, and therefore force may only be used in a retaliatory manner (defensively, not aggressively.)

So how does that apply here? People clearly have the right to travel. People also clearly do not have the right to expose others to Ebola - doing so is an act of aggression. When Thomas Duncan lied on the form he filled out while leaving Liberia, stating that he had not been exposed to Ebola, even though he knew without a doubt that he had, he was committing an act of aggression upon two continents: Europe and North America. His flight was far enough along during the incubation period that he could very easily have gotten sick during his travel and infected the hundreds of people sharing the airplane with him.

In other words, had the governments in the three countries involved been able to objectively determine that he was ill, they would clearly have been acting within their mandate to protect the populace by isolating him.

The problem is that they couldn't make that determination, and had to rely on screening instead. Screening, as I understand it, involves a questionnaire, which Duncan lied on, and a temperature check, which Duncan passed legitimately. The evidence clearly shows, then, that screening does not work.

What is really needed is an inexpensive, instant test so that screening could be made accurate enough to work. In the real world, though, that technology does not yet exist, so we must look at alternatives.

So what would have prevented Duncan from contaminating North America with Ebola? One possibility is quarantine. Suppose for a moment that, leading up to the airport, individuals had to go through 3 weeks of quarantine. Had this step been in place when Duncan flew out, he would have gotten sick and died in Africa. Meanwhile, foreign care workers, supplies, and the like, would still be able to come on commercial flights. Care workers returning home would also be required to go through this quarantine process.

Another alternative would be to route all flights leaving West Africa through Lajes Field, a US Air Force base in the Azores. People would deplane there, and undergo a 3 week quarantine before heading on to their final destination.

How does this square with the non-aggression principal, though? Does this violate the individual right to travel? It is admittedly difficult to square my desire to shut off travel from West Africa against my desire for universal freedom. Ultimately, it comes to this: allowing the transmission of Ebola is unacceptable, and government's primary job is to protect its citizens' right to life. That protection unfortunately outweighs the rights of people attempting to leave afflicted regions, just as the government had the right to isolate Mary Mallon (commonly known as "Typhoid Mary"), even though she had committed no crime other than to be an asymptomatic carrier of Typhoid. Ultimately, she was a victim of circumstance - confined because she was an unwitting accomplice to a murderous pathogen.

Ebola presents a deadly threat, and there is no quick test to determine if a person is an as-yet asymptomatic carrier. The only effective means to make that determination is through a quarantine process. This process is not permanent; if done properly, it will last no longer than 21 days. There is no reason for the process to be cruel — comfortable accommodations can and should be provided for people put through the ordeal. It is unfortunate that people leaving West Africa would be subjugated to confinement, like Ms Mallon, because they have committed no crime other than to be at risk of carrying Ebola.

Is a quarantine process even possible? For air travel, I believe it is. The US, WHO, and local governments could coordinate their efforts with airlines. For ground and water travel, I'm afraid the answer is most likely "no." The only way it could be made remotely effective would be to bulldoze a clear border around the entire afflicted region, and either man the border to catch people trying to break quarantine, or use autonomous robot guns to do the same. Then there's the logistical nightmare of maintaining a blockade to prevent sea travel. The US is committing 3000-4000 troops, and it doesn't seem likely that such an engagement could clear enough land, even for autonomous robot guns to pick up the slack. Liberia's border alone spans 1,587 kilometers.

Still, by forcing air travel through quarantine, rather than banning travel altogether, perhaps we can get the intended benefit of a total air-travel shutdown without the unintended consequence of making people feel like they're being left to die and resorting to any means necessary to escape.

Ebola in Dallas

I wanted to have a place to aggregate facts. While obviously I am more worried than with my previous information aggregation post, I am trying to retain my calm by collecting and sharing facts. Times, when listed, are when I learned about those stories, not when they were reported. Also, they're in my time zone: Central US.
So here we go.

• 2014-10-15
  Nina Pham (the first health care worker to contract Ebola from Duncan) is no longer the only person in history to contract Ebola on US soil. Late last night, another worker tested positive. Meanwhile, Ms. Pham's boyfriend is also in quarantine. So here's what this says to me: R0 in Dallas is 2, in line with the average for Ebola. Malthus must be smiling from his grave.[1]
• 2014-10-12
  Just as we were breath a sigh of relief on Michael Monnig's behalf, a health care worker who treated Duncan has tested positive for Ebola. R0 has officially gone from 0 to 1, and the contact circle has to have expanded significantly. How many people did this health care worker treat after becoming infectious? Hopefully the answer is "zero." Interesting bit from the article:

  The worker became infected despite wearing full protective gear while treating Duncan, who later died from the disease, during his second visit to the hospital.

  [1] Can we pretty pretty please shut off travel from West Africa now, or at least require everybody leaving to go through quarantine? If we get this thing in Dallas under control, but another outbreak starts somewhere else, then what good will have been accomplished?
• 2014-10-09
  Michael Monnig tested negative (sorry - no link. This was widely reported.) R0 is still 0 in Dallas, thankfully. Hopefully it continues to stay that way. 21 days from when Duncan was hospitalized is October 19. Unfortunately, due to the poor implementation of containment protocols (several days elapsed before cleaning Duncan's vomit, several days elapsed before sterilizing the apartment, with people inside, etc., that isn't the day when we can really say that nobody will catch it from Duncan's pre-hospitalization period. I'd peg that date right around Halloween.
  There is also the risk of transmission during disposal of Duncan's body and cleaning the isolation ward where he was treated. So let's say it takes 3 days to dispose of the body; that would imply the clock for workers involved in that process starts 10/11, and runs out on November 1.
  In all, this implies that whenever there is a bona-fide case, we can expect five weeks to elapse before we know whether that case was successfully contained. Possibly more time, now that I think about it. Had Duncan survived, he would continue to be contagious for 7 additional weeks, at least via semen.
• 2014-10-08 8:49 pm
  Dallas County Sheriff Deputy Michael Monnig went to an urgent care clinic in Frisco, Texas with his wife on Wednesday
  A witness at the clinic described him as 'hunched over and flushed'
  The deputy was inside the apartment where Ebola patient Thomas Duncan fell ill - the officer wasn't wearing protective clothing
  The CDC said the person is not one of the 48 contacts being monitored
  The CareNow clinic was placed in lock-down
  Sgt Monnig's family said today the CDC had told them that their loved one was not at risk and they were just taking precautions
  

  The day after going into the apartment, Monnig and his fellow officers were told to bag up the clothes they'd been wearing. Their police cars were also taken out of commission.
  'That starts putting question marks in your mind,' Monnig told WFAA in an October 3 report. 'You know when you go home and then the next day you start hearing that equipment is being quarantined or asked to be bagged up, that you had on or were driving.
  'Then your question is, "well, what about me?" And so those were the questions that were raised.'
  Now the question is: Why wasn't Monnig warned before entering the home completely without protection?
  [1]

• 2014-10-08 3:50 pm
  Unnamed Dallas County Sheriff's deputy walks in to a walk-in clinic and says he was in Duncan's apartment without protective gear and thinks he has Ebola. Earlier today, Duncan passed away. (I found out much earlier, but forgot to update this page...) [1]
• 2014-10-05 7:42 am
  Duncan in critical condition. A day or so ago he was in "serious but stable" condition. Looks like his gambit may not have paid off. Here's hoping his family has not contracted it, and that no animals carted off with any of his vomit. [1]
• 2014-10-03 8:20 pm
  My brother summarized this article fairly well:

  Girlfriend and children of Patient DumbFuck now showing symptoms. CDC dropping the ball on their quarantine and care. Why is a news source in the UK the first to report this?

  [1]
• 2014-10-03 8:07 pm
  Jesus. Sanitation workers are getting zero training. [1]
• 2014-10-03 4:06 pm
  Duncan's former boss in Liberia says that Duncan knew he was exposed and came to US specifically to seek treatment. His gambit may very well have condemned his family and hundreds of others to death. [1]
• 2014-10-02 9:33 am
  Number of people being screened grows to 80. I would think that taking this guy at his word, that he was not symptomatic when he boarded the flight, is not sufficiently conservative, considering the stakes. The list ought to include anybody who was traveling through Brussels, DC, or Dallas on 9/20. If I were on any flights on that day, I would be very concerned right now. TX health officials apparently have a broader list of 100 people.

  ... health officials have also formally ordered four of Mr. Duncan's close family members to stay home and not receive any visitors until at least Oct. 19. The family members could face criminal charges if they don't abide by the order.

  I think that's prudent. People who know me might wonder how I square that with my libertarian bent. It's fairly simple: people who have reason to believe they present a risk to others should not expose others to that risk - doing so would be an act of aggression, and thus violate the nonaggression principal. I don't particularly like the lack of due process, however. [1]
• 2014-10-02 8:26 am
  Interesting commentary from my friend tmi3rd. Basically, if Duncan survives, expect a bunch of folks from West Africa to try to come here for treatment. [1]
• 2014-10-02 7:36 am
  I spent some time yesterday saying that Ebola in W. Africa had an R0 around 1.2. Turns out my memory did not serve me well; it's actually 1.5 in Guinnea, 1.6 in Liberia, and 2.5 in Sierra Leone. Why the difference between nations? A number of things, as I understand it. First, R0 is a measure of how much a virus is actually transmitting, not of its potential to transmit. So if you have control over the epidemic, then R0 will be less than 1, and the epidemic will end. If you don't, then R0 will be greater or equal to 1, and the epidemic is spreading. You can think of R0 as an exponential factor. [1]
• 2014-10-02 7:16 am
  

  There is considerable misunderstanding concerning the potential for aerosol transmission of filoviruses. The data on formal aerosol experiments leave no doubt that Ebola and Marburg viruses are stable and infectious in small-particle aerosols, and experience of transmission between experimental animals in the laboratory supports this [49, 56–63]. Indeed, during the 1989–1990 epizootic of the Reston subtype of Ebola, there was circumstantial evidence of airborne spread of the virus, and supporting observations included suggestive epidemiology in patterns of spread within rooms and between rooms in the quarantine facility, high concentrations of virus in nasal and oropharyngeal secretions, and ultrastructural visualization of abundant virus particles in alveoli [17, 50]. However, this is far from saying that Ebola viruses are transmitted in the clinical setting by small-particle aerosols generated from an index patient [64]. Indeed patients without any direct exposure to a known EHF case were carefully sought but uncommonly found [65]. The conclusion is that if this mode of spread occurred, it was very minor. [1]

  In other words, there is some evidence that a different strain, Ebola Reston, has been communicated in an airborne manner, among apes. Ebola Reston was the subject of a chapter or two in The Hot Zone. A facility where apes were being studied, in Reston, Virginia, had to be quarantined, all of the apes destroyed, and the building chlorinated. No humans were infected in that incident. There has still never been a documented case where humans have caught Ebola via an airborne route, as far as I know.
• 2014-10-02 6:30 am
  Same article as last night - I was in a rush and didn't read the whole thing. More info from there:
  • Witness who described the vomit/screaming during the ambulance-load is a Bosnain immigrant named Mesud Osmanovic.
  • Stocks had reactions one might expect: everything tanked except for those of companies with Ebola treatments in the pipeline
  • Dallas school super Mike Miles claims the school-aged children were not showing symptoms and therefore presented little risk of spreading the virus. This ignores, IMHO, the fact that Duncan took a full week to show symptoms.
  • "Texas officials said health workers who took care of the patient had so far tested negative for the virus and there were no other suspected cases in the state." This contradicts USA today and WFAA (Dallas ABC Affiliate) reports that there was a second suspected case. Perhaps that 2nd case tested negative?
  • Buried at the bottom of the article is perhaps the most important bit of information, Duncan's travel itinerary:

    A Liberian official said the man traveled through Brussels to the United States. United Airlines said in a statement that the man took one of its flights from Brussels to Washington Dulles Airport, where he changed planes to travel to Dallas-Fort Worth.

    If he really was not symptomatic until 9/24, then that itinerary isn't horribly concerning. If he was already trying to fight through things, hoping for better treatment in the US than he could get in Africa, then that itinerary means he had 3 separate airplanes and 2 layovers where he was spreading EBOV prior to making it to Dallas. Even if he was not symptomatic, as reported, I think it ought to be clear that air travel from West Africa needs to be shut down immediately.
  [1] [2] [3]
• 2014-10-01 8:21 pm
  Duncan puked on the ground outside his apartments while trying to get into the ambulance. His whole family was reportedly screaming. [1]
• 2014-10-01 2:38 pm
  
  • Patient name is Thomas Eric Duncan.
  • On 9/15, Duncan helped his carry his landlord's daughter to the hospital for care. This is thought to be how he was exposed.
  • Duncan is believed to have had contact w/ 12-18 people, including 5 school-aged children from 4 different schools.
  • Schools are to undergo a "thorough cleaning" (bleaching? not clear), but remain open.
  • The 18 people are going to be monitored daily for 21 days.
  The implication of the events of 9/15, as I see it, is that Duncan knew he'd been exposed, and boarded a plane anyway. [1]
• 2014-10-01 10:19 am
  Dr Jesse L Goodman says several people were exposed and it's likely many more will be infected. I'm amazed that somebody saying something like this is given any press time in the "don't panic" press atmosphere. [1]
• So much for R0 remaining 0... A second person is being "monitored." [1]
• What is R0? [1]
• The ambulance used has been decontaminated, presumably by spraying with bleach, and the EMS workers have been quarantined. This was reported to have been done as of 9/30, 2 days after patient zero was transported to the hospital. Sure hope everybody else who rode in that ambulance has been contacted. I've seen no reports as to whether that is the case.
  [1] [2]
• Patient Zero's timeline:
  

  9/20 - Arrives from Liberia without symptoms

  9/24 - Symptoms begin

  9/26 - Seeks care

  9/28 - Hospitalized

  href='https://twitter.com/GioBenitez/status/517069057666084864'>[1]

  Some observations: Patient Zero apparently sat around thinking it was just a cold for 2 full days before seeking care. Whoever he sought care with on 9/26 dropped the ball by either not asking if he'd been to West Africa recently, or by disregarding that vital piece of information. Patient Zero then spent another 2 full days becoming more virulent before he was finally hospitalized.
  I have seen no reports as to whether the original caregivers have been quarantined or are just under observation. I have likewise not seen any reports as to whether the facility where he sought care on 9/26 is being or has been decontaminated.
• Ebola is spread by direct contact with bodily fluids and is not airborne. This is often presented as a fact which should be comforting. Consider this list of bodily fluids, though:

  Body fluids- as obvious as this may seem- include (but are not limited to) blood, sweat, tears, vomit, urine, feces, semen, vaginal secretions, and the like. [1]

  The implication is that sitting on a vinyl cab or bus seat after an infected person contaminates it with sweat (or worse) may be more dangerous than you might think.

  The threat to motorcycle drivers and their passengers is obvious but flatbed trucks are not necessarily any safer. “The back of the truck has to be cleaned out between patients,” says William Fischer, a physician who helped to fight the Ebola epidemic in Guinea this past spring and is now back in the U.S. But getting the needed resources to clean the vehicle or cleaning it well enough can sometimes be a problem. [2]