Stop growing or meet the four horsemen?

By Mary Odum

I took some time off from writing this summer, as I was busy getting unmarried and moving back to my original home, Florida. Don’t ever change your name—it’s a real hassle to change it back, from Logan to Odum. The divorce was quite amicable, after almost 40 years together, and Alaska provides few obstacles to the process. The house in Alaska sold quickly, to friends, so here I am, literally a hot mess, in north-central Florida, trying to re-acclimate to 92 degrees in the shade with 95% humidity. Instead of wolverines and bears traipsing through the yard, it is raccoons and possums. Instead of goshawks eating the chickens, I have fledgling cardinals at my feeder. And instead of glorious mountain tundra runs, I have quiet paddles along sacred springs and lakes. I have encountered enough old friends and acquaintances here that I am quickly regaining my sense of place in this sunny, hot, subtropical, watery paradise.

Emergence of the four horsemen

Americans are now receiving unsubtle messages from the universe that perhaps we have reached our limits, and it is time to stop trying to grow the economy. The four horsemen of pestilence, famine, war, and death are emerging on a global basis, as energy inputs wane and the global economic system begins to turn down. Yet feedback from the system is still telling our system to grow, when perhaps it would be wiser to expend more energy on resilient contraction. The threat of Ebola impels me in particular to find my voice again, as the blogosphere is mincing around the real issues here.

Ebola marks a potential visible turning point in our society, as the mandates and feedback loops in a system geared towards growth as its primary goal begin to oppose basic public health and safety principles, morality is subverted, and systems begin to break down.  Historically, small African Ebola outbreaks have had high mortality rates of up to 90% in small, isolated villages which limited spread of the disease. The current Zaire strain has been reported with lower mortality rates ranging from reports of 5364% mortality (Glatter, August 4th, 2014, Medscape & WHO, August 6th, 2014). This potentially lower mortality rate may be bad news, because it increases transmissibility. The disease has spread quickly across borders, aided by modern transportation systems. As of this week, Ebola is now loose in Lagos, a chaotic, rapidly growing, port city of 21 million, the largest city in Africa.

Diseased_Ebola_2014 4.27.17 PMThe data coming from countries in West Africa are probably inaccurate and dated. Chaotic environments and limited public health mechanisms combine with a shackled, indebted World Health Organization, hampered low-budget aid organizations and a main stream media whose primary goal is to promote economic growth all combine to create a biased, skewed picture. Time will tell, but confirmed reports and numbers lead to a developing picture of a potential pandemic.

Americans believe that our vaunted western medical health care system protects us from all threats. But our system is a capitalistic, just-in-time system that uses a global supply chain and intensive energy requirements to operate at close to 100% occupancy and high efficiency in order to maximize profits, especially for the very ill in intensive care or costly isolation beds. It’s hard to get a bed sometimes now—the system would break down very quickly in a pandemic, with most unable to access medical care.

Two Ebola victims have been brought back to the United States (Emory Hospital) for high-tech cure and probably to better access their blood at the Atlanta CDC to begin working on potential vaccines and cures. Ebola has not been a target for pharmaceutical research up to now, because the disease historically impacted people who could not provide first-world profits on drug purchases, and the disease killed people too fast for profits to be made. Pharmaceutical companies prefer to treat chronic illnesses that allow greater, recurring profits.

The West Africa Ebola outbreak began in March of 2014, and is now expanding rapidly in 5 or 6 countries. The 2014 West Africa Ebola Outbreak Wiki is one of the most current sources, which describes containment complications:

Difficulties faced in attempting to contain the outbreak include the outbreak’s multiple locations across country borders, inadequate equipment given to medical personnel, funeral practices such as washing a body, and reluctance among country people to follow preventive practices, including “freeing” suspected Ebola patients from isolation, and suspicion that the disease is caused by sorcery, or that doctors are killing patients. In late July, the former Liberian health minister Peter Coleman stated that “people don’t seem to believe anything the government now says.”

Add public health limitations in Africa to the presence of a rapid global transmission system in the form of modern air travel, and we’ve got the potential formula for a global pandemic. Direct flights, poor air filtration and limited sanitation in airplane heads, overcrowded seating, and the relatively late onset of symptoms, combined with the mandate to limit any regulatory process that might curtail economic growth, and expansion of Ebola to more countries is almost assured.  In the US, the presence of 50 million people in the US without healthcare, overly crowded urban populations, high-tech, for-profit healthcare not prepared for a pandemic, and a very mobile population could easily make an African problem an American problem

Economic growth or public health?

In our globally connected society, we are all just one direct flight away from a potential pandemic if we subvert public health mandates for economic growth. The coincidental African economic summit held this week in Washington DC is a snapshot of this problem—economic growth is the focus, and serious public health concerns are something to be discussed quietly in back rooms outside of media coverage, rather than prominently on the agenda. I can only imagine the quiet discussions, focused on the economic impact of curtailed air or other travel to countries.

If we shut down all travel, what would a shutdown to many African countries do to our global supply chain? What would a pandemic panic do to economic growth, unstable currencies, and stock markets? In a world where there’s only a 3 day supply of food on the shelves, even in prosperous countries, how can we possibly close borders, except with martial law? We’re all connected, and running at top efficiency with little resiliency in the system. What happens when the universal systemic mandate for economic growth conflicts directly with the general public health of a society? Which is worse, letting Nature have her way with us, or intentionally sticking a spoke in the wheel of our economic machine and bringing it to a sudden halt? What about the oil? Nigeria supplies critical oil and LNG to many countries, especially Europe, which is the largest regional importer of Nigerian oil. And so on. Authorities in some countries are beginning to shut down non-essential travel to the affected countries, but even that action may be a case of too little too late in this situation. My critical-care-nurse daughter commented this week, I’ve seen enough zombie movies to know that this ends badly. 

So what can we do?

I usually end my posts with advice for personal action. The future is uncertain here, but the factors involved suggest that the WHO may soon label this a “Public Health Emergency of International Concern (PHEIC).” What an acronym! You might consider buying a box of disposable vinyl gloves and particulate respirator masks, for this or other epidemics or other pollution hazards that travel by air that are guaranteed to arrive on your doorstep in our lower-energy future. Consider how you would fare in an extended quarantine situation if stranded in your home, if not for this potential pandemic, then for other hazards in our future? Consider how to begin living in a lower energy world, where less energy impacts every facet of your life. And if you’ve got air travel scheduled in the next three months, stay apprised of the news out of West Africa, and consider alternatives. It is wise and prudent to avoid placing too much faith in a capitalistic, just-in-time system that is straining at the bounds of peak efficiency, in a world in overshoot and diminishing energy inputs.

Thelma and Louise . . . . Could there be a more apt analogy for the results of autocatalysis and exponential growth? Baby blue 1966 Thunderbird convertible . . . zoom, zoom!
Thelma and Louise . . . . Could there be a more apt analogy for the results of autocatalysis and exponential growth? Baby blue 1966 Thunderbird convertible . . . zoom, zoom!

The real issue here is the systemic mandate or even imperative of economic growth. Because the primary goal of our national and international economic systems is growth at all costs, we subvert everything else–values, ethics, even health. And the gas pedal is pressed to the floor as we continue to roll over the cliff.

Header art: Four Horsemen of the Apocalypse – Conquest [Pestilence?], War, Famine & Death, an 1887 painting by Victor Vasnetsov
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  • sunweb

    This is a great essay.
    The four horsemen are always riding but not globally as they will/are be.
    An interesting addition. We have smoke here in Minnesota from the fires out west of us and it looks like some is coming from the fires in Sweden. As a 12 year survivor of lung cancer, with emphysema and about 50% capacity this smoke is a real drain on me. The point is a secondary result of growth.

    • Thanks, John. Pollution expands to exacerbate problems brought on by diminished energy flows. I saw a headline is some environmental blog (grist? treehugger?) that implied that wildfires were unnatural–well, they’re only unnatural as a consequence of fire suppression, and the additional wastes that we’ve contributed through our industrial society. What else is in the smoke that wouldn’t have been in it 100 years ago?

      • sunweb

        Add the climate to the fire issue. Too. Methane mixed in? Our lake here in Northern Minnesota has mercury from coal I believe. It simply goes on and on. I am glad people with your skills and caring are monitoring what is happening.

  • NJP1

    When a religious fundamentalist in the USA goes into a rant that disease is the will of god, and that vaccination/immunisation cannot prevent it (being the work of ‘big government’ and thus must be treated with suspicion)—what is the difference between that and the equally backward tribes of central Africa?

    • I would not describe tribes of West Africa as backward, NJP. I have often thought that we need a reverse Peace Corps in this country, where kids go overseas to learn how to live within limits and cultures with less addiction to oil.

      Religions that frame illness as the will of God may not be so different from a scientist who sees illness and death as necessary consequences of an evolving system’s renewal?

      • NJP1

        Both fundamentalist Americans and superstitious Africans give credence to supernatural powers in one way or another.
        You cannot ‘retrofit’ humanity to the point of acceptance of a depleted standard of living, other than by natural forces.
        Nature uses death as a natural force in the regulation of the global ecosystem, whereas humanity, over the last 2 centuries (or millenia–depending on which way you look at the problem) has found a means to temporarily defeat those natural laws, and invented god)s) to justify his actions and insist that aforesaid gods look on benevolently while the planet is being pillaged
        Science, by and large, simply points out the truth.

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  • This is from a previous discussion of complexity in healthcare in the US at the Oil Drum that is pertinent here. . . .
    ************************************
    If a critical care staff washed their hands/used handrub as many times as they needed to comply with hygiene policies, they have to collectively wash their hands for about 230 minutes a day per patient. Which doesn’t leave much time for care.

    “There are few data measuring rates of contact by healthcare workers (HCWs) with intensive care unit (ICU) patients (direct contacts) and their immediate environment (indirect contacts), or estimates of the time needed for 100% hand hygiene compliance. We measured this using a prospective trained observer study in a 12-bedded UK adult general ICU admitting > 600 mixed medical/surgical patients annually. HCWs were observed in ICU bed spaces for 1-h periods by a single researcher using a pre-determined plan, such that all 12 beds were observed for similar times and throughout the day. Mean daily rates of direct and indirect contact between HCWs and ICU patients were calculated. Observed post-contact hand hygiene compliance was also measured. Numbers of contacts/day that were or were not followed by hand hygiene, and estimates of the time needed daily for 100% compliance were calculated. On average, each patient was contacted directly 159 [95% confidence intervals (CI) 144-178] times and contacted indirectly 191 (95% CI 174-210) times/day. Observed post-contact hand hygiene rates were 43% for direct contacts and 12% for indirect contacts. Staff contacting more than one patient during routine care, who carry the highest risk of transmitting infection between patients, made, on average, 22 direct and 107 indirect contacts without adequate hand hygiene/patient/day. One hundred percent hand hygiene compliance by all healthcare workers would require about 230 min/patient/day (100 min for direct and 130 min for indirect contacts).”

    McArdle, FI, Lee RJ, Gibb, AP, Walsh, TS. How much time is needed for hand hygiene in intensive care? A prospective trained observer study of rates of contact between healthcare workers and intensive care patients. J Hosp Infec 2006; 62 (3): 304-10.
    http://www.ncbi.nlm.nih.gov/pubmed/16406198

    This study didn’t count the violations based on not washing/rubbing before you enter the room, just after. So if one really went by policy, the fail rate would be much higher, since most staff are going from room to room and only wash on exiting a patient room. And yes, surgical units are the worst, in studies. Four hours at the sink is the cumulative total per patient per day for all the caregivers going into that room.

    This is a perfect example of how complexity is going to fail, since an ICU is about as complex as it gets. In the ICU, you’ve got perhaps 5, perhaps 20 people going in and out of the patient’s room every hour, depending on the type of unit and time of day. At times things are calm, and at others, caregivers are stressed. Some are specialists focused on one task, others are generalists focused on the big picture for the patient. Hand hygiene falls pretty low on the list between the six drips you’re titrating for about 12 different parameters, and equipment and technology and charts and crashing blood pressures. Handwashing falls off of the list when things get really hairy. The addition of handrub in this decade has allowed us to improve, but then so have the bugs.

    So here’s another example of third and fourth order consequences, and sometimes the small things being the ones to take you down. I will illustrate again, because folks just don’t take the connections far enough. You have a crisis–either a Katrina like problem where you’re understaffed with sick patients, or any other short term problem resulting in additional stress to the system. Most hospital systems are already running at full tilt, with less than 10% capability to expand rooms/staff/ventilators; probably more like 5% because the chief limit–Liebig’s law–is trained staff. The crisis bumps up the acuity of the patients. The staff are now working longer hours, with sicker patients. Eventually, you have to start triaging care and patients. But it may be the little things that get you–the housekeeper is busy elsewhere or called in sick, and filling handrub dispensers fell off the bottom of her list. Or, because the supply truck couldn’t come, you’re running out. Or, the cost went up because of the cost of gasoline, and now only every other dispenser is being filled because it’s costly or deliveries are halted, so staff are back to washing their hands, yet they’re still trying frantically to adhere to policies and standards that developed in much better times when there were more resources. Mistakes start to happen, and maybe its the medication error, or the CT scan was down for the fourth time this week, or simply someone who forgot to wash their hands in a setting with Superbugs. No one talks about this.
    ************************************

    Add in a pandemic, with the need for careful isolation garb for each patient, and you can’t maintain high-tech healthcare for long, making staff very vulnerable.

    – See more at: http://campfire.theoildrum.com/node/6626#comment-662318

  • Brian

    The real irony to me is the truth Ebola is trying to teach us, that there is a trade off between mortality rates and transmissibility. The mortality of those with Ebola goes down while transmission rates go up, which is why mortality is dropping. Those calling humans a virus or bacteria on this earth miss that maximum power principle is really about the intersection between efficiency and speed that maximizes work through time. The reason I feel we don’t want to accept this is because we would have to embrace pulsing, we want to believe we are an idealized virus that can have it all at all times whether it be resources, money, good feelings, or even relationships. Our society may be like a virus, but not the idealized one. We will relearn that we can’t have it all all the time. So glad to see you back at least till you decide you need another break 😉

    • Brian, I am happy to see that you are still out there in the blogosphere, and perhaps wiping fingerprints off your laptop screen, as your girls try to snatch the laptop out of your lap. Or stepping on Legos.

      Yes, we suck as viruses. From the long-term perspective, our mortality rate is way too high, leading to complete failure as transmissible viruses :

      • Brian

        Sending off my oldest to pre school to hopefully be an infectious agent to a prosperous way down. With any luck the worst he will ever come home with is a ton of homework, I have stressed the importance of skipping all infectious agents. Any chance of success?

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  • Update on the “shackled, indebted WHO.” WHO mission creep began in the 1959, when the WHO was muzzled on the topic of ionizing radiation contamination of the environment, when the WHO agreed to misinform the public in subordination to the global nuclear governing body, the IAEA, in order to protect civil and military nuclear interests. Our governments and our international organizations are motivated to prevent economic losses and buoy stock markets instead of protecting public health. The cruise ship over-reaction today is a result of the CDC under-playing the “low risk of air [and other] travel,” since that belief in the low-risk led to travel by quarantined contacts, with the expressed consent of the CDC, who apparently believes their own propaganda. Political motivations to down-play threat lead to distrust of government by citizens and further devolution of centralized government–and further spread of plague. The appointment of a lawyer political hack today to be “Ebola Czar” in the US reinforces those impressions. WHO and CDC agendas to sell more health technology, millennium development, and other ways to expand healthcare also reinforce the idea that all of our centralized organizations work to keep the economy spinning as fast as possible, first and foremost, while throwing public health under the bus. One can only wonder if that mission shift from public health to economic growth extends to lying about EVD cases by government bodies.

    “”Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” WHO said in the document. “A perfect storm was brewing, ready to burst open in full force.” The U.N. health agency acknowledged that, at times, even its own bureaucracy was a problem. It noted that the heads of WHO country offices in Africa are “politically motivated appointments” made by the WHO regional director for Africa, Dr. Luis Sambo, who does not answer to the agency’s chief in Geneva, Dr. Margaret Chan. WHO is the U.N.’s specialized health agency, responsible for setting global health standards and coordinating the global response to disease outbreaks.”

    http://bigstory.ap.org/article/6fd22fbcca0c47318cb178596d57dc7a/un-we-botched-response-ebola-outbreak#

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  • The senior UN coordinator for the international response to Ebola encourages travel to ‘vibrant and alive’ Ebola-hit West Africa, as death toll tops 5000. “I want to encourage everybody to maintain travel, tourism even to places that have Ebola. There is just no reason not to go to Freetown, Monrovia, Conakry.”

    http://swineflumagazine.blogspot.com/2014/11/un-encourages-travel-to-vibrant-and.html