As I write, I am sitting in what might be my last airplane seat, stacked cheek to jowl with a couple with a cute but runny-nosed baby. My trip was with girlfriends on a bike tour in California, and I made the most of it, living very much in the moment. As I traveled, I wore my infection control hat, scanning the settings with new eyes for potentially dangerous situations. I was careful in public places such as airports, trolleys, and the BART, washing my hands frequently and keeping them folded in front of me. I was much more aware of impulses to touch my face. I watched a couple in the San Francisco airport who were headed to Nairobi touch their faces, many times, as they waited. Airport bathrooms were mostly hands-free, but the automatic toilets sprayed their contents powerfully in all directions when flushed. There was a new sign in the TSA line warning us to wash our hands because of Middle East Respiratory Syndrome (MERS), but no mention of Ebola (EVD). TSA used gloves to pat me down, but they were not washing their hands after contact with people. Boarding passes, drivers licenses, and credit cards were swiped and exchanged, along with bills and coins. I saw a large homeless population on the waterfront in San Francisco with no access to bathrooms or handwashing, who were using the streets as open latrines. I saw prostitutes. Hotels had carpets and mattresses that would defy cleaning in an outbreak. I saw people hugging, and shaking hands, and doing all kinds of human, caring, or even loving things that would be extinguished in a pandemic.
Today the first nurse within the US healthcare system has acquired EVD. My nursing friends are worried. Are we ready for this? How do we communicate risk, or should we settle for optimistic reassurance that our system can handle this? What are our biggest needs in preparation? Continue reading Clutching our world views with a death grip
We are in uncharted territory with the Ebola virus disease (EVD). The last time we had a plague that was this deadly was the Black Death in the 14th century, when there were only 450 million people in the world. That pandemic killed 30% to 70% of the population. There is no benchmark for EVD, which kills 3 out of 4 people it touches, and is emerging into a global population of 7 billion.
This pandemic signifies a turning point for society in response to peak oil, highlighting the problem of globalization for a planet of 7 billion people. We have lost control of a deadly outbreak, and our responses to its exponential growth are linear at best, ensuring that this plague will most likely spread further. Many in first world countries think we are immune to plagues. How might transmission of EVD change as it moves from a low-resource or low-transformity setting in West Africa to resource-rich (high-transformity) countries? How might the battle against this epidemic change as it breaks out into different environments?
Welcome to the arcane and short-sighted world of public health strategic planning. This post introduces the term surge capacity, a term we will hear often in the coming months of this growing Ebola (EVD) epidemic. Surge capacity is the ability to manage sudden or prolonged increases in overall healthcare demand, and the key components are the 4 S’s of staff, stuff, structure and systems, for hospital and community preparedness (Adams, 2009). During a pandemic, lack of surge capacity in all four of these areas become key limiting factors: hospital isolation beds (structure), healthcare providers (HCP-staff), isolation gear (stuff), and an efficient, just-in-time, high-transformity system, which is an obstacle to resilience. Continue reading The 4S’s of surge capacity
An article on the difficulty of building truly green buildings and recent discussions about the healthcare system triggered thoughts about a major transition problem that is occurring over and over again—the problem of a complex hierarchy that demands feeding with extra energy. Previous posts about the added complexity that digitization brings are pertinent here, but this post is about the general problem of how we respond to limits by adding complexity, and what it might take to remove complexity at the top of the hierarchy without collapse. Continue reading Adding and removing complexity
Recent news about Hanford leaks, a flurry of news surrounding the two-year anniversary of Fukushima, and today’s news about breast cancer rates in the US center my thoughts on blind spots in health research. I will use ionizing radiation again as an illustration of environmental linkages to disease, beginning with the trigger for this post, which was a new World Health Organization (WHO) report. Previous posts about nuclear hazards are linked here and here.
This week, the WHO published a preemptive report on Fukushima, only two years after the disaster. The WHO concluded that “for the general population inside and outside of Japan, the predicted risks are low and no observable increases in cancer rates above baseline rates are anticipated.” This conclusion is from the same organization that has been muzzled on the topic of ionizing radiation contamination of our environment since 1959, when they agreed to misinform the public in subordination to the global nuclear governing body, the IAEA, to protect civil and military nuclear interests. If you believe that Fukushima has not increased background risk and there will be no increases in cancer rates, I have a bridge to sell you. Mark Twain’s maxim about lies, damn lies, and statistics can be applied here. The point of this post is to examine western medicine’s epistemology of disease, specifically examining how we select the risk factors that are involved in cancer and other diseases. Continue reading Lies, damn lies, and radiation health
The discussions in the US this week surrounding the constitutionality of health insurance payment mandates and the fact that my terminal degree is in health policy helped me to choose a topic for this week’s post. The US Supreme Court question that the Justices are examining this week has to do with the issue of insurance payment mandates for individuals—is it constitutional? The goal of Obama’s The Affordable Care Act is a goal of healthcare for all within the existing system. One primary argument of those supporting the plan is that, while not perfect, the plan is a good start in transitioning to a universal healthcare system. Yet the plan and the current discussions make a number of unstated assumptions about a healthcare system embedded within a capitalist, free market economic system of the wealthiest country on the planet. These assumptions need to be exposed in order to view the problem systemically. I would suggest that these assumptions are not even correct to begin with for the existing system, and that the assumptions will become even less true in a permanently declining economy associated with peak oil. Rousseau said, “Good laws lead to the making of better ones; bad laws bring about worse.” In my opinion, creating bad laws now that assume that the current system can grow infinitely only lead to further catastrophe. Continue reading Healthcare for All in the U.S?