Better Decisions Through Data.
EbolaCare(TM) PPO out-of-network in Dallas?
And, indeed, insurance is how Liberia originally came up. (This goes back to our original point that this mistake should have been caught by the billing department, or at least administratively by the hospital after the fact.) The sister of the Ebola patient specifically remembers telling the ER nurse her brother was a visitor from Liberia, because the hospital kept asking for a social security number for insurance purposes. She explained he didn’t have one because he was a recent visitor from Liberia. (And, indeed, the ER nurse dutifully noted down this in travel history section, it seems. Travelers visiting the U.S. be advised: if your home insurance doesn’t cover your U.S. travels, consider a travel insurance policy. Medical care in the U.S. can be expensive, and stereotypical E.R. administrators aren’t enamored with the uninsured.)
Cryptocoin bubble and why some better decisions through data are better left unmade
Our motto is “better decisions through data.” Those better decisions don’t always make you friends. Some intelligent people with advanced degrees and large Internet followings have argued that, since Bitcoin has risen 7 orders of magnitude in value, it must again rise 7 orders of magnitude (and I suppose a few coins will be worth more than the GDP of Europe in a few years). If you tell them otherwise (and also point out that anti-fraud mechanisms have been extremely important in the history of the Republic, ever since George Washington canceled the serial numbers on bills during the Revolutionary War) they will publicly throw a temper tantrum. Obviously, they are very invested in Bitcoin. Bitcoin and related technologies may offer all sorts of advanced in the field of electronic payments and other innovations, but another 7 order magnitude rise isn’t in the cards, no matter how powerful or influential the people are that wish it. (Perhaps a topic for a future blog post.)
Real-estate bubble
Similarly, if one argued back in 2004 based on the ratios of rents to real estate prices that there was an obvious real estate bubble, certain politically influential real estate agents would give you the evil eye. You wouldn’t be popular at their parties, no matter how many times you pointed to Robert Shiller’s classic book or explained that finance and economics were also subject to natural laws. (These laws stem from the relationship to physical resources, and, via the relationship between matter, energy, and information can ultimately be traced back to the laws of physics. This is yet another potential future blog topic.) This kind of denial of reality by those heavily materially invested in the status quo is the sign of a bubble.
Better U.S. medicine through data
Physician Ford Vox pointed out in his recent CNN piece writes that “reveal the fragility of our much-vaunted American health care system.” And much-vaunted it is. However, big data has long revealed that the American health care system is in many ways an extreme outlier among first-world health systems. (On a humorous note, we order many times more MRIs than anyone else, not necessarily with better outcomes. We have a lot of MRI machines in this country.) Undoubtedly, there are still many ways big data and analytics can improve US healthcare, which we might come back to in future articles.
Send me your tired, your yearning, but not your uninsured Ebola medical tourists?
Dr. Vox makes some interesting observations about the errors in Dallas. He recommends, for example, that a CDC nurse follow up with all recent West African travelers. To fund this proposal, he recommends an entry fee, noting that we must think “out of the box” in the current crisis. This seems to us like an excellent suggestion. We don’t wish to encourage medical tourism, as some Internet trolls have unkindly accused Mr. Duncan of being. (Had he suspected he was carrying Ebola, it seems very unlikely he would have endangered his finance or son, now both under grave threat.)
Liberian Social Security Numbers
That said, under the new rules (if not the existing rules), U.S. hospitals should be required to report all West African travelers appearing in an acute care environment to the county health officials (and, directly or indirectly, the CDC) if they are not already. We would take Dr. Vox’s suggestion a step further by suggestion this information include passport or SSN numbers. This could then be used by Dr. Vox’s recommended CDC nurse for follow-up. If a slip-up like the one in Dallas resulted in Mr. Duncan’s release, it would soon be caught by the CDC nurse preparing a follow-up phone call the next day. We’re not experts on HIPAA patient privacy rules, but it seems such reporting to county officials and the CDC is already authorized under existing rules on dread communicable diseases. By tracking all West Africa or Ebola-suspect patients in acute care environments, this would also provide an opportunity for the CDC to use big data analytics. (The WHO could also future coordinate similar information from other countries & exit interviews from West African countries.) On entry, contact information and travel plans for recent West African travelers should be collected by customs to permit such follow-ups, especially for U.S. Citizens where this may not always be asked.
Epidemiology 101, big data for the CDC on West African travelers in the US?
These steps seem obvious and epidemiology 101, but we mention them here because apparently they weren’t implemented. Beyond Dr. Vox’s suggestions and our own above, customs and Dr. Vox’s proposed CDC nurse may wish to take a cue from NBC News. All visitors from West Africa should be urged to self-quarantine for 21 days as a courtesy to their US hosts, even if they do not believe they are at risk. As Dr. Vox points out, there are still some mysteries or unexplained disease vectors surrounding Ebola. Why is this disease afflicting even those who believe they have taken great care to prevent exposure?
Ebola just like the Black Plague?
Ebola’s historic fatality rate is around 90% untreated, which is comparable to the death rate of infection with the Bubonic Plaque that wiped out 30-60% of the population of Europe, Asia, and the Middle East during the 14th century. (The virulence is also obviously comparable.) Ebola’s fatality seems to be dropping with each new epidemic, but this shouldn’t be surprising: parasites often evolve to be less fatal to their hosts, so that they can spread further through the population. Even with the best care, it seems the fatality of this present Ebola epidemic is above 50%. There is a vaccine on the horizon that appears effective (at least in chimpanzees), but untested vaccines often have serious side-effects, such as their own fatalities or adverse effects like brain damage. It will also take some time to scale up production of these vaccines or experimental drugs to meet the demand. Given that the dangers of the disease seem to far outweigh experiment vaccine risks, health authorities may have little choice to begin administering these vaccines to (presumably quite willing volunteers) in the effected areas once supplies become available. That we are considering such extreme measures indicates the gravity of the situation. The alternative is build more Ebola treatment centers that, as described in articles about the structures being used by Doctors without Borders, seem little more than a glass-enclosed holding places for the 50% walking dead.
Ebola is very funny. Really it is. Ha ha.
It’s time to leave this article on a humorous note. Believe it or not, plagues like Ebola are very funny. Or at least they are some years after they’ve happened. The ancient Greek comedy The Birds from 414 BC featured a plague. Although the current version of the Wikipedia article linked doesn’t seem to mention this, in one of the more comical scenes the title subject, The Birds, drop dead from the sky. The ancients yell “the plague! The Plague!” and some of the play’s characters begin to go mad. This comical scene is based on an actual historical event that took place a few years before. Ancient Greece, it seems, was afflicted with some sort of avian flu or bacterial pestilence that caused significant deaths and madness among both humans and birds at the time. It caused a very real panic at the time, although audiences laughed about it years later.
Our friend Dr. Beak treats Ebola?
Long before current events, we poked fun in a blog article on medieval plaque masks. The comical bird masks were lampooned then and now. Although our article focuses on the primate gas mask aspect of these masks (useful against black death but thought to be unneeded for Ebola), the entire out-fit was a fully-working, head-to-toe complete hazmat suit from the 1300s! At time of this writing, Wikipedia seems to disagree with itself, arguing in a different article that the plague hazmat clothing and bird masks were really the invention of a Dr. Lorme in 1619, who really did seem to envision a hazmat-style suit. (The engravings lampooning the idea date to shortly after this period.)
Relevant, amazing 700-year-old medical technology
Then, as now, many find the bird mask quite laughable. Some of the Wikipedia articles scoff at the outfit, pointing out that it was based on a ridiculous, superstitious medical theory. While it may have helped protect the wearer, it would have been a vector for fleas to help spread the disease. But whether invented in the 1300s or 1619, the plague customs described in the historical literature are quite functional hazmat suits, amazing for their time!
The quarantine is another medical invention that has been with us for 700 years, and is still quite effective. During the 1300s plague, visitors would be asked to wait in a holding area outside towns for 40 days, that being the period believed was sufficient for any communicable disease to pass. The quarantine was ineffective against black death, as sources note with a sniff of derision, as it was primarily spread by rats and fleas that pass through the quarantine.
Yet this nearly millennia old medical technology is still with us today, and quite effective against Ebola if fully implemented. We refined it — figuring out the exact period (21 days) required for the specific disease. We’ve tried to make it smart with airport screenings, rather than the “dumb quarantine” of the middle ages required for all visitors, and that hasn’t worked so well in this case.
Then and now
Then as now, there have been a small part of the population that “gets it” while the rest of society have ignored the best science and suffered the consequences. If everyone in Liberia wore the complete 1600s (or even 1300s!) head-to-toe plague doctor’s custom, Ebola’s spread would be impossible! This, of course, isn’t a reasonable suggestion. Poverty prevents this, and hazmat suits apparently are taken off in shopping malls in favor of chlorinated hand washes. (It’s hard to shop in a plague doctor’s outfit, presumable.) Malaria is common in this region, and mosquitoes are one of many unlikely vectors for the disease. To be truly safe, and protect against still unknown transmission vectors, one would need to even sleep in the plague doctor’s outfit. (Dr. Vox points out in his article that some of the healthcare worker’s infections can only be explained by their hazmat suits “slipping”, i.e., briefly not being worn in the heat.) 24/7 might have been possible in a European winter, but West Africa is just to hot.
Similarly, if we had adopted the strictness of the medieval Europeans, and enforced the full 21-day quarantine on all West African travelers, we would not see Ebola in Dallas. No doubt this “dumb quarantine” would hinder the response by preventing much needed personnel and responders from entering and leaving Africa. But even if the “dumb quarantine” of the middle ages was wasteful and ineffectiveness in an age of much shorter lifespans, in some way they had the right idea.
(Is the modern Ebola epidemic the result of mistakes made due to poverty or lack of education? If so, big data for public policy tools might help as we’ve previously noted.)
Institutional memory
Some of the West’s institutions still exist from that age. We have an institutional memory of the Black Death, and that can help guide our responses today. (The Black Death is even in some of nursery rhymes. “Ring around the Rosy” describes the symptoms to children.) We should also not forget the barbaric acts that were committed during the Plague. Large numbers of people were simply buried alive in some cases, the 10% that might have survived sacrificed to human fear.
We think we’re better today, but are we? Ebola treatment centers, as described in major media, sound almost like glass containers for the 50% walking dead to wait their time. And, we’ve already seen the impact of human fear in Dallas. What must fear be doing to hinder containment of this terrible disease back in Africa?
We told you Ebola was funny. Really it is.
And we promised a humorous end to this article. Think of all the comic masterpieces, like the Greek The Birds, our foolishness in this present calamity will inspire. Surely the software glitch that sent a patient home with Ebola will soon be the stuff of future comedic movies. It’s already the stuff of Internet memes and late night jokes.
Related posts:
1 2
There are no comments so far