Filed under: Emergency, Flu, Flu Wiki, General Musings, Government, Health, NPR, Pandemic, Plague, Predictions, Preparedness, Science, Science Fiction, Society, Survival, Writing stuff
Well, we all will, unless there’s some sort of miracle breakthrough in medicine or technology. But that’s not what I’m talking about. Rather, I’m talking about something anyone who has thought about it much has probably already assumed is true: that in the event of a large-scale pandemic, procedures will be put into effect by medical authorities to determine who will be treated and who will be allowed to die.
This is called triage. And to the best of my knowledge, for the first time such procedures are being publicly put forth as being applicable for all hospitals in the US, in recognition that it is better to have consistent and uniform criteria already in place before a disaster hits. The May issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), today carried a supplement titled Definitive Care for the Critically Ill During a Disaster. From the press release on the ACCP website:
(NORTHBROOK, IL, May 5, 2008)—In an unprecedented initiative, US and Canadian experts have developed a comprehensive framework to optimize and manage critical care resources during times of pandemic outbreaks or other mass critical care disasters. The new proposal suggests legally protecting clinicians who follow accepted protocols for the allocation of scarce resources when providing care during mass critical care events. The framework represents a major step forward to uniformly deliver sufficient critical care during catastrophes and maximize the number of victims who have access to potential life-saving interventions.
“Most countries, including the United States, have insufficient critical care resources to provide timely, usual care for a surge of critically ill and injured victims,” said Asha Devereaux, MD, FCCP, Task Force for Mass Critical Care. “If a mass casualty critical care event occurred tomorrow, many people with clinical conditions that are survivable under usual health-care system circumstances may have to forgo life-sustaining interventions due to deficiencies in supply, staffing, or space.” As a result, the Task Force for Mass Critical Care developed an emergency mass critical care (EMCC) framework for hospitals and public health authorities aimed to maximize effective critical care surge capacity.
So, is this just good public health planning? Well, yes. But it is also very sobering to read the following:
The proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.
“When”. Emphasis mine. Not “if”. The news report goes further:
Bentley said it’s not the first time this type of approach has been recommended for a catastrophic pandemic, but that “this is the most detailed one I have seen from a professional group.”
While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.
Devereaux said compiling the list “was emotionally difficult for everyone.”
That’s partly because members believe it’s just a matter of time before such a health care disaster hits, she said.
“You never know,” Devereaux said. “SARS took a lot of folks by surprise. We didn’t even know it existed.”
Again, emphasis mine.
I’ve written many times about the possibility of widespread flu or some other kind of pandemic. Partly this is just because such a catastrophe sets the stage for Communion of Dreams. But more importantly – and this is even part of the reason *why* I wrote Communion of Dreams – is that I don’t think that people give this matter nearly enough thought.
It is good to see that the public health authorities are taking this step. And I was heartened to hear about it on NPR as I started to compose this post. Maybe it will prompt people to stop and think for a moment about what they themselves should be doing to prepare for some kind of pandemic or other disruption. Because I bet that almost no one you know is actually ready to ride out such an event – and by the time you hear of a pandemic starting, it will be too late to get everything you will need to increase the chances of you and your loved ones surviving. This is not fear-mongering; this is taking some reasonable precautions – the same sorts of precautions that have lead to the development of this new triage plan. If you want to know more, check out the Flu Wiki (where they also link to this resource).
Yeah, we’re all gonna die. And I can easily imagine disaster scenarios where I would not want to live. But I sure as hell don’t want to die needlessly from something I can avoid, or ride out with a little advance prep.
Jim Downey
Filed under: Civil Rights, General Musings, Government, Health, Music, NPR, Scott Simon, Society
Brief follow-up to this post.
This morning Scott Simon of NPR did his weekly meditation on the story of Christopher Ratte and the Hard Lemonade. It is worth a listen, as usual – Simon looks past the immediate news item to the underlying issues, as I try to do. He points out that at each stage of the whole debacle the various officials responsible were just “following procedure”, not risking taking some action on their own initiative which would lead to a common sense resolution for everyone involved. As he notes:
… But you might remember what happened to the Ratte family next time a poll discloses that the American people distrust bureaucracies, public or private, whether they run schools, airlines, or health-care systems – they abide by procedures, not people. They take lemons, and just make a mess.
Jim Downey
(With thanks and apology to Bob Dylan.)
Filed under: BoingBoing, Civil Rights, General Musings, Government, Health, Society
Via BoingBoing, news of just how vigilant they are in Detroit to make sure you read the label of any beverage you are served:
Boy, 7, taken from family after drink mixup at Tigers game
The sign above the Comerica Park concession stand said: “Mike’s Lemonade 7.00.”
So when Christopher Ratte of Ann Arbor ordered one for his 7-year-old son at the April 5 Detroit Tigers game, he had no idea he was purchasing an alcoholic beverage.
Or that his son would end up spending three days and two nights in the custody of Children’s Protective Services.
A park security guard spotted 7-year-old Leo Ratte drinking the Mike’s Hard Lemonade, confiscated the bottle and took the family in for questioning.
Yep. Didn’t just tell the guy to drink the damned thing himself. Didn’t warn him that giving the kid an alcoholic beverage in a public venue wasn’t a great idea. Took the family in for questioning. What followed was Kafkaesque. And all too common when one transgresses something that the authorities think you shouldn’t do.
They took his kid to a foster home, where he stayed for several days before being released into the custody of his mother. And the father was prohibited from living in his own home for a full week, so that he wouldn’t have contact with the child.
And that happy outcome wouldn’t have happened nearly so quickly had not the parents been professors at the University of Michigan, with the full power and resources of the University available to them to help deal with the nightmare. From the news article:
Don Duquette, a U-M clinical professor of law and director of the child advocacy law clinic, said he got a call from the chair of Ratte’s U-M department at 9 a.m. the next day. Duquette spent most of that day on the phone, trying to get Leo back into his parents’ custody.
* * *
Duquette said the fact that Ratte and Zimmerman got their son back so quickly was unusual and due only to their sophisticated legal counsel.
Ratte said he and his wife know that they were lucky to have the resources of U-M behind them.
“Class has something to do with the fact that the child was only in care for two days,” Duquette said. “What the referee said was that she would have kept the case for at least a week while the department completed the investigation. … If you’re not sophisticated, the system isn’t set up to give you very much of a chance to work against the ritual that’s ordinarily done.”
It took three more days for the judge to dismiss the complaint, allowing Ratte to return to his home. That happened after Leo and his 12-year-old sister, Helena, were taken back to Detroit for further interviews.
Imagine if it had been you. Think you would have been able to get your kid back so easily?
*Sigh* I am not against the state watching out for the safety of children, and following up on any reported cases of abuse. Not at all. But look at what happened – this guy, perhaps a bit clueless about modern alcoholic drinks (I’ll admit – I hadn’t heard of this beverage before – I pay no attention to ‘alcopop’ drinks. I drink beer, or scotch, and could have made the same mistake), no doubt distracted by all the excitement and activity of taking his 7 year-old son to a ballgame – accidentally gives his kid this bottle without carefully reading the label to see that it contains alcohol. Guard notices the kid drinking it. Guard confronts parent, who denies knowing that the thing had alcohol in it. Guard summons police, and the nightmare begins, and at no point does anyone in authority exercise the slightest bit of common sense.
Why? Probably because once the paperwork started, everyone involved on the side of the authorities was ‘just doing their job’.
I don’t know what Michigan law is on the matter, but a number of state laws allow parents to give their kids alcohol, so long it is consumed in the presence of the adult. In Europe, kids routinely drink alcohol with meals. It used to be that most cough medicines contained a large alcohol content, even the stuff made for kids (this may still be the case). I grew up having alcohol now and then with my family. OK, ignore that last item – I’m not the best example, godless heathen that I am.
Anyway, my point is that it isn’t like the kid was plastered, or that the father was doing anything dangerous. The guard should have just told the guy to stop. Once the cops were called, they should just have exercised a little discretion (which happens all the time, particularly if it is another cop involved in a transgression), warned the guy, and sent father and son on their way.
Insanity. Glad I don’t have kids.
Jim Downey
(cross posted to UTI.)
Filed under: Flu, General Musings, Pandemic, Predictions, Preparedness, Press, Science, Society, Writing stuff
Communion of Dreams is set in a post-pandemic world, some 40 years after a new flu strain has caused massive death and global disruption.
For the most part, people never really think about the flu or any other virus presenting much of a threat. Partially, this is due to not wanting to think about such things as death. Partially, it is because there really isn’t much in the way of treatment for most viral diseases. As a result, sometimes it is difficult to get much information in the news, unless you really work at it. A good example of this is the recent outbreak of EV71 in China – my wife caught a brief mention of it on the BBC news, told me. I had to really hunt around to find this:
Mass intestinal virus infection up to 1,520, kills 20
HEFEI — A lethal outbreak of intestinal virus in Fuyang City in east China’s Anhui Province has killed 20 children and befallen 1,500 others, the provincial health department said on Tuesday.
Du Changzhi, Anhui Provincial Health Department deputy chief, said the virus, known as enterovirus 71, or EV71, had altogether sickened 1,520 children, claiming 20 lives by Tuesday morning.
Of the sick, 585 had recovered thus far. At present, 412 sick children have remained in hospital for further medical observation. Of the total, 26 are seriously ill.
The Wall Street Journal did have this:
China Suffers HFMD Outbreak
Common Illness Catches Attention Of Global Officials
HONG KONG — A deadly outbreak in eastern China of a common childhood illness that rarely kills people has caught the attention of international health officials.
The outbreak of hand, foot and mouth disease, or HFMD, has killed 20 children in Fuyang, a city in eastern Anhui province, and has affected some 1,200 children altogether, according to the Anhui provincial health department. Of those cases, 341 children are still in the hospital.
A report by the state-run Xinhua news agency late Sunday evening said the outbreak began in early March and cited the city’s health department as confirming that the disease was caused by enterovirus-71, one of several viruses that can cause HFMD.
* * *
China’s Health Minister Chen Zhu visited Fuyang on Saturday, according to the Xinhua report. Chinese health officials at the local level in the past have sometimes played down disease outbreaks early on, only to be caught off guard later.
Indeed. There have been a number of such problems with reporting outbreaks in China, as we saw with the SARS virus in 2003. What this means is that a new virus can get established before anyone really knows what is going on. And that could be really catastrophic in terms of implementing public-health plans to limit the spread of any major new disease.
[Major Spoilers Ahead.]
At the end of Communion, I reveal that the new engineered flu virus which has been released comes from China. I did this for this reason – to draw attention to this very real problem. It’s bad enough that some virus could pop up just about anywhere where there is very little public health infrastructure, and so be missed. That a threat could come, and be intentionally ignored, is really dangerous. You really gotta wonder just what people are thinking when they do this.
Just as you really gotta wonder why such things are not covered in the news, rather than the latest celebrity gossip or outrage.
Jim Downey
Filed under: Feedback, Flu, Heinlein, movies, Pandemic, Religion, Robert A. Heinlein, Science Fiction, Society, Survival, Writing stuff
A discussion over on UTI about a post I made there took a bit of an odd turn, engendering some interesting discussion about polygamy. This morning I made a comment that I thought I would share here, since it does relate directly to some of the things I do in Communion of Dreams. You’ll see what I mean.
Heinlein’s use . . . of non-standard family structures got me thinking about many of these issues when I was very young, and helped me form my opinions intellectually before getting into emotional commitments.
I tend to think that the serial monogamy that we see as a default in Western countries reflects the differences between societal conventions and evolutionary inclinations, with a big helping of “we live a whole lot longer now than early humans did” thrown in for good measure. It is rare to see a marriage last more than ten or fifteen years these days, and I think that makes a lot of sense – when most humans lived until 30 or so, it would make sense that pair-bonding would be a good strategy to raising and protecting children into early adulthood. That would mean a “marriage” of about the length I mention above.
But we live a lot longer now, and people grow and change throughout their lives. So it is unsurprising to me that divorce is common (something like half of all marriages end in divorce) as a way of dealing with these changes. Some people find a way to grow in tandem with their partner, and some find ways of allowing a certain freedom of definition for each partner within the structure of an ostensibly conventional marriage (some, of course, do both). Different cultures have found different strategies to accommodate these stresses – some allow for polygamy of the ‘conventional’ sort (think the Mormon or Islamic variety), some make divorce easy, some de-emphasize marriage itself, some ‘look the other way’ when one or the other partner in a marriage cheats or has a formal concubine system.
A fairly recent development in all of this has come to be known as polyamory – defining relationships as being more open and less “possessive”. There are some fairly well-known practices and practitioners, such as Penn Jillette. This attitude pretty well covers most of Heinlein’s alternative marriage structures and can work for some people, though it would understandably require a different sort of approach and mindset than what is commonly considered about marriage/love/relationships. In an homage to Heinlein I had originally used alternative family structures as the “norm” in my SF novel set about 50 years from now (a survival-strategy response to environmental conditions), but early readers of the book got too hung up on that so I changed it. Perhaps if/when I am an established author I can get away with it, as RAH did.
Children? I dunno – don’t have any, by choice. Not an issue for me, in several senses of the term.
[Mild spoilers ahead.]
To me, the novel actually does work better the way I had the family relationships defined before, with a group marriage built around a small number of adults who have just a couple of fertile people at the core. This would allow for those precious few who are able to have children (remember, the fire-flu plague had not just killed vast numbers – it also left most people who survived it sterile) to do so with minimal stress, the rest of the family caring for them and the children born into the family. Think how it would be otherwise: the few fertile couples trying to have and raise children in a society desperate for kids, maybe even willing to steal them or force child-baring couple to give their children to others.
But this change was just too hard for some people to wrap their heads around comfortably – they wanted to turn it into something about sex rather than about children. Maybe they felt threatened by the idea, since the time-frame of the novel was so close to our own. I dunno – my head doesn’t work that way. So I made the change, and tried to work in enough explanation for the type of ‘family’ that exists in the book, while removing the polyamory element. So far no one has commented on the current version as being a problem for them, and that is likely how it will stay.
Jim Downey
(Again, if you didn’t recognize the quote used in the title, shame on you. It’s from this.)
Filed under: ACLU, BoingBoing, Civil Rights, Cory Doctorow, General Musings, Government, Predictions, Privacy, Society, Terrorism, Wired, YouTube
Man, I love the UK, particularly Wales. Have been there half a dozen times, and enjoyed it every time.
But I have to admit, the whole creeping and creepy 1984 mindset about CCTV there drives me nuts. The Brits are well on their way to being a true surveillance society. As I have written recently:
I am constantly dismayed by just how much Great Britain has become a surveillance society, to the point where it is a dis-incentive to want to travel there. In almost all towns of any real size, you are constantly within sight of multiple CCTV cameras, and there is increasing use of biometrics (such as fingerprint ID) as a general practice for even routine domestic travel.
Well, there’s another development related to this: the mindset that for “security purposes” the police and public need to “be aware” of people taking photographs. I’m not talking about around some kind of secure military base or something – I mean in general. This sort of thing has been mentioned numerous times over at BoingBoing (in particular, check out this, this, and this), but an item yesterday really jumped out at me:
Middlesbrough cops, goons and clerks grab and detain photographer for shooting on a public street
That links to this Flickr account of the incident:
My friend and I were photographing in the town. I spotted a man being detained by this security guard and a policeman, some kind of altercation was going on, i looked through my zoom lens to see what was happening and then moved on.
Moments later as i walked away this goon jumped in front of me and demanded to know what i was doing. i explained that i was taking photos and it was my legal right to do so, he tried to stop me by shoulder charging me, my friend started taking photos of this, he then tried to detain us both. I refused to stand still so he grabbed my jacket and said i was breaking the law. Quickly a woman and a guy wearing BARGAIN MADNESS shirts joined in the melee and forcibly grabbed my friend and held him against his will. We were both informed that street photography was illegal in the town.
Two security guards from the nearby shopping center THE MALL came running over, we were surrounded by six hostile and aggressive security guards. They then said photographing shops was illegal and this was private land. I was angry at being grabbed by this man so i pushed him away, one of the men wearing a BARGAIN MADNESS shirt twisted my arm violently behind my back, i winced in pain and could hardly breathe in agony.
A policewomen was radioed and came over to question the two suspects ( the total detaining us had risen to seven, a large crowd had now gathered)
The detaining guard released me, i asked the policewoman if my friend and i could be taken away from the six guards, she motioned us to a nearby seat and told all the security people to go. She took our details, name, address, date of birth etc. She wanted to check my camera saying it was unlawful to photograph people in public, i told her this was rubbish.
Now, before you get all worked up hatin’ on the Brits for not respecting the civil liberties of their citizens and guests . . .
. . . here’s a little gem about New York’s finest, also courtesy of BB:
NYPD cop: videoing me breaking the law is a terrorist act
This video is of a man filming a cop who parked illegally in front of a fire hydrant. He follows her, asking questions, and she mostly ignores him. Then something truly disturbing happens.
A retired police woman comes by and informs the first cop, and the man filming that citizens aren’t allowed to film anybody who works for the police department “’cause of the terrorism.”
OK, isolated incident. But here’s a little something else to consider about how the “War on Terror” is suppressing civil liberties of all of *our* citizens and guests:
Border Agents Can Search Laptops Without Cause, Appeals Court Rules
Federal agents at the border do not need any reason to search through travelers’ laptops, cell phones or digital cameras for evidence of crimes, a federal appeals court ruled Monday, extending the government’s power to look through belongings like suitcases at the border to electronics.
The unanimous three-judge decision reverses a lower court finding that digital devices were “an extension of our own memory” and thus too personal to allow the government to search them without cause. Instead, the earlier ruling said, Customs agents would need some reasonable and articulable suspicion a crime had occurred in order to search a traveler’s laptop.
On appeal, the government argued that was too high a standard, infringing upon its right to keep the country safe and enforce laws. Civil rights groups, joined by business traveler groups, weighed in, defending the lower court ruling.
The 9th U.S. Circuit Court of Appeals sided with the government, finding that the so-called border exception to the Fourth Amendment’s prohibition on unreasonable searches applied not just to suitcases and papers, but also to electronics.
So, it isn’t just your underwear and sex toys that the Feds want to paw through when you travel outside the US. It’s also any data you might have on any kind of electronic device. “‘Cause of the terrorism,” you know.
Jim Downey
(Cross posted to UTI.)
Filed under: Book Conservation, General Musings, Health, Predictions, Science, Science Fiction, Society, Survival, tech
As a book conservator, one of the things I deal with most frequently is problems caused by the embrittlement of paper and other cellulose materials. This embrittlement is, generally, caused by residual acid content from the manufacturing of those materials. For a period of about 130 – 140 years (basically from the start of the American Civil War until just before the turn of the 21st century), paper was most widely manufactured using an acid bath to wash away non-cellulose fibers, which left that residual acid content slowly weakening the paper. This is a process known among conservators and librarians as “slow fire“, since it is essentially an oxidation process akin to the combustion of fire, but on a longer time scale. Perhaps surprisingly, this mechanism wasn’t understood at all until about the time of my birth some fifty years ago, when research started to show what was actually happening to paper at this very basic level.
Now the majority of paper is made using an alternative process, primarily due to environmental needs (less pollution). It is a side benefit, but an important one, that this usually results in a much more stable and longer-lasting paper, one which doesn’t have that residual acid content causing problems. Because paper doesn’t have to become embrittled with age – I have lots of examples of paper made 500 years ago that looks as fresh and supple as paper made last week. The paper we’re most widely using now has a similar stability.
* * * * * * *
Now, it seems, scientists studying evolution and extinction may have stumbled upon a similar stability issue with regards to humans, and it could portend a medical breakthrough which would save countless lives and extend others.
Writing for Seed Magazine this week, Peter Ward notes that of the five major mass extinction events in Earth’s history, one of them was undoubtedly due to a single chemical:
But now, together with Mark Roth of the Fred Hutchinson Cancer Research Center in Seattle, I believe we have found a possible biochemical scar, present within living animals, that links Earth’s greatest mass extinction to a single substance: hydrogen sulfide (H2S). Hydrogen sulfide is a relatively simple molecule that gives rotten eggs their distinctive foul odor and is quite toxic–in high concentrations a single breath can kill. And it looks like that is what happened: Hundreds of millions of years ago, hydrogen sulfide probably saturated our oceans and atmosphere, poisoning nearly every creature on Earth.
Yet some creatures, like our very distant ancestors, must have somehow survived this toxic environment. What Roth has discovered is that H2S, incredibly, also has the ability to preserve and save lives. In small doses the chemical puts many animals into a state of “suspended animation,” a useful adaptation that would have allowed creatures to, in essence, hibernate through the catastrophe of mass extinction. If this idea is correct, our understanding of the deep past could lead to a dramatic medical revolution very soon.
What kind of dramatic medical revolution? The Science Fiction dream of suspended animation, allowing people with an illness or injury to be “set aside” for decades until medical science comes up with a cure, or a way of putting their brain in a newly cloned body?
Nope. Something a lot simpler, and probably a lot more useful. This:
When we humans are cut or injured, our bodies naturally produce small quantities of hydrogen sulfide. In essence, the body may be trying to put itself into suspended animation to survive the injury, an instinct held over millions of years in our genes. Yet whenever one of us is dying, say from a heart attack, our first instinct is to give that person oxygen. The problem with this “life-saving” first response may be that the oxygenated red blood cells rush to the damaged cells and act like gasoline on a fire. Oxygen is one of the most chemically active substances on Earth, and though we need it to survive, it can ravage our bodies. The oxygen increases the reactions causing the heart attack in the first place; it tears up more cells and overwhelms the virtual suspended animation that the body-produced hydrogen sulfide created. Then it kills you.
Oxygen. From whence we get the term Oxidation. As in “burning” or “fire”. So, what to do? Here’s the concluding bit from the article:
Perhaps our first instinct in instances of a heart attack should be to cool the body and let hydrogen sulfide do its natural work. To save life, in other words, you may first have to effectively suspend it with hydrogen sulfide. This tactic may just be what got us so far in the first place.
There is no clear understanding yet of why our injured bodies are able to produce hydrogen sulfide or why H2S puts some mammals into suspended animation. But I believe that Roth has found our body’s own memory of the ancient events that nearly killed our distant ancestors. Some proto-mammals may have been exposed to H2S, and instead of dying, they were placed into a state of suspended animation that allowed them to survive until the initial hydrogen sulfide levels subsided and they were reanimated. Some lucky evolutionary accident ensured the mammals’ safety through a deep sleep, and that accident may still be dormant within us. That which allowed our ancestors to survive millions of years ago might also be a means of our survival now.
* * * * * * *
Like paper made 50 years ago, I am not as supple or fresh as when I was born. I too have experienced my own version of embrittlement. There is only so much my body can do to keep up with the effects of oxidation. There are plenty of commercial products out there touting their antioxidant effect, just as there are products I use to neutralize acid in paper, but none of these will return me to my youth, just as I cannot reverse the effects of embrittlement in paper.
But it seems that perhaps we have a new insight into some of the mechanisms at work. I don’t expect to live forever, but I certainly wouldn’t mind having better and more effective medical treatment for what time I have. As a conservator, my best hope is to preserve what suppleness there is still left in paper. I’d be willing to settle for the same thing, myself.
Jim Downey
You may have heard of the 5.2 quake we had in this area this morning (epicenter about 150 miles from here, I’d guess). I missed that, what with being sound asleep and all. Got people rattled, you might say.
Well, we just had an aftershock here about 45 minutes ago. I was writing an email to a friend at the time, said this:
I think we just had another post-quake shock. Whole house vibrated, and my monitor did a little dance.
Hmm. Should check the USGS and see if they have anything posted yet.
Nope. But I filed a report.
Well, the report is now up: a 4.5 event, according to IRIS. Interesting. That may be the most powerful one I’ve felt.
Lots of people don’t think of the Midwest as being particularly active, seismically (and otherwise). But we’re probably sitting on top of one of the biggest potential disasters when it comes to likely earthquakes: the New Madrid Fault. Hereabouts, people actually worry about this from time to time, though not nearly enough in terms of applying architectural and engineering knowledge to minimize risk. Because that would cost money.
Shocking, I know.
Jim Downey
Communion Of Dreams 