Questions about Ebola. Questions about an essential reading list.

View 846 Tuesday, October 14, 2014

“Transparency and the rule of law will be the touchstones of this presidency.”

President Barack Obama, January 31, 2009

I have just learned that Harlan Ellison had a stroke last week, but is in recovery, and has been visited by many of his friends.  He is an old friend. We are not close, but we have been good friends for decades. Mike Glyer’s account is here.  http://file770.com/?p=19220 

 

 

The October Column FINAL is now in the hands of the managing editor, and will begin to appear at Chaos Manor Reviews. I remind you that this is Pledge Week. I do not constantly bombard you with requests that your subscribe except during the weeks when KUSC, the Los Angeles classical music station, hold their pledge drive. This place operates like public radio. It’s free, but it is publicly supported, and won’t survive without subscriptions and patronage. If you have not subscribed, this is the time to do so. If you can’t remember when you last renewed your subscription this would be very good time for that. We have several levels of subscription and support. Paying for This Place

The official line is that American hospitals are all prepared to handle Ebola, so we need not have an international quarantine. This opinion is not universally shared:

http://www.theguardian.com/world/2014/oct/14/who-new-ebola-cases-world-health-organisation?CMP=fb_gu

Ebola

Something that is not being actively noticed in the media is a statement I read from Ms. Pham that she was involved in the initial (2nd) reception of Mr. Duncan when he presented in the ER. At that time she had NO protective gear to shield her from an active case of Ebola that had yet to be diagnosed.

The danger to the medical community is not from shedding virus during the treatment. It is rather to the EMTs who pick up the patient, the receptionist at the Doctor’s office, the other patients in the waiting rooms, and the ER staff all of whom have direct contact with a patient with active symptoms and already in an infectious state. It does no good to don protective gear after you have already been exposed.

With only 19 hospital beds in the country rated to treat this Level 4 disease we are just whistling in the dark about the ability of the medical establishment to contain the outbreak. The typical Doc in a Box facility or even major hospital are ill equipped to handle a presenting case. Most of the scares we will see in the next few weeks will be merely false alarms that turn out to be something else. But then we get the real event that contaminates a major medical center and is the lead in to infecting most of the skilled caregivers. Ebola requires a Level 4 care but most of our facilities are Level 2 and only a few are even Level 3.

This will end up as a major social catastrophe, the medical resources consumed and the treatment reduced to families providing the only treatment received. The only treatment that will be available will be to keep the patient hydrated while experiencing major loss of fluids and salts. And the net result will be that 50% of the patients die, even with the best treatment. In spite of all the claims of miracle vaccines that are being investigated the only recognized treatment is a plasma treatment from a person who has already recovered.

The only way to fight this problem is to institute a full scale mobilization. A person who comes down with Ebola will be placed under military supervision, and treated by people who have recovered and are now well and immune . All the messy things that need to be done to clean up a person with total loss of body control. And then carry out the disposal of the 50% who fail to survive. The lucky 50% would then be drafted as caretakers for the next round of infections. The survivors would have their blood drawn weekly for plasma to be given to the new patients. (The new miracle treatments that the pharmaceutical industry promises have not even passed the initial safety trials let alone dosage or efficacy and the ramp up in production would be like penicillin during WW2 – a miracle but not available for several years due to production problems). Strangely the only recognized treatment besides plasma from a survivor is nano- silver (which was recognized effective by the DoD against viruses in the blood but has major criticisms ) but obviously has no commercial possibilities.

We are lucky that Ebola has such a poor reproduction capability. Each victim on average only contaminated 2 new individuals, unlike measles which has a reproduction factor of 48. So like clockwork we can expect a doubling of the cases every 2 or 3 weeks. Think of the horror if the instead of 2**n we were facing 48**n. But one year gives us an n=17 (or worst case n= 25), and with a base of 4000 present cases the number of cases to be expected will be very high – and 50 – 70% fatalities. If the doubling time is taken as 2 week we would have the whole Earths population involved within a year (less isolates)

There is a minute but real possibility that we can stop it THIS time. More likely however is the probability that, thanks to inadequate quarantine, that the genie is already out of the bottle. so we will see the progress is remorseless, and the chances of the disease dying out are nil. If the virus destroys a small isolated village no one notices, but now that it has reached the major metropolitan regions of Liberia etc. it will spread like a wildfire. Wealthy people will flee to other countries for safety, and since they are under the 3 week max incubation period their illness would be undetectable for a few days. Even the tests that are available will give a negative result until about the 4th day of active symptoms as virus spreading contaminates the surroundings. People will flee from danger carrying the plague with them to the four corners of the world. It will be the Middle Ages all over again, with each village and castle isolating itself until the disease breaches the defenses. And like in the Middle Ages our leaders will exhort our masses to put their faith in the Medical Establishment / God. The net result being a loss of faith and a new Reformation.

Earl

I do not share your pessimism, but I also do not share the unbridled optimism of the officials.  The President waited a long time before realizing the importance of this.  Ebola is not easily made into a weapon, but coupled with suicide bombers that transformation is not so difficult.  I do not believe that Washington is taking this threat as seriously as it should.

Wednesday AM: A second nurse who cared for Mr. Duncan has now developed Ebola, showing symptoms one day after she took a commercial airline flight.  The President has cancelled a fund raising tour and a golf game and will hold a cabinet meeting.  More news in the Wednesday VIEW.

 

 

My experience is 30 odd years in the nuclear industry dealing with surface contamination at various levels. For very high levels of contamination two separate layers, each sealed were used. The first one removed on leaving contaminated area. Then past a step off area to remove second layer. For really hot areas a second person assisted and was fully dressed out.

The technique of removing protective gear MUST be trained as it is easy to make errors. The best training uses a fine UV fluorescent powder as contamination. The worker is checked after task to determine success. Should be repeated until a clean result is obtained. And importantly annual retraining.

Protocol error could be a training error not a mistake.

Tom

The lack of training of ER personnel in use of isolation gear is becoming manifest, despite all the public statements about how well prepared we are. 

 

 

On Reading Lists:

 

Dr. P:

Greetings, sir! I hope you’re well.

A while back (ten years ago?), you posted a list of essays and books that you considered essential reading for people keen on understanding history as you do. I was wondering if you would consider reposting that list, as I’ve been unable to find it using Google keyword searches.

Thank you!

Bart Leahy

I must have that list somewhere, but I’m not finding it. I do have a list of works that I consider essential for anyone growing up as a citizen in Western Civilization. When I catch up with some other works I will try to recompile it.

Meanwhile: there are a number of books of great importance, but as I grow older, I realize that what seems to be missing in western education now is an historical framework in which to insert various works so that they can be imbedded in their time. One very readable book that does this is Fletcher Pratt, Battles That Changed History. Pratt chooses fewer battles than the classical battles that changes history books, but his strength is that he embeds his into an overview of western history. That doesn’t substitute for a good sense of western history from the times of the Battle Ax People to the Fall of the Soviet Union, but that’s what you will want. Many of us started with A Child’s History of the World. I read that at age 5, although it is intended for older children, and I see to it that all my grandchildren have it. Van Loon’s Story of Mankind is another book I can recommend. The important thing is to have a notion of what went on at various times. Then you can begin to learn history. You haven’t learned it from those books, but you do have a bit of a picture.

A fairly good edition of Pratt can be found at Gutenberg Press.

And, frankly, the California Sixth Grade Reader of 1914 that I have recently put up as an eBook contains a number of essential stories and poems that at one time everyone was simply assumed to have read. The stories in that book are a sampling, but that was a fairly good sampling.

After that we have, from previous entries in this column:

Liberal Education in a nutshell

In an article titled "An Education in 404 Pages," by James Baccus, Vanderbilt Magazine, Spring 2003 issue, page 11, the author cites the following as the most significant recommended reading for someone interested in a liberal education but without the time to read the works in full.

1. Ralph Waldo Emerson, "Self Reliance."
2. Alexis de Tocqueville, "The Principle of Interest Rightly Understood," from Democracy in America.
3. Thucydides, "the Melian Dialogue," from the History of the Peloponnesian War.
4. James Madison, Federalist 10 and 51.
5. Adam Smith, "On the Division of Labor," from The Wealth of Nations
6. Voltaire, Letter 15, "On the System of Gravitation."
7. Richard Feynman, "The Uncertainty of Science," from The Meaning of It All.
8. Plato, "The Cave," from The Republic.
9. Michel de Montaigne, "Of Cannibals," from The Essays.
10. John Stuart Mill, "Of the Liberty of Thought and Discussion," from On Liberty.
11. Karl Popper, Chapter 10, The Open Society and Its Enemies
12. Fyodor Dostoevsky, "The Grand Inquisitor," from The Brothers Karamazov.
13. Martin Luther King, Jr., Letter From Birmingham Jail.
14. Virginia Woolf, Chapter 6, A Room of One’s Own.
15. Abraham Lincoln, "The Gettysburg Address."
16. Suetonius, "Augustus, Afterward Deified," from The Twelve Caesars.
17. George Orwell, "Politics and the English Language."
18. Edmond Burke, "Letter to the Sheriffs of Bristol."
19. Samuel Johnson, Number 21, The Rambler.
20. Immanuel Kant, "On Perpetual Peace."
21. Henry David Thoreau, "On Seeing," from his Journal.
22. Plutarch, "On Contentment."
23. Soren Kierkegaard, "The Story of Abraham," from Fear and Trembling.
24. William Hazlitt, "On the Feeling of Immortality in Youth."

Jim Woosley

I might quibble here and there, and I think some of those entries are less important than some that were left out, but there’s nothing wrong with that list. I’d certainly include a couple of Plutarch’s lives in addition to the essay; they’re fun anyway. And Cicero on how to make a speech isn’t fun but is very much worth slogging through. Do understand, though, that this is a small selection of works that civilized persons should be exposed to over their lifetimes.

Dr. Pournelle, While reading your page I came across the reading list for a liberal education. Am I to take the word Liberal to mean politically liberal as we see in the United States today, or are we talking about a classical education? I am interested to understand. If you truly do recommend some of these books I will hunt them down.

Douglas Knapp

When I was a lad, a "liberal education" meant broad, with philosophy, an education in "the liberal arts," as opposed to narrow and more technical education such as one got in a music conservatory or an architectural school. The St. John’s College "Great Books" program was sort of the epitome of liberal arts education.

In those days most college graduates were Republicans (about 75%) so "liberal" didn’t mean politically liberal in the modern sense, but for that matter, a political liberal in those days wasn’t automatically an anti-anti-Communist supporter of welfare and of relaxing or ending discipline in schools. But in those days the Democratic Party was the party of "tariff for revenue only" and the Republicans were for protective tariffs, Democrats were for states’ rights and the Republicans had most of the black vote.

There are no items on the list given above that one should not have read, but it would be impossible to agree with everything there since there are mutual contradictions. And as I said, I would add some items, and if doing that required taking some off the list, I’d do that: not all the ones listed are the highest priority.

The real problem is trying to get an education of the old variety on the cheap. It’s far better to have read Federalist #10 than no Federalist Papers at all. It’s far better to have read some of Tocqueville than none, and it’s far better to have read some of Mill’s On Liberty than none of it, and part of one of Plato’s works than none of them, and — well, you get the idea. For those starting late and trying to see what this liberal education stuff is all about, that’s no bad list.

But I would seriously add a few summary works. Barzun’s Dawn to Decadence, Pratt’s Battles That Changed History, and Paul Johnson’s Modern Times are among them probably longer than the entire list given above, but they contain a great deal of understanding of our era.

Anyway, you will do yourself considerable good by finding those works and reading them.

You may find one problem: most of these works sort of refer to each other. Clearly the earlier ones don’t refer to the later, which is why many Great Books programs take works in chronological order, but there are difficulties with that approach too. The result is that you may not fully understand any of those works until you have read them all.

Classics are not always works one is glad to have read or wishes one had read, but one doesn’t want to read (although that can often enough). Some are a delight, and more so the second time you read them after you get that understanding that comes with familiarity with what was once the world of civilized discourse.

Hello, Jerry,

In addition you the rest of your reading, consider the newly-reprinted _A Stroll With William James_, by Jacques Barzun (U Chicago Press).

Someone on the William James discussion list called it "delightful", and they were right. All-around good book.

[Incidentally, I would add some part of Locke’s Second Treatise and the Declaration of Independence to the great essays subset of the Great Books. Also, bits of Adam Smith. And…]

Regards,

John Welch

Which I can certainly agree to.

Freedom is not free. Free men are not equal. Equal men are not free.