A New Energy Revolution? Ebola and Competence: a discussion

View 846 Thursday, October 16, 2014

“I have observed over the years that the unintended consequences of social action are always more important, and usually less agreeable, than the intended consequences.”

Irving Kristol

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

President Barack Obama, January 31, 2009

This is an exemplar of many letters I have received recently.

Lockheed – Commercial fusion in 10 years?

Hi Dr. Pournelle,

After all the decades of disappointments, is the era of fusion power now actually within reach? Lockheed sounds very confident in this article:

http://www.theguardian.com/environment/2014/oct/15/lockheed-breakthrough-nuclear-fusion-energy?CMP=fb_gu

They expect to have a commercial 100 MW deuterium-tritium reactor that will fit on a truck in 10 years. I’ll go out on a limb and predict that if they do, the “environmentalist wackos” will find some reason to oppose it.

Bill

I intend to look into this: clearly if it were true, it would change the world. Science fiction writers and academic futurists have speculated about the consequences of cheap energy. One of the earliest was Heinlein. I have written about the Second Industrial Revolution: the First made energy available for manufacturing. One consequence was big cities, because much of the big energy of that revolution was centralized and concentrated, and required large capital investment before you could make use of it. The Second Industrial Revolution, which I call “the quarter inch drill”, came about with the development of widely distributed low cost high energy devices that could be used nearly anywhere and which were affordable by nearly anyone.

Both these Revolutions – and they truly were – depended on energy production and that remained dependent in turn on great industries: mining, transportation, drilling, refineries, power plants and distribution grids.

Cheap distributed energy production from low capital devices would be another Revolution.

For most of the history of mankind, something like 90% of mankind lived at the edge of survival. Historians call this the Malthusian Era. Most of the population worked in agriculture and the distribution of agricultural produce. Peasant had perhaps one change of clothing, and labored six days a week (seven in cultures uninfluenced by the Bible) relieved only by holidays. There was no science of medicine. Lives tended to be short. Food consumption was not much above survival rates.

As Gregory Clark observes in A Farewell to Alms, “The average person in the world of 1800 was no better off than the average person of 100,000 BC. Indeed, the bulk of the world’s population was poorer than their remote ancestors.” This condition prevailed across the world. “Jane Austen may have written about refined conversations served over tea in china cups. But for the majority of the English as late as 1813 conditions were no better than for their naked ancestors of the African savannah. The Darcys were few, the poor plentiful.”

The industrial revolution changed all that. Mr. Darcy was wealthy, but even the poorest in America have, or can have if they take the trouble to work the system, television, access to transportation, more than enough to eat along with some discretionary income for cigarettes and liquor, and some access to medical care that the very wealthiest could not have afforded before 1930. Mr. Darcy had little of this.

All this change was brought about by the various industrial revolutions.

Cheap energy widely available, plus human initiative, added to the Computer Revolution, will have similar effects – or potentially could. Of course the likelihood that all the good will be absorbed by bureaucracy and the effects will not happen is reasonably good.

The history of civilization has this thread: more and more of the output of the society is converted into structure. The structure is controlled by rent seekers who become a bureaucracy. The Iron Law of Bureaucracy prevails. Sometimes – the discovery of the New World, the inventions that inspired the first three Industrial Revolutions – productivity is so great that the structure is evaded. The bureaucracy doesn’t have the means to control and regulate and redistribute. That happened in the Computer Revolution, but it appears that the regulators will gain control of that, too.

Look for the Iron Law to assert itself if small cold fusion becomes possible.

 

Of course none of this applies if the technology is not there.  The Lockheed effort is not the only possible “small fusion” effort. http://www.extremetech.com/extreme/191754-cold-fusion-reactor-verified-by-third-party-researchers-seems-to-have-1-million-times-the-energy-density-of-gasoline

I do wonder why there is not a larger ferment within the scientifically cognoscente press.  Most of that press is controlled by the regulatory aristocracy, but surely there are some independents. We can hope.

Ebola

 

Ebola

Dear Mr. Pournelle;

I don’t want to minimize the danger of Ebola — I’ve suspected for some time that a pandemic might be sufficient to collapse our civilization. But I do want to ask: is it the responsibility of the Federal Government to prevent its spread? If so, how far does that extend? Should the CDC have not only advisory but enforcement authority? Should the Federal Government dictate procedures to all hospitals anywhere near an airport?

Granted there are less intrusive measures already available to Federal authority. However, it has seemed to me on more than one occasion that when something frightens or enrages us, we are prone to demand that The Authorities fix it — using powers which, in saner moments, we never gave them.

If we want a non-intrusive government, it seems to me we will also need to find ways to respond to genuine emergencies which don’t require government intrusion.

Yours,

Allan E. Johnson

I would say that it is the responsibility of the federal government not to import Ebola, since the states don’t have the authority or the ability to control international travel.  So far as interstate travel is concerned, that has to be federal again; the states are not permitted to erect immigration barriers against other states.  Should they be? The Constitution gives interstate commerce to the Congress.

I would suppose that a wise federal government would try to avoid direct regulation and responsibility for hospitals within the states (other than federal facilities such as the VA), but I have little expectation of wisdom from the current bureaucracy and even less from the administration.

I would presume that the Federal excise tax on medical equipment (20%) would impose a moral obligation on the federal government, but I doubt anyone feels that.

 

Have any of you noticed the elephant in the room?

We have two nurses infected and sick with Ebola.

We have a family that was in contact with Duncan while he was getting sick even after his temperature spiked to 103.5. So far none of them are sick.

While I am sure this is premature one tentative conclusion I draw is that the patient is not particularly contagious until well into the "I’m sicker than hell" state. It’s worth thinking about.

{^_^}

True of his strain. Not of other strains. [JEP]

 

At the moment the head of the CDC is adamantly testifying that Ebola is both undetectable before they are symptomatic and can not transmit Ebola during the period they cannot detect it. They are currently defining 100.4 degrees (If I recall correctly) as a critical temperature. So the nurse with a 99.5 fever probably would not be a danger to people around her. At 101.5 she’d be a danger to people around her if, for example, she stumbled and somebody tried to help her by grabbing her to steady her.

But, then, we do have the families that are not affected (so far) even with the patient spiking to a fever of 103.5 and nurses over exposed due to inadequate protection early on to consider. This hints you really have to try hard to become infected. West Africans with their funerary procedures seem to go out of their way to be exposed to Ebola. Doctors and nurses are in intimate contact with patients which puts them in extreme danger, God bless them every one!

With that as a background, I am inclined to the opinion that the media are toning this to panic the populace and sell their newsware rather than provide the word that the danger really is minimal if the responses of the medical profession are carefully considered and well trained. It is actually rather difficult to transmit Ebola, at least this strain and probably all five strains.

I also rather like the CDC’s advisory role. "We advise you not to fly and we are notifying the airlines of this. It will be up to the individual airline to let you fly or not. If they do not our warning will shield them from lawsuits over refusing to let you fly." Inform the public if a person advised not to fly actually is allowed to fly after the warning. The public tries and convicts the airline "for free."

If the CDC does maintain stocks of materials both written and equipage that can be requested by states or medical facilities on short notice, that is also a very good thing.

Our Constitution should prevent the CDC from moving in and taking over on its own initiative.

{^_^}

By the way – I take issue with what I’ve read of the protocol for taking off the medical moon suits. I suspect they need to rethink it for Ebola at least. I suspect duct tape and Velcro are your friends here. The Velcro is to allow the suit to part at the shoulders so it can be peeled (and rolled) down the body with the contaminated surface in side. That allows the hood to come off first over the head while the wearer leans forward and pulls a tab connected down to the lip of the head gear’s cowling. Expose skin only to the inside surfaces.

Once the cowling and hood is off pull on the suit below the shoulders to pop the shoulder Velcro loose. Pull the hands partway out of the gloves that are duct taped to the sleeves of the garment. Peel the suit off like a condom rolling the contaminated surfaces inside. Once it is down step out of the booties. Only uncontaminated insides should be exposed at this time. Have tabs off the front of the shoes maybe an inch or so to allow the wearer to step on one tab with the other foot to free the feet from the booties.

Then take off the inner layer of protection that’s not normally called for.

Then toss everything into a barrel of chlorine water using long tongs or whatever.

{^_^}

I would suppose that there have been engineering studies of this, or at least of removing protective gear contaminated with corrosive substances; but that supposes more competence than I am finding in examining the health care bureaucracy. There are competent people in the bureaucracy, but the Iron Law still prevails, and it has worked its will on administration and bureaucracy alike; or appears to have. Why does the chap who told us all the hospitals are ready for Ebola still have a job? And who is the supervisor of the people who told Nurse Amber that it was all right to fly with a 99.5 F fever even though she had probably been exposed to Ebola? Is that person still employed and answering health questions?

But then we have been led to expect competence in many parts of this administration

But then I tend to take an engineering approach to problems.  First you have to define an objective.

http://www.foxnews.com/politics/2014/10/16/cdc-considers-adding-names-people-monitored-for-ebola-to-no-fly-list/

The move is being considered as a response to Wednesday’s disclosure that Dallas nurse Amber Joy Vinson was cleared to fly on a commercial airliner earlier this week despite having been exposed to the Ebola virus while treating Thomas Edward Duncan at Texas Health Presbyterian Hospital.

On Monday, a CDC official cleared Vinson to fly from Cleveland to Dallas on board Frontier Airlines Flight 1143 despite the fact that she had called and reported having a slight fever, one of the common symptoms of the Ebola virus. Vinson’s reported temperature — 99.5 degrees — was below the threshold of 100.4 degrees set by the agency and she had no symptoms, according to CDC spokesman David Daigle.

 

 

Problems Quarantining Ebola

Jerry,

My thanks to reader Earl for his pointer to the WHO release that mentions 5% of recently studied Ebola incubation periods not (I’m stating this carefully) provably falling within the nominal 21 days.

The actual wording in the WHO release (at

http://www.who.int/mediacentre/news/ebola/14-october-2014/en/) is "Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval."

(It’s easy to take the missing 2% and infer those cases incubated for even longer than 42 days. Note though that any such study necessarily will include some uncertainty as to when infection actually first took place; some or all of the missing 2% might also be that. Regardless of that uncertainty, the 3% of cases WHO does specify at 22-42 days incubation is alarming enough.)

Also worth noting is another recent study (story at

http://www.naturalnews.com/047281_Ebola_symptoms_incubation_period.html)

which says that between .2% and 12% of recent cases may still not show symptoms 21 days after infection. That’s quite a wide range of uncertainty, but FWIW the median 5.9% is quite close to WHO’s overall 5% non-21-day cases.

There are also studies showing significant numbers of individuals infected with Ebola who have remained asymptomatic indefinitely.

http://download.thelancet.com/flatcontentassets/pdfs/PIIS0140673614618390.pdf?id=aaadpDXSyNZVP5Qg76oKu,

and http://www.ncbi.nlm.nih.gov/pubmed/10881895.

The now-known longer-than-21-days incubation periods (plus the real possibility of transmission by asymptomatic individuals) may well account for a problem I’ve seen reported from the current West African outbreak: Localities that were thought to be past their crisis with sharply declining infection rates have seen renewed outbreaks.

Meanwhile, the implications for US quarantine attempts are clear – simply waiting 21 days will not work. Further, it’s not clear that there is any practical quarantine length that will be effective.

The immediate conclusion I’d draw is that fast-turnaround (minutes not days, on-the-spot not lab) tests for virus presence are an essential part of any effective Ebola entry-prevention policy.

The immediate policy implication is that mass-deploying such tests (in the works from at least two different sources, http://khon2.com/2014/10/14/tulane-doctor-developing-faster-ebola-test-detection-in-minutes/

and

http://denver.cbslocal.com/2014/10/14/colorado-test-for-ebola-could-speed-up-diagnosis-to-10-minutes/)

should be a crash priority.

It’ll be, uh, interesting to see how long it takes the CDC and White House to reach the same conclusion. Or, more likely, be forcibly led to it… Whatever works.

Porkypine

Never waste a crisis.  If this one causes some reforms of the bureaucracy it may increase the competency of an important federal agency and our confidence in it.  I fear I do not have high hopes for this.  The Iron Law is pretty implacable.

 

There are several flaws in the fast tests mentioned by Porkypine

First. Present data indicates that a victims will not test positive to Ebola for as much as 4 days after frank symptoms. One shudders at the thought of a Real Case of Ebola being turned away because of a quick negative result, free to cough all over folks on the bus or subway.

Second> WHO defines a negative result as TWO tests taken 48 hours apart. This is quite different from the sloppy results that CDC is pushing. A quick test would not provide any advantage except to point out the obvious positives. You would still need 48 hours (or the 4 days after symptoms) to safely pronounce a negative result. This was a point where the bureaucrats at WHO castigated the bureaucrats at CDC as not being careful. (such a delightful image – bureaucrats facing off with automatic weapons at 2 paces and may God protect the Right )

Earl

 

 

Ebola Visas

Jerry:

Regarding State Department protocols permitting visa issuance: I am a retired Immigration Officer. State can (and has) revoked visas that have already been issued. It would be a fairly simple matter to cancel all visas issued at consulates in the affected countries. Normally, people who reside in those countries must receive visas only from their own consulates. I suppose exceptions would have to be made for diplomatic visas.

The mechanism whereby this would be implemented would be to notify all common carriers of such cancellation. The carriers would be liable for substantial fines for allowing persons with such cancelled visas to board a flight to the US. This would be more effective than stopping direct flights, since it is easy for people to connect through another location such as Brussels.

Best Regards,

Greg Fiorentino

Why is this not being done?

In this: http://www.foxnews.com/politics/2014/10/16/lawmakers-grill-health-officials-over-ebola-response-resistance-to-travel-ban/

Is this quote: "But health officials continued to downplay the need for flight restrictions for flights to and from West Africa, arguing that officials still would have a difficult time tracking where travelers have been. "

Having just been through customs in two countries, that’s a non-starter. If it’s an electronic passport, just check the records – and if not, check the date on the customs stamp! This is not rocket science. Sure it’s not perfect, but it’ll be a darn sight better than nothing. There’s another agenda here, and I wonder just how much of the information we’re being fed is truth and how much is spin.

Doug

I would think that not importing new strains would be a high priority move.

 

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