Sunday, October 12, 2014

species final exams: dmitri orlov offers a prudent and scalable ebola mitigation strategy


cluborlov |  I have already mentioned that it may be a good idea to make arrangements through which survivors would be able to feed themselves, and provide them with the few other necessities for survival.

Beyond that, there are the basic mechanics of handling the pandemic. The current strategy treats it as a medical problem, best handled by doctors and nurses working in hospitals and clinics. This strategy only works for as long as the epidemic can be said to be under control; once it can be said to be out of control, the surviving doctors and nurses (medics are usually the first to be exposed—and to die) would be well advised to specifically refuse to handle Ebola patients.

In absence of any curative or preventive therapies, Ebola patients need shelter, hydration, hygiene, palliative care and, if and when they die, sanitary disposal of the remains. The goal is to do what is possible to give patients a chance to recover more or less on their own. To this end, it is very important to do all the things necessary to make sure that people are dying just from Ebola, and not from exposure, dehydration, or from any of the opportunistic diseases that thrive in disrupted circumstances, such as cholera and typhus. Sanitation is the most important aspect of the entire operation.

These services need not be provided by trained medics. The main two requirements for such service are: 1. psychological immunity to scenes of horrific suffering and death; and 2. immunity to Ebola. The first of these requirements comes down to natural talent; some have it, some don't. The second requirement is being provided free of charge by the Ebola virus itself, in cooperation with the survivors' immune systems.

English lacks a good word to describe this type of specialist, but we don't have to reach far to find one: the Russian word for it is “sanitar.” A popular Russian saying goes “wolves are sanitars of the forest” because they take care of disposing of the sick, the weak and the lame, thus giving those that survive a better chance. A sanitar need not be medically trained, but some training is needed: in diagnosis, palliative care, sanitation procedures and corpse disposal.

A third requirement is one that applies to the sanitation service as a whole: the number of sanitars has to scale with the rate of infection. Since the number of those infected is increasing exponentially, the number of sanitars assigned to serve them has to be able to increase exponentially as well. It seems outlandish to think that sufficient numbers of people will spontaneously volunteer for the job, and this means that they have to be press-ganged into service. And a super-obvious way to do just that is to simply never discharge Ebola survivors: once you are in, you are in until the pandemic is over, or until you die, whichever comes first. If you recover, you are given a bit of training, and then you go to work.

If you don't like the mitigation strategy I am proposing, please feel free to propose your own. Keep in mind, however, that what you propose has to automatically scale with the increase in the rate of infection, which is exponential. Sure, you can propose setting a public health budget, but then it has to double every couple of weeks—and keep doubling until the number of patients is in the billions.

1 comments:

BigDonOne said...

......all because TPTB were too squeamish to execute Plan R while there was still a chance to avoid scenarios like above. BD nailed it weeks ago.

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