- Dec 17, 2013
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Came across Rick Wilson's little Twitter story from last July -- beware, there is some coarse language in it -- and was kind of amazed he predicted the current outbreak so well.
It occurred to me the story could use some updating, given what has happened so far. I used his story as a foundation, changed a few things about it, brought the known facts into it, and made my own predictions. This is the result.
---
A (Revised) Thought Experiment
Tomorrow, or perhaps next week, someone will get on a plane in Cleveland. He hasn’t been contacted by CDC because he’s been out of town. This man was on the Frontier flight from Dallas to Cleveland on October 9. This man, a businessmen traveling to three U.S. cities to various corporate locations, has no outward signs of Ebola and he has no reason to think his nagging sore throat and a headache are anything but a cold or maybe the flu. Come to think of it, is he feeling the effects of a low-grade fever, too? Got to be the flu. Supposed to be bad this winter.
Headache? Has to be the pressures of the trip. Always is. He hates this part of the job, but it’s necessary. Still, he can’t shake the feeling he isn’t at his best when he gets in a cab in Kansas City. Wow, the crowds are infuriating. Leave it to him to schedule this trip during the first World Series in Kansas City in 29 years! He checks into his hotel, and rests. He wakes up, the headache worse, the cough and fever a definite factor. He fights through the day, feeling worse as it goes along. That afternoon, he gets on a plane to Phoenix.
Again, getting into the cab, he notes how he feels, and that can best be described as “lousy.” Checks into another hotel, manages to drag himself downstairs to the restaurant to eat, coughing and feeling achy the entire evening. Then he drags himself back upstairs to bed. Next morning, the sun shining through the narrow slit in his hotel curtains is blinding and painful. He walks into the bathroom and promptly throws up. But he's got meetings today. He swallows a handful of Tylenol and stands in the shower until his head clears a little.
His day goes downhill, with the headache roaring back. At lunch the businessman excuses himself, racing to the bathroom to vomit. By late afternoon, he's feverish, racked with pain in his back. His guts are like liquid fire. He’s seen Fox News, he’s heard about Vinson, but they keep talking about the Cleveland-to-Dallas return flight for her. He has no reason whatsoever to think about being on a plane flying with her into Cleveland. Even if he did, she wasn’t contagious going into Cleveland. Was she?
He Googles for the nearest walk-in clinic, takes a cab there and is still trying to get work done while he sits for two hours in the crowded waiting room. The sudden spike in his fever hits, and he vomits without warning, this time on the lap of his fellow waiting room patient. He's shocked. It's ... bloody.
The woman shrieks, grabs her ear-infected kid and drags him with her into the bathroom, panicking. If she knew what was happening, she’d know she was not panicking enough. Now, the Doc-In-A-Box staff knows this guy is sick. They hustle him back, helping to clean him up. Gloves, but no masks at this point. After all, this guy isn’t Thomas Eric Duncan. He didn’t come here from Liberia. For goodness sake, he’s from Cleveland! No one in the clinic stops to think that’s where Vinson was about 10 days ago.
The patient is having trouble making himself understood the fever is so high. But hey, it's gonna be a pretty bad flu season, and this guy just has the bad luck to be an early victim ... that’s gotta be it.
The doc, a graduate of a decent medical school in the Midwest and an internal medicine specialist hired by the hospital that owns this walk-in, rolls in after the two nurses have cleaned him a bit and takes his vitals. There's an important moment happening out in the waiting room. Ear-infection mom and her toddler? Tired of waiting. They've gone home to change clothes before going to the corner mega-drug store that also has a walk-in.
The doc doesn't see a lot of cases like this. Ever, in fact. He walks out of the room, unconsciously shoving his gloves into his pocket. Now, there are a whole bunch of CDC and DHS rules about early identification of outbreaks, and the reporting of same. But ninety percent of his cases are sprains, trivial cuts, kids with ear infections, flu shots. This can’t be anything irregular. No way. Ebola would not stroll into a walk-in clinic in Phoenix. Would it?
This guy is spiking 103, is in distress. Obviously the flu, a very bad case. Doc walks out, washes his hands, and decides to make the call ... right after he looks at little Johnny's split lip, a local carpenter’s deeply imbedded wood sliver, and telling Mrs. Gomez antibiotics don't help the common cold but prescribing one anyway. He's dialing the phone when he hears loud, distressed shouts. The patient is standing in the hall, bloody diarrhea running down his pants leg. It's a mess, and he’s obviously getting delirious. His two nurses and one orderly are trying to help get the patient in hand. Doc hangs up in mid-dial and hits the speed button for 911.
The nurses and orderly are scrubbing down. The floor is an unspeakable horror of watery feces and blood. A departing patient skirts the visible muck, but maybe not entirely. Midafternoon traffic is a horror, and the ambulance takes 24 minutes to arrive. The patient is quiet again, whispering for water. The EMT's know something is off about this one. One had spent time in Africa with Samaritan’s Purse. But even he doesn’t automatically think "Ebola." And no one mentions the bloody mess they just cleaned up.
Banner Samaritan's ER procedures are a lot better. But just before Business Guy’s ambulance pulls up into the ER bay, another ambulance rushes a gunshot victim into the hospital. Probably a drug deal gone bad, thinks the doc on duty. Happens around here a lot. That ambulance crew that radioed in about a severely ill flu patient? They’re just going have to drop him off and let him wait.
Meanwhile, the hotel maid enters room 618, currently housing the luggage – and dirty clothes – of our vomiting, feverish businessman. She's disgusted he’d leave such a mess behind in the bathroom, but begins to clean it up. She's got on Playtex gloves, but she stops to wipe her brow ...
The doc at the walk-in surveys the mess of his day, and the cleanup continues, He fleetingly remembers the CDC disease reporting rules. But it was just flu, and the guys at Samaritan will report it if it’s serious. Won’t they?
Meanwhile, our traveling businessman is on a gurney, on fluids. He's hallucinating and fever-shouting. He rolls his head to the side, and vomits out what looks to be mostly blood. It shocks the ER staff. Not exactly what they’re used to. They're careful, thinking “blood-borne pathogens,” because … well, because it's blood. But they're really scared when they notice … it's ... chunky, and not like when someone throws up lunch, either.
They ask one of the attendings working on the gunshot victim what to do. He takes a peak out through the curtain and goes pale. He shouts, “Get that patient into isolation, stat.” Nurses don masks and gloves, and roll him into an isolation room. The doc tells his colleagues they will have to work the gunshot themselves. He follows the gurney with Business Guy on it down the hall to the isolation room. But it's not hermetic, negative internal pressure. It’s just a room, and when the door opens, the outside air and the inside air become mixed …
They get blood panels running. No one has said the word, "Ebola." But now there's a weird feeling in the air. This isn't typical ER work. They haven’t seen Ebola before, but they’ve all read the CDC bulletins over the last two weeks, and this is all seemingly very familiar. Two more doctors are called downstairs from internal medicine, and at a break, one of them says, "How do we report a suspected infectious disease again? Isn't there a website?"
One of the ER docs has training on the CDC's NORS system, but it's his day off. They ask around, and eventually hospital legal gets wind of it. The administrator and the hospital’s general counsel both agree: "Wait for blood work to come back in first. No need to start a panic. Don't want our ACA score dinged." So Patient X is in isolation, feverish, given fluids, plenty of care. A very nervous, bordering on frightened staff, gets a virologist/epidemiologist consult ordered in.
The virologist hears the business guy’s symptoms over the phone, but the staff doesn't go into detail. When he arrives and gets briefed, he too turns pale and says, “You called CDC, right?” Blank stares. “Uh … “ He calls CDC, tries to find the right person. Too late in the day. He leaves a message. Calls back. Leaves another one on someone else’s voicemail. Calls a third time. Voicemail again. Gives up.
---
See Post #2 ...
It occurred to me the story could use some updating, given what has happened so far. I used his story as a foundation, changed a few things about it, brought the known facts into it, and made my own predictions. This is the result.
---
A (Revised) Thought Experiment
Tomorrow, or perhaps next week, someone will get on a plane in Cleveland. He hasn’t been contacted by CDC because he’s been out of town. This man was on the Frontier flight from Dallas to Cleveland on October 9. This man, a businessmen traveling to three U.S. cities to various corporate locations, has no outward signs of Ebola and he has no reason to think his nagging sore throat and a headache are anything but a cold or maybe the flu. Come to think of it, is he feeling the effects of a low-grade fever, too? Got to be the flu. Supposed to be bad this winter.
Headache? Has to be the pressures of the trip. Always is. He hates this part of the job, but it’s necessary. Still, he can’t shake the feeling he isn’t at his best when he gets in a cab in Kansas City. Wow, the crowds are infuriating. Leave it to him to schedule this trip during the first World Series in Kansas City in 29 years! He checks into his hotel, and rests. He wakes up, the headache worse, the cough and fever a definite factor. He fights through the day, feeling worse as it goes along. That afternoon, he gets on a plane to Phoenix.
Again, getting into the cab, he notes how he feels, and that can best be described as “lousy.” Checks into another hotel, manages to drag himself downstairs to the restaurant to eat, coughing and feeling achy the entire evening. Then he drags himself back upstairs to bed. Next morning, the sun shining through the narrow slit in his hotel curtains is blinding and painful. He walks into the bathroom and promptly throws up. But he's got meetings today. He swallows a handful of Tylenol and stands in the shower until his head clears a little.
His day goes downhill, with the headache roaring back. At lunch the businessman excuses himself, racing to the bathroom to vomit. By late afternoon, he's feverish, racked with pain in his back. His guts are like liquid fire. He’s seen Fox News, he’s heard about Vinson, but they keep talking about the Cleveland-to-Dallas return flight for her. He has no reason whatsoever to think about being on a plane flying with her into Cleveland. Even if he did, she wasn’t contagious going into Cleveland. Was she?
He Googles for the nearest walk-in clinic, takes a cab there and is still trying to get work done while he sits for two hours in the crowded waiting room. The sudden spike in his fever hits, and he vomits without warning, this time on the lap of his fellow waiting room patient. He's shocked. It's ... bloody.
The woman shrieks, grabs her ear-infected kid and drags him with her into the bathroom, panicking. If she knew what was happening, she’d know she was not panicking enough. Now, the Doc-In-A-Box staff knows this guy is sick. They hustle him back, helping to clean him up. Gloves, but no masks at this point. After all, this guy isn’t Thomas Eric Duncan. He didn’t come here from Liberia. For goodness sake, he’s from Cleveland! No one in the clinic stops to think that’s where Vinson was about 10 days ago.
The patient is having trouble making himself understood the fever is so high. But hey, it's gonna be a pretty bad flu season, and this guy just has the bad luck to be an early victim ... that’s gotta be it.
The doc, a graduate of a decent medical school in the Midwest and an internal medicine specialist hired by the hospital that owns this walk-in, rolls in after the two nurses have cleaned him a bit and takes his vitals. There's an important moment happening out in the waiting room. Ear-infection mom and her toddler? Tired of waiting. They've gone home to change clothes before going to the corner mega-drug store that also has a walk-in.
The doc doesn't see a lot of cases like this. Ever, in fact. He walks out of the room, unconsciously shoving his gloves into his pocket. Now, there are a whole bunch of CDC and DHS rules about early identification of outbreaks, and the reporting of same. But ninety percent of his cases are sprains, trivial cuts, kids with ear infections, flu shots. This can’t be anything irregular. No way. Ebola would not stroll into a walk-in clinic in Phoenix. Would it?
This guy is spiking 103, is in distress. Obviously the flu, a very bad case. Doc walks out, washes his hands, and decides to make the call ... right after he looks at little Johnny's split lip, a local carpenter’s deeply imbedded wood sliver, and telling Mrs. Gomez antibiotics don't help the common cold but prescribing one anyway. He's dialing the phone when he hears loud, distressed shouts. The patient is standing in the hall, bloody diarrhea running down his pants leg. It's a mess, and he’s obviously getting delirious. His two nurses and one orderly are trying to help get the patient in hand. Doc hangs up in mid-dial and hits the speed button for 911.
The nurses and orderly are scrubbing down. The floor is an unspeakable horror of watery feces and blood. A departing patient skirts the visible muck, but maybe not entirely. Midafternoon traffic is a horror, and the ambulance takes 24 minutes to arrive. The patient is quiet again, whispering for water. The EMT's know something is off about this one. One had spent time in Africa with Samaritan’s Purse. But even he doesn’t automatically think "Ebola." And no one mentions the bloody mess they just cleaned up.
Banner Samaritan's ER procedures are a lot better. But just before Business Guy’s ambulance pulls up into the ER bay, another ambulance rushes a gunshot victim into the hospital. Probably a drug deal gone bad, thinks the doc on duty. Happens around here a lot. That ambulance crew that radioed in about a severely ill flu patient? They’re just going have to drop him off and let him wait.
Meanwhile, the hotel maid enters room 618, currently housing the luggage – and dirty clothes – of our vomiting, feverish businessman. She's disgusted he’d leave such a mess behind in the bathroom, but begins to clean it up. She's got on Playtex gloves, but she stops to wipe her brow ...
The doc at the walk-in surveys the mess of his day, and the cleanup continues, He fleetingly remembers the CDC disease reporting rules. But it was just flu, and the guys at Samaritan will report it if it’s serious. Won’t they?
Meanwhile, our traveling businessman is on a gurney, on fluids. He's hallucinating and fever-shouting. He rolls his head to the side, and vomits out what looks to be mostly blood. It shocks the ER staff. Not exactly what they’re used to. They're careful, thinking “blood-borne pathogens,” because … well, because it's blood. But they're really scared when they notice … it's ... chunky, and not like when someone throws up lunch, either.
They ask one of the attendings working on the gunshot victim what to do. He takes a peak out through the curtain and goes pale. He shouts, “Get that patient into isolation, stat.” Nurses don masks and gloves, and roll him into an isolation room. The doc tells his colleagues they will have to work the gunshot themselves. He follows the gurney with Business Guy on it down the hall to the isolation room. But it's not hermetic, negative internal pressure. It’s just a room, and when the door opens, the outside air and the inside air become mixed …
They get blood panels running. No one has said the word, "Ebola." But now there's a weird feeling in the air. This isn't typical ER work. They haven’t seen Ebola before, but they’ve all read the CDC bulletins over the last two weeks, and this is all seemingly very familiar. Two more doctors are called downstairs from internal medicine, and at a break, one of them says, "How do we report a suspected infectious disease again? Isn't there a website?"
One of the ER docs has training on the CDC's NORS system, but it's his day off. They ask around, and eventually hospital legal gets wind of it. The administrator and the hospital’s general counsel both agree: "Wait for blood work to come back in first. No need to start a panic. Don't want our ACA score dinged." So Patient X is in isolation, feverish, given fluids, plenty of care. A very nervous, bordering on frightened staff, gets a virologist/epidemiologist consult ordered in.
The virologist hears the business guy’s symptoms over the phone, but the staff doesn't go into detail. When he arrives and gets briefed, he too turns pale and says, “You called CDC, right?” Blank stares. “Uh … “ He calls CDC, tries to find the right person. Too late in the day. He leaves a message. Calls back. Leaves another one on someone else’s voicemail. Calls a third time. Voicemail again. Gives up.
---
See Post #2 ...
