Parademic week ending 160821

#(160821)

1 Smallpox Rumor; 2 Over Abundance of Caution; 3 Megacities - Changing circumstances; 4 Zika Politics; 5 Human Side - CBRNE; 6 Knowledge Sharing; 7 Frankenmosquitos; 8 Admitting errors - Trust; 9 Is there an End; 10 Electronic Memorials; 11 DOD Manual 3025.01 DSCA.

-1. Was expecting this fear about disease from old bodies to come up again after the anthrax from reindeer in Siberia 160814-7.3↓. Experts Warn of Threat of Born Again Smallpox from Old Siberian Graveyards. Currently 24 people are in hospital in Salekhard, on the Arctic Circle, after contracting potentially lethal anthrax from unfrozen reindeer or human burial sites, but scientists say this is far from the only threat as climate change grips Siberia. ¶ First noted this in 121204-4A↓. Scientists Warn of the Return of SMALLPOX after Arctic Graves Melt Due to Climate Change, Will Smallpox Reemerge in Siberia as Corpses Thaw from Climate Change, Is Undead Smallpox Reemerging From Siberian Graves. Foreshadowing was in Microbiologists Keep Finding Giant Viruses in Melting Permafrost (2015), Will Climate Change Bring Back SMALLPOX. Siberian Corpses Could Ooze Contagious Virus If Graveyards Thaw out (2014). My suspicion is that since Climate Change is not generating much concern (i.e. funds and action) the finding something that is more scary may be a ploy to spur concern.

-2. #Book Review. Personally I am bored with this topic, but it is still around and is worth looking into to understand one aspect of parademic. The Panic Virus: A Book With No Expiry Date. The chief value of this book is not that it details the history of this spurious, erroneous, and damaging smear against one of the most important life enhancing technologies discovered (which it does), but that it delves into how such a false notion took hold, was promoted, and enabled. Published 4 years ago, The Panic Virus is still probably the best book in its field for this very reason. ¶ What lies at the root of the irrational fear of vaccines is what I believe is pure emotionalism and a disdain for reason. “But when it comes to decisions around emotionally charged topics, logic often takes a back seat to what are called cognitive biases – essentially a set of unconscious mechanisms that convince us that it is our feelings about a situation and not the facts that represent the truth”. Without logic, any arbitrary assertion is given a cognitive status it does not merit and impossible discussions about proving a negative ensue. If causal scientific data is considered to be equivalent to contextless correlations, anecdotes, and Jenny McCarthy's "mommy instinct" it is clear which side gains and which loses. It is especially egregious when those arguing with such overt fallaciousness are left unchallenged and regard science as just another way of "knowing" no different from rank mysticism, to which emotionalism ultimately has to degrade to as evidence is eschewed and evaded in favor of "intuition" [Cover]. A similar book is Deadly Choices about Vaccination.

            -2.1. A fictional view of a future where an opposite extreme of overabundance of caution continues after the global pandemic. Though not true these type of speculations give perspective on how people could interpret and respond. Is 21^st Century Civilization Immune. A Review of the Novel Immunity [Cover] In the universe of Immunity, the TX virus, a genetic recombinant of influenza and Lassa Fever that emerged in Texas, has circled the globe in a murderous spree. By killing 4% of the world's population the pandemic threw the governments of the world into a quarantine laden panic. At the time of the events depicted in the novel, the pandemic is over but occasional flareups continue to occur, prompting draconian controls, in the name of "public health", on the population. The plot of the novel centers on a young former socialite who has is struggling to flourish in this setting that is rife with unsavory individuals and public health "police" who are ready to pounce with just one errant cough or elevated temperature reading on the ubiquitous thermal scanners that this world is rife with. Like other fiction the apparent story line is not what is actually being explored, but other social concerns such as the inequity between the have’s and have nots Socioeconomic Disparities in Health: Pathways and Policies (2002, a topic that has often been written about over the years), and the creation of a police state in the name of (bio)security (terrorism), Comment: Is Terrorism Creating a Police State. ¶ It is probably just coincidence that the Ebola like disease (Lassa) that spreada easily (Flu) was caled TX in a novel published in May 2015 after Thomas Eric Duncan: First Ebola Death in U.S. (October 2014).

-3. Another theme of parademic is that modern conditions have not been encountered before, rendering historically based models useless, and have changed the environment. The conditions are denser populations over larger geographic areas, with rapid transportation and communications linking these areas internally and to other nodes; infrastructure unable to keep pace with needs and maintenance; humans populations crashing into areas where there may be reservoirs of toxins, disease, or forced the migration of  dangerous animals (Forced Closer to Humans, Crocodiles Face Their Greatest Existential Threat); agriculture and domestication decreasing the number of species and variety within a species, making these more vulnerable to a single biological threat (From Lack of Diversity to Lack of Funding, Seed Banks Face a World of Challenges); pollution and contamination of land, water, air, (Stop 'Naming and Shaming' Polluted Cities. It Doesn't Work, Why We Pretend to Clean Up Oil Spills) impacting on food sources, biomes, climate water cycles and air/respiration. Then there are the biological selective pressures that make biothreats more lethal, or resistant to treatment.

            -A. We don’t necessarily know what human behavior will be in the context of biodisaster based on history of previous events. Biodisasters are global, slow, insidious, discontinuous in time and space, making them are very different that other types of disasters. In fact the source of the disaster is different than the normal geodisasters Timeline: Zika's Origin and Global Spread. The source of a biodisaster disaster is largely invisible and in the soil, air, food, water, shelter, and other living things, especially other people. These differences are enough that “normal” disaster preparation, response and recovery may be the direct opposite of what is needed, and will exacerbate the situation, and usually control and containment are months or years late as the norm is to wait until after it accelerates in a human population or threatens livelihood. One of the more dramatic visual demonstrations of this change of human populations and global environment is The Age of Megacities. The world is a crowded place, with more than 7 billion people on the planet as of 2014. About half of this population lives in urban areas, and ongoing migration into city centers has given rise to the megacity—a metropolitan area with 10 million people or more. Today the world has 28 megacities, and that figure is projected to increase. Scroll down to explore the historic growth of ten of today’s largest cities. See How Humans Have Reshaped the Globe with this Interactive Atlas. Anticipating Human Behavior in Disasters. Myths, Exaggerations, and Realities.

↕4. To Fight Zika, NYers are Calling 311 to Complain about Empty Swimming Pools. As mosquito season ramps up local Zika related anxiety, the city's reporting an uptick in complaints about empty swimming pools that are gathering standing water. NBC News reports that these so called 'zombie pools' have garnered about 491 complaints since June 15th of this year. Last summer, there were only 226 complaints. This does not correspond with last weeks 160814-4↓ Poll: Most Americans Aren't Worried about Contracting Zika, 77% of people polled say it's not a big concern. Like maps 160814-4.4A↓ ones needs to compare and contrast polls to get a best available picture. What is being compared, how are questions asked, geographic area(s), relative sample size (10% of the world is not the same as 10% of a small village)  Most Americans Favor Late Term Abortion If Zika Harms Fetus, Zika Virus and the Election Season Less than half the public (44%) are aware that no legislation to add funding for Zika virus response efforts has been passed. Among this group, just over half (55%) say not passing the funding legislation is a problem, including 25% who say it is a “very serious” problem, leaving 43% who do not consider it a problem. 4.2↓.

            -A. It may be that New York is a bit sensitive about disease outbreaks after Ebowla, the quarantine of a nurse who tested negative for Ebola only 15 miles for New York City Kaci Hickox Slams Christie for 'Abundance of Politics' on Ebola, and a soup incident Quarantines Are for the Little People: NBC’s Nancy Snyderman Breaks Ebola Confinement to Get Soup. It may also be as simple as 311 is a easy way to gather data What a Hundred Million Calls to 311 Reveal About New York.

            -B. In any case it appears that thought there are efforts to make Zika a political issue for this years election. It is being trumped by the normal response to biodisaster, apathy is the norm [Chart]. No motivation to return to congress to pass legislation. However if things go bad then there will be a huge after the fact backlash for political fodder 160814-4.1C↓. Zika Prevention Is a Matter of National Security. A recent poll suggested 77% of Americans are not significantly concerned about Zika, and Congress went on summer recess without authorizing President Obama’s emergency Zika appropriation. Apathy in the midst of an emerging public health crisis is dangerous.

            -C. What Could Make Americans – and Congress – Care About Zika. For the 1^st time in the agency's 70 year history, the CDC in early August issued a travel advisory for part of the continental US, warning pregnant women to stay away from a neighborhood in Miami. The culprit: the Zika virus. Four messages of: No message, Fear, Moral, Human rights. It’s challenging for a single event to generate anxiety or fear. Public concern about diseases may not spike until there are widely publicized threats, unfortunately by the time the public is concerned, the threat is already here and spreading. Concern by the mass public has come and gone by the time Congress authorizes funding. The goal then is not to generate messages about a specific event at the time, but the general threat well beforehand so contingency funds are available when needed. 'Nobody's Looking': Why US Zika Outbreak Could Be Bigger than We Know. Zika Funding Can't Wait for Congress to Come Back from Vacation. Florida Zika Outbreak: Why More Cases Don't Mean the Outbreak is Growing.

            -4.1. Business has similar issues as politicians. What is the upside and downside of supporting Zika. The Race for a Zika Vaccine Is Intense. But it May Be Missing the Most Important Players. Vaccine development seems like a risky venture for manufacturers that have recently taken part in a string of emerging diseases rodeos, from SARS and Ebola to the West Nile virus and the 2009 H1N1 pandemic. Those efforts have required significant investments on the part of major pharmaceutical companies, and have yielded either modest or no financial return. ¶ Uncertainty over US government funding for Zika is also making it harder to entice the big companies to pursue a vaccine.

            -4.2. The Price of Zika. About $4 Million Per Child. To talk about Zika virus control is to talk about money. Vaccine development, mosquito abatement, and even the distribution of DEET repellant takes (and currently lacks) major federal dollars. ¶ But the real price of Zika, and the reason the disease has gone from arboviral nobody to world wide bugaboo, is the devastating birth defects that can appear in children born to infected women. While it’s hard to predict how many children will be born with Zika related neurodevelopmental disorders, it is clear caring for these children will take a toll. And experts are already calculating the cost of a generation of US babies impacted by Zika. Which brings up How the Media Can Better Inform the Public about Zika. Thousands of people living in the continental United States and U.S. territories are infected with Zika virus, but many Americans continue to hold mistaken beliefs about Zika, how it is transmitted, what risks it poses, and what can and should be done to protect against it. public misinformation about Zika, including these misconceptions: 36 percent incorrectly thinks that an adult with Zika is likely to die from it; 46% think that people with Zika always have noticeable symptoms; 28% believe you are likely to get Zika if someone who has it sneezes or coughs on you. 4↑. In Florida, Pregnant Women Cover Up and Stay Inside Amid Zika Fears, Pregnant Women Advised to Avoid Travel to Active Zika Zone in Miami Beach. The Beat, and the Bug Spray, Go On in South Beach Despite Zika Threat.

           -4.3. How the Zika Response is Going beyond Reactive Approaches. "Fighting Ebola: A Grand Challenge for Development" taught the US Agency for International Development a couple of things. It became clear that the grand challenge model worked well as a way to rapidly source and deploy innovations, but also that the midst of an outbreak was not the best time to call for those ideas. Just like trying to educate people on a unfamiliar topic such as parademic in the middle of a crisis is not the best idea.

            -4.4. Wonder if there will be an international ban of travel to Florida. Taiwan Confirms Sixth Imported Zika Case in Taiwanese Traveler Who Visited Miami, Florida. The Central Epidemic Command Center for Zika Virus announced the sixth imported Zika case identified in Taiwan. The case is a 44 year old female who resides in New Taipei City and visited Miami, Florida, US during July 31 and August 11, 2016 for business. Taiwan CDC: Imported Zika Case with Travel History to Miami. Zika Cases May Prompt Call to Avoid Miami Beach. Zika Virus Now Believed to Be Spreading in Miami Beach. Zika Cases Reported in the United States. With Zika Confirmed on Miami Beach, Restaurants Brace for the Worst. Officials: Zika Won't Hurt South Florida Tourism in Long Run 6.1A↓. Zika Virus Now Actively Spreading in Miami Beach, CDC Expands Travel Advisory.

            -A. Miami International Airport, over 80 airlines serve MIA to approximately 150 destinations around the world. In 2015 there were 21,206,557 international passengers, and 23,143,690 domestic ones that went though MIA, making it the The 10^th busiest airport in the United States, Miami Dominates US to Latin America and Caribbean; London Heathrow Top International Route [Map]. Worried Florida Republicans Push Ryan for Zika Action. Officials: Zika Found in South Beach; Spraying Not Practical, Crews Conduct Zika Spraying in Miami Beach. 10^th Zika Virus Infection Confirmed in Korea.

            -4.5. In addition to biopolitics, exploitation, humor, economics, media coverage, rumor, misinformation, grief and fear/panic; art and music (possibly the most human of behaviors) about the event indicate a biodisaster has become a parademic. New York Clinic Turns to Art in Zika Fight. LA Art Exhibition Look at Dying Through Words, Photos [Photo, Photo]. Make This Amazing Plague Doctor’s Mask.

            -A. Literature and folklore are also part of art and music. We see this with the doomsday narrative More Mass Death Across Planet Provide Us More Proof Something Huge Is about to Happen - Are We Now Witnessing Prophecy Unfolding doomsday narratives that underlie the tendency to over react over mass animal die offs, On Animal Deaths and Human Anxieties, The Mystery of Mass Bird Deaths. Mass die off are something to watch for as a potential indicator of a biodisaster, but are not definitive. These events represent synchronicity, where if one make the same prophecy for centuries it is likely that something will appear to fit the prophecy, The Truth About “Mysterious” Mass Bird Deaths, Why Are Chilean Beaches Covered with Dead Animals [Photo, Photo]. On the other hand there are recorded and observable events that may indicate the precursors of a mass global extinction due to human behavior. Not judgement of deity, but then this judgement is described as being because of the sin’s of mankind, so give a possibly spin that even if wrong the prophecy is right, Mass Animal Die Offs Are on the Rise, Killing Billions and Raising Questions [Art]. Unfortunately conspiracy theories like aflockalypse make it more difficult to test the hypothesis of mass extinctions, and make it easier to deny biodisasters as being eligible for the golden fleece award of science. The CRAP Test for Evaluating Sources.

-5. How to Address the Human Side of Critical Incidents. Most chemical, biological, radiological, nuclear, and high yield explosive (CBRNE) critical incidents differ from more common hazardous materials (hazmat) events by virtue of four factors: broader scope, enhanced physical toxicity, malicious intent, and the potential to do the unimaginable. The net effect is new levels of stress and psychological toxicity. Though this is a rare article that addresses the human side of CBRNE, it still only looks at the Terrorism aspect, not the self inflicted terror which don’t even require a CBRNE event, nor the far more frequent natural events and accidents. It also focuses on the impact on individuals (psychology) not on communities and cultures, and ignores that the containment and control measures can also have negative impacts. What Will Americans Do about Their Fear of Terrorism.

Comment: Other aspects of the Human Side – Appreciate the all too rare article that addresses the Human Side of CBRNE. However, probably because the article had to be short, focusing on CBRNE Terrorism, it did not address all the issues, and ignored the far more frequent natural events and hazmat accidents. A recent example of lack of awareness of the human side is Ebola in West Africa where containment and control of the outbreak of a R1 disease was hindered by not being aware of funeral practices, belief that the decease was a fake, and the hiding of the dead and sick. There was also the Ebowla phobia where there was not a CBRNE event, but was self inflicted terror resulting in economic losses, walking worried clogging hospitals, denial of civil rights and political exploitation (fear mongering). If you or anyone else is interested in Human Behavior and Social Consequences in the context of BioDisaster I curate a weekly blog on this topic at http://parademic.typepad.com

-6. Accurate knowledge sharing is a near universal problem, though spreading misinformation (misexplaining) does not share this issue. Some are more than willing to get information, but not willing to share (control of information is power). The other side of this coin is information acceptance, either because it doesn’t follow the accepted “party line”, or the source is not trusted. Data Sharing Should Become Routine for Best Response to Public Health Emergencies. The recent outbreaks caused by Ebola and Zika viruses have highlighted the importance of medical and public health research in accelerating outbreak control and have prompted calls for researchers to share data rapidly and widely during public health emergencies. However, the routine practice of data sharing in scientific research, rather than reactive data sharing, will be needed to effectively prepare for future public health emergencies. Investigating Information Sharing Behavior: the Mediating Roles of the Desire to Share Information in Virtual Communities. Reciprocity Norms and Information Sharing Behavior in Online Consumption Communities: An Empirical Investigation of Antecedents and Moderators.

            -6.1. The curator of H5N1 may or may not have read some of Parademic’s weekly listicle stubs that related to communication; specifically Anthrax in Siberia (160807-7, 160731-9↓) and that Zika will be non public health and political issue in about a month, but will become one again about March 2017 (160724-4.1, Zika politics has been in ↕4.# every week, including 4↑). If he did use it that’s the intent of Parademic, to provide a resource for those whose work is related to biodisaster but don’t have the time to do deeper research or make connection between stories. In any case his comments provide a good brief summary of typical behavior related to information sharing about a biodisaster.

            -A. His comments in Zika in Florida: The Struggle for Message Control is based on CDC Issues Zika Travel Warning for Miami Beach after Mayor Says "No Zika Outbreak" There. Though H5N1 tends to give a national type to the behavior, all the ones listed can be found in every country alongside a biodisaster. Local vested leaders (government, business, etc) try to coordinate to minimize the problem and control the message. Not yet vested leaders, or those ordered not to report, and those in need to funds try to maximize the problem and take control or confuse the message. These are sometimes called rumors, or anonymous sources. This message control is done by: suppression, delay, saying nothing, declare the biothreat is over, have no free press or online presence, framing to give positive spin, denial 4.4↑. The recent Siberian Anthrax was quickly contained and controlled, in fact faster than the recommended 7 to 10 days for cutaneous, or 60 days for inhalation and gastrointestinal. Apparently they use of an Anthrax Vaccine, that does not require 5 shots every after a month then every 6 months. Also apparently fire and bleach don’t damage permafrost, and there was no culling of the reindeerheads the exposed nomads depend on 160807-7 et al↓. Miami Beach Mayor Says He Was 'Kept in the Dark' about Zika, always a good idea to coordinate with all stakeholders for crisis communications, if one wants a consistent message.

            -B. There are several good sources on media relations, and consequences of trying to cover up: 10 Principles of Effective Crisis Communications, The 10 Steps of Crisis Communications, The 5 Principles of Crisis Communication, Six Principles of Crisis Communication, 5 Principles for Effective Crisis Communications, Zika and Ebola Risk Communication, Crisis Comm, Crisis & Emergency Risk Communication (CERC).

-“I now inform you that you are too far from reality”. –  Muhammad Saeed al-Sahhaf [Cartoon, Meme]. He was my favorite example of what to do and not to do in media relations when I was teaching a Consequence Management Media Relations class in an Emergency Medical Response to Weapons of Mass Destruction course.

-7. 160807-4, 160424-4.3↓. Frankenmosquitoes about to Be Released. Florida Keys Opposition Stalls Tests of Genetically Altered Mosquitoes, because of the vocal opposition of people there, the local mosquito control board hasn't yet approved the trials, instead putting it on the November ballot as a nonbinding referendum. Zika Virus: Floridians Fear 'Pandora's Box' of Genetically Altered Mosquitos. Scientists say Key Haven is ‘the perfect’ island for releasing the genetically modified insects – but locals refuse to be ‘lab rats’ (actually a term used by only one women, but used several times over the years [Meme]) in FDA cleared experiment. FDA Debates Releasing Genetically Modified Mosquitoes into Florida Keys (2015), Things to Know about GMO Mosquito Test Proposed in Florida

            -A. It is a fairly consistent pattern that when a particular belief “loses” then they politicize it (start controversy), usually starting years before the loss. This is not so much to win but to cause delay, possibly in hopes that conditions will change that will be more favorable to their position – in this case this area has the best mosquito control in the world, making it a good bet that they will be no Zika babies in the area, therefore nothing to change public opinion – or that the matter become moot. In the case of the Florida Keys this opposition, likely a small vocal minority GMO Free Florida, is not new (emergent) but has a history: Millions of GMO Insects Set for Release in Florida Keys (2015), Crossbred with the herpes simplex virus and E. coli bacteria; Florida Keys: Sunshine, Blue Skies and Genetically Modified Mosquitoes (2015); Mixed Feelings Over GMO Mosquitoes in The Keys (2015);  f2 Unapproved GM Mosquitoes Being Shipped to US for Release NOW (2014); Genetically Modified Mosquitoes Set off Uproar in Florida Keys (2013); Florida Scientists Prepare to Release Hundreds of Thousands of Genetically Modified Mosquitoes (2012); Key West Resident: We Won't Be 'Lab Rats' for Florida Mutant Mosquitoes Plan (2012); Concerns Raised about Genetically Engineered Mosquitoes (2011).

            -B. Fighting Zika in the US: The Battle Over GMO Mosquitoes. For decades, residents of the Florida Keys have been combating 45 species of mosquitoes that inhabit these islands. In recent years, the pesticides used have lost effectiveness against the mosquitoes, experts said, requiring more spraying and larvicide to control the populations. ¶ The reason Key Haven was chosen as a possible testing ground for the genetically modified organisms (GMOs) predates the current Zika crisis. From 2009 to 2010, a mosquito species known as Aedes aegypti – the same kind of mosquitoes that carries Zika – sparked a dengue fever outbreak here that infected at least 88 people according to Florida Department of Health.

            -C. This process has been observed with other GMOs, anti-vax (Florida Whooping Cough Outbreak Fuels Anti-Vaxxers) and most recently Study Says FluMist Vaccine Does Indeed Work, Contradicting CDC. In June, the CDC said the popular nasal flu vaccine isn't effective based on its use in U.S. children, but a new Canadian study says that it does indeed work. It's not at all clear who's right. For those interested in this process the best documented example of people continuing to fight law and science after a clear decision was reached is Twenty Years After a Landmark Supreme Court Decision, Americans Are Still Fighting About Evolution (2007), What Has Been the Outcome of Court Cases Testing Creationism and Intelligent Design [Meme]. Other times the debate does not have a legal/political/science consensus and can take to resolve, and then this can be expected to repeat the politicized (not the same as political) process again, Keeping Biological Research Safe.

-8.  160814-9.1, A↓. U.N. Admits Role in Cholera Epidemic in Haiti. Now starts the years long process of reputation and trust being developed and if there will be legal penalties. Debate Continues Over U.N. Role in Bringing Cholera to Haiti. The U.N. appears to be on the verge of admitting it played a role in introducing cholera to Haiti in 2010. But critics are still waiting for the agency to take full responsibility. U.N. Chief: Moral Responsibility to Help Haiti Cholera Victims but U.S. Judge Upholds U.N. Immunity in Haiti Cholera Case. Poor Sanitation Persisted at U.N. Missions Long After Haiti Cholera Crisis. UN to Provide 'Material Assistance' to Haiti Cholera Victims.

            8.1. Mistrust seems to be part of the parademic problems that interfere with medical and non medical response to biodisaster. The following my be possible to generalized globally to other disciplines, but does not apply to terror tactics against the soft targets of health care Fearful of Bombings, Syria's Communities Refuse New Hospitals, Doctors Without Borders Evacuates Teams From Hospitals In North Yemen. If there is a norm of preexisting violence against health care, then imagine how much worse it could be during a biodisaster where there is insufficient resources to help everyone, another health inequity, or that health care is held responsible for the event. Rebuilding Patient–Physician Trust in China. In China mistrust is especially pronounced. First, illicit payments from pharmaceutical companies and red packets (hongbao, or monetary gifts) from patients have traditionally accounted for a substantial portion of Chinese physician salaries. Second, China now has over 109 million middle class individuals, more than any other country. A concurrent expanding middle class and shifting in insuranceschemes has resulted in a population of patients with unprecedented access to and expectations of medical care. The Epidemic of Violence Against Healthcare Workers (2004) [Photo]. ¶ Recommendations to rebuild patient–physician trust:

• Require medical humanities as a core component of clinical training, with experiential learning and community partnerships. i.e. patients and health care workers are human. Why Get a Liberal Education. It Is the Life and Breath of Medicine. Many may be surprised to learn that liberal education is deeply ingrained in medical school curricula. Yes, medical students learn anatomy, physiology, biochemistry and neuroscience, but they also have courses in ethics, leadership, policy, economics, sociology and psychology. To succeed at their trade, doctors not only need to have a sophisticated knowledge of biology, they also must master the complex clinical micro and macro systems in which their patients live and they work, about culture and communication. It is no longer good enough – and probably never was – for a doctor to simply know the appropriate medication to prescribe or diagnostic test to order.
• Encourage more transparency in doctors' practices and in the health care system as a whole to include media relations and a patient bill of rights and responsibilities.
• Create laws and legal measures that promote mandatory but non punitive, medical error reporting with streamlining of neutral (independent third party), transparent procedures for recording and resolving medical disputes.
• Transition away from red packets with reforms that increase physician fixed salaries.
• Increase the time spent in medical encounters to at least 10 minutes. Time to build rapport.

-9. As stated before, in biodisaster there is no definite beginning or end. After the End of Ebola. There are exceptions in the narratives of Ebola as something that was. These are found in the accounts of those who lost loved ones and who continue to grieve, as well as those who form part of national infrastructures still struggling from disruption and massive loss of lives. These accounts, visible throughout the outbreak, are still being captured across a range of disciplines. In contrast, the accounts of local staff and volunteers who worked tirelessly at ETCs to help fight their country’s battle with Ebola are barely visible. Yet, it is precisely their stories that provide some of the most valuable insights into how the social, economic, and psychological effects of Ebola continue despite the political and humanitarian rhetoric pronouncing its end.

-10. Have covered memorial tattoos [Photo], virtual memorials [GIF], spontaneous memorials [Photo], memorial websites [Screen Shot], videoed eulogy [Video] before. Biodisasters are mass casualty/fatality events, with accompanying parademic of grief expressions, sometimes without a body, or way too many in the same place and time. The impact of grief [Chart] on a community – shock/denial, anger/blame, depression/apathy, bargaining/create meaning, acceptance/forget (SPARTA) – is rarely planned for in biodisaster Hazard, Vulnerability, and Risk Analysis, with the ability to communicate it faster, wider and more often changes things since Aug 20, 1911 First Around the World Telegram Sent. These new memorials represent the changing nature of what is considered private, the proper way to express grief, influenced by technology, and give a way to anticipate negative community attitudes about control and containment. 'I Miss You So Much': How Twitter Is Broadening the Conversation on Death and Mourning. Death and mourning were largely considered private matters in the 20^th century, with the public remembrances common in previous eras replaced by intimate gatherings behind closed doors in funeral parlors and family homes. Social media is redefining how people grieve, bringing conversations about death back into the public realm, sociologists found. Twitter in particular, they say, is broadening the discourse around who may engage when someone dies.

            -A. With parademic grief is not limited to death but loss that impacts on identity and the event does not have to be real to cause grief (Screen Save). One means for coping is virtual bereavement groups For Parents Who Have Lost a Baby, Some Aid in Their Grapple with Grief, Virtual Grief Support Groups. In a sense online anti-vax are like a community of online grief groups, but one that gets stuck at one stage of grief, The Grief Cycle - One Parent's Trip Around, The Autism Spectrum Disorder Grief Cycle.

-11. #Document. Just released by the “unofficial” organization that “leaks” official documents. DOD Manual 3025.01, Volume 1 Defense Support of Civil Authorities: Overview, Appendix 9B: CBRN Response Enterprise, Appendix 9C: DOD Health and Medical, Appendix 11D: DTRA. DOD Manual 3025.01, Volume 2 Defense Support of Civil Authorities: DOD Incident Response, Appendix 4C: Potential General Purpose Force Contributions During a Complex Catastrophe, Section 10: Animal and Plant Disease Response, Section 11: MCM Distribution, Section 12: Pandemic Influenza and Infectious Disease. DOD Manual 3025.01, Volume 3 Defense Support of Civil Authorities: Preplanned DOD Support of Law Enforcement Agencies, Special Events, Community Engagement, and Other Non-DOD Entities does not cover support to HHS, that is covered in DoD Directive 6010.22, “National Disaster Medical System (NDMS).