Parademic Notes Week Ending 160925

#(160925)

1. Fairness; 2. Doctors Kill President; 3. Mass Despair; 4. Zika; 5. Human Factors - Disease Outbreaks; 6. Cooperation vs Competition; 7. What do you call ____; 8. Health Care and Monitoring Geography; 9. Art; 10. Inferno; C. Communications Corner.

-1. ∩ Though about who gets organ donations this is also a potential parademic problem. A Litmus Test of Fairness. Lay people think that the sickest patients and those on waiting lists should be treated first – and to some degree medical professionals – while ethicists tend to have a different set of priorities. This is the conclusion of a study investigating the principles that apply to the fair allocation of scarce medical resources. Having once been in the position of explaining this to some excellent role players during a two week long, very realistic combat exercise, this is not a comfortable thing to explain. It did avoid problems later when people observed that the most critically injured were not being treated first. One issue with Crisis Communications is that it waits for the crisis, when it is better to get hard to take messages before the crisis. In a biodisaster this will not be just choosing which individuals have the best chance to survive when resources are limited and can help with the massive recovery of the aftermath. Whole communities may have to be chosen to not be helped first. [Chart]

            -A. Situation B. During an Epidemic (Edited): 5000 individuals in community. 2500 individuals need hospital care. There are only 500 hospital beds available. [Photo]

• To the sickest individuals.
• According to the order of falling sick, been ill the longest.
• Prioritizing those most likely to survive the infections as result of the hospital care. That is fully recover and not have a chronic/handicapping condition afterwards.
• Prioritizing those who have essential roles for keeping society operational.
• Combination of criteria of age. Youngest first, prognosis of survival and duration of life, or lottery.
• By age. Youngest first or those who are in prime of life who can reproduce, live for the longest afterwards, and are of a age to be vulnerable to other disease and hardships.
• Random selection. Lottery.
• Priority to those who have contributed in the past to the common good.
• Preference to those who contribute substantially to the costs of treatment. If the money is sufficient the order will likely be for themselves, their family, their friends and then the remaining sick. The remainder are likely to selected by above criteria.

            -1.1. Microbes Have No Morals. First we learned to fear germs, then we learned to love our microbiome. But both sides get the biology basically wrong.  There is also a similar idea that Microbes don’t recognize borders (8A↓), but that has more implications than just not being stopped by walls, political boundaries, differences in culture. Borders are not a fiction, but they are not what people suppose either. Much was made of the porous borders during the West African Ebola outbreak, but is that unique. Myth and Reason on the Mexican Border. Border Bias, The Belief That State Borders Can Protect Against Disasters. Also consider that diseases hide, often times in borders Ebola Is Not Gone, It's Hiding.

            -A. Note that Borders comes up in parademic frequently. I directly observed differences in the concept while a pandemic planner. Federal officials wondered why I was interested in areas outside my regional area that were bordering or had significant commerce with my area. Local officials in border areas just assumed that I was interested in their cross border interactions, and often times has unofficial connections with counterparts in other jurisdictions 2.1↓. My first experience with this was as a college student working at an elementary school where I was helping clearing out an “old” fallout shelter supplies that was on campus. My two coworkers were from Mexico and both mentioned that they did not have shelters in Mexico because they were outside the US and would not be hit with nuclear bombs. 8↓.

-2. September 19, 1881, James A. Garfield died by what today would be considered medical malpractice (Doctor Confesses: I Lied to Protect Colleague in Malpractice Suit). At the time, American medics didn't believe germs existed, and so their attempts to remove the two bullets lodged in Garfield by an assassin without antiseptics led to blood poisoning and complications that ultimately killed him. The Listerian Revolution, the Gross Clinic & the Agnew Clinic, The Death of President Garfield, 1881. His death was about 220 years after germ theory was first proposed, 30 years after the theory was proven both in the lab and during the Crimean War (Florence Nightingale), 20 years after the American Civil War experience [Photo], repeated proof 20 years later in the Spanish American War, and finally a standard of care by World War I. One would think there would have been provided conclusive evidence and consensus by 1881 but there are still beliefs and practices in and outside of the medical field that indicate this is still not completely accepted, Breaches in the OR: The Perioperative and Infection Prevention Challenge. How Antiseptic Surgery Arrived in America, Diffusion of Medical Innovation 7A. ¶ My speculation is that as communication improved in quality and speed, the public became more vocal about death caused by medical practice, which exceeded death cause by direct combat.Concurrently the technology of sterile operations improved making it possible to avoid infection, with the addition of antibiotics if an infection did occur. There was also increasing litigation for medical malpractice, and old doctors who would not accept germ theory slowly aged out, retiring from practice and teaching. This changed the expectations, the ease to be sterile, and the penalties if one was not. The general public would take even longer for this knowledge to be accepted. History’s Biggest Presidential Health Cover Up.

-Quote. “Yes, I shot him, but his doctors killed him”. – Charles Guiteau

            -2.1. One reason for the lag in acceptance of ideas like sanitation, parademic, germ theory, is there is a temporal and geographic separation between cause and effect in biodisasters, that we are already experiencing biodisaster but have not noticed or recognized it yet. Why Some Emerging Infectious Diseases Cause Epidemics. Forty years ago, a patient exhibiting symptoms believed to be from malaria sought treatment in a small village in the Republic of the Congo in Africa. Later, it was determined this patient didn’t suffer from malaria, but from a virus that would cause a major disease outbreak decades later and more than 1,000 miles away: 1976 Ebola Outbreak's Lesson: Behaviors Must Change. One of the changes may be that some global biodisaster may be international problems but solved locally. Ebola Pandemic Shows that Cities, Not Nations, Should Lead on Public Health. The 2014 Ebola pandemic offered many lessons but perhaps none more apparent than the need to shift responsibility for public health from nations to the cities within them 1.1A↑. #Book How a People’s Science Helped End an Epidemic, #Book Ebola's Message. Public Health and Medicine in the Twenty First Century, and by coincidence both of these were reviewed in Public Health: Beating Ebola 5.5↓by Dr Piot, 160828-10*↓. ¶ Experiences and Psychosocial Impact of West Africa Ebola Deployment on US Health Care Volunteers, which I believe is a first of its kind study. #Book Corruption in the Time of Ebola: A Review of Amy Maxmen's Ebola's Unpaid Heroes, which is not a newly discovered issue but was known during the outbreak: Lost on the Ebola Money Trail (2015), Step One to Fighting Ebola. Start with Corruption (2015), African Scientist: African Corruption Made Ebola Worse (2014).

-3. ∩ This is about the panic that happens in evacuation situation, some of which happen in a parademic reaction to an accelerating biodisaster. What Causes Mass Panic in Emergency Situations. The most dangerous zones were places where decisions had to be made (medical and government decisions), areas where bottlenecks occurred and caused congestion (supply and distribution of daily life needs and access to medical care), and dead ends where participants were forced to turn around and walk back against the flow of the crowd (no cure or protection, nowhere safe to shelter). Mass panic is not so much a problem in parademic, though there were periods such as Ebolaphobia and 5 Historical Manias That Gripped Societies, Then Disappeared. Mass Despair and mass Low Morale, over time, are the real problem.

↕4. As One Miami Area is Taken Off Zika Advisory, Another Triples in Size. The CDC today removed Miami's Wynwood neighborhood from its Zika travel warning while keeping in place strong cautions for pregnant women, just days after Florida officials tripled a 2^nd transmission area in Miami Beach. Predict Zika's Spread. It's Hard Enough to Count the Cases. Predicting Zika's course in the continental US is difficult. Health experts have never confronted a virus quite like this one: a mild infection that can nonetheless devastate unborn infants, and that is transmitted by both mosquitoes and sex. This statement is not true. Have stated before that keep track of numbers and location in a biodisaster is difficult, especially if the vector, human or mosquito, is mobile. Have also mentioned that nightmare scenarios are ones where the symptoms do not show up for many years, liked HIV, syphilis, mumps, rubella, but spreads in the meantime, or show up in the next generation (sterilization).

            -A. This is a scenario already explored in fiction with Zoo season 2 finale, Children of Man, and related story lines, and doomsday predictions, some dating back as far as the first writing systems and calendars. A Child Born Today May Live to See Humanity’s End, Humans Will Be Extinct in 100 Years Says Eminent Scientist, Will Humans Survive the Sixth Great Extinction.

            -4.1. Zika Could Open Up a New Frontier in Workplace Injury Litigation, Just Probably Not in Texas. Dallas County Health and Human Services is ready to fight any local outbreak with spraying, aerial and otherwise, and the city has signed off on the county doing whatever it needs to do. Another group is ready, too, the lawyers. Some see the potential for Zika to set new precedent in workplace injury litigation. Others say that, in Texas at least, personal injury lawyers might be barking up the wrong tree. Legal issues stemming from a biodisaster range from lawsuits for  contamination, legislation, mandatory medical treatments, civil liberties (quarantine), requests for information that was withheld, liability, injunctions, misuse of funds, medical scams,  probate for deceased which gets very interesting if no family of heirs survive, real estate and other property disposition.

            4.2.  Brazil Attorney General Seeks to Block Aerial Anti Mosquito Spraying Amid Zika Fight, Aerial Spraying Cut Zika Mosquitoes in Miami, Adult, Larval Insecticides Pack Deadly Punch to Mosquitoes, Zika: U.S, 160918-4↓. Labeling a Risk: Scary Words Versus Neutral Words Versus Euphemisms. When dealing with pesticide risks (and perceptions), we observe an interesting paradoxical situation operating. The rural workers, who use these products in their routine, in general don’t care. They don’t perceive the risks they are exposed to as serious. So they resist using PPE. For them the pesticide risk is relatively high hazard and low outrage. On the other hand, the general population fears tiny amounts of pesticide residues in the food. For them the risk is relatively low hazard and high Outrage. How Risk Affects the Way People Think about Their Health. C↓.

            4.3. USA: Zika Hoaxes, Conspiracy Theories Prevail Online. The Zika virus is a real, medically proven infection. It’s been shown to cause microcephaly, a severe birth defect in infected pregnant women. More than 3,000 people have Zika in the United States. But if someone lived through Facebook, they might think otherwise. C↓.

-5. Global Ethics Forum: The Next Pandemic with Dr. Ali Khan (Video). In over 20 years at the CDC, Dr. Ali Khan battled Ebola, SARS, and other deadly diseases. But, as he reveals in this fascinating talk, what really worries him is the effect that political and social factors can have on fighting these outbreaks. When I first started the origins of a parademic perspective as a pandemic planner for the 2009 Flu mentioning human behaviors that lead to disease outbreaks, made them more difficult to contain and control was dismissed out of hand. Now it is starting to be more widely recognized. If I had to chose a single short source about parademic this is it. #Book The Next Pandemic: On the Front Lines Against Humankind's Gravest Dangers [Cover].

            -5.1. #Book. Emerging Infectious Diseases and Society tells a very simple yet effective story of how emerging and reemerging infectious diseases have plagued society throughout the ages. The author provides an overview of the factors that affect the emergence of infections, providing compelling evidence for the importance of this health subject in modern society. The author relates human demographics and behaviours to major worldwide disease outbreaks, offering a historical perspective to show not only how these diseases have had to adapt to a socially and industrially developing world, but also how different emerging infections have themselves had a hand in shaping our society. By chance these was a discussion on the Contagions Google Group about texts for a Plagues and Peoples courses. This and the following are some of the texts suggested. This also raised a question. It is easy to cite a source by just  providing the link – albeit this is not a proper MLA citation). However, if one gets a source from correspondence from another person or website, should that be acknowledged or not.

            -5.2. #Book. Deadly Companions: How Microbes Shaped Our History. Ever since we started huddling together in communities, the story of human history has been inextricably entwined with the story of microbes. They have evolved and spread amongst us, shaping our culture through infection, disease, and pandemic. At the same time, our changing human culture has itself influenced the evolutionary path of microbes, one cannot be truly understood without the other. Beginning with a dramatic account of the SARS pandemic at the start of the 21^st  century, this takes us back in time to follow the interlinked history of microbes and man, taking an up to date look at ancient plagues and epidemics, and identifying key changes in the way humans have lived - such as our move from hunter/gatherer to farmer to city dweller - which made us vulnerable to microbe attack. Showing how we live our lives today - with increasing crowding and air travel - puts us once again at risk. One thing becomes clear: that for generations to come, our deadly companions will continue to shape human history.

            -5.3. #Book. Alcamo's Microbes and Society, is intended for liberal arts students taking a foundation course in the life sciences. It discusses the role of microbes in our everyday lives, from food production to their roll in biotechnology and the numerous other ways that microbes contribute to our world. It goes on to explore such topics as the function of microbes in ecological systems and environmental systems. Coverage of bioterrorism, antibiotic resistance, and microbial disease offer students a broad and current perspective of the extensive impact of various microbes. Highlights both the positive and negative impact that microorganisms have in our society.

            -5.4. #Book. Political Biology: Science and Social Values in Human Heredity from Eugenics to Epigenetics questions the structures of knowledge – particularly the separation of genetics from the social sciences – and the ways in which genetics pulled biology and medicine from the social sciences and social inquiry. Exploring the reconfiguration of the border between life and social sciences following the rise and fall of certain scientific views of human heredity. Political biology reopens closed connections between certain scientific statements and political values, connections that have been chopped off under the weight of historical stratification. This reopening seems particularly important right now, as a particularly neglected view of science – soft heredity – is being renewed. Is Social Evolution Lamarckian or Darwinian.

            -5.5. This is an usually clear cluster, which happens frequently in parademic, where there is a cluster of people and beliefs (such as anti-vax Vaccine Deniers Stick Together, and Now They’re Ruining Things for Everyone), and parademic weekly notes tend to largely be a one or two general themes. Usually if there is a book review in the weekly notes it is usually only one. This week there are ten books. Not sure why this happens. This may be a artifact that a single news story can result in many related stories. It is also likely that I am primed to look for items that fit into stubs as they develop of the week, in this case because the Contagions Google Group 5.1↑ was sharing about possible textbooks for a course on people and disease (and that does not add contagions A Summer in Review. ¶ What is strange though it that 2.1, 5↑ and 7A, 10↓ were before or unrelated to that discussion Sometimes Ideas Are in the Air. This is known as synchronicity, Magical Thinking, Delusions, or Synchronicity. 160911-2, 160724-6, 160522-1, 160320-1, 160313-4, 160306-10, 151227-2, 151220-3, 151206-4, 151101-50A, 151018-10a, 151004-48, 150927-39, 150614-E.6.2*¹↓ and many more.

-6. Once Opposed to Maternal Health, Islamic Scholars Become Champions. One Nigerian man saw a big problem in his community: too many women were dying in childbirth. So he turned to the region's Islamic leaders for help. Cooperation is what will lead to survival in a biodiaster, competition will lead to extinction.

-7. The administrator of the Contagions Google Group recently asked what for me turned out to be a complicated question. What’s in a Name. Name the historical period from c.450 (end of the Western Roman Empire, though not everyone at the time knew it had ended) to 800 AD (crowning of Charlemagne as Holy Roman Emperor): Late Antiquity, Migration Age, Early Medieval Period (the winner at 63% among this professional historian/anthropological group), Dark Ages. Likewise what we call biodisasters opens up interesting insights into perception of an biodisaster: Climate Change vs Global Warming - Integrating Climate Change into National Security Planning. Dust bowl, or drought of the 1930s. Rockly Mountain Locusts Swarms of 1848 or the Miracle of the Gulls. The Plagues of Egypt -  10 plagues - Biblical Metaphor, “a plague on both your houses”. 2009 H1N1 Pandemic, Swine Flu, the Flu Hoax. The Black Death - 2^nd Bubonic Plague. This is more than the same word meaning different things, or different words meaning the same thing. This is the word (iconic image) being the whole context itself, a full narrative contained in one of a few words.

            -A. The who total history of modern anatomical human disease starts with the Prehistoric baseline 95% of total human existence (200,000 years), when humans were too few, too spread out, too slow moving, to sustain epidemics. First epidemiological transition – Agricultural revolution (Neo Lithic starting around 10,000 years ago diffusing to about 4000 years ago).  Second epidemiological transition – Industrial revolution (beginning around 1760 ∓ 10 years to sometime between 1840 to 1840. Third epidemiological transition is the current time, which include vestigials of the first and second, and may end with microbes adapting to anti-biontic (Antibiotic Resistant Superbugs Are the Biggest Global Health Threat, UN Says, How We'll Tackle Diseases That Are Becoming Untreatable), vaccines, aseptics 2↑, and pollutants (ISIS Suspected of Launching First Chemical Attack Against U.S. Troops in Iraq, Indonesia Dismisses Study Showing Forest Fire Haze Killed More than 100,000 People, High Containment Laboratories: Improved Oversight of Dangerous Pathogens Needed to Mitigate Risk, GAO Finds 11 More Breaches at High Security Labs, Volkswagen Wins Parody Nobel Prize For Diesel Cheating 151004-8↓). An Unnatural History of Emerging Infections, the Contagion’s blog function as a shared file cabinet 140309-2↓. #Book.

            7.1. An example where choice of a term invokes completely different narrative, and likely generate rumors and mythology is mass grave sites. This example of mass grave is not correct in the parademic sense – intended as temporary storage of bodies until such time as they can be death with, though historically the location was permanent. Here the term being used more for shock value, partly because mass grave implies criminal behavior of mass murder, massacre (Nazi, ISIS, Drug Cartels, Genocide). Unearthing the Secrets of New York’s Mass Graves, Abandoned Hart Island: New York City’s Mass Burial Ground. [Photo, Photo, Photo, Photo]. 160918-5.2↓. Another example is the difference between technical and popular language, both being different contexts/narratives; Is India in the Throes of a Fever Outbreak, which is technically a syndemic. Mosquitoes Are Now 'Resistant' to the Chemicals Used in Fumigation Drive to Tackle Dengue and Chikungunya Crisis.

            -7.2. It has been noted that rumor and myth are contagious like, both following social networks and connections. The Group Contagion Effect. The Influence of Spatial Groupings on Perceived Contagion and Preferences. Using contagion theory (diffusion, crowd behavior) as a framework for studying the influence of spread of qualities in a group. We found that people's preferences change depending on how objects are arranged in a group. They prefer to choose from a closely arranged group (possibly including the meaning close to the observer) if one unidentified object in that group has a positive quality, but prefer to choose from a group in which objects are farther apart if one unidentified object in that group has a negative quality (possibly including the meaning remote to the observer). We call this pattern of preference the group contagion effect. We also found that the magnitude of the effect increases if the number of objects possessing the positive or negative quality increases. This could explain mass hysteria events such as Ebolaphobia if a remote, distant threat is hyped, and then appears, or made to appear to be, in close proximity.

-8. How ZIP Codes Nearly Masked the Lead Problem in Flint. ZIP code data included people who appeared to live in Flint and receive Flint water but actually didn’t, making the data much less accurate than it appeared, Understanding Spatial Relationships and Patterns. These are “one of the quirkier ‘geographies’ in the world.” Zip Codes and Spatial Analysis: Problems and Prospects, and colleagues have called out their unacceptability for small area analyses Zip Code Caveat: Bias Due to Spatiotemporal Mismatches Between Zip Codes and US Census – Defined Geographic Areas – The Public Health Disparities Geocoding Project. ¶ If I were to have simply summarized blood lead statistics by ZIP code, the pattern would not have been striking. The state, having done just this, incorrectly concluded that the change in water source had no discernible effect on Flint children. ¶ The folly reflects an all too common reliance on arbitrary boundaries for defining public health issues. ZIP codes have recently garnered attention as being a key determinant of health, curbing the old idea that biology was the primary director of one’s health. AP News Guide: The Flint Water Crisis, a Year on.

            -A. Another problem that become apparent early on when I was a pandemic planner was borders. Jurisdictions, borders, hospital service areas, syndromic monitoring Monitoring Over  the Counter Medication Sales for Early Detection of Disease Outbreaks. Recognizing that the people I supported did not understand that microbes don’t respect borders (1.1↑) and that jurisdictions are not useful for surveillance and early warning, started playing with other ideas. As political and economic boundaries clearly were useless (hospital service areas being a combination of  both) I looked at: Zip codes, population densities; watersheds/flood zones, water sources for water borne disease; climate areas, biomes and anthromes (anthropogenic – human activity changes of the in environment) with ethnical and cultural subareas; impoverished, famine and conflict areas; Supply and traffic corridors (air, sea, ground and communication). I concluded that for each outbreak there would need to be a different system or geographic area depending on the syndemics. This is similar to Area Commands in ICS4 supported by mobile task forces as well as mobile command and control, instead of a staging area and disaster EOC. Overall though each system was anthropomorphic, (Anthropomorphic Personifications of Death: Comparative Study, Anthropomorphism to Zoonoses: Two Inevitable Consequences of Human–Animal Relationships) [Photo] to include Region E which I was responsible for. To mitigate the problems of the overly artificial borders that were not based on biology, had neighboring areas of interest (Asia, Canada, Mexico, Regions C + D), contacts with counterparts in other areas and organizations, and diseases and biodisasters in addition to H1N1. Unfortunately these were frowned upon. Akin to a city fire department ignoring wild fires on the edge of their urban area, and never coordinating with other fire departments. Franklin Roosevelt's Press Conference December 17, 1940. CDC Director: Why I Don’t Support a Travel Ban to Combat Ebola Outbreak. 1.1A↑.

-9. Human vs. Pathogen: The Art of Battling Infectious Disease. Retro Posters Promote an Ancient Battle: Humans vs. Disease. People and Disease can be divided into many sub categories of human behavior, art and disease being one.

-10. Have been waiting for this to be made into a movie, scheduled to be released at the end of October. Book Review: Dan Brown’s ‘Inferno’, Dan Brown’s “Inferno”: Good Plot, Bad Science, On a Scavenger Hunt to Save Most Humans, [Chart]. It will be of parademic interest as it is informed by Ebola and other disease outbreaks, but of more interest is the question that should nature be permitted to keep the human population down, or should we permit the whole human race to go extinct. One of the SWAG of this curator is that fictional narratives can influence behavior. For example the society will collapse in a global pandemic (or zombie apococlypse) and people will have more the fear from the living and battle each other. There are several examples of mass suicides of cults who have accepted that narrative, and fiction being accepted as fact (not just anti-vax and quacks) The Oscars: Why Hollywood Tales Become 'Real' History, The Paradox of Fiction, 'Losing Yourself' in a Fictional Character Can Affect Your Real Life, The “CSI Effect”.

4. Starting this week the Crisis and Emergency Risk Communication (CERC) Corner [Logo] will be a regular item in Parademic. It may not appear weekly as the Corner may not be parademic related each time. Crisis Communication 4.2↑ and media relations are a vital to avoid, mitigate, redirect, inform during the acceleration (becomes a crisis) of biodisaster, or a hyped nonevent, and the resultant parademic. CDC Special Zika Virus Newsletter- September 23, 2016, When Emotions Run High. Crises often create heightened emotional responses. When emotions run high, it is often difficult to communicate public health messages effectively - it would be better if this communication happened before, but then it is unlikely people will be interested. The following basic circumstances are more likely to increase anger:

When people have been hurt

When they feel threatened by risks not of their own making

When they feel their fundamental beliefs are being challenged

When people feel weak in the face of others who are more powerful

When they feel like they haven’t been treated fairly or with respect

When people feel manipulated, ignored, or trivialized

If communicated in an insensitive way, emergency response messages may increase dissention and outrage.