This ain't Hell, but you can see it from here

Category: Foreign Policy

  • “Previews of Coming Attractions”

    People wonder just how bad the Ebola outbreak could get. Well, with a bit of understanding of the relevant mechanisms, knowledge of the math involved, and a spreadsheet, putting together a “quick and dirty” approximate model for the spread of that disease is relatively easy.

    What it shows may be somewhat hard to swallow. And it is a simplified model; reality will be somewhat more complex. But for the early stages of an epidemic – and we’re still in the relatively early stages of this one – I think this should be relatively close.

    First, a few known facts and/or best estimates for the current outbreak and about Ebola itself.

    1. Although the first case was reported 6 months ago, the current outbreak has actually been ongoing since Dec 2013. The index case infection(s) occurred in Guinea, in late Dec 2013. It simply wasn’t recognized as Ebola for around 3 months.
    2. The mortality rate (percentage of those infected with the disease who die) for a disease outbreak cannot be calculated until after the outbreak has run its course. However, an estimate – the current case fatality rate (CFR) – can be calculated. The CFR is a snapshot in time, and tends to rise during the course of an outbreak as more complete information becomes available and some of the patients sick at the time of last calculation die. For the current outbreak, data indicates that the CFR for the current outbreak is approximately 53%.
    3. The total number of reported Ebola cases during the current outbreak is believed to be only approximately 40% of the actual number of cases.   Roughly 60% of the cases (and deaths)in the current outbreak are believed to have never been reported – or in other words, multiply the current reported totals for cases and deaths by 2.5 to get the best guess at the true number.
    4. Facts and best estimates concerning Ebola virus disease.
    • The average Ebola incubation period seems to be about 10 days (min observed is 2 days; max observed is 21).
    • During incubation, patients are asymptomatic (without symptoms). Individuals are not in general contagious prior to becoming symptomatic.
    • At the onset of symptoms, patients begin shedding the virus in bodily fluids and become contagious.
    • Transmission of Ebola appears to be via human-to-human transmission through close contact and/or contact with contaminated fomites/surfaces. Contact with an symptomatic Ebola sufferer’s bodily fluids (sweat, urine, feces, vomit, semen, vaginal secretions, mucous, saliva, or blood) is believed to be the mechanism by which Ebola is transmitted from person to person. For that reason, shaking hands with or standing within 1 meter of an Ebola patient without PPE is considered close contact.
    • The virus appears to enter the human body through mucous membranes or open wounds.
    • Aerial transmission of Ebola does not appear to be a normal means of transmission from human-to-human. However, the possibility cannot be ruled out. Ebola Reston is believed to have spread between primates in different rooms of the famous Hazelton “monkey house” in Reston, VA, through the facility’s ventilation system. After analysis, aerial transmission through the facility’s ventilation system was determined to have been the most likely mechanism by which that Ebola variant spread.

    How epidemics work.

    An epidemic in an immunologically naïve population (e.g., one that has no previous exposure, and thus no natural resistance to the disease) works and can be modeled at a somewhat simplistic level as follows.

    1. A first case – termed the index case – becomes infected. This begins the first generation of the outbreak.
    2. The index case proceeds through the disease’s incubation period. For Ebola, this is on average 10 days. For Ebola, the individual is not contagious during the incubation period.
    3. The individual becomes contagious. For Ebola, this occurs with the onset of symptoms. Also for Ebola, the period during which a sufferer is contagious lasts until they either recover (average is approximately 16 days) or die (usually around day 10 after onset of symptoms). (One caveat here: the Ebola virus persists in certain organs of recovered Ebola patients for up to 90 days after clinical recovery. Though the recovered patient’s body does eventually rid itself of the virus, transmission to others after recovery can occur. In particular, sexual transmission of Ebola by a “recovered” Ebola patient several weeks after clinical recovery has been recorded.)
    4. Transmission to others occurs during the period while an infected person is contagious. During this period, the individual transmits the disease to some number of other individuals. The average number of persons to whom each sufferer transmits the disease is a critically important parameter, called the “reproduction number”. So long as this number is greater than 1, the number of people infected will continue to increase. It’s just a question of how fast.  For the current Ebola outbreak, the reproduction number is estimated to be somewhere between 1.5 and 2.
    5. The transmission to others referenced in step 4 begins the next generation of the virus. Steps 1 through 4 then repeat.

    That’s it. Until the numbers of persons with some type of immunity to the disease (either through survival or vaccination) in the affected population becomes significant, the above is a reasonably accurate – though somewhat crude – description of how an infectious disease propagates through a susceptible population.  It will hold until something (deaths, developed immunity, behavioral changes, whatever) changes the transmission cycle of the disease – usually by changing the reproduction number.

    Those familiar with calculus might be wondering if this is a process exhibiting exponential growth. The answer, unfortunately, is yes. Epidemics in fully susceptible populations are indeed exponential growth scenarios until “herd immunity” (the fraction of the population immune due to prior exposure or vaccination) becomes significant – or until the population dies out, or something else intervenes to reduce the reproduction number below 1.

    The Model.

    Here is a simplified spreadsheet model I’ve come up with for the current West Africa Ebola outbreak. As noted, it’s a rather crude, “quick and dirty” model. But it gives a reasonable idea of what may be in store; I don’t think it’s grossly in error.  Format is Excel 97-2003.  If anyone with more knowledge of the subject or the parameters in question has criticism or comment, I’m all ears. Getting it right is what’s important.

    Fair warning:  I would suggest you (a) sit down, and (b) get a cup of coffee (or something stronger) before you look at the model.  And I wouldn’t recommend do so immediately after or while eating.

    Assumptions used were the following.

    • Single index case in late Dec 2013.
    • 53% mortality rate.
    • Reproduction number of 1.57
    • Average incubation period of 10 days.
    • Transmission on average occurs (and thus begins the next generation of the epidemic) on day 5 after each infected individual’s symptoms begin.
    • Reported cases and deaths are each 40% of actual.
    • Estimates based on averages are reasonably representative of physical reality and will not be grossly in error.

    For 9 October – the start date of the model’s generation 20 of the outbreak – this model predicted a reported number of cases of 7,724 and a reported number of deaths of 4,090.

    Per the CDC website, on 8 October 2014, the reported number of cases was 8,011; the reported number of deaths was 3,857.

    On the “bright side” – if you can call it that – the model I developed doesn’t predict 1.4 million cases until late Feb/early Mar 2015. Without changes in the outbreak, CDC predicts that number of cases by late January.

    I guess I could say “Happy Halloween” at this point; the above is certainly scary enough. But I don’t see much to be happy about above.

    THIS is why we need to do everything possible to keep this sh!t out of the United States. Period.

    Are you listening, Mr. President?

  • Redefining “No direct Contact”

    As you may have read few things to Hondo’s post a day ago about the DOD stating that there will be a portion of the deploying force that will have direct interaction with the Ebola virus. The DOD gave the following statement that this does not mean interaction with actively infected patients.

    “In response to comments I made today about U.S. military personnel potentially coming in direct contact with Ebola infected individuals, specific to lab testing, I want to clarify my remarks. U.S. military personnel working in the labs are not interacting with patients, only samples. The testing labs are manned by highly skilled and trained personnel from the U.S. Naval Medical Research Center. These labs provide 24-hour turnaround results on samples received from area clinics and healthcare providers, with the capability to process up to 100 samples per day.”

    Yet back in September the White House website published a article that stated that 65 Commissioned Officers who will be utilized to provide treatment of infected healthcare workers.

    The United States Public Health Service Commissioned Corps is preparing to deploy 65 Commissioned Corps officers to Liberia to manage and staff a previously announced Department of Defense (DoD) hospital to care for healthcare workers who become ill. The deployment roster will consist of administrators, clinicians, and support staff.

    I start to worry when Commanders make the following statements about Ebola.

    The fear and uneasiness for soldiers and their families is something brigade commander Colonel Heath Roscoe understands, but he feels the soldier’s education, training, and preparation will be enough to fight Ebola as well as any fear.

    “I feel my soldiers are well trained,” said Roscoe. “There will be apprehension, but the more I read about (Ebola) the more comfortable I become about going over there.

    It seems that form me the more I read gives me the exact opposite feeling about the situation. Not to mention the problems caused by fear of the outbreak. There is a video from the POV of a nurse on the front lines as he takes care of several patients and documents what seems to be a typical day.

    A town hall meeting was held at Fort Hood on Monday for families of the soon-to-be deployed soldiers to talk about their concerns or fears about the mission into Africa. Roscoe said the soldiers being deployed are all very well-disciplined and will be taught to exercise good hygiene to keep Ebola risk low. Even in a worst-case scenario, Roscoe assured families their loved ones would be okay.

    “If a soldier were to get Ebola over there, they will be okay because America will take care of them.”

    “…”

  • “Eager to Rid Itself of Iraq”

    “. . . the President’s team at the White House pushed back, and the differences occasionally became heated. … and those on our side viewed the White House as so eager to rid itself of Iraq that it was willing to withdraw rather than lock in arrangements that would preserve our influence and interests.”

    No, that’s not a quote from Charles Krauthammer, Ann Coulter, or another Conservative political commentator.  It’s not a quote from some politician with an “R” after his name, either.

    As Jonn noted earlier today, that quote is reportedly from former SECDEF Leon Panetta’s upcoming memoir.

    Panetta goes on to state his opinion that White House engagement would have resulted in an agreement for some residual level of US forces to remain in Iraq post-2011.  He further states his belief that those forces would have made a critical difference in the recent situation there.

    But what would Panetta know?  After all, he’s only the former SECDEF and DIR CIA.

    My take on this is somewhat different from Jonn’s.  Panetta’s job as SECDEF wasn’t to make the decision on Iraq.  Rather, his job was to advise the POTUS regarding the ramifications of either option – then to implement the decision made by the POTUS.  Sounds to me like he did precisely that.  My issue here is very different than Jonn’s.

    The current Administration has been trotting out the “we really wanted to keep some forces there, but the Iraqi government wouldn’t let us”      bunch of bullsh!t      load of horsesh!t      baldfaced lie      whopper      flight of fantasy      tall tale       revisionist history recently concerning the 2011 US -Iraq negotiations.  With all due respect:  quit trying to “rectify” history again, Mr. President.  Because as they might have said where I grew up:  “Now, that dog just don’t hunt.”  Your attempts to “blame Bush” here are being disavowed by people who saw what your Administration actually did – from the inside.  Everyone can see the attempt to “blame Bush” this time is bull.

    Panetta is saying essentially the same thing here as the former US Ambassador to Iraq, Ryan Crocker has said elsewhere.  So Panetta’s account would seem to have support from someone else who was in an excellent position to know “ground truth” in Iraq.

    How about you quit trying to blame the current situation in Iraq on your predecessor, Mr. President.  In 2011, your hands weren’t tied.  You had your chance to prevent the current problems there from developing – and your Administration consciously chose not to.  Instead, you played Pontius Pilate and “washed your hands of the matter”.

    Fine. But the subsequent rise of ISIL and it’s takeover of much of Iraq is a direct consequence of that “hand-washing”.  That means that the situation in Iraq today with ISIL is your responsibility – yours, not someone else’s.  You and your Administration are the ones who “screwed the pooch” here.

    You own this.  Time to “man up” and admit it – for once.  (Hey, a guy can dream – can’t he?)

     

  • The Ebola issue

    As it stands right now, I have mixed opinions about how to handle the Ebola question.

    On one hand, the way that this outbreak is going on is a serious concern. The World Health Organization made a statement that it expects the number of new Ebola outbreaks to increase exponentially. But also in the number of health care workers that have been infected is also alarming. Also the lack of education about and fear of Ebola is doing about the same level of damage to the area. In short this is a issue that that cannot be handled without outside help. So on paper sending in military support to the area sounds good. We have done similar actions in the Philippines for Hurricane Haiyan. So why not right? Well there is the simple issue of the how.

    The question is how are you going to fight it? Michael D. Lumpkin raised concern that the United States military is established more for trauma then for things like this.

    “Our deployable medical capabilities are generally trauma medicine, treating people who suffer wounds in combat and things of that nature,”

    The first question that I have is how does the DOD intend to adequately train 500 health care workers per week on how to care for infected patients. Also where are these 500 health care workers going to be coming from? The local population is not going to work due to the lack education and information on it. How are you going to staff the Ebola treatment centers when they are finished? Not to mention the risk of violence by the local population.

    Also how are you going to prevent burn out from the health care workers?

    In testimony prepared for the hearing, Brantly described the challenges and difficulties of working in what was already a “woefully inadequate healthcare system of a country still struggling to recover from a brutal civil war.” He “witnessed the horror that this disease visits upon its victims — the intense pain and humiliation of those who suffer with it, the irrational fear and superstition that pervades communities, and the violence and unrest that now threatens entire nations.”

    Treating Ebola patients, he said, “is not like caring for other patients. It is grueling work. The personal protective equipment we wore … becomes excruciatingly hot, with temperatures inside the suit reaching up to 115 degrees. It cannot be worn for more than an hour and a half.”

    Also is the question of how to handle treatment for potential infections of soldiers during the operations. From the reports

    When he fell ill on July 23, “I came to understand firsthand what my own patients had suffered,” Brantly said. “I was isolated from my family and I was unsure if I would ever see them again. Even though I knew most of my caretakers, I could see nothing but their eyes through their protective goggles… I experienced the humiliation of losing control of my bodily functions and faced the horror of vomiting blood—a sign of the internal bleeding that could have eventually led to my death.”

    Speaking for myself as a Licensed practical nurse, I would not have a problem going if called. However I would like to know what people think we can do in Liberia and what we actually do. Because a disconnect like this is going to get Soldiers seriously hurt or killed.

  • Public opinion as policy

    Public opinion as policy

    Barack Obama

    The Washington Post publishes a piece in it’s pages today about our really cool president who doesn’t let world events bother him entitled “Obama sets his own pace in a world whirling with crises“.

    They fawn over the fellow in the White House who makes decisions based on polling results after weeks, if not months, of taking the pulse of American public opinion. Always making the more popular decision. That practice has led to the worst foreign policy (if you can find a single policy), rampant unemployment, rampant overspending by government, an unsafe world in which we’re surrounded by enemies, further endangering our own economy as well as our national security.

    The American people are boobs – there are 300,000,000 million people acting in their own interest. That’s human nature and it’s the same across the globe. What we need is a leader to lead us, not one more boob acting in his own interests. If we needed a government that made policy based on the popular opinion, Gallup would be the president.

    Because we’ve been geographically removed from many of the problems in the world, we want stuff that makes us comfortable. Sending our troops to war makes us uncomfortable, as it should, but our short-sightedness and our need for immediate comfort makes us end conflicts before the enemy agrees that the war is over. And so, we’ve sent troops to Iraq three times in the last twenty years when all we really needed to do was finish the job the first time.

    It will be the same in Afghanistan;

    With a schedule for Iraq withdrawal already set, he developed policies for ending the then-faltering war in Afghanistan. In a pattern that would repeat itself on other issues, he deliberated for months, and then split the difference by simultaneously announcing a surge of troops and the timing of their departure.

    But as he tried to engage the world on his terms, Obama quickly found out that the world had thoughts and plans of its own. Far from the reset Obama sought with Russia, President Vladimir Putin sought a new balance of power through aggression in Ukraine. While Obama offered a fresh start for the United States in the Muslim world, the Arab Spring headed toward destabilization rather than democracy.

    Six years later, events seem to have spun out of his control, and Obama must react to the actions of others. Putin’s aggression in Ukraine has sparked the greatest East-West crisis since the Cold War. Islamic State advances have swallowed up a large swath of the Middle East and threaten a global upheaval far beyond the shock of al-Qaeda’s 2001 attacks.

    It’s no coincidence that the world seemed to fall apart soon after Obama’s decision to half-ass the surge in Afghanistan – he sent a message to the world that we weren’t really committed to anything anymore and the fear and respect for the US that George W. Bush had fostered in his eight years had dissipated and from the four corners of the world came chaos.

    That’s why there is no strategy for Iraq, or any other place in the world, for that matter – the White House is waiting to see what Americans want to do, before they do something that we might consider “stupid”. Because the Obama Doctrine is “don’t doing anything stupid”, and it ends up being “don’t do anything”. That’s why the President can play golf and fiddle while the world burns around him – he’s waiting for Americans to make policy – the best political answer – the answer that is popular. And most likely wrong.

    George W. Bush ignored public opinion in 2006, when Congressional Republicans lost in the mid-terms, and Bush brought relative peace to Iraq. You’d think someone might have noticed that if they weren’t so busy trying to get elected rather than doing the right thing for the country.

  • ISIS May Have MANPADS Now

    Remember that Syrian airbase that ISIS overran the other day?  Well, it looks like they might have obtained a few useful things when they took it.

    What kind of useful items?  Try advanced MANPADS, for starters.  The Washington Post is reporting that a cache of MANPADS were among the items ISIS obtained when they took that Syrian base.  The MANPADS obtained were reportedly SA-16s, although at least one photo released may be that of an SA-18.

    Along with MANPADS, ISIS reputedly obtained MIG-21s and AIM-9 Sidewinders as well when it captured the base.

    They’ll need qualified pilots, facilities, and maintenance personnel to use the latter two items of course.  But MANPADS aren’t that difficult to use – and if they captured the systems, presumably ISIS also captured a number of Arabic-language manuals as well.  And they’re, well, man-portable.

    If true, this is not good news.

  • Well, Well, Well

    I ran across an interesting little story yesterday.  While rumors about the subject have circulated, good documentation has been hard to come by for nearly 13 years.

    Until now.

    Clinton on Sept. 10, 2001: I could have killed bin Laden but ‘I didn’t’

    Gee.  That’s . . . interesting.   Looks like Richard Miniter was right all along regarding those claims he made in Losing bin Laden, doesn’t it?

    Don’t simply take my word for it; recorded audio of the admission exists.  Listen to Clinton’s admission yourself if you like.  It’s found at about 5:34 in the video clip found here.

    Clinton made the admission in a speech he gave to a group of Australian business leaders.  The date of that speech?  September 10, 2001.

    Yeah.

    This kind of crap happens when a nation’s leadership persists in treating acts of war as a “law enforcement matter”.   Or when a nation elects someone President who is nothing but a naive but charismatic charlatan who’s clueless about most everything except giving speeches and chasing tail.

    Or in Clinton’s case – when both are true simultaneously.

    And spare me that, “But Bush has been POTUS for months when 9/11 happened!” bullsh!t.  There’s no way in hell anyone can fix 8 years of abject mismanagement and neglect in barely 7 1/2 months.  That’s particularly true when those running the show previously screw things up as badly as Clinton and his cronies did.

    So, all of you libidiots out there who’ve had your head up your 4th point of contact for years, and who kept blaming Bush for 9/11?  How about you just go grab a big honking cup of STFU now.  And keep yer yaps shut about 9/11 – permanently.  (Especially you, idiot who comments here as vietnam war protestor.)

    While you’re keeping that yap shut, how about you chew on this to occupy your mouth instead:  your “sainted hero” Billy-boi admitted he could have prevented 9/11.  He also admitted he consciously decided not to do that.

    And chew on this, too:  a President’s job is to make those hard decisions when are necessary to protect this nation.  A President who refuses to do that because “someone might get killed” is not fit to hold the office.

  • We are not the world’s policeman, but…

    In the Washington Post today, Editorial page editor Fred Hiatt writes “Obama’s foreign policy reveals the effects of disengagement“. Hiatt lists the scant foreign policy of this administration. While the world begged for leadership, the president, instead focused on transforming domestic policies to suit his own politics. The results of that disengagement from the world, according to Hiatt;

    Obama’s determination to gear down in Europe and the Middle East, regardless of circumstances, guaranteed that the United States would not respond strategically to new opportunities (the Arab Spring) or dangers (Putin’s determination to redraw the map of Europe).

    When ordinary citizens in Tunisia, Egypt, Syria and elsewhere in the Arab world unexpectedly began agitating for democracy, the West might have responded as it did after World War II (with the Marshall Plan) or the fall of the Berlin Wall (with a commitment to a Europe whole and free). If the United States had taken the lead, Europe and America together could have offered trade, investment, exchange and cultural opportunities to help bring the region into the modern, democratic world.

    But for Obama the tumult in Egypt and elsewhere was a distraction, not a once-in-a-generation opportunity. The West responded timidly and inconsistently, and the moment was lost.

    For Russia, Obama offered Putin a “reset” strategy of improved relations. But when it became clear that Putin wasn’t interested — that he wanted to re-create a Russian empire while blocking the achievement of a Europe whole and free — the West again had no strategic response. Obama could have bolstered a unified Europe with military, diplomatic and trade measures. Instead, as Putin wrecked democracy in Russia, annexed Crimea and fomented war in Ukraine, Obama and his European counterparts were reactive and divided.

    In Iraq and Syria, Obama’s predictions proved wrong. Without the 15,000 or so troops that U.S. generals hoped to station in Iraq for training and counterterrorism, the United States had no leverage as Iraq’s armed forces devolved into sectarian militias. When challenged by al-Qaeda, the army and the state itself quickly shattered.

    Without Western backing, the moderate rebels in Syria are in retreat. Assad did not fall, and extremists — with a far more capable arsenal than the moderates have — established a state that Eric Holder finds “more frightening than anything I think I’ve seen as attorney general.”

    Libya’s government, until recently spurned in its requests for help, gradually lost control. The country is now so dangerous that on Saturday the United States had to evacuate its embassy.

    I’ll concede that we have no money left to be the world’s policeman, but, if your own hometown’s policemen all quit one day before there was a period to adjust to the new scenario, your hometown would look much like the world today.

    Leadership and the lack of leadership are the subject of many op/ed pieces these days. The US could be a leader in the world without spending a lot of money on defense, unfortunately, we have a leaderless country in a leaderless world. Our own Secretary of State is a national punchline, soon to be an international punchline. Even Hillary Clinton took an opportunity this weekend to criticize the Obama Administration for being rudderless in regards to foreign policy, according to the Washington Times;

    She then seemed to take another jab at Mr. Obama’s White House, saying that America spends a “lot of money and a lot of time and effort” to exert influence around the world.

    But “I think we would be able to succeed more effectively if we were clearer about who we are and what we stand for and the values that we hold,” she added during the CNN interview.

    We continue to pour money into foreign governments trying to influence them, but that’s not working. numbers are flying around today about the amount of money that the world poured into Gaza would have rebuilt the entire infrastructure of that state, but Hamas used it to buy missiles and build tunnels into Israel instead.

    Leadership is harder, and therefore not the chosen path for this administration. leadership on the border would have been nice, but the solution from this administration was more spending instead – and it was the same lack of leadership that caused that crisis in the first place.

    I like to toot my own horn, so I’ll mention that I predicted this chapter of our history unfolding before us back in May, 2007 when I warned about electing someone from Congress instead of someone with actual leadership experience.

    By the way, when someone in the Washington Post decides to criticize a Democrat President, the White House needs to take a look at the way they’re doing the people’s business.