Monday, November 17, 2014

Recurring risks

A recent Pew Trust survey of what people are most concerned about identifies inequity as the issue for Americans.  The locus of that concern over inequity has resided in Ferguson, Missouri, since this past summer's events.  Now, as we wait for the grand jury decision on the officer who shot and killed Michael Brown, cities all across the country have made plans to stand up their emergency operations centers because of possible demonstrations around the outcome.  It will be about more than that particular shooting.  Police departments across the board are having to answer indirectly for the response of the Ferguson and St. Louis police departments, none of which was by the book. 

Meanwhile, our concern that Ebola is coming to this country to infect us all has receded.  I wish I could say this is because everyone has understood the science behind the infectious disease, but I suspect that is rather that attention spans have moved on to other issues.  The West African coast is by no means out of the woods on Ebola, but there do appear to be some signs of progress with diagnostic tests that quickly identify then isolate patients while their contacts are tracked down and monitored.  Nigeria appears to have been most successful in its efforts, using mobile phones to quickly upload information and dispatch medical assistance.

In America, the airports that carry the traffic from West Africa are all monitoring incoming passengers.  And when soldiers return from helping to set up emergency centers in West Africa, they are being quarantined for 21 days.  So far at least, only four cases have been diagnosed in the United States -- three in Texas and one in New York City.  Three of the four patients survived, and it is suspected that the fourth might have lived if he had been properly diagnosed when he presented himself at the hospital.

We'll undoubtedly return to the issues of inequality and infectious disease again.  It is to be hoped that those on the front line will show us what it is to be a good citizen, a respectful participant in our democratic process.

Thursday, November 6, 2014

Coming up for air.

I have been down in the weeds with several risk issues that have been in the news, teaching two UW graduate courses on back to back days, and speaking at a couple of significant events here in Seattle.

I promise to write more in the November column for ASA News & Notes, which ships next Monday.

I intend to spend part of that column talking about what a social conscience can mean to a public company.

Wednesday, October 8, 2014

Purposeful Education

Now that the Ebola patient who was being treated in the Dallas hospital has died, it's time to get moving, without hysteria, with purposeful calm, on two fronts.

First, the media, particularly the virtual and broadcast media, need to tamp down the sensational hysteria and take that same amount of airtime to educate the American public about the value of flu shots, vaccinations for their children, and any other measures they feel might keep Americans safe.  I say this because we are about to deploy troops to Africa and it is likely that some of them -- or Americans already working in Western Africa -- might fall ill and need to be treated in our communities.

Second, it's not just hospitals who need to sit up and pay attention, and rehearse their response -- although from the comments of associations of nurses, it's clear that institutional strategies have not been shared, nor have the protective measures that will be put in place for personnel.  And the training and rehearsals must also include ambulance drivers and EMTs as well as a range of other medical support personnel. 

Meanwhile, vaccine trials proceed.   Trying out vaccines on patients already infected is not the same as a full on Stage 2 double bind trial that carries its own risks. In our rush to find a way to contain the virus, and to find a vaccine that works, we'll find a range of ethical questions presenting themselves.

Let's get started.

Wednesday, October 1, 2014

Public Health and the Secret Service both need better checklists

The Liberian public health and airport security personnel in Liberia did their jobs, and checked outgoing passengers at three distinct checkpoints.  We've patted ourselves on the back in this country for the sophistication of our medical capabilities, yet as I listened to the story today of the nurse in Dallas who followed a "checklist" and got a Big Red Flag answer back from the patient, but failed to escalate it in such a way that the team could isolate and contain the patient -- in fact, they sent him away with antibiotics and he came back a second time when he felt worse -- I thought once again of Dr. Atul Gawande's book, The Checklist Manifesto

This type of error is called one of ineptitude, as opposed to one of ignorance, presumably.  We don't know if this was an Ebola-specific checklist; one prepared by the hospital itself; or one from the Center for Disease Controls.  A quick read of Gawande's book might be very helpful, especially if the checklist has more than 5-7 items on it, without what Gawande calls "pause points."  His book is full of stories of how pilots, builders of skyscrapers and surgical teams perform extremely complicated feats, and how using checklists that involve every member of the team makes a difference.  His work in this respect for the World Health Organization has made a large impact:  deaths after surgeries have been reduced significantly by the implementation of several simple procedures that are part of the checklist.

I would also recommend the book to the new acting director of the Secret Service and to the panel that is currently being constituted to review the disturbing procedural/process failures over the last several years for the organization charged with guarding the president.  It may be that those procedures or processes have become shopworn.  Certainly it must be the case that, unless on a form of high alert (the United Nations responsibility, for example) agents' situational awareness is at an all time low.  Whether this is a factor related to the move from Treasury to the Department of Homeland Security or not is difficult to estimate, but will undoubtedly be reviewed by the panel.

The tipping point I mentioned last week seems more vivid as weeks go by.  Yet there was one piece of good news this morning:  that it appears Nigeria, the most populous and also most well-off African country in terms of infrastructure and medical personnel, has contained Ebola.  We just can't move quickly enough to get more personnel, hospitals, emergency operations centers and supplies deployed in the remaining countries. 

Thursday, September 25, 2014

A tipping point?

As I teach my second class this week, I realize how very focused I have been on two global issues, each of which has their own consequences from a risk perspective.

Many of you have been reading me on Ebola risk since last spring.  Though it does appear that the rapid mutation and growth of cases has caught the attention of the world stage, we are still a month or so away from seeing the actual deployment that result from commitments from the private sector (The Gates Foundation $50 million; Paul Allen $4 million, for example); and from both governmental organizations and world health organizations often funded with a mix of public and private sector funds.  This morning's New York Times story on home deaths in Monrovia, Liberia,  is just one more illustration of far away from our comprehension such a human situation is. All I am able to do is monitor the modeling that is now being done by research teams on how and where the virus will spread.

I understand that not more attention is being paid because terrorist threats from ISIL (The Islamist State) have risen to such a level that the United States once again finds itself leading an effort to push back against a cultural and religious landscape it doesn't understand.  This is especially the case now that ISIL is using social media to make its brutal points, as it continues to behead unbelievers on camera.

Watching the Ken Burns series called "The Roosevelts" last week caused me to reflect on how little either Teddy or FDR would have been able to accomplish today, with every moment, every gesture, every inflection studied of our leaders is analyzed into the ground.  FDR, for example, was able to prepare Americans for a war they initially did not want through the effective use of his "fireside chats."  When it was suggested after his first broadcast that he do them more often, he replied that their effectiveness would lie in them not being too frequent.  Ultimately he made 30 such talks over 11 years, covering both the Great Depression and World War II.

Today President Obama is in an entirely different place and time:  social media records every gesture,  microphones pick up even private conversations, and not much is any longer considered confidential.  He faces a passive aggressive Congress and election year votes that may change the very composition of the Congress, conveniently on a long break until after those elections.  To his credit, the president is leading as he always has wanted to lead: in the presence of other nations who also have a stake in the outcome.  To see both a Saudi prince and a Saudi woman piloting missions today is another sign of how things are evolving.

I'm keeping an eye on all of it, and have the rare privilege of being able to talk about these matters with my students as part of understanding the checks and balances that make up our system of government.  We use three lenses on such current topics:  ethics, policy, and law, especially when influenced by the evolution of technology.

For students especially, "we choose hope over fear."  (President Obama, yesterday, to the United Nations Assembly)

Sunday, September 14, 2014

Ebola Risk

I wish those public health departments would hold off from announcing that there is no risk to residents in America.  We don't know how long this will be true since globalization has truly reduced both time and space among countries.  It's also now being rather quietly suggested among epidemiologists that the virus is mutating so rapidly that it could become airborne.

I published an ASA News & Notes column last Monday on high level Ebola risk and the cultural dimensions that make containing Ebola just that more difficult.  Tomorrow a London-based magazine called The Risk Universe will be publishing a piece directed primarily to the financial sector, on how firms can prepare for bio-threats.  I'll post it up to our website, in case you're not already signed up to receive updates.  You can adapt many of the practices I recommend for businesses for your own family.

Monday, August 25, 2014

The bell has tolled. Did you hear it?

We all shivered when we read that the Napa region in California was recovering from a 6.0 magnitude earthquake early yesterday morning.  Today, some of the excitement has receded, as the area assesses damage and cleans up.
Always in the trunk of my car: boots, water bottle and "evac pack" with flares, blanket, etc.

From first floor hallway, our "away" backpack that contains supplies, water, food. I also have included information on medications, insurance policies, credit cards, etc.

We're nearing the end of a glorious Seattle summer, and starting to think about back to school matters.  Even as we're out there picking up school supplies, why not see what you can do about building or enhancing your emergency supplies kit?  Take a look at what you've got that needs to be replaced, or what you need in fact to get started.

My own challenge is larger than life.  Though we have one of those backpacks filled with dried rations, I don't eat processed foods any longer.  So I've started to think about what I could maintain off the grid that might work:  cans of low salt beans or tomatoes work fine, as do containers of unsalted nuts, but that's about it.  I eat several cups a day of raw salad or steamed vegetables, and four fruits, and a handful of nuts.  So that means I've got to start thinking about year-round gardening in a relatively small space.  I'll keep you posted on what I come up with.

In our neighborhood, we've organized even further.  Not only do we have the 300+ house region divided up with first aid and daycare sites identified, but we've raised the money to invest in medical supplies housed in each region.  We're now producing a laminated flyer with area-specific information for residents.   We're hosting a community event in September, and also signing up folks at an upcoming neighborhood event.  We have identified neighbors with special skills or access to tools we might need in the event of a major earthquake.

So we're moving forward, on the assumption that there won't be help from police or fire or emergency teams from the city for at least three days.  We are getting ready, that is, to help ourselves.

This model can be replicated in any city, anywhere.  If you'd like more information, let me know.