Category Archives: Healthcare

Flu or Ebola?

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The following blog is written by a emergency room doctor who is comparing today’s Ebola epidemic to the Flu epidemic of 1918. It does make sense that since flu season is upon us that we are more than likely to get the flu than Ebola. Flu is contact and airborne, so that quick trip to Walmart could be the time that someone sneezed into their hands and then grabbed hold of that shopping cart. Disgusting isn’t it.

https://shirley-mclain.net/2013/01/12/are-you-sharing/ This link takes you to a previous blog I did a year or so ago on the flu called “Are You Shring”. Take a look at it. It might just save you a lot of misery. Shirley

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I’ve been walking the earth for a half a century, so I’m sure I’ve picked up a bit along the way. I know the Gettysburg Address by heart. I can recite all the presidents. I can taste the difference between Diet Coke and Diet Pepsi, and I’m fairly certain I can tell you the starting lineup from the 1976 Cincinnati Reds. But if you ask me if I’m worried about Ebola, if our hospital is ready or if our nurses and staff are up to the challenge, chances are you will probably hear me say this:

“Hell if I know.”

I have been practicing emergency medicine for more than 20 years and I’ve seen close to 100,000 patients. I’ve written a few books, published some papers, lectured a bunch of times, pissed off about 10,000 soccer moms when I wrote an article telling them their kids weren’t playing the pros. I once even testified in front of a congressional sub-committee on hospital disaster preparedness. I’m still beating myself for at least not stealing a pen, but it was part of my duty as the physician director of mass casualty preparedness for our emergency department.

So you would think if anyone in the emergency department trenches would be versed as to how this Ebola scare will unfold, if it will spread, what to expect, how to diagnose, screen, protect and treat, then I suppose it would be me.

If an investigator for Joint Commissions or some other oversight agency, a member of the press or a committee trying to ensure CDC compliance were to pull me aside to spot check my Ebola acumen, they’d be satisfied with my answers and I’d leave them feeling like they had done due diligence as an administrator.

“Dr. Profeta, do we have enough protective stuff and does everyone know how to use it?”
“Yup.”
“Are the screening plans in place?”
“Yeah, ya betcha.”
“Is the staff versed in transmission and spread of Ebola?”
“Darn tooten.”
“Has everyone read all the CDC and hospital communiqués regarding Ebola?”
“Sure have.”
“Have you practiced the drills in the ER in case we have someone show up with a possible exposure?”
“More times than Lois Lerner has hit her hard drive with a hammer.”

But if they were to ask me if there are any other issues they should be aware of, I’ll just stare with round blank eyes and keep my mouth shut until the right question is asked; the question they will pretend does not exist.

“Dr. Profeta, will they – the staff, you, your partners – show up? “
“That, I don’t know.”

Some years ago when I first started in practice, a very large hospital in our area was having trouble getting patients rapidly admitted from the ER to the floors. This resulted in a tremendous backlog of patients and extreme ER overcrowding. This naturally increased patient wait times and directly impacted the health of those coming to the ER. So, naturally, the hospital system formed a committee and hired consultants. They looked at every single variable: time to laboratory, time to X-ray, nursing changeover, bed request time and on and on and on. Do you know what they found? The roadblock in the movement of patients through this major medical system was housekeeping. Think about that. Housekeepers, traditionally the lowest paid and least-skilled division of employment of the hospital, were responsible for the movement and throughput of patients more than any other factor.

If the rooms on the floor were not cleaned fast enough, then no patients could move from the ER to the floor, and no patients from the waiting room to the ER. ER wait times rose and patient care suffered. Housekeepers handcuffed the entire system, and not because they were lazy. The regulations, protocols and procedures put into place to clean a room are so extensive that rapid room turnover was next to impossible with the current staffing model. That stuck with me. What is the rate-limiting step in a mass casualty scenario or massive patient influx that would handcuff us? Where will all the preparedness collapse? What is the leaking O-ring? What am I afraid will fail?

As I alluded to a bit earlier, I appeared before members of Congress who were investigating Midwest medical centers and regional hospital preparedness for a mass casualty event. The focus was on our readiness should a major earthquake hit the Midwest. The congressmen wanted to know if we had the capacity to mobilize our staff; they asked what assistance we needed. Toward the end of the discussion, they asked each of us what we were most afraid of. The responses were typical answers you would give to a member of Congress if you were seeking money (not having enough resources, not enough congressional or governmental support, not having enough staff or equipment or infrastructure, etc.)

When they got to me, asking what I worried about, I simply said: “The flu.”

Now, flash forward. I wonder if what I really meant to say was “Ebola.”
IV push
When it comes to our ER and our ability to provide the best care during the worst extremes, I have no doubt we can mobilize our hospital to care for hundreds and hundreds of seriously injured patients. We have modeled our Emergency Department response to a mass-casualty incident in much the way Israeli hospitals have structured their programs. (As a side note, Israel is light years ahead of us in terms of all mass casualty – chemical, biological, environmental, mad-made – preparedness.) Specifically, we model our plan after Western Galilee hospital on the border of Israel and Lebanon. This is a large, major, modern-day medical center under constant threat from Hezbollah rockets from Lebanon. They train and drill with a level of involvement, passion and commitment that exceeds anything we can muster.

The staff at my hospital in Indianapolis, however, has bought into it and I truly believe that there is no ER in Indiana, and few in the Midwest, that have a better plan in place. We also gained a better understanding of the type of injuries we would see in each scenario. More specifically, we wanted to know from a pure number standpoint how many patients would have to go to the operating room the minute they hit the door, how many would need to be on ventilators and how many would need emergent life-saving intervention. Fortunately, and not so fortunately, the proliferation of research in this area has provided plenty of hard data well documented in the literature. Ultimately, all things being equal, the data seems to indicate a suicide type bomb loaded with ball bearings or other projectiles placed in a crowded area will result in the largest number of patients requiring immediate, emergent and life-saving intervention. While a disaster like a major earthquake will result in far more fatalities, far less people will require absolute immediate operative or life-saving intervention. All we really need to know is, what type of event, how many patients, and it’s pretty easy to calculate what to expect from an acuity standpoint. In the ER, it isn’t the total number of patients that concerns us, it’s the number we get that will die if not treated in minutes or a few hours. The rest we have no problem letting wait.

Ultimately, though, what I am getting at is that the trauma from a major incident like an earthquake or terrorist attack is very predictable. All you really need to know is the type of event and the numbers and you almost immediately have a pretty good idea of what to expect.

But a real bad flu?

There is no way you can prepare for it. The goal should be to protect your hospital from it.

We have seen influenza pandemics before, the most notable being the Spanish flu of 1918. Researchers estimate between 20 and 100 million peopled died from this strain of flu. What was even more concerning was the number of deaths that occurred in previously healthy people. Each year in the United States, about 30,000-40,000 deaths and 200,0000 hospitalizations can be attributed in part to influenza. Most deaths are in the elderly with pre-existing serious health problems. The Spanish flu of 1918 was different. It killed the healthy, able bodied. It unleashed an incredible degree of viral savagery with an infection rate of nearly 50 percent. It was a biological holocaust.
Field Hospital
Doctors and nurses treat flu patients lying on cots and in outdoor tents at a hospital camp during the influenza epidemic of 1918. (Photo: Hulton Archive/Getty Images)

Thus my biggest fear has always been a strain of flu that is highly contagious with a high mortality rate. The Spanish-flu mortality rate of 1918 was 2 to 5 percent. Ebola has a 20 to 90 percent mortality rate, but it fortunately is not quite as contagious as Influenza. However, I still keep going back to flu and envisioning an epidemic of the Spanish type that will quickly fill all our inpatient beds, every ICU bed, every ventilator, every outpatient bed, every cot, gurney and chair in the ER and in all the waiting rooms. I’m afraid that a flu virus this aggressive will bring five dying flu victims to our ER each day and dozens more with a real possibility of dying.

This would occur on top of a department that is always operating at capacity and drowning in documentation and electronic medical record bureaucracy. After 30 days in our ER, nearly 150 people will have died, providers will be physically and mentally spent and morale will be at below-despair levels. Multiply it by 20 or so other hospitals in the area and now we are talking about 3,000 members of our community dead in only a single month. The obituary pages of the local paper will be thicker than the advertising section the day after Thanksgiving. Expand that number statewide and nationwide and the numbers become so immense they aren’t even real.

Now imagine a realistic scenario in which the flu vaccine only provides immunity to 50 percent of the recipients. That means that half of our ER staff who are seeing all these patients will have little protection, outside of gowns, masks, and gloves, against a virus that is spread primarily though coughing, sneezing and saliva. Simply put, some of us in the trenches in damn near every ER in America will almost certainly die. It could be me, it could be any one of my partners, colleagues and co-workers and it could be one of our children or a spouse who gets infected when one of us comes home thinking the headache and fatigue they are feeling is simply exhaustion from the workload of the day. Can you picture it?

Now imagine that huge numbers of hospital staff – from doctors to housekeepers, from food services to registration, from security and parking to transportation will decide not show up. They will call in sick or simply just say: “No, I’m not coming to work today.” In just a few days, human waste, debris, soiled linens, the sick, the dying and the bodies will pile up. We will be overwhelmed and unable to offer much in the way of assistance because the labor-intensive protocols that allow us to safely care for even one patient are just too exhausting. These procedures are barely repeatable more than once or twice of day, and fraught with so many steps and potential for mistake that it becomes too physically and emotionally taxing for the staff to do … so they simply wont show up.

And I am not sure I will, either.

I love emergency medicine. I love helping people and saving lives and I think I’m pretty good at it, but I am also a person and I have a wife and three children that I love and want to see grow up. I also am keenly aware that not a damn thing I do will have any real impact on the survivability of a patient with either the Spanish flu or Ebola. Fluids, rest and prayer is about all there is to offer. There is an old adage that says a hospital is no place for a sick person. I think whoever first said that had Spanish flu and Ebola in mind.

So we drill and we prepare and we post placards and do screening but no one is asking why in the hell are they coming to us in the first place? Fluids and rest can be provided anywhere: an empty warehouse or a huge tent in the middle of farmland. Why would we not just take the care to them in the form of special traveling Ebola-mobiles that triage and treat the patients at home? Why can we deliver the mail, pickup the garbage and recyclables at damn near every house in America, but we can’t pull up a retrofitted UPS van, drop off a mid-level provider in a hazmat gown, let them do an assessment, draw some blood, drop off cans of rehydrating formula to their doors, clean linen, biohazard bags, gowns and gloves for family members, slap a warning sticker on the front door, tell them you will stop by tomorrow and move on to some other location? I know I sound crass, perhaps like I don’t really have sympathy for these very ill patients. This could not be further from the truth. I’m just kind of angry. I know there is a better way than risking the infrastructure of a medical center for the sake of a few patients that will either do OK at home with simple supportive care or die no matter what care I provide. We’ve had years to prepare for this, we’ve hung all our hopes on a vaccine and not nearly enough thought on containment should a vaccine fail.

Today’s Ebola is tomorrow’s Spanish flu. We’ve had nearly a hundred years to get ready and the best we can come up with is plastic suits, double gloves, respirators, and masks. The battleground of this problem can’t be in the hospital. It is unwinnable in our emergency rooms.

I think I might just call in sick.

Dr. Louis M. Profeta is an emergency physician practicing in Indianapolis. He is the author of the critically acclaimed book, The Patient in Room Nine Says He’s God.

Why Ebola Is Such A Uniquely Terrible Virus

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This is another article on Ebola. These articles are to educate and not cause unnecessary fear. Being forewarned is being forearmed. Have a blessed day. Shirley

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Physician Thomas Klotzkowski cleans Florian Steiner, a doctor for tropical medicine, in a disinfection chamber at the quarantine station for patients with infectious diseases at the Charite hospital in Berlin.
The Ebola virus is uniquely terrible for many reasons, but it doesn’t actually kill you. Your own immune system does.
In its struggle to beat back the virus, your immune system’s reaction ravages the rest of your body, leaving your blood vessels weak and leaky.
Soon, blood and plasma start pushing through, sometimes coming out of your pores and every orifice.
But long before the body begins to fail — around the time Ebola first enters the blood — the virus starts tripping up our defenses.
Here’s how it kills, how it spreads, and how it can be treated. In every step of the way, this deadly virus is uniquely terrible.

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ebola virus
The Ebola virus. So small. So deadly.
Ebola is a filovirus, a type of virus made from a tiny string of proteins that coat a single strand of genetic material. Particles of the virus live in an infected person’s blood, saliva, mucous, sweat, and vomit.
When someone is at the height of the illness (typically after five or more days), one-fifth of a teaspoon of that person’s blood can carry 10 billion viral Ebola particles, The New York Times reports.
An untreated HIV patient, by comparison, has just 50,000 to 100,000 particles in the same amount of blood; someone with untreated hepatitis C has between 5 million and 20 million.
If those particles find an entry point, like a cut or scrape, or if a person touches his or her nose, mouth, or eyes with fluids that contain them, they get to work quickly.

How It Kills
ebola patient blood sample sierra leone
Ebola how it kills
Touch is integral to patient care — and the best way to spread Ebola.

Once inside the bloodstream, the virus targets a compound called interferon. Interferon, named for its role in “interfering” with the virus’ survival process, alerts the rest of the immune system to the presence of a foreign invader. Normally, interferon would deliver its warning message straight to the cell’s command center via a special “emergency access lane.”
Ebola is too smart for that old trick.
The virus hijacks the delivery process — preventing the immune system from organizing a coordinated attack — by attaching a bulky protein to the messenger. In its misshapen form, the messenger can’t enter the cell. The immune system remains unaware of the problem, and the virus gets free range to attack and destroy the rest of the body.
This is when Ebola goes on a replication rampage. Once the virus starts growing, few things can stop it.
The virus starts infecting organs, killing the cells inside and causing them to burst. All of their viral content pours into the blood. By this time, the immune system begins responding to the crisis in turbo mode, but it’s far too late. Rather than destroying the virus, our defenses simply rip our own bodies to The World Health Organization has said the virus seems to kill about 70% of people infected, though it’s hard to know the true numbers while the outbreak is still in progress.

How It Spreads
Ebola how it spreads
ebola patient escaped liberia
Ebola doesn’t need to be airborne to cause an epidemic. Anyone who touches a sick patient is at risk.
Although Ebola spreads less easily than a cold, because it isn’t airborne, the Ebola virus is far more persistent.
Like cold germs, Ebola virus particles survive on dry surfaces, like doorknobs and countertops, for several hours. But unlike a cold virus, which primarily infects the respiratory tract, Ebola can also live in bodily fluids like blood and saliva for several days at room temperature.
Doctors have found Ebola in the semen of men who have survived the virus up to three months after they recover.
It’s important to remember that someone with Ebola isn’t contagious until he or she starts showing symptoms. This happens when enough of a person’s cells have been overtaken by the virus, a process that scientists say appears to require a hefty load of viral particles in the body.
There’s also the prospect of Ebola mutating into something more deadly. Peter Jahrling, one of the head scientists at the National Institute of Allergy and Infectious Diseases, thinks the virus could already be changing into something more dangerous, Vox reports.
In recent tests with Ebola patients in Liberia, Jahrling has noticed that the infected seem to have more of the virus in their blood, which could presumably make them more contagious.
And even worse, it preys on our human need to touch and care for the sick, which is why much of its spread is to caregivers and healthcare workers.
“The mechanism Ebola exploits is far more insidious,” as Benjamin Hale wrote in Slate. “This virus preys on care and love, piggybacking on the deepest, most distinctively human virtues.”
That’s why the virus strikes children, their parents, families, and communities. All it takes is one small slipup, one uncalculated act of humanity, and the disease spreads even further.

How It Is Treated
Ebola treatment
Bellevue Hospital Workers Ebola Prep
Ebola treatment is dangerous — and expensive.
It’s tough to believe that anyone could survive Ebola, given its quick and violent progression. But two Americans did, and thousands of people in Guinea, Liberia, and Sierra Leone have as well.
The virus’ quick progression makes comprehensive treatment in a well-equipped facility key for raising one’s chances of survival. If doctors can keep a person strong enough for long enough, that person’s immune system can eventually clear the virus on its own.
In Atlanta, two Americans were nursed back to health with a combination of experimental drugs and traditional treatment. By keeping their patients’ organs working with intravenous fluids (to replenish the body with the fluids it is quickly losing), ventilators (to keep the lungs pumping oxygen throughout the body), and drugs to keep blood pressure from dipping dangerously low, they gave them the best chance of survival.
That sort of treatment is pricey, though.
The bill for the average Ebola patient treated in the US is a lofty $1,000 per hour. In West Africa, where that sort of money isn’t available, most patients simply go home to die.
To date, no federally approved vaccine or medicine for Ebola exists.
by:ERIN BRODWIN

Ebola and Sneezing

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Can You Get Ebola from a Sneeze?

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Do you have of fear of getting Ebola? I’m not talking about panic just the thought that it could happen. There is a lot known about the disease but there is also unknowns. I am thinking about it because my husband flies frequently to Washington DC and Dallas. I know on those flights he is with people from all over the world. He was in the airport on the day the man who eventually died was there.
I know if he contracts the disease, I will also. I’m not so much afraid for myself as I am for my children and their families. I live close to my daughter and I am of the age that if I get sick she comes to me to help. What do I do from now on just tell her to stay away. I know if it’s not flu like symptoms then there won’t be an issue. I just have to leave this in God’s hands.
I think it is important for everyone to stay aware of what is happening. Knowledge about the disease will keep down panic, no matter what is happening in the world.

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While experts argue over whether Ebola will mutate and become airborne, questions linger about what exactly airborne means in the first place.

For example, could you get Ebola from a sneeze? And, if so, would that mean it was airborne?

“With airborne illnesses, like influenza or tuberculosis, you can easily get sick by inhaling tiny pathogenic particles floating around in the air,” according to NPR, based on interviews with two virologists, Alan Schmaljohn at the University of Maryland School of Medicine, and Jean-Paul Gonzalez at Metabiota.

That’s not the case with Ebola, which requires large droplets to transfer.

Could Ebola Become Airborne?

“That means an Ebola-infected person would likely have to cough or sneeze up blood or other bodily fluids directly in your face for you to catch the virus,” Schmaljohn told NPR. “If that drop of blood doesn’t land on your face, it will just fall to the ground. It won’t be swimming in the air, waiting to be breathed in by an unsuspecting passerby.”

So while it’s theoretically possible for someone with Ebola to sneeze and emit a large drop of saliva into someone’s eye, it’s so unlikely that health officials don’t waste much time parsing out those hypothetical scenarios, Schmaljohn said.

“WHO is not aware of any studies that actually document this mode of transmission. On the contrary, good quality studies from previous Ebola outbreaks show that all cases were infected by direct close contact with symptomatic patients,” the World Health Organization says.

Quick Ebola Test, Not Quarantine, Could Be Best Defense

Doctors tend to have a different definition of “airborne” than the general public, Reuters points out. To doctors, it means that the germs are so tiny that they can float in the air for long periods, even when dry. They can infect people from a distance because they make their way deep into lungs when inhaled. Chickenpox, measles and tuberculosis are examples of airborne diseases.

A more appropriate term for Ebola, then, may be “droplet-borne.”

With Ebola, “when someone coughs, sneezes or … vomits, he releases a spray of secretions into the air,” according to Reuters. “This makes the infection droplet-borne. Droplet-borne germs can travel in these secretions to infect someone a few feet away, often through the eyes, nose or mouth. This may not seem like an important difference, but it has a big impact on how easily a germ spreads.”

And the good news? Droplet-borne diseases are much harder to spread than airborne illnesses.

BY SHEILA M. ELDRED

Ebola: Are You Afraid?

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XXXXX WARNING, PICTURES MAY BE DISTURNING XXXXX

ebolaThis article came out from ABC News and it got me to thinking about if I am afraid of catching the disease but I am afraid for my children and Grandchildren. I don’t think I’m afraid but I do have a chance of being exposed through my husband who flies out of Washington DC frequently. Thousands of people fly out of the airport he uses daily. He returned from a trip a week ago. What if that first case was on his plane flying into Dallas? It gives one a lot to think about.

Are you afraid of being exposed? For me personally I have to leave it in God’s hands and stay vigilant. The article below gives you some info that you need to know.

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ebola2The deadly Ebola virus has arrived in the United States with the first diagnosis on American soil this week, bringing national attention back to the outbreak that has ravaged West Africa.

Health officials confirmed that a patient in Dallas was diagnosed with Ebola about a week after arriving from Liberia to visit family on Sept. 20. The patient was placed in isolation Sept. 28, but may have exposed five school age children in the days between arriving in Texas and being isolated.

“There is no doubt in my mind we will stop it here,” Centers for Disease Control and Prevention Director Dr. Thomas Frieden said at a news conference.

ebola3Ebola has killed 3,338 people and infected 3,840 others since the outbreak began in March, making it the worst outbreak since the virus was discovered in 1976. More people have died from Ebola in the last seven months than in every other Ebola outbreak to date combined, according to data from the World Health Organization.

Although those who have received care on American soil have generally fared well, WHO officials have said that the world needs to do more to stop the outbreak in Africa and keep it from expanding.

ebola5The CDC warned that the outbreak could reach 1.4 million cases by the end of January without proper intervention. But with additional resources and intervention, the outbreak could be over by about the same time, the agency said.

Here’s what you need to know about the Ebola virus

What Is Ebola?

The Ebola virus is as a group of viruses that cause a deadly kind of hemorrhagic fever. The term “hemorrhagic fever” means it causes bleeding inside and outside the body. The virus has a long incubation period of approximately eight to 21 days. Early symptoms include fever, muscle weakness, sore throat and headaches.

As the disease progresses, the virus can impair kidney and liver function and lead to external and internal bleeding. It’s one of the most deadly viruses on Earth with a fatality rate that can reach between approximately 50 to 90 percent. There is no cure.
How Is It Transmitted?

The virus is transmitted through contact with blood or secretions from an infected person, either directly or through contaminated surfaces, needles or medical equipment. A patient is not contagious until he or she starts showing signs of the disease.

Thankfully, the virus is not airborne, which means a person cannot get the disease simply by breathing the same air as an infected patient.

Where Did the Virus Come From?

The dangerous virus gets its name from the Ebola River in the Democratic Republic of Congo, which was near the site of one of the first outbreaks. The virus was first reported in 1976 in two almost simultaneous outbreaks in the Sudan and the Democratic Republic of Congo. They killed 151 and 280 people, respectively.

Certain bats living in tropical African forests are thought to be the natural hosts of the disease. The initial transmission of an outbreak usually results from a wild animal infecting a human, according to the WHO. Once the disease infects a person, it is easily transmissible between people in close contact.

Until this outbreak, approximately 2,361 people had been infected since the disease was identified in 1976. More than 1,548 of those infected died from it.

How Is It Transmitted?

The virus is transmitted through contact with blood or secretions from an infected person, either directly or through contaminated surfaces, needles or medical equipment. A patient is not contagious until he or she starts showing signs of the disease.

Thankfully, the virus is not airborne, which means a person cannot get the disease simply by breathing the same air as an infected patient.

Who Is At Risk?

The virus is not airborne, which means those in close contact can be infected and are most at risk. A person sitting next to an infected person, even if they are contagious, is not extremely likely to be infected.

Health workers and caregivers of the sick are particularly at risk for the disease because they work in close contact with infected patients during the final stages of the disease when the virus can cause internal and external bleeding.

In this outbreak alone, more than 100 health workers have been infected and at least 50 of them have died, according to the WHO.

Heathcare Entitlement: Yes or No

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obamacare3

Is Every American Entitled to Healthcare?

That is a question that has caused a great deal of striff in this country from the poorest to the richest person. There is right and wrong to both side so this argument and no matter who wins it they will be a price to pay. As a practicing RN for 32 years I saw the good and the bad in the healthcare system. My personal thoughts are that our system is broken and has been for many years. I also believe that everyone should have basic healthcare especially the old and young. No matter what my feelings I want to present both sides in this blog so you can make up your own mind.

47.9 million people in the United States (15.4% of the US population) did not have health insurance in 2012 according to the US Census Bureau. The United States and Mexico are the only countries of the 34 members of the Organization for Economic Co-operation and Development (OECD) that do not have universal health care.

Proponents of the right to health care say that no one in the richest nation on earth should go without health care. They argue that a right to health care would stop medical bankruptcies, improve public health, reduce overall health care spending, help small businesses, and that health care should be an essential government service.

Opponents argue that a right to health care amounts to socialism and that it should be an individual’s responsibility, not the government’s role, to secure health care. They say that government provision of health care would decrease the quality and availability of health care, and would lead to larger government debt and deficits.

Did You Know?

27 million previously uninsured people will gain coverage under Obamacare according to a 2013 White House estimate.

obabmacare4The United States and Mexico are the only countries of the 34 members of the Organization for Economic Co-operation and Development (OECD) that do not have universal health care.

The United States spent $8,508 per person on health care in 2011, over 2.5 times the average spent by member countries of the OECD ($3,322 per person).

The US five-year survival rate for all cancers is 64.6%, over 10% higher than the five-year cancer survival rate in Europe (51.6%),[26] and a 2009 study found that the United States had better cancer screening rates than 10 European countries including France, Germany, Sweden, and Switzerland.

In 2014, the Commonwealth Fund ranked the United States last in overall health care behind (in order) United Kingdom, Switzerland, Sweden, Australia, Germany, Netherlands, New Zealand, Norway, France, and Canada.
Argument For and Against Obama Care

Pro Arguments

Obamacare2The founding documents of the United States provide support for a right to health care. The Declaration of Independence states that all men have “unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness,” which necessarily entails having the health care needed to preserve life and pursue happiness. The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare” of the people. According to former Congressman Dennis Kucinich (D-OH), as part of efforts to “promote the general welfare,” health care “is a legitimate function of government.”

Instituting a right to health care could lower the cost of health care in the United States. According to a 2013 study, under a single-payer system, in which all citizens are guaranteed a right to health care, total public and private health care spending could be lowered by $592 billion in 2014 and up to $1.8 trillion over the next decade due to lowered administrative and prescription drug costs. According to the American Medical Association, on average, private health insurance plans spend 11.7% of premiums on administrative costs vs. 6.3% spent by public health programs. According to a study in the American Journal of Public Health, Canada, a country that provides a universal right to health care, spends half as much per capita on health care as the United States. In 2010 the United Kingdom, another country with a right to health care, managed to provide health care to all citizens while spending just 41.5% of what the United States did per capita.

A right to health care could save lives. According to a 2009 study from Harvard researchers, “lack of health insurance is associated with as many as 44,789 deaths per year,” which translates into a 40% increased risk of death among the uninsured. Another study found that more than 13,000 deaths occur each year just in the 55-64 year old age group due to lack of health insurance coverage. In addition, a 2011 Commonwealth Fund study found that due to a lack of timely and effective health care, the United States ranked at the bottom of a list of 16 rich nations in terms of preventable mortality. In Italy, Spain, France, Australia, Israel, and Norway, all countries with a right to health care, people live two to three years longer than people in the United States.

The right to health care is an internationally recognized human right. On Dec. 10, 1948 the United States and 47 other nations signed the United Nations Universal Declaration of Human Rights. The document stated that “everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including… medical care.” In 2005 the United States and the other member states of the World Health Organization signed World Health Assembly resolution 58.33, which stated that everyone should have access to health care services and should not suffer financial hardship when obtaining these services. According to a 2008 peer-reviewed study in the Lancet, “[r]ight-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.” The United States and Mexico are the only countries of the 34 members of the Organization for Economic Co-operation and Development (OECD) that do not have universal health care. As of 2013 over half of the world’s countries had a right to health care in their national constitutions.

A right to health care could make medical services affordable for everyone. According to a 2012 study from Consumer Reports, paying for health care is the top financial problem for US households. According to a peer-reviewed study in Health Affairs, between 2003 and 2013, the cost of family health insurance premiums has increased 80% in the United States. According to the Kaiser Family Foundation, 26% of Americans report that they or a family member had trouble paying for medical bills in 2012, and 58% reported that they delayed or did not seek medical care due to cost. According to one estimate of a proposed bill to implement a single-payer health care system in the United States (HR 676), 95% of US households would save money [51] and every individual in the United States would receive guaranteed access to publically financed medical care.

Providing all citizens the right to health care is good for economic productivity. When people have access to health care, they live healthier lives and miss work less, allowing them to contribute more to the economy. A Mar. 2012 study by researchers at the Universities of Colorado and Pennsylvania showed that workers with health insurance miss an average of 4.7 fewer work days than employees without health insurance. [55] According to an Institute of Medicine report, the US economy loses $65-$130 billion annually as a result of diminished worker productivity, due to poor health and premature deaths, among the uninsured. In a Jan. 14, 2014 speech, World Bank President Jim Yong Kim stated that all nations should provide a right to health care “to help foster economic growth.”

A right to health care could improve public health. According to a 2012 study in the Lancet that looked at data from over 100 countries, “evidence suggests that broader health coverage generally leads to better access to necessary care and improved population health, particularly for poor people.” In the United States, people are 33% less likely to have a regular doctor, 25% more likely to have unmet health needs, and over 50% more likely to not obtain needed medicines compared to their Canadian counterparts who have a universal right to healthcare. According to a 2008 peer-reviewed study in the Annals of Internal Medicine, there were 11.4 million uninsured working-age Americans with chronic conditions such as heart disease and diabetes, and their lack of insurance was associated with less access to care, early disability, and even death.

Because the United States is a very wealthy country, it should provide health care for all its citizens. Many European countries with a universal right to health care, such as Germany, France, the United Kingdom, and Italy, have a lower Gross Domestic Product (GDP) per capita than the United States, yet they provide a right to health care for all their citizens. As of 2012, 47.9 million people (15.4% of the US population) did not have health insurance and, according to a June 2013 study, even with the Obamacare reforms as many as 31 million people will still be uninsured in 2016. The United States spent $8,508 per person on health care in 2011, over 2.5 times the average spent by member countries of the OECD ($3,322 per person). With that level of spending, the United States should be able to provide a right to healthcare to everyone.

Providing a right to health care could benefit private businesses. If the United States implemented a universal right to health care, businesses would no longer have to pay for employee health insurance policies. As of 2011, 59.5% of Americans were receiving health insurance through their employer. According to the Council on Foreign Relations, some economists believe the high costs of employee health insurance place US companies at a “competitive disadvantage in the international marketplace.” According to the Business Coalition for Single-Payer Healthcare, a right to healthcare under a single-payer-system could reduce employer labor costs by 10-12%.

A right to health care could encourage entrepreneurship. Many people are afraid to start their own businesses for fear of losing the health insurance provided at their existing jobs. The Kauffman-RAND Institute for Entrepreneurship Public Policy estimated that a 33% increase in new US businesses may result from the increased access to health insurance through the Obamacare health insurance exchanges. A 2001 study found that providing universal health care in the United States could increase self-employment by 2 to 3.5 percent.

A right to health care could stop medical bankruptcies. About 62% of all US bankruptcies were related to medical expenses in 2007, and 78% of these bankruptcies were filed by people who already had medical insurance. In 2010, there were 30 million Americans who were contacted by a collection agency about a medical bill. If all US citizens were provided health care under a single-payer system medical bankruptcy would no longer exist, because the government, not private citizens, would pay all medical bills.

A right to health care is a necessary foundation of a just society. The United States already provides free public education, public law enforcement, public road maintenance, and other public services to its citizens to promote a just society that is fair to everyone. Health care should be added to this list. Late US Senator Ted Kennedy (D-MA) wrote that providing a right to health care “goes to the heart of my belief in a just society.” According to Norman Daniels, PhD, Professor of Ethics and Population Health at Harvard University, “healthcare preserves for people the ability to participate in the political, social, and economic life of society. It sustains them as fully participating citizens.”

Con Arguments

The founding documents of the United States do not provide support for a right to health care. Nowhere in the Declaration of Independence does it say there is a right to health care. The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare,” not to provide it. The Bill of Rights lists a number of personal freedoms that the government cannot infringe upon, not material goods or services that the government must provide. According to former Congressman Ron Paul (R-TX), “you have a right to your life and you have a right to your liberty and you have a right to keep what you earn in a free country… You do not have the right to services or things.”

A right to health care could increase the US debt and deficit. Spending on Medicare, Medicaid, and the Children’s Health Insurance Program, all government programs that provide a right to health care for certain segments of the population, totaled less than 10% of the federal budget in 1985, but by 2012 these programs took up 21% of the federal budget. According to US House Budget Committee Chairman Paul Ryan (R-WI), government health care programs are “driving the explosive growth in our spending and our debt.” Studies have concluded that the expansion of insurance coverage under Obamacare will increase the federal deficit by $340-$700 billion in the first 10 years, [and could increase the deficit to $1.5 trillion in the second 10 years. Even with these expenditures, the Congressional Budget Office (CBO) estimates Obamacare will leave 30 million people without health insurance. If everyone in the US were covered under a universal right to health care, the increase in the federal deficit could be even larger than under Obamacare.

A right to health care could increase the wait time for medical services. Medicaid is an example of a federally funded single-payer health care system that provides a right to health care for low-income people. According to a 2012 Government Accountability Office (GAO) report, 9.4% of Medicaid beneficiaries had trouble obtaining necessary care due to long wait times, versus 4.2% of people with private health insurance. Countries with a universal right to health care have longer wait times than in the United States. In 2013 the average wait time to see a specialist in Canada was 8.6 weeks, versus 18.5 days in the United States in 2014. In the United States, fewer than 10% of patients wait more than two months to see a specialist versus 41% in Canada, 34% in Norway, 31% in Sweden, and 28% in France – all countries that have some form of a universal right to health care.

Implementing a right to health care could lead the United States towards socialism. Socialism, by definition, entails government control of the distribution of goods and services. Under a single-payer system where everyone has a right to health care, and all health care bills are paid by the government, the government can control the distribution of health care services. According to Ronald Reagan, “one of the traditional methods of imposing statism or socialism on a people has been by way of medicine,” and once socialized medicine is instituted, “behind it will come other federal programs that will invade every area of freedom.” In Aug. 2013, when Senate Majority Leader Harry Reid (D-NV) was asked if Obamacare is a step towards a single-payer universal health care system, he answered “absolutely, yes.” The free market should determine the availability and cost of health care services, not the federal government.

Providing a right to health care could raise taxes. In European countries with a universal right to health care, the cost of coverage is paid through higher taxes. In the United Kingdom and other European countries, payroll taxes average 37% – much higher than the 15.3% payroll taxes paid by the average US worker. According to Paul R. Gregory, PhD, a Research Fellow at the Hoover Institution, financing a universal right to health care in the United States would cause payroll taxes to double.

Providing a right to health care could create a doctor shortage. The Association of American Medical Colleges predicts a shortfall of 63,000 doctors by 2015 due to the influx of new patients under Obamacare. If a right to health care were guaranteed to all, this shortage could be much worse. In the United Kingdom, which has a right to health care, a 2002 study by the British National Health Service found that it was “critically short of doctors and nurses.” As of 2013 the United Kingdom had 2.71 practicing doctors for every 1,000 people – the second lowest level of the 27 European nations.

A right to health care could lead to government rationing of medical services. Countries with universal health care, including Australia, Canada, New Zealand, and the United Kingdom, all ration health care using methods such as controlled distribution, budgeting, price setting, and service restrictions. In the United Kingdom, the National Health Service (NHS) rations health care using a cost-benefit analysis. For example, in 2008 any drug that provided an extra six months of “good-quality” life for £10,000 ($15,150) or less was automatically approved, while one that costs more might not be. In order to expand health coverage to more Americans, Obamacare created an Independent Payment Advisory Board (IPAB) to make cost-benefit analyses to keep Medicare spending from growing too fast. According to Sally Pipes, President of the Pacific Research Institute, the IPAB “is essentially charged with rationing care.” According to a 2009 Wall Street Journal editorial, “once health care is nationalized, or mostly nationalized, medical rationing is inevitable.”

A right to health care could lower the quality and availability of disease screening and treatment. In countries with a universal right to health care certain disease treatment outcomes are worse than the United States. The US 5-year survival rate for all cancers is 64.6%, compared to 51.6% in Europe. The United States also has a higher 5-year survival rate than Canada. Studies have found that US cancer screening rates are higher than those in Canada and 10 European countries with universal health care including France, Germany, Sweden and Switzerland. The United States is estimated to have the highest prostate and breast cancer survival rates in the world. The United States also has high survival rates after a stroke, with an age-adjusted 30-day fatality rate of 3 per 100, lower than the OECD average of 5.2 per 100. In addition, the 30-day survival rate after a heart attack is higher in the United States than the OECD average.

A right to health care could lower doctors’ earnings. The Medicare system in the United States is a single-payer system where government pays for health care bills, and between 1998 and 2009 it reduced physician payments in three different years. In 2009, Medicare payments to health care providers were almost 20% below those paid out by private insurance. In Britain and Canada, where there is a universal right to health care, physicians have incomes 30% lower than US doctors. According to a 2011 study, in comparison to US specialists, the average specialist in Canada earned 30% less, and the average specialist in the United Kingdom earned 50% less. Any lowering of doctor payments in the United States could reduce the number of young people entering the medical profession, leading to a doctor shortage.

A right to health care could cause people to overuse health care resources. When people are provided with universal health care and are not directly responsible for the costs of medical services, they may utilize more health resources than necessary, a phenomenon known as “moral hazard.” According to the Brookings Institution, just before Medicaid went into effect in 1964, people living below the poverty line saw physicians 20% less often than those who were not in poverty. But by 1975, people living in poverty who were placed on Medicaid saw physicians 18% more often than people who were not on Medicaid. A Jan. 2014 study published in Science found that of 10,000 uninsured Portland, Oregon residents who gained access to Medicaid, 40% made more visits to emergency rooms, even though they, like all US residents, already had guaranteed access to emergency treatment under federal law. Since Medicaid provides a right to health care for low-income individuals, expanding this right to the full US population could worsen the problem of overusing health care resources.

The majority of Americans do not believe there should be a right to health care. According to a 2013 Gallup poll, 56% of Americans do not believe that it is the “responsibility of the federal government to make sure all Americans have health care coverage.” In 2012, Gallup found that 54% of Americans opposed the idea of federally-financed universal health coverage.

People should pay for their own health care, not have it given to them by the government. Under a single-payer system, the right to health care is paid for through taxes, and people who work hard and pay those taxes are forced to subsidize health care for those who are not employed. In the United States, people already have a right to purchase health care, but they should never have a right to receive health care free of charge. Health care is a service that should be paid for, not a right.

Football Can Be Harmfull

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This is a repost from DNews on Football and one of my blogs on just how unhealthy football is. The season has started again and I cringe. I’m married to a college football fanatic plus anything else that has to do with a ball of any kind.

I hate football just because of the damage that it does to it’s players and now it seems to the audience also. Why do we humans participate in things that cause others pain for our enjoyment? Remember Rome and the Gladiators. Even after 100’s or thousands of years nothing hasn’t changed. I can visualize the cave man playing dodge ball with rocks and people cheering as the rock bounced off his head. I don’t see the attraction at all.

I’m sure there will be people who can’t understand my side either. They think I just don’t know how great the game is. My son and my husband can talk on the phone for an hour about who’s playing and where they playing,along with spouting numbers who has done this or that. I don’t get the attraction.

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Football has an intellectual attraction that keeps fans interested, according to Almond.

The game requires understanding a vast, complex series of rules (that are amended each year), and players can move in many different and unexpected directions (unlike baseball, for example). There are big swings in momentum, and it’s satisfying to watch.

“What’s happening in football for a fan is that you are combining this primal aggressive buzz (with) this unbelievably strategically dense game. Baseball players are static. Football is carefully controlled chaos.”

Despite the pull football exerted on Almond, a lifelong Oakland Raiders fan, he decided that he couldn’t watch it anymore because of its seamier side: its violence, misogyny and the corrupting influence of big money.

“It’s complicated,” Almond said. “But for me, the darkness was enough to realize that I didn’t want to be a sponsor anymore.”

The skull and crossbones, a common symbol for ...

Image via Wikipedia

According to an article I read today in “The Week“, a losing football team can kill you.  The University of California did a study of the death rate following the Rams Superbowl trips in 1980 and 1984.  The record review revealed some very scary numbers.  After the team lost their bid for the Superbowl, heart attacks deaths went up fifteen percent in men, twenty-seven percent in women, and twenty-two percent in senior citizens.  Four years later when the Rams won the Superbowl the numbers didn’t change at all.

This study shows how much emotion is put into your favorite football team.  The lead researcher felt people reacted due to making the team “a family member.”  A die-hard becomes very emotional, causing stress.  This stress increases the pulse rate, raises blood pressure and can trigger a cardiac event.  Is ranting and raving because your team lost the game worth the possibility of having a heart attack and possibly dying?

Take a look at this video and you can see what it is feels like to experience a heart attack.  This video was made in England and says to call 999, but here we call 911.  Please pay attention, it could save your life.  That’s my two-cents for today.

http://youtu.be/LUt1xXASm_s

What They Don’t Tell You

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What They Don’t Tell you

I am obese, fat, fluffy, heavy, big boned or whatever term you want to call me, a person that weighs to much. I have been heavy all of my life that I can remember. I can also say that I love to eat good tasting food. Being 65 years old (all most) I am now developing or have developed some of the problems that go along with my weight.

I have tried every diet and quick fix under the sun. At one time when I lived in Hawaii I lost 110 pounds. I was walking, dancing, scuba diving and having the time of my life. I came back to the mainland and all that stopped. I was in contrast turmoil over my son being in Iraq during Desert Storm. I am a stress eater and I gained every pound back and more.

Over the years I have considered gastric bypass surgery but could never make myself do it. I think I am afraid of what could happen. I know what being heavy is and I know what it feels like to be healthy and a good weight. The article I am posting today is about a woman who has had bypass surgery and how it has affected her life. It certainly gave me something to think about. Have a blessed day. Shirley

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By Shannon Britton What They Don’t Tell you

At 27 years old, I weighed 486 pounds and decided to have gastric bypass surgery. I know what you might be thinking: “Oh, you took the easy way out.”

Let me tell you, having weight loss surgery is far from easy. It involves a total commitment to a lifestyle change.

Before my surgery nearly three years ago, I met with my surgeon, nutritionists, exercise coaches and a psychologist. I went to classes and learned about meals, exercise and how my body would change. We learned about plastic surgery — how many weight loss patients have their skin tucked because they have all this excess skin hanging from your body in weird places.

Man lost more than 200 pounds in 3 years 12-year-old gets gastric bypass surgery Wife loses 100 lbs., stuns Army hubby

I was prepared, or so I thought.
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On November 23, 2011, the day before Thanksgiving, I went under the knife. Since then, I’ve lost 268 pounds.

But the thing they do not prepare you for is how you change emotionally after losing a large amount of weight. At first, I thought I would just have this newfound confidence. I’d be thinner and want to run around naked. OK, maybe not naked, but I had this fantasy in my head that one day I would wake up with a body that I loved and would feel comfortable putting into a bikini — that I’d have no body shame whatsoever.

People would accept me more because I wasn’t seen as obese and unhealthy. Dating would get easier. Clothes would fit better. I wouldn’t be judgmental toward other extremely obese people because I was once huge.

Boy, was I wrong.

First off, even though I feel amazing and I am starting to like the way I look, there are days in which I hate my body. I hate how certain clothes push against my excess skin, making it bulge out (think muffin top, but worse). I hate the way the skin hangs down on my arms, and thighs, back and stomach. I hate that it will take at least $15,000 (if not more) in plastic surgery to rid these last 30 to 40 pounds off of my body.

I also have stretch marks and surgery scars across my abdomen and stomach, so being intimate with my boyfriend can be intimidating at times. I knew what I was getting into when I signed up for this, but that knowledge doesn’t erase the self-consciousness I feel when I get out of the shower, or when a stranger or child snickers because they don’t understand why my body looks the way it does.

My relationships also changed. When I first had my surgery, the guy I was with had been a best friend of seven years. He found me attractive at 486 pounds, though I’m not sure why. But once I lost my first 68 pounds, he left.

My surgeon explained that this is common among his bariatric patients. For some reason, it can shake the other partner psychologically when one loses weight, gains confidence and starts getting more attention. But the experience taught me that someone who is jealous of something that makes me better, healthier and stronger never had my best interests at heart.

Dating after that was a struggle, until I met my current boyfriend six months ago. Most guys got scared because they were afraid to take me to dinner, afraid they would break my new diet resolve, and when they saw a picture of what I used to look like, they started to wonder what would happen if I gained a few pounds again.

What else has surprised me about losing weight? No one ever told me that it would upset me when severely obese people get special attention because they choose to be heavy — like when TV shows feature people who are happy to weigh 600 pounds, or people who post YouTube videos professing love of their excess weight.

What They Don’t Tell you

Don’t get me wrong, I think it is great that people are comfortable in their own skin, because many times I’m not always comfortable in my own skin. But for me, being heavy wasn’t a choice. So I guess I have a hard time identifying with them.

Obesity is debilitating to your health. I used gastric bypass surgery as a tool to save my life so that I wouldn’t develop diabetes, have a heart attack at age 35, have a stroke, and to hopefully lower my risk of cancer. Now I have no tolerance for excuses about not being able to eat healthy and exercise.

See, here’s the bottom line: The biggest thing that no one ever tells you about losing weight is that eventually, the number on the scale no longer matters.

What matters is how you feel, how you look and how happy you are. I know at my current weight I am still medically obese, but I have a clean bill of health. Through my bad days and my good days, I am happier now than I have ever been. When I struggle or feel myself about to slip into old habits, I pull out a picture of what I used to look like.

And I remind myself that nothing tastes as good as being healthy feels.

Yellow Fever

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people-infected-with-yellow-fever Hello because of the research I did on Yellow fever epidemics for my book “Dobyns Chronicles.” Buy Here: http://www.amazon.com/dp/BOOKNMM468 I thought I would share it with you.

Yellow fever epidemics struck the United States repeatedly in the 18th and 19th centuries. The disease was not indigenous; epidemics were imported by ship from the Caribbean. Prior to 1822, yellow fever attacked cities as far north as Boston, but after 1822 it was restricted to the south. Port cities were the primary targets, but the disease occasionally spread up the Mississippi River system in the 1800s. New Orleans, Mobile, Savannah, and Charleston were major targets; Memphis suffered terribly in 1878. Yellow fever epidemics caused terror, economic disruption, and some 100,000-150,000 deaths. Recent white immigrants to southern port cities were the most vulnerable; local whites and blacks enjoyed considerable resistance. As you read it killed thousands so we have been blessed as a country to not have it now. It had to be scarey times back then. Did you have relatives who died from Yellow Fever.

This information is from Wikipedia

mosquitoYellow fever, known historically as yellow jack or yellow plague[1] is an acute viral disease.[2] In most cases symptoms include fever, chills, loss of appetite, nausea, muscle pains particularly in the back, and headaches.[2] Symptoms typically improve within five days.[2] In some people within a day of improving the fever comes back, there is abdominal pain, and liver damage begins causing yellow skin.[2] If this occurs there is also an increased risk of bleeding and kidney problems.[2]

The disease is caused by the yellow fever virus and is spread by the bite of the female mosquito.[2] It only infects humans, other primates and several species of mosquito.[2] In cities it is primarily spread by mosquitoes of the Aedes aegypti species.[2] The virus is an RNA virus of the genus Flavivirus.[3] The disease may be difficult to tell apart from other illnesses, especially in the early stages.[2] To confirm a suspected case blood sample testing with PCR is required.[4]

A safe and effective vaccine against yellow fever exists and some countries require vaccinations for travelers.[2] Other efforts to prevent infection include reducing the population of the transmitting mosquito.[2] In areas where yellow fever is common and vaccination is uncommon, early diagnosis of cases and immunization of large parts of the population is important to prevent outbreaks.[2] Once infected, management is symptomatic with no specific measures effective against the virus.[2] In those with severe disease death occurs in about half of people without treatment.[2]

Yellow fever causes 200,000 infections and 30,000 deaths every year,[2] with nearly 90% of these occurring in Africa.[4] Nearly a billion people live in an area of the world where the disease is common.[2] It is common in tropical areas of South America and Africa, but not in Asia.[5][2] Since the 1980s, the number of cases of yellow fever has been increasing.[6][2] This is believed to be due to fewer people being immune, more people living in cities, people moving frequently, and changing climate.[2] The disease originated in Africa, where it spread to South America through the slave trade in the 17th century.[1] Since the 17th century, several major outbreaks of the disease have occurred in the Americas, Africa, and Europe.[1] In the 18th and 19th century, yellow fever was seen as one of the most dangerous infectious diseases.[1] The yellow fever virus was the first human virus discovered.[3]

Signs and symptoms
Yellow fever begins after an incubation period of three to six days.[7] Most cases only cause a mild, infection with fever, headache, chills, back pain, loss of appetite, nausea, and vomiting.[8] In these cases the infection lasts only three to four days.

In fifteen percent of cases, however, sufferers enter a second, toxic phase of the disease with recurring fever, this time accompanied by jaundice due to liver damage, as well as abdominal pain. Bleeding in the mouth, the eyes, and the gastrointestinal tract will cause vomit containing blood, hence the Spanish name for yellow fever, vomito negro (“black vomit”).[9] The toxic phase is fatal in approximately 20% of cases, making the overall fatality rate for the disease 3% (15% * 20%).[10] In severe epidemics, the mortality may exceed 50%.[11]

Surviving the infection provides lifelong immunity,[12] and normally there is no permanent organ damage.

Cause
Yellow fever virus
Virus classification
Group: Group IV ((+)ssRNA)
Order: Unassigned
Family: Flaviviridae
Genus: Flavivirus
Species: Yellow fever virus
Yellow fever is caused by the yellow fever virus, a 40 to 50 nm wide enveloped RNA virus, the type species and namesake of the family Flaviviridae.[3] It was the first illness shown to be transmissible via filtered human serum and transmitted by mosquitoes, by Walter Reed around 1900.[14] The positive sense single-stranded RNA is approximately 11,000 nucleotides long and has a single open reading frame encoding a polyprotein. Host proteases cut this polyprotein into three structural (C, prM, E) and seven non-structural proteins (NS1, NS2A, NS2B, NS3, NS4A, NS4B, NS5); the enumeration corresponds to the arrangement of the protein coding genes in the genome.[15] Yellow fever belongs to the group of hemorrhagic fevers.

The viruses infect, amongst others, monocytes, macrophages and dendritic cells. They attach to the cell surface via specific receptors and are taken up by an endosomal vesicle. Inside the endosome, the decreased pH induces the fusion of the endosomal membrane with the virus envelope. The capsid enters the cytosol, decays, and releases the genome. Receptor binding as well as membrane fusion are catalyzed by the protein E, which changes its conformation at low pH, causing a rearrangement of the 90 homodimers to 60 homotrimers.[15]

After entering the host cell, the viral genome is replicated in the rough endoplasmic reticulum (ER) and in the so-called vesicle packets. At first, an immature form of the virus particle is produced inside the ER, whose M-protein is not yet cleaved to its mature form and is therefore denoted as prM (precursor M) and forms a complex with protein E. The immature particles are processed in the Golgi apparatus by the host protein furin, which cleaves prM to M. This releases E from the complex which can now take its place in the mature, infectious virion.[15]

Transmission

Aedes aegypti feeding

Adults of the yellow fever mosquito Aedes aegypti. The male is on the left, females are on the right. Only the female mosquito bites can transmit the disease.
Yellow fever virus is mainly transmitted through the bite of the yellow fever mosquito Aedes aegypti, but other mosquitoes such as the tiger mosquito (Aedes albopictus) can also serve as a vector for this virus. Like other Arboviruses which are transmitted via mosquitoes, the yellow fever virus is taken up by a female mosquito when it ingests the blood of an infected human or other primate. Viruses reach the stomach of the mosquito, and if the virus concentration is high enough, the virions can infect epithelial cells and replicate there. From there they reach the haemocoel (the blood system of mosquitoes) and from there the salivary glands. When the mosquito next sucks blood, it injects its saliva into the wound, and the virus reaches the bloodstream of the bitten person. There are also indications for transovarial and transstadial transmission of the yellow fever virus within A. aegypti, that is, the transmission from a female mosquito to her eggs and then larvae. This infection of vectors without a previous blood meal seems to play a role in single, sudden breakouts of the disease.[16]

There are three epidemiologically different infectious cycles,[6] in which the virus is transmitted from mosquitoes to humans or other primates. In the “urban cycle,” only the yellow fever mosquito Aedes aegypti is involved. It is well adapted to urban centres and can also transmit other diseases, including dengue fever and chikungunya. The urban cycle is responsible for the major outbreaks of yellow fever that occur in Africa. Except in an outbreak in 1999 in Bolivia, this urban cycle no longer exists in South America.

Besides the urban cycle there is, both in Africa and South America, a sylvatic cycle (forest cycle or jungle cycle), where Aedes africanus (in Africa) or mosquitoes of the genus Haemagogus and Sabethes (in South America) serve as vectors. In the jungle, the mosquitoes infect mainly non-human primates; the disease is mostly asymptomatic in African primates. In South America, the sylvatic cycle is currently the only way humans can infect each other, which explains the low incidence of yellow fever cases on the continent. People who become infected in the jungle can carry the virus to urban centres, where Aedes aegypti acts as a vector. It is because of this sylvatic cycle that yellow fever cannot be eradicated.[6]
epidemic 1820
In Africa there is a third infectious cycle, also known as “savannah cycle” or intermediate cycle, which occurs between the jungle and urban cycle. Different mosquitoes of the genus Aedes are involved. In recent years, this has been the most common form of transmission of yellow fever in Africa.[17]

Pathogenesis[edit]
After transmission of the virus from a mosquito, the viruses replicate in the lymph nodes and infect dendritic cells in particular. From there they reach the liver and infect hepatocytes (probably indirectly via Kupffer cells), which leads to eosinophilic degradation of these cells and to the release of cytokines. Necrotic masses known as Councilman bodies appear in the cytoplasm of hepatocytes.[18][19]

Fatality may occur when cytokine storm, shock, and multiple organ failure follow.[10]

Diagnosis[edit]
Yellow fever is a clinical diagnosis, which often relies on the whereabouts of the diseased person during the incubation time. Mild courses of the disease can only be confirmed virologically. Since mild courses of yellow fever can also contribute significantly to regional outbreaks, every suspected case of yellow fever (involving symptoms of fever, pain, nausea and vomiting six to ten days after leaving the affected area) is treated seriously.

If yellow fever is suspected, the virus cannot be confirmed until six to ten days after the illness. A direct confirmation can be obtained by reverse transcription polymerase chain reaction where the genome of the virus is amplified.[4] Another direct approach is the isolation of the virus and its growth in cell culture using blood plasma; this can take one to four weeks.

Serologically, an enzyme linked immunosorbent assay during the acute phase of the disease using specific IgM against yellow fever or an increase in specific IgG-titer (compared to an earlier sample) can confirm yellow fever. Together with clinical symptoms, the detection of IgM or a fourfold increase in IgG-titer is considered sufficient indication for yellow fever. Since these tests can cross-react with other flaviviruses, like Dengue virus, these indirect methods cannot conclusively prove yellow fever infection.

Liver biopsy can verify inflammation and necrosis of hepatocytes and detect viral antigens. Because of the bleeding tendency of yellow fever patients, a biopsy is only advisable post mortem to confirm the cause of death.

In a differential diagnosis, infections with yellow fever have to be distinguished from other feverish illnesses like malaria. Other viral hemorrhagic fevers, such as Ebola virus, Lassa virus, Marburg virus and Junin virus, have to be excluded as cause.

Prevention[edit]
Personal prevention of yellow fever includes vaccination as well as avoidance of mosquito bites in areas where yellow fever is endemic. Institutional measures for prevention of yellow fever include vaccination programs and measures of controlling mosquitoes. Programs for distribution of mosquito nets for use in homes are providing reductions in cases of both malaria and yellow fever.

Vaccination

The cover of a certificate that confirms that the holder has been vaccinated against yellow fever
Main article: Yellow fever vaccine
Vaccination is recommended for those traveling to affected areas, because non-native people tend to suffer more severe illness when infected. Protection begins by the tenth day after vaccine administration in 95% of people,[20] and lasts for at least 10 years. About 81% of people are still immune after 30 years. The attenuated live vaccine stem 17D was developed in 1937 by Max Theiler.[20] The WHO recommends routine vaccinations for people living in affected areas between the 9th and 12th month after birth.[4] Up to one in four people experience fever, aches, and local soreness and redness at the site of injection.[21]

In rare cases (less than one in 200,000 to 300,000[20]), the vaccination can cause yellow fever vaccine-associated viscerotropic disease (YEL-AVD), which is fatal in 60% of cases. It is probably due to the genetic morphology of the immune system. Another possible side effect is an infection of the nervous system, which occurs in one in 200,000 to 300,000 cases, causing yellow fever vaccine-associated neurotropic disease (YEL-AND), which can lead to meningoencephalitis and is fatal in less than 5%[20] of cases.[4][10]

In 2009, the largest mass vaccination against yellow fever began in West Africa, specifically Benin, Liberia, and Sierra Leone.[22][23] When it is completed in 2015, more than 12 million people will have been vaccinated against the disease.[22] According to the World Health Organization (WHO), the mass vaccination cannot eliminate yellow fever because of the vast number of infected mosquitoes in urban areas of the target countries, but it will significantly reduce the number of people infected.[22] The WHO plans to continue the vaccination campaign in another five African countries—Central African Republic, Ghana, Guinea, Côte d’Ivoire, and Nigeria—and stated that approximately 160 million people in the continent could be at risk unless the organization acquires additional funding to support widespread vaccinations.[24]

In 2013, the World Health Organization stated “a single dose of vaccination is sufficient to confer life-long immunity against yellow fever disease.”[25]

Compulsory vaccination[edit]
Some countries in Asia are theoretically in danger of yellow fever epidemics (mosquitoes with the capability to transmit yellow fever and susceptible monkeys are present), although the disease does not yet occur there. To prevent introduction of the virus, some countries demand previous vaccination of foreign visitors if they have passed through yellow fever areas. Vaccination has to be proven in a vaccination certificate which is valid 10 days after the vaccination and lasts for 10 years. A list of the countries that require yellow fever vaccination is published by the WHO.[26] If the vaccination cannot be conducted for some reasons, dispensation may be possible. In this case, an exemption certificate issued by a WHO approved vaccination center is required.

Although 32 of 44 countries where yellow fever occurs endemically do have vaccination programmes, in many of these countries, less than 50% of their population is vaccinated.[4]

Vector control

Information campaign for prevention of dengue and yellow fever in Paraguay
Control of the yellow fever mosquito Aedes aegypti is of major importance, especially because the same mosquito can also transmit dengue fever and chikungunya disease. A. aegypti breeds preferentially in water, for example in installations by inhabitants of areas with precarious drinking water supply, or in domestic waste; especially tires, cans and plastic bottles. These conditions are common in urban areas in developing countries.

Two main strategies are employed to reduce mosquito populations. One approach is to kill the developing larvae. Measures are taken to reduce the water accumulations in which the larva develops. Larvicides are used, as well as larva-eating fish and copepods, which reduce the number of larvae. For many years, copepods of the genus Mesocyclops have been used in Vietnam for preventing dengue fever. It eradicated the mosquito vector in several areas. Similar efforts may be effective against yellow fever. Pyriproxyfen is recommended as a chemical larvicide, mainly because it is safe for humans and effective even in small doses.[4]

The second strategy is to reduce populations of the adult yellow fever mosquito. Lethal ovitraps can reduce Aedes populations, but with a decreased amount of pesticide because it targets the mosquitoes directly. Curtains and lids of water tanks can be sprayed with insecticides, but application inside houses is not recommended by the WHO. Insecticide-treated mosquito nets are effective, just as they are against the Anopheles mosquito that carries malaria.[4]

Treatment[edit]
As for other flavivirus infections, there is no cure for yellow fever. Hospitalization is advisable and intensive care may be necessary because of rapid deterioration in some cases. Different methods for acute treatment of the disease have been shown to not be very successful; passive immunisation after emergence of symptoms is probably without effect. Ribavirin and other antiviral drugs as well as treatment with interferons do not have a positive effect in patients.[10] A symptomatic treatment includes rehydration and pain relief with drugs like paracetamol (known as acetaminophen in the United States). Acetylsalicylic acid (aspirin) should not be given because of its anticoagulant effect, which can be devastating in the case of internal bleeding that can occur with yellow fever.

Epidemiology

Endemic range of yellow fever in South America (2009)

Endemic range of yellow fever in Africa (2009)
Yellow fever is endemic in tropical and subtropical areas of South America and Africa. Even though the main vector (Aedes aegypti) also occurs in tropical and subtropical regions of Asia, the Pacific and Australia, yellow fever does not occur in these parts of the globe. Proposed explanations include the idea that the strains of the mosquito in the East are less able to transmit the yellow fever virus, that immunity is present in the populations because of other diseases caused by related viruses (for example, dengue), and that the disease was never introduced because the shipping trade was insufficient, but none are considered satisfactory. [27] [28] Another recent proposal is the absence of a slave trade to Asia on the scale of that to the Americas. [29] The trans-Atlantic slave trade was probably the means of introduction into the Western hemisphere from Africa. [30] Worldwide there are about 600 million people living in endemic areas. WHO officially estimates that there are 200,000 cases of disease and 30,000 deaths a year; the number of officially reported cases is far lower. An estimated 90% of the infections occur on the African continent.[4] In 2008, the largest number of recorded cases were in Togo.

Phylogenetic analysis identified seven genotypes of yellow fever viruses, and it is assumed that they are differently adapted to humans and to the vector Aedes aegypti. Five genotypes (Angola, Central/East Africa, East Africa, West Africa I, and West Africa II) occur only in Africa. West Africa genotype I is found in Nigeria and the surrounding areas.[31] This appears to be especially virulent or infectious as this type is often associated with major outbreaks. The three genotypes in East and Central Africa occur in areas where outbreaks are rare. Two recent outbreaks in Kenya (1992–1993) and Sudan (2003 and 2005) involved the East African genotype, which had remained unknown until these outbreaks occurred.

In South America, two genotypes have been identified (South American genotype I and II).[6] Based on phylogenetic analysis these two genotypes appear to have originated in West Africa[33] and were first introduced into Brazil.[34] The date of introduction into South America appears to be 1822 (95% confidence interval 1701 to 1911).[34] The historical record shows that there was an outbreak of yellow fever in Recife, Brazil, between 1685 and 1690. The disease seems to have disappeared, with the next outbreak occurring in 1849. It seems likely that it was introduced with the importation of slaves through the slave trade from Africa. Genotype I has been divided into five subclades, A through E.[35]

The evolutionary origins of yellow fever most likely lie in Africa, with transmission of the disease from primates to human beings.[36] It is thought that the virus originated in East or Central Africa and spread from there to West Africa. As it was endemic in Africa, the natives had developed some immunity to it. When an outbreak of yellow fever would occur in an African village where colonists resided, most Europeans died, while the native population usually suffered nonlethal symptoms resembling influenza.[37] This phenomenon, in which certain populations develop immunity to yellow fever due to prolonged exposure in their childhood, is known as acquired immunity.[38] The virus, as well as the vector A. aegypti, were probably transferred to North and South America with the importation of slaves from Africa, part of the Columbian Exchange following European exploration and colonization.

The first definitive outbreak of yellow fever in the New World was in 1647 on the island of Barbados.[39] An outbreak was recorded by Spanish colonists in 1648 in Yucatán, Mexico, where the indigenous Mayan people called the illness xekik (“blood vomit”). In 1685, Brazil suffered its first epidemic, in Recife. The first mention of the disease by the name “yellow fever” occurred in 1744.[40]

Although yellow fever is most prevalent in tropical-like climates, the Northern United States was not exempted from the fever. The first outbreak in English-speaking North America occurred in New York in 1668, and a serious one afflicted Philadelphia in 1793.[41] English colonists in Philadelphia and the French in the Mississippi River Valley recorded major outbreaks in 1669, as well as those occurring later in the eighteenth and nineteenth centuries. The southern city of New Orleans was plagued with major epidemics during the nineteenth century, most notably in 1833 and 1853. At least 25 major outbreaks took place in the Americas during the eighteenth and nineteenth centuries, including particularly serious ones in Cartagena in 1741, Cuba in 1762 and 1900, Santo Domingo in 1803, and Memphis in 1878. Major outbreaks have also occurred in southern Europe. Gibraltar lost many to an outbreak in 1804, in 1814, and again in 1828.[42] Barcelona suffered the loss of several thousand citizens during an outbreak in 1821. Urban epidemics continued in the United States until 1905, with the last outbreak affecting New Orleans.[43]

Due to yellow fever, in Colonial times and during the Napoleonic Wars the West Indies were known as a particularly dangerous posting for soldiers. Both English and French forces posted there were decimated by the “Yellow Jack.” Wanting to regain control of the lucrative sugar trade in Saint-Domingue, and with an eye on regaining France’s New World empire, Napoleon sent an army under the command of his brother-in-law to Saint-Domingue to seize control after a slave revolt. The historian J. R. McNeill asserts that yellow fever accounted for approximately 35,000 to 45,000 casualties of these forces during the fighting.[44] Only one-third of the French troops survived for withdrawal and return to France. Napoleon gave up on the island, and in 1804 Haiti proclaimed its independence as the second republic in the western hemisphere.

Yellow Fever Epidemic of 1878 can still be found in New Orleans’ cemeteries.
The yellow fever epidemic of 1793 in Philadelphia, which was then the capital of the United States, resulted in the deaths of several thousand people, more than nine percent of the population. The national government fled the city, including President George Washington.[45] Additional yellow fever epidemics struck Philadelphia, Baltimore and New York in the eighteenth and nineteenth centuries, and traveled along steamboat routes from New Orleans. They caused some 100,000–150,000 deaths in total.[46]

In 1858 St. Matthew’s German Evangelical Lutheran Church in Charleston, South Carolina, suffered 308 yellow fever deaths, reducing the congregation by half.[47] In 1873, Shreveport, Louisiana lost almost a quarter of its population to yellow fever. In 1878, about 20,000 people died in a widespread epidemic in the Mississippi River Valley.[48] That year, Memphis had an unusually large amount of rain, which led to an increase in the mosquito population. The result was a huge epidemic of yellow fever.[49] The steamship John D. Porter took people fleeing Memphis northward in hopes of escaping the disease, but passengers were not allowed to disembark due to concerns of spreading yellow fever. The ship roamed the Mississippi River for the next two months before unloading her passengers.[50] The last major U.S. outbreak was in 1905 in New Orleans.[6][51]

Ezekiel Stone Wiggins, known as the Ottawa Prophet, proposed that the cause of a Yellow fever epidemic in Jacksonville, Florida, in 1888 was astronomical.

The planets were in the same line as the sun and earth and this produced, besides Cyclones, Earthquakes, etc., a denser atmosphere holding more carbon and creating microbes. Mars had an uncommonly dense atmosphere, but its inhabitants were probably protected from the fever by their newly discovered canals, which were perhaps made to absorb carbon and prevent the disease.[52]

Yellow fever in Buenos Aires, 1871
Carlos Finlay, a Cuban doctor and scientist, first proposed in 1881 that yellow fever might be transmitted by mosquitoes rather than direct human contact.[53][54] Since the losses from yellow fever in the Spanish–American War in the 1890s were extremely high, Army doctors began research experiments with a team led by Walter Reed, composed of doctors James Carroll, Aristides Agramonte and Jesse William Lazear. They successfully proved Finlay’s ″Mosquito Hypothesis.″ Yellow fever was the first virus shown to be transmitted by mosquitoes. The physician William Gorgas applied these insights and eradicated yellow fever from Havana. He also campaigned against yellow fever during the construction of the Panama Canal, after a previous effort on the part of the French failed (in part due to mortality from the high incidence of yellow fever and malaria, which decimated the workers).[6]

Although Dr. Reed has received much of the credit in United States history books for “beating” yellow fever, he had fully credited Dr. Finlay with the discovery of the yellow fever vector, and how it might be controlled. Dr. Reed often cited Finlay’s papers in his own articles, and also gave him credit for the discovery in his personal correspondence.[55] The acceptance of Finlay’s work was one of the most important and far-reaching effects of the Walter Reed Commission of 1900.[56] Applying methods first suggested by Finlay, the United States government and Army eradicated yellow fever in Cuba and later in Panama, allowing completion of the Panama Canal. While Dr. Reed built on the research of Carlos Finlay, historian François Delaporte notes that yellow fever research was a contentious issue. Scientists, including Finlay and Reed, became successful by building on the work of less prominent scientists, without always giving them the credit they were due.[57] Dr. Reed’s research was essential in the fight against yellow fever. He should also receive full credit for his use of the first type of medical consent form during his experiments in Cuba, an attempt to ensure that participants knew they were taking a risk by being part of testing.[58]

Max Theiler
During 1920–1923, the Rockefeller Foundation’s International Health Board (IHB) undertook an expensive and successful yellow fever eradication campaign in Mexico. The IHB gained the respect of Mexico’s federal government because of the success. The eradication of yellow fever strengthened the relationship between the US and Mexico, which had not been very good in the past. The eradication of yellow fever was also a major step toward better global health.[59]

In 1927, scientists isolated the yellow fever virus in West Africa. Following this, two vaccines were developed in the 1930s. The vaccine 17D was developed by the South African microbiologist Max Theiler at the Rockefeller Institute in New York City. This vaccine was widely used by the U.S. Army during World War II.[39] Following the work of Ernest Goodpasture, Theiler used chicken eggs to culture the virus and won a Nobel Prize in 1951 for this achievement. A French team developed the French neurotropic vaccine (FNV), which was extracted from mouse brain tissue. Since this vaccine was associated with a higher incidence of encephalitis, FNV was not recommended after 1961. 17D is still in use and more than 400 million doses have been distributed. Little research has been done to develop new vaccines. Some researchers worry that the 60-year-old technology for vaccine production may be too slow to stop a major new yellow fever epidemic. Newer vaccines, based on vero cells, are in development and should replace 17D at some point.[4]

Using vector control and strict vaccination programs, the urban cycle of yellow fever was nearly eradicated from South America. Since 1943 only a single urban outbreak in Santa Cruz de la Sierra, Bolivia, has occurred. But, since the 1980s, the number of yellow fever cases have been increasing again, and A. aegypti has returned to the urban centers of South America. This is partly due to limitations on available insecticides, as well as habitat dislocations caused by climate change. It is also because the vector control program was abandoned. Although no new urban cycle has yet been established, scientists believe that this could happen again at any point. An outbreak in Paraguay in 2008 was thought to be urban in nature, but this ultimately proved not to be the case.[4]

In Africa, virus eradication programs have mostly relied upon vaccination. These programs have largely been unsuccessful because they were unable to break the sylvatic cycle involving wild primates. With few countries establishing regular vaccination programs, measures to fight yellow fever have been neglected, making the future spread of the virus more likely.[4]

Birth Control

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birthcontrol Sen. Mike Lee: Women Largely Use Birth Control Recreationally That headline caught my attention and when I read the article about what this Senator said I was a little in-sensed. To me that statement told me he was dumber than a “box of rocks” when it comes to women’s issues. I have to say this blog is my opinion being voiced but I guess you could tell that from the first two sentenses. I am old enough now I do not have to worry about birth control anymore, but it is something that affects every female in this country at one time or another. Whether they use it or not is their choice and that choice has remained intact. What hasn’t remained thanks to the Supreme Court ruling is the accessibility of that control.

Supreme Court Hobby Lobby has posted an article stating they did not want to force their beliefs on others but that is exactly what they have done. Abortion is one thing but assessable birth control is another. When people force their way onto everyone it usually causes a rebound action sooner or later. I know that companies that have to pay for birth control are worried about their bottom line. But what do you think is going to happen with the woman who can’t afford the cost of birth control. There will be unwanted pregnancies, illegal abortions conducted in the dirty dark rooms as they were done in the past. We have put a lot of money into the insurance companies that deny us the medications we need because of their cost and now the Supreme Court has given some companies the right to deny coverage if they have religious objections. If that is not forcing employees to follow your belief, I don’t know what else it will be.

birthcontrol2I am a middle aged female that has worked with the public most of my adult life. I have watched the poor suffer due to lack of medical care. Our medical system is broken and has been for many years. Not everyone gets the care they need. I feel the Birth Control issue was brought about by politics and I for one am sick of it. People should be our concern not Democrats or Republicans.

Thank you for reading this. I felt I needed to voice my opinion. This is a very bad situation that can lead to more bad situations. I hope God has mercy on this country because right now our future doesn’t look to bright.