Author: Marie2

They are also ….

Early in my career, I was tasked with reviewing the files of my employer’s biggest fails.  What expertise/skills should the decision maker have had, what information was available, what information should have been available, and in real time what were the decision errors.  In cases reconstructed there were several to dozens decisions made over a period from a few months up to two years.  The experience level of the decision makers ranged from four years to twenty.  The most common characteristic was that non-reversible decisions were made prior to receipt of standard complete information.
It was tempting and would have been easy to run with that and trash those decision makers.  It would also have been a denial of reality.  Industrywide, full and complete information before the first decision had to be made was the exception and not the rule.  And more than 99% of the time, it works out just fine.  On the other hand, conservative decision makers that “just said no” with incomplete data, were as likely to pass on a gem as a POS.  A better observation of those fails is that the decision makers didn’t recognize the narrative gaps, the risk level of those gaps, and efforts to fill those gaps quickly before the next decision point.  IOW managing the case.  Containing and limiting the fail.  Or managing it out of a fail.

The biggest fail, the largest in the industry up until that time, was different.  There was information up the wazoo in that file.  It was unique.  Nothing like the decision makers (and there were several on this case) had ever seen before.  They did all lack the higher level accounting/finance skills to grasp fully all the details because such skills hadn’t been all that necessary over the prior decades.  Yet, as the “Monday morning quarterback” the conceptual fail was glaringly obvious to a rookie like me.  All of the standard measures that had worked so well for so long were based on a particular operating model, and the proposed model was so different, that the decision makers didn’t appreciate that those measures didn’t apply and didn’t know what did.  Never been tried before and never since.  (Conceptually the payoff could be exceptional; unfortunately, the risk is huge.)

Years later A was deeply hurt when I chastised him for playing the perfect “Monday morning quarterback” in his review of a fail.  He told a colleague, “Marie yelled at me.”  Yes, I did.  He’d trashed one of the principle decision makers, B, instead of looking at all the decision points based on the information known at that time and the multiple fails by multiple decision makers.  Based on his review, firing B would have been appropriate.  That wouldn’t have been totally fair nor instructive for that person and others.  Objectively, the review task is to find the errors and omissions and how to prevent that fail from happening again.  A, who I liked very much, had failed at his assignment, and B, who I didn’t much care for, wasn’t fired and improved his skills from my in-depth review of the fail.

Shinseki wouldn’t have been fired in a fair hearing.  Unfortunately, his critics piled on without collecting, much less assessing, rudimentary information on the situation at VA hospitals.  Same with Hillary Clinton on Benghazi (might be the only thing I haven’t/don’t criticize her for).  The US public health system is weak today because the public doesn’t appreciate it’s vital role and has been underfunding it for decades in favor of privatized medicine.  However, it’s still operational for infectious diseases and it’s the parents that refuse to have their children vaccinated that are responsible for most of the recent outbreaks of what were thought to be preventable infectious diseases.

Presby D may well be below the median in quality care and staffing.  But who can say without qualification that most US hospitals would have done better when Mr. Duncan appeared in their emergency rooms and was later admitted, tested and cared for?  Mr. Duncan denied both times during his ER interviews that he’d come in contact with anyone that had been seriously ill.  He went further and denied that he could possibly have been exposed to Ebola and the hospital ran the test in spite of his denials.  The same thing happened at the Lagos hospital that Mr. Sawyer was taken to after collapsing at the airport.  And Sawyer had been under observation in Monrovia for Ebola.  

There are likely many “should ofs” in the Duncan case.  But “could ofs” in real time?  Not so clear.   With the exception of Nurse Vinson leaving the Dallas area while she was being monitored for development of Ebola.  While the situation is still evolving, the US public health and medical community are performing and should soon be up to speed.   (And apparently trashing both here is more popular than reading the data that I’ve been collecting and posting.)

As the collective and cable news freakouts begin with the second Dallas health worker having been diagnosed with Ebola,  with more data, our collective ignorance level seems to be increasing.  Yes, there are important issues wrt to this second health care worker, but the odds that anyone contracted Ebola from her are close to zero.   A hedge because there is no public information on the range of behaviors that primary Ebola victims engaged in during the asymptomatic and early symptomatic stages of their infections.  Only that they seem not to have infected anyone else during that stage.  A closer look at Nigeria is informative.  
On September 24, 2014 Forbes reported Nigeria Free of Ebola as Final Surveillance Contacts are Released

AFP then added, “Nigeria has not reported any new cases since September 8, the WHO said. If there are no further cases, Nigeria could be declared Ebola-free on October 20.”

Dr. Chukwu provided further details, saying, “No cases are under treatment, no suspected cases. There are no contacts in Lagos that are still under surveillance, having completed a minimum of 21 days of observation.”
…

This was just over two months since Patrick Sawyer, a Liberian-American, had flown to Lagos from Liberia on July 20th.  Sawyer collapsed at the airport and was immediately admitted to hospital.  It was approximately a day before it was suspected that he was infected with Ebola and suffering Ebola Virus Disease (EVD).  At that time he was isolated, tested, and treated.  Contract tracing, quarantine, and monitoring began quickly after that.  Unfortunately, Sawyer died five days later on July 25th.  It appears that he was well into the symptomatic phase of Ebola, “acutely ill” per CDC, when he arrived in Lagos.  (Day 10-16 since infected.)

In total there were nineteen to twenty-one reported Ebola cases and eight deaths (a 38% to 42% fatality rate if case reports are correct).  The CDC has issued a report, Ebola Virus Disease Outbreak — Nigeria, July-September 2014 that details the events and government and medical community actions that contained this outbreak.  

The first significant fact in this report is that Mr. Sawyer was under observation for Ebola at a hospital in Monrovia and developed a fever on July 17th and was advised not to travel.  With airport screening for fever, Mr. Sawyer would have been denied a boarding pass.  Second fact, he denied any exposure to Ebola during his admission process to the hospital in Lagos.  Third, Lagos public health authorities were immediately alerted to a possible Ebola case.

Port Health Services conducted early contact tracing at the airport and worked with airlines and partners to ensure notification of the outbreak through International Health Regulations (IHR 2005) mechanisms (3). The EOC case-management team took over management of each laboratory-confirmed or suspected case, triaged potential patients, and decontaminated areas inhabited by them. …Having the capacity to conduct Ebola laboratory diagnosis in-country at the Lagos University Teaching Hospital facilitated rapid identification of confirmed cases and quick discharge of persons with suspected Ebola who tested Ebola negative.
…
As of September 24, 19 laboratory-confirmed Ebola cases and one probable case had been identified (Figure 1). A total of 894 contacts were identified, and approximately 18,500 face-to-face visits were conducted by contact tracers to assess Ebola symptom development.

Makes the initial public health response in Dallas look a bit shabby.  On the other hand, Duncan likely received a higher level of care in the Dallas hospital than Sawyer had in Lagos, and the health workers in Dallas were better protected.  Of the twenty confirmed or probable cases in Nigeria, thirteen had been in direct contact with Sawyer, three had second order contact, and three had third order contact.  The task for the medical community was complicated by an ECOWAS colleague of Mr. Stewart’s who had met him at the airport in Lagos.  (Can we assume that the greeting included very close contact such as hugging?)  He broke his quarantine order and sought private medical care in a hotel in Port Harcourt  He survived, but his doctor,  Dr. Ikechukwu Enemuo, didn’t.  Enemuo was one of the second order contacts and he was the contact for at least one third order, his wife who has survived.  Enemuo wasn’t diagnosed with EVD while he was alive, seems not to have received any specific EVD care, and died 8/22 before being admitted to hospital.  

The first health worker death in Lagos was on August 6, 2014.  Seventeen days from possible first contact on 7/20.  By August 4, that nurse and one doctor had been confirmed with EVD and another three workers at the hospital were being tested. By August 19, Ebola had claimed the lives of two doctors, one nurse, and two health workers that had treated Sawyer.  While those numbers don’t look great, it’s not known how quickly they were put under care after the first symptoms appeared.  Those in Nigeria with EVD that survived, received the standard hydration and palliative care and none of the yet to be proven experimental treatments.  It has been demonstrated that quality standard care seems to reduce the fatality rate from 70%  to closer to 40%.  Not yet clear how much the survival odds  increase based on when in the course of the disease the care is initiated.

What’s shocking is that TX Presbyterian Hospital, TX public health agencies, and/or the CDC didn’t quarantine all those that treated Duncan.  Freaking Nigeria did better than that.  Based on this update, Amber Vinson, the second healthcare worker to be diagnosed with Ebola, will be transferred to a special bio-containment unit in Atlanta for care. The US has four units of the CDC’s highest calibre, wouldn’t be confident that Vinson sought medical attention at the first sign of a low-grade fever as Pham did.  Still, within three to four days she likely put her own health at more risk than anyone else.

White House press secretary Josh Earnest is talking to reporters …

This is completely unacceptable and inadequate.  What is so freaking difficult about designating a lead, medical professional, spokesperson for the Executive branch of the USG?  Should have been done two months ago.  It’s not as if the federal government doesn’t employ plenty of people that would be qualified for this assignment.  My preference, for reasons not interesting enough to recite, would be the Acting Surgeon General, Rear Admiral Boris Lushniak.  It’s why you don’t have political appointees like Salazar running Interior when BP has a catastrophic blowout and like Burwell running HHS when an epidemic emerges.

Then maybe the CDC wouldn’t make statements such as this one without more evidence/proof:

“The first several days before the patient was diagnosed appear to be the highest risk period,” the director of the CDC has said.

My colleague Lauren Gambino has more:
The two infected nurses had `extensive’ contact with Thomas Eric Duncan in the days before he was diagnosed with Ebola and was extremely ill, excreting large quantities of highly-contagious body fluids.

Prior official statements said that Pham only came into contact with Duncan AFTER he’d been diagnosed.  That was on 9/30.  And it does seem odd that someone with EVD would be more contagious when his/her viral load is lower instead of later when it’s higher.  

The CDC continues to report that the incubation period for Ebola is two to twenty-one days.  If by “incubation” the CDC means from infection to the earliest objective symptom, a low-grade fever, the two day period would be encouraging and comforting.  The twenty-one days would be troubling.  It’s still looks to me as if the asymptomatic incubation phase is a week +/ – 2 days.  However, from the reported cases it looks more like twenty-one days from infection to death and not twenty-one days from infection to first symptoms.

Early detection and isolation saves lives.  Can it still be done quickly enough in Liberia, Sierra Leone, and Guinea to slow down the epidemic?

With today’s announcement(Guardian link) that a healthcare worker at Texas Health Presbyterian hospital in Dallas has tested positive for Ebola, expect a renewal of the hysteria on cable news and the anti-science public.

it was confirmed that a close contact of the healthcare worker – who officials said was wearing full protective gear when he or she made contact with Duncan – has also been placed, “proactively”, in isolation [September 30].

While the announcement didn’t include much information, it’s enough to add to a provisional time line, and is higher quality data than what medical personnel in western Africa have been able to collect.
September 15 – Thomas Eric Duncan reportedly assists a gravely ill, young pregnant woman who died shortly thereafter (not verified if it was a day or several days).

September 20 – Duncan enters the US.  (Left Liberia Sept. 19th.)

September 24 – Duncan exhibits symptoms

September 25 [ED from 26 – see UPDATE below] – Duncan seeks medical attention at Texas Health Presbyterian.  Released when tests didn’t confirm several possible diagnoses which didn’t include Ebola.  

September 28 – Duncan taken to the hospital via ambulance and admitted.  (Family could not confirm that Duncan had had any contact with Ebola.)

September 30 – Duncan tests positive for Ebola.  A hospital statement detailed the steps taken by the hospital since the admission of Duncan, on 28 September, on his second visit. That would include the protocol for protection of health care workers, contact tracing and monitoring for symptoms, and isolation/quarantine for non-health care workers that had been in closest contact with Duncan before his hospital admission.

October 8 – Duncan dies (23 days from suspected infection date)

October 10 – Late evening, one of Duncan’s hospital health care workers reported low-grade fever.  Was tested for Ebola and placed in isolation (within 90 minutes).

October 12 – Hospital worker Ebola test positive.

Frieden told CBS the worker had treated Duncan multiple times after the Liberian man was diagnosed, and said that all those who had treated Duncan were now considered to be potentially exposed.

Let’s look at Spain:

September 22 –  Brother Manuel García Viejo was admitted to hospital in Madrid after being evacuated from Sierra Leone where he worked as a hospital medical director.

September 25 – Brother Manuel García Viejo dies.

September 30 – Teresa Romero Ramos, health care worker exhibited low grade fever.

October 6 – Positive Ebola test and admitted to hospital.  (October 7, second test confirmation.)

Health officials said the infected medical worker had been in contact once with Brother García Viejo while he was alive and with his clothes after he died.

Subsequent to hospital admission, Ramos developed additional symptoms:

The patient was suffering from diarrhoea, vomiting and coughing, the doctor said.

On October 8th, Ramos was able to give several short phone interviews.  By the next day (10/9), she had been intubated and her condition was reported to be deteriorating.

(Note: In August, Rev. Miguel Pajares was admitted to the same Madrid hospital after being diagnosed with Ebola in  Liberia.  He died  five days later.)

Days between earliest possible contact to suspected or known earliest symptoms.

Duncan: nine days (9/15 to 9/24).

Teresa Romero Ramos: eight days (9/22 to 9/30).  (From latest possible contact: five days; 9-25 to 9/30.)

Dallas hospital health care worker: ten days (9/30 to 10/10).

Disease stage of known/suspected victim/patient at time of earliest possible transmission

Liberian pregnant woman died within hours or up to four days later.

Brother Manuel García Viejo died three days later.

Thomas Duncan died eight days later.

The Liberian woman received no medical attention.  Duncan appears to have been admitted to hospital at an earlier stage in the progression of the disease than Viejo and likely received more aggressive medical care.

Piecing together these three cases, provides important data.  First, Duncan, Ramos, and the Dallas health care worker all came in contact with an extremely ill, late stage, Ebola victim.  Second, the shortest possible known time-frame from contact to low-grade fever symptom is five days, and the longest possible, documented time-frame from contact to low-grade fever is eight days.  There may be more certainty as to the date of Duncan’s contact with an Ebola victim, 9/15, but less certainty as to the date of the earliest possible symptom, low-grade fever.  By 9/24, nine days after contact, he experienced observable, but apparently not unduly worrisome, symptoms; those came two days later, day eleven..

In Ramos’ case and from news reports, the onset of observable symptoms was five to six days after recording a low-grade fever (Spanish health authorities deny any symptoms other than a low-grade fever when on October 6th, she was admitted to hospital, and a test returned a positive for Ebola.  From there her health deteriorated rapidly over the next three to four days.  Also note that Ramos’ was being monitored because she had been a health care worker for a known Ebola patient that had died, and yet, her low-grade fever and self-reported fatigue were dismissed for five to six days (depending on which published report is accurate).  Setting 9/22 (Day 1) as when Ramos was infected:

Day 8 – low grade fever and slight fatigue
Day 14 – additional symptoms, transported via ambulance to hospital, and tested positive for Ebola
Day 15 – second test returned positive for Ebola
Day 16 – 18 – health condition worsens

If 9/15 was Duncan’s Day 1:

Day ? – low-grade fever
Day 8 [ED from 9] – other symptoms
Day 11 – significant additional symptoms; evaluated by ER doctor/nurse
Day 13 – seriously ill, tested, and hospitalized.

It appears that Duncan became sicker faster than Ramos did.  Or he could have been infected earlier than the reported 9/15 or Ramos later than 9/22.

Ramos 9/25 infection date:

Day 5 – low grade fever and slight fatigue
Day 11 – additional symptoms, transported via ambulance to hospital, and tested positive for Ebola
Day 12 – second test returned positive for Ebola
Day 13-15 – health condition worsens

A 9/25 infection date for Ramos makes the time lines for her and Duncan more similar.  

From this, it’s more likely than not that the Dallas health care worker was infected between Duncan’s Day 15 through 20 or September 30 through October  5.  The period when all health care workers attending to Duncan were wearing hazmat type clothing.    

In the fourteen to fifteen days between Duncan’s contact with Ebola and diagnosis, none of those who he came in contact with have or are exhibiting any symptoms of Ebola and all are being monitored for low-grade fever.  Not those he was staying with when he was asymptomatic and symptomatic from 9/20 through 9/28.  Not hospital personnel that had contact with him on 9/26.  Not those that transported him to the hospital on 9/28 or hospital workers that cared from him from 9/28 to 9/29, although they would have been wearing some level of protective clothing.  

While it’s too soon to state with absolute certainty, the evidence is good that the Ebola incubation period from being infected to low-grade fever is approximately one week, plus/minus two days.  The isolation of the Dallas health care worker within as little as 90 minutes and no more than few hours of exhibiting a low-grade fever will provide the best evidence as to the possibility of Ebola being transmitted during the incubation phase.  That would be bolstered by any contacts Ramos had that were limited to her incubation phase.  Ramos’ case will add data to Duncan’s regarding how contagious Ebola is in the early symptomatic phase, first six days.  As it’s now fourteen or more days since Duncan had close and unprotected contact with others during that phase, evidence is mounting that it’s no more than weakly contagious, if at all, in the early symptomatic phase.  And quickly after that becomes highly contagious.  That’s essentially what public health officials have been saying, and it means that all of Duncan’s hospital care givers must be considered at high risk for having been infected.

The data on the effectiveness of treatment and of the treatment methods have some way to go before being proven.  The fatality rate of this epidemic is reported to be 50%; so, something is operating to spare half of those that test positive for Ebola.  It could be an individual’s ability to fight off the disease, adequate supplemental fluids in a critical phase of the disease, and/or new treatments such as ZMab or antibodies from the blood of Ebola survivors.

Today from The Guardian, Spanish Ebola Nurse Shows Signs of Improvement.

On Friday, health officials said they had secured an antibody cocktail known as ZMab to treat the nurse. She had previously been injected with antibodies extracted from the blood of Ebola survivors.
/…
Health official Fernando Simón said the presence of the virus in Teresa Romero Ramos’s blood appears to be diminishing. “We have high hopes that the infection is under control,” he said. However, given the seriousness of the virus he said it was impossible to determine whether she was out of danger.

Update [2014-10-13 12:11:54 by Marie2]: NYTimes reports that it was after 10:00 pm, September 25 and not the previously reported September 26th when Duncan first went to the hospital ER.

Update 2: 10/15/14 Nurse Pham, the first American Ebola patient diagnosed in the US, had contact with Duncan the first nine of ten days he was in isolation care at Texas Health Presbyterian Hospital, according to medical records obtained by AP. After running a fever on Friday, Oct. 10, she went to the hospital where she was placed in an isolation unit.

Promoted by Steven D to the front page, and now placed back in the diaries section as it has scrolled off the front page. Thank you, Marie.

The story of Thomas Eric Duncan (NYTimes link) and his families has been reported in such a piecemeal and somewhat frenzied fashion that even people that think they are well enough informed to comment keep repeating falsehoods and speculations as facts.  This confusion hasn’t been helped by incomplete, and possibly untrue, statements from Louise Troh and those she’s asked to speak on her behalf.  While much still remains unknown, the two latest NYTimes reports, Here and Here are more coherent.

Mr. Duncan, who goes by Eric, is the youngest of seven siblings, according to his brother, Wilfred Smallwood, who lives in Phoenix. His father was an engineer for an American mining company, Mr. Smallwood said.

After five years in the refugee camp in French-speaking Ivory Coast, the family moved to Ghana, where there was less of a language barrier, Mr. Smallwood said. A sister, who now lives in Charlotte, N.C., was the first of the clan to make it to the United States, shortly after the war began. Their mother came a decade later, followed by Mr. Smallwood, but Mr. Duncan left Ghana and returned to Liberia, where he stayed.

Some additional background from The Guardian:

Duncan’s half-sister, Mai Wureh, had arrived with her husband in the US in 1989, shortly before Taylor’s invasion, and helped her family apply for resettlement there, but the application was denied.
“Mai had filed for us to leave the war zone, but after a long time, the US rejected all of us,” Smallwood said.

Duncan, Smallwood and about 20 other family members fled in the opposite direction from Taylor, to a refugee camp outside the Ivorian border city of Danane.

Reading that for the second or third time shamed me into recognizing how little I knew of the Liberian First Civil War and from there how little of knew about Liberia other than the war criminal Charles Taylor and the Nobel Peace Prize winning President, Ellen Johnson Sirleaf.  (What a really bad hand Sirleaf was dealt.)

At some point in my readings, it occurred to me that whatever Mr. Thomas Eric Duncan did or didn’t do in his difficult and tragic life, USians should really STFU about any negative impacts on the US from Liberia or Liberians.  This country could have followed Nantucket’s lead and abolished slaverywith the founding of this country.  Instead the “good people” of this country followed Britain’s lead in finding a place to ship free black men and women in this country.  The American Colonization Society was like an early 19th Century NGO.  

In December 1816, alarmed by the rapidly growing free black and slave populations, the Reverend Robert Finley, a Presbyterian minister from Basking Ridge, New Jersey, travelled to Washington, D.C. to gather support for colonization which he saw as the solution to the growing racial tension in the United States.  He led a meeting which created the ACS on December 21, 1816.  The meeting included some of the most powerful and influential men in the country such as Henry Clay, Daniel Webster, and John Randolph of Virginia.  Finley believed the presence of blacks in the United States was a threat to the national well-being and felt Africans Americans would only be able to fulfill their potential as human beings in Africa. …

Free black men and women of that time were Americans in language, thought, education, technology, skills, and religion.  Whether anticipated or not, these Americo-Liberians became the minority rulers for 133 years.  They declared their independence from the American Colonization Society in 1847, but maintained political and economic ties to the US.  

A coup in 1980 ended the one party Whig rule.  Formally, relations between the US and Liberia were unchanged.  However, the sectarian divide pot was being stirred.  Charles Taylor, in custody in the US for embezzlement charges filed against him by the new Liberian government, just happened to escape from jail and made his way back to Liberia.  His help?   Charles Taylor ‘worked’ for CIA in Liberia.

US authorities [in January 2012] say former Liberian leader Charles Taylor worked for its intelligence agencies, including the CIA, the Boston Globe reports.

The revelation comes in response to a Freedom of Information request by the newspaper.
A Globe reporter told the BBC this is the first official confirmation of long-held reports of a relationship between US intelligence and Mr Taylor.

The Liberian First Civil War ensued and Mr. Thomas Eric Duncan and his family fled to a refugee camp in Ivory Coast.  We are such an arrogantly proud and cruel people.

Promoted by Steven D (with small title change). I have some personal matters which require my attention, and Martin is likely not going to be posting much today, so thank-you Marie.

The (MSM induced?) panic in this country over one man carrying the Ebola virus entering the US is from a health standpoint irrational.  Not to dismiss the seriousness of the epidemic in certain western African countries nor that it doesn’t need to be contained as well as possible.  Both given short shrift in the west from the early warnings issued by Médecins Sans Frontière  (MSF).  The danger is highest for health care workers treating Ebola patients and not the general public.  It’s been spreading in areas with extremely limited health care resources, poor sanitation, and cultural practices that facilitates its spread.

Equally troubling, if not more so,  is the ease with which people are engaging in unfounded conspiratorial thinking.  And that’s not limited to those in Liberia, Guinea, and Sierra Leone.

Continue reading below the fold …
CBS News cites social media, Facebook, Twitter, Instagram as the promoters of fears and conspiracies.  If they’d done a bit more investigation, they would have seen that the comment sections to MSM news reports are jam-packed with such assertions and rightwing conspiracy sites are having a field day.  Most of them boil down into some organization, usually governmental, that is hiding the extent of the epidemic and/or difficulty of transmission and/or having created and/or disseminated the virus to kill off certain populations.  A few reject that it’s a virus at all.

As someone who enjoys donning a tin-foil hat on occasion, I view these Ebola conspiracists as dangerous crazies.  Pattern recognition is a valuable human (probably animal) quality.  But only when the “dots” are real and the logic connecting them is solid.  Otherwise it leads to nonsense like the Birthers.  And one real dot is not a pattern either.  That leads to dangerous illness as The Guardian reported: Polio outbreak reaches record high of 202 cases in Pakistan this year.

Pakistan has detected a record number of polio cases already this year, a senior government official said Saturday, as militants target vaccination teams and accuse doctors of being spies and sterilising boys.
…

It’s true that the US unconscionably employed a doctor in the effort to track down OBL.  Breaking the trust necessary for health care workers to do their polio vaccine work in rural parts of Pakistan is the fault of the USG and not the people that are now suspicious of health care workers.  Restoring such trust will take time and effort.  Unfortunately, in the interim many innocent people will become polio victims.  

But how the hell did people make the leap to injections that would sterilize boys?  Rumors from Indira Ghandi’s forced sterilization programme in the early 1970s?  With a population over 186 million (up from 59 million in 1970), the government of Pakistan may wish that such a substance existed, but it doesn’t.  Plus,

Widespread or systematic forced sterilization has been recognized as a crime against humanity by the Rome Statute in the Explanatory Memorandum. This memorandum defines the jurisdiction of the International Criminal Court .

Not that Pakistan is a signatory to the Rome Statute (and the US hasn’t ratified it).  But neither is China nor India.

All things considered, there is some legitimacy for certain populations to be suspicious of diseases and western medical treatments for them.  But that doesn’t include white USians.  They’re just in a subset that may exist in all populations that engage in stinkin thinkin.

BBC Reports that UK GDP rose to 0.9% in the 2nd quarter.  Up from the more anemic 0.7% in the 1st quarter.  And up a whopping 3.2% from the 2nd quarter in 2013.

The recession in the UK now appears to be a thing of the past.  Maybe.

The methodology for calculating GDP has been slightly revised.  It now includes estimates of the sales of illegal drugs and prostitution.

These changes have added billions of pounds to the total amount produced by the economy. But because there have been revisions to the measures going back to the 1970s, the amount of growth from quarter to quarter has not changed a great deal.

Now if the UK government could only figure out a way to tax those illegal goods and services.  

Promoted by Steven D.

Like all the other institutional failures being ascribed to cultures, such as the NY Fed, VA hospitals, etc? Or is the job/mission just too darn tough to expect zero failures?  Does the fact that only two Presidents have been shot in the past hundred plus years indicate that the Secret Service does a fine job or has mostly been lucky?  Lucky that Lynette Fromme waved a gun without firing and Sara Jane Moore fired and missed?  It’s interesting to note that Moore came to the attention of the Secret Service before she shot at President Ford on September 22, 1975:

Moore had been evaluated by the Secret Service earlier in 1975, but agents decided that she posed no danger to the President.  She had been picked up by police on an illegal handgun charge the day before the Ford incident, but was released. The police confiscated her .44 caliber revolver and 113 rounds of ammunition.

(Cont. below the fold …)
Not so different from the recent WH fence jumper as reported by WAPO.

Four days after the incident, a look back shows that Gonzalez had come to the Secret Service’s attention twice earlier this year.

Once detained by VA police when he was found to have an arsenal in his trunk and a map with a line pointed to the WH.  The Secret Service interviewed and cleared him.  In August he was hanging around the WH fence with a hatchet in his waistband.  Fully aware of the earlier incident, the official said, “he did not exhibit any mental-health issues at that point. He had not engaged in any criminal activity.” Gonzalez was let go.

Just your ordinary, everyday armed USian.

With this incident freshly in mind along with the recent Secret Service agents partying in advance of the Presidential detail, WAPO did a bit of reporting this weekend into a 2011 incident: Secret Service Stumbled After Gunman Hit White House Residence in 2011.  As far as it goes, it’s a decent report and definitely worth reading.  The Secret Service does not fare well in it.  But it begs a few questions.

First, why did it take almost three years to put this story together?  Was it embargoed until new security measures, such as ShotSpotter, were in place and functioning?  Or held back not to give a potential copycat any ideas?

Second, how does it compare to the original report, Oscar Ramiro Ortega-Hernandez arrested after shots fired near White House?  The differences are striking beginning with shots fired near White House and not that shots hit the White House.  Then there were the assurances.  Just an unexplained nut:

One official, speaking on the condition of anonymity because the investigation is continuing, said Ortega-Hernandez’s alleged motive may have been anger. “He hates the president, he hates Washington, he hates society,” the official said.

A lone wolf (isn’t it always in the good ole USA? Except for the assassination of Lincoln, of course.):

Ortega-Hernandez has a record of arrests for relatively minor offenses in Texas, Utah and Idaho, authorities said, but he has not been linked to any radical organizations.

A revealing, and most troubling aspect to me, of the first report was:

In trying to determine why he traveled to the nation’s capital from the western part of the country, investigators also found no connection between him and the Occupy D.C. protest, according to three law enforcement officials familiar with the case.

How much time and effort was the Secret Service devoting to a perceived threat from Occupy D.C?  Hatchetman with a sawed-off shotgun, two sniper rifles, an assault rifle, a bolt-action rifle, one intact shotgun and five handguns, no threat.  Occupy D.C, very scary.

The latest report reveals another perceived threat:

Amid conflicting radio chatter, including a Secret Service dispatcher calling into 911 with contradictory descriptions of vehicles and suspects, police began looking for the wrong people: two black men supposedly fleeing down Rock Creek Parkway.

Very scary black men.  Not that there’s ever been a black assassin of a POTUS (who lives a majority African-American city), but I guess, you never know.

Should we make anything of the names of the two perps?  Oscar Ramiro Ortega-Hernandez and Omar Jose Gonzalez?  Not exactly what I would expect to see as would-be assassins of the first black POTUS.  Possibly not even what the Secret Service is seeing in the large volume of threats being made against Obama.  Hope it’s just on odd coincidence.  

Promoted by Steven D.

Sounds kinky.  And it is.  But it’s bedding for money instead of sex.

ProPublica and This American Life released an important story this week by Jake Bernstein.  The ProPublica written story is Inside the New York Fed: Secret Recordings and a Culture Clash and the audio version is The Secret Recordings of Carmen Segarra.  The audio presentation structure of the story may be slightly better than the written report, but the latter includes important information not covered in the audio version.  Thus, the fullest appreciation of the story is gained by reading and listening to both versions.

Cont. below the fold.
What’s not mentioned is that the culture of the Federal Reserve that is cited as a reason why the examiners failed to thwart the financial meltdown isn’t unique to the Fed.  It’s exactly the same culture that led to the demise of Arthur Andersen and Enron.  The same culture that led to the bond ratings agencies to assign investment grade ratings to the various forms of mortgage backed securities and derivatives.  The same culture that put AMBAC into Chaper 11 bankruptcy and has left MBIA reeling.  Likely only slightly different from the culture at the SEC, FDIC, Fannie Mae, and Freddie Mac.  From all reports and actions to date, something similar seems to have infected the financial fraud unit of the Justice Department.  And it’s the same culture that has been embraced by all levels of the MSM.  IOW, the Walter Cronkites are extinct.

With such rotten core cultures in US financial regulatory  and affiliated financial oversight institutions, how did the US financial community operate for well for so long?  Roughly from the mid-1930s until 2008.  The answer is both simple and opaque.  The culture changed.  And the change was so gradual that it was difficult to detect.  Except by those that lived and breathed the prior culture, almost all of whom had retired and/or died by the time the “new” culture became endemic.  Their successors, like Michael Silva in Bernstein’s story, may have been trained in the technical details but never experienced that within the prior culture.  Segarra is like a throw-back.  Beating her head against a cultural wall that won’t budge.  How well I know that.  Yet, unlike Segarra, I had the privilege of being there before schmoozing dominated.

Bill was a Sr. VP.  A naturally gifted schmoozer.  Yet, in a meeting with his counterparts at a large bank that had had a long-standing, perhaps a hundred years, business relationship with his employer, he didn’t mince his words.  He said, “X is the worst bank in California.”  He followed that up with, “We’re out of here.”  Bill knew when to trust his subordinate analysts.  X bank died seven years later.  Three years after Bill had retired with forty-one years at one company.

Words that David Bein (the Columbia finance professor hired to review the FED) would have resonated with Bill.

That meant hiring “out-of-the-box thinkers,” even at the risk of getting “disruptive personalities,” the report said. It called for expert examiners who would be contrarian, ask difficult questions and challenge the prevailing orthodoxy. Managers should add categories like “willingness to speak up” and “willingness to contradict me” to annual employee evaluations. And senior Fed managers had to take the lead.

Bill would have reached down and pulled someone like Segarra up and instead of firing her, would have said, “Way to go!”   Then would have told those that had given Segarra flack to apologize to her.  

He wasn’t perfect.  On one team, I and my colleagues had to seriously consider the possibility that we’d receive pink slips for refusing to entertain further a deal that Bill was under pressure from the CEO to approve.  (A McKinsey & Co. deal that prefigured the GS-Banco Santander deal with conflict of interest but was extremely high risk for our employer.  While never fully defined, the subsequent lawsuits for one company that got suckered into it were in the hundreds of millions of dollars.)  Bill didn’t even fire me when after months of vacillation, I informed him that his pet project had turned into a POS.  He reassigned me and the project continued to rack up sunk costs for several more years before it was killed off.

Bill’s direct report AVPs followed his lead.  25% schmooze and 75% technically proficient.  The schmooze component was less for their subordinates.  What was critical to our success and we depended on was that there was virtually zero schmooze component to the work of  bank regulators, bond rating companies,  SEC, and CPAs.  That schmoozers become losers.  Unless they become TBTF.  

Joe Lieberman didn’t have it in 2006, but as a sore loser in CT, he was somehow able to get ballot access as an independent for the November general election which, much to the dismay of all the efforts of liberal Democrats to fire him, he won.

Lisa Murkowski didn’t have it in 2010, but as a sore loser in AK, she couldn’t get ballot access for the general election.  Instead, she ran as a write-in candidate, and to the dismay of Teabaggers, she won.

Mississippi has a sore loser law; so, McDaniel is SOL for the US Senate in 2016.  And the Teabaggers are livid.  

Cantor didn’t have it.  Virginia prohibits it:

According to the Code of Virginia’s section on candidates and elections (24.2-520), candidates filing for a primary must sign a statement agreeing that if they lose, their names cannot be printed on ballots for the general election. Meaning, if a candidate in the Republican primary for the 5th District loses on June 8, he or she cannot run as a third-party candidate in November.

(And the filing deadline for write-in candidates is the same as for the primary.)

But guess who has it up the wazoo?

This week the NYTimes declined to endorse a candidate in New York’s Democratic primary contest.  Cuomo would surely liked to have had that endorsement, but he’s got a fat war chest and his opponent, Zephyr Teachout, remains little known.  FWIW, The Nation and NOW endorsed Teachout.  

Tonight it has become a bit more interesting.  But first three important bits of information.  NY primaries are closed.  The party candidates for Governor and Lt. Governor  run separately in the primary.  The two winners run jointly on the party ticket in the general election (single ballot line).  However, before the primary election, gubernatorial candidates offer a ticket with one of the Lt. Governor candidates.  Cuomo has been running with Kathy Hochul and Teachout with Tim Wu.

The NYTimes just endorsed Tim Wu for Lt. Governor.

There still seems little to no doubt that Cuomo will win the nomination.  But will Democrats choose to stick Cuomo with Teachout’s choice for Lt. Governor?  And will Teachout perform as poorly as has been predicted?

Teachout has no primary loser insurance.  “New York’s progressive political party,” New York – Working Families Party launched Teachout’s political career and then blinked.  The Nation covered the gory details of WFP’s nominating convention.  Cuomo is their guy.  Thus, if by some bizarre twist of fate, Teachout wins the Democratic Party primary, Cuomo will still be on the general election ballot as the WFP nominee.  And he’ll have two more lines as the nominee for the Women’s Equality and Independence parties.  

The WFP decided to be ever so pragmatic in choosing Cuomo as its nominee.  They feared Teachout as their nominee would jeopardize its ballot access and Cuomo would be mean to them after he won his second term.  And Cuomo whispered a bunch of sweet nothings to secure the WFP nomination.  The WFP basically chose to be irrelevant in the 2014 gubernatorial election.  Wouldn’t it be a hoot if this “progressive party” ends up with the DINO candidate and the Democratic Party ends up with the progressive candidate?  And the WFP loses ballot access because Cuomo fails to get enough votes on the WFP ballot line?

The Chicago Tribune was a long laughing stock for that headline blunder.

Understanding how the Tribune blew it has probably consumed more ink and attention than how “Truman Beat Dewey.”  And there are lessons in that from the SCOTUS decision in Harris v. Quinn and the ALEC anti-public employees unions legislation that has been put in place by a few Republican governors.  Scott Walker has so far succeeded in beating back the unions. John Kasich was overwhelming rebuffed by the voters in a referendum on this question three years ago.  Yet, Kasich is projected to win re-election this year.

So, how did Truman defeat Dewey?  While the race was close in a few states, it wasn’t close in the Electoral College 303 to 189.  “Dewey Defeats Truman” was the outcome that the Chicago Tribune publisher wanted.  (Not unlike Fox in 2000.)

What often goes unmentioned about the 1948 election is that Truman not only won, but Democrats regained control of the Senate and House.  Not by small amounts but large ones.  The House went from 248 Republicans and 185 Democrats to 171 Republicans and 263 Democrats, and Democrats retained the majority in both houses in 1950.  (The Tribune also reported in its 1948 election  results coverage that Republicans had retained majority control of both houses; so, it was a triple strike-out blunder for the Tribune.)

So, what changed the outcomes in that election from what some (many?) expected?  The 1946 mid-terms were a disaster for Democrats and not unlike the 2010 mid-terms.  How did Truman and Democrats recover so quickly in two years?  Truman did rail against what he called “the do nothing Congress.”  But if obstruction from Republicans was enough to flip control of Congress, why didn’t it work in 2012?  Why is it projected not to work in the 2014 House races?
However, it wasn’t exactly a “do nothing Congress.”  They were eager beavers in passing  The Taft-Hartley Act, one of many anti-union bills that the “do nothing Congress” passed during their two years in power .  Truman vetoed it and Congress over-rode his veto.  The CIO was particularly active in the 1948 election on behalf of Democrats.  Twenty-five percent of the workforce was unionized, and other than postal workers, most union workers were in the private-sector.  Today, private-sector union workers are down to 6.7% nationwide.  A once potent political force has been decimated.  

Even though Truman and the new Congress failed to repeal Taft-Hartley (the first of many betrayals of unionized working men and women by Democrats), labor remained strong for the next couple of decades.  (Congressional Democrats won big in 1956 and 1958 and did so with a popular GOP President.)  In part because as private-sector union members declined, the “little Wagner Act” in NYC initiated a period of public sector union growth.  Except for the AFSCME locals such as the Memphis Sanitation workers(currently under privatization threat) and UAW under Walter Reuther, organized US labor gradually became more AFL than CIO.  What does this mean for electoral politics in the 21st Century?

As of this writing, it’s curious how different two governors implementing ALEC approved legislation, including public employee union bashing, are faring.  First there’s Scott Walker in the purple-blue state of WI.  After years of demonstrations and push-back attempts by unionized public employees, and as reported by RawStory

Both candidates received 46 percent support among registered voters, with 6 percent undecided, the Marquette Law School Poll taken from May 15 to18 found. The previous poll in March showed Walker leading Burke 48 percent to 41 percent.

 
Still time for Burke to pull it out, but it’s going to be a tough slog because Walker’s disapproval numbers are oddly not that high and seems close to set in concrete amongst voters.  Plus Walker will have scads of money from well-heeled rightwing corporate elites (both WI based and out-of-state).  Burke has public employee unions.

The other ALEC approved governor is in a deep red state.  A state with below average union worker participation.  Although not scraping bottom at 3.3% with South Carolina.  The low union membership participation rate didn’t stop this governor from going after unions as relentlessly as Scott Walker.  There were push-backs from unions, but it’s tough with such a small member base to roar loudly and gain national attention as those in WI did.

He’s a shoo-in to win the Republican primary next month.  But oddly, his approval numbers are low.  So, low that against both of  two contenders for the Democratic nomination he’s behind by six points.  He has time (and likely plenty of money) to win in November, but how can it be that he has a steeper uphill climb than Scott Walker?  Who is this governor?  Sam Brownback in the state of Kansas.  Here’s recent information on the state of organized labor in Kansas.  And Brownback poll numbers.  An incumbent Republican governor in Kansas could be in trouble?   What’s the matter with Kansas?

Thinking about all of this, I became interested in looking at union membership in both the private and public sectors by state and discovered that the numbers aren’t as easy to find as I expected.  The best BLS reference chart by state lumps all employed workers and union members together.   A report from The Center for Economic Progress breaks down the private and public sector union membership rates.  Using the data from these two reports, here’s what WI and KS (in thousands for 2012) look like:

Kansas
Emp 1,248
Pvt 1,120 (unionized 40; rate: 4.0% [2011 rate: 4.6%])
Pub 228 (unionized 45; rate 18% [2011 rate: 19.7%])

Pub/total emp. 18%

Wisconsin
Emp 2,606
Pvt  2,232 (unionized 154; rate: 6.9% [2011 rate: 7.0%])
Pub 372 (unionized 139; rate: 37% [2011 rate: 50%])

Pub/total emp. 14%

As Corbett is the only incumbent GOP Governor that appears to be in trouble (and he didn’t go on an ALEC rampage but the public is angry about funding cuts to schools and there’s the Sandusky matter), does PA look any different?

Pennsylvania
Emp 5,454
Pvt  4,798 (unionized 379; rate: 7.9% [2011 rate: 9.3%])
Pub 654 (unionized 357; rate: 55% [2011 rate: 52%])

Pub/total emp. 12%

How about Ohio:
Emp 4,800
Pvt  4,179 (unionized 351; rate: 8.4% – [2011 rate: 8.6%])
Pub 637 (unionized 253; rate: 40% [2011 rate: 43%])

Pub/total emp. 13%

A few observations.  Unionization rates in both the public and private sectors dropped in all four of these states between 2011 and 2012 except in the PA public sector.  It was already so low in Kansas that it’s not a factor.  However, public sector employment to total employment in Kansas is higher than in the other states and it’s possible that Brownback attacking those that are unionized has increased the feelings of vulnerability for the public sector workers and they’ve had enough of him.  

There were almost no bright spots for private sector union workers between 2011 and 2012 and the steepest drop was in PA.  OTOH, that increase in public employee unionization is a possible countervailing trend which also exists in KY and MI.  (KY private sector also increased.)  And Corbett got push-back from not restoring school funding.  (Coincidence that Sen McConnell (R-KY) and Gov Snyder (R-MI) are vulnerable?)  If not for the Sandusky matter, would Corbett be in a toss-up or better situation for his re-election?

Probably.  The union factor in OH, while deteriorating, is currently a bit stronger than in PA and Kasich seemed to be cruising to another victory.  But wait – that prediction may be a bit premature.  TPM Poll: Ohio Guv Race In Dead Heat.  That poll may be an outlier.  However, it does conform to how hinky statewide elections get when private sector unionization rates approach a dead zone and public sector rates decline in the same direction.  (At the lower end of the dead zone, there might be another hinky zone.)

Workers may struggle to connect the dots between unions and income/wealth inequality, but they aren’t getting any help with this from the Democratic Party.  (A political party fully in bed with the non-unionized, corporate charter school movement.)  ALEC and Scott Walker appear to have gotten the formula correct for corporate power.  And if it can be done in WI, it can happen in a few other places.