Jim White

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Iran Threatens to Chase Terrorists in Pakistan (Just Like US!)

As I noted in discussing the first reports of the explosion at Parchin, early September saw a larger than usual incident along the Iran-Pakistan border, with a force of over 70 militants and a truck packed with over 1000 pounds of explosives attacking an Iranian border station. Thomas Erdbrink then noted last week that two separate incidents along the border resulted in the deaths of “a senior officer” and “three police officers” in two separate incidents in the same region.

Iran is quite upset by these events and no less than the second in command of the IRGC is speaking out today, warning Pakistan that if they can’t control the terrorists in the border region, then Iran will have no alternative but to chase them, even in Pakistani territory:

Iran will step in to contain terrorists if Pakistan refuses to take measures in order to secure its borders to keep terrorists from slipping into the Islamic Republic, a senior Iranian military commander says.

“We believe that every country should respect its commitments vis-à-vis its own internal security as well as that of neighboring countries. Border security is a common and pressing need for neighboring countries. We are, in principle, against intervening in the affairs of any country, but if they fail to abide by their obligations we will have [no choice but] to act,” the second-in-command of the Islamic Revolution Guards Corps (IRGC), Brigadier General Hossein Salami, said on Thursday.

“Terrorists, wherever they may be, even on the soil of neighboring countries, we will find them, and if they do not give up acts of terrorism, we will deal with them without reservation,” the senior commander added.

Gosh, maybe the US should go to the UN or the ICC to complain about such a blatant violation of Pakistani sovereignty if such an attack takes place. Just as soon as the US stops violating Pakistani sovereignty with drones, that is.

The article goes on to quote Salami that Iran has very good intelligence on the terrorist groups in the border region and then notes that “Iranian security forces have apprehended a number of perpetrators behind the recent killings” regarding the incidents described in the Erdbrink report.

Gosh, with intelligence that good on the border zone terrorists, maybe Iran will start using drones in Pakistan, too. I can only imagine the chaos that would sow among the chattering classes inside the Beltway.

Texas Hospital Violated Basic Precaution in WHO Ebola Patient Treatment Guidelines

The incompetence of Texas Health Presbyterian Hospital Dallas is staggering. In following today’s rapidly developing story of a second nurse at the hospital now testing positive for Ebola, this passage in the New York Times stands out, where the content of a statement released by National Nurses United is being discussed (emphasis added):

The statement asserted that when Mr. Duncan arrived by ambulance with Ebola symptoms at the hospital’s emergency room on Sept. 28, he “was left for several hours, not in isolation, in an area where other patients were present.” At some point, it said, a nurse supervisor demanded that Mr. Duncan be moved to an isolation unit “but faced resistance from other hospital authorities.”

The nurses who first interacted with Mr. Duncan wore ordinary gowns, three pairs of gloves with no taping around the wrists, and surgical masks with the option of a shield, the statement said.

“The gowns they were given still exposed their necks, the part closest to their face and mouth,” the nurses said. “They also left exposed the majority of their heads and their scrubs from the knees down. Initially they were not even given surgical bootees nor were they advised the number of pairs of gloves to wear.”

The statement said hospital officials allowed nurses who interacted with Mr. Duncan at a time when he was vomiting and had diarrhea to continue their normal duties, “taking care of other patients even though they had not had the proper personal protective equipment while providing care for Mr. Duncan that was later recommended by the C.D.C.”

From the context of both the New York Times article and the nurses’ statement, it seems most likely that this movement of nurses from treating Duncan to treating other patients took place during the period after Duncan was admitted to the hospital and before the positive test result for Ebola was known. However, from the nurses’ statement showing that at least some of the personnel on duty realized Duncan almost certainly had Ebola, proper isolation technique should have been initiated immediately.

And that movement of nurses from a patient who should have been in isolation back into the general patient population is a huge, and obvious, error. Consider this publication (pdf) put out in August by the World Health Organization, summarizing precautions to be taken in care of Ebola patients. The very first page of actual content, even before the section labeled “Introduction”, is a page with the heading “Key messages for infection prevention and control to be applied in health-care settings”. The page lists nine bullet points about dealing with ” hemorrhagic fever (HF) cases” (hemorrhagic fever diseases include Ebola). Here is the third entry on that list:

Exclusively assign clinical and non-clinical personnel to HF patient care areas.

There really is no point in saying a patient is isolated if staff are freely moving back and forth between the isolation area and the general patient population. I’m wondering how long it will be until there is a whole new management team at Texas Health Resources, the parent firm for the hospital.

Saddam’s WMD: Technology Made In USA, Delivered by Rumsfeld

In a blockbuster story published last night by the New York Times, C.J. Shivers lays out chapter and verse on the despicable way the US military covered up the discovery of chemical weapons in Iraq after the 2003 invasion. Even worse is the cover-up of injuries sustained by US troops from those weapons, their denial of treatment and denial of recognition or their injuries sustained on the battlefront.

Why was this covered up, you might ask? After all, if George W. Bush would joke at the White House Correspondents’ Dinner about looking under White House furniture for Saddam’s WMD’s, why didn’t the US blast out the news of the WMD’s that had supposedly prompted the US invasion?

The answer is simple. The chemical weapons that were found did not date to the time frame when the US was accusing Saddam of “illegally” producing them. Instead, they were old chemical weapons that dated from the time Saddam was our friend. They come from the time when the US sent Donald Rumsfeld to shake Saddam’s hand and to grease the skids for Iraq to get chemical weapons to use in their war against Iran.

Chivers give us the details:

From 2004 to 2011, American and American-trained Iraqi troops repeatedly encountered, and on at least six occasions were wounded by, chemical weapons remaining from years earlier in Saddam Hussein’s rule.

In all, American troops secretly reported finding roughly 5,000 chemical warheads, shells or aviation bombs, according to interviews with dozens of participants, Iraqi and American officials, and heavily redacted intelligence documents obtained under the Freedom of Information Act.

/snip/

The New York Times found 17 American service members and seven Iraqi police officers who were exposed to nerve or mustard agents after 2003. American officials said that the actual tally of exposed troops was slightly higher, but that the government’s official count was classified.

/snip/

Then, during the long occupation, American troops began encountering old chemical munitions in hidden caches and roadside bombs. Typically 155-millimeter artillery shells or 122-millimeter rockets, they were remnants of an arms program Iraq had rushed into production in the 1980s during the Iran-Iraq war.

All had been manufactured before 1991, participants said. Filthy, rusty or corroded, a large fraction of them could not be readily identified as chemical weapons at all. Some were empty, though many of them still contained potent mustard agent or residual sarin. Most could not have been used as designed, and when they ruptured dispersed the chemical agents over a limited area, according to those who collected the majority of them.

But here is the real kicker:

Participants in the chemical weapons discoveries said the United States suppressed knowledge of finds for multiple reasons, including that the government bristled at further acknowledgment it had been wrong. “They needed something to say that after Sept. 11 Saddam used chemical rounds,” Mr. Lampier said. “And all of this was from the pre-1991 era.”

Others pointed to another embarrassment. In five of six incidents in which troops were wounded by chemical agents, the munitions appeared to have been designed in the United States, manufactured in Europe and filled in chemical agent production lines built in Iraq by Western companies.

Good old USA technology, conveniently exported to European firms that we helped to build factories in Iraq to produce chemical weapons to be used against Iran. That is what caused injury to US servicemen who were routinely denied care and quickly sent back into battle because they weren’t missing limbs. Chivers talked to a number of those soldiers and their stories are so consistent they nearly blend together. Also consistent was the instant classification of the injuries, presumably because of the embarrassment to the Bush Administration they would cause should the press look into them too rigorously.

Sadly, though, the story is not yet over. The US left Iraq in 2011, knowing that chemical weapons were still stored in bunkers at Al Muthanna. At the end of Chivers’ report: Continue reading

Ebola Transmission: Health Care Worker Practice Most Important Consideration

Not long after we learned that a health care worker treating Thomas Duncan has tested positive for Ebola, I ran across this terse tweet from Mackey Dunn, the pen name of Don Weiss, who is “a medical epidemiologist with the New York City Department of Health and Mental Hygiene”. The tweet linked to this short but incredibly important blog post. In the post, Weiss notes the baffling development that a health care worker, who wore full personal protective equipment (PPE), contracted Ebola from Duncan even though at this point, none of his family or other close contacts, who did not have full PPE, have developed symptoms of the disease.

That set of facts prompts Weiss to pose the question “So, what does this tell us about Ebola and how we can attain control?” His answer begins:

One, that Ebola patients become more infectious as the illness progresses. The newly reported case in a healthcare worker had onset on October 10th. If we take 9 days as the mean incubation period for Ebola this means the healthcare worker’s exposure was sometime around October 1, which was day 8 of Mr. Duncan’s illness. This is similar to what was seen with SARS, that patients become more infectious (and dangerous) with time.

In setting up the circumstances for his question, Weiss had noted that Duncan was hospitalized, ending exposure to family members, on day 5 of his disease.

Although he doesn’t mention it, this aspect of Ebola, where patients produce more virus and become more infectious during the course of a fatal infection, also accounts for why burial practices are so important to containing the spread of Ebola. Patients produce the most virus and are thus at their most infectious at death.

The converse also appears to be true. Duncan was symptom-free when he flew from Liberia to Dallas on September 19 to 20. At 24 days since the end of that trip, we have now passed the incubation period, commonly given as 2-21 days, for Ebola to develop in anyone who could have been exposed during the flights. No infections among those airline passengers have been reported. I have yet to see a major media outlet mention this point, though.

We are now at 16 days since Duncan was hospitalized, ending his family’s direct exposure, so we have passed the two-thirds point of the incubation period for them (and well past the 9 days that Weiss gives as the average incubation period for Ebola).

The second part of Weiss’ musings on the infection of the nurse is extremely important:

Second, that only hospitals that are well prepared to care for highly infectious patients should be allowed to do so. Standard practice is to have a staff person dedicated to observing the donning (putting on) and doffing (taking off) of PPE. This observation should continue throughout the period of clinical care (from an ante-room with a window). Perhaps gentle reminders during the doffing can avoid the presumed situation in Spain where the nurse may have touched her face with a gloved hand.

When a patient presents to a hospital early in the illness there is time to transfer to such a facility. That’s the plan here in NYC. Bellevue hospital has a specially equipped ward to care for Ebola patients. Their staff are well trained. The number of healthcare workers entering the room should be kept to a minimum, especially after day 7 of the illness.

Weiss was prescient in his push for an observer for workers putting on and taking off PPE. In today’s New York Times, we have this on the CDC’s thoughts regarding improving practices for health care workers treating Ebola patients: Continue reading

Described Focus of Protest in Kabul Dependent on News Outlet

Khaama Press photo of Sunday's protest in Kabul.

Khaama Press photo of Sunday’s protest in Kabul.

A protest variously described as featuring “over a hundred”, “hundreds” or “over 500″ protesters took place in Kabul on Sunday. The object of the protest, however, was very dependent on whose report (or even whose headline) on the protest is being read.

The Wall Street Journal ran with the headline “Islamic State’s Siege of Kobani, Syria Sparks Protest in Kabul, Afghanistan” while Iran’s PressTV went with “Afghan protesters blast US-led forces, BSA”. Remarkably, Afghanistan’s Khaama Press did not see it necessary to spin the focus of the protest in a particular direction, using the headline “Afghans protest against Islamic State, US and NATO forces in Kabul”.

The Khaama Press article quickly sums up the protest:

Over 500 people participated in a demonstration against the Islamic State and presence of US and NATO forces in Afghanistan.

The protesters were shouting slogans against the presence of US and NATO forces in Afghanistan and in support of the Kurdish people who are fighting the Islamic State militants.

Protesters were also carrying signs purporting crimes committed by US and NATO forces in Afghanistan and resistance of the female Kurdish fighters against the Islamic State.

The US and NATO were also accused by protester for supporting the extremist groups in Afghanistan and Kobane.

We learn in the article that the protest was organized by the Solidarity party of Afghanistan, which Khaama described as “a small and left wing political party in the country”. Presumably, since they were allowed to stage the protest, the ban on the party issued in 2012 must have been lifted.

One has to read the Wall Street Journal article very carefully to find any evidence of the US criticism that was in the protest. The article opens:

Residents of Kabul have a war on their own doorstep: The provinces around the Afghan capital have seen an upsurge in violence this year.

But the conflict in Syria was on the minds of demonstrators who marched Sunday in solidarity with the town of Kobani, Syria, currently under siege by Islamic State militants.

Over a hundred Afghans—most of them women—held placards supporting Kurdish fighters defending the city.

Near the end, the article mentions, but dismisses as “conspiracy theory”, the accusations of US involvement in the creation of ISIS:

Conspiracy theories often thrive in Afghanistan, and at Sunday’s protest, many demonstrators expressed the belief that Islamic State was a U.S. creation. Some held placards saying, “Yankee Go Home.”

The article then mentions the BSA without stating that it was also a target of the protest other than citing the “Yankee Go Home” sign.

PressTV, on the other hand, focused exclusively on the anti-US aspects of the protest. In fact, the video accompanying their story does not match the photo that is used in the video frame while the video isn’t playing. The photo, which is full-frame, shows protesters somewhere burning an American flag, but the video itself-which appears to match the same event in the Khaama Press photo-only partially fills the frame and does not show any flag-burning. PressTV opens:

Afghan protesters have staged a rally in the streets of the nation’s capital, Kabul, to reiterate their opposition to the continued presence of US-led troops in the war-ravaged country.

Hundreds of demonstrators marched through the capital on Sunday to also express their outrage against the so-called Bilateral Security Agreement (BSA) signed by the newly-inaugurated President Ashraf Ghani Ahmadzai.

The protesters were reportedly carrying banners pointing to alleged crimes committed by US and NATO forces across Afghanistan

Remarkably, even though Iran is staunchly opposed to ISIS, the PressTV story makes no mention of the protest also being aimed against ISIS, or even of the accusations of a US role in the creation of ISIS.

Congratulations to Khaama Press for choosing to not spin a story that major outlets in the US and Iran used as propaganda pieces.

Moral Rectitude? No, John Brennan is a Honey Badger

A tweet yesterday by Arif Rafiq noted that there was a US drone strike in North Waziristan yesterday just a few hours before Pakistani Prime Minister Nawaz Sharif would visit a spot only 20 miles away. At the New York Times article Rafiq linked:

Prime Minister Nawaz Sharif of Pakistan visited a military camp in the tribal district of North Waziristan on Thursday in what was seen as a pointed show of support and an attempt to bolster his troubled relationship with the country’s top generals.

The rare visit by Mr. Sharif to the tribal belt came three months after the military launched a sweeping offensive against the Taliban in North Waziristan, a hub of Taliban and Qaeda activity.

/snip/

His visit to Miram Shah, the main town in North Waziristan, on Thursday showed Mr. Sharif standing staunchly behind the country’s generals. “Our courageous troops are fighting a difficult war against an invisible enemy,” he told soldiers. “This is a war for the survival of Pakistan.”

Pakistan’s military claims that 80 percent of North Waziristan has been wrested from the militants and that at least 1,000 militants have been killed in the offensive, known as Zarb-e-Azb, which started on June 15. The figures are impossible to independently verify because the area is out of bounds for most reporters.

According to Pakistan Today, Sharif was emphatic in claiming victory by Pakistan over the militants they were attacking in North Waziristan:

Praising Pakistan Army for the success of Operation Zarb-e-Azb, the prime minister said he visited areas of North Waziristan which used to be havens for terrorists but now the army had purged all anti-state elements from there.

Despite Sharif’s claim of total victory over the terrorists, the US obviously feels the job is not complete, as drone strikes this week have been heavy, including the strike Rafiq notes in the Times article as only 20 miles from where Sharif would visit a few hours later.

The beginning of this week was marked by observance of Eid-ul-Azha, but the religious holiday had no bearing on the timing of drone strikes by the CIA. This Express Tribune article notes that US drone strikes in North Waziristan killed five in the pre-dawn hours Monday, another five later on Monday, six early Tuesday, and another eight also on Tuesday.

And then as AP recounts, there were two separate attacks overnight Wednesday and Thursday that killed five more. Near the end of the Times article linked by Rafiq, we get the observation of how close in location and timing it was to Sharif’s visit:

In an unexpected turn, Mr. Sharif’s visit also had an unusual dimension in terms of his relationship with the United States. Hours before he arrived, an American drone fired a missile at a vehicle in Datta Khel, 20 miles west of the camp where Mr. Sharif visited. Four people were killed and two were wounded, a Pakistani security official said on the condition of anonymity.

Clearly, when it comes to drone strikes in Pakistan, John Brennan is a honey badger. He don’t care about religious holidays. He don’t care about the Pakistani military claiming to have established control of North Waziristan. He don’t care about the Prime Minister entering the area. John Brennan just don’t care.

Who ever heard of a honey badger with moral rectitude?

Parchin Blast Site Far From Disputed Chamber

Yesterday, I described what was known at the time about a mysterious blast near the Parchin military site in Iran. I postulated that satellite imagery would soon be available to help sort out the mystery of what took place. A tweet this afternoon from @dravazed alerted me to this article at the Times of Israel, which, in turn, linked to this story posted at israeldefense.com.

Satellite imagery described as from Sunday night’s blast at the Israel Defense site shows several buildings destroyed. The article claims that the blast looks like an attack on a bunker:

Satellite images obtained by Israel Defense and analyzed by specialist Ronen Solomon clearly show damage consistent with an attack against bunkers in a central locality within the military research complex at the Parchin military compound.

Because of the unique shape of the large building adjacent to those destroyed by the blast, I was able to find the location of the blast on Google Maps. Also, with the help of this article from 2012 in The Atlantic, I was able to locate both the area inspected by IAEA in 2005 and the site of the disputed blast chamber where it is alleged that research to develop a high explosive fuse for a nuclear weapon has been carried out. None of these three locations, the blast site, the chamber site or the area inspected in 2005, lies within the boundaries marked as Parchin on Google Maps. The blast site looks to be near a populated area of what is marked on Google Maps as Mojtame-e Maskuni-ye Parchin (which appears to translate as Parchin Residential Complex A if I used Google Translate appropriately). In fact, the blast site appears to be just over a mile from an athletic field. On the map below, #1 is the disputed blast chamber location, #2 is the blast site and #3 is the area inspected in 2005. Note that both the blast chamber site and the area inspected in 2005 are more removed from what appear to be the populated areas.

Final

I am far from an image analysis expert, but the blast site looks to me to be more like an industrial site than a cache for storing explosives. If a bunker were indeed located here, that would put the local planning in this area on a par with West, Texas.

It will be very interesting to see how US officials describe the damage and the site where it occurred.

Blast at Parchin Kills at Least Two; Timing Stinks

Detailed information is not yet available, but by all accounts there was a very large explosion east of Tehran Sunday night, around 11:15 local time. Many believe that the explosion took place at Parchin, the military site that has been at the center of controversy raised by those who accuse Iran of carrying out work there to develop an explosive trigger for a nuclear bomb. Some of the most detailed information comes from Thomas Erdbrink of the New York Times:

A mysterious explosion at or near an important military complex rocked the Iranian capital on Sunday, lighting up the skies over the city.

Iranian official sources denied the explosion had taken place at the complex, the expansive Parchin military site east of the city, where international monitors suspect Iran once tested triggers for potential nuclear weapons. But the enormous orange flash that illuminated Tehran around 11:15 p.m. local time clearly came from that direction, several witnesses said.

Officials at Iran’s Defense Industries Organization, though also denying that the explosion took place at Parchin, confirmed that two people were missing after “an ordinary fire” caused by “chemical reactions of flammable material” at an unspecified production unit, according to the semiofficial Iranian Students’ News Agency. There was no word on the location of the fire.

Witnesses in the east of Tehran said that windows had been shattered in the vicinity of the military complex and that all trees in a hundred-yard radius of two villages, Changi and Hammamak, had been burned. The villages are on the outskirts of the military site.

The map below shows the area in question:

Google Map of Parchin showing outlying villages of Changi and Hammamak.

Google Map of Parchin showing outlying villages of Changi and Hammamak.

As seen on the map, Changi is very close to Parchin, but Hammamak is on the other side of Parchin and the two villages are over three miles from one another. A blast fireball that scorched trees over three miles apart must have been quite spectacular.

Many factors go into calculating the strength of blasts, including the type of explosive and what type of containment might have been present. However, FEMA provides (pdf) this rough guideline (via DTRA) of the radius over which various types of damage might be expected to occur as a function of the amount of explosive material used:
Blast radius

Because it relates to assessing damage from terrorist bombs, the FEMA figure breaks the amounts of explosives down into the amounts that can be carried by cars, vans and large trucks. The Times story doesn’t report on how far away from the complex windows were shattered, but the effect of burned trees in villages over three miles from one another suggests that such damage would reach quite a ways. At the very least, it would appear that the blast had the equivalent of more than 10,000 pounds of TNT, and perhaps significantly more than that.

A report from BBC does give a blast radius for window breakage: Continue reading

Reuters Reporter Dan Williams Tries to Help Israel Sell Iron Dome, Ignores Problems

In a story published at 7:28 am this morning, Reuters more or less transcribed a sales brochure for Israel trying to get other countries to buy their own versions of the Iron Dome system. I have written on Iron Dome a couple of times, noting that it amounts to a billion dollar boondoggle and that Congress now wants US contractors to get their portion of the take from the huge funds the US is pouring into the program.

A recent summary of how the effectiveness of Iron Dome has been over-hyped can be found here. The New York Times also addressed problems with Iron Dome here.

Remarkably, it seems that Reuters reporter Dan Williams could find none of this information about problems with Iron Dome while he copied from Israel’s sales brochure for Iron Dome:

Normally, an advanced new weapon system with a battle-proven success rate of 90 percent would have global defense procurement agencies on the phone in minutes. But Israel’s Iron Dome rocket interceptor is yet to prove a hit with buyers abroad.

In terms of operational achievement, tested on the Gaza, Lebanese and Egyptian Sinai fronts, Iron Dome is unrivalled in the arms market. However its uniqueness – developed for a particular threat in a particular place – also limits its appeal to countries dealing with more conventional military adversaries.

But the praise for Iron Dome doesn’t stop there. Later in the piece, Williams says:

So far the system – its effectiveness against Palestinian rocket fire demonstrated beyond doubt since 2011 – has been bought by just one foreign country. Its identity is being kept secret by both sides.

So far, at the time of this writing, about two hours after Reuters posted the article, I have had no response from Williams on Twitter to my calling out his uncritical transcription of Iron Dome effectiveness and Reuters has posted no comments on the story even though I submitted a comment about an hour ago.

Bigger Problem in US Than Ebola: Enterovirus D68 Spreading Respiratory, Paralytic Diseases in Children

Electron micrograph of enterovirus particles. Photo by Linda M. Stannard, University of Cape Town as reproduced in Wong's Virology online.

Electron micrograph of enterovirus particles. Photo by Linda M. Stannard, University of Cape Town as reproduced in Wong’s Virology online.

It has now been five days since we learned that Thomas Duncan, who came to Dallas from Liberia, tested positive for Ebola. His condition has been downgraded to critical, but so far none of his contacts have come down with Ebola symptoms. Because those most likely to have been infected by him are now under close observation and have limited contact with others, it seems quite likely the disease will not spread in the US beyond the small handful of people under close monitoring.

By contrast, the US is in the midst of an ongoing outbreak of a virus that has put many children into intensive care units with severe respiratory illnesses. A handful of children in Colorado initially having respiratory illness have progressed to paralysis of some limbs and have tested positive for the virus. Four children who died from severe respiratory illness have tested positive for the virus but the CDC states that the role of the virus in these deaths is not yet known. Late yesterday, a medical examiner in New Jersey stated that the virus was the cause of death for a four year old boy.

The virus involved in this outbreak is Enterovirus D68. Background on the virology of enteroviruses in general can be found here, courtesy of Wong’s Virology online. There are five groups within the enterovirus genus. By far, the most well-known group is the one that comprises the polioviruses. Enterovirus D68 falls within the newest group of enteroviruses that are designated with numbers.

These are some of the smallest and simplest viruses known. The viral particle contains only a single piece of RNA. Inside the host cell, this RNA is turned into a single protein that then is capable of chopping itself into the four smaller proteins found on the viral coat. There is no membrane around the virus and the particles are stable at acid pH, so inactivation is best achieved with bleach or other disinfectants whose label say they are active against non-enveloped viruses.

The CDC released information on the outbreak on September 12, noting that hospitals in Kansas City and Chicago first alerted CDC to unusual numbers of children presenting with severe respiratory symptoms. The latest CDC information on the outbreak includes:

From mid-August to October 3, 2014, CDC or state public health laboratories have confirmed a total of 538 people in 43 states and the District of Columbia with respiratory illness caused by EV-D68.

The report continues:

EV-D68 has been detected in specimens from four* patients who died and had samples submitted for testing. The role that EV-D68 infection played in these deaths is unclear at this time; state and local health departments are continuing to investigate.

The difficulty for healthcare providers with this virus is that symptoms for those infected can range from very mild to severe. As also seen with poliovirus, only a small fraction of those infected get the most severe form of the disease. In the current outbreak, a very high proportion of the children with the worst respiratory symptoms already suffered from asthma:

Of the 19 patients from Kansas City in whom EV-D68 was confirmed, 10 (53%) were male, and ages ranged from 6 weeks to 16 years (median = 4 years). Thirteen patients (68%) had a previous history of asthma or wheezing, and six patients (32%) had no underlying respiratory illness.

/snip/

Of the 11 patients from Chicago in whom EV-D68 was confirmed, nine patients were female, and ages ranged from 20 months to 15 years (median = 5 years). Eight patients (73%) had a previous history of asthma or wheezing.

Parents and school administrators are being encouraged to monitor children with asthma more closely during this outbreak and to be especially vigilant about measures to prevent spread.

Transmission of the virus, according to CDC: Continue reading

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