Why Ebola spread in Dallas: Americanism

Lorenzetti’s Allegory of Good Government, 1339

We’re number one.  That’s what we always tell each other.

We have the best health care in the world.

Our public safety institutions are number one in the world.

We  are the richest country in the world.

We are supremely over confident.

How many people know that when Dr. Kent Brantley and Nancy Writebol returned from Liberia with ebola that their care was paid for by Samaritan’s Purse?  I’ll bet a lot of us just assumed that the US government picked up the tab for the flight, biocontainment units, ZMapp doses and hospital stays.  Not so.  So, who is paying for the transport and treatment of Nina Pham and Amber Vinson?

Probably a few more of us have questioned whether money was behind the shoddy care that Mr. Duncan got in Texas.  I have.  I’m betting that his lack of insurance and status as a foreign national had a lot to do with why he wasn’t immediately isolated when he first came to the hospital and why he was left in the ER for hours, some nurses say days, before he was transferred to a critical care unit.

As for the best health care in the world, the nurses were very unprepared for ebola.  The biggest chunk of the blame goes to the hospital.  It’s a hospital for the middle class and those who can afford the best health care in the world.  That’s where people go to have their babies and bypass operations.  Maybe they didn’t associate their kind of hospital with an epidemic in a third world country.  Bad things happen to THOSE people over there in Africa.  Not their kind of people in Dallas.  At best, that’s a benign form of American narcissism.  We’re so used to having clean water and streets and good food.  So, why should the hospital get all Girl Scouty and be prepared for a situation that will never happen to it?  Training for such an eventuality takes time from nurses doing their duties and time is money.  It’s the American way.

The CDC seems to have vastly overestimated the outcomes of our educational institutions, especially our K-12 schools, where everyone should have a pretty good understanding as to where Liberia is.  But then again, Liberia was a state created by former American slaves in the 19th century and Texas is a state notorious for trying to rewrite the past when white Americans might have done bad stuff to anyone.  But still, don’t these ER intake people, nurses and doctors watch the news??  At least one nursing supervisor seems to have been on the ball and insisted on moving Mr. Duncan to an isolation unit instead of letting him shed viruses all over the ER but she was shot down by her administration.  Still, you’d think that a hospital so concerned with its reputation and profits would have been more proactive in limiting the damage that his presence was causing.  Not so, apparently.

And what was the hospital thinking when they gave antibiotics to Duncan when they hadn’t bothered to find out whether he  had a bacterial infection that required them?  Does Texas Health Presby Hospital routinely overprescribe antibiotics?  Is this a hospital or a student health center?

What were Republicans and Democrats thinking when they cut the budget for the CDC by 12% and the NIH by 20%?  Friedan said yesterday that $30 million was restored earlier this year in an “anomaly”.  How the hell are you supposed to prepare for emergencies if you never know what your budget is going to be from one year to the next?  We complain about administrators making decisions for our health care instead of physicians but our bigger problem is that we have politicians making decisions for our disease fighting institutions.  Should the CDC and NIH know in advance what diseases are going to become epidemic on some kind of 5 year plan and ask for the right budget money in advance?  Or are their functions compromised by their unreadiness brought on by this reckless political posturing?

And everyone, politicians, journalists and people who should know better, is under some mistaken belief that the private sector is going to step up and perform the tasks in research and disease prevention that the CDC and NIH were created to do.  But they’re too busy trying to reap profits for the shareholders to engage in such money sucking activities like research. Meanwhile, we underfund the NIH and CDC.  Is that so Republicans can point to what a sh*%%y job government does?  Are they paying no attention to how our scientific infrastructure is being dismantled in this country and concentrated on a few narrow therapeutic areas?  They are leaving a gap that no one is able to fill.

This may be the richest country in the world but the riches are hoarded by some pretty selfish individuals and we don’t seem to be able to get our act together to force them to give up their loot for the greater good.

A little ray of hope came through yesterday when I saw that some television content providers are breaking away from the package deals offered by cable companies to allow viewers ala carte channel selection.  That’s great because eventually I will no longer have to subsidize right wing propaganda from Fox News or be forced to pay for Fox to mislead unsuspecting American viewers.  I’m betting that a lot of like minded individuals across the country will drop Fox from their lineup the second they are able to do it.

But the damage may already be done.  The Senate may fall into Republican hands this November and in the next two years, the predators who have been stalking us since FDR got us out of the Great Depression will finally be able to finish us off.   The willfully ignorant elderly and angry white males will finally stick a fork in us, and allow the extremists to carelessly destroy Social Security, roll back women’s rights and plunge us back into recession with unrestrained austerity.  The only thing that will stand between the power extremists and us will be Barack Obama.  That right there is a very depressing scenario.  But maybe he will have the courage to stand aside when we finally pick up our torches and pitchforks.

We have been living a myth of our greatness.  We’ve been in denial about how government works.  We have told ourselves lies about how we can “starve the beast” that once made our country a formidable force of good around the world.

I’m only glad that the ebola crisis here will be under control before the next session of Congress begins and before the gung-ho, American exceptionalists who take over show us just how unexceptional we are to the hunters who prey on the young, old, and weak.

Section from Lorenzetti’s Effects of Bad Government, 1339

 

More speculation and budget numbers at Angry Bear Blog.

Live Blogging the Congressional Hearings on US Ebola Response

Disclaimer: This is not a panic/hysteria site.  We’re interested in learning all we can about the US response to the disease and whether our governmental institutions are funded adequately to respond optimally.

With that in mind, you can watch the hearings online at PBS.org.  So far, we have had opening statements from the CDC (Friedan), NIH (Fauci), BARDA (Robinson), FDA (Borio) and a representative from Texas Health Presbyterian Hospital.

The most notable announcement so far was from Anthony Fauci from the NIH.  He says that Nina Pham will be transferred to the NIH this evening for further treatment.

Also note that there will be a lot of Republicans and Democrats on this committee who voted to cut the budgets of these institutions when they approved the sequester.  So, keep that in mind when you listen to these bloviators.

And, now, on with the live blog.  Geeks are encouraged to comment because I’m pretty sure there is going to be technical information presented, especially wrt to drug discovery efforts.

 

A reminder about ebola treatment

There are a couple of articles about the guy who arrived from Liberia who turned up at a Dallas hospital with ebola.  One is from the DailyMail (UK), which sounds like breathless hysteria inducing gossip mongering, and the other is from Reuters.  I’m going with Reuters for veracity.  In either case, it sounds like this could be serious.  Wait, here’s one more from NBC.

The patient, Thomas Duncan (I’m not using the middle name because he’s not a criminal), reportedly carried an infected pregnant woman to a hospital in Liberia.  That woman later died from the illness.  Then, he takes a flight to Texas.  He’s allowed on the flight because he is symptom free.  Ok, that’s mistake number one.  He probably should have been held in quarantine for the length of time of the incubation period, which can be up to 21 days.  Actually, it probably doesn’t matter if the quarantine happened in Liberia or Texas, though presumably it mattered a great deal to his fellow passengers.  Nah, I’m going with my gut here.  If you’re trying to leave Liberia or one of the other most heavily infected countries, you should be subjected to a quarantine to prove you’re not a carrier.  If Liberia couldn’t do it, Texas, or some other connecting way station in the US, should have.  But then, this is Rick Perryland.  My condolences to relatives that live there.  I know they didn’t vote for him.

Come to think of it, there’s probably going to be a backlash against the African community in Texas that Perry will likewise fail to prevent.  And Texas has all those gun totin’, constitution wavin’, do gooders.  If there is a spread of ebola, plugging one of the patients and allowing infected blood to spill all over Dallas is probably only going to exacerbate the problem.

Which leads to the next issue.  According to the DailyMail (remember, gossip mongering), Mr. Duncan went to a hospital in Texas complaining of symptoms and told the health care workers that he had just arrived from Liberia.  That’s L-I-B-E-R-I-A.  You know, the place with all the sick and dying ebola victims?  That have the same symptoms that he was displaying?  They sent him home with antibiotics.

Now, either somebody wasn’t listening to him or they have the stupidest treatment team in the world in Dallas.  Antibiotics are completely useless against viruses.  I’m going with option one- someone wasn’t listening.  Well, you know, there was probably a language barrier.  I’ll leave it at that.

The NBC article says that Mr. Duncan’s nephew had to call the CDC after the initial treatment in Dallas.  Even he figured out that the health care professionals in Dallas weren’t taking this seriously:

Health officials have acknowledged that Thomas Eric Duncan, 42, was initially sent home from Texas Health Presbyterian Hospital in Dallas when he showed up on Sept. 26 complaining of fever and abdominal pain. He had to return two days later in an ambulance.

That was the day “I called CDC to get some actions taken, because I was concerned for his life and he wasn’t getting the appropriate care,” Duncan’s nephew, Josephus Weeks, told NBC News on Wednesday night. “I feared other people might also get infected if he wasn’t taken care of, and so I called them to ask them why is it a patient that might be suspected of this disease was not getting appropriate care?”

Weeks added that he hoped “nobody else got infected because of a mistake that was made.”

Maybe the insurance time clock alarm went off and the hospital thought he looked remarkably well that morning.  It was probably just a coincidence.

So then Mr. Duncan’s condition worsens.  His family calls an ambulance to take him to the hospital. Before he gets into the ambulance, he vomits all over the sidewalk.  His family is screaming their heads off in panic.  We have no direct evidence that the ambulance team recognized the danger to themselves or others or whether they called a HazMat team or whether they sprayed the area with chlorine and took all of the family members immediately into quarantine.

Hey, this is a convenient time to remind all those right wingers out there that even if you don’t have insurance, the ER is not allowed to turn people away!  Yes, a man in Duncan’s condition can make repeat visits to the ER and vomit all over the chairs while he patiently waits there for hours to see a doctor while the other health care workers obliviously prepare another dose of antibiotics.

Do we know whether Mr. Duncan has insurance?  He’d better because no one in Texas without insurance is allowed to get ebola.  Perry didn’t expand Medicaid. Update: Duncan is not an American citizen.  He’s just here for a visit.  So, we can guess that one of the reasons why the hospital didn’t keep a sick Liberian who was showing signs of possible ebola infection when he first showed up is because they were concerned with the costs.  Oh, yes, my best beloveds, hospitals are more than willing to toss sick people out when it starts to get too expensive for the insurance company.  We have been there.

We really need an investigation of the behavior of the hospital that discharged Mr. Duncan to discover whether this was the result of a bad cost-benefit calculation.  Did the hospital just take a wild bet that Mr. Duncan did not have ebola so they wouldn’t have to keep him in an expensive isolation unit?  Enquiring minds want to know.

Now we come to the treatment phase for Mr. Duncan.  It turns out that ZMapp, the monoclonal antibody (not antibiotic, pay attention, there is a difference), is no longer available.  The DailyMail calls it a “miracle” treatment.  That’s not surprising for the DailyMail but it is misleading, stupid and demonstrates a complete lack of understanding on the part of the “journalist”.  ZMapp is an experimental treatment that had an n of 7 primates before it was thrown into humans.  If the barrier for proving efficacy was that low when I was still in drug design, my project teams would have made the companies I worked for billions several times over by now and would have cured obesity, depression, alzheimer’s disease, multiple sclerosis and several different kinds of cancer.  In other words, there’s not much evidence that ZMapp has cured anything yet.  Sure, a couple of patients took the drug but they had excellent care here in the US and that alone might have been enough to cure them.  The body *will* recover on its own if it can stay well enough to mount a vigorous immune response.

Anyway, ZMapp monoclonal antibodies are grown in tobacco plants.  My lab partner had more experience in growing proteins in plants so she could probably talk about this in more detail.  But from my own experience growing proteins in insect cells and e coli, I can tell you that the amount of protein recovered could be minute and the amount varied based on the conditions the cells were grown under.  Grow them too fast or neglect them for even half an hour and you might have to start all over again.  Growing in tobacco plants would seem to give the company a little more control over the product but it still takes time.  Then there is the issue of purification, which still can seem like an art form in some cases.  And the damn things have to fold properly AND they have to not aggregate, which I understand is an issue with antibodies.  They loves to aggregate.  Even if they grow the tobacco at lightening speed and collect as much ZMapp as they can, it’s going to be small quantities of an unproven drug.

Come to think of it, you have to wonder why governments, including our own, are not calling on all of the out of work drug discovery professionals to lend a hand.  Oh, that’s right.  We’d have to be paid and as we all know, government isn’t good for anything.

So, don’t count on Mr. Duncan to receive any miracle cures.  Let’s just hope he gets decent care in Texas to help his body ride out the storm.

In the meantime, I have read that Glaxo Smith Kline (GSK) is trying out a vaccine.  I haven’t heard a lot about this but vaccines are generally good things, unless you’re Jenny McCarthy or some clueless control freak, overeducated but bored, suburban helicopter mom who managed to get through college without ever taking a basic biology course.  How much you wanna bet a whole lot of them in Texas suddenly get religion when it comes to vaccines, demanding on TV with righteous indignation that GSK provide freebies of an almost untested, non-FDA approved vaccine? There’s a satire just waiting to be written but it really isn’t funny.  Anyway, I hope it can produce some kind of immune response but it’s probably too late to help Mr. Duncan.

As for the rest of Texas, let’s hope it can survive the bumbling first responses.  Since Mr. Duncan returned to the US, he has had ample opportunity to infect his girlfriend’s kids- who go to school. (See paragraph above)  His poor girlfriend is probably in jeopardy if they had sex without a condom because the virus can persist in semen for a time even after the patient recovers. Well, I’m still not panicking but I’d feel a lot more confident about a vigilant response if Mr. Duncan had landed in Hawaii where everyone is insured, there’s a whole ocean separating the islands and there’s a history of treating people with infectious disease.

Somedays, it just seems like Texas is giving the rest of the country the finger.

 

This week in STEM: Annnnd a NEW round of job cuts!

This morning, Microsoft announced a new round of job cuts.  It recently acquired Nokia and that seems to be where the bulk of the 18,000 hits are going to come from.  Let’s try to parse why they’re doing this, shall we?  Here’s an explanation from new CEO Satya Nadella:

The larger-than-expected cuts are the deepest in the company’s 39-year history and come five months into the tenure of Chief Executive Satya Nadella, who outlined plans for a “leaner” business in a public memo to employees last week.

“We will simplify the way we work to drive greater accountability, become more agile and move faster,” Nadella wrote to employees in a memo made public early Thursday. “We plan to have fewer layers of management, both top down and sideways, to accelerate the flow of information and decision making.”

The size of the cuts were welcomed by Wall Street, which viewed Microsoft as bloated under previous CEO Steve Ballmer, topping 127,000 in headcount after absorbing Nokia earlier this year.

“This is about double what the Street was expecting,” said Daniel Ives, an analyst at FBR Capital Markets. “Nadella is clearing the decks for the new fiscal year. He is cleaning up part of the mess that Ballmer left.”

The goal is to simplify the work process.  That sounds good.  Everyone likes simplicity.  It makes work easier to deal with if the path forward is cleared of unnecessary complexity and clutter.  But that’s not really why they’re simplifying, is it?  The goal of the simplification is actually to “drive greater accountability”.  On the surface, this also seems reasonable until we stop to consider, accountable to whom?  If you’ve been paying attention in the last decade, this usually refers to shareholders.  Shareholders want greater accountability.  Does that mean they want a bunch of reports and retrospective analyses to peruse at their leisure to make sure everything is being done with an eye towards simplicity, agility and speed?  Probably not.  Accountability is generally a code word for shareholders wanting to see that they’re not spending a penny more on people than they absolutely have to so that they can increase the amount of money they can hoard get for their shares.  It will be up to these 18,000 people to account for their existence.

It sounds like they’re going to get rid of management- everywhere.  Good luck with that! </snark>

Finally, we see that Steve Ballmer left a mess.  Not sure what that’s all about since I’m not in the software side of tech and I only use Microsoft products under duress.  But just because the company now has 127,000 people doesn’t mean that some of them necessarily have to go.  Unless they need to be accountable, of course.  I’m sure this comes as no surprise to the workers at Nokia but no one forced Microsoft to buy them.

So, to recap, Microsoft buys struggling cell phone manufacturer Nokia, drinks its smooth and tasty patent milkshake and discards the worker bees because they are no longer sufficiently accountable.

If anyone is still wondering why the US doesn’t make anything worth exporting, look no further than this layoff announcement and the rest of the carnage happening at IBM, Cisco, Intel and Hewlett-Packard.  It looks like a bloody hemorrhage this month.  There will be a lot of tech workers hitting the virtual pavement.  Contrast this with the way Germany handles its STEM workers.  When times get tough, they reduce their hours to part time and keep their wages high.  That way, when the economy recovers, they can rev their engines up again and work productively with a work force that has not lost its critical skills.

German shareholders and the government work together in a smart way to ensure they have the skills to compete in the market later.  American shareholders and government?  ehhhhhh, not so much.  Finland (the home of Nokia) must be thrilled with Microsoft’s announcement, even though they must have been expecting it since the acquisition.

Someone should tell the Microsoft people to stop referring to its workforce as a “mess” that needs to be cleaned up.

In the meantime, Derek Lowe wrote another post about the prospects of new Chemistry PhDs.  It looks like the number of post docs has gone down in recent years and the number of unemployed PhDs has gone up.  So, to recap, you spend 4 years as an undergrad and about 5-7 years getting your PhD in a very difficult subject that demands sharp, innovative thinking and many thousands of hours of lab work and what do you get for your hard work?  Not much.

Paraphrasing what a former colleague told me in 2009, when it comes right down to it, the reason why employers say they can’t find good help anymore is because what they want, what they really, really want, is a new graduate with 25 years of experience.  I would add, and someone who they can make accountable whenever they please.

Hey, did you hear about the CDC losing track of influenza and smallpox vials?  Funny what persistent underfunding and a round of sequestering will do to your disease control mechanisms.  I’m not surprised after what I heard during my trip to Cambridge, MA in May.  A recent visitor to the CDC said that the place is demoralized and disorganized with co-workers not even knowing who was in their groups.  I don’t blame this on government since the CDC didn’t used to be this FUBARed.  No, I blame it on the authoritarian nut cases in the Republican party whose intractable, unyielding, “take-no-prisoners”, never compromise, never surrender attitude and actions are putting the rest of us at risk.

We need to hold them accountable.

Oh, by the way, congresspersons who vote for more H1B visas in the immigration bill before the excess glut of American STEM workers are re-employed should be vigorously primaried.

 

Thursday: Chrysler, Cytokine Storms and Crowd Control

Eight years of the Bushies have left me paranoid.  I suspect there is a dosier on me in the Department of Homeland Security, I worry about being able to get on planes, and periodically I say “Hi!” to the NSA when I’m on the phone.  It’s hard for me to see myself as a threat to anyone but distrust has become ingrained in many of us since 9-11.  I don’t like to think ill of our government but something feels deeply weird about the recent flu pandemic.

But before I get to that, the big news today is that Chrysler is on the verge of bankruptcy due to the recalcitrance of bondholders to strike a deal with Treasury.  That’s right, banks and hedge funds have been holding out expecting that the government will sweeten the pot instead of forcing the automaker to bankruptcy court where assets will be sold and thousands of jobs lost.  What happens to Chrysler will surely happen to GM and when that happens, I would expect to see a lot of very angry autoworkers who will see their way of life disappear due to the unchecked greed of bank and hedge fund managers. And this is partially due to the gentle handholding that the Bush and Obama administration have been giving the banks since they lost all of our money.  It could get really ugly.  James Kwak at Baseline Scenario has more to say about banks and the government in a Cuban Missile Crisis scenario that will make your blood boil.  Just go read it.

Back to the flu thingy.  Mexico has now issued directives on crowd control due to the “pandemic” swine flu:

The president said a shutdown of a broad range of public services and activities would start Friday and continue through Tuesday, encompassing the long Cinco de Mayo holiday weekend. Most federal offices will be closed; restaurants, schools and museums will remain shuttered; and spectators will be barred from all professional soccer matches.

Churches are expected to be nearly empty on Sunday.

The measures came as the World Health Organization raised its alert level on swine flu to Phase 5 on Wednesday, based on the flu’s continuing spread in the United States and Mexico. Phase 5, the next-to-highest level in the worldwide warning system, has never been declared since the system was introduced in 2005 in response to the avian influenza crisis. Phase 6 means a pandemic is under way.

Worldwide, at least 10 countries have confirmed cases of swine flu.

“All countries should immediately activate their pandemic preparedness plans,” Dr. Margaret Chan, the W.H.O. director general, said at a news conference in Geneva. While she emphasized the need for calm, at times she spoke as if a pandemic had already begun, saying, for instance, “W.H.O. will be tracking the pandemic.”

Now, I’m not a health professional but this seems to me to be a bit of overkill.  I have to assume they know something I don’t but so far there is no evidence that this particular flu triggers a cytokine storm.  A cytokine storm is what killed young healthy adults during our worst flu pandemics in the past.

triggering a cytokine storm

It was the reason for half of the deaths from the 1918 Spanish Flu and was also present in the Asian and Hong Kong flus of the recent past.  A cytokine storm is what happens when your immune system takes it up to 11.  The body sort of overreacts to the flu antigen and unleashes an immune system “storm” of macrophages, T-cells and other elements of its defense arsenal.  Usually, there is a feedback mechanism that tells the body to stop before it goes too far and damages itself.  In cytokine storms, the feedback mechanism doesn’t get triggered so the body can’t stop itself.  People with robust immune systems, where all systems are ‘go’ most of the time, tend to fare the worst during these kinds of flu.

But here’s the thing.  As recently as yesterday, the CDC bulletin on Swine flu makes no reference to a cytokine storm.  It just looks like a normal seasonal flu with the expected symptoms.  The people most at risk are the typical populations: kids under 5, senior citizens, people with compromised immune systems.  Nevertheless, Mexico is closing up shop, going on siesta and cancelling tickets to their soccer games.  It seems a bit extreme.  The only thing I can think of that would provoke this kind of reaction is that the vaccine makers didn’t see this one coming and they don’t have a vaccine ready.  So, we’re all kind of vulnerable- to a typical flu.  If you get it, you can expect to be sick and uncomfortable.  You probably won’t be able to take the cheap anti-virals to make it less bad.  And if you fall into one of the high risk groups, it could be serious.  But other than that?  It’s not like 1918. There won’t be body laden carts driven by lackadaisical smartasses crying, “Bring out your dead!”

Having a country on lockdown seems counterproductive to me, especially in a bad economy.  Not all of us can work from home and some of our employers have made that pretty impossible these days anyway.  I suspect that such a directive could make the economic crisis exponentially worse.  But yesterday as I went into work, there were signs posted on the doors telling people to not enter the buildings if they had a runny nose, sore throat, fever or cough.  I considered for a moment whether my scratchy throat was due to spring pollen or some deadly plague and decided that going through the medical review team gauntlet was probably not worth the day off and went in.  But still, you have to wonder why we go to these extremes over a typical flu.  Maybe we’re just covering our asses.  Maybe we just can’t deal with illness these days when everyone expects a quick cure and a shot for everything.  Or maybe it’s just a perfect excuse to keep everyone scared and indoors.

I told you I was paranoid.

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Tuesday: Influenza as Infuence-ah

I waited for my mom to call yesterday.  Any minute now, I thought.  She was in hysterics over the bird flu epidemic that never materialized a few years back.  At the time, I had to patiently talk her off the ledge:  There are many steps from chickens to people.  First, it has to be virulent in the bird population.  Then it has to be transmissible to humans, no mean feat.  It helps if you live on a poultry farm.  Do you live on a poultry farm, Mum?  No?  Well, that’s a relief.  Then, when it jumps to humans, it could simply stop there.  That’s right, it doesn’t have to go any further.  To be transmissible *between* humans, it has to mutate again.  And to be really deadly, it has to be spread really easily.  More mutations.  I mean, Bush is jumping the gun but if you’re really worried, you can track the mutations of the virus sequence  on one of the federal health sites.

That calmed her down for about 2 days before the next *ping* from the department of homeland security.  She called yesterday afternoon at about 2:30pm with some chit chat about Memorial Day plans before she hit me up on the Swine Flu Panic of 2009.

This flu is different.  First of all, it helps if you keep swine in your backyard.  Boyfriends do not count.  It looks like it can be spread to people but in the end, it’s still just flu and despite the fact that it seems to be out of season and somewhat more debilitating, the standard rules apply:  Wash your hands, stay away from people who are sick, do not touch surfaces of things a sick person might have touched, if you get sick, see your doctor for any available anti-viral meds, blah, blah, blah.  The vaccine manufacturers are probably already on it.

So, it’s a health problem.  But a worldwide catastrophe of Armageddon like proportions with the horseman of death stalking the rolling green hills of central Pennsylvania?  Probably not.

What it may be is a way for Obama to get his HHS nominee appointed as quickly as possible without the Republicans sitting on the nomination and pointing out more culture war related inconveniences.  As the NYTimes reports in its editorial today:

While health officials scramble to keep up with the fast-moving virus, it is deeply disquieting that the Obama administration has few of its top health officials in place. The Senate, delayed by Republican objections, is finally scheduled to debate the confirmation of Kathleen Sebelius on Tuesday to be secretary of health and human services. And the White House has yet to announce a nominee for director of the Centers for Disease Control and Prevention. Those are two of the most important positions for dealing with an infectious disease epidemic.

Ok, this is ridiculous.  It is nearly May.  Obama was elected in November.  In six months, he hasn’t even got his cabinet in place?  He doesn’t have a head of the frickin’ CDC?    Please.  Do not tell me that this economic crisis has consumed so much of his time that he hasn’t put together a roster of people to fill the remaining slots.  He should have gotten that together back in June of last year.  What the hell is going on here?

So, this is what he’s reduced to: panicking the citizenry, just like Bush used to do, in order to get his way and leapfrog over the confirmation process.  Don’t get me wrong.  Republicans are reprehensible when they hold up nominations like this over trivialities and put us all at risk for a really serious problem.  But this is not a well run executive branch if its cabinet positions are still pending after 6 months.

Still, I’m only mildly surprised.  I never did have much faith in government by shmooze.

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