Monday, November 11, 2013

Nightmare Scenario

I've posted this particular scenario before on a couple of different comment threads, but I want to post it here. I was doing some extra thinking about this today; I woke up today with a sore throat and while I was out for my walk (a short one because I didn't feel good and it's been a miserable day), I was thinking more at length at what would happen if I wound up sick.

I shell out, on average, 139 dollars a month for health insurance. I'm going to be visiting in the near future to see if I can't possibly get a better deal than what I have, but I've got fairly decent health insurance - that I still have to pay for, and there's still a rather substantial deductible - that is, the amount of money you have to pay out-of-pocket before your insurance, that you pay $139.00 or more for a month decides you've paid enough and steps in to cover the rest (usually to the tune of several thousand dollars - more than I've got right now). Even a thousand dollar deductible is enough to destroy me financially right now; if I need emergency surgery for something, I won't be getting it. I'll likely end up dying, even with the new ACA, simply because nothing was done about deductibles. Or I'd owe several thousand dollars, and I'd have that debt piled on the debt that I already have (and if your response to this is "get a better job," go fuck yourself with a cyanide-laced cactus. What the hell do you think I'm doing, you dumb piece of self-centered garbage?)

I know I can't be the only person in this situation. The ACA is a lot of much needed reform, but it didn't nearly go far enough. As a matter of a fact, it falls drastically short of what's required for basic national security.

How is a lack of easy access healthcare a threat to national security? Well, I hope you weren't planning on sleeping tonight...

(aside) Random words: - Terrorism - Bombing - Airplanes - IED - Plot - Support - Al Qaeda - Shooting - do I have your attention yet, NSA? FBI? Anyone out there? Good. Sit down. Maybe you'll learn something so you can do your damn job instead of spying on exes and spouses. (/aside)

If I got sick, I would have no choice but to go into work. None. I have no PTO (paid time off - this thing apparently exists), being part-time, and I'm not capable of making any hours that I lose up. Thus, if I get sick, I have no other choice if I want to get paid but to go into work feeling ill. Because getting paid is the only way that I can get myself treated. If I get really sick, I still don't have a choice. And I'm not the only one.

Now figure this: the situation I've just described? It applies to just about everyone who's part-time. My company does not care if I get sick; so I don't care if I go in sick. That's my basic philosophy; I will feel like shit, but I will still go into work, because to not go in means I won't get paid and I need that money if I hope to be able to treat want's making me ill.

How many Americans, do you think, eat at fast food joints like Arby's, or Taco Bell, or McDonald's, or Burger King, a year? Do you care to guess? I'd say a lot, wouldn't you? Think about the number of times that you stop off at one of these places; I'd say I eat out maybe five or six times a month, but it depends on the month in question; some months are just harder than others and in addition to being disgusting, McDonald's is expensive as hell.

Most of the people working at these joints? They're part-time.

Which means that if they want to be able to cover their medical bills for getting sick, they can't afford to miss work. Which means they come in, sick, and make your food, sick. And you'd never know, especially if they don't say anything to their manager or their manager simply does not care. McDonald's has proven before that it doesn't care about worker safety; like every other company in existence, loyalty is unidirectional and personal responsibility and ownership for mistakes roll down the pay-grade; values like team work and working hard are things management wants you to learn so they don't have to.

So you've got people who work in the food sector that are willing to come in sick, and make your food, sick, because they have no other option. Isn't that a pleasant thought?

Now hold that thought, because it gets a lot worse from here.

How much do you know about viruses? Viruses are complicated machines, right? I mean, on the surface they seem simple enough - strands of RNA that are carried in a capsid injected into the cytoplasm of the cell  (or nucleus, depending upon type).

Say "hi" to one of the most lethal viruses on the planet
To the right of here is the ebolavirus. Ebola is a very famous pathogen; it's noted for being so incredibly lethal that it kills its host usually before the host has a chance to spread the virus. Most viruses give it time before; there's a period where you're infected but you don't know it (called the incubation period; when we're talking about cells specifically, this is called a eclipse phase - the cell's infected, but it doesn't show any signs of being infected yet). Ebola has an incubation period of around 12 days; one day you get infected, anywhere from 8 to 25 days later, you get hit with the symptoms and usually die pretty quickly after that. One particular strain that broke out in Zaire had a fatality rate of 90%. That means, infect 10 people that you know - your parents, your loved ones, your teachers, your friends - out of every 10 you infect, only 1 survives. What's more, every single instance of non-accidental infection since the 1970s (when it first appeared) has resulted in a fatality rate of over 50%. Go back to our model; select 10 people you love. Only 5 of them can survive. Who lives and who dies? What's worse? There's no only one vaccine and that's not been really tested. Even worse? They proved it spreads through the air, like Influenza (which I'm going to be talking about in a minute, since influenza is a marvelously wicked little piece of natural engineering, and proof that if there is a God, he's an utter bastard).

Okay, okay, so we knew Ebola was scary. Everyone does; that's why it's a level 4 biohazard. It's also been relatively contained to Africa; there was only one outbreak in Renton, Virgina.

Ebola's lifecycle
Ebola is a specific type of virus; it's a gram-negative virus (-) that uses its vRNA to copied to an mRNA, and the virus also brings along a particular enzyme that allows it achieve this, called a RNA-polymerase. This is what allowed it to copy over from an (-)RNA to a (+)RNA, which is then used to produce more (-)RNA (vRNA); meanwhile, that (+)RNA is also used to produce proteins by hijacking the cell's natural machinery; the end result of this is an assembly line that produces the RNA necessary, and the capsid necessary, for more viruses that then go out and infect other cells. As far as I know, Ebola and its variants are not lysic; they don't destroy the cell when they're hatched.

I mentioned another virus above; influenza. Let's take a look at influenza, shall we? Ebola, for all we care, is a world away. It doesn't affect us and our little world. Influenza is different. Influenza happens everywhere. We're all familiar with it - it's often shortened to "the flu" and we see requests for yearly vaccinations (which, mind you, I didn't get this year; I know one of the side effects of vaccination is flu-like symptoms for a few days and hey, guess what? I can't afford to miss work because of those symptoms). The flu is interesting; see, the flu and Ebola are close cousins; both of them are gram-negative viruses. But Influenza is different.

Take a look at nature's self-assembling jigsaw puzzle
As far as I know, Ebola's genome comes whole; you get the whole RNA strain injected in one shot. This means that any mutation that happens to the virus happens because of an error when the polymerase makes a mistake. Polymerases are not capable of fixing these mistakes; these mistakes stick with the genome and are copied over with each consecutive replication. Enough of these errors add up overtime and you get a new virus species.

Influenza's genome isn't like that.

See, when an Influenza virion latches onto your cell, it file dumps. The Influenza genome doesn't come in one piece; it comes in eight. And one inside of the cell, these eight pieces can recombine to form a complete genome (a process called reassortment). This is all done in the cytoplasm of the host cell; once the genome is restructured,  the process of replicating the restructured genome begins. And it doesn't come with instructions; the eight pieces fit themselves together however they see fit at the time. Usually it's in the same manner that existed inside of the parent virion. But not always. It doesn't take an idiot to see how this can lead to enormous genetic variation, but I'm not done yet. Influenza is more than just a self-assembling jigsaw puzzle that comes in one box.

To create an Influenza virus, all you need is eight pieces of genome. Those eight do not have to be from the same virion So if you're infected with multiple types of the flu, some of which might be harmless, all of them are preforming this file dump into your cells. For sake of reasoning let's call them Strain A and Strain B. Strain A has 8 parts - A1 through A8. Strain B has 8 parts, too; B1 through B8.

Strain A is marginally infectious to humans; it'll make you sick, it'll make you miserable, but it's nothing that really runs the risk of killing you if you take good care of yourself. Strain B, on the other hand, is completely harmless. This strain is only lethal to, say birds. But boy is it lethal; nearly 80% lethality rate. Somehow, you get infected with both. Strain A latches onto your cell and file dumps all eight pieces of its genome in that cell. Strain B does the same thing.
Influenza works sort of like this

Remember to get a complete Influenza virus, all you need is eight - count 'em, eight - genome pieces. You've got 16 floating around inside of your cell right now; some parts from Strain A mix with parts from Strain B; now you've got Strain C, which consists of A1, A2, B3, B4, A5, B6, A7, and A8. This is an entirely new strain. And guess what?

This strain is lethal. It's highly lethal.

You went from having something that was bad enough to laying you up for a few days and something that was only lethal to birds to having something with a 80% lethality rating humans. And hey, guess what? I understated the danger here, since the polymerase that's been copying Strain A could've been making mistakes along the way, resulting in Strain A merging with mutated Strain A, resulting in Strain C.

When virologists say these viruses have a lot of variation, kids, they're not joking.

So why am I wasting your time with this? I mean, now you know why it's important to get your flu shot, but that's it, right?

Well, no, that's not it. See, Influenza is dangerous. We don't think of the flu as dangerous, but it was the flu that killed 3-5% of the world's population in 1918 - anywhere from 50 to 100,000,000 people. Don't you think that could happen again?

So, let's get back to practicality here. You have our fast food workers, forced to come into work sick and make your food sick because they can't afford to miss a day; no paid time off, no way to make up hours, none of that, and you need money to get better, and to get money, you need to work, so you need to work while sick to get better. Basic logic. We'd like to think that people wouldn't come into work sick, but not everyone can afford to be that Middle Class White, folks. So we have our fast food staff, who basically feed this nation, and they're very vulnerable to a virus.

Take one determined ideologue, add a chemistry kit, and give them a couple strains of Influenza to play around with. Since Influenza is self-assembling and delightfully infectious, it's the perfect virus for any committed bioterrorist. How hard can it possibly be to get a sample of one of the most common viruses in the world to play with? Hell, it might not even require that much work. It might just happen by accident, since the best things happen on accident; but however you do it, you walk away from it with a very contagious and highly lethal variant of Influenza.

Now let's say you've put two-and-two together and realized there's a massive underclass of people, who aren't protected at all from any sort of virus outbreak, responsible for feeding the nation. The entire nation - or all major urban areas, anyway. Influenza is extremely contagious and very easy to spread; what's more, people (such as myself) can't or won't get vaccinated, either because they can't (like myself) afford to lose days off work owing to flu-like symptoms or because of some vacuous, airheaded ideological reason (really, neither is a good excuse; I've told my doctor I'll go back in December, when I have time off, to get the vaccination, but it'll seriously depend on what else I have going on; I did, however, get the Tetanus and Pertussis vaccinations, though).

All it'd take is one group of committed ideologues to infect themselves and then expose themselves to as many people as possible. Americans, by in large, don't seek out preventative care because they can't afford it.
About 44 million people in this country have no health insurance, and another 38 million have inadequate health insurance. This means that nearly one-third of Americans face each day without the security of knowing that, if and when they need it, medical care is available to them and their families.
Having no health insurance also often means that people will postpone necessary care and forego preventive care - such as childhood immunizations and routine check-ups-completely. Because the uninsured usually have no regular doctor and limited access to prescription medications, they are more likely to be hospitalized for health conditions that could have been avoided
Take a look at that number. Around 44 million people, at the time of that interview. And they completely forego preventive care - like immunizations. That is a huge underclass of people that's just begging to get popped with a nasty flu-like bug that can replicate the cytokine storms of the 1918 flu virus. So our committed ideologues, who have basically sealed their own death warrant, begin to expose as many of these people, including ones in the food service industry, with this new flu virus. Since people won't visit the doctor until it's too late, what you end up with is a mass of bodies that suddenly start turning in emergency rooms with congestive heart failure, inability to breath, drowning in your own fluids, whatever pleasant fate this virus bestows on its victim - and there's no vaccination.

Oh, but because they hit the food service industry, it spreads even faster. If you take your virus and give it an incubation period of about 25 days - during which the infected is still contagious but they aren't showing symptoms yet themselves - how many additional people do you think they can infect? How many people do you think will get infected by the ones they infected? If one person infects even 10 other people per day (not an outrageous assumption, assuming that you made your virus very contagious - as the flu tends to be), that's nearly 70 infected people by the time the week is over. Now, 70 does not a pandemic make; but you've to figure how many people those 70 are going to infect; if you're good a figuring exponential increases, you can probably figure this easier than I can., but it comes out to a lot of people infected in just that first week. Just because you're infected doesn't mean you'll show symptoms, mind you, and it doesn't mean your immune system won't just beat the virus back - unless, of course, you're looking at the type of influenza that triggers a cytokine storm. A cytokine storm is when your immune system attacks itself; and the stronger your immune system, the healthier you are, the more likely it is to kill you.

By the time this blows up, our ideologues are already dead. The people in the food service industry, the people in the service sector in general, are helping to spread it because hey, it's just the flu, and you can't afford to take that time off work. It's spreading like wildfire. People are finally rushing to get the care they need - or maybe not, since a hospital bill is still really expensive when your deductible is a couple thousand more than your total personal worth and your co-pay is the difference between your kid eating lunch that week and not.

So, you tell me - how many people do you think will die as a result of this attack?

Will you be one of them?

I brought up bioterrorism because everyone flips their shit about terrorism in general; we're a nation of fucking cowards who shove our heads in our collective asses at the first sign of danger. A much more likely scenario? This all happens on accident.It doesn't take a lot to get a new influenza virus. We're generally good about catching it and isolating it before it can spread, but all it takes is one with an incubation period that's a little longer than average, with twice or more the lethality, and you're looking at a Pandemic.

By relying on the private market for insurance, and forcing people to ration insurance, we're begging, practically begging, for a pandemic - natural or man made.

So how do you prevent this from becoming a reality? Well, if you're an American, this is done one of two ways:

1. Shove your head in your ass and pretend it's not a real threat. What's on TV tonight? Odds are, you may be right. We might never see a dangerous pandemic.

But then, knowing what you know about Influenza now, do you really want to take that chance? It takes a lot of copies of the new viron RNA to generate a new species, but it happens easier with Influenza than it does with other (-)RNA viruses simply because of the packaging.

Know also that the United States is very good at ignoring pandemics. Gonorrhea - which, mind you, is verging on superbug status and doesn't have many antibiotics left you can treat it with - may be an epidemic. But when was the last time you heard of that?

2. Do what Jesus would do: fire people who come into work sick and refuse to leave work because they need money. At least they don't infect the rest of us as they slowly die in the streets, right?

Do note that I only talked about viruses. I could've instead talked about how we're running out of antibiotics that can be used to treat bacterial infections - and the great and glorious Free Market God won't be offering a solution any time soon because it's more profitable to turn out Viagra and Cialis than it is a functional antibiotic to treat a superbug (bolding mine):
…Infections are not that common compared to other types of conditions like high blood pressure or high cholesterol. It’s a reality that many of the drug companies left this market [antibiotic research] because of financial realities that are placed on them. These are companies that are for-profit companies, and like you said, they have to answer to people. They have to develop drugs that will make money, and that’s not an antibiotic.
So there's that little bit to think about. 

So what's the take away, then?

Well, for starters, anyone who opposes a socialized healthcare system, or any kind of system that offers free care for all its citizens based on tax income, has no room to be talking about national security, since this is a huge national security risk. To hear them babble on about the border is a fucking joke; they don't care, really, they only want to insult brown people and act racist without being called it. They're weak on national security, because they're more interested in themselves and their pocket books. Kids, you can't take your money with you when you die. Viruses don't care whether you're rich or poor, but if you're rich, you're likely to have access to better care than if you're poor.

Second, this situation we're in right now - a large population, mostly poor, supporting a small upper class while working our asses off - is roughly analogous to the one set up in the 1300s. You know, the one that the Black Death toppled. A massive die off of people would, only slightly, upset the economy and society. But that's okay, since as long as I have my head lodged between my lower intestine and my colon, it's not happening.


Ed. Note: I personally do not have the experience necessary to create a virus, nor do I have the resources, nor would I even if I did. I've always been more of a theory person rather than a doer; but that doesn't exclude others from doing it.

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