My recent blog posts have generated a lot of controversy. On the one hand, there are those who agree that there should be a ban on issuing visas to Ebola hot zone nations, as well as mandatory quarantines for returning medical workers. On the other there’s a vocal contingent that feels that science doesn’t support that.
My position is clear. We have a deadly, virulent pathogen with 70% mortality rate, for which there’s no cure. It doesn’t present with any fever 13% of the time, so that marker, for screening, or for quarantine purposes, is meaningless as a protective measure. And 5% of those who will fall prey to Ebola do so after the 21 day incubation period is over – up to 42 days after, so the 21 day quarantine is guaranteed to fail to catch one in twenty of those who will go on to have it, infecting plenty as they go.
There’s been a lot of hand-wringing and arguing by the vocal contingent that feels that quarantines are part of the “hysteria” that folks who don’t understand the issue with their keen insight fall prey to.
That’s badly mistaken. But that’s what they believe, generally without having done much, or any, research beyond watching the news and reading an occasional Yahoo article. Of course, they also feel they shouldn’t have to know anything besides what their heart tells them. Research? That’s for crazies. Who’s got time to research?
The arguments are always politically motivated, with no basis in science. But they’re strident arguments. Usually peppered with pejoratives. “Hysteria.” “Scare-mongering.” “Panic.” “Loons.” That sort of thing.
The problem is they lack any merit.
I tend to be skeptical of all claims, and use logic, science, and research, to arrive at conclusions. And I listen to acknowledged experts. For instance, a premier heart surgeon’s opinion carries significantly greater gravitas than someone who’s read two articles about the functioning of the heart on Web MD.
Enter a man, a doctor who won the Nobel Prize for Medicine and Physiology in 2011. He knows a thing or two about Ebola, and about epidemiology. One could argue he knows more than most living on the planet. Certainly more than politicians or clueless media hacks. He’s about as big as it gets on the topic, and he has spoken.
Guess what? He favors strict quarantines. For the exact reasons I have been arguing.
Surprised? Why would you be? I talk to a lot of doctors. They universally think the political BS that’s driving policy decisions on Ebola are likely to result in a lot of people dying who could have avoided it, because the measures that are in place have very little value.
And the NY doctor who lied about his self-quarantine? The nurse in Maine who refuses to comply with her quarantine? They are either complete dolts willing to endanger everyone as tribute to their narcissism, or they are deliberately trying to endanger their fellow man. Those are the two possibilities. I frankly don’t know which it is, and don’t much care.
I do know that the debate about quarantines is misguided foolishness. Of course you need to quarantine anyone who could spread the plague, especially given that 13% won’t have a fever even when their viral loads are through the roof.
But don’t take it from me. Take it from the 2011 Nobel Medicine prizewinner in medicine. I think we can all agree that makes him more up on the topic than anyone reading this blog. If you still feel your opinion is superior to his, I invite you to share your Nobel prize in medicine with us so we can grasp what the good doctor missed.
Of course, the vocal denier contingent, like Holocaust deniers or those who are convinced the earth is flat, won’t be swayed by one of the world’s foremost experts in the subject telling them they’re sadly mistaken. Because they have a unique grasp of the truth.
Normally I wouldn’t care. But this is the future of the U.S., and the entire continent, we’re talking. Isn’t it about time to start listening to the adults, and not those with foolish political agendas?
We are staring a full blown epidemic full in the face, and the politicians and CDC are inviting potential carriers into the country at a rate of 150+ per day, in spite of the fact that most hospitals are not equipped to deal with a BSL-4 pathogen, ensuring it will spread when the infected show up at their local medical center. The CDC, the President, and a bunch of idiot health care providers are arguing against quarantines – which the Nobel prizewinner says is a recipe for epidemiology disaster. Guess how many arguing against quarantines are experts on epidemiology? None. They’re political creatures advancing a political, ideological agenda, not good science.
Which should scare the crap out of every thinking person. It’s akin to giving the sixteen year old the keys to the liquor cabinet and the car, and asking him to voluntarily behave while you’re out of town for the week.
It won’t end well.
For those who are convinced they “know” that Ebola can’t survive very long on something like a subway poll or an airline armrest, I’d invite you to read this summary of a 2010 study that shows that knowledge to be completely wrong, as well.
See, that’s the problem with researching things to the point you actually understand all the aspects, versus spouting off whatever uninformed opinion you developed from watching the news or reading Wikipedia. These things are knowable. Most just won’t spend the modicum of effort to be informed. Usually because it runs counter to their agenda.
Which places us all at tremendous risk.
Here is commentary from an ER physician that was published today in the Minneapolis StarTribune. It says precisely what I’ve been saying:
Statements stating that quarantine of Ebola-exposed healthcare workers is not supported by medical science are misguided.
It would be true to say that quarantine takes into account best current medical knowledge and considers the vagaries of disease presentation, difficulties with protocols, the unpredictability of human behavior and the incredible risks involved.
Repeatedly it is stated that individuals are not infectious until they are symptomatic. Where is the large scale data supporting this? At what point is someone deemed symptomatic? There is considerable uncertainty here. Sources citing “symptomatic’ doctrine invariably cite fever – suggesting that if no fever there is no risk.
An elevated temperature is a “sign”. It is an objective manifestation of a disease process that can be seen, felt or heard by an examiner (e.g. rash, mass, heart murmur, abnormal reflex, etc)
Feeling “feverish” (hot, chills, fatigued, etc) is a symptom. Symptoms are sensations perceived by a patient (e.g. pain, nausea, weakness, muscle aches, etc). Multiple times I have seen patients for an unrelated injury (e.g.laceration) and they are incidentally found to have a temperature but do not “feel” feverish or suspect their temperature is elevated (i.e. are not symptomatic).
Additionally confounding is the fact that disease presentations are variable. Every experienced clinician has seen atypical presentations of disease – it is commonplace.
The clinical upshot of these realities is that it is difficult to identify when symptoms begin, and sometimes symptoms are not present in spite of a sign suggesting illness (e.g. fever/infection).
One could make the case that the NYC physician (fingers crossed for this caring man’s recovery) was symptomatic on Tuesday (noted he felt weak) but did not develop temperature and seek attention until Thursday. Do we really know with certainty at what point exactly he was capable of passing on the disease (a kiss, a nosebleed, severe trauma and ambulance transport to the ER, other?)
The fact is that we really don’t know as much as press releases suggest we do. The biologic and medical manifestations/consequences of disease are not as cut and dried as reports suggest. The art and science of medicine involves consideration of what is not known. Experience warns against hubris and false assuredness. Signs and symptoms are inexact. Each person reacts differently to illness and our experience with Ebola is limited. Basing major public health decisions on individuals’ ability to make such determinations is a risk.
Given the uncertainty of signs and symptoms, the inability to determine the exact moment of infectious potential, the human element and the tragedy of infecting even one person with Ebola, I believe that it is reasonable to quarantine those with significant exposure to the disease. Quarantine is supported by sound medical judgment – it differs in that it includes a greater margin of safety than lesser recommendations. This difference in opinions also applies to flight restrictions and quarantine options for W. Africa.
The need for healthcare providers is real and tremendously important. West Africa needs the world’s utmost humanitarian, medical and economic support. Though quarantine of risk individuals may make recruitment of medical personnel more difficult, it is not a reason to reject our commitment to protecting others.
My respect for Dr. Anthony Fauci, the CDC and others who have commented and wrestle with this issue is high. Support for quarantine of exposed individuals is consistent with medical knowledge. The differences in opinion involve what constitutes an “abundance of caution”.
I’m sorry. I don’t mean to be a big buzz kill. But the unfolding Ebola story fascinates me in the way that driving by a car crash fascinates rubberneckers. I know that says nothing good about me, but hey, I yam what I yam.
In this latest from the NY Post, the CDC admits for the first time that Ebola can indeed be spread from droplets…like from a sneeze. My suspicion is that the story is changing from the CDC because it knows fairly soon it’s not going to be able to explain away the rash of new cases headed our way within the next month, and it wants to be on record for having covered all bases on warnings.
For those following along at home, we’ve gone from “the risk of Ebola coming to the U.S. is extremely low” from the CDC and the President (when they had both been advised it was 25% within 3-6 weeks at the beginning of Sept), to “Ebola is nothing to worry about, we’ll beat this” from the mainstream media (which abruptly went silent with that BS when the New Yorker printed its expose yesterday featuring statements from some of the foremost experts in the country on the disease who make it clear that it’s the farthest thing from easily beaten or nothing to worry about that you could imagine), to “It’s not that contagious,” to…”It could be spread via a sneeze or contact with sweat.”
Does anyone see the progression here? No? Just me?
Now, before we get started with the witticisms, a la “More people have married Kim Kardashian than died of Ebola in the U.S.,” which while a knee slapper and arguably a worse fate, will likely only hold true for a little while longer, stop and consider the nature of the U.S. response to a deadly BSL-4 pathogen that’s raging out of control in West Africa.
It has been purely politically-driven, and even at that flies in the face of what the majority of Americans say they want (in the latest polls, nearly 70% want a travel ban), and that most U.S. doctors deem prudent (75% favor a travel ban). In other words, continuing to issue visas to hot zone countries flies in the face of the will of the people, as well as what people with medical training recommend.
Does that seem like a smart way to handle a disease that is deadly, contagious, and for which there’s no cure?
Fatal Exchange has a countdown deal right now, and is .99 for a day or so. Get it while it’s hot. My first published novel. You could do worse. Like being sneezed on by a symptomatic doctor who’s just returned from Liberia and isn’t feeling tip top as he rides the subway or bounces next to you in the rock concert.
I was sent a letter to the editor from a veterinarian which perfectly expresses my thoughts on the voluntary quarantines that are being proposed to “beat” Ebola, along with the screening at airports that uses temperature as the gating item which is the U.S.’ first line of defense against the disease.
Remember that 13% of Ebola sufferers never present with a fever.
Also recall that the 21 days is an average across a slew of cases where it’s 95% sure the subject doesn’t have the disease. Which leaves the 5% that present between day 21 and day 40. Oh. Them.
The U.S. is acting as though neither of these important data points exists. One has to ask why that is. To what good purpose?
I stated on Facebook that I view the public health question as very straightforward: A deadly, virulent plague with no cure is spreading exponentially through X, Y, and Z countries. Do you: A) Stop issuing visas to those countries so no potential carriers arrive within your borders to infect your population, or, B) Keep giving them out and do voluntary quarantines for a period understood to be inadequate in 5% of the cases, and screen passengers using a metric that doesn’t present in 13% of the cases?
How is this a difficult decision for anyone with a working brain?
Australia, as I predicted, has now taken the single most important possible step in protecting its citizenry from a modern plague: Don’t let the plague carriers in. Duh. But not the U.S.
Here’s an excellent article in the New Yorker that every person who says Ebola is no big deal and can be beaten by western medicine would be well advised to read.
Pay particular attention to where the article says that sweat is one of the fluids that is riddled with virus and highly contagious once the carrier is symptomatic. But don’t anyone worry. Because few people sweat or anything.
Anyway, now for the letter to the editor. It speaks for itself and requires no additional commentary from me:
Editor, Lewiston Morning Tribune:
If I wish to import a horse into the United States from Liberia or any African country other than Morocco , the horse needs to undergo a 60 day quarantine period at a USDA approved quarantine facility prior to mingling with the general population of horses in this country. Africa has a disease called African Horse Sickness that does not exist in the US ; this is the way we have kept it out of this country. African Horse Sickness does not cause disease in people, only horses; our government has determined that it would be devastating to the US horse industry if it were to come here.
The United States (and virtually all other countries) require a myriad of tests and often quarantine prior to bringing in a foreign animal.
I can’t legally cross state lines in the United States with a horse or cow without a health certificate signed by a USDA accredited veterinarian stating that the animal has been inspected and found free of infectious disease. In most cases blood tests are also required. In fact I can’t legally cross the Snake River and ride my horse in Idaho without a health certificate and a negative blood test for Equine Infectious Anemia.
I’m not complaining; the United States of America , the States of Idaho and Washington as well as the other 48 states take the health of our livestock very seriously, and we have a very good record at keeping foreign animal diseases out of our country. I am happy to do my part to maintain bio-security in our animal population.
If I am a resident of Liberia incubating Ebola, to enter the United States all I need to do is present a valid visa, and lie when asked if I have been exposed to Ebola. Within hours (no quarantine required) I can be walking the streets of any city in the United States .
I feel very fortunate to live in a country that values our animals so highly.
David A. Rus#########, DVM
This guy walks into a bar.
Something happens, and then he walks out.
If there’s a character arc, he walks out different than when he walked in. The difference could be substantial, or subtle, but at the end of the vignette, he’s change in some way.
That’s the essence of all stories. The character’s transformation. The arc.
When you ask yourself, “What’s the point?” to your entire book, the answer should be the character arc. I’ll give you some examples from films that are easily recognizable. In The Matrix, Neo reluctantly discovers he is “the one,” and with that discovery, evolves into something different. That transformation into a new state of awareness is his arc. It’s the classic hero’s journey. It’s a story about a whole bunch of shit, but at its core, it’s that the world’s an illusion, and as the hero discovers that, the discovery changes him forever, and us with him. In the Karate Kid, it’s more obvious. The MC transforms into his altered, transformed self to win the bout. Same thing in Rocky. Same thing in every major film of the last twenty years. Slumdog Millionaire? MC evolves over the course of the contest to learn what’s really important in his life, and his awareness is forever changed because of it. Pick a movie or a book, that’s the underlying arc. An MC who changes over the course of the story.
This is the same character arc as in most classic fiction. The hero must endure adversity and emerges transformed, enlightened, changed. It’s a metaphor for life. We’re constantly evolving in the face of new information and uncertainty. What makes a character’s arc interesting is the way it mirrors our own experience – how it resonates with us as real when we see it. Not real as plausible, but real as in how we recognize the journey as similar to our own.
It’s the same story, regardless of genre, over and over. In a romance, the main character meets the love interest, and by the time it’s over he or she is changed, and his/her awareness is forever different than when he started. In a thriller, the MC is altered by the experience, the adventure/challenge. In a dramatic work, ditto. Books can be about a lot of things, but at their essence they’re about the change in awareness of the characters that takes place as a result of their having traveled through the story. I maintain that when they work, they work because we as readers are along for the ride, and we feel that afterglow, that satisfaction, of having had our awareness changed as well for having read the stories.
If you know your character arc, that is to say, the point of your story, you can summarize your story in one sentence. Sometimes in a few words. Invariably, the summary that works best is a summary of the character arc. I can do it with mine. It’s essential to writing a compelling blurb. If you can’t do it with your book, you don’t have a clear picture of the arc, and if you don’t, how the hell are you going to write it? You can hope the point comes to you as you go along, but that’s like setting off for New York from Los Angeles and hoping you find your way there, rather than knowing where it is and having a map.
Get the map. It’s way easier.
That’s all I have for you on character arc. Books have been written on how to create one. But I just told you the basics. The character should emerge from the experience that is the basis of the book changed in some fundamental way, and that change forever alters the way they understand reality – and ideally, brings that understanding back to ordinary reality with them, to share. The rest is how that happened. There are a million ways to tell it, which is what we all try to do every day.
Five days ago, on October 18th, I posted a controversial blog that expressed my alarm at the way the U.S. was approaching Ebola. This was right after the contagion in Dallas was really hitting its stride. I resisted as long as I was able, because I try to avoid discussing religious or politically charged topics – they never go anywhere good.
I got a lot of comments on Facebook along the lines that a travel ban for travelers from West Africa could never work, well, you know, because the President, who lied about the likelihood of Ebola hitting American shores, said it would never work. Because, well, it just wouldn’t, you know?
Tonight, a physician who was treating Ebola patients in West Africa and who returned to the U.S. about the mid-point of the average incubation period was diagnosed with the disease in New York, after presenting with a 103 fever this morning. Two days ago he began feeling sluggish and unwell, but not so much that he didn’t go to restaurants, use the subways, go bowling (bowling?!?), take taxis, etc.
Now, let me be the first to commend him for his altruism in going to unfortunate places and devoting his time, and yes, risking his life, to treat others suffering from a modern plague with a 70% mortality rate in those countries.
Let me also be the first to condemn his idiotic behavior in putting his fellow citizens at risk by traveling around more than I do on a three day binge, after returning to New York from Africa, knowing with his medical training that he was well within the incubation period of the disease, and could not only have it, but spread it. To call it irresponsible is to be charitable.
If I wrote this in a novel I’d get terrible reviews, because nobody would believe that a doctor could willfully expose people as this one did. Three people have been immediately quarantined. How many more come down with Ebola from this exposure is anyone’s guess at this moment.
But it highlights one glaring fact. Actually, two. First is that if this is what a well-trained healthcare professional would do after returning from a plague area where an incurable disease is spreading like wildfire, what can we honestly expect from laymen? And yet the US’ approach has been to allow West African travelers to enter its borders, and relied on “screening” and “self-monitoring.” How’s that going so far? That looks like 0 for 2 to me. And now the most important city in the US (the financial system is situated there) is an Ebola hot zone. But we “shouldn’t worry” per the authorities. You know, because Science! And we’re ready for this! And if we stop consuming the terrorists, er, the virus, wins!
Um, really? We won’t know how much more spread we have from Dallas for another couple of weeks, in spite of the hyperbole from the media. And we’re just getting started on this one. Tomorrow there’s nothing preventing another one of these horror stories. And another, and another, and another. Because the administration thinks it’s a good idea to bring potential carriers of this nightmare plague into the nation’s borders. You know, because otherwise the sky will fall, or people will think we’re racist hatemongers.
The doctor in New York is a white male. I’m not being racist. Death knows no color or creed, and the risk to fellow humans is the same regardless of skin color, eye shape, hair texture, etc. I’m also not a trained medical professional. But I do know that if people are traveling from the place where everyone’s dying of the incurable disease? Might be a bad idea to say, “come on in, make sure you behave responsibly, you little dickens, and if you don’t, well, you’re still not going to be blamed for the deaths you cause and the countless millions that are spent trying to clean up after you and stop the spread before the US becomes the first world version of Mad Max.” Because to me it’s a bad idea. How about, “You can’t come in until you prove you’re not Typhoid Mary?” Is that too much of a stretch?
What will the financial cost of this be? How likely are people to be to want to get on a plane when the person who sat in the seat before them could have been another altruistic physician returning from Liberia, or flying to visit someone after feeling sluggish and tired? How many of these outbreaks do we have to see before we figure it out? Let’s take Dallas as an example. The hospital there will probably go BK. Patients are canceling their surgeries, avoiding the place. This is one of the most revered hospitals in Dallas, and it’s going to likely be a casualty of Mr. Thompson’s decision to lie on his questionnaire after being exposed to Ebola and fly to Texas. And there’s the cost of tracking hundreds, or thousands, of the exposed. The cost to people when their health insurance goes through the roof as insurers back away. The cost of treating the afflicted. The cost to the airlines, Dallas hotels, restaurants, etc. It’s a big number, and that’s from only one patient slipping in. Multiply that by however many more you think likely as travelers pour in from the hot zones. It’s not pretty.
And how about the guy who touched the good doctor’s fork and knife and napkin at the restaurant? Because he or she undoubtedly is cringing right now. How about the cab driver? You know who has the highest mortality rate in Africa, after those caring for Ebola victims? Cab drivers. Because they invariably get stuck driving the victim to the hospital. I could go on and on, but then this blog would be a novella, not a blog.
For everyone who is going to say, “but he self-monitored, so that works,” I’d say, really? The professionals who are treating this are dying like flies, so they aren’t that sure their protocols are all that great (I still don’t see how a BSL-4 pathogen, which requires a closed breathing system and pretty much a full on hazmat suit, can be safely handled with some tape on gloves, some goggles, and hope – but then again, I’m not one of the 400+ who have given their lives to discover that may not be a great idea). And nobody’s sure exactly at what point in the incubation the patient becomes aggressively contagious – the viral load in his sweat, saliva, other bodily fluids builds to critical mass and he goes full blown, but at what point is he close enough to full blown to infect? One hour before he takes his temperature and goes, holy shit? Three? Six? Twelve? Twenty? Nobody’s sure. Everyone’s making educated, and in some cases, fatally incorrect, guesses.
Politicians and administration mouthpieces who aren’t doctors are saying he posed almost no risk to those he was around on the subway, but they have no idea. Just as nobody really knows whether the new CDC protocols are adequate to keep it from spreading to healthcare workers. I mean, again, politicians and people with no medical training are saying they are, but they aren’t donning their little CDC protocol suits and going in to wipe an Ebola patient’s ass, so to them it’s another, “mistakes were made” oops if they’re wrong, or another “mysterious breach of protocols” when the nurses start dropping. Anyone see the moral hazard here? It’s pretty much the same as letting Congressmen have different insurance and financial plans than those they mandate for the population. Huge moral hazard because they aren’t at personal risk. In business, you’d say they have no skin in the game. And that’s always a bad thing.
In Africa, the average Ebola carrier infects two more. And those two infect two more. And so on. The WHO estimates have the total infection at 1.5 million or so by the end of January, the number doubling every 12 days. How is that not scary as shit for a virus that is deadlier than bubonic plague (bubonic plague is 60%, Ebola 70%, although in these early cases it’s lower in the U.S. – but it’s still extremely early in the curve to be able to know what it actually will turn out to be here, because not everyone’s going to have the same immune response, the same level of care, the same overall health when it started, and, yes, the same luck)?
Now, I know this is going to be unpopular, but I’ve even seen some articles trumpeting that the Dallas carrier’s family has been cleared, with no contagion. But you know my bet? He knew he’d been exposed, lied about it, and then when he started to present with it, told his family to avoid all contact with him, because he’d seen what it does. That’s about the only explanation I can come up with that makes sense. They avoided him, so they’re alive. Good for them. But that doesn’t mean it’s not all that contagious, because about 5K dead in Africa would beg to differ, as would every doctor on the planet, as would 400+ medical workers. Of course it’s contagious enough you should worry. It’s worse than the frigging plague.
And yet we’re being told not to give in to “hysteria.” Not to panic. Okay. I’m not panicked at all. I’m 1000 miles from the U.S. Couldn’t be calmer. Here’s a truth: It’s not panic or hysteria when you do a risk calculation that says things are doomed to get far worse at this rate. It’s being realistic. Sure, there have “only” been four cases of Ebola here so far, so it’s statistically irrelevant. But it’s also only the first few minutes of the first inning. And we’re dealing with a BSL-4 pathogen for which there’s no cure. If you don’t find that worrisome, you aren’t paying attention.
I get kind of testy when I see the mainstream media trying to spin Ebola as worse than a cold, but certainly not something Americans shouldn’t expect to walk away from, based on the stats so far from a tiny sampling. There’s simply no basis for that conviction. If there are 1000 cases here, and the death toll is “only” 200, well, then we can extrapolate and say it’s “only” a 20% mortality rate in a first world country. But with eight and God knows how many more to come (the US is processing 150 expedited visas a day from West Africa, so you can expect more – a lot more), we’ll all get to find out.
The other part of this I’m offended by is that the U.S. is putting the entire continent at risk, because if and when this spreads into clusters of outbreaks, if and when it spreads to Mexico and points south, they don’t have hundreds of millions to throw at cleaning up for the administration’s decision to keep the U.S. as destination number one for Ebola-exposed carriers. So you can expect the mortality rates in those countries to be more in line with good ol 70%. And for the spread to be much more severe.
I know the flu kills 250K to 500K a year. But how many billions are exposed to it a year and contract it? Or put simply, how many Americans have to die before the U.S. figures out it might not be a good decision to refuse a travel ban? My fear is that it will soon be a moot point, because it can all turn sideways on us pretty quickly.
I’ll make some predictions. If this doesn’t get handled competently over the next few weeks the market will be a smoking crater, there will be new horror stories on a daily basis, and the U.S. will be a pariah to all its neighbors. The dollar will suffer and the government will have a difficult time borrowing to fund the debt-based lifestyle it enjoys but can’t afford, industries like tourism, airlines, restaurants, health care will go into the toilet, and the financial impact of this decision to keep the borders open will be one of the most costly in American history.
For once I’m so upset I don’t even care if you buy my crap or not. I mean, I’d hope you would to show solidarity, but if you don’t I’ll understand.
And please, save the “Ebola has only hit a few people, it’s not a big deal” comments. Just because you can’t do exponential math or predict accurately past the end of your nose, kindly don’t parade that defect with pride. I can count. I know at the start of all epidemics in history it’s been only a few cases. I get it. But let’s all agree you know about as much about how many cases there will be in the U.S. within sixty days as you know what the price of Amazon will be in sixty days, which is to say, not at all, so any argument from that position is simply your unfounded opinion. It’s okay to have those, as I’ve just expressed mine, but if you think I’m in error, go write your own blog about why I’m way off base. I can write it for you. “Don’t panic. The Titanic’s engineers assure us that it’s unsinkable. The engineers of the mortgage backed securities markets assure us that the real estate market can never crash so badly as to take the whole world right to the brink. And right now a whole bunch of non-scientist, non-doctor politicians and their mouthpieces are saying you don’t have to worry about Ebola.”
See, the problem is that’s like saying, “the odds of dying of Ebola in the U.S. are less than you being attacked by a tiger, walking out your front door!” Which I get. I also get that if you have hundreds, or thousands, of people flying into the country with tigers every week, that glib assurance goes out the window pretty fast.
To me that always sounds like, “Don’t worry, I’ve driven for years without a safety belt – you don’t need em!”
Until you do, Sweetie, until you do.
But by then it’s always too late.
The key to writing good dialogue is putting yourself into the character’s shoes and becoming them when they’re talking. The secret to writing better dialogue is to be a ruthless editor who uses common sense rather than some set of arbitrary rules developed for academic or journalistic writing.
As an example, people often repeat the same word when they’re talking. Listen to any conversation. They also say things like um, and uh, and you know, and kind of, and like, all the rest of the “sloppy” catalog of things you’re advised to excise from your writing. The problem is that if you follow that counsel you’ll wind up with dialogue that sounds nothing like the way people talk. So you need to own your characters and pay attention to how people actually speak in the real world, which is easier than it sounds.
Stephen King is a master of dialogue, in that his characters immediately sound genuine when we meet them. They’re fully formed and consistent. There’s no pretension. They sound like people do. That should be your benchmark.
When you’re done with a dialogue-heavy scene, read it aloud. Act it out. Be the characters. How do they sound? Like some bad version of a Mamet play, or like real people? If they sound anything but genuine and natural get out your red pen, because your job ain’t over. You gave birth to these people. You’re responsible for them being believable.
And of course, when you write dialogue, you should apply the same question you do with everything else: What’s the point? If you know the reason you have dialogue in a scene, whether to move the plot along or to offer the reader insights into some aspect of the characters’ inner workings via that verbal window, understand the objective before you write the dialogue. It’ll go way better for you and the reader if you do.
There are countless books available on how to write decent dialogue. I’d advise you to read some of them, but if you don’t, I just basically told you what’s in them.
The only other thing I’ll add is that less is more in dialogue. If you can communicate things non-verbally, such as state of mind or attitude, do so. If a guy walks onto a crowded bus and seems like he’s about ready to explode with rage, how would we know it in real life? There would be nonverbal tells. Clues. We’d see things. Maybe his coloring. Maybe the way he looks at people. Maybe his expression. Maybe he sighs, barely controlling his anger. Maybe he’s breathing differently, or grinding his teeth, or his eyes are narrowed, his nostrils flaring, jaw muscle pulsing, lips thinning, whatever. There are dozens of ways to convey his state of mind so that when he does say something, we instantly know this man’s pissed, and his words are only a small part of the powder keg that is his temperament at the moment.
Dialogue is as much about what’s said as what isn’t. If you view every bit of it as an important opportunity to inform the reader of important clues about the characters, you’ll wind up with far more interesting scenes. And if you pare the dialogue down to what’s essential to getting the point across, you’ll be ahead of the game.
Just a quick note to say I got tons of email from folks congratulating me on being featured in the newest KDP newsletter.
Pretty cool. If you’d told me couple of years ago I’d be featured by Amazon as an example of indie success, I’d have said you were insane.
Now, you’re the smartest guy in the room.
Hopefully sales will go through the roof. My gut says probably not, but hey, can’t complain about an Amazon feature, especially when it didn’t cost anything. I mean, I could, because God knows I could complain about anything, but I won’t. For which we are all grateful.
I’ve also gotten a spate of questions asking what my secret is. To that end, here is everything I know about self-publishing and writing, collected as a few blogs that lay it all out. I have no additional info to share – this represents everything I’ve learned and done, and represents my current and past approach:
Good luck with your writing. It’s an interesting and difficult road, but one I’m glad to have traveled.
So, hurricane, looting, civil unrest. Quite a month for me, September was.
Now here we are in mid-October, and I’m watching the headlines about the U.S. Ebola spread and shaking my head.
Why? Well, let’s see. First, out of pure self-interest. The area of Mexico I live in sees a ton of American tourists. There are direct flights from places like Dallas every day. Which means that an outbreak of a contagious pathogen in the U.S. is only a few hours flying time from me. And because Mexico is dependent on tourist dollars it won’t do what it should, which is stop all travel from the U.S., where, in spite of the double-speak of the media, there is now an active Ebola outbreak whose scope and severity is a big question mark.
And the way the U.S. has handled the outbreak so far is beyond criminal. It is so bad it borders on evil.
The administration knew in September that there was a 25% chance of Ebola showing up in the U.S. within 3 to 6 weeks. And yet everyone from the President to the CDC lied and said the odds were “extremely low.” If you have a loaded gun being held to your head, and one of the four chambers has a bullet in it? Those odds aren’t extremely low. They’re unacceptably high. I quote from Reuters: “First and foremost, I want the American people to know that our experts, here at the CDC and across our government, agree that the chances of an Ebola outbreak here in the United States are extremely low,” Obama said.
Except that’s not in any way true. It’s false, misleading…a bald faced lie. Just as is his statement this morning that the U.S. is not facing an Ebola outbreak and thus we shouldn’t give in to hysteria. Really? See, where I come from, if you have cases of Ebola popping up and you aren’t sure how many people are affected or how far it’s spread, that’s an outbreak. That’s certainly an outbreak in Africa. It’s actually the textbook definition. Only in the U.S., it’s not an outbreak – it’s, what, a little Ebola soiree? Only in the modern U.S. could a one-in-four chance of a deadly plague surfacing in weeks be described as “extremely low” and an obvious outbreak somehow be “not an outbreak.” Doesn’t everyone start to get really nervous when we are assured that a dog isn’t a dog, by the guy who just got finished telling us a cat’s really not a cat?
Of course, the CDC has been mishandling public health threats for some time, so that’s nothing new, nor have instances of American presidents lying through their teeth proved particularly rare – it’s almost the national pastime to tally the falsehoods these days. But during this little adventure we’ve seen literally countless examples of ineptitude bordering on treasonous. Let’s take allowing a feverish, symptomatic health care worker who was on a watch list as exposed to Ebola, to get on an airliner. Flying from a busy Ohio airport into one of the larger hubs – Dallas. When the worker called the CDC and asked if it was acceptable to fly commercial even though she was presenting with a fever, and after one of her colleagues was already diagnosed as the first case of Ebola transmission in the U.S., the geniuses at the CDC said, “sure.”
The same liars who knew there was a 25% chance of it arriving within 3 to 6 weeks are assuring us that the safeguards in place – which consist of taking temperatures and asking questions (the same safeguards that have a 100% fail rate the only time they were tested so far – by the Dallas patient who subsequently died after infecting nobody knows how many yet) – will protect us all. No, sweetheart, they didn’t, and they won’t. They are no more going to stop the spread of Ebola in the U.S. than having high school dropouts searching 80 year old grandmothers at airports will serve as a meaningful deterrent to organized terrorists. It’s all bullshit. It’s doing things that are ludicrous so you can appear to be taking action. And it doesn’t. Work. At. All.
The CDC recommendations for dealing with the disease for hospital workers is basically what you’d use for BSL-2 level diseases (Biological Safety Level 2) – but Ebola is a BSL-4 disease. So folks? It’s probably not a “breach in protocol” that resulted in these nurses getting sick, and it’s not going to be further breaches – it’s that the precautions the CDC recommends aren’t adequate to protect people from BSL 4 diseases. Here’s an excellent link that explains why.
Anyone with even cursory understanding of epidemiology will take one look at a nation with proven outbreaks, that has no travel restrictions, no effective quarantines in place, inadequate protocols that fail on their face, and whose borders have a welcome mat out for the afflicted from hard hit Ebola epicenters, and cringe, because there is absolutely not a chance in hell of this ending well.
And what did the U.S. just do as its response to a plague that could spell the end of days for the U.S., as well as most of the planet if it runs unchecked? Why, appoint an “Ebola czar.” You’d probably think that given the stakes this would be a seasoned public health expert, a doctor with decades of epidemic containment experience, right? Well, what you actually got is a party hack attorney with no more experience in public health and plague containment than my dog.
I just can’t make this crap up. If I wrote it in a novel it would get laughed off the page. “Nobody’s that stupid. The real world doesn’t work that way. There’s no way that the government would do everything possible to seemingly ensure the spread of the virus. One star for realism. Blake’s a moron.”
Last year I wrote a novel that scared the living bejesus out of me, so much so I almost didn’t publish it. That novel, Upon A Pale Horse, chronicles the fictional spread of a deadly virus for which there’s no publicized cure (those determined to spread it of course developed a vaccine in secret, but only for their elite circle), and which has a very high mortality rate – the perfect mechanism to reduce the population of the world by two thirds or more, especially in the “undesirable” areas, while eliminating what remains of the Constitution and the Bill of Rights. In that novel, rich, privileged zealots, whose bought and paid for politicians kowtow to their whims, engage in social engineering using bio-weapon-developed retroviruses. It scared the crap out of me because as I researched it I realized that even though it was presented as fiction the science behind it was frightening, and the historical basis for the story was far too plausible, if not eerily factual (don’t even get me started on the chimps used for bio-weapons development in Liberia that were later used in vaccine development, and the history of simian contamination of vaccines, like the polio vaccine).
And here we are, about 15 months after I published that cheery little tome, and a virulent virus is spreading in Africa, and now, in the U.S., while the public health apparatus takes steps that are about as effective as prayer in stopping its spread. Nobody seems to be going, “Um, your society is highly mobile and travels constantly – isn’t confined to its rural village or one metro area – increasing the odds of it spreading to pandemic levels in no time, because you won’t be able to quarantine a hundred outbreaks as they occur – the direct result of failing to close your borders and pretending to take effective quarantine steps while just posturing.”
I also keep hearing these insane claims that we’re not to worry because there will soon be an antidote or a vaccine. You know, because we have the power of 10 scientists with our superpowers. But of course that ignores that after 34 years of working on one for HIV, there isn’t one. Same bright minds that have been unable to develop one for AIDS are suddenly going to have one within a year or so for Ebola. Just cause. About the only positives I’ve seen are announcements by companies in China, Canada, and Japan that they have possible “promising” treatments – which haven’t been tested on humans, and which, like the promising treatments for HIV in the early days (like AZT, which turned out to be poison), are so speculative as to be happy dreams at this point. Maybe one of these treatments will do something other than enrich the shareholders of the publicly traded companies touting their “progress.” I hope so, but have learned not to hold my breath. Looking at the first ten years of HIV, and the last 35 of Ebola, promising isn’t a word I’d toss around lightly.
Folks, I am trying very, very hard not to be alarmist. But when I read the lawyerlike parsing of language that the CDC uses I pucker.
For instance, not only per Obama is the outbreak of Ebola in Dallas not an outbreak, but Ebola isn’t “airborne” per the CDC’s definition – if someone sneezes and a cone of mist sprays five or six feet, that’s not “airborne,” because technically that mist isn’t air, it’s droplets – so when you hear pundits saying, “but it’s not airborne” they’re technically correct in the same way Clinton was correct that oral sex wasn’t “sexual relations” – in a way that would be laughed out of any reasonable discussion, but which liars hide behind.
When someone from the CDC, or some well-intentioned talking head, says, “Well, at least it’s not airborne,” they are saying that the virus doesn’t literally float in air and thus can’t be caught through inhalation. But it does exist in saliva and sweat. So when they’re saying that, to assure you it’s okay to get on a plane or not worry about the guy coughing in the hall, you have to understand who’s doing the saying, and why they’re using very narrow definitions that don’t mean what you think they do. The fact is that depending upon the viral concentration levels in the victim’s saliva and mucous, of course them sneezing on you, or on a surface you later touch, is going to carry an infectious risk. To say it doesn’t is as misleading as telling you that the risk of Ebola coming to the U.S. is “extremely low” when they knew it was about one in four.
I’ll end this rant with one key takeaway: Just about every Ebola expert in Africa is now dead, of Ebola, after underestimating its virulence. That’s not a particularly stellar track record for the experts. As an example, Doctors Without Borders, whose protocols are held out as noteworthy examples of success with the virus? 16 of their people in South Africa alone had contracted Ebola as of four days ago. So much for bulletproof protocols and having it all under control.
I sincerely hope my read on all this is overly pessimistic, and that the party functionary lawyer with zero related experience in anything approaching medicine, or science, or being more than a party hack, directs the efforts of the public health emergency with an adroit hand. I hope that this outbreak proves to be completely different than every other one seen to date and the spread isn’t scary bad. I hope that the same geniuses that allowed an infected victim into the country, and another infected victim to fly while symptomatic, develop some modicum of logic and reason and do something besides take temperatures (which we know doesn’t work) and ask questions (because people tend to lie, especially if they think not doing so is a death sentence) all the while misstating to us the true risks.
I will be watching this unfold from 1000 miles away, but even that’s too damned close for comfort. I’ll be looking for a small hill town nobody has ever heard of, or a fishing hamlet at the end of a dirt road where they haven’t seen a Gringo for twenty years, because my gut says that in about three weeks we’ll be seeing more ugliness as the inexorable progress we’ve seen in all the other outbreaks continues, and I have no interest in waiting until the crowd understands it’s been lied to, because panicked crowds can do strange things – I just lived through that, and I’d rather pass on a repeat at a much, much, much larger scale. If I’m wrong, which I dearly hope I am, I’ll have gotten a few months of well-deserved relaxation while writing my novels and maybe gotten even more sunburned. If I’m right, I don’t want to consider the lay of the land moving forward.
As always, be well, be good to each other, and try to make a difference, even if it’s only petting a dog or playing with a baby. It may not matter in the scheme of things, but it will to the dog or baby, and perhaps that’s all that really matters in the end.
And of course, buy my crap.
I love my German publisher. I mean, I frigging love those big lugs. But I especially love their cover artist, who just sent me JET – Ops Files, and is working on JET – Betrayal, next.
I mean, talk about portraying action, adventure, etc. in a glance.
As I dig out from hurricane related issues and follow the ebola debacle with open mouth, it’s nice to see something positive.
Here it is. If you haven’t downloaded it, JET – Ops Files is free for a limited time, so what’s your excuse?
You know those dystopian novels where there’s this scruffy stranger moving along a bleak deserted highway, usually with an adorable mutt trailing him? And there’s either smoking ruins in the distance, or a barren landscape, or some sort of radioactive looking swamp?
I have two adorable mutts.
NEWS: JET wins finalist in the annual Kindle Book Review Awards, Upon A Pale Horse wins semi-finalist. I should have bribed some judges or something.
Living out of a rucksack might have been appealing to me when I was in my teens or twenties, but it kind of sucks in 2014. Not that I’m complaining – still got all my fingers and toes, as do the pooches. But recovery time is longer, and being displaced like I currently am, blown to the far horizon by Hurricane Odile, has put a definite crimp in my production schedule – and if I can’t produce more crap, how can I demand that you continue buying it? See the problem?
Reports from my buddies in Baja are conflicting – some say there’s little dependable power and the place looks like something out of Book of Eli, others are saying the lights are on in some neighborhoods and there’s reliable delivery of food to the few grocery stores that are open. Either way, I’m going back, the only question being when. No point in returning to a smoking crater, but by the same token I’ve got deadlines to meet and plans to make, repairs to organize, enemies and critics to mock and vilify.
My hope is to make it back within ten days. We’ll see how that goes.
Not that I dislike mainland. In earlier days I spent a lot of time in Mazatlan, which is all good, but that was before I had a workload like I do. And not to be overly dramatic, but I just heard the reports of four gunshots – when you get good enough to make distinctions like handgun or rifle, you know you’ve spent too much time here. I wish I was kidding. Fortunately, they sounded like they weren’t immediately outside, so that’s something, I suppose.
Thanks for the outpouring of support and well wishes. I’ll put the bite on those who want to help me out by directing you to REBlake.com on Oct. 6th to assist with the launch of the first two NA/YA romances going live on the 7th. Not to guilt trip anyone into pimping me or anything. Although hoping you’ll do exactly that. Hint, hint.
That’s all I have for an update. I’m trying to reintroduce a sense of normalcy into all this, but it ain’t easy. Then again, nobody ever said it would be. And it could be worse. I mean, at least there’s no ebola, right? Right…?