Play Ball

The other night I had the pleasure of attending a Las Vegas Aviators game at the Las Vegas Ballpark. They played (and lost to) the Sacramento River Cats. That picture is me with the Aviators mascot, Spruce the Goose.

The facility is in an area of town known as Summerlin. For those who don’t know Vegas, it’s a “suburban” Master Planned Community on the West edge of town. The Ballpark itself is within walking distance of a newer outdoor shopping complex (the kind of place that does a farmer’s market on the weekend) and a high end locals casino resort. It’s easy to get there from two different exits on the highway that loops around town or two major east/west roads. There’s ample parking, a real effort to appeal to foodies while still having access to classic ballgame fare, and comfortable seating for 8196 with a total capacity over 10,000. The night I attended there were about 7300 present.

There has been a lot of talk about the Oakland A’s coming to town, adding Major League Baseball to Vegas’s stable of professional sports teams. We currently have the reigning world champion WNBA Aces and NHL Golden Knights, as well as other teams. The latest legislative session passed a law to make it possible, land deals are in talks, and MLB is considering whether to let it come to pass. But nothing is set in concrete.

Here’s the thing: a typical A’s game is currently bringing in barely enough fans to fill the locals oriented Ballpark way on the West edge of town. Some games end up with fewer fans in the stands than the minor league game I saw the other night! Somehow they plan to fill a brand new 30,000 seat stadium close to the Strip and all the Strip traffic with limited parking available on a regular basis. Oh, and it’s the same freeway exit as people are using to get to Allegiant Stadium T-Mobile Arena, and the “back way” to Harry Reid Airport.

I’m not sure who’s coming out ahead on this deal, but it certainly isn’t the people of Las Vegas. I’m not even going to bet on whether this will actually come to pass, or whether it’s just a gambit to make Oakland beg to keep their team.

If they do make it here I’ll have the same policy I do for the Raiders: I’ll buy one team T-shirt and one hat for the Las Vegas A’s; and the day they announce they are leaving town they are dead to me.

Immigration Roundup

When the COVID Public Health Emergency ended, some immigration policies also ended. I’ve written multiple times about immigration both legal and undocumented in the past, with a focus on the broken system and why none of the “reform” ideas being floated are good ideas. But since Mr. Biden has a long rich history of disfiguring reform initiatives, he’s probably exactly where he wants to be.

Here’s one of my early efforts from 2007, where I look at the issues and the stakeholders.

By 2009, we had crazy machines to replace undocumented farm workers.

In 2014 we noticed the Children’s Crusade Redux at the border.

Oh, let’s not forget Chris Christie in 2015 wanting FedEx style tracking of visa holders.

in 2018 I brought you commentary on the Dreamers and a comprehensive post on the topic that I think still largely stands true. Real reform still must include a radical lifting of immigration caps, hiring a lot of staff to process people who want to be here legally, simplifying forms so someone with a grade school education and little knowledge of English can fill them out, and severe penalties for employers that don’t follow the law. Spoiler alert, we won’t be getting any of that.

What we will get? Another heaping helping of Joe Biden as Democratic nominee for President whether we like it or not.

Candida auris: Truth and Fearmongering

Recently, a website I used to respect posted an item on a problem with a relatively new fungal pathogen called Candida auris and how it poses a problem for Las Vegas in particular. I would like to talk about this issue in a balanced and truthful way.

My credentials: or, why should you listen to me? I am a Registered Nurse (RN) Infection Preventionist. I am a member of the Association for Professionals in Infection Control and Epidemiology. I hold two certifications: Certified Rehabilitation Registered Nurse and Certified in Infection Control. Furthermore, I work in Las Vegas and live in a suburb of Las Vegas. Go Knights Go.

Some Resources by Actual Professionals: I actively encourage you to see what the CDC, the WHO, the NIH, medical journal JAMA, my professional organization APIC, healthline, okay fine Wikipedia, and the State of Nevada have to say. The public might have a right to be skeptical about what the CDC has to say, which is why I want to provide multiple sources (that all say mostly the same things).

And Now Some Sensationalist News Items: It gets pretty crazy. Of course some sources are better than others, but sensationalist news gets attention.

An important thing to remember: I’m going to stop for just a moment to explain a technical detail. You probably know what an infection is: it’s when a germ is making you sick. But most people don’t know what colonization means: that’s when a germ is there but it’s just hanging out and not making anybody sick. There is of course the risk it could cause an infection, but it isn’t right now. Most of the C.auris cases you’re hearing about are colonization, not infection.

But what would the symptoms of infection be if it’s not colonization? Depends where the germs are. If it’s in the urinary tract, UTI symptoms. If it’s in a wound, symptoms of an infected wound. You get the picture. An infection in the blood is particularly bad regardless of what organism is involved since the bloodstream is effectively a superhighway around the body.

Oh, and one more thing: I am always careful to specify Candida auris or C.auris to distinguish it from it’s itchy but mostly harmless cousin, Candida albicans — which causes thrush and what most people would call a “yeast infection.” There are other Candida species that are rare and not a huge public health threat.

Why it seems like Nevada and Vegas have so much of this stuff: Maybe you’ve heard the saying “you can’t find a fever if you don’t take a temperature”? Well the idea that you don’t find things you aren’t looking for cuts both ways. Most places aren’t looking for it — it’s a special test that in most places has to be sent away to a lab with special equipment (and by the way not all FedEx offices will accept biological specimens for shipment). Your local Quest or LabCorp might come back with “yeast” and nothing more. Last year, the State of Nevada insisted on testing all residents in Long Term Care, Long Term Acute Care, Skilled Nursing Facilities, and on patients in many other hospitals. They tested; they found more of it than most people expected. Why Vegas in particular? Because roughly 80% of the state population lives in Clark County.

Why test those facilities? Because people in the kind of places where they call them “residents” instead of “patients” have severe medical problems to begin with. They’re in and out of acute care hospitals. They have plenty of chronic conditions and often end up with complications. They’re at risk for opportunistic infections from lots of different organisms, including C.auris. Sure, they tested a few people who were just fine until the motor vehicle accident, but that was the exception.

Ok, so how do you test for it? Per the CDC “The nurse or doctor will wipe or rub a cotton swab on the skin near your armpits and the area where your leg joins your body (groin). The test is not painful. The swab will be sent to a lab, and in 1 to 2 weeks, the lab will tell your doctor the results.” Ok so remember that we are looking for it in armpits and crotches when it comes to colonization. That will come up again later.

A quick summary of the bad news: It’s hard to test for, it’s a lot more common than most people know (and not just in Las Vegas!), it’s resistant to many antifungals (it’s not a bacteria so it wouldn’t be susceptible to antibiotics), there’s no proven decolonization strategy, and yes an infection could potentially be deadly.

Is there any good news? Yes! First, it’s a big heavy germ that does not and cannot float in droplets or the air. A C.auris cell is 2.5-5 micrometers, twice the size of the typical bacterium and ten times the size of a tuberculosis germ. Someone with a C.auris infection or colonization does not require droplet or airborne precautions, just contact precautions (gloves and gown) while in the hospital. It is not, I repeat NOT, lurking in casino air ducts waiting to reach out and make you sick! More good news: bleach will kill it on surfaces. Note: do not clean granny’s groin and armpits with bleach.

What can I do to keep from getting it? Remember that we test for colonization in the groin and armpits? Keep adult activities clean and in clean places. Don’t go to the casino floor naked (they frown on that anyway). If you or a family member have chronic conditions, make cleanliness your habit. If you find yourself or a loved one in a hospital, be that person that reminds others to clean their hands. That includes visitors, doctors, and staff! If a staff member rolls her eyes, that’s exactly the person you needed to remind so don’t let her get to you. And a pet peeve, gloves are not a substitute for hand cleaning and must be changed between patients!

By the way, World Hand Hygiene Day is May 5, right between May the Fourth be With You and Nurses Week. My building will be celebrating all three.