Ebola Reaches NYC

New York's Bellevue Hospital Prepares For Possible Ebola Cases

Last night, New York’s first case of Ebola was confirmed. Margaret Hartmann has a helpful primer on what we know about the situation:

On Thursday, Dr. Craig Spencer, who had been working with Doctors Without Borders treating Ebola patients in Guinea, was rushed to New York’s Bellevue Hospital with a high fever. A few hours later, tests confirmed the worst: Spencer has Ebola, making him the fourth person diagnosed with the disease in the United States, and the first diagnosed outside of Texas. So far, the situation appears to be under control: Bellevue has been preparing for weeks, Spencer was hospitalized shortly after becoming symptomatic, and officials are already tracking down anyone he may have come into contact with. However, the fact that he went to a bowling alley, took a taxi, and rode the subway on Wednesday night is not likely to calm those already on edge about the virus.

Alexandra Sifferlin examines the city’s preparations:

New York City has been prepping and drilling its hospitals for the possibility of an Ebola patient since July 28, when it was confirmed that Americans Dr. Kent Brantly and Nancy Writebol had contracted Ebola in Liberia. “I wanted to know that our staff was able to handle [a possible Ebola patient],” says Dr. Marc Napp, senior vice president of medical affairs at Mount Sinai Health System.

“We’ve prepared for a variety of different things in the past: anthrax, H1N1, small pox, 9/11, Hurricane Sandy,” Kenneth Raske, president of the Greater New York Hospital Association (GNYHA) told TIME. “This preparation is not unusual.”

Cohn compares NYC’s Ebola response to the one in Dallas:

CDC has dispatched a “go” team of advisers and clinicians, although some were already in New York anyway. They will not simply track down possible contacts, as they did in Dallas. They will also help health care workers avoid infection, which they did not do in Dallas. That’s important, because the biggest threat right now almost surely isn’t to subway riders or bowlers. It’s the public health workers who will be taking care of Spencer.

Cohn also remarks that the response “looks and feels a lot different than what took place a few weeks ago, when the first American diagnosis took place in Dallas, Texas, and neither the hospital nor public health officials seemed quite certain what to do”:

The tragic horror of Ebola is that the people most at risk of getting the disease are those caring for the sick. That’s likely how Spencer got it, after all, and as a worker with Doctors Without Borders he presumably knew what he was doing. But what was true yesterday is true today. Experts expect isolated cases of Ebola to show up here and there, but they don’t expect outbreaks, because the U.S. has the resources and infrastructure to contain the spread and treat those who get it.

However, Ed Morrissey thinks this case “raises a whole lot of questions about the CDC’s latest approach to dealing with travelers from western Africa”:

They expect to control the potential spread of the disease by asking them to take their temperatures for 21 days and keep from being in public too much. If a health professional who’s had experience with Ebola can’t follow those guidelines, why should we expect anyone else to follow them?

Now we have a fresh case in the most populous city in the nation, and the potential for hundreds of contacts thanks to the subway ride, the cab, and the use of the bowling alley. Did he have a drink at the bowling alley? Eat food? Did wait staff handle any glasses or dishes? Did he use rental shoes and house bowling balls?

But Matthew Herper talks to infectious disease expert William Schaffner, who isn’t worried about New Yorkers getting Ebola from the subway:

“I think the risk is close to zero. I would even say it’s zero because none of those people had any contact with his body fluids,” Schaffner says. “I would feel no concern had I been standing next to him on the subway.”

The reason, Schaffner says, is because when patients first become sick with Ebola, there simply isn’t that much virus in their bodies. “It’s very hard to transmit the virus in those first days of illness,” he says. “As the illness progresses, for sure the viral load in the body increases. It can get into the skin cells or onto the surface of your skin. That’s when people are near death.”

The risk of transmission is not constant, he says. It gets worse and worse as patients get sicker and sicker. When they are very sick, Ebola is very much like cholera, with large volumes of fluid flooding out of the body as diarrhea or vomit. Those fluids are teeming with virus, and that is what health care workers are exposed to.

Sarah Kliff wants us to remember that Spencer “a doctor who decided, voluntarily, to go to Guinea to treat Ebola patients”:

This is a country that desperately needs more doctors to fight back an epidemic. The United States has 245.2 doctors per 100,000 people. Guinea has 10. Spencer is not part of the problem. From what we know, he did not put New Yorkers at risk for Ebola. He’s part of the solution, one of a small handful of doctors who worked to combat a deadly, overwhelming disease.

And Abby Haglage worries that Spencer getting sick will stop other doctors from following his example:

His brave mission, followed by a devastating diagnosis, complicates an already nightmarish scenario for health-care workers fighting against Ebola: It may be deterring doctors from helping—right when they’re needed most. The news of Spencer’s positive test for the virus, announced Thursday night in New York City, might achieve the exact opposite of his stated goal.

(Photo: A member of Bellevue’s Hospital staff wears protective clothing during a demonstration on how they would receive a suspected Ebola patient on October 8, 2014 in New York City. By Spencer Platt/Getty Images)