A doctor diagnosed with the Ebola virus in New York City is raising public health questions – and concerns – in one of the world’s most densely populated urban areas.
Thirty-three year-old Dr. Craig Spencer of New York was diagnosed with Ebola Thursday night after being placed in isolation at Bellevue Hospital. Before he was rushed to Bellevue in Manhattan Thursday afternoon, the Doctors Without Borders physician took the subway to Brooklyn on Wednesday night, where he spent a few hours at a bowling alley, and then took an Uber car back home.
Local health officials said today that Spencer was not symptomatic – and therefore not contagious – at the time he was out in public Wednesday night. The next morning, he took his temperature and reported that it was 103F, and immediately reported it to MSF, which then notified the state and city health departments. (New York Gov. Andrew Cuomo said Friday morning the doctor’s temperature had been 100.3F, not 103F as previously reported.) Only two hours elapsed between the initial phone call and Spencer’s arrival at Bellevue.
Still, the diagnosis has raised concerns about the potential for Ebola to spread in a city as densely packed and populated as New York. But in a late night press conference, the mayor and governor of New York, as well as the city and state health commissioners were quick to assure the public that New York was prepared for such a case, and that everything had gone according to plan in identifying, isolating and bringing Spencer to Bellevue.
“We are as ready as one could be for this circumstance,” said Cuomo. “What happened in Dallas was the exact opposite. Dallas unfortunately was caught before they could really prepare, before they knew what they were dealing with. We had the advantage of learning from the Dallas experience.”
President Barack Obama meanwhile spoke on the phone Thursday night with Cuomo and, separately, with New York City Mayor Bill de Blasio, offering any additional federal support necessary in terms of patient care, the maintenance of safety protocols for healthcare workers, and the identifying of any of Spencer’s contacts who might be at risk of exposure.
The case poses a very low risk to general public
The public has been assured that riders of the subway, and even residents of Spencer’s apartment building, are at very low risk of getting infected. “There is no reason for New Yorkers to be alarmed,” said de Blasio. “Ebola is an extremely hard disease to contract.”
As sobering as the Dallas experience was for that city, widespread cases in New York are unlikely, officials said, because Spencer was asymptomatic when he was in public places, and because Ebola is only spread from person-to-person when two conditions are met.
First, the infected person must be symptomatic, meaning he has a fever, is feeling nauseous, has a headache or is otherwise feeling ill; and there must be direct contact with his body fluids — saliva, sweat, blood, urine, vomit or feces — at this time with another person’s mucous membranes such as in the eyes, nose or mouth, or with an open wound.
City health commissioner Dr. Mary Travis Bassett said that Spencer had gone for a three mile jog, and that the night he visited the bowling alley, also strolled along an outdoor area in downtown Manhattan where he ate at a restaurant. He was taking his temperature twice a day since leaving from Guinea on Oct. 14 and did not have a fever until the morning of Oct. 23, the night after he visited the bowling alley and after his other excursions. Bassett said that since Spencer was a doctor and fully aware of his risk of having been infected with Ebola, he had been limiting his contact with others since arriving back in the U.S. once Oct. 17.
A limited number of close contacts are at risk
Because Spencer was alone in his apartment when he began feeling ill, with a fever and some gastrointestinal problems, the number of people who may have had direct contact with him when he started becoming contagious is small. New York City health officials said on Friday that Spencer’s fiancee had been quarantined along with two of his friends. On Thursday night, Uber issued a statement saying they had confirmed with both CDC and New York health officials that “neither our driver partner nor any of his subsequent passengers are at risk.” The statement added, “Our thoughts are with the patient and his loved ones.”
Spencer’s Harlem apartment is currently cordoned off, and officials will likely sterilize or incinerate all of its contents, as they did with the apartment in which Dallas Ebola patient Thomas Eric Duncan lived, and with the apartment of Nina Pham, one of the nurses whom Duncan infected. Employees of the New York City Health Department arrived at the apartment building Thursday to hand out flyers to Spencer’s neighbors and reassure them, along with the rest of the city, that the risk to the general public is exceedingly small.
Bellevue is prepared to treat Ebola patients
New York State has designated eight hospitals to care for Ebola patients, including Bellevue. While all 200 hospitals in the state are prepared to isolate and initially handle anyone who might come in with suspected Ebola, if they test positive they will be transferred to one of the eight hospitals that are designed to treat patients with staff that has drilled in the proper protocols for protective equipment and handling and removal of waste. At Bellevue, for example, the lab for testing blood samples is contained within the isolation unit so samples from infected patients are not mingled with those of other patients.
Federal officials said Thursday that the CDC would also be sending a team of specialists in epidemiology, infection control, and communications to New York City that day to assist in contact tracing, monitoring, and other infection control activities including the proper use of personal protective equipment.
Given the mistakes made in Dallas, in which one patient infected with Ebola transmitted the virus to two health care workers, New York City is on alert. However, in a press conference late Thursday night, Mayor Bill de Blasio assured the city that Bellevue had been drilling for this possibility for months.