NYC Doctor Has Ebola; NY, NJ Impose Quarantines

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Oct. 24, 2014 -- The governors of New York  and New Jersey have ordered a mandatory 21-day quarantine for all health care workers and others who have come in contact with people who have the deadly Ebola virus in West Africa.

The move comes a day after an American doctor was diagnosed with Ebola in New York. Craig Spencer, 33, an emergency medicine doctor at New York-Presbyterian/Columbia University Medical Center, returned to the U.S. Oct. 17. He treated Ebola patients in Guinea for Doctors Without Borders.

New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie announced the decision to impose quarantines Friday afternoon. Calls for this stringent measure have grown louder since Spencer was diagnosed.

Spencer was checking himself for Ebola symptoms while traveling around New York City, in accordance with the guidelines of Doctors Without Borders. He reported a low-grade fever Thursday morning and was immediately hospitalized. Doctors Without Borders does not recommend a 21-day quarantine for international health care workers returning home from a stint of Ebola care in West Africa.

The evening before Spencer's diagnosis, he took the subway several times and went bowling at The Gutter bowling alley before he took an Uber cab home. He also went to The High Line, a public park, and may have eaten at a restaurant, officials said.

"Since taking office, I have erred on the side of caution when it comes to the safety and protection of New Yorkers, and the current situation regarding Ebola will be no different," Cuomo said in a news release. Christie added, "By demanding these enhanced measures, we are ensuring that any suspected cases are identified quickly and effectively, and that proper safeguards are executed."

The state health departments of New York and New Jersey will have the authority to hospitalize or quarantine travelers coming through John F. Kennedy International Airport or Newark Liberty International Airport.

Given that health care workers who treat people with Ebola are at such high risk for infection, some have questioned whether stronger measures should be used to keep them out of public spaces for 21 days after they’ve cared for an infected patient. Symptoms appear within that timeframe if someone catches the virus.

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Asked that question earlier Friday at a news conference, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said: “That is something that is right now under very active discussion. You’ll be hearing very shortly what the guidelines will be.”

Also at that news conference was Nina Pham,  a nurse treated for Ebola at the National Institutes of Health. She was released from the hospital Friday after five separate blood tests showed no trace of the virus. 

Pham caught the disease while caring for Thomas Duncan at Texas Health Presbyterian Hospital in Dallas. Duncan, a Liberian citizen, flew to the U.S. before he showed symptoms of Ebola. He died at the hospital on Oct. 8.

“I feel fortunate and blessed to be standing here today,” Pham told reporters.

She also thanked Kent Brantly, MD, for donating his blood to her.  Brantly recovered from Ebola after catching it while treating patients in Liberia. Other than Brantly’s blood, Pham received no other experimental treatments, health officials said.

She didn’t take questions and said that fighting the disease had been stressful for her and her family. She asked for her privacy as she returned to Dallas to be reunited with her dog, Bentley, who has also been declared free of Ebola.

Pham, 26, was part of a team of caregivers who took care of Duncan during the first 3 days of his stay at the Dallas hospital, before he was diagnosed. Staff members who took care of him then may not have been wearing adequate protective gear, the hospital and CDC acknowledge.

Another nurse who took care of Duncan at Texas Health Presbyterian Hospital, 29-year-old Amber Vinson, also caught Ebola. On Friday, Emory University Hospital in Atlanta said in a statement that Vinson is “making good progress,” and tests no longer detect Ebola in her blood.

But Vinson “remains within Emory’s Serious Communicable Diseases Unit for supportive care,” the hospital said.

Mayor: 'No Reason for New Yorkers to Be Alarmed'

Spencer, meanwhile, remained in isolation at New York’s Bellevue Hospital after tests showed he had Ebola Thursday night.

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Hoping not to repeat the same missteps made in Dallas, city officials jumped into action on Thursday night. They activated an emergency operations center in Brooklyn to track down anyone who might have come into contact with Spencer. Speaking in both English and Spanish, New York Mayor Bill de Blasio gave a calming message to the city, the most populous in the nation.

“There is no reason for New Yorkers to be alarmed,” he said. “Ebola is very difficult to contract.”

“New Yorkers who have not been exposed to a patient’s bodily fluids are not at all at risk,” he said.

“We have been preparing for months for the threat posed by Ebola. We have clear and strong protocols which are being scrupulously followed,” he said.

CDC Director Tom Frieden, MD, said the agency had been in close contact with Bellevue since before Spencer was admitted, helping that facility prepare for the possibility of caring for Ebola patients.

Frieden said another strike team of CDC Ebola response experts was on the way to assist the medical staff who are caring for the doctor.

De Blasio said other hospitals in the city are also prepared in case more patients come forward.

“We had the advantage of learning from the Dallas experience,” Cuomo said.

Retracing Spencer's Steps

Cuomo said they’ve identified four people Spencer may have had close contact with when he was having symptoms. One of those people is his fiancee. He said all are being quarantined.

Spencer didn't have symptoms when he returned to the U.S., said Mary Travis Bassett, MD, New York City’s health commissioner.

He was rushed to Bellevue and isolated on Thursday morning after he reported a 100.3-degree fever and vomiting to health authorities. A blood test confirmed the Ebola infection a few hours later.

“He did not have a fever until [Thursday] morning,” Bassett said.

But Bassett stressed that his lack of symptoms made it very unlikely that he infected anyone else as he moved around the city. That’s because viral levels build in the body over time. People become more infectious the sicker they get.

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“He did not have a stage of disease that would have created a risk of contagion on the subway,” she said.

Disease detectives are hard at work tracking any other people who might have been in contact with him. Bassett said they'll use the travel history on his metro card to follow his movements.

Spencer is the ninth person to be treated for Ebola in the U.S. since the recent outbreak in West Africa began. All but two have been health care workers.

Robert Lowes of Medscape Medical News contributed to this story. 

WebMD Health News Reviewed by Brunilda Nazario, MD on October 24, 2014

Sources

SOURCES:

Bill de Blasio, mayor, New York City.

Andrew Cuomo, governor, New York.

Tom Frieden, MD, director, CDC, Atlanta.

Mary Travis Bassett, MD, health commissioner, New York City.

News conference, New York City officials.

Nina Pham, nurse, Dallas.

Anthony Fauci, MD, director, National Institute of Allergy and Infectious Diseases.

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