October 23, 2014Also available in: Spanish, French, Russian, Korean, Italian
Mayor Bill de Blasio: Good evening. Before I offer remarks, I just want to note – we are joined by Governor Andrew Cuomo, by Health Commissioner Mary Bassett of the city of New York, Health Commissioner Howard Zucker of the state of New York, the president of the Health and Hospitals Corporation of New York City, Dr. Ram Raju, and on the phone, Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention. Dr. Frieden will address us after the remarks by the rest of us.
Today, testing confirmed that a patient here in New York City had tested positive for Ebola. The patient is now here in Bellevue Hospital. We want to state at the outset – there is no reason for New Yorkers to be alarmed. Ebola is an extremely hard disease to contract. It is transmitted only through contact with an infected person’s blood or other bodily fluids – not through casual contact. New Yorkers who have not been exposed to an infected person’s bodily fluids are not at all at risk. And we want to emphasize that New York City has the world’s strongest public health system, the world’s leading medical experts, and the world’s most advanced medical equipment.
We have been preparing for months for the threat posed by Ebola. We have clear and strong protocols, which are being scrupulously followed and were followed in this instance. And Bellevue Hospital is specially designed for isolation, identification, and treatment of Ebola patients. Every hospital in the city is prepared in the event that other patients come forward.
The patient in question is a doctor who has worked with Ebola patients in West Africa. And when his symptoms emerged, he was taken to Bellevue by specially trained emergency medical service workers who followed all transport protocols. The patient is now in isolation. The health department has a team of disease detectives, who have been at work tracing all of the patient’s contacts, and we are prepared to quarantine contacts as necessary.
There have been reports about the patient’s movements. Again, these medical detectives are at work putting together the pieces of the timeline. But we emphasize again, Ebola is very difficult to contract. Being on the same subway car or living near a person with Ebola does not in itself put someone at risk. We are working very closely with our state and federal partners to ensure that we protect the health of all New Yorkers. People should rest assured that the extraordinary medical professionals of this city and this state are working to ensure that every protection is in place.
A moment of commentary in Spanish before I turn to Governor Cuomo:
Hoy el Hospital Bellevue admitió un paciente que dió positivo por Ebola
No hay motivo de alarma. Las posibilidades de que el neoyorquino promedio contraiga Ebola siguen siendo muy, muy pequeñas.
La Ciudad se ha estado preparando para el Ébola durante meses y tenemos un sistema bien diseñado para diagnosticar, aislar y tratar a este paciente
With that, I want to welcome comments by Governor Cuomo, who has remained in close communication with us here in the city over the last weeks. His team has been extraordinary in their preparation, their coordination with us. Welcome, Governor Cuomo.
Governor Andrew Cuomo: Thank you. Thank you, Mayor. As the mayor said, the past few weeks we have been preparing for just this circumstance. We were hoping that it didn’t happen, but we were also realistic. This is New York, people come through New York, they come through New York’s airports – so we can’t say that this is an unexpected circumstance. The – we have had a full coordinated effort that has been working literally night and day coordinating city, state, and federal resources – coordinating and drilling from airports to transportations to subway stations to ambulances to hospitals – so we are as ready as one could be for this circumstance.
What happened in Dallas was actually the exact opposite. Dallas, unfortunately, was caught before they could really prepare, before they really knew what they were dealing with in Dallas. And we had the advantage of learning from the Dallas experience. Just the other day – they’ve been long days, but I believe it was yesterday – we had 5,000 healthcare workers in the Javits Center who were being drilled on just this situation.
We also had a fortunate circumstance here that the affected person was a doctor – a person – a doctor who worked on Doctors Without Borders, so he was familiar with the possibility and the symptoms, etcetera, and he handled himself accordingly. Our best information is that, for the relevant period of time, he was only exposed to a very few people, partially because he knew exactly what the illness was all about and he was taking precautions on his own.
As the mayor mentioned, I know the word ‘Ebola’ right now can spread fear just by the sound of the word. Ebola is not an airborne illness. It is contracted when a person is extremely ill and symptomatic, and is basically contracted through the bodily fluids. Having had the time to prepare as we did, we have been fully coordinated all day long. I spoke with our new Ebola czar, who President Obama appointed, Ron Klain. They were immediate in sending CDC teams. Sylvia Burwell from the Federal Homeland Security office had been fully coordinated. They’ve reviewed everything that we’ve been doing. We’ve been doing it with their advice. And we are, after having spoken with everyone, doing everything that we need to be doing.
I know it’s a frightening situation. I know when you watched it on the news and it was about Dallas, it was frightening – that it’s here in New York, it’s more frightening. New York is a dense place, a lot of people on top of each other, but the more facts you know, the less frightening the situation is.
We’ve already acted very, very quickly and identified about four of the people who we believe – we believe there are four people who he came in contact with during the relevant period – and we are already in contact with all four people. So, we feel good about the way we are handling the situation. Obviously we wish the best for the doctor and we hope for a recovery for the doctor, but from a public health point of view, I feel confident that we’re doing everything that we should be doing and we have the situation under control. And I want to applaud the mayor and the mayor’s team, but also – as a personal point of privilege – thank my team for the good work. This has been weeks and weeks of preparation and getting a lot of agencies to work together, but the proof is in the pudding and today it worked well – so, congratulations to them.
Mayor: Thank you very much, Governor. Now I would like to turn to our New York City Health Commissioner Dr. Mary Bassett, who has been in charge of all of the preparations here in the city and particularly working closely with Bellevue as the lead institution that we have designated for handling these cases. Dr. Bassett.
Commissioner Dr. Mary Bassett, Department of Health and Mental Hygiene: Thank you, Mr. Mayor, and good evening, everyone. As you all know, for the last couple of months now, we’ve been working closely with our city hospital system, with our state partners and our federal partners to prepare for the possibility of a diagnosis of a patient with Ebola in New York City.
Today we have the first patient with a presumptive positive Ebola test. This test was completed at our public health lab and will be confirmed at the CDC labs, we expect, within the next 24 hours. Let me go over with you what we know about this patient at this time. This is, of course, an evolving situation in which information will continue to come forward, but I want to share with you what we know at this time.
As you have already heard, the patient is presently hospitalized in isolation at this hospital. The patient is a 33-year-old doctor working with the famed human services organization Doctors Without Borders, Médecins Sans Frontières, in Guinea. He completed his work in Guinea on the 12th of October and left Guinea on the 14th of October via Europe, where he arrived in the United States at JFK Airport on the 17th of October. During – at the time that he departed Guinea, throughout his journey home to the United States, he was well with no symptoms.
When he arrived in the United States, he was also well with no symptoms, and he, being a medical doctor, undertook to check his temperature twice a day, which he has done since he departed from Guinea. On the 21st, he began feeling somewhat tired, but the first actual symptoms that the patient displayed were today, sometime between 10 and 11 this morning when he experienced a fever and contacted MSF, who rapidly contacted the health department, and the process of bringing this patient to Bellevue Hospital as a person considered at high risk for Ebola began.
We know that during the time that the patient was home – before he became sick – that he did leave his apartment. He – we are aware that he went on a three-mile jog – a sign that he was feeling quite well – and he also took the subway system. We know that he’s ridden on the A train, the number 1 train, the L train. We are still getting more information about this, but we know that yesterday that he went to a bowling alley in Williamsburg. He was feeling well at that time and – except for his feeling of fatigue – and once again, his first symptom of fever occurred today – and that was the beginning of his assessment. We are aware that he has been in close contact with his fiancé and with two friends, both of – all three of these contacts are healthy and are being quarantined. The governor mentioned an additional person – this person was a driver of an Uber car with whom the patient had no direct physical contact and is considered not to be at risk.
On – today, he – when he reported fever, he contacted the Health Department, we contacted EMS and he was brought to Bellevue Hospital. The test for Ebola was conducted on blood drawn here at Bellevue Hospital and conducted at our public health lab. I think that I should turn over to Dr. Zucker to talk about the process of his transfer. We really are confident that all of the protocols that we’ve worked so hard to put in place for communications with all levels of our public health system, with our emergency medical system, with our public health system, have worked as well as we expected them to work, and we are glad that the patient is safely here at Bellevue Hospital. Over to you, Dr. Zucker.
Commissioner Howard Zucker, State Department of Health: Thank you. Thank you, Dr. Bassett, and thank you, Governor Cuomo and Mayor de Blasio. Firstly, our wishes and prayers go out to this doctor, his family and friends for a speedy recovery.
As you’ve heard the timeline of what we have heard about this patient, I think it’s important to mention that – as Bellevue has been preparing for this, and we as a state and a city have been preparing for this for a while – all of the processes involved in making sure that he has been monitored, taken care of here at the hospital – I’ll mention that in a minute – but most importantly, him getting into the hospital.
The EMS system brought him in with the proper protective gear. He was immediately brought to the isolation area that Bellevue Hospital has established for patients who could have Ebola. He has been taken care of by an excellent team and all of his medical problems are being addressed. As you know, Ebola patients can have a lot of different problems and these are all being watched for closely.
I think it’s also important to just reiterate that you can only get Ebola by being exposed to bodily fluids – and that’s a very important point to make. He has been in the hospital, as we know. His symptoms began – he had a fever – that symptom began this morning, and some of the other symptoms as well this morning. I think that it’s important to just reiterate that the management of all the issues that come forth with Ebola have come together nicely with this patient, and we look forward to a quick recovery for him.
Governor Cuomo: Once again, we’d like to thank our federal partners who have really been extraordinary – the new Ebola czar, who just started the job, Ron Klain; Sylvia Burwell, who is the head of Health and Human Services; and the head of the CDC, Dr. Tom Frieden, who is with us tonight by telephone. And we’ll turn it over to Dr. Frieden now.
Doctor, can you hear us?
Dr. Thomas Frieden, Director, Centers for Disease Control and Prevention: Yes, I can. Can you hear me?
Governor Cuomo: Yes, very well.
Dr. Frieden: Okay, well, thank you very much, Governor, and thank you to the mayor. And first and foremost, our thoughts and focus are with the doctor – the patient – in New York City. When it comes to his care, the federal government has and will continue to provide whatever assistance is required to ensure that he is treated safely and effectively.
I think, as has been said, it is very important that people understand how Ebola spreads and what the risk is. When someone gets Ebola, they become – they are not infectious initially, but they become increasingly infectious the sicker they get. So right now, the concern is for the health care workers who are caring for him at Bellevue.
Fortunately, Bellevue has been preparing for this and drilling this. CDC has been in close communication with hospital authorities. In fact, by coincidence – or because of good preparations – we already had a team on the ground that has spent several days reviewing all of Bellevue’s preparations, even before this patient became ill. They have both reviewed the preparations and observed the hospital working.
We are also sending an additional CDC Ebola-response team, which is in transit now, with individuals who have extensive experience treating Ebola, so that we can work in partnership with Bellevue to ensure that the patient gets as safe and effective care as possible. We’re also encouraged by the transport process that was used that would eliminate, or minimize, any risk of transmission during that process.
As has been said, there are several individuals who had contact with the patient before he developed a fever and before he was isolated – and those individuals will be monitored for 21 days. I remind people that, for the case of Mr. Duncan – Dallas – even his household contacts were with him for several days after he became ill – did not develop Ebola. Ebola is a scary disease, and it’s fearsome because of how severe the illness is, but it does not spread easily. It does not spread like the flu or the common cold or measles. It only spreads by direct contact with the bodily fluids of someone who is ill. I will say that, as a former commissioner of the city health department, it is a fantastic health department and, at CDC, we’re delighted to work in partnership. And we’ll do everything to ensure that the coordination at the federal, local, and state levels is seamless, and provide for all of the needs so that care of the patient, the isolation, and the contact tracing will all be done in a way that absolutely minimizes risk.
And I would encourage anyone who wants more information to check our website at cdc.gov. And we look forward to continuing to work closely with New York City. Thank you.
Mayor: Thank you. Thank you very much, Dr. Frieden – and Dr. Frieden will stay with us during the question and answer period. And with that, we’d like to turn to questions from the media. Yes –
Commissioner Bassett: Yeah, I’ll give you as much information as I have. As I’ve said at the outset, this is an evolving situation in which we are still interviewing people, including talking to the patient. And I’ll echo what everyone else has said – that we are all – our main focus, of course, is on the recovery of that patient.
The bowling alley was in the Williamsburg section of Brooklyn. It’s called The Gutter bowling alley. The patient went there with friends, and he did bowl while he was there, according to our understanding of events.
The patient was not feeling – although he reported fatigue – he was not symptomatic. He had no fever. And as Dr. Frieden has explained, we are very clear that people become contagious as they become sick. So his first fever, in fact, was today, earlier this – in the late morning today. And he did not have a fever for the whole time since he left Guinea until this morning.
My understanding is that, out of an abundance of caution, that the bowling alley closed. And we, of course, will be sending health department staff on-site tomorrow to look at the bowling alley.
So that’s – you know, I can only reiterate what we’ve been saying for weeks – that the way people contract Ebola is by being in touch with a person who is sick with Ebola, and being in touch with their body fluids. And of course, the doctor was a doctor who was working in an Ebola treatment center in Guinea and that, presumably, was how he became infected.
At the time that he was at the bowling alley, he had had no fever.
Commissioner Bassett: The – whoa, suddenly I’m being truly mic-ed.
The – we obviously want to protect people’s privacy, but these are individuals who will be permitted to opt for home quarantine.
Commissioner Bassett: The patient, of course, is in the hospital. One of the patients is in the hospital today.
Mayor: One of the other –
Commissioner Bassett: One of the other patients. One of the other contacts.
So there are three contacts, one of whom is in the hospital today.
Commissioner Bassett: So you’re asking about the health workers here at this hospital. The health workers, of course, are using full protective gear. They were ready because we knew that this patient was being transported. He had a very orderly removal from his home with emergency workers who were in full protective gear.
He came here and had a very smooth transfer up to the isolation ward, where he’s been looked after by experienced, seasoned health workers who all have been training for this purpose over the last months – training, drilling, and so on. These workers are working on this unit exclusively. And as far as having anybody who has opted out of that, I would actually turn to Dr. Raju – I’m not aware that any have.
Dr. Ram Raju, President, Health and Hospitals Corporation: No one opted out.
Commissioner Bassett: No, that’s what’s so important about the work that Bellevue has done to prepare for this day – something that they began months ago in August. There is a longstanding isolation unit here – one that dates back to the 1990s and the days of the AIDS epidemic when multi-resistant TB was a real scourge in this city. This unit has been converted for the care of patients with Ebola. There is a small dedicated laboratory on this unit so that it is really a self-contained space. So I really want to applaud the preparations of Bellevue Hospital – they’ve worked really hard to put in place all of the systems that were needed. So that means not only having all of the stuff, they also have all the stuff and they have all the systems, the processes in place – and everything today worked as we hoped it would.
Governor Cuomo: If I can add –
Governor Cuomo: I think one of the advantages is the healthcare workers feel prepared – and they feel equipped. The upside of all the rigor and all the drills and all the meetings is they know they were prepared just for this moment – and we learned from Dallas that way. And as I said, yesterday the mayor and I were with a session – there must have been 5,000 healthcare workers. We have an abundance of equipment, an abundance of training, an abundance of experienced professionals, and I think that’s brought their confident in the entire system up.
Mayor: And, further – I just want to clarify – these folks at EMS, for example, have not only been training for weeks and weeks, but they are first responders. Their jobs is to protect other people. They take it very seriously – it is a matter of honor that they take on a difficult role. Equally, Bellevue is legendary for having taken on a host of challenges over the years. The professionals here at Bellevue are the finest, they are the most battle-tested. So, anyone who is working as part of the team helping this patient knows exactly why they’re doing it and what they’re doing as part of their sense of mission. Yes –
Commissioner Bassett: Well, the patient – today – developed a fever and had some gastrointestinal symptoms as well. So these are the symptoms that let us know that this patient had a clinical picture that was really fully consistent with Ebola.
Commissioner Bassett: Fatigue can be a symptom of many things. I think that the thing to make clear is that the first time that this patient had fever was today and it’s – and fever is the typical sign of a person developing contagious Ebola.
Mayor: And over here for one more and then we will come to this side, yes –
Commissioner Bassett: What I can say is that his friends said that he – that they felt he seemed well, but the – and the patient, as I’ve said, did not report any fever, although he did report that he felt tired.
Mayor: Yes –
Commissioner Bassett: Well, he did really – he did attempt to self-isolate. And we’re still getting clear the amount of time that he spent outside of his apartment. But our impression is that he spent most of his time in his apartment and he was taking his temperature twice a day. He was being mindful about contact with people – he is a medical doctor, as we have all said, so he was very alert to signs and symptoms of Ebola, coming from a place where Ebola is truly ravaging the population.
Commissioner Bassett: The waste?
Commissioner Bassett: We for the – we have contracts in place for the removal of medical waste.
Commissioner Bassett: The patient really only displayed symptoms today and I see no reason for the tenants in the apartment building to be concerned. We have –
Mayor: [inaudible] the apartment is isolated –
Commissioner Bassett: The apartment is isolated. No one is going in the apartment. We have ensured that nobody will enter. The super will not let anybody in. There is no housekeepers expected to arrive. The apartment is locked and not accessible.
Commissioner Zucker: I just was going to make the other point that he actually even left his key in his apartment and locked the door – he’s a very –
Mayor: Meticulous –
Commissioner Zucker: – meticulous individual – recognized that if the key was floating around, someone might pick it up and find interest.
Mayor: Dr. Bassett just wants to add –
Commissioner Bassett: I just wanted to add, also, then – to point out that the State Health Department, Dr. Zucker, announced just last week that eight hospitals in this state would be designated as settings where Ebola patients could be cared for. We are the first state to identify a limited number of hospitals, of which this hospital is one – Bellevue Hospital is one of the five hospitals in New York City. And as you’ve all been hearing, they have been working, they were ready – today they showed how ready they were to accept a patient who was ultimately diagnosed –
Mayor: Let the governor go and then Jonathan.
Governor Cuomo: Just to clarify, all – there are about 200 hospitals in the state. They are all prepared if someone walks into the hospital and presents themselves and suggests that they might have the illness. But to get all 200 hospitals ready for intensive treatment, obviously, would have been very difficult, so the decision was made to take eight hospitals – one of them is Bellevue – and really focus and concentrate intensive efforts. And that turns out to have been a wise and prudent course of conduct.
Commissioner Zucker: May I add also that we – the Department of Health [inaudible] to look at these hospitals – and all of the hospitals across the state – and Bellevue was one of the hospitals we already came in and looked at to be sure they were prepared for a patient like the patient that you’ve seen today. So we are already one step ahead.
Mayor: Jonathan –
Commissioner Zucker: At this point, this would be a clinical decision based on the team that is taking care of him right now. So we will see how his progress goes, but they are prepared here to take care of him, like any other adult patient.
Mayor: In the back –
Commissioner Bassett: Well, we know that he left his apartment – so, a quarantine would’ve meant that he never left his apartment – but he did self-isolate in the sense that he –
Mayor: He limited –
Commissioner Bassett: He limited his contact with people and saw friends. He did leave his apartment, so I don’t want to give the impression that he was in his apartment the entire time.
Commissioner Bassett: He was – during the time that he was leaving the apartment, he had had no fever. He was monitoring his temperature twice a day, as has been recommended, and he had no fever. I don’t want to give the impression that he was self-quarantining or – because he was leaving his apartment.
Mayor: But let’s be clear – the second he had that fever, he did report immediately and cooperated fully in getting in here in the right way, but also communicating his previous movements, people he had been in contact with. He’s been very very informative to help [inaudible] we call them the medical detectives, trace the other pieces of the equation. Dr. Zucker –
Commissioner Zucker: And may I add that also – that your contagiousness is related to how sick you are, and so he came in very early in his illness, and so, that’s important as well.
Governor Cuomo: But that is – that is a very important point in this case – that he was a doctor, he was familiar with the illness, he was taking his temperature twice a day. Yes, he had fatigue – he also went for a three-mile jog, right? So he couldn’t be that fatigued. And when he started to sense that he had a fever, he came in right away – and that’s when you are contagious is when you are really extremely ill – and he presented himself this morning.
Mayor: Let’s have Dr. Bassett and Dr. Zucker speak about the fact that – again, I always want to preface – this is a very difficult disease to contract. It is not an airborne disease. It takes rather intimate contact with someone to contract the disease. I’ll let them take it from there.
Commissioner Bassett: That’s right. So, there are two parts to your question – what do we know about his whereabouts? So we know that he went to a place called The Gutter, a bowling alley in Williamsburg in Brooklyn. To get there he took the A train and the L train – that was yesterday. We also know that sometime that day he also went to the High Line, may have stopped and gotten – gone to a restaurant along the way. So we’re just – we’re going to be getting more information about this. We – he is fully cooperating with us, we have his MetroCard, and we are going to have the chance to talk with him – remember, he is a hospitalized patient in intensive care – about all of the – to line up everything from his MetroCard travel and where he was. Let me turn to your question about the subway. Once again, we all have been saying to all of you for weeks now that people with Ebola are contagious when they are sick – and what’s contagious about them are their body fluids. At the time the doctor was on the subway, he had not had fever, he had no problem with his body fluids in the sense that he had no diarrhea, no vomiting, no blood loss – all of these symptoms that occur when people become much sicker. He was not symptomatic at that time. He had no fever. And so he did not have a stage of disease that creates a risk of contagiousness on the subway. We consider that it is extremely unlikely – the probability being close to nil – that there would be any problem related to his taking the subway system.
Commissioner Zucker: I just want to echo the words of Dr. Frieden. Remember, the patient in Dallas had – was – many people were exposed to him and, in the end, only very very few people got sick – and so, that is an important point. And regarding the subway, I would get on the subway tomorrow and ride the subway.
Commissioner Bassett: This is the only place he’s come.
Commissioner Zucker: When he – right – when he had the fever, he contacted his employer, MSF, and then that set into chain the correct motion.
Mayor: We’ll take a few more.
Commissioner Bassett: I think let’s not talk about that right now.
Mayor: Well, I think we’re talking about the current situation, so –
Mayor: Again, I’m – respectfully – I want to say that we’re talking about an immediate situation – we’re talking about a patient who is a medical doctor who handled with the communication with the city health department properly. He’s here in the right facility. Let’s stay where we are on that.
Governor Cuomo: It’s bad Karma, [inaudible].
Commissioner Bassett: Yes.
Commissioner Bassett: All of the contacts, the three – two friends and his fiancé – are well and they are all in the process of being quarantined.
Commissioner Zucker: [inaudible]
Mayor: Last question, right there –
Commissioner Bassett: They would not be tested. They are not symptomatic – there would be no reason to test them.
Commissioner Zucker: – symptoms.
Commissioner Bassett: Unless they develop symptoms.
Mayor: Unless they develop symptoms. Go ahead –
Commissioner Bassett: Yes.
Commissioner Bassett: No.
Commissioner Bassett: He was – and he was wearing full protective gear and is aware of no breach.
Commissioner Bassett: I’m sorry – I didn’t hear you.
Commissioner Zucker: He has been home. He has been home since his return.
Mayor: Alright, we’re going to conclude. I just want to thank all of my colleagues and especially thank the staff here at Bellevue – they’re doing extraordinary work at this moment. We will, of course, have additional updates as information is available. Thank you, everyone.
Commissioner Bassett: Thank you.