February 2, 2020
Mayor Bill de Blasio: About a week ago, I reported New Yorkers on the status of the coronavirus and I said at that point it was a question of not if but when. And now, we have our first case under investigation here in New York City. This individual, this patient who is being evaluated right now did exactly as they should have – followed the guidelines that the City of New York put out and they met these specific criteria: they had traveled to China, they did have the specific symptoms associated with coronavirus, and they did come to get medical care here at the hospital – exactly what we want anyone in a similar situation to do. We will in the next 48 hours, hopefully sooner, get results back from the testing of this individual. If this is a positive case, we'll confirm that publicly right away. And the individual of course will be treated until they are at a point where they are no longer symptomatic and contagious. Also, if it turns out to be a positive case, the Department of Health will do the work that it is well known for in tracing back all substantial contacts the individual’s had to ensure that anyone else who may have been affected gets the potential medical treatment they need. That work would start immediately in the instance of a positive measure. What I would say as a non-doctor and then you'll hear from our Commissioner of Health is there is still a lot we do not know about the coronavirus, a lot the global medical community does not know. What we do know, causes us a tremendous amount of concern and causes the City in New York to be in a high state of readiness. This is a disease now with over 12,000 cases worldwide. Eight of them here in the United States and 259 individuals have died so far globally. We take it very, very seriously and we will use all measures at our disposal to protect New Yorkers. And obviously we are working now with the guidance provided by the federal government and we're going to work immediately to implement that guidance. There's a lot we still need to get clarity on regarding it. The orders that were issued, there's a lot we have to work through with the Centers for Disease Control. There are many outstanding issues, but what's clear is we're going to work immediately to keep all New Yorkers safe.
My message to New Yorkers, first of all, for the vast majority of New Yorkers, the most important thing to recognize is this issue is being addressed. It's being addressed by the federal government, it’s being addressed by the city government, which has the strongest public health apparatus in the nation. People should be very clear about what this disease is and what it isn't and New Yorkers I always say are not intimidated easily. New Yorkers should go about our lives, continue doing what we do. Normally you can rest assured there will be constant updates on the situation.
We understand some things about this disease. As I said, others are still unclear. But what is clear is the only way you get it is with substantial contact with someone who already has it. You don't get it from a surface. You don't get it from glancing or very temporary contact based on what we know now. So, the bottom line, traditional rules of public health apply here. Just be smart. If you're in the presence of someone with symptoms make sure that if that person needs medical care, they're getting it. Do the basics like wash your hands and all the things you would normally do during flu season. And if you know someone, and this is the crucial point, if you yourself or anyone you know matches the criteria here, they have the symptoms and they have a connection to travel to the affected areas of China, see a medical professional immediately. That is the most important thing.
For the vast majority of New Yorkers, they will never have a reason to have to follow that guidance. But for anyone who has been to the affected areas of China or been closely connected to a family member or others who have, who have the symptoms, and then if they have those symptoms themselves, that's the kind of person who needs to get to a doctor immediately. And I have to emphasize immediately, that's how we ensure that each individual gets the help they need and that this problem does not spread. We are going to be working together again, federal government, state government, city government, all together. And I ask every New Yorker to help spread this information. And if you yourself need care or you know anyone who does, do not hesitate, get that care right away. Just very quickly in Spanish before turning to our Health Commissioner.
[Mayor de Blasio speaks in Spanish]
With that, I'll turn to our Health Commissioner, Dr. Oxiris Barbot.
A little extra height there. There you go.
Commissioner Oxiris Barbot, Department of Health and Mental Hygiene: Good evening. So, as the Mayor says, we are confirming our first individual who has been designated as a patient under investigation. This individual did what we have been asking New Yorkers to do, which is if you have traveled to affected areas in China within the last 14 days and you have symptoms, fever, cough, shortness of breath, or you're feeling unwell, to contact your doctor or to seek care in an emergency department. Additionally, this particular situation really highlights the fact that all of the measures that we have put in place with our partners are working the way that they should be working. So that when the patient presented here to Bellevue, they were appropriately evaluated, the appropriate first line tests were done to rule out a potentially common virus that could have been accounting for those symptoms, and they immediately called us when they had the information that indeed there was positive travel and a negative BioFire.
Because of patient confidentiality, we're not going to share any detailed information. And the only thing I will say is that the patient is stable and doing well. It's a reminder, however, that there are many New Yorkers across the city that are understandably anxious about what they may be seeing in the news. And that sometimes there are folks who prematurely think that they have a person who has coronavirus. But I want to assure you that we have strong systems in place to ensure that as soon as someone presents at one of our emergency departments or sees one of our physicians in the city, that we've got measures in place and we will promptly bring that attention to New Yorkers. It's also an opportunity for me to remind New Yorkers that the symptoms that can be consistent with the coronavirus are also the ones that are consistent with influenza. And so, this flu season is a very strong and heavy flu season and it's not too late to get your flu shot because it's very easy to confuse the two.
The last thing I will say is that this is a time for New Yorkers to continue their vigilance and to continue the advice the Mayor gave, which is if you've traveled to the affected area in the last 14 days or have come in contact with someone who has traveled and are feeling unwell, call your doctor or come into one of our emergency departments and we will take care of you. This is not a time to fall prey to false information that you may be seeing on the internet, to fall prey to the stigma that is trying to be propagated. This is a time for New Yorkers to know the facts, to help spread the facts and to seek care early. Thank you.
Mayor:Thank you, doctor. Two points – one, anyone who needs care, anyone who believes they have the symptoms and needs attention should not worry about the cost of it. You can come to one of our public health facilities, one of our hospitals or clinics. Obviously, that care will be provided immediately. No one should hesitate. Second, I want to thank everyone at Bellevue – this is a place that has dealt with some of the greatest health challenges over the last decades, including some of the most frightening international phenomenon that visited us here in New York City. And this is, I think, a place unparalleled on the earth in terms of how to – having the ability to deal with something like this effectively. So, once again, the whole team at Bellevue, everyone who works here – the doctors, nurses, everyone – finds themselves in the forefront of a nationally important situation and they are more than up to the task and I want to thank every one of them for all they're doing to help all of us.
With that, want to take any questions – yes?
Commissioner Barbot:So, the patient felt unwell and presented themselves to Bellevue Hospital.
Commissioner Barbot:So, I don't have the details whether they – yeah, whether they came in on a direct flight or an indirect flight. But the point is that they followed our instructions – were unwell and sought the care that they needed quickly.
Mayor:This is much different.
Mayor:Look, I think we should remember – and I remember those days very vividly during the Ebola crisis – we were dealing with the great unknown and we were dealing with a disease where there were a lot more answers and they were really bad answers. We know the spectrum in which this disease exists and it is very frightening, but it is not Ebola. Ebola was a devastating disease and yet the professionals here at Bellevue handled it head on and New Yorkers – and I was really proud of New Yorkers then – they didn't panic. They want to about their lives. They listened to the guidance. They acted on the guidance. So, I feel if we could get through that, I have no doubt we can get through this, but it is bringing back those memories for sure.
Mayor:The first part – I'll just jump in the first part. What I'm trying to emphasize is, no one should hold themselves back from medical treatment because they're worried about the cost. This is, first of all, a public health emergency. Second of all, this is a city that provides people in need with health care. So, what I'm trying to make sure does not happen is someone is worried how are they going to pay their private doctor and they hesitate to go get care, which puts them in danger and everyone else in danger. If you have the symptoms and you don't have a doctor to turn to come to one of our facilities, Health and Hospitals, and you will get care.
Go ahead to the second part.
Commissioner Barbot:So, in terms of the way in which the virus is transmitted, it's transmitted by droplets, which means that someone who coughs, sneezes and doesn't cover their mouth can potentially transmit the virus. It's not spread by airborne the way that, for example, measles might be transmitted. And so, every day we're learning more about the way in which this virus is transmitted and how easily it can be transmitted. But, right now, we feel confident that the most likely way to be infected by the coronavirus is by having extended contact with household contacts – so, family members, people that may live together. It is, however, also known that there can be transmission out of the home, but we're not quite yet certain how easy that might be.
Commissioner Barbot:So, as I said earlier, the patient is stable and is receiving care in the appropriate level of infection control that is indicated. This is an opportunity to remind New Yorkers that this is not something that you're going to contract in the subway or on the bus. And we want New Yorkers to practice everyday precautions that we ordinarily share during this time of the year, which is to wash your hands frequently, cover your mouth and your nose when you cough or you sneeze. And if you're unwell, if you're feeling sick and you have these symptoms, call your doctor because it might be time for you to get your flu shot.
Commissioner Barbot:So, they're under the appropriate level of precautions – infectious disease precautions that we would take with any other patient.
Mayor: I'm going to just intervene and say in a second I'll take another question, but I think formulating just a little more vividly what kind of precautions those are so people can understand? Does anyone from Bellevue want to speak to that? Just what – just a little bit of the protocol that you use in these cases. And please introduce yourself and you might want some height. There you go.
Dr. Kerry Dierberg:My name is Dr. Kerry Dierberg. I'm the hospital epidemiologist and the Chief of Infectious Disease here at Bellevue Hospital. So, we are taking the appropriate infection control measures as recommended by the Centers for Disease Control and our department of health here in terms of how we are caring for this patient and the room that this patient is in.
Commissioner Barbot:So, this person – there is no family here in New York City.
Mayor:And that – that was one of the things – so just everyone understands the level of vigilance that's already being implemented – Department of Health, working with Health and Hospitals immediately checked to see if there are other family members. Had there been, there would of course been the inquiry, where any of them symptomatic? But there this was someone who was staying in a place that was not with family or friends.
Commissioner Barbot:I will start and then I will defer to my Bellevue colleagues. So, the symptoms were fever, cough and a runny nose – like, that simple – and just not feeling well. You know, I don't know why she chose to come to Bellevue, but I'm glad that she did because it's one of the jewels that we have in our public hospital system.
Mayor:And it’s internationally famous – but anything else you want to add to the question? No?
Dr. Dierberg: So, as a part of evaluating any of these cases, we look for other respiratory viral illnesses that are actually much more common in our community such as influenza, which we're actually seeing a lot of right now, and also see in return travelers. So, part of our protocol is to evaluate people for other respiratory viral infections such as the flu.
Mayor:Yeah, I would – I mean, if either of my colleagues knows the answer, we'll certainly tell you what we can, but I'm not sure we have all that history at this point. I think that – look, this thing's been evolving over days and a common sense point – what we know is there's an incubation period, so someone might've come in without exhibiting any symptoms and then start to exhibit them later. I think the important point now is, here's someone who did the right thing and they did the right thing for themselves and they did the right thing for everyone else by coming in and getting care. So, you all now are in a position to do a tremendous public service to say, okay, here's someone who, they're not from here, but they did exactly what we would want them to do. And maybe the only place they heard of was Bellevue Hospital. I'm glad they came to Bellevue, right? I'm glad they didn't wonder where am I going to go or maybe I can't go there or whatever. Just get to medical help right away.
Commissioner Barbot:So, the person came from mainland China and we actually are working very closely with CDC and we are hopeful that we will soon be able to do the test here at our public health lab, which is actually just across the street. The issue is, since it's a new test, there are set protocols in place where the CDC first has to standardize the way it runs the analysis, they have to get a waiver from the FDA, and then they're able to then transmit it to localities that have labs that have the specialized equipment and skill staff to be able to do it. And so we fit that bill and my hope is that within a week or two weeks, we will be able to start doing it here in the city.
Mayor:Let me just add a little urgency to that. You know, a week ago we were already saying at the previous press conference we were asking the CDC to authorize New York City to do the testing. We clearly have the capacity here. So, I know the CDC has his hands full, but it would actually help everyone, it would also help the CDC, to authorize New York City to do this testing. This is the premier public health apparatus in the nation. We could help move on these issues more quickly if we had the capacity to test. Grant us that ability. That's my plea to the CDC. On the question of where in China, you heard from mainland China. I don't know if we're in a position to say anything more than that. I'm just – no, we are not.
Okay, go ahead.
Mayor:I'm going to start, but I think this also is a opportunity for the Commissioner to talk about what we did talk about a lot during the Ebola crisis, the disease detectives, if you will, and the people at Department of Health would do this work. But I want to say at the beginning, this individual didn't have a family here in New York City, didn't stay with friends, so we didn't have those kind of contacts of living in the same space with someone, which is the primary concern right now. There was no one apparently, at least based on what we know now, who would have been in that kind of close proximity. If we get a confirmation in the next 48 hours that this is a case of coronavirus, a very extensive charting of all their contacts will be undertaken, particularly focusing on if there was anyone they were in more regular contact with. But we don't know enough yet in this case to say there is anyone like that. I'm actually happy to say we know for sure they were not staying with any individual here in New York City. At least that's what we have right now. Now, Commissioner, I think everyone would benefit from you explaining just how that “detective work” happens in general.
Commissioner Barbot:So, I want to start off by emphasizing something that the Mayor said – this person is not yet a confirmed coronavirus patient. And so, we – and given the fact that they have no close family contacts, which is most likely to be the route of transmission, we haven't yet initiated these protocols. However, we have very robust measures in place to be able to identify and retrace someone's steps, be able to determine what the potential risk may have been based on where they were to then determine to what degree we then need to do the individual contacts and then the appropriate public health education to make sure that if those individuals haven't heard the recommendations about contact contacting us if they're symptomatic, that they know how and when to contact us.
Mayor:Commissioner, I'm just going to jump in on that. Could you just – a little bit more on how it works, the kind of questions that – again, I don't know what their formal title is, but the disease detectives, the kind of question, the kind of mapping they do.
Commissioner Barbot:So, we ask them in very excruciating detail, you know, what did you do when you woke up and give me every account for every single 15 minute interval about where you were, who you may have had contact with, what the extent of that contact with was in terms of, was it casual or was it more extended? Did you share eating utensils? Did you kiss? Did you have more intimate relations? I mean, we get into the very nitty gritty of how it is that someone might come in contact with someone.
Commissioner Barbot:I can't answer that. I'll defer to my Bellevue colleagues, but we were notified very early this morning. And my understanding is that the patient had presented shortly before that. At this point, there are no other individuals in the city that have reached the threshold of being a patient under investigation.
Mayor:You’re still too low –
Dr. Dierberg:I'm still too low. I'm trying so hard. I can confirm that the patient was here – arrived here very late last night. And the patient was in the United States for approximately two days before developing symptoms.
Mayor:Look, I may not be a public health expert, but my job is to protect all New Yorkers. So, I'll say, I think there is a common sense reality here that this disease has been growing rapidly all over the world and that it is particularly problematic because we don't know everything we want to know about it. So, taking actions to try and stop the disease from spreading into other countries make sense? There's a lot that we still need to sort out with the CDC. This happened pretty suddenly, so there's a lot of practical issues that have to be resolved. There's real work to be done. If we had a number of people who needed to be in isolation, how to do that the right way. Clearly, there could be a very substantial expense and we would expect as we have in past crises, the federal government to help and assist us with that. But the basic notion that very serious actions had to be taken, I agree with that. And we're going to do everything we can to take the federal government's instructions and put them into action. We don't know yet what the extent of that will be, but we're going to do everything we can to keep New Yorkers safe.
Mayor:Okay, let’s do the first few – step up – you know, you have a medical degree –
Dr. Dierberg:I’m trying –
I think I'm trying to just grow. So, the staff are wearing the appropriate level of personal protective equipment as recommended by Centers for Disease Control to keep themselves safe. The patient is receiving good supportive care, but no other specific treatments.
Commissioner Barbot:So, the important thing here is – and before I answer that, I want to just sort of build on the previous response and just be clear that there is no definitive treatment for this virus, that we can only provide supportive care. And so, to answer your question, that's why the travel history is so important and that's why it's so important for New Yorkers to make sure that they're up to date on their flu vaccine, because they're so similar in their presentations. Again, the other thing with coronavirus is, as the Mayor said earlier, there is a spectrum of symptoms. And we are hearing, you know, the over 12,000 individuals who have primarily been diagnosed in China, those are the ones who have sought medical care and are more affected. What we don't have a good sense of is, how mild can this illness be? And that's why we're taking a very forward-leaning stance and making sure that we don't miss any opportunities to identify an individual early, get them the care that they need early, and prevent any potential transmission.
Mayor:Let me try as a layman here, and, Commissioner, if there anything you need to correct, feel free, or my colleagues to correct. I think the challenge here is first of all, we’ve got a disease that the medical community doesn't know enough about. Second, there's no cure right now, but that doesn't mean that everyone who contracts it ends up in the same situation. Obviously, a huge number of people contracted disease and some have died and that is tragic, but nowhere near the number who have contracted the disease. So, what I think starts to become evident here is, some people get this disease –and I would say, from what we know, if they are healthier, they are more likely to weather it, come out the other side. If they already have a vulnerabilities, they're in greater danger. But there are people who get this disease, weather it, and then go on with their lives. What we're trying to make sure is, if you can track this disease, you don't give it to other people. So, that's the fast action to get them away from everyone else and make sure they're isolated and supported as they get well. So, this one, I wish it was in a way a sort of simpler equation – that we had a cure or we knew it treated everyone the same. But, in fact, what comes through is the common sense part. If you have the symptoms, don't wait, don't wonder what it is, just go get medical care. If it turns out it is this disease, that is not the end for you, a lot of people are going to come through this, but then job-one becomes making sure they don't infect anyone else.
Commissioner Barbot:Yeah –
Mayor:Correct. Okay. Other questions if there's any anymore.
Commissioner Barbot:So, I wouldn't say that it's a problem. I would say that it's a new test that was developed and that has to go through the proper protocols to confirm that results are replicable and consistently so. And then, once that test was refined, the next step is getting FDA approval to have non-CDC labs run that test. So, you know, we had a similar situation when we were fighting against Zika – that was a novel virus where a new test had to be developed. Initially, we were not able to do it in the city, but in short time the CDC was able to perfect the test, send it to us, we were able to do the internal controls and get it up and going quickly.
Mayor:Let me agree with my colleague, but add, again, a layman's point of view. I'm sure that's all accurate, but they should do that as quickly as possible. We need as much urgency at the CDC as possible. Sometimes bureaucracy stands in the way, so I want to know that they're doing everything in their power to speed the process so we can give that test right here in New York City.
Mayor:I don't have – I'm not an expert. I'm saying, we asked for it a week ago, we're still asking for it, they better pull out all the stops because the faster they do that, the better off everyone will be.
Anyone else? Last call – yes?
Mayor:If we get the right to do the test, where would we be doing it?
Commissioner Barbot:For right now, it would be only our lab to do that test across the street. The public health lab, yeah.
Mayor:A highly secretive facility, across the street –
Mayor:Right, because – and the care, let's separate where the formal test is done from where the care is given. Go to wherever you can get care right away.
Commissioner Barbot:The important thing to emphasize is that this is a two-step diagnostic procedure. You're going to go to your doctor or your local emergency department. There's a very simple task called BioFire, and that tests for 26 common viruses. And so, once that's negative, then the provider calls us, says this person has met the travel criteria, they're symptomatic, we've ruled out 26 common viruses that could have accounted for their symptoms and then we take it from there to say, yes, we confirm that this patient is a patient under investigation. Send us these samples and we're going to run the test.
Mayor:Flipping it around, Commissioner. If one of those 26 diseases is confirmed, end of discussion?
Commissioner Barbot:End of discussion, but it also depends on what their clinical picture is, right? If they are very mildly affected and they have a positive BioFire and we're confident that they, you know, have a way in which we can contact them, they can get back in touch with us to make sure that their symptoms are not getting worse – you know, we take every caution to make sure that the diagnosis that we have found is indeed the one. And in this particular time, we want to make sure that we don't lose track of them.
Commissioner Barbot:Biofire – B-I-O-F-I-R-E.
Commissioner Barbot:Months – yeah –
Mayor:[Inaudible] ignore the box.
Deputy Commissioner Demetre Daskalakis, Department of Health and Mental Hygiene: I'm going to ignore the box.
Demetre Daskalakis, Deputy Commissioner of Disease Control. So, we've heard from the National Institutes of Health that they are aggressively pursuing a vaccine. Realistically speaking, if it goes smoothly, it could take a year or more. So, we were not thinking a vaccine is going to be an immediate answer.
Mayor:Last call –
Deputy Commissioner Daskalakis:So, the testing, the sort of standard viral panel that you heard about – the BioFire that Dr. Barbot referred to, that's happening at local laboratories. So, I think, for instance, this one happened at Bellevue, so they did that initial screening. Testing for the coronavirus specifically is being sent to Atlanta to the Centers for Disease Control. That's who currently is doing testing.
Dr. Dierberg:The patient came by EMS.
Dr. Dierberg:I’m not sure.
Mayor: Okay. So, I think that covers it for now. Any new developments, we're going to alert you right away and we'll keep you posted as we go along. Please spread the word to New Yorkers about the precautions they should take and please spread the word to the CDC that we need the ability to give that test right here in New York City.