Cuomo and Christie Order Strict Ebola Quarantines.

Katie Orlinsky for The New York Times        

N.Y. TIMES

The governors of New York and New Jersey on Friday ordered quarantines for all people entering the country through two area airports if they had direct contact with Ebola patients in Guinea, Liberia and Sierra Leone.

The announcement signaled an immediate shift in mood, since public officials had gone to great lengths to ease public anxiety after a New York City doctor received a diagnosis of Ebola on Thursday.

A few hours later, New Jersey health officials said a nurse who had recently worked with Ebola patients in Africa and landed in Newark on Friday had developed a fever and was being placed in isolation at a hospital. The nurse, who was not identified, had been quarantined earlier in the day under the new policy, even before she had symptoms. Officials did not know Friday night whether or not she had the virus.

The new measures go beyond what federal guidelines require and what infectious disease experts recommend. They were also taken without consulting the city’s health department, according to a senior city official

A passenger on the No. 1 train, one of three trains that Dr. Craig Spencer, New York City’s first Ebola patient, rode on Wednesday. Credit Todd Heisler/The New York Times        

In New York City, disease investigators continued their search for anyone who had come into contact with the city’s first Ebola patient, Dr. Craig Spencer, since Tuesday morning. Three people who had contact with Dr. Spencer, 33, have been quarantined, and investigators have compiled a detailed accounting of his movements in the days before he was placed in isolation at Bellevue Hospital Center on Thursday.

He remained in stable condition on Friday, and doctors were discussing the use of various experimental treatments. He was able to talk on his cellphone and was even well enough to do yoga in his room, according to friends.

Officials from New York and New Jersey said they were still working out many details, including where people would be quarantined, how the quarantine would be enforced and how they would handle travelers who do not live in either of those states.

The mandatory quarantine for nonsymptomatic travelers will last 21 days, the longest documented period it has taken for an infected person to show symptoms of the disease.

On Friday, the White House sidestepped questions about whether a nationwide quarantine of returning health care workers was being considered. Instead, officials defended the procedures the administration has put in place, including enhanced airport screenings and the monitoring of people arriving from Ebola-afflicted countries.

In New York City, health officials said that initial reports were incorrect when they indicated that Dr. Spencer had a 103-degree fever when he notified the authorities of his ill health. He actually had only a 100.3 fever. Officials attributed the mistake to a transcription error and said the lower temperature made it highly unlikely that he could have spread the disease before going to the hospital. Still, out of caution, they were tracing his contacts back to Tuesday, the day he began feeling fatigued. Dr. Spencer had been working with Doctors Without Borders in Guinea, treating Ebola patients, before leaving Africa on Oct. 14 and returning to New York on Oct. 17.

Much of the public’s concern focused on the movements of Dr. Spencer the night before he reported feeling ill.

On Friday, officials added some new details about those movements. He traveled on the A and L subway lines to Brooklyn, where he went bowling in Williamsburg and took a taxi back to Manhattan on Wednesday evening. He assured officials that he did not have symptoms at the time.

Earlier in the day, he went for a three-mile jog along Riverside Drive. On Tuesday, the day Dr. Spencer first began to feel sluggish, he visited the High Line and ate at the Meatball Shop in the West Village.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, said Dr. Spencer probably should have stayed home beginning on Tuesday.

“At that point I would have locked myself in, and I would have started checking my temperature hourly,” he said.

Dr. Schaffner also said he saw no need for an automatic 21-day quarantine or isolation period for people arriving from West Africa, not even health workers. There is no medical reason for it, he said, because people are not contagious until they develop symptoms.

Officials both national and local conspicuously conveyed the idea that the public should not overreact. President Obama was photographed in the Oval Office hugging Nina Pham, the Dallas nurse who was just declared Ebola-free after being in isolation since Oct. 16. Mayor de Blasio rode the subway, to demonstrate that the virus could not be spread through casual contact, like holding a subway pole.

The Ebola virus can be transmitted to other people only through bodily fluids when an infected individual begins to show symptoms. At the onset of illness, the amount of virus in the body is generally low, so the risk of infection is also considered small.

As the disease progresses, the amount of virus in the body multiplies and so does the risk of contagion.

Dr. Spencer’s fiancée, Morgan Dixon, has been quarantined at Bellevue Hospital Center. Officials said she would be allowed to return to the apartment she shared with Dr. Spencer, which has been cleaned, and carry out the rest of her quarantine there.

“There is the pure science and the protocols that must be put in place based on that science, in terms of what we know and what can come from that,” said Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University and a special adviser to Mayor de Blasio. “On the other end of the spectrum, there is the world of abundance of caution. Public officials are constantly trying to find the right balance.”

A special locked isolation ward at Bellevue Hospital Center is being used to treat New York’s first Ebola patient. Credit Benjamin Norman for The New York Times        

Doctor in New York City Is Sick With Ebola

Dr. Craig Spencer (right) and fiancee Morgan Dixon    Photo: Instagram

 A doctor in New York City who recently returned from treating Ebola patients in Guinea became the first person in the city to test positive for the virus Thursday, setting off a search for anyone who might have come into contact with him.

The doctor, Craig Spencer, was rushed to Bellevue Hospital Center and placed in isolation at the same time as investigators sought to retrace every step he had taken over the past several days.

At least three people he had contact with in recent days have been placed in isolation. The federal Centers for Disease Control and Prevention, which dispatched a team to New York, is conducting its own test to confirm the positive test on Thursday, which was performed by a city lab.

Dr. Spencer, 33, had traveled on the A and L subway lines Wednesday night, visited a bowling alley in Williamsburg, and then took a taxi back to Manhattan. People infected with Ebola cannot spread the disease until they begin to display symptoms, and it cannot be spread through the air. As people become sicker, the viral load in the body builds, and they become increasingly contagious.

The driver of the taxi, arranged through the online service Uber, did not have direct contact with Dr. Spencer and was not considered to be at risk, officials said.

The Meatball Shop on Friday in Greenwich Village, where Dr. Craig Spencer had visited. Credit Todd Heisler/The New York Times        

Speaking at the news conference, city officials said that while they were still investigating, they did not believe Dr. Spencer was symptomatic while he traveled around the city on Wednesday and therefore had not posed a risk to the public.

“He did not have a stage of disease that creates a risk of contagiousness on the subway,” Dr. Mary Bassett, the city health commissioner, said. “We consider it extremely unlikely, the probability being close to nil, that there will be any problem related to his taking the subway system.”

Mayor Bill de Blasio, speaking at a news conference at Bellevue on Thursday night, sought to reassure New Yorkers that there was no reason to be alarmed.

“Being on the same subway car or living near a person with Ebola does not in itself put someone at risk,” he said.

Still, out of an abundance of caution, officials said, the bowling alley in Williamsburg that he visited, the Gutter, was closed on Thursday night, and a scheduled concert there, part of the CMJ music festival, was canceled. Health workers were scheduled to visit the alley on Friday.

At Dr. Spencer’s apartment building, his home was sealed off and workers distributed informational fliers about the disease.

Since returning, he had been taking his temperature twice a day, Dr. Bassett said.

He told the authorities that he did not believe the protective gear he wore while working with Ebola patients had been breached but had been monitoring his own health.

Doctors Without Borders, in a statement, said it provides guidelines for its staff members to follow when they return from Ebola assignments, but did not elaborate on the protocols.

Emergency medical workers, wearing full personal protective gear, rushed to Dr. Spencer’s apartment, on West 147th Street. He was transported to Bellevue and arrived shortly after 1 p.m.

He was placed in a special isolation unit and is being seen by the designated medical critical care team. Team members wear personal protective equipment with undergarment air ventilation systems.

Ebola is transmitted through bodily fluids and secretions, including blood, mucus, feces and vomit.

Because of its high mortality rate — Ebola kills more than half the people it infects — the disease spreads fear along with infection.

At least two Doctors Without Borders workers have contracted the disease so far this year.
Norwegian physician Silje Lehne Michalsen was infected in Sierra Leone and recovered this month, according to the Nordic Page website.
A French nurse was also diagnosed with Ebola on Sept. 16 while working in Monrovia, Liberia, and recovered in France.

N.Y. TIMES

Can You Get Ebola From a Bowling Ball?

Although the surface of a shared bowling ball is a likely place to find germs — and some people avoid bowling for this very reason — it is extremely unlikely that Ebola could be passed that way. There is no evidence that it has been passed, as colds or flu sometimes are, by touching surfaces that someone else touched after sneezing into their hand. Ebola is normally passed through contact with blood, vomit or diarrhea.

If someone left blood, vomit or feces on a bowling ball, and the next person to touch it did not even notice, and then put his fingers into his eyes, nose or mouth, it might be possible. But, the Ebola virus does not not normally build up to high levels in saliva or mucus until very late in the disease — several days after the initial fever sets in — and it is unlikely that someone that ill would have just gone bowling. Also, the Ebola virus is fragile and susceptible to drying out. It does not normally survive for more than a few hours on a hard, dry surface.

N.Y. TIMES

Can Pets Get Ebola?

Bentley, the one-year-old King Charles Spaniel belonging to Nina Pham, a nurse who contracted Ebola.Credit Courtesy of Sana Syed/PIO, City of Dallas, via Associated Press

Ebola is primarily an animal disease. Its natural reservoir is probably fruit bats, which can live with the virus without getting ill. Gorillas, chimpanzees and humans all die rapidly after getting infected.

Ebola is found in some hunted African animals, including forest antelopes and rodents. Pigs, guinea pigs, horses and goats have been infected experimentally and either had no symptoms or mild ones. Ebola has not been found in any African felines, such as lions, so cats may be immune.

Dogs living with humans apparently can get infected. Although the virus itself has not been found in dogs, antibodies have been detected in their blood, suggesting the dogs had survived infections.

Gabon has had several Ebola outbreaks, and in 2005 French scientists tested 337 dogs for antibodies. Many were village strays that lived on what they caught and scraps that hunters threw them.

Villages in which there were both human deaths and hunters returning with infected bush meat — which often started the outbreaks — had the most dogs testing positive.

The most likely explanation, the scientists said, was that the dogs were infected with the virus from meat scraps and from licking human vomit. They were not known to get ill.

Whether dogs can pass the virus to humans or to other dogs is unknown. Many diseases — including polio and typhoid — have silent human carriers who never get sick but pass fatal infections to others.

Ebola is not known to exist in any North American animal species, including bats. But many species clearly could become carriers.

Since dogs interact intermittently with humans and with animals in city parks and rural forests, they could be a vector for transmitting Ebola from humans into wildlife, where it could, in theory, establish a permanent American reservoir.

While an infected dog could be quarantined, it would have to be caged indefinitely, since it is unknown how long it might remain infectious.