How Ebola hits New York?

A doctor who recently returned from treating Ebola patients in Guinea tested positive for the disease in New York on Thursday evening and is being isolated at Bellevue Hospital. The diagnosis of Dr. Craig Spencer, 33, marks the second uncontrolled Ebola case imported to the U.S. (Other people stricken with the disease have been brought to the country for treatment.) In the previous case, a Liberian man named Thomas Eric Duncan spread the virus to two nurses at a Dallas hospital and eventually died. Handling of the first Ebola patient raised questions about America’s preparedness for the disease, and a diagnosis in New York unrelated to the Dallas case could show if things have improved since those earlier missteps. Here’s what to focus on in the days ahead.

1. How many people did the patient come into contact with? New York Governor Andrew Cuomo said at a news conference on Thursday evening that the patient had been in contact with four people. New York City Health Commissioner Mary Bassett identified the four as Spencer’s fiancée, two friends, and an Uber driver in whose vehicle Spencer was a passenger. Ebola is spread only through direct contact with the bodily fluid of someone who has symptoms.

Spencer had been working with Doctors Without Borders in Guinea, and the medical organization said he monitored himself in accordance with the group’s guidelines.  There will be plenty of scrutiny regarding Spencer’s movements before he called Doctors Without Borders on Thursday morning to report a fever. The New York Times reported that he took a subway from Manhattan to Brooklyn the previous night. Even riding a subway train with an Ebola patient is low-risk because the disease is not transmitted through the air. Still, workers who were potentially exposed at the Dallas hospital where Duncan was treated were asked not to take public transportation.

Identifying and monitoring Spencer’s contacts is the first step in containing a new outbreak. If the list is only four names long, that’s a much smaller pool of potential contacts than those monitored after Duncan was diagnosed.

2. How ready is New York’s Bellevue Hospital? The first troubling sign in the Texas case was the fact that Duncan was misdiagnosed and sent home the first time he presented at the Dallas hospital with symptoms and a travel history consistent with Ebola. That put his family and people in the community at risk and delayed his treatment. No hospital in America wants to repeat that mistake. Bellevue has beendesignated by New York State as a destination for potential Ebola cases, and it has already dealt with some false alarms.

Spencer was transported by specially trained medics wearing hazardous materials protective gear, the city health department said. Those steps should have reduced the risk of further transmission.

3. How fast is his apartment cleaned up? One of the most discouraging scenes in Texas was the apartment where Duncan had stayed. His family was left for days with contaminated linens and clothing, a clear sign that state and local officials didn’t have a handle on things. Other public health offices should have learned and prepared for a similar scenario. Spencer’s apartment in upper Manhattan was reportedly sealed off on Thursday. If New York officials don’t quickly have a plan in place for clearing out contaminated items and relocating anyone else who might live there, it means they haven’t learned from the missteps in Dallas.

4. Where’s the Centers for Disease Control? After two nurses caught the virus while treating Duncan, the CDC said it would immediately dispatch staff to hospitals with additional confirmed Ebola cases to make sure health-care workers take the recommended steps to protect themselves. Getting a site manager to Bellevue to oversee workers—especially as they put on and take off protective gear—is crucial to preventing the spread of Ebola to health-care workers.

5. How do the public and politicians react? The reaction to Ebola in the U.S. in some corners was way out of proportion to the risk. A Texas college said itwouldn’t welcome students from Nigeria last month, and some parents have even pulled kids out of schools that faced no risk of Ebola. Politicians have called on bans of travelers from Ebola-affected countries, many of them Americans such as Spencer, returning from aid work. The tenor of the reaction to the second imported Ebola case—in a media capital with a fierce tabloid tradition—will tell us a lot about how the U.S. will deal with future Ebola cases.