tv Hardball With Chris Matthews MSNBC October 23, 2014 11:00pm-12:01am PDT
emergency services in new york city dispatched one of the 36 teams in the -- they have been set up by the new york city fire department to handle first medical response and also medical transport for infectious diseases and hazardous materials. the fire department of new york city has more than 30 specialty teams set up to handle difficult situations like this.
one was dispatched today. the time that elapsed from when he first took the temperature and realized he had a fever and the time he was in isolation at the hospital appears to have been in total about two hours. after they had him at bellevue, they tested his blood at bellevue. that preliminary test came up positive for ebola between 8:00 p.m. and 9:00 p.m. tonight. in recent weeks before this diagnosis, new york city has been actively preparing to handle the care of an ebola patient in the event of an outbreak the training here is part of the national effort to sharpen the abilities of u.s. hospitals and health workers after the experience of treating the first patient in dallas resulted in two misses contracting the disease themselves from the patient they were assisting. centers for disease control held a huge training session for
thousands of health care workers in new york. doctors and nurses, and even janitors and security staff, anybody who might need to know what to do and how to handle themselves if they dealt with a symptomatic ebola patient. all of them got lessons, thousands of workers got lessons in putting on and taking off the protective gear that is so crucial to protecting health workers and nurses, doctors and nurses from the virus. this equipment in the case of an ebola patient is so intense and so all encompassing that health workers are the ones in treating when they are very symptomatic. when you get very symptomatic as an ebola patient, that almost always means you are, unfortunately, excreting lots and lots and lots of body fluids. the risk of death, the immediate cause of death for many patients is dehydration because of the
amount of body fluids that they essentially expunged from their bodies over the course of becoming very ill with the disease. it's because of that infectious body fluid that health workers come in contact with that there wear this personal protective equipment. those workers also got a pep talk from andrew cuomo. he went to the training and told the crowd that knowledge and training would defeat this disease. he encouraged them to remain calm and confident -- excuse me, competent in their profession. just two days after that training session, that training in new york has gone from being preparation to being actual medical practice. at a press conference tonight, officials urged everyone to remain calm. they stressed that ebola, while it is a scary disease and often a fatal disease, it is not easily transmitted. no one who has not had contact with the bodily fluids of a
systematic ebola patients is at risk for ebola even though new york city has its first patient. they announced that the disease detectives have traced to him and has his movements. though that patient had spent time out and about, including going to a bowling alley, officials said visiting the high line. he did do some degree of self isolation in the past week. >> he did attempt to self isolate, and we are still getting clear the amount of time that he spent outside of his apartment. 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. >> tonight that patient is at bellevue hospital. it's one of eight specially designated facilities in the state of new york, one of five
in new york city specially designated to handle a potential case of ebola. the training that thousands of health care workers went into, had at the convention center days ago, thousands of those workers were drilled on those preparations and trainings just a couple days ago. none too soon, because it has been called in to practice tonight. let's bring in the director of -- he serves as an adviser to the mayor. he joins us from in front of the hospital. >> thank you. >> you are standing in front of bellevue. this patient was taken there tonight. why were bellevue and four other hospitals specially designated as a place where ebola patients would be handled in the event that one did turn up? >> the idea here is to make sure that there are facilities that are up to speed to care for a
patient that gets sick with ebola. it's a very complicated process. dehydration and fluids is really critical. this is very difficult to manage. also infection control. all of that has to be done well. on the other hand, the possibility that here or anywhere else, the patient can walk into an emergency room of a smaller hospital, maybe less well-equipped, and there have been claims made to make sure that patients and staff our safe between someone walks into the emergency room randomly until they get to a specialized hospital, whether in new york city or the national centers. >> in terms of the unpredictability of where somebody might turn up, to the point you're making, governor cuomo kept stressing over and over again that every facility in hospital in new york in his jurisdiction is prepared to recognize a patient at risk in
to do a correct and safe initial diagnosis. it does raise the question to those of us who are professionals, what the differences between a run-of-the-mill hospital can't do that these hospitals can. >> there is a certain initial screening that has to be made. if we think back to the case of duncan, when he was greeted at that hospital in dallas for the first time in the emergency room and sent home because of whatever communication problems between the triage system and the actual care system. all those things have to be recognized. i don't think there is a hospital in the country that is not acutely aware of that very unfortunate progression. it starts with every hospital being able to understand when they have to focus in on a patient who might be a candidate for having ebola. that doesn't mean they have to have a full-blown, complete systems and all the infection control configurations necessary in the isolation rooms, but they
have to start with recognition and isolation of the patients, calling the right people immediately and getting them out safely transferred. what the governor was referring to quite correctly is a lot of focus on that. it's not even that simple because patients can walk into their local family doctor and their interns to wait in the waiting room until they get called in to be seen. this has to go pretty deep if we are going to make sure that we are not having any patients slipping through the cracks here. >> in terms of everybody trying to get very definitive in terms of when dr. spencer started to feel symptomatic. people have started to absorb the information that only symptomatic patients can pose the risk to others. how are new york city officials doing thus far in terms of addressing the worries about transmission in the community? all this detail about him going to a bowling alley, traveling by
cab, subway, eating at a restaurant in manhattan. the risk of somebody becoming symptomatic today but who may not have been feeling well the last couple of days, how do you assess communication on that and the risk? >> if you think about what is it that public officials should be saying to people? the last thing anyone wants to do is create unnecessary and unscientific panic. what we have to do is be able to present the facts as we know them. as you just stated, the patients are not considered communicable until they develop symptoms. what happened with dr. spencer two days ago, three days ago, before the symptoms came upon him is something that we have a responsibility to give people the information as we know it. if things change, can we learn more about this disease? it's possible. but we can be pretty confident in saying to the public, we really don't have any
substantive chance for getting ebola from dr. spencer taking a subway ride or even eating at a restaurant unless there was direct contact with bodily fluids at a time when he had symptoms. there has been long, hard discussions about every aspect of this by the city and state officials before they arrive at what is the message to the public. we saw some crazy things, including schools being shut down, schools decontaminated, friends of cousins of brothers who were once in africa being shunned by their co-workers and so forth. the responsible public position is to make sure that the public knows the facts, as straightforwardly and as honestly as to possibly be presented. there is nothing held back in terms of what we know as the facts. conversations with the cdc, dr. freiden and all the officials in new york, it was a consensus. is or isn't there a chance of
somebody catching the ball from riding in a subway car that dr. spencer had ridden on? the fact is, we just don't think that is a risk that should make anybody stop riding the subway. >> thank you very much. i really appreciate it. >> my pleasure. >> standing there outside bellevue hospital, where this first new york city ebola patient is in isolation tonight. joining us now from outside dr. craig spencer's apartment building is a reporter from an affiliate. thank you for joining us from uptown manhattan. what has the scene been like tonight? we were told that the doctor locked up his apartment tied and that nobody has been in there since. what is the scene on the ground? >> still sealed up right now. not too many of his neighbors have been coming in and out, but the few that we have seen say they were shocked.
they found out that he came back as positive. some said they didn't expect it to happen in new york city. at same time they said they are not too concerned about their safety. they understand this is only passed through bodily fluids. they would take the precautions over the next few days but are not too worried about their safety. i did talk a couple neighbors that said even though they are not concerned about getting ebola, they are upset and frustrated and incredulous this was able to slip through the cracks, able to fly to the united states and travel around manhattan the way that he has even though he had been in guinea with doctors without borders. >> in terms of the response, when he called emergency responders from home. he called doctors without borders. doctors without borders called the health department, health department called emergency services. they dispatched one of these teams that the new york city fire department maintains specifically for medically
responding to and transporting people in cases of infectious diseases or hazardous materials. is there any evidence on scene of either that response, the way they have treated the apartment since then, or was the block at all closed off today? >> it was closed earlier today. i have been out here since 3:00 this afternoon. there were remnants of the yellow police tape and some of the trash cans. the super of the building would not let us go inside, but his apartment has been sealed off. there were wearing hazmat suits earlier today. the emergency responders and neighbors say that dr. spencer was transported out of his apartment building wearing a hazmat suit. the past few weeks, the hospitals and health care workers in new york city have been preparing for a moment like this just in case. as soon as that call went through, they went through the protocol they needed to make sure this area was safe before
they transported him to bellevue hospital. >> sheldon, than for being with this. >> talking about the new york preparations there, anybody who either is a new yorker or who has ever been a new yorker can tell you one thing. the last decade and a half in the city, there is almost nobody who inspires more confidence than firefighters. learning that the fire department in new york not only was the emergency medical response team dispatched to transport this doctor, we now know that initial transport is a big part of what you need to get right in terms of limiting contacts in making sure that infectious disease protocols are maintained from the very beginning. it's no surprise that the fire department was given responsibility for that. they don't just have one team designated that they have set up in relation to ebola to handle infectious disease cases like
that. because it's the new york city fire department, of course, they have more than 30 of these teams constantly training. for dealing with all issues in terms of contagious elements and hazardous materials. new york city is a place, again, if you live here or have ever spent considerable time here in the last 15 or so years, we are of preparedness taken very seriously. when you are surprised about preparedness, it is because you are surprised they have thought of stuff that you would have never thought to be worried about until it happened. we will be right back.
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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 them are not at all at risk. we want to emphasize that new york city, has the strongest public health system, the world's leading medical experts and most advanced medical equipment. we have been preparing for months for the threat imposed by ebola. we have strong protocols that are being scrupulously followed and were followed in this instance. >> calling new york city the
world's strongest public health system, saying that the world's leading medical experts and most advanced medical equipment are being called on as necessary to handle new york city's first ebola patient. that was the mayor speaking at bellevue hospital in manhattan where the press conference was held earlier tonight. speaking at bellevue hospital tonight after the first ebola patient diagnosed outside of texas in this country was sent to bellevue at about 1:00 p.m. this afternoon. 33-year-old dr. craig spencer, who has been in isolation at bellevue since about 1:00 p.m. this afternoon. bellevue is a legendary institution, not just in new york, but in the united states. oldest public hospital in the country. as such, it has been through
hell and high water in terms of emerging diseases and fear of emerging diseases and the real challenges of managing infection in america's largest city in a big public health context. when the mayor calls new york city the world's strongest public health system with the world's leading medical experts, what does that tell us in practical terms about how emergency room staff, frontline staff who will be on this case and future ones too, how did those frontline workers handle this case, particularly an environment like this? joining me now is jeremy faust. thank you for being here. >> thanks. >> when the mayor talks about new york city as having an unimpeachably strong public health care system, is that fair?
do you think that new york city has a strong network of care and good systems? >> new yorkers take pride in everything we do, including medicine. i agree with the mayor that we took a lot of pride in being prepared and preparing to be prepared. the name of the game is coronation and preparation. my colleagues have faced everything throughout history, and they have rose to that challenge and will keep doing that with this. >> coronation is part of the name of the game, what do you mean? >> with the city, state and government on preparation. every single day, things change. when the facts change, you have to go with that. you have to say, look, we are able to be nimble and change as things occur. it is coordinated in its preparedness. >> cdc's specific guidelines for health care workers have changed not radically, but significantly
from the first case of ebola at dallas. when those protocols changed, how did those change in protocols ricochet through the system? how did that change? >> the way it's working now is because of the changes. everybody has to be retrained. every single person who has any chance of confronting a patient with this disease has to go through retraining. that involves lengthy procedures for getting all the equipment on, and now the importance of getting it off correctly. we are in the process of training everybody. little by little, everybody is getting on board with that. when things change, you have to change and be ready. the general attitude is that we can do whatever is needed. >> in terms of the way that you do that training at mount sinai, is there a sense this is ebola-specific work that the united states needs to do specifically because of this
moment in time for this disease, or is there a sense this is a more general infectious disease preparedness that we may be ramping up very quickly right now? that may be a broader help or basis for future instance. >> there is no question this will be transferable skills. what we are doing now will not just help with this situation, which will be very well controlled, but for other situations in the future which might be as scary or scarier in terms of how this disease is infected. it's very important to make sure everyone feels that we are doing what we need to do. if there is a win on the other side, the next time we are that much better. that is the way medicine in general response. >> what is hardest for you about the personal protective equipment and doing everything right? what takes the most repetition or what keeps you up at my that you were you might not do right?
>> i actually think that we have a great system in place. it's not a matter of adding more things to do. that can look like a little bit flail, like you are flailing. the important thing is to do it correctly. getting the equipment off is just as hard. one of the greatest strategies they have had in this new regime, you have to have a buddy system, somebody who watches you. that extra layer of teamwork is part of the whole thing. that will keep people sick going forward. >> being responsible can be more comfortable thing thaan knowing that you are on your own to make sure you do it right for itself. thank you for being here. >> thanks. >> up next, dallas county judge, clay jenkins, who became nationally known in this nation as overseeing the ebola response in dallas.
i know it's a frightening situation. i know you watch it on the news when 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 this situation is. 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 transportation 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. we had the advantage of learning from the dallas experience. >> new york governor, andrew cuomo, speaking at bellevue hospital talking about the new york city and state in response to this breaking news that a doctor just back from west africa has tested positive for the ebola virus. comparing the new york response to what happened in dallas,
where the very first patient to be diagnosed, thomas eric duncan, he was treated. sadly, that treatment in dallas was not successful. he died earlier this month in dallas. that is the facility that took him in and treated him after first missing the diagnosis the first time he came to the emergency room. he is the very first ebola patient to have been diagnosed with the disease in the u.s. and the only person to have been either diagnosed here or treated here who also died here. two nurses who treated him contracted the disease while being treated. the first was initially treated at that hospital and later moved to be treated at the national institutes of health in maryland. she is said to be in good condition. the second nurse also contracted ebola in the course of treating mr. duncan. she was placed at that same hospital and quickly moved to emory hospital.
her family released a statement yesterday saying that her blood has already tested negative for ebola nine days after she was first diagnosed. she remains in treatment. what can we learn from the dallas experience about how to diagnose and treat the disease, how to protect health care workers on the front lines so bravely providing that care? if you had helmed the dallas response and had been through everything that dallas has just been through over these past few weeks, what would you say tonight to new york about what has to started here and what is going to continue until this is resolved? what would your advise be? joining us now is clay jenkins, who has been helming the response in dallas. judge jenkins, it's great to see you sir. what is your response and how you felt tonight when you heard this news that for the first time outside of dallas, another
city is now coping with their first ebola diagnosis? >> my heart goes out to craig spencer and all those who love him, to the mayor and leadership in new york. but i can tell you, having helmed this in dallas, new york, you have a great public health system. you will get unparalleled support from the cdc, and you'll be okay. if he did not come into contact with bodily fluids of craig spencer, you don't have ebola. if you normally ride on the subway, you shouldn't be afraid to do so. ebola can only live in bodily fluids for two to four hours outside the body, and there's no evidence at all that dr. spencer, who is a physician and accurately reported his symptoms, lost any bodily fluids before being isolated by the health officials.
>> i don't know if you were able to see the press conferences done tonight by the governor and the mayor and the new york city health commissioner and the state health commissioner, but there is a big public communications effort to be very clear about those things you just said. the new york mayor tonight said that if you have not come into contact with the bodily fluids of an ebola patient, you are not at risk for ebola. is there any advice that you can give from your experience in dallas? you having tried to be so clear with what is a real risk and what wasn't and how to be compassionate in the face of fear, anything you advise new york city officials and how best to communicate about this and how repetitive they should be? how would you tell them to approach it? >> i think repetition is key,
empowering all of your community leaders, school districts, leadership, the clergy, block captains, leaders in all industries and from all walks of life to give those messages out peer to peer and door to door. you are fighting two things,ou are fighting ebola, and you are fighting public fear that arises from ebola. right now, what we need is for the public to get the facts. you know, new yorkers are savvy people. they are smart and tough and can rise to any challenge. if they have the facts, they can deal with this. those public health disease detectives have to hit the ground running. find every person who has had card, checking all those various things out, cast a broad net of disease contacts, but here is an important thing to remember, new
york. eric duncan was symptomatic and very sick for five days. we found 48 contacts, and all of them were negative for ebola, and all of them are passed their monitoring period. i am telling you from firsthand experience, you will be okay. >> judge clay jenkins, a man who knows what he speaks, a man who has been through it. it's a real pleasure to have you here tonight. i know you don't have to do this, but i appreciate you being here. >> thank you. >> still ahead, a look at the federal response to the ebola crisis. we will have the latest. stay with us.
andrew cuomo provided some detail tonight in terms of the level of coordination that has been happening beyond just here in new york city tonight. watch. >> having had the time to prepare as we did, we have been fully coordinated all day long. i spoke with are new ebola czar, who president obama appointed. they were immediately sending cdc teams. sylvia burwell from the homeland security office have been fully coordinated. they have reviewed everything that we have been doing.
we have been doing it with their advice, and we are -- after having spoken with everyone, doing everything that we need to be doing. >> governor cuomo said the homeland security office. sylvia burwell is the secretary of health and human services. understandable screw up at a time like this. the federal government has been reviewing everything that new york has done so far since this first patient was suspected. the director of the cdc spoke via telephone and said in addition to the response team heading to new york city tonight, this rapid response team from the cdc, he said actually the cdc already had a team on the ground in new york city for several days specifically to review all of the plans and procedures related
to ebola at this particular hospital. the cdc already had a special team here to review plans and procedures at bellevue even before this latest ebola case arose and the doctor was sent to bellevue for isolation and treatment. we were also told that president obama has been fully briefed by his homeland security advisor. we are joined now by senior white house correspondent, chris jansing. thanks for joining us. >> hi, rachel. >> what do we know about the scope and the reaction from the white house. >> what they like to say is this is a full government response. we just named the agencies to the cdc. they are all working on this. day two, welcome to the white house. he is stepping into a situation
that really does already have this extensive infrastructure. this is something that the white house has been putting together for quite a while now, but obviously gaining more intensity. this is something when we were talking to josh earnest earlier today, he said, i don't even know where his office was. i assume he has an office. i don't even know about his staff. i can tell you, having talked to a number of people at the white house today, this is why they brought him in. he has great management experience. they don't think it will be somebody who will be in front of the camera. the people tonight in terms of new york who will be doing that kind of thing, he will be working behind the scenes to coordinate this response. it's important to say as well when you talk about having folks on the ground from the cdc, they
have done all the numbers. they know where the likelihood is of the infections happening. they know where people are coming in from those areas of western africa. new york city is one of those hubs. it's not surprising they had people in place. they have a part of that rapid response team on the way tonight. >> it's striking the federal decision to limit all travelers to five specific airports in the united states. two in the new york city area, one in new jersey and one, jfk. that is where dr. spencer flew in. we have seen president obama clear his schedule at times as these cases have developed, particularly when there was news that health care workers had become infected. do you know anything about what we should expect from president
obama specifically, changes to his schedule or any response? >> we haven't seen that yet. i was talking to people tonight, and they say that's always a possibility, but they feel they have the infrastructure in place. it's also important to point out that we are focused on new york city in the coming days. from the federal government response, they are also looking at west africa. this is something they have been focused on for a while, because how do you stop people from infected with ebola from coming over here? that's by getting to it at the source. as you well know, there has been a tremendous response, including the department of defense. you are talking about places with the worst outbreaks with no infrastructure. the u.s. government is going in as the lead agency. in some places, the only agency going in. the only country going in.
essentially building a health infrastructure from scratch. that is something we talked a lot less about, but it's something the white house is very much focused on and something that goes all the way through, not just our national security teams, but our diplomatic teams and so on. and there are still big struggles they are having. responses from other countries to lend a hand in terms of money, in terms of personnel. they are still working on that part. >> chris, thanks for joining us tonight. thank you. >> my pleasure. >> it's fascinating the pentagon's role in this. they are outsized in terms of resources in terms to all other elements of the united states government. one of the things they can do is intensive, logistical work overseas in austere conditions. the pentagon is not being called up because you can shoot the
virus, but it's because the pentagon can go somewhere where there is nothing before they get there and can set up something that can be used in an ongoing way either by u.s. military personnel or by domestic personnel or in cases of international aid efforts. they can set it up in places where nobody else can. to see the mobilization ramp up has been impressive. days like this, there is never more of a reminder that you can get about the interlinking health crises around the world and our seeming feelings of impermeability here in one of the most industrialized nations. we have more to come. stay with us.
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in the late 1960s, a region in nigeria was walled off from the world by the nigerian government as part of civil war. what resulted was a health disaster for the people stuck inside and walled off from the rest of the world. what was borne out of that was a group of doctors who decided that the welfare of needy people, sick people needed health care, was more important than any political boundary for any reason. that group of doctors call themselves doctors without borders.
they have since gone on to win the nobel peace prize and have become one of the most respected humanitarian organizations on earth. in this ebola crisis, they have been on the vanguard in the fight against the disease in western africa. three shifts a day for 24 hours a day, six management centers across western africa staffed by hundreds of volunteer doctors and nurses who come to them from around the globe. doctors without borders said that it was taking a toll on their volunteers. soon after discovering he was sick, he passed from the disease in the facility run by doctors without borders. the group has been raising a global alarm about this crisis starting long before any governments were taking it seriously outside of the region. earlier they celebrated their 1000th ebola survivor. an 18-year-old boy from lead.
recovered fully from having been infected with the disease. doctors without borders is once again dealing with the news that one of their own volunteer physicians has contracted ebola. that patient is dr. craig spencer. he is at bellevue hospital in new york city. dr. morris, thanks for being here tonight. nice to have you back. >> thank you. glad to be with you. >> in terms of what we heard tonight with new york city political and health officials, did they describe anything about the way this was handled from the initial contact with this patient that either comforted you in terms of the response or that worried you? >> the response seemed to be the appropriate one. this isn't someone who came in through the airport, but a doctor who was trained and obviously expecting to monitor himself for symptoms.
everything was done exactly the way it should have been done, from the information that we have. he was put into a special ambulance, taken safely to the hospital and immediately put into isolation. >> in terms of the way this is being treated and the way people are being reassured, they have announced the specific subway lines on which he has traveled and that he went bowling in williamsburg in brooklyn last night. he traveled to the high line, to a restaurant somewhere in chelsea or the west village. all of those announcements caused a flurry of worry among people who might have done those same things. do you feel that new york city officials are assuring people adequately in terms of the risk associated with any of his travel to any of those places and why they are telling us he was there in the first place? >> i guess they are trying in good new york city fashion to be
as candid and complete as possible. the reality is, as i think all of your guests have said, the only way to catch ebola is by contact with bodily fluids or excreta, or a corpse, unfortunately, of someone who has symptomatic ebola, someone who has a fever and other signs which usually include nausea, vomiting and often bloody diarrhea. contact with those bodily fluids is the only way we know that is possible to become infected. for the others, it's just an interesting travelogue at this point. >> we are left to be calm about that and fascinated about it, trying to be realistic about and the actual risk imposed. thank you very much for being with us. >> thank you. >> professor of epidemiology at columbia university.
in terms of what we know, the facility where dr. craig spencer is being treated was designated ahead of time by new york state to be one of five facilities in new york city that was not just prepared like everybody but extra prepared, a designated center of excellence for handling a case like this. they knew it would be at bellevue. there are four other hospitals in the city designed to handle it just as well. three other facilities in new york state that also got that same designation. intense training they have been very vocal about here in new york ahead of this happening with two of five airports where people are traveling from west africa into this country, i think they knew it might be here more likely than it would be anywhere else. it's no longer practice, it's under way. thank you for being with us tonight. much more ahead. stay with msnbc throughout the night for the latest.
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