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tv   All In With Chris Hayes  MSNBC  October 24, 2014 12:00am-1:01am PDT

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cal help right away. ask your doctor about cialis for daily use and a free 30-tablet trial. person's blood or other bodily fluids, not through casual contact.
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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. >> our wishes and prayers go out to the doctor, his family and
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friends for a speedy recovery. as you've heard the time line 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 awhile, all of the processes involved in making sure that he has been monitored, taken care of here at the hospital i'll mention a minute and most importantly him getting into the hospital. the ms 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 have been watched for closely. i thinks important to reiterate that you can only get ebola by being exposed to bodily fluids
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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 simms, as well, this morning. i think that it's important to just reiterate that the management of all of the issues that come fort with ebola have come together nicely with this patient and look forward to a quick recovery for him, thank you. >> 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 and sylvia behrwell and head of the cdc tom frieden who is with us tonight by telephone and will turn it over to dr. frieden now. can you hear us?
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>> yes, i can. can you hear me? >> yes, very well. >> okay, thank you very much. thank you very much for mayor an thoughts with the focus and doctors and patients in new york city. the federal government will continue to provide whatever assistance is required. i think it's important for people to understand how it spreads. so right now the concern is for the health care workers and the cdc has been in close communication with hospital authorities. in fact, by coincidence or because of good preparation.
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we already had a team on the ground and spent several days reviewing all of bellevue's preparations even before this patient became ill, therefore, reviewed the preparations and observed the hospital working. we will -- 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 could 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 to eliminate or minimize any risk of transmission during that prose s -- there were several individuals who had contact with him before he developed a fever and isolated and those individuals will be monitored
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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 does not spread easily, like the flu or the common cold or measles. only spreads by direct contact of body fluids of someone 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 will do everything to ensure that coordination of the federal, local and state levels is seamless and provides for all of the needs so that the care of the patient, the isolation and
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the contact tracing will all be done in a way that minimizes absolutely the 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. 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. [ inaudible ] >> can you speak a little louder? >> yeah. [ inaudible ] [ inaudible ] >> yeah, i'll give you as much information as i have. as i have said at the outset,
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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 there, and he did bowl while he was there according to our understanding of events. the patient was not feeling -- you know, 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
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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 has 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 was how he became infected. at the time that he was at the bowling alley, he had had no fever.
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[ inaudible ] >> the -- suddenly i'm being truly miked. the -- we obviously want to protect people's privacy, but the -- these are individuals who will be permitted to opt for a home quarantine. >> what about at the hospital? >> the patient, of course, is in the hospital. one of the patients is in the hospital today. >> one of the other -- >> one of the other patients -- one of the other contacts, so there are three contacts, one of whom is in the hospital today. yes. >> can you tell me -- the restrictions being placed on workers that come in contact what -- suspected --
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[ inaudible ] travel and quarantine and opt out -- [ inaudible ]. >> 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 and 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.
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i'm not aware of any that have. >> no one opted out so -- [ inaudible ] >> 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 long-standing isolation unit here, one that dates back to the 1990s and the days of the aids epidemic when multiresistant tb was a real scourge in this city. this unit is -- has been converted for the care of patients with ebola. there's 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
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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. >> if i could add -- >> just one second. >> i think one of the advantages is the health care 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 that must have been 5,000 health care workers. we have an abundance of equipment, an abundance of training, abundance of experienced professionals, and i think that's brought their confidence in the entire system up. >> and further, i just want to clarify, these folks at ems, for example, not only have been
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training for weeks and weeks but they are first responders. their job is to protect other people. they take it very seriously. it's a matter of honor that they take on a difficult role. equally, bellevue is legendary of 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. [ inaudible ] >> 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 was -- had a clinical picture that was really fully consistent with ebola.
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>> is fatigue a symptom? >> fatigue can be a symptom of many things. i think that the thing to make clear is that the first time this patient had fever today, and it's -- and fever is the typical sign of a person developing contagious ebola. >> and over here for one more, then we'll come to this side. yes. [ inaudible ]. >> what i can say, his friend said that he -- that they felt -- he seemed well. but the -- and the patient as i've said did not report any fever. and although he did report that he felt tired. >> yes. [ inaudible ]. >> well, he did really -- he did attempt to self-isolate, and we're still getting clear the
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amount of time he spent outside 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's a medical doctor, as we've all said, so he was very alert to the -- to signs and symptoms of ebola coming from a place where ebola is truly ravaging the population. [ inaudible ]. >> the waste? [ inaudible ] >> we have for the -- we have contracts in place for the removal of medical waste. [ inaudible ] >> the patient really only displayed symptoms today, and i see no reason for the tenants in the apartment building to be concerned. we have -- the apartment is isolated.
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no one is going in the apartment. we have assured no one will enter. the super will not let anybody in. there are no housekeepers expected to arrive. the apartment is locked and not accessible. >> dr. zucker had a point. >> i was going to make the other point he left his key in his apartment and locked the door as a very meticulous individual and recognized that if the key was floating around, somebody may pick it up. >> dr. 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
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and as you've all been hearing, they've been working, they were ready today. they showed how ready they were to accept a patient to -- >> and we all -- >> the governor -- >> just to clarify, all -- there are about 200 hospitals in the state. they have all prepared if someone walks into the hospital and presents themselves and suggests that they might have 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 that was a wise and prudent course of conduct. >> may i add also that, we, the department of health, was ordered to look at these hospitals and all 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
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patient like the patient you've seen today, so we're already one step ahead. >> john. [ inaudible ] >> and at this point as we go forward -- >> this would be based on the clinical team taking care of him right now. so we'll see how his progress goes. they are prepared to take care of him. [ inaudible ]. >> it seems like a physician -- >> we know he left his apartment and so that he -- self-quarantine would have meant he never left his apartment but he did self-isolate in the sense -- [ inaudible ]. >> he limited his contact with people and saw friends.
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he did leave his apartment, so i don't want to give the impression that he was in his apartment the entire time and -- [ inaudible ] >> he was -- during the time that he was leaving the apartment, he had had no fever. he was monitoring his temperature on a -- 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. >> 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 and been very, very informative and called in the medical detectives to trace the other pieces of the -- >> 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 --
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>> 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 have been that fatigued, and when he started to sense that he had a fever, he came in right away, and that's when you're contagious is when you're really extremely ill, and he presented himself this morning. >> you said that dr. -- [ inaudible ]. getting sluggish. can you tell us any more about where in the city he may have gone and also we all take the subway and the a-train and the l-train train. anything about cleaning the trains --
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>> let us have dr. bassett and dr. zucker speak about -- again, i want to preface, this is a very difficult disease to contract. it is not an airborne disease but it takes rather intimate contact to contract the disease. >> that is right. what do we know about his whereabouts? he went to a place called the gutter, a bowling alley in williamsburg in brooklyn that to get there he took the at -- the a-train and l-train and went to the high line, may have stopped and gone to a restaurant along the way, so we're just -- we're going to be getting more information about this. we -- he's fully cooperating with us. we have his metro card, and we are going to have the chance to talk with him. remember, he is a hospitalized
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patient in intensive care, about all of the -- to line up to -- everything from his metro card 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're sick, and what's contagious about them, 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 in -- at that time. he had no fever, and so he did not have a stage of disease that creates a risk of contagiousness
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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. >> dr. 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's an important point and regarding the subway, i would get on the subway tomorrow and ride the subway. >> to follow up on this, we know -- [ inaudible ] >> this is the only place -- >> when he had the fever, he contacted his employer, msf, and then that set into chain the correct motion. >> we'll take a few more. >> the doctor in quarantine as
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opposed to -- [ inaudible ]. the department of state and they [ inaudible ]. and i was wondering d.o.h has one policy and it's you wrap it up in plastic and burn it -- >> i think let's not talk about that right now. >> again, i'm respectfully -- i want to say we're talking about the immediate situation. we're talking about a patient who is a medical doctor who handled the communication with the city health department properly. he's here in the right facility. let's stay where we are on that. >> that's bad karma. >> [ inaudible ]. >> yes. [ inaudible ] >> all of the contacts the three, two friends and his fiancee are well, and they are all going -- are all in the process of being quarantined.
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>> they would not be tested -- >> last question. >> they would not be tested. they are not symptomatic. there would be no reason to test them. [ inaudible ] >> symptoms. >> unless they develop symptoms. >> [ inaudible ]. >> yes. >> [ inaudible ]. >> no. >> [ inaudible ]. >> he was, and he was wearing full protective gear and is aware of no breach. [ inaudible ] >> i'm sorry i didn't hear you. >> he has been home since his return. all right. we're going to conclude it and i just want to thank all of my colleagues and especially 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. >> all right. as you can see we've just been listening to a press conference
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from bellevue hospital where new york city and state officials have been giving the latest news on the first diagnosed case of ebola in new york city. dr. craig spencer, a 33-year-old physician with doctors without borders who are recently returned to guinea after treating ebola patients is now in a special isolation unit specifically designed and prepared at bellevue hospital in new york for this incident. dr. spencer was escorted in a specially appointed ambulance with a police escort to bellevue from his view in harlem this afternoon after calling 911 following simms including a 103-degree fever and nausea. he actually called his organization, msf, they called the department of health and the department of health now called 911. dr. spencer was tested and that test came back out positive this evening. the cdc is expected to conduct its own test, as well. administration official tells nbc news that several members of the cdc's rapid response team will arrive in new york city
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tonight, and others will be there in the morning. dr. spencer is in one of four specially equipped isis rooms in bellevue hospital which has nine other rooms that could be quickly converted to treat additional patients if necessary. there is no expectation that will become necessary. however, strongly emphasize at this point no one else has been diagnosed with ebola in new york city. dr. spencer's fiancee is in quarantine, not symptomatic. he did take a subway to a bowling alley in brooklyn wednesday night and took an uber home but says he was not exhibiting a fever at that time although he did tired. further, according to "the time". health care workers have disbursed across the city to see who else may have come in contact with him. you will recall that thomas eric duncan before receiving treatment in the dallas hospital where he died did not infect any family members. this despite the fact that he was symptomatic and in a relatively confined space for them for days and it should be noted new york has been
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preparing for this in the words of mayor de blasio and governor cuomo, for days and nights and sending people to those hospitals who pretended to have symptoms and travel histories consistent with a possible ebola diagnosis. joining me right from outside bellevue hospital in msnbc news katy tur. what's the latest? >> reporter: you make a great point about duncan. he did not infect his family members even though symptomatic. new york city officials want to make sure people do not start to panic over this. there are 8 million people in the city. he took the subway, took a cab. they don't want to have mass fear be spread. they're giving a great amount of detachment. he took the one train, a-train and l-train to a bowling alley and a cab back.
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they said it is extremely unlikely anythinpossibly could have happened on the train or anyone else could have been exposed. although he was feeling unwell, fatigue that he didn't start to show signs of a fever until today between 10:00 and 11:00 in the morning. that he had been checking his temperature twice a day and that's when he immediately called health officials then they breedly brought him to bellevue. four others in close contact with him are contacted and all in quarantine and that includes his fiancee. they want to be measured in their response and they also want to make sure that this man is not vilified. he's not treated as if he has done something wrong. they were very careful to say he was not symptomatic before this morning. that he was feeling tired in the days prior but that could have been anything and went on a three-file run and very careful to say he did not expose the public. he is an upstanding doctor there
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with doctors without borders treating ebola patients at great risk to himself and when he came home he was self-quarantining he went into the bowling alley. he's on day nine yesterday. day ten today, the day that he started to feel feverish and called health officials, that is definitely some cause for concern. chris. >> katy, thank you very much. joining me now dr. kemp sutkovitz at memorial sloan-kettering. a little "q" and "a" here. gentlemen, dr. spencer goes to guinea and treats patients there and comes back through jfk. >> right. >> ten days ago. at jfk he is subjected to the enhanced travel screening which consists of what?
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>> at that time it was before the most recent -- >> okay, so -- >> the previous travel screening. >> old school which was presumably a series of questions about travel and that's that but no deliberate plan to follow him up in any sort of active -- >> the new one would have created a chain in which there is a follow-up procedure if that had been in place? is that the difference between the new and old one. >> he did it himself. because he certainly lived in fear of catching ebola all that time he was over there in guinea, i mean that's what one wakes up in the morning is did i catch it so he took his temperature out of self-interest and public information. >> he went to his apartment. he was self-isolating. what does that mean? >> that's a tough one for me to define. i think she meant he wasn't going out partying every night. i think that he was measured in the way he went about his
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business and kept his -- a few friends around him and that's it. the only ones who have cause to worry, 8 million new yorkers need not worry, totally zero. i think his girlfriend and vaguely defined couple of other friends have something to be nervous about for the next couple of weeks, i also want to emphasize not only is he courageous and should be thought of as so but the nurses and doctors and everyone else in bellevue cleaning the room and bringing the food, they have a real concern ahead of them buts that's the extent. >> the fiancee being quarantined, two friends and i misspoke before. the car he took last night was a taxi not an uber but the uber driver was the fourth contact they'll be looking at. >> that person would not have risk, again, what we've learned a whole lot from dallas but knew a whole lot before dallas and knew from 20 years ago studies that were really well done from outbreaks in africa about
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household contacts that there is a 16%/1/6% transmission rate in household contacts. >> one in seven -- >> if you're living -- that's a really important statistic. i haven't heard it put in those words. living in a household with an outbreak, in a household with someone who is symptomatic. >> with mom who is sick and dying. >> one in six. >> 1 in seven and in that same study zero out of ho people who lived in the house but never touched the ill person developed infection. so unless the uber driver or the cab driver was unusually physical about his passenger, that would be uber, then there's zero risk. i mean i think we know that from science, not from public health pr >> that's a good point. i want you to stick around. a lot for questions and important to underscore that people in new york city should not really change anything about
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how they're going about their lives. the chance of contracting ebola is essentially vanishingly minuscule. dr. spencer did visit places in new york yesterday before coming down with a fever. details with where he went and who officials consider a risk and what you should know ahead. stick around.
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we are following breaking news at this hour. the first ebola case diagnosed in new york city. governor cuomo and bill de blasio set up a press conference to "a" train reassure new
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yorkers they are not at risk. ebola is extremely hard to contract. people not exposed to their bodily fluids are not at all risk. >> dr. spencer returned from guinea working with doctors without borders at an ebola treatment center. according to "the new york times" he was monitoring himself for signs of infection after his return and the hospital where he works in the emergency room, new york-presbyterian said he has not been on duty since he got back from guinea. new york officials said that he exhibited signs of not feeling well to bellevue earlier today, although he did not exhibit a fever according to health officials until this morning.
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he had been checking his fever twice a day and when he saw it this morning that's when he contacted his employer doctors without borders who contacted the health department and called 911. as we saw in dallas people who had extensive contact with duncan did not become infect. it is not especially contagious early on. dr. spencer was out in public last night traveling on the subway from manhattan to a bowling alley in williamsburg, brooklyn and taking a taxi back to his home in harlem. but it wasn't until today that he exhibited a fever of 103. >> let's talk about the travels of dr. spencer. i don't think there's a medical reason for them to have those concerns.
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>> it is a bit moot when you're first symptomatic with ebola virus infection, there's very little virus in your system. it's only as you're progressing in an intensive care unit where the virus inactivates your host defense mechanism. it's only in the advanced stages of your illness that we have lots and lots of virus. >> the more virus you have the most transmittable it is. >> who is getting sick in liberia? it's either the hospital workers or people taking care of loved ones at home in the advanced stages of the illness. keep saying to yourself, advanced stages or the illness. or burying the newly dead. >> as we know in the case of thomas duncan, he had -- it's probable he contracted the virus from a pregnant woman who he carried into a house who died
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four hours later, i believe. so it was very -- terminal stage essentially of her illness. >> so who's at risk? >> let's talk about who's at risk. it's the hospital workers in bellevue. they are the ones at risk. there's a fundamental question we need to ask tonight is, is bellevue ready to handle a patient with advanced ebola virus infection. so the point is unless -- >> so gutter, the williamsburg bowling establishment, whose owners are probably -- >> i would bowl there tomorrow. >> yes. right. >> if i bowled. you take the a train, the 1 train. all of these things are -- yeah. >> what i'm hearing from you is you're not going to do this, but you would sit on the sofa from this guy.
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>> remember, advanced stage of the illness, that's what's going to transmit the infection. >> i certainly would. yeah. sitting on the sofa is not an issue. taking care of him, drawing blood on him, dealing with him as a patient who's quite sick. i don't know that he is or isn't sick, but if he starts to hemorrhage. and this is a hemorrhagic fever. the blood is chalk full of virus starts to ooze everywhere. in dallas, it was a first case that manifested in the u.s., we saw two contractions. both the nurses who were attending. >> not from the emergency room. >> no, not from the marijuana room. even sicker than he was. >> what can we expect here as this goes forward. it seems to me there's two things to think about. as long as the outbreak and a genuine epidemic in west africa
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continues to rage, there will be additional cases that menifest. and health workers like those in bellevue. >> the next question is what are we doing now for those patients in bellevue. we've had a 90% survival rate in the united states right now. and one of the common feature of who survived and who didn't is who got an early intervention. will this patient have access to the two anti-viral drugs that are available? will he have access to immune globulin. you don't care about the red blood cell, you care about the antibodies. why aren't we preparing serum. all these things are probably under discussion right now. >> bellevue hospital, it's the oldest public hospital in america. it's been treating people, regardless of cost since the 18th century. >> treated the last smallpox case in the united states.
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>> it's the biggest public hospital where people from all walks of -- well, i should say people without means, without access to any other health care can find care at bellevue. because of that, these are people that, as doctors, experience a tremendous variety of illnesses that they have to treat. >> but as you say, they're specialized procedures here that emory and national institutes of health and the center in nebraska all have that we have not we don't know if they exist here. >> i think the horrible sequence of events in texas has been turned to good in so far as everybody is now really, really serious to learning how to down and doff their outfit. i think the level of preparation now just compared to even three weeks ago is night and day. they've been digging in for 2 1/2 months.
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almost three months now. >> there's good news to report tonight about ebola. there's bad news to report coming out of the west africa. we're seeing the potency of it right now. >> stay with us.
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>> we are covering the first ebola case in the city of new york. we will continue our coverage with the former surgeon general of the united states after this quick break. stay with us.
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a single ember that escapes from a wildfire can travel more than a mile. that single ember can ignite and destroy your home or even your community you can't control where that ember will land only what happens when it does get fire adapted now at fireadapted.org >> i know it's a frightening situation. when you watch it on the news and it was dallas, it was frightening. here in new york, it's more
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frightening. new york is a dense place. a lot of people are on top of each other. but the more facts you know, the less frightening the situation is. >> the first case of ebola in new york city. earlier today, we received confirmation a virus has spread in west africa. mali confirmed the first case of ebola in that country. the patient is a young girl whose mother died in guinea several weeks ago and was brought by her family in the country according to a health ministry official. on a more positive note here in the the u.s., amber vinson who contracted earlier this month is now officially ebola free after a blood test yesterday. no word on when she will be leaving emory university hospital. the nbc camera man who contracted ebola in liberia is
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ebola free this week and in the hospital. people get ebola from being around very, very sick people. not people who felt a little funny and then became symptomatic later that night. mukpo says he will be more cautious in the future. >> do you know how you contracted ebola? >> that's a million dollar question? >> will it change what you do? >> i don't think i'll change what i do, but next time if i'm in a situation where my life is at stake, i'm going to be much, much more hesitant to put myself in a position that is likely that i could get hurt. >> joining me now, richard carmona. can you put into the context this ebola outbreak. they're hearing two things. we're hearing don't panic, we can control this.
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don't worry about where you go. and then the w.h.o. says crisis levels. i think people are having a little hard time keeping those two parallel. dr. carmona, are you there? >> oh, there you are. okay. >> so put into context the significance and severity of this outbreak both global by and then here in the u.s.? >> it's definitely significant. it's a challenge. however, you know, we know how to control it. but it's an imperfect system. let's face it. people can get on planes. we will see cases slipping through and we have ton transparent and educate the american public that there are good safeguards in place, multilayers of public health protection and they provide
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pretty good coverage, but it also relies on people being honest and telling us their whereabouts. if they were in an endemic area or if they were near people with ebola and also that they comply with the health directions. that's tough. when people flee the country because they're scared, they may be unwilling to their those thoughts. because of a number of reasons, some of which i mentioned it's not a perfect system. patients can still slip through. >> there's an operating assumption under which the new york city public health system had been operating for two months. that paid dividends this evening. >> yes. that's absolutely true.
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there's a lot of information that went out where possibly the challenge was understated. the comments were overreaching. we have everything under control. we have a great public health system. people can inadvertently circumvent the system and that's why everybody has to be on alert so we capture those who fall through the tracks. >> thanks very much. we'll be right back with much, much more.
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>> we're back with the first case of ebola in new york city. with me the director of texas children center for vaccine development. and the infectious specialist. thoughts about west africa, the state of the outbreak there? how close we are to stamping it out. >> so things are still very scary. the good news is we've sent 3,000 troops into liberia, the uk sent troops into sierra leone. now if we can put together some kind of infrastructure in place so we have the beds, the trained personnel the world health organization has not attached to it. 70% of the patients have to get into treatment facilities and
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70% of the burials have to practice safely. that what it's going to take to turn it around. we have to rely on accelerated development of three new vaccines coming on line. >> we're seeing a learning curve here in the u.s. >> i think it's a very compassionate, civil and very accomplished city. the way we did this was textbook perfect from a perspective informed by the troubles in dallas, but also informed by lots and lots of practice. new york city really looked great through this, i think. >> i think everyone, their thoughts are with dr. spencer. also doctors without borders does incredible work in the most difficult places. doctorswithoutborders.org. they're an organization, deserving your attention.
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stay with msnbc and msnbc.com for much more on this breaking news story. good night. we are back live with continuous special coverage of what appears to be a new case of ebola in the united states. this is the first case in this country that is not connected to the patient who died in dallas this month. the new position is a 33-year-old doctor named craig spencer. he is attached to new york presbyterian hospital in new york city. it was believed he was infected in the west african nation of guinea. we were told he was working to fight the ebola epidemic alongside the heroic international medical organization called doctors without borders. new york officials said dr. craig spencer felt some mild fatigue in the last couple of days but nothing serious. he has been self monitoring by taking his temperature twice a

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