TIME ebola

NYC Mayor Noshes on Meatballs to Calm Ebola Fears

Doctor Quarantined At NYC's Bellevue Hospital After Testing Positive For Ebola
Mayor Bill de Blasio of New York City speaks at a press conference October 24, 2014 in New York City. In New York City. Kena Betancur—Getty Images

Mayor says he was not informed of new quarantine plans

New York City Mayor Bill de Blasio, his wife Chirlane McCray, and New York City Health Commissioner Mary Bassett on Saturday afternoon dined at a West Village restaurant that briefly closed after it was revealed the city’s first Ebola patient, Dr. Craig Spencer, had himself enjoyed a meal there not long before being diagnosed with the disease.

“We are not only resilient, we are not only tough, we stand by each other,” said de Blasio in a press conference after his meal at The Meatball Shop, a well-known city eatery specializing in its eponymous dish.

In a notable revelation, when asked by reporters about New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie’s Friday decision to enforce a mandatory 21-day quarantine for all health workers returning from the three West African countries hardest hit by the Ebola outbreak, de Blasio confirmed that neither governor told him about the plan beforehand. On Saturday, Illinois announced it will put similar measures into place.

“In an atmosphere of crisis, we respect the chain of command,” de Blasio said. The mayor would not directly answer whether he supports the mandatory quarantine plan, nor would City Health Commissioner Bassett. The mayor did, however, say the quarantine directive was made with “inherent flexibility.” Bassett will be overseeing quarantines in New York City, though she told TIME she hasn’t seen anything in writing yet.

Both de Blasio and Bassett tried several items on The Meatball Shop’s menu, seeking to emphasize it was safe to eat there. The restaurant, however, didn’t need the mayoral stamp of approval. It was packed with the usual weekend brunch crowd, while owner Daniel Holzman told reporters that when he reopened the restaurant at 6 p.m. local time Friday there was a line down the block filled with restaurant supporters.

“It’s an example of how New Yorkers deal with a challenge,” said de Blasio of the packed house.

Dr. Spencer, the city’s sole Ebola patient, is currently being treated at Bellevue Hospital, while his fiancée and two of friends are still under quarantine.

 

TIME ebola

Study: Current Aid Promises Won’t Contain Liberia’s Ebola Outbreak

Health workers from the Liberian Red Cross wear protective gear as they shovel sand which will be used to absorb fluids emitted from the bodies of Ebola victims in front of the ELWA 2 Ebola management center in Monrovia on October 23, 2014.
Health workers from the Liberian Red Cross wear protective gear as they shovel sand which will be used to absorb fluids emitted from the bodies of Ebola victims in front of the ELWA 2 Ebola management center in Monrovia on October 23, 2014. Zoom Dosso—AFP/Getty Images

Liberia does not have the resources it needs to end the Ebola outbreak any time soon.

The amount of treatment center beds and infection control resources needed to curb the Ebola epidemic in Montserrado County, Liberia vastly surpasses the donations pledged for the region from the international community, scientists say.

In a new report published in the journal The Lancet Infectious Diseases, researchers from Yale School of Public Health used modeling to compare estimates of case numbers in Liberia to currently available resources as well as those resources promised by international bodies. Their data show that without significantly scaled up efforts, there will be 170,996 cases of Ebola and 90,122 deaths related to the virus in Montserrado County by Dec. 15. But, the researchers say that if there’s a significantly ramped up effort that provides 4,800 treatment beds and a fivefold increase in detection and diagnostics in November, there could be 77,312 cases prevented by the same date.

Here’s the problem: The United States, for example, has only promised 1,700 beds to all of West Africa. Clearly, those numbers do not match up, making catastrophic projections for case and death tolls all the more realistic.

“While the window of opportunity for timely control of the Ebola outbreak has passed, the risk of catastrophic devastation both in West Africa and beyond has only just begun,” said study author Alison Galvani, a professor of epidemiology at Yale in a statement. “While vaccines to prevent Ebola remain unavailable, our study urges a rapid and immediate scaling-up of all currently available non-pharmaceutical intervention strategies to minimize the occurrence of new cases and deaths.”

But where is that scale-up going to come from? The answer is unfortunately unapparent.

TIME ebola

How to Talk to Your Kids About Ebola

Electron micrograph of Ebola virus
NIAID/EPA

Here's the best way to calm kids' fear and anxiety over Ebola

Even Centers for Disease Control and Prevention director Dr. Tom Frieden admits it: “Ebola is scary.” But for kids seeing alarming headlines without understanding the context of the disease, Ebola can seem like a looming and personal threat.

TIME spoke to Dawn Huebner, a clinical child psychologist and author of the book What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety about the best way to talk about Ebola with your kids—without scaring them silly.

What should I say to my child who is really scared about Ebola?
Let them know that it’s important to think about proximity—how close they themselves are to the virus. Which is to say: not very. “It’s really important to underline that we are safe in the United States, and that people who have contracted Ebola have been in West Africa or were treating patients with Ebola,” says Huebner. “Not only should parents underline how rare Ebola is, and how far away the epidemic is occurring, but also how hard the disease is to contract.” Huebner says parents can tell their older children that direct contact with an infected person’s bodily fluids like vomit or diarrhea is necessary to spread Ebola. “This has been reassuring to the children I see, as they know they are not going to be touching that,” she says.

By ages 7 and up, kids begin to grasp that their worries and fears aren’t always rational. “Parents can talk to kids about how one of the ways worries and anxiety get their power is by making us think about things that are very unlikely,” says Huebner.

Should I keep my child away from the news?
Your kids can watch the news to stay informed, but media overload is not always a good thing. “The news is often sensationalized and gives kids the idea that they are at an imminent risk,” says Huebner. When kids see endless stories about Ebola on the news, they don’t always realize they’re hearing the same thing on loop. “I’ve had kids come into my office who are under the impression that there are hundreds of people in the U.S. with Ebola.”

How do I know if my child is reacting appropriately to the news?
“An appropriate reaction would be to feel nervous and ask some questions, but to be reassured by the parents’ answers,” says Huebner. Psychologists distinguish between questions that are information-gathering, and questions that are reassurance-seeking. If a child asks reassurance-seeking questions—like “Are we going to be ok?”—once or twice, that’s normal. But asking the same questions over and over signifies that a child is really dealing with anxiety and that their concern is not being curbed. At that point, parents may need to sit their children down for a longer conversation to address their fears and concerns.

My kids don’t want to fly on an airplane over the holidays. How do I convince them they are safe?
It’s important to emphasize that the vacation destination is one that is safe, and not at great risk for Ebola. Parents can also stress that no one in the United States has yet contracted Ebola from a plane ride. However, parents should avoid making comparisons, like “It’s more likely to get in a car crash than to get Ebola.” That will only stress a child out more.

Ebola freaks me out too, and I accidentally overreacted in front of my child. How do I fix this?
“One of the wonderful things about children is that you really can revisit things that didn’t go so well the first time,” says Huebner. If parents slip up with an overreaction, they should have a conversation with their children and reference the moment. She suggests a conversation opener like this one: “I was thinking about when you overheard me on the phone with my friend. I was really overreacting. I got nervous when I heard about Ebola, and you saw me when I was nervous. Now I’ve gotten information and I’ve calmed down, and I’ve realized this is a very sad thing that’s happening far away. It’s sad, but it doesn’t have to be scary for us.” Rational, calm conversations will help ease a child’s fears about Ebola.

TIME ebola

Does Insurance Cover Ebola Care?

Your chances of getting Ebola in the U.S. are very slim. But if you do, who's footing the bill?

Ebola care is pricey, with estimates ranging from $5,000 to $25,000 per day, according to several health care analysts and experts who spoke to TIME. Some patients will end up spending weeks at a hospital, racking up a bill of $500,000 or more. That includes everything from paying the medical staff to disposing of waste, to the cost of resources like protective gear.

“The cost of treating a patient is going to vary vastly from hospital to hospital, [starting with] length of stay,” says Andrew Fitch, a health-care pricing expert at NerdWallet. “A patient treated in Dallas was only hospitalized for two weeks while another was treated for six weeks. The cost of dialysis and IV fluids is going to add up pretty fast and that is going to be compounded by the cost of isolation.”

So who foots the bill?

If you have insurance in the U.S., your insurer is likely going to cover the costs under emergency and/or inpatient care coverage. Even though patients with Ebola often first present in the emergency room, the disease is typically intensive and can last for several weeks. Major insurance providers TIME spoke to said they would cover Ebola treatment—but bear in mind that coverage starts after a person has met his or her deductible, which can be upwards of $13,000 for some family plans and $6,000 for an individual plan, says Jeffrey Rice, CEO
of Healthcare BlueBook, a Tennessee company that calculates health-care prices for consumers.

Dr. Craig Spencer, the Ebola patient in New York City, has health insurance coverage through Doctors Without Borders. Missionaries like Dr. Kent Brantly, Dr. Richard Sacra and Nancy Writebol have insurance through their missionary groups. Nebraska Medical Center, which has treated two patients with Ebola, including Sacra and NBC freelancer Ashoka Mukpo, says all of its patients’ care has so far been covered by their insurance providers.

But what if you don’t have health insurance?

Despite numerous requests from TIME to Texas Health Presbyterian Hospital in Dallas, the hospital did not confirmed how the uninsured Liberian patient Thomas Eric Duncan’s care was paid for. Analysts believe it’s unlikely that Duncan’s family will be dealt a hefty bill given how high-profile the case was and the mistakes made by the hospital.

Nebraska Medical Center says it would go about treating an uninsured patient with Ebola the same way that it would treat any patient who comes into their emergency room without insurance. They are federally obligated to treat the patient, and then the patients who cannot pay for their care can apply for financial aid and become part of the hospital’s charitable care program. “We provide millions of dollars worth of this kind of care yearly,” a Nebraska hospital spokesperson told TIME.

What if you get sent to a hospital that’s out of network?

Being treated at out-of-network hospital or by an out-of-network doctor could, in theory, result in a hefty bill. Getting out-of-network treatment covered by your insurance company is decided on a case-by-case basis based on medical necessity. While insurers have the legal right to refuse to cover this type of treatment, says Sabrina Corlette of the Center on Health Insurance Reforms at Georgetown University, it’s highly unlikely that they would sack the patient with the bill.

If your stuff needs to be incinerated, does insurance cover that?

One of the surefire ways to get rid of any lingering virus within an Ebola patient’s home is to incinerate their belongings. But do they get reimbursed? Most likely. If a government body or medical professional recommends or requires the destruction of property as a preventative measure in the spread of the virus, the value of the destroyed items would most likely be covered at the cost to replace them, or at depreciated value under a home, business or renters policy, says Amy Bach, executive director of United Policyholders.

Does insurance cover experimental drugs?

No, but that’s because there’s typically no cost involved at all when a drug is still in research and development.

 

TIME ebola

Dallas Nurse Released After Declared Free of Ebola

Pham is Ebola-free

A Dallas nurse who was infected with Ebola while treating a patient with the disease is free of the virus and has been discharged, the National Institutes of Health said Friday. Pham will head home to Texas Friday after first meeting with President Barack Obama, according to the President’s schedule.

Nina Pham was admitted to the National Institutes of Health Clinical Center in Bethesda, Maryland on Oct. 16 and has made a speedy recovery. She fell ill while caring for Thomas Eric Duncan, a Liberian man who was diagnosed with Ebola in Dallas and died of the disease Oct. 8. “We think of the National Institutes of Health as National Institutes of Hope, and hope went up a notch,” said NIH director Francis Collins in a press conference introducing Pham Friday.

Pham said at that conference she felt “fortunate and blessed” to be Ebola-free. She’s now heading back to Texas to return to a normal life and spend time with her dog, who has also been declared free of the virus. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said they confirmed Pham’s health five times, calling Pham “an extraordinarily courageous and lovely person.”

The treatment unit in which Pham was treated was built in 2011 as part of a bioterrorism preparation plan. The seven-bed unit is designed to care for patients with serious communicable diseases and has a staff of 50 to 60 highly-trained infectious disease experts and health care workers. The unit has special ventilation systems and waste disposal systems.

Pham received donated plasma from fellow Ebola survivor Dr. Kent Brantly, but it’s unclear how much of an impact that had on her recovery. Pham has asked for privacy for herself and her family.

News of Pham’s impending release comes just hours after Bellevue Hospital in New York City confirmed it’s treating that city’s first case of the Ebola virus.

Emory University Hospital also announced on Friday that another Dallas nurse battling Ebola, Amber Vinson, no longer has the virus in her blood, though she will remain in the hospital for supportive care.

TIME ebola

How Ready Is New York City for Ebola?

The city says it's much more prepared for Ebola than Dallas

Doctors Without Borders physician Dr. Craig Spencer tested positive for Ebola on Thursday, Oct. 23, at Bellevue Hospital in New York City, immediately testing the strength of the city’s preparation for the deadly disease.

Given the mistakes made during the first case of diagnosed Ebola in the United States—Thomas Eric Duncan in Dallas—New York City has more fears to quell and also more to prove. Can it do better than Dallas?

Its leaders certainly think so.

New York City has been prepping and drilling its hospitals for the possibility of an Ebola patient since July 28, when it was confirmed that Americans Dr. Kent Brantly and Nancy Writebol had contracted Ebola in Liberia. “I wanted to know that our staff was able to handle [a possible Ebola patient],” says Dr. Marc Napp, senior vice president of medical affairs at Mount Sinai Health System.

“We’ve prepared for a variety of different things in the past: anthrax, H1N1, small pox, 9/11, Hurricane Sandy,” Kenneth Raske, president of the Greater New York Hospital Association (GNYHA) told TIME. “This preparation is not unusual.”

New York City is also one of the first cities to adopt a new system that designates one hospital within a region—Bellevue in this instance—to be the headquarters for Ebola care. If there’s a patient who is a risk, like Spencer, Bellevue will take the patient. Should a potential Ebola case walk into the emergency room of another hospital, those patients can be transferred to Bellevue.

This is not the first time New York officials have responded to a possible Ebola case. In early August, Mount Sinai announced it had a patient with a travel history and symptoms that were a red flag for Ebola. The emergency room isolated the patient and the hospital sent blood for tests to the Centers for Disease Control and Prevention (CDC)—tests that ultimately came back negative.

The city wasn’t as lucky with Spencer, who had been self-monitoring since returning from Liberia. Spencer notified Doctors Without Borders when he ran a temperature on Thursday morning. Staff from New York’s Bellevue hospital were soon at his doorstep in hazmat suits, ready to take him in for treatment to the hospital.

“We were hoping [this] wouldn’t happen but we were realistic,” New York Governor Andrew Cuomo said in a press conference at Bellevue Thursday night. “We can’t say this was an unexpected circumstance.”

Cuomo noted that New York City had the advantage of learning from Dallas’ experience and its mistakes. Texas Presbyterian Hospital failed to diagnose Duncan with Ebola right away, despite his Ebola-like symptoms and the fact he’d been in Liberia.

“The trigger went off again when the nurses got sick in Dallas,” says Mount Sinai’s Napp. New York officials worked closely with the CDC and local health departments as well as with JFK Airport to ensure procedures were in place for identifying people who may be at risk for Ebola at every point of entry to the country. On Oct. 21, the city hosted an Ebola education session that was run by area health experts, with members of the CDC who demonstrated the proper donning and doffing personal protective equipment (PPE). Over 5,000 health care workers and hospital staff members took part.

“As a result of the missteps in Dallas, there were a whole new series of protocols,” says Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City.

There are some challenges—New York has spent time and energy preparing based on now outdated CDC guidelines. The new CDC guidelines for PPEs were only announced on Oct. 20, which doesn’t give the city much time to “practice, practice, practice” them as CDC director Dr. Tom Frieden has suggested.

And New York City has the challenge of sheer size and density. New Yorkers live in very close quarters with one another. Thankfully, Ebola isn’t an airborne disease, so even though Spencer traveled Brooklyn to go bowling, since he wasn’t symptomatic, anyone he might have encountered is at very low risk of contracting the disease.

For now, New York City has just one patient, and it plans to get it right. Doing so might restore American confidence in the system—but failure would be devastating.

Read next: Can You Get Ebola From Subway Poles and Bowling Balls?

TIME ebola

Can You Get Ebola From Subway Poles and Bowling Balls?

New York City Subway System
Getty Images

Lots and lots of research says no

Concerns were raised Thursday that the New York City doctor Craig Spencer, MD, who has been diagnosed with Ebola, had been to a Brooklyn bowling alley, had ridden the subway, and been inside an Uber taxi.

So, can you get Ebola from bowling balls or subway poles, or Uber doorhandles for that matter?

The short—and accurate—answer is no, and that’s based on what scientists know after decades of studying Ebola. Spencer was not symptomatic at the time, according to reports, which means he was not contagious at the time.

But, you may ask again, shouldn’t people who rode on the same train, in the same taxi or who touched the same bowling balls as Spencer, worry a little?

The research that exists says, again, no. The virus only survives inside bodily fluid of an infected person—meaning their blood, sweat, vomit or feces—that then comes into contact with an open sore or the mucus membranes of another person.

Data suggests the virus can, in theory, survive on surfaces if it’s inside a liquid. But the only confirmed case of a person getting Ebola from an object or material that can carry infection was during an Ebola outbreak more than a decade ago in Gulu, Uganda, when a patient got the disease by sleeping with a blanket that had been used by an Ebola patient. Based on what we know about transmission of the virus, that blanket must have had an infected person’s wet bodily fluids on it.

A study from 2007 by researchers at the Tulane School of Public Health and Tropical Medicine sampled 31 objects and surfaces that were not visibly bloody—they looked at bed frames, stethoscopes, etc—inside an isolation ward that treated Ebola patients. All specimens tested negative for the virus, suggesting the risk of transmission from surfaces was extremely low.

Read next: How Ready Is New York City for Ebola?

TIME ebola

Mali Minister of Health Confirms First Ebola Case

First case is a 2-year-old

Mali’s Minister of Health said the country has its first case of Ebola in a tweet Thursday.

The patient is reportedly a two-year-old girl who recently came into the country from Guinea, Reuters reported. The country borders Guinea, where the Ebola outbreak started. Mali is one of the first countries to start experimental vaccine trials.

TIME Heart Disease

How Mindfulness Protects Your Heart

Mauro Speziale—Getty Images

Tuning in to your body is good for your health

Self-aware people have better heart health, a new study suggests.

People who are mindful score higher on healthy heart indicators, according to recent findings published in the International Journal of Behavioral Medicine from Brown University researchers. The team looked at whether having something called “dispositional mindfulness”—which means you’re the type of person who’s very aware and attentive to what you’re feeling and thinking at any given moment—was a factor for heart health. They found a pretty significant connection: people with high mindfulness scores had an 83% greater prevalence of good cardiovascular health.

Having dispositional mindfulness doesn’t necessarily mean you’re regularly practicing mindfulness processes, like meditation. For some people, being more present is a natural part of their personality. For the rest of us, some say, it can be learned.

In the study, the researchers asked 382 people to evaluate statements that measure their level of mindfulness. Participants responded to statements like “I find it difficult to stay focused on what’s happening in the present”on a six point scale ranging from “almost always” to “almost never.” The participants who scored highest with the best mindfulness scores also had very healthy scores when it came to the seven American Heart Association indicators for cardiovascular health. Those include avoiding smoking, being physically active, having a healthy body mass index, consuming decent amounts of fruits and vegetables, and maintaining good cholesterol, blood pressure and fasting blood glucose levels.

The associations appeared to be strongest with factors including smoking, BMI, fasting glucose and physical activity. “The society we live in right now is very promoting of cardiovascular disease…cigarettes are still pretty inexpensive, and jobs are sedentary,” says study author Eric Loucks, an assistant professor in epidemiology at Brown University. “People who are more mindful tend to have more awareness of where their mind and bodies are at. By increasing our awareness, we might become more aware of the impact of what we are doing on ourselves.” If a mindful person is less physically active, Loucks suggests, they might notice that they have less energy.

Mindfulness-Based Stress Reduction has been taught in some medical settings for years, and Loucks points out that mindfulness scores tend to go up with the practice. “It does seem like mindfulness can be taught,” he says. “I think it’s good for it to be available for people who are interested in it…we shouldn’t force people to go mindfulness [training] if they don’t want to go. But it has the potential to be a resource.”

The findings are still preliminary, and the reasons for the connection are still inconclusive. But if corroborated, mindfulness interventions may be non-invasive ways to help people adopt healthier behaviors.

TIME ebola

Health Care Worker Tests Positive for Ebola at New York City Hospital

The entrance to Bellevue Hospital on Oct. 23, 2014 after a doctor who recently returned to New York from West Africa was rushed with a fever t o be tested for possible Ebola, the city's health department said.
The entrance to Bellevue Hospital on Oct. 23, 2014 after a doctor who recently returned to New York from West Africa was rushed with a fever t o be tested for possible Ebola, the city's health department said. Timothy A. Clary—AFP/Getty Images

A test confirmed he has the virus

A health care worker who was rushed to New York City’s Bellevue Hospital Thursday has reportedly tested positive for Ebola.

Craig Spencer had recently returned to the United States from one of the three West African countries hardest hit by the Ebola outbreak. The New York Times reported Thursday night that the Centers for Disease Control will need to confirm the initial positive test.

Spencer was transported to Bellevue by a specially-trained team wearing personal protective equipment, after he reported experiencing fever and gastrointestinal symptoms. Given the health care worker’s recent travel history, the Centers for Disease Control and Prevention and the New York City Department of Health concluded that he should undergo Ebola testing. They also screened for more common illnesses like Malaria.

The patient recently worked with Doctors Without Borders, and contacted the group Thursday morning to report a fever, the organization confirmed. “As per the specific guidelines that Doctors Without Borders provides its staff on their return from Ebola assignments, the individual engaged in regular health monitoring and reported this development immediately,” Doctors Without Borders said in a statement sent to TIME.

Disease detectives from the City’s Health Department have already started actively tracing the patient’s contacts as a precaution. They will notify and isolate anyone at potential risk of contracting Ebola. A White House official told TIME Obama has been briefed on the New York case multiple times Thursday.

New York City previously designated Bellevue Hospital to receive any Ebola patients that should enter the city. Bellevue has also been preparing to accept Ebola patients from other hospitals if need be. New York City hospitals in general have been preparing and drilling for the possibility of a patient with Ebola since August, most recently by holding an an Ebola education session for over 5,000 local health care workers on Tuesday.

This is the second time New York City has seen a potential case of Ebola. In the first case, a patient at Mount Sinai Hospital wound up testing negative for the virus.

–with additional reporting by Zeke Miller

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