TIME ebola

Doctors Without Borders Responds to New York Ebola Case

Doctor Quarantined At NYC's Bellevue Hospital After Showing Symptoms Of Ebola
Bryan Thomas—Getty Images A New York City Police officer stands at the entrance to Bellevue Hospital October 23, 2014 in New York City.

"Extremely strict procedures are in place"

Doctors Without Borders/Medecins Sans Frontieres (MSF) confirmed Friday that one its staff members tested positive for Ebola in New York City this week. While the patient’s identity, Dr. Craig Spencer, has been made public, MSF declined to provide further details about his him, citing privacy reasons.

Spencer had recently returned from Guinea, where he was part of the humanitarian aid group’s efforts to treat the Ebola epidemic there. MSF had strict procedures requiring members returning from Ebola-stricken areas to monitor themselves by taking their temperature twice a day for potential signs of a fever, an early sign of the virus. When Spencer found his temperature was high on Thursday morning, he immediately called MSF, which then contacted the New York City Department of Health & Mental Hygiene.

MORE: Ebola in New York: How Worried Should the City Be?

“Extremely strict procedures are in place for staff dispatched to Ebola affected countries before, during, and after their assignments,” Sophie Delaunay, executive director of MSF said in a statement. “Despite the strict protocols, risk cannot be completely eliminated. However, close post-assignment monitoring allows for early detection of cases and for swift isolation and medical management.”

According to the group, three MSF members and 21 locally employed staff have been infected with Ebola; thirteen have died. MSF has 3,000 employees working in West Africa to treat Ebola patients; more than 700 international staff from around the world have spent varying amounts of time in the region battling the epidemic.

TIME ebola

Ebola in New York: How Worried Should the City Be?

A doctor diagnosed in New York City raises public health questions in one of the world's most densely populated urban areas

Dr. Craig Spencer, 33, of New York was diagnosed with Ebola Thursday night after he was isolated at Bellevue Hospital. Before he was rushed to Bellevue in Manhattan earlier Thursday afternoon, the Medecins Sans Frontiers (MSF) MD took a subway to Brooklyn on Wednesday night where he spent a few hours at a bowling alley, and then took an Uber car back home. Health officials say that he was not symptomatic—and therefore not contagious—at the time. The next morning, he took his temperature and reported that it was 103F, and immediately reported it to MSF, which then notified the state and city health departments. (New York Gov. Andrew Cuomo said Friday morning the doctor’s temperature had been 100.3F, not 103F as previously reported.)

The diagnosis has raised concerns about how quickly Ebola could spread in a city as densely packed and populated as New York. But in a late night press conference, the mayor and governor of New York, as well as the city and state health commissioners were quick to assure the public that New York was prepared for such a case, and that everything had gone according to plan in identifying, isolating and bringing Spencer to Bellevue. “We are as ready as one could be for this circumstance,” said Cuomo. “What happened in Dallas was the exact opposite. Dallas unfortunately was caught before they could really prepare, before they knew what they were dealing with. We had the advantage of learning from the Dallas experience.”

President Barack Obama meanwhile spoke on the phone Thursday night with Cuomo and, separately, with New York City Mayor Bill de Blasio, offering any additional federal support necessary in terms of patient care, the maintenance of safety protocols for healthcare workers, and the identifying of any of Spencer’s contacts who might be at risk of exposure.

The public has been assured that riders of the subway, and even residents of Spencer’s apartment building, are at very low risk of getting infected. “There is no reason for New Yorkers to be alarmed,” said de Blasio. “Ebola is an extremely hard disease to contract.”

As sobering as the Dallas experience was for that city, widespread cases in New York are unlikely, they said, because Spencer was asymptomatic when he was in public places, and because Ebola is only spread from person-to-person when two conditions are met.

First, the infected person must be symptomatic, meaning he has a fever, is feeling nauseous, has a headache or is otherwise feeling ill; and there must be direct contact with his body fluids — saliva, sweat, blood, urine, vomit or feces — at this time with another person’s mucous membranes such as in the eyes, nose or mouth, or with an open wound.

City health commissioner Dr. Mary Travis Bassett said that Spencer had gone for a three mile jog, and that the night he visited the bowling alley, also strolled along an outdoor area in downtown Manhattan where he ate at a restaurant. He was taking his temperature twice a day since leaving from Guinea on Oct. 14 and did not have a fever until the morning of Oct. 23, the night after he visited the bowling alley and after his other excursions. Bassett said that since Spencer was a doctor and fully aware of his risk of having been infected with Ebola, he had been limiting his contact with others since arriving back in the U.S. once Oct. 17.

And because Spencer was alone in his apartment when he began feeling ill, with a fever and some gastrointestinal problems, the number of people who may have had direct contact with him when he started becoming contagious is small. New York City health officials said on Thursday that Spencer’s fiancee was in isolation at a hospital, two of his friends and the driver of the Uber car he rode were being monitored.

On Thursday night, Uber issued a statement saying they had confirmed with both CDC and New York health officials that “neither our driver partner nor any of his subsequent passengers are at risk.” The statement added, “Our thoughts are with the patient and his loved ones.”

Spencer’s apartment is cordoned off, and officials will likely sterilize or incinerate all of its contents, as they did with the apartment in which Dallas Ebola patient Thomas Eric Duncan lived, and with the apartment of Nina Pham, one of the nurses whom Duncan infected.

New York State has designated eight hospitals to care for Ebola patients, including Bellevue. While all 200 are prepared to isolate and initially handle anyone who might come in with suspected Ebola, if they test positive they will be transferred to one of the eight hospitals that are designed to treat patients with staff that has drilled in the proper protocols for protective equipment and handling and removal of waste. At Bellevue, for example, the lab for testing blood samples is contained within the isolation unit so samples from infected patients are not mingled with those of other patients.

Given the mistakes made in Dallas, in which one patient infected with Ebola transmitted the virus to two health care workers, New York City is on alert. However, in a press conference late Thursday night, Mayor Bill de Blasio assured the city that Bellevue had been drilling for this possibility for months.

With additional reporting by Zeke Miller

TIME Cancer

Here’s How Well Your Genes Can Predict Your Breast Cancer Risk

Researchers say genetic sequencing can predict breast cancer risk better than previously thought

Your genes have a lot to say about who you are and how healthy you are. But for certain diseases, including cancer, so many genes are likely involved that it’s hard for doctors to come up with a useful, reliable way to turn your DNA information into a precise risk score.

But in a paper published in the journal Cancer Epidemiology, Biomarkers & Prevention, researchers say that combining the known genetic players in breast cancer can predict with much higher accuracy a newborn girl’s theoretical risk of developing the disease.

MORE: Angelina Jolie’s Surgery May Have Doubled Genetic Testing Rates at One Clinic

Alice Whittemore, a professor of epidemiology and biostatistics at Stanford University School and Medicine, and her colleagues included 86 known genetic variants that have been associated with breast cancer—including BRCA1 and BRCA2, which are relatively rare but confer a very high risk of disease compared to those that have a smaller contribution—and created a computer model that took into account the rates of breast cancer among women who had these genetic variants.

This model served as a predictor for breast cancer based on womens’ genetic makeup. When researchers looked at the top 25% of risk scores, they found that these would account for about half of breast cancer cases in the future. Using previous models, genetic variants could account for only 35% of future cancer cases.

“Our results are more optimistic than those that have been previously published,” says Whittemore, “because we took 86 known genetic variants associated with breast cancer, and took what was in the world’s literature about how common those variants are, and by how much a factor they increase risk. And the more genetic variants that are identified, the better we will get at this.”

MORE: BRCA Gene Can Be A Cancer Triple Whammy, Study Finds

Since the paper was submitted, several new genetic variants have been linked to breast cancer, and adding those to the model, says Whittemore, could make it more effective.

But just because a woman may have been born with a high genetic risk for breast cancer doesn’t mean that she can’t change that risk. The model found that lifestyle factors, which are in a woman’s control, can generally lower that genetic risk as well. And the higher a woman’s genetic risk, the more she can reduce it with healthy behaviors.

“The news is that even if you are at high genetic risk of developing breast cancer, it’s all the more reason to do what you can to modify your lifestyle to lower your risk by changeable factors even if your genes aren’t changeable,” says Whittemore.

TIME ebola

How Worried Are You About Ebola?

Electron micrograph of Ebola virus

As the Ebola epidemic continues in West Africa, the U.S. and other countries could also see cases of the disease in coming weeks and months.

Tell us how you feel about the U.S.’s efforts to contain Ebola in this 10 question survey, and see how other responders rate the country’s preparedness.

TIME ebola

Dozens Who Had Contact With the First U.S. Ebola Patient Are in the Clear

Mayor Mike Rawlings speaks during a news conference about the recent Ebola infections with Dallas County Judge Clay Jenkins and Dallas County Health and Human Services Director Zachary Thompson at the Dallas County Administration Building on Oct. 20, 2014 in Dallas.
Chip Somodevilla—Getty Images Mayor Mike Rawlings speaks during a news conference about the recent Ebola infections with Dallas County Judge Clay Jenkins and Dallas County Health and Human Services Director Zachary Thompson at the Dallas County Administration Building on Oct. 20, 2014 in Dallas.

"We are so happy this is coming to an end"

The first wave of people who were being monitored because they had direct contact with the first Ebola patient in the U.S. were declared free of the disease early Monday, an important step in the containment effort.

The Texas Department of State Health said 43 people were in the clear after they had contact with Thomas Eric Duncan, who died of the disease Oct. 8. Health officials have been taking their temperature twice daily for 21 days, the longest incubation period for the virus, and said that none have developed symptoms. Those individuals will now be taken off the watch list and will no longer need to be checked for symptoms.

At least two health care workers who helped treat Duncan have been infected, amid an outbreak that has killed more than 4,500 people in West Africa.

The group taken off the watch list Monday includes “a mix of health care workers, household contacts and community members whose last possible contact with the state’s first patient was Sept. 28,” the department said. They had to make themselves available for daily monitoring and were told not to leave the state during the incubation period.

The four people who lived with Duncan after he arrived from Liberia, where he contracted the disease, have also shown no signs of infection and will be taken off the watch list. They included Louise Troh, Duncan’s girlfriend, his son with Troh and two young men. They were placed under quarantine because of their high risk but will be now allowed to leave their temporary home.

“We are so happy this is coming to an end, and we are so grateful that none of us has shown any sign of illness,” Troh said in a statement. “We ask to be given privacy as we seek to rebuild our home, our family and our daily living.”

Texas state health officials and the Centers for Disease Control and Prevention continue to monitor 120 people, including health workers who cared for Duncan while he was hospitalized at Texas Health Presbyterian before he died, and passengers who sat within three feet of a nurse from the hospital who flew on two commercial flights on Oct. 10 and Oct. 13. Those health care workers have now been told to remain at home and avoid public places.

Read next: Nigeria Is Ebola-Free: Here’s What They Did Right

TIME ebola

Nurse Infected With Ebola in Dallas Now Being Treated in Maryland

Texas Nurse Infected With Ebola Transferred To Maryland
Chip Somodevilla—Getty Images The airplane carrying Texas Health Presybterian Hospital nurse and Ebola patient Nina Pham takes off from Love Field airport October 16, 2014 in Dallas, Texas.

Nina Pham now has a staff of 50-60 trained health care workers taking care of her at the National Institutes of Health

Nina Pham, the first person to be infected with Ebola in the U.S., arrived at the National Institutes of Health Special Clinical Studies Unit in Maryland just before midnight Thursday evening, the NIH said Friday.

Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and Dr. Rick Davey, deputy director of NIAID’s division of clinical research, said Pham was in fair condition and resting comfortably. Davey will be the physician overseeing Pham’s care.

Fauci said that from the time when Liberian Ebola patient Thomas Eric Duncan became the first person diagnosed with the disease in the U.S., “we made very clear that we could make the highly specialized facility available if called upon. We were called upon to accept Nina and we did.”

The seven-bed NIAID unit in Rockville, Maryland was created in 2011 as part of the U.S.’s bio-terror preparedness efforts. It’s designed and equipped to care for patients with the most dangerous infectious diseases. The unit has a dedicated staff of 50 to 60 personnel who are specially trained in infection control for biohazards, and, said Fauci, retained continuously to keep their education up to date. The unit’s isolation unit has a separate ventilation system that directs air into specialized filters, and the unit has a dedicated system for removing patient waste and other biohazardous materials.

The center is not just a hospital, but also a research facility. Every patient treated there is also a research subject, and Pham will be no exception. Dr. H. Clifford Lane, clinical director of NIAID, said that Pham’s virus and her immune system’s response to it will be studied extensively. The researchers at the unit are also part of vaccine studies and are working on ways to intervene earlier in the disease’s course with better treatments. Such treatments may help not just Pham, but also the thousands in West Africa currently battling Ebola.

As far as what therapies Pham will receive, Fauci would only reveal that Pham has so far received, while in Dallas, plasma donated from Dr. Kent Brantly, the first American patient successfully treated for Ebola — Brantly was diagnosed while in Liberia before being flown to the U.S. for treatment. Pham is at all times being cared for by four to five nurses working 12 hour shifts; two of these nurses are allowed into her room at one time, with the remaining nurses serving support duties. One full-time infectious disease doctor and one critical care intensive care physician is also assigned to her care in rotating shifts.

TIME ebola

CDC Expands Ebola Alert to Passengers on Both Flights Nurse Took

The Frontier Airlines plane that Amber Vinson flew from Cleveland to Dallas on Monday, flies out of Cleveland Hopkins International Airport Wednesday, Oct. 15, 2014, in Cleveland.
Tony Dejak—AP The Frontier Airlines plane that Amber Vinson flew from Cleveland to Dallas on Monday, flies out of Cleveland Hopkins International Airport Wednesday, Oct. 15, 2014, in Cleveland.

The Centers for Disease Control (CDC) asked passengers on Frontier Airlines flight 1142 from Dallas to Cleveland on Oct. 10 to call their hotline

The Centers for Disease Control expanded precautionary efforts Thursday night by reaching out to passengers on an earlier flight that Ebola patient Amber Vinson took before she had reported any symptoms of the virus.

The CDC said anyone on Frontier Airlines flight 1142, which flew from Dallas to Cleveland on Oct. 10, should call the agency at 800-CDC-INFO (800-232-4636). Amber Vinson, the second nurse to test positive with Ebola in the U.S., took that flight after taking care of the U.S.’s first diagnosed Ebola patient, Thomas Eric Duncan, who died on Oct. 8.

The passengers will be interviewed by CDC officials about the flight and about any potential symptoms they may have developed since flying. “Individuals who are determined to be at any potential risk will be actively monitored,” the CDC said in a statement about the notification.

Ebola is transmitted by an infected person when that person is symptomatic, and only through direct contact with that individual’s body fluids, which include blood, saliva, vomit or diarrhea. Vinson had a slight fever of 99.5 degrees before flying Oct 13 from Cleveland to Dallas. CDC director Dr. Tom Frieden said that passengers on the flight from Cleveland back to Dallas were being notified out of an abundance of caution. He said that they were at very low risk of exposure since Vinson presumably did not vomit or spread body fluids during the flight.

Now the agency says, “Based on additional information obtained during interviews of close contacts to the second healthcare worker from Texas Presbyterian Hospital who tested positive for Ebola, the … CDC is expanding its outreach to airline passengers now to include those who flew from Dallas/Fort Worth to Cleveland on Frontier flight 1142 on Oct. 10.”

TIME ebola

Here’s Who Is Being Monitored for Ebola

Contact monitoring after the U.S. Ebola cases

The key to containing spread of a virus like Ebola, public health experts tell us, is tracking down every person with whom an infected person had direct contact. Such contact tracing includes people in their family who might have shared hugs or kisses, or health care workers who handled any specimens.

Who is currently being traced in this way? Here’s what we know.

How many people are being monitored?

48 people who had direct contact with Thomas Eric Duncan

For now, officials at the Centers for Disease Control (CDC) say that 48 people had direct contact with Thomas Eric Duncan before he was isolated on Sept. 28 and diagnosed on Sept. 30. CDC has not clarified where those people might have had contact with Duncan. Four members of his immediate family who were staying in the same apartment as Duncan since he arrived in the U.S. have been quarantined for 21 days, the incubation period for the Ebola virus. But it’s not clear whether the remaining 44 include public citizens in the same apartment building or whether it also includes others in the community.

76 health care workers who cared for Duncan

Between Sept. 28, when Duncan was put into isolation at Texas Health Presbyterian Hospital, and Oct. 8, when he died, 76 health care workers participated in his care, performing duties that potentially exposed them to his infectious body fluids. All are being monitored, according to the CDC. At the minimum, that involves having the health care workers take their own temperature twice daily, and report any fever above 100.4F or any other symptoms of Ebola, including nausea, headache, vomiting and diarrhea.

It’s not clear how many, if any, are being actively monitored, which involves public health officials performing the temperature checks twice daily and asking detailed questions about any other possible symptoms.

Can contacts travel?

According to CDC director Tom Frieden, people who are part of contact tracing are advised not to use public transport. They are limited to so-called controlled movement, such as a personal car.

Amber Vinson, the second nurse to test positive, however, traveled by plane from Dallas to Cleveland on Oct. 10, two days after Duncan’s death. Vinson had apparently been intimately involved in Duncan’s care while he was alive, including drawing his blood and inserting catheters. Even if she did not have a fever before she boarded the plane, Frieden said, “because she was in a group of individuals known to have exposure to Ebola, she should not have traveled on a commercial airline.”

While in Cleveland, Vinson reported a temperature of 99.5F. That is below the CDC threshold of 100.4F for Ebola isolation, but because of her direct contact with Duncan’s body fluids, Vinson was told by CDC to return to Dallas, according to a CDC spokesperson. She did, on Oct. 13, on a commercial flight.

Frieden said on Oct. 15 that Vinson reported no symptoms of Ebola; Ebola patients can only spread their disease when they are symptomatic and through direct contact with their body fluids, including vomit, diarrhea or blood.

Why isn’t every contact of Duncan’s under quarantine?

Because Ebola only spreads through contact with body fluids when the patient is symptomatic, the risk of contracting Ebola through casual interactions is very low. Passengers on the plane that brought Duncan into the U.S., for example, are not at risk because he was not symptomatic during this trip.

Passengers on Vinson’s flight from Cleveland to Dallas, however, are being monitored out of an abundance of caution. Because she had a fever, the CDC notified Frontier Airlines, the carrier, that Vinson “may have been symptomatic earlier than initially suspected, including the possibility of possessing symptoms while on board the flight,” according to Reuters. Those passengers are now being monitored for Ebola symptoms.

Duncan’s family members are under quarantine because they were in direct contact with Duncan when he first became ill, and have a high chance of having touched his infectious body fluids.

Health care workers are also at high risk, since they handled Duncan’s body fluids as he became more and more symptomatic in the hospital. They are supposed to be protected from exposure by personal protective equipment, but Frieden acknowledged that the gear used by health workers in the Duncan’s early hospitalization was “variable” and that both Vinson and Nina Pham, the first nurse to test positive for Ebola, might have been infected during this time.

TIME ebola

5 Reasons Ebola Was Contained in the Congo

Researchers report on another cluster of Ebola cases in the Democratic Republic of Congo, where Ebola first emerged

While the world rightly focused on the growing number of Ebola cases emerging from Africa’s west coast this summer, the virus made another appearance in the heart of the continent: in the Democratic Republic of Congo (DRC), where Ebola was first identified in the 1970s. That outbreak—which was of another strain of Ebola Zaire—spread to just 69 people, however, and a report in the New England Journal of Medicine, has some answers as to why.

The DRC outbreak began with a pregnant woman who butchered and ate a dead monkey her husband had found in the Inkanamongo village, near a remote, forested area in the equatorial province. Presumably, the monkey was infected with Ebola; the woman became ill on July 26 and died on August 11. A local doctor and three health workers who performed a Cesarean section to remove the fetus before burial were also infected and died of Ebola.

Nearly two dozen others who were infected had direct contact with the woman, and most of them had helped care for her after she became sick. Forty nine of the 69 people who either had confirmed or suspected infection died. The number of cases was kept to a minimum, say the study authors, for five reasons, which could help inform how to contain the epidemic in the west.

1. While both regions practice similar cultural rituals surrounding burial, including touching the bodies of the dead, some behaviors in the equatorial DRC differ from those in West Africa, and thus help to limit spread of the virus from person to person.

2. The strain circulating in DRC is also genetically different from that in Guinea, Sierra Leone and Liberia, and may have a different disease trajectory.

3. The remote and relatively isolated locations of villages in DRC helped to contain the virus and prevent it from spreading as quickly as it does in large, mobile populations.

4. The DRC may have a stronger health response to Ebola given its longer history with the virus. Since it first appeared there in 1976, the Congo has weathered six outbreaks and may have more experience in responding quickly and educating its citizens about how to control infection.

5. Finally, because the virus has circulated among the people in DRC, they may have more immunity to it, and could be in a better position to fight off infection.

The DRC outbreak provides a stark contrast to the way Ebola has erupted in West Africa; it shows how an experienced and prepared community might be one of the most important ways to help stop spread of a deadly disease. Similar strategies have helped to contain the epidemic in Nigeria and Senegal, which neighbor the most heavily affected countries in West Africa but are close to declaring their outbreaks over.

Read next: Lawmakers Grill Obama Administration Over Ebola Outbreak

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