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.

TIME ebola

Can You Get Ebola From Subway Poles and Bowling Balls?

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.

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.

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 Governor Andrew 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 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

TIME Mental Health/Psychology

Reliving A Friend’s Death May Help Lessen Grief

Nearly 40% of those who did not relive a the death of a loved one showed signs of prolonged grief disorder

Reliving the death of a close friend or family member may reduce the experience of long-term grief, according to a new study in JAMA Psychiatry.

The study assigned 80 people who had lost a loved one within the past few years to a 10-week regimen of cognitive behavioral therapy. Some of them were also assigned to exposure therapy, in which patients were made to relive the death of the loved one. Nearly 38% of those who did not get the additional exposure therapy showed symptoms of prolonged grief disorder, which includes yearning for the person who’s gone, bitterness about accepting the death and difficulty in engaging in life. Only 15% of those people who got the extra treatment showed signs of it.

Painful as it is, reliving a death may improve a patient’s ability to process loss and adapt to it, the study suggests.

“Including exposure therapy that promotes emotional processing of memories of the death is an important component to achieve optimal reduction in [grief] severity,” the study reads. “Despite the distress elicited by engaging with memories of the death, this strategy does not lead to aversive responses.”

Though researchers acknowledge some limitations, the study’s implications suggest some changes in the way doctors approach treatment for those in grief.

“Reluctance to engage with their distressing emotions may be a major reason for not managing the grief more effectively,” the study reads. “The challenge is to foster better education of clinicians through evidence-supported interventions to optimize adaption to the loss as effectively as possible.”

TIME Infectious Disease

University of Maryland Confirms Meningitis Cases

The University of Maryland has confirmed an unknown number of meningitis cases among its students.

“There are confirmed and suspected cases of viral meningitis and viral syndromes on campus, and they are being tracked carefully by the University Health Center in partnership with the Prince George’s County Health Department,” University Health Center Director Dr. David McBride said in a statement sent to TIME on Thursday. “We have reached out to the organizations that are primarily affected with information about the condition and what to do in the event that they are feeling unwell.”

Viral meningitis is less severe than bacterial meningitis, but it can still cause stiff necks, nausea and fever. There’s no specific medication for the illness, but most people recover within seven to 10 days. Hospitalization may be necessary in particularly severe cases.

College students are thought to be at a greater risk for viral meningitis than the general population due to the closeness of college life, like sharing cups, living with roommates and eating in dining halls.

TIME ebola

#TheBrief: What Are the Rights of People Quarantined for Ebola?

The term "quarantine" goes back to the Bubonic Plague epidemic. How has it evolved since then?

A tense waiting game ended this week for family and several others who had come into contact with Thomas Eric Duncan, the first patient to be diagnosed in the U.S. with Ebola and who died of the virus on Oct. 9. All received a clean bill of health after being closely monitored for signs of infection and kept in isolation for three weeks.

But while many in Dallas breathed a sigh of relief, fears sparked anew in New Jersey when an airline passenger showing signs of fever arrived from Liberia, one of the countries hit hardest by the current outbreak, and was sent to a medical center in case he might have contracted Ebola. With more people facing the possibility of detainment as a precaution, it’s important to get all the facts on what it actually means to be quarantined.

Watch this brief history on how outbreaks have been handled since the plague days, as well as a primer on what kinds of rights you have while being held and monitored for symptoms.

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 120,000 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, at least two dozen new genetic variants have been linked to breast cancer, and adding those to the model, says Whittemore, could make it more accurate.

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 study also found that lifestyle factors, which are in a woman’s control, can generally lower the genetic risk by half. And the higher a woman’s genetic risk, the more she can reduce it with healthy behaviors. So avoiding excessive amounts of alcohol and smoking, or maintaining a healthy weight, for example, can bring a genetic risk of 30% down to around 15%, while a woman with a 4% genetic risk of developing breast cancer can reduce her risk by 2%.

“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.

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