TIME ebola

Obama Hugs Nurse Who Survived Ebola

President Barack Obama hugs nurse Nina Pham, who was declared free of the Ebola virus after contracting the disease while caring for a Liberian patient in Texas, during a meeting in the Oval Office in Washington on Oct. 24, 2014.
President Barack Obama hugs nurse Nina Pham, who was declared free of the Ebola virus after contracting the disease while caring for a Liberian patient in Texas, during a meeting in the Oval Office in Washington on Oct. 24, 2014. Saul Loeb—AFP/Getty Images

The nurse was cleared of Ebola Friday morning

A few days ago, Dallas nurse Nina Pham lay in bed in an isolated hospital room at National Institutes of Health (NIH) where her doctors donned hazmat suits to care for her. On Friday, President Barack Obama hugged Pham, now free of Ebola, in the open air of the Oval Office.

“Let’s give a hug for the cameras,” he told Pham.

Health and Human Services Secretary Sylvia Burwell, NIH infectious disease head Anthony Fauci, along with several other doctors and family members, were also present at the Friday meeting.

Pham contracted Ebola while caring for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, who died Oct. 8 at Texas Health Presbyterian Hospital in Dallas. Pham was subsequently moved to NIH in Maryland to undergo treatment, and was declared Ebola-free Friday morning.

After a patient was diagnosed with Ebola in New York City on Thursday, the hug was a triumphant moment amid continued fear over the potential for Ebola to spread in the U.S. White House Press Secretary Josh Earnest told journalists at press briefing Friday that Pham’s recovery served as “a pretty apt reminder that we do have the best medical infrastructure in the world.”

TIME ebola

NYC Officials Trace Ebola Patient’s Steps as Mayor Urges Calm

Three others have been quarantined

As health officials work to clear anyone who may have come into contact with New York City’s first Ebola patient, Mayor Bill DeBlasio reassured residents that the city is prepared to treat Ebola patients and is not at risk of a widespread Ebola outbreak.

“New Yorkers who have not been exposed to an infected person’s bodily fluids are simply not at risk,” said DeBlasio at a Friday press conference. “We’ve had clear and strong protocols from the beginning, and they have been followed to the letter.”

Health officials are currently contacting everyone Ebola patient Craig Spencer may have come into contact with since Tuesday morning “in an abundance of caution,” according to New York City Health Commissioner Mary Travis Bassett. Spencer, a doctor who returned from Guinea on Oct. 17, was diagnosed with Ebola Thursday.

Spencer’s fiancee, along with two friends, has been quarantined and restricted from public spaces. Gutter and Blue Bottle, a bowling alley and coffee shop visited by the patient, have been cleared and reopened, and a third establishment, the Meatball Shop, is closed temporarily but is expected to be cleared.


A Metropolitan Transportation Authority official told TIME that the city’s subway system is safe to ride, but noted that protocols had been updated to ensure safe handling of any potentially infectious waste. Spencer reportedly rode the subway from his home in Harlem to Brooklyn Wednesday.

Spencer is being treated in an isolation unit at New York’s Bellevue Hospital. He is in stable condition and communicating with friends via cell phone, officials said.

–additional reporting by Alice Park

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

The #Ebowla Jokes Need to Stop

Charlotte Alter covers lifestyle, crime, and breaking news for TIME in New York City. Her writing has appeared in The New York Times and The Wall Street Journal.

As New Yorkers joke about catching Ebola from a bowling ball, just imagine how scared Dr. Craig Spencer must be

As soon as New Yorkers learned that Dr. Craig Spencer, a volunteer Doctors Without Borders physician who had recently returned from West Africa, had been diagnosed with Ebola, panic set in. And as soon as people learned that he’d been bowling the night before, that panic appeared to turn to a kind of sick joke. #Ebowla starting making the rounds on Twitter and finally, there was something about Ebola that seemed kind of funny.

As the alarming details of Dr. Spencer’s New York adventure emerged—a heroic stint caring for the sick in Guinea, a flight home, and then later, a subway ride, a walk along the High Line, a meal at a restaurant, an Uber ride—the fact that he went bowling the night before checking himself into Bellevue Hospital, where he was isolated immediately, was the detail that has captured the collective imagination.

And just as quickly, that fact turned into a deluge of Twitter jokes, each one hoping to be funnier than the next.

One could argue that this was a group-think defense mechanism to distract ourselves from the horror of Ebola’s presence in America’s most populous city. As one tweeter put it:

But somewhere along the line, the tone changed. It stopped being about bowling and started being about Spencer and his character.

This is a guy who signed up to work with Doctors Without Borders, arguably one of the more difficult jobs in the world, to help strangers in one of the most dangerous health zones on the planet. If you found out a United States Marine was playing CandyCrush right before he got blown up by a landmine, would you be laughing then?

Some expressed a similar callousness toward Amber Vinson, the Dallas nurse who contracted Ebola while treating Thomas Eric Duncan and then flew—with approval from the Centers for Disease Control and Prevention—from Cleveland to Dallas.

Do people think Vinson wanted to catch Ebola? Thankfully, Vinson appears to have recovered from the virus, according to NBC.

Some of Spencer’s critics are saying that because he began to feel sluggish on Tuesday, he should have immediately stayed home. These must be people who have themselves never felt a little worn out on a rainy day. Spencer told doctors he was taking his temperature twice a day as a precaution, and he did not yet have a fever on Wednesday, which means he was not symptomatic of Ebola.

Doctors Without Borders said Thursday night that Spencer had followed all recommended protocols for medical workers returning from the afflicted regions. “As long as a returned staff member does not experience any symptoms, normal life can proceed,” the organization said in a statement. “Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms.”

While the Twitterverse is having a good chuckle over #ebowla, Spencer is in an isolation ward. Details of his condition have not yet been released, but it’s easy to imagine his psychological state. He must be terrified. He’s just spent a month watching what Ebola does to afflicted bodies, and now he’s alone, surrounded by hazmat suits, unsure if he’ll ever touch another human being. As Ebola survivor Dr. Kent Brantly wrote in TIME:

“During my own care, I often thought about the patients I had treated. Ebola is a humiliating disease that strips you of your dignity…I finally cried for the first time when I saw my family members through a window and spoke to them over the intercom. I had not been sure I would ever see them again.”

Spencer’s fiancée, Morgan Dixon, is also in isolation at Bellevue. Imagine how she must be feeling. Yesterday was just a normal New York morning, but last night she and her fiancé went to sleep alone, and while it’s too soon to say for sure, there is the risk—and almost certainly, for them, the fear—that they might never see each other again.

So far, every single person, including Spencer, who has been treated for Ebola in the United States became infected because they risked their lives to help others. That’s true of Brantly and the health worker he worked with, Nancy Writebol. It was true of Thomas Eric Duncan, who’d carried a neighbor to the hospital in Liberia, where she was turned away and sent home. And it was true of the two Dallas health care workers who contracted the virus from Duncan before he died.

We should be praising all of them, not mocking them. And as collective fear has morphed into scorn, the response, on Twitter anyway, is without empathy—and is truly embarrassing.

Still, this Ebola joke got it right:

 

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

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

More Than 5,000 Health Care Workers Attend Ebola Training

CDC and Mount Sinai health workers demonstrate how to put on and off Ebola personal protective equipment at an Ebola education session in New York City Alexandra Sifferlin

"We are having a family meeting"

More than 5,000 health care and hospital infection control workers gathered at the Javits Center in New York City for an Ebola education session amid growing concern among hospital workers over Ebola preparedness.

“We are having a family meeting,” Kenneth Raske, president of the Greater New York Hospital Association (GNYHA) told TIME. “The turnout is spectacular. We may not answer every question [today], but we are committed to finding the answers.”

The event, which was streamed live nationwide, featured Centers for Disease Control (CDC) experts offering live trainings on how to safely care for patients with Ebola. It was hosted by the Healthcare Education Project from GNYHA/1199SEIU and Partnership for Quality Care.

New York governor Andrew Cuomo helped kick off the event, touting New Yorkers’ resilience and ability to always “rise to the occasion” from 9/11 to Hurricane Sandy. “We have a new challenge we must meet today,” said Cuomo. New York City Mayor Bill de Blasio also made an appearance, thanking health care workers.

“Regardless of immigration status, we will help them all,” said de Blasio, referring to the possibility of patients with Ebola coming into a New York City emergency room.

The session included a hands-on demonstration of personal protective equipment (PPE) led by Dr. Bryan Christensen of the CDC’s domestic infection control team for the Ebola response. On Oct. 20, the CDC revised its guidelines for Ebola-related care, recommending full-coverage PPE and supervision while taking PPE on and off.

Christensen supervised registered nurse Barbara Smith of Mount Sinai Health System as she demonstrated how to put on and take off all the pieces of PPE: sanitizing her hands, putting on her first set of gloves, sitting in a chair to put on her foot covers, donning her suit—and finally doing a little jig, to audience laughter, once she was completely suited. Afterward, she took off each piece, sanitized her gloves numerous times and checked for any holes. The entire process took 15 to 20 minutes, which the CDC said cannot be rushed.

Over 5,000 health care workers gather in the Javtis Center in New York City to attend an Ebola education session. Alexandra Sifferlin

CDC officials also reviewed Ebola care protocols in detail, from what to wear and how to discard linens (they can’t be washed) to the way hands should be washed and how to use an alcohol rub to clean gloves before removing them, something that is not usually part of standard procedure. For respiratory protection, the CDC recommends either a powered air purifying respirator (PAPR) or a disposable respirator like N95. Emory University Hospital uses the former; the Nebraska Medical Center uses the latter. “When we use equipment we are not used to, it makes it difficult,” said CDC’s Dr. Arjun Srinivasan. “The way we address this is practice, practice, practice.”

Massive education sessions like this have been held before over health threats like anthrax, H1N1 and smallpox. “We had to have this in a convention center to accommodate folks,” George Gresham, president of 1199SEIU United Healthcare Workers East told TIME. “Back in the 80s when the AIDS epidemic first started, I was a health care worker myself, and it was the unknown that was the mystery, and the fear, and I think that’s the same here. “

The massive number of health care workers that crowded into the conference center proves that they crave more education about caring for potential Ebola patients. Even though some states, including New York, are identifying specific hospitals that will take in any Ebola patients for actual care, all health facilities have to be prepared for the possibility that a patient like Thomas Eric Duncan could walk through their doors.

The hope is that the session was helpful and positive. “I think this is another moment we can calm the public and reassure the public of health care workers’ commitment,” Gresham said.

TIME Food & Drink

The Last Days of WD~50

One of the world’s most famous chefs prepares to close the doors on his landmark restaurant

“I’m just gonna go downstairs and put on my prom dress,” Wylie Dufresne says one afternoon in September at his restaurant on New York’s Lower East Side. He’s wearing a hoodie and he’s changing into a chef’s jacket. Nothing fancy, but there is an air of ceremony in the kitchen. After 11 years of service, wd~50 will close in November, ending an era for modern cuisine.

Over the last decade, Dufresne made a reputation for himself as the mad scientist of New York’s kitchens, putting out brain-teasing dishes like shrimp noodles (that’s noodles made from shrimp), cylindrical quail, fried hollandaise cubes and edible eggshells. Such inventions left some scratching their heads—why fix an egg that ain’t broken? But others embraced his creativity, and over time, his reputation congealed.

Tasting those shrimp noodles never came all that cheap. Today, the restaurant offers two tasting menus: 12 courses for $155, or five courses “from the vault” (a sort of greatest-hits selection) for $90.

And like so many New York stories, price is what has brought this institution to an end: a new building is being developed on the site. This development is driving Dufresne out of the address that gave his restaurant a name: 50 Clinton Street.

Dufresne was on the American avant-garde in using many of the chemical and mechanical innovations (see that WD-40 joke) that define “modernist cuisine” or “molecular gastronomy”—immersion circulators, sous vide precision cooking, foams and the rest. Such methods are often associated with the name Ferran Adrià, the chef behind the now-closed elBulli in Spain, which Dufresne says “blew the doors open” for imaginative cooking.

Dufresne’s enthusiasm for chemicals and high-tech gadgets came as many American chefs ran in the opposite direction, embracing the farm-to-table ethos of whole foods prepared simply. The laboratory of culinary magic tricks at wd~50 couldn’t have seemed more different.

When Dufresne perfected his condiment-frying technique, he thought it would be his big break: “You know, I can fry hollandaise, I can fry ketchup, I can fry mustard,” he says, “I thought, ‘This is gonna be my meal ticket.’ I bought a red and yellow phone because I thought McDonald’s would call, and it was just going to ring. And they were going to say, ‘Please come to us. Show us how we can fry our condiments. We’ll give you the key to the city, and Ronald McDonald will be at every one of your kids’ birthdays until they’re 28.’ Of course that didn’t happen.”

It is hard to think of any other top-tier chef who would get so excited at the prospect of partnering with the Golden Arches. But Dufresne has no qualms about mixing fancy thinking with mass production. He’s explored the idea of patenting some of his inventions. And he says he takes inspiration from the supermarket aisles. “Whether it be cereal technology or candy technology or snack technology, puff snacks,” he says, “I’m always curious to know how those things are made and how we can take that technology, those ingredients, and apply it to a stand-alone restaurant.”

As much as he seizes these methods himself, Dufresne does wish they didn’t have such a bad rap. He wants people to know that his selection of chemical ingredients is just as discriminating as his selection of the meat or fish he serves based on their source. He wishes scientists had done better PR for themselves in developing the new ingredients he uses.

And as much fun as these tricks are, Dufresne maintains that he owes much more to his mentor, culinary superpower Jean-Georges Vongerichten (who is a co-owner of wd~50), than anyone else. He praises Vongerichten’s dedication to lightening and simplifying traditional French cuisine. “For me,” he says, “it begins and ends with the French.”

For all Dufresne’s flash, he does stay true to this ethos. While his dishes are surprising, they’re seldom overwhelming. Take a hanger steak tartare he recently served accompanied by Asian pear, an amaro sauce and a scoop of Béarnaise ice cream. That last ingredient had the intrigue of invention: it didn’t even hint at melting until it was eaten. But the flavors were subtle, complicated only by the bitter sauce smeared on the plate. As Dufresne likes, there was nowhere to hide any imperfection.

Dufresne has flourished in this intersection of old and new. “Clarence Birdseye knew more about frozen foods in 1920 than you and I do today,” he says. That overlooked trust of the past shows in his kitchen’s enthusiasm for trying new techniques with ancient roots. On a recent visit, one line cook was stomping on plastic bags of dough with clean sneakers, a method for making udon noodles easier to form that Dufresne says Japanese housewives were doing centuries ago (sans the plastic or sneakers).

Most of the wd~50 has agreed to stay on until the restaurant closes in November. Malcolm Livingston II, the pastry chef, has a job lined up at Noma in Copenhagen, voted the world’s best restaurant. Dufresne says that he’s on the lookout for a new space and would be open to trying a new neighborhood, but nothing has stuck yet. In 2013, he opened Alder, which offers a more affordable but similarly playful menu, not far from the restaurant he’s now closing.

Dufresne has a lot of history on the Lower East Side, and especially at 50 Clinton Street. He met his wife, Food Network Magazine editor-in-chief Maile Carpenter, in the restaurant when she came to interview him about its opening when she was a food editor for Time Out New York.

Dufresne is a cookbook obsessive (he estimates he has about 1,400 or 1,500 at home) and he’s working on adding his own to the canon. It will be the story of wd~50, co-written with Lucky Peach editor Peter Meehan. “We’re trying to figure out how to capture 11 years, and we have a lot of dishes to choose from,” he says. “Some people might not have enough recipes for a book. We probably have too many.”

For now, though, Dufresne says he’s focused on the restaurant that bears his initials: “We’re gonna try and really make it very special to the very end, because it’s still special to us.”

Vongerichten, for his part, said he’ll mourn the passing of his student’s restaurant. “For those who have been lucky enough to eat there, [it] will never be forgotten.”

At 44, Dufresne is too young for his legacy to be complete. But the legacy of wd~50 will be its invitation to young chefs to think different, to ask why certain standards are followed and dare to break them.

“Our hope is that when it’s all said and done, we have left the industry a little bit better off,” he says. “Not that we found it in disrepair or anything like that, but that we’ve contributed to the body of knowledge…That we’re helping people understand things a little bit better, and that we’re making ourselves smarter, we’re making cooks smarter, we’re making diners smarter.”

TIME Infectious Disease

Here Are The Diseases In NYC Rats

sewer rat
Getty Images

A new reason to dodge the rodents

Infected with 1.6 bacterial agents and 3.1 viruses, the average New York City rat is a cesspool of disease. But perhaps more frightening to hear is that they’re also host to “many more novel viruses” with unknown potential to harm city dwellers, according to a new study in the journal mBio.

“Our findings indicate that urban rats are reservoirs for a vast diversity of microbes that may affect human health and indicate a need for increased surveillance and awareness of the disease risks associated with urban rodent infestation,” says the study, which looked at samples of blood, urine and feces in 133 rats.

The report found that about 40% of the rodents had at least one viral infection and nearly all had a bacterial infection. A total of 13 rats had more than five viruses. Salmonella and Bartonella were among the bacteria in the sample, but E. coli took the crown as the most common bacterial pathogen. Nearly 40% of rats in the sample had the bacteria, known to cause severe illness replete with vomiting and diarrhea. Pathogens associated with hepatitis C, which can cause liver failure, were among the most common viral pathogens present.

MORE: FDA Approves Combined Hepatitis Drugs

Diseases in rats can have implications for people who live in urban areas in close proximity to the rodents, which can often access the food supply. Despite the prevalence of rats in urban areas, the health implications of rat infestation has not been studied in great depth, but the study says that should change.

“With continued urbanization, highly successful synanthropic species like the Norway rat are likely to play increasingly important roles in zoonotic disease ecology as the size and complexity of the human-rodent interface increases,” the study reads.

To translate, as humans and rats cross paths more often, the potential to pass along disease will increase.

MONEY Budgeting

Guess Which U.S. City Is the Most Expensive

141014_REA_EXPENSIVELIVING
Nikreates—Alamy

Hint: It's not NYC.

On average, American households spend the largest share of their annual expenditures on housing. The average family spends $16,887 on housing per year, equating to 33% of the average household’s annual expenditures. But how much do those expenses vary from city to city, and which places are the most expensive?

Well, the Bureau of Labor Statistics recently released a report (link opens PDF) detailing Americans’ average annual expenditures on housing and related items. And contrary to popular belief, New York City is not the most expensive city to live in. Two U.S. cities have overtaken it.

A breakdown of housing costs

The BLS took a deep dive into all the costs of housing, rather than simply comparing the cost of rent or average mortgage payments. Their analysis also took into account utilities (electric, water, and natural gas), household furnishings and equipment (textiles, furniture, floor coverings, appliances, and the like), housekeeping supplies, and other household expenses. What they found was that average annual expenditures on housing were far higher in both Washington, D.C., and San Francisco than in New York.

most-expensive-city-no-longer-nyc_large
Source: Bureau of Labor Statistics.

The data is current as of 2012, and housing costs in the District of Columbia and San Francisco have risen since then. In D.C., the rise in housing costs is being led by the redevelopment and gentrification of the downtown area, which in turn is being triggered by the high relative number of government and government-related jobs, particularly in the defense contracting sector. Baby boomers are also moving from the suburbs into the city.

In San Francisco, housing costs have always been high, but they’re spiking because of a confluence of factors. The continued boom in technology companies in Silicon Valley — most notably Apple, Google, and Facebook — means that a growing cadre of high-paid employees want to live in the area. Add in a longtime lack of housing development in the city, and you have a rise in housing prices that has become a contentious issue in the San Francisco Bay area as longtime renters are priced out of the city. TechCrunch’s Kim-Mai Cutler provides a great, in-depth piece on San Francisco’s housing problem.

The difference in annual housing costs between the two most expensive cities and the national average is a staggering $10,000. Excluding New York City, the difference between the two most expensive cities and other major U.S. metropolitan areas is over $5,000 annually. If you’re thinking of moving, it’s smart to compare costs carefully before moving to one of the most expensive cities in the U.S.

National differences in housing cost

While the above data is just from major U.S. cities, we have other data from the Bureau of Economic Analysis showing the real value of housing dollars in each state compared with the national average.

real-value-of-housing_large

You can see that generally, coastal states are more expensive than non-coastal states, as many people enjoy living near the ocean. You can also see that the Northeast on average is more expensive than the rest of the country except for California. These high costs, coupled with better weather and low to no income taxes, are why many retirees move south to Florida, Texas, etc.

If considering moving to a more expensive city, you should be sure the benefits will be worth the extra expense. For instance, while I pay a high cost of living to live in New York City, the quality of life that I get in the city makes it well worth it, in my opinion. While New York state is ranked poorly in terms of the happiest states in the U.S., New York City is ranked in the top quartile by happiness among U.S. cities, according to the Gallup-Healthways Well-Being Index.

The most important thing is to live in a place where you are happy. While the main determinants of happiness are the same for everyone, the specifics vary. Be sure that an increased cost of living comes with an increased quality of life.

TIME People

Al Sharpton Turns 60

From the time he preached his first sermon at age four, Sharpton has spent a career on the pulpit and in the spotlight

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