New York Ebola Patient Enters More Serious Phase of Illness, Officials Say

New York Ebola Patient Enters More Serious Phase of Illness, Officials Say


Dr. Craig Spencer in an undated photograph

The condition of New York City’s first Ebola patient, Dr. Craig Spencer, worsened on Saturday, though he remained awake and communicative, health officials said.

Dr. Spencer, 33, was “entering the next and more serious phase of his illness, as anticipated with the appearance of gastrointestinal symptoms,” Ana Marengo, a spokeswoman for the city’s public hospital system, said in a statement. Dr. Spencer has been in isolation at Bellevue Hospital Center since Thursday, when he reported having a fever of 100.3 degrees.

The statement was careful not to convey a sense of pessimism, and patients undergoing treatment can worsen before they recover. In a brief telephone interview from his room at Bellevue, Dr. Spencer spoke of his sickness in a neutral tone that seemed stripped of illusions: “I’m still undergoing treatment,” he said.

Dr. Spencer said he had received “about 200 calls from reporters and 300 emails.” Adding that he did not mean to offend, he said, with a touch of wry humor, that he had other priorities: “When you have Ebola, not the best way to spend your time.”

Asked how he was feeling at that moment, Dr. Spencer brightened, saying that, in spite of everything, “I am feeling well.”

Part of the usual course of the disease is the onset of diarrhea, which can cause patients to lose an enormous amount of fluids and electrolytes. That, in turn, can shut down their kidneys and disrupt the heart’s rhythm. The key to treating Ebola patients is supportive care, experts say, so that they can stay alive long enough to allow their immune systems to fight off the virus, which usually begins two to three weeks into the illness.

The Bellevue team caring for Dr. Spencer is in constant communication with the Centers for Disease Control and Prevention, as well with as hospitals that have successfully treated Ebola patients, including Emory University Hospital and the Nebraska Medical Center, according to Ms. Marengo’s statement. Like other Ebola patients, Dr. Spencer has been receiving both antiviral and plasma therapy, the statement said.

While the statement did not elaborate on the nature of the plasma therapy, some researchers believe that transfusing blood products from Ebola survivors into infected patients may help fight the virus, and the treatment has been used experimentally.

After Dr. Spencer was taken to the hospital on Thursday, the city began tracing all of his contacts back to Tuesday, when he first began feeling fatigued, though not feverish.

Over those two days, Dr. Spencer went jogging in his Harlem neighborhood and walked the High Line. He dined out and, the night before he developed a fever, went bowling in Brooklyn. He took three subway lines and a taxi.

City officials have been quick to reassure the public that people exposed to Ebola are not contagious until they are symptomatic, with one of the initial symptoms of infection being fever. The virus, experts say, is transmitted only through close contact with bodily fluids like blood, saliva, sweat or vomit, and does not live for long on surfaces like a subway pole. Both Mayor Bill de Blasio and Gov. Andrew M. Cuomo have ridden the subway to show that it was safe.

After criticizing Dr. Spencer on Friday for not following the guidelines for quarantine — he had been monitoring his temperature, but not while under quarantine — Mr. Cuomo appeared to retreat from those remarks on Saturday.

“I didn’t mean to be critical of Dr. Spencer, and I hope that’s not the way it was interpreted,” Mr. Cuomo said. “He was a hero. I mean, these people go, leave this country, go to West Africa to help people with a terrible disease.” He added: “I think what he did was great.”

For his part, Mr. de Blasio continued to defend Dr. Spencer while speaking to reporters on Saturday, calling him “a soldier who goes into battle to protect us.”

The mayor played down the lack of notice city officials received from Mr. Cuomo, a Democrat, and Gov. Chris Christie of New Jersey, a Republican, before they ordered that travelers exposed to the virus be quarantined upon arriving at Newark Liberty International and Kennedy International Airports, despite opposition from many medical experts.

“In an atmosphere of crisis, we respect the chain of command,” Mr. de Blasio, a Democrat, said.

When the city health commissioner, Dr. Mary T. Bassett, was asked what she thought of the quarantine order, Mr. de Blasio stepped in, saying, “This is not about personalities.”

The Centers for Disease Control and Prevention issued its own statement on Saturday expressing support for health care workers like Dr. Spencer and Kaci Hickox, a nurse being held in quarantine at a hospital in Newark after returning from treating Ebola patients Sierra Leone, even though tests showed she did not have the virus.

“The epidemic there won’t end without them, and without their work, the U.S. will be at increased risk,” the C.D.C. said. “We must protect their health, safety and well-being and treat them with respect when they return home while continuing to take action to protect Americans so Ebola does not spread here.”

http://www.nytimes.com/2014/10/26/nyreg … tw-nytimes
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by Dave Hodges
By ANEMONA HARTOCOLLIS