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'The Rachel Maddow Show' for Thursday, October 23rd, 2014

Read the transcript to the Thursday show

Show: THE RACHEL MADDOW SHOW
Date: October 23, 2014

Guest: Dr. Stephen Morse, Dr. Amesh Adalja, Dr. Kathryn Jacobsen

RACHEL MADDOW, MSNBC HOST: Thanks, Chris. And we are expecting that press
conference any moment. We`ll have it live here. I appreciate it.

Thanks to you at home for joining us for the next hour. As Chris has just
been reporting for these last few minutes, there is serious breaking news
tonight from our nation`s largest city. From New York City, where, just
within the last half an hour, City health officials have confirmed that a
New York City doctor has tested positive for Ebola in preliminary testing.
This is testing that still remains to be confirmed by the CDC. But this is
being treated as a new, positive Ebola case. Even before the blood tests
came in tonight confirming that the doctor was a positive result, New York
City was effectively treating this as - as if it was a positive test. New
York City was effectively treating this doctor even before the blood test
came in today, as if this was a positive test. But now that blood test has
come in positive.

The doctor in question, he recently returned to the United States from
treating Ebola patients in the nation of Guinea in West Africa. The
doctor`s name is Craig Spencer. He`s in his early 30s, he recently
completed a humanitarian mission treating Ebola patients in the West Africa
nation of Guinea. Guinea, Sierra Leone and Liberia are the three nations
in West Africa where the Ebola epidemic is now raging. Doctors Spencer was
working with the group Doctors without Borders. He returned from Guinea to
New York City nine days ago.

Doctors without Borders is the Nobel-prize winning international medical
relief organization. They`re truly heroic and effective organization.
They`ve done more internationally to try to treat Liberia -- excuse me. To
try to treat Ebola patients in Liberia and other countries and contain the
epidemic almost in any other group you can name on earth. Doctors without
Borders said today that since his return from Guinea, the doctor had been
monitoring his own health. New York City officials say that he was
generally not feeling well for the past couple of days. But it was
apparently nothing that alarmed the doctor very much until this morning.

At around 11:00 a.m., we`re told that the doctor did feel significantly
symptomatic. He took his own temperature. He found that his fever was 103
degrees, which, as you know, is a pretty high fever. The doctor then
immediately called the organization, Doctors without Borders, to report
that he had this fever. Doctors without Borders then called the New York
City Department of Health. The New York City Department of Health then
called the New York City Fire Department. Shortly thereafter, emergency
medical workers in protective gear specially trained we are told to respond
to this sort of diagnosis, they were dispatched to the doctor`s apartment
in Harlem, in Upper Manhattan. They brought him to Bellevue Hospital here
in New York City. He was in isolation at Bellevue Hospital, admitted just
after 1:00 p.m. this afternoon, which means from the time that he first
notified anybody that he had a fever until he was in isolation in a
hospital that has been designated as one of the places where an Ebola
diagnosis would go in this city, was just roughly about two hours.

The doctor, again, has been in isolation at Bellevue Hospital Center in New
York City, since 1 p.m. this afternoon.

And now, late tonight, again, just within the past half hour, New York City
officials are confirming that preliminary tests show that the doctor has
contracted the Ebola virus. This sort of shaky footage that you are seeing
right here, the reason that`s a little shaky is because this is - these are
crews and officials setting up right now for an anticipated press
conference.

We are expecting to hear from the mayor of the New York City, possibly from
Governor - New York Governor Andrew Cuomo, New York City health officials
about this latest case.

Now, the hospital where this doctor works is New York Presbyterian
Hospital. That hospital has put out a statement today saying that this
doctor has not treated any patients in New York since he arrived back in
the United States.

In the meantime, though, even before they had the positive test in terms of
his blood work, as I say, New York City was effectively treating this as a
likely positive case. New York City health officials have already begun
the process of contact tracing, trying to figure out everywhere the doctor
has been since he returned to the United States, particularly since he may
have been symptomatic, they are trying to find everybody who he may have
had contact with.

Authorities are not saying how many people they`ve tracked down so far. We
are told that the doctor`s girlfriend is currently under quarantine,
according to New York City health officials so far, she is healthy herself
and not symptomatic.

This afternoon, again, before the positive blood test came back, the
Centers for Disease Control already said that they were dispatching a
special team to New York City. They did take pains to say there are
already a number of CDC-trained Ebola experts in the city already.

Earlier this month, New York City officials had announced that Bellevue
Hospital would be the dedicated hospital for any suspected Ebola case
throughout the entire city. So this protocol, in terms of how New York
City, the nation`s largest city, the nation`s most intensely densely
populated major population area, would handle a suspected case of Ebola.
This is a protocol that had been worked out in advance.

We know that at Bellevue they do not have special bio-containment units
like the ones that Emory University Hospital and the Nebraska Medical
Center, but Bellevue says that it is prepared, they say they know that they
are the designated hospital, obviously, for New York City intake. They
also say they can treat up to four Ebola patients within their own
isolation unit at that hospital. They say they began training staffers
earlier this month to make sure that they were prepared to safely treat
patients should New York City cases arise. But again, we are awaiting a
press conference, which should start momentarily from New York City
officials about this latest case. And this is the latest person in the
United States to be diagnosed with Ebola in this country. This is the
fourth person to be diagnosed here. There have been other health workers
who contracted the disease in West Africa who were diagnosed there and
brought back here for treatment.

This is the fourth case total of somebody to be diagnosed with the disease
here. It`s the first case to be diagnosed outside of Dallas, Texas.
You`ll recall that the first ever diagnosed Ebola case in this country was
a man who turned up at a hospital in Dallas. The second two Ebola
diagnoses in this country were nurses who helped in his care at that Dallas
hospital. But this patient in New York City tonight is a physician
himself. He works at New York Presbyterian Hospital. He had just returned
from Guinea where he had been treating Ebola patients.

Among the questions that we have now as we wait to hear further
information, is how long he really was symptomatic how much danger anybody
might have been who came in contact with him or who was somewhere where he
was in the last couple of days. And whether or not New York City in the
terms of its protocols and its planning, is doing this in such a way that
they are confident that they`re operating in protocols that will keep
anybody from getting infected and that will provide him the best chance of
surviving this too often fatal disease. Joining us now is Dr. Stephen
Morse he`s the professor of epidemiology at the Mailman School of Public
Health at Columbia University.

Dr. Morse, thank you for being with us tonight. I appreciate your time.

DR. STEPHEN MORSE, COLUMBIA UNIV. EPIDEMIOLOGY PROF.: Thank you.

MADDOW: How prepared is New York City and are New York City hospitals for
Ebola patients?

MORSE: I think New York City has been working on this for a while ever
since the first reports of Ebola. And they`ve been training intensively,
as you have mentioned, for the last several weeks. So I think New York
City was expecting that, sooner or later, probably sooner, there would be a
patient coming with Ebola. Perhaps it was going to be someone getting off
a flight. In this case, it was someone who had gone there heroically, to
treat patients. But I think that the city has been preparing for this for
quite a while, just in case. And although it`s sad that it`s necessary, I
think the right things were done from all accounts.

MADDOW: Is it likely that the patient will be treated in New York City?
That this is where he`ll remain for all of the supportive care and
everything else that goes along with treating somebody once they are
symptomatic, or is the expectation that he`d be transported to one of the
specialty bio-containment centers like at Nebraska or at Emory of the NIH.

MORSE: I don`t think we know at this point. And I think that largely
depends on his condition, whether he`s medically stable for example.
There`s no reason why with the appropriate training and facilities that we
have here, there`s no reason why he couldn`t be treated here in New York
and - I think just as well, as at one of those specialized facilities.
They`ve shared their protocols, and the information about what they did to
help those patients through. Is now public knowledge. And I`m sure that
the people at Bellevue are quite familiar with it. As at the city health
department.

MADDOW: In terms of the contact tracing that`s already happened,
obviously, it now seems brilliant in retrospect that they started that,
without waiting for the positive blood test. That they thought there was
enough indications that this could be a real case. That they got right on
that today. As soon as they knew that this patient at least potentially
existed.

In terms of what we`re told about the doctor`s symptoms, the layman`s
understanding about the risk from an Ebola patient is that they don`t pose
a risk of transmission to anybody else until that person is symptomatic.
If the doctor, obviously, spiking a 103 fever today, knew enough to call
the health authorities and get himself isolated, there is - still remains
the question of him feeling generally unwell, we`re told, for the last
couple of days. Should we think of that as the kind of symptomatic, which
means he could have posed a transmission risk to others over the last
couple of days with sort of a general feeling of malaise?

MORSE: Well, it`s most likely that you would look for fever as the major
symptom. And they were following the case definition when they suspected
he had Ebola. If he hadn`t been feeling well and didn`t have a fever, we
don`t know all of the details, but the chances are very good that he is not
going to be a transmission risk to anyone.

And even afterwards, Duncan, for example, Thomas Duncan in Dallas, the
first case to come to America, the first patient to come to America, was on
his own for several days. And they did quite a bit of contact tracing and
never found anyone who got infected as a result of that period.

MADDOW: Right.

MORSE: Between when he came to the emergency room and when he got actual
treatment.

MADDOW: Excellent point. In terms of comparing that Dallas experience and
this New York experience, obviously, Dallas is a big city. But it is
nothing compared to a population density and all the things that go along
with that. In New York City, one of the things that was initially reported
tonight about Dr. Spencer here in New York City is that he has both ridden
in taxis and on the subway over the past couple of days. The report that
last night, before calling authorities this morning with a high fever, he
was at a bowling alley in Brooklyn. In terms of those places that may have
a lot of population density, a lot of people, a lot people passing through
those places. A lot of people potentially being in those places where he
was in close quarters. How do you think New York City officials should and
how do you think they will handle public worries about those places where
he was in the last 12 to 24 hours?

MORSE: Well, I think the health department is very experienced in contact
tracing. And I think we`ll find every possible contact they can, just to
be cautious. I think most of the people he`s come in casual contact with,
anyone who may have been on the same bus or taxi, is probably very likely
not going to have any real danger unless they actually touched the patient.

MADDOW: One of the things that has - we`ve seen happen, both in the
national media and I think actually it`s been a little bit stoked weirdly
by our proximity to the election. But we have seen, on the one hand, the
nuts and bolts contribution of health officials in dealing with this - not,
excuse me, not this epidemic, but the risks of this epidemic becoming an
outbreak in this country. We`ve seen that happening at a very practical
level. We saw the mistakes made in Texas and the way officials are trying
to learn from those things and set new protocols. Part of Bellevue being
designated as the place where a patient like this would go today, is part
of that planning that`s happened on short notices. Officials are trying to
figure how to deal with this.

At a totally different level, there`s been a lot of hysteria and a lot of
undercutting of authoritative assurances about how the disease is
transmitted. You`ve got public officials in some cases, politicians saying
don`t believe public, don`t believe public health authorities. This is an
aerosol spread disease. This is a disease that you get the same way that
you get a common cold. You can get this at a cocktail party, you can get
this walking down the street. With those fears being stoked out there,
that creates a new public health challenge in terms of there being a new,
whole new city involved, a whole new patient involved, a whole new
population that that didn`t previously think they were being exposed.

What`s the right way to sort of counter that misinformation?

MORSE: Well, I think with correct information. In general, I think, New
York City has a lot of experience doing this, our health department is
extremely competent and careful. And of course, it`s going to be a real
challenge, because this is the first Ebola patient we`ve seen in New York,
but it`s - then anticipated for quite a while that this could happen. Most
of the people who may have even come in contact with him before he
developed the fever, are probably at very little risk, if any. Those who
came in casual contact next to him in the lane, at the next lane in the
bowling alley, probably are at really no risk at all. But the city, I`m
sure will trace down, the health department will do as much contract
tracing as possible just to reassure people as well as to find those who
might have actually become infected so they can be tested and put into
quarantine or isolation depending on whether they`re sick or not.

MADDOW: Dr. Morse, I mentioned earlier about the role that Doctors without
Borders, the organization he was affiliated with when he was working in
Guinea, the role that MSF, Doctors without Borders has had in treating this
worldwide epidemic and the yeoman`s work that they`ve done on the ground in
terms of trying to contain the epidemic and care for people who are
afflicted with it in the places that are worse off. In the course of that
sort of record of achievement, there have been Doctors without Borders
workers who have been infected in the past. They have not been immune from
this, their anti-transmission protocols are seen as the gold standard, if
only because they`ve got so much experience and they`ve treated so many
patients, especially in austere conditions. Is it of worry to you? Should
it be of worry to us that a doctor working under gold standard infection
control protocols, as Doctors without Borders, supposed to be the best in
the world, that is, somebody working with them fairly recently has himself
been exposed? Should that make us worry about even their protocols? Or
are some infections of health care workers literally unavoidable?

MORSE: Well, Medecins Sans Frontieres, Doctors without Borders, I agree,
has done a heroic job really taking on this tremendous work of all the
patients and these - all the Ebola sufferers in this area and obviously
still don`t have enough space for everyone. But they also have a really
excellent safety record. In general, I think this is only the second
international that this foreign worker who became infected, and very few
have. Some of those who may have become infected, who are local, may have
become infected through local contacts with their own family members as
happened in one case.

So I think that the lesson there, is the people who do this are heroic.
They are putting their lives on the line. But I still think, that although
mistakes happen occasionally, they are rare with MSF. And I think, in
general, it can be done properly and carefully.

MADDOW: Dr. Stephen Morse, professor of epidemiology at the Mailman School
Public Health at Columbia University here in New York City.

Dr. Morse, thank you very much for being with us. I appreciable your time
tonight.

MORSE: Thank you.

MADDOW: As we`re awaiting a press conference right now at Bellevue
Hospital, which has just received the first Ebola patient that they have
treated, again, a young doctor who was treating Ebola patients in Guinea
returned to this country nine days ago. He has, himself turned up now with
a high fever. He had a fever he said of 103 today. Called authorities.
They had him in isolation at Bellevue Hospital within two hours. As we
await a press conference today from New York City Mayor Bill de Blasio,
health officials and others in terms of that patient`s condition and also
how New York City is handling things like contact tracing and infection
control, both in his treatment and in terms of figuring out whether the man
might have posed a threat to anybody else before he was put in isolation
today, as we wait for that press conference to start, which we expect any
moment, I also want to bring in Dr. Amesh Adalja. He is representative of
the Infectious Disease Society of America. Dr. Adalja, thank you very much
for being with us. I appreciate your time.

DR. AMESH ADALJA, INFECTIOUS DISEASE SOCIETY: Thanks for having me.

MADDOW: Do you know enough about how New York City has prepared to say
whether or not the protocols here and the means by which Dr. Spencer was
handled today and he is going to be treated thus far, learn from some of
the mistakes made in Texas? Whether or not New York City actually seems
prepared?

ADALJA: do believe that New York City is much more prepared than many
other cities because New York City is a cosmopolitan city that has dealt
with numerous infectious disease outbreaks, numerous, you know, things like
anthrax, West Nile fever, this is the health department that dealt with
Typhoid Mary, this is a different city than Dallas. And they have learned
from what happened in Dallas. And Bellevue has been specially equipped to
take care of Ebola patients while not a bio-containment facility, it`s very
close. So much as close as you can be based on what I`ve seen what
Bellevue has done.

MADDOW: Dr. Adalja, in terms of the progression of what appears to be Dr.
Spencer`s disease, we should say that the preliminary test for him has
turned up positive for Ebola, it is yet to be confirmed by the CDC. But he
is being treated as a positive patient.

What we`re told is terms of his being symptomatic is that he had a fever of
103 when he called authorities today. And that he was in isolation within
two hours of that initial call. They dispatched EMTs who were specially
prepared for this type of diagnosis to go collect him from his apartment
and bring him to the isolation ward at Bellevue. Is it of concern or ought
to be of concern that his fever was so high when he first contacted
authorities? Does that indicate that he might have been symptomatic and,
therefore, potentially infectious for a considerable amount of time before
he made that call?

ADALJA: Well, the fever of 103 is concerning. And there are reports that
he was feeling sluggish and not feeling well prior to having that fever.
However, I would emphasize that Ebola is only spread through blood and body
fluid of an infected person who is symptomatic. So, if he wasn`t having
vomiting or if he wasn`t having diarrhea, the likelihood that he could have
transmitted have very little. Because you have to have body fluids being
emanated from a person just like the issue with Amber Vinson on the
airplane. The same issue.

MADDOW: When we`ve seen so much public discussion of personal protective
equipment in the way that doctors and nurses, people treating Ebola
patients can keep themselves safe, I think part of the reason that -
forgive the term about fear-mongering politicians have been able to get
away with saying things like oh, Ebola, is an aerosol disease, it`s an
airborne disease. It`s spread like the common cold, don`t believe them
when they tell you that it`s only body fluids. Is that - we`re seeing
these personal protective equipment modeled in the hospital setting, in
terms of people treating Ebola patients, that makes it seem like, well, you
know, if it`s just body fluids and these people aren`t trying on purpose to
get in contact with them, why are they geared up so extensively? I think
the visual is hard to square with the assurance that you give. Can you
talk about the - at least the sensory gulf between what we`re seeing there
and what you just said?

ADALJA: All right, so Ebola is a deadly disease, it`s a scary disease.
It`s not very contagious, but it does require meticulous attention to
infection control, making sure that you`re not exposed to the blood and
body fluids of someone infected with Ebola, because just a very small
amount of the virus can be enough to cause an infection, if in the right
circumstances. And we`ve known from the 24 Ebola outbreaks prior to this
one, that health care workers are disproportionately infected because
they`re in such high contact with blood and body. (INAUDIBLE) isn`t expect
casually, but it is very, very important that health care providers take it
seriously and can wear the appropriate personal protective equipment. Not
only just put it on appropriately, but take it off appropriately, and have
no breeches in protocols that they are completely protected. And if you do
that, then Ebola can be treated safely. It`s unclear how this physician
got infected. And I wonder if that was one he was taking care of a
patient, or it might have been when he was not even taking care of a
patient, inadvertently came into contact with someone with Ebola. Those
are important questions for Doctors without Borders to answer.

MADDOW: In terms - I don`t mean to get gory about this, but I feel like
you are the man to ask. Is it worth clarifying that part of the reason
that health care workers we see in this intensively protective equipment is
- maybe not the right lesson for thinking about people`s risk who might
have been at the same bowling alley with Dr. Spencer last night. Because
of the way that Ebola patients get symptomatic when they are very sick or,
indeed, close to death. Health care workers who are treating people who
are deathly ill with Ebola who are very, very sick, are dealing with
copious amounts of body fluids in a way that nobody would be if they were
dealing with somebody who either didn`t know that they were symptomatic or
who had just gotten the first mild fever without noticing it. Is it fair
to clarify that?

ADALJA: Yeah, that`s exactly correct. And that`s also borne out by
looking at Mr. Duncan, the patient who died in Dallas, his 48 contacts,
none of whom were infected. Even the person that share - that was sleeping
in the same bed with him and taking care of him while he was not
hospitalized didn`t get infected. This isn`t a disease that spreads
casually. It really is blood and body fluid and health care workers are at
a disproportionate risk. And no one in a bowling alley or no one in the
subway is going to get unless they are exposed to blood and body fluids,
and it seems like he wasn`t having any of those symptoms at that time.

MADDOW: Dr. Adalja, in terms of Dr. Spencer`s own safety, there have been
a - there`ve only been now four people diagnosed with Ebola in terms of the
Ebola diagnosis happening in this country for the first time. But there
have been a number of people treated here. One person treated for Ebola in
this country has died, and that was Thomas Eric Duncan who was apparently
infected in Liberia, and who had his treatment here, treatment, we should
say that was delayed by an initial misdiagnosis at that hospital in Dallas.
Everybody else has survived. Is there reason to believe that Dr. Spencer`s
prognosis, even if he gets very ill, is - is fairly good here? Simply
because he`s being treated in a state of the art Western hospital and that
the likelihood of dying from this disease should be seen now as the
experience that we`ve got as significantly lower than the likelihood of
dying with this disease in a field hospital-type setting in a less
developed country?

ADALJA: That`s only true. The physician was diagnosed immediately. He is
going to start getting IV fluids, fever control, anti-nausea medications
immediately, so he has the best chance of recovery, because this was
diagnosed early. We know for many infectious diseases, the faster you get
treatment, the more likely you are to survive. And now as you said, Mr.
Duncan had a delay in treatment, which led to his severe course, and we
seem that - the other individuals that were treated in the United States,
they all have survived. So I anticipate he`ll have a good outcome.
Because he`ll be treated aggressively in fact.

MADDOW: Whether or not they decide to keep him at Bellevue or whether they
decide to move him to one of the specialty units that we have at Emory and
NIH and Nebraska, places that have had some experience in treating other
patients in this country. If you were advising Dr. Spencer`s friends and
family in terms of what to expect for his course of disease, if he`s got
103 fever today, let`s say he did have a couple of days of feeling sluggish
before this. What are the key days, what are key numbers of days to watch
in terms of whether hope - whether we should be hoping for his survival or
whether we should be more worried? This - over the course of the disease,
is there a predictable progression in terms of - in terms of when we should
start looking for key signs of his strength?

ADALJA: We don`t understand basically who survives and who dies. That
still hasn`t been worked out with Ebola. However, we do know that most of
the severe complication happened in the second week of illness. So
depending on when his symptom started, we start to see him going kind of a
rocky period, a critical period in the second week. But it`s also going to
depend on how his prognosis, blood work they`re able to do there and
looking at his kidney function, his respiratory function, all of those
things are going to be monitored to kind of predict when he sort of going -
if he can hit a rocky course or if it`s going to be a very uneventful
course. But this will all be monitored day-to-day. And I think there
probably will be update daily. And Bellevue does have a special
laboratory there designed for the patients, which is something that Dallas
did not have.

MADDOW: Good point. Dr. Amesh Adalja, very helpful to talk to you
tonight, sir. Thank you very much for you time.

ADALJA: Thanks for having me.

MADDOW: Dr. Amesh Adalja with the infectious disease society of America.

I also want to bring in Katy Tur, Katy, with NBC News, NBC News
correspondent, and she`s outside Bellevue and has been doing some reporting
on how New York City authorities have been handling not just this case, but
also contact tracing related to Dr. Spencer. Katy, it`s good to see you.
Thanks for joining us.

KATY TUR, NBC CORRESPONDENT: Hey, Rachel, the good news about Bellevue is
that it has been designated as an Ebola treatment center. They did a run
through with reporters last week showing everybody exactly the preparations
that they have in - have in place in order to treat somebody with this
disease. So he was rushed there immediately. This was the place you`re
going to go if you come down with Ebola in New York City. It happened
around 11:50 this morning that he called the health department and
complained of a 103 degree fever. The health department then called 9-1-1
and 9-1-1 decided to send a hazmat team and an ambulance to rush him from
his home apartment building straight here to Bellevue.

Now, we know that he was out last night. He took a taxi from Harlem to a
bowling alley in Williamsburg. He had some sort of physical contact with
his girlfriend this morning. He says that he self-quarantined the second
he started to feel the severe symptoms, fatigue, nausea and fever. Of
course, he was very feverish, 103 degree fever. But we are learning that
the health officials are saying that he did feel sluggish in the days prior
to that. So it`s unclear why he would decide that it was OK to go out or
why he would decide that it was OK to have any contact with his girlfriend.
Presumably this man, this doctor knows a lot about the disease and a lot
about how it can spread. So it`s that sort of those circumstances that are
very much under questioning right now, where this is a big confusion as to
why he would decide to go out. Now, he`s an ER doctor at Columbia
Presbyterian here in New York City. He`s been back for ten days. The
hospital says that he has not been to the ER. He has not seen patients
since he has been back. He has been nowhere near that hospital. The CDC
is now going to confirm these results to make sure that yes, he has tested
positive for Ebola.

Meanwhile, the health department out here is going through an interviewing
and tracking everybody that he might have come into contact, with anybody
that might potentially pose a high risk. We do know from sources that his
girlfriend is under quarantine right now. We also heard that she had some
sort of contact with him this morning. But they`re tracing that. They`ve
already gone to his apartment building. They`ve handed out flyers. They
started questions people there. They`re going to try and trace it as much
as they can. It`s New York City, this is 8 million people here. You take
the subway, you take taxi. So, of course, there`s going to be a lot of
concern about whether or not he came into contact with people. But as
we`ve been hearing for weeks now about this, is that you cannot contract
this disease unless you have contact with the bodily fluids. So, they do
want to maintain some level of caution, some level of level-headedness to
this city to not send everybody into a panic.

MADDOW: Katy, in terms of the initial response. You`re right to point
out, actually, it rings a bell for me now when you`re talking about the run
through that they did at Bellevue to demonstrate preparedness at the public
health level in case of just this sort of eventuality. We know that one of
the ways that played out today was that when the health department was
contacted, he made that initial call. And the health department learned
about his circumstances that he was somebody who had had contact with Ebola
patients. That he`s somebody who knows what he`s talking about in terms of
his self diagnosis and self-monitoring and that temperature. When they
knew this was honestly, a likely case, we`re told that they dispatched
paramedics. They dispatched some sort of EMT team to him that was
specially trained or specially equipped in order to safely get him from his
apartment to Bellevue. Do we know anything else about who that New York
City team of first responders was? Or how they might be specially equipped
for handling a case like this?

TUR: From the moment that he called, they treated this as if it were a
positive case of Ebola because of his contact. So, there was never any
doubt in the health officials minds the way, the seriousness of the matter.
They sent an EMS crew out there, that`s the highly trained - highly
specialized New York City first responders. They have every - every piece
of gear that you can imagine. They are trained for every sort of first
responding situation, be it the terrorism attack, be it the bio attack, be
it a case of Ebola.

So they have all of the gear necessary -- or they are supposed to have all
of the gear necessary in order to deal with a circumstance like this. And
those are the people that were dispatched when they got this call. He was
taken in an ambulance, it had a police escort. They took it very seriously
from the start. Rachel.

MADDOW: Katy Tur, outside Bellevue Hospital. Katy, thank you, we`ll be
checking in with you soon, I`m sure.

Right now, again, at Bellevue, what you`re looking at right here is a live
shot as we await a public press conference we are expected to be led by New
York City Mayor, Bill de Blasio. And other health officials were told at
one point that it may also include New York City governor Andrew Cuomo.
We`re expecting to hear from them, an update not only on the status of this
latest Ebola patient in the United States, Dr. Craig Spencer returned nine
days ago from the nation of Guinea where he was working with Doctors
without Borders treating Ebola patients in that country. Again, the doctor
phoned health authorities this morning when he found himself to have a
fever of 103 degrees. But he has been back in this country for nine days.
We`re told he felt slightly sluggish or slightly off for a couple of days
before he felt seriously sick.

Today, it was less than roughly two hours between the time that he made
that call and New York City officials got him into isolation at a specially
designated unit at Bellevue hospital in New York City. That just happened
today. His first blood test confirming the positive test for Ebola came in
tonight, just about an hour ago. We`re awaiting a confirming test from the
CDC. But, again, it is being treated as a positive test -- positive case
right now. And even before the blood test, he was being treated as a
positive case of Ebola in this country, which may, if he is, indeed,
positive, turn out to be very important in terms of infectious disease
control and the sort of epidemiological side of this new diagnosis.

I want to bring in Dr. Kathryn Jacobsen, she is an associate professor of
epidemiology at George Mason University.

Dr. Jacobsen, thanks very much for being with us.

DR. KATHRYN JACOBSEN, GEORGE MASON UNIVERSITY: Hi, Rachel.

MADDOW: It sounds like we`ve learned a lot from (INAUDIBLE), and that New
York City was prepared to have a ambulance ready with trained personnel to
safely transfer the patient to the hospital. And what we see if we look at
West Africa, is that more than 440 health care workers have contracted
Ebola there. And almost 250 health care workers in West Africa have died.
Which is a large proportion of all of the pieces. So, the focus now is
going to be on protecting health care workers, making sure that everybody
at the hospital is trained in how to put on the protective gear, take care
of the patient and take off the protective gear. And it sounds like the
hospital is ready to take care of his patient safely.

MADDOW: One of the things we`re told that New York City has been doing,
and it almost sounded sci-fi esque when you first heard about it. But now,
once there`s a patient, it seems like the smartest thing in the world.

That they reportedly were sending fake patients, people presenting with
faked symptoms and case histories that would indicate likely Ebola
exposure. And, basically, to run live tests on the hospitals and emergency
rooms around the city to see if they could handle it. Is that the sort of
thing that makes hospitals get their protocols in order and find out what
they`re doing wrong in a quick way?

JACOBSEN: Definitely, we do not want to be making up pandemic response if
it`s flu, mass casualty events or something like an Ebola case. We don`t
want to be coming up with (INAUDIBLE) on the flight. So, we do want to
have protocols in place ahead of time, practiced with everybody who is
being involved, everybody from the - in the field, folks to the critical
people to those who are involved in communicating with the public. We want
to have a cheer sense of everybody`s role. So we can make sure that the
public is protected and that patients get the best care possible.

MADDOW: Dr. Jacobsen, in terms of what New York City does next, we are
watching - we watch the sort of extraordinary response going to effect this
afternoon, even before we got the positive blood test with the contract
tracing starting right away, Mayor de Blasio making public remarks earlier
today although we are waiting more from him now, that they`ve got the
positive results. A CDC team dispatched to New York City again, today,
even before they had the positive results. What is the important sort of
day two, day three stuff that needs to happen in terms of making sure this
remains an isolated case? Obviously, protecting health workers is the
first instance. But if there`s a chance that he`s potentially infected his
girlfriend or somebody else with whom he`s had close contact in the very
recent past, what should happen next in terms of New York City getting that
right?

JACOBSEN: It will be important just like in Texas where the friends and
family members who have very close contacts with the patients, do have
their temperatures monitored, probably the health department will be
checking in at least twice a day to see if there are any symptoms like a
fever or something else - But, again, the likelihood is really small, that
something like that`s going to end up being an Ebola case. We see in Texas
that two health care workers became infected, but none of the family or
immediate contacts did. Ebola is not something that spreads through casual
contact. The infection rate is relatively low. It`s not highly
contagious. So, there`s really almost any significant possibility that
people say, who he may have accounted out in the public in the past few
days, could have had any sort of contact that could have been infectious.
So the girlfriend and other close contacts will stay at home for three
weeks and they`ll be monitored closely. But at this point, contact
tracing, yes for the public, but the concern will primarily be on making
sure that the health care workers are protected.

MADDOW: I don`t mean to be instant - to the plate of this doctor who`s
just been diagnosed with - after all, life threatening disease. But I do
have to ask if he should have essentially self-isolated for the first 21
days that he was back. One of the things that health authorities have
talked about in terms of travelers from West Africa nations people who may
have been in contact with Ebola patients in those countries is that
everybody should not necessarily just be monitored for 21 days, but that -
for a 21 day period particularly anybody who knows they had close contact
with symptomatic Ebola patients, should there be, essentially, a de facto
quarantine that goes into effect even without any other symptoms rather
than just self-monitoring?

JACOBSEN: It may be that as a result of this case, the recommendations for
travelers who are known to have an Ebola exposure will change. And my
guess is that CDC will be entering guidelines that request that people who
have known exposure do to - self isolate for the full three weeks. It`s a
little hard to make any sort of assessment in this particular case. Saying
but, somebody felt sluggish for a few days. He probably had jet lug, too.

MADDOW: Yes.

JACOBSEN: So, international travelers feel sluggish, that`s not
necessarily anything to do with having Ebola.

MADDOW: Dr. Kathryn Jacobsen, epidemiologist of George Mason University.
Really, really helpful to have you with us tonight. Thanks very much,
Doctor.

JACOBSEN: Welcome.

MADDOW: Again, we are awaiting press conference right now from New York
City officials. We are expecting this to be led by New York City Mayor
Bill de Blasio.

This is the scene right now at Bellevue hospital. New York City has been
through some incredible and publicly touted preparations over the past few
weeks as the nation watched, fairly riveted, to what the city of Dallas
did. Dallas which had no indication that it was going to be first, but
ended up being the place with the first three Ebola patients diagnosed in
this county. One who flew in from West Africa and two who became infected
when they treated that man. As Dallas struggled at times, and acted
heroically, and did their best, but also did manage to get two more people
infected as Dallas muddled through and struggled through their experience
with Ebola, the rest of the major cities in the nation thought about how
they could do it. New York City has been particularly public about their
own preparations. We`ve had a lot of public pronouncements about things
like fake patients being sent to present fake symptoms and fake case
histories that might indicate likely Ebola exposures into emergency rooms,
the hospitals around the city just to test them and see how they are doing.
There was a massive, massive training at the Javits Center, which is the
huge convention hall in New York City for thousands of health workers all
being trained, all at once, on mass, at the Javits Center in terms of CDC
gold standard protocols on staying safe while both diagnosing and treating
Ebola patients.

We`ve seen in New York City a New York governor Andrew Cuomo, made a public
pronouncement about New York states, designating specific hospitals that
would essentially be the frontline. A number of hospitals chosen, a couple
of them - a few of them in New York City, but also in other parts of the
state, that essentially would be the designated place for newfound Ebola
cases to be handled, not only New York state that`s doing that, but New
York State was one of the first large states to announce that they would do
that. That protocol has gone into effect. Again, Dr. Craig Spencer
tonight having a preliminary first blood test positive for Ebola. They
will have that test redone at the CDC so the CDC will confirm whether or
not that test is in fact positive. But this is being treated as the
positive patient. He called authorities today with 103 fever, contact
tracing under way in terms of people he may have had contact with since
having symptoms in New York including the man`s girlfriend who is now under
quarantine. But again, we await public word right now from New York City
officials. We`ll be right back. Stay with us.

(COMMERCIAL BREAK)

MADDOW: So, again, we`re watching Bellevue hospital tonight in New York
City. Just within the last hour and a half or so we have learned about the
first patient testing positive for Ebola in New York City. It`s a
preliminary test the CDC will confirm it. New York City officials, though,
have been treating this patient all day as a de-facto Ebola case. Now that
the first blood test has come back positive all the more so, we`re awaiting
word from New York City mayor and other health officials in terms of the
treatment of this doctor, recently really return from Guinea where he was
treating Ebola patients. The treatment of the doctor, the condition of the
doctor and also measures that New York City is taking and has taken, thus
far, to ensure that nobody else gets infected by this first New York City
patient.

I do have to tell you, though, as we await that press conference, we also
have a second developing story that also happens to be from New York
tonight. And it is a strange and unsettling story. I have to tell you
upfront, this may end up being just a tragic and unusual street crime, but
for reasons you will see in a moment there are worries tonight that it may
be connected to other recent incidents, particularly the events yesterday
in Ottawa and two days earlier in Quebec. This afternoon around 2:00 local
time, a man wielding a hatchet on a New York City street rushed at a group
of four uniformed New York City police officers. The man hit one of the
officers in the arm with a hatchet, hit another, one of the other officers
in the head with the hatchet, the other officers opened fire on him. The
man was killed. Both officers who were hit with the foot and a half long
hatchet did survive the attack. The police commissioner today said this
attack seemed to come out of the blue.

(BEGIN VIDEO CLIP)

BILL BRATTON, NYC POLICE COMMISSIONER: Unprovoked, and not speaking a
word, the male then swung at one of the officers with the hatchet, striking
his right arm. After striking that officer, the suspect continued swinging
the hatchet, striking a second officer in the head, causing him to fall to
the sidewalk. At this point, no known motive for this attack has been
established. The investigation is continuing.

(END VIDEO CLIP)

MADDOW: Now, the New York City police officer who was hit in the head
suffered a fractured skull, required surgery this evening. A civilian
nearby was also hit by gunfire when police officers shot at the man with
the ax. The bystander who was accidentally hit with the police bullet was
listed in stable condition. The suspect, again, I should say, was killed.
So far police officials in New York say they do not know why the man
attacked those officers. It`s been reported that the officers had stopped
to pose for a picture for a freelance photographer. But police say they
have talked to the photographer and the person is cooperating with them, so
there`s no indication as to whether or not that eventuality is connected
with the attack that was subsequently launched on those officers.

Police have not yet named the suspect who, again, was killed by police
gunfire as the event was taking place. And he may have just taken
advantage of that pause on the sidewalk to lash out, we still know very
little about what happened today. But, of course, after two apparent lone
wolf low tech attacks on uniform personnel in Canada this week, officials
in the U.S. are also on heightened alert. This evening, the New York
Police Department sent a patrol bulletin cautioning officers to be on
alert. After the shooting yesterday at the Canadian parliament. The
bulletin cautioned police to be on alert for potential attacks on uniformed
officers. But in the investigation of this attack this afternoon by this
man wielding a hatchet, New York City police say nothing so far connects
the suspect to any extremist groups. We`ll keep following the story.
We`ll let you know if more information becomes available. But have joining
us now is Richard Esposito with the NBC News investigative unit. Richard.
Thanks very much for being with us. I appreciate it.

RICHARD ESPOSITO, NBC INVESTIGATIVE UNIT: Sure.

MADDOW: In terms of the summary that I just gave there, can you tell us
the latest in the story and also, can you correct me, if I misdated
anything there?

ESPOSITO: No, I think - I think Rachel, I think you really got it on the
head. The police responded heavily because of the nature of the attack and
because at very early part of the investigation indicated a person who
might be this man, might be this man, had stuff on his Facebook page that
could point towards fundamentalist leanings. So they responded very
heavily. But they have also responded very clearly and cautiously. They
don`t know - why he did it, nothing they found as - when I left the office
about an hour ago was hate literature. They found, you know, of the
prayers from the Koran, they found a picture of what appeared to be a
Moorish soldier, a fighter. What they found was at the head a very
determined adversary. That`s the way one of the chiefs of police Kim
Roister (ph) described it A man who was determined to get at police. So,
he charged at him. There`s video of him pulling the hatchet from his
backpack and managed to get in three swings hitting two cops before they
opened fire. So that kind of street behavior, you know, can point toward
someone who is emotionally disturbed. We`ve certainly seen that before.
And even today, the incident in Canada, well, they are linked to Jihadists
in one case. There are tentative links in another case. There`s little
doubt that the motive ultimately might have been jihadist. But one guy had
domestic problems, the other guy had been living in a homeless shelter.
So, you don`t really know what prompts the - decision.

MADDOW: Richard, I`m going to have to cut it, I`m sorry. New York Mayor
Bill de Blasio starting this press conference at Bellevue. Let`s go to
him.

(PRESS CONFERENCE)


BILL DE BLASIO, NEW YORK`S MAYOR: Good evening (inaudible) I just want
note we are joined by Governor Andrew Cuomo, by Health Commissioner Mary
Bassett of city of New York, Health Commissioner Howard Zucker at the state
of New York, the President of the Health and Hospitals Corporation of New
York City, Dr. Ramanathan Raju, and on the phone Dr. Thomas Frieden,
Director of the Senators for Disease Control and Prevention. Dr. Frieden
addresses afternoon remarks by the rest of us.

Today testing confirmed that a patient here in New York City had tested
positive for Ebola. The patient is now here in Bellevue Hospital. We want
to state at the outset there was no reason for New Yorkers to be alarmed.
Ebola is an extremely hard disease to contract. It`s transmitted only
through in contact with an effected person`s blood or other bodily fluids,
not through casual contact.

New Yorkers who have not been exposed to an effected person`s bodily fluids
are not at all at risk. And we want to emphasize that New York as world
strongest public health system, the world`s leading medical experts and the
world`s most advance medical equipment.

We`ve been preparing for months for the threat imposed by Ebola. We have
clear and strong protocols which are being (inaudible) followed and were
followed in this instance. And Bellevue Hospital is specially designed for
isolation patient treatment of Ebola patients. Every hospital in the city
is prepared in the even that other patients come forward.

The patient in question is a doctor who has worked for Ebola patients in
West Africa and when his symptoms emerged he was taken to Bellevue by
specially trained emergency medical service workers who followed all
transport protocols.

The patient is now in isolation. The health department has a team, a
disease detective who has been at work, tracing all of the patient`s
contacts and we are prepared to quarantine contacts as necessary. There
have been reports about the patient`s movement, again, these medical
detectives are at work putting together the pieces of the timeline. But we
emphasize again, Ebola is very difficult to contract being on the same
subway car or leaving near a person with a Ebola who has not in itself but
someone at risk.

We are working very closely with our state and federal partners to ensure
that we protect the health of all New Yorkers. And people should rest
assure of the extraordinary medical professionals of the city and this
state are working to ensure that every protection is in place.

A moment of commentary in Spanish before it turn to Governor Cuomo.

UNIDENTIFIED MALE: (Speaking Spanish).

DE BLASIO: With that I want to welcome comment by Governor Cuomo who has
remained in closed communication with us here in the City over the last
weeks. His team has been extraordinary in their preparation and
coordination with us.

Welcome Governor Cuomo.

ANDREW CUOMO, (D) NEW YORK: Thank you. Thank you Mayor.

As the mayor said the past few weeks, we`ve been preparing for just this
circumstance. We were hoping that it didn`t happen but we were also
realistic. This is New York. People come to New York. They come to New
York`s airports. So we can`t say that this is an expected circumstance.
The -- we have had a full coordinated effort that is been working literally
night and day coordinating city state and federal resources, coordinating
in drilling from airports to transportations, to subway stations, to
ambulances, to hospitals.

So we are ready as one could be for this circumstance. What happened in
Dallas was actually the exact opposite. Dallas unfortunately was caught
before they`ve could really prepared, before they really knew what they
were dealing with in Dallas. And we had the advantage of learning from the
Dallas experience. Just the other day, in the long days, but I believe it
was yesterday we had 5,000 health care workers in the Javits center who
were being drilled on just this situation.

We also had a fortunate circumstance here that the effective person was a
doctor, person, a doctor who worked on Doctors Without Borders so he was
familiar with the possibility and the symptoms, et cetera and he handled
himself accordingly.

Our best information is that for the relevant period of time, he was only
exposed to a very few people, partially because he knew exactly what the
illness was all about and he was taking precautions on his own.

As the mayor mentioned, I know the word Ebola right now can spread fear
just by the sound of the word. Ebola is not an airborne illness. It is
contracted when a person is extremely ill and symptomatic and it`s
basically contracted through the bodily fluids. Having a lot of time to
prepare as we did, we have been fully coordinated all the day long.

I spoke with our new Ebola Czar what President Obama pointed, Ron Klain.
They were immediate in sending CDC teams, so we were very well from the
Federal Homeland Security Office, have been fully coordinated. They
reviewed everything that we`ve been doing. We`ve been doing it with their
advice and we are after having spoken with everyone doing everything that
we need to be doing.

I know it`s a frightening situation. I know when it watched it on the news
and it was about Dallas, it was frightening that it`s here New York, it is
more frightening. New York is a dense place. A lot of people on top of
each other, but the more facts you know the less frightening this situation
is.

We were already acted very, very quickly and identified about four of the
people who we believe -- we believe there are four people who he came in
and contact with during the relevant period and we are already in contact
with all four people. So we feel good about the way we are handling the
situation. Obviously, we wished the best for the doctor and we hope for a
recovery for the doctor but from the public health point of view, I feel
confident that we`re doing everything that we should be doing and we have
this situation under control.

And I want to applaud the mayor and the mayor`s team and also like as a
personal point of privilege I thank my team for the good work. This has
been weeks and weeks of preparation in getting a lot of agencies to work
together but the purpose in the putting in today it worth well. So
congratulations to them.

DE BLASIO: Thank you very much governor. Now I would like to turn to our
New York City Health Commissioner Dr. Mary Travis Bassett who has been in
charge of all the preparations here in the city and particularly working
closely with Bellevue as the lead institution that we have designate for
handling this cases. Dr. Bassett.

MARY TRAVIS BASSETT, NEW YORK CITY HEALTH COMMISSIONER: Thank you Mr.
Mayor. And good evening everyone. As you all know, for the last couple of
months now, we`ve been working closely with our city hospital system, with
our state partners and our federal partners to prepare for the possibility
of a diagnosis of the patient with Ebola in New York City. Today we have
the fist patients with a presumptive positive Ebola test.

This test was completed at our public health lab and will be confirmed at
the CDC labs. We expect within the next 24 hours. Let me go over with you
what we know about this patient at this time. This is of course an
evolving situation in which information will continue to come forward but I
want to share with you what we know at this time. As you all have already
heard the patient is presently hospitalized in isolation at this hospital.

The patient is a 33 year old doctor working with the same human services
organization, Doctors Without Borders and that (inaudible) in Guinea. He
completed his work in Guinea on the 12 of October and left Guinea on the
14th of October via Europe where he arrived in United States at JFK Airport
on the 17th of October.

During at the time that he departed Guinea through out his journey home to
the United States he was well with no symptoms. When he arrived in United
States, he was also well with no symptoms. And he being a medical doctor
undertook to check his temperature twice a day, which he has done since he
departed from Guinea.

On the 21st, he began feeling somewhat tired but the actual symptoms that
the patient displayed more today sometime between 10:00 and 11:00 this
morning he experienced a fever and contacted MSF who rapidly contacted the
health department and the process of bringing this patient to Bellevue
Hospital as a first and considered at high risk for Ebola began.

We know that during the time that the patient was home before he became
sick that he did his leave apartment his. He -- We are aware that he went
on a three-mile jog, sign that he was feeling quite well. And he also took
the subway system. We know that has ridden on a train, the number one
train, the L-train.

We`re still getting more information about this but we know that yesterday
that he went to a bowling alley in Williamsburg. He was feeling well at
that time and except for his feeling of fatigue.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY
BE UPDATED.
END

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Show: THE RACHEL MADDOW SHOW
Date: October 23, 2014

11PM

Guest: Irwin Redlener, Sheldon Dutes, Jeremy Faust, Clay Jenkins, Stephen
Morse

RACHEL MADDOW, MSNBC HOST: So we are back live with continuous special
coverage of what appears to be a new case of Ebola in the United States.

This is the first case in this country that is not connected to the patient
who died in Dallas this month. The new patient is a 33-year-old doctor.
His name is Craig Spencer. He is attached to New York Presbyterian
Hospital in New York City. But it`s believed he was infected in the West
African nation of Guinea, where until recently, Dr. Spencer was working to
fight the Ebola epidemic, alongside the heroic international medical
organization called Doctors Without Borders.

New York officials say Dr. Craig Spencer felt some mild fatigue in the last
couple of days but nothing serious. He has been self monitoring. He`s
been taking his temperature twice a day since he returned from Guinea last
week.

He reportedly did not have a temperature until this morning, but then he
did and quite a high one. They`re saying it was 103-degree fever when he
today contacted Doctors Without Borders to tell them about his fever. That
organization then contacted the health department. The health department
contacted local emergency services in New York City.

And this is interesting. The emergency services in New York City
dispatched one of the 36 teams in the FDNY, 36 so-called Haz Tac teams that
have been set up by the New York City Fire Department to handle first
medical response and also medical transport for infectious diseases and
hazardous materials.

Again, the fire department of New York City, FDNY, has more than 30
specialty Haz Tac teams set up to handle difficult situations like this.
One was dispatched today. That especially-equipped FDNY unit brought the
doctor to Bellevue Hospital.

He was then put in isolation inside that hospital. All in all, the time
that elapsed from when he first took that temperature and realized he had a
fever and he first made that phone call and the time he was in isolation at
the hospital appears to have been in total about two hours.

After they had him at Bellevue, they tested his blood in the lab at
Bellevue, that preliminary test came up positive for Ebola between 8:00
p.m. and 9:00 p.m. tonight. At least, that`s when we were notified of it.
In recent weeks, even before this diagnosis, New York City has been
actively preparing to handle the diagnosis in care of an Ebola patient, in
the event of an outbreak.

The training here is part of a national effort to sharpen the abilities of
U.S. hospitals and health workers after the experience of treating the
first patient in Dallas resulted in two nurses contracting the disease
themselves from the patient they were assisting.

This week, the Centers for Disease Control held a huge training session for
thousands of health care workers in New York. The training included
doctors and nurses, and we`re told even janitors and security staff --
anybody who might need to know what to do and how to handle themselves if
they ended dealing with a symptomatic Ebola patient.

All of those workers got lessons, thousands of workers got lessons in
putting on and taking off the protective gear that is so crucial to
protecting health workers and nurses, doctors and nurses from the virus.
Again, the personal protective equipment in the case of an Ebola patient is
so intense and so, all encompassing in part because health workers are the
ones in treating when they are very symptomatic. And when you get very
symptomatic as an Ebola patient, that almost always means you are,
unfortunately, excreting lots and lots and lots of body fluids.

The risk of death, the immediate cause of death for many patients is
dehydration, because of the amount of body fluids that they essentially
expunged from their bodies over the course of becoming very ill with the
disease. It`s because of that large amount of infectious body fluid that
health workers come in contact with, that they wear this sort of personal
protective equipment.

Those workers at that training at Javits Center also got a pep talk from
New York Governor Andrew Cuomo. He went to the training. He told the
crowd there knowledge and training would defeat this disease. He urged
them to remain calm and confident in their -- excuse me, competent in their
profession.

Now, just two days after that giant training session, that training in New
York has gone from being preparation to being actual medical practice.

At a press conference tonight, officials urged everyone in the New York
region to remain calm. They stressed that Ebola, while it is a scary
disease and it is often a fatal disease, it is not easily transmitted.
They said no one who has not had contact with the bodily fluids of a
symptomatic Ebola patient is at risk for Ebola even though New York City
has its first patient.

They also announced that the disease detectives have already gone about the
business of tracing this patient`s possible contact, and his movements
throughout the city over the last few days. Though that patient had spent
time out and about in New York City, including going to a bowling alley,
and officials said visiting a high line and other New York City spots,
officials also said he did do some degree of self isolation in the past
week.

(BEGIN VIDEO CLIP)

DR. MARY BASSETT, NYC HEALTH DEPT. COMMISSIONER: He did attempt to self
isolate it, and we`re still getting clear the amount of time that he spent
outside of his apartment. But our impression is that he spent most of his
time in his apartment, and he was taking his temperature twice a day. He
was being mindful about contact with people.

(END VIDEO CLIP)

MADDOW: Tonight, that patient is at Bellevue Hospital. Bellevue Hospital
is one of eight specially designated facilities in the state of New York,
one of five in New York City, specially designated to handle a potential
case of Ebola.

Well, tonight, the training that thousands of New York City health care
workers had at the convention center in New York City just days ago,
thousands of those health care workers were drilled into those preparations
and that training just a couple of days ago, and none too soon, because it
has been called in to practice tonight.

Let`s bring in now the director of the National Center for Disaster
Preparedness, Dr. Irwin Redlener. He also serves as a special adviser to
New York City Mayor Bill de Blasio. He joins us from in front of Bellevue
Hospital live tonight.

Dr. Redlener, thank you so much for being with us. I appreciate it.

DR. IRWIN REDLENER, NATIONAL CENTER FOR DISASTER PREPAREDNESS: Thank you,
Rachel.

MADDOW: You are standing in front of Bellevue. This patient was taken
there tonight per New York City protocol. Why were Bellevue and four other
New York City hospitals specially designated as a place where Ebola
patients would be handled in the event that one did turn up?

REDLENER: Well, the idea here is to make sure that there are facilities
that are up to speed as possible to care for a patient that gets sick with
Ebola. It`s a very complicated process. This issue about the dehydration,
the fluids, is really critical. And this is very difficult to manage, and
then, of course, all the infection control, the PPE and all of that has to
be done well.

On the other hand, there`s also the possibility that here or anywhere else
in the country, the patient can walk into an emergency room of a smaller
hospital, maybe less well-equipped, and there have been plans made to make
sure that patients and staff are safe between the time somebody would walk
into the emergency room randomly until they get to a specialized hospital,
whether it`s one here in New York City or one at the national centers.

MADDOW: In terms of the unpredictability of for somebody might turn up, to
the point you`re making, Governor Cuomo in particular kept stressing over
and over tonight at this press conference, that every facility, every
hospital in New York obviously in his jurisdiction, he said every New York
hospital is prepared to recognize a patient at risk and to do a correct and
safe initial diagnosis.

It does raise the question to those of us who aren`t professionals about
this about what the differences between what a regular, run-of-the-mill
hospital could do, and what these special hospitals could.

REDLENER: Right. So, there is a certain initial screening that has to
happen. If we think back to the unfortunate case of Duncan, where he was
greeted at that hospital in Dallas for the first time in the emergency room
and was sent home because of whatever communication problems between the
triage system and the actual care system, all those things have to be
recognized. I don`t think there is a hospital in the country, in fact,
that is not acutely aware of that very unfortunate progression.

So, it starts with every hospital being able to understand when they have
to really focus in on a patient who might be a candidate for having Ebola.
That doesn`t mean they have to have a full-blown, complete PPE systems and
all the infection control configurations necessary in the isolation rooms
that patients will go, but they have to start with recognition and
isolation of the patients, putting on the PPE, calling the right people
immediately and getting the patients safely transferred.

So, I think what the governor was referring to quite correctly is a lot of
focus on that. And, by the way, Rachel, it`s not even that simple because
patients could walk into their local family doctor and their interns to
wait in the waiting room until they get called in to be seen.

So, this has to go pretty deep if we are going to make sure that we are not
having any patients slipped through the cracks here.

MADDOW: In terms of everybody trying to get very definitive in terms of
when Dr. Spencer started to feel symptomatic. People have to absorb the
information that only symptomatic patience can pose the risk to others.
How are New York City officials doing thus far in terms of addressing the
worries about transmission in the community?

We`ve all this detail about him going to a bowling alley, traveling by cab,
traveling subway, essentially eating at a restaurant in Manhattan. The
risk of community transmission for somebody who became symptomatic
definitely today but who may not have been feeling well the last couple of
days, how do you assess their communication on that and that risk?

REDLENER: Well, it`s actually -- you know, if you think about what is it
that public officials should be saying to people, the last thing anybody
wants to do is create unnecessary and I would say unscientific panic.

So, what we have to do is be able to present the facts as we know them. As
we know, as you just stated, Rachel, the patients are not considered
communicable until they actually develop symptoms. So, what happened with
Dr. Spencer two days ago, three days ago, four days ago, before the
symptoms actually came upon him is something that we really have a
responsibility to give people the information as we know it.

If things change in a month, can we learn more about this disease? It`s
possible. But, right now, I think we can be pretty confident in saying to
the public, we really don`t have any kind of substantive chance for getting
Ebola from Dr. Spencer taking a subway ride or even eating at a restaurant
unless there was direct contact with bodily fluids at a time when he
already had symptoms.

There has been long, hard discussions about every aspect of this by the
city and state officials before they arrive at kind of what is the message
to the public. We saw some crazy things out there, including schools being
shut down. I think it was in Texas. And schools decontaminated, friends
of cousins of brothers who were once in Africa being shunned by their co-
workers and so forth.

And I think it`s the responsible public position to make sure that the
public knows the facts, as straightforwardly and as honestly as to possibly
be presented. And I`ll tell you, there is nothing held back in terms of
what we know as the facts.

And conversations with the CDC, Dr. Frieden and all the officials at state
and city in New York, it was a consensus. It is or isn`t there a chance of
somebody recently catching Ebola from riding in a subway car that Dr.
Spencer had ridden on. And the fact is, we just don`t think that that is a
risk that should make anybody, for example, stop riding the subway.

MADDOW: Dr. Irwin Redlener, director of the National Center for Disaster
Preparedness, serves as an advisor to New York City Mayor Bill de Blasio --
Dr. Redlener, thank you very much. I really appreciate it. Thank you.

REDLENER: My pleasure. Thank you, Rachel.

MADDOW: Dr. Redlener, standing there outside Bellevue Hospital, where
again this first New York City Ebola patient is in isolation tonight.

Joining us now from outside Dr. Craig Spencer`s New York City apartment
building is reporter Sheldon Dutes from WNBC-TV.

Sheldon, thank you for joining us tonight from uptown Manhattan, from
Harlem.

What`s been the scene like there tonight? We were told that the doctor
locked up his apartment tied and that nobody has been in there since. But
what`s the scene on the ground?

SHELDON DUTES, WNBC-TV: Still sealed up right now. Not too many of his
neighbors have been coming in and out of the apartment, but the few that we
have seen say they were shocked. They came home from work today to find
out that that this diagnosis came back as positive. And some said they
didn`t expect it to happen in New York City.

But at same time, though, they said they are not too concerned about their
safety. They understand that this is only passed through bodily fluids.
So, they said that they were going to take the precautions over the next
few days but are not too worried about their safety.

I did talk a couple neighbors that said even though they are not concerned
about getting Ebola, they are upset and frustrated and a little incredulous
this was able to slip to the cracks, able to fly to the United States and
travel around Manhattan the way that he has the past few days, even though
he had been in Guinea with Doctors Without Borders.

MADDOW: In terms of the response, when he called emergency responders from
home. Again, we know the progression of that, was that he called Doctors
Without Borders. Doctors Without Borders called the health department,
health department called emergency services.

And we`re told that emergency service dispatched one of these Haz Tac teams
that FDNY, the New York City Fire Department maintains specifically for
medically responding to and transporting people in cases of infectious
diseases or hazardous materials.

Is there any evidence on scene of either that response, the way they have
treated the apartment since then, or was the blocked close off today?

DUTES: The block was closed earlier today. I have been out here since
about 3:00 this afternoon. When we first showed up out here, there were
remnants of the yellow police tape and some of the trash cans outside of
these apartment buildings. The super of the building would not let us go
inside, but we`ve been told that his apartment has been sealed off.

And yes, there were wearing hazmat suits earlier today. The emergency
responders and neighbors say that Dr. Spencer was transported out of his
apartment building wearing a hazmat suit.

You know, for the past few weeks, a lot of the hospitals and health care
workers in New York City have been preparing for a moment like this just in
case. So, as soon as that call went through, they went through all the
protocol that they needed to make sure this area was sick before they
transported him to Bellevue Hospital.

MADDOW: WNBC-TV`s Sheldon Dutes from outside Dr. Craig Spencer`s New York
apartment in Harlem tonight -- Sheldon, thanks for being with us. I
appreciate it.

You know, talking about the New York preparations there, anybody who either
is a New Yorker or who has ever been a New Yorker can tell you one thing,
particularly over the last decade and a half in this city, that there is
almost nobody who inspires more confidence New York City firefighters.

So, learning that the fire department in New York not only was the
emergency medical response team dispatched to transport this doctor, we now
know that initial transport of a symptomatic patient is a big part of what
need to get right, in terms of limiting the total number of potential
contacts in making sure that infectious disease protocols are maintained
from the very beginning. It`s no surprise that the fire department was
given responsibility for that.

But then also that they don`t just have one team designated that they have
set up especially in relation to Ebola to be able to handle potential
infectious disease cases like that. No, because it`s the New York City
Fire Department, of course, they`ve got more than 30 of these teams which
are constantly training, not just for dealing with an infectious disease
situation exactly like this, but for dealing with all issues in terms of
contagious elements and hazardous materials.

New York City is a place -- again, if you live here or have ever spent
considerable time here, particularly in the last 15 or so years, where
preparedness is taken very seriously. When you are surprised about New
York City preparedness, it is because you are surprised they have thought
of stuff that you would have never thought to be worried about until it
happened.

We`ll be right back.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

MAYOR BILL DE BLASIO (D), NEW YORK CITY: We want to state at the outset --
there is no reason for New Yorkers to be alarmed. Ebola is an extremely
hard disease to contract. It is transmitted only through contact with an
infected person`s blood or other bodily fluids, not through casual contact.
New Yorkers who have not been exposed to an infected person`s bodily fluids
are not at all at risk.

We want to emphasize that New York City has the world`s strongest public
health system, the world`s leading medical experts and the world`s most
advanced medical equipment. We have been preparing for months for the
threat posed by Ebola. We have clear and strong protocols which are being
scrupulously followed and were followed in this instance.

(END VIDEO CLIP)

MADDOW: New York City Mayor Bill de Blasio calling New York City the
world`s strongest public health system, saying that the world`s leading
medical experts and the world`s most advanced medical equipment are being
called on as necessary to handle New York City`s first Ebola patient.

That was the Mayor de Blasio speaking at Bellevue Hospital here in
Manhattan where the press conference was held earlier tonight. Mayor de
Blasio, Governor Cuomo and others speaking at Bellevue Hospital tonight
after the first Ebola patient diagnosed outside of Texas in this country
was sent to Bellevue at about 1:00 p.m. this afternoon. He`s 33-year-old
Dr. Craig Spencer, who has been in isolation at Bellevue since about 1:00
p.m. this afternoon.

Bellevue is a legendary institution, not just in New York, but in the
United States. It`s the oldest public hospital in the country. It`s used
to being a front line institution for providing care for people regardless
of their ability to pay. It has been as such for centuries.

As such, it`s been through hell and high water in terms of emerging
diseases and fear of emerging diseases and the real challenges of managing
infection in America`s largest city, in a big public health context. When
the mayor calls New York City the world`s strongest public health system,
with the world`s leading medical experts, what does that tell us in
practical terms about how emergency room staff, frontline staff who are
going to be on this case and any future ones too, how did those frontline
workers handle this case, particularly an environment like this?

Joining us now is Dr. Jeremy Faust. He`s an emergency medicine resident
physician at Mt. Sinai hospital here in New York City.

Dr. Faust, thanks for being here.

DR. JEREMY FAUST, MT. SINAI HOSPITAL: Thanks.

MADDOW: When Dr. de Blasio -- when Bill de Blasio talks about New York
City as having an unimpeachable strong public health system, do you think
that`s fair? Somebody practices an emergency medicine in the city. Do you
think that New York City has a strong network of care and good systems?

FAUST: I think that New Yorkers take a lot of pride in everything we do,
including our medicine. So, I think that, yes, I agree with the mayor that
we took a lot of pride in being prepared and preparing to be prepared.

So, at this point, the name of the game is coordination and preparation.
And I think he`s right. We`re ready for these kinds of things. My
colleagues have faced everything -- you can name it -- throughout history,
and they have rose to that challenge and they`re going to keep doing that
with this.

MADDOW: When you say coordination is part of the name of the game, what do
you mean?

FAUST: I mean, we`re coordinating with the city, with the state and
government on preparation. And every single day, things change. Facts
change on the ground, and when the facts change, you have to go with that.
And you can`t say, well, this is our stance, we`re sticking it. You have
to say, look, we are able to be nimble and we can change as things occur.
So, it`s coordinated and it`s preparedness.

MADDOW: The CDC`s specific guidelines, particularly for health care
workers in terms of treating Ebola patients have changed not radically, but
they have changed significantly since that first case of Thomas Eric Duncan
resulted in him infecting two health care workers during the course of his
treatment at Dallas. When those protocols changed, in terms of the way
that you train here in New York City, how did those change in protocols I
guess ricochet through the system? How did that change the way that you
train in what you do?

FAUST: Well, the way it`s working now is because of the changes.
Everybody has to be retrained. And even at the top levels. So, every
single person who has any chance of confronting a patient who might have
this disease has to go through retraining. And so, that involves fairly
lengthy procedures for getting all the equipment on, and as we now know,
the importance of getting it off correctly.

And so, we are in the process of training everybody. And little by little,
everybody is getting on board with that. So, we have to just, when things
change, you have to be quick change with them and be ready. And I think
the general attitude is, we can do whatever is needed.

MADDOW: In terms of the way that you do that training at Mount Sinai, is
there a chance this is Ebola-specific work that the United States needs to
do and some place like Mount Sinai needs to do, specifically because of
this moment in time in this particular disease, or is there a sense that
this is actually a sort of more general infectious disease preparedness
that we may be ramping up very quickly right now? Because we knew this
first patient was going to happen in New York, but may be sort of broader
help or broader basis of more wide training for future instance.

FAUST: Yes, Rachel, there is no question that this is going to be
transferable skills. What we are doing now will not does help with this
situation, which I think is going to be very well-controlled, but for other
situations in the future which might be as scary or scarier in terms of how
this disease is infected.

So, I think that, yes, it`s very important to respond and to make sure
everyone feels that we are doing what we need to do. But, yes, there is a
win on the other side, the next time we are that much better. That`s how
basically medicine in general response.

MADDOW: As an ER doctor, what`s hardest for you about the PPE, about the
personal protective equipment, about doing everything right? What`s the
part of it that takes the most either repetition or the thing that keeps
you up at night, that you were you might not do right?

FAUST: Well, I`m not really that worried because I actually think that we
have a great system in place. It`s not a matter of adding more things to
do. I think that that can look like a little bit flail, like you are
flailing. The important thing is to do it correctly. I think that getting
the equipment off is just as hard. One of the greatest strategists they
have had in this new regime, you have to have a buddy system. So, someone
who watches you, and you`re really being cared for at every step.

And I think that extra layer of teamwork is really part of the whole theme,
and that`s going to keep people really safe going forward.

MADDOW: Yes. I got to say, even just in terms of human psychology, being
responsible for another person doing it right can actually be more
comforting then knowing that you are on your own, to make sure you do it
right for itself.

Dr. Jeremy Faust at Mt. Sinai Hospital emergency medicine resident
physician, thank you for being here.

FAUST: Thanks.

MADDOW: All right. Up next, we`re going to be actually joined by Dallas
County Judge Clay Jenkins who became nationally known in this country as
the man who has overseen the local Ebola response in Dallas that we`ve been
talking about so much tonight. Judge Jenkins joins us next.

We`ll be right back.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

GOV. ANDREW CUOMO (D), NEW YORK: I know it`s a frightening situation. I
know you watch it on the news when it was about Dallas and it was
frightening. That it`s here in New York, it`s more frightening.

New York is a dense place. A lot of people on top of each other, but the
more facts you know, the less frightening this situation is.

We have had a full, coordinated effort that has been working, literally,
night and day coordinating city, state and federal resources, coordinating
and drilling from airports to transportation, to subway stations, to
ambulances, to hospitals. So, we are as ready as one could be for this
circumstance.

What happened in Dallas was actually the exact opposite. Dallas,
unfortunately, was caught before they could really prepare, before they
really knew what they were dealing with in Dallas. And we had the
advantage of learning from the Dallas experience.

(END VIDEO CLIP)

MADDOW: New York Governor Andrew Cuomo speaking at Bellevue Hospital
talking about the New York City state in response to this breaking news
that a doctor just back from West Africa has tested positive for the Ebola
virus in New York City. Governor Cuomo comparing the New York response,
what tonight, to what happened in Dallas, where the very first patient to
be diagnosed with Ebola in the United States, Thomas Eric Duncan, he was
treated.

Sadly, that treatment in Dallas was not successful. Mr. Duncan died
earlier this month at Texas Health Presbyterian in Dallas. That`s the
facility that took him in and treated him after first missing the diagnosis
the first time he came to the emergency room.

Thomas Eric Duncan is the very first Ebola patient to have been diagnosed
with the disease in the U.S. He`s the only person to have been either
diagnosed here or treated here who also died here.

Two nurses who treated Mr. Duncan contracted the disease while being
treated. The first, Nina Pham, was initially treated at that same
hospital. She was then later moved to be treated at the National
Institutes of Health in Maryland. She is said now to be in good condition.

The second nurse, Amber Vinson, she also contracted Ebola in the course of
treating Mr. Duncan. She was initially placed at that same hospital, Texas
Health Presbyterian. She was then quickly moved to Emory Hospital. Ms.
Vinson`s family released a statement yesterday saying that her blood has
already tested negative for Ebola just nine days after she was first
diagnosed. She remains in treatment.

What can we learn from the Dallas experience about how to diagnose and
treat the disease, how to protect health care workers on the front lines so
bravely providing that care?

If you had helm the Dallas response and had been through everything that
Dallas has just been through over these past few weeks, what would you say
tonight to New York about what has started here and what is going to
continue until this is resolved? What would your advice be?

Well, joining us now is Dallas County Judge Clay Jenkins, who has been
helming the response in Dallas. Judge Jenkins, top elected official in
Dallas County, it`s great to see, sir. Thank you for being here.

CLAY JENKINS, DALLAS COUNTY JUDGE: Thank you, Rachel.

MADDOW: Let me first just ask broadly, your reaction, your response, how
you felt tonight we heard this news that for the first time outside of
Dallas, another city is now coping with their first Ebola diagnosis?

JENKINS: Well, my heart goes out to Spencer and all those who love him, to
Mayor de Blasio and to leadership in New York.

But I can tell you, having helmed this in Dallas -- New York, you`ve got a
great public health system. You`re going to get an unparallel support from
Tom Frieden and the CDC, and you`re going to be OK.

If you did not come into contact with the bodily fluids of Craig Spencer,
you don`t have Ebola. If you -- if you normally ride on the subway, you
shouldn`t be afraid to do so. Ebola can only live in bodily fluids for two
to four hours outside the body, and there`s no evidence at all that Dr.
Spencer, who is a physician and accurately reported his symptoms, lost any
bodily fluids before being isolated by the health officials.

MADDOW: I don`t know if you were able to see the press conferences done
tonight by the governor and the mayor and the New York City health
commissioner and the state health commissioner, Dr. Frieden was there on
the phone. But there is a big public communications effort to be very
clear about those things you just said.

The New York Mayor de Blasio tonight said, if you have not come into
contact with the bodily fluids of any bill patient, you are not at risk for
Ebola. That was reflected over and over again from every different angle,
from all of those officials.

Is there any advice that you can give from your experience in Dallas? And
you having tried to be so clear with what is a real risk in what wasn`t,
and then why the state -- and how to be compassionate in the face of fear -
- is there anything that you would advise New York City officials and how
best to communicate about this and how repetitive they should be? Whether
it should be a new message so people don`t think they`ve already heard it
before? How would you tell them to approach it?

JENKINS: And I think repetition is key, and powering all of your community
leaders, whether they`d be school districts leadership, the clergy, block
captains, leaders in all industries and from all walks of life to give
those messages out peer to peer, and door to door, because you are fighting
two things. You are fighting Ebola, and you are fighting public fear that
arises from Ebola.

Right now, what we need is for the public to get the facts. You know, New
Yorkers are savvy people. They are smart and they`re tough and they can
rise to any challenge. If they have the facts, they can deal with this.

Those public health disease detectives have to hit the ground running.
Every person who has had any contact, get in the subway car, check all
those various things out, cast a broad net of disease contacts.

But here is an important thing to remember, New York -- Eric Duncan was
symptomatic and very sick for five days. We found 48 contacts, and all of
them were negative for Ebola, and all of them are passed and monitoring. I
am telling you from firsthand experience, you`re going to be OK.

MADDOW: Judge Clay Jenkins, a man who knows of what he speaks in these
matters, a man who has been through it, just as New York City is starting
through tonight. Judge Jenkins, it`s a real pleasure to have you here
tonight. I know you don`t have to do this, you got enough on your plate in
Dallas -- but I appreciate you being here. Thank you.

JENKINS: Rachel, thank you.

MADDOW: Thank you.

All right. Still ahead, a look at the federal response to the Ebola
crisis, including from the White House tonight. NBC`s Chris Jansing is
going to will have the latest.

Stay with us.

(COMMERCIAL BREAK)

MADDOW: Just a short time, New York Governor Andrew Cuomo provided some
detail tonight in terms of the level of coordination that has been
happening beyond just here in New York City tonight. Watch.

(BEGIN VIDEO CLIP)

CUOMO: Having had the time to prepare as we did, we have been fully
coordinated all day long. I spoke with are no Ebola czar, who President
Obama appointed, Ron Klain. They were immediately sending CDC teams.
Sylvia Burwell from the federal homeland security office, have been fully
coordinated. They have reviewed everything that we have been doing. We
have been doing it with their advice, and we are -- after having spoken
with everyone, doing everything that we need to be doing.

(END VIDEO CLIP)

MADDOW: Governor Cuomo said Sylvia Burwell form the homeland security
office -- I think he misspoke. Sylvia Burwell obviously is the secretary
of health and human services. Understandable screw-up at a time like this.

But you heard the governor of New York there say that the federal
government has been reviewing everything that New York has done so far
since this first patient was suspected. During the press conference
tonight, the director of the CDC, Dr. Tom Frieden, he spoke via telephone.
He said in addition to the CDC response team heading to New York City
tonight, this rapid response team from the CDC, this one he said actually
the CDC already had a team on the ground in New York City for several days
specifically to review all of the plans and procedures related to Ebola at
this particular hospital.

The CDC already had a special team here to review plans and procedures at
Bellevue even before this latest Ebola case arose in the doctor was sent to
Bellevue for isolation and treatment.

We were also told that President Obama has been fully briefed on this
latest case tonight by his homeland security advisor, Lisa Monaco.

For more on the federal response to this latest Ebola case here in New York
City, we are joined now by NBC News senior White House correspondent, Chris
Jansing.

Chris, thanks very much for joining us. I appreciate it.

CHRIS JANSING, NBC NEWS SENIOR WHITE HOUSE CORRESPONDENT (via telephone):
Hi, Rachel.

MADDOW: What do we know about the scope of the federal response, sort of
resources are being mobilized by the federal government tonight and what
the reaction has been from the White House?

JANSING: Well, what they like to say is this is a full government
response. And the fact of the matter is, we just need the agencies from
Health and Human Services, to the CDC, and in fact, the Homeland Security,
who are all working on this.

And you got Ron Klain, you know, day two, welcome to the White House.

MADDOW: Yes.

JANSING: He is stepping, though, into a situation that really does already
have this extensive infrastructure. This is something that the White House
has been putting together for quite a while now, but obviously gaining more
intensity with the situation in Dallas.

So, you know, you have the National Security Council, the CDC, HHS, and
this is something when we were talking to Josh Earnest, the White House
press secretary, earlier today. He did not even know where his office is.
I assume he has an office. I don`t even know about his staff.

So, he`s stepping in, but I can tell you, having talked to a number of
people at the White House today, and been in touch with members of the
administration tonight, this is why they brought him in, that he`s got
great management experience. They don`t think he`s going to be somebody
who will be in front of the camera. The people tonight in terms of New
York who are going to be doing that kind of thing, he will be working
behind the scenes to coordinate this response.

And I think it`s important to say as well, Rachel, when you talk about, for
example, already having these folks on the ground from the CDC, they have
done all the numbers. They crunched all the numbers. They know where the
likelihood is of the infections happening. They know where people are
coming in from those areas of Western Africa.

And so, New York City being one of those hubs. It`s not surprising they
had people in place. They have a part of that rapid response team on the
way tonight and a few more will be coming in tomorrow, Rachel.

MADDOW: Right. It`s striking a federal decision to limit all travelers
from West Africa to five specific airports in the United States. Two in
the New York City area, one in Newark, New Jersey and one, JFK, which
ultimately is where Dr. Spencer flew in when he came from Guinea via Europe
and arrived last week.

Chris, we have seen President Obama essentially cleared his schedule at
times as these cases of Ebola have developed here in the U.S., particularly
when there was news that health care workers had become infected while
treating the initial patient in Dallas.

Do you know anything about what we should expect from President Obama
specifically, changes to his schedule or any response that we should expect
from him?

JANSING: We haven`t seen that yet. I was talking to people tonight, and
they say that`s always a possibility, but they feel they have the
infrastructure in place. It`s also important to point out that we are
focused on New York City in the coming days.

But from the federal government response, they are also looking at West
Africa. This is something they have been focused on for a while, because,
obviously, how do you stop people from infected with Ebola from coming over
here? And that`s by getting to it at the start.

And so, as you well know, there has been a tremendous response, including
the Department of Defense. You are talking about places with the worst
outbreaks with no infrastructure. So, the U.S. government is going in as
the lead agency. And in some cases, for a while, the only agency going in,
the only country going in, and essentially building and health
infrastructure from scratch. And so, that`s something we talked a lot less
about, but it`s something the White House is very much focused on and
something that goes all the way through, not just our national security
teams, but our diplomatic teams and so on.

And there are still big struggles that they are having. They`re getting
responses from other countries to lend a hand in terms of money, in terms
of personnel. But they are still working on that part, Rachel.

MADDOW: NBC News senior White House correspondent, Chris, thanks for
joining us tonight. I really appreciate you joining us so late. Thank
you.

JANSING: My pleasure.

MADDOW: You know, it is fascinating the Pentagon`s role in this.
Obviously, the Pentagon is outsized in terms of resources in terms to all
other elements of the United States government. And it has been through
for a long time.

But one of the things they can do is intensive, logistical work overseas in
austere conditions. And so, no, the Pentagon is not being called up
because, as people say on talk radio, you can shoot the virus, it`s because
the Pentagon can go somewhere where there is nothing before they get there
and they can set up something that can be used in an ongoing way, either by
U.S. military personnel or by domestic personnel or in cases of, you know,
international aid efforts by groups like Doctors Without Borders or anybody
else. They can set it up in places where almost nobody else can.

And to see the mobilization ramp up on the military side has been
impressive just in terms of what they are trying to do there. But days
like this, there`s never more of a reminder that you can get about the
interlinking of health crises around the world and our seeming feelings of
impermeability here in one of the most industrialized nations.

All right. We`ve got more to come. Stay with us.

(COMMERCIAL BREAK)

MADDOW: In the late 1960s, a breakaway region called Biafra in Nigeria was
essentially walled off from the world by the Nigerian government as part of
civil war. What resulted was a health disaster for the people who were
stuck inside Biafra and walled off from the rest of the world.

What was born out of that was a group of doctors who decided that the
welfare of needy people, sick people who needed health care, was more
important than any political boundary for any reason.

That group of doctors call themselves Medecins Sans Frontieres/Doctors
Without Borders. They have since gone on to win the Nobel Peace Prize.
They have since gone on to become one of the most respected humanitarian
organizations on earth.

In this Ebola crisis, Doctors Without Borders have been on the vanguard in
the fight against the disease in Western Africa. They`ve been running
three shifts a day, 24 hours a day, for months and months and months,
operating six Ebola crisis management centers across Western Africa, staff
by hundreds of volunteer doctors and nurses who come to them from around
the globe.

In July, Doctors Without Borders announced that their efforts were taking a
toll on their volunteers. They announced their chief doctor had contracted
the virus himself while treating patients in Sierra Leone. Soon after
discovering he was sick, Dr. Sheik Umar Khan died from the disease in the
facility run by Doctors Without Borders.

The group has been raising a global alarm about this crisis starting long
before any governments were taking it seriously outside of the region.
They`ve been calling for a coordinated international response.

Earlier this week, they celebrated their 1000th Ebola survivor -- an 18-
year-old boy from Liberia who recovered fully from having been infected
with the disease.

But tonight, Doctors Without Borders is once again dealing with the news
that one of their own, another one of their own volunteer physicians, has
contracted Ebola. That patient is Dr. Craig Spencer. And he is now in
isolation at Bellevue Hospital in New York City.

Joining us now once again is Dr. Stephen Morse, professor of epidemiology
at the Mellman School of Public Health at Columbia University.

Dr. Morse, thanks for being here tonight. It`s nice to have you back.

DR. STEPHEN MORSE, COLUMBIA UNIVERSITY: Thank you. Glad to be with you.

MADDOW: In terms of what we heard tonight with New York City and state
political and also health officials, did they describe anything about the
way this was handled from the initial contact with this patient that either
comforted you in terms of the response or that worried you?

MORSE: Well, the response seemed to be the appropriate one. This isn`t
someone who came in through the airport, but a doctor who was trained and
obviously expecting to monitor himself for symptoms.

But I think everything was done exactly the way it should have been done,
from the information we have. And he was put into a special ambulance,
taken safely to the hospital and immediately put into isolation.

MADDOW: In terms of the way this is being treated and the way people are
being sort of reassured, as New York City, they have announced the
specifics subway lines on which he traveled, they have announced that he
went bowling in Williamsburg in Brooklyn last night. They`ve described him
traveling to the high line, to a restaurant somewhere in Chelsea or the
West Village, if it was near the high line.

All of those announcements obviously caused a little shiver, right, caused
a little flurry of worry among people who might have done those same
things.

Do you feel that New York City officials are assuring people adequately in
terms of the risk associated with any of his travel to any of those places
and why they are telling us he was there in the first place?

MORSE: Well, I guess they are trying in good New York City fashion to be
as candid and complete as possible.

The reality is, as I think all of your guests has said, the only way to
catch Ebola is by contact with bodily fluids or excreta, or a corpse,
unfortunately, of someone who has symptomatic Ebola, someone who has a
fever and other signs which usually include nausea, vomiting and often
bloody diarrhea.

Contact with those bodily fluids is the only way we know that is possible
to become infected. So, for the others, it`s just an interesting
travelogue at this point.

MADDOW: Exactly. And we are left to be both be calm about that
travelogue, while also fascinated about it, trying to be realistic about
any actual, actual risk posed of infection.

Dr. Morse, thank you very much for being with us tonight. I appreciate it.

MORSE: Thank you.

MADDOW: Dr. Stephen Morse, professor of epidemiology at Columbia
University.

In terms of what we know, the facility where Dr. Craig Spencer is being
treated tonight was designated ahead of time by New York state, to be one
of five facilities in New York City that was not just prepared like
everybody but extra prepared, essentially a designated center of excellence
for handling a case like this.

They knew it was going to be at Bellevue. There`s four other hospitals in
the city designed to handle it just as well. Three other facilities in New
York state, outside of New York City, that also got that same designation.
There`s been Intense training that they have been very vocal about here in
New York ahead of this happening with two of the five airports where people
are traveling from West Africa into this country, being in the New York
City region. I think they knew it might be here more likely than it would
be anywhere else. But it`s no longer practice, it`s underway.

Thanks very much for being with us tonight. We`ve got much more ahead on
the first person to be diagnosed with Ebola in New York City.

Stay with MSNBC throughout the night for the latest.




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