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All In With Chris Hayes, Thursday, October 23rd, 2014

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Show: ALL IN with CHRIS HAYES
Date: October 23, 2014

<Guest: Kent Sepkowitz, Peter Hotez>

DR. MARY TAVIS BASSETT, NYC HEALTH COMMISSIONER: Once again, his first
symptom of fever occurred today and that was the beginning of his
assessment. We are aware that he has been in close contact with his
fiancee and with two friends. Both of -- all three of these contacts are
healthy and are being quarantined.

The governor mentioned an additional person. This person was a driver of
an Uber car with whom the patient had no direct physical contact and is
considered not to be at risk.

On -- today, he -- when he reported fever, he contacted the health
department. We contacted EMS and he was brought to Bellevue Hospital. The
test for Ebola was conducted on blood drawn here at Bellevue Hospital, and
conducted at our public health lab.

I think that I should turn over to Dr. Zucker to talk about the process of
his transfer.

We really are confident that all of the protocols that we`ve worked so hard
to put in place for communications with all levels of our public health
system, with our emergency medical system, with our public health system,
have worked as well as we expected them to work, and we`re glad that the
patient is safely here at Bellevue Hospital.

Over to you, Dr. Zucker.

DR. HOWARD ZUCKER, NY STATE HEALTH COMMISSIONER: Thank you. Thank you,
Dr. Bassett and thank you, Governor Cuomo and Mayor de Blasio.

Firstly, our wishes and prayers go out to this doctor, his family and
friends for a speedy recovery. As you`ve heard the timeline of what we
have heard about this patient, I think it`s important to mention that as
Bellevue has been preparing for this and we as a state and a city have been
preparing for this for awhile. All of the processes involved in making
sure that he is monitored, taken care of at the hospital, I`ll mention in a
minute, but most importantly getting him into the hospital.

The EMS system brought him in with the proper protective gear. He was
immediately brought to the isolation area that Bellevue Hospital has
established for patients who could have Ebola. He has been taken care of
by an excellent team and all of his medical problems are being addressed.
As you know Ebola patients can have a lot of different problems and these
are all being watched for closely.

I think it`s also important to just reiterate that you can only get Ebola
by being exposed to bodily fluids and that`s a very important point to
make.

He has been in the hospital as we know. His symptoms began -- he had a
fever. That symptom began this morning and some of the other symptoms, as
well this morning.

I think that it`s important to just reiterate that the management of all
the issues that come forth with Ebola have come together nicely with this
patient and we look forward to a quick recovery for him.

Thank you.

GOV. MARIO CUOMO (D), NEW YORK: Once again, we`d like to thank our federal
partners who have really been extraordinary. The new Ebola czar who just
started the job, Ron Klain, Sylvia Burwell, who is the head of health and
human services, and the head of the CDC, Dr. Tom Frieden who is with us
tonight by telephone and will turn it over to Dr. Frieden now.

Doctor, can you hear us?

DR. TOM FRIEDEN, CDC DIRECTOR (via telephone): Yes, I can. Can you hear
me?

CUOMO: Yes, very well.

FRIEDEN: OK, well, thank you very much, Governor. Thank you to the Mayor.

And first and foremost our thoughts and focus are with the doctor and
patient in New York City. When it comes to his care, the federal
government has and will continue to provide whatever assistance is required
to make sure he is treated safely and effectively.

I think as has been said, it`s very important that people understand how
Ebola spreads and what risk is. When someone gets Ebola, they become --
they`re not infectious initially but they become increasingly infectious
the sicker they get.

So, right now, the concern is with the health care workers caring for him
at Bellevue. Fortunately, Bellevue has been preparing for this and
drilling this. CDC has been in close communication with hospital
authorities. In fact, by coincidence or because of good preparations, we
already had a team on the ground and spent several days reviewing all of
Bellevue`s preparations even before this patient became ill, therefore,
reviewed the preparations and observed the hospital working.

We will -- we are also sending an additional CDC Ebola response team, which
is in transit now with individuals who have extensive experience treating
Ebola, so that we could work in partnership with Bellevue to ensure that
the patient gets as safe and effective care as possible. We`re also
encouraged by the transport process that was used that would eliminate or
minimize any risk of transmission during that process.

As has been said, there are several individuals who had contact with the
patient before he developed a fever and before he was isolated and those
individuals will be monitored for 21 days. I remind people that for the
case of Mr. Duncan, Dallas, even his household contacts were with him for
several days after he became ill, did not develop Ebola.

Ebola is a scary disease and it`s fearsome because of how severe the
illness is but it does not spread easily, does not spread like the flu or
the common cold or measles. It only spreads by direct contact of body
fluids of someone who is ill.

I will say that as a former commissioner of the city health department, it
is a fantastic health department and at CDC we`re delighted to work in
partnership and will do everything to ensure that coordination of the
federal, local and state levels is seamless and provides for all of the
needs so that the care of the patient, the isolation and contact-tracing
will all be done in a way that minimizes risk.

And I would encourage anyone who wants more information to check our
Website at CDC.gov and we look forward to continuing to work closely with
New York City.

MAYOR BILL DE BLASIO (D), NEW YORK CITY: Thank you. Thank you very much,
Dr. Frieden.

And Dr. Frieden will stay with us during the question and answer period and
with that we`d like to turn to questions from the media.

Yes?

CUOMO: Can you speak a little louder?

(INAUDIBLE)

BASSETT: Yes, I`ll give you as much information as I have. As I said at
the outset, this is an evolving situation in which we are still
interviewing people, including talking to the patient and I`ll echo what
everyone else has said, that we are all -- our main focus, of course, on
the recovery of that patient.

The bowling alley was in the Williamsburg section of Brooklyn. It`s called
the Gutter Bowling Alley. The patient went there with friends and he did
bowl while he was there according to our understanding of events.

The patient was not feeling, you know, although he reported fatigue, he was
not symptomatic. He had no fever and as Dr. Frieden has explained, we are
very clear that people become contagious as they become sick.

So, his first fever, in fact, was today earlier this -- in the late morning
today. And he did have a fever for -- or did not have a fever for the
whole time since he left Guinea until this morning.

And my understanding is that out of an abundance of caution, that the
bowling alley has closed and we, of course, will be sending health
department staff on site tomorrow to look at the bowling alley.

So, that`s -- you know, I can only reiterate what we`ve been saying for
weeks that the way people contract Ebola is by being in touch with a person
who is sick with Ebola and being in touch with their body fluids. And, of
course, the doctor was a doctor who was working in an Ebola treatment
center in Guinea. And that was how he became infected.

At the time that he was at the bowling alley, he had had no fever.

(INAUDIBLE)

BASSETT: Suddenly, I`m being truly miked.

The -- we obviously want to protect people`s privacy. But the -- these are
individuals who will be permitted to opt to -- for a home quarantine.

The patient, of course, is in the hospital, one of the patients is in the
hospital today. One of the other patients -- one of the other contacts, so
the three contacts, one of whom is in the hospital today. Yes.

REPORTER: Can you tell me (INAUDIBLE)

BASSETT: So, you`re asking about the health workers here at this hospital.
The health workers, of course, are using full protective gear. They were
ready because we knew that this patient was being transported. He had a
very orderly removal from his home and with emergency workers who were in
full protective gear. He came here and had a very smooth transfer up to
the isolation ward, where he`s been looked after by experienced, seasoned
health workers who all have been training for this purpose over the last
months, training, drilling and so on.

These workers are working on this unit exclusively and as far as having
anybody who has opted out of that I would to Dr. Raju.

DR. RAM RAJU, NYC HEALTH AND HOSPITALS CORPORATION PRESIDENT: No one opted
out. So --

(INAUDIBLE)

BASSETT: No, that`s what`s so important about the work that Bellevue has
done to prepare for this day, something that they began months ago in
August. There is a long-standing isolation unit here, one that dates back
to the 1990s and the days of the AIDS epidemic when multi-resistant TB was
a real scourge in this city.

This unit is -- has been converted for the care of patients with Ebola.
There`s a small dedicated laboratory on this unit, so that it is really a
self-contained space.

So, I really want to applaud the preparations of Bellevue Hospital. They
worked really hard to put in place all of the systems that were needed, so
that means not only having all of the stuff, they also have all the stuff
and they have all the systems, the processes in place and everything today
worked as we hoped it would.

CUOMO: If I could add --

UNIDENTIFIED MALE: Just one second.

CUOMO: I think one of the advantages is the health care workers feel
prepared and they feel equipped. The upside of all the rigger and all the
drills and all the meetings is they know they were prepared just for this
moment. And we learned from Dallas that way.

And as I said, yesterday, the mayor and I were with a session that must
have been 5,000 health care workers. We have an abundance of equipment,
abundance of training and experienced professionals and I think that`s
brought their confidence in the entire system up.

DE BLASIO: And further, I just want to clarify, these folks at EMS, for
example, not only have been training for weeks and weeks but are first
responders. Their job is to protect other people, they take it very
seriously, it`s a matter of honor they take on a difficult role.

Equally, Bellevue is legendary of having taken on a host of challenges over
the years, the professionals here at Bellevue are the finest. They are the
most battle-tested.

So, anyone who is working as part of the team helping this patient knows
exactly why they`re doing it and what they`re doing as part of their sense
of mission. Yes?

(INAUDIBLE)

BASSETT: Well, the patient today developed a fever and had some
gastrointestinal symptoms, as well. So these are the symptoms that let us
know that this patient was -- had a clinical picture that was really fully
consistent with Ebola.

REPORTER: Is fatigue a symptom?

BASSETT: Fatigue can be a symptom of many things. The thing to make clear
the first time this patient had fever was today and it`s -- and fever is
the typical sign of a person developing contagious Ebola.

DE BLASIO: And over here for one more then we`ll come to this side. Yes.

(INAUDIBLE)

BASSETT: What I can say, his friend said that he -- that they felt he
seemed well. But the -- and the patient as I`ve said did not report any
fever. And although he did report that he felt tired.

DE BLASIO: Yes?

(INAUDIBLE)

BASSETT: Well, he did -- attempt to self-isolate and we`re still getting
clear the amount of time that he spent outside 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. He`s a medical doctor, as we`ve all said, so he was very
alert to the -- to signs and symptoms of Ebola coming from a place where
Ebola is truly ravaging the population.

(INAUDIBLE)

BASSETT: The waste?

We have contracts in place for the removal of medical waste.

The patient really only displayed symptoms today and I see no reason for
the tenants in the apartment building to be concerned. We have --

(INAUDIBLE)

BASSETT: The apartment is isolated. We`ve insured that nobody will enter.
The super will not let anybody in. There`s no housekeeper expected to
arrive. The apartment is locked and not accessible.

CUOMO: Dr. Zucker, had a point?

ZUCKER: I was going to make the other point he left his key in his
apartment and locked the door as a very meticulous individual and
recognized if the key was floating around, somebody may pick it up and
(INAUDIBLE)

DE BLASIO: Dr. Bassett, just want to add?

BASSETT: I just wanted to add also then to point out that the state health
department, Dr. Zucker, announced just last week that eight hospitals in
this state would be designated as settings where Ebola patients could be
cared for. We are the first state to identify a limited number of
hospitals of which this hospital is one. Bellevue Hospital is one of the
five hospitals in New York City, and as you`ve all been hearing, they`ve
been working, they were ready today. They showed how ready they were to
accept a patient to --

(CROSSTALK)

CUOMO: Just to clarify, all -- there are about 200 hospitals in the state.
They have all prepared if someone walks into the hospital and presents
themselves and suggests that they might have illness. But to get all 200
hospitals ready for intensive treatment, obviously, would have been very
difficult. So, the decision was made to take eight hospital, one of them
is Bellevue, and really focus and concentrate intensive efforts, and that
turns out that was a wise and prudent course of conduct.

ZUCKER: May I add also, we -- the Department of Health was ordered to look
at these hospitals and all the hospitals across the state and Bellevue was
one of the hospitals we already came in and looked at to be sure they were
prepared for a patient like the patient you`ve seen today. So, we`re
already one step ahead.

DE BLASIO: John?

(INAUDIBLE)

(CROSSTALK)

ZUCKER: Sorry. This would be based on the clinical team taking care of
him right now. So we`ll see how his progress goes. They are prepared to
take care of him like any other Ebola patient.

(INAUDIBLE)

BASSETT: Well, we know he left his apartment and so that he -- self-
quarantine would have meant he never left his apartment, but he did self-
isolate in the sense that he`s --

(INAUDIBLE)

BASSETT: He limited his contact with people and saw friends. He did leave
his apartment, so I don`t want to give the impression that he was in his
apartment the entire time and --

(INAUDIBLE)

BASSETT: He was -- during the time that he was leaving the apartment, he
had had no fever. He was monitoring his temperature on -- twice a day as
has been recommended and he had no fever. I don`t want to give the
impression that he was self-quarantining or -- because he was leaving his
apartment.

DE BLASIO: Let`s be clear the second he had that fever he did report
immediately and cooperated fully in getting in here in the right way but
also communicating his previous movements and very, very informative to
help, and we called in the medical detectives to trace the other --

ZUCKER: May I add that also that your contagiousness is related to how sick
so he came in very early in his illness and so --

CUOMO: That is a very important point in this case that he was a doctor,
he was familiar with the illness. He was taking his temperature twice a
day.

Yes, he had fatigue. He also went for a three-mile jog, right? So, he
couldn`t have been that fatigued, and when he started to sense that he had
a fever he came in right away. And that`s when you`re contagious is when
you`re really extremely ill and he presented himself this morning.

(INAUDIBLE)

DE BLASIO: Let us have Dr. Bassett and Dr. Zucker -- I want to preface,
this is a very difficult disease to contact. It is not an airborne disease
but takes rather intimate with someone to contracting the disease. So, let
them take it from there.

BASSETT: That is right.

Two parts of your question, what do we know about his whereabouts? So, we
know that he went to a place called the Gutter, a bowling alley in
Williamsburg in Brooklyn, that to get there he took the A-train and L-
train. That was yesterday.

We also know that sometime that day, he also went to the high line, may
have stopped and gone to a restaurant along the way. So, we`re just --
we`re going to be getting more information about this. We -- he`s fully
cooperating with us. We have his metro card and we are going to have the
chance to talk with him.

Remember, he is a hospitalized patient in intensive care about all of the
lineup to -- everything from his metro card travel and where he was.

Let me turn to your question about the subway. Once again, we all have
been saying to all of you for weeks now that people with Ebola are
contagious when they`re sick and what`s contagious about them, their body
fluids. At the time the doctor was on the subway, he had not had fever.
He had no problem with his body fluids in the sense that he had no
diarrhea, no vomiting, no blood loss -- all of these symptoms that occur
when people become much sicker.

He was not symptomatic in -- at that time. He had no fever. And so, he
did not have a stage of disease that creates a rick of contagiousness on
the subway. We consider that it is extremely unlikely, the probability
being close to nil, that there would any problem related to his taking the
subway system.

UNIDENTIFIED MALE: Dr. Zucker.

ZUCKER: I just want to echo the words of Dr. Frieden. Remember, the
patient in Dallas had -- was many people were exposed to him and in the end
only very, very few people got sick. And so, that`s an important point.

And regarding the subway, I would get on the subway tomorrow and ride the
subway.

REPORTER: Follow up on this (IANUDIBLE)

BASSETT: This is the only place he`s --

ZUCKER: When he had the fever he contacted his employer, MSF, and then
that set the chain into the correct motion.

DE BLASIO: Yes, we`ll take a few more.

REPORTER: The doctor in quarantine as opposed to (INAUDIBLE)

BASSETT: I think let`s not talk about that right now.

DE BLASIO: Again, I`m respectfully -- I want to say we`re talking about
the immediate situation. We`re talking about a patient who is a medical
doctor who handled the communication with the city health department
properly. He`s here in the right facility. Let`s stay where we are in
that.

CUOMO: That`s bad karma.

(INAUDIBLE)

BASSETT: Yes.

All of the contacts the three, two friends and his fiancee are well and
they are all going -- are all in the process of being quarantined.

ZUCKER: And they would not be tested.

DE BLASIO: Last question.

BASSETT: They would not be tested. There`s -- they are not symptomatic.
There would be no reason to test them.

ZUCKER: Symptoms.

BASSETT: Unless they develop symptoms.

(INAUDIBLE)

BASSETT: Yes.

(INAUDIBLE)

BASSETT: No.

(INAUDIBLE)

BASSETT: He was and he was wearing full protective gear and was aware of
no breach.

I`m sorry I didn`t hear you.

ZUCKER: He`s been home since his return.

DE BLASIO: All right. We`re going to conclude it and thank all of my
colleagues and especially thank the staff here at Bellevue. They`re doing
extraordinary work at this moment. We will, of course, have additional
updates as information is available.

Thank you, everyone.

BASSETT: Thank you.

HAYES: All right, as you can see. We`ve just been listening to a press
conference from Bellevue Hospital where New York City and state officials
are giving the latest news on the first diagnosed case of Ebola in New York
City.

Dr. Craig Spencer, a 33-year-old physician with Doctors without Borders,
who recently returned from Guinea after treating Ebola patients, is now in
a special isolation unit specifically designed and prepared at Bellevue
Hospital in New York for this incident. Dr. Spencer was escorted in a
specially appointed ambulance, with a police escort to Bellevue, from his
home in Harlem this afternoon, after calling 911 following symptoms,
including a 103-degree fever and nausea.

In fact, I should correct that. He actually called his organization MSF,
they called the Department of Health and the Department of Health then
called 911.

Dr. Spencer was tested, and that test came back positive this evening. The
CDC is expected to conduct its own test as well.

Administration official tells NBC News that several members of the CDC`s
rapid response team will arrive in New York City tonight and others will be
there in the morning. Dr. Spencer is one of four specially equipped
isolation rooms in Bellevue Hospital which has nine other rooms that could
be quickly converted to treat additional patient if necessary. There is no
expectation at this moment that that will become necessary.

However, we strongly emphasize at this point no one else has been diagnosed
with Ebola in New York City. Dr. Spencer`s fiancee is in quarantine,
presently not symptomatic. Dr. Spencer did take a subway from Manhattan,
to a bowling alley in Brooklyn Wednesday night, and took an Uber home. He
said he was not exhibiting a fever at that time although he did feel tired.

Further, according to "The Times", health care workers have dispersed
across the city to determine who else might have come in contact with Dr.
Spencer in recent days.

You`ll recall that Thomas Eric Duncan, before finally receiving treatment
in the Dallas hospital where he died, did not infect any family members,
this despite the fact he was symptomatic and in relatively confined space
with theme for several days.

It should also be noted, New York City has been preparing for this
eventually in the words of Mayor De Blasio and Governor Cuomo, day and
night, for more than two months and enacting CDC protocols, training
nurses, even testing the reaction of 11 city hospitals by sending people to
those hospitals who pretended to have symptoms and travel histories
consistent with a possible Ebola diagnosis.

Joining me right now from outside Bellevue hospital in New York City is NBC
News correspondent Katy Tur.

Katy, what`s the latest?

KATY TUR, NBC NEWS: Now, you make a good point about Thomas Eric Duncan,
the fact that he did not infect any of his family members, even though he
was symptomatic in the apartment. New York City officials want to make
sure that people do not start to panic over this. There are 8 million
people in this city, he did take the subway, he took a cab, they don`t want
to incite mass fear in the city, because people will think that they can
get Ebola by getting on the subway. So, they`re being very measured in
their response and they`re giving a great amount of detail.

He did take the one train, the A-train and the L-train last night to a
bowling alley in Brooklyn and a cab back. They say it is extremely
unlikely that anything could have possibly happened on that train. That
anyone else could have been exposed.

They said although he was feeling unwell in the past few days, fatigue,
that he didn`t start to show signs of a fever until today between 10:00 and
11:00 in the morning. He`s been checking his temperature twice a day and
that`s when he immediately called health officials and they immediately
brought him here to Bellevue.

Four other people he had been in close contact with are of concern for
health officials, right now. They`ve all been located and contacted and
they`re all in quarantine. That includes his fiancee. They want to be
measured in their response and they also want to make sure that this man is
not vilified. He`s not treated as if he has done something wrong.

They were very careful to say that he was not symptomatic before this
morning. That he was feeling tired in the days prior, but that could have
been anything. He even went on a three-mile run. They`re very careful to
say that he did not expose the public. That he`s an upstanding doctor.

He was there with Doctors Without Borders treating Ebola patients great
risk to himself and that when he did come home, he had been self-
quarantining up until yesterday when he went to this bowling alley.

That being said, if you`re going to contract Ebola from what we`re hearing
from experts say it`s highly likely between days eight and ten. He`s on
day nine yesterday when he went outside. Day ten, today, the day that he
started to feel feverish and called health officials, that is definitely
some cause for concern -- Chris.

CHRIS HAYES, MSNBC HOST: Katie, thank you so much. Joining me now, I have
Dr. Kent Sepkowitz, who is here. He is a contributor for "The Daily
Beast." He is an infectious disease specialist, deputy physician-in-chief
at Memorial Sloan Kettering.

All right, let`s do a little Q&A. Here`s what we know. Dr. Spencer goes
to Guinea. He treats patients there. He comes back through JFK ten days
ago. At JFK, he is subjected to the enhanced travel screening, which
consists of what, as far as we know.

DR. KENT SEPKOWITZ, DEPUTY PHYSICIAN-IN-CHIEF, MEMORIAL SLOAN KETTERING:
At that time, it was before the most recent --

HAYES: OK. Travel screening regime.

SEPKOWITZ: Old school, which was presumably a series of questions about
travel and that`s that, but no deliberate plan to follow him up.

HAYES: So the new one would have also created a chain in which there`s a
follow-up procedure that have been in place. Is that the difference
between the old one and the new one?

SEPKOWITZ: Yes. But he did it himself because he certainly lived in fear
of catching Ebola all that time he was over there in Guinea. He very
dutifully took his temperature out of self-interest as well as public
health interest.

HAYES: So he comes through JFK. He goes to his apartment from what we
heard from New York City commissioner of public health, it appears that he
was not self-quarantining, but he was in her words self-isolating. What
does that mean?

SEPKOWITZ: That`s a tough one -- I need to define what she meant. I think
she meant that he wasn`t going out partying every night. I think that he
was measured in the way he went about his business. He kept I think
friends around him and that`s it.

I think only people that have cause for worry and there are a few here, 8
million New Yorkers need not worry at all, zero, totally zero. I think his
girlfriend and vaguely defined couple of other friends have something to be
nervous about for the next couple of weeks.

I also want to emphasize that not only is he courageous and should be
thought of so, but the nurses and doctors and everyone else at Bellevue,
the people cleaning the room, the people bringing the food, they have a
real concern ahead of them. But that`s the extent of people in New York
City who need to be worried.

HAYES: The fiancee who is being quarantined. By the way, I misspoke
before the car he took was a taxi. It was an Uber driver who was the
fourth contact apparently.

SEPKOWITZ: Yes. That person would not have risk. Again, we`ve learned a
whole lot from Dallas, but we knew a whole lot before Dallas and we knew
from 20 years ago from studies that were really, really, really well done
from outbreaks in Africa about household contacts that there is a 16
percent transmission rate in household contacts.

HAYES: If you`re living -- that`s a really important statistic. I never
heard it put in those words. You`re living in a household in a country
undergoing an outbreak. In a household with someone who is symptomatic and
one of six.

SEPKOWITZ: Yes, 16 percent and in that same study, zero out of 40 people
who lived in the house, but never touched the ill person developed
infection. So unless the Uber driver or the cab driver was unusually
physical about his passenger that would be Uber, then there`s zero risk.
We know that from science, not from public health PR.

HAYES: That`s a good point. I want you to stick around. There`s a lot
more questions. People in New York City should not really change anything
about the way they`re going about their lives. The chance of contracting
Ebola is essentially vanishingly minuscule.

Dr. Spencer did visit places in New York yesterday before coming down with
a fever. Today, we`ll details on just where he went, who officials
consider a risk, and what you should know ahead. Stick around.

(COMMERCIAL BREAK)

HAYES: All right, we are following breaking news at this hour, the first
Ebola case diagnosed in New York City. Governor Andrew Cuomo and Mayor
Bill Deblasio just wrapped up a press conference with health officials.
They sought to reassure New Yorkers that they are not at risk.

(BEGIN VIDEO CLIP)

MAYOR BILL DEBLASIO (D), NEW YORK: Ebola is an extremely hard disease to
contract. It`s 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.

(END VIDEO CLIP)

HAYES: Patient, Dr. Craig Spencer, returned on October 14th from Guinea
where he had been working with Doctors Without Borders on an Ebola
treatment center. According to the "New York Times," Spencer was
monitoring himself for signs of infection after his return in the hospital
where he works in the emergency room, New York Presbyterian.

He has not been on duty, that`s a key fact here, since he got back from
Guinea. New York City officials told NBC News that Dr. Spencer exhibited
signs of not feeling well for a couple of days prior to his admission to
Bellevue earlier today although he did not exhibit a fever according to
health officials until this morning.

He had been checking his fever twice a day and when he saw the fever this
morning, that is when he contacted his employer, Doctors Without Borders,
who in turned contacted the health department who called 911.

And as we saw in Dallas where people had extensive contact with Thomas Eric
Duncan early in his illness did not become infected, the virus is not
especially contagious early on.

Now as emerge, Dr. Craig Spencer was out in public last night traveling
from on the subway from Manhattan to a bowling alley in Williamsburg,
Brooklyn, then taking a taxi back to his home in Harlem. But it wasn`t
until today that he exhibited a fever of 103.

Joining me now is Dr. Peter Hotez, director of Texas Children`s Center for
Vaccine Development and still with me, Dr. Kent Sepkowitz, infectious
disease specialist, deputy physician-in-chief at Memorial Sloan Kettering
Cancer Center, contributor of the "Daily Beast."

Let`s talk about the travels of Dr. Spencer because I think, you know,
there are some who are going to have some concerns even though I don`t
think there is a medical reason for them to have those.

DR. PETER HOTEZ, DIRECTOR, TEXAS CHILDREN`S CENTER: It is a bit moot isn`t
it? Because when you`re first symptomatic with Ebola virus infection,
there`s very little virus in your system and so there`s very little virus
to transmit from person to person.

Remember it`s only as you`re progressing, when you`re very sick in a
hospital bed or in an intensive care unit where the virus inactivates your
host defense mechanisms. It`s only in the advanced stages of your illness
that you have lots and lots of virus.

HAYES: The more virus you have obviously the more easily transmittable it
is.

HOTEZ: Well, look, I mean, who is getting sick in Liberia? It`s not
people walking around in the streets. It`s either the hospital workers or
it is people taking care of sick loved ones at home or handling the
secretions in the advanced stages of the illness.

Keep saying to yourself, advanced stages or the illness or burying the
newly dead because it takes time for petrification to happen --

HAYES: In fact as we know in the case of Thomas Duncan, he had -- it`s
probable he contracted the virus from a pregnant woman who he had taken to
a hospital, was turned, who he carried into a house who died four hours
later, I believe. So it was very -- terminal stage essentially of her
illness. So who`s at risk?

HOTEZ: Let`s talk about who`s at risk. It`s the hospital workers in
Bellevue. They are the ones at risk. There`s a fundamental question we
need to ask tonight is, is Bellevue ready to handle a patient with advanced
Ebola virus infection.

Look what happened to Texas Health Presbyterian. That`s a good hospital.
That is not some slackly community hospital that is a first grade hospital
and yet look what happened, and so the point is unless --

HAYES: So Gutter, which is the Williamsburg bowling establishment, whose
owners are probably --

HOTEZ: I would bowl there tomorrow.

HAYES: Yes. Right.

HOTEZ: If I bowl.

HAYES: You would bowl there tomorrow and take the train, the one train.
All of these things are -- yes. What I`m hearing from you is you`re not
going to do this, but you would sit on the sofa of this guy in his
apartment.

HOTEZ: Remember, advanced stage of the illness, that`s what`s going to
transmit the infection.

SEPKOWITZ: I certainly would. Yes. Sitting on the sofa is not an issue.
Taking care of him, drawing blood on him, dealing with him as a patient
who`s quite sick, and I don`t know that he is or isn`t sick, but if he
starts to hemorrhage and this is a hemorrhagic fever. So the blood that is
chalk full of virus starts to ooze everywhere, that`s a messy situation.

HAYES: And so you raise a point here about, you know, we saw an index case
in Dallas, it was a first case that manifested in the U.S. We saw two
contractions. Both the nurses who were attending --

SEPKOWITZ: Not from the emergency room.

HAYES: No, not from emergency room.

SEPKOWITZ: But after he was even sicker than he was.

HAYES: That`s an important point, right, no one in the family who was in
the house with him. What can we expect here as this goes forward? It
seems to me there are two things to think about.

One is that as public health officials have been warning as long as the
outbreak and a genuine epidemic in West Africa continue to rage, there will
be additional cases that manifest. And two is health workers like those in
Bellevue.

HOTEZ: The next question is what are we doing now for this patient at
Bellevue Hospital? Remember the survivors that we`ve seen. We`ve had a 90
percent survival rate of the Ebola virus infection in the United States
now.

And one of the common features of who survived and who didn`t is who got an
early intervention. Will this patient have access to the two anti-viral
drugs that are available? Will he have access to immune globulin?

You don`t care about the red blood cells, you care about the antibodies.
Why aren`t we preparing serum? All these things are probably under
discussion right now.

HAYES: Bellevue Hospital, it`s the oldest public hospital in America.
It`s been treating people regardless of cost since the 18th Century. It
has seen everything.

SEPKOWITZ: Treated the last smallpox case in 1947 in the United States.

HAYES: That`s exactly right and it is the biggest public hospital where
people from all walks of -- well, I should say people without means,
without access to any other health care can find care at Bellevue. Because
of that, these are people that, as doctors, experience a tremendous variety
of illnesses that they have to treat.

HOTEZ: It`s a first grade hospital.

HAYES: But as you say, they`re specialized procedures here that Emory and
National Institutes of Health and the center in Nebraska all have that we
have not we don`t know if they exist here.

SEPKOWITZ: I think the horrible sequence of events in Texas has been
turned to good in so far as everybody is now really, really serious to
learning how to don and doff their outfit. I think the level of
preparation now just compared to even three weeks ago is night and day.
They`ve been digging in for 2-1/2 months almost three months now.

HAYES: There`s good news to report tonight about Ebola. There`s bad news
to report coming out of the West Africa. We`re seeing the potency of it
right now.

HOTEZ: The numbers are going up. They are continuing to climb.

HAYES: So I want to talk about all of that if you gentlemen will stick
around. Stay with us.

(COMMERCIAL BREAK)

HAYES: We are covering the developing story of the first confirmed Ebola
case in the city of New York. We will continue our coverage with a former
surgeon general of the United States after this quick break. Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

GOVERNOR ANDREW CUOMO (D), NEW YORK: I know it`s a frightening situation.
When you watch it on the news and it was Dallas, it was frightening. Here
in New York, it`s more frightening. New York is a dense place. A lot of
people are on top of each other. But the market facts you know, the less
frightening the situation is.

(END VIDEO CLIP)

HAYES: That was New York Governor Andre Cuomo urging calm earlier this
hour in response to the first confirmed case of Ebola in New York City.
And tonight`s new case comes from a very mixed week of Ebola news.

Earlier today, we received confirmation a virus has spread in West Africa.
That`s bad news. Government of Mali confirmed the first case of Ebola in
that country. The patient is a young girl whose mother died in Guinea
several weeks ago and was brought by her family in the country according to
a health ministry official.

On a more positive note here in the U.S., Amber Vinson, the Texas Health
Presbyterian Hospital nurse who contracted Ebola earlier this month is now
officially Ebola free after a blood test yesterday. No word on when she
will be leaving Emory University Hospital.

Nina Pham, her colleague is reportedly in good condition at an NIH facility
in Maryland. And Ashoka Mukpo, the NBC cameraman who contracted Ebola in
Liberia is also officially Ebola free as of this week and out of the
hospital.

Tonight after news broke of the Ebola case in New York City, he tweeted,
quote, "People get Ebola from being around very, very sick people. Not
people who felt a little funny and then became symptomatic later that
night."

He of course would know. In an interview with NBC`s Kate Snow this week,
Mukpo said he will be more cautious in the future.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Do you know how you contracted Ebola?

ASHOKA MUKPO, NBC FREELANCE CAMERAMAN: That`s a million dollar question?

UNIDENTIFIED FEMALE: Will it change what you do?

MUKPO: I don`t think I`ll change what I do, but next time if I`m in a
situation where my life is at stake, I`m going to be much, much more
hesitant to put myself in a position that is likely that I could get hurt.

(END VIDEO CLIP)

HAYES: Joining me now by phone is a former surgeon general of the United
States, Richard Carmona. Dr. Carmona, can you put into the context the
significance of this Ebola outbreak because I think people are hearing two
different things.

We`re hearing don`t panic. We know how to control this. Don`t worry about
where you go and they are also hearing the WHO says crisis levels. This is
unprecedented. We`ve never seen anything like this. I think people are
having a little hard time keeping those two parallel. Dr. Carmona, are you
there?

DR. RICHARD CARMONA, FORMER U.S. SURGEON GENERAL (via telephone): There
you are. OK.

HAYES: So put into context the significance and severity of this outbreak
both globally and then here in the U.S.?

CARMONA: It`s definitely significant. It`s a challenge. However, you
know, we know how to control it. But it`s an imperfect system. Let`s face
it. People can get on planes. We will see cases slipping through and we
have to be transparent and educate the American public that there are good
safeguards in place.

Multilayers of public health protection and they provide pretty good
coverage, but it also relies on people being honest and telling us their
whereabouts. If they were in an endemic area or if they were near people
with Ebola and they comply with the health directions. That`s tough.

When people flee the country because they`re scared, they may be unwilling
to share those thoughts with somebody who might detain them and prevent
them from leaving the country so these are all very though things.

But I do have every confidence in the multi-layered system we have in
place, but because of a number of reasons, some of which I mentioned it`s
not a perfect system. Patients can still slip through.

HAYES: It`s seems to be important that there will be an anticipation on
the part of the public that there probably will be more cases in the future
and in fact that was the operating assumption under which the New York City
public health system had been operating for two months. That paid
dividends this evening.

CARMONA: Yes. That`s absolutely true. There`s a lot of information that
went out where possibly imagine was understated. The comments were
overreaching. We have everything under control. We have a great multi-
health system. People can inadvertently circumvent the system and that`s
why everybody has to be on alert so we capture those who fall through the
tracks.

HAYES: Dr. Richard Carmona, former surgeon general of the United States,
thank you very much. We`ll be right back with much, much more.

(COMMERCIAL BREAK)

HAYES: We`re back with continuing coverage of the first case of Ebola in
New York City. Still with me Dr. Peter Hotez, the director of Texas
Children Center for Vaccine Development and Dr. Kent Sepkowitz, a
infectious specialist, deputy physician-in-chief at Memorial Sloan
Kettering Cancer Center, "Daily Beast" contributor.

All right, Dr. Hotez, thoughts about West Africa, the state of the outbreak
there? How close we are to stamping it out?

HOTEZ: So things are still very scary. The good news is we`ve sent 3,000
troops into Liberia. The U.K. sent troops into Sierra Leone. Now we can
put together some kind of health care infrastructure in place so we have
the beds, the trained personnel the World Health Organization has now put
some numbers attached to it.

They are saying 70 percent of the patients have to get into treatment
facilities and 70 percent of the burials have to practice safely that what
it`s going to take to turn it around. We have to rely on accelerated
development of three new vaccines coming on line.

HAYES: We`re seeing quite a learning curve here in the U.S. it appears.

SEPKOWITZ: I think New York was a very compassionate, civil and very
accomplished city. The way we did this was textbook perspective informed
by the troubles in Dallas, but also informed by lots and lots of practice.
New York City really looked great through this, I think.

HAYES: I think everyone -- their thoughts are with Dr. Spencer. Also
Doctors Without Borders does incredible work in the most difficult places,
doctorswithoutborders.org. They`re an organization deserving your
attention. Dr. Peter Hotez and Dr. Kent Sepkowitz, thank you very much.

That does it for us tonight. Stay with MSNBC and msnbc.com for much more
on this breaking news story. Good night.

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

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