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The Rachel Maddow Show, Transcript 10/23/14

Guests: 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

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