Now that we know this patient has Ebola, he will be intensely monitored for progression of the disease. Once symptomatic, patients with Ebola get worse quickly.
We can expect that he will have significant fluid loss from sweating with fever and gastrointestinal loss from vomiting and diarrhea. He will need to have his electrolytes like sodium and potassium replaced, and he may need blood products like plasma.
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Over time, his kidney and liver functions may become impaired and he may experience acute lung injury. The health care team will need to be prepared to place a central line, a larger type of IV that goes into a larger blood vessel in the neck. Over the next few days, his kidneys may not function well and he could need dialysis.
The health care workers at Bellevue Hospital will need to take meticulous care while providing care and performing procedures and especially during the time of “doffing,” removing their personal protective equipment (PPE).
The staff at Bellevue is well-prepared. They have been training for this event, as we have at all the major hospitals. It’s anxiety-provoking for hospital staff, of course. But the people taking care of him are highly trained and the most fit to be in that room with him. We don’t let residents in or nursing students. We have really skilled clinicians who are experienced at medical procedures that need to be done.
We have screened out people for training that have too much anxiety. Or any nurse or doctor who could be diabetic or asthmatic. You don’t want them in restrictive clothing in case they have an asthma attack or an episode of low blood sugar.
Ebola is like swimming in the ocean. If you have fear, you drown. If you are not a swimmer, if you are not prepared — you should not be in that room.
As for New Yorkers, they should not panic. While Ebola is highly infectious, it is not highly contagious. In addition, when you first get symptoms, the level of virus is very low. It is not until four to five days after your symptoms have started that the amount of virus in the blood is highest.
From what we know, Dr. Spencer was not symptomatic when he went to the bowling alley. Nevertheless, the Health Department will interview those whom he was with to inquire regarding the type of contact they had with him and if there was any exchange of body fluids.
It is important to reassure people who may have been on the subway or in a cab with Dr. Spencer that there is virtually no risk to those who had casual contact and certainly no risk for those who had no contact.
For example, none of the close contacts of Mr. Duncan who was the gentleman who succumbed from Ebola in Texas have contracted Ebola, not even his girlfriend who slept in the same bed next to him.
What we do know is that concentrations of Ebola in the blood is essentially negligible until one has symptoms. Unlike HIV and Hepatitis C where persons infected with these viruses can have high levels of virus in their blood without any symptoms, persons exposed to Ebola do not have virus in their blood that can be detectable until they have symptoms.
Therefore the risk to close contacts is low prior to him becoming ill. Over the course of a few days after symptoms, the amount of virus in the blood increases as the patient becomes more ill.
Dr. Judith Aberg is the chief of infectious diseases for The Mount Sinai Health System.
