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Long IslandColumnists

Like a Well-Oiled Machine

A scary disease, two sick patients, and a New York

public-health system that sprang into action.

Dr. Ronald Primas, Manhattan internist: "These two patients were visitors

from New Mexico. They weren't feeling well. They called the front desk at the

hotel, asking for a doctor. They were referred to me. This was Tuesday. They

thought they had influenza. For three days, they'd been treating it with

Tylenol and Advil and not getting any better. Fever. Headaches. Body ache.

Joint pain. Both of them also had swollen lymph nodes in the groin. But no

runny nose. No cough. No sneezing. They said they could come to the office.

"When I examined them, I couldn't believe the gentleman actually made it

in. He had a fever of 105. I knew he had to be admitted. I was thinking

malaria. I asked if they'd been out of the country. They said no. So maybe it

was hantavirus or West Nile. I certainly wasn't thinking 'bubonic plague.'

"But then I saw the woman had the classic bubo on her leg. A very swollen,

tender lymph node with reddish, purple color on her upper thigh. At that point,

I asked about the possibility of plague. And she said, 'Oh yeah, by the way,

in the summer, the state did identify plague on our property with rodents.'"

Dr. Paul Ettestad, public-health veterinarian, state of New Mexico: "In

July, they had called up about a dead wood rat on their property. It tested

positive for plague - the rat, and fleas that were on the rat.

"This is a rural-suburban area about 10 miles out of Santa Fe. Three or

four acres for every house. Beautiful views of the Sandia Mountains. But it's a

part of the state where the conditions happen to be ideal for plague. So it

wasn't really a surprise. We just told them about the need to take certain

precautions."

Dr. David Perlman, infectious-disease specialist, Beth Israel Medical

Center: "It was late afternoon, Election Day, when I got the call. A couple

from New Mexico were on their way to the ER. Dr. Primas was saying it might be

plague.

"Plague? We never see plague. There is plague globally, in the

less-developed world. It's in the medical books. But it's been 100 years - more

- since we've had a case in New York. So I guess you'd say I was skeptical but

concerned. Was it real? Was it terror? And was it pneumocystic? That's the

critical initial question.

"Before they arrived, we wanted respiratory precautions in the emergency

room. Keep them isolated. I ordered quick chest X-rays, which came back fine.

So the isolation was just a precaution. I was trying to interview him and she

called out, 'I can give you a better story.' She said, 'We came to New York for

business on Nov. 1. We went out to dinner on Saturday night. On Sunday

morning, we were feeling sick. We both had swollen glands,' he on the right,

she on the left. She told me about the plague on their property. They made it

easy. She even had all the phone numbers in her Palm Pilot. The doctor in New

Mexico, the person they spoke to from the CDC, everyone. We got both of them on

antibiotics immediately."

Dr. Beth Raucher, chief epidemiologist, Beth Israel: "My role as the

hospital's director of infection control is to protect the patients and the

health-care workers from infection and to coordinate communication outside.

We're in the business of taking care of people, and that has to come first.

"I got in touch with senior administrators at the hospital. We didn't want

them to wake and hear it on the news. David had already notified the city

Health Department. I called the state Health Department. They contacted the

CDC. This really got done snap-snap-snap."

Dr. Paul Ettestad, New Mexico veterinarian: "People's idea of bubonic

plague comes out of the Middle Ages, wiping out a third of the population in

Europe.

"In the scheme of things, it's pretty rare. This is the only case we've had

this year. Last year, we had one. The year before, one. In 1998, we had nine

cases. In '99, it was six. The last fatality was 1994. "It's not something

you're gonna get just by coming out here. We don't have Lyme disease. We

haven't had anyone die of West Nile. When we hear about those things, some

people probably say to themselves, 'God, I don't want to go to New York. I'm

afraid I might get one of those things.' It's all where you come from, I guess."

Dr. Marci Layton, assistant commissioner for the Bureau of Communicable

Diseases, New York City Health Department: "From a public-health point of view,

everything went perfectly, from the patients on down. When the patients went

to see the physician, they raised the concern about plague. They were aware of

the fact they had plague on their property. The physician got them to the

hospital right away. The hospital got them isolated, which was a precaution

worth taking.

"As soon as the male patient's culture was ready, it got immediately to the

lab. And we had staff and technology to test it here, which took about an

hour. A few years ago, we would have had to send it out to the CDC in Colorado.

"And we had to communicate with the public. We put the information out. We

emphasized it was a naturally acquired infection from another part of the

country. There was no risk locally.

"There is one last piece that we are still worried about. The gentleman is

still doing poorly. All of us are very concerned for the family. The system

worked well, but we're not ready to say it was all a success."

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