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
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? 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
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
"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
"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."