Transcript: Mayor De Blasio Attends Briefing with Governor Cuomo on Ebola

October 26, 2014

Governor Andrew Cuomo: Good evening. Thank you all for being here today. It’s my pleasure to be with the mayor once again. Dr. Howard Zucker is the State Health Commissioner. Dr. Mary Bassett is the New York City Health Commissioner. We have Patrick Foye in the front row from the Port Authority of New York and New Jersey; Dr. Shorris, First Deputy Mayor; Larry Schwartz, Secretary to the Governor. I'll make an opening statement. I'll then turn it over to the mayor. The commissioners will have some points and then we'll take whatever questions you may have. The care of Dr. Spencer at Bellevue has been proceeding exceptionally well. I want to take this opportunity to applaud the entire team at Bellevue and the New York City personnel for doing a great job.

The Ebola situation first reared its ugly head in Dallas. That was just about a month ago, believe it or not. So we had plenty of time to prepare and drill, which we did, and we coordinated. But still, game time is where it counts and we had prepared for many, many weeks, but it was still a question mark what would happen when game time arose, and game time arose, and everyone performed exceptionally well – and I want to applaud them. We think that the more information we provide New Yorkers the better. There's a lot of misinformation out there. There's a lot of questions out there. So this evening is an attempt to provide more information so New Yorkers have the facts.

This evening we're going to be explaining the travel protocols that will be going in place, which were announced by the Port Authority, Governor Christie, and myself on Friday. In general, the CDC is in the process of establishing protocols. They have had a number of protocols that have been evolving. Different states are developing their own protocols for their particular situations – and these protocols we think are appropriate for our situation here in this region. My personal practice is to err on the side of caution. Over the past four years as governor, I've gone through floods, hurricanes, blizzards – I'm waiting for the locusts. There were no locusts yet, but I wouldn't be shocked if they arrived. And my practice has always been to err on the side of caution.

The old expression is hope for the best but prepare for the worst, and that is exactly what we have done for four years in New York and has served us well, and that's what we're doing here. The protocols were discussed over weeks. Again, we had the advantage of seeing what happened in Dallas, and then had the advantage of preparing. So we've been having these discussions for many, many weeks with all the interested parties and people from across the nation, who have actually had experience in these areas. Dr. Zucker will go through the protocols in detail, but in general, a healthcare professional who returns to this region, who had exposure to infected people, or citizens who are returning or coming to the US, who had exposure to infected people, will be asked to remain in their homes for a 21-day quarantine period.

During those 21 days, healthcare workers would check on them twice a day to monitor their temperature and condition. If they develop symptoms, they will be transferred to a hospital. Interestingly, the organization Doctors Without Borders, which is one of the main organizations that prepares medical personnel for this kind of duty, their procedures require that, upon return, a healthcare professional stay out of work for three weeks, basically to decompress – my word, not theirs – for three weeks before returning to work. We would take that policy one step further and say three weeks, but remain at home for that time. If their organization does not pay for the three weeks – Doctors Without Borders does – but if their organization does not pay for the three weeks, we will. If their employer is going to put them at a disadvantage because of the three weeks, we will talk to the employer to explain that situation, if necessary.

The other protocols that are being discussed by CDC and other states will have returning passengers or healthcare professionals who were not in contact with an affected person to be monitored but on a less rigorous level. The system – CDC and some states have adopted a system whereby the returning passenger will be monitored but doesn't have to stay at home. I think this situation that we're outlining is operationally easier to monitor, and if – God forbid – it turns out that the person was infected, being at home they will have been in contact with many fewer people than had they been all throughout the city. I'll be asking all local public health districts in the state to accept and administer this protocol.

I want the state to have the same protocol, no matter where you are in the state – New York City versus Nassau, versus upstate, etcetera. I understand that the main point of our efforts is to stop the virus at its source, which is in West Africa, and we will encourage healthcare professionals to help. I had a conversation with the mayor where we're going to organize a meeting of the hospitals and healthcare organizations in New York, and we are going to affirmatively ask them to encourage staff to do this. We're exploring on the state side any rights that we could help extend to employees to facilitate their doing this kind of volunteer work. If you are a military personnel on reserve, you get called to duty, you return, you get your pay, you get your benefits, and you couldn't have been prejudiced by the employer.

We want to look at – we consider this situation analogous to that situation. This is a war on a virus in West Africa, and anything we can do to extend those types of benefits to these healthcare professionals, we want to do. Remember, these healthcare professionals – like Dr. Spencer – these people are extraordinary for their valor, and their courage, and their compassion in going to perform this, and anything we can do to encourage it, we want to do. I understand that some people may believe the 21-day home quarantine is a burden. I would ask for their cooperation and understanding – and remember what we're trying to balance. We're trying to balance aid to West Africa, and protection and the public health of New Yorkers, and addressing the fear and concern of New Yorkers.

We've spoken many times about the reality of Ebola. It's not an especially new disease – it was discovered in 1976. It is not like the flu – it is not easily caught. All the evidence says that it's transmitted through bodily fluids once the person is infected and highly contagious. So there's no cause for general alarm, but again, we want the people of New York to know we're staying one step ahead, we're doing everything possible – some people will say we're being too cautious. I'll take that criticism because that's better than the alternative. And as governor of New York, my number one job is to protect the people of New York, and this does that. With that, I will turn it over to Mayor de Blasio.

Mayor Bill de Blasio: Thank you very much, Governor, and thank you. We've said for weeks now that the partnership between the state of New York and the city of New York has been exceptional. I reminded people earlier today at Bellevue Hospital of the fact that the trajectory from the moment Dr. Spencer called and said he had a fever – from that moment until this very hour – protocols have been followed to the letter because they were determined earlier – weeks and weeks earlier – in careful coordination between the city, the state, and of course, the federal government as well. That is what’s going to get us through this crisis – that teamwork, that sense of collegiality, that sense of working from the same plan. And I want to thank the governor and Dr. Zucker, who have been exceptionally communicative in that effort.

Now, today, at Bellevue – the reason I went to Bellevue – and Dr. Bassett was there, as well as Dr. Ram Raju, who’s the head of the Health and Hospitals Corporation – we went there because the healthcare workers were affected by a few – when I say affected, meaning emotionally, personally affected – by a few different things. One – they have had the experience, in some cases, of having people react negatively to their service in this crisis. I want to pick up on Governor Cuomo's analogy – when we send a soldier overseas to defend our freedom, we welcome them back. A reservist who goes overseas we call a hero. We want to do everything we can to support them and normalize their lives. Well, we have nurses and other personnel at Bellevue who have already been treated with some discrimination, of people not willing to come in contact with them, missing the whole point about this disease that the governor just outlined. It's not an airborne disease. Casual contact does not provide an opportunity for anyone to contract this disease. And yet, sadly, some New Yorkers have treated the very people who are helping us at Bellevue Hospital with some discrimination. We've said today that's absolutely unacceptable. And of course, a lot of the personnel at Bellevue were affected by the treatment of Nurse Hickox – and we're troubled by it. I think the bottom line is, we want to see all of our medical personnel who are part of this fight treated with respect, and dignity, and support.

I have to tell you, I mentioned also – and I said this to the Governor earlier – I had occasion to speak to Dr. Spencer late afternoon yesterday. This is a hero who went to fight for all of us. We need more good men and women like that, and they need to know that we will have their back every step along the way. So I think the important point is that we've gotten to the point we're at today where, when we had a case – and the governor and I talked many times, and said each day that we didn't have a case was a good day, but we knew as leaders that the next day might be different – when we finally had a case, all of the public sector employees from all levels responded brilliantly.

Our EMS workers did exactly as they had trained. Our Bellevue nurses, doctors, lab technicians – everyone responded brilliantly. We want to respect them, and uphold them, and support them throughout this crisis, because their success will certainly determine everything for the rest of us going forward. And I want to, again, emphasize – we will remain in very close working relationship, constant conversation with the state. The two health commissioners have been in constant conversation for weeks and weeks. That will continue until the day that we can say that this crisis is over. Thank you, Governor.

Governor Cuomo: Well said. Dr. Zucker –

Commissioner Dr. Howard Zucker, NY State Department of Health: Thank you. Thank you, Governor. Thank you, Mayor. There have been many questions regarding our state screening procedures at JFK Airport. So I thought maybe what I could do is to walk you through exactly what we're doing – and I think perhaps the best way of doing this is through three scenarios, or when a patient enters the system. So the screening would first begin by being conducted by the U.S. Customs and Border Patrol just after the passenger, obviously, gets off the airplane, and we'll get a travel history there, and whether they've traveled to any of the affected countries. A secondary screening will be conducted on that passenger as well, and they will be contacted by the Centers for Disease Control who will be there.

In addition, an additional screening will now be performed, which will include the New York Department of Health, and the New York City Department of Health and Mental Hygiene. So we will have people there onsite, along with, obviously, the CDC, to get a history, get more information, find out exactly the patient's clinical picture, what happened, are they fine, are they well, are they sick.

So the first scenario will be – let's say the patient came in and the patient actually has symptoms, has a fever, is not feeling well, and we're worried that the patient actually has an Ebola virus infection. So they will be transported immediately, with medical transportation in protective gear, and the PPEs, just as Dr. Spencer was transported from his home – the same kind of protection – to one of the facilities that we've identified – the governor announced the specific hospitals here in the region as well as upstate, but since we're talking about JFK, to one of the hospitals that we have down in the city – for further evaluation and treatment, and from there forward to find out whether the patient has Ebola.

Another scenario would be, if a patient came in or a person came in, got off the airplane, and that person says that in their communication with the CDC, with our Department of Health, and with the city's Department of Health, that they believe they came in direct contact with someone who was infected with the Ebola virus, but they're not feeling sick, but they're not febrile [inaudible] fever – they're fine, but they did believe that they came in contact. They will be transported by a private vehicle – which we will arrange, either at the Department of Health, the state, or the local health department – they will be transported to their home. And once they’re at their home, they'll be quarantined for the 21 days.

Let me talk about that a little bit. They'll be home. If they have family members there, they'll be with their family members. And for those who don't have a home or were in the United States or in New York, not coming to – specifically to go back home – [inaudible] accommodations will be made – we will work on that. Under the quarantine that they will have, they will have two unannounced visits by the Department of Health to check on them, to see that they are there –these will be unannounced – to see what their symptoms are, to see if they have any symptoms, for that matter, to see if they have a fever – we'll check their temperature – to see how they're feeling. This will be in coordination – there will be local health department coordination with us. These will be made every day to be sure that they are doing well. The department will then follow through with this all the way to the 21st day after their last exposure to a patient with Ebola.

A third scenario would be if someone comes in, the patient gets off the plane, and they say that they were not anywhere near any patients with Ebola. They have no symptoms, they're fine, and these people will be treated on a case-by-case basis, but at a minimum – at a minimum – it's important to make that point – that the New York State Department of Health or the local health authorities, depending on where they're going, will monitor them twice a day for temperature as well as for symptoms that may occur during that 21-day period that we've spoken about. They would not automatically be subject to quarantine, but we will monitor and see where they are and see what develops.

We feel that this is the best way to strike that balance between public health and public policy, to make sure that we don't miss any cases of anyone with Ebola as they come back into the United States through JFK. And we look forward to working together on all this with our local health departments, and we appreciate all the work that the mayor and Commissioner Bassett – working with us on this as we move forward – and in other areas of the state, obviously, we work with many local health departments there as well. So I thank you.

Governor Cuomo: Commissioner Bassett?

Commissioner Dr. Mary Bassett, NYC Department of Health and Mental Hygiene: Thank you. And thank you, Governor, Mayor, Dr. Zucker. I had the chance to talk with Dr. Zucker about this guidance today, and I look forward to continuing to collaborate with him on their implementation. As we've all been discussing, the fact that we work so closely together in the weeks, in fact, months of preparation for the arrival of the first case of Ebola in New York City, was displayed, to all of our great relief, on Thursday when we could talk about how seamlessly our collaboration had worked in ensuring the management of Dr. Spencer.

I also had the chance to speak today to Sophie Delaunay – I'm not going to be pronouncing her name right, she's French – and the Executive Director of Medecins Sans Frontieres, or Doctors Without Borders, which is a humanitarian organization for which Dr. Spencer worked, and which has provided so many health workers to the response in West Africa – and I assured her that I would work with her closely to ensure that we implement this policy – as we work out its details – as humanely as possible. And I just want to echo what all of us have said this evening – the importance of the response in West Africa remains central to the security of public health in our city and our country. It is not only a moral imperative to address this tragic epidemic in West Africa, it's a public health imperative.

We have to stop this epidemic at its source, and ensuring a robust response to the West African epidemic is part of all of the work that we do here. So I look forward to continuing to work jointly with Dr. Zucker – we share our commitment to protect and promote the health of all New Yorkers. And I have to end once more with saying what we've all been saying to you so many times over the last days, that Ebola is not transmitted casually. It's not something that people get by simply walking down the street. It's not airborne – it is transmitted through contact with someone sick with Ebola and contact with their body fluids. So we will continue to work through this new policy and I look forward to our continuing collaboration.

Governor Cuomo: Thank you so much, Commissioner. Questions, comments, queries.

Question: Governor, you've said repeatedly that the best way to deal with fear is with facts. The fact, according to Dr. Bassett and a broad swath of scientists, is that Ebola simply is not contagious, if it's – if the person is asymptomatic. So, given that fact pattern, why quarantine – I know you say, an abundance of caution, err on the cautious side – but if they simply can't spread it, then –

Governor Cuomo: The question comes down to this – that is a fact, that the person cannot communicate the disease until they are symptomatic. The – and the whole, really – the question on the protocol is, do you ask the person to stay at home for 21 days while you monitor them twice a day, or do you let them go about their business and do whatever they're doing, and have a healthcare worker meet up with them twice a day to take their temperature, and monitor their symptoms, etcetera? I believe it is much – it’s – from an operational, efficiency point of view, and from a safety point of view, the preferred option is to ask them to stay at home.

The healthcare worker will come to their house twice a day. They can have their family, whoever is normally there. It's not that they're stopping their life – they have their full life – but if they become symptomatic, you will have limited the number of people they will have been in contact with. It will have been the number of people who were in that home, as opposed to the number of people who they may have experienced on a daily travel. That is a significant difference for us. We just saw the city going through a marvelously performed task – but a very difficult task – of retracing where was Mr. Spencer – trains, restaurants, etcetera. It's much easier if the person is home.

Again, Doctors Without Borders, which is the organization that Commissioner Bassett mentioned, their policy now is to remain out of work for three weeks, just as a decompression period – again, my word, not theirs. This takes it one more step – and please remain at home. Enjoy yourself, enjoy your family, but remain at home. Easier to operate – and if – God forbid – the person becomes infected, we will have known with certainty the number of people who were exposed to that person during that period of time.

Mayor: I want to just emphasize for a moment the key point that the governor and Commissioner Zucker made. Communicating with the individual from the moment of arrival, openly explaining what the policy is, accommodating their needs, protecting their salary and their work status – everything that Nurse Hickox didn't experience in the last few days – I want to say that's a very important point – that if someone is told with the respect they deserve as a returning hero how our policy works, and it's being done in a supportive manner, that is a far cry from what we saw the other day.

Governor Cuomo: See – there’s no doubt that the mayor makes a good point – also, there's no doubt but that this is a safer policy. Your point is, really, is it an unnecessary inconvenience to the individual? And I think when you weigh the “inconvenience to the individual” with the additional safety factor that safety wins. And I also believe –

Question: – what about fear, though, and disseminating fear and the possibility of mixed signals – because you’re saying that facts trump fear and tamping down on fear is a top priority –

Governor Cuomo: Oh – I think the exact opposite. I think, if anything, this is going to be probably the safest protocol in the country, and if anyone has – I like to say, New Yorkers are anxious by their DNA, right? Knowing that we have probably the safest protocol in the United States? That should give people tremendous comfort.

Question: Governor, what if an individual is resistant to the quarantine, what – how do you – 

Governor Cuomo: I do not believe that's going to be the case. Remember, you have two types of individuals who we're talking about. First is a health professional – a public-health professional who just showed magnificent courage and generosity of spirit to go to West Africa to do this in the first place. And as the mayor said, when you explain the totality of the circumstances about what we're trying to do, I think they will be receptive and understanding. And again, it's not like a terrible task is being asked of you. You stay at home with your family, with your friends, with your visitors, and we will compensate your salary and make sure the employer doesn't prejudice you for that. So I don't anticipate a lack of cooperation. If there was a lack of cooperation, obviously we have the legal right to enforce it, but I don't think it ever comes to that.

Question: Governor, you talked on Friday about not trusting people to be able to stay at home for 21 days. That they might slip out and that would endanger, you said, hundreds of people. What has changed over the past two days?

Governor Cuomo: No, no. We're talking about the news media, specifically. We were – no, this is the same thing. They would be at home for 21 days, and a health-care – this is what we were talking about on Friday. They would be at home for 21 days, and a healthcare worker would check on them twice a day.

Question: You had talked about people being in facilities. Governor Christie had talked about that as well. It was presented as if people would be in a hospital, or something like that.

Governor Cuomo: They could be in a hospital if they needed a hospital, but if they don't need a hospital and they have a home, then it would be their home. If they don't have a home, then we will find a facility, a hotel, et cetera, because they don't have a place to stay. If they're coming here, even as a citizen, they must have had an intended place to stay. If they had no place they were staying, then we'll find a place for them to stay.

Question: Governor, what's your reaction to the New Jersey nurse's treatment, and to the White House criticism while the mayor next to you is [inaudible] for unity's sake, there isn't the White House [inaudible]?

Governor Cuomo: The White House, first of all, and CDC will establish a protocol. They have yet to establish their protocol for this situation, and we have to operate now, right? We live in the here and now. Number two, whatever the CDC comes up with, they will be the first to say, I believe, that they understand states have different needs. And what New York needs is different than what Nebraska may need, is different than what Kansas may need, is different than what Florida may need. CDC will come up with general operating protocols, but the states are free to design their own protocols.
If there is a region in the country that has more differences than New York-New Jersey, I don't know of one, but this will be consistent. It will probably be somewhat safer than what CDC comes up with, once they come up with their definitive protocol, but I'll take that criticism, if you want to call it a criticism that I want to be safer than CDC says, fine.

Question: Governor, could you talk to us about the healthcare workers who are addressing Dr. Spencer now and how your policy affects their lives, since they are already in contact with an Ebola patient?

Governor Cuomo: It doesn't. It doesn't. To me, I'm not a medical professional, but I think it's fair to say this, and we do have medical professionals with us. The healthcare worker at Bellevue, or in New York, who is performing care for an Ebola patient, is in a dramatically different situation than a healthcare person in West Africa. We just spent a month training, and drilling, and buying equipment, and more equipment, and rehearsals, and more rehearsals – the staffing ratio for an Ebola person, we have one person in Bellevue, dozens of nurses I would bet are attending that one person. West Africa is the exact opposite. They have hundreds of people with Ebola, and many fewer personnel. There is no comparison between the two, but Dr. Zucker or Dr. Bassett may want to comment on that.

Mayor: Even before then I wanted to jump in and just say ...

Governor Cuomo: Or Dr. de Blasio.

Mayor: Yes, I've got my new degree. Those very dedicated healthcare professionals at Bellevue work for me, and I asked this very same question of the governor and Dr. Zucker. I agree entirely with the governor's response. The professionals at Bellevue, besides the fact that they have been training rigorously for months, are following exceedingly careful protocols, and we have absolute confidence in that situation. So, it is a different dynamic and each and every one of them, as we speak, goes home at night – they take very careful precaution – but they go home at night back to their communities, as they should.  By the way, in all the instances where American medicine has succeeded, and the two doctors will do a much better job than I will of explaining this, but we've had a number of Ebola patients, some flown back from West Africa, some who developed the condition here, by contact. The – each and every one was brought back, except for Mr. Duncan, who was in a very, very extreme and advanced state by the time he finally got the care he deserved, but all of the others benefited from American medicine, and were brought back to a full recovery, are out in their communities now. All the people who treated them would go home every night back to their homes, to their communities, to their families. In the vein of focusing on facts and not fear, let's look at the fact that this nation, time and again over these last weeks, has successfully treated individuals stricken with this disease, and that means hundreds and hundreds of healthcare workers who are able to go back home each night and do so safely.

Governor Cuomo: Let me make one other point [inaudible].

Dr.  Bassett: The two doctors.

Governor Cuomo: Yeah. Now Dr. Cuomo’s there. We –  in this country, we have entire industries where people work with very dangerous viruses on a daily basis, experimenting, researching, etc. And they do it day in, day out as an occupation. You can't compare our system with what's happening in West Africa. One of the reasons we have the problem we have is because West Africa doesn't have the sophistication of the system that we have. And if they did, the problem wouldn't have gotten to this level, even in West Africa, right? We know how to deal with it, and we've shown that. But I'm sorry, Dr. Zucker, and then Dr. Bassett.

Dr.  Zucker: First, I'd like to say that last night I had the opportunity to go over to Bellevue to the unit where Dr. Spencer is being taken care of, just at the time of change of shift, which is a critical moment, and I watched the nurses as they – one nurse came out and the other nurse went in, and the whole process of gearing up and going in to take care of the patient, Dr. Spencer. I had a chance to speak to the doctors, the other nurses taking care, look at the lab that's there, the whole unit that is there, and the unbelievable care that he's receiving. And as an ICU doctor myself, I've watched many patients in critical-care environments, and I will tell you that this is absolutely  – first of all, his care is unbelievably excellent, but also just the way that transition took place to make sure that there were no breaks in the system. And I have also had the opportunity to work in Haiti after the earthquake, and I have been in the environment where you're trying to do relief work of the nature, and granted it's not as risky an environment as someone in an Ebola infection, but I realized the potential of what could happen in this situation, when you're working under those conditions. And these are completely different scenarios. Just so you know, the nurses are being monitored, their temperatures are being checked, and we are [inaudible] is taking care of Dr. Spencer, but I think it's important to recognize these are definitely different conditions that they're under, having seen both of them.

Dr.  Bassett: May I just add a couple of things – one is, I wanted to be clear that everyone who's had contact with Dr. Spencer, whether they were wearing personal protective ... All of them were wearing personal protective gear. All of them have been entered into active monitoring and they're checking their temperatures twice a day. That will continue until they've made it through the 21 days since their last contact with Dr. Spencer, as Dr. Zucker has just explained. In addition, I do think that we should acknowledge the fact that there have been African health systems that have been able to control the Ebola outbreak. As you know, Nigeria had an imported case and they've recently been declared Ebola-free. Senegal had an imported case. They've also been declared Ebola-free. When adequate resources are made available, that includes both materials and personnel, the African epidemic can be brought under control. That's why it's so important that we all work together to ensure that that response continues to be supported. I would also acknowledge, because I think it's fair that we do so, that many of the ideas about the safe care of patients with Ebola came from the organization Doctors Without Borders. The very useful idea of a buddy system, for example, was first implemented by Doctors Without Borders, as part of the African epidemic. The many other outbreaks of Ebola that have occurred over the last 40 years have used those same systems.

Question: Doctor, I'd like to return the issue of the person who might be not symptomatic, feels fine, has been reported to quarantine, wants to go out and get a pack of cigarettes at the corner store, maybe he wants to go to the movies. In other words, he's not compliant. This city has a history with tuberculosis with people who are not compliant in taking their medicine, will not take their medicine, as Dr. Bassett knows, were actually detained and roughed up so that they would get their medicine. I'm wondering, how far does the threat go for somebody who is non-compliant.

Governor Cuomo: You raised the dire situation, but let's take a step back. We have two types of people we're talking about, right? We're talking about healthcare professionals who are returning. I say about the healthcare professionals who are returning – I believe that they are going to be highly cooperative and they're going to understand it. First, I believe these are outstanding individuals as a matter or character, because they're self-selecting that they agreed to do this in the first place, which means they are, in my book, really extraordinarily compassionate, generous people. And I think their word and their integrity is good, and if they say they're going to cooperate, they're going to cooperate, plus you're going to send a person twice a day, unannounced so you'll know if they're not at home. The second group of people who come, citizens who – sort of what Mr. Kaplan was asking about – if they have a place to stay, they'll stay in that place. If they don't have a place to stay, we'll find a facility that they can stay in. They'll have people check twice a day. If there was evidence that the person was violating the quarantine, we have the legal authority to enforce it. I do not see that situation developing. When you're talking about tuberculosis, you are talking about a long-term situation. This is 21 days where people can have people visit, they can be with their family, they can be with their friends, they can be with their girlfriends. It's not like this is the toughest duty on these twenty-one days. Yes, we have legal authority to enforce it. No, I don't see that as being necessary. If it was necessary, we would enforce it. Do you want to comment, Dr Zucker?

Dr.  Zucker: I was just going to mention, to pick up on your point about tuberculosis, there is a program that is to directly observe individuals who don't necessarily want to take the tuberculosis medicine. This is a program which actually the head of our CDC was very instrumental and I don't know if he started it, but he was instrumental in that program. It just shows you the need to make sure that you're there, that you're monitoring somebody, and I think this picks up on where we are with regards to making sure that we are keeping an eye on those patients who could have [inaudible].

Question: Is there an estimated [inaudible] healthcare workers from the New York-New Jersey area who are now in fact in West Africa? Do you have any numbers?

Dr.  Bassett: The only estimate that I'm aware of is that the eligible population would be about one or two people a day who would fall in this category of people who would now be asked to quarantine themselves at home.

Question: Returning, a day?

Dr.  Bassett:   I don't – yes, yes.

Question: The first time at the airport, interviews would be conducted by customs, you said?

Dr.  Zucker: When the passenger comes in, they obviously go to customs. CDC, and then the New York State Department of Health, and the New York City Department of Health and Mental Hygiene together will evaluate the patient.

Question: All of those entities have agreed to do this?

Dr.  Zucker:   We've agreed to do it, and we've spoken to CDC earlier today.

Question: Is the person under home quarantine allowed to have visitors?

Governor Cuomo: Yes.

Question: What does this mean for Kaci Hickox now. It's 21 days home quarantine. Can she go home? Is she –

Governor Cuomo: You'd have to ask – I don’t have the specific facts on that case. You'd have to ask the Jersey officials. But my – I – I’ve been – my understanding is, she's going to have a test tomorrow for the Ebola virus, and my guess is if that's negative then she'll be on to – on with the rest of her life. But I don't know. You should ask the New Jersey officials for the details.

Unknown: All right, guys. One more.

Question: Yeah, your reaction in that case, the way she's been treated?

Governor Cuomo: Well, you know, obviously, the – I don't know all the facts about the case, but you want to treat these people who are coming back with extreme sensitivity. I used the word – in my book, they're heroes, and I think we have to be grateful for what they did, and their service. I'm sure they're going to be understanding about concerns on the other side, the quarantine, etc., but these are people who really showed great compassion and great courage.

Question: Is there a shift on policy? On Friday you said there would be a facility for mandatory quarantine, during the news conference they were a part of, and now you're saying at home.

Governor Cuomo: No, always at home, unless you don't have a home – then you'd have to be in a facility.

Question: Governor Cuomo, could you react to White House pressures and the mandatory quarantine?

Governor Cuomo: I have had none, and – I've had none. And also, remember, the CDC will eventually come up with their protocols. That's their advisory protocols, and correct me if I'm wrong, commissioner, but it is totally in a state's authority to implement what that state thinks is appropriate in their particular case. And what we're saying tonight is, we think these protocols are appropriate, given our particulars. And I do not believe you're going to have a uniform set of protocols all across the country no matter what. Other states have already adopted other protocols. So you'll find different varieties of protocols all across the country.

Question: Governor, if a New Yorker comes back via Dulles or Atlanta, do you expect him or her to turn themselves in to the system?

Governor Cuomo: They'll go through whatever they go through at Dulles –

Question: If they're found asymptomatic at Dulles, they'll be let go and they can take Amtrak up to New York.

Governor Cuomo: Yeah. Well, they could do that.

Dr.  Zucker: We've all seen it. There's a different state, different jurisdiction, and we're working with the other jurisdictions as well, so, then we'll have some more information about that after we speak with –

Question: Are you adding some other jurisdictions to quarantined New Yorkers?

Dr.  Zucker: No, I'm not saying that. I'm saying that from the standpoint of the name of the person, we may have some information about that person, that they live in New York. That's all.

Governor Cuomo: But remember, different jurisdictions already have different protocols. I don't believe there's going to be a national protocol. CDC will put out guidance. Some will do more, some will do less. Can you do less than a CDC protocol? Or do they –

Dr.  Zucker: That's the [inaudible] –

Governor Cuomo: That's the minimum.

Question: With jurisdictions, you could take someone [inaudible] down from Maine and transiting into New York, and put them into a New York quarantine.

Governor Cuomo: At a – when they come to a New York facility.

Mayor: Excuse me a second. I just want to – hold on. I think we have to be very careful. I appreciate the questions, but let's be careful. The difference between someone who has no symptoms, and someone who has symptoms anywhere and might be traveling, Dr. Bassett wanted to make a clarification on that.

Dr.  Bassett: I just wanted to be absolutely clear, that unchanged is the rule that we should all be able to repeat to anyone we know who has traveled to any of the three countries. If you've been in one of these countries in the last three weeks, and you have fever or you're sick, that you should seek care immediately. It doesn't matter who you are, it doesn't matter what your immigration status is, or your ability to pay for medical care. It's absolutely critical that we don't lose that message in all of this conversation about the level of symptoms. Anyone who's sick and has traveled in the last three weeks should seek care. Period.

Governor Cuomo: I cut off that gentleman there, young – sir?

Question: The New York Times reported today that the Obama administration had requested that you end the mandatory quarantine. Will you be asking The New York Times for a retraction on that story?

Governor Cuomo: Oh, I've asked them for retractions on many stories. It's done me absolutely no good. So – but if you're asking what the facts are, the – they have not – I have informed them about our policy. The current CDC policy is somewhat less than our policy. I understand that, I'm totally fine with that. I am governor of the state of New York. I said that my job is to protect the people of New York. I believe this does that, and that's my main responsibility. If the CDC thinks that a different policy would work in a different part of the country, that's great, but I think this is the best policy for New York, and that's my concern, and that's why they pay me, and that's my priority, and that's what I'm going to do.

Question: Governor, allowing people to stay at home, why was this not all spelled out on Friday?

Governor Cuomo: Well – it's exactly what we were talking about on Friday. It's a home quarantine, but it is a mandatory quarantine.

Question: Has Governor Christie agreed to that?

Governor Cuomo: Yes, this is what we talked out – about on Monday. We did not have at that time the written protocols, and we said we will soon be putting out written protocols. This is two days later, and these are the written protocols.

Question: Governor, I hate – I know we all want to leave, but [inaudible] in his news [inaudible] the other day, expressly said that these people could not receive visitors. That even if you get a grocery delivery, someone will leave it at the door, and the person will open the door, take the grocery in –

Mayor: You're talking about – wait a minute. Let's be clear. You're talking about the three currently quarantined.

Dr.  Bassett: It's about the three individuals who are under quarantine. That's correct.

Mayor: Different dynamic. This was the first case we had in New York. We made a set of decisions around that case. Going forward, this is a state protocol. So, each situation is different. I think you’re – I appreciate the question, but I think there's a little bit of absence of understanding that in changing events people update policies. So, the three who are now quarantined – what Dr. Varma said was exactly correct.

Phil: Thank you, guys.

Mayor: Thank you.

Governor Cuomo: Thanks.