A Family’s Perspective – “The Brutality of Sepsis will Haunt Us for the Rest of Our Lives”

What Having Ebola Is Really Like

Jeremy Faust is editor-in-chief of MedPage Today, an emergency medicine physician at Brigham and Women's Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine. Follow

Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In part 2 of this exclusive video interview, MedPage Today's editor-in-chief Jeremy Faust, MD, talks with Craig Spencer, MD, MPH, of Brown University in Providence, Rhode Island, about the 10-year anniversary of his treatment for Ebola at Bellevue Hospital in New York City.

You can watch part 1 of this interview here.

The following is a transcript of their remarks:

Faust: Can you tell us just about how you felt in those first few days and how sick you got?

Spencer: How did I feel? You know, there's not really a good metric. I've said to people, imagine that you had a stomach bug and the flu together, and then multiply that by 10, and maybe that starts to make you kind of feel what you feel like when you get to your worst.

Maybe one way to describe it is that your fever gets so high that you take medication to bring it down, and it comes from 105 down to 101, and when your fever gets down to 101, you feel like you're on vacation because it feels so much better than 105.

I don't think there's really a good way to describe it, but it's kind of the worst that you felt with all of the things you've ever felt multiplied by a factor of 10. That probably does a decent job.

It's not like that the whole time. There are different waves of symptoms that people have. You may go from like intense fatigue to a really bad, bad sore throat, a headache, difficulty breathing, vomiting, diarrhea, muscle aches. It's kind of a whole host of symptoms that maybe will crash in and then fade away and then progress in different steps throughout the first week to 10 days of your illness.

And if you can make it through that, the likelihood that you're going to survive gets higher every day.

Faust: And I'm just curious how your days were, because sometimes you're so sick that you just can lie in bed all day and time goes by and there's no need for a book or a television or a conversation. You're just there and you're just alive and you're existing. And there's other times when you don't feel great, but you'd say, "Hey, I'd like an iPad," or something. What were your days like?

Spencer: Looking back, I don't know how I spent them other than sending messages or speaking to close family. I didn't speak to reporters, even though many tried to contact me. It's not like I got to sleep in and hang out and eat potato chips and sit on the couch and watch TV, but I was able to focus on some things that needed to be done. So logistic things, thinking about my friends that were under quarantine, thinking about my own partner, thinking about my family, and also trying to get up and exercise, do things, move around, do yoga, to just kind of move my body.

They had got a Nordic track, like a stationary bike, that my physician demanded I get on for at least 15 minutes every day. And there were some days when I just had zero desire to do that, but she forced me to do so. I guess she didn't want me to get any clots in my legs or whatever it may be.

So I think that that was really helpful. But I certainly didn't catch up on the Lord of the Rings trilogy or anything like that. It was mostly, basically that -- just trying to survive.

Faust: And this was the early years of -- well, not that early -- of iPhones and iPads and that kind of stuff 10 years ago in 2014. Did you take notes, records, even voice memos? Do you have a record of your feelings and thoughts at that time?

Spencer: I do. It was kind of also the beginning of the cloud, and so I was able to take some pictures and have some conversations and try to save them. That wasn't my primary focus, but I do recall in the aftermath and then years later coming across some of those messages and photos.

Because when I left the treatment center, nothing could come with me. So that included my glasses, that included my phone, anything that I went in there with stayed in there and then ultimately got incinerated. And so [when] I left I didn't have a phone, didn't know how to upload my things to the cloud and whatnot. So only some of the things came across.

But, I don't know, maybe it's good that I don't have too deep or profound a memoir of those days. I don't know. I don't know whether that's a blessing or not.

Faust: And in terms of how sick you got, there's feeling crappy and laid out and spending your days in bed and as you said, not catching up on the latest streaming show. But then there's also what you and I would call being really sick, which is that your life is in danger, which is that your blood work or your vital signs or your imaging show objective evidence that you are a person whose life is in danger.

Can you just tell us a little bit of how sick you really got in terms of whatever marker it might be? Did you have bleeding, were you anemic, hyponatremia, low sodium, those kinds of things. How bad did things get for you?

Spencer: You know, it's hard because I know how bad they got for other people. So it seems almost hard complaining about it.

So for most folks, the big thing is that your platelet numbers, the things that help your blood clot, can go really, really low. And mine got really low. So you need to think about a couple complications of that. One, you can just start bleeding, which people do. But also because if you want to do procedures like put in a central line or other things where you can continue to monitor vital signs and other really important things, then those things become a lot riskier to do. Because if your platelets are very low, you can cause bleeding, which can cause complications.

So very early on, my providers and myself, we chatted through and said, "OK, let's put in a central line now before things get any worse." And I'm glad that we did. They were able to draw blood from one spot. It was a lot more convenient, and we could do it in a way that wasn't more dangerous, as it would've been a couple days later.

Liver enzymes go up and so it looks like you have a shock to your liver -- because you do. Anemia, your blood levels will go down. You'll have a whole host of aberrations in simple things like your electrolytes, your sodium, and your potassium. Mine were all over the place. I appreciated the fact that every day we'd chat about it and, "OK, things are getting a little bit worse today. OK, let's hope they plateau out soon."

But I remember Laura Evans, a doctor that was primarily taking care of me most days, one day came in, sat on my bed and said, "OK, your liver enzymes look like this, this looks like this, this looks like this." And said, "You know, your VDRL (venereal disease research laboratory) is positive." And I was listening and it took me a few seconds. I looked at her and I said, "I'm sorry, what?" And she just smiled. The VDRL is basically -- she was trying to joke and tell me that I had syphilis in addition to all of these things.

So it took me a second to realize that she was joking and what it actually meant, but I kind of appreciated that it was her way of saying, "Yeah, I know that this sucks, but let me see if I can try to lighten the mood a little bit." So it was funny.

Faust: The coin flip. You casually said, "Oh, it's a coin flip if I live or die," which is not a great set of odds for anything. You were obviously concerned about other people, and that's who you are, Craig. But at some point you had to be thinking, "Oh my gosh, I might not make it."

Were there times when you thought -- I'm not gonna make it -- or was it always like, "Well, it's 50/50, but I'm here. I'm at Bellevue, I'm getting great care. It's probably 80/20"? Or were there times where it's like, "Oh, this is getting worse. I'm not going to make it."

Spencer: I can honestly say, and I've thought about this a lot and been asked about this a couple times, there was no point in my illness where I thought, "All right, you're not going to make it. This one lab test or this finding or whatever just portends a negative outcome for you, and what are you going to do about it?" I just don't recall thinking about that.

Faust: Do you remember a moment when you thought, "OK, I'm going to make it, I'm going to be OK"? And if so, did that come before or after any experimental treatments that you received?

Spencer: I received a bunch of experimental treatments that did absolutely nothing for me, and probably only made me worse, if anything. I got convalescent plasma, which I've spoken about and written about. I don't think that it helped me. I don't know that it hurt me, although after I got that I needed oxygen for a day or two, so I don't know.

Was there a day where I'm like, "Oh, I got this"? I think once things plateaued and my numbers weren't getting any worse, that was certainly reassuring. I knew that even for how bad I felt and looked, I didn't feel probably as bad or look as bad as most of the patients that I saw in Guinea. That was remarkably helpful.

And I think there was a point at which I was offered one of these medications you might remember from that time, ZMapp and ZMAb, these kinds of hard-to-get medications that were unproven but seemed to be the best option and the best chance of help. I remember I was offered one of these medications at a point after I'd already tipped over into the I'm-likely-to-survive phase, and ultimately denied taking that medication, knowing that if I didn't take it, probably it would be helpful for somebody else somewhere earlier on in their course.

Faust: Let's talk a little bit about the people who took care of you. I hear rumors that at some point you felt well enough to get some pretty good Korean food in there. Tell me about the nurses and what they were bringing you.

Spencer: What was really cool about the nursing staff and seeing them just a few days ago at this event at Bellevue is just how reflective of the U.S. It was in that it was just really hard working, amazing, and almost exclusively immigrants. It was just really, really, really cool to see people from all over the world, from East Africa, from Haiti, from Korea, that had moved to New York, had worked as incredible nurses in the [intensive care unit], and then had stepped up to take care of me and other patients.

In addition to being amazing nurses, many of them were amazing cooks. So one of the Haitian nurses brought me homemade Haitian black rice one day, which was amazing. June, the Korean nurse, brought me in some homemade bibimbap one day, which I absolutely love. It took me a while to get my appetite back, but if there was anything that was going to do it, it was absolutely the stuff that they were bringing in, for sure.

Faust: That's great. Let's talk a little bit about future outbreaks. People hear the call, they go, and they want to help. When they come back, how should we, in this year, deal with that? What kind of testing, what quarantining or isolation -- what's the way that people should come back from, say, a Marburg outbreak that's looking to be successfully dealt with in Rwanda right now? If anyone was over there, how would you recommend we deal with that?

Spencer: I mean, we've learned a lot in the past decade, but a lot of what we knew a decade ago still applies, right?

So we have systems in place where people will be on lists, they'll be followed by the city, the CDC, and the City of New York and the Department of Health will be aware and will be able to follow folks like this. It's fit specifically for people that have worked in treatment scenarios, for example, not had high risk exposures like a needle stick, etc., but kind of the normal exposure. Then we know what works. We know that routine monitoring, taking your temperature twice a day, have that contact tracing, have that connection with local health authorities, and then reporting your symptoms as they develop and working through these algorithms, through this triage with this time-proven process for when you actually need to seek any type of higher care.

People say, "OK, well why don't we just quarantine everybody that comes back just to be careful?" The problem is that one, it doesn't help. Two, it might hurt. And it might hurt because it makes it a lot harder for people to be able to respond. If you know that you're going to go somewhere for 6 weeks and then you're going to come back for 3 weeks and have to sit in a hotel room or in a hospital bed or whatever it may be, out of an abundance of caution, that means that that many fewer people are going to be able to respond.

We need people to respond to these outbreaks. We need people. When I talk about this... In Guinea, Liberia, and Sierra Leone where I was working as a physician, they had almost as many physicians in those three countries combined as the one single hospital where I was treated for Ebola in New York City, right? So if we want to contain these things and keep ourselves safe, we need to respond to them at their source quickly. That's often going to need people that are willing to donate their time and maybe put a little bit of their safety on the line.

But we know that we can manage their return in a way that is both safe and non-stigmatizing, but also supportive in a way that gets other providers to be able to respond.

Faust: In light of what you just said, why do you think Ebola has never spread outside of a few hotspots?

Spencer: Because it's pretty hard to transmit, right? Everyone just thinks that it's like COVID or that it's this highly contagious virus. It's not, it actually doesn't do a good job of spreading. It tends to kill a lot of the people that it infects and maybe that helps spread as part of funerals, etc., in healthcare settings. But with pretty basic preventions, you can often slow down or completely stop the spread. And we've learned a lot about that.

That's the important thing, right? In the United States, when we have universal precautions in hospitals, even if we're not wearing personal protective equipment, you're likely not going to have massive outbreaks. Maybe you'll have some you'll recognize and you'll put in place other protocols.

But in a lot of other places around the world, even some of those basic things that we think of -- running water to wash your hands, an adequate supply of gloves -- may be in short supply. That makes it a lot harder for them, especially in healthcare facilities, to stop this spread.

Faust: And what's your take on the new-ish vaccines?

Spencer: So we have vaccines for Ebola, which are absolutely fantastic and super helpful in outbreaks when we can use them as part of a ring vaccination strategy -- to identify people who got sick, find their contacts, and then vaccinate them as quickly as possible with the hope of preventing them from developing Ebola, which has been very effective. Those vaccines are great. Thankfully, there's a stockpile of them that sits with the World Health Organization and countries can request them pretty quickly once there's an outbreak.

There are also treatments. There are a couple FDA-approved treatments for Ebola, these monoclonal antibodies, which people may know about from COVID. Basically, these are just ways to lower mortality and to provide some type of treatment for a disease that can have fatality of 40%, 50%, 60%, if not higher depending on the circumstances of care. These treatments are great.

The problem is that since they've been approved, there have been five Ebola outbreaks, and only a third of all patients that have been diagnosed with Ebola since then have actually received these treatments. That's because even if they're really good, they're not always accessible, especially to the people in the places that they need them.

Faust: Craig, are you immune to Ebola? Do you know what your antibody status is? Do you know what the possibility is that you could have Ebola reactivate? Tell us about that.

Spencer: I don't want to find out. But what we do know is that we understand there's long-term protection. If you measure my Ebola titers now, they'll be really high. We assume that that means that I can't get infected again with that single strain of Ebola -- of which there are multiple strains -- so Ebola Zaire.

There's also Ebola Sudan, which caused outbreaks 2 years ago. We don't know what protection against one means against the others, but I don't necessarily want to find out.

In terms of reactivation, we know that there was an outbreak a couple years ago in Guinea that was linked back to a survivor who had this recrudescence, this virus that had been dormant in their body that kind of came back alive and was transmitted to another person and caused an outbreak.

We've also had a couple cases where people have had meningitis from virus that was long thought to be gone that happened to just be hiding away somewhere in someone's central nervous system, for example. What do we know about this as a larger scale phenomenon? We know that it's extremely rare. There have only been really like a handful of known cases. We don't know how prevalent it is.

Does it mean that, for me, I need to continue to be worried about the possibility that Ebola will someday kind of re-erupt? I don't think so. It doesn't seem to be the case. But I tend to be a little more thoughtful and careful in that I have a family member that needs an organ transplant and I've taken myself off the short-list for that because, even if there's a one-in-a-million possibility, I don't want to tempt that one-in-a-million possibility.

So this is still an area in which we've learned a lot over the past decade, but for which we still have a lot of questions that remain unanswered.

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An Emergency Doc's Experience Contracting Ebola

Jeremy Faust is editor-in-chief of MedPage Today, an emergency medicine physician at Brigham and Women's Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine. Follow

Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In part 1 of this exclusive video interview, MedPage Today's editor-in-chief Jeremy Faust, MD, talks with Craig Spencer, MD, MPH, of Brown University in Providence, Rhode Island, about the 10-year anniversary of his treatment for Ebola at Bellevue Hospital in New York City.

The following is a transcript of their remarks:

Faust: Hello, Jeremy Faust, medical editor-in-chief of MedPage Today. I'm so excited to be joined today by Dr. Craig Spencer.

Craig Spencer is an emergency physician and associate professor at Brown University and the Brown University School of Public Health. Ten years ago, he was working with Doctors Without Borders treating patients with Ebola in Guinea and returned to the United States and later found out that he had contracted Ebola virus. This month marks the 10-year anniversary of his treatment at Bellevue Hospital and ultimately his discharge, and he has since gone on to do great work.

Dr. Spencer, Craig, thank you so much for being here.

Spencer: Thank you for having me on.

Faust: So how did you find out 10 years ago that you had Ebola?

Spencer: You know, I really found out when my provider sat down next to me on my bed when I was at Bellevue Hospital and said, "Well, your Ebola test is positive." But I kind of knew earlier in the day when I had a fever and had been taking all of my anti-malaria medications religiously the whole time that I was away.

Having been in an environment where I worked every single day with dozens and dozens of patients who had Ebola, sure I was using protection and we knew that that reduced the risk to nearly zero, but not to fully zero. So I had an idea, then I had certainty, then I had a couple weeks of difficulty.

Faust: Yeah. Do you know how you got it and what was the window from the last patient you treated until you had symptoms, until you got diagnosed?

Spencer: Yeah. The last patient I treated was somewhere around maybe October 13th or 14th. I got back to the U.S. On October 16th, and I think went to the hospital October 23rd. I'm sure a quick search of the internet will bring up hundreds of articles determining whether or not that's true. So it was probably around 9 days or so from the last patient contact until I developed a fever.

In terms of where I got sick, almost certainly inside the treatment center where every day I took care of folks for hours and hours, who often at the last moments of their life were having a lot of vomiting, having a lot of diarrhea, were really dehydrated. And I and the team that I worked with were absolutely intent on making sure that if people were going to die, that they were going to die with some dignity. Not covered in their own excrement and their own feces, their own vomit.

That is absolutely the highest risk moment, when taking care of people where there's just virus all around. Even in personal protective equipment, sometimes it can get through.

Faust: Do you have a moment where you thought, "Oh, I made a mistake," or it's just the law of averages, something happened?

Spencer: It's almost impossible to describe what it's like to be in a place like that to folks that have never been in a place like that. But every moment felt like a landmine from the time you got in the country and started taking care of patients. From the first patients you saw, the first time you put in an IV on someone -- something that I do all the time, I've done thousands and thousands of times -- but it was almost as if I was doing it the first time in West Africa, in Guinea, because I was in a really hot suit and it was a really hot day and I was already dehydrated and I was wearing two pairs of gloves, and I was scared, scared, scared. Knowing that if I missed, if something happened, if I poked myself, had a needle stick injury, I would die. It's not that I would be infected. It's not that I would get sick. It's that I would die.

Faust: And by the way, that's just a bravery that you and people like you accept, and I just want to acknowledge that that is awesome and amazing.

When you came back to the United States, you felt fine. You went about your business, you famously went bowling, you got in an Uber, all these things -- and people lost their collective minds because they thought that you were putting people at risk. I know that you don't feel guilty about that because you also know about the dynamics of the spread. This is not a virus that spreads asymptomatically; it's got a long incubation period.

How did you handle that moment? You probably were thinking about your life, but did it affect you that people were saying, "Craig Spencer's not a hero, he is a dangerous person who put us all at risk?"

Spencer: Honestly, no. I don't think anyone that went to do that and the thousands of other people from around the world that really showed up, including the tens of thousands of people in Guinea, Liberia, and Sierra Leone that put themselves and their own family on the line -- those are the real heroes here.

But I don't think anyone that showed up from the U.S., people like myself, went there to be a hero. I think we went there because we heeded a call knowing that if we didn't put this out at its source, we were going to be in really big trouble if this spread further internationally.

At the time that I got sick, there was no TV in the room where I was treated. Apparently they had just that morning checked all the boxes to be completely prepared and ready for an Ebola patient. And maybe the one box that they didn't see -- because it was the least important at the bottom -- was to make sure there was a TV in the room with cable and 2,500 channels or something. There was none of that.

So it was probably good, right? I had an idea of what was happening outside, but that was not at all where my focus was at.

What I knew then -- and what history has proven to be correct over and over again -- is that you don't transmit, you're not infectious until you're symptomatic. And that the public health guidelines that the organization I was working for and that other public health organizations had developed around that time worked. They worked, they worked just as they were supposed to.

And I am not only proud of the fact that they worked, but I will stand up again and again and say it's really important and really valuable to have organizations, public health organizations, that can give us that guidance so we're able to do this and do this correctly. It's really easy to give broad guidance that doesn't accord with the science. That just means that people aren't going to support it, aren't going to follow it, and then we make ourselves a lot less safe.

Faust: And I just want to reiterate for this audience that unlike COVID, where we learned about that virus in real time, this is not the case with Ebola. We understand from experience that what you just said is true. And the example I always hold up is that the gentleman who passed away from Ebola in Texas was discharged from the ER [emergency room] with Ebola unbeknownst to anybody, went home, hung out with his family, they were taking care of him for days with no kind of precautions, and none of them got Ebola. But then when he was readmitted to the hospital and they diagnosed him, all the precautions were in place, and two nurses wearing full PPE [personal protective equipment] did get Ebola.

So it really is truly a disease that is different than say a COVID or an influenza in that it's transmissible at the end. So I just want people to understand that this is not an area where there's known unknowns. We know this thing.

Spencer: Yeah. And it's also important to point out the fact that very much unlike COVID, where there is asymptomatic transmission, we know that virus can linger in spaces, whether it's poor ventilation, for example. You can walk into a room unbeknownst to you and be exposed and be infected, which is why we had a whole host of precautions in place over the past nearly 5 years.

With Ebola -- Ebola is a disease of compassion. It is transmitted by caring. And so it is people like healthcare providers, people that put themselves on the line, many of them often with inadequate or insufficient personal protective equipment but still do this because they feel duty bound to take care of people at the most infectious period of their illness. And also family members, the people that if you can't find a hospital to take care of you, if you can't afford to get treatment at a clinic, you're always going to have your family there to do this, regardless of the risk to them.

And that is where Ebola spread. It's spread through compassion. It's spread through care. That's why really close family members and really heroic local physicians in most scenarios were the ones that were on the line and most likely to be exposed.

Faust: Agreed. And that's why I've written a lot of stuff over the years, but my piece about Kaci Hickox in which I said that we ought to be celebrating people like her and not punishing them with unnecessary precautions, I think that stands and it stands for all of your colleagues. I have so much admiration for you and everyone else in that space.

I do want to talk about the moments after that diagnosis. And you know, Craig, you and I are very good friends, but we haven't talked about this part. I've heard you talk a little bit about the ICU [intensive care unit] at Bellevue Hospital, but can you just take us through literally the moment? OK, you have Ebola -- or at least your test was positive, which is the you have Ebola moment -- literally what happens next? Like, here, put on this mask, put on this space suit. What is your doctor wearing at that point? And tell me just the next 5 minutes, the next 10 minutes, what happens in those moments?

Spencer: So all interaction that I had had once I had arrived in Bellevue, in the treatment room itself, was with providers wearing personal protective equipment.

Faust: What did that look like? Can you tell us specifically what they were?

Spencer: Space suits. I mean, it looked like Buzz Aldrin landing on the moon. But the PAPRs [powered air purifying respirators], this type of personal protective equipment, is way more comfortable for them. It's meant to be much more protective, much easier to put on and take off, and to lower the risk of infection for providers, which is key and very important.

So yes, we're having all conversations -- for me, the next 19 days every conversation was with someone, usually a nurse in my room, in one of those spacesuits. But in the first couple minutes after my confirmed diagnosis, the question was like, OK, what do we do next?

And what I appreciated was having a medical team that knew that when it came to treating Ebola patients, compared to them I was the expert. Right? This is something that I had done hundreds of times in the past month before.

And so we were able to chat about things that I saw, things that I worried about, things that we should be thinking about, and they were able to be there, be present, listen, but also kind of strategize the next steps. "OK, let's think about some of the investigational medications that maybe we could look into. Let's think about how we're going to handle this, this, this, or this. What should we do with your family? How do we think about this from a media perspective? Do we hold on announcing this? Do we wait?" And so it was a lot of those conversations, more logistics and kind of nuts and bolts of what comes next.

I don't particularly remember thinking, "Oh my gosh, this is my death sentence." I do remember thinking then -- and more so over the next couple days -- of how incredibly lucky, in almost a guilty sense, that I was able to come into Bellevue in the afternoon and by that evening already have a positive test, know that my test was positive.

Because for the past 6 weeks, I had taken care of patients, many of whom waited days, if not longer, to get their test results back. And that whole time being in limbo, not knowing what's happening, being inside an Ebola treatment center, and maybe you have just malaria, or maybe you have malaria and Ebola but you don't know. And then maybe you finally get that diagnosis days later. I had it within hours and I was grateful for that, but also felt a bit guilty that I had access to something that the hundreds of people I had just seen and taken care of didn't.

Faust: Yeah. And we'll come back to that. That's an area where you've spoken eloquently [about] many times, and I want to reiterate that too.

The special pathogens team at Bellevue did wonderful work. I think they were as prepared as anybody could be. But I still don't even know where you went. Were you in the ER when you came in, or were they like, "Oh wait, you're a PUI" -- person under investigation -- or "You're a high-likelihood Ebola patient, you're going right to the ICU"? Where were you literally and what were you wearing? Did they put you in any kind of protective equipment?

Spencer: That's a good question. I don't think they dressed me up, which is probably good. I think I was focused on some other things. But you know, I went straight from the ambulance up to a treatment room, a dedicated treatment room, so there wasn't an intermediary stop. It was directly from ambulance to treatment room -- negative pressure where you put a PUI, a person or a patient under investigation. So yeah, a direct line from one to the other.

Faust: Is that the ICU in that case?

Spencer: That was a room that had been kind of retrofitted. It was previously where tuberculosis patients that needed a longer stay for treatment in the hospital would stay. So that area of that floor had been repurposed as the special pathogen unit where they would take care of Ebola patients and anyone else with concerning, high-consequence diseases.

Faust: Is that the room where you stayed for the next several, I guess, couple of weeks?

Spencer: It was indeed. I went in and had a 19-day stay in the exact same spot. Maybe, I don't know, 90 square feet, which in New York is pretty spacious, but after nearly 3 weeks it starts to feel a little small.

Faust: Yeah. I was wondering, because again, with all the protocols in place we ought to believe that it's a very containable pathogen, and yet if I'm in the ICU and the guy in the next booth has Ebola, I might be a little concerned. This is not the case.

Spencer: Absolutely not. No, no, no, 100%.

The people at greatest risk really were me -- my risk of dying just looking at the numbers was a coin flip -- but the next greatest risk of course was the nurses, primarily the nurses. There were many of those every single day that came into my room to help with all manner of things, and they were at the highest risk of exposure, them and the other healthcare providers. But in terms of nosocomial transmission, transmission around the hospital, the risk of that was zilch.

Faust: Right. And again, hats off to the Bellevue team. One of the big things that we as doctors don't think about are some other risks, like waste management. What happens to the stuff coming out of your body, the toilet? And they have to deal with that. That's a really big challenge, and they did a remarkable job.

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Ebola: How A Disease Is Prevented From Spreading

Marie Roseline Darnycka Belizaire (L) helps to lead WHO efforts to tackle Ebola in the Democratic Republic of Congo

For health workers on the frontlines of the battle against Ebola, time means everything.

Earlier this month, the World Health Organization (WHO) declared an international health emergency in the Democratic Republic of Congo (DRC) after an outbreak of Ebola. The second-deadliest Ebola epidemic in history, it has killed more than 1,600 people so far and the numbers are rising.

Haitian doctor Marie Roseline Darnycka Belizaire is helping lead the WHO's efforts to tackle the disease in the DRC, where additional challenges include armed conflict, tough terrain and widespread fear and suspicion.

Here, Marie Roseline talks us though the process of trying to contain Ebola.

Step one: The first case

One case of Ebola is an epidemic. When someone is suspected to have the virus, we must quickly get samples to check and confirm that.

The symptoms are very, very similar to lots of other diseases, like malaria for example. It can begin with abdominal aches, headaches, sore throats, fevers. After two days, there will be an exacerbation of these symptoms and others may be exposed. For example, you can have diarrhoea, you can also have a higher fever. After five to seven days, we can begin to see haemorrhagic symptoms. When we get into the last stages of symptoms, we have very pronounced asthenia, when the person becomes very weak.

Ebola patients look like any person who is sick. When you are very accustomed to seeing people with Ebola, you can distinguish an Ebola sufferer with the most severe symptoms. It's like someone who is very ill with a lot of pain in his body. He's looking at you with some anxiety, some fear of dying. We have found people who have escaped and have gone to hide themselves to die.

We have put in place what we call a surveillance system. Members of the community go between houses to detect if someone is sick. If this is the case, they will refer this person to a health centre where the health worker has to refer this person to the Ebola team if the symptoms are the same as those seen in Ebola. At that point, we will receive an alert.

To distinguish a case of Ebola we have to make a sample. When we suspect a case, only a laboratory can say it is or it is not.

The person is then transferred to an Ebola treatment centre for the sample to be collected and analysed. Throughout this time, the patient will be receiving psychological support. This is important because it is a deadly disease that can kill several family members at the same time, people are often stigmatised when they have it, and some people think they have Ebola because they have done something wrong.

Step 2: The diagnosis

If the sample is positive, we now know we have an Ebola case. At this point, we put all pillars of our response plan into action.

Ebola is not killing you spontaneously, there is time to go for help.

If you get to a treatment centre in the first two days of symptoms, you have a 95% chance of being healed. But if you go 10 days after symptoms begin, you have a 95% chance of dying.

One of the main difficulties we're having is when a doctor within the local health structure suspects someone of having Ebola they are not calling quickly. The problem that we have is that 90-95% of the health structure is private. So when they refer the patient quickly, they say that they are not earning anything. Sometimes they keep the patient and then the patient infects other people in the health structure.

After the patient is informed of a positive result, the team will go to the family to tell them and offer psychological support.

In the Ebola treatment centre, we make sure that every treatment is available to the patient. We make some laboratory analyses to see if the kidneys are OK, if the heart is OK. Once we check all the biological functions of the person, the committee dealing with the treatment meet and decide what the best option available is.

If the person comes early, if they come late, they are treated at the same level. All of the patients are receiving the treatment. All of those patients are receiving the vital support. All the patients are receiving psychological support, and all the patients have the right to have a family member there, although direct contact is not allowed.

We are some times also called after a community death. In this case we arrange a safe and dignified burial.

Step 3: 'Mapping'

Once the psychological support is in place and the family is accepting of the result and understands what it means, our surveillance team will go deeper into an investigation we launched when we validated the case as suspected.

We do what we call "mapping". The mapping is to find where and with whom this person has been, not only in the period since symptoms began but also 21 days before this.

If someone has been in a church, we have to go to the church and try to find all the people that have been around this person. If this person went to prayer, then the pastor may have put his hand under the person. So then we have to find all the people that have been in the same room praying as this person.

How many people are affected completely depends on the movements of this person.

Marie Roseline Darnycka Belizaire says 'mapping' is a central part of the fight against Ebola

Sometimes we find that families are the main contacts, but we find also friends who are visiting, and in the community we find neighbours who have been visiting after hearing that this person has been sick in their house. When the person has been in hospital, this means all the co-patients are also contacts, workers in this hospital who have been dealing with the person are also contacts and people who have been visiting patients in the same room as the confirmed case are also contacts. You can understand how difficult it is after listing all those contacts to identify them and find them.

When we have identified each direct contact in the case one by one, we follow all of them for 21 days. While we are monitoring them, we also offer them vaccinations.

We also offer vaccinations to contacts of contacts. Those are people who have been in contact with someone who has been in direct contact with the confirmed case. Contacts of contacts of contacts are offered vaccines too.

We call these groups the first, second and third generation of contacts. There is a median number of contacts we have established of between 50 and 150 people, which helps to guide us when we are looking for them.

We have had a case that generated 356 contacts because he was a singer. It all depends on the mapping of the person.

Step 4: Vaccinations

The first, second and third generation of contacts are all offered the vaccine, but the vaccine is not mandatory.

Before offering them the vaccine, we explain why we are proposing it and why it would be good for them to take it. We also explain to them what will happen to them once they take it, because there are some symptoms they can have afterwards. After all this, they decide if they want it.

When they decide not to take the vaccine, we try to convince them. But in the end, it is a personal decision.

It is normally not so difficult to get people to take the vaccine but sometimes we have issues.

We have found people who don't want to take the vaccine because they don't want to put any external liquid in their body. We have those that have refused because they have a religion that doesn't want them to take vaccines. We have people who refuse just because they don't believe in Ebola. And we have people refuse because they think they are protected against all the bad things in the world. We have faced all of those things when people refuse them.

The vaccine has been invaluable for those who want to take it.

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We do not vaccinate everyone in the country because the vaccine is still under investigation, the number of vaccines that are available now is not enough, and by vaccinating the third ring of contacts, we create what we call community immunisation anyway. This means that the entire population is not in need of the vaccine.

We are working in very remote places, so sometimes we are carrying the vaccine on our heads. We had a team who had to walk more than five hours to a place because no cars, no motorcycles could get there so they had to go by foot.

With very remote places in the forest, we can also have insecurity because there are armed groups operating there.

Sometimes you think you might not survive. One of our colleagues has been killed and there are also people in the community who have been killed in their houses because they are working with us in the response.

Step 5: Cross-border co-ordination

We also support bordering countries with their preparedness and response plan.

When someone - a contact - is displaced to another place, we rapidly contact the other country. We have contacts who have travelled to Uganda but we have informed Uganda quickly and those contacts have been identified and come back to the DRC.

So far, the recommendation of WHO is not to close the borders. We should reinforce checks on the borders, screenings at the point of entry - this is the recommendation.

At the points of entry, if someone is sick and trying to get to another country, you can detect them there.

Step 6: Epidemic over

To declare that an epidemic is over, we have to have 42 days without any cases. Forty-two days is double the incubation period.

After the Ebola is declared finished, we begin with a surveillance phase. This is 90 days during which the team is still in the field. We train local people to try to make the system sustainable. We also actively search the community to find any cases that have been hiding somehow.

After an outbreak, we want to help local health systems to become more reliable.

This interview has been edited for length and clarity.

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