NY Plague Cases Test Health System

By ERIN McCLAM, Associated Press Writer

NEW YORK (AP) — Two cases of plague at a New York City hospital turned out not to be bioterrorism, but they provided an opportunity to test how the city health system would handle an intentional attack.

The good news: Doctors say the system worked.

Hospital staff and health officials applied lessons from last year's anthrax attacks to diagnose and treat the two patients quickly — and to prevent unnecessary public fear over the obscure disease.

The bubonic plague cases, diagnosed in a New Mexico couple who showed up at Beth Israel Medical Center on Nov. 5, were the first in New York City in at least a century.

"This was scary. Even the doctors had never seen a case,'' said Dr. Beth Raucher, an epidemiologist at Beth Israel Medical Center, where the two patients were treated. "But everybody did what they had to do.''

Plague — along with anthrax, smallpox and a handful of other deadly agents — is on a short watch list distributed by the federal government, which wants to make sure doctors and hospitals recognize a bioterror attack quickly.

But plague's symptoms can be difficult to spot. The disease is characterized by swelling, weakness and fever, symptoms that can signal anything from flu to West Nile virus.

Health officials say they were lucky in this case. The couple, John Tull and Lucinda Marker of Santa Fe, N.M., told the private physician who first saw them that a rat on their property had once tested positive for plague.

The physician, Dr. Ronald Primas, also noticed an additional telltale symptom: swelling in Marker's groin, which signaled the type of plague was likely bubonic.

The physician referred the couple to Beth Israel, where infectious disease expert Dr. David Perlman warned the emergency room staff that the two would need urgent attention and would need to be isolated as a precaution.

Bubonic plague is not contagious. But left untreated, it can transform into pneumonic plague, a more dangerous disease that can be spread from person to person.

"The critical thing was to go through that with the ER staff,'' Perlman said. "We didn't want to let them wait around in the waiting room.''

Beth Israel officials quickly called the city health department. Both sides say they have learned to communicate much better since the anthrax attacks highlighted the nation's bioterror risk.

And when city health officials arrived, they gave the patients' blood antibody tests — one of a new arsenal of rapid diagnostic tests paid for with anti-bioterror funding available since the Sept. 11 attacks.

"The anthrax incidents really emphasized how critically important the lab is,'' said Dr. Thomas Frieden, the city health commissioner. "We expedited the lab work that was required to verify the cases, and that's really encouraging.''

When the test came back positive, Frieden hastily called a press conference to emphasize that the couple's form of plague was not contagious.

The anthrax attacks cast a shadow over the handling of the plague cases. Last fall, many health officials were criticized for not coming forward soon enough, and for providing vague information to a scared public.

"One of the fundamental lessons is that we need to be open and honest,'' Frieden said in an interview. "We need to tell people what we know and what we don't know.''

Marker is recovering and was released from the hospital Wednesday. Tull, her husband, remained in critical condition and is on antibiotics, under the close watch of doctors. He was "making modest improvement,'' hospital spokesman Jim Mandler said.

Health officials say 10 to 20 people in the United States contract plague each year. About one in seven U.S. cases is fatal.

Doctors not involved with the recent plague cases emphasized there is no way to predict exactly how an intentional biological attack might unfold. But they praised the city's response as quick and appropriately cautious.