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Second Health Care Worker Diagnosed with Ebola in U.S.; CDC Protocols for Prevention of Ebola Transmission to Health Care Workers Examined; Are Airport Screening Measures Sufficient?

Aired October 15, 2014 - 07:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


CHRIS CUOMO, CNN ANCHOR: Elizabeth, this is not new. We've been hearing from health care workers, specifically the nurses, from the beginning. The question is not whether or not they're telling the truth, but what's being done about it.

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Right. Exactly, Chris. And certainly this second infection with Ebola among a health care worker raises the question, is this hospital capable of safely taking care of Ebola patients in our other hospitals in the United States, safely capable of doing so?

(BEGIN VIDEOTAPE)

COHEN: Breaking this morning, only four days after critical care nurse Nina Pham was found to be infected with Ebola, a second health care worker has been diagnosed with the deadly disease. the hospital staffer, at Texas Health Presbyterian is one of 76 health care workers who provided care for the now-deceased Ebola patient Thomas Duncan. According to the hospital, the staffer was immediately isolated after an initial report of a fever Tuesday. The CDC says they've interviewed the patient to identify any contacts or potential exposures in the community.

ROSEANN DEMORO, EXECUTIVE DIRECTOR, NATIONAL NURSES UNITED: Our nurses are not protected. They're not prepared to handle Ebola.

COHEN: Another infection on the heels of shocking new allegations from unnamed nurses at the hospital who say there were no protocols to deal with Duncan.

DEBORAH BURGER, CO-PRESIDENT OF NATIONAL NURSES UNITED: On his return visit to the hospital, Mr. Duncan was left for several hours not in isolation in an area where other patients were present.

COHEN: All this released by National Nurses Union. The union wouldn't say how many nurses came forward nor would they identify them. The nurses say protective gear they wore left their necks exposed.

BURGER: The nurses raised questions and concerns about the fact that the skin on their neck was exposed. They were told to use medical tape wound around their neck that is not impermeable. COHEN: The hospital did not address the allegations directly but said

in a statement "Patient and employee safety is our greatest priority and we take compliance very seriously."

DR. TOM FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: We're not sure how she was infected but we're not waiting for the results of our investigation. We're immediately changing any procedure that we think can be improved to increase the safety of those caring for her.

COHEN: But an official close to the situation tells CNN that in hindsight Duncan should have been transferred to Emory or Nebraska, hospitals that are more than ready to treat Ebola. Remarkably Pham, the first person to contract Ebola within the U.S., says she's doing well and feels blessed to be cared for by the best team of doctors and nurses in the world.

JENNIFER JOSEPH, NINA PHAM'S FRIEND AND FORMER COLLEAGUE: I know for a fact Nina is somebody who never shies away from safety. We have an entire department on infection prevention and infection control in the hospital. We're briefed almost monthly on infection control.

(END VIDEOTAPE)

COHEN: I want to read exactly what that official told me. The official said "If we knew then what we know now about this hospital's ability to safely care for these patients then we would have transferred him to Emory or Nebraska," meaning Thomas Eric Duncan, the original patient. It's important to note, this hospital has treated one Ebola patient, two health care workers got sick. Emory and Nebraska collectively treated five patients, no health care workers got sick. Alisyn, Chris?

CUOMO: All right, Elizabeth, and obviously the important question is going to be, why is that? Is there something that's being done differently or is it just about being done better? So we have to learn going forward. Alisyn for more discussion on this.

ALISYN CAMEROTA, CNN ANCHOR: We are going to talk all about that, Chris. Joining us now is Dr. Anthony Fauci, director of National Institute of Allergy and Infectious Diseases at the National Institutes of Health and CNN's chief medical correspondent, Dr. Sanjay Gupta. Gentlemen, thanks so much for being here.

Dr. Fauci, when you woke up and heard our breaking news that there is another patient who has been diagnosed with Ebola in Texas, what did you think?

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASE, NATIONAL INSTITUTES OF HEALTH: Well, it's extremely disappointing and sad that this individual got infected. It didn't surprise me because it was very clear that the conditions that led to the infection of Nina Pham clearly were the conditions in which this person was exposed. And so I was not surprised. I was saddened and disturbed, but I was not surprised. So clearly there was something that went on in that setting that did

not totally protect those health care workers. And that's something that has got to be changed and that's the reason why the CDC has sent their team down there to try and find out what went wrong and to make sure that doesn't ever happen again in that hospital or any place else. We've got to protect our health care workers.

CAMEROTA: We sure do. And Dr. Fauci, it sounds like there were many things that went wrong in Texas. In fact this morning, the Thursdays are going public with the conditions. Let me read to you their list of things that worried them. Number one, they say that Thomas Duncan was left for hours in an exposed area before being moved into isolation. Number two, they say that patients who were exposed to Duncan were only kept in isolation for a day before then being moved to areas around other patients.

Number three, the nurses treating Duncan were caring for other patients at the same time. Number four, preparation for Ebola, they say at their hospital, Texas Presbyterian, amounted to little more than quote "an optional seminar for staff." Number five, in the face of constantly shifting guidelines, nurses were allowed to follow whichever guidelines they chose. That's, this is an incredible disclosure from the nurses. What will happen today at hospitals going forward as a result of this?

FAUCI: Well, first of all, I have no reason to not believe what those nurses are saying at all. If that's true, that's clearly not acceptable. So right now, as you've heard, what the CDC is doing, that they will deploy top teams to any hospital that has an Ebola patient, number one.

Number two, instead of there being passive training -- go to a website, here's a piece of paper -- to actually have drills where you have people who are experienced in this, practicing with individuals in hospitals, about showing them what to do. And that's exactly what you heard from the CDC, that they're ratcheting up in a much more proactive way as opposed to passive training.

CAMEROTA: But Dr. Fauci, how could this have happened? How could these conditions have been in place when Thomas Duncan showed up?

FAUCI: I can't explain it, we're going to have to go to the hospital and find out, which the CDC is there on site trying to find out what went wrong. I think everyone needs to realize, you can't deny it -- something went wrong in that hospital. Those two people should not have gotten infected.

CAMEROTA: Sanjay, we know that Thomas Duncan, they believe yesterday, it came out, that he was in contact with 70 separate people. Who as of yesterday, were under observation. Two of those health care workers now have tested positive. Do you think there will be others?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Most likely. I mean you know, it's hard to say. You don't want to say that because you hope it doesn't happen. But look, we don't entirely, we're not entirely sure why these two health care workers became infected. So until you can really pinpoint that down, you know, I think it's going to be challenging.

And I know you just asked Dr. Fauci the question about what happened at this hospital. I hope that the hospital comes forward and says if they can figure out what happened, not because you know, they want to beat up on themselves, but because I think there's probably a lot to be learned here for other hospitals. Something really did not work.

Again, I've made this point before, Alisyn. It really can work. We've seen people really stop transmission in really tough spots around the world, central and West Africa, in the past, I mean, you know, not having transmission from health care workers from the patients. And I think the fact that you have this wonderful hospital, and the hospital that has lots of resources, and now two people have gotten infected from one patient, it's crazy.

If I could ask a question as well, Alisyn, just pragmatically, Dr. Fauci, I know one of the vaccine trials is something you've talked about. There's obviously a lot of interest, and the idea that you could start to possibly protect health care workers who are understandably frightened. Is there any consideration to fast- tracking a vaccine of some sort? I know that there's one at the NIH. Are there other things that could help more immediately? Dr. Fauci?

FAUCI: Well, first of all, Sanjay, good question. We are fast- tracking it really quite fast. Right now it's in the phase one trial. We have all 20 of our volunteer there. We want to clear them for safety and then we're going to go out into an expanded trial that will be involving a larger, larger number of people including in West Africa, specifically in West Africa. And there will be people that are involved in the trial that will have access to the vaccine. It's going about as fast as any vaccine trial that I've ever been involved with over the last few decades.

CAMEROTA: Dr. Fauci, there are more things coming out from the nurses. And I don't mean to harp on this, but I just want to read some more. They just came out this morning, and this one is particularly eyebrow-raising. Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their heads and necks were exposed as they cared for the patient with explosive diarrhea and projectile vomiting. Why were they just using medical tape to protect themselves?

FAUCI: I cannot explain why they were doing that. If they're claiming that that's happened, I believe them, certainly. I have no reason not to believe them. But if in fact that happened, that is not acceptable that that happened. That's not acceptable. That would put them at risk, a, to have exposure of skin, and, b, for a tape, when you pull the tape off, you erode, you could inflame the skin. That is not a good idea.

CAMEROTA: Dr. Fauci, we really appreciate you coming on. We always appreciate hearing from you. We know you're busy. We're going to let you go right now this morning to attend to all the breaking news.

But Sanjay, I want to continue with you. So when you hear this list of complaints from the nurses, how confident are you that there are not other hospitals around the country this morning that are equally ill-prepared?

GUPTA: Well, let me address the last point you brought up with regard to the medical tape. So the scenario is this, we showed essentially what the protective garb as outlined by the CDC would look like. You know, putting it on, taking it off. This is the guidance that the Centers for Disease Control has been providing to hospitals. And you know, a couple of days ago we showed that in fact the neck was exposed.

And so, you know, you can imagine you're told these things about Ebola. You hear that the bodily fluids could potentially cause an infection and your neck is exposed. And then they're told to put this medical tape on. You know, to answer your question -- in some ways, it's not even so much that the guidance wasn't there. It's that the guidance is not good guidance. It doesn't seem to fit with what we know about the science of Ebola. If it can pass through any place in the skin where you may have a break, even a break that you don't recognize, for example on your neck, then you got -- you go the to protect the skin. It sounds very simple, but it just didn't seem to happen here even if they had followed it to a tee.

CAMEROTA: Right. So again, this morning, is there some sort of massive nationwide training session that hospitals, health care workers and nurses are sitting in?

GUPTA: Well, I don't know. I know they've been doing these large, sort of remote training sessions. I think there's people who are going to hospitals like the one in Dallas and providing training. I don't know if they're going to all hospitals. I can tell you when I was at the CDC a few months ago in their command and control center, they were talking about the fact they were doing these large calls with ERs, primary care docs, frontline doctors all over the country and going through the guidance, so some of that information may have gotten out there.

But the problem again is that, surprisingly, and I think you know, given how much time they've had here, surprisingly, it's not good guidance, it doesn't seem. Even if you got the guidance out there, it's got to be good guidance. And that's the part that's particularly, it's worrisome to me. It's not that challenging. We're not talking about some new experimental vaccine or experimental medication. We're talking about covering your skin, covering your skin, because that's how you get Ebola. If you're a health care worker taking care of a sick patient, that's the time they're most infectious. That's why health care workers do get sick. Cover your skin. Why that didn't happen is very concerning.

CAMEROTA: Yes, we can see the confusion. Sanjay, thanks so much for explaining all this. We will check back in with you. But meanwhile, let's go over to Chris.

CUOMO: And I think that Sanjay's frustration is well warranted in this situation because it is something that is not complicated to do. Sanjay himself has brought you stories about it being done effectively in the middle of nowhere in West Africa where it's done in tents, let alone in a top-notch facility like Texas Presbyterian. So that takes us to accountability. There are a lot of different people involved here, different agencies and alphabet soup acronyms. The question becomes, who is in charge, and do they know they have a problem at this hospital.

Listen to Jake Tapper talking to someone in charge down there in Texas about how they perceive how they've done so far.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: I can tell you from hearing that, they did a terrific job of caring for Mr. Duncan and protecting their employees.

JAKE TAPPER, CNN ANCHOR: What you've said just isn't true. They didn't do a great job. A great job is when you treat an Ebola patient and he survives, not you turn him away from the hospital and then he actually gets worse and then he comes back and then you treat him and then he dies, and no one else on staff gets Ebola.

(END VIDEO CLIP)

CUOMO: All right, now it seems painfully simple. Jake Tapper there talking to the former president of the Dallas Medical Association. This comes down, let's bring back in Alexander Van Tulleken, a doctor obviously, and Dr. Joseph McCormick. It's good to have both of you here. Accountability matters in a situation like this. It's not about a blame game, but it's about who's in charge, who's doing the right things, because this is not in-depth science we're talking about. What do you see with the experience you've had, Dr. McCormick in dealing with Ebola outbreaks and what it takes to get it right, what do you think is going on here?

DR. JOSEPH MCCORMICK, FORMERLY WITH WHO AND CDC: I think there was a certain level of confidence that was probably misplaced. The CDC has been there. I don't know what they've been doing, but they've been there. Clearly they've been in contact with the hospital. And yet, all of the litany of things that we've just heard were not done.

CUOMO: Right, because the NIH and the CDC both say they, they, they, but Dr. Van Tulleken, they are they, right? They're in charge, they're there in the hospital, they could be changing protocols like that. They know what to do.

DR. ALEXANDER VAN TULLEKEN, CNN MEDICAL ANALYST: It very interesting when you hear Anthony Fauci saying this shouldn't have happened. The necks were exposed. You follow the protocol exactly, as you said, and yet can you still get infected. So the sense I have is that we've been playing catch-up with every single aspect of this. And even when we had an infected nurse, we didn't take those other 70 people who were in the same situation as her, isolate them, start doing serial blood tests, start quarantining them, monitoring them.

So we still have the sense of, well, we're working on protocols. There are people literally right now, as we speak, in that room, having to follow some kind of protocol. We were just discussing, you know, what are they doing? Do they now have a --

(CROSSTALK)

CUOMO: And look, and this is something that will be a little bit of an insight for people watching. When you're running a hospital, you think you're a big shot. Something like this happens and you have monsters start falling on your head, with big federal agencies, and often it causes what they call paralysis by analysis. So many people telling you what to do, you do nothing.

Do you think with all the obvious things that are being missed here, we may be dealing with that as well?

MCCORMICK: We may well be. I think we should have started to ask ourselves a lot more questions after the very first of this episode when Mr. Duncan came back. That should have raised red flags right there. And somebody should have been asking questions about, OK, if you blew this one, what are you going to do next? And we -- and I'm not sure that happened.

And it may well be that simply they're overwhelmed with the enormity of this, the press coverage. I'm sure they're getting hundreds of phone calls.

Look, way down in South Texas, 500 miles away, we were getting phone calls about my cousin says there's a case over in Valley Baptist Health Center. I mean, this -- people have unrealistic, but there are fears. I suspect more of this is going on in Dallas. And that may be adding to the whole paralysis of unable to change. And then we heard Dr. Haley say, oh, everything is fine, they did a great job. And Dr. Haley is an old friend, but I must disagree with him.

CAMEROTA: That's not a great job.

MCCORMICK: Not a great job, no.

CAMEROTA: Gentlemen, stick around. We're going to go over to Michaela, because there's other news and headlines.

MICHAELA PEREIRA, CNN ANCHOR: Other news, and of course we will get back to breaking news. But right now, a few headlines.

Defeating ISIS is going to be a tall order, President Obama acknowledging that while meeting with coalition military leaders. He says the nearly two dozen countries are united behind this long-term campaign. ISIS advances continue, meanwhile, in Syria and Iraq, despite relentless air strikes. Militant fighters are poised to launch an attack on a major air base in western Iraq.

New details emerging now about the accused gunman who killed one American and injured another at a gas station in Saudi Arabia. The Saudi embassy says the shooter is a 24-year-old dual U.S. and Saudi citizen who worked with the victims until he was recently fired for drug issues. The two workers -- the two victims, rather, worked as defense contractors. The shooter was injured in the shoot-out with security forces.

Overnight, violence erupting once again in Hong Kong. Police fired pepper spray into a massive crowd of demonstrators who are trying to take over a major road outside government headquarters. At least 45 people were hauled away in handcuffs. Meantime, officials in the country launching an investigation now into a video allegedly showing a pro-democracy demonstrator being beaten by plainclothes officers.

Another big recall to tell you about this morning, this time Toyota recalling nearly 1.7 million vehicles worldwide, including more than 400,000 here in the U.S. These recalls address brake problems and fuel line problems. They could possibly cause fires. Toyota says it is not aware of any crashes, injuries, nor deaths as a result of those defects, but we wanted to pass that along to you.

Chris, Alisyn?

CAMEROTA: All right, thanks so much. So how can screening at airports stop Ebola from entering the U.S.? Temperature checks can help. But Thomas Eric Duncan would have gotten cleared anyway. We'll discuss what other steps can be taken.

(COMMERCIAL BREAK)

CUOMO: We do have breaking news for you. There is another case of Ebola diagnosed in the United States in Dallas. The person who has it is a health care worker who was helping to treat Thomas Eric Duncan, the man who died of Ebola there.

And as we know, the Liberian national flew into the U.S. and did not show signs of Ebola until after he landed. We also know that when he told the hospital of where he'd been, they didn't react.

However, let's deal with the air travel. Precautions are now in place at airports that likely would not have stopped Mr. Duncan from entering the U.S., ultimately ending up in Dallas. So what are these new precautions? Can they be effective? Does the U.S. need to consider something more severe?

Let's bring in Miles O'Brien, CNN aviation analyst. Miles, thanks for coming in on this. Let's start with the extreme, OK? We just had Congressman Sessions, the hospital in Dallas is in his district, so he's relevant here. He says 4,000 people with passports are out there. We can't control this travel. Just isolate. Isolate for now. That gets a lot of push-back. Your take?

MILES O'BRIEN, CNN AVIATION ANALYST: Well, first of all, I don't think it's possible. I mean, we live -- we're all in the same planet here and isolating this kind of thing is not going to happen.

CUOMO: Stopping flights?

O'BRIEN: Well, you know, but think of the humanitarian consequences of that. I mean, these are poor nations that are relying on the airlift capability.

CUOMO: So allow humanitarian aid, but no other travel. Do you think we can do it? O'BRIEN: Well, I don't think it's possible, first of all, and I think

the consequences of that are so great and so draconian that I think it is better to approach it the way it is being approached now.

Let's bear in mind, what we're talking about this morning is not another traveler that has caused the spread. We're talking about health care workers who may or may not have been using proper procedures, coming in contact with one person who got in before a lot of what we're talking was already in place. Now, he traveled. He asymptomatic. But this was before there was all that, the level of screening and the questionnaires.

Now, we do have to rely on people having candor and be honest about where they've been and who they've been in contact with. Let's hope that people will do that. We can't assume that to be the case. But I think, with proper procedures, taking the temperatures at various steps along the way on the trip and hoping that people are at least candid about who they've been in contact with, this can be nipped without doing the draconian measure of shutting down these countries, which are in desperate need of help right now.

CAMEROTA: How are the screenings going, now that they're in place at the airports?

O'BRIEN: Well, it seems like it's good. I've been looking at it, but I find it kind of surprising that in Paris and in Brussels they haven't started screening. Because most of the direct flights are going through those places. Now we've got them at JFK, that's good. Heathrow has started it up right now. It would be good if that first stop along the way -- and, you know, frankly, let's, you know, defense in death is the term they use in nuclear power. You want to have several layers of safety along the way.

CAMEROTA: In fact, if you don't catch it at Brussels and Paris, if you don't catch someone who's contaminated, then isn't it -- then you've exposed an entire plane on a trans-Atlantic flight.

O'BRIEN: Exactly. And think -- I was just at Logan Airport two days ago. We flew in and there was a plane completely surrounded by crash trucks. It had come in from the Middle East. There were four people on there who had fevers and they had completely cordoned it off. So there is -- you can tell people are spring-loaded for this. You could say, well, that's an over-reaction. But, in this context, maybe it's the right thing to be doing to presume this to be Ebola. I think the system now has awakened to this and you're not going to have a repeat of the Duncan situation exactly as it played out.

CUOMO: I wonder, though. I wonder, though, because, you know, Mick and I have been wondering about this since this began. You have this 21-day thing where you don't know right away if somebody has it. You have all these different ways to get into the United States. You have influenza. You have false positives. It just seems that if you're looking at this as a way to stop it, you're looking in the wrong place.

PEREIRA: Well, so interesting, though, what we were talking about is that Dr. McCormick was just on air, talking how instructive it is that it's health care workers that are getting sick. It's not the family members. And so far we haven't seen people on the planes getting sick. So it would seem that this testing is working, the screening is working. Is it effective, is it efficient, are we hearing about big lags now at the airport? Because you know that's when people will start pushing, right, Miles? Is when their travel is slowed down.

O'BRIEN: Exactly.

PEREIRA: But does it seem efficient, the way it's being done?

O'BRIEN: I haven't heard any ripple effects to this. I mean, the temperature-taking is a very nonintrusive procedure.

PEREIRA: And pretty quick.

O'BRIEN: And quick.

CUOMO: And it's only a few people.

O'BRIEN: Yes, and they're honing it down to just a small group of people coming out of these countries. So I think when you consider the grand -- the layers of security we already contend with, this is just a kind of the rounding era kind of stuff.

PEREIRA: I ask that, because then you can make it keep happening. If it's cumbersome, we'll get rid of it, right? So if it -- but -- so it's good to see that this is working and it's effective.

O'BRIEN: And you look at history, what happened with SARS in Asia. This, they were actually able to do this in a way that didn't slow down the system and choke it.

CAMEROTA: Miles, thanks so much. Great to see you this morning.

All right, we're going to have more breaking news this morning, with another case of Ebola at Texas Presbyterian. Nurses are furious about the lack of protocol. Wait until you hear the laundry list of complaints they have. Health care workers are speaking out about it so we will talk to a furious head of the nurses union about the latest developments.

CUOMO: And Dallas health officials are getting set to brief reporters on this latest case at the top of the hour. We will bring it to you live so you can hear from them what they say the situation is.

(COMMERCIAL BREAK)