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NEW DAY

New Ebola Case in Dallas; Officials Give Update on Ebola Cases

Aired October 15, 2014 - 08:00   ET

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


(BEGIN VIDEOTAPE)

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT (voice-over): 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 the 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 have interviewed the patient to identify any contacts or potential exposures in the community.

ROSEANN DEMORO, 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.

DEMORO: 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.

DEMORO: 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 in a statement said, "Patient and employee safety is our greatest priority and we take compliance seriously."

DR. TOM FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: 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 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, infection control in the hospital. We're briefed almost monthly on infection control.

(END VIDEOTAPE)

CLAY JENKINS, DALLAS COUNTY JUDGE: These tests will be double confirmed by the CDC.

CHRIS CUOMO, CNN ANCHOR: They're briefing reporters on the latest case of Ebola and what they're going to do to make things better.

Let's listen in.

JENKINS: Like Nina Pham, this is a heroic person. I'm sorry, I said like Nina Pham, this is a heroic person, a person who dedicated her life and is dedicating her life to helping others and is a servant leader. This is a person with their life before them, and a person who is dealing with this diagnosis with the grit and grit and determination that Nina has dealt with the diagnosis.

And like Nina, the protocol to find the virus worked well in that within 90 minutes of taking her temperature, she was in isolation in the hospital, and we hope that, and pray that, like Nina, she will get on a good track. As you know, Nina has moved from stable to good, and the doctor may have some information on her health when he speaks this morning.

So the fight against Ebola in Dallas is a two-front fight. We have 48 diseased contacts we focused on in the community that were contacts with Eric Duncan. The good news about those 48 people is they are asymptomatic and have no fever, and we are at the tail end of their monitoring period. Sunday will mark the end of that monitoring period, and the chance of those people becoming symptomatic at this point, or getting the Ebola virus, is extremely remote.

However, at the hospital, we have a situation involving 77 people, two of which have tested positive for Ebola. We are preparing contingencies for more and that is a very real possibility. You can imagine the anxiety of the families of these 77 people. You can imagine the gut shot that this is to the family that is Presbyterian Hospital, that has done a great job of taking care of this community for many, many years. I hope this community will rally around the human beings that are suffering and worrying now, even as they go about their calling of serving others.

Now, with me today is Dr. Varga, the executive vice president of Texas Health Presbyterian, who will speak next.

Mayor Mike Rawlings will speak after Dr. Varga, and we'll take some very limited questions after that time. We're giving you the very limited information that we have at present. We are continuing to get information and will be updating you throughout the day in a variety of ways.

And we have some very important work that I need to get to quick -- that the mayor and I need to get to at the conclusion of this.

So, Dr. Varga?

DR. DANIEL VARGA, TEXAS HEALTH RESOURCES: Excuse me, thank you, Judge Jenkins.

Good morning. My name is Dr. Daniel Varga. I'm the chief clinical officer for Texas Health Resources. And I want to thank the mayor, the judge, the CDC, state health officials, and the Dallas County Health Department for their continued partnership as we manage this unprecedented crisis.

As others have said this morning, today's development, while concerning and unfortunate, is continued evidence that our monitoring program is working. Currently, as Judge Jenkins says, we continue to monitor 75 health care workers in conjunction with the state.

And while I cannot discuss patient specifics, I can tell you this new patient was involved in the care of Mr. Duncan, the original patient whose passing we still mourn.

Our interests at this time, first and foremost, is making certain both our current patients receive the care they need. That will remain our focus. The health and safety of our patients and employees remains our highest priority and we will continue to coordinate with officials at all levels to meet the challenge that Ebola presents to our hospital, our community and our country.

A lot is being said about what may or may not have occurred to cause some of our colleagues to contract this disease, but it's clear there was an exposure somewhere, some time, in their treatment of Mr. Duncan.

Let's be clear, we're a hospital that serves this community incredibly well and we have for nearly a half a century. We're a hospital that may have done some things different with the benefit of what we know today, but makes no mistake, no one wants to get this right more than our hospital, the first to diagnose and treat this insidious disease that's now attacked two of our own.

After several weeks of great emotion and great effort, our team spirit is tried and tested, and the support of so many is really helping everyone to rise to continue to meet this challenge.

Thank you.

MIKE RAWLINGS, DALLAS MAYOR: Good morning. Another long evening and morning for many, many people. We rallied together and we decided that we needed to move quickly, like we did Sunday morning, to make sure two things happened. One, that effective cleaning was done as soon as possible, and, two, neighbors and the citizens were communicated.

It is no odd thing that we decided to do this at 7:00 in the morning, so when folks are getting up, they know what the facts are. It is a concerted effort, not only with the county and the state and the city, but individuals out there. This morning, Chief Brown, Chief Bright, our city manager, were all working coordination to accomplish our goals for this morning.

Dallas Fire and Rescue went to the 6000 block of Village Bend Drive, where they began phase one of decontamination of the common areas and the areas outside the apartment. Our patient lived alone and with no pets. The State of Texas has hired Protect Environmental for phase two, that inside the apartment and the cleaning of the car, and the movement of the same -- removing the same. That hopefully will be done early this afternoon.

I personally was at the apartment complex this morning and talked to citizens as they were waking up and moving about, which leads us to the second part of our strategy, communication. We work closely with the apartment managers in creating a strategy that I think is working. Each apartment in their complex was, the door was knocked on and we talked to as many people that came to the door as possible.

Same time, the apartment complex will be handing out flyers and information to apartment complexes nearby. So we cast the net a little wider. And then we had reverse 911 calls that went out at 6:15 this morning.

Meanwhile, we continue to not only monitor the 48 individuals that came in contact with Mr. Duncan, but we take care of Louise and her family, who are still in isolation. They are asymptomatic and they are doing well, and, as you know, we moved Nina's pet yesterday and are making sure that that pet is well and taken care of at the same time.

I think there are two things that I hearken back to this. The only way that we are going to beat this is person by person, moment by moment, detail by detail. We have those protocols in place at the city and county, working closely with the CDC, and the hospital.

The second is we want to minimize rumors and maximize facts. We want to deal with facts, not fear. And I continue to believe that, while Dallas is anxious about this -- and with this news this morning, the anxiety level goes up a level -- we are not fearful. And I'm pleased and proud of the citizens that I talked to day in and day out, knowing that there is hope if we take care and do what is right in these details.

It may get worse before it gets better, but it will get better.

With that, we will take a few questions, all right? And -- but there are a lot of questions we can't answer because either we don't know or because testimony and discussion is going to take place later this week. But we will try to give it a go and give you as much information as we can.

We'll start on this side, go ahead and we'll take a couple questions here and we'll move to that side. Yes, sir?

REPORTER: This is for Dr. Varga. Kevin Sack with "The New York Times".

Dr. Varga, can you talk a little bit about the hospital's view of how this is happening now. And obviously we're empathetic with what you guys are going through, but one case can be looked at as a possible breach. It seems like a second case might suggest some sort of systematic institutional problem. Can you fix that?

VARGA: I don't think we have a systematic institutional problem. I think the biggest challenge we have right now is obviously, first and foremost, the care of the two patients that we have, and the ongoing screening of folks in the community.

Our emergency department has continued to have folks come in. It's a tribute to the information that's been out there in the community, about folks to be aware of this symptomatology around Ebola. Our ED has been handling folks through that very appropriately.

I think the case of this patient here tonight again shows that the ability to intake those folks, get them into isolation, and manage them has been very effective.

But we're looking at every element of our personal protective equipment, and infection control inside the hospitals. We don't have an answer for this right now, but we're looking at every possible angle around this.

RAWLINGS: Thank you. Right down here, you raised your hand.

REPORTER: Was this person a nurse?

CUOMO: All right. Hearing the questions is going to be difficult right now but the answers matter, so we're going to keep listening in, and you'll see for yourself it's evident what they're discussing.

JENKINS: She is a woman.

RAWLINGS: Yes. Over here, what's the -- and then we'll come back. Go ahead.

REPORTER: Are you awaiting test results on any other patient -- any other employees? Because obviously this one was in the works yesterday during a press -- the other press briefing. And we weren't told.

RAWLINGS: That's the state's decision and I'll let them speak to that. Later today, there will be a discussion -- there will be a joint conference call, as normal, with the CDC and the state.

REPORTER: About this case or about another case?

RAWLINGS: About this case.

JENKINS: Yes. And let me, I'm not sure when -- what briefing you're referring to.

CUOMO: All right. We're going to try and give you perspective on what was just said and why.

Let's bring in CNN chief medical correspondent, Dr. Sanjay Gupta, CNN senior medical correspondent, Dr. Elizabeth Cohen, and Dr. Richard Carmona. He was the 17th surgeon general of the United States under George W. Bush, and he's a distinguished professor at the University of Arizona.

Just to reset what we were just listening to, press conference from the officials, local officials, important to note down in Dallas here. It was led by Judge Clay Jenkins. That will seem unusual. It is not in this area of Texas County.

Judge is given power over disaster preparedness and this falls under that. That's why the judge was there.

But, Sanjay, let me start with you. Who was not there is also notable. They said the things you expected them to say. We're doing our best, the monitor is working, the person who has this, a woman, they wouldn't say more than that, is a health care worker. She's (AUDIO GAP) doing her job.

Where was the fed and where is there an understanding of how to make things better because the person there, Dr. Varga, said no systematic problem here?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yes, I mean, there's a couple of concerns. The first point about the federal sort of authority here I think it surprises people that the Centers for Disease Control, as much as people think they will sort of swoop in and take care of a situation like this as it occurs, that wasn't the plan initially. We now know they're going to send teams to Dallas to help oversee what is happening there, but that won't the original plan and they don't have specific authority or mandate power in Dallas. They can't say you must do X, Y and Z.

So whether that relationship's going to change and some make the argument that look, this is no longer just a Dallas issue. This is a national issue that we have to have a federal oversight in some way, you know, that may happen.

And I think with regard to the protocols in place, Chris, I think there's two issues, just sort of trying to explain this as well as I can. Part of it is implementing the protocols the best that you can and the second part, are they good protocols? And I think both those things matter here. I don't know that these are necessarily the best protocols, because there was still so much skin exposed, for example, in these health care workers who had direct contact with patients, and that's obviously a big problem.

ALISYN CAMEROTA, CNN ANCHOR: Elizabeth, I heard some new things I want to bounce them off you in this press conference that we didn't know before. We found out this next patient, the second patient is a woman, and they said something that I thought indicated that she's young, he said the judge said "like Nina," who we know is a young nurse, "this person has their whole life before them."

They continue to monitor 75 patients, I think that's a higher number than we had originally thought. The new patient has no pets. They have canvassed the apartment building where this new patient lives and talked to neighbors and they will begin the process of cleaning and doing whatever they need to do in her apartment. What else did you hear, Elizabeth?

COHEN: Also, I want to touch on the first thing that you said, that this is a woman and I agree with you it sounded like she's young.

This doesn't surprise me. This is actually very simple. The health care workers that are most at risk are the workers who, one, spend the most time with the patient, and two, who are responsible for cleaning up. So we don't know perhaps this woman is a doctor, just if you look at gender roles in health care, it probably is a nurse. And so, those are the ones who are the most exposed.

CUOMO: All right. Elizabeth, thank you very much.

Let's get back into the pressers because they're taking more questions about what's going on there.

REPORTER: The question now is, are other hospital workers being monitored even at their homes or at the hospital because, if we had two that had -- that came down with symptoms very early on, are steps being made that they're isolated now?

(INAUDIBLE)

JENKINS: Let me --

RAWLINGS: And that will be our last comment.

JENKINS: That's going to be our last comment. We need your help on this. We have 75 people who are hospital workers and we don't want a situation where people are afraid that if they bump into an asymptomatic person who works at a hospital and has been involved in the care of Mr. Duncan at the Kroger's that they've been exposed to Ebola. Because what this case further illustrates, these two heroic women plight illustrates, is Ebola comes from the body fluids of a symptomatic Ebola victim, and that's how they contracted the disease. And that's how Eric Duncan contracted the disease.

You don't contract the disease from being around asymptomatic people. They are regularly testing their temperatures. We are going to set up a place where, if people want to be away from their family, they have the opportunity to do so. Or if, like Nina, they live alone with their dog and they choose to be monitored there, they can do that.

This is not going to be a situation where we're going to be protective orders on 75 health care workers. This -- the system right now is working. They are taking their temperature regularly. If they have a slight headache, a slight fever, if they get a chill because the breeze blows, they take their temperature. If they have any temperature or any other loose stool or any other system, they immediately go into isolation in the hospital and they are tested. And --

REPORTER: They're not working. (INAUDIBLE)

JENKINS: They are -- they are not -- they are employed but not working.

RAWLINGS: Thank you, guys. That's it. Appreciate it.

CUOMO: All right. Let's bring in Dr. Richard Carmona.

Doctor, thank you for joining us this morning. It is a little conspicuous who was absent at that presser. We understand that the county judge has broader jurisdiction than an ordinary county judge. But these are not experts on what's going on this. You have the CDC, you have the NIH.

Do you believe there say need for leadership there especially when you hear one of them say they don't have a systemic problem at this hospital?

DR. RICHARD CARMONA, 17TH SURGEON GENERAL OF THE UNITED STATES: Well, thanks for the opportunity to comment, and I'm, like my colleagues, Dr. Gupta and Elizabeth Cohen who have covered the story so well, Dr. Fauci and Tom Frieden, who have been at the forefront of this for us, nationally, we are all concerned there is a problem, from the first case that was diagnosed after Mr. Duncan died, we knew there had to be a break in policy, procedure, protocol, the type of equipment being used, and now it's becoming manifest because there are many more potential exposures.

So, I do have some significant concerns because of the complexity of the issue and the fact is that over time, since after 9/11, we put a lot of money, the federal government, into communities to hospitals to train for all hazards, which included bio events such as this.

The challenge of course is when you don't have these events for years, these are perishable skills. People forget. If you're not practicing, if you're not staying on the edge of the best science, you forget and when something happens gaps occur.

So, it's really important that they work closely with the CDC now to ensure that they have the best practices.

CAMEROTA: So, Dr. Carmona, when you say there is a problem, do you mean there's a Dallas hospital problem or there is a nationwide hospital problem here?

CARMONA: I can't speak to a nationwide problem. As surgeon general I was involved in a lot of the training, education, working with my colleagues at NIH and CDC to ramp up after 9/11 to ensure we had the best preparedness programs in place which included bio agents. The problem is after these things happen, our memories start to fade. Our government stops to fund programs. Research is not as robust as it should be and so on, so there's a rippling effect that goes out.

And again, the most important thing is if you're not training on a regular basis, if you're not being given the most recent information on a regular basis and going through scenario-based stressful training, these are perishable skills.

CUOMO: Understood, Doctor.

CARMONA: And that's where the risk comes in.

CUOMO: Understood.

Sanjay, let me get you back in here, though, because yes, you have perishable skills, you have to train and spend the money. However, Dr. Frieden, when he was in West Africa, you told me he had on the whole biohazard suit. That is not what these men and women who are doing the work on the front lines in the hospital in Texas have.

Why not? Why don't they have the stuff that Dr. Frieden from the CDC had when he went into an Ebola exposed environment?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: I think that that does --

(CROSSTALK)

CUOMO: Sanjay, go ahead.

GUPTA: OK. I think that increases the confusion a little bit around this, and whether you say that this is a double standard or you know, he was a government official and therefore they just were taking extra caution, you know, I think it's a really important point. You know, we see the hazmat suits. We see these full protective suits all the time, and then we hear that it's only really necessary if someone has direct contact with patients.

But what you're looking at is video of the head of the Centers for Disease Control, Dr. Frieden, in West Africa touring an Ebola facility, not taking care of patients, wearing the full protective gear.

Look, again, I don't want to overstate this, maybe it was just because he's a government official, they said this is what you have to do, but what does that mean for the people who are providing direct care for patients here in the United States -- they see their CDC chief not taking care of patients directly wearing all that garb and they're not wearing the same garb here. That sort of confusion makes it I think even more challenging for people to do their jobs and have confidence.

CAMEROTA: Sanjay, I have a question one of the things Dallas officials reported, they touted the success with this second victim, a female, they said within 90 minutes of taking her temperature, she was in isolation. Why not within five minutes of taking her temperature? What is so complicated about getting into isolation?

GUPTA: It should not be complicated, Alisyn. It should be fairly easy. I think the most important thing at that point, once there's a suspicion someone may have come in contact with Ebola and they have a fever, the most important thing, greatly limit the people now in contact with that person and who are is there is protected in some way, properly protected.

You know, whether it's 90 minutes or five minutes I'm not sure. I think the reason they call it a success is because they found somebody early and they will get treatment or get care early and this seems to make a big difference in terms of their overall prognosis. But yes, I mean ultimately if these numbers just start to grow they're going to have to have a system in place that very, very rapidly addresses what these patients need, and that is to isolate them so they don't get other people sick.

CUOMO: And, of course, the big concern is to make less patients, right? That's why we want to see what's going on in terms of being proactive, getting it right and going forward.

Dr. Carmona as a former surgeon general, can you speak to the need for leadership from the top in the press conference we just watched where there is no one on the federal level there? And, secondly, can you speak to what we keep hearing from experts that you don't have to wait 21 days. You could do blood tests much soon ear long to find out if someone exposed has actually now picked up the virus.

CARMONA: Well, all of those are important points, but as Sanjay has been outlining, I mean, this is very confusing because mixed messages seemingly are emanating from the local level to the federal level so people are confused. They're concerned.

You know, my heart goes out to this young nurse who has become ill, and one of the things I know because being a registered nurse as well as a physician is that your nurses are often the best barometer of the activity, the operations, and the quality of care that's being produced in any organization, because you're at the bedside 7/24.

So, these allegations are quite disturbing of using tape to cover a neck that could be permeable and trying to kind of jimmy-rig a system apparently that really wasn't meant to be used that way which exposes some of the challenges. So, I think we should listen carefully to what the nurses are telling us. I think we need to have the CDC team in there which is what I said, Dr. Frieden said, Dr. Gupta said early on, where there was an apparent break and need to find out where the wreak was. And as Dr. Frieden says, we have to look at our protocols, some of which are several years old to make sure they reflect the best science today.

CAMEROTA: Dr. Carmona, would all of this be streamlined if we had a surgeon general in place today?

CARMONA: Well, I think it would help. I know that's some might feel that's bias. But the surgeon general is the doctor of the nation, the surgeon general is a trusted, authoritative, authentic person that the public relies on for information whether it be smoking, obesity, terrorism, weapons of mass destruction -- issues that I dealt with when I was surgeon general but you are the chief communicator, you're the chief health officer.

And so, I think it is important that we have appropriately vetted senior public health official who has earned and merits the title of surgeon general to address these issues and coordinate all of those activities so that one person is speaking to the American public and allaying their fears and educating them at the same time. We must inform but we have to be careful not to enflame the public.

CUOMO: Right now, as you're speaking, Dr. Carmona, we're split screen and showing the people at home. This is footage of officers and emergency responders in the area where this second health care worker, this young woman lives. Obviously, they have to canvas the area to clean where she was and inform neighbors.

And that goes to what Dr. Carmona, Sanjay, was just talking about, which is enflaming the situation. This is difficult. You want to show urgency. You want to show that you're in control and that you have a serious problem, but you also want to show people that you are in control. It seems that second part is getting more difficult to communicate. Is that just cynicism or is that just a function of the facts on the ground?

GUPTA: No, I think you're absolutely right and I think that same sort of balance we saw even in West Africa, you've got to have a very strong front. Those officers now going to that apartment building, you can imagine what the people in the other apartments are starting to think. That's just going to create fear.

Is there a way around that? I don't know. They have to do their jobs here, but it's obviously going to make other people worried.

In West Africa, they were careful because they knew if they went to someone's house to see who their contacts may have been, those people would be stigmatized and ostracized, wouldn't be able to function within the community, the society anymore.