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Man Under Isolation Order With Dangerous From of Tuberculosis; Texas Family Hangings
Aired May 30, 2007 - 14:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
KYRA PHILLIPS, CNN ANCHOR: I'm Kyra Phillips, live at the CNN world headquarters in Atlanta.
ROB MARCIANO, CNN ANCHOR: And I'm Rob Marciano, in for Don Lemon, who's on assignment.
Keeping an eye on Atlanta, where a man is quarantined under armed guard with an extremely dangerous form of tuberculosis.
PHILLIPS: It's also the headquarters for the Centers for Disease Control. We're expecting a news conference any time with the latest on the search for others who may have been infected.
You're live in the CNN NEWSROOM.
It's the first federal quarantine order in more than 40 years, along with a global health alert, all of it sparked by one man infected with an extremely rare, extremely dangerous strain of tuberculosis. He's now under guard, right here in Atlanta, but he certainly didn't stay put earlier this month, and that has health authorities worried.
CNN's Elizabeth Cohen is at Grady Memorial Hospital with more.
Elizabeth, what have you learned?
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: What CNN has learned, Kyra, is that in the days before this man got on a plane from Atlanta, he checked with local health authorities, they advised him not to get on the plane, but then he said, "What if I wear a mask while I travel?" And authorities have told CNN that they told him that that would be OK. They concurred with his decision to travel with a mask on.
Now, all of this was before they realized that he had the extensively drug-resistant kind of tuberculosis. That's the kind that is particularly dangerous -- Kyra.
PHILLIPS: And we were talking yesterday just about how big this threat is, and there was a lot of confusion, Elizabeth, to his wife, who hasn't even shown traces of TB, yet there are passengers on the airplanes that were rows and rows behind him that are concerned that they might be effected.
Everybody is still being asked to get a test; however, the good news is that it's pretty slim that those that were not too close to him for long periods of time have been infected.
COHEN: Right. It's important to understand how TB works in general, and in particular with this man.
Let's first talk about how it works in general.
Your chances of getting TB when you are in line at the supermarket behind someone with TB, you're not going to get TB from that person. The chances are extremely low.
You get TB when you live with someone who has TB. And even then people don't always get it. You get TB when you're sitting next to someone on a plane for many hours, and again not even in that situation do people get TB.
TB is contagious, but not the most highly infectious disease out there. And this man in particular has a particularly low chance of giving it to someone. CDC, the health authorities tested him, they tested his sputum (ph), and found that he would be at extremely low risk of giving it to somebody else.
PHILLIPS: So what happens next for this patient?
COHEN: Well, we've learned that what happens next is that he is planning on going to National Jewish Hospital in Denver, where they do a very specific kind of surgery. They're experts at this, at taking the portion of the lung that is the most infected and removing it so that then the whole disease becomes easier to treat.
It's not known when he'll be allowed to travel to Denver. It's not known how he'll be allowed to travel to Denver. That's all going to happen in the future.
PHILLIPS: And Elizabeth, a lot of us got the booster shots as kids. Didn't this vaccinate us against TB?
COHEN: What you get when you're a kid is you get a TB test. You may remember it, it's that multi-prong test that goes into your skin, and that lets you know if you've recently been -- if you've recently been exposed to TB. It's a test.
PHILLIPS: All right. Elizabeth Cohen, live in front of Grady Hospital.
We'll talk to you throughout the day. Thank you so much.
And this health scare clearly shows that TB is a threat in the U.S., but it's even a greater risk beyond our borders. Take a look at these latest numbers from the Centers for Disease Control and Prevention.
There were 662 TB-related deaths in the U.S. in 2004. Worldwide -- and this might surprise you -- nearly two billion people are infected with tuberculosis bacteria. That's about a third of the Earth's population. Now, most of them never go on to develop active TB, the infectious form of that disease, but each year nine million of them do. And of those, two million people will die.
Now, once again we are waiting for a live news conference from the CDC on the tuberculosis scare. We aren't expecting Julie Gerberding, the head of the CDC, to speak, but a number of other experts that are involved with this case. We'll take it live as soon as it happens.
MARCIANO: Sadness, horror and confusion, the emotions running through a Texas town that's trying to come to terms with the unthinkable. A mother apparently kills her small children and herself. All were found hanging from a closet rail.
We get more now from Chris Hawes of our affiliate WFAA.
(BEGIN VIDEOTAPE)
OPERATOR: Hello?
UNIDENTIFIED FEMALE: Hello?
OPERATOR: Yes, what's going on?
UNIDENTIFIED FEMALE: My mom, Alejandra...
CHRIS HAWES, REPORTER, WFAA (voice over): But as the little girl spoke those words, Gilberta Estrada was already gone. When Estrada's sister went to check on her, she found the mother dead and her four little girls hanging from a closet beam beside her.
UNIDENTIFIED FEMALE: The children are sick, really bad.
HAWES: Only the tiniest, 8-month-old Evelyn, survived. Still breathing when her aunt found her, a sweater wrapped around her neck.
SHERIFF LARRY FOWLER, PARKER COUNTY, TEXAS: The 8-month-old baby is fine and is going to be held overnight, I understand, for observation.
HAWES: Detectives don't know how long the crime was planned or exactly how it was carried out.
FOWLER: My mind cannot get around how all this could happen. I mean, I really don't know.
HAWES: They do know the 25-year-old mother had been depressed. She separated from her common-law husband in February after getting a restraining order against him. She says he hurt her.
A relative tells us that man, the father of the three of her girls, is planning his children's funeral.
(END VIDEOTAPE)
MARCIANO: That was Chris Hawes of WFAA reporting.
Autopsies on Estrada and her daughters were to begin this morning.
PHILLIPS: There are new concerns about how long U.S. troops will stay in Iraq after some comments by the White House today. We'll take that live when it happens, but first we want to take you to the CDC, where we're getting an update on the tuberculosis scare.
(JOINED IN PROGRESS)
DR. MARTIN CETRON, DIV. GLOBAL MIGRATION QUARANTINE: We don't have a lot of new information for you today, but we understand there's a lot of interest and a lot of questions that you may have, and this is the reason we scheduled this media briefing.
I'd like to give you a short update on some of the -- some of the information we have, and I'll turn over some of the TB-specific questions to Dr. Castro after that, and then we'll open it up for questions and answers.
The good news is -- about the patient. The patient continues to feel well and be asymptomatic. He is currently still in isolation at an Atlanta hospital, and he's under the care of infectious disease specialists at this hospital.
The medical news that we have evolving also continue to be reassuring. As Dr. Gerberding indicated yesterday, we believe that his degree of infectiousness is quite low. And as she indicated yesterday, his sputum (ph) continues to be smear-negative. That is, we don't see the visible evidence of the tuberculosis bacteria on the stain, and we are still awaiting culture results from that which takes several weeks.
We cannot and won't talk further about this individual patient or the specifics of his medical care out of respect for his privacy, and that is a matter being handled between his health care providers and the patient.
We also know there have been a lot of questions about the quarantine and isolation process about the orders. And I'd like to first take a step back to inform folks about the difference between isolation and quarantine.
Isolation, as a public health tool, is used when we ask for the restricted movement of an individual who's already sick with a communicable disease, and in this case, XDR tuberculosis, who has already has evidence of disease. And as Dr. Gerberding indicated yesterday, this patient has clinical evidence of pulmonary tuberculosis, with extremely drug-resistant strain.
Quarantine, on the other hand, is when this restriction of movement is applied to an individual who has been exposed or suspected exposed, but has not yet developed disease. And so there's a clear distinction. As such, this patient is under an isolation order that was issued by the CDC. It is not a court order, it is an administrative order under the authority of CDC and under the Public Health Service Act statute to be able to issue this order to restrict his movement in order to protect the public's health.
And while, as we indicated yesterday, the probability of his being highly contagious is smaller, the consequences of spread of this germ are extremely high because of the extreme drug-resistant nature of this organism, and the potential threat this would pose to others who may be infected, especially those whose immune system may be compromised for any reason.
It is very, very rare for us to use federal authority to issue an isolation or quarantine order under the Public Health Service Act statute, and the reason for this is that, when these are needed, the vast majority of times the state and local health departments have the authority and their own laws to take care of those situations.
In this instance, the reason for use of a federal isolation order is because of the nature of international travel and potential for interstate spread. And so, under the Public Health Service Act statute, the authority exists for the use of federal isolation and quarantine to prevent the importation and interstate spread of communicable infectious diseases, we don't take this authority lightly.
This authority is used in this case as it applies to an individual, although occasionally this authority is used as it may apply to a conveyance or some cargo. In this case, the individual is under this isolation order in part because of the international arrival and because of the need to transfer him across state lines. We certainly hope that in the very near future that this federal isolation order will be able to be lifted and to resume a more normal approach to the covenant of trust for protecting the public's health risk in that situation.
This is an ongoing situation, and there are -- will likely unfold further. I'd like to also inform you about the -- a bit about the contact tracing information.
This investigation is just beginning. We're just initiating this. It is very challenging, as you're well aware.
There were multiple flights involved, only two of which that we have been highlighting as ones of concern to us because of the long duration, greater than eight hours in nature, in the confined setting of an aircraft cabin with many people on board. And so our focus has been on these two international flights, but we are piecing together the full itinerary, and have a list available to you of all of the flights, including the very -- the smaller flights within Europe.
The contact tracing investigation, as Dr. Gerberding indicated yesterday, is not an instantaneous process. One not only needs to reconstruct the -- accurately the airline flights, request the manifests through multiple government sources and multiple airlines internationally, then take that manifest information, identify where the individual is at, and from there try to develop and retrieve locating or contact-specific information in order to find those individuals.
This is a cumbersome and difficult and challenging process. We wish that this were something that could occur much more swiftly, but currently this takes time.
It is for this reason that we've also elected to share publicly with you the names of those flights, and we have some information about the specific seats that we can make available in order to have those persons who may self-identify to us by calling the CDC info line, 1-800-CDC-INFO, in order to get further, very specific advice in terms of managing the risk.
This contact investigation is a cooperative international effort with multiple countries and partners. And it is proceeding in that vein, and we are still learning more as we speak. But let me give you a bit of additional information in terms of the numbers of individuals, and some of -- and highlighting some of the specific flights.
The outbound international transatlantic flight that occurred on May 12th from Atlanta, arriving May 13th in Paris, was an Air France flight, number 385. And this was also, we've learned, a Delta code share 8517.
In total, there were 433 -- or approximately 433 passengers on board, with 18 crew. This flight, although routinely scheduled for just over eight hours, we understand had some delays and potentially up to 30 -- 13, excuse me -- 13 hours in duration. And thus qualifies under those WHO guidelines.
The persons, according to the WHO guidelines who we focus on and follow are the two rows in front, the row of the index case, and two rows behind. So these five rows in total constitute somewhere in the range of 40 to 50 passengers who would be a priority for initiating outreach and contact. And as well as all 18 crew members on that flight.
The other flight -- and at this point in time we know from the patient approximately where he sat, and from our international partners, somewhere in the section in the bottom part of the plane between rows 14 and 57, likely somewhere around row 51. But we don't have the specific seat number at this time and are working that issue currently.
On the return flight, which was much more recent, our Canadian partners have provided -- had received the manifest and have much more information. The patient sat in seat 12-C. This occurred on May 24th from Prague to Montreal on Czech Air Flight 0104.
There were 191 passengers and nine crew on this flight. Approximately 30 persons were in that risk area, two rows in front, two rows behind, who are the highest priority for actively seeking and following up at this point. That flight, too, is reported to have lasted greater than eight hours in duration.
The other flights, which we can make available to you after this, involved the routing from Paris to Athens, from Athens to Tira (ph) Island in Greece, on Olympic Air, from Mykonos to Athens, Athens to Rome, Rome to Prague. And again, the last return on Prague to Montreal.
And as you're aware, the passenger -- the patient and his spouse traveled by vehicle over land from Montreal into the United States, and we made contact with him on Friday afternoon between Albany and New York City. And then Dr. Gerberding informed you voluntarily and swiftly the patient was isolated in New York City on Friday through the weekend until we were able to arrange his transfer down to here.
I want to emphasize that the focus of the international air contact investigation is really right on those two transatlantic flights. We will also provide a schema of those flights, the aircraft frame, and the indication of rows.
And anyone who was on those flights who wishes further information for contact and follow-up, which would include a baseline skin test and a repeat skin test in eight to 10 weeks, can call CDC info, 1-800-CDC-INFO. We will also actively be reaching out to those individuals once we have the full manifest and the passenger information.
The way this contact investigation will go in an international framework is the citizens of their respective countries will be contacted by the public health authorities in those countries as we share and distribute. And we've been actively having conference calls on a daily basis with international partners in this regard.
I think at this point I'd like to turn the update over to Dr. Castro to give you some update on the TB and the XDR-TB status, and then following that we'll take some questions.
QUESTION: Would you mind just saying your name and spelling it for us?
CETRON: Sure. My name is Martin Cetron, the director for Global Migration and Quarantine at CDC.
Admiral Castro?
DR. KEN CASTRO, DIRECTOR, DIV. TUBERCULOSIS ELIMINATION: Thank you. Good afternoon.
Again, I'll reiterate. I'm Kenneth Castro, assistant surgeon general in the Public Health Service and director of CDC's Division of Tuberculosis Elimination.
Tuberculosis continues to be one of the most common communicable diseases throughout the world, with the World Health Organization reporting approximately eight million person per year and accounting for about 1.6 million deaths. The presence of Extensively Drug- Resistant Tuberculosis was recently defined as recent as 2006, implying that we're dealing with bacteria that are resistant not only to the most important first-line drugs, but you're also losing some of the most important second-line drugs, leaving relatively few choices for appropriate treatment, and the reason for the concern and not wanting anyone infected with these types of strains.
The flight, as you've heard, of concern is a flight that's over eight hours in duration. And we usually rely on established criteria based on previous investigations that have set the scientific basis for these types of policies. Our standard operating procedures are always to identify persons who have been exposed, all for an initial evaluation at baseline, repeat the evaluation within about two months to identify anyone who has been recently infected.
In the case of tuberculosis, there are two stages to tuberculosis, one that we most commonly call latent tuberculosis. So after exposure to air that is containing these bacteria, you can become infected. Then following that infection, it may take some time for you to develop the antibodies that would manifest as a positive skin test. That's why we do the follow-up investigation within about two months, and no more than three after the exposure has occurred.
It is important to identify that person who have latent tuberculosis infection pose no threat whatsoever to those around them. They carry a risk of progressing to developing tuberculosis disease if they have debilitating conditions, such as HIV infection, such as cancer, poorly controlled diabetes, and several other conditions, and that's why we also want to make sure, to acknowledge that patients on the flight who may have not been seated in the vicinity that we're targeting get offered the ability to be tested.
We will then make sure that the appropriate medical evaluations take place in their respective countries of origin. And as you heard Dr. Cetron, we are working with the authorities to accomplish that both in the United States and overseas. And it's been very rewarding to see the response from all our partners both in North America, as well as in Europe, as an initial response.
Dr. Cetron, let me turn this over to you.
CETRON: I wanted to just also update the other flight numbers for the smaller flights so that people wouldn't be under the mistaken impression of all of the routing between those. And so let me go through them systematically. We'll also make them available on the CDC Web site after this press conference.
So the flight from Paris to Athens was on May 14th. It was an Air France carrier, and the flight number is 1232.
On May 16th, Athens to Tira (ph) Island in Greece was on Olympic Air Flight number 560.
On May 21st, Mykonos to Athens on Olympic Air 655. May 21st, Athens to Rome on Olympic Air 239.
And May 24, Rome to Prague, on Czech Air 0727. And then again May 24, Prague to Montreal on Czech Air 0104. And that was the recent transatlantic return.
At this point I'd like to open the floor for questions. We'll start with some questions in the room.
QUESTION: Can you explain again -- can you explain again why you're concentrating just on those two flights and less so on the other flights?
CETRON: Yes. TB is spread via an airborne route with prolonged and continued exposure. And from some of the evidence that Dr. Castro shared with us yesterday on previous flight investigations, flights shorter than eight hours in duration did not pose a significant risk. And so we're really concentrating on those prolonged flights with greater than eight hours in duration that would be compatible.
I don't know if there are other...
QUESTION: Is it possible people on those smaller flights could be infected? Or is that just -- it's not even plausible?
CETRON: Dr. Castro?
CASTRO: The risk of tuberculosis infection in a short flight is very low, so much so that we haven't targeted these flights. Of course we acknowledge that people are going to be worried. And that's why we're making available opportunities for those who are concerned to seek medical evaluation and get tested.
So, the fact of the matter is, I would assume that we're not going to find any infection, but we will certainly make sure that we deal with concerned citizens who want to be tested.
CETRON: Yes. We appreciate people's concerns, but we've got to...
QUESTION: Eight hours is the cutoff?
CETRON: That's the cutoff according to CDC and WHO guidelines, correct.
QUESTION: The father of the TB patient has told us that no one told his son specifically not to travel, and his son asked doctors before traveling to Europe whether he was a threat to anyone, and that he was told no, he was not. He says doctors did tell his son they preferred he not travel, but that dad says he asked if the son -- if they were saying, so just to cover their posteriors -- not the exact wording -- and they replied yes.
Can you respond to that?
CETRON: We can understand that that's their perspective, and they have shared that perspective with us.
We were told other things by those involved. Neither Dr. Castro nor myself were in that conference. CDC was not, you know, engaged in that discussion, but it is our understanding that a family conference was held with Fulton County Health Department, and clinicians and the patient and his family, and that they were advised that he had multi- drug-resistant tuberculosis disease with an indication of pulmonary tuberculosis and advised against travel.
And so that's where you have it. It is -- it has been clear that there wasn't a legal order issued to the patient, although -- in terms of not traveling -- but it's a different understanding of what took place and what occurred in that conference. I would suggest since we weren't directly involved in that, that that question be more appropriately directed to the officials of the Fulton County Health Department.
QUESTION: We understand that this man's wife is not infected, does not have any symptoms. Do we know about his other friends and family? Have other people been tested? And if so, has anyone been infected?
CETRON: So the investigation of contact tracing goes beyond the air contacts, as you're alluding to, and is quite appropriate, and that is just beginning. And we're understanding that the close contacts on the ground are being reached to now to have that testing.
I'm not aware of the results of that. It would take some time for that to occur. But you're correct that the wife, on her initial testing, we understand, had tested negative. That needs to be repeated, as Dr. Castro...
QUESTION: (INAUDIBLE) that she tested negative? Does that say anything about his level of contagiousness, if you will?
CETRON: I think -- I think we're greatly reassured by her initial negative test. Of course, as Dr. Castro indicated, there's a long incubation period, and those are baselines that need to be repeated. And she needs to be followed.
I think that is reassuring. We also don't know at what point in time the patient himself was exposed, and that is an on going part of the epidemiological investigation as well. So, we're still working through that. It's really early. But those are encouraging findings.
QUESTION: Doctor, you talked about the patients -- or the passengers who may have been sitting next to this patient. Can you talk about people who may have been in the terminal, who may have been sitting next to him for long periods of time, hour, hour and a half, before they boarded the plane? Are they in any danger?
CETRON: You know, by and large, as Dr. Castro indicated, tuberculosis is spread through prolonged contact, and the kinds of -- the kinds of casual contact that you may see in line, or, you know, passing in the street or in the airport outside of it is not the kind of contact that transmits tuberculosis. So, those people should be reassured this is not the kind of pathogen that is transmitted by short, casual contact. And that's why we focus on these long-haul, confined spaces with contained air circulation.
QUESTION: You mentioned that it looks like you're looking at about 50 -- 80 passengers total between the two flights that you're concerned about, 30 in one and 40 to 50 in the other. How many of those have you been able to reach?
And also, you mentioned that long periods of time is when you have to spend with somebody where you could possibly be infected. What about people who work with him, spend eight hours or more in a confined space with him? How are you checking on those people? Because you don't know how long he's been exposed.
And finally, you're not revealing his name for privacy reasons. Is that a legal or is that a medical decision? And at what point does the public have the right to know -- for instance, coworkers, et cetera -- versus the personal privacy rights?
CETRON: I'm going -- I'm going to defer to Dr. Castro for the contact tracing characteristics. Dr. Castro's been doing this for years and years for tuberculosis.
Regarding the -- when you said focusing on those 80 or so, this is the priority given the risks as the science we have currently today. We are reaching out more broadly and we're working through you to have those people who were on those two long-haul flights to contact us if we aren't able to reach them through that specific contact information.
We are still trying to get not just the manifest and the name and the country of citizenry, but actual locating information for those individuals. This takes time, longer than we'd like and longer than is necessary in an era where we have to track emerging pathogens across air flights. And we hope that system will be fixed and streamlined and improved in the future, but that takes time, which is why we're hoping that you will help us bring these folks forward so they can be evaluated.
It is important to note that there is a long incubation time and that people won't develop pulmonary tuberculosis after exposure in an overnight fashion. This is a process that goes weeks to months. And so there is time. Now, there is an urgency in getting a baseline skin test so that that can be compared and we can identify a recent conversion.
With regard to contact tracing of his work contacts and so on, I'll defer to Dr. Castro.
CASTRO: Thank you. I alluded to our standard operating procedures for any time anyone with tuberculosis is found, and what we normally do is we have a gradient of investigations that start with the closest contacts and keep moving out as you identify persons with infection.
If you test the close contacts, as was alluded in one of the questions, and find no evidence of infection, you're not very justified to keep testing many other persons. On the other hand, if you start finding infection, then you start testing people who are more casual contacts, you start with the family, workplace, leisure, and you cover all these areas. The local health department is addressing that, and that investigation is taking place.
I'd also like to go back to a question that was asked about the potential risk of infection. There are several factors that contribute to the risk of infection. One is the extensive pulmonary disease. Second, the symptoms available, and third, whether the smear -- the respiratory secretions present the bacteria as seen under the microscope.
We have reassuring evidence from the relative causity (ph) of symptoms, the fact that the smear has been negative by microscopy, positive by culture, that this would be less infectious than the usual person. However, it's also important to acknowledge that, as Dr. Gerberding acknowledged yesterday, in places like San Francisco and Vancouver, they have demonstrated that about 17 percent of their TB cases seem to be accounted for by people who are smear-negative but culture-positive.
So, clearly the concern is there. We can offer a certain level of reassurance, but the reassurance will really come with the investigation and the actual facts that unveil during the investigation.
CETRON: I'd like to take some calls from the phone. First caller, please.
UNIDENTIFIED FEMALE: Thank you, Doctor. Our first question comes from Robert Versel (ph) of NBC News. Your line is open.
VOICE OF ROBERT VERSEL (ph), NBC NEWS: Hello, thank you for taking the call.
I have a question about airplanes. Did the CDC offer to fly this man home from Europe when they made contact with him in Europe? He has told the media that he did -- that there was no such offer, Tom Skinner (ph) was quoted as saying there was. Could you clear that up? The second thing is, why did you fly him to Atlanta when there are reports that he's ultimately getting his treatment at Denver?
CETRON: Those are great questions. Thank you. When we reached him -- finally caught up with this individual in Rome, one of my quarantine officers who spoke to him to share the information about the progressive culture results, and to make clear under no uncertain terms should he use commercial aircraft, we also indicated that we were looking at and working options to safely arrange his transport back to the United States.
That would require some time. We indicated a couple of places where he could reach out and get some assistance, including the American Embassy. We also identified a former CDC colleague that worked for Dr. Castro, the TB division, U.S. physician who was working with the Ministry of Health in Italy that could help identify possible places to be evaluated in Rome, and that we needed to get back to him.
At the time, we were having high-level discussions at CDC, including the use of -- CDC assets to fly to Rome and retrieve this person and having the discussions as people know, that is not a snap of the finger kind of thing to do, having those discussions. They were under way at the time and plans were being made for that as one of the options, along with other systems, including other forms of air ambulance, et cetera.
Unfortunately, we were told by our colleague, that when she went to the hotel to find the individual in order to convey more of this information that things were ongoing, that he was no longer there. So, those options were constrained by the fact that we no longer knew where the individual was for a fair period of time.
Did I answer both of those questions? OK. Maybe one more question from the phone. Lauren Neergard, A.P.
UNIDENTIFIED FEMALE: Thank you, Lauren Neergard, your line is open, from the Associated Press.
VOICE OF LAUREN NEERGARD, ASSOCIATED PRESS: Hi, thank you.
If you could tell us a little bit more about the points where he eluded you and how you might improve that in future cases, especially with diseases that would spread through more casual contact, did you actually consider asking Italy to quarantine him locally? And can you talk us through how the no-fly list, the steps of that went in place and where perhaps the airlines didn't catch him?
And then you also alluded to the difficulty in contact tracing through airlines. I know you had been working to create an electronic database with the airlines. Where does that stand?
CETRON: That's a great set of questions, Lauren.
We were exploring all sorts of options to remove the public health concerns that he represented, not just to the U.S. citizens, but others around. And as I indicated, one of our former CDC colleagues worked with the Ministry of Health, and we were looking at options for the temporary isolation and assessment phase in Rome as well as other potential options that are under way.
We reached out on Thursday afternoon to federal partners to see what options there were to get help in identifying where the individual may be and what we could do to alert potentially folks at international airports, so they would let us know if they had found him. Unfortunately, at the time, those discussions were ongoing, we have subsequently learned that the patient around that same time was already landing in Montreal via Prague on that flight. So, while we reached out to our federal partners and colleagues to use these tools, it was really sort of too late at that point in time.
You're right about the manifest problem, we've had this for years. Those of you who've followed some of the issues we've been developing, are aware that we have a new proposed quarantine rule, which would include the ability to request and access electronic manifest records within 24 hours that requires some database adjustments. That rule has gone through.
Public comment, we're compiling those comments and hope to move forward to a final rule on electronic manifest information with the fields that we need in public health to find people, to locating information is different and being able to build that into a system. So that -- we hope to be able to expedite and bring to closure very quickly.
I think there was a question from NBC about why he was asked to go to New York and why he was transported to Atlanta. That was the first time we connected with this individual, and New York City was the nearest point in which we could isolate him and evaluate his condition and confirm that the previous lab results, which were now quite old, that he was still smear-negative. We needed that period of time, so he was issued a temporary federal isolation order in New York City in order to accomplish that evaluation, where he spent the weekend.
The patient was offered by me a number of different options in terms of where to from there. One option included staying in New York City if he wished to begin and initiate treatment. Another option was to come home to Atlanta on the CDC aircraft, escorted in a safe way. And the third option was potentially to move to National Jewish. That option required additional logistics which couldn't be accomplished at that time, and the patient opted for a decision. He called back to us and said I'd like to come to Atlanta. So, that's why he was transported in that fashion.
QUESTION: Can those logistics be accomplished now?
CETRON: We're working right now on a plan to ensure that the patient can safely move across interstate lines and get the care that he wishes and needs at National Jewish Hospital in Denver, but that will take -- again, that -- we're working on those plans.
QUESTION: That's something you would actually end up doing? (INAUDIBLE).
UNIDENTIFIED MALE: Guys, would you use the microphone, please. Mike, somewhere (ph) in the front.
CETRON: Mike.
QUESTION: Doctor, you said a second ago in response to Lauren's question that you were having those discussions with other federal officials about the no-fly order. You found out he was already landing in Montreal. How did you find that out? Also ...
CETRON: We subsequently interviewed the patient up in New York City by our apee (ph) team, and he told us the flight that he took from Prague to Montreal and what time that flight touched down. We went back and looked, and it was at the same time we were actually initiating the conference call federal partners.
QUESTION: You found out later. Also, to clarify, you -- you haven't actually been in -- health officials have not been in contact with anyone yet on those flights, those two trans ...
CETRON: Through the manifest, we haven't reached actively to any of those individuals that I'm aware of as of this morning's international conference call. Now, really, the real answer to that is that this contact investigation is going on in several countries, and, you know, each country is working that issue, so I can't speak other than from the U.S. perspective, but we have received as of Dr. Gerberding's call yesterday, reports back to us of several individuals on these implicated flights and have been -- begun providing that information, what they need to them.
So, people have been reached, but through the manifest system that I described on the -- the active site, outward, we have not, for the airline investigation, not reached them yet.
QUESTION: And how many people on each of those five flights in your ...
CETRON: Yes, the smaller flights, we're still reconstructing the number, the seating and the number of passengers on the smaller European flights that were of short duration.
QUESTION: If the patient is going to be going to Denver, is that something that you would actually be carrying out?
CETRON: The patient's transport to National Jewish Hospital in Denver, in order for him to get the care he needs, would be under -- because it's an interstate movement, and because of his situation, would occur under a continuation of the CDC isolation order, and we will prepare all of the logistics and arrangements to do that in a safe manner that protects public health.
That transport is being worked in conjunction with the patient's insurance provider. We -- and exactly the specifics of that logistics I'm not aware of where we are on that. But we will be involved in that transport to make sure that there's no public health risk.
QUESTION: And as was brought up earlier, how are you trying to balance the patient's right to privacy, with the public's right to protection?
CETRON: I think the way to balance that is for us to basically through interviews with this patient, identify the circle the concentric circles of contact that Dr. Castro indicated, find those people. It's not as large a number of folks. It's still challenging number, but it's not thousands and thousands, and it's a contact investigation that we reach out to those individuals who believe they were exposed.
The passenger -- the patient has been fully compliant in giving us the names of these different flights and helping us to assist in identifying those who may be at risk. That's how we're doing that. I don't think publicly naming the individual, which we never do, has any advantage in achieving that part of the contact information since this is not a disease that is spread by casual interactions with the public.
QUESTION: Has his condition worsened from before he left for Europe, and is he showing any actual symptoms now? CETRON: I believe that his condition is stable, from what's been reported to us, and in terms of symptoms he has evidence of pulmonary tuberculosis with this drug-resistant organism.
But he doesn't have the overt symptoms of active, hectic cough, or coughing up lots of sputum, or coughing up blood, God forbid. We are grateful that he's a healthy individual, and so all these things contribute to the fact that his infectiousness risk, as Dr. Castro indicated to others, is on the lower end of the spectrum, but certainly not zero.
And as I indicated earlier, the context of the pathogen he has is one in which the consequences of spread are quite high. So that's why we have actions we have.
QUESTION: Would you consider this a blatant disregard for the public's health, or do you really believe that at this point in the investigation, he didn't think he was doing anything wrong? And number two, could he face any sort of penalty, any sort of fine, any sort of charges for what he's done?
CETRON: As Dr. Gerberding indicated yesterday, the patient had from his own perspective, compelling reasons to travel, and there were no legal orders in place preventing his travel and no laws were broken. Since we've issued our federal isolation order, he's been fully compliant and, you know, I believe figuring out, you know, that aspect of the past is not nearly as important as taking the perspective and moving forward, aligning his interest and needs for care and treatment, to get well, and the public's health interest and needs in the same place, right now, is where our focus is.
QUESTION: What can you tell us about what this gentleman does for a living, where he works, even in what county he works? And what words of advice would you give to the other passengers on those long flights who may not have sat within two rows forward or back of him, but who are probably worried about, right now?
CETRON: Right. And as Dr. Castro indicated, I'll let him speak to that, we are reaching out to all the passengers, that goes beyond the WHO guidelines, in providing information. Some basically reassurance and some the fact that they have the opportunity to get baseline skin testing and then repeat skin testing in two months, and we'll continue to engage, consulting with their providers and health departments on how to manage it.
We all hope there will be no secondary transmission or cases related to this and we'll all be greatly reassured, regarding his employment and place of employment all those things, I don't have that information, and we'll be active finding thousands contacts.
CASTRO: I can reassure you that without having to disclosing personally identifying information, the health department has that information and is reaching out to those individuals who need to be tested.
CETRON: I'm going to take a call from the phone, police, Richard Knox, NPR?
QUESTION: Thanks very much. Still not clear why the ball was dropped in several places there in this narrative. For instance, in letting him travel, in this era of CRCB, if any MDRX-TB could be extensively --
CETRON: I'm going to repeat what I thought I heard, was did CDC or public health let him travel with MDRX-TB?
QUESTION: I'm sorry. I had a problem with my headset. I took it off. It's not clear why the ball was dropped by anybody or who it was dropped by, at several points. First of all, when he had MDR-TB, in an era of (INAUDIBLE) is it a good idea for anyone to travel? And what could have been done to prevent it from happening in the first place?
Secondly, the no-fly order that was issued, do we have any information to why Czech Airlines didn't know about that?
CETRON: OK. Richard, I think, there's a difference of opinion about whether anybody condoned his travel. I think it's very clear from the conversations we had with the health department that they clearly told him not to travel, and they were aware and he was aware that he had MDR-TB, at least on the 10th of May before he traveled on the 12th, and he was clearly instructed not to.
My understanding is that a written affirmation of that was being prepared to hand to him and arrived after he had already departed, and so that's where that gap occurred. And as Dr. Gerberding indicated yesterday, in many ways we balance individual freedoms and public good, and we depend on a covenant of trust and not every one of these situations -- in fact, the vast, vast minority of situations of infectious tuberculosis, drug resistant or otherwise, require legal restraining orders in order to keep people from moving, in order to encourage them to do the right thing.
The preferred approach is to work with that covenant. And, as she indicated in this case, the individual had a compelling interest from his own perspective to initiate that travel out of the country. I think you were then referring to the ball drop on the return side from Rome --
PHILLIPS: Alright. Very interesting point that Dr. Martin Cetron pointed out there, he's the Director of the Division of Global Migration and Quarantine at the CDC. If you're just tuning in, we're taking this live news conference about this patient infected with tuberculosis that flew on two transatlantic flights. Of course it's been a tremendous scare throughout the United States, even overseas, wondering who could be infected, if indeed that's the case, what's the deal with this patient? Is he in quarantine?
A couple things we can try and hammer out for you here right now. We can tell you he is in isolation. This patient with TB is in isolation, not in quarantine. He's at Grady Memorial Hospital here in Atlanta, Georgia. He is going to be taken to a special hospital in Denver that specializes in respiratory disorders, and he will be treated there.
Still, the question is how long will he be in isolation? Will he be able to live a normal life? Will he be released? No one seems to be asking that question at this point so we can't answer that. We just know he'll be transferred to another hospital, which gets back to why did he travel and was he advised not to travel or not? You could hear the doctors right there at the CDC say, look, he was warned, he was told not to travel.
CNN also gained an exclusive interview with the Medical Director of the Fulton County Health Department, Dr. Eric Benning and he was asked the same question. This is what he said about advising this man not to travel.
(BEGIN VIDEO CLIP)
DR. ERIC BENNING, FULTON CO. HEALTH DEPT.: He was told at least on three occasions -- not three different occasions, but during a meeting, on three different times at least, and his personal physician concurred with that recommendation.
(END VIDEO CLIP)
PHILLIPS: So now you're hearing doctors come forward, you heard even the doctors at the CDC saying, hey, this patient was warned not to travel with the infectious disease that he had, that they were advising against that.
However, it was pointed out at that news conference that no legal order was issued. So the question is, why wasn't one issued? Is that not normal procedure? But that point was made, they want to balance personal freedoms and let the patient make the choice, even when they advise that individual not to travel, still no legal order was issued. So lets go a step further, was the patient advised to travel if indeed he decided to, with a mask? This is what Dr. Benning said.
(BEGIN VIDEO CLIP)
BENNING: Wearing a mask is one of the things that we suggested to him.
UNIDENTIFIED REPORTER: You did tell him to wear a mask if he traveled.
BENNING: We suggested to him to wear a mask, and my understanding is that he did actually have access to masks.
UNIDENTIFIED REPORTER: But he did not -- did he indicate whether he wore them or not?
BENNING: I haven't spoken to him about what he did on the plane. So I don't know whether he actually wore the mask or not, but he indicated a willingness to do so when I met with him.
(END VIDEO CLIP) PHILLIPS: OK. So bottom line, this is what we know as we hear from doctors, we hear from the CDC. No legal order was issued to tell this patient with TB not to travel.
It looks like at this point, it was up to the patient whether he wanted to travel or not and put others possibly at risk. You hear from Dr. Eric Benning there at the Fulton County Medical Center that they were saying they advised him not to travel, but if he did, to wear a mask. Obviously that did not happen.
Now this individual with TB being moved to a special hospital in Denver. We'll continue to follow up on the risks to those that flew with him on those two trans-Atlantic flights. That information is being released, still every passenger on those aircraft are asking -- doctors are saying getting a test for TB. And we'll continue to follow the story and try to hammer out all the details.
MARCIANO: Definitely a lot more questions that have to be answered.
Well, trying to move heaven and earth in search for their missing daughter. Madeline McCann's parents seek help from the Pope and everyone else that they think that can help them. We'll talk about that ahead in the NEWSROOM.
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MARCIANO: You may remember the hit by Simple Minds, "Don't You Forget About Me." Well, it's turned an anthem in the search for Madeline McCann, the 4-year-old British girl who vanished while vacationing with her family in Portugal. The song is part of a special video played for crowds at soccer games in Europe.
Meanwhile, Madeleine's parents sought spiritual comfort at the Vatican today. They talked with the Pope in a meeting they say will sustain them during their ordeal. CNN's Bureau Chief from Rome, Alessio Vinci, reports.
(BEGIN VIDEOTAPE)
ALESSIO VINCI, CNN BUREAU CHIEF, ROME (voice over): For faithful Catholics, a face-to-face meeting with the Pope, even one lasting just a few seconds, is a thrill and blessing beyond value. Kate and Gerry McCann are devout church-goers, and their brief encounter with Pope Benedict XIV offered them a great deal of spiritual strength.
GERRY MCCANN, MADELEINE'S FATHER: We have very mixed emotions about being here and of course why we're here, it's not normal circumstances. It would be one of the most exciting things we could do in our own lifetime, but we're very much on our minds is the fact that we're here without Madeleine.
VINCI: But this was not just a spiritual journey, it was an attempt for the media-savvy couple to keep their search for their missing daughter in the public eye. Outside Britain and Portugal where Madeleine was kidnapped, few know about her. UNIDENTIFIED MALE: Madeleine McCann, no, I'm afraid I don't.
UNIDENTIFIED FEMALE: Is this the little girl that got kidnapped? You know, the only thing I know is what I saw on CNN last night.
UNIDENTIFIED MALE: No.
VINCI: The Pope talked what Madeleine's parents at the end of a weekly general audience, but it was a photo opportunity in which the anguish was plain to see. Later at a new conference, the McCanns showed a poster which they hope will soon be shown across Italy and Europe.
KATE MCCANN, MADELEINE'S MOTHER: He said that he would pray for us and our family and that we continue to pray for Madeleine's safe return.
VINCI: The Pope, now the latest player in a relentless media campaign that has grown beyond the borders of England and Portugal.
DAVID BECKHAM, SOCCER PLAYER: If you have seen, this little girl ...
VINCI (on camera): In the coming days, Kate and Gerry McCann plan to travel to other European nations including Germany and the Netherlands. They know that the longer they can keep Madeleine's picture on the front pages of newspapers around the world, the better chance they have of finding their daughter.
Alessio Vinci, CNN, Rome.
(END VIDEOTAPE)
PHILLIPS: An American in al Qaeda, his new message, straight ahead from the CNN NEWSROOM.
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