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Sanjay Gupta MD

Ebola Epidemic

Aired August 03, 2014 - 07:30   ET

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


DR. SANJAY GUPTA, CNN HOST: I want to welcome our viewers in the United States and around the world to a very special edition of SGMD.

We are live outside of Emory University Hospital.

The video that you're watching now or about to watch is pretty historic. This is one of the first patients infected with the Ebola virus to ever set foot in the United States. In fact, a patient with Ebola has never had been in the Western hemisphere of the world. It's remarkable. Medically, scientifically, historically, this is a real first.

Now, we're going to tell you about this patient. His name is Dr. Kent Brantly. We're going to introduce to the doctors who were tasked with saving his life, and we're going to show you exclusive images of how this is all going to transpire.

But to start, I want to talk a little bit about the medical evacuation. This was no easy task. It required travel with this Gulfstream airplane. It was outfitted with a special containment unit to keep the patient stabilized and the personnel on the plane safe.

Also, after the plane landed at a military base outside of Atlanta, this is a military base, we watched the scene unfold.

First of all, an ambulance and then the transfer of the patient onto the ambulance. Now, we did talk to the ambulance team and they tell us that they took the patient by ground specifically because no helicopter could be equipped safely for this type of situation. Now, then, there was a caravan of vehicles carrying Dr. Brantly, you can see it there. This is all on the busy crowded freeways of Atlanta and they ended up right here at Emory University Hospital.

Now, when the ambulance got to Emory and they unloaded, it was quite a scene. It was remarkable and we haven't seen anything like this at this hospital the guys in protective suits and one of the men you see him right there coming out of the ambulance, walking into the hospital, that is, in fact, Dr. Brantly, the patient. Now, this past week, his condition, by the way, had been described to us as grave. So, it was a bit of a surprise for us to see him walking.

We have subsequently also learned that he was even able to shower prior to departing Liberia for this flight. Just how sick was he is the question a lot of people asking and what does that mean going forward?

I want to talk to the NIH's Dr. Anthony Fauci about that and much more as well in just a moment.

But, first, I wanted to share with you something else. We've now learned that Dr. Brantly's family, they're here at the hospital as well, his wife, his sister, his parents. They have waited and they have wondered for days now about his condition, about this evacuation, about whether their loved one would live or die. And now, we were just told that they shed tears of joy when they saw this unfolding live on CNN, some of the images that you have just seen yourself.

There still are plans, by the way, to evacuate a second American medical worker Nancy Writebol. She recently became (INAUDIBLE) to transport as well. If all goes well, she'll join Dr. Brantly this coming week.

Now, this is a historic moment. The first cases of Ebola in Western hemisphere and they fell sick in the midst of the worst outbreak in history.

(BEGIN VIDEOTAPE)

GUPTA: This is the mask with an air purifying system over here. It makes it much more comfortable I'm sure to breathe in and also purifies the air. What is it you are putting on now? How --

DR. BRUCE RIBNER, EMORY UNIVERSITY HOSPITAL: This is a Tyvek suit.

GUPTA (voice-over): Each time, Dr. Bruce Ribner will check in on his new patients, he's going to have to suit up. He's training for the assignment of his life. He'll be treating the first patients with Ebola ever in Atlanta, in the United States, in the western hemisphere of the world.

The patients Nancy Writebol and Dr. Kent Brantly, both of them had a calling to service and they both found themselves caring for the sick at Samaritan's Purse Ebola Center in Liberia. They were devoted to their patients, even knowing that they could be risking their own lives.

JEREMY WRITEBOL: I don't think it was on any of our minds when the first wave of the epidemic hit in April and we got word of it, we knew that that was a potential that they would have to deal with.

GUPTA: Within a month of the first reports of Ebola in guinea, it had crossed borders into Liberia and to Sierra Leone.

I traveled to West Africa to report on the epidemic and even then, it was apparently that it was quickly growing into the deadliest Ebola outbreak in history. It can only be passed on through bodily fluids like blood, but even a single virus article may be enough to cause the fatal disease. It was last week when Writebol and Brantly, the center's medical director, began experiencing symptoms of Ebola, fever, headaches, vomiting. They suspected the worst and immediately isolated themselves.

It took just days to confirm those suspicions. They had the disease that they had fought so hard to treat, even as they worsened they sent messages of faith to their family and friends.

DR. DAVID MCRAY, JOHN PETER SMITH HOSPITAL: I'm praying fervently that God would help me survive this disease. Please continue to pray along with me and pray for my friend Nancy who is also very sick and for the doctors who are taking care of us. Thank you all so much. Peace, Kent.

GUPTA: Those prayers have taken the form of this specially outfitted medevac jet left to evacuate the Americans and bring them back to Emory University Hospital. It's one of four sites in the country with a special containment unit. Though no magic pillow waits them, Dr. Bruce Ribner believes they have a good chance at saving their lives.

(on camera): How did this all transpire for you? Did you get a call?

RIBNER: One morning, we did get a phone call and they said we understand you have a special unit. Without hesitation, of course, we said yes.

GUPTA: Any hesitation in accepting these patients?

RIBNER: Actually, it's been the reverse. We have a small cadre of ICU nurses who staff our unit. I actually had two nurses who were scheduled to go on vacation tomorrow and they both canceled their vacations and they said we have been training for this. We are not going to miss this opportunity to care for this patient.

GUPTA: We know that the risk is small, but it would be even smaller if these patients did not come here. If you don't have anything magical to provide, why take the risk at all?

RIBNER: I think you've been in that part of the world. And you know the level of care that can be delivered. These are Americans who went over there to supply humanitarian mission of medical care for these individuals. And our feeling is that they deserve the best medical care they can get.

(END VIDEOTAPE)

GUPTA: And I can tell you the isolation ward we're talking about here at Emory is state of the art in terms of bio protection. We know it's located on its own floor of the hospital and the rooms themselves are encased in glass. Think of them as sort of glass boxes. They have this special intercom systems, which means the patients family can see and talk to them while still staying protected. We think some of that is happening right now.

Look, we've been talking about this for some time. Ebola is a disease with known cure, no known vaccine, but could that change? Is it about to change? And what's next for Dr. Brantly? We'll be right back.

(COMMERCIAL BREAK)

GUPTA: I'm here at the Emory University Hospital here in Atlanta. Just behind me is where we briefly saw an American doctor infected with Ebola actually walk into the hospital here, after being medevaced from Africa.

Now, we know right now that he and a second American patient Nancy Writebol did receive experimental treatments, although we don't have a good idea whether that has helped. We're going to learn that over the next few days but at least one vaccine has been tested for safety in healthy human volunteers.

And earlier, I spoke with Dr. Thomas Geisbert. He's been working with Ebola in a lab for a quarter century.

(BEGIN VIDEOTAPE)

GUPTA: Right now, as you know better than anybody, there's only certain things you can do in the field, in the hospital. There's no particular medicine for Ebola. It's supportive treatment which means replacing fluids, sometimes replacing blood clotting factors if someone is bleeding. But your group at the University of Texas got a $26 million grant to develop a vaccine and two medicines. A lot of people asking about this.

Now, how far along is it?

PROF. THOAMS GEISBERT, UTMB: They're at different stages. But basically what our grant covers is taking three treatments that we think are the most promising that have shown substantial ability to protect animals against Ebola in a bio safety level for laboratory.

So, these treatments, or one of these, is actually a vaccine that works as a post exposure treatment, much like the rabies vaccine use here in the United States. Another is a small molecule inhibiter called SIRNA. And the third is just conventional monoclonal antibodies. All of these have been able to completely protect nonhuman primates against Ebola and when given after exposure, and nonhuman primates are the gold standard animal model.

GUPTA: You are talking about the vaccine, two medicines and so far had some success with nonhuman primates. But it has been used my understanding on a human before as well in an emergency situation?

GEISBERT: That is correct.

GUPTA: What happened?

GEISBERT: A few years ago a laboratory worker in Germany had an accident with a needle, so the person was working with a small animal, jabbed herself with the needle. And within 40 hours, a vaccine was flown from North America, this was the vaccine that we work on here called vesicular stomatitis virus. This is a viral vector that expresses an Ebola virus glycoprotein. That vaccine was transported to Germany. The individual was given the vaccine, and she survived.

At this time, we really don't know whether she was really infected, you know, or the vaccine just really worked great. But the vaccine itself did not cause any significant adverse effects which is a good thing.

GUPTA: When something like this is happening now, Mr. Geisbert, around the world, and given that none of the treatments that you're describing have been approved by the FDA, it could change in the future, but is there a -- is there a possibility that if this gets worse in West Africa or in other parts of the world that some of your medicines may start to get used, they'll say, look, we have no other options this is the best thing that could possibly help, let's start doing it?

GEISBERT: It's a very good question. And there's a lot of regulatory issues involved. You know, it is -- there have been times when as you pointed out with the case in Germany where a vaccine was used under compassionate use. It's a very complicated and complex situation because of the safety. We certainly don't want to be seen as given unproven experimental treatments to humans, but at the same time, I -- you know, under compassionate use if you are infected with Ebola, you know, certainly anything would seem to be better than nothing.

GUPTA: Thanks for joining us. Really appreciate it.

GEISBERT: Thank you.

(END VIDEOTAPE)

GUPTA: And joining me from Washington now to talk more about this is Dr. Anthony Fauci. He's the director of the National Institute of Allergy and Infectious Diseases and he's the guy we turn to always when we have questions about this topic.

Thanks for joining us.

Let me just bounce out of what we were just watching there, these experimental vaccines. They seem to have had some -- in monkeys. We hear there's another human safety trial that's launching in September. But what is the general attitude, Dr. Fauci, when there is no other option? Is there thought to giving the vaccine maybe perhaps to the health workers in Africa at a minimum?

DR. ANTHONY FAUCI, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES: The vaccine we just heard about is a post-exposure vaccine. Generally, when we think about a vaccine, it's one you give before someone gets exposed or before someone gets infected. So, we're working on a few of these including some of the earlier work on the VSV one that was just mentioned.

Right now, they finished animal studies, Sanjay, and we're about to go into what's called phase one clinical trials in humans to see if it's safe and if it induces an immune response that you would predict would be protective. It would be extremely unusual at this point to go straight from preclinical into people in the field. You'd at least want to get some safety data which in our case will be done with them by January and then we'll know then if it's, "A," safe and, "B," if it induces a response to predict to be predictive.

When you have therapies, namely true therapies for it, then you can go to the FDA and determine the circumstance to see if you can get what was just mentioned the compassionate use to be able to give it even though you don't have the proper, complete line of testing.

GUPTA: That makes sense. You know, one of the things you may have heard and I heard as well is pretty startling was that Dr. Brantly was given a blood transfusion from a patient who he had helped treat, a patient who had recovered from Ebola. The theory seemed to have been that blood that was transfused into Dr. Brantly's body could contain antibodies to help fight off the virus.

What do you think of that? I mean, could that have helped? Has it been done before? What's your overall thought?

FAUCI: That's a rather extreme approach to have done that, but what they were thinking as you said correctly, Sanjay, this young boy -- and, again, I'm getting this second hand, the way you are, is that this young boy was infected and recovered which means, he very likely had an I immune response particularly antibodies if you took blood from that person or serum or plasma and infused it into Dr. Brantly you may have given him some of the antibodies which could have been protective. This is just theoretical in the hypothetical that that's what happened.

GUPTA: One thing real quick, Dr. Fauci, you may have seen some of the video, Dr. Brantly walking into the hospital today. We heard he was able to take a shower before he left Liberia. He seemed to be doing much better than expected. We had heard he was in serious condition, stable but serious condition.

What did you make of that?

FAUCI: Well, from the video that I saw, he looked certainly like he was out of the danger of having acute catastrophic phase of his disease but he's still not out of the woods from what we've heard how serious condition was before.

So, what will likely go on at Emory is they'll make sure that he's in good fluid balance, that he doesn't have any electrolyte abnormalities, that he doesn't have any secondary infections, and that he has organ system function that's good, is his renal function good, is his hepatic function good? What about cardiovascular? Those are the kinds of things they'll be looking at.

But the fact that he walked out without some help from that ambulance is really very good news to see somebody in that condition who previously was really very gravely ill.

GUPTA: And just finally, really quick, Dr. Fauci, this is a pretty remarkable day. It's pretty remarkable for me to just be here to cover a story like this. This is your life. This is your area of expertise. Just a quick thought on today?

FAUCI: Well, it is -- it is extraordinary. I think there are so many things extraordinary about what happened. This is, as you said correctly, Sanjay, this is the most severe outbreak in the history of Ebola, ever since it was first recognized in 1976. We have the opportunity now to be able to take care of a patient here. But it also shows that we are equipped, were it ever to happen.

People keep asking the question, somebody gets on a plane, gets infected in an African country, is well and then comes here and is sick. And people ask, is there going to be an outbreak like we saw in the West African countries and the answer is no. Because we have the capability as we've seen on your show to be able to handle these kinds of things.

GUPTA: Always appreciate having you on the program. Thanks so much, Dr. Fauci.

FAUCI: Good to be with you, Sanjay.

GUPTA: And up next, we're going to -- thank you.

Up next, we're going to hear from the head of the CDC as well. I'm going to ask this simple question: how did he sign off on the transfer of this patient? How did it transpire? That's next.

(COMMERCIAL BREAK)

GUPTA: The first Ebola patient on U.S. soil is being treated right here behind me at Emory University Hospital. This is the hospital where I work, where I'm on faculty here in Atlanta.

I just spoke with Dr. Tom Frieden. He's the head of the U.S. Centers of Disease Control and Prevention.

(BEGIN VIDEOTAPE)

DR. TOM FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL & PREVENTION: Ebola is a virus that can be stopped. It can be stopped in the community by control measures and it can be prevented from spread in hospitals by meticulous infection control. That means you really have to follow every one of the procedures carefully.

Doctors Without Borders, MSF, has been caring for Ebola patients for many years in outbreaks. They've never had a death in one of their workers. So, their -- and that's in work in Africa without the kind of advanced infection control procedures we have here.

The stakes are higher with Ebola, but the risk is no higher. It's a virus that's easily inactivated with standard cleaning solutions in a hospital. I think we fear it because it's so unfamiliar but we shouldn't let that unfamiliarity trump our reason about the possibilities, the likelihood, the availability of effective infection control in hospitals throughout the U.S.

Ebola's a huge risk in Africa. It's not going to be a huge risk in the U.S.

GUPTA: Yes. And, again, you know, it's clear that the resources are more readily available in the United States. They're better.

But that human element, again, you're knowingly bringing a patient with Ebola into the United States, a virus that has not been here. And if there is some sort of lapse in the human element of precautions, I mean, how do you tell your neighbors? You live here in Atlanta, how do you tell your neighbors and frankly people in the United States that we are a 100 percent confident this isn't going to turn into something more, even if it isn't a mass outbreak, how can you tell people to be 100 percent confident that someone else won't die or get sick as a result of this decision?

FRIEDEN: Ebola does not spread by casual contact. And it doesn't spread by somebody who's not ill. It spreads when people get sicker and sicker and sicker, the amount of virus in their body increases and so the risk in Africa is the health care workers who are caring for them and in the burial process. Those are the two things that are driving the outbreaks in Africa, and we can prevent those risks from happening here.

(END VIDEOTAPE)

GUPTA: You know, the idea of Ebola being here in our backyards, it can be alarming no doubt. We keep hearing from you on this. But earlier this year, I spent time in guinea to help separate some of the facts from fiction.

(BEGIN VIDEO CLIP)

GUPTA: Well, Ebola is not the great plague. There's no question about that. But it is a --

(END VIDEO CLIP)

GUPTA: all right. We are being -- we have a little bit of trouble with the video there. Just want to give you a quick update, though, we are being told that Dr. Brantly's wife just visited her husband for 45 minutes.

Painting a little bit of a picture for you -- think of the room he is in as sort of a glass box, close, a few inches away even but able to talk by phone or by intercom, she said he's in great spirits and he's so grateful overall for all of this. And we're going to stay all over this story.

But there are a couple important points I want to make because we've heard from so many of our viewers about this. The way that this virus spreads, as frightening as it maybe, as much as we've heard about it from these remote villages in Africa, it doesn't spread in the air. It isn't something that people are going to get as a result of being a resident in Atlanta or in the United States. This is something that's spread by close contact and transferring bodily fluids over. Also, another important point -- people don't become able to

spread that virus, don't become contagious at all until they are quite sick. So, this whole idea of someone walking through an airport and shaking hands and spreading the virus that way. That just doesn't happen. It's not how Dr. Brantly got infected. It's not so many others got infected as well.

We do know in some of these remote villages that I visited in Africa, there are just tragic tales of people not trusting doctors, staying home, they're sick, their loved ones cleaning up for them, trying to care for them and as a result getting infected themselves, infecting their children, and entire families get infected and dying.

It is one of those things that certainly we're going to keep on top of. We're going to be able to tell you the latest of what's happening here at Emory University Hospital, but also the latest about what's happening in Ebola in West Africa. Lots of updates. As we get them, we'll give them to you.

A check of your top stories, they're up next, right after a quick break.