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New Case of Ebola in Dallas; CDC News Conference on New Dallas Ebola Case

Aired October 12, 2014 - 11:00   ET


ANNOUNCER: This is CNN breaking news.

BRIAN STELTER, CNN HOST: Good morning. I'm Brian Stelter. It's time for RELIABLE SOURCES, a special edition, a full hour of breaking news coverage as a second Ebola case has been confirmed in the United States in Dallas.

The infected person has not about identified, but we know that she treated Thomas Duncan, the man who died on Wednesday in Dallas. She is said to be a female nurse.

We may learn more in a few minutes a CDC press conference. We are standing by for that.

But let me set the stage by bringing in our CNN correspondents and experts. In Dallas, national correspondent Ed Lavandera, who is outside the hospital where this has happened and where the new patient is now quarantined. And in New Orleans, senior medical correspondent, Elizabeth Cohen. And in Washington, Dr. Gavin Macgregor-Skinner, an infectious disease expert, who joined me here on RELIABLE SOURCES last week and I want to get his take a little later this hour about the media coverage of all of this.

But, let start, Ed, by telling us, what did we learn this morning at the first local press conference that took place?

ED LAVANDERA, CNN NATIONAL CORRESPONDENT: The significant headlines of what we know so far is that this is a health care worker who was not considered to be one of the high-risk people that was being monitored. This was someone in the lower risk category, but this was someone who came into contact with Thomas Eric Duncan, not during his initial visit that first emergency room visit where he was turned away and then returned three days later. So, it was after he had come back to the hospital.

And we are told -- and this is the disturbing part of all of this -- is that this health care worker had been using protective gear, the gowns, the masks, the facial mask, the gloves and everything, and despite all of that, has still become infected.

Also this morning here, Brian, a great deal of attention focused around the apartment complex where she lives just a few miles away from here at the hospital. We are told by city officials that there was a reverse 911 call that went out to people within a four-block radius of where she lives, information being sent out and calls being placed and decontamination of her apartment. And also, the areas where she came into contact with, we are told that within -- after registering that low-grade fever Friday, that she drove herself here to the hospital and was quarantined within 90 minutes of discovering that she had that fever, but nonetheless, she drove herself here to the hospital.

I saw hazmat teams here this morning working in the parking garage and in the buildings where she had been taken in and ironically enough. She's being kept in the area, the same isolation area where Thomas Eric Duncan was being treated, Brian.

STELTER: Thank you, Ed.

Elizabeth, what do we know about the type of care the nurse delivered? Earlier, we've reported on CNN that this was a female nurse. We don't know a name or anything more about that.

Do we know exactly what her role was?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: We don't know, Brian. It actually is a really important issue. Was she delivering direct patient care? Did she touch the patient?

You know, nurses do a lot of different things. Perhaps, for example, she was transporting soiled garments. That's another possibility. There are lots of them.

And you know, the CDC says that health care workers who were doing all sorts of things, whether you're directing patient care or transporting soiled garments, you need to take these protective steps. But hospitals, in general, Ebola aside, often, there's been concerns that they have trouble with getting everyone to take these protective measures, that he is there a been this emphasis on doctors and nurses who are with the patient doing the protective measures but maybe there hasn't been enough --

STELTER: Elizabeth, we actually pause there and listen to the head of the CDC, Thomas Frieden, speaking now.

DR. THOMAS FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: Public worker in Texas has tested preliminarily positive for infection with Ebola virus. Confirmatory testing is under way at CDC and will be completed later today. We don't know what occurred in the care of the indexed patient, the original patient in Dallas, but at some point, there was a breach in protocol and that breach in protocol resulted in this infection.

The health care worker developed symptoms on Friday. They were assessed last night and this morning. Or last night, I should say, they were -- today is Sunday. They were assessed Friday and tested yesterday and the laboratory response network laboratory in Austin, Texas, tested their result preliminarily positive. That result came in late last night, about exactly 12 hours ago.

And I will outline the steps that we have been taking before, since and in the future to address this.

The individual was self-monitoring and immediately on developing symptoms, as appropriate, she contacted the health care system and when she came in, she was promptly isolated. The level of her symptoms and indications from the test itself suggest that the level of virus that she had was low.

There are four things that we are doing at this point. First, to make sure that we do everything possible to care safely and effectively for this individual. Second, assessing her possible contacts from the moment she developed symptoms and the CDC team lead for the Dallas investigation has interviewed her and it appears at this time that there is only one contact who may have had contact with her while she may have been infectious. That individual is under active monitoring.

Third, we are evaluating other potential health care worker exposures because if this individual was exposed, which they were, it is possible that other individuals were exposed. We know that this individual did provide care to the index patient on multiple occasions and that care included extensive contact.

Fourth, we will undertake a complete investigation of how this may have occurred. That's so important so we can understand it better and intervene to prevent this from happening in the future.

I want to go into a little bit more detail first on what we are doing to promote safe and effective care and then on the investigation. In terms of safe and effective care, we had already begun several days ago to ramp up the education and training of health care workers at this facility. The care of Ebola can be done safely, but it's hard to do it safely. It requires meticulous and scrupulous attention to infection control and even a single, innocent, inadvertent slip can result in contamination.

Second, we are recommending to the facility that the number of workers who care for anyone with suspected Ebola be kept to an absolute minimum.

Third, we recommend that the procedures that are undertaken on -- to support the care of that individual be limited solely to essential procedures.

Fourth, we are looking at personal, protective equipment, understanding that there is a balance and putting more on isn't always safer, it may make it harder to provide effective care. So, all aspects of personal protective equipment.

And, fifth, we are recommending that there be a full-time individual who's responsible only for the oversight, supervision and monitoring of effective infection and control, while any patient with suspected or confirmed Ebola is being cared for.

CDC has sent additional staff to Texas to assist with this response. And we will continue to work closely with them. In the investigation itself, we look at three different phases.

What happens before someone goes in to an area with someone with suspected or confirmed Ebola is being cared for? What happens in that space? And what happens when they leave?

The two areas where we will be looking particularly closely is the performance of kidney dialysis and respiratory intubation. Both of those procedures may spread contaminated materials and are considered high-risk procedures. They were undertaken on the index patient as a desperate measure to try to try to save his life.

In taking off respiratory protective equipment, we identify this as a major potential area for risk. When you have gone into and potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material -- contaminated material touching you and being then on your clothes or face or skin, and leading to an infection is critically important and not easy to do right.

So, these are areas that the investigation will look at, but we don't know what it will find. We will be doing that over the coming days.

Before I turn it over to Dr. Lakey, commissioner of the Texas Department of State Health Services, I do want to make two final points.

The first is that, unfortunately, it is possible in the coming days that we will see additional cases of Ebola. This is because the health care workers who cared for this individual may have had a breach of the same nature of the individual who appears now to have a preliminary positive test. That risk is in the 48 people who are being monitored, all of whom have been tested daily, none of whom so far have developed symptoms or fever and in any other health care workers who may have been exposed to this index patient while he was being cared for.

We are still determining how many health care workers that will be. That is an intensive investigation. It takes many hours of tracing steps. We will cast the net wider. There, though, is no risk to people outside of that circle, of the health care workers who cared for the individual patient and the initial 48 patients or contacts who had definite or possible contact with the index patient, who we have already identified.

The second point I want to make is that what we do to stop Ebola is to break the links of transmission, to break the chains of transmission. And we do that by making sure that every person with Ebola is promptly diagnosed, that they are promptly isolated, that we identify their contacts, and that we actively monitor their contacts every day for 21 days. And if they develop symptoms or fever, we do the same process again.

That is how we have stopped every Ebola outbreak in history, except the one currently in West Africa. That's how we stop it had in Lagos, Nigeria. That's how we will stop it in Dallas. So, breaking the links and chain of transmission is the key to

preventing further spread.

I'd like to turn it over to Dr. Lakey.

DR. DAVID LAKEY, TEXAS COMMISSIONER OF HEALTH (via telephone): Thank you, Dr. Frieden. This is David Lakey, the commissioner of health from the state of Texas.

And I appreciate all the support from the CDC that the CDC has given us, not only over the night, but over the last several weeks as we have been working through this unprecedented event. Our staff have been working throughout the night, trying to gather more information and as we get more information, as appropriate, we will provide that information.

But as Dr. Frieden noted, we do have one health care worker. The health care worker that had extensive contact with our initial parent who did what was appropriate, with early symptoms, game in to be checked.

And we facilitated getting the blood test done that test came back at 9:30 last night, and as Dr. Frieden noted, was positive. The controls were appropriate. The amount of virus in her blood was less than what was there when they first index case came back, but it is a positive test.

So, our hearts really do go out to this individual and the family. (INAUDIBLE) health care worker who is willing to compassionately care for Mr. Duncan and again, our thoughts and prayers are with them. We are -- we have been preparing for events such as this, putting in contingency plans. Again, we're refining those plans and a lot of work is taking place right now.

As Dr. Frieden noted, the 48 original contacts continue to be monitored and they continued to do well. And we have this one health care worker that now needs our care.

And so, as Dr. Frieden noted, we are going to -- have been and will continue to monitor health care workers, stepping that up to make sure that any health care worker that has any fever or any other symptoms will be quickly identified, as was this individual, continue to work to make sure the infection control practices that are being performed at the hospital are at the highest standards and fully evaluating what is under way and figure out exactly what happened that allowed this individual to be infected.

And we have brought in more public health officials, public health staff. Epidemiologists to make sure that we have the individuals we need to fully evaluate the situation. And again, appreciate the work from the CDC and their support for Texas right now as we work through this situation. Thank you.

FRIEDEN: We will now take questions. We will start in the room and then go to the phone.


REPORTER: Steve Gulock (ph) from WSB-TV in Atlanta.

This health care worker, you said, had multiple contacts with the original patient. In your interviews with her, has she been able to specifically isolate a chance where this may have occurred, where this breach, you say, in those interviews with her talking about why you're specifically investigating, maybe where she is taking off the equipment or anything -- why you're focusing on that part in your investigation?

FRIEDEN: We have spoken with the health care worker and that individual has not been able to identify a specific breach. The way we do investigations like this is we look at every single interaction, what was the nature of that interaction. We look at any other information we can gather.

I was not mentioning the taking on or off PPE or the procedures related to the investigation, but as a general rule, these are the two areas where we see the greatest risk.

REPORTER: And a follow up, is this going to change the way health care workers anywhere, whether it's here in Atlanta or Dallas, interact with these potential patients, wearing more gear? Or what's going to change now?

FRIEDEN: I think it is certainly very concerning. And it tells us that there is a need to enhance the training and the protocols, to make sure that the protocols are followed. The protocols work. We have decades of experience caring for patients with Ebola. But we know that even a single lapse or breach, inadvertent can result to infection.

So, figuring out how all of the things that we can do, to minimize that risk, such as those I went through, reducing the number of health care workers, reducing a procedure to essential procedures, having a site monitor there, these are all things that we'll be looking at closely.

We'll go to the phone for questions.

OPERATOR: Thank you. We'll begin the question and answer session. If you'd like to ask a question, please press star 1. Please unmute your microphone and say your name clearly and name.

Our first question comes from Dr. Richard Besser, ABC. Ask the question.


Dr. Frieden, you were saying how difficult it is to implement proper infection control and how one slip can be so dangerous. Is there any consideration of moving to a system where you would move patients to these specialized units where they actually are trained instead of treating them in hospitals where they really don't have that training? FRIEDEN: We're going to look at all opportunities to improve the

level of safety and to minimize risk, but we can't let any hospital let its guard down because a patient, an American returning or somebody else coming into this country who had exposure and maybe didn't even have an awareness of that exposure, may become ill. So, we do want hospitals to have the ability to rapidly consider, isolate and diagnose people who may have Ebola.

Again, anyone who's been in Guinea, Liberia or Sierra Leone in the past 21 days and who has a fever or other symptoms should be immediately isolated and evaluated for Ebola.

So, the -- I would distinguish that diagnosis needs to be done anywhere, then thinking about what's the safest way to provide that care, that's something we'll absolutely be looking at.

BESSER: Thanks very much.

FRIEDEN: On the phone. Next question.

OPERATOR: Thank you. We have Michelle Salcedo (INAUDIBLE) press your mute button. Michelle Salcedo?

Let's got the next question. Caleb Hellerman, CNN. The line is open.


I was wondering if you could, Dr. Friedman, if you could -- or Dr. Lakey, if could say anything more about the kind of extensive contacts, what was the role of this person who's become infected and also if you can just clarify the monitoring process? I mean, you're saying she (ph) would self monitoring. Are some of the other contacts getting in-person visits or just what is exactly the process for taking her temperature and reporting in, if you could clarify that. Thank you.

FRIEDEN: So, I will turn that over to Commissioner Lakey and I do want to really thank the Texas and Dallas health authorities who have been working around the clock since the diagnosis of the first patient and have monitored every one of those 48 patients and taken their temperature and have now intensively surged to address this latest development.

Dr. Lakey?

LAKEY: Thank you, Dr. Frieden.

The 48 individuals that have been known to have contact or potential contact, those individuals have daily had an on-site visit where they saw one of the epidemiologists and had a subsequent fever check later in the day. The health care workers, where there was no breach in contact, were doing self-monitoring.

And so, in light of this case, we are looking at the ongoing monitoring of all the health care care workers and looking at -- going forward, having an epidemiologist see them and more active surveillance for these individuals. Again, the health care workers where there had been no breach in personal protective equipment has been doing self-monitoring up until today.

HELLERMAN: If I could just quickly follow up, this woman was not in that group of 48 contacts, she was an additional person and do you have any sense of how many more people this might expand up to?

LAKEY: This individual was not part of the 48. And we are looking at defining what that new number is. Working on that pretty hard right now.

HELLERMAN: Thank you.

FRIEDEN: In order to identify that number, we cast the net wide. We identify first anyone who might have had contact and then we do detailed interviews and record reviews with each and every one of them to identify those who definitely did have contact, those who definitely didn't and those for whom we cannot rule out they had contact.

Go to the next question on the phone.


REPORTER: Thank you.

Dr. Frieden, could you please explain and clarify what you were talking about -- try to limit things to essential procedures. What does that mean? What's essential and what's not essential? How do you limit procedures and not compromise --

FRIEDEN: So, in terms of limiting, first, as we do everywhere Ebola patients are cared for, we try to keep to an absolute minimum the number of health care workers who enter the area, that reduces risk.

Second, we try to ensure that the procedures that are undertaken are kept to the absolute minimum. So, for example, a blood draw to monitor electrolytes is very important but if someone is not having diarrhea and vomiting, maybe it only needs to be done once a day rather that multiple times a day.

I'm not saying that was done differently previously, just saying that is an example how we might limit things to essential procedures.

Next question?


REPORTER: Yes, thank you.

Dr. Frieden, I was wondering if could you comment a little bit more on the preparedness of hospitals, regular hospitals that are outside of this -- these bio containment units that have treated the other Ebola patients who have come to the U.S. do you think this incidence -- what do you think it says about the preparedness generally of hospitals around the country, is it an outlier or are you concerned now about hospital preparedness?

And the other just related question, you mention now that an infection control person should be -- should be -- protection control officials should be monitoring in hospitals? Is that a guideline for all hospitals or were you talking specifically about this Texas hospital?

FRIEDEN: So, let me ask -- answer the second question first. In Ebola treatment units in Africa, one of the things that we have identified as potential contributor to infections that have occurred there is the lack of an on-site manager at all times who doesn't have any specific responsibilities, other than overseeing and supervising everything that's been done to make sure that infection control is being done correctly, that procedures are being done correctly.

I was saying we will ensure that is done going forward in Texas -- at this particular hospital.

In terms of your first question, very important to distinguish for infection and control the physical layout from the procedures and policies and training and staff work. In terms of the first, the demands are not extensive. There are some special demands in place, like an anteroom, for example, a room before for people to take off and put on protective equipment.

But it is not a disease that spreads through the air, so it doesn't require some of the most intensive infection control physical procedures. However, on the personnel training, supervision, follow- up, monitoring, it is very clear that the necessity of doing this right 100 percent of the time does require a very intensive training, follow-up, monitoring process.

Next question.


REPORTER: Good morning, thank you for taking the call and doing this morning.

Dr. Frieden and Dr. Lakey, if you could respond to this question. One, how frustrating is this for you, after saying, you know, after saying we are going to stop Ebola in its tracks and to know that a breach of protocol among a professional is what caused this new transmission? And two, is it shaking your faith in hospitals around the country to adequately educate and prepare their staff?

FRIEDEN: I'll start, and then turn it over to Dr. Lakey.

It's deeply concerning that this infection occurred and our thoughts are with the health care worker who was providing care and appears to have become infected, if that test is confirmed, in the process of that care. That doesn't change the bottom line here, which is that we know how to break the chains of transmission. We need to ramp up the infection control for any patient suspected or confirmed as having Ebola and we need to do what we've been doing with contact tracing and monitoring.

If you go back to what happened here, she identified symptoms immediately on their onset. She was isolated promptly. At this point, it looks like there is one additional contact potentially from that illness period. That individual does not have fever.

So, we are looking very closely at that, but it doesn't change the bottom line. The bottom line is we know how Ebola spreads. We know how to stop it from spreading, but it does re-emphasize how meticulous we have to be on every single aspect of the control measures, from rapid diagnosis to effective isolation, to effective care with infection control, to scrupulous contact investigation.

Dr. Lakey?

LAKEY: Thank you, Dr. Frieden. I guess I would like to second what Dr. Frieden said. I firmly believe that we are going to stop this here. We have to be very careful. We need to closely look at the practice, the infection control practices as they are occurring in the hospital, to be meticulous, to make sure that there are no breaches.

You know, is it frustrating or disappointing? Of course it is. You know, our hearts go out to families, to the health care worker that is -- that is infected. And she is going to have a rough time. And we need to be -- continue to make sure they gets the care that she needs.

I think it's -- we have been doing contingency planning for situations like this. I think one of the things I've learned in disaster response, you know, you have to have a little humility in how you approach things. Be very cautious with how we approach things and we need to continue to do that and continue contingency planning.

And -- but do I doubt that we are going to stop this spread here in this one hospital? No. I firmly believe we will stop it. Thank you.

FRIEDEN: Next question.


REPORTER: Hi, Dr. Frieden. I was just wondering if there is any updated guidance on when screening would start at the additional airports that were announced last week.

FRIEDEN: So, yesterday, we began screening at JFK International airport in New York city. That screening went smoothly. There are a lot of lessons being learned through that to make sure that screening goes smoothly for passengers, other passengers.

As we said before, we are anticipating starting screening at the other four airports this week and we anticipate that starting on Thursday.

Next question. OPERATOR: (INAUDIBLE)

REPORTER: Yes, can you speak to how a health care worker using these precautions apparently caught the Ebola when people who had close contact in that apartment for several days did not? And do you have any plans to transfer this new case to one of the specialty hospitals, Atlanta or Nebraska or something, some place like that?

FRIEDEN: With regard to the first question, when patients have Ebola, they become progressively infectious the sicker they become, because the amount of virus in their body and in their secretions increases. And the people who had contact with this individual, the index patient in Dallas, prior to his isolation are not yet out of their 21-day exposure period. So, we are not out of the woods yet with potential additional cases among contacts before isolation.

But medical procedures involve dealing with blood, dealing with body fluids, diarrhea, vomit, other things, that may have very large quantities of virus. And that's why the personal protective equipment and the protocols are so important, because as someone gets sicker, they get more infectious also.

We will look at all possibilities to ensure the safe care of patients to the greatest extent possible.

Next question?

OPERATOR: (INAUDIBLE) "Washington Post."

REPORTER: Hi, Dr. Frieden. I was wondering whether either you or Dr. Lakey could clarify -- this health care worker was not in the initial group of 48. So, earlier this morning, Vargas (ph) said there were 19 hospital employees they were tracking. So, is this person part of that 19 or is it part of a larger group? That was one question.

And second question was, the hospital by its up track record has not provided the best information. They have had to do a lot of walk- backs. I know the hospital initially said this morning that there was low-grade fever. Are there any other symptoms? Is there any other information that we need to parse further, given the hospital's track record in not providing accurate information initially?

FRIEDEN: I'm sorry. I have forgotten your first question. Could you repeat it?

QUESTION: Is this person part of the 19 the hospital was tracking or is a larger go up of people...


FRIEDEN: Thank you.


FRIEDEN: So, the 48 contacts identified were individuals who had contact with the index patient up to September 28, the day that he was isolated.

This individual was not exposed in that period of time. We look at time periods for exposure. Those 48 are, as per everything we know, the only people that he may have had contact with before he became isolated.

In terms of the care there in the hospital from the 28th to October 8, the date he passed away, that's a period of 10, 11 days when there may have been additional contacts, given the fact that this individual clearly was exposed then. That's what's being investigated now.

So, that first contact period -- contact tracing period identified what we still believe is all 48 who were exposed up to the time he was isolated. Now we are doing a new investigation, given the diagnosis late last night of this individual, of anyone else who may have been exposed once he was on what should have been effective isolation.

In terms of the clinical status of the patient, I can say that our information is that as of at least some time back, she was showing only mild symptoms and low-grade fever. Our team lead did interview her directly and we will continue to monitor very closely to ensure that she gets the best possible care.

We will take two more questions on the phone.


QUESTION: Thank you.

I wanted to find out specifically with this patient, the one, the new patient, why was she not -- because you kind of gone around this -- why was she not initially included in the 48 that were monitored?

And then also I wanted to ask Dr. Frieden, when he was over in Africa, did you have -- did you take special precautions that you normally wouldn't have with the putting on the protective equipment? Thank you.

FRIEDEN: So, as I just indicated, we monitored all contacts up to the time of the index patient's admission on September 28.

Given this apparent infection, we now are -- will be evaluating and then monitoring all contacts who may have had exposure during the hospital stay. I will ask Dr. Lakey to comment further or that on any other issue in a moment.

In terms of precautions in Africa, yes, they're very specific for personal protective equipment, taking it off, putting it on and what happens there.

Dr. Lakey?

DR. DAVID LAKEY, COMMISSIONER, TEXAS DEPARTMENT OF STATE HEALTH SERVICES: Thank you, Dr. Frieden. I really don't have much to add, besides what you provided. The

health care workers that were in full PPE, personal protective equipment, during their involvement in the care of the initial individual were classified as minimal risk. And those individuals had guidance to do self-monitoring that were not in that 48.

And so this individual is doing that. And at -- and the earliest signs of illness, check their temperature and was evaluated. Thank you.

FRIEDEN: We will take the last question.


QUESTION: Hi, thanks for making such great information available today.

I'm wondering, how common is it for people to be on dialysis or to be intubated during an Ebola infection? Is that something you have seen in other patients treated in Western countries? Just wondering how common that is and how often health care workers have had to deal with those situations. Thanks so much.

FRIEDEN: Thank you.

I don't know the details of the other patients cared for in other parts of the world. But I'm not familiar with any prior patient with Ebola who has undergone either intubation or dialysis.

Certainly, it would be very unusual if it has happened before. I do want to clarify one thing. Of the 48 contacts being monitored, including the 10 who are known to have had contact, that does include health care workers who had contact with the index patient before he was isolated on September 28, but doesn't include anyone after September 28.

Before I make a couple of concluding remarks, just turn it over to Commissioner Lakey, for anything more you want to say?

LAKEY: Well, thank you again for your support.

Obviously, a very trying day, a very busy night of work that's going on to make sure that we fully understand what happened, and we can make sure that the hospital has the expertise, the infection control practices that they need to prevent any other individual from being exposed to this virus.

Again, appreciate the health care worker on the earliest signs coming in and being cared for appropriately. And, again, we are bringing in the resources we need to fully understand this as quickly as possible.

So, again, my appreciation to the CDC for the work that they continue to do to assist us. Thank you.

FRIEDEN: Thank you, Dr. Lakey. And thank you for the terrific work your team in public health is doing there. We really do appreciate the partners partnership. Your work on the ground makes a really big difference.

And we're honored to be part of the team doing that with the state and the city and the hospital.

The bottom line here, we are very concerned that a preliminary positive has been identified among a health -- in a health care worker who provided care to the index patient. We will have confirmatory testing later today at CDC.

We will identify any additional contacts, both of that individual before they were diagnosed and other individuals who may have provided care for the index patient and, similarly, may have been exposed and actively monitor those individuals. We will also undertake a thorough investigation to understand how this may have happened. And we will ramp up infection control to do whatever we can to minimize the risk that there would be any future infections.

And, finally, our thoughts go out to the health care worker, their family, understanding how difficult a time this is for them and for other health care workers who now may have been exposed or are now known to may have been exposed, and need to really go through that anxiety-producing time.

These are the individuals who we need to monitor. This is how we break the links of transmission. It is possible that we will see additional cases in those who had contact with either of the two patients, but there is no doubt that we can break the links of that -- the links in the chain of transmission.

We have done it before and we will do it here. And the team in Dallas is doing an excellent job making sure that happens.

Thank you all so much for your interest in covering this topic.

STELTER: Dr. Tom Frieden, the head of the CDC, calling this new case of Ebola in Dallas very concerning, but also saying that health care protocols do work and that some sort of breach of protocol happened in Dallas. Unclear what exactly that breach was.

The government here clearly trying to stay ahead of public concern about Ebola by holding these press briefings, by answering questions on Twitter, by posting infographics in Facebook, all of it.

So, now let me bring back in Elizabeth Cohen, CNN senior medical correspondent.

Elizabeth, what stood out to you from that press conference?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Well, two very -- in a very difficult situation, two very small pieces of sort of good news.

One is that the levels of virus in this woman's blood are relatively low. That's good. They caught it early. Much easier to treat someone when you catch it early. Also, it's also a good thing that this woman only had one contact while she was contagious. That's a lot better than the 48-plus that the -- that Mr. Duncan had.

It's a lot easier to keep track of one person. And that one person, we are told, has been isolated.

But, Brian, there are two questions I think stand out here. One is that Dr. Frieden mentioned -- it was a little bit surreptitious, but he said, you know, those protocols that we put out about how health care workers should protect themselves must be followed to a T.

And he said something to the effect that more is not better. So, you know, for example, they are supposed to double glove in some situations. Well, triple gloving is a violation of protocol and actually could make things worse, instead of making things better, because then you need to take off three pair of gloves, you know, gloves with infectious stuff on them.

So I think that may become an issue as they look into this. Another factor that I thought was interesting, Brian, is that this woman who is now sick, she was not on the official list of 48 contacts that Mr. Duncan had.


COHEN: Right.

And what Dr. Frieden said was the reason for that is that that official list, it ended on September 28. This woman took care of him in the hospital and he was hospitalized from September 28 until the day he died on October 8. So, she wasn't on the official list because she had contact with him after September 28, and she was self- monitoring.

Well, these 48, they were getting visits from health care workers. Was it enough that she was self-monitoring? Should she have just been self-monitoring? It's a lot of questions here as to how she and fellow health care workers were being followed up upon.

STELTER: Elizabeth, thank you. Stand by.

I have to fit in a quick break here.

But you at home probably have some questions after hearing that press conference. I know I do. So, we will get some of those questions answered with our experts right after this quick break.


STELTER: Welcome back to our breaking news coverage here on RELIABLE SOURCES, as folks are waking up to the news this morning that there is a new case of Ebola in the U.S., a case involving a nurse at the same hospital in Dallas where Thomas Duncan died on Wednesday.

This is big news, not because all of you watching are in danger from Ebola -- you are not -- but because this is a human drama that's unfolding, the kind of human drama that frankly cable news is very compelled by and is very interested in. It's like so many other stories that we cover here week to week here on RELIABLE SOURCES.

Let me bring back in New Orleans senior medical correspondent Elizabeth Cohen, and, in Washington, Dr. Gavin Macgregor-Skinner, an infectious disease expert.

I would love to talk to you both about what we just heard from this press conference from the head of the CDC.

Right before the break, Elizabeth, you were saying that there are still some big questions we don't have answers to about what breaches in protocol could have caused this new person to have been infected with Ebola, and now that person is isolated at the hospital in Dallas.

COHEN: Right.

It seemed clear from what Dr. Frieden was saying is that there was some kind of a breach of some kind, and that it needs to be determined what that breach was. One thing that he mentioned -- and I don't have his ex-wording, but he said something to the effect that more is not better. If the guidelines say, under certain conditions, for example, double glove, you don't want to triple glove or quadruple glove, that more is not necessarily better.

Presumably, one of the reasons is that you have to take all of this off. And once it's already become infected, that's an issue if you have more. So, I think that there are various things that they are going to be looking to determine what the actual breach was.

STELTER: Gavin, I'm thinking about my mom this morning, who happens to be a nurse in Maryland. There's so many, hundreds of thousands, probably millions of nurses and other health care workers all across the country. And they are really on the front line of this, especially in Dallas; is that right?


And we are getting phone calls every day of people saying, look, we know this is really important. We want to help in being prepared. What can we do?

And what we are seeing at the moment is that we are hearing lots of discussion about hospital infection control and protocols. It's more than that. Our hospitals throughout the country pride themselves on high standards, quality systems. Now, there is a quality system called bio-risk management system.

Bio-risk management -- and Dr. Frieden correctly said this -- we need to look at the safety and the risk and the management and the supervision. That all comes under a bio-risk management system. And we're not hearing anybody talk about that. And we also need to talk about, how do we come up with some sort of national training program right now? STELTER: What is the most reliable source, since we are here on

RELIABLE SOURCES, Gavin? Where do we go for the accurate information to this story? Because, sometimes, I turn on television, and I don't see people like you. You were actually an infectious disease expert. You were in Nigeria treating patients recently.

Instead, I see other kinds of doctors who don't actually necessarily have firsthand experience with Ebola. So, where do you recommend people go for accurate information?

MACGREGOR-SKINNER: Another great question, Brian.

Again, we are using -- the CDC are the world experts. They produce the guidance documents. We go to CDC for that guidance document. When it comes to a hospital, though, it gets really challenges whether we have to look at the law, the legislation, and how we take guidance and legislation.

For information, though, I stick with the World Health Organization, I stick with CDC, and Doctors Without Borders to get reliable information. But back here in the U.S., we really -- and I think Dr. Frieden identified these quite correctly -- there are some very significant issues that we haven't come up with -- with answers or solutions to just yet.

STELTER: So, tell me a couple of those. Tell me a couple of those that we should be asking about in the days to come.

MACGREGOR-SKINNER: Right now, we should be looking at the hospitals in this country that have the high biocontainment units, the high biocontainment suites that are able to look after and care for, long-term care for Ebola patients.

These hospitals also need to have management systems in place. Dr. Frieden talked about management and supervision. We -- if it's a breach protocol, where was the supervisor? And that -- we don't know where that is. So, we need to be able to say to hospitals throughout the country, you need to be able to detect.

You need to be able to isolate. You need to be able to prevent the spread of Ebola, but you also need to be able to raise your hand and say, we cannot take on an Ebola patient and manage the long-term care. Therefore, if a patient comes to our hospital, we are going to have to transport them to one of these hospitals that already have a high biocontainment unit and have the management systems in place.

STELTER: Elizabeth, hearing Dr. Gavin Macgregor-Skinner talk about this, I'm thinking to myself, we are talking about a long-term story, aren't we, something that we are going to be hearing about for weeks and months to come? Is that basically guaranteed at this point?

COHEN: Oh, I think we certainly are looking at a long-term story, Brian.

You know, this epidemic, this outbreak is not going anywhere in West Africa. It is here for a while. And if it is in West Africa for a while, that means we here in the United States continue to be at risk, as we have seen with the case of Mr. Duncan and the health care worker who he has now infected.

So, we need to do some long, hard thinking about systems that have been in place in this country for a long time. The government in the United States doesn't like to say one hospital's better than another, but, you know, we all as patients know, look, some hospitals are better at some things than others.

And maybe it's time -- I have heard experts say to me today and earlier -- maybe it's time to say, look, we ought to be directing possible Ebola patients to certain places, that there are some hospitals that are better than others at, for example, protecting their health care workers.

STELTER: And, Elizabeth, since we have a lot of journalists watching this hour, what is the one thing that journalists should be doing to be careful in the way they communicate to viewers about this story?

COHEN: The one thing, the most important thing I think is to not sort of increase hysteria.

You remember the sheriff's deputy, where there were some concerns that he had Ebola, and my sources were telling me, look, this deputy never had contact with Mr. Duncan. Therefore, he doesn't have Ebola. And I tried to be very conservative when I was on television talking about him.


COHEN: It is very important to remember that not everything that looks like Ebola is Ebola.


STELTER: Maybe that's our keyword for all of this, the word conservative.

Elizabeth and Gavin, thank you both for being here this morning.

MACGREGOR-SKINNER: Thank you, Brian.

COHEN: Thank you.

STELTER: After this break, we are going to stay on our breaking news coverage about concerns here in the U.S., but turn to a media story that frankly is baffling to me. It's the NBC News crew that agreed to self-quarantine, but is now under a mandatory quarantine. I will share my reporting with you about why that has happened after this quick break.


STELTER: Welcome back to RELIABLE SOURCES. There have been no small number of exaggerations in the media

about the threat posed by Ebola here in the U.S. But for some reporters who are covering this story, the risk is very real.

We should keep in mind the freelance NBC cameraman Ashoka Mukpo, who is receiving treatment in a Nebraska hospital now after he contracted Ebola while working with NBC over in Liberia, let me put up on screen some good news, a statement that we received yesterday from Mukpo's family.

They say he is doing well, he's getting better. And I will part of it for you.

He has been steadily improving over the past 48 hours. He's been symptom-free during that time and is steadily increasing his physical strength and spirit. His appetite has returned and he is asking for food. And it goes on to say that they believe he has turned the corner, and with time, will make a full recovery.

But back here in the U.S., the rest of the NBC crew that he was working said they were going to self-quarantine, they were going to stay in the homes for the 21-day period recommended by doctors.

That is why it was very confusing when on Thursday a local Web site in New Jersey said that Dr. Nancy Snyderman had been spotted out in public, even though she was supposed to be staying at home.

Well, on Friday night, the state of New Jersey imposed a mandatory quarantine on that crew. NBC is not commenting on exactly what has happened here, but I will put up their statement on screen.

They have said that they fully support the guidelines set by the local can authorities. "we continue to expect they will be followed. Our team are all well with normal temperatures, which they check multiple times a day, and they are also in daily contact with local health officials."

Unfortunately, Dr. Nancy has not commented on what happened here, so we don't know for the time being.

But I want to bring in a guest I have had here on RELIABLE SOURCES before, Dr. Gail Saltz.

She's a psychiatrist and a regular on television. And I want to talk to her about the anxiety that viewers may feel when hearing about Ebola.

But, first, Dr. Saltz, let me ask you about this NBC crew. I have a feeling the main reason why people like Dr. Nancy Snyderman are asked to stay at home is because otherwise it can create concern and hysteria in the community. What was your reaction when you heard about this mandatory quarantine?

DR. GAIL SALTZ, ASSOCIATE PROFESSOR OF PSYCHIATRY, THE NEW YORK PRESBYTERIAN HOSPITAL AT WEILL-CORNELL SCHOOL OF MEDICINE: Well, I think it is understandable. I think that even if there is really not a risk, because we know

that this disease is passed through exposure to secretions -- and if you are walking around town, that is not going to happen -- that there is -- as we said, we need to be able to trust our health officials.

We need to feel a confidence in them that they are following the rules, and that if we are creating important rules to limit the spread of this disease, then those need to be followed. And I think that you basically mess with people's confidence if you breach that.

STELTER: The Pew Research Center came out this week with a poll that was I thought pretty encouraging. It found that most Americans are not too concerned about Ebola.

Only 21 percent said they somewhat worried, 11 percent said they were very worried that they or someone in their family will be exposed to the virus, and that means the vast majority of Americans are not too concerned.

What are you seeing in your patients? Are you seeing increased levels of anxiety?

SALTZ: Yes, actually, I think those are interesting numbers, because 11 percent, that accounts for probably -- first of all, that's a huge number of people when you think about it.

And those are people who are probably predisposed to anxiety, and so that is what I am seeing. I tend to see people who are already anxious, and people who are already anxious are going to have their anxiety probably raised by anything that would be considered a large- scale disaster that is not 100 percent controllable or predictable.

That is the typical thing. We could talk about a natural disaster, but Ebola is a world concern. And those kinds of things raise people's anxiety. So I am seeing more anxiety in my patients.

But I think that people need to know that it would be fairly normal to have anxiety about something that doesn't seem completely predictable, like this health care worker coming down with it. We thought, well, it is contained. And as long as people are really following the rules, that is likely true.

So, people shouldn't be anxious, because as the vast majority of people obviously realize, they are not really at risk.

STELTER: And that is why it is a big story here on cable news. It is not because people are in imminent danger. It's because it's a mystery. It's the kind of story that is very intriguing to people that they pay attention to for that reason.

I have got to run, unfortunately, Dr. Gail Saltz, but thank you for being here.

SALTZ: My pleasure.

STELTER: Well, we have been in breaking news mode this morning, so we're wrapping up RELIABLE SOURCES, but we're going to share some of our planned segments online on

That's where our media coverage keeps going seven days a week. We have got a story up there about how NBC News thought about hiring Jon Stewart for "Meet the Press" before choosing Chuck Todd. So, check that out and our planned segments online.

I will see you right back here next Sunday at 11:00 a.m. Eastern time. And if you can't join us live, make sure you set your DVR.