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Ebola Blood Transfusion; Ebola Protection; Ebola Care; U.S. Strike on ISIS

Aired October 14, 2014 - 14:00   ET

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

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PAMELA BROWN, CNN ANCHOR: I'm Pamela Brown, in for Brooke Baldwin. Thanks so much for being here with us on this Tuesday.

The first American to contract Ebola in the U.S. is now breaking her silence. Just moments ago, 26-year-old Nina Pham, who treated Thomas Eric Duncan before he died, releasing this statement through the Dallas hospital. Quote, "I'm doing well and want to thank everyone for their kind wishes and prayers. I am blessed by the support of family and friends and am blessed to be cared for by the best team of doctors and nurses and the world here at Texas Health Presbyterian Hospital Dallas."

Meantime, sobering news about the future of this epidemic. The World Health Organization estimating there could be up to 10,000 new, that's right, new Ebola cases in West Africa's hardest hit countries by the first week of December. As it stands right now, there are nearly 9,000 reported cases, nearly half of them deadly. And at least seven cases are in the U.S. But to date, only one, Duncan's, has been fatal.

And a wider view of the current epidemic globally. Eleven countries across three continents are affected. The most recent, a Sudanese U.N. medical worker who died last night in Germany. CNN senior medical correspondent Elizabeth Cohen is right outside Texas Health Presbyterian with an update on Pham's condition.

And before we get to Pham, Elizabeth, we understand that Duncan's family actually requested a blood transfusion but the hospital initially denied that request, is that right?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Right, that's what Duncan's family tells me is that from the time he was hospitalized on September 28th, they knew -- they'd heard about this procedure. They asked for a blood transfusion from a survivor but the hospital told them, no, that it was not proven to be effective and they would not go down that road. Now, finally, they did go down that road on October 4th. Nancy Writebol got an inquiry to see if she would donate her blood. But it turned out that Duncan was not a match for anybody. But this family, while, of course, they're so pleased to hear that Nina Pham is getting this treatment and that she's doing well, they're wondering why it took so long for the hospital to go down the road of getting - to get a transfusion for their loved one.

BROWN: And as you point out there, Elizabeth, Pham is getting a blood transfusion we've learned from another American Ebola patient. Tell us what you know about that and how this can be helpful for her treatment.

COHEN: Sure. So when someone survives Ebola, like Kent Brantly did, his body has developed antibodies to the virus to fight off the - to fight off that virus. So if you give that blood to someone who's currently suffering from Ebola, those same antibodies can get in there and fight the Ebola.

I actually was talking with someone who treated -- a health care worker who took care of an Ebola patient. I said, do you think it made a difference? And she said, oh, yes, I definitely think that it made a difference.

But, I will tell you, there's no proof that it's made a difference. No one has done a study. But right now, with Ebola, they don't have a choice. They have to try things that are clinically unproven.

BROWN: And that makes you wonder, in light of what you just said, why the hospital initially denied or refused to ask about that blood transfusion.

And talking about Duncan, we're learning from the A.P. that 70 hospital staffers cared for Duncan while he was hospitalized there. What can you tell us about that?

COHEN: Right. So Nina Pham was one of them. And up until her illness, health authorities were not following these health care workers. They thought, look, well, they're protected. They're wearing full protective gear. We don't need to follow them. And then once she got sick, they started following them. So now they're getting daily visits from health care workers, they're getting - from health officials. They're getting their temperature taken. But it was thought that this protective gear worked so well that there was no reason that they needed to be followed by officials.

BROWN: And what's so interesting here, Elizabeth, is that Pham is actually being treated at the same hospital where she contracted the virus. I'm curious to know what changes in procedure have been put into place in light of the fact that she took care of Duncan and then contracted the virus.

COHEN: Right. So the CDC sent in many people to come and help train them how to use this protective gear because clearly something didn't go exactly the way that it should. And I'll tell you, Pam, this protective gear is not easy to use. It is especially not easy to take off. I don't want to get too graphic, but Ebola patients put out a lot of fluids, and doctors and nurses, their gowns get very soiled. Taking off garments that are soiled with infectious material is tricky.

And not all hospitals have drills. Not all hospitals have practiced this. As a matter of fact, most doctors and nurses haven't drilled in this. They have - they have very little if any experience in this. So the CDC is trying to train them so that they can do it better.

BROWN: All right. Well, we're going to continue this discussion, Elizabeth, a little bit later in the show because we're expecting to hear from the CDC at 3:00 p.m. Eastern Time. Thank you so much for that.

And as Elizabeth just pointed out, you know, much of this conversation surrounding the case of the Dallas nurse still continues to focus on her protective gear and how a breach may have happened while she was treating Ebola patient Thomas Duncan. But as CNN's chief medical correspondent Dr. Sanjay Gupta found out, following the CDC guidelines on the proper way to put on the gear still leaves plenty of room for error.

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DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: So I want to give you an idea of what the CDC is recommending in terms of how to protect yourself with this personal protective gear. I'm also going to show you how to take it off, which some say is the most dangerous part. I will point out as we start to do this, I work in an operating room every week. This is different than what most doctors, I think, are used to, at least in the operating room.

Now, I do want to point out, this is a little different than how I suited up when I was in Guinea, but we're following CDC protocol. Now I want to show you how I'm going to take this protective equipment off and I'm also going to put a little chocolate sauce in my hand which could represent a possible Ebola contamination. Take a look.

This is the mask back on. So here would be the most likely contaminated area would be my gloves, maybe the front of my gown a bit like this. OK. Now I've got to - I've got to treat this as if I'm potentially contaminated. I come out. What I'll going to do with this particular gown, I'm going to rip it all off together and everything's going to come off simultaneously. But a part of the glove sort of brushed against my hand, my arm there, that could potentially be an exposure.

If the glove didn't come off properly, I would reach underneath here as best I could and get underneath there, but perhaps, if I didn't do it exactly right, there could be another potential exposure there. I'm reaching behind now, as well as I can, but let's say the side of my face shield was contaminated and I touched here, that could potentially be an exposure. Same thing here now with the face mask.

So now take a look. Right there, see a little bit of chocolate sauce, one possible exposure and over here on my neck, one possible exposure.

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BROWN: And as Dr. Gupta points out right there, protective covering like this could work just fine and that all hospitals, both here and overseas, have a slightly different process when it comes to the gear. But still, the possible lack of effectiveness is alarming.

So let's bring in Dr. Celine Gounder, an infectious disease and public health specialist, to discuss this. Dr. Gounder, Sanjay said this is different than how he suited up in

Guinea. That these scrubs may not be as protective. Because as we saw there, some of his skin was exposed. So what's this telling you?

DR. CELINE GOUNDER, INFECTIOUS DISEASES AND PUBLIC HEALTH SPECIALIST: Thanks for having me on, Pamela.

What I would say is that the hazmat suits that you see now in the picture behind us do cover much more of the skin than do the standard equipment that we use in the hospital. So the gowns, the gloves, the masks, the face shields. In addition, the hazmat suits, they actually use duct tape around the wrist to make sure there's nothing that's going to get in underneath.

One of the things that's been proposed is, well, why don't we decontaminate people before they take off the gowns and gloves and so on. The problem is, with what you just saw Sanjay wearing, fluid that you would be using for decontamination could actually leak underneath the gloves, for example.

Another concern I have with what we just saw was when Sanjay took off the mask. So if the mask had some fluid on it and he's then taking it off, he could've contaminated his fingers and then spread it to his face.

BROWN: So really the key here is how you take off the protective gear, is that right?

GOUNDER: That's exactly right. So you have to take it off in a very specific order. And to do that, you actually have to put it on in a very specific order. So, for example, the gown needs to go on before the gloves so the gloves should cover the wrist. You want the mask to be the last thing you take off so your face shield or your goggles need to go on after you put on the mask and then come off before you take off the mask. So there's a lot of rigor to how you do all of this.

BROWN: It seems, though, that there's a lot of room for error. And like you point out, there's so many steps that you really have to be perfect in doing. And these suits aren't foolproof. I mean is that what you see?

GOUNDER: Right. They're not foolproof. And, again, some people are saying, well, maybe we should be using hazmat suits. In part because that would allow for better decontamination with fluids, with bleach, for example, before you take this off. Doctors Without Borders, the leading experts on treatment and management of Ebola, they have in addition a buddy system where somebody watches you, walks you through taking everything off. And you do it in a very slow manner. For some people it takes as long as, and this is with the hazmat suit approach, 45 minutes to take everything off because you're doing things so slowly and systematically.

BROWN: Yes, you wonder why the buddy system isn't mandatory. It just makes a lot of sense.

GOUNDER: Absolutely. I agree.

BROWN: All right, Dr. Gounder, thank you so much for being here with us. We appreciate your insight.

GOUNDER: My pleasure.

BROWN: And up next right here on NEWSROOM, if a patient is taking a turn for the worst, should doctors and nurses risk their lives to save them? At what point does care cross the line? I'm going to speak with a medical ethicist about that.

And, plus, moments from now, President Obama meeting with top military leaders from around the world on the war against ISIS. If air strikes aren't working, will they be rethinking strategy? This as new video surfaces of ISIS terrorists training for war. This is CNN's special live coverage.

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BROWN: They are desperate measures to save an Ebola patient's life. Kidney dialysis, used to filter blood, respiratory intubation to help a patient breathe. Thomas Duncan, the first person to die of Ebola in the U.S., was treated with both in the final efforts to save his life. But there are new questions posed by the CDC as to whether these last resort measures could've put infected nurse, Nina Pham, and her colleagues at greater risk. Now, health officials are considering this. If a patient cannot be saved, should doctors stop from doing everything they can and just save themselves? Listen to this point from N.I.H. Director Dr. Anthony Fauci on CNN.

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DR. ANTHONY FAUCI, DIRECTOR, NATL., INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES: Those kinds of procedures heightened greatly the risk of a health care worker getting a deadly disease, that has to at least be put on the table to consider that you might want to take a look at the things you don't want to do when someone is so far advanced that it's unlikely you'll save them.

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BROWN: So let's bring in Kenneth Goodman, director of the University of Miami bioethics program.

Looking at the risks posed by those Ebola procedures, at what point do you think that those invasive measures cross the line and are just too risky to do, especially when you're considering working with an Ebola patient like Duncan?

KENNETH GOODMAN, CO-DIR., UNIVERSITY OF MIAMI BIOETHICS PROGRAM: Mind you, we have difficulty now deciding whether any particular treatment at the end of life is beneficial. These could be really difficult judgment calls even in the absence of Ebola. And our experience in the United States is we regularly over treat patients at the end of life. Whether or not cardio pulmonary resuscitation, dialysis or intubation is going to be effective in the case of an Ebola patient is, I'd argue that's something should be left to the judgment of clinicians who are taking care of that patient. If in their judgment the -- unlikely to be successful, then as you just heard, that's among the data that should be put on the table.

BROWN: So you think it should be up to a doctor, then, to decide that saving the patient isn't worth endangering the health worker?

GOODMAN: Well, the doctor himself and the nurse herself or himself is going to be that health worker. Obviously, every hospital in the United States of America right now and probably around the world are working on policies and procedures best to govern the way we should respond to these kinds of cases. We've had so far more -- fewer westerners with Ebola than you had at dinner last night at your house. We're trying to figure out what the best strategies are to accomplish two ends which are uncontroversial, high quality patient care and protecting the people who are giving it.

We need to prepare for that. We need better policies and procedures. And, by the way, the next time someone says let's cut taxes for public health or aid to Africa, let's remind them what the cost of that is. We need to do this in a thoughtful, measured way. And I think right now we're gathering data about precisely the questions you're asking.

BROWN: And I'm curious to know when you're giving these really serious procedures, like dialysis and intubation, how difficult is it for a doctor to follow all the necessary protocol when they're in the thick of it like that?

GOODMAN: I don't know if anyone can answer that question right now. I mean we are gathering data as quickly as we can about what it's like to practice medicine and nursing wearing personal protective equipment. It's a challenge. It's a challenge to get it right as you've seen. And the actual practice of medicine and nursing is going to be complicated. There's no doubt about it. But, in fact, we tend to rise to these challenges. I think actually what you're seeing now is a society that's trying to come to terms with the health threat, gathering data and trying to identify the best policies and practices. When we have people who have actually gone through it and we can learn from them, that will increase our knowledge base tremendously.

BROWN: Kenneth Goodman, interesting to hear your perspective, thanks for coming on the show.

And up next, right here on NEWSROOM, as the U.S. bombs ISIS in a keyboarder city, the terrorist group releasing new propaganda pictures of their training.

And, military operations. This as President Obama gets ready to discuss strategy with military leaders around the world.

Plus, as America debates whether a terminally ill patient should die on his/her own terms, you're going to hear from one mother who is revealing a secret, she helped give the lethal dose to her own daughter.

(BEGIN VIDEO CLIP) UNIDENTIFIED FEMALE: She was never going to go into a restaurant that she loved to do. She was not going to go to a movie. She was not going to make love again. Her whole life was over.

(END VIDEO CLIP)

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BROWN: The question on a lot of people's minds today, is the war against ISIS actually working? The White House says it is. Right now, President Obama is at a secure facility getting ready to meet with the top defense chiefs from 22 different nations. This as the U.S. continued dropping bombs on military targets. In Syria, smoke rises as we see from the key border town of Kobani, where 21 air strikes have just taken out compounds, tanks, trucks, and even an ISIS building. Twenty-three in total across Iraq and Syria. The biggest number since the air campaign began. But ISIS is still not showing any sign of backing down. In fact, today, they sent out new propaganda pictures of their training and military operations in the Iraqi town of Dialia (ph). Joining me now to discuss this, Jake Tapper, chief Washington correspondent.

Great to see you, Jake.

JAKE TAPPER, CNN CHIEF WASHINGTON CORRESPONDENT: Hey, Pamela.

BROWN: So we hear the White House today coming out and saying the strategy is working. But yet, as we just pointed out, it seems like every day ISIS continues to advance. So how do you make sense of this?

TAPPER: Well, it's early days of the campaign, but you're right, I mean the people who are skeptical of whether or not this campaign is working point out that most military experts say that this is not going to work unless there is some effective ground troops on the ground. And currently there are not. The United States is not coordinating at all with any of the Syrian fighters inside Kobani, for example.

And there are questions about how committed the U.S. is to working with the Syrian Free Army, which, as you know, is not invited to this conference today. The United States says it's only sovereign nations that are invited. But the Syrian Free Army, which - there have been a lot of talks about arming the so-called moderate rebels in Syria. That's them. They want to play a bigger role. They want to be communicating better with the United States and the coalition partners when it comes to information on the ground and that relationship is still somewhat frayed.

So I think the questions are very cogent. How can this work without more eyes and ears on the ground and also, of course, combat troops.

BROWN: And we just talked about, Jake, the fact that President Obama will be in a very important meeting today discussing all of this. What do you expect to come out of this meeting, Jake?

TAPPER: Well, it's a meeting that President Obama is having with the defense ministers or secretaries of defense from 22 different countries. That's an important thing to note because obviously with you trying to get another country to contribute more in terms of fighters or cash or whatever to fight a group such as ISIS, that's not a decision that's going to be made at the defense minister level. That is going to be made at the head of state level.

So what I suspect we're going to hear is more defining of what this specific roles are from these countries that you see named there, the UAE, Turkey, et cetera. We're probably going to hear more about the roles that some of these countries are going to play when it comes to training and arming these moderate Syrian rebels. But I would not suspect we're going to hear anything in terms of any major strategy shift because that's not the kind of decision that would come out of a meeting with defense ministers.

BROWN: Yes, that's a good point. Jake Tapper, thank you so much.

TAPPER: Thanks, Pamela.

BROWN: And Jake will have much more on this coming up on "The Lead" at 4:00 p.m. Eastern.

And just ahead right here on NEWSROOM, we're getting word the Spanish nurse with Ebola, the one who lost her dog, is helping to treat herself. Hear why.

Plus, on the day a 29-year-old who's choosing to die on her own terms speaks out about her decision, a mother reveals she helped her own terminally ill daughter end her life. You're going to hear the secret she's now sharing with the world, up next.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: After I dosed her, so to speak, it took forever for her to stop breathing. And all that time, I'm thinking, please don't wake up.

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