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CDC Holds Press Conference on Ebola

Aired October 14, 2014 - 15:00   ET

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

ANDERSON COOPER, CNN ANCHOR: And it's possible we may hear something about that also in this press conference coming up.

PAMELA BROWN, CNN ANCHOR: Yes, I'm also curious to know that Pham is been treated at the same hospital where she contracted the virus, and she's treated by presumably by some of the nurses that helped Duncan.

Do we know how they're dealing with this? Are they frightened at all, considering what happened to Pham, considering that, perhaps, there was something with the protocol that obviously wasn't working since Pham contracted the virus?

COOPER: Well, you know, what is interesting is Nina Pham was not, nor were other nurses there, among the people who were being monitored by health officials. There were dozens here who had contact with Thomas Eric Duncan who were having their temperatures taken.

Nina Pham was doing this on her own, was self-monitoring, but she wasn't under any kind of observation, nor was anyone else from the hospital. That now has certainly changed. A number of the medical personnel who worked on Thomas Duncan are being observed to see if they possibly come down with anything. It's very possible this could have spread to others if this was some sort of a mistake in the protocol that was used or in the protective gear that was used.

And again they have not officially been able to determine how Nina Pham contracted the virus at this point.

BROWN: You can imagine that's concerning to those nurses there at the hospital. Anderson Cooper, thank you so much.

We're going to continue this discussion after the CDC press conference.

And let me bring in Dr. Celine Gounder now, an infectious disease and public health specialist.

As we heard Anderson talk about, Dr. Gounder, there has been a blood transfusion given to Pham from Kent Brantly. Of course, we know that he was infected with Ebola and has recovered. How can this help her treatment?

DR. CELINE GOUNDER, INFECTIOUS DISEASE AND PUBLIC HEALTH SPECIALIST: When someone gets an infection, whether it's Ebola or some other infection, your body's immune system secretes what are called antibodies. Antibodies are proteins that essentially bind the virus particle, thereby neutralizing it and also recruiting other immune cells to come help fight infection. So the idea is that Brantly's blood has the right antibodies to fight off the Ebola virus infection. And so by essentially giving her his antibodies, she might be able to recover as well.

BROWN: And it's important to note here because I think a lot of people are asking, well, why didn't Duncan get the same blood transfusion? I guess their blood types weren't a match. So Pham is really fortunate in that, that she was a match.

GOUNDER: She's very lucky because not everybody is going to be a blood type match.

However, I do agree that it doesn't look very good aesthetically, so to speak, that Duncan did not receive a blood transfusion, while all of the Americans who were able to access it did so.

BROWN: How critical do you think -- I mean, I know that as we have talked about, there's no cure for Ebola. But how much does something like this, like a blood transfusion, how much of a difference can that make?

GOUNDER: Well, it could make a tremendous difference. One of the reasons that Ebola is so deadly is that the vast majority of people are not able to secrete, to produce the right antibodies to fight off the infection. And so if you have somebody who luckily did and you're able to assist others by giving them that person's antibodies, it could make a big difference.

BROWN: I want you to walk us through, Dr. Gounder, the gear, the protective gear that these doctors are supposed to wear.

Our Sanjay Gupta -- and, hopefully, we can show the video. Sanjay Gupta right here actually is putting on the gear. And you can see, there's a lot of room for error here. It doesn't completely cover his entire body as we work toward that video. What's your take on this?

GOUNDER: Well, I think, in general, should this be protective enough? Well, we have thought so up until now. One of the key issues is when you take off this equipment that there's the potential that you take the gloves off incredibly, so that you actually get bodily fluids on your hands as you're taking them off. You could have had some bodily fluids that get on to the mask. And the mask is the last thing that's removed. And so you could be contaminating your fingers after you take off the mask and then maybe touching your face. So there's a lot of room for error.

Some have suggested using hazmat suits and there are problems with that as well. One of the advantages of that approach is you might be able to decontaminate somebody with bleach, for example, before they remove the hazmat suit, which with this you can't do. If you did it with this, you would be at high risk for splashing them on whatever skin is still exposed. BROWN: But I would think, and correct me if I'm wrong, you're the

expert, the hazmat suit would be a better option and provide more protection, right?

I mean, we saw his neck and hair was exposed there and, in fact, he got chocolate syrup on there which was supposed to mimic what would happen if you're taking care of an Ebola patient.

GOUNDER: Right. Right.

Well, part of the issue here is that not every hospital has hazmat suits. And as we're moving towards possibly centralizing care for Ebola patients, which is one thing that is being talked about now, we have only four biocontainment units in the country.

However, one of the suggestions has been perhaps we need a specialized treatment center in each state, for example, regional treatment centers. And those could potentially be geared up with hazmat suits. There's a lot of training that's involved in the appropriate use of a hazmat suit.

And we wouldn't want to make things even more complicated for the average health care worker in terms of possible contamination and removing something.

BROWN: Because it all comes down to, as you point, seems like to me, removing, the way you remove the gear, the protective gear after you treat an Ebola patient.

We know Nina Pham has contracted the virus. Apparently, she was following all the protocol. What is your assessment of what might have happened as we try to figure this out?

GOUNDER: Well, I think the two key parts of the removal, so to speak, that are very high risk are the gloves.

So you have two sets of gloves that you're wearing. And there's the way that Sanjay showed on the screen where he pulls off the gown and then turns the gloves inside out as he's pulling off the gown. That's one approach the CDC recommends.

There's another one we call beaking, so to speak, where you pull and form sort of a beak out of the glove that's covering the palm of your hand and pull it off inside out over the hand, so that you're not contaminating the glove underneath.

That's not something that's standard practice among health care workers. This is something that's very specific to care of Ebola patients. So it requires very specialized training.

BROWN: Something that I think a lot of people want Dr. Frieden in the CDC press conference coming up right here on the show to address is whether hospitals really are adequately prepared to handle Ebola patients in the wake of what happened with Thomas Duncan and then Nina Pham.

What do you hope to hear from this press conference, Dr. Gounder?

GOUNDER: Well, I'm hoping to hear, one, that we have a plan for some more specialized, regionalized treatment facilities in the country.

I think that practice makes perfect and that if you have people who are really charged with caring for these kinds of patients who have intense training, I think will have better outcomes, both for the patient as well as for the health care providers.

I think one of the problems that we're facing in a lot of hospitals, you have some people very concerned. Then you also have health care workers who say, well, this isn't going to happen to me. I'm never going to see an Ebola patient. Why do I really need to pay attention to any of this?

So if you really charge certain people, certain facilities with having to care for these patients, they know that there's a high likelihood that they will be responsible.

BROWN: Like at Emory in Atlanta and elsewhere, because, I think that's been something that's been brought up...

GOUNDER: Precisely.

BROWN: ... and Dr. Frieden sort of talked about yesterday saying that, you know, they are exploring the option of transferring Ebola patients to facilities that specialize in this.

And I think what some people might not understand or, you know, take into account is that the CDC can't force these hospitals to follow the procedures or to do -- take certain steps. They can only provide sort of the guidelines. Is that right? It's really up to the states, is that correct?

GOUNDER: Yes. So the CDC does not have regulatory authority over the hospitals to follow their guidelines. They're providing information.

But it really comes down to the hospitals to take responsibility for training their staff. So, you know, there is a loophole there you could say in terms of things happening as they should.

BROWN: All right. And as we await this press conference with Dr. Frieden from the CDC, we're going to take a quick break.

But stay with us, more to come.

(COMMERCIAL BREAK)

BROWN: We're just getting word that ISIS militants have surrounded another Iraqi air base, one of the largest in Anbar province. And we're also hearing Iraqi security forces are fleeing for the second day in a row there.

And in Syria, ISIS fighters are moving deeper inside the city of Kobani on the Syrian/Turkish border. You're looking at new pictures here, right here, after the U.S. carried out the biggest number of airstrikes since the war on ISIS began, all this as President Obama hunkers down in a secure facility along with top defense chiefs from 22 different nations.

We're going to be following this story, more on that in just a minute.

But, first, let's go to the CDC press conference talking about Ebola. Take a listen.

(JOINED IN PROGRESS)

DR. THOMAS FRIEDEN, CDC DIRECTOR: We're helping with all aspects of the response.

In Dallas, what we have done over the past 48 hours to improve infection control there is send a team into the field. And we have sent CDC's most experienced staff, people who have worked on Ebola outbreaks for decades, people who have stopped Ebola outbreaks in very difficult situations in Africa, people who are experts, leading the world in everything from laboratory science, to infection control, to hospital administration.

And we're working hand in glove, side by side with the folks at the hospital and with the teams from the health departments in Texas, as well as the county leadership and the state.

Some of the things that the teams are doing to improve safety are looking at every step in the procedures. And those experts are making immediate enhancements in what's being doing. I'll mention three in particular, although they are three of just a large series.

The first and most important is ensuring that, every hour of the day, there is a site manager there who is overseeing aspects of infection control. That individual makes sure that the personal protective equipment is put on correctly and taken off correctly.

In fact, in our work stopping Ebola in Africa, this is the single most important position to protect health workers, a single site manager who is expert and oversees every aspect of the process.

Second, we're enhancing training, ongoing, refresher, repeat training, including by two nurses from Emory who have cared for Ebola patients and are assisting and training nurses and other staff at the hospital in Dallas.

And, third, we're recommending that the number of staff who go in for care be limited. We want to limit the number of staff who are providing care so that they can become more familiar and more systematic in how they put on and take off protective equipment, and they can become more comfortable in a healthy way with providing care in the isolation unit.

Those three general steps are very important. And we're also doing many other things, looking at everything from the type of personal protective equipment used to the procedure for putting it on and the procedure for taking it off. Now, I have been hearing loud and clear from health care workers from

around the country that they're worried, that they don't feel prepared to take care of a patient with Ebola, that they're very distressed that one of our colleagues now has contracted Ebola and is fighting the infection in Dallas.

A single infection in a health care worker is unacceptable. And what we're doing at this point is looking at everything we can do to minimize that risk, so those who are caring for her do that safely and effectively.

There are certain additional things that we will be doing going forward. One thing we want to make sure is that whatever is done with where care is provided, every hospital in the country needs to be ready to diagnose Ebola. That means that every doctor, every nurse, every staff person in an emergency department who cares for someone with fever or other signs of infection needs to ask, where have you been in the past month? Where have you been in the past 21 days? Have you been to Liberia, Sierra Leone or Guinea?

That's important. That will reduce the risk that someone will come into a hospital and not be diagnosed. The fact is that usually infections and health care settings spread from someone who is not yet diagnosed. So, we have to shore up the diagnosis of people who have symptoms and who have traveled.

The second thing that we will be doing starting today is establishing a CDC Ebola response team. For any hospital anywhere in the country that has a confirmed case of Ebola, we will put a team on the ground within hours with some of the world's leading experts in how to take care of and protect health care workers from Ebola infection.

That will include experts in infection control, in laboratory science, in personal protective equipment, in management of Ebola units, experts who will assist with experimental therapies, public education and environmental controls.

We have at CDC some of the absolute best experts in the world. They have devoted their lives to stopping Ebola. Many of them, like myself, are physicians trained in infection diseases and public health. Others are specialists in laboratory science or outreach, experts in everything from contact tracing to epidemiology to what it takes to stop an outbreak in different settings.

They will look at everything from the physical layout of care to the personal protective equipment used. They will bring supplies of personal protective equipment. They will assist with transport of patients should that become necessary. They will assist with waste management and decontamination.

In addition, for training of health care workers throughout the country, we will be ramping up Webinars, conference calls, outreach, support through hospitals, hospital associations, professional associations, state and local health departments and more.

I would like to now turn to the situation in Dallas in terms of infection control. And -- I'm sorry -- in terms of contacts and just outline where we are.

First, our understanding is that the nurse remains in stable condition, and we're thinking of her -- I am thinking of her constantly and hoping for her steady recovery.

For the first patient, the index patient, as we call him, there were 48 contacts. Those contacts have now passed more than two-thirds of their risk period. They have all passed more than 14 days. And while it wouldn't be impossible that some of them would develop the disease, they have now passed through the highest-risk period. And it's decreasingly likely that any of them will develop Ebola.

Second, for the nurse who is now hospitalized, there was one and only one contact. That is a representation of what happens when you do active monitoring, when you do contact tracing, and when you encourage people to come in for care promptly. In the first patient who had Ebola in the U.S., 48 potential contacts, in the second, one potential contact.

And that individual had contact before the nurse was severely ill. The nurse is not severely ill now. And, generally, people are not highly infectious at that point. So we will hope that he does not develop infection.

Third, since the nurse did develop infection, we can't rule out that other people who cared for the individual, the first patient, the index case, had exposure. Our teams have been working very hard to cast a wide net and identify everyone who might have been exposed in that circumstance. That includes anyone who went into the room and that includes people who might have handled specimens of blood that were taken from him.

At this point, the team has identified 76 individuals who might have had exposure to the index patient. Of those 76 individuals, all will be monitored for fever or symptoms on a daily basis actively.

I know it's in the media, and there are several of those individuals who have been concerned about their health and have come in for care and been evaluated. Dr. Lakey will outline the results of those evaluations.

I will share with you that it is very anxiety-provoking to have been -- had a potential exposure to Ebola. When I got back to West Africa, I had gone into Ebola treatment units. And let me tell you, every time I had the slightest sore throat or headache, I was concerned.

And that's what we want health care workers to do, be concerned about their health if they are in this group of 76 individuals, and, if so, come in for care rapidly so they can be assessed.

We would much rather see a false alarm than someone who lets their illness go on for a day and potentially get sicker and potentially exposes others. So that's the system as it should work. We want people to come in if they have any symptoms.

Given that there was one patient, the second patient, the nurse did get infected, it's possible we will see other people become ill. We hope that won't be the case. And I don't want anyone to take out of this that there were 76 exposed people. There's 76 people who had some level of contact and therefore are being actively monitored.

So I will stop there and turn it over to Dr. Lakey for details of those individuals and anything else you would like to say -- David.

DR. DAVID LAKEY, COMMISSIONER, TEXAS DEPARTMENT OF STATE HEALTH SERVICES: Thank you, Dr. Frieden.

And good afternoon, everyone.

It's been 14 days since our first case of Ebola was diagnosed in the United States. And we have had a very busy time here. Since the passing of Mr. Duncan, we have unfortunately had one additional case. And we know that's one too many, and we knew that's a possibility.

And if she's listening, again, we're thinking about you and doing everything we can to make sure you get the treatment that you need.

We have a force here on the ground in Texas to make sure that this is contained. And we have state leadership here on the ground in Dallas, teams from the CDC, the hospital and local partners all working together to confront this.

Health care workers are understandably worried. And our top priority is their safety and the health of everyone in Texas.

I had the opportunity yesterday to go to the hospital and talk in detail with the team there on the ground at Presbyterian Hospital. That team consists of, at the CDC, individuals from the state, state epidemiologists, epidemiologists from the local health department.

We're fortunate to have two nurses from Emory right here on the ground and working in concert with the hospital. They are looking at every detail of infection control. And it's really to have the best national and international experts here on the ground at the Presbyterian.

The group of people originally identified as contacts, the 48 individuals, have passed the critical period, as Dr. Frieden outlined, and they are doing well. Obviously, we need to continue to monitor them, but the good news is that they continue to do well.

The one close contact of the health care worker diagnosed this weekend is also doing well and has no symptoms. That person is being actively monitored. We are also caring for and monitoring the health care worker's dog. And that is going well.

We are actively monitoring a group of health care workers, as Dr. Frieden noted, who were previously self-monitoring and had contact with Mr. Duncan. They're all doing well. But if symptoms are detected, even minimum symptoms, those individuals will be isolated and very likely will be tested for Ebola.

Now, we really do want to err on the side of caution. When people exhibit symptoms, they are identified extremely quickly due to the vigilant monitoring. And I want to assure individuals that no additional cases of Ebola have been detected.

We understand that there's a lot of anxiety among workers. And we want to calm their fears and detect a case as quickly as possible. And we will quickly announce any positive results. And we're committed to giving you that information.

So, we have a large number of individuals now under active surveillance. But that seems to be going well due to that partnership between the federal government, the state government and local government working with the hospital. We're all very committed to fighting Ebola here in Dallas. And it's our singular focus with experts across the state and country.

So, with that, Dr. Frieden, I would like to hand it back over to you.

FRIEDEN: Thank you. And we will now take questions starting with in the room.

QUESTION: Sabrina Tavernise, "New York Times."

How many of the 76 were health care workers? Do we know?

FRIEDEN: Those are all health care workers.

All of the people exposed to the second patient were health care workers, except for the one close contact I mentioned.

(CROSSTALK)

FRIEDEN: I'm sorry. I said that wrong.

The 76 were all exposed to the -- let me say it again so we get it all right, because there are a lot of numbers and let's get it straight. First off, the first patient, the index patient, before he was hospitalized, had exposures or potential exposures to 48 people.

Second, once he was hospitalized, there were at least 76 people who might have come into contact with him or his blood and who are being monitored now. We may identify a few more people as we go through records and identify other information, but that's the number who may have participated in some way in the care of the index patient.

There's also one individual who was exposed to the second patient before she was isolated.

QUESTION: Janice McDonald, ABC.

We understand that each hospital has to be able to diagnose an Ebola patient. But once they're diagnosed, why not then transfer them to one of the high-level containment centers?

FRIEDEN: We're absolutely looking at all of the options, looking at the possibility of transferring patients when necessary. And that's one of the things the Ebola response team would consider. QUESTION: Doug Stoddart with NBC News.

It's our understanding that the nurse who was infected had received her certification for critical care nursing about two months ago. Are you comfortable with that level of experience treating Ebola patients?

FRIEDEN: I think we -- what we are dealing with is a disease that's unfamiliar in the U.S. And caring for Ebola can be done safely, but it's hard.

And we want to make sure that the protocols that we have the support we have for health care workers are there on the ground so we can assist. And I have thought often about it. I wish we had put a team like this on the ground the day the patient, the first patient was diagnosed. That might have prevented this infection.

But we will do that from today onward with any case anywhere in the U.S.

On the phone?

UNIDENTIFIED FEMALE: Thank you on the phone lines. If you would like ask a question, press star one and record your name clearly. To remove yourself from the queue, you may press star two. And one moment, please.

Our first question comes from Meg Tirrell with CNBC.

You may ask your question.

QUESTION: Hi, guys.

I'm just wondering, are you concerned about health care workers, you know, feeling safe and well-prepared on the job, concerned at all that folks will be afraid to come to work?

FRIEDEN: We are concerned that if health care workers are afraid to come to work or patients are afraid to go to hospitals or health care settings, we could see wider health care impacts.

That's why it's so important that we focus on what will work here. We know how to stop Ebola. We know that care has been provided in hospitals throughout Africa without infections. But we know it's hard. And we know that a single breach can cause an infection.

We know that a single slip can cause an infection. That's why we're looking at every aspect of the procedures, so that we can make them safer. And we're empowering health care workers with information, because, when you're concerned about something, when you're worried about it, I find it's always helpful to get more information about it, so you can understand it more fully.