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At This Hour

Second Nurse Tests Positive for Ebola in Dallas; Nurses Speak Out About Lack of Training; Second Ebola Patient Flew from Cleveland to Dallas

Aired October 15, 2014 - 11:00   ET

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

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JOHN BERMAN, CNN CO-ANCHOR: Hello, everyone, I'm John Berman.

MICHAELA PEREIRA, CNN CO-ANCHOR: And I'm Michaela Pereira.

BERMAN: This morning, we've got a lot of news. Not only do we know that Ebola came to the United States, but it's spreading here.

We woke up to the stunning news that a second health care worker in Texas has tested positive for the virus, and this raises serious questions about whether the hospital there was or even now is prepared for this kind of situation.

Both infected health workers cared for Thomas Eric Duncan, the Liberian national who died from the disease one week ago.

PEREIRA: Yesterday the CDC said it was sending an additional team to Dallas to, among other things, figure out just how these workers were exposed.

Health officials still don't know exactly how two health-care workers contracted Ebola. Was it a break in protocol with their safety gear? Did they have the proper gear? Is the protocol the correct protocol? Seventy-five other health-care workers are now being monitored.

(BEGIN VIDEO CLIP)

JUDGE CLAY JENKINS, DALLAS COUNTY: We are preparing contingencies for more, and that is a very real possibility. You can imagine the anxiety of the families of these 77 people.

MAYOR MIKE RAWLINGS, DALLAS: We rallied together and decided we needed to move quickly like we did Sunday morning to make sure two things happen.

One, that effective cleaning was done as soon as possible, and, two, neighbors and the citizens were communicated.

(END VIDEO CLIP)

BERMAN: Nurses who worked in this hospital are telling their union that they were not trained to deal with Ebola patients. They point out serious lapses in safety in dealing with Duncan.

PEREIRA: So what is most important now is for the CDC to get all the facts, which is what it is doing in Dallas.

However, criticism is mounting from those like the nurses union who say much more care should have been taken ahead of time.

I want to discuss so many of these aspects with our chief medical correspondent Dr. Sanjay Gupta. Also joining us, senior medical correspondent Elizabeth Cohen.

I think, Elizabeth, we should begin with the second health-care worker for folks just waking up to learn this news about the second nurse testing positive for Ebola among the people that cared for Thomas Eric Duncan.

How did this all happen? What was the chain of events they found out she was sick? Did she present and say "OK, guys, things are serious now"?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: They haven't explained to us whether she took her own temperature and saw it was elevate word will it was during one of these visits that she and her colleagues have been getting from health officials that they took the temperature and figured it out.

The bottom line is they caught it very early on, and that's really crucial, so there was very little time for her to get -- for her to infect someone else.

BERMAN: Sanjay, I think a lot of people are looking at this with a little bit of alarm right now, because when Thomas Eric Duncan was finally diagnosed with Ebola after being sent home, we should say, the whole world was watching Texas Health Presbyterian.

The entire medical community had its focus there. Yet nevertheless, something still went wrong.

SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yep, I think there's no question, and whether the protocols weren't in place or whether or not they were good enough protocols, I think those are things that, you know, they're going to try and hopefully address.

And we're not hearing much in response to some of these outrageous claims of what was going on in the hospital around the care of Mr. Duncan.

But I think you're absolutely right. And, you know, I think even before that, John, we were hearing, look, a patient's going to arrive, but other people are not going to get sick

We're confident. We've done this in central Africa and west Africa for years. We know how to do this. We got this, almost, was sort of the attitude.

And now we're seeing that -- I don't know if it was some false sense of confidence or what, but hopefully there's some lessons learned here because we're going to see other patients in this country with Ebola.

PEREIRA: Yeah. We want to talk to you a little later in the show about that protocol that exists and the guidelines, and you can even show us just that the protective gear and how it's to be put on and the challenges there.

But I want to ask you specifically about something you mentioned, the care that these two patients who are nurses -- that's the other thing to remember. These are nurses who are now patients.

There have been some calls. People say why don't we move them to specialized isolation units. There's four of them around the nation.

What are the pros and cons of that, Sanjay? They would get the great care they need there, but by transporting them, I guess, you're then putting people in that chain of contact in harm's way as well.

GUPTA: Well, there's divided opinions on this. Let me say a couple things. First of all, I think you need to distinguish between what is treatment of a patient and what is prevention of secondary infection, so making sure that patient sick with Ebola doesn't infect other people. They're both very important and there's some crossover there.

From the treatment standpoint, I think there is no specific treatment, first of all, for Ebola. It's a lot of management of fluids, perhaps a blood transfusion like we know Nurse Pham received in Dallas.

I think treatment really seems like it could be done in many different places, even access to experimental medications.

In terms of preventing secondary infections, Michaela, you make a good point. You could say, look, we're just -- as soon as someone is diagnosed, we're going to move them to one of these centers. That is a possibility.

The problem is, the patient's already come to this hospital, wherever they may be. They've had contact with health-care providers at that hospital, wherever they may be. They may be in isolation but then have to be moved out of isolation into a ambulance, perhaps a plane, and then go to another hospital.

So instead of reducing the chance of secondary infections, my concern is you could make it worse. Now we don't know that for sure, but I think that's a valid concern.

BERMAN: The question, though, to be blunt, is there are now legitimate issues and questions about this specific hospital, Texas Health Presbyterian, because two patients now, two nurses, have become infected there. The two cases now only to come down with Ebola in the United States happened inside that hospital.

And, Elizabeth, I know you've been there in the Dallas community. What is now the sense among this group of, what, 76 other people as they're doing this contact tracing, who may have come in contact with Thomas Eric Duncan? What about all these other people inside that web right now? COHEN: It's interesting. We're not hearing directly from those people.

The nurse's union says that they've heard from them.

You know, often when I've dealt with hospitals where there are issues, employees are terrified, and I don't use that word easily. They're terrified of speaking out, because they're terrified of losing their jobs.

I don't know if that's happening here. I can just say, having covered these issues for years and years and years, that employees don't like to raise their hand and point out what's wrong, for obvious reasons -- they might get fired.

PEREIRA: Yeah. And we know that there's obviously so many points that they're looking at right now, not the least among them the latest health-care worker that was sickened, Dallas officials looking to disinfect her home and the places that she's been.

Dr. Sanjay Gupta, Elizabeth Cohen, we're going to be talking with both of you a little more later on the show. Thanks so much for joining us. Great work, both of you in the field.

BERMAN: Yeah. We're going to stay on this. We have a series of questions we need answered on this, because this is a very serious situation.

Ahead, from claims nurses were not properly trained or prepared to handle Ebola to the real possibility that this could have infected other people here. We're going to cover that.

PEREIRA: All of this while President Obama meets with world leaders @THISHOUR, trying to rally support for the global fight against Ebola.

Back home, though, confidence in his ability to lead the response is fading. We'll discuss.

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(BEGIN VIDEO CLIP)

DR. THOMAS FRIEDEN, CDC DIRECTOR: You know, I've 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.

(END VIDEO CLIP)

BERMAN: That was the head of the CDC saying in hindsight he would have done things differently with the first Ebola patient in Dallas. Nurses wish officials had a team and, moreover, a plan in place before this situation.

PEREIRA: Yeah. They're making some pretty astounding claims about how woefully unprepared Texas Health Presbyterian Hospital was to deal with Ebola.

They say the patient who eventually died, Thomas Eric Duncan, he wasn't immediately put into isolation.

They also say that nurses' protective gear left their necks exposed, that hazardous waste piled up and that nurses received no hands-on training to deal with Ebola and generally they felt as though they weren't being supported.

BERMAN: Jean Ross is co-president of National Nurses United. And, Jean, thanks so much for being with us.

Given this list of complaints that we saw this morning, can we expect more cases in the coming days?

JEAN ROSS, NATIONAL NURSES UNITED: Well, you always hope you won't but let's face it, there's a breach there because of the lack of protocol. Not a breach in the protocol but a lack of it as the nurses say.

So it's -- what those nurses in Dallas are telling us is what we found from our survey. You know, overwhelmingly they're all saying the same thing. To the public, to the CDC, whatever, they say we are all prepared, don't worry.

And the nurses are saying no, we are not. We ask for the plan. They either don't have one, they direct us to a website and say, "Here are the CDC guidelines." We ask for direct hands-on training and drilling, practicing, and either we don't have the staff, we don't have the equipment, et cetera.

PEREIRA: And the fact is, you can't control when a patient comes to your hospital with a fever or an illness or potential Ebola case. We know that that's not something you can anticipate.

You were part of the conference call held yesterday held by the National Nurses Association. There's another conference being made today.

I'm curious. What kind of specific changes are you and the nurses wanting? I think that all of us would agree, given the fact that a second nurse now has become sick, the urgency really increases.

ROSS: It does. We have felt the urgency for some time, but true to form, very often what we warn about employers do not take, we believe, seriously enough. And that goes for many other issues, not just Ebola.

Unfortunately because we don't have a nationalized system of health, we have a for-profit, fragmented, piecemeal system here, and people really are urged to do -- to follow CDC guidelines.

But you can't mandate it. There's no enforcement, and you cannot do a coordinated effort unless the hospitals choose to do this.

Now this -- you know, people are picking at this Dallas hospital, but truthfully, this could happen at any hospital in America, and from the response at our survey, they are all saying we're in the same shape.

BERMAN: It's interesting you say that, because these are not the first Ebola patients treated in the United States. They were treated at Emory Hospital in Atlanta and there were no infections among the health-care workers there. They've been treated in Nebraska at a hospital there. No infections among the health-care workers there.

So where does the responsibility lie then in the case of Texas Health Presbyterian?

ROSS: Well, it's very clear to us. We're very clear, as a nurse, what our responsibility is, it's to care for the patient, to advocate for the patient, and to let the employer know when we are not prepared. It's the employer's responsibility to make sure we are prepared and have the appropriate gear to do so. They just have not been listening, or listening too slowly.

So we want a single uniform standard, an optimal standard, a gold standard, for what equipment we should be using and how to use it. We see that with the people at Emory. We see that with the folks in Nebraska. We see it with the people that are over in Africa trying to help and we believe that that uniform standard should apply to any of us as we approach these patients that may come in.

PEREIRA: Jean, this may seem completely out of left field, but I'm thinking about the fact of what we've seen over the last few years, with the economy the way it is, budgets being constrained. I'm really curious if you think any of that played into how -- well, obviously it plays into how day-to-day operations are being done. But, I can imagine if there is that kind of -- those kind of constraints, they're only made worse by an emergency like this.

ROSS: You know, I can't speak for what happened in Dallas, in particular, as to the whys and wherefores of why they chose not to set up the protocols and do it well from the get-go. But I can tell you from my over 40 years of experience as a nurse, the for-profit bottom line mentality that we have, well in everything, but in health care it's disastrous. And so it wouldn't matter if it were Ebola. Unfortunately, now that is what it is. It's a life-threatening virus.

But we, as nurses, deal with this all the time. We tell employers this is what we need. This is what needs to happen and unless you have a union contract and have ways of doing more than encouraging the employer to do what's necessary, you can't make them. Nobody can make them.

BERMAN: Jean Ross, co-President of National Nurses United., thank you so much for being with us. And again, we thank you and everyone in your profession for the work that you do and are doing right now.

PEREIRA: The tough work, the important work, and the hands-on work. That's the thing. The front lines of this battle, it's the front lines. You have to pause and reflect on that a little.

BERMAN: Look, which makes the questions that we're asking right now all the more important.

PEREIRA: We get accused of sort of trying to point the finger and play the blame game, but we're trying to figure out what went wrong so we don't repeat it again. We don't want Dallas happening in other cities across America.

BERMAN: And among the allegations for what went wrong -- no proper training, no proper protective gear. These, again, the alleged mistakes that were made in treating the first diagnosed case of Ebola in the United States. We will play more of what nurses claim happened in that hospital ahead.

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BERMAN: Alright, we have even more breaking news for you this morning on this news, that a second patient in Texas has been diagnosed with Ebola, a second medical care worker. Now, we just learned that this second patient, this health care worker, flew on a plane from Cleveland to Dallas the night before she was diagnosed or she went to the hospital showing symptoms of Ebola. She traveled from Cleveland to Dallas on Frontier Airlines Flight 1143.

PEREIRA: Right now we're being told that Frontier Airlines is reaching out to advise any passengers that would have been aboard that flight from Cleveland to Dallas on Flight 1143 with Frontier Airlines. This is a concern because, of course, they want to make sure they have this contact research done of everybody that the patient would have come in contact with. One of the things, though, is if she hadn't been systematic, is there a risk? So obviously we want to have that conversation with our medical professionals.

BERMAN: The CDC specifically says that she exhibited no symptoms on the flight, that the passenger and crew says she exhibited no symptoms on the flight and that that airplane was cleaned that night and then again the next day. Nevertheless, the news that she was on a plane and not restricted in her travel, interesting in and of itself.

I want to bring in Dr. Seema Yasmin. She's a public health professor in Dallas and a former disease detective at the CDC and Dr. Frank Esper, infectious disease specialist. And, Dr. Yasmin, I want to start with you here in Dallas, every day that passes we learn something new about the protocols that were in place and were not in place. Let us keep this new piece of information in perspective. She flew from Cleveland to Dallas, this new patient, before she showed symptoms of Ebola. However, should any health care workers who had come in contact with Thomas Eric Duncan, should they be flying at all?

DR. SEEMA YASMIN, DALLAS PUBLIC HEALTH PROFESSOR: Well, I think this is the question that so many local residents are asking right now. We know that she did not have symptoms when she was on the plane, and so that means that she was not at risk of transmitting the virus to anyone. Given now, frontier airlines is asking more than 100 people to come forward and contact them, that's going to increase the amount of work, the amount of resources we put into contact tracing, and it can really make people panic a lot more, so we may need to see some changes in protocols based on the idea that there is so much concern and anxiety around Ebola. Perhaps, we need to address the idea that if you are self-monitoring, you should stay within a certain area.

PEREIRA: Dr. Esper, an infectious disease specialist, ironically enough, joining us from Cleveland today. This contract tracing brings us to the conversation about voluntary versus mandatory isolation or even quarantine. Are you of the mind that maybe if there is a question mark, when in doubt, quarantine?

DR. FRANK ESPER, INFECTIOUS DISEASE SPECIALIST: Certainly, I think the question about who needs to be identified, who needs to be monitored for the 21 days to ensure they don't develop symptoms, is really dependent on their exposure and on their exposure history. And it's very difficult for us to go ahead and say to, you know, 50 to 70 people, stay in your homes, watch daytime TV for the next 21 days. It's pretty tough, I can tell you.

The issue, though, is really to try to understand the disease and what we need to do. I think the biggest problem we have right now is a perception problem. We have a perception now that we do not have this under control, that we are seeing more and more cases because of what we're not doing and we need to reassure everyone, the people who are at risk, the people who are exposed, that we are watching them, that we are ensuring that they do not continue to spread this disease to anyone else.

BERMAN: Dr. Yasmin, the reason we have a perception problem, I think, is because of what has happened in Dallas over the last couple weeks. First off, Thomas Eric Duncan was not admitted to this hospital after he went in exhibiting symptoms, then he was admitted, now not one but two health care workers who treated him have been infected by Ebola. So it is understandable why this problem exists. And as you point out, Thomas Eric Duncan died. So is this hospital the best equipped? Now, when you are Dallas, are they equipped to deal with the two patients that they currently have?

YASMIN: That's a tough question to answer, but one of the key things is we keep talking about whether we should airlift Ebola patients to these biocontainment units. We have to take a reality check. There are four biocontainment units, between them they have about 17 beds and I spoke to the folks at the Nebraska biocontainment unit just yesterday. They said sure, we have 10 beds, we're the biggest unit, but we'd only be comfortable taking two, maybe three Ebola patients.

So this idea that we can airlift people to a special place will quickly become redundant if those 17 beds or fewer beds become filled. And that's why it's so critical now that we learn from the missteps here in Dallas and we make sure that every hospital in the country is ready to deal with an Ebola patient. The likelihood is, if somebody feels ill, they will not turn up in Nebraska, they will go to a regular emergency room.

PEREIRA: Right. One last question for you, Dr. Esper, as an infectious disease expert, you know this all too well, is that hospitals have emergency protocols in place as it stands, but Ebola is a game changer, is it not?

ESPER: You know, it certainly is. Ebola is a disease that is not very forgiving of mistakes. It does not forgive the mistakes that you make when you're treating the individual patient who is afflicted with this disease, as well as in the infection control protocols that we must be stringent and we must be meticulous in protecting the health care workers. And unfortunately, Ebola -- there's still a lot that we don't know about the disease and it's unfortunate that we are still learning on the job. It is an important aspect of us to understand all the missteps that we have already made, to ensure that places like Dallas, but all across the country, do not continue to make those same mistakes.

BERMAN: Let us hope that is the case. Dr. Seema Yasmin and Dr. Frank Esper, thank you so much for being with us. We really appreciate your help here. And as you say, perhaps the 24/7 hotline, which is what Texas Health Presbyterian has, and maybe annual training, is not enough to deal with Ebola, which is not forgiving.

PEREIRA: Yeah, absolutely. We continue to search for answers after another health care worker is diagnosed with Ebola. Ahead at this hour, Dr. Sanjay Gupta and Elizabeth Cohen will return and answer some of our questions. Stay with us.

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