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Legal View with Ashleigh Banfield

Ebola Patient Flew Before Diagnosis; Nurses Speak Out; Protecting the Health Care Workers; Dow Plummets Nearly 300 Points; Obama Delays Travel for Ebola Conference

Aired October 15, 2014 - 12:00   ET

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

ANNOUNCER: This is CNN breaking news.

ASHLEIGH BANFIELD, CNN ANCHOR: Hello, everyone. I'm Ashleigh Banfield.

And our breaking news on the Ebola in America. We have just learned the name of the second health care worker who's been infected with Ebola. We've also just learned that she flew on an airplane the day before being diagnosed with this deadly condition. So if you flew from Cleveland to Dallas on Monday of this week on Frontier Airlines Flight 1143, the Centers for Disease Control and Prevention, they want to talk to you, and they want you to call. Reuters News agency is saying that her name, the infected nurse, is Amber Vinson, and that she, too, helped care for the late Ebola victim, Thomas Eric Duncan, who fell ill and died at Texas Health Presbyterian Hospital. Just like nurse Nina Pham, who tested positive on Sunday. Vinson came down with a fever yesterday, just one day after she took that flight.

I want to bring in former CNN anchor and now CNN aviation analyst Miles O'Brien, as well as CNN medical analyst Dr. Alexander van Tulleken, an epidemiologist and infectious disease expert as well. And then also from Atlanta, CNN's Dr. Sanjay Gupta.

First to you, Sanjay, should other passengers be concerned considering how much information we've been getting about when you are contagious, when you show symptoms and when you're around other people? Break it down for me if you could.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, they're going to be concerned because they just got a call - they got a thing saying they should call the CDC. And, obviously, that's going to raise their concerns, understandably.

Your point is the important one, though, Ashleigh, and that is that you don't -- you really don't transmit this virus, spread it until you are sick yourself. And it sounds like from what we're hearing, if she's being completely honest, that she was not sick until she got back into Dallas, developed a fever and 90 minutes later was in isolation.

I am curious what the CDC is going to say to these passengers when they get the call. My guess is they'll say, look, you -- there was a passenger who was subsequently diagnosed with Ebola on your plane. We think your risk is very, very low, but you should take your temperature yourself for 21 days. You don't need to quarantine yourself, you don't need to stay indoors, but take your temperature. We think it's unlikely to show anything. But that's likely going to be their recommendation.

BANFIELD: So, Miles, Dallas is not like every other city in America in that it has DFW. It has one of the busiest airports in this country. And this woman flew into DFW. It was a conversation I had with my staff just yesterday, that that's the concern for America is that DFW is a hub. What should the airlines be doing right now?

MILES O'BRIEN, CNN AVIATION ANALYST: Well, let's not forget, as Sanjay pointed out, that, you know, we're talking about an exchange of fluids that causes the virus to be passed. Just sitting in a metal tube with somebody who may or may not have it is not going to give you Ebola. The precaution is important.

What -- a lot of this goes down to the perception among air travelers. Are they going to be concerned about getting on those airplanes? And the airline industry needs to stay out in front of this. It isn't that - it doesn't take a huge impact to use these infrared devices, for example, to detect people who have a higher temperature and screen them along the way. We've been talking about international flights but this --

BANFIELD: Yes, we're not doing it domestically.

O'BRIEN: This raises the specter of domestic flights and it causes a whole ripple effect of concern which comes out of that, should there be screening in and out of Dallas right now? Possibly. Maybe that's something we should be looking at. But as we well know, she might very well not have had that fever on that airplane and might have --

BANFIELD: Or might not have known she had the fever, just thought the airplane was warm. That's my --

O'BRIEN: And thus may not have been actually contagious (INAUDIBLE). A whole series of questions here. But it does go to perception and the concern that people are getting --

BANFIELD: So let's take your information, right next door, to Dr. van Tulleken, because when you say, you know, sitting in the metal tube, it doesn't mean that you're just going to catch it. But at the same time, whoever had the armrest next to her, whoever perhaps got on that flight that might have taken passengers from that gate right back out again without a really thorough bleach cleaning of the airplane. We don't know enough about how long that virus, as delicate as it is, could actually survive on a surface, do we?

DR. ANDREW VAN TULLEKEN, CNN MEDICAL ANALYST: So I think its - so we can find (INAUDIBLE). Whether or not it's viable after a few hours is very difficult to tell. But I think - I think you're absolutely right, Miles, that just being on that metal tube -- we've had other people who are symptomatic with Ebola travel by air before, particularly Patrick Sawyer, the man who - the American national who brought Ebola to Nigeria, and he did not pass it on to anyone on the plane. So I think the risks for people on this plane is very low. But what we're seeing again, the biggest story here is that someone

who was exposed to Ebola, who was supposedly being monitored, albeit a passage surveillance system, was allowed to get on a plane.

BANFIELD: Was allowed to get on an airplane.

VAN TULLEKEN: And that -- and she could easily - as you say, she could have directed - she could have developed a fever on the plane or she could have got on and just gone, you know, I've got a bit of a headache, I'll take a Tylenol.

BANFIELD: Speaking of -

VAN TULLEKEN: Yes.

BANFIELD: I want to bring in our senior medical correspondent, Elizabeth Cohen, who's just been doing remarkable reporting out front on this.

And, Elizabeth, do you have any information on this second patient and her identity, and what Dr. van Tulleken just said, how could she have been flying?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: You know, there's something I don't understand here, Ashleigh, and that's that these health care workers, we're told, are now getting daily visit from health officials. Daily visits. So unless she did like an up-and-back in a couple hours to Cleveland, what did -- she didn't show up for that daily visit. So if they're supposed to be getting daily visits, it seems like they shouldn't be leaving the Dallas Airport.

I've reached out to state officials. They are very hard to get ahold of. I will tell you, it's hard to get answers out of them. But that's a question that's out there, how was she allowed to get on a flight if she was supposed to be getting daily visits from health officials. I think there is - you know, I don't think anyone's saying that all - or, well, maybe someone is. But the point isn't should they be quarantined, but really you want to let them out of Dallas? That seems a little tricky.

BANFIELD: Sitting right next to people. I mean right next -- I was on a flight just this week with two small children and those are close quarters.

Let me bring in Sanjay Gupta back again for this question. And I don't understand these rules of quarantine. I mean some of them are slightly quarantined, which to me defies the purpose completely. Some are under monitor. Some are under penalty of law not to leave the apartment. How does this work and what's the point of being slightly quarantined?

GUPTA: Well, you know, the -- it's unusual for sure, and I think this is part of the confusion. Typically when you think of quarantine, when you think of someone being quarantined because you want to - you want to diminish the risk that that person is to the public's health at large. That is not what we're talking about here with Ebola because, again, unless someone is sick, they're really not a threat to the public at large. The reason for people in Dallas were quarantined who were friends, family of Mr. Duncan, was because there was a concern with them that they may not stay in their apartment, that they may not be able to get their temperatures monitored and they would be hard to track as a result. It wasn't because of a specific concern about the risk to public health. But that was confusing.

And then you add in this notion of active surveillance versus passive surveillance. Active surveillance means somebody's coming and taking your temperature for you, being there, recording all that. Passive is more that you're doing it on your own and that - and giving that information to health authorities. There are different levels here. It's confusing. But I think you've got to remember the underlying point here is, again, if you're not sick, you're not transmitting the virus. So the quarantine isn't in place for that specific reason.

BANFIELD: Yes. Although I'm so concerned about just when you're actually sick, when you know you're running a fever. I'm the worst person to take my temperature. I think it's just hot outside, but --

GUPTA: If I could just make a quick point about that, Ashleigh.

BANFIELD: Yes, quickly, too.

GUPTA: Don't - I think we think about this in a binary sense, too. You're not contagious at all and then if you develop a fever, suddenly you're contagious. That's not -- that's a little too simplistic. I think the sicker you are, the more contagious you are. Someone who just has a fever, it's not to say that they've suddenly now gone into the contagious part of things and they're transmitting virus. The reason people get sick is there's a lot of virus in their body, that's what makes them sick, and it also makes that virus more likely to spill over outside of their body.

BANFIELD: Can I just ask Dr. van Tulleken to weigh in on that point that Sanjay just made as well? The fact that I have two small children, and we share cups, and we share - you know, we spend a lot of close contact together. If someone does develop a fever, and you're maybe in the early stages and not as contagious as you would be, say, on day 14, but you're that close to your family.

VAN TULLEKEN: Yes. I mean I think the closer you are physically to someone, the more likely you are to share bodily fluids with them, the higher the risk goes.

BANFIELD: Even in those early, early stages?

VAN TULLEKEN: Sanjay's absolutely right, the higher the viral load in these patient, the more dangerous it is. And that's - and that's why, I think, we see these transmissions in hospitals, the case of (INAUDIBLE).

BANFIELD: Doesn't it shock you that Thomas Eric Duncan's partner, who was sharing the same bed -

VAN TULLEKEN: Yes. BANFIELD: Those same sheets that ultimately ended up being hazardous waste, the same apartment, for days and days and days, is almost at the end of her 21-day period. It seems astounding that she's OK, as is the son, as are the two grown, you know, family members in the apartment as well.

VAN TULLEKEN: Well, the issue you're raising there is really, really important. So this is why we keep saying this disease is quite hard to catch is because for every person who's a nurse wearing protective gear, who's been exposed and has caught it, there are many, many more people who have been exposed and haven't caught it. And the higher the viral load, the easier it is to catch, as Sanjay says.

BANFIELD: Which also brings in what Miles said -

VAN TULLEKEN: Yes.

BANFIELD: You just can't catch it, you know, in a metal tube.

VAN TULLEKEN: But everything here says we have to be much more careful than we're being about people who have been exposed.

BANFIELD: Yes. I don't want to be that one chance. You know that - yes, you're absolutely right, not highly contagious but highly, highly infectious.

By the way, on your screen, if you were on Frontier Flight 1143, the Centers for Disease Control and Prevention would really like you to give them a call. The number is 1-800-CDC-INFO. 1-800-CDC-INFO. Again, that was the flight, 1143. Just let me be absolutely clear on the day. I'm just going to ask our control room to be absolutely clear on the day that that flight happened. That was on October the 13th. October 13th, Flight 1143, Frontier Flight, Cleveland to Dallas.

I want to ask everybody if you can stay around, please, Dr. van Tulleken, Miles O'Brien, Sanjay Gupta and Elizabeth Cohen.

The nurses who were in that Dallas hospital were reportedly pretty darn confused about what protocols they were supposed to be following in just going to their job and caring for their patients. And it raises a very big question, are nurses at hospitals around this country being given the information and the proper equipment that they need to protect themselves adequately and protect their patients as well? Because, don't forget, they're treating other people, too. The president of the national nursing organization is up next.

(COMMERCIAL BREAK)

BANFIELD: Welcome back.

I want to talk about those scathing allegations that were made by unidentified nurses at Texas Presbyterian Hospital. The workers there do not belong to a union. But here's what they told an organization called National Nurses United. For one thing, Thomas Eric Duncan, the Liberian national who came to the hospital two times and who died there a week ago, was not put into isolation for hours. What's more, the nurses' protective gear left gaps around their necks. And they were told to use medical tape to cover up those gaps. Hazardous waste was allowed to pile up from floor to ceiling because they say there was no one to remove it. And there was no formal mandated training. In fact, say the union leaders, there seems to be - there seems to have been no plan there at all. Have a listen.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE (voice-over): There was no advanced preparedness on what to do with the patient. There was no protocol. There was no system. The nurses were asked to call the Infectious Disease Department. The Infectious Disease Department did not have clear policies to provide either.

(END VIDEO CLIP)

BANFIELD: I'm joined from Boston now by the co-president of the National Nurses United, Karen Higgins. CNN's Dr. Sanjay Gupta is still with me as well.

Miss Higgins, if I can just begin with you and the extremely serious allegations that are being leveled against this hospital, is this a problem at this hospital, at Texas Presbyterian, or is this something far more widespread? This is something that is systemic around the country?

KAREN HIGGINS, CO-PRESIDENT, NATIONAL NURSES UNITED: I think it's much more widespread. I think that we're hearing from nurses across the country that they probably feel as ill-prepared as they did in Dallas. And this is a major concern for all of us that we've been, you know, going on and on and on about.

And it's time we take this seriously now that we have a second case, is that we have to do better in what we provide for equipment to keep the employees safe, especially those taking care of that patient.

And then the second piece is the training. It has to be done. Stop pointing fingers and fix the problem and do not let Dallas happen again anywhere else in this country.

BANFIELD: You know, I just want to dovetail off of what you just said, Miss Higgins, by something that's breaking right now. I've got a statement from the press secretary at the White House saying that President Obama had some travel plan today for New Jersey and Connecticut and that travel has now been postponed.

The reason being that the president late this afternoon is planning to convene a -- a group of Cabinet agencies coordinating the government's response to the Ebola outbreak. There's going to be apparently something this afternoon. They're not telling us exactly which agencies, but just Cabinet agencies are going to be coordinated. The travel for the president is off to deal with this as well.

Sanjay, is that the response that Miss Higgins was just talking about, that there needs to be a bigger response perhaps at the level of the White House? DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yes, I think -- I

think Miss Higgins is absolutely correct. And my guess is that Health and Human Services, also the Transportation Department will likely be a part of whatever meeting, this conference that you just described.

I mean, you know, it's amazing to me in some ways that, you know, we're talking about some of the basic things required in hospitals. You know, as much as we talk about the experimental vaccines and therapies, some of this is just the basics, the bread-and-butter stuff, and it wasn't implemented well.

And the interesting thing is I can't tell if the protocols weren't there, if people really weren't given them or if all that's dwarfed by the fact that the personal protective equipment that I heard in that same statement from the nurses union was so deficient. It's pretty remarkable to me considering how long, you know, in some ways we've been thinking about this as a country.

I mean, I've been covering this story since April and I know at the CDC, they said over the last several months, we're getting hospitals prepared for this sort of thing. First case example really did not seem to work well.

BANFIELD: Karen Higgins, can you just --

HIGGINS: No, it didn't work well.

BANFIELD: Yes. And I'd like you to -- just to get a little bit more about what the phone calls were like that came to you from these nurses who reported to you these incredible breaches. That it seems like severe breaches in protocol. Especially this first one. That this patient on his second admission was allegedly left in a waiting room. And I believe it's where there might have been up to four other patients, is that accurate? Am I getting that right? There might have been four other patients --

(CROSSTALK)

HIGGINS: I think there was, at least.

BANFIELD: What was the complaint, that the nursing supervisor tried to change the circumstance and couldn't?

HIGGINS: It sounded like even she was met with resistance to, you know, providing a better place to put this patient.

BANFIELD: Like isolation?

HIGGINS: Isolation. And, again, it shows you that we were not prepared nor this, that they were not set up to take this kind of patient. I mean, we have infectious disease controls but we never were prepared to take somebody at this level that needed this kind of care. And I think we saw this. I mean, we saw this and I think -- like I said, unless we change what we're doing and make it more of a standard practice for everyone, we are going to see it happen again and we need to stop it. And I think that's why we're making a stand to say, enough is enough.

Stop blaming people. Fix the problem --

BANFIELD: So -- this defies logic. And I'm going to just correct myself here. It wasn't four patients who were present in the -- in the waiting room, it was up to seven.

What would be the defense of someone who suggests to a nursing supervisor who wants to put a patient like Eric Duncan, Thomas Eric Duncan, in isolation? What would be the defense? Don't create hysteria? We don't have a proper facility? What would be the defense for that? Or is there any?

HIGGINS: There is no defense for that. That's the problem. We knew. We knew this is a possibility. We knew how sick these patients would be. We knew that you needed to isolate them. So if you even had a question that this man had that, then that -- that should have automatically went into effect immediately.

BANFIELD: Sanjay? Can you weigh in on this? Can you think of -- I always want to play the devil's advocate. I just cannot for the life of me, and I don't know your business.

GUPTA: Well, let me --

BANFIELD: Think of why on earth someone would be left like that in a waiting room.

GUPTA: Well, I think Miss Higgins' point is exactly correct. Let me shoot down what many people may think right away. Were we sure he had Ebola at the time that he was put in this other area with seven other patients? And to Miss Higgins' point, that doesn't matter. See, the way hospitals work --

BANFIELD: Yes, who cares? Be cautious.

(LAUGHTER)

GUPTA: -- if the suspicion is there and you've tested, then the point is at that point you have to treat the patient as if they might have Ebola until proven otherwise. That is how hospitals work. Because you want to be conservative. You want to be very, very cautious. And it doesn't sound like that happened here. So it sounds like they were sort of having it both ways.

We don't -- maybe we don't really think he has Ebola. We're going to go ahead and test. But we really don't think, so we'll put him in a room with other patients. That's just -- you can see how contradictory that is in terms of patient care.

HIGGINS: Sure.

BANFIELD: And then, Miss Higgins --

(CROSSTALK) BANFIELD: I just wanted to ask you about the one claim that -- it's very serious, and I just want to make sure that we're covering all the bases we can. The fact that there's hazardous waste piling up to the ceiling, and I don't think that's -- I don't think that's hyperbole. I think they literally meant that there was that much waste if you think of all the bed sheets and everything else that was being used.

HIGGINS: Right.

BANFIELD: Would it also be fair to say that moving it and transporting it was a dangerous job in itself and until they had the right staffing and the right contractors in place to do that, to keep it in one isolated area might be the safe way so we could see both sides of that story?

HIGGINS: Well, I will say that, I mean, as bad as it is and as dangerous as it is to have all of that piling up, it was probably the most -- the only thing that they actually did truthfully do is to not move it until they actually had an idea of how to actually move it. So I don't think that was the wrong thing to do.

It was wrong that it had to pile up like that. But, again, it goes back to the fact they didn't know what to do.

BANFIELD: Yes.

HIGGINS: They didn't know how to deal with it and they didn't know what to do. And I just wanted to --

BANFIELD: That there wasn't a mechanism in place.

HIGGINS: Yes. And I wanted -- I just wanted to say, I mean, CDC has stepped up and said, you know, now we will bring a team in immediately when we hear somebody has Ebola. You know what? That's good. It's a nice step. But it's not going to fix the problem. You still have to have those that are going to be standing at the door when this patient comes in, be ready to take care of this patient and do everything they can to be protective of the patient, of everybody else and of everybody that's in contact with them.

So it's a great idea for them to get in there. But we can't say, oh, they're going to show up, so we're going to be all right. And when are they going to show up? Four hours, five hours later? There could be a lot of problems before then. So that's not good enough.

BANFIELD: And everyone needs to remember the nurses and doctors are really on the front lines of this.

HIGGINS: Right.

BANFIELD: Who else deals with those kinds of fluids but the nurses and doctors and family members.

Thank you so much, Miss Higgins. I really appreciate it. It's good of you to help us out and navigate through this.

HIGGINS: No problem.

BANFIELD: Sanjay Gupta, I'm going to ask you to stick around as well.

GUPTA: Yes.

BANFIELD: In the meantime, we're watching some other big news, and that is this. The Dow plummeting today, almost 300 points down right now. And just a brutal opening. In fact just plummeting right from the opening within a half hour.

So what's to cause this? Is it Ebola? Is it the scare? Is it the president responding? It's a lot of that. But really there's some other big news as well that's causing that. And it's financial news, and it's Europe, and it's China, and it's the good old stimulus.

We're going to talk about it in a moment.

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