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British Prime Minister Boris Johnson in Intensive Care with coronavirus. Aired 3:30-4p ET

Aired April 6, 2020 - 15:30   ET



BIANCA NOBILO, CNN CORRESPONDENT: It was curious actually in the press conference today, Kate, it was noted by several journalists that the Prime Minister had been underscoring how precious the NHS was and how precious each of these beds in hospital is right now as Britain nears the peak of this outbreak, 439 people dying today.

One of the journalists asked the question, well, which is it, is the Prime Minister fit and well enough to lead the country at this point or is he so sick that he requires one of those precious beds that so many people need at the moment in the United Kingdom.

So, I think that kind of question which was struggled to be answered by those at the press conference certainly started people asking that question. You know, which one is it? Boris Johnson is somebody who always goes out of his way to project a vibrant, strong leadership. He's exuberant and he also doesn't like to divulge personal details.

But clearly the health of the Prime Minister now is absolutely integral to the health of the nation. So that's why people were asking questions this afternoon trying to discern is he well enough to be making decisions not just on a daily basis, Kate, that pertain to this country's health and ability to withstand this outbreak but on an hourly basis. Clearly now he has given those responsibilities to his de-facto deputy, Dominic Raab, who'll be taking those key decisions in the coming hours and days,

KATE BOLDUAN, CNN HOST: And I think you pose, and other journalists are posing the paramount question right now, if the Prime Minister is well enough to be leading the country at this point. Really, really sad turn of events right now.

Soon as you have updates, please bring it to us, Bianca. I really appreciate it. Thank you so much. Joining me right now, CNN chief medical correspondent Dr. Sanjay Gupta. And Sanjay, thank you for jumping on so quickly.

Clearly a lot not known but as we're learning -- what we heard right there from Bianca, we know -- it sounds like we know one thing essentially. That he clearly has worsened because he is now been moved into intensive care. What are your questions that you have now for the limited information that has been made public about the Prime Minister?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, you know, he was admitted to the hospital last night is my understanding. About ten days after he was first diagnosed. What we heard last night was that it was for more routine sort of you know evaluation in the hospital for some testing and things like that.

We want to know, you know, just what was his status at that time last night? And then obviously the question, Kate, is what happened today that sort of prompted this move to the intensive care unit?

It's usually one of a few things. The most obvious thing especially with something that is a respiratory problem, there was concern about his ability, Boris Johnson's ability to sort of continue on his own without some additional oxygen. Maybe even a breathing machine. Don't know that for sure, obviously. But that's one of the reasons people go to the intensive care unit.

Sometimes it can be due to heart issues if someone's unable to maintain blood pressure for some reason, they need to have medications placed that are typically monitored and administered in intensive care unit. It could just be sometime out of an abundance of caution.

Look, we can't monitor someone as closely as we would like on a general care floor. Need to go to the intensive care unit or it's some sort of more sophisticated therapy. Some sort of treatment.

Of course, as you know, Kate, here is no specific known approved therapy for COVID but sometimes that there's certain medicines to try, sometimes they do that in the intensive care unit.

But to your point, something clearly changed. And what was happening as of last night to today is a very different sort of story. So my guess is that it probably has something to do with his heart or his lungs. And we -- we don't have that information right now.

BOLDUAN: Look, and I was -- I remember Governor Cuomo actually saying last week, at the end of the last week, in terms of how they talk about resources here in New York. He basically classified an ICU bed in his mind is any bed that requires a ventilator. And I found that interesting. And I do wonder, though, if we're told he wasn't on -- Boris Johnson was not on a ventilator before, if he is now, what does that indicate?

GUPTA: You know, first of all, being 10, 11 days out from his initial diagnosis, this is the pattern. You know as we really looked at this data, this is a pattern that we've seen over and over again that somebody may have a sudden sort of somewhat abrupt decline in their ability to just maintain their breathing on their own. And they need to have mechanical support.

I think you're right. I think what you're driving at, Kate, is right. Is like in the midst of a pandemic, if someone is going to the intensive care unit it obviously has to be for good reason.

[15:35:00] Because these are obviously a very precious commodity and the number one reason right now is because of ventilators. And it's not just ventilators but it's the respiratory therapists that actually, you know, administer all that therapy and they're taking care of the ventilator and the patient, and all of the monitoring and all that goes on. You need not hour-by-hour monitoring, you need minute-by- minute monitoring now. So, all of that is the case.

Now it may be that they're worried enough about him that they think that he may need one so he's sort of in that phase in between. And they thought it would be better for him to be in the intensive care unit just as a caution. But a very -- a very concerned caution in the sense that they think that he may end up being someone who needs to have a breathing tube placed and placed on this ventilator.

But again, we don't know. That is the pattern that we're seeing in so many other patients. I think we know he is 55 years old as well. Kate. So, he's younger than that very vulnerable age group but that's not to say that many people of that age range are ending up hospitalized and in the intensive care unit.

BOLDUAN: And I think what you're hitting on something that is really important for people is one thing I know I've been struck by in hearing people's stories and I love your perspective on it, is the pattern.

While there is so much not known and so much not known about why it hits one person differently than another person. But the pattern of mild-ish symptoms and then this quick turn where they quickly need to be put on a ventilator, that's been, I think, kind of the scariest part of the pattern watching this play out.

GUPTA: Yes, I think typically when you think about these type of infections, I think the perception typically is look, someone has an infection, in this case the viral infection, the virus continues to replicate and in a linear fashion, in a linear way it starts to -- you know, the body -- if it cannot fight this infection well enough starts to become overwhelmed by the virus.

But what seems to happen sometimes, Kate, is that it sort of seems to be OK for a period of time. The patient is sick but doing relatively OK. And then there is a decline, you know, pretty suddenly. And sometimes it can be because the body's own immune system is actually the culprit here.

It's not so much the virus but the body reacts in an aggressive way and it's the inflammation from the body itself and all of the other molecules with the inflammation that kind of -- that's causing the problem, making it difficult for someone to breathe, making it difficult for their organs to function.

Sometimes it can be that there're certain things that allow the lungs to contract and expand well and those particular things in the body start to become depleted and that could cause sort of a sudden decline. Again, we don't know. But it's important really for the physicians,

the clinicians that are taking care of Boris Johnson or anybody in that position, because the way that would you treat that would be very differently. If it's the immune system that is overreacting, you might give something to suppress the immune system. If it's the virus, you would not want to give something to suppress the immune system, you would focus on just maintaining lung function and everything else to sort of support the patient.

So, you don't know. It's important to sort of figure it out. We know he's 55 so that puts him in a different pattern compared to other patients who are elderly more vulnerable populations, but you know that's probably right now what's happening in that intensive care unit. What exactly --

BOLDUAN: Sanjay.

GUPTA: -- is going on with his lungs and his heart.

BOLDUAN: Sorry. What would the next -- I mean Downing Street needs to put out some more information. There's no question as this continues and goes into the evening. What would be your first question to them right now in regard to trying to get a good handle on where the Prime Minister is in the course of this illness or how well or not, he is in the moment?

GUPTA: Yes, I mean, I think, you know, from a medical perspective, you know you clearly want to know what exactly was the reason for the transfer to the intensive care unit? And even more specifically, is he now on a breathing machine?

If he is on a breathing machine, how is he responding to that breathing machine? You know, most people will respond well. And they will have, you know, a recovery as they're supported by a breathing machine. Is he is falling into that sort of category where he's responding well.

I think it is safe to say as well though that you know when you're on a breathing machine like this, you usually are often sedated. You know, you're not able to really -- because of the medicines they give you, to really be cognizant and aware and interacting in some way -- at least not initially.

BOLDUAN: Sanjay, that might sound like just to kind of part of the process for anyone. But when it comes to the leader of a country, what you just said is a very important fact.


GUPTA: Yes, it is important. And I think that it is medically necessary. You know I mean when you're in a situation like that, in order to get somebody stabilized, to make sure they are comfortable, that they are responding well to the therapy that you're giving them, for a period of time we often give medicines to basically sedate somebody. And to make sure we -- all those other therapies that we're giving to that person have a higher chance of succeeding. BOLDUAN: Yes, Sanjay, thank you so much.

All right, stick around with me. Everybody stick around. We have much more on this breaking news right after this.



BOLDUAN: All right, we're back with breaking news. U.K. Prime Minister Boris Johnson has been moved to intensive care as he continues to battle coronavirus but with this new development he's been moved into the ICU.

Let me get over to CNN international diplomatic editor Nic Robertson with more on this. Nic, do you have an update?

NIC ROBERTSON, CNN INTERNATIONAL DIPLOMATIC EDITOR (via Cisco Webex): We do. The Prime Minister we're told is conscious at this time that has been moved to the ICU as a precautionary measure in case he needs a ventilator.

So, the implication here from Downing Street is that he is not on a ventilator at this time -- a precautionary measure. But I think it's worth noting here that 24 hours ago Downing Street was saying that Prime Minister Boris Johnson was being moved as a precautionary step. And now, of course, is in the ICU.

The British medical assessment of people that get into the critical care phase of the health service system here that are in the Prime Minister's age bracket, that is 55, between 50 and 69, have a 54 percent chance of recovery. So, those statistics are not particularly favorable. Obviously worse for older people. But those are statistics that come from the British medical profession dealing with the virus.

The hospital that he is in at the moment say they have had over 400 patients -- coronavirus patients so far. That they are short of staff because of people being off sick. That they have had shortages of personal protection equipment. But they do say that they have quite a number and range of well-maintained, good ICU areas.

So, the Prime Minister is in a hospital in the center of London, just a few minutes drive from Downing Street. He went there yesterday. Not in an ambulance but in a regular vehicle. He went, we're told, at that time, not in an emergency situation.

But I think this is what we've been discovering from the information that Downing Street has been giving so far. That they tend to downplay the severity of the situation. We saw that in the press conference today. Multiple questions asked of this now deputy, the man who stepped up to take over, Dominic Raab, the Foreign Secretary, First Secretary of State. And the answers kept pushing back at that press conference.

That his condition -- that they wouldn't specifically comment on was that he was still capable in capacity, to still be leading a country just a few hours ago. So, I think caution when we listen to the lines that we get from Downing Street at the moment.

BOLDUAN: Nic, is it clear to you at the moment who is running the British government right now?

ROBERSTON: It is very clear. They've made this very clear. The Prime Minister has nominated Dominic Raab, the Foreign Secretary who is also the First Secretary of State who is the natural person to step up to take the Prime Minister's place. This is decided on case-by-case basis. Of course, this isn't something that ever happens with any kind of regularity whatsoever, but the Prime Minister has nominated him to take over.

Indeed, Dominic Raab chaired the Prime Minister's normal morning meeting just about 12 hours ago now. That was quite a short meeting. I was outside of Downing Street when he went in, the Health Secretary went in as well. While it's the Prime Minister normal short, beginning of the day meeting to catch up with his cabinet, it was dominated, obviously, by the coronavirus issue.

But already this morning Dominic Raab was already stepping up and taking over from the Prime Minister although at that time we were told the Prime Minister was still leading the country. That has changed now.

BOLDUAN: All right, thanks so much.

Let me bring in Dr. Megan Ranney. She's a New York physician. We were talking to her at top of the show. Doctor, what do you take from all of this?

DR. MEGAN RANNEY, ASSOCIATE PROFESSOR OF HEALTH SERVICES, BROWN UNIVERSITY: So, it's tough to know all of the information that we just got is helpful, suggesting that the Prime Minister is not yet on a ventilator.

Based on the story that we've heard to date, my suspicion is, is that the Prime Minister probably developed one of the very common complications of COVID-19 which is problems with your lungs and with your breathing. We're seeing that a lot of patients with COVID-19 develop something that we call ground glass opacities or little teeny inflammations throughout your lungs that we're still trying to figure out, are they infection, are they fluid, what exactly is causing them?

When that happens, we're finding that patients get short of breath and they're oxygen levels drop. Sometimes to very dangerous levels. And at that point people need closer monitoring, they need higher levels of oxygen, they may need extra respiratory support in a special negative pressure room that helps to minimize the chance of infection for other people around them.


So that may be my best guess as to what's happening here based on the description that we've received to date.

BOLDUAN: Right, and obviously you don't speculate on exactly the Prime Minister's condition, but when you hear this, do you expect he would be on a ventilator now?

RANNEY: So, not necessarily. We certainly send people to the intensive care unit for that really high level of monitoring. We usually have a higher or a lower number of nurses for a patient. So, for instance in extensive care units, in my own state, we usually have about a two to one ratio, so any nurse only has two patients at a time.

So, it may just be that the Prime Minister needs higher levels of nursing care, again, needs higher levels of oxygen or other non- ventilator based respiratory supports that simply are not possible in a normal floor bed. But it does create a concern that he could be heading towards a ventilator.

And one of the things that's so tough about COVID-19 is that we just don't have great science yet to predict who is about to get sicker and why and how to intervene on it? So, it's tough for me to say what's going to happen next because we've seen some people spend a week in the ICU and never go on a ventilator and are fine. Other people get intubated and spend two weeks on a ventilator and never come off. Some people are in the middle and go on a ventilator for a little bit and then go on to do OK.

And there are a lot of other experimental treatments that are being used in the course of trials across the world right now. Those may also be things they're considering using for the Prime Minister, although most of those would not require an intensive care unit bed.

BOLDUAN: Dr. Ranney, thank you so much. Let me get over to Elizabeth Cohen, Elizabeth, you've been watching this, listening to this news, what do you see here?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: You know, there are two things I want to talk about here, Kate.

First of all, I think people need to remember, that with dangerous viruses, sometimes this happens. I have done more than one story on someone with the flu who went to the doctor in the morning, they said, yes, you have the flu, go home, drink, you know, plenty of fluids, you'll be fine, and they were dead by night. That can happen.

And what I'm hearing from doctors who are treating COVID patients is that patients can look good, they may even look like they're getting better and even recovering, and then they can take this dangerous turn.

And that brings me to the second point, Kate, which is related. We just heard Sanjay talk about how a healthy person's immune system can actually work against them. So, the Prime Minister is 55. His immune system may be in great shape. That could -- I'm not saying it is -- but it could work against him. Because the immune system just goes on this full-fledged battle and it actually ends up reacting in ways that hurt the body, and that is really a problem. It's called a cytokine storm and it can set you up for a terrible situation.

We hope that is not the situation that he's in. But it is important to remember that even though we're mostly, or we're very much worried about elderly people, even younger people with healthy immune systems, those immune systems can work against them.

BOLDUAN: Do you, guys, do we have Megan Ranney still, Dr. Ranney still with us? I just had a quick question for her. Just bouncing off just what Elizabeth was just talking about, what contributes to this quick turn? What do you see in this?

RANNEY: So, we don't exactly know what causes the quick turn. There are a lot of theories out there. Some are, like she described, and as Dr. Gupta described, that there is this cytokine storm, that there is this sudden release of lots of chemicals within your body that create an enhanced inflammatory condition.

There is also some other hypotheses out there, some theories about what might cause this, like maybe it's due to little micro-clots in your vasculature. We don't exactly know why some people are taking this very sudden turn for the worse and we don't exactly know how to predict who it's going to happen to or when it's going to happen?

But based on the description, so far, it sounds like the Prime Minister has had a gradual decline. So again, I would suspect that he's having one of those COVID-19 respiratory problems, these bilateral pneumonias or infiltrates in the lungs that are probably hurting his ability to oxygenate. And I hope that he's not experiencing that sudden inflammatory storm that we're seeing in some patients.

BOLDUAN: Yes, Dr. Ranney, thank you very much.

We're going to have much more on the breaking news coming up this hour, British Prime Minister Boris Johnson, as we've been discussing, moved into the ICU. We're live in London with the very latest, next.



ANNOUNCER: This is CNN breaking news.

JAKE TAPPER, CNN HOST: Welcome to THE LEAD. I'm Jake Tapper.

And we begin this hour with breaking news. Just minutes ago, we learned that U.K. Prime Minister Boris Johnson has now been moved to intensive care as he battles coronavirus.

Johnson was first admitted to a London hospital last night, ten days after he first tested positive. The Prime Minister is one of 1.3 million confirmed coronavirus cases around the globe. There are more than 73,000 deaths from coronavirus worldwide that have been reported.

And in the United States, more than 10,000 people have died, 10,389 as of this hour --neighbors, friends, family members. This time last week, there were 1,200 deaths. Now more than 10,000. As the nation's top infectious disease expert Dr. Anthony Fauci is now warning, the U.S. is struggling to get coronavirus under control.

First, let's go to CNN's Bianca Nobilo in London. Bianca, tell us what you're learning about Boris Johnson.

NOBILO: Well, Jake, it's a rapidly developing situation. The last statement that we had from Downing Street was that the Prime Minister was taken to the intensive care unit at 7:00 p.m. local time. So now that's about two hours ago.