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The Lead with Jake Tapper

Battle Against ISIS; Ebola Patient Dies; CDC Comments on First U.S. Ebola Death

Aired October 08, 2014 - 16:00   ET

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

JAKE TAPPER, CNN HOST: The first person on U.S. soil to die from this outbreak of Ebola died today. And now another person who may have contracted the disease is being raced to a hospital in Dallas.

I'm Jake Tapper. This is THE LEAD.

The national lead, Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, is dead, leaving behind a family grieving and still hoping that the virus spares them. So what can we learn from the missteps in treating him? The CDC will speak for the first time since his death just minutes from now.

And breaking right now, this ambulance may be carrying a second Ebola patient in the Dallas area, one who may have set off red flags during a medical screening.

And the world lead. The president set a goal to degrade and destroy is, so why is the U.S. letting, in some critics' views, letting those terrorists run over a key city so close to the Turkish border?

Good afternoon, everyone. Welcome to THE LEAD. I'm Jake Tapper.

A lot of news for you this afternoon. We begin with the breaking news in our national lead, as a family mourns and the medical community deals with the first Ebola patient in this outbreak to die in the United States. There is word of another patient in the Dallas area being monitored for Ebola.

This patient is being transported right now. Today, sadly, at 7:51 this morning Central time, Duncan, Thomas Eric Duncan, became the first person to die of the horrible virus on U.S. soil in this outbreak, according to Texas Presbyterian Hospital in Dallas.

Right now, we are waiting for the CDC to update the public for the first time since his death and we will bring that news to you live. Duncan, as you know, spent his final hours on dialysis and a respirator with his vital organs failing him and his family too shaken to see him one more top via a laptop camera in his room.

They're left with a lot of grief and a lot of questions about the medical community's lack of urgency early on and again when it was already too late. Duncan did not receive an experimental Ebola drug until 10 days after he got sick, while another American patient flown from Liberia, NBC cameraman Ashoka Mukpo, he received an emergency drug transfusion from Ebola survivor Dr. Kent Brantly, just days after arriving home.

Senior medical correspondent Elizabeth Cohen joins us now from Dallas.

Elizabeth, what is the hospital saying about Duncan's death?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: The hospital is saying very little, other than they grieve with the family, that they give their condolences and that he died of an insidious disease.

Jake, we have reached out to ask why didn't he get that blood transfusion? The family asked for it. The family says that the hospital told them, hey, you know what? It's not proven effective. It's not proven effective, but other patients have gotten it in the hopes that it would work. The hospital is really saying very little about that delay in getting him the experimental drug that we mentioned.

They said that they gave him that treatment in consultation with the CDC and with Emory Hospital, but a lot of unanswered questions for this family right now.

TAPPER: And, Elizabeth, let's talk about this new possible case of Ebola out of the Dallas suburb of Frisco. What do you know about this case?

COHEN: We have just been told by the state of Texas that this person is not one of the 48 contacts that is currently being followed by health authorities.

So there are 48 known contacts. This person is not one of them and that there is no indication right now that this person had direct contact with Mr. Duncan. However, according to, you know, alerts that have gone out, somebody went to this urgent care center in Dallas and they were showing early signs and symptoms of Ebola, and they said that they had had contact with Dallas -- quote -- "patient zero."

Well, first of all, who knows if they really, truly said that. Sometimes, these things get lost in translation through various law enforcement authorities.

(CROSSTALK)

TAPPER: Elizabeth, I'm going to cut you off right now. I'm sorry. The CDC press conference is starting and we're going to cover that live, the Centers for Disease Control.

(PRESS CONFERENCE JOINED IN PROGRESS)

UNIDENTIFIED FEMALE: -- CDC Director Tom Frieden.

DR. THOMAS FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: Thank you very much and good afternoon.

Today, we are deeply saddened by the death of the patient in Dallas. Despite maximal interventions, we learned today that he passed away. And our thoughts go out to his family, friends. He is the face that we associate now with Ebola.

Since the start of the epidemic, 3,742 patients in West Africa have been documented to have died from the disease. We don't have their faces as prominently in front of us. And we know that even more people have been affected.

So we think about this and we remember what a deadly enemy Ebola is and how important it is that we take every step possible to both protect Americans and stop the outbreak at its source in Africa.

One of the things we do to protect Americans here in the United States is to improve our preparedness in our health care system. The three key steps are first thinking of the possibility of Ebola and identifying who may have the disease, so that, second, they can be rapidly tested and, third, effectively isolated.

That's crucial for our response. And the identification, diagnosis and safe care of anyone who may have Ebola needs to be top of mind right now for health care providers throughout the country. At CDC, we do quite a bit to support health care workers in addressing and assessing patients. We have provided detailed information that should be available to every front-line health care worker about how to address a patient who may have Ebola.

Anyone with fever should be asked if they have been in West Africa, specifically Guinea, Sierra Leone and Liberia, in the past 21 days, and if so, rapidly isolated, fully assessed and, if appropriate, tested for Ebola. We provide something called Health Alert Networks, which reach hundreds of thousands of health care workers. We do Webinars.

We reach out to professional organizations, hospitals, emergency department associations,medical associations and many others so that we can ensure that the available information is up-to-date and useful. Right now, the bottom line of what we're talking about today is that we're stepping up protection for people coming into this country and for Americans related to travel.

We will continuously look at ways that we can increase the safety of Americans, and we do that at many different levels. We do that in Dallas, where officials there are working intensively to monitor every person who might have had contact with the index patient to ensure that if they do develop fever, they're immediately isolated and the chain of transmission can be broken.

We do that in our health care system with the kind of outreach I have described, so that patients will be rapidly diagnosed and if found to have Ebola rapidly and effectively isolated.

We do that at the source, understanding that until this outbreak is over in West Africa, whatever we do can't get the risk to zero here in the interconnected world that we live in today. And we do that through entry and travel programs, including the efforts that we undertake in West Africa and some that will be described in more detail later in this briefing. I think -- before turning it over to Deputy Secretary Alejandro

Mayorkas from the Department of Homeland Security, I would like to emphasize the basic principles we use when looking at interventions.

We continuously evaluate ways to better protect Americans. Protecting Americans is our number one priority. Second, we make sure that whatever we do is something that works, that we evaluate and that we can think of ways to continuously improve.

Third, we recognize that whatever we do, until the outbreak is over in West Africa, we can't get the risk to zero in this country. That's why we continue to surge the CDC response in West Africa and the whole of government U.S. response in West Africa and, in fact, the international response, where we're seeing hundreds of health care workers, hundreds of millions of dollars and intensive effort deployed in the three countries most heavily affected.

And, finally, as we say in health care, above all, do no harm. We have to ensure that whatever we do doesn't unintentionally increase the risk that we will be at risk.

Just to remind us of what happened a decade ago in the SARS outbreak, the SARS outbreak cost the world more than $40 billion, but it wasn't to control the outbreak. Those were costs from unnecessary and ineffective travel restrictions and trade changes that could have been avoided.

What we want to do is ensure that we don't undermine our ability to stop the outbreak at its source and unintentionally increase our risk here.

So to outline some of the new measures being taken and review some of the measures that are already taken, I will turn it over now to Deputy Secretary Mayorkas.

ALEJANDRO MAYORKAS, U.S. DEPUTY SECRETARY OF HOMELAND SECURITY: Thank you very much, Dr. Frieden.

The Department of Homeland Security is focused on protecting the air traveling public and is taking steps to ensure that passengers with communicable diseases like Ebola are screened, isolated and quickly and safely referred to medical personnel.

We have implemented a range of measures to ensure a layered approach. To date, the existing measures in place include issuing do-not-board orders to airlines if CDC and the Department of State determine a passenger is a risk to the traveling public, two, providing information and guidance about Ebola to the airlines, three, posting notices at airports to raise awareness about Ebola, and, fourth, providing a health notice commonly referred to as a care sheet to travelers entering the United States that have traveled from or transited through the affected countries with information and instructions should there be concern of possible infection.

We are announcing -- we have announced today enhanced measures. Specifically, the enhanced screening will consist of targeted questions, temperature checks and collection of contact information of travelers from the three affected countries entering the United States at five airports, JFK, Newark, Dulles, Chicago O'Hare, and Atlanta.

Customs and Border Protection officers, by way of background, the CBP officers observe all passengers for overt signs of illnesses through visual observation and questioning as appropriate for those entering the United States at all ports of entry. In addition, moving forward, all travelers arriving to the five airports I identified in the United States from Liberia, Sierra Leone and Guinea will undergo the enhanced screening measures.

They will answer targeted questions about whether they have had contact with Ebola patients. We will collect additional U.S.-based contact information should CDC need it to contact them. And, finally, we will take their temperature with a non-contact thermometer, which can be a key indicator of potential infection.

We are taking these additional measures in a dynamic environment to ensure a layered approach and that we take the security measures that we assess to be needed right now.

With that, Dr. Frieden, I will turn it back.

FRIEDEN: Thank you.

Before opening for questions, I would just recap that at -- starting at JFK on Saturday and at the four other airports that were mentioned in the following week -- and that was Dulles, Newark, Chicago, and Atlanta -- these five airports represent about 94, nearly 95 percent of all of the 150 travelers per day who arrive from these three countries.

The Department of Homeland Security, CBP, Customs and Border Protection will be implementing a new detailed questionnaire, as well as temperature-taking and providing information to each traveler. If any travelers are found to either have a fever or have history of contact with Ebola, then the on-site Centers for Disease Control and Prevention public health officer will further interview that individual, assess the individual and take additional action as appropriate.

Now, I want to really emphasize that this is stepping up protection. It's going to find people with fever or contact who don't have Ebola. In fact, we know that over the past couple of months, about one out of every 500 travelers boarding a plane in West Africa has had a fever. Most of those had malaria.

None of those, as far as we know, have been diagnosed with Ebola. So we expect to see some patients with fever, and that will cause some obvious and understandable concern at the airports.

I would like to spend a minute just talking about malaria because it is so important to understand how it's relevant here. Malaria is spread by mosquitoes. You can't get it from somebody else and malaria is a disease which in West Africa is extremely common. It's also a disease which traditionally has been known in health care

as a fever that comes and goes. So, it may come for 48 -- and then go away in cycles of every two or three days. The species of malaria in this part of the world comes back every two or three days.

And so, it would not be surprising if we saw individuals with malaria have a fever after coming back here and that might be a common presentation among those who have fever, if any such people are identified. This is why incidentally we strongly encourage Americans to traveling to areas of the world that have malaria to take preventive medications which are highly effective at preventing malaria.

What we would do in this situation is a clinical assessment and an exposure assessment. If appropriate, we would hand that individual off to either the local health care system that might need to assess and isolate the individual and test them and we would facilitate that or to the local public health system which would, if the person is actually a contact, take appropriate action to, at a minimum, ensure that their temperature is taken every day for 21 days after the last exposure.

So, just before taking questions, I would reiterate that what we're doing is stepping up protection. We will evaluate the new measures and start them on Saturday at JFK and over the coming week at four other airports I mentioned. We'll evaluate this experience. And we are always looking for better ways that we can better protect Americans.

Thank you and we'll start with questions in the room.

Just wait for the mike. Thank you.

REPORTER: Dr. Frieden, there are some critics out there who are saying that even with these enhanced efforts that people will fall through the seams, that it won't be enough. Will these efforts be enough to protect the country, to protect other people from Ebola?

FRIEDEN: What we're doing is putting additional protection. We've been very clear that as long as Ebola continues to spread in Africa, we can't make the risk zero here. We wish we could. We wish there were some way that we could make it zero here.

I understand there have been calls to ban all travel to West Africa. The problem with that is it makes it extremely difficult to respond to the outbreak and it makes it hard to get health workers in because they can't get out. If we make it harder to respond to the outbreak in West Africa, it will spread not only to those three countries but to other parts of Africa, and will ultimately increase the risk here. That's why the concept of above all doing no harm is so important here.

Next question in the room?

REPORTER: Hi. I'm wondering what else other times that sub-screening might have been conducted at airports? And, you know, if so, how effective is this actually at finding sick people?

FRIEDEN: The -- we looked at different screening methods at different times. The thermometers that are used are highly effective. They're FDA-approved. They're approved for use in U.S. hospitals. They don't require touching the patient and they give a reliable result.

Deputy Secretary Mayorkas, is there anything more that you'd like to say about prior events?

ALEJANDRO MAYORKAS, DEPUTY SECRETARY OF HOMELAND SECURITY (via telephone): I do not believe so, Dr. Frieden. Thank you.

FRIEDEN: Next question in the room.

REPORTER: What's the legal authority that the federal government has to hold American citizens if they need to be quarantined or something? And also, there have been some public health experts that said that basically it's kind of like looking for a needle in a haystack and really the effect of what's happening today is sort of to calm the kind of public panic about Ebola, that -- you know, the risk of catching somebody with it is pretty low, but that the real effect is to calm people down, basically.

FRIEDEN: I'll make a couple of points and turn it over to Deputy Secretary Mayorkas.

The first point is that the number of travelers is relatively small. We're talking about 150 per day. So, it's not an effort that would be particularly disrupted to large numbers of people. We think it's manageable. In terms of the legal authorities both within the public health and within the border efforts, there are legal authorities. In public health most fundamentally, there is a right to protect the public and we can do that by isolating individuals who may be infectious and may be a risk to the public.

Mr. Mayorkas?

MAYORKAS: Thank you, Dr. Frieden.

I would just amplify that response. Indeed, in our screening, we have the authority to take measures with respect to U.S. citizens as well as non-citizens, to ensure that the public safety where security is not threatened. That is in the public health arena just as it is in the national security arena. Thank you.

FRIEDEN: And we'll go to the phone for the next question and we'll take a few from the phone and then come back to the room.

OPERATOR: And the first question today is from Jon LaPook from CBS News.

JON LAPOOK, CBS NEWS (via telephone): Hi, Tom.

FRIEDEN: How are you?

LAPOOK: Here's my question. The CDC has said that really all we need are face masks, gowns and gloves in order to be adequately protected and then you see these big hazmat suits. And I'm wondering if ironically any consideration is being given to the possibility that these clunky suits are increasing the risk of inadvertent contamination because in taking them off someone can actually get contaminated?

FRIEDEN: Thank you, Dr. LaPook.

There is a balance here. More cumbersome personal protective equipment is, the greater the possibility will be that there will be a problem. For example, in West Africa, we've seen needle sticks with clean needles through infected or -- not infected but potentially contaminated gloves. It's difficult to work in more cumbersome personal protected equipment and that's why we're looking at as many practical approaches that will still be safe.

We recognize that there's understandable concern with the infection in Spain, with the infections in West Africa to make sure that our health care workers are safe. And that's why CDC has infection control experts who work intensively with any facility that is concerned about or has a patient with Ebola.

Next question on the phone?

OPERATOR: Our next question is from Sean Rob (ph) from FOX News.

REPORTER: Thank you for taking my call.

My question, Doctor, you may have explained this in a previous conference call. Explain to us whether Thomas Duncan was eligible to receive blood plasma from Dr. Brantly.

FRIEDEN: So, specific questions about the care of the patient who died in Dallas would have to be referred to the hospital there. I would just remind us that Ebola, even with the best of treatment, is a terrible disease and is fatal in a high proportion of cases. And we encourage rapid and early diagnosis because the earlier someone is diagnosed the more likely they will be to survive.

In the room?

REPORTER: (INAUDIBLE) WXIA-TV 11 Alive News here in Atlanta.

What information can you tell us about a possible second Ebola patient in Texas? Do you know whether this person was in contact with Mr. Duncan? Was he one of the people you've been watching or was he perhaps recently in West Africa?

FRIEDEN: My understanding is and this is kind of recent information, but we will get definitive information in the next few hours, is that there is someone who does not have either definite contact with Ebola or definite symptoms of Ebola who is being assessed. And you know what we expect is that as people are more concerned, as there is a higher index of suspicion, people will be assessed, there will be rumors and concerns and potential cases and that's as it should be. We should just keep it in perspective. Right now, there's only one patient who has ever been diagnosed with

TB -- I'm sorry, with Ebola in the U.S. and that individual tragically died today. We are tracing the other -- the 48 people, 10 with definite and 38 with possible contact. None of them as of today has had fever or symptoms suggestive of Ebola.

But we recognize we're not out of the 21-day waiting period and we're actually at the peak incidence period of eight to 10 days. So, it's certainly a time when we're anxious and carefully assessing.

REPORTER: Was he one of the people you've been monitoring?

FRIEDEN: We'd have to get back to you on that. My understanding is that he had neither definite contact nor definite symptoms suggestive of Ebola.

Next in the room?

REPORTER: Hi. Noah Levy (ph) with "The Los Angeles Times".

Given the demand for manpower and supplies in West Africa, are there critical resources that are being diverted for the screening process that could perhaps be better utilized on the ground in West Africa or elsewhere?

FRIEDEN: The screening program here is not diverting from or in any way undermining our efforts in West Africa. The temperatures will be taken under the supervision of Customs and Border Protection. CDC already does staff quarantine stations and we'll need to add a small number of additional staff to provide 24/7 coverage of these five airports and it is in no way going to make it more difficult for us to stop the outbreak in Africa.

In the room?

REPORTER: Earlier, you talked about the added level of screening includes checking temperatures. But if the symptoms don't show up for potentially 21 days, how does that help?

FRIEDEN: We're looking at every layer that can be put in and we're assessing different possibilities for what can be done. One of the issues that's quite important is the information that's provided to travelers who arrive in this country and that's provided in West Africa, it's provided here through the CBP entry station, through information to individuals entering here, and that's one of the areas that we'll be looking at closely in the coming days.

Next question in the room?

REPORTER: Could you describe where the decision to do this additional screening at airports came from? Did you originate in Homeland Security or with the CDC or in the White House first? I ask because I know you were critical of taking this step a week ago.

And second, can you tell us more about the quarantine facilities. Are they -- will they be at each of these airports? Will the staffers testing temperatures and asking these questions, will they be wearing protective gear?

FRIEDEN: I'll start and ask Deputy Secretary Mayorkas to continue.

I have said consistently that we will do whatever is effective to protect Americans. This is a whole of government response. It's a whole of government response in Africa and it's a whole of government response here and we look carefully to see what we can do most effectively to protect Americans.

Deputy Secretary?

MAYORKAS: I would echo -- thank you, Doctor -- I would echo Dr. Frieden's remark. This has been a collective effort across the administration to respond to this outbreak of Ebola in West Africa. The individual Customs and Border Protection officers will not be wearing masks. That has been the medical assessment of the need right now. Thank you.

REPORTER: Are there quarantine stations in each of these airports?

FRIEDEN: Yes, there are quarantine stations in each of these airports.

JONATHAN COHN, THE NEW REPUBLIC: Hi. Jonathan Cohn from "The New Republic".

You said we can't eliminate the threat to the United States, and so, we take of the outbreak overseas. Can you speak to a second for the state of the international response? I mean, what is the resource situation there? What needs to happen to stop the outbreak there that isn't happening already?

FRIEDEN: We are seeing surging in of resources into the country, into each of the three countries and what CDC is doing to each of the countries and districts within the countries. These are three countries that have three different epidemics and Liberia has had the most extensive epidemic so far, there have been in some areas of Liberia, some decreases in recent weeks, but we don't know whether those will hold in Sierra Leone, we're continuing to see increases in cases that are very concerning. Any have seen increases and decreases and we're monitoring that very closely.

We've seen a greatly strengthened response from the World Health Organization and the United Nations. We've seen many other countries stepping up including the United Kingdom. If you look at Sierra Leone and if you look at our efforts just as an example to do laboratory work, the CDC operates several of the essential laboratories in these countries, but in addition, the United Kingdom, South Africa, Russia, China, China, Canada, the European Union, and I'm probably leaving out a few, also do laboratory work.

So, there has been really a strong international response. The challenge is how rapidly the disease is spreading.

But we are seeing in West Africa some signs of progress. For example, we're seeing more safe burials in Liberia. USAID has contracted with an organization that's expanding throughout the country to provide safe burial services. We are working closely with communities to do that and to isolation and treatment capacity.

So, I think we're beginning to see that kind of surged response have an impact on the front lines. But it's going to be a long, hard fight and in West Africa, we are far from being out of the woods.

There has been a major effort from the U.S. and other partners. We hope and expect to see more resources coming in from countries around the world matching the kind of leadership that the U.S. is showing.