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Early Start with John Berman and Zoraida Sambolin

Second Ebola Diagnosis in Texas; Patient Now Isolated; Are CDC Protocols Sufficient to Control Ebola?

Aired October 15, 2014 - 05:30   ET

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

CHRISTINE ROMANS, CNN ANCHOR: Well, I have this question about hospital-acquired infections. Even on a perfect day, you have hospitals in the United States and in Europe, quite frankly, that have trouble stopping hospital-acquired infections. This particular case is really, really stunning. You're talking liters and liters of body fluids coming out of this patient who is highly, highly contagious.

If they can't control these kinds of -- if they can't control bugs on a regular day, do we have what it takes to control something like this?

DR. ALEXANDER VAN TULLEKEN, CNN MEDICAL ANALYST: Well, what I'd tell you is at the moment, the current things we're doing do not seem to be adequate. I think if you -- if you have a well-trained team wearing the right equipment, there's no reason to think that anyone should be catching Ebola because you can prevent any contact with bodily fluids.

And we are seeing -- you know, we have historically been able to control diseases when we work very hard at it. But I think what we're seeing now is the CDC has not advised people on how to train to look after these patients. And the protocols are vague and difficult to follow. And even if you could follow them perfectly, I suspect they're inadequate anyway. So I think what we need --

ROMANS: What are they, those protocols? What are those protocols?

VAN TULLEKEN: So at the moment, CDC actually has two different protocols for caring for Ebola patients. And they don't say which one you should choose so -- in terms of the personal protective gear alone. OK. So perhaps taking on and put it off, there are two different protocols. And they say use either one.

Then within those protocols, they're vague on things like what kind of gloves you should wear. And there's a huge difference between a vinyl glove and a nitrile glove. The vinyl gloves are brittle and easy to break, nitrile gloves are very strong and hard to break. Then when something goes wrong in those protocols -- remember, no protocol is perfect. Protocols are about reducing the risks.

What we don't see is the protocols don't contain any information about what to do so if you tear a glove, which could happen to any -- type of gloves and hospitals all the time. That could happen to anyone. Then what do you do? Do you need to shower? Do you need to bathe in bleach? Do you need to be quarantined? Do you need -- you know, we don't -- we don't have any guidance on that.

So we're seeing every way a shortfall in these protocols. And there's no protocol for using the protocols. No protocol for where I should be on (INAUDIBLE), no protocol on how to train people and so on.

JOHN BERMAN, CNN ANCHOR: Dr. Van Tulleken, the question now, going forward, is, are they in a place where they can, you know, put this is Genie back in a bottle in Texas?

ROMANS: Right. Right.

BERMAN: How do you fix this situation? We've gone from the patient from Liberia, now to two more patients.

VAN TULLEKEN: Right.

BERMAN: Is this number going to keep growing and how do we stop it from growing?

VAN TULLEKEN: Well, the number you're talking about just could be zero. And it's a very -- it's a very interesting number because it tells you how many people a single case will infect. At the moment the answer is two. And if a single case infects two people, and those two people infect two people, you have a growth of virus and that's the thing we've been saying can never happen in the U.S.

I still think that anyone listening to this program should not be concerned about an Ebola epidemic in the U.S. What they should be concerned about now is nurses not turning up to work. They should be concerned about whether or not hospitals can protect their staff. We saw this in southern Toronto. And so the effects -- the effects in the U.S. can be very substantial without any more people getting Ebola.

So what I'd say is, at the moment the CDC do not -- even after Nina Pham, we have not got a sense of people -- I'm sure there are people staying up all night, but we haven't got a sense of what they're doing to try and solve this problem.

I think now, if I was one of the 70 people exposed working on Thomas Eric Duncan, I want -- I would want daily blood tests. I would want -- I would be taken out of work. I'd be quarantined and I would be observed extremely carefully for the next few days. And this 21-day period maybe you need to think about extending that as well because we don't know that much about this -- we don't know much about this virus. It's very hard to be 100 percent confident about any aspect of it.

BERMAN: Doctor Alexander Van Tulleken, thanks so much for being with us on the phone, putting this in perspective right now.

As the doctor said, you know, I do not think, he does not think, experts do not, there is a risk of an of outbreak of Ebola in America. But it does raise serious questions about the protocols in place and whether our system can handle this type of threat. ROMANS: And he has some good advice that I hope authorities are

heeding, daily blood tests, need to quarantine those 70 people at least for a few days, closely watch them, those people who were treating that first Ebola patient from Liberia. And just really, really making sure these health care workers are protected and taught how to use these protocols because it's not fair. Imagine if you have nurses all over the country stop in going -- not going to work.

BERMAN: These are brave people on the front lines.

ROMANS: This is -- right.

BERMAN: They're treating patients of all kinds.

ROMANS: Absolutely.

All right, 34 minutes past the hour. Much, much more on this stunning breaking news. A second Ebola patient in Texas, after the break.

(COMMERCIAL BREAK)

ANNOUNCER: This is CNN Breaking News.

ROMANS: Breaking news this morning on EARLY START. The CDC has just announced a second health care worker at Texas Presbyterian Hospital in Dallas. A second health care worker has tested positive for Ebola and has been isolated.

BERMAN: Now this was a second person who provided care for the first Ebola patient diagnosed in the United States, Thomas Eric Duncan, now two, two, I suppose I should say, so far of the people who have cared for Thomas Eric Duncan have themselves been diagnosed with Ebola.

I want to bring in CNN senior medical correspondent Elizabeth Cohen.

Elizabeth, what do we know how about this new patient?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: All we know, John, is that this new patient is another health care worker. We also know that this was not unexpected.

CDC Director Tom Frieden has been saying for the past day or two that basically, we should, you know, be ready for more of these because if there was a breach in safety protocol that got Nina Pham sick, well, presumably, that same breach in protocol might have occurred in other health care workers as well.

ROMANS: Nina Pham, that 26-year-old, I believe, nurse who helped to take care of Thomas Eric Duncan. She was one of dozens and dozens of people who were caring for this man.

What do we know about the protocols, Elizabeth? Because there are procedures for dealing with something like this, something highly contagious like this in the bodily fluids. Obviously, something went wrong. COHEN: Right, something obviously went wrong. We don't know exactly

what. It may have been that they weren't always consistent about the type of gear that they wore. It might have been that they weren't consistent about the process of putting it on or more importantly taking it off.

You know, not to be too graphic but I was speaking to a nurse who has cared for a Ebola patient, and she said, look, liters and liters of fluids are coming out of these patients, that's just part of their illness. And you become quite soiled. And taking off very soiled clothing is -- you know, protective gear, is a tough thing to do. And I think that's one -- that's really sort of a key thing that's come out of this.

I think the CDC kind of thought, well, you know, anybody should know how to do this. We've been telling hospitals for months to get ready for this. But the reality is that you can tell them on paper to be ready, but actually doing it requires practice and skills, and a dedicated team that really believes in this and is really devoted to this, and not all hospitals have that.

BERMAN: We have some video of Dr. Sanjay Gupta putting on and taking off the gear that we can run right now just to give people a sense of how careful you do have to be when doing this.

And, Elizabeth, we're going to talk over this. You know, if there are two now health care workers who have tested positive for Ebola, the question is, could there be more? Where are we in the timeline right now of exposure?

COHEN: So I'm going to -- I'm going to actually take out a calendar as I speak with you because the last time any of these workers would have an exposure to Duncan was exactly a week ago, October 8th. The most worrisome window for infection with Ebola is eight to 10 days after being exposed to an infected person. And we are -- if I'm reading my calendar right, we're right now at day eight.

So in the next couple of days we may be seeing more. Now if we get past 10, 12, 13, that's -- you can't breathe a sigh of relief but you can feel a little bit more reassured, but right now, you know, one Sunday, one today. I would not be at all surprised if there are more.

ROMANS: So, Elizabeth, if you have a heart attack or, you know, pain in your left arm or you have car accident, you go to any hospital. The closest hospital.

Do we need to be thinking about something like Ebola as having designated highly trained facilities specifically for that purpose? Is it too much?

We were watching that video of Sanjay taking on -- taking off the protective gear. Is it too much to ask harried nurses and doctors in big hospitals across the country to deal with this?

COHEN: You know, safety experts tell me that it really is too much to expect them to do that. But this sort of in it of itself is in a way its own specialty. And actually, some hospitals are better at dealing with heart attacks than others because they drill for it.

ROMANS: That's true.

COHEN: And so some hospitals are going to be better with dealing with extremely infectious patients than others are. This is not an easy thing. And you need a team that's dedicated to it. And you need a team that believes in it.

You know, hospital, not all. Many hospitals are excellent with this. But some hospitals even have a bad track record with washing hands.

ROMANS: Yes.

COHEN: When people don't want to study it, a lot of these -- a lot of health care workers don't wash their hands. And that's easy, right? I mean, anybody can do that. But they -- they're not in the culture, meaning the culture of the hospital they work in. That culture somehow doesn't support or require it.

I've been in hospitals where I was horrified that people weren't washing their hands.

ROMANS: Yes.

COHEN: I've been in hospitals where they're washing their hands every single time. It's the unique -- again this isn't a high-tech thing in many ways. This is about being in a culture that believes in safety and that tells their employees slow down and do it right.

ROMANS: The thing about the hand washing. And you and I both covered that hand washing problem in the health care system. The problem with that is that it doesn't hurt a dock for or a nurse right away. It's something that manifests later on down the line, maybe another patient. Ebola, if they get it -- if they themselves are exposed, now you've got potentially a security issue in the hospital where your doctors and nurses can't come to work and they have been treated, you know.

BERMAN: Elizabeth, you know, there are questions now about this specific hospital, Texas Health Presbyterian, whether it was up to the task. And an official close to the situation is telling CNN-- I want to read this to you. If we knew then what we know now about this hospital's ability to safely care for these patients then would have transferred him, Tomas Eric Duncan, somewhere else, either Emory or Nebraska. This hospital's facilities specifically built to treat situations like this Ebola situation.

What's the concern that there are now two Ebola patients in this hospital that perhaps did not handle one case the right way?

COHEN: Right. I actually just -- that official said that to me just moments ago on the phone. And I think the concern is, you know, we're seeing -- really basically the proof right now. If they have done -- this is hard to say correctly, but if they had drilled on it correctly, you know, you'd have at Nebraska or at Emory. No health care workers got sick there. And two have gotten sick here. You know, that's not a great -- I mean, Texas Health Presbyterian

treated one patient, two workers so far have gotten sick. Nebraska's treated I believe on their second or third patient. Emory is on their third. Nobody there has gotten sick.

Training and drilling matter. And that's why this official said, you know what, if we could turn the hands of time back, we would -- we should have transferred them. I think -- I think there was a lot of confidence that sort of any hospital could do this and I think that they now realize that some of that confidence is misplaced.

ROMANS: All right. Elizabeth Cohen in Dallas reporting for us this morning on the phone.

Thank you so much, Elizabeth. We'll be talking to you again very, very soon.

I want to bring in Dr. Joseph McCormick, here with us in the studio. He's a professor and dean at the University of Texas School of Public Health, formerly at the World Health Organization and the CDC.

A second case. Another caregiver infected with Ebola at this hospital. Clearly, protocols were not followed.

DR. JOSEPH MCCORMICK, UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH: Exactly. No question about it. And the protocols were not followed from day one to today, that's very clear.

BERMAN: Well, that's -- that's shocking to hear that because this was a case, Thomas Eric Duncan, once it was finally diagnosed, once after he was finally admitted to that hospital, the whole world was watching.

MCCORMICK: Exactly.

BERMAN: The entire medical community in the United States, including the official medical community, the CDC, was watching. And you were saying now that while everyone was watching in plain view the protocols were not followed?

MCCORMICK: It's clear that they were not. And I think Elizabeth Cohen is probably correct in the sense that there was a tremendous amount of complacency.

Look, when you look at what's going on in West Africa, and you say, they don't have anything and look, they're -- you know.

ROMANS: Right.

MCCORMICK: We've got everything and nothing is going to happen in our hospital, and I think it's just not that easy. It just isn't. And without protocols, I mean -- I ran a program for 15 years in Sierra Leone where we took care of lots of fever patients every day. Under the most simple, the conditions you see today in West Africa.

ROMANS: Right. MCCORMICK: But we had a protocol. And we -- we had one, only one

breach of protocol in 15 years. So you can do this, you can do it at a standard hospital in this country, but you have to have the protocol.

ROMANS: So --

MCCORMICK: You have to know what you're going to do.

ROMANS: Is the problem that the CDC was having -- we saw this coming, right? We saw Ebola simmering and bubbling in Africa. We knew it was coming.

MCCORMICK: For years. For 40 years.

ROMANS: We know that it was coming.

MCCORMICK: Yes, yes.

ROMANS: So, you know, the webinars from the CDC and maybe every year doing a drill at your hospital, that's simply not enough?

MCCORMICK: I think a yearly drill that probably is more like an in- service is certainly not enough.

ROMANS: Right.

MCCORMICK: You've got to think about what do pilots do? What do surgeons do? They drill regularly. And I also think you have to have a dedicated team. A team that's probably volunteer. That's dedicated. And so that's the team you know is going to take over when you have this kind of situation.

The problem with having these focused things like Nebraska is that this is not going to go away. This is the future, particularly as Africa develops, we get larger cities with more people. The opportunity for spread of these diseases is not going to go away. We have to be prepared nationally, not just say, well, we'll let's technology take care of it.

BERMAN: That's future. What about the now? Now there are two Ebola patients being cared for by this hospital that you say clearly did not handle the first case very well.

ROMANS: Right, should they be there?

MCCORMICK: That -- I think that's really a serious judgment call by the state, by the hospital, and by CDC. It would be unfortunate to have to transfer them. Neither one of them are seriously ill, so we're not -- but we don't want to transfer them when they're really ill.

ROMANS: Right.

MCCORMICK: So I think that's a very difficult judgment call. It's a question for me of can they change their stripes? Can they put protocols in place that everyone is confident, the CDC, other people are confident that will work. There are protocols things do work. But you have to have the protocol.

ROMANS: Some of the nurses' and even -- Western Nurses Union are saying this, as sort of blaming the victim. I mean, you're throwing these nurses into a situation where --

(CROSSTALK)

MCCORMICK: That's the last thing we should do.

ROMANS: Right. The hospitals haven't planned for it.

MCCORMICK: Absolutely. Absolutely.

ROMANS: They knew it was coming and that -- you know, these are people who are on the front line. And there's a real risk. There's a real risk. What happens if nurses don't want to go to work because they're concerned about their own safety?

MCCORMICK: Sure. Well, look at what happened in Monrovia, there was a threat of a strike because people were afraid. And you can understand why. So we have to fix this. And I think this is -- this is an urgent matter because we do have -- it's fixable, but it has to be fixed now, not next week or next month.

ROMANS: We were talking to Elizabeth Cohen, some hospitals are very good at, you know, treating heart disease or heart attacks so the hospitals are very good for cancer care. Hospitals have specialties. Do there need to be places that are simply, if there's an Ebola case that's where you go?

MCCORMICK: This disease does not require high-tech kind of care in that sense. It's not an airborne disease. It's not influenza. We should be able to handle it in any good hospital in this country because we have other infectious diseases.

ROMANS: Right. True.

MCCORMICK: And we don't know where they're going to appear. So, you know, if somebody has a heart attack and put them in the hospital and then transport them, we're not worried about it transmitting to somebody. Here, this is different issue. So we should be able to deal with this. Even the serious illness. You can deal with.

BERMAN: Well, in this case they haven't yet shown that they can deal with it in the proper way.

MCCORMICK: That's right.

BERMAN: So what do you now do with the dozens and dozens of people on these watch lists who have been in contact not just with Thomas Eric Duncan now but with these two new patients?

MCCORMICK: You know, this is also worse. there's some science that comes in here that could be followed. We know, for example, one of the early, early signs of this disease is a dramatic drop in a group of white cells called lymphocytes. And it occurs really early. We know that there arises in certain molecules called (INAUDIBLE) comments.

Those kinds of things could be followed. They're not difficult to do. So that's one of the things you could do even before people become ill with a fever. I want to emphasize, though, nobody's going to spread this virus if they're not ill. And even if they are ill and they report it right away, as these folks have, they're not -- they're not putting other people at risk. And the earlier -- despite what the hospital wanted to say, I still think that the earlier we get people and get them stabilized, treat them with plasma.

I think Mr. Duncan, I'm sorry, to -- but he should have been treated with plasma early on. And the earlier we get them and treat them which is one of the advantages of keeping them at a particular hospital.

Think about it, if we want to get somebody from Dallas to Nebraska, they're going to go on an airplane?

ROMANS: Right.

MCCORMICK: So are we going to have this fleet of airlines to help there, they're going to, you know, with all and -- I mean, it becomes a really difficult scenario.

ROMANS: Complicated.

MCCORMICK: And this is available by the hospital themselves.

BERMAN: Let's hope. All right, Dr. Joseph McCormick, thanks so much for being with us. Appreciate it.

Republicans Nice to see you this morning.

MCCORMICK: My pleasure. Thank you.

BERMAN: All right. The breaking news we're covering, a second health care worker in Texas diagnosed with Ebola. How did it happen? Going to raise these questions and more, just ahead.

(COMMERCIAL BREAK)

BERMAN: Having major development, very big breaking news from Texas. The CDC, about an hour ago, announced a second health care worker at Texas Health Presbyterian Hospital in Dallas has tested positive for Ebola. This patient has now been isolated. The CDC is calling the diagnosis of this second Ebola infected health care worker, quote, "a serious concern."

ROMANS: This was another health worker who provided care for that first Ebola patient diagnosed in the United States. The man who came from Liberia, spent some time in the United States, went to the hospital, was discharged, then went back again, spent some time there and ultimately died. Now this health care worker, this second health care worker reported a

fever Tuesday was immediately isolated at that hospital. And health officials now have to work to identify anyone who came in contact with the health care worker. We're told there could be up to 70 people who were treating Thomas Eric Duncan, that first -- that first health care worker who fell ill and died. That first patient in the U.S. who fell ill and die.

BERMAN: Well, they call this contact tracing. First, they were just tracing everyone who came in contact with Thomas Eric Duncan. Now the Web is even getting bigger now, they have to trace everyone who has come in contact with these two health care workers who have themselves become infected in Texas right now. They are in care.

We should note that these two new Ebola patients are now inside Texas Health Presbyterian. The very hospital where protocols, the protocols, have come under serious question in the last few days.

ROMANS: And we've been looking at some of these pictures. Sanjay Gupta did a nice demonstration for us just showing what it's like to put on and take off this protective gear. Once the protective gear is soiled, how to take it off. And it is easy to see how you could breach those protocols. How easy it would be to touch the skin to some of those fluids.

BERMAN: Very, very difficult to do it perfectly. But Ebola is a virus where you need to be essentially perfect if you are caring for an ill patient. So there are serious questions as we sit here this morning. What to do with the two new patients with Ebola in Texas. Should they be moved to a facility in Nebraska or Emory Hospital at Atlanta, where they have facilities specifically designed for this?

The CDC Director Thomas Frieden yesterday said he wants to put together a S.W.A.T. team to go to these hospitals as soon as a new case develops.

ROMANS: He wish he'd done it in the first case. He wish he'd done it in the first case. But they want to start doing that -- they want to start doing that now. Raises a lot of concerns about whether hospitals are able to contain the virus and protect health care workers. I think that's a really important part of the story, too. You've got two health care -- health care workers now infected.

BERMAN: And Elizabeth Cohen tells us, when you look at the calendar, these next few days are crucial. These are the days when you would expect to see infections develop among people, if they are going to develop at all, for people who were in contact with Thomas Eric Duncan. You would expect them to happen yesterday, today, tomorrow, the next day. These are a crucial few days right now and now that there are two cases you can bet they're looking very, very closely.

ROMANS: That's it for us right now. We'll leave it over -- send it over to Alisyn and Chris to continue following this breaking news.