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Legal View with Ashleigh Banfield

Dallas Nurse with Ebola; CDC Press Conference

Aired October 13, 2014 - 12:00   ET


DON LEMON, CNN ANCHOR: This was not supposed to happen in America. The hospital staff took every imaginable precaution but couldn't keep Ebola from spreading. So now what? We expect to hear from the head of the CDC, live at any moment. We'll have that for you.

Also this hour, bombs away in Kobani as ISIS bears down on Baghdad. Iraqi troops now threatening to flee unless U.S. boots march in to help.

And a scary moment in New York. A guy pops out of a subway grate and tosses a smoke bomb at a street side restaurant. The smoke is harmless, but it raises a red flag about the security of the city's massive underground grid.

Hello, everyone, I'm Don Lemon, in today for Ashleigh Banfield. Thank you for joining us. Welcome to LEGAL VIEW.

The Centers for Disease Control and Prevention just about to bring us new information on Ebola, wondering what they're going to say about this huge story that has gotten even bigger with the first case of Ebola transmission inside of the United States.

And as we have been reporting, a nurse who was caring for the Liberian patient who died last week in Dallas has herself tested positive after what the CDC is calling a breach in precautionary protocols. You'll see today's update live as soon as it gets underway. That should start very shortly. And, again, we'll carry it for you here on CNN.

And while we wait to bring you the very latest on that one, want to get to CNN's senior medical correspondent Elizabeth Cohen. She joins us now in Dallas.

What are we learning about this sick nurse and what do we expect the CDC to stay this morning to update us, Elizabeth?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: We were told yesterday, Don, that this nurse is in stable condition. We've not received an update from the hospital today. We were told yesterday that the level of virus in her blood was low. So it's great that they've been able to treat her so early on in the course of her disease. That's really important.

Now, one of the things I expect to hear from the CDC is that we're told by a spokesman there that they're exploring further the possibility of designating certain hospitals in the United States to be Ebola treatment hospitals. In other words, that when someone is found to have Ebola, that they wouldn't necessarily stay at the hospital where they were diagnosed, but they would be sent to a hospital that specialized in handling tough infectious diseases and that had done drilling in bio hazards practices.

Now, the reason for that, he said, is really because of the experience here. This is a hospital that used protective gear but still a nurse got infected with Ebola. So, clearly, something didn't go quite right.

LEMON: And that was - you know, that's a good question that some of our viewers had been asking last week, and we even posed to Dr. Gupta on my show at 10:00 here on CNN, why were they being taken to different hospitals when the -- remember the first Ebola patients came in to the United States? They were transported to Emory Hospital and many people thought that Emory would be the designated hospital. Now, you know, weeks later, a month or so later, they're just getting around to designating, you know, certain hospitals. Why did this take so long? That's the question, Elizabeth Cohen.

COHEN: Well, I think it's interesting, they haven't done the designating. They are just thinking about designating. So they're just sort of exploring the idea.

You know, when those folks came from Africa, they had a while to think through, where do we want to send them? And so the obvious choices are, Emory and Nebraska. Those are two of just four hospitals that are designated as special centers that specialize in these kind of, you know, biohazards. So it's a great question and it speaks to sort of a larger question. You know, in the United States, when someone's sick, they walk into an emergency room, that's usually is - that often is where they stay. So there was no reason technically for the patient to be moved out of Presbyterian into a place like Nebraska or Emory. It's just not the way that hospitals work. If they have an intensive care unit, they take them on. But a lot of experts I'm talking to, Don, say that that's not the way it should be. That we should really be designating certain hospitals around the country to treat Ebola patients.

LEMON: Uh-huh. Stand by, Elizabeth, I want to keep you here but I also want to bring in Dr. Amesh Adalja. He is a representative of the Infectious Disease Society of America.

What do you make of one of the possibilities that Thomas Frieden is going to talk about today is making hospitals, certain hospitals, designated hospitals for Ebola? Is that a good idea?

DR. AMESH ADALJA, INFECTIOUS DISEASE SOCIETY OF AMERICA: I do think it is an idea with a lot of merit. And we do that for other diseases. We think of heart attacks. We think of trauma. We have designated trauma centers. During H1N1, a lot of places served as centers of excellence where they took care of the sickest H1N1 patients.

Here I think the argument could be made that this should be done for Ebola because you want to have people that are there not only to get the best treatment for the patients, but also to provide care in the safest manner. And every hospital should be able to take of an Ebola patient, however we know that there's varying degrees of penetration of infection control procedures and there may be some gaps in training that need to be corrected at other hospitals. But all hospitals should be prepared to identify a case that may show up in their emergency department, isolate them and do the initial stabilization and then maybe perhaps transfer if that's the path that we're going to take as a country.

LEMON: Dr. Adalja, what do you make of the CDC's claims of, quote/unquote "inconsistencies" in the methods the sick nurse used to protect herself, you know, possibly putting - getting, you know, infected or coming in contact with the virus taking - putting on or taking off, really the protective gear?

ADALJA: So we know that personal protective equipment works. It's used to stop every outbreak that's occurred in the past 40 years or so. However, it does require meticulous attention to detail, both putting it on and taking it off. And we saw what happened in Spain where an individual may have contaminated or self (ph) after they've taken - took off the gear. And I think that's an important point. And that's something that Doctors Without Borders emphasizes in their guidance, that they have to have a second person there whose sole job it is - is to make sure that that person takes off their protective equipment in a manner that is safe and using a checklist so that they don't skip any steps and it's all done in a way to minimize risk.

LEMON: Elizabeth Cohen, so this nurse wasn't the only person, obviously, treating, you know, Thomas Eric Duncan. What are they doing for other hospital staff, other nurses, other doctors who may have come in contact with him?

COHEN: You know what, Don, it's an interesting question. I think many of us assumed that the CDC or other health authorities were following these health care workers, were meeting with them every day to check their temperature, just like they were doing for Duncan's family. But it turns out that that's not the case. Health care workers who worked on Duncan after it was realized that he had Ebola, they were wearing protective equipment, so health authorities did not follow them. They did not monitor them. They didn't even have a complete list of who they were. And so they were expected to self-monitor, to take their temperatures twice a day, to sort of, you know, check and see how they were feeling. And so now they are visiting them. They're visiting them every day. They're taking their temperature. Some people said that really should have been done from the beginning.

LEMON: The question is, though, and I'm sure Elizabeth can answer this, but I want to ask the doctor first and then I'll get back to Elizabeth. Is it even really possible to train all hospitals to care for Ebola properly and, you know, we were talking about designated hospitals is probably a better idea, I would imagine, to have a few places that are more equipped to handle it than others, because the possibility of training every single hospital staff in the country where a patient might be taken, that's really, you know, probably too much to ask, doctor?

ADALJA: So hospitals isolate patients for lots of diseases, for MRSAs, for influenza, for meningitis and that's part of the team care and -

LEMON: Doctor, I have to interrupt you now. We're going to get to that press conference happening now from the Centers for Disease Control.

DR. THOMAS FRIEDEN, CDC DIRECTOR: Safer and easier. Yesterday, we confirmed the first case of Ebola contracted in the United States in a health care worker who carried for what we refer to -- who we refer to as the index patient in Dallas, Texas. Our thoughts are with this health care worker. She is now being cared for and we understand that she's clinically stable. Please refer any questions on her care to the hospital where she's being carried for so that only information that she and her family want released is released.

The existence of the first case of Ebola spread within the U.S. changes some things and it doesn't change other things. It doesn't change the fact that we know how Ebola spreads. It doesn't change the fact that it's possible to take care of Ebola safely. But it does change substantially how we approach it. We have to rethink the way we address Ebola infection control because even a single infection is unacceptable.

I'll get into some details of what we're thinking about with regard to how to make care even safer in a minute, but I want to just step back first and outline what we're doing and what the current status is. First, before the index patient in Dallas was hospitalized and isolated, there were 48 potential contacts, 10 known to have contact with him, 38 who may have had contact with him. All of those 48 contacts have been monitored daily. None of them have developed fever or other symptoms as of now. This is consistent with what we know about Ebola, that people aren't sick when they don't have symptoms and the sicker they get, the more infectious they may become because the amount of virus in their body increases.

Second, for the health care worker who was diagnosed yesterday, we have been discussing with her, our team lead in Texas has spoken with her on multiple occasions. She's been extremely helpful and we have identified one and only one contact who had contact with her during a period when she was potentially, although likely not infectious, because it was at the very onset of her symptoms. That individual is also being monitored and, as of now, has no symptoms suggestive of Ebola and no fever.

Third, is to identify the health care workers who also cared for the index patient and ensure that they are actively monitored for development of symptoms or fever. And if they develop either symptoms or fever, that they're immediately isolated, assessed, and tested. That process is still underway. The team worked hard through the day yesterday, into the night yesterday, and are still actively working today to interview each one of the large number of health care workers who might potentially have had contact with the index patient when he was hospitalized. And the thinking here is straightforward. If this one individual was infected and we don't know how within the isolation unit, then it is possible that other individuals could have been infected as well. So we consider them to potentially be at risk and we're doing an in-depth review and investigation.

So these are the three categories of contacts. Contacts with the index patient before he was hospitalized, contacts with the health care worker who was diagnosed yesterday and contacts who may have also had contact with the index patient after he was hospitalized. All of them will be actively monitored and that's how we break the chain of transmission. We prevent another generation of spread of Ebola.

In addition, as I indicated yesterday, we are doing a detailed investigation to better understand what might have happened with the infection of the health care worker. We look at what happens before people go into isolation, what happens in isolation, and what happens when they come out of isolation. And we're particularly concerned with that third process, taking off the isolation personal protective equipment, because if it is contaminated, there's the possibility that a worker will contaminate themselves and become infected in that process.

From day one, we've had a team on the ground in Dallas working closely with the hospital, the state and the local health officials. When the additional patient was diagnosed, we doubled down and sent an additional team in place. That team has been at the hospital just about continuously since. They've been working through the night. We're not just doing an investigation. We're immediately addressing anything that could potentially make it safer and easier to care for people who have or may have Ebola.

We're not going to wait for the final results of that investigation and I can go in some detail later to what we are doing in the short run. But each time we identify a process or training or equipment or protocol that can be improved there, we are improving it right there on the site.

I want to clarify something I said yesterday. I spoke about a breach in protocol and that's what we speak about in public health when we're talking about what needs to happen and our focus is to say, would this protocol have prevented the infection? And we believe it would have. But some interpreted that as finding fault with the hospital or the health care worker. And I'm sorry if that was the impression given. That was certainly not my intention.

People on the front lines are really protecting all of us. People on the front lines are fighting Ebola. The enemy here is a virus. Ebola. It's not a person. It's not a country. It's not a place. It's not a hospital. It's a virus. It's a virus that's tough to fight. But together, I'm confident that we will stop it. What we need to do is all take responsibility for improving the safety of those on the front lines.

I feel awful that a health care worker became infected in the care of an Ebola patient. She was there trying to help the first patient survive and now she has become infected. All of us have to work together to do whatever is possible to reduce the risk that any other health care worker becomes infected.

When we think about hospitals where Ebola care can be given, really there are two different steps. The first is diagnosis. And every hospital in this country needs to think about the possibility of Ebola in anyone with the fever or other symptoms that might be consistent with Ebola who has traveled to any of the three countries, Liberia, Sierra Leone, and Guinea, in the previous 21 days. Whatever else we do, that's critical throughout our entire health care system so that patients are rapidly diagnosed if additional patients become ill in this country.

Second is the issue of care of Ebola once the diagnosis has been made. I think what we recognize is that that care is complex and we're now working very closely with the hospital to make that care simpler and easier with hands-on training, hands-on oversight and monitoring. And that's something that we will do any time there is a case of Ebola.

Now I want to just end, before I turn it over to Commissioner Lakey, with thinking a bit about what comes next. What's going to be happening in the coming days and weeks? Well, first is the safe and effective care of the health care worker in Dallas. And we will do everything to make sure that those who are taking care of that individual are doing so while protecting themselves and that that individual gets the best possible care.

Second, as I said yesterday, we need to consider the possibility that there could be additional cases, particularly among the health care workers who cared for the index patient when he was so ill. That's when this health care worker became infected and we're concerned and would unfortunately not be surprised if we did see additional cases in health care workers who also provided care to the index patient.

Third, we will continue to track all contacts. All of the 48 from the initial patient's exposure before he was hospitalized. The one -- the one individual who was exposed to the health care worker who is hospitalized now and all of the health care workers who may have been exposed during the initial care of the index patient.

Fourth, we'll work with hospitals throughout the country to think Ebola in someone with a fever or other symptoms who has had travel to any of the three affected countries in the previous 21 days.

And fifth, we will double down on training, outreach, education and assistance throughout the health care system, through professional associations, through hospitals, through group organizations and individuals reaching out to health departments at the state and county levels and cities and elsewhere so that we can increase the awareness of Ebola and increase the ability to respond rapidly.

We wish the situation in Dallas were different than it is today. We wish this individual had not been infected and we're concerned that there could be other infections in the coming days. But what we're doing now is implementing an immediate set of steps that will ensure that the care of that individual is safe and effective while we look at longer term at what this implies for what we should be doing to care for Ebola as safely and effectively as possible wherever it may arise.

And with that, I'll turn it over to Dr. David Lakey who's commissioner of the Texas Department of State Health Services.

DR. DAVID LAKEY, TEXAS HEALTH COMMISSIONER: Thank you, Dr. Frieden, and thanks, everyone, for being part of this briefing today. Obviously it's been a very tough several days here in Dallas. Very tough day in the last several days for the hospital staff.

We knew there was a possibility that one of the health care workers could become infected but it's still very disappointing. And our -- I know the family is possibly listening and so I want them to know that our thoughts and prayers are with them, with the health care worker and with the staff that are working hard on her care right now.

There's many components to our response here in Dallas. Dr. Frieden talked about many of those components. Our top priority right now is the contact investigation. This hard work -- a lot of work is taking place. We've pulled in additional staff from throughout the state of Texas. Complimenting the work of the CDC and the Dallas Health Department's staff and so we're bringing in the resources to do the contact investigation from many different levels of government to identify those individuals and contact them as quickly as possible.

Dr. Frieden talked about infectious control. Obviously a critical component of this response. Looking hard at the infectious control practices and making sure that they are even more stringent than what they are right now and have CDC experts, the best in the field here at -- in Dallas working with us to make sure that we are as stringent as possible with infection control.

The health care worker's apartment initial cleaning has been done. Additional evaluation and cleaning will be accomplished today. We're doing this with local leaders but -- but also with other state agencies to make sure that we do that in accordance with the best guidance that is out there.

One issue related to the final cleaning is that the health care worker has a dog. And we want to make sure that we respond appropriately. And so we're working hard to find a location to care for the dog and a location where we can have the proper monitoring of the dog.

And finally, the work that we're doing is contingency planning. Again, we know the possibilities that can occur and we want to be prepared. And so a lot of work is taking place right now with a variety of health care providers, emergency managers, EMS to make sure that we are ready for whatever needs to take place.

And at the same time, following the folks that we know have been contacted and the 48 individuals that we've been monitoring so far and the additional individuals that Dr. Frieden has discussed today, making sure that all of them know what needs to happen if any of them start having symptoms.

And so, again, a lot of work is taking place here in Dallas and we continue to be grateful for the support from the CDC and our many other partners in this response.

And with that, Dr. Frieden, I'll hand the line back over to you. Thanks.

FRIEDEN: Thank you very much, Dr. Lakey, and thank you for all what the team there is doing there in Texas. It's an excellent working relationship and we value it greatly. Before turning to questions, I'll just comment that the situation is

fluid and we will continue to update you as we get more information. In the room.

UNIDENTIFIED FEMALE: Doctor, you spoke about the possibility of further infections. Is that because there's a known safety procedure or protocol that perhaps was not followed? And my follow-up question to that is, if you cannot pinpoint the breach in protocol, how do you move forward with education?

FRIEDEN: If we knew that there was a specific incident, such as a needle stick, that would indicate that we could narrow it down the health care workers at risk for those who had that specific exposure. Since we don't know what the exposure was but we know that there was an exposure, then we have to cast the net more widely and see in terms of monitoring -- monitor a larger proportion of the health care workers and in terms of infection control protocols or procedures improve every aspect of those procedures every time we see something that could be improved.

So, for example, our staff there now are watching as patients put on and take off all of their protective garb. They are retraining staff in how to do that safely. They are looking at the types of personal protective equipment that are used to see if there are some types that may be easier to put on or take off and thereby reduce the risk that someone would unintentionally contaminate themselves.

We're looking at what we do when someone comes out of the isolation unit and possibly spraying them down with a product that would kill the virus if there is contamination. That was already in our guidelines for gloves but we're looking at that more broadly.

We're also looking at things that can be done within the isolation facility to reduce the risk that individuals, personal protective equipment could become contaminated with the Ebola virus. So there are a series of things that are already implemented in the past 24 hours and we will continue to look at that in terms of how can we make care easier and safer?

MIRIAM FALCO, CNN CORRESPONDENT: Hi, it's Miriam Falco from CNN. You have been telling us about what needs to be done and how prepared we are for months now. You've been telling us for a long time about the risks and all the things that can be done. But you just said that you're working at making care simpler and you're providing hands-on training.

It seems like there's a gap in what you may have thought was happening at the nation's hospitals and what actually is happening. Have you thought about bringing in somebody like Doctors Without Borders, which has been successfully treating patients in Africa for years, to learn about how they do it? And then the second question I have is regarding the travel.

You have said multiple times that travel ban is not helpful for many reasons but many people still think, why not keep those people who may be sick from coming into this country. Can you better explain why you don't think a travel ban is a good idea?

FRIEDEN: I'm sorry, your first question again?

FALCO: The training about --

FRIEDEN: Training. Thank you. We've worked very closely with Doctors Without Borders, MSF, in fact we've replicated their training course and we have dozens, hundreds of U.S. doctors and other health care workers who are going to Africa to fight the outbreak at the source, going through a CDC-run training program that replicates the training that MSF has done.

The same team at CDC who created that training course is training physicians throughout the U.S. but definitely, we will be looking over the coming days in how we can increase training and increase training materials and availability most urgently for the health care workers caring for the patient in Dallas but more generally throughout our health care system.

It is worth highlighting that the single most important thing for every other hospital in the country to know is the importance of taking a history of travel. That if someone has fever or other symptoms that could be Ebola, ask where they have been in the previous 21 days. And if it's to Liberia, Sierra Leone or Guinea, then immediately place them in isolation, consult with us and state and local health department and we'll go from there. But that's what the health care system in general needs to really focus on.

In terms of travel, we're looking at multiple levels of protection. The first is screening of people on departure from these three countries. All are screened with a questionnaire, all have their temperature taken. 77 people in the last two months were not allowed to board, not allowed to enter the airport even because they had fever or other symptoms. None of those were diagnosed with Ebola and many of them had malaria.

In addition, starting yesterday at JFK International Airport in New York City, we began screening people who came from these countries -- these three countries also with a detailed questionnaire and a temperature check. Since that was implemented, 91 such individuals were identified. None of them had fever. Five of them were referred for additional evaluation by CDC. None were determined to have exposure to Ebola. So this is in place at JFK.

Thursday of this week we anticipate having this in place at four additional airports in the U.S. and we'll learn from that experience.

Also making sure that doctors throughout the health care system diagnose Ebola promptly is very important. On the issue of banning travel, I understand that there are calls to do this. I really tried to focus on the bottom line here. The bottom line here is reducing risk to Americans. The way we're going to reduce risk to Americans is do the steps of protection I just went through and stop it at the source in Africa.

Today, CDC has 150 of our top disease detectives throughout the three countries and many of the counties, districts, and prefectures within the three countries helping to turn the outbreak around working along with the Department of Defense, with USAID, with the World Health Organization and with many other governments which are surging in to help stop it at the source.

If we do things that unintentionally make it harder to get that response in, to get supplies in, that make it harder for those governments to manage, to get everything from economic activity to travel going, it's going to become much harder to stop the outbreak at the source. If that were to happen, it would spread for more months and potentially to other countries and that would increase rather than decrease the risk to Americans.

Above all, do no harm. And that's why we want to focus on stopping the outbreak at the source.

LEMON: All right. You're listening -- you're listening to Thomas Frieden, the director of the Centers for Disease Control and Prevention. And also joining him there was David Lakey who's the commissioner for the Texas Department of State Health Services.

Really giving us a lot of the information in a very short amount of time just about 20 minutes, maybe a little bit shorter than that. Talking about the new precautions that they are taking, how they're looking at the spread or possible spread of Ebola now, apologizing really for giving the impression, he said, that the nurse who was infected in Dallas after treating what he calls an index patient, we know it's Thomas Eric Duncan, may have infected herself by either putting on or removing the protective gear.

I want to bring in now our senior medical correspondent Elizabeth Cohen, as we are talking about this.