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Another Health Care Worker with Ebola in Dallas; Coming into Contact with Ebola Patients

Aired October 15, 2014 - 08:30   ET

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

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Those people would be stigmatized. They would be ostracized. They wouldn't be able to function within that community, that society anymore. We're not at that level here in the states, you know, obviously, but this has to - this has to be, this is basic sort of contact tracing and this is basic work that needs to be done to protect them while hopefully not scaring them too much simultaneously.

ALISYN CAMEROTA, CNN ANCHOR: And, Sanjay, as we - as far as we know at the moment, according to the press conference, all this happened as she spiked a temperature, this next victim, and she is in isolation. So at her apartment, what has to happen with her linens and her belongings?

GUPTA: Yes, no, I'm glad you brought up that, Alisyn. It's a very good point and I think it bears repeating every single time we can that she should not have been contagious or infectious. She should not have been spilling the virus into, you know, into the community on to other people. So she shouldn't really be a threat.

I think what will happen there is this term that we've been hearing a lot of over the past month, abundance of caution. They'll probably remove the things that she had direct contact with in her apartment. And if it were a hospital, that stuff would be destroyed, burned, incinerated. And that's what may happen here as well.

CAMEROTA: All right, Sanjay, thanks so much for the information. It's been great to have you throughout the whole program.

GUPTA: You got it.

CHRIS CUOMO, CNN ANCHOR: And hopefully we'll get some information about the use of this blood test on this health care worker and Ms. Pham because now that we know they can test and not wait those 21 days, hopefully they're getting more advanced in their detection.

CAMEROTA: Yes. For the other 70 plus people that they're monitoring.

CUOMO: That's right.

CAMEROTA: All right.

CUOMO: We're going to take a break here right now and we'll continue to follow the breaking news and new details just coming in from Dallas. Specifically, did officials calm Ebola concerns or just add fuel to the fire in the presser they just held? We'll break it down with all the latest developments. We have a great medical team of experts here for you. Stay with us.

(COMMERCIAL BREAK)

CUOMO: Welcome back.

Officials in Dallas just briefing us on the newest case of Ebola, acknowledging it could get worse before it gets better, but they believe it will get better. Now, how long could that take and are they prepared to do it, to make things better? Let's get back to senior medical correspondent Dr. Elizabeth Cohen to recap and update what we just heard from officials.

Elizabeth.

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Hi, Chris.

There were several interesting things in that press conference. One is that an official said, "I don't think we," meaning Presbyterian Hospital, "have a systematic or institutional problem." I think many people would beg to differ with that. This hospital took care of one Ebola patient and two health care workers got sick. Emory and the University of Nebraska took care collectively of five Ebola patients and no health care workers got sick. And you sort of wonder, when will this hospital, you know, take responsibility and say, we need to - you know, we are going to figure out what went wrong because clearly something went wrong.

CUOMO: Yes. And the question is, Elizabeth, do you wait for that or do you step in -- and by you meaning the federal government here, the CDC, who's supposed to be in charge -- and do it for them. Now, the CDC has announced new measures to take in Dallas. They didn't have anyone at the press conference. But what are the measures?

COHEN: The measures are, there's a multitude of them and they are all aimed at making this hospital a safer place to treat Ebola patients. So sending in Doctors Without Borders teams. Of course, they have more experience than anyone in treating Ebola patients. Improving processes and procedures for safety. Put a site manager in place. That person would just be concerned about making sure that it was safe for workers. I'm sort of shocked that wasn't done originally. Establish a CDC response team. That team is already here and I believe more are coming. And increase training opportunities.

I think what this adds up to and what experts are telling me it adds up to is that there was overconfidence in this hospital. When the CDC came here, they weren't even keeping track of health care workers, two of whom have become sick. They figured, oh, they were wearing protective gear and they work at the hospital, you know, they didn't even monitor these folks. Obviously, they now know that that was not the right way to go.

CAMEROTA: Elizabeth, thanks so much for the information.

Let's bring in CNN medical analyst Dr. Alexander van Tulleken and Dr. Joseph McCormick, professor and regional dean at the University of Texas School of Public Health.

Gentlemen, thanks for being here.

I'm sure you were listening in on the Dallas press conference that was just had there by health officials. They said a lot of interesting things. They continue to monitor 75 people now. that was a little bit higher than what we thought who had originally had contact with the patient, Thomas Duncan. One of the things that they said, which was interesting, is that 48 people, 48 of those who had contact with him, are about to reach the end of the window. This Sunday marks the end of the window they believe during which they could have contracted the disease. That means 21 days have passed and then they're in the clear permanently, Dr. Tulleken?

DR. ALEXANDER VAN TULLEKEN, CNN MEDICAL ANALYST: I mean that's -- as far as we know, that seems to be right. I mean the average incubation period, as the professor was saying, is 6.3 days. So it seems like 21 days out we really are in the clear.

DR. JOSEPH MCCORMICK, PROF. AND REGIONAL DEAN, UNIV. OF TEXAS SCHOOL OF PUBLIC HEALTH: Yes, I mean, what -- this is a probability issue. Once you get past the mean incubation period, the probability drops and drops and drops. By the time you get to 21 days, it's really very low that you're going to see it (ph).

CUOMO: But can't you know before about -- with a blood test, as you were explaining to us earlier?

MCCORMICK: Well, I - I think so. I think that there are a number of different blood tests you could use to start to get a very clear idea if someone's circulating virus, is someone dropping their -- the key white count that's indicative of disease, are they changing these key molecules that occur also with disease relatively early on? I think we can do a lot of those things, and we should be. Certainly for those people who seem to be the very highest risk of potential infection.

MICHAELA PEREIRA, CNN ANCHOR: You know, it was interesting to hear them talk about the fact that there are these 77 point of contacts, but there are two patients that are sickened, that we know are both nurses now. And you were talking that it's very interesting to learn that it's the health care workers, it's not been these other points of contact. And I know that everybody seems to think, oh, we're obsessing about this hospital in Dallas, but it's so important, Dr. McCormick, that we look at this hospital so that other hospitals can plan for the eventuality of a case coming to their ER.

MCCORMICK: If this is not a learning experience for every hospital in the country, then they must be asleep.

VAN TULLEKEN: Yes.

MCCORMICK: Because this -

PEREIRA: Call to action right there.

MCCORMICK: This absolutely has to be a learning experience and, unfortunately, learning about, you know, what went wrong.

PEREIRA: Yes.

VAN TULLEKEN: I mean I think what we'd really have liked to have seen in that press conference is more details. So we hear about people being monitored now. What does monitoring mean? Does monitoring mean they get a daily phone call? I think - I think my feeling is they should be having daily blood tests of the kinds we're just talking about. All those people should probably be isolated. Are they still at work?

MCSHANE: Right.

VAN TULLEKEN: You know, are they at work? They definitely shouldn't be at work.

CUOMO: Panic is a function of the unknown, OK.

VAN TULLEKEN: Yes.

CUOMO: And of mixed messaging and a lack of leadership. And again, no disrespect to the county judge, and I understand that he has broader powers in Texas than you might assume, but to not have a member of the CDC there who's supposed to be handing everything down to these people just breeds a lack of confidence. I mean you've worked with the CDC, doctor. Don't you think there's a role here that needs to be filled?

MCCORMICK: There is a role and I think that the traditional CDC relationship is now proving to be, I think, somewhat of a liability in the sense that CDC cannot come in and say, you will do x, y and z. They don't have the legal authority for that. So it's always been, you invite us, we'll come and help. You tell us what you need and we'll help you. But I think in this kind of circumstance, and any kind of epidemic, I think we've got to have a different arrangement.

PEREIRA: It should be a clear czar. I mean we were talking about this (INAUDIBLE) behind the set is the need for someone to be leading sort of the call - the call for action, the protocols, setting the guidelines, like an Ebola czar, for lack of a better word.

VAN TULLEKEN: It's - I think what we have here -- it's very difficult, when you criticize leadership, you start to point the finger at individual people. And what we have is a system that is actually very, very hard to lead. There's a very, very diverse range of agencies responsible. And the idea of a czar would be to centralize that responsibility and also to have someone where the buck stops, where you can say, this is about enforcing a relatively simple set of things, about making a relatively simple set of decisions and make sure that you have a system in place to make sure people adhere to those rules.

And so, you know, the Ebola czar does not have to be the world's foremost expert in infectious disease. You could look at someone from industry, particularly the airline industry, very good at safety protocols, very good at making sure they're universally adhered to. That would be my feeling. CAMEROTA: Doctors Van Tulleken and McCormick, thanks so much for all the information today. It's been great to have you here on set.

Let's get some more news with Michaela.

PEREIRA: Yes, a few headlines. Let's get to those right now.

CAMEROTA: Let's do it.

PEREIRA: ISIS advancing, continuing in Syria, in Iraq, despite relentless air strikes. Militant fighters are poised to launch an attack now on a major airbase in western Iraq. President Obama acknowledging that defeating ISIS will not happen easily. He says the nearly two dozen nations are united behind this long-term campaign.

Another round of violence erupting in Hong Kong. Police fired pepper spray into a crowd of demonstrators trying to take over a major road outside government headquarters. We're told about 45 people were arrested. In the meantime, officials there launching an investigation into this video allegedly showing a pro-democracy demonstrator being beaten by plain clothes officers.

At least 17 American soldiers were exposed to nerve (INAUDIBLE) mustard gas after the invasion of Iraq. That's according to "The New York Times," which in their report also says the government, the U.S. government, withheld that information from troops and from military doctors. The report suggests the government's secrecy prevented soldiers from receiving proper medical care and official recognition of their illnesses. You know there will be repercussions with that.

Toyota with a major recall this morning. More than 1.5 million vehicles from around the globe, both Toyota and Lexus are being recalled over brake problems and a fuel leak issue that could start a fire. More than 400,000 vehicles in the United States are part of that recall. The company says it has not heard of any crashes or injuries or deaths as a result of the problem.

Can I talk baseball? Can I?

CUOMO: Please.

PEREIRA: OK. Kansas City Royals now just one win away from the World Series. They beat the Orioles to take a 3-0 lead in the American league championship series. The Royals still have not lost in the post season, winning all eight games. They can finish things off tomorrow in Baltimore -- or today, rather. Game four in Baltimore today.

And how about those Giants? Just sayin'. That's all I'm saying.

CAMEROTA: Exciting. Thanks, Michaela.

PEREIRA: You're welcome.

CAMEROTA: All right, the battle against Ebola is about treating and containing Ebola, but how can so many people be tracked down and monitored after coming in contact with someone who's contracted the disease? We're going to break down all of those numbers for you.

(COMMERCIAL BREAK)

(BEGIN VIDEOCLIP)

CLAY JENKINS, DALLAS COUNTY JUDGE: Like Nina Pham, this is a heroic person, a person who dedicated her life, and is dedicating her life to helping others, and is a servant leader.

(END VIDEOCLIP)

PEREIRA: Welcome back to NEW DAY. That was Dallas County Judge Jenkins, just moments ago speaking about the second health care worker infected in Dallas with Ebola. Officials already have begun the daunting task of what is being called contact tracing, locating all people, any people, who have come in contact with that health care worker.

So, with precious hours and days having passed, how many people could be in jeopardy, and how can officials find everyone who may be impacted before the disease spreads any further? Joined again live by CNN medical analyst, Dr. Alexander van Tulleken. We call you Xand with all respect in the world.

Let's talk about this contact tracing. Why don't we set up kind of, like, three scenarios? The first one being a patient that tests positive for Ebola shows up sick and has the symptoms, comes to the hospital, is tested, then the work begins. Not only on his medical treatment, but on tracing every person they've come through contact with.

VAN TULLEKEN: Yes, so if we mention this red figure represents someone who has been in contact with, for instance, someone like Thomas Eric Duncan.

PEREIRA: Yes.

VAN TULLEKEN: Nina Pham who's had Ebola. They develop symptoms and so they are now positive for Ebola, so now we need to contact trace every single person.

PEREIRA: And we mean everybody.

VAN TULLEKEN: So, the first thing to do is say since you developed symptoms and therefor became contagious, you can infect other people. Where have you been?

PEREIRA: What did you do?

VAN TULLEKEN: And what have you done? Now, if you imagine, you know, the average incubation period is six days.

PEREIRA: Right.

VAN TULLEKEN: After that, you know, once you're symptomatic, you might - - before you go to hospital, might be a few days. If you ask me what I've been doing for the last three days, it's going to be quite difficult to remember.

PEREIRA: It is. All of the places that you've gone, any errands you have done, any stop you made at an ATM, et cetera, et cetera. These are all things that they really have to pay attention to.

VAN TULLEKEN: What we're using is the three-foot rule, and the three- foot rule seems to be that you can't be -- three foot is about arm's length.

PEREIRA: Okay, so about here.

VAN TULLEKEN: And, so, it's quite easy - - There's a big difference between arm's length, under arm's length (ph).

PEREIRA: Yes.

VAN TULLEKEN: So, if you're interacting with someone at a cash register, something like that.

PEREIRA: Sure.

VAN TULLEKEN: You're closer than three feet. So, all of those people have to be contacted, and then the question is, what do you do with them then? Well, you need to make sure that you can stay in touch with them.

PEREIRA: Yes.

VAN TULLEKEN: They need information that they've been exposed, and they need information about who to contact if they develop symptoms and what symptoms develop.

PEREIRA: And, again, you're relying on human ability, memory, honesty. And it isn't even nefarious, but you just might not remember.

VAN TULLEKEN: Let's not forget- -Exactly, so, first of all, it's very hard not to miss anyone, okay?

PEREIRA: Yes, absolutely.

VAN TULLEKEN: So you have to use - You have to be a real detective here. I mean, you're going to be using e-mail, telephone, Facebook, personal information. You may have to go, gas station, you have to go back to the gas station to see who was on that at that time. Who served them, which register, which register are you at? Very, very hard to do, so a detailed questionnaire is where we start.

PEREIRA: And, again, it's really key and somebody like, we know that Nina Pham, she knew right away this is a concern because I've been around Ebola patients, and she quickly went to -- Let me swipe this to the next scenario.

VAN TULLEKEN: Yes.

PEREIRA: She quickly went to the hospital, was isolated. Let's talk about the second scenario, is when you have an Ebola patient. This is one of the contacts, so if somebody in the network of contacts that, for example, Duncan or Nina Pham, the nurse, would have come in contact with, then what?

VAN TULLEKEN: So, the ideal is you get someone who displays no symptoms for 21 days.

PEREIRA: I'm feeling fine.

VAN TULLEKEN: We can stop monitoring you, and that's okay. But, what we've seen is that isn't really good enough anymore. So, we used to say okay, okay, alright, we'll watch you for 21 days. Now that we have these two health care workers infected, we have to say this is America. We should be doing serial blood tests on them, and they should be at home. They probably don't have to be in a hospital room, positive pressure room or anything like that.

PEREIRA: But just alone in their home.

VAN TULLEKEN: With family, with pets. That's okay, but somewhere where they're not out in contact with lots of other people. So, you limit that as much as possible.

PEREIRA: And the first red flag is the fever?

VAN TULLEKEN: The first red flag is fever or feeling unwell. I mean, this is a virus that presents -- Your body only has a few ways of getting ill, if you like, and a fever is usually an early manifestation of your immune system getting going. But feeling unwell, you may not notice it, but even maybe you're out in the cold, something like that, you know, it could be a variety of unwell symptoms.

PEREIRA: And the key is this 21 days, again, because that's sort of the outside that we're looking at. And again, Xand and I have been really cautious. We don't want to over-panic people. We want to have urgency when we talk about this.

The question mark is, what if we miss someone? What if, in those contacts, there's somebody who came within the three feet of a sick patient with symptoms, what if we missed one of those points of contacts? And that's the concern.

VAN TULLEKEN: So, the only way of addressing that is doing what we're doing now, which is talking about it in the press, in the media, make sure the public are generally informed. So, if you are in the region, and this is the really difficult bit, is we say at the moment if you're in the region where there's been someone with Ebola and you develop symptoms, you know, should you worry and how should you seek care?

At the moment we say contact your health care provider. Now, that's a tricky thing to do. Go to a hospital, you potentially expose more people.

PEREIRA: And we see there on the front line. VAN TULLEKEN: At the moment we do not have an Ebola hotline where you can phone and say I was in the region, I worked at that gas station, I think I've seen that guy who is sick come in. We don't have any of those systems in place. This is one of the criticisms we've offered of the CDC. But, at the moment, I think it's reasonable to say if you're concerned you have symptoms, speak to your health care provider.

PEREIRA: You've been doing a great job for us today.

VAN TULLEKEN: Thanks very much.

PEREIRA: I'll shake your hand and I'll come in within three feet of you. Thank you so much for that Dr. van Tulleken. Alisyn, to you.

CAMEROTA: Alright, thanks so much, Michaela. We are going to have more details on the breaking news coming up.

Plus --

CUOMO: She should be worried about high school and hanging out with her friends. Instead, wait until you meet this extraordinary 15-year- old. She is deciding to spend her time making other kids' lives better, and guess what? You can help her do it. It's the Good Stuff.

CAMEROTA: We need it.

(COMMERCIAL BREAK)

CUOMO: That's my theme song. I love "Fancy." Time for the Good Stuff. Speaking of the Good Stuff, the "ROOTS" series that everybody is loving so much, bumped today for obvious reasons, will be back tomorrow with Christine Romans and her discovery that she is in fact a Viking princess.

PEREIRA: What?

CUOMO: No, no, no.

PEREIRA: Okay.

CUOMO: You'll have to see it, but I'm telling the truth.

Today's edition of the Good Stuff, an extraordinary young woman.

(BEGIN VIDEOTAPE)

CUOMO (voice-over): 15-year-old Leanne Joyce, okay? She spent time in the hospital when she was younger for a congenital heart problem. That is the bad stuff in this story, but the challenge is always how we're going to deal with the trouble that comes our way, and this kid shows us all how to be. She created Positive Impact for Kids. It's a charity that helps hospitalized kids with everything from get well cards to Xboxes and iPads, whatever they need to help keep up their spirits. LEANNE JOYCE, FOUNDER, "POSITIVE IMPACT FOR KIDS": I just want kids to

feel as normal as they can, because I know what it's like and it's not fun otherwise.

PEREIRA (voice-over): Great gal.

CUOMO: Remember, she is only 15. Now, so far, get this, Leanne has raised $30,000.

PEREIRA: Wow.

(END VIDEOTAPE)

CUOMO (on camera): She has helped kids in all 50 states.

PEREIRA (on camera): That's really impressive.

CUOMO: Already. Here's her goal. 100,000 bucks by the time she graduates from high school. She's up for a $10,000 grant from Kind Causes. So, you're hearing this, you're home, you're drinking your coffee, you're looking at your - - I want to help.

PEREIRA: Yes.

CUOMO: You can. You can visit them online, and you can help right there.

PEREIRA: That's amazing.

CAMEROTA: Great story. Teenagers, see, they can make things happen. Sometimes.

CUOMO: There is hope. As we heard from the mayor down in Dallas, things are bad now, but hopefully they will get better.

CAMEROTA: They will.

CUOMO: She is proof that we can all do better, and she certainly is. There is a lot of news for you this morning. Let's get you right to the "NEWSROOM" with Ana Cabrera who's in for Carol Costello. Ana?

ANA CABRERA, CNN ANCHOR: It is a busy morning. As you know, we have breaking news, so let's get right to.

ANNOUNCER: This is CNN breaking news.

CABRERA: Hello, again. I'm Ana Cabrera in for Carol Costello this morning.