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State of the Union

CDC: "Breach In Protocol" Led To New Ebola Infection; Nurse Had Extensive Contact With Ebola Patient Who Died; A Travel Ban To Shut Out Ebola;

Aired October 12, 2014 - 12:00   ET

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

CANDY CROWLEY, CNN HOST: Welcome to STATE OF THE UNION.

This morning we are following breaking news, a new case of Ebola in Dallas. The infected woman is a nurse who had contact with the Ebola patient, Thomas Eric Duncan who died of the virus last week.

During a news conference in the past hour, the director for the Centers for Disease Control and Prevention revealed the nurse is not one of the 48 people being monitored, because they had contact with Duncan before he was isolated.

(BEGIN VIDEO CLIP)

DR. TOM FRIEDMAN, DIRECTOR, CENTER FOR DISEASE CONTROL AND PREVENTION: At some point there was a breach in protocol, and that breach in protocol resulted in this infection.

(END VIDEO CLIP)

CROWLEY: Earlier this morning the mayor of Dallas assured the public that everything possible is being done to prevent the Ebola virus from spreading.

Anthony Fauci is joining us now. He is the director of NIH, the National Institutes of Health. We are also joined by CNN senior medical correspondent, Elizabeth Cohen, and CNN correspondent, Ed Lavandera outside of Dallas Presbyterian Hospital in Dallas.

But first I do want to go to Dr. Fauci of the National Institutes of Allergy and Infectious Diseases. He joins us by phone.

Dr. Fauci, what is the American public to make of this second Ebola case, and as I understand it, the first case of Ebola being contracted -- contacted within the United States?

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASE (via telephone): Well, I think it is important to point out that it is very unfortunate that this individual was infected while caring for an Ebola patient. It clearly had to be a breach of the protocol when one goes in and takes care of the patient with the personal protective equipment that is part of the CDC protocol.

Apparently, the person did use PPEs or the personal protective equipment, but there was clearly a breach in the protocol that is really unfortunate for this very courageous person taking care of Ebola patients. But I think it needs to be put into context that this -- when you are talking about its relationship to an outbreak, you can't make an extrapolation that this is now is danger more so to the American people, because you know (ph) that the contacts that were traced are now being monitor and where appropriate isolated.

So the idea about the American public themselves as a public feeling safe, nothing has changed there. It's very unfortunate we have a case of a worker who was infected while taking care of the patient, but that really is a different situation, than the threat of an outbreak in our country.

CROWLEY: It is, but I will tell you, Dr. Fauci, it does seem and I think what adds to the fear of Ebola that is outsized for the danger of Americans getting Ebola, I think the reason it is outsized is that it does seem that we are sort of reassured at every point that things are being taken care of, and then come in at the protocol, and we know how to stop this, and the next thing we know, a nurse who is following CDC protocol apparently is -- did in fact come down with the virus. And so it just seems like, oh, wait, now that was a problem, and before it was that they could not get to the apartment of the - you know, so it does not seem to be a feeling that officials whoever they may be in Texas or at the CDC don't actually have their arms around this.

FAUCI: Well, when you talk about a breach in protocol, that is something that is a human inadvertent error that again I have to emphasize it is certainly understandable when the public who even follows this may be carefully, maybe just intermittently sees that these things happen. But I think that it is important to get back to what I said just a moment ago about the issue of an outbreak in this country which nothing that has been evolved over the last weeks indicates anything different than what the CDC has been saying that when you have the capability which we do to do the contact tracing and the isolation that an outbreak won't occur, but that does not address the point that you are making which is an important point.

There have been glitches. There was the original misstep at the emergency room when the person was not immediately diagnosed, that was unfortunate. That didn't add to an issue about an outbreak, and this unfortunate situation with the breaching of protocol certainly inadvertently, but that happens.

We do know that when protocols are followed carefully, because we have literally experienced since 1976 with 24 outbreaks that when you do follow the protocol carefully, you don't get infections of health care workers. And the example of the Doctors Without Borders who very, very rarely, and only until just recently did they have any infection at all. So it is unfortunate.

But what the CDC is doing right now is that they are in Dallas. They are reviewing to see just what might have happened with the breach and to underscore what needs to be done to prevent further breaches from occurring among health care workers.

CROWLEY: Dr. Fauci, how did they know it was a breach of protocol?

We hear that she is well enough at least at this point for them to say, walk us through what you did. We know that there are multiple contacts with the patient in isolation while she was following CDC protocol to protect herself. So, you know, is there - did they come to that simply because there is no other way she could have gotten it?

FAUCI: That is true. And we also know examples of the breaches of protocol where this has happened under other circumstances.

But I think that the American public needs to know is that someone can go in and think they are following the protocol, and then inadvertently particularly at the point where they are taking off the personal protective equipment, that is something that we keep emphasizing as one of the most vulnerable periods where you are taking care of the patient could be for an hour or more at a time. You're stressed. You're fatigued. You do everything right, and then you are getting to the point where you are going to be taking off the equipment. That is the vulnerable point if it is not done absolutely perfectly that that's how the breaches occur. And in direct answer to the question, it had to have been a breach in the protocol, because we know from very long experience that when protocols are strictly followed, this does not happen.

CROWLEY: And finally, one question that occurs to me is that we know that those folks who had been in contact with the first Ebola patient in the U.S., who unfortunately died last week in Texas at this hospital we are talking about, we know that they tracked down the people that he had been in contact with...

FAUCI: Right.

CROWLEY: ...and they had this pool of 48, and this is when he with was ill. So they knew that he was, you know, obviously could transmit this virus, there was transmission, but they did not then, what they said to the folks after he was in isolation, the nurses and the doctors, whoever was taking care of him and in contact with him, they said, monitor your -- it seems to me what they said was, so take your temperature twice a day and let us know if you get sick. That there was not the kind of one-on-one attention that the 48 had gotten.

FAUCI: Right.

CROWLEY: Is that a smart idea?

FAUCI: Well, let me explain. That is a very good point that you bring up. When a person who is taking care of an individual with the proper personal protective equipment, the standard protocol that has worked that they are not considered at a high risk if they do the protocol correctly. So there is an assumption that they are following the protocol. Therefore they are monitoring themselves and that is exactly what this individual did and it worked.

She monitored herself as soon as she got a fever Friday night. She reported it. She went under the appropriate isolation. The diagnostic material was done initially in Dallas and then sent to CDC and now she's under care.

So it is quite unfortunate that she got infected but herself mo monitoring made a very, very good effect in the sense of not having her go for a period of time, but we have literally measured in hours before she got under the right isolation. So that protocol of monitoring did actually work.

CROWLEY: Dr. Anthony Fauci at NIH for us this morning. Thanks for phoning in. We really appreciate it.

FAUCI: Good to be with you.

CROWLEY: We want to go to CNN correspondent Ed Lavandera in Dallas now.

Ed, what is going on in the apartment complex where this latest victim of the Ebola virus lived?

ED LAVANDERA, CNN CORRESPONDENT: Well, it is a densely populated neighborhood here just a few miles away from hospital where she is now at, but the city officials say that there was a reverse 911 call that was sent out to people within a four-block radius of this apartment complex warning them and telling them about the situation, paperwork that was being delivered to various homes and educating people about how Ebola is spread, and that sort of thing.

Obviously, city officials here are very aware, very sensitive to the fact that this situation has caused anxiety and stress for so many people. So city officials say that they are trying - they're trying to get ahead of that.

What they have also have sent out hazmat teams to that apartment complex to clean up areas. We saw the hazmat teams at the parking garages in one of the buildings where we presume this patient had or this health care worker had come back here to the hospital after she had driven herself here, as we've seen is a lot of that work and a lot of that work continues as well as what we have seen from CDC officials is that the work to identify the contacts that she has had since she has become symptomatic is the very important next step in all of this. We know of one close contact of this health care worker who has already been isolated, but that work to identify the other possible contacts is being done similar to what was done when Thomas Eric Duncan was diagnosed with Ebola as well. Candy?

CROWLEY: Ed Lavandera on the scene for us. Thanks so much. Ed, we will be back to you, I'm sure.

When we come back, how deep was the breach in protocol? Was it a breach in protocol? And are other health care workers at risk?

(COMMERCIAL BREAK)

CROWLEY: We are following the breaking news, a new Ebola infection in Dallas.

Officials say, a female nurse who had, "extensive contact," multiple occasions with patient Thomas Eric Duncan, the man who died of Ebola last week has tested positive for the virus. A little bit ago the head of the Centers for Disease Control said, a breach in protocol led to the new infection.

Joining us now, CNN senior medical correspondent, Elizabeth Cohen, and Dr. Gavin Macgregor-Skinner. He is an infectious disease expert and works at Penn State.

Doctor, help me understand this because we listen to the CDC, and we listen to the Texas Public Health officials and they say, we are doing, you know, we, you know, decontaminated here and this is under control and we've done this and we've done that. And then in the same breath saying, we are very concerned.

So what we are told by the CDC is breach of protocol, that's what happened here. Something that this nurse was supposed to be doing wasn't done. Do you go with that?

DR. GAVIN MACGREGOR-SKINNER, INFECTIOUS DISEASE EXPERT: No, I don't, Candy.

The nurse was doing her job looking after Mr. Duncan and had visit and seen him, had direct - close contact with him numerous times. This whole idea of the breach of protocol we are underestimating what it takes to actually do patient care for an Ebola patient. It is about management. It is about supervision.

So, again, we've heard Dr. Friedman talk about this morning there needs to an investigation, but part of the investigation should not be the government, that should be a neutral party that goes down (ph) there, turns that investigation into the lessons learned and looks at the management and the supervision in that hospital (INAUDIBLE) hospital staff.

CROWLEY: And so what you mean by that is that the nurse was nursing and someone should have been overseeing that in the room with her or outside the door, is that where you think that the problem was?

MACGREGOR-SKINNER: Exactly. And for a highly infectious disease like Ebola, we teach a system called the buddy system, and that is if you and I were treating the Ebola patient, I'd be watch you, you be watch me. I don't do anything unsupervised. If I (INAUDIBLE) you come with me. And we teach this throughout the world in treating highly infectious diseases. Where was her buddy?

And so if that nurse made a mistake, and again, the breach of protocol -- the protocols are a piece of paper. So it comes down to how many training did she get, how much supervisions did she get, and if you see a breach because she's under -- she should be under good supervision, and (ph) say (ph), hang on. You made a mistake. We need to decontaminate you.

CROWLEY: Elizabeth, when you listen to the CDC this morning, we heard from Dr. Fauci earlier in the show, and now this, what do you make of this? I think part of the problem really is the idea that the CDC and the Texas health officials come out to assure people and yet the more they talk, the less assuring they seem to be.

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: I think that is a fair statement. I mean, first of all that this man got into the United States and went to a hospital, and nobody, you know, that he was Liberian. He had just been to Liberia then that got missed. And now we hear that a health care worker who was wearing full protective gear now has Ebola.

I mean, I think, it is concerning just the facts in and of themselves are concerning.

CROWLEY: And do you have any idea what this breach might have been? I mean, what is the potential, and we are hearing that it is a supervising breach, but at some point obvious this nurse was exposed.

COHEN. Right.

So, Dr. Friedman did not say, but he did say one thing that I thought was a little bit surreptitious, but it may have led us to something. He said, putting on more isn't always safer. That's what he said, putting more on isn't always safer when it comes to the protective gear.

So, you are supposed to do exactly what the protocol say. Now, is it possible for example that when she was supposed to double glove, she tripled glove, put on three pairs of gloves. That might sound better but in fact then you have to take off the three pairs of gloves instead of two pairs of gloves. Could that have been a problem?

But I think what Dr. Macgregor-Skinner said is so important which is that there needs to be supervision, there needs to be a buddy system. And so I really hope that what this comes down to is that the nurse isn't blamed. I really hope that people look at the hospital and the system they were using to make sure that their health care workers are safe.

CROWLEY: In fact, Doctor, we were talking about that all of the sudden it was like, it is her fault. It just seemed so -- a little bit over the top. Now, we don't know that there wasn't a buddy system.

MACGREGOR-SKINNER: No, we haven't heard yet. We haven't heard what the supervisory system was.

And again going (ph) back, the CDC guidance and the protocols -- the CDC are the best in world with what they do, but it is the implementation, and we are not getting enough information now. And again, as we go and talk about the hospital preparedness and readiness throughout the country, many hospitals have the facilities, but they don't have the management systems, they don't have the how to implement in place. And they need to be able to say, we are not ready and this is what we need. We need a national training program. Use those (ph) CDC (ph) protocols and help them with the (ph) national training program.

CROWLEY: And I'm assuming would also work for other diseases as well, and it is a same protocol for a lot of the contagious diseases. So it wouldn't be just in case you get Ebola, there are other times that these procedures can be used.

MACGREGOR-SKINNER: Candy, winter is flu season. We are about to hit flu season. At the moment we've got only a few Ebola cases. We're going to get many, many flu cases coming in with fatigue and body aches, the same as early symptoms of Ebola. We need to go look at triage. We look at - we need to have our national communication strategy and a plan to address what we're going to do as we come (ph) the flu season.

CROWLEY: One of the things that came up, Elizabeth, I think in the show we did earlier today was who is the point person here? Because the CDC really - I mean, it's great they have a partnership with the folks in Texas, but in the end, who does one go to, who is that point person that is managing this both from a public relations point of view which is very important, to which most Americans they are fine, they don't have to worry, but also very importance to say, we are on top of this. Who is that?

COHEN: You know, Candy, it's a great question and I'm going to give you a highly technical answer, which is that it's a little bit mushy.

And part of that is because the public health folks are very sort of Democratic by nature, they like teamwork, they don't like to sort of necessarily sort of take control and just say, I'm the boss. And so the CDC does not like to say, I'm the boss. The CDC likes to defer to states and say that the state is taking the lead and that CDC is there for consultation. I think under these circumstances, I have heard a lot of people asking, gee, it is time for the CDC to say, wait a second, this time, we are in charge.

CROWLEY: And doctor, you know, I thought that the doctors love to take charge and perhaps I know the wrong doctors.

The question here is should there be a person that is in charge, on a nationwide basis, to do the sorts of things you were talking about management training and the buddy system, that kind of thing?

MACGREGOR-SKINNER: And we have that. We have that, Candy.

In Public Health Preparedness for Emergencies we work very closely with the emergency management agencies from the federal, state, to the county level. There are people within -- professionals within the country that are trained specifically to be emergency managers and so they would go to the hospital and say, what do you need? And the hospitals would say, we need this, and they will go the get them.

But just with the Ebola patients we're going to look at the whole system. It's not just the hospital. We know that some of the patients are going to die. We know - so what systems do we have in place for the funeral directors, the mortuaries, the -- and disposing of the body.

We know as we heard from Dr. Friedman, who is one of the CDC directors say, we have to take the blood samples and look at the health (ph), the (ph) patient (ph) care (ph). Are we working closely with the labs? You know, how do we identify that you're (INAUDIBLE) with this infectious vial of blood full of billions and billions of virus and we have to give a heads up to the lab to handle this with extra caution under the legislation that we have to follow? Those systems aren't there --

CROWLEY: We can't assume that is being done already?

MACGREGOR-SKINNER: We don't know because nobody has told us.

CROWLEY: Let me ask you because I know you work with emergency rooms in the hospitals to be prepared. What effect does this have and it seems to be the most effective right now are in the hospital, the nurses, and the aides, and the lab technicians, that that's the place where they are following this most closely.

MACGREGOR-SKINNER: The hospitals are doing that?

CROWLEY: Yes. No, the hospital -- I mean if I were a nurse right now somewhere I would be thinking, oh, man, any fever that comes in here would be scary to me.

What are you hearing from folks that work inside hospitals?

MACGREGOR-SKINNER: I get contacted everyday by so many hospital staff, and what they want - they want the opportunity to say, yes, we can detect Ebola patients through history and fever, we can isolate them, and we can prevent spread. But we are not prepared - we're not ready for the long-term patient care.

So as we put them into isolation we'd be able to say, look, where is our (ph) nearest hospital that has the high containment system for Ebola, has the management systems so that we can then transport them from a hospital to a high-volume containment unit in a hospital. And they don't have that -- we don't have that map. We don't have a map with the hospitals. We don't have a functional network for transport or communication developed and working at the moment.

CROWLEY: Dr. Gavin MacGregor-Skinner, thank you for being here giving us a lot to think about. A lot - it sounds like a lot that's not being done at the moment. So, thank you.

And Elizabeth Cohen, our thanks to you as always, our senior medical correspondent.

It is time - is it time to impose a travel ban to prevent a spread of Ebola breakout here in the United States. More on our breaking news story after this break.

(COMMERCIAL BREAK)

CROWLEY: Following breaking news here, a female nurse in Dallas has tested positive for Ebola. She had extensive contact with Thomas Eric Duncan, the Liberian man who flew to the U.S. and came down with Ebola after arriving in Dallas. Duncan died last week. This is the first case of Ebola transmission here in the U.S., and the CDC says it is a result of a, "breach in protocol".

With us now, Dr. William Schaffner is chairman of the Department of Preventive Medicine at Vanderbilt University. And Dr. Amesh Adalja, he's a board certified physician for infectious disease and a senior associate at the University of Pittsburg Medical Center. And Dr. MacGregor-Skinner remains with us here in the studio.

So Dr. Schaffner, let me begin with you and talk to you about this breach of protocol. Explain to me exactly what that means to you about what happened?

DR. WILLIAM SCHAFFNER, CHAIRMAN, DEPT. OF PREVENTATIVE MEDICINE, VANDERBILT UNIVERSITY: Well, something obviously inadvertent happened, because the nurse to date has not reported an overt breach, and her colleagues working with her have not reported that a breach took place.

However, this is early days in the investigation, and if subsequent information comes out, we will find it. As many of us have said, the most hazardous moment is actually when you are going on break, when you are off of your shift, and after working in an intensive environment like this with all of the protective equipment, you are eager to take it off.

And there you absolutely need a buddy to help you, guide you do it in the appropriate sequence and slowly and carefully because that moment of disrobing of the protective equipment is when you can inadvertently contaminate yourself.

So that's actually that is the most, more hazardous there than actually taking care of the patient.

CROWLEY: Dr. Adalja, tell me how is that at this point with the nurse involved saying, I don't recall any time where it might have been a breach, those around her apparently reporting they don't recall any time, how then are they so sure it is a breach of protocol?

DR. AMESH ADALJA, BOARD CERTIFIED PHYSICIAN FOR INFECTIOUS DISEASE: Because protocols have been put in place by the CDC and the hospital for how you don protective, personal protective equipment, and the gowns and the gloves and the mask and the eye protection, all of that occurs.

And then it is like Dr. Schaffner said, it's very hard to tell when someone maybe taking something off and they may inadvertently touch their face. They may use something that is very innocuous, and that's why, as Dr. Schaffner said, a buddy system is essential.

And that's what MSF is doing. If you read their protocols in Africa, they have a second person watching the person take off their equipment and watch and making sure that meticulous care is taken so that no inadvertent contamination occurs.

Because how many times you touch your face when you're not even thinking about it, it is very hard to keep track of. CROWLEY: And Dr. Macgregor-Skinner, why then - if it is possible, taking off -- a number of people have said, taking off that equipment is almost more important how you do than putting it on. Why then were, was not the group of people who cared for this man under kind of closer watch? They were self-monitoring as I understand it?

MACGREGOR-SKINNER: Well, we are not sure. And we don't know, Candy, what the supervision system was in place, and Dr. Frieden, the CDC director, actually mentioned that in West Africa and I have just come back from Nigeria where we set up hospital isolation wards and received patients.

We actually had one person being the supervisor of the doctors and the nurses and the janitorial staff, and any other staff that came into that isolation suite, and that was part of the protocol.

And if someone was watching you, they would say, you have made a mistake and I have to get some chlorine and bleach and wash you down. Again, in our U.S. system, hospitals, we are not used to working in the buddy system and it has to be trained.

We are not used to working under someone supervising a physician and saying, you made a mistake. No, no, I'm a doctor, and so that does not happen in our culture.

CROWLEY: So, Dr. Schaffner, do you feel, that every hospital in the country because you never -- let's take it out of Ebola, but we all understand that the risk is low for most Americans at this point for Ebola.

But the thing is that you never know what hospital, who would have picked Dallas and you know, so you don't know what hospital. Are you convinced that the idea of the buddy system and other protocols are firmly in place in other emergency rooms or does it worry you we might have another, for instance, at some point at a hospital that is not at this point properly trained?

SCHAFFNER: Well, obviously, I have not been in every hospital.

CROWLEY: Right.

SCHAFFNER: But I can tell you that is, the system we have in place at Vanderbilt, and we have it in place, because it is re recommended by the CDC. The CDC really is the conductor of the public health orchestra and if you will, there are violins and drums out there all working semi-independently.

But it is coordinated to produce coherent public health music to push this metaphor and that it is a system that's been in place for a long time. It works very smoothly. They get the feedback from below. They modify their protocols.

And in this instance specifically in Texas, the CDC, the Texas State Department of Health, and the Dallas county people have worked harmoniously, and I give their public health response really an "A" not only for effort but for execution. Because they have defined the people at increased risk, they are monitoring them carefully. The health care workers, Candy, were put on notice that because they were providing health care and absent a recognized breach, they were to take their own temperatures twice a day and report in.

That system worked perfectly. As soon as that nurse detected an elevated temperature, she called up, reported in, came in and was put in isolation, and things are going forward. So, if we don't expect perfection, then we won't be quite as disappointed.

And of course, from time to time, there will be a break in protocol. It is a large country. There are lots of us there and there are opportunities for breaks. The protocols minimize that risk.

And they have been very effective both in Africa, in previous outbreaks. "Doctors Without Borders" working very well in Nebraska and in Emory and in other institutions are prepared to do that.

As I have told you, we have conducted drills in our own institution with fake Ebola patients, and have looked at that very, very carefully and other institutions are doing the same thing around the country.

CROWLEY: Dr. Adalja, let me ask you to take a step back to what you have heard today from Dallas, from the CDC, and earlier from the NIH, tell me what if anything concerns you about the second patient or about how the U.S. in general is handling this.

ADALJA: The second patient when I first heard about it, I was hoping that it was from the first visit to the emergency department where we know that the diagnosis was not recognized because their isolation procedures were not in place.

The fact that this happened in the second hospitalization makes you wonder how it happen and why a breach in the protocol and was the training adequate at this hospital?

We know that all hospitals isolate patients for other diseases like tuberculosis or MRSA and influenza, but here keeping with the protocol and being strict with infection control procedures is essential because this is a very deadly virus.

The virus hasn't change. It is only spread through contact with blood and body fluids of a symptomatic person. So we can't do the virus any favors by not following meticulous infection control, that's really what happened here.

And that's the most concerning part is that how well are people prepared to follow these and do we have safeguards in place to make sure they are doing appropriately if they are not that experienced with it.

CROWLEY: I'm going to have to leave it there. Thank you so much, Dr. Adalja, Dr. Schaffner, as well as Dr. Macgregor-Skinner. Thank you all for being with me.

Next up, we will listen to what the city of Dallas is telling people about the new Ebola infection.

(COMMERCIAL BREAK)

CROWLEY: Welcome back to STATE OF THE UNION. We are following breaking news out of Dallas. A nurse who had extensive contact with the man who died of Ebola last week has tested positive for the virus.

Joining us now is Dr. Alexander Garza, a former assistant secretary with the Department of Homeland Security. Doctor, the city of Dallas is placing phone calls to some residents informing them of the latest developments.

I want you and our audience to listen to what people are hearing when they pick up their phones.

(BEGIN VIDEO CLIP)

ANNOUNCER: This is an important message from the city of Dallas. Please be advised that a health care worker who lives in your area has tested positive for the Ebola virus. This individual is in the hospital and isolated. Precautions are already in place to clean all known potential areas of contact to ensure public health. While this may be concerning, there is no ongoing danger to your health.

(END VIDEO CLIP)

CROWLEY: So Dr. Garza, what do you think? Is that effective?

DR. ALEXANDER GARZA, FORMER ASSISTANT SECRETARY FOR HEALTH AFFAIRS: Well, you know, I think it is sort of plus/minus. In one way it is good to always communicate with the public about the risk and about disease in the community.

On the other hand, just listening to it, I think if I got a phone call on my machine saying that, I am not sure that would heighten the people being scared of the virus, and so, think it is plus/minus on whether that's going to be an effective strategy or not.

CROWLEY: And I think you have hit on one of problems that we've any number of experts say to us, the risk of someone in the United States contracting Ebola is very, like in infinitesimal, and we understand that, but the fear of Ebola is great at this point.

GARZA: Right.

CROWLEY: So as a public health expert, when you look at what has gone on in Dallas, when you look at how it has been responded to, how would you fix it if we suddenly put you in charge?

GARZA: So, first of all, that would be a very tough position to be in. Secondly, I think, you know, there is a dynamic here. So there's the health dynamic and the medical care of the patient that has receive and the public health expectations.

But I also think that there is a social dynamic and so there is a social disruption when things come into the community that are fearful and unknown. You have to address both of those, and so I have done a good job of addressing the health side and the public health side, but maybe not so much that social disruption side, and then how do you go about doing that?

Well, a lot of it is brought in with the communications experts and how do we reach people and deliver a message that says that, look, this is concerning, but we are on top of it, and these are the things that you need to know.

CROWLEY: I know that you have a military background as well as having worked for the Department of Homeland Security. So I want to take advantage of that --

GARZA: Sure.

CROWLEY: -- and ask you what you think of some of the 3,000 to 4,000 troops up to that much from the U.S. may be sent into West Africa to help set up tents, and to help, you know, make uncontaminated areas to bring patients into.

How much of a help is that going to be in that situation? I read all of the time that what they need are doctors and nurses, so I am trying to figure out how much of a help this will be and how safe will it be for U.S. troops?

GARZA: So, I think any help that we can bring to those countries is a good thing. And what the military brings is a professional background of logistics and command and control. And so what they bring to the fight is exactly those things.

They bring manpower and expertise in getting things done. So setting up the treatment centers I think will be a big step in that direction. As far as their safety concerns, I think it is always something that the military preaches to their soldiers is how to be careful and safe.

No matter if it is kinetic environment like Iraq and Afghanistan or facing a contagious agent, and they go through the whole list of risk assessments to make sure that they can bring everybody home alive either way.

CROWLEY: Dr. Alexander Garza, associate dean to St. Louis University, College of Public Health. Thank you so much for your time today.

GARZA: Absolutely, thank you.

CROWLEY: We will continue right after this.

(COMMERCIAL BREAK)

CROWLEY: Welcome back to CNN's breaking news. In Dallas, a second patient has fallen victim to Ebola is hospitalized and in isolation in Dallas said to be in fairly good condition. She presented with a low- grade fever.

She has been found to be carrying the Ebola virus although we are waiting for the Centers for Disease Control to confirm that diagnosis so very few people have little doubt.

I am joined today by Dr. Amesh Adalja, Dr. Gavin Macgregor-Skinner and Dr. William Schaffner. I want to talk to all you about this idea of bio-containment centers. The idea that this is a tough job -- even though it is easy to administer to a patient, it is hard to follow the protocols and know the protocols and understand them.

So if there are these bio-containment units, what is the feasibility that someone comes up with the patient with Ebola moving them to those?

SKINNER: Well, we have great examples, Candy, where we have brought the U.S. citizens from West Africa by plane and safely and landed at the airports and used the ambulances to transport those patients safely from the airport to either Emory University Hospital or to Nebraska Medical Center. We have done that safely.

Now we've done it numerous times and not just once, and so again, we have to put out a functional network that includes not just through communication but also transport, and we can put that in place. We have the resources here in the U.S. to that.

CROWLEY: Dr. Adalja, what do you think about that notion? I have talked to Dr. Schaffner before about it, and I know that he is not completely keen on it for a number of reasons, but I want to get your take first?

ADALJA: So, we do this for a lot of different diseases. For example, you have level one trauma centers. We take heart attacks to cardiac centers, stroke centers, and I think it's reasonable to think about if it might be better to start triaging to bio-containment facilities if we are not going to ensure complete compliance with our protocol.

Because we know that those places do things a little bit differently, they are drilled and they are trained and that may be the difference here, and lot of calls for that. I think it is something that needs to be explored.

CROWLEY: But Dr. Adalja, sorry, but when you have a heart patient, you don't have to decontaminate the helicopter or the ambulance.

ADALJA: Right. I'm talking just in general about regionalization of the care. We have places in Nebraska. We have a place at Emory. The NIH has some capacity so you have to think about is that something that we should do for this handful of Ebola patients that we may or may not get.

Technically every hospital should be able to care for an Ebola patient, but I'm just afraid now with this breach in protocol, there is going to be a lot of talk about this. It's something that we should probably get ahead of and start thinking about it or even tiering hospitals within a metropolitan center.

Where the tertiary care centers are the most adept at using infection control procedures should they be in the place where the patient is eventually transferred to once they present to the local emergency department.

That whole discussion probably needs to be made because we may get more imported cases, and I think we have to be ready for them.

CROWLEY: And Dr. Schaffner, you and I discussed this a little bit earlier actually before the second patient got the Ebola virus, and are you still having hesitation about having patients transported to the bio-containment centers?

SCHAFFNER: Well, I think it is a very important discussion to have, but I should note that these patients could present in the emergency room at literally any hospital in the country, and then before they are transferred, if it were to happen, they have to be admitted and stabilize and assessed.

So every hospital really does need to have this capacity, and then there's the patient who presents and is too sick to be transferred even with within a city. So every hospital really needs to develop this capacity, should the need arise, to take care of the patients not only effectively, and that straight forward, and we know that our doctors can do that but also safely.

CROWLEY: We do have to have that first step. I mean, you don't know what hospital a patient might show up.

SKINNER: Exactly, but we don't have the 1-800-help-ebola help number either. As we are screen through airports, one of the critical functions at airports now is giving people advice that after they leave the airport and develop fever and have just come back from West Africa, stay at home.

Don't hop in the taxi or subway, stay home, ring this number, we'll come to you. Please, don't turn up in the emergency department where there are children with broken arms and other condition. Don't start spreading and creating that potential for further spread.

CROWLEY: And there is that occasion where Dr. Adalja, whether or not we could have a national message saying to people, if you think that you have this, stay where you are and call this number. What do you think about that? That would certainly take away some of those, like the ambulance trip, and the danger to the emergency room personnel, et cetera.

ADALJA: With the small number of people who have traveled to the three Ebola stricken areas in West Africa and when they are back here within the 21 days, if they get symptoms, they should call at least if they are calling 911 now, they should be telling people that they were there.

So that that EMTs and paramedics can take appropriate precautions, and hospitals can expect them, but like Dr. Schaffner said, every hospital really has to be on alert to do this and they should be running protocols now making sure the protocols are adequate for this.

They should be training. They should be educating the staff, because this could happen anywhere where you have an imported case, and the travel screening is not going to catch everybody.

CROWLEY: Dr. Adalja, Dr. Schaffner and Dr. Macgregor-Skinner, thank you all for joining this hour. And thank you for watching STATE OF THE UNION.

CNN will continue to follow this Ebola story throughout the day. I'm Candy Crowley in Washington. "FAREED ZAKARIA GPS" is next.

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