Second Dallas Health Care Worker Diagnosed with Ebola; Protocols Crucial in Stopping Spread of Ebola
ANNOUNCER: This is CNN breaking news.</s>CHRIS CUOMO, CNN ANCHOR: Alright, good morning and welcome to NEW DAY to our viewers in the U.S. and around the world. I'm joined by Alisyn Camerota, and we do have breaking news about Ebola in the U.S. A second health care worker in Texas now infected with the virus. Health officials say the worker reported a high fever last night, and was immediately isolated. This beleaguered hospital now has two cases on their hands.</s>ALISYN CAMEROTA, CNN ANCHOR: Yes, confirmation is expected today from the Centers for Disease Control. This comes as nurses there allege a shocking lack of protocol in treating the virus within their own hospital. We have a lot of breaking developments in the Ebola front this morning for you. Our coverage begins with senior medical correspondent Elizabeth Cohen who is live for us from Dallas. Elizabeth, tell us all of the details that you've learned this morning.</s>ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Alisyn, as you've said, what we've learned is that now a second health care worker here at Texas Health Presbyterian has been diagnosed with Ebola. CDC director, Tom Frieden, basically tried to prepare the country for this earlier this week when he said if there was one, there may be more, because this breach in protocol wasn't Nina Pham's fault. It was a problem with the protocol, it appears, that was used at this hospital. Now, a nurse's union says that they've been getting complaints from nurses at this hospital. Some of the allegations are pretty shocking. Let's take a listen to what this union had to say.</s>DEBORAH BURGER, CO-PRESIDENT OF NATION NURSES UNITED (via telephone): Our nurses are not protected, they're not prepared to handle Ebola. On his return visit to the hospital, Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present. The nurses raised questions and concerns about the fact that the skin on their neck was exposed. They were told to use medical tape wound around their neck that is not impermeable.</s>COHEN: Now to be -- to be clear here, the union did not release the names of the nurses, did not say how many nurses made these calls, but certainly concerning to hear this, coupled with the fact that now two workers have become infected with Ebola - Chris, Alisyn.</s>CAMEROTA: It is so troubling. So now that hospital behind you is treating two -- has had two outbreaks or I should say two exposures. So are they equipped? Do they feel equipped to deal with this second case now?</s>COHEN: You know, in the beginning, before this happened, over the summer, the CDC was saying look, any hospital can handle an Ebola patient, we've sent out emails and guidelines and given webinars. I was speaking with an official or leader this morning who said, you know what? In retrospect, we should have transferred Thomas Eric Duncan to either Emory or to Nebraska. Those are two hospitals that are especially trained to deal with these kinds of biohazards. I think the feeling among many experts I've talked to is that there was too much confidence in every hospital in America. That every hospital would be able to handle an Ebola patient when clearly we've seen that at one hospital when they took care of an Ebola patient, they got two more people sick.</s>CAMEROTA: Great point. Elizabeth, thank you. We'll talk to you throughout the show.</s>CUOMO: Well, look, here's the problem, you don't get to choose where you have Ebola cases so you do need to be prepared. Let's get some perspective on what this means for this one hospital and what it means for the threat going forward in general. We have with us Dr. Joseph McCormick. Now few know more about Ebola than he does. He helped investigate the first Ebola epidemic in Central Africa. He worked on the CDC on that and is now a professor and regional dean at the University of Texas School of Public Health. Thank you very much, Doctor, for being with us here this morning. The first big point is when you hear that a second nurse who was treating we believe obviously the man who died, Mr. Duncan, are you shocked to hear this?</s>DR. JOSEPH MCCORMICK, PROFESSOR AND REGIONAL DEAN, UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH: Not shocked at all particularly after we had the first one. I think the first one was a bit more of a surprise than the second because I think that started to make us examine the actual protocols that were being used more thoroughly. When I see what the procedures, even that Dr. Gupta showed us. I'm saying to myself, whoa, this is not to me, the kind of protocol that should be used. The probably the biggest danger is, when you are taking off your gear. When -- after you've seen the patient you may be contaminated. That's the biggest issue. From what I saw, there needs to be some, some changes in that protocol. But there was no protocol. We heard from the very beginning that when -- when Duncan was seen, all the way through the handling of specimens.</s>CUOMO: So do you think this is about what's going on in this specific hospital or is this is a little bit of a window into the reality of how difficult it is to deal with Ebola?</s>MCCORMICK: You can deal with Ebola in a hospital like the Presbyterian Hospital, but you have to have the protocols. Whether you're in the hospital in the middle of Sierra Leone or a hospital in Dallas, you have to have the protocols in place. You have to get buy-in by all of the team. You have to have a trained team, it's not that difficult, but it has to be done. And if you're saying, well, we're so good technically that we're not worried about it. That's the kind of complacency that I think Elizabeth Cohen is talking about.</s>CAMEROTA: We want to bring in Dr. Alexander Van Tulleken. Thanks so much for joining us. So we know -- we learned yesterday that the patient, Mr. Duncan, who died, had been -- 70 health care workers had come into contact with him. Two of them are now sick. Talk about the exponential quality of this, to all the people that they've come into contact with for the past 48 hours or week now have to be checked?</s>DR. ALEXANDER VAN TULLEKEN, CNN MEDICAL ANALYST: I think we have to approach this as if that's a possibility. Personally, I think it's extremely unlikely. But what we've seen is a lot of talk about precautionary principles and taking as much care as we can. It hasn't worked. So I would look at the rest of these 70 people and their contacts, as being a much higher risk than we previously we would have done. What I think the hindsight would have been sensible. We do have a sensitive blood test to look for the virus in the blood. Why we weren't getting serial blood measurements on this. If nothing else, just to improve our knowledge.</s>CUOMO: You told about this yesterday, I was completely shocked. Because we've been telling everybody and it is true, you have a 21-day window here, that's very confounding to when you're exposed to when you can give it to somebody else. But during that 21 days just to follow up, Dr. McCormick, you can test on day one of the 21-day period and know whether or not I have the virus, true?</s>MCCORMICK: Not necessarily on day one.</s>CUOMO: Which day?</s>MCCORMICK: Well, it depends on how much virus you got in the first place. This gets into the weeds of the science, but if you get a big dose like Mr. Duncan probably did, then you're going to see the virus within three or four days.</s>CUOMO: So it's not foolproof. You can't test all 70 of these people right now that Alisyn points out and know who do we have to worry about and who don't?</s>MCCORMICK: Well, there are other tests that can be used and again this gets a little bit in the science. But one of the things we know is that the first thing that goes with severe disease, particularly severe disease is a group of white calls called the lymphocytes go right out the bottom. That happens pretty early.</s>CAMEROTA: So aren't they testing them, Dr. Van Tulleken?</s>TULLEKEN: As far as we can see, Nina Pham was under passive surveillance meaning --</s>CUOMO: Why?</s>TULLEKEN: The why is exactly right, we've started to believe our own dogma about Ebola and how difficult it is to catch. We've heard a mantra from the CDC saying this is a difficult disease to catch. In many ways it is. It's a nuanced message to communicate that, but I would have treated this, I think these people now have to be treated as if they are lucky to have it.</s>MCCORMICK: One of the things that's very instructive. I go back to the fact this is not that easily transmitted. Look at the family members. Look at the contacts. They were under circumstances that nobody else was. That's typically what we see in the epidemics. The transmission rate is about 10 percent.</s>CAMEROTA: Great point. They don't appear to have any symptoms yet. They haven't spiked a fever yet. So what's happening in the hospital? Is it just that there are more bodily fluids being exchanged?</s>MCCORMICK: We don't know what happened in the family, but clearly there's more contact with body fluids, but my point is, that the protocols themselves. They clearly didn't get those right and that's what's happening in the hospital.</s>CUOMO: We have Sanjay Gupta on the phone right now I believe. Doc, can you hear us?</s>DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT (via telephone): I got you, Chris. Good morning.</s>CUOMO: And thank you for being with us, Doc, ahead of schedule here, but let me ask you something. Because you did this great demonstration that I'm sure the doctors here saw and all of us did, of how difficult it can be to take off the equipment. And this idea of we need a right protocol in place to make this safe, is that making a little too simple in terms of how difficult this actually is to do with 100 percent certainty?</s>GUPTA: Well, with 100 percent certainty obviously adds a very high bar, but I think it could be a lot better than it is now. And that you know, there have been examples you know throughout the history, I mean, people have been taking care of patients with Ebola since 1976. Where you know, you have really low, if any transmission from patients to health care workers. I give the example of "Doctors Without Borders," up until this year, we know there have been transmissions this year. But up until this year, there really had not been transmissions between patients to health care providers. It can be done in part it involves proper protocols. I do want to point out that when I did that demonstration to show that, the way I did that was to follow the CDC protocols exactly as they were outlined and handed out to hospitals all over the country. I wanted to show that exact protocol.</s>CAMEROTA: That's a great point.</s>GUPTA: We do know in Emory and Nebraska for example and Alisyn, I think you were speaking to the nurse from Nebraska yesterday they use a protocol that's above and beyond that. And those are the places that are designated centers, you know, that are known to be able to do this. They have a different protocol than the CDC. I think that tells us something.</s>CUOMO: Yes. Dr. McCormick, when you watched Sanjay's demonstration there. What's the problem?</s>MCCORMICK: The first problem for me is you've got contaminated hands. What we did in Sierra Leone and surely many other people, and I suspect I know "Doctors Without Borders" does. You wash your hands the very first thing, before you take anything off.</s>CAMEROTA: You take off your gloves and then --</s>MCCORMICK: No, no, no, you wash your gloves, you put them in bleach. That kills the virus on contact. Then you take off your gown, and all the other paraphernalia because then you've got cleaner gloves. You've got gloves that are clean.</s>CAMEROTA: Why isn't the CDC recommending that?</s>MCCORMICK: Then you wash them again. That, I couldn't tell you. That's what we've done for a long time.</s>GUPTA: To that point, Dr. McCormick, we did that exact thing what you're describing. There would be buckets essentially of this bleach- like substance, you would come out. You would just soak your hands in there and then you would start disrobing. You have somebody helping you to disrobe, a sort of buddy. If there was contamination on the front of the gown, they were literally, they had these spray bottles and they would spray the gown before we started taking it off.</s>CUOMO: It's not that sophisticated. We were doing similar things, Sanjay, with Katrina because we didn't know what was in the water. It's not that you have to create new science to figure out how to stay safe. We have the second case. This is scary, OK, but again for perspective, Dr. McCormick. People are tuning in this morning, another case. This is it now, pandemic. This is the panic. It's going to happen. Everyone's going to get it. Does this mean anything like that to you?</s>MCCORMICK: Nothing at all. We're not going to get it. I said this last night. We're not going to have an epidemic or a pandemic in the United States.</s>CAMEROTA: How can you be so sure?</s>MCCORMICK: Because we know how to control this. If we have to send everybody to Nebraska or Atlanta, then that's what we'll do. And we know how to screen for it and we know how to control this. And we don't have anything like the level that we're seeing for example in West Africa.</s>CAMEROTA: Dr. Van Tulleken, we are told that Nebraska only has ten beds. We can't necessarily send everybody much as we might want to. Should this new patient who has been diagnosed this morning be going to Nebraska for treatment?</s>TULLEKEN: I think they certainly need a really detailed evaluation of who's looking after him in this place. It doesn't need to be in a different building. But the quality of the team needs to be very different. And when we talk about why these protocols don't work, why are they different from the World Health Organization protocols? The CDC logic is the WHO protocol is too hard to follow. There are too many steps. We don't want people making mistakes.</s>CAMEROTA: You mean the bleaching of the hands with your gloves on.</s>TULLEKEN: What that speaks to me is a sort of laziness about whether or not we prepare -- how well prepared to train the people. It's not hard for "Doctors Without Borders" train people all the time. So it seems -- and I think Professor McCormick is exactly right. We shouldn't be worried about an Ebola epidemic here. But we should definitely be worried about the effect on American life. And so as people stop going to hospitals, as nurses stop going to hospitals, that changes things for everything. So we're not going to get Ebola, but we are going to get serious effects in this country.</s>CAMEROTA: So you're worried that doctors and nurses will start refusing to treat people because they're worried.</s>TULLEKEN: We've seen it in other epidemics. We see big, big concerns for this and we've heard the nurses union over the last couple of days saying we don't feel protected. That should be terrifying for all of us.</s>CUOMO: What we are talking about right now that the nurses are complaining. You have to give them special attention because they really are the first line responders on this. Let's play some more of the sound of what their concerns are. Here it is.</s>BURGER: Lab specimens from Mr. Duncan were sent through the hospital tube system without being specifically sealed and hand-delivered. The result is that the entire tube system, which all the lab specimens are sent, was potentially contaminated. There was no advanced preparedness on what to do with the patient. There was no protocol. There was no system. The nurses were asked to call the Infectious Disease Department. The infectious Disease Department did not have clear policies to provide either.</s>CUOMO: All right, so that was the co-president of the National Nurses United Union, speaking on behalf of the Dallas nurses. Sanjay, hindsight is always 20/20 and you have this anonymous health official, which is bootstrapping what the nurses union just said. Which is if we know now what we knew then, we should have sent Duncan to Nebraska or Emory, somewhere that knows what they're doing. Can you make that type of judgment at this point that we'll only have certain places that know how to do this right or does everywhere have to know how to get it right?</s>GUPTA: Well, you know, with regard to these claims, you know, if this is true, this is pretty concerning. And it's not so much even a hindsight issue, Chris, because you remember for months, they've been talking about preparation. They've been talking about the fact at the CDC level that we anticipate a patient will come to the United States with Ebola. So and they've been, they said that they've been going for laying out protocols for hospitals, primary care doctors, emergency rooms to follow. You hate to believe that that's the case, that you have to only have a few designated centers. I understand the momentum for that. The problem from a pragmatic standpoint is a patient shows up wherever in the United States. They're not going to show up necessarily in one of these cities, in Atlanta or Nebraska. And what is -- what happens at that point? Patient goes to the hospital. They go check in at the emergency room desk. They come in contact with people. They come in contact with health care providers. They may or may not get put into isolation. They're going to have blood drawn. Then they're going to be transported. The idea is to transport them to one of these places, they go by ambulance, by plane, arrive at another hospital. Think about how many more people now start to get potentially affected by this patient who is sick, apparently, that's why they're going to the hospital and could potentially be infectious. It just seems that yes, I understand the momentum for these designated centers, but the idea that we've waved the white flag and say you know what, we can't do what the "Doctors Without Borders" were able to do in these tent hospitals in the middle of remote Africa. We can't do that at big hospitals in the United States is baffling to me. It's disappointing to me, but maybe that's where we ought to be. I still think the idea of a "Doctors Without Borders" team or somebody like them going to these hospitals may be the better way to do it.But maybe that's just, we're just not there yet.</s>CAMEROTA: Is that the answer, Dr. Van Tulleken? Let me repeat some of the other things the nurses unions have said. So, no advanced preparedness, you heard her say that. Their necks were exposed. They now think that skin contacts might have had some sort of vulnerability.</s>VAN TULLEKEN: Yes, Sanjay's point that a single medical charity is has shouldered the burden of dealing with this entire epidemic, basically and that should be absolutely terrifying. They're doing a better job, we're not talking about some tiny little rural hospital in America. We're talking about a big significant hospital in a major American city. And what we're seeing here is a massive failure on a much larger scale, which is if we had reacted to this in Africa where we needed to several months ago, then we wouldn't be dealing with what we're dealing with now.</s>MCCORMICK: I would like to add something more. We've had the vaccines that are currently now that everybody is running around for 10 years.</s>CUOMO: Ten years.</s>MCCORMICK: They've been out there for 10 years.</s>CAMEROTA: Vaccines against Ebola have been out there for 10 years.</s>MCCORMICK: Experimental vaccines that worked in nonhuman primates. But they never went any further than that, because our system says, if you can't pay, you don't play. That means if you're poor, we're not going do spend the money as a pharmaceutical company or whatever, to develop vaccines. So, now, we're going to pay probably billions of dollars to try to deal with this. Absolute catastrophe in West Africa, when probably $25 million or $50 million would have developed them through at least phase 1 and phase 2.</s>CUOMO: Does that go through treatments as well with your understanding?</s>MCCORMICK: Absolutely, absolutely.</s>CAMEROTA: How close are we to a vaccine?</s>MCCORMICK: Well, we have one vaccine, both vaccines one developed at NIH, one developed at the military, protect nonhuman primates.</s>CAMEROTA: But how close are we to making it --</s>MCCORMICK: But now, what they have to put them through phase 1 and phase 2. They're doing that now. I think you heard Dr. Fauci talk about that.</s>CUOMO: What do you need more, a vaccine or a treatment?</s>MCCORMICK: Yes.</s>CUOMO: You need them both?</s>MCCORMICK: Well, you do, because what you would do is use the old smallpox protocol and vaccinate all the contacts right away. That would get them on the road to an immune response that would certainly blunt their infection, if not stop it. So that's the one thing you would do. And then obviously you need the treatment so that you don't have the death rate that we have.</s>CAMEROTA: Gentlemen, thank you. Thanks so much for being here. We will be talking to you throughout the show. There is other news, though. So, let's get to Michaela and the rest of the headlines.</s>MICHAELA PEREIRA, CNN ANCHOR: And rest assured, we will follow up with our top story as soon as I get you through the headlines right now. But I want to let you know what else is going on. The Supreme Court paving the way for dozens of abortion clinics in Texas to reopen immediately. The justices ordered the state not to enforce a law requiring clinics to have hospitals level standards. Opponents of the law say the guidelines were restrictive to women's health. More appeals are suspected, and the case could end up before the justices. Breaking overnight: military leaders from North and South Korea healed held their highest level talks in seven years. This meeting comes amid renewed tensions and shooting incidents off the waters off the western coast of the Koreas. The spokesman for the South Korean defense ministry suggested the meeting was a goodwill gesture on both sides. No future meetings are set up at this point. At least 17 American soldiers were exposed to nerve or mustard gas after the invasion of Iraq. Now, that is according to "The New York Times", which also says the U.S. government withheld that information from troops and military doctors. The report suggests the government secrecy prevented soldiers from receiving proper medical care and official recognition of their illnesses. To sports, the Kansas City Royals now just one win from the World Series, beating the orioles to take a 3-0 lead in the American League championship series. Royals still haven't lost in the postseason, 7-0 now. They can secure their ticket to the series with a win today in game four. Meanwhile, the NLCS, the Giants beat the Cards to go up two games to one in their series, game four tonight in that beautiful city by the bay, San Francisco.</s>CUOMO: That is nice for --</s>PERIERA: You know who I'm cheering for.</s>CUOMO: That's OK. But it's shaping up to be a good series, great teams this year.</s>PEREIRA: Yes, really good.</s>CAMEROTA: All right. Thanks, Michaela. So, we're continuing to follow the breaking news that we have for you this morning. A second health care worker is infected with Ebola in Dallas. In the hospital staff, he was on the hospital staff and we're wondering, are they spreading Ebola by somehow handling the gear wrong? Or going through protocol incorrectly? We're going to talk to someone who is helping to implement new training, that's ahead.