Return to Transcripts main page

SANJAY GUPTA MD

Ebola's Twisting Path to the U.S.

Aired October 4, 2014 - 16:30   ET

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


DR. SANJAY GUPTA, CNN HOST: Welcome back to SGMD.

It has been a historic week with the first case of Ebola ever diagnosed now here in the United States. Some of what we've seen this past week is frightening. But also, it's important to point out this isn't some mysterious, unknown enemy. We have science. We have facts.

I'm going to do what I can over the next half hour to make sure the situation is clear -- what is real, what is not.

So, let's briefly recap. The outbreak of Ebola disease in West Africa is expanding. There are now more than 6,000 cases there. In some places, the conditions are so desperate and that's where this latest chapter began.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): In this hospital, Thomas Eric Duncan, the first patient diagnosed with Ebola in the United States, is fighting for his life.

JOSEPHUS WEEKS, DUNCAN'S NEPHEW: We are just hoping and praying that Eric survives the night and we just got our hopes up for him.

GUPTA: Doctors say he's now in serious but stable condition. Duncan is a Liberian national and he traveled for the first time ever to the United States to visit his family in Dallas. He may have become infected on September 14th. That's when he helped carry a pregnant woman who later died from Ebola to the hospital.

UNIDENTIFIED MALE: We had a scenario in our community in this very yard. We find ourselves a pregnant girl by the name of Marthalene passed. Eric Duncan, who used to live in the room there, was one of the caretakers of Marthalene.

GUPTA: September 19th, Duncan flies from Liberia to Brussels, Belgium, showing no obvious Ebola symptoms or fever during airport screenings. From there, he boards United Airlines Flight 951, en route to Washington Dulles, connecting to another Flight 822 to Dallas.

September 20th, he arrives in Dallas and heads to this apartment complex to visit family. Four days later, he starts developing symptoms. He walks into this Dallas emergency room on the 25th of September,

vomiting and with the fever. He tells the nurse he had traveled from Africa but is sent home with antibiotics and does not undergo an Ebola screening.

September 28th, his condition worsens. He returns to the hospital by ambulance and is placed in isolation. The next day a family friend calls the CDC complaining that the hospital isn't moving quickly enough with his test results.

By Tuesday the 30th, the lab results confirm the patient has Ebola. The hospital admits it was a failure to communicate among hospital staff that led to the patient's release after his initial visit.

DR. MARK LESTER, EXECUTIVE VICE PRESIDENT, TEXAS HEALTH RESOURCES: He volunteered that he had traveled from Africa in response to the nurse operating the checklist in asking that question. Regretfully, that information was not fully communicated throughout the full team.

GUPTA: Investigators are now monitoring up to 20 people who are his contacts for symptoms from paramedics who transported him, to doctors and nurses in the hospital to his family, girlfriend, and five school age children. But so far, none has been confirmed to be infected.

(END VIDEOTAPE)

GUPTA: Now, watching how things have been handled in Texas has understandably caused many concerns, mistake at the hospital, a family in isolation.

Well, over the past week, I had a chance to talk with the head of the Centers for Disease Control and Prevention a few times and I raised some of these issues.

(BEGIN VIDEOTAPE)

GUPTA: Dr. Frieden, I'm curious about -- I know you've had a very busy week. Who is in charge? And if you're in charge -- I mean, can you mandate things to happen?

We know what's going on in Dallas. Could you say, look, here's what you absolutely need to do in Dallas, this is required, I'm enforcing this to happen?

And if you can't do that, why can't you do that? Somebody needs to have some leadership, it seems, over the whole situation.

DR. THOMAS FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: Absolutely. And we work very closely with state and local governments. And when there's an episode in a state or local government, they are in charge and we support them in every way. They assign an incident manager; they establish an emergency operations system; they outline every aspect and we work very closely with them. There's a great collaboration.

I think the issue that we've been challenged by is what do you do with the waste?

GUPTA: Is it necessary to have somebody who is absolutely in charge -- sort of a czar, if you will, over this? Who doesn't just provide guidance or recommendations, but provides mandates?

FRIEDEN: In every place, where Ebola is spreading, our number one recommendation is to establish what we call an incident management system, where one person is in charge and you break down the tasks into smaller tasks to make sure that everything gets done and followed up.

And that's been done in Texas. They've done exactly what we've recommended. They have an incident manager in place. We're supporting that person. The state of Texas is supporting that person and I'm confident we'll break the chain of transmission there.

(END VIDEOTAPE)

GUPTA: And we're going to have much more on Ebola coming up.

Look, I know you've got a lot of questions. I understand that. Questions about how this spreads? What's really a risk? We're going to answer some of those, coming up.

(COMMERCIAL BREAK)

GUPTA: A lot of people asking how this latest Ebola patient got to the United States without being flagged. What we've learned is that Thomas Eric Duncan, a 42-year-old man from Liberia was screened for fever at the airport when he left. In fact, he was screened three times. And he wasn't ill until several days after getting here.

But Liberia has said, look, it wants to prosecute Duncan because they say he lied during the screening when he was asked questions at the airport. They say he didn't reveal that he, in fact, had been exposed to an Ebola patient a woman that he helped a few days prior.

Now, I want to put this whole issue to one of the best minds working on this problem, the whole problem of beating this Ebola outbreak -- Dr. Anthony Fauci. He's director of the National Institute of Allergy and Infectious Diseases. He's the guy we turn to often.

Thanks for joining us, Dr. Fauci.

You know, you heard this as well.

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES: Good to be here.

GUPTA: It sounds like Liberia is going to prosecute Mr. Duncan for not revealing had contact with this woman who later died. What about the United States? What's our role in handling someone like Mr. Duncan?

FAUCI: Well, handling him is what actually happened. There were obviously some missteps, but first when you identify someone who is here and we had said several times that inevitably we were going to have someone who got on a plane without symptoms which would get them through the screening process that this individual got through when he left from Liberia and then once here our role is our capability is to be able to identify and isolate the person as quickly as you possibly can, give them appropriate treatment, and importantly, begin the very meticulous process of contact tracing, which is the fundamental mechanism whereby you prevent an outbreak.

So, from the standpoint of what we would do is exactly what we did. Obviously without some of the rough points that occurred during that process.

GUPTA: Yes. I mean, I guess in some ways maybe I'm asking more of a legal question. I'm just curious because the scenario could be that people will know that they've been exposed, they're not sick yet, but get on planes and come to the United States for treatment. You can understand that, Dr. Fauci, because treatment is so hard to get over there and getting any kind of care. This may happen more and more.

Is this something the United States has given thought to or your department has given thought to in terms of do we take all those patients? Is there going to be anything else done?

FAUCI: Well, of course, obviously, you always continually re- evaluating the situation. The only difficulty is there is that window.

Now, clearly if someone is exposed and has symptoms and wants to come to the United States for treatment, they are not going to be able to get on a plane. They will be stopped at the airport at the West African countries on that end of the process.

The window that's the vulnerable window is someone who exposed and then winds up with no symptoms for a period of time that could be as many as 21 days and then does get on the plane being asymptomatic. There's really not much that you can do except rely on that screening of symptoms and fever. And every once in a while it is conceivable, as has happened by the reality of the Duncan case, that someone will slip through during the asymptomatic period.

GUPTA: I want to talk a little bit about what I think seems to be the biggest concern for a lot of people and this idea of who are contacts. In Dallas, for example, everyone who's deemed a contact we know that a health official is coming in twice a day taking their temperature, checking for fever.

So, a few questions around that. First of all, can you be contagious without having a fever?

FAUCI: If you look at the kinetics of studies -- and this is a very important question, the answer to that is, no. You never say 100 percent but it's essentially 100 percent. And the reason is you don't get the ability to isolate virus until the person develops symptoms.

So, you have a period of time of a window where the person clearly is infected. There's no doubt about that. But the virus starts to become isolatable at the time that the person develops symptoms, because of that you can make a reasonable conclusion that that person will not be able to transmit it. Again, in biology nothing is 100 percent, but that's quite a reasonable conclusion to make.

GUPTA: And fever is oftentimes the first symptoms, is that -- I mean, that's what they're using to screen at airports, if you see a fever, is that going to be the first symptom, or might they have other things first?

FAUCI: Again, not 100 percent, but, again, if you look at a group of patients, almost invariably, fever is the thing that signals the onset. Now, you may get a bit of achiness before you actually spike the fever. But they're very closely juxtaposed.

So, if a person has a fever, that really is the signal that that person is infected, if, in fact, they do have Ebola. That's what you usually see. And as with all fevers, fevers are generally associated with chills and aches and a feeling of malaise due to the cytokine release of the inflammatory proteins that get released when you get a fever.

GUPTA: We place a lot of faith and on this idea of screening, and especially using fever. But we also know that we can mask a fever using medications -- Tylenol, aspirin, things like that. So, if someone wanted to basically disguise their fever, couldn't they just take some medication and get through airport screening?

FAUCI: Certainly that's a possibility. And the point that you're making from a number of different angles is that nothing is 100 percent. You have to look at probabilities.

And the likelihood of someone getting a fever, hiding their fever -- of course, those are all possibilities. Those are hypotheticals. Unlikely that that would happen. If someone has a spike in a fever, you'll probably still see a degree of temperature elevation.

GUPTA: OK. I mean, and I'm pointing out some of -- how the screening works, but obviously there are limitations to it. And let me just give a quick reminder, again, to your point to people of what these symptoms on early on generally includes a fever, sometimes headache also, muscle aches, weak also in, just feeling lousy.

As it progresses you see vomiting, diarrhea, oftentimes you see a rash. There can be a characteristic rash. There can be internal and even external bleeding in some cases. Also, red eyes, that can sometimes be a sign of the bleeding as well.

But in any case, we've been told very definitively that a person cannot infect others before they are actually sick and I think that's a fundamentally important point. All the people who came across Mr. Duncan before he fell ill, they have nothing to worry about.

Is that right? And I just want to be 100 percent clear on this that people on the planes and the airports where he traveled, all of that, they -- Dr. Frieden said zero percent chance of being infected. FAUCI: By all evidence that we have when a person is not symptomatic,

they don't transmit. That's the reason why when people do contact tracing, they focus on the contacts that have occurred from the time that the person was asymptomatic. And as you know, if you look at the course of Mr. Duncan, not only was he not with symptoms during the flight but even several days after he landed and went from Dulles to Dallas, because he wasn't symptomatic until the 24th, which is four days after he had landed.

GUPTA: Always a pleasure, sir. An honor to have you on our program. Thank you.

FAUCI: Thank you. Good to be with you.

GUPTA: And coming up, we're going to have some more on the family that is being forced to stay inside their home. Public health officials have some powers in all this that may surprise you.

(COMMERCIAL BREAK)

GUPTA: Ebola patient Thomas Eric Duncan has been in isolation in the hospital since Sunday.

Meanwhile, his family is under a quarantine order -- his son's mother, Louise, his own child and his two nephews all in one apartment. They've been told some specific things. They can't even go down the stairs, for example.

My colleague Anderson Cooper spoke exclusively with Louise earlier this week.

(BEGIN VIDEO CLIP)

ANDERSON COOPER: So what did they tell you that you needed to do?

LOUISE, CLOSE FRIEND OF EBOLA PATIENT: To stay home. I have to stay home and monitor my temp, taking my the temperature, they're going to be monitoring all of us. My son should stay home, my nephew, every one of us should stay home for 21 days. And we should not have to come outside. If we have to come outside, right on the porch, but not get down the stairs.

COOPER: What did you think when you heard that?

LOUISE: Scary. I was -- I'm scary.

COOPER: And have you gone outside at all?

LOUISE: No, I'm inside, and they did not bring food here. They came late here last night with paperwork for us to sign that if we step outside, then they're going to take us -- they're going to take us to court, that we'll have committed a crime. But up to this time, they have not brought us any food, any food.

(END VIDEO CLIP) GUPTA: That was Thursday morning and since then, she has been delivered some food. But for most people this is totally unfamiliar territory -- but not for Dr. Howard Markel.

He joins me now. He's a professor of pediatrics and communicable diseases at the University of Michigan, a medical historian and author of the book "Quarantine."

Thanks for being back on the program, Doc.

DR. HOWARD MARKEL, AUTHOR, "QUARANTINE": Thank you, Sanjay.

GUPTA: When they hear this scenario that I just described, I think it's pretty shocking for a lot of people, but health officials pretty much anywhere in the United States do have this power, right? What's -- what is the limit of the power?

MARKEL: Well, the powers are actually quite strong. More than 100 years ago the commissioner of health, New York City, was testifying before Congress and they asked, what are the limits of your powers? And he said, well, Senator, I could make city hall a quarantine hospital tomorrow if I wanted to.

So, if indeed the health authorities feel that you're a threat, that you're not cooperating and that you might infect others particularly for a very serious disease like Ebola, their powers are extremely strong.

GUPTA: As I understand this, part of this is from reading your books frankly, the practice of quarantine, I mean, even the word itself goes back to 14th century Venice. It wasn't Ebola obviously they were trying to stop at that time, but it was the black plague, is that right?

MARKEL: Yes. It was bubonic plague and Venice was one of the major ports of the world at that time and plague was traveling just as Ebola is today. And they ordered a quarantinario, or quarantina giorni, which means 40 days, that's where the word quarantine comes from.

But ever since the 1375 edict of quarantine, we've been fine-tuning and changing the meaning of the word.

GUPTA: Did it work? I mean, would you say quarantines work? Is there a way to give a context? How well do they work?

MARKEL: Well, this is an eternal question in public health. You know, when it was done back then and even until maybe 100 years ago, it was often relied upon as a -- as a means of last resort because we didn't have antibiotics or antivirals or vaccines.

Today, it's very rarely done but only for diseases that are very easily transmitted such as influenza, if it were a deadly form of influenza because that could be transmitted while you're in close contact with someone if they cough or sneeze on you, at you. And the other one is for a disease that is so novel and so deadly that we don't want to take chances and so I think Ebola is falling in that latter category.

But people have been arguing whether it works or not ever since quarantine was first proposed in the 14th century.

GUPTA: You know, I think a lot of people when they hear quarantine they hear these stories, they think about Typhoid Mary, that's a story a lot of people are familiar with. She was a carrier of the disease typhoid and that means she wasn't sick herself but she could give it to others and unfortunately she was a cook. So, she made a lot of people sick. The city locked her up.

For how long was she locked up?

MARKEL: Oh, for -- well, she was locked up twice, once they let her out about four or five years and she went back to cooking. And the carriers of typhoid carry it in their gallbladder and it does shed on their hands when they cook and she got other people sick and she spent a decade or so on North Brother Island, which is on the east river in New York City. I've been there, even though you are right near a city, it's about as desolate and lonely a place as you can imagine.

GUPTA: Dr. Howard Markel, it's always good to see you. I see Ann Arbor, Michigan, behind you according to "Forbes" magazine, the most educated city in America. I love that we have that in common, sir. Thanks for joining us.

MARKEL: Glad to be here, Sanjay.

GUPTA: And when we come back, you've got questions about Ebola. So, I put together some answers. Stay with us.

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

GUPTA: They can be quite similar and that can be confusing and keep in mind people come back with fevers and cough. It could be all sorts of different things.

Here's the big critical difference with Ebola. A travel history and a history of any particular risks is absolutely crucial.

#EBOLAQANDA QUESTION: He got here on an airplane full of people. Who knows how many people may have been exposed?

GUPTA: When he got on the plane, he wasn't sick, when he got off of the plane, he wasn't sick. Very important because one thing that we keep hearing over and over again I think is an important point is that you don't spread this virus until you are sick yourself. So, the fact that he was in what is known as the incubation period, carrying the virus clearly in his body but not spreading it.

#EBOLAQANDA QUESTION: What exactly are the airports doing to screen people coming in internationally?

GUPTA: If someone were to land in the United States and have developed symptoms, they got on the plane totally healthy, got off the plane and now sick, then that would prompt a medical evaluation once he got here to the United States. So, the real key to this is trying to detect or screen before people get on planes from countries where Ebola's known to be such as these three countries in West Africa.

#EBOLAQANDA QUESTION: Why isn't Ebola containment working?

GUPTA: Part of the problem is that, you know, if someone gets sick during the time they are sick but not yet in the hospital, they can come in contact with lots of people. They need to go back and trace those people. It's called contact-tracing. If you miss the contacts and one of those people gets sick, then you can start to have a whole another group of people who can potentially become infected.

#EBOLAQANDA QUESTION: Can Ebola be transmitted by sneezing? Does it live on surfaces for very long?

GUPTA: Ebola can live outside the body on surfaces. I think that's part of this question. It can do that if it's exposed to sunlight obviously, if the handrails are cleaned or something like that, that would deactivate the virus. But let's say those things don't happen, the virus can live there even for several days.

While Ebola can live in all sorts of different bodily fluids, it's less likely to be transmitted through coughs or sneezes -- much more likely to be transmitted through blood.

(END VIDEOTAPE)

GUPTA: So, I hope that it helps answer some of your questions. That's going to wrap things up today, though, for SGMD.

Time now, though, to get you back into the CNN NEWSROOM with Poppy Harlow.