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Dallas Health Care Worker Tests Positive for Ebola; Interview with John McCain; Interview with Bernard Sanders

Aired October 12, 2014 - 09:00   ET


ANNOUNCER: This is CNN breaking news.

CANDY CROWLEY, CNN ANCHOR: And our news is out of Dallas, where one of the health care workers who had contact with Ebola patient Thomas Eric Duncan has tested positive for the virus. Duncan died last week.

The worker, who is not being identified, is listed in stable condition in a Dallas hospital's isolation unit. Dallas officials held a news conference moments ago.


JUDGE CLAY JENKINS, DALLAS COUNTY: There is nothing about this case that changes that basic premise of science, and so it's important that while this is obviously bad news, it is not news that should bring about panic.


CROWLEY: Dr. William Schaffner is chairman of the Department of Preventive Medicine at Vanderbilt University.

You are as well an expert in infectious diseases. And we have talked before, Doctor, and we had a little chance to talk right before we began. And I have to say, listening to that news conference, as a nondoctor, nonexpert, I didn't find it all that comforting. There were several things that stuck out to me.

And one of them was that this worker that apparently has come down with Ebola -- we're waiting for the CDC to confirm that -- but the worker was in what they said, you know, full CDC-recommended garb when she treated the patient the second time he was in the hospital. That's when they discovered Ebola.

She -- he or she had on a gown, a glove, a mask and a shield, and came down with Ebola. That's not totally comforting to me.


The good news is that this was already a worker who was being monitored, who, as soon as they themselves discovered that they had an elevated temperature, self-reported and went right into the emergency room for care.

Now, we don't know exactly what this worker was doing with Mr. Duncan, but, yes, indeed, they had all their protective gear on. Now, let's all recognize that the most hazardous time for the worker is when they're taking the gear off. They have to do that in a careful sequence, in a very deliberate fashion, so that in that process, they don't contaminate themselves.

CROWLEY: Sure, but...

SCHAFFNER: So further investigation will elucidate some of this and where the contamination may have occurred.

CROWLEY: Sure. I mean, you just would, because we have been told and assured by the CDC that they have been dealing with state hospitals and local hospitals for months prior to this, so you would think that health care workers would have some notion of how to take it off.

But, as you say, we don't know how this virus was picked up. I think the other thing, because you mentioned self-monitoring, the other thing that caught my attention was this person was self- monitoring, which to me means they were taking their temperature every two days, but they were not necessarily reporting to the CDC or to someone in Dallas, and that now they have brought in CDC people and the people in that self-monitoring pool, those 48 people, will now answer questionnaires from epidemiologists and will be monitored by them.

So that tells me that they have an increased concern, unless I misunderstand what self-monitoring means.

SCHAFFNER: Well, this was a pool of people who were on a protocol. The protocol was for them themselves, for they themselves to take their temperature twice a day, twice a day, and those temperatures were then reported into a central office.

So there was constant communication. There were CDC and state health department people working with the Dallas County people all along, but the CDC has augmented this now with more personnel because the CDC personnel will now actually have conversations with all of these people who are being monitored on a regular basis. That's what I heard.

CROWLEY: So don't you think that indicates sort of an increased concern about these workers in the self-monitoring pool, which I think we were sort of led to believe were less likely to have gotten the virus?

SCHAFFNER: They are less likely to have gotten the virus, fortunately.

And I think what public health is doing here is providing an extra cocoon of protection, if you will, around this circumstance to reassure everyone that absolute -- and this includes the people who are being monitored -- to reassure everyone that every possible precaution is being taken.

CROWLEY: And we're also told -- it was also said in the news conference that this health care worker had not been to work for two days, so I don't know whether that means Friday and Saturday, the person wasn't at work, or Saturday, Sunday the person wasn't at work.

But, at some point, you get a fever. So it is -- it says to me it's possible if you contract that fever right after you -- the first time in the day that you take your temperature, if you're still at the hospital, that's a problem.

SCHAFFNER: Well, my understanding was, I think I heard that this person detected their fever at home.

But let me provide some reassurance there. This is not like flipping a switch, you're noninfectious and then you're completely infectious. Indeed, in the beginning features of an illness, even after you become symptomatic, you are not maximally hazardous.

You become more at risk to your caregivers as the illness proceeds and as the virus continues to spread throughout the body. So, right in those very early moments, it's actually not easy to recover the Ebola virus from patients.

CROWLEY: So, it's -- the sicker you get, the more infectious you are is what you're saying.

Let me ask about the pet inside the apartment, simply because I know that there's been a case I think in Spain where this was sort of an issue. Do pets get Ebola? Is this a danger?

SCHAFFNER: It is not a danger. We're not concerned.

That pet is now going to be monitored. We know that this virus can circulate in animals, but pets have not been a feature of Ebola spread, whether in Africa and certainly not here in the developed world. We all thought that that attention in Spain to the dog of the person who was ill was ill-advised and was a distraction. I'm not really concerned about this pet. I'm sure the pet will be monitored carefully and cared for.

CROWLEY: So some animals, not pets, but some animals obviously have been thought to carry the virus, but not necessarily catch it.

SCHAFFNER: Well, in Africa, it's fruit bats.

CROWLEY: Bats, right.

SCHAFFNER: Exactly right. And they can occasionally transmit the infection to small antelopes in the forest and occasionally to great apes.

So dogs and cats and just animals on farms in Africa have not been considered part of the spreading of this disease at all.

CROWLEY: And what do you make of -- because one of the times I talked to you, you said something interesting to me, which was, once the virus is out, like not in the body anymore, but on seats or in waste, that it begins to lose its potency over time.

We were talking about the apartment of the first Ebola patient at the time. So now we hear the police, that they sent in hazmat to decontaminate the open areas in the apartment. They sent people to decontaminate the parking lot at the hospital where this patient drove himself or herself inside the car. They blocked that all out.

They did all the handrails, et cetera, et cetera. Is that an overabundance of caution or is that exactly what this takes?

SCHAFFNER: Oh, this is a beautiful execution of a very thoroughly thought-through plan. I was very impressed.

They were prepared for all of these contingencies, and they moved on them very expeditiously. You know, the somewhat delay the first time getting into the apartment was given a lot of play. I thought that that was overplayed. You just had to close the door, and that was not a problem.

And then this virus, which is fierce within the body, once it gets out into the environment starts to deteriorate, starts to die off very quickly.

CROWLEY: Right. Right.

Dr. Schaffner, I want you to hold on a bit for me.

We have our senior medical correspondent, Elizabeth Cohen.

I don't know, Elizabeth, whether you're on the phone or in front of a camera.

But I under -- there you are.

I understand you have some news about the patient.

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Right. I have been told by an official that this patient, this health care worker, is a nurse and is a woman.

And so those are all the details we know about the nature of the work that this health care worker did. We know also that this person was considered to be not a high-risk contact. It's not clear why they wouldn't -- she wouldn't be considered high-risk since she was involved in the -- in Mr. Duncan's care.

CROWLEY: Right, and since she was wearing some material anyway to protect herself from the virus.

Elizabeth, as you watch, I have been talking with Dr. Schaffner, who's still listening and joining us in our conversation.

As you listened to this news conference, I just somehow didn't find it completely reassuring. Dr. Schaffner was much more assured, and he's the expert. But I want -- I want to get your opinion, because you cover this so closely.

What are the big questions out there for you?

COHEN: I mean, the big question is, how did she contract Ebola if she was following the CDC guidelines about wearing personal protective equipment? How did that happen?

Is it because there was some kind of a misstep? Was there some kind of a lapse in following the instructions? Or are there perhaps problems with those guidelines? Was there a problem in taking the equipment off? That's an issue, because, by then, you have got contaminated material. And taking it off can be an issue.

Also, did the hospital supply her with someone to help her put it on and help her take it off? As the experts in Africa tell me, you want a buddy. You want someone who is putting it on for you and taking it off with you and really watching to make sure that everything is done perfectly.

CROWLEY: Right. And that's something that Dr. Schaffner also talked about, was that in -- in taking it off, you have to be really careful.

And I want to get yours and then talk to Dr. Schaffner about this as well, the diversion that this that Presbyterian Hospital announced, which was, OK, we're not taking any more E.R. patients. They said, oh, it's -- you know, we just don't have the staff to deal with it.

That also, I thought, was a little concerning. It says to me that they're maybe worried about their emergency room. Or am I over- reading that?

COHEN: You know, it's not clear. I don't know why they wouldn't have the staff. They have taken care of an Ebola patient before. I don't know why taking care of this one patient would take up so much staff. That's not clear.

You know, I'm seeing -- we have been seeing a lot of things being done not for medical reasons, but to sort of calm the public. And maybe patients wouldn't be so excited about going to their E.R. right now, when they know there's an Ebola patient in there. Maybe that is what going on.

CROWLEY: There is that.

Elizabeth, I hope you will stick with us.

Dr. Schaffner, I hope you will stick with us too.

We have to take a quick break. We want to come back because I have lots more questions. And I know you all have lots more answers.



MIKE RAWLINGS, MAYOR OF DALLAS, TEXAS: At 7:15, a reverse 911 call was sent out to the four blocks around the apartment complex.

And we left printed material at each door. So, there are any questions, folks should call 311. And, obviously, if anyone feels sick or needs paramedics, they should call 911.

The Dallas Fire and Rescue hazmat team have -- has cleaned up the common areas and decontaminated any of the open areas of apartment complex...


CROWLEY: That was the mayor of Dallas describing at a news conference that occurred just about 15, 20 minutes ago, describing the things that Dallas has done after discovering that there is now a second Ebola patient that has -- that did treat the first Ebola patient who died last week.

So this is the first known transmission of Ebola in the U.S.

Joining me here for this discussion, Ed Lavandera. He is in Dallas for us, Elizabeth Cohen -- she's our senior medical correspondent -- and Dr. William Schaffner, who is an expert on infectious diseases out of Vanderbilt University Hospital.

I want to start, Eddie, with you. I haven't had you chime in yet.

Give us a brief wrap-up for those just joining us of what was said at the news conference and what wasn't said.

ED LAVANDERA, CNN CORRESPONDENT: Well, it's interesting, Candy

This is a female health care worker that came into contact with Thomas Eric Duncan on the second visit, we're told, by hospital officials here. It wasn't that first visit, where he was turned away, but it had to do with the second visit.

We're told by hospital officials also that this person has not come to work for the last two days. The address that the mayor of Dallas -- you heard him talking about this four-block area around the apartment complex where she apparently lives that has been decontaminated and the people had been -- had been alerted about is probably three or four miles away from here in the hospital, so obviously a great deal of concern for the folks that live around those -- those -- those apartment complexes.

But I think the real -- the real headline and the real troublesome part of all this is that, according to the hospital, that this health care worker was following all of the protocols, all of the guidelines, wearing the protective gear, as they were in contact with Thomas Eric Duncan and part of his care.

And despite all of that, this person did contract the Ebola virus. And health -- health officials here at the hospital simply say that that is obviously something they're very concerned about. They didn't talk about whether or not that would change any protocols, but it was definitely, you know, quite a scene here.

Just a little while ago as we pulled up this morning just before 6:00 Central time, I had seen the hazmat trucks that were around the hospital in the -- in the parking garage where apparently this worker had driven themselves to. City officials say that they were in the process, and the hazmat teams out here, decontaminating everything in that parking garage, handrails and that sort of thing.

And they say that that's a protocol that had been put into place and a plan that had been put into place last week -- Candy.

CROWLEY: Dr. Schaffner, let me bring you in on the whole idea that -- that this nurse, female nurse, was in fact following, according to officials, CDC protocol about what she should have on.

We know that taking it off can be as dangerous as not having anything on because you can touch things as you take off this garb. But what does this tell you -- well, first of all, one assumes they would have known about the protocol, since CDC keeps telling us they have been working with local hospitals and state hospitals.

And -- and, second of all, when you look at what is required at that level, and that would be the gown and the mask -- the protective shield, mask, and obviously a gown, is there someplace in that protection that is vulnerable?

SCHAFFNER: Well, we weren't there. And I don't know exactly everything that was done.

But the protocol and what we heard was entirely appropriate, gowns, gloves, a mask, and then also in addition a face shield. That should have provided really very, very good protection. There apparently was no major injury, such as a needle stick. Otherwise, this nurse would have been in the very high-risk group.

So I'm really concerned about how the material was taken off when she went off-duty. That's the occasion where contamination has occurred in other health care settings. And we frequently use a buddy, someone who watches you do it, doesn't help you physically, but makes sure that you do it in the right sequence and that you do it slowly and carefully, so that you don't contaminate yourself.

Further investigation will tell us whether all of those procedures were carried out.

CROWLEY: And, Doctor, right now, listening to what you just heard, knowing the protocols in place, is your concern about the spread of Ebola in the U.S. higher or lower than it was before?

You and I have talked that I -- I didn't think it was the most calming-influence news conference that one could have heard, but is your -- are you -- is your concern ratcheted up at all?

SCHAFFNER: Well, my concern is reinforced.

We know that the two groups of persons who are at greatest risk of acquiring the infection are family members who care for the patient and then health care workers in West Africa and around the world, because health care workers, despite all their protective equipment, have risks in close contact in a sustained fashion with the patient.

Now, mind you, this has been done wonderfully, without hazard, at other institutions in the United States where patients with Ebola have been cared for. So this is an unfortunate event. It may happen occasionally. It concerns us, of course, and we will find out some of the details as time goes on.

CROWLEY: Elizabeth Cohen, bringing you back in, what -- what do you think is the most outstanding question here? Is it, why was this person seen as low-risk, and yet comes up with it?

And it now seems to me that they are treating those low-risk patients differently.

COHEN: Right. I think that's definitely a question. Why was this patient seen as low-risk?

And, of course, the big question is, how did this person, how did she get Ebola if she was wearing full protective gear? And I think there's another question, sort of a bigger-picture question, which is, you know, as Dr. Schaffner pointed out, other institutions have taken care of Ebola patients, and nobody has gotten sick.

Emory has taken care of three. Nebraska has taken care of two. None of their health care workers have gotten sick. And it certainly makes you wonder, should Ebola care be reserved to a certain number of hospitals in the United States, rather than done by just any hospital?

It's not that managing the Ebola patients is necessarily -- it necessarily requires a terribly sophisticated level of care. I mean, it requires obviously a sophisticated level, but a lot of hospitals could do it. But keeping the health care workers safe is not easy. We have seen hundreds of health care workers get sick from Ebola. Perhaps, should only certain hospitals be allowed to handle them?

CROWLEY: I will ask Dr. Schaffner about that in a second and see what he thinks.

Eddie, just to you, the other thing in this that I thought was interesting was that there is now someone in isolation that was a -- described as a close contact. Do we know anything about that?

LAVANDERA: That -- I'm sorry, the close contact of?

CROWLEY: There was a -- I -- the -- Dr. Varga said something about that a -- someone who was a close contact of the new patient has been put in isolation.

LAVANDERA: Well, obviously -- yes, sorry.

So, now you begin that process of trying to figure out all of the contacts that this health care worker had been in touch. And that is obviously something we saw going into place when Thomas Eric Duncan was diagnosed with the Ebola virus, that they -- I think officials here said they had some 19 CDC detectives on the ground in -- in part of that process now.

Yes, 19 is the correct number, 19 CDC detectives on the ground. And now part of that process will also include formulating the list of all of the contacts that this particular health care worker had. How many people were in her apartment? How many people has she been in touch with over the last few days?

Just how far back they will need to do that is obviously something the CDC teams will have to take care of. But that list will be very, very crucial in reaching out to all of them. And I think that's why you're also seeing this initial step this morning of alerting -- and they said they -- they mentioned that they sent out a reverse 911 call to the four-square-block area around where this health worker left, and -- and leaflets alerting people to -- to what was going on, so that that contact investigation is now something that begins in earnest this morning.

CROWLEY: Dr. Schaffner, bringing you in on these two questions, the first is, is it -- when they describe this as a close contact of this new Ebola patient being put in isolation, is that inside or outside the normal course of events, because so many of these people were sent home?

Is it the close contact that has put this person in isolation?

SCHAFFNER: Well, this person, whom we don't know, and we don't know the nature of this close contact, obviously had some face-to-face and perhaps hands-on touching contact with this new patient, the nurse who has just recently been diagnosed.

So that would be a person who is of great interest and could possibly have acquired the infection.

CROWLEY: Sure, but if you're not infectious until you have a fever, why would that person go in isolation?

SCHAFFNER: Yes, they haven't told us enough information to make that decision.

And this may again be something of an excess of caution in this case. We will see.

CROWLEY: And I wanted to ask you about two other things. One is this diversion, the idea that, well, we don't have enough people here to take care of new E.R. patients, so they're being sent to other hospitals.

What do you make of that?

SCHAFFNER: I think that's also an excess of caution.

I think Elizabeth said -- said it well. There may be enough hullabaloo around this case, so they just decided, it's more prudent, at least in the short term, to not bring emergent patients to our institutions. Regularly patients can still come in and be admitted.

But for a short term, perhaps it would be better for all concerned, while things calm down a bit, just to divert emergency care to other institutions who will pitch in and help out.

CROWLEY: And what do you make of the idea that Elizabeth was talking about that some -- some have discussed, which is maybe there should just be certain hospitals who are highly trained in protecting workers that receive Ebola patients?

I mean, heaven only knows we don't -- we hope there are no more, but what about the idea of just having certain hospitals that deal with it?

SCHAFFNER: Well, for starters, every hospital has to be prepared to make the diagnosis or be suspicious of patients, because patients can show up in anyone's emergency room.

So that part applies to all of us. The second thing is, as Elizabeth said, the core care, the supportive care can be done by intensivists, hospitalists all across the country. This is the sort of thing that they do each and every day.

It's the health care worker safety part that pushes this discussion to say that, if a patient is diagnosed and is still not too ill, ought they be transported to one of these special facilities?

I was just at a meeting of the Infectious Diseases Society of America, and people were discussing this over coffee. And, you know, it's an unresolved issue. There's a sense that every hospital ought to be prepared, and their personnel should be sufficiently well- trained.

And then there's the other side of the question that says, well, after you have taken care of two or three of these patients, you really get better at it. It's an unresolved issue. And, of course, there are downstream issues. How will the patient be transported? Who's responsible for that?


SCHAFFNER: Frankly, who pays for all that?

So it gets very complicated very quickly. But I would say, by and large, I would come down to the side that every hospital ought to be prepared to take care of these patients. They will come into your emergency room, and they may be too sick to transport, even if you would like to do that. So you had best be prepared.

CROWLEY: And, Dr. Schaffner, just quickly, knowing what you now know from that news conference and from your experience dealing with infectious diseases, what -- what do you most want to know about this patient and this case right now, as information continues to come out?

SCHAFFNER: Well, like Elizabeth, all of us would like to know exactly how this patient, how this new patient, this nurse, acquired her infection.


SCHAFFNER: That will be very, very instructive for all of us.

CROWLEY: Dr. William Schaffner out of Vanderbilt University Hospital, thank you so much.

Elizabeth Cohen, our chief medical correspondent -- or our senior medical correspondent, thank you.

Ed Lavandera in Dallas for us, thank you all so much.

And we're going to continue following developments of this new Ebola story throughout this hour.

But up next if air strikes are not stopping ISIS whose ground forces will? We get point and counter point from U.S. senators, John McCain and Bernie Saunders.


CROWLEY: Now to the war on ISIS.

We have been told all along that air strikes alone won't defeat ISIS, but the only boots on the ground, Kurdish fighters and the Iraqi security forces both appeared to be losing territory and there doesn't seem to be anyone else who wants to do a ground war.

With me now Senator John McCain, Republican from Arizona. Welcome, Senator. We appreciate it.

Let me talk to you first about this breaking news we have this morning, and that is, look, I'm not a doctor, you're not a doctor, we can only listen to doctors. But do you get the sense that the federal government is on top of this? Is there anything more you think the federal government can do?

SEN. JOHN MCCAIN (R), ARIZONA: Well, first of all, from spending time here in Arizona, my constituents are not comforted. There has to be more reassurance given to them. I would say that we don't know exactly who's in charge. There has to be some kind of czar.

I think that we have to look at people coming into the United States, not only at our airports here but the places where they leave from. As you know, there are not direct flights from Africa. And Americans have to be reassured here. I don't think we are comforted by the fact that we were told there would never be a case of Ebola in the United States and obviously that's not correct. I was impressed by your panel, but frankly I'd like to know who's in charge, among other things.

CROWLEY: OK. And let me get you back to something that you and I have talked about before, and that is this war on ISIS.

We see territory -- Kurdish territory in Syria that seems in danger of falling to ISIS. We now see Anbar province, which just seems to be just one city or so away from being taken over by ISIS. This is despite two months worth of U.S. or U.S.-led air strikes. So what is next in this activity against ISIS? I know you want to call it a war. Whatever you want to call it, what does the U.S. do next?

MCCAIN: First of all, they're winning and we're not. And the Iraqis are not winning, the Peshmerga, the Kurds are not winning, and there's a lot of aspects of this. But there has to be a fundamental re-evaluation of what we're doing because we are not -- we are not degrading and ultimately destroying ISIS.

I don't believe that ISIS will take Baghdad, but I think they can take the airport and that is crippling. And I also think that they can infiltrate into Baghdad with explosives, suicide bombings, et cetera, they can really dislocate -- well, the first thing you've got to do is recognize that this present pinprick bombing is not working. Second of all, you need more boots on the ground in form - in the form of forward air controllers, special forces and other people like that.

You have to arm the Peshmerga, who are using old weapons that are Russian vintage against ISIS, who's using ours. You have to do, I believe, what Erdogan and the Turks are asking and that is we create a buffer inside Syria and a no-fly zone. It's immoral to send free Syrian army people into the barrel bombing of Bashar al Assad. And by the way, as we bomb is, Bashar al Assad moves in and he has intensified his strikes against the free Syrian army.


MCCAIN: So there has to be, Candy, a re-evaluation and a reengineering of what we're doing, because it's not working.

CROWLEY: There are U.S. advisers, as you know, some of them with Iraqi troops, at least in the protection of Baghdad or around Baghdad. You know that there is not public support for any kind of battalions of U.S. soldiers going back to Iraq. But there has not seemed to be any other country willing to put people inside Iraq to fight ISIS. So where does this go?

I mean, when the -- if the administration -- I'm sure every day they're looking at it and saying, OK, do we need to refigure this? I mean, how do you refigure it given all of the restraints there are in taking this fight to ISIS?

MCCAIN: First of all, I'm not advocating sending battalions back in...


MCCAIN: ...but we can do a lot more down at the operating level. We have to understand there's no boundary between Syria and Iraq. Why should we differentiate? Certainly ISIS doesn't.

We certainly must give them the weapons and capabilities that they need. But right now we are going to have to have effective air strikes. You can't have that without forward air controllers on the ground. In Kobani, there's no way you can use -- orchestrate air support in that kind of urban fighting.

The ISIS has adjusted to these air strikes. Fortunately for them we gave them two weeks warning. And so this has to be a robust campaign with American forward air controllers and Special Forces on the ground supplying weapons to the Peshmerga and also supplying the free Syrian army and recognizing that you have to go after ISIS and Bashar al Assad at the same time or you will not succeed.

CROWLEY: I want to ask you about Kobani.

The U.N. special envoy to Syria has warned that if Kobani falls, the civilians that are left in that city, as I understand it almost half of it now under ISIS control that they will all be massacred, who likely to be massacred. Who protects those civilians?

MCCAIN: I don't think that it's possible to protect those civilians who are basically trapped within Kobani. I also agree there will be a massacre.

I remember when 8,000 people were ethnically cleansed in Srebrenica, which then galvanized Bill Clinton for us to intervene in Bosnia some time ago. We can't afford to let this continue. And the stronger ISIS gets, the greater the threat to the United States of America. That's what we have to understand and that's why tough decisions have to be made and not gradually. We have to completely revamp our strategy, which clearly is not succeeding.

CROWLEY: And by revamping, you want more powerful, broader more expansive air strikes and boots on the ground insofar as they can be with Iraqi troops and forward-looking for the air assaults, is that correct?

MCCAIN: Buffer zone in Syria, no-fly zone, take on Bashar al Assad the same as we have ISIS. Recognize there's no distinction between Iraq and Syria, arm the Peshmerga and let it be known that we are in this thing to win because it is a threat to the United States of America if they are able to establish this caliphate.


MCCAIN: General Allen had said that it would take more than a year to retake Mosul, the second largest city. We can't afford that.

CROWLEY: Senator John McCain, thank you so much...

MCCAIN: Thank you.

CROWLEY: ...for being with us this morning from Phoenix. We appreciate it.

I want to go at the ISIS problem from a different perspective now. Senator Bernie Sanders is an independent from Vermont. He joins me.

Senator Sanders, I think it's fair to say and describe you as a dove, but you have also warned that you think ISIS is a dangerous and lethal operation and needs to be stopped. Tell me as you look at what's happening now, and that is that while the air assaults continue and have some effect on their targets, they don't seem to be slowing ISIS in any way. What's your next move?

SEN. BERNIE SANDERS (I), VERMONT: Well, Candy, I think the main point being made is of course ISIS is a brutal, awful, dangerous army and they have got to be defeated. But, Candy, this is not just an American problem. This is an international crisis. This is a regional crisis. And I think the people of America are getting sick and tired of the world and the region, Saudi Arabia and the other countries saying hey, we don't have to do anything about it. The American taxpayer, the American soldiers will do all the work for us.

Most people don't know is that Saudi Arabia is the fourth largest defense spender in the world, more than the U.K., more than France. They have an army which is probably seven times larger than ISIS. They have a major air force. Their country is run by a royal family worth hundreds of billions of dollars.

CROWLEY: Sure. But they have shown no sign at all that they want to go in and neither have the Jordanians although they seem a little more interested or the Turks. And so I'm just wondering since everyone agrees there needs to be ground forces of some sort that are effective, whether if those Arab nations don't step forward as you want them to do and come in on the ground, does the U.S. then pull out its air strikes? I mean, how would -- how do you handle that?

SANDERS: Well, here's -- the question that question that we have got to ask is why are the nations in the region not more actively involved? Why don't they see this as a crisis situation?

Here's the danger, Candy. If the Middle East people perceive this is the United States versus ISIS, the West versus East, Christianity versus Islam, we're going to lose that war. This is a war for the soul of Islam and the Muslim nations must be deeply involved. And to the degree that developed countries are involved, it should be the U.K., France, Germany, other countries as well.

So I worry very much, and I go out around Vermont and around the country, and people are saying, yes, we're concerned about ISIS, but we're also concerned about the collapse of the American middle class. And infrastructure...


SANDERS: ...which is falling apart. The need to create jobs in America. We can't do it alone. It has to be an international and a regional coalition.

CROWLEY: Well, in fact I mean the president and his administration have collected any number of nations both in Europe and Arab nations who say, we support you and we support this idea of going against ISIS. And some countries have said, we'll help you train some troops. We'll give you money. We'll provide a training base. But in the -- at the end of the day what's needed is folks on the ground. I wonder what you think of Senator McCain saying, what we need is

a much more aggressive, much more expansive air strikes from the U.S.- led coalition. We need to arm the Peshmerga and we do need to have more -- not U.S. battalions of troops, not a group marching in, but more of those advisers and more of those people who can tell the air assaults where they should go. What about that role for America?


SANDERS: It's a problem for the international community. And you asked me a moment ago, why aren't other countries more deeply involved? I will tell you why.


SANDERS: Because they believe that the American taxpayers are going to do it and American soldiers ultimately will do it. And as long as that signal is out there, that is what's going to happen.

I want the Saudi Arabian government to be actively involved. I want their troops to be on the ground. I don't want them to believe that we're going to do it for them. So, yes, I think we have to play a very strong and supportive role with the U.K., with France, with Canada, with other countries. It cannot and should not be the United States alone.

CROWLEY: And as far as the role so far that the U.S. is playing, is that too far for you or just about right?


CROWLEY: I mean, we're leading the air assaults --

SANDERS: I think the president -- it is very easy to criticize the president, you know, but this is an enormously complicated issue.

We are here today because of the disastrous blunder of the Bush- Cheney era which got us into this war in Iraq in the first place which then developed a can of worms that we're trying to deal with right now. So I think, again, it has to be an international effort. I think the United States along with other countries have got to play an active role. ISIS is a terribly dangerous organization. This is -- we have to do it internationally and regionally.

CROWLEY: And if that support is not there in terms of the ground troops that you are calling for from the Saudis, the Turks, the Jordanians, et cetera, if that help is not forthcoming on the ground, then does the U.S. pull out? It seems to me it's a catch-22 to say, hey, you know, somebody has to deal with this but it shouldn't be us so -- but it's dangerous and it is a threat to us, so when does the U.S. step back?

SANDERS: It is a threat to us, it is a threat to the U.K., maybe even a greater threat and to France. And so long as the word is out that people think we're going to do it, they're not going to step up to the plate. So I think what the United States has got to demand, yes, we're going to be in this thing, not with troops on the ground but with air attack support and other support, arming those people who need to be armed. But you guys are going to have to get into this as well.

CROWLEY: So would you support broader air strikes and would you support arming -- it sounds like you would, arming the Peshmerga, the Kurdish forces?

SANDERS: Yes. I think we should arm -- even that's a difficult issue to make sure that the people that we arm today don't turn against us tomorrow. But I think providing arms for those people who we can trust and providing air support is in fact something we should be doing.

CROWLEY: But for you, would it be confined to the Peshmerga? I know that you voted against arming and training Syrian rebels. So is there a difference to you between the Peshmerga and the Syrian rebels?

SANDERS: Here's where I am. We have been at war for 12 years. We have spent trillions of dollars. I'm chairman of the Senate Committee on Veterans' Affairs. We have 500,000 young men and women who have come up -- come home with PTSD and TBI. What I do not want and I fear very much is the United States getting sucked into a quagmire and being involved in perpetual warfare year after year after year. That is my fear.

CROWLEY: Senator Bernie Sanders, I thank you so much for your time today. We appreciate it.

SANDERS: Thank you.

CROWLEY: Come see us in Washington.


CROWLEY: Next up, we will ask our political panel about what seems to be President Obama's growing list of frenemies.


CROWLEY: The midterm election is just over three weeks away and candidates left and right are stumbling toward the finish line but Democrats in particular seem to be running away from President Obama.

Around the table, "CROSSFIRE" host, Newt Gingrich and S.E. Cupp. Also here Neera Tanden, from the Center for American Progress, and Marc Lamont Hill of "HuffPost Live."

Well, you know, I don't know if the president's been in a book store lately but the fact to the matter is that Leon Panetta has just joined the pile-on of former administration officials that really, to me, especially right before midterm, never mind that he has two more years left, have done some real damage in kind of undermining the president. Is this out of the norm?

NEWT GINGRICH, CNN CROSSFIRE HOST: Yes. Given that Panetta himself is a career politician, to not wait until January to release the book. I mean, I don't know if his publisher said, look this is where you will maximize sales, but this is a guy who has been a pretty loyal Democrat since he became one in the '70s. And for him to come out with his book before the election I think is a little surprising. The book is not. The book reflects Bob Gates' criticisms, very similar in that sense.

CROWLEY: We have heard, and Hillary Clinton, I mean, everybody just sort of backing away from this.

NEERA TANDEN, PRESIDENT AND CEO, CENTER FOR AMERICAN PROGRESS: I think there's a big difference between Hillary's book and Panetta's book.

If you actually look at what you talked about, talks about being -- going from a team of rivals to an unrivaled team, big distinctions. I think the issue is Leon Panetta, first of all there's a public record of everything he said about Iraq and Syria and there are differences between what he said in the book and what he said at the time.

CROWLEY: Kind of immaterial to what it does --

TANDEN: No, and I hear -- let's be very partisan, I agree with Newt. I think it's also -- we have -- you know, we have forces in Iraq now. We have -- we are sort of engaged in this military engagement. To me, it's very unseemly to be kind of Monday morning quarterbacking all these decisions when we have troops there and he was the secretary of defense.

CROWLEY: Maybe they are trying to push him though. I thought with Panetta, of course, wasn't a book written a while ago that he was, you know, there was a certain element of, you know, get tough, step up.

MARC LAMONT HILL, CNN POLITICAL COMMENTATOR: I think you're being generous. I think this is all about self-serving politics, I think about making money off publishing commitments. I think that's what it's all about. It's not uncommon for people to do this every president has someone from the administration at some point...


HILL: step out. Yes. But oftentimes they're lower string people. I mean, when David Kuo (ph) writes the book about, you know, George Bush the evangelicals is very different than a high-ranking cabinet member.

S.E. CUPP, CNN CROSSFIRE HOST: I think there's a lot of -- there's a lot of legacy protecting here from Hillary to Leon Panetta to Bob Gates and you have to remember, while President Obama can say, well, sure, maybe we made mistakes over here in foreign policy, look at what we did with Obamacare and the economy.

Leon Panetta and Bob Gates lived in this national security foreign policy world. It is a direct reflection on them. And I think they want to protect themselves and their legacies on some of these singular failures in particular.

TANDEN: They shouldn't do it at other people's expense but I think that's what's --


GINGRICH: Part of this may be more than ego, you have with Gates in particular, but also (INAUDIBLE) Panetta, people who see themselves as public servants, not elected officials. And I think that they are genuinely, deeply worried about exactly what John McCain talked about. I mean, I think when you have two back-to-back secretaries of defense saying to you this is a -- this is a mess, I think they're part of -- there is something profound about what the administration is doing wrong that's in those two books.

TANDEN: Just a minute ago, you were saying he was a career Democrat though.

CROWLEY: Well, he is a career Democrat, but the truth is that in their interviews, they go farther than that and they talk about ISIS and they do -- I mean, they have been sort of pushing at him.

CUPP: They were very clear, both of them were very clear that they were frustrated, that they thought a lot of these decisions were being made from a political point of view and not from a foreign policy perspective. And that, for someone who lives in a national security domain must be pretty chilling and frustrating.

TANDEN: I guess Leon Panetta has -- he was on the record in Iraq saying we need the agreement of the Iraqi government. Now he is saying, no, no, no, I didn't say that. But he has testimony after testimony after testimony. And he is rewriting history now in his book.

HILL: This is the most disgusting example of Monday morning quarterbacking I have ever seen. Everyone --

CROWLEY: But we don't know what he was saying behind closed doors. And you know, because they have to come out and say, I mean, your defense secretary isn't going come out and go -- yes.

GINGRICH: No. But the facts is everybody who was deeply involved in that, except the administration says over and over again, they could have had a deal, they could have worked it had out.

CROWLEY: But they didn't.

GINGRICH: The difference between this president's non- involvement and George W. Bush's involvement was stunning. And that's what I think both Gates and Panetta are saying, you can't try to lead the world occasionally between golf courses.



CROWLEY: I'm sorry, but we --


CROWLEY: This was three weeks from the midterms, right, and here's above the fold, "Washington Post," dubious practices used in Ferguson. Ebola outbreak grim equation. Anbar at risk of falling to jihadists.

This is not -- I mean, I just sort of pictured the president waking up and going, here's the post, sir. This is not an atmosphere. Now we have a second Ebola case, in which you want to be a Democrat, is it?

HILL: I disagree. I disagree.

Let's start with the left there. (INAUDIBLE). But if you're going to start with the left of that paper, "dubious practices in Ferguson," that actually I think is mobilizing people of color to polls. I think that's going to get people to vote. And in places like North Carolina, it could be a differencemaker. Ebola, no, that never works out for any sitting president, Democrat or -- never heard of anyone saying, the Ebola uptake.

CROWLEY: But because -- but it also, you know, the Democrat, I think you heard a little of this from John McCain today, which was you got to get out there and reassure people. Who the heck is in charge of this? Who's the guy that's going to make sure that two doesn't make three doesn't make six?

CUPP: Well, and that's the problem. I mean, to play politics with Ebola is a little crass, whether you're Joan Walsh on the left blaming Rick Perry our some folks blaming Obama for it. But I think what it does create is an idea of incompetence and worry about some of these big federal bureaucracies. So, we are meant to trust the CDC and FEMA and DHS and all of these bureaucracies when over the past few years, they've messed a lot up. I think the anxiety is that the federal government might not be as in control of the situation as it seems.

TANDEN: Just to be clear, the CDC does not have a lot of incidents of messing a lot of things up. This is a scary issue. We should be -- we should be monitoring it, but I actually think just attacking the government creates more panic.


CUPP: The CDC was storing deadly strains of the flu in Ziploc bags, the same kind I have in my kitchen, just a few months ago.

TANDEN: Yes, but that's not -- not like these people -- (INAUDIBLE) somebody (ph) on that, but the CDC in the United States is one of the most effective centers of disease control in the world and I actually think this is part of the problem, the constant attack on the government and everything.

(CROSSTALK) HILL: Not necessary.

CUPP: It's not an attack.

HILL: But creating a sense of panic.


CROWLEY: The Obama administration.

GINGRICH: Let me try to paint a picture. The CDC a decade ago dealt with SARS in five months, decisively, completely...

CUPP: Effectively.

GINGRICH: ...lean forward. These guys did not lean forward. They did not respond in December, January, February, March. They are just now beginning to respond. That's part of it a deeper part. In the time that we've lost two American -- one American to Ebola, we have lost 6,000 veterans to suicide. And it is stunning. And so the country wakes up and they say, well, Iran is missing, Crimea is missing, Ukraine is missing, I'm supposed to worry about ISIS today, Ebola is the new thing. You know, I think the country is drowning in a sense of the thing falling apart.

HILL: An imaginary sense of panic being created. SARS is eliminated --

CUPP: It's not imaginary.

HILL: SARS eliminated in five months, we've been dealing with American death for Ebola for what, three weeks now? You talk about veterans dying -- a tragic thing but they -- veterans have been committing suicide for a long time this is not a uniquely Obama thing.

CROWLEY: We're going to continue this conversation (INAUDIBLE). Neera Tanden, Newt Gingrich, Marc Lamont Hill, S.E. Cupp.

Thank you all for watching STATE OF THE UNION. I'm Candy Crowley in Washington. Watch us each week at this time or set your DVR.

Fareed Zakaria, "GPS," starts now.