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CNN NEWSROOM

New Ebola Case Diagnosed in Dallas; Nurses Union: Duncan Not Isolated from Patients

Aired October 15, 2014 - 09:00   ET

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


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

ANNOUNCER: This is CNN Breaking news.

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

The breaking news at this hour, a bombshell announcement on this Ebola crisis. Texas health officials now say another case of Ebola has been diagnosed here in the U.S. and this latest unnamed victim is a second health care worker, a woman who helped treat Thomas Eric Duncan. And this morning's news triggers even more alarms. It means even more people could have been exposed to this highly infectious disease and will now need to be identified and monitored.

This really does underscores the critical, the very dangerous mistakes that were made, how did health officials mishandle the first Ebola case diagnosed on U.S. soil and why were there not proper protections for all the health care workers who took care of Duncan?

(BEGIN VIDEO CLIP)

CLAY JENKINS, DALLAS COUNTY JUDGE: At the hospital, we have a situation involving 77 people, two of which have tested positive for Ebola. We are preparing contingencies for more, and that is a very real possibility.

(END VIDEO CLIP)

CABRERA: Let's start our coverage now in Dallas. CNN senior medical correspondent Elizabeth Cohen is outside Texas Health Presbyterian Hospital, the center of this crisis in the U.S.

Elizabeth, what more can you tell us about this new case?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Ana, we don't have a lot of details. What we know is that this is a woman that she treated Thomas Eric Duncan, the original patient, that she lives alone with no pets and that they have gone in to decontaminate her apartment.

Now I want to put what's happened here in Dallas in some context, Ana. This hospital has treated one Ebola patient and two health care workers who became infected with Ebola in the process at the University of Nebraska and Emory University. They together treated five patients and no health care workers got sick -- Ana.

CABRERA: It is very surprising, Elizabeth, to see another health care worker as you just mentioned where others have been treated and it seems to have gone very smoothly. Are they saying any more about how many people they fear could be diagnosed in the next few days?

COHEN: You know, Doctor Frieden was very clear -- the head of the CDC -- that, you know, it would not be unexpected to see more of these cases pop up. We are in that worrisome window. It's been a week since Mr. Duncan passed away, and infections tend to show up about eight to 10 days after someone is exposed to someone who is sick, so it would not be surprising if we saw more health care workers become ill.

CABRERA: And any talk this morning about sending these two Ebola cases there in Dallas to one of those special containment units, those biocontainment units that we know are set up and prepared at four different hospitals around the U.S.?

COHEN: Ana, I haven't heard any talk of that here, although this hospital is notoriously pretty much silent on everything. What I have heard is an official said to me, look, at the CDC, they recognize that if they could do this all over again, they would have sent Duncan to Emory or to the University of Nebraska. He said that they -- I mean, I think it was the CDC was caught a little bit unawares.

So they really thought that any hospital could handle this and handle it safely, but as we've seen, there is a difference between hospitals. They're just not created equal. This official also saying that the CDC supports the concept that maybe only a few hospitals should treat Ebola patients, but coordinating all of that is difficult. There are a lot of details involved.

CABRERA: All right, Elizabeth Cohen staying on top of it for us, thank you.

I want to bring in now CNN's chief medical correspondent, Dr. Sanjay Gupta, here in Atlanta, and listen to this testy exchange, Sanjay, between the secretary of Health and Human Services and Matt Lauer on the "Today" show this morning just a couple of hours ago.

(BEGIN VIDEO CLIP)

MATT LAUER, HOST, NBC'S "TODAY" SHOW: Yet with all due respect, Madam Secretary, you're not answering my question.

Do you have complete confidence that that facility can successfully treat these two patients without spreading this virus further?

SYLVIA BURWELL, HEALTH AND HUMAN SERVICES SECRETARY: Matt, what we have put in place are what we believe oversight and assistance in the implementation of the protocols that we know can work and have worked over 30 years in terms of fighting Ebola.

(END VIDEO CLIP)

CABRERA: So Sanjay, first off, Sylvia Burwell there cites the strength of Ebola protocols but that seems to be what has failed here to begin with, right?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yes, I mean, to some extent. Let me just give a little bit of detail to that. I think it's important. There are sort of two parts to this, Ana. I mean, one is the prevention of secondary infections, of other people getting an infection, and then the other part is the treatment of a patient that once they are infected.

You got to think about these things a little bit differently. From a treatment standpoint, given that there is no specific treatment for an Ebola infection, one could make the argument I think that most hospitals could provide what is need which is to replace IV fluids, in this case the nurse down in Texas got a blood transfusion, even at that Dallas hospital, the same sort of thing that patients at Emory got.

What -- the other part of it is, can you protect other patients or health care workers from getting infections? And obviously Dallas has not done a good job of that. I don't know that by sending patients to Emory or to Nebraska you're going to make that problem go away. Patients can show up anywhere in the country, right, Ana?

I mean, we don't know where, what city they're going to land in. They could show up at any hospital.

CABRERA: Right.

GUPTA: They be come in contact with health care workers at that hospital and if they get transferred they would come in contact with ambulance drivers, perhaps pilots and then a whole another set of health care workers at the new hospital. So I think we've got to think long and hard about this idea of transferring patients and instead focus on really making sure these hospitals can all do the job.

CABRERA: Right. We also know the CDC has assembled now a team of experts there to go to Dallas to help with training, to help with protocols.

GUPTA: That's right.

CABRERA: To help with better preparation in moving forward and treating these Ebola patients. So how confident are you in this hospital's ability to treat and maybe contain these Ebola cases?

GUPTA: Well, you know, the track record is not good so far. And I would hope that it wouldn't happen but it is possible that we'll hear about another health care worker who develops a fever and tests positive for Ebola, but take a look at the next steps. One could make the case these should have been first steps but leaving that aside, these are the next steps, sending teams that include people who have been trained by the Doctors Without Borders to Dallas. That's something, you know, Doctors Without Borders has a terrific

track record of, taking care of patients in tough spots, in Central and West Africa, improving processes and procedures, putting that site manager in place, that's literally, Ana, someone who's going to observe people taking on -- putting on and taking off their gowns, establishing a response team so as soon as there is an infection that is confirmed -- there's a go team.

They show up at these hospitals and help take care of patients. Those are some of the things that they're talking about now.

Again, I like many other people, I think some of this should have been put in place earlier, whether that was a reflection of a little too much confidence in the whole situation, I don't know, but I think those things could make a difference if implemented properly.

CABRERA: Do you think those will be sufficient?

GUPTA: Well, you know, here's what I keep coming back to. And then this is almost more philosophical. But, you know, again, there -- Doctors Without Borders has been taking care of patients in Central and West Africa. I've been to these places. They are not big hospitals like Texas Presbyterian. They are tents that are literally put up in the middle of fields that take care of patients and they protect themselves well, they take care of the patients and up until this year there's never been a patient transmit the virus to a health care worker.

That hasn't happened in those really, really tough spots so I guess what I'm being asked to believe is we can't do the same thing at a big hospital like Texas Presbyterian? We can't have confidence that we can protect health care workers like they can do in really, really tough rural parts of Africa.

I'd like to believe we can. We just have to do it and this is -- this is pretty basic stuff. This isn't relying on some new experimental vaccine or new experimental therapy or something that's technologically sophisticated. It's bread and butter stuff that needs to be really well implemented.

CABRERA: But based on what you just said, Dr. Gupta, I mean, we do know that many, this outbreak who are getting infected are health care providers in west Africa. So does that mean we're dealing with a whole different strain of Ebola than we have not seen in the past?

GUPTA: Well, again, let me clarify. Health care workers often do get infected. And oftentimes it's local health care workers who see a patient for the first time, and then don't know the patient has Ebola. I was specifically talking about the Doctors Without Borders, a team of people who are trained. They do this kind of work all the time.

CABRERA: Right.

GUPTA: They go in and take care of these patients specifically. But they also --

BLITZER: They are getting affected, too, no, right.

CABRERA: They are this year. But decades they did not. Does that indicate somehow the virus has changed is your question. I don't think there's any evidence that the transmission has changed, and it's become airborne or anything. Just have a lot more patients. You have more patients than we've ever had before. We keep hearing about the lack of basic resources now in those areas.

Again, not a problem I would think here at big hospitals in the United States, so their track record in the past has been excellent with dealing with a few patients. Here we are just dealing with one initially and two health care workers got sick.

If I could just point out one more thing to you, Ana. I mean, the whole notion of what does constitute protection. You know, I did a demonstration a couple of days ago showing that even with the CDC sort of protocols, there's still parts of your body that are not fully covered.

You can see for example there, my neck not fully covered. That was something that nurses about and that, you know.

CABRERA: Right.

GUPTA: Dr. Frieden himself was in West Africa recently and when he was touring in Ebola ward, I think we have some video of this as well, he was fully covered. He is the head of the CDC, he was in West Africa, touring an Ebola ward. You can see him putting on that. That's what he was asked to wear over there. He wasn't taking care of patients. He was touring and still that's the level of protection that he put on over there.

Now part of this could be that he's a government official and you know, they obviously to be very, very careful, but I think it does raise the question, should that level of protection be in place here in the United States because that's --

CABRERA: And Sanjay, we are going to talk more about the protection and perhaps what wasn't in place in Dallas prior to these two infected nurses.

So stay with me, Sanjay. I didn't mean to cut you off but we do want to get to this other angle here that has to do with these nurses who were there, where Thomas Eric Duncan died and some of their representatives at the nurses union are now speaking out, what they are saying is shocking.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Hospital officials allowed nurses who interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while providing care for Mr. Duncan.

(END VIDEO CLIP)

CABRERA: You will hear much more from these nurses straight ahead.

(COMMERCIAL BREAK)

CABRERA: Welcome back.

A nurse's union says it's now sounding the alarm on the Dallas hospital where a second health care worker has now been diagnosed with Ebola. National Nurses United says it spoke with a number of registered nurses at that hospital, Texas Health Presbyterian Hospital Dallas.

And the union's executive director said what they told her made her cry. She says adequate safety protocols were not in place. Nurses were not protected from exposure when they had contact with Thomas Eric Duncan, the Liberian patient who died of this disease earlier this month.

Now, the union has released a statement on behalf of the nurses and we want to play part of that statement. And we want to warn you, you might find some of this quite graphic and very disturbing.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: When Mr. Thomas Eric Duncan first came into the hospital, he arrived with a temperature that was tested with an elevated temperature, but was sent home. On his return visit to the hospital, he was brought in by ambulance under suspicion from among his family he had Ebola.

Mr. Duncan was left for several hours not in isolation, in an area where other patients were present. Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced resistance from other hospital authorities.

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.

Initial nurses who interacted with Mr. Duncan wore generic gowns used in contact-droplet isolation, front and back, three pairs of gloves with no taping around the wrists, surgical masks with the option of an N-95 and face shield. Some supervisors said even the N-95 masks were not necessary.

The gowns they were given still exposed their necks, the parts closest to their face and mouth. They also left exposed the majority of their heads and their scrubs from the knees down. Initially they were not even given surgical booties nor were they advised the number of pairs of gloves to wear. After they recommended that the nurses wear isolation suits, the

nurses raised questions and concerns about the fact that the skin on their neck was exposed. They were told to use medical tape and had to use four to five pieces of medical tape wound around their neck that was not impermeable and has permeable seams. The nurses have expressed a lot of concerns about how difficult it is to remove the tape from their necks and are uncertain whether it is being done safely.

Hospital managers have assured nurses that proper equipment has been ordered, but it has not arrived yet. Nurses had to interact with Mr. Duncan with whatever protective equipment was available at the time when he had copious amounts of diarrhea and vomiting, which produces a lot of contagious fluids.

Hospital officials allowed nurses who interacted with Mr. Duncan to then continue normal patient care duties taking care of other patients, even though they had not had the proper personal protective equipment while providing care for Mr. Duncan, that was later recommended by the CDC. Patients who may have been exposed were one day kept in strict isolation units. The next day they were ordered to be transferred out of strict isolation and into areas where other patients, even those with low-grade fevers who could potentially be contagious.

(END VIDEO CLIP)

CABRERA: So, we have a lot to discuss here, but first I want to read you something from Texas Health Presbyterian Hospital responding to these allegations.

A spokesman says, quote, "We take compliance very seriously. We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting."

So, back with me now, CNN chief medical correspondent Dr. Sanjay Gupta in Atlanta, and also joining me here in New York, CNN medical analyst, Dr. Alexander Van Tulleken.

So much to talk about, Dr. Van Tulleken, I know you were taking notes and writing fast and furiously here. Let's hit on the very basics that one thing she said is the nurses who are still treating Ebola patients because we have two nurses there, still don't have the right protective equipment.

DR. ALEXANDER VAN TULLEKEN, CNN MEDICAL ANALYST: This is what is extraordinary, is that this is not -- I mean, Nina Pham has been in the hospital for a while now. I mean, you can get this equipment at home depot if you really need it, at least better than they're using it, but certainly you can FedEx it overnight from places where it is available. So that's extraordinary to me, and that to me is the absolutely key issue, that this isn't something we go well next time someone comes to Dallas Presbyterian we need to worry about this.

At the moment, they have two patients in the hospital and we don't know what's going on. In the press conference this morning, we did not hear details about any of the things --

CABRERA: Is there a reason that the officials wouldn't want to give specifics? Does it have to do with privacy laws?

VAN TULLEKEN: I think because they have to make it up as they go along. Unfortunately bits of these mistakes are in the hospital. So, when you hear about things like patients being moved into and out of isolation, you go, this smacks of dithering and poor specific leadership in this hospital.

But there are mistakes where it's reasonable to go even if they did exactly what the CDC recommended they do, they probably still would have gotten infected Ebola because the CDC protocols followed perfectly do not protect us as well as they should, and Sanjay demonstrated that really, really nicely.

So, we have failures at multiple levels, at an international level to stop the epidemic in Africa. We've got failures at a national level to notify hospitals. I don't think Dallas Presbyterian is a bad hospital at all. I think that these are systematic failures you see anywhere and specific mistakes made where I think supervisors have not played a good role in leadership either.

CABRERA: One of the most shocking things I heard on this tape, I direct this question to you, Sanjay, the fact there were apparently nurses who were treating Duncan, maybe didn't have the right protective equipment and were out there treating other patients. How much of a problem or risk could there be here?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: I mean, that's, I agree with Alex as well. I mean, that's a real risk. They're bringing up some violations of basic infectious disease protocol.

Now, how much of this is because the protocols were not in place, how much of this is because they're not good protocols and how much is it because people are just so busy they did not bother to adhere to things that they knew well. I don't know the answer. It's hard to play the blame game at all here, and that's not the point at all.

But it's clear more nurses than not did not feel they entirely knew what they should be doing, they did not feel they had the proper protective equipment which, you know, as Alex, said if you follow CDC protocols, they didn't have the right protective equipment. Months having gone by we've known this was likely to happen the CDC said this for months we'll get a patient with Ebola in the United States. These are the basic things that they should have been able to do well.

CABRERA: And the executive director of that nurses union said, "We are not fear mongering, we're trying to prepare."

The nurses had much more to say what they've been experiencing at Texas Health Presbyterian Hospital. We'll hear that straight ahead when we return, so doctors, stick with me.

(COMMERCIAL BREAK)

CABRERA: Welcome back.

Nurses at that Dallas hospital where two health care workers are now being treated for Ebola are speaking out through a nurse's union this morning. What they have to say is shocking and very troubling.

Just a few moments ago, we played part of their statement where the nurses said they lacked proper equipment in clothing when they were interacting with Thomas Eric Duncan who died of this disease. We want to play you the rest of their statement in its entirety.

Listen.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Were the protocols breached? The nurses say there were no protocols. Some hospital personnel were coming in and out of the isolation areas in the emergency department without having worn the protective equipment. CDC officials who were in the hospital and infectious disease personnel who have not kept the hallways clean.

They're going back and forth between isolation pod and back in the hallways that were not properly cleaned, even after the CDC, infectious control personnel, and doctors exited those hallways after being in the isolation pods.

Advanced preparation that had been done by the hospital primarily consisted of emailing us about one optional lecture or seminar on Ebola. There was no mandate for nurses to attend training or what nurses had to do in the event of arrival of a patient with Ebola like symptoms.

This is a very large hospital. To be effective any classes would have to be offered repeatedly covering all times when nurses work, instead this was treated like hundreds of other seminars that are routinely offered to staff.

There was no hands on training on the use of personal protective equipment for Ebola, no training on the symptoms to look for, no training on what questions to ask. Even when some trainings did occur after Mr. Duncan had bested positive for Ebola, they were limited, and they did not include having every nurse in the training practicing the proper ways to don and doff, put on and take off, the appropriate personal protective equipment to assure that they would not be infected or spread an infection to anyone else.

Guidelines have now been changed several times, but it is not clear what version Nina Pham had available. The hospital later said that their guidelines had changed and that the nurses needed to adhere to them. What has caused confusion is that the guidelines were constantly changing.

It is later asked which guidelines should be followed. The message to the nurses was it's up to you. It is not up to the nurses to be setting the policy the nurses say in face of a virulent disease. They needed be trained optimally and correctly in how to deal with Ebola and the proper PPE doffing, as well as how to dispose of the waste.