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HOUSE CALL WITH DR. SANJAY GUPTA
More Than 100 People Sickened by Swine Flu; How the CDC is Trying to Solve the Disease and Where We Are With the Vaccine; 'Patient Zero'
Aired May 2, 2009 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN HOST: Good morning. You are watching HOUSE CALL. I'm Dr. Sanjay Gupta, reporting to you from Emergency Operations Center here at the Centers for Disease Control.
As we know -- we've been talking about it all week -- more than 100 people have been sickened by what we are calling the swine flu or H1N1 virus. While the investigations around this virus are taking place here, it is somewhat mysterious.
Later on, I'm going to be talking to some of the leaders here at the CDC to find out how they're trying to solve this investigation, and also, where we are with the vaccine.
As you may know, I was in Mexico all week as well. We found someone who, a lot of people are calling, "patient zero." I'll introduce you to him; he's an adorable little boy.
First, we start in the back corridors here at the CDC. Swine flu specimens are coming in from all over the world. What do they do with these specimens, what do they mean, and how close are we to a vaccine?
GUPTA: How many samples have come in here to the CDC?
MICHAEL SHAW, ASSOC. LAB DIR., CDC INFLUENZA DIVISION: I couldn't even tell you.
SHAW: Just for seasonal influenza, we get about 10,000 a year.
GUPTA: With regard to swine flu or H1N1.
SHAW: This one. It's steadily increasing, which is why I'm reluctant to give a number because we are getting them in from states all the time and it's become a challenge just to keep track of. The data entry is getting to be a factor.
GUPTA: What is it about ...
SHAW: About hundreds of them are coming in every day now.
GUPTA: What is it about the CDC that makes it so special? You hear them speaking, "Send it to the CDC for a financial confirmation," what does that mean?
SHAW: Yes. The way the WHO system is set up, there are laboratories for surveillance of the regional activity that can detect the viruses that are out there in circulation. And if they find something they can't identify, there are collaborating centers. When we got a report from southern California that they had a virus that they knew was influenza A but they couldn't tell what subtype it was, it didn't look the seasonal virus. So, it came here right away, we saw what it was, and basically, you know the story from there. The ball started rolling.
GUPTA: Somebody said, "I have never seen this before."
SHAW: That's true. This particular virus, with this particular combination of genes, we have never seen before in humans or animals. It is totally new. The gene composition, we had -- we had seen people occasionally infected with the pig virus that has been circulating for the last 10 years, but, you know, that's just like one person, maybe they'll infect another, it's a dead end.
This one appeared to be different. Plus, it also picked up two genes from pig viruses that are circulating in Europe and Asia. And that was the big surprise, because we've never seen that before.
GUPTA: Are we making a vaccine? What are they doing? Are they making a vaccine?
SHAW: We are -- yes.
SHAW: We are trying every approach we can. We have a strain that we think is a good candidate that has been sent to two laboratories, one in the U.S., one in the U.K., to try to develop a fast-growing version of it that can be sent to the drug companies. We have to characterize it to make sure that it's looking like what's circulating out there, that it hasn't changed in the process of being selected.
But, yes, the first one that we are thinking might be a good choice has gone to the laboratories for the next step.
GUPTA: It's end of April, beginning of May now. When we might see it?
SHAW: Yes. If things go well, something might be in the hands of the manufacturers within a month. We are doing the best we can as fast as we can -- which is the message, I guess, we really want to get out. You know, we are working day and night in trying to get this done.
GUPTA: I still have a lot of questions about all that is happening here at the CDC and how they are coordinating the response to the wine flu. So we sat down and talked with Dr. Anne Schuchat. (BEGIN VIDEOTAPE)
GUPTA: What about the severity of this virus?
DR. ANNE SCHUCHAT, CDC SCIENCE & PUBLIC HEALTH PROGRAM: The severity of the virus is difficult to assess. We are learning every day, and we are thinking that it's really just about one week since we activated our Emergency Operations Center. In trying to understand and predict the severity at one week is like trying to estimate a baseball player's batting average one week into the season.
GUPTA: So, when -- you know, we hear from the Mexican government that things are stabilizing, the fatality rate is going down, the number of hospitalizations is going down. Is that a good sign or is that false reassurance?
SCHUCHAT: Well, I think it's great to hear that and I think it needs to be verified. And I hope that's the case.
We also need to fully understand the scope of what they went through, but it's so important to realize, even if things are getting better in Mexico, and at the point when I hope we see them getting better here in the U.S., we need to be vigilant because influenza can come, it comes back every season regularly.
And when we see novel strains that actually went on to cause pandemics, we sometimes had second or even third waves of disease. So, a decrease in cases this spring doesn't mean that this virus won't continue to circulate and resurge in the fall.
GUPTA: Has a vaccine been recommended now?
SCHUCHAT: No. We are at the stage where we are trying to understand the situation. We are trying to characterize the severity and the epidemiologic characteristics.
GUPTA: We interviewed Mike Shaw, who you may know no doubt, the director of lab or that response team. He says they are working towards developing a vaccine.
SCHUCHAT: Absolutely. So, there's a development stage and then there's a production stage. And what's going on right now is that a vaccine seed strain is being grown-up and characterized. After that step, you end up trying to develop pilot lots, large numbers of doses of the vaccine candidate strain that can be used in studies. So we are definitely moving forward aggressively and Mike is doing a fantastic job with it.
GUPTA: Is there going to be enough Tamiflu?
SCHUCHAT: You know, I know that we have recently been able to order an increased set of regimens for the U.S. Strategic National Stockpile, and we are in so much better shape than we were a few years ago. When we started talking about pandemic preparedness a couple years ago -- I know you've been following the story, Sanjay -- there wasn't that much Tamiflu. And there's a lot now. And there's probably even more now than ever in the past.
This past season, we had some problem with resistance to the drug in one of the seasonal strains, the regular seasonal flu, H1N1, turned out to be resistant to Tamiflu this year. But we are lucky that the production is, you know, is increasing and that we have a better supply than we had. And going forward, you know, looking into the fall, I think the issues of the antiviral drugs and making sure we have the ones that we need in ample supply is important.
GUPTA: I wish you the best of luck. And I'm glad you are here and providing a lot of good information for people. I really appreciate it.
GUPTA: When HOUSE CALL returns, I'm going to give you a tour of this bustling place called the Emergency Operations Center. It's sort of like the nerve center for the CDC. That and medical headlines in 60 seconds.
ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: Welcome back to HOUSE CALL. I'm Elizabeth Cohen with this week's medical headlines.
News this week about a possible breakthrough for autism. Researchers at Vanderbilt University along with scientists around the country have identified the first genetic variation associated with autism. This could possibly lead to genetic testing or even treatment in the future. Scientists looked at about a million pairs of DNA, tested them and found that one particular variation is more common in individuals with autism. The bottom line: Scientists feel they are getting closer to understanding any genetic causes of autism.
And, the FDA issued a new rule requiring over-the-counter pain relievers to carry new bolder warnings about the potential risks of serious side effects. Labels for acetaminophen also known as Tylenol must warn consumers of the risk of severe liver damage. Labels for a class of drugs known as non-steroidal anti-inflammatory drugs must warn of the risk of severe stomach bleeding. The new rule gives manufacturers one year to re-label their products.
And as the swine flu outbreak continues, some people still have questions about whether it's safe to eat pork. So, to be clear, this virus is not spread through eating pork products. Health officials tell CNN the virus isn't spread by eating or handling prepared pork or any other products derived from pigs. However, pork products should always be cooked safely to temperatures of 160 degrees Fahrenheit or 70 degrees Celsius.
The virus is named swine flu because it's normally found in pigs, but people can also get it as we are seeing now.
GUPTA: We had a rather unique look at the Emergency Operations Center for the CDC with the director of this place.
Toby, thank you so much for joining us.
TOBY CRAFTON, OPERATIONS MGR., CDC EOC: My pleasure.
GUPTA: You know, the first thing that struck me when I walked in here, and I said (ph), I've been in this room before, is just how busy this is.
CRAFTON: The operation center here has a staged ramping up procedure and we don't automatically go from nothing to what you see here. So, as time progresses, you know, we go from different stages up to full activation, which we are right now. And the last time that we were really at this level was during Hurricane Katrina.
GUPTA: Right now, all the samples from Mexico for example, we hear suspected cases, we hear confirmed cases -- are they, for the time being, being confirmed here?
CRAFTON: I believe that's correct, yes. I know we are expecting some more cases from Mexico as well. So, that's my understanding.
GUPTA: So, we're looking at a screen and it points (ph) to a lot of people when it comes to how this is going to be treated. But what is this we are looking at, Toby?
CRAFTON: This is case count information that we maintain. It's as of -- as you'll see, they're as of 11:00 o'clock every day. One of the issues that we have to deal with is with the 24-hour news cycle, is maintaining a current picture of the case count. And what we can't do is chase cases all day long.
GUPTA: Is someone literally counting the number of cases?
CRAFTON: Each one of those regions that you see on that map right there has a team of epidemiologists and folks that are working on making sure that they have tracked each one of the cases in that region. And so, they are literally down there getting calls from all those states, talking to the state health officials, talking to the epidemiologists in each state and tracking the numbers. And as the laboratory confirmations get done, they are marrying the information between the epi (ph) case and the lab case and then confirming it and then we start count it as a case.
GUPTA: How does this end? What do you think happens?
CRAFTON: It's hard to say. It's -- right now, there's so much that's still unknown about the severity of the disease here in the United States.
GUPTA: The epicenter of this outbreak -- is it really a pig farm down in Mexico? Well, earlier this week, I traveled down there to try and find "patient zero," the first person infected with this virus.
GUPTA: And we are back with a very special edition of HOUSE CALL.
You know, as the number of cases of H1N1 flu started to accumulate, scientists started to focus their attention on where this virus may have originated. We made our way out of Mexico City, about two hours north, to a small town called La Gloria. This is an area that is in close proximity to pig farms. That is important. Scientists believe that pig farms may have been the source of all this.
We were in search of "patient zero" mainly because we wanted to find out who this affected first, but also, this location, possibly being the ground zero for this H1N1 flu. There are a lot of lessons to be learned here, lessons that potentially can be applied to the rest of the world.
GUPTA (voice-over): As the number of cases of the swine flu build around the world, everyone has been on the hunt for the source.
(on camera): We've long suspected that the origin of swine flu may have been on a pig farm, and now, we are headed towards one, about two hours north of Mexico City. We think we may find where this virus started. We may also find him, Edgar Hernandez -- people believe he is the "patient zero," the first patient to contract the virus.
(voice-over): La Gloria, it's a village where everyone knows someone. I showed this motorcycle rider Edgar's picture. His name is Frederick and he offers to take me.
(on camera): Don't drop me. OK.
So, after hours of searching and hours of driving, we are finally going to meet the little boy that everyone is calling "patient zero."
(voice-over): There he is. Edgar Hernandez, a little 5-year-old boy who got so sick.
(on camera): Did you have a headache? (SPEAKING SPANISH)
EDGAR HERNANDEZ, POSSIBLE FIRST SWINE FLU VICTIM: (SPEAKING SPANISH)
UNIDENTIFIED FEMALE: He had headaches and in the throat.
GUPTA (voice-over): He was brought to this clinic where he was diagnosed as possibly the first case of swine flu of this outbreak. So, where did it come from? Edgar's mom thinks she knows.
(on camera): A lot of people are saying that the swine flu came from a lot of pig farms. Do you believe that? UNIDENTIFIED FEMALE: (SPEAKING SPANISH)
UNIDENTIFIED FEMALE: That's what she hears.
GUPTA: No question we stumbled onto a controversy here. The citizens of La Gloria really believe that the pig farms in the nearby areas got so many of their citizens sick. So, we decided to pay those pig farms a visit.
(voice-over): The industrial pig farm is huge and owned by American company Smithfield Foods. People in town say they believe this is the source of the outbreak.
(on camera): We finally made our way to the hog farm, but the Mexican Department of Agriculture and the company itself say they've done testing and the tests have come back negative. They simply won't let us through security; they simply won't show us the pigs.
(voice-over): This medical mystery now only half-solved. We know who may have first contracted swine flu, we just don't know where he got it.
GUPTA: He is an adorable little boy and he is doing very well, as you can see there. His doctors and his family say he's fully recovered. But scientists are going to be converging here to try and figure out what lessons might be learned.
I should add as well, regarding Smithfield, we got a statement from them that reads, "Smithfield Farms has no reason to believe that the virus is in any way connected to its operations in Mexico. Its joint ventures in Mexico routinely administer influenza virus vaccinations to their swine herds and conduct monthly tests for the presence of swine influenza."
Up next on HOUSE CALL: We're going to go to some of the areas that are hardest hit by H1N1. We're going inside Mexico City to the hospitals.
Stay with HOUSE CALL.
GUPTA: Welcome back to a very special edition of HOUSE CALL. I'm Dr. Sanjay Gupta reporting to you from Mexico.
So, how do you take care of patients in the middle of an outbreak? How do you take care of their physical health? How do you take care of their anxiety?
We went straight into the hospitals to find out.
GUPTA (voice-over): It started off like any other flu, springtime in one of the world's largest cities. But within a week, Mexico City would look like this.
(on camera): It's hard to believe this but what you're looking at is a uniformed officer carrying a rifle outside a public hospital. We are here outside one of the largest public hospitals in Mexico City, you can't get inside. They're very concerned about crowds gathering in the wake of the swine flu.
There are lots of patients inside; many of them waiting to see doctors; many have been here for several hours. They have their masks on but this is what the situation's become here in Mexico City.
(voice-over): Chaos, and yet patients need care. They continue to flood in all day, all night. The question is: how do you treat what you don't understand?
(on camera): They came in. They were in their 20s, 30s and 40s. They weren't the elderly or the very young that we typically associate with the flu, but these are people in the prime of their lives. They were getting sick. They were dying.
And the doctors here were mystified. Over the next couple of weeks, they had a medical mystery to solve and a lot of that solving took place right behind these gates.
(voice-over): We also spoke with Mexico City's mayor.
(on camera): How worried are you?
MAYOR MARCELO EBRARD, MEXICO CITY: Very worried.
GUPTA: Very worried.
(voice-over): The hospitals are overwhelmed not only with patients but also with press. But we were able to get in.
(on camera): I tell you what, it's next to impossible to get into a hospital like this one. Finally, I told them I was a doctor. They let me in with a small camera so we could try and figure out how they're taking care of these patients with the swine flu. Let's take a look.
(voice-over): We now know, over the last two weeks, nearly 2,000 people came to hospitals like this one in Mexico, and around 150 died.
(on camera): As you can see, this is one of the hallways where they're taking care of a lot of the patients with the swine flu. As you can notice here, there are no patients in the hallway. They're trying to keep all the patients sequestered in a room.
(voice-over): But the key to all of this is figuring out who exactly needs treatment.
(on camera): One of the things that's so critical in an outbreak like this is trying to identify patients early for patients at hospitals like this for two weeks before anyone could figure out what was going on. Finally, someone realized there was probably a virus that the world had never seen before and they went to laboratories like this one to try and sort that out.
(WOMAN SPEAKING SPANISH)
GUPTA (voice-over): The hospital management did not want us to see these hospital workers, upset because they weren't given masks or meds. They came out anyway and told us.
Under all the pressure, Mexico City in springtime is starting to show cracks and everyone is hoping the swine flu can be controlled -- and soon.
GUPTA: And there's lots of questions coming up about this outbreak called the H1N1 or swine flu outbreak. You've got questions, we've got answers.
Stay with HOUSE CALL.
GUPTA: We're back with a special edition of HOUSE CALL here from the CDC's Emergency Operations Center.
You know, we can't help but noticing that all this talk about the swine flu and H1N1 virus, it's got a lot of people worried and it's raised a lot of questions. We want to give you some answers. Here's Elizabeth Cohen with your "Empowered Patient."
COHEN: Sanjay, my inbox runneth over as I'm sure your does, too, with questions about swine flu -- not to mention my Tweeter account and my Facebook account. So, this week in "Empowered Patient," I answer 15 questions about swine flu. And I'd like to answer three of them here right now.
First of all, just how contagious is swine flu? Well, we know that it's spreading from person-to-person. That's definitely clear. However, it is important to note that it's actually -- it's not spreading like wildfire. For example, the little boy in Texas who died from swine flu, no one in his immediate family caught it from him. So, you can imagine parents or grandparents taking care of this child. They didn't get sick. So, I think that's an important thing to mention.
Also, as far as we know, no one's gotten swine flu from being, let's say, on an airplane with someone with swine flu. So, that's also important to keep in mind.
Second question: how close do you have to be to a sick person to get swine flu from them? Experts tell me three to six feet. That's what's considered the breathing zone. However, it needs to be in an enclosed space and for a certain amount of time. Just passing someone on the street is not going to give you swine flu.
And last, should I be freaking out? No. You should not be freaking out. The experts I talked to were unanimous on this point. They said: arm yourself with information and then make decisions about what you want to do to stay safe. Now, arming yourself with information, that's when you go to CNN.com/EmpoweredPatient, where I have these 15 questions asked and answered -- Sanjay?
GUPTA: I'll tell you, I have a feeling this place, the Emergency Operations Center, is going to stay busy for some time to come. They've been working 24 hours a day for over a week now and they say it could last many weeks into the future still.
Unfortunately, that's all the time we have for today. If you miss any part of today's show, be sure to check out my podcast: CNN.com/podcasting.
And remember, this is the place for the answers to all of your medical questions. You can watch the show, you can join us at CNN.com/health and I'm Twittering. We've got a lot of followers: Sanjay Gupta CNN.
Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.