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Second Ebola Infected Patient Arrived in Atlanta at Emory University Hospital for Treatment

Aired October 15, 2014 - 23:00   ET


ANDERSON COOPER, CNN ANCHOR: Don, thank you very much.

Good evening, everyone. As Don said we are live in Dallas tonight with fast moving developments in the Ebola crisis.

Now, just a short time ago, the latest nurse to be diagnosed with Ebola arrived in Atlanta for treatment at Emory University hospital. She was able to walk with some assistance. Breaking news tonight, we are learning that at least part of the reason sunny was moved is because of some concern that health care worker at this hospital may walk out. More on that in a moment.

29-year-old Amber Vinson tested positive, as you know, after caring for Thomas Eric Duncan who died last week here at Texas Presbyterian hospital. More breaking news as well, a top hospital official is now apologizing for the fact that Duncan was initially sent home with a prescription for antibiotics and was told to take Tylenol.

In a written statement to be delivered at a hearing on Capitol Hill, the chief clinical officer and senior executive vice president for Texas health resources writes and I quote, "unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and highly skilled medical team, we made mistakes. We did not correctly diagnose his symptoms of those of Ebola. We are deeply sorry."

Also tonight, there has been a lot of concern because Vinson took a commercial flight from Cleveland to Dallas just two days ago. Concern that she may have exposed hundreds of people to Ebola since she had an elevated temperature at the time she boarded the flight.

The head of the CDC, says that never should have happened. She never should have gotten on the flight. But we also have learned tonight that Dr. Sanjay Gupta has learned that Vinson actually called the CDC before she got on the flight and no one said, don't fly.

Not only that, there have been changes to the CDC guidelines of what even constitutes a fever. So there is a lot to get to in this hour. Sanjay joins me live.

So explain what happened here. She called someone at the CDC to report her temperature. But she was still able to get on the flight. They said, OK.

DOCTOR SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, that's what it sounds like, Andersen. And I think that is very surprising, obviously, given all that we have know about Ebola. And some of the concerns about flights coming out of West Africa for example.

But here is the scenario. She flew from Dallas to Cleveland on October 10th. On October 13th, she is flying back. Now mind you, this is after she has taken care of Mr. Duncan who by this point, they, everyone knew had -- had Ebola.

She is taking her temperature. That's what she is told to do, self- monitor. The morning of the 13th, she takes her temperature. It is 99.5. She calls the centers for disease control and says she is in Cleveland. She is going to get on a flight. Her temperature is 99.5. And she has not told to, not take the flight. There is no guidance given to her. So that's why she got on the flight and flew back to Dallas.

Very different from what we heard from Dr. Frieden who said she fell into the sort of category of controlled movement. Meaning that, having been somebody who took care of a patient with Ebola, she should not have been on commercial flight. That she was going to travel at all. That she should have been on a charter flight or by car. But she should never have been able to get on a commercial flight in the first place. We know she did despite reporting an elevation in temperature, Anderson.

COOPER: I mean, good for her for calling the CDC. But, I mean, as you pointed out earlier when we talked about this. Had she been in West Africa and gone to the airport and told somebody, yes, I had been treating an Ebola patient O and I have a slightly elevated temperature, they wouldn't have let her on the flight.

GUPTA: No. And that's what I find so surprising. And frankly, startling, you know, in West Africa, we have been talking about the screening protocols for some place. My colleague, Elizabeth Cohen returned from Liberia not that long ago. They take your temperature, first of all, so she would have been found to have an elevated temperature. They give you a questionnaire. One of the primary questions you have been asking. Have you been around anybody with Ebola? She clearly had. If she had answered yes to that question, that would have been flagged. And she likely would not have been able to take the flight. She would have gotten more questions. But ultimately, not been allowed to board a comer flight.

That's West Africa. Here in the United States, despite the fact she fit the criteria, she was able to get on a commercial flight. Her temperature was 99.5 and she had contact. She was caring for a very sick patient with Ebola.

COOPER: You know, why is this significant about the CDC, changing the guidelines on what constitutes a fever with, with Ebola. Why is that important for people to understand?

GUPTA: Well, you know. We place a lot of faith in the fact that what is considered symptomatic from Ebola. And fever is one of the first signs. And it is one of the things that they use for screening tests as a sort of a precursor, you know. This is going to be one of the first symptoms of Ebola. So you can catch it early. 101.5 has been the number. You look at the CDC guidelines. Recently,

it said 101.5. Now, they lowered it to 100.4. That means that people who have a lower temperature could still be at risk of getting Ebola. You may have felt, you know, pretty comfortable saying, look, my fever is not 101.5. So my chances are pretty low. Now they're saying if it is 100.4. You are still potentially going to be someone at risk.

What drove this, Anderson. And I find this fascinating is the first nurse, Nina Pham, when she got sick, and had the symptoms of Ebola, her temperature was not 101.5. It was lower than that. And that got the doctors and obviously, everyone thinking. So she develop symptoms of Ebola without a true fever as we have defined it. Maybe we should revise our guidelines.

COOPER: So, what -- I mean, to me, what stand out about this, and correct me if I am wrong, is that, because all along we have been saying based on what the CDC has said is that until you have that fever of 101.5, you really can't -- you are not -- you can't contaminate somebody else. You can't give somebody else Ebola if you, yourself, are infected. Now, it seems what the CDC is saying is well, actually that wasn't true. Now, we think it's 100.4 that you'll, that you are actually sick with it and that you are able to transmit it to others. Is that correct? So, are they essentially just kind of correcting themselves after, kind offing sure people that they knew exactly the parameters on this thing?

GUPTA: I mean, they're clearly revising their guidelines because, now they have evidence of this, this patient, the nurse, the first nurse, who clearly had, all of the, many of the other symptoms of Ebola. The nausea, vomiting, perhaps. Things that would be very concerning but did not have the fever of 101.5.

So, just placing so much faith in the, if someone doesn't have a 101.5 temperature, we don't really worry about that. That seems to be, poor thinking. And now we are saying, even lower than that, you could still develop the symptoms of Ebola.

It is fair to say that still, if you don't have other symptoms, if you are not vomiting, if you don't have some of the symptoms in your, that are associated with bodily fluids, you are still going to be low risk just for spreading the virus. But what is considered symptomatic, big question, that seems to be changing. It seems to be getting to encompass a larger group of people than we previously thought.

COOPER: I wondered, Sanjay -- stay with us. I want to bring in Jeremy Boal. He is the executive vice president, chief medical officer of New York's Mount Sinai health system.

Thanks so much, Dr. Boal, for being with us. You say that nobody should ever work with Ebola patients unless they're confident that they have been trained to use the protective equipment and that's one of the thing that nurses at the hospital here have apparently been protesting. They didn't have enough training or even proper protocols to follow. I talked to Dr. McCormack who said he talked to nurses at another hospital in, in Texas, who said that, basically, they were told to just watch videos on You Tube. Does that worry you? DR. JEREMY BOAL, EXECUTIVE VICE PRESIDENT, CHIEF MEDICAL OFFICER OF

NEW YORK'S MOUNT SINAI HEALTH SYSTEM: You know, it does worry me. I think at the at the end of the day, every nurse, everybody who comes in contact with a patient who either is at risk for Ebola or has Ebola has to be fully trained and feel very confident, not only that they know how to use the equipment, but they're using it with a buddy who is watching and making sure that they're putting it on the right way and removing it. Donning and doffing correctly.

Because when patients with Ebola are most infectious, when you know, the sickest, you know, and they are having vomiting and diarrhea and the like, that, those steps become incredibly important in terms of preventing transmission.

So I get very concern when I hear that a plan for keeping workers safe is really just to watch some videos. I think that is fine for general education. But when it comes down to actually treating a patient, there needs to be very serious attention and drilling of the staff until they are confident and feel confident they know how to use the equipment.

COOPER: Because I know at Mount Sinai, I talked to one doctor on the program the other day, (INAUDIBLE) who said that early o, you know, there was a scare in Mt. Sinai. And early on, when the CDC first sent out, kind of a heads-up bulletin to Mount Sinai and other hospitals saying, you know be on the lookout. You guys started drilling and kind of preparing for this. It is certainly seems like that did not happen at this facility.

BOAL: You know, that is certainly how it seems. Obviously, we don't have all the facts on the ground from Dallas. But even in the health system like the Mount Sinai health system, you know, this isn't something that you can fix overnight. We spent a number of months now doing drilling, doing an enormous amount of work with our frontline stuff who are likely to encounter a patient at risk for having Ebola or with Ebola. And we are not even satisfied with the work we have done yet.

This is, you now, people say that safety is a dynamic nonevent. In other words, it takes an enormous amount of energy and effort to create an environment where nobody gets hurt. And unless everybody is attending to that, I do think we are imposing risk on our stuff that isn't appropriate.

COOPER: Sanjay, I have been surprised about, and I have talked about this before in the program, just by the lack of transparency that we are getting here from this hospital in Dallas, and this is not to bash or point fingers at them. But I do think transparency is really important in a situation like this, not just to inform the public but t inform other hospitals about what went right and more importantly what went wrong. What didn't work.

This hospital has not been transparent at all. We have heard nothing directly from the hospital really, about the problem that they faced, about what went wrong, what they didn't do right. And now, we have a health official tomorrow who is going to apologizing before Congress with any level of detail about what actually went wrong.

GUPTA: Those details are so important, Anderson, for the exact reasons. Look, I mean, it is probably incredibly uncomfortable for the officials in this hospital to apologize, to admit their mistakes in the situation. But as you point out, and correctly, it is really not, that's not the most important point anymore. The most important point is that this is a good hospital. It has a great reputation. And yet the mistakes were made. The same sorts of mistakes could be made at other hospitals.

The other hospitals need to hear from them what happened here in Dallas because there are going to be other patients that arrive in the United States. They can be cared for quite easily. I think the Ebola can been contained. It has been in many parts around the world -- in Western and central Africa certainly for decade. It can be done here as well.

But what went wrong? My guess not going to be stuff that is particularly complicated or difficult to fix. But if they've don't know what the problem is, then how are you going to fix it? And so, I think they need to be incredibly transparent. And I hope that we hear some of that tomorrow during those hearings.

COOPER: Yes, Doctor Boal, I mean, do you guys, I mean, at the hospital, do you have some sort of, even private communications with other hospitals like, does this hospital contact you and say, you know what, here is what we did wrong? I mean, I am not even saying that they need to tell the media about it. But it would give me a level of confidence of at least they were communicating with other hospitals. Does it work like that at all? My sense is it doesn't?

BOAL: You know, I think there is some internal communication that occurs between hospitals. We haven't had a communication with this hospital per se. But we have been in close contact with Emory, with other hospitals in New York, with the department of health leadership here in New York, because what we are trying to do is share best practice to figure out, you know, what can we learn from our colleagues and peers so that we don't repeat mistakes that are avoidable.

COOPER: Yes, Dr. Boal. I know we are going to have more with you and Sanjay as well. Stick around. We are going more with you later on in this hour, including answering -- answers to viewer question about Ebola because we are getting flooded with questions, fears, and concerns about the disease that spread beyond Dallas, obviously. Because this latest nurse to be infected traveled via commercial airline just before she was diagnosed.

Amber Vinson is her name. She went on a trip to Ohio. Returned to Dallas just two days ago. Now, that trip has affected Kent State University where her parents and another relative work.

Susan Candiotti joins me live with the latest on that.

So what do we know about how Vinson spend her weekend in Ohio. Because I saw a statement from Kent saying she did not come on campus. She, you know, there was no risk to anybody on campus.


Yes, we really don't know much about how she spent her weekend here. She flew here on a Friday and went back to Dallas on Monday. But we don't know with whom she met other than being at home. Did she go someplace else? Did meet with other friends? We don't have the details now.

But as you said Kent State University did make the point that she did not visit the campus here. She graduated here, got her nursing degree and Bachelor of Science degree from here as recently as 2008.

COOPER: Her parent and another relative did visit the campus as I understand. But, I mean there is no way they could have, even if they, they had become infected by her, they wouldn't have, gotten come down with it so quickly to pass it to others, correct?

CANDIOTTI: It is really unlikely. But certainly her parents and one of the relative do work here on the campus. Kent State said that they're not faculty member. They have other jobs here that they won't characterize or define in any way. And they said that they came here to work here, as they normally do, on Monday and Tuesday. And they think even on Wednesday, today.

But once they found out, from the nurse, from their daughter, from Vinson, that she had become ill. The parents immediately contacted Kent State University. Told them about it. And they were told to just go home and stay at home for the next 21 days as a precaution.

It's not clear whether they're there, in a mandatory basis or, it is voluntary. But, they haven't been back to work here. And there is no major concern here on campus.

CANDIOTTI: All right, Susan. Good information. Thanks, Susan Candiotti.

Unfortunately, started to become a refrain in the story, concerns of Ebola spreading throughout the neighborhood where these patients live. It happened at Thomas Duncan's apartment complex and the nurse Nina Pham's neighborhood. And now the Dallas area where Amber Vinson calls home.

Gary Tuchman was there.


GARY TUCHMAN, CNN NATIONAL CORRESPONDENT (voice-over): Amber Vinson's home in the village apartment complex. It is just a few minutes from the hospital where she works as a nurse.

Sadly, there is a routine we are getting used to when a case of Ebola is diagnosed in Dallas. The police arrive. Their crime tape goes up. Hazmat workers arrive. Their trucks pull in. News choppers fly overhead. And all of the cameras focus on the victim's home.

The ritual also includes authorities texting, calling and knocking on the doors of neighbors.

UNIDENTIFIED MALE: They told me there was an Ebola patient in my apartment complex.

UNIDENTIFIED MALE: We were -- woken up by 6:15 in the morning with a notification that a third Ebola case had been verified.

UNIDENTIFIED MALE: I mean, I have some friend that are, that I thought we a little overly paranoid. But now it is right across the street from me it is a little scary.

UNIDENTIFIED MALE: That's the worst thing you can do is panic.

TUCHMAN: I agree? Are you anxious?

UNIDENTIFIED MALE: A little anxious. A little anxious, only, I want to know where is it going, where is it going to lead to.

UNIDENTIFIED MALE: I had a bad stomach virus about four days ago. It went away two days ago. And I feel totally fine now. But if I would still be sick right now I probably would be pretty scared.

TUCHMAN: (INAUDIBLE) is also a neighbor. What she tells us about a part time job she has also tells us about the times we are living in.

UNIDENTIFIED FEMALE: This morning I was babysitting a woman with a 3- year-old, and a newborn, and she had multiple baby sitters and some of them have nurse jobs. She told the ones who are nurses that she didn't want their services any more. She is understandable. But from my view I like of look, wow, that is a pretty major decision to cancel someone's job.

TUCHMAN: You are saying she canceled the nurses because there are two nurses that have come down with Ebola, afraid to have nurses?


TUCHMAN: Tomas (INAUDIBLE) says he and his wife have vowed not to change their lifestyle, but to stay aware.

UNIDENTIFIED MALE: We keep informed what is going on. And now that it is here, more so.

TUCHMAN: That's the way so many people feel in this neighborhood and this city.


COOPER: Gary Tuchman joins me.

Do you find people are frustrated -- I mean, expressing frustration about the lack of transparency from the hospital. Do you find people expressing that to you as well?

TUCHMAN: Yes. All over the city, people are bewildered with the lack of communication from the hospital. This hospital is a very respected institution in this community. I have a buddy who I went to high school with in New Jersey, moved to Dallas. Two weeks ago he had retina surgery. And he was at the same time as Mr. Duncan. He said he had topnotch care.

We are seeing now in the community, a lot of people saying maybe there is a person or persons in this hospital, more concerned with, covering their behind than giving out relevant information.

COOPER: It does seem like they are circling the wagons just to kind of protect themselves. And hopefully, that will change in a couple days. We will see.

Gary, appreciate the reporting from the neighborhood.

Quick reminder, you can always set your DVR so you can watch "360" whenever you like.

Just ahead tonight in this hour, how medical groups treating Ebola patients in West Africa, how they're managing to keep most if not all of their workers safe. Because this is really interesting. They don't have the same high-tech equipment as a lot of these hospitals do. They're working very tough conditions. But what they say they need to keep battling the outbreak is going to interest you.

Plus the litany of missteps here in Dallas that began with misdiagnosing with Thomas Duncan. And really only seemed to keep getting worse. More on allegations from nurses that cared about him from the nurses union.

We'll be right back.


COOPER: Welcome back.

We have more breaking news tonight. Texas Presbyterian Hospital in Dallas, just release aid statement about how it is protecting its employees and the public at large.

The statement read in part and I quote "Texas health Dallas is offering a room to any of our impacted employees who would look to stay here to avoid even the remote possibility of any potential exposure to family, friends and the broader public. We are doing this for employees' peace of mind and comfort. It is not a medical recommendation," they say. "We will make available employees who treated Mr. Duncan, a room in a separate part of the hospital throughout their monitoring period."

So that is after a second nurse, obviously, Amber Vinson contracted Ebola. Now, she arrived at Emory University hospital in Atlanta for treatment. Just this evening, Vinson and her co-worker, Nina Pham, are the first U.S. health care workers to be infected with Ebola inside American hospital.

Now, there are part of a much larger story. Today, the World Health Organization said that nearly 9,000 people have been infected with Ebola, mostly in Guinea, Liberia, and Sierra Leone. More than 4400 people have died so far. Those numbers include 427 health care workers have fallen ill in Africa, 236 of whom have died. Even highly experienced groups, like doctors without borders have lost workers in this epidemic, something unusual for them.

For most part, they're able to keep their workers safe because of their much admired safety protocols. Sean Casey is the Ebola emergency response team director for international medical core which opened its Ebola treatment here in Liberia a month ago. I spoke to him earlier.


COOPER: Sean, talk to me about the protocols that you use through IMC and your clinics. I mean, is there -- the protection health care workers, is it about the kind of gear, is it about the protocols that are in place, that the simplicity of the training, what?

SEAN CASEY, INTERNATIONAL MEDICAL CORPS: Right. It is important to have the right gear. We use the same standard, doctors without borders, tie chem suits and with separate hoods, has three pairs of gloves in some case. But the most important thing is how you take it off really. And that is up to 20 steps that have to be followed sequentially, it has to be supervised. And so, we have safety inspectors who watch our staff doff their personal protective equipment. So they call out every motion.

COOPER: Those protocols were not in place clearly early on at this hospital here in Dallas. And the protective gear they were using it not as advanced as protective gear you were using. Your clinic has been open for a month. None of your health care workers has been infected, but it isn't the most sophisticated medical facilities. That's what is interesting.

So I think a lot of people assume well, a hospital in the United States treating Ebola patient, in it is in extremely sophisticated facility, but that's not, necessarily, what's going to make the difference.


Our Ebola treatment unit here in Liberia is in the forest, actually, down a dirt road next to a leper colony. And we have over 100 patients in the last month since we opened. And our staffers say, it is really not the sophistication of the equipment that we have, it is just about following simple protocols about how the equipment is put on, how it is taken off, and how we move within the Ebola treatment unit to not contaminate ourselves and to keep our hands clean.

COOPER: So does it surprise you've the problems medical workers are having in the United States at least at this hospital?

CASEY: Well, it's not entirely surprising because I think our staff have had more training than some staff in -- would have in the United States. Because we are trained to do exactly what we are doing. This is all that we do here. COOPER: I mean, Sean there has been talk here in the United States of

travel bans, of stopping commercial flights. Do you have a problem keeping staff, getting staff in and out? Because that's one of the arguments against some sort of, an all-out ban. That it would make it more difficult for aid workers to come back and forth?

CASEY: Yes. The international air connections are critical for our staff, our volunteers and our supplies to get here. And there is a physical issue and a psychological issues. The physical issue is that we need to move bodies and supplies to get here. And if we don't have those flight connections that becomes much more complicated. The Psychological barriers is we need people to feel confident coming here. And if they're not sure that they're going to be able to get home, it's harder to recruit and it is harder to retain.

COOPER: I heard some aid workers say little, look, there just needs to be a greater footprint on the ground. There needs to be more personnel from more organizations, from more countries, from governments involved, money that is being donated. There just need to be more on the ground in these countries, is that what you are seeing as well?

CASEY: Yes. We need more of everything, actually. I mean, you have been in the Philippines, and in Haiti after disasters in those places. And there is a rush of organizations and aid workers within days. And here it has been months of trickle. We -- we just don't have enough hand on deck. There aren't enough organizations.

Some of the resources are starting to come in. But this is an enormous task that covers multiple countries. It requires technical expertise, infrastructure, all kinds of things that have to happen simultaneously. And we are not moving fast enough.

COOPER: Sean Casey, appreciate all you and your organization are doing. Thank you so much.

CASEY: Thank you, Anderson.


COOPER: Just want to underline something Sean said there at the end. They're not moving fast enough. There are just not enough personnel on the ground. There is not enough government donating money, governments donating -- sending medical personnel over there, groups, sending medical personnel over there. It -- this thing is not under control. And until it is under control in, in Liberia, in Sierra Leone, in Guinea, it is going to continue to be a problem everywhere else in the world.

Chief medical correspondent, Dr. Sanjay Gupta, joins me again. Also, Dr. Pardis Sabeti, a geneticist and an infectious disease researcher at Harvard University joins me.

So Sanjay, Sean who was just saying there, I mean, his treatment center, you know, as he said, he is in a forest down a dirt road next to a, you know treatment center for people who have leprosy or (INAUDIBLE) disease. To keep the staff safe, you don't necessarily need the most high tech sophisticated hospital to contain this virus. And yet, this high tech sophisticated hospital in Dallas clearly couldn't handle it the way they should have.

GUPTA: It was a great interview and it made some really important points. And you know, I hope everyone hears that point. Because the idea of keeping the health care workers safe is something that can be done, is being done, and when it is being done, it is being done in some really remote tough spots around the word. So, you know, if you are asking yourself right now, watching this. If they can do it in western and central Africa and without hardly any resources, why couldn't they do it in Dallas? And if you are asking the question, you are asking the right question to yourself right now.

This isn't challenging in terms of what needs to be done. I mean, we know that this spreads through bodily fluids. And we know that if that -- those bodily fluids get on your skin, you have breaks in your skin and that can be a source of infection. So cover your skin.

You know, I hate to sound so simplistic, but that's a sounds basic. And then, we know the protocols at the -- that the Ebola, protocols from the CDC there in Dallas did not always allow the skin to be covered. So Sean made some really good points.

COOPER: Yes. I did think so as well.

Dr. Sabeti, I mean, I find what you do fascinating. This whole idea of, you know, genetic research. Your researches trace the origins of this strain of Ebola that is called the Zaire strain back to a single infection last December. What have you learned about it? And how concerned are you about the ability of this virus, to -- to, to transmit? Because that WHO, the world health organization, they're warning of possibly 10,000 new cases a week. Currently there is about a thousand new cases a week, 10,000 cases a week by this December if things continue down this path.

DR. PARDIS SABETI, GENETICIST, HARVARD UNIVERSITY: Absolutely, Anderson. And that's a, of course, a major concern. And it has been a concern for a very long time what's going on in Liberia, in Sierra Leone and in Guinea.

The important thing, though, to note is that this is something that we can contain. This is a virus. And actually, that even though a lot of people have been talking about the transmission, the transmission is trackable, right? We always know who contacted who. These are air droplets that may be people with close connection with each other. But we can actually, with good diagnostic, good contact tracing, really pursue this in other countries. And then focus our attention on Liberia, Sierra Leone, and Guinea.

So I think this is a situation that is challenging, but we have the tools to do it.

COOPER: And Dr. Sabeti, where did you trace this? I mean, when did it, this outbreak, do you know where it started and how? SABETI: Well right now we have limited -- we have limited samples

that we are able to sequence. But the sequencing technology is available that as we have samples and we can analyze them, we can say what is going on.

And what we see is actually that, a few strains that were sequenced in Guinea, and a number that we sequence in Sierra Leone, shows a single transmission event likely, you know, now have been predicted to be a child in Guinea. But that we are seeing these individual transmissions. So we can actually trace this transmissions through the sequence of the virus. So we can see who is likely to have transmitted to who.

COOPER: It is fascinating work.

Sanjay, there is word tonight that the CDC might, and we emphasize might, add Ebola patients to in infectious disease in no fly list. They are not even Ebola patients, but people who have in some way had connection with Ebola patients to a no fly list in conjunction with department of homeland security. Is that a good idea? Does that make sense?

GUPTA: I think it probably does make sense. And I think Dr. Frieden eluded to that today in his comments. I mean, he said that patients who are being monitored, either self-monitoring, taking their own temperature, or being actively monitored, or someone comes in and takes their temperatures for them and records that, they shouldn't be flying. He said they shouldn't been getting on commercial flights. So they can get on charter flights. They could get in their cars and drive around. But they should not be on commercial flights.

So, the way he describes it, Anderson, it sound like that was already their recommendation. So, enforcing it, giving it teeth through an actual no fly list, it does seem to make some sense.

COOPER: Doctor Sabeti, there is always a fear amongst some people that a virus can mutate and somehow in this case become airborne. Is that a real possibility with Ebola?

SABETI: So there has been a lot of discussion about this idea of airborne or not airborne. Ebola can be transmitted in small particles, in droplets. That's why health care workers are at great risk and why we have to focus on individuals with these sorts of singular contacts.

Airborne is a much different thing. It usually happens with respiratory viruses, usually happens with a virus that can be dried into droplets and go, sort of in the air. And that's obviously a very frightening idea. Because it is something where you wouldn't know who infected you.

That is likely many mutational steps away for this virus. So that is not the main thing we should be concerned about. Nonetheless, we know the virus does change over time. And it is having a lot of human to human transmissions. Most important thing we should do is regardless stop the virus. And so, we need to set up diagnostic capacity across the countries, all countries to make sure we can detect it, and then, we can focus our attention on countries that need our help right now.

COOPER: Dr, Pardis Sebati, appreciate you being on the program. Thank you. Sanjay, stay with us as well.

Up next, the crucial missteps at the Dallas hospital, how we got to this point? I want to get to Sanjay's take on all that. And we will answer some questions from you, our viewers. We'll be right back.


COOPER: Welcome back.

We have been hearing from a lot of you asking some important questions about Ebola. So we wanted to take some time tonight just to answer some of them with Dr. Sanjay Gupta in Atlanta, at Emory University and Dr. Jeremy Boal, chief medical officer of the Mount Sinai health system in New York City.

Sanjay, let me start with you. One of our viewers, Madeline posted on facebook, what happens when a sick person goes to emergency and then he is diagnosed with Ebola, while entering the building or elevator, talking to nurses on check-in, all those people are exposed. How is that taking care of for walk-ins? What would be the protocol?

GUPTA: Well it is a very good question and it's not going to be a, completely precise answer. But here's how things should work. If there is a suspicion, so based on travel history, based on symptoms, based on those things, the suspicion someone has Ebola, the first step is that the person should be put in the isolation. So you right away want to mitigate, minimize, the number of people the person comes in contact with. Can't make that zero because, obviously, someone is going to evaluate the patient, initially take a history all of that. But you want to reduce it as much as possible.

By the way, Anderson, as you know, it doesn't sound look that is what happened in the case of Mr. Duncan. It sounds like even after the suspicion was raise about him, he was still in another room with some seven patients. That shouldn't have happened.

COOPER: And then -- but then, the person who check the patient in, who took their information and social number, would that person then have to just monitor themselves for the next 21 days?

GUPTA: Yes. So people who are considered, you know, potentially have come in contact with the patient, they may not have been providing direct care, but close enough to potentially be a contact, they would have to usually self monitor, then taking their own temperature for 21 days.

COOPER: And Sanjay, you and I talked about this a little bit last night. And nurses were told apparently to put tape around their necks early on. Would that work as a preventative measure? I mean, I have never heard of that.

GUPTA: No, I never heard of that either. I actually have some of these tapes here. I wanted to show you. This is what they're talking about. And the concern was the nurses said their necks were not covered. And that was a potential portal of entry. They were literally told them I am going to ask to this, Anderson, because it is ridiculous. But they were told actually to put the tape around their neck. Wrap it around four to five pieces of this tape and wrap it around. It's not even -- it is permeable. So that wouldn't do the job even if they did do this to.

So, you know, but to be clear, I don't think that this was some sort of hospital policy. I mean, what it sounds like, it was somebody who was frustrated. Didn't have a good answer in terms of how these nurses should protect their neck and said maybe just wrapping tape around it would be, an option. Turns out that was a bad option. But I don't think that was hospital policy by any means.

COOPER: Dr. Boal, Dee on facebook was wondering why are people who are being monitored not under quarantine?

BOAL: So folks who are being monitored who don't have a fever and don't have any symptoms, they're not infectious. And they're not at risk to anybody. The monitoring is, to catch somebody early on in the process. So they can be put into a qua quarantine situation if they become infectious. But if they have -- if they have been exposed and they no fever and no symptoms, they're not at risk to anybody.

COOPER: And Dr. Boal, are you confident that we know enough about Ebola to really determine when somebody is infectious? Because now the CDC 00 I mean, originally people are talking about, you know, temperature of 101.5, now it is, you know, 100.4. So it seems like that is kind of shifting a little?

BOAL: You know, I think that what the CDC is trying to do is to cast the broadest possible net so that nobody who is infectious slips through and is assume to be not infectious. If one is a symptomatic, if there -- they have normal healthy immune system as vast the majority of people do and they have no fever and no symptoms, I do think that is a reasonable standard to say they're not infectious.

Now, whether they become infectious at 100.4 or 101.5 I think is debatable and I do think it is the smart move when we don't know to move that back to 100, 100.4. Really, any evidence of fever at all. Let's just be safe. And keep other people safe.

COOPER: Right.

Dr. Boal, appreciate you sticking around and answering questions. Thanks very much. Sanjay, as well as always.

Up next, my conversation with Dr. Kent Brantly. He is a remarkable man, an Ebola survivor. He has been donating his own plasma to other Ebola patients here in the United States.

We'll hear from him ahead.


COOPER: Well, the midst of the Ebola crisis, there are a few success stories, very few, I should point out, one of them is Dr. Kent Brantly, an Ebola survivor. He and Nancy Writebol contracted, another American missionary worker contracted the virus while caring for Ebola patients and their families in Liberia. They were treated at Emory University hospital in Atlanta and both recovered.

Here is Dr. Brantly saying good-bye to the team at Emory who cared for him. He was released in late August. His work helping Ebola patients has not stopped however. Dr. Brantly donated plasma, his own plasma, to three patients in the United States.

Dr. Rick Sacra, his colleague at Samaritan's Purse, the freelance cameraman Ashuka Mukpo as well, as both of those right now in Nebraska Medical center, and most recently here in Dallas, to nurse Nina Pham. Dr. Brantly also continues to advocate passionately for the patients in West Africa. I spoke to him earlier today.


COOPER: First of all. How are you doing?


COOPER: Yes. Do you feel back to full strength?

BRANTLY: I don't know when I will say I feel back to normal. But my strength, my stamina and my energy are improving a lot. I feel a lot better than two weeks ago.

COOPER: When you heard about this latest case in the United States, I am wondering what want through your mind?

BRANTLY: My heart just sank. You know, health care workers go into this profession to serve people, to relieve suffering, to cure disease, to come alongside people in the worst times of their lives. And now, were we have a second health scare worker in Dallas who is doing just that for a patient suffering greatly. And now she is sick. And it just, made my heart sink. Ha been praying all over again for the staff of the hospital there.

COOPER: There is obviously a lot of concern in the United States about the spread of the disease here. And not only, what's happening in West Africa, but the spread of disease here. Do you think that concern about Ebola spreading to the United States is justified? Do you worry about Ebola spreading to the U.S.?

BRANTLY: I think there is a lot of irrational fear about Ebola spreading in the United States. We think about what weave have seen so far, we had one man who came from Liberia, contracted the disease there. Came to America and got sick here. And now who else has the gotten sequester sick from him? It is two health care workers who were taking intimate care of him, cleaning up his bodily secretions, dealing with his blood and medical procedures, those are the two who have gotten sick. Not 48 people somewhat people being tracked by the CDC.

COOPER: The 48 who had contact with him. BRANTLY: Contacted him in the community. No one from that group has

gotten sick. It is the people who were taking close care of him in a hospital setting.

COOPER: Do you know how you got it? I mean, was there a moment that you look back on it and say that was it. That was the moment?

BRANTLY: I'm convinced that I did not get Ebola in the isolation unit.

COOPER: Really.

BRANTLY: Our process there was safe. Every time I went into the unit full of Ebola patient, I was fully suited up. In the suit.

COOPER: Every part of your skin covered?

BRANTLY: Every centimeter. Every inch.

COOPER: And there is, you know, there is a sentiment, let's stop flights (INAUDIBLE) who have kind of shut down contact with West Africa. But the truth of the matter is, regardless of what went things about having flights, until this is dealt with in West Africa, until the outbreak is controlled and stopped in West Africa, it is going to continue to come to the United States. It is going to come to Western Europe. It is going to continue to, at least the possibility of spreading around the world?

BRANTLY: That's absolutely correct. Until this epidemic is stopped in West Africa, it will continue to be a global problem. There have been suspected or confirmed cases in the United States, in Spain, in Brazil had a suspected case. We are talking about three continents outside of Africa that have been affected by this epidemic, this outbreak. And the answer is not simply close the borders and, and let them deal with it themselves. We have got to be proactive. We have to go -- put an end to this epidemic or it is going to keep coming back to cause problems and suffering in the global community.

COOPER: You have done something which is really struck a lot of people. You have repeatedly donated your own blood, your own plasma in order to help those who have been affected. You have -- is the four times now that you have done this?

BRANTLY: Three or four.

COOPER: Three or four. What's that process like?

BRANTLY: So I have donated my plasma which is not actually whole blood. The blood is made up of red blood cells and plasma. So they can take the blood out of my arm, and put it in a special machine that separates the red blood cells from the plasma and they give me red blood cells back. And then they take the plasma. And the plasma is the part of the blood that contains the antibodies that will fight Ebola. So that's the part of my blood they're taking and giving, kind of as an experimental drug to these patients. It is very fortunate that the three patients I have been able to donate too. They and I share the same blood type. And that's why I have had the unique opportunity to help in that way.

COOPER: Would you donate plasma again if you were the same blood type?

BRANTLY: I pray there is no more need for plasma donations in this country. But I will keep doing it as much as is needed as much as I can. If it will help, if it will potentially help save some body's life.


COOPER: Up next, America's top general weighs in on the Ebola crisis in the United States. Is he as concerned as many Americans, and satisfied with how federal health officials are handling the crisis? That's ahead.


COOPER: It has been a fast-moving day for many here in Dallas. A second nurse who treated Thomas Eric Duncan is now infected with Ebola. And the fact that she flew on a commercial airline with an elevated temperature well, has a lot of people worried tonight.

Today, President Obama promised a more aggressive approach to containing Ebola in the United States.

CNN's Kyra Phillips sat down with General Martin Dempsey, chairman of the joint chiefs of staff for an exclusive interview. She asked him about the crisis and the response so far.


KYRA PHILLIPS, CNN CORRESPONDENT: Are you, General Dempsey, worried about Ebola here in the U.S.?

GEN. MARTIN DEMPSEY, CHAIRMAN, JOINT CHIEF OF STAFF: I have been worried about Ebola globally for about 90 days. And I have has some on my staff that were probably a little more worried than I was in a few weeks or months before that.


DEMPSEY: I am worried about it because we know so little about it. You know, you will hear different people describe whether it could become airborne. I mean, if you bring two -- you know, two doctors who happen to have that specialty into a room. One will say no way it will become airborne. But it could mutate so it would be harder to discover.

It actually disguises itself in the body which makes itself dangerous and has that incubation period of 21 days.

Another doctor will say, well, if it continues to mutate at the rate it is mutating and if we go from 20,000 infected to 100,000, the population might allow it the opportunity to mutate and become airborne. Then it will be a extraordinarily serious problem. I don't know who is right. I don't want to take that chance. So I am taking it very seriously.

PHILLIPS: With this Ebola situation and all the major gaps in the system that we have seen, the CDC director said the agency should have taken control of that Dallas hospital. What does that tell you about the U.S.'s capability to respond to a bio-terror attack?

DEMPSEY: We have a contingency plan for managing pandemics. That is things that would begin to exceed capability of a particular community or state even to deal with it. And we update it periodically. And this is one of the cases where we are dusting it off. We are very closely in contact with all of, national institute of health, world health organization, centers for disease control, U.S. agency for international development for the stuff going on overseas.

PHILLIPS: So what do you say to all Americans that are looking at this Ebola situation and are in absolute panic?

DEMPSEY: Ebola is a, to use a sports metaphor, this need to be an away game. And that's why the United States military is involved. We want to keep this -- we want to help international health organizations service organizations, nongovernmental organizations, we want to help them keep this in isolation inside of the three countries.

But, I have studied this thing. And there is risk that it, that the, that the rate of reproduction, the ability of one patient to affect first two and then four and then eight, and it becomes exponential. So we have really got to be aggressive about the isolation and treatment matters that we are taking on.

Inside the homeland, again, we are in support of those. But I can promise you that the United States military will do its part which civil authorities to keep this thing from coming to our homeland.


COOPER: That does it for us. We will be here tomorrow as well. Somebody is Got to Do It starts now.