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New Ebola Case Diagnosed In Dallas; Nurses Say They Weren't Protected; Revising Ebola Protocols

Aired October 15, 2014 - 10:00   ET

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


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MAYOR MIKE RAWLINGS, DALLAS: We want to deal with facts, not fear. And I continue to believe that while Dallas is anxious about this and with this news this morning, the anxiety level goes up a level, we are not fearful.

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ANDERSON COOPER, CNN ANCHOR: Good morning. I'm Anderson Cooper live in Dallas. Thanks very much for joining me. A lot to cover in the hour ahead. We begin this hour with a big announcement on the Ebola crisis.

Texas health officials now say another case of Ebola has been diagnosed in the U.S. This latest unnamed victim is a second health care worker, a woman at the same hospital where Nina Pham is being treated. She also helped treat Thomas Eric Duncan.

Exactly how she came into contact and what kind of contact she had with Duncan we do not know. We know that she lived alone in this apartment block, both that unit and her car are going to be cleaned by a special crew today.

This morning's news triggers even more alarms, obviously. It means even more people could have been exposed to the highly infectious disease and will now need to be identified and monitored as well. It also underscores the critical and 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 Thomas Eric Duncan?

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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.

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COOPER: A very real possibility indeed, they're monitoring some 76 people who had contact with Thomas Eric Duncan. We're covering all the angles of the story as it unfolds.

Our correspondents, guests and analysts will break down all the angles for us. But let's begin with our coverage here in Dallas. CNN's senior medical correspondent, Elizabeth Cohen, is joining me outside Texas Health Presbyterian Hospital. So what more can you tell us?

ELIZABETH COHEN, CNN SENIOR MEDICAL CORRESPONDENT: I can tell you that when the CDC first got here to Dallas they weren't even monitoring the health care workers inside this hospital.

COOPER: They were focused on outside.

COHEN: The community, the neighbors, the family members, those people. And so they weren't focused on monitoring these health care workers, but now they realize that that was a misstep.

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COHEN (voice-over): Only four days after critical care nurse, Nina Pham, was found to be infected with Ebola, a second health care worker has been diagnosed with the deadly disease. The hospital staffer at Texas Health Presbyterian is one of the 76 health care workers who provided by care for the now-deceased Ebola patient, Thomas Duncan.

According to the hospital, the staffer was immediately isolated after an initial report of a fever Tuesday. The CDC says they've interviewed the patient to identify any contacts or potential exposures in the community.

ROSEANN DEMORO, EXECUTIVE DIRECTOR OF NATIONAL NURSES UNITED (via telephone): Our nurses are not protected. They're not prepared to handle Ebola.

COHEN: Another infection on the heels of shocking new allegations from unnamed nurses at the hospital who say there were no protocols to deal with Duncan.

DEBORAH BURGER, CO-PRESIDENT OF NATION NURSES UNITED: On his return visit to the hospital, Mr. Duncan was left for several hours not in isolation in an area where other patients were present.

COHEN: All this released by National Nurses Union. The union wouldn't say how many nurses came forward nor would they identify them. The nurses say protective gear they wore left their necks exposed.

BURGER: The nurses raised questions and concerns about the fact that the skin on their neck was exposed. They were told to use medical tape wound around their neck. That is not impermeable.

COHEN: The hospital did not address the allegations directly, but in a statement said "Patient and employee safety is our greatest priority and we take compliance very seriously."

DR. THOMAS FRIEDEN, CDC DIRECTOR: We're not sure how she was infected, but we're not waiting for the results of our investigation. We're immediately changing any procedure that we think can be improved to increase the safety of those caring for her.

COHEN: But an official close to the situation tells CNN that in hindsight Duncan should have been transferred to Emory or Nebraska, hospitals that are more than ready to treat Ebola. Remarkably Pham, the first person to contract Ebola within the U.S., says she's doing well and feels blessed to be cared for by the best team of doctors and nurses in the world.

JENNIFER JOSEPHN, NINA PHAM'S FRIEND AND FORMER COLLEAGUE: I know for a fact Nina is somebody who never shies away from safety. We have an entire department on infection prevention, infection control in the hospital. We're briefed almost monthly on infection control.

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COHEN (on camera): I want to put some numbers in context. "Doctors Without Borders" has treated more than 2,000 Ebola patients and two health care workers have become infected. This hospital treated one Ebola patient and two health care workers got infected. Experts I'm talking to say that speaks volumes about the safety precautions being taken or not being taken inside Texas Presbyterian -- Anderson.

COOPER: Elizabeth, I mean, we really don't know a lot of the details about the care that Thomas Eric Duncan received. Let's be honest about that. Nor the protocols that were allegedly in place either the protocols were not in place.

They weren't prepared to have an Ebola patient here, or the protocols that were in place weren't followed and/or the protocols weren't followed or the protocols themselves are not good enough. Those seem to be the three options.

COHEN: Yes. I think you've run through them well and a nurse's union said they heard from nurses here and all three were true. There weren't protocols able to take care of the situation, what protocols there were weren't followed.

And this is really important, Anderson, that when nurses spoke up and said "Wait a minute, something's wrong here," that they weren't listened to. The best safety experts in the world will tell you that that is a huge problem.

That when you see a hospital with a bad safety record it's because the nurses are not being listened to, they're kind of being pooh-poohed.

COOPER: Let's also now talk about what we do and do not know about the second hospital worker who has now tested positive. Do we know exactly -- is it a nurse? Do we know if this person was actually treating -- having direct interaction with Thomas Eric Duncan? Were they handling just fluids, blood, do we know?

COHEN: We don't know. We know this person is a woman. We know she was directly taking care of Thomas Eric Duncan. I think it's interesting. I was talking to a nurse who took care of Ebola patients at a different hospital and she said she felt nurses were particularly vulnerable. They spend more time with the patient and they're also -- they're the ones responsible. I don't mean get too graphic, but for cleaning up bodily waste and you have a huge amount of diarrhea, a huge amount of vomit when you're dealing with Ebola patients.

COOPER: All right, Elizabeth, we'll check in with you throughout this hour. The nurses union, as Elizabeth mentioned, said it is sounding the alarm, to use their words, on the Dallas hospital where two health care workers are diagnosed with Ebola.

National Nurses United said, it spoke with a number of registered nurses at Texas Health Presbyterian Hospital here in Dallas. The union's executive director said what they told her made her cry.

She says adequate safety protocols were not in place and nurses were not protected from exposure when they had contact with Thomas Eric Duncan, the Liberian patient who died of the disease this month. The union has released a statement on behalf of those nurses.

We want to play part of that statement for you and we want to warn you, you may find some of it quite graphic and disturbing.

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UNIDENTIFIED FEMALE (via telephone): 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 spent 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 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 face shield.

Some supervisors even said 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 a 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 is not impermeable and has permeable seams. The nurses have expressed a lot of concern 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.

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COOPER: Frankly, these allegations by the union, nurses union, are shocking. Texas Health Presbyterian Hospital is responding to the allegations, a spokesman says, I 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."

That's not much of a statement, frankly. I have a panel of doctors with me. I'll get their take right after the break.

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UNIDENTIFIED FEMALE (via telephone): 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.

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COOPER: That's allegedly part of a statement from a number of registered nurses here at Texas Health Presbyterian Hospital Dallas as read by a leader of the National Nurses United, a nurse's union. Texas Health Presbyterian Hospital is responding to the allegations.

And a spokesman says and I quote, listen to this statement, because it doesn't really respond to the allegations. They say "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."

They're talking about annual training. Let's discuss this with CNN chief medical correspondent, Dr. Sanjay Gupta. He's joined by CNN medical analyst, Dr. Alexander Van Tulleken and Dr. William Schaffner, the chair of the Department of Preventative Medicine at Vanderbilt University Medical Center.

Sanjay, when you hear that statement, you're talking about a hotline, annual training, that doesn't respond to any of the serious allegations, apparently being made by this union according to what they say are nurses inside this hospital.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yes, that's unfortunate, Anderson. It's unfortunate for a couple reasons. It's obviously uncomfortable. Maybe they're finding it difficult to respond until they look into these things a little bit more carefully, but it's uncomfortable also because some of these things should have been done ahead of time.

Whether it's a hotline, whether it's more training and drills, whether it's having all of this protective gear in place, part of the statement we heard earlier you, Anderson, was that nurses didn't have the protective gear available to them.

So forget the training and drills. Even if you are very diligent about that, if you didn't have the gear, obviously, it would make it very challenging to do your job.

And also I think it's important for them to really talk about what they've learned here because this is going to happen in other hospitals and there can be important lessons learned, I think, for other hospitals based on what happened in Dallas.

COOPER: Dr. Tulleken, I mean, the nurses in their statement said the hospital's order for protective clothing has yet to be delivered and nurses were told to put tape on their necks for protection. Does that make sense to you?

DR. ALEXANDER VAN TULLEKEN, CNN MEDICAL ANALYST: I mean, it's absolutely extraordinary that we don't have the right protective gear in this hospital. Let's be clear, this isn't an issue of preparedness, this is an issue of ongoing care in a place where there are two Ebola patients and those patients caught that Ebola in that hospital.

So we really, really have to be looking at this in detail. I think Wendell Watson's statement, the spokesman there, is absolutely extraordinary because what they should be saying is, first of all, this is not a bad hospital.

These mistakes, although there are some mistakes which seem pretty unforgivable, the vast majority of them could have been made in most hospitals in America. We desperately need more information about what they're doing so that we can learn.

In the meantime, we need to know exactly what they're doing because a vague statement about monitoring patients isn't enough. We need to know exactly what's going on.

COOPER: It seems everybody's kind of running for cover and obviously the focus is on treating the patients that they currently have and now there are two Ebola patients here. But without transparency, it doesn't build confidence and confidence is key right now.

Sanjay, there's also this report that the nurses who treated Duncan apparently also treated other patients as well. Dr. Schaffner, is that a problem?

DR. WILLIAM SCHAFFNER, DEPARTMENT OF PREVENTATIVE MEDICINE, VANDERBILT UNIVERSITY: Well, Anderson, this is a long, dirty laundry list of allegations which, if true, and we don't know the result of that yet, if true is just appalling, frankly. So this is a lesson for all hospitals across the country. We've been doing our own drilling. We're doing more as a consequence of these events in Dallas.

Every hospital in the country really needs to be prepared to receive an Ebola patient. That patient can come into the emergency room of any hospital in the country. We need to do the preparation, the training, the drilling, and we need to have the appropriate equipment in place ready to meet that patient at the door.

COOPER: Sanjay, the protective protocol, even on the CDC web site, you tested it out just the other day and you ended up with -- you were using chocolate syrup, but you ended up with stuff on your arms and your neck. Are the protocols that are being recommended by the CDC, are they enough?

SANJAY: I don't think so, to be perfectly candid. And it raises this question, even if you do all the training, even if you do all the drills, you follow those protocols, if they're in inadequate, that's a huge problem.

There's a basic thing here which we've been talking about, frankly, since March and April when I was out in West Africa and that is that this Ebola virus spreads through bodily fluids that gets on your skin, basic premise, cover your skin. It sounds pretty simple.

I feel almost silly saying it. I want to point out as well we see a little bit of confusion in that we see people with hazmat suits, for example, getting on planes and things like that. But we also saw when Dr. Frieden himself was in West Africa touring around the Ebola wards, he was also wearing, as you see there, full gear.

This is the gear that people have become accustomed to seeing. If you look at that and see when he's fully dressed up, and anybody who wears this is fully geared up, there's no skin showing. It's imperative. That's what the "Doctors Without Borders" recommended that I do as well when I was out there, basic stuff.

You could not go in there even to just tour around without being fully covered. So how can we at the same time say nurses, health care workers in a U.S. hospital who are taking care of a patient with Ebola wear different sort of protection? It's confusing.

It also makes it sound like in some way there's a little double standard here. We know what works we should implement that here as has worked so well in West Africa.

COOPER: Dr. Tulleken, he doesn't even talk about covering your footwear, which would seem to be a prime area where fluids could get on.

TULLEKEN: What's extraordinary about the web site to me, someone just tweeted me and said Sanjay wasn't following the correct protocol, he didn't do it properly. He was following the correct protocol, of course, but he's following one of two protocols.

So the CDC actually gives you two and says you can choose whichever one. So there are huge gaps even in which protocol you should use let alone in the detail. I absolutely agree with Sanjay.

I think Elizabeth Cohen just made that the really, really important point that there's one organization in the world that has looked after a significant number of Ebola cases and that's "Doctors Without Borders," 2,000 cases, two hospital workers infected.

So we know this can be done and I think Sanjay has made the point all morning, this is bread-and-butter stuff. This isn't high-tech medicine. We're not asking people to do anything very complicated. I think blaming the nurses is absolutely wrong.

But what we're seeing is a failure of leadership at a very high level to deliver the relevant protocols and that isn't just personal protective gear, although I think the failure of protocols is very representative. That starts with every single patient at every single hospital.

What questions do you ask? Have you taken the travel history through to following up all the contacts? Again, we're seeing massive weaknesses there. We've got exposed people. We should have been taking serial blood samples on Nina Pham and the other exposed.

We have 70 people, serial blood samples. You can find this virus in the bloodstream much quicker than 21 days, but we haven't been bothered to pay for the test.

COOPER: Dr. Alexander Van Tulleken, appreciate you being with us. Sanjay Gupta as well. Dr. William Schaffner as well, thank you very much.

There's more to cover on this story. There are Ebola checks at our airports and some are calling for travel bans from the disease hot zones. Would it work? Would something like that squash the spread? Richard Quest joins us after the break.

(COMMERCIAL BREAK) COOPER: While there have been growing calls for the U.S. to institute a travel ban from the Ebola hot zones, some commercial carriers, they've already dropped flights from West Africa. That's raising concern among aid groups transporting their workers.

CNN aviation correspondent, Richard Quest joins me. Before we get to the issue of flights, I want your reaction to the story that's just out, that protective gear has been delivered to first responders at the three New York City airports, JFK, LaGuardia, and Newark airports.

Because a statement from the Port Authority reads "We distributed personal protective gear to our first responders in the event it may be needed to deal with the Ebola situation especially at airports. As you probably know, there could be occasions when our officers are in contact with a person suspected of having the virus.

Our actions in distributing this gear is above and beyond anything required by the CDC and is done for the protection of our employees." Do you think this makes sense, Richard?

RICHARD QUEST, CNN AVIATION ANALYST: Well, we've gotten an entire raft of regulations in which I have some of them here for infection control guidelines for cabin crew member, for airports. So there's a whole raft of regulations about how people are supposed to respond.

Once they get an indication or a suspicion that a passenger is suffering from a fever or an Ebola-type symptom. But here's the problem, Anderson, to some extent, the critics are universal in saying that you can have all the checks you like at the airport, but it's very easy either to lie or to evade or simply a passenger is not symptomatic yet.

So the upshot is whilst it sounds good, it looks good, and it gives a feeling of security, what many believe is that all these measures -- although useful -- can give a false sense of total security.

COOPER: So, Richard, why not just stop flights from Liberia, from Guinea, from Sierra Leone? I know people say, well, look, that will affect aid workers but, I mean, couldn't aid workers take charter flights?

QUEST: That's what we're heading towards. That's exactly what we're heading towards. There are virtually no direct flights to Europe and certainly to the United States from those parts of the world.