How can the spread of Ebola be stopped in the US?

How can the spread of the Ebola virus be stopped? Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases, joins Hari Sreenivasan to discuss lessons learned in the missteps made in treating Ebola patient Thomas Eric Duncan, who is now in critical condition at Texas Health Presbyterian Hospital.

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    Good evening. Thanks for joining us. U.S. health officials said today they have fielded inquiries about 100 suspected cases of Ebola since the first case in the United States was confirmed in Dallas, but that no new infections have been identified.

    This afternoon, officials from the Centers for Disease Control raced to Newark Airport to meet a plane that had landed from Brussels. Two passengers believed to be from Liberia became ill during the flight. Later health officials said that the two apparently do not have Ebola.

    Another similar scare was reported in West Florida today, and those two suspected cases in the Washington, D.C.-area turned out not to be Ebola either.

    But, Thomas Eric Duncan, the Liberian man who on Thursday became the first person in the U.S. with Ebola today was downgraded from serious to critical condition.

    Joining us now from Washington is one of the nation's top health experts, Dr. Anthony Fauci. He's the director of the National Institute of Allergy and Infectious Diseases.

    The government has been saying that they are prepared, that they've been sending out information for weeks. Is there in that information a checklist for hospitals to go through on what to do if someone walks into their emergency room and has these symptoms, with this travel history?


    Indeed there is. There is a certain thing called the HAN – H-A-N – a Health Alert Network, the CDC has been sending out several of these over the last weeks to months to underscore several things.

    And the one that's most relevant to what we're talking about today is the specific alert that if someone comes into an emergency room, or a clinic with symptoms that are suggestive of Ebola, it's important that you take a travel history.

    And if a person tells you that they've recently traveled to West Africa, and have come back, that you then treat them in a way that keeps them to be observed before you rule out the possibility that they have Ebola. That has been given in instructions and alerts now for a considerable period of time.


    Is it just a matter that some of these hospitals did not pay attention to it? Because why did the case in Dallas turn out the way that it did if the hospitals had this information at the ready?


    Well, they certainly had the information and we just have to recognize it for what it is, and what it was. It was a misstep.

    It should not have happened, there's no excuse, but hopefully rather than having any blame game, we would look forward and make this a lessons learned – that we really have to pay attention to the CDC alerts.

    I think part of the positive spin-off of all the publicity that the Dallas case is getting is the fact that emergency room and clinic physicians throughout the country are now acutely aware of this misstep.

    And I can guarantee you if someone comes into a clinic now with symptoms compatible with Ebola and gets asked by a physician, 'are you from West Africa,' that every physician is going to ask that question.


    What about the government's role in helping those just beyond the hospital.

    Say, for example the first responders, if someone is in an ambulance, they are responding to a call with someone who might have flu-like symptoms, or otherwise?


    Well, again, there's infection control and protective mechanisms for a lot of different diseases, not only Ebola, but when there is a suspicion of Ebola, one should go into what we call the CDC protocols about protection of the health care worker.

    Now, one of the important things that we need to emphasize is that when someone is identified as either with Ebola symptoms particularly, let's take the case in Dallas, once you establish a case of Ebola the important public health measure to prevent an outbreak is the contact tracing that is currently going on in Dallas.

    Because, historically for the 38 years now that we have experience with dealing with Ebola essentially in central and southern Africa, is that when you get the contacts under observation and observe them for the period of time, which is 21 days, so that you could rule out whether or not they do or do not have Ebola, that's the way you prevent an outbreak and that's the reason why, despite the initial misstep, we feel that we have the health care infrastructure to be able to implement that and prevent an outbreak here.


    So, what's the federal government's role in trying to coordinate those other resources beyond the hospitals in terms of the local authorities?

    There seems to be a gap there in time between when this person was diagnosed with Ebola and when say a Hazmat crew got to their house, or had to quarantine the family members.


    There is a historic, very strong relationship between our Centers for Disease Control and prevention, our CDC, and the state and local health authorities.

    They take the signals from the CDC, the CDC sets down the guidelines, and for example as soon as the case was identified in Dallas, the CDC sent at least 10 health professionals there and likely more to come to be able to help in the implementation of those protocols – particularly the contact tracing protocols.

    There really is very good interaction between the national level CDC and the local and state health authorities.


    We had Dr. Frieden on the NewsHour just a couple nights ago, where he was saying really the best way to get this is to get it at the source, in Africa, and obviously a lot of people are concerned about the travel and the free-flow of people and goods back and forth, so is there anything we can do to improve the level of kind of quarantine in West Africa before people get onto the planes and go wherever they're going to go in the world?


    There is a process going on that very few people appreciate. If you or I were let's say in Monrovia, Liberia, right now at the airport and we had a fever, which is checked for everyone that is trying to get onto a plane, we would not be able to get on a plane to leave Liberia to come to the United States, or any place else.

    So, it's the exit screening from the country, which really proves to be quite effective. Obviously if someone doesn't have symptoms and doesn't have a fever and is in that phase of incubation where they are infected and they really don't know that they're infected, there's always the possibility that that would slip through, as did Mr. Thomas Duncan.

    The problem is, he was also asked to question at the exit part as to whether he had contact with a person with Ebola and either he didn't realize that he did, or I don't know what the answer to that is, but that snuck through – that will happen.

    But on the other end, when a person does get here, once they're identified we do have the protocols to do the kind of identification, isolation, protection of health care workers and contact tracing.


    Is there any practical way to keep entire populations of West Africa in quarantine for 21 days before they board a plane?


    The answer to that is no. I know it's an obvious question that people ask. I get asked that all the time, and Tom Frieden from the CDC gets asked that all the time.

    If you look historically at trying to essentially quarantine a country, the negative effects of that really outweigh any positive benefit. In fact, health authorities are in agreement that you can almost certainly have a negative effect, because you prevent the free-flow of things that they need to contain the epidemic.

    It would make it much worse for them. And as we've said, the best way to protect the United States of America is to completely shut down the epidemic in West Africa, not necessarily to quarantine anybody in West Africa but to put into place the infection control methods that would allow us to be able to suppress that.

    That's the best way to protect the United States. Stop it in West Africa.


    Dr. Anthony Fauci, thanks so much for your time.


    Good to be with you.

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