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What does the U.S. Ebola ‘czar’ need to do? – Part 2

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    The appointment of an Ebola czar was greeted with a mix of support and real skepticism over the president's choice for the job.

    We look at his possible role, as questions keep escalating about just how prepared the U.S. health system is.

    Two voices from the world of public health tonight. Pamela Cipriano is president of the American Nurses Association. It's a professional organization representing the nation's 3.1 million registered nurses. And Dr. Amesh Adalja is an infectious disease physician and a representative of the Infectious Diseases Society of America, whose members include doctors, scientists and other health care professions.

    We welcome you both to the "NewsHour."

    To you first, Dr. Adalja.

    Looking at Ron Klain, who the president appointed to coordinate government efforts on Ebola, what does he need to do, do you believe?

    DR. AMESH ADALJA, Infectious Diseases Society of America: He really needs to coordinate a response.

    You have got multiple agencies that have responsibilities now, the CDC, the FDA, Department of Defense, USAID. We need an integrated response where everybody is talking to everybody and there's one plan that's going to be executed to stop this outbreak in West Africa and also keep Americans safe here in the United States.


    And, Ms. Cipriano, what would you add to that, from your perspective?

  • PAMELA CIPRIANO, President, American Nurses Association:

    I think that's a very good description, I think, in addition, to be able to reach out across state organizations and communities, because that's really often where the information gets disseminated to the health care organizations.


    Well, Ms. Cipriano, let me stay with you. There's some criticism of Mr. Klain we're already hearing, some of it from Republicans and others, saying who the president should have appointed was someone who's a physician or someone with a public health background. How much do you think that's going to matter in this role?


    I believe there's already many experts throughout the CDC and HHS who can provide that expertise.

    And, again, I think what we're looking for is someone who can manage the response, provide the coordination that's required. This is very much like any other emergency situation. And when you have an incident command center, the person who is in charge of that is not necessarily the content expert for that particular condition.

    It is someone who's very accustomed to managing overall communications, planning, follow-up, data collection, and execution throughout the organization or the geographic area. So I think someone who comes with these skills is actually more important and then can tap the experts on the ground or, again, nationally or internationally, who can provide the medical expertise.


    Dr. Adalja, in your view, should it have been someone with public health experience?


    It doesn't necessarily have to be someone with public health experience. It needs to be somebody that has the ear of the president, that can understand the science and the medicine behind what the interventions are.

    But we really need somebody that is the lead on not just Ebola, but also emerging infectious disease, biosecurity. That's really what we need, is somebody that is there, because after this Ebola outbreak ends, there are other emerging infectious disease threats, like the Middle East Respiratory Syndrome. There's Chikungunya. There's dengue fever.

    So we really need somebody that's there kind of all the time serving at the pleasure of the president that can coordinate these responses, because when you have what happened, the missteps that happened in Dallas, it really illustrates the fact that you need to have a coordinated response.


    Well, in connection with that, Ms. Cipriano, we learned today that the Centers for Disease Control says they're going to be issuing new guidelines, stricter guidelines for health care workers to follow. How serious were the lapses leading up to what's happened today? Are they understandable lapses? Are they — how do you see that?


    The American Nurses Association, along with many other nurses, was part of a conference call yesterday with more than 6,000 R.N.s that talked with CDC officials.

    So, this is something that we have been asking for to provide the clarity about, particularly the personal protective equipment and the education associated with the correct procedures to put them on and take them off. And we know that that's one of the primary ways that we can safeguard health care workers.

    So we think this is a big step in the right direction. We expect that these revised guidelines will be out momentarily. However, the other important thing is to use the lessons learned from the Texas hospital to be able to inform those. Again, the initial guidelines that CDC issued have been around for a long time relative to normal protective conditions.

    They also have instructions for escalating the precautionary measures for highly contagious infectious diseases. And again the combination of really looking at what is the right equipment, right — what are the right techniques is critically important. And I think we recognize that if there's any lapse on the part of the users or the part — anywhere in the health care organization, that that creates a threat that's really not something that we can sustain.


    Dr. Adalja, we know that right now, there are only four hospitals in the country with so-called established containment procedures for patients with Ebola.

    At this point, is it still the correct move for the CDC to be making to have patients transferred to those centers, as long as there are only a few? At what point do other hospitals need to be — to get up to speed?


    Well, there is two parts to my answer to that question.

    All hospitals have to be prepared to initially recognize, isolate and get the ball rolling if they get an Ebola patient, because travelers can present anywhere. However, after the events in Dallas, it's become clear that not every hospital can take care of an Ebola patient safely.

    And while we have space in these biocontainment units, that should be where people should be transferred. And we need to think when — if we do get a situation where we have more patients than we can care of, which may be unlikely, but could occur, we have to think about tiering which hospitals and metropolitan centers are adept at doing infection control. And that may be our tertiary academic medical centers where patients should go, because we don't want to repeat the events of Dallas again.


    Ms. Cipriano, from the standpoint of nurses, how do you view that? Which are the right hospitals to be treating these patients as these cases arise?


    Well, what we have seen from the four organizations that have these biocontainment units, they are highly skilled, they're very practiced, and they have not had any lapses or problems with staff getting infected.

    So I think there is a great benefit, while those number of patients would be small, to see if they could seek care there once someone is identified and diagnosed, although I absolutely agree that one of the most important things that is every health care organization has the tools and following the right procedure to screen, because we have a mobile society and anyone can cross our threshold.

    I think it will be important to say that there will be a limited number of facilities initially, again, because the learning curve is so critically important, not only for understanding the protective equipment, but the entire organization that has to gear up for handling blood and body fluids, lab specimens, the contaminated waste, everything that requires an organization to muster all of those services together, and that, even though organizations are prepared, if you have been doing this or you know that you have the specialized resources, it will be easier to care for those patients.

    So I would suspect that we will be seeing a plan that does limit the number of facilities.


    And just finally, Dr. Adalja, what should ordinary folks watching, citizens watching this program right now who are worried about Ebola, what should they know, what should they look to for reassurance?



    The general public is really getting seized with this panic, and it's legitimate panic, because they're getting mixed messages, and stories are changing. There are panics all over the country when someone gets sick somewhere and they think it's Ebola.

    But the key message I would give is that Ebola is a deadly and scary virus, but it's not very contagious. It's something that is only spread through contact with the blood and bodily fluids of an infected individual. It's not spread in casual contact.

    And there really is no concern over a generalized outbreak in the United States. And we have to be vigilant at our hospitals to identify these patients, so the lessons from Dallas are actually learned.


    Dr. Amesh Adalja and Pamela Cipriano of the American Nurses Association, we thank you.


    Thank you.


    Thank you.

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