New Ebola Case Diagnosed In Dallas; Nurses Say They Weren't Protected; Revising Ebola Protocols
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.</s>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?</s>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.</s>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?</s>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.</s>COOPER: They were focused on outside.</s>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.</s>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.</s>ROSEANN DEMORO, EXECUTIVE DIRECTOR OF NATIONAL NURSES UNITED (via telephone): Our nurses are not protected. They're not prepared to handle Ebola.</s>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.</s>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.</s>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.</s>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.</s>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."</s>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.</s>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.</s>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.</s>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.</s>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.</s>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.</s>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?</s>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.</s>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.</s>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.</s>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.