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The sole confirmed Ebola patient in the U.S. continues to fight for his life in a Dallas hospital. American health officials remain confident in their ability to contain the disease here. But the situation in West Africa is far bleaker. The head of the Centers for Disease Control and Prevention said Sunday the virus is spreading so fast there that “it’s hard to keep up.” Even with a renewed international response, the number of cases is growing exponentially. Despite calls for stricter screening at airports, many argue the only way to prevent more cases in the U.S. is to stop the outbreak overseas. Diane and her guests discuss the challenges of containing Ebola here and abroad.
- Dr. Anthony Fauci Director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
- Lawrence Gostin Director, O’Neill Institute for National & Global Health Law; director, World Health Organization Collaborating Center on Public Health Law & Human Rights.
- Bryan Lewis Computational epidemiologist, Virginia Bioinformatics Institute at Virginia Tech.
- Dr. Terry Jodrie Emergency Room Physician, Washington Adventist Hospital in Washington, DC; Medical Director for Prince Georges County Fire EMS Department.
MS. DIANE REHMAnd thanks for joining us. I'm Diane Rehm. The so-confirmed ebola patient in the U.S. continues his fight for light in a Dallas hospital. Some fear a wider outbreak and see missteps in the handling of his case as a sign America may not be fully prepared for a pandemic. Others believe we can keep the disease from spreading.
MS. DIANE REHMJoining me to talk about the risks of a U.S. ebola outbreak and what health officials are doing to contain the disease both here and abroad, Dr. Anthony Fauci of the National Institutes of Health, Larry Gostin of the O'Neill Institute for National and Global Health Law and the World Health Organization, and Bryan Lewis of the Virginia Bioinformatics Institute at Virginia Tech.
MS. DIANE REHMYou are welcome, as always, to be part of the conversation. We'll try to answer as many of your questions as we can. Join us at 800-433-8850. Send us an email to firstname.lastname@example.org. Follow us on Facebook or send us a tweet. Welcome, gentlemen, thanks for being here.
DR. ANTHONY FAUCIGood to be with you, Diane.
MR. LARRY GOSTINIt's a pleasure.
MR. BRYAN LEWISPleasure.
REHMThank you. Dr. Fauci, I understand there's a meeting today at the White House to further discuss options in regard to safeguarding the U.S. against an outbreak of ebola. Tell us what they'll be talking about.
FAUCIWell, the question that's on the table is the issue of what we call entry screening. Currently, what is going on right now in the West African countries is what's called exit screening. So if you and I were in Monrovia right now and we wanted to get on an airplane to come to the United States, we would have our temperature taken and we'd be questioned about certain issues.
FAUCIIf, in fact, we were sick, we had symptoms or we had a temperature, we would not be allowed to get on the plane. The question that arises now is there any added benefit to have a similar type of screening upon entry in the United States. And that's a question that's open for discussion. And what will be discussed is the pros and the cons and the kinds of resources that would be necessary if, in fact, you wanted to put in effect an entry screening process of whatever type gets discussed.
REHMI understand the pros. What are the cons?
FAUCIWell, the issue is the bang for the buck, whether or not you are actually going to make any major difference in identifying someone that had gotten through the exit screening, what it would entail, what are the logistic aspects of it and the cost of it, the cost benefit as well as whether or not the convenience/inconvenience factor. There are a number of things, Diane, that one discussed and that will be openly discussed and on the table.
REHMHere is an email from Jane in Williamsburg, Virginia. "Is there solid scientific proof that someone carrying the ebola virus with a fever of less than 101.5 degrees is not contagious at all or is it that someone with the virus can be contagious with any amount of fever, but the higher the fever the more contagious?"
FAUCINo. There is not a direct relationship between 103 versus 102.5 and 102. There's a cutoff of 101.5 level that is the cutoff point in the airport situation. I think it's important to point out that you are infectious in the sense that you can transmit to someone if they come into contact with body fluids. So although a fever is an important indication that someone might be infected, you've got to make sure you don't completely equate that with transmitting to another person because you could have a fever with no body fluids, no cough, no vomit, no diarrhea or nothing.
FAUCIYou're not gonna transmit it. We're gonna make sure people don't confuse that.
REHMAnd turning to you, Bryan Lewis. You're a computational epidemiologist at the Virginia Bioinformatics Institute. You study how diseases spread. Still, there's only one diagnosed case here in the U.S. How long before you expect to see another?
LEWISThat's a really challenging question, Diane, and that's something that our lab, the Network Dynamics and Simulation Science Lab's been looking at over some time. I think as evidence rolls in from this latest imported case, this first imported case, that we'll be able to gauge that a little better. I guess on a scale of one to 10, I would say, with one being sort of a worst-case scenario, this is maybe on, like, a three on that scale in terms of we would've liked to have seen that case detected a little earlier and also he was spending a fair amount of intimate time with a larger number of people than just a couple.
LEWISSo I think that the number of cases that might come from this imported case, I'm hoping is zero, however it might be a little larger than we would see sort of in general expectation as there are other cases that come in the future.
REHMAnd Larry Gostin, you're director of the World Health Organization's Collaborating Center on Public Law and Human Rights. What are your thoughts about the lessons we learned in the delay in both recognizing that Mr. Duncan did have ebola and, as well, the losing track of the homeless man who apparently came in contact with him?
GOSTINWell, I think the delay in West Africa was monumental and really let an epidemic run out of control. The delay here was unfortunate, but I agree with most public health authorities that the overall risk to the public is exceedingly low. The hospital and the health authorities made mistakes. There's no question about it. We can't repeat that. We need to learn from it, but my hope is that there will be no additional case and, if so, as Bryan says, very minimal.
GOSTINBut we don't want delays. This is a horrible disease. We don't want mistakes.
REHMBut apparently, Bryan Lewis, you're concerned that we cannot not fear an outbreak in this country until ebola is contained in West Africa.
LEWISIn terms of an epidemic of ebola in the United States, I mean, by the strict definition of epidemic, we could consider that as sort of already occurring since we would never expect to see any cases of ebola in the United States, so that's exceeding that expectation. However, in terms of it spreading much further than the initial group of people who might have come in contact with an imported case, I see no likelihood of that becoming very large.
REHMAnd to put all this into perspective, Dr. Fauci, how do the odds of catching ebola in this country compare with other infectious diseases?
FAUCIDespite the fear and the concern about ebola 'cause of its cataclysmic dramatic nature of what we see and the reality going on in West Africa, for the average American, ebola is very, very, very low on the things that Americans should be concerned about in the realm of infectious diseases that are communicable. We have the flu season coming up soon.
FAUCIWe have enterovirus D68 that children in 43 states are getting infected with right now. We have a number of other things that we need to be concerned about. Even though this is big public awareness and a lot of concern, when you talk about risk to the American public, it's exceedingly low on the totem pole.
REHMTell me how Mr. Duncan is being treated and why his condition has gone from serious to critical?
FAUCIWell, first of all, I'm not taking care of him, obviously...
FAUCI...Diane, so I don't know that, but I can speak in generalities. Ebola is a very serious disease. When you're under the care of an excellent health facility like in Texas, you get optimum critical care, which, in many respects, is comprised, fundamentally, of fluid replacement. When people lose fluid with diarrhea and vomiting and occasionally bleeding, they get hypovolemic. They go into shock. They get multiple organ system -- even if you optimally take care of that, this is such a virulent virus that you can have organ system dysfunction nonetheless, even with good care.
FAUCISo, obviously, the hospital is reporting that he went -- first he was critical, then he went to serious and now, he's back in critical. That just tells you what we already know, that ebola is a very serious disease.
REHMLarry Gostin, you heard Dr. Fauci talk about this meeting at the White House today and some discussion of the possibility of an entry examination. Do you favor that?
GOSTINWell, I mean, there isn't a lot of evidence that entry screening prevents these kinds of disease, but I think given the fact that there's such public concern and also given the fact that the outbreak in West Africa is really, truly frightening, I think we should certainly know if somebody's come from an infected area. We should target those people for additional screening. So I think we need to do a little bit more, but I really -- there is a tradeoff, as Tony said.
GOSTINIf you literally have lines hundreds of yards long, then you're gonna need to think about, you know, what you're gaining for that (unintelligible)
REHMLarry Gostin of the World Health Organization. Short break here and we'll be right back.
REHMAnd as we talk about the ongoing outbreak of ebola in West Africa, there remains only one confirmed case of ebola being treated here in the U.S. I gather that today the NBC photographer who contracted ebola in Liberia is, if not already here, on his way back for treatment. One other question regarding transportation is whether the White House may at least discuss the idea that so many have put forward, Dr. Fauci, and that is closing off travel to the United States from countries where ebola has become a very serious problem. Is that on the table?
FAUCII don't know all the agenda items on that meeting obviously, so I cannot say, Diane, whether that will be discussed. The only thing that we've heard on the airways, even this morning, is that they're going to be discussing entry criteria -- or entry screening, excuse me. So I'm not sure and I wouldn't know and I probably wouldn't tell you even if I did know.
REHMThat's what I was wondering about. What do you think, Larry Gostin?
GOSTINYeah, I think it would be an actually very bad idea.
GOSTINWell, first of all it would actually violate international law. The international health regulations of the World Health Organization really make sure that you balance public health with both human rights and international commerce. And remember, the affected states are increasingly fragile, unstable. Their GDP is going down.
GOSTINIf you actually -- if the United States, of all countries, said we're going to put that -- West Africa in a cellophane wrapper and nobody can come out of it to our countries, others will follow. And the governments there could be destabilized, the economy. I just think that that kind of overreaction would be a bad thing. And it might even exacerbate the epidemic on the ground there.
GOSTINWell, because you would have difficulties with medical evacuations. You might have problems with supplies coming in, coming out. And if that occurred I think we'd be, if anything, at an increased risk. I just think we just need to be sensible here.
REHMThere are many people concerned about sending our military troops into Liberia for fear of their own perhaps contamination. How seriously do you consider that as a problem, Bryan Lewis?
LEWISIt's certainly something we need to be concerned about, and that's part of the work we've funded through one of the agencies, the Department of Defense. And that's one of the problems we're actually looking at actively. We need to make sure that everyone that gets sent over there is also safe, is able to accomplish their mission safely and return home healthy. I think given the experience we've seen with other aid workers that if proper precautions are taken, the risk of transmission is very, very low. We've got Doctors Without Borders who have treated thousands of people over there for long hours. And to date only, I think, experienced one person who did get infected.
REHMAnd perhaps we've had some deaths of doctors, Dr. Fauci?
FAUCIYeah, we have. We've had infections and deaths of health care providers but I think we should point out that people should know the military are not going to be there for the direct care of patients. The military will be there for command and control, logistics, engineering and setting up field hospitals, transportation and those types of logistics. The military will not be doing what Medecins san Frontier does. They will not be directly taking care of patients.
REHMAnd here's an email from Kathryn in New York. She says, "I've heard reports airports are simply taking travelers temperatures and asking them to fill out a questionnaire. What I've not heard discussed is the possibility that those attempting to board a flight could simply pre-medicate with Advil or Tylenol to lower their fever. Someone with resources to fly and with exposure to ebola may be desperate to get to the U.S. where their chances of survival could be improved," Larry Gostin.
GOSTINYeah, that actually occurred with SARS because they did a lot of fever screening with SARS, particularly in Asia. And I was even on a flight and in business class they were actually giving ibuprofen to people to avoid any kind of -- that's one of the problems with fever screening. It's not very clear that it's reliable. People might premeditate -- pre-medicate. And so we just -- I mean, we need to know where people have come from. To me a travel history is the most important thing.
REHMBut if that's the case, Dr. Fauci, what in the world good is screening going to do at American airports?
FAUCIAgain, there're going to be pros and cons. One of the possibilities is someone gets on a plane and doesn't have a fever. I mean, to get screened, let's say in Monrovia, doesn't have a fever at the time and gets a flight that goes from Monrovia to Brussels, layover in Brussels, Brussels to Dulles or to Kennedy...
REHM...and is taking Tylenol the whole time?
FAUCINo, no, no, no, no, no. What I'm saying is that when you -- put aside for a moment the Tylenol hypothesis, okay, because that really -- I think that's off the edge. So if you're asking me what a potential rationale for taking a temperature at the exit and at the entry, scientifically the rationale, whether you decide you want to do it or not, that's going to be discussed.
FAUCII'm not making a judgment on that.
FAUCIBut the rationale would be that if you don't have a temperature in reality, forget about Tylenol, when you get on the plane in Monrovia, you then go to Brussels, you have a couple of hour layover, you get on a flight and then you go to the United States. You might be developing a temperature during that period of time, which is another window. And if in fact you get your temperature taken when you land at wherever you land, you may pick up that extra person. Now that may be a one-in-who-knows-how-many-hundred-thousand it's going to be, but that is one of the rationales. And I'm making no judgment whether that's a good idea or a bad idea.
REHMDon't you have an opinion?
FAUCII do, but I'm not going to preempt a discussion that's being taken place at the White House today. I'll let that discussion take place.
REHMAnd then offer your opinion.
FAUCIMaybe, maybe not.
REHMReally? Why wouldn't you offer your opinion?
FAUCIWell, because it's just an opinion. And if a policy is made at the government level, I don't think it would be productive to come out and say, well, I don't really think that should be done. You get together. It's not an absolute black or white call. There's no absolute right or wrong. There will be a judgment call and I think we need to get behind the combined judgment of knowledgeable people.
GOSTINAnd I think what Tony's saying is that, you know, you have to measure how much risk reduction you get for the amount of costs and the inconvenience that you achieve. And that's really ultimately a policy decision.
REHMInteresting to me that Liberia is planning to prosecute Mr. Duncan saying he lied on the form by saying he had no contact with anyone who'd suffered from Ebola. What about us? What about a questionnaire? Are we prepared to bring a lawsuit against a man like Mr. Duncan for having lied on that form, Dr. Fauci?
FAUCIWell, I'm sitting next to a lawyer here. I think I'll give that to Larry Gostin.
REHMAll right. Okay.
GOSTINSure. I mean, I don't know if you remember the case, Diane, of Andrew Speaker. He had multidrug-resistant tuberculosis and he knew it. And he got on a flight. He left the United States for his honeymoon and he went to various places and he never disclosed it. And even then it was – with that kind of really, in my view, abhorrent behavior, we couldn't do anything. I think it would probably be a crime technically if you actually had actual knowledge and you lied on your form because these are federal forms. And so potentially it could happen. But I think there would have to be some really intentional decision to – that would place the public at harm.
REHMOkay. I want to give you all a worse-case scenario that I've been wondering about. Supposed somebody gets on a plane and has shown no symptoms whatsoever. And then because it is such a long flight from West Africa to wherever begins vomiting on the plane? What happens to that plane? What happens to those passengers? What happens, Bryan?
LEWISWell, this is getting a little bit out of my domain of expertise but I think the examples we've seen before is you would probably want to isolate that plane, do some decontamination as they do in West Africa in these Ebola treatment units and monitor those people for fever for the following days.
GOSTINI mean, to me it depends very much whether the person who is vomiting had been in the region. I think clearly if...
REHMOkay. Let's assume they have.
GOSTINIf they had been in the region then I'm sure that Tony and Tom Frieden and others would be called and there would be a decontamination and very active contact tracing of everybody on -- in that vicinity.
REHMAnd not putting that plane and those people into some sort of...
FAUCI...you're struggling there.
FAUCIThere are protocols for that.
REHMOkay. Tell me.
FAUCIOkay. And actually a version of that happened very successfully at Newark Airport over the weekend. So it's interesting that you bring this up, exactly that. And what happened was that a person who had come from one of the West African countries was on a flight that went from Monrovia to Brussels, Brussels to Newark. The person went into the bathroom on the plane and had a bout of nausea and vomiting. And what happens in that situation is that there is a determination made of whether or not the person has a reasonable chance of having ebola.
FAUCIIf it is the case then what they do is they do all the decontamination, they get the individual and they put the individual under isolation. And you gather the contact information for all of the people on the flight and you give them instructions about what they need to do if in fact over the next 21 days they get fever. It's a very clear protocol that is successfully implemented. If the person is judged the way the person in Newark was judged to actually have no ebola at all, it was something that was a common cause of nausea, then that's it. Case closed.
REHMAnd you're listening to "The Diane Rehm Show." Doesn't it take 21 days to be assured that ebola is not there?
GOSTINWell, don't confuse the exposure and incubation period versus a person who's throwing up and sick and you want to determine if they have ebola. There are two ways to do that. You can make a clinical judgment. And if the clinical judgment says it's very unlikely this person has ebola, then that's it. If you're not sure and you say they may have ebola, you do a molecular analysis. And are you able to determine in anywhere from a few to 72 hours whether the person has Ebola. That timeframe is different than the incubation period of the contacts that you would then have to follow for 21 days to determine if they actually did get infected.
REHMOkay. So without having done a 72-hour molecular study, how can anyone be absolutely certain that this person does not have ebola?
FAUCIOkay. All right. It's done first, there are two layers. One is a clinical judgment. So let's say I'm on a plane, okay.
REHMRight. And you're a doctor.
FAUCIAnd I -- no. I'm on a plane and I'm not a doctor and I just have a history of -- I just faint. I'm so afraid on the plane that I faint. So I'm sitting there and all of a sudden I faint and the person next to me says, my god, he might have ebola. So then all of the things that -- the flight attendants would be running back and forth. And then when I land, a CDC person will come and get on the plane and someone will say, I think this guy has ebola. And he'll ask me, say, excuse me, what happened? I don't know, I was sitting in my seat and I just blacked out for ten seconds.
FAUCIDo you have a history for blacking out? Yeah, I do that every time I get on a plane. How do you feel right now? I feel pretty good. Let me take your temperature. Your temperature is perfectly normal. You don't have ebola. Judgment call, you don't need to do an ebola test.
REHMBut you used fainting as an example. This man or woman threw up in the restroom.
FAUCIRight. And a clinical determination was made that there is an exceedingly low chance that that person has ebola. Now, if you want to get into the realm of you want 100 percent risk-free on everything you do, then I better not get out of this seat and go out onto Connecticut Avenue because I'm going to be in trouble.
REHMBut I would think -- I would think, and Bryan, you can help me here, I would think that the other people on that plane are going to be mighty worried for the next three weeks.
LEWISFor the next three -- well, so again, if we are -- when you said worse-case scenario I was assuming that we were -- this person actually had ebola. Even in the case where someone has ebola, I think the chances of everyone on that plane getting infected or even a few are pretty low. And so if you follow the precautions that are taken in West Africa with decontamination, I think you have a reasonable chance that you're not going to get too many people on that plane infected anyways.
LEWISAnd again, I think with the timeframe for the diagnostic kit being a few hours to 72 hours, that pretty certain ascertainment could be achieved by the evening or the next day. And so, yes, I think those people might be pretty nervous but there's a lot of other things to be nervous about in this world as well.
GOSTINWell, I mean, two things in my mind. I mean, one is that if you wanted to really reassure people going above what you would need to do, you would wait until you had a confirmatory test. If the public health authorities thought that that confirmatory test was even needed. And then they would be reassured. I think public health authorities would want to know where they were headed for. And CDC actually does have very clear protocols for this.
REHMAll right. Short break here and when we come back, it's time to hear your questions, comments. I look forward to speaking with you.
REHMAnd welcome back as we continue our conversation about Ebola, it's continuing spread in West Africa and risks to the U.S. Let's go first to Alex in Charlotte, N.C. Hi, you're on the air.
ALEXHello there, Diane.
ALEXThanks for taking my call.
ALEXI have -- I'm very troubled and concerned by the border situation and this fanatic situation we have going on in the world with these fanatics trying to kill us. So, and to relate those to, what if -- instead of them putting on a suicide bomber jacket to go, you know, because they seem to embrace death -- what if they infected, say, a few hundred of their people -- and they have thousands -- and they sent them to the African countries which -- where they have lots of access to those, of course -- got them infected, instructed them and trained them on exactly how to go spread this virus in highly populated areas, like retail malls, you know, schools, hospitals, whatever?
REHMOkay. All right. Dr. Fauci, what do you think?
FAUCIWell, one can always make a hypothetical scare, terrorist scenario. And if I were a terrorist and I wanted to do much damage, I wouldn't pick Ebola as my weapon, because it is not something that is easily transmitted from person to person. As we've heard and said many times, you have to come into direct contact with body fluids. That's not a very efficient way to spread something in the population.
GOSTINYeah, I mean Tony is of course right. I mean, the worst bioterrorism agents -- I've written about this even before this -- and I said, Ebola, you wouldn't choose Ebola. You would choose something that could be aerosolized, that you could spread very, very widely. Just imagine it, somebody who is very, very sick with Ebola, would have to get from West Africa to Latin America, make their way up across the border, and it would be obvious that they were very, very sick. And I think it would just -- it's just not realistic.
REHMAll right. And joining us now by phone from Takoma Park, Md., Dr. Terry Jodrie. He's an emergency room physician at Washington Adventist Hospital. He's also the medical director for Prince Georges County, Md., and County Fire EMS Department. Dr. Jodrie, I know your hospital is located just outside Washington in an area that has many residents from West Africa. What procedures are you and your staff using to detect possible Ebola cases?
DR. TERRY JODRIEWell, we utilize a screening tool at initial contact that, first, you know, ask the person if they're sick. Second, we direct questions to whether they've been in an endemic area. If both of those are positive, we immediately isolate the patient and begin more sophisticated screening.
REHMWell, at the same time, what's your hospital doing to avoid the same kinds of mistakes -- and they were plural -- that were made at the hospital in Dallas?
JODRIEWell, again, immediately, when the patient presents, the screening tool is employed. And everyone who has contact with the patient from that point on has the information from the screening tool.
REHMBut is there any special training for potential Ebola-patient outbreaks at your hospital?
JODRIENo, I would not say we have had specific training towards Ebola outbreaks. We've certainly undergone training for exposure to anything that would require body-substance isolation, which includes Ebola amongst other, you know, other communicable diseases.
REHMOkay. But you're also in charge of emergency response. Have those personnel adopted these specific CDC algorithm that EMS providers should use if they suspect there is Ebola?
JODRIEWell, yes and yes. Yes, primarily, the first thing that we instruct first responders in is body-substance isolation for all patients. Second is, there has been a CDC advisory for EMS specifically directed towards detection and isolation of potential patients.
REHMOkay. Here's what I'm trying to get at. Suppose you are called into a person's home because of some sickness, some outbreak. Would you don that kind of protective equipment before going in? Or would it be an after-the-fact response?
JODRIEWell, according to the algorithm, on presenting to a case where someone's presenting with symptoms that are consistent with a communicable disease, as determined by pre-call -- pre-arrival instruction, we would go with an M95 mask, with gloves and with eye protection. That would be the basic level of protection we would use given that set of circumstances. On arrival, we would query the patient regarding the potential for exposure.
REHMAnd here's an email. Final question for you, Dr. Jodrie. Someone asks, how an ambulance is decontaminated between patients. Are there different levels of universal precautions?
JODRIENo, they are pretty much standard. We use an antiseptic solution. All surfaces are wiped down.
REHMAnd that's it?
REHMOkay. Dr. Terry Jodrie, an emergency room physician at Washington Adventist Hospital. Thanks for joining us.
REHMAnd, now, let's go to, I think it's Serge, or Serge, in Dallas, Texas. Hi, you're on the air.
REHMYes, go right ahead, sir.
SERGEYes, Diane. A great show. I'm a very fan of you. (sic) Every morning I will listen to you.
SERGEWhy do we need five thousand medical personnel in Liberia? We know, in the 80s, AIDS was supposed to be coming from Africa. We are very skeptical with whatever people say here.
REHMSo why are we sending military personnel to West Africa?
GOSTINWell, Tony could answer this as well, but -- and he'll want to add -- but, I mean, NGOs on the ground, like Doctors Without Borders, have been calling for this. And when Doctors Without Borders, for the first time in decades, asks for a military response, it means that they and people on the ground are overwhelmed. When President Obama said that he was going to devote military assets to help on the ground in Liberia, I said, I'm very proud of my country. I think it was the right thing to do and it's desperately needed. Desperately.
LEWISI think the military response is appropriate for the logistical support that's needed on the ground there. And if there's one organization in the world that does logistics very well, it's the U.S. military.
REHMSo by logistical support, you mentioned construction of hospitals or facilities of that sort. But how could the military not come in contact with individuals who may be contaminated?
LEWISIt would be very, very, very low risk contact. The most important and the most risky contact is when you're directly trying to take care of a patient. And that's the reason why, unfortunately, so many brave and dedicated healthcare workers have gotten infected and died, because that's the big risk. It's never zero risk if you go over there and get involved in that community. But it is a low risk. So what they will be doing will be things that we mentioned -- command control, construction, transportation, logistics, and setting up the field hospitals.
REHMAll right to Nickie in Fort Washington, Md. Hi, you're on the air.
NICKIEHi. Good morning and thank you for taking my call.
NICKIEAnd thank you, Diane, for having a very calm-level conversation as opposed to what has been happening in the mainstream media, full of hyperbole and excitement. The purpose of my call is to ask specifically to what extent did perhaps institutional bias in the healthcare system -- based on class, race gender -- impact the treatment of Mr. Duncan in the Dallas facility, when you compare the treatment that he received -- that is, he came in, was sent home, was given antibiotics, sent home -- as compared to the treatment of the medical workers who were flown and airlifted here to the United States and given experimental drugs.
NICKIEAnd to that extent, I'm wondering what kind of drugs is Mr. Duncan receiving in Texas? And also, how critical we should be of the response of the local government in terms of just cleaning the facilities with which they imposed the family to stay in that infected apartment?
REHMI think there are lots of people who've had concerns about that, Larry.
GOSTINYeah, I'll leave Tony to answer about what medications, if anything, that he's been getting. I don't think, necessarily, this is a class issue. I do think it's a question of lack of preparedness. And one of the -- I've been pondering this, Diane. And many of your questions have suggested this, is, you know, why did -- why were there seemingly elemental mistakes that occurred there? Why weren't we prepared. But first of all, I do think we're going to learn from it. And I do agree with public health authorities that we're well prepared. But consider this -- there are nearly 3,000 local health departments across the country that have enormous variability in terms of their capacity, their training, their human resources and the like.
GOSTINAnd so, we are a federalist system. And locals are there -- now, the CDC and NIH and others are impeccable. And they came in and they helped straight away. But that's, I think, at bottom, it's just enormous variability in the United States.
REHMAnd the fact of the matter is that you're contradicting yourself. You say, on the one hand, we're well prepared. On the other hand, mistakes were made...
REHM..and perhaps will continue to be made. There's no way to stop humanity from making mistakes. But back to the question of how Mr. Duncan's treatment has differed from that of the health professionals.
FAUCIWell, Diane, you've got to realize that that's apples and oranges here, because Mr. Duncan is the only person who came into the country with Ebola unwittingly. The other two were prepared medevacuations. So you really can't compare that. You have to compare what happened with Mr. Duncan with the thousands of people that walk into the busy emergency rooms throughout the country.
REHMBut I guess there are a lot of people who do want to know whether he is getting the same kind of superb treatment that the doctor who recovered.
FAUCIOkay. So he is now in a very fine hospital in Dallas, getting intensive care with a team that's highly experienced, giving him optimum care. He is different now, remember, than someone who's been preselected to come in. The care is the same -- intensive care, intravenous, electrolyte balance, organ system dysfunction correction if possible. Now, I'll get to the specific therapy. Dr. Brantly and Nancy Writebol got ZMapp. ZMapp is no longer available. There is no ZMapp. So it isn't as if there's ZMapp there and they're not giving it to Mr. Duncan.
REHMIs there a rush to production of more?
FAUCICertainly there is. In fact, HHS and the Department of Defense are working with the company to try and scale up the production of it. But there is no ZMapp left.
REHMAnd you're listening to "The Diane Rehm Show." To I understand correctly that Dr. Brantly is not well today? That there have been reports that he is not.
FAUCII think you're confusing him with the -- with another person.
REHMI don't think so.
FAUCIKent Brantly, you're saying? No. What -- well, I can't comment on Kent Brantly. I don't know of his case. But there is the person who came in -- another physician who was treated, discharged, and then now readmitted because of pneumonia, which they do not think is Ebola relapse. They think it's another secondary thing.
REHMOkay. If I'm incorrect, I do apologize. What about her comment regarding the cleanup of apartment, the containment of the people who were there. One wonders, you know, how any local jurisdiction is going to deal with that.
GOSTINWell, there has to be protocols in advance. I mean, the one thing that we know about health emergencies is that you have to plan and double-plan in advance. And it was, in my view, inexcusable that this had not been planned for. I am absolutely certain that those in the know took notice of that. And I would pray and hope that that wouldn't happen again and that we need to prepare for it.
REHMSo have protocols been changed as a result of how Mr. Duncan and his family have been treated?
FAUCIOkay. So first of all, you've got to separate the two. Because Mr. Duncan was admitted under a typical kind of isolation protocol and under the protection of the personal protection equipment of the healthcare workers. That's a clear CDC protocol. So that protocol was existing. He was admitted under it. What you're talking about is the removal of waste. That was a permit issue where the permit was not ready, it was not issued to be able to remove the waste. That is a bureaucratic glitch that has been corrected. And, as Larry said, hopefully that correction is now done and we won't have to worry about that anymore.
REHMJust one step at a time. Correction, correction, correction. Dr. Fauci, Larry Gostin, Bryan Lewis, thank you all so much. Good luck at the meeting today. I hope you'll let us know what transpires.
FAUCII'm not going to be there.
REHMYou're not going to be there? You should be there. Thanks for listening all. I'm Diane Rehm.
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