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Nearly a thousand people have died from Ebola since the latest outbreak of the virus began. Last week the World Health Organization declared an international public health emergency. Two Americans who contracted Ebola while working in Africa were flown back to the U.S. under tight security and given an experimental drug. Their health improved. But doctors do not yet know if the drug – called ZMapp – had any effect. The treatment of two white Americans when hundreds of Africans are fighting for their lives has spurred intense debate. Diane and guests give an update on the epidemic and discuss the ethics of experimental drugs to treat Ebola.
- Dr. Kevin Donovan director, Pellegrino Center for Clinical Bioethics at Georgetown University Medical Center.
- Dr. Thomas Frieden director, U.S. Centers for Disease Control and Prevention.
- Dr. Anthony Fauci director, National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Researchers now believe the current outbreak of Ebola might have begun in December in Guinea. The virus has since spread to three other African nations and killed nearly a thousand people. An experimental drug given to two Americans who contracted Ebola in Africa has sparked debate over who should get treatment.
MS. DIANE REHMThe World Health Organization is convening a panel of medical ethicists today to discuss the issue. Joining me in the studio with the latest, Dr. Anthony Fauci of the National Institutes of Health, and Dr. Kevin Donovan of Georgetown University Medical Center. Joining us from a studio in Atlanta, Dr. Thomas Frieden.
ANNOUNCERHe's director of the Centers for Disease Control and Prevention. Throughout the hour, we'll try to take as many of your calls as possible, your email. Call us on 800-433-8850. Email firstname.lastname@example.org. Follow us on Facebook or send us a tweet. Thank you all for being here.
DR. ANTHONY FAUCIGood to be with you.
DR. KEVIN DONOVANThank you, Diane.
DR. THOMAS FRIEDENGreat to be here.
REHMDr. Frieden, I'll start with you. The two Americans who contracted Ebola in Africa have been given that experimental drug ZMapp. Tell us how they're doing.
FRIEDENWell, the conditions of the individual patients are really up for them and their caretakers -- their medical care team to address. We did hear over the weekend that the physician indicated that he was getting stronger every day. I think the bottom line about Ebola is that we do know how to stop it, and we have to stop it in Africa if we're going to protect not only the countries where it's spreading but ourselves as well.
FRIEDENAnd there are tried and true measures of addressing the Ebola outbreak. This is an unprecedented situation, but we have the means to control it now. And we hope there'll be drugs and vaccines available soon. But even without them, we need to and we can stop it.
REHMI gather you continue to call this an outbreak rather than an epidemic, Dr. Frieden.
FRIEDENWell, some of that is a question of semantics. We now have four countries involved. And in each of them, we have outbreak situations. So we don't see it spreading throughout the whole population. We do see it spreading from two main drivers in the countries where it's spreading. The first is healthcare, especially where patients aren't diagnosed with Ebola and then may infect healthcare workers, family members, and other patients.
FRIEDENAnd the second, in some parts of Africa, are burial practices which may expose people to infectious body fluids and have result in some transmission. So the outbreaks are occurring in four different countries. And in each of them, there are different characteristics. But what's really unprecedented about this is, first, it's the first time it's been in West Africa, so it's not familiar to healthcare workers or communities in that area.
FRIEDENSecond, it's the first time we're seeing such a large number of cases in urban areas, and that raises new challenges of tracing contact and dealing with many different healthcare facilities and providers. And also, we have real challenges in terms of the weak health systems, particularly...
FRIEDEN...in the West African countries.
REHMAll right. Now, I'd like to turn to you, Dr. Fauci. When you were on this program on July 31 with Laurie Garrett, she said Nigeria is the big Kahuna of the Africa continent. Nigeria would be a completely different state of affairs, and I asked you whether Nigeria could be a tipping point. And you responded, well, certainly. I mean, it would be terrible if it gets into the type of spread we're seeing in the other three countries. Nigeria is the most populous nation in Africa. It's a nation that interacts very much with the rest of the world. It's now in Nigeria. Dr. Fauci, what are you thinking now?
FAUCIWell, I'm thinking, to underscore what Dr. Frieden just said, that we can control...
FAUCIWe can control it by proper public health, isolation capabilities. We certainly hope -- and help is going to be implemented to the Nigerians to be able to control it. If we see the type of explosive outbreak in Nigeria that we're seeing in the other three countries, that would really be terrible. So it's very important, intensely important, to put, you know, a real full court effort on trying to contain it in Nigeria because of the nature of the country, the populous of the country, the interaction with the rest of the world.
REHMHow many cases have thus far been reported in Nigeria?
FRIEDENNigeria's had so far 10 cases that they're aware of. All of them result from transmission from the initial patient who traveled from Liberia. And we've been in close touch with the Liberians, so -- with the Nigerians to help them establish isolation and treatment facilities, trace contacts. They now have more than 180 contacts who they've been tracing daily.
FRIEDENAnd establish emergency response facilities so that they can stop this. But the concern is what will the next generation of spread by because each of the additional eight or nine patients may have exposed others. So the challenge is to control the outbreak before it flares more widely.
REHMDr. Fauci, you were in the midst of a sentence.
FAUCINo, actually, that's the point. What one needs to do -- and contract tracing is the most important way to do that, to determine who was exposed and if they're exposed, put them under the proper isolation. There has not been -- and hopefully there won't be -- an explosive outbreak in Nigeria. And that's exactly why I was just saying that you really need to put a full court effort on trying to do that, getting the people who are sick in the proper containment and the proper isolation and doing the tracing of the people who are exposed in order to be able to keep them under the proper containment and isolation so that you don't have the explosive spread.
REHMIs there more trust and awareness in Nigeria of how to contain Ebola than we've seen in either of the other countries?
FAUCIWell, it's tough to say that. I mean, Nigeria is a country that we have significant relations with from the standpoint economically and otherwise. So there very well may be more ease in dealing with authority. The other countries have had difficulties with regard to civil unrest. So it may be some authority problems in the others that we hopefully wouldn't see as much in Nigeria, but it's very difficult for me to make that judgment right now, Diane.
REHMNow, the question of ZMapp and turning to you, Dr. Donovan. Some people have said that it was improper to bring two white Americans back to this country and to treat them with an experimental drug while nearly a thousand Africans were dying and had not been given the drug. What was your reaction?
DONOVANWhen you think about it, that's really a multi-part question. Was it appropriate to treat these two people? Was it appropriate to bring them back? Was it appropriate not to treat the many Africans who've also been exposed to the same virus? I think that if you take them in turn, it's certainly not unreasonable and certainly not unethical to say to healthcare workers that we have a experimental intervention.
DONOVANThis is not a treatment yet. This is an experimental intervention which means what? It means we don't know if it works. We hope it will. We also don't know what harm it might do to you if you take it. Therefore it requires informed consent. Now, giving it to couple of people with medical backgrounds, you may have a better chance of getting reasonable informed consent because they can understand the risks and benefits and the balance between the two.
DONOVANBut it also is true they were Americans, and that's why they got it. They got it because their organization got it for them and got it to them. Should it be offered to Africans? Why not? In fact, those people who have placed themselves in harm's way by treating those being affected by this epidemic or outbreak certainly should have the opportunity to be treated like anyone else. But there's some real practical issues as well.
REHMWell, one of the practical issues is that this ZMapp is still under animal studies, is it not?
DONOVANAbsolutely. This is not, as I said, a recognized treatment yet. And it hasn't undergone the proper studies to know if it can be effective, and it can be safe. Let's assume that those studies have been done, which they haven't, but they will be. OK. When they have been done, will we be able to offer it to everything that needs it? Not until there's enough to offer. And that's another practical issue. Right now, there were a handful of doses available so that even if other people would have accepted it and known what they were getting into, there wasn't enough to go around.
FAUCIIndeed. That's the case. Right now, there's a supply problem. Revving up and getting enough doses even to do the proper clinical trial and balance the issue of a clinical trial with the compassionate to get it to people who'd be willing to have an informed consent before it's been established that it's effective. Right now, the limiting factor is supply.
REHMDr. Anthony Fauci. We'll take a short break here. When we come back, we'll talk more, take your calls, your email. Stay with us.
REHMAnd in this hour we're talking about the outbreak of the Ebola virus which has now spread to four African countries. Here with me in the studio, Dr. Anthony Fauci and Dr. Kevin Donovan. Joining us from a studio in Atlanta, Dr. Thomas Frieden. He's director of the U.S. Centers for Disease Control and Prevention.
REHMDr. Frieden, I know you have to leave us at half past the hour. Here's an email from Andrew in Hollandale Beach, Fla. He says, "I don't understand one basic aspect of the Ebola crisis. We're told Ebola's transmitted by direct contact between bodily fluids and an infected person and the bodily fluids of another person. Yet even medical professionals in West Africa have been infected despite precautions. So how did this happen? And what is the most typical means of transmission that has been observed?" Dr. Frieden?
FRIEDENThank you. Well, first it's important to be clear that people who have been infected with the Ebola virus are not infectious to others until or unless they become ill themselves with fever and other symptoms. At that point, then all of their body fluids, whether it's blood or saliva, stool or urine, may have the Ebola virus in them. And if they're not identified as having possible Ebola, healthcare workers may not use any personal protective equipment, not gloves and not eye masks, not face masks. And so it would be possible to have the virus introduced to a healthcare worker.
FRIEDENWhat we have found is that, with strict infection control, there is a minimal or no risk of infection. But the challenge is that that infection control has to be strict. So there are really three ways that healthcare workers are getting infected. The first is from patients who aren't recognized to have Ebola and therefore are not isolated, and personal protective equipment isn't used.
FRIEDENSecond, if there are contacts outside of the high containment units with patients with Ebola -- and this may happen in the areas where there are outbreaks where healthcare workers may get exposed in non-clinical settings or in non-isolation ward settings -- and, third, if there are any lapses in infection control. And the other main driver are some unsafe burial practices in parts of Africa.
FAUCIWell, yes, I agree with that. Those are the three issues. And probably the most important is the first where someone comes in, and you don't know that they have Ebola. And they come into an emergency room setting. The idea about the third point, about the breakdown in protocol, the people there are experienced and doing their best.
FAUCIBut you really need to appreciate the intense stress of the situation that they are under when they go into those suits and they stay in there for three or four hours at a time in 100-degree-plus weather, that, you know, taking the material off, taking the suits off, there could possibly be a breach. I still think that that's not the primary reason why they're getting infected, but I've spoken personally to people who've come back and visited me here and explained to me the conditions that they're under. And it's very, very stressful. So there could possibly be some breaches. But the first one is probably the most predominant one.
REHMThe World Health Organization is convening a panel of medical ethicists today, Dr. Donovan. One question that has been asked is whether WHO or the United States ought to declare a travel ban. What is your thinking?
DONOVANWell, that's not entirely an ethical question, I'll have to admit. The problem would be that you don't want an absolute travel ban in part because people are also going there to help out with the outbreaks in that...
REHMWell, obviously that would be with the exception of medical professionals. But, Dr. Fauci, this disease seems to be spreading.
FAUCIIt's spreading within the country...
FAUCICountries, it is. I think when you talk about a complete travel ban, you really need to leave that to the judgment of the countries on the ground about whether they want to let people in or let people out. The WHO is certainly following this very, very carefully and in consultation with the countries. And before you get to that step, they really need to weigh all the issues.
REHMWhat about you, Dr. Frieden? Where are you with the idea of a travel ban?
FRIEDENYou know, the first line of defense is to stop the outbreak at the source. The second is to help the four countries that are involved in fighting the outbreaks to improve what's called exit screening so that people who are sick don't get on to airplanes and fly. And ideally people who have been -- had a high-risk exposure also don't leave the country in an uncontrolled situation.
FRIEDENAnd what we've done at CDC, we have surged our response, and we're putting 50 staff in the field in the coming days. And already we have several dozen there now helping countries address every aspect of their response, from better detection to better contact management, to better isolation and care, to better infection control and burial practices.
FRIEDENAnd one of the things they're helping with is improving the exit screening. So they've worked with the airport and public health authorities in several of the countries, and will be in all four by the end of the week, to have them do a better job screening people and then following up. If they find people who are sick, they'll know what to do with them.
FRIEDENAnd the third line of defense really is -- because we're all connected and there is a lot of travel -- is to make sure that healthcare workers in this country have a high index of suspicion. And if someone comes in who has been in particularly West Africa in the past three weeks and has a fever, think that it could be Ebola, even though it's much more likely to be malaria or a routine infection. But think it could be Ebola and rapidly get them isolated and tested.
REHMAnd, Dr. Frieden, you know as well as I that the U.S. has been criticized in some quarters here at home and abroad for not doing enough to help those African nations. The CDC is leading the effort. You heard Virginia Republican Congressman Frank Wolf say the response by the U.S. and the NGOs was "uncoordinated and rudderless." How do you respond to those criticisms?
FRIEDENOur focus now is moving forward. Now that we have been invited and participating in the response fully it is to make sure that we do whatever we can to strengthen both the countries and the World Health Organization's hand to stop the outbreaks. We think they can be stopped, they will be stopped with traditional public health measures. But it's going to be a long, hard fight.
FRIEDENAnd what I'm hoping is that we cannot only stop Ebola but also leave behind in these and other countries much stronger systems that can find problems when they first occur, respond to them promptly, and prevent them effectively.
FRIEDENIf those systems had been in place already when this happened, we certainly would have the outbreak already under control.
REHMDr. Donovan, what about your response to those who say the U.S. and other major nations are not doing enough to help Africa?
DONOVANWell, I think that the United States and European nations having resources that aren't available in western African makes it almost obligatory for us to want to intervene, above and beyond the fact that it's in our own best interests as well. But the interventions are the ones that Dr. Frieden was talking about, the ones that are most likely to be effective.
DONOVANWhen we talk about, you know, the experimental drugs and interventions such as that, even vaccines, those aren't going to be ready in time to have a significant impact on this outbreak. But the public health measures, the protective gear, the IV fluids, those we could have over there in a very short period of time sufficient to make a difference.
REHMIs that -- are those uniforms or protective gear being sent in great quantity, Dr. Fauci?
FAUCIThe answer is yes, but to underscore that, that's the immediate issue now. The helping to build up the infrastructure is really the important thing so that this doesn't happen again and that we can -- when we get control of it, it's a sustained control. But the answer to your question, Diane, yes, resources are being immediately brought to bear in those countries right now.
REHMBut how do you respond to the criticisms that you've heard from members of congress and elsewhere?
FAUCIWell, I mean, Diane, when you respond when someone tells you that the United States and the rest of the world is not doing enough, it appears you're not doing enough when things are out of control. But I believe the countries involved -- and certain the United States government is trying very hard. As you've heard, the CDC has deployed not 50 additional of their health officers over there to help. And we now have the Disaster Assistant Relief Team, the DART team from USAID that's being implemented to go over there. So things are happening.
REHMAnd, Dr. Frieden, I know you're going to have to leave us. If there were an outbreak in the U.S., how would it be handled?
FRIEDENWell, you know, it's certainly possible that a traveler from West Africa who was infected with Ebola could come down with the disease here. And if that were to happen, it would be very important for the clinicians taking care of that individual to quickly suspect that it could be Ebola, to quickly isolate the individual and get them tested. It's even now impossible that family members or healthcare workers who cared for that individual before they were diagnosed could become infected.
FRIEDENBut we could certainly stop it here because it does not take a special isolation facility. It just takes being especially careful with standard isolation procedures to prevent the spread of Ebola. And we don't have the kind of burial practices here that might spread the disease further. So we can stop it here but the most effective way to protect Americans is to stop it in Africa. And that's what we have staff really working around the clock to do now. And...
REHMSo what's being done, do you think, at America's international airports and other entry sites, Dr. Frieden?
FRIEDENWell, first, we're helping the affected countries to improve their exit screening. And, second, we do have quarantine stations which we operate at U.S. airports in case there are ill travelers who are concerns about people coming into the country.
REHMDr. Thomas Frieden, he's director of the U.S. Centers for Disease Control and Prevention. Thank you so much for joining us, sir.
REHMAnd you're listening to "The Diane Rehm Show." Dr. Fauci, the WHO declared that Africa's Ebola outbreak is an international health emergency. Explain what that means in real terms.
FAUCIWell, that means that they are going on the highest alert and calling up the countries of the world to mobilize with resources and with attention to it. So they call it a public health emergency of international concern, is the precise thing that they call it, and by international concern means that the outbreaks are serious enough that if we don't pay attention to it, it could have international implications and go beyond where it is right now in the western African countries.
FAUCISo it really is a level of alertness and preparedness that they feel is necessary to be able to stop this hopefully in its tracks. And that's what they mean when they say of international concern.
REHMYou wanted to add to that Dr. Donovan.
DONOVANWell, I think that we probably should take note of the fact that the criticism about the United States and other countries not doing enough may not be entirely unfounded. After all, this is not the first Ebola outbreak. And we know what it takes to develop drugs to treat it. We know what it takes to develop vaccines to prevent it. This hasn't been done up until now.
DONOVANAnd I think the reason it hasn't been done up until now -- and it may be done now -- is simply because this one is scarier. It scares the western countries who are able to mount this kind of response. And up until now, these have been outbreaks, small numbers of people in faraway lands. And as a result, there's been very little pressure to produce a better response.
REHMOn pharmaceutical companies.
FAUCICorrect. And as I mentioned last time on this show, Diane, we have been working on interventions for Ebola for years now...
FAUCI...because the first recognized outbreak was in 1976. There have been about two dozen outbreaks since then, certainly of smaller magnitude than the current one. But we have been trying, by doing the basic science and the early clinical trials on interventions, including vaccines, but the incentive to get pharmaceutical company partnership to take that to fruition with a product is perceived as, well, you've had two dozen outbreaks since 1976. And the total number of people in those outbreaks was less than 2,000.
FAUCISo now you have an outbreak that is on everybody's front page throughout the world, and now everybody's excited about what can we do about it and why didn't we do anything about it?
REHMSo what is ZMapp? And how does it work, Dr. Fauci?
FAUCIWell, ZMapp is a cocktail of three antibodies. And an antibody is a protein that the body generally makes in response to an infection and that you make in response to a vaccine. But instead of being a vaccine, it's actually producing artificially these antibodies which are directed against the Ebola virus. And theoretically and hopefully, practically, we'll be able to block and suppress the virus. So that's what ZMapp is. It's a cocktail of antibodies.
REHMNow, there are a number of healthcare missionaries returning from Liberia apparently today to North Carolina. We don't know how many. And I don't know whether they are infected or not. Would they be given ZMapp as a preventive?
FAUCIAbsolutely not. Absolutely not, for so many reasons. Why? If we had it, it would be inappropriate to give it to someone who you don't even know if they're infected. And, number two, there is, as Dr. Donovan said, literally less than a handful of doses available. So it's really a question that is a moot point.
REHMAll right. Short break here. When we come back, your calls, comments, questions. I look forward to speaking with you.
REHMAnd welcome back. We're talking about the spread in West Africa of the Ebola virus. Thus far, it's been contained in four African countries. The number of people who have died of Ebola near a thousand. Let's open the phones now. We'll go to Carlana in Pittsburgh, Penn. Hi there. You're on the air.
CARLANAHi. I'm calling to tell the audience something that your guests will not say out loud, which is that our public health system has been starving for the past 30 to 40 years from lack of funding. And it's gotten worse since 2000 with the Republican tax on budgets which, when you cut taxes and you cut budgets, you cut staff and you cut resources. And the public health professionals have been laid off. They've been laid off over the recent years. So we don't have a public health system with the staff and the resources needed to deal with a pandemic in our own country.
REHMAll right. Thanks for calling. It is true, is it not, that the funds for the World Health Organization have been cut and now we're trying to put more money back in? Dr. Donovan.
DONOVANWell, I think what Carlana was referring to was the public health infrastructure in the United States. But you are right. The World Health Organization funds for dealing with this type of problem have also been cut. It's been a bad economy, as a lot of people know. And that has affected our ability to respond to these things. Nevertheless, the United States is far and away in better shape to deal with this than the poor West African countries.
REHMAll right. Here's an email from Jimmy at Indiana University, who says, "ZMac is" -- sorry, "ZMapp is a drug based on monoclonal antibodies, which are very expensive, with limited supplies. Who pays for the manufacturing of the drug -- the pharmaceutical company, the WHO, the U.S. government or the affected African countries?" Dr. Fauci.
FAUCIWell, in general, if you have a monoclonal antibody that is going to be widely used -- the monoclonal antibodies are used therapeutically extensively in this country and throughout the world. In the perfect model, the company would produce it, they would pay for it, and they would have a profit margin that would allow them to sell it and continue to manufacture it. In a situation here, where you have a very small company that has these antibodies that we haven't even proven are effective or even safe yet, in order to rev it up, they're going to have help. And in fact, the federal government is going to help them.
FAUCIAnd the part of the Biomedical Advanced Research and Development Authority of the Department of Health and Human Services is going to put some resources in there to help the scale up...
FAUCIWell, it's going to be in millions of dollars. I can't give you the exact amount because I don't know, Diane. But it'll be enough to help them to scale up the production so that we can actually go into the clinical trials to prove safety and efficacy and then make it on a compassionate basis available -- if in fact it is effective -- to the Africans who need it.
DONOVANIn the best of all possible worlds, the countries where the epidemic is occurring would also be paying for this as well. Unfortunately, it's happening in one of the poorest places in the world. They do not have the financial resources, just like they don't have the medical resources. The Unites States, therefore, will fill that gap. And that's not entirely altruistic either because we know this virus could be weaponized.
REHMAll right. To Michael in Fayette, Ala. Hi, you're on the air.
MICHAELThank you so much. One -- let me compliment "The Diane Rehm Show" first on at least one thing. You all give the listeners so much more time to respond -- to ask questions than do so many programs on secular, conservative talk radio. And what I...
REHMAll right, Michael. But we've got to move on.
MICHAELOh, I'm sorry. Three things I found out about Ebola on C-SPAN...
REHMOne. One, please.
MICHAEL...concern me deeply. Illiteracy of adults who are unable to read the brochures about prevention and sanitation, cultural folk ways, where they cut and even kiss dead corpses during funerals, and rural villagers' persecutions of public health workers. That wonderful caller just before me about -- was spot-on about not only the Tea Party, what they've done to...
REHMAll right. But let's not get into politics right now. What about these cultural habits?
FAUCIYeah. That's a problem.
FAUCIOf course. And that's one of the issues that's compounding the problem. And we've mentioned it a couple of times, is that the proper disposal of bodies when individuals die, the cultural norms in those countries say you touch the body, you kiss the body, you handle the body, and that does nothing but continue to spread the infection. So we're dealing with issues that are deeply ingrained in the culture that are counterproductive to the efforts to try and control the epidemic.
REHMAll right. To Wilson in Sao Paulo, Brazil. You're on the air.
WILSONWell, first of all, I would like -- can you hear me Ms. Rehm?
REHMYes, I can, sir.
WILSONYes, I'm sorry. I'm calling from far away. First of all, thanks for the information. I love your show.
WILSONLet me go quickly here. We know that China have a lot of people working, you know, at the African continent. And I just wonder, like, if somebody, you know, from China, you know, contracts the virus and go back to China, you know, how would be the China, you know, and U.S. cooperation work in order to take care of this problem? Because we all know that China has billions of people there. I'll take my answer off of the phone. Thank you so much, Ms. Rehm.
REHMAll right. Thanks for calling.
FAUCIWell, I think, sure, China is a big country. They have over a billion individuals. But they also have the capability to be able to contain. So their healthcare delivery system in China is not primitive. It's not the kind of situation that we have in the West African countries. So I think what the caller is saying, suppose someone -- a Chinese citizen is in Africa, gets infected and goes to China, the same way that we were talking about, that it is conceivable if not likely that someday someone is going to come to the United States. The Chinese authorities have the capabilities with their system to be able to isolate and take care of individuals, despite the size.
DONOVANAbsolutely. And the other thing that should be kept in mind is that, you know, this type of problem transcends politics. So that any help that we can give or any help that they would accept would occur, just like it will in any other nation.
REHMOK. To Linda in Baltimore, Md. You're on the air.
LINDAOh, thank you. I love your show, Diane. And I'll be fast.
LINDAI'm in Baltimore. I graduated years ago from Morgan State, which is a basically black school. There's another black school here, Coppin. And in a few weeks, thousands and thousands of kids are going to be coming from Nigeria and others to go back to college in Baltimore -- or in other places. OK? What's happened -- what I want to know is you indicated, I think, that there's a period of time when you can catch it, don't know you have it till you get fevers. How much time is that? How many days is that? A person could fly here possibly, I'm asking, in those days, go to college, kiss everybody hi, hi, and, oh, my god. That's my question.
FAUCIIt's 21 days.
FAUCIAnd just to underscore that the issue about exit screening that Dr. Frieden brought up, that when they come back from these countries to -- for their educational approach here in the United States, there will be exit screening. In other words, are you sick? Now, the other issue is if they are not sick and get here and are sick, that underscores that when someone comes into an emergency room, we emphasize -- and I learned it in the first half a year in medical school -- the most important thing, one of the most important things in the history when, you know, a patient comes in, is what is your travel history?
FAUCISo you need to know if someone comes in and is a Nigerian, you ask them -- or is a -- someone from Sierra Leone or Liberia or Guinea...
REHMOr an American who's been traveling.
FAUCIExactly. Exactly. Is that -- what is your recent travel history? So it's a combination of exit screening from the country, so that if you have a fever, you don't get on the plane.
REHMIf you don't have a fever, you will get on a plane.
FAUCIAnd then you get here, and you get a fever. Then that you need to know what the travel history of the person is.
REHMThat's pretty scary, Dr. Fauci, I must say. Let's go to Joe in Fort Myers, Fla. Hi.
JOEHello, Diane. Thank you for taking my call.
JOEMy question is the fact that aid workers are mistrusted by the local populations where they work has often been mentioned. Is this because of operations like the CIA operations and the polio vaccines in Afghanistan? Or has this been a longer, more Africa-centric problem?
DONOVANThis is a problem in Africa -- West Africa and especially places like Liberia, where the government has not been the friend to the populous. You know, it isn't just Western medicine that they're afraid of. They're afraid of their own government in many cases. Certainly, Western medicine has not had a good track record in Africa either. And so that there is some reason to be suspicious of people who want to come and do experimental studies on them.
REHMHere's an email question. "How did the two American caregivers contract the Ebola virus, if they were following all the correct steps?" Everybody has that question. Dr. Fauci.
FAUCIYeah, and I think that we answered it, but let me reiterate it -- is that they certainly knew and do know what the proper protocol procedures of how to handle with personal protective equipment. It is possible that they came into contact with a sick person before they knew the person had Ebola. Or, if they contracted Ebola at the time they were dealing with a person who they knew had Ebola, it is conceivable that there was an inadvertent breach in protocol.
FAUCIAnd I want to emphasize that when people hear that, you can imagine the terrible stress that these healthcare heroes are under when they're taking care of dozens and dozens of patients and you're the only doctor or there's a handful of doctors. You have those suits on four hours at a time. You're dehydrated. The temperature is over 100 degrees. It is conceivable that there was an inadvertent breach in the protocol of protective equipment.
REHMNow these healthcare professionals who are coming back to North Carolina today from Liberia, or this week, from Liberia, I would think that the people of North Carolina might have some real concerns. Dr. Donovan.
DONOVANI'm sure the people of North Carolina have some real concerns. I expect the healthcare workers themselves have greater concern because they have had a real opportunity for exposure. Those who are now in North Carolina, in the United States, will be under our healthcare system. The precautions will be much stricter and much more enforceable. If for no other reason, something as trivial as we have air conditioning, you know, the people who are dealing with them are in these space suits, are not also dying of dehydration and the heat.
DONOVANI think that under these circumstances, we have to remember that the healthcare workers from the United States, from Canada, from Europe, are joining healthcare workers in Africa, who have been putting up with this without adequate protection...
DONOVAN...and in terrible conditions, knowing the risks, and still placing themselves in harm's way in order to treat these patients. I think that this is in the noblest ideals of the medical profession. And I think that that should be noted.
REHMAnd you're listening to "The Diane Rehm Show." Here's an email. "If a patient survives Ebola, does he or she become immune?" Do we know, Dr. Fauci?
FAUCIWe don't have human data to indicate that there's protection. Based on pure immunological principles, you could make the assumption that they are certainly immune to the strain of Ebola that they got infected with. The strain that's circulating now is called the Zaire strain. So if they got re-exposed, it's likely they'd be protected. In monkey models, monkeys are protected against the same strain if they get immunized or if they get infected.
REHMLet's say, hypothetically, that you do get enough of an effective vaccine or medication to treat or prevent Ebola, Dr. Donovan, should healthcare workers be given that medication first and foremost?
DONOVANI think that there's good reason to handle it that way and good ethical justification for it. To begin with, as we've already been talking about, these are the people who have volunteered to put themselves in harm's way. These are the first responders. If we don't take care of them, who should we take care of? From a very practical point of view, if we don't keep healthcare workers healthy, how are they going to continue treating those who get sick? So I think -- and, thirdly, if we wouldn't do that, how are we going to attract other altruistic healthcare workers to this fight?
REHMAnd with the WHO meeting today, the ethics issues -- what are some of the issues they'll be dealing with?
DONOVANThey're going to be dealing with exactly the things we've been talking about. Hopefully they've been listening to your show and will now know the answers.
REHMI hope you're right, Dr. Donovan. All right, let's go back to the telephones to, let's see, Ed in Fort Worth, Texas. Good morning, you're on the air.
EDHi. Dr. Fauci, can you please state with certainty that you have seen test results from these two Americans brought back from Liberia that positively without a doubt confirm that they have Ebola and what strain it is they have? My problem so far has been with the press coverage and the near hysteria that has been engendered, particularly on the Internet, with reports that these Americans have an Ebola infection. Yet the World Health Organization has very specific recommendations that there are numerous other diseases that ought to be tested for first, before an Ebola test is even administered.
EDAnd with my -- with the primitive medical conditions in Liberia, I am having questions about...
ED...about the -- whether these people really have Ebola.
FAUCII have not myself seen the data. But the diagnosis of Ebola was made by people who I have extreme confidence in knowing how to diagnose Ebola.
FAUCISuch as the people who were there in Liberia where they were infected, and currently the people who are now at Emory, who are taking care of them.
REHMWhat are the other possible diseases or viruses that could have affected these workers?
FAUCIWell, they had the classical signs and symptoms of what we call the hemorrhagic fevers.
FAUCISo the hemorrhagic fevers that we know are the most common are Ebola, Lassa and Marburg. They certainly could have had one of the others, but they didn't. The diagnosis was made by molecular virology and definitive. But maybe a more practical answer to your question, Diane, if someone comes into an emergency room with a fever, feeling terrible, and they're in that geographic region, what else could they have? Probably the most common thing they'd have would be malaria.
REHMOK. We'll leave it at that and follow the path of that virus and hope it stays right where it is for now and that we can deal with it. Dr. Anthony Fauci of the National Institutes of Health, Dr. Kevin Donovan of the Georgetown University Medical Center, thank you both.
FAUCIThank you. Good to be with you.
DONOVANThank you, Diane.
REHMAnd thanks for listening, all. I'm Diane Rehm.
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