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tv   Inside Story  Al Jazeera  October 1, 2014 5:00pm-5:31pm EDT

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take on the los angeles angels, the top seed in the american league. playoffs continue throughout the month of october. i'm michael yves. thank you for watching this edition of al jazeera america. inside edition.with ray suarez is next. we'll see you right here at 6:00. you. >> ebola is here. this time not in the bloodstream of a doctor rushed back after helping the stricken in west africa, but hitching a ride with a liberian headed to texas. that's inside story. >> hello, i'm ray suarez.
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diseases were usually spread by boats. now everything is faster. you can get on a plane in west africa, change plains in europe and be in the united states the next day. until they show serious symptoms you can't look at a passengerrer and say yep, that guy has got ebola. the center for disease control is assuring americans we can stop disease in its tracks in the u.s. what will that take? all eyes are on texas, and the patient hospitalized in stable but serious condition. >> he talked about the ebola case wednesday in the dallas hospital now fleeting the patient. an investigation is underway monitoring the people the infected man came into contact with, which includes school children. >> today we learned that some
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school-aged children have been identified as having had contact with the patients, and are now being monitored at home for any signs of the disease. i know parents are extremely concerned, but let me assure that these children have been identified, they are being monitored, and the disease cannot be transmitted before having any symptoms. >> the patient, thomas erik duncan arrived in texas on the 20th. authorities in liberia and in the u.s. say duncan was not sick when he boarded the flight, and that stringent screening measures are in place pa. on friday, he went to the emergency room. was evaluated, got antibiotics and sent home.
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on sunday the patient called for help. he was admitted to the hospital and immediately isolated. >> the patient did exhibit nausea, vomiting. >> the ambulance used to transport the patient was quarantined. the hospital was under pains to explain why the patient was sent home in the first time. >> he volunteered that he had traveled from africa in response to the nurse operating the check list. that nurse was part of a team to collect information.
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>> it is certainly possible someone who had contact with this individual could develop ebola in the coming weeks, but there is no doubt in my mind that we'll stop it here. >> the ebola outbreak in sierra leanio, guinea and liberia has killed more than 3,000 people. just two weeks ago the united states pledged military and logistical support to help the countries overwhelmed by the epidemic. now the virus has reached our shores, so far it's just one case. >> i also want to make the case the dynamics are so
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significantly different than they are in east africa or west africa that the chances of it being spread are very, very small. >> we've done several editions on inside story of the ebola in recent week all with advice to stop the spread of this terrible disease in west africa. are we ready to take the measures prescribed for africa here at home, limiting people's movements, quarantine of those suspected of being infected. joining us for that conversati conversation, professor of medicine and medical director for the control program at the university of chicago medical center. here in washington, lawrence
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gostan health law professor. and from lima, peru, professor of tropical medicine school of health. dr. landon. let me start with you. someone shows up at the emergency room. they're presenting with a variety of symptoms that could be other things. how do you screen them at first point of contact? >> most hospitals are doing what they described in texas and what we would do at the university of chicago. everyone who comes is asked if they've traveled to any of the areas affected. they're shown a map to indicate where they were. they get put immediately in an isolation room. >> as far as you understand how does it happen to happen that somebody could be sent home? we're told that early on the
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symptoms of ebola are not necessarily those that you see later in the course of the disease. is it easy to make a mistake? >> well, i think you have to ask the question about the travel. taking a gook travel history is absolutely the number one thing we can do to identify an ebola patient early. that's why we also have the triage person ask the question but all er staff has been train and asked to duplicate that process so we're less likely to have someone fall through the cracks. >> i'm sure a lot of people have been watching the progress of this story. as long as it was a half world away didn't think they had to really learn the deep biological mysteries of how this things spreads. what should people know about when you're contagious, when you're not, and what to watch for if someone has been to west africa and now isn't feeling well?
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>> right, well, i think the key points are, indeed, that it's difficult to point out or identify patients who have ebola early on in the course of their deed. however, there is some degree of comfort in knowing that this is a virus that is really only spread by very sick people and direct contact for their blood or bodily fluids. >> you have been in west africa, and when you returned to south america there was a point that you weren't feeling well. we invited you to the program, but you begged off because of ill health. were you worried that you might have been infected? >> no, i was not. my illness at that time was nothing similar to ebola. it was a much more casual kind of gi problem that we might get from time to time. so i was not concerned, no. >> did somebody ask you if you had been to west africa?
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>> i'm very familiar with this disease and i've been treating patients with ebola and different outbreaks for a couple of different decades, i felt comfortable that my symptoms were not that of ebola. i stayed home for a day. the day after that i felt better and went on with my work and my life. >> is there a line that separates good preventive care, a good public health measures, and intrusion. do you remember back in the 1960 he is when haitians were being quarantined and suspected of being carriers and particularly susceptible to hiv. >> well, there is a line. certainly if you have got
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somebody with the history, you want to--that's not discriminatory. that's based on science and fact. if you're stereotyping people the way we did with a.i.d.s. and the way we've done with haitians and others or if you're stereotyping based upon sexual orientation or something like that, that's clearly crossing the line. we've done that. the thing about frightening diseases like this is we tend to scape coat and we stereotype. we have to stick with the science. that's very important. >> looking at it from the outside you may say well, a patient has an obligation. if it's normal feeling they
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don't want to get. but do they remain the obligation to remain tractable and traceable and tell you where they've been. >> they don't have a legal obligation but an ethical obligation. contact choosing is the tried rand true method. that's why when cdc director said we're going to get this done. he princely means two things. contact, isolation. those are critical things. you need to have cooperation of the public for that. the problem in west africa is that they've lost all trust in their government. that's been the problem. they won't allow contact. it drives the epidemic underground. here i would very much hope that people would come forward. of course there is the issue of
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confidentiality, whether they would want to have it made public. >> dr. landon, speaking of contact tracing we've now found out that in the interim time between leaving the hospital and returning much sicker mr. duncan, the patient, had a wide range of contacts, including with children, with family members, with people that he came across while he was traveling, can you realiz really ever be sure of everyone someone comes in contact with when doing something like this, trying to put together a history . >> as dr. bosh mention earlier, ebola is helpful in this respect. you really can only get it having direct bodily fluids. we all have a pretty good idea whose bodily fluids we've come in contact with in contrast with measles it could be anyone up to
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hundreds of feet away or someone who rides in an elevator a few hours later. that's almost impossible to do adequate contact tracing. but with ebola it's relatively easier to figure out who has been in close enough contact to have a meaningful exposure. that doesn't necessarily mean that other people who may have walked by him in the hallway aren't going to be worried, but i'm much less worried about them. build. >> we'll be back after a short break. we'll continue to look at ebola on the occasion of the first confirmed says in th case in the united states.
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>> coming back to inside america. i'm ray suarez. the arrival of ebola in the united states it this i'm on the program. not through the infected daughter rushed home for emergency treatment but in the form of an individual already in the country who presented himself for treatment in texas. dr. daniel bosh from lima, peru, while we would stipulate that he is a thoughtful guy, he's not so thoughtful that he would stand on the rooftop staring into the camera. it takes time to go through the satellite to him.
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it's not because he's thinking deeply about the answer. many people who have gotten ebola before, could the virus be changing form? could it be mutating even as it's reading to even more human hosts? >> i think it would normally go through some small mutations. those can have consequence in terms of our ability to protect the virus through some of the tests that we have. it could have consequences in terms of some drugs that we're developing now, and whether it would work if those mutations were to be drastic. some of the other things discussed or worried about are very unlikely. it would be unlikely, for example, that these--this degree
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of mutation or the virus would change so it would have a different mode of spread to become airborne or something like that. i don't think that's a major concern for us. >> not to belabor the point why is that a concern? when i was covering the h1n1 epidemic in new, i walked through some of the emptiest streets in the word because of doctors worried about the virus merging with another virus to become a virulent strain. why are we not worried about that with ebola. >> well, it's a different matter in how severely ill a person might become once he or she is infected, but i can't really think in 20 years of studyingify russs of any example where the fundamental of characters of a virus or other pathogen has changed because of mutation
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where we have something that will spread like that. it's really unlikely. >> i like the term in your bio. anti-microbial stewardship. is there information sharing in your world so that all the doctors on staff are looking for people presenting with symptoms of something that is break out a half world away? >> there are a number of--we have health alert networks. our colleagues, we have a list serve so we can hear about new cases and clusters that happen, and i'm responsible for letting all of our fal faculty and
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staff foe so they will know how to focus their efforts. >> how much can you delve in a person's travels? should there be a hot list. should you change planes in paris from somewhere in west africa or heathrow airport in london or head to a city in the united states. should it pop up on some sort of tracking record when you're entering the united states that you've recently been in africa? >> well, it should be stamped on your passport, so you should know it. but it seems to me that in the normal course of events we try to keep track of passengers and terrorists for other kinds of reasons. for infectious diseases if we have reason to believe that somebody is ill on a plane, you
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might recall a while ago where somebody with highly drug resistant tuberculosis got on a plane to his honeymoon, we knew that was happening. we need to keep track of that person and the people that they come into contact with. that is a matter for public health authorities. yes, if we have a suspicion that there is a very serious infectious disease on board an aircraft we should keep particular attention to people who are potentially exposed and where they change planes. >> are you confident that the cdc is up to the task? >> well, the cdc has what they call a migration and quarantine unit. they've had it a long time. that unit is in place in all the major airports in the united states. they don't have as much control outside of the united states when you board the plane. that is a problems. but we do the best we can to try
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to track people and if we can identify them when they enter the united states there are very clear protocols for contact tracing between the cdc and the state health department. the problem is that as i think you said earlier i don't know it really isn't that easy to find out this person has an ebola or if this person has sars. you can semen forking isn't quite reliable, and by looking at the person you can't always tell. so we have a long way to go. we're still actually somewhat primitive in being able to identify who might be infected with the disease when it comes to an u.s. airport. >> in the case where you have someone who has been rebreathing circulated air wh of someone who has been coughing.
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can we follow someone who has been scattered from the o'hare field, where they go? >> in the case of tuberculosis the people of most risk are those who sit within six rose of the victim. those who sit within six rose are followed up much more closely and then a second layer of letting people know that you may have been exposed to databaset.b. things are different with ebola. the cdc has released guidelines to all the major airlines of what to do with that person if they become ill on the plane and how to manage it throughout the flight and what to do when they get to their destination. >> we'll be back with more "inside story" in a moment. have we entered an era of viral mobility and poses threats. we haven't even fully taken in
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account. stay with us.
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>> you're watching inside story on al jazeera america. i'm ray suarez, dr. bosh, officials believe they have gotten control of this thing and ceased the spread from person to person. that the other countries affected in west africa are closer to getting a handle on this. >> unfortunately, we're still a long ways away. there has been a necessary upscaling of the response in recent days and weeks, which is of course a positive development, but we can't use the same strategies that we've used in the past. we have too many cases in
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liberia and sierra leone to think that we can follow each individual contact. we have to use broader strateg strategies. so still a very serious situation in liberia and sierra leone to a somewhat lesser extent than guinea. i think it will be with us for many more months. >> how will we know that things are getting better? are there some signs. some numbers of new cases, numbers of new deaths are the public health officials in those heavily infected countries will know that they've turned a corner? >> well, exactly right. we do follow the things that you just mentioned, number of new cases, particularly important whether the new cases come from areas where we recognize where there is transition, which is unfortunate, but nevertheless expected. or come from areas where we haven't recognized any transmission to date, which would indicate there are new areas and still in circulation.
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we may see an increasing, even when we get things a little more under control, the case counts may go up for a little while because our surveillance will be better. we'll be more able to detect and find the cases and count them. but ultimately that's what we're going to pay attention to is the case counts. >> given the large reservoir of disease in west africa and the way people move around the planet, would it be worthwhile to assume that there would be more cases in the united states? >> yes, i would say that i agree with the doctor yesterday when he said that he's confident we'll stop this in his tracts, but i also don't think this will be the last time that we have to do this. >> will it be worthwhile to keep people a little worried? there has been reassurance and maybe during reassurance people don't pay close attention. should we be making them a little bit more worried? >> i think there are people who
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are plenty worried right now. but i think come play santacy may be an issue going forward. we need to make sure that we remain vigilant an. >> professor, we don't have a worldwide tool kit. we have practices here. practices there. should we have an out of the box strategy in an inter connected world for dealing with co contagions like this. >> it we've got increasing populations. congregated cities. this animal human interchange. we can be on a plane across don't inspects in hours i think ebola is a game changer. i think it has changed the way we think about things.
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when you look at the who. they say well, we're not the responders, if you're not, who is? it's the county's responsibility, but if you have countries with no health systems that's not going to work. we don't have a global response. in the end the security council has to get involved. >> professor, doctors, great to have you on this edition of "inside story." thanks for being with us. in washington, i'm ray suarez. >> coming up, the director of the secret service announcing she's stepping down. director julia pierson's resignation comes amid a number
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of high security breaches. plus new details about the first diagnosed case of ebola here in the u.s. the patient's family said that he was sent home from the hospital lace before he was admitted and diagnosed. we have more coming from hong kong. that and more coming up at 6:00. this is tech know, a show about innovations that can save lives. we are going to explore the intersection of hardware and humanity and we are doing it through unique ways. this is a show about science by scientists. let's check out our team of hardcore nerds. i am phil torres, an entymologist. from base can camp, we are on the scene after raging wildfire. the scientists who go directly in the path of a firestorm.


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