Media Conference Call: Ebola in the U.S. (Audio)

Media Conference Call: Ebola in the U.S. (Audio)

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Sub-Saharan Africa

Infectious Diseases

Listen as Laurie Garrett, CFR senior fellow for global health, discusses the recent arrival of a traveler infected with Ebola in the United States, as well efforts to combat the virus's rapid spread throughout West Africa.

OPERATOR: Excuse me, everyone; we have all the speakers in conference.

Please be aware that each of your lines are in a listen-only mode. At the conclusion of today's presentation, we will open the floor or questions. At that time, instructions will be given as to the procedure to follow if you'd like to ask a question.

I would now like to turn the conference over to Dr. Novotny. Dr. Novotny, please begin.

NOVOTNY: Hi, I'm Tom Novotny, a Professor of Public Health at San Diego State University and it's my pleasure to start off this conference with Laurie Garrett, who's the Senior Fellow from Global Health with the Council on Foreign Relations.

And she has been working with Ebola, which is now gaining significant press attention, due to the fact that we have, now, a first case of Ebola discovered in the United States. But she actually dates back her history of work on this to approximately 1995, during the first noted Ebola epidemics in Kikwit in -- in Sub-Saharan Africa.

So, with that, let me, with pleasure, turn this over to Laurie Garrett to make some introductory remarks and then we'll turn it over for questions after that.

GARRETT: Greetings, everybody, and I want to leave as much time for questions as possible, so I'll be extremely brief.

The Ebola epidemic continues to rage in Western Africa and there is increasing concern about the quality of the numbers, meaning really how many people are infected, how many have died, how many may have survived, and whether or not any of the interventions are adequately capturing the patients.

And I don't mean capture as in physically take captive, but capturing as in you know the numbers; you know they're there.

Meanwhile, of course, all attention, since yesterday's press conference from the CDC and Texas authorities issued the notification, is on Dallas. And lots and lots of Americans are asking tough questions, mostly out of a sense of fear that the virus could spread beyond its current confines in the hospital facility in Dallas.

And I think it's worthwhile to remind everybody that far less resourced countries have managed to stop Ebola very swiftly.

Those would include Senegal, which had a case introduced. The individual crossed the border, had contact with quite a number of other people before ending up in a hospital facility. Senegal was able to track all the contacts and isolate the single case and got no secondary spread.

And in the case of Nigeria, a much more complex scenario, involving a traveler who was living in Wisconsin and traveled from the United States to Liberia, Liberia to Togo, Togo to Lagos; infecting healthcare workers and members of his delegation with his virus, which he succumbed from.

And though that spread to another city, Port Harcourt, Nigeria successfully brought that under control and there is, at this time, no evidence of (ph) secondary transmission in that outbreak.

So, I think it's helpful to put it in context and for Americans to realize we have a much better-resourced health system than either Senegal or Nigeria. We should be able to keep this under control and as Tom Frieden, the Director of the CDC said yesterday, in his press conference, that (ph) we can bring this under control.

So, with that, Tom, do you have any questions?

NOVOTNY: Yeah, thank you very much, Laurie, for that update.

And I would like to start off the questions and then we'll open up the -- the conference call to others to do so.

But the first question I have is, especially as a former CDC public health professional myself; does this identification of a case here in the United States, in a -- in a person who traveled from Liberia, the hot spot of the epidemic, to the United States indicate a failure of a screening mechanism that would be put into place for the airlines, but also at the point of contact with -- initial contact with the healthcare system, because he had returned from Liberia on the 24th and then reported for care in an emergency room in Texas on the 26th and was told to go home.

So what -- what's your thought on -- on just the procedural aspects of this, given that there's been so much publicity and, in fact, protocols implements throughout the healthcare system in the US?

GARRETT: Yeah, tough question.

First of all, the only screening we have at the moment for the airlines is do you have a fever. And some of the airlines are actually running people through either thermal doorways -- thermal detector portals; sorry, or actually having them -- their temperature taken.

If an individual has a fever, the airlines have a right to deny them their seat on the plane, if they're coming from parts of the world where there is suspicion of circulation of infectious disease, which in this case would include Ebola.

So this individual was, by all reports, screened. He had no fever and he boarded the flight feeling completely well.

There is absolutely no evidence in this case, contrary to the case of Patrick Sawyer, who flew from Wisconsin to Liberia to Togo to Nigeria; there is no evidence in this case that the individual had any reason to believe that he was infected with anything.

He then went to Texas. The precise route of travel has not been released. And was well for the initial of his time in Dallas and it was only have a few days that he developed symptoms. So, up to then, I don't see any failure.

If there is a failure up to the moment that -- you know on the 26th of September, when he first sought care, it would be that we should not rely on airport screening techniques as the be-all and the end-all.

I think we've learned this lesson over and over and over again. And I would just give, as a few key examples, you know, when the H1N1 swine flu exploded, many countries, particularly in Asia, quarantined entire jet-loads of Americans and Mexicans, because we were where it started.

And in Hong Kong, a whole jet-load of Americans and others were -- were quarantined in a hotel in Hong Kong. It -- it -- the quarantines, the attempts to isolate people based on fever had zero impact on the spread of H1N1 around the world. And every country, no matter what measures they took, ended up getting flu in -- within their borders.

The other example that's probably more cogent to the case of Ebola is pneumonic plague. In 1994, there was a plague epidemic in India and it really got out of control, even though plague is completely preventable with prophylactic cheap antibiotics and treatable with cheap antibiotics.

But nevertheless, it was out of control in India and there was quite a bit of hysteria in the country. Here in New York City, it was realized by then Mayor Rudolph Giuliani that the majority of all flights to the United States from India, either directly or -- or routed through London, came into JFK Airport in New York.

And so he ordered his health department to screen all the planes and not let passengers off unless they had passed screening, and to train INS and immigration officers how to recognize plague cases.

It completely failed. Most the people who were pulled aside as likely carriers of the disease turned out to be completely healthy. In -- in one case, it was a woman chewing betel nuts.

And in contrast, people who actually did come down with feverish disease and had so seek healthcare were -- got right past the airport and went right into their homes in Queens and other parts of New York City before they were detected. So I think the general -- one big take-home is you can't stop viruses at airports; doesn't work.

You -- you may be able to slow it down a bit. You may be able to decrease the possibility of an active carrier transmitting within the environment of a jet by screening out people with fevers, but you can't give any country 100 percent protection based on anything you do at an airport.

The second question is what about the individual seeking healthcare and then being turned away. I don't know all the details; none of us do. There are various press reports regarding what happened on the 26th; why the individual was sent home with antibiotics.

Apparently the individual did inform the intake nurse that he had been in Africa, but for whatever reason, this did not trigger a mechanism within the hospital. I -- I can't really speak to details, because none of really have them at this point.

But I can say, in a general sense, that this should be a big warning in the United States. Unlike our neighbors to the north, in Canada, or our friends in Western Europe, we in the United States have 43 million people with -- still with no health insurance.

We have a system of health provision that takes individuals with either not ability to pay or who cannot afford large copayments and shuttles them to public hospital emergency rooms, where they may be warehoused for hours on end, waiting to see a physician and potentially infecting others in the waiting room environment.

You know, most people who lack the ability to pay for their healthcare tend to avoid going to see doctors and avoid going to hospitals until they're so sick that they just can't, you know, avoid it any longer.

And they could have infected, in that avoidance period, any number of coworkers, family members, colleagues, people they saw at church, people they say wherever they went in a large, congregated setting.

So I think our special vulnerability, as Americans, rests with the fact that we have an enormous population of Americans that do not feel they can access healthcare.

NOVOTNY: I think we can now turn this over to other questioners. Christina (ph) from the conference service, could you please start that process?


At this time, we'll open the floor for questions. If you'd like to ask a question, please press the star key followed by the one key on your touchtone phone now.

Questions will be taken in the order which they are received. Again, to ask a question, press star one.

Our first question comes from Lee Cullum with Public Media for North Texas.

QUESTION: Hi, Laurie; it's Lee Cullum. I'm a journalist in Dallas, so especially interested in this story.

The Dallas news, incidentally, has just released information that a few students were exposed to this patient but do not, at this point, appear to be ill.

I'm just wondering; what would your advice be for this city at this moment, including its airport.

GARRETT: I would say stay calm. Dallas. I carefully watched your governor, Rick Perry; his press conference today, in which he made the announcement that there were -- he didn't say kids in school.

He said school-aged children; a very important distinction, because there was nothing said by any of the people in that Texas press conference to indicate that the children who had been exposed had also gone to school and potentially exposed other children.

But I think that the -- it makes no sense for people in Dallas, or anywhere else in America right now, to take any kind of drastic measures or steps to protect themselves from Ebola. There is no generalized spread of this virus in the United States of America at this time.

QUESTION: Thank you. That's good advice.

OPERATOR: Thank you. Our next question comes from Bart Jansen with USA Today.

QUESTION: Thanks so much for having the call.

I was familiar with the difficulties of airport screening because of that previous swine flu and I guess a SARS attempt about a decade ago.

But I wonder if, through your reporting in the past, whether you would have any other suggestions or any other ideas about anything that either airlines or airports might do to stem the spread of this.

Is there anything -- checking for fevers is -- is difficult because you could have a fever for any number of reasons. But I wonder; is there anything else that they could be doing, in terms of that airline travel?

GARRETT: Well, Bart, I think we could go through a long list of possible things that any given airplane carrier could do or any individual who is a traveler could do. But the bottom line, really, is we're in a globalized world and while that is an often-repeated cliché, let's drill down on what that means.

The -- the -- 20 years ago, when I wrote "The Coming Plague" and warned about all this, it was already a world where everybody, to do business, had to fly places. Any real serious company had business dealings in foreign countries.

Now, 20 years later, it's almost impossible to -- to have a position on the U.S. stock market without globalization of your business.


GARRETT: And that means that you can't survive economically without a lot of travel.

I think that the scale of travel, the scale of movement of people around the world and the numbers of people that going to what, even 10 years ago, were considered you know hard-to-reach exotic locales.

This has all transformed to such a degree that I think the idea that you can stop a virus at the airport or before it gets on an airplane is as much an antique as the notion that Ellis Island will screen out all disease among the immigrants.

QUESTION: OK, thank you.

OPERATOR: Thank you. Our next question comes from Lisa Vives with Global Information Network.

QUESTION: Thank you for taking my question.

Several writers have noted that African doctors or -- or medical professionals have not been evacuated from the country once they've become infected. And -- and -- and in -- and in fact, they've died with -- with the infection.

Since the Africans are on the frontline and we really need Africans to be there, are we cutting -- shooting ourselves in the foot by not taking the best care of the African professionals?

GARRETT: Well, Lisa, that's a great question. Let me step; make a little bit bigger question.

We need at least 3,000 more health professionals on the ground in these countries right now. Some -- some of it's doctors and nurses; some of it's people who know how to do health communication, track disease victims, all of that.

The danger, at this moment, in an overreaction from the American public, is that we will start to demand that all those selfless volunteer Americans that have gone over and are helping Liberia right now, helping Sierra Leone, helping Guinea; that all of them will be banned from returning to their home country.

And we've already had the problems at some of the neighbor states were not allowing MSF volunteers to take R&R to recuperate from their arduous efforts for a week or two, in a safe zone and then go back.

We've seen that some African countries and some Asian countries have stipulated that if their nationals volunteer and go to help in the epidemic, they will not be welcome to come home.

I think the worst thing that could happen right now is to any further erosion in the kind of global solidarity that we absolutely must have if we are going to have any prayer of stopping this epidemic in West Africa.

And you know if we don't stop it now, not only will we have tens of thousands who have perished from this disease, but we could very well end up with Ebola as a permanent, low-level feature in the background in these communities, meaning endemic.

And that could, in turn, further stigmatize and isolate these countries, drive them into deeper, deeper poverty. They're already amongst the most impoverished places on the planet.

QUESTION: And what about them -- doctors not being airlifted out for care, not being given ZMapp, not being able to go to Germany and then dying as a result?

GARRETT: Well, of course, nobody's getting ZMapp anymore. There is no more ZMapp. So, there were very limited supplies and there's really no clear evidence, one way or the other, that ZMapp worked. There just wasn't a clinical trial so you just don't know.

But, putting that aside, your -- your more important question is why is one quality of are available to a selfless health provider who happens to be a national citizen versus to the outsiders coming in; the foreigners, performing side-by-side, the same tasks.

And that's a very legitimate question and you're not going to keep you know health personnel on the ground, doing their job if they don't feel somebody has their back. It's kind of a classic notion in the U.S. military; you don't send any -- anybody into harm's way without being able to prove to them before they go, we've got your back; leave nobody behind.

This is a very, very awkward moment for the international response community and one of the reasons that the first announced hospital the U.S. was building with this 25-bed facility in Monrovia is that it's meant to be specifically for infected healthcare workers.

So it would provide the same quality of care, regardless of what kind of passport you hold, but if you're part of the frontline responders and you contract Ebola; this will be a special care facility just for those workers and that's under construction right now.

OPERATOR: Thank you.

Again, if you'd like to ask a question, press star one on your phone.

Our next question comes from Richard Kim with The Nation magazine.

QUESTION: Hi, Laurie.

So the U.S. response so far, in part, has been led by AFRICOM, and not just the US, but other military units around the world.

Unlike in -- in the past in some other incidents, I'm hearing very few objections about this from -- from health advocates, with the understanding that military units are the only ones with the real logistical capacity to -- to take on this mission.

Is that an assessment that you share, Laurie, and do you have any concerns about how this sort of global response has been securitized around Ebola?

GARRETT: Well, I don't think the Ebola response has been securitized. Just because you have some military personnel doesn't mean that it's now a military response.

I think it's pretty sad that the German military's been unable to make deliveries, because their air force is so run down and out of condition that none of their flights have managed to make it from Germany all the way to Liberia, Sierra Leone or Guinea.

And that kind of points even more strongly to the disproportionate capacities of the American Armed Forces.

You know, you can site a million reasons for why that would be the case, but it is. It's true. The fastest, best logistic responder on the planet is the United States Armed Forces. And you know when MSF reached out and called for the U.S. military support, this was a soul-searching moment for an institution that had never previously worked with military forces of any country.

And then have even put their own responders in harm's way, without armed guards. Even in situations where MSF personnel had been kidnapped or subjected to hostile attack.

And I think we -- I think everybody involved I this outbreak knows what is most essential; has been for months, but now really is, is a speedy response. You know our window is closing fast on how much longer the sort of text book approaches to controlling an outbreak of something like Ebola will work.

If we get too high a saturation of virus in the general population, suddenly the sort of care-quarantine component becomes less and less effective and we start having to think about approaches to epidemic control that we have not used in well over a century, anywhere in the world.

And that's just a horrible...

QUESTION: Can -- can you spell that out a little bit? What - what would those responses be and what's the sort of tipping point?

GARRETT: Well, I don't think anybody knows what the tipping point is. That -- because we're in completely unchartered territory here. We haven't been in this place before. We have no historic example to turn to.

We don't have cookbooks to draw from this; says (ph) this how you proceed in this kind of an epidemic. But I think that, in past -- in the 20 prior Ebola epidemics, control has been facilitated primarily in healthcare settings.

So the goal was to prevent people from having contact, physically, with an ailing patient by removing the individual from the household or wherever they might be and putting them in a treatment facility that also was a quarantine facility.

So, all the care facilities had double duty. There were also securitized, to use your word, meaning that they -- you know, they would have police or someone ensuring that the family couldn't get in and the patient couldn't get out until the patient was healed.

And similarly, taking care of bodies and ensuring that the burial procedures did not, in any way, allow physical contact between people at the burial and the cadaver.

So -- but all of those are very labor-intensive and they assume that you have enough hospital beds available and enough healthcare workers available that every single infected individual can actually get care and actually get in a facility and be isolated from others so that they do not spread their disease. And that is not the case right now in these countries.

And the real question is whether, even at the current accelerated pace, adequate numbers of care facilities can be constructed and adequate numbers of volunteers found from all over the world to tend to those facilities that the care model of quarantine can continue to be utilized effectively.

If not, then we go to totally uncharted territory that takes you all the way back to, you know, the plagues of the past, where isolation is with or without care. It's just to isolate.

OPERATOR: Thank you. Our next question comes from Rafael Abizariz (ph) with L.A. Nation.

QUESTION: Thank you. Thank you for organizing this conference call.

My question is what is the risk that the virus travels south of the border, since Dallas is so close to Mexico?

GARRETT: Thank you for that question, Rafael (ph).

You know, the irony is that when the first individual who was a caregiver; a missionary caregiver who contracted Ebola in Liberia, was airlifted to the United States.

Some of our right wing commentators said, you know, that this was -- this individual should not be brought home, because he might contaminate all of America. Donald Trump famously said; this is endangering my life.

But also, some commentators started talking about this is more evidence that we need to close our border with Mexico, because terrible things come from Mexico, like Ebola. And here, you're asking exactly the opposite. Could Mexico get Ebola from America?

Look, I go back to the very first question and comment in this entire press briefing, and that is that we're in a time of globalization and risk is a shared experience. Would Mexico get it from US? Would Mexico get it from Liberia? Would Mexico get it from Argentina? Would Mexico get it from Nigeria?

We are globalized. There's no way to point fingers anymore. It's the wrong way to even think about global health. Finger-pointing only results in failure to respond and in a stigmatization, which of course the Security Council, a week and a half ago, passed a resolution condemning.

QUESTION: So the short answer is yes.


QUESTION: The -- the short answer is yes; the countries south of the border are at risk, or at least they have greater risk because...


GARRETT: I did not -- that is not what I said. If that's the way you're going to construe what I just said then you will be misquoting and misstating what I've said and I think the other reporters...
QUESTION: I -- I -- I...

GARRETT: I think all the other reporters on the line heard what I said.

QUESTION: I just need to have a clear view if -- if because the virus has already traveled across the Atlantic if the region is in greater danger because what you said; it could travel anywhere. That's -- that's what I'm getting from your comments.

GARRETT: I don't think Dallas is at risk from one case, in security, in a Dallas hospital. So if I don't think Dallas is at risk from that one case, I sure don't think Mexico is.

QUESTION: OK, that's great. Thank you very much.

OPERATOR: Thank you.

Again, if you'd like to ask a question, press star one on your touchtone phone now.

We have no more questions at this time.

NOVOTNY: Well, I -- I would...


NOVOTNY: ... like a -- yes; hi. I would like to offer one. This is Tom Novotny again.

Laurie, we have had this Dallas case visit a healthcare facility and I did not hear the press conference with Governor Perry, but I think the important thing is -- is that the mode of spread has to be emphasized; that is that this is still through droplet infection or bodily fluid contact and not airborne transmission.

And I know we've talked about this in the past, but I -- I was wondering whether or not the question was raised about airborne transmission and -- and whether or not the -- the press conference dealt with this and that was there any further worries about actual patient contact -- bodily fluid contact with this individual, aside from those in the healthcare facility.

GARRETT: Well, as I'm -- as I'm sure all the reporters on this line know, in his press conference yesterday, Tom Frieden said the chance of transmission when (ph) an individual is asymptomatic, has no active symptoms is, quote, "zero," end quote, and that all transmission is via contact; physical contact with the bodily fluids of an infected individual.

So, you know, what this is really saying is you -- your -- your highest risk individual is going to be the caregiver. And whether the caregiver is your mother, your sister, your brother, a nurse or a doctor; these are the individuals that are wiping your brow, cleaning you up, trying to feed you and doing all the intimate contact things that could put them at risk for transmission.

There is no evidence that any strain of Ebola, including the Ebola Reston strain found exclusively in monkeys; there's no real evidence of airborne transmission ever. And for this virus to mutate into a form that could be airborne transmissible would involve an absolutely phenomenal scale of mutational event.

It isn't like looking at one type of flu that infects birds and trying to figure out what it would take for that bird flu infector to become a mammal infector. Those are -- that's asking the virus to fundamentally change its entire machinery, its entire genome. This is a tiny, tiny change.

In the case of Ebola, this is a virus that has evolved to exclusively infect cells that line what's called the endothelial lining, that line blood vessels, blood veins, capillaries and so on. And they have a little protein that sticks out from the surface of those blood vessel cells.

That protein is the key that the virus uses to open up a cell and get inside and infect the cell. It -- it has no genetic capacity to use the keys, if you will, or protein receptors that are on the surface of things, like your alveolar cells and your lungs.

And anybody that imagines that a mutational event could turn this virus into a lung-infectious or nasal-infectious or mouth-infectious form is simply not studying the biology correctly. And I would just add one other thing.

Yes, we say it is, quote, only transmissible via contact, but that does not say that contact transmission is a minimal or a minor event. This epidemic has spread quite readily. The virus is getting around through large populations in West Africa, through contact.

So there's no selection pressure to draw on the tenets of Darwin on this virus for it to mutate into an airborne-transmitter. It's managing to find plenty of hosts to infect without fundamentally changing its genetic machinery. And again, for it to go airborne would be a fundamental change in the genetic machinery of the Ebola virus.

OPERATOR: Our next question comes from Lisa Vives with Global Information Network.

QUESTION: Thank you so much.

I just read recently that Cuba was now going to send over 400 medical technicians; doctors, nurses. And it just made me wonder, you know how -- how much time to medical professionals need to get up to speed to be able to handle this new environment?

I know they've been to Haiti, but this is a totally different situation.

GARRETT: That's a really good question.

The -- one of the things the U.S. military is doing is trying to build a facility that can process 500 health workers a week through infection control training. So, in theory, it takes a week to get adequately trained in order to be able to handle patients.

We don't have a lot of details on the Cuban healthcare workers. So, for example, I don't know how many of them speak English and obviously it would be tough for them to undergo a training done by English speakers or to understand patients if they don't speak English.

On the other hand, a lot of people in these countries will be speaking with their dialect and their African language, which ever one of the languages is their language. So, you know, everybody's having to try and make do and figure out how to get along, without clear language signals.

I think the real challenge for the Cubans will be figuring out how they can go through the -- the training and then assimilate into the sort of MSF design and they're only going to Sierra Leone; the Sierra Leonean government design apparatus for collecting patients and treating them.

And well, you know, they have -- they're doctors, like anybody else; they're nurses, like anybody else. They have training and hopefully they can quickly absorb the infection control training and -- and the last thing we want to see is infected Cubans.

QUESTION: All right. Thank you.

OPERATOR: Thank you. Dr. Novotny, would you like to ask another question?

NOVOTNY: Well, I -- I think, you know, the -- the issue of the -- the children who were -- or the school-aged children in Dallas; I wanted to hear that one more time. Were they actually exposed in any way that was meaningful or was this just that they were in the same place?

I mean, you know, I didn't hear what the governor had to say, but what -- what was the concern about them?

GARRETT: Well, the governor's language was very, very careful. And you know, for those who have followed Rick Perry for a long time; extreme care was not what Rick Perry was historically noted for in his comments.

So it was -- it's obvious that this was very, very, very important not to send an alarmist signal through the Texas population. He -- I -- I think he chose his words carefully. He said they were school-aged children; not they were children in school. And he didn't indicate whether he was talking about two kids or five kids. No numbers were given.

My impression, and it's only that, from what was said by the other Texas health officials and by what's posted on the official Texas State and local Dallas County health websites, is that this individual -- the traveler really didn't have much exposure, beyond the family he was visiting and that family had children.

And I suspect the school-aged children that they're talking about are the children in that family.

NOVOTNY: That makes sense.

One last question that I wanted to make sure that we discussed was right now, we've got the U.S. military involved. Many other countries now are sending healthcare providers and -- and equipment, et cetera.

What is the role (ph) now of the WHO? How's it evolving, because they have been criticized roundly for their slow response and also because their - their resources have been overtaxed on this as well? So any -- any thoughts on how the WHO is emerging on this?

GARRETT: Well, WHO has a catch-up game on its own credibility; that's for sure. And I think the whole institution is well aware of that.

And the United Nations set up a superstructure that is above WHO and commands a much larger range of the United Nations institutions. And that is now operational, as of yesterday, out of Accra, Ghana, which is also where the air bridge is for transport of supplies and personnel into the affected areas.

W -- the big announcement out of WHO today is that after having turned away vaccine manufacturers, who came in March and April to WHO, saying we have candidate vaccines for Ebola; would you help facilitate us doing clinical trials on them on an emergency basis, given this outbreak? WHO said no and turned them down.

Now, WHO convened an expert group of vaccine expertise, drawn from all over the world and from multiple institutions and they concluded their proceedings and issued a statement this morning that basically says we think there are two reasonable candidate vaccines.

One was developed in Canada and is being commercialized by a small American company, and the other is from Glaxo-SmithKline, based on a product originally developed in the Netherlands by a company called Crucell, which GSK bought out and, as part of buying out the company, inherited this candidate vaccine.

WHO is now committed to facilitating clinical trials, as rapidly as possible, on these two vaccines to see which may be, first of all, safe and, secondly, show any efficacy in reducing the possibility of an individual becoming infected and at what kind of dose what -- does it require boosters.

There's (sic) a lot of questions that have to be answered before you green-light a company to make millions of doses of vaccine. But at least now, WHO is really committed, as of this week, to try to facilitate getting the answers to those essential questions.

NOVOTNY: Great, thanks.

OPERATOR: Thank you. Again, if you would like...

NOVOTNY: Any other questions?

OPERATOR: ... to ask a question, press star one on your touchtone phone now.

Our next question comes from Saundra Torry with USA Today.

QUESTION: Thanks for doing this, Laurie.

You mentioned all the reasons why the airport screening at either end wouldn't work. What do you think would be helpful in the United States to be doing right now, so emergency rooms are ready or -- or whatever's needed is done. What are the next few steps to take?

GARRETT: Yeah, I think that the most important thing right now is, first of all, Governor Perry said that Texas was one of only 13 states in the nation that have undergone and completed training from the CDC on how to identify and diagnose Ebola and how to the lab work.

That means that 37 states aren't ready at all. I would say, if I was in one of those 37 states, I would be putting a lot of pressure on my Governor's office; get us that training now.

The second thing is I am already hearing, anecdotally, of healthcare workers, very sadly -- and lab personnel who are refusing to take care of people who come from West Africa.

And I could see a really horrible stigmatization unfolding in this country against any people who are either of West African descent or have traveled in West Africa, for whatever reason, and including countries that don't have any Ebola at all.

And that would be wrong, it would be immoral, it would be violating the Hippocratic Oath and -- and -- and just -- just a really horrible thing to see happen. It's what we saw in the early days of AIDS, as doctors refused to treat people who were infected with HIV.

And I think to counter that kind of a reactionary position; it's very, very important that hospitals all over the country take very seriously the kind of training that is necessary to make physicians, nurses, lab technicians, everybody that is in a hospital understand how to protect themselves, while, in fact, continuing to provide care.

And I think if we can't speed up that sort of process, we're going to see real tragedy on our hands.

And I would say, finally, if I were running an emergency room, which would be crazy, 'cause I'm not an M.D. But if I were, I would be seriously be considering whether or not we could create a special, set-aside area in -- off of our emergency room standard waiting area, where we would exclusively have people who present with a fever, so that we keep people who may have a (sic) infectious disease separate from the rest of the waiting room population.

And I would put priority on processing them quickly. Regardless of their age or symptoms, if they have a fever, let's get them separated from the general population and let's evaluate them as quickly as possible to screen out any possibility that Ebola might spread in our waiting room areas.

OPERATOR: Thank you.

Dr. Novotny, we have no more questions at this time.

NOVOTNY: Well, thanks very much...


GARRETT: I think we actually need to wrap it up at this point.

NOVOTNY: Right, right.

And if I could just add one thing to Laurie's last comment is that this -- this protocol approach is what is being put into place with the training that is being provided and that hospitals are just doing this in other kinds of situations and I think we'll be able to implement this quite successfully, especially now that the warning bell has been sounded by the situation in Dallas.

GARRETT: Here, here.

Well, I, unfortunately, have to run to do the Charlie Rose Show; to tape it. And so I need to exit immediately. But I want to thank all of you who were on the call for your interest. And, Tom, thanks so much for helping out.

NOVOTNY: Sure. Thank you, Laurie. It was great to have you on this case.

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