Program: Al Punto with Jorge Ramos
Content: Interview with Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC)
Air Date: Sunday, October 12, 2014
JR: Jorge Ramos
TF: Tom Frieden
JR: Dr. Frieden, thank you so much for talking to us.
TF: My pleasure.
JR: Can you give us any updates? Are you concerned right now of new cases of Ebola here in the United States?
TF: I really think we have to step back and let’s be really clear. Ebola is not going to spread widely in the U.S. We’ve had one patient diagnosed in the U.S. – that was in Dallas, Texas. That individual had contact with ten people and may have had contact with another 38 people. Each of those 48 contacts is being monitored each day. None of them have developed symptoms. So while the disease is taking a terrible toll in parts of Africa, it’s not going to spread widely in the U.S. You can only get Ebola from someone who’s sick with Ebola, and you can only get it by contact directly with them or their body fluids. It’s not nearly as infectious as flu or the common cold.
JR: Dr. Frieden, you don’t want to impose a travel ban. Why not? Don’t you think that you’re putting the whole country at risk for only 150 people coming in here every day?
TF: I certainly understand why people are calling for restrictions on travel. If we look back to what happened in SARS, the SARS outbreak cost the world more than 40 billion dollars. Most of those costs were travel and trade restrictions that didn’t help stop the outbreak. But even more importantly, if we were to ban travel, we would isolate these countries. If that happens, it gets harder to fight the outbreak there and —
JR: But isn’t that precisely —
TF: — if that happens —
JR: — what you want, Dr. Frieden?
TF: — the outbreak — but just, just let me finish. If that happens, the outbreak spreads more in Africa, and then actually creates more risk to us here. So we say in medicine, “above all, do no harm.” And this would do harm.
JR: But isn’t that precisely what you want to do? Don’t you want to isolate those countries so they can deal with these crises right now and not put the rest of the world at risk?
TF: No. The key thing to do is to isolate patients, not communities, not countries; to treat and isolate patients. That’s how you stop the outbreak. We’ve stopped every Ebola outbreak in history until this one, and we can still stop this one. What we have to do is actually surge in support, support these countries. But what we have done is to implement rigorous screening protocols, so every person getting on a plane from these three countries, we ensure that an approved, FDA-approved thermometer is used by a CDC-trained staff to see if they have fever. If they have fever, they don’t fly. This week, we’re starting new protocols in the U.S. where we’ll check people again to see if they’ve had contact or fever when they arrive. But if we completely shut them off, it makes it much harder to respond. You know, we really are all an interconnected world. And while we wish we could get the risk to zero here, until the outbreak stops in Africa, it won’t be zero here. But by engaging and supporting and helping, we can protect ourselves better.
JR: General John Kelly, chief of the U.S. Southern Command, warned that if Ebola breaks out in Central America or the Caribbean, there will be mass migration into the United States. Is he right?
TF: You know, I don’t think we’re going to see widespread transmission in countries that have good infection control. So having good infection control and very old practices that don’t spread the disease can allow us to contain this. Ebola doesn’t spread like flu, doesn’t spread like measles. It only spreads by direct person‑to‑person contact. But we are concerned with some of the fears and some of the behaviors that are following concerns of Ebola and may end up causing harm economically or even from a health standpoint; for example, patients not going to healthcare facilities when they need to get care.
JR: So I spoke with Dr. Aileen Marty from FIU and from the World Health Organization, she told me that in her opinion, Latin America is simply not ready for a crisis like this. I understand you’re going to be meeting with a Latin American president soon. What are their concerns?
TF: Not just for Ebola, but for any health threat, it’s important that each country has in place the core public health infrastructure. And in some countries, that’s far too weak, and that public health infrastructure means laboratories that can test for Ebola and other health threats. It means disease detectives like our epidemic intelligence service officers who can track problems, see if they’re real. If they are, stop them and prevent them. It means having surveillance or tracking systems to see if new things are emerging, and perhaps most importantly, it means having entities like the CDC and state and local health departments like public health departments around the world that can oversee and convene and respond effectively. And we know that many countries in Latin America have very strong public health systems. But all of us could always make those stronger.
JR: The Spanish nurse who attended the Ebola patient in Spain, of course, is now infected. In a recent poll here in the United States, 80 percent of registered nurses said that hospitals have not communicated any policy regarding potential admissions of patients infected by Ebola. Why?
TF: It’s very important that we use the concern for Ebola to encourage health care workers to think Ebola, particularly people working in emergency departments. If you’ve got a patient with fever, then by all means ask about travel history. And if that person has been in Guinea, Sierra Leone or Liberia in the past 21 days, immediately isolate them, take a detailed history, and if they may have Ebola, get them tested. We’ve provided checklists and algorithms for all healthcare workers working in emergency departments and similar places so that you can go through a systematic way of working as a team to identify and isolate patients if another patient were to arrive.
JR: Doctor, you compare what we’re going through right now with AIDS. You said that in 30 years in public health you’ve never seen anything like this. Is this just the beginning?
TF: You know, I think we have to put it in perspective. We’re not going to see anything like the health burden of AIDS from Ebola unless in the unlikely event it were to change or mutate. We’re not going to see a million people infected in this country. I’ll be very surprised if there is — there is spread — what we’re seeing in this country are individual patients coming in. It’s not impossible that they might infect a family member or someone who cares for them in their healthcare system if they don’t get promptly diagnosed. But we are not going to have a widespread outbreak of Ebola in the U.S. That’s not going to happen. What is reminiscent of HIV is the fear that people feel about something that’s unfamiliar. What’s also reminiscent is the frustration as a doctor of not having specific antiviral medications to confront it. And what concerns me, not about the U.S., but about Africa, is that if it spreads in Africa, it could have the health, economic and social destabilization that HIV did, not because of the number of people who are affected, which is just massively greater in HIV, but because of the destabilization that it causes for the healthcare system where doctors and nurses are afraid to come to work in parts of Africa, where patients are afraid to go in for care. So in that way, it reminds me of HIV. But the scope of the impact from the virus itself is not going to be anywhere near that order of magnitude.
JR: Dr. Frieden, two more questions and that’s it. Are you concerned about our southern border, that people infected with Ebola might cross from Latin America to the United States?
TF: The only case of Ebola diagnosed or that’s probably existed in the Western Hemisphere was the gentleman in Dallas who tragically died earlier this week. But we will continue to track the spread of the disease, and that’s why, as a world, it’s in all of our interests to have better systems in place to identify problems when they emerge and to track them carefully.
JR: Now, in Spain, the dog of an Ebola-infected nurse was destroyed. Animal activists were protesting this decision. Can animals be infected, and do you agree with the decision of Spanish officials that sacrificed the animal?
TF: While animals can be infected with Ebola, I was surprised to see that decision, and I think, you know, there are a variety of other options that might have been considered. But in fairness, this is a very new situation, and we’re all dealing with it in different ways – when Ebola comes for the first time to our country or our community, as happened in Dallas. So we’re always looking at how we can improve the response, but I think the bottom line here is that we know how Ebola spreads. Ebola spreads from someone who’s sick with Ebola and it only spreads through direct contact with them or their body fluids. We know how to stop Ebola. We know how to prevent and control Ebola, and I’m confident that for the countries that take prompt action as Nigeria did, we can stop outbreaks.
JR: And finally, Dr. Frieden, every time you talk, I see you’re very calm. It’s like you’re not really worried. What keeps you awake at night?
TF: Well, what does worry me is West Africa. In West Africa, we’re still seeing cases increasing at a very rapid rate. And that just is tragic for those countries, but it’s also a risk for the world, and that’s why it’s so important that we continue to support West Africa, because if they don’t control it, it becomes a problem for — it can become a problem for Africa more generally, and for the world for many months or even years to come. So it’s urgent that we control it there now, and speed is of the essence. And anything that we do that slows down that response actually could increase our risk.
JR: Dr. Frieden, thank you so much for talking to us.
TF: Thank you very much.
JR: I really appreciate it. Thank you.