>> welcome to al jazeera america. i'm david shuster in our headquarters in new york. we're waiting for a live press conference from the cdc. the center of disease control. we're expecting an update on the second update from a nurse who was treating duncan erik thomas. they have blamed a protocol breach for the nurse being infected with the virus, and that is creating criticism from

the hospital. there is controversy over who is in charge of the control of the ebola outbreak. joining us from the cdc headquarters in atlanta is robert ray. what are we expecting from this press conference this morning? >> good afternoon, david. dr. thomas frieden is likely to come out and answer some of the questions you just brought up, and also probably go into detail about the new team that has landed in dallas will be investigating, what they're going to be sifting through. what they will consider the breach, the protocol breakdown and figure out how that occurred with the nurse and the potential for the fact that there may be other health workers that may come down with symptoms in the coming days. we're expecting to hear from him very shortly. as you say a lot of

controversy--you know, one of the biggest questions that we keep hearing if this hospital wasn't prepared or up to par to treat someone with the ebola virus, why didn't they originally move there duncan to university of nebraska in omaha or even here to atlanta to emory university hospital, which is just a few blocks down the road from the cdc. >> there has been controversy about the cdc declaring, and to your point, that every hospital has to be prepared for the oath and the chances of one. and the point you have made is to identify regional hospitals best equipped to do this? >> exactly. you consider the hospital in dallas as a major institution and clearly there has been issues there. remember, a couple of months ago there is only four units in the entire country that would be

able to handle and quarantine people with ebola. one in atlanta, washington, omaha and montana. those are specialized you wants. not every hospital is prepared for that, and not every healthcare worker is prepared for that. as we heard from the nurse's group, they're hearing that a lot of people feel that they're not appropriate. they don't understand the steps it takes to not get the ebola infection. as a matter of fact, we were just in alabama last week witnessing some cdc training on the ground simulated training for folks going over to west africa in the coming weeks, and it is so meticulous, david, the amount of steps it takes to make sure that the safety equipment is done properly, and to get it off. it's remarkable. even the workers there who have had experience with this were making mistakes, and the teachers were making them go through it again and again and again. so phenomenal. i don't hour a small tiny little rural hospital in say iowa or alabama, somewhere like that,

would be able to take anyone with the ebola infection. it is tough enough for a place like emory university to deal with this, let alone an institution with very little training on an infection that began over in west africa and is not native to here in america. >> robert, there have been some national health experts who have been putting the blame on the state of texas to slowly not inviting the cdc team fast enough and not look for information aggressively. are they blaming the state of texas or texas health officials for what's gone wrong other than this verbiage of a protocol breach? >> yeah, i mean, that's all we heard is the verbiage of the protocol breach. perhaps they would address those rumors swirling around today in the press conference. i think they will likely will. we'll hear from someone with the texas health department from this press conference as well. you know, i think if you really

look at this, the cdc is the big federal institution, and you have the state health departments who want to do their best, and you kind of get some bureaucracy mixed together and some finger pointing, and perhaps some of the media is creating that as well. we're just out here. we're hoping that dr. frieden addresses some of those issues inside the cdc, and we'll have answers momentarily. >> we're expecting the general update about any outbreak of cases around the country. there have been some media reports of an outbreak. one person was showing ebola symptoms in massachusetts. any updates on the cdc on that? >> again, we'll wait to hear. the dcd is very limited in what they're revealing this morning in the wake of yesterday's news. it's usually what occurs. they're not making anybody available. we requested an interview with

dr. frieden, and they said they're not going to make him available until more of this comes out. dr. frieden and other officials have said this is a possibility that we'll see a lot more people who will be going into local hospitals with flu-like symptoms which is how ebola starts. it's very similar to the symptoms of the flu. there will be a lot of people who think they have ebola some how who go in, and of course they're going to be released. that's the nature of a big infection like this coming to a country who has never seen it before. there is going to be--and i hate to use the word--some panic. the thing is no one should be panicking. ebola is only transferred through bodily fluids, and it has actually a very tough infection to get. >> we're talking with robert ray, outside of the cdc headquarters in atlanta. we're looking at a live picture of the podium where the officials will announce--let's listen. >> good afternoon.

you're joining cdc's update of the ebola response. i'm barbara reynolds dcd public affairs. for those of you in the room asking questions will you please wait for the microphone and give your name and affiliation. our first speaker today is cdc director dr. tom frieden. >> good afternoon, everyone, and thank you very much for joining us. stopping ebola is hard. we're working together to make it safer and easier. yesterday we confirmed the first case of ebola contracted in the united states in a healthcare worker who cared for what we--who we refer to as the index patient in dallas, texas. our thoughts are with this

healthcare worker. she is now being cared for, and we understand that she is clinically stable. refer any questions on her care to the hospital where she's being cared for, for the information that she and her family want released is released. the existence of the first case of ebola spread in the u.s. changes some things, and it doesn't change other things. it doesn't change the fact that we know how ebola spreads. it doesn't change the fact that it is possible to take care of ebola safely. but it does change substantially how we approach it. we have to rethink the way we address ebola in infection control. even a single infection can unacceptable.

i'll get into details of what we're thinking about with regard on how to make care safer in a minute, but i want to step back first and outline what we're doing and what the current status is. first, before the index patient in dallas was hospitalized and isolated, there were 48 potential contacts, ten known to have contact with him. 38 who may have had contact with them. all of those 48 contacts have been monitored daily, none of them have developed fever or other symptoms as of now. this is consistent with what we know about ebola, that people aren't sick when they don't have symptoms, and the sicker they get the more infectious they may become because the amount of virus in their body increases.

second, for the healthcare worker who was diagnosed yesterday, we have been discussing with her our team lead in texas, we have spoken with her on multiple oakess. she has been extremely helpful, and we've identified one and only one contact who had contact with her during a period when she was potentially although likely not infectious because it was at the very on set of her symptoms. that individual is also being monitored and as of now has no symptoms suggestive of ebola and no fever. third, is to identify the healthcare workers who also cared for the index patient, and insure that they are actively monitored for development of symptoms for fever and if they develop either symptoms or fever, that they're immediately isolated, assessed, and tested.

that process is still under way. the team worked hard through the day yesterday into the night yesterday, and are still actively working today to interview each one of the large number of healthcare workers who might potentially have had contact with the index patient when he was hospitalized. and the thinking here is straightforward. if this one individual was infected, and we don't know how within the isolation unit then it is possible that other individuals could have been infected as well. so we consider them to potentially be at risk, and we're doing an in-depth review and investigation. so these are the three categories of contacts. contacts with the index patient before he was hospitalized, on tacts wit contacts with the healthcare worker and contact with those who may have had the index patient after he was

hospitalized. all of them will be actively monitored and that's how we break the chain of transition. we break another generation of bread with ebola. in addition as i indicated yesterday we are doing a detailed investigation to better understand what might have happened with the infection of the healthcare worker? we look at what happens before people go into isolation, what happens in isolation, and what happens when they come out of isolation, and we're particularly concerned with that third process, taking off the isolation personal protective equipment because if it is contaminated there is the possibility that the worker will contaminate themselves and become infected in that process. from day one we've had a team on the ground in dallas working closely with the hospital, the state and local health officials when the patient was diagnosed we double down and sent an additional team in place. that team has been at the

hospital continuously since. they've been working through the night. we're not just doing an investigation, we're immediately addressing anything that could potentially make it safer and easier to care for people who have or may have ebola. we're not going to wait for the final results of that investigation, and i can go in some detail later to what--what we are doing in the short run, but each time we identify a process for training, for equipment, for protocol that can be improved there. we are improving it right there on the site. i want to clarify something that i said yesterday. i spoke about preach in protocol. that's what we spoke about when we talk about what needs to happen, and our focus is to say that would this protocol would have prevented this infection?

we believe it would have, but some interpret that in finding fault with the hospital or the healthcare worker. i'm sorry if that was the impression given. that was not my intention. people on the front lines are really protecting all of us. people on the front lines are fighting ebola. the enemy here is the virus. ebola. it's not a person. it's not a country. it's not a place. it's not a hospital. it's a virus. it's a virus that is tough to fight. but together i'm confident we will stop it. we need to all take responsibility for improving the safety of those on the front lines. i feel awful that a healthcare worker became infected in the care of an ebola patient. she was there trying to help the first patient survive. now she has become infected. all of us have to work together to do whatever possible to

reduce the risk that any other healthcare worker becomes infe infected. when we think about hotels where ebola care can be given, the first is diagnosis. every hospital in the country needs to think about the possibility of bobble, and anyone with the fever and symptoms of ebola and who has traveled to the three countries of liberia, sierra leone and guinea in the last 6 21 days, second is the care of ebola once the diagnosis has been made. i think what we recognize is that care is complex, and we're

now looking very closely with the hospital to make that care simpler and easier with hands-on training, overidentity and monitoring, and that is something that we will do any time there is a case of ebola. now i want to just end before i turn it over to commissioner l lackey to think about what comes next. first is the he have safe and effective care of the healthcare worker. we will do everything to make sure that those career for her will be taking care of themselves, and that individual will have the best possible care. second, we need to consider the possibility that there could be

additional cases particularly among the healthcare workers who cared for the index patient when he was so ill. that's when this healthcare worker became infected, and we're concerned, and unfortunately, we would not be surprised if we saw additional cases in the healthcare workers who also provided care to the index patient. third, we will continue to track all contacts, all 48 from the initial patients, exposures before he was hospitalized. the one individual, who was exposed to the healthcare worker, who's hospitalized now, and all of the healthcare workers who may have been exposed during the initial care of the index patient. fourth, we'll work with hospitals throughout the country tcountry.

fifth, we'll double down on training, outreach, education and assistance throughout the healthcare system through professional associations, through hospitals, through group organizations and individuals reaching out to health departments at the state and county levels and cities and elsewhere, so that we can increase the awareness of ebola and increase the ability to respond rapidly. we wish the situation in dallas were different than it is today. we wish this individual had not been infected, and we're concerned there could be other infections in the coming days. what we're doing now is implementing an immediate set of steps that will insure the care of that individual is safe and effective while we look longer term at what this implies for what we should be doing to care

for ebola as safely and effectively as possible wherever it may arise. with that i'll turn it over to dr. lakey. >> i know the family is possibly listening, we want them to know that our thoughts and prayers are with them, the healthcare worker and the staff working with them right now. dr. frieden talked about the components, and now we'll talk

about the contact information. we pulled additional staff throughout the state of texas complimenting the work of the cdc and dallas health department staff, we're bringing in the resources to do the contact investigation from many different levels of government to identify those individuals and contact them as quickly as possible. dr. frieden talked about infection control. looking hard at the infectious control practices and making sure that they're even more stringent than what they are right now and have cdc experts, the best in the field here in dallas working with us to make sure that we are as stringent as possible with infection control. the healthcare workers apartment initial cleaning has been done. additional evaluation and cleaning will be accomplished today. we're doing this with local leaders, but also with state

agencies to make sure that we do that in accordance with the best guidance that is out there. one issue related to the final cleaning is the healthcare worker had a dog. we want to make sure that we respond appropriately. we're looking for a location to care for the dog, and a location to have properly training with the dog. the work we're doing is contingency planning. we know what can occur, so we want to be prepared. a lot of work is taking place with a variety of healthcare providers, emergency managers, ems to make sure that we're ready for whatever needs to take place, and at the same time following the folks that we know have been contacted, and the 48 individuals that we've been monitoring so far, and the additional individuals that

dr. frieden has discussed today, to make sure they know what happens when they start having symptoms. a lot of work is taking place, and we continue to be grateful for the support for the cdc and our many other partners in this response. with that dr. frieden. i hand the lineback over to you. >> thank you very much, and thank you for all the team is doing there in texas. it's an slept working relationship and we value it greatly. before we turn to questions we'll comment that the situation is fluid and we'll continue to update you as we get more information. >> doctor, you spoke about the possibility of further infections. is that because there is a known safety procedure or protocol that perhaps was not followed. and my follow-up question is if you cannot pin point a breach in protocol how do you move forward in fortification.

>> if we knew the single incident, such as a needle stick, then we could narrow down the exposure. since we do know what the exposure was, then we have to cast the net more widely and see in terms of monitoring--monitor a larger proportion of the health wear workers and in terms of infection control protocols or procedures improve every aspect of those procedures every time we see something that could be improved. so for example our staff there are watching as patients put on and take off all their protective garb. they're retraining staff and how to do that safely. they're looking at the types of personal protective equipment that are used to see if there are some types that may be easier to put on or take off, therefore reduce the risk that someone would contaminate

themselves. we're looking at what we do when someone comes on the isolation unit and possibly spraying them down with product that would kill the virus if there is contamination. that was already in our guidelines for gloves, we're looking at that more broadly. we're looking at within the isolation facility that personal equipment could become contaminated with the virus. we'll continue to look at that in terms of how can we make care easier and safer? >> hi, from cnn. you have been telling us about what needs to be done, how prepared we are for months. you've been telling us for a long time about the risks and all the things that can be done. you just said that you're working at making care simpler

and providing hands on training. it seems that there is a gap in what you may have thought was happening at the nation's hospitals and what is actually happening. have you thought about bringing in someone like doctors without borders who have been successfully treating patients in africa for years, to learn how to do it? and secondly the question regarding the travel. you said multiple times that travel ban is not helpful, but many people think why not keep those people who may be sick from coming into this country? can you better explain why you don't think a travel ban is a good idea? >> sorry, your first question again? >> training. >> thank you. we worked very closely with doctors without borders, msf, we've re replicate their training course. and we have healthcare workers

who are going to africa to fight the outbreak at the source, going through a cdc run training program that replicates the training that msf has done. the same team at cdc who created that training course is training physicians throughout the u.s. but definitely we will be looking over the coming days and how we can increase training and increase training materials and availability most urgently for the healthcare workers caring for the patient in dallas, and throughout the healthcare system. it is worth highlighting that the single most important thing for every other hospital in the country to know is the importance of taking a history of travel. that if someone has fever or other symptoms that could be ebola, ask where they have been in the previous 21 days. and if it's to liberia, sierra leone or guinea, place them in isolation, and consult

with us and we'll go from there. that's what the healthcare system in general needs to really focus on. in terms of travel we're looking at multiple levels of protection. the first is screening of people on departure from these three countries. all are screened with a questionnaire. all have their temperature taken. 77 people in the last two months were not allowed to board, not allowed to enter the airport because of fever or symptoms. none of those were diagnosed with ebola. many of them have malaria. in addition starting yesterday at jfk international airport in new york city we began to screen people who came from these three countries. these three countries with detailed questionnaire and temperature check. since that was implemen implemented 91 such individuals were identified. none of them had fever.

five were referred to additional follow up with cdc. none were found to have ebola. we'll put this in place in four additional airports. we'll learn from that experience. also making sure that doctors throughout the healthcare symptom diagnose ebola promptly. that's very important. the issue of banning travel. i understand that there are calls to do this. i really try to focus on the bottom line here. the bottom line here is reducing risk to americans. the way we're going to reduce risk to americans is do the steps of protection i just went through, and stop it at the source in africa. today cdc has 150 of our top disease detectives throughout the three countries and many of the counties, districts and pre-fixtures in the countries to

turn the problem around. work with the "world health organization" and many governments who are surging in to help stop it at the source. if we do things that unintentionally make it harder to get that response in, to get supplies in, that make it harder for those governments to manage, to get everything from economic activity to travel going, it's going to become much harder to stop the outbreak at the source. if that were to happen it would spread for more months and potentially to other countries, and that would increase rather than decrease the risk to americans. above all, do no harm. that's why we want to focus on stopping the outbreak at the source. and protecting americans wherever ebola may arise, even though we know that may be challenging.

>> texas presbyterian is a relatively large hospital. and still had a breach like this. do you still feel confident that smaller hospitals can handle an isolated patient with ebola symptoms? >> we're going to look at the issue to safely and effectively care for patient with ebola. it is important that very hospital be prepared to diagnose someone with ebola. remember there may be americans who have deployed or traveled to the area who come back, so whatever we do, we're not going to eliminate travel from these countries. >> thank you, dr. frieden. i'm michelle merrill with hospital employee health. you do everything to protect healthcare workers. i was wondering if you feel that you could be certain that in the presence of a patient with