york. coming up at 7:30 eastern, cnn spotlight on comedy legend joan rivers right here on cnn. learn about her life and her groundbreaking career. that special coming up later tonight. "cnn newsroom" continues at the top of the hour. right now "sanjay gupta, m.d." another dire warning about the deadly ebola outbreak. the world health organization now saying as many as 20,000 people could be infected before this outbreak is contained. we know that more than 3,500 people have been infected so far and more than half of them have died. one of the people currently fighting for his life is american missionary dr. rick sacra. he's the third american health care worker now to be infected with ebola in liberia. and on friday he was medically transported to the nebraska medical center's biocontainment unit. and american nantionsy writebol recovered from the disease in atlanta. she spoke for the first time this week about her extraordinary recovery. >> the question is usually asked

what do you think saved you. was it the zmapp drug? was it the supportive care? was it the liberian and our u.s. health, our u.s. medical people? was it those doctors and nurses that helped to save you? or was it your faith? and my answer to that question is all of the above. >> you know, writebol beat the odds. but this crisis is far from under control. in fact, the head of the cdc says time is running out. >> there is a window of opportunity to tamp this down, but that window is closing. >> i can tell you that, you know, dr. frieden went on to echo the same thing he'd said more than a month ago in front of congress. >> we know how it spreads. we know how to stop it from spreading. the challenge is to do that everywhere that's needed.

>> but frankly, you know, i'm not entirely sure what that means. i think details really do matter here. and we haven't heard enough specifics of the plan. we certainly haven't seen enough results. and on that vein i want to bring in the head of the usaid and it's also fair to say he's the new man in charge of the united states ebola response. welcome back to the program. >> thank you, sanjay, thanks for having me. >> let's start off by asking a broader question. what is the united states obligation in all of this and how and when does it get determined? >> it's actually quite clear to mount and help support an international effort to help our liberian colleagues get over this ebola crisis. and dr. frieden is exactly right to point out with 3,500 cases and 1,900 deaths, in this is an urgent epidemic that demands an urgent and at-scale response and we have a clear strategy that we're pursuing together with international partners to make sure that that happens.

>> i was there in april in guinea, near where this all started, and even -- that was just a few weeks after the first diagnosed cases. even within that time, about a week, ten days, the case rate tripled at that time. msf, doctors without borders, at that time, several months ago, were saying this is already out of control. they couldn't keep up. they couldn't follow contacts, for example, to try and prevent the outbreak from spreading. are we late? i mean, what happened here, raj? so many times in the past we've been able to control this. did something get missed? >> well, two things, first, since march we've had nearly 100 u.s. personnel including experts from the centers for disease control disaster responders on the ground helping countries in west africa. we've, in fact, delivered more than 100,000 personal protective equipment kits, trained providers on how to use them, more than doubled the laboratory and diagnostic capacity on the ground which is where a lot of this data comes from. but it is essential to understand the context.

and in an environment where there effectively is not a proper, functioning, higher-order health care system, there simply has not been nearly enough treatment available for people with ebola which is why we're now pursuing a strategy of getting 1,000 beds set up in liberia to treat patients with ebola and yesterday we noted an increase of our investment of 75 million additional dollars to help make sure that is a well-resourced, at-scale and effective response. >> you mentioned some of the specifics of the dollar amount. the number of beds that will be created as a result of that. what about the infrastructure overall? these problems that you describe are not going to go away, right? this is a response to an outbreak right now. we know there's another outbreak happening in congo, a different strain of ebola. these happen all the time. why won't each outbreak in the future be like this now? is this the way outbreaks are going to be? >> this should not be the way

that outbreaks are going to be handled. that's why we're putting in place a strategy that will tamp this down in west africa. the strategy has three essential components. one is quickly scale up treatment. 1,000 beds including getting critical care personnel to go to liberia to be part of the response. there are critical care personnel that want to volunteer or be part of this effort they can go to usaid.gov and register. second, there will be -- and is a strong prevention approach. so, we've already delivered 5,000 who-certified body bags but we're training teams throughout liberia to conduct safe and dignified burial because so much of the transmission is happening when they're handling bodies of the deceased. and third, we're working on the broader societal issues. for example, we've already delivered tons of food items to families of affected communities

and to the hospitals themselves so patients get adequate food. >> dr. raj shaw, thank you for joining us. i get to point out i get to call him raj we've known each other since we were kids and i'm a bit older as well. >> thank you, sanjay. we lost a legend on thursday when joan rivers died at the age of 81. we're still waiting on a lot of the details but we do know that she had some trouble with her breathing during the procedure. that's the respiratory arrest and as a result it's likely that her brain and her heart had gone without oxygen for too long. you know, joan was such a fixture in our lives and the story of what happened to her has left a lot of us with some unanswered questions. one of them is how much of a risk is there to having a procedure done in an outpatient center? there's always going to be risks, about your airway, losing your airway, blood clots or heart problems are a allergy to medication. it's only half of 1% of people

will suffer a complication like the one she apantly suffered. many will also ask, look, should this procedure have been done in a hospital instead of a clinic hi hindsight is 20/20 and the vast majority do just fine but there are some things you can and should do ahead of time. it's an elective procedure. you have time. check out the clinic and learn about the anesthesia at the clinic. you should know which doctors are going to be present and be comfortable with all of them being there. you should also know what the emergency plan is in case things don't go well. and you can also go to the website of your state's medical board and search for any malpractice judgments or disciplinary actions that may have been taken against your doctor. lastly, and this is an important one, you need to be completely honest and fully disclose your medical history, any medications you've been taking. that one, of course, is on you. still to come, hard to believe, but we are marking the

13th anniversary of 9/11. i was there. i saw all that dust. what did it do to the brave men and women who first responded to the attack on the world trade center? there are some new findings that are just coming out. we've got them for you. that's next. (vo) ours is a world of passengers. the red-eyes.

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13 years later it's hard to believe more than 2,500 9/11 rescue and recovery workers have been formally diagnosed with cancer. think about that. that rate is a choppi inwhoppin higher than the population at large. especially among the responders that worked amidst the dust as the years go by the number of cases will continue to go up. >> workers are seeing tons of

debris from the world trade center tower. >> to try to locate someone that might still be alive. >> perhaps the survivors might be found. >> in the days and weeks after the towers fell, the vice cop and first responder at ground zero worked on the overnight shift and most of the time he was coated in dust. >> i was like a raccoon. you had smoke and dust caked onto your eyes. you could see, like, where your eyes would tear, there were little trickles of cleaved skin where your tears went down your face. >> his only protection from breathing in the toxic air a bandana that hung loosely to cover his nose and his mouth. a few years after the attack 9/11 was slowly receding into the background. then in 2004, he got sick. >> i got very sick. i was getting cold sweats. feeling i was a little hunched over. i thought it was definitely food poisoning. >> an emergency room doctor

agreed and sent him home. but four months later he was doubled over again with a stabbing pain in his abdomen. >> one of the doctors came in. and told me, it looks to me like you have a very large mass inside your abdomen. it could very well possibly be cancer. i was diagnosed there with stage three lymphoma and i believe i only had about a 30% chance of survival. >> ernie's cancer was aggressive. by the time doctors discovered it, an 11 centimeter tumor, the size of a small grapefruit had formed in his abdomen. rarely do doctors know what causes it. but they do think environmental toxins may play a role. >> there was a study that came out tomorrow, ernie, that said we now know that people getting sick at ground zero had nothing to do with the environment, how would that make you feel? >> well, i would have to say it

would be a total lie because any doctors i've spoken to, even the nurses, they all say the same thing, oh, it's definitely related. so many rescue workers and especially cops and firemen. >> okay. >> thank you. >> okay. >> i received some bad news on my p.e.t. scan there was some activity that looked a lot like cancer. they weren't 100% sure. >> it's true that exposure to chemicals in the dust has made many responders sick. most have serious respiratory problems. but questions about cancer have eluded scientists until now. dr. david presant chief medical officer of the new york city fire department authored a study in 2011 published in the

"lancet" medical journey suggesting something that started to change this whole conversation, answering the question that many believed would never be answered, that firefighters working at ground zero are, in fact, at increased risk for cancer. >> we found a 19% increase in all cancers in our exposed firefighters as compared to our nonexposed firefighters. >> 19% increase in cancer rates. that's a significant increase. >> that's a significant increase. we excluded cancers that might have been diagnosed early, so we still see this 19% increase. when we put those cancers back in -- >> right. >> -- we see a 32% increase. >> to be clear, the study in 2011 was specific to firefighters. many of whom were there when the dust first rained over lower manhattan. but that study and others since then are reshaping our understanding about the relationship between dust and cancer. >> a firefighter's who was

there, world trade center, and developed cancer over the last ten years. they have the lingering question why did i get this cancer and was it related to the dust. and you would say what? >> for most instances, it was world trade center related. >> since 9/11 the number of responders diagnosed with cancer is up to more than 2,500. the year before that, the number was closer to 1,100. and the years after federal officials stopped short of linking 9/11 exposures with cancer, in 2012 58 types of cancer were deemed eligible for coverage under the world trade center health program. to valbona none of this addresses his most urgent concern. is his cancer back. >> bad news, i'm going to faint. >> hello! >> hey. >> hey. how are you? >> okay. very good. >> all right. i got good news for you. it looks good. >> oh, great.

>> i might actually have to spring you. can you stand it? will you miss me? i will miss you. >> i will. >> that's five points and a star for one year every year cancer free. >> nice. >> all right. you wear that with pride, all right? >> thank you. >> i've gotten my life back. i feel like a feather floating in the wind right now. >> and i hope you will join me this thursday night for this documentary called "terror in the dust." thursday night september 11th only here on cnn.

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ask just about anyone which of these two things is worse for you a sugary drink or a cheese burger and they'll tell you it's the burger and almost every time they'd be wrong. low carb versus low fat, blah blah blah. and in 90 seconds or under i'm going to boil it all down for you. if you are worried about heart disease i think the evidence has become pretty clear. low carb is the way to go. look, study after study shows that you're likely to lose more weight on a low carb diet and keep that weight off, but even more important the measures of heart disease including your cholesterol levels seem to improve more on a low carb rather than a low-fat diet and that brings me back to these. yes, the sugary drink could be worse for your heart than the cheeseburger. if you're still not convinced, consider this, in the early 1970s the low-fat trend got pretty big. we started removing fat from our food and we replaced it with

sugar. lots and lots of sugar. and what happened over these last 40 years? obesity rates skyrocketed, so did diabetes. heart disease remains the biggest killer of men and women in this country. it turns out we knew all along our bodies simply couldn't handle all that sugar. as human beings we used to get sugar once or twice a year when fruit fell from the trees even honey was protected by the bees. now sugar is everywhere. we eat more than 100 pounds a year on average and the sugar hits our livers like a tsunami wave. we can't process it. we can't digest it. we simply can't handle it and eventually that sugar gets churned out into the worst kind of cholesterol particles, the kind that are associated with heart disease. all of it can happen within just two weeks. so for your heart low carb wins out over low fat. check the clock. just in time. all of it brings us to our fit nation challenge. we're one week away from the

malibu triathlon, six cnn viewers and i will be racing. a little nervous. but we've been training eight months now for this big day. in january these six cnn viewers were selected to join me on a journey to become triathletes. they all had one common goal. to make a change. and over the last eight months, i've seen them transform. swimming. dozens of hours. biking hundreds of miles. and running farther than they ever thought possible. >> today we're going to do a 400-yard swim on the ocean. >> with hard work comes rewards. they're healthier physically and mentally. connie's breakthrough it's not all about the scale. >> if weight loss would have been my only goal this year i may have quit within the first few weeks. this experience has given me so much more than weight loss. it's given me strength. confidence and endurance, new friends new sports and lots of spandex and a great tan. >> mike learned how to balance

his new healthy lifestyle. >> the structure i have in my life now is amazing. i plan my meals a week ahead of time. eating out is a rarity. >> karen now makes herself a priority. >> i've learned to listen and take care of my body. the proper sleep and nutrition is very important. >> for ron he learned that age really is just a number. >> age does not define who i am or what i can do. it is simply a milepost along the journey of my life. >> jamile started this journey recovering from cancer. he beat that cancer and he got his confidence back. >> i'm capable of the same things but those things may take me longer. the sooner i made peace with my new normal the easier i was on myself which helped me grow into my new body and achieve better results. >> and last but certainly not least, sia. >> it's so important to have your family and friends on board. their involvement is critical to your success. >> she's right. getting the support of those

around you it's an absolute must. just one more week to go, guys, and i can't wait to see all of you on the starting line and the finish line next sunday morning. but this weekend some big changes, historic changes, are in store at your local pharmacy. and i'm pretty happy about it. i'll tell you why after a quick break. this is kathleen. setting up the perfect wedding day begins with arthritis pain and two pills. afternoon arrives and feeling good, but her knee pain returns... that's two more pills. the evening's event brings laughter, joy, and more pain... when jamie says... what's that like six pills today? yeah... i can take 2 aleve for all day relief. really, and... and that's it. this is kathleen... for my arthritis pain, i now choose aleve. get all day arthritis pain relief with an easy-open cap.

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could mean less waiting for things like security backups and file downloads you'd take that test, right? what are you waiting for? you could literally be done with the test by now. now you could have done it twice. this is awkward. go to comcastbusiness.com/ checkyourspeed. if we can't offer faster speeds or save you money we'll give you $150. comcast business built for business. i want to end on a bit of a good note today. an important move in the world of health that may have flown under your radar. cvs the second largest drugstore chain in the united states behind walgreens they stopped selling tobacco in their stores. i always thought it was a bit surprising that a store that was primarily a pharmacy, a store that was designed primarily to

improve people's health would also sell tobacco. angels and demons side by side on the shelf. but the fact of the matter is up until this week that was exactly the situation and make no mistake people bought a lot of tobacco at cvs. about $2 billion a year. now, on one side you have people who say, look, that's all well and good. this hasn't gone far enough. what about candy? what about junk food? what about sugary drinks? it's a fair point. but unlike food products tobacco has absolutely no redeeming qualities. none. no calories. no nutrition. nothing. it's associated with nearly half a million deaths per year in the united states and smokers on average live ten years less. now, on the other side some people will say, look, this isn't going to make a bit of a difference because people will simply find another place to buy their smokes. also a fair point but not necessarily true. an article in the journal "health affairs" show existing bans in pharmacies in boston and san francisco led to 13% fewer purchases overall. apparently to a lot of people it

was too much of as hassle if they couldn't buy it at their favorite store. it would make an even bigger difference if all these stores that profit by improving our health stay true to that core mission. if they did that, we could save an estimated 65,000 lives a year. that's going to wrap things up for "sg md" today. time now, though, to get you back into the "cnn newsroom" with poppy harlow. 5:00 eastern time, you are in the "cnn newsroom," i'm poppy harlow joining you this evening from new york. president obama is delaying executive action on immigration reform at least for now. the white house says no action until after the november midterm elections. the president is weighing executive moves that may allow a path to legal status for millions of undocumented workers in this country. options may include