white house. guys, thanks very much. you can follow us on twitter, tweet me at wolf blitzer or tweet the show at cnn sit room. and join us tomorrow right here at the situation room or dvr the show so you don't miss a moment. thank you very much for watching. i'm wolf blitzer in "the situation room," erin burnett "outfront" starts right now. >> ebola, how the system failed. why was the patient sent home after he h was feverish and just flown in from west africa. and plus he had direct contact with at least five children. what is their threat to them and their classmates. and the ebola patient co-workers, they talked just before he left for dallas. let's go "outfront."

good evening. i'm erin burnett. "outfront," the first ebola diagnosis in america. but perhaps most disturbing, new details about a texas hospital mistakes exposed the public to the deadly virus. the patient identified late today as the man you see here, thomas eric duncan is a 42-year-old man from liberia. he went to texas health presbyterian hospital on tuesday and he told hospital workers he had just arrived from liberia, the center of the outbreak but they gave him some antibiotic and pain reliever and sent him home. he exposed children to ebola for about three days and then for 72 hours, duncan is not in isolati isolation, not even in a hospital, he is out walking around. when he finally returned to the hospital on sunday he told the staff again he had just arrived

from liberia and he was feverish and vomiting, it was only then that they finally admitted him. he was diagnosed yesterday with ebola, five days after he first went to the hospital. let's say that again. five days after he first went to the hospital. he is now listed in serious condition. can you imagine how this case has been handled is fuelling outrage and we start with elizabeth cohen, outside of the hospital in dallas. and the question i have is how could this have happened? >> reporter: erin, unfortunately miscommunication happen at hospitals with a greet deal of frequency but seldom does it have this devastating consequences. >> the family of the ebola patient thomas eric duncan said he's in pain and hasn't eaten for a week and now in serious condition at the hospital. now health authorities are monitoring between 12-18 people, including five children.

they all had contact with dungeon, on this, his first trip from liberia to the united states. authorities want to make sure they too don't have signs of ebola. >> the public can be assured, you're going to be safe. this virus is isolated, is being contained, will be contained. >> reporter: but there are safety questions here in dallas and in the united states. duncan arrived in the u.s. from liberia on september 20th, five days later he went to the hospital for care but was sent home. and officials say in response to a nurse's question, he volunteers he came from africa. >> the nurse was part of a care team taking care of him in the emergency department. regretfully, that information was not fully communicated throughout the full team. and as a result, the full import of that information wasn't factored into the clinical decision-making. >> reporter: two days later,

duncan runs to the hospital and a close friends tell cnn the hospital wasn't moving fast enough so the friend called the cdc. the cdc directed them to the texas department of health leading to a phone call to the hospital. duncan was isolated and after tests it was confirmed he had ebola. we are told he called family and friends from the hospital and prayed with them on the phone and cried. while there are questions about the hospital's handling there are also concerns about airline handling. i came back from liberia, and no one took our temperature and i was told to hon tor my health for 21 days but no one told me what to look for. back in dallas, the children and relatives of the patient have been advised to stay home. >> we'll add custodial staff to

that part of the building. regular disinfectants will help. >> everyone who had contact with duncan are feeling fine and not in quarantine. >> people cannot transmit this disease until they have symptoms. so individuals who do not have symptoms will not transmit the disease to other individuals. the chance of transfer is zero. >> reporter: and even with the first case diagnosed in america, the us will not get to be like liberia, where poverty has led to chaos and misery. and now as i mentioned, this kind of miscommunication like what happened at this hospital, this is not an unusual event. there are experts that have written books about miscommunication at hospitals and hopefully this event is a clear call that something needs to be done. erin? >> thank you elizabeth. and something that can fuel shock and outrage when you consider texas is one of the 13 states in the united states that

was supposed to be completely ready for this to happen. "the new york times" tonight is reporting something very important. they are saying that duncan had direct contact with a pregnant woman who had ebola just four days before he left liberia for the united states. "the new york times" reports that duncan helped the sick woman get to the hospital by taxi. she was convulsing and yet turned away at the hospital because there weren't enough beds. she died hours later. "the new york times" also reports that others who have come into contact with her are now sick or dead. another big sign that the u.s. missed screening du ining dunca coming into the united states. dr. sanjay gupta. days before he was helping carrying a pregnant woman who died of ebola. shouldn't they know that. >> it is difficult not to pile

on a little bit, right, erin, with regard to this. there is no question this is a dropped ball. there was a misstep in terms of how it was handled and history will record this buzz it was the -- because this was the first patient diagnosed with ebl in the united states -- ebola in the united states and they missed it. the travel history, when you have a patient that says look i'm from liberia, i have a fever, i'm vomiting, i fit the criteria that the cdc has set out for the hospitals, very, very clear and they just missed it. as much as we talk about vaccine trials and experiment with medications and contract tracing, this is 101 stuff and it didn't get done properly here. and as a result, i will point out, there are other people who had contact with him after he was sick. and that has got to be hugely frustrating for him and especially for those people, that did not need to happen. >> it didn't. and to your point, that we know now he was sick and went to the

hospital and was sent home with just anti-biotic and pain killer. and so another 48 hours go by before he comes back to the hospital so that is 48 hours where he was having symptoms and others could have been exposed. >> no question. he got an anti-biotic, because they said he had a viral illness and didn't think it was ebola. anti-biotics wouldn't work for that and the pain workers, but it is still baffling, why, when the guy said i'm from liberia and i have these symptoms, why something more didn't happen. and what we heard is the nurse talking about she had taken the travel history but it didn't get communicated to the team in charge. i don't understand it. usually the lead person -- there is a lead person on the teams that will sign off on the discharge paperwork before a patient is sent home, it just shouldn't have been missed. and these hospitals have been going through drills over and

over again to not miss these things. >> sanjay, thank you. he will be back to answer questions of when a symptom is a symptom and when you can contract it. and right now the mayor of dallas is out front. thank you tor taking the time to -- for taking the time to be with us. the new york times is reporting mr. duncan had helped a pregnant woman and carry her and she died of ebl and others who -- ebola and others who interacted with h her, he would have known that she died, and did he tell them that he had been with someone who died of ebola? >> i don't know what conversation took place. they were trained to take that information. they took that information and dr. gupta is right, they took that information and we need to

get on to make sure our citizens are safe here in dallas. >> who is responsible for that failure? >> well, i think basically the hospital is first and foremost accountable for all of their patients and their safety. i feel great about presbyterian hospital, my daughter was born there and we've used it many times. when we deal with a tough situation like this we have to be perfect and they weren't. >> and then after this, the ambulance was used for two more days and it was decontaminated but that stopped. was that a mistake? >> not at all, because they assumed this person had some other illness. once they came back and picked him up, they realized this guy was from west africa and they then put all of their gear in place, they had their protocol and they followed it exactly.

those folks have been put in isolation at this point. the ambulance has been put in isolation. and once this thing kicked in, i think all of the things were done correctly. but that early-on decision was important. >> and one thing that confuses me in terms of what officials really know and maybe you can help me understand this a little bit, because if the ambulance is now in isolation because they are worried the virus could be somewhere on it, at the same time they are saying it is not a hearty virus, it dies very quickly. those two things seem to be in conflict with each other. mayor, are you conformable that no one -- comfortable that no one else has been infected in dallas by mr. duncan or are you sure? >> well first of all i think we have to take every precaution even though i don't believe the ambulance is an issue. we know that he contacted some people, okay. maybe up to 20 individuals. we've got a cross jurisdictional

team tracking each of the individuals, interviewing them to make sure there are no symptoms shown. as dr. gupta said, you cannot transfer this unless you are showing symptoms. and they've got -- it takes a while to incubate so time is on our side to make sure that we capture this and nip it in the bud so nobody else gets infected. hopefully in 21 days everybody is healthy. >> and the question about his identity, the family and the friends of mr. duncan relayed this to the media. the hospital and the airline wasn't releasing it. in this kind of a case, i have to ask you, of such important public health when we look at the future here, wouldn't this be a case where you would release the name? >> no. we are law-abiding governments here and we have hippa regulations and we're going to make sure that the patient is first important 57b thand then

up everybody he's contacted and make sure they are not infected and we monitor those individuals. but privacy is important to me and i think to this government. >> i understand. >> that but what about people who might not know his name and might just know the picture. he might not even know a name, somethinge else might have touched at walmart. that is frightening, isn't it? >> no question. and that is why we have to retrace his sfeps and find -- steps and find everybody he's in contact with. >> mayor rawlings, thank you very much. and the u.s. ebola paretien had to take two flights to get home. how many others could have been exposed. and 2,000 americans will be in the hot zone and what will happen when they come home. and the missteps by the handling of the first signs of

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breaking news tonight, we're learning troubling new details about a breakdown in communication that allowed a man with ebola to be sent home from the hospital. we are learning that for three days before he would be quarantines, according to the hospital, thomas duncan told a nurse he was in africa days earlier when he was sick and that information never made it to doctors. moments ago i spoke to his former boss in liberia and told us duncan is extremely fortunate

to get the care he is in the united states because in liberia, he says, he could have died. >> we do not have the medical facilities here. we are asking for international assistance. but since he came to america, he is blessed to be able to get well. >> the obama administration is closely monitoring the treatment of the first person testing positive for ebola in the u.s. and jim acosta joins me life from the white house. jim, what is the latest there? >> reporter: the white house is urging the public to be calm as the centers for disease control tries to get a handle of this. president obama at the cdc said it was unlikely for someone with ebola to reach our shores but this patient was said not to pose a risk. here is what he had to say. >> it is our view that we have the medical infrastructure that is necessary to meet -- to try

to treat this individual that does have ebola in a way that doesn't pose a significant risk to other patients in the hospital, to the doctors and nurses caring for that individual and certainly doesn't pose a significant risk to the broader community. >> in the meantime, the white house is using social media to spread the facts about ebola. officials have been tweeting ab posting on instagram this message and we can throw it up on screen. it says you can't get ebola through air or water. you can't get ebola through food in the u.s., adding later it can only be spread with the blood or body fluids of people sick with ebola, but despite these efforts to get the word out, this is something the white house is watching very, very closely tonight, erin. >> as they should be. thank you, jim. and now dr. sanjay gunpointuptae

and dr. semma jasmine, formerly with the cdc and now with the dallas news. you can tweet us. and sanjay, we know the symptoms, fever, sick to your stomach. that could be mild, that could be anything. a light cold or feeling under the weather. and people are tweeting, is it possible someone could be walking around with light symptoms for days interacting with people not knowing they are spreading the virus? >> they are very unlikely, for a couple of reasons, erin. first of all, it can start off looking similar to flu as you mentioned. but ebola progresses much more quickly. it gets bad fast is what i'm saying. but i think the history here is important. a lot of people will have flu-like symptoms and in fact a lot of people coming back from africa will have things that

cause fever that are not ebola, but the real thing is the history here. were you in contact with people who had ebola? you talked about this particular person who had been with somebody who had ebola. so the history is so important here. we talked about this earlier. they missed part of the history or didn't act upon part of that history of this patient. but it is critical. in africa, contact with ebola patients, that raises your antenna. >> and we have a tweet here. brandy said couldn't a ebola patient spread the virus if they are showing flu-like symptoms and no fever. so when is a symptom a symptom. they say if you don't have symptoms not contagious, at what moment could it become contagious? >> i think sanjay mentioned this a moment ago. people are very sick. they have high fever, muscle aches, nausea, vomiting and

diarrhea and it is a serious illness. and early on you might mistake it for flu but it rapidly progresses. >> and this man went to the hospital and three days went by and he went home. he was sick enough to go to the hospital but not sick enough to keep him. >> so many people have said this. we are shocked that the travel history was not taken seriously or mochb forward or -- taken forward. >> and semma, i want to play one question for you. >> can you contract the virus through a subway pole or a confined place like a subway or a bus. >> so can you get it from a subway or a pole. >> it can be disinfected using

regular bleach and other routine products used in hospitals. there are a lot of transmission on subways, ebola is not transmitted through the air, it has to be direct contact with bodily fluids. >> and somebody asks if it spreads only by physical contact and elizabeth cohen reported that 3 feet distance is safe in liberia and what if someone coughs and hits your skin, isn't that the same as touching a person? >> it is theoretically possible that someone could be infected talking about that scenario. but first of all, it would still be bodily fluids but just that it got on your skin or on your body and caused an infection that way, it is less like lynx and the amount of virus in what you are coughing or sneezing up versus being in your blood,

we're talking exponentially different than what you cough or sneeze up. you want to target things the most trouble some or the most problematic. theoretically it is possible but that is a low yield area. >> and we are told not to panic, but yet doctors are using has mat suits when they are close to people? >> i agree this is disconcerting and in west africa as well. and they are coming into contact with secretions, diarrhea and vomit and so on. it is different than walking through a subway or walking through a mall. where again, it is theoretically possible that you might have virus present in something that someone would cough. but the levels of virus are so low. >> they are not that high. >> that the odds are so high against it. >> and doctor, we know five students at four schools had

contact with the ebola patient. is there extra concern for kids? >> the messaging again is that children exposed are monitored in the same way as adults. the incubation range is the same in adults as in children. we do know they did have direct contact with him but so far all five children are healthy and showing no signs of ebola. >> thank you very much all three of you. and for more go to cnn.com/out front as we've been covering this over the past six months. up next, the ebola patient took multiple flights to get to dallas. he was screened in liberia and allowed to enter the united states. how this affected passengers and the public. >> and soon many are going to the hot zone. what happens when they return to the united states? is there any plan at all?

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from brussels to dallas. he is in isolation in a dallas hospital tonight. united citing the cdc said there no chance someone on the flights caught ebola, but first renee march is out front zblfrnlt the line earn government tells us that the passenger stopped in brussels on his way back to the u.s. we know he boarded flight 951 to dallas, collecting to another flight, 822 to dallas. local governments and ebola hot spots screen passengers for temperature scanners and look for obvious signs of illness. >> we made sure that every traveller that leaves that country is tested to see if they have a fever before they get on the plane. if they have a fever, they don't get on the plane. thank you. >> reporter: cnn medical

correspondent elizabeth cohen and her crew were checked at the liberia airport as they were prepared to leave and when passengers arrive on u.s. soil, customs and border patrol officers are supposed to question their whereabouts and visually scan for symptoms. but she was surprised there weren't more thorough checks. one officer said he was unsure what symptoms she would experience if she was infected. >> to bolster that, the cdc has been involved in training officers who are on the front line of this to make sure they understand and they have been trained on the symptoms of this illness. >> the most important thing to do is ask every patient with a fever, have you traveled, and if so, where? and if they tell you they've just come from west africa, put them in isolation immediately. >> reporter: and while duncan was not showing symptoms, which experts say he was not

contagious. "the new york times" reports he had just helped a pregnant woman who died of ebola hours later. >> and the customs officer flagged the potential passenger and the cdc is present at airports and takes over from there. they say that customs officers will hand out this flier to passengers arriving to the u.s. from ebola-effected countries and details the symptoms and incubation period for ebola. in the meantime, erin, we know the u.s. government is not advising that airlines not fly to countries impacted by ebola. that said, the cdc is putting out travel notices, essentially warning travelers about the potential danger. >> renee, thank you so much for that report. we have a lot of questions now for the spokesperson from the cdc. david daigle. i want to start with what is happening here on the u.s. side.

you hearden a reporting and elizabeth cohen was in liberia days ago and when she came back, her team was direct with customs and said look, we were in liberia and covering the crisis for cnn and one crew member said the response was welcome back to the united states and was sent right on his way. another one was asked whether he had mud on his shoes. this is just pretty shocking. is this going to -- stop right now or is it going to take time? >> hi, erin. i don't know about elizabeth's particular experience but i can tell you that when i returned from nigeria, i went through screening in legos and when i arrived in atlanta, i thought it was a very good questionnaire and they asked me about my travel history and where i came from, so my experience was different i guess. >> given that this happened, is

there any other communication from cdc or customs or border control to make sure it is consistent and they are doing the right thing. >> we do work with the customs and border control at 20 different embarkation places in the u.s. and i heard the mention, if you think back to sars, the yellow carbon dioxide cards handed out where the outbreak was occurring so it sounds like there is coordination on escalating different steps to warn people. >> so i want to ask you about flights from west africa and liberia. you heard renee reporting. if thomas duncan survives, it is going to be probably because he came to the united states and he got the medical care here. "the new york times" is reporting days before he got on that flight, he helped a pregnant woman that died later and others who had contact with

her has died. and then will you have people purposely getting on to planes to come to the united states so they might live? >> apologize. i haven't seen the new york times report and i don't know about the flight history coming to the u.s. so i have been immersed in what we are doing here in dallas so i don't feel like i can go into that. >> i understand. >> that but if he does survive, are you then worried that other people from ebola-stricken countries will have incentive to come to the united states because as we know there is not the medical care there that they need. >> yeah, that certainly would be a concern. but once again, i don't know a lot of the details for this particular case. >> i understand. got it. it is a concern. i understand. >> certainly. >> and the patient in texas was screened at the airport in liberia for a fever. now that failed for whatever reason. questions weren't asked. for whatever reason. that didn't work and he came into the united states.

is it something you will consider recommending that flights from these countries should no longer come to the u.s.? >> no. i don't think so. and that is certainly not -- i'm not even sure if that is a cdc call. >> right, i understand. but now there are risks for people getting on those planes and come to the united states. does that change the thinking? >> i think he got on the plane asymptomatic, without any symptoms whatsoever. with the fever -- the symptoms occurred after he landed or arrived in the u.s. so it is very difficult to prevent that. i mean the viruses don't respect borders. >> right. and i'm agreeing with you. but i guess i'm saying given there is this pertd that you -- period that you get on a plane and you don't know you have it, should flights be stopped to prevent that from happening again. >> no. we have a good application for the screening here and in west

africa and working with customs and border control and i think we can escalate it with warnings and so i think we can stop it before it is serious. >> and the chance that zero passengers on that plane can contract it. and when you say zero chance, he didn't have symptoms. does the cdc know at what instant a person goes from not having symptoms to having symptoms? >> i'm not sure i understand the question. do we know on what day or what exact time you go from -- >> there is no chance it could spread if you don't have a symptom. but do you know when a symptom is a symptom and when a person can become contagious. >> typically between the 22nd and the 21st day but we typically see it around the eighth day, from the exposure. >> thank you very much, i appreciate your time tonight. and out front next,

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breaking news, the u.s. military is watching the ebola situation in texas closely tonight. the first of 3000 american troops have deployed to liberia to help fight the outbreak there. more than 1800 people have died. when happens when those troops come back to the united states. barbara starr is at the pentagon. and we hear day in and day out about the fight against isis, but the fight against ebola is high on the list. there are more being deployed to west africa than iraq and syria. >> good evening. correctly. chairman dempsey making this fight against ebola making this a priority even as the fight against isis goes on. we heard he called into his office a series of experts,

medical experts on ebola to get a perm briefing about what is going on here and what the risks are and the situation is. we are told the concern is not just about keeping the troops safe but the humanitarian crisis in west africa and concerned the rate of infection could provoke a security crisis across africa. some of the concerns of the chairman as he works on plans to send the 3000 troops to west africa and how to keep them safe and healthy. >> and dr. lipkin who was just here, told me he thinks it may be 1.2 million people who will die of this, to give a scale of what west africa that is dealing with. the troops heading to that zone, what happens when they come home? >> this is the key question even as we stand here tonight. the pentagon acknowledges it doesn't have an answer to it. the defense department and the military, the joint chiefs trying to work out a solution to that problem. we are told tonight by a top

defense official it is very possible the rules will require that the troops be put in some sort of isolation for some period of days upon their return from africa, and they would not be allowed directly to go back to their families and to their bases until a period of days pass and everyone is absolutely sure that they are healthy. what if some of the troops become ill with ebola? the hope is that they won't. they can keep them away from people who are ill. but there is very limited evacuation -- air evacuation capacity out of africa. tonight they are looking at the possibility of converting military transport aircraft to have those isolation chambers to fly ill troops home if it comes to that. erin. >> barbara, thank you very much. and "outfront" next, ebola has hit the united states before. it sparked fear and panic but doctors and scientists fought back. and the iraqi army, unable to stop the advance of isis on

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you will hear what nancy writebol went through, and also the powerful message she wants to deliver to mr. duncan. also another alleged sexual assault incident involving the disappearance of hannah graham. lots going on at the top of the hour. all right, we'll see you in just moments, anderson. thank you. and health officials in dallas are monitoring at least five school age children who came into contact with duncan. tonight, they're looking to screen anybody who came in contact with him. the first time the u.s. responded to an outbreak. here is athena jones. >> reporter: the announcement from the head of the centers for disease control was chilling. >> an individual traveling from

liberia has been diagnosed with ebola in the united states. >> until yesterday, ebola had been largely confined to west africa. now it is here and not the first time. >> a mutated strain of the killer virus struck a research facility outside of washington, d.c. >> in 1989, an airborne strain of the virus quickly spread through virginia, creating fear and panic just outside the nation's capital. >> the monkeys were dying with nose bleeds, there was blood all over the place and it was clearly a highly potentially infective environment, loaded with ebola virus. >> reporter: the doctor was in charge of the facility when the outbreak occurred. >> we had one event where a monkey got loose in one of the rooms. he didn't want to get caught and he was smart about it. we had a hard type catching him.

>> reporter: in the end, the particular strain of that virus, dubbed the restin strain. >> if one of us have it, ten of us. >> reporter: the threat of ebola spreading in the united states may have been low at a time, but the threat of the epidemic was real. >> the projection i make for the spread of the virus, is this, 24 hours, 36 hours, 48 hours. >> reporter: professor david hayman helped to investigate the first ebola outbreak in 1976. >> ebola is a disease that is fairly easily controlled. but at the same time it is a disease that is terrifying to people. >> reporter: the current patient being treated in a dallas, texas hospital is in serious condition. health officials are working to contact anybody who may have come into contact with him. once again, the concerns are

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breaking news, mortars heard in baghdad's green zone, american forces continuing to pound isis targets in both iraq and syria, while turkey, who is a crucial player because it shares a border with both iraq and syria has finally agreed to join the fight. but the man tapped by the obama administration to coordinate the fight against isis has told us exclusively today that the war won't be fast. training syrian rebels which is apparently the key to fighting the terror organization on the

ground is going to take a long time. >> over the long-term, the course is to have vetted forces. >> it will take a long time. >> we have been saying it all along. it could take years, we have to manage our expectations. >> as for the fight in iraq, doesn't look like that will happen any time soon either. tom foreman has more. >> reporter: military bases overrun by isis, all while there are reports of iraqi troops being slaughtered and dropping the firearms and running, president obama said he thought the iraqi teams were more ready to fight. >> that is absolutely true. >> reporter: and why not? $20 billion in coalitions, years of training, and american lives lost to set up the quarter of a million troops as the iraqi army, amid much hope.

>> we're coming closer to the day when they can assume responsibility for defending their own country. >> reporter: but then as the bulk of u.s. troops withdrew in 2011, many sunni members of the military felt that prime minister nouri maliki, a shiite, was pushing them out of power. one colonel saw the divisiveness firsthand. >> the sunni soldiers are not fighting for iraq. the military literally is fractured between religious lines, you have sunni leadership and shiite leadership. again, if we could guess rid of the religious factor you have some very good soldiers. >> reporter: which brings up another problem. analysts say many, perhaps thousands of the good sunni troops trained by american soldiers now appears to have crossed over to the isis side. and half the troops left can't be counted on as partners.

now, the chief of staff is facing hard questions even as talks swirl of more training. >> you think the people you're training will only go back and fight against isol, do you really believe that, general? >> reporter: the iraqi army is desperate for more troops, they are offering amnesty for troops if they will just join the fight, but what then? >> there will be not american boots on the ground, the promise has been said. but is this a promise that can be kept? >> i don't think so. >> reporter: most voters do not want that. but right now, american wishes may depend on the iraqi will to fight. >> in the end, erin, when you think about what you had just a moment ago, that question, can this be done? and we're told it could take years and a lot of training. the problem as we see right here is even with years, even with a lot of money, even with a lot of

training there is no guarantee of results. because certainly the iraqi army has been set up to be ready for this fight today and they're not. >> that of course is the unfortunate truth. thank you again, tom foreman. and thank you for joining us, we'll be back here again tomorrow night. "ac360" begins though, right now. good evening, thank you for joining us. it was just one security breach too many. this guy has run across the white house lawn and through the front door and hallways which caused a chain of events that caused a secret service worker her job. it did not end the dysfunction that could have cost the president his life. also tonight, new sexual assault allegations in regards to the missing university of virginia student hannah graham. tonight, we begin with more we've learned. some of it is troubling, ebola in the united states. we're devoting a good portion of this and