>> thank you so much. >> we'll see you back here in half an hour. >> "sanjay gupta m.d." starts right now. welcome to s.g.m.d. it has been a historic week with the first case of ebola ever diagnosed in the united states. some of what we've seen this past week is frightening but also it's important to point out this isn't some mysterious unknown enemy. we have science. we have facts. i'm going to do what i can in the next hour to make sure what is clear, what is real, what is not. so a brief recap, the outbreak of ebola in west africa is now expanding. there are more than 6,000 cases there. in some places the conditions are so desperate and that's where this latest chapter began. in this hospital thomas eric duncan, the first patient diagnosed with ebola in the united states, is fighting for his life. >> we're just hoping and praying that eric survives the night and we just -- we've got our hopes up for him. >> doctors say he's now in

serious but stable condition. duncan is a liberian national and he traveled for the first time ever to the united states to visit his family in dallas. he may have become infected on september 14th. that's when he helped carry a pregnant woman who later died from ebola to the hospital. >> we had a scenario in our community. we find ourselves with a pregnant girl marthalyn who passed. >> september 19th he flies from liberia to brussels, belgium, showing no obvious sign or symptoms of ebola on screening. from there he boards to a flight to dallas. september 20th he arrives in dallas and heads to this apartment complex to visit family. four days later he starts

developing symptoms. he walks into this dallas emergency room on the 25th of september vomiting and with a fever. he tells the nurse he had traveled from africa but is september home with antibiotics and does not undergo an ebola screening. september 28th his condition worsens. he returns to the hospital by ambulance and is placed in isolation. the next day a family friend calls the cdc complaining the hospital isn't moving quickly enough with his test results. by tuesday the 30th the lab results confirm the patient has ebola. the hospital admits it was a failure to communicate among hospital staff that led to the patient's release after his initial visit. >> he volunteered that he had traveled from africa in response to the nurse operating check list in asking that question. regretfully that information was not fully communicated throughout the full team. >> investigators are now

monitoring up to 20 people who are his contacts for symptoms from paramedics who transported him to doctors and nurses in the hospital to his family, girlfriend, and five school age children. but so far none has been confirmed to be infected. now, watching how things have been handled in texas has understandably caused many concerns. a mistake at the hospital, a family in isolation. i've had a chance to talk with the head of cdc a few times and i raised some of these issues. dr. frieden, i'm curious. i know you've had a busy week. who's in charge? if you're in charge, can you mandate things to happen? we know what's going on in dallas. can you say, look, here's what you absolutely need do in dallas, this is required, i'm enforcing this to happen. and if you can't do that, why can't you do that? somebody needs to have some leadership, it seems, over the

whole situation. >> absolutely. and we work very closely with state and local governments, and when there's an episode in the state or local government, they're in charge and we support them in every way. they assign an incident manager, establish an emergency operation system, they outlied every aspect, and we work very closely with them. there's a great collaboration. i think the issue we've been challenged by is what do you do with the waste. >> is it necessary to have somebody who's absolutely in charge, sort of a czar, if you will, over this who doesn't just provide guidance and recommendations but provides mandates? >> in every place where ebola is spreading our number one recommendation is to taeb a system where one person is in charge and you break down the tasks into smaller tasks to make sure that everything gets done and followed up. that's been done in texas. that's been recommended. they have an incident manager in place. we're supporting that person. the state of texas is supporting that person and i'll confident

we'll break the chain there. >> i know you've got a lot of questions, i understand that, questions about how this spreads, what's really a risk. we're going to answer some of those coming up. ok, if you're up there, i could use some help. smart sarah. seeking guidance. just like with your investments. that sets you apart. it does? it does. you're type e*. and seeking another perspective is what type e*s do. oh, and your next handhold... is there. you don't have to go it alone. e*trade gives you the support and guidance to make informed decisions. are you type e*? every time you take advil you're taking the medicine doctors recommend most for joint pain. more than the medicine in aleve or tylenol. the medicine in advil is the number one doctor recommendation for joint pain. relief doesn't get any better than this. advil

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you know, a lot of people are asking how this latest ebola patient got to the united states without being flagged. what we learned is that thomas eric duncan, a 42-year-old man from liberia, was screened for fever at the airport when he left. in fact, he was screened three times, and he wasn't ill until several days after getting here. liberia has said, look, it wants to prosecute duncan because they say he lied during the screening when he was asked questions at the airport. they say he didn't reveal he had, in fact, been exposed to an ebola patient, a woman he helped a few days prior. i want to put this issue of this whole problem, this problem of beating the ebola outbreak.

he's the guy we turn to often. thanks for joining us. dr. fauci. >> good to be here. >> it sounds like liberia is going to prosecute mr. duncan for not revealing having contact with the woman that later died. what's our role in the united states for handling someone like mr. duncan? >> well, handling him is what actually happened. there were obviously missteps but when we identified someone that was here and we said several times inevitably we were going to have someone who got on a plane without symptoms which would get them through the screening process that this individual got through when he left liberia. once he got here, our role and

ca ca ca cape capability. you prevent an outbreak some of from the standpoint of what we would do is exactly what we did obviously without some of the rough points that occurred during that process. >> yeah. i mean i guess in some ways maybe i'm asking more of a legal question. i'm curious. the scenario could be that people know they've been exposed, they're not sick yet, but get on planes and come to the united states for treatment. so you can understand that, dr. fauci, because treatment is so hard to get and get any kind of care. this may happen more and more. is this something the united states has given thought to or your department in terms of do we take all those patients? is there going to be anything else done? >> well, of course, they're re-evaluating the situation. the only difficulty is that window. now, clearly if someone is exposed and has symptoms and wants to come to the united states for treatment, they're not going to be able to get on a plane. they will be stopped at the airport at the west african

countries on that end of the process. the window that's the vulnerable window is someone who is exposed and then winds up with no symptoms for a period of time that could be as many as 21 days and then does get on the plane being asymptomatic. there's really not much you can do except rely on that screening of symptoms and fever. and every once in a while, it is conceivable as has happened by the reality of the duncan case that someone will slip through during the asymptomatic period. >> i want to talk a little bit about what i think seems to be the biggest concern for a lot of people and this is the idea of who are contacts. in dallas, for example, everyone who's deemed a contact, we know a health official is coming in twice day, taking a temperature, checking for fever. so a few questions around that. first of all, can you be contagious without having a fever? >> if you look at the kinetics of studies -- and this is a very

important question -- the answer to that is no. you never say 100%, but it's essentially 100%. and the reason is you don't get the ability to isolate virus until the person develops symptoms. so you have a period of time of a window where the person clearly is infected. there's no doubt about that. but the virus starts to become isolatable at the time that the person develops symptoms. because of that, you can make a reasonable conclusion that that person will not be able to transmit it. again, in biology nothing is 100%. but that's quite a reasonable conclusion to make. >> and fever is oftentimes the first symptom, is that -- i mean that's what they're using to screen at airports. if you see a fever, is that going to be the first symptom or do you like to have other things first? >> again, not 100%. but, again, if you look at a group of patients, almost invariably fever is the thing

that signals the onset. you may get achiness before you actually spike a fever but they're very closely juxtaposed. if a person has a fever, that really is the signal that that person is infected, if, in fact, they do have ebola. that's what you usually see. as with all fevers, fevers are generally associated with chills, malaise and aches due to the proteins that get released when you get a fever. >> we place a lot of faith on this idea of screening and especially using fever, but we also know that we can mask a fever using medications, tylenol, aspirin, things like that. so if someone wanted to basically disguise their fever, couldn't they just take some medication and get through airport screening? >> certainly that's a possibility. and the point that you're making from a number of different angles is that nothing is 100%. you have to look at probabilities. and the likelihood of someone

getting a fever, hiding their fever, of course, those are all possibilities. those are hypotheticals. unlikely that that would happen. if someone has a spike in the fever, you'll probably still see a degree of temperature elevation. >> okay. and i'm pointing out some of how the screening works, but obviously there are limitations to it. let me give a quick reminder of your point to people of what these symptoms are early on. generally includes fever, headache, muscle aches, weakness, just feeling lousy. as it progresses you see diarrh diarrhea, vomiting, rash, there can be external and internal bleeding in some cases and red eyes. that can sometimes be a sign of bleeding as well. in some cases we've been told definitively a person cannot infect others before they are sick. that's a fundamental point. all the people that came in contact with mr. duncan before

he fell ill, they have nothing to worry about. is that right? i want to be 100% clear on this. the people on the planes and the airports where he traveled, all of that, they have, dr. frieden said, zero percent of being infected. >> by all evidence we have when a person is not symptomatic, they don't transmit. that's the reason why when people have tracings, they focus on the contacts that occurred at the time the person is asymptomatic. as you know, when you look at the koufrs mr. duncan, not only was he not with symptoms during the flight but even several days after he landed and went from dulles to dallas because he wasn't symptomatic until the 24th, which is four days after he had landed. >> always a pleasure, sir. an honor to have you on our program. thank you. >> thank you. good to be with you. and coming up, we're going to have some more on the family that's being forced to stay inside their home. public health officials have

some powers in all this that may surprise you. will that be all, sir?

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>> what did they tell you? >> stay at home. when they were going to be everyone should stay home for 21 days and we should not come outside. if we have to come outside, come out on the porch but not go down the stare g the stairs. >> what did you think when you heard that? >> scary. if we step outside, they are going to take us to court and we'll have committed a crime. but up to this time they have not brought us any food, any food. >> that was on thursday and since then she's been delivered food but for many people, this

is unchartered territory. joining me is a doctor from the university of michigan, a medical historian and author of the book "quarantine." thanks for being back on the program, doc. >> thank you, sanjay. >> when they hear this scenario, i think it's shocking for a lot of people but health officials have this power, right? what is the limit of the power? >> well, the powers are actually quite strong. more than 100 years ago, the commissioner of health of new york city was testifying before congress and they asked what are the limits of your powers? and he said, well, i could make new york city a quarantine tomorrow if i wanted to. if, indeed, the health authorities feel that you're a threat, that you're not cooperating and you might infect others, particularly for a very serious disease like ebola, their powers are extremely strong. >> as i understand it -- and part of it is from reading your books, the practice of gau

quarantine, it wasn't ebola they were trying to stop at that time but it was the black plague. is that right? >> yes, it was. venice was one of the major ports of the world at that time and plague was traveling, just as ebola is today and they ordered a quarantine, which means 40 days. that's where the name quarantine comes from. ever since that 1375 edict of quarantine, we have been fine-tuning and changing of the word. >> did it work? do quarantines work? how well do they work? >> well, this is an eternal question in public health. when it was done back then and maybe even until 100 years ago, it was often relied upon as a means of last resort because we didn't have antibiotics or antivirals or vaccines. today it's very rarely done but only for diseases that interest

very easily transmitted, such as influenza if it was a deadly form of influenza because that could be transmitted if you're in close contact with someone if they cough or sneeze on you and then another instance is when it's so deadly and you don't want to take chances, and i think ebola has been falling into that category. people have been arguing whether it works or not ever since quarantine was first proposed in the 14th century. >> i think a lot of people when they hear quarantine, they think of a carrier of the disease and she was a cook. so she made a lot of people sick. and the city locked her up for -- how long was she locked up? >> oh, for -- well, she was locked up twice. once they let her out after four or five years and then she went back to cooking and you do -- a

carrier, salmonella scary it in their gallbladder and it sheds on their skin. and then she spent more time in the east river of new york city. i've been there. even though you're right near a city, it's about as desolate and lonely a place as you can imagine. >> according to forbes magazine, you are from the most educated city in america. glad we have that in common. >> glad to be here, sanjay. you've got questions about ebola so i put together some answers. stay with us. for your eyes, heart and brain go down easier. for a limited time, get your four-dollar coupon at centrum.com. whenwork with equity experts

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keep in mind, people come back with fevers and cough and it can be all sorts of different things. here's the big critical difference with ebola. a travel history and a history of any particular risks is absolutely crucial. when he got on the plane, he wasn't sick. when he got off of the plane, he wasn't sick. very important, because one thing that we keep hearing over and over again, i think it's an important point, you don't spread this virus until you are sick yourself. so the fact that he was in what is known as the incubation period, clearly carrying the virus in his body but not spreading it. if someone were to land in the united states and have developed symptoms, they got on the plane totally healthy, got off the plane and now sick, that would prompt a medical evaluation once they got here to the united states. so the real key to this is

trying to detect or screen from where countries is known to be, which is these three countries in west africa. part of the problem is that someone gets sick during the time that they are sick but not yet in the hospital, they can come in contact with lots of a people. they need to go back and trace those people. it's called contact tracing. if you missed the contact and they get sick, you can start to have another group of people who could potentially become infected. ebola can live outside the body on surfaces. i think that's part of this question. it can do that if it's exposed to sunlight, obviously, if the handrails are not clean or something like that, that would deactivate the virus. the virus can live there for several days. while ebola can live in body fluids, it's less likely to be transmitted through could you

haves or sneezes and much more transmitted through blood. i hope that answers at least some of your questions. that's going to wrap things up for "s.d., m.d." time now for christi paul and doug blackwell. good morning. so glad to have you with us. i'm christi paul. >> and i'm victor black well. we begin with the fight against isis. a 21-year-old marine is believed to be the first american casualty. >> corporal general spears evacuated out of an osprey. the pentagon says that he's lost at sea. >> coalition strikes killed at least 30 isis members yesterday. kurdish