With guest hosteen of cbs news who looks at the ebola crisis. He is joined by laurie garrj schaffner. Weom like a major demonstrators are the trying to strangle democracy in hong kong, the protesters were initially net by a harsh police crackdown, standoff continues today as student leaders call for the resignation of hong kongs chief executive. Joining me from washington is jon huntsman. He served as the u. S. Ambassador to china from 2009 to 2011. As a former candidate for the republican president ial nomination in 2012. And i am pleased to have him here with me on this program. Welcome, john. Thanks, ian, good to be with you. Lets just start by telling us where we are right now in in this dispute. How dangerous is it and how has it played out in your view . Well i think on the ground, we clearly have a stan standoffi think that is likely to last some time which probably accommodates the needs of both sides. It accommodates the needs of beijing because they cant seen as cracking down or doing anything drastic any time soon and certainly accommodates the demonstrators and the freedom seekers in hong kong because, listen, hong kong is just a freewheeling place and this is the way they do business, so i suspect that the shortterm prognosis is they will likely remain as they are, tens of thousands maybe reaching 100,000 people in the financial district of hong kong, and the dynamic in beijing will be an interesting one, ian, because what i think is reflect if the of is xi jinpings personalized leadership style, which is far different from anyone we have seen sing dung so ping so whatever happens out of beijing will be very reflect if the of him and his experiences and his leadership style as opposed to any kind of collective approach to problem solving that we saw, for example, under the term of john lamine or under hojingtao, they dont have nearly the personalized approach or the Political Power Base that scituate has so they have to broker deals within the Standing Committee of the pollitt bureau, especially as it relates to hong kong. As you remember some of the issues that played out under the reign of john or tao and i cite 2003 specifically they were fairly successful in terms of their ability to kind of settle things out, but this is a different player, xi jinping, and this is all playing out in a much different dynamic given the high politics that exist in beijing, particularly driven by this whole anticorruption program. Has he overplayed his hand . I mean you were in hong kong right after they put out that white paper that changed the nature of suffrage in the upcoming election. It is clearly on him to a degree. Did he go too far . Well we are going do know that in the weeks and months ahead. How he chooses to deal with hong kong Going Forward, suffice it to say hong kong as opposed to, you know, one country two Systems Approach that designed with Margaret Thatcher as they were developing the basic law back in the eighties and nineties, it is looking more like one country as opposed to two systems, one country. But what is inside xi jinpings head as all of this plays out, you have to remember that, you know, xi jinping has a much different relationship with hong kong than his predecessors did so he was a Party Secretary running shanghai not long ago, a Major Economic competitor with hong kong. So he saw hong kong very much as a rival, and probably full of troublemakers and high school gallons for the most part and then you dig a generation deeper than that and xi jinpings father, swoon as the story goes was responsible for hong kong under moo a say dong and thats when the british and other parties were running subversive operations out to the mainland and so there was indeed a black hand. Behind all things in hong kong back in those days as seen by beijing, and so i suspect xi jinping based upon even his early formative years still probably sees hong kong as full of some western troublemakers who ultimately are behind a lot of this. Back in 1997, during the handover, hong kong was i think 16 percent of chinas gdp, it is tiny now, even if there needs to be a crackdown, are those steps he is less concerned about taking . Because it just doesnt matter as much to chinas future . Well, you have the domestic component in china and then the regional component and certainly the global component, they are all important but as he sees it certainly in 97 during the handover, hong kong was, in fact, the goose laying the golden egg economically for china. Today, i suspect that xi jinping and many of the leaders in beijing probably see hong kong increasingly as just another big chinese city with none of the unique economic characteristics that made it so different some years ago. And there has traditionally been a rivalry between shanghai and hong kong, rivally in terms of attracting investment, in terms of locating corporate headquarters, the advancement of economic development, hong kong has always maintained its connection to that bulwark of rule of law and that which is really created that economic and political uniqueness over at least the last 150 years, but increasingly it is seen as just another big city in china, and sadly i think that may be the way in which some of the Decision Makers proceed as they view their options Going Forward. And that is the way that xi jinping sees it but is that the way the Chinese People see it and i am wondering shanghai has gotten a lot wealthier and people are saying hong kong are a bunch of spoiled children and dont know how good they have it and always complaining but now you have a lot of mainland chinese themselves who are quite wealthy and spent a lot of time there and have their own aspirations is it possible that they is out of touch with a large amount of his population on this issue . You know, i think she is, for the most part, in touch, he gets around, he has been through, sort of a populist leader for the most part and i have to tell you he is fairly popular and the well thought of mess cli so, messcally, so domestically, so if anyone has some kind of power in a different approach he would be a leader be able to do that. He is fully consolidated power over his last two years of leadership. He has a direct shot to the 19th Party Congress which will be in about three years, and then he will be around another five years after that. But here is another complicating factor, ian, about the timing of this whole thing because we have got elections and a whole reform discussion will play into 2017 and if this whole universal suffrage model isnt clearly defined beyond what we understand it to be today, then the next opening is going to be five years later, which takes us to 2022, well what is playing out in 2022 in beijing . You have the 20th Party Congress, and the real change of leadership where scituate will be stepping down and somebody else will be stepping in to the primary role there, and we all know that during those Leadership Transitions nothing gets done, there is a hyperoccurrence environment that people accept into and if the universal suffrage rules of the road cant be defined some time fairly soon, i think we are in a long waiting game that could create more in the way of citizen turnout, both in hong kong, the anxiety associated with last of understanding, with respect to the original commitment and then you have got the whole taiwan difficult negligence, which is a very, very important aspect of the story, little reported and commented on, but you have elections there in 2016, you have got municipal elections next year and then of course president ial elections in 2016, and how this plays out will have enormous implications for president ial politics in taiwan. But you dont see sympathies, particular sympathies among the mainland chinese population for the occupy Hong Kong Movement as it stands right now . You will certainly have pockets of those who are sympathetic, particularly among the young people, but they are more recently it has been a fairly deep wave of nationalism throughout china, xi jinping has consolidated power and solidified himself as a single leader in the tradition of former leaders and has broad based support but you will have pockets of the population, and i would say increasingly among the when this is left to chance without any definition put around it, you will probably have more in the way of sympathizers, so does that give xi jinping more flexibility in your view if he acts decisively one way or the other now . In other words, if he decides to crack down or if he decides that there is going to be some form of compromise, maybe forces the chief minister to actually step down . Well. He doesnt have a lot of margin for error here, one they have achieve executive in hong kong who is not popular and seen as being in the hip pocket of beijing, he is not widely liked and respected by the people of hong kong. So to have him as the intermediary is negotiating with one hand tied behind your back so to speak, and then beyond that, the high politics they are playing out in china for xi jinping make it so he doesnt have margin for error, so they have got this Anticorruption Campaign playing out and making a lot of enemies as he takes down some of these fairly senior leaders. You know, he calls it the tigers, he is taking out tigers and flies, well the tigers he is taking out, people like kung who at one point was the most powerful man in china responsible for the security apparatus, and military leaders like ho, these people have their own Political Networks and you Better Believe that they are going to gun for xi jinping at every opening, and if xi makes a bad call here and things dont go his way that could escalate in terms of antixi sentiment at least among the political elite in china pretty quickly and i am sure he knows that so he will be very careful in terms of the choices he considers for hong kong. Is that going to make him more reluctant if things get back to call on the poa because at the end of the day does he not want to be beholden to that group for favors and give them power in the resolution of the hong kong crisis . The calling or to take that type of action would be disastrous, it would be disastrous for the image of china which i know down deep they care about and disastrous in terms of some corner of the party who are more reform minded and oriented. It would be a disaster in terms of the very survival and wellbeing economically of hong kong because increasingly, even just as this plays out with just tear gas and umbrellas at this point, you know, corporations are going to begin to vote with their feet, and at least what i am hearing people are reconsidering hong kong as a regional headquarters, already packing up their bags and moving the places like singapore, this could be very real and the Worst Nightmare scenario for xi jinping is to see capital flight out of hong kong and china, that they cant afford to see happen which i would put as being just as painful as any of the implications that might result from any kind of harsh crackdown. So he is clearly very constrained in this environment, looking at it from the hong kong reformist perspective as well, we do have demands now from the leadership such as it is in the occupy central movement, that if cy long does not step down by the end of the day tomorrow they are going to occupy government buildings. Do you believe that xi jinping can stand aside and not require a harsh crackdown if they actually follow through on that . I can think i suspect he can let it play out to a certain extent but at some point there will have to be some compromise and some brokered settlement that is somewhere between, you know, one person, one vote, which is ultimately what everyone thought would be the outcome, and one committee, one outcome, which is what came out of the white paper in june. They just changed the rules fundamentally. So somebody is going to have to open up the negotiation with the primary the principal players in hong kong and strike some sort of compromise, i dont know yet what that will be but it is going to have to be something along the lines of how you broaden the pool of candidates that will then be allowed to stand up for a vote. Do you allow candidates, for example, if they can reach a certain number of signatures by key constituencies within hong kong. Will you take the 1,200 delegates so to speak who are responsible for vetting the handful of candidates, and in the white paper it also came out that the criteria for running are, are you patriotic and do you love china . That is the language that was used and so ultimately beijing really does have the upper hand in terms of choosing whatever that slate of candidate happens to be. So the key will be how you open up the slate and how you allow more fresh air in and maybe more diverse voices. That is not an easy thing to do but i suspect that is about the only, the only choice ahead other than some sort of harsh crackdown which would be a disastrous thing for china, for the region and i think for the global economy. One of the things that bolstered xis charisma in imhien is all of the talk about a chinese dream, very different from his use of an american dream, and i guess what i want to ask you, can there be one chinese dream that encompasses aspirations of hong kong . Do you believe he believes that, do you believe he can or do you believe he can . The beauty of the chinese drum which is on billboards plastered all over the country is that you can make the chinese dream whatever you want. You live in the north, south, east, west, whatever you aspire to, that can be part of the chinese dream. It is a little bit like the old wild weapons american frontier where you can make whatever life you want, get out there and dream big and work hard and you can go places so if you are sitting in hong kong although your dream might be a little bit dashed today in terms of the principles of democracy and universal suffrage i am sure the summers are still keeping the dream alive at some point there will be recognition hong kong is a very, very special place and will benefit enormously by maintaining those individual characteristics. So you think buy some time right now, show some flexibility, maybe a technocratic solution, the scituate eventually if he overplayed it to begin with may be a little smarter in this right now than a lot of observers think . He cant afford to make a bad decision on hong kong. Given how the Anticorruption Campaign is playing out, given the long knives that will lie in wait for him, given the economic importance even today of hong kong and how the global marketplace will perceive the choices that he will make, all of that is registering loud and clear, i have no doubt about it in beijing, so he is going to have to thread the needle and it wont be an easy thing to do but the stakes for him politically are extremely high. So taken internationally for a second, you talk about the fact that u. S. Corporations and others are already rethinking whether or not hong kong is the place they want to be longterm. Of course we are also seeing a lot of american corporations with a lot of concerns the with whether Mainland China is somewhere they want to be longterm, the am cam report that is coming out. Is china becoming so big at this point and so different that you would expect to see more conflict and confrontation with the United States . Well, any time you have a trading relationship that exceeds 500 billion per year going on a trilliondollar per year, which will make it the largest economic relationship the world has ever known, you are going to have some tricky issues, you are going to have trade disputes, some of them are going to look down right unresolvable, and they are going to carry with them a lot of emotion and passions, for heavens sake we had a longstanding relationship with the eu by i remember difficult discussions about Airline Subsidies and bananas that became difficult. So as the relationship with china grows and as it it increases in size and complexity clearly we will have more trade complaints and disputes, i think that is a given. But important in in all of this is how xi jinping chooses to steer his reform package Going Forward, which we are going to know a lot more about in the next week or two with the fourth men numb which will build on the third plenum of the 18th Party Congress which spelled out the principles of fiscal and financial reform, how to deal with things like urbanization, the hundreds of millions of people who are moving from the central part of the country into the city centers. How you deal with things like reform of the state owned enterprises of which there are 110 Key Companies of which there are five mega, Mega Companies they must be reformed in terms of the rules of the road in order for the broader economic reform measures to ever have any chance of being implemented. So the answer to a lot of this, where the economic relationship with not only the u. S. But the rest of the world goes, is really tied up in these reform measures and if i were a gambling person, which i am, i guess, i would say that we have another two to three years before the 19th Party Congress where scituate will continue, xi jinping will continue to consolidate his power base which is substantial and the 20th Party Congress, in 2020 i think he will be full time focused on the economic reforms, many of which are down right audacious and aspirational, and i suspect we will lack back seven, eight years down the road and see that xi jinping had an impact on china with respect to economic reform much like dinping when he swung open the doors to United States for purposes of trade and investment. If we look at xi jinpings rule so far, Economic Transformation but also very much consolidation of power, do you view what we have seen so far in hong kong as really fundamentally about the latter and do you really believe at the end of the day that he is able to back away from it . If that is what is required in this situation . Yeah, yeah. So this is a little taste, i think, of what lies ahead over the next ten, 20, 30 years in other traditional chinese cities, so hong kong being a special autonomous region in sar is a little different in terms of its more recent history. And a lot of its influences. But with the new generation emerging in china, network, accessing the outside world, 200, 200, 300,000 student studying in the use, hundreds of thousands in other western countries, the pull toward greater openness, transparency and fundamental democratic principles i think will grow more and more intense. So as xi jinping sits back and analyzes hong kong i think he is probably thinking to himself, how i address and answer hong kong will in large measure probably have some connection with how i address similar circumstances in the next ten years of his leadership. And the way he has addressed it not only on the International Stage but also domestically you look at some of the statements that have been made by Chinese State media sound a little more hardline in terms of calling for the Police Forces to respond very quickly and the hong kong population to support it, certainly if you are in china today you are getting a very specific and very limited view of what is going on on the ground in hong kong. Is that a mistake . Does he need to back away from that, especially if compromise is where we have to go here . Compromise will have to be a part of it, but then you have to get back to his leadership model. So he has established himself not as a bowp participant with the Standing Group participant with the Standing Group committee when you come to a decision after ruminating and giving and taking with situate the traditional chinese leadership model, at least under the last two leaders. He is singularly positioned himself in the model of mao and in the model of ding. 01 . Ping this is about the singular player in all of this and he will have to figure out where to compromise and how to compromise and indeed how to deal with some of these difficult and thorny issues because he is just on the leading edge of clearly what will be a whole lot more. You have got to remember the story of hong kong is not just limited to hong kong and the nonchinese countries in the asia pacific region, but in every major hotel and every major bookstore and drugstore where they have newspapers, increasingly you have got western newspapers that are available, they try to gazette them from time to time but getting access to the outside world is not so difficult in china. You have got to do a little work to jump the great firewall but that is easily done and a whole lot more information circulating there about the rest of the world than people might imagine. Lets go to u. S. Foreign policy, especially given your background in it. If you were sort of advising the president today in do you even want to touch this issue or are you just kind of leave it alone . I think the United States has a certain name brand globally, and part of our name brand whether we like it or not is a country that is willing to stand up and support a democratic principles, human rights and a free marketplace and i think our voice would be absent and missing if we didnt Say Something about the principles of universal suffrage, you can couch that anyway you want but i think our voice wants to be heard. I also think that some statement about the importance of maintaining the uniqueness of hong kong and not disrupting the elements and a free economy that have made it so unique and really a beacon for the rest of the world, that doing anything to jeopardize or disrupt that would be a very sad day. There is a way of getting some messaging in that would remind the world of our values and that we dont inside away from talk about them. But also hoping that the situation copies down and resolves itself in hong kong because it is in everyones economic and political interest to see that happen. And the americans have to say this is fundamentally chinas issue, the it is not our fight or go further than that . Well, if there is violence, you would see capital flight, you would see carnage economically within hong kong that would be absolutely disastrous, but in terms of what we would commit beyond providing at least a very loud megaphone, you know you look at Tiananmen Sqaure and the sanctions we put in place around Tiananmen Sqaure are still in place by the way, and your average investment by u. S. Companies in china, i remember at the time well, went from millions of dollars to hundreds of thousands of dollars on a per investment basis. It would be disastrous and ruinous and that would be the greatest impact suffered by the people of hong kong and china is that you would see one of the great economies of the world would all of a sudden die overnight. Lets hope it doesnt come to that. The jon huntsman thank you very much for joining me this evening. Thank you, ian. We continue our conversation with john green. He joins us from washington. He was the Senior Vice President for asia at the center for strategic and international studies. Welcome, mike. Thank you. So you just heard some of my conversation with jon huntsman, let me ask you, wher where do yu think things are right now . It seems we are poised on a precipice, do you believe we can find flexibility . Well, i thought jon huntsman laid out precisely how xi jinping should think about hong kong, what is at stake for his reputation, his economy. And i thought jon made a compelling case i would agree with that we should aim for that kind of flexibility and compromise. I am not sure we will get it, though, at least judging from recent history. Xi clear slay Decision Maker and consolidated power around himself like dong and mao like we havent seen for some time in china but when you look at the other cases that sort of parallel this, the unrest in chu in g, the confrontations with philippines, and we see how china has cracked down on international ngo, and civil society, the pattern is that xi doesnt back down, that he is showing strong fist everywhere and it may be this is temporary because he has an ambitious reform agenda, but it may also be reflection of what some chinese say which is he talks like dung but hits like mao, so i am not convinced he will exit this, he will flexibility but explore the logic that jon huntsman described earlier. I mean since the crisis with hong kong has started is there reason to believe that he has any ability or willingness to show flexibility . An and or is that too positive of a shade. I think that scituate has approached Wealth Creation trump Everything Else so the chinese calculus in tibet and neighboring states and especially in hong kong is that if we make you rich you will be happy and that will be the end of it. I think this is a kind of turning point in how the leadership look at hong kong because it is clear that money cant buy you love, that development in hong kong or even the fear of economic damage in hong kong is not enough to detour these protesters from demanding what they were promised in 2007, which is universal suffrage. So this is a new world, i suspect that sort of betrays the logic of chinese domestic politics and Foreign Policy xi has championed, at the same time this is not like july 1st, 2003, when there were protests, large protests against chinas antisub version law, and in that case, the executive in hong kong backed off and compromised in this case, though it is a white paper out of beijing so much harder to find a face saving compromise because now it is all on xi jinping himself , there is no middleman who made this declaration, who can now take the hit as tung in 2003 and sort of back away and preserve face for beijing, and the final point on this, and the reason why i think this is not going to go away, is that the protesters are extremely well organized, you know, they have this app called fire chat which is blue tooth technology, largely impervious to the great firewall, the great chinese wall on the internet, and they are determined. What do you think the response needs to be from the United States now and where does it need to be Going Forward . So i thought i the Administration White House statement was good, was very much on point, it took a little while, but what they put out yesterday and today reconfirmed our support for universal suffrage in hong kong and our support for the aspirations of the people protesting. The white house didnt say we support exactly their demands because there is it is a large group, there is some fuzziness and division, but i thought that was the right thing to say. Going forward, we are going to have to lock arms with other democracies around the world, and not allow defection. The british were a bit slow to come around on this one. This is going to take some lateral diplomacy with other g7 countries and so forth and some effective dip city with beijing to make it clear we are trying to find a face saving way out that gets us past this, to the legitimate aspirations of the people protesting. I am sure you saw one of the initial responses from the Chinese Government was the foreign factors, foreign influence in helping to promote this instability in hong kong. Of course there are lots of americans that would like to see these students succeed, but do you think the United States government has any role in actively trying to assist . I think we have to be careful to be honest. This is not the green revolution and not the middle east. This is an open society with access to technology, social media, and we have to be careful. Not to be appearing to foment or intervene and i think our counsel general in hong kong is probably the strongest china hand, he used to work for me at the embassy, we have in the state department and i think he is keeping a fairly low profile of letting the declaratory policy mostly doubt of, come out of washington and handling it exactly right. We cant be seen as fomenting revolutions. As you see it, as china is getting larger and all the special challenges they are a facing ultimately the United States and china just getting further apart in is this becoming a much harder relationship to manage . I mean on the one hand we are actually becoming much more interdependent. Many more American Students and Chinese Students here we have common interests dealing with problems like north korea, on the other hand, increasingly i think beijing is viewing this relationship as zero sum, as adversarial. The Obama Administration is in part to blame because they have had a very inconsistent articulation of what our strategy is with china, in 2009, the theme was, and the president said we are going to respect core interests, china is going to respect ours and we are going to respect theirs which sounded like we were splitting the chinese in with china after the finance crisis, very untop dollar with our allies and in 2010, 2011 we swung back with this pivot and the pentagons rebalance strategy which looked like w we were containing china and in the second term secretary kerry and susan rice and others have emphasized xi jinpings proposal for a new model of great power relations which sounds like the u. S. And china as the two great powers managing asia at the expense of our allies, so is china our partner is china our adder have sarah . Complicated question. The position of the administration is, has sort of confused it and swung back and forth, the reality of course is we want to expand cooperation with china but we are not going to tolerate efforts to reorder asia and we are going to stand by our allies and we are going to stand by our principles and particularly our democratic principles, it is pretty basic but we have not been consistent about how we say that and as a result trust between the leader, china leadership and the white house is probably as low as it has been for any president since nixon, so that makes it a tough environment to work in but i think so far the administrations policies on hong kong look right to me. It is an important point to leave us on. Thank you for joining us today, mike. Thank you. Hi, i am dr. Jon lapook, professor of medicine at nyu Medical Center and chief correspondent with the cbs news with scott pelley. I am filling in for charlie rose who is on assignment. The first ebola case in the United States was confirmed in dallas, the center force Disease Control and prevention confirmed the man flew to flew to the u. S. From liberia and currently in isolation as texas health presbyterian, meanwhile the epidemic continues to grow rapidly in west africa, as of now there have been more than 7,100 cases across liberia, sierra leone and guinea, more than 3,300 people have died, according to the World Health Organization, in new york with me now is brian walsh Senior Writer for Time Magazine and editedd todays cover story about ebola and Laurie Garrett senior fellow for Global Health at the council on foreign relations. And dr. William schaffner, the of vanderbilt university, welcome everybody. Thanks for coming. Bill, why dont you start off on if giving everybody, assume people know nothing, give us a little primer on go larks why dont you tell people what it is. So this is a virus that actually lives in the wild, largely among fruit bats and very successfully and only occasionally gets out into human populations. And starting in 1976, it has caused a series of outbreaks largely in the congo, not exclusively there, usually in rural villages, the villagers got interacted with animals and products to the fruit bats, became infected themselves and those outbreaks were relatively quickly contained. It was a serious virus, because when it got into people, it had high fatality rates, sometimes as high as 90 percent. Sometimes lower. Now, more recently, it has occurred in west africa many thousands of miles distant. Heretofore unknown to the medical community there and it has spread very, very rapidly. It is an illness that when you get it, is characterized by fever, feeling terribly stick, muscle cramps, loss of appetite, diarrhea, nausea, strom mitting, sometimes rash, and progressive if untreated and if you have a fatal case, you become close toes, comatose and slip away overtime. But in this current outbreak it seems to have gotten out of the rural areas into the bigger cities, monrovia and that is where all of the mischief has now occurred. Is that fair to say . Yes. It is definitely. Fair to say, it is important to know in, note this virus is not easy to transmit from one person to another. First of all, it is only stick people who become contagious for others and then it is their bodily the fluids, so you have to have contact with their bodily fluids in order to effect transmission. It spreads so readily in these three west african countries because the medical care system was very modest, shall we say, ithere was no knowledge of the disease. People moved around a lot so that enhanced its spread. And the there were certain social and cultural practices that contributed to its spread. For example, the burial practices are such that the body is paid respect by cleaning it thoroughly, there is a lot of contact with the body fluids, and so family members caring for ill people and caring for the dead often were the paradoxically the very victims and the next generation of transmission and so the epidemic rolled on. And so that is a good point to bring it here to brian walsh and you hav you have been thinkt what is going on in africa, we heard that about 75 percent of the people who got infected were caregivers, most of them women. What has been your thinking about what has been going on. You are seeing an enhanced response over the last few weeks, president obama is talking about it, a major topic of the u. N. General general assy last week but still this is not something that is getting under control really in sierra leone and again knee and it is incredibly difficult you mentioned these are systems where the Healthcare System is already badly damaged, these countries are coming out of civil war and now trying to deal with this disease and on one hand, yes, we didnt know how to control it and a lot harder to do when you are talking of dozens and dozens and dozens of new cases, and it is very difficult conditions and having to use very challenging personal Protection Equipment to make sure that you, the doctor, you the investigate dors dont actually get the disease so this is something that is not going to end any time soon, i think. I saw a video from sierra leone that was shown to me by dan kelley who is a dr. From usc f that went there and in it, there was a woman carrying a baby, and she was asked about fear, and she was asked, are you afraid that the doctors are going to inject you with ebola . And she said well you hear a lot of things, you know, you dont know what to believe. Yes. It definitely seems that was something that was hindering a response early on. I mean, there were doubts that this was actually real, i think there was a lot of fear certainly, when you think of the fact that often the Healthcare System is so overwhelmed you wouldnt be getting doctors, people only show up when somebody actually died and i had a reporter in the scene in nonrove i cant who was following sort of the body retrieval course there is and there was a lot of public anger, we called you when stick people never showed up and now you are coming when there are dead bodies and cant carry out the funeral rights we are used to, it is challenging in any kind of society, particularly in this one to mount this kind of response. Laurie father i want to turn to you. Garrett by mid june this was all right the biggest outbreak of ebola in history. Why did it take seemingly two americans getting infected at the end of july for the world to really take up note and Pay Attention in the way that they should have . I dont think that did it. I think it wasnt until the end of august that the world sat up and took notice. The two american case, you know, made donald trump worry he should get ebola and should keep them in liberia but that had nothing to do with mobile station of our response. We have to step back. First of all this was misdiagnosed as cholera in the early days so the first of december, in a remote rain forest area of guinea what you heard described in terms of the relationship of bats in the rain forest area, this is a triangulated area where the three countries share a piece f the rain forest so very quickly it had the potential of crossing borders. That is the first feature that is unique in the sense that in the 20 prior outbreaks we never had cross border transmission. So for the first problem we had was it had to be recognized by three countries, three countries had to have shared response, three countries had to coordinate. None of that happened. Why not . Well, why would they . They all have been locked in civil war. They hate each other. They have had huge animosities, i mean, guinea housed militia that attacked and cut off the arms and legs of kids across the border in liberia. This was a terrible time and everybody who is, you know, over ten years old in these cultures remembers and knows who they hate and fear. And this doesnt go away any faster than our civil war kiss patriot, dissipated there are still people who get mad at me today, faster than grant took richmond. So that is the first thing. So it was misdiagnosissed as cholera because the major presentation was diarrhea. So you have got all the way to march before you get a correct diagnosis and then the alerts start going into the system but meanwhile, who, the World Health Organization who is severely beleaguered, a Million Dollars budget deficit and in its most recent Health Assembly voted to slash its infection disease budget down to a mere 114 million a years, so you try battling and epidemic with only 114 million and 22 staffers including secretaries, okay then so they are beleaguered and whos attention was grabbed by a whole different phenomenon which was the middle east yes, sir sphir toir syndrome in saudi arabia, and then there was huge Political Tension around that, already had gone through one hajj worrying they would be hurt and a lot of controversy on the, on is saudi front and they fired the minister of health in saudi arabia, they fired the guy who was leading all of their investigations, all of this was going on and distracting to who. Meanwhile our cdc was distracted because some infections occurred inside the cdc facilities and long lost smallpox samples were found, you know, stored at nih and so on. Members of congress were calling for the firing of the director of the cdc, tom freed den and ordered a special passage in his laboratory our only facility for rapid diagnosis for ebola shut down, full stop pending congressional investigation. Almost everybody that would be an ebola specialist was bogged down with this congressional, congressional inquiry and then you get to july, what happens in july . All of europe goes on vacation for six weeks, you start calling who, hello is anybody answering the phone and get all the way out to august, by then, we have seen this thing grow to being not only unprecedented in terms of three countries but unprecedented as it becomes an urbanized epidemic and you are going into urbanized slum areas where not only is there historic distrust but current distrust. Nobody likes the government, they dont like the cons, you know, now you have got msf is the only major responder, they are showing up. Doctors without borders. Showing up in space suits. A which is scary. And the people see, they see them coming and saying, we want your child, your child is infected we are going to remove your child from the home. Bill, in terms of you know what happened, a man came from liberia on a plane, not a healthcare worker, felt perfectly fine and when he came to the United States he developed symptoms on the 24th, went to a hospital in dallas on the 26th, with symptoms, and something got lost in the status there because, sauce there because he was extent home and spent a couple of days at home a and was brought in by ambulance when he felt even sicker. When you hear this story what are you thinking . Well, what i am thinking, i am surprised and distressed and we need to obviously review those circumstances very carefully because all of us can learn lessons from that. I mean hospitals across the country, my own included have been reviewing all their Infection Control policies and procedures, we have been drilling and we have asked all of our providers to when they see a patient with fever to ask two questions. Have you been outside the United States and if so, where . Now, 11 of my colleagues actually wondered the following. We wonder what it is that this the patient actually said to the nurse and no disparagement i am just making an observation now if the patient just said i am from liberia, i have to wonder, did the nurse know where liberia was . I think we have a special vulnerability in the United States. Our friends to north dont share this. Our friends across the atlantic dont share this. We have 13 percent of our population with no healthcare insurance still. We have huge millions more under insured with such high copays they avoid healthcare. We have we have a built in Health Treatment the avoid damages system in this country. So most americans that are in either low insurance or no insurance will just tough out a fever. They cant afford to go. Okay . And then the second problem is, when they do go, it will be a Public Hospital emergency room where they are going to spend 12 hours waiting to see a doctor and during that time, what we know about go larks if there is one thing we know, is that all 21 epidemics have exploded in hospitals. All 21 epidemics have you know that phrase, meaning there is a spread within a medical setting. Brian, we are talking about it here and of course people are concerned about it. What the are you hearing in terms of the concern of the people, the people who you work with . Well certainly when you have one case coming to the United States that set off alarm bells, fair or not one case in the United States versus literally thousands of cases across the launching and west africa that is Just National i feel there is a decent job of communication i mean the cdc was pretty good in actually making it clear this did not pose a risk to you individually, the average american. I have no doubt it can be kept under control. Right. And i am sure he that is almost sortly true. What laurie is saying that i would be concerned if say with a different virus one that is more communicable and dangerous than ebola, whether the Hospital System is ready for that, just as well as we see a lot of hospital acquired infections, but yes, the cdc has control and we may see another one and see another case coming out of this one, it would be the first time i spread in the, s and this is still an imported case, we presume he got sick in liberia and came here, people shouldnt worry too much but that doesnt mean the system is in any way ready for what would be a much bigger challenge. I think we all have to fro real fast here in the United States and face some if brutal reality. There is, as brian said, we are still on the as 7 dance as 7 dance in this horrible epidemic in west africa. And if you two the numbers if you do the math are absolutely staggering, what is coming, what already is. The officially reported numbers are almost irrelevant. They kind of give you a vague barometer of scale, but as the cdc said in their publication last week, the numbers are offer by an order of magnitude of at least 2. 5. 50,000 to over a million . I think the numbers are off by three, actually and especially in sierra leone, even now the sierr sierra leone govet is acknowledging they dont believe their own numbers. Why . If most of the people are not coming in to the Health System then there is no way to count them. If most of the people die in their village, without ever being counted or noted, then there is no way that we have that death total accurate. So what do the numbers really look like . If you do the math, it is pretty clear we already have or are very close to 20,000 cumulative cases i in the three countries. Guineas epidemic dwi oldest of the three seems to have receded for the time being. Now lets go forward it is doubling every 15 to 21 days. So we will play the conservative and go to 21 days. Right. So we have got 20,000 now, that means by some time in mid october, we will be up to 40,000, by some time at the end logic we will be at 82000, christmas, 400,000 and if you look at percentage of death, this is another number that has been grossly undercounted because so much of the death is invisible and while you may count the intake, you dont know what happens when the person goes back to their village. So right now the death toll looks to be around 50 percent but there is a new publication in the british medical journal and a new analysis by the London School of hygiene and tropical medicine that puts the real figure at 70 percent, so i ask you, just try as an american to put in your head, 400,000 infected 70 percent of them die and that is christmas. So america wakeup, this isnt the only isolated individual who is going to end up in dallas, texas infected. And thats where we started off. We are in a globalized world and the risk is shared. Understood. And this is a perfect time we only have a few minutes left, is it possible for us to have a healthcare and aid to west africa to africa in such a way that it least them with a Healthcare System that has been wilt for, built for the first time and can do them good in the future . You have a quantum increase in the manpower and resources you are throwing at them. What laura is saying about the growing rate of these cases, it is like trying to catch up with a runner and you are increasing your speed but the run search getting twice as fast every 21 days so even though you think you are putting more and more into the response you are still falling further and further behind and thats where we are right now so it would be great to have a system or lead behind the system as a legacy that would deal with these other disease and conditions in a better way, be more prepared for the next crisis because this wont be the last one but we are not even close to dealing with this one right now. How do we go into warp speed is it possible and just going to keep moving away from us, or i mean we are talking we havent dealt with this, dealt with this as a major disaster, the hate cahaitiquake were lining up to e and you could text on your phone to the red cross and donate money, i dont see anything like this here. This is not what people feel ultimately is not, you know, i think so much a desire to help as fear and when you have a case come to the United States like this, i feel, i really worry that feeling is only going to intensify. Thank you, Laurie Garrett very much, thank you, brian walsh and dr. Bill schaffner, thank you for joining me for this important discussion 0 about go lavment for more about this program and early episodes visit us on line at pbs. Org and charlierose. Com. Funding for charlie rose has been provided by the cocacola company, supporting this Program Since 2002. American express. Additional funding provided by and by bloomberg. 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