in t.b. research, patients lie. about a third of patients don't take medication as prescribed and a third don't take them at all. can dill lewd yourself and think they are taking their. if we see people take their meds we believe they took them. now, doctor, reliant on self-reporting and making certain that people tell us the truth before they leave, and then that we catch the fever at the right time, if they can a temperature, we have to do better than this, we are here to work with you, and we expect a better outcome. >> take has expired. >> i'd like to thank the panel for joining us today. dr. freeden i was happy to hear you say we will consider any options to protect americans i think that's the purpose of everyone here today. i do want to ask you about texas.

have they done a root caught analysis of what happened at texas, and come up with an action plan on what we with learned from that incident, we have the detailed hospital checklist preparedness which we with have heard about today, have there been any recommendations on updating this in light of what happened. >> we with have a team of more than 20 of some of the word's top disease detectives in texas now, we were there we left the first day that it was diagnosed. we identified three areas of focus. anyone who has fever and travel history to west africa, and dr. vargas spoked about that issue. the second is contract tracing and the graphic i provided outlines what we are doing there. the state of texas is doing a terrific job,

making sure every single contact of mr. duncan is monitored. the temperature taken by a outreach worker every day. so of the 48 none have developed symptoms, none have developed fever. we are now looking at the contacts that may have had contact as the two syringes who became infected did, and our thoughts are with them. and we're delighted that n.i.h. is supporting the hospital in texas, and also that emery university is doing that as well. and the third area is after identification and contact tracing is effective isolation, and we are looking very closely as what may have happened the result in these two. >> and i assume if there are any new recommendations this protocol will be updated and redistributed? >> we always look at the data to see what we with

can do to better protect americans. >> you are kind enough to share with us this graphic, and in it you mentioned a company in aims iowa called new link, which is working on one of the vaccines that uh just went with into phase one clinical trials this week. >> that is correct. >> i had an opportunity to talk two of their employees and i know they are working around the clock trying to help come up with a vaccine that will meet the protocol and the standards for scalabilitien, that i think everyone is looking for. the department of defense, have called this one of the most advanced in the world. and they have requested contracts with h.h.s. expanding the manufacturing. to add a third site for manufacturing to complete the scientific studies required to scale up manufacturing. and complete the additional safety study to provide newly manufactured vaccines that are equivalent to the originals.

and they have also identified companies to work as subcontractors. can you tell us what h.h.s. is doing to make sure the contracts are moving forward. >> thank you, sir. >> providing assistance on site, and also at the manufacturing sites and working with them to expand the production with other companies including a very large company leer in the united states. >> and also. >> yes. >> the h.h.s. is also involved on the other end, because the trial that was started were not only in collaboration with the department of defense, but we admitted our first patient at our clinical center for a phase one trial. it is my understanding

that the ultimate goal is to also expand this clinical testing into some of the effected regions in africa as well. once we with have an understanding of some of the concerns that were identified earlier in your testimonies. >> that is quite correct. in fact, when i was saying after we get through phase one, i was talking about both vaccines and the new link. both if they are safe and induce the response, we feel is appropriate, we will expand both of them into larger trials in west africa. >> mr. waggingner, we have heard about the issue of travel restrictions can you walk us through the strengths and weaknesses. welsh -- >> if you can hurry with a quick answer. >> so -- we have the ability to you the data that they give us to be able to see where travel is originating from. they are instances where

travelers may go to different locations we may not see that, butler our questioning and our view, we can identify that they have been to these regions or if they come through a border as they fly to canada or mexico. the possibility is there, but the possibility is there that we would miss one. it is easier to manage and control it when we know people are coming from and not intentionally frying to deceive it. >> you are listening to the continuing coverage of the congressional hearings into the ebola outbreak on u.s. soil. they have been calling it an epidemic. our guest in the studio taking issue with that phrase. also, while the speakers were speaking we learned that a yale university student is now being tested for ebola as well. the student spending a month in liberia, researching the outbreak, and then was admitted to yale new haven hospital with a fever last night. doctors expect the test

results within the next 24 hours. a lot to get you caught up on, but we with are going to take a break in our coverage resumes in a few minutes.

snot only shows the personal equipment, but details the odder never which it should be put on and removed. i would note sha shoe covers are not included in this graphic, but you do see a fair amount of exposed skin around the eyes and forehead, and of course, the necking. now, dr. freeden this is going to be hard to see. this is your picture in western africa, and as you can see there is hip to toe covering in goggles and i believe if i understand the circumstances correctly, you were just abouting to to been dosed with a near toxic dose of chlorine, is that correct. >> yes. >> that's why you can't have skin ex-en posed

because it is impossible to do the disinfection if you will, after taking care of an ebola patient, or being in a ward, it is impossible to do the disinfection, if there is skin exposed because exposed skin would be killed by the chlorine and that would not be good for the person delivering the care. i mentioned this statement, i am so concerned we know the numbers are going up on ebola. we know the case rate is going to increase, we know that 10% are healthcare workers and we know that 56% of those healthcare workers in western africa will succumb to the illness, so that is a dire warning if anyone involved in delivering healthcare. i would submit, what kind of stock pile of this personal equipment.

>> let me ask this question, you know, what did you think the first person would look like? when you knew -- or that it was a possibility, we with have the gentleman who died in nigeria at the end of july that could have gotten on a plane, what did you think that would look like? what was patient zero going to look like. >> the time is expired. >> what is the match up there. >> you may go ahead and answer quickly, thank you, doctor. >> our goal has been to get hospitals ready. the specific type of personal protective equipment to be used is not simple, and there's no single right answer. but there's a balance between protective

equipment that's more familiar or less familiar, more flexibility and less flexible that can be decontaminated, so the use of different types of protective is something that we are looking at very intensively now in dallas in conjunction with the healthcare workers there. >> thank you, we now recognize for five minutes. >> thank you, mr. chairman. i have so many questions, i just want to begin by thanking the healthcare professionals that are on the front line, and i would like to ask consent to put into the record, mr. chairman, a letter from randy wine garden from the american federation of teachers that represents many nurses into the record. i else also like consent to put in the record, the diary of paul farmer from partners in health. who has among other things said the fact is

that weak health systems are to blame for ebola's rapid spread. in west africa. and we know that west africa has 24% of global diseases. health work force for 90,000 people. so i'd like to focus on what we ragone to do to help that infrastructure. i want to focus on our infrastructure here. we have a vast infrastructure, hospitals, community health centers i want to point out too, where people may present themselves. nurse evers, nurses aids. no one better than the united states but do we have the ability to train and equip as we talk about in military terms, do we have the ability to really train and equip. let me just put a couple of things on the table.

in terms of the nurses. >> is there a problem with not following the protocols or something wrong with the protocols? and how are we going to ensure that if even if we have the best protocols in the word, that everybody knows how to use them. congresswoman showed the various protective gear that our nurses are supposed to have, and yet, two days apparently, went by when they were not wearing shoe covers that their necks were not covered that skin, in fact, as dr. burgess was talking about, was in fact exposed. even as we knew that he had ebola. so how are we going to make sure despite how we

are going to check at the airports. i am from chicago, i talked to the health director, i know what we are doing, but there's still the chance that someone can present anywhere. so how come the nurses in dallas weren't protected and how are we going to make sure that everybody can be. >> so first, just to clarify, those first couple of days the 28th, 29th, 30th were before the diagnosis was known. so he had suspected ebola, the test was being drawn, and assessed. but he had not yet been diagnosed with ebola. congresswoman were you saying otherwise. >> he presented with ebola symptoms he had been to the emergency room just a couple of days earlier saying he had been from africa, and i believe the cdc

protocols that were given, said that people should been wearing that protective covering even before the official diagnosis. i would certainly hope, thank you for yielding, dr. freeden, i would certainly hope, that here going forward if a patient shows up saying he is from africa and he is vomiting and has diarrhea well we don't have the lab results in you would start treating that person like they had ebola. >> absolutely. absolutely. i wanted to clarify, that those first couple of days the 28th, and 29th, he was being isolated for ebola, the diagnosis was confirmed on the 30th, on the 30th we sent a team there. >> and when we look at the -- to answer your question, of those first couple of days there was some variant in the use of personal protective equipment. the hospital was certainly trying to implement cdc protocols. >> i know, but going forward, how are we going to assure that just trying -- how are we

going to educate people, news the nurses are saying across the country, that they have not been involved, and that they are not trained properly. or have the equipment. first, think ebola. any time a patient is suspected contact us and we will talk you through how to provide care while we get the test done, and if it is confirmed we will be there within hours. my time has ex-en fired. >> when did you come one with that plan? >> that you just stated the plan in terms of training for nurses when was that decided. >> we -- look at our preparedness continually. >> she was asking specifically for those nurses when was the plan put in place for the texas hospital. saying you need to follow this from this point on. >> the day that the

diagnosis was confirmed we sent a team to texas. >> thank you. >> on our collective response to the on going ebola outbreak, and commend my cheeks onen both sides of the aisle, your unanimous attendance to this hearing. since my time is limited i would like to get directly to my. this is a follow up, i don't think we got around to an answer on that. and i will direct the question to dr. freeden and to dr. varga, maybe first to dr. varga. as we know from new reports there's been a second healthcare worker who has contractenned ebola. now that she is receiving isolated treatment at emery university containment unit, in

atlanta. we must examine the protocol break downs that resulted in the contraction of ebola, by these two nurses who were directly in contact treating thomas duncan. dr. varga, in your written testimony you say that the first nurse,fan, was using full protective measures under the cdc protocol. while treating. has your organization identified where the specific breeches in protocol. are alternatively the inadequacies of the protocol.

>> for care with mr. duncan, was wearing protective patient equipment through the whole period of time. as dr. freeden already ever mentioned, with the confirmed the level of personal protective equipment, was elevated to the full hazmat style, we with don't know at this particular juncture what the source or the cause of the exposure that caused nina to contract the disease was. >> i am going to interrupt you, because the limitation of time, i want to go to dr. freeden.

do the c.d.c. guidance, your guidance, on the you of p.p.e., mirror current international standards that by the way, are being adhered to, for the international standards. in those countries sierra leone, guinea and liberia. >> the international standards are something that evolve and change. we use different p.p.e. in different settings there's no single right answer. i commend you for the job you are doing, and i know this is -- these are tough times for all of

us. but i think some consistency is what we need. and that brings me to my next question. and my last question. and again, dr. freeden, does the issue of elevated temperature, you -- you know, is it 100.4, is it 101.5. is it 99.6? i think there's some great confusion, because initially when people were screening, mr. wagner, at the airports in west africa, the temperature threshold, was 101.5. and then i think now the screens that we are doing at the five major airports including heart felt, international and atlanta, it is now 100.4. when mr. duncan came for

the first time to the texas presbyterian hospital, his temperature was what, 100.1. within 24 hours of course it was 103. so when mom and dad, are out there and their child has a temperature, and this fall is flu season, and they are going to the doctor, they are going to demand being corrected for ebola. give us some guidance on what is elevated temperature, and when should parents with concerned? >> well, first, parents should not be concerned about ebola unless you are living in west africa, or the child has had exposure. and right now the people who have had exposure are providing care for ebola patients or the contacts of the three ebola patients and i outlined those in this sheet. for our screening criteria, we are always going to try to have an additional margin of safety. and so we look at that, and we would rather check

more people, and assess and so we will always have that extra margin of safety for our screening. >> thank you, and i yield back. >> thank you. >> listening to our continuing coverage. right now it would be safe to say that congress has more questions than they have received answers concerning what happened in texas and now, there are new developments concerning a student at yale university. we are going to take a break, we will bring you the details concerning that particular student when we come right back.

>> this is al jazeera america live from new york city. i'm tony harris with a look at

today's top stories. a second nurse is infected with ebola after caring for duncan man tested positive.ebola and now two nurses have been infected as well. a yale university student is being tested for the virus. and events intensifying in hong kong after police accused of beating a demonstrator. results within the next 24 hours. we want to go back to washington where the testimony continues as they search for answers as to how this is managed to happen and also how it is managed to spread.

>> and the new link corporation, which is the reason why we are moving along. so that's one reason -- i showed that slide where the nih, and the researches at this end, and then you have to push the envelope further to the product, to derisk it on the part of the companies. companies don't like to take risks. when they don't have -- >> so can you quantify a time line for the ebola vaccine to be on the market? is it theseble for any vaccine to be approved in time to assist in the current outbreak. >> well with, your question has a couple of assumptions. the first is that the vaccine is safe and it works. the second is going to be how long is this outbreak going to last at it's level.

if you look at the dynamics it looks very serious. our response to this, i mean the global response is not kept up with the rate of expansion. if that keeps up, as the cdc has projected, we may need a vaccine to actually be an important part of the controlled of the epidemic itself as opposed to what the original purpose of it was, was to protect healthcare workers alone, but now if you have a raging epidemic, and to be quite honest with you, i cannot predict when that will be if you have a lot of rate of protection. to give you the answer. in it slows down it is a much longer time. if you have a lot more people in your vaccine trial, it takes less time. if we have trouble logistically, which we might, of getting people into the trial, it may take longer. so i would like to give

you a firm answer, but we with can't right now. >> another, in addition to the vaccines, part of controlling the virus is early diagnosis and treatment, i know there are some diagnostic tests that are being developed can you speak to the prospects of improved diagnostics that can assist? >> right. well, there are a couple of agencies that are working on diagnostics. do get earlier diagnosing nossics. >> thank you. i thank the witnesses for joining us today, and the work you are undertaking. i believe you mentioned there are ever 100, to one hundred fifth people coming into the united states from the effected areas. >> that's my understanding, yes. >> so mr. wagner, you had mentioned we are

screening 94% of those people? >> as of today with the expansion to the four additional locations that covers about 94%. >> so 94% are being covered that means that somewhere between two and 3,000 people a year are coming into this country without being screened from the effected areas. >> well, they would undergo a different form of screening. we are still going to identify they have been to one of the three effected regionens and we with are still going to ask them questions. we will be alert to any overt signs of illness. if they are sick, and we will also give them a fact sheet about ebola, the symptoms what to watch for, and who to contact. >> we will not be checking temperatures or having them fill out a contact sheet. >> so there's two to 3,000 people entering this country a year without checking their temperature, without having the contact sheet that 94% of those people. >> you