ebola. we have also provided the august 27th dallas county health department algorithm and screening questionnaire. at 10:30 p.m. on september 25th, mr. duncan presented to texas health presbyterian dallas emergency department with a fever of 100.1. abdominal pain, dizziness, nausea and headache. systems that could be associated with many other illnesses. he was examined and underwent numerous tests over a period of four hours. during his time in the e.d. his temperature spiked to 103 degrees fahrenheit but dropped to 101.2. he was discharged early on the morning of september 26th and we have provided a timeline on the notable events of mr. duncan's initial emergency department visit. on september 28th, mr. duncan was transported to the hospital by ambulance. once he arrived at the hospital he met several of the criteria of the ebola algorithm. at that time -- >> i'm wolf blitzer in

washington. we will monitor this hearing and get back to it. it's 1:00 p.m. in washington, 7:00 p.m. in brussels. 2:00 a.m. friday in tokyo. wherever you're watching from around the world, thanks very much for joining us. the ebola crisis certainly the top priority today for so many leaders here in the united states as well as elsewhere around the world in africa and europe. this is the scene right now on capitol hill where members of congress are holding a hearing on the u.s. response to the ebola outbreak and cases here in the united states. several lawmakers are particularly outraged at how the centers for disease control and prevention in atlanta has handled the infections at texas health presbyterian hospital in dallas and demanding answers from the cdc director tom frieden who is testifying today. there you see him on the left part of your screen. frieden admits his agency should have sent a larger response team to dallas when the first ebola diagnosis was made there, but today, he insisted the cdc is

prepared to deal with the crisis and is protecting americans' health. that's the number one priority. >> there is a lot of fear of ebola and i will tell you, as the director of cdc, one of the things i fear about ebola is that it could spread more widely in africa. if this were to happen, it could become a threat to our health system and the health care we give for a long time to come. our top priority, our focus, is to work 24/7 to protect americans. that's our mission. >> there are other major developments in the ebola crisis that we're following as well. here's what we know. right now, two sources tell cnn nina pham, the first nurse to come down with ebola after caring for a man who died from the disease, is now being transferred from texas health presbyterian hospital in dallas to a national institutes of health facility outside of washington, d.c., and nearby

maryland. that transfer order comes a day after pham's colleague amber vinson was transferred from dallas to emory university hospital in atlanta, georgia. both the n.i.h. facility and emory are two of the four hospitals with specialized ebola isolation units. meantime there are growing concerns of how vinson was able to board a flight from cleveland to dallas, only a day before being diagnosed with ebola. federal official tells cnn vinson called the cdc to report she had a fever of 99.5 before she took the flight, but she was not told to stay off the plane. we've also learned that the cdc is considering putting 76 health care workers at texas health presbyterian hospital on a list banning them from flying while being monitored for ebola symptoms. and in washington, president obama once again canceling travel plans this for a second straight day to hold meetings on the ebola response over at the white house.

meanwhile, leaders in belgium, france, great britain and africa are also holding briefings on the crisis, clearly deep concern in europe as well. we're covering all angles of the story. dr. sanjay gupta is outside emory university hospital in atlanta, elizabeth cohen in dallas, rene marsh at dulles international airport outside of washington, d.c. sanjay, let's start with you. this -- the news, at least right now, is that the first nurse to contract ebola, nina pham, she is now being flown to an n.i.h. facility right outside of washington national institutes of health facility. we heard dr. anthony fauci make that announcement at this hearing just a little while ago. why do you believe she's being transferred? >> well, it's interesting. i'm looking at my notes here when dr. vargas was talking about her, he said her care was evolving, was how he described this in reference to the fact she was being transferred over to the n.i.h. it's a vague term. i'm not sure what she means by

that. what he means by that. i apologize. we know that amber vinson perhaps came here to emory in this building behind me because they were concerned about whether or not they would have the staff to be able to care for her, even though there's obviously 76 staff members who are staying home, there are others that have been furloughed, a question, there's been concerns of nurses may walk out, so this may fall into that same category, is there enough staff to actually be able to take care of her. good news, sounds like she's doing well. doesn't sound like she's taken a decline in her health. that's prompting this decision, wolfe. >> clearly a concern maybe the texas hospital not up to the challenge. that's why they're moving both of these nurses. one has been moved to atlanta. the other one here to washington, d.c. i want everyone to standby. i want to go back to the hearing. the q&a with these witnesses is beginning. >> yourself, somebody else advised you that's a position we need to protect fledgling democracies.

>> my recollection of that conversation is that that discussion was in the context of our ability to stop the epidemic at the source. >> but we can get supplies and medical personnel into the ebola hot zones and so stopping planes and i've heard you say this on multiple occasions, that we have a thousand plus persons per week coming to the united states from hot zones, am i correct on that? coming from those areas? >> there are approximately 100 to 150 per day. >> okay. now, i mean, the duncan case has seriously impacted dallas and northern ohio. if the administration insists on bringing ebola cases into the united states, clearly you've determined how many ebola infectious cases the u.s. public can handle. n.i.h. can handle two of these beds. do you know the number. >> our goal is for no patients. >> as long as we don't restrict travel and not quarantining

people and not limiting their travel, we still have a risk and so these issues of surveillance and containment i don't understand. this is the question the american public is asking, why are we still allowing folks to come over here and why once they're over here no quarantine? >> our fundamental mission is to protect americans. right now we're able to track everyone who comes in. >> you're not stopping them from being around other people, doctor. i understand that and have a high respect for you. the american people says even so they're not limited from travel, not quarantined for 21 days. they could still show up with symptoms, bypass the questions mr. wagner referred to in the thermometers on there. and this is what happened with the nurse who went to cleveland. so i'm concerned here. is this going to be your maintaining position of the administration, that there will be no travel restrictions? >> we will consider any options to better protect americans. >> thank you. i now give five minutes to miss deget.

>> thank you, mr. chairman. dr. frieden, i've got some questions for you and dr. varga for you and i appreciate yes or no answers because i have a lot to move through and only a short amount of time. dr. frieden, in the spring of 2014, ebola began spreading through west africa causing increasing concern within the international public health community, correct? >> correct. >> ebola has an incubation period of about 21 days and is not contagious until the person with the virus begins to be symptomatic, beginning often with a fever, correct? >> between two and 21 days, yes. >> ebola is transmitted through contact with a patient's bodily fluids including vom police, blood, feces and saliva and concentrates heavily as the patient becomes sicker presenting increasingly greater risk to those who may come in contact with 24ethem, contract? >> correct. the cdc has developed guide loans if patients present with

symptoms of ebola and distributed them to hospitals around the country in the summer of 2014, correct? >> correct. >> now, dr. varga, can you hear me? >> yes, ma'am. >> your hospital received the first cdc health advisory about ebola on july 28th, and this advisory was given to the directors of your emergency departments and signage posted in your emergency room, that is right? >> yes, ma'am. >> was this information given to your emergency room personnel and was there any actual person to person training at texas presbyterian for the staff at that time? >> yes or no? >> was given to the emergency department. >> was there actual training? >> no. >> on august 1st, your hospital received an e-mail from the cdc specifying how to care for ebola patients and advising intake personnel to ask a question about travel history from west africa, is that right? >> that's correct. >> now on september 25th, almost two months after the first

advisory received by the hospital, thomas eric duncan showed up at texas presbyterian with a fever that spiked up to 103, and he told the personnel that he had come from liberia. despite this, the hospital sent him home. is that right? >> that's not completely correct. >> they did send him home, right? >> that's correct. >> now three days later, on september 28th, he took a severe turn for the worse and was brought back by ambulance. the hospital staff nurses and everybody else wore protective equipment, is that right? >> that's correct. >> and then eventually put shoe covers were put on too. do you know how long that took them to put the shoe covers on? >> i don't. >> now because ebola is highly contagious when the patient's symptomatic the protective gear has to shield them from any contact with bodily fluids, is that right, dr. freeden. >> >> correct. >> now i have a slide i would

like to put up and i got it from "the new york times" today. it's the photo of the people in the various protective gear. so the first one on the left shows what they're supposed to wear when they come in contact with -- when they're not having contact with the bodily fluids. the second one shows what they're supposed to have with the bodily fluids. so i want to ask you, dr. varga, is what they were wearing at first before the ebola was diagnosed that first set of protective gear? >> i'm sorry, i can't see the picture right now. >> okay. i was told you would be able to. dr. frieden, what should they have been wearing of that protective gear before the ebola was diagnosed? >> i can't make out the details but the recommendations vary as to the risk including whether the patient is having diarrhea or vomiting and may expose health care workers. >> this guy, he had diarrhea and

vomiting. so -- and your testimony, people should have been completely covered, is that right? >> i would have to look at the exact details to know what the answer to that question would be. >> you don't know whether they should have been completely covered if the patient had diarrhea and vomiting and had come from west africa? >> if the patient had diarrhea and vomiting additional covering is recommended under the cdc recommendation, yes. >> now my other question that i want to ask, and i'm going to have to get dr. varga, i'm going to have to get your testimony since you can't see my chart, now, subsequently a number of people, health care workers, were put into this group, this protective work, is that right, dr. frieden? people who were being monitored? >> so health care -- >> and on october 10th, nina pham, presented with a fever and she was admitted to the hospital, is that right? >> yes. >> and then on october 13th, amber vinson, who was

self-monitoring, she presented with a fever and she was told by your agency, she could board the plane, is that right? i just have one more question. >> that is my understanding. >> now your protocols -- >> i need to correct that. >> i have not reviewed exactly what was said but she did contact our agency and she did board the plane. >> and she says she was told to board the plane. >> that may -- >> now your august -- >> that may well be correct. >> your august 22nd protocol say people who are being monitored should not travel by commercial conveyances, don't they? >> time has expired. >> you can answer the question. >> that's what they say. >> people who are in what's called controlled -- controlled movement should not board commercial airlines. >> right. and that's people who have had close contact with these patients, right? that's what your guidelines say. >> guidelines say that people, health care workers with appropriate personal protective equipment don't need to be but people without appropriate

personal protective equipment need to travel -- >> the gentle lady's time has expired. >> i ask for the record the interim guidance stated october 22nd, entire imguidance august 1st and cdc health advisory july 28th be included. >> without objection. dr. frieden, i need you and doctors in texas to get back to the committee as a follow-up to her questions. you comments you made to us was that if she was wearing appropriate protective gear she's okay to travel if she was not she should not have traveled and you told us we don't know. we need to find that out. i recognize the chairman of the committee for five minutes. >> thank you, again, mr. chairman. i think most americans realize that it is -- you have 21 days, if you go beyond 21 days, you're virtually no risk of ebola if you go that far. but it's conceivable then that

after 14 or 15 days, you, in fact, can still get ebola, is that correct? >> yes. >> so i want to go back to the restricting of travel. particularly by non-u.s. citizens. 150 folks a day into the u.s. from west africa. so it's -- the conditions as you talked about, exit screening, all folks from there, exit screened, so it's perfectly conceivable that someone even after 14 days, can exit screen, they're okay, no fever, and, in fact, get to their destination, perhaps in the united states, and have the worst, is that right? >> yes. >> so if our fundamental job is to protect the american public, the administration, as i understand it, as i've looked at the legal language, does -- the president does have the legal

authority to impose a travel ban because of health reasons including ebola is that not correct? >> i don't have the legal expertise to answer that question. >> the -- i saw language earlier today, we can share that with you, but he does from what we understand, not only an executive order that former president bush issued when he was president, but also legal standing as well. so if you have the authority and it's my understanding again that a number of african countries around west africa, around these particularly these three nations, in fact, have imposed a travel ban from those three countries into their country, is that not true? >> i don't know the details of the restrictions. there are some restrictions. >> it's my understanding that they said no, and including even jamaica, as i read in the press earlier this week, has issued a

travel ban from folks coming from west africa. are you aware of that? >> i don't know the details of what other countries have done. i know some of the details and some of them have been in flux. >> i guess the question that i have is, if other countries are doing the same an as you said, the fundamental job of the u.s. now is to protect american citizens, why cannot we move to a similar ban for folks who may or may not have a fever, knowing, in fact, that the ex exposure rate 14 or 15 days is well within the 21 days and, in fact, knowing 150 folks coming a day, not 100% -- it's 94% in terms of screening from u.s. airports, it seems to me that this is not a failsafe system that's been put into place at this point. >> mr. chairman, may i give a full answer? >> i look forward to it.

>> right now, we know who's coming in. if we try to eliminate travel, the possibility that some will travel over land, will come from other places and we don't know they're coming in, will mean that we won't be able to do multiple things. we won't be able to check them for fever when they leave. >> do we not have -- if i can interrupt you, do we not have a record of where they've been before, i.e., a passport or travel status as they travel from one country to another? >> borders can be porous, especially -- >> may i finish? >> go ahead. >> in this part of the world we won't check them for fever when they leave, won't be able to check them for fever when they arrive. we won't be able as we do currently to take a detailed history to see if they were exposed when they arrive. when they arrive we wouldn't be able to impose quarantine as we now can if they have high risk contact. we wouldn't be able to obtain detailed locating information which we do now including not

only name and date of birth but e-mail addresses, cell phone numbers, address, addresses of friends to identify and locate them. we wouldn't be able to provide all of that information as we do now to state and local health departments so they can monitor them under supervision. we wouldn't be able to impose controlled release, conditional release, on them or active monitoring if they're exposed or to, in other words -- >> my time has expired. i have a swift gav toll my left. i just don't understand, if we have a system in place, that requires any airline passenger to -- from coming in overseas with a date of birth to make sure they're not on the anti-terror list, we can't look at one's travel history and say, no, you're not coming here. not until this situation, you're right, it needs to be solved in africa but until it is, we should not be allowing these

folks in. period. >> gentleman's time has expired. recognize mr. waxman for five minutes. >> thank you, mr. chairman. dr. frieden, you have a difficult job. in fact, all of your colleagues who are involved in the different agencies have a difficult job because this is a fast-moving issue. and you're trying to -- you're trying to explain things to people and educate them with limited information and partial authority. in fact, the cdc can't even do anything in the state. they have to be invited in by the state. you can't tell the states to follow your guidelines. you can give them guidelines. so you're dealing with a fast-moving situation and you have to strike a balance about informing the public on the one hand and keeping it from panicking on the other. so let's go to basics. if people are frightened about

getting ebola, what assurances can we give them that this is not going to be a widespread epidemic in the united states as you have said on numerous occasions? >> the concern for ebola is first and foremost among those caring for people with ebola. that's why we're so concerned about infection control anywhere patients with ebola are being cared for. second, in the health care system as a whole, to think about travel because someone who has a fever or other signs of infection needs to be asking, where have you been in the past 21 days and if they've been in west africa immediately isolated assessed and cared for. >> so we have to make sure that we monitor health care workers because they're exposed to people who have ebola. the questions have been raised, what about all these people coming in from africa from the countries where the ebola epidemic is taking place. and you've been asked, why don't we just restrict the travel either directly or indirectly,

from anybody coming in from those countries? i would like to put up on the screen a map to show the passenger flows from those countries. that map shows that if you -- i'll hold it up here -- looking at those particular countries in africa, they could go to any country in europe, they could go to turkey, egypt, saudi arabia, china, india, they can go to other countries in africa, and then from those other countries come in the united states. so i suppose we can set up a whole bureaucratic apparatus to be sure somebody didn't really travel from nigeria or cameroon or senegal or guneny or sierra lee lone, to be sure they really didn't get here from any of those countries. that could be the emphasis but it seems to me what you're saying is that we want to monitor people before they leave those countries, to see whether

they have this infection, and we want to monitor when they come in these countries to see when they have this infection? >> that's what we're doing. we're able to screen on entry. we're able to get detailed locating information, we're able to determine the risk level. if people were to come in by, for example, over land to another country and then entering without our knowing that they were from these three countries we would actually lose that information. currently we have detailed locating information. we're taking detailed history and sharing information with state and local health departments so they can do the follow-up they decide to do. >> dr. fauci do you agree with dr. frieden on this point? >> i do. >> you wouldn't put a travel ban in? it sounds like we always say, seal off our borders. don't let those people come in. now that's usually referenced to the immigration matter, not

public health, particularly, might be a tangental issue, but we know certain countries, where the epidemic is originating, why not stop them? >> well, i believe that dr. frieden and yourself just articulated it very clearly. it's certainly understandable how someone might come to a conclusion that the best approach would be to just seal off the border from those countries but we are dealing with something now that we know what we're dealing with. if you have the possibility of doing all of those lines that you showed, that's a big web of things we don't know what we're dealing with. >> so what we know, is this epidemic can spread if there's contact with body fluids from somebody showing the symptoms of ebola, or someone who has been exposed to that individual. if we had a travel ban wouldn't we force these people to hide

their origin and wouldn't we also not know where they're coming from if they're going out of their way to hide it? a ban or quarantine with hindrance to fight the epidemic in west africa and the worst the epidemic becomes in west africa the greater it's going to be a problem all over the world including the united states. >> the gemntleman's time has expired. >> is that your position, dr. fewically? >> now we recognize the chairman of the committee for five minutes. >> thank you, mr. chairman. dr. frieden, i want to be sure i heard you right. you said that we cannot have flight restrictions because of a porous border. so do we need to worry about having an unsecure southern and northern border? is that a big part of this problem? >> i was referring to the border of the three countries in africa. >> you're referring to that border, not our porous border? >> mr. wagner, would it help you all, the border patrol, if we

secured the southern border and eliminated illegal entry. >> travel is coming across like the northern border. we're going to inquire their information in their data bases, ask them their travel history, where they're coming from, how they arrived in the country. >> yes or no was sufficient. i need to move on. dr. frieden, i want to come back to you. i would remind you that week before last when i was at the cdc and i thank you for letting me come down to follow up with you all on some of our committee work, that i recommended a quarantine in the affected region. and hold people there. i still think that is something that we should consider. quarantining people for 21 days before they leave that region, it helps every country. i want to go back to an issue that you and i talked about at the cdc and the subsequent phone call and that is, the medical waste. and you assured me that standard protocols were being followed for disposal of this waste. and we know that 20, 25 years

ago, hospitals could incinerate their waste. epa regulations now prohibit that. and the waste has to be trucked. and they outsource the care of this medical waste and it results in that going to central processing centers. so, let me ask you this. is ebola waste as contagious as a patient with ebola? >> ebola waste or waste from ebola patients, can be readily decontaminated. the virus itself is not particularly hearty. it's killed by bleach, auto claving, by a variety of chemicals. >> okay. is ebola medical waste more dangerous than other medical waste? >> the severity of ebola infection is higher. you want to be certain when you're getting rid of it that you handle it -- >> is the cdc assessing the capabilities of hospital to manage the medical waste of

ebola patients and does the cdc allow offsite disposal of ebola medical waste? >> my understanding is, that latter question, yes, we've worked closely with the department of transportation as well as the commercial waste management companies to insure that capability. >> we have an added danger in having to truck this waste and move it to facilities. are the employees at the processing centers being trained in how to dispose of ebola waste? >> we have detailed guidelines for the disposal of medical waste from care of ebola patients. >> all right. you and i talked a little bit about my troops from fort campbell that are going to be over there and i have some questions from some of my constituents. are the american troops going to come in contact with any ebola patients or with those exposed to ebola or included in any of

these controlled movement groups? >> the -- as i understand it from the department of defense, their plans do not include any care for patients with ebola or any direct contact with patients with ebola. that said, we would always be careful in country because there is the possibility of coming in contact with someone with symptoms and being exposed to their body fluids and why the department of defense is being careful to avoid that possibility. >> we're going to rely on self-reporting? >> no. we're taking temperatures at many locations within the country. we are having a hand washing stations. >> so you're moving away from self-reporting? because originally it was -- you said our structure was built on self-reporting when i visited with you earlier and i found a quote from you from december 2011 at the george comstock

lecture and tb research. hip poc craties was right, patients lie. about a third of patients don't take medication as prescribed and the third don't take them at all. you can either delude yourself and think patients are taking their medications or not. in tb control it's a simple model. if we see people take their meds we believe they took their meds. dr. frieden, relying 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 have a temperature, we've got to do better thanes this. we can do better than this. we are here to work with you and we expect a better outcome. i yield back. >> time expired. recognize mr. braley for five minutes. >> i would like to thank the panel for joining us. dr. frieden, i was happy to hear you say we will consider any option to protect americans. that's the purpose of everyone here in this room today. i want to ask about texas. are you familiar with the

sentinel event reporting? >> yes. >> has cdc done a root cause analysis of what happened at texas presbyterian and come up with an action plan on what we learned from that incident? we have the detailed hospital checklist for ebola preparedness which we've heard about here today, have there been any recommendations on changing, modifying or updating this in light of what happened at texas presbyterian? >> we have a team of more than 20 of some of the world's top disease detectives in texas now. we were there. we left the first day the patient was diagnosed. we identified three areas of particular focus. the first is the prompt diagnosis of anyone who has fever or other symptoms of infection and travel history to west africa and dr. vargas spoke about that issue. the second is contact tracing. and the graphic that i provided earlier outlines what we're doing there very intensively. the state of texas and the county are doing a terrific job along with our staff making sure that every single contact of the

first patient mr. duncan is monitored. their temperature taken by an outreach worker every day for 21 days. most of the way through that risk period. of the 48, none have developed symptoms, none have developed fever. we are now looking at the contacts who -- health care workers who may have had contact as the two individuals 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 emory university is doing that as well and that the third area is after identification and contact tracing is effective isolation and we're looking very closely at what might possibly have happened to result in these two exposures. >> and i assume if there are any new recommendations based upon that analysis this protocol sent out will be updated and redistributed? >> we always look at the data to see what we can do to better

protect americans. >> thank you. dr. fauci, you were kind enough to share with us this graphic and you mentioned a company in aims, iowa, called new link, which is working on one of the vaccines that just went into phase one clinical trials this week, correct? >> that is correct. >> and i had an opportunity to talk to two of their employees yesterday and i know that they are working around the clock trying to help come up with a vaccine that will meet the protocol and the standards for scaleability that i think everyone is looking for. the w.h.o. and department of defense, hhs and the public health agency in canada have called this vaccine one of the most advanced in the world. and they have requested contracts with hhs to expand the manufacturing, to add a third site for manufacturing, to complete the scientific studies required to scale at manufacturing, and complete the additional safety study to provide newly manufactured vaccines equivalent to the original vaccines and also

identified companies to work as subcontractors. dr. robinson, can you tell us what hhs is doing to make sure that those contracts are moving forward as quickly as possible? >> thank you, sir. we have reviewed their proposal. it looks very favorable. and we will be over the next several weeks finalizing the negotiations with them. prior to that we have been helping them with their submissions to the fda in providing assistance on-site and also at the manufacturing science in working to expand their production with other companies including a large kp here in the united states. >> and also, mr. braley. >> yes. >> the hhs is also involved in the other end of it because the trials that were started, were not only in collaboration with the department of defense, but we admitted our first dsv patient at our clinical center in bests they a da for a phase one trial. not only in the testing but in the ultimate production. >> it's my understanding, dr. fauci and robinson, that the

ultimate goal is to also expand this clinical testing into some of the affected regions in africa as well once we 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 that, after we get through phase one on the trial, i was talking about both vaccine, the glass owe smith kline and the newlink, both if they're safe and induce the response we feel is important, we will expand both of them into larger trials in west africa. >> mr. wagner, question for you, we've heard a lot today about the issue of travel restrictions. can you sort of walk us through the strengths and weaknesses of that approach from your standpoint and border security? >> well, i have to -- >> the gentleman's time has expired. >> so we have the ability to use the data that the airlines give us to be able to see where travel is originating from. there are instances where

travelers may go to different locations and we might not see that. through our questioning and our review of their passport we can identify that they've been to these affected regions or come through one of the borders, fly to canada or mexico, it's more difficult for us to do it, but the possibility is there. the possibility is also greater than we would miss one. i do agree with what the experts, you know, say, it's easier to manage it and control it when we know where people are coming from voluntarily and not intentionally trying to deceive us. >> gentleman's time expired. the word is voluntary. i recognize dr. burgess for five minutes. >> thank you, mr. chairman. i would like to stay with what chairman upton was talking about on the travel restriction. the secretary of health and human services under the public health service act has the authority to issue a travel restriction. under the pandemic plan that was adopted in 2005, the president has the ability to issue a travel restriction. 2005 was geared toward the pandemic avian influenza but was

amended in july of this year to include the hem more rajjic fever. i believe that authority very clearly exists. the question is why the executive branch and agency will not exercise that authority? mr. chairman, i think perhaps this committee should consider forwarding to the full house a request that we have a vote on a travel restriction because people are asking us to do that and i think it is -- they are exactly correct to make that request. dr. frieden, the first nurse who was infected over the weekend is now being transferred away from presbyterian. and yet her condition has been reported in the news media as she is stable and she has been improving. so is the reason that she is having to be removed because the personnel are no longer willing to stay at presbyterian to take care of her? >> texas presbyterian is really dealing with a difficult situation. they're working very hard because of the events of the past week, they are now dealing

with at least 50 health care workers who may potentially have been exposed. the management of those individuals making sure if any of them develop any symptoms whatsoever even the slightest they come in immediately to be assessed so if they develop ebola, we hope no more will, but we know that's a possibility, since two individuals did become infected, others may, that makes it quite challenging to operate and hospital and we felt it would be more prudent to focus on caring for any patients who come in, health care workers or others that might come in with symptoms. >> i don't disagree. you and i have talked about this and i am fully in favor of individuals who have been diagnosed that they do be taken care of in centers as dr. fauci, you know that somebody wants to to do research on the ebola virus they can't go to a regular university setting and do that.

they must go to one of the laboratories they have the capability of protecting the personnel who are not only doing the experiments but other personnel surrounding in the lab. is it possible to get a -- had a picture from the "dallas morning news" which had the cdc recommended personnel protective equipment, i think we have it there, and this not only shows the personnel protective equipment but the order in which it should be put on and removed. shoe covers are not included in this graphic, but you do see a fair amount of exposed skin around the eyes and the forehead and, of course, the neck. now, dr. frieden, this is going to be hard to see, but this is your picture. in western africa. and as you can see, there is head to toe covering and goggles and i believe if i understand the circumstances correctly, you were just about to be daased with a near toxic dose of

chlorine, is that correct? yes. >> that's why you can't have skin exposed because it's impossible to do the disinfection if you will after taking care of an ebola patient or being in an ebola ward it's 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 mention this in my opening statement, i am so concerned, we know, we know the numbers in west africa are going up on ebola. we know the case rate is going to increase. we know that 10% of those cases are health care workers. and we know that 56% of those health care workers in western africa will succumb to the illness so that's a pretty dire warning for everyone -- anyone who's involved in delivering health care. and i would just submit, well, dr. robinson, let me ask you, what kind of stockpile of this personal protective equipment do you have available to the health care workers on the front line. a new patient could come in

tonight and go to any hospital in this country and present themselves, are you going to be able to quickly deliver a stockpile of personal protective equipment like this some. >> so we know from talking to the manufacturers, there are no shortages right now and they are willing to deliver within 24 hours or less. >> let me ask this question, dr. frieden. you know, what did you think the first patient was going to look like? you knew you would have a patient zero or it was a possibility. we had the gentleman who died in nigeria at the end of july who could have got on a plane to minneapolis. what did you think that was going to look like? what was patient zero going to look like and now you've seen what it really looks like. what is the match up there? >> you may 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 that's more flexible and less flexible, that can be decontaminated more or less easily. the use of different types of protective equipment is something that obviously we're looking at very intensely now in dallas in conjunction with the health care workers there. >> thank you. i recognize for five minutes. >> i have so many questions. i want to begin by thanking the health care professionals on the front line and i would like to ask unanimous consent to put into the record, mr. chairman, a letter from randy winegarten from the american federation of teachers which represents a bunch of nurses -- many nurses into the record. i'd also like unanimous 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 disease burden, 3% of world health work force, 1 doctor in liberia for 90,000 people. so i would like to focus on what we're going to do to help that infrastructure, but in my limited time 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, nurses, nurses aides, no one better than the united states, but do we have the ability to train and equip, as we talk about in military terms, in syria, do we have the ability really to train and equip? let me put a couple things on the table.

in terms of the nurses, i still don't feel like we have a good answer of why nurse one and nurse two contracted ebola. is it because there was a problem with not following the protocols or is there something wrong with the protocols? and how are we going to ensure that even if we have the best protocols in the world that everybody knows how to use them? congresswoman deget 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, their necks were not covered, that skin, in fact, as dr. burgess was talking about, was, in fact, exposed. even as we knew he had ebola. so how are we going to make sure, despite how we're going to

check at the airports, i'm from chicago, i talked to our health director today, i know what we're doing, but there's still the chance that someone could present anywhere? how come the nurses in dallas weren't protected and how are we going to make sure everybody can be? >> so first just to clarify one thing. those first couple of days the 28th, 29th, 30th, were before his diagnosis was known. so he had suspected ebola, the test was being drawn and assessed, but he had not yet been diagnosed with ebola. and in our team's review -- >> is that -- excuse me one second. congresswoman, were you saying otherwise? can i yield? >> the gentlelady will yield but 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 to

the dallas hospital said that people should be wearing that protective covering, even before the official diagnosis. i would certainly hope -- thank you for yielding. i would certainly hope that here going forward, if a patient shows up saying he's from africa, and he's vomiting and he has diarrhea, you wouldn't say, well, we don't have the lab results in yet, you would start treating that person like they had ebola? >> absolutely. >> reclaiming my time. >> i wanted to clarify that those first couple days, the 28th and 29th, he was being isolated for ebola, the diagnosis was confirmed on the 30th. the 30th we sent a team there and when we look at the -- to answer your question of those first couple of days, there were some -- there was some variability 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, you know, how are we

going to educate people, nurses, the nurses are saying they -- across the country, that they have not been involved and that they are not trained properly or have the equipment. >> three phases. first, think ebola, anyone with travel history and symptoms. second, any time a patient is suspected isolate them, contact us and we will talk you through how to provide care while we get the test done and if it's confirmed, we will be there within hours with the cdc ebola response team. >> my time has expired. >> just in response, when did you come up with that plan? >> the -- >> you just stated, the plan in terms of training for nurses, when was that decided? >> we look at our preparedness continuously, so awareness has been something we've been promoting in extensive ways. >> i mean she was asking specifically for those nurses when was the plan put in place for the texas hospitals, you need to follow this protocol from this point on?

>> the day the diagnosis was confirmed, we sent a team to texas. >> thank you. >> dr. ginger is recognized for five minutes. >> i want to thank chairman murphy for calling the subcommittee back to washington to hold today's hearing on our collective response to the ongoing ebola outbreak and commend my colleagues on both sides of the aisle. your near unanimous attendance to this hearing. since my time is very limited, of course, i would like to get directly to my questions. this is kind of a follow on to maybe what miss cha cou ski was asking and i'm going to direct the question to dr. frieden and to dr. varga, maybe first to dr. varga. as we know from new reports yesterday, there's been a second health care worker who has contracted ebola, miss amber vinson. now that she's receiving isolated treatment at emory university containment unit in

atlanta, we must examine the protocol breakdowns 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, miss pham, to contract ebola was using full protective measures under the cdc protocol while treating mr. duncan. has your organization in texas identified where the specific breaches in protocol were that resulted in her infection or alternatively, the inadequacies of the protocol? dr. varga, that question is for you. >> thank you, sir. we are investigating currently

the source of this obvious exposure and contraction of the illness. we've confirmed that nina, through her care with mr. protective patient equipment through the whole period of time as dr. frieden already mentioned with the diagnosis of the ebola confirmed, the level of personal protective equipment was elevated to the full hazmat style. we 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'm going to interrupt you for a second because of limitation of time.

i want to go to dr. frieden. health care personnel were following cdc protocols which include ppe, personal protect equipment, do they mirror current international standards that by the way are being adhered to. those international standards in west africa in those three countries, sierra leone, guinea and liberia? >> the international standards are something that evolve and change. we use different ppe in different settings. there's no single right answer and this is something we're looking at very closely. our current guidelines are consistent with recommendations from the world health organization is my understanding. >> i would think that there would need to be, dr. frieden, and i commend you for the job that you're doing. i know these are tough times for

all of us. i think some consistency is what we need. and that brings me to my next question and my last question. again, it's tu, dr. frieden, the issue is it 104.5, there's some great confusion. initially when people were screening mr. wagner at the airports in west africa, the temperature threshold was 101.5. and then i think the screenings we're doing at these five major airports including hartsfield international in atlanta, it's now 100.4. when mr. duncan came for the

first time to the texas presbyterian hospital, his temperature was 100.1 and within 24 hours it was 103. when mom and dad are out there and their child has a temperature and this fall is flu season and they're going to the doctor, they're going to demand being checked for ebola. what's elevated temperature and when should parents be concern? >> parents should not be concerned about ebola unless you are living in west africa or the child has had exposure to ebola and right now the only people who have had exposure to ebola in the u.s. are people who either 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're always going to try to have an additional margin of safety. we look at that.

we rather check more people and assess and so we'll always have that extra margin of screening for our safety. >> thank you. i yield back. >> thank you all for tackling this important public health issue of the ebola virus. i want to thank the experts of the centers for disease control and the nih and medical professionals across the country especially those at emory university healthcare who have been pro-active in containing and treating the virus. i agree with president obama and all of you, we have to be as aggressive as possible in preventing any transmission of the disease within the united states and boosting containment in west africa. i also think we need to pause here. this is a wake-up call for america that we cannot allow nih

funding to stagnate any longer. earlier this year in the budget committee i offered an amendment to the republican budget to restore cuts to nih and repair the damage of the government shutdown of last year. unfortunately it did not pass on a party line vote. we will only save lives if we can robustly fund medical research in america and keep america as the world leader. so i would like to turn to some of that research that's going on. it's going to be research that will be our longer term response to ebola and it will be vaccines to prevent the disease and drugs to treat it. i want to walk through a basic point here. the development of vaccines and treatments for ebola is different from the development of many other drugs. there's not a large private market for ebola drugs. the development requires the leadership of our country and

nih has been working on a vaccine for many years and he reported today they moved into phase 1 clinical trials. can you explain to us why government support is so important for developing ebola vaccines in treatments? >> when you have a product that you want to develop that's not a great incentive on the part of the pharmaceutical companies because of a disease whose characteristics is not a large market. we have the experience when you deal with emerging and re-emerging disease whether it be influenza or a rare disease that could be used deliberately in bioterror or rare disease like ebola that if you look prior to the current epidemic, there were 24 outbreaks since 1976. the total number of people in those outbreaks was less than 3,000. it was about 2,500.

so we were struggling for years to get pharmaceutical partners ourselves doing basic clinical research and we did get some pharmaceutical partners like we have now which is the reason why we're now moving along. that's one of the reasons. i show that slide why nih and research is at this end and then you have to push the envelope further to the product to derisk it on part of the companies. companies don't like to take risks when they don't have a clear -- >> can you quantify a time line for an ebola vaccine to be on the market? is it feasible for any vaccines to be approved in time to assist in the current outbreak? >> 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 will this outbreak last at its level. it looks very serious. our response to it -- when i say our, 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 control of the epidemic itself as opposed to what the original purpose of it was was to protect healthcare workers alone. now if you have a raging epidemic and to be honest with you, i cannot predict when that will be. if you have a lot of rate of infection, a vaccine trial makes a much shorter time to give you the answer. if it slows down, it's a much longer time. if you have a lot more people in your vaccine trial, it takes less time. if we have trouble logistically of getting people into the trial, which we might, it may

take longer. i would like to give you a firm answer but we can't right now. >> 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 in this outbreak? >> there are a couple of us -- when i say us, i mean agencies working on diagnostics. dr. frieden's group at the cdc has played a major role in leadership. we have several grants and contracts out to get earlier and more sensitive diagnostics. >> thank you. >> thank you, mr. chairman. i thank the witnesses to joining us today and the work that you are undertaking. dr. frieden, i want to clarify something you said earlier. i believe you mentioned that there are approximately 100 to 150 people day coming into the united states from the affected areas? >> that's my understanding, yes. >> to mr. wagner, you have mentioned that we're screening

94% of those people? >> we'll take a quick break. that's it for me. for our international viewers, christiane amanpour is coming up next. for our viewers in the united states, this coverage will continue. >> they would undergo a different form of screening. we're still going to identify that they've been to one of those three affected regions and we're still going to ask them questions about their itinerary and be alert to any overt signs of illness and we'll also give them a fact sheet about ebola, about the symptoms, what to watch for and most importantly to who contact. >> will we check their temperature? >> we will not check temperatures or have them fill out a contact sheet. >> there's 2,000 to 3,000 people entering this country a year without checking their temperature and without having a contact sheet that 94% of those affected people -- >>