>> that case, please rise, and i will swear you in. raise your right hand. do you swear the testimony you are about to give is the truth k, the whole truth, and nothing but the truth? >> i do. >> i do. >> i do. >> i do. >> thank you, doctors. you are now subject to the penalties in title 18. of the u.s. code. we call upon you to give a five-minute opening statement. dr. frieden, you are recognized first. >> thank you, committee members. i very much appreciate the opportunity to come before you to discuss the ebola epidemic and our response to protect americans. my name is dr. tom frieden. i am trained as a physician. i'm trained in internal medicine and infectious diseases. i completed the c.d.c. epidemic

intelligence training, and i've worked in the control of diseases -- communicable diseases and others since 1990. ebola spreads only by direct contact with a patient who is sick with the disease or has died from it, or with their body fluids. ebola is not new, although it is new to the u.s. we know how to control ebola. even in this period, even in largos, nigeria, we have been able to contain the outbreak. we do that by tried and true measures of finding the patients promptly, isolating them effectively, identifying their contacts, ensuring that if any contact becomes ill, they are rapidly identified, isolated, and their contacts are identified. but there are no shortcuts in the control of ebola. and it is not easy to control

it. to protect the united states, we have to stop it at the source. there is a lot of fear of ebola. i will tell you, as the director of c.d.c., 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-seven to protect americans. that's our mission. we protect americans from threats, and in the case of ebola, we do that by a system at multiple levels. in addition to our efforts to control the disease at the source, we have helped each of the affected countries establish exit screening so that every

person leaving has their temperature taken. in the two-month period of august and september, we identified 74 people with fever. none of them entered the airport or boarded the plane. as far as we know, none of them were diagnosed with ebola. that was one level of safety. recently we have added another level of screening people on arrival to the u.s. that identifies anyone with fever here. and we have worked very closely with the department of homeland security and customs and border protection to implement that program. i would be happy to provide further details of it later. we've also increased awareness among physicians throughout the u.s. to think ebola in anyone who has fever and/or other symptoms of infection and who has been to west africa in the established laboratory

services. in fact, one of the laboratories in austin, texas, identified the first case here. have fielded calls from concerned doctors and public health officials through out the country. 300 calls,re than and only one patient, mr. ogden, had ebola, but that is one too many. we are open to ideas as what we can do to keep americans as safe as possible as long as the outbreak is continuing. we have established merchants a response teams that will go within hours to any hospital that has an ebola case to help them provide effective care, safety. there is a lot of understandable concern about the cases in doubtless. -- in dallas.

i have one slide of the contact tracing activities, and we provided copies for the members. the two core activities in dallas are to ensure there is effective infection control and to create contact here. you see a timeline of exactly what has happened in the identification of contacts. we have followed each of the contacts. wen any become ill, immediately isolate them so we can break the chain of transmission. that is how you stop ebola. i can go through the details when you wish. we are also working to ensure there is effective infection control there, and i can go through the details of that. cdc works 24/seven to protect americans. there are no shortcuts. everyone has to their part. there are more than 5000 hospitals in this country, more

than 2000 500 health departments at the local level. we are there to support, with world-class expertise, and we are there to respond to threats that we can help protect americans, and we are always open to new ideas. we are always open to data because our bottom line is using the most accurate data information to inform our actions and protect health. thank you. >> thank you. i will now recognize dr. fauci. >> thank you, chairman murphy, ranking members. you just heard about the public health aspects of the ebola virus disease. i appreciate the opportunity to speak with you this morning addressing of th infectious disease. thee events started with /11, whichnts of 9

were closely followed by the anthrax attacks rate it was in that environment that a multifaceted approach toward irish terrorism was mounted by the federal government, one of which was the research to develop countermeasures. he soon became aware that naturally occurring operates of disease are just as much of a terror to the american and world oflic as a deliberate fire terror. you see on the slide the number one we call category a pathogens, from anthrax, botulism, lay, smallpox, but look at the last bullet, pharrell hemorrhagic fevers. the pharrell hemorrhagic fevers are difficult because they have a high degree of fatality and infectivity upon contact with the fluids. therapy is supportive without specific interventions, and we do not have a vaccine. what is the role of the national institutes of health?

we could advance the slide? the role of the national institutes of health in the research endeavor. we do basic and clinical research and we apply and supply resources for researchers in industry and academia to advanced product development. the endgame of what we do our diagnostics, therapeutics, and vaccines. i'm sorry, could we get the slide back on the last slide? no, the previous one. i am very sorry. right get it back, there, there. this is a multi-institutional endeavor. as you can see on the slide, the nih is responsible for basic research and early concept the moment. something that we did relatively unknown because of the lack of interest on the industrial partners of making interventions. who youered with barda,

will hear from short letter, and then we partnered with industry, as i will tell you, to ultimately get the approval of products through collaboration of fda. next slide. you heard a lot of therapeutic interventions. i would like to spend a moment talking to you about a few of them. it is important to realize that they are all experimental. none of them have proven to be effective. when you hear about getting a drug that has a positive effect, we do not know at this point, a, is it a a positive effect, or is it b, causing harm? that is why we need to study these effectively. the first one on the list is -- it looks very good in animal models. it needs to be proven in the humans. there are others such as the biocryst product.

you heard about the tekmira d rug, which is being used in the others you will hear about,. these are just a few of those that will be going into clinical trials and are being used in an experimental way with compassionate use with approval from the fda in certain individuals. b turn to this slide is an important one. slides regarding a vaccine. we've been working on an ebola vaccine for a number of years. he did the original studies shown in animal models to be favorable. we are now at the stage where we are in phase i trials, started september, when a second vaccine was started a couple of days by the u.s. military in collaboration with nih. when we finished those trials, namely asking is it safe, and doesn't induce a response that

you would predict would be protective, it is important to make sure it is safe, if this parameters are met, we will advance to a much larger trial in larger numbers of individuals isdetermine if it actually effective as well as not having a paradoxical negative ella terry is effect. the reason we think this is important is that if we do not until the epidemic with pure public health measures, it is entirely conceivable that we may need a vaccine and it is important to prove that it is safe and effective. i would like to close by making an announcement to this entity, because i am sure you will have a her about it soon in the pressprich this evening, tonight, we will be admitting to the clinical studies unit, the special clinical studies unit at the national institutes of am, otherwiseh known as nurse number one. to nih. be coming we will be supplying her with state-of-the-art care in our

high-level containment facilities. thank you very much, mr. chairman. >> thank you. dr. robinson? >> good afternoon, chairman durfee, chairman upton, and others of the subcommittee. thank you for the opportunity to speak today by the efforts on the ebola. i am dr. robertson, a former vaccine developer, and i have been working on pandemic and bio threats. is the government agency responsible for supporting advanced development and procurement of novel countermeasures such as vaccines, drugs, diagnostics, and medical devices for the entire nation. barda exists to address consequences of violence rates best of bio threats. it supports development for man-made threats on a routine basis to respond to emerging like h1n1.

today we are responding to ebola . said, when it comes to ebola, the best way to protect our country is to address the current epidemic in africa. barda works with partners to transition the countermeasures from early development into advanced the moment towards ultimate fda approval. since 2006 we have built an advanced pipeline of more than 150 countermeasures for threats. have of these products been fda approved in the last two years, and today we are transitioning several promising vaccines and candidates from ihrly development under an

in ensuring these candidates are available as soon as possible. barda eliza's partnerships with utilizes public and private partnerships. barda has worked a flexible and responsive infrastructure to develop and manufacture medical countermeasures. pandemic, and the approved framework has been afforded to federal and industry partners. last year we made five new vaccine and the dates in record time. currently we are working with a wider array of partners, including canada, the u.k., rican countries

to make and evaluate these candidates. barda has established a counter measure infrastructure to respond to immediate public health emergencies. we are using a number of our to make these products available as soon as possible. are on-site at the manufacturer, to provide technical assistance and oversight to expedite availability. we are working with cdc and others in the government and internationally with modeling efforts to look at the ebola out rate as it -- outbreak as it becomes epidemic and other impacts that may occur. barda supports production of medical counters. -- countermeasures.

today we are assisting ebola vaccine manufacturers with scale the production, and we are supporting development and of z mapp, expanding capacity of z alternativerking on antibody candidate to expand production capacity. pending the outcome of animal challenge studies, barda will support additional development to treat ebola patients. under the vaccine front, barda is working to scale up manufacturing of vaccines to commercial scale for clinical studies in africa next year. in addition to efforts in the barda supports other activities and including develop and guidance of patient

movement, standards of care, andort and guidance, ongoing coordination and communication with national and international communities. we face challenges as have been discussed in the coming weeks and months with the ebola and asc continuing, these countermeasures are evaluated. bottom line is my colleagues here and our partners will use all of our collective capabilities to address today's ebola epidemic and be better prepared for future outbreaks. i want to thank the committee for your generous and continuous support and the opportunity to testify. thank you. >> thank you. >> good afternoon. >> will you please all the mike close ashe mike as possible. >> thank you for inviting me to

testify today on the ebola epidemic. my colleagues are determined to do all we can to help end it as quickly as possible. the desire and need for safe and effective vaccines and treatments is overwhelming. fda has taken steps to be proactive and flexible. they're leveraging on our authorities and working to expedite the government, manufacturing, and availability of safe and effective products for ebola. the provided fda advised companies to guide their submissions. we are reviewing data as it is received. these actions help advance the on ofopment of investigativ products as quickly as possible. result, the vaccine candidates being developed by

the companies began phase one critical testings on september 2, and the vaccine candidates began similar setting on october 13 the er partnering with u.s. government agencies that support medical product development, including barda and the department of defense. fda was able to authorize the use of the ebola the agnostic test under our emergency authorization within 24 hours of request. of two authorize the use additional tests, and these tests are essential for an effective public health response. we are supporting the world health organization. we are providing technical advice to the who as it worse to assess the role of convalescent asthma in treating patients with ebola. i participate in a consultation

focused on vaccines in geneva which included dozens of experts as well as from affected countries in west africa. participants agreed continued investigation of vaccines must be evaluated in clinical trials and in the most urgent manner. fda is working closely with government colleagues and the vaccine helpers to support this. it is important to note that while we all went access to orediate therapies to cure prevent ebola, the scientific fact is that this investigation of products are in the earliest stages of development. there's tremendous hope that some of these products will help patients, but it is also some may hurt patients and others may have little or no effect. torefore, access investigation of products should be through clinical trials when possible. they allow us to learn about product safety and legacy, and they can provide an adequate

means for access. we are working to develop a protocol to allow conference -- companies to evaluate most products under a common protocol. the goal is to ensure a pool of interpretable data and generate actionable results in the most expeditious manner. it is important for the global community to know the risks and benefits of these products as soon as possible. trials are established, we will continue to enable access to these products when available and requested by clinicians. we have mechanisms such as compassionate use which allow access an investigation products outside of clinical trials when we assess that the expected benefits outweigh the potential risks for the patient. ebolatell you that every patients in the u.s. has been treated with at least one investigational product. acause ebola is such

serious disease, fda has approved such requests within a matter of a few hours and often times in less than one hour. fdae are more than 250 staff involved in this, and everyone has been proactive, thoughtful, and adaptive to the complex situation that has emerged. we are committed to sustaining our engagement to support a response to the ebola epidemic rate thank you, and i will take your questions later. >> thank you. you recognize for five minutes. >> thank you for the opportunity to discuss the efforts of u.s. customs and border reduction in deterring ebola. each day about one million travelers arrive in the united states. cdc is responsible for

travel in the airports. within this broad responsibility, our mission remains to prevent terrorists and weapons from entering the united states. we play an important role in of disease inductionn into our countries. cdp officers assess each cover for signs of illness. in response to the recent virus outbreak in west africa, we are working to ensure that front-line officers are provided information and equipment needed to identify and respond to international travelers who may pose a threat to public health. all cvp officers are provided training to addressing any transmission of the fires. healthcludes public

training to identify through observation and questioning the symptoms of ill travelers. cvp also provides training for how to respond to travelers with potentially illness, including referring people for secondary screening as well as training with implementation of quarantine protocols for it provides training for its personnel of blood-borne n, other preventive measures. we are committed to ensuring our field personnel have the most accurate information regarding this virus. information sharing is critical, and cvp engages with

health and medical authorities. has station and officer at our national carding center to provide expertise and facilitate requests for information. cvp beganctober 1, providing information notices to travelers entering the united states. provides the travel information and instruction should he or she have a concern of possible infection. in addition to screening all passengers for wellness, starting october 11, cvp and cdc began enhanced screening of travelers of the three countries, and we have expanded efforts at dulles, atlanta, newark. in coordination with cdc, these travelers are asked to complete a cdc questionnaire, provide contact information, and have

their temperature check. based on these efforts, cdc quarantine officers will make a public health assessment. since the measures went into effect, cdc has done enhanced screening at on travelers for individuals known to have traveled through the one of these three affected countries. 13 travelers were identified by officers as needing additional screening applied on all ports of entry. a total of eight of these travelers have been sent to tertiary very screening by cdc and it is important at all passengers were examined and released. receivep training, if they identify a traveler believed to be ill, they will isolate the traveler and contact the local cdc quarantine officer, along with local public health authorities. cvp officers are trained to employ universal precautions in infection control when they

encounter individuals with overdose and tons of illness or contaminated items in examinations of baggage and cargo. when necessary cvp will take the appropriate measures based on the level of potential exposures. these are designed to minimize risk to the public and have been utilized collaboratively on a number of occasions. cvp will continue to monitor the ebola outbreak with information to our personnel, and we are working with partners to evolve measures as needed to deter the spread of ebola in the united states. thank you for the opportunity to testify today. speak with dr. varga. >> good afternoon, chairman murphy, ranking member degette. i'm the chief clinical officer

texas health resources. i am board certified in internal medicine and have more than 24 years in medical education and health care administration. i'm truly sorry i cannot be with you in person today, and i appreciate committee plus understanding of our situation and how important it is for me to be in dallas. texas health, presbyterian hospital is one of 13 acute-care hospitals. we are an 898 bed hospital treating some of the most complicated cases in north texas in terms of -- texas health dulles is recognized as a magnet facility for excellence in nursing. texas health resources is one of the largest state-based centers,

not-for-profit health systems in the united states and the largest in texas. our mission is to improve the health of the people and the communities we serve, and we care for all patients regardless of their ability to pay. community anderse we provide one standard of care for all, regardless of race or country of origin. as the first hospital in the country to both diagnose and treat a patient with ebola, we are committed to using our experience to help other hospitals and health care providers, protect public health against this insidious virus. it is hard for me to put into words how we felt when our patient thomas dunkin lost his n lost his- dunca struggle. it was devastating to the teen who tried so hard to save his life, and we keep his family in our thoughts and prayers. unfortunately, in our initial despitet of mr. duncan,

best intentions and a highly skilled medical team, we made mistakes. we did not correctly diagnose his symptoms as those of ebola and we are deeply sorry. also, in her effort to communicate to the public weekly and transparently, we inadvertently provided information that was inaccurate and had to be corrected. unsettling towas a community already concerned and confused them and we have learned from that experience as well. a nurse from our hospital family who courageously care for mr. duncan was also diagnosed with ebola. our team is dedicated to help her win that fight, and on tuesday her condition was upgraded to good, and as mentioned earlier, nina's care continues to evolve. prayers ofl you the the entire texas health system are with her.

yesterday, we identified second can giver with ebola, and i also tell you our thoughts and prayers remain with her as well. a lot is being said about what they are may not have occurred amber to nina and contract ebola. we know they are both extremely skilled nurses and were using for protective measures under the cdc protocols, so we do not know how and when they were infected. anis clear there was exposure somewhere sometime, and we are poring over records and observations and doing all we can to find the answers. you have asked about the sequence of events with regard to our preparedness for ebola and treatment of mr. duncan. events from our timeline are attached to our statement, but here is an overview. as the epidemic in africa worsened over the summer, texas health hospitals and facilities

begin advocating propositions and risksms associated with the virus. there was an advisory received about the disease and it was shared with other personnel. the health care advisory and courage all providers in the u.s. to consider ebd and the diagnosis of the onus, in other words, a fever, in person to it recently traveled to affected countries. the cdc adviser was sent to all directors of our emerging departments and signs were all posted in the e.d.'s. all regional hospital leaders and leadership across our system received an e-mail directing all had at a policy in place to address how to care for patients with ebola-like systems. the e-mail also drew attention to the fact that our electronic

health record documentation in emergency departments included a question about travel has treat to be completed on every patient . attachments to the e-mail included a draft emergency policy that specifically d, a poster, and a cdc advisory from 7/28. of u.s.st 1 guidelines patients suspected to have the disease was the ship is to staff, including the physicians and nurses on august 1 and august 4. over the last two months, the dallas county health and community services department indicated with us for a possible case of ebola. we have also provided the august 27 thousand county health department, rhythm and screening questionnaire. at 10:30 p.m. on september 25, texasncan, presented to

health, emerge with a fever and1,0 with nausea headache. he was examined and underwent numerous tests over a time of four hours. hisng his time in the e.d., temperature spike to one of three. it later dropped to 101.2. he was discharged early on the morning of september 26 and we provided a timeline on the n's initialr. dunca emergency department visited on september 20, he was transported to hospital on the ambulance. he met several criteria of the ebola outdoor them. the cdc was notified, hospital in texasall cdc department of state recommendations in an effort to ensure the safety of patients, hospital staff, volunteers, nurses, decisions, and visitors. perfect if equipment into the water-in per meal counts, high

protection and gloves. since the patient was having diary, shoe covers was shortly thereafter added. we notified the dallas county services department and their infectious disease personnel arrived shortly after. 30, ebola wasth diagnosed. later that day, cdc was notified, and they arrived october 1. >> doctor, one moment please. we are going way over time. we want to hear some details, but could you wrap up, because a lot of members want to ask you questions. >> ok. >> thank you. >> thank you. i would like to underscore we have taken all the steps possible to maximize the safety of our workers, patients, and

community, and we will continue to make changes. we are determined to be an agent of change across the u.s. health-care system by helping our peers benefit from her experience. lo has a long history of excellence. thank you for the opportunity to testify. each will be recognizing person on the committee for five minutes of questioning. we will keep a strict time on this. let me start off here with dr. frieden, a second nurse took a flight to cleveland after she registered a fever. we have reports she said she told she cdc and was could fly? >> my understanding was she contacted cdc. >> were you part of that

conversation? >> no, i was not. >> was there a plan that limited the her contacts with other citizens? >> the protocol for people moving and monitoring people who are exposed to ebola identifies as high risk someone you did not wear appropriate her some protective equipment during the time they care for a patient with ebola. what specifically did she tell you? uncan's team was not under the same observation, so what did she tell you her systems were? seen the not transcript of the conversation. my understanding is she reported no symptoms to us. >> another question, quickly. regard to the new patient being transferred to nih, will people come into contact with her be under travel r

restrictions? >> according to the guidelines that the people who will be coming into contact with her will be physicians, nurses, and others who will be in personal protective equipment. therefore, they are not restricted. >> why is she being transferred? >> to get the state-of-the-art care in a containment facility. conditionr deteriorated or improved? >> she has not paid at this point from the report we are getting from dallas is her condition is stable and she seems to be doing reasonably well. i have to verify that myself when my team goes over there. >> if other people come to dallas, will they also come to nih? >> we have a limited vast database of being able to do this level of care in

containment. our total right now is to bed. she walked by one of them. phone, we spoke on the you remained opposed to travel restrictions, he said cutting commercial ties will hurt these fledgling moccasins. is this your opinion, or did someone advise you, someone within the administration, where did this opinion come from that is of high importance? >> my sole concern is to protect americans. we can do that by continuing to take the steps we are taking here as well as to-- >> did someone advise you on that, someone outside of yourself? >> 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, so stopping planes, and i have heard you say this in

multiple occasions, we have 1000-plus persons per week coming out of the united states from hot zones, am i correct on that -- coming from those areas? >> there are approximately 100 to 150 per day. impactsuncan case dallas and northern ohio. my understanding is bringing ebola cases into the united states, clearly, you have determined how many infection raises the u.s. public can handle. nih can handle two of these beds. do you know how many across the country? >> our goal is no -- >> i understand. as long as we are not partying people, we still have a risk. these issues of surveillance and containment i do not understand. this is the question the american public is asking. why are we still allowing folks to come over here and once they are over here no quarantine?

>> are fundamental mission is to protect millions. right now we are able to attract everyone who comes in. >> [indiscernible] my concern is the american people say they are not limited from travel, not 14 421 days because they can still show up with symptoms, still bypass questions. and this is what happened with the nurse who went to cleveland. so i'm concerned here, is this maintainbe a position of the administration that there will be no travel restrictions? >> we will consider any options to better protect americans. degew five minutes to ms. tte. >> thank you. i have question for you and i would appreciate yes or no answers because i have a lot to move through and only a short time. dr. frieden, and the spring of 2014, ebola again spreading to

west africa causing concern within the international public health community, correct? >> correct. >> beginning often with a fever, correct? >> between two and 21 days. through is contracted bodily fluids, and the virus concentrate more heavily as the patient becomes sicker, presenting increasingly greater risks to those who may come into contact with them, correct? >> correct. >> the cdc has developed guidance if haitians consistent with ebola symptoms and has distributed them to hospitals in 2014, correct? >> correct. varga, your hospital received the first health advisory on july 28, and this

advisory was given to the directors of your emergency departments and signage was posted in the emergency room, is that right? >> yes. >> was this much information given to your emergency room personnel, and was there any training at texas respiratory and for the staff at that time? yes or no? >> it was given to the emergency department. >> was the actual training? >> no. hospitalust 1, your received an e-mail from the cdc specifying how to care for ebola patients, and advising intake or smelled asking question about travel history from west africa him is that right? >> is correct. >> on september 25, almost two months after the first advisor received by the hospital, thomas duncan showed up with a fever that spiked up to one of three and he told the personnel that he had come from liberia. despite this, the hospital sent him home, is that right?

>> not completely correct. >> they did send him home, right? >> >> that is correct. three days later on september 28, he took a severe turn for the worse. the hospital staff and everybody else wore protective equipment, is that right? >> correct. >> eventually put shoe covers on. do you know how long that took? >> i do not. >> because ebola is highly contagious when the patient is symptomatic, the protective gear has to shield them from any contact with bodily fluids, is that right? >> correct. >> i have a slide i would like to put up, and i got it from the new york times, the photo of the people in the various protective gear. the first one on the left shows what they are supposed to wear when they come in contact, when

they are not having contact with bodily fluids. the second one shows what they are supposed to have with the bodily fluids. i want to ask you, dour . varga, if what they were wearing at first, the first set of protective gear? >> i cannot see the picture right now. >> i was told you would be able to. after frieden, what should they have been wearing of that protective year before the?ebola was diagnosed >> i cannot make out details, but the recommendation vary as to the risk him including whether the patient is having fiery or vomiting and they exposed health-care workers -- had diarrhea and vomiting. in your testimony, people should have been completely covered, is that right? >> i would have to look at the exact the deals to know what the answer is. >> so your position is they

should not be completely covered if -- >> if they had diarrhea and vomiting, additional coverage is recommended, yes. >> my other question i want to ask him and i am going to have to get dr. varga's testimony since you cannot see my chart. subsequently, a number of people, health-care workers, were put into this group, this particular, is that right, dr. frieden, people who were being monitored? phan wasr 10, nina admitted? >> yes. >> october 13, amber, was ted with a fever and told she could board the plane. >> she did contact our agency

and she did board the plane. >> she said she was told to board the plane. say evilst 22 protocol who are being monitored should not travel by commercial conveyance. >> [indiscernible] >> that is what they say. >> people who are in what is movementntrolled should not board commercial airlines. >> and that is people who have had close contact with these patients, right? that is what your guidelines say? >> it says health-care workers with appropriate equipment do not need to be, but people without personal protective equipment do need to travel by control transfer -- >> mr. chairman, i just asked for the record the interim guidance dated october 22, august guidance dated

1 -- >> without objection. we need you to get back to the committee to follow up with her question, because your comments you just made to us was that if she was wearing appropriate protective gear, she was ok to travel. if she was not, she did should not have travel. and you told us we do not know. we need to find that out. you, mr. chairman. i think most americans realize you have 21 days. if you go beyond 21 days, your virtually of no risk of ebola. is conceivable that after 14 or 15 days you in fact can still get ebola, as i crept? >> yes. >> i want to go back to the restricting of travel,

particularly by non-u.s. citizens, these 150 folks a day into the u.s. from west africa. the conditions as you talked about, exit, screening, all there are exit screens, so it is perfectly conceivable that someone after 14 days can exit screen, they are ok, no fever, and in fact get to their destination, perhaps in the united states, and have the worst, is that right question mark >> -- is that right? >> yes. >> the fundamental job, to protect the american public, the president does have the legal banority to impose a travel because of health reasons, including ebola. is that not correct? >> i do not have the legal expertise is a question. >> i selling which earlier

today. we can share that with you. he does, from what we understand, and not only an executive order that former president bush issued when he was present, but also the legal standing as well. if you have the authority, and it is my understanding again that a number of african west africa,und around these three nations, in fact have imposed a travel ban from those three countries into their country. is that not true? >> i do not know the details of the restrictions. there are some restrictions. >> it is my understanding they and including jamaica, as i understood in the press, has issued a travel ban from folks coming from west africa. are you aware of that? >> i do not 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 i have is if other countries are doing

the same and 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 exposure rate 14 days or 15 days is well within the 21 knowing the 150 folks coming a day, not 100% -- 94% in terms of screening from me. airports >> it seems to this is not a failsafe system has been put into place >> thus far. may i give a full answer? >> i look forward to it. >> right now we know who is coming in. eliminateto do travel, the possibility that some will travel over land and come from places and we do not know they're coming in on meaan

we will not be able to do awful things. we will not be able to check them for fever when they leave -- >> can we not have a record of where they have been before, i.e., at passport from a travel status, as they travel from one country to another? ous,orders can be por especially in this part of the world. we will not be able to check them for fever when they leave, when they arrive. you'll not be able, as we do currently, to take a history to see if they were exposed in a arrive. when they arrive, we would not be able to impose quarantine as we now can you have a high-risk contact. we will not be able to obtain information as he do now, including not only name and date of birth, but e-mail addresses, cell phone numbers, addresses, addresses of friends so we can locate them. we would not be able to divide all the information as we do now to state and local health departments so that they can

monitor them under supervision. we would not be able to impose conditionalelease, release on them, or active monitoring if they are exposed -or- two >> my time is expired. i just do not understand. if we have a system in place that requires any airline passenger coming in over seas to make sure they are not on the antiterrorist list that we cannot look at one's travel history and say, no, you're not coming here, not until this situation. be're right, it needs to solved in africa, but until then, we should not be letting these people in, period. >> i recognize mr. waxman. >> thank you. dr. frieden, you have a difficult job. in fact, all of your colleagues who are involved from the

different agencies have a difficult job, because this is a fast-moving issue. to explain things withople and educate them limited information and partial authority. the cdc cannot even do anything in a state. they have to be invited in the state. you cannot tell the states to follow your guidelines. you can give them guidelines read your dealing with a fast-moving situation, you have to strike a balance about informing the public on the one hand and keeping it from taking on the other. 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 academic in the united states come as you have said, on numerous occasions? >> concern is first and foremost

caring for people with ebola. that is why we are sconcerned with infection control and where -- anywhere 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 asked where have you been in the past one days, and if they have been in west africa, immediately isolated, assessed, and cared for. >> we have to make sure we monitor health care workers about because they are exposed to people who have ebola. the question has been raised, what about these people coming in from africa, from the countries where the ebola epidemic is taking place? you have been asked why don't we just restrict the travel eith er directly or indirectly from any one coming into those countries. i would like to put up on the screen a map to show the passenger flows from those countries. that map shows -- if you hold it

up here -- if you're 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, other countries in africa, and then from those ther countries, come into united states for it i suppose we could set up i hope your credit card rattus to make sure somebody did not travel from nigeria or cameroon or senegal or any or sierra leone to be sure they do not really get here from any of those countries. that could be our emphasis, but it seems to me what you are saying is that we want to monitor people before they leave his countries to see whether infection and we want to monitor them when they come into these countries to see whether they have these infections. is that what you are proposing to do? >> that is what we are doing.

we are able to screen on entry. we are able to determine the risk level if people were to come in by going over land to another country and then entering without our knowing that they were from these three countries. we would actually lose and that information. currently, we have detailed locating information. we are taking detailed histories and sharing information with state and local health departments so they can do the follow-up that they decide to do. with. fauci, do you agree dr. freeman on this point -- dr. point?en on this >> i do. we know certain countries, where the epidemic is originating, why not stop them? >> i believe dr. frieden and

yourself just articulated very clearly, it is understandable how someone might come to the 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 are dealing with. if you have the possibility of doing all of those lines that he showed, that is a big web of things we do not know where we are dealing with. >> so what we know, is this epidemic can spread if there is contact articles from someone who is showing the symptoms of ebola or someone who has been exposed to that individual. if we had a travel ban, would we to hidece these people there are jen, and wouldn't we also not know where they are coming from if they are going out of their way to hide it, a ban, with reference to fighting

the epidemic in africa, and the worse the epidemic becomes in west africa, the greater it is going to become in the united states -- is that your position, dr. fauci? >> now we recognize >> now recognize the vice chair of the full committee for five minute. >> i want to be sure i heard you correctly, you said to chairman upton we cannot have flight restrictions because of a porous border. do we need to worry about having an unsecured southern and northern border? is that a big part of the problem? >> i was referring to the border of the three countries in africa. >> your referring to that border, not our border. would it help you all, the border patrol, if we secured the southern border and eliminated illegal entry? >> travelers nut and across the northern border or southern border, a and information in databases and we will ask their travel history, where they're coming from and how they

arrived. >> yes or no would be sufficient. i need to move on. i want to come back to you. i would remind you when i was at the cdc for letting me come down to follow up with you in our committee work, i recommend a quarantine in the affected region and people there. i still think that is something we should consider. quarantine people for 21 days before they leave that region. what we talked about at the cdc and subsequent phone call, medical waste. you assured me standard protocol filed for disposal of this waste, and 25 years ago, hospitals could incinerate their rates. the epa regulations prohibit that and it has to be trust and

they outsource the care of medical waste and it results, the simple processing centers. let me ask you is this. is ebola as contagious as a patient with ebola? >> ebola waste 0 waste from ebola patients can be decontaminated. of virus itself is not particularly hardy. variety of chemicals. >> is it more dangerous than other medical waste? >> the severity of ebola infection is higher. when you are getting rid of it. >> the capabilities of hospitals that manner and mental -- manage medical waste and does the cdc ala off site disposal of ebola. >> we work with the department

of transportation, and commercial waste management companies to ensure that capability. >> we have an added danger and had to truck this waste. employees of processing centers being trained and have to dispose of ebola waste. >> we have detailed guidelines for the disposal of medical waste for care of ebola patients. >> you and i talked about my troops from fort campbell that are going to be over there and i have some questions from my constituents. are american troops going to come in contact with any ebola patients or those exposed to ebola or included or any of these controlled movement groups? >> as i understand it, there are

no plans to include care for patients with ebola or any direct contact with patients with ebola. that said, we would always be o t with symptoms and being exposed to their body fluids, that is why the dod is being careful to avoid that possibility. , we are taking going to rely on temperatures applications in many countries. we have handwashing stations -- >> you're moving away from self-reporting, because originally used said your was based on self-reporting. i found a quotation from december 2011 on the george comstock lecture. have cartridges was right. pocrates was right. you can either delete yourself in whether patients are taki

possibility. if we see people take them we believe they took them. relying on self reporting and making certain people tell us the truth before they leave and we catch the fever at the right time if they have a temperature we have to do better than this. we can do better than this, we expect a better outcome. i yield back. >> mr braley for five minutes. >> i was happy to hear you say we would consider any options to protect americans. that is the purpose of everyone in this room today. i want to ask about texas. i you familiar with the seminal event reporting? >> yes. >> has cdc done rubicon's analysis 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 hart senate office

building preparedness' which we heard about 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 20 of the top disease detectives in texas, we wary there, we left the first data patient was diagnosed. we identified three areas of particular focus. the first is the prompt diagnosis of anyone with fever or other symptoms of infection and a travel history to west africa. the second is contact tracing and the graphic i provided earlier outlines what we are doing intensively. the state of texas doing a terrific job with our staff making sure every single contact of the first patient, mr. duncan, is monitored, the temperature taken by outreach worker everyday for 21 days. most of the way through that risk period. none have developed symptoms, none have developed fever.

we are now looking at the contacts, health care workers who may have had contact as the two individuals who became affected did and our thoughts are with them, and we are delighted the nih is supporting the hospital in texas and and more university as well. the third area after identification and contact tracing is affected and we are looking at what might possibly have happened to result in these exposures. >> if there are any new recommendations based on that analysis this protocol that was set out is read distributed? >> we look at how to protect americans. >> you were kind enough to share with us this graphic, and a company called new link, working on the vaccines that just went in to face one clinical trials

this week. >> that is correct. >> we talked to two employees yesterday, they're working around the clock to help come up with a vaccine that will meet the protocol and the standards for scaleability that everyone is looking for. h h s in canada called this vaccine one of the most advanced in the world and they requested contracts with hhs to expand manufacturing to add a third site for manufacturing to complete the scientific studies required to scale up manufacturing and complete the save the city to provide noon remanufactured vaccines that are equivalent to the original vaccines and identified companies to work as subcontractors. can you tell us what h h s is doing to make sure those contracts are moving forward as quickly as possible?

>> we have reviewed their proposal. it looks favorable. we will be finalizing negotiations with them. prior to is that we have been helping with submissions to the fda and providing assistance on site and the manufacturing sites and working to expand their production with other companies including a large company in the united states. >> and also the h h s is involved in the an end of it because the trial that was started was not only in collaboration with the department of defense the we admitted our first bst patient at the clinical center in bethesda for a phase 1 trial so not only in testing but also in the ultimate production. >> it is my understanding that the ultimate goal is to expand this clinical testing in to some of the effected regions in everett that as well once we had an understanding of some of the concerns identified earlier in

your testimony is. >> quite correct. after we get through a phase 1, glaxosmithkline and the new link they are safe and induce the response we feel is appropriate we will expand both of them into larger trials in west africa. >> a question for mr. waggoner. we heard a lot today about the issue of travel restrictions. can you walk us through the strengths and weaknesses of that approach from your standpoint in border security? >> if you could hurry through a quick answer. >> we have the ability to use the data at the airlines give us to see where travelers is originating from. there are instances where travelers may go to different locations and we may not see that but through questioning and review of their past 4 we can identify they have been to be infected regions if they come through one of the borders of canada or mexico it is more

difficult for us to do it. but the possibilities greater -- i agree with what the experts say is easier to manage and control what we know about. not intentionally trying to deceive us. >> the word is voluntary. at recognize dr. burgess for five minutes. >> i would like to say what chairman upton was talking about on the travel restrictions this secretary of health and human services and public health service act has the authority to issue a travel restriction. under the pandemic plan adopted in 2005, the president has the ability to offer staff travel restriction. 2005 was geared toward the pandemic avian influenza but was to include the hemorrhagic fever so i believe that authority clearly exists. the question is why the executive branch in the agency will not exercise that

authority. perhaps this committee should forward a request that we have a vote on travel restrictions because people are asking us to do that and i think they are exactly correct to make that request. the first nurse who was infected over the weekend is being transferred away from presbyterian and the condition has been reported in the news media as she is stable and has been improving. the reason she is removed is because the personnel are no longer willing to stay at presbyterian to take care of her? >> texas presbyterian is dealing with a difficult situation, they are working very hard because of the events of the past week, they are dealing with at least 50 health care workers who may potentially have been exposed. management of those individuals, making sure that if any of them developed 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 is a possibility. and others may. that makes it challenging to operate. we felt it would be prudent to focus on caring for any patients the come inn, health care workers who might have symptoms. >> we talked about this and i am in favor of individuals who have been diagnosed that they do be taken care of incentives and you know that somebody wants to do research on the ebola virus can't go to a regular university setting and do that. they must go to one of the laboratories where they have the capability of protecting the personnel who are not only doing the experiments but other personnel in the lab. is it possible to get a picture from the dallas morning news

which has the cdc recommended personal protective equipment? i think we have it there and did not only shows personal protective equipment that details the order in which it should be put on and removed, and shoot covers are not included in this graphic but you do see a fair amount of exposed skin around the eyes and the forehead and the nick. it this is going to be hard to see but this is your picture in western africa. as you can see there is head to toe covering and goggles and if i understand the consequences, you are about to be dosed with a near toxic dose of chlorine bleach is that correct? >> yes. >> that is why you can't have been exposed. impossible to do the disinfection if you will after taking care of an ebola patient, being in an evil awarded 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 care. i am so concerned, we know the numbers are going up on ebola and the case rate will increase, we know 10% of those cases are health care workers and we know that 50% of those health care workers in west africa will succumb to the illness so that is a dire warning for anyone involved in delivering health care. 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? no travel restrictions a new patient could come in tonight and go to any hospital in this country and protect themselves, will you be able to quickly deliver a stockpile? >> we know from talking to manufacturers there are no shortages and we're willing to

deliver within 24 hours or less. >> let me ask this question, what did you think first person was like, when you knew you would have patient zero at some point or it was a possibility, we had a gentleman who died in nigeria at the end of july who could have gone on a plane to minneapolis what did you think that would look like? what was the patient zero going to look like? what is the matchup? >> thank you. our goal has been to get hospital's ready, specific personal protective equipment to be used is not simple and fair is no single right answer but there's a balance between protective equipment that is more familiar or less familiar or more flexible or less flexible that can be decontaminated more easily or less easily so the use of different protective --

something we are looking at intensively now in dallas in conjunction with health care workers. >> i have so many questions. i want to begin by thanking the health care professionals on the front line and i ask unanimous consent, a letter from randi weingarten from the confederation of teachers which represents nurses into the record. unanimous consent to put in the record the diary, from partners in health among other things, the fact is week health systems are to blame for ebola's rapid spread in west africa. we know that west africa has 24% of global disease, 3% of world

health workforce, one doctor in liberia for 90,000 people. i would like to focus on what we are going to do to help that infrastructure but in my limited time i want to focus on our infrastructure. we have a vast infrastructure, community hospitals where people may present themselves. 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, do we have the ability to train and be quick? let me put a couple things on the table. in terms of the nurses i don't feel we have a good answer of weiner some 1 and bears 2 contracted ebola. is it because there was a

problem that was not found in protocols or is there something wrong with the protocols and how are we going to ensure that even if we had the best protocols and the world that everybody knows how to use them. congressman degette should 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 and their necks were not covered, and it was in fact exposed. so how are we going to make sure, i am from chicago, i know what we are doing. there is still anywhere. how come and nurses in dallas

were protected and how we make sure everybody can be? >> those first couple days, 28 or 29 or 30th were before his diagnosis was known. suspected ebola the test was drawn and assessed. had not been diagnosed with ebola and the team's review. >> excuse me one second. were you saying otherwise? >> the gentlelady will yield but he presented with ebola symptoms, he had been to the emergency room a couple 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. thank you for yielding. i would certainly hope that

going forward if a patient shows up saying he is from africa and he is, in and has diarrhea that you don't say we don't have the lab results in yet you would start treating that person like they have ebola. >> absolutely. i want to clarify those first couple of days 28 su bent 29 scooby was being isolated for ebola. diagnosis was confirmed on the 30th. we sent a team and when we look to answer your question that those first couple days there was some variability in the use of personal protective equipment. the hospital was certainly trying to implement cdc protocol. >> going forward how are we going to assure that just trying -- how are we going to educate people, nurses, across the country, that they would not be involved or trained properly or have the equipment? >> three phases.

first, anyone with travel history and symptoms, 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 is confirmed we will be there within hours of the ebola response team. >> my time is an expired. >> when did you come up with that plan? when was that decided? >> we've look at our preparedness continuously so awareness is something we have been promoting an intensive way is. she was asking for those nurses. when was the plan for the texas hospital, you need to follow this protocol from this point on. >> the day the diagnosis was confirmed we sent that team to texas. >> thank you. dr. gingrey is recognized. >> i think chairman murphy for

calling the subcommittee to washington to hold the searing on the ongoing ebola outbreak and commend my colleagues on both sides of the aisle, near unanimous attendance to is this hearing. since my time is limited i would like to go directly to my questions and this is a follow-on to what miss schakowsky was asking. i don't think we got to an answer on that and i will direct the question to tom frieden and first to dr. varga. there has been a second health care worker who contracted ebola, amber vinson. now that she has received 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. the first nurse to contract ebola was using full protective measures under the cdc protocol while treating mr. duncan. has the organization in texas identified where the specific breaches in protocol that resulted in her infection, and the inadequacies of the protocol. >> that question is for you, dr. varga. >> thank you, sir. we are investigating currently the source of this obvious exposure and contraction of the illness.

we confirmed nina, through her care with mr. duncan was wearing patient equipment through the whole period of time comment as tom frieden already mentioned with the diagnosis of 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 for the cause of the exposure that caused her to contract the disease. >> i will interrupt for a second because of limitation in time. i want to go to tom frieden. tom frieden, as dr. varga just stated health care personnel were following cdc protocols while treating mr. duncan which include the use of so-called personal protective equipment.

do the cdc guidelines, your guidelines on the use of tp e mirror current international standards that by the way are being adhered to those international standards in west africa in those three countries, sierra leone, and guinea and liberia. >> international standards are something that have been changed. we use different ppb in different settings. there is no single right answer and this is something we're looking at closely. current guidelines are consistent with recommendations from the who is my understanding. >> i would think there would need to be, i commend you for the job you are doing and i know these are tough times for all of us, but some consistency is what we need. that brings me to my next question and my last question.

does the issue of elevated temperature -- is it 100.4, 100.5499.6? there is great confusion. initially when people were screaming mr. wagner at the airports in west africa, the temperature threshold was 101.5 and now the screens we are doing at these five major airports, and international atlanta are 100.4. when mr. duncan came for the first time tuesday texas presbyterian hospital, 100.1 and it was 103. when mom and dad, when their

child has a temperature, this fall and flu season and going to the doctors they will demand a check for ebola. when should parents be concerned? >> parents should not be concerned unless you are living in west africa where the child has had exposure to ebola and right now the only people who had exposure to ebola in the u.s. are people who either are providing care for ebola patients or the contacts of three ebola patients and i out one those in this sheet. for the screening criteria we are always going to try to have an additional margin of safety so we look at that and we would rather check more people and assess and always have that extra margin of safety for our screening. >> thank you and i yield back.

i recognize miss castor for five minutes. >> thank you for tackling this informed public health issue of ebola virus and i think the experts at the centers for disease control and medical professionals across the country, those that and more university health care who have been proactive in containing and treating of a virus. i agree with president obama 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 but i also think we need to pause. this is a wake-up call for america that we cannot allow the nih funding to stagnate any longer. earlier in the budget committee offered an amendment to the republican budget to restore cuts to and i age. the budget cuts inflicted over the past two years and repair the damage of the government

shut down last year, it 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 sell i would like to turn to that research that is going on now because it is going to be research, longer term response to ebola, vaccines to prevent the disease and drugs to treat it. i want to walk through a different point, development of vaccines and treatments for ebola is different from the development of many other drugs. there is not a large private market for ebola drugs and development requires leadership of our country and nih has been working on vaccine for many years, and they have moved into some phase of clinical trials. can you explain to us why

government support is important for developing ebola vaccines in treatments? ..>> well, when you have a prodt that you want developed, there is 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 are dealing with emerging and reemerging disease, the influenza or a rare disease that could be used deliberately in bioterror or a rare disease like ebola that if you look fire to the current epidemic -- prior to the current epidemic there were 24 outbreaks since 1976 and the total number of people in those outbreaks were is less than 3000, about 2500. we were struggling for years to get pharmaceutical partners -- ourselves from doing the fundamental basic clinical research. and then we did get pharmaceutical partners, like we have now with glaxosmithkline,

which is the reason we are moving along. that is one of the reasons that i showed that slide -- i showed that slide where the nih and the research is at this end and you have to push the envelope further to the product and de-r isk it on the part of the companies. companies don't like to take risks when -- >> can you quantify a timeline for the ebola vaccine to be on the market? is it feasible for any vaccine to be approved in time for the current operation? >> 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 that the level? if you look at the kinetics and the dynamics of the epidemic, it looks very serious. our response -- when i say "our, " i mean the global response has 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, to protect health care workers alone. now if you have a raging epidemic -- to be quite honest with you, ms. castor, i cannot predict when that will be. if you have a lot of rate of infection, the vaccine trial gives you a much shorter time to get the answer. if 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 adjusting lee, which we might, of getting people into the trial, it might take longer. i would like to give you a firm answer but we can't right now. vaccines,tion to the 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 prospect of

improved diagnostics that can assist in this outbreak? >> there are 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. recognize mr. gardner for five minutes. todr. frieden, i want clarify something you said earlier. i believe you mentioned there are approximately 100 to 150 people a day coming in to the united states from the affected areas? >> that is my understanding, yes. >> mr. reiner, you mentioned we are screening 94% of the people? spansion toay, with the four additional locations, that covers about 94%. >> 94% being covered, that means somewhere between 2000 between

2000-3000 people a year coming into this country without being screened from affected areas. a they would undergo different form of screening. we are still going to ask them questions about their itinerary. we are alert to any overt signs of illness and chlorinated with cdc and public health of they are sick. we are also going to give them a fact sheet about ebola, about the symptoms, and most important link, who to contact. >> will you be checking temperatures? >> we will not be taking temperatures. >> so there are 2000-3000 people a year entering the country without taking temperatures, contextfilling out a she. >> they're going to arrive at hundreds of different airports throughout the united states. >> i want to talk about travel restrictions. non-us military commercial flights are currently going into the affected

countries? >> i don't have the exact numbers. >> does anyone on the panel know? from the united states or from anywhere? >> from the united states into those areas. >> there are no direct flights into the united states. >> or into west africa? >> there are direct flights into west africa? >> how many? does anybody on the panel know how many? back to the united states? >> there are no direct flights coming back to the united states from those affected areas. what about from europe? >> there are hundreds of flights coming from europe. >> and people from west africa throughhrough their -- there.

and there is 94% screening. >> we would have to get back to numbers, butof huge quantities of supplies are needed. >> if you could get back to me with that number, i would appreciate it. are you aware if nigeria has a travel ban on countries affected by the outbreak? >> they do not. the areas brought up regularly to me when i go home, what should i tell my local hospitals and local doctors that they need to do to address ebola? >> make sure if anyone comes in with fever or other symptoms of , they need to ask where they have been for the last 21 days and whether they in west africa. >> and the training the small

local district hospital would receive, is that the same kind of metropolitan hospital would receive? >> there are override the of forms of training. hospitals are usually supported by the state. >> what do we need to do to make sure people understand that there could be similar conditions, similar circumstances, so we don't have a situation where people are panicked. >> the key issue as you point out is that we are going into flu season. by all means, get a flu shot. for health-care workers, anytime someone comes in with fever or other infection, take a travel history. that's really important. >> you mentioned that we can't have a travel ban because you are afraid of the impact it would have, but you don't know how many personnel or flights are currently in use. >> my point earlier on was that

of passengers are not allowed to come directly, there is a high likelihood they will find another way to get here, and we will not be able to track them as we currently can. talking supplies and personnel. how many? how much equipment? not able to track people coming directly, we will lose the ability to monitor them for fever, to collect information and share it with local authorities, and to isolate them if they are ill. you.ank we now recognize mr. wilshire for five minutes. >> first, i want to understand this. u.s. andn came to the infected to health-care workers in dallas, correct? >> at this point, none of the 48

contacts he had prior to haveoping symptoms developed anything and they of all past the point -- >> we have had two incidents in the united states, but this is such a highly contagious disease, we are on full alert, correct? >> it is as severe disease. it is not nearly as contagious as other diseases, but any infection in a health-care worker is unacceptable. >> and there is an enormous amount of public concern about this, so we appreciate the effort you're making. there has been some concern about what happened in dallas, the efforts made. and now you're telling us that there has been information provided to all of the hospitals in the country about what protocols to follow, correct? >> that's right. >> is it feasible that all of

our hospitals are going to be in a position to provide state-of-the-art treatment or as a practical matter does it make sense for hospitals to contact you when they have a potential infection, for you to come, and then for there to be centers where an individual can be treated. >> every hospital needs to be able to think it may be ebola, call us -- we have had hundreds of calls, and then we will determine what treatment is best for that patient. -- this isalso heard absolutely a public health infrastructure issue where he gets out of hand, correct? >> public health measures can control ebola. >> they have effective measures in nigeria where they have been able to contain it, but they have no public health infrastructure in the three countries where the epidemic is now gaining headway, correct? >> right. >> and in the u.s., we are

fortunate to have a pretty good infrastructure, but we do have to have an answer, i think, to this question that is being asked about travel. a concern people have because it is seen as a "easy answer. co i want to understand what the answer." "easy it seems like a debate within the medical community, but it may be a psychological answer but not necessarily in effect of medical answer. all of us have been asking you to give your explanation as to why, from a medical standpoint, you have concluded that a total travel ban is inappropriate and not effective. >> first off, many of the people coming to the u.s. from west africa are american citizens, american passport holders, so

that is one issue to be aware of. way, i don't have much time, but if we're going to encourage people to go and do important work, including military personnel, we have to take them back and make sure we can treat them if they do get the illness, correct? >> people travel and people will be coming in for it >> you say there is basically a trade-off. if there is a full ban, there are ways around it and then you lose the benefit of being able to track folks who may be infected and that could lead to a greater incidence of outbreak. it is a trade-off. is that essentially what is going on? >> we are open to any possibility that will increase the safety of americans. >> are there midpoints that makes sense to you in coordination with your colleagues, particularly mr. wagner? >> we would look at any proposal that would improve the safety of americans.

>> this is not about funding so i am not going to ask you because i think we know what your answers would be, but i just want to share the concern expressed -- mr. chairman, we may want to have a hearing at some point about funding requirements to make sure the emperor's structure this country needs to be in place before thishing -- infrastructure country needs to be in place before something happens is robust that we have people who are strong and trained and ready to do the job. that is not today's hearing, but i think it is a question we should address the cause with 20% across-the-board funding and nih, i find not to be a reckless decision. 12% at cbc i think is reckless. we have to revisit our priorities and making sure we have the emperor structure in public health to protect the -- infrastructure and public health to protect the american people.

>> we do have a hearing scheduled on that. >> i now recognize mr. griffith. >> thank you, mr. chairman. i believe we should have reasonable travel restrictions. i am submitting a letter for the a prominentcites medical and travel security services country with more than 700 locations in 76 countries that reports that africans have imposed air, land and travel bans by persons from countries where ebola is present.

south african development community members only allow highly restricted entrance from ebola affected regions with monitoring for 21 days and public gatherings discouraged. i find that interesting because some of those countries have had a previous ebola outbreaks themselves. >> i will take your word for it. >> i will tell you that this is a concern to a lot of our constituents and mine as well. recently, a father from virginia prayers for his daughter because she lives in the complex with the first nurse and was very concerned. while i think i know the answer, i would like to get your answer. he asks, if i get to 21 days and is nothter is in fact --

infected, can i exhale and breathe a sigh of relief? >> he can do that now. the first nurse only exposed one contact in that was in the very early stages of her illness. at most, one person from the community was exposed. >> i appreciate that. he said there were some concern coming out of dallas that the patient's dog may be infected. by the virus be transmitted dogs? i did some homework on mess because i thought it was an interesting question and i found a publication from march of 2005 the did a study on dogs in and dogs in france as a control group. they showed that while dogs have antibodies for ebola, they are asymptomatic, but the study went further to say that there are a

lot of questions about how ebola is transmitted. there is a question as to whether or not or how the ebola outbreak occurred. it wasn't in normal ways, human human, and the report indicates the dogs might be -- might be -- i don't want to scare folks -- might be suspect. isn't it true that we don't know a whole lot about the outbreak of ebola and when we are trying to a sure american people -- just like previously we didn't think it would come to this country and then if it did get to this country we wouldn't have any problems controlling it and now we have all kinds of people being monitored. aren't there a lot of questions about how ebola is spread? >> although we are still

learning a lot, we have a lot of information about ebola. we have a good sense of how it .s controlled we have looked at exposure to animals. we don't know of any documented ,ransmission from dogs to human but we will be looking to help assess that situation. seenthough we have not transmission, we have a lack of evidence as opposed to evidence that it cannot be transmitted. we have no restrictions on travel of human beings. how about the dogs? i called customs. they said experts are there. called the usda. they said that would be cdc. i understand all of your reasons -- while i don't agree with them

completely, i understand about humanitarianism in all of that, but don't you think we should restrict travel on dogs? legs we will follow-up on what is recommended -- >> we will follow-up on what is recommended. >> i like to start by mentioning "will americaled meet the ebola challenge?" i would like to submit that for the record. this has been a very enlightening hearing. i would like to acknowledge that the kentucky international guard, which is taste in my district, is in senegal providing help for the 101st. so into the ink them for their effort. displaying my

ignorance, we know that you cannot do text ebola until it -- until itagious becomes symptomatic, at which point it is contagious. is there any way to detect going on? >> at this point, we don't have a test that would identify it before someone has symptoms. the test only turns positive when they are sick. the test is for the virus itself. that is another reason we are confident that it doesn't spread -- we can't even find tiny amounts of it in people's bodies until they get sick. is there any research been done on a possible test for this? >> there's a lot of research being done to understand, diagnose, prevent and treat better. sensitive to have a

media treat situations like this. certainly, the media can be a very important part of providing public information about a potential threat to public goety, but they can also .verboard i see comments in the media the threat oft ebola and the spread of ebola. while it has spread to two health-care workers, i know the public may perceive that differently. like, for instance, in the washington post today, a picture of a woman at the dulles airport who looks mummified because of her concern about contracting ebola. one survey showed 98% of the american people are aware of the ebola situation and not even 50%

know there is an election coming up in three weeks. media has certainly alerted people that something is going on. my question to you is has the helpful orage than harmful in having the public have an appropriate level of concern as to what the situation is. workersimes health care become infected and ill it is unacceptable and our thoughts with those health-care workers and hoping for their recovery. it is certainly understandable that there is media interest. it is new to the united states. it is a scary disease. there was a movie made about it. it is important that we pay attention and the doctors, hospitals, community clinics in health care practices

stop it at the source to make is completely safe. i thinkthe coverage, many would agree, may exaggerate the potential risks or confuse people about the risks. we know about ebola. cdc has an entire group of professionals who spend their entire careers working on ebola. they stop outbreaks all the time. outbreaktopped every except the current one in africa. there is zero doubt in my mind that are in a mutation there in thet be an outbreak u.s.. it warrants attention but it's important to put it in perspective. >> i agree. additionaly

authority that cdc would find helpful in conducting your responsibilities. specific authority that would make it easier to do your job? >> we are looking at a variety of things, procurement, for example, to see if there are changes that might allow us to respond more quickly and effectively. >> thank you. i yield back. fore recognize mr. johnson five minutes. >> thank you for being here. thank all of you on the panel for being here today. politics orabout international diplomacy. this is about public health and protecting the safety of the

american people, particularly our health care workers who are some of the high risk folks to be exposed. as of my main concerns though we don't know what we don't know. throughout testimony and questioning today, i have heard you say multiple times i don't know the details of this, i don't know the details of that. i think what the american people , is some assurance that somebody does know the details. salome us your question. do we know yet how the two -- so let me ask you a question. do we know yet how the two health-care workers contracted the virus? was it a breakdown in the protocol? was it a breakdown in the training of the protocol?

do we know of the protocol works? >> the investigation is ongoing. we have identified possible causes. >> so we don't know. we don't know. i get that. we don't know. you know, the people in ohio are , especially now that we know that one of those health-care workers traveled through ohio, even spend some time in akron with family members. kasich's governor immediate actions to try to address the situation. in my experience as a military war planner, 26 and a half years in the military, and i know we have the military engaged in this process overseas, we don't wait until the bullets start flying to figure out whether our war plan is going to work.

when did the cdc find out their was an outbreak of ebola in west africa? >> late march. >> one of the things we do in the military is conduct operational readiness inspections. scenarios inworld controlled environments, no notice, so that those who are going to be responsible for whatting a war plan know to do when the first shot is fired. no panic, no second-guessing, they know what to do. ebolae plan to address an outbreak ever been tested by the cdc in a real-world environment? >> not only has the plan been tested, that outbreak control has been done multiple times in

west africa. >> i am talking about in america. >> in america also. >> do you know of any hospitals in southeastern ohio that have participated in any kind of real world scenario of an ebola outbreak? >> i can speak to that -- cannot speak to that specific example. >> let me go further. daymentioned that 150 per roughly are coming in from west africa. let me give you a scenario. in tosay a person comes the country from west africa, and let's say that everything in the screening process works right. they may be on day 14 of having in westosed to ebola

africa. symptoms andwith go through the screening process and then go to wherever they may go. day 17 or 18 they start getting ill and start seeing a spike in their temperature. if they want into any emergency room in appalachia, ohio, and start throwing up and having planoms, does your identify that can tell that hospital emergency room what to do and then scenario? don't know that person came from liberia or any other place. >> we have detailed checklists and down rhythms we have provided widely two health-care workers throughout -- algorithms

we have provided widely two health-care workers throughout the country to determine if there is an outbreak of ebola and if they do, to call for help, and we will be there. mr. madison is next for five minutes. >> thank you, mr. chairman. a number of questions. i will try to move through them quickly. dr. friedman, it strikes me that controlling the outbreak in west africa is really one of the real of to keeping americans safe. the reports indicate we may be losing ground in liberia. what would enhance the international community's ability to gain some ground in africa in terms of actions and resources? that itwe're finding is is moving