it's to create this economy that we have and it causes the small businesses to say i don't want to get above 50 jobs in order to have the burdens and the costs associated with obamacare so it is absolutely not the affordable care act. ..

>> >> there is no reason the federal government should only and and have a department of the interior to cover that is a waste of time. i would also eliminate much of the military budget if it were my choice. if we cut military spending in half we would still we the largest military budget in the world by far. if we cut in half again and we would still have the largest budget in the world if we cut in half a third time and reduce it down 1/8 of what we're spending we would still have the largest military budget in the world. we need to bring our troops home and return to a system

of national defense instead of international offense. hays: first of all, i would do that i did at city hall for 24 years when we balance to -- balanced as 24 budgets and created jobs we took saying this line by line the things that we thought were essential to deal with public safety and build a community. those were the things that we ought to do in congress. and cut waste. it is incredible. of a billion and a half dollar spent on real-estate that is not needed and vacant real-estate that the government writes the check for every year. it is unnecessary. we have an advertisement out now how we spent $600,000 to generate facebook likes? we supported a puppet show

and those are the things that we would take a look at to reduce the cost of government because it is their. there are plenty of ways to be dealt with on a quick basis. if we go line by line we could have an added benefit to the economy and cut spending that is a necessary hill: the budget is one of the key problems in our country. we're $17 trillion in debt and climbing and possibly a fly 16 spending $1 trillion just on interest of the national debt. with the slightly upward trend is disturbing that is why i support the balanced budget amendment i don't thank you could get this group of career politicians together to cut spending

without having a goal or objective. all those that support such constitutional line item veto to help the president to cut serious spending in bills in a constitutional way. but the real thing we need to do get our budget priorities in mind is to demand accountability and that is what congress needs to do and shift as much power as we can and to state and local government and not have everything centralized. and also relating to our deficits to pay down the debt of our grandkids to move the country for every half to get the economy growing again. i talked about you were jobs seven years ago there are 30 million fewer people working at this stage of the recovery if we get the

economy growing and revenues coming in then we can have a deficit reduction and long-term debt reduction to keep the strong viable economic leader in the world. to talk about the health priorities for the most needy citizens and we cannot do that if we don't have a healthy growing economy. standiford: unfortunately we cannot balance the budget by tinkering around the edges. at this point it will be significant cuts and it has to be significant cuts and insignificant areas. the military are too easy choices to make to where the people would feel those cuts the least but enjoy the

benefits the most. that's it the next question goes to patrick hays. >> united states with immigration there are 12 million immigrants and most are hired by american employers. congress is reluctant to normalize the equation. it is an impossible task to build on the southern border will cost billions income across canada or see or stay beyond the visa expiration date what would you do to solve this reality? hill: we have to secure the

border that. hays: but i believe that the same time that we can deal with some of the issues that have to deal with the economic sort of a guest worker program. there are numerous examples of crops rotting in the fields because we don't have enough to do the harvest. but both sides the republican and democratic side, both are permitted -- committed to deal with the immigration program and bull's-eyes feel very strongly that securing of borders. but if we could just get out of the way to sit down like i talked about at city hall. we did not care about was democratic garbage but the problems needed to be solved and dealt with in the future of the country is relying on

with those economic benefits to come up with a reasonable and administrative approach to dealing with those as well as the administration if to deal with the issues dealing with the economy. that can be done jointly. not one at a time it is a to sighted approach in a bipartisan way those solutions are there. hill: emigration is one of the issues that splits congress as a frustrating issue. president obama in my judgment has not been a leader here like a lot of things and cannot bring polls sides together to focus on our border. to solve the humanitarian crisis on the american mexican border but by

encouraging for families do take the risk to come to the border with their kids and it breaks my heart it is a humanitarian crisis. i a agree with the nine that securing the border is the top challenge that we have to move beyond that to solve the humanitarian crisis. we need to do what democrats and republicans that amended the law to allow them to get to the border in the first place. that has been called for bipartisan support and the president was opposed placing personal politics. my personal view he is not encouraging leadership. we want to encourage people to work in the trades and ph.d. and research to make it easier to come into the country legally. people wait for years to come to this country. years.

small rooms in hong kong kong, years to come to our country. it is wrong to do anything except support legal immigration to figure out a way to figure out how to cure the border. standiford: i am certainly not for building a fence there are two sides one keeps us in the other keeps us out that only to keep the peaceful people out but don't want to be kept in. however millions of people break the law but if peaceful people break the law there is something wrong with the law itself. in this lot of restrictive immigration is a canada sea of prohibition that has created millions of

criminals quote-unquote aunt criminal activity to sneak people in. people sneaking across the border and they are desperate to get here once they are so there is activity at the borders. we can either redouble our efforts to secure the border and create a national identification card and increase the invasive application that we now have four jobs to require you to approvers citizenship before you are allowed to work, or change the law itself. our economy is demanding these laborers if we don't

change the law we will simply spend more and more money on the problem without fixing it. hays: this is a perfect example again of what we can do when we work together instead of trying to promote discord and the reason i indicated a first wanted to run, we have a commonality of purpose and one of the first things i was as well running for congress what is the first thing i would do when i got to washington? my answer was that would find a republican and member a and make a french. there are two little relationships to recognize the future of the country is not more important than the

national election. people recognize they have faced they have to do and we don't waste time to get them accomplished. >> arkansas proposal to raise the minimum wage is seeing significant support in the state would do support a federal minimum wage? why or why not? hill: i do not support raising the federal minimum wage in the reason is the belief of labor markets need the ability to have flexibility and raising that minimum-wage teachers creating steppingstone type jobs for the youngest people in our society tried to develop skills for greater work and dignity for greater work to move their lives for word for better and higher opportunities. raising minimum wage teachers that. the cbo says it could cost

1 million jobs if we raise the federal minimum wage to the proposed level. that concerns me. it also raises consumer prices because while small businesses may teacher hiring new people but it does force existing employers -- employees to work longer but that helps the least among us to bring in extra revenue and raises cost for people on a tight budget. i am concerned so i think the cbo base this out persuasively. standiford: this is another example of government intrusion of the free market trying to set arbitrary floors. wages are a private contract

with an employer and employee. employees and employers should bargain for the prices that they are willing to pay and so it just pushes people out there don't have the skills to get the lowest paid jobs. the application is people try to support a family on minimum wages and it is almost never the case. the vast majority that are affected by minimum wage are upper middle-class. they are starting now working with minimum-wage jobs through high school and early college. it almost never affects those people that are trying to support a family on this and tom.

>> but them kidding this kills they need it is one more example of the feel-good lot where government steps in and it feels good and pay people more. but with raising the minimum wage had a positive effect and they read raise it at 20 or $15 an hour. at a certain point so it should be obvious why we should not have this to begin with. hays: it is incredible that we are a guide favor of raising first of all, the minimum wage going for the ballot the vast majority of arkansas is $6.25 an hour over three years period rigo

$8.50. there was a young lady on this campus last week to said she had a 40 hour a week job and still could not make ends meet trying to go to college. that is less than $1,000 per month before taxes and if not the second lowest in the country and support raising the minimum wage and i have signed the petition. i think it is a choice travesty for those working in poverty. it is hard to understand where my two opponents are coming from. it actually helps the economy the board gives them the ability to earn a livable wage you take care of their families. making $6.25 but only with two or three jobs at that rate. i strongly differed with the

two candidates in terms of minimum wage but arkansas deserves a raise. we'd go to the polls to support the end by implications and i know what the magic number is of the federal minimum wage but i would hope we could get together in a bipartisan way but also raise the federal wage in terms of my support it is their and i hope the arkansas joined with me to make that happen. hill: what is the best way to help young people develop skills and develop opportunities for a better career and a way to help families do better? if a family is truly in poverty the minimum wage is not an answer.

id discourages jobs and work see tax credit is a more effective idea to help finlay's. >> we have public schools have failed our kids in and which is why i support of literacy and to hell and touche change the tax code nationally to encourage economic growth. no more running back to the new fracturing base overseas with our economy here with more jobs and opportunities. >> the next question goes to debbie standiford. >> what is the policy regarding isis m1 sacrifices should americans not in uniform be asked to make to pay for that policy?

standiford: not in uniform? i think america's response to isis as thomas jefferson said, a friendship with all countries and entangling alliances with nine. we could policing the rips in the walls. government intervention once again has created much to the spread of lives but with many dictators we had to go in and takes them out there. hand it creates a worse problem than they have to go in again and again and again to solve the problem.

the problem never gets any better we spend more and more until the military budget is absolutely bankrupting us. so what we should do is pull our troops backed, all people we are creating a pullback of these policies to bring them home. hays: the fact is the homeland the security of our people is critical we witnessed on 9/11 one of the greatest travesties that has ever taken place on the homeland. that was the prime example that we cannot always protect ourselves simply by trying to do is things within our borders we have to reach out like we are now. is the goal of isis is to

attack us over here then try to do damage and injury to the folks that live here in these united states coming in fact, i had a chance to serve in the military and was a captain in the army reserves the was proud of the men and women who served in our armed forces. right now we're using our technology trying to do battle in their area rather than have them come over to have a situation like 9/11. the world is too connected that we can just say the borders are one we can stay behind but my reaction put people in harm's way we have done that before that i think we have to make sure those that have a stake in the area geographically are partners with us and we are aggressive to protect our homeland and certainly with

partnerships with the greater stake than we do. hill: i will echo that thought we have of the armed forces with the national security interest. i would suggest that isis and terrorism problem has been made worse over the last couple of years with a lack of leadership from our president. his id decision in syria created a spot prices allowed it to explode in syria and move across to iraq the president's lack of leadership with the status of forces agreement leading to a strategic ground and air support forces allowed

it to blossom to make it a clear and present danger to our interests and to the country and therefore we must suspend behind the curve to find a strategy that goes back isis to put together a coalition with the clear strategy in support the american people and then have an overwhelming chance of success in putting that together that america's leadership will roll isis back but i believe this problem blossomed due to lack of leadership do to president obama. and putting people in harm's way there we have boots on the ground there they're risking their lives for our country and our way of life and it is something that can be worse in the u.s..

we saw it at boston, for could and out here we have examples of terrorists getting into our country to do was harm. standiford: all this interventionism is like stirring a hornet's nest camorrista echidna stick the more they swarm. we have been in the middle east decade after decade intervening with national security interest which for me is a euphemism for oil. we cannot create safety to threaten people with a big stick day are adrian terrorism is coming back to visit us because what we have done for decades past.

i am not an isolationist and example would be north korea and non interventionist would be swift and peaceful countries around the world that doesn't have the terrorism that we have. >> moderator: we have reached a point in the evening that we are prepared for closing statements. by random selection patrick hays goes first. hays: banks to those who are watching and also to my wife and daughter and her husband and three grandchildren who inspired me in large measure to get into this race because their generation is not been taking care of for a look that when you have the rancor and discord the

washington displays we don't care about problems we just care about partisanship and that is wrong for over 24 years we've balanced budgets and took care of solving problems whether it was democratic core republican if they need to make people's lives better in that is exactly what i need to do we don't need to worry about the election but the next generation that is why i intend to do for all income levels to take that kind of experience to solve problems to make the country of better place for all of us to live and in particular those three grandkids. tomorrow will be a better day is much too complex with

how we solve those problems not today but tomorrow and the next day every day i get working with other people to make sure good things happen from the united states of america we want to work four jobs in the future of the country and we will do it. god bless america. standiford: from ebola to a isis government promotes year. it always carries the implication without government a disaster will be fall us my candidates describe ways the federal government should step in to fix the economy, immigration and various things but none of those have anything to do with defending our rights.

this past weekend i met at couple who were from poland. i share the tab was running for congress and i was a bit nervous to be here today. they told me that because of the things they have seen they wanted me to be here and speak against overreaching government. and they want me to me that voice. i am honored and humbled i am also honored and humbled i am here to speak for my children because i want them to have more freedom, not less. i want them to have the freedom to make mistakes or bad choices and learn from them. i am here to speak for the unborn children that we are birthing with massive amounts of debt without their permission. we do not have the moral right to birding people who

do not have the ability to speak for themselves. i am speaking for silent voices that are asking please stop thinking government is the answer to the problems. government is force. that is all. thank-you. hill: i n in this race because i care about our community and state i spent 30 years been people together as an adviser to president bush 41 as a volunteer at children's hospital and a community backer helping people bring their dreams to life their new business are doctors practice i helped them to achieve their dream. i believe strongly in our

country in the freedoms american g.i. no i can be a change agent and people trust me and send me to represent them in washington. cutting out the regulatory burden i have been on the front lines knowing how to cut regulation back as a business person and executive branch. and we will help to get this economy growing again through tax savings. i know i represent a clear contrast in this election someone who has been their. who has helped is -- build businesses create jobs and understand the burdens of the washington and wet blanket led by president obama over the economy. i am not a career politician tax-and-spend liberal on a plot to do something to make our country better because fewer mandates, more

choices, less government one-size-fits-all and more opportunities for all people and i believe that is the person, people love the second congressional district want them to represent them as a job creator and a business person to take common-sense conservatism to washington. >> moderator: thanks to all panelist for appearing. also to is a journalist for your contributions and a special thanks to the university of arkansas and rattles performance center. thanks for joining us this concludes our program for the second congressional district. more is coming up. goodnight. ♪ ♪ ♪

several health experts give information on various types of ebola strains their reputed gang vaccine treatments to effectively contain the outbreak in west africa was part of the conference hosted by johns hopkins in baltimore. [inaudible conversations] >> good morning i have the privilege to be dean of bloomberg school of public health lullaby to welcome everybody today to the symposium and everyone watching on internet the title is ebola crisis context in response our school was founded 99ers ago and since then we have stood ready to confront the world's most pressing challenges and ebola is no exception. our school and johns hopkins

have faculty and staff and central and west africa working to reduce transmission and prevent death and build trust for families and communities. the ebola virus threatens the people living in west africa creating uncertainty in our country and others around the world. this is a critical time to convene thought leaders and experts has well as the johns hopkins community to educate about the ebola virus. today we will discuss the impact of the epidemic in west africa, current and future possible status is and to project their fees and recommendations on strategies to prevent the spread of the disease. of a bite to a knowledge of our alumni who work around the world but especially those working with doctors without borders on the front lines of this crisis into

recognize the doctor who is here with us today. the international and the medical overseer and is that the school for the reunion. so welcome to the data debate -- to the debate. [applause] also i welcome our speakers and i would like to thank them for being with us on such short notice especially to a faculty member of microbiology and immunology who organized the symposium and him and his team provided logistical and organizational support. thank you both for your leadership. one week ago peter, the director for malaria research institute contacted me to suggest we invite a speaker to discuss the ebola

epidemic. that idea grew into a symposium. the percy president daniels asked us to expand the agenda to bring the audience as large as possible. a former but as a professor of law at university of toronto since his arrival 2009 with the brighter appreciation bet as an anchor institution and has articulated strategic goals for the university and the lead and pushed us. ron is a scholar at the intersection of law and government economic development. and elected a fellow of the

american academy awards and arts and sciences including the honoring dr. from the university of toronto it is my pleasure to welcome president dan mills to the podium. [applause] >> thanks so much and for your great and inspired leadership through public health. i want to thank what is so hard and end then the general share their experiences and expertise. the speed that this symposium came together is testament to our capacity across divisions were from the school of nursing, school of medicine, affiliated partners to help understand the public health crisis and

to form asea effective response that as the matter of public health service the professor of epidemiology of 1918 through 1919 providing the foundation for public agencies to day per of course, bedtime and time again you and then to reach havoc on vulnerable populations. and then leading to the who campaign to rid the world of smallpox then returned it to his and then in hospitals and clinics to key in debt as the numbers are reported

to deal but then can you process the struggle and put it tuesday in managed but the darker implications with the outbreak is not met with a sustainable international response, we are acutely aware of complications of director margaret chang declared a crisis for international peace and here a. but we are well-positioned

to help ignite a the is a rather invest practices if it is an assessment and her its i wonder if they're listening to any response to work with ministries of health. these collaborative efforts range from training programs to put 1,000 health workers in liberia to assist with the epidemic manage to read to you take the analytical model to make bettors to t.j. presents but to educate the front line refers of

course, as a research university we will follow the obligation is a moral one that demands to continue to employ personal courage and great that define us i am deeply grateful to each of you to be here today your presence and your engagement

as far as optimism i know this will be a productive day and i will talk about the important work that lies ahead i hope we will be able to do more to lend the expertise and energy now to send the program over from the school of public health with research including influenza also in emerging viruses has also looked at the coronavirus and most recently ebola. sharing discoveries could be as important with the efforts to communicate effectively about infectious disease with the media and broader public. in addition to the instrumental and viable role to argue this symposium is

part of the program thanks for your extraordinary efforts to bring this together. thanks for being here today. [applause] >> good morning. thanks to the speakers to so kindly agreed to come on short notice and the audience and everyone streaming online. putting together a very broad and wide ranging symposium that people can appreciate. we split this into two general sessions they could be five presentations on the response of unpreparedness and for dealing with the epidemic. then we will give the keynote address the have a

panel that at that point we hope to wring gauge the audience with the range of questions they have regarding challenges for the intervention strategy for the ebola outbreak to focus more on what is going with concerns about ebola and we will touch on as well. komer for speaker from the bloomberg school of public health the hopeful community base strategy to fight ebola is the title. [applause] and i get to find my slide.

i will start at the beginning. there rigo. thanks very much and i am please do talk to about a community-based energy to fight the bill as an operation rare privilege to be involved in. to put it in context of course, we see the ebola virus diseases at the center and this is a picture of the emerging epidemic and as you can see it started in december not with the exponential part of the curve so has concern and others will talk specifically about the patterns but it is not just a virus there is a number of epidemics going on in west africa.

it is a contagion of fear and distrust that only within the country but internationally. this has led to other types of patterns it is important to recognize what we're doing and why. so it has to do with a series of self reenforcing types of feedback that leads to epidemics one with the health system itself with a very weak health system with the inability to pay health workers and when the epidemic struck we had the tragedy with losses were of over 100 dead in liberia alone and worsening of

health conditions as collateral with also malaria and ammonia but also in terms of the economy said fields are not being harvested with trade and income and poor nutrition and the cycle around this area and car around social capital and institutions the government has been unable to order the services and lost the trust a government with damage to community cohesiveness to reinforce. and i want to highlight the assistant minister of health in liberia he is the point

person for the ebola outbreak in liberia also a graduate of the school of public health and is an associate with us and he has written how it is important to take international support to win the public's trust to stop the of break in his statement we must be helpful to not know me say this to me in the international audience but his own staff and his own people. the slogan within liberia is something to the fact -- to the fact is be safe. the rationale for community-based strategy emerging from the experience and it shows basically over the months and this is where

monrovia is that where you see where it started off and is starting to you taper off. this is one of the early counties that they had a lot of distrust. so communities are mobilizing different ways to address the epidemic in and how she is is care center and in the local county itself. there are other rationales and also in charge of the community care center there is not a lot of running water that people can watch hands with the roadside stop

and to find local ways to improve hygiene with water in operation also to back up the notion with a community approach that is needed so we took says cdc models and updated them trying to model the strategy is to bring in lots of beds and you can note survey of the projection from february but you need a lot of external mobilization and adding to the bet a massive social mobilization you can come up with projections so there is some analytic support to support this type of approach.

but coming from experience itself this is what we should recognize from the day arce, go they have experience with epidemics of ebola and the question ziad with us describing control depend on a community based strategy during those discussions he offered to say we have 120,000 doctors and nurses with the experience offering to bring 1,000 of their experience unicef is on the logistics' side and the optimism with the world bank.

sova to facilitate how this works of how the ebola outbreak is actually working this goes back to the vicious cycles. looking at the community hospital and to identify six people and at the hospital level you have patient care so there is exposure from the hospital staff and is the word in every society to take as special place because of what happens with dignity for the dead but

often in the next of kin who wash the body but it is a critical and central part to bring the community together so we're asking for major behavior change in with those components to take care of patients and also during the burial plot we see is the approach to reenforce fear that is the bad side and the care the and all three levels. so their notion is basically

by the aspects trying to reinforce ownership to integrate survival with the high quality of care and of course, a dignified burial with the notion to strengthen to reinforce and i have to say it is a palm in the face of the storm but a lot of it is passive knowledge so the role that we have played is to extend and reinforce in a way to be implemented in west africa. so this notion was putting together the concept from the care center this is where i test but is

tableside disciplinary team in a local area to combine strategy that all three levels of community depends on training paid workers then standard operating procedures the way to minimize exposure to provide types of facilities that screen patients in separate areas as well as its own lab and then it package that has to come together to codify a response spinach now the concept in liberia basically as being no way to transport the we have this as a place

to take care of patients also originally using community members to transport and care givers and we transform that into health workers and of what it looks like the red is the facility but this is the scheme for what looks like. said day arce kong the team has 33 people with the coordination management and a treatment center side with community outreach and half of those conditions are nurses on the liberian emitted 60 people relying largely on community leaders and health volunteers with

health care assistance and that type of management and of course, we need literally some translation alrich try to get as many english speakers as possible. that is an idea what it looks like the want to highlight that within the same day we had people to put the concept together so i want to note in particular from the school of nursing at the leadership and expertise knowledge in the condo but also understand the concept of ebola of that is the standardized codified acknowledge. and chris was able to jump

across to work on developing the infection control protocols and continues to have leadership there and recent graduates from the school of public health and was also able to help on the community mobilization aspects. as an ongoing team this is an old set that we want to show you the us 30 people that are currently involved. . .

because the need of analytical support and you are going to hear more of that later from josh and perhaps derek but it's also notably a multidisciplinary type of support and particular interests in the experience on the

implementation research. we are able to provide training, technical support and advice that it is a challenge of our responsibility here with clinical teaching and otherwise but we are somehow managing. and of course a large area of specific expertise that is needed, and we need to rely on our good means to stand behind the protocol developing because a lot of these protocols will not be the evidence to support them and there's a lot of other agencies that won't be able to stand behind them and it's about making the most of what we have and convening and influence them to support the fight. so i want to end with the frontline a picture of francis and it's a statement that he had been given to his own staff and to his own population. but i think that it's just as important for us here and we are neighbors, community leaders and global citizens uniting for the common good with you we can

accomplish even more. thank you very much. [applause] thanks very much, david. we have to move on to the next presentation. it's my great pleasure to introduce tricia is a professor of medicine and senior epidemiologist at johns hopkins school of medicine and the johns hopkins health system. her dissertation is entitled rethinking care, lessons from the current and previous ebola outbreaks. >> thank you and welcome, everybody. we want to thank the organizers of this as well as president

daniels. i'm actually charged with talking a little bit about some of the epidemiological background and medical aspects of this particular disease and trying to tie it into what the doctor peters just doctor peters just discussed and making the argument that by improving care we can also improve engagements in the community. just to remind everybody this is one of the viral fevers of which there are many this is coming from the french word "a string," and there are two in this family, one ebola. ebola's name actually came from the ebola river which is in the democratic republic of congo and it was first discovered in 1976.

there are five species of the fibrous. it is barely been found in the philippines. that is the one virus that does not infect humans as far as we know. the strain is one of the most feared associated with the very high mortality. the outbreaks primarily began in south africa as identified by the circles and this is where most of the experience of the outbreaks that have been reported worldwide has been garnered. and it's actually relatively recently that this has emerged in west africa. and in fact this started in the area that is right here at the corner of where sierra leone and

liberia come together. and the index case is thought to be a 2-year-old boy. if you look at this picture you can see a cartoon of how the transmission occurred moving throughout guinea as well as in sierra leone and liberia. so, a nice chain of events if you will with transmission to very remote areas and urban sites and that is one of the most notable features of this particular outbreak. this is one of the few. there has been one other in an irvine area. to date since the neighbor numbers are changing there are a number of suspect cases. the country that has been the

most affected by this is liberia. but also significant cases are sierra leone and guinea as you know. what's most important is what has occurred in the last three to four weeks into the burden of this particular outbreak is increasing. so in the democratic republic of congo, the outbreak is actually a separate outbreak and it began in the equatorial province where in the area very similar to where some of the original outbreaks occurred, it began with the pregnant woman who butchered and animal that had been given to her by her husband. what i would like to talk to now is the clinical presentation of this.

this disease presents a very acutely usually six to ten days after exposure, but after 21 days very long specific symptoms with diarrhea, vomiting, severe headaches. it sounds like the influenza and that is one of the big challenges is that it sounds not only like influenza but it sounds like malaria. it sounds like typhoid fever and a lot of things that you see in this part of the world. hemorrhage is most as we think about not as dramatic as in the movie outbreak. what we see is sometimes even a rash but even as it is less than 15% of the cases. and it's not really leading to death in the spacious.

this is a cartoon of how the disease progresses with these very nonspecific symptoms that occur early on. then you move to the more emphasized phase that it can be very minimal. it's when people declare themselves and they can either progress into a much more fermented form of the disease with shock or they can move into a phase where they have clinical improvements which is really actually thought to be partly associated with an immune response. what i would like to do is argue that we need to move away from just isolating patients and by the likes to show you some data about the basic medical care we

can take the hiv drugs and africa and to improve the outcomes and i think that we can take the simple medical care into africa and improve outcomes. so, this is the day that there is an outbreak of the fever with an extremely high a case for mortality rate around 87 or 88% and africa. when these cases came into the health care systems and people were given simple hydration, what he saw as a dramatic decrease in the mortality. one of the more famous outbreaks is a case fertility rate of close to 80% of the cases that occurred. the of the last 25 patients received intravenous fluid resuscitation and the case fatality rate dropped between 30 to 40%. so, there is also now emerging

data frothese particular outbreaks that with the fluid resuscitation without being able to measure the electrolytes we are just giving people a lecture life supplements and therapy that the case fatality rate in the camps they tried this or the treatment center has actually dramatically decreased. the investigation therapies also that have been talked about in the western world i'm not going to dwell on these because we both given a much bigger area of discussion than i can give. but just to note that these have not really been used in africa. they've primarily been used here the second component is how do you get transmission, and i believe the leave -- you will

never get anybody that works on infection control not telling you that we must do infection control and i absolutely believe that isolation is going to be part of what we have to do to break the chain of inception. this particular infection and transmission through the breaks in the skin, mucous membrane exposure and exposure with needles. initially you can get infection from meeting bush meat or in a ban on all come up with a transmission that is human to human it's really via contact and direct contact with the secretions whether it's a sweat or blood, etc.. there is no evidence of the airborne transmission with this particular virus. at this point we don't think that -- the risk of

transmission, what do we know about this? as i said there've been 26 prior outbreaks. all of these have been terminated with pretty simple barrier precautions. a lot of what you're currently seeing is not needed to terminate these outbreaks. it requires a very assiduous attention to making sure that it's appropriate that it doesn't need to be super complicated. what do we know about this? while in one of the outbreaks we have the best data from, 16% of the household contacts develop ebola. 29% who have correct contact with cases and their fluids became infected. but no household members who have no direct contact became infected. so, i think that's one of the

messages that we can dispel is if you don't have contact you will not become infected. but interestingly, in this outbreak, ed of the cases come as oed out, so 80 out of the 315 were healthcare workers was decorated by the institution of the very simple precautions and intensive training. and this is an epidemic curve. here is where they implemented the barrier precautions. you can see that there were cases for about a week after the implementation that would sit with the fact that these people were integrated. there was one isolated case, by the way the black bars are healthcare workers. whether there was transmission, and this particular health-care worker admitted to ripping her eyes -- rubbing her eyes. in terms of uganda what have we learned? twenty-six confirmed cases, and the specimens were tested using

rt ctr. they found that you can find the virus in many of the bodily secretions. so you can see the saliva skin schools. they can continue for up to 90 days after and you get better from the infection. but what i found most interesting about the study into the and the reason i present it is that among the environmental isolates, none of the isolates were caused from long bloody specimens come it was truly the bloody specimens that you could isolate us in the environment. and then finally, there is a very famous case from a johannesburg hospital, an unrecognizable case that came in and recovered patient had upper and lower endoscopy during their care and anesthesia assistant put in the central line.

the assistance remained undiagnosed for ten days. anna had many procedures that you would actually see commonly in the hospital. hemodialysis, and actually alternately died. despite this company had no, they had no secondary transmission. so, what about spain and dallas. you will say what happened there? what i can tell you if there is a dangerous moment and this is not a health-care worker issue. this is a systems issue. but when you get out of these isolation units, your tired, you take off your protective gear, your sweaty and remember it's about 115 degrees in these suits especially if you're in africa and you take off your glasses or touch your face like that. it can be something as simple as that data can be almost

devastated and unforgiving. so what do we do? what do we want? we want to identify the cases as david mentioned we want to triage these cases. we certainly want to put in place infection control and we want to train people about doing it. i'm not going to dwell much on peace. this outbreak has been complicated by a love of human factors and distrust not only of the government but medical care providers and by improving outcomes i think we can improve that distrust. the other human factor in terms of medical infrastructure i don't know how many of you heard the piece on npr this morning morning about the case in liberia and the changes that isolation.

there is a lack of personal protective equipment sometimes it is reused and not appropriately cleaned. and sometimes it is even makeshift. to give you a sense of this, this is from last week where they talked about challenges with supplies, obstetrical gloves that were defeated or absent such. the handwashing stations consist of water jugs and even sometimes those are scarce. the supplies of soap, bleach and alcohol gel or a depleted and you have as i mentioned rudimentary isolation facilities. david really don't with some of the challenges with the cultural habits that have complicated this. so let me summarize by saying this is an acute viral illness

but i'm my perspective, what is remarkable about this is that after sars, h. 79 has impacted healthcare providers who are just doing their jobs. and i think that all of these are examples of failure of infection control. and this is something that is not sexy. it's just about doing it right and learning how to drive. and we have to start thinking about paying attention to how can we drive down this road a little bit better. to garner the kind of respect and trust we need a medical care we have to change the time of care and look at the data about the hydration and integrate those into the public health response and start talking about

not only decreasing the transmission by isolation and prevention but also decreasing mortality. so thank you. a [applause] we are going to move onto the next speakers who are the associate directors of the global health policy at the kaiser family foundation and also the lecturer in international development department at the john hopkins university school of advanced international studies. his talk is entitled to financing in the governing of the global response to ebola rv are we where we need to be.

>> i think that we are ready to go. it's a pleasure to be here. thank you to the organizers for putting this wonderful sympathy and together it is an honor for me to join the rest of the speakers here and talk about the very pressing issue. my talk today is going to be focused on three main things. i wanted to cover the economic, social and some of the political impacts of ebola. i wanted to talk about the response of the u.s. government response to date and the international community response as well as the violence that's been provided to support the response in west africa. then i would like to take a step back and look at the broad implications of this outbreak

for the governance of the responses to the international concern. i think that the cases have been mentioned already. we are up to over 4,000 deaths in africa from this virus that crossed the five countries that have had cases of the three most effective cases, and what i wanted to focus on first was the sort of broader economic and social impacts. so, the world bank put out a study initially in september and the updated last week to discuss what they saw as the economic impact of the ebola epidemic and the most west african countries. this is just one of the charts from it. there are many different ways the slice and dice the data but they look at several scenarios going forward. one way where ebola is fairly well controlled which they

called low ebola, and one where the epidemic is not controlled. and by the end of 201500 you have on the order of 200,000 cases, which is a very high estimate of course. but, should that occur, the economic conditions are very dire. in 2013, both sierra leone and liberia were among the countries that experienced the highest rate of growth in the world. sierra leone was second and liberia was sixth. at the outbreak has already c already caused the economies in the country to shrink and that trend will only continue. i wrapped up in this economic data but going on is the major sectors that are drivers of the economies of the countries, the agriculture sector which makes up 50% of the economy in liberia, the mining sector which makes it a great portion of the

economies of the countries are severely impacted by the controls on movement and of the decisions the decisions made by individuals and firms to not engage in productive economic behavior. the fiscal implications of the tax revenues just when they need to be spending more on responding to the epidemic has been shrinking, the the tax and service revenues taxidermist revenues are down and this will continue to do so most of the cost from the economics contraction is due to this behavior the fear into the distrust that is generated by the virus and while we don't have good data on the impact of that particular behavior in west africa right now the world bank

did a study on the epidemic and found that of the 30 to $50 billion but was lost during that epidemic in 2002 and 2003, 80 to 90% of the economic losses could be explained by this subversion behavior and not the direct cost to patient care and not be in direct to be in direct cost of the lost productivity. so, this is obviously very important for the government in liberia and the government itself has said that this race is a specter of it becoming a failed state and that is not outside observers saying that that is the representatives themselves. they were meant to have a national election today but were unable to hold it. they had actually postponed it to do to the emergency from ebola. so, turning now to the u.s. government response, there are multiple u.s. government agencies that have responded to the outbreak in west africa. i won't talk about all of these. some of them are agencies

focused on vaccine development and we have other speakers to cover that topic about iowa talk about usaid, the cdc and the department of defense. so usaid is the lead government agency agency that's in charge of coordinating all of the different u.s. agencies involved in the response in west africa to every addition of a disaster assistance response team which has been on the ground since early august. about 20 to 30 people and they coordinate all the resources provided by the others and that includes the cdc which has on the order 12130 people stationed across this africa right now. the largest deployment of their staff for any international health response. it's the first time the u.s. government through the process the office of foreign disaster assistance has declared a disaster that is a public health disaster so there are a lot of first involved in the response to this.

as you have likely heard, the military is becoming involved in the ebola responds. president obama made a statement about a month ago now saying that the department of defense would become increasingly involved at the time he stated that that would mean 3,000 troops would be sent over to assist in the response. that's now been bumped up to 4,000 troops. not all of those troops are there. they are in the process of scaling that up on the order of 200 to 300 troops are there right now that their responsibilities are to help build the ebola treatment units. 17, 100 units is the goal and to set up a training program for up to 500 healthcare workers a week to help staff dose treatment units. they also support what just ask a transportation by creating a bridge of moving personnel and

equipment and also are involved in laboratory testing that there's been a bright line that has been drawn by the leaders in the department of defense -- no military medical personnel would be involved in the direct patient care to be at least that is the thinking right now. so, the funding piece of this, this chart shows you on the line as the cases have increased over time a commitment by the u.s. government have also increased. there was an early response back when the first cases were reported, the cdc was involved in an early response, but that scaled up a little bit in august as the first members were sent out and then of course last month they were dramatically scaled up. the pledge for the u.s. government for september was the $750 million would be provided for the response. this is now actually increased

in october to $1.25 billion. one alien of which is made up of the department of defense budget that has been freed up to be reprogrammed from the war funds meant for supplemental funding for the war effort in iraq and afghanistan is now provided for this humanitarian effort. clearly the largest expenditure in the dod history. but that money is not ready to go. the congress has asked the leaders to provide a more detailed plan about how that money will be spent and in which ways they plan on doing that by the end of this week as a matter of fact. so, turning to the international response, what has been the international donors support for

the response and this data comes from the un, the office of the coordinator for humanitarian affairs, and they have a financial tracking service which tries to keep tabs on all the money being provided by all the different players like private actors as well that are being funneled towards the west africa response. i just pulled out some of this information as you can see at the top there are two categories of financing. there are contributions and commitment, which we consider to be firm either money in the bank or commitments made on a legal basis as a contract signed to the solid commitment of the financing. there are additional pledges of support. that's important to keep in mind what is a commitment and what is the pledge. and you can see that together they total $818 million.

and i pulled out from that data the commitment in this chart by the various donors and actors who see the united states has provided the most in terms of financing to date but there are very important supporters such as the world bank and african development bank. and even the data foundation pledged $50 million have provided 14 of that as far as buggy as shows yesterday. in other governments have provided much less. of course, there have been some pressure on other wealthy countries to provide more support. ..

>> >> making sure that the transport and fuel for cars and vehicles and a community in gauge read. adding up the investment of all things needed we have $1 billion over the next six months for ebola response with firm commitments they have 50 percent of the need estimated by the with if you look at the pledged amount

we're at 83 percent of the total. that is the financing peace but it if you will build the bowl was treatment units you'll need to staff those one of the most riveting figures to be from a recent report from last week was the start showing the bet capacity of requirements in the three countries most affected you can see with liberia and sierra leone only 26 percent of the cases that need to be isolated in beds are current so the demand is much higher than the current capacity.

so another bottleneck is where will all the health care workers from these clinics come from? in to train those health care workers with a lot more to be done but there will be 3,000 just in sierra alone but to talk about the government's of the emerging infectious diseases in general. and has been the international community has done too little too late and it might seem ironic less than 10 years ago the

international came -- community came together to reinvent the framework by which they come together to mobilize against emerging infectious diseases and that is with the health regulations their revised 2005 through 2007. that framework unrevised expanded the who mandate in the context of these public health events and set requirements for countries to build the capacity to respond to reemerging events within their borders. in theory the framework was there but clearly in reality of investments have not been made since the document was signed. the weakness all along is

the countries that are able to invest in core capacities and there is no mechanism or a requirement for international assistance to build up the basic health capacity everyone was on their own. even though it was in the best interest of all to make sure those capacities did exist. so right now even earlier this year there are efforts to bolster that effort. the u.s.-led with the international health regulations were a reality called the ebola health agenda because at the time it was announced live in the u.s. government was closed due to a snowstorm it did not gather that attention and that it is now because ebola crisis represents the

exact thing that this agenda is trying to address so they just had a meeting to bring together leaders of u.s. government with high levels of representation in including the organization's and those that made pledges to build the capacity with the assistance to the united states as of now there is no additional money associated it is meant to be a mobilizing force to get the different actors to work towards a common goal to build capacity. another idea floated just last week saying he thinks there needs to be a global pandemic facility basically with money and assets in

responding to emerging diseases that can be rapidly mobilize in the case of an epidemic that is just an idea at this point but it is clear from these efforts that the framework encapsulated by the international health regulations has them working as intended so by either of bolstering those or going around those regulations it is to try to tweak the system to make it work better for the next time. so the lessons that i can see from this epidemic so far in the face of public health emergencies that there is no substitute to major every country has that basic capacity to respond to

infectious diseases because they do arrive and spread without warning so in the country without that capacity is a weak link perhaps for the entire globe. and finally it leads to overwhelming results of the time of need. thank-you. [applause] >> so we have incorporated some time for questions because we it is important to set up a conversation there are two microphones so right now this is a natural break point i encourage anyone to walk up if we kaska speakers to come up to field these questions is us

natural break point we have heard about the responses and we will feel some questions moving on to the second part of the symposium. >> i have a question we hear summer over 1 million in 2016 some are a couple hundred thousand and today i saw 15,001 assumptions go into those numbers in which igg is closer to reality?

>> i am happy to answer that and josh will be talking about this more so i don't think any of the numbers can be believed with the actual projections some of the high and projections are over 4 million but the assumptions that go into it are not clear and those models are outdated. for example, the models from cdc show 2.5 times as many people have the deep -- diseased and identified have assumptions of full mixing of the population that basically the hospital and the community at burial to have these contained areas with different transmission rates bet is an account for changes the implementation

so they are rigid in what they can do so look at the models because none have a way of actually changing the exponential curve to use the model as an indicator of relative impact of different strategies is how i try to use it but it is an area of importance to develop a different class to be responsive but i think josh will talk more about this specifically. >> good morning. thank you. with the cdc we will return to liberia in three weeks

most of the national organizations those ngos will allow the people to be trained before they can volunteer to the west african countries from the calculation 50 are researchers from that clinical aspect. my question is developing a site for training volunteers we ask the question at the cdc in minnesota with their problem is they do not have been a construction so

setting up a different institution? >> i don't have anything. [laughter] >> a good question of what we can do here at the hospital why we have because to do the training their. and partly it is a question to adapt to the resources that you have so that protective equipment we have here at the hospital is very different than what we can get in liberia or sierra leone but it is a good point.

because you can also comment on that. >> actually looking at training there is multiple groups doing training that one of the challenges is that effort has not been well integrated or catalog. so it is hard for a lot of people to get their hands around all of the activities that ongoing. your point is absolutely valid and make sure we provide these resources. it is something we are back to do this effectively we probably will have to encourage a lot more international leadership and we have seen today. >> the key for that comment it helps to concentrate the

will of this institution to step forward and there is a major effort to put a fairly major program together to train the trainers and already has senior abubble institutional support the real question is how quickly can react? begin as your question says we need these people now and everybody going to the cdc is the trickle but helps to concentrate their urgency to put these programs together.

>> from sierra leone ebola hedges created problems in sierra leone. so are there any plans in place to take care of those who lost their family from ebola? >> no large plants but it is something that was highlighted. it is part of what they asked us to do with what to do with orphans and the

stigma around survivors as well with the psycho social trauma with their care givers so there is a need to have a program to address those concerns for the orphans also survivors and caregivers this something that will emerge as a larger effort. >> those are two organizations that is a good place to look for those efforts and where they are right now. >> we will take one more question then hold the rest for later. >> my question is in

relation to showing the three stages of signs and symptoms it looked like the latter stage where the immune system will kick in it or not to defeat the disease so what do we know about cases where the immune system kicks sand during the earlier stages or if their cases where mild ones present? >> there will be a little bit of the discussion about some of this. but if you notice what you hear in the press is people are given serums early on in the illness as an attempt to neutralize the antibody

early on. so that you can modulate the immune system in a way to impact not only the severity of the other types of interventions going on is vaccinating early on so i would say not only about the pathophysiology what the media is trying to do is better understand the mechanisms given this is the first time in the developed world has care and access

provide no there is a lot to combat the doctor will speak about these in the next session. [applause] >> we will have our featured talk then morph into a panel discussion on the challenges and intervention strategies i would like to introduce a colleague of mine nobel laureate director of research institute of microbiology and immunology peter? [applause] >> good morning thank you.

our nation's leading spokesperson it is my privilege as the chair of public health center for infectious diseases a native of iowa attended college in the cora and led a distinguished career with those activities following september 2001 attacks mike stepped up to the international arena. appointed special adviser to the secretary of hhs for public health avernus and appointed to the world health organization about panda makes and with

additional duties has has threats and food safety and antibiotic resistance. creating public awareness requires bravery on the one hand we will risk those officials adult life to be criticized at the same time causing panic among the public might distended eloquent job with the public and in 2000 he published a book that made "the new york times" best-seller list and in response to the current epidemic of ebola he has published a series of articles articulating what is happening of what we need to know.

and publish what we need to fight ebola and makes the case africa has changed with a large population shift and then publish what we are afraid to say about ebola they're respiratory transmission calls for a leadership from the united nations. "politico" features an article called the ebola epidemic is about to get worse. much worse and the real discrepancies from the cdc and who are 100 fold the part in terms of predictions and finally an article this past weekend raises the issue of the black swan the unprecedented event that we regret how we perceive it.

called a prospective please welcome michael. [applause] >> first, thanks for that kind introduction i very much appreciate the invitation. edition it is very humbling to be here because two of those mentors and one is in london and could not be with us but i take full responsibility for what i said wrong and it was instructive but it is an honor to be here today to share this. also want to thank president daniels for being here a very busy a college

president says a lot about the commitment of this institution and mindsets and last but not least i never forget about the fact everytime i get a sponsor talk it is those inexperience the most amazing tragedy i had a conversation yesterday that was very painful where one colleagues when leaving the treatment center sawtooth children struggling by themselves quite ill nobody was there to help and it was heart wrenching to hear a man to watch people died been to go out in the street to see these two young children we can never forget at the heart of all of this is that. i have no disclosures from a

financial standpoint but i know whole hell lot less than i did six months ago. so take whatever i have to say in that light so making an effort to understand well doing a major piece we now have reviewed over 900 papers published an 700-degree deal and the more i've learned a lesson i know. said using that to set the tone for merck congressman once said it was not take turns with the illusion of knowledge that cross the great seas. the second thing the nobel prize laureate one step to take precedence cannot be fooled to gaslight addition to say foray public-health

response that it cannot be fooled but it sets the tone for my comments i want to share with you. even with my own evolution from where i was from back in july i don't consider having been wrong before but i am willing to understand as we learn more we may look at how we understand the world around us. as you noted peter, using the concept of the black swan event an economist described very nicely the metaphor of a black swan it was a well publicized book

in in 2007 and suggested blacks won events would come as a great surprise catastrophic and have been quickly which could be a slight alteration from this event. but in retrospect there once that we rationalize i'd like to challenge that notion because we are about to see a rolling blackouts associated with this event in the hope we can stop a number by anticipating instead of waiting until they happen then understand what we could have done about it. the story line for the last 10 days in this country is individuals come from west africa to dallas county texas then be rapidly identified a very effective and comprehensive response

and the health care worker is wary we did it right with an extract 10 days with the eye on the ball. then to look at what could have gone right if we did something different but to show a sense of how we leave for word and then by taking a step back where we are at. so today let me say we have a lot of unexpected ahead of us. to not expect anything carved in stone libya's scientific intellectual piece of dynamite be prepared. to do nothing we are afraid

we cannot respond. with the public health world. with the amount of hubris from ebola 24 outbreaks in humans but 19 of those were community outbreak's. five had a laboratory situation. . .