the next page was therapeutic development. the treatments for the symptoms of the ebola virus as opposed to a vaccine that would hopefully prevent the virus from spreading, correct? he had a slide that talked about the vaccines that were in or approaching phase one trial. the first is the glaxo smithkline. the second was new link genetics. i asked him questions about that at the time. i questioned doctor robinson. in this particular slide, it appeared there were only two companies, glaxo smithkline and a new link that had phase one trials ongoing. has there been a change to that since the hearing? >> since the hearing on october 16th, the phase one trial has been under way.

they are almost complete and they are very optimistic that they start next phase of the trial with both of those vaccines in west africa. >> this slide indicated that there was a third company, but they were not expected to engage in phase one trials until the fall of 2015 which is a substantial ways away from where we are today. >> there other potential vaccine candidates in the pipeline. we are supporting some of those. they are behind this timeline and we are right now focused on trying to figure out if these vaccines are and effective and if they are, get them into use to control the epidemic in west africa. part of the emergency funding request will be $157 million for barta to continue to accelerate the development and manufacturing of vaccines and therapeutics for the outbreak. >> my understanding from talking to the folks at new link

genetics is these clinical trials that have been ongoing at walter reed and the national sn institute of allergy and infectious disease, there is good rapport against the agencies and the company involved. that there is continuing to be ongoing interactions with the department of defense sponsors as well. that would be the defense threat reduction agency and the joint vaccine acquisition program. is that your understanding as well? >> that is in fact every week once or twice a week i run a call with all of the parties. so that we are all joined at the hip through every step of the process. we know what's going on and we share information and we know what to anticipate. fda has been a key partner as well. because of the fact that it's their regulatory authority.

it is going to determine what moves forward and what doesn't. i never thought i would find myself in this situation, but we are racing to catch up with fda. it's a great situation to be in. everybody is working extremely effectively. >> great. >> doctor, mr. barton asked you a question about trying to contain an em demmic with an absolute quarantine. is there an ebola epidemic in the united states right now? >> there is not. and that's why they are trying to contain it there. >> one of the things we talked about during these hearings is the importance of focusing on facts and science and medicine. in 1900, the two leading causes of death in this country were influenza, pneumonia and tuberculosis. neither is a leading cause of death because of the response of

science and medical health. when you look at the fact that in 2012, there were 25 million people living with hiv around the globe and the case of ebola, with the proper application of science and medicine and public health, we should be able to manage this crisis if we devote the necessary resources on a global basis. would you agree? are. >> yes, i agree. >> thank you. >> you are recognized for five minutes. >> thank you and i appreciate you having this second hearing on ebola and i want to thank the panelists for coming. we would like to see mr. kline be a part of this. the committee made a request for a new one here. they will have transparency to talk about it. they would be focussed on

working with us to get solutions to this. the last time you were here, we talked about a number of things. one was the comments that we heard from samaritans to groups that will be on the second panel. one of the things is the comments you previously made. they were blown off by the agency and i asked a few about that. you said you heard about it. have you looked into it to see what's going on? can you follow-up on that last conversation we had about those complaints? >> i am not familiar with suggestions or complaints or concerns that have been raised that we have not addressed.

>> one was a quote that kind of blue me off and made others that implied they were not being taken seriously. you said you would look into it. do you agree with that statement or have response? >> we are certainly still learning about ebola and the best way to fight it. that's a critical component of activities and a component of

the emergency funding request as well. is it still going on and you think it was being under estimated and not being under estimated to that level? >> the cdc publications estimated the degree of under reporting could be as high as 25 back over the summer. our sense is that is likely to have decreased in areas. including systems to track the disease and they don't have a place to come in. they are less likely to be accounted for. >> is there new conversation that we had especially the white house about what has been talked about by a lot of members having a travel ban for those having direct contact with people in

west africa and come back into the united states to have them to make sure we didn't come back with ebola? >> my top priority is to protect the american people. i have said and others have said that we will look at anything. we don't want to interfere with the system that allows us to track people when they leave and arrive for 21 days after at 100% follow-up for most people who come into the country. if we don't have it, it could result in a greater than a lower degree of risk. >> let me ask you about ron kline. we did ask that he participate in this. he is designated as the ebola

czar. have you had contact about strategy and how to deal with this? >> i have frequent contact with him. he advances. >> the two had disagreements on how to approach this. >> we have not. if you felt he ought to go that way, is there a hierarchy right now? >> he has been clear and specific decisions that are at the cdc. >> i appreciate your questions and answers and thanks for coming in. >> thank you to our panelists for dedicated work. we heard that the key to keeping the united states is to e

raticate them at their course. while we had early indications of momentum begin to emerge, it seems as if the situations in sierra leone and guinea are not showing the promising signs. what additional resources are they doing? >> the emergency funding is essential to our ability to protect ourselves here at home and stop ebola. too many blind spots and weak links in places in africa and elsewhere. we have large amounts of travel and animal human interface and large members of people. all three of the cdc components and all of the components are so important. the cdc-related components are domestic and stopping ebola and preventing the next ebola through the global work.

>> i know it's a few weeks ago and they are four individuals from cdc in guinea. france is taking the lead on ebola response in this country because the united states needs to take a more leadership-active role or does it have the capacity to do so? >> excuse me. for the cdc specific response, we provide a comprehensive public health approach in each country. as of today, we have approximately 175 staff on the ground. we have the most staff in sierra leone. we also have more than 20 staff or roughly 20 in guinea. we get the french speaking staff and we have 12 as of today dealing with that cluster and

trying to stop it at the source. >> what are about engaging on a more international impact. how does the community get engaged to devote the resources for this world health crisis? >> it's a robust global response. my understanding is that contributions from other countries total more than $1 billion. they have been active and effective. they have been stepping up in sierra leone and french and eu support to guinea and other areas. >> we keep hearing that there is a great need for medical volunteers to travel to west africa. do you have a sense of how many medical personnel are needed and how would one get involved? >> for american health care workers with the u.s. agency for international development maintaining a website. you can go and volunteer. we ask that americans who want

to be involved do so through another organization. they are not going as individuals, but part of an organized approach. not just clinical care, but public health measures. >> that's reaching out. is there activism in terms of recruiting personnel? >> there is quite a bit of effort by individual organizations within the u.s. for our own part. we are looking at epidemiologists not only among the staff, but they may be able to deploy. this is going to be a long road and take many months. we need people who are willing to go not just for a week or a month, but several months or longer so they can get that max mall effect by being there. although for the clinical interventions where you are working in the isolation unit, we like to limit that to to six weeks so people can be well

rested and minimize the chance of taking a risk. >> we heard that hospitals across the country are having difficulty sourcing ppe. what is the cdc's and the allocation of these and could the u.s. ramp up manufacturing needed to contain a domestic ebola outbreak. >> the doctor addressed the manufacturing aspects from the cdc perspective. we operate the strategic national stockpile and we stockpiled ppe to enable to us rapidly within hours deploy to whatever hospital in the u.s. that's one of the components and in addition, we conducted what are called rapid emergency preparedness visits to more than 30 hospitals and ten states. one component of that is addressing whether they have sufficient ppe.

we prioritized reports near airports where those airports where people come in or where a large number of the africans live. we understand that not all of them get what they want. they have been working to ramp up manufacture and prioritize the facilities most likely to need it and we have been working with the national stockpile. the ppe that we can deploy quickly. >> thanks to each of you for being here and shedding light on this situation. both for you and you, you have told us that this emergency

funding request supports nonspecific funding. not all would be directly for ebola, would it? >> i would disagree. it is divided into two components. all of it is addressing ebola. it addresses it with respect to the cdc and in ways. domestic preparedness for ebola and other threats. we think it would be most responsible to not only address them and strengthen the system, but addressing the risk that there will be another outbreak and the spread of ebola or a disease like ebola elsewhere through the security component. >> could not some be handled through the traditional appropriations process? >> the situation is urgent with respect to earthquakes ebola. they indicate for the control, the size can triple.

as the director, i am not going to address the mechanism, but i can say the need for urgent funds with flexibility and the use of funds is crucial. you commented that 2,000 travelers are being monitored. how many are being monitored this moment. what is the number? >> roughly 1500. the number is lower than it had been previously. >> what maintains the list of who is being monitored? >> everyone comes through the process customs and border protection. we work in conjunction and that is collected and opinion hours we provide it to each department and monitor with the state departments and resolve challenges if someone is hard to find and moves from state to state. >> are there any being monitored that you lot of track of? >> a tiny fraction.

less than 1% have been monitored and not found. they were later found to have left the country to go back on travel or otherwise. the program is relatively new and started about a month ago. what we are finding is excellent participation from the states and the travelers, but it is challenging and one of the things that would be supported in the funding request are funds from the departments to operate. >> how many are told to seek medical attention? if you have 1500 adults and some from west africa, more. malaria is common. for example, in the past several weeks, four individuals used the care kit for ebola we provided at the airport. took their temperature and found it was elevated and called the

number they were provided with where it was safely transported and cared for. they were ruled out and cared for in a safeway. >> let me ask and we talked about waste management. what to do with the ebola patients. are any of those being transported across the country? >> my understanding is that some are auto claving it. that the decision of the waste management companies was then to take that auto claved material which is sterile and move it for consideration. >> that is meaning that the waste is being transported across the country? not only auto claved, but anything not being auto claved is being transported? >> i am not aware of anything at

present. are the states notified of that transport? >> i am not familiar with the details. they have been looking at different measures. they had a meeting with the medical waste industry to get input from them. we worked with the department of transportation and what we have done in the individual cases. that's from the federal level and the state for the management of waste. >> i yield back. >> you said a travel ban, i think i'm quoting you would cause us to lose contact of how many people travel to the country. what do you mean by that? >> well, right now we have a system. the system is an open system. we know when people are

entering. we know where they are coming from. we know through our cooperative efforts with border protection, of when they are arriving. they are arriving through five funnels and airports right now. we have that connectivity. with a travel ban, the essence is what? no one moves. however -- >> it's from those countries. >> at the same time there is this potential that people move from country a to country b. from b to c and c to the united states and they can be from western africa. in my assessment of this, in essence it's what we have right now and the system that works following these individuals who are coming from western africa or the affected nation. >> if they were not coming and we had a travel ban, how can we lose track? >> through multiple routes going from one to another to another. >> they won't have a passport

that said where they started some. >> again, that system can be worked around, if you will. right now we have a system is allowed to follow people. we know where they are coming in from that allows us to follow them. >> i'm from missouri and you have to show me. that doesn't make sense with a travel ban from the hot zone countries. if they were not coming in, how we could lose track. if they are not coming in the first place. if they want to do a work around on their passport where they started, correct. >> let me ask you. you were talking about the travel ban also. you said less people coming in now. the last one was october 16th, i

think. the number was 100 to 150 people. >> it has been closer to 70 to 80 per day. cut by about 50. >> that's my understanding. >> and some seem to think if we gave you an unlimited check, do you think enough money would fix the problem? >> we have the ability to stop ebola, but that will require what the emergency funding request asks for. stopping it at the source and preventing another ebola situation where the world is most vulnerable. i'm sure you have seen the story of a nurse that was diagnosed with ebola in mali.

she was diagnosed after she was deceased. some people would call them the 1%. also un peace keepers that have been injured and after she was deceased, they found out she had ebola. the first ebola death is eight days after the last hearing in here, the 24th of october was the first death. they found out there was a 70-year-old item who came from sierra leone or guinea. he came from guinea. he apparently was the person who brought him to deceased.

instead of kidney disease he deceased from ebola. in the area, they didn't know she obviously had symptoms before she passed away. the other side of the aisle, they said he self quarantined and took care of himself. was he not misleading? he didn't answer where he had been. he said he was home in the apartment and they checked the subway passes. they have the bowling alley and the pizza parlor. did he not? in new york? >> in terms of the mali situation, we have 12 staff on the ground there now. >> they have been there how

long? >> we had staff there since before the first case helping them with ebola preparedness and the 2-year-old who died who you mentioned was unrelated to the current case. the 70-year-old gentlemen who died lived in a town on the border. >> i'm talking about a nurse, not a 2-year-old. >> the source case for the nurse is the 70-year-old. he lived on the border between mali and guinea. his ebola diagnosis was not recognized. people thought he died from the other problems and there is a cluster of cases there and we are working intensively to stop it. even the challenges of mali, if ebola gets in, it will be hard to get out. we are hoping to stop that. >> i went back weeks later and tried to sanitize the mosque he had been prepared for burial in, correct? >> that is my understanding. >> i would like to see as i said on the 16th, a travel ban and i

don't understand how you can lose track of people who never came in the first place. i yield back. >> you are recognized for five minutes. >> thank you, mr. chairman and thank you to the panel. dr. friedin, i have been reaching out to the hospitals in north carolina and i have a number of reports that are saying that they receive the protective equipment and where they need. specifically a short supply and 95 masks. what does the cdc play this this and why would there be a delay in this equipment? >> we looked at three levels of hospitals. first the hospitals around the airports and we want to make

sure they have ample supply. also the specialty facilities like nebraska and emery and nih. second is the facilities where large numbers of people from africa live where we might have another case and third is all of the other facilities. given the number of facilities, there is not enough on the market for some of the products to give every hospital as much as we like. we have a national stockpile and that stockpile already has enough ppe to distribute to hospitals that urgently need it within hours. we also have worked through the rapid ebola preparedness teams or rep teams with several dozen hospitals to get them ready. when we work with them, we found although they might have shortages, they have been able to meet the shortages.

they are most likely to need the facilities. we have ample supplies to the national stockpile. >> do you want to comment on that as well? >> sure. one of the things my office has done since the very beginning is reach out and work with them. i personally have spoken to the leadership at each of the companies and each of them now have gone to 24-7. >> the manufacturing. >> three shifts a day. they made a commitment to work with them and we are doing this so if a hospital is on our first list of being really ready to take care of ebola patients or needs them urgently, they will prioritize the orders. what they said is because a lot of people are frightened, many hospitals are they think double and triple ordering ppe from different distributors and

manufacturers. they want to be sure they get some. part of our job is to be sure working and they get what they need. as the doctor said through the stockpile, we are confident that they can get enough ppe to any any have enough. the manufacturers and distributors have developed training material. they don't have to train on them. they will go out to a facility and let you use other kinds of samples to practice. >> to practice. >> dr., in relation to travel, i have been raleigh durham international. that is not one of the five designated airports. and the first line. they are not health care professionals.

with this increased threat of ebola. is the cdc prepared or has dedicated funds to the airports to help with training and personnel issues. >> part is to ramp up and working with the funneled airports now and we worked closely with customs and border protection. it has been an excellent partnership and provided training and information. there is a entire for more information. we ensure that almost all go to the airports. >> one last question. is the cdc working with osha and department of labor helping hospitals to be trained for the prepared readiness? >> they have been part of the teams and offers services and information to hospitals that are working on preparedness.

>> great, thank you. i rich that he was here with us today. i think the new ebola czar provided the new information. >> my home is texas 22. it's a suburban district. many folk who is live there work down at the texas medical center. they may live in rural parts. cotton is still king. it spooked them badly. shut down for days because two students coming back from cleveland with a nurse who had been exposed.

cleveland is not as close to houston as it is to dallas. texas had a cruise ship docked there and came up early because a nurse self imposed far an teen in the cabin. 55 gallon drums. 1,800 degrees fahrenheit burned them from treated them in dallas. it comes through texas 22. the deluge of information coming from cdc and awful y'all. it's confusioning and overwhelming. i heard it from big hospital systems and 1345u8 providers. the mercy centers from my hometown of sugarland, texas.

i'm worried about the other guys like st. michael's. i have a question for all three panelists. the first is for you. what is your organization doing to ensure that small guys like st. michael's are ready if an active ebola patient shows up at 2:00 in the morning on thanksgiving night? >> three things. first, we are working with the travelers themselves so that they know where to go and have a number to call. they are checking their own temperature so they can identify if they have symptoms and they are cared for before they become infectious. second, we are providing information through our website and webinars and demonstration and training and practices to hospitals throughout the u.s. as well as hands on training through our rep teams and team fist there were to be a case. we are working with the state health departments that are key

here. one of the components of the emergency funding request is strength eping and providing more resources to state health departments exactly for this to strengthen infection control for ebola, other deadly threats and things that are daily endangering the threats throughout the country. the departments and hospitals have a critical roll to play and maximize the impact of that. it will require the resources that it will require taking an approach that addresses ebola as well as other deadly threats and strengthens the systems of infection control. >> how about yourself? >> one of the things we have done is reach out to all of the hospitals around the country. they are organized into coalitions which are community level collects of hospitals and dialysis and nursing homes and

others. texas has a well organized system of this and reaching out through them, they are able to reach st. michael's and say if they needed personal protective equipment. if they needed help with dper size and training, they could get it. number two as i mentioned, we had a very aggressive outreach and education campaign. it has been open to health care providers including health care providers from st. michael's and anywhere else. people can take advantage of numerous phone calls and webinars. they reached nurses and doctors and hospital administrators and ems professionals. at this point we reached over 360,000 people across the united states with this. it is our goal that every hospital like st. michael's as they say they recognize a case and safely isolate a case and to be able to get help.

finally through the health departments, you know you will hear from them in a while. they called the state health department and if they have questions or concerns, this is a good position. >> one more question for you. you were quoted on october 2nd. essentially any hospital in the country can take care of ebola. do you stand by the quote today? >> clearly it's much harderly in the country as we recognized. every hospital in america should be ready to recognize ebola, isolate someone safely and get help so they can provide effective care. that's why we established the team ebola response team that will fly in at a moment's notice for a highly suspected or confirmed case to help hospitals throughout the country. >> thank you, i yield back.

>> i recognize mr. jones for minutes. >> want to thank the panel for joining us today. thank you very much. >> have any other states applied stricter standards than the cdc has in terms of how to handle ebola? >> cdc guidelines are just that. the states are free to be stricter than that. we are gratified that most have followed standards and what we say is clear. >> do you know if any states have stricter standards? >> some do. >> all right. >> why do you think the states are adopting stricter standards than the cdc? are you confident that your standards and the guidelines and standards are strong enough? >> we believe our standards if followed are protective of the public. they require that people who may be at any elevated risk or some

ri risk, they have temperature monitored every day. that is something that allows us to interact with the person and talk with them and to determine on an individual basis if they should stay home that day or if they might be reasonable to allow them to do other things. >> have you talked to the states that have stricter standardards to find out for the stricter standards? >> i had communications and understand some of their thinking process. the number of individuals who are subject to those stricter standards is small. all of those individuals by our standards should be in direct active monitoring. someone watches them take their temperature and and they don't have the fever. >> the last time that you were with us, we talked about having tested the standards.

have the standards been fully tested across the country back to what my colleague from texas mentioned so that every hospital knows what to do? have they been tested? >> the standards in monitoring travelers are being implemented by every state in the country or virtually every state in the country. tracking people coming back and monitoring them. >> have they been tested? >> i'm not sure i understand your question, but with respect to the -- >> then let me explain the question. going back to my military experience and i think some of the gentlemen here can understand that, we do things called operational readiness inspections. we don't wait for the bullets before we know what they will do when they do start flying. you come to appalachia, ohio. there lots of community

hospitals. they dot our region. are those hospitals fully up to speed? have they tested and signed off on any guidelines that they have tested their ebola process? >> in terms of hospital preparedness, many hospitals have undertaken drills. we have also -- >> has cdc mandated some. >> they don't mandate that hospitals do drills. we have guidance and resources for hospitals. >> have you recommended? 35r. >> directly involved with doing that and reviewed for the visited hospitals. those most likely to receive a case. we visited those hospitals and have overseen the drills and preparedness and worked with them on advancing their preparedness. >> it's my understanding that there several ebola centers scattered across the country referred to as infectious

disease centers. most have a capacity of to two people treated in the united states have been transported to one of these centers to better manage the illness. in the event that a larger number of cases were to show up in the u.s., how do they plan to treat the load that exceeds the available bed space in the centers? >> the challenge of a cluster would be substantial and a matter of using all available -- >> define a cluster. >> it could be or ten cases in a practical scenario. this could be seen. in this case we would use all available local resources. if need be, surging health care workers in and transport patients to facilities around the u.s. they could be treated.

>> they are set up to handle one or two patients to handle the requirements of the disease. the virus. do we have transportation systems that are capable of transporting ebola patients if that outbreak were to be bigger than one or two that we are talking about. >> we are working with the state department and others to increase the capacity to transport patients. >> what about being transported to other places. would they receive lower quality care than one of the infectuous disease centers? >> the quality can be provided and it's an intensive care unit care. they consulted on the care of every patient cared for in the u.s. and provide it to each one.

he is going to get you at this point. >> we will try to it's able to get closer to what i am. they take it somewhere else. and when that happens, are you notified and is she required to tell you as far as i know? >> the infectious disease.

i believe that that and that division would be part of the response. i'm correcting that. >> that is correct. do you know whether or not the secretary transferred money from the cdc's global health programs? >> i would have to get back to you. >> likewise on the cdc's preparedness and public response division. >> i have to get back to you. >> both of those are part of the ebola response. >> you indicated what you don't know and do you know if they were transferred at all? >> they are the secretary's transfer and i don't know the details of what has been done. >> okay. >> so you don't know the details. you would not know if any of this was transferred to help support the financial underpinnings of obamacare? >> i don't know.

>> likewise, do you know of any transfers made to the administration by the administration for children and families to care for increasing numbers of unaccompanied children arriving in the united states? >> i am not familiar with that. >> would you give us the answers to all of those? >> i can get you the fair amount of money. part of that is a 5.4 billion and funding. some of that is supposed to go to hhs. they said in his letter to make resources and domestically and internationally. and that goes hhs. it then talks about transferring the funds over to homeland security to increase customs and border control operations. do you know what money they are

getting? >> we work closely. the ebola required a very extensive response. the plexibility is a critical component of the funding request. >> that are funding request is as was pointed out in an editorial by david and hope i pronounced that right. a former surgeon general. isn't that correct? >> i don't know. the funding details. >> in regard to mr. claim, have sat down with them? i greatly appreciate that. that would be very, very helpful. some of the outbreaks in the

past in the outbreak and i don't know where the disease came from. it may be bats, but we have not determined that. we determined it for a similar virus from research. >> the meat, i understand from the deputy from excrement? are they eating that as well? >> it may be saliva. >> i'm not sure the animal reservoir we had spreading from unsafe care or unsafe burial.

it couldn't have come from human contact. we are not sure what animals carry it. what else? we do know that it's transmitted if you eat it. >> it may not be the consumption of the push meat, but the consumption and handling where you are exposed to other bodily fluids. >> i yield back. >> thank you, mr. chairman. i want to apologize to you and the panel for running in and out. the democratic leadership is working on who our next ranking member of this full committee is going to be. it's not going to be me. thank you for your vote of confidence. so i just wanted to ask a few questions and leave you in the

capable hands. the first thing is the what exactly is the purpose of that fund and what would it be used for? >> the contingency fund is to deal with the unpredictable nature of ebola. the possibility that it might spread to countries where it is not currently in place and might require very extensive, expensive control measures there. also we might have new interventio interventions, such as a vaccine and need a largely and potentially expensive program to implement a vaccine program for health care workers. >> why would you need to do that through a contingency fund and not an emergency supplemental if that situation -- either of those situations presented themselves? >> in the words of one of my staff at cdc in the case of

ebola, it's the lack of speed that kills. we need to be able to respond very quickly to changing conditions on the ground. >> and we're seeing that right now in africa s that right? things are changing quickly in africa. >> absolutely. we're responding to a cluster in mali. we're moving out with disease didn'ts into a remote. rural area to address clusters of disease before they become large outbreaks. >> do you have a sense of why the number of cases in liberia has recently dropped? >> we believe this is proof of principle, that the approach that we're recommending can work. but we're still seeing large numbers of cases in at least 13 of the 15 counties of liberia. we have seen that decrease taper off so that we have seen a leveling off of cases that have been reported. every one of those cases needs intensive follow-up contact, monitoring of contacts and we're still having perhaps between 1 and 2,000 new cases per week in

west africa. this is still a very large epidemic. >> and that kind of leads me to my final question, which is you have said repeatedly, and frankly there's been a lot of pushback on this, not just from this committee but from lots of other folks. you've said repeatedly that you don't think that travel bans and quarantines are the way to go about addressing this. and i'm wondering if you can tell us whether that's still your view and if so, why, and if it's not, why not. >> we're willing to consider anything that will make the american people safer. any measure that's going it to inkre increase the margin of safety. one of the things we have done is implement a travel system so people leaving these countries are screened for fever, arriving in the u.s. are monitored for fever, are linked with the local health department. we're now working with state and local health departments to monitor each of those

individuals each day and we're seeing very high adherence rates to that. so we have a system in place now. the risk to the u.s. is directly proportional to the amount of ebola in west africa. the more there is, the higher our risk. we have to reduce the risk u there by attacking it at the source. but whatever we can do to reduce the risk to this kocountry, we' certainly willing to consider. >> so you would still consider a travel ban if that it seemed like the only solution? >> if there were a way to ensure that we didn't lose that system of tracking people through every step of their travel and once here, we would consider any recommendation. but it's not cdc that sets travel policy for the u.s. government. >> right, and what i'm concerned about is if ebola goes to other count countries in africa in general, it will be harder and harder to trace where people came from.

>> the spread of ebola to other places in africa is one of the things we're most concerned about because it would make it harder to control. we were able to work with nigerian authorities to stop the cluster in nigeria. right now mali is in the balance of where we'll be able to stop the cluster before it gain. s a foothold. the longer it continues, the greater the risk it will spread to other countries. >> thank you very much, mr. chairman. >> mr. terry is recognized. >> unanimous concept to be able to ask questions. >> yes, you're recognized. >> dr. frieden, from nebraska, i'm really proud of the efforts of university of nebraska med center. at least we're top in something. it's not football, but it gives us a sense of real pride despite the last patient outcome, which they did heroic efforts.

but also in that regard, they seem to have been the ones that, especially in comparison to the dallas baptist hospital, we're kind of the -- that they were setting the standards on the practi practices. so that begs the question or at least we should ask the question of whether the cdc should develop an accreditation type of program on infectious disease programs to ensure that these hospitals maintain a level of competency in readiness. is something. like that ongoing? >> first, we really appreciate the facility in nebraska and their willingness to step forward in a phenomenal care they have provided to all of the patient who is have come to them. despite the outcome of the physician recently, we know that heroic measures were undertaken and the staff there really deserve the gratitude of all of us. we appreciate their willingness

to consult with other facilities and share their experience because that's critically important. >> which they have done, and again, hospitals like johns hopkins is asking them how to do it is a source of pride. >> what we have approached is something called the rapid ebola preparedness team where we send a team in to work with the facility to outline every aspect of their preparedness and to see how ready they are and to provide recommendations for what more they can do. e we also worked with state health departments so they can determine which of the facilities within their state that are most appropriate to take patients with ebola or other infectious diseases, because they are best prepared for that. in terms of accreditation, that's something we have discussed with the joint commission. whether that makes sense in the long run or not is something we're open to exploring. >> as a layperson, it seems to make sense you would have an area where there is one hospital

that has that level of accreditation. and then it begs the question that if they are going to be that go-to hospital in a region or a state, whether there should be maintenance funding behind that. what do you think? >> we certainly believe they should receive resources. there's funding within the emergency funding request both from cdc and from asper to support such facilities. >> the question is just to clarify, would that be part of the president's requested dollars? >> yes, it is. >> doctor? >> e yes, it is. >> very good. and again, dr. frieden and dr. laurie, one of the experiences here is that we know that, let's see umc has 11 units but the reality is they could only have three patients at a time because all the collateral circumstances. so do we need more

biocontainment units like what emory has, dr. frieden? >> we think we need some increase in the number of facilities that can safely care for someone with ebola or another deadly infection. we have been working closely with hospitals throughout the country to increase that capacity and the emergency funding request would enable us to get to the level where we would have a greater degree of comfort with the facilities out there in the kmaft. >> just to clarify that some of the dollars that would be in the emergency funding, the president's request would be to expand the number of biocontainment units. >> yes. >> very good. one of the questions about having three patients at unmc, these folks don't have any insurance and they are hold iin the back for the funding of those patients. is there anything with hhs, dr.

laurie, or cdc that can reimburse facilities for health care costs? >> i believe the secretary indicated in the hearing last week that we're open to mechanisms that would make them whole for the expenses they have had. >> open to it and doing things, there's a big gap between those two. is there any further discussions to reimbursing? >> i think we understand that the cost of caring for these patients is quite substantial and the secretary indicated that she would look forward to working with congress on this issue, yes. i might also just add in terms of the emergency funding that is necessary. it is clear that hospitals that are going to take care of ebola patients need additional training and we very much appreciated the fact that university of nebraska and emory have been now working side by side often with the rep teams to help with that. part of a funding request would

also establish something that would look like a national education and training center that would move to another level, i think, of preparedness for hospitals that really wanted to attain that and get help with doing that. >> okay, thank you very much, my time is expired. >> that concludes the questions for this panel. we thank you and also members may have some additional questions. we do appreciate the availability of all of you in responding to us. thank you very much. >> thank you. >> as this panel is moving out, i'll begin to introduce the second panel so we can move forward here and i'll introduce to the panelists and ask mr. terry to introduce one as well. we'll start off here first mr. ken isaacs is the vice president

of program and government relations for samaritans purse. also dr. david is the commissioner of the texas department of state health services, but is here today testifying on behalf of the association for state and territorial health officials. and mr. terry, if you'd like to introduced the other panelists. >> i would be honored to introduce the chancellor of university of nebraska medical center in nebraska medicine. he is recent to nebraska, but certainly making a huge impact, especially with the biomedical containment center where they have hosted three ebola patients and they are setting the standards for how to treat the ebola patients and setting the standards for the employees that come in contact and work with those. unmc is a great facility. they are very forward thinking.

there are probably ranked very high in a lot of areas of care, but it's probably the research that is making them known internationally so i'm proud to introduce dr. jeffrey gold. >> thank you. when doing so has the practice of taking testimony under oath. do any of you have objections of taking testimony under oath? the chair that advised you that you're entitled to be advised by counsel. all the panelists have said no. in that case, please rise and raise your right hand. do you swear the testimony you're about to give is the truth, the whole truth and nothing but the truth? all have answered affirmatively. you are under oath. we're going to ask you each to give a five-minute summary of your written statement.

we'll begin with mr. isaacs. >> thank you, chairman and teemed members of the council and guests of the committee and are letting me testify. it's a privilege to be before you in regards to the ebola outbreak in west africa. since ebola entered in march through its explosion on to the international spotlight in july and even now when it appears the disease has crested in liberia, but i want to stress today that we have discovered that there are many important questions we simply do not know the answer to and need to know the answer to them. i want to run through them quickly. i will say that going last means you have to reshuffle everything you're going to say because it's all been said before. but i think that a good question to know the answer to is how are the doctors become infected. some of those doctors have been our staff, some of those doctors have been our co-workers that were treated at nebraska.

and even recently the gentleman in new york, they were all wearing level four gear. how did they get infected? can the virus live in other mammals besides primates, bats, rodents and humans? i have worked and lived in africa for about 25 years and i have eaten my share of bush meat. it's something like a groundhog. and so what does it mean, where does the virus live? the point is that can it jump into the animal population here, we need to know that. as with other viruss, is it possible that ebola can be asymptomatic? we know for a fact of three situations where blood were drawn on patients who were nonsymptomatic and all three tested positive one of the problems that exists today in liberia where samaritans purse is working is there's no protocol to move

blood from liberia to laboratory where these tests need to be checked and results found out. i will just say i'm not trying to be a fear monger, but there are things we need to look at critically and should not be afraid u to ask questions. if my written testimony, there's one paper from the new england journal of medicine that reports that 95% of the cases of ebola incubate in 21 days. the inference is 5% not until 42 days. we need to know what the 5% means. while the media coverage is already decreasing and people feel that ebola has peaked, we do not think it has. i totally agree with dr. frieden, i think we need to vigorously and in a sustained manner fight this disease in africa. i think that no card can be taken off the table, and i think that while we hear from many health experts that we know how the disease is spread, we know how to fight it and stop it, the

truth is that lessons come at a painful price. and when a new lesson comes about, all the policies are changed. so i heard the word humility used several times today by different members of the panel, and i think that's a good word because ebola is a humbling disease. when you talk to the ep deemologists, they are all over the place. cdc is saying 1.5 million by the middle of january and the world health organization is saying in december 10,000 people a week. the point is we don't know. several things that i want to say right quick is we're seeing the disease go down in liberia today as it regards empty hospital beds, as it regards deaths and as it regards patient loads. at the same time, we're seeing a significant increase in sierra leone. if anything it has ran its

course and we don't know what it's course is. if you look at the charts, it is peaked two times before. so the question really is are we at a peak. or we in a trough before the next uprise. practically speaking, i think that a couple things that we need to look at is travel ban, travel restrictions or i like to say travel management should not be taken off the table. the real threat to the united states i do not feel is going to be how many people are sick here. the real threat to the united states is what will happen if the disease spreads into countries that cannot handle. . i'm talking about a sub indian continent, pakistan, myanmar, countries highly pop lated that have low public health standards. you can see a death toll that would be unimaginable in the impact around the globe would affect us as well. so i think i'm out of time

there. thank you. >> thank you. dr. gold, you're recognized for five minutes. >> chairman murphy, other members of the subcommittee, thank you for the opportunity to discuss the ebola outbreak and the nation's response and how the nation can maintain a state of readiness to respond to future highly infectious diseases. i'm jeff gold and i have the honor as serving as chancellor at the nebraska medical center. my testimony today will focus on the challenges of dealing with ebola and our nation's readiness to respond to highly infectious diseases. this has been said many times earlier today and well before, the united states is dealing with a serious public health crisis with the ebola outbreak in africa. it's a crisis in the united states has the expertise to contain and to help resolve. one of the most pressing goals to accomplish from the ebola outbreak is how to best leverage

the know-how to train and better prepare the nation's health care system to combat future highly infectious threats like ebola here and around the world. the university of nebraska medical center is recognized as a national resource for our readiness to provide care for ebola patients and also our ability to provide training on ebola and other highly infectious diseases. we have successfully treated ebola now in two patients and not in one most recently passed away yesterday. we have provided consultations to many hospitals, clinics across the united states including bellevue in new york howe on how to deal with therapies for patient who is arrive in their emergency departments, et cetera. our readiness is based upon more than nine years of preparation, protocol development and team training to deal with highly infectious, deadly diseases. as a result, we are now

responding o to literally hundreds of hospital inquiries across the nation asking how to prepare if ebola arrives in their community. emory is experiencing similar inquiries and we are working closely together. one step that we took to respond to the immediate national demand for information and training was to work with apple computer to convert our nine years of protocols and procedures into easily accessible and completely downloadable materials and v videos for health care providers that was accomplished in this one week, which is now available through apple and public media and can be accessed on any personal computer with well over thousands and thousands of physicians and members of the public who are downloading content specifically about personal protective equipment and others. you might ask why nebraska? this followed the 9/11 attacks.

it was built upon concerns about anthrax on congressional offices and sars attacks. international travel uncreased the chance of global spread of highly infectious diseases. our unit has written and rewritten protocols and procedures and collaborates with national organizations and other medical centers. we train with local emergency management and military unit through our relationship with others. . we spend a great deal of time considering the response plan with another highly infectious disease were to occur and how this could be scaled. which specializes in developing measures to weapons of mass destruction including highly infectious viruss. we have a history of conducting extensive research in these areas including vaccines,

antivirals, early detection, et set ra. what's become obvious from this ebola crisis is a national readiness plan is absolutely necessary. our biocontainment unit is one of four in the nation. the capacity and the number of units in the nation must be increased and a national readiness plan that trains must be established. the number of actual beds is under 20. the number of usable beds is under 10. and i assure you that every unit such as ours will always maintain at least one bed if is ever needed for a staff member that becomes ill. that immediately knocks the number down by four, five or six. the university of nebraska medical center and emory are working closely with the cdc on how training might be most effectively delivered. it must begin soon and we have done so in advance of any funding considerations. as congress considers funding, i

urge that this include a number of items and i will just read them by title as they are contained many my briefing documen documents. a national training in ebola and highly infectious diseases to develop a tooer training system. training should include setting up an accreditation program that indpeptly nationally accredits organizations, emergency departments, et cetera, to establish and maintain their skill level of readiness. an annual maintenance of funding for increased role of existing biocontainment units. we have funded the readiness of our unit totally off internal dollars up to this point. funds to expand the number of treatment centers and existing biocontainment units, specifically to increase bed and staff capacity within existing units as well as new units. and finally, reimbursement for care for ebola patients not covered by insurance.

ladies and gentlemen, we have the expertise and know how to contain ebola and other infectious threats. however, we must ensure that our nation's health care professionals are adequately trained, properly equipped and rigorously drilled. i thank you so much for this privilege. >> thank you, dr. gold. >> thank you, chairman, i'm the commissioner of the texas department of state health services. i have been in that role for eight years. this last month has been one of the most tough as the commissioner of state health services. on september 30th, the texas state public health laboratory diagnosed the first case of ebola in the united states. the diagnosis of mr. duncan with ebola set in motion a process we in public health refine through continued use, tried and true public health protocols, including identifying those individuals who have had contact, making sure they are monitored, providing care of

those infected, isolating individuals and when needed, using quarantine. the magnitude of the situation was unprecedented. while mr. duncan was one man in one city in one state in the country, the outcomes with his case could impact the whole state and other 35r9 parts of the united states. we along with our colleagues and dallas and the cdc and prevention took the responsibility to contain the spread of this disease very seriously. we organized a local incident command structure to handle the event and at a state level we activated response. while our mission was to protect the public's health by eliminating the number of people exposed to the congress, the challenges associated with carrying out that mission were numerous. the care of mr. duncan presented its own challenges. identifying the first person in the united states infected with this disease, the infection control challenges, transportation, the ability of

experimental treatments and vaccine, training for health care workers on the higher standards of infection control and personal protective equipment, guidance and supplies. . and when mr. duncan passed away, we handled issues related to carrying his human remains, which remain highly infectious for months after death. unfortunately during the care, two nurses became infected. nurse who is had put their lives and their careers on the line to take care of mr. duncan and to protect the public's health. concerns relating to the handling of these three e ebola patients included questions about decontaminating their homes, automobiles, decisions about how to handle the their personal. effects, monitoring of pets and patient transportation issues. and addressing the public's concerns. identifying potential contacts and monitoring those individuals

had some risk of exposure that also involved many challenges. decisions about who to quarantine and what level of quarantine, balancing public health and individual's rights, providing accommodations for those confined to one location for the 21-day monitoring period, quickly processing control orders, coordinating two system checks a day for each person under monitoring and managing the transportation and testing of laboratory specimens. throughout all these specific challenges, our experience in dallas exemplified successful responses to emergency situations. having clear roles and responsibilities among the various entities involved strong lines of communication, and an incident command structure staffed by trained emergency management and public health professionals to ensure the response's direction really requires a partnership at all levels of government and throughout state and federal government. the outcomes in dallas proved

the strength of the public health's process. hundreds of people were monitored in the state. two cases of ebola resulted from the direct care of the case and they were detected early in the disease onset and they recovered. no cases resulted from community, poe sure. at this time, texas is providing active monitoring for individuals who arrived in the united states from one of the outbreak countries. texas has monitored 80 individuals under the airport screening process. texas is also like other states working to ensure that capacity exists in the state u to care for patients with high consequence infectious diseases like ebola. two centers are able to stand up on a short notice to receive a patient and texas is working to identify additional capacity within our state. as ebola screening and monitoring transitions into our routine processes, our focus in texas is now shifting to include complete evaluation of the response in dallas and a

discussion of how to improve the public's response system in texas as a whole. and sharing our experiences and our lessons learned nationwide. governor perry put together a task force for response to evaluate the texas system and to make recommendations for improvement. we take that extremely seriously. i believe this discussion among government l and nongovernmental individuals among varied stake holders and including experts will result in a texas and the nation being better prepared to handle the next event. while we do not know what form the next event will take, we do know that there will be another event. as i tell my colleagues at the state and national level, it's my expectation that as a commissioner of health that i'm going to have to manage one major disaster each and every year. one unthinkable event per year. that's why the funding that is provided to states through the hospital preparedness program is

very important to what we do. that partnership is really critical. finally, i want to thank my colleagues at both the dallas county health department and the cdc for their work and their support in this really was a team effort. thank you, sir. >> dr. gold, i know you have travel plans. will you be able to accommodate that. >> yes, sir. >> i'll recognize myself for five minutes. dr. gold, you mentioned a number of comments about what needs to be done with the administrati administration's request for funding. i don't know if you had a chance to read it. have you? >> at least in general terms, yes. >> would you know whether or not there's an adequate plan to support the request yet? >> i don't think the granularity is in the written materials that have been provided. >> would you do us a favor as someone at a hospital, would you get to the committee specific

recommendati recommendations? in fact, i would ask that of all the panelists. it would be very helpful to have that kind of granularity. you have been o africa. >> yes, sir. >> the cdc has guidelines for health monitoring and movement for health care workers in africa. now they classify as those who have had direct contact with those sick with ebola while wearing personal protective equipment. you have cited that some people wearing equipment have still contracted ebola. >> it's an obvious fact, yes. >> so this some risk have no mandatory restrictions on public activities. there's no requirement for returning health care workers to avoid public transportation like subways, bowling alleys, et cetera. i want to add, we have done a survey of members on this side and every single member who asked hospitals in their district has returned comments saying all those hospitals said for the first 21 days, those

health care workers are not going near a patient. they will be furloughed, they are to stay home, taking temperature multiple times a day. do your workers follow guidelines such as this when they return? >> e we actually have written our own protocols and guidelines back in late july when dr. brantley was coming back. we contacted cdc and asked them what their protocols were. and frankly, they told us just to have our staff check their temperature twice a day. if they got a fever gorks to the local health department department. we didn't feel that was adequate because we came through a serious bout with ebola and had a more realistic encounter with it than perhaps other people had. so we created our own protocols. we check our staff through direct monitoring every day four times a day. and we do keep them in a restricted movement, no-touch

kind of protocol for 21 days. >> so your protocol goes beyond the cdc recommendations. >> there's no question our protocol goes beyond. >> that's not necessary, do you agree? >> there was a question a minute ago about cdc disregarding what we're say iing. cdc is a large organization. they create a policy. so if you call them and say, well, we think we ought to do this. they say that's not our policy and don't engage any further. that's just the reality that we have run into. i don't mean any disrespect to cdc, i'm very appreciative of them. but for us, we live in a a small town. or national headquarters has 40,000 people. what we have ran into is that the spouses of some of our returning staff don't want thunderstorm coming home. the staff don't want to be around our children. we don't want to spook everybody in our community. >> you're ering on the side of extra safety.

let me ask another question. a it listed there are some problems for people, the ngos, charitable workers traveling back and forth to western africa. is that a fact there's difficulties with travel. >> i think that's one of the greatest vulnerabilities that the united states has to fight the disease in west africa. there is not a dedicated humanitarian bridge. what has happened, there's been a lot of talk about a 21-day waiting period would make it onerous for volunteers and wouldn't go. for volunteers not to have an assurance that they can get a flight out. i promise you they will not go. >> how many airlines can fly in and out? >> i think it's 200 a week. that's general population. i u don't moe how many relief workers. >> we don't have a bridge for relief workers. >> there are two airlines. one is brussels air. you just walk.

you go anywhere. you're not monitored for anything. the second one is royal air mo rack. if they should decide it's not in their commercial interest to continue flying in, there will become an effective commercial quarantine on liberia. what's the backup plan? >> plus as i understood, getting supplies to west africa is a huge problem. we understand twice had to lease planes. >> $460,000 a piece. each one can take about 85 tons. but logistics in and out for cargo, logistic for people, we have a great vulnerability there. there's one organization that is flying like a nonprofit. they have done four flights. that's great, but that's not enough. >> let me make sure i understand what would you recommend. the united states government could help sponsor a charter flight twice a week from the united states to africa, from africa to the united states, so

workers, government workers, volunteers, ngos would have a clear bridge to be tested before they got on the flight, tested during the flight, tested when they land. at one point the united states would simplify this process. >> i 100% support the concept of a humanitarian air bridge from the united states directly u to west africa. there would be 1,000 details to work out, but we have a vulnerabili vulnerability. if brussels air stops flying for commercial reasons, we'll have no air access. >> thank you. i'm out of time. i will yield to mr. green for five minutes. >> thank you, mr. chairman, and thank you our panel for waiting today. and to follow up, it would also be more certainty because, like youd said, just walking around, it would be the testing and i assume these health care workers would love to have that because they don't want to infect their

own families. i know in october there were a lot of seemed like unusual statements being made about ebola. when the state of texas developed protocols right after that, i appreciate that, because it really sounded like everybody was getting back to normal and saying, okay, this is an illness, we're going to deal with it and this is how we can do it. so i appreciate the state doing that. let me go on with some questions. dr. gold, one of the interests i have, and i said earlier, is that how did the university of nebraska develop this facility? i think it was in '05 and was it a combination of state, local, university funds, federal to develop the largest containment lab in the country? >> thank you, the unit was opened in 2005. it was planned shortly after the 9/11 events, the anthrax scares

and it was done predominantly on university funds, to some small extent state funds and i believe there were some department of defense dollars involved in the planning as well. however, very importantly, the maintenance of the staff which costs about a third of a million dollars to maintain the preparedness has been totally bourn by the university and medical center. >> i appreciate that, because the leadership -- i'm just surprised that no other university would take that lead, and i appreciate nebraska doing that. my colleagues know my daughter is there and was recruited to come up there in '09 and i appreciate -- although when she told me back in the '90s, she wanted to be an infectious disease doctor, i don't want you to treat me anything you know about. she's like most medical professionals, that's her job. we want to make sure we protect

them to do that. nebraska center now has treated several patients. what is the spending that's required to prepare the hospital to treat an ebola patient? >> the direct costs that we have experienced and we have compared notes closely with emory and we're not far apart is approximately $30,000 per day for each patient admitted. the average length of stay, i guess it went down over the weekend a good deal, but for the two patients that went home was 18 days. they were both treated in a relatively early stages of their disease. that's the direct cost of equipment, supplies, nursing care, et cetera. as i say, that's extremely close to the number that the folks at emory have come up with. that does not include the cost of the preparation, which i just referred to and it does not include the cost of what i would

call the opportunity cost, which is this a ten-bed unit that's otherwise used for medical, surgical admissions that would otherwise be completely full with routine patients receiving their care. >> okay. are the policies that were in place prior to the current outbreak still in use? or has the university made changes as protocol and guidelines based on real life experiences? >> we do evolve our policies and procedures. we learned a lot from each of the patients, particularly the first patient that we housed. we put a completely self-contained laboratory unit in so laboratory specimens are not transported outside the unit. we are also privileged and there's been a lot of discussion about waste management, is we decontaminate all the waste as it leaves the unit. so there's no transportation of waste material outside of of the

unit. which makes it much safer for the community and it also makes it much less expensive for us to have that built into the unit. this is only because the unit was planned as it was constructed prior to 2005 understanding that the disposal of infectious waste would be a big problem from logistical as well as expense. >> mr. chairman, i know i'm out of time and i appreciate because from where we were at six weeks ago, we have evolved and i'm glthe experiences we're learning from and i appreciate our panels being here today. >> the gentleman yields back. >> thank you, mr. chairman. and baring with us what is a long and informative hearing. dr. gold, there is a difference, though, between the type of patient you get at your center

because they are referred. there's not a direct access where someone thinks, i've got ebola, i'm going to go to dr. golds center in omaha. dr. duncan came flu the emergency room with all of the other patients that came in that thursday night and his case had to be out of the other load that was in the emergency room. . but in your situation, a patient only comes after they have only been identified. is that correct? >> thus far, the patients that we have admitted to the buy cocontainment unit have all come with a diagnosis, a pcr diagnosis of ebola. however, given our national representation, the number of phone calls, e-mails, even emergency room visits has actually been quite interesting with people with illnesses saying please tell me if i have ebola. >> well, let me just ask you about that so patients who arrive in your emergency room --

i mean, you outlined how you have a dedicated laboratory handling of the specimens from an ebola patient, but that's someone you know about. somebody comes to the emergency room and have fever, headache, all of these other complaints, in addition if someone thinks to do the pcr ebola test, but they are going to get a any number of other blood tests and these tests would go through the normal auto analyzers in the lab without knowing that that patient actually had an ebola possibility or is that, in fact, separated out of your emergency room? >> yes, sir, we have put protocols in place and widely shared them for triage screening in the emergency department. if there's any suspicion that a patient has a travel history or symptom complex, they are immediately sequestered. there's a specific nursing protocol for personal protective equipment, et cetera.

there's a notification of the team and the laboratory specimens are processed through the bibiocontainment species ev before we know the results. we are doing pcr testing on site now, which make s it a lot faster and a lot easier. otherwise, it would have taken days previously. >> but again, i would just point out that that is in a perfect world. in the rough and tumble e.r., all of those protocols would not immediately be available. we'll get back to that, but i just have to ask you, the typhoid mary analogy, that's the first time i have heard of that. we all remember of lore. do yours carry the ability to infect people when they are

asymptomatic? >> we don't know. that's the question. a typhoid mary was dealing with bacterial infection. what i do know for a a fact is there have been a number of asymptomatic people whose blood has been drawn and tested positive. and i think that there is something about the pcr test that i heard dr. frieden say in medicine you never say 100%. the thing with ebola is if you don't bat 1,000 every day, somebody dies. >> and someone else is exposed. >> my point in saying that is not to raise fear, but we need to keep it contained. >> you raise a point of two of your doctors were infected and you weren't sure why. e we had two nurses in dallas that were infected and we're not sure why. and again, that just underscores that there's probably not known about this disease than what is

known. that's why i began this we all ought to step back and have a little bit of humility. i would extend that to mr. waxman and he's not known for his humility. we all have to have humility in dealing with this. i have to ask what you did in dallas to sort of restore good order and discipline at a point where it really almost veered toward being out of control. i mean, it took a lot of courage to exercise those control orders on the individuals when you did that. i will admit to being somewhat surprised turning on the news and hearing that had happened. what were some of the things that went through your mind as you developed that? >> so we don't take control orders lightly. in texas i can put a control order. it's not enforceable until i get a judge to enforce it. but we have to get the monitoring done in an event like this. we have to make sure that people do not have fever.

if i could got knot get that done the way i needed to protect the public's health, i take taking the public's health extremely seriously so we put a control order in place. if you do that, you need to make sure you provide the support services around that individual to make sure there's food, other support there so you can make sure it's as humane as possible. with the nurses, following the nurse that became infected, we needed to make sure we had monitoring in place. we also as we looked and stratified risk, it looked to e me that the biggest risk was inside that room with mr. duncan. so for those individuals, we said, it's best during this time period that you don't go into large public settings, movie theaters, churches, et cetera. it becomes a very large evaluation when that occurs. unfortuna

unfortunately if somebody becomes infected. we're a i believe to work with that staff. they took this very seriously, to be able to limit their movement for the highest risk individuals. >> very good. dr. gold, are your patients reimbursed by insurance when patients are referred to you? >> we are in the process of having those discussions with the insurance carriers and with their employers, but to date we have been unsuccessful for a commercial carrier. i can't really tell you anything has happened in the last 24 to 48 hours, but they have not responded. >> thank you, i appreciate that. >>. mr. waxman is recognized for five minutes. >> thank you, mr. chairman. i'll take five and maybe take an additional two like we saw from the other questioner. president obama sent to congress a $6.2 billion supplemental budget request to enhance the response to the ebola outbreak. the president's request is

intended to both fund both immediate and long-term needs in the united states and west africa. dr. gold, you can both speak to the readiness of our public health system here in the united states. the president's budget request designated $621 million to cdc for domestic response, including funding for state and local preparedness, enhanced laboratory capacity and infection control efforts. it also designates $126 million for hospital preparedness. can you comment on the need for additional funding for state and local public health authorities? what are the top funding priorities? >> thank you, sir. as i outlined in my comments, state public health, local public health is having to do a lot of work right now. having the laboratory system out there to rapidly diagnosis individuals is essential for us to make the diagnosis and

isolate individuals. the ep deemologist that contact individuals, talk to them, figure out the risk is essential. the hospitals having predesignated facilities so we can care for those individuals is very important. this isn't the only event. we have had had multiple events west fertilizer explosion, hurricane ike, that system to be able to rapidly respond is essential. a lot of that is paid for by hpp funds. my hpp budget was reduced by 36% this last year. >> hospital preparedness and give us some examples of areas where additional funding would be helpful. >> i think the additional funding would be helpful to build the educational programs

to get the referral centers as well as community hospitals completely up to speed. the additional fundings will allow to scale -- infectious crisis of this nature for which we currently do not have resources. and to build a sustainable infrastructure such as serum reserves such as core laboratory testing, et cetera, so we have and sustain a national preparedness level. >> thank you, i want to pivot to the funding for international efforts. mr. isaac, samaritans purse has been on the ground since march and understands the environment there. i want to talk to you about the ngo perspective on continuing needs and efficient use of resources. what are the main priorities on the ground in west africa?

and what resources are needed to accomplish those efforts? >> so if i may just add something to what you said, we're been there for 11 years. the disease broke out in march. so we have a large footprint. we have 350 staff, about 20 ex-patriots, we have a lot of capacity in the country. and when the drz broke out, we 100% focused on fights it. what we are seeing today that we think that other resources are needed for, this is very practical, but you know what, logistics are everything. there's a lot of discoordination and confusion right now between the u.n. players, unhos and the dod about gaining access to air lift. there are no protocols in place about moving blood samples. so if cdc goes to an area and there's 12 people that test positive. they call us in. we're not able to take the blood

samples out. we have to move them out by land. a rapid diagnostic test is one of the greatest things needed there. and i think frankly that if the u.s. military was running the coordination cell, things would get. -- would be done quicker. >> the u.s. is helping and committed to helping in liberia and provided resources and funding as we continue our aid efforts, we must also keep in mind the need for flexible response. initial reports indicate that there are empty beds in ebola treatment units so the aid efforts have adjusted accordingly to monitor occupation and only build additional as needed. i hope we can quickly pass the president's budget request. we heard from this panel our first panel about the urgency of the task at hand and the public health catastrophe that will

occur in west africa if we fail to do so. thank you very much. >> certainly i'd like to see that happen too. i hope you'll take a look at they need a bridge to move people back and forth because that's a struggle right now. i recognize mr. long for five minutes. >> thank you, mr. chairman. and i thank you all for being here. not only that, but what you do on a day-to-day basis. i for one really appreciate it. dr. gold, you said -- let me ask you something before that. dr. martin was taken to your facility, correct? >> yes. >> and the reports that we got. on the news, turned on the radio and said there was a doctor with ebola that was very critical was

the first thing i thought. and i probably had the same thought a lot of people did. that's probably not a good thing when they say that he's very critical. he later deceased just a few days later. and i apologize i had to step out of the room, which i normally don't do. i'm usually here for the whole duration, but was there a reason that he was delayed coming to this country for assistance, for help? do we know? because that seems strange that he would be that far gone before they would think about flying him out. >> it's unclear to us what the logistics were that might have delayed it. as we are told that he had an initial blood test for ebola that was negative and only three days later did he test positive. when he tested positive, there was a period of time before at least we were contacted. i don't know whether the transportation organizations or

the state department were contacted, but from the time we were contacted, the plans for transfer were put into place virtually immediately. there was also a good deal of uncertainty how stable he was immediately prior to transfer, but once the decision was made to transfer him, rest assured he got every conceivable treatment. >> i'm sure he did. i wasn't implying that at all, but i was curious why they waited as long to try to get him. when i heard that first report, very critical. >> it's common for people to test negative even when they are symptomatic. we have heard about other people who have tested positive who were asymptomatic. this is not 100% certainty disease. we're learning an awful lot about the spectrum of how symptomatic people get versus their viral levels, et cetera. >> let's switch up the topic a little bit. you said in your written

testimony that you have coordinated with the cdc and hhs on readiness and treatment. can you tell us more about that collaboration on what specific issues have you advised the administration? >> we are working with emory, with the cdc on standing up educational protocols, visiting institutions to help them enhance their readiness, hosting teams from other institutions across the united states and nebraska. we have recently had a team of nine or ten people from johns hopkins university as well as putting together a series of protocols that would be used for accreditation or certification of readiness and maintenance. >> when you say you advised the administration, have you spoken with mr. klein, the ebola czar? >> yes, sir, many times.

>> did they accept your recommendations and did they reject any of your recommendations? >> we're working specifically with dr. lurey who was your guest earlier and we speak probably daily on the development of these protocols. there's a conference call that's scheduled for friday. >> you feel they are taking your recommendations. >> yes, sir, so far. >> and mr. isaac, we were talking about earlier you were in your testimony people traveling on planes and being checked temperature wise every so often, three times a day? >> our staff are under protocol to take their temperature four times a day? >> their own personal temperature? >> no, we have staff in our ebola task force that call them every day and we keep a log of it. i could call my office and tell you where every one of our people are. >> but you're talking about your staff, not their patients.

>> yes, our staff. >> okay. >> we're just monitoring their health. >> i misunderstood earlier. you hear reports about checking their temperature when you get off the plane. i think we need to do a travel ban as i mentioned before. they say take their temperature and then they say they cannot be. symptomatic, not have a temperature and still have ebola. my question is still invalid. but thank you all again for your service and what you do and for being here today. mr. chairman, i yield back. >> thank you, mr. griffin you're recognized for five minutes. >> thank you, mr. chairman, i appreciate that. thank you all for being here and thank you for the work you have been doing there for 11 years. it's a good organization. not just there but around the world. speaking of that, in your written comments you said many public health experts are telling us we know the disease, how to fight it, how to stop it. everything we have seen suggests we do not know the science of ebola as well as we think we do.

i touched on this earlier in the previous testimony related to, i believe, the reservoir speez shees is what dr. frieden was talking about what dr. frieden talking about. you touched on that in your written testimony as well. you asked the questions, can the virus live in other mammals besides pry mates, bats, rodents and humans. you attached a study related to pigs. do you ask this question because your people on the ground have some questions or just because it's a blank slate and we don't have much research on it? >> i think ebola is potentially a much more serious disease than it is given respect for. what we are seeing is that it is flexible. it is deceptive. it's sneaky, it's agile. every time somebody thinks they have it figured out, it shows us something new. i think we as a society can't make assumptions we know what it

is and what it will do. i think we need to be extraordinarily careful about letting it come onto this shore. while it is true that when it has come here, we've quickly identified it and isolated it, the truth is that, as these doctors can tell you, particularly the gentleman from texas, if he had 10 or 20 or 50 cases down there, it would consume his capacity to isolate it. so while we can isolate it, if it were to get out from under us, it could quickly exceed our capabilities. that's why i think it is so extremely important to invest resources to fight and stop this disease in africa before it gets off that continent in major way. >> i appreciate that. have any of your people there in africa indicated to you that they're concerned about animals that might be carrying the disease? >> we live ebola 24 hours a day. that's all we talk about. we talk about it all. we are worried about it. evidently in spain, they thought

the little dog -- they killed it. in texas, you put in isolation. i'm glad she got her dog back. i'm a big dog guy. >> i would refer you to a study that came out in march of 2005 in emerging infectious disease -- i guess that's the name of the pub ligs, a cdc publication, i'd be happy to get you a copy of it. it's available where they talk about the potential of dogs. it says although dogs can be asymptomatically infected, in other words, they don't get the disease, but they're carrying the antibodies for the disease and this study says asymptomatically infected dogs could -- doesn't say they are -- could be a potential source of human ebola outbreaks and of virus spread during human outbreaks which would explain only epidemiologically unrelated human cases. it goes on and talks about there

are cases in the past in africa where they don't have any idea where the disease came from. i asked dr. frieden about that. he said maybe bats but they still don't know what all the reservoir species are. in a prior hearing when we were here in october, i said what are we doing about animals coming into this country. it was more or less laughed off. but it is a concern. wouldn't you agree mr. eye sacks? >> i do agree. i'll tell you why this is so important, this isn't the flu. this is a disease that kills 70% of the people that get it. if you look at what the disease has done this year, 5500 people dead, 13,000 cases. that's extraordinary. none of us have swam in these waters before. i don't think we can use case studies that come from 1976 to today to make assumptions about an unprecedented event that crosses national boundaries. it's now in mali whek r when you

look at the disease, the caseload may be going down in liberia, but the disease is spreading geographically. we fear very soon we'll see it in sierra leone and it's already been identified in mali. >> i appreciate your comments on that oovmts i liked your term travel management because i do believe we want people to be able to get there to provide human taryn relief like your organization does. at the same time i think we have to be very, very careful. with that, i yield back. >> recognize mr. ton co-for five minutes. >> thank you, mr. chair. state and local health departments and local hospitals serve as the front lines of treatment and containment of infectious diseases in the united states n. the case of thomas duncan, the country saw the challenges faced by local health departments and hospitals dealing with an unexpected infectious disease. dr. lakey, now that you've had some time to reflect on mr. duncan's case and how it was

handled, can you talk about some of the challenges texas health presbyterian hospital faced in terms of preparedness? >> yes, sir. i think the first challenge was to recognize the first case ever in the united states, a rare disease in the united states. everyone is watching what is occurring in africa. to think that that was going to occur in your emergency room on a busy night was a challenge. i think there are a challenge related to the national strategy. i say national because there's experts outside of government that review those strategies on infection control. the assumes that any community hospital can care for an individual that has that much diarrhea, that much vomiting, with that much virus in those fluids, i think was a faulty assumption. it took a really dedicated team to be able to care for that

individual. i think one of the lessons learned was that health care nurses, physicians, they take their responsibility extremely seriously. they showed up to take care of mr. duncan and their colleagues. i think a lot of people were worried that health care wouldn't show up, that health care providers would not show up, but they showed up. i think there was a lesson related to the level of personal protective equipment, and that was changed. so higher level of personal protective equipment. i think we learned that you don't have to wait for a temperature of 101.5 to diagnose the individuals. we lowered that temperature threshold because we wanted to make sure we identified individuals early. we identified them with temperatures of 100.6, 100.8 which by the previous guidelines wouldn't have met the criteria for testing. those are some of the lessons there. >> in what ways could the dallas and the texas state public health departments have been better prepared to handle an unexpected case of ebola or any

infectious disease? >> i think there's several components to that. i think the necessity to train -- i think health departments across texas and across the nation had been preparing. there was a lot of information that we had been sending out, but that's different than saying this is a real event and i have to be ready right now. i think one of the things that we're doing right now, to make sure we improve our preparedness is not only making sure that all hospitals are ready to think that ebola is possible and in the differential diagnosis, isolating those individuals and informing individuals, but make sure there's a system across the state where those individuals then can be seen and be tested before you get to a level of a hospital that can care for those individuals. no hospital wants to be an ebola hospital. it's just hard on your -- getting other individuals into your emergency room, if you're

labeled the ebola hospital. so there's reluctance across the united states to step up and be that facility. but that is one of the things that we're working on right now. >> thank you. dr. gold, as you said in your testimony, university of nebraska medical center is recognized as a national resource for your readiness to provide care for ebola patients. you have successfully treated ebola patients. just last week another patient who sadly passed away was brought to your facility for treatment. can you briefly describe the protocols and procedures unmc had in place that ensured staff was appropriately prepared to care for ebola patients? >> yes, sir. since the unit was stood up in 2005 the staff of between 40 and 50 people have been sustained, and that staff meets on a monthly basis to go over policies and procedures, emerging trends in africa, in south america, et cetera, as well as works closely with the

military through strat come. that team also drills four times a year and they do real exercises in the community with waste disposal, with paramedic transport, et cetera. we also practice donning and dofing, use of various types of personal protective equipment, dialysis, rest to be management, et cetera. all the typical procedures and protocols are not only learned but actually practiced hands on realtime at a minimum four times a year for every staff member. >> thank you very much. mr. chair, i yield back. >> thank you. mr. terry, five minutes. >> dr. gold, what are the costs and impacts of being prepared when you are preparing and practicing four times a year when all of those pieces within the community are also participating? >> the actual out-of-pocket costs have been calculated to be between $250,000 and $350,000 a

year to maintain the core team of nursing support, techs, respiratory therapists, et cetera. that doesn't count the inkind time that our physicians and other leaders put into it, as well as does not count the time of the maintenance of the unit, the air handlers, water supply, auto claefs, maintenance of stock of equipment, et cetera. that's just the personnel time that goes into maintaining the readiness. >> in your opening statement, and i handed this in one of my questions to the cdc, is that for the level of facilities that unmc and emery are and when you train and practice like this, there should be some maintenance funds to offset those costs? >> well, we certainly agree with that. i believe the cdc over time has had a relationship with the