apply them in other responses. we are cop it we can prevent in a bowl outbreak here, and that congress has put us in a strong position to protect americans. to make sure we are prepared as the epidemic has example five, the cdc has done the following -- instituted layers of protection starting in affected countries where our staff work intentionally -- intensely on airports running. on how toded guidance manage sick passengers. along with partners and dhs and state and local health agencies, we continually assessed and improved inbound passenger screening and management. as the president announced, the cdc is working with dhs to

intensify screening at united states airports. this is something my colleagues from dhs will be discussing. we have worked with american hospitals to reinforce and strengthen controls. we have intensified training and outreach to build awareness. we have expanded lab capacity across the united states to test for ebola. we have developed response protocols for the evaluation, isolation, and investigation of symptomatic individuals. --have instance of louis extensively evaluated suspected cases. we remain confident that a bol is not a significant health threat to the united states. it is not transmitted easily, and it does not spread from people who are not ill. it is possible another infected traveler might arrive in the u.s.. should this occur, we are confident we can prevent the

kind of significant transmission of ebola that would lead to an outbreak here in the united states. remember thatt to the only way to protect americans is to end this ebola epidemic and to continue extensive focus on west africa. messagesare, implement . we are determined to stop this one. it will take meticulous work, and we cannot take shortcuts. tonk you for the opportunity appear before you today, and for making cdc's work on this epidemic and other health threats possible. >> thank you, dr. marla. erlin. chairman, ranking member,

distinguished members, thank you for inviting me to speak with you. i appreciate the opportunity to testify on the department of homeland security's role in the management of ebola. testify along with my colleagues. i want to thank the texas state and local officials who will testify later. the hs works closely with the state of texas on a number of important issues. we appreciate their work. is responsible for securing our borders and safeguarding the american public from communicable disease. office of health affairs is at the intersection of homeland security and public health, with a mission to advise, promote, integrate, and enable a safe and secure nation. achieve this by enhancing the health and wellness of the dha --king force and him

protecting the nation. in my role, i provide medical and health expertise. in this capacity, i'm helping to cornett with components and provide them with medical advice regarding the department's efforts in repairing for an responding to a bowl of. -- ebola. this is the largest a bowl outbreak in history. it has had devastating impacts. on september 30, 2014, cdc confirmed the first travel related case. sadly, he has since passed away. the patient did not have symptoms when he left liberia, nor when he entered the united states. but developed them approximately five days after his arrival.

the public concerns surrounding this event and possible future public exposure to ebola from international travels is understandable. although it is important to member that the cdc has stated that the risk of an ebola outbreak in the united states is very low. the president has been focused every day on the government's response. health,tated to senior homeland security, national security advisers that the epidemic in west africa is a top national security priority. dhs takes this issue very seriously. we have been closely monitoring the ebola outbreak since april. we are actively engaged in a bowl a response, working with federal and international partners to develop multiple mechanisms to allow screenings. we are closely monitoring the situation. actively engaged with state and local partners and adjusting processes as needed.

has unlimited methods to eliminate risk. take a layered approach to make sure there are varying the points through which an ill individual could be identified so there is a simple point of failure. to this end, we are also focused on protecting those traveling by air and taking steps to ensure that passengers with communicable diseases like ebola are screened, identified, isolated, and quickly and safely referred to medical personnel. we have been working with the cdc to implement an additional layer of screening for travelers entering the united states, which is scheduled to begin this weekend. these additional screening protocols are just some of the many actions the federal government has taken in our layered approach to help ensure the risk of ebola in the united states remains minimal. rssistant commissioner wagne will go into more detail. but i would like to highlight other key actions that we have taken to date and will continue

to take. they have posted messages from the cdc at select airport locations that provide awareness on how the prevent the spread of infection. typical symptoms of ebola, and instructions to call the doctor if it traveler becomes ill. engages with industry partners and a mystic and foreign air carriers to provide information, reinforcing the cdc's message on ebola and providing guidance. centerrough the national , continues to monitor the outbreak and is producing tailored ebola products. the u.s. coast guard is monitoring vessels known to be inbound from the bowl in affected countries, and is providing information to the captain of the port.

we provide personnel with health including impacted regions symptoms of the virus, and mode of transmission. the department of homeland security has worked closely with its interagency partners to develop a layered approach to ebola response. always assessing the measures we have in place, and will continue additional actions moving forward of appropriate to protect the american people. i look forward to working with you to address any concerns or questions. mr. wagner. opportunity for the to discuss the efforts of u.s. customs and border protection's. more thanwe process one million people into the united states. 280,000 of them enter at international airports.

cbp is responsible for securing the nation's borders while facilitating the flow of legitimate trade and travel that is so vital to our nation's economy. within this broad responsibility, our mission remains to prevent terrorist and terrorist weapons from entering the united states. we also play an important role in limiting the introduction, transition, and spread of serious medical diseases from foreign countries. we have had this role for over 100 years, and is travel and threats change, cdp has changed as well. inhave had modern protocols place that guided response to a variety of signal to get health threats over his and years. cbp officers assess each traveler for overt signs of illness, in response to the reasonable outbreak, -- recent is workingeak, cbp to ensure that frontline officers are provided the information, training, adequate men needed to identify and respond to international travelers who may pose a threat to public health. providedfficers

guidance and training on addressing travelers with any potential illness, including communicable diseases. cbp officer training includes public health training, which teaches officers to identify through visual observation and questioning, the overt symptoms and characteristics of ill travelers. cp also provides operational training and guidance on how to respond to travelers with potential illness, including referring individuals to cdc quarantine officers for secondary screening, as well as training on assisting cdc with bowman tatian of isolation and protocols. provide web-based training covering key elements of blood-borne pathogen exposure control plan, protections from exposure, use of personal protective equipment, and other preventive measures and procedures to follow a potential exposure incident. we are committed to ensuring field personnel have the most accurate updated information regarding the ebola virus.

since the operative again, cdp for your -- field personnel have provided guidance. with numerous and regular updates since then. we provided information on regions of importance, symptoms of virus, and modes of transmission. operational procedures and precautions for processing passengers showing signs of illness will continue to provide our officers -- >> is your mic on? --we will continue to abide provide information on ebola preparedness and response measures. we provide guidance to the field on baggage inspection from travelers from infected countries. proper handling of meat products and handling and disposal of garbage from inbound international flights. information sharing is critical. cbp continues to engage with authorities on the state, national, and local level.

since 2011, we stationed a liaison officer at the cbp national targeting center to provide expertise and facilitate information between the two of two groups.the currentnse to the outbreak, cbp identifies travelers whose travel originated in or transit through guinea, liberia, and sierra leone. starting october 1, cbp started providing a health alert notice to travelers entering the united states from these affected countries. this information notice provides the traveler information and instructions should he or she have a concern of possible infection. in addition -- [no audio]

>> have their temperature checked. they willese efforts, make an assessment. in 94% ofrts rollout travelers from the effected countries. we continue just green for overt signs of illness and all passengers, and will also on all ebola sheets locations the company's effective -- effected companies. officers received turning, we will separate the training -- the traveler from the public, and contact local public health authorities to help with further medical assessment. thewill continue to monitor ebola outbreak, provide timely

information and guidance to field personnel, and work closely with dhs and internation interagency partners to deter the spread of ebola in the united states. peggy for the opportunity to testify today. -- thank you for the opportunity to testify today. >> the chair recognizes himself for questions. like any threat overseas, we would rather illuminate that threat before it can get into the united states. this threat is no exception. overseas the efforts and in africa to contain and control this. part of that effort are flights into western africa, with health care officials to help stop the spread of this viral disease. constituents, and many americans, are asking the question -- why aren't we banning all flights from west africa into united states? i want to give you

the chance to answer that question. >> mr. chairman, i appreciate the opportunity to speak to that. i know it is a concern of many people. outbreak in liberia, guinea, and sierra leone, is now at a point where we may be able to stop it. ande focus our efforts resources on stopping in. needder to stop it, we uninhibited transit into and out of the country. [no audio]

>> out into the rest of the world. our opportunity now is to get the disease at its source. and what we want -- [no audio] >> we work closely with partners in cdc. we work through an interagency process with it. dhs is prepared to take any steps necessary. we want to make sure we defer to public health expertise in this issue to cdc. dr. merlin, you said this is not a significant health threat to the united states. brinsfield, he-- said the risk is very low.

could you elaborate on that, and this deadly, wicked virus is transmitted? >> thank you. as you say, this is a horrible virus. andauses horrible disease people who are infected, it has a high mortality rate. but you know a lot about this virus. experiencem 40 years how to stop outbreaks of this virus. peopleus is acquired by through direct contact from infected individuals who are symptomatically they don't get the disease from contact with asymptomatic.e it is often contracted by people caring for an individual who is infected and sick. is anacquisition incubation. , where the person who has acquired the virus is not him or herself symptomatic.

it ranges eight to 11 days. it can be shorter, it can be longer. when the person develop symptoms, and only when the person to symptoms, is a person capable of spreading the disease to other individuals. .> dr. brinsfield >> i agree. this is a disease that preys on poor public health and infrastructure. we have excellent public health and infrastructure in this country. and bodilyontact fluid contact rather than influenza, which would be airborne. >> that is correct. think a lot of people want to know what what point will we have a treatment or cure, or vaccine for this disease. what's the latest? >> mr. chairman, i will provide a brief overview. there are a number of

investigational countermeasures eithere being made for vaccinating to prevent ebola, or drugs that can be used to treat ebola. [no audio] >> we are having trouble bringing you this commercial committee field hearing on ebola. some technical issues we are trying to overcome. we are taping it, we will have it for you in its entirety later. it looks like we have the signal back, we will return to it live

now. occasional cases in the u.s., and occasional cases in africa now. a method we can use now to attack the outbreak epidemic in africa. what we need to use now is the standard of ehealth message of isolating infectious people so they don't spread the disease to and burialsduals, of people need to be handled appropriately. lastly, dr. brinsfield, they had advisers in the white house to coordinate state and local efforts. that position was eliminated in the current administration. do you know why? and who is responsible for coordinating at the federal, state, and local level? >> we have a robust interagency process. we have been meeting regularly on this issue. we believe very strongly that the different varied expertise

is available are all necessary to come to the table and make educated decisions. >> the chair recognizes the ranking member. >> thank you. when i left the jackson, mississippi airport this morning, the news talked about this hearing. a number of people solemnly, and they wanted to know is it safe? what do i have to have? needless to say, it is on the minds of a lot of people in this country. , ithat extent, dr. merlin think it is important that we can sing off the same page of music. as we push information out. the better off we are. can you provide this committee with how that process works,

from a public health standpoint in notification to state and local earners around the country? -- partners around the country? thompson, i will tell you forthe process works identification of cases. is that which you would like me -- >> that is fine. >> we have worked with federal, state, and local partners to distribute information to health departments, to health department personnel, as well as to hospitals and physicians on the signs and symptoms of ebola. the travel history that is there for ebola. and how to detect ebola infections. on our website, we have provided

checklist for facilities. we provide guidance for facilities and how to do this. we have provided guidance on how facilities and physicians should handle an individual who they think is suspected of ebola, and how they can place them in isolation immediately so they don't infect others. and we have provided testing for ebola diagnostics around the country. we offer 20 47 consultative services through the cdc for people who have questions about how to handle a suspected -- [no audio] >> i want to go -- [no audio] >> two people to come and get treated. [no audio]

>> came and died. the public is trying to say what happened? i think we have to somehow provide a level of confidence to differencethat the is still part of the system. can you help me, if not other members of the committee with a response to that? -- [no audio] >> we apologize for the trouble we are having. once again, we are taping this. we do plan to bring this to you later in our schedule.

in the meantime, megan from role has written a story . the top republican on the senate armed services committee has lifted his hold on emergency ebola funding request, clearing the way for $750 million in fiscal 14 war funds to be shifted to cover the response to the crisis in africa. james and half in oklahoma had been the last holdout after the committee agreed yesterday to million, following a more specific pentagon request this week for a 180 day ebola operation. that is from today's cq roll call. this morning, we spoke with the georgetown university official on the u.s. response to ebola in this country. host: joining us now is lawrence

gostin, director of georgetown university's o'neill institute for national and global health law. what do you do at georgetown? guest: i run the institute, which looks at national and global health law at the law school. i'm a professor, and the director of the w.h.o. center. host: what is the world health organization? what is its mission? guest: it hasn't lived up to its mission, to be the leading global health coordinator for global health around the world. it was the first agency that was put forward from the united nations in 1948. it had wonderful plans. it has failed badly. if the w.h.o. was meant to lead for ebola, this is its failure moment.

it is really very sad to see. it's funding has been chopped. host: it has a budget of about $4 billion. the u.s. contributes $180 million. with that kind of money, what can it do with regard to ebola, and was at currently doing? guest: it can't do very much. it has a budget about one third of the cdc's budget. and it has a global mandate. a couple of years ago, it had a big budget deficit, and it cut back. it cutback most of the epidemic response staff. it is low on staff. it's gone from its days of being a global health leader to really a technical organization. i believe that it has to change, because we need the w.h.o. to lead and succeed.

but it is incapable of doing it. the un security council, the united states military, have really stepped into a gap of leadership. i think that is sad. i want to make sure that the w.h.o. gets much stronger. host: has the military needed to step in? guest: absolutely. i am proud of my country. we have stepped up, much too little, much too late. but when nobody else would. we are now calling for other nations to really send in their health personnel, military personnel. it has gone beyond public health. doctors without borders is one of the bravest organizations. they have been working in africa in 20 years, they have always been against the military. and yet they said, this is hopeless, we really need to get that kind of logistical command

and control, engineering, into our country. the president has obliged. i am pleased to see that. host: it is october 10. the u.n. is holding a meeting today. there is a hearing down in dallas, which we are covering live. the homeland security department is meeting at the dallas airport to talk about responses to ebola. you have the military going over. who is taking the lead on this? is it coordinated, do think it needs to be more coordinated? guest: this question of who is in charge has been a huge problem. the fact is, nobody is in charge. there are hundred of ngo's, governments, it ain't workers -- aid workers.

missionaries on the ground. the government itself is too fragile in some cases, they don't have the stewardship to really be in charge. the united states can't be in charge. they are in liberia, you control their own military. they can't control the chinese military, cuban doctors, anything else. and the w.h.o. doesn't want to be in charge. the truth is, we just don't have incident control, where you have a just ask and clarity -- logistics and clarity. it is fragmented on the ground. host: we are talking about the u.s. and global response to the ebola crisis. republicans, call (202) 585-3881, democrats, call (202) 585-3880, independents, call (202) 585-3882. lawrence gostin is our guest, he is with georgetown university, with a background in law and public health. combining those two backgrounds, legally, what can the u.s. do?

what do you think the u.s. should do to prevent ebola from coming more into our borders? guest: the first thing we should do is deal with it where the tragedy is occurring, at its source. if you can lower the reservoir of infection, the chances of it coming here or to europe will be lower. in the united states, we spend a lot of time talking about travel bans, travel restrictions. president obama and the cdc just yesterday announced they would be screening at airports. there was some very dangerous proposals on the table, particularly from senators asking for travel bans. that would've been disastrous, and made matters worse. i think the president did the most measured thing he could do. he is only going to be screening those passengers originating from one of the three most

infected countries, sierra leone, guinea, liberia. he is to take their temperature. he is going to be asking them a series of questions. airport authorities are. the next day, canada and the uk followed along. i think it is measured. will keep us safe? probably not. fever screening is very difficult. it is a long incubation period. thomas duncan would not have been flagged because he was not -- >> we are going to leave this discussion from this morning's "washington journal" to return to the dallas-fort worth area, the hearing on the ebola. >> i would immediately get in touch with someone in knows the answer to that question.

>> the chair recognizes the gentlelady from texas, ms. jackson lee. >> mr. chair, ranking member, let me thank you both for this vital hearing. i think my colleagues for their presence. i am particularly -- again, i think my chairman and ranking member and i think the two members, several members from this region. i think them for their engagement and participation in this ongoing challenge. thank -- we will see some local officials in our next panel, but i want to thank them now and appreciate the work that their county and out -- all of the local responders have done. thank you to them. and certainly thank you to all of you for your presence here today and the valiant work you have done. was at the, i airport and i raised the red flag, not the historical flag,

as i was able to be escorted from customs and border protection to look at the fine men and women that work there. unitited the containment by cdc. we were told on the day i the cdc team was in dallas. i saw the equipment. i went down to the sub basement to see the equipment -- when i say equipment, the tribeca suits suits, to make sure that the cdc and others have it. i think it is important for the american public to know that we are stopped in airports with in airports with this kind of equipment. but i raised the red flag. i think there was an error made by not designating bush intercontinental airport as one of the sites to have this

enhanced screening. to themade a request president, the secretary, and the centers were disease betrol, and i hope this will responded to. again this is a red flag. this is not hysteria. it is based on the travel that comes into bush intercontinental airport. also, it is not west africa. we must the restraint and how we define it. it is a series of countries, guinea, sierra leone, and liberia. we are interrelated. the president has done a remarkable job and i want to thank him for the 130 civilians, units,you units -- epu and of course the 350 million and another 700 million, i believe, that i hope the congress and all of us will convince the congress to support.

and i especially want to thank the men and women from the united states military that are seen to be on their way. i took the time to speak to some of our medical profession are is harris healththe system. i would like to stuff her moment to join my colleagues in toressing -- i would like stop for a moment and join my colleagues in expressing sympathy for mr. duncan's family. let me relate to you where i think infrastructure and practical application may be two distinct things. we have the greatest health system in the world but are we practically prepared? that is why we're having this oversight hearing. if you have any indication of an ebola patient, without any recrimination, you

clear out a hospital. haitians are not going to come. do we need to put -- patients are not going to come. a we need to put contamination unit? hospitals are saying during the flu season, an average citizen is getting pushback on the ambulances to bring people with those kinds of symptoms. it is quiteicated different, but they are like, similar. do you think it is appropriate to have those kinds of units? do you think they need to be separately placed? question,stand the and no, i think that all facilities need to be able to care for people who present at facilities for care, and we can't rely on individuals to present to selected facilities -- all facilities meet --

go onto the next question and then i have one for mr. wagner as my time comes up. this goes to the two medical personnel. i am told in a survived by nurses, across the country, 80% are saying hospitals have not communicated any policy regarding potential admission of patients infected by ebola. 80% of hospitals have not invited education for the nurses and some hospitals have insufficient supplies. your answer to how you're going to get all hospitals prepared -- and mr. wagner, your answer on airports that are not in the scheme of several airports -- what are your men and women doing, and where do they take these patients if they find they are infected? i thank you. you can answer about this survived by nurses who say they are not prepared. >> that is a concern. to our state out

and local health departments and departmentshospital to see those things are addressed. nurses need to feel they practice in a safe environment and they can deal with patients who are potentially infectious, whether it is ebola or something as >> is influenza. they need to have versatile protective equipment and we will follow up on that. >> where are these persons -- what are you doing in airports that are not in this five members? >> we do need to keep to the five-minute rule. we have 16 members of congress. go ahead and answer. >> any location outside of the five, we will intensify their travel and provide them with an information notice about the symptoms of ebola and where to go for help if they start to develop symptoms or where to go

for additional information. >> thank you, the chair recognizes mr. sanford. >> thank you, mr. chairman. thank you for holding this hearing. thank you to the ranking members. what i am hearing back home is people are very concerned about the disconnect between what they see and what they hear. what they are hearing is it is not communicable. people are relatively safe. meanwhile they are seeing pictures of people coming out of buildings wearing spacesuits and what people are telling me that home is, i do not have a spacesuits. how am i safe? or is a real disconnect in terms of what they are seeing and what they are hearing. i would follow-up on the chairman's point. in,was your words, mr. marl just a minute ago that the disease is "ferocious," andeading exponentially," the largest outbreak ever of

ebola. i asked my staff to look at how we have treated these things in the past and one of the benchmarks they used as the spanish flu of 1918, which killed millions around the world. and the different protocols between new york city and pittsburgh, which at that time were two of the bigger cities on the east coast. new york immediately implemented quarantine. pittsburgh waited a month, and as a result, very, very different result in those respective cities. new york faring quite well relative to pittsburgh. what people would say to me back home is, wait a minute. if this thing is as very let as some folks suggest, why in the let peoplee going to fly from that part of the world -- and this is following from the chairman's question he is getting from his constituents as well -- to this part of the world? what you said a moment ago is we

need uninhibited travel. but the last time i checked, the 101st airborne do not fly on delta. military air can get resources, people, professionals without having civilians go in and out. the second thing you said was, we want to prevent these countries from collapsing economically. i think that overstates the case. from a u.s. standpoint, certainly what happens in guinea or sierra leone is not going to dry up the american economy and from the opposite end, we have had a travel embargo with cuba for 50 years now and it has not crippled the country. it seems to me what a lot of people back home are saying, why wouldn't you just -- if you are over there, we're are not going to issue you a travel visa coming over here until this is sorted out. going back to my colleague from utah's question a moment ago, there seems to be a real mismatch between cdc is saying,

border patrols, health-care professionals -- until that is sorted out, why wouldn't you say let's just wait on travel for right now? are veryssman, those good questions and they are understandable questions. i have to admit i wince every time i see the tv images with people in spacesuits, because it thes an impression about infectivity of the virus. it is not realistic. .t is an overreaction and i think it inflames people's and how ebolaola is spread. doctors without borders is has taken care of ebola patients for years by using established personal protective equipment that does

not include those sort of spacesuits that you see on , without acquiring infection in their workers. so, a little of this -- some of it is unfortunately media driven. as to the difference between the influenza epidemic of 1918 and major there are really differences -- >> i understand, but i see we have gone to a yellow light. we have a couple seconds left. again, prohibition on civilian travel from this part of the world, that part of the world. if you are over there, don't come over here. why not? >> we feel that would cause the disease to grow in that area and spillover into other countries and then spillover more into the u.s. the real opportunity now is to put out that disease there. every travel restriction that

has been placed on travel into that area has interfered with people trying to help not being able to get there. either travel resurgence a reduction in air travel. it is not the u.s. military. people from europe, china, cuba trying to get there to help. make doing what we need to do a harder. that is why we ask for the american people's understanding of that. >> i hear you. i have questions on that, but my time has expired. >> mr. barber is recognized. >> thank you, mr. chairman. this veryou for important hearing today. people back home are concerned and i came here to ask questions on their behalf and get answers. before i do that, i want to extend my condolences to mr. duncan's family and to all of the people in the countries who are affected.

i think the video we have seen on television of the suffering and africa just touches our heart. isnow the united states mobilizing to help. so i commend our men and women in uniform for taking this mission on. i know they will do an creatinge job facilities for health care for the sick. and i want to commend you because you are really on the , how to make sure we control, people coming and you might be bringing this disease to our country. i appreciate what the chairman not earlier about this being a political issue and we have to make sure we avoid making it one. this is an american issue for the safety of the people we represent, and it is an american issue for what we always do so well, and that is help other countries who were not able to

do what they need to do for themselves. and i do hope, mr. chairman, as we look at what is needed here we as members of congress will return after the election fully committed to providing the funding that is necessary to provide the resources that are necessary for and for our men and women trying to protect the nation and address this disease. i want to go to a question that ,as come up a couple times commissioner wagner, how do we control or manage travelers coming from countries that are most affected today? i understand the concerns about stopping flights come up but let i suggest another possible -- understand the concerns about stopping flights, but let me suggest another possible action. would it be helpful to require individuals who are not u.s. citizens or permanent residents traveling from the countries affected to require them to go

through the local american consulate or embassy and their respective countries to get a visa, and perhaps we could implement screening at that location, before people embarq to the united states? could you comment? embarck toe people the united states? could you comment? >> they do have to have a visa. once they get that visa, if they have that disease or illness, upon entering into the united states, as part of our authorities, requiring an inspection process, we will be alert or a sign of illness in a person -- >> may i please interrupt? i appreciate that people have to of a visa. maybe this is a question for the state department. could we not implement at our

embassies and consulates the same screening procedures like you are implementing, perhaps beyond what you're implementing, before they come into our country? it seems we would be in a position- in a better to protect the citizens. >> i would to defer to the department of state. >> let me turn next to dr. m erlin. i want to commend the cdc for taking on this incredible challenge. i am cognizant that unfortunately the cdc has been impacted heavily by budget cuts in the last several years. as i said, we will take a look at white unique -- what you need to make sure the job is done with the resources needed. ermin, i have one question

as time is running out -- is it not possible, and perhaps it is over way -- underway -- to develop a test? could we not examine the person in another way rather than having the disease become apparent? that isessman barber, an excellent question and it comes up repeatedly. we have currently no diagnostic that will detect ebola before an individual -- and current testing may not detect ebola with me -- within the first three days of illness. if there is a patients suspected of having ebola and the first test is negative, we often recommend a second test at 72 hours. i think that is a good challenge

, and it would be very helpful to have a test like that developed. perform on asts to symptomatic individuals is very difficult because you need to find a target that is present in enough -- you need to find something that is distinctive and present enough in the infected individual and the noninfected individual, and that is very hard to do. chairman,ciate, mr. my time is up. let me close by saying i think we need to redouble our efforts in testing. i think it would be very useful in our efforts to controlling this disease. thank you. >> the chair recognizes the gentleman from florida, mr. clawson. >> thank you for coming here today. i appreciate your service to our country. i appreciate how hard you are working to keep us safe. thank you to the ranking member in the chair for doing this meeting, particularly

here in dallas. good job. we have great first responders in our country. parts of my a large life overseas, i just want to say is not comparable to anything i have seen, and i want to congratulate you on that. and really say good job. i am worried now about our first responders going to africa. ermin,st question to dr. m we're going to have 3200 medical troops who are not experts in these mobile labs. my question to you -- are our good samaritans going to be ok here? are they going to be safe? that is the first thing that popped into my mind. i have so many veterans in my district. are our first responders going to be ok to go to africa? the second thing i wanted to ask -- how long until we do have a vaccine? what will it take to get there?

as i adjusted this morning, you saying -- as i understood this morning, you saying this is a fatal infectious disease, up to 90%? and not necessarily contagious like influenza. sounds still pretty deadly. so, how far out is a vaccine? and my question to mr. wagner. you talked about the enhanced efforts and you will get us more information on procedurally what that means. how long until you are there? i remember after 9/11, it took us a long while, it took a while for tsa to really get up to speed. they are a lot better at what they do now then after the disaster. a similar analogy. how long until you are confident there are no holes in the security wall that is your force? if you will answer these questions for me, i really appreciate it. >> thank you some of congressman

clawson. of anyone who we deploy in an epidemic like this is of utmost concern. we are putting people in harms way by putting them someplace they might get infected. we are working with our partner organizations and dod to do the training and provide personal , to keepe equipment infected.m getting our forces are not going to be on a treatment mission. they will not be providing direct care. they will be doing logistical work. but still, it is a concern. we will do everything possible to prevent people who are trying to help from getting infected.

>> i think the goal here is zero. i agree. i agree completely. now i am forgetting your second question. >> vaccines. vaccines. i would prefer that the national institutes of health, which is responsible for overseeing the , speak tovelopment the actual timetables for development. fortunately there are candidate vaccines available that have in nonhumancy primates. but before administering those vaccines to people, you need to be absolutely sure they do no harm to people when you administer them to people and those trouser going on now. -- those trials are going on now. you have to have the trials.

you have to have the manufacturing capability. the agencies are working simultaneously to do the trials and ramp up manufacturing, but nih is better to testify on that and i am. >> these trials and days of crisis, do those trials go to the top of the heap? because there is quite a backlog, as you know. theycan assure you, the have punches at the top of the heap. of diseases,host measles, mers, sars, including the symptoms of ebola. what we are kicking off saturday at jfk is extended procedures about taking people from temperatures and asking them very specific questions about contact with people who have ebola, and working closely with cdc to get that answer affirmative, and getting them into some professional medical

care to address that. all the other locations will continue, too, and we have four other locations, i'm sorry, that will kick off saturday, at some point next week. 40% ofll cover about travel from those locations. in real quick? that means you are doing face-to-face training in the airports with those offers are's, so we will have an updated procedure almost immediately? >> -- with those officers, so we will have an updated procedure almost immediately question my >> we have annual training with all of our officers. our basic academy trading trains on recognizing symptoms of illness. that is ongoing and continuous. we have done that for a number of years, going back to a lot of our pandemic planning with sars

and murders and a lot of other contagious illnesses out there. >> thank you -- thank you. >> the chair recognizes mr. o'rourke. >> thank you, mr. chairman. i understand that there are experimental treatments for ebola and mr. duncan was diagnosed on september 30, but did not receive treatment until october 4. give me your thoughts on that and whether that may have contributed to his death. delay in hiss the receiving the treatment. the people who understand best the decision-making process around whether and when to administer experimental therapies to the patient are really the care team providing care for the patient and the patient's family. we at cdc, our job is to make

the public health officials and the team aware of what experimental therapies are available and how to go about acquiring them. sometimes we facilitate that. but we do not actually -- >> you do not have the authority to order specific treatments. that would be a question that are asked to the care team? >> exactly. >> let me move on. we have talked a lot about airports and what we're doing to screen their capacity training protocols. from a public health perspective, and i'm going to an mr. wagner from operational perspective -- what about other points of entry, seaports and lan ports, from a ports, fromh -- lan a public health perspective? >> we have had a number of cargo ships that have come -- they come in all the time with people who are sick on the ships. and

often the coast guard is sort of the first line of defense on that. they engage with the coast guard and then usually with i believe with c.d.c. and with us to determine what the best course of action is with the person on -- on a ship. this is more complicated because often there's a question of how long the person's been on the ship and where the ship has been and what the person's nature of exposure was. so these are harder cases to deal with, and they're also harder because often the person who's sick on the ship is gravely ill. it's a more difficult situation to deal with. >> and, mr. wagner, what capacity do we have at these other ports to handle potentially infected travelers? >> it's a lot more challenging because we don't have the advance notice of the traveler's itinerary or their arrival. so again, we would be alert for any overt signs of ill

necessary and through our routine questioning -- >> officers at land ports are receiving that training? >> yes. >> know to look for that? >> absolutely, yes. all our officers get that. normal processing of a traveler f. they see signs of ill necessary, they have the contacts with c.d.c. to get the professional advice on what to do and for followup for the traveler. tu berk lows is, measles, any other illnesses. >> my last question, c.d.c. add rs emergency preparedness grants. $640 million that go to all states. what concerns or questions do you have or answers for us about accountability for how that money is spent and used, especially given some of the mistakes made in dallas with the handling of mr. duncan's case? and what recommendations, if any, do you have going forward in terms of additional accountability and potentially additional resources if you feel that those are needed?

>> that's a very good question, congressman. i think we need to assure that -- and steps have already been taken in this patp grant and he hospital preparedness grant programs are well coordinated. and that both grants assure that not only health department but facilities are well prepared for potential and infectious disease emergencies, and that we sort of have a seamless system. you know, the -- prior to about two ago, the grants were administered independently, and now they're better coordinated. but we need to be sure that the guidance is reaching the people in the facilities who will -- who will encounter the patient for the first time, and they know how to respond. and that they are exercised. they're not simply protocols

that are put away. they're things that people know how to do. >> we'll submit for the record some questions that try to get to the root of this, whether that money is being well spent right now or whether we have the appropriate accountability to ensure that we have the training in place, especially given some of the mistakes that were made. would love to get your answers to though. thank you. with that i yield back to the chair. >> the chairman recognizes mr. barton. >> i'm glad to be recognized, mr. chairman. and i'm glad to be a junior member ad hoc of your committee today. >> we're glad to have you. >> you and mr. thomton are holding a good hearing, and i'm glad to be a small part of it. mr. chairman, i want to feed off of the very first question that you asked in your question period. i think this is a serious issue. it's obvious that people are affected by it. it's very obvious that people are concerned by it.

here in the north texas region, it's real. we've had an ebola case, an individual not from the area, who's traveling to the area, has contracted the disease and has died. so it's not academic. first and foremost, this should be treated, i think, as a public health issue. it's not a international diplomacy issue. it's not a foreign policy issue. it's not a civil rights issue. it's a public health issue. in the community that i actually live in, ennis, texas, about three years ago, a teacher contracted tuberculosis, was teaching his class, one of his students contracted the disease. when that became known, the texas department of public health, which is going to testify on the next panel, came in to the school district, interviewed all the students immediately in the class,

quarantined some, monitored some, came down, held a public hearing that i helped facilitate. but that was treated immediately as a public health issue and dealt with, and dealt with in such a way that there were no other cases contracted of t.b. it really doesn't appear to be right now that we're treating this primarily as a public ealth issue. in direct response to the chairman about why we don't stop flights from these countries in africa, your response was was because we need to send team and supplies over there to combat the disease. well, obviously, that's something that needs to be done, but as governor sanford pointed out, you don't have to have commercial flights to send flights into a country. if we were really treating this

as a public health issue, why would we not immediately stop these flights? and then on a case-by-case basis, send equipment and ople as necessary and on a case-by-case basis allow people to come out? why do we have to have commercial flights that, under the best of screening procedures that you've talked about, you're almost guaranteeing mathematically to miss some people. so with due respect, i -- i don't accept that answer. we can't stop flights simply because we need to get people in. do you have a response to that or maybe the doctor might want to respond, too. >> well, i, mr. barton, i will -- i understand and our xperience has been that when

there are interruptions in air travel, it impedes the public health response. there -- there might be work arounds like military transport, that's ifficult and it's -- and right now time is of the essence. >> but let me -- let me -- who makes that decision? is that a presidential decision? is that a secretary of state decision? is that a secretary of homeland security decision? who makes that decision about banning flights? >> sir, i'd just like to point out and i'll defer, that there are no direct flights from those areas. so that it's more an issue of what people are on flights coming from the -- from the intermediate airports. >> correct. so there are no direct

airports. these travelers are going to brussels, ghana, london, paris, and more rocco to come here. and it may just be a couple of people on a single flight of 300 or 350 people. >> but you can still ban it. you could still -- if the gentlemen who came from liberia through -- through, i believe, brussels, he could have been stopped in brussels. or not even allowed the visa to leave to go to brussels. >> and i think that's the most important point, sir s. that point we defer to our colleagues at state. and there's a good coordination process around those questions. >> but my question on the table is who makes the decision? is it the president or the secretary of state or the homeland security or -- who makes that decision? >> sir, i would defer to the interagency process that's ongoing under the president on this one. >> so it is the president? >> i would say that there are many different actions that you've discussed here. one related to visa, one related to flights landing. those are different authorities

at the department -- eye know my time has expired, mr. chairman. could a governor of a state or ould a -- an airport authority ban flights from a particular region or does that have to be done at the federal level? >> sir, most of the rirpts are landing rights airports and they request permission from customs and border protection to land. it's a question for the aret authorities on what business they choose to do or not do. >> so theoretically, d.f.w. airport could ban a flight from -- a passenger cominging -- >> i would have to defer on them on what business decisions they make and which airlines they go to. >> thank you, mr. chairman, for your kurters si. >> thank you. the chair recognizes the gentleman from texas. >> thank you, mr. chairman. i'm trying to understand,

what's the scientific explanation for the response that a travel ban would actually make things worse? >> thank you for asking that question. we have a disease now that we understand how many -- the range of how many people are infected. and we know how many people will be infected next month if nothing is done and how many people will be infected by the end of the year if nothing is done. and we know the size and the scale of the international effort that is required -- it's -- it's a remarkable international effort that is required to stop it. and we know -- we have good projections on how much delay will -- how many deaths will be caused by delay. and we are very afraid that

things that are done that impede travel will delay the interventions that -- that prevent the progression of the disease. and if the disease progresses to the point that it can't be stopped, it's going to spill over into other countries and create a greater threat for the u.s. so, we feel that understandably the notion of stopping travelers now might prevent a traveler from arriving in the u.s., but we know we can prevent an outbreak from that. but the greater risk is that by delaying stopping the epidemic in guinea, and liberia, you create a much larger epidemic that is impossible to control. the disease becomes endemic in africa and that we're dealing with this for -- for the foreseeable future, that we can't stop it. what we want to do is stop it

right now when we -- with -- we know how to do it. we just -- we have the resources there to do it, and we don't want to do things that would impede that. >> it seems to me that there's two great risk e. and that is spread of the disease outside those three countries and then following up on a point mr. wagner was making, from the flight standpoint, from people that are traveling from those three countries anywhere else, what kind of international coordination are we seeing? and i was wondering if you could maybe give us an idea as to -- i mean, who else is -- who else is helping us? how -- what is the international community doing to stop the spread of the virus into the other adjacent countries and from going to airports like brussels and any other point in between? >> i -- i can tell you from a public health perspective,

c.d.c. regards this as a very high priority. e have 140 -- over 140 individuals deployed to not but uinea and liberia, neighboring countries, where they are training, involved in working with the ministries of health and training individuals so that they know how to detect disease early and engage in contact tracing and break the transmission of disease. so what we want to happen in those countries is for them, when the disease -- when an ember of the disease lands in their country and starts a fire, for them to be able to quench the disease as quickly as possible. and that's the sort of public health approach -- i don't know about the air travel issue. and i defer to my colleagues. they may know about the coordination of air travel. >> the response is well

coordinated under the united nations and hos been for several weeks. and i would defer questions on followup on the international response to them and their department of state partners. >> let me ask you this question. aside from the hemorrhaging, the symptoms of the virus appear very similar to any severe flu. are there any other distinctions? >> in clinical presentation, early clinical presentation, no. it's unfortunate that it has the name of viral hem rajic fever because only a minority of patients develop bleeding symptoms and that is late in the course of the disease. so early in the course of the disease, the first three days s -- it's a flu-like ill necessary. it's fever, malaise. there's nothing about the clinical presentation that would make you know it was ebola. after about three days, there's

usually profound nausea, vomiting and diarrhea, and that's what my colleagues and i, when we hear stories about people presenting, that's what really raises the flag that this might be ebola. so the travel history and exposure history are very important to influence with the early symptoms to understand where someone might actually have ebola. you can't tell just on the symptoms alone. you need more information. >> thank you. >> the chair recognizes the doctor who actually practiced at presbyterian hospital. >> thank you, mr. chairman. i thank the panel for being here. i appreciate you all spending time with me on the telephone earlier this week. it was very helpful. and i'm sure we'll continue to have discussions as this story evolves. we're appropriately respectful of the passing of mr. duncan. i think we also ought to acknowledge the passing of

patrick sawyer at the end of july. mr. sawyer was a -- was an individual who worked in liberia, commuted to there from his home in minneapolis. and after attending his ill sister in liberia, flew on to lagos and before he could board the plane back to minneapolis died of ebola and could have been patient zero two months before we had the experience here. so, dr. merlin, i guess my question is i'm sure they'll be expert reports on the case that occurred here in dallas. did you do any study what might have happened had patient zero arrived in minneapolis on july 30? >> congressman, i'm not aware of that. and i'll have to get back to you on that. i don't know. >> the reason i ask the question, it was put pretty clearly, you had a situation at presbyterian. a nurse does an intake

evaluation, and apparently some travel history is given that perhaps provided a really important clue that then was subsequently lost in all of the activities involved with treating the individual. from the c.d.c. standpoint, are you concerned at all with the directives and missives and action alerts that you have been putting out for months, somehow they weren't getting through to the frontline, to the people at the tree only desk? because really there was only one response. i'm here for a fever and a stomach ache. i've traveled from africa. put down the ipad. go through that door where the two men in moon suits will meet you and walk you into an isolation unit. really, that's the only response s. that not correct? >> congressman, i agree with you. as someone who has worked in a

hospital and an emergency room, things you know that in retrospect are often a lot clearer than they are when patients present. >> but from a c.d.c. perspective, you put out these directives to the hospitals, to the people on the frontlines. you got to be, you know, this is not the flu as usual. you got to be thinking about this. and if i'm at c.d.c., i have to be concerned that that message did not get down to the frontline. not to be critical of anyone. not to be accusatory of anyone. but the message didn't get to the frontline. what are you going to do now differently to make sure that message does get to the people on the frontline? because that's really the critical part that was missed. >> i -- i -- i think what we need to do is to work with regulatory organizations, like the joint commission, to be compliance with reparedness is a higher -- a

higher priority and that when -- when facilities are accredited that it is something that is looked at critically and they look at whether the frontline staff has -- is trained on these things. >> i would just offer that business as usual may not get it. because this is no ordinary time with what we're dealing with. now, two airlines, air france and british airways stopped going to monrovia in summer, i think in august. so they just simply on their own decided they were going to stop service there. i know people have asked me, the president actually suspended air operations through the f.a.a. into the airport in israel for a while this summer while there was some bombing going on. so we know that authority exists. ok, mr. thompson provided this nice graph. and doctor, you'll recognize this graph. this is a classic growth curve. you've got a lag phase. you've got a log phase. the log phase, the phase of

growth, the exponential phase. and in two countries at least, ate pierce that they are in the log rhythmic phase. dr. fauts said at another hearing a few weeks ago, that when you get to exponential growth, exponential always wins. o my question is where on this is the fit -- where on this line is the threat matrix such that you would recommend to the president we have got to do something different and we have got to stop this disease and not allow it to be imported to our country? because this doesn't come in, it's not like pandemic flu. you can only get ebola if you go get it and then bring it home. so where is the point on this graph where that would occur? >> we are already at the point where we believe that all stops need to be pulled out in preventing the growth of the

disease in africa. and that can really -- and that's what we need to focus on. because the risk in this country will not be eliminated until we eliminate the spread of disease in africa. and i think the -- the crucial -- that comes down to the crucial point, is that we will ot be safe until we -- we stop the growth of that disease because it has now infected so many people. and it is reproducing so ickly that it will inevitably, unless we stop it, it will inevitably become endemic and i will inevitably be a greater threat. so i think the president's already taken the message out to the american people and to the u.n. that this is the time

right -- the opportunity space is right now. >> i know my time is up. with all due respect, i disagree with you. i don't think the president has put a significant amount of importance on this. i'm not sure he's said this is the time of zero defense. we've got to do everything perfectly. doctors without borders, that's been their experience. they have a low infection rate because they do everything by the book every time. and we need to do -- we need to adopt that same attitude here. thanks, mr. chairman. you're very kind. >> the gentlemen's time has expired. the chair recognizes the gentleman from california. >> thank you, mr. chairman. what i've taken away from this hearing and what we've learned over the past month is we have to fight this aggressively, most importantly over in the countries involved in west africa. two, that we have to be prepared here locally, whether it's the airport screenings that take place or the hospitals that are ready, and also, three, that we have to

bus some of the -- bust some of the myths out there that i think is creating unnecessary hysteria. so i want to first start with what we can do here localry with the airport screenings. and mr. wagner, we know that every day about 1.75 million people are in the air in the united states. e have about 100,000 pilots, 95,000 flight attendants who are on the frontlines, who would be exposed to this. and i think some good questions are rightfully being asked. and so one of my concerns, although we have five amptse that are now going to have intensified screenings, what would happen if somebody were to fly from, say brussels to dallas-fort worth airport and then, like many foreign travelers, stuck around in the united states for two to three weeks, and went from dallas-fort worth to say, san francisco international airport, and that's not one of the five designated airports. would that person who perhaps

did not present symptoms at d.f.w. but started to present symptoms as they went into san francisco, is there anything there that would allow us to screen that individual? >> well, customs and border protection is only going to screen them on their initial entry into the united states. so when we see them coming into d.f.w., we would identify that travel has having originated in one of those three areas. we would have provided them the information notice about symptoms to watch out for and where to go and seek help. the information notice also has a message to the doctor that they can provide. but then we're relying on that person -- wherever they travel within the united states f. they start to develop those symptoms, they need to go get the proper medical care and get the medical authorities to make that determination. is it ebola or is it the flu or is it something else? >> sure. dr. merlin, as far as our local hospitals, i'm having a conference call with all of our hospital officials on tuesday, and what are we doing to reach

out to them to make sure that they know what to look for if a patient comes in and has been traveling to some of these west african countries and is presenting symptoms? we've been commuing with -- communing with hospitals with a variety of mechanisms. we have an health alert network that goes out to thousands of facilities and providers in the country. we've been working with our state and local partners to reach out to facilities and physicians. we have a -- a regular conference call called the coca call, which is a clinical outreach call where i believe one of the ones recently on ebola had about 6,000 participants on it. and we've been working through

the medical societies. there were a lot of presentations. this is infectious disease week, and the infectious disease society of america just had its meetings, and there were a lot of presentations on ebola. and we have a large group in our emergency operations center that regularly now is having outreach calls to either individual hospitals that want questions answered or professional groups that want to have questions answered. we've had conference calls from, you know, single facilities to large groups of facilities, trying to help them with their preparations. >> and, dr. merlin, my colleague, mr. barber from arizona, alluded to the c.d.c. budget. and budgets reflect priorities and values. and i think the numbers around the c.d.c. budget over the past few years reflect that prioritizing public health and addressing worldwide health emergencies have not been our top priority when it comes to the numbers.

from 2010-2014, c.d.c. budget has steadily gone down. from 2012-2013, the program level for the c.d.c. was cut by $293 million, which included $13 million in cuts to our efforts to prevent and respond to outbreaks of e mrging infectious diseases. is today's funding level for the c.d.c. adequate to address the worldwide splet and what could happen here in the united states? would you like more? and if you had more, what would you do with it? >> that -- the response to that, i will defer to the c.d.c. director and h.h.s. i'm not in the position at c.d.c. where i really understand and participate in the full budget formulation. >> has your budget been cut since sequestration? >> the budget for my division is about -- i just have to -- i'll have to get back to you on that. it has not been -- it -- there

-- my budget comes from multiple different sources. and i'd have to get back to you on that. >> sure. thank you, mr. chair. and i yield back. >> the chair now recognizes the gentleman from texas. >> i'd like to thank the chairman today for holding this hearing, and welcome all the congressmen to my district. this is the heart of my congressional district. it's the economic hub. thousands of my constituents come to work every day in this district, and as you know, five million international travelers come through this airport every year. so, in response to that, i'd like to submit for the record a letter to the honorable jay johnson that i made this morning asking for dallas-fort worth international airport to be included -- or added to the list of five airports that are going to have the increased

screening. >> without objection, so ordered. >> thank you. are agner, there approximately 13,500 people from the affected areas that have traveled -- travel visas that are active at this point. what federal agency is responsible for knowing who those 13,500 people are and the status of their travel? >> well, the department of state issues that visa. so they would be responsible for who has them and under what conditions. customs and border protection would encounter that individual when they arrive to the united states and part of what we determine in that inspection process is does that person intend to comply with the terms of that visa? and then are there any grounds for inadmissibility such as an

illness that would prevent them from coming in? >> so if we indeed are at a critical point in containing this disease, don't you think it's important -- or wouldn't you think it's important that there be some identifiable base of people that are -- that have come through customs and border control that are in the united states or have traveled in the united states that have presented their passport, have been questioned, have been screened, and so that we have some idea of what the number is. and you areany people and you this is an effective? -- how many people could this possibly have ineffective --

affected? dfw airport is not usually the primary point of entry for these countries but as most people across the country know, if you go anywhere in the united states you will have to go through dfw airport. thisnk it is critical at point that we understand that people are coming in to jfk and coming in to newark and these other five entry points and staying one or two or three weeks or four weeks and then they are coming through dfw airport and going all over the country. think this is a key place where we need to have an active program or screening going on. do we have a cdc facility that is close? are we one of the 20 areas where

center >> we do not have a staff so the. we may have a physical space but it is not currently staffed. >> i would like to request that dfwcdc strongly consider airport as well as george bush .nternational in texas >> for the record along with sick -- tonyn, tothe the secretary with the same request. that asld concur with

well. >> i yield back. ms.the chair recognizes johnson. >> thank you. usual appreciation for all the people who are here and all of the respond ease to this particular crisis. concern reallymy ofl center on the details why we are in this position. it would seem to me i know that cdc had put protocols and every major hospital in this country. for number of weeks prior to this happening. do so no matter what else we we have got to depend on people that we question and whether or not they give the correct

information. about takingg temperatures and i do not know what other type of interrogation that they will have. that we seem to me here and plan for the expenditure but look very closely and what we have in .lace already i do not know what questions were asked when this man went to the hospital the first time nor do i know what temperature he had. that much of to me what we are worried about right now could have been eliminated. because the protocols are in what and i do not know

happened with the protocols. do, tomatter how much we look at every person coming in this country, we have got to carry out our own written protocols when they get here. and so i am concerned about us sitting here and thinking about the elaborate things we can do to make things better when we know we are not going to pay for it when we go back to washington. we have not yet. we do not have any money. i am concerned that we not get too much pie-in-the-sky in planning but rather utilize what we have in place. was there any falter in the protocols that were in place? >> in terms of the adherents to

protocols and what should have cap in presbyterian hospital, i really differ to the hospital itself and the local health the onest, they are who are responsible for reviewing that. i would not want to say because i do not want -- i do not know the details but i want to say to your point i think it is important to move from things like protocols to things like checklists where every patient in order to process through the facility, there has to be a checklist and they have to check off & whether they have done this because that takes the a firml and makes it responsibility and for things important like this, we really need to do it.

that is one approach that do not think as much in the way of burden and assures better compliance with recommendations. >> thank you. , what are we going to be doing differently than what we did when the patient and her not askntry, did we questions? >> if he were to enter through dulles will have identified him as traveling from one of the affected regions. we would have given him a questionnaire to fill out that we were with cdc that talks contact information, health status, do they have any mostoms in place and importantly in this case, have they had any contact with anyone that has had ebola? referred them to --

refer them to a medical professional to have their temperature taken. if they need any professional medical review we would coordinate with cdc on-site to have that. >> can it not be assumed that someone comes here from iberia -- liberia, that they have been in contact? >> no. our questions about contact really have to do not with being around in an area that is infected but really particularly contact,omeone has had exposure to body fluids, have they had a splash of body their, have they with unprotected hands, touched body -- a person they

who was known to have ebola, have they been for an extended period of time around someone who was known to have ebola? one of the things that we know about the disease in places like is patchy.it there are places where there is a lot of disease and there is places where there is very little disease and our strategy out there is to prevent it from becoming spread all over the place. -- we wouldnk it is not say in our public health language that everyone from those countries who had people from those countries had contact. >> how would you determine in origin, if you cannot assume or at least act as if, it is a possibility coming from those areas where it is prominent, how would you draw the line from

where they are coming from? >> your question is excellent and it ties into the question earlier about the tests for a simple -- symptomatic disease. there is no objective tests, we the examination of the visual, looking for the person trying to tell whether the person might be ill and the persons answering a series of questions to see whether the answers make sense. that is the nature of the examination. >> thank you. it reef.e we can make >> it depends on how the people answer the question. >> thank you. my time is expired. >> he did not reveal he had been in contact with the ebola virus

in liberia. is that correct? >> i am not sure if he was aware. >> he did not truthfully answer the question on the exit screening when he was asked if he had exposure and it turned out he had exposure. >> thank you. of quickve a bunch questions and if you could keep -- aanswers short so i can lot of this follow-up on other questions, i do want to say that i do not think we are doing enough. this disease gets a foothold we take away the haveostic question if you been in these affected countries. i do not think we are doing enough. let me start with you. we would pick five airports. we have learned that mr. duncan was less than truthful on his screening. we have announced to the world

of what airports not to go through if you want to come to the united states because we have better treatment. we maybe do something like funnel people who have traveled in one of these countries, through airports, is that a step in the right direction? i think banning all the flights is the right step. but funneling and screening. >> i do not know if we can do that. it relies on who the airlines choose to bring to us. >> we do not have the authority to say you can only come from the sport. >> i do not believe so. >> that is something we might be able to fix. you talk about how you have the authority to stop people for health reasons. how often does that happen, you stop one person today. i do not ever hear about it on

the news. is it a frequent occurrence, you stop people? >> we have a million people coming in every day. i would say it is not frequent but it happens several times a week. than in onea less million chance. >> it is who we have been advised that have a communicable disease and we get information and put it in our system and recognize that and stop them. --even now someone can someone who is not showing symptoms is going to get through. >> if they are not showing any overt symptoms it is tough to recognize that they would be sick or have a disease that is yet to emerge in them. i am not sure -- >> i understand, i do not want shed all my rights to international travel anymore than anyone else does. we have the obvious countries

that we need to be suspect of and short of an absolute travel ban on these countries or anceling commercial flights, interim step is substantially enhanced screening and maybe follow-up screening every few days after they arrived. you are nodding your head. i have a couple of questions for you. i am sorry if i am skeptical and some of the things you're saying. and myrican people constituents have lost trust in the government for variety of reasons and i do not want to bring politics into public health. we have the lowest level of trust in government i think in my memory. add to that every outbreak novel or zombie movie you see starts with someone from the government sitting in front of a panel like this saying there is nothing to worry about. member thet your first two ebola patients that came back to the united states or american doctors who became

infected who had all the training in the world and they were able experts. my constituents and to some degree i am a little skeptical of the statement, if you take the precautions, it is difficult to get. how did these doctors get it, american trained doctors, how did they come out in the first place if it is that difficult to get and if our health care workers are safe? what ime clarify for you said. -- for people who are health care workers, who are putting themselves in an environment where there are patients known to be infected copiousla, who have body fluid in the environment that carry the virus that people

have to practice scrupulously known procedures for preventing acquisition of the virus. it is a dangerous environment into which to work. it can only be done by scrupulous adherence to those precautions and caretaking measures. for outside of those environments, when you are talking about a situation like we have a very sophisticated health-care system and a sophisticated health-care system, when we identify a case, we are capable of doing what we have done with mr. duncan and we would do with any future case is assuring in collaboration with local and state health officials community,e hospital

the case is isolated and treated and quicklyct identified and aggressively identified. if contacts are not reliable, steps are taken to be sure that the contact can be followed. if there temperatures are monitored and if they should he come symptomatic, they are immediately hospitalized. we know this works. work -- it works in the u.s. and it worked in nigeria and it worked in senegal. we can stop cases like that. i think the difference between -- hopefully the difference between the zombie films on this testimony is this is real. >> i hope so. i see my time is expired. i wish you the best of success in your efforts to contain this

in africa and america. thank you. i want to ask dr. merlin question. a second ago you said it appeared that mr. duncan may have deceived the screeners at the airport. i'm looking at this memo that was prepared for the committee. let me read you this and see if there is something that needs to be clarified. although it is believed that he contracted the virus while helping a pregnant woman to the hospital, the woman's family told neighbors she was suffering from malaria, a disease with similar symptoms, not ebola. there is no proof he intended to deceive airport screeners on his questionnaire. is a fair question and relook at theto

questionnaire to see what the language is. myself and there is no way to know, no way to ask .r. duncan i am skeptical that with ebola well-established in monrovia, and i believe this woman he assisted was being taken to an ebola hospital for treatment of ebola and she was turned away, this is my understanding. try to find out. i am skeptical that he actually thought she had malaria. point, our question maybe if we're asking if he had been exposed, the question may have to be, have you been exposed to anyone who has died of an infectious disease in the

last period of time. we need to make sure we are not permitting, overly permissive and the questions. -- in the questions. >> let me give your -- get your opinion on how the disease is spread. is he your opinion that it would be highly unlikely that the disease would be spread through if someonetum or sneezed or coughed or for instance in airline travel, bodily fluids inside a laboratory? advance ebola disease, all body fluids are highly infectious. for someone with advanced disease, i think all of those materials would be highly infectious. >> including coughing and sneezing. that you --not be

you have to get the splatter into your face, into your eyes for it to be infectious. i want to emphasize that people exitre traveling, on screening, they have had their temperatures taken so they are asymptomatic when they board the airlines. they are not going to develop advanced disease on the eight to 12 hour or 18 hour flight. there is no risk that is going to be an exposure on an aircraft of someone with highly infectious bodily fluids like that. that is not going to happen. >> if someone could transmit ebola through conversation and you do not have a hazmat suit. putum thats spit or s

is put in someone's eye which happens in normal conversations, would that be a way to -- >> people who are in close contact with someone with advanced disease are at risk. i want to emphasize that people who have no symptoms pose no risk to anyone so the asymptomatic individual who speaks poses no risk. someone who develops symptoms early in disease which is the fever and flu, they are not highly infectious. it is only late in the disease as you are caring for someone who has advanced disease and they cough on you and they get the fluid in your face, yes, that is a risk. >> one more question. should we concerned about other strands of the virus? several species of

ebola virus. we are dealing with ebola zaire. concerned need to be in africa about all the other species where they are, and other outbreaks of ebola zaire to be sure that they are contained. can cause or most of them can cause very severe disease. concerned need to be about the other strains. >> thank you. >> we thank the witnesses for their testimony. this has been very valuable to the american people and we support you and wish you all the best in your efforts to control and contain this horrific virus. this panel is now dismissed. clerk will prepare the witness table for the second panel.

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short break in this health field hearing. the house homeland security holding this hearing dallas-fort worth

toa in the u.s. response ebola. also, thomas duncan, a liberian been mentioneds during this hearing, he was the first patient diagnosed with the ebola virus in the united states. he died earlier this week in a dallas hospital. we expect this hearing to resume shortly. coverage here on c-span.

>> in a moment, we'll resume our live coverage of this hearing on ebola response in the united states. the associated press is offering firsttory from the american who had flown back to the u.s. for treatment to ebola. he is urging calm for the people of dallas and elsewhere worried about contracting the deadly disease. dr. brantley tells alumni magazine that people should be finding ways to help the hardest-hit countries to cope and not outbreak worried they're at risk because a hospital miles away treated a patient. the ebolatoll from outbreak is now more than 4,000, with the vast majority of the in three west african countries.