full protective measures under the cdc protocols, so we don't yet know precisely how or when they were infected. but it's clear there was an exposure somewhere sometime and we are poring over records and observations and doing all we answers.nd the you have asked about the on july 28 an infection prevention nurse specialist at texas health received the first centers for disease control and prevention health advisory about ebola virus disease. and began sharing it with other texas health personnel. the health care advisory encouraged all health care

providers in the u.s. to consider e.b.d. and the diagnosis of febral illance on the other fevers and persons who had recently traveled to infected countries. the c.d.c. advisory was also sent to all directors of our emergency departments and signage was posted in the e.d.'s. on august 1, texas health leaders, including all regional and hospital leaders and the e.d. leaders across our system received an email directing that all hospitals have a hospital emergency policy in place to address how to care for patients with ebola-like symptoms. systems. the e-mail also drew attention to the fact that our electronic health record documentation in emergency departments included a question about travel has treat to be completed on every patient . attachments to the e-mail included a draft emergency policy that specifically d, a poster, and a cdc advisory from 7/28.

of u.s.st 1 guidelines patients suspected to have the disease was the ship is to staff, including the physicians and nurses on august 1 and august 4. over the last two months, the dallas county health and community services department indicated with us for a possible case of ebola. we have also provided the august 27 thousand county health department, rhythm and screening questionnaire. at 10:30 p.m. on september 25, texasncan, presented to health, emerge with a fever and1,0 with nausea headache. he was examined and underwent numerous tests over a time of four hours. hisng his time in the e.d., temperature spike to one of

three. it later dropped to 101.2. he was discharged early on the morning of september 26 and we provided a timeline on the n's initialr. dunca emergency department visited on september 20, he was transported to hospital on the ambulance. he met several criteria of the ebola outdoor them. the cdc was notified, hospital in texasall cdc department of state recommendations in an effort to ensure the safety of patients, hospital staff, volunteers, nurses, decisions, and visitors. perfect if equipment into the water-in per meal counts, high protection and gloves. since the patient was having diary, shoe covers was shortly thereafter added. we notified the dallas county services department and their infectious disease personnel arrived shortly after. 30, ebola wasth

diagnosed. later that day, cdc was notified, and they arrived october 1. >> doctor, one moment please. we are going way over time. we want to hear some details, but could you wrap up, because a lot of members want to ask you questions. >> ok. >> thank you. >> thank you. i would like to underscore we have taken all the steps possible to maximize the safety of our workers, patients, and community, and we will continue to make changes. we are determined to be an agent of change across the u.s. health-care system by helping our peers benefit from her experience. lo has a long history of excellence. thank you for the opportunity to

testify. each will be recognizing person on the committee for five minutes of questioning. we will keep a strict time on this. let me start off here with dr. frieden, a second nurse took a flight to cleveland after she registered a fever. we have reports she said she told she cdc and was could fly? >> my understanding was she contacted cdc. >> were you part of that conversation? >> no, i was not. >> was there a plan that limited the her contacts with other citizens? >> the protocol for people moving and monitoring people who are exposed to ebola identifies as high risk someone you did not wear appropriate her some protective equipment during the

time they care for a patient with ebola. what specifically did she tell you? uncan's team was not under the same observation, so what did she tell you her systems were? seen the not transcript of the conversation. my understanding is she reported no symptoms to us. >> another question, quickly. regard to the new patient being transferred to nih, will people come into contact with her be under travel r restrictions? >> according to the guidelines that the people who will be coming into contact with her will be physicians, nurses, and others who will be in personal protective equipment. therefore, they are not restricted. >> why is she being transferred?

>> to get the state-of-the-art care in a containment facility. conditionr deteriorated or improved? >> she has not paid at this point from the report we are getting from dallas is her condition is stable and she seems to be doing reasonably well. i have to verify that myself when my team goes over there. >> if other people come to dallas, will they also come to nih? >> we have a limited vast database of being able to do this level of care in containment. our total right now is to bed. she walked by one of them. phone, we spoke on the you remained opposed to travel restrictions, he said cutting commercial ties will hurt these fledgling moccasins. is this your opinion, or did someone advise you, someone within the administration, where did this opinion come from that

is of high importance? >> my sole concern is to protect americans. we can do that by continuing to take the steps we are taking here as well as to-- >> did someone advise you on that, someone outside of yourself? >> my recollection of that conversation is that that discussion was in the context of our ability to stop the epidemic at the source. >> but we can get supplies and medical personnel into the ebola hot zones, so stopping planes, and i have heard you say this in multiple occasions, we have 1000-plus persons per week coming out of the united states from hot zones, am i correct on that -- coming from those areas? >> there are approximately 100 to 150 per day. impactsuncan case dallas and northern ohio.

my understanding is bringing ebola cases into the united states, clearly, you have determined how many infection raises the u.s. public can handle. nih can handle two of these beds. do you know how many across the country? >> our goal is no -- >> i understand. as long as we are not partying people, we still have a risk. these issues of surveillance and containment i do not understand. this is the question the american public is asking. why are we still allowing folks to come over here and once they are over here no quarantine? >> are fundamental mission is to protect millions. right now we are able to attract everyone who comes in. >> [indiscernible] my concern is the american people say they are not limited from travel, not 14 421 days because they can still show up

with symptoms, still bypass questions. and this is what happened with the nurse who went to cleveland. so i'm concerned here, is this maintainbe a position of the administration that there will be no travel restrictions? >> we will consider any options to better protect americans. degew five minutes to ms. tte. >> thank you. i have question for you and i would appreciate yes or no answers because i have a lot to move through and only a short time. dr. frieden, and the spring of 2014, ebola again spreading to west africa causing concern within the international public health community, correct? >> correct. >> beginning often with a fever, correct? >> between two and 21 days.

through is contracted bodily fluids, and the virus concentrate more heavily as the patient becomes sicker, presenting increasingly greater risks to those who may come into contact with them, correct? >> correct. >> the cdc has developed guidance if haitians consistent with ebola symptoms and has distributed them to hospitals in 2014, correct? >> correct. varga, your hospital received the first health advisory on july 28, and this advisory was given to the directors of your emergency departments and signage was posted in the emergency room, is that right? >> yes. >> was this much information given to your emergency room personnel, and was there any training at texas respiratory and for the staff at that time? yes or no? >> it was given to the emergency

department. >> was the actual training? >> no. hospitalust 1, your received an e-mail from the cdc specifying how to care for ebola patients, and advising intake or smelled asking question about travel history from west africa him is that right? >> is correct. >> on september 25, almost two months after the first advisor received by the hospital, thomas duncan showed up with a fever that spiked up to one of three and he told the personnel that he had come from liberia. despite this, the hospital sent him home, is that right? >> not completely correct. >> they did send him home, right? >> >> that is correct. three days later on september 28, he took a severe turn for the worse. the hospital staff and everybody else wore protective equipment, is that right? >> correct. >> eventually put shoe covers

on. do you know how long that took? >> i do not. >> because ebola is highly contagious when the patient is symptomatic, the protective gear has to shield them from any contact with bodily fluids, is that right? >> correct. >> i have a slide i would like to put up, and i got it from the new york times, the photo of the people in the various protective gear. the first one on the left shows what they are supposed to wear when they come in contact, when they are not having contact with bodily fluids. the second one shows what they are supposed to have with the bodily fluids. i want to ask you, dour . varga, if what they were wearing at first, the first set of protective gear? >> i cannot see the picture right now. >> i was told you would be able

to. after frieden, what should they have been wearing of that protective year before the?ebola was diagnosed >> i cannot make out details, but the recommendation vary as to the risk him including whether the patient is having fiery or vomiting and they exposed health-care workers -- had diarrhea and vomiting. in your testimony, people should have been completely covered, is that right? >> i would have to look at the exact the deals to know what the answer is. >> so your position is they should not be completely covered if -- >> if they had diarrhea and vomiting, additional coverage is recommended, yes. >> my other question i want to ask him and i am going to have to get dr. varga's testimony since you cannot see my chart.

subsequently, a number of people, health-care workers, were put into this group, this particular, is that right, dr. frieden, people who were being monitored? phan wasr 10, nina admitted? >> yes. >> october 13, amber, was ted with a fever and told she could board the plane. >> she did contact our agency and she did board the plane. >> she said she was told to board the plane. say evilst 22 protocol who are being monitored should not travel by commercial conveyance. >> [indiscernible] >> that is what they say. >> people who are in what is

movementntrolled should not board commercial airlines. >> and that is people who have had close contact with these patients, right? that is what your guidelines say? >> it says health-care workers with appropriate equipment do not need to be, but people without personal protective equipment do need to travel by control transfer -- >> mr. chairman, i just asked for the record the interim guidance dated october 22, august guidance dated 1 -- >> without objection. we need you to get back to the committee to follow up with her question, because your comments you just made to us was that if she was wearing appropriate protective gear, she was ok to travel. if she was not, she did should not have travel.

and you told us we do not know. we need to find that out. you, mr. chairman. i think most americans realize you have 21 days. if you go beyond 21 days, your virtually of no risk of ebola. is conceivable that after 14 or 15 days you in fact can still get ebola, as i crept? >> yes. >> i want to go back to the restricting of travel, particularly by non-u.s. citizens, these 150 folks a day into the u.s. from west africa. the conditions as you talked about, exit, screening, all there are exit screens, so it is perfectly conceivable that someone after 14 days can exit screen, they are ok, no fever, and in fact get to their

destination, perhaps in the united states, and have the worst, is that right question mark >> -- is that right? >> yes. >> the fundamental job, to protect the american public, the president does have the legal banority to impose a travel because of health reasons, including ebola. is that not correct? >> i do not have the legal expertise is a question. >> i selling which earlier today. we can share that with you. he does, from what we understand, and not only an executive order that former president bush issued when he was present, but also the legal standing as well. if you have the authority, and it is my understanding again that a number of african west africa,und

around these three nations, in fact have imposed a travel ban from those three countries into their country. is that not true? >> i do not know the details of the restrictions. there are some restrictions. >> it is my understanding they and including jamaica, as i understood in the press, has issued a travel ban from folks coming from west africa. are you aware of that? >> i do not know the details of what other countries have done. i know some of the details and some of them have been in flux. >> i guess the question i have is if other countries are doing the same and as you said the fundamental job of the u.s. now is to protect american citizens, why cannot we move to a similar ban for folks who may or may not have a fever knowing in fact that the exposure rate 14 days or 15 days is well within the 21

knowing the 150 folks coming a day, not 100% -- 94% in terms of screening from me. airports >> it seems to this is not a failsafe system has been put into place >> thus far. may i give a full answer? >> i look forward to it. >> right now we know who is coming in. eliminateto do travel, the possibility that some will travel over land and come from places and we do not know they're coming in on meaan we will not be able to do awful things. we will not be able to check them for fever when they leave -- >> can we not have a record of where they have been before, i.e., at passport from a travel status, as they travel from one country to another? ous,orders can be por especially in this part of the

world. we will not be able to check them for fever when they leave, when they arrive. you'll not be able, as we do currently, to take a history to see if they were exposed in a arrive. when they arrive, we would not be able to impose quarantine as we now can you have a high-risk contact. we will not be able to obtain information as he do now, including not only name and date of birth, but e-mail addresses, cell phone numbers, addresses, addresses of friends so we can locate them. we would not be able to divide all the information as we do now to state and local health departments so that they can monitor them under supervision. we would not be able to impose conditionalelease, release on them, or active monitoring if they are exposed -or- two >> my time is expired. i just do not understand. if we have a system in place that requires any airline

passenger coming in over seas to make sure they are not on the antiterrorist list that we cannot look at one's travel history and say, no, you're not coming here, not until this situation. be're right, it needs to solved in africa, but until then, we should not be letting these people in, period. >> i recognize mr. waxman. >> thank you. dr. frieden, you have a difficult job. in fact, all of your colleagues who are involved from the different agencies have a difficult job, because this is a fast-moving issue. to explain things withople and educate them limited information and partial authority. the cdc cannot even do anything in a state. they have to be invited in the

state. you cannot tell the states to follow your guidelines. you can give them guidelines read your dealing with a fast-moving situation, you have to strike a balance about informing the public on the one hand and keeping it from taking on the other. from panicking on the other. so let's go to basics. if people are frightened about getting ebola, what assurances can we give them that this is not going to be a widespread academic in the united states come as you have said, on numerous occasions? >> concern is first and foremost caring for people with ebola. that is why we are so concerned with infection control and where -- anywhere in the health-care system as a whole, to think about travel, because someone who has a fever or other signs of infection needs to be asked where have you been in the past one days, and if they have been in west africa, immediately isolated, assessed, and cared

for. >> we have to make sure we monitor health care workers about because they are exposed to people who have ebola. the question has been raised, what about these people coming in from africa, from the countries where the ebola epidemic is taking place? you have been asked why don't we just restrict the travel eith er directly or indirectly from any one coming into those countries. i would like to put up on the screen a map to show the passenger flows from those countries. that map shows -- if you hold it up here -- if you're looking at those particular countries in africa, they could go to any country in europe, they could go to turkey, egypt, saudi arabia, china, india, other countries in africa, and then from those ther countries, come into united states for it i suppose we could set up i hope your

credit card rattus to make sure somebody did not travel from nigeria or cameroon or senegal or any or sierra leone to be sure they do not really get here from any of those countries. that could be our emphasis, but it seems to me what you are saying is that we want to monitor people before they leave his countries to see whether infection and we want to monitor them when they come into these countries to see whether they have these infections. is that what you are proposing to do? >> that is what we are doing. we are able to screen on entry. we are able to determine the risk level if people were to come in by going over land to another country and then entering without our knowing that they were from these three countries. we would actually lose and that information. currently, we have detailed locating information.

we are taking detailed histories and sharing information with state and local health departments so they can do the follow-up that they decide to do. with. fauci, do you agree dr. freeman on this point -- dr. point?en on this >> i do. we know certain countries, where the epidemic is originating, why not stop them? >> i believe dr. frieden and yourself just articulated very clearly, it is understandable how someone might come to the conclusion that the best approach would be to just seal off the border from those countries. but we are dealing with something now that we know what we are dealing with. if you have the possibility of doing all of those lines that he

showed, that is a big web of things we do not know where we are dealing with. >> so what we know, is this epidemic can spread if there is contact articles from someone who is showing the symptoms of ebola or someone who has been exposed to that individual. if we had a travel ban, would we to hidece these people there are jen, and wouldn't we also not know where they are coming from if they are going out of their way to hide it, a ban, with reference to fighting the epidemic in africa, and the worse the epidemic becomes in west africa, the greater it is going to become in the united states -- is that your position, dr. fauci? the vice recognize chairman of the full committee for five minutes. >> thank you, mr. chairman. to frieden, you just said

chairman upton that we cannot have flight restrictions because of a porous border. worry abouto having an unsecured northern and southern border? >> i was referring to the border of the three countries in africa -- >> you're referring to that border and on our porous border. would it help if we eliminated legal entry? >> we are going to ask them their travel history, where they are coming from, how they arrived -- sufficient.no was dr. frieden, i would remind you a week before last at the cdc, and i thank you for allowing me to follow-up on some of our committee work, that i recommended a quarantine in the affected region and hold people there. i still think that is something that we should consider.

daysntining people for 21 before they leave, it helps every country. i want to go back to an issue that you and i have talked about at the cdc and in a subsequent phone call, and that is the medical waste. u.s. shortly that standard protocols were being followed for disposal of this waste. we know that 20, 25 years ago, hospitals could incinerate their waste. epa regulations now prohibit that in the waste has to be trucked, and they outsource the care of the medical waste, and it results in that going to central processing centers. so let me ask you this. is it ebola waste as contagious as a patient with ebola? >> ebola waste, waste from ebola patients, and be readily decontaminated. the virus itself is not particularly hardy.

is killed by bleach, by a variety of chemicals. ebola waste more dangerous than other medical waste? >> the severity of the infection is higher, so you want to be certain when you're getting rid of it -- >> is the cdc assessing the capabilities of hospitals to manage the waste of ebola patients, and does the cdc allow off-site disposal of ebola medical waste? >> my understanding is the latter question, yes, we work closely with the department of transportation as well as the commercial waste management companies to ensure that capability. inso we have an added danger having to truck this waste and move it to facilities. are the employees at the processing centers been trained and how to dispose of ebola waste? >> we have detailed guidelines

for the disposal of medical waste from the care of ebola patients. >> all right. you and i talked about my troops from fort campbell that are going to be over there, and i have some questions from some of my constituents. are the american troops going to come into contact with any ebola patients or with those exposed to ebola or included in any of these controlled movement groups? >> as i understand it, from the department of defense, their plants should not include any care for patients with ebola or any derek contact with patients from ebola. bet said, would always careful because there is always the possibility of coming into contact with symptoms and being exposed to their body fluids, that is why the dod is being careful to avoid that possibility. >> we are still going to rely on self-reporting? we are taking

temperatures applications in many countries. we have handwashing stations -- >> you're moving away from self-reporting, because originally used said your was based on self-reporting. i found a quotation from december 2011 on the george comstock lecture. have cartridges was right. pocrates was right. you can either delete yourself in whether patients are taking their medications or not but if people say they are taking their meds, we believe they are taking their meds for it to lying on relying on self reporting, and if they catch the fever at the betterime -- we can do

than this and we expect a better outcome. i yelled back. >> mr. braley for five minutes. i was happy to hear you say we will consider every option to protect americans. but i do want to ask you about texas. are you familiar with the concept of sentinel event reporting? >> yes. >> has cdc done a root cause analysis of what happened at texas presbyterian and, with an action plan on what we learn from that incident? we have a checklist for ebola preparedness, which we have heard here today. have there been recommendations on changing or modifying this in light of what happened at texas presbyterian? >> we have a team of 20 of the top specialists in texas now. we have identified three areas of particular focus.

first is the prompt diagnoses of anyone who has fever or other symptoms of infection with a travel history to west africa, and dr. vargas spoke about that issue. the second is contact tracing, and the graphic i provided earlier outlines what we are doing very intensively in the state of texas in the county doing a terrific job along with our stuff making sure that every single contact with mr. duncan is monitored and the temperature taken by an outreach worker every day for 21 days good most of the way through that risk period. of the 48, none have developed symptoms, none have developed fever. --are looking at the contact the health care workers who may have had contact, as well as the 2 individuals who became affected, our thoughts are with them, and we are delighted that nih is supporting the hospital in texas and at emory university is doing that as well. the third area is after

identification and contact tracing, effective isolation. we are looking closely at what might have happened to result in those exposures. i assume if there are any new recommendations based upon that analysis, the protocol that was sent out will be updated and redistributed? >> we always look at it data to see what we can do to better protect americans. >> thank you. youfound -- dr. fauci, share with us this graphic and you mentioned a company in ames, iowa working on one of the vaccines that went into clinical trials this week, correct? >> that is correct. >> i had an opportunity to talk to two of their employees and i know they are working around-the-clock to help, with a vaccine that will meet the protocol and the standards for scalability that i think everyone is looking for. defense,department of

hhs have called this vaccine one of the most advanced in the world and they have requested to expandwith hhs manufacturing, to add a third site for manufacturing, to complete the scientific studies required for manufacturing, and to complete the safety study to provide newly manufactured vaccines equivalent to the original vaccines, and they have also identify companies to work with subcontractors. dr. robinson, can you tell us what hhs is doing to make sure that the contracts are moving forward as quickly as possible? >> thank you, sir. we have renewed their proposal. it looks very favorable. we will be finalizing negotiations with them. prior to that we are helping them with submissions to the fda, providing assistance on site and also at the manufacturing sites to help them expand production with other

large companies in the united states. braley, hhs is involved out the other and because the files started were not only in collaboration with department of defense, but we admitted our first patient in bethesda in the phase one trial. it is not only in the testing but in the production. >> it is my understanding, dr. that the dr. robinson, ultimate goal is to land his clinical testing into the affected regions in africa as well once we have an understanding of some of the concerns that ride in a fight earlier in your testimony's death that were identified earlier in your testimony 00 --that were identified earlier in your testimonies. >> if they are safe and reduce the response we feel is appropriate, we will expand both of them into larger trials in west africa. bama mr. wagner, we have heard a

lot about the issue of travel restrictions. can you walk us through the strengths and weaknesses of that approach from your standpoint in border security? >> time is expired so if you could give a quick answer -- >> we have the ability to use the data the airlines give us to see where travelers originating from. there are instances where travelers may go to different locations and we might not see that, but through our questioning and view, we can identify safe and duties affected regions or if they come through one of the borders, if they fled to canada or mexico. it is more difficult for us to do it but the possibility is greater -- i do agree with what the experts say. it is easier to manage and control when we know where people are coming from voluntarily. "voluntary."s dr. burgess for five

minutes. >> the secretary of health and human services has the authority to issue a travel restriction under the pandemic plan that was 2005, the president has the ability to issue a travel restriction. 2005 was geared towards the pandemic avian influenza but it was amended in july of this year to include hemorrhagic fever. i believe that authority very clearly exists. the question is why the executive branch or why the agency will not exercise that authority. mr. chairman, perhaps this committee should consider forwarding to the full house a request that we have a vote on travel restrictions because people are asking us to do that and i think they are exactly correct to make that request. , the first nurse who was infected over the weekend is being transferred away from presbyterian. and yet her condition has been

serially reported in the news media as she is stable and she has been improving. the reason she is having to be removed because personnel are no longer rolling to stay at presbyterian that's willing to stay at presbyterian to be with her? >> they are working very hard and because of the events of the past week they are dealing with at least 50 health-care workers who may have potentially been exposed in the management of to make sureuals they develop any symptoms whatsoever from even the slightest, they come immediately to be assessed so if they develop ebola -- we hope no more well but know that is a possibility, since two individuals became infected and others may -- that makes it challenging to operate in the hospital and we felt it would be more prudent to focus on caring

for any patients who come in, any health-care workers or others who come in with symptoms. >> i don't disagree, and you and i have talked about this, and i'm fully in favor of individuals who have been diagnosed, that they be taken care of in centers and dr. fauci, you know if somebody wants to do research on the ebola virus, they can't just go to a regular university setting a new that. -- and do that. they have to go to one of the laboratories were the applicability of protecting the personnel. -- where they have the capability of protecting the personnel. there was a picture in the "dallasorning news -- morning news" where the cdc recommended personal protective equipment. it also details the order in which it should be put on and remove. i would note that shoe covers are not included in this graphic . you see a fair amount of exposed skin around the eyes and the

ehead and, of course, the neck. dr. frieden, this is going to be hard to see, but this is your picture in west africa. gogglestoe, covered in and i believe if you, understand the circumstances currently, you are about to be dosed with a new toxic dose of chlorine, correct? >> yes. >> that is why you cannot have been exposed because it is impossible to do the disinfection after taking care of the ebola patient or being in tenable award. it is impossible to do the disinfection if the skin is exposed because exposed skin would be killed by the chlorine and that one of the good for the person delivering the care -- that would not be good for the person delivering the care. we know the numbers in western africa are going up on ebola. we know the case rate is going to increase. we know that 10% of those cases are health-care workers. and we know that 56% of those

health-care workers in western africa will succumb to the illness. that is a pretty dire warning for anyone who is involved in delivering health care. i would just submit -- dr. robinson, let me ask you, what kind of stockpile of this personal protective agreement you have available to the health-care workers online" patient could come in tonight and go to any hospital in this country and present themselves. are you going to be able to quickly deliver a stockpile of personal protective equipment like this? >> we know from talking to the manufacturers right there that there are no shortages right now and they're willing to deliver 24 hours or less. >> let me ask you this question, dr. frieden. what did you think the first patient was going to look like? you knew you would have patient zero at some point or it was a possibility. who diedhe gentleman in nigeria at the end of july who could've gotten off the

plane in minneapolis. what did you think that was going to look like? what was patient zero going to look like? what is the match of their? >> go ahead and answer quickly. thank you, doctor. >> our goal is to get hospitals ready. the protective equipment used is not simple but there is a balance between equipment that is more familiar, less familiar, more flexible, less flexible, can be decontaminated more easily or yes -- less easily. itiously, we're looking at very intensively now in dallas in conjunction with the health-care workers there. right, represented it -- representative schakowsky for five minutes. >> i would like unanimous

consent to put into the record randi weingarten from the american federation of teachers, which represents many nurses come into the record. i would also like unanimous consent to put into the record the diary of paul farmer from partners in health who has among other things said that the fact is that weak health systems are to blame for ebola's rapid spread in west africa, and we know that west africa has 21% of mobile disease burdens, 3% of the world health workforce, one cracks -- one doctor in liberia for 90,000 people. i would like to focus on what we are going to do to help that infrastructure, but in my limited time i want to focus on our infrastructure here. ,e have a vast infrastructure hospitals and community health

centers, where people may present themselves. aides. nurses no one better than the united states. but do we have the ability to train and equip, as we talk , do wen military terms have the ability to train and equip -- let me put a couple things on the table. , i stillof the nurses don't feel like we have a good answer of why nursing one and nurse one and nurse two contracted ebola. is it because there was a problem with not following the protocols or is it because of the protocols? how do we ensure that even if we have the best protocols in the world everybody knows how to use them? degette showed the

protective gear that our nurses are supposed to have, and yet two days apparently went by when they were not wearing shoe covers, that an act -- their necks were not covered, as dr. burgess said, may have been exposed even though they knew he had ebola. how do we make sure when we check at the airports -- i am from chicago, cuts to our health director today -- i talked to our health director today, but there is still a chance anywhere -- how are we going to make sure that everybody can be protected? >> just to clarify one thing, those first love days, the 20, 29th, -- first couple of days, the 28th, 29th, 30th, were before his likenesses was known. the tests had been drawn and assessed but he had not yet been diagnosed with ebola. in our team's review --

>> excuse me one second. congresswoman, were you saying otherwise? ield.e gentlelady will y he presented with ebola symptoms, he had been to the emergency room just a couple days earlier saying he had been from africa, and i believe the cdc protocols that were given to the dallas hospital said that people should be wearing a protective covering even before the official diagnosis. i would certainly hope -- thank you for you think -- thank you for yielding, ms. schakowsky -- i would hope going forward that if a patient shows up saying he's from africa and he is vomiting and has diarrhea, you wouldn't say "we don't have the lab results in yet,k" you would start treating a person as if he has ebola. >> absolutely. those first couple of days comes he was being isolated for ebola.

the diagnosis was confirmed on the 30th and on the 30th we sent the team there and when we look at -- to answer your question -- those first couple of days there was some variability in the sub protected -- in the use of protective equipment. the hospital was trying to implement cdc protocols -- >> going forward how do we make sure that just trying -- how are we going to educate people, saying-- the nurses are across the country that they have not been involved and they have not trained properly. any time a patient is suspected, isolate them and contact us and we will talk you through how to provide care while we get the tests done and we will be there within an hour. >> when did you come up with

that plan? the plan in terms of training, when was that decided? >> we look at our preparedness continuously, so awareness has been something that we have been promoting an extensive ways -- she was asking specifically for nurses -- when was the plan would interface -- put into place for the texas hospital? >> the data diagnosis was confirmed we sent a team to texas. rey is confirmed for five minutes. >> i want to thank the chairman for walking main the subcommittee back to washington in response to the ongoing outbreak, and commend my colleagues on both sides of the aisle, the near unanimous attendance for this hearing. since my time is limited i would like to get to my questions. this is kind of a follow-on to y was asking.kowsk

i don't think we ever got around to an answer on that. i will direct my question to dr. frieden and maybe first two dr. varga. as we know from reports yesterday, a second health-care worker has contracted ebola, ms. amber vinson. now that she has received treatment at emory university in atlanta, we must examine the protocol breakdowns that resulted in the contraction of people of by these two nurses -- contraction of ebola by these two nurses who were treating, stumping -- treating thomas duncan. written test your them in a you say that the first two contracted, ebola was using full protective measures under the cdc protocol while treating mr. duncan. has your organization in texas identified where the specific

breaches in protocol were that , orlted in her infection alternatively, the inadequacy of the protocol? dr. varga, that question is for you. >> thank you, sir. we are investigating currently of this exposure and the contraction of the illness. inhave confirmed that nina, care with mr. duncan, was wearing protective patient equipment through the whole period of time, and as dr. frieden already mentioned, with the diagnosis of the ebola , the full hazmat style

, we don't know at this , what the juncture source or the cause of the toosure that caused nina contract the disease was -- >> i will interrupt you because of limitation of time. i want to go to dr. frieden. just stated, health-care personnel were following cdc protocols while treating mr. duncan, which include the use of so-called ppe, personal protective equipment. do the cdc guidelines on the use of ppe mirror current international standards that, by the way, are being adhered to, those international standards, in west africa in those three countries -- sierra leone, guinea, and liberia? >> the international standards

are something that evolved and changed. we use different ppe in different settings. there is no single right answer and there's -- this is something we're looking at closely. our current guidelines are consistent with the world health organization is my understanding. >> i would think there need to be, dr. frieden -- and i commend you for the job you are doing. i know these are tough times for all of us. but i think some consistency is what we need. and that brings me to my next , andion, my last question again it is to you, dr. frieden. the issue of elevated temperature. it know, is it 100.4, is 101.5, is it 99.6? confusionere is great , because initially when people were screening, mr. wagner, at the airports in west africa, the

101.5,ture threshold was and then i think now the screening we are doing that these five major airports, atlanta, it is 100.4. when mr. duncan came for the first time to the texas presbyterian hospital, his temperature was, what, 100.1, and within 24 hours it was 103. when mom and dad are out there -- when a child has temperature and it is flu season and they are going to the doctor, they are going to demand being checked for ebola. give us some guidelines on what is elevating the temperature and when should parents be concerned ? >> parents should not be concerned about evil unless you are living in west africa or the child has had exposure to ebola.

the only people who have had exposure to ebola in the u.s. are people who are providing care to ebola patients or the contacts of the three ebola patients. for our screening criteria we are always going to try to have additional margins of safety. we look at that and we would rather check more people and assess -- we are going to always have that extra margin of safety. >> thank you, and i yield back. castor forize ms. five minutes. >> thank you for tackling this important public health issue of want toa virus, and i thank the centers for disease control and the nih and medical professionals across the country, especially those at emory university health care, with been proactive in containing and treating the virus.

i agree with president obama and all of you, we have to be as aggressive as possible in preventing any transition of the disease within the united states , and boosting containment in west africa. but i also think we need to pause here. this is a wake-up call for nihica that we cannot allow funding to stagnate any longer. earlier this year in the budget committee i offered an amendment to the republican budget to restore the cuts to nih. the budget cuts that have been inflicted over the past two years, and repair the damage of the government shutdown last year. unfortunately it has not passed, on a partyline vote. wewill only save lives if can robustly find medical research in america and keep america is the world leader. i would like to turn to some of the research that is going on now, because it is going to be research that will be our .onger-term response to ebola

it will be the vaccines to prevent the disease and the drugs to treat it. anddevelopment of vaccines treatment for people is different from the development of many other drugs. there's not a large private market for ebola drugs. the development requires leadership in our country, and testified, hasci been working on a vaccine for many years, and he reported today and has moved into some phase one clinical trials. you explain why government support is so important for developing ebola vaccines and treatment? >> well, when you have a product that you want developed, there is not a great incentive on the part of the pharmaceutical companies because of a disease whose characteristics is not a large market. we have the experience when you

are dealing with emerging and reemerging disease, the influenza or a rare disease that could be used deliberately in bioterror or a rare disease like ebola that if you look fire to the current epidemic -- prior to the current epidemic there were 24 outbreaks since 1976 and the total number of people in those outbreaks were is less than 3000, about 2500. we were struggling for years to get pharmaceutical partners -- ourselves from doing the fundamental basic clinical research. and then we did get pharmaceutical partners, like we have now with glaxosmithkline, which is the reason we are moving along. that is one of the reasons that i showed that slide -- i showed that slide where the nih and the research is at this end and you have to push the envelope further to the product and de-r isk it on the part of the

companies. companies don't like to take risks when -- >> can you quantify a timeline for the ebola vaccine to be on the market? is it feasible for any vaccine to be approved in time for the current operation? >> your question has a couple of assumptions. the first is that the vaccine is safe and it works. the second is going to be how long is this outbreak going to last that the level? if you look at the kinetics and the dynamics of the epidemic, it looks very serious. our response -- when i say "our, " i mean the global response has not kept up with the rate of expansion. if that keeps up, as the cdc has projected, we may need a vaccine to actually be an important part of the control of the epidemic itself, as opposed to what the original purpose of it was, to protect health care workers alone. now if you have a raging epidemic -- to be quite honest with you, ms. castor, i cannot

predict when that will be. if you have a lot of rate of infection, the vaccine trial gives you a much shorter time to get the answer. if it slows down, it is a much longer time. if you have a lot more people in your vaccine trial, it takes less time. if we have trouble adjusting lee, which we might, of getting people into the trial, it might take longer. i would like to give you a firm answer but we can't right now. vaccines,tion to the part of controlling the virus is early diagnosis and treatment. i know there are some diagnostic tests that are being developed. can you speak to the prospect of improved diagnostics that can assist in this outbreak? >> there are couple of us -- when i say "us," i mean agencies working on diagnostics. dr. frieden's group at the cdc has played a major role in leadership. we have several grants and contracts out to get earlier and more sensitive diagnostics. >> thank you. recognize mr. gardner

for five minutes. todr. frieden, i want clarify something you said earlier. i believe you mentioned there are approximately 100 to 150 people a day coming in to the united states from the affected areas? >> that is my understanding, yes. >> mr. reiner, you mentioned we are screening 94% of the people? spansion toay, with the four additional locations, that covers about 94%. >> 94% being covered, that means somewhere between 2000 between 2000-3000 people a year coming into this country without being screened from affected areas. a they would undergo different form of screening. we are still going to ask them questions about their itinerary. we are alert to any overt signs of illness and chlorinated with cdc and public health of they are sick.

we are also going to give them a fact sheet about ebola, about the symptoms, and most important link, who to contact. >> will you be checking temperatures? >> we will not be taking temperatures. >> so there are 2000-3000 people a year entering the country without taking temperatures, contextfilling out a she. >> they're going to arrive at hundreds of different airports throughout the united states. >> i want to talk about travel restrictions. non-us military commercial flights are currently going into the affected countries? >> i don't have the exact numbers. >> does anyone on the panel know? from the united states or from anywhere? >> from the united states into those areas. >> there are no direct flights into the united

states. >> or into west africa? >> there are direct flights into west africa? >> how many? does anybody on the panel know how many? back to the united states? >> there are no direct flights coming back to the united states from those affected areas. what about from europe? >> there are hundreds of flights coming from europe. >> and people from west africa throughhrough their -- there. and there is 94% screening. >> we would have to get back to numbers, butof huge quantities of supplies are needed. >> if you could get back to me with that number, i would appreciate it. are you aware if nigeria has a travel ban on countries affected

by the outbreak? >> they do not. the areas brought up regularly to me when i go home, what should i tell my local hospitals and local doctors that they need to do to address ebola? >> make sure if anyone comes in with fever or other symptoms of , they need to ask where they have been for the last 21 days and whether they in west africa. >> and the training the small local district hospital would receive, is that the same kind of metropolitan hospital would receive? >> there are override the of forms of training. hospitals are usually supported by the state. >> what do we need to do to make sure people understand that

there could be similar conditions, similar circumstances, so we don't have a situation where people are panicked. >> the key issue as you point out is that we are going into flu season. by all means, get a flu shot. for health-care workers, anytime someone comes in with fever or other infection, take a travel history. that's really important. >> you mentioned that we can't have a travel ban because you are afraid of the impact it would have, but you don't know how many personnel or flights are currently in use. >> my point earlier on was that of passengers are not allowed to come directly, there is a high likelihood they will find another way to get here, and we will not be able to track them as we currently can. talking supplies and personnel. how many? how much equipment?

not able to track people coming directly, we will lose the ability to monitor them for fever, to collect information and share it with local authorities, and to isolate them if they are ill. you.ank we now recognize mr. wilshire for five minutes. >> first, i want to understand this. u.s. andn came to the infected to health-care workers in dallas, correct? >> at this point, none of the 48 contacts he had prior to haveoping symptoms developed anything and they of all past the point -- >> we have had two incidents in the united states, but this is such a highly contagious disease, we are on full alert,

correct? >> it is as severe disease. it is not nearly as contagious as other diseases, but any infection in a health-care worker is unacceptable. >> and there is an enormous amount of public concern about this, so we appreciate the effort you're making. there has been some concern about what happened in dallas, the efforts made. and now you're telling us that there has been information provided to all of the hospitals in the country about what protocols to follow, correct? >> that's right. >> is it feasible that all of our hospitals are going to be in a position to provide state-of-the-art treatment or as a practical matter does it make sense for hospitals to contact you when they have a potential infection, for you to come, and then for there to be centers where an individual can be treated. >> every hospital needs to be

able to think it may be ebola, call us -- we have had hundreds of calls, and then we will determine what treatment is best for that patient. -- this isalso heard absolutely a public health infrastructure issue where he gets out of hand, correct? >> public health measures can control ebola. >> they have effective measures in nigeria where they have been able to contain it, but they have no public health infrastructure in the three countries where the epidemic is now gaining headway, correct? >> right. >> and in the u.s., we are fortunate to have a pretty good infrastructure, but we do have to have an answer, i think, to this question that is being asked about travel. a concern people have because it is seen as a "easy answer. co i want to understand what the answer." "easy

it seems like a debate within the medical community, but it may be a psychological answer but not necessarily in effect of medical answer. all of us have been asking you to give your explanation as to why, from a medical standpoint, you have concluded that a total travel ban is inappropriate and not effective. >> first off, many of the people coming to the u.s. from west africa are american citizens, american passport holders, so that is one issue to be aware of. way, i don't have much time, but if we're going to encourage people to go and do important work, including military personnel, we have to take them back and make sure we can treat them if they do get the illness, correct? >> people travel and people will be coming in for it >> you say

there is basically a trade-off. if there is a full ban, there are ways around it and then you lose the benefit of being able to track folks who may be infected and that could lead to a greater incidence of outbreak. it is a trade-off. is that essentially what is going on? >> we are open to any possibility that will increase the safety of americans. >> are there midpoints that makes sense to you in coordination with your colleagues, particularly mr. wagner? >> we would look at any proposal that would improve the safety of americans. >> this is not about funding so i am not going to ask you because i think we know what your answers would be, but i just want to share the concern expressed -- mr. chairman, we may want to have a hearing at some point about funding requirements to make sure the emperor's structure this country needs to be in place before thishing -- infrastructure

country needs to be in place before something happens is robust that we have people who are strong and trained and ready to do the job. that is not today's hearing, but i think it is a question we should address the cause with 20% across-the-board funding and nih, i find not to be a reckless decision. 12% at cbc i think is reckless. we have to revisit our priorities and making sure we have the emperor structure in public health to protect the -- infrastructure and public health to protect the american people. >> we do have a hearing scheduled on that. >> i now recognize mr. griffith. >> thank you, mr. chairman. i believe we should have

reasonable travel restrictions. i am submitting a letter for the a prominentcites medical and travel security services country with more than 700 locations in 76 countries that reports that africans have imposed air, land and travel bans by persons from countries where ebola is present. south african development community members only allow highly restricted entrance from ebola affected regions with monitoring for 21 days and public gatherings discouraged. i find that interesting because some of those countries have had a previous ebola outbreaks themselves.

>> i will take your word for it. >> i will tell you that this is a concern to a lot of our constituents and mine as well. recently, a father from virginia prayers for his daughter because she lives in the complex with the first nurse and was very concerned. while i think i know the answer, i would like to get your answer. he asks, if i get to 21 days and is nothter is in fact -- infected, can i exhale and breathe a sigh of relief? >> he can do that now. the first nurse only exposed one contact in that was in the very early stages of her illness. at most, one person from the community was exposed. >> i appreciate that.

he said there were some concern coming out of dallas that the patient's dog may be infected. by the virus be transmitted dogs? i did some homework on mess because i thought it was an interesting question and i found a publication from march of 2005 the did a study on dogs in and dogs in france as a control group. they showed that while dogs have antibodies for ebola, they are asymptomatic, but the study went further to say that there are a lot of questions about how ebola is transmitted. there is a question as to whether or not or how the ebola outbreak occurred. it wasn't in normal ways, human

human, and the report indicates the dogs might be -- might be -- i don't want to scare folks -- might be suspect. isn't it true that we don't know a whole lot about the outbreak of ebola and when we are trying to a sure american people -- just like previously we didn't think it would come to this country and then if it did get to this country we wouldn't have any problems controlling it and now we have all kinds of people being monitored. aren't there a lot of questions about how ebola is spread? >> although we are still learning a lot, we have a lot of information about ebola. we have a good sense of how it .s controlled we have looked at exposure to animals. we don't know of any documented ,ransmission from dogs to human

but we will be looking to help assess that situation. seenthough we have not transmission, we have a lack of evidence as opposed to evidence that it cannot be transmitted. we have no restrictions on travel of human beings. how about the dogs? i called customs. they said experts are there. called the usda. they said that would be cdc. i understand all of your reasons -- while i don't agree with them completely, i understand about humanitarianism in all of that, but don't you think we should restrict travel on dogs? legs we will follow-up on what is recommended -- >> we will follow-up on what is recommended. >> i like to start by mentioning

"will americaled meet the ebola challenge?" i would like to submit that for the record. this has been a very enlightening hearing. i would like to acknowledge that the kentucky international guard, which is taste in my district, is in senegal providing help for the 101st. so into the ink them for their effort. displaying my ignorance, we know that you cannot do text ebola until it -- until itagious becomes symptomatic, at which point it is contagious. is there any way to detect going on?

>> at this point, we don't have a test that would identify it before someone has symptoms. the test only turns positive when they are sick. the test is for the virus itself. that is another reason we are confident that it doesn't spread -- we can't even find tiny amounts of it in people's bodies until they get sick. is there any research been done on a possible test for this? >> there's a lot of research being done to understand, diagnose, prevent and treat better. sensitive to have a media treat situations like this. certainly, the media can be a very important part of providing public information about a potential threat to public goety, but they can also .verboard

i see comments in the media the threat oft ebola and the spread of ebola. while it has spread to two health-care workers, i know the public may perceive that differently. like, for instance, in the washington post today, a picture of a woman at the dulles airport who looks mummified because of her concern about contracting ebola. one survey showed 98% of the american people are aware of the ebola situation and not even 50% know there is an election coming up in three weeks. media has certainly alerted people that something is going on. my question to you is has the helpful orage than

harmful in having the public have an appropriate level of concern as to what the situation is. workersimes health care become infected and ill it is unacceptable and our thoughts with those health-care workers and hoping for their recovery. it is certainly understandable that there is media interest. it is new to the united states. it is a scary disease. there was a movie made about it. it is important that we pay attention and the doctors, hospitals, community clinics in health care practices stop it at the source to make is completely safe. i thinkthe coverage, many would agree, may exaggerate the potential risks or confuse people about the risks.

we know about ebola. cdc has an entire group of professionals who spend their entire careers working on ebola. they stop outbreaks all the time. outbreaktopped every except the current one in africa. there is zero doubt in my mind that are in a mutation there in thet be an outbreak u.s.. it warrants attention but it's important to put it in perspective. >> i agree. additionaly authority that cdc would find helpful in conducting your responsibilities. specific authority that would make it easier to do

your job? >> we are looking at a variety of things, procurement, for example, to see if there are changes that might allow us to respond more quickly and effectively. >> thank you. i yield back. fore recognize mr. johnson five minutes. >> thank you for being here. thank all of you on the panel for being here today. politics orabout international diplomacy. this is about public health and protecting the safety of the american people, particularly our health care workers who are some of the high risk folks to be exposed. as of my main concerns though we don't know what we

don't know. throughout testimony and questioning today, i have heard you say multiple times i don't know the details of this, i don't know the details of that. i think what the american people , is some assurance that somebody does know the details. salome us your question. do we know yet how the two -- so let me ask you a question. do we know yet how the two health-care workers contracted the virus? was it a breakdown in the protocol? was it a breakdown in the training of the protocol? do we know of the protocol works? >> the investigation is ongoing. we have identified possible causes. >> so we don't know. we don't know. i get that. we don't know. you know, the people in ohio are , especiallyow that

we know that one of those health-care workers traveled through ohio, even spend some time in akron with family members. kasich's governor immediate actions to try to address the situation. in my experience as a military war planner, 26 and a half years in the military, and i know we have the military engaged in this process overseas, we don't wait until the bullets start flying to figure out whether our war plan is going to work. when did the cdc find out their was an outbreak of ebola in west africa? >> late march. >> one of the things we do in the military is conduct operational readiness inspections.

scenarios inworld controlled environments, no notice, so that those who are going to be responsible for whatting a war plan know to do when the first shot is fired. no panic, no second-guessing, they know what to do. ebolae plan to address an outbreak ever been tested by the cdc in a real-world environment? >> not only has the plan been tested, that outbreak control has been done multiple times in west africa. >> i am talking about in america. >> in america also. >> do you know of any hospitals in southeastern ohio that have participated in any kind of real world scenario of an ebola outbreak? >> i can speak to that -- cannot

speak to that specific example. >> let me go further. daymentioned that 150 per roughly are coming in from west africa. let me give you a scenario. in tosay a person comes the country from west africa, and let's say that everything in the screening process works right. they may be on day 14 of having in westosed to ebola africa. symptoms andwith go through the screening process and then go to wherever they may go. day 17 or 18 they start getting ill and start seeing a spike in their temperature.

if they want into any emergency room in appalachia, ohio, and start throwing up and having planoms, does your identify that can tell that hospital emergency room what to do and then scenario? don't know that person came from liberia or any other place. >> we have detailed checklists and down rhythms we have provided widely two health-care workers throughout -- algorithms we have provided widely two health-care workers throughout the country to determine if there is an outbreak of ebola and if they do, to call for help, and we will be there. mr. madison is next for five minutes. >> thank you, mr. chairman.

a number of questions. i will try to move through them quickly. dr. friedman, it strikes me that controlling the outbreak in west africa is really one of the real of to keeping americans safe. the reports indicate we may be losing ground in liberia. what would enhance the international community's ability to gain some ground in africa in terms of actions and resources? that itwe're finding is is moving quickly and there is a real risk it will spread to other parts of africa. therefore, the key ingredient to progress there is speed. the quicker we surge in a response, the quicker we blunt the number of cases and the risk ,o other parts of the world

including the u.s., decreases. angress has provided agreement to use money from the department of defense. received $30e million for the first 11 weeks of this fiscal year, which we appreciate. has an unprecedented number of people in the field right now in west africa and texas. how many people do you have doing airport screenings? >> i would have to get back to you with the exact numbers. we are overseeing screenings to make sure they are done correctly and to screen individuals here -- >> make sure you get that ifber, and also find out those resources are best used there or elsewhere with your limited number of people. is there progress in developing test to determine

if somebody has ebola? >> a more rapid test would be helpful. we are currently testing one in africa that is simpler and quicker and would be more aspful even if it is not thorough. to me that when it comes to infection control and prevention and hospital standards, i think he very wisely from hospital to hospital in this country. what regulatory or legislative actions could strengthen these systems? how can we reduce this variability among hospitals in ?ur country >> infection control in our country generally is a challenge cdc worksing that hard to improve.

hospitals are regulated by the states in which they operate and the issue of what could be done isimprove infection control complex. cdc has a large program of ofpital prevention infection. we share new efforts in new ways to do things better. that center of excellence model is an important one. suggesting that while you can provide guidance, implementation is more of a state function than a federal function. do you think we should be looking at that issue? we have a federalist system. the cdc provides information and input that roughly 5000 hospitals in the country were not regulatory. >> one other line of question. there is no good news about ebola, but at least it is not , it does not transmit

as an airborne identity. it is clearly that we do not want to underestimate the trent -- the ability to transmit it. the focus is on ebola and rightly so, but there are other airborne transmittal pathogens that ought to be of great concern. birds being one of them. is this experience we have had with ebola, how do we learn from it to make sure we are prepared for other, human to human that mayible pandemics have a higher rate of transmission van ebola? >> two major lessons. prevented at the source. either go to find it, stop it, and prevented, it would be over already.

country, tor continue preparedness and public to find and stop public health threats. >> recognized for five minutes. >> thank you. today, we have referred to , referred to nurse one and nurse two. these are two young women who dedicated their lives to helping other people, sick people. nurse oneo them as and nurse to does not sit well with me. it is reminiscent of dr. seuss, thing one and thing two. these are not things. i would like to think -- first nurse and the second nurse -- these are young women with families. one particular has a fiancé. i think it would serve us well are humanr these

beings, young women, who have dedicated their lives to help people. i would like to open with that. dr., he said in your testimony earlier, only by direct contact can you contract ebola. you contest that statement? and it is not airborne? you agree? >> it spread person-to-person not by the airborne. >> if you need personal contact fluids, why is it scrubbed four times? aren't they wasting money? contact,n have bodily

why -- >> it is a scary disease. >> so it is just for public perception. they do not need to be doing that. >> we have detailed guidelines. you need to be sick and generally, the first symptom of illness is a fever. >> do you need a fever to be contagious? >> later in the disease when people are deathly ill, they may not have a fever but they would be able to walk at that point. >> you need to show symptoms within 21 days of exposure. are contagiousu at that point? time, anywhereon from 0-21 days. question early within the first 21 days or so. >> you said there were 121

people from west africa to the united states. you are opposed to -- constituents are in favor of you orng -- i predict the president will put on traveling restrictions. and ik they are coming think sooner rather than later. 150 a day and you rationalize, we do not need to worry about that because they can get cross orders and go by land. number might be reduced to five or 10 a day? >> i cannot comment on what numbers. >> if someone had to make an effort rather than going on airport and jumping out a plan, if they really had to, don't you think the number would dramatically dropped? >> i know people come back. right now, we are able to screen them and collect information. >> what if they do not come back question mark a lot of people miss country, they do not come back.

what happens then? if you have five coming in today, i were my constituents rather have five a day coming in. this thing was checking for temp -- temperatures, like it will help, is like scrubbing what does not need to be scrubbed. i would like to commend reading this copy, ebola is coming to america. the u.s. had a chance to stop the virus in its tracks but it missed. before mr.ame out duncan came to this country and diagnosed with ebola. there is good reading there. i also recommend, if you want to google a hospital from hell, hospital fromla, hell, if you get a chance to read that, i think everyone would be in favor of the travel

restrictions and today, the health administration just today said customs and border control immigration and nations are at risk of coming into contact with ebola. are we prepared for that? protected?ents this came out today. >> we china my how to wear the protective gear and what circumstances. travel with a whole host of potential diseases, we are aware and we trained to recognize signs of over illness. we have protocols without professionals to get those care and into that protect our employees. >> they phone the same category as nurses. save us ande to protective of the country. god bless you. i yield back. >> the german is retired. >> thank you so much.

i have a number of questions. i would like to start in regard exposed, myurses understanding is the first nurse, was exposed in the emergency room. is that correct? repeat theu question? in thefirst nurse was emergency room? is that correct? >> it is not correct. she came in contact with mr. duncan when mr. duncan was up.sferred >> that was some time up from september 28 through the 30th. is that correct? >> that is correct. sent, wasond nurse

she also an icu nurse? so they were exposed after the --nt that is not correct. the nurses from the time may have first contact with mr. duncan were in personal protective equipment according to cdc guidelines. nina cared for mr. duncan. stop you right there. they are already using universal but were using more isolation. just answer yes or no. >> yes. i is ok. this, and i will just back up, on october 2 -- excuse me, october 6, i sent a letter calling for travel restrictions.

there is no question i believe they need to be put in place. after having this subcommittee hearing now, i believe even more strongly that we need them. i want to back up to a couple of questions. are there multiple strains of ebola? >> five different subspecies. this outbreak is one particular subspecies. all of these have been closely related third >> we know it has to one particular strain. the quote was, unless it mutates, there will not be an outbreak here in the united states, is that correct? be a largell not outbreak here buying a mutation. >> lemon nurses were using how has thisar,

happened? it tells me something is changing herein are we currently looking into the situation now? what we have seen is very little change in the virus. we do not think it is spreading by any different way. you have artie said a couple of times it is not airborne. you are protecting yourself and your protecting your patient and you are protecting your family. based on precautions, i am sure. we are now having this conversation and i am concerned about that. is notre confident this an airborne transmission. nurses working very hard and working with a patient who is very ill and was having a lot of vomiting and diarrhea. a lot of infectious material. the investigation is ongoing, but we immediately implemented a series of measures. >> i will move on. faste discussion of

for ebola, where are they at with that? >> a diagnostic test? there are three authorized for use. taken some proactive steps by contacting commercial manufacturers who we know have potential technology to bear here. we reached out to a handful who might be interested in working with us. >> you're in the process of working toward a fast-track process. >> yes. we expedite every such path. >> leslie, i am speaking on behalf of my constituents in every in my cut -- in the country. i just do not believe it is acceptable, the quote you have given us, as the reason for why she -- we should not implement

travel. i believe we can. dofar as our border patrol, you believe there is a way we can implement tracking of individuals, if we do not allow it >> yes. we have a way to determine that through review of passport. it is easier when they come to direct places. >> rue, thank you. thank you for indulging. i am over time here. >> thank you, mr. chairman. i appreciate your holding this hearing. i've talked to a number of health care professionals and listening to the panel as well. i want to join with chairman upton in urging the president to immediately issue a travel ban until such time as they can firmly and scientifically prove

that americans are safe from having more ebola patients coming into the united states. i know, dr., you expressed disagreement with that. have you all had any conversations within the white about a travel ban and whether or not the president has the authority? many of us have said the president does have the authority to do it today. >> from the point of view of cdc, we are willing to consider anything -- >> have you considered an have you ruled it out, or have you not considered it at all? have you had conversations with the white house about a travel ban? it is a yes or no question. conversations with the white house about a travel than? >> we have had discussions on the issue of travel >> have you ruled it out? if you are in those

conversations, maybe they had their own conversation about you, but if you were involved in conversations with the white house about a travel ban, did they rule it out and are they still considering it? --we will consider anything >> are you going to answer the question about your conversation with the white house? is the white house considering a travel ban? >> i can't speak for the white house. >> have you had conversations with them about it? -- >> wecussed discussed the issue of travel. >> i would urge you, if you do not think it travel ban is the right way to go, a lot of people disagree with you, at a minimum, you ought to look at -- you can travel in the united states from liberia. have you all considered that were discussed it or ruled it out? authority is our to acquire the isolation of individuals. >> but you said you do not think there should be a travel ban. att about at least looking

extending visas to non-us citizens? >> the cdc does not issue visas. can make a recommendation to the white house that you think would be in the best interest of the american people to have that kind of suspension issued. are you not aware of that? >> we would certainly consider anything that will reduce risk to americans. >> do you have a high level of confidence that our u.s. troops over there right now, through activity are already in those countries. up to 3000 of those trips will be sent over from president obama. do you have a high level of confidence those trips are protected so they will not contract ebola? >> we work very closely with dod on the protocols. say there is zero risk there in those countries,

but they are not participating in high risk activities. protocols inishes that case? >> they are following cdc protocols, but they follow their own. theet me ask you about protocols. i have heard reports that some people of some of the other organizations that have been there for a while, you have got a group, a showman by the name of shawn kaufman, who is involved with some of the doctors over there that got infected. they have been working for decades in some cases. he said he warned your agency that the guidelines you had on the below were relaxed and his response was "they kind of blew me off. oh off." blew me >> do not know that occurred.

>> i hope you go find out. is a real concern. i've talked to a number of medical professionals in my district. not are concerned they have had consistent protocols. there have been at least four in the last few weeks were the protocols keep changing. first nurse that was infected, you personally said the protocols have been breached. have you back away from that? you said the protocols were breached. were they breached? yes or no? >> our review of the records suggest -- if you did not know for a fact -- do you still stand by the statement that protocols were breached? definite exposure -- >> i yield back. >> the ranking member and the

chairman have a final two-minute wrapup. >> he started to say looks like was exposed in the first couple of days before the diagnosis came in. >> that is our leading hypothesis. >> thank you. have you now see in my chart from the new york times about protective gear? ofyou know which types protective gear health-care workers were wearing in the last few days? guard, folks would have been wearing the first fiction or. >> thank you. it is your testimony, you do not really know how either one of these nurses were. is that correct?

>> that is correct. >> i want to say one last thing. discussionsa lot of today about a lot of issues. i will make a statement and i will ask you to comment. it seems to me, beside from trying to stop the ebola from africa, the things we can do here, number one, better ourning to people in emergency rooms, better responders, not just send them out e-mails and bulletins. we can have more robust protective gear at the early stages someone looks like he might have a risk for ebola. number three, it might be useful to have cdc on the ground earlier. down to the come dallas hospital until after the diagnosis. two days, people were moving in and out of mr. duncan's room and we do not know exactly what happened. can you comment on that?

>> i do not agree completely on the framing. we are looking carefully at the equipment issue. we consult immediately every time. 300 --ave been more than only mr. duncan was confirmed to have ebola. we will do everything we can to support the front lines. >> i would ask for both this chart, and the flights to be included in the effort. i would also ask all of our witnesses if they would continue updatedthis committee as changes in developments are made. i ask unanimous consent to put these statements in the record. >> i previously asked for unanimous consent but i do not think we ever agreed to it.

>> it is so ordered. i now recognize for another two minutes. yourg listened to all of testimony, couple things stand out for me. i appreciate the statement of honesty. that we made mistakes. i did not hear that for many of you and that troubles me. what has happened here is your protocol depends on everyone being honest 100% of the time. i am not a medical expert. i study behavior as a psychologist. people are not honest 100% of the time. it relies on tools that take temperatures. a 121 chance they may register something. and a person -- that is not helpful. recognize human behavior, the protocols may not be salt -- may not be followed. itt you put -- watch you put

on and watch it taken off and do things. the example of how this failed was there was an assumption, you travel. granted the assumption that you use all the right protective gear, but we looked at this and you are not aware of what she wore. to this extent, these are my recommendations. i believe we need an immediate ban on commercial and nonessential travel until we have an accurate screening process to treat the disease. a mandatory court order for any american who has traveled to or return from the ebola hot zone countries. because of an assumption and without this assumption of what they were was dawned and remove properly. number three, through training for health care hospital workers for personal equipment used in

the treatment of ebola patients, and --ber four, identify those trained. inber five, identify gaps the statutory language to take more aggressive and immediate -- four but -- public health in ebola. or any other action congress needs to do to facilitate your needs. number six, accelerate on development and clinical trials investigations on drugs and diagnostic tests. number seven, acquisition of vehicles capable of examining military personnel who may have contracted ebola in africa to return to the united states beyond the current capacity. number eight, additional contact and testing for public health agencies. number nine, to provide for

congress and the resources needed to assist health interventions in africa so we can stop people of their. the members coming back today for the hearing and i especially appreciate the testimony of the panel. -- to be entered into the record. >> yes. the office of and specter general, and the photographs i demonstrated earlier today? >> so ordered. they will be demonstrated in the record. >> mr. chairman, i want to -- to acknowledge -- >> we will follow up and notify participants and when that will be. agreedhat witnesses plea to respond properly paired with that, the hearing is adjourned.

[captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2014]

>> so, i am told by the president is going to reach out to members of the energy and commerce committee about what should the next up be. -- step b. i know that i am going to encourage the president to put in a no-fly zone from that region of the world. particularly for folks trying to travel here on a visa. we need to send the signal now.

closed.er is until we resolve the issue in west africa, we will not allow folks with diseases from that region to be coming to the united states w get the problem fixed. >> thank you. . want to restate i gave a list of several recommendations. i want the white house to consider those. including a travel ban on people who are not citizens coming to the united states currently until we have some problem solved. also to make sure that we have travel restrictions once they come back here. and on people who are treated ebola patients. -- have treated ebola patients. it is clear from the errors that were made, the people can make mistakes, that they will not be trustworthy in the places where they have been. what we ought to be doing is all of these steps. what we are asking for may