you think should be taken? senator jenkins. >> we have all been moved obviously in profound ways with the beheadings and what has happened. and every discussion always starts with, why did we wait so long. the president called it the j.b. crew. he didn't take it seriously. back when assad in syria a couple of years ago horrifically used chemical weapons against his citizens, and was just trying to figure out what to do, nick rahall said, i want to give the president of the doubt. we need leadership. our country is not respected around the world. we are a johnny-come-lately -- [laughter] >> it seems like to every

crisis. i fully support air strikes in iraq. i fully support air strikes in syria. but i also want to make sure that all of the arab communities steps up to the plate and put their boots on the ground, put their men and women, like we do, on the line. i'm telling you, this isis stuff just shows how much our lack of leadership has led to a much more dangerous world we live in. >> thank you. congressman rahall? >> isis is a threat to america's national security. it must be taken seriously and

no joking around here with this heinous group. it's vital that we cut the head of the snake off. president obama is conducting air raids as we speak to hit at the head of the snake. the command and control centers in iraq and in syria. i support those strikes. i voted for a limited authorization, not for these strikes, but a limited authorization to arm the moderate syrian rebels until december 15. should we have identified these moderate rebels years ago? sure. you bet we should have. to make sure the arms are not used against us in the future. it's a risky strategy upon by the president has embarked. i'm opposed to any boots on the ground. i opposed the iraq war. and i don't want to see us go through that again. any further actions that the president takes, in my opinion, deserves an open debate in the halls of congress, so that the peoples' representatives can speak so we can have a free flow

of information. yeah, i have been to some of these classified briefings. and yes, this is a serious issue. and have there been mistakes made in the past? you betcha. but that's gone. we have to look to the future ap we have to address this growing threat to our national security. and yes, we must bring our allies on board. and build an international coalition in which the first president bush did, in which i supported, when he went into iraq to get them out of kuwait. that's the type of coalition building we need now. to ensure that the allies in the region have a skin in the game. it's their security that is a threat immediately before this threat crosses our borders.

>> senator jenkins. >> the house and the senate went out on recess. by all accounts, it's the longest break in anybody's memory, so they can go out and campaign. i think it's an outrage that our elected representatives are not in washington, not putting up a vote on whether or not we should engage more fully in this war in the middle east and iraq and syria. but, no, they put politics first and spending time on the campaign trail talking about it. they are not in washington doing something about it. >> that's obama. the house of representatives controlled by your party, your new-found party.

second of all, you know, we need to be back home meeting with our people, hearing their issues. that's why we in the house are the closest elected federal officials to the people. because nobody gets to the house of representatives by appointment, only by elections. so yes we ought to be hear what , you are saying about isis and about social security and medicare. we should not be allowing these out-of-state billionaires to be pouring millions of dollars in west virginia trying to buy this state so they can have a puppet in the congress that they can control. west virginia is not for sale, my friends. we are not for sale and we need to stand up for the working values of west virginia families and west virginia values, and that is what we need to push harder in our nation's capital. >> thank you.

next question. it has to do with social security and medicare trust funds. a significant portion of the people of west virginia rely on social security and medicare benefits and many in the future will be counting on those benefits, too, for benefits and health care. the trust fund supporting social security will be depleted, forcing a reduction in benefits if nothing is done. for medicare, the forecast for depletion of that fund will be further. how do you think action should be taken? congressman rahall? >> social security is a contract that our seniors have with their federal government. that contract should in no way be renigged upon or changed in any manner, shape, or form. social security is not the reason we are in debt today. social security has not been a part of the problem with deficit

spending. this is money everyone pays into and that money should be there, should be there when we are ready to retire. i have supported cost-of-living adjustments more than the 1.5% that went to our seniors this past january. i have legislation that would recalculate the way the formula is derived that makes up the cola adjustment. the formula doesn't take in the true cost of the economy, like electricity going up and gasoline going up and if you read the bill, was never in the bill i supported. what was in that bill was a tax on billionaires. so why do you think the billionaires are ganging up against me? duh. social security is a contract. i'm against privatizing social

security, as these puppet masters want. the best way to shore up long-term issues of social security, put people to work. pass an infrastructure, jobs bill, that puts our people to work in good-paying jobs and good-paying jobs, when you have a job, you pay taxes and that helps reduce the deficit and can help shore up social security. so let's not forget about a grl ood old-fashioned jobs bill. that's what we need. medicare, i'm not for changing medicare into a voucher system as the billionaires and ryan budget wants to do. medicare should be there, not changing a voucher system and pay more and get less. >> senator jenkins. >> i agree that social security, medicare is a contract, a moral obligation. we must do everything. i oppose privatization of social security.

i oppose a voucher program for medicare. it is just, again, more rhetoric trying to scare. these ads that he has been running are falls and deceptive. they actually call them "meta-scare." when he talks about the carbon tax, he has been saying it's not in there and has the nice u.s. house of representatives seal on it. here is the progressive caucus. maybe this is like obamacare, you didn't read the bill before you passed it, so let me read it. \[applause] >> let me read it. let me read it. impose a price on carbon pollution, the progressive budget he voted for would impose a $25 per ton price on carbon

dioxide. there's only one person that i can find, because every political commentator, all the washington folks, the people who drafted it say there is a carbon tax in it. he wants to keep running from it. i want to leave the last second and mention this campaign finance, my 30 seconds. campaign finance. individual contributions versus pac. 80% of the jenkins for congress contributions are from individuals. only 32% are from individuals for nick rahall. in-state versus out-of-state, 61% of my contributions are from in-state.

only 28% of his are from in-state. we want to talk about who's owned, look at the facts. and read the law. >> first of all, congress never passed a law of two pages. i don't know what you are reading from. some type of summary printed up after the fact. i read that budget. i have it on my desk. no where is carbon mentioned it. it is a tax on billionaires and protects the social safety net for our working families in this country. that's what that budget was all about. but let's get back to campaign finance, since he brought it up. i believe all this dark money that is flooded our state should be disclosed. we have to do it in our personal campaigns. the p.a.c. funding that i have, i'm proud from the umwa, from business leaders. from dentists, cyclists.

it comprises fully-disclosed donations. that's what my support is all about. and i don't back away. i have a pledge that i put out there and signed, but unfortunately, my opponent doesn't want his dark money disclosed from whence it's coming. could be a federal government hijacking our democracy. that's the fear we should have in our democracy. >> senator jenkins. >> guess what? the i.r.s. employees p.a.c. contributed to his campaign. [laughter] >> the i.r.s. employees p.a.c. contributed to your campaign. i'm telling you, it's an outrage. i only have 30 seconds. we are going to be talking a lot more about this outside

it was me when counter-p.a.c. said let's get the dark money out, he said no. it was me who showed up a week ago for a meeting to get dark money. he didn't show. it's all talk. and no action. where were you? your campaign manager showed up. we said where are you? he said, you know what? i'm not at liberty to say where he is. i said are you at liberty to sign this? he said, no. i said can you get him on the phone? he said no, i can't. >> we're onto the next question. i'm sorry. i won't have to ask about campaign financing. [laughter] no, let's talk about it. >> we're going on to another topic, you'll have your closing statements.

next question is about jobs and the economy. much of the dwailt revolving around the coal industry in west virginia has to deal with jobs. preserving jobs this that industry will not move west virginia's economy to any great degree. apart from the coal industry, what initiatives or policies do you think should be implemented to promote job growth in west virginia as well as across the nation? mr. jenkins. >> the progressive budget cut the military $900 billion. we ought to keep talking about those votes. you know what? the best jobs bill in west virginia, the best jobs action in west virginia would again to get this administration off of our backs. every time a question like was asked, well, what's the future after coal? it makes me think i'm not going to get baited into the idea that coal is over.

you know, nick rahall may think it's a slump, which is when he turned his back on a a coal miner in logan when the coal miner said why did you support obama twice and nick rahall said , because he is a democrat and turned and walked away from him. i'm telling you, what we need to do is get west virginia back to work. we need to get our coal miners back to work. i am the sponsor of the legislation bringing the hatfields and mccoy trail system back to west virginia. i believe in tourism. i believe in manufacturing. i believe in health care. these are critically important, but i will never turn my back on our hard-working coal miners and our coal communities in west virginia. thank you, congressman ra

hall? >> coal, has been and always will be our number one industry in west virginia. i'll never turn my back on our coal industry or our coal miners. but let us face it my friends, we cannot put all of our eggs in the coal basket. we need to diversify our economy. and i am very proud of the efforts i have taken to diversify our economy. using my leadership on the transportation and infrastructure committee, using my past chairmanship of the house resources committee. and get things done for our people has produced in southern west virginia, just one example in the tourism field, after i protected the new river in 1977, my first year in the congress, i built upon that protection. and in the mid-1980's, build the largest system of

federally-protected rivers east of the mississippi. president was reagan. guess who his interior secretary was? james wyatt. he recommended a veto thinking that the federal government was extending protection of federal lands. everybody was for it in west virginia. i had republican friends in west virginia saying can call the president and get him to back off this veto. it was signed into law. we have one of the largest federally-protected rivers and helped draw the boy scouts of america to west virginia. my opponent mentioned the hatfield and mccoy trail system, i got the first $600,000 from the federal level to study such a trail system in southern west virginia. it is doing what whitewater rafting is doing for the southeastern part. i directed the corps of engineers to release water for

whitewater rafting. previous to that, they had been fighting each other. that is another additional rafting season. producing receive news and jobs for our people. >> senator jenkins. >> he talked about not turning his back. when he voted for a carbon tax, he turned his back on west virginia coal miners. when he voted against the rains act to limit the government overreach, he turned his back on hard-working people of west virginia. i could go on and on on his votes, when he said in 2009 when all of those permits were held up by the e.p.a. and nick rahall said the e.p.a.'s just doing their job, he turned his back on west virginians. and when he runs these ads and says i'll never let anybody stand in the way of our west

virginia ways, well, i'm telling you, barack obama, nancy pelosi, harry reid are staying and standing in the way of our jobs and he's standing there and helping them every step of the way. he voted for her six times as speaker! if he is elected here in two, three weeks, guess what, he is going to vote for her again. >> congressman rahall. >> there he goes again. a carbon tax that never became law, that was not even in the bill, if you read the bill. i am for coal. i'll look every coal miner in this state in the face and as i have done. references has been made to the rains act which would have required every regulation of the

federal government to be subjected to congressional approval. outrageous. that would have endangered our food safety laws, our air traffic safety laws. i would rather zero in on the e.p.a. as i have done, being -- being a moderate democrat with republicans can get my support and get my help in death getting democratic votes. that's the type of bipartisanship we need. >> we are done with our questions for this evening and now go to the closing statements from the two candidates. senator jenkins will be first. >> thank you very much. that 90 minutes went by quick. i again welcome the fact that the "herald dispatch" was able to facilitate this.

i have been pushing for substantive debates. we have a very spirited exchange. i have been hoping for this, wanting it, asking for it for months. finally congressman rahall agreed. thank you to the "herald dispatch," thank you to all who are watching. but again, back to my first point, this is about the house of representatives. you know, our constitution and our framers set up a pretty good process. we elect a president for four years. but we have the house of representatives elected every two years. this is an opportunity to make a change, to make an adjustment. to say, you know what? is it really working for you. and i don't know how you can spend the last 38 years or the last lifetime of being a west virginian and not understand

that west virginians are hurting. families are hurting. we had 5,000 coal jobs lost. we have had 43% of our coal employment in appalachia wiped out. we have obamacare has an $800 billion raid on medicare. we've got problems, folks. and don't think -- maybe just ask yourself, do you think 39 and 40 are going to be any different when you have got a record like he has? so i stepped up to the plate to say i wanted to give the voters of west virginia and third congressional district an opportunity for a change. not a supporter of barack obama. not a six-time voter for nancy pelosi. not somebody who cut our military pensions, as the congressman has done when he rolled back their colas. we can go on and on and has been a robust campaign.

but let me close with this issue as he keeps bringing up about the ads. the house majority p.a.c. is nancy pelosi's super p.a.c. and gets this money in her p.a.c. to run against me, these are anti-coal money. the d.c.c.c. because they are out for the environmental policy are helping nick rahall. and his ad that is recently running was declared the most dishonest, one of the top five most dishonest ads in the entire country this election cycle. i asked for clean elections and i asked to get special money

out. he said no. he is beholden to the p.a.c. contributions. i would be honored to have your vote for a change of direction and not a change of pace. [cheers and applause] >> let the congressman speak now. congressman rahall? >> as i said in my opening statement, i have and always will be a fighter for west virginia values. i'm very proud of my record. i have run on it every time i have run for re-election and it is one that represents west virginia values and represents our love of god, our love of family and our love for this great state of ours. you know, it means work ing

ing across party aisles toorks. and today's dysfunctional congress, it means a great deal to work across the aisle and work with republicans against my own party when it comes to passing legislation that seeks to reign in overreaching anti-coal e.p.a. agenda and it is working to protect our coal miners' health and safety benefits and raise the minimum wage which my opponent opposed in the state legislature, making sure that a good education is available to everyone, not just the wealthy. i always put west virginia first. who's going to be able to help the people of southern west virginia the most? that's the big question in this election. i can bring investments,

highways and water and sewage reconstruction. i have broadened our tourism potential and aided our colleges and universities. strength agenda our veterans services, $16 billion bill we passed this year. or on the other side of the equation, who is going to be there doing the bidding for out of state billionaires who have an agenda that is totally adverse to west virginia's best values? we don't need the extremes in the republican or democratic party. what we need to do is end the gridlock and disfunction to continue our -- rather than follow those hidden agendas. believe it you mean, -- believe me, they are behind a hidden agenda. they are supporting all these efforts in congress to cut and gut programs that are so vital to our families in west virginia. follow the money my friends. when out of state billionaires

came a-talking, my opponent went a-walking. that's what it boils down to. he'll do their bidding. i support coal. to support coal, you have to spot our coal miners. i have good democratic and republican friends. i do work across party aisles. even in this very divisive congress, i can bring both sides together to make things happen in west virginia above party politics. i was born and raised here in west virginia. it's my home. and it will always be my home. it's where my heart is. you have honored me with your support in the past and for the sake of our state's future, i'm hoping and asking you to stick with nick again. keep the ball rolling. and i ask you for your vote. thank you for participating and god bless each other. [cheers and applause] >> applaud both candidates, please.

>> thank you. thank you everyone for being here this evening. special thanks to the candidates for sharing your views and barbs with each other. but it has been a great event and thank you for being here. us on twitter and like us on facebook. c-span is bringing you over 100 senate and house debates and you can share in your reaction with what they are saying. engage byuch and following us on twitter and liking us on facebook. debatend i's c-span

coverage, at 8:00 p.m., the new 9:00hire senate debate, at p.m., the only debate for senate,es for oregon jeff merkley and monica webby, and at 10:00 p.m., the louisiana ,ifth district house debate between one democrat and one independent. sherman shepherd on politico will be on washington journal , and at morning at 7:45 a: 30, alex smith and atima omara, washington journal is live on saturday on c-span.

earlier today, nina pham, the dallas nurse who contracted ebola announced that she is now free of the disease. -- being infected, she was transferred to the national institutes of health. >> we will, and answer a few questions for you, and then we returned to texas to resume a fall, happy, healthy life. [applause] good afternoon. i feel fortunate and blessed to standing here today. i would first and foremost like to thank god, my family, and my friends. ordeal, i put my trust in god and the medical team. i am on my way back to recovery, even after i reflect on others

who have not been so fortunate. i am so incredibly thankful for everyone involved in my care from the moment that i became ill and was admitted to presbyterian hospital in dallas to the day of my release from the nih. to thankspecially like dr. kamber l.a. for his selfless act of donating plasma to me -- hiskent brantly for selfless act of donating plasma to me. i would also like to thank the entire support team. ower ofve in the p prayer, because people all over the world have been praying for me. i cannot thank everyone enough for their prayers and their expressions of hope and love. i give a prayer now for the recovery of others, including my

and ther. amber benson, doctor in new york. this was very challenging for me and my family. ,lthough i no longer have ebola a while until be i have my strength back. i asked for my privacy and for my family's privacy so that i can get back to a normal life and reunites with my dog, bentley. [laughter] thank you everyone. [applause] thank you very much, nina, and before i open for questions, i want to recognize two people who really helped us in linking with nina and to getting to know her as essentially a member of our family here at nih, and that

is nina's mother diana and her sister, kathy. [applause] so -- >> how do you knows that she is virus free? what did you do for her? virusknow that she is free because we had five consecutive negative pcr's on her. i don't want anyone to take that that is the normative or the standard, that anyone can be declared fire or site free because they had five negative tests. free becauseirus they had five negative tests. patient back and ebola to health is to allow them to

fight off the virus and allow them to essentially get rid of the virus. [inaudible] i would leave that up to her, that is not my place to answer right now. >> should americans are others returning from west africa the under more strict or mandatory quarantine? >> that is under discussion right now, but i want to point out that it is not just the cdc, ing soon, but right now we cannot discuss that. you might be -- [inaudible] >> i can repeat what i have been saying all the time. the way you get ebola is having

direct contact with an individual's body fluids. i must point out that you must separate the risk to the general with peoplee risk like nina and her colleagues. they are two different things. nina put herself in a situation which she knew was a risk, that because of her character and her bravery and because of her colleague in the field, she unfortunately got infected. that is a different story for the general public. she was a very sick person. >> what have you learned from treating nina pham? and what have you learned where other doctors and teach other doctors to helping other people get better? her, we have a considerable amount of laboratory data, remember that

this is only one patient, we were a cause that her colleagues, and with our colleagues at amory and nebraska, and we are comparing notes back-and-forth, and it is important for people to understand that there is a public health issue, and then there is a scientific understanding of what is going on. and that is what we do here. primary care of the patient is first, but mixed with that is collecting data, and when you have one or two or three, you have to focus very much and try to get that information, and gradually we will be able to say things that will help others where they can take pair -- take care of patients. that does not mean that everybody has to do that, but we have to learn from that. why has it taken so long to

get an ebola vaccine? >> there are a lot of reasons why, to say that you have to get a vaccine, you have to separate that from a vaccine candidate, , ebola is at of all and we are trying to figure out how the disease will change, and we are planning a larger efficacy trial with a randomized controlled trial, and we will be able to do that without some other design. indirect answer to your question, you recall that we started on this 10 years ago, and we have done different andations of improvements, one must appreciate that the incentive for a pharmaceutical company to get involved in

putting a major investment in the development of a vaccine of a disease, which, until the outbreak, less than 2500 people were infected, we did not have the kind of incentive is asian on the part of industry -- ation on the part of the industry's. i don't -- well, first of all, the funding is a very complicated issue. we should put that off of the table. we have the capability and the resources to do the trial that will hopefully start at the beginning of 2015. yes? >> can you give me a turning point and nurse pham's health in turning around? >> i don't want to make an

absolute statement on that, because remember she was taken care of very good people in two separate hospitals. when she was in texas presbyterian, she was in the process of actually doing better she came to us and she cap doing better and better. not pinpoint in one nation at what was the turning point. the one thing that we are very happy about is that the turning point occurred. that is conceivable but we cannot prove that. we have so many different factors at the same time going into the care of the patient, it is virtually impossible to say that this is the thing that dead and this is the thing that did not do it.

it is just impossible to do, i am not trying to evade it, but that is the reason why you want to do clinical studies where you can actually get that information so the next time we have an outbreak or even during this outbreak, we can say we recommend this because we know that it works. at this point, everything is experimental. we want to take things that are experimental and make it evidence. congratulations, we wish you well when you go home today, the who reports that about 70 percent of those infected in west africa have died because of this myra's. how do you explain -- because of this fire a's. how do you explain the speedy recovery -- because of this virus. how do you explain her speedy recovery? >> i don't have all of the

answers, but it could be because she is a young and healthy individual, and because she also systeme to get into a that was able to get her health care early, and that she was able to get into a health care system that was able to give her everything that she needed. that tells you that that contributed. but how can you relate that to 70% versus this percent? it is impossible. >> what is nina's prognosis? issue cured? -- is she cured? what are the long-lasting effects? >> let me clarify, she is cured. and let a tell you about the long-lasting effects. a couple of years ago, i got influenza, and influenza has longer-lasting effects than ebola.

back to work after a couple of days and i felt very weak, that i would not be surprised anybody recovering from ebola would take a couple getays or so or longer to all of their strength back. she is such an incredible lady, she is going to do it quickly. are there any restrictions on and nina's travel, where she can go, who she can talk to, whom she can see, and how do she traveled back to dallas? i would have to leave that confidential right now. that is something personal and private and i don't want to have hordes on her. she asked for her privacy and we will give her her privacy. >> can you talk a little bit about the communication of nina's family? how closely did you relate her condition to her family? >> we have a system in there that is easy to communicate, the

family talks by phone, by face time, and things like that. i am not going in the room, img going by to say hello, and she taught me how to use going by-- i am just to say hello, and she taught me how to use facetime. [laughter] >> how confident are you the hospitals are covering good information and providing other health care professionals to ensure that they will not end up like nina? >> as you probably have noticed, there is a very strong, aggressive, educational effort that is going on led by the federal government, and the cdc is playing a major role in that. toare doing things to try educate more people, and not only educate them, but make sure that we have people trained, retrained, practice, and so people have the right and to --

the ability to identify. thank you all very much, we appreciate you break -- you being here. nina? you tell us about nina verying to miss much. i gave her my cell phone number and case she gets lonely. [laughter] [applause] >> we love you nina! >> yay! [laughter] [applause] on our facebook page, we have been asking you the u.s. response to ebola and if it his been effective? , of course itys says. the ridiculous hype and scare tactics over this is unbecoming of a reasonable society. what everne says, no,

happened to quarantining those who return from ebola-stricken countries? earlier today on capitol hill held a hearing on the u.s. response to ebola, and we u.s. health care workers are able to handle the disease. here is a look at that hearing now. gentlemen, before i gavel this to a start, i think you already heard, please put your cell phones either off or preferably on airplane mode. you're certainly welcome to take pictures as long as you don't stand up or in any other way block other people. we have a large panel today, members have flown in from all over the country to hear these people and to ask questions, so the only thing i ask is that, please, give them all the opportunity to do that.

this is the one place that applause is not appreciated. americans have a right to know that the money that is being taken from them is being used and well spent. on the oversight government committee is to hold the government accountable to the taxpayers. the taxpayers want to be safe. the taxpayers want to know that our government is prepared.

in this case, we leave no stone unturned in ensuring and shoring today that america is planning for tomorrow. beginning in march of 2014 in the west african nation the world first learned about yet another new outbreak of the ebola virus. due to poor detection it's possible the outbreak started late last year. by august, ebola spread to sierra leone, liberia, and guinea. according to the centers for disease control and prevention ebola epidemic is the largest in history and sadly the virus has claimed at least 4,000 lives to date. by the end of september, the cdc confirmed the diagnosis of the first travel associated case of ebola in the united states. the situation is rapidly

developing and changing, and americans are understandably worried. they are worried that their governments response to the outbreak and in particular, the steps we are taking to control the spread of ebola. with the high fatality rate as much as 70%, ebola looks of public health around the world. an outbreak in american cities or any major city in the world could be very costly to contain and could have major economic impacts. yesterday's news was a doctor in new york city tested positive for ebola and this is particularly distressing. there is certainly some good news to report on our efforts to contain the outbreak created no new ebola cases have been reported in nigeria in 46 days. over 40 people who came into contact with the ebola patient thomas eric duncan in dallas

have now gone through the 21 days monitoring period without demonstrating any symptoms and perhaps that means our preventive systems of those in contact is good, even though as we will see today, not perfect. we have the worlds most advanced health world's most advanced health care system undeniably in america. we spend the most money to have that system and as long as our response is well-coordinated there is an ability to contain this disease but we are not out of the woods yet. we will examine agents tasked with responses to the ebola outbreak into this examination follows a series of statements and actions that have the the -- have eroded public confidence in our response. infected traveler from liberia made it through the department of homeland security screaming

and arrived at international travelers into the dallas-fort worth area. when the same individual exhibited signs or symptoms of ebola, a hospital turned him back into the community and offered an evolving account of how this happened. without evidence, the director of the cdc declared that a nurse at the hospital who became infected with ebola must have contracted it through, and i quote, a breach of protocol. medicine is in stone over the telephone or the television. medicine is the business of looking at a patient, evaluating the patient, measuring and

questioning the patient, and not in fact, guessing how someone became a patient. could reduce the victims who contracted ebola at the hospital was cleared by the cdc to board a commercial airline flight even though she reported having fever and contact with the patient mr. duncan. the news that medical doctor returning now has tested positive for ebola has raised even more questions about procedures and treating questions and risks to americans responding with great courage and generosity from here to the infected areas. we need to know why there've been breakdowns and if our system for responding to such serious crisis is working properly. there is a line that i was supposed to read, and i think we all know the system is not yet refined to where we can say that it is working properly. how effective are the efforts at containing the disease in west africa?

are the training and equipment at equipment that the front-line health-care workers and military personnel received in the past or future, adequate? is an airport screening that went into effect weeks ago reliable? -- are the government agencies doing everything they can do to foster the development of ebola treatments? what threat does ebola posed to international trade and americans traveling abroad wax when a situation like this arises from the government is supposed to rely on prior planning and rapid effective response that can identify mistakes quickly and correct them. congress has recognized and considered the threat of an outbreak on a bipartisan basis. the bumbling that we have seen in despite the efforts to

ensure protocols and funding in place to avoid the very mistakes we've already seen. president obama's appointment to to serve as the ebola czar in my opinion sadly shows that the administration has on the one hand recognized the missteps and on the other hand is not prepared to put a known leader in charge or in fact a medical professional in charge. that doesn't make it a political decision, but it makes it a decision in which we have to ask and we will ask today, is their interagency coordination in place and simply overseeing it or in fact are we expecting mr.

klain to put together interagency coordination to show the leadership to make it happen ? to sift through the conflicting claims of science and medicine that have already reached conclusions versus the reality that those conclusions at least in several cases have proven wrong. we did invite him to testify and we are very disappointed that he wasn't able to but we understand that he's just started and we do not expect that would be repeated if there is a follow-up hearing. let me say in my role in this committee and others i've traveled to the world health organization's headquarters. i have seen them say to us as visitors that pandemics, are in fact, already planned for and

although they talk about the inevitability of a pandemic we have invested billions of dollars to be prepared for them. let me say before anyone pulls the trigger on either apolitical or denouncing medicine that in fact this is not a new problem. nearly 100 years ago in 1918-1919, the influenza pandemic known as the spanish flu, claimed at least 20 million people -- thank you -- around the world. and that pandemic started at an american base that i was stationed at proved to be the source of the first known outbreak.

it spread fast around the base and other places and eventually worldwide. famously it's well aware that not only was the outbreak critical but in fact soldiers were put on the ships and sent out recognizing that in fact we were adding to disease and the suffering. the asian flu of 1957-1958 originated in the far east spread to the u.s. and caused at least 70,000 deaths. the flu of 1968 and 1969 also spread and caused an estimated 34,000 deaths. it would be a major mistake to underestimate with ebola cards

do to populations around the world and any further fumbles or missteps relying uncertainties told to us by people who cannot defend how that certainty came to be and when it fails to be correct how they could have been so wrong can no longer be tolerated. i look forward to hearing from this panel of witnesses in an effort not to solve a problem that should take the problem appropriately seriously and recognize what we don't know could kill us and with that i recognize the ranking member for his opening statement. >> thank you mr. chairman and i thank you again for holding this hearing. i think this is the reason we have an oversight committee to address those problems that our nation and in this case the world face. yesterday working for borders tested positive for ebola still getting additional details based on information from new york and federal officials so far it appears healthcare authorities have come a long way preparing for ebola said thomas duncan walked into a texas hospital last month. new york had been preparing for this possibility for weeks.

about 5,000 health care workers were drilled on the protocols and procedures just this past wednesday. a special team with full transported the octor handle ebola. they placed him directly into an isolation unit and began treating him as soon as possible and they started tracing his contacts immediately. as new york officials said last night they hoped they wouldn't have to face a ebola case that they did. they were also realistic and they worked diligently and professionally over the last month to prepare themselves for

this day. but there are many questions about this case but we cannot assume that it will be the last and i would remind all of us this is our watch. of course we must continue to be vigilant and we need to continually reevaluate our workers many of whom are here today and to those health-care workers, on behalf of a grateful congress and a grateful nation i thanked you for what you do everyday. i want to express our thanks to nina pham and amber vinson, the nurses from texas who contracted ebola when they treated mr. duncan. by now we've all seen their

pictures. two brave young women who risked their lives to simply do their jobs. just like nurses across the country every single day, 24/7, 365 days a year. i understand that ms. pham's condition has been upgrated and ms. vinson has been cleared of the virus. the new case should also demonstrate we can no longer ignore the crisis in west africa. we can no longer ignore it. nearly 10,000 people have died from this disease or they are battling it as we speak, many in the most gruesome conditions imaginable.

i believe we have a fundamental and humanitarian obligation to address the crisis in africa. we are the richest nation in the world, and we have the resources and expertise to make the biggest difference. however, for those that may not agree that we have an obligation to help, they must understand addressing the ebola crisis in africa is also in our self-interest as a nation. public health experts warn that to protect americans at home we need to address this outbreak at the source in africa. the longer the outbreak continues the more likely it will spread to the rest of the world, including more cases right here in the united states of america, and we do not take strong action now, it would cost

much more in the long run. health care experts know how to fight this disease. this week the world health organization declared nigeria and senegal free of ebola. this was achieved through a combination of early diagnosis, contact tracing, infection control, and safe burial. but we still face great challenges in sierra leone, guinea, and liberia where the public health infrastructure and new cases are increasing at an alarming rate. last month the u.n. security council unanimously adopted a resolution declaring the ebola outbreak as a threat to international peace and security.

the u.n. established except for more than a dozen actions that provided a six-month budget request for $988 million. however, they are hundreds of millions of dollars short. they need funding for treatment beds, training for health care workers, and supplies to prevent infection. they need resources for things as basic as food and vehicles and fuel. as the head of the united nations mission warned the security council just last week, and i quote, we either stop ebola or face an entirely unprecedented situation for which we do not have a plan. there've already been several hearings on how to prepare ourselves in the united states.

today i intend to ask the witnesses what are the most significant concrete and destructive steps our nation can take to address this outbreak at its source. i am grateful to the international medical corps for being here today to provide an on-the-ground assessment with his group and others on the front lines needed to stop the spread of ebola. i know you must feel empathy for mr. spencer, who testified yesterday. i've asked my staff to place your testimony on the website as some of the best testimony explaining what is going on in africa, and i think the public should have an opportunity to read all 10 pages. dr. spencer was one of your compatriots battling ebola in west africa, and i'm sure his situation is one that all of

your health care workers must fear on a daily basis. but the truth is dr. spencer and your group and many others are doing one of the only things that will truly ensure the world will be free of ebola. we need to support you as much as we can, and we must do it forcefully, and we have to convince the rest of the world to do the same. again, i say this is our watch. and to my fellow committee members, it is not a time for us to move to common ground. we have no choice but to move to higher ground. so with that, i look forward to the testimony, and i yield back. >> all members will have seven days to separate opening statements and we go to the panel of what is his.

the honorable michael lumpkin is the assistant secretary of defense for special operations and our intensity conflict at that the united states department of defense. major general james lariviere is the deputy director of political military affairs in africa at the united states department of defense. the honorable john ross -- sorry, i just got off a flight. the honorable john ross is the inspector for the united states department of homeland security. the honorable nicole laurie is the assistant secretary for preparedness response of the department of health and human services.

next is the co-president of the nurses united and the senior vice president of international operations at the international medical corps. ladies and gentlemen, pursuant to the rules of the committee, would you rise and raise your right hand and take the oath. do you solemnly swear or affirm the testimony that you're about to give will be the truth, the whole truth, and nothing but the truth? please be seated. let the record reflect all of the witnesses answered in the affirmative. as you all can see we have a large panel and i know there will be many questions, so i would ask that you realized your entire opening statements will be in the record and that you limit your oral testimony and your opening to five minutes. with that, mr. lumpkin? >> chairman issa, ranking member cummings, and distinguished members of the committee, thank

you for the opportunity to be here this morning regarding the department department of defense roll in the united states comprehensive ebola response effort which are a national security priority and response to a global threat. due to the u.s. military's unique capabilities, the department has been called upon to provide interim solutions that will allow other departments and agencies the time necessary to expand and deploy their own capabilities. u.s. military efforts may also galvanize more robust and coordinated international effort, which is essential to contain this threat and to reduce human suffering. before addressing the specific elements of the dod ebola response efforts, i would like to share my observations of the evolving crisis and our increasing response. after visiting liberia -- which i returned from several weeks ago -- i was left with a number of overarching impressions that are shaping the department's role supporting usaid. first, our government has deployed a top-notch team

experienced in dealing with disasters and humanitarian assistance. second, the liberian government is doing what it can with its very limited resources. third, the international response is increasing regional -- regionally due to our government's response efforts. fourth, i traveled to the region thinking we face a health care crisis with a logistics challenge and in reality, what i found is that we face a logistics crisis focused on a healthcare challenge. fifth, speed and a scaled response matter. incremental response will be outpaced by the rapidly growing epidemic. finally, the ebola epidemic we face is truly a national security issue. absent our government's coordinated response in west africa, the virus is increasing

in its spread and brings the risk of more cases here in the united states. now i would like to turn to the dod's role in the overall whole of government response in west africa. in mid september, president obama ordered the department to undertake military operations in west africa and direct support of usaid. secretary hagel directed that military forces undertake a twofold mission. first, support usaid and the overall u.s. government efforts and second, responded to the department of state requests for security or evacuation assistance if required. direct patient care of ebola-exposed patients in west africa is not part of the dod's mission. secretary hagel approved the

efforts falling under the lines first, command and control, logistics support, engineering support and training. in the last six weeks, dod has undertaken a number of synchronized activities in support of these lines and efforts to include designating and named operations united assistance. establishing the intermediate staging base and to carve senegal with strategical tactical airlift. constructing a 25 bed hospital in monrovia and constructing up to 17 ebola treatment units also known as etu's in liberia and preparing to train local and third country health care support personnel, enabling them to respond to these treatments throughout liberia. i would like to reiterate that the u.s. personnel on to provide direct care to ebola patients in west africa. in addition to the activities of operation united assistance, the department continues two enduring programs in the region, operation onward liberty,

partnered with armed forces of liberia, to improve their professionalism and capabilities, and we are expanding the regional efforts of the department's cooperative biological enhancement program, to provide a robust enhancements to biosafety from a biosecurity and surveillance systems in west africa. and all of the circumstances the protection of the personnel and the prevention of any additional transmission of the disease remains paramount planning factors. there is no higher operational priority than protecting our department of defense personnel. in conclusion, we have a comprehensive u.s. government response and increasingly a coordinated international response. the department of defense's interim measures are an essential element of the u.s. response to lay the necessary groundwork for the international community to mobilize its response capabilities. now is the time to devote appropriate u.s. resources necessary to contain the threat

and to establish the processes for better future responses. with that, i would like to introduce my colleague from the joint staff, major general lariviere, we are ready to answer your questions and appreciate the opportunity to be here. >> i understand you do not have a separate opening statement? >> i do not, but stand ready to answer any questions. >> thank you. mr. roth. >> good morning, chairman, ranking member cummings and numbers of the committee for inviting me to testify about the dhs damage when the pandemic suffice to make a surprise. we must have the ability to continue operations in the event of a pandemic. in 2006, congress appropriated $47 million in supplemental funding to dhs for them to plan, train, and prepare for potential pandemics. we recently conducted an audit of those efforts focusing on the department's preparation to

continue operations in achieving its mission should a pandemic occur. the report of the audit is attached in my written testimony that i've submitted testimony. in short, our audit concluded that the dhs mismanaged the program in three ways. first, we found the dhs did not adequately conduct a needs assessment before purchasing protective equipment and antiviral drugs. as a result, we could not determine the basis for the dhs's decisions regarding how much or what types of the pandemic supplies to purchase, store, or distribute. as a result, dhs may have too much of some equipment and too little of others. for example, we found that dhs has a stockpile of about 350,000 white coverall suits and 16 million surgical masks. but hasn't but hasn't been able to demonstrate how either fits into their pandemic prepared his preparedness plans.

it has a significant quantity of antiviral drugs but again, without a full understanding of the department's needs in the event of a pandemic, we have no assurance that the quantity of drugs will be appropriate. second, dhs purchased much of the equipment and drugs without thinking through how these supplies would need to be replaced. material dhs has purchased has a finite shelf life. for example, tsa's stock includes about 200,000 respirators that are beyond the five-year usability date guaranteed by the manufacturer. in fact, the department believes the entire stockpile of personal protective equipment will not be usable after 2015. likewise, the antiviral drugs dhs purchased are nearing the end of their effect of life. dhs is attempting to extend the shelf life through an fda testing program, but the results of that are not guaranteed. third, dhs did not manage it in

the degree of drugs or equipment. as a result, the dhs didn't know how much protective equipment and drugs it had on hand or where it was being stored. drugs and equipment have gone missing and conversely the audit has found the drugs in the dhs inventory that the department thought had been destroyed. we visited multiple sites and found drugs that were not being stored in a temperature-controlled environment. because dhs cannot be assured they were properly stored they are in the process of recalling a significant quantity because they may not be safe or effective. we made 11 recommendations in the dhs has conquered with all of them. the department is taking action to implement the remaining ten recommendations. we will continue to keep the committee informed about the department's progress. mr. chairman and that concludes my statement and i welcome any questions.

>> dr. lurie. >> distinguished members of the committee, i am a doctor, the assistant secretary for preparedness and response at the u.s. department of health and human services. i'm also a primary care doctor. i appreciate the opportunity to talk with you today about the steps that hhs and others have taken since the ebola outbreak began in west africa. we are working 24/7 and sure that we can prevent and curtail the spread of the disease here at home. thanks to the foresight of the congress, the leadership of this and prior administrations, the dedicated work of the hhs, whole of government approach that we are taking we are better positioned than ever to respond to ebola and a range of other threats that may affect this country.

i serve as the assistant secretary and as the principal advisor to the secretary on all matters related to health and preparedness for emergencies. since the confirmation in 2009, we worked hard to ensure we have the tools necessary to prepare for and respond to any disaster with public health consequences. i led the modernization of the countermeasure enterprise, created new opportunities for the coordination among state and local public health and health care systems, and strengthened our ability to make better decisions before, during, and after an emergency. our approach allows us to be flexible and nimble in response to the known and unknown threats. as you know, for cases of ebola have been detected in the united states, and our hearts go out to the family of mr. duncan and the nurses that have been affected, as well as the physician in new york. we are pleased the nurses are doing so well and we wish them a sufficient and speedy recovery. we are extremely serious in our focus on protecting america's

health security, and the best way to do that is to end the epidemic in west africa. time, we are expediting the at the same time, we are expediting the countermeasures and preparing our system to deal with any potential cases in this country. so not long after this epidemic began, i convened that federal stakeholders to see what can be accomplished as quickly as possible. thanks to past investments, we have leveraged the assets to urgently speed the development and testing of the vaccines and therapeutics for ebola. these advances allow us to create ebola countermeasures in record time so we have products to use as soon as we have the national proof of efficacy. our strategic investments in the infrastructure, including the centers for innovation and manufacturing established in 2012 and newly established manufacturing network, would be used to get vaccines and therapeutic into vials for us. we are also leveraging our relationship in the street and

the public-private sector per us to scale up the vaccine manufacturing. in addition, our public health care system must be prepared to deliver safe care at a moment's notice. investments in the hospital preparedness program into the public health preparedness program have meant program have meant the program have meant the health care systems and state and local public health departments are prepared to respond to public health emergencies. since the epidemic began, we've been using these programs to educate systems, stakeholders, and ensure capacities are in place. we've launched a very aggressive national outreach education program to promote a safe and effective detection and treatment of ebola patients. the system we now have in place is based on changes and lessons learned including those come from to as the assistant secretary.

based on the first u.s. cases, hhs has already made adjustments to minimize the spread of ebola. these include tightened guidance for the use of protective equipment and expanding aggressive national education campaign for healthcare workers and screaming and active monitoring of passengers entering the united states now funneled through five airports. we've been working collaboratively, including the transport contaminated waste with the department of transportation, medical evacuation, deployment of military personnel and workers and workplace safety with osha. members of the committee i understand why you and your constituents are concerned. we take domestic preparedness very seriously. our top priority is protecting the health of americans. i can assure you my team, the department, and our partners have been working and continue to work long hours to prepare our nation for threats like this. with lessons learned from this new challenge, we are making efficient use of the investments provided and we have made

tangible and meaningful progress since you first created this office in 2006. as a result, hhs has been able to provide support to the states and communities. i thank you again for the opportunity to address these issues and welcome your questions. >> ms. burger? >> members of the committee, i am deborah burger -- co-president of the national nurses united representing 190,000 members in the largest organization of nurses in the united states. the ebola pandemic and the exposure of health care workers and the real threat that it could occur elsewhere in the u.s. represents a here and present danger.

every r.n. who works in the health care facility could be nina pham or amber vinson who contracted ebola while treating thomas eric duncan at texas presbyterian hospital in dallas. one patient diagnosed and dead in this country, two nurses in this country, two nurses infected so far. in our survey of over 3,000 nurses from over 1,000 hospitals in every state, d.c., and the virgin islands reveals 85% of the nurses say they are not adequately trained and the level of preparation for ebola in our facilities is insufficient. 68% of our rns still say their hospital has not communicated any policy for admission of a potential ebola patient. 84% still say their hospitals have not provided a ebola education with the opportunity to interact and ask questions. 44% say their hospitals lack insufficient supplies of eye

protection now. 46% say they are insufficient supplies of fluid resistant impermeable gowns in their hospital. 41% say their hospitals do not have plans to equip isolation rooms. initially the nurses who interacted wore gowns and gloves with no taping around the wrists, surgical masks with the action of face shields leaving their neck exposed. two of them became infected. this is what happens when guidelines are inefficient and voluntary. the new cdc guidelines of protective equipment leave no skin exposed as a direct testament to the courage of dallas whistleblower who first spoke to us. we've called on president obama to invoke his executive authority and urge the congress legislatively to mandate uniform

optimal national standards. these include full-body hazmat suits that meet the aftm f-1670 standard for ebola penetration and be and the aftm 1671 standard for viral penetration which leaves no skin exposed or unprotected. approved air powered purifying respirators with a factor of at least 50 or higher standard as appropriate. at least two direct care rns for each ebola patient and the additional and no additional patient care assignment. continuous on-site interactive hands-on teaching with the r.n.'s and updates responsive to the changing nature of the disease. the precautionary principle must be utilized when developing public health policy designed to protect patients, the public,

nurses, and all health care workers who may be exposed to potentially infectious patients. lest we forget the risk of exposure to the population at large starts with the front-line caregivers. it does not end there. as we have seen with school closures in ohio and texas and the quarantine of airline passengers, improper protection and inadequate protocols and hospitals can lead to public exposure. the response to ebola has been dangerously inconsistent and inadequate. the lack of mandates and shifting guidelines from agencies and reliance on voluntary compliance has left caregivers uncertain, unprepared, and vulnerable to infection. our experience with u.s. hospitals is they will not act on their own to secure the highest standards of protection without a specific directive

from our federal authorities, by an act of congress, or potential presidential executive order. the new cdc guidelines represent progress with improved standards for training, as we've been demanding for months. the cdc guidelines are still unclear on the most effective protective equipment, specifically allowing hospitals to select protective equipment based on availability and other factors. we are the first line of defense. no nation would ever contemplate sending soldiers into the battlefield without armor and weapons. give us the tools we need. all we ask from president obama and congress is not one more infected nurse. thank you. >> mr. torbay?

>> on behalf of international medical corps, one of the few agencies to be treating ebola patients, i'd like to thank you for inviting me to testify today and for your leadership and convening this critically important hearing. we would also like to express our appreciation to the u.s. government for their pivotal action and generous support for the response. our response to the ebola outbreak has been robust. by the end of november, i anticipate we will have a total of about 800 staff in liberia and sierra leone and approximately 70 will be expatriates. the international medical corps has been in west africa since 1999. our ebola response started in late june with community education and in sierra leone, and late july and after we realized the epidemic reached out-of-control levels, we deployed our emergency response teams to both sierra leone and liberia and decided to get

involved in the treatment of the cases. when our emergency teams arrived in liberia in august, what we found on the ground confirms urgent action was required. in a few short months, four months from the ebola outbreak had brought the country's already fragile health care system to the brink of collapse. many were dying. most were afraid. previously busy hospitals were too frightened to go for the fear of being infected with the virus. rather than risk infection, mothers spurned life-saving vaccinations for their children and if their child became ill even seriously ill all too many believed the safer option was not seek treatment at all. with funding from usaid, we

opened our first 70-bed ebola treatment center in liberia and admitted our first patient on september 15. currently we have 53 beds occupied and staff of 17 ex- patriots and 161 liberian nationals. to date it remains one of just two in liberia operating outside of monrovia. in the next six weeks we expect to open three additional treatment units and two in the northern province. within the next two weeks we expect to open a training center to train other staff on case management protocols. this center that will be adjacent to the treatment unit we will offer a fast-paced training for those that will be involved in the treatment of the ebola patients. we will open a similar center in sierra leone in the future as well. such hands-on training is the key to protecting health care workers who must operate in an environment where all know the

ebola virus is present. the guidelines are important for they must become but they must become with hands-on training to be truly effective. mr. chairman, i would like i would like to briefly share some of what we know works. this will help highlight several areas on what is needed to go forward. first and foremost, we need to contain the disease at its source. for that to happen, we have learned seven factors that need to be in place. this includes having operational ebola treatment at the staff by well trained health professionals, a robust referral system between community care centers and ebola treatment units as well as between ebola treatment units themselves take advantage of available capacity in certain areas, limiting the spread of the virus in the community is essential to the containment plan. therefore, focus on community sensitization including education, awareness and outreach are critical. finally, contact tracing and

burial teams are critical to limit transmission. i would like to conclude by offering some recommendations to the committee for consideration. more detailed recommendations can be found in our written testimony. first, one of the most critical lessons learned from this response has been the importance of having the human resources ready and prepared to address the outbreak of infectious disease. cadres of health care workers need to be well trained and supported to staff the treatment units start the treatment units and care center to be effective in countries as well as to prepare other countries in the region for any potential future outbreaks. second, ensure the availability of the appropriate protective equipment. third, ensure clear protocols for evacuating healthcare workers. this is essential for the recruitment, training and maintaining of health staff in the sierra leone and liberia.

liberia. fourth, open airspace to and for the countries must be maintained. the growing restrictions on travel to and from west africa fully isolate countries further compromise the supply-chain and inhibit efforts to recruit qualified staff. these factors will further enable the outbreaks to continue. fifth, we need to accelerate and supports the production into vaccines and technologies. finally, the developing and implementing recovery efforts and a long-term strategy we must focus on building stronger health care systems in the region. mr. chairman, there is no doubt that we will stop this outbreak and if done correctly build the tools to prevent another outbreak of such proportions. international medical corps looks forward to working with you to make this happen. once again, thank you, mr. chairman and ranking member cummings, for allowing me to present this testimony and i would be glad to answer any questions or comments you might have. >> i would like to thank all of the witnesses. i'm going to withhold my

questioning at this time and mr. turner go first. the gentleman from ohio is was recognized. >> i appreciate that. i'm under a time constraint having to return back to my district and i appreciate the chairman during that. tuesday i had the opportunity to talk to secretary hagel about the ebola mission, and i believe he takes this very seriously and he's very concerned about about the effect on our men and women in uniform and also on the effects of protecting the american public. i am very concerned about the protocols of protecting the american public, and since i only get one question my question is going to be about that although i am also very concerned as the american public about the protection of our men and women in uniform. i'm very skeptical of the dod protocols, and i think the american public is skeptical. we have two threats, one of ebola coming here, or number two, individuals that have been exposed to ebola falling ill. we've had four cases, two of

them came here, two are the two are the result of people being exposed and then falling ill. three were health care providers. the american public is very concerned that individuals have been exposed to the ebola virus have had a significant public access after being exposed. this is during the period while they were falling ill to ebola. on october 10, ebola came to visit ohio. amber vinson traveled from dallas, texas, to cleveland. while she was in cleveland, she was at local businesses, and of course, she flew on a flight almost 300 people had contact with her while she was falling ill to ebola. fortunately, ohio doesn't have a report at this time, but on october 20, the ohio delegation on a bipartisan basis, sent a letter to the cdc challenging their protocols with respect to people who have been known to have been exposed to ebola. we all know the stories, trying

on wedding dresses, flying, going on a cruise, bowling, riding on the subway. although some of these issues are personal responsibility, they do go to the issue of protocols, and if you look at the october 10 department of defense guidelines in paragraph four, it says a commander has authority, which means they may they don't have to -- quarantine someone up to ten days if they are concerned about an individual who's been exposed. we know the doctor in new york fell apparently after he was in days and then it goes on to say no known exposure and that doesn't mean they were not know no exposure that there's a 21- day monitoring period, but it suggests that the individuals return to routine daily activities. those routine daily activities would include going on cruises, flying, wearing wedding dresses, bowling and riding on the subway. so i'm very concerned as the american public is that the multiplier effect of the

contacts that could occur in the public and as we are learning as we've looked at in light of what has happened, i believe both of the cdc rules and the dod guidance should be revised. in light of what we now know and we are seeing in the concerns of the multiplier effect, again, three healthcare providers that have significant public contact while falling ill to the ebola virus, do you believe that this october 10 guidance should be advised, and, mr. lumpkin, i would like your answer, too. >> the first thing i would say is as i mentioned in my opening statement we at the dod are not doing direct patient care. so our operations in support of usaid are focused on those lines of effort if the command and control, the logistics -- >> but that doesn't mean that no one is going to be exposed to the virus. i understand what you're saying about the health care providers and non-health care providers,

but the gentleman that flew here first, patient number one wasn't a health care provider either. >> very true, but because we have different categories of risk and i would like to turn over to my joint staff colleague here to explain the risk categories and the mitigation strategies. >> thank you for the question. the protocols we've put in place cede the cdc standard as you mentioned. we will be testing personnel twice a day while they are deployed, take their temperature and to insure that if they were exposed and could become infected we could isolate them effectively. the zero- to ten-day timeline that you discussed is the timeline that will take place in country, and commanders have the

authority to remove thire personnel -- >> but as we already know from the doctor in new york he indicated the news reports are correct but his symptoms occurred at 11 days so ten days too short. >> 21 days can't start until out of the affected areas to the 21 day monitoring period will take place -- >> which means they could be traveling which would be an additional exposure. >> we will try to limit their exposure prior to their departure, but the 21-day timeline won't start until they're back in the united states. >> i am highly skeptical and the public is worried and i believe these need to be revised. the delegation said they believe it needs to be revised. the american public is concerned people that are exposed are having too much contact in the public and raising the risk to the united states citizens. thank you, mr. chairman. >> general, i just want to make sure as the ranking member that you're clear in what you're saying and in what mr. turner was asking.

if someone like the doctor in new york that tested positive is in fact held for ten days, needs on a commercial airplane, one of your sergeants leaves on an airplane, arrives in new york and on the 11th or 12th day goes positive, your ten days will have done nothing and you won't get the opportunity to have an outside in other words a quarantine of 21 days after you get back doesn't matter, and i think that is what he was very much asking is the example he gave of a doctor from just yesterday tells i think all of us that ten days is not long enough if that person then travels on a commercial airplane where they can then infect the passengers. is that your question? >> correct. >> perhaps i'm not being clear. the ten days is to attempt to limit their possibility for

exposure while they are in country in liberia. they will then be screened for temperature and possible exposure prior to getting on a government contract or u.s. military contract to be returned to the united states. once they have flown back to the united states, they will be given 21-day monitoring period they will be required to come into the unit twice a day for medical checks by u.s. military medical personnel at the unit where they will have their temperature taken and looked by a medical professional to see how they are doing. that will take place for 21 days back in the area to ensure that they do not become infected. they will never be more than 12 hours from possibly spiking a fever. if they do exhibit symptoms and spike a fever once they are back in the united states, they would be taken to a treatment facility and begin the isolation process. >> mr. cummings? >> mr. torbay, i want you to comment on that in a minute.

i'm curious -- you deal with this every day, but i want to go to some other things first. i know your organization is incredibly busy. but your input is very crucial. in addition to your detailed written statement, you provided some pictures, and i'm hoping you can explain what we are seeing. first, i believe this picture is a ebola treatment center. can you describe what we are seeing here. >> this is an ebola treatment unit. this is the isolation unit. what you see is the workers in yellow suits with a mask or a actually in the restricted area. no one is allowed to go in there without a full personal protection equipment and training. and outside, they are taking

notes, and the supervisor to make sure that proper protocols are taking place as they are entering the treatment unit. >> in your testimony you said you need about 840 of these every week. you've also said, and i quote, the current demand far exceeds the supply. the two manufacturers for the overall production are at full capacity. you go on to say that in the current stage they will meet around 35% of the demand. is that right? >> that's correct. >> what can we do to provide more effective jeer? >> 840 for the hospital. that's the one ebola treatment unit, not for the entire operation. what we need to do is encourage the manufacturers to increase the supply line and make sure that anybody that has the capacity or has some of those in

stock to release them because a lot of them are in stock in the areas that are not actually in actually iendemic. >> let me go to another picture. in this picture there is a little truck in the background and it has a flathead. >> there is a lack of ambulances in liberia, so we took a flatbed truck and put a mattress and covered it with a tarp, and this is what we take to get patients from the community to the ebola treatment unit. >> in your written statement you said, put simply, we need three things -- people, commodities, and money. buy commodities, i mean everything from the ppe disinfectants to vehicle transportation, mattresses, bedding and clothing. so is this what you're talking about in the additional vehicles

to transport the patients? >> ambulances that code could go up to the centers and transfer patients to the ebola treatment unit for treatment. >> let me go to the next picture. this is not a picture that you provided for the hospital in leone. there are people on the floor and there's fluid everywhere and they appear to be removing a dead body. can you please explain why is it so important to have proper burial procedures? >> the viral load -- that the body is at its highest, this is when it is most contagious, so is important to have proper burial procedures. the way that we go about it is we spray them with disinfectant, chlorinated water, put them in a body bag and sprayed them again. we put them in a second body bag and a spray that again and a third body bag and sprayed them

before we transfer them to the burial ground, so it is extremely important that proper burial procedures are followed all the time. >> would more resources help the process as you just described? >> we need more burial teams. in the countries they are not enough. it's probably one third of the need. we need body bags and training for the burial teams as well as the vehicles for transportation. >> with the committee's indulgence i would like to play a short video clip showing how the final stage of the process is currently being handled. >> [inaudible]

>> thank you, mr. chairman. right now there are a lot of people watching this hearing, and many of them do not know the extent of the crisis in west africa. they do not know the urgency of the need. you have a microphone in front of you an opportunity to reach millions of people this morning. if there is one thing you want to talk the american people, what would that be? >> thank you, mr. cummings, for giving me this opportunity.

we need to deal with the virus at its source in west africa. steps can be taken to deal with this. we need to immediately increase treatment capacity by deploying and training proper health personnel. we need commodities as we discussed and ambulances. we need financial resources. we need further containment at the community level as well. we need to contain it at that level. this is a global issue. it's not just a west africa issue. we need to work together as one team to tackle this and put an end to this outbreak. once we do so, we need to continue the investment in rebuilding the whole care system in west africa as well as preparedness in other countries. we need to make sure that this outbreak does not reoccur. the u.s. has and is playing a pivotal role. i am proud to say that the u.s. has led the way and continues to

answer the call and other countries are following the lead of the u.s. >> mr. turner asked a great question and the chairman tried to get some clarification of the military folks. what was your reaction -- we have health care workers in the back and the american people working to read what do you feel as an appropriate way to address this, and should the american people be concerned? we have people going over to africa to help out. >> i would like to clarify one thing. no transmission. that's the first thing. unless the patient develops symptoms the patient cannot transmit the virus. so monitoring the temperature is critical because as long as the patient is asymptomatic, there is no risk of transmitting the disease. we follow the protocol very much

in line with what the general said as well as with the cdc. there is no risk which means somebody that hasn't been exposed to the virus hasn't been in contact with someone with ebola. we bring them on a commercial airline and monitor them for 21 days and twice a day we contact them to make sure it happens. those people we do not allow them to actually travel. we ask them to stay out of the risk area even in west africa for 21 days so actually they have no symptoms before we allow them back, and high risks are people that have knowingly been exposed to the virus and those will be quarantined and monitored and the minute that there are sometimes they will be tested for ebola and admitted. if i heard you correctly come it period is nong

value, and the only real way to ensure that someone is not contagious, or not going to is more thanious to be outside the risk area or 21 days, not exposed to other people who exempted -- who hibit symptoms for 21 days. >> that's correct. it is important to wait for 21 days after the last known exposure to the virus. known exposure. general, you're going to be operating some seven labs. anyone who works in those labs takes materials out of those labs, has secondary exposure to liquids and so on

in fact is in direct risk, aren't they? the testing labs, because we party had that in dallas is in fact a point of transmission. it is not just the individual, but in fact the materials that come out of the individual. is not correct? >> the military personnel working in labs are infectious disease specialist. >> i don't want to know who they are. i want to know are they exposed. >> they are considered low risk because they have the entire suite of protective equipment and extensive training. >> one of my problems, general, very little time and i want to be pleasant through this whole thing, but we have the head of cdc, supposed to be the expert and he's made statements that simply aren't true. doctor, you can get ebola sitting next to someone on a bus if they throw up on you. that's reasonable.

>> the way you get ebola is by exposure to body fluids, yes. >> ok, when the head of the cdc says you can't get it from somebody on the bus next to you, that is just not true. when the head of the cdc says we know what we are doing, but in fact health care professionals wearing what they thought was appropriate protective material got it and that means it's wrong. when the head of the cdc goes on television and says sometimes less protection is better and then has to reverse the protocol so we no longer have nurses, ms. burger, who had their necks exposed, that was wrong, wasn't it, ms. burger? it, ms. burger? the cdc gave false information, basically saying it was ok to have your neck area exposed when in fact if someone threw up on you, that could be -- >> i don't honestly know that those nurses were instructed

that their necks were ok to be exposed. >> the head of the cdc when asked whether you had full body suits versus simply the mouth said sometimes more is not necessarily better. so the head of the cdc was wrong. we are relying on protocols coming from somebody who has been proven not to be correct. isn't that true? >> those nurses were not protected. >> mr. roth, i don't want to belabor waste, fraud, and abuse , although that is a lot of what this committee looks for. if i understand correctly, your report shows they didn't know what they were buying and why particularly well. they bought large amounts without a recognition that it was going to essentially expire and without a plan to rotate or in some other way put those materials to good use the way dod normally does in order to prevent items from expiring the secondary use. is that correct?

>> that's correct. >> although you can't reach every conclusion, did you discover, for example, the facemasks benefit of buying them, they simply had a rotating inventory they could've drawn from that would've allowed the vendor to maintain a stockpile said they would only take possession which is also done on occasions, they would only take possession when they needed and in fact wouldn't have to buy it or rather rent the availability of it, did you look into that at all or did they look into that at all? >> they did not look into it all. we make our recommendations, we explore the options you talk about. >> all of those options need to be looked at, evaluated, and available to members of congress before we start writing checks for large stockpiles. would not be correct? >> that is obviously up to congress to decide.

now the department is starting to do planning we had recommended. >> i will close with mr. torbay. the pictures that the ranking member showed in the situation in africa is certainly desperate. i know my constituents are most worried about what comes here. but realizing the 4000 air versus less than one handful here certainly shows us where the problem is, and i think you said that very well. but in fact, medical personnel that are dispatched from here go there, and in more than a few cases, find themselves infected. it's not true? >> correct. >> so i want to ask, it might be both, but is that primarily because of the conditions under which those doctors and nurses and other health care professionals find themselves working, or is it for lack of training?

is it more one or the other? >> mr. chairman, it is a combination of both. our medical staff are heroes, doctors and nurses. they work in probably 95-degree temperature wearing those coverings videos you've seen. our rotations are every hour. we get them out of them every hour because they are dehydrated. >> they are capable of not getting affected if they are in a good facility with one patient rather than questionable facilities and monthly for 24 hours a day, trying to deal with an onslaught of patients. is that correct? >> in our facility, we have 230 staff members and their only job is actually to look after the patient. >> to the greatest extent possible, i will ask one last question that i would like to have people say yes or no. ebola is a 35-year-old disease. it is not new. it was discovered a long time

ago and we havfe spent money looking into it, planning for it. the various flus come into one set going back to 1918 are not new and they have this -- and that they can be transmitted and that they kill. since this is a 100-year process that leads to deal with modern infectious diseases, is there inherently a similarity that whether it is ebola or in fact a pandemic, and that we in congress should be looking at the planning and the prevention and a training somewhat homogeneously. in other words, today we are looking at ebola. should we be looking at infectious diseases, the training, prevention, handling some emergency, should we on this side, the nonprofessionals, look at this as a failure of not just ebola, but infectious diseases of this entire sort

that we could have been and should have been more prepared for. to the extent you can appreciate a yes or no. ms. burger? >> yes. >> doctor. >> and say some of our complicated question. ebola and flu are very different spread very differently. >> i was using infectious as the shift in the i want. i wasn't trying to say those which can be aspirated or in some other way transmitted. the point is aids and lots of other diseases, aids being much more similar to ebola as far as flu transmission, we've had these for a long time. we are now seeing failures. are these failures to a certain extent we were planning to do with infectious disease, prepare our health care system and doctgors and nurses and in fact it appears as though we train them, but not the level we

should -- yes or no? >> we are learning new things about ebola. ebola has never been in this hemisphere before. we are developing procedures as quickly as possible. >> to the extent the virus is transmitted in the same way when we look at the logistics, the acquisition management, the answer would yes. >> this is outside our purview. >> with that, i will go to the gentlelady from new york. >> thank you. i would first like to thank all of our distinguished panelists for coming today during what is a critical time in the federal government's response to an urgent global crisis. first, i would like to take a moment to commend the health care professionals in new york city for their outstanding