>> absolutely. the incubation period is to to 21 days. that is why it is important to a 21 days after the last known exposure to the virus. >> again, known exposure. that's correct. general, you are going to be operating some seven months. anyone who works in those labs takes materials out of those labs, has secondary exposure to review bell, 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 under the individual. is not correct? >> said the military personnel working in labs are infectious disease specialist. >> i don't want to know who they are. i want to know where they exposed. >> they are considered low risk because they have the entire suite of protective equipment and extensive training. >> one of my problems come in general, very little time and i want to be pleasant through this whole thing, but we have the ahead of cdc, supposed to be the expert and he's made statements that simply aren't true. dr., you can get ebola sitting next to someone on a bus if they throw up on you. that's reasonable? >> the way you get a bullet is by exposure to body fluids, yes. >> okay, 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, these burger, who had their necks exposed. that was wrong, wasn't it, ms. burger? the cdc gave false information, basically saying it was okay 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 next word exposed. >> the head of the cdc when asked whether you had full body suit versus simply the mouth said sometimes more is not necessarily better. said the head of the cdc was

wrong. we are relying on protocols coming from somebody who has been proven not to be correct. it's not true? >> those nurses were not protected. >> mr. roth, i don't want to belabor waste fraud and abuse them 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 is 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 do in order to prevent items from expiring the secondary use. is that a correct? >> that's correct. >> in the u.k. at 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 almost 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 riding checks for large stockpiles. would not be correct? >> that is obviously up to congress to decide. now the department is doing the cleaning 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 that 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 not 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 of the other? >> mr. chairman, is a combination of both. our medical staff are heroes, doctors and nurses. they work in probably 95-degree temperature wearing in those 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 is a 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 euro disease. it is not new. it is discovered a long time ago it would've 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 illinois or d. and that they can be transmitted and that they kill. since this is a 100 euro 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 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.

he brought light 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 be much more similar to ebola as far as flu transmission, we've had these for a long time. we are now seeing failures. i despair us to a certain extent we were planning to do with infectious disease prepare our health care system and r..yours 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 attacking procedures as quickly as possible. >> to the extent the viruses transcend the same way when we

look at the logistics, the acquisition management, the answer would yes. >> this is outside our purview and light. >> without 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 response yesterday to our first case of ebola. new york city has been working with new york state come in the center for disease control prepare for this in our nation's largest city, based on what we know now, i believe they have

responded and done absolutely everything way. a young physician had returned from west africa 10 days ago where he had been working on the ebola crisis with the dock or is without borders. upon arrival into the united states, the doctor was flagged by the cdc and the customs and border patrol and reported to new york city health authorities. yesterday when he reported he had a 103-degree temperature and was experiencing pain and nausea among the new york city health care system spring into action. the patient was immediately transported to a specialty trained as tacky and that, weren't erstwhile protective equipment to bellevue hospital. the hospital has been designated for the identification of potential a bowl of patients by the city and state officials.

governor cuomo has designated a special hospitals in new york city. earlier this week, a specially trained cdc team visited bellevue and determined that the hospital has been trained and proper protocols and is well prepared to treat patients. i must say that i respond to your concerns about nurses and at the hospital there were clear protocols in place established by the health department to ensure that nurses and all staff caring for the patient follow the strictest safety guidelines and protocols. contact teams are ready to quickly identify, notify and if necessary quarantine any contacts the patient may have had on history tips on the subway visit to a restaurant and

a ride in a taxicab. the health department is now working with the hh the leadership, bellevue's clinical team and the new york state department of health. and the cdc is assisting staley and ms. affaire. they are in close communications at the new york city health department, bellevue hospital. i would say all elected officials and they are providing technical assistance and resources. the cdc already had 18 of ebola experts in new york city. they were already there to help. remember his name told were flown and last night for the cdc leave the so-called cert team to join colleagues already on the ground and we are told that for cdc professionals will come in if needed. the cdc at ebola response team lullaby within 24 hours to any location in the united states where he cases reported in so far this is absolutely true.

it is what has happened in new york city. this week on the cdc named new york city as one of six states who will begin active post-arrival monitoring of travelers whose travel originates in either liberia, sierra leone or ginny and arrive at one of the five airports in the united states doing enhanced screening. active post-arrival monitoring means that travelers without fear northampton consistent with the uvula symptoms will be followed up daily by state and local health departments for 21 days from the date of their departure from west africa. an active post-arrival monitoring will begin on one day, october 27th. i want to reiterate that ebola is not airborne. someone affected can only

transmit the virus as they are experiencing symptoms, bodily fluids in direct contact, vomiting, blood, saliva. there are over 9000 reported cases in over 4000 ballots. i am told that the american health system is now actively reviewing to vaccines. they are in clinical trials and are responding. my question really is to you, dr. lurie about the hospital preparedness program. first i would like to request a statement prepared by the trust for america's health, a nonprofit. >> without objection placed in the record. >> attacks about the need for enhanced funding, that are funding is not to the threat our country faces. i would like to ask you, how does the program help ensure that our hospitals that are so designated across america are prepared to respond in a health

emergency. i would like to thank your program for the help you gave to the great city of new york via thank you. >> a gentlelady's time is expired, they of course can answer. >> thank you so much. we were very glad inside last night to see the kudos to the program and the kudos to new york city for their tremendous job in responding. our program gives money to states and in the case of new york city, directly to new york city to help the health care system become prepared. it is to find a set of a basic things that every health care facility needs to do and provides the funding for training for exercising were planning for other things necessary for hospitals and other health care facilities to be prepared. it is in fact that bellevue another hospitals in new york

city have to do such a tremendous job getting ready for this and we will continue to support them through this program and others as they move forward. >> thank you. the gentleman from florida, mr. mica. >> first, i have to take a point of personal privilege. i apologize for being on a plane. the committee should know, you know, the country faces to the credible threats right now. one is isis, the threats we've seen that threatens not only the united states, but the world and our allies. but i accompanied him and we had a democrat member from the foreign relations committee was in iraq. we were in iraq last night as we left there at 6:00 in the evening and flew all night. this is how dedicated he is to

make sure that we are prepared over there. you would be so proud of our troops that we saw incredible in general to get called to do some test status. but i saw some men and women and they are just awesome and we had a chance to meet with some of our allies to get them to step up to the plate. but we face that threat nationally, domestically and internationally. we face up to, a very serious threat, dr. torbay, this ain't going away anytime soon, is it? the >> it? the >> all the steps being put in place, it would be contained. >> here's a report i read on the plane last night that says experts warn the infection rate could reach 10,000 a week by early december. is that semi-accurate?

the way things are going now. this is a report i got on probably the people that are most at risk are health care workers, whether they are or here. without the correct? this is not today, the unit 404 cases of a bulla and health care workers. 200 ready to die. pretty high fatality, right-click >> that's correct. that thank you, ms. burger for representing the nurses. do we know how those nurses were infected or exposed, how they caught ebola for sure? >> tanks to the whistleblowing efforts of briand, we know that the nurses did not have optimal standards for personal protection. >> so we know that they were properly protected. >> or train. >> were trained.

>> dr. lurie, you said we are putting additional protocols in place, dating, rate? what is the most reach like a week ago, month ago click >> the most recent and some personal protective equipment has been in the last couple of days. it was changed in response to the situation. >> so when the last couple of days. he said airport screening. when was screening. when was that instituted, the new guidelines? >> i can't recall exactly. but the funneling into the airports within response in the last week. >> i can tell you it is not working, okay? always got to do is look at craig spencer. he was tested there. it is not working. now he is a medical professional. he reported his elf. and then you see cases where

egad, we are not prepared still. part of this hearing is all about mr. roth report. right, mr. roth? we spent millions of dollars getting prepared. didn't you just testified that in fact, on page seven year, 200,000 of our pandemic respirators have gone beyond their five year manufacturer warranty? >> ones of the tsa. >> on page six woman to testify this is a bottle of hand sanitizer and you tested it. 84% of the hand sanitizer is expired. is that right? how do i tell the american people that we are prepared, we spent millions of dollars.

you were just in your testimony talking about how it's important that the right protection. almost all the equipment in this report in fact it's either out of date. it was the purchasing made, we don't know who is going to get it. >> mr. roth, but yes. you are correct very >> the gentleman's time is required. >> your report is correct. i thank you. i have additional questions. thank you. >> thank you. the gentleman from massachusetts. connector and one i think the members of the panel for their testimony and the work they do on a regular basis. the folks that don't already know may be pleased to know the news was released that the presbyterian is ebola free. that is good news on one front. also a little bit of good news

is that the united states has taken a lead in the international response to this and we don't often give credit where it's due i'm not and we should all be proud this country at this recognize that we have issues with an arab country or that we have to deal with in terms of people that may be exposed or come down with the disease in this country or be here treating somebody are we to have to go to the source with the shock and all kind of approach. we are losing situations. so we need all the things that mr. torbay talked about. we have the largest response. the people that are supplied and trained and equipped sufficiently to get the job done. so my first question might be to mr. lumpkin and dr. lurie in mr. torbay cometh the international effort now large enough? is it well enough coordinated? is there sufficient training and a permit are those involved.

what remains to be done and by whom? mr. lumpkin. >> in west africa, u.s. leadership is galvanizing support on the international front. we have gone in with speed and scale so they are coalescing in order to the epidemic. >> are the people well-trained and equipped enough? is the responsive patient enough in who should he responsible in what remains to be done if anything? >> i would agree with mr. trained ors assessment. the situation west africa has taken time to get the resources in place there. u.s. leadership has been incredibly well clubman incredibly important. as a result of that, we're finally seeing many other countries of the world that the

tip of resources and west africa. is it well enough coordinated to start containing the situation and bringing it around? >> the u.s. and the u.k. has stepdad. now it is time to the rest of the world to follow suit. we are starting the training in sierra leone. in the next few weeks the training would be open, which is critical. supplies are coming in. the different levels are coming in and we hope the pipeline will continue. i think the other countries need to step out. we cannot forget about kenny and containment of the ebola in

guinea. this is where you started. businesses need to be a baltimore. the economical -- the economic toll is just phenomenal. we need to think about technology as well. the vaccine is critical, but also the companies they did start thinking about creative ways when they come back and monitor instead of having to rely on patients checking the temperatures twice a day. i think if the international interventions continue at the same pace that it is now, i think it will be contained within the next four to six months. i would also like to thank the department defense for putting and this has cut down three to five days to five to seven hours. so we are accepting patients, releasing bad and avoiding the

isolation ward. >> thank you. this is in the hearing, but mr. roth, thank you for your work. i'm always amazed they don't go to the bank at audited later, but mr. chairman. this is not new. people think we could've done a lot further along in terms of either treatment or medicine on not. there is that no profit motive sufficiently involved on that. what are we doing anything along the situation in the chairman's question earlier. what do we do to make sure we have the forward inking that the free market and profit motive, what are we going to do as a public policy? >> that's a great question and i thank thank you for you. were it not for the investments in getting going with vaccines and therapeutics, we would be

nowhere near where we are now with the safety testing of two promising vaccine candidates going on and soon to be testing since they are therapeutics. so we need to think about emerging diseases. we need to think about developing countermeasures and we appreciate the support for the biomedical advanced research and development authority and they have helped us to ensure there is a market and ensure and work on these threats. >> you talk about public financing being used to establish markets as opposed to the private industry on a going out and trained to work with the free-market aspects? >> women talking about very positive public partnerships and tremendous models we develop

over the past several years, whether it has been about bio threats are about pandemic flu that i really make it not possible, yes. >> thank you. gentleman from north carolina. >> thank you, mr. chairman. my questions are for the assistant secretary and for the general. our men and women in uniform are in regions affect did by ebola. to their parents, their mothers and fathers of these men and women, do you have every confidence that they have every bit of equipment they need to be protected, to be safe and return healthy? mr. trained war. >> the safety of our servicemembers. >> the right answer is yes. >> is absolutely paramount and you can never mitigate and we've

taken all the steps. my answer is yes. >> we are making every effort to ensure that the troops of the property name improper equipment so they can return home safely. >> mr. lumpkin, you said in your opening statement that if in fact day, if someone contracts up to an country, they will be returned to the united states. is that correct? >> i did not say that in my opening statement. >> you mention the cdc facility where treatment will be given. then they ask you a question. >> if somebody comes down to no, how will they be cared for?

will they be cared for in country or will they be returned to the united states? >> i refer to my staff counterpart on the specifics. >> thank you for the questions. to take care of the groups in country, there'll be two hospitals. one established in sierra leone. if a u.s. uniform military person does in fact contract say. disaster? they are treated in country. if they identified for some reason it's having high-risk exposure and exhibits sent tons and will be moved on. if they are age symptomatic, on a dod aircraft. how do they know these individuals out of country in the event that happened? >> for controlled movement, any

aircraft pointed out various asymptomatic and not contagious at that point. so any aircraft, at the present time, the only aircraft that can move the symptomatic patients is the phoenix air contract to use a moving. >> how many patients can the aircraft told? >> the aircraft can hold one at a time >> is that sufficient? >> even the number of ebola patient the united states is the united states has had total at the present time, it is sufficient. >> so at this time the department of defense has a statement work through the system to put together an isolation pod that can carry multiple persons for aircraft testing and not so very -- i'm sorry, development will begin in october as testing in december

procurement will begin in january. >> in january. >> how many individuals will be able to transfer? >> 15. >> 15 at the time of the turnaround. >> we hope to procure a number of these systems so they can be put on nbc 17 so we could move multiple c-17. >> so we can take less than 10 people out of country in a weeks time. >> if they are symptomatic. >> so this is not at all sufficient. the mac we don't know -- at current time, we will not be doing direct patient care and so we anticipate. >> i understand. how many american troops will we have in the region by the end of the year? what is our maximum?

>> 3000. >> 3000. this is very disconcerting. mr. lumpkin, is it a question of resources? does congress need to appropriate funds that we can get more planes, more logistical support here so that we can have the capacity is something absolutely horrible happens to our fighting men and women in country? >> we clearly have an identified requirement. other than to say that one for the records to make sure because i'm not familiar with the actual requirements. >> i think he should get familiar with that position process. if we currently have one plane controlled by the state department, i am asking the department of defense at the mass number of airplanes come equipped in a training capacity we have come in nearly expending half a trillion dollars annually on the department of defense if you need it, we look at it. we will demand it. if we are putting men and women in harms way, potentially where

they contract ebola, the idea we have one airplane in the united states to get these men and women out of country in a safe manner if they contract what is absolutely horrible, which we want to control, which we absolutely want to control. the idea that you come before in giving us this type of testimony raises great concerns. i know you have been asked to do a lot of absolutely respect that. though we are asking you in the legislative branch to tell us what you need and we look at it. because we don't plan to put our men and women in harms way without any capacity to care for them. our veterans, our fighting men and women deserve the best training in the world and they have it. but it means the proper protocols are there to make sure they are protect kids and a something that happens they are immediately taken out of harms way, cared for and return back to their normal state.

>> i yield back. >> i think the gentlemen. we now go to the second gentleman from massachusetts, mr. lynch. >> thank you, mr. chairman. i thank you and mr. cummings for holding this hearing. in the panel, you've been very helpful. there has been some testimony this morning and i want to drill down on that because sometimes that is helpful when people in the panel disagreed. dr. lurie, you testified in the written testimony that we are better prepared than other and you have one of those comprehensive response on the ground. on the other hand are inspector general, you were commenting on how the analysis you to the dhs are the equipment purchases are not adequate and in some cases the rehnquist ant and the usefulness of the equipment are

drugs beyond the expiration date. dr. lurie come you testified you have a very aggressive system in place in the other hand, president burger for national berkshires united said it they've done a survey. they have done a survey of 3000 nurses. from every state in the union and the district of colombia. they have not been trained to deal with nicole lurie and preparedness is woefully insufficient indeed drizzly inadequate. so, those are two different stories of what's going on here. i understand we don't want to panic deep bow, but we also don't need happy talk in terms of what were dealing with.

when they come before this especially and there's nothing to worry about. we've got this. that's when i start to worry. now as to who to believe, i think the nurses and the massachusetts association as well and they are on the ground. they are in the battle against ebola. they are the ground troops, doing this work everyday. they are exposing themselves in her haps their families, perhaps their families if things go wrong, if they don't have the adequate equipment. so when they tell me that they are not prepared, i tend to believe them. i think those are facts. and we need to make sure that we get the equipment and training they need to protect themselves and protect our communities and protect their families. there are a couple of facts that

we've gotten in the briefings from the various panelists. one fact is that the cdc estimates by this january there will be up to 1.2 million people in west africa afflicted with ebola, 1.2 million. the estimated by dod is 1.2 million, 1.2 million in january. now they were done at different times, so the difference might be just a period of time that they were taken if things go as they are right now, 1.4 million. we've got a real and present danger to the people of west africa and the people of the united states who i am pledged to protect. now i understand it is a

post-arrival approach. we have these hospitals as people drive from west africa, we are going to begin an analysis and quantity chesty man and making sure they are not carrying ebola. it seems to me and mr. torbay, yet powerful testimony, a lot of written it quite frankly and you have had a chance to talk about it, the u.s.a. and the focus should be on west africa. what we are setting up here right now with this post-arrival in the u.s. approach is we are going to set up these hospitals, all of this equipment, everything here in the united states and wait for those folks to arrive. and i believe we should be doing the opposite, but we should also be doing something else that matters predeparture.

we know we are about to 1.4 million people and not for cut a slit did with ebola. we have to be on the ground there. instead of the restriction here in the united states, there should be a 21 day preapproval. they need to present themselves and report and person until they get on that plane. we can take the temperature in a blood sample is necessary. so 21 days later when they appear to travel, we test them again. now we've got to contact points on a person before they fly to the u.s. and we can also do the post-arrival check as well. we are not taking this seriously enough. we are not. we need to help our brothers and

sisters in west africa absolutely. but we've got to have a fact-based approach to this. this can be just about ideology and happy talk. we have to look at this very seriously and have a scientific-based approach to what we are going to do about this problem. i don't think it helps to say we've got an aggressive thing on the ground. everything is good. i've got a feeling you'll come back again as a whole different story. we've heard that before. we've got to post this in a very deliberate manner and take a much more seriously than what i am hearing here today. we owe that to the citizens they represent in the united states as well as the individuals in west africa who want to support as well. mr. torbay, let me ask a question. we want to make the containment

after in west africa. think about this. if we are putting our folks all over the world to medical personnel on the ground, in monrovia or freetown, wouldn't it be better, wouldn't it strengthen the infrastructure there in the ground in west africa as opposed to just having a post-arrival process here in the united states? >> thank you for your question, mr. lynch. as i mentioned, it needs to be contained at the source in west africa. this is where the investment needs to take place, this is where equipment and supplies need to take place and this is where most of the investment needs to take place. that said, we cannot just focus on one without the other. we had the symptoms of the outbreak of west africa.

we need to deal with the problem and that is actually at the community level of west africa. i believe there are some temperatures being taken being departed before they do the flight. >> they do on the plane. i'm talking about doing something 21 days before steve got two contact points that you cannot measurements on. it is not foolproof, but having two contact points there in west africa. >> okay, mr. chairman. thank you for your indulgence. >> quick response, mr. torbay. >> what we are worried about in 21 days because the minimum requirements. if we oppose 21 days, that is nine weeks and it's extremely difficult to allow doctors and nurses after nine weeks before they come back.

we cannot completely wrap ourselves in a bubble here. people will go from guinea or sierra leone and wait a couple of days and come here and there's not much we can stop for doing that. so the preparedness needs to take place at both ends. >> so there's only a few flights. >> we've got to move on. i thank the gentleman for his good points. dr. lurie, when you are in front of congress and 2011, the reauthorization of the pandemic act, that created your agency in your position come you had an exchange with mr. rogers, colleague of ours or michigan. he said this. there is somebody that makes the decision, somebody absolutely in charge. not cdc, not nih, not fda or anyone else. it is here. you are responsible that's

right. see where the key person, right? >> my role is to be the principal at pfizer to the secretary of his batters, yes. >> you are the keepers of the government for medical preparedness public health emergencies. >> and hhs. >> got it. >> i want to put up a couple sides. just to be clear, you are the person, your agency in response to lead the nation in preventing, preparing for public health emergencies and disasters. further down the secretary of hhs delegates to the leadership role of all health, medical services support, function and health emergency and public health events. you are the key person. correct? >> best of the legislation said, yes. >> your website confirms that. you are the key person. have you met with the new evil

of response coordinator? >> yes, i met with him his first day and night several conversations. >> have you met with top your frieden at the cdc? >> by me. and talk to mr. frieden every single day. >> we expect that to happen. the story that says 39 million that could have gone to an ebola vaccine. are you familiar with that story? >> i'm going to do that. are you familiar with the $275,000 in the restaurant intervention to develop a new menu was spent at nih dollars? are you familiar with the fact 2000000% to encourage acquires,

money from nih? are you familiar with? >> i'm not familiar. are you familiar with the fact $39 million i just cut to the chase. one of the things you learn in your first economics, not that i was a great student, but i did study economics. one of the things they tell you is opportunity cost. when he spent allocate resources for one thing come you by definition can't use those resources for something else. why infected we spend so much money on, for example, $374,000 for preschoolers when in fact some of this money i've got a lot by the press account and isaf with $39 million could've been used to help with treatment

for something like ebola and potentially vaccines. are you involved in the decision that nih makes when they decide how to our kate money quiet >> i involved in the decisions related to her by a defense and preparedness programs for infectious diseases, yes. the cdc, fda, my office, dod, dhs and the department of agriculture robert together on those issues. >> at argue the point person import native knowledge that? >> yes. >> so at some point you have to sign off and say it's okay. $374,000 is used for puppet shows and so does using the opportunity for that money to develop our vaccine for something like ebola. >> i'd like to do but -- there's misunderstanding about how it's

allocated, but that is not the responsibility. >> liska back to the exchange with mr. rogers with the act that greedy juror position. mr. rogers says this. you said this when he responded to mr. rogers. you are in fact in charge. you are the key person at hhs. you said i have found through experience that indeed i have the authority that i need to be in charge. you follow up by saying i find that the collaboration with sister agencies and hhs, i don't think it has never been better. we're working extremely close together. i think they recognize and respect the fact we provide policy direction and are in charge. all the efforts we've undertaken across hhs have done that.

you told mr. rogers would discuss whether we would have the key position that in fact everything was working great. you were the person in charge within hhs cordoning policy, direction and you were in charge of working closely together. >> and i would stand by that statement. >> back to the key question. might we be closer to having a vaccine today if you aren't allowing all this millions of dollars, $39 million to be spent on what many americans use questionable uses for tax dollars, particularly the outbreak in the united states. >> thanks to the investments we've had in bio defense and our focus and department of defense on this critical issue over the past decade. we now have to vaccines in safety testing and at the nih and dr. rhee. >> dr. lurie, that is my point. might they be further in testing if you had wasted $39 million on

things most taxpayers think they're ridiculous. in fact, can we put up the second slide. the second slide specifically mentions, ebola, you were supposed to be giving for this. might be more ready if you hadn't spent $39 million of hard-earned taxpayer money and puppet shows for preschoolers and invested in vaccines for ebola. yes or no. might be the further along if the money had not been spent someplace and apply to the question at hand. >> the develop mint is a long and complicated. >> is a complicated. could've been used for it. you work closely for the direction. those are your words not mine. they use the development vaccine. >> i am not in a position to

comment on the overall nih budget. >> the gentleman is recognized. >> i think the chair. i think the main public health message of this hearing is probably counterintuitive that it leaves for u.s. citizens, we face probably more risk from the flu. so hopefully everyone will be getting their flu shot after hearing this hearing. during many other public health precautions we should be taking such as handwashing at teams like that which are too often neglected. back to ebola, the public is concerned that we are doing too little too late. so i would like to explore some of the gating factors that might limit an appropriate response. mr. torbay was very specific in his testimony come of mentioning that obviously manufacturers are 35% of the estimated for the appropriate type of cover up.

and you could explore what you can augment the supply of those essential coveralls. >> i like to clarify this manufacturers with a specific site different than other organizations used. i do not remember the manufacturers, but i'd be more than happy to provide comments to riding after the testimony for the record. >> of course we all hope on the committee that we don't get the point where we need augmented emergency flights by dod to shift our soldiers back home. but mr. mchenry asked inappropriate questions. those are men and women in uniform and their families want to know they will be sufficient capacity to get them back home. one of the concerns of the public is three health workers have been in fact did in the u.s. and one actually oversees returning. i think we're all looking for the right sort of response.

we all hope and pray for her safe recovery, but when he felt sluggish on tuesday, perhaps it would have been more than that to be exposed to some of the worst infections in africa, but from tuesday to thursday was taken extraordinary taxpayer effort, tracing, all sorts of things to try to limit the risk of exposure. ..

you have to remember that they are humans. you can't expect them to use their common sense at that point. they need a team of a report to that checks on them as mr. torbay indicated that follows them and makes the decisions for them so that they are no longer hope care workers that but they are patients that need our protection and care. and so to that end it would make sense to have a professional team monitoring them and making the recommendation recommendations so they can actually relax and not have to

worry about the are contaminating or exposing anyone to the infectious disease. that would help in making sure that everyone that volunteers to take care of these patients and puts their own families life at risk actually is well taken care of after their service. >> so you're suggesting doctor spencer should have been viewed as a patient earlier than thursday and should have had a team of counselors to advise him because his judgment could be trusted? the >> exactly. >> as far as international response mr. torbay mentioned that we had some individuals in america paul allen and mark zuckerberg have given more than

any nation. so france that has had involvement in that area traditionally are these other nations, what should we expect of them? >> and all hands on deck approach is necessary. i think the realization that this is not a west african problem but he global problem that could take any country anywhere around the world especially with travel being the way it is. people need to realize the threat and realize any contribution that they can make will make a difference. as you mentioned it contributed more than some countries did, and i think the u.s. government should continue to put pressure on those countries. >> i see that my time is expired. >> i now recognize the gentleman from michigan mr. wahlberg.

>> general, thank you for your service. the number one question or concern i've been getting on this issue in the past several weeks comes from family members as the military would be active national guard troops a concern that what they seem go on in places where they expect their family members to have a death sentence as a result being proud members signing onto that and committed to their efforts yet there are concerns that their loved ones haven't been given the necessary tools and rules of engagement and all the rest to handle what they've been trained for the biggest concern on the phone calls or meetings in public is that this is a death

sentence being sent into the combat a virus and with great uncertainty because of the multitude of changes in particle coming from what they hear in the news and in this administration with responsibilities and also the lack of information coming from the military on what they are doing. let me ask if he was just briefly walk us through a daily routine of one of the soldiers that have been sent over to west africa. >> i've spoken to the commander on the ground and the folks at afrikaans -- africom. the individuals on the ground for an average soldier and again i would emphasize first none of

the military personnel are providing direct patient care. we have four lines of effort, command and control, logistics, engineering and training as other particles for treating patients isn't something that -- >> but they do come in contact with contractors with -- >> absolutely. the purples in place as mr. lumpkin can testify to there is a 3 feet of separation talking to the local nationals ended up speaking a force on the liberian and the u.s. military side quite strictly. the average day for soldier would be getting up eating the guitar temperature taken in the morning and do whatever task you were going to do. if you are in the command center that import that approves the command center terminal working

on the generators or whatever it is you're doing in the command center. it involves eating only fruits from food sources, drinking from bottled water and washing your hands and chlorine solution virtually everywhere you go. at the end of the day every time you come back into the compound at the end of the day where wherever you're going to get your temperature taken again to ensure that you stay ebola free. >> while the u.s. military personnel have zmapp or other experimental drugs on their ground black >> i'm not aware there i not aware there will be any zmapp available on the ground. the equipment will be issued to

them depending on their level of expected exposure for the vast majority of people that will include gloves, boots, a suit for the medical personnel would be more along the way for lines for the health care providers. >> doctor lurie, in 2005 the bush administration proposed a change that would allow the cdc power to combine individuals be leaked to be infected with deadly pathogen mike pandemic flu. president obama unrolled this in 2010. does the cbc need or should have two m. sure this outbreak like ebola is contained and controlled? >> thank you for the question. i think with every situation we are always reviewing and taking a look at whether we have the authorities we need to do the job in our system now that it rests with the states and they

have authority to do that when they think it's necessary. >> the cdc should have that authority and it should be flexible. there is authorization don't you think that would be a valuable authority to have? >> we are always learning and based on our experience that is what we will be looking at going forward. >> i hope so. i'm not sure that we are adjusting as rapidly as possible and i'm certain we are not giving any type of security to our medical workers, nurses including our citizens out there that we have a solid policy in place that is first and foremost protecting our citizens against these type of problems and i think it's evidence of either hearing today in hearings that will go on but you're not bringing a sense of security and as a member of congress representing a district i'm expressing the point of view who believe that we are less secure than we ought to be if we could

use the policies that we could put in place. mr. chairman and i yield back. >> i will now recognize the gentleman from virginia, mr. army for six minutes in the spirit of =. >> it seems to me based on what we know in the hearing that united states objectives have to be twofold. domestically it is to protect and prevent. that goal cannot be successful if we don't address the second goal which is to deal with the disease at the source and west africa. and especially given the fact that we are potentially looking at an explosion of infection that is exponential in a very short period of time in the next two months it seems to me there is enormous urgency in the

latter not to diminish at all the need to address the former. we have some good news today. the nurse peabody has been declared a ebola free. but dealing with the first part to protect him a thousand thanks to the protective gear and particles of the guidelines that were in place at her hospital. while the cdc was giving us assurances of how hard it was to contract the disease we are pretty confident we have things in place and so forth. two of the health care workers including ms. nina pham came down with it. doctor lurie eu think that perhaps the cbc missteps? >> they said some have been made that they've taken a quick look

at the experience and presented as easy. >> doctor lurie i'm asking a public information health question on how to deal with event when i was the head of my county. never reassure the public when you don't know. never do that because it is your credibility. as you've heard from some of the questions on the other side to attack the credulity of the administration by extension. because the cdc wasn't capable of saying not yet. we don't know. it's a work in progress. what's so horrible about doing that? >> i think right now as we look at the situation we see that it is a work in progress and we can see that it's taking constant steps to just a just as we learn more. >> ms. burger coming to you indicated he would welcome a law establishing if not executive order preferably a wall that codifies establishing uniform guidelines, uniform protocols so we don't have this up and down.

of procedures in hospitals depending on where you live; is that correct? >> excuse me, you left out one critical word which is mandatory optimal standards for the personal protection created the cdc guidelines are merely guidelines and all 5,000 hospitals in the usa gets to pick and choose what part of the guidelines they implement. >> i take your point. doctor lurie, whether the administration welcomes such legislation and order is the president contemplating such executive action? >> one of the things to keep in mind is the federal government does not license or regulate hospitals in this way. they are regulated primarily by states that i think it's fair to say at this point but no hospital wants to see its

health-care workers infected. the cdc guidelines provide options for safe protective equipment in large part because there's probably not a one-size-fits-all solution. it's important for people to be able to practice in the equipment that they are using comfortably day-to-day provided that it meets the safety standards but the cdc has articulated. >> not sure what that means in terms of whether the administration is contemplating executive order or you would welcome the legislation that would make it mandatory as suggested, but we will be in touch i'm sure. final set of questions mr. torbay. in the united states there are 245 doctors per population and in liberia, 1.4. in guinea one, sierra leone,

2.2. health spending per capita come $8,895 here in the united states $65 in liberia. $32 in guinea. the cbc says if we don't achieve 70% of the isolation of existing ebola victims in the affected countries, the number of victims or people with ebola in these areas could reach 1.4 million by january 20. roughly around when the president gives the state of the union address. that is astounding and whatever problems we've got with the relatively limited number of ebola patients in the affected regions obviously becomes enormously magnified when you're looking at that kind of a number how in the world do we contain this before it becomes

explosive? it's already the largest ebola epidemic ever recorded to but to go from roughly 10,000 or so to 1.4 million in the next two and a half months is job dropping. >> thank you for the question. there are steps that could be taken and that are being taken and to hopefully never achieve that 1.4 million number and that includes isolation of patients -- for the ebola treatment such as the one at the international running in the county. >> mr. chairman i promise the cdc says if you isolate 77% now, you would achieve complete the

basement of ebola in the affected regions. in other words, then we are on a path to the complete reversal. >> also we cannot forget the need for the regional preparedness outside of those countries. we know one patient and mali was taken to a hospital. regional preparedness is critical and that includes training the teams and that could also treat ebola, detect contact tracing and it includes community messaging so not the conflicting messages that go out as well as the stalking of supplies needed in case of an outbreak. this is critical as well and this is an area that is being ignored in terms of preparedness. >> thank you. >> now the gentleman from south carolina mr. gaudi.

>> i want to start by thanking the nurses and doctors, hospital workers, soldiers and others for their courage and their sacrifice. most of us run away from danger and disease and risk and very few people are willing to run towards it so i want to start by thinking that group of people. i want to read you a quote and you tell me if you can tell me who the author of the quote is beginning with the development of a strategy might roll could be to help find the country to be ready for any kind of adverse public health events including a response to any challenges the future may bring. do you know who said that? >> you did. in your page it says you are the secretary for preparedness and response and your work has included evaluating public health preparedness conducting 32 tabletop exercises on the hypothetical crisis such as

smallpox, anthrax, pandemic influenza. another story on you and your career which is an incredibly commendable career said your job is to plan for the unthinkable a global flu pandemic. a bioterror attack, she's on it, massive earthquake, yes she has a plan it commissioned that includes both science and a communication strategy. so i was sitting there thinking here we have a doctor with an incredible background in medicine who also happens to plan for crises like ebola whose job description also includes communication strategies. so why in the hell did the president pick a lawyer to be the ebola czar and not you?

connect can i take one moment to verify my answer about the question because i think that i didn't understand it fully. the cdc has ample authority to do but it needs to do. and it's use to those authority many times. the proposed regulation would ve refined the process but the underlining statute already gives the authority that is needed. >> the record is now complete with respect to door position on the quarantine. now i want a record to be complete on why in the world of the president pick a lawyer to head the ebola crisis instead of somebody with your varied background. >> and i appreciate the confidence. the role of the coordinator in the white house is a whole of government coordination role. >> i appreciate that, doctor lurie, but he's not a doctor committee is not an osteopath

come he's not a nurse come he's not an epidemiologist, he doesn't have a background in communicable disease, he doesn't have a background in infectious disease, he doesn't have a background in west africa so how in the world is he the best person to be the ebola czar and not you -- and i don't want to hurt the secretary's career and i fear that i will by complimenting her but she is an incredibly bright person, one of the more capable people i've met in the last ten years is your boss, the secretary of hhs. we disagree on fairness on a lot of policy, but she actually has a background through her work in the foundation in global health. you're a doctor mac. if this were an outbreak of people that don't have a role in west africa or if this were an outbreak of the contested

elections in west africa, then i would say yes go higher mr. claim. but it's not. it's a medical crisis. so why not you? >> right now i have a full-time job in the the department of health and human services. i appreciate the vote of confidence and i have a lot of confidence in him. >> how about another dr. who's an expert in infectious disease or an expert in west africa or the delivery of healthcare? god forbid we pick somebody with a background in medicine instead of a lawyer. and in the interest of full disclosure, i am one. >> with respect i think the will of the coordinator role of the coordinator of the white house doesn't require a doctor it requires someone that is able to bring part of the government together to enhance the covert nation. >> i'm going to make you this promise and i want you to hold me to it. the next time there's an opening on the supreme court i want you

to see whether or not the president considers a doctor or a dentist for that job. and we actually are about to have a vacancy for the attorney general. and i want you to consider or be mindful of whether or not he considers may be like a tattoo artist to be the next attorney general. i promise he will not. he will pick a lawyer for the supreme court and to be the head of the attorney general department of justice. i'm just lost why he wouldn't pick someone with a medical or healthcare background to be the ebola czar. can you understand why people might possibly think that this could perhaps be a political pick instead of a medical science health pick? can you understand how people might be a little bit suspicious spinner i can understand a whole variety of issues.

>> despite the medical background. i was going to but hugo believed the government works together is that experts come together -- >> i'm going to take that answer that he has none. he has me, doctor frieden, doctor fauci. we could go on and on. >> we had access to those people before we had mr. klain. so why pick a lawyer to head up the response for ebola? color me cynical cynical it just appears to be political. but but with that, mr. chairman i would yield back. >> with my friend yield? >> of course i will yield to the gentleman from virginia.

>> i just want to join my friend and colleague from a nonlawyer it's the healthiest thing we've had in the last 50 years. thank you. >> are you applying? are you interested? i think the gentleman. now recognize the gentlewoman for five minutes. >> i think the chair. doctor lurie are you trying to say someone needs to be good at coordinating and managing and cutting through a lot of the bs? >> that is exactly right. i think the panel for meeting with your committee today to our committee today to discuss this issue and i want to let you know my thoughts and deep appreciation are with all of the health care professionals dealing with this crisis and those in the audience and because i represent illinois a special shout out to those from the chicagoland area. my questions are about the role in west africa. secretary lumpkin i know some

commented that there is no reason to involve the u.s. military in this kind of humanitarian crisis. why is the u.s. military so critical to getting that but they are under control in west africa? >> thank you for the question. again we are in direct support in the whole of government efforts. usaid came to us because of our speed and scale of response. we can mobilize quickly, we can and still command and control but we have to keep in mind think about 200 inches of rain a year. when we were there it was raining six to eight hours a day sometimes and many of the roads are impassable except by foot and what goes by foot is the ebola virus as well so there was

an accessibility to the various areas. we have the ability to reach and get those areas and to support usaid. we have the ability to do construction and to build the ebola treatment units. when i was there i had the chance to get on the ground to talk to some u.s. navy's building the monrovia medical unit and working through the rain with the equipment to get what looks to be impossible they make it possible. the final piece that we can do is scale to training for up to 500 workers per week to staff these treatment units. so we bring the capacity in order to do that. so, again, we are an interim solution to support usaid into the international community to mobilize in order to take over

our efforts. >> so you feel you have extensive experience in conducting the humanitarian efforts like this? >> we supported usaid on numerous occasions. we've done it in places like japan several years ago, the philippines most recently, the team on the ground we worked with from the disaster assistance response team has extensive experience working with the department of defense and we are very tightly lashed out and i would say that it's seamless. >> thank you. general can you provide general can you provide a status update on the operations in the region and let us know what your biggest challenges are? >> yes ma'am, thank you for the question. as mr. lumpkin said we were asked to do this mission because of our unique capabilities. as we are here today we have 698 personnel on back split between

liberia and senegal. we are expecting the next 24 hours to 121st airborne division will complete its move in the country and we will begin a rotation for them to take over the command and control piece of this equipment continues to flow through the staging base and. as mr. lumpkin said, we were asked to do engineering. usaid asked us to be prepared to build up the 17 ebola treatment units and we've been asked to build a 12 since we are currently under construction and as for the training effort, we have identified the national training center in monrovia where we will bring in the military trainers to begin training healthcare workers in the next couple of weeks. >> if this epidemic is not contained and it spreads over a continent do you agree that this affects international security?

>> to reiterate my comments, this is a national security priority for the united states that truly has global impacts. so, we have an opportunity right now to flood the zone to make sure we have the capabilities in the country working as a whole of government to mobilize the community to respond. while it still is at a point while it is dire if it gets worse it is good to be hard to manage, so we need to take this opportunity that we have right now. >> thank you both for your testimony and again, a deep appreciation to all of the health care professionals. thank you. >> i think the gentlewoman and i will now recognize myself for five minutes and i want to thank the six of you for your continuation and your efforts in the united states of america and

the men and women that serve on the front lines of the workers and first responders i join in thanking all of those that run to the sound of the guns into the graces that have been that they are amazing individuals and have our thoughts and prayers and hearts behind them. on the military side of things i don't know whether to start with mr. lumpkin or the general, but help me understand the proximity to the challenge how many usaid personnel are they supporting? >> i don't have the number above my head. >> do you have a range? is that hundreds? >> it is so integrated -- my understanding, doctor, is there

is a 21 day window in which a person who may have been exposed to ebola will actually potentially come down with ebola and starts to show signs of having this virus is that correct, 21 days? >> that's correct. stack why do we only hold the troops for ten days before we release them to bring them back to the united states? >> thanks for the question. i can understand the confusion on this but let me see if i can make it clear. to start the 21 day period for monitoring has to take place outside of the infection zone. for us, that would be in the united states. out of an abundance of caution, prior to departure in order to reduce the risk, commanders will be about two renew their personnel from whatever jobs they were doing for up to ten

days prior to the departure from liberia in case of to limit their exposure and provide an extra layer of protection. >> i'm going to need further explanations because i don't understand about ten days the science is 21 days. >> that the 21 day monitoring for the military personnel will take place stateside after they've left in order to ensure that they are ebola free just as it was described previously for other healthcare workers. >> of the written material that i see out there, talked about talk about fever which is monitored twice a day and other symptoms. what are the other symptoms? >> they might include nausea, diarrhea, red eyes, muscle

eight, fatigue. >> so anyone of the symptoms could be happening and not have a fever and you could have the virus, correct? you could have fatigue for instance before you have a fever. >> that is correct that you only transmit the disease when you are. >> if you have one of these symptoms and your coming through customs and border patrol for instance we have about a million people a day that come through the united states border. we have these custom order patrol agents and officers that are wonderful people. they are dedicated and committed in the tough and difficult job and we are asking them to make an assessment of somebody in about a minute or so as to whether or not this person potentially has ebola. how would the world are we going to train them so they have these assessments? >> let's be clear about what's

happening. first they are funneled to five major airports where people are specially trained to do tight screening. if in fact they have symptoms of ebola or they have a fever, then they get referred to secondary screening. >> are you telling me that it worked? did it work in the case of doctor spencer? spin of the reason we moved active monitoring for people to come back to the countries from the united states is exactly for this reason. >> if people don't have a fever when they come through customs and border patrol stations we still believe they need to be very actively monitored for 21 days. doctor spencer took his temperature at the earliest moment as i understand it.

he called authorities and was isolated expeditiously. >> so you don't think he was contagious in the 48 hours before blacks >> from what we understand, people are infectious and they have a fever coming up before him. >> so why did you close the bowling alley? why did they come and you know, put other people in the quarantine? if he isn't contagious, he barely showed a fever and he's a doctor and he said he didn't have a fever until the morning, why did you have to shut down the bowling alley? >> it is a good question and we want to move it in an abundance of caution. the bowling alley is closed for so that it can be cleaned and decontaminated out of an abundance of caution and i expect that it will be open in the not-too-distant future. >> you can transfer this through sweat. that secretion can hold the virus for some time, correct? >> it is being cleaned out of an

abundance of caution, yes. >> i just don't have the confidence that we are dealing with people who have a no contact with ebola patients why we wouldn't hold them for a 21 day period to make sure that their loved ones, the people of this country and i don't understand why we wouldn't put that travel restriction in place and why we don't get a little more strict. the self quarantine didn't work in the case of doctor spencer and she's one of the great people in this earth he went to go help save people's lives and he's an emergency room physician >> will the gentleman yield? i would like a clarification on one of your responses to the chairman's question. you said that the quarantine cannot happen in the country of

origin or of infection and that you would quarantine for ten days and save liberia before you would allow them to come to the united states. my first question is why can't you? clarification, why can't you quarantine the country particularly if we are sending over the military that could build a unit. >> i will teach her to the doctor's what our infectious disease fellow us to be absolutely certain that everybody is ebola free it has to be outside of the infection zone for all intensive purposes the entire country of liberia is an infection zone but i would be for the doctor for further verification. >> the guidelines )-right-paren to get that if you have no risk and if you've not been exposed to other people, you haven't touched other people --

>> the question was about military personnel. >> you haven't cared for the sake of ebola patients and if you are in personal protective equipment you haven't had a breach of personal protection that depending on the category you are at low or no risk. >> i'm not buying it. >> my time is expired. we has expired. we will go to the gentleman from pennsylvania. >> i want to follow up on that and thank you for joining us today, secretary lumpkin and major general lariviere. the abundance of caution has been used in this room today and what i'm wondering specifically and i will invite will open that up to either of you gentlemen is there any reason why this

proposal -- mr. connolly and mr. maloney brought it up is there any reason we went and want to just into want to just use the 21 day wading period in west africa before we bring people back to the united states? who >> our 21 day monitoring process is done at the unit. it's done twice a day to have direct contact with a healthcare professional for everybody that comes home and it is commensurate with guidelines that other organizations are following the soviet are following the same guidelines that the cdc and others recommend. >> when you say in the unit you mean whether it is in west africa or the united states trade >> while there is an country monitoring and monitoring when

they return home. when they return back to the continental united states were a point of origin so to speak they will go through a 21 day process where twice a day for 12 hours apart they will refer to their unit and do positive discussions with a healthcare provider and have their temperature taken to see if, to make sure they do not show any symptoms but keep in mind going back to the risk of the department personnel is because we are not providing direct healthcare to the ebola patients. our risk is much lower than those that do to begin with. >> you're answering my question with what we are doing and i'm asking why couldn't you do it a little differently? why couldn't you do the 21 day wading period in the country just to be extra careful that we are not bringing this virus back to the united state's?

>> again everybody will be monitored twice a day for the temperatures over all intensive purposes we are basically doing what the cdc recommends every single day while we are in the country by having their temperature taken twice a day immediately prior to the departure we will have the personnel go through a questionnaire to find out if in the last few days before they left if it possibly could have come into contact as anything other than a low risk category before we transport them home to start for 21 days. the ten day period which is causing all of the confusion that is an additional period in which they would be removed from whatever jobs they were doing if they were out and about on the town to further reduce the possible risk. >> thank you for that answer but again the answer but again you're telling me what the plan is right now and i'm asking you

why couldn't you be a little more careful with the plan, go of him were overboard with the protection and extend the wading period to 21 days? and it seems to me you are deeper into the cdc on this. >> it's also the u.s. military infectious disease with interagency partners. >> may i ask you gentlemen to please consult with those sources and ask them to consider a 21 day in country wading period just to be in an abundance of caution? cynically will people do that. >> i also want to ask you know we heard about this terrible potential for the spread of the disease in west africa were

depleted by january a million infections or more. the suffering, and one question i have is number 13200 american servicemen and women enough to properly trained to defeat this enemy. >> based on the requirements that have been asked of us from usaid who were supporting in country the answer is yes. >> the next question is are there enough trainees so that we can train enough people to take care of the problem? spinnaker that is a question i i would have to divert the expertise on the ground. >> with anyone on the panel like to take that question? >> there are health workers not necessarily from sierra leone that from but from the u.s. and other african countries from

asia that would bring to the country as well to help the treatment and the containment and we are hoping with the training that's been provided into the supplies and development on that actually that should be sufficient. that being said it is difficult to encourage people to go and work in west africa given the conditions on the ground but also given the conditions that they might actually stay for a longer period as well so this is why we try to balance it in terms of going at the same time making sure that they can actually leave and go back home. >> my time has expired. thank you. >> are there any united states personnel that have any symptoms of ebola? >> not to my knowledge. >> i recognize the gentleman from texas. >> i want to follow up before i go to my line of questioning.

you talked about an overabundance why we closed the bowling alley and it's why the airline took out the seeds and reupholster. we are hearing a lot of the caution. from the purely held standpoint wouldn't it include an air travel ban complete to the affected countries like we've seen in some of the european countries? >> i don't believe it would. >> i'm going to disagree. i'm glad we are having this hearing today. this is my second hearing on ebola and i was disturbed in the first hearing that the homeland security committee had in dallas to see the cdc pointing fingers at the cbp and the national institutes of health. it's one of the reasons i said we needed it needed to appoint somebody to be the point person, somewhere the buck stops. the president chose -- and i'm going to join with being of us got to go putting a lawyer instead of a doctor.

josh earnest told reporters ultimately it would be his responsibility to make sure all the government agencies who were as possible for aspects of this response but their efforts are carefully integrated into key will also be playing the role making sure decisions get made. one of the key things is working with congress and i think that he should be here today or at a hearing today called very soon. we are the ones that signed the checks. i think that he needs to be here and also part of the finger-pointing that we saw was that the nurses in texas book called following to the best of their ability with a variable to do it think that it was entirely inappropriate they threw the nurses under the bus. my wife is a nurse and she and i were both individually hurt and offended by that and i think that these nurses were doing the

best they could. a ebola patient isn't always going to present. they will show whether their local hospital when they show symptoms. every hospital needs to be trained. am i correct in saying that your testimony -- what was the percentage that were not prepared? >> i believe it is 85 to 86% but you have to remember these are voluntary guidelines. they are not mandates and until there is a mandate from congress or the president, we will continue -- >> i'm not a big fan of government regulation. maybe the joint commission for the states. i would also like to enter they were also thrown under the bus and this is one of their responses to that. since we do have mr. lumpkin and general here i wanted to ask a couple of quick questions about our military involvement.

general, why did you join the military? to serve my country. my dad was a marine. >> traditionally the job is to serve and protect the country with guns and bombs. i understand the mission is expanding and you are out now building health facilities. a very laudable but is this really what the military was designed for? it seemed if you wanted to build healthcare facilities you would join the peace corps and not the military. >> this is a national security threat and as it has been stated previously the idea has been to fight this overseas so it doesn't further come back. >> is the military the only organization that can build hospitals and treatment facilities?

aren't there thousands if not hundreds of thousands of contractors worldwide that can do that? >> absolutely that we were asked to use our capabilities to jumpstart the process getting it in place so we could turn it over to those organizations. >> are these facilities going to be near existing facilities are they going to be greenfield facilities or brownfield facilities or other locations nearby where patients are going to be congregating? >> we've been asked to build a treatment units and locations that were coordinated between usaid. >> so you could be working on an expansion in an existing hospital treating ebola victims within those guidelines? >> the ones we have been asked to construct none of those were expansions. they were all unique. >> what's personnel would be wearing ppe?

you have 80-deee plus conditions in these countries and the natural inclination is going to be why do i need to wear this type of suit? >> that is a great question. of the protocols that will be followed or that the u.s. military personnel will be issued a basic set they will have with them in the country but because quite frankly the jobs they will be doing they will not be required to wear -- >> i have one quick question. there's been a lot of confusion about this ten days and 21 days. they will come back to the united states and go to the unit and monitor the unit. between the 12 errors if they are not being monitored are they going to be able to ride the subway can see their girlfriend, go to a bowling alley? the >> on the military facility they will be allowed to go home but

having to refer to the unit every 12 hours will limit their ability to travel not sure they're off base. >> my time is expired. >> now the distinguished gentleman from illinois mr. davis for five minutes. >> thank you mr. chairman and i want to thank the chairman issa for calling this hearing. it's an instructive and helpful and i want to thank all of the witnesses for a hearing and being with us. with o'hare airport being one of the busiest in the world and with chicago where i live being absolute transportation hub where millions of people come into and through our city each and every week, first of all i want to command our public

health officials under the leadership of the illinois department of public health and our city officials and homeland security for what they have done in terms of preparation to screen individuals as they come and have places that they can go should anything be detected. our hospitals have been fully cooperative and i commend all of them. i also want to commend all of our health workers who are the frontline individuals because while others can stand and cheer from the sidelines, you are in the arena. you are actually there. you are not the spectators. i've heard a great deal of information and i'm delighted to live in a country that is

willing to use some of its resources to be available in such a way that it does play and understands an international role so i want to thank our military for being in west africa. i agree with those that recognize that we don't have enough resources there to actually do all that we can and all that is needed to be done but i commend us for the effort and for what we are indeed doing. i think i have a little more confidence in the cdc and our health professionals because every day as i understand it, our protocols are under review that whatever has been

established with every incident we are learning new approaches, new techniques and we are putting those into place. so i'm not sure that i have as much gloom and doom because we have had the crisis before and we found a way and we will find a way to stay ahead of this one. doctor lurie let me ask you notwithstanding the advances that we've made in medical science and infectious disease continues to cause millions of deaths every year throughout the world and we know that the primary strategy has been to vaccination, developing vaccines. what we ask are there other strategies and other approaches that are being used elative to

human behavior activity? i always remember to my mother who didn't have any medical training but she always told us that an ounce of prevention was worth much more than a pound of cure. are we able and are we doing things that can help prevent and arrest the impact of these infectious diseases? >> i appreciate your question, congressman. as a primary care doctor every time i see a patient and how important communication is both with my patients and with my community one of the challenges of dealing with this outbreak in west africa has been that there are a lot of deeply held beliefs. there hasn't been sufficient information about how one contract this disease or how to

prevent one from getting it and i believe that there's been a tremendous effort in public education and i expect that's going to continue in the days and weeks and months ahead. here at home as well there have been efforts to educate the public but many of them have centered on the populations whose heritage is in west africa and in the areas of the country where the populations exist in the state and local health departments have been have shown tremendous leadership in reaching out to those populations, helping them understand how to recognize and how to protect themselves here and importantly helping them provide information for their families in west africa whether it's on the internet, whether it's by skype or text, whatever. there is certainly much more public education and outreach to

do both in west africa and likely here but i really applaud your observation because it is important to anything we do in medicine or public health. >> thank you very much. >> to my colleagues that are concerned about the czar it occurs there were those of us are those of us that know things and then there are those of us that know how to make things happen and get things done and i think that the president may have had that in mind as he made the appointment. >> now the gentleman from kentucky. >> thank you mr. chairman. mr. lumpkin and mr. general lurie -- general lariviere there are members and i hope that you will understand my first question would be focused on

their safety and training and well-being. but i need to ask doctor lurie a question first. are you familiar with the treatment of the three patients in the united states the treatment regimen that they've received plaques we have heard in the press that they've received zmapp and also perhaps blood transfusions. is that true? >> there've been more than three treated have some familiarity with the treatment, yes. >> doesn't include blood transfusions such as zmapp? >> my understanding is that some patients received zmapp when it was available and some of the patients have received blood transfusions. >> so the best minds that we have and doctors that we have in this country, their consensus is that with the best treatment for them? major general, my question to you is can you assure us that the best treatment available in

this country will be available to our soldiers in the unfortunate circumstance that any of us contract ebola plaques >> absolutely. as stated earlier, there will be a hospital both in monrovia and senegal where they will be stationed and it's there to exclusively take care of the u.s. military personnel. ..

by sitting next to somebody who is exhibiting symptoms on a bus? >> thank you for your question. first of all for the record i'm not a doctor so i cannot be -- what we learned is that less there's contact with bodily fluid -- >> would that include perspiration? >> that could include perspiration. >> to have to contact the skin? >> i can't answer that. my understanding is it has to be through a broken skin but i'm not sure about that. >> would you say it's possible even if it's not likely?

your protocol you described before say that somebody was classification of low risk is prevented from taking public transportation. so surely you foresee that somebody, maybe not likely but is it possible that somebody could catch the ball on across? >> we haven't experienced that. with ebola could be possible. there's no scientific evidence that proves workers against. >> there's no scientific evidence that could be transmitted through saliva, vomit, perspiration? >> yes. >> doesn't live on surfaces? can it live or more than 50 minutes on a surface? >> i cannot answer that. >> you can't answer? >> i didn't know the answer. >> may be dr. lurie can. cam ebola survive outside of a patient on in your service or any period of time? >> they can survive on an inert surface for very portrait of time depending on -- >> let me ask you. is it possible, not likely, is a

possible civil can't contract ebola sitting next to someone on a bus who has it? can you imagine a way that could happen? is it possible to? >> one would have to have been in contact with body fluids. it does include perspiration. >> major general, get back your soldiers here. you have assured us they been adequately trained in avoiding the contraction of the ebola. if a soldier came to you and said major general, is it possible, not likely, is it possible to contract ebola sitting next to someone on the bus who has it? what would your answer be to them? i trust you will give us a straight answer. >> i would defer to the medical professionals as the doctor just said. it can be transmitted through sweat, bodily fluids has been noted. and i would say that that is why we have such three suit

separation. that's why we don't -- >> fim a soldier and ascii that, what would your answer be? >> my answer would be, it's a hypothetical. >> it could certainly have been -- >> they could possibly happen. >> i'm asking you to answer hypothetical. >> you are asking me to answer hypothetical so it could possibly happen but i would defer and say in all likelihood and need to follow the procedures you were taught. >> i'm hoping they're getting the best training possible and i'm concerned if they're being told they can't catch it on a bus. can you tell me which answer to the soldier would be if he said, can i contract -- >> for the record they're not getting on buses with liberian citizens. they are in senegal, but -- >> we have other members from kentucky serving in the military. >> fort campbell folks will be

there, absolutely. they won't be getting on buses with liberian personnel either come and so i would tell them to go in and follow the protocols. >> just quickly. our confidence has been shaken in the cdc because we get to the king answered. when it first with milton was going overseas to combat ebola i was skeptical but then on second thought i said that's where our competency in the government resides, or the confidence resides in the american public is with our military and their ability to focus on a mission. today you've and to the question for you refer to cdc guidance whether they should be courting for 10 days in country or 21 days in country. what i'm asking you for the safety of the soldiers and for the safety of the public is to use your own judgment. we trust the military actually more than the cdc on this. so please, use that to guide you. >> absolutely and that's why i reiterate, once they returned we are having, not the

self-monitoring but cdc standards because we're the military, having those individuals monitored by their units once they are back. >> if the public would like to see them stay on the base for the 21 days after they are back -- >> i understand their concern, but come and again, this is, we think it's prudent to have them checked twice a day on base but be able to return to their loved ones. >> we appreciate that you mentioned is the noise has been to protect this country and we appreciate your service. >> i thank the gentleman. now the gentlelady from new mexico. >> thank you, mr. chairman. with the arrival of ebola in the united states we are all in this committee really concerned about whether or not our emergency preparedness systems are effective and whether our public health system is an effective response mechanism. i think