>> as of today with the expansion to the four additional locations, that covers about 94%. >> of the 100 to 150, 94% being covered. that means somewhere between 2,000 and 3,000 people a year are coming into this country without being screened from the affected areas? >> well, they would undergo a different form of screening. we're still going to identify that they've been to one of those three affected regions. and we're still going to ask them questions about their itinerary. we'll coordinate with cdc and public health if they're sick. and we're also going to give them a fact sheet about ebola, about the symptoms, what to watch for, and most importantly, who to contact. >> would we be checking their temperature? >> we will not be checking the temperatures or having them fill out a contact sheet or about their -- >> so there's 2,000 to 3,000 people entering this country a year without checking their temperature, without having the contact sheet that 94% of those affected people. >> they're going to arrive at hundreds of different airports throughout the united states. >> okay.

>> i want to talk a little bit more about the travel restrictions. dr. frieden, how many commercial flights are currently going into the affected countries? >> i don't have the exact numbers. >> does anyone on the panel know how many commercial flights are going into these areas? mr. wagner, you don't know? >> from the united states or from anywhere. >> from the united states into those areas. >> there are no direct flights, no commercial flights. >> into the area? >> into any -- >> into west africa? >> there are flights into west africa. >> how many? >> that i don't have offhand. >> anybody on the panel know how many? how many coming back into the united states? >> there are no commercial flights coming directly into the united states from those three areas. >> and what about europe? >> there's hundreds of flights coming from europe. >> okay. so people traveling from west africa to europe to here? >> that's generally how they would get here. >> and 94% screening.

how many flights are required daily, every other day or weekly to get the supplies and personnel to the affected areas? >> the quantity of supplies is quite large. we would have to get back to you in terms of the numbers, but there's huge quantities needed. not just supplies, also personnel who need to move back and forth. >> if you could get back to me with that number, i'd appreciate it. now, dr. frieden, nigeria. are you aware nigeria has a travel ban? >> i believe that is not the case. >> they do not? okay. dr. frieden, one of the issues that had been brought up regularly to me back in the district when i go home, what should i tell my local hospital and local doctors they need to do to address ebola? >> the single most important thing they need to do is make sure that if anyone comes in with fever or other symptoms of infection, they need to ask

where they've been for the past 21 days and whether they've been in west africa. >> and the training that, the small local district hospital would receive, is that the same kind that a major metropolitan hospital would receive? >> there are a variety of forms of training. we support hospitals. hospitals are regulated by states, not by cdc. >> dr. frieden, what do we need to do? we're entering the flu season. what do we need to do to make sure that people understand that there could be similar conditions, similar circumstances so that we don't have a situation where people are, indeed, panicked? >> the key issue, it is as you point out, getting into flu season. by all means, get a flu shot. and for health care workers, any time someone comes in with a fever or other signs of infection, take a travel history. that's really important. >> dr. frieden, i wanted to go back to what i said at the beginning.

you mentioned we can't have a travel ban because you're afraid of the impact it would have. but you don't know how much personnel, equipment and flights are currently in use. >> my point earlier on was that if passengers are not allowed to come directly, there is a high likelihood they will find another way to get here, and we won't be able to track them as we currently can. >> we're talking about supplies, equipment and personnel. how many? how many flights? how many personnel? how much equipment? >> the point i made earlier was that if the -- if we are not able to track, we'll lose that ability to monitor for fever, collect the locating information and to isolate them if they're ill. >> gentleman's time expired. thank you, now mr. welsh for five minutes. >> thank you. i want to follow up on some of the questions. first of all, i want to

understand this. one person who has come to the u.s. and then he infected two health care workers in dallas, correct? >> at this point, none of the 48 contacts he had before getting isolated have developed symptoms. and they're mostly well past the maximum incubation period. >> and for everybody on the panel, it's code red. we have had very few -- two instances of infection here in the united states, but this is such a highly contagious disease that we're on full alert, correct? >> it's a disease -- it's a severe disease. not nearly as contagious as other diseases, but any infection is unacceptable. >> that's right. and there's an enormous amount of public concern and apprehension about this. we appreciate the full-on efforts that you're making. there's been some lessons learned from what happened at dallas, the hospital's been forthcoming about mistakes that were made.

and now there's been information provided to all the hospitals in the country about what protocols to follow, correct? >> correct. >> on a practical level, is it feasible that all of our hospitals are going to be in a position to provide state-of-the-art treatment? or does it make sense for hospitals to contact you when they have a potential infection for you to come and then for us to have centers to which that individual who is infected can be treated. >> every hospital needs to be able to think it may be ebola, diagnose it, call us as they do. we've had hundreds of calls and then we will send a team to determine what is best for that hospital and patient. >> and then, what we have also heard this is absolutely a public health infrastructure issue where it gets out of hand, correct? >> public health measures can control ebola. >> right.

and they have been able to contain it but no public health infrastructure in these three countries where the epidemic is now getting headway, correct? >> exactly. >> and then in the u.s., we're fortunate to have a pretty good infrastructure. but we do have to have an answer, i think, to this question that's being asked about travel. that is a concern that people have because it is seen as a, quote, easy answer. and i want to understand what the debate is within the medical community. you know, for a lot of us sitting up here, we're hearing from our constituents. sounds like something we can do and that will eliminate any possible of an infection coming here. but that may be a psychological answer, but not necessarily an effective medical answer. all of us have been asking you to give your explanation. and anyone else can come in as to why from a medical standpoint you have concluded that a total travel ban is inappropriate and not effective.

>> first off, many of the people coming to the u.s. from west africa are american citizens. american passport holders. that's one issue just to be aware of. >> and, by the way, i don't have much time. but our health care workers, even if there's some risk of infection, if we're going to encourage people to go and do the important work, including military personnel, we've got to make sure we can treat them if, in fact, they do get the illness, correct? >> people travel. and people will be coming in. >> and as i understand it, you say there's basically a tradeoff. if you have a full-off ban, there's going to be ways around it and you're going to lose the benefit of being able to track folks who may be infected. and that could lead to a greater incidence of outbreak. it's a tradeoff, is that essentially what's going on? >> open to any possibility that will increase the safety of americans. >> right. so are there midpoints that in terms of travel restrictions as opposed to a travel ban that may make sense you in coordination

with your colleagues, particularly mr. wagner? >> we would look at any proposal that would improve the safety of americans. >> all right. this isn't about funding, so i'm not going to ask you because i think we would know what your answers would be. but i just want to share my concern that it was expressed by ms. castor. we may want to have a hearing at some point about what is the funding requirements to make certain the infrastructure this country needs, to be in place before something happens is robust, it's strong, we've got people who are trained, they're ready to do the job and they have everything they need. so that's not today's hearing. but i think it's a question that we should address because with 20% across the board funding in nih, i find that to be a reckless decision. with 12%, it's cdc, i think that is definitely the wrong direction. i think this congress has to revisit our priorities on making

certain that we have the public health infrastructure to be prepared to protect the american people. >> i think i should say, we are planning a second hearing in preparation that will also ask if nih does have the flexibility now to transfer funds as well as hhs. who's next? >> i now recognize mr. griffith for five minutes. >> thank you, mr. chairman. i believe we should have reasonable travel restrictions. and in answering a question of my colleague from colorado, mr. gardner, you indicated that nigeria didn't have any restrictions and that is accurate. but i have in my position, i ask it be submitted for the record, a letter from delegate robert g. marshall of manassas, virginia, to terry mccullough. in that he cites a travel and security services company reports that african countries have imposed total air, land and water travel bans by persons

from countries where ebola is present. the countries include kenya, cape verde, south sudan, gambia, rwanda, kenya, south african development communities, 14 countries only allows highly restricted entry from ebola-infected regions with monitoring for 21 days and travel to public gatherings is discouraged. i find that interesting because some of the countries had previous outbreaks, as well. wouldn't you agree some of the countries have had to face it before? >> i would have to check the list carefully to know. but i'll take your word for it. >> all right. i will tell you that this is a concern to a lot of our constituents and to mine, as well. and i was checking my facebook page recently when i saw a facebook friend of mine asked for prayers for her daughter because she lives in the apartment complex with the first nurse, nurse number one, as i think somebody referred to her earlier and was very concerned and while i think i know the answer, i'd like to get your

answer so that i can reassure this father. and that is his question is, if i count to 21 days and my daughter is not infected, at that point, can i exhale and breathe a sigh of relief? >> not only can he do that? but he can do that now. because the first nurse only exposed one person, one contact, and that was only in the very early stages of her illness. at most, one person from the community was exposed. >> and i appreciate that. he also asked a second question. he said there's some suggestion coming out of dallas that the patient's dog may be infected and may have infected other dogs through actual contact or by feces. can the virus be transmitted by dogs? and i will tell you i did some homework on this because i thought it was an interesting question. and found a cdc publication from march of 2005 that did a study on dogs in africa in the infected areas and a study in

france as a control group. and they found that while dogs show antibodies for ebola, they are asymptom matic. but there's a lot of questions about how ebola is transmitted. and in some instances, in 2004, republic of congo, in the sudan, there's a question mark as to whether or not, or how that ebola outbreak occurred. it wasn't in the normal or standard ways. it wasn't human to human. and this report indicates that dogs might be, might be, i don't want to scare folks, might be suspect. i guess my question to you is, isn't it true we really don't know a whole lot about the various outbreaks of ebola. and when we're trying to ensure the american people we didn't think it wouldn't come to this country and if it did, we wouldn't have problems controlling it. now we've got people being

monitored. isn't it true there's still a lot of questions about how ebola is spread? >> although we're still learning a lot about ebola and every other organism we study and control, we have a lot of information about ebola. we have a good sense of how it's controlled. and we've looked at the issue of exposure to animals. we know that in parts of africa, consumption of forest living animals can be a cause. we don't know of any documented transmission from dogs to humans, but that's why the authorities with our agreement have quarantined the dog. and we will be helping them to assess that situation. >> it's also true while we have no evidence of transmission from humans to dogs, we don't know if there can be. you have a lack of evidence as opposed to negative evidence. we don't have clear evidence you can't transmit it either. and what's interesting is that raised the question for me ab t about, okay, we've got no restrictions on travel of human beings, how about the dogs. i called customs and they said

our experts are there. and after pushing them a little bit, that's the usda, we call usda and they said that would be cdc. i understand all your reasons, while i don't agree with them completely, i understand the concerns about humanitarian, et cetera, but don't you think we ought to restrict travel dogs? >> now recognize for five minutes. >> thank you, mr. chairman. and before i begin my questioning, i'd like to submit for the record an article entitled will america's fragmented public health system meet the ebola challenge by mark rothstein, the director of institute of biomettics. i'd like to submit that for the record. >> thank you. i'd like to thank the panel for their testimony and answering the questions. and this has been an enlightening hearing. i also want to acknowledge at the beginning that the kentucky air national guard which is based in my district is

participating in this effort. at the risk of displaying my ignorance, we apparently know you can't detect it until it becomes symptomatic or contagious. is there any kind of test that would indicate whether anything's going on in the body? sometimes my doctor will say, you've got an elevated blood count, something's going on there. is that true of the ebola? would that not indicate something's going on? >> at this point, we don't have a test that would identify it. the test only turns positive when they're sick. and the test is for the virus itself. and that's why -- that's another reason besides the patterns of disease that we're confident it doesn't spread. we can't even find tiny amounts of it in people's body until they get sick. >> is there any research being done as to a possible test, earlier test for this?

>> there's a lot of research being done to try to understand and diagnose and treat and prevent better. >> good. i am a media person by background. that's where i spent most of my career. i'm sensitive how the media treat situations like this. and certainly the media can become -- can be a very important part of providing public information about a potential threat to public safety as this is. but they can also go overboard as we know. and i'm curious because i see every day comments in the media about the spread of ebola and outbreaks of ebola. while, yes, it has spread, i know that the public may hear that very differently. and perceive there to be a much broader and widespread incident of ebola in the country. and i see things like, for instance, in the washington post today, the picture of the woman at dulles airport who looks like she's mummified because of her

concern of contracting ebola. and i know that now one survey showed 98% of the american people are aware of the ebola situation and, you know, not even 50% know there's an election coming up in three weeks. the media has certainly let the public know there's something going on. my question to you is, has the media coverage so far been helpful or harmful in your efforts to have the public have an appropriate concern and awareness of what the situation is? >> well, any time health care workers become infected and ill in this country, it's unacceptable and our thoughts are with the two infected health care workers in hoping for their recovery. so it's certainly understandable that there's intense media interest. it's new to the united states, it's a scary disease, had a movie made about it. and it's important to have that

attention so that we as a society pay attention. and doctors and hospitals and community health clinics think of the possibility of ebola. that we generate the societal will and resources to both protect americans and stop it at the source because it's got to be stopped at the source to make us completely safe. some of the coverage, i think many would agree may exaggerate the potential risks or may confuse people about the risks. there really is a lot we know about ebola. cdc has an entire branch, entire group of professionals who spend their careers working on ebola and other similar infections. they go out and stop outbreaks all the time. we have stopped every outbreak of ebola until the current one in west africa. there's zero doubt in my mind that barring a mutation, which we don't think is likely there will not be a large outbreak in

the u.s. so i think we wcome the attention, it'd be important at times to put it in perspective. >> i appreciate that. i agree totally. one final question in the last 30 seconds. are you -- is there any additional authority that cdc would find it more helpful in conducting or meeting your responsibilities? i know most of yours is guidance and information. is there any specific authority that congress could grant you that would make it easier for you to do your job? >> we're looking at a variety of things, emergency procurement, to see in conjunction with the administration whether there are some changes that might allow us to respond more quickly and effectively. >> thank you. i yield back. >> recognize mr. johnson for five minutes. >> thank you, mr. chairman and dr. frieden, thank you for being here. thank all of you on the panel for being here today. you know, this is not about

politics, it's not about international diplomacy. it's about public health and protecting the public safety of the american people. particularly our health care workers who, if i understood correctly you've acknowledged some of the high-risk folks to be exposed. you know, i want to -- one of my main concerns, dr. frieden, is we don't know what we don't know. throughout testimony and questioning today, i've heard you say multiple times i don't know the details of this. i don't know the details of that. and i think what the american people are wanting is some assurance that somebody does. do we know yet how the two

health care workers in dallas contracted the virus. was it a breakdown in the protocol? was it a breakdown in the training of the protocol. do we know whether or not the protocol works? >> the investigation is ongoing, we've identified possible causes. we're not waiting for the investigation to -- >> we don't know. we don't know. >> the people in ohio are concerned, especially now that we know that one of those health care workers traveled through ohio, even spent some time in akron with family members i applaud governor kasich's immediate actions to try and address the situation. in my experience as a military war planner 26 1/2 years in the

military. we don't wait until the bullets start flying to figure out whether our war plan is going to work. dr. frieden, when did the cdc find out that there was an outbreak of ebola in west africa? >> late march. >> late march. has there been, one of the things we do in the military is that we conduct what's called operational readiness inspect n inspectio inspections. we give real world scenarios in controlled environments, no notice, so that those who are going to be responsible for executing a war plan knows what to do when the first shot is fired. no panic, no second guessing, they know what to do. has the plan to address an ebola

outbreak ever been tested by the cdc in a real world environment? >> not only the plan, but outbreak control has been done multiple times in parts of africa. what had not been done is in this part of africa which -- >> i'm talking about here in america. >> in america also. we do a series of preparedness plans, for example. >> which -- do you know of any hospitals in eastern and southeastern ohio that participated in any kind of real world scenario of an ebola outbreak. >> i can't speak to that specific example, no. >> okay. let me go a little bit further. you mentioned earlier that 150 per day, roughly, are coming in from west africa. i think mr. wagner indicated 94% screening. let me give you a scenario. let's say a person comes in to the country from west africa. and let's assume that everything in the screening process works right.

may be in day 14 of having been exposed to ebola in west africa. they show up here in america with no symptoms. they go through the screening process. and so they go on about wherever they go. akron, cleveland, cincinnati, los angeles, wherever. day 17 or 18, they start getting ill. and they start seeing a spike in their temperature. if they walk into any emergency room and appalachia, ohio, and start throwing up, having symptoms, does your plan identify that? and does your plan tell that hospital emergency room what to do in that scenario? they don't know that person came from liberia or any other place.

>> we have detailed checklists and algorithms we've distributed widely, provided repeated trainings and information so that health care providers throughout the country have a detailed checklist of what to do step by step by step to determine whether the person has ebola if they do, to call for help and we will be there. >> okay. mr. chairman, i yield back. >> mr. green's next in line. so mr. mathison is next for five minutes. >> well, thank you, mr. chairman. i have a number of questions. i'll try to move through them quickly. dr. frieden, as was mentioned by a cup m of people in the opening statements, strikes me the control in the outbreak in west africa is one of the key issues to keeping americans safe. the reports indicate we may be losing ground in liberia. what would enhance the international community's ability to gain control of the situation in west africa in

terms of actions and resources. >> the fight against ebola in west africa is challenging. the health systems are weak. what we're finding is that it's moving quickly and there's a real risk it will spread to other parts of africa. therefore, the key ingredient to progress there is speed. because the outbreak is increasing so quickly, the quicker we surge in a response, the quicker we blunt the number of cases, and the risk of other parts of the world, including the u.s. decreases. >> and are you resource constrained in that context? >> congress has provided money or approval or agreement to use money for the department of defense, usaid has resources going in. at cdc, we received through an anomaly, $30 million for the first 11 weeks of this fiscal year, which we appreciate. >> let me ask you. you have a number, the cdc has a number, unprecedented number of people in the field right now in west africa and texas.

how many people do you have deployed doing airport screenings? >> i would have to give you the -- get back to you with the exact number. we're working both to oversee the screenings in west africa and make sure they're done correctly and screen individuals here, collect information on them and transfer -- >> get that number and also find out if those resources are best used there or elsewhere. following up on the questioning, is there a development of a more rapid test to determine if someone has ebola than what we use today? >> more rapid test would be very helpful. the u.s. navy has a pilot test in development. we're currently testing that in parts of west africa. it's simpler, quicker and would be very helpful. even if it isn't quite as sensitive. we're working with a number of commercial manufacturers also on a more rapid test than there is currently. >> seems to me -- legislative or

regulatory actions could strengthen these systems. to the end, how can we reduce this variability. >> something cdc works hard with state health departments and state governments to improve. hospitals are regulated by the states within which they operate. and the issue of what could be done to improve infection control is complex. cdc has a large program, hospital infection prevention. and there we support regional efforts to share lessons and figure out new ways to do things better. and that kind of center of excellence model is a very important one. >> but you're suggesting while you can provide the information and the expertise and the

guidance the actual implementation and responsibility still a state function more than a federal function. do you think we should be looking at that issue? >> in the u.s.? >> yeah. >> we have a federalist system. the cdc provides information and input. there are roughly 5,000 hospitals in the country, we're not a regulatory agency. >> right. one other line of questions. there's no good news about ebola, but at least it is not an airborne transmit entity. we don't want to underestimate the ability to be transmitted. and while the focus is on ebola and rightly so for this hearing, there are other airborne transmissable pathogens that ought to be great concern to everyone including this congress that exist around the globe

today, mers being one of them. is this experience we bow ith e how do we learn from it to prepare for other human to human transmittable pandemics? >> i think there are two major lessons. first, to prevent it at the source. if we had the basic public health system in place in these three countries a year ago to find it, stop it and prevent it, it would be over already. and second, within our country, to continue to support hospital preparedness, community preparedness and fundamentally the public health measures to find, stop and prevent health threats. >> okay. thanks, mr. chairman. >> mr. long recognized for five minutes. >> thank you, mr. chairman. and today we have referred to people on the panel, people up here have referred to nurse one and nurse two.

and these are two young women that have dedicated their lives to helping other people. sick people. and to refer to them as nurse one and nurse two doesn't sit well with me. it's reminiscent of dr. suess thing one and thing two. the first nurse to contract ebola was nina pham and the second nurse -- these are young women with families. one in particular has a fiancee. i think it would serve us well to remember these are human beings, young women that have dedicated their lives to help g i ing people. i'd like to open with that. dr. frieden, you said earlier only by direct contact can you contract ebola. is that -- do you standby that statement? >> direct contact with someone who is ill or died from ebola or

their body fluids. >> and it's not airborne, and you agree it's not an airborne. cannot be contracted airborne. >> ebola spreads person to person, not by the airborne route. >> you need personal contact. >> yes. >> if you need personal contact with bodily fluids, why is there an airliner in the denver airport right now that frontier airlines has scrubbed four ti s times. aren't they wasting money? why can't they get that back in service? if you have to have bodily contact, close contact, why scrub that airliner. >> i understand people are concerned about ebola. it's a scary disease. >> so it's just for public perception? they really don't need to be doing that, right? >> we have detailed guidelines along with epa for how to clean airlines. >> do you need a fever to be contagious? >> you need to be sick, generally the first symptom is fever. >> do you need a fever to be contagious? >> late in the disease when

people are deathly ill, they may not have fever, but they would likely be unable to walk at that point. >> this 21-day period from exposure, during that 21 -- could you be contagious at the third day of that point? >> only if you were sick. only if you had symptoms. >> okay. and the incubation period is anywhere from 0 to 21 days. >> 2 to 21 days, generally within the first ten days or so. >> you said today 100 or 150 people a day coming from west africa into the united states. you're opposed to travel restrictions, which the constituents in the seventh district in missouri are in favor of travel restrictions. i predict you're going to put on or the president's going to put on travel restrictions. i don't know if it's going to be today, tomorrow, two weeks or a month from now. i think they're coming. sooner rather than later. if there's 150 a day and you rationalize, well, we don't need to worry about that because they

could get cross borders, go by land and then get here. if that 100 to 150 a day, don't you think reduced to five or ten a day if we did put on travel restrictions? >> i can't comment on what numbers -- >> if someone had to make an effort other than going out to their local airport and jumping on a plane, don't you think that number would dramatically drop? >> i know that people do come back. and right now, we're able to screen them, collect their information. >> what if they don't come back? a lot of people come back and we lose track of them. what happens then? my point is if you have five coming in in a day, i and my constituents would rather have five a day coming in and this thing for checking for temperatures like it's going to help is kind of like scrubbing a plane that doesn't need to be scrubbed. but i'd like to commend folks reading this copy of bloomberg business week, "ebola is

coming," coming to america. the u.s. had a chance to stop the virus in its tracks, but it missed. that issue came out before mr. duncan came to this country and before he was diagnose e ed wit ebola. there's good reading in there. also recommend, too, if you want to google a hospital from hell is swamped by ebola and "new york times" from a couple of days ago. if you get a chance to read that. i think that everyone would be in favor of the travel restrictions we've talked about here here today. and today, osha just today said that customs and border control immigration and enforcement agents are at risk of coming into contact with ebola. are we prepared for that? are they protected to the fullest extent what they need? >> we issue -- >> this just came out today. >> we issue them personal protective gear and train them

on how to wear it and what circumstances to wear it. they encounter all kinds of different travelers with a whole host of communicable diseases. we are aware and we train to recognize signs of overillness and we have the protocols with the health professionals to protect our employees. >> to me they fall in the same category, they're there to save us and help people and protect people in this country. god bless them. i'll yield back. >> gentle lady from north carolina. >> thank you so much, mr. chairman. and i have a number of questions. i'd like to start with dr. varga in regard to the two nurses that were exposed. my understanding is one of the nurses, first nurse, nurse -- ms. pham was exposed in the emergency room, is that correct? >> i'm sorry, could you repeat

the question, please? >> the first nurse was exposed in the emergency room, is that correct? >> no, that would not be correct. nina was one of our icu nurses, came in contact with mr. duncan when mr. duncan was transferred from the emergency department up to the e.d. >> that was some time from september 28th to the 30th, is that correct? >> that's correct. >> and the second nurse, ms. vincent, was she also an icu nurse? >> that's correct. >> so they were exposed after the point we would've already started recognizing that ebola was being questioned. is that correct? >> no, that's not correct. the nurses in the icu when they had contact with mr. duncan were in personal protective equipment

according to the cdc guidelines. nina -- >> dr. varga. i'm going to stop you there. they were already using universal precautions but also had -- were using some of the more isolation and just answer yes or no. >> yes. >> okay. to that, i'd like to move on, dr. frieden, this, of course, and i'll just back up. on october 2nd. excuse me, october 6th, i sent a letter to the cdc to cbp and hhs calling for travel restrictions. there's no question, i believe, travel restrictions needs to be put in place. and now after having this subcommittee hearing, i believe even more strongly that we need them. and i just want to back up to a couple questions for dr. frieden and dr. fouche, do we know the strains -- are there multiple strains of ebola?

>> there are five subspecies. this outbreak and all of the strains that we've seen have been closely related. >> okay. so we know that it's isolated to one particular strain? >> yes. >> now, you had mentioned and, i believe, the quote was, unless it mutates, there will not be an outbreak here in the united states, is that correct? >> there will not be a large outbreak here barring a mutation. >> well, the question i have is, when the nurses were using the protective gear then, how is this that this has happened? it tells me that something is changing here. and are we -- are we currently looking into this situation right now? >> we're absolutely looking for other mutations or changes. what we've seen is very little change in the virus. we don't think it is spreading by any different way. >> so you're -- and you've already said a couple of times that you don't believe this is airborne and yet there, again, i know how nurses are. i was one for 21 years before coming to congress. you're protecting yourself,

you're protecting your patient, your family. they followed precautions, i am sure, and now we're having this conversation. and i'm very concerned about that. >> we are confident this is not airborne transmission. these nurses were working very hard, they were working with a patient who was very ill, who was having lots of vomiting, lots of diarrhea. there was a lot of infectious material and the investigation is ongoing. but we immediately implemented a series of measures to increase the level of safety. >> okay. i'm going to move on. in the discussion of fast tracking a test for ebola, where is the fda on that? is there a fast track process right now that you know of? >> for diagnostics tests? >> yes. >> so there are three tests authorized for use under our eoa authorities. and we have also taken some proactive steps by contacting manufacturers, commercial manufacturers who we know have

potential interest in technologies to be brought to bear here. and we've reached out to a handful who might be interested in working with us. >> so you're in the process of looking towards a fast track process? >> yes, we would expedite every such test. >> great. thank you. and dr. frieden, lastly. you know, there again, i'm speaking on behalf of my constituents and every american in this country. i don't believe it is acceptable that the quote you have given us. we won't be able to track them as the reasoning for why we should not implement travel restrictions. i do believe we can. and, mr. wagner, as far as our customs and border patrol, do you believe there's a way that we can implement tracking? >> tracking? >> tracking of individuals. >> yeah, we have ways to determine a person's itinerary and travel. it's easier when they're coming on a direct ticket from those -- >> true. true. but as you pointed out, they're coming from -- thank you, mr. chairman.

i thank you for indulging my overtime. >> thank you, mr. chairman. i appreciate you holding this hearing. and i want to thank all of the panelists for coming and participating. and i've talked to arm in of health care professionals, as well. and listening to the panel, as well. i want to join in instituting a travel ban until such time that they can firmly and scientifically prove that americans are safe from having more ebola patients coming into the united states. and i know dr. frieden, you expressed disagreement with that. have y'all had any conversations within the white house about a travel ban and whether or not the president has the authority. because many of us have said the president does have the authority to do it today. >> from the point of view of c cdc, we're willing to consider

anything that would -- >> have you considered that? have you ruled it out? have you had conversations with the white house about a travel ban? >> we've -- >> that's a yes or no question. have you had conversations with the white house about a travel ban? >> we've discussed many aspects. >> how about a travel ban? have you had that conversation? >> we've had discussions on the issue of travel to and from west africa. >> have y'all ruled it out? >> i can't speak for the white house. i can speak -- >> you can speak for the cdc. if you were in those conversations, maybe they had their own conversations without you. but if you were involved in conversations, did they rule it out? are they still considering it? >> we'll consider anything -- >> are you going to answer the question about your conversations with the white house? is the white house considering a travel ban? >> i can't speak for the white house. >> do you know if they've ruled out a travel ban? >> i can't speak for the -- >> have you had conversations about it?

>> we've discussed the issue of travel. >> i would urge you. if you've ruled out a travel ban, you don't think it's the right way to go, there are a lot of people who would disagree with you, you ought to look at immediately suspending visas seeking to travel into the united states from sierra leone, liberia and guinea. have y'all considered that or discussed it or ruled it out? >> at cdc, our authority is to quarantine individuals. >> earlier, you said, you don't think there should be a travel ban. what about at least suspended visas to nonu.s. citizens? have you looked at that? >> cdc doesn't issue visas. >> but you can make a recommendation to the white house that it would be in the best interest of the american people to have that kind of suspension issued, can't you? are you not aware of that? >> we -- we would certainly

consider anything that would reduce risk to americans. >> let me ask you this, do you have a lie level of confidence that our u.s. troops over there. i've got estimates around 350 troops are already in those three infected countries, up to 3,000 troops are going to be sent over by president obama. do you have a high-level of confidence that those u.s. troops are protected with all the protocols in place so they will not contract ebola? >> we've worked very closely with eod on their protocols. >> do you have a high level of confidence they're protected? >> i would not say there's zero risk. they're in those countries but not participating in high-risk activities. >> are you consulting with dod? who establishes the protocols? >> they are following the cdc protocols. >> let me ask you about the property comes. protocols. i've read reports about other organizations. you've got the group samaritans purse, gentleman by the name of

shawn kauffman involved with the doctors over there with the doctors that have been infected. he said that he warned your agency that the guidelines that you had on ebola were lax. and his response was, quote, they kind of blew me off. meaning your agency. blew him off when he was warning you that your property comes were la protocols were lax. are you aware of that? have you identified who blew him off in your agency? >> i don't know that occurred. >> well, i would hope you'd go and find out. because there's a real concern. you know, one of the biggest concerns i get from the hospitals in my district i've talked to and i've talked to a number of hospital officials, medical officials, professionals in my district, they're concerned they haven't had consistent protocols. there have been at least four in the last few weeks where the protocols keep changing. now, with the nurse, the first nurse infected, i believe you personally said that the

protocols were breached originally. have you backed away from that? >> we're looking at what might -- >> you said the protocols were breached. were the protocols breached with the first nurse infected? yes or no? >> our review of the records suggests within the first few days. >> if you didn't know for a fact, you shouldn't have said it. do you withdraw that statement? >> there was a definite expos e exposure. >> were protocols breached? >> time has expired. >> it's tradition in this committee that the ranking member and the chairman have a two-minute wrap-up. >> dr. frieden, would it be fair to say that it looks like the first nurse ms. pham was exposed in the first couple of days before the diagnosis came in? >> that's our leading hypothesis. >> thank you. now, dr. varga, we've still got you, i hope. >> yes, i'm here. >> have you seen my chart from

the "new york times" about the protective gear? >> yes, ma'am. >> do you know which of these types of protective gear, ms. pham and other health care workers were wearing during those first two days? >> nina would have been wearing the second garb, the folks in the e.d. would be wearing the first picture. >> it's your testimony you don't really know how ms. pham, well, either one of these wonderful nurses were exposed, is that correct? >> that's correct. >> okay. i just want to say one last thing. i think that we've had a lot of discussion today about a lot of issues. and my take away is this. and dr. frieden, i guess i'm going to make a statement. i'd ask you to comment on it. seems to me that aside from trying to stop this ebola in africa, the thing we can do here is, number one, we can give better training to the people in

our emergency rooms and first responders, not just send tm out e-mails or bulletins. number two, we can have more robust protective gear at an early stage if somebody looks like they might have a risk for ebola. and number three, i think it might be real useful to put cdc on the ground much earlier. here, they didn't come into this dallas hospital until after the diagnosis. so there was two days when people were moving in and out of mr. duncan's room. and we don't know exactly what happened. dr. frieden, could you comment very briefly on that? >> agree completely on the training. we're looking very carefully at the personal protective equipment issue. we consult immediately every time and there have been more than 300 consultations for hospitals that have thought they might have a patient we bow la. only mr. duncan was confirmed to have ebola. we can't be everywhere. everyone has to do their part, but we will do everything we can to support the front lines. >> and mr. chairman, i'd ask for

both this protective gear chart and also our map of the flights to be included in the record. and i would also ask -- >> out of time. >> also ask all of our witnesses if they would continue to keep this committee updated as the changes in procedures or developments that are made as we go along. and i'd ask unanimous consent to put any other members' opening statements in the record. >> mr. chairman, i had previously asked for unanimous consent. >> granted. >> i don't think we ever agreed on it. >> so ordered. >> now the final two minutes. >> having listened to all of your testimony, a couple things that stand out for me. one, i appreciate dr. daniel varga's statement of honesty, that we made mistakes. i didn't hear that from many of you, and that troubles me. what has happened here is your

protocol depends on everyone being honest 100% of the time. people are not honest 100% of the time. secondly, it relies on tools for taking temperatures, which have their own reliability issues. 1 in 21 chance during those 21 days may register something. and a person can mask it. that's not helpful. we also have to recognize human behavior that protocols may not be followed, that's why you have a fail safe system of a buddy watching you take on your garb, take it off. and i think an example of how this failed. there's an assumption in the travel, dr. frieden, you said cdc granted her travel with the assumption that she used all the protective gear, but we've looked at this it does not appear she wore the proper ones. these are my recommendations. i believe we need an immediate ban on commercial nonessential

travel from guinea, liberia and sierra leone until we have an accurate screening process and treat this disease. number two, a mandatory quarantine order for any american who has treated an ebola patient and traveled to or returned from the hot zone countries. because of an assumption. without this assumption of what they wore was donned and removed properly. number three, immediate training and thorough training for hospital workers to include review of equipment used in the treatment of possible ebola infected patients. the wear and removal. number four, identify specific medical centers equipped and trained to treat potential ebola patients and expansion of those as soon as possible. number five, identify gaps in statutory language that may prevent cdc and any other federal agency including barta, nih from taking immediate action to protect public health from ebola.

any other action congress needs to do to facilitate your needs. number six, accelerate directives on deployment of clinical trials for all promising ebola vaccines, investigational drugs and diagnostics tests. number seven, acquisition of vehicles and airplanes capable of transporting american personnel to return the united states beyond the current capacity of two. number eight, additional contact tracing and testing resources for public health agencies. and number nine, to provide information of congress regarding any resources needed to assist health interventions, aggressive health interventions in africa so we can stop ebola there. i appreciate all the members coming back today for this hearing. and i particularly appreciate the testimony of the panel. unanimous consent that the members' written opening statements. without objection, will be entered into the record. >> i have a document entered

into record. the department of homeland security and then the photograph that i demonstrated earlier today. >> that will be included in the record. again, thank all the members -- >> all right. you're hearing the end of the hearing. tim murphy, luke russert is with us on capitol hill. the word of the day is travel ban, at least on the republican side of that committee. am i right? >> you are right, joy. and you saw that hearing wrap up there a little under three hours, and we were alerted ahead of time from conversations we had with aides to that committee that the travel ban would be the politically partisan issue that would come here. everything's political in washington, d.c. and even ebola seems to get political. you saw republicans going after the cdc, the head, dr. frieden right there about the travel ban, whether or not it should be in effect. and his answer was very simple. look, if we do that, if we do not permit folks to travel, they'll find some other way around our travel ban by going to some other country and from then on we won't have the ability to take their temperature, get the data about where they're going, their own

personal data. and it could be cumbersome. that was backed up by the commissioner of the border patrol also seated next to dr. frieden who sort of said the same thing. nevertheless, a point of contention for a lot of republicans on that panel. you saw from democrats the validity of why there should be a travel ban. and also something i found fascinating, more should be done in terms of u.s. aid to africa to curtail the disease and prevent this even the threat of travel, sort of putting more resources there. overall, did we learn a lot? i would say maybe the most important thing here that nih only has two beds capable of helping out ebola patients for intense biocontainment. i found that an interesting fact. lastly, i would also say in the context of the hearing that we heard, this idea that moving forward, they said there very well could be more ebola patients that could be coming out of texas or wherever. if anything, it seems we're at

the beginning, within the beginning, joy. >> and we have entered the realm of politics. there's been one person who has come from the african continent and i'm not sure it's the mo most -- and art kaplan has been watching the hearings with me the whole time. your take. is a travel ban now the rallying cry around which americans can be confident about how to solve the ebola crisis? >> i don't think so. i think this travel ban issue is overblown. and the reason i say that is we've had four americans come back. one liberian make it here. that doesn't seem like the right ratio. i think almost no one is traveling from these infected countries. it sounds good, but it doesn't accomplish what we want. what we want is sending people to those countries to tamp down the epidemic. the way i would put it simply is this, we don't get a handle, there's going to be more leakage

of people, cases and exposures. our troops, our doctors, europeans, others. the only way to get this thing under control is to cap it at its source. that's what we've got to do. >> and not for nothing, but you've had four of the patients that have come back to the united states, you know, with the ebola virus or americans, you can't ban them from traveling home. >> no, you certainly can't. i think it's a wonderful example to examine our inability in this country to control illegal immigration. 34,000 passengers were screened in western africa during their travel to europe, the united states and other points in the world. if we were to eliminate travel to the united states, human nature is people will find a way to get here. and that eliminates our best weapon in this fight, which is screening. >> yeah. indeed. not to mention the fact there are americans now also at risk, too. and i doubt that the americans would stand for a travel ban of our people going elsewhere.

but that does wrap things up for "the reid report" "the cycle" is up next. you've been watching the house committee hearing on the u.s. response to ebola. plenty of fireworks in the testimony. as we also wait for an executive order on ebola. president obama's expected to issue one today so he can deploy the u.s. national guard and reserves to liberia. it's called "operation united resistance," and nearly 600 u.s. troops are already there. national guardsmen will be part of the force. the goal, constructing labs and hospital beds as the world health organization warns that the number of infections are doubling every four weeks. back here in the states, both nurses infected after treating the index patient are being moved out of that dallas hospital that many accuse of botching protocol on many levels. the first nurse, nina pham heads to an isolation unit. the second worker, amber vincent

is already at emory university hospital in atlanta down the street from cdc headquarters. where dr. kent brantly and nancy writebol were treat eed successfully. a doctor who was flown in last month from sierra leone. meantime, nbc camera man ashoka mukpo is recovering at the university of nebraska medical center in omaha. the same high-tech facility that helped dr. richard sakra recover. there's a fourth similar unit in montana. the facilities have never had a person to person infection like we are seeing in dallas. >> knowing what i know, i would try anything and everything to refuse to go there to be treated. i would feel at risk by going there. if i don't actually have ebola, i may contract it there. >> and today, four more u.s. airports in addition to jfk are beginning that extra screening for passengers who traveled to the states from west africa. they impacts about 1