protecting federal workers from communicable diseases such as the h one n one virus also known as the swine flu the ranking member and subcommittee members will have five minutes to make opening statements and all members will have three days within which to submit statements for the record at this time i would like to ask unanimous consent for the testimony of bennie thompson of the homeland security committee to be entered into the record way this after those hearings has been convened to examine and discuss current federal worker safety protection and policies as chair of the federal workforce subcommittee it is my responsibility to ensure the health and safety of our federal employees especially frontline federal workers who are what the job of keeping the american public's health while we've all seen the headlines have read provide our agency witnesses an opportunity to elaborate on their own perspective their own respective responses to the h one n one virus outbreak today also affords us the chance to enter into a dialogue about the implementation of future policies that would govern and lay out the rights of frontline workers to access protective gear during a time of potential crisis this is especially lethal form the at the result of a public health emergency or a manmade disaster since nine eleven our country as a whole has awakened to the need for ongoing emergency preparedness subsequently federal agencies have been charged with drawing up a variety of disaster scenarios so that government can respond effectively and swiftly in time of crisis however all one has to do is recall the horrific events hurricane katrina on the gulf coast to remind to be reminded that much work in the area of emergency emergency preparedness and continuity of government remains to be done in addition to the work needed to ensure the public safety it is essential that agencies implement adequate and uniform worker protection policy for the employees who protect the nation as part of their daily duties the general emergency response planning efforts emergency without such a policy not only is the front line workers being put at risk but the health of their families and the communities in which they live and the general welfare of the public is also placed at risk and short the federal government cannot ably respond at the very personnel needed as part of that response are themselves compromised frontline federal workers their families the communities where they reside and where their kids go to school deserve to be reassured that their employer the federal government which in this case we are responsible for has done everything possible to guarantee their protection while on the job i'd like to thank the witnesses in advance for their willingness to appear and testify as we take a hard look into what is being done what is not being done to keep our frontline federal workers safe this concludes my opening statement and i  ranking member mister a thank you chairman lynch for holding this important hearing on protecting the protectors and assessment of frontline for workers in response to the swine flu h one n one outbreak i also want to thank the witnesses for taking time out of their busy schedule to testify before the subcommittee and appreciate your understanding of flexibility given the series of votes that we need to participate and we do appreciate your time and your attention your you're being prepared for this and i want to thank you so much for your  participation as federal workers across all sectors have been involved in the response to the medical emergency is crucial that the proper protocols are in place to protect these workers the health of americans depends on a healthy federal workforce i hope our witnesses can give us insight into the current response to one n one epidemic and give and help us assess where we have succeeded and where we have failed as a result of the threats from sars and avian influenza former president george w bush issued the national strategy for pandemic influenza november first two thousand and five the strategy guides the nation's readiness and response to flu pandemics and has given directions to the federal state local governments and how to respond in the wake of the current h one  one flu outbreak a key part of the strategy quote is to sustain the infrastructure and mitigating impact to the economy and the functioning of society end quote to exactly what we're here to talk about today although cannot damage physical infrastructure such as roads and caroline's the way other catastrophic events might it can cripple an organization through impact on the organization's human resources and prevent it from completing its essential functions when that organization is the federal government the consequences can be dire planning for the protection of federal workers for from illness and also for continuity of operations should a large enough of employees get sick is essential a strong federal response to a pandemic is a key to mitigating the severity of the illness and loss of life and for the easing of potential devastating effects that an outbreak or a pandemic flu can have on our nation's economy personnel policies must reflect the twofold goal of keeping our federal workers healthy and there ensuring continuity of operations providing protective gear updating telework and others social distancing policies and implementing health information technology are valuable parts of the pandemic flu strategy these tools allow federal agencies to continue their important roles in responding to an emergency recently was brought to my attention the department of homeland security while issuing a written guidance to protect its employees is not in fact executing the guidelines on the front lines managers customs and border protection officers from wearing protective masks since our borders provide an opportunity to slow the spread of h one n one we must ensure the health of our first line defense the border patrol agents transportation safety administration officials and other law enforcement healthcare professionals disturbed by this contradictory message from department of homeland security i along with one thousand of my colleagues sent a letter to secretary janet napolitano demanding immediate rate balance that we must strike between protecting our front line employees and not causing mass public fear and alarm i hope our witnesses can provide some answers as we look into the effect of this epidemic is having in our federal workforce again i thank you for your participation and look forward to hearing from with thank  thank you and i recognize gentleman from virginia mr connelly for five minutes thank you mr chairman and i want to thank you for holding this important step to me hearing we must seize this opportunity to explore steps that we can take to protect the nation from this or future pandemics ninety years ago an influenza epidemic swept the world starting here in the united states killing approximately fifty million people today and has mobility means that other pandemics because fred even more quickly and more broadly federal state local governments have made significant investments emergency preparedness since september eleventh in my district fairfax county opened a state of the art emergency operations center regionally the metropolitan watching council governments whose emergency preparedness council i chaired until being elected to this job has coordinated cross jurisdictional emergency response plan with the goal of enhancing interoperability the state of virginia has pursued similar efforts while those efforts of positioned us to respond to emergencies more effectively with focus more on response to a variety of attacks perhaps then events such as a pandemic that's been the levels of government of a substantial investments in both physical infrastructure and personnel for emergency preparedness we must be able to identify efficient ways in which to ensure these existing facilities and that works can address both pandemics as well as terrorism in addition to preparing our response to such a pandemic we need to take all possible steps to reduce the likelihood that they can occur i'm concerned for example that the widespread use of antibiotics in factory farms could be creating super germs that would be resistant to medication we use in humans well we do not know if there's any link between the use of antibiotics in factory farms and the swine flu it is timely reminder that our stock of chairman as the hearing brief made apparent we need to take aggressive steps to protect our transit security employees from pandemics it's unconscionable the t s a our border patrol our customs employees are not permitted to wear respiratory masks well thank you it is the custom of this committee to swear witnesses for testimony would you please rise and raise your right hand would you repeat after me will do a brief introduction of the witnesses panel one mr thomas glass director technical support and emergency management occupational safety and health administration mr glass the director director of the division of respiratory disease study of the national institute for occupational safety and health and holds board certifications in internal medicine allergy and the knowledge of pulmonary diseases authored  more than sixty publications primarily in the area of lung immunology tuberculosis and occupational lung disease nancy was named associate director of the human resources policy division of the s office of personnel management and september two thousand and five in this position she leads the design development and implementation of innovative flexible merit based h r policies in two thousand and three was awarded the presidential rank award of distinguish executive for extraordinary accomplishments in the management of government programs ms elaine do was confirmed as the department of glass five minutes just as a general guideline that box in front of you will keep track of your time five minutes to summarize your written statement that has already been entered into the thank you for this opportunity to discuss the occupational safety and health administration's strategy for the protection of america's federal workers from the new strain of influenza a two thousand and nine h one n one virus before i testimony i want to express my gratitude for the many federal workers who have responded so quickly to the current outbreak it is clear that federal agencies must be prepared for public health emergencies so that the federal work places are not disrupted and the delivery of essential programs and services are not adversely affected the full range of osha's training education technical assistance and for spent in public or reach programs will be used to help protect federal workforce preparation is critical osha has been gauging efforts associated with the national strategy for pandemic influenza influenza which directs all federal departments and agencies to plan prepare for a possible influenza pandemic to support that effort osha has published two guidance documents to help all employers including federal employers better protect their employees and lessen the impact of a pandemic on society and the economy our guidance on preparing workplaces for an influenza pandemic includes and occupational risk pyramid for to pandemic influenza to help employers select for their employees appropriate administrative work practice and internet controls and personal protective equipment based on exposure risk associated with specific tasks osha's current outreach efforts are aimed primarily at high risk and very high risk workers those who have direct contact with infected individuals as part of their job responsibilities such as health care workers and first responders osha recognizes the importance of protecting health care workers like those working at the veterans affairs on whom this country were allied identify treat and care for individuals with the flu osha has issued a pandemic influenza preparedness and response guidance for health care workers and employers which provides valuable information and tools about the health care facility responsibilities during pandemic alert periods osha is also developing guidance for employers on how to determine the need to stockpile rest respirators and face masks along with facts sheets quick cards written in english and in spanish the agency's website w w w dot osha dot gov contains a comprehensive information dealing with a pandemic as well as a link to the federal website at w federal agency heads play a central role in protecting their employees safety and health the occupational safety and health administration has broad requirements for agency heads to establish and maintain comprehensive occupational safety programs as part of their programs qualified safety health inspectors must inspect and identify hazards in the workplace and investigate accidents and employee complaints based on findings from investigations agencies established engineering and work practice controls and where necessary provide respiratory protection and personal protective equipment as well as training on the use of respirators and how to get the respirator fit tested and to wear it properly when to wear personal protective equipment how to properly put on and take off personal protective equipment osha also performs inspections of federal agency workplaces and force of standards in a manner that is similar to the approach existing in  private sector but federal agencies are not penalize for noncompliance as part of the two thousand and nine age one n one outbreak has been fully engaged in federal court nation on issues related to work protections osha is providing technical assistance to our federal partners in general and agency specific issues related to the health and safety of their staffs i'm confident that the numerous exercises we have carried out in emergency planning at both federal and local levels since two thousand and one will pay off in our ability to work together in combat in this threat to the workplace mr chairman i would characterize the situation for the federal workforce just as the president has described it for the nation because for deep concern but not panic i'm very confident in the expertise of oceans medical scientific compliance assistants and forstmann personnel osha is prepared to address this threat and will protect our workforce i will keep you good afternoon chairman flange and ranking member chaffetz and other distinguished members of the subcommittee i'm dr david weissman director of the division of respiratory disease studies at the centers for disease control and prevention i genuinely appreciate this opportunity to speak to you today and update you on the current efforts that c d c is taking to respond to the two thousand and nine h one n one influenza outbreak providing frequent and informative communications about the outbreak is an important c d c priority is proud to be part of an aggressive response by c d c to understand the outbreak and to implement effective control measures it's important to note that our nation's current preparedness is the direct result of investments and support by congress for pandemic preparedness and the hard work of federal state and local officials all across the country the two thousand and nine one n one influenza virus is contagious and spreads from human to human it spreads in a similar way as seasonal influenza in that flu viruses are thought to spread mainly from person to person through coughing or sneezing by people with influenza sometimes people can get infected by touching something with flu viruses on it and then touching their mouth or nose or eyes surveillance has been ramped up around the country to try and get a better understanding of the magnitude of this outbreak and we're actively tracking the progression of this virus globally it's important that we continue to be vigilant we need to be prepared for a possible return of this virus to the u s in the fall c d c has and continues to develop specific recommendations for what individuals communities clinicians and other professionals can do everybody has a role to play in limiting this outbreak individuals can take actions rent respiratory infections frequent hand washing is something that we emphasize is an effective way to reduce transmission adults with flu like illness should stay at home and not go to work children with flu like illness should also stay home and not go to school or child care and if you're ill you shouldn't get on an airplane or any public transport to travel taking personal responsibility for these things will help reduce the spread of this new virus as well as other respiratory illnesses during public health emergencies like the current outbreak protecting workers including federal workers is a top priority like all of us workers can contract influenza through general community exposures and some workers especially health care workers and emergency responders  higher risk for infection because their jobs by definition bring them into repeated close contact with individuals who are ill with this virus these workers represent a particularly high priority for prevention a team effort to minimize the effects of the outbreak on workers by developing and disseminating guidance on precautions to prevent transmission of the illness in the workplace our guidance is informed by the hierarchy of controls used to reduce exposure including engineering controls like isolation ventilation and physical barriers administrative and work practice controls like social distancing and telecommuting hand hygiene and cough etiquette and personal protective equipment gloves glasses and respiratory protective devices as the outbreak evolved specific guidance on the appropriate use of these controls is guided by our evolving understanding of the outbreak and the level of evidence supporting the effectiveness of the various controls as part of the larger c d c response we fielded questions and provided assistance to other federal agencies responding to this influenza outbreak for example soon after the start of the outbreak the department of homeland security contacted us and we helped them develop infection control measures to protect their most at risk employees we've continued to be in communication with v h s as the outbreak has evolved we've also provided guidance to the u s postal service the department of defense and the u s general services administration to help them protect their employees from the virus as we learn more c d c will evaluate its guidance and update it as appropriate and we'll continue to work with other federal agencies to provide the best and most current possible guidance for federal workers in closing we're working hard to understand and control this outbreak and to keep the public and the congress fully informed about the situation and our response we're working in close collaboration with our federal partners including our sister h h s agencies and other federal departments even if this outbreak proves to be less serious than we might have initially feared we must anticipate the possibility of a subsequent or follow on outbreak several months down the road while we must remain vigilant it's important to note that in no time in our nation's history have we been more prepared to face this kind of challenge we look forward to working closely with you to address this evolving situation as we face the challenges in the weeks and months ahead thanks again for the opportunity to testify before you and i'll be happy to answer any questions that you have thank you shaq welcome you chairman lynch ranking member and members of the subcommittee thank you for including the office of personnel management in your discussion of this important topic i would like to share with you our efforts to ensure the federal government is prepared to meet their human resources management challenges posed by the recent h one n one flu outbreak as well as any future pandemic health crisis are essential function in this regard is to provide critical human resources services to ensure the federal government has the civilian workforce it needs to continue essential missions in an emergency these include emergency staffing authorities leave flexibilities evacuation payments telework and flexible working arrangements we are continuously preparing for an influenza pandemic by developing and updating comprehensive human resources guidance and conducting briefings for federal human resource specialists as well as town hall meetings for employees and numerous federal agencies it is not possible to overstate my concern and that of o p m director john berry that we do everything necessary to protect the wellbeing of all federal employees however we had o p m do not have the expertise to make judgments about the and appropriateness of certain men afic a sions and protective devices to front line workers therefore we have tried to keep federal agencies apprised of the latest expert advice on these issues for example at the h one n one human resources readiness forum we hosted last friday we made available representatives of the c d c osha and the federal occupation health service and the department of health and human services to answer questions about personal protective measures the form focus on pandemic influenza readiness for human resources directors federal employee union leaders and other interested parties o p m and other panelists answer the questions that way most heavily on the minds of managers and employees when they think about how a pandemic health crisis will affect them one tool that can be extremely useful in coping with a pandemic health crisis is telework it can help mitigate the spread of influenza by promoting social distancing while allowing the critical work of the nation to continue o p m director john berry recently announced a new initiative that we hope will help agencies ramp up their telework readiness this initiative is driven not only by director barry's belief in the value will work life programs generally but more specifically in the importance of tel work as a tool for emergency planning under the director's telework initiative we will convene and advisory group of telework program managers to formulate standards for agency telework policy which we have asked agencies to submit to o p m for our review each agency has been asked to appoint a telework managing officer and to ensure their existing appeals process is transparent to employees finally we will work with congress to assure the provision of highly high quality broadly accessible telework training that will provide the baseline everyone needs to achieve success with implementation and of this initiative we believe we will see not only an improvement in the consistency and quality of telework policies but also an increase in participation and tele work employees who work telework regularly and effectively under normal circumstances are well positioned to continue to work from home during any type of emergency our pandemic planning provides that employees who are not currently teleworking certainly may be able to tel during an emergency however experience teleworkers have the necessary equipment commuter connectivity and practice working from remote location that will enable them to continue critical work during an emergency the current outbreak reminds us we must always be prepared to take care of our employees while continuing to meet the needs of the nation federal agencies need to ensure their pandemic plans are up to date they should make sure they have t agreements with as many telework eligible employees as possible and should test employees eligibility to access agency networks from home as well as their procedures for communicating with employees who are teleworking o p m stan ready to provide guidance and support thank you for inviting me here today and i'd be happy to respond to any question thank you secretary do thank you good afternoon  chairman and members of the committee thank you for your op the opportunity to come before you this afternoon and discuss how the department of homeland security is preparing and protecting its employees in response to the two thousand and nine h one  still forming our critical mission this may mean that some employees need to wear personal protective equipment some employees may need to telecommute others may need to stay home if they have illness in their family or if their child's schools close committed to working with a component heads throughout the department and across the federal government to provide our employees with the safest possible working environment our workforce of safety and security is always a top priority it's important to know that we are making all of our decisions based on the science and epidemiology as recommended by the centers for disease control and prevention the workplace guidance from the departments of health and human services the department of labor occupation office the public health community and the world health organization planning for a pandemic has been ongoing for several years in fiscal year two thousand and six the department able to build the basis of its pandemic program  began purchasing personal protective equipment for use by mission essential employees currently personal protection equipment is pre positioned at fifty three d h us locations and field offices nationwide the department has also stockpiled two types of antro viral s trademarks tamiflu and relenza dedicated for d h us workforce protection us has on hand approximately five hundred forty thousand courses of anti virals targeted for its mission essential workforce guidance on the use of that and child has recently been published another element of planning the work was done in two thousand and six through several planning documents including the da just pandemic influenza contingency plan publishing screening protocols for pandemic influenza in the air and maritime environments draft a federal interagency pandemic influenza strategic plan and the national strategy for  taishan plan and we have exercised these plans in october two thousand and eight v h s conducted interdepartmental pandemic influenza tabletop exercise the purpose of the workshop was to facilitate in de discussions and highlight potential actions addressed in departmental work force protection during the pandemic influenza that all the h s components were represented along with thirteen other federal departments and agencies with a total of  supplant effective communication in any disaster is critical and a severe pandemic where there would be nationwide consequences is no exception d h s has made communication from secretary through the rest of leadership and through the components a top priority guidance was issued by headquarters officials and components advising our employees to follow procedures and recommendations of the c d c and we have consulted with department of labor office regarding workforce protection training has also been crucial for preparing d h us workforce in the event of a pandemic the office of health affairs with india just develop pandemic awareness training and this is on d v d and available decomp components additionally some components such as ice immigrations and customs enforcement have further developed training the department is taking several steps to ensure continued responsiveness to the components request and to ensure health and safety of our d h us workforce moving forward one of our goals is to provide uniform occupational health services across the department in order to ensure operational components can deliver post exposure prophylaxis and treatment of employees more effectively in the future in addition we hope to strengthen our internal medical oversight capacity ensuring th us full units utilizes the capabilities of our medical personnel and health affairs as well as our emergency services medical personnel finally our health affairs office has been developing a more formal macro not mechanism for providing medical advice to the component in conclusion d h s remains dedicated to protecting the health and safety of our workforce in the event of a pandemic and during this recent h one n one outbreak i will continue to work closely with secretary napolitano and our component head in response to the needs of the d h s s employees throughout this outbreak and in the future as i said our work for safety and security is a top priority thank you for helping this hearing and look forward to your question thank you often the c begin by saying thank you to all of you for your willingness to appear before the committee let me let me try to sort of collapse the issue because the scope of proper s who are responsible for protecting our country and our security in their own way as well as i believe we have forty thousand customs and border patrol officers just to give you a a concerted effort to deny the employee the right to have a mask and ninety five masks to be to be more specific but  protective masks now these folks as i say have high contact i got a lot of feedback from my folks on the mexican border and i have to have some empathy for their position if you look at the numbers of h one n one cases in the border states of of texas arizona and california those  mask guidance is that when an officer specifically know auspex that an individual has swine flu or is ill then they're supposed to put on the mask  if they're within six feet of that person the problem here as you probably can guess is that there's a seven day number one number two you've got to get close enough to these folks to do person is ill and so that guidance on mandatory mask wearing is virtually useless to someone on the ground doing this work and a s we followed the medical evidence given to us by the c d c review of one and one virus and based on the medical evidence we determined that there was apart from that apart from that determination that a person doesn't have the right mask there is no there was not medical indication that it would be appropriate to wear the mask in the workplace based on the   you don't think this is a high risk situation when you have these folks screening you know hundreds if not thousands of travelers coming in from in this case mexico where we had a workplace there has to be a high probably a reasonable probability that the employees are going to encounter the sickness sickness in their life line of duty and based on the medical evidence i know i've said that before but i have to keep that going back to we consulted with the experts and it did not seem appropriate wearing masks is not a neutral physical condition and there are risks with that with certain populations and wearing the maybe thousands of people i hate to be the thousand personnel line after this person has as already you know wanted and checked a thousand people coming through from mexico and this whole volume of people is continually coming through and this person is not allowed to disinfect from one you know one shift to another and you know that that that troubles me greatly my understanding is that a did change protocols on the cleansing of bins but i will check into that mr chairman i'm going to let mr conley say a few things we're going to come back to this again look i'm not satisfied with your answer i'm not satisfied with the policy the h s was adopted by their employees i think the decision should be made on the ground and your guidance's have been totally non responsive to  this situation of voluntary use of masks where these individuals feel they need to and i'm receiving nothing here you're going to continue to revaluate absolutely that's not good enough that's not good enough we'll legislate if that's what i gotta do to get the permission for my federal workers to wear masks on the mexican border in the middle of an epidemic a pandemic or the threat of one if i get to legislate that they have the right to wear masks to protect themselves and their families and their communities that's what will do but i shouldn't have to do that i shouldn't have to blow up the bureaucracy just to get something done this is a simple issue this is a really simple issue protect these workers they're protecting us they're screening thousands of people coming in if they're infected what about the exposure of those other passengers what about the exposure of the families what about the exposure to kids what about the exposure to the towns in which they live you know and you look at the numbers in texas arizona and california and like i say the four times the national average it's not an immigration thing it's and you're saying that you're following the medical evidence this is common sense this is common sense it's not you know in my prior job i used to have to wear respirators a while though it's not a comfortable thing it's not something someone is going to leap to do if they feel it's necessary they will they will put the mask on it's hot it's stuffy it's not something that people enjoy doing so there's almost a inclination that people won't wear them but when these workers feel that they are at risk and they need that protection well we ought to provide that we're supposed to be an example the power of example the federal government as an employer these are these are very brave people these are good people these are hard workers and you know we  should be taking care of them the way that they're taking care of the american people and i don't think that's being done right now i really don't and i think this bureaucracy this back and forth about agency they said this forget that stuff but just get it done let's get these masks to the employees but then use it when they deem it necessary let them protect themselves and let's move on actually is whatever time you make my five minutes while you are gone i'll be brief and my apologies for missing the first portion had a similar hearing next door and i appreciate your understanding of my questions are there for you because i concur with the the chairman here on this this is not acceptable you said in your testimony that safety is your top priority do you believe that the actions of the department of homeland security are consistent with ultimately touching or coming in contact and all of that i just find it absolutely astronomical or just unacceptable that our federal workers were not allowed if they so choose to dawn things that would protect them from the very  safety as its top priority i find nothing in the evidence to suggest that this was the right move if that written the written policies needed just meant i would hope that you would return to this committee and that the homeland security would return to this committee and demonstrate that truly safety is a top priority because i see nothing that would exemplify that i think is also something we should note in terms of culturally you know i've spent quite a bit of time in my career in asia it's  commonplace if you have a have a cold or you're somewhat sick you wear a mask and nobody thinks a second of it may be a westerner who's been there for the first time or first time i saw but people become very accustomed to it i find a great discrepancy between your insistence that safety is the top priority and that what we went through and are going through at the border and with our t s a employees and a host of other federal workers who go through this i just find what sort of what sort of drills or what sort of training or what sort of preparation is there that that actually happens for these types of things and specifically as relates to the whole telecommuting because we could have very quickly had to get into a scenario as it relates t and we've done town hall suggesting this i know o p m has run several drills where we have a good segment of our workforce and those are not people who normally work but we have sent them home to  hundred i'm sorry yes i think i think one thing that we're learning is that you have to practice and then practice and then practice because your connectivity changes you know you do it do it in six months they all wear the masks voluntarily border patrol so those agents those border patrol agents under the instruction of your managers you monday my assigned duties include processing inbound passengers and i regularly come into contact with members of the traveling public arriving from mexico and those contacts require contact within six feet of those individuals he goes on to say that on monday april twenty seventh this is right around the time that this became a very apparent that he was the twenty second so this is five days into the the crisis i was scheduled to work primary inspection  from nine thirty to five thirty after i set up on the blue dye began processing passengers i put on my protective gloves in the ninety five mask i have this is what ninety five mass not not city block the aisles passengers could approach the other supervisor mr campbell block the blue door behind them i was processing a passenger at the time and she interrupted the inspection ordered me to remove the mask  take the mask off now you are not authorized to wear mask he goes on to say i finish the processing of the passenger and remove the nitrile gloves used hand sanitizer to clean his hands and then remove the n ninety five mask he said after i move the mask because i was told me not to wear a mask while processing passengers he told me that the only time i could wear a mask was if the person standing in front of me was showing obvious signs of a flow as had been explained in a muster briefing other customs and border patrol officers for that mask i was encountering individuals who were coming in from mexico city and other cities in central mexico with a flying swine flu was prevalent i also had a cold at the time and i was thought i was especially vulnerable to getting another  i was also concerned about exposing other members of my family at approximately nine thirty while wearing an n ninety five respirator mask while working i was approached by chief who instructed me to remove my mask i explained to him that i had taken the training for the rest  that and it's and it's all around the country so it's not an isolated case what i would say to that is that during the first round of h one n one we did consistent with with ocean and i'm going to explain allow decisions to be made by individual supervisors based on their susman of risk what we heard back from the employees is that created at least a perception at least a perception of inconsistency with when you mentioned some people were wearing masks so the inconsistency so what we're looking at right now is should that practice continue should be individual sites the first line supervisor discretion minutes i was in local government long enough to know when i hear somebody words it's not an official policy of the department but it was an open opportunity for local supervisors to deny the employee free choice to wear this or not is that a fair explanation of your there's no policy department policy against that i guess i am not sure by free choice i mean the the employer has to manage the workplace and determine if it's record point out that unlike the airports people do not cross into united states specifically to get free medical care but one of the realities of the federal mandate a free medical care in this country is that people that are outside the country that want to receive free medical care from terror just have to get in their car and drive across the border and present themselves with their illness and one of the issues that have not been discussed i exposure of our men and women at the port of entry because of the attractive nuisance of situation actually encouraging people to come into the united states who are showing symptoms because they can get treated for free in in to an airport and i want to make that clear so that we understand what kind of situations are along the border now the issue of the primary and secondary where the secondary people allowed to wear masks at a time that the primary was the   cabaret licenses and government my question to you the procedure that somebody in primary atalanta entry have you wear or of the procedure that they would go anybody want to talk about that with a six foot to me sounds absolutely absurd as somebody who grew up crossing the border the primary inspector is add a window he asked specifically makes contact with the driver then proceed to make contact with every member in that vehicle which usually means placing his his or her head into the vehicle to be able to hold that conversation to you and discuss the six foot four primary is absolutely absurd we're talking face to face the  discussions going on and then for a six foot issue to come up is that you have any explanation of how anyone in primary could operate their duty and still maintain a six  foot barrier between them and the individuals making contact with i believe most private screening would be within sixty atalanta what is the department doing today and i apologize for being here late but i had another hearing the bouncing back and forth what are we done today to make it clear for how's the policy been changed to allow the men and women that are on the front line to make this determination themselves guidance does not warrant the use of respirators and ninety five even in the conditions that we're discussing here so the medium risk which is it within the general public recurring for a long the time does not warrant the use of supervisor you know let me just be very frank about this i have seen the public relations game played along the border for thirty years this certainly looks to me more like a p r concern that a public health concern and i operated a public health department for three million people for ten years and there's no way in a whirl i could have asked my county or city employees not to be given they have the ability to make that call i mean there is that issue of free choice when it comes here for your health this is one that i just think this goes way over and i and man i'm sorry i know you're busy having to carry quite a burden walk in this room but frankly i think this is an indictment on the system that they worry about perceptions more than allowing people to make that choice themselves to protect their health and i just think that it is going to be one that's not going to be let up until it's corrected thank you very much the same in the next breath you've got all your customs border patrol agents all wearing them voluntarily so you're not relying on c d c because all those folks can wear the masks but you get fifty thousand of those that can't wear the masks and you've got whatever medical evidence you've but you've made two different decisions where there really isn't a distinction between the jobs being done by those those those officers so you're not relying on c d c i know you're trying to shift the responsibility to them but you've already taken it upon yourself to make a dual policy between border agents and and t s a and you know customs folks so and  of flu you know as long as people do you know not only respiratory protection but the whole range of protections you know what's really important so let's not lose track of the fact that people need to do the range of done to do it within the context of an educational program to make clear that if people use those devices that they should also follow the other you know protections you know the other things that we've talked about again hand washing distancing to the possible to the extent possible barriers and also understanding you know the strengths and limitations of the devices so so that was our that's the one anecdote i can give you of where that really i just received a message from the chairman i gather he's going to be quite some time so he wanted to let you all know that he will dismiss the first panel and will have questions for the record could we could we have a second to try to accommodate all the witnesses and i know some members on our first panel had other engagements that i had let us know of in advance we decided that we would continue any questions with that panel in writing and the responses would be return as is the custom here at this subcommittee we usually swear witnesses so i ask both witnesses to rise and raise your right hand swear that the testimony you will give before the subcommittee is the truth the whole truth and nothing but the truth let the record reflect that both witnesses have answered in the affirmative border patrol agents and whose parent organization is the american federation of government employees he has been a border patrol agent and san diego california area since one nine hundred seventy eight where he is a strong advocate for secure borders and fair treatment of the dedicated men and women who patrol them most calling kelly is the national president of the national treasury employees union and which is the nation's largest independent federal sector union representing employees  thirty one separate government agencies a former i r s revenue agent ms kelly was first elected to the union's top post in august one thousand nine hundred four year term as national executive vice president welcome to both of you and i appreciate your forbearance and your patience mr barr you now have five minutes for an opening statement thank you thank you chairman lynch protecting our federal workforce is pretty much a no brainer it's in everyone's interest not just as a favor to the employees but any sensible manager needs that workforce there despite the advances we've made in automation a few baby steps and telework many of the tasks performed by federal employees have to be done with face to face contact with the public law enforcement first responders health care primarily the american federation of government employees represents many of these employees in the department of homeland security veterans affairs social security bureau of prisons and other federal agencies that the american public relies upon and it makes absolutely no sense to have those employees unnecessarily taken out of the equation by having their health and jeopardized by predictable events and let me be clear we're not just talking about the recent swine flu outbreak we had the sars outbreak in april of two thousand and three and yet here we are more than six years later and it appears that the lessons have not been learned our agents at the border be they border patrol agents c b p officers and the t s o s come in contact with people from countries all over the world some of whom and i'm not saying by any means the majority but some of whom are carrying communicable diseases these officers and agents should be allowed to take reasonable precautions in order to safeguard their howl while there was refreshing to hear the under secretary for management for d h s be up front about the department's policies those policies are quite frankly appalling and admission that supervisors with no medical experience whatsoever are given the full rein to decide whether employees can protect themselves there are two things that our government should be doing for employees it should be providing them with the protective equipment that they need and facilitating their use of that equipment border patrol agents are provided with soft body armor to protect themselves against armed assailants listening to the undersecretary for management and the inane policy that she was articulating brought to mind a policy what a policy would look like for border patrol agents if they were told you can don your body armor when the bullets start flying when you're within range of someone and they sneeze on you it's too late at that point you don't don the mask you've already been infected these employees should be allowed to wear the mask when they feel the need for that mask i am i suppose equally mystified and appalled as you sir when i hear these alibis for why they're not doing the right thing for their employees this is something that's a no brainer you can go to and one of the excuses that i've heard is well our employees haven't been trained properly they haven't filled out the medical questionnaire and they haven't been fit tested you can go down to the corner the corner hardware store and buy and ninety five respirator millions of americans do it every year they don't have to fill out a medical questionnaire they don't get fit testing it's kind of common sense it reminds me very much of the little warnings that they put on firearms warning this could be dangerous well yeah if you experience a lightheadedness after you put this on even though you haven't been trained then common sense tells you maybe i should take this off we give these folks at the border arrest authority we give them guns to defend themselves and empower them to use deadly force if necessary and yet we can't trust them to make common sense judgments about their own health  before i close my statement i would like to introduce into the record some of the examples at the airports with the t s o s of how different this policy has been administered i would say i'm just at that without objection you can you can answer that for the record as a border patrol agent i can happily report that up until this point they have not prohibited our agents from wearing respirators and other personal protective equipment but i am very well aware of other instances within customs and border protection officers who are part of the same bureau within the department of homeland security in the in those situations where in fact they encounter more people than we do every day coming in from mexico and i would just say as an aside that when someone transiting from mexico where probably during the height of the outbreak twenty five thirty three  percent of the people were wearing some type of facial protection they must've thought that they hit the twilight zone when they hit the us mexico border and didn't see any of the people inspecting them wearing any type of equipment this is unacceptable and it needs to change and i appreciate your hearing to make inroads in that direction thank you very much thank you mr president kelly thank you very much chairman lynch thank you for holding this hearing today and for inviting me to testify on behalf of the thousands of employees represented by empty who work every day to protect our country from threats and who have continued to do their critical work diligently during the current swine flu outbreak the n u represented employees most affected by the current spread of the h one n one influenza work for the department of homeland security as we've been discussing our customs and border protection officers and agricultural specialists work at the land at the sea and at the airports of entry across the country and our transportation security officers work at airports you have clearly articulated the work that they do and the number of travelers that they interact with every day doing their jobs and why the six foot rule that we've heard about does not work many of these employees work on the us mexico land border many also process international flights from mexico once the origin in the breath of the swine flu became clear these employees in particular were concerned about protecting their health and that of their families that is certainly reasonable the u s government had advised against unnecessary travel to mexico and all of the first cases of h one n one flu in the u s involve people who had recently traveled from mexico and unless they came into the u s illegally they must have passed through a port of entry staffed by these employees those who work on the land border saw their mexican counterparts often just steps away wearing masks as they perform their duties some of these employees one of the option of wearing a protective mask or respirator but c b p and t s a have prohibited the wearing of masks unless an employee is in close contact with an ill traveler under that circumstance a mask is required to be worn now as soon as questions began coming into n t e u from our members across the country as to whether or not they could wear respirators or masks n t e u began trying to find out what the current policy was we contacted c b p we contacted t s a and we contacted homeland security and we got no answers during this time a da just spokes person was quoted in the press has saying quote the department of homeland security has not issued an order saying our employees cannot wear masks and the c b p spokes person was quoted saying quote c b p officers and border patrol agents are provided personal protection gear which they may utilize at their discretion but c b p and t s a were both clearly enforcing a prohibition without exception across the board this was not on a manager by manager basis it was clearly  a from the head of c b s or the head of homeland security some statements from v h s that appeared in the press indicated that managers who were preventing the wearing of the masks were misinformed about the actual policy the idea that a few managers were misinformed is clearly not accurate and heard from many many employees from around the country and as you already noted attached to my written testimony or affidavits from some of them relating instances of supervisors demanding that they remove their masks some of them are disturbingly threatening and some include comments indicating that the reason for the prohibition was fear of alarming the public the affidavits also confirm that the policy has not been disseminated in writing and that employees requests for written guidance on the issue have been denied i trust that this committee will ensure that the employees who provided these affidavits will be free from any negative impact within the department or the bureau and their jobs after researching possible scientific or medical reasons for prohibiting the optional wear of masks at c b p and p s a n t u is convinced that the reasons are not based on science or medicine but on public relations in our view avoiding unnecessarily alarming the public is not without merit however it is one factor that must be weighed against the potential health risks to employees their families and others it is difficult to weigh the competing factors when there is a refusal to even acknowledge them the first person to die in the u s from swine flu was a toddler the second was a pregnant woman both had traveled from mexico to the us some of our members working on the mexican border are parents of young children some may be pregnant or have a pregnant spouse some may live with family members who are particularly vulnerable does the risk of possibly alarming the public carry more weight than the unnecessary possible exposure to the swine flu of individuals in the to my knowledge and members at ports of entry have followed the directives of their local managers and they have worked diligently through this swine flu outbreak even if they have requested and been denied the ability to wear protective masks for reasons of great concern to themselves and their families these employees deserve better they deserve to know what the policies are they deserve to know who is responsible for making those policies they deserve to the reasons for the policy they deserve to have the opportunity to provide information to the policy makers and in this instance they need the policy to be changed to reflect a rational balance that gives more weight to the importance of their ability to protect their health than to the potential for public alarm i thank you very much for holding this hearing and for your views on this issue which you have made very clear throughout the day and i look forward to any questions that you might have for me thank you thank you both  guess i remember when i first started to travel internationally the first time i saw security officers with heavy weaponry it might have been might have been we hadn't had it here in the united states and it was a little bit of a surprise but now you see it everywhere and it's become the norm and i think that if you travel in now the folks wearing those  gave their own discretion to wear a mask but other employees were not that you work in conjunction with or in the same area with can you identify any reason that might be the case or only time you encounter us along the immediate border is if you're trying to enter the country illegally we do operate traffic checkpoints on certain highways not a large number of agents engaged in that activity but even in those areas we have not heard reports of agents being prohibited from wearing it but obviously it's a different universe of people that you're encountering for example if you're up in oceanside california most of the people that you encounter have not crossed the border so you're not it's a different threat level so most agents don't feel the need what are your own thoughts on undertaking these changes legislatively instead of i know you're a collective bargaining agent for a lot of these employees each of you talk to me about you know would be glad to work with the committee on whatever it is that would require i do have to say that i think it's very disappointing if it has to come to that when the first day that this became an issue that i became aware of this as an issue i really believed it was just a misunderstanding or a miscommunication and that if i made a call that of course they would make it clear that employees could wear the mask at their discretion i think that's what i thought i thought this was going to be an easy one that was on day one and then you know i started getting the finger pointing well we're waiting for this one to do this and that and can you give us a little time and by the fourth day i was getting a little impatient and then i started talking to everybody that everybody was pointing the fingers at in the hopes that someone would just step up and do the right thing and here we are i guess about eighteen days later and no one has stepped up yet to do the right thing and no one has even been willing to be up front about why they say on the one hand even when i listen to the testimony of the earlier panel said first and i wrote this down first she said and i believe i heard this right first she said the voluntary wearing of masks was not warranted and that that was secretary napolitano decision then later she said there was no department level prohibition against wearing the mask well that's a little different and then the third one i heard was that individual supervisors were allowed to make the decisions which is i wrote some notes here that i won't repeat to you about my thoughts about it but i know that that's absolutely false because i have talked to our members at airports across the country and t ports of entry across the country including the southwest border and anywhere that i mexico comes in and there was one very clear directive given and that was no masks to be worn they were told that in masters no one would put it in writing and no one will take responsibility for it so i think it would be a shame if it has to be legislated that someone would not just step up and do the right thing but if that's what it takes and to you will be glad to work with you to help make that happen in avoid this in the future so  cannot believe that employees would ever be put in this position again and from what everyone says this will happen again whether it's in the fall or in two years or five years and we should not have to ever be having this conversation again  i think we may be at that point after the sars epidemic six years ago agencies were directed to come out with assessments and guidance c b p came out with an assessment estimating that forty to fifty percent of its workforce would be taken out of service due to a pandemic with the proper medical response i would say that nearly all of the work force would be taken out of the equation with nonsensical procedures in place waiting until it's too late and one of the disturbing parts of that guidance that draft guidance was call for greater flexibility to discipline people for taking sick leave when they were affected by that it was just mind numbing to see their spin on or their take on how to deal with this rather than protecting the employees and ensuring that they did not get sick when they were sick i mean that one of the worst things that you can do is show up sick because then you're going to infect your coworkers work with us you've already raised a number of points the sick leave i understand from the testimony that i received directly from the committee there were some workers compensation issues  drafting such legislation moving it along i appreciate all the work you've done both of you in representing your employees and the people that are on the on the ground doing this i got a lot of evidence and from your folks and from you well and i think you've got a good perspective of things on the ground so we would we would welcome your involvement in drafting the legislation going forward because think about this it doesn't mean that the next train won't be lethal and what happened then if if we had the same nonsensical policy in place and folks started dropping out of their their know my family is very much involved in the post office and i remember when they had the anthrax attacks on the post office and my sisters both had young children at the time were worried about should i go into work because you know if i get some of the stuff in my clothes i'll come back and affect the kids it's the same dynamic it takes a certain amount of courage out of this and especially  employees who exercise judgment every minute that they are on the job so why not respect and let them make the judgment as to whether or not they think that they should wear a mask you know we have no idea how many who doesn't care they can put out all the statements they want about caring about employees but actions really speak louder than words especially on issues like this absolutely i mean this is a this is a perfect illustration i think  and appears to be a real shortage of common sense within this bureaucracy it appears that the legislature is going to have to step in and force that i know that the the greater public good the greater public good is not well served if the employees who are responsible for protecting us transmission as mission agents for deadly diseases spreading and not just to their own family but well beyond within their own communities and facilitating a pandemic event so thank you very much once  drafting this legislation so you can work with our god thank you very much for your willingness to testify a sorry about the long wait but we really do appreciate your testimony here today if we could possibly have the panel final pa give the subcommittee is the truth the whole truth and nothing but the truth let the record show that both of the witnesses have answered in the affirmative i'll offer a brief introduction of our witnesses and then each will be allowed to present an opening statement of about five minutes in length dr thomas f all brian has been a consultant and infectious diseases for over twenty years and a medical director of the microbiology laboratory at brigham and women's hospital he also serves as an associate professor of medicine at the harvard medical school co director of the world health organization collaborating center for the surveillance of anti m resistance and vice president of the alliance for the prudent use of antibiotics dr jeffrey levy is the executive director of trust for america's health where he leads the organizations advocacy efforts on behalf of a modernized public health system dr levy is also an associate professor at the george washington university department of health policy where his research has focused on yes thank you very much chairman lynch and subcommittee members for the opportunity to testify on behalf of the alliance for the prudent use of antibiotics concerning how best to protect frontline workers and the health organization with the mission of strengthening society's defenses against infectious diseases by appropriating by promoting appropriate use of antibiotics and by controlling any micro resistance and i think about it i was pleased to hear that in the discussion of this mr connelly brought up the issue of agricultural use of antibiotics which is one of the things we've tried to restrain as part of the general effort to keep strains of bacteria viruses from becoming resistance resistant based in boston the a p a has affiliated chapters in over sixty countries and it is the world's largest network that's totally dedicated to education and research concerning and about it resistance with the goal of of preserving these lifesaving drugs that plays into the that particular interest plays themselves which is a concern moving forward but another one that has to be kept in mind is that should there be very severe into ones outbreak with cases of viral a lot of cases of viral pneumonia in the past there's evidence that the mortality of these illnesses has been greatly magnified by super imposed bacterial infections  as well would mean that the resources the drugs available to treat such pneumonias would be diminished if antibiotic resistance increases to the point where as in some past years with stuff like oxide there have been virtually no drugs left for that treatment so this is a particular concern of ours that relates not hopefully not to the influence we've had or even to the coming into lenses but is a potential threat added threat to a to a severe influenza influenza outbreak and i might say that one of the problems about firelit influenza just thing about the discussion we've been hearing and i think it plays into some of these questions of how we respond to one of the one of the problems is that of all the contagious illnesses there is none that is wild caught or is unpredictable as viral influenza most other things most of the other major infections there is a way to project forward what will happen with influenza virus that is as i think has been demonstrated over and over again is is very hard to do so that that creates a level of uncertainty that we don't encounter with our with the other diseases i would say that we've been impressed and by the good work that's been done by health public health agencies both up both national and state public health agencies in recent years in building up infrastructure to deal with these problems and to deal with the input with the lack of predictability and i think again in their response has become much more sophisticated and i think the congressional support they have had in getting better funded and better funding for their programs i've helped enormously in this in putting us way ahead it's helped also or will help i think the general support for biomedical education that that the congress has been very good at in recent and and in the new disciplines that are coming in i would be willing to predict that going forward another ten years the viral influenza which will still be with us with the new threats will be much more predictable we will be able to pick up earlier new strains we'll be able to get a sense of which way they're going and how to get i think with our ability by this broad biomedical research will enhance our ability to get out ahead of them sooner and to have a proper response to norm a fact seems faster and perhaps make better drugs and deploy them faster so i think a lot with all of this we don't want to i would like to point out how much infrastructure has been built both in public health and basic bio research to give us a better control of all these issues going forward and as you can imagine even the issues that have been discussed here better predictability would help a lot on the  just on the subject and just occurred to me that on the subject has been discussed here about about the workers protection and the voluntary masks and so on it's not my feel but just one thing that occurred to me that  that in mind that in a impending epidemic it's important to put some restraint on panic not to not to allow people to be overly panicked because that diffuses resources and complicates everything and that may have been an element of that as i say an element in there somehow they got into the idea of mask wearing and i'm i'm just occurs to me that there might be a way to deal with that in the sense that it is a public relations issue as you point out it is a cultural issue with the understanding of what a mask wearing is and it could be distinct metabolized by careful public health but careful it is with the media would be fairly easy to get the word out that masks are precautionary are conditional provisional and that people  encountering mask wearing people doesn't mean that something terrible is about to happen it's just it's just a cultural response to a problem that people can adjust to and as you point out we've adjusted culturally to seeing and seeing the guides in airport security and i think in other cultures asia as as the as the  ranking member pointed out in asia mask wearing does not trigger would not be seen as a trigger of public concern because it's it's kind of random and haphazard and people do it anyway and it just occurred to me that maybe that's a small element that could be introduced this that might and if if it were true that some of the public health concerns were that that that might be minimized by paying attention a little too hearing i want to depart a little bit from my prepared remarks just to address some of the specific questions around public health guidance around mask wearing i think it's really important in the context of a public health emergency for all agencies of the federal government including the department of homeland security to consistently and clearly follow c d c and osha guidelines for their employees both because it's the right thing to do and because it's a model for other employers it's unfortunate that because of all the voting that there wasn't an opportunity for the c d c i think to explain in more detail the rationale and the science behind their guidelines which as i understand it do not currently called for the group to you know routine use of and ninety five respirators and so it's not clear that the department of homeland security was violating what is current public health guidance and i think there are operating there are opportunities in this situation to pass legislation that could better protect federal workers and actually all workers but i think we need to take care in drafting such legislation so that the policy that is legislated is both based on the science and flexible enough so that we don't box ourselves in as the science evolves our understanding for example of what  appropriate precautions in the context of an influenza epidemic has been changing over time in part because of the investment in research that has been occurring over the last several years it would be unfortunate if we mandated certain types of approaches to disease control and legislation that that may be outstripped by improvements in our understanding and the science so i hope that we can find a balance here between making sure we're doing everything we can to protect workers with out substituting i think for you know or or restricting ourselves to current understanding of the science as science may be evolving and i think that to me brings me to a series of questions that we posed in our testimony today that addresses broader questions including but beyond the use of and ninety five masks and i'd like to just very briefly put some of those questions on the table the first and probably most basic is have the federal agencies updated and reviewed their continent their strategic plan the implement their implementation strategies associated with the national strategic plan the current office of personnel management guidelines which covers the entire federal government including the h s has not been updated since two thousand and six and a lot has happened since two thousand and six in terms of the guidance that c d c has put out that osha has put out and those should be incorporated into the o p m policies and in fact you know it's not just the d h s s workers we need to be concerned about there's a wide range of federal employees who are consistently at risk including those who are working in health care facilities or at the greatest risk we need to make sure are being protected for critical employees i think that we clearly need to know in addition to the issue of the ninety five masks what other workplace changes can be made to promote social distancing but also we need to think about the c d c recommendations around stockpiling of anti  recommends not just that agencies that employers stockpile anti virals for treatment but also for profile access so employees who are going to be retuned routinely exposed to the virus which could individual agencies have not done that yet except in some rare occasions and the strategic national stockpile has no courses in its supply for that kind of profile access so that would be an opportunity to address legislatively or through the appropriations process similarly if we move towards war abroad or use of mass whether it's an ninety five or a face mask again have agency stockpiled that if the there is a whole there's a tremendous production capacity problem and if we are going to move towards use of these and there may be a point in the context of a pandemic where we would want workers to routinely wear and ninety five masks or surgical masks we don't have enough in the stockpile to make that happen so the guidelines w be meaningless if the federal government hasn't taken steps to make sure we have those things available i think the last point that i would want to make is broadly speaking around sick leave for health care workers and i would say health care workers means people who are working in v a in the ody hospitals and prison hospitals or investigators working for c d c but also those people whom we asked to volunteer in the context of a pandemic and the various medical and volunteer corps who come forward we need to make sure that we're providing them with adequate protection and that when people do become sick in the context of their work because they placed themselves at risk that they are not using up their sick leave but th federal government is making sure that they are continue to be paid and in fact the co pay it's associated with their care and through their federal insurance will also be covered that's a broader issue around sick leave in terms of even following c guidelines to stay home if someone in your household is sick we need a lot of flexibility from o p m we need to broadly from other federal employers as well as employees from other employees in the private sector as well those are areas that i think could together become a comprehensive package that would make i think very useful legislation in assuring in a broad sense where protecting federal workers in the context of a pandemic or of some other kind of of that in in testimony quite a bit in fact but it seems despite their analysis there was a decision by the found almost security to allow some employees which was very difficult to explain and i think from a public health standpoint the most important thing to do in a crisis like this is to be consistent yeah and so either be very consistent in hearing to the c d c guidelines or if you're changing it then change it that clear i mean i think just for lots of reasons that have nothing to do with fluid workers want to wear gloves or certainly having hand sanitizer available is certainly something very prudent under any circumstances these folks are also being asked to  t these people you know to check their close physical contact with these people as well but they're also being asked to do this sort of analysis i mean i don't i'm not quite sure that i understand what the passive surveillance is that not being asked to test the level of of infectivity by getting themselves i hope but i don't think that's that's the issue i think just backing up a little bit year and there are a lot of fatalities from viral influenza and it happens over various periods of time is almost no no uniform level of protection for that it's too random on the other hand in a very serious focused short term highly lethal type of influenza you want to use everything possibly that you could as for example was done with size and was affected in size and sorrows it was contained at a time when really i think the expectation was that it could not be and could not be contained so that there's a a range of of appropriate response that c d c and guidelines are trying to adjust to and one of the problems is the nimbleness with which you can adjust and i i'm thinking it may be maybe the technology is at hand to adjust these more quickly  as circumstances change and i don't i can't translate that into what it means day to day for who uses what but i think that's the kind of the general problem that that's being dealt with here  is trying to get the right degree of alertness for this week's risk and i and i think we saw taken totally out of this context but we saw in the c d c s evolving guidance around school closures that at the beginning of the outbreak there was very serious concern because we didn't know how lethal this was going to be and as we learned more and had more experience and recognized that that kind of approach was probably not going to be effective in containing the spread and that combined with the fact of the virus turned out in this stage not to be as lethal that c d c backed off from that recommendation and schools are remaining open and i think that's part of the flexibility that we need to be able to build into whatever policy approaches ultimately we need to be consistent across the federal government each stage but the answer or the approach that you take at the beginning of an link the u s domestic and the international public surveillance efforts what does it say what type of assessment would you give this recent experience  you talked about the need for coordination here because this is obviously global how would you grade our response at least in this most recent iteration of you know i have well i would have to say first that i wasn't really focused on the timelines very carefully it wasn't that wasn't my major concern but i had the impression that the response was really quite good and quite prompt that from the time it could f identified that this was a new virus this was something new which is critical thing and one secondly that was one to which we don't have immunity it's enough different from the previous influenza viruses so we don't have immunity and that there were multiple cases turning up and the early testimony the early evidence from mexico that that actually that yes it actually overestimated the variance of this that by the time that came in over a week or two it struck me that c d c was very alert and richard besser i think you've pointed out said i think maybe being concerned that that that they had overreacted said well you have to do this you have to move very quickly you only have one chance to get ahead of these things you have to over react and i think w h o again the sensitized i mean they have had some training in recent years the general director of of w h o was in china once i was broke out which was and the chinese response to that was really very good finally and i was also i think was was responsible was the what's in hong kong and the responsible officer for the original dealing with the flocks of chickens with the avian influenza flu i think their response they went to top level alert as i recall almost as soon as they almost as soon as they could so i think whether it's ideal or not they global response national and global response was better than it has been previously was quicker and more alert to use masks on the other hand you had the world health organization going to level five one level short of pandemic it seems to me that there's some inconsistency there and i the united states plan does not tracks the w h o levels but actually doesn't start gearing up on its plan until we reach w h o level six which is not to say that lots of stuff wasn't put in place i mean i would agree with dr ryan that the public health response was nominal in the in the situation because the u s plan assumes that the initial outbreak will be somewhere far away from the united states and that didn't turn out to be the case and so lots of triggers were not pulled in the planning at least in the in the you would not have until people pulled the people follow the u s plan rigidly the problem with the w h o stages is that it does not make a distinction between whether something is a very real and or not there england so something can be pandemic meaning it's a novel virus and it's worldwide and not be terribly lethal or not be any worse than and seasonal flu which may at least so far is not the case may change but it's certainly not the case now we need in those stages to be able to distinguish which is not to say that you don't want to raise your awareness it doesn't mean you don't want to raise your response but i think there's a communications problem there that when you reach a level five you know we're one step away from a full blown pandemic that we need to be able to sing which when it is very low and we're not very well and because i think that creates a very different kind of public response and a different kind of policy response  would say yes i think it's seven which made it a very good point that has other implications about the mismatch between the high level response and low level i think we may have because the high level  that once you have that understanding that alertness triggered the cascade the ramifications the cascade of ramifications at all levels of society is enormously complex  terms of what are you going to do about school closures and what does that mean about the school budget in the school and that learning how to fine tune all and this today's subject is a perfectly good example that learning how to fine tune all these ramifications for all these different ultimately everybody everybody's is something that we've never had as i say as you point out there's never been a lot of influence pandemic from almost a century now there's never been one that's dotted close to the united states before so that's that's a new we've always had some time so the quick response the need for this country to be involved instantly almost in all these levels points out that you really maybe have to people have to start thinking about a master plan about all the details i mean this isn't my field and i'm i don't really not an authority on what's been done in this but i just from what i've heard it sounds as though there needs to be attention to as you draw out a chart of all this what happens at what level and how quickly and also the ranking member they indicated they may want to submit questions to you in writing and then obviously you'd be given a reasonable period within which to respond in writing as well but in their absence i just want to thank you for your willingness to come before the committee off a very thoughtful testimony we appreciate your patience while we had all these votes across the way but thank you very very much for your willingness to testify and we really appreciate the work that you've done on