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UPDATE ON THE U.S. PUBLIC HEALTH RESPONSE 

TO THE EBOLA OUTBREAK 

HEARING 

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

NOVEMBER 18, 2014 

Serial No. 113–180 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 

COMMITTEE ON ENERGY AND COMMERCE 

FRED UPTON, Michigan 

Chairman 

RALPH M. HALL, Texas 

JOE BARTON, Texas 

Chairman Emeritus 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOSEPH R. PITTS, Pennsylvania 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

Vice Chairman 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

ROBERT E. LATTA, Ohio 

CATHY MCMORRIS RODGERS, Washington 

GREGG HARPER, Mississippi 

LEONARD LANCE, New Jersey 

BILL CASSIDY, Louisiana 

BRETT GUTHRIE, Kentucky 

PETE OLSON, Texas 

DAVID B. MCKINLEY, West Virginia 

CORY GARDNER, Colorado 

MIKE POMPEO, Kansas 

ADAM KINZINGER, Illinois 

H. MORGAN GRIFFITH, Virginia 

GUS M. BILIRAKIS, Florida 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

HENRY A. WAXMAN, California 

Ranking Member 

JOHN D. DINGELL, Michigan 

FRANK PALLONE, JR., New Jersey 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANICE D. SCHAKOWSKY, Illinois 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

JOHN BARROW, Georgia 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

JERRY MCNERNEY, California 

BRUCE L. BRALEY, Iowa 

PETER WELCH, Vermont 

BEN RAY LUJAN, New Mexico 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TIM MURPHY, Pennsylvania 

Chairman 

MICHAEL C. BURGESS, Texas 

Vice Chairman 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

GREGG HARPER, Mississippi 

PETE OLSON, Texas 

CORY GARDNER, Colorado 

H. MORGAN GRIFFITH, Virginia 

BILL JOHNSON, Ohio 

BILLY LONG, Missouri 

RENEE L. ELLMERS, North Carolina 

JOE BARTON, Texas 

FRED UPTON, Michigan (ex officio) 

DIANA DEGETTE, Colorado 

Ranking Member 

BRUCE L. BRALEY, Iowa 

BEN RAY LUJAN, New Mexico 

JANICE D. SCHAKOWSKY, Illinois 

G.K. BUTTERFIELD, North Carolina 

KATHY CASTOR, Florida 

PETER WELCH, Vermont 

PAUL TONKO, New York 

JOHN A. YARMUTH, Kentucky 

GENE GREEN, Texas 

JOHN D. DINGELL, Michigan (ex officio) 

HENRY A. WAXMAN, California (ex officio) 

(II) 

(III) 

C O N T E N T S 

Page 

Hon. Tim Murphy, a Representative in Congress from the Commonwealth 

of Pennsylvania, opening statement ................................................................... 1 

Prepared statement .......................................................................................... 4 

Hon. Kathy Castor, a Representative in Congress from the State of Florida, 

opening statement ................................................................................................ 5 

Hon. Marsha Blackburn, a Representative in Congress from the State of 

Tennessee, opening statement ............................................................................ 7 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 7 

Prepared statement .......................................................................................... 8 

Hon. Henry A. Waxman, a Representative in Congress from the State of 

California, opening statement ............................................................................. 9 

Hon. Fred Upton, a Representative in Congress from the State of Michigan, 

prepared statement .............................................................................................. 176 

WITNESSES

Thomas R. Frieden, Director, Centers for Disease Control and Prevention ....... 10 

Prepared statement .......................................................................................... 13 

Answers to submitted questions ...................................................................... 180 

Nicole Lurie, Assistant Secretary for Preparedness and Response, Department 

of Health and Human Services ........................................................................... 24 

Prepared statement .......................................................................................... 26 

Answers to submitted questions ...................................................................... 185 

Boris D. Lushniak, Acting Surgeon General of the United States, Department 

of Health and Human Services ........................................................................... 40 

Prepared statement .......................................................................................... 43 

Answers to submitted questions ...................................................................... 189 

Ken Isaacs, Vice President, Programs and Government Relations, Samaritan’s 

Purse ..................................................................................................................... 90 

Prepared statement .......................................................................................... 93 

Answers to submitted questions ...................................................................... 191 

Jeff Gold, Chancellor, University of Nebraska Medical Center ........................... 137 

Prepared statement .......................................................................................... 139 

Answers to submitted questions ...................................................................... 195 

David Lakey, Commissioner, Texas Department of State Health Services, 

on Behalf of the Association of State and Territorial Health Officials ............ 145 

Prepared statement .......................................................................................... 147 

Answers to submitted questions ...................................................................... 204 

SUBMITTED MATERIAL

Statement of American Hospital Association dated November 18, 2014, submitted by Mr. Burgess ......................................................................................... 57 

Statement of the American Federation of State, County, and Municipal Employees dated November 18, 2014, submitted by Mr. Green ............................ 169 

Subcommittee memorandum .................................................................................. 177 

(1) 

UPDATE ON THE U.S. PUBLIC HEALTH 

RESPONSE TO THE EBOLA OUTBREAK 

TUESDAY, NOVEMBER 18, 2014 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The subcommittee met, pursuant to call, at 1:38 p.m., in room 

2123 of the Rayburn House Office Building, Hon. Tim Murphy 

(chairman of the subcommittee) presiding. 

Members present: Representatives Murphy, Burgess, Blackburn, 

Scalise, Harper, Olson, Gardner, Griffith, Johnson, Long, Ellmers, 

Terry, Barton, DeGette, Braley, Lujan, Castor, Tonko, Yarmuth, 

Green, and Waxman (ex officio). 

Staff present: Sean Bonyun, Communications Director; Leighton 

Brown, Press Assistant; Noelle Clemente, Press Secretary; Brenda 

Destro, Professional Staff Member, Health; Brad Grantz, Policy Coordinator, Oversight and Investigations; Brittany Havens, Legislative Clerk; Sean Hayes, Deputy Chief Counsel, Oversight and Investigations; Charles Ingebretson, Chief Counsel, Oversight and Investigations; Carly McWilliams, Professional Staff Member, Health; 

Emily Newman, Counsel, Oversight and Investigations; Alan 

Slobodin, Deputy Chief Counsel, Oversight and Investigations; Tom 

Wilbur, Digital Media Advisor; Peter Bodner, Democratic Counsel; 

Brian Cohen, Democratic Staff Director, Oversight and Investigations, and Senior Policy Advisor; Lisa Goldman, Democratic Counsel; Amy Hall, Democratic Senior Professional Staff Member; Elizabeth Letter, Democratic Professional Staff Member; and Nick Richter, Democratic Staff Assistant. 

Mr. MURPHY. Good morning. Today we convene our hearing on 

the Update on the U.S. Public Health Response to the Ebola Outbreak, from the Subcommittee on Oversight and Investigations. 

I will begin with a 5-minute opening statement. 

OPENING STATEMENT OF HON. TIM MURPHY, A REPRESENTATIVE IN CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA 

Yesterday, Dr. Frieden, you shared with me a well-known 

quotation worth repeating: ‘‘Life can only be understood backward, 

but it must be lived forward.’’ Today, we will review the lessons 

learned so far from the Ebola epidemic in West Africa and the plan 

to move forward as the administration asks taxpayers for $6.2 billion in new spending to fight this deadly outbreak. 

2 

So I want to see a plan that is simple and direct. Number one, 

prevent Americans from contracting Ebola; two, treat those who 

contract Ebola effectively; and three, stop the spread of Ebola at its 

source in West Africa. On the side of Ebola, however, its goal is to 

spread, kill, mutate, and repeat. There is no cure or vaccine so we 

have to work together to break the chain. 

The steps we must take begin with erecting a strong perimeter 

of defense. That is why I outlined 10 recommendations at our last 

hearing which included a ban on non-essential commercial travel; 

a 21-day quarantine or isolation for those who have had hands-on 

treatment of an Ebola patient; upgrades and training for personal 

protective equipment; designating specific Ebola-ready medical centers; accelerate development of promising vaccines, drugs, and diagnostic tests; additional aircraft and vehicles capable of transporting American medical and military personnel who may have 

contracted Ebola back here for treatment; additional contact tracing and testing resources for public health agencies; and information for Congress regarding any resources needed. 

Some of these measures have been implemented, and others are 

still needing to occur. 

Our role here is to all work together to help define the mission 

and ensure the policies put forth are straightforward and flexible 

to accommodate the ever-changing nature of this Ebola outbreak. 

Like Occam’s Razor, the best solution is the simplest one with the 

fewest assumptions. 

As we have seen, missteps are caused by ignorance and arrogance. They are corrected by knowledge, humility, and honesty. Let 

us consider some of the false assumptions the Federal Government’s response has been based upon. Any hospital could treat an 

Ebola patient. A negative Ebola test result means a patient doesn’t 

have Ebola, but just this week, a physician from Sierra Leone died 

after being flown to Nebraska for emergency treatment after initial 

tests showed a negative result for the virus. His colleagues are now 

in quarantine, causing even greater anxiety in a medical profession 

that has already lost more than 500 to Ebola. Hospitals and health 

care workers would have some proper guidance on personal protective equipment. Self-isolation and quarantine orders aren’t necessary, it was said. CDC guidelines do not require a three week 

self-isolation period for healthcare professionals who have been 

treating Ebola patients in West Africa. It was said that these volunteers can return to work immediately. But the hospitals I talked 

to did not agree. I asked an ER doctor from my district about 

whether any of his colleagues volunteering in West Africa could 

come back to work immediately. He had a simple response, and 

quoting him, he said, ‘‘They should stay away.’’ 

The administration continues to oppose travel restrictions and 

quarantines, yet respected institutions have such policies to ensure 

public health is protected. The Department of Defense has a quarantine policy as well as many local hospitals and medical institutions throughout the U.S. It is impossible for the American people 

to understand why the Government would have one standard for 

the military and yet another standard for people who may have 

been in the same, or possibly more perilous circumstances. 

3 

Consider the cost of the administration’s position. Senator Schumer has asked the Federal Government to reimburse New York 

$20 million for the costs associated with the 500 healthcare workers it took to prevent an outbreak in New York City because of the 

case of Dr. Craig Spencer. Now, the taxpayers have every right to 

ask: Wouldn’t it have been more cost effective for the administration to instead require all returning healthcare workers to adhere 

to a 21-day isolation policy? 

We all need honesty and humility today. The American public is 

fine with a doctor who says, ‘‘This is our plan based on what we 

know today, but as the facts change—as they most assuredly will— 

then we have to change our approaches.’’ A patient and the public 

expect that. 

Now, Anthony Fauci of the NIH has said we should not look at 

the what ifs. I categorically disagree. That is exactly what we need 

to do, what Congress needs to do, and everybody involved with this 

needs to do. What if the outbreak migrates to other countries? 

What if the outbreak extends to other continents? And if we get 

new information that says a change in policy is needed, tell us 

what you have learned and why a change is required. 

As one example, we have set up screening protocols at five different airports to accept passengers from West Africa. Is this complex approach the easiest and safest way to deal with an Ebola 

threat? Are we hoping that we will be lucky enough to catch each 

potential carrier? Can we track the hundreds or perhaps thousands 

who might otherwise have been exposed if we have 5 U.S. arrival 

points, countless potential destinations, and numerous connections 

through Europe? With a disease that has no margin of error like 

Ebola, I would rather be good than lucky. 

We need to consider whether there should be a simpler approach 

of one arrival point that would allow us to easily track those returning aid workers and Government professionals coming from 

West Africa. The administration must also review whether Government charter flights are needed to help get aid workers to West Africa since many commercial airlines have ceased traveling there, 

and they also have concerns about shipping supplies to Africa. 

I would like to ask the administration’s Ebola czar, Ron Klain, 

about this issue, but when we asked for him to appear before our 

subcommittee, we were told that he ‘‘wasn’t ready.’’ Another congressional committee made a similar request, and I understand 

they were told that the White House Ebola response coordinator 

had ‘‘no operational responsibility.’’ But for very few press interviews, this individual seems to be missing-in-action. No wonder the 

American people have concerns with the administration’s response 

planning. We want to clear that up today, and we have good panels 

to do that. 

The public is given plans that keep changing from agencies that 

sometimes feel paralyzed, led by a czar who isn’t ready against a 

disease that is killing more every day. Well, we stand ready to 

work with the administration to keep the American people safe 

from the Ebola outbreak. I welcome all the witnesses and look forward to learning more about the latest public health actions on 

Ebola, and more details about the emergency funding request. 

[The prepared statement of Mr. Murphy follows:] 

4 

PREPARED STATEMENT OF HON. TIM MURPHY

Yesterday, Dr. Frieden you shared with me a well-known quotation—‘Life can 

only be understoodbackward, but it must be lived forward.’ 

Today, we will review the lessons learned so far from the Ebola epidemic in West Africa and the plan moving forward as the administration asks taxpayers for $6.2 

billion in new spending to fight the outbreak. I want to see a plan that is simple 

and direct: 

1. Prevent Americans from contracting Ebola 

2. Treat those who contract Ebola effectively 

3. Stop the spread of Ebola at its source in West Africa. 

On the side of the Ebola virus is to spread, kill, mutate, and repeat. There is no 

cure or vaccine so we must break the chain. 

The steps we must take begin with erecting a strong perimeter of defense. That’s 

why I outlined ten recommendations, which included: • A ban on non-essential commercial travel; 

• A 21-day quarantine or isolation for those who have treated an Ebola patient 

• Upgrades and training for personal protective equipment 

• Designating specific Ebola-ready medical centers 

• Accelerate development of promising vaccines, drugs, and diagnostic tests; 

• Additional airplanes and vehicles capable of transporting American medical and 

military personnel who may have contracted Ebola back here for treatment; • Additional contact tracing and testing resources for public health agencies; 

• Information for Congress regarding any resources needed. 

Some of these measures have been implemented. Others still need to occur. 

Our role here is to help define the mission and ensure the policies put forth are 

straightforward and flexible to accommodate the ever-changing nature of this Ebola 

outbreak. Like Occam’s Razor, the best solution is the simplest one with the fewest 

assumptions. 

As we’ve seen, missteps are caused by ignorance and arrogance. They are corrected by knowledge, humility, and honesty. 

Consider some of the false assumptions the Federal Government’s response has 

been based upon: • Any hospital could treat an Ebola patient. 

• A negative Ebola test result means a patient doesn’t have Ebola. Just this week, 

a physician from Sierra Leone died after being flown to Nebraska for emergency 

treatment after an initial test showed a negative result for the virus. His colleagues 

are now in quarantine, causing even greater anxiety in a medical profession that 

has already lost more than 500 to Ebola. • Hospitals and health care workers were had proper guidance on personal protective equipment. • Self-isolation and quarantine orders aren’t necessary. CDC guidelines do not require a three week self-isolation period for healthcare professionals who’ve been 

treating Ebola patients in West Africa. These volunteers can return to work immediately. 

But the hospitals I talk to don’t all agree. I asked an ER doctor from my district 

about whether any of his colleagues volunteering in West Africa could come back 

to work immediately. He had a simple response. They, quote ‘‘should stay away.’’ 

The administration continues to oppose travel restrictions and quarantines, yet 

respected institutions have such policies to ensure public health is protected. 

The Department of Defense has a quarantine policy as well as many local hospitals and medical institutions throughout the U.S. It’s impossible for the American 

people to understand why the Government would have one standard for the military 

and yet another standard for people who may have been in the same—or possibly 

more perilous—circumstances. 

Consider the cost of the administration’s position. Senator Schumer has asked the Federal Government to reimburse New York $20 million for the costs associated 

with the 500 healthcare workers it took to prevent an outbreak in New York City 

because of the case of Dr. Craig Spencer. 

The taxpayers have every right to ask: Wouldn’t it have been more cost effective 

for the administration to instead require all returning healthcare workers adhere 

to a 21-day isolation policy? 

We need honesty and humility today. The American public is fine with a doctor 

who says, ‘‘This is our plan based on what we know today.’’ But as the facts change, 

and they most assuredly will, then we must change our approach. A patient and 

the public expect that. 

Anthony Fauci of the NIH has said we should not look at the ‘‘What ifs.’’ 

I categorically disagree. That is exactly what we need to do. 

5 

What if the outbreak migrates to other countries? What if the outbreak extends 

to other continents? 

If we get new information that says a change in policy is needed, tell us what 

you have learned and why a changed is required. 

As one example, we have set up screening protocols at five different airports to 

accept passengers from West Africa. Is this complex approach the easiest and safest 

way to deal with an Ebola threat? Are we hoping that we will be lucky enough to 

catch each potential carrier? Can we track the hundreds of thousands who might 

otherwise be exposed if we have five US arrival points, countless potential destinations, and numerous connections through Europe? 

With a disease that has no margin of error like Ebola, I’d rather be good than 

lucky. 

We need to consider whether there should be a simpler approach of one arrival 

point that would allow us to easily track those returning aid workers and professionals coming from West Africa. 

The administration must also review whether Government charter flights are 

needed to help get aid workers to West Africa since must commercial airlines have 

ceased traveling there. 

I’d like to ask the administration’s Ebola czar, Ron Klain, about this issue. But 

when we asked for him to appear before our subcommittee, we were told that he 

‘‘wasn’t ready.’’ When another Congressional committee made a similar request, I 

understand they were told that the White House Ebola response coordinator had ‘‘no 

operational responsibility.’’ But for a very few press interviews, this individual 

seems to be missing-in-action. No wonder the American people have concerns with 

the administration’s response planning. 

The public is given plans that keep changing from agencies that are paralyzed— 

led by a czar who isn’t ready against a disease that is killing more every day. 

We stand ready to work with the administration to keep the American people safe 

from the Ebola outbreak. I welcome all the witnesses and look forward to learning 

more about the latest public health actions on Ebola and more details about the 

emergency funding request. 

Mr. MURPHY. I now turn toward Ms. Castor for 5 minutes for an 

opening statement. 

OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. CASTOR. Chairman Murphy, thank you very much for holding today’s hearing, the second that we have had on the Ebola outbreak. And at our hearing last month, Americans were rightfully 

concerned about the news they were hearing. It was just weeks 

after Thomas Duncan arrived at Texas Presbyterian with Ebola, 

and just days after two nurses who had treated him had become 

infected. In response to these cases, the CDC updated their protocols for treatment of Ebola patients, and issued travel guidelines 

for those who had treated or been exposed to Ebola. 

Our hearing back then was held just 3 weeks before the election, 

and it seemed that much of the discussion of quarantines and travel bans reflected political concerns, instead of the advice of public 

health experts. But today, when we look at where things stand 

with regard to domestic preparedness, we are in a much better 

place. No cases of Ebola have been transmitted to any member of 

the general public in the United States. With new procedures in 

place, and with the exception of Dr. Craig Spencer in New York, 

no individual has knowingly entered the U.S. while infected with 

Ebola. Airport screening and new CDC monitoring guidelines implemented by State and local public health departments are in 

place, and we have successfully treated 8 Ebola patients that have 

entered U.S. hospitals. 

6 

I want to give credit to these hospitals and healthcare professionals that have treated these patients. The professionals at 

Emory University, the NIH, the University of Nebraska Medical 

Center, Bellevue, and Texas Presbyterian. Their readiness has 

made a huge difference. And I want to welcome Dr. Gold from the 

University of Nebraska and thank him for sharing his expertise 

today. 

Unfortunately, the news from West Africa is not as good. While 

case counts in Liberia have slowed, there continue to be rapid increases in the number of Ebola cases in Sierra Leone and Guinea, 

and officials are now concerned about the appearance of Ebola in 

Mali. And that, Mr. Chairman, is why we need to continue to focus 

on the U.S. response in West Africa. It is a credit to our country 

that we are leading the effort to end the epidemic in West Africa, 

and the early results from Liberia indicate that our efforts and the 

efforts of our partner countries can make a real difference, but 

there is still much work to do. 

I want to acknowledge all of the medical professionals who are 

doing that work, and in particular, say a few words about Dr. Martin Salia. We learned yesterday that Dr. Salia, who had been flown 

to Nebraska for treatment after developing Ebola while working in 

Sierra Leone, died from the disease. We send our condolences to his 

family, and acknowledge his bravery and selflessness in helping 

fight this disease. 

West Africa is balanced on the edge, and if our efforts and the 

efforts of the World Health Organization are not successful, millions of people in these countries facing a looming humanitarian 

crisis will continue to suffer. And I am glad that Mr. Isaacs from 

Samaritan’s Purse is here to give the perspective of the international aid community on the West African outbreak. 

Mr. Isaacs, your group and other groups like yours are doing difficult but critical work, and you deserve support. We are now in a 

much better position to addresses cases of Ebola that appear in the 

United States than we were a few months ago. And I appreciate 

Dr. Frieden, Dr. Lushniak, Dr. Lurie, Dr. Lakey for joining us 

today to share lessons learned, and tell us how we can continue to 

improve and move forward. And I am also looking forward to the 

perspective of our witnesses on the administration’s supplemental 

Ebola budget request. It is critical that Congress support this appropriations request. It would support domestic preparedness, help 

fortify 50 Ebola treatment centers nationwide, it would support the 

development of treatments and vaccines for Ebola, and it would 

support USAID and the U.S. Military in their critical efforts to 

eliminate Ebola in West Africa. 

Mr. Chairman, I suspect that in the year to come, we will have 

our share of discussions over the budget, but I know we all support 

the goals of the President’s Ebola Outbreak Plan to combat it, and 

I hope we can move quickly to provide the requested appropriations. 

Thank you, and I yield back. 

Mr. MURPHY. The gentlelady yields back. 

Now recognize the vice chair of the full committee, Mrs. 

Blackburn, for 5 minutes. 

7 

OPENING STATEMENT OF HON. MARSHA BLACKBURN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF TENNESSEE 

Mrs. BLACKBURN. Thank you, Mr. Chairman. I appreciate the 

hearing, and I want to say welcome to all of our witnesses. We appreciate your time. 

I think we have to realize, with the nearly 15,000 cases and over 

5,000 deaths, that this Ebola epidemic is the worst since the discovery of the virus in ’76. And you need to look at what the precedent is there: 2,400 known cases of Ebola prior to this outbreak. 

So we know that this is something that is going to be difficult and 

take some time to deal with, and we appreciate your efforts on that 

part. 

And there is a little bit of good news coming out of Liberia. There 

is also kind of a mixed bag of news that is coming out of the region, 

and it all leads us to look at the magnitude of the situation in front 

of us, as well as the human-to-human transmission of the virus 

which has drawn attention to the need to be better prepared to 

keep Americans safe, and that is our goal. You know, most Americans believe it is the job of ASPR and the job the CDC to keep 

Americans safe from infectious disease, and that all efforts need to 

be on the table when it comes to keeping Americans safe. Don’t 

take anything off the table. 

The chairman mentioned some of those suggestions that were 

made at the last hearing. Indeed, yesterday I was at Fort Campbell 

with some of my troops who are over there now trying to build the 

hospitals, and are training their medical personnel. And I think it 

is of concern to us that the administration has been opposed to 

travel bans and to quarantines; items that we think might work. 

Even the Institute of Medicine recently held a workshop where researchers raised a number of questions about the characteristics of 

the Ebola virus. They concluded, and I am quoting, ‘‘many of the 

current risk quarantine policies and public health mitigation measures could be better informed and more effective if the means and 

potential routes for transmission were more thoroughly characterized. Until we know more about the nature of the deadly virus, it 

seems prudent to keep all commonsense measures on the table.’’ 

And with that, I yield to Dr. Burgess. 

OPENING STATEMENT OF HON. MICHAEL C. BURGESS, A 

REPRESENTATIVE IN CONGRESS FROM THE STATE OF TEXAS 

Mr. BURGESS. I thank the gentlelady for yielding. I thank our 

witnesses for being here today. Dr. Lakey, good to see you again. 

This epidemic will surely go down in history as one of the most 

serious public health—from a global perspective, one of the most 

serious public health crises of the last 100 years. 

At our last hearing, we had a great deal to discuss, and certainly 

many of the brave pronouncements from the middle of September 

were found to be non-operational by the middle of October, and 

there were failures in dealing with this crisis. Certainly, communication was lacking. Systems and protocols broke down, and provisions that we all thought were readily at hand were never in place 

to begin with. I hope we know better than to let this happen again. 

This summer’s emergency, to me, emphasized one thing, and that 

8 

is have a lot of humility when you are dealing with this virus because it is difficult to predict. 

As a physician, one of my biggest concerns since July has been 

the safety and the protection of healthcare workers. I want to 

thank the CDC for always being responsive to my telephone calls 

over the last several months, and the various conference calls that 

we had over the summer were helpful. And I have to tell you something, until you have this damn thing in your backyard, it is just 

hard to estimate how it is going to affect daily life on so many levels. Sure, we had a hospital that was hurt by the crisis. We are 

probably lucky we didn’t have more than one that was hurt. Trash 

collection, sewer treatment, school districts, every one down the 

line was affected by having this virus in our area. 

So we do have to take great care and closely follow the epidemic 

in Western Africa. It is important that that be brought under control. I also have to tell you I am grateful for the services of the hospitals that have handled the known Ebola patients, but I am much 

more worried about that unknown patient who could walk through 

an emergency room door at 3 o’clock tomorrow morning, unknown 

to anyone, unannounced, and provide the same set of circumstances that we have already been through. I am not sure we 

have learned entirely the lessons. 

Thank you, Mr. Chairman. I will yield back. 

[The prepared statement of Mr. Burgess follows:] 

PREPARED STATEMENT OF HON. MICHAEL C. BURGESS

This Ebola epidemic will surely go down in history as one of the most serious public health crises of the last several hundred years. 

At our last hearing, we had a lot to discuss. Overall, we failed in our response 

to the Ebola crisis. Communication was lacking, systems of protocol broke down, 

and provisions were never in place to deal with this crisis to begin with. We know 

better than to let this happen again. This summer’s emergency only emphasized 

that we must have humility when discussing Ebola. 

As a physician, one of my biggest concerns over the last six months or so was the 

safety and protection of health workers. I could not—and still do not—understand 

why health workers on the front lines of the epidemic in Africa were so much better 

protected than the nurses and doctors who treated Ebola patients in the United 

States. It is not only vital to contain the Ebola virus wherever it may be, but we 

must also ensure we are doing all we can to protect those who are serving these 

very sick and contagious patients. Until it is in your back yard as it was in mine 

in Texas, it is hard to comprehend the depth of the issue at hand. 

I commend Dr. Frieden, the CDC and the other members of the panel for making 

yourselves available to the Congress so we may discuss policies that better protect 

the American public from infectious diseases like Ebola. I thank all of our witnesses 

for being here today. 

It is my hope that we continue to make progress in this fight. Today’s hearing 

is another good start. We must examine the response plan, protocol, U.S. guidelines, 

travel restriction policies, budget for dealing with this crisis and protective gear and 

proper precautions for health workers. But finally, we must also take great care to 

closely follow the epidemic in West Africa, as it is only a matter of time before another patient walks through the doors of an unsuspecting U.S. hospital. 

When—not if—that happens, we must be prepared. 

I yield back. 

Mr. MURPHY. Gentleman yields back. 

I now recognize the ranking member of the full committee, Mr. 

Waxman, for 5 minutes. 

9 

OPENING STATEMENT OF HON. HENRY A. WAXMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. WAXMAN. Thank you, Mr. Chairman. I am pleased you are 

holding this hearing. This is a very important topic, and it is appropriate for Congress to learn about it because the American people want to know what is happening and want some answers. But 

I picked up a couple of comments from the other side about having 

humility, learning from what has happened, and hope we know 

better because of what we have learned. When we last had a hearing in October, there was a pronounced disconnect between what 

the public health experts were telling the committee, and the rhetoric of some of the committee members. Some members called for 

quarantines and travel bans that experts had determined would be 

harmful. Some claim that the administration’s protocols for screening and tracking travelers wouldn’t work. Some even insinuated 

that immigrants with Ebola would soon be crossing the southern 

border, or that Ebola had mutated and become transmissible by 

air. This is hysterical. Rhetoric certainly induces a great deal of 

fear. 

But, Mr. Chairman, none of these things were true. After two 

cases were transmitted in Texas, the Centers for Disease Control 

acted quickly and decisively to acknowledge the gaps and revise 

protocols. It has learned from its experiences. It has now been 33 

days since our last Ebola hearing, and since then, not one case of 

Ebola has been transmitted in the United States. Only one traveler 

since then, Dr. Craig Spencer, has unknowingly brought a case of 

Ebola into the country, and it appears that our healthcare system 

responded effectively. Dr. Spencer knew how to immediately report 

his symptoms, was quickly isolated, and safely transported to a 

hospital equipped to treat a patient with Ebola, and his close contacts were monitored. 

The health experts told us that our public health measures could 

protect the public from Ebola, and it turns out, Mr. Chairman, they 

were right. 

So it is good that we have a chance today to show some humility 

and acknowledge that the fears that were expressed openly at our 

last hearing were not justified. As I said in that first hearing, we 

should have a sense of urgency about the epidemic in Africa. There 

is a lot of work to be done to stop the ongoing humanitarian crisis 

there, and we should view the appearance of Ebola cases in the 

United States as a wakeup call about the need for us to invest in 

public health preparedness at the Federal, State, and local levels. 

President Obama is trying to address these challenges, and we 

should support those efforts, because if we don’t stop Ebola in Africa, it could travel to other places, it could spread, so we have to 

control the epidemic where it is happening. 

On November 5, the President submitted a $6.2 billion emergency supplemental funding request to Congress to improve domestic and global health capacities in 3 critical areas; containment and 

treatment in West Africa; enhanced prevention, detection and response to Ebola entering the U.S.; and buttressing the U.S. public 

health system to respond rapidly and flexibly to all hazards in the 

10 

future. It is critical, Mr. Chairman, that Congress support this request. 

There is ample precedent for an emergency public health supplemental appropriation of this magnitude. In November 2005, the 

Bush administration requested $7.1 billion in emergency supplemental funding to speed up the development of a vaccine, and fund 

State, local, and Federal preparedness. Ultimately, a bipartisan 

Congress provided President Bush with over $6 billion of this funding. In 2009, Congress provided the Obama administration with 

nearly $7 billion in emergency spending authority to combat H1N1 

influenza virus. Congress did the right thing by making those investments. They saved lives, they enhanced our preparedness, and 

the Congress should do the right thing now. 

Thank you, Mr. Chairman. Yield back the balance of my time. 

Mr. MURPHY. The gentleman yields back. 

I would now like to introduce the distinguished panel for today’s 

hearing, for the first panel. 

We are joined by Dr. Thomas Frieden, the Director of the Centers for Disease Control and Prevention; the Honorable Nicole 

Lurie, the Assistant Secretary for Preparedness and Response at 

the U.S. Department of Health and Human Services; Rear Admiral 

Boris Lushniak, the Acting United States Surgeon General, who 

also oversees the operations of the United States Public Health 

Service Commissioned Corps, comprised of approximately 6,000 

uniformed health officers. 

I will now swear in the witnesses. 

You are aware that the committee is holding an investigative 

hearing, and when doing so, has had the practice of taking testimony under oath. Do you have any objections to testifying under 

oath? All the witnesses say they do not. The Chair then advises 

you that under the rules of the House and the rules of the committee, you are entitled to be advised by counsel. Do you desire to 

be advised by counsel during your testimony today? All the panelists waives that. In that case, if you will all please rise and raise 

your right hand, I will swear you in. 

[Witnesses sworn.] 

Mr. MURPHY. Thank you. All of the panelists have answered in 

the affirmative. So you are under oath and subject to the penalties 

set forth in Title XVIII, section 1001 of the United States Code. 

You may now each give a 5-minute summary of your written statement. We will start with you, Dr. Frieden. 

STATEMENTS OF THOMAS R. FRIEDEN, DIRECTOR, CENTERS 

FOR DISEASE CONTROL AND PREVENTION; NICOLE LURIE, 

ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE, DEPARTMENT OF HEALTH AND HUMAN SERVICES; 

AND BORIS D. LUSHNIAK, ACTING SURGEON GENERAL OF 

THE UNITED STATES, DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

STATEMENT OF THOMAS R. FRIEDEN 

Mr. FRIEDEN. Thank you very much, Chairman Murphy, Congresswoman Castor, Full Committee Ranking Member Waxman, 

and the other members of the committee. We appreciate the opporVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
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tunity to come before you today and discuss what has happened in 

the past month since the last hearing. 

In the basics of Ebola, we continue to see the pattern that we 

have seen over the past 4 decades. In fact, in the more than 400 

contacts that we have traced in the U.S., we have not seen spread 

outside of that one incident in Dallas in the healthcare setting, 

among more than 2,000 travelers who have been monitored since 

arriving from West Africa. We have seen a series with fevers but 

none with Ebola. 

So nothing changes the experience that we have to date that 

Ebola spreads from someone who is sick, and it spreads through either unsafe caregiving in the home or healthcare facility, or in Africa, unsafe burial practices. 

Emergency funding is absolutely critical to protect Americans. It 

is critical to stop the outbreak at the source in Africa, and to 

strengthen our protections here at home. Globally, in each of the 

three epicenter countries we have seen rapid change, and flexibility 

is absolutely key to the response. In Liberia, we have seen promising developments in recent weeks, with some decrease in numbers, but still the number of new cases each week is in the many 

hundreds, and our ability to stop it is very challenging because it 

is now present in at least 13 of the 15 counties of Liberia, and our 

staff are now responding to as many as one new cluster or outbreak per day, compared over the past 4 decades with one cluster 

or outbreak every year or 2. It is going to require a very intensive 

effort to trace each one of those chains of transmission and stop it 

so that we can end Ebola. 

In Sierra Leone, we are still seeing areas with widespread transmission, although some of the areas that have implemented the 

strategies we recommend have seen significant decreases as well. 

Guinea, in some ways, is the most interesting or concerning or instructive to look at because it shows what might happen in the future if we have progress in the first 2 countries. There is a challenge to trace each outbreak, each case, to reach each community 

and end the chains of transmission. That is why the emergency 

funding request outlines a comprehensive approach that is simple, 

straightforward, and focused, and approaches things by prevention, 

detection, response, 3 main categories. In West Africa, that prevention involves quarantine and screening, involves infection control 

and hospitals and burials, it involves detection so that we find outbreaks promptly, and strengthen surveillance and strengthen the 

ability of healthcare facilities and public health workers there to 

stop chains of transmission, and response through core public 

health functions of contact tracing, training, infection control, public health education and outreach, and the use of rapid response 

teams. 

Globally, we are also seeing new threats with the cluster of cases 

in Mali. CDC has surged. We have 12 staff on the ground today 

in Mali. We were there before their first case, and they are now 

tracing more than 400 contacts, and we are helping them to do that 

and to test any who may have symptoms that could be Ebola. We 

also are aware that with the end of the rainy season, other parts 

of West Africa may experience an increase in travelers from the affected countries, and may be at increased risk. The metaphor of a 

12 

forest fire holds here, with the center burning still strongly, with 

a series of brushfires around the region, and with sparks that have 

the potential of igniting new sources and new challenges in the 

struggle against Ebola. 

Globally, the funding request also addresses the global health security aspect so that we can, with an emergency focus, stop the 

kind of vulnerabilities that keep other countries vulnerable and us 

vulnerable. Most of that, about 33⁄44 of the CDC component of that 

request, is to strengthen the warning systems; detection, laboratory 

networks, and others. There are also funds to respond rapidly and 

to prevent wherever possible. 

For the part of the funding request that covers the U.S., we have 

made progress. We are doing that through a series of levels, but 

each of those is going to require significant investments. Stopping 

it at the source in Africa, screening all travelers when they leave 

Africa, screening travelers when they arrive to the U.S., tracing 

each traveler for 21 days after they arrive here in all of the 50 

States. The States have really stepped up and are doing an excellent job of that, with CDC support and guidance, with excellent 

participation from Customs and Border Protection, which is now 

providing electronically collected data in just a question of hours to 

the States. We are seeing most States reaching 100 percent of travelers regularly, according to the information that they are reporting 

to us. So this is a relatively new program, but it is going smoothly. 

It is, however, working on borrowed dollars, and we will need funding from the emergency funding request to support this and other 

key measures of prevention, detection and response within the 

U.S., public health systems, hospitals, laboratory networks, active 

monitoring, and more. 

Finally, I would emphasize that intensive public health action 

can stop Ebola. In Nigeria, they were able to surge and stop a cluster from spreading. Mali is now in the balance of whether it becomes the next Nigeria, having successfully contained a cluster, or 

the next Liberia or Sierra Leone, with widespread transmission. 

This is a real warning that we must not let down our guard. The 

shifts and the changes in the epidemiology in Africa are just an 

emphasis of the need for a rapid and effective response, and emphasized that the only way to protect us in the U.S. is to stop it 

at the source, and to build the systems both in Africa and in the 

U.S. that will find, stop and prevent Ebola and other infectious disease threats. 

Thank you very much. 

[The prepared statement of Mr. Frieden follows:] 

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Mr. MURPHY. Thank you. 

Dr. Lurie, you are recognized for 5 minutes. 

STATEMENT OF NICOLE LURIE 

Ms. LURIE. All right, good afternoon, Chairman Murphy, Member 

Castor, and other members of the committee. 

I am Dr. Nicole Lurie, the Assistant Secretary for Preparedness 

and Response, or ASPR, at HHS. I appreciate the opportunity to 

talk to you today about actions that ASPR has taken to enhance 

our national preparedness and strengthen our resilience to public 

health threats. 

While it is essential that we continue to focus on controlling the 

Ebola outbreak in West Africa, we also have a critical responsibility to protect our country from this disease. Today I will highlight three areas in which ASPR’s work is critical to our domestic 

response. 

First, the Biomedical Advance Research and Development Authority, or BARDA. Building on its previous successes in medical 

countermeasure development, BARDA is speeding the development, 

testing, and manufacture of Ebola vaccines and treatments. Second, the Hospital Preparedness Program has, since the beginning 

of this outbreak, been preparing hospitals and first responders to 

recognize and treat patients with suspected Ebola. And, third, our 

Federal resources and responders, whether the National Disaster 

Medical System, the Medical Reserve Corps, other public health 

service, stand ready to support a comprehensive response should it 

be needed in the coming months. 

BARDA, in coordination with other medical countermeasure 

partners, has a great track record in expanding the medical countermeasures pipeline, and building needed infrastructure to do so. 

In addition to developing and procuring 12 products since Project 

Bioshield’s inception over a decade ago, BARDA’s Centers for Innovation in Advanced Development and Manufacturing, and its Fill 

Finish Manufacturing Network, are being used to produce, formulate, and fill vaccines and treatments for Ebola. 

Complementing our success and medical countermeasure development, ASPR has made great strides in U.S. healthcare system 

preparedness. HPP, or Hospital Preparedness Program, investments have fostered an increased level of preparedness throughout 

communities in this country, and decreased reliance on Federal aid 

following disasters. In the last several years, HPP awardees have 

demonstrated their ability to respond to and quickly recover from 

disasters, including tornadoes, floods, hurricanes, and fungal meningitis from contaminated steroids. 

Through HPP, ASPR is actively engaged in Ebola preparedness 

by developing and disseminating information, guidance and checklists, and serving as a clearinghouse for lessons learned. Together 

with CDC, we have launched an aggressive outreach and education 

campaign that has now reached well over 360,000 people through 

webinars and and national calls, including with public health officials, hospital executives, frontline healthcare workers and others 

across the U.S. My office, along with the CDC, continues to recruit 

hospitals willing and able to provide definitive care to patients with 

Ebola in the United States. Concurrently, we are working with perVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
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sonal protective equipment manufacturers to coordinate supply and 

distribution, and are working with HPP-funded healthcare coalitions to collaboratively assess needs and share supplies across communities. 

The likelihood of a significant Ebola outbreak in the United 

States is quite small, but ASPR, HHS and our interagency partners 

are, as you know, part of a coordinated, whole-of-Government response, a response that extends on the one hand to West Africa, 

and on the other, through State and local Governments and to hospitals and communities throughout the United States. As is typical 

for other emergencies and disasters, ASPR is responsible for public 

health and medical services, and coordinates Federal assistance to 

supplement State, local, territorial, and tribal resources, and response to public health and medical care needs during emergencies. 

I would like to close with an overview of the recent emergency 

funding request from the administration that includes $2.43 billion 

for HHS. 

ASPR’s request supports two major components; BARDA’s product development efforts, and HPP’s preparedness initiatives. Specifically, funding will support development of an Ebola vaccine and 

therapeutic candidates, clinical trials, and commercial-scale manufacturing. Funding will ensure that communities will be able to 

purchase additional personal protective equipment, that healthcare 

workers will receive additional training, and patient detection, isolation and infection control, and that we further build our preparedness for the future by ensuring that all States have facilities 

that can handle an infectious disease as serious as Ebola. 

Mr. Chairman and members of the committee, the top priority of 

my office is protecting the health of Americans. I can assure you 

that my team, the Department, and our partners have been working and continue to work to ensure our Nation is prepared to respond to threats like Ebola. 

I thank you for this opportunity to address these issues, and welcome your questions. 

[The prepared statement of Ms. Lurie follows:] 

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Mr. MURPHY. Thank you. 

Now, Dr. Lushniak, you are recognized for 5 minutes. 

STATEMENT OF BORIS D. LUSHNIAK 

Mr. LUSHNIAK. Great. Thank you so much for this opportunity, 

Chairman Murphy, Member Castor, members of the Oversight and 

Investigations Subcommittee, and thanks again for having us here 

to testify about the U.S. Public Health Service Commission Corps 

and its role in responding to the Ebola outbreak in West Africa. 

I am here to provide information to you about what the Office 

of the Surgeon General, and specifically the United States Public 

Health Service Commission Corps, has contributed to this U.S. 

Government-wide effort to stop the spread of Ebola virus disease, 

in essence where it began, in West Africa. 

The Commission Corps of the U.S. Public Health Service is made 

up of 6,700 uniformed officers. They are assigned to 26 different departments and agencies of the Federal Government, serving in 800 

locations worldwide. I am very proud of this group of officers. They 

are highly trained, mobile, medical and public health professionals, 

operating under the departmental leadership of the Secretary of 

Health and Human Services, and the day-to-day oversight of the 

Surgeon General and the Assistant Secretary for Health. 

The Commission Corps is one of the seven uniformed services of 

our Nation. The only uniformed service of its kind in the world. It 

is an unarmed, uniformed service dedicated to a public health mission, and to medical care for underserved and vulnerable populations. The mission of the Corps is to protect, promote, and advance the health and safety of the Nation. 

For 125 years, this is an anniversary year for us, Corps officers 

have been the Government’s dependable resource for health expertise and public health emergency services, working closely with the 

ASPR in times of war in the past, and other national or international emergencies. Corps officers, like officers in our other sister 

services, can be deployed at a moment’s notice anywhere in the 

world to meet the needs of the President, the HHS, to address 

needs related to the well-being, security, and defense of the United 

States. 

We have had a long history of doing this; protecting the health 

and safety of the Nation by addressing infectious disease overseas. 

Smallpox, as an example, polio, now Ebola. To ensure that we can 

meet the mandate to respond rapidly to urgent or emergency public 

healthcare needs around the globe, the Corps has established a 

tiered response system composed of 41 different general, as well as 

specialty response teams. We have deployed in the past to events 

ranging from terrorist events; 9/11, the Boston bombings, anthrax, 

natural disasters, hurricanes, Katrina, Rita, Wilma and Sandy, humanitarian assistance in Haiti, Indian Ocean tsunami, reconstruction stabilization in Iraq and Afghanistan, public health crisis, 

H1N1, suicide clusters on Indian reservations, to hospital infrastructure rescue in the Mariana Islands. Over the past 10 years, 

the Corps has undertaken over 15,000 officer deployments in support of nearly 500 distinct missions and events. Corps officers now 

are currently operating in both the United States and in West Africa in clinical, epidemiological, education, management, liaison 

41 

roles, supporting the Department of Health and Human Services, 

as well as working under the auspices of the Centers for Disease 

Control and Prevention. We have 900 officers stationed with the 

CDC. 

One critical element of the Department’s plan for combating the 

Ebola outbreak targets the ongoing need for healthcare personnel 

in the Ebola-affected countries. United Nations estimated that 

1,000 international healthcare workers would be needed on the 

ground in West Africa to bring the outbreak to an end. There is a 

wide consensus that in order to create conditions that will encourage both West African and international healthcare workers to contribute, yes, their time and skill to contain and ultimately end the 

Ebola outbreak, it is essential to establish a dedicated facility to 

provide high-level care for those healthcare workers should they 

become infected with the virus. In support of this objective, the 

Corps has deployed trained clinicians, physicians, nurses, behavioral health specialists, infection control officers, pharmacists, laboratory workers, administrative management personnel, to Liberia 

to staff the Monrovian Medical Unit, the MMU. This is a U.S. Government-funded 25 bed hospital that has been configured to function as an Ebola treatment unit. It provides advanced Ebola treatment to Liberian and international healthcare workers, and to nongovernmental organizations and U.N. personnel involved in the 

Ebola response. 

DoD, the State Department, USAID, have provided invaluable 

support for this mission. It is being carried out with the full cooperation of the Liberian Government and its Ministry of Health. 

The first team of the United States Public Health Service Commission Corps officers completed one week of advanced training in 

Alabama in October. They arrived in Liberia on October 27. The 

full complement, a staffing of 70 Corps officers, each of whom voluntarily accepted this assignment to provide direct care for Ebola 

patients. Additional training was completed in Liberia with support 

of NGOs such as Medecins Sans Frontiers and the International 

Medical Corps. We have the equipment, we have gone through 

safety, clinical care, and management protocols. On November 12, 

the MMU accepted its first patient, a Liberian healthcare worker. 

Today, the fourth patient is soon to be admitted. Four overlapping 

teams of 70 officers will be scheduled for rotations of approximately 

60-day deployments, for an estimated 6 months of operations at 

this MMU. 

In conclusion, the safety of our personnel is our highest priority. 

We are making every effort to ensure that all Corps officers on the 

ground are working in an environment that will minimize any risk 

to their personal safety and security, following guidance from the 

CDC. To ensure the safety of our officers, their families, friends, coworkers, and the communities in which they live, work and play, 

upon return, officers will undergo exposure risk assessment and, as 

indicated, be monitored by public health authorities. We look forward to welcoming home our personnel returning from this mission, providing them support, and thanking them for their extraordinary efforts on behalf of the Nation and peoples of West Africa. 

42 

Thank you, Mr. Chairman, other members, and members of the 

subcommittee, and I will be happy to answer your questions at this 

time. 

[The prepared statement of Mr. Lushniak follows:] 

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Mr. MURPHY. Thank you, Doctor. 

I will now authorize myself 5 minutes for questions for our panel. 

Dr. Frieden, in the weeks that you have been dealing with this 

in the United States, can you highlight perhaps the top 3 things, 

lessons learned and modified from this that could give the public 

assurances that you are adapting as need be? 

Mr. FRIEDEN. The most important principle that we are following 

in Ebola control is to find out as quickly as possible, as definitively 

as possible, what works, and then to implement that, both on the 

ground in West Africa and in the U.S. What we have found is that 

treating Ebola in the U.S. is difficult. The two infections in Dallas 

were an indication of that, and we immediately moved to add a 

margin of safety to our guidelines for infection control and personal 

protective equipment. We also have put into place multiple levels 

of protection. Our top priority is protecting Americans, and we do 

that through control at the source in Africa, screening on exit, 

screening on entry, and the active monitoring program, as well as 

work with individual hospitals and health departments. 

We have something called rapid Ebola preparedness teams that 

have now visited more than 30 hospitals in more than 10 States 

to get those hospitals ready for the next Ebola case, if one occurs, 

and actually, a team had been to Bellevue before Dr. Spencer even 

became ill. 

Mr. MURPHY. OK. 

Mr. FRIEDEN. So that rapid response is key and rapid adjustment 

as we learn more about Ebola and Ebola in the U.S. 

Mr. MURPHY. OK, I want to get back on the hospitals issue in 

a minute here. 

Dr. Lurie, in August of 2014, under Section 564(b) of the Food 

and Drug Cosmetic Act, Secretary Burwell declared that circumstances exist justifying the authorization of emergency use of 

in vitro diagnostics for detection of the Ebola virus. Did you help 

advise Secretary Burwell of that declaration, do you recall? 

Ms. LURIE. Yes. 

Mr. MURPHY. OK. So even though she declared Ebola to be an 

emergency for purposes of the FDA law, she has not declared Ebola 

to be a public health emergency under this, and she has not made 

this declaration even though the World Health Organization, in 

August, declared Ebola to be a public health emergency. 

Do you agree or disagree, is this a public health emergency in 

the United States? 

Ms. LURIE. So in order for an investigational diagnostic test or 

drug to be used in the United States, the Secretary has the authority to declare that the conditions of a potential public health emergency exist. As I think Dr. Frieden and others have highlighted, 

fortunately, we have been very successful in the United States in 

detecting and controlling this disease. We have had two very unfortunate cases of transmission of this disease in the United States, 

but not others, and we believe that all of our efforts are quite effective in controlling the disease at this time. 

Mr. MURPHY. We hope so, but ‘‘fortunately’’ is also an operative 

word there, and we want to make sure we are doing everything 

that we possibly can. 

50 

On page 6 of your testimony, you mentioned you are responsible 

for coordinating the Emergency Support Function Number 8 response using domestic or—emergencies. Is that an operational responsibility that you have? 

Ms. LURIE. So my responsibilities are both policy and advice, and 

we have operational response under ESF 8, yes. 

Mr. MURPHY. And that has been activated under the response to 

Ebola? 

Ms. LURIE. Yes, the Secretary’s operations center is activated, 

and all components of ASPR are hard at work. 

Mr. MURPHY. I am just trying to clarify, so you are still the coordinator for emergency support function, or is that now Mr. Klain? 

Ms. LURIE. Mr. Klain is the Ebola coordinator for the country, 

yes. 

Mr. MURPHY. OK. So let me look at this. What data are you modeling, or have you done a data modeling, to determine the number 

of cases we may anticipate in the United States? Have you done 

any of that data modeling? 

Ms. LURIE. So one of the things that we have done, actually, as 

a lesson learned from H1N1, is brought together modelers from all 

across the Federal Government. 

Mr. MURPHY. And how many cases are you planning for in the 

United States? 

Ms. LURIE. So I think our models suggest that if we continue to 

be very aggressive about our exit screening from West Africa, our 

entry screening, tracking travelers for 21 days with active and direct active monitoring, as we are doing, that we might expect a 

handful of cases in the United States, potentially in an unrecognized cluster, but that we don’t anticipate that we are looking at 

a widespread outbreak. 

Mr. MURPHY. So you are asking for $6.2 billion here, but you are 

saying you are expecting a handful of cases. And Senator Schumer 

just said, look, you owe New York City $20 million because we had 

to track all these people that came in contact with someone, but 

you don’t believe in a policy of some kind of self-isolation, even 

though many of these NGOs do believe in self-isolation. So there 

is a disconnect here: Expect a handful of cases, don’t expect more, 

but asking for 50 hospitals to be prepared throughout the United 

States, but—help me understand where this—— 

Ms. LURIE. Sure. 

Mr. MURPHY [continuing]. $6.2 billion—— 

Ms. LURIE. I would be happy to. I don’t think that there is really 

a disconnect at all. Our strategy for hospital preparedness looks 

first at being sure that beyond the bio-containment facilities at 

Emory and Nebraska and NIH we have good strong hospital capacity to recognize, and treat through the entire course of illness, an 

Ebola patient, first in the 5 cities where all passengers are being 

funneled. A next ring of hospitals is needed for geographic dispersion around the country to places where travelers are most likely 

to go, and that is a pretty good range of States now throughout the 

country. 

One of the things that we have learned, and you had asked Dr. 

Frieden about lessons learned, is that Mother Nature always has 

the upper hand. That means that we have to think about what is 

51 

next after Ebola. Ebola has taught us that we really need high-containment facilities. So far our planning has been for pandemic preparedness on something that is airborne like pandemic flu. The 

containment needs, the infection control needs for something like 

Ebola are very, very different. 

So part of this emergency request is being able to meet our needs 

now by having a broad geographically dispersed network of hospitals able to treat Ebola, but it is also building toward the future 

because we don’t know where the next cases are going to show up, 

or the next kinds of travelers are going to show up, but we need 

to be prepared not only for today but for the next decade and for 

the next century. 

Mr. MURPHY. I am way over my time. 

I recognize Ms. Castor for 5 minutes. 

Ms. CASTOR. Thank you very much. 

On November 5, the President requested $6.2 billion from Congress to enhance the U.S. Ebola response. The President’s request 

focuses on stopping the outbreak at its source in West Africa. 

Dr. Frieden, in your testimony you said you were focused in West 

Africa on prevention, detection, and response. Can you go into 

greater detail. The President’s request designates $603 million to 

CDC for international response efforts. Discuss how these funds 

would specifically be used. 

Mr. FRIEDEN. Thank you very much. Our approach would be on 

the prevention side to implement and strengthen quarantine and 

screening procedures so that those can be continued long-term, and 

individuals with Ebola or potentially exposed to Ebola would be isolated, traced, and then promptly isolated if they become ill. 

Second on the prevention side is infection control. This is an 

enormous challenge for West Africa because each of the facilities 

caring for patients needs to think of the possibility of Ebola in 

countries where malaria is endemic, and where the symptoms of 

malaria and Ebola are not easily distinguishable. So that prevention is infection control and quarantine. 

On the detection side, laboratory and related services to find infections and find illnesses as soon as they occur. That relates to 

some of the U.S. funding which would allow us to work with companies and other parts of the U.S. Government to optimize some 

of the testing modalities. And then surveillance, so we are tracking 

what is going on with the detection. And training of healthcare facilities to identify cases so they are found, isolated, cared for, and 

don’t cause outbreaks. And then response; the core public health 

activities of contact tracing, training of healthcare workers, surveillance, public health education, outreach, rapid response teams, and 

support diminished periods of help so that we don’t need to be 

there long-term. So we are training people to do the kind of prevention, detection, response that we are doing now. 

Ms. CASTOR. And what, if any, public health infrastructure was 

in place in West Africa beforehand? 

Mr. FRIEDEN. There were very weak systems in place prior to 

this, public health or healthcare, really a shortage of trained workers, so part of our effort is to build up those systems so that they 

can continue that for many years to come. 

52 

Ms. CASTOR. OK, and the budget request also would direct $1.98 billion to USAID, $112 million to the Department of Defense, and 

$127 million to the Department of State. Can you go through how 

funding to those agencies would assist in the broader effort? 

Mr. FRIEDEN. I would have to refer you to them for the details, 

but in general, USAID is coordinating under the DART, or Disaster 

Assistance Response Team, process, and they are enlisting many 

partners within countries, for example, for burial teams which now 

exist all over Liberia, and are rapidly and safely and respectfully 

collecting human remains of people who may have died from Ebola. 

We are also addressing some of the critically important areas of 

supporting development in areas like the Guinea forest region 

where there is a lot of resistance and some resentment, and services in that region are going to be very important in allowing us 

to get in and do Ebola control. 

Ms. CASTOR. OK. Dr. Lushniak, how would the supplemental 

funding assist the public health service in their work in West Africa? 

Mr. LUSHNIAK. I think to the large extent, certainly running the 

Monrovia Medical Unit, it is supported by multiple agencies. Within the Department of Health and Human Services, certainly, the 

supplement will assist us in that endeavor. DoD plays a key partnership role. They are really supplying us with equipment, supplies, a lot of the logistical support on the ground. USAID, as mentioned by Dr. Frieden, is really out there also pushing ahead. And 

so, you know, from our perspective is that to have a continuous 

presence on the ground, and if we strongly believe that this mission 

is important, as I do, which is providing that medical care to 

healthcare workers, that the supplemental will assure a success in 

that mission. 

Ms. CASTOR. Now, we have heard from Doctors Without Borders 

and other international organizations about the need for flexibility 

and adaptability in our response and in that budget request. Dr. 

Frieden, what measures are built into the supplemental budget request that would give us that flexibility and adaptability? 

Mr. FRIEDEN. Well, first, there is the contingency fund of $1.5 

billion requested by the President, split essentially equally between 

the State Department/USAID and HHS, including CDC. That 

would be available, for example, if the disease breaks out in another part of Africa that we need to intensively surge to, or if we 

do have an effective vaccine, to implement a vaccine campaign will 

be quite challenging. 

Second, within the budget request there is transfer authority, 

and that is extremely important so that we can adapt our response 

to what is needed. And third, within the CDC budget in particular, 

it would be a single budget line, so we would have flexibility within 

CDC to spend the resources specifically for Ebola control, as they 

will be most efficient and most effective. 

Ms. CASTOR. Thank you very much. I yield back. 

Mr. MURPHY. Gentlelady yields back. 

I now recognize Mrs. Blackburn for 5 minutes. 

Mrs. BLACKBURN. Thank you, Mr. Chairman. 

Dr. Frieden, let me come to you. As I mentioned in my opening, 

keeping Americans safe, this is where our focus ought to be. And 

53 

you said in your testimony $621 million would be used to fortify 

domestic public health strategies, and you didn’t mention the managing of waste products from patients with Ebola. And according 

to the Institutes of Medicine report from earlier this month, a patient with Ebola generates 30 to 40 times more medical waste than 

another patient. The report also states there is limited ability to 

handle Ebola medical waste in the U.S. 

So I have a couple of questions. I can take a yes-or-no answer 

on these and be very happy with that. It will help us move quickly. Will part of this funding, this $621 million, be directed to managing the medical waste products from treating Ebola patients, or 

will hospitals be expected to building on-site incinerators or 

autoclaves to decontaminate the waste? 

Mr. FRIEDEN. Yes, funding will go to support hospitals to 

strengthen their waste management systems. 

Ms. BLACKBURN. OK, and then do you have any plans to require 

sterilization of category A waste, including Ebola waste, on-site or 

as close as the source—to the source as possible? 

Mr. FRIEDEN. CDC already provides guidelines for the management of waste potentially contaminated with the Ebola virus, and 

we would continue to recommend those same guidelines. 

Ms. BLACKBURN. Does this include on-site? 

Mr. FRIEDEN. Decontamination can be done either on-site or can 

safely be moved off-site—— 

Ms. BLACKBURN. Where is it going to go? 

Mr. FRIEDEN. Where we are supporting hospitals to deal with 

Ebola, we would want that done on-site. 

Ms. BLACKBURN. All right. Kind of got a little skirting the question there. Do you plan to procure and utilize mobile medical waste 

sterilizers? 

Mr. FRIEDEN. That would be one option that could be considered. 

Ms. BLACKBURN. Do you plan to do it? 

Mr. FRIEDEN. It would depend on whether it made sense for the 

facility itself. 

Ms. BLACKBURN. OK. What about the waste in Africa where we 

are supporting efforts? 

Mr. FRIEDEN. In Africa, incineration is the method used for 

waste disposal in general. 

Ms. BLACKBURN. OK. On-site? 

Mr. FRIEDEN. Generally on-site, yes. 

Ms. BLACKBURN. On-site, OK. 

Dr. Lurie, I would like to come to you for a moment, if I may 

please. The funding request includes $157 million for BARDA to 

support the manufacture of vaccines and synthetic therapeutics for 

use in clinical trials. Would this funding be slated to support manufacturing at one of the 3 Centers for Innovation in Advanced Development and Manufacturing that were established through previous funding for BARDA, or are you looking at other potential 

manufacturing partners? 

Ms. LURIE. Right now, funding is being used, and it would be anticipated to use to support both vaccine development, vaccine manufacturing, and fill and finish vaccine capacity. Also the continued 

capacity, and fill and finish of therapeutic products such as ZMapp. 

We are actively engaged both with the Centers for Innovation in 

54 

Advance Development and Manufacturing, and with the Fill/Finish 

Network components to look at the role that they can play. 

Mrs. BLACKBURN. So you are engaging other partners. 

Ms. LURIE. We are engaging a range of partners—— 

Mrs. BLACKBURN. Private sector. 

Ms. LURIE. Yes. 

Mrs. BLACKBURN. OK. 

Ms. LURIE. We are engaging the range of partners that it is going 

to take to get us vaccine and therapeutics. 

Mrs. BLACKBURN. OK. Well, we had read Secretary Burwell’s testimony last week, as I am sure you have, from the Senate Approps. 

Committee, and it seems as if the funding for BARDA would go to 

manufacturing quantities of those products that undergo successful 

early development at NIH, and we know there are several private 

companies who have committed significant resources to development treatments or vaccines for Ebola, and we want to make certain that those companies are involved in processes going forward. 

So it is my understanding you are saying you plan to include 

them and invite them. 

Ms. LURIE. So any company with a promising product is always 

welcomed into BARDA, and we have a system to sit and talk with 

them, determine whether they have promising candidates, and for 

them to submit proposals that get evaluated. What I can tell you 

in this sense is that it is generally NIH’s role to support the early 

development of products. It is BARDA’s role to support the advanced development of products, and BARDA is, and will continue 

to support the advanced development of both vaccines and therapeutics, and to get them scaled up so that if they work, they can 

be used in a mass vaccination campaign, or in therapies. 

Mrs. BLACKBURN. Thank you. I yield back. 

Mr. MURPHY. Gentlelady yields back. 

I now recognize Mr. Waxman for 5 minutes. 

Mr. WAXMAN. Thank you, Mr. Chairman. 

Dr. Frieden, you and a number of other experts have said numerous times, and you said it here today, the key to protecting Americans from Ebola is stopping the disease at its source in West Africa. 

Can you explain the approach being taken in West Africa to contain the spread of this disease? 

Mr. FRIEDEN. In brief, to identify patients who have Ebola 

promptly, get them isolated and cared for safely, and in the event 

that individuals die, have them buried respectfully and safely without spreading disease. To turn off those 2 main drivers of the infection; unsafe care and unsafe burial. That is what we have done to 

date in every outbreak until now, but the size, scale and speed required now remains daunting. Instead of dozens or a handful of 

cases, still hundreds or thousands of cases to deal with. 

Mr. WAXMAN. So would you say the approach is working but the 

epidemic is moving too quickly to keep up with the amount of 

cases? 

Mr. FRIEDEN. I think the decrease in cases in some areas within 

West Africa is proof of principle that the approach works, but we 

are still very far from the finish line. 

55 

Mr. WAXMAN. Um-hum. Well, what are the consequences of failure in Africa? 

Mr. FRIEDEN. If we are not able to stop the Ebola epidemic in 

West Africa, the risks are very high that it would spread to other 

parts of Africa because of travel within Africa. If that were to 

occur, then it could be a matter of many years before we would be 

able to control it, and the threat to the U.S. and other countries 

would be proportionately greater. 

Mr. WAXMAN. Well, some people say if that is the concern, why 

don’t we just seal off Africa, not let people travel here from Africa. 

Would that solve the problem? 

Mr. FRIEDEN. From the standpoint of public health, we look at 

first and foremost protecting Americans from risk, protecting 

Americans from threats, and currently we have systems in place 

that trace each person who leaves one of the three affected countries, each person who arrives to the U.S., and follows them for 21 

days. We have already had people develop fever who have called 

up the Health Department with the 24/7 number that we provided 

to them, and have been safely transported and safely cared for, and 

have ruled out for Ebola, but those systems rely on knowing where 

people are coming from and how they are getting here. 

Mr. WAXMAN. The President has asked for more money in a supplemental budget. A big portion of that is going to go to our efforts 

in Africa to try to stop and contain this disease, but some of that 

money is going to be used right here in the United States to enhance U.S. Government response to the Ebola outbreak. The request includes $621 million for CDC for domestic Ebola response. 

Can you give a brief summary of what programs and initiatives are 

covered by this funding? 

Mr. FRIEDEN. Thank you. These would allow us to work with 

States so that all travelers are traced on a daily basis, and if they 

become ill, are promptly and safely taken to a facility that is ready 

to care for them. They would result in safer hospitals, not just from 

Ebola but also other infectious disease threats. There is a small research component that would allow us to implement a vaccine trial, 

probably in Sierra Leone, in the coming months to determine 

whether vaccination works. Other research would help us with 

rapid diagnostics so that we could detect more rapidly if someone 

became ill. We also would support all jurisdictions to be better prepared for Ebola and other infectious disease threats, have safer 

hospitals, more rapid response, and work very closely between the 

State and the hospital systems within the State on infection control 

generally, Ebola and other deadly threats, specifically, working 

very closely with the funding for ASPR and other parts of hospital 

preparedness. 

Mr. WAXMAN. Well, it seems to me that it shouldn’t be partisan 

in any way for us to give the grant of money the President has requested to deal with this terrible epidemic in Africa, and to protect 

Americans as well, and the request is quite balanced in helping us 

deal with the situation as we now have it. And past times, we have 

always had bipartisan support. But talking about here in the 

United States, what if we had a pandemic flu, that would certainly 

be a lot more dangerous because of how fast it could spread. Would 

these funds help us to deal with that? And secondly, are we preVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00059 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
56 

pared for a pandemic flu? Do we have a stockpile of the medications, and are we ready—as you said, we don’t know what will 

come next, but if that happened, are we ready for it? 

Mr. FRIEDEN. We always work to be better prepared today than 

we were yesterday, and better prepared tomorrow than we are 

today. A pandemic of influenza remains one of the most concerning 

possibilities in all of infectious disease threats. The funding in the 

emergency funding request would assist this country, health departments, hospitals, the healthcare system, the public, to be better 

prepared for Ebola and other infectious disease threats, such as 

pandemic influenza, yes. 

Mr. WAXMAN. OK, thank you. Thank you, Mr. Chairman. 

Mr. MURPHY. I now recognize Dr. Burgess for 5 minutes. 

Mr. BURGESS. Thank you, Mr. Chairman. 

Before I start my questioning, I would like to submit for the 

record this document from the American Hospital Association for 

the record for today’s hearing. 

Mr. MURPHY. Without objection. 

[The information follows:] 

57 

58 

59 

60 

61 

62 

63 

Mr. BURGESS. And, Dr. Frieden, the administration’s additional 

funding request states that money will go toward 50 Ebola treatment centers throughout the United States. Some States—Texas— 

have already started to designate sites on their own. So will Statedesignated centers be included in that number 50, or will that be 

in addition to? 

Mr. FRIEDEN. I will comment, and Dr. Lurie may want to continue. 

Our approach is to strengthen the statewide systems. It would be 

the States that would be responsible for—in collaboration and communication with hospitals, determining which hospitals would be 

used, but what we have asked each State to do is four things related to the active monitoring program. First, establish the program, including information flow from the State Health Department to local health departments. Second, establish a 24/7 hotline 

for any traveler or anyone who thinks they may have Ebola, to call 

so that they can be safely managed. Third, establish safe transport 

between wherever that person calls from, and the facility that the 

State has decided will be the facility to assess them or treat them 

for Ebola. And the fourth is to work with their hospitals to identify 

facilities that are able to do that assessment and treatment. 

Mr. BURGESS. I would just add, it would be great if you had a 

24/7 hotline for hospitals when they find that that suspected patient is on their doorstep at 3 o’clock in the morning. 

But, Dr. Lurie, let me ask you the same question. The 50 centers 

that are designated in the President’s budget request, is that in addition to the State-designated centers, or would those two Statedesignated centers in Texas fall under the purview of the 50 centers that President Obama is describing? 

Ms. LURIE. So as Dr. Frieden said, our process and our plans 

have been to work through the States to identify facilities. The 

process works basically—— 

Mr. BURGESS. So make—— 

Ms. LURIE [continuing]. As such—— 

Mr. BURGESS. Make it real simple. The 2 centers that Governor 

Perry has designated in the State of Texas, do those fall under the 

parameters of what the President’s budget request as it exists 

today? 

Ms. LURIE. The funding will go to the States, and the States, in 

conjunction with the hospitals, will determine which of the hospitals will serve as infectious disease containment centers or the 

Ebola treatment centers. 

Mr. BURGESS. I guess that is as close as I am going to get to an 

answer. 

Let me just ask you a question, Dr. Lurie. Do you report to Ron 

Klain? Is that someone how who is in the hierarchal reporting 

structure that you have? Is he a person to whom you report? 

Ms. LURIE. I report to the Secretary, and I interface with Mr. 

Klain on a very regular basis. 

Mr. BURGESS. Well, in your testimony, you say that, under the 

national response framework, my office, your office is responsible 

for coordinating the Emergency Support Function Number 8 Response, which is listed here. So where does Mr. Klain’s responsibility fall in the Emergency Support Function Number 8? 

64 

Ms. LURIE. So during different kinds of events in the United 

States, whether they are national disasters or whether they are 

other kinds of emergencies, either FEMA is activated, as it is for 

hurricanes and floods, and I know we have worked together in 

Texas on a number of those things, FEMA is activated in Emergency Support Function Number 8, public health and medical services are activated under that framework. 

In other kinds of emergencies—— 

Mr. BURGESS. And that is—let me just interrupt for a minute. 

And that is under the coordination and control of Secretary 

Burwell, is that correct? 

Ms. LURIE. Emergency Support Function 8, yes. 

Mr. BURGESS. Does Mr. Klain have a role with Emergency Support Function Number 8? 

Ms. LURIE. So in this situation, we have not had a declared national emergency, FEMA has not been activated, however, we do 

have, obviously, a very serious situation in the United States, and 

Mr. Klain is the national—— 

Mr. BURGESS. Let me interrupt you for a moment because—— 

Ms. LURIE [continuing]. Coordinator for this country. 

Mr. BURGESS [continuing]. My time is going to run out. So I 

guess it is not fair to say that you have an emergency plan, but 

do you have a very serious situation plan that you are working 

under? 

Ms. LURIE. We are doing very aggressive planning, both for what 

we have in the here and now, and for all the what ifs. And we work 

across HHS and with all of the rest of the components of the Federal Government on that what-if planning. 

Mr. BURGESS. And I am going to assume that you will be able 

to make the details of that plan available to the committee staff? 

Ms. LURIE. It continues to be in draft. We continue to work 

through the what-if with our partners across Government, yes. 

Mr. BURGESS. Well, yes was the answer, you will—— 

Ms. LURIE. Yes, we can—when we have the rest of the plan together, it is something that is a whole-of-Government plan, it is not 

an HHS plan. 

Mr. BURGESS. OK, well, it is time. 

And then, Dr. Frieden, I just have to ask you. We had 2 nurses 

that worked at Presbyterian Hospital that were infected. I am just 

going to tell you, when you get that call at 2 o’clock on a Sunday 

morning that a nurse has been infected, you don’t have a lot of confidence that things are working the way they were outlined. 

Do you have any insight as to how those two nurses became infected, and what we can do to protect our healthcare workers going 

forward? 

Mr. FRIEDEN. While we don’t know definitively how those infections occurred, the evidence points to them having been infected in 

the first 48 hours after Mr. Duncan was admitted to the hospital, 

before his diagnosis was confirmed. That is consistent with the period of time between onset of symptoms and exposure. It is also 

consistent with the observations of the team from CDC that arrived 

on the day of diagnosis of Mr. Duncan, and found that in the intense efforts of the healthcare workers to protect themselves, they 

may have inadvertently increased their risk by some of the ways 

65 

that they were working with personal protective equipment. And 

that is why CDC immediately strengthened the margin of safety, 

and established new guidelines for personal protective equipment 

that include, as 2 critical components, practicing repeatedly so that 

healthcare workers have comfort with the equipment they will be 

using, and direct observation of every step of putting on and taking 

off the protective equipment. 

Mr. BURGESS. And this just underscores why it is so important 

to have those treatment centers available around the country, because I can just tell you, the average ICU is not set up for that 

type of activity of the donning and doffing of the protective equipment. 

I also have a problem with the time frame that you just enumerated because Mr. Duncan’s family never became symptomatic, and 

I would suspect it is later in the course when he was throwing off 

really massive amounts of viral particles where the greater risk for 

exposure to those healthcare workers occurred, but I am sure you 

and I will have future discussions about that. 

I will yield back. 

Mr. MURPHY. And just to clarify, Dr. Frieden, during that time 

Mr. Duncan—at what point did he actually disclose that he had 

been in Western Africa and been exposed to Ebola? 

Mr. FRIEDEN. My understanding is that he disclosed that he was 

from West Africa on the earlier emergency department visit, which 

started on the 25th of September. He was admitted on the 28th of 

September. 

Mr. MURPHY. OK, thank you. 

Now Mr. Green is recognized for 5 minutes. 

Mr. GREEN. Thank you, Mr. Chairman. 

And to follow up my colleague from Texas, I know our State has 

designated two locations, but about 2 months ago I was at the 

Texas Medical Center in Houston and there was some interest in 

trying to do that, too, and that may not be one of the two locations 

that the Governor has designated, but I will have a question later 

for Dr. Gold from the University of Nebraska how it was unique 

that the University of Nebraska created that facility there and how 

it happened. 

But let me get to my questions for you, Dr. Frieden. What is the 

process and timeline for updating and communicating changes to 

protocols to local healthcare providers—because we know there was 

an issue about that last month—what is the process, or have the 

processes changed at the CDC from what we did, say, in October? 

Mr. FRIEDEN. With respect to CDC guidelines, we use the latest 

data, information and experience to develop guidelines. We consult 

widely with affected parties to get input, and then as soon as we 

have a clear set of guidelines that we communicate, we then disseminate those through a wide variety of networks. 

Mr. GREEN. What we have learned from the fear is isolation and 

personnel protection from the experience at Texas Presbyterian, 

and how are these lessons being shared with other hospitals so we 

can avoid the same errors. And, again, the feeling that somebody 

shows up at 3 o’clock at one of my not-for-profit hospitals in urban 

Houston, how are they going to be able to deal with something like 

that? 

66 

Mr. FRIEDEN. We are dealing with this from both sides of the 

equation. First, the patient side, and what we have done is for 

every single person coming from West Africa, they are greeted, 

they are asked detailed questions, their temperature is taken, and 

they are provided a care kit that includes a thermometer, a log for 

taking their temperature, a wallet card with a 24/7 number to call, 

and we have already had multiple times in the past few weeks individuals take their temperature, find that they had an elevated 

temperature, call that number, be safely transported to, and safely 

cared for in, a facility. They all ruled out for Ebola, but the system 

worked in those cases. 

We can’t guarantee that it will work in every case, and that is 

why we are working very intensively with hospitals throughout the 

U.S. to prepare them for the possibility that they could have someone with Ebola. We have released guidelines, we have done, in conjunction with the rest of HHS, training sessions, we have had hospital visits by rapid Ebola preparedness teams to more than 30 

hospitals in more than 10 States, and we will continue to work intensively with the healthcare system so that they are increasingly 

well prepared to address a possible case of Ebola. 

Mr. GREEN. The CDC is not a regulatory agency. How can you 

provide clarity over the CDC’s authority and responsibilities in setting and enforcement of these protocols? Do you have any authority 

and enforcement over hospital settings? 

Mr. FRIEDEN. CDC provides guidelines and information. We provide tools and feedback to facilities. We do not regulate in this 

area. That would be up to other entities within the Federal and 

State Governments. 

Mr. GREEN. OK, thank you. 

Dr. Lurie, without a commercial market, the development and 

manufacture of many medical countermeasures, like those against 

Ebola and other infectious diseases, require a public-private partnership. Congress recognized this when it created the Project Bioshield, successfully driving innovation by providing a stable source 

of funding so that a reliable market for medical countermeasures 

was in place. 

Dr. Lurie, as you know, the development and medical countermeasure for a biological threat agent can take a decade or more, 

and often $1 billion to develop. The U.S. Government research on 

Ebola countermeasures goes back a decade, but the level of investment and urgency was not enough to prepare us for the current situation. Can you provide a dollar figure on how much investments 

you perceive is needed for Ebola vaccines and drugs to allow us to 

get to the chance of successfully developing a product? 

Ms. LURIE. So I am sorry, I didn’t hear the last part of the question. 

Mr. GREEN. OK. Can you give—— 

Ms. LURIE. Could I provide a dollar figure for what? 

Mr. GREEN. Can you provide us an estimated dollar amount on 

how much investment you perceive is needed for Ebola vaccines 

and drugs to allow us the best chance of successfully developing 

these products? Again, like I said earlier, our research program in 

Ebola has been going on for a decade. Are there any resources you 

67 

could use that would—and how much would we need to do to get 

the drugs—— 

Ms. LURIE. Absolutely. 

Mr. GREEN [continuing]. And vaccines? 

Ms. LURIE. And, in fact, one of the reasons that we now have two 

vaccines that are finishing safety trials is because of prior investments made across the U.S. Government in trying to develop an 

Ebola vaccine, and also with Ebola therapeutics. As you know— 

may know right now, those vaccines are finishing those early trials 

and, thanks to money that was provided in the CR, we have been 

able to accelerate some of the work both on vaccines and on therapeutics. 

Whether these vaccines work is going to be something that we 

are going to learn over the next coming months with the trial in 

West Africa. At the same time, we have now gone ahead and invested in the advanced development of 3 other vaccine candidates, 

and additional ways of scaling up and making the therapeutics so 

that we never put all of our eggs in one basket. We always want 

to do better, and we will continue to do that through the investments. 

We have really appreciated the support from Congress, from 

BARDA, and Project Bioshield in this regard. 

Mr. GREEN. OK, thank you, Mr. Chairman. I know I am out of 

time, and I want to thank our colleague—our panel today, and I 

am waiting for our second panel. 

Mr. MURPHY. Gentleman yields back. 

Now I recognize the chairman emeritus, Mr. Barton, for 5 minutes. 

Mr. BARTON. Thank you, Mr. Chairman. 

And Congressman Green didn’t want to brag, but he has a family 

member who is very active in this up at Nebraska, and we appreciate his family being on the frontlines, and I am sure he is—I 

think it is your daughter—isn’t it your daughter that works up 

there? So we want to welcome out witnesses, and on the second 

panel, Dr. Lakey, from Texas, we are glad that you are here. 

My first question, I am going to ask the Rear Admiral, the Acting 

Surgeon General. I believe that we should treat this first and foremost as a health issue and not as any other kind of an issue, and 

it puzzles me that we have not really effectively put in a travel ban 

from West Africa. I know we have alerted people and all of that, 

but when we had the hearing down in Dallas-Fort Worth, at the 

airport, the answer we got was because we need to send personnel 

over there, we don’t want to prevent people traveling to here. 

As a pier public health official, as the Surgeon General, why 

would we not put in a true quarantine and just flat prevent any 

travel from West Africa? 

Mr. LUSHNIAK. Well, certainly, as stated, and have a strong belief in this, is that currently as we have it, you know, the idea of 

having a travel ban prohibits all travel. To some extent there is 

that sense of travel of healthcare workers to Western Africa, and 

I stated earlier the real resolution to this issue is solving the problem in West Africa, but at the same time, instilling a travel ban 

has a total loss of control of who enters and how they enter this 

country. And as Dr. Frieden stated earlier, we have set up these 

68 

systems, the systems that are in place right now allow us to know 

where people are coming from, it allows us to track them appropriately through the public health endeavors at the State and local 

level, and to be able ultimately to follow them appropriately, to be 

able to intervene if symptoms appear, and then be able to direct 

them, detect them appropriately and to instill the right response 

for that. 

So right now as the system works, as the Acting Surgeon General, I find that the appropriate course of action. 

Mr. BARTON. OK. Well, it just puzzles me, if we were to have a 

health outbreak, tuberculosis or something, there wouldn’t be any 

question in my area that the Texas Department of Health would 

put a true quarantine in place. And I understand some of the external reasons, but, you know, if you are trying to contain an epidemic, it is old-fashioned but an absolute ban and absolute quarantine does work. 

I want to ask Dr. Frieden, there has been some concern that perhaps we don’t really know how this disease is transmitted, and unless something has come out very recently, some of the individuals 

in Texas that were potentially infected and put on the watch list 

had no apparent means of transmission, yet they were symptomatic. Is your agency conducting any research right now to see if 

perhaps there might be more methods of transmission than we 

think exist today? 

Mr. FRIEDEN. We do a broad variety of research specifically on 

Ebola and on the public health spread and epidemiology of it. The 

two infections that occurred in this country of the two nurses at 

Texas Presbyterian are infections that occurred at a time when Mr. 

Duncan was highly infectious. He had production of large quantities of highly infectious material, through diarrhea and vomiting, 

and that would be our leading explanation of how they are most 

likely to have been infected, although we do not know for certain. 

We describe what we see, and what we see in Africa is that people become infected by caring for or touching someone who is either 

very ill with Ebola or who has died from it. And when we analyze 

the amount of virus in a patient’s body, it goes from undetectable 

when they are exposed but not ill, to very small quantities when 

they first become ill, and then as they get sicker, the quantities increase enormously. And if someone dies from Ebola, the quantities 

are quite large—— 

Mr. BARTON. Well—— 

Mr. FRIEDEN [continuing]. Of infectious material. 

Mr. BARTON [continuing]. As a medical professional yourself, 

what is your confidence level that there is no other method of 

transmission than we know about today? In other words, are you 

100 percent certain that there is no other way, are you 70 percent 

certain? 

Mr. FRIEDEN. In medicine, we say never say never. So I would 

not be surprised if there were unusual occurrences of spread from 

a variety of ways, but the way it is spreading by and large in Africa, the way it spread here, and the risk to people here are brought 

by those two main mechanisms of touching body fluids of someone 

very ill. I will mention that one of the things that we looked at in 

our new guidance in the U.S. is what is done in U.S. healthcare 

69 

facilities is very different from what is done in African healthcare 

facilities. There is more hands-on nursing care. There may be artificial respiration or ventilation of someone, and that may generate 

infectious particles and that is why we have strengthened the level 

of respiratory protection in our personal protective equipment—— 

Mr. BARTON. Thank you. 

Mr. FRIEDEN [continuing]. Guidelines. 

Mr. BARTON. Thank you, Mr. Chairman. My time has expired. 

Mr. MURPHY. Thank you. 

Now I recognize Mr. Braley for 5 minutes. 

Mr. BRALEY. Thank you, Mr. Chairman. 

And, Dr. Lurie, I want to clarify some of the questions that Congresswoman Blackburn was asking you earlier because, at our first 

hearing on October 16, Dr. Fauci was kind enough to present us 

with some materials and walked us through them, including this 

product development pipeline, which I think you described in your 

testimony, talking about early concept and product development 

being the province of NIH, the advanced development being the 

province of BARDA, then commercial manufacturing by the industry itself, and then regulatory review. And then the next page in 

his presentation dealt with Ebola therapeutics and development. It 

is my understanding these are the treatments that are being developed for the symptoms of the Ebola virus, as opposed to a vaccine 

that would hopefully prevent the virus from spreading, correct? 

And then he had a slide that talked about the Ebola vaccines that 

were in or approaching phase 1 trial. The first one is the 

GlaxoSmithKline, the second one was NewLink Genetics, which is 

based in Ames, Iowa, and when I asked him questions about that 

at the time, and I also questioned Dr. Robinson, in this particular 

slide, it appeared there were only two companies; GlaxoSmithKline 

and NewLink, that actually had phase 1 trials ongoing. 

Has there been any change to that since our hearing on October 

16? 

Ms. LURIE. Since the hearing on October 16, the phase 1 trials 

have been underway. They are almost completed. We are analyzing 

the data, and I think we are all very optimistic that we will be able 

to start the next phase of the trial, which will be a randomized control trial with both of those vaccines in West Africa. 

Mr. BRALEY. This slide indicated that there was a third company, 

Crucell, but they were not expected to engage in phase 1 trials 

until the fall of 2015, which is a substantial ways away from where 

we are today. 

Ms. LURIE. There are other potential vaccine candidates in the 

pipeline. We are supporting some of those, but you are right, they 

are behind this timeline, and we are right now focused on trying 

to figure out if these vaccines are safe and effective, and if they 

are, get them into use to control the epidemic in West Africa. 

Mr. BRALEY. And—— 

Ms. LURIE. So part of the emergency funding request will be $157 million for BARDA to continue to accelerate the development 

and manufacturing of vaccines and therapeutics for this outbreak. 

Mr. BRALEY. And my understanding from talking to the folks at 

NewLink Genetics is that these clinical trials that have been ongoing at Walter Reed and the National Institute of Allergy and InfecVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00073 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
70 

tious Disease have been progressing well, that there has been good 

rapport between the oversight agencies and the company involved, 

and that there is continuing to be ongoing interactions with the Department of Defense sponsors as well, which would be the Defense 

Threat Reduction Agency and the Joint Vaccine Acquisition Program. Is that your understanding as well? 

Ms. LURIE. That is. In fact, every week, either once a week or 

twice a week, I run a call with all of the parties, NIH, CDC, FDA, 

BARDA, the DoD components, so that we are all joined at the hip 

through every step of the process. We know what is going on, we 

share information, we know what to anticipate. 

FDA has been a really key partner in this as well because, in 

fact, it is their regulatory authority that is going to determine, you 

know, ultimately what moves forward and what doesn’t, as well as, 

obviously, the results from the trial. I never thought I would find 

myself in this situation, but I am saying we are all racing to catch 

up with FDA. It is a great situation to be in, that everybody is 

working extremely effectively together. 

Mr. BRALEY. Great. 

Dr. Lushniak, Mr. Barton asked you a question about trying to 

contain an epidemic with an absolute quarantine. Is there an Ebola 

epidemic in the United States right now? 

Mr. LUSHNIAK. There is not an Ebola epidemic in the United 

States. The epidemic is, at this point in time, limited to Western 

Africa, and once again, that is why we are trying to contain it 

there. 

Mr. BRALEY. And one of the things that we have talked about 

during these hearings is the importance of focusing on facts and 

science and medicine. In 1900, the two leading causes of death in 

this country were influenza, pneumonia and tuberculosis, and neither one of those are a leading cause of death anymore because of 

the response of science and medicine and public health. 

So when you look at the fact that, in 2012, there were 35 million 

people living with HIV around the globe, and that there are currently 14 to 15,000 diagnosed cases of Ebola, it seems to me that, 

with the proper application of science and medicine and public 

health, we should be able to manage this crisis if we devote the 

necessary resources on a global basis. Would you agree with that? 

Mr. LUSHNIAK. Yes, I agree. 

Mr. BRALEY. Thank you. 

Mr. MURPHY. Mr. Scalise, you are recognized for 5 minutes. 

Mr. SCALISE. Thank you, Mr. Chairman, and I appreciate you 

having this second hearing on Ebola. And I want to thank the panelists for coming. I would have liked to have seen Mr. Klain be a 

part of this. I know the committee has made a request for him to 

appear. I am not sure what, you know, if he is the Ebola czar, what 

his real role is if he is not going to be coming before the committees 

that hold the administration accountable, and have some transparency to talk about it. I hope he is not planning just to be a propaganda czar; that he would actually be focused on working with us 

to get solutions to this, but I do want to thank the panelists that 

are here. 

Dr. Frieden, the last time that you were here we had talked 

about a number of things. One of those was the comments that we 

71 

heard from Samaritan’s Purse. It is a group that is going to be on 

the second panel. I am not sure if you saw their testimony. One 

of the things I had asked you about were some of their comments 

they had previously made, that they were blown off, in essence, by 

your agency, and I had asked if you knew about that. You said you 

had heard about it, hadn’t looked into it. Have you looked into it 

to see what is going on? There are some people in your agency that 

maybe warrant taking advice from groups like that seriously 

enough. Can you follow up on that last conversation we had about 

those complaints that Samaritan’s Purse made? 

Mr. FRIEDEN. I am not familiar with suggestions or complaints 

or concerns that have been raised with us that we have not addressed. I have received one communication from Samaritan’s 

Purse, a very helpful communication about safety of our own staff, 

and we immediately acted upon that. 

Mr. SCALISE. At the last hearing, I had read to you some comments that they had made. One was a quote where they said they 

kind of blew me off, and then they made some other comments that 

implied that maybe they weren’t being taken seriously by your 

agency. They never said it was you, but I asked if you had looked 

into that or heard about it. Your quote was, ‘‘I don’t know that that 

occurred,’’ and then you had said you would look into it, and so 

that is why I was asking if you had looked into it since our last 

hearing. 

They make some other claims in their testimony that they are 

going to give today. This is some of the comments that they make: 

‘‘Many public health experts are telling us that we know the disease, how to fight it and how to stop it. Everything we have seen 

in this current outbreak, however, suggests that we do not know 

the science of Ebola as well as we think we do.’’ Do you agree with 

that statement, or have any response? 

Mr. FRIEDEN. I think we are certainly still learning about Ebola 

and what is the best way to fight it. That is a critical component 

of our activities, it is a critical component of the emergency funding 

request as well. 

Mr. SCALISE. All right. They also say the disease has been underestimated from day 1. Do you know if that maybe was going on, 

is it still going on, do you think that it was being underestimated, 

maybe now not being underestimated to that level? 

Mr. FRIEDEN. CDC publications estimated the degree of underreporting could be as high as a factor of 2.5 back over the summer. 

Our sense is that that is likely to have decreased in some areas. 

Fundamentally, the more out of control it gets, the more systems 

don’t keep up with it, including systems to track the disease, and 

if patients don’t have a place to come in, they are much less likely 

to be counted and accounted for. 

Mr. SCALISE. Is there any new conversation that you have had 

with the administration, especially the White House, about what 

has been talked about by a lot of our Members of having some sort 

of travel ban, or at least a holding period for folks who are over 

there, having direct contact with people in West Africa that have 

Ebola, and then come back into the United States, to at least have 

some longer period to look at them to make sure they don’t come 

72 

back with Ebola? Have you all had those conversations since we 

last met? 

Mr. FRIEDEN. Yes, we have. My top priority as CDC director is 

to protect the American people, and I have said, and others have 

said, that we will look at anything that will reduce the risk to 

Americans. What we don’t want to do is inadvertently make it 

worse by, for example, interfering with the system that we have 

now which allows us to track people when they leave, when they 

arrive, and for 21 days after. We are at 100 percent follow-up in 

most States for people who have come into this country, and that 

kind of system, if we don’t have it, could result paradoxically in a 

greater rather than a lower degree of risk. 

Mr. SCALISE. Well, let me ask you about Ron Klain because, 

again, we did ask that he come and participate in this. He has been 

designated by President Obama as the Ebola czar. Have you had 

contact with him about strategy about how to deal with this? 

Mr. FRIEDEN. Mr. Klain is the Ebola Response Coordinator. I 

have frequent contact with him. He coordinates the response of different parts of the U.S. Government. He advances—— 

Mr. SCALISE. Have the two of you all had any disagreements on 

how to approach this? 

Mr. FRIEDEN. No, we have not. 

Mr. SCALISE. None. If you did, who would ultimately make the 

decision, if you felt we ought to go this way and he felt the administration ought to go that way, is there a hierarchy right now? 

Mr. FRIEDEN. Mr. Klain has been very clear that technical decisions, scientific decisions that are the purview of CDC are made by 

CDC. 

Mr. SCALISE. All right, I am out of time, and I appreciate your 

answers. And thanks for coming again. 

Thanks. Yield back. 

Mr. MURPHY. OK, gentleman yields back. 

Now I recognize Mr. Tonko for 5 minutes. 

Mr. TONKO. Thank you, Mr. Chair, and thank you to our panelists for your dedicated work on this issue, and for appearing before 

us today. 

We have heard time and time again that the key to keeping the 

United States safe is to eradicate the virus at its source, and while 

we have had early indications of momentum begin to emerge in Liberia, it seems as if the situations in Sierra Leone and Guinea are 

not showing the same promising signs. 

So, Dr. Frieden, in your opinion, do we have the resources deployed in these countries to turn the tide of Ebola, and if not, what 

additional resources are needed? 

Mr. FRIEDEN. The emergency funding request is essential to our 

ability to both protect ourselves here at home and stop Ebola at the 

source, and also to prevent the next Ebola. There are too many 

blind spots, too many weak links in places in Africa and elsewhere 

where we have large amounts of travel, where we have animalhuman interface, and we have large numbers of people, and that 

is why all three of the CDC components of this, and all of the components of the emergency funding request are so important. The 

three CDC related components are domestic preparedness, stopping 

73 

Ebola in West Africa, and preventing the next Ebola through our 

global health security work. 

Mr. TONKO. Thank you. And I know that as of a few weeks ago, 

the count on the ground through CDC is four individuals from CDC 

in Guinea. While I know that France is taking the lead on Ebola 

response in this country, does the United States need to take a 

more leadership-active role, or does it have the capacity to do so? 

Mr. FRIEDEN. Excuse me. For the CDC-specific response, we provide a comprehensive public health approach in each of the affected 

countries. As of today, we have approximately 175 staff on the 

ground in West Africa. We actually have the most staff in Sierra 

Leone, where the needs are greatest. We also have more than 20 

staff, or roughly 20 staff, in Guinea, but there are additional needs 

for staff in Guinea, and we have worked very hard with the African 

Union and with other partners to get French-speaking staff there. 

With the cluster in Mali, we now have 12 staff as of today in Mali 

dealing with that cluster and trying to stop it at the source. 

Mr. TONKO. And what about engaging a more international impact? How does the international community get engaged to devote 

its additional resources for this world health crisis? 

Mr. FRIEDEN. There has been a very robust global response. My 

understanding is that currently contributions from other countries 

total more than $1 billion. The World Bank has been very proactive 

and effective. Also we have seen the UK stepping up in Sierra 

Leone, and increasingly French and EU support to Guinea and 

other areas. 

Mr. TONKO. Um-hum. And, Dr. Frieden, we keep hearing that 

there is a great need for medical volunteers to travel to West Africa. Do you have a sense of how many medical personnel are needed, and how would one get involved? 

Mr. FRIEDEN. For American healthcare workers, the U.S. Agency 

for International Development, USAID, maintains a Web site. On 

that Web site you can go and volunteer. 

We ask that Americans who want to be involved do so through 

another organization, so they are not going as individuals but as 

part of an organized approach. And there is a broad need for assistance, including French-speaking assistance, including not just clinical care, but also epidemiologic interventions and public health 

measures. 

Mr. TONKO. So that is reaching out for volunteers. Is there any 

activism in terms of encourage or recruiting personnel? 

Mr. FRIEDEN. There has been quite a bit of effort by individual 

organizations within the U.S., as well as USAID. For our own part 

at CDC, we are looking at epidemiologists among not only our own 

staff, but former staff and people from the broader public health 

community who may be able to deploy. 

What we are finding is that this is going to be a long road. It 

is going to take many months, and so we need people who are willing to go not just for a week or a month, but for several months 

or longer, so that they can get that maximum effectiveness by 

being there. Although for the clinical interventions, where you are 

working in the isolation unit, we would like to limit that to 4 to 

6 weeks at most so people can be well-rested, and minimize their 

chance of taking a risk that might result in infection. 

74 

Mr. TONKO. Um-hum. And, Dr. Frieden, we have heard 

anecdotally that hospitals across the country are having difficulty 

sourcing PPE. What is the CDC’s role in facilitating the PPE supply chain and the allocation of these PPEs, and could the U.S. 

ramp up manufacturing of PPE needed to contain a domestic Ebola 

outbreak? 

Mr. FRIEDEN. Dr. Lurie and ASPR can address some of the manufacturing aspects. From the CDC perspective, we operate the 

Strategic National Stockpile. We have already stockpiled PPE to 

enable us to rapidly, within hours, deploy PPE to any hospital 

within the U.S. That is one of the components of the emergency 

funding request, but in addition, we have conducted what are 

called REP, or rapid emergency preparedness, visits to more than 

30 hospitals in more than 10 States. One component of that is addressing whether they have sufficient PPE. We have prioritized 

hospitals near those five airports where people come in, or where 

a large number of the African diaspora live, and we already have 

identified dozens of hospitals which are prepared in terms of their 

procedures and have ample PPE, but we understand that not every 

hospital in America can get every amount of personal protective 

equipment they want, and that is why Dr. Lurie’s office has been 

working closely with manufacturers to both ramp up manufacture 

and prioritize those facilities most likely to need it. And we have 

been working with the SNS, or Strategic National Stockpile, to 

have PPE that we could deploy very quickly to hospitals around 

the country. 

Mr. TONKO. Thank you. 

I yield back, Mr. Chair. 

Mr. MURPHY. Thank you. 

Mr. Harper is recognized for 5 minutes. 

Mr. HARPER. Thank you, Mr. Chairman, and thanks to each of 

you for being here and shedding some light on this evolving situation. 

And both you, Dr. Frieden, and you, Dr. Lurie, have told us that 

this emergency funding request supports non-immediate, nonEbola-specific funding as part of this. Not all of this would be directly for Ebola, would it? 

Mr. FRIEDEN. No, I would disagree with that. 

Mr. HARPER. OK. 

Mr. FRIEDEN. The request is divided into 2 components; immediate and contingency. 

Mr. HARPER. All right. 

Mr. FRIEDEN. All of it is addressing Ebola. It addresses it with 

respect to the CDC in three ways; domestic preparedness for Ebola 

and other infectious disease threats, because we think it would be 

most responsible to not only address Ebola, but also strengthen our 

system more broadly. Stopping Ebola in West Africa, and addressing the risk that there will be another Ebola outbreak, spread of 

Ebola, or spread of a disease like Ebola elsewhere in the world 

through the global health security component. 

Mr. HARPER. Could not some of that be handled through the traditional appropriations process? 

Mr. FRIEDEN. The situation is urgent with respect to Ebola. CDC 

models indicate that for each month of delay in control, the size of 

75 

the outbreak can triple. So as a CDC director, I am not going to 

address the mechanism, but I can say that the need for urgent 

funds, with flexibility in those use of funds, is crucial. 

Mr. HARPER. If I could, Dr. Frieden, ask you, you had commented 

earlier that 2,000 travelers had been monitored, or are being monitored. How many are being monitored this moment? What is that 

number? 

Mr. FRIEDEN. It is roughly 1,500. The number of travelers entering is lower than it had been previously. 

Mr. HARPER. Who maintains that list of who is being monitored? 

Mr. FRIEDEN. So every person who comes through, goes through 

the CBP process, Customs and Border Protection. We work in conjunction with CBP. That information is collected from the travelers, 

and within hours, we provide it to each State health department. 

We then monitor with the State health departments and resolve 

challenges, if someone is hard to find or moves from State to State. 

Mr. HARPER. OK, are there any that were being monitored that 

you have lost track of? 

Mr. FRIEDEN. A tiny fraction. Actually, less than 1 percent have 

been monitored and then not found. Some of those were later found 

to have left the country to go back on travel or otherwise. The program is relatively new, it only started about a month ago, and 

what we are finding is an excellent participation from the States 

and the travelers, but it is challenging, and one of the things that 

would be supported in the emergency funding request are funds for 

State health departments to operate those systems. 

Mr. HARPER. And of those that are being monitored, how many 

are being told to seek medical attention? 

Mr. FRIEDEN. We do expect that there will be a steady stream 

of people with symptoms. It you just take a set of 1,500 adults, you 

are going to expect some to have flu, some type of other illnesses, 

and from West Africa, more, because malaria is common. So, for example, in the past several weeks, there have been four individuals 

who used the care kit to check and report Ebola, that we provided 

them at the airport, took their temperature, found that it was elevated, called the number that they were provided with, were safely 

transported to a healthcare facility, and safely cared for there. 

They all ruled out for Ebola, but they were cared for in a safe way. 

Mr. HARPER. All right, let me ask for just a moment. We talked 

a little bit today about waste management, and what to do about 

the waste of treated Ebola patients. Is any of that waste being 

transported across the country as part of this process? 

Mr. FRIEDEN. My understanding is that some of the facilities are 

autoclaving it, and that the decision of the waste management companies was then to take that autoclaved material, which is, as far 

as everything we know, sterile, and then moving it to another State 

for incineration. 

Mr. HARPER. OK, and so that is meaning that the waste is being 

transported across the country? 

Mr. FRIEDEN. This is really a—— 

Mr. HARPER. I know it is being autoclaved, but anything not 

being autoclaved that is being transported? 

Mr. FRIEDEN. I am not aware of anything in that category at 

present. 

76 

Mr. HARPER. If it is being transported through various States, 

are the States notified of that transport? 

Mr. FRIEDEN. I am not familiar with the details. The EPA has 

been looking at different measures. They have had a meeting with 

the medical waste hauling industry to get input from them. We 

have worked with the Department of Transportation, and what we 

have done in the individual cases is ensure that there is the appropriate authority in place from the Federal level, from DOT, and 

from the State level for the management of waste. 

Mr. HARPER. I yield back. 

Mr. MURPHY. Mr. Long, you are recognized for 5 minutes. 

Mr. LONG. Thank you, Mr. Chairman. 

Dr.—is it Lushniak? 

Mr. LUSHNIAK. Yes. 

Mr. LONG. OK, you said that a travel ban, I think I am quoting 

you right, would cause us to lose contact on how many people are 

traveling to this country. What do you mean by that? 

Mr. LUSHNIAK. Well, right now, we have a system, and the system is an open system. We know when people are entering, we 

know where they are coming from, we know, through our cooperative efforts with the Customs and Border Protection people, of 

when they are arriving. They are arriving through five funnels, airports, right now, and we have that connectivity. With a travel ban, 

you know, the essence of a travel ban is what—no one moves, however—— 

Mr. LONG. It is from those countries—— 

Mr. LUSHNIAK. It is from those countries—— 

Mr. LONG [continuing]. That are hot zones. 

Mr. LUSHNIAK. But at the same time, there is this potential that 

people move from country A to country B, from B to C, from C to 

the United States, and they can very well be from Western Africa. 

So in our, you know, or my assessment of this, in essence, is what 

we have right now is a system, and a system that works following 

these individuals who are coming from Western Africa, from the affected nations—— 

Mr. LONG. But if they weren’t coming, if we had a travel ban on 

them, how could we lose track of them? 

Mr. LUSHNIAK. Well, through multiple routes. It is rerouting 

from one country to another, to another. In other words, the United 

States—— 

Mr. LONG. They are not going to have a passport or a visa or 

something that says where they started? 

Mr. LUSHNIAK. Well, again, that system can be sort of worked 

around, if you will. You know, right now, we have a precise system, 

a system that is allowed to follow people who come in. We know 

where they are coming in from, which allows us to follow them. 

Mr. LONG. I am from Missouri and you have to show me. I mean 

that doesn’t follow to me, it doesn’t make any sense that if we had 

a travel ban from these hot zone countries, if they weren’t coming 

in from those countries, how we could lose track of them. 

Mr. LUSHNIAK. Well—— 

Mr. LONG. If they are not coming in the first place—— 

Mr. LUSHNIAK. Um-hum. 

77 

Mr. LONG [continuing]. And if they want to do a workaround, we 

are going to have on their passport where they started, correct? 

Mr. LUSHNIAK. Potentially, if the passports are correct, if they 

have not been manipulated. 

Mr. LONG. Dr. Frieden, let me ask you. You were talking about 

the travel ban also, and you said that there are less people coming 

in now, and the last time we were here, I believe it was October 

the 16th, when you were last in to testify, at that time, the number 

we were using was 100 to 150 people per day. Do we know what 

that number is now? 

Mr. FRIEDEN. From the data that I have seen until recently, it 

has been closer to 70 to 80 per day. 

Mr. LONG. So it has been cut by about 50 percent for one reason 

or another. 

Mr. FRIEDEN. That is my understanding. 

Mr. LONG. And some people seem to think that if we just wrote 

a big check or gave you an unlimited checkbook, that this problem 

would go away. Do you think enough money would fix this problem? 

Mr. FRIEDEN. I think we have the ability to stop Ebola, but that 

is going to require doing what the emergency funding request asks 

for, strengthening our system here at home, stopping it at the 

source in Africa, and preventing another Ebola or Ebola-like situation where the world is most vulnerable. 

Mr. LONG. There was a story out yesterday on the AP, and I am 

sure you have seen the story, of a nurse that was diagnosed with 

Ebola in Mali, and she was diagnosed with Ebola after she had deceased. That is the first time they knew she had Ebola. And I know 

she worked in a hospital and a care center that dealt with the elite. 

Some people would probably call them the 1 percent of Mali, but 

she dealt with people in the elite, also U.N. peacekeepers that had 

been injured, and after she deceased, they found out she had Ebola 

and they didn’t know where it had come from. And the first Ebola 

death in Mali was 8 days after we had our last hearing in here, 

I think it was the 24th of October was the first death. Then they 

went back and they were trying to figure out how she had contracted this, and then they went back and they found out that 

there was a 70-year-old gentleman that had come from, I don’t 

know if it was Sierra Leone or where it was, but one of the—I 

think it was Guinea, he came from Guinea—and apparently the 

person that brought him to the hospital later deceased, they are 

not sure that was Ebola, but they found out that instead of kidney 

disease, he deceased from Ebola. And it is just disconcerting to me 

and my constituents how, in a hospital in that area, that they 

didn’t even know that she obviously had symptoms before she 

passed away from Ebola. And one thing, just to wrap up really 

quickly, I know I am kind of hitting two or three different areas, 

but Dr. Spencer, we heard one of the folks on the other side of the 

aisle earlier say that he self-quarantined, took care of himself. Was 

he not very misleading—he didn’t answer where he had been. He 

said he had been home in his apartment, and they checked the subway passes and they checked his credit card and things and found 

out that he had actually been to the bowling alley, that pizza parlor, and taking public transportation, did he not, in New York? 

78 

Mr. FRIEDEN. So in terms of the Mali situation, we have 12 staff 

on the ground there now. 

Mr. LONG. Right. 

Mr. FRIEDEN. And as—— 

Mr. LONG. And they have been there how long? 

Mr. FRIEDEN. We have had staff in Mali since before their first 

case—— 

Mr. LONG. OK. 

Mr. FRIEDEN [continuing]. Helping them with Ebola preparedness. And then the 2-year-old who died, who you mentioned, was 

unrelated as far as we know to the current case. The 70-year-old 

gentleman who died actually lives in a town that is on the border. 

Mr. LONG. I am talking about a nurse that passed away, not a 

2-year-old. I didn’t mention a 2-year-old, so this—— 

Mr. FRIEDEN. No, the source case for that nurse is the 70-yearold who you mentioned, sir. He lived in the town of Kurmali, which 

is on the border between Mali and Guinea, and his Ebola diagnosis 

was not recognized. He had other health problems. People thought 

he had died from the other health problems. And there is now a 

cluster of cases there, and we are working very intensively to try 

to stop it because, given the challenges of Mali, if Ebola gets into 

Mali, it is going to be very hard to get out, so we are hoping to 

be able to stop that—— 

Mr. LONG. And they went back 3 weeks later and tried to sanitize the mosque that he had been prepared for burial in, correct? 

Mr. FRIEDEN. That is my understanding. 

Mr. LONG. So I would like to see, as I said back on the 16th, a 

travel ban, and I still don’t understand how you can lose track of 

people that never came in the first place. 

I yield back. 

Mr. MURPHY. Thank you. 

Mrs. Ellmers, you are recognized for 5 minutes. 

Mrs. ELLMERS. Thank you, Mr. Chairman, and thank you to our 

panel. 

Dr. Frieden, one of the things that I have been doing is reaching 

out to the hospitals in North Carolina, and in my district alone, I 

have a number of hospitals that are saying that they are experiencing delays in receiving some of the protective equipment and 

protective wear that they need—specifically, a short supply of 

Tyvek suits, shrouds, and N95 masks. They are being told that it 

could be 6 to 8 weeks, or possibly even longer. What role does the 

CDC play in this, and why would there be a delay in this equipment? 

Mr. FRIEDEN. We have looked at three levels of hospitals. First, 

the hospitals around the airports. We want to make sure that they 

have ample supply. Also, the hospitals, I should say, which are the 

specialty facilities like Nebraska, Emory and NIH. Second is the facilities where large numbers of people from the African diaspora 

live, where we might have another case. And third is all of the 

other facilities in the country. And given the number of facilities, 

there is not currently enough PPE on the market of some of the 

products to give every hospital as much as they would like. 

At CDC, we have a Strategic National Stockpile, and that stockpile already has enough PPE to distribute to hospitals that urVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00082 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
79 

gently need it within hours. We also have worked, through our 

rapid Ebola preparedness teams, or REP teams, with several dozen 

hospitals around the country to get them ready. When we work 

with them, we have found that, although they might have shortages of some protective equipment, they have been able to meet 

those shortages by contacting the manufacturers. And I understand 

that what Dr. Lurie and her office has done is to work with the 

manufacturers to both scale up, so they are working very hard to 

produce more, and prioritize facilities that are most likely to need 

supplies. For some of the products, such as N95s—— 

Mrs. ELLMERS. Um-hum. 

Mr. FRIEDEN [continuing]. We have ample supplies in the Strategic National Stockpile, and we could provide as needed. 

Mrs. ELLMERS. OK. And, Dr. Lurie, do you want to comment on 

that as well? 

Ms. LURIE. Sure. One of the things that my office has done 

through our critical infrastructure programs, since the very beginning, is we try to work with the manufacturers and distributors. 

Mrs. ELLMERS. Um-hum. 

Ms. LURIE. I have personally spoken to the leadership at each of 

the manufacturing companies, and each of them now have gone to 

24/7—— 

Mrs. ELLMERS. Manufacturing. 

Ms. LURIE [continuing]. Three shifts a day manufacturing. 

Mrs. ELLMERS. Um-hum. 

Ms. LURIE. In addition, they have all made a commitment to 

work with us, and we are actively doing this so that if a hospital 

is on our first list of being—— 

Mrs. ELLMERS. Um-hum. 

Ms. LURIE [continuing]. Really ready to take care of Ebola patients, or needs PPE urgently, they will prioritize the orders. 

What they told me, very interestingly, is that because a lot of 

people are frightened, that many hospitals are, they think, double 

and triple ordering PPE from different distributors and different 

manufacturers because they want to be sure that they get some. 

Mrs. ELLMERS. Um-hum. 

Ms. LURIE. So part of our job is to be sure working within that 

people get what they need. And as Dr. Frieden said, through the 

Strategic National Stockpile, we are very confident that we can get 

enough PPE to any hospital that has an Ebola patient. 

Mrs. ELLMERS. OK. 

Ms. LURIE. We also want to be sure that they have enough. The 

manufacturers and distributors have also developed some training 

material, so you don’t have to train on real PPE. They will go out 

to a facility—— 

Mrs. ELLMERS. Um-hum. 

Ms. LURIE [continuing]. And let you use other kinds of—— 

Mrs. ELLMERS. Um-hum. 

Ms. LURIE [continuing]. Samples to practice. 

Mrs. ELLMERS. To practice, OK. 

Dr. Frieden, in relation to travel, I have been in touch with my 

local airport, Raleigh-Durham International, and obviously, that is 

not one of the five designated airports, but I am concerned about 

our Customs and Border Protection officers. They are the first line. 

80 

They would be the first to come in contact. They are not healthcare 

professionals. With this increased threat of Ebola, has the CDC 

prepared or dedicated additional funds to those airports outside of 

the five designated to help with training and personnel issues? 

Mr. FRIEDEN. Part of the emergency funding request is to ramp 

up some of the quarantine services. Our focus is working in the five 

funneled airports now, and we have worked very closely with Customs and Border Protection. It has been an excellent partnership. 

We have provided training, information, but we understand that 

there is a desire for more information. With the funneling process, 

we are now able to ensure that almost all travelers go to those five 

airports. 

Mrs. ELLMERS. One last question: Is the CDC working with 

OSHA and Department of Labor on helping hospitals to be trained 

and up and ready for the preparedness? 

Mr. FRIEDEN. Yes, OSHA has been part of the CDC teams and 

offers its services and information to hospitals that are working on 

preparedness. 

Mrs. ELLMERS. OK, great. Thank you. 

Mr. FRIEDEN. Thank you. 

Mrs. ELLMERS. And I just want to say also that I wish that Mr. 

Klain was here with us today as part of this panel because I think 

the information that our new Ebola czar—that he could provide 

some very important information, so I just want to state that. 

Thank you. 

Mr. MURPHY. The gentlelady yields back. 

I now recognize Mr. Olson for 5 minutes. 

Mr. OLSON. I thank the Chair. And welcome to our witnesses. 

My home is Texas 22. It is a suburban Houston district. Many 

folks who live there work down at the Texas Medical Center, and 

many live in rural parts of Texas 22. Needville, Texas, where cotton is still king. 

The Ebola case in Dallas spooked them. It spooked them badly. 

Two schools in Cleveland, Texas, shut down for days because two 

students were on a flight coming back from Cleveland with that 

nurse who had been exposed. Cleveland is closer to Houston than 

it is to Dallas. Galveston, Texas, had a cruise ship docked there 

came home early because a nurse from Dallas self-imposed-quarantined herself in her cabin. The waste coming from Dallas is coming down to Galveston UTMB to be incinerated in 55 gallon drums, 

1,800 degree Fahrenheit to completely burn the waste from treating Ebola cases in Dallas. 

Everything that goes to Galveston comes through Texas 22. One 

common frustration I have heard over and over back home is the 

deluge of information coming from CDC and all of you all. It is confusing and overwhelming. I have heard that from big hospital systems and small providers. Emergency centers like St. Michaels in 

my own town of Sugarland, Texas. I am worried about the little 

guys like St. Michaels. 

Now, the question for all three panelists, the first one is for you, 

Dr. Frieden. What is your organization doing to ensure that small 

guys like St. Michaels are ready if an active Ebola patient shows 

up at 2:00 in the morning on Thanksgiving night? 

81 

Mr. FRIEDEN. Three things. First, we are working with the travelers themselves so that they know where to go, they have a number to call, they are checking their own temperature so that they 

can promptly identify if they have symptoms and be cared for before they become severely infectious. Second, we are providing information through our Web site, through webinars, through demonstration and training practices to hospitals throughout the U.S., 

as well as hands-on training through our REP teams and our 

CERT Teams if there were to be a case. And third, we are working 

very closely with State health departments which we really think 

are key here. And one of the critical components of the emergency 

funding request is strengthening and providing more resources to 

state health departments exactly for this; to strengthen infection 

control for Ebola, other deadly threats, and things that are daily 

endangering the health of patients throughout the country. And we 

think that state health departments and hospitals have a critical 

role to play, and to maximize the impact of that, it will require the 

resources and it will require taking an approach that addresses 

Ebola as well as other deadly threats, and strengthens our everyday systems of infection control. 

Mr. OLSON. Dr. Lurie, how about yourself, ma’am? HHS helping 

St. Michaels? 

Ms. LURIE. Helping St. Michaels? Well, so one of the things that 

we have done through our Hospital Preparedness Program is reach 

out to all of the hospitals around the country. Hospitals are now 

organized into coalitions, which are community-level collections of 

hospitals and dialysis facilities and nursing homes and others. 

Texas has a very well organized system of this, and reaching out 

through them, they are able to reach to St. Michaels, number one, 

to say if they needed personal protective equipment, could they get 

it through their coalition. If they needed help with exercises and 

training, they could get it through their coalition. Number two, as 

I mentioned before, we have had a very aggressive national outreach and education campaign that has been open to healthcare 

providers, including healthcare providers from St. Michaels and 

anywhere else around the country. People can take advantage of 

numerous phone calls and webinars. They have reached nurses, 

they have reached doctors, they have reached hospital administrators, they have reached EMS professionals around the country. At 

this point, we have reached over 360,000 people across the United 

States with this. 

So finally, it is our goal that every hospital, including hospitals 

like St. Michaels, will be able, as Dr. Frieden says, to think Ebola, 

to recognize a case, to safely isolate a case, and to be able to get 

help. And finally, through the state health departments, and I 

know you will hear from Dr. Lakey—— 

Mr. OLSON. Yes. 

Ms. LURIE [continuing]. In a little while, they call the state 

health department, and if they have questions or concerns about a 

patient with an Ebola-like syndrome, the state is in a very good position to help as well. 

Mr. OLSON. And, Dr. Lushniak, after your question, but one more 

question to you, Dr. Frieden. You were quoted on October 2 saying, 

82 

this is a quote, ‘‘Essentially, any hospital in the country can take 

care of Ebola.’’ Do you stand by that quote today? Any hospital. 

Mr. FRIEDEN. Clearly, it is much harder to care for Ebola safely 

in this country than we had recognized. It is the case that every 

hospital in America should be ready to recognize Ebola, isolate 

someone safely, and get help so that they can provide effective 

care. That is why we established the CERT Team, CDC Ebola Response Team, that will fly in at a moment’s notice for a highly suspected or confirmed case, to help hospitals throughout the country. 

Mr. OLSON. Thank you. 

Yield back. 

Mr. MURPHY. Now I recognize Mr. Johnson for 5 minutes. 

Mr. JOHNSON. Thank you, Mr. Chairman. And I too want to 

thank the panel for joining us today. Thank you very much. 

Dr. Frieden, have any other States also applied stricter standards than the CDC has in terms of how to handle Ebola? 

Mr. FRIEDEN. CDC guidelines are just that, for States, and 

States are free to be stricter than that. We are gratified that most 

have followed our standards, and really what we say is pretty 

clear—— 

Mr. JOHNSON. But do you know if any States have stricter standards? 

Mr. FRIEDEN. Yes, some do. 

Mr. JOHNSON. OK. All right. Why do you think the States are 

adopting stricter standards than the CDC? Are you confident that 

your standards, the CDC guidelines and standards, are strong 

enough? 

Mr. FRIEDEN. We believe that our standards, if followed, are protective of the public. They require that people who may be at any 

elevated risk, or some risk, rather, those individuals have their 

temperature monitored every day by direct active monitoring. And 

that is something that allows us to interact with the person, to talk 

with them, and to determine on an individual basis if they should 

stay home that day, or if it might be reasonable to allow them to 

do other things. 

Mr. JOHNSON. Have you talked to any of the States that have 

stricter standards, to find out their rationale for the stricter standards? 

Mr. FRIEDEN. I have had some communication with some of the 

individuals involved, and understand some of their thinking process. The number of individuals who are subject to those stricter 

standards is really quite small, and all of those individuals, by our 

standards, should be in what is called direct active monitoring, 

which means someone actually watches them take their temperature each day, has a conversation with them, and confirms that 

they are healthy and don’t have a fever. 

Mr. JOHNSON. OK. The last time that you were with us, we 

talked about having tested these standards. Have the standards 

been fully tested, the guidelines been fully tested across the country, back to what my colleague from Texas just mentioned, so that 

every hospital knows what to do? Have they been tested? 

Mr. FRIEDEN. So the standards in monitoring travelers are being 

implemented now by every State in the country, or virtually every 

83 

State in the country, tracking people coming back from West Africa, monitoring them for fever—— 

Mr. JOHNSON. Have they been tested? 

Mr. FRIEDEN. I am not sure I understand your question, but with 

respect to the traveling—— 

Mr. JOHNSON. Then let me explain the question. You know, going 

back to my military experience, and I think some of the gentlemen 

here can understand that, we do things called operational readiness inspections. We don’t wait for the bullets to start flying before 

we know what we are going to do when they do start flying. You 

come to Appalachia, Ohio, there are lots of little community hospitals that dot our region. Are those hospitals fully up to speed, 

have they tested and have they signed off on any kind of guidelines 

that they have tested their Ebola process? 

Mr. FRIEDEN. In terms of hospital preparedness, many hospitals 

have undertaken drills. We have also—— 

Mr. JOHNSON. Has CDC mandated any drills to—— 

Mr. FRIEDEN. CDC does not mandate that hospitals do drills. We 

provide guidance, support, and resources for hospitals to do that. 

Mr. JOHNSON. Have you recommended that they conduct drills? 

Mr. FRIEDEN. Yes, and we have been directly involved with them 

in doing that, and we have reviewed for the REP-visited hospitals, 

those that are most likely to receive a case, we have visited those 

hospitals, we have overseen their drills, we have overseen their 

preparedness, and we have worked with them on advancing their 

preparedness. 

Mr. JOHNSON. OK. It is my understanding there are several 

Ebola centers scattered across the country, also referred to as infectious disease centers. Most of them have a patient capacity of one 

to two people. As of right now, most individuals with Ebola treated 

in the United States have been transported to one of these centers 

to better manage their illness. 

In the event that a larger number of cases were to show up in 

the U.S., how does the CDC plan to treat a patient load that exceeds the capacity of available bed space in those centers? 

Mr. FRIEDEN. The challenge of a cluster of Ebola would be substantial, and it would be a matter of using all available—— 

Mr. JOHNSON. Define a cluster. 

Mr. FRIEDEN. It would be a handful of cases. It could be 5 or 10 

cases. 

Mr. JOHNSON. OK. 

Mr. FRIEDEN. In a kind of practical worst case scenario, this is 

something that could be seen. In this case, we would use all available local resources, if need be, surging healthcare workers in, and 

we would also transport patients to facilities around the U.S. 

where they could be treated. 

Mr. JOHNSON. These centers are set up to handle one or two patients because of the unique requirements of the disease, the virus. 

Do we have transportation systems that are capable of transporting 

Ebola patients if that outbreak were to be bigger than the one or 

two that we are talking about? 

Mr. FRIEDEN. We have some transportation facilities for Ebola 

patients in the U.S. We are working with the State Department 

and others to increase the capacity to transport patients. 

84 

Mr. JOHNSON. What about those who might be transported to 

other places, would they be receiving lower quality care, in your 

mind, than at one of the infectious disease centers? 

Mr. FRIEDEN. No, we think the quality of care can be provided. 

It is really an intensive care unit care, and CDC clinicians have 

consulted on the care of every single patient cared for in the U.S., 

and provided to each and every one of them access to experimental 

treatments and state-of-the-art care. 

Mr. JOHNSON. OK. 

Mr. MURPHY. Gentleman’s time has expired. 

Mr. JOHNSON. Thank you. I yield back. 

Mr. MURPHY. Thank you. 

Ms. DeGette, do you have questions that you wanted to ask? 

Ms. DEGETTE. Go ahead. 

Mr. MURPHY. She is going to yield at this point. 

I now recognize Mr. Griffith for 5 minutes. 

Mr. GRIFFITH. Thank you, Mr. Chairman. Dr. Frieden, I am 

going to try to move through these as quickly as I can, so I appreciate short answers. 

You are aware that the Secretary of HHS is able to transfer 

funding from your department to other departments, isn’t that correct? She can take funding from your department and stick it 

somewhere else, isn’t that correct? 

Mr. FRIEDEN. There is limited transfer authority as far as my 

understanding goes. 

Mr. GRIFFITH. And when that happens, are you notified, is she 

required to tell you that she has transferred funds? 

Mr. FRIEDEN. As far as I know, yes. 

Mr. GRIFFITH. And has the Secretary transferred funds in 2014 

from the division of Emerging and Zoonotic Infectious Disease? 

Mr. FRIEDEN. I—— 

Mr. GRIFFITH. Yes or no? 

Mr. FRIEDEN. I don’t know the answer to that off-hand. I could 

get back to you with that information. 

Mr. GRIFFITH. If you could get that information for me? 

Mr. FRIEDEN. Yes. 

Mr. GRIFFITH. And I believe that that particular division would 

be a part of the Ebola response, I am correct in that? 

Mr. FRIEDEN. That is correct. 

Mr. GRIFFITH. And do you know whether or not the Secretary 

has transferred money from the CDC’s global health programs? 

Mr. FRIEDEN. I would have to get back to you on that as well. 

Mr. GRIFFITH. All right. Likewise, the same would be on the 

CDC’s Public Health Preparedness and Response Division? 

Mr. FRIEDEN. I would have to get back to you. 

Mr. GRIFFITH. And both of those also would be a part of your 

Ebola response, wouldn’t they? 

Mr. FRIEDEN. Yes, they would. Yes, they are. 

Mr. GRIFFITH. Now, you have indicated that you don’t know 

about whether these monies were transferred. Do you know if any 

monies were transferred at all during 2014? Do you have any information? 

Mr. FRIEDEN. There is a Secretary’s transfer, but I don’t know 

the details of what has been done. 

85 

Mr. GRIFFITH. OK, and so you don’t know the details. So you 

would not know if any of this was transferred to help support the 

financial underpinnings of the Obamacare, ACA? 

Mr. FRIEDEN. I don’t—I do not know. 

Mr. GRIFFITH. And likewise, do you know if any transfers were 

made by the administration for children and families to care for increasing number of unaccompanied children who arrived in the 

United States? 

Mr. FRIEDEN. I am not familiar with that financial—— 

Mr. GRIFFITH. You are not familiar with that, but would you get 

us the answers to all of those? 

Mr. FRIEDEN. We can certainly get you those answers. 

Mr. GRIFFITH. Likewise, I am curious, the President apparently 

has requested a fair amount of money, and part of that is related 

to Ebola and part of that is $1.54 billion in contingency funding. 

Some of that is supposed to go to HHS, it says in his letter, to 

make resources available to respond to evolving epidemic both domestically and internationally. And I am looking here and it says 

that, while $751 million of that is to go to HHS, it then talks about 

transferring those funds over to Homeland Security to increase 

Customs and Border Control operations. Have you been in the loop 

on that? Do you know what kind of money you all are getting, and 

what are they talking about with Customs and Border Control operations? 

Mr. FRIEDEN. We work very closely with the CBP, and we understand the need for contingency funds for Ebola in case, for example, 

Ebola would spread to another country that required a very intensive, extensive response. So that flexibility is a critical component 

of the emergency funding request. 

Mr. GRIFFITH. OK, and that funding request is, as was pointed 

out in an editorial by David Satcher, and I hope I am pronouncing 

that right, a former director of CDC, and a former Surgeon General. That request by the President is actually greater than what 

we have been spending on Alzheimer’s, isn’t that correct? 

Mr. FRIEDEN. I don’t know Alzheimer’s funding details off-hand. 

Mr. GRIFFITH. All right, and in regard to Mr. Klain, have you all 

had sit-down, face-to-face meetings? 

Mr. FRIEDEN. Yes. 

Mr. GRIFFITH. And how many of those meetings have you all 

been—— 

Mr. FRIEDEN. Well, I would have to get back to you with the 

exact number. 

Mr. GRIFFITH. If you could give me that number, I would greatly 

appreciate that. That would be very, very helpful. 

Now, in some of the outbreaks in the past, historically, in Ebola 

that have occurred in Africa, isn’t it true that there are sometimes 

that we have an outbreak and we don’t know where the disease actually came from, where it was picked up? 

Mr. FRIEDEN. We have not identified definitively the animal reservoir of Ebola. We think it may be bats or bush meat, but we have 

not determined that. We have determined it for a similar virus, 

Marburg, from research that CDC scientists did. 

86 

Mr. GRIFFITH. And the meat, I understand. The bats, would that 

be from excrement? I mean how would the bats spread it, or are 

they eating the bats as well? 

Mr. FRIEDEN. Well, it may be saliva, it may be carried—bats, as 

mammals, carry a lot of pathogens that are similar to the pathogens that infect humans. 

Mr. GRIFFITH. But this is just 1 of many areas where we are not 

really 100 percent sure of how the disease is spread, particularly 

in Africa? 

Mr. FRIEDEN. Well, I would clarify. We are not sure of the animal 

reservoir. From all of the experience we have had spread among 

human populations is from either unsafe care or unsafe burial in 

the outbreaks that we have assessed so far. 

Mr. GRIFFITH. So that is once there has been an outbreak, but 

there are occasions when the outbreak just starts and nobody had 

it there before, so it couldn’t have come from human contact, it had 

to come from this animal reservoir, and we are not sure exactly 

what animals carry it, whether or not it is, you indicated spittle, 

excrement, what else? We do know that it is transmitted if you eat 

a diseased animal, is that correct? 

Mr. FRIEDEN. It may be actually not so much the consumption 

of bush meat, but the hunting and handling and cleaning of bush 

meat where you may get exposed to blood and other body fluids. 

Mr. GRIFFITH. OK. 

I appreciate it, and yield back. 

Mr. MURPHY. Now recognize Ms. DeGette for 5 minutes. 

Ms. DEGETTE. Thank you, Mr. Chairman. And I want to apologize to you and to the panel for running in and out. The Democratic leadership right now is actually working on who our next 

ranking member of this full committee is going to be. It is not 

going to be me. Thank you for your vote of confidence. And so I just 

want to ask a few questions, and then I am going to leave you in 

the capable hands of Mr. Green. 

Dr. Frieden, the first thing I wanted to talk to you about is the 

contingency fund that has been requested in the emergency supplemental. What exactly is the purpose of that fund, and what would 

it be used for? 

Mr. FRIEDEN. The contingency fund is to deal with the unpredictable nature of Ebola, the possibility that it might spread to countries where it is not currently in place, and might require very extensive, expensive control measures there. Also that we might have 

new interventions, such as a vaccine, and need a large and potentially expensive program to implement a vaccine program in affected communities and for healthcare workers. 

Ms. DEGETTE. And why would you need to do that through a contingency fund and not through an additional emergency supplemental, if either of those situations presented themselves? 

Mr. FRIEDEN. You know, in the words of one of my staff at CDC, 

in the case of Ebola, it is the lack of speed that kills. We need to 

be able to respond very quickly to changing conditions on the 

ground. 

Ms. DEGETTE. And we are seeing that right now in Africa, is that 

right? 

Mr. FRIEDEN. That is. There—— 

87 

Ms. DEGETTE. Everything is changing very quickly in Africa. 

Mr. FRIEDEN. Absolutely. We are responding to a cluster in Mali, 

we are moving out with CDC disease detectives into very remote 

rural areas to address clusters of disease before they become large 

outbreaks. 

Ms. DEGETTE. Do you have a sense of why the number of cases 

in Liberia has recently dropped? 

Mr. FRIEDEN. We believe this is proof of principle, that the approach that we are recommending can work, but we are still seeing 

large numbers of cases in at least 13 of the 15 counties of Liberia. 

We have seen that decrease taper off so that we have seen a leveling-off of cases that have been reported. Every one of those cases 

needs intensive follow-up, contact tracing, monitoring of contacts, 

and we are still having perhaps between 1,000 and 2,000 new cases 

per week in West Africa, so this is still a very large epidemic. 

Ms. DEGETTE. And that kind of leads me to my final question, 

which is, you have said repeatedly, and, frankly, there has been a 

lot of pushback on this, not just from this committee but from lots 

of other folks, you have said repeatedly that you don’t think that 

travel bans and quarantines are the way to go about addressing 

this, and I am wondering if you can tell us whether that is still 

your view, and if so, why, and if it is not, why not? 

Mr. FRIEDEN. We are willing to consider anything that will make 

the American people safer, any measure that is going to increase 

the margin of safety, and one of the things that we have done is 

to implement a travel system so that people leaving these countries 

are screened for fever, arriving in the U.S. are monitored for fever, 

are linked with the local health department. We are now working 

with State and local health departments to monitor each of those 

individuals each day, and we are seeing very high adherence rates 

to that. So we have a system in place now. 

The risk to the U.S. is directly proportional to the amount of 

Ebola in West Africa. The more there is, the higher our risk. The 

less there is, the lower our risk. We have to reduce the risk there 

by attacking it at the source, but whatever we can do to reduce the 

risk to this country, we are certainly willing to consider. 

Ms. DEGETTE. So you would still consider a travel ban if that 

seemed like the only solution? 

Mr. FRIEDEN. If there were a way to ensure that we didn’t lose 

that system of tracking people through every step of their travel, 

and once here, we would consider any recommendation, but it is 

not CDC that sets travel policy for the U.S. Government. 

Ms. DEGETTE. Right. And what I am concerned about is if Ebola 

goes to other countries, and in Africa in general, it will be harder 

and harder to trace where people came from. 

Mr. FRIEDEN. The spread of Ebola to other places in Africa is one 

of the things that we are most concerned about because it would 

make it much harder to control. We were able to work with Nigerian authorities to stop the cluster in Nigeria. Right now, Mali is 

in the balance of whether we will be able to stop the cluster there 

before it gains a foothold in Mali. But the longer it continues in the 

3 affected countries, the greater the risk that it will spread to other 

countries. 

Ms. DEGETTE. OK, thank you. 

88 

Thank you very much, Mr. Chairman. 

Mr. MURPHY. Gentlelady yields back. 

Now Mr. Terry is recognized for 5 minutes. 

Mr. TERRY. I ask unanimous consent to be able to ask questions. 

Mr. MURPHY. Yes, you are recognized, yes. 

Mr. TERRY. Thank you. 

Dr. Frieden, from Nebraska, I am really proud of the efforts of 

University of Nebraska Med Center. At least we are top in something. It is not football, but it gives us a sense of real pride, despite 

the last patient’s outcome, which they did heroic efforts. But also 

in that regard, they seemed to have been the ones that, especially 

in comparison to the Dallas Presbyterian Hospital, were setting the 

standards on the practices. 

And so that begs the question, or at least we should ask the 

question, of whether the CDC should develop an accreditation type 

of program on infectious disease programs to ensure that these hospitals maintain a level of competency and readiness. 

Is something like that ongoing? 

Mr. FRIEDEN. Well, first, we really appreciate the facility in Nebraska and their willingness to step forward, and the phenomenal 

care they have provided to all the patients who have come to them, 

and despite the outcome of the physician recently, we know that 

heroic measures really were undertaken, and the staff there really 

deserve the gratitude of all of us, and we appreciate them. We appreciate also their willingness to consult with other facilities, and 

to share their experience because that is critically important. 

Mr. TERRY. Which they have done, and I—— 

Mr. FRIEDEN. Yes. 

Mr. TERRY [continuing]. Again, hospitals like Johns Hopkins asking them how to do it is a source of pride for us as well. 

Mr. FRIEDEN. What we have approached is something called the 

REP Team, the Rapid Ebola Preparedness Team, where we send a 

team in to work with the facility, to outline every aspect of their 

preparedness, and to see how ready they are, and then to provide 

recommendations for what more they can do. 

We have also worked with the State health departments so that 

they can determine which of the facilities within their State that 

are most appropriate to take patients with Ebola or other infectious 

diseases, because they are really best prepared for that. 

In terms of accreditation, that is something that we have discussed with the Joint Commission. Whether that makes sense in 

the long run or not is something that we are open to exploring. 

Mr. TERRY. All right, as a layperson, it seems to make sense that 

you would have an area where there is one hospital that has that 

level of accreditation. And then it begs the question that if they are 

going to be that go-to hospital in a region or a State, whether there 

should be maintenance funding behind that. What do you think? 

Mr. FRIEDEN. We certainly believe that they should receive resources. There is funding within the emergency funding request, 

both from CDC and from ASPR, to support specialty facilities such 

as the one in Nebraska. 

Mr. TERRY. And so the question then is, just to clarify, would 

that be part of the President’s requested dollars? 

Mr. FRIEDEN. Yes, it is. 

89 

Mr. TERRY. Dr. Lurie? 

Ms. LURIE. Yes, it is. 

Mr. TERRY. Very good. 

Ms. LURIE. Yes. 

Mr. TERRY. So, Dr. Frieden and Dr. Lurie, one of the experiences 

here is that we know that, let us see, UNMC I think has 11 units, 

but the reality is they can probably only have three patients at a 

time because of all of the collateral circumstances. So do we need 

more bio-containment units like what Emory and UNMC have? Dr. 

Frieden? 

Mr. FRIEDEN. We think we need some increase in the number of 

facilities that can safely care for someone with Ebola, or another 

deadly infection. We have been working very closely with hospitals 

throughout the country to increase that capacity, and the emergency funding request would enable us to really get to the level 

where we would have a greater degree of comfort with the facilities 

out there and the capacities. 

Mr. TERRY. Well, just to clarify that some of the dollars that 

would be in the emergency funding, the President’s request, would 

be to expand the number of bio-containment units? 

Mr. FRIEDEN. Yes. 

Mr. TERRY. Very good. And one of the questions about having 

three patients at UNMC, these folks don’t have any insurance and 

they are holding the bag for the funding of those patients. Is there 

anything with HHS, Dr. Lurie, or CDC that can reimburse these 

facilities for the healthcare costs? 

Mr. FRIEDEN. I believe that Secretary Burwell indicated in the 

hearing last week that we are very open to mechanisms that would 

make them whole for the expenses that they have had. 

Mr. TERRY. Open to it and doing things—there is a big gap between those two. Is there any further discussions to reimbursing, 

Dr. Lurie? 

Ms. LURIE. I think we understand that the cost of caring for 

these patients is quite substantial, and as Dr. Frieden said, Secretary Burwell indicated that she would look forward to working 

with Congress on this issue, yes. 

I might also just add in terms of the emergency funding that is 

necessary, it is clear that hospitals that are going to take care of 

Ebola patients need additional training, and we very much appreciated the fact that University of Nebraska and Emory have been 

now working side by side often with the REP Teams to help with 

that. Part of our funding request would also establish something 

that would look like a national education and training center that 

would move to another level, I think, of preparedness for hospitals 

that really wanted to obtain that and to get help with doing that. 

Mr. TERRY. OK, thank you very much. 

My time has expired. 

Mr. MURPHY. All right, that concludes the questions for this 

panel. We thank you. And also Members may have some other additional questions. I would appreciate your responsiveness to those. 

We do appreciate the availability of all of you in responding to us, 

so I thank you very much. 

Mr. FRIEDEN. Thank you. 

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Mr. MURPHY. As this panel is moving, I will begin to introduce 

the second panel so we can move forward here. And I will introduce 

two of the panelists, then we will ask Mr. Terry to introduce one 

as well. 

We will start off here—just a moment here. First, Mr. Ken Isaacs 

is the Vice President of Programs and Government Relations for 

Samaritan’s Purse. Also Dr. David Lakey is the Commissioner of 

the Texas Department of State Health Services, but is here today 

testifying on behalf of the Association of State and Territorial 

Health Officials, correct? 

Now, Mr. Terry, if you would like to introduce the other panelist. 

Mr. TERRY. I would be honored to introduce Dr. Jeffrey Gold, the 

Chancellor of the University of Nebraska Medical Center and Nebraska Medicine. He is recent to Nebraska, but certainly making 

a huge impact, especially with the Biomedical Containment Center 

where they have hosted 3 Ebola patients, and they are setting the 

standards for how to treat the Ebola patients, and setting the 

standards for the employees that come in contact and work with 

those. UNMC is a great facility. They are very forward-thinking. 

They are ranked very high in a lot of areas of care, but it is probably the research that is making them known internationally, and 

so I am proud to introduce Dr. Jeffrey Gold. 

Mr. MURPHY. Thank you. Well, for the panel, you are aware the 

committee is holding an investigative hearing, and when doing so, 

has had the practice of taking testimony under oath. Do any of you 

have any objections to taking testimony under oath? The Chair 

then advises you that under the rules of the House and the rules 

of the committee, you are entitled to be advised by counsel. Do any 

of you desire to be advised by counsel during your testimony today? 

And all the panelists have said no. In that case, would you please 

rise and raise your right hand, and I will swear you in. 

[Witnesses sworn] 

Mr. MURPHY. All have answered affirmatively. You are now 

under oath and subject to the penalties set forth in Title XVIII, section 1001 of the United States Code. 

I am going to ask you each to give a 5-minute summary of your 

written statement, and we will begin with Mr. Isaacs. 

STATEMENTS OF KEN ISAACS, VICE PRESIDENT, PROGRAMS 

AND GOVERNMENT RELATIONS, SAMARITAN’S PURSE; JEFF 

GOLD, CHANCELLOR, UNIVERSITY OF NEBRASKA MEDICAL 

CENTER; AND DAVID LAKEY, COMMISSIONER, TEXAS DEPARTMENT OF STATE HEALTH SERVICES, ON BEHALF OF 

THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH 

OFFICIALS 

STATEMENT OF KEN ISAACS 

Mr. ISAACS. Thank you, Chairman Murphy, and esteemed members of the council and fellow guests of the committee for letting 

me testify today. It is a privilege to be before you regarding the developments of the Ebola outbreak in West Africa. 

Since Ebola entered Liberia in March through its explosion into 

the international spotlight in July, and even now, when it appears 

that the disease may have crested in Liberia, the world has learned 

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much about Ebola, but I want to stress today that we have also discovered that there are many important questions that we simply 

do not know the answer to, and we need to know the answer to 

them. 

I want to run through them quickly. I will say as an offside that 

going last means you have to reshuffle everything you are going to 

say because it has all been said before. 

But I think that a good question to know the answer to is how 

are the doctors who are returning to America becoming infected. 

Some of those doctors have been our staff, some of those doctors 

have been our coworkers that were treated at Nebraska. And even 

recently, the gentleman in New York, they were all wearing level 

4 gear. How did they get infected. 

Can the virus live in other mammals besides primates, bats, rodents, and humans. Now, I have worked and lived in Africa for 

about 25 years, and I have eaten my share of bush meat. It is not 

always bats. It is mostly something like a groundhog. And so what 

does it mean, where does the virus live. And the point is that can 

it jump into the animal population here. We need to know that. 

As with other viruses, is it possible that Ebola can be asymptomatic, sort of a Typhoid Mary kind of a thing. We know for a fact 

of three situations where blood was drawn on patients who were 

non-feeble, who were non-symptomatic, and they all three tested 

positive. One of the problems that exists today in Liberia where Samaritan’s Purse is working is that there is no protocol to move 

blood from Liberia to Rocky Mountain Laboratory where these kind 

of tests would need to be checked and results found out. 

You know, I will just say I am not trying to be a fear monger, 

but I think that there are things that we need to look at critically, 

and we should not be afraid to ask questions. In my written testimony, there is one paper from the New England Journal of Medicine that reports that 95 percent of the cases of Ebola incubate in 

21 days. The inference is 5 percent don’t incubate until 42 days. 

We need to know what that 5 percent means. 

While the media coverage is already decreasing, and people 

maybe feel that Ebola has peaked, we do not think it has. I totally 

agree with Dr. Frieden. I think that we need to vigorously and in 

a sustained manner fight this disease in Africa. I think that no 

card can be taken off the table, and I think that while we hear 

from many health experts that we know how the disease is spread, 

we know how to fight it and we know how to stop it, the truth is 

that lessons come at a great and expensive and painful price, and 

when a new lesson comes about, then all of the policies are 

changed. So I heard the word humility used several times today by 

different Members of the panel, and I think that that is a good 

word because Ebola is a humbling disease. 

When you talk to the epidemiologists, they are all over the place. 

CDC is saying 1 1⁄2 million people by the middle of January, and 

the World Health Organization is saying that in December maybe 

10,000 people a week. The point is we don’t know. 

Several things that I want to say right quick is we are seeing the 

disease go down in Liberia today as it regards the empty hospital 

beds, as it regards deaths, and as it regards patient loads, but at 

the same time, we are seeing a significant increase in Sierra Leone, 

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the country next to it, so it is clear that the disease has not peaked. 

Actually, if anything, I would say that it perhaps has ran its 

course, and we don’t know what its course is. And if you look at 

the epidemiological charts in Sierra Leone, it has peaked two times 

before. So the question really is are we at a peak or are we in a 

trough before the next up rise? 

Practically speaking, I think that a couple of things that we need 

to look at is a travel ban, travel restrictions, or I like to say travel 

management, should not be taken off the table. The real threat to 

the United States I do not feel is going to be how many people are 

sick here. The real threat to the United States is what will happen 

if the disease spreads into countries that cannot handle it. And I 

am not talking about Africa, I am talking about in a sub-Indian 

continent, I am talking about in India and China and Pakistan, 

Myanmar, Bangladesh, countries that are highly populated, that 

have low public health standards, and have low hygiene standards. 

You could see a death toll that would be unimaginable, and the impact around the globe would affect us as well. 

So I think I am out of time there. Thank you. 

[The prepared statement of Mr. Isaacs follows:] 

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Mr. MURPHY. Thank you. 

And, Dr. Gold, you are recognized for 5 minutes. 

STATEMENT OF JEFF GOLD 

Mr. GOLD. Chairman Murphy, other members of the subcommittee, thank you so much for the opportunity to discuss the 

Ebola outbreak and the Nation’s response, and how the Nation can 

maintain a state of readiness to respond to future highly infectious 

diseases. 

I am Jeff Gold, and I have the honor as serving as Chancellor 

of the University of Nebraska Medical Center. My testimony today 

will focus on the challenges of dealing with Ebola, and our Nation’s 

readiness to respond to highly infectious diseases. 

This has been said many times earlier today, and well before, the 

United States is dealing with a serious public health crisis with the 

Ebola outbreak in Africa. It is a crisis that the United States has 

both the expertise to contain and to help resolve. 

One of the most pressing goals to accomplish from the Ebola outbreak is how to best leverage the knowhow to train and to better 

prepare the Nation’s healthcare system, to combat future highly infectious threats like Ebola here and around the world. 

The University of Nebraska Medical Center is recognized as a 

national resource for our readiness to provide care for Ebola patients, and also our ability to provide training on Ebola and other 

highly infectious diseases. We have successfully treated Ebola now 

in two patients, and not in one. Most recently, passed away yesterday. We have provided consultations to many hospitals, clinics, 

emergency departments across the United States, including Bellevue Hospital in New York, on how to deal with therapies for patients who arrive in their hospitals, their emergency departments, 

et cetera. 

Our readiness is based upon more than 9 years of preparation, 

protocol development, and team training to deal with highly infectious, deadly diseases. As a result, we are now responding to literally hundreds of hospital inquiries across the Nation, asking how 

to prepare if Ebola arrives in their community. Emory University 

Hospital is experiencing similar inquiries, and we are working 

closely together. 

One step that we took to respond to the immediate national demand for information and training was to work with Apple Computer to convert our 9 years of protocols and procedures into easily 

accessible and completely downloadable multimedia materials and 

videos for healthcare providers. That was accomplished in 1 week, 

which is now available through Apple and through public media, 

and can be accessed on any personal computer, with well over 

thousands and thousands of physicians and members of the public 

who are downloading content specifically about personal protective 

equipment and others. 

You might ask why Nebraska. Why is the bio-containment unit 

that we opened in 2005 in existence. This followed the 9/11 attacks. 

It was built upon concerns about Anthrax on congressional offices 

and SARS attacks. We recognize that the commonest of international travel increased the chance of global spread of highly infectious diseases. Our unit has written and rewritten protocols and 

138 

procedures, and collaborates consistently with national organizations and other medical centers. We rigorously train with local 

emergency responders, State emergency management, and military 

units through our relationships with STRATCOM and others. We 

spend a great deal of time considering the response plan if another 

highly infectious disease were to occur, and how this could be 

scaled. 

The university is also a Department of Defense authorized university affiliated research center, which specializes in developing 

medical countermeasures to weapons on mass destruction, including highly infectious viruses. We have a history of conducting extensive research in these areas, including vaccines, antivirals, early 

detection, et cetera. 

What has become obvious from this Ebola crisis is that a national readiness plan is absolutely necessary. Our bio-containment 

unit is one of four in the Nation. The capacity and the number of 

units in the Nation must be increased, and a national readiness 

plan that trains healthcare providers must be established. The 

number of actual beds is under 20, the number of usable beds is 

under 10, and I assure you that every unit such as ours will always 

maintain at least one bed if it is ever needed for a staff member 

that becomes ill. That immediately knocks the number down by 

four, five, or six. 

The University of Nebraska Medical Center and Emory are working closely with the CDC and HHS on how training might be most 

effectively delivered. It must begin soon, and we have done so in 

advance of any funding considerations. As Congress considers funding, I urge that this include a number of items, and I will just read 

them by title as they are contained in my briefing documents. A 

national training in Ebola and highly infectious diseases, to develop a tier training system. Training should include setting up an 

accreditation program that independently nationally accredits organizations, emergency departments, et cetera, to establish and maintain their skill level of readiness. An annual maintenance of funding for increased role of existing bio-containment units to maintain 

their readiness. We have funded the readiness of our unit totally 

off of internal dollars up to this point. Funds to expand the number 

of treatment centers and existing bio-containment units, specifically, to increase bed and staff capacity within existing units, as 

well as new units. And finally, reimbursement for care for Ebola 

patients not covered by insurance. 

Ladies and gentlemen, we have the expertise and knowhow to 

contain Ebola and other infectious threats, however, in order to do 

this, we must ensure that our Nation’s healthcare professionals are 

adequately trained, properly equipped, and rigorously drilled. 

I thank you so much for this privilege. 

[The prepared statement of Mr. Gold follows:] 

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Mr. MURPHY. Thank you, Dr. Gold. 

Now, Dr. Lakey. 

STATEMENT OF DAVID LAKEY 

Mr. LAKEY. Thank you, Chairman Murphy, and members. For 

the record, my name is David Lakey, the Commissioner of the 

Texas Department of State Health Services, and I have been in 

that role now for 8 years. This last month has been one of my most 

trying and tough months as the Commissioner of the Department 

of State Health Services. 

On September 30, 2014, the Texas State Public Health Laboratory, a laboratory response network laboratory, diagnosed the first 

case of Ebola in the United States. The diagnosis of Mr. Duncan 

with Ebola set in motion a process we in public health refine 

through continued use, tried and true public health protocols, including identifying those individuals that have had contact with 

people that have been infected, making sure that they are monitored, providing care to those that have been infected, isolating 

those individuals, and when needed, using quarantine. 

The magnitude of the situation really was unprecedented. While 

Mr. Duncan was one man, staying in one city, in one State in the 

country, the outcomes associated with his case could impact the 

whole State and possibly other parts of the United States. 

We at the Department of State Health Services, along with our 

colleagues in Dallas and our colleagues at the Center for Disease 

Control and Prevention took the responsibility to contain the 

spread of this disease very seriously. We organized a local incident 

command structure to handle the event, and at a State level, we 

activated our emergency response management centers. While our 

core mission was simple in concept; to protect the public’s health 

by limiting the number of people exposed to the virus, the challenges associated with carrying out that mission were numerous. 

The care of Mr. Duncan presented its own challenges. Identifying 

the first person in the United States infected with this disease, the 

infection control challenges, waste management and transportation, the availability of experimental treatments and vaccines, 

training for healthcare workers on the higher standards of infection 

control, and personal protective equipment guidance and supplies. 

And when Mr. Duncan regretfully passed away, we handled issues 

related to caring of his human remains, which remained highly infectious with Ebola for months after death. Unfortunately, during 

the care of Mr. Duncan, two nurses became infected. Nurses who 

had put their lives and their careers on the line to take care of Mr. 

Duncan and to protect the public’s health. 

Concerns relating to the handling of these three Ebola patients 

included questions about decontaminating their homes, their automobiles, decisions about how to handle their personal effects, the 

monitoring of pets, and patient transportation issues, and addressing the public’s concerns. Identifying potential contacts, and locating them and monitoring those individuals had some risk of exposure that also involved many challenges. Decisions about who to 

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and an individual’s rights, providing accommodations for those confined to one location for the 21-day monitoring period, quickly procVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00149 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
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essing control orders, coordinating two symptom checks a day for 

each person under monitoring, and managing the transportation 

and the testing of laboratory specimens. 

Throughout all of these specific challenges, our experience in 

Dallas exemplified common requirements for successful responses 

to emergency situations. Having clear roles and responsibilities 

among the various Government agencies and entities that are involved, strong lines of communication, and an incident command 

structure staffed by trained emergency management and public 

health professionals to ensure the response’s cohesive direction. It 

really requires a partnership at all levels of Government, and 

throughout State and Federal Government. 

The outcome in Dallas proved the strength of the public health’s 

process. Hundreds of people were monitored in the State. Two 

cases of Ebola resulted from the direct care of the index case, and 

they were detected early in the disease onset, and they recovered. 

No cases resulted from community exposure. 

At this time, like other States, Texas is providing active monitoring for individuals who arrive in the United States from one of 

the outbreak countries. Texas has monitored approximately 80 individuals under the airport screening process. Texas is also, like 

other States, working to ensure that capacity exists in the State to 

care for patients with high consequence infectious diseases like 

Ebola. Two centers currently are able to stand up on a short notice 

to receive a patient, and Texas is working to identify additional capacity within our State. 

As Ebola screening and monitoring transitions into our routine 

processes, our focus in Texas is now shifting to include complete 

evaluation of the response in Dallas, and a discussion of how to improve the public’s health response system in Texas as a whole, and 

sharing our experiences and our lessons learned nationwide. 

Governor Perry has put together a task force for infectious disease preparedness and response to evaluate the Texas system, and 

to make recommendations for improvement. We take that extremely seriously. I believe this discussion among Governmental 

and nongovernmental individuals, among varied stakeholders, and 

including experts in pertinent fields will result in a Texas and the 

Nation being better prepared to handle the next event. 

While we do not know what form the next event will take, we 

do know that there will be another event. As I tell my colleagues 

at the State and national level, it is my expectation that, as the 

Commissioner of Health, that I am going to have to manage one 

major disaster each and every year. One unthinkable event per 

year. And that is why the funding that is provided to States 

through the Hospital Preparedness Program, in fact, is very important to what we do, and that partnership is really critical. 

And finally, I want to thank my colleagues at both the Dallas 

County Health Department and the Center for Disease Control for 

their work and their support, and this really was a team effort. 

Thank you, sir. 

[The prepared statement of Mr. Lakey follows:] 

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Mr. MURPHY. Thank you. 

Dr. Gold, I know you have some travel plans. We have about 20 

minutes of questions, will you be able to accommodate that? 

Mr. GOLD. Yes, sir, whatever your needs are. 

Mr. MURPHY. Thank you very much. Appreciate that. 

And I will recognize myself for 5 minutes. 

Dr. Gold, you mentioned a number of comments about what 

needs to be done with the administration’s request for funding. I 

don’t know if you have had a chance to read it. Have you? 

Mr. GOLD. At least in general terms, yes. 

Mr. MURPHY. OK. So would you know whether or not there is an 

adequate plan to support the request yet? I don’t want to put you 

on the spot. 

Mr. GOLD. I don’t think the granularity is in the written materials that have been provided. 

Mr. MURPHY. Would you do us a favor, as someone at a hospital 

dealing with this, could you make sure you get to the committee’s 

specific recommendations? In fact, I would ask that all the panelists who have all dealt with this, that would be very, very helpful 

to have that kind of granularity. 

Mr. GOLD. Yes. 

Mr. MURPHY. Thank you. 

Dr. Isaacs, you have been to Africa. 

Mr. ISAACS. Excuse me? 

Mr. MURPHY. You have been to Africa? 

Mr. ISAACS. Yes, a lot of times. 

Mr. MURPHY. The CDC has guidelines for health monitoring and 

movement for healthcare workers who have been treating Ebola 

patients in Africa. Now, they classify as some risk those professionals who have had direct contact with a person sick with Ebola 

while wearing personal protective equipment. 

You have cited that some people wearing personal protective 

equipment have still—— 

Mr. ISAACS. Yes. 

Mr. MURPHY [continuing]. Contracted Ebola. 

Mr. ISAACS. Yes, it is an obvious fact, yes. 

Mr. MURPHY. So these some risk individuals have no mandatory 

restrictions on travel or public activities, in fact, there is no requirement for returning healthcare workers to self-isolate or avoid 

public transportation, like subways, bowling alleys, et cetera. I 

might want to add, we have done a survey of Members on this side 

and every single Member who asked hospitals in their district has 

returned comments saying that all those hospitals said for those 

first 21 days, those healthcare workers are not going near a patient. They will be furloughed, they are to stay home, take their 

temperature multiple times a day. 

Does Samaritan’s Purse healthcare workers follow guidelines 

such as this when they return? 

Mr. ISAACS. Yes, we have actually written our own protocols and 

guidelines back in late July when Dr. Kent Bradley, who has testified here, was coming back. We were bringing out about 40 people. 

We contacted CDC and asked them what their protocols were and, 

frankly, they told us just to have our staff check their temperature 

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ment. We didn’t feel that that was adequate because we had just 

come through a very serious bout with Ebola, and I think we probably had a more realistic encounter with it than perhaps other people had, and so we created our own protocols. 

We check our staff through direct monitoring every day, four 

times a day. We have a little bit lower threshold, and we do keep 

them in a restricted movement, no touch kind of protocol for 21 

days. 

Mr. MURPHY. So you are saying that your protocol goes beyond 

the CDC recommendations. 

Mr. ISAACS. There is no question our protocol goes beyond the 

CDC. 

Mr. MURPHY. Well, CDC says that is not necessary. Do you 

agree? 

Mr. ISAACS. Well, you know, all I can say, I mean there was a 

question a minute ago about CDC, you know, disregarding what we 

were saying. CDC is a large organization. They create a policy. So 

if you call them and say, well, we think we ought to do this, they 

say, well, that is not our policy, and then they don’t engage any 

further. That is just the reality that we have run into, and I don’t 

mean any disrespect to CDC, I am very appreciative of them, but 

for us, we live in a small town, so our national headquarters is in 

a town with 40,000 people. What we have run into is that the 

spouses of some of our returning staff don’t want them coming 

home. The returning staff don’t want to be around their children. 

And we don’t want to spook everybody in our community. 

Mr. MURPHY. So you are erring on the side of extra safety? 

Mr. ISAACS. Yes, sir, we are. 

Mr. MURPHY. Let me ask another thing. This has to do with discussions I have had with Franklin Graham—— 

Mr. ISAACS. Um-hum. 

Mr. MURPHY [continuing]. Son of Billy Graham, and highly respected individuals here, but listed that there are some problems 

for people, the NGOs, the charitable workers, et cetera, as well as 

Government workers traveling back and forth to Western Africa. Is 

that a fact that there are difficulties with travel? 

Mr. ISAACS. I think that is one of the greatest vulnerabilities that 

the United States has to fight the disease in West Africa. There is 

not a dedicated humanitarian bridge. What has happened, I mean 

there has been a lot of talk about, well, a 21-day waiting period 

would make it onerous for volunteers and they wouldn’t go. I will 

tell you what will make it very onerous is for volunteers not to 

have an assurance that they can get a flight out. I promise you 

they will not go. 

Mr. MURPHY. How many airlines can currently fly in and out of 

Western Africa? I heard it is like Sabrina Air and—— 

Mr. ISAACS. Well, I think it is 150 or 200 a week, according to 

what he was saying. That is general population. I don’t know how 

many relief workers. 

Mr. MURPHY. But we don’t have a bridge for the relief workers. 

Mr. ISAACS. There are two airlines that fly in and out of Liberia. 

One is Brussels Air, and by the way, when you get off in Brussels, 

you just walk, you can go anywhere, you are not monitored for anything. And the second one is Air Maroc—Royal Air Maroc. If they 

156 

should decide it is not in their commercial interest to continue flying into Monrovia, then there will become an effective commercial 

quarantine on Liberia, then what is the backup plan? 

Mr. MURPHY. Plus, as I understand it, getting supplies to West 

Africa is a huge problem. We understand that twice they had to 

lease planes. 

Mr. ISAACS. We had to have two 747s—— 

Mr. MURPHY. At a cost of? 

Mr. ISAACS. About $460,000 a piece, and each one can take about 

85 tons. And for cargo logistics in and out. For people, I think we 

have a great vulnerability there. There is one organization that is 

flying like a nonprofit. They have done four flights. That is great, 

but that is not enough. 

Mr. MURPHY. So let me make sure I understand, what you would 

recommend is that the United States Government could help sponsor a charter flight twice a week from the United States to Africa, 

from Africa to the United States, so that Government workers, volunteers, NGOs, et cetera, would have a clear bridge, in which case 

they could be tested before they get on the flight, tested during the 

flight, tested when they land at one point in the United States, 

would simplify this whole process. Am I correct? 

Mr. ISAACS. I 100 percent support the concept of a dedicated humanitarian air bridge from the United States directly to West Africa. Now, there would be 1,000 details to work out, but we have a 

vulnerability. If Brussels Air stops flying for their commercial reasons, we will have no air access. 

Mr. MURPHY. Thank you. 

I am out of time. I yield to Mr. Green for 5 minutes. 

Mr. GREEN. Thank you, Mr. Chairman. And I thank our panel 

for waiting today. 

And to follow up, I think that it would also be more certainty because instead of, like you said, going to Brussels or somewhere 

else, and just walking around, it would be the testing, and I assume these healthcare workers would love to have that because, 

like you said, they don’t want to infect their own families. 

Dr. Lakey, let me thank you, because I know in October, there 

were a lot of—seemed like unusual statements being made about 

Ebola, but when the State of Texas made the decision on how you 

would develop the protocols right after that, I appreciate that because it really sounded like everybody was getting back to normal 

and saying, ‘‘OK, this is an illness, we are going to deal with it, 

and this is how we can do it.’’ So I appreciate the State doing that, 

but let me go on with some questions. 

Dr. Gold, one of the interests I have, and I said earlier, is that 

how did the University of Nebraska develop this facility? I think 

it was opened in ’05, and was it a combination of State, local, university funds, Federal, to develop the largest containment lab in 

the country? 

Mr. GOLD. Thank you. The unit was opened in 2005. It was 

planned shortly after the 9/11 events, the anthrax scares, and it 

was done predominantly on university funds, to some small extent 

on State funds, and I believe there were some Federal Department 

of Defense dollars involved in the planning as well. However, very 

importantly, the maintenance of the staff, which costs us approxiVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00160 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
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mately between 1⁄4 and 1⁄3 million dollars a year to maintain the 

preparedness, has been totally borne by the university and the 

medical center. 

Mr. GREEN. Well, I appreciate that leadership, and I am just surprised that no other university would take that lead, and I appreciate Nebraska doing that. Now, my colleagues, both Congressman 

Terry and Joe Barton, know my daughter is there and she was recruited to come up there in ’09, and I appreciate—well, and although when she told me back in the ’90s she wanted to be an infectious disease doctor, I said I don’t want you to treat me for anything you know about. But she is like most medical professionals. 

That is her job. And we want to make sure we protect them to do 

that. 

But Nebraska center now has treated several patients, and what 

is the spending that is required to prepare the hospital to treat an 

Ebola patient? 

Mr. GOLD. The direct costs that we have experienced, and we 

have compared notes pretty closely with Emory and we are not far 

apart, is approximately $30,000 per day for each patient admitted. 

The average length of stay, I guess it went down over the weekend 

a good deal, but for the two patients that went home, was 18 

days—— 

Mr. GREEN. Yes. 

Mr. GOLD [continuing]. And they were both treated in the relatively early stages of their disease. And that is the direct cost of 

equipment, supplies, nursing care, et cetera. And as I say, that is 

extremely close to the number that the folks at Emory have come 

up with. That does not include the cost of the preparation, which 

I just referred to, and it does not include the cost of what I would 

call the opportunity cost, which is this is a 10-bed unit that is otherwise used for medical, surgical admissions, that would otherwise 

be completely full with routine patients receiving their care. 

Mr. GREEN. OK. Are the policies that were in place prior to the 

current Ebola outbreak still in use, or has the University of Nebraska Medical Center made changes to its protocol and guidelines 

based on literally real-life experiences? 

Mr. GOLD. We do evolve our policies and procedures. We learned 

a lot from each of the patients, particularly the first patient that 

we housed. We, for instance, put a completely self-contained laboratory unit into the bio-containment unit so that laboratory specimens are not transported outside of the unit. We are also very privileged, and I note there has been a lot of discussion about waste 

management, is we decontaminate all of the waste as it leaves the 

unit so there is no transportation of any infectious waste material 

outside of the unit, which makes it much safer for the community, 

and it also makes it much less expensive for us to have that built 

into the unit. And this is only because the unit was planned as it 

was constructed prior to 2005, understanding that the disposal of 

infectious waste would, indeed, be a big problem from logistical as 

well as expense, and, therefore, it was self-contained. 

Mr. GREEN. Mr. Chairman, I know I am out of time, and I appreciate—because where we were at 6 weeks ago, we have actually 

evolved and I am glad the experiences, we are actually learning 

from them. And I appreciate our panelists being here today. 

158 

Mr. MURPHY. Thank you. Gentleman yields back. 

Now I recognize Dr. Burgess for 5 minutes. 

Mr. BURGESS. Thank you, Mr. Chairman. I want to thank all of 

our witnesses for being here today, and bearing with us through 

what has been a very long but a very informative hearing. 

Dr. Gold, there is a difference though between the type of patient 

you get at your center, because they are referred, because there is 

not a direct access where someone thinks, oh, I have Ebola, I am 

going to go to Dr. Gold’s center in Omaha. Mr. Duncan came 

through the Presbyterian emergency room with all of the other patients that came in that Thursday night, and his case had to be 

winnowed out of all of the other load that was in the emergency 

room, but in your situation, a patient only comes after they have 

been identified, is that correct? 

Mr. GOLD. Thus far, the patients that we have admitted to the 

bio-containment unit have all come with a diagnosis, a PCR diagnosis of Ebola. However, given our national reputation, the number 

of phone calls, emails, even emergency room visits has actually 

been quite interesting with people with febrile illnesses saying 

please tell me if I have Ebola. 

Mr. BURGESS. Well, let me just ask you about that then. So then 

patients who arrive in your emergency room—I mean, you outlined 

how you have almost a dedicated laboratory handling of the specimens from an Ebola patient, but that is someone you know about. 

If somebody comes to the emergency room and they have fever, 

they have a headache, and they have all of these other complaints, 

I mean in addition, if someone thinks to do the PCR Ebola test, but 

in addition, they are going to get a CBC, they are going to get a 

urinalysis, they are going to get any number of other blood tests, 

and these tests would go through the normal auto-analyzers in the 

lab without knowing that that patient actually had an Ebola possibility, or is that, in fact, separated out of your emergency room? 

Mr. GOLD. Yes, sir, we have put protocols in place, and we have 

also widely shared them for triage screening in the emergency department if there is any suspicion that a patient either has a travel 

history or a symptom complex, they are immediately sequestered, 

there is a specific nursing protocol with personal protective equipment, et cetera. There is a notification of the team, and the laboratory specimens are processed through the bio-containment unit facilities, and then decontaminated as if they were positive, even before we know the results of the PCR. And we are doing PCR testing 

on-site now, which makes it a lot faster and a lot easier, otherwise 

it would have taken days previously. 

Mr. BURGESS. But again, I would just point out that that is in 

a perfect world. In the rough and tumble, Buford, Texas, ER, all 

of those protocols would not immediately be available. 

And we will get back to that, but, Mr. Isaacs, I just have to ask 

you, I mean that Typhoid Mary analogy that you used, that is the 

first time I have heard of that. Now, we all remember Typhoid 

Mary of lore, and she actually had the ability to infect people. Do 

your Typhoid Marys carry the ability to infect people when they 

themselves are asymptomatic? 

159 

Mr. ISAACS. We don’t know. That is the question. Now, Typhoid 

Mary, in the case of her, she was dealing with a bacterial infection—— 

Mr. BURGESS. Right. 

Mr. ISAACS [continuing]. But what I do know for a fact is that 

there have been a number of asymptomatic, non-feeble people 

whose blood had been drawn and it tested positive. And I think 

that there is something about the PCR test that, you know, I heard 

Dr. Frieden say, in medicine, you never say 100 percent. But the 

thing with Ebola, if you don’t bat 1,000 every day, somebody dies. 

Mr. BURGESS. Right. 

Mr. ISAACS. And—— 

Mr. BURGESS. And someone else is exposed. 

Mr. ISAACS. Yes. My point in saying all of that is not to raise 

fear, but it is saying that we need to go to Africa and beat the disease over there. 

Mr. BURGESS. Yes, sir. 

Mr. ISAACS. We need to keep it contained. 

Mr. BURGESS. You know, you raise a point of two of your doctors 

were infected, and you weren’t sure why. We had two nurses in 

Dallas who were infected, and we are not sure why. And, again, 

that just underscores that there is probably more not known about 

this disease than what is known, and that is, again, why I began 

this with, we all ought to step back and have a little bit of humility. I would even extend that to Mr. Waxman. I mean, he is not 

known for his humility. We all have to have a little humility in 

dealing with this. 

Dr. Lakey, I just have to ask you. What you did in Dallas to sort 

of restore good order and discipline at a point where it really almost veered toward being out of control, I mean, it took a lot of 

courage to exercise those control orders on the individuals when 

you did that, and I will admit to being somewhat surprised turning 

on the news and hearing that that had happened. What were some 

of the things that went through your mind as you developed that? 

Mr. LAKEY. So we don’t take control orders lightly, and in Texas, 

I can put a control order, it is not enforceable until I get a judge 

to enforce it. But we have to get the monitoring done in an event 

like this. We have to make sure that people do not have fever, and 

if I could not get that done the way that I needed to protect the 

public’s health, I take protecting the public’s health extremely seriously, and so we put a control order in place. Now, if you do that, 

you need to make sure that you provide the support services 

around that individual to make sure that there is food, other support there so you can make sure it is as humane as possible. 

With the nurses following the nurse that became infected we, 

again, needed to make sure we had monitoring in place. We also, 

as we looked and stratified the risk, it looked to me like the biggest 

risk would be inside that room with Mr. Duncan, and so for those 

individuals, we said it is best during this time period that you don’t 

go into large public congregate settings, movie theaters, churches, 

et cetera. It becomes a very large epidemiological evaluation when 

that occurs, if unfortunately, somebody becomes infected. And we 

were able to work with that staff, and they took this very seriously 

160 

to be able to limit their movement for the highest risk in individuals. 

Mr. BURGESS. Very good. 

And, Dr. Gold, are your patients reimbursed by insurance or, are 

you reimbursed by insurance when patients are referred to you? 

Mr. GOLD. We are in the process of having those discussions with 

the insurance carriers and with their employers, but to date, we 

have been unsuccessful in any reimbursement through a commercial carrier. And I can’t really tell you whether anything has happened in the last 24 to 48 hours, of course, but they have not responded. 

Mr. BURGESS. Thank you. I appreciate that. 

Mr. MURPHY. Now, Mr. Waxman, you are recognized for 5 minutes. 

Mr. WAXMAN. Thank you, Mr. Chairman. I will take five and 

maybe take an additional two, like we saw with the other question 

there. 

Earlier this month, President Obama sent to Congress a $6.2 billion supplemental budget request to enhance the U.S. Government 

response to the Ebola outbreak. The President’s request is intended 

to fund both immediate and long-term needs in the United States 

and West Africa. 

Dr. Gold and Dr. Lakey, you can both speak to the readiness of 

our public health system here in the United States. The President’s 

budget request designated $621 million to CDC for domestic response, including funding for State and local preparedness, enhanced laboratory capacity, and infection control efforts. It also 

designates $126 million for hospital preparedness. 

Dr. Lakey, can you comment on the need for additional funding 

for State and local public health authorities, what are the top funding priorities? 

Mr. LAKEY. Thank you, sir. As I outlined in my comments, the 

State public health, local public health, is having to do a lot of 

work right now. A laboratory response network, having a laboratory system out there so we can rapidly diagnose individuals is essential for us to make the diagnosis and isolate individuals. 

The epidemiologists that contact individuals, talk to them, figure 

out the risk, is essential. The hospitals having pre-designated facilities so we can care for those individuals is very, very important. 

This isn’t the only event. We have had multiple events; West Fertilizer explosion, Hurricane Ike, et cetera. That system, to be able 

to rapidly respond, is essential. Now, a lot of that is paid for by 

HPP funds. My HPP budget was reduced by 36 percent this last 

year. And that pays for the training, the education, the things that 

take place in order for the hospital systems to be ready. 

Mr. WAXMAN. Um-hum. I wanted to ask Dr. Gold for his response. Would additional funding assist in hospital preparedness, 

and give us some examples of areas where additional funding 

would be helpful. 

Mr. GOLD. I think the additional funding would be helpful to 

build the educational programs, to get the referral centers, as well 

as community hospitals completely up-to-speed. The additional 

fundings will allow to scale response in event we need to bring 

American soldiers or other volunteers back to the United States. 

161 

Additional funding will be used to create preparedness for future 

infectious crises of this nature, for which we currently do not have 

resources, and to build a sustainable infrastructure such as convalescent serum reserves, such as core laboratory testing, et 

cetera—— 

Mr. WAXMAN. Um-hum. 

Mr. GOLD [continuing]. So that we have and sustain a national 

preparedness level. 

Mr. WAXMAN. Thank you. 

I want to pivot now to the funding for international efforts. Mr. 

Isaacs, Samaritan’s Purse has been on the ground in Liberia since 

March, and understands the environment there. I want to talk to 

you about the NGO perspective on continuing needs and efficient 

use of resources. What are the main priorities on the ground in 

West Africa, and what resources are needed to accomplish those efforts? 

Mr. ISAACS. So if I may just add something to what you said. We 

have actually been there for 11 years—— 

Mr. WAXMAN. Yes. 

Mr. ISAACS [continuing]. And the disease broke out in March, so 

we have a large footprint, we have 350 staff, about 20 expatriates, 

we have aircraft there, we have a lot of capacity in the country. 

And when the disease broke out, we were 100 percent focused on 

fighting it. 

What we are seeing today that we think that other resources are 

needed for, this is very practical but you know what, logistics are 

everything, and there is a lot of discoordination and confusion right 

now between the U.N. players, UNHAS, UNAMIR, and the DoD 

about gaining access to airlift. There are no protocols in place 

about moving blood samples, so if CDC goes out into an area and 

identifies a new village, and there are 10 or 12 people who test 

positive, they call us in because we have assembled rapid response 

teams. We are not able—— 

Mr. WAXMAN. Um-hum. 

Mr. ISAACS. —to take the blood samples out to other aircraft, we 

have to move them out by land. A rapid diagnostic test is one of 

the greatest things that are needed there, and I think, frankly, 

that if the U.S. Military was running the coordination cell, things 

would—— 

Mr. WAXMAN. OK. 

Mr. ISAACS [continuing]. Be done quicker. 

Mr. WAXMAN. Well, the U.S. is committed to helping in Liberia, 

and has provided personnel, resources, and funding. As we continue our aid efforts, we must also keep in mind the need for a 

flexible response. Initial reports indicate that there are empty beds 

in Ebola treatment units in Liberia, so the aid efforts have adjusted accordingly to monitor occupancy and only build additional 

ETUs as needed. 

Mr. Chairman, I hope that we can join together to quickly pass 

the President’s budget request. We heard from this panel and we 

heard from our first panel about the urgency of the task at hand, 

and the public health catastrophe that will occur in West Africa if 

we fail to do so. 

Thank you very much, and yield back the balance of my time. 

162 

Mr. MURPHY. I appreciate that. Certainly, I would like to see 

that happen, too, and I hope you also take a careful look what Mr. 

Isaacs’ group is also looking at. They need a bridge to move people 

back and forth because that is a struggle right now. 

Mr. WAXMAN. Um-hum. 

Mr. MURPHY. Now I recognize Mr. Long for 5 minutes. 

Mr. LONG. Thank you, Mr. Chairman. And I thank you all for 

being here, and not only that, but what you do on a day-to-day 

basis because I for one really appreciate it. 

Dr. Gold, you said—well, let me ask you something before that. 

Dr. Martin Sali, is that how it is pronounced? 

Mr. GOLD. Yes, Salia. 

Mr. LONG. Salia. Dr. Salia was taken to your facility, correct? 

Mr. GOLD. Yes. 

Mr. LONG. And the reports that we got on the news, turned on 

the radio and they said that there was a doctor with Ebola that 

was very critical, was the first thing I thought, and I probably had 

the same thought as a lot of people that that is probably not a good 

thing when they say that he is very critical. He later deceased just 

a few days later. I apologize, I had to step out of the room for a 

few minutes, which I normally don’t do, I am usually here for the 

whole duration of these hearings, but was there a reason that he 

was delayed coming to this country for assistance, for help? Do we 

know, because that seems strange that he would be that far gone, 

so to speak, before they would think about flying him out? 

Mr. GOLD. It is unclear to us what the logistics were that might 

have delayed it. As we were told, that he had an initial blood test 

for Ebola that was negative, and only three days later did he test 

positive. And when he tested positive, there was a period of time 

before at least we were contacted, I don’t know whether the transportation organizations or the State Department were contacted, 

but from the time we were contacted, the plans for transfer were 

put into place virtually immediately. 

There was also a good deal of uncertainty how stable he was immediately prior to transfer, but once the decision was made to 

transfer him, rest assured that he got every conceivable treatment. 

Mr. LONG. I am sure he did, and I wasn’t implying that at all, 

but I was just curious as to why they waited as long to try and get 

him a—because when I heard that first radio report—— 

Mr. GOLD. I am told—— 

Mr. LONG [continuing]. And they said he was very critical—— 

Mr. GOLD [continuing]. That is not uncommon for people to test 

negative even when they are symptomatic. We have heard about 

other people who have tested positive who were asymptomatic. 

This is not 100 percent certainty disease, and we are learning an 

awful lot about the spectrum of how symptomatic people get, 

versus their viral levels, et cetera. 

Mr. LONG. Let me stay with you, Dr. Gold, and switch up the 

topic just a little bit. You said in your written testimony that you 

have coordinated extensively with the CDC and HHS on readiness 

and treatment. Can you tell us more about that collaboration, on 

what specific issues have you advised the administration? 

Mr. GOLD. We are working with Emory, with the CDC and with 

ASPR on standing up educational protocols, visiting other instituVerDate Mar 15 2010 15:13 Jul 23, 2015 Jkt 037690 PO 00000 Frm 00166 Fmt 6633 Sfmt 6633 F:\113THCONGRESS\113180EBOLAUPDATENDSCANS\113180EBOLAUPDATEPENDING
163 

tions across the United States to help them enhance their readiness, hosting teams from other institutions across the United 

States. In Nebraska, we have recently had a team of 9 or 10 people 

from Johns Hopkins University, as well as putting together a series 

of protocols that would be used for, if you will, accreditation or certification of readiness, and maintenance of readiness. 

Mr. LONG. And when you say you have advised the administration, have you spoken with Mr. Klain, the new czar—the Ebola 

czar? 

Mr. GOLD. Yes, sir, several times. 

Mr. LONG. OK, and did the administration, did they incorporate 

or accept your recommendations, and did they reject any of your 

recommendations? 

Mr. GOLD. We are working specifically with Dr. Lurie, who was 

your guest here a little bit earlier, and we speak probably daily on 

the development of these protocols. There is a conference call that 

is scheduled for Friday—— 

Mr. LONG. So you feel they are accepting your recommendations? 

Mr. GOLD. Thus far, yes, sir. 

Mr. LONG. Good, OK. And, Mr. Isaacs, we were talking about 

earlier, or you were in your testimony, people traveling on planes 

and being checked temperature-wise every so often, three times a 

day, did you say, or what were—— 

Mr. ISAACS. Our staff are under protocol to take their temperature four times a day. 

Mr. LONG. Their own personal temperature? 

Mr. ISAACS. No. We actually have staff in our Ebola task force 

that call them every day, and we keep a log of it. I could call my 

office right now and tell you where every one of our people are—— 

Mr. LONG. But you are talking about your staff, not their patients? 

Mr. ISAACS. Yes, our staff. 

Mr. LONG. OK. 

Mr. ISAACS. Not—— 

Mr. LONG. OK. I got you, OK. 

Mr. ISAACS. We are just monitoring their health. 

Mr. LONG. Right. OK, good. OK, I misunderstood earlier because 

you hear these reports about, well, we will check their temperature 

when they get off the plane. I think we need to do a travel ban, 

as I have mentioned before, but if they say, well, take their temperature, and then they say they cannot be symptomatic, not have 

a temperature and still have Ebola, so my question is probably invalid since you are talking about your staff. 

But anyway, thank you all again for your service and what you 

do, and for being here today. 

Mr. Chairman, I yield back. 

Mr. MURPHY. Thank you. 

Mr. Griffith, you are recognized for 5 minutes. 

Mr. GRIFFITH. Thank you, Mr. Chairman, I appreciate that. 

Thank you all for being here, and thank you, Mr. Isaacs, for the 

work that you all have been doing there for 11 years. Samaritan’s 

Purse—— 

Mr. ISAACS. Thank you. 

164 

Mr. GRIFFITH [continuing]. Is a good organization, and appreciate 

what you all have done—— 

Mr. ISAACS. Thank you. 

Mr. GRIFFITH [continuing]. Not just there, but around the world. 

Speaking of that, in your written comments, you said many public 

health experts are telling us that we know the disease, how to fight 

it, and how to stop it. Everything we had seen in this current outbreak, however, suggests we do not know the science of Ebola as 

well as we think we do. I touched on this earlier in the previous 

testimony related to, I believe, the reservoir species is what Dr. 

Frieden was talking about, and that we don’t know the full extent 

of the reservoir species. And you touched on that in your written 

testimony as well, and you asked questions can the virus live in 

other mammals besides primates, bats, rodents, and humans, and 

you attached a study that related to pigs. Do you ask this question 

because your people on the ground have some questions, or just because it is a blank slate and we really don’t have much research 

on it? 

Mr. ISAACS. I think that Ebola is potentially a much more serious 

disease than it is given respect for. What we are seeing is that it 

is flexible, it is deceptive, it is sneaky, it is agile, and every time 

somebody thinks they have it figured out, it shows us something 

new. And I think that we as a society cannot make assumptions 

that we know what it is and what it will do. I think that we need 

to be extraordinarily careful about letting it come onto this shore. 

And while it is true that when it has come here, we quickly identified it and isolated it, the truth is, as these doctors could tell you, 

particularly the gentleman from Texas, that if he had 10 or 20 or 

50 cases down there, it would consume his capacity to isolate it. 

And so while we can isolate it, if it were to get out from under us, 

it would quickly exceed our capabilities, and that is why I think it 

is so extremely important to invest resources to fight and stop this 

disease in Africa before it gets off that continent in a major way. 

Mr. GRIFFITH. And I appreciate that. Have any of your people 

there in Africa indicated to you that they are concerned about animals that might be carrying the disease, or is that just a question—— 

Mr. ISAACS. We live Ebola 24 hours a day. It is all we talk about. 

We talk about it all. 

Mr. GRIFFITH. Right. 

Mr. ISAACS. And, yes, we are worried about it. We don’t know. 

Evidently, in Spain, they thought the little dog—they killed it. In 

Texas, you put it in isolation, and I am glad the lady got her dog 

back, I am a big dog guy, but who knows if it—maybe there is some 

science on this, but I think that we don’t know. 

Mr. GRIFFITH. Well, I would refer you to a study that came out 

in March of 2005 in the Emerging Infectious Disease—I guess that 

is the name of the publication, but it is a CDC publication. I would 

be happy to get you a copy of it, and it is available, where they talk 

about the potential of dogs, and it says that although dogs can be 

asymptomatically infected—in other words, they don’t get the disease, and sometimes the science gets confused on television, they 

don’t get the disease—but they are carrying the antibodies for the 

disease, and this study says asymptomatically infected dogs 

165 

could—doesn’t say they are, could—be a potential source of human 

Ebola outbreaks and a virus spread during human outbreaks, 

which would explain some epidemiologically unrelated human 

cases. And it goes on, and it talks about there are cases in the past 

in Africa where they don’t have any idea where the disease came 

from. And I asked Dr. Frieden about that, and he said that maybe 

bats, but they still don’t know what all the reservoir species are. 

In a prior hearing before today, when we were here in October, 

I said, what are we doing about animals coming into this country, 

and it was more or less laughed off, but it is a concern, wouldn’t 

you agree, Mr. Isaacs? 

Mr. ISAACS. I do agree, and I will tell you why it is so important. 

This is not the flu, this isn’t influenza, this is a disease that kills 

70 percent of the people that get it. And, if you look at what the 

disease has done this year—5,550 people dead, 13,000 cases—that 

is extraordinary. And none of us have swum in these waters before, 

and I don’t think that we can use case studies that come from 1976 

today to make assumptions about an unprecedented event that 

crosses national boundaries. It is now in Mali. When you look at 

the disease, the caseload may be going down in Liberia, but the 

disease is, in fact, spreading geographically. We fear that very soon 

we will see it in Sierra Leone, and it has already been identified 

in Mali. 

Mr. GRIFFITH. Well, and I appreciate your comments on that, and 

I liked your term ‘‘travel management‘‘ because I do believe we 

want people to be able to get there to provide humanitarian relief, 

like your organization does. At the same time, I think we have to 

be very, very careful. 

And with that, Mr. Chairman, I yield back. 

Mr. MURPHY. Gentleman yields back. 

Now I recognize Mr. Tonko for 5 minutes. 

Mr. TONKO. Thank you, Mr. Chair. 

State and local health departments and local hospitals serve at 

the frontlines for treatment and containment of infectious diseases 

in the United States. In the case of Thomas Duncan in Dallas, the 

country saw the challenges faced by local health departments and 

local hospitals dealing with an unexpected infectious disease. 

So, Dr. Lakey, now that you have had some time to reflect on Mr. 

Duncan’s case and how it was handled, can you talk about some 

of the challenges Texas Health Presbyterian Hospital faced in 

terms of preparedness? 

Mr. LAKEY. Yes, sir. I think the first challenge was to recognize 

the first case ever in the United States. A rare disease in the 

United States. Everyone was watching what was occurring in Africa, but to think that that was going to occur in your emergency 

room on a busy night was a challenge. I think there was a challenge related to the national strategy, and I say national because 

there are experts outside of Government that review those strategies on infection control. But the assumption that any community 

hospital can care for an individual that has that much diarrhea, 

that much vomiting, with that much virus in those fluids I think 

was a faulty assumption, that it took a really dedicated team to be 

able to care for that individual. 

166 

I think one of the lessons learned was healthcare nurses, physicians, they take their responsibility extremely seriously, and they 

showed up to take care of Mr. Duncan and their colleagues. I think 

a lot of people were worried that healthcare wouldn’t show up, that 

healthcare providers would not show up, but they showed up. 

Mr. TONKO. Um-hum. 

Mr. LAKEY. I think there was a lesson related to the level of personal protective equip. And that was changed, and so the higherlevel personal protective equip, and I think we learned that you 

don’t have to wait for a temperature of 101.5 to diagnose the individuals. We lowered that temperature threshold just because we 

wanted to make sure we identified individuals early, and we identified them with temperatures of about 100.6, 100.8, which, by the 

previous guidelines, wouldn’t have met the criteria for testing. So 

those are just some of the lessons, sir. 

Mr. TONKO. And in what ways could the Dallas and the Texas 

State Public Health Departments have been better prepared to 

handle an unexpected case of Ebola or any infectious disease? 

Mr. LAKEY. Yes. So I think there are several components to that. 

I think the, you know, necessity to train, you know, I think health 

departments across Texas and across the Nation had been preparing. There was a lot of information that we had been sending 

out, but that is different than saying this is a real event and I have 

to be ready right now. I think one of the things that we are doing 

right now to make sure we improve our preparedness is not only 

making sure that all hospitals are ready to think that Ebola is possible, and in the differential diagnosis, isolating those individuals 

and informing individuals, but make sure that there is a system 

across the State where those individuals then can be seen and be 

tested before you get to a level of a hospital that can care for those 

individuals. No hospital wants to be an Ebola hospital. You know, 

it is just hard on getting other individuals into your emergency 

room if you are labeled the Ebola hospital. And so there is some 

reluctance across the United States to step up and be that facility, 

but that is one of the things that we are working on right now. 

Mr. TONKO. Thank you. 

Dr. Gold, as you said in your testimony, University of Nebraska 

Medical Center is recognized as a national resource for your readiness to provide care for Ebola patients. You have successfully treated Ebola patients, and just last week another patient who sadly 

passed away was brought to your facility for treatment. Can you 

briefly describe the protocols and procedures UNMC had in place 

that ensured staff was appropriately prepared to care for Ebola patients? 

Mr. GOLD. Yes, sir. Since the unit was stood up in 2005, the staff 

of between 40 and 50 people has been sustained. And that staff 

meets on a monthly basis to go over policies and procedures, 

emerging trends in Africa and South America, et cetera, and as 

well as works closely with the military through STRATCOM and 

the Offutt Base. But that team also drills 4 times a year, and they 

do real exercises in the community with waste disposal, with paramedic transport, et cetera. 

We also practice donning and doffing, use of various types of personal protective equipment, dialysis, respiratory management, et 

167 

cetera. So all of the typical procedures and protocols are not only 

learned but actually practiced hands-on, real-time—at a minimum 

four times a year for every staff member. 

Mr. TONKO. Thank you very much. Mr. Chair, I yield back. 

Mr. MURPHY. Thank you. 

Mr. Terry, 5 minutes. 

Mr. TERRY. Thank you. 

Dr. Gold, what are the costs and impacts of being prepared when 

you are preparing and practicing four times a year, when all of 

those pieces within the community are also participating? 

Mr. GOLD. The actual out-of-pocket costs have been calculated to be between $250,000 and $350,000 a year to maintain the core 

team of nursing support, techs, respiratory therapists, et cetera. 

That does not count the in-kind time that our physicians and other 

leaders put into it, as well as does not count the time of the maintenance of the unit, the air handlers, water supply, autoclaves, 

maintenance of stock of equipment, et cetera. That is just the personnel time that goes into maintaining the readiness. 

Mr. TERRY. In your opening statement, and I hinted this in one 

of my questions to the CDC, is that for the level of facilities that 

UNMC and Emory are, and when you train and practice like this, 

there should be some maintenance funds to offset those costs. 

Mr. GOLD. Well, we certainly agree with that. I believe that the 

CDC over time has had a relationship with the Emory organization, predominantly to protect the employees of the CDC that work 

with highly infectious agents in their testing laboratories and 

around the world. 

We have not had that type of relationship, and would think it 

would be appropriate perhaps through the UR instructor or 

through some other vehicle that exists. 

Mr. TERRY. Are you being homered? 

Mr. GOLD. Sorry? 

Mr. TERRY. Emory being in Atlanta and CDC being there, are 

they just giving money to the hometown hospital—— 

Mr. GOLD. I think they needed a—— 

Mr. TERRY [continuing]. Or is there some contractual—— 

Mr. GOLD [continuing]. Just like we need a way to take care of 

our employees if something tragic were to happen and they were 

to become ill, they need a way to manage their employees as well, 

and I think that was the original basis of the relationship. We 

would—— 

Mr. TERRY. OK. 

Mr. GOLD [continuing]. Very much enjoy a similar relationship. 

Mr. TERRY. And I think you are on equal, if not better, footing, 

medically speaking, at least. 

Speaking of that, just to pick your brain a little bit here, and 

maybe someone has already done this, but you have had two successful patients that got to hug all the doctors and nurses that 

helped them, and then we had the last patient that came in that 

appeared from the TV video to be in supercritical condition. What, 

in your opinion, is the reason that perhaps this physician, the latest patient, passed away? Any takeaways from being how you were 

able to treat the first patients versus this one that came in a more 

critical condition? Any lessons learned? 

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Mr. GOLD. I think the most important lesson learned is that the 

early we have access to treat any patient here or in Africa, the better the yield is going to be. 

This particular patient had renal failure, liver failure, was unconscious when he arrived in the United States, and what we have 

learned is that those are all very bad predictors of outcome. The 

earlier patients that we cared for did have early organ failure, but 

were reversible through good supportive care, and they all received 

experimental medication, as did this patient, but I believe that the 

organ system failure we dealt with over the weekend was just far 

too extreme. 

Mr. TERRY. So I mean with just this one example, it is probably 

not certain, but is there just a point of no return with an Ebola patient, their organs have already shut down, is there a way of treating them so they can survive, or is it just at that point not survivable? 

Mr. GOLD. I don’t think it is possible to predict. Young people, 

this gentleman was in his early 40s, and the thinking was that it 

was worth an all-out effort to attempt to save him. And I don’t 

think, if you could take the exact same patient twice, that you 

could predict the outcome. 

Mr. TERRY. Yes. Very good. Appreciate it. And, Dr. Gold, you and 

Nebraska Medicine and UNMC make us proud. I appreciate all of 

your efforts. 

Mr. GOLD. We have a great team. Thank you, sir. 

Mr. TERRY. You do. With Mr. Green’s daughter. 

Mr. MURPHY. Gentleman yielding back? 

Mr. TERRY. I yield back. 

Mr. MURPHY. All right, I will recognize Mr. Green for 1 minute 

of wrap-up. 

Mr. GREEN. Thank you, Mr. Chairman. I ask unanimous consent 

to place in the record a statement by the AFSCME, the American 

Federation of State, County and Municipal Employees, urging Congress to support the President’s emergency funding of $6.18 billion. 

Mr. MURPHY. Without objection. 

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Mr. GREEN. And, Mr. Chairman, I want to thank both panels 

today. I know the first one is gone— 

Mr. MURPHY. Can’t hear you. 

Mr. GREEN. I just appreciate our witnesses being here, but also 

for the panel that was put together, and that is what our Oversight 

and Investigations Subcommittee is supposed to be doing, and I appreciate it. But to follow up on my colleague, I am the first time 

in history that the intelligence from your children went back down 

the tree, and so I just appreciate that the first time in many times. 

Thank you. 

Mr. MURPHY. So noted for the record. 

I want to thank this panel—you can have 30 seconds here. Go 

ahead. Dr. Burgess. 

Mr. BURGESS. Well, I was going to thank the panel, too. I mean 

I have been through a number of these hearings. Our committee, 

of course, has done hearings. I was allowed to sit in Homeland Security when they did a field hearing in Dallas. I sat through the 

hearing on foreign affairs last September. This has been the most 

informative panel that I have had the pleasure to hear from, and 

I really appreciate—I know it was a long day and I know we made 

you wait a long time, but I really appreciate you guys sticking with 

us and sharing with us the information that you shared because it 

has been absolutely critical. 

And I will yield back. 

Mr. MURPHY. Thank you, Doctor. 

I want to add to that. I almost had the feeling that the first 

panel we had today was spiking the ball. ‘‘We got this, and we can 

be confident.’’ And I don’t agree. After we had our hearing several 

weeks ago, we put forth several recommendations, among them we 

needed some level of travel restrictions. People ought to be isolated 

for 21 days, and what I hear, Mr. Isaacs, Dr. Lakey, I don’t know 

if it is the same for Dr. Gold, not only did you do that along with 

the hospitals of so many colleagues, but your employees didn’t complain. They recognized they don’t leave their compassion at the borders of Africa. 

I thank them for that selflessness of all, not only while they are 

there, but in returning home. From this, several takeaways. That 

people with level 4 gear can still get Ebola. We don’t know all the 

routes. And what we don’t want to have is a false sense of security 

that everything is fine. I worry that the first hearing, this room 

was packed with cameras and people in the Press. At this point in 

the hearing, what you have told us should still tell us we have to 

keep our radar up full alert here. We have a major battle for this 

taking place in Africa. We have a very difficult time for getting 

people in and out of there, and if any of those airlines stopped their 

flights, could happen at any moment, we are at a loss for moving 

people and supplies in and out of there. 

So along those lines, I hold to it that we should still have people 

do 21-day restrictions from touching patients when they come back. 

I am glad that hospitals are doing that anyways. I hate to think 

what would happen if that did not occur. And, quite frankly, I 

think the hospital would have to tell other patients if they did have 

some employees who were recently with Ebola patients. But I also 

want to echo what Mr. Isaacs said, I am going to try and work this 

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out, that we ought to have a bridge for people going to and from 

Africa, for all your selfless workers, from so many charities, Catholic Relief and Methodist and so many other groups I have heard 

from—Doctors Without Borders—we need a way for them easily to 

go and easily come back, and we can help monitor them, so this 

is one less thing to worry about. With the amount of money we are 

talking about going through this, I, quite frankly, especially when 

you look at $20 million going to New York City just to monitor the 

people exposed to that doctor, that would pay for a heck of lot of 

flights, and we could have a charter system to do that. 

Please stay in touch with us. Committee members will have 10 

days to get other comments of the committee, and they will also 

have questions for you, and we ask that you respond in a timely 

manner with any questions for the committee. 

And with that, again, thank you to the panel, and this committee 

hearing is adjourned. 

[Whereupon, at 5:08 p.m., the subcommittee was adjourned.] 

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