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Live Coverage Of Congressional Hearing on Ebola

Aired October 16, 2014 - 14:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

JOHN WAGNER, ACTING ASSISTANT COMMISSIONER, CUSTOMS AND BORDER PROTECTION'S OFFICE OF FIELD OPERATIONS: As of today, with the expansion to the four additional locations, that covers about 94 percent.

REP. CORY GARDNER, R-COLO.: OK, so of the 100 to 150, 94 percent are being covered. That means that somewhere between 2,000 and 3,000 people a year are coming into this country without being screened from the affected areas?

WAGNER: Well, they would undergo a different form of screening. We're still going to identify that they've been to one of those three affected regions. And we're still going to ask them questions about their itinerary. We're going to be alert to any overt signs of illness in coordinate with CDC Public Health. If they're sick, we're also going to give them a fact sheet about Ebola, about the symptoms, what to watch for. And, most importantly, who to contact --

GARDNER: Would we be checking their temperature?

WAGNER: We will not be checking the temperatures, or having them fill out a -- a contact sheet or -- or about their --

GARDNER: So, there's 2,000 to 3,000 people entering this -- this country a year without checking their temperature? Without having the contact sheet that -- that 94 percent of those affected people --

WAGNER: They're going to arrive at hundreds of different airports throughout the United States.

GARDNER: OK. I want to talk a little bit more about the travel restrictions.

Dr. Frieden, how many non-U.S. military flights -- commercial flights are currently going into the affected countries?

TOM FRIEDEN, DIRECTOR, CENTERS FOR DISEASE CONTROL AND PREVENTION: I don't have the direct -- I don't have the exact numbers.

GARDNER: Does anyone on the panel know how many commercial flights are going into these areas?

Mr. Wagner, you don't know?

WAGNER: From the United States, or from anywhere? GARDNER: From the United States into those areas.

WAGNER: There are no direct flights -- commercial flights from those three affected areas to the United States.

GARDNER: And into the area?

WAGNER: Into any --

GARDNER: Into West Africa.

WAGNER: There are flights into West Africa.

GARDNER: How many?

WAGNER: That, I don't have, offhand.

GARDNER: Anybody on the panel know how many?

How many coming back into the United States?

WAGNER: There are no commercial flights coming directly into the United States from those three areas.

GARDNER: And what about Europe?

WAGNER: There's hundreds of flights today coming from Europe.

GARDNER: OK. So, people traveling from West Africa to Europe to here?

WAGNER: That's generally how they would get here.

GARDNER: And 94 percent screening.

How many flights are required daily, every other day or weekly to get the supplies to personnel to the affected areas?

FRIEDEN: The quantity of supplies is quite large. I'd -- we would have to get back to you ion terms of the numbers. But there's a huge quantity needed. But it's not just supplies, it's also personnel we need to move back and forth.

GARDNER: Well, if you could get back to me with that number, I would appreciate it.

Now, Dr. Frieden, Nigeria -- are you aware if Nigeria has a travel ban from the countries affected with the outbreak right now?

FRIEDEN: I believe that is not the case. They do not.

GARDNER: OK. Dr. Frieden, one of the issues that I -- has been brought up regularly to me back in the district when I go home -- what should I tell my local hospital and local doctors that they need to do to address Ebola?

FRIEDEN: The single more important thing they need to do is make sure that if anyone comes in with fever or other symptoms of infection, they need to ask where they've been for the past 21 days, and whether they've been in West Africa.

GARDNER: And the training that a small local district hospital would receive -- is that the same kind that a major metropolitan hospital would receive?

FRIEDEN: There are a variety of forms of training. We support hospitals. Hospitals are regulated by states, not by CDC.

GARDNER: Dr. Frieden, what do we need to do? We're entering the flu season now, as somebody else on the panel had mentioned. What do we need to do to make sure that people understand that there could be similar conditions, similar circumstances that we don't have a situation where people are, indeed, panicked?

FRIEDEN: Key issue -- it is, as you point out, getting into flu seasons. By all means, get a flu shot. And for health care workers, anytime someone comes in with fever or other signs of infection, take a travel history. That's really important.

GARDNER: Dr. Frieden, I just want to go back to what I said at the beginning. You mentioned that we can't have a travel ban because you're afraid of the impact that it would have, but you don't know how much personnel, equipment and flights are currently in use.

FRIEDEN: My point earlier on was that if passengers are not allowed to come directly, there is a high likelihood that they will find another way to get here. And we won't be able to track them as we currently can.

GARDNER: But we're talking about supplies, equipment and personnel. How -- how many? How many flights? How many personnel? How much equipment?

FRIEDEN: The -- the point I made earlier was that if the -- if we are not able to track people coming directly, we'll lose that ability to monitor them for fever, to collect their locating information to share that with local public health authorities, and to isolate them if they're ill.

GARDNER: Mr. Chairman, I yield.

REP. TIM MURPHY, R-PA.: The gentleman's time's expired. Thank you.

I now recognize Mr. Welch for five minutes.

REP. PETER WELCH, D-VT.: Thank you. I want to follow up with some of Mr. Gardner's questions. First of all, I want to understand this. There has been one person that came to the U.S., and then he infected two health care workers in Dallas, correct?

FRIEDEN: At this point, none of the 48 contacts he had before getting isolated have developed symptoms. And they're mostly well passed the maximum incubation period, although not completely out of the woods.

WELCH: All right.

FRIEDEN: And two health workers --

WELCH: And for everybody on the panel, it's code red. We have had very few -- two instances of infection here in the United States, but this is such a highly contagious disease that we're on full alert, correct?

FRIEDEN: It's a disease that has a -- it's a very severe disease. It's not nearly as contagious as some other diseases, but any infection in a health care worker is unacceptable.

WELCH: That's right. And there's an enormous, enormous amount of public concern and apprehension about this. So, we appreciate the full-on (ph) efforts that you're making. There's been some lessons learned from what happened in Dallas. The hospital's been forthcoming about mistakes that were made. And now, what you're telling us is that there has been information provided to all our hospitals in the country about what protocols to fallow, correct?

FRIEDEN: Correct.

WELCH: Now, just on a practical level, does it really make -- is it feasible that all our hospitals are going to be in a position to provide state-of-the-art treatment? Or does it really, as a practical matter, make sense for hospitals to contact you when they have a potential infection, for you to come, and then for us to have centers to which that individual who is infected can be treated?

FRIEDEN: Every hospital needs to be able to think it may be Ebola --

WELCH: Right.

FRIEDEN: -- diagnose it, call us as they do. We've had hundreds of calls. And then we will send a team to determine what is best for that hospital and that patient.

WELCH: And then, what we have also heard -- Ms. Schakowsky asked this question -- this is absolutely a public health infrastructure issue where it gets out of hand, correct?

FRIEDEN: Public health measures can control Ebola.

WELCH: Right. And they have had effective measures in Nigeria, where they've been able to contain it, but they have no public health infrastructure in these three countries where the epidemic is now getting some headway, correct?

FRIEDEN: Exactly. Right.

WELCH: And then, in the U.S., of course, we're fortunate to have a pretty good infrastructure. But we do have to have the answer, I think, to this question that is being asked about travel. That is a concern that people have because it is seen as a, quote, "easy answer." And I just want to understand what the debate is within the medical community. For a lot of us sitting up here, we're hearing from our constituents. It sounds like something that we can do, and that will eliminate any possibility of an infection coming here. But that may be a psychological answer, but not necessarily an effective medical answer. All of us have been asking you to give your explanation -- and anyone else can come in -- as to why, from a medical standpoint, you have concluded that a total travel ban is inappropriate, and not effective.

FRIEDEN: First off, many of the people coming to the U.S. from West Africa are American citizens -- American passport holders. So, that's one issue just to keep aware of.

WELCH: All right. And then -- by the way, I don't have much time. But our health care workers, even if there's some risk of infection, we're going to encourage people to go and do the important work, including our military personnel. We've got to take them back and make sure we can treat them if, in fact, they do get -- they do get the illness, correct?

FRIEDEN: People travel --

WELCH: Right.

FRIEDEN: -- and people will be coming in.

WELCH: And as I understand it, you say there's basically a tradeoff. If you have a full-off (ph) ban, there's going to be ways around it, and then you're going to lose the benefit of being able to track folks who may be infected. And then that could lead to a greater incidence of outbreak. So, it's a tradeoff? Is that essentially what's going on?

FRIEDEN: We're open to any possibility that will increase the safety of Americans.

WELCH: Right. So, are there some midpoints, like -- that -- in terms of travel restrictions, as opposed to a travel ban, that may make sense -- you in coordination with your colleagues, particularly, Mr. Wagner?

FRIEDEN: We would look at any proposal that would improve the safety of Americans.

WELCH: All right. I -- this isn't about funding, so I'm not going to ask you. Because I think we would know what your answers would be. But I just want to share my concern that -- it was expressed by Ms. Castor. Mr. Chairman, we may want to have a hearing at some point about what is the funding requirements to make certain that the infrastructure this country needs to be in place before something happens is robust, it's strong, we've got people who are trained, they're ready to do the job, and they have everything that they need. So, that's not today's hearing, but I think it's a question that we should address. Because with 20 percent across-the- board funding at NIH, I find that to be a reckless decision. With 12 percent at CDC, I think that is definitely the wrong direction.

I think this Congress has to revisit our priorities on making certain that we have the public health infrastructure to be prepared to protect the American people. MURPHY: I think I'll just say, (ph) we are planning a second hearing --

WELCH: Thank you.

MURPHY: -- and in preparation for that, we'll also ask if NIH does have the flexibility now to transfer funds, as well as HHS.

WELCH: I look forward to that.

MURPHY: I now recognize Mr. Griffith for five minutes.

REP. MORGAN GRIFFITH, R-VA.: Thank you, Mr. Chairman.

I believe we should have reasonable travel restrictions. Dr. Frieden, in answering a question of my colleague from Colorado, Mr. Gardner, you indicated that Nigeria didn't have any restrictions. And that is accurate.

But I have in my possession -- I ask it be submitted to the committee for the record -- a letter from Delegate Robert G. Marshall of Manassas, Virginia, to Governor Terry McAuliffe, governor of the Commonwealth.

And in that, he cites the International SOS, a prominent medical and travel security services company, with more than 700 locations in 76 countries, reports that African countries have imposed total air, land, and water-travel bans by persons from countries where Ebola is present. The countries include Kenya, Cape Verde, Cameroon, Mauritius, South Sudan, Namibia, Gambia, Gabon, Cote D'lvoire, Rwanda, Senegal, Chad and Kenya, South-African development community members, 14 countries, only allows highly-restricted entry from Ebola-affected regions with monitoring for 21 days, and travel to public gatherings discouraged.

I find that interesting, Dr. Frieden, because some of those countries have had previous outbreaks of Ebola themselves. Wouldn't you agree that they -- that some of those countries have had to face Ebola before?

FRIEDEN: I would have to check the list carefully to know, but I'll take your word for it.

GRIFFITH: All right. I will tell you that this is a concern to a lot of our constituents, and to mine as well. And I was checking my Facebook page recently when I saw that a Facebook friend of mine, a father from Virginia, asked for prayers for his daughter, because she lives in the apartment complex with the first nurse -- nurse number one, as I think somebody referred to her earlier -- and was very concerned.

And while I think I know the answer, I'd like to get your answer so that I can reassure this father. And that is -- his question is, "If I count to 21 days and my daughter is not infected, at that point can I exhale and breathe a sigh of relief?" FRIEDEN: Not only can he do that, but he can do that now. Because the first nurse only exposed one person, one contact, and that was only in the very early stages of her illness. One person from the community was exposed. GRIFFITH: And I appreciate that. He also asked a second question. He said, "There's some suggestion coming out of Dallas that the patient's dog may be infected, and may have infected other dogs through actual contact or by feces. Can the virus be transmitted by dogs?"

And I will tell you that I did some homework on this, because I thought it was an interesting question, and found a CDC publication from March of 2005 that did a study on dogs in Africa in the affected areas, and a study in France as a control group. And they found that while dogs show antibodies for Ebola, they're asymptomatic.

But the study went further to say that there's really a lot of questions about how Ebola is transmitted. And in some instances, Gabon in '96, and 2004, Republic of Congo likewise, 2004 in Sudan, that there is a question mark as to whether or not -- or how that Ebola outbreak occurred. It wasn't in normal or standard ways. It wasn't human to human. And this report indicates that dogs might be -- might be, I don't want to scare folks -- might be suspect.

I guess my question to you is isn't it true that we really don't know a whole lot about the various outbreaks of Ebola. And so when we're trying to assure the American people -- just like previously we didn't think it would come to this country, and then we thought if it did get to this country, we wouldn't have any problems controlling it, now we've got all kinds of people being monitored. Isn't it true there's still a lot of questions about how Ebola is spread?

FRIEDEN: Although we're still learning a lot about Ebola, and every other organism that we study and that we control, we have a lot of information about Ebola. We have a good sense of how it's controlled.

And we've looked at the issue of exposure to animals. We know that in parts of Africa, consumption of forest-living animals can be a cause. We don't know of any documented transmission from dogs to humans, but that's why the authorities, with our agreement, have quarantined a dog. And we will be helping them to assess that --

GRIFFITH: And it's also true that while we have no evidence of transmission from human to dogs, we really don't know if there can be. We have what we call in law -- used to be a lawyer -- you have a lack of evidence as opposed to negative evidence. We don't have clear evidence that you can't transmit it, either.

And what's interesting is that raised the question for me about, OK, we've got no restrictions on travel of human beings. How about the dogs?

I called Customs. They said, "Well, our experts are there." And then after pushing them a little bit, they said, "That's USDA." We called USDA, and Dr. Frieden, they said that would be CDC. So I understand all your reasons, while I don't agree with them completely. I understand the concerns about humanitarianism, et cetera. But don't you think we ought to at least restrict travel, dogs?

FRIEDEN: We'll follow up in terms of what's possible and indicated.

MURPHY: Now recognize Mr. Yarmuth for five minutes.

REP. JOHN YARMUTH, D-KY.: Thank you, Mr. Chairman. Before I begin my questioning, I'd like to submit for the record an article entitled, "Will America's Fragmented Public Health System Meet the Ebola Challenge?" by Mark Rothstein (ph), who's the director of the Institute of Bioethics at the University of Louisville Medical School. I'd like to submit that for the record.

Thank you. I'd like to thank the panel for their testimony, and answering the questions. This has been a very enlightening hearing. I also want to acknowledge at the beginning that the Kentucky Air National Guard, which is based in my district, is in Senegal right now providing the infrastructure for the 101st. So in their efforts, I want to acknowledge their participation in this effort.

At the risk of displaying my ignorance, we apparently know that you cannot detect the Ebola until the same time it becomes symptomatic, when it becomes contagious. Is there any other kind of test that would indicate whether anything's going on in the body? I know that sometimes my doctor will say, "Well, you've got an elevated white blood cell count. Something's going on there." May not know exactly what it is.

Is that true of the Ebola? Or is that -- would that not indicate that something's going on?

FRIEDEN: At this point, we don't have a test that would identify before someone has symptoms. In fact, the test only turns positive when they're sick. And the test is for the virus itself. And that's why -- that's another reason besides the patterns of disease, that we're confident that it doesn't spread. We can't even find tiny amounts of it in people's body until they get sick.

YARMUTH: Is there any research being done as to a possible test, earlier test for this?

FRIEDEN: There's a lot of research being done to try to understand, and diagnose, and treat, and prevent better.

YARMUTH: Good. I am a media person by background. That's where I spent most of my career, so I'm very sensitive to how the media treat situations like this. And certainly, the media can become -- can be a very important part of providing public information about a potential threat to public safety as this is. But they can also go overboard, as we know. And I'm curious, because I see every day comments in the media about the spread of Ebola, and outbreaks of Ebola. And while yes, technically it has spread from one person to two health care workers, I know that the public may hear that very differently, and perceive there to be a much broader and widespread incident of Ebola in the country.

I see things like, for instance, in The Washington Post today, the picture of the woman at Dulles Airport who looks like she's mummified, because of her concern of contracting Ebola. So -- and I know that now, one survey showed 98 percent of the American people are aware of the Ebola situation, and not even 50 percent know there's an election coming up in three weeks. So the media has certainly let the public know that there's something going on.

My question to you is has the media coverage to -- so far been helpful or harmful in your efforts to have the public have an appropriate concern and awareness of what the situation is?

FRIEDEN: Well, any time health care workers become infected and ill in this country, it's unacceptable. And our thoughts are with the two infected health care workers, and hoping for their recovery. So it's certainly understandable that there's intense media interest. It's new to the United States. It's a scary disease. Had a movie made about it.

And it's important to have that attention so that we as a society pay attention, and doctors in hospitals, and community health clinics, and primary care practices, think of the possibility of Ebola; that we generate the societal will and resources to both protect Americans and stop it the source, because it's got to be stopped at the source to make us completely safe.

Some of the coverage, I think many would agree, may exaggerate the potential risks, or may confuse people about the risks. There really is a lot we know about Ebola.

CDC has an entire branch, entire group of professionals who spend their careers working on Ebola and other similar infections. They go out and stop outbreaks all the time. We have stopped every outbreak of Ebola until the current one in West Africa.

There's zero doubt in my mind that, barring a mutation, which changes it, which we don't think is likely, it will not be a large outbreak in the U.S. So I think we welcome the attention. It'd be important at times to put it in perspective.

YARMUTH: I appreciate that. I agree totally. One final question in the last 30 seconds. Are you -- is there any additional authority that CDC would find more helpful in conducting or meeting your responsibilitie? I know most of yours is guidance and -- and information, but is there any specific authority that Congress could grant you that would make your job -- would make it easier for you to do your job?

FRIEDEN: We're looking at a variety of things -- emergency procurement, for example -- to see, in conjunction with the administration, whether there are some changes that might allow us to respond more quickly and effectively.

YARMUTH: Thank you. I yield back.

MURPHY: I recognize Mr. Johnson for five minutes.

REP. BILL JOHNSON, R-OHIO: Thank you, Mr. Chairman.

And Dr. Frieden, thank you for being here. Thank all of you on the panel for being here today.

I -- you know, this is not about politics. It's not about international diplomacy. It's about public health and protecting the public safety of the American people, particularly our healthcare workers, who, if I understood correctly, you've acknowledged are somewhat high-risk folks to -- to be exposed.

You know, I want to -- one of my main concerns, Dr. Frieden, is that we don't know what we don't know.

Throughout testimony and questioning today, I've heard you say multiple times, "I don't know the details of this. I don't know the details of that." And I think what the American people are wanting is some assurance that somebody does know the details.

So let me ask you a question. Do we know yet how the two healthcare workers in Dallas were -- contracted the virus?

Was it a breakdown in the protocol? Was it a breakdown in the training of the protocol? Do we know whether or not the protocol works?

FRIEDEN: The investigation is ongoing. We've identified some possible causes. We're not waiting for the investigation to be --

JOHNSON: So we don't know?

FRIEDEN: We're immediately --

(CROSSTALK)

JOHNSON: I -- I -- I get that. We don't know.

You know, the -- the people in Ohio are concerned, especially now that we know that one of those healthcare workers traveled through Ohio, even spent some time in Akron with family members. I applaud Governor Kasich's immediate actions to -- to try and address the situation.

You know, in -- in my experience as a -- as a military war planner, 26 and a half years in the military -- and I know we've got military engaged in this process overseas -- we don't wait until the bullets start flying to figure out whether our war plan is going to work.

Dr. Frieden, when did the CDC find out that there was an outbreak of Ebola in West Africa?

FRIEDEN: Late March.

JOHNSON: Late March.

Has there been -- one of the things that we do in the military is that we conduct what's called operational readiness inspections.

We give real-world scenarios in controlled environments, no notice, so that those who are going to be responsible for executing a war plan knows what to do when the first shot is fired. No panic. No -- no second-guessing. They know what to do.

Has the plan to address an Ebola outbreak ever been tested by the CDC in a real-world environment?

FRIEDEN: Not only has the plan been tested, but outbreak control has been done multiple times in parts of Africa. What has not been done is in this part of Africa, which had never seen --

JOHNSON: No, I'm talking about here in America?

FRIEDEN: In America also, we do a series of preparedness plans. For example --

JOHNSON: Which -- do you know of any hospitals in -- in eastern and southeastern Ohio that have participated in any kind of real-world scenario of an Ebola outbreak?

FRIEDEN: I can't speak to that specific example, no.

JOHNSON: OK. Let me -- let me -- let me go a little bit further.

You -- you mentioned earlier that 150 per day, roughly, are coming in from West Africa. I think Mr. Wagner indicated 94 percent screening.

Let me give you a scenario. Let's say a person comes into the country from West Africa, and let's assume that everything in the screening process works right.

They're maybe in day 14 of having been exposed to Ebola in West Africa. They show up here in America with no symptoms. They go through the screening process, and so they go on about wherever they go -- Akron, Cleveland, Cincinnati, Los Angeles, wherever.

Day 17 or 18, they start getting ill, and they start seeing a spike in their temperature.

If they walk into any emergency room in Appalachia, Ohio and start throwing up, having symptoms, does your plan identify that, and does your plan tell that hospital emergency room what to do in that -- in that scenario? They don't know that person came from Liberia or any other place.

FRIEDEN: We have detailed checklists and algorithms that we've distributed widely, provided repeated trainings and information so that healthcare providers throughout the country have a detailed checklist of what to do step by step by step to determine whether the person has Ebola, if they do, to call for help and we will be there.

JOHNSON: Mr. Chairman, I yield back.

MURPHY: Mr. Green's next in line, but (inaudible), so Mr. Matheson is next for five minutes.

REP. JIM MATHESON, D-UTAH: Well, thank you, Mr. Chairman.

I have a number of questions. I'll try to move through them quickly.

Dr. Frieden, as was mentioned by a couple of people in their opening statements, it strikes me that controlling the outbreak in West Africa is really one of the real key issues to keeping Americans safe. The reports indicate we may still be losing some ground in Liberia, so I guess I'd ask the question what would enhance the international community's ability to gain control of the situation in West Africa in terms of actions and resources?

FRIEDEN: The fight against Ebola in West Africa is challenging. The health systems are weak.

What we're finding is that it's moving quickly, and there's a real risk it will spread to other parts of Africa. Therefore, the key -- the key ingredient to progress there is speed.

Because the outbreak is increasing so quickly, the quicker we surge in a response, the quicker we blunt the number of cases and the risk to other parts of the world, including the U.S., decreases.

MATHESON: And are you resource-constrained in that context?

FRIEDEN: Congress has provided money -- or approval or agreement to use money for the Department of Defense. USAID has resources going in. At CDC, we received, through an anomaly, $30 million for the first 11 weeks of this fiscal year, which we appreciate.

MATHESON: Let me ask you, you have a number -- CDC has a number, an unprecedented number of people in the field right now in West Africa and in Texas.

How many people do you have deployed doing airport screenings?

FRIEDEN: I would have to give you -- get back to you with the exact number. We're working both to oversee the screenings in West Africa and make sure they're done correctly and to screen individuals here, collect information on them and transfer that information -- MATHESON: It'd be interesting to get that number and also find out if there're -- if those resources are best used there or elsewhere with your limited number of people. That'd be interesting to here.

Following up on Mr. (inaudible) questioning, is there a development of a more rapid test to determine if someone has Ebola than what we use today.

FRIEDEN: A more rapid test would be very helpful.

U.S. Navy has a pilot test in -- in development. We're currently testing that in parts of West Africa. It's simpler, quicker and would be very helpful, even if it isn't quite as -- as sensitive in West Africa.

But we're working with a number of commercial manufacturers also on a more rapid test than there is currently.

MATHESON: It seems to me that when it comes to infection control and prevention and hospital epidemiology standards, I think they vary widely from hospital to hospital in this country.

What legislative or regulatory actions could strengthen these systems? I mean, to the end, how can we reduce this variability among hospitals in our country?

FRIEDEN: Infection control in our hospitals generally is a challenge and something that CDC works hard with hospitals and state health departments and state governments to improve.

Hospitals are regulated by the states within which they operate, and the issue of what could be done to improve infection control is complex.

CDC has a large program of hospital infection prevention, and there, we support regional efforts to share lessons and figure out new ways to do things better infections. And that kind of center of excellence model is a very important one.

MATHESON: But you're suggesting that while -- while you can provide the information and the expertise and the guidance, the actual implementation and responsibility is still a state function more than a federal function.

Do you think we should be looking at that issue?

FRIEDEN: In the U.S.?

MATHESON: Yeah.

FRIEDEN: We have a federalist system. The -- the -- the CDC provides information and input. There are roughly 5,000 hospitals in the country -- we're not a regulatory agency.