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tv   House Homeland Security Committee Field Hearing on Ebola  CSPAN  October 12, 2014 3:00pm-4:01pm EDT

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that is important so we can understand it better and intervene to prevent this from
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happening in the future. i want to go into a little more areil first on what we doing to promote safe and effective care. safe and effective care, we had already begun several days ago to ramp up the education and training of health care workers at this facility. may be doneebola safely, but it's hard to do safely. it requires scrupulous attention to infection control and even a single inadvertent, innocent slip can result in contamination. we are recommending to the facility that the number of workers that care for anyone with respect to ebola began to an absolute minimum. we recommend the procedures that are undertaken to support the care of that individual be committed to essential
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procedures will stop forth about we are looking at personal protective equipment, understanding there's about -- there's a balance and putting more on isn't always safer and may make it harder to provide effective care. recommending there be a full-time individual responsible only for the oversight, supervision, and water drink of effective control where anyone suspected of having a bullet is being cared for. the cdc has sent additional staff to texas to assist with this response and we will continue to work closely with them. in the investigation itself, we look at three different phases. what happens before someone goes in to an area where somebody is suspected of having ebola is being cared for.
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what happens in that space and what happens when they leave. the two areas where we will be looking particularly closely is the performance of kidney dialysis and respiratory intimation. both of those procedures may spread contaminated materials and are considered high risk procedures. they were undertaken on the indexed nation as a desperate measure to try to save his life. taking off respiratory protective equipment, we identified this as a major potential for risk. when you have gone into and essentially contaminated gloves, masks or other things, to remove those without risk of contaminated material touching you and then being on your close, face or skin and leading
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to an infection is critically important and not easy to do right all stop these are areas the investigation will look at but we don't know what it will find. we will be doing that over the coming days. , i do wantrn it over to make two final points. unfortunately, it is possible in the coming days that we will see additional cases of ebola. this is because the health care workers who cared for this individual may have had a breach of the same nature of the individual who appears now to have a limiter a positive tests. in the 48 people who are being monitored, all of whom have been tested ailey, none of them so far have developed symptoms or fever and in any other health care workers who may have been exposed to
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this index patient while he was being cared for. we are still determining how many health care workers that will be. that's an intensive investigation and takes many hours of retracing steps. we will always cast the net wider, though there is no risk to people outside of that circle caredlth care workers who for the patient in the initial 48 patients or contact who had possible contacts with the patient we have already identified. the second point i want to make is what we do to stop ebola is to break the link of transmission, to break the chains of transmission. to make sure every person with ebola is promptly diagnose and probably isolated and we identify their contacts and actively monitor their contact every day for 21 days and if
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they develop symptoms or fever, that we do the same process again. that is how we have stopped every ebola out rake in history except the one currently in west africa. that is how we stopped it in nigeria, that is how we will stop in dallas. breaking the links in the chain of transmission is the key to preventing further spread. i would like to turn it over now to dr. leahy. >> thank you. on the commissioner of health in the state of texas. i appreciate all the help the cdc has given us, not only overnight but over the last several weeks as we have been working through this unprecedented event. our staff had been working throughout the night trying to gather more information and as we get more information as appropriate, we will provide that information. we do have one health care worker that had extensive
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contact with an initial patient who did what was appropriate with early symptoms that came in to be checked. we facilitated getting the lead test done and that test came back at 9:30 last night. as dr. frieden noted, it was positive in the controls were appropriate and the amount of virus in her blood came back as a positive test. our hearts go out to this individual and the family. health care worker who was willing to compassionately care for mr. duncan and again, our thoughts and prayers are with them. we have been preparing for events such as this, putting in the contingency plans and we are refining those plans and a lot of work is taking place right now.
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the 48 original contacts continue to be monitored and continue to do well. we have one health care worker that needs our care. we have been and will continue to monitor health care workers and are stepping that up to make sure any health care worker that has a fever or any other symptom will be quickly identified and continue to work to make sure trackedction control this is being performed at the hospital are at the highest standard and fully evaluating figuredunderway and out exactly what happened that allowed this individual to be infected. in more public health staff,ls, public health epidemiologists, to make sure we have the individuals we need to fully evaluate this situation.
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we appreciate the work from the cdc and their support as we work through this situation. >> we will now take questions. we will start in the room and go to the phone. worker haslth care had multiple contacts with the original patient. interviews, has she been able to isolate a chance for this reach may have occurred? >> we have spoken with the health care worker and that person has not been able to identify a specific reach. the way we do investigations like this is look at every single interaction and look at
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any other information we can gather. as a general rule, these are the areas where we see the greatest risk of stop >> is this going to change the way health care workers anywhere, whether in atlanta or dallas interact with these patients? what is going to change now? >> is very concerning. is a need to enhance training and protocols to make sure those protocols are followed. the protocols work. we have decades of experience caring for patients with ebola but even a single lapse or breach can result in infection, so figuring out all the things we can do to minimize that risk, such as those i went to, reducing the number of health care workers, having a site
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monitor there, these are things we will be looking at closely. we will go to the phone for questions. >> thank you. we will begin the question and answer session. please say your name clearly. our first question comes from abc. saying how difficult it is to implement proper infection control and how one slip can be dangerous. is there any consideration of moving toward a system where he would move nations to these specialized units where they are trained in set of treating him and hospitals where they don't have that training? >> we are going to look at all opportunities to improve safety and minimize risk, but we can't let any hospital let its guard in american returning or someone else coming
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into this country that had exposure and maybe did not even have an awareness of the exposure may become ill. theant hospital to have ability to consider and isolate and diagnose people who may have ebola. giddy,who has been liberia, or sierra leone and has a fever or other symptoms should be immediately isolated and evaluated for ebola. that theistinguish diagnosis needs to be done anywhere, than thinking about what is the safest way to divide that care -- that is something we will absolutely be looking at. >> thank you very much. press your mute button. let's go to the next question.
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cnn, the line is open. >> thank you. if you could say anything more about the kind of contact or what was the role of this person who became infected and if you could clarify the monitoring process. are some of the other contact getting him person visit or what is the ross us for taking the temperature and rep putting in? over to thern that commissioner and i want to thank the texas and dallas health authorities who have an working around the clock since the diagnosis of the first patient and have monitored every one of those patients had taken their temperatures and have intensively served to address this latest development. individuals known to
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have had contact or potential hadact, those individuals an on-site visit where they saw one of the epidemiologists and had a subsequent fever check later in the day -- the health care workers where there was no breach in contract were doing self-monitoring. in light of this case, we are looking at the ongoing monitoring of all the health care workers and going forward, see a an epidemiologist more active individual. they had been doing self-monitoring up until today. >> this woman was not in the group of 48 contacts. she was an additional person. do you have any idea how the more people that might be
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expanded to? >> this individual was not part of the 48. we are working on that the hard right now. >> in order to identify that number, we cast the net wide and identify anyone who might have had contact and then do detailed interviews and record reviews with each and every one of them to identify those who definitely did had contact, those who didn't than those who we cannot >> could youtop weree clarify what you talking about where you tried to limit things to essential procedures? what does that mean? what is essential and how do you win at procedures and not compromise that?
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in terms of limiting, as we do everywhere, ebola patients are cared for -- we try to keep to an absolute minimum the number of health-care workers that enter the area. that reduces risk. second, we try to make sure the procedures are taken to the absolute minimum. for example, a blood draw is very important that if someone is not having diarrhea and vomiting, maybe it only needs to be done once a day rather than multiple times a day. that was done differently previously, i'm just saying that was an example of how we might limit things to essential procedures. next question? >> thank you. i was wondering if you could comment a little more on the preparedness of hospitals that
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are outside of these that havement units treated the other ebola patients who have come to the u.s.. incident -- this what do you think it says about preparedness generally of hospitals around the country? are you concerned about hospital preparedness? that an infection control person should be in hospitals. as a guideline for all hospitals or are you talking particularly about the texas hospital? >> let me answer the second was units. in ebola treatment in africa, one of the things we have identified as a potential contributor to infections that have occurred there is a lack of an on-site manager at all times that doesn't have any specific
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responsibilities other than overseeing and supervising everything being done to make sure infection control is being done correctly. saying we would ensure that is being done going forward in texas. question,f your first it important to distinguish the from thelayout procedures and policies and training and staff work. in terms of the first, the expensive. not there are some things where there are places for people to put on and take off protective equipment, but it is not a disease that spreads through the air, so it does not require some of the most intensive infection -- infection control.
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on the personnel, training, supervision and follow-up monitoring, it is very clear the necessity of doing this right 100% of the time does require a very intensive training, follow-up, monitoring process. next question? >> good morning and thank you for taking the call. if you could respond to this western -- how frustrating is we'reor you after saying going to stop ebola in it tracks, to know a breach of protocol among a professional is what caused this new transmission. is it shaking your faith in hospitals around the country to
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adequately prepare their staff? >> i will start and then turn it over. it is deeply concerning this infection occurred and our thoughts are with the health care worker who was providing care and appears to have become infected. that does not change the bottom line witches we know how to break the chains of transmission. we need to ramp up infection control for any nation suspected or confirmed of having ebola and we need to do what we have been doing with contact tracing and monitoring. she identified symptoms immediately on the onset and was notified promptly. it looks like there was one other additional contact of that illness and that individual does not have fever. we are looking closely at that and it does not change the bottom line and the bottom line
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is we know how ebola spreads. we know how to stop it from spreading, but it does reemphasize how meticulous we have to be on every single aspect of the control measures from rapid tightness is to isolation to effective care with infection control to the scrupulous investigation. i would like to second what he just said. i firmly believe we are going to stop this year. careful ande very we need to closely look at the infection control practices as they are occurring, to be meticulous to make sure there are no breaches. is it frustrating were disappointing as to mark of course it is. our hearts go out to the families to the health care worker that is infected.
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she is going to have a rough time and we need to continue to make sure she gets the care she needs. we have been doing contingency planning for situations like this. one of the things i have learned in disaster response is you have to have a little humility in how you approach things and be cautious. we need to continue to do that and continue contingency planning. do i doubt we are going to stop the spread here it is one half of all? no. i firmly believe we will stop it. >> next question. >> i was wondering if there was in the updated guidance on when screening would start at the additional export -- additional airports announced last week?
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>> yesterday, we began screening at jfk international airport in new york city. that screening went smoothly and there are a lot of lessons being learned to make sure's greeting goes smoothly -- to make sure screening goes smoothly for passengers. airre anticipating starting port screening at the other four airports starting on thursday. next bastion. stop --question will next question. a can you speak to how health-care worker apparently caught ebola when people who had close contact in the apartment for several days did not? do you have any plans to transfer this new case to one of the specialty hospitals? with regard to the first question -- when patients have ebola, they become progressively
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infectious the sicker they become because the amount of virus in their body and in their secretions increases. the people who had contact with this index patient in dallas prior to his isolation are not yet out of their 21 day exposure. we are not out of the woods yet with additional cases among contacts before isolation. but medical procedures involve dealing with what, dealing with body fluids, diarrhea and other things that may have very large quantities of virus and that's why the personal protective women and protocols are so important. as someone get sicker, they get more infectious. we will look at all the possibilities to make sure of the safe care of patients to the greatest ability possible. i was wondering whether dr. lakey could
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clarify -- this health-care worker was not in the initial group of 38. earlier this morning, it was said there were 19 hospital employees they were tracking. part of that 19 or is it part of a larger group? thesecond question was hospital by its own track record has not provided the best information. they have had to do a lot of walk backs will stop the hospital originally said there was low-grade fever. are there any other symptoms or information given the track record of not providing accurate in this -- accurate information initially? >> i'm sorry. i have forgotten your first question. that part of the people
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they were tracking or is it part of a larger group? >> the 48 contacts identified were individuals who had contact with the index nation up to the day he was isolated. this individual was not exposed to that time. those 48 as for everything we know, are the only people he may have had contact with before he became isolated. in terms of the care in hospital from the 28th to october 8, that is the time when there may have been additional contacts given the fact this individual was clearly exposed that. that is what is being investigated now. the first contact identified what we still believe is all 48 who were exposed up to the time
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he was isolated. now we are doing a new investigation, given a diagnosis late last night of anyone else who may have been exposed once he was on what should have been effective isolation. statuss of the clinical of the patient, our information is at least as of sometime back, she was showing only mild symptoms and low-grade fever. our team lead did interview her will continue to monitor her closely to make sure she is the best possible care. we will take two more questions on the phone. i wanted to find out specifically with this new kind of gonehave around this -- why would she not initially included in the 48 that were monitored? and i also want to ask when you
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were in africa, did you take special cautions you normally would not have with putting on protective equipment? >> as i just indicated, we monitored all contacts up to the time of the index patients admission. given this apparent infection, we will be evaluating and who mayng all contacts have had exposure during the hospital stay. in terms of precautions in africa, they are very specific for personal protective equipment, taking off, putting it on and what happens there. >> thank you. add otherve much to than what you have provided. workers in full personal protective whitman
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during their involvement in the individual initial were at minimal risk will stop those individuals had guidance to do self-monitoring that were not in that 48. this individual is doing that and the earliest signs of , temperature, and what was evaluated. >> we will take the last bastion. >> thank you for making such great information available today. i'm wondering how common is it for people to be on dialysis or be intubated during and ebola infection? inthat something you've seen patients treated in western countries? common thatng how
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is and how often health-care workers have had to deal with those situations? >> thank you. ofon't know the details those other patients cared for in other parts of the world, but i'm not familiar with any prior patient with ebola who has undergone either intubation were dialysis. certainly, it would be very unusual if it has happened before. i do want to clarify one thing -- of the 48 contacts being monitored, including the 10 known to have had contact, that does include health-care workers who had contact with the index patient before he was isolated on september 28 but does not include anyone after some umber 28. before i make a couple of concluding remarks, going to make sure commissioner lakey has nothing to say. >> thank you for your support. it's obviously a very trying day and busy night.
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the work that is going on to make sure we fully understand what happened and can make sure the hospital has the expertise and infection control practices they need to prevent any other individual from being exposed again, we appreciate the health-care worker coming in with the early signs of being cared for appropriately. resources we need to fully understand this as quickly as possible. to the cdc for the work they continue to do. >> thank you. thank you for the terrific work your team is doing there. theeally do appreciate partnership in your work on the ground makes a big difference. we are honored to be part of the team doing that with state, city at hospitals will stop the
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bottom line here is we are very concerned a preliminary positive has been identified in a health-care worker who provided care to the index patient. confirmation rate testing later today at the cdc and we will identify any additional contacts that individual had before they were diagnosed and other individuals who may have divided care for the x patient that may have similarly been exposed and actively monitor those individuals. also undertake a thorough investigation to understand how this happened and we will ramp up infection control to do whatever we can to minimize the risk that there would be any future infections. finally, our thoughts go out to the health-care worker, their family, understanding how difficult a time this is for them and other health care workers who may have been , they need to go through
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that anxiety producing time. these are the individuals that we need to monitor and this is how we break the links of transmission. we will seele additional cases with those who had contact with either of the two patients, but there is no doubt we can rake in the chain of transmission. we have done it before and we will do it here and the team in dallas is doing an excellent job making sure that happens. thank you all so much in your interest in covering this topic. >> the house homeland security committee held a field hearing on friday in the dallas-fort worth area to hear from state, local, and federal officials about their response to the ebola virus. thomas duncan, the liberian national who was the first patient tightness with ebola in the united states died wednesday in a dallas hospital. members heard from are presented as from the department of homeland security, health and human services, the centers for
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disease control, and the texas the part of state health services. this portion of the hearing is one hour 40 minutes. >> we are here today to discuss the threat to the united states homeland, to the ebola virus am and what is being done to stop the spread of this terrible disease. now the virus has begun to spread and the american people are rightfully concerned. they are concerned because the ebola virus is an unseen threat and is only a plane flight away from our shores. we have witnessed that with the recent case here in dallas, the
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first totality -- first fatality from ebola. we must be sure to confront this crisis with the facts. blind panic won't help us stop this and fear mongering will only make it harder to do so. that is why we are here today, to ask the american people's questions and get answers from the experts. assuranceare seeking that our state and local officials are doing everything in their power's to keep this virus outside the united states. already, there has been a vigorous response. we hope to hear more today about exactly what has been done, and what needs to be done going forward. two weeks ago, thomas r duncan traveled here from liberia. by way of brussels and dulles airport. he fell ill, and presented himself for treatment at texas health presbyterian hospital in dallas.
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mr. duncan's diagnosis set in motion an extensive public health operation involving federal, state, and local officials to identify and assess any individuals with whom he may have had contact. a process called contact tracing. that contact tracing effort continues today. our prayers are with everyone who is currently being monitored as part of this incident. we are thankful that to date, there been no additional cases of ebola standing from this case. it is difficult, but it is one of the few ways to contain the disease. containment also requires swift coordinated action. in this hearing, and investigations into the boston marathon bombings, we heard about the importance of the incident command system. the system is a vital tool for making sure first responders at all levels engage quickly and decisively, rather than argue about who is in charge.
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the importance of such a response mechanism was highlighted in the 9/11 commission report. it has since saved countless lives. i was encouraged to learn that officials here in texas instituted the structure, and today, state and federal officials were: located in the dallas county emergency operations center, enabling vital information sharing and coordination. to be clear, the situation here is far different than what is happening in west africa. we have a strong public health infrastructure in place, particularly here in texas. it enables us to work to contain this virus more effectively. dallas is not the only area that we must be vigilant. we need to ensure that state and local responders nationwide are prepared to move quickly if the virus is detected anywhere else within our borders. hospitals are recognizing this, and have made nearly 190
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inquiries with the cdc about cases they believe could be ebola. thankfully, testing was only wanted in 24 of these cases. only one case was confirmed as ebola. public health and medical personnel must remain vigilant, ensure all hospital personnel are informed, followed protocols to identify the virus, and take appropriate quarantine measures. we must reinforce the importance of taking travel histories and sharing that information with all relevant personnel. protecting the homeland from the ebola virus also requires us to put measures in place at our airports. i am pleased the president announced earlier this week additional entry screening efforts that are being launched. beginning tomorrow, enhanced screening measures will be activated at jfk airport, and soon after at dulles, o'hare, newark, and atlanta.
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his airports received more than 90% of all travelers from liberia, sierra leone, and guinea. the department of homeland security has been involved, and i commend secretary johnson for his leadership. we must also closely monitor the situation overseas, and continue our global response efforts. i've spoken with the homeland security adviser numerous times to ensure we are doing all that is necessary. we discussed exit screening procedures that have been put in place by cdc trained personnel. the screening has stopped 77, out of a total of 36,000 individual screened. fortunately, none of those 77
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have been diagnosed with ebola. there have been many positive aspects of this response, there have also been missteps. for instance, here in dallas, mr. duncan's travel history was not communicated to all relevant medical personnel when he first sought treatment, which led to his release from the hospital, and the potential that additional people were exposed to the virus. there were also problems removing hazardous biomedical waste from the apartment where mr. duncan's family was quarantined. the soiled materials remained in the home for days after the ebola diagnosis was confirmed. we must learn from the steps, and ensure the proper procedures are followed. going forward, we must consider all policy options for stopping the spread of this disease. i have heard many ideas.
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everything from stopping inbound flights from specific countries to additional screenings at home and abroad. we hope our witnesses will discuss options that are being considered in the trade-offs that we have to confront. we also have to ensure unnecessary government red tape does not slow down the response. in fact, we passed -- an appropriation was made in the house seeking $750 million towards response efforts. i would urge the senate to follow the lead of the house and approve the pentagon's request to transfer additional resources to this fight. now is not the time for politics. congress has been loath to get anything done the session. if there has never been a time to come together and put pettiness aside, it is now. we must get this right, and make sure that federal protocols are
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put in place, and communicated to our state and local partners when a situation is critical occurs. my hope today is that we don't focus on politics, but instead, here from our panel, and focus on solutions. we are all in the same boat. we need to work hard to make sure our nation is protected from this threat. i want to thank the ranking member for being here today in my home state of texas, and the showing of support for the shared goal. before i turn it over to him, i would also like to commend our first responders, our medical personnel and public health officials who have responded courageously to the case here in dallas. most importantly, our thoughts and prayers are with the victims and the families affected at this crisis. i look forward to hearing from the witnesses, and hear from them what more can be done to keep americans safe.
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with that, the chair recognizes the raking member, mr. thompson. >> good afternoon. want to thank the chairman for holding this timely hearing on our efforts, both domestic and international, to contain and prevent the spread of the ebola virus. also, i think the witnesses for appearing here today. i look forward to the testimony. additionally, i want to thank the chair and the board of directors of the dallas-fort worth airport, and their executive staff, for hosting the committee today. i want to extend my condolences to the family of thomas eric duncan, the first person diagnosed with ebola on american soil. we are not here to dehumanize mr. duncan. unfortunately, his diagnosis, and the procedures that followed, raised critical questions about our preparedness for highly infectious diseases such as ebola, and how federal, state, and local authorities
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coordinate in their aftermath. as ranking member of this committee, i often urge my colleagues not to use opposition of influence to promote fear in the public. hence, i want to clarify that while it is proper to have serious concerns about the ebola virus, it would be irresponsible for us to foster the narrative that an ebola epidemic in the united states is eminent. rather, this searing provides us an opportunity to review state, local, federal, and global public health infrastructure, learn where there are inconsistencies and gaps, and lay the foundation for eliminating these disparities. while the ebola virus has caused the united states to institute new screening procedures at airports, it is incumbent upon us to work with our international partners to eradicate the virus at its origin, in west africa.
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the current ebola outbreak is the deadliest outbreak on record. according to the assistant secretary general of united nations, it is also impairing national economies, wiping out livelihoods and basic services, and could undo years of effort to stabilize west africa. eliminating this virus at its source is a surefire way to prevent more ebola cases in the united states. as citizens of the global community, it is not only our responsibility to limit this fires, but help them recover. the united states'response seems as though the international community did not act aggressively soon enough.
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in march, the world health organization issued a notice of in a bowl outbreak in guinea, after the outbreak in liberia. in june, doctors without borders, a nongovernmental organization declared the outbreak out of control. the world health organization and the international community did not improve on its efforts until august. according to a chart that i have here. we had a little until the spike started in august of this year. mr. chairman, i submit for the record this charge. earlier, i stated in a bowl outbreak is not imminent. what should be discussed is the value of public health
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infrastructure, and the cost of maintaining it. many times, it is used for a pawn. viruses do not know political parties. preparedness grants from the cdc, and office of the surgeon general hit already struggling state and health departments hard. we can use our platforms to respond funding, and support the federal cost of maintaining a public health and for structure. i hope that our discussion today can yield a step in this direction.
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i also support the chairman's, that this disease does not see party. it is an american problem, the world needs our best minds to address. i look forward to the testimony of witnesses. i yield back the balance of my time. >> i thank the ranking member. dr. tobin merlin is the director of the department of preparedness and emerging diseases. in this role, he is responsible for the cdc's laboratory response network, infectious disease and emergency response for nation, and emerging infection epidemiology and laboratory capacity programs. next, she serves as the acting
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assistant secretary of health affairs and chief medical officer for the department of homeland security's office of health affairs. she began her service in july 2008, previously served as the associate chief medical officer and director of the division of workforce health and medical support. prior, she served on a detail to the national security staff as a director of medical preparedness policy. thank you. mr. john wagner, i want to thank you for the tour you gave me, and how you would deal with potential ebola victims. mr. wagner became his current position in 2008. he overseas employees and specialists that protect our
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borders. his annual budget provides operations that support national security and customs and commercial trade. the full written statement will appear in the record. >> good afternoon. i appreciate the opportunity to be here today to discuss the current epidemic of ebola in west africa, as well is the work the cdc is doing to manage the global consequences of this epidemic. i have been particularly involved with colleagues here in dallas, addressing the first u.s. diagnosed ebola case. like you, our hearts go out to the family and friends of mr. duncan. as the cdc director noted, mr. duncan puts a real face on the epidemic for all americans.
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the ebola epidemic in guinea, liberia, and sierra leone is ferocious. it continues to spread exponentially. the current outbreak is the first that has been recognized in west africa, and the biggest and most complex ebola outbreak ever documented. as of last week, the surge past 7900 cumulative reporting cases. we believe the numbers could be two to three times higher. fortunately, the u.s. and others in the global community are intensifying the response in order to bring this critical situation under control. from the time the situation in west africa escalated from an outbreak to an epidemic, we have anticipated that a traveler might arrive in the united states with the disease. the imported case of ebola in dallas required the cdc and the nation's public health system to
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implement rapid response protocols that have been developed in anticipation of such an event. within hours of confirming that the patient had ebola, cdc had a team of 10 people on the ground in dallas to assist the capable teams from the texas state health department and local authorities. we have worked side-by-side with state and local health officials to prevent infections of others. together, we assessed all 114 individuals who might have possibly had contact with the patient. we narrowed down the contacts to 10 who may have been around the patient when he was infectious. 30 others with whom infection could not possibly be ruled out. these individuals are being tracked, and will be tracked for 21 days for any signs of symptoms. they will quickly be isolated if symptoms develop area.
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we are also working to identify and learn lessons from the initial patient encounter. and other events that cop located our response, and to apply them in other responses. we are cop it we can prevent in a bowl outbreak here, and that congress has put us in a strong position to protect americans. to make sure we are prepared as the epidemic has example five, the cdc has done the following -- instituted layers of protection starting in affected countries where our staff work intensely on airports running. they provided guidance on how to manage sick passengers. along with partners and dhs and state and local health agencies, we continually assessed and improved inbound passenger
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screening and management. as the president announced, the cdc is working with dhs to intensify screening at united states airports. this is something my colleagues from dhs will be discussing. we have worked with american hospitals to reinforce and strengthen controls. we have intensified training and outreach to build awareness. we have expanded lab capacity across the united states to test for ebola. we have developed response protocols for the evaluation, isolation, and investigation of symptomatic individuals. we have instances of extensively evaluated suspected cases. we remain confident that ebola is not a significant health threat to the united states. it is not transmitted easily, and it does not spread from people who are not ill.
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it is possible another infected traveler might arrive in the u.s.. should this occur, we are confident we can prevent the kind of significant transmission of ebola that would lead to an outbreak here in the united states. it is important to remember that the only way to protect americans is to end this ebola epidemic and to continue extensive focus on west africa. and they are, implement messages. we are determined to stop this one. it will take meticulous work, and we cannot take shortcuts. thank you for the opportunity to appear before you today, and for making cdc's work on this epidemic and other health threats possible. >> thank you, dr. merlin. >> chairman, ranking member,
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distinguished members, thank you for inviting me to speak with you. i appreciate the opportunity to testify on the department of homeland security's role in the management of ebola. i'm honored to testify along with my colleagues. i want to thank the texas state and local officials who will testify later. the hs works closely with the state of texas on a number of important issues. we appreciate their work. dhs is responsible for securing our borders and safeguarding the american public from communicable disease. the dhs office of health affairs is at the intersection of homeland security and public health, with a mission to advise, promote, integrate, and enable a safe and secure nation. we achieve this by enhancing the
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health and wellness of the dha working force and protecting the nation. in my role, i provide medical and health expertise. in this capacity, i'm helping to cornett with components and provide them with medical advice regarding the department's efforts in repairing for an responding to ebola. this is the largest a bowl outbreak in history. it has had devastating impacts. on september 30, 2014, cdc confirmed the first travel related case. sadly, he has since passed away. the patient did not have
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symptoms when he left liberia, nor when he entered the united states. but developed them approximately five days after his arrival. the public concerns surrounding this event and possible future public exposure to ebola from international travels is understandable. although it is important to member that the cdc has stated that the risk of an ebola outbreak in the united states is very low. the president has been focused every day on the government's response. he has stated to senior health, homeland security, national security advisers that the epidemic in west africa is a top national security priority. dhs takes this issue very seriously. we have been closely monitoring the ebola outbreak since april. we are actively engaged in a bowl a response, working with federal and international partners to develop multiple mechanisms to allow screenings. we are closely monitoring the situation.
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actively engaged with state and local partners and adjusting processes as needed. dhs has unlimited methods to eliminate risk. take a layered approach to make sure there are varying the points through which an ill individual could be identified so there is a simple point of failure. to this end, we are also focused on protecting those traveling by air and taking steps to ensure that passengers with communicable diseases like ebola are screened, identified, isolated, and quickly and safely referred to medical personnel. we have been working with the cdc to implement an additional layer of screening for travelers entering the united states, which is scheduled to begin this weekend. these additional screening protocols are just some of the many actions the federal government has taken in our layered approach to help ensure the risk of ebola in the united states remains minimal.
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assistant commissioner wagner will go into more detail. but i would like to highlight other key actions that we have taken to date and will continue to take. they have posted messages from the cdc at select airport locations that provide awareness on how the prevent the spread of infection. typical symptoms of ebola, and instructions to call the doctor if it traveler becomes ill. tsa engages with industry partners and a mystic and foreign air carriers to provide information, reinforcing the cdc's message on ebola and providing guidance. oha, through the national center, continues to monitor the outbreak and is producing tailored ebola products. the u.s. coast guard is monitoring vessels known to be

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