[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
THE EBOLA CRISIS: COORDINATION OF A MULTI-
AGENCY RESPONSE
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
OCTOBER 24, 2014
__________
Serial No. 113-163
__________
Printed for the use of the Committee on Oversight and Government Reform
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
DARRELL E. ISSA, California, Chairman
JOHN L. MICA, Florida ELIJAH E. CUMMINGS, Maryland,
MICHAEL R. TURNER, Ohio Ranking Minority Member
JOHN J. DUNCAN, JR., Tennessee CAROLYN B. MALONEY, New York
PATRICK T. McHENRY, North Carolina ELEANOR HOLMES NORTON, District of
JIM JORDAN, Ohio Columbia
JASON CHAFFETZ, Utah JOHN F. TIERNEY, Massachusetts
TIM WALBERG, Michigan WM. LACY CLAY, Missouri
JAMES LANKFORD, Oklahoma STEPHEN F. LYNCH, Massachusetts
JUSTIN AMASH, Michigan JIM COOPER, Tennessee
PAUL A. GOSAR, Arizona GERALD E. CONNOLLY, Virginia
PATRICK MEEHAN, Pennsylvania JACKIE SPEIER, California
SCOTT DesJARLAIS, Tennessee MATTHEW A. CARTWRIGHT,
TREY GOWDY, South Carolina Pennsylvania
BLAKE FARENTHOLD, Texas TAMMY DUCKWORTH, Illinois
DOC HASTINGS, Washington ROBIN L. KELLY, Illinois
CYNTHIA M. LUMMIS, Wyoming DANNY K. DAVIS, Illinois
ROB WOODALL, Georgia PETER WELCH, Vermont
THOMAS MASSIE, Kentucky TONY CARDENAS, California
DOUG COLLINS, Georgia STEVEN A. HORSFORD, Nevada
MARK MEADOWS, North Carolina MICHELLE LUJAN GRISHAM, New Mexico
KERRY L. BENTIVOLIO, Michigan Vacancy
RON DeSANTIS, Florida
Lawrence J. Brady, Staff Director
John D. Cuaderes, Deputy Staff Director
Stephen Castor, General Counsel
Linda A. Good, Chief Clerk
David Rapallo, Minority Staff Director
C O N T E N T S
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Page
Hearing held on October 24, 2014................................. 1
WITNESSES
The Hon. Michael Lumpkin, Assistant Secretary of Defense, Special
Operation/Low-Intensity Conflict, U.S. Department of Defense
Oral Statement............................................... 7
Written Statement............................................ 9
The Hon. John Roth, Inspector General, U.S. Department of
Homeland Security
Oral Statement............................................... 17
Written Statement............................................ 19
The Hon. Nicole Lurie, M.D., Assistant Secretary for Preparedness
and Response, U.S. Department of Health and Human Services
Oral Statement............................................... 60
Written Statement............................................ 62
Ms. Deborah Burger, R.N., Co-President, National Nurses United
Oral Statement............................................... 71
Written Statement............................................ 73
Mr. Rabih Torbay, Senior Vice President, International
Operations, International Medical Corps
Oral Statement............................................... 80
Written Statement............................................ 82
APPENDIX
2014-10-16 Texas Health Resources Ebola Update................... 155
CRS HHS Annual Funding Preparedness and Response................. 157
2014-10-23 WSJ There's Plenty of Money to Fight Ebola............ 158
FY2014 HHS Appropriations Overview............................... 161
2014-10-20 WP Beating Ebola Through a National Plan.............. 164
2014-10-24 AAPS U.S. Public Health Response to the Ebola Outbreak 166
THE EBOLA CRISIS: COORDINATION OF A MULTI-AGENCY RESPONSE
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Friday, October 24, 2014
House of Representatives,
Committee on Oversight and Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 9:30 a.m. In Room
2153, Rayburn House Office Building, Hon. Darrell E. Issa
(chairman of the committee) presiding.
Present: Representatives Issa, Cummings, Mica, Turner,
McHenry, Jordan, Chaffetz, Walberg, Amash, Gowdy, Farenthold,
Massie, Collins, Bentivolio, DeSantis, Maloney, Tierney, Lynch,
Cooper, Connolly, Cartwright, Kelly, Davis, and Lujan Grisham.
Staff present: Will L. Boyington, Deputy Press Secretary;
Molly Boyl, Deputy General Counsel and Parliamentarian;
Lawrence Brady, Staff Director; Ashley H. Callen, Deputy Chief
Counsel for Investigations; Sharon Casey, Senior Assistant
Clerk; Steve Castor, General Counsel; John Cuaderes, Deputy
Staff Director; Adam P. Fromm, Director of Member Services and
Committee Operations; Linda Good, Chief Clerk; Elizabeth
Gorman, Professional Staff Member; Frederick Hill, Deputy Staff
Director for Communications and Strategy; Christopher Hixon,
Chief Counsel for Oversight; Caroline Ingram, Counsel; Michael
R. Kiko, Legislative Assistant; Mark D. Marin, Deputy Staff
Director for Oversight; Emily Martin, Counsel; Ashok M. Pinto,
Chief Counsel, Investigations; Laura L. Rush, Deputy Chief
Clerk; Jessica Seale, Digital Director; Andrew Shult, Deputy
Digital Director; Katy Summerlin, Press Assistant; Rebecca
Watkins, Communications Director; Tamara Alexander, Minority
Counsel; Meghan Berroya, Minority Chief Investigative Counsel;
Aryele Bradford, Minority Press Secretary; Courtney French,
Minority Counsel; Jennifer Hoffman, Minority Communications
Director; Una Lee, Minority Counsel; Juan McCullum, Minority
Clerk; Suzanne Owen, Minority Legislative Director; and Dave
Rapallo, Minority Staff Director.
Chairman Issa. The committee will come to order.
Without objection, the chair is authorized to declare a
recess of the committee at any time.
The Oversight Committee exists to secure two fundamental
principles. First, Americans have a right to know that the
money Washington takes from them is well spent. And, second,
Americans deserve an efficient, effective government that works
for them.
Our duty on the Oversight and Government Reform Committee
is to protect these rights. It is our solemn responsibility to
hold government accountable to the taxpayers. Taxpayers want to
be safe. Taxpayers want to know that our government is
prepared. In this case, we leave no stone unturned in ensuring
today that America is planning for tomorrow.
Beginning in March 2014, in the West African Nation of
Guinea, the world first learned about yet another new outbreak
of the Ebola virus. Due to poor detection, it is possible the
outbreak started late last year. By August, Ebola had spread to
Sierra Leone, Liberia, and Nigeria.
According to the U.S. Center for Disease Control and
Prevention, the 2014 Ebola epidemic is the largest in history
and, sadly, the virus has claimed at least 4,000 lives to date.
By the end of September, the CDC confirmed the diagnosis of
the first travel-associated case of Ebola in the United States.
The situation is rapidly developing and changing; and Americans
are understandably worried, worried about their government's
response to the outbreak and, in particular, the steps we are
taking to contain the spread of Ebola.
With the high fatality rates--as much as 70 percent--and no
FDA approved vaccines or medicines, Ebola is a serious threat
to public health around the world. An outbreak in an American
city or any major city of the world could be very costly to
contain and could have major economic impacts. Yesterday's news
was a doctor in New York City tested positive for Ebola, and
this is particularly distressing.
There is certainly some good news to report on our effort
to contain the outbreak. No new Ebola cases have been reported
in Nigeria in 46 days. Over 40 people who came into contact
with the Ebola patient, Thomas Eric Duncan, in Dallas have now
gone through the 21-day monitoring period without demonstrating
any symptoms. And perhaps that means that our preventive
systems of those in contact is good, even though, as we will
see today, not perfect.
We have the world's most advanced healthcare system
undeniably in America. We spend the most money to have that
system. And as long--sorry--as long as our response is well
coordinated and officials use common sense, there is an ability
to contain this disease, but we are not out of the woods yet.
Today we will examine efforts to coordinate Federal
agencies tasked with responding to an Ebola outbreak. This
examination follows a series of Statements and actions that
have eroded public confidence in our response.
An infected traveler from Liberia made it through the
Department of Homeland Security screening and arrived at
international travelers and into the Dallas/Fort Worth area.
When the same individual exhibited clear signs of Ebola--
symptoms of Ebola, a hospital turned him back into the
community and offered an evolving account of how this happened.
Without evidence, the director of the CDC declared that a
nurse at this hospital who became infected with Ebola must have
contracted it through, ``a breach of protocol.'' Medicine is
not done over the telephone. It is not done over the
television. Medicine is, in fact, the business of looking at a
patient, evaluating a patient, measuring a patient, and
questioning a patient, not, in fact, guessing how someone
became a patient.
A separate nurse who contracted Ebola at that hospital was
cleared by the CDC to board a commercial airline flight, even
though she reported having fever and contact with the patient,
Mr. Duncan.
The news of that medical doctor returning from Guinea--the
news that a medical doctor returning from Guinea now has tested
positive for Ebola has raised even more questions about
procedures and treating patients and risks to Americans
responding with great courage and generosity from here to the
infected areas.
We need to know why there have been breakdowns and if our
system for responding to such serious crisis is working
properly. That was a line I was supposed to read. I think we
all know that the system is not yet refined to where we could
say it is working properly.
How effective are our efforts at containing the disease in
West Africa? Are the--are the training and equipment that
frontline healthcare workers and military personnel received in
the past or will receive in the future adequate? Isn't airport
screening that went into effect 2 weeks ago reliable? Are
government agencies doing everything they can do to foster the
development of Ebola treatments? What threat does Ebola pose to
international trade and America's--Americans traveling abroad?
When a situation like this arises, government is supposed
to rely on prior planning and rapid, effective response that
can identify mistakes quickly and correct them. Congress has
recognized and considered the threat of an outbreak on a
bipartisan basis. The bumbling we have seen comes despite
concerted efforts by Congress to ensure protocols and funding
were in place to avoid the very mistakes we have already seen.
President Obama's appointment of Ron Klain to serve as the
Ebola czar sadly, in my opinion, shows the administration has,
on one hand, recognized the missteps and, on the other hand, is
not prepared to put a known leader in charge or, in fact, a
medical professional in charge.
That does not make it a political decision, but it makes it
a decision in which we have to ask and we will ask today: Is
the interagency coordination already in place and he is simply
overseeing it or, in fact, are we expecting Mr. Klain to put
together interagency coordination to show the leadership to
make it happen, to sift through conflicting claims that science
and medicine have already reached conclusions versus the
reality that those conclusions, at least in several cases, have
proven wrong.
We did invite the President's new czar, Mr. Klain, to
testify, and we are very disappointed that he was not able to.
But we understand he has just started, and we do not expect
that that would be repeated if there is a followup hearing.
Let me just say, in my role in this committee and others, I
have traveled to the World Health Organization's headquarters.
I have seen them saying to us, as visitors, that pandemics are,
in fact, already planned for. And although they talk about the
inevitability of a pandemic, we have also invested, as
Americans, billions of dollars to, in fact, be prepared for
them.
Let me just say before anyone pulls the trigger on either a
political or denouncing medicine that, in fact, this is not a
new problem. Nearly 100 years ago, in 1918-1919, the influenza
pandemic known as the Spanish flu killed more people than any
other outbreak of disease in history. It claimed at least 20
million people--oh, thank you--around the world.
In that pandemic, an American base, one that I was
stationed at, Fort Riley, Kansas, proved to be the source of
the first-known outbreak. The flu spread fast around the base
and other bases and eventually worldwide. Famously, ``The Big
Red One'' is well aware that not only was the outbreak
critical, but, in fact, soldiers were put on ships and sent out
from there further--not recognizing that, in fact, we were
simply adding to the disease and the suffering.
The Asian flu of 1957-'58, which originated in the Far
East, spread to the U.S. and caused at least 70,000 deaths. The
Hong Kong flu of 1968-'69 also spread to the United States and
caused an estimated 34,000 deaths.
It would be a major mistake to underestimate what Ebola
could do to populations around the world, and any further
fumbles, bumbles or missteps or relying on postulate,
certainties told to us by people who, in fact, cannot defend
how that certainty came to be and when it fails to be correct
how they could have been so wrong, can no longer be tolerated.
I look forward to hearing from this panel of witnesses in
an effort not to solve a problem, but to take the problem
appropriately seriously, recognize that what we don't know
could kill us.
With that, I recognize the ranking member for his opening
Statement.
Mr. Cummings. Thank you very much, Mr. Chairman. And I
thank you again and again for holding this hearing.
I think this is the reason why we have an Oversight
Committee, to address those problems that our Nation and, in
this case, the world face.
Yesterday, Dr. Craig Spencer, a physician working for
Doctors Without Borders, tested positive for Ebola. We are
still getting additional details.
But based on information from New York and Federal
officials so far, it appears that healthcare authorities have
come a long way in preparing for Ebola since Thomas Duncan
first walked into a Texas hospital last month. New York had
been preparing for this possibility for weeks, and about 5,000
healthcare workers were drilled on protocols and procedures
just this past Wednesday.
A special team with full protective gear transported Dr.
Spencer to Bellevue Hospital, which is specifically designated
to handle Ebola. They placed him directly into an isolation
unit. They began treating him as soon as possible. And they
started tracing his contacts immediately.
As New York officials said last night, they had hoped they
would not have to face an Ebola case, but they did. They were
also realistic, and they worked diligently and professionally
over the last month to prepare themselves for this day.
There are many questions about this new case, but we cannot
assume it will be the last. And I remind all of us this is our
watch. Of course, we must continue to be vigilant, and we need
to continually reevaluate our protocols and training procedures
to protect our healthcare workers, many of whom are here today.
And to those healthcare workers, on behalf of a grateful
Congress and grateful Nation, I thank you for what you do every
day.
I want to express our thanks to Nina Pham and to Amber
Vinson, the two nurses from Texas who contracted Ebola when
they treated Mr. Duncan. By now, we have all seen their
pictures, two brave young women who risked their lives to
simply do their jobs and to feed their souls, just like nurses
across this country, every single day, 24/7, 365 days a year. I
understand that Ms. Pham's condition has been upgraded and Ms.
Vinson has now been cleared of the virus. We thank them for
their bravery and their commitment.
This new case in New York should also demonstrate that we
can no longer ignore the crisis in West Africa. We can no
longer ignore it. Nearly 10,000 people have died from this
disease or are battling with it as we speak, many in the most
gruesome conditions imaginable.
I firmly believe we have a fundamental, moral, and
humanitarian obligation to address the crisis in Africa. We are
the richest Nation in the world, and we have the resources and
expertise to make the biggest difference. However, for those
who may not agree that we have a moral obligation to help, they
must understand that addressing the Ebola crisis in Africa is
also in our self-interest as a Nation.
Public health experts warn that, to protect Americans here
at home, we need to address this outbreak at its source in
Africa. The longer the outbreak continues, the more likely it
will spread to the rest of the world, including more cases
right here in the United States of America. And if we do not
take strong action now, it will cause much, much more in the
long run. The encouraging news is that healthcare experts know
how to fight this disease. They know how to do that.
This week the World Health Organization declared Nigeria
and Senegal free of Ebola. This is a tremendous accomplishment
that was achieved through a combination of early diagnosis,
contract--contract tracing, infection control, and safe burial.
But we still face grave challenges in Sierra Leone, Guinea, and
Liberia where the public health infrastructure is deficient and
new cases are increasing at an alarming rate.
Last month the United Nations Security Council unanimously
adopted a resolution declaring the Ebola outbreak ``a threat to
international peace and security.'' The U.N. established a
mission for Ebola emergency response. They set forth more than
a dozen mission-critical actions and they provided a 6-month
budget request for $988 million.
However, they are hundreds of millions of dollars short.
They definitely need funding for treatment beds, training for
healthcare workers, and supplies to prevent infection. They
need resources for things as basic as food and vehicles and
fuel.
As the head of the United Nations mission warned the
Security Council just last week, ``We need to stop Ebola now or
we face an entirely unprecedented situation for which we do not
have a plan.''
There have already been several congressional hearings on
how to prepare ourselves here in the United States. So today I
intend to ask our witnesses what they believe, in their expert
views, are the most significant, concrete, and constructive
steps our Nation can take to address this outbreak at its
source.
I am particularly grateful to Mr. Torbay from the
International Medical Corps for agreeing to be here today to
provide his on-the-ground assessment of what his group and
others on the front lines need to stop the spread of Ebola.
Mr. Torbay, I know you must feel great empathy for Dr.
Spencer, who tested positive yesterday. I have asked my staff
to place your testimony on our Website. It is some of the best
testimony explaining what is going on in Africa, things that
work, and I think the public should have an opportunity to read
all 10 pages.
He was--Mr. Spencer--Dr. Spencer was one of your
compatriots, battling Ebola in West Africa, and I am sure his
situation is one that all of your healthcare workers must fear
on a daily basis. But the truth is that Dr. Spencer and your
group and many others are doing one of the only things that
will truly ensure the world will be free of Ebola. We need to
support you as much as we urgently can, and we must do it
forcefully. And we have to convince the rest of the world to do
the same. Again, I say this is our watch.
And to my fellow committee members and the members of this
great Congress, it is not a time for us to move to common
ground. We have no choice but to move to higher ground.
And so, with that, Mr. Chairman, I look forward to the
testimony today. And, with that, I yield back.
Chairman Issa. I thank the gentleman.
All members will have 7 days to submit opening Statements
for the record.
And, with that, we go to our panel of witnesses.
The Honorable Michael Lumpkin is the Assistant Secretary of
Defense for Special Operations and Low-Intensity Conflict at
the United States Department of Defense.
Major General James Lariviere--or--close enough--is the
Deputy Director of Politico-Military Affairs in--let's see--
Affairs in Africa at the United States Department of Defense.
The Honorable John Ross--sorry. I just got off a flight. I
apologize. The Honorable John Roth is the Inspector General for
the United States Department of Homeland Security.
The Honorable Nicole Lurie is the Assistant Secretary for
Preparedness and Response at the U.S. Department of Health and
Human Services.
Ms. Deborah Burger is the co-president of the National
Nurses United.
And Mr. Rabih Torbay is the Senior Vice President of
International Operations at the International Medical Corps.
Ladies and gentlemen, pursuant to the rules of the
committee, would you please all rise, raise your right hands,
and take the oath.
Do you solemnly swear or affirm that the testimony you are
about to give will be the truth, the whole truth, and nothing
but the truth?
Chairman Issa. Please be seated.
Let the record reflect that all witnesses answered in the
affirmative.
As you all can see, we have a large panel. And I know, from
the dais, there will be many questions. So I would ask that you
realize that your entire opening Statements will be in the
record and that you limit your oral testimony in your opening
to 5 minutes.
WITNESS STATEMENTS
STATEMENT OF HON. MICHAEL LUMPKIN
Chairman Issa. With that, Mr. Lumpkin.
Mr. Lumpkin. Chairman Issa, Ranking Member Cummings, and
distinguished Members of the committee, thank you for the
opportunity to be here this morning regarding the Department of
Defense's role in the United States's comprehensive Ebola
response effort, which are a national security priority in
response to a global threat.
Due to the U.S. military's unique capabilities, the
Department has been called upon to provide interim solutions
that will allow other departments and agencies the time
necessary to expand and deploy their own capabilities. U.S.
military efforts may also galvanize more robust and coordinated
international effort, which is essential to contain this threat
and to reduce human suffering.
Before addressing the specific elements of DOD's Ebola
response efforts, I would like to share my observations of the
evolving crisis and our increasing response. After visiting
Liberia, which I returned from several weeks ago, I was left
with a number of overarching impressions that are shaping the
Department's role supporting USAID:
First, our government has deployed a topnotch team
experienced in dealing with disasters and humanitarian
assistance.
Second, the Liberian Government is doing what it can with
its very limited resources.
Third, the international response is increasing regionally
due to our government's response efforts.
Fourth, I traveled to the region thinking we faced a
healthcare crisis with a logistics challenge. In reality, what
I found was that we face a logistics crisis focused on a
healthcare challenge.
Fifth, speed and scaled response matter. Incremental
responses will be outpaced by a rapidly growing epidemic.
Finally, the Ebola epidemic we face is truly a national
security issue. Absent our government's coordinated response in
West Africa, the virus's increasing spread brings the risk of
more cases here in the United States.
And now I would like to turn to DOD's role of our overall
whole-of-government response in West Africa.
In mid-September, President Obama ordered the Department to
undertake military operations in West Africa in direct support
of USAID. Secretary Hagel directed that U.S. military forces
undertake a twofold mission: First, support USAID in the
overall U.S. Government efforts and, second, respond to
Department of State request for security or evacuation
assistance if required.
Direct patient care of Ebola-exposed patients in West
Africa is not part of DOD's mission. Secretary Hagel approved
unique military capabilities falling under four lines of
effort: command and control, logistics support, engineering
support, and training.
In the last 6 weeks, DOD has undertaken a number of
synchronized activities in support of these line of efforts, to
include designating a named operation, Operation United
Assistance; establishing an intermediate staging base in Dakar,
Senegal; providing strategic and tactical airlift; constructing
a 25-bed hospital in Monrovia; constructing up to 17 Ebola
treatment units, also known as ETUs, in Liberia; and preparing
to train local and third-country healthcare support personnel,
enabling them to serve as the first responders in these Ebola
treatment units throughout Liberia.
I would like to reiterate that the U.S. military personnel
will not provide direct care to Ebola patients in West Africa.
In addition to the activities of Operation United
Assistance, the Department continues two enduring programs in
the region: Operation Onward Liberty, partners with armed
forces of Liberia to improve their professionalism and
capabilities; and we are expanding the regional efforts of the
Department's cooperative biological enhancement program to
provide robust enhancements to biosafety, biosecurity, and
biosurveillance systems in West Africa.
In all these circumstances, the protection of our personnel
and the prevention of any additional transmission of the
disease remain paramount planning factors. There is no higher
operational priority than protecting our Department of Defense
personnel.
In conclusion, we have a comprehensive U.S. Government
response and, increasingly, a coordinated international
response. The Department of Defense's interim measures are an
essential element of the U.S. response to lay the necessary
groundwork for the international community to mobilize its
response capabilities. Now it is the time to devote appropriate
U.S. resources necessary to contain the threat and to establish
the processes for better future responses.
With that, I would like to introduce my colleague from The
Joint Staff, Major General Lariviere. And we look ready to
answer your questions and appreciate the opportunity to be
here.
[The prepared Statement of Mr. Lumpkin follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you.
And I understand, General, you do not have a separate
opening Statement.
General Lariviere. No, sir, I do not. But I stand ready to
answer any questions you might have.
Chairman Issa. Thank you.
Mr. Roth.
STATEMENT OF HON. JOHN ROTH
Mr. Roth. Good morning, Chairman Issa, Ranking Member
Cummings, and Members of the committee. Thank you for inviting
me to testify about DHS's management of pandemic supplies.
DHS must have the ability to continue its operations in the
event of a pandemic. In 2006, Congress appropriated $47 million
in supplemental funding to DHS for them to plan, train, and
prepare for potential pandemic.
We recently conducted an audit of those efforts, focusing
on the Department's preparations to continue operations in
achieving its mission should a pandemic occur. The report of
our audit is attached to my written testimony that I have
submitted to this committee.
In short, our audit concluded that DHS mismanaged their
program in three ways. First, we found that DHS did not
adequately conduct a needs assessment before purchasing
protective equipment and antiviral drugs.
As a result, we could not determine the basis for DHS's
decisions regarding how much or what types of pandemic supplies
to purchase, store, or distribute. As a result, DHS may have
too much of some equipment and too little of others.
For example, we found that DHS has a stockpile of about
350,000 white coverall suits and 16 million surgical masks, but
hasn't been able to demonstrate how either fits into their
pandemic preparedness plans. It has a significant quantity of
antiviral drugs. But, again, without a full understanding of
the Department's needs in the event of a pandemic, we have no
assurance that the quantity of drugs will be appropriate.
Second, DHS purchased much of the equipment and drugs
without thinking through how these supplies would need to be
replaced. The material DHS has purchased has a finite shelf
life.
For example, TSA's stock of pandemic protective equipment
includes about 200,000 respirators that are beyond the 5-year
usability date guaranteed by the manufacturer. In fact, the
Department believes that their entire stockpile of personal
protective equipment will not be usable after 2015.
Likewise, the antiviral drugs DHS purchased are nearing the
end of their effective life. DHS is attempting to extend that
shelf life of these drugs through an FDA testing program, but
the results of that are not guaranteed.
Third, DHS did not manage its inventory of drugs or
equipment. As a result, DHS did not readily know how much
protective equipment and drugs it had on hand or where it was
being stored. Drugs and equipment have gone missing. And,
conversely, our audit has found drugs in the DHS inventory that
the Department thought had been destroyed.
We visited multiple sites and found drugs that were not
being stored in a temperature-controlled environment. Because
DHS cannot be assured that they were properly stored, they are
in the process of recalling a significant quantity of them
because they may not be safe or effective.
We made 11 separate recommendations. DHS has concurred with
all of them. One of those recommendations has been fully
implemented, and the Department is taking action to implement
the remaining ten recommendations. We will continue to keep
this committee informed about the Department's progress.
Mr. Chairman, that concludes my prepared Statement. I
welcome any questions.
[The prepared Statement of Mr. Roth follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Dr. Lurie.
STATEMENT OF HON. NICOLE LURIE, M.D.
Dr. Lurie. Good morning, Chairman Issa, and Ranking Member
Cummings, and other distinguished Members of the committee.
I am Dr. Nicole Lurie, the Assistant Secretary for
preparedness and response at the U.S. Department of Health and
Human Services. I am also a primary care doctor.
I appreciate the opportunity to talk with you today about
the steps that HHS and other agencies have taken since the
Ebola outbreak began in West Africa. We are working 24/7 to
control the epidemic there and to ensure that we are prepared
to prevent and curtail the spread of disease here at home.
Thanks to the foresight of the Congress, the leadership of
this and prior administrations, the dedicated work of HHS and
the interagency whole-of-government approach we are taking, we
are better positioned than ever before to respond to Ebola as
well as a range of other threats that may affect this country.
I serve as the Assistant Secretary. I serve as the
principal advisor to the Secretary on all matters related to
public health and medical preparedness in response to
emergencies. Since my confirmation in 2009, we have worked hard
to ensure that we have the tools necessary to prepare for and
respond to any disaster with public health consequences.
I have led the modernization of the Medical Countermeasure
Enterprise, created new opportunities for coordination among
State and local public health and healthcare systems, and
strengthened our ability to make better decisions before,
during, and after an emergency. Our all-hazards approach allows
us to be flexible and nimble in response to known and unknown
threats.
As you know, four cases of Ebola have been detected in the
United States. Our hearts go out to the family of Mr. Duncan,
the nurses who have been infected, as well as the physician in
New York. We are pleased that the nurses are doing so well and
wish them and the physician a speedy recovery.
We are extremely serious in our focus on protecting
America's health security. The best way to do that is to end
Ebola epidemic in West Africa. At the same time, we are
expediting the development of medical countermeasures and
preparing our systems to deal with any potential cases in this
country.
So, not long after this epidemic began, I convened the
Federal medical countermeasures stakeholders to see what could
be accomplished as quickly as possible. Thanks to past
investments, we have leveraged U.S. Government-wide assets to
urgently speed the development and testing of vaccines and
therapeutics for Ebola. These advances are allowing us to
create Ebola countermeasures in record time so that we will
have products to use as soon as we have the necessary proof of
efficacy.
Our strategic investments in the countermeasure
infrastructure, including our Centers for Innovation in
Advanced Development and Manufacturing established in 2012 and
newly established Fill Finish Manufacturing Network, will be
used to get Ebola vaccines and therapeutics into vials for use.
We are also leveraging our strong, ongoing relationships with
industry and public-private sector partners to scale up vaccine
manufacturing.
In addition, our public health and healthcare systems must
be prepared to deliver safe care at a moment's notice.
Investments in the hospital preparedness program and the public
health emergency preparedness program have meant that
healthcare systems and State and local public health
departments are prepared to respond to public health
emergencies.
Since the epidemic began, we have been using these programs
to educate healthcare systems stakeholders and ensure
surveillance in laboratory capacities were in place. We have
launched a very aggressive national outreach and education
program to promote the safe and effective detection, isolation,
treatment of Ebola patients.
The system we now have in place is based on changes and
lessons learned from each emergency, including those I have
confronted, as the Assistant Secretary.
Based on the first U.S. Cases, HHS has already made
adjustments to minimize the spread of Ebola. These include
tightened guidance for the use of personal protective
equipment, an expanded aggressive national education campaign
for healthcare workers, and screening and active monitoring of
passengers entering the United States now funneled through five
airports.
We have been working collaboratively with our interagency
partners, including on transport of contaminated waste with the
Department of Transportation, medical evacuation with the
Department of State, deployment of military personnel with the
Department of Defense, and worker and workplace safety with
OSHA and NIOSH.
Mr. Chairman and Members of the committee, I understand why
you and yours constituents are concerned. We take domestic
preparedness very seriously. Our top priority 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 long hours to
prepare our Nation for threats like this. With lessons learned
from this new challenge, we are making efficient use of the
investments provided and we have made tangible, meaningful
progress since you first created this office in 2006. As a
result, HHS has been able to provide crucial health and medical
support to our States and communities.
I thank you again for this opportunity to address these
issues and welcome your questions.
[The prepared Statement of Dr. Lurie follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Ms. Burger.
STATEMENT OF DEBORAH BURGER, R.N.
Ms. Burger. Thank you, Mr. Chairman and Members of the
committee. I am Deborah Burger, a registered nurse and----
Chairman Issa. Could you pull the mic just slightly closer.
Thank you.
Ms. Burger. Thank you.
--and co-president of the National Nurses United,
representing 190,000 members in the largest organization of
nurses in the United States.
The Ebola pandemic and the exposure of healthcare workers
to Ebola in Texas and the real threat that it could occur
elsewhere in the U.S. represent a clear and present danger to
public health.
Every R.N. Who works in a healthcare facility could be Nina
Pham or Amber Vinson, both of whom contracted Ebola while
treating Thomas Eric Duncan at Texas Presbyterian Hospital in
Dallas. One patient diagnosed and dead in this country. Two
nurses infected so far.
And our survey of over 3,000 nurses from over 1,000
hospitals in every State, D.C., and the Virgin Islands reveals
85 percent of the nurses say they are not adequately trained
and the level of preparation for Ebola in our facilities is
insufficient.
68 percent of R.N.s still say they have not--their hospital
has not communicated any policy for admission of a potential
Ebola patient. 84 percent still say their hospitals have not
provided Ebola education with the opportunity to interact and
ask questions.
44 percent say their hospitals lack sufficient supplies of
eye protection now. 46 percent say there are insufficient
supplies of fluid-resistant impermeable gowns in their
hospital. 41 percent say their hospitals do not have plans to
equip isolation rooms.
Initially, the nurses who interacted with Mr. Duncan wore
non-impermeable gowns, three pairs of gloves with no taping
around the wrists, surgical masks with the option of N95s and
face shields, leaving their necks exposed. Two of them became
infected. This is what happens when guidelines are inefficient
and voluntary.
The new CDC guideline that protective equipment leave no
skin exposed is a direct testament to the courage of Dallas
whistleblower Briana Aguirre who first spoke to us.
We have called on President Obama to invoke his executive
authority and urged Congress legislatively to mandate uniform
optimal national standards.
These include full-body HazMat suits that meet the ASTM
F1670 standard for blood penetration and the ASTM F1671
standard for viral penetration, which leaves no skin exposed or
unprotected; NIOSH-approved air-powered purifying respirators
with an assigned protection factor of at least 50 or higher
standard as appropriate; at least two direct-care R.N.s for
each Ebola patient and the additional--and no additional
patient care assignment; continuous onsite interactive hands-on
teaching with the R.N.s and updates responsive to the changing
nature of the disease.
The precautionary principle must be utilized when
developing public health policy designed to protect patients,
the public, nurses, and all healthcare workers who may be
exposed to potentially infectious patients.
Lest we forget the risk of exposure to the population at
large starts with the frontline caregivers. It does not end
there. As we have seen with school closures in Ohio and Texas
and the quarantining of airline passengers, improper protection
and inadequate protocols in hospitals can lead to public
exposure.
The response to Ebola from U.S. hospitals and governmental
agencies has been dangerously inconsistent and inadequate. The
lack of mandates and shifting guidelines from agencies and
reliance on voluntary compliance has left caregivers uncertain,
severely unprepared, and vulnerable to infection.
Our experience with U.S. hospitals is they will not act on
their own to secure the highest standards of protection without
a specific directive from our Federal authorities by an act of
Congress or potential Presidential executive order.
The new CDC guidelines represent progress with improved
standards for training, as we have been demanding for months.
The CDC guidelines are still unclear on the most effective
protective equipment, specifically allowing hospitals to select
protective equipment based on availability and other factors.
We are your first line of defense. No nation would ever
contemplate sending soldiers into the battlefield without armor
and weapons. Give us the tools we need. All we ask from
President Obama and Congress is not one more infected nurse.
Thank you.
[The prepared Statement of Ms. Burger follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you.
Mr. Torbay.
STATEMENT OF RABIH TORBAY
Mr. Torbay. Chairman Issa, Ranking Member Cummings, and
distinguished Members of the committee, on behalf of
International Medical Corps, one of the few agencies in the
world to be treating Ebola patients, I would like to thank you
for inviting me to testify today and for your leadership in
convening this critically important hearing. We would also like
to express our appreciation to the U.S. Government for their
pivotal action and generous support for the response.
Our response to the Ebola outbreak has been robust. By the
end of November, I anticipate we will have a total of about 800
staff in Liberia and Sierra Leone. Approximately 70 of these
will be ex-patriots. International Medical Corps has been
operational in West Africa since 1999.
Our Ebola response started in late June with community
education and sensitization in Sierra Leone. In late July and
after we realized the epidemic has reached out-of-control
levels, we deployed our emergency response teams to both Sierra
Leone and Liberia and decided to get involved in treatment of
Ebola cases.
When our emergency teams arrived in Liberia in August, what
we found on the ground confirmed that urgent action was
required. In a few short months, fallout from the Ebola
outbreak had brought the country's already fragile healthcare
system to the brink of collapse.
Many were dying. Most were afraid. Previously busy
hospitals and clinics were empty, with both staff and potential
patients too frightened to go there for the fear of being
infected with the virus.
Rather than risk infection, mothers shunned lifesaving
vaccinations for their children and, if their child became ill,
even seriously ill, all too many believed the safer option was
not to seek treatment at all.
With funding from USAID, we opened up our first 70-bed
Ebola treatment unit in Bomi County in Liberia as we admitted
our first patients on September 15. Currently, we have 53 beds
occupied and staffed by a team of 17 ex-patriots and 161
Liberian nationals. To date, this issue remains one of just two
in Liberia operating outside of Monrovia.
Within the next 6 weeks, we expect to open three additional
Ebola treatment units, one in Liberia in Margibi County and two
in Sierra Leone's Northern Province, specifically in Lunsar and
Makeni.
Within the next 3 weeks, we expect to open a training
center in Bung County to train other NGO staff on case
management protocols. In this center, which will be adjacent to
our Ebola treatment unit, we will offer a fast-paced, 7-to 12-
day training for those that will be involved in the treatment
of Ebola patients.
We will open a similar center in Sierra Leone in the near
future as well. Such hands-on training is the key to protecting
healthcare workers who must operate in an environment where all
know the Ebola virus is present. Strong guidelines and
regulations are important, but they must be combined with
hands-on training to be truly effective.
Mr. Chairman, I would like to briefly share some of what we
know works. This will help highlight several key areas to focus
as well as what is needed going forward.
First and foremost, we need to contain the disease at its
source. For that to happen, we have learned that several
factors need to be in place.
This includes having operational Ebola treatment units that
are staffed by well-trained health professionals, a robust
referral system between community care centers and Ebola
treatment units as well as between Ebola treatment units
themselves to take advantage of available bed capacity in
certain areas.
Limiting the spread of the virus in the community is
essential to containment plan. Therefore, the focus on
community sensitization, including education, awareness, and
outreach are critical. Finally, contact tracing and burial
teams are critical to limit transmission.
I would like to conclude by offering some recommendations
to the committee for consideration. More detailed
recommendations can be found in our written testimony.
First, one of the most critical lessons learned from this
response has been the importance of having the human resources
ready and prepared to address an outbreak of infectious
disease.
Cadres of healthcare workers need to be well trained and
supported to staff the treatment units and care centers in the
affected countries, as well as to prepare other countries in
the region for any potential future outbreaks.
Second, ensure availability of appropriate personal
protective equipment.
Third, ensure clear protocols for evacuating healthcare
workers. This is essential for our recruitment, training, and
retaining of health staff in Liberia and Sierra Leone.
Fourth, open air space to and from the Ebola-affected
countries must be maintained. The growing restrictions on
travel to and from West Africa will only isolate the affected
countries further, compromise the supply chain, and inhibit
efforts to recruit qualified staff. These factors will further
enable the severe outbreak to continue.
Fifth, we need to accelerate and support the production of
vaccines and innovative technologies.
Finally, in developing and implementing recovery efforts
and a long-term strategy, we must focus on building stronger
healthcare systems in the region.
Mr. Chairman, there is no doubt that we will stop this
outbreak and the death and, if done correctly, build the tools
to prevent another outbreak of such proportions. International
Medical Corps looks forward to working with you to make this
happen.
Once again, thank you, Mr. Chairman and Ranking Member
Cummings, for allowing me to present this testimony. I would be
glad to answer any questions the committee might have.
[The prepared Statement of Mr. Torbay follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Issa. Thank you. I would like to thank all our
witnesses.
I am going to withhold my questioning at this time and go--
let Mr. Turner go first.
The gentleman from Ohio is recognized for 5 minutes.
Mr. Turner. Mr. Chairman, I greatly appreciate that. I am
under a time constraint, having to return back to my district,
and I greatly appreciate the Chairman doing that.
Tuesday I had the opportunity to talk to Secretary Hagel
about the Ebola mission. And I believe that he takes this very
seriously and he is very concerned both about the effects on
our men and women in uniform and, also, on the effects of
protecting the American public.
I am very concerned about the protocols of protecting the
American public. And since I only get one question, my question
is going to be about that, although I, too, am very concerned,
as all the American public is, about the protection of our men
and women in uniform.
I am very skeptical of the DOD protocols, and I think the
American public is very skeptical. We have basically two
threats: one, Ebola coming here; or two, individuals who have
been exposed to Ebola falling ill to Ebola.
We have had four cases. Two came here. Two are the result
of people being exposed to Ebola here and then falling ill.
Three were healthcare providers.
Now, the American public is very concerned that individuals
who have been exposed to the Ebola virus have had significant
public access after being exposed. This is during a period
while they were falling ill to Ebola.
Now, on October 10, Ebola came to visit Ohio. Amber Vinson
traveled from Dallas, Texas, to Cleveland. While she was in
Cleveland, she visited local businesses. Of course, she flew on
a flight there. Almost 300 people had contact with her while
she was falling ill to Ebola.
Fortunately, Ohio doesn't have a report at this time of a
case of Ebola. But on October 20, the entire Ohio congressional
delegation, on a bipartisan basis, sent a letter to the CDC
challenging their protocols with respect to people who have
been known to have been exposed to Ebola.
Now, we all know the stories: trying on wedding dresses,
flying, going on a cruise, bowling, riding the subway. Although
some of these issues are personal responsibility, they do go to
the issue of protocols.
And if you look at the October 10 Department of Defense
guidelines, in paragraph 4, it says that a commander has
authority, which means they may--they don't have to--quarantine
someone up to 10 days if they are concerned about an individual
who has been exposed. Now, we all know that the doctor in New
York fell ill, apparently, after 11 days.
And then it goes on to say that no known exposure--now, it
doesn't mean they weren't exposed--it means no known exposure--
that there is a 21-day monitoring period, but it suggests that
the individuals return to routine daily activities. Well, those
routine daily activities would include going on cruises,
flying, wearing wedding dresses, bowling, and riding the
subway.
So I think I am very concerned, as the American public is,
as to the multiplier effect of the contacts that could occur in
the public. And as we are learning, as we have looked at, in
light of what has happened, I believe that both the CDC rules
and perhaps the DOD guidance should be revised.
General, in light of what we now know and what we are
seeing and our concerns of the multiplier effect, again, of
three healthcare providers who had significant public contact
while falling ill to the Ebola virus, do you believe that this
October 10 DOD guidance should be revised?
And, Mr. Lumpkin, I would like your answer, too.
Mr. Lumpkin. I think the first thing I would like to say is
to make sure--as I mentioned in my opening Statement, is that
we at DOD in West Africa are not doing direct patient care. So
our operations in support of USAID are focused on those lines
of effort of the command and control, the logistics, the----
Mr. Turner. But, Mr. Lumpkin, as you know, that does not
mean that no one is going to be exposed to the virus. I mean, I
understand what you are saying about the distinction between
healthcare providers and non-healthcare providers. But the
gentleman who flew here first, Patient 1 in the United States,
was not a healthcare provider either.
Mr. Lumpkin. Very true.
But I want to make sure you understand that, because we are
not--we have different categories of risk. And I would like to
turn it over to my Joint Staff colleague here to explain the
risk categories and the mitigation strategies for each one of
them.
General Lariviere. Mr. Turner, thank you for the question.
The protocols that we have put in place, we think, exceed
the CDC standard. As you mentioned, we will be testing
personnel twice a day while they are deployed, take their
temperature, and to ensure that they--that, if they were
exposed and they did become infected, we could isolate them
effectively.
The 0-to 10-day timeline that you discussed is the timeline
that will take place in country. Commanders will have the
authority to remove their personnel,----
Mr. Turner. But, General, as we already know from the
doctor in New York, he indicated, if the news reports are
correct, that his symptoms occurred at 11 days.
General Lariviere. Yes, sir.
Mr. Turner. So is it you are 10 days too short?
General Lariviere. Yes, sir. Well, the 10 days were in
country. The 21 days can't start until they are actually out of
the affected area. So the 21-day monitoring period will take
place----
Mr. Turner. Which means they could be traveling on day 11
and no longer isolated?
General Lariviere. They could be traveling on day 11, but
they will--the 21----
Mr. Turner. Which would result in additional exposure?
General Lariviere. No, sir. We will try to limit their
exposure prior to their departure. But the 21-day timeline
won't start until they are back in the United States----
Mr. Turner. Well, my time is up.
But I want to indicate I am highly skeptical. The American
public is worried. I believe these need to be revised. The Ohio
delegation sent to CDC, they believe theirs need to be revised.
The American public is concerned that people who are
exposed are having too much contact with the American public
and raising the risk to the United States citizens.
Thank you, Mr. Chairman. I appreciate it.
Chairman Issa. Thank you.
And, General, I just want to make sure, as the ranking
member--I just want to make sure that you are clear in what you
are saying and what Mr. Turner was asking.
If someone like the doctor in New York who just tested
positive is, in fact, held for 10 days, leaves on a commercial
airplane--if one of your gunnery sergeants leaves on an
airplane, arrives in New York and on the 11th or 12th day goes
positive, your 10 days will have done nothing and you won't get
that opportunity to have them outside--you know, in other
words, the quarantine of 21 days after you get back doesn't
matter.
And I think that is what Mr. Turner was very much asking,
is the example he gave of a doctor from just yesterday tells, I
think, all of us that 10 days isn't long enough if that person
then travels on a commercial airplane where they then can
infect the passengers on the airplane.
Is that your question, Mr. Turner?
Mr. Turner. Correct, Mr. Chairman.
Chairman Issa. Thank you.
Do you have any further clarification?
General Lariviere. Perhaps I am--perhaps I am not being
clear. The 10 days is to attempt to limit their possibility for
exposure while they are in country in Liberia.
They will then be screened for temperature and possible
exposure prior to getting on a government contract or U.S.
military aircraft to be returned to their unit back in the
United States.
Once they have flown back to their unit in the United
States, they will be given a 21-day monitoring period where
they will be required to come into the unit twice a day for
medical checks by U.S. military medical personnel at their unit
where they will have their temperature taken and looked in the
eye by a medical professional to see how they are doing. That
will take place for 21 days back--back in the rear area to
ensure they that do not become infected.
They will never be more than 12 hours from possibly spiking
a fever. If they did exhibit symptoms and spike a fever once
they were back in the United States during one of those medical
checks, they would immediately be taken to a treatment facility
and begin the isolation process.
Chairman Issa. Mr. Cummings.
Mr. Cummings. Yes.
Mr. Torbay, I want you to remember what was just Stated and
I want you to comment on that in a minute. I am going to--I am
really curious as to what you--you deal with this every day.
So--what you think of it. But I want to go through some other
things first.
I know your organization is incredibly busy, but your input
is very crucial. In addition to your very detailed written
Statement, you provided some pictures, and I am hoping you can
explain what we are seeing.
First, I believe this picture is an Ebola treatment center.
Can you briefly describe what we have seen here. And where is
that?
Mr. Torbay. Absolutely. This is in Bomi County in our Ebola
treatment unit. This is the isolation unit. What you see, the
two health workers in yellow suits with a hood and a mask are
actually inside the restricted area. Nobody is allowed to go in
there without full personal protection, equipment, and
training.
And outside they are taking notes. There is a supervisor to
make sure that proper protocols are taking place as they are
entering the Ebola treatment unit.
Mr. Cummings. And, in your testimony, you said you need
about 840 of these suits every week. You also said this, ``The
current demand far exceeds the supply. There are currently two
main manufacturers for our acceptable overalls, and they are
producing at full capacity.'' You go on to say, We estimate
that at the current stage, they will meet around 35 percent of
the demand. Is that right?
Mr. Torbay. That's correct.
Mr. Cummings. And so what can we do to help provide more
protective gear?
Mr. Torbay. Absolutely. First of all, I would like to
clarify that it is 840 PPEs for a 60-bed hospital. That is for
one Ebola treatment unit; it is not for the entire operation.
What we need to do is encourage those manufacturers to increase
the supply line and make sure that anybody who has the capacity
or has some of those PPEs in stock to release them, because a
lot of them are in stock in areas that are not actually
endemic, and they need to be released for those that are
treating patients.
Mr. Cummings. Now going back, let me go to another picture.
Mr. Torbay, in this picture there is a little truck in the
background, and it has some kind of tarp on a flatbed. Can you
tell us what the truck is used for?
Mr. Torbay. This is a makeshift ambulance. There is a lack
of ambulances in Liberia. So we took a flatbed truck, we put a
mattress in it, and we covered it with a tarp. And this is what
we take to get patients from the community to the Ebola
treatment unit.
Mr. Cummings. In your written Statement. You said, ``Put
simply, we need three things, people, commodities, and money.
By commodities, I mean everything from PPEs, to disinfectant,
to vehicles for transportation, mattresses and beds and
clothing.'' So is this what you are talking about in additional
vehicles to transport patients? Is that what you are talking
about?
Mr. Torbay. Absolutely. To transport patients. Additional
vehicles for burial teams. Ambulances that could go out to the
communities, to the community care centers and transfer
patients to the Ebola treatment unit for treatment.
Mr. Cummings. Now let me go to the next picture. This is
not a picture you provided, but one from a hospital in Sierra
Leone. There are people on the floor. There is fluid
everywhere. And there is a team of people in full protective
suits that appear to be removing a dead body. Can you please
explain why it is so important to have proper burial
procedures?
Mr. Torbay. Absolutely. The viral load in a dead body is at
its highest. This is when it is most contagious. So it is
extremely important to have proper burial procedures. The way
we go about it, when a person succumbs to the disease, we spray
them with disinfectant, chlorinated water. We put them in a
body bag; we spray them again. We spray the body bag again. We
put them in a second body bag', we spray the body bag again.
And a third body bag, and we spray them before we transfer them
to the burial ground. So it is extremely important that proper
burial procedures are followed all the time.
Mr. Cummings. And would more resources help with that
process that you just described?
Mr. Torbay. Absolutely, sir.
Mr. Cummings. And how so?
Mr. Torbay. We need more burial teams. The burial teams on
the ground in the three countries are not enough. They possibly
contribute probably a third of the need. We need body bags. We
need training for the burial teams, as well as vehicles for
transportation of dead bodies.
Mr. Cummings. Mr. Chairman, with the committee's
indulgence, I would like to play a very short video clip,
showing how the final stage of this process, the burials, is
currently being handled.
[Video shown.]
Mr. Cummings. Thank you, Mr. Chairman.
Mr. Torbay, right now there are a lot of people watching
this hearing. And many of them do not know the extent of the
crisis in West Africa. They do not know the urgency of the
need. You have a microphone in front of you. You have an
opportunity to reach millions of people this morning. If there
is one thing you want to tell the American people, what would
that be?
Mr. Torbay. Thank you, Mr. Cummings, for giving me this
opportunity. We need to deal with the Ebola virus at its source
in West Africa. Steps can be taken in order to deal with this.
We need to immediately increase treatment capacity by deploying
and training proper health personnel. We need commodities, as
we discussed, PPEs, ambulances. We need financial resources. We
need further containment at the community level as well. It is
not just about treatment; we need to contain it at the
community level. This is a global issue. It is not just a West
Africa issue. We all need to work together as one team to
tackle this deadly disease and put an end to this outbreak.
Once we do so, we need to continue the investment in
rebuilding the health care system in West Africa, as well as
preparedness in other countries. We need to make sure that this
outbreak doesn't reoccur. The U.S. has and is playing a pivotal
role. I am proud to say that the U.S. has led the way and
continues to answer the call, and other countries are following
the lead of the U.S.
Mr. Cummings. Just one last thing. Mr. Turner asked, I
thought, a great question. And the chairman tried to get some
clarification about military folks. What was your reaction to--
you deal with this disease. We have got health care workers in
the back of you, and the American people are looking on. I
mean, do you feel that that is an appropriate way to address
this? And should the American people be concerned? I mean, we
have got people going over to Africa to try to help out.
Mr. Torbay. I would like to clarify one thing. If there are
no symptoms, there is no transmission. That is the first thing.
Unless the patient develops symptoms, the patient cannot
transmit the Ebola virus. So monitoring temperature is
critical, because as long as the patient is asymptomatic, there
is no risk of transmitting the disease. We follow a slightly
different protocol, but it is very much in line with what the
General said, as well as with the CDC.
There is no risk, which means somebody who hasn't been
exposed to the Ebola virus; he hasn't been in contact with
somebody--in fact knowingly infected with Ebola. We bring them
on a commercial airline. They monitor their temperature for 21
days twice a day. We contact them to make sure it happens.
There is low risk or some risk. And those people, we do not
allow them to actually travel on commercial airlines. We ask
them to stay out of the risk area, even in West Africa, but out
of the risk area for 21 days to make sure that actually they
have no symptoms before we allow them back.
And there is high risk. Those are people that have
knowingly been exposed to the virus. Those will be quarantined
and monitored. And the minute they develop symptoms, they will
be tested for Ebola and admitted.
Mr. Cummings. Thank you, Mr. Chairman.
Chairman Issa. Thank you.
And I want to followup on the ranking member at that point.
So if I heard you correctly, the fact is the 10-day waiting
period has absolutely no value, that, in fact, the only real
question, the only real way to ensure that someone is not
contagious or not going to become contagious is for them to be
outside the risk area for 21 days, not exposed to other people
who exhibit symptoms for 21 days. Is that correct?
Mr. Torbay. I think where the 10 days comes from is that
the majority of symptoms appear within 7 to 10 days after----
Chairman Issa. Or 11 in the case of the gentleman from New
York.
Mr. Torbay. Absolutely. I said majority. There are
exceptions. The incubation period is 2 to 21 days. That is why
it is important to wait for 21 days after the last known
exposure to the virus.
Chairman Issa. Again, known exposure. That is correct.
Now, General, you are going to be operating some seven
labs. You said you are not doing medicine, but anyone who works
in those labs, takes materials out of those labs, has secondary
exposure to, if you will, liquids and so on, in fact, is in a
direct risk, aren't they? The testing labs, because we have
already had that in Dallas, is, in fact, a point of
transmission. It's not just the individual, but, in fact, the
materials that come out of that individual. Isn't that correct?
General Lariviere. So the military personnel who are
working in the labs are infectious disease specialists who do
this----
Chairman Issa. I don't want to know who they are. I want to
know are they exposed.
General Lariviere. They are considered actually low risk
because they actually have the entire suite of protective
equipment and the extensive training.
Chairman Issa. You know, one of my problems, General, very
little time, and I want to be pleasant through this whole
thing. But we have the head of CDC, supposed to be the expert,
and he has made Statements that simply aren't true.
Doctor, you can get Ebola sitting next to someone on a bus
if they, in fact, throw up on you. Can't you? That is
reasonable.
Dr. Lurie. The way you get Ebola is by exposure to body
fluids, yes.
Chairman Issa. OK. So when the head of the CDC says you
can't get it with somebody on the bus next to you, that is just
not true.
When the head of the CDC says you cannot in fact--that we
know what we are doing, but, in fact, health care
professionals, wearing what they thought was appropriate
protective material, got it, then that means he is wrong. When
the head of the CDC goes on television and says, sometimes less
protection is more--is better, and then has to reverse the
protocols so that we no longer have nurses, Ms. Burger, who
have their necks exposed, that was just wrong, isn't it? Ms.
Burger?
Ms. Burger. That their necks were exposed?
Chairman Issa. I mean the fact is the head of the CDC gave
false information, basically saying it was OK to have your neck
area exposed, when, in fact, if somebody threw up on you that
could be----
Ms. Burger. I honestly don't know that those nurses were
instructed that their necks were OK to be exposed. I know
that----
Chairman Issa. The head of the CDC, when asked about
whether you had to have full body suits versus simply the
mouth, said sometimes less is--you know, more is not
necessarily better. So the head of the CDC was wrong. We are
relying on protocols coming from somebody who has been proven
not to be correct. Isn't that true?
Ms. Burger. Those nurses were not protected. Correct.
Chairman Issa. Mr. Roth, I don't want to belabor waste,
fraud, and abuse at this hearing, even though that is a lot of
what this committee looks for. But if I understand correctly,
you have--your report shows that they didn't know what they
were buying and why particularly well. They bought large
amounts without a recognition that it was going to essentially
expire and without a plan to rotate it or in some other way put
those materials into good use the way DOD normally does in
order to prevent items from expiring that have secondary use.
Is that all correct?
Mr. Roth. That's correct.
Chairman Issa. And although I know you can't reach every
conclusion, in your material, did you discover that, for
example, the face masks, that instead of buying them they
simply could have had a rotating inventory that they could have
drawn from that would have allowed the vendor to maintain a
stockpile but rotate it so they would only take possession--
which is also done at DOD on occasions--they would only take
possession when they need it, and, in fact, they wouldn't have
to buy it but rather rent the availability of it. Did you look
into that at all or did they look into that at all?
Mr. Roth. They did not look into that at all. Certainly
when we make our recommendations, one of the things that we ask
them to do is explore the types of options that you talk about.
Chairman Issa. So all of those options are going to need to
be looked at, evaluated, and available to Members of Congress
before we start writing checks for large stockpiles. Wouldn't
that be correct?
Mr. Roth. That's obviously up to Congress to decide. And
certainly now the Department is starting to do the kinds of
planning that we had recommended.
Chairman Issa. I will close with Mr. Torbay. The pictures
that the ranking member showed and the situation in Africa is
certainly desperate. And I know my constituents are most
worried about what comes here. But realizing that 4,000 there
versus less than one handful here certainly shows us where the
problem is. And I think you said that very well. But, in fact,
medical personnel that are dispatched from here go there and,
in more than a few cases, find themselves infected. Isn't that
true?
Mr. Torbay. Correct.
Chairman Issa. So I want to just ask--it might be both--but
is that primarily because of the conditions under which those
doctors and nurses and other health care professionals find
themselves working, or is it for lack of training? Is it more
one or the other?
Mr. Torbay. Mr. Chairman, it is a combination of both. Our
medical staff, they are heroes, doctors and nurses. They work
in probably 95-degree temperature wearing those PPEs that you
have seen. Our rotations are every hour. We get them out every
hour because they are dehydrated.
Chairman Issa. So they are capable of not getting infected
if they were in a good facility dealing with one patient rather
than questionable facilities, endlessly, for 24 hours a day,
trying to deal with an onslaught of patients. Is that correct?
Mr. Torbay. I would say in our facility--it's a 70-bed
facility--we have 230 staff members. And their only job is
actually to look after the patients that are infected with
Ebola.
Chairman Issa. To the greatest extent possible, I am going
to ask one last question that I would like to have people say a
yes or no. Ebola is a 35-year-old disease. It is not new. It
was discovered a long time ago. And we have spent money looking
into it, planning for it. The various flus, the influenzas,
going back to at least 1918, are not new, and they have a
similarity in that they can be transmitted and they kill. Since
this is a hundred-year-old process of dealing, at least, with
modern infectious diseases, is there inherently a similarity in
that, whether it's Ebola or, in fact, a pandemic, that we in
Congress should be looking at the planning and the prevention
and the training somewhat homogenously?
In other words, today we are looking at Ebola. Should we be
looking at infectious diseases, the training, the prevention,
the handling, the emergency? Should we on this side, the
nonmedical professionals, look at this as a failure of not just
Ebola, but infectious diseases of this entire sort that we
could have and should have been more prepared for? And to the
extent you can, I would appreciate a yes or no. Doctor?
Mr. Torbay. Yes.
Chairman Issa. Ms. Burger.
Ms. Burger. Yes.
Chairman Issa. Doctor?
Dr. Lurie. It is a somewhat more complicated question.
Ebola and flu are very different. And they are spread very
differently.
Chairman Issa. Well, I was using infectious diseases and
the isolation, the maintenance, and so on. I wasn't trying to
say that those which can be aspirated or in some other way
transmitted. The point, though, is AIDS and lots of other
diseases--AIDS being much more similar to Ebola as far as fluid
transmission--we have had these for a long time. We are now
seeing failures.
In your opinion, Doctor, are these failures to a certain
extent the fact that we said we were planning to deal with
infectious disease, prepare our health care system, and our
doctors and nurses, and, in fact, it appears as though we
trained them but not trained them to the level we should? Yes
or no.
Dr. Lurie. I think that our failures largely relate to the
fact that we are learning some new things about Ebola. Ebola
has never been in this hemisphere before. And as we are
learning those things, we are tightening up our policies and
procedures as quickly as possible.
Chairman Issa. Mr. Roth.
Mr. Roth. To the extent that the viruses transmit in the
same way, when we looked at the logistics, the acquisition
management, I would say the answer would be yes.
Chairman Issa. Doctor? Or Mr. Lumpkin.
Mr. Lumpkin. This is outside of our purview and lane.
Chairman Issa. OK.
With that, I will go to the gentlelady from New York.
Mrs. Maloney. Thank you.
And I first would like to thank all of our distinguished
panelists for coming today during what is a critical time in
the Federal Government's response to an urgent global crisis.
First, I would like to take a moment to commend the health
care professionals in New York City for their outstanding
response yesterday to our first case of Ebola. New York City
has been working with New York State, the Centers for Disease
Control, to prepare for this. And our Nation's largest city,
based on what we know now, I believe they have responded and
done absolutely everything right. A young physician had
returned from West Africa 10 days ago, where he had been
working on the Ebola crisis with the Doctors Without Borders.
Upon arrival into the United States, the doctor was flagged by
the CDC and Customs and Border Patrol, and reported to New York
City health officials. Yesterday, when he reported he had a
103-degree temperature and was experiencing pain and nausea,
the New York City health care system sprang into action. The
patient was immediately transported to a specially trained Haz-
Tac Unit, wearing personal protective equipment, to Bellevue
Hospital. The hospital had previously been designated for the
isolation, identification, and treatment of potential Ebola
patients by the city and State officials.
Governor Cuomo has designated eight special hospitals in
New York City. Earlier this week, a specially trained CDC team
visited Bellevue and determined that the hospital has been
trained in proper protocols and is well prepared to treat
patients.
I must say that I respond to your concerns about nurses.
And at the hospital, there were clear protocols in place
established by the health department to ensure that nurses and
all staff caring for the patient followed the strictest safety
guidelines and protocols. Contact teams were ready to quickly
identify, notify, and, if necessary, quarantine any contacts
the patient may have had on his three trips on subway, visit to
a restaurant, and a ride in a taxi cab. The health department
is now working with the HHC leadership, Bellevue's clinical
team, and the New York State Department of Health. And the CDC
is assisting us daily in this effort. They are in close
communications with the New York City Health Department,
Bellevue Hospital, I would say all elected officials, and they
are providing technical assistance and resources.
The CDC already had a team of Ebola experts in New York
City. They were already there to help. Three members I am told
were flown in last night from the CDC's so-called CERT team to
join their colleagues already on the ground. And we are told
that more CDC professionals will come in if needed. The CDC
Ebola Response Team will arrive within 24 hours to any location
in the United States where a case is reported. And so far, this
is absolutely true, it is what has happened in New York City.
This week, CDC named New York City and State as one of six
States who will begin active post-arrival monitoring of
travelers whose travel originates in either Liberia, Sierra
Leone, or Guinea, and arrive at one of the five airports in the
United States doing enhanced screening. Active post-arrival
monitoring means that travelers without fever or symptoms
consistent with the Ebola symptoms will be followed up daily by
State and local health departments for 21 days from the date of
their departure from West Africa. And active post-arrival
monitoring will begin on Monday, October 27.
I want to reiterate that Ebola is not airborne. Someone
infected with Ebola can only transmit the virus if they are
experiencing symptoms, bodily fluids in direct contact,
vomiting, blood, saliva, diarrhea. There are over 9,000
reported cases and over 4,000 deaths. I am told that the
American health system is now actively reviewing two vaccines.
They are in clinical trials. And we are responding.
My question really is to you, Dr. Lurie, about the hospital
preparedness program. But, first, I would like to request that
this Statement that was prepared by the Trust for America's
Health, a nonprofit----
Chairman Issa. Without objection, that will be placed in
the record.
Mrs. Maloney. It talks about the need for enhanced funding,
that our funding is not up to the threat that our country
faces.
I would like to ask you, how does the program help to
ensure that our hospitals that are so designated across America
are prepared to respond in a health emergency? And I would like
to thank your program for the help that you gave to the great
city of New York. Thank you.
Chairman Issa. The gentleman gentlelady's time has expired,
but you, of course, can answer.
Dr. Lurie. Well, thank you so much. And we were very
gratified last night to see the kudos to the program and kudos
to New York City for their tremendous job in responding. Our
program gives money to States--and, in the case of New York
City, directly to New York City--to help the health care system
become prepared. It is defined as a set of eight basic things
that every health care facility needs to do and provides the
funding for training, for exercising, for planning, for the
purchase of personal protective equipment, and other things
necessary for hospitals and other health care facilities to be
prepared. It is, in fact, one of the reasons that Bellevue and
I believe other hospitals in New York City have been able to do
such a tremendous job getting ready for this. And we will
continue to support them through this program and others as
they move forward.
Chairman Issa. Thank you.
The gentleman from Florida, Mr. Mica.
Mr. Mica. Well, first off, I have to take sort of a point
of personal privilege. The chairman missed a word in his
opening Statement and apologized for being on a plane.
The committee should know, you know, the country faces two
incredible threats right now. One is ISIS, or this threat we
face from terrorism we have seen this week. It threatens not
only the United States, but the world and our allies. But Mr.
Issa, and I accompanied him, and we had a Democrat Member from
the Foreign Relations Committee, was in Iraq. We were in Iraq
last night. We left there at 6 o'clock in the evening and flew
all night. And this is how dedicated he is, to make sure that
we are prepared over there. You would be so proud of our troops
that we saw. Incredible.
And General, too, you get called on to do some tough stuff.
But I saw our men and women. They are just awesome. And we had
a chance to meet with some of our allies to get them to step up
to the plate. But we face that threat nationally, domestically,
and internationally.
We face Ebola, a very serious threat. Dr. Torbay, this
ain't going away any time soon, is it?
Mr. Torbay. We are hoping that we could contain it. If all
steps that are being put in place are followed, it will be
contained.
Mr. Mica. Here is a report I read on the plane last night.
It says, ``Experts warn the infection rate could reach 10,000 a
week by early December.'' Ten thousand a week. Is that semi
accurate?
Mr. Torbay. That is what the----
Mr. Mica. The way things are going now. This is a report I
got on probably the people that are most at risk are health
care workers, whether they are there or here. Would that be
correct? This isn't up to date, but you had 404 cases of Ebola
in health care workers; 232 died. Pretty high fatality rate,
right, Doctor?
Mr. Torbay. That is correct.
Mr. Mica. OK.
Thank you, Ms. Burger, for representing the nurses. Do we
know how those nurses were infected or exposed, how they caught
Ebola, for sure?
Ms. Burger. Thanks to the whistleblowing efforts of Briana
Aguirre, we know that the nurses did not have optimal standards
for personal protection.
Mr. Mica. OK. So we know that they weren't properly
protected.
Ms. Burger. Or trained on protocol.
Mr. Mica. Or trained. OK. All right.
Dr. Lurie, you said that we are putting additional
protocols in place, guidance. Right? When was the most recent?
Dr. Lurie. The most recent----
Mr. Mica. A week ago? A month ago?
Dr. Lurie. The most recent guidance on personal protective
equipment has been in the last couple days.
Mr. Mica. And what about--OK.
Dr. Lurie. It was changed in response--it was changed in
response to the situation at Dallas Presbyterian.
Mr. Mica. OK. So in the last couple of days. You said
airport screening. When was that instituted, the new
guidelines?
Dr. Lurie. I can't recall exactly the date that it started.
Mr. Mica. A week ago.
Dr. Lurie. The funneling into the five airports was in
response in the last week.
Mr. Mica. Last week. I can tell you, it is not working. OK?
All we got to do is look at Craig Spencer. He was tested there.
It is not working.
Now, he is a medical professional. He reported himself.
And then you see cases where, again, we are not prepared
still. The whole part of this hearing is all about Mr. Roth's
report. This is the inspector general's report, right, Mr.
Roth?
Mr. Roth. Yes.
Mr. Mica. We spent millions of dollars getting prepared,
right?
Mr. Roth. Correct.
Mr. Mica. OK. Didn't you just testify that in fact--and it
is in this, I think page 7 here--200,000 of our pandemic
respirators have gone beyond their 5-year manufacturer
warranty?
Mr. Roth. The ones that TSA----
Mr. Mica. On page six, don't you testify that--this is a
bottle of hand sanitizer. You tested it. Eighty-four percent of
the hand sanitizer is expired that you tested. Is that right?
Mr. Roth. That is correct.
Mr. Mica. So how do I tell the American people that we are
prepared, that we spent millions of dollars for a pandemic--and
here it happens to be Ebola. And you just heard testimony how
important it is to have the right protections. The equipment,
almost all the equipment you cited in this report in fact is
either out of date, it was--the purchasing made no sense. We
don't know the inventory. We don't know who has got it. We
don't know who is going to get it. Is that right, Dr. Roth?
Mr. Roth. Mr. Roth, but thank you for the promotion.
Mr. Mica. OK. I upgraded you.
Mr. Roth. Yes. You are correct.
Chairman Issa. The gentleman's time has expired, but if you
call everyone ``doctor,'' you will do very well.
Mr. Mica. Your report is correct. And I thank you. I have
additional questions. Thank you.
Chairman Issa. Thank you.
The gentleman from Massachusetts, Mr. Tierney.
Mr. Tierney. Thank you very much, Mr. Chairman.
Thank the members of the panel for their testimony here
today and for the work that they do on a regular basis. I think
folks here that don't already know may be pleased to know that
the news was just released that the Presbyterian Hospital Nita
Pham is Ebola-free, according to the National Institute of
Health. And she will be released today. I think that is good
news on one front on that.
I think also a little bit of good news, and Mr. Torbay was
mentioning it, is that the United States has taken the lead in
the international response to this. And I think we don't often
give credit where it is due on that. I think we should all be
proud that this country at least recognizes that not only do we
have issues within our own country here that we have to deal
with in terms of people that may be exposed or come down with
the disease and come to this country, or be here when they are
treating somebody, but that you do have to go to the source
with a shock-and-awe type of approach as if you were in some
sort of battle. We are losing lives. And we are losing
situations that could then endanger the entire international
community. So we need a shock and awe, all the things that Mr.
Torbay talked about. Do we have a large enough response? Is it
coordinated accurately? Are the people that go there supplied
and trained and equipped sufficiently to get the job done?
So my first question might be to Mr. Lumpkin and Dr. Lurie
and Mr. Torbay, is the international effort now, in fact, large
enough? Is it being well enough coordinated? Is there
sufficient training and equipment for those that are involved
in it? And if not, what remains to be done and by whom? So Mr.
Lumpkin.
Mr. Lumpkin. In West Africa, U.S. leadership is galvanizing
support on the international front. So what we have seen is
that since the--we have gone in with speed and scale that the
international community is coalescing to come together in order
to fight the Ebola epidemic.
Mr. Tierney. Dr. Lurie, is that coordinated enough? Are the
people well trained and equipped enough? Is the response
sufficient enough? Who should be responsible for what remains
to be done, if anything?
Dr. Lurie. So I would agree with Mr. Lumpkin's assessment
of the situation in West Africa. It has taken time to get the
resources in place there. U.S. leadership has been incredibly
welcomed and incredibly important. As a result of that, we are
finally seeing many other countries of the world step up to put
resources in place in West Africa.
Mr. Tierney. So, Mr. Torbay, maybe you can help me. Is the
response adequate enough? Are people that are now involved
trained enough and equipped enough? Is it well enough
coordinated to be able to start containing the situation and
then hopefully wrestling it to the ground?
Mr. Torbay. The U.S. and the UK have stepped up. Now it is
time for the rest of the world to follow suit. The training is
picking up. The DOD started their training. We started our
training. The minister of defense in the UK is starting their
training in Sierra Leone. I think, within the next 3 to 4
weeks, the training would be up to speed, which is critical.
Supplies, PPEs are coming in. The different levels of PPEs,
they are coming in. We hope that the pipeline will continue to
come in. I think the other countries need to step up. We cannot
forget about Guinea and containment of the Ebola in Guinea.
This is where it started. Businesses need to get involved more.
The economical toll of this outbreak is just phenomenal. We
need to think about that. We need to think about technology as
well. The development of vaccine is critical, but also
technology companies need to start thinking about creative ways
to monitor people when they are coming back, monitoring the
temperature instead of having to rely on patients checking
their temperature twice a day. And I think if the
interventions, the international interventions continue at the
same pace that it is now, I think it will be contained within
the next 4 to 6 months.
I would also like to thank the Department of Defense, the
U.S. Navy, for putting a lab actually in Bong County, right
next to our ETU. This has cut down the testing time from 3 to 5
days to 5 to 7 hours of Ebola patients. So we are accepting
patients, testing them, releasing them if they are negative,
and avoiding infections by them staying in the isolation ward.
Mr. Tierney. Thank you. This isn't the hearing for it, but
Mr. Roth, thank you for your work. I am also amazed that
agencies like DHS don't go to the Government Accountability
Office or somebody in advance to learn how to set up a protocol
as opposed to waiting until they get audited later and find out
that they didn't do it correctly.
But Mr. Chairman, I suspect we will hear that later.
Dr. Lurie, last question. This is not new. Ebola has been
around a while. Obviously, people think that we could have been
a lot further along in terms of vaccination or some other type
of treatment or medicine on that. But there has been no profit
motive sufficiently involved on that. What are we doing--not
just with Ebola, but anything along the situation line with the
chairman's question earlier--what are we going to do to make
sure that we have the kind of forward thinking that if the free
market and the profit motive isn't going to resolve these
things and get them done, what are we going to be able to do as
a public policy?
Dr. Lurie. I this is a great question, and I thank you for
it. Were it not for the investments in biodefense and getting
going with Ebola vaccines and therapeutics, we would be nowhere
near where we are now with the safety testing of two promising
vaccine candidates going on and soon to be testing some
therapeutics. So we do need to think about emerging diseases.
We do need to think about developing products, countermeasures
for them now. And we have appreciated the support from Congress
for BARDA, the Biomedical Advanced Research and Development
Authority, both through its direct funding and through the
Project Bioshield Special Reserve Fund that have helped us
ensure that there is a market, ensure that product developers
and manufacturers will step up to the plate and work on these
important threats.
Mr. Tierney. So you are talking about public financing
being used to establish those markets on that as opposed to
just the private industry on its own going out and trying to
work with the free market aspect?
Dr. Lurie. We have been talking about some very positive
public-private partnerships and some tremendous models that we
have developed over the past several years, whether it's been
about biothreats or whether it's been about pandemic flu, and
now with Ebola, that are really making that possible, yes.
Mr. Tierney. Thank you.
Thank you, Mr. Chairman.
Chairman Issa. Thank you.
The gentleman from North Carolina.
Mr. McHenry. Thank you, Mr. Chairman.
My questions are for the Assistant Secretary and--the
Assistant Secretary and for the General. We have our men and
women in uniform that are now in regions that are severely
affected by Ebola. To their parents, their mothers and fathers
of these men and women, do you have every confidence that they
have every bit of the equipment and training that they need to
be protected, to be safe, and to return home healthy?
Mr. Lumpkin?
Mr. Lumpkin. The safety of our servicemembers----
Mr. McHenry. The right answer is yes.
Mr. Lumpkin [continuing]. Is absolutely paramount. And
while you can never mitigate risk to zero, I think we have
taken all the steps to mitigate the risk. So my answer is yes.
Mr. McHenry. General?
General Lariviere. Sir, the combatant commander and the
services are making every effort to ensure that the troops have
the proper training and proper equipment they need for this
mission so that they can return home safely.
Mr. McHenry. Mr. Lumpkin, you said in your opening
Statement that if infected, if someone contracts Ebola in
country, they will be returned back to the United States and
cared for in a CDC facility. Is that correct?
Mr. Lumpkin. I did not say that in my opening Statement.
Mr. McHenry. But you mentioned a CDC facility where
treatment would be given. Then let me ask you a question: If
somebody comes down ill in country, how would they be cared
for? Will they be cared for in country, or will they be
returned to the United States?
Mr. Lumpkin. They will be returned to the United States.
But I would defer to my Joint Staff counterpart on the
specifics.
General Lariviere. Thank you for the question. So to take
care of the troops in country, there will be two Role 2
hospitals; one established in Monrovia, one established in
Sierra Leone. The medical personnel there will be trained in
how to treat Ebola victims if a U.S. uniformed military person
does, in fact, contract it. To answer your question whether
they will be treated in country or sent home, the answer is
obviously both. If they are identified for some reason of
having high risk of exposure, or if they actually do start to
exhibit symptoms, they will be cared for initially in country,
and then they will be moved home. If they are asymptomatic,
they will do what we call a controlled movement, which will be
an individual movement on a DOD aircraft.
Mr. McHenry. How many aircraft are outfitted to move these
individuals out of country in the event that this happens?
General Lariviere. So, for controlled movement, any
aircraft can do, because as has been pointed out, they are
asymptomatic and not contagious at that point. So any aircraft
could do. At the present time, the only aircraft that can move
the symptomatic patients is the State Department's Phoenix Air
Contract, which you have seen moving the other Ebola patients.
Mr. McHenry. How many patients can that aircraft hold?
General Lariviere. The aircraft can hold one at a time, and
can do four movements a week at this point.
Mr. McHenry. Four movements a week?
General Lariviere. Yes, sir.
Mr. McHenry. Is that sufficient?
General Lariviere. Given the number of Ebola patients that
the United States has had in total at the present time, it is
sufficient. However----
Mr. McHenry. But that is not how these epidemics work.
General Lariviere. Right. So, at this time, the Department
of Defense has an urgent U.N. Statement that is being worked
through the system with TRANSCOM to put together an isolation
pod that can carry multiple persons for C-17 aircraft. Testing
will begin in October--or I am sorry, development will begin in
October, testing in December. Procurement will begin in
January.
Mr. McHenry. In January?
General Lariviere. In January.
Mr. McHenry. In January. And how many individuals will be
able to be transported?
General Lariviere. Fifteen at a time.
Mr. McHenry. Fifteen at a time. What is the turnaround time
for the plane? How many movements a week?
General Lariviere. We hope to procure a number of these
systems so that they can be put on any C-17, so if we had--so
we could move multiple C-17s to----
Mr. McHenry. So, at current State, we can take less than 10
people out of country in a week's time.
General Lariviere. If they are symptomatic.
Mr. McHenry. So this is not at all sufficient.
General Lariviere. We don't know--at the current time, we
expect we will not be doing direct patient care. And so we
anticipate----
Mr. McHenry. I understand. But how many American troops
will we have in the region by the end of the year? What is our
maximum?
General Lariviere. In the vicinity of 3,000.
Mr. McHenry. Of 3,000.
General Lariviere. Yes, sir.
Mr. McHenry. This is very disconcerting. Is it a question
of--Mr. Lumpkin, is it a question of resources? Does Congress
need to appropriate funds so that we can actually get more
planes, more logistical support here so that we can have the
capacity if something absolutely horrible happens to our
fighting men and women in country?
Mr. Lumpkin. Well, we clearly have an identified
requirement. And as we develop the capacity, I would like to
take that one for the record just to make sure I get you--
because I am not familiar with the acquisition and the process
or the actual requirements that would----
Mr. McHenry. I think you should get familiar with the
acquisition process if we currently have one plane that is
controlled by the State Department. I am asking the Department
of Defense, with the mass number of airplanes, equipment, and
training capacity that we have, nearly--spending nearly half a
trillion dollars annually on the Department of Defense. If you
need it, you will get it. We will demand it. Because if we are
putting these men and women in harm's way, potentially where
they can contract Ebola, the idea that we have one airplane as
the United States to get these men and women out of country in
a safe manner if they contract what is absolutely horrible,
which we want to control, which we absolutely want to control,
the idea that you are coming before us and giving this type of
testimony raises great concerns.
I know you have been asked to do a lot. And I absolutely
respect that. But we are asking you in the legislative branch
to tell us what you need, and we will get it. Because we don't
want to put our men and women in harm's way without any
capacity to care for them. Our veterans, our fighting men and
women deserve the best health care in the world, the best
training in the world. And they have it. But it means the
proper protocols at the top level are there to make sure they
are protected. And if something bad happens, they are
immediately taken out of harm's way, cared for, and returned
back to their normal State.
And, with that, Mr. Chairman, I yield back.
Chairman Issa. I thank the gentleman.
We now go to the second gentleman from Massachusetts, Mr.
Lynch.
Mr. Lynch. Thank you, Mr. Chairman.
And I thank the ranking member, Mr. Cummings, for holding
this hearing.
And I thank the panel. You have been very helpful.
As a matter of fact, there have been some marked contrasts
between the testimony here this morning. And I want to drill
down on that a little bit, because sometimes that is helpful
when people on the panel disagree.
Dr. Lurie, you testified, and it is in the written
testimony, that we are better prepared than ever and that you
have a comprehensive response on the ground.
On the other hand, Mr. Roth, our inspector general, you
were commenting how the analysis done by--I think you were
talking about DHS in your testimony, how the equipment
purchases are not adequate, in some cases the wrong equipment;
in other cases the usefulness of the equipment or drugs are
beyond the expiration date. Dr. Lurie, you testified that you
have a very aggressive system in place.
And, on the other hand, President Burger from National
Nurses United said that they have done a survey. They have done
a survey of 3,000 nurses from every State in the Union and the
District of Columbia. And 85 percent of those nurses say that
they have not been trained to deal with Ebola, and that
preparedness is, and this ``woefully insufficient and
dangerously inadequate.''
So those are two different stories of what is going on
here. Now I understand we don't want to panic people. But we
also don't need happy talk in terms of what we are dealing
with. And maybe it is just me, but lately, when a government
agency comes before this committee especially and tells me
there is nothing to worry about and we have got this, that is
when I start to worry.
Now, as to who to believe, I think the nurses--and I know I
have got some nurses here from the Massachusetts nurses
association as well, I know how hard they work. They are on the
ground. They are our front lines in this battle against Ebola.
They are our ground troops. They are the people who are doing
this work every day. They are exposing themselves, and perhaps
their families, perhaps their families, if things go wrong, if
they don't have the adequate equipment. So when they tell me
that they are not prepared, I tend to believe them. I think
those are facts. Those are facts. And we need to make sure that
we get them the equipment and the training they need to protect
themselves and to protect our communities and to protect their
own families.
There are a couple of facts that we have gotten in the
briefings from the various panelists. One fact is that the CDC
estimates that by this January, there will be up to 1.2 million
people in West Africa afflicted with Ebola--1.2 million. The
estimate by DOD is 1.2 million, 1.2 million in January. Now,
they were done at different times, so the difference might be
just the period of time that they were taken, if things go as
they are right now, 1.4 million. So we have got a real and
present danger to the people of West Africa and to the people
in the United States, who I am pledged to protect.
Now, I understand that the current approach is to use what
they call a post-arrival approach so that we are going to have
these hospitals, and that as people arrive from West Africa, we
are going to begin an analysis and a quarantine and checking
them and making sure that they are not carrying Ebola.
But it seems to me--and I listened, and Mr. Torbay, you
have given some very powerful testimony, a lot of it written,
quite frankly, and you haven't had a chance to talk about it,
but you were saying that the focus should be on West Africa.
And what we are setting up here right now with this post-
arrival in the U.S. approach is we are going to set up these
hospitals, all this equipment, everything here in the United
States, and wait for those folks to arrive.
And I believe that we should be doing just the opposite.
Well, we should be doing that, but we should also be doing
something else, and that is pre-departure. Pre-departure. We
know that we are about to have 1.2 million, 1.4 million people
in West Africa afflicted with Ebola. We ought to be on the
ground there. We ought to have--instead of the restriction here
in the United States after they come in of 21 days, there
should be a 21-day pre-approval. When they say they want to
travel to the United States, they need to present themselves
and report in person 21 days before they get on that plane. And
we can take their temperature and a blood sample, if necessary,
so that 21 days later, when they appear to travel, we can test
them again. Now we have got two contact points on that person
before they fly to the U.S., and we can also do that post-
arrival check as well.
But we are not taking this seriously enough. We are not.
And, you know, we need to help, you know, our brothers and
sisters in West Africa, absolutely. But we have got to use--we
have got to have a fact-based approach to this. This can't be
just about ideology and happy talk. You know, we have to look
at this very seriously and have a scientific-based approach to
what we are going to do about this problem. And I don't think
it helps to say we have got an aggressive thing on the ground,
everything is good. Because I have got a feeling, in a couple
of months, you are going to come back here and give us a whole
different story. We have heard that before. So we have got to
approach this in a very deliberate manner, and take it much
more seriously than what I am hearing here today. And, you
know, we owe that--we owe that to the citizens that we
represent here in the United States as well as to those
individuals in West Africa, who we obviously want to support as
well.
But Mr. Torbay, let me just ask a question, wrapping up
here. Your focus, you were saying that you want to make that
containment effort in West Africa. Wouldn't it be--think about
this. If we were putting our folks from all over the world, you
know, medical personnel on the ground, you know, in Monrovia or
at Freetown, wouldn't it be better, wouldn't it strengthen the
infrastructure there on the ground in West Africa, as opposed
to just having a post-arrival process here in the United
States?
Mr. Torbay. Thank you for your question, Mr. Lynch. You
know, as I mentioned, it needs to be contained at the source in
West Africa. This is where the majority of the investment needs
to take place. This is where training needs to take place. This
is where equipment and supplies need to take place. And this is
where most of the investment needs to take place.
Now, that said, we cannot just focus on one without the
other. What we are doing here in the U.S., we are treating the
symptoms of the outbreak in West Africa. We need to deal with
the root cause of the outbreak, of the problem, and that is
actually at the community level in West Africa. I believe pre-
departure there are some tests, temperatures being taken for
anybody actually departing any of those countries before they
board the flight.
Mr. Lynch. At the time of the flight, yes, they get tested
before they get on the plane. What I am talking about is doing
something 21 days before, so that you have got two contact
points that you can have measurements on. It is not foolproof.
But having two contact points there in West Africa before you
arrive in the United States----
Mr. Jordan [presiding]. The gentleman can respond.
Mr. Lynch. OK, Mr. Chairman. Thank you for your indulgence.
I know I am way over.
Mr. Jordan. Do you have a quick response, Mr. Torbay?
Mr. Torbay. One thing that we worry about in terms of 21
days, we are having difficulties recruiting health personnel
from the U.S. to go and work there because there is a minimum
requirement of 6 weeks. If we impose an additional 21 days,
that is 9 weeks. And it is extremely difficult for any hospital
or university to allow doctors and nurses to take off for 9
weeks before they come back. Again, we cannot completely wrap
ourselves in a bubble here. People will go from Guinea or
Sierra Leone to Senegal, will wait a week, take a flight to
Europe, wait a couple of days, then come here, and there is not
much we can stop it from doing that. So the preparedness needs
to take place at both ends.
Mr. Lynch. With all due respect, though, there is only a
few flights, there is only a couple of flights out of there.
You can actually do this.
Mr. Jordan. We have to move on. I thank the gentleman for
his good points.
Dr. Lurie, when you were in front of Congress in 2011 back
during the debate on the reauthorization of the Pandemic Act,
the act that created your agency and your position, you had an
exchange with Mr. Rogers, a colleague of ours, from Michigan.
He said this: ``There is a point person, somebody that makes
the decision, somebody that is absolutely in charge. It's not
CDC. It's not NIH. It's not FDA or anyone else. It's you.''
Your response was, ``That's right.'' So you are the key person.
Right?
Dr. Lurie. My role is to be the principal adviser to the
Secretary on these matters, yes.
Mr. Jordan. You are the key person in the government for
medical preparedness, public health emergencies; you are the
key person in the U.S. Government.
Dr. Lurie. In HHS.
Mr. Jordan. Got it. Let's go to the first slide, if we
could. I just want to put up a couple slides. This is straight
from your Website, just to be clear. It says you are the
person, your agency, the Assistant Secretary for Preparedness
and Response to lead the Nation in preventing, preparing for,
and responding to the adverse health effects of public health
emergencies and disasters.
Further down, the Secretary of HHS delegates to you the
leadership role of all health medical services, support,
function in health emergency and public health events. You are
the key person. Correct?
Dr. Lurie. That's what the legislation says, yes.
Mr. Jordan. No, that is not the legislation. That is your
Website.
Dr. Lurie. That is my role.
Mr. Jordan. Yes, that's the Website. The legislation
definitely says that. Your Website confirms that.
Dr. Lurie. That is my role.
Mr. Jordan. You are the key person. Have you met with Ron
Klain, the new Ebola response coordinator?
Dr. Lurie. Yes, I met with him his first day, and I had
several conversations and an in-person meeting with him
yesterday.
Mr. Jordan. Have you met with Tom Frieden, Dr. Frieden at
the CDC?
Dr. Lurie. I meet with and talk to Dr. Frieden almost every
day.
Mr. Jordan. Good. We would expect that to be taking place.
Are you familiar with the story that Ms. Harrington did in the
Washington Beacon I think, the story that says $39 million
worth of NIH funding that could have gone to an Ebola vaccine.
Are you familiar with that story?
Dr. Lurie. I am not familiar with the story. But if you
familiarize me on the specifics, I would be happy to respond.
Mr. Jordan. I am going to do that. Are you familiar with
the fact that $275,000 on a restaurant intervention to develop
new children's menu was spent of NIH dollars? Are you familiar
with that? Are you familiar with the fact that $2 million were
spent to encourage the elderly to join choirs? Money from the
NIH. Are you familiar with that?
Dr. Lurie. I am not familiar with the details of grant
programs at NIH----
Mr. Jordan. $53,000 on a project studying sighs. Are you
familiar with that? Are you familiar with the fact that $39
million of NIH funding was spent for all kinds of things that--
I mean that I guess cut to the chase. One of the things you
learn in your first economics class. Not that I was a great
student, but I did study a little economics. One of the things
they tell you is the term opportunity costs. Right? When you
spend and allocate resources for one thing, you by definition
can't use those resources for something else. And so here is
what I think a lot of American people want to know: Why, in
fact, did we spend so much money on, for example, $374,000 to
host fruit and vegetable puppet shows for preschoolers when, in
fact, some of this money, as catalogued by the press account
and by staff, totaling $39 million, could have been used to
help with treatment for something like Ebola and potentially a
vaccine? Are you involved in the decisions that NIH makes when
they are deciding how to allocate some of that money?
Dr. Lurie. I am involved in the decisions related to our
biodefense and our preparedness programs for emerging
infectious diseases, yes. The NIH, the CDC, the FDA, my office,
DOD, DHS, the VA, and the Department of Agriculture all work
together on those issues.
Mr. Jordan. But aren't you the point person in coordinating
all of that?
Dr. Lurie. Yes.
Mr. Jordan. So, at some point, you have to sign off and say
it's OK that $374,000 is used for puppet shows instead of
potentially being used--losing the opportunity to use that
money to develop a vaccine to deal with something like Ebola.
Dr. Lurie. So, with respect, sir, I think you have--I would
like do a little bit of clarification here. I think there is a
little misunderstanding about how the NIH budget is allocated.
But that is not my responsibility and my purview. So I suspect
we should----
Mr. Jordan. Let me go back to that same exchange you had
with Congressman Rogers just a couple years ago, when we were
reauthorizing the act that created your position and made you
the key person. Mr. Rogers says this--you said this when you
responded to Mr. Rogers--how can we improve functions at HHS to
ensure that you are, in fact, in charge--that you are the
person in charge? NIH is in HHS, right?
Dr. Lurie. Yes.
Mr. Jordan. Yes. So you are the key person at HHS. How can
we improve, Mr. Rogers asked you. You said, ``I have found
through experience that indeed I have the authority that I need
to be in charge.'' You followup by saying, ``And I find that
the collaboration with sister agencies and HHS, I don't think
it has ever been better. We are working extremely close
together. I think they recognize and respect the fact that we
provide policy direction and are in charge. And I think all the
efforts that we have undertaken to coordinate across HHS have
done that.'' So you told Mr. Rogers, when we were discussing
whether we were going to reauthorize this act to keep your
position, that, in fact, everything was working great. You were
the person in charge. You were working within HHS coordinating
policy, direction, and you were in charge and working closely
together.
Dr. Lurie. And I would stand by that Statement.
Mr. Jordan. So back to the key question. Might we be a
little closer to having a vaccine today if you weren't allowing
all this millions of dollars--$39 million to be spent on what
many Americans view as questionable uses for their tax dollars,
particularly in light of the fact we have an Ebola outbreak in
the United States?
Dr. Lurie. Thanks to the investments that we have had in
biodefense and our focus and Department of Defense's focus on
this critical issue over the past decade, we now have two
vaccines in safety testing and at the NIH and Walter Reed.
Mr. Jordan. Dr. Lurie, that's my point. Might they be
further than safety testing if you hadn't wasted $39 million on
a bunch of other things that most taxpayers think are
ridiculous?
In fact, one of your specific charges is, in your--can we
put up the second slide?
The second slide specifically mentions--this is again from
your--Ebola. You are supposed to get ready for this. Might we
be more ready if you hadn't spent $39 million of hard-earned
taxpayer money on puppet shows for preschoolers instead of
invested that in treatment and vaccines for Ebola?
It is a ``yes'' or ``no.'' You can--might we be further
along if that money had not been spent someplace and could have
been applied to the question at hand?
Dr. Lurie. I don't believe that would be the case.
Mr. Jordan. You don't think $39 million would have helped
us get closer to a vaccine?
Dr. Lurie. You know, the development of a vaccine is a long
and complicated process. It takes years----
Mr. Jordan. Is it a costly process, too?
Dr. Lurie. It is. And it----
Mr. Jordan. It's a costly process?
Dr. Lurie [continuing]. Takes years and years and years to
do that.
Mr. Jordan. $39 million could have been used for it. You
are the person in charge who works closely to direct policy
direction. Those are your words, not mine. Might we have been
better off if, in fact, it had been used to develop a vaccine?
Dr. Lurie. I am not in a position to comment on the overall
NIH budget.
Mr. Jordan. The gentleman is recognized.
Mr. Cooper. I thank the chair.
I think the main public health message of this hearing is
probably counterintuitive: that, at least for U.S. citizens, we
face probably more risk from the flu. So hopefully everyone
will be getting their flu shot after hearing this hearing.
There are many other public health precautions we could be
taking, such as handwashing, things like that, which are too
often neglected.
Back to Ebola, the public is concerned that we are doing
too little too late, so I would like to explore some of the
gating factors that might limit an appropriate response.
Mr. Torbay was very specific in his testimony, mentioning
that probably we are meeting--our manufacturers--there are only
two, apparently--are going to be able to meet only 35 percent
of the estimated demand for the appropriate type of coverall.
Could you name those two manufacturers? And we could perhaps
explore what could be done to augment the supply of those
essential coveralls.
Mr. Torbay. First of all, I would like to clarify that
those manufactures manufacture the specific type that we use.
It is different than types other organizations use.
And I do not remember the manufacturers, but I will be more
than happy to provide it to the committee in writing after the
testimony.
Mr. Cooper. For the record.
Mr. Cooper. There are some other gating factors. Of course,
we all hope on the committee that we don't get to the point
where we need augmented emergency flights by DOD to, you know,
ship our soldiers back home, but Mr. McHenry asked an
appropriate question. Because our men and women in uniform and
their families want to know that there will be sufficient
capacity to get them back home.
I think one of the concerns of the public is that three
health workers have been infected in the U.S. and one actually
overseas returning. And I think we are all looking for the
right sort of response.
This doctor in New York--and we all hope and pray for his
safe recovery, but when he felt sluggish on Tuesday, perhaps it
would have been more appropriate to limit his contact with
others, you know, since he had been exposed to some of the
worst of the infections in Africa. But that gap from Tuesday to
Thursday, that will take an extraordinary taxpayer effort--
contact tracing, all sorts of things--to try to limit the risk
of exposure.
What is the appropriate protocol for people who are known
to be at risk during this crucial 10-day period, 11-day period,
21-day period to try to limit contacts? Like, everyone would
have to feel sorry for his fiance or his girlfriend or the
other folks, you know, he was close to, when he is a skilled
medical professional who presumably should have known, well, it
is getting a little dicey here, and to call in when he has a
103-degree temperature. Is there a better response than that?
For any of the panelists.
Ms. Burger?
Ms. Burger. I think it is unrealistic to expect that any
healthcare professional that is working under extremely
stressful situations, including Tina and Amber and several
doctors--you have to remember that they are humans. You can't
expect them to use their common sense at that point because
they are patients. They need a team that they report to, that
checks on them, as Mr. Torbay has indicated, that follows them
and makes the decisions for them so that they are no longer
healthcare workers, they are patients that need our protection
and care.
And so, to that end, it would make sense to have a
professional team monitoring them and making the
recommendations so they can actually relax and not have to
worry that they are contaminating or exposing anyone unduly to
the infectious disease.
And I think that that would really help in making sure that
everybody that volunteers to take care of these patients and
puts their own families' lives at risk actually is well taken
care of after their service.
Mr. Cooper. So you are suggesting that Dr. Spencer should
have been viewed as a patient earlier than on Thursday and
should have had a team of counselors to advise him because his
judgment could not really be trusted at that point?
Ms. Burger. Exactly. Exactly.
Mr. Cooper. Well, that is a pretty bold recommendation.
As far as international response is concerned, Mr. Torbay
mentioned that U.S. and U.K. have stepped up. We have had some
individuals in America--Paul Allen, Mark Zuckerberg--who have
given more money individually than many nations have given. So
that is an astonishing response.
But what can we do to get more nations involved? I am
thinking, for example, of France that has had involvement in
that area traditionally. What are these other nations--what
should we expect of them?
Mr. Torbay. I think an all-hands-on-deck approach is really
necessary. I think a realization that this is, again, not a
West African problem, it is a global problem that could hit any
country anywhere around the world, especially with travel being
the way it is. People need to realize the threat, and they need
to realize that any contribution that they can make actually
will make a difference.
As you mentioned, private foundations and corporations here
contributed more than some countries did. And I think the U.S.
Government should continue to put pressure on those countries
to actually contribute to the cause.
Mr. Cooper. Thank you, Mr. Chairman. I see that my time has
expired.
Mr. Chaffetz [presiding]. I thank the gentleman.
I now recognize the gentleman from Michigan, Mr. Walberg,
for 5 minutes.
Mr. Walberg. Thank you, Mr. Chairman.
General, thank you for your service.
Probably the number-one question or concerned phone call I
have been getting on this issue in the past several weeks comes
from family members of our military, whether it be Active,
National Guard, Reserve troops--a concern that what they have
seen go on in places where they expect their family members to
potentially have a death sentence as a result of being proud
members of the military and signing on for that and committed
to their efforts. Yet there are concerns that the way it is
carried out at times, their loved ones haven't been given the
necessary tools, armaments, rules of engagement, and all the
rest to handle what they have been trained for, trained to do.
That is a concern for them.
But the biggest concern that they are conveying to me on
those phone calls or meetings in public is that this is a
potential--a death sentence, being sent in to combat a virus,
and with great uncertainty because of the multitude of changes
in protocol, at least perceived by them, coming from what they
hear in the news, hearing from leaders in this administration,
with responsibilities, and also the lack of information coming
from the military on what they are doing.
Let me ask if you would just briefly walk us through a
daily routine of one of the soldiers that has been sent over to
West Africa.
General Lariviere. Congressman, thank you for the question.
I have spoken to the commander on the ground, and I have talked
to the folks at AFRICOM, and this question comes up quite a
bit, actually.
The protocols for an individual on the ground for your
average soldier--and, again, I would like to emphasize first:
None of the military personnel will be providing direct patient
care. We have four lines of effort: command and control,
logistics, engineering, and training. So we are not--the
protocols for treating patients is not something that
individual soldiers will be doing.
Mr. Walberg. But they do come in contact with contractors,
with aid----
General Lariviere. Absolutely. And so the protocols in
place over there, as Mr. Lumpkin can testify to since he has
recently returned, there is a no-touch policy over there. There
is a 3-feet separation when you are talking to local nationals
over there. And that is being enforced both on the Liberian and
U.S. military side quite strictly.
In your average day for a soldier over there, it would be,
obviously, getting up, eating chow, doing the usual morning
routine, get your temperature taken first thing in the morning,
and then go out to whatever task you are going to do. Again, if
you are in the command center, that involves going from your
building directly over to the command center and sitting at a
computer terminal or working on the generators or whatever it
is that you are doing inside the command center.
If it would involve--it involves eating only food from
approved sources, drinking mostly bottled water, or exclusively
bottled water, and washing your hands in chlorine solution
virtually everywhere you go.
You go through your day. At the end of the day, every time
you come back in the compound, at the end of the day, wherever
you are living, you get your temperature taken again--again,
more chlorine wash--in order to ensure that you stay Ebola-
free.
Mr. Walberg. Will the U.S. military personnel have ZMapp or
any other experimental drugs available to them on the ground?
General Lariviere. There will not--there will not be any--I
will have to take that for the record.
General Lariviere. I am not aware that there will be any
ZMapp available on the ground.
The personal protective equipment will be issued to them,
depending on their level of expected exposure. For the vast
majority of people, that will include surgical gloves,
overgloves, boots, and a Tyvek suit. Obviously, for the medical
personnel, it will be more along the lines we talked about here
for the healthcare providers.
Mr. Walberg. OK.
Dr. Lurie, in 2005 the Bush Administration proposed a rule
change that would allow the CDC broad powers to confine
individuals that are believed to be infected with deadly
pathogen-like--the pandemic flu. President Obama withdrew this
rule in 2010.
Do you believe the CDC needs or should have this authority
to ensure an infectious disease outbreak like Ebola is
contained and controlled?
Dr. Lurie. Thank you for that question.
You know, I think, with every situation, we are always
reviewing and taking a look at whether we have all the
authorities we need to do the job. In our system of government,
right now that authority rests with the States, and they have
authority to do that when they think it is necessary.
Mr. Walberg. But CDC shouldn't have that authority that
they did have? And it could be flexible. There was certainly
authorization. They didn't have to. Don't you think that would
be a valuable authority to have?
Dr. Lurie. So what I would say is I think that we are
always learning and adjusting based on our experience, and that
is one of the things I think we will probably be looking at as
we move forward.
Mr. Walberg. Well, I hope so. We are sure learning right
now. I am not sure we are adjusting as rapidly as possible.
And I am not--I am certain we are not giving any type of
security to our medical workers, nurses, including our citizens
out there, that we have a solid policy in place that is first
and foremost protecting our citizens against these type of
problems. And I think it is evident by the hearing today and
hearings that will go on that you are not bringing us a sense
of security.
And as a Member of Congress representing a district, I am
expressing that point of view from my citizens, who believe
that we are less secure than we ought to be if we had used the
policies that had been put into place.
Mr. Chairman, I yield back.
Mr. Chaffetz. I thank the gentleman and will now recognize
the gentleman from Virginia, Mr. Connolly, for 6 minutes in the
spirit of equal time.
Mr. Connolly. I thank the chair.
It seems to me that, based on what we know and what we are
hearing today on the panel, the United States' objectives have
to be twofold. Domestically, it is to protect and prevent. And
that goal cannot be successful if we don't address the second
goal, which is to deal with the disease at the source in West
Africa. The two go hand-in-glove.
And especially given the fact that we are potentially
looking at an explosion of infection that is exponential in a
very short period of time, the next 2 months, it seems to me
there is enormous urgency in the latter, not to diminish at all
the need to address the former.
Now, we had some good news today. A nurse, Ms. Pham, has
been declared Ebola-free. Thank God. But as Ms. Burger points
out, dealing with the first part, protect and prevent, it
wasn't thanks to the protective gear and the protocols and the
guidelines that were in place at her hospital. While CDC was
giving us assurances how hard it was to contract the disease,
``We're pretty confident we've got things in place,'' and so
forth, two healthcare workers, including Ms. Pham, came down
with it.
Dr. Lurie, in retrospect, do you think perhaps, not
intentionally of course, but in a zeal to reassure the public,
CDC misstepped?
Dr. Lurie. You know, I think that CDC has said that some
missteps have been made. But they have taken a quick, hard
look----
Mr. Connolly. But isn't it----
Dr. Lurie [continuing]. At the experience. They have
pivoted, as you see----
Mr. Connolly. Dr. Lurie, I am asking--I am asking a public
information, public health question. I have had to deal with
that in my county, when I was the head of my county, during
anthrax attacks. And one rule I had was: Never reassure the
public when you don't know. Never do that. Because when you do
that, you damage your credibility.
And you heard it here today from some of the questioning on
the other side of the aisle. It gave them an opening to attack
the credibility of the administration by extension because the
CDC was not capable of saying, ``Not yet. We don't know. We're
still--it's a work in progress.''
What is so horrible about doing that?
Dr. Lurie. I think right now, if we look at the situation,
we see that it is a work in progress. And what you see is that
we are taking constant steps to adjust as we learn more.
Mr. Connolly. Ms. Burger, you indicated that you would
welcome a law establishing--if not an Executive order, but
preferably a law because that codifies it--establishing uniform
guidelines, uniform protocols, so we don't have this up-and-
down myriad of procedures at hospitals depending on where you
live. Is that correct?
Ms. Burger. You left out one critical word, which is
mandatory optimal standards----
Mr. Connolly. Yes.
Ms. Burger [continuing]. For personal protection.
Mr. Connolly. Yes. I----
Ms. Burger. The CDC guidelines are merely guidelines, and
all 5,000 hospitals in the USA get to pick and choose what part
of the guidelines they implement and----
Mr. Connolly. I take----
Ms. Burger [continuing]. The personal protection.
Mr. Connolly. I take your point.
Dr. Lurie, would the administration welcome such
legislation? And/or is the President contemplating such
Executive action?
Dr. Lurie. So one of the things I think to keep in mind is
that the Federal Government does not license or regulate
hospitals in this way. Hospitals are licensed and regulated
primarily by the States. But I think it is fair to say at this
point that no hospital wants to see its healthcare workers
infected.
The CDC guidelines now provide a couple of options for safe
personal protective equipment in large part because there is
probably not a one-size-fits-all solution. It is important for
people to be able to practice in the equipment that they are
using and comfortably using day-to-day, provided that it meets
the safety standards that CDC has articulated.
Mr. Connolly. OK. I am not sure what that means in terms of
whether the administration is contemplating an Executive order
or whether you would welcome some legislation that would make
it mandatory, as Ms. Burger suggests. But we will be in touch,
I am sure.
Final set of questions.
Mr. Torbay, in the United States, there are 245 doctors per
100,000 population; in Liberia, 1.4; in Guinea, 1--10; Sierra
Leone, 2.2. Health spending per capita, $8,895 here in the
United States; $65 in Liberia; $32 in Guinea.
CDC says if we don't achieve 70 percent of isolation of
existing Ebola victims in the affected countries, the number of
victims or people with Ebola in these areas could reach--could
reach--1.4 million by January 20th, the day roughly around when
the President gives his State of the Union address. That is
astounding. And whatever problems we have with the relatively
limited number of Ebola patients in the affected regions,
obviously it becomes enormously magnified when you are looking
at that kind of number.
How in the world do we contain this before it becomes
explosive? It is already the largest Ebola epidemic ever
recorded, but to go from roughly 10,000 or so to 1.4 million in
the next 2 1/2 months is very--I mean, it is jaw-dropping.
Mr. Torbay. Thank you for your question.
There are steps that could be taken and that are being
taken to contain this and to hopefully never achieve that 1.4
million number. And that includes isolation of patients, quick
isolation of patients the minute we know that they develop
symptoms, treatment, referral to the Ebola treatment units,
such as the one that International Medical Corps is running in
Bong County----
Mr. Connolly. And if I could interrupt you--and, Mr.
Chairman, I promise I am done after Mr. Torbay.
CDC says if you isolate 70 percent now, you achieve
complete abatement of Ebola in the affected regions. I mean, in
other words, then we are on a path to the complete reversal of
the progress of the disease. But if we don't do that, we are
headed in the opposite direction.
Sorry.
Mr. Torbay. In addition to treatment, community awareness
and education is critical.
But, also, we cannot forget the need for regional
preparedness outside of those three countries. We know of one
patient in Mali already. Yesterday, a 2-year-old girl was taken
into a hospital in Mali.
Regional preparedness is critical. And that includes
training of teams that could actually treat Ebola, detect,
burial teams, contact tracing. It includes consistent community
messaging so there are no two conflicting messages that go out,
as well as stocking of supplies that are needed in case of an
outbreak. This is critical, as well, and this is an area that
is being ignored in terms of preparedness.
Mr. Connolly. Thank you.
And, Mr. Chairman, thank you for generousness.
Mr. Chaffetz. I thank the gentleman.
I now recognize the gentleman from South Carolina, Mr.
Gowdy.
Mr. Gowdy. Thank you, Mr. Chairman.
I want to start, Mr. Chairman, by thanking nurses and
doctors, hospital workers, soldiers, and others for their
courage and their service and their sacrifice. Most of us, Mr.
Chairman, in life run away from danger and disease and risk,
and very few people are willing to run toward it. So I want to
start by thanking that group of people.
Dr. Lurie, I want to read you a quote, and you tell me if
you can tell me who the author of this quote is.
``Beginning with the development of a strategy, my role can
be defined as helping our country to be ready for any kind of
adverse public health event, including a response to any
challenges the future may bring.''
Do you know who said that?
Dr. Lurie. Yes, I do.
Mr. Gowdy. Who?
Dr. Lurie. I did.
Mr. Gowdy. You did. That is exactly right, in a Penn
Medicine article.
And your bio page says that you are the Secretary for
Preparedness and Response, and your work has included
evaluating public health preparedness, conducting 32 tabletop
exercises on hypothetical crises, such as smallpox, anthrax,
botulism, plague, pandemic influenza.
Another story on you and your career, which is an
incredibly commendable career, said your job is to plan for the
unthinkable. ``A global flu pandemic? She has a plan. A
bioterror attack? She's on it. Massive earthquake? Yep.'' She's
got a plan. It's a mission that includes both science and a
communication strategy.
So I was sitting there, Dr. Lurie, thinking, here we have a
doctor with an incredible background in medicine, who also
happens to have planned for crises like Ebola, whose job
description also includes communication strategy. So why in the
hell did the President pick a lawyer to be the Ebola czar and
not you?
Dr. Lurie. So I appreciate your questions. Before I answer
your question, can I take just one moment to clarify my answer
about the quarantine question? Because I think I didn't
understand it fully.
CDC has ample quarantine authority to do what it needs to
do. I think the--and it has used those authorities many, many
times. The proposed regulation would have refined the process
we have used, but the underlying statute already gives CDC the
authority that is needed.
Mr. Gowdy. OK. You----
Dr. Lurie. So with that clarification, I just wanted to----
Mr. Gowdy. So the record is now complete with respect to--
--
Dr. Lurie. Thank you.
Mr. Gowdy [continuing]. Your position on----
Dr. Lurie. Right.
Mr. Gowdy [continuing]. On quarantine.
Now I want the record to be complete on why in the world
the President picked a dadgum lawyer to head the Ebola crisis
instead of somebody with your vast and varied background.
Dr. Lurie. And I appreciate the vote of confidence.
The role of the Ebola coordinator in the White House is a
whole-of-government coordination role.
Mr. Gowdy. Well, I appreciate that, Dr. Lurie. But Mr.
Klain is not a doctor. He is not an osteopath. He is not a
nurse. He is not an epidemiologist. He doesn't have a
background in communicable disease. He doesn't have a
background in infectious disease. He doesn't have a background
in West Africa.
So how in the world is he the best person to be the Ebola
czar and not you or--and I don't want to hurt her career, I do
not want to hurt Secretary Burwell's career, and I fear that I
will by complimenting her. But she is an incredibly bright
person. One of the more capable people I have met in the last
10 years is your boss, the Secretary of HHS. Now, we disagree,
in fairness to her, on lots of policy, but she actually has a
background, through her work, The Gates Foundation, in global
health.
You are a doctor. I mean, if this were an outbreak of
people who don't have wills in West Africa or if this were an
outbreak on contested elections in West Africa, then I would
say, yes, go hire Mr. Klain, but it is not. It is a medical
crisis. So why not you?
Dr. Lurie. So right now I have a full-time job doing my job
in the Department of Health and Human Services. I really
appreciate the vote of confidence. And I have a lot of
confidence in Mr. Klain.
Mr. Gowdy. Well, how about another doctor? How about
somebody who is an expert in infectious disease or an expert in
West Africa or the delivery of health care? I mean, God forbid
we pick somebody with a background in medicine instead of a
dadgum lawyer. And in the interest of full disclosure, I am
one. But----
Dr. Lurie. So, with respect, I think that the role of the
coordinator at the White House doesn't require a doctor. It
requires somebody who is really expert at coordination and
bringing the parts of government together to enhance the
coordination.
Mr. Gowdy. Well, I am going to make you this promise, OK?
And I want you to hold me to it, OK? The next time there is an
opening on the Supreme Court, I want you to see whether or not
the President considers a doctor or a dentist for that job.
And we actually are about to have a vacancy for our
Attorney General, and I want you to consider or be mindful of
whether or not he considers maybe, like, a tattoo artist to be
our next Attorney General. I promise he will not. He will pick
a lawyer for the Supreme Court, and he will pick a lawyer to be
the head of the Attorney General--Department of Justice.
I am just lost as to why he wouldn't pick somebody with a
medical or healthcare background to be the Ebola czar. I mean,
can you understand why people might possibly think this could
perhaps be a political pick instead of a medical/science/health
pick? Can you understand how people might be just a little bit
suspicious?
Dr. Lurie. I can understand the public's concerns about a
whole variety of issues. I believe that Mr. Klain has
tremendous experience in doing the job that he was chosen to
do.
Mr. Gowdy. Well, cite me all his medical background then. I
was going to let you go, but you said he has tremendous
experience. Cite me all of his medical, infectious disease,
communicable disease, healthcare delivery background.
Dr. Lurie. You know, one of the terrific things about the
way the government works together is that experts come together
all the time. There is tremendous knowledge----
Mr. Gowdy. I am going to take that answer as that he has
none.
Dr. Lurie. There are a tremendous number of doctors that he
has at his disposal. He has me, he has Dr. Frieden, he has Dr.
Fauci, he has Dr. Collins. You could go on and on and on.
Mr. Gowdy. Yes, and it would just make--but you know what?
We had access to all those people before we had Mr. Klain. All
those people worked for the government before the President
hired Mr. Klain, didn't they?
Dr. Lurie. And----
Mr. Gowdy. So why pick a lawyer to head our response to
Ebola? It just--you know, color me cynical, it just appears to
be political.
But, with that, Mr. Chairman, I would yield back----
Mr. Connolly. Would my friend yield?
Mr. Gowdy. Of course I will yield to the gentleman from
Virginia.
Mr. Connolly. Well, I just wanted to join my friend in
calling for a nonlawyer appointment to the Supreme Court. It
would be the healthiest damn thing we have had in the last 50
years. Thank you.
Mr. Gowdy. Are you applying? Are you interested?
Mr. Connolly. No.
Mr. Chaffetz. I thank the gentleman.
I will now recognize the gentlewoman from Illinois, Ms.
Kelly, for 5 minutes.
Ms. Kelly. Thank you, Mr. Chair.
Dr. Lurie, are you trying to say that we need someone good
at coordinating and managing and really cutting through a lot
of the BS?
Dr. Lurie. That is exactly right.
Ms. Kelly. Thank you.
I want to thank the panel for meeting with our committee to
discuss this important health crisis issue.
And I want to let you know that my thoughts and deep
appreciation are with all the healthcare professionals dealing
with this crisis and those in the audience. And because I
represent Illinois, a special shout-out to those from Chicago,
the Chicagoland area.
My questions are about the DOD's role in West Africa.
Secretary Lumpkin, I know there are some that have
commented that there is no reason to involve the U.S. military
in this type of humanitarian crisis. Why is the U.S. military
so critical to getting the epidemic under control in West
Africa?
Mr. Lumpkin. Thank you for the question.
Again, we are in direct support of USAID and their whole-
of-government efforts. USAID came to us because of our speed
and their scale with response. We can mobilize quickly. We can
instill command and control, provide the infrastructure. We
have the ability to do logistics. We do it very well, both
strategically and tactically, to move supplies.
The one thing you have to keep in mind, within Liberia,
they get about 200 inches of rain a year. When we were there,
it was raining, you know, 6 to 8 hours a day some days. In that
time, many of the roads are impassable except by foot. And what
goes by foot is the Ebola virus, as well. So there was
inaccessibility to the various areas. We have the ability to
reach and get those areas and to support USAID.
We have the ability to do construction and to build these
Ebola treatment units. When I was there, I had a chance to get
on the ground and talk to some U.S. Navy Seabees who were
building the Monrovia medical unit. And working through the
rain with the equipment there to get what looks to be
impossible, they make possible.
Then the final piece is we can do scaled training. We can
bring a boot-camp-like training to train up to 500 healthcare
workers per week to man and to staff these Ebola treatment
units. And so we bring the capacity in order to do that.
So, again, we are an interim solution as we roll in there
to support USAID until the international community can mobilize
in order to take over our efforts.
Ms. Kelly. So you feel you have extensive experience in
conducting humanitarian efforts like this.
Mr. Lumpkin. Well, we have supported USAID on numerous
occasions. We did it in Haiti. We have done it in places--Japan
just several years ago, the Philippines most recently. The team
on the ground we have worked with before. The team lead from
the Disaster Assistance Response Team has extensive experience
working with the Department of Defense. And we are very tightly
lashed up, and I would say it is seamless.
Ms. Kelly. OK. Thank you.
General, can you provide us with a status update on the
operations in the region and let us know what your biggest
challenges are?
General Lariviere. Yes, ma'am. Thank you for the question.
As Mr. Lumpkin said, we were asked to do this mission
because of our unique capabilities. As we are here today, we
have 698 personnel on the deck, split between Liberia and
Senegal. We are expecting here, in the next 24 hours, the 101st
Airborne Division will complete its movement into country and
we will begin a rotation for them to take over the command and
control piece of this. Equipment continues to flow through our
immediate staging base in Dakar, Senegal.
As Mr. Lumpkin said, we were asked to do engineering. USAID
asked us to be prepared to buildup to 17 Ebola treatment units.
We have actually been asked to build 12, and 3 are currently
under construction.
And as for the training effort, we have identified the
Paynesville National Training Center in Monrovia as the site
where we will bring in military trainers to begin training
healthcare workers here in the next couple of weeks.
Ms. Kelly. For both of you, if this epidemic is not
contained and it spreads further over the continent, do you
agree that this really affects international security?
Mr. Lumpkin. Again, to reiterate my opening comments, this
is a national security priority for the United States that
truly has global impacts.
So we have an opportunity right now to flood the zone, to
make sure we have the capabilities in country, working as a
whole of government, and mobilize the international community
to respond while it still is at a point, while dire--if it gets
worse, it is going to be harder to manage. So we need to take
this opportunity we have right now.
Ms. Kelly. General, did you have anything?
General Lariviere. Nothing additional.
Ms. Kelly. Well, I want to thank you both for your
testimony and for your service to the country.
And, again, a deep appreciation to all the healthcare
professionals.
Thank you. I yield back.
Mr. Chaffetz. I thank the gentlewoman.
I will now recognize myself for 5 minutes.
And I want to thank the six of you for your dedication and
commitment to fighting this and for the efforts here in the
United States of America.
And to the men and women who serve on the front lines,
those healthcare workers and first responders, I join with Mr.
Gowdy in thanking those that will actually run to the sounds of
the guns in the crisis that happens. They are amazing
individuals, and they have our thoughts and our prayers and our
hearts behind them.
I have a few questions, particularly on the military side
of things. I don't know whether to start with Mr. Lumpkin or
the General. But help me understand their proximity to the
challenge here. How many USAID personnel are they supporting?
Mr. Lumpkin. I don't have that number off the top of my
head, and I want to be accurate. So I would like to take that
back----
Mr. Chaffetz. Do you have a range? I mean, is it hundreds?
Is it----
Mr. Lumpkin. It is so integrated--the disaster----
Mr. Chaffetz. OK. If you will get back to me.
Mr. Lumpkin. I will be able to do that.
Mr. Chaffetz. My understanding, Doctor--we've got one
doctor here on the panel--is that there is a 21-day window in
which a person who may have been exposed to Ebola will actually
potentially come down with Ebola and start to show signs of
having this virus. Is that correct, 21 days?
Dr. Lurie. That is correct.
Mr. Chaffetz. So, General, why do we only hold our troops
for 10 days before we release them to bring them back to the
United States?
General Lariviere. Yes, sir. Thanks for the question. And I
can understand the confusion on this, but let me--let me see if
I can make it clear.
To start, the 21-day period for monitoring has to take
place outside the infection zone. For us, that will be in the
United States.
Out of an abundance of caution, prior to departure--in
order to reduce their risk, commanders will be allowed to
remove their personnel from whatever jobs they were doing for
up to 10 days prior to departure from Liberia just to limit
their exposure and provide an extra layer of protection.
However----
Mr. Chaffetz. I am going to need further explanation on
this----
General Lariviere. Right.
Mr. Chaffetz [continuing]. Because I don't understand the
10 days when the science says the 21 days, but----
General Lariviere. Well, the 21 day takes place--well, the
21-day monitoring for U.S. Military personnel will take place
Stateside after they have left in order to ensure that they are
Ebola-free, just as was described previously for other
healthcare workers.
Mr. Chaffetz. Let me understand, Doctor. The written
materials that I do see out there talk about fever, which is
monitored twice a day in the case of the military, and other
symptoms. What are the other symptoms?
Dr. Lurie. Other symptoms might include nausea, diarrhea,
red eyes, muscle aches, fatigue.
Mr. Chaffetz. So any one of those symptoms could be
happening and not have a fever and you could have the Ebola
virus, correct? You could have fatigue, for instance, before
you have a fever.
Dr. Lurie. That is correct, but you really only transmit
the disease when you are febrile.
Mr. Chaffetz. So if you have one of these symptoms and you
are coming through Customs and Border Patrol, for instance, is
one of my deep concerns. We've got about a million people a day
that come through the United States border. We've got these
Customs and Border Patrol agents and officers that--they are
wonderful people. I mean, they are dedicated and committed at a
tough and difficult job. And we are asking them to make an
assessment of somebody in about a minute or so as to whether or
not this person potentially has Ebola.
How in the world are we going to train them so that they
can have these assessments?
Dr. Lurie. So let's be clear about what's happening now.
First, all travelers are funneled--from West Africa are
funneled to five major airports, where people are specially
trained to do tightened screening. If, in fact, they have
symptoms of Ebola or they have a fever, then they get referred
to secondary screening. And then, additionally, they are----
Mr. Chaffetz. But that didn't work.
Dr. Lurie [continuing]. Interviewed by staff----
Mr. Chaffetz. It didn't work. Are you telling me that it
worked? Did it work in the case of Dr. Spencer? Did it work?
Dr. Lurie. So the reason that we now have moved to active
monitoring of all people that come back from these countries to
the United States is exactly for this reason, so that if people
don't have a fever when they come----
Mr. Chaffetz. You see where we lack some confidence, right?
Dr. Lurie. If people don't have a fever when they come
through--when they come through the CBP, Customs and Border
Patrol, stations, we still believe they need to be actively
monitored for 21 days. That is exactly what happened.
Mr. Chaffetz. But active--this active----
Dr. Lurie. And Dr. Spencer took his temperature. At the
earliest moment, as I understand it, he called authorities and
was isolated very expeditiously.
Mr. Chaffetz. So you don't think he was contagious those 48
hours before?
Dr. Lurie. From what we understand, people are infectious
when they have a fever, not beforehand.
Mr. Chaffetz. So why did you close the bowling alley? Why
did they--why did they, you know, put other people in
quarantine? If he is not contagious because he barely showed a
fever and he is a doctor and he says he didn't have a fever
until that morning, why did you have to shut down the bowling
alley?
Dr. Lurie. You know, it is a good question, and I think it
gets to your issue of confidence. We really want to move in an
abundance of caution. The bowling alley is closed so that it be
cleaned and decontaminated out of abundance of caution. And I
expect it will be open and people will be bowling----
Mr. Chaffetz. So he could have gotten----
Dr. Lurie [continuing]. In the not-too-distant future.
Mr. Chaffetz. He could have gotten sweaty, right, and you
can transfer this via sweat, right? That secretion could
actually hold the Ebola virus for some time, correct?
Dr. Lurie. So the bowling alley is being cleaned out of an
abundance of caution, yes.
Mr. Chaffetz. I just don't have the confidence that we are
dealing with people who have a known--we are talking about
people who have come in direct contact with Ebola patients. Why
we wouldn't hold them for a 21-day period to make sure that
their loved ones, themselves, the people of this country--I
don't understand why we wouldn't put that travel restriction in
place, why we don't get a little bit more strict in putting
quarantines--the self-quarantine didn't work. It didn't work in
the case of Dr. Spencer, and he is one of the great people of
this earth. I mean, he went to go help save people's lives, and
he is an emergency room physician, my understanding.
So that is the concern. That is----
Mrs. Maloney. Will the gentleman yield?
Mr. Chaffetz. Sure.
Mrs. Maloney. Thank you.
I would like a clarification from the Major on one of your
responses to the chairman's questions. You said that the
quarantine cannot happen in the country of origin or the
country of infection and that you would quarantine him, as I
understand from your answer, 10 days in, say, Liberia before
you would allow them to come to the United States.
My first question is, why can't you quarantine----
Mr. Chaffetz. We don't have first questions. Ask the
question.
Mrs. Maloney. Clarification.
Mr. Chaffetz. We have to yield. People have flights----
Mrs. Maloney. Clarification.
Mr. Chaffetz. Yes.
Mrs. Maloney. Clarification. Why can't you quarantine in
the country of infection, particularly if we are sending over
military that could build a quarantine unit?
General Lariviere. Ma'am, I will defer to the doctors. But
what our infectious disease personnel tell us, in order to be
absolutely certain that everybody is Ebola-free, it has to be
outside the infection zone. And for all intents and purposes,
the entire country of Liberia is an infection zone. But I would
defer to the doctor for clarification.
Mr. Chaffetz. Go ahead.
Dr. Lurie. So the CDC's guidelines right now indicate that
if you have no risk, if you have been in--if you have not been
exposed to other people, you haven't touched other people, you
haven't cared----
Mr. Chaffetz. Her question was about military personnel who
are in the infection zone who did have contact.
Dr. Lurie [continuing]. You haven't cared for sick Ebola
patients, and if you are in personal protective equipment, you
haven't had a breach of personal protective--you haven't had a
breach of your personal protective equipment, that, depending
on the category, you are at low or no risk.
Mr. Chaffetz. I am not buying it. I am just not buying it.
Dr. Lurie. Well----
Mr. Chaffetz. My time has expired.
Dr. Lurie. OK.
Mr. Chaffetz. We will go to the gentleman from
Pennsylvania, Mr. Cartwright, for 5 minutes.
Mr. Cartwright. Thank you, Mr. Chairman.
I want to followup on that.
And thank you for joining us today, Secretary Lumpkin and
Major General Lariviere.
But, you know, the expression ``an abundance of caution''
has been used here in this room here today. And what I am
wondering specifically--and I will open that up to either of
you gentlemen--is there any reason why this proposal--you know,
Mr. Lynch brought it up, Mr. Connolly brought it up, Mrs.
Maloney brought it up, I believe Mr. Chaffetz brought it up. Is
there any reason why we wouldn't just want to use a 21-day
waiting period in West Africa before we bring people back to
the United States?
Mr. Lumpkin. Our 21-day monitoring process is done at the
unit. It is done twice a day, as far as where they have direct
contact with a healthcare professional for everybody that comes
home. And it is commensurate with guidelines that other
organizations are following. So we are following the same
guidelines as the--that CDC and others recommend.
Mr. Cartwright. When you say ``in the unit,'' you mean in
the unit whether it's in West Africa or in the United States.
Mr. Lumpkin. No, no. Well, there is in-country monitoring,
and there is monitoring once they return home.
Mr. Cartwright. OK.
Mr. Lumpkin. So once they return back to the continental
United States or their port of origin, so to speak, they will
go through a 21-day process where twice a day, 12 hours apart,
they will report to their unit and do positive discussion with
the healthcare provider and have their temperature taken to see
if--to make sure that they don't become febrile or show any
symptoms.
But keep in mind, going back to the risk of the Department
of Defense personnel in country, because we are not providing
direct health care to Ebola patients, our risk is much, much
lower than those that do to begin with.
Mr. Cartwright. All right. And you are telling--you are
answering my question with what we are doing, and I am asking
you, why couldn't you do it a little differently? Why couldn't
you do the 21-day waiting period in country just to be extra
careful that we are not bringing this virus back to the United
States?
General Lariviere. Yes, sir. Again, everybody in country
will be monitored twice a day for their temperature. So, for
all intents and purposes, we are checking--we are basically
doing what the CDC recommends every single day while we are in
country by having their temperature taken twice a day.
Immediately prior to departure, we will have personnel--we
will go through a questionnaire to find out if, in the last few
days right before they left, if they have been in more--
possibly could have come into contact and be anything other
than a low-risk category before we transport them home to start
the 21 days in CONUS.
The 10-day period, which is causing all the confusion, was
merely an additional period in which case they would be at a--
be removed from whatever jobs they were doing, if they were out
and about the town, in order to further reduce their possible
risk.
Mr. Cartwright. Well, General, I thank you for that answer,
but, again, you are telling me what the plan is right now. And
I am asking you, why couldn't you be a little more careful with
the plan, go a little more overboard with the protection and
extend the in-country waiting period to 21 days rather than the
10 days?
And it seems to me that you gentlemen are deferring to the
CDC on this. Are you?
General Lariviere. Well, sir, it is the CDC; it is also the
U.S. military infectious disease doctors who, in consultation
with their interagency partners, are the ones that----
Mr. Cartwright. Well, let me cut it short, then. May I ask
you gentlemen to please consult with those sources and ask them
to consider a 21-day in-country waiting period just to be in a
real abundance of caution?
Mr. Lumpkin. We will do that.
Mr. Cartwright. I thank you for that.
I also wanted to ask: You know, we have heard about this
terrible potential for the spread of this disease in West
Africa. What did we say? By January, a million infections or
more. The suffering, the horror there.
And one question I have is, No. 1, is 3,200 American
service men and women enough to properly train to defeat this
Ebola enemy?
Mr. Lumpkin. Based on the requirements that have been asked
of us from USAID, who we are supporting in country, the answer
is yes.
Mr. Cartwright. And then the next question is, are there
enough trainees, are there enough healthcare workers in West
Africa that we can train enough people to take care of the
problem?
Mr. Lumpkin. That is a question I would have to defer to
the USAID and their expertise on the ground to----
Mr. Cartwright. Would anyone on the panel like to take that
question?
Mr. Torbay. There are health workers, not necessarily from
Sierra Leone and Liberia, from the U.S., from other African
countries, from Asia, that we are bringing to the country, as
well, to help with the treatment and the containment. And we
are hoping, with the training that is being provided and the
supplies and the momentum that is actually now ongoing, that
actually that should be sufficient.
That being said, for the time being, it is still really
difficult to encourage people to go and work in West Africa,
given the conditions on the ground but also given the
conditions that they might actually stay in West Africa for a
longer period, as well. So this is why we are trying to balance
it in terms of going there but, at the same time, make sure
that they can actually leave and go back home when they can.
Mr. Cartwright. Well, my time has expired. I thank you.
Mr. Chaffetz. All right. I thank the gentleman.
Quickly, Mr. Lumpkin, are there any United States
personnel, military or USAID, that have any symptoms of Ebola?
Mr. Lumpkin. Not to my knowledge.
Mr. Chaffetz. Thank you.
I now recognize the gentleman from Texas, Mr. Farenthold.
Mr. Farenthold. Thank you, Mr. Chairman.
I want to followup, before I go into my line of
questioning, with Dr. Lurie.
You talked about an overabundance of caution as to why we
closed the bowling alley, as to why the airline took out the
seats and reupholstered and recarpeted. We are hearing a lot
about an overabundance of caution.
From a purely health standpoint, wouldn't an overabundance
of caution include an air travel ban, complete, to the affected
countries, like we have seen in some European countries?
Dr. Lurie. No, I don't believe it would.
Mr. Farenthold. All right. I am going to respectfully
disagree.
Now, I am glad we are having this hearing today. This is my
second hearing on Ebola, and I was actually really disturbed
during the first hearing that the Homeland Security Committee
had in Dallas to see the CDC pointing fingers at CBP, CBP
pointing fingers at the National Institutes of Health.
It is one of the reasons I said we needed to appoint
somebody to be the point person, someone where the buck stops.
And the President chose Mr. Klain. I am going to join with Mr.
Gowdy in being a little skeptical of putting a lawyer instead
of a doctor in.
But Josh Earnest told reporters ultimately it will be his
responsibility to make sure that all the government agencies
who are responsible for aspects of this response, that their
efforts are carefully integrated. He will also be playing a
role in making sure decisions get made.
I think one of the key things in that role is working with
Congress, and I think he should be here today or at a hearing
to be called very soon. We are the ones that sign the checks.
We've already signed a $750 million check to fight this Ebola.
I think he needs to be here.
I also--part of the finger-pointing we saw was the CDC
saying the nurses in Texas broke protocol, when I think they
were following, to the best of their ability, what they were
able to do. I think it was entirely inappropriate they threw
the nurses under the bus. My wife is a nurse, and she and I
were both--were individually hurt and offended by that. I think
these nurses were doing the best they could.
And, listen, an Ebola patient isn't always going to present
at an Ebola center. They are going to show up at their local
hospital when they show symptoms. Every hospital needs to be
trained.
And, Ms. Burger, am I correct in saying your testimony is--
what was the percentage that weren't prepared?
Ms. Burger. I believe it's 85 to 86 percent. But you have
to remember these are voluntary guidelines; they are not
mandates. And until there is a mandate from Congress or the
President, we will continue to have issues.
Mr. Farenthold. I was thinking maybe--you know, I am not a
big fan of big government regulation--maybe the joint
commissions or the States.
Mr. Chairman, I would also like to enter for the record a
Statement from Texas Health Resources. They were also thrown
under the bus, and this is one of their responses to that. So
I'd like to enter that for the record.
Mr. Chaffetz. Without objection, so ordered.
Mr. Farenthold. Now, we have talked about who is not here.
I want to talk--since we do have Mr. Lumpkin and the General
here, I wanted to ask a couple of quick questions about our
military involvement.
General, why did you join the military?
General Lariviere. To serve my country. And my dad was a
Marine.
Mr. Farenthold. And, traditionally, the military's job has
been to serve and protect this country with guns and bombs. I
understand the mission is expanding and you all are out now
building health facilities in Ebola-plagued areas. Very
laudable, but is this really what the military was designed
for?
It seems like if you wanted to build healthcare facilities
and help countries, you would have joined the Peace Corps and
not the--or USAID and not the military.
General Lariviere. Sir, as Mr. Lumpkin Stated, this is a
national security threat. And, as has been Stated previously,
the idea has been to fight this overseas so it doesn't further
come back here----
Mr. Farenthold. But isn't----
General Lariviere [continuing]. On our--I'm sorry.
Mr. Farenthold. All right. And is the military the only
organization that can build hospitals, morgues, and treatment
facilities? Aren't there thousands, if not hundreds of
thousands, of contractors worldwide that can do that?
General Lariviere. Absolutely. But we were asked to use our
unique capabilities, as was Stated earlier, to jumpstart this
process, get it in place, so we could turn it over to those
organizations.
Mr. Farenthold. And so are these facilities going to be
near existing facilities for Ebola patients? Are they going to
be greenfield facilities or brownfield facilities? Are the
locations nearby where patients are going to be congregating?
General Lariviere. We have been asked to build treatment
units in locations that were coordinated between USAID and the
Government of Liberia.
Mr. Farenthold. So very possibly you could be working on an
expansion to an existing hospital that is treating Ebola
victims within those guidelines.
Mr. Lumpkin, you look like you want to jump in.
Mr. Lumpkin. No, of the ones we've been asked to construct
per USAID, none of those are expansions. They are all unique,
new----
Mr. Farenthold. OK. And----
Mr. Lumpkin [continuing]. Ebola treatment units.
Mr. Farenthold. So, then, you talked a little about PPE.
What personnel would be wearing PPEs? I mean, you've got 80-
degree-plus, highly humid conditions in these countries, and
the natural inclination is going to be, why do I need to wear
this Tyvek suit?
General Lariviere. That is a great question.
So the protocols that will be followed are that all U.S.
military personnel will be issued a basic set of PPE that they
will have with them in country, but because of the temperatures
and because, quite frankly, of the jobs they will be doing,
they will not be required to wear it all the time.
Mr. Farenthold. OK.
And I've got one quick last question. There has been a lot
of confusion about this 10 days and then 21 days. After the 10
days in Africa, they are going to come back to the United
States and go to their unit and be monitored in the unit.
Between the 12 hours that they are not being monitored by their
unit, are they going to be able to ride the subway, see their
girlfriend, go to a bowling alley, and take an Uber?
General Lariviere. They will be on the military facility.
They will be allowed to go home, either to the barracks or to
their families. But, obviously, every 12 hours will limit their
ability--having to report to the unit every 12 hours will limit
their ability to travel much further off base than you could go
in order to get back for evening formation.
Mr. Farenthold. But you will be--all right. Thank you very
much. My time has expired.
Mr. Chaffetz. And I thank the gentleman.
I now recognize the distinguished gentleman from Illinois,
Mr. Davis, for 5 minutes.
Mr. Davis. Thank you very much, Mr. Chairman.
And I want to thank Chairman Issa for calling this hearing.
I think it has been very instructive, very helpful.
And I want to thank all of the witnesses for appearing and
being with us.
With O'Hare Airport being one of the busiest in the world
and with Chicago, where I live, being an absolute
transportation hub, where millions of people come to and
through our city each and every week, I first of all want to
commend our public health officials, under the leadership of
the Illinois Department of Public Health, and our city
officials and Homeland Security for what they have done in
terms of preparation to screen individuals as they come, to
have places they can go should anything be detected. Our
hospitals have been fully cooperative, and I commend all of
them.
I also want to commend all of our health workers who are
the frontline individuals. Because while others can stand and
cheer from the sidelines, you are in the arena. You are
actually there; you are not the spectators.
I have heard a great deal of information--and I am
delighted to live in a country that is willing to use some of
its resources to be available in such a way that it does play
and understands an international role. So I want to thank AID
and our military for being in West Africa.
I agree with those who recognize that we don't have enough
resources there to actually do all that we can and all that is
needed to be done. But I commend us for the effort, and I
commend us for what we are indeed doing.
I think I have a little more confidence and a little more
faith in the CDC and our health professionals because every
day, as I understand it, our protocols are under review, that
whatever has been established, that's for right now, but with
every incident, we are learning new approaches, new techniques,
and we are putting those into play. And so I am not sure that I
have as much gloom and doom, because we have had crises before
and we've found a way, and we will find a way to stay ahead of
this one.
Mr. Davis. Dr. Lurie, let me ask you, notwithstanding the
advances that we have made in medical science, infectious
disease continues to cause millions of deaths every year
throughout the world. And we know that the primary strategy has
been vaccination, developing vaccines. Let me ask, are there
other strategies and other approaches that are being used
relative to human behavior activity? I always remember my
mother, who didn't have any medical training, but she always
told us that an ounce of prevention was worth much more than a
pound of cure. Are we able, and are we doing things that can
help prevent and arrest the impact of these infectious
diseases?
Dr. Lurie. I very much appreciate your question,
Congressman. As a primary care doctor, I see--every time I see
a patient--how important communication is, both with my
patients and with my community. One of the challenges of
dealing with this outbreak in West Africa has been that there
are a lot of deeply held beliefs. There has not been sufficient
information about how one contracts this disease or how to
prevent oneself from getting it. And I believe that there has
been a tremendous effort at public education. And I expect that
that's going to continue in the days and weeks and months
ahead.
Here at home as well, there have been efforts to educate
the public, but many of those have centered on the populations
whose heritage is in West Africa. And in the areas of the
country where those populations exist, State and local health
departments have shown tremendous leadership in reaching out to
those populations, helping them understand how to recognize and
protect themselves here, and importantly helping them provide
information for their families in West Africa, whether it's on
the Internet, whether it's by Skype, whether it's by text,
whatever. There is certainly much more public education and
outreach to do, both in West Africa and likely here. But I
really applaud your observation because it is centrally
important to anything that we do in medicine or public health.
Mr. Davis. Thank you very much.
Thank you, Mr. Chairman. I know that my time has expired.
But I would just like to say to my colleagues who are concerned
about the czar, you know, it occurred to me that there are
those of us who know things, but then there are those who know
how to make things happen and how to get things done. And I
think the President may have had that in mind as he made the
appointment. I yield back.
Mr. Chaffetz [presiding]. I thank the gentleman.
I now recognize the gentleman from Kentucky, Mr. Massie.
Mr. Massie. Thank you, Mr. Chairman.
Mr. Lumpkin and Major General Lariviere, as you already
know, there are members of Kentucky's Air National Guard in
country. And so I hope you will understand that my first
questions will be focused on their safety and training and
well-being.
But I need to ask Dr. Lurie a question first. Are you
familiar with the treatment of the three patients in the United
States, the treatment regimen that they have received? We heard
in the press that they received ZMapp and also perhaps blood
transfusions. Is that true?
Dr. Lurie. So there have been more than three patients
treated in the United States, but I have some familiarity with
their treatment, yes.
Mr. Massie. Right. So does it include blood transfusions
and ZMapp?
Dr. Lurie. So my understanding is that some patients
certainly early on received ZMapp when it was available, and
some of the patients have received blood transfusions.
Mr. Massie. So the best minds that we have, the best
doctors that we have in this country, their consensus was that
that would be the best treatment for them.
Major General, my question to you is can you assure us that
the best treatment available in this country will be available
to our soldiers in the unfortunate circumstance that any of
them contracts Ebola?
General Lariviere. Yes, sir, absolutely. As I Stated
earlier, both--there will be a Role 2 hospital both in Monrovia
and in Senegal, where your Kentucky National Guardsmen will be
stationed that is there to exclusively take care of U.S.
military personnel.
Mr. Massie. And when they return Stateside, will they have
access to ZMapp and blood transfusions if that's what the
doctors prescribe?
General Lariviere. Whatever the doctors prescribe, they
will be--it will be available for them.
Mr. Massie. OK. Thank you very much. Mr. Torbay, you seem
to be sort of where the commonsense resides here, because you
have been on the front fighting Ebola. And I really appreciate
what you have done over there. And clearly, our futures are
linked with West Africa. We want to see it solved. We want to
see it cured over there. In some of the things that you have
mentioned today about gradiating people into no risk, low risk,
and high risk, and then treating them differently instead of a
one size fits all makes a lot of sense to me. My question to
you is, is it possible--not likely, but is it possible to
contract Ebola by sitting next to somebody who is exhibiting
symptoms on a bus?
Mr. Torbay. Thank you for your question. First of all, for
the record, I am not a doctor, so I cannot be very specific
when it comes to that. From what we learned, unless there is
contact with bodily fluid----
Mr. Massie. Would that include perspiration?
Mr. Torbay. That could include perspiration.
Mr. Massie. And do you have to contact the skin or could
you touch somewhere where that an Ebola victim has touched?
Mr. Torbay. I can't answer that. My understanding is it has
to be through broken skin, but I am not really sure about that.
Mr. Massie. So do your protocols--but would you say it's
possible even if it's not likely? Your protocols that you
described before say that somebody who has a classification of
low risk is prevented from taking public transportation. So
surely you foresee that somebody--it is maybe not likely, but
is it possible that somebody could catch Ebola on a bus?
Mr. Torbay. We haven't experienced that. You know, with
Ebola, it could be possible. There is no scientific evidence
that proves it or proves against it.
Mr. Massie. There is no scientific evidence that it can be
transmitted through saliva, vomit, perspiration?
Mr. Torbay. Saliva, vomit, perspiration, yes.
Mr. Massie. OK. Does it live on surfaces? Can it live for
more than 15 minutes on a surface?
Mr. Torbay. I can't answer that.
Mr. Massie. You can't answer that?
Mr. Torbay. I do not know the answer to that.
Mr. Massie. Maybe Dr. Lurie can. Can Ebola survive outside
of a patient on an inert surface for any period of time?
Dr. Lurie. It can survive on an inert surface for variable
periods of time depending on the----
Mr. Massie. OK. Then let me ask you is it possible--I am
not asking you is it likely--is it possible that somebody could
contract Ebola sitting on a bus next to somebody who has it?
Can you imagine a way that could happen? Is it possible?
Dr. Lurie. One would have to have been in contact with the
body fluids of the person.
Mr. Massie. Does that include perspiration?
Dr. Lurie. It does include perspiration.
Mr. Massie. OK. Major General, I want to get back to our
soldiers here. You have assured us that they have been
adequately trained in avoiding the contraction of Ebola. If a
soldier came to you and said, Major General, is it possible,
not likely, is it possible to contract Ebola sitting next to
somebody on a bus who has it, what would your answer be to
them? And I trust you are going to give us a straight answer.
General Lariviere. So I would defer to the medical
professionals, as the doctor just said. It can be transmitted
through sweat. Bodily fluids has been noted. And I would say
that, you know, that is why we have the 3 feet separation, that
is why we don't shake hands.
Mr. Massie. So if I am a soldier and I ask you that, sir,
what would your answer be?
General Lariviere. Well, I guess my answer would be it's a
hypothetical.
Mr. Massie. It could certainly happen.
General Lariviere. It could possibly happen.
Mr. Massie. I am asking you to answer a hypothetical then.
General Lariviere. You are asking to ask me to answer a
hypothetical.
Mr. Massie. OK.
General Lariviere. So it could possibly happen, but I would
defer and say, low likelihood, and you need to follow the
procedures that you were taught in your training session.
Mr. Massie. I am hoping they are getting the best training
possible. And I am concerned if they are being told they can't
catch it on a bus. Can you tell me what your answer to the
soldier would be if he said, Sir, can I contract Ebola?
General Lariviere. So, for the record, they are not getting
on buses with Liberian citizens. And your Kentucky Guardsmen
are actually in Senegal, so----
Mr. Massie. Understood. We have other members from Kentucky
serving in the military.
General Lariviere. Absolutely.
Mr. Massie. They are going to be, as I understand it, hot
zones.
General Lariviere. And Fort Campbell folks will be there
obviously. But they won't be betting on buses with Liberian
personnel either. I would tell them to go ahead and follow
their protocols.
Mr. Massie. So, just quickly, our confidence has been
shaken in the CDC because we get conflicting answers. And when
I first heard the military was going overseas to combat Ebola,
I was skeptical. But then, on second thought, I said that's
where our competency in the government resides, where the
confidence resides of the American public is with our military
and their ability to focus on a mission.
Today you have answered some questions where you deferred
to CDC guidance, for instance whether they should be
quarantined for 10 days in country or 21 days in country. What
I am asking you, for the safety of the soldiers and for the
safety of the public, is to use your own judgment. We trust the
military actually more than the CDC on this. So please use that
to guide you.
General Lariviere. Absolutely. And that's why I reiterate
that once they return, we are having not the self-monitoring,
but we are actually exceeding CDC standards because we are the
military and having those individuals monitored by their units
once they are back.
Mr. Massie. And the public, by the way, would like to see
them stay on the base for the 21 days after they are back.
General Lariviere. And I understand their concern. But
again, this is--we think that it's prudent to have them checked
twice a day on base, but be able to return to their loved ones
in the evening.
Mr. Massie. What we appreciate is your mission is and
always has been to protect this country. And we appreciate your
service.
General Lariviere. Thank you.
Chairman Issa [presiding]. I thank the gentleman.
And we now go to the gentlelady from New Mexico.
Ms. Lujan Grisham. Thank you, Mr. Chairman.
Clearly, with the arrival of Ebola in the United States we
are all in this committee really concerned about whether or not
our emergency preparedness systems are effective, and whether
our public health system is an effective response mechanism.
And I think I share with everyone on this committee that we are
concerned that we have seen protocols have to be adjusted, that
we wish we had better training, that we are concerned about
hospital responses. I would just add, particularly after the
last Statements, and I don't disagree that we want the highest
standard of response, but a multitude of responses that are not
based on scientific evidence and best practices. If they are
not--if they aren't sound, then we create even more confusion
and more panic by individuals, and we can't really manage a
public health or an emergency system's response. Those are
clear lessons that I learned as the secretary of health dealing
with--I wasn't there to deal with hantavirus in New Mexico, but
we had those experts certainly there. But I was there for SARS,
for potential pandemics, for not having enough flu vaccine. And
I am still there dealing with one of the worst hepatitis C
issues in the United States. So, unfortunately, in New Mexico
we know how important it is to have a good, solid, strong
public health and emergency response system.
To that end, I know that we have been both critical and we
have recognized that whether or not Congress invests sufficient
resources in the CDC and the NIH and all of our other partners
that have a response to emergency preparedness, we expect that
there is still in place a robust response. But I want to be
clear that has the fact that these policymakers have failed
Congress to invest appropriately and have cut funding, has that
had a negative--Dr. Lurie, has that had a negative impact on
our ability to respond not only to Ebola, but all public health
crises?
Dr. Lurie. No. I think that, you know, we have seen an
erosion in support for public health at several times in our
country's history. And each time that happens, we look back
through the retrospectoscope and wish we had done something
different.
Ms. Lujan Grisham. So I am not sure I understand your
answer. So you don't think that having reduced resources
targeted at these issues has had any negative impact?
Dr. Lurie. So we actually just had the opportunity to
survey----
Ms. Lujan Grisham. Because I will tell you that my public
health team will say it is. My hospital association says it is.
That individual hospitals around the country say it is. And the
fact that you have a decentralized public health system--so
even if you had the authority to mandate, you don't have a
system that you could do a mandate. And I don't know that I
agree, although I really respect my colleague, Mr. Connolly,
that you want a mandate here, but we have another issue in this
country, which is we do not have a centralized public health
system. Your ability to manage State by State by State by
State, and I have a poor State with a centralized system,
fairly effective, but I can tell you even there, it was hard
for us to manage all of our county emergency response partners
in a crisis.
Dr. Lurie. No, you are absolutely correct. And certainly we
are hearing a lot from States that they are very concerned
about the reductions in support for public health and for
public health preparedness. And many of them are really looking
hard at how they are going to have to cope with the latest
rounds of reductions.
Ms. Lujan Grisham. And are you prepared now to really think
about best practices and more centralized approaches, and
requiring maybe a different protocol for our public health
emergency response systems in this country? I think if we did
that even when Congress doesn't do its job to adequately fund
for these public health issues so that we only react when there
is a crisis instead of--and I appreciate someone talking about
precautionary principles, that we ought to be proactive in as
many cases as we can where the evidence is sound about being
proactive in that particular manner. But, in fact, I do expect
that the Federal Government, even with limited resources, does
everything it can to identify what those best practices are and
to regularly identify what the risks are if you don't
adequately fund, and what the impact is to States who also find
themselves without adequate resources to prepare and be trained
effectively.
Dr. Lurie. I so much appreciate your passion for public
health and for the resourcing of public health. It's so
important. The way public health is organized in this country
by law is that the Federal Government by and large can provide
guidance and tools and best practices, but the implementation
of other aspects of public health is either at a State or local
level. And as I think you know well, it's organized differently
in different States.
Ms. Lujan Grisham. That's my point. Is it may be time to
think about whether or not that in and of itself is an
effective strategy in this country.
Dr. Lurie. I think it's a very interesting idea.
Ms. Lujan Grisham. Thank you.
I yield back.
Chairman Issa. The gentlelady's time has expired. I thank
the gentlelady. I now ask unanimous consent that page 172 of
the CRS report entitled Funding of the HHS Assistant Secretary
for Preparedness and Response in millions of dollars be placed
in the record. Additionally ask--without objection.
Chairman Issa. Additionally ask that the Wall Street
Journal article in the opinion section, entitled ``There is
Plenty of Money to Fight Ebola,'' be placed in the record.
Without objection.
Chairman Issa. Last, I would ask that the Fiscal Year 2014
HHS appropriations overview by CRS be placed in the record at
this time.
Without objection, so ordered.
Chairman Issa. We now go to the gentleman from Michigan,
Mr. Bentivolio.
Mr. Bentivolio. Thank you very much, Mr. Chairman.
And thank all of you for coming today and testifying before
this committee on a very important subject. A great deal of
importance to the people in my district.
And Mr. Roth, a quick question. What is the Federal
Government's present readiness status to handle a pandemic or
other emergency where there is a surge in medical needs in a
specific region?
Mr. Roth. I can only speak to the DHS component, which is
what we studied.
Mr. Bentivolio. OK. Are you familiar with--do you have any
idea how many mobile hospitals are in the inventory to be
deployed at a reasonable amount of time, meaning 1 day to 3
days, to a region that is experiencing a surge in medical
needs? And that's for any reason whatsoever, another Katrina,
HAZMAT emergency, pandemic, earthquake, tornado.
Mr. Roth. We did not look at that in the audit that I
testified about.
Mr. Bentivolio. OK. In 14 months being in office, or since
I have been in office for the last 14 months, my office has
been investigating that need. So our first responsibility is to
protect this country. And I haven't found any in the inventory.
So there is no mobile hospitals available, no mobile isolation
units deployable that could be deployed within hours or days of
an emergency.
And Ms. Burger, I have a question. You are a nurse. How
long have you been a nurse?
Ms. Burger. Forty-three years.
Mr. Bentivolio. Forty-three years. My wife has been a nurse
for 37 years. So thank you very much for your service. Now, I
have a question. When a person has any type of infectious
disease, whether it is Ebola or the flu, I know they are
transmitted differently, but for each step that an infected
person makes, does it or does it not increase the risk of its
spreading exponentially?
In other words, give you an example. If somebody came down
with the flu, it's quite possible that, you know, well, if they
stay in their home, the only people that are probably going to
get sick or infected from that flu is those people that are in
the home. But if any member of that household leaves that
house, goes to the drug store, goes to the supermarket,
whatever the case may be, does the potential to infect others
increase?
Ms. Burger. Well, if it's the flu, if you know you are----
Mr. Bentivolio. Airborne.
Ms. Burger. And they also have good hand washing, so if you
are not in direct contact with the airborne virus going into
your eyes by yourself putting your hands into your eyes or
something, that is not likely.
But what we are talking about here today is the Ebola
preparedness in this country.
Mr. Bentivolio. I understand.
Ms. Burger. And it's completely different in this country
because there are about 5,000 hospitals in this country and
5,000 ways to manage this disease.
Mr. Bentivolio. How many of those hospitals have an
isolation unit that is capable of containing the Ebola virus?
Ms. Burger. Well, according to what the hospitals report on
a daily basis in the newspapers is that they are all ready and
they can isolate patients at a moment's notice. But what we
just got reported to us yesterday was a nurse that thought
she--from Kansas City who has a, quote, negative pressure room
which was nonoperable.
Mr. Bentivolio. OK. That is one negative pressure room. It
is very important, especially with Ebola, correct, to have that
capability?
Ms. Burger. Correct.
Mr. Bentivolio. OK. Now, what I am trying to get at is if a
patient walks in with flu-like symptoms, the first thing they
will do when they go to a hospital is they will visit an
administrative clerk that does some triage, asks some insurance
questions. Is that not correct?
Ms. Burger. Well, if they have got the flu, most of the
time, they are at home in bed.
Mr. Bentivolio. Well, OK. That's not always the case. They
could be experiencing fever and they--you know, they do come to
the emergency room.
Ms. Burger. If they are seriously ill from----
Mr. Bentivolio. If they are seriously ill with flu-like
symptoms. So is it possible--what is the protection that an
administrative clerk that meets you at the hospital, the
receptionist that asks, you know, what are your symptoms, why
are you here, what is your insurance? What is the chances of
them being infected by an Ebola virus?
Chairman Issa. The gentleman's time has expired. She can
answer. But I just--you are not talking--you are saying flu-
like symptoms, but you are assuming that the person has Ebola?
Mr. Bentivolio. Correct. Correct.
Chairman Issa. The gentlelady can certainly answer.
Ms. Burger. OK. Again, as I say, several, 5,000 hospitals
all have different protocols on how they handle Ebola. Some
security officers are now asked to step in. They are given
little Ebola kits that have a gown, some gloves, and a surgical
mask. But I think that that's what we are talking about is that
everybody, everybody needs to be trained and prepared and
educated on how to handle a potential Ebola patient so that
that clerk is also not exposed to unnecessary virus from Ebola.
Mr. Bentivolio. Thank you very much.
Chairman Issa. I thank the gentleman.
We now go to the other gentleman from Michigan, Mr. Amash.
Mr. Amash. Thank you, Mr. Chairman, and thank you to this
panel for being here today. Earlier this month several
airlines, including Kenya Airways, British Airways, Air Cote
D'Ivoire, and Nigeria's Arik Air, suspended flights to and from
certain affected countries in West Africa. Our own State
Department issued travel warnings to our citizens, urging them
to delay nonessential travel to Liberia and Sierra Leone. And
recent reports suggest that more than two dozen countries have
restricted entrance to persons who have traveled to West
Africa.
So my question is to Dr. Lurie and to Mr. Torbay. Under
what circumstances, if any, do you think a travel ban or
increased travel restrictions would be appropriate to safeguard
Americans?
Dr. Lurie. So I thank you for that question. Over the past
week, we have increased and tightened up our screening measures
for individuals traveling from the three affected countries.
You know they are all now being funneled through the five major
airports. They get screened before they leave. They get
screened when they come. Every passenger coming from an
affected country now has their information given to the State
and local health authorities. And they will be actively
monitored for 21 days. So we have really tightened that up
quite a bit, and I believe it should be sufficient.
Mr. Amash. How about a travel ban? Is there any
circumstances in which you would support a travel ban?
Dr. Lurie. We think a travel ban would be incredibly
unproductive or counterproductive.
Mr. Amash. In what ways?
Dr. Lurie. Well, first of all, right now, we have a really
good mechanism to identify and track every single person coming
now from affected countries. If you were to put a travel ban in
effect, for example, you would have people coming into this
country who we wouldn't know were here, we wouldn't even know
how to find them or monitor them. And that would become a
serious problem.
Mr. Amash. But if someone is flying commercial, for
example, and they don't exhibit symptoms, but they have been in
a region that's infected, how are you going to know that they
are infected? Or that they might have been infected?
Dr. Lurie. I think the whole point of doing the exit
screening and then the screening when they come to the United
States, and then following them for 21 days, taking their
temperature twice a day, is exactly so that we can see them
through the end of the incubation period and, if necessary, be
on top of that within hours of them exhibiting a fever.
Mr. Amash. Mr. Torbay, same question.
Would you support a travel ban under any circumstances?
Mr. Torbay. No. We don't. A travel ban, first of all, we
have to recognize there are no direct flights from those three
West African countries to the U.S. The majority of people
actually transit through Europe. So a travel ban will have to
include flights coming from Europe, which I don't think would
be feasible at this stage. But even with that, we can't,
because if we are talking about fighting Ebola at its source,
we need health professionals to be able to travel in and out of
the country. We need supplies to be able to be flown into the
country in order for us----
Mr. Amash. Do they predominantly travel through commercial
airlines?
Mr. Torbay. Absolutely.
Mr. Amash. Would it be prohibitive to require them to
travel through charter jets?
Mr. Torbay. It would be very expensive.
Mr. Amash. The question, a followup question, you had said
earlier and the doctor had said that if there is no symptoms,
there is no risk to other people. What if someone were to get
onto an airplane with no symptoms, but you have an 8-hour
flight to the United States from a European country, let's say,
and they have been in West Africa and then Europe to the United
States. Couldn't they exhibit symptoms on the flight? And isn't
that a risk?
Dr. Lurie. I very much appreciate your question and
concern. And I think that is exactly why now all of the planes
are being routed through the five airports, and why by the time
a plane lands on the ground, both Customs and Border Patrol and
the CDC quarantine office are notified about whether there are
any sick passengers on the plane. When they get off the plane,
they are asked the same questions again, and they are given
information about the symptoms of Ebola and what to do if they
have any.
Mr. Amash. Thanks.
I am going to yield my remaining time to the gentleman from
Florida, Mr. Mica.
Mr. Mica. Thank you.
First of all, what you have got in place has failed. The
doctor, the New York doctor just came through, and he got the
temperature thing and all of that. But it failed. He self-
reported. I think basically what you have is a 21-day period
from where they have been subject to the infection, and people
need to be quarantined coming out of those countries. You don't
need a travel ban. You need to go to the people who pose a
risk.
I understand it is only 80 to 150 coming out of those
countries right now entering the United States a week. Is that
right? Approximate? That's what I am told. But you quarantine
them. My grandparents, when they came into Ellis Island, were
subject to quarantine. We quarantine lots of people. I will
take you up to where we did it. Or they self-quarantine
themselves. They pose a risk. Every traveler doesn't. But
people need to be identified.
We just came through the airport today at Dulles. And,
again, we didn't come from one of those countries, but we
didn't have to. You just said transited. They can transit.
Chairman Issa. The gentleman's yielded time has expired. If
you could wrap it up.
Mr. Mica. Well, again, just some common sense that doesn't
prevail around here or anywheres. You have 21 days. Look at
this guy again. Learn by his example. He flew out, the 12th was
his last day there. You count 21 days forward. So he should
have been subject to quarantine, not exposing himself on the
subway or other places. Then your guidance finally on----
Chairman Issa. I will do a second round. I will come back.
Mr. Mica. Let me just finish because others went over.
Chairman Issa. I ask unanimous consent the gentleman have
an additional minute.
Mr. Mica. OK. Just an additional minute. Here is a picture.
I don't know if it's true. It's New York. Your workers and how
you spread this stuff. The nurses, it was either taking this
their things off or exposure to the skin. We don't know.
Do you know, Ms. Burger? No.
We don't know. OK. Here is a picture I saw. My wife told me
about this. She saw it on TV. These are New York police first
responders. Do you have a memo to first responders on how to
deal with this stuff?
Dr. Lurie. We do. We put out guidance for first responders.
We had a----
Mr. Mica. This is a press account. Just a video. I don't
know if it is true. But it shows them putting their gloves and
other stuff and tape from the area of New York into a public
trash can. So, again, what you have got to do, you have got to
make sure first responders, nurses, all the protective things
in place where we have exposure. And we have exposure.
And the testing at the airport is not working. We need a
quarantine in place period for those coming out there or you
are not going to stop this. The doctor was a very responsible,
educated individual. Thank you.
Chairman Issa. I thank the gentleman.
I ask unanimous consent the ranking member have 1 minute.
Without objection.
Mr. Cummings. Thank you. Mr. Torbay, the quarantine. Can
you talk about that? I know you are interested in what is
happening in Africa, but I know you are also interested in what
is happening here. Can you just comment on that?
Mr. Torbay. You know, as I mentioned, one of the main
pillars for actually fighting Ebola in West Africa is the
ability to take staff and bring them back home. We cannot
recruit staff from the U.S. or anywhere else in the world if
there is a chance that they might not be able to come back home
to their families and to their duties, to their other duties.
And putting people in quarantine actually goes against our
ability to recruit and to retain. And therefore, it will go
against our ability to fight the virus in West Africa.
Mr. Cummings. Thank you, Mr. Chairman.
Chairman Issa. I thank the gentleman.
We now go to the gentleman from Florida for 5 minutes.
Mr. DeSantis. Thank you, Mr. Chairman.
Dr. Lurie, as I understand it, Congress in 2006 passed the
Pandemic All Hazards Preparedness Act. We reviewed that and
reauthorized it in this Congress. And one of the key points in
that was establishing an Assistant Secretary for Preparedness
and Response, which is of course you. And this was supposed to
be the focal point for these responses. You were quoted
previously as saying that you have responsibility for getting
the Nation prepared for public health emergencies, whether
naturally occurring disasters or manmade, as well as for
helping it respond and recover. It is a pretty significant
undertaking, end quote.
And it just occurs to me I am glad to see you here, but I
have not seen you out front. I know communications is supposed
to be part of what you do. So have you been appearing at public
meetings over the last several weeks in conjunction with Ebola?
Have you been participating in any briefings for the public?
Dr. Lurie. So let me start by saying and repeating
something I said in my testimony, that back in the spring, when
we first learned about Ebola in West Africa, our whole office
activated to start taking action on behalf of the country and
on behalf of West Africa----
Mr. DeSantis. I appreciate that. But can you speak since
this has become heightened with the American people in the last
3 or 4 weeks, it seems like your profile has been a lot lower
than some of the other folks even though your office is a key
one. So how would you respond to that?
Dr. Lurie. So I think one of the things we know about
dealing with public health emergencies is the public does
better if there are one or two consistent spokespeople. Dr.
Frieden has played the major role in that because the CDC has
the lead for the public health aspects of the response. What I
can tell you is----
Mr. DeSantis. What would you say about this? I appreciate
that. Let me ask you this. The President had what were billed
in the press as emergency Ebola meetings at the White House.
One last Friday and then a week ago tomorrow on Saturday, after
I guess he played a round of golf. Did you attend either of
those meetings?
Dr. Lurie. Our Secretary attended those meetings. And I
have met with her every single day since we got involved in
this response.
Mr. DeSantis. Did you attend?
Dr. Lurie. No, I did not.
Mr. DeSantis. OK. And so has the White House or the
Secretary of HHS instructed your office to stand down as being
the point office in favor of this new Ebola czar?
Dr. Lurie. Not at all.
Mr. DeSantis. OK. So here is an issue. Thomas Eric Duncan,
he brought Ebola to the U.S. Your office is clearly what was
envisioned in this legislation. And yet he was able to bring
the disease here. So what would you--were you guys prepared in
your office for Thomas Eric Duncan, or did you drop the ball,
and could you have done some things better?
Dr. Lurie. So what happened with Mr. Duncan required a
whole system to work, right? It required the Federal components
to be in place. It required State and local health departments
to be in place. It required hospitals to be in place. And it
required individual health providers, doctors or nurses, all to
be able to do their job.
Certainly there were some breakdowns in links in the chain.
Do I think that we have done a good job preparing hospitals and
the health care system in our country for disasters? Yes, I do.
Do I think we are being very aggressive now about preparing
health professionals and health care providers and institutions
to be able to recognize, treat, and isolate cases of Ebola? I
think we are being very, very aggressive about that.
Mr. DeSantis. So how would you--explain to me then, so the
Pandemic Act seemed to have your office being kind of a point
person in HHS. Now we have this Ebola czar. So how does the
chain of command work in terms of how we are confronting Ebola
at this stage? Is the HHS assets, is everyone reporting to Ron
Klain now and then Klain is directly reporting to the
President? What is your understanding of this?
Dr. Lurie. So Mr. Klain's role and responsibility is to
coordinate all the different aspects so that we are
increasingly working in a whole of government response. It's to
make sure that all the parties are working together on a day-
to-day basis to make decisions.
Mr. DeSantis. Isn't that in your job description anyways? I
mean aren't you kind of a czar to deal with these pandemics?
Dr. Lurie. So I have responsibility for dealing with
medical and public health emergencies, particularly
domestically. And the other thing that I think is really
important to recognize is that the bulk of this response is a
global health response. It's not a domestic response. My office
has been active, along with the CDC, the NIH, the FDA, in
meeting with the Secretary since the beginning of this, as I
said, almost every day.
Mr. DeSantis. Well, I appreciate that. I know that the
chairman invited Mr. Klain here. I wish he would have come so
we can ask--some people, as Mr. Gowdy pointed out, may have
some reason to question whether this is the right individual to
actually execute the medical component of this, or whether this
is more for political reasons. I would have liked to have been
able to ask him some questions to try to probe that further.
Chairman Issa. Would the gentleman yield?
Mr. DeSantis. Yes.
Chairman Issa. For the record, we did invite him. We had
hoped he would be here.
We also invited the World Health Organization
representative. And as you know, we fund about half of their
entire budget.
And their answer to us was that basically they don't do
congressional hearings. So I am sending a letter to the
appropriators, letting them know they don't do congressional
hearings about how they are spending our money and how they are
going to fight something like this.
But it is an area of concern. As you say, you have got an
attorney who has been hired to do this as a czar, you have the
World Health Organization, and neither wanted to appear.
I yield back.
We now go to the gentleman from Georgia for 5 minutes, Mr.
Collins.
Mr. Collins. Thank you, Mr. Chairman.
I appreciate you each being here and the sense. And there
is a lot that has concerned me from this hearing. Actually, I
came into this hearing hoping--in some ways, we got some
assurance, but in also other ways very concerned about some of
the answers that were given. And I may get to that in a moment.
But I want to focus on--being from Georgia, I want to focus
on a positive note. And I want to focus on something that was
really--because back when Dr. Brantly and Ms. Writebol, which
seems like an eternity ago now, were brought to the United
States, they came to the--really, the constituents, my
constituents started feeling fear. A lot of people were
concerned this is something that we don't understand and how
you get it. And then in the weeks and days after that, the
conflicting and inaccurate public Statements that followed the
arrival from CDC, others, and as it just went ahead have caused
even more panic. In fact, today in one of my local press
outlets there is a--basically just an opinion poll that people
can click in--and said 75 percent believe that the CDC's
information from the beginning of this was just inaccurate and
not helpful. You have a level of trust that is gone with many
people. But what happened here was really time to switch gears
and say that, frankly, from my perspective Georgia got it
right. Emory got it right. Nebraska has got it right. There are
some places that have got it right. And what I want to know is
as we continue this process, as we look at the precautions, as
we look at the things that are going on, is focus on the
protocols for Ms. Burger and the nurses and the folks who come
into the very front stages of this, they do it in a way that
they follow protocol, they have the protocols in place and have
the equipment in place. And I think this is what I want to
commend Emory University in Atlanta for being able to be the
first hospital to successfully treat an Ebola patient. And
actually the fourth, Amber Vinson, is our understanding is
still recovering at Emory and has been declared Ebola free.
That is a good thing.
Emory did this because they were set up with the CDC on
those levels that we heard about your, Dr. Lurie, on the table
tops. They worked with CDC. They are one of those outlets in
case something happened, which the CDC is in Georgia as well,
most of which I am so proud of, except some of the public
Statements by the director, who has really lost confidence of
many on this Hill and many in the country by the Statements
that were made and the actions that he took. For him to be the
face is really a concern of this.
So the question I have is in looking at this, Emory has put
out a lot of great stuff. And, with unanimous consent, Mr.
Chairman, I would like to add the editorial from John Fox, who
is the president and chief executive officer of Emory Health
Care, Beating Ebola Through a National Plan.
Chairman Issa. Without objection, the entire article will
be placed in the record.
Mr. Collins. And I do appreciate that, because I think this
is a national response. You said something just a moment ago,
Dr. Lurie, that I am not going to focus on, but you said this
was not a domestic, this was a global issue. Well, aren't we
part of global? So what part would you be missing in
understanding of how that would affect us? In fact, when your
main concern was if it was something overseas, when we have
places like Emory and Nebraska doing it right, we have those
doing the protocols that were not forced upon them, they had it
ready to go, was it not--shouldn't it not have been a part of
your job?
Dr. Lurie. Maybe you misunderstood what I was trying to
convey. What I was trying convey is----
Mr. Collins. Very quickly enlighten me.
Dr. Lurie. OK. So I have domestic responsibilities for
preparedness. In fact, one of the things that I was reflecting
on when I was listening to your comments is that, prior to
taking this job, I had an opportunity to go around to every
county in Georgia with your Georgia public health officials and
do those table top exercises for biopreparedness. I spoke to
the leadership at Emory yesterday. And we are very grateful for
their incredible response and their leadership, not only in
taking care of patients at Emory but now helping us and helping
the rest of the country as we build out and develop a regional
strategy for taking care of----
Mr. Collins. I appreciate that. Because I do want to be--at
least let's accentuate the positive, health care workers that
are getting it right. But I share Ms. Burger's concern, and
there was some other discussions lately, is let's say they did
switch planes. There is not a tracking. They don't fly into one
of the five airports. They come in in different ways and then
present at an emergency room, which by the way in my area, a
lot of times poor areas, they do go to the emergency room with
flu-like symptoms all the time. All the time. It is part of the
problem we have got. And it is going to get worse. So the
people who do ask those questions, having them trained and
having them adequately prepared. And I think this is the part
that concerns me.
You made this Statement, and I just want to end here
because there is the concern out there is for the people to
understand what is done right. Emory University, Nebraska, and
those kind of things that have done what it took to follow
protocols and be prepared. That is the No. 1.
From the CDC level and the spokesman level, there has been
a disastrous failure at that. There has been now with Mr. Klain
a disastrous failure in at least perception that we are taking
this health care seriously, not just an administrative
assistant. We needed someone else that has the credentials that
you have or others.
But here is my problem. After we discussed everything on
when they actually got here, the doctor in New York, which I
was in New York, just came back last night and came this
morning, up there seeing what is going on. Here is your
response. And it is the response that the American people
cannot hear anymore. And that is after it happened, out of an
abundance of caution, we cleaned the bowling alley. Out of an
abundance of caution, we went back. The American people need to
see the abundance of caution beforehand. That is your job. That
is the job of the CDC and the job of preparedness. And they
wanted to see the abundance of caution before our health care
workers were put at risk, before our system was bun, and that
is where the abundance of caution needed to come. And from
that, from a very positive Statements from Emory University and
Nebraska and others who did it right, and I want to
congratulate them, I want to also highlight that an abundance
of caution should have started a while back, not after the
fact.
And with that, Mr. Chairman, I yield back.
Chairman Issa. I thank the gentleman.
We now go to the gentleman from Florida, Mr. Mica.
Mr. Mica. Well, a perfect lead in. Now, you sat here and
told us you are responsible for both domestic preparedness and
a global response.
Dr. Lurie. No.
Mr. Mica. What are you doing?
Dr. Lurie. No, my responsibility is a domestic
responsibility primarily.
Mr. Mica. OK. So you have nothing to do with the global
response? More from this article about WHO, who wouldn't come
here today. First of all, this is the worst Ebola outbreak in
history. Is that right? Is that not right?
Mr. Torbay. Yes.
Mr. Mica. OK. And it says the World Health Organization
said today it would probe complaints that it had been too slow
to wake up the scale of Ebola. Then it says critics have
questioned why WHO only declared an international health
emergency in August, 8 months after the epidemic began. Did the
administration or anyone in a position of authority from the
United States, where we spend millions of dollars into WHO, ask
them to proceed?
Dr. Lurie. So let me----
Mr. Mica. Did they?
Dr. Lurie. Let me put a finer point on this.
Mr. Mica. Do you know if they did? You can say you don't
know.
Dr. Lurie. So I don't know if they did what?
Mr. Mica. If we did anything. Is there a letter? Anything?
Did we go after WHO? This is a global----
Dr. Lurie. We have been----
Mr. Mica [continuing]. Disaster. We spend lots of money on
the World Health Organization. And this isn't my stuff. I am
just reading you what I am telling you that people are coming
after.
OK. This isn't a panic. It is to be prepared. Now, are you
in charge of being prepared?
Dr. Lurie. I am in charge of being prepared.
Mr. Mica. OK. Then I think you need to turn your
resignation in. Have you read this report? Have you read this
report about preparedness that the IG? Do you have some
authority over preparedness at DHS?
Dr. Lurie. I have no authority over preparedness at DHS.
Dr. Lurie. Then you don't have the authority to do the job.
Who has the authority to do the job? He has just prepared for
this committee; it is dated the 24th. He says the stuff they
bought, nobody knows even the inventory where it's gone. You
have got equipment to protect people that is out of date; it
won't protect them. They even put up hand sanitizer, they
looked at 84 percent of them are expired. Is that your job or
somebody else?
Dr. Lurie. DHS----
Mr. Mica. And if it isn't your job, isn't it the new czar's
job? Whose job is it to protect the American people?
Dr. Lurie. First, let me clarify that DHS has
responsibility to buy personal protective equipment for its----
Mr. Mica. Have you been over there to see what they have?
Have you been over there to see what they are doing and have?
Have you seen this report? Folks, staff, make sure she gets a
copy of this report. This is a scathing report. Page after
page, the inventory outdated, stuff that we bought, we spent
millions of dollars, and we aren't prepared.
Let me ask you another question. Having been here a while,
I was through the bird flu. This is transmitted even by an
individual. And if it takes inconvenience--first of all, you
should quarantine the health care workers.
You are wrong, Mr. Torbay. They are the most exposed to
this. So anyone who has been exposed, for 21 days coming into
the United States, must be quarantined. I don't care if it's
inconvenient. They should recognize their own risks, too. And
we should watch those people. You had one guy come in
yesterday. He got to his what, 18th day or something, came down
with it. OK. So I think--and it may not be that many health
care workers. But they are the most exposed, unless you are
burying the people like you just saw with the photo from him.
If you are burying people or you are in the medical, you
quarantine those people for their own risk, even if we pay for
it, to keep this thing from spreading.
Right now we are lucky. OK. We don't know what infected the
nurses. We don't know, again, if there will be other cases. But
you have to take steps in an emergency situation like this.
She claims she doesn't have the authority to see what DHS
has to keep us prepared. Somebody needs to see that we are
prepared. Again, this isn't panic.
Last question. OK. Bird flu. I was involved in bird flu.
These people are coming by planes. When some plane comes from
Africa or transit through and it has passengers from there,
what are we doing with it? The plane.
Dr. Lurie. With the plane itself?
Mr. Mica. Yes, the plane. They have been on the plane. They
might have barfed in the plane. There might be excrement. There
may be vomit. There may be a body fluid. They sat in a seat. We
don't know. We don't know if those nurses got it from taking
off equipment incorrectly or if it touched their skin.
Dr. Lurie. There are protocols for cleaning the plane.
Mr. Mica. You just testified earlier that perspiration
would do it.
Dr. Lurie. There are protocols for cleaning the plane.
Mr. Mica. I want to know the protocols they have in place.
I have seen the equipment that we have, and Centers for Disease
Control actually got some then. And we could bring up--it is a
heating device that heats the plane to 140 degrees to kill the
germs. That is what we used in the bird flu. Are we doing
anything like that to make sure those planes aren't little
Ebola transporters?
Dr. Lurie. Mr. Mica, you sound upset. And I am sorry for
that.
Mr. Mica. I am not upset. I am a happy boy.
Dr. Lurie. We will make sure that you get the protocols for
cleaning the plane.
Mr. Mica. But I am not happy with, again, you told me you
are responsible for preparedness. Now, if that is not your
responsibility, is it the new guy's--does he have the ability
to go in and make certain that we are prepared? It hasn't hit
here yet. But what you want to do is be prepared. The Boy
Scouts marching song. Be prepared. We spent millions of
dollars, and this inspector general of the United States of
America has gone in at our request and looked at what one
agency is doing to be prepared, and it is a scathing report we
are not prepared.
So you go back to the other guy who didn't show up today,
the new czar. We want to work with you. We don't want the
American people at risk. We have already been through this, as
I said, with bird flu. Are those planes being properly
sterilized? Because this can spread. OK? It hasn't spread. We
aren't at risk right now. And then the protocols. You give to
the committee and put in the record----
Chairman Issa. The gentleman's time has expired.
Mr. Mica. I want to see the first responders' direction.
Then I will put these pictures of the videos from New York
disposing of the gloves and the masks.
Chairman Issa. Without objection, they will be placed in
the record.
Mr. Mica. Thank you.
Dr. Lurie. We would be happy to get you those protocols and
the protocol for cleaning the plane. And I very much look
forward to working with you and other Members of Congress as we
move forward with this.
Mr. Mica. Thank you.
Chairman Issa. Thank you.
Mr. Mica. I have a plane to catch.
Chairman Issa. I thank you. And have a safe flight. It will
be about your 12th in 4 days.
I am not going to ask a second round of questioning. But I
do want to ask just one question, and then we will go to Mr.
Cummings for his close.
There was a Statement made just it seems like an eternity
ago, but about maybe 15 minutes ago, about following people for
21 days after they land.
Dr. Lurie, currently there is no visa restriction or law
that gives you specific authority. Do you believe you have the
authority under existing public health laws to force followup
daily temperature checks and the like? Let's just assume for a
moment we take the gentleman from Florida's analysis that a
plane comes in, a person tests--let's just say elevated
temperature for a moment--they test positive later or not, for
the other people on the plane, do you have the authority then
to compel them to go to be tested, or is it just hope for the
best that they will recognize a high temperature and report it?
Dr. Lurie. No, I believe that we have the authorities that
we need. But you know, we are constantly looking at and
updating our policies based on the situation at the time. And
so we will continue to look and be sure we have the authorities
that we need.
Chairman Issa. OK. In addition to asking for those
protocols, which you have already said you are willing to give
us, I am going to direct the committee to, in fact, ask
questions of you and other areas and, of course, our new czar
as to specific authorities you may have that would support
requiring people. There has been a lot of discussion about
restrictions on people's travel.
And I agree, quite frankly, with many of the people here
that it sounds like a great idea; it's a great sound bite, but
then when you actually try to figure out how you would stop
somebody from leaving Sierra Leone, going to Paris, spending a
day there and then booking a flight here, the practical reality
could well be that it would be circumvented.
However, the question of a planeload of people coming in--
and I came in today into Washington, DC, I came in with a
Marine major. I came in with a Marine major who has a cold and
who has many of the symptoms. And he did not go through a
check. They are not doing temperatures. If he later reports,
the whole question from a public health standpoint of, are we
prepared to locate and to mandate surveillance on people so
that after the fact, we can accurately do a containment is one
that I am directing the committee to ask a series of questions.
And Doctor, your organization obviously would be a part of
it.
Dr. Lurie. We would be happy to. Would you give me a
moment, since you talked about the guy with a cold, to do a
quick educational sound bite?
Chairman Issa. This will be your closing Statement, Doctor.
Dr. Lurie. Sure. Anybody who has a fever or flu-like
symptoms during this season ought to be asked to provide a
travel history, to look at whether they have been out of the
United States in the past 21 days, and whether they have been
in one of the affected countries.
Chairman Issa. I couldn't agree with you more. And if I get
a fever, having been in Iraq, Kuwait, Saudi Arabia, UAE, and,
well, additional places, meeting with people, many of whom have
traveled to Africa recently, I will be the first to rush to the
hospital to report.
With that, we go to the gentleman from Maryland, Mr.
Cummings.
Dr. Lurie. We will take care of you.
Mr. Cummings. Thank you very much, Mr. Chairman.
First of all, I want to thank all of our witnesses for
being here today. And I must tell you that I can understand the
emotion of the American people. When there is an issue of life
and death, and when you have people who put their lives on the
line to take care of the sick, not knowing whether they will
become sick themselves, that's serious business. When you have
our military going across the sea to try to make a difference,
as I always say, change the trajectory of somebody's destiny,
and the idea that they may come back with a disease that could
possibly kill them, that's serious business.
So, you know, as I listen to you, Mr. Lumpkin, you, Major
General, I have absolutely no doubt that you will do everything
in your power to protect our military. I have no doubt about
that. And I think that if you find that as you go through the
procedures that you have in place, if you feel those procedures
need to be changed or even tweaked so as you might be more
effective and efficient in that goal, you will do that. Is that
correct?
Mr. Lumpkin. That is correct.
Mr. Cummings. And you, Dr. Lurie, I want to thank you for
what you are doing.
And one of the things I guess that really concerned me, you
know, when I looked at all, Dr. Lurie, and I saw all those
health workers, nurses I guess it was, and then I see Ms.
Burger sitting next to you, and then I hear about people not
being not trained in the hospitals, I think it would be almost
legislative malpractice for me not to ask the question--and it
may have been asked before when I was out of the room--how do
we make sure that those folks receive the training? They are
not just running around saying--just complaining to be
complaining. They want to be the best. They don't mind--they
don't mind putting their lives in danger. But they want to know
that everything possible to make sure that they are safe, they
want to make sure those things are in place. And I am so glad
that Ms. Pham, Nurse Pham, has been found to be Ebola free now.
But how do we make sure that they know that?
And Ms. Burger talked about an Executive order, and then
the chairman was asking you about, Dr. Lurie, whether you had
all the things you need to be able do what you need to do. I
just got to ask you when you listen to Ms. Burger--and Ms.
Burger, I watched you on television. I know your passion. No, I
am serious. I feel it. It's contagious. And it is strong. And I
know you care about the people that you represent. No doubt
about it.
So how do we do that, Dr. Lurie? Help me.
Dr. Lurie. Sure. First, let me say, Ms. Burger and I, and
probably every nurse in America share the same goal, to keep
them safe, to be sure that they are trained, to be sure that if
they are front line providers that they have the education, the
knowledge, the adequate PPE, the training, and the exercises to
stay safe. So I can tell you a little bit about what we have
been doing. We have been reaching through the top--we have got
a very comprehensive now national education program going on.
We have reached through the top for all the hospital
associations, through all the hospitals, through the nursing
associations. I was on the phone with 10,000 nurses the other
night. And there were more that wanted to get on the phone. And
we have said to them all, Please, if you are a hospital,
conduct a medical and a nursing grand rounds. Do first patient
training--do first patient drills and exercises. Make sure that
your nurses are trained and your front line nurses have to
practice putting on PPE to proficiency. OK. Have policies,
plans, and protocols in place, and drill and exercise them.
We have said to the nurses and other front line health
professionals, Here is the guidance. Please be sure that the
checklists and other things are posted in your places of front
line care. Please ask your hospitals and your administrators to
be sure there are plans, practices, and policies in place, and
that you have the PPE required to do your job.
We have said to State and local health departments, We
would like you to call every hospital in your jurisdiction,
find out if they put those plans in place, find out if those
exercises are in place, find out if that PPE is in place, and
report back to us.
And we will continue to be reaching out with material, with
training, with education opportunities until we have got this
done.
Mr. Cummings. Ms. Burger, this is your moment. This is your
moment. Dr. Lurie just talked about--I hope you don't mind, Mr.
Chairman, this is important.
Chairman Issa. Not at all.
Mr. Cummings. Dr. Lurie just talked about what they are
going to do and what they are doing. Those ladies that were
behind you today, they want to know--some of them left now--but
they want to know that they are going to be protected. Now, you
heard what she just said. Can you just react? Maybe you might
want to give her some advice as to what you all--and I am not
trying to be smart, I am serious. This is a critical moment. Go
ahead.
Ms. Burger. The nurses that were here have legislative
visits. They are getting fully engaged in this hearing, and
they appreciate the opportunity to be here. But--and what I
would like to say is that until the CDC guidelines and training
and education and personal protective gear at an optimal level
are mandatory, no matter how good the guidelines are, no matter
how good the intentions are, we need to ask Congress to step up
and do what is right for the United States of America and its
citizens by making sure the frontline caregivers have mandatory
optimal standards for protective gear and training and
education.
Mr. Cummings. So there is a gap, Dr. Lurie. Am I right?
Based upon what she just said--in other words, you may be
saying all these things, but then it's a whole other thing for
the hospitals to provide the things that you tell them they
need to go and get. Am I right?
Dr. Lurie. I think Ms. Burger and I share the same goal,
and I share the same goal, as I said, with most nurses and
nursing organizations around the country, and look forward to
working with them and moving forward so that we can be sure
that nurses across this country, who put themselves on the line
of fire every single day with other front line health care
providers, are safe.
Mr. Cummings. As I close, I just want to thank you, Mr.
Torbay, for your testimony.
And I want to say to all of us, it goes back to we have to
address the issue here in America. No doubt about it. But we
also have to go back to the source. We have got to do that.
And I think, Mr. Torbay, your testimony about some basic
things that are needed, such as food, vehicles, fuel, staff,
supplies, resources, things that can be--that will allow us to
try to stop this in Africa so that it does not continue to come
to our shores is so very, very important. And I just hope that
the Congress is listening to you. And I realize that there
are--we need more international partners--I think that's what
you just told us--people coming in and helping this. Because
this does not just affect Africa or the United States, it
affects the world. And so I don't know how we convince folks
to--that is other countries to do more to get up to that $988
million figure, but we have got to figure out a way to do that.
Would you agree? Then I will close. I will close.
Mr. Torbay. Absolutely. I fully agree with you.
I think the whole world needs to realize that we are all in
this fight together and the resources need to be available
until we get this virus under control.
And, at the same time, I would like to thank the committee
for its leadership on this issue as well as the U.S. Government
and its agencies for taking the lead and responding to the
Ebola crisis. They have been doing a tremendous job, and we are
very proud to be part of it.
Mr. Cummings. Thank you, Mr. Chairman.
Chairman Issa. Thank you. I want to thank all of our
witnesses here today.
In closing, I am going to make a comparison. And I think it
is an important comparison for the American people to put it in
perspective.
As was alluded to earlier, I just came back from what has
become a theater of operation in Iraq where ISIS now, like an
ugly, resilient virus or infection, has shown up again and
Islamic terrorism is murdering people far away.
While I was there, there was a murder in Canada. And around
the globe, small, but significant, events occur in which we
realize that terrorism does not stay in the country that we
think it begins in or is predominantly in.
In the war on terror, we rely on the Department of Defense
and our U.S. military as our primary way to eliminate that--
those actors in faraway places, like Iraq, Afghanistan, and
Syria.
We also rely on the Department of Homeland Security to deal
with a comparatively small risk, small event, here in the
United States, whether it is 9/11, which was horrific, or--and
led to its founding, or the occasional lone actor or small
group that try to conduct terrorism here in the United States.
It is that teaming of the large effort at the source and,
in fact, an equally important effort at home for the relatively
isolated cases that come through that seem to be so close to
the problem we are facing with Ebola.
Ebola is, in fact, a disease that has periodically reared
its ugly head for more than three decades. It will, in fact,
until there is a cure, rear its head again. Like many diseases
in which a virus, eventually we find a cure. That cure is only
good if everyone takes it.
The idea that we are going to find a shot in a country--in
a continent of a billion people living mostly in poverty means
that, even when we find it, it may, in fact, be there for
generations, and like smallpox, tuberculosis, and others, they
never seem to be completely gone.
Our effort and the effort that all of you articulated very
well today has to be, first of all, in Africa, at the source.
There World Health Organizations, USAID and, once again, the
United States military have and are taking up the fight against
this dreaded disease.
Mr. Roth, your testimony and the testimony that I believe
we will have following this that the Department of Homeland
Security has an obligation, a unique obligation, one in which
they were formed to deal with things which threaten the home
front, Ebola and particularly the movement of people who may be
infected fall squarely within their jurisdiction, and they seem
to have not been prepared.
So, as we conclude here today, it is my view that we will
be doing both public and nonpublic investigation in the weeks
and months to follow, looking for transparency--and, Dr. Lurie,
you said this very well--transparency to the American people.
What we tell nurses and doctors and healthcare professionals we
need to tell the public.
Because unlike some things where the first responder is, in
fact, the greatest threat, the first responder with Ebola is
not the first to come in contact with the infected individual.
Almost in every case there will be a cab driver, a bus
driver, family, friends, and others who will already have had
an unprotected contact by the time a first responder is aware
that there may be a problem. By the time that person suits up,
he or she already will, in fact, be exposed.
So as we begin looking at the protocols, I think we have to
understand one thing: There is no perfect solution. There is no
way that every American is going to place themselves in a
HazMat suit from morning until night.
To deal with this disease, we will have to go to its
source. We will have to work together with our partners around
the world to eradicate it in Africa, because, ultimately, like
terrorism has been to the American people for more than a
decade, this disease will not, in fact, be eradicated if we
wait until it comes to our shore.
So I thank you. I believe this was a worthwhile hearing.
I thank Mr. Cummings and the tremendous turnout of members
who came back on the eve of their elections for this important
hearing.
And, with that, we stand adjourned.
[Whereupon, at 1:34 p.m., the committee was adjourned.]
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