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LEGAL VIEW WITH ASHLEIGH BANFIELD

CDC Director Testifies Before Congress

Aired October 16, 2014 - 12:00   ET

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


ANNOUNCER: This is CNN breaking news.

ASHLEIGH BANFIELD, CNN ANCHOR: Hi, everyone. I'm Ashleigh Banfield. Thanks for being with us. This is LEGAL VIEW

So many of you are wondering how person after person could have made so many mistakes about Ebola. Stay tuned because any second now, the people who were supposed to make sure that nobody caught Ebola in America, that Ebola would never become an American crisis, well, they're going to try to explain themselves under oath, no less, to a panel of pretty unhappy lawmakers on Capitol Hill. Seats are empty now, but they're filling up fast. This hearing of the House Energy And Commerce Committee on oversight might make you angry, but it also might scare you some way, because either way, you're going to see it live, just as soon as that gavel comes down and they call that thing to order.

In the meantime, breaking news out of, yet again, Dallas. The nurse named Nina Pham, infected while treating the latest Ebola victim who died, Thomas Duncan, well she now is being transferred to the National Institutes of Health in Maryland. That's one of four medical centers certified for biocontainment, another is Emory Hospital in Atlanta. And yes, that's familiar, because it's where the nation's newest Ebola patient, the Dallas nurse named Amber Vinson, was flown just last night. These remarkable pictures coming to you live overnight.

This summer, two Ebola patients were treated at Emory successfully and were released. Another was admitted last month and is expected to go home soon. So that's the story within the last 24 hours and in other headlines, three Texas schools are now shuttered, closed today, along with two in Ohio, because students flew or may have flown on the same airplane that Amber Vinson flew on Monday evening. At the time, Vinson had a very slight fever and had just -- had just had extensive contact with Thomas Eric Duncan, yet she was told it was okay. Effectively, she wasn't told that she couldn't get on an airplane. Apparently, that came from a call to the CDC. So that policy, that's probably likely to change.

Overseas this hour, a contact of the Ebola stricken nurse's aide in Spain, well now that person's turned up in the same Madrid hospital, running a fever. No diagnosis yet, but listen up, that person was considered low risk. I repeat, that person was considered low risk. And is now in the hospital with a fever. I could go on. I want to hear from our medical correspondents, Elizabeth Cohen in Dallas and Sanjay Gupta in Atlanta. First to you, Elizabeth Cohen, can you give me the latest on Nina Pham and now this transfer to the NIH.? ELIZABETH COHEN, CNN SR. MEDICAL CORRESPONDENT: Yes, we're told that

Nina Pham is in good condition and she's being transferred to the NIH. I was told by an official that this was a mutual decision between her and the hospital. You know, it's not clear exactly why they want to do this. We do know that, you know, this has been a strain on this hospital. This is a hospital with a great reputation here, but now, you know, people are nervous because this is known as the hospital that has the patients with Ebola and also 76 of their staff members are sitting at home because they helped take care of Thomas Eric Duncan. So certainly, you know, that's a lot of staff not to have with you. Certainly, having her in a different hospital would certainly take some of that strain away. Ashleigh?

BANFIELD: And, you know, there's so much talk, Elizabeth, about the people who were around Thomas Eric Duncan, some of the health workers who might be considered no risk or low risk and Sanjay, maybe you can weigh in here, because after all of this, misstep after misstep, I am thoroughly confused about what no risk or low risk actually means. I'm just reading now that this person who's headed to the hospital with a fever was a low risk contact of that Spanish nurse's aide. What are we to make of this?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, these are a little bit of arbitrary terms. There's not exact, precise definitions. People who are going to be at the higher risk are people who are going to have had direct contact, usually health care providers having direct contact with the person who is sick with Ebola and may not have had all the protective gear.

For some reason there was some sort of breach in the protective gear. Lower risk people are going to be people who may have been close to the person with Ebola, but did not have as direct contact and no risk, may be people who may have been in an area, in a same sort of location, but really were never within a certain number of feet of the patient. Again, these are not exact definitions, but that's sort of the general idea. It does, usually, it means that the -- whoever they are, they're going to be monitored. They're going to have their temperature taken, usually for 21 days.

They are not a threat to the public health unless they are sick themselves. So that's why they're not quarantined. The only reason they're quarantined if there's some concern that they may not self- monitor, they may leave and be lost to follow up. So, that's just an overview of how it works, Ashleigh.

BANFIELD: So Sanjay, I'm just going to break in for a moment. I usually don't want to cut away for Capitol Hill for a subcommittee meeting, but this is a big one. Look how packed it is in this hearing room. This is where the questions should be answered today about what's gone wrong, how do we learn from it, how do we do better and looking to the future, how can we prevent some of these horrible mistakes? Right now, you're looking at a pretty powerful panel. Members of the CDC, the NIH, the USDA, the Health and Human Services Committee, the Department of Homeland Security, and also a representative from the hospital in Dallas. The questions will be tough and probably very rigorous and probably quite heated, as well, considering the level of frustration that's in this country right now about Ebola. Right now, the person that you're going to hear from is Congressman Tim Murphy, Republican from Pennsylvania. He is the subcommittee chairman, so let's listen in to his opening remarks.

REP. TIM MURPHY, (R), PENNSYLVANIA: Good afternoon. I convened this hearing of the Subcommittee of Oversight Investigation, Committee on Energy and Commerce. We will need to make sure that the media -- when the witness is speaking, we are clear of the center section.

Today, the world is fighting the worst Ebola epidemic in history. CDC and our public health system are in the middle of a fire. Job one is to put it out completely, and we will not stop until we do.

We must be clear-eyed and singular in purpose to protect public health, and to ensure not one additional case is contracted here in the United States. We in Congress stand ready to serve as a strong and solid partner in solving this crisis, because there is no greater responsibility for the U.S. government than to protect and defend the safety of the American people.

The stakes of this battle couldn't be any higher. The number of Ebola cases in Western Africa is doubling about every three weeks. The math still favors the virus, even with the recent surge in global response.

With no vaccine or cure, we are facing down a disease for which there is no room for error. We cannot afford to look back at this point in history and say we should have done more.

Errors in judgment have been made, to be sure, and it is our immediate responsibility today to learn from those errors, correct them rapidly, and move forward effectively as one team, one fight. Let us candidly review where we stand.

When the latest Ebola outbreak in West Africa was confirmed months ago, authorities thought it would be similar to the 1976 outbreaks, and quickly contained. That turned out to be wrong.

By underestimating both the severity of the danger and overstating the ability of our health care system to handle Ebola cases, mistakes have been made. What was adequate practice for the past has proven to fall short for the present.

The trust and credibility of the administration and government are waning as the American public loses confidence each day with demonstrated failures of the current strategy. But that trust must be restored, but will only be restored with honest and thorough action.

We have been told, quote, "Virtually any hospital in the country that can do isolation can do isolation for Ebola," unquote. The events in Dallas have proven otherwise.

Current policies and protocols for surveillance, containment and response were not sufficient. False assumptions create real mistakes, sometimes deadly mistakes. We must understand what went wrong so we can get a firm handle on

this crisis. Why was the CDC slow to deploy a rapid response team at Texas Health Presbyterian Hospital? Why weren't protocols to protect health care and hospital workers rapidly communicated what training of health care workers receive?

And there were things about Ebola we don't know. How long does the virus live on surfaces or on certain substances? How do health care workers wearing full protective gear still get infected? Can it be transmitted from a person who does not yet have a high fever?

Both CDC and NIH tell us that Ebola patients are only contagious when having a fever. However, the largest study of the current Ebola outbreak found that nearly 13 percent of confirmed cases in West Africa did not have associated fever.

Now, I respect the CDC as the gold standard for public health. But the need for strong congressional oversight and partnership remains paramount. I want to understand why CDC and the White House changed course in 2010 on proposals first introduced in 2005 that would have strengthened the federal quarantine authority. We're here to work through these and fix these problems.

I restate my ongoing concern that administrative officials still refuse to consider any travel restrictions for the more than 1,000 travelers entering the United States each week from Ebola hot zones. A month ago the president told us someone with Ebola reaching our shores was unlikely, and that we've taken the necessary precautions, to increased screening at airports, so that someone with the virus does not get on a plane for the United States.

Screening and self-reporting in airports have been a demonstrated failure. Yet, the administration continues to advance a contradictory position for this failed policy that, frankly, doesn't make sense to me, especially if priority one is to contain the spread of Ebola and protect public health.

It troubles me even more when public health policies are based upon a state of concern over cutting commercial ties with fledgling democracies, rather than protecting public health in the United States. This should not be presented as an all-or-none choice.

We can, and will, create the means to transport whatever supplies and goods are needed in Africa to win this deadly battle. We do not have to leave the door open to all travel to and from hot zones in Western Africa, while Ebola is an unwelcome and dangerous stowaway on these flights. I am confident we can develop a reason (ph) and successful strategy to meet these needs.

The current airline passenger screening at five U.S. airports through temperature-taking and self-reporting is troubling. Both CDC and NIH tell us that the Ebola patients are only contagious when having a fever, but we know this may not be totally accurate.

A determined infected traveler can evade the screening by masking the fever with ibuprofen, or avoiding the five airports. Further, it is nearly impossible to perform contact-tracing of all people on multiple international flights across the globe. So let me be clear to all the federal agencies responding to the

outbreak: If resources or authorization is needed to stop Ebola in its tracks, tell us in Congress. I pledge -- and I believe this committee joins me in pledging -- that we will do everything in our power to work with you to keep the American people safe from Ebola outbreak in West Africa.

I now recognize the ranking member of the committee, Ms. Degette, five minutes.

REP. DIANA DEGETTE, (D) COLORADO: Thank you, Mr. Chairman. On Monday, the director general of the World Health Organization called the Ebola outbreak, quote, "the most severe acute health emergency seen in modern times."

She warned that the epidemic, quote, "threatens the very survival of societies and governments in West Africa."

This WHO assessment is no exaggeration. CDC predicts that up to 1.4 million West Africans could be affected with Ebola. Many more will die from treatable illnesses due to the collapse of these countries' public health infrastructure.

This is a humanitarian crisis, and we have a moral imperative to help in West Africa. But ending the West Africa outbreak is also a U.S. national security imperative, because doing so is the best way to keep Ebola out of the United States.

I was alarmed, like all of us were, when Thomas Duncan flew to the U.S. while harboring Ebola, and even more disturbed to learn of his discharge from the Texas Presbyterian E.R. with a fever, after reporting that he had traveled from Liberia. Even worse, we learned this week two nurses treating Mr. Duncan, Nina Pham and Amber Vinson have contracted Ebola. I know, Mr. Chairman, we all join in sending these women and their families our prayers.

These new cases raise serious questions. The Washington Post wrote yesterday that Texas Presbyterian, quote, "had to learn on the fly how to control the deadly virus," and that the hospital was, quote, "not fully prepared for Ebola."

We need to find out why this hospital was unprepared, and if others are, too. And we need to make sure that the CDC is filling these readiness gaps. We should be concerned about the appearance of Ebola in the U.S. and the transmission to two health care workers.

But we should not panic. We know how to stop Ebola outbreaks by isolating patients and tracing and monitoring contacts. The U.S. health care system can prevent isolated cases from -- from becoming broader outbreaks.

And that's why I'm glad Dr. Frieden is here with us and Dr. Varga will be with us by video. Because I -- because it would be an understatement to say that the response to the first U.S.-based patient with Ebola has been mismanaged, causing risk to scores of additional people.

I know both of these gentleman will be transparent and forthright in helping me to understand how we can understand our response when yet another person, and it will inevitably happen, shows up at the emergency room with these kind of symptoms.

I appreciate the steps taken by CDC and Customs to begin airport screenings. These steps are appropriate. And as some call for cutting off all travel, as the chairman said, this won't be reasonable to be able to stop anybody with Ebola from coming into the United States. And we don't want to take steps that would endanger Americans by interfering with efforts to halt the outbreak in Africa.

You know, there's no such thing as Fortress America when it comes to infectious diseases. And the best way to stop Ebola is going to be to stop this virus in Africa. Experts from Doctors Without Borders have told us that a quarantine on travel would have the, quote, "catastrophic impact on West Africa."

Also, earlier this week, the director of NIH, Dr. Francis Collins said had we adequately funded his agency for over a decade, we would already have an Ebola vaccine. His words are a reminder that key public health agencies have faced stringent, stagnant funding for several years, hampering our ability to respond to this crisis.

Mr. Chairman, six weeks ago, when I first sent you a letter to ask for this hearing, the scope of the problem in West Africa was beginning to come into focus. Now, the situation is dire. Let's work together to make sure that we stop it as quickly as we can.

With that, I yield the balance of my time to the gentleman from Iowa, Mr. Braley.

REP. BRUCE BRALEY, (D),IOWA: Thank you.

Our duty today is to make sure the administration is doing everything possible to prevent the spread of Ebola within the United States. Our number one priority in combating this disease must be the protection of Americans, and we have to figure out the best way to do that.

My heart goes out to all those suffering from this horrible epidemic. I'm very proud by the hard work done by American troops, doctors, nurses, and other volunteers to combat this disease.

Congress must come together, put aside partisan differences, and help stop this outbreak. Today I hope to hear what steps the administration is taking to prevent the spread of Ebola and respond to the outbreak. I'm greatly concerned, as Congresswoman Degette has expressed, that the administration did not act fast enough in responding in Texas. We need to look at all the options available to keep our families safe and move quickly and responsibly to make any necessary changes at airports...

MURPHY: The gentleman's time is expired.

BRALEY: ... and hospitals.

MURPHY: OK. We're gonna -- we have a lot to do here, so we'll just keep going.

(CROSSTALK)

(UNKNOWN): OK. Thank you.

MURPHY: Thank you. I now recognize the chairman of the full committee, Mr. Upton, for five minutes.

REP. FRED UPTON, (R), MICHIGAN: Well, thank you.

Let -- let me first begin by thanking our witnesses and all the members, Republicans and Democrats, for being here today.

You know, it's unusual to convene a hearing in D.C. during a district court parade (ph), but on this issue, there is no time to wait. I was likewise glad to see the president get off the campaign trail yesterday to finally focus on the crisis.

People are scared. We need all hands on deck. We need a strategy, and we need to protect the American people, first and foremost. It is not a drill. People's lives are at stake, and the response so far has been unacceptable. As chairman of this committee, I want to assure the witnesses

that we stand ready to support you in any way to keep Americans safe. But we're going to hold your feet to the fire on getting the job done and getting it done right.

Both the U.S. and the global health community have so far failed to put in place an effective strategy fast enough to combat the current current outbreak.

The CDC admitted more could have been done in Texas. Two health care workers have become infected with Ebola, even as nurses and other medical personnel suggest that protocols are being developed on the fly.

And none of us can understand how a nurse who treated an Ebola- infected patient and who had, herself, developed a fever was permitted to board a commercial airline and fly across the country. It's no wonder that the public's confidence is shaken.

Over a month ago, before Ebola reached our shores, we wrote HHS Secretary Burwell seeking details for the preparedness and response plan here at home and abroad. And it's clear whatever plan was in place was inefficient, but I believe that we can and must do better now.

We need a plan to treat those are are sick, to train health care workers to safely provide care and to stop the spread of the spread of this disease here at home and at its source in Africa. This includes travel restrictions or bans from that region beginning today. Surely we can find other ways to get the aide workers and supplies into these countries, and from the terrorist watch lists to quarantines. There are tools used to manage air travel to assure public safety. Why not here? We can no longer be reacting to each day's crisis. We need to be aggressive and finally get ahead of this terrible outbreak.

The American people also want to know about our troops and medical personnel who are courageously headed to Africa to treat the sick. How are they gonna be protected? We want to know that health care workers here in America have the training and resources necessary to safely combat the threat as well.

So it's not just the responsibility of the U.S. The global health community bears the charge to finally get ahead of the threat, develop a clear strategy, train all of those involved in combating this disease and eradicate the threat.

We have all heard the grave warnings that this is gonna get worse before it gets better. People are scared. It is our responsibility to ensure that the government is doing whatever it can to keep the public safe.

Diana Degette and I have partnered together on the 21st century cures initiative, to help improve the research and speed, the approval of life-saving medicines and treatments. And while much attention has been paid on how this effect can help with diseases like cancer and diabetes, these same reforms have to be -- help us in the development of treatments for deadly infections like Ebola. We are partners in this effort to save lives.

I yield the balance of my time to Dr. Burgess.

REP. MICHAEL C. BURGESS, (R), TEXAS: Thank you, Mr. Chairman. My thanks to the panel for being here today, and I think everyone here agrees we must fix this.

America's response to the Ebola virus disease outbreak is not a political issue; it's a public health crisis, and a very dire at that. The frightening truth is that we cannot guarantee the safety of our health care workers on the front lines.

It has been known for some time that health care workers have an out-sized risk in western Africa. Fifty-six percent of the -- they have a 56 percent mortality rate of those health care workers who catch this disease.

Two nurses have contracted Ebola in the United States, and indeed, we have to learn from the current situation in Texas and use any information we can gather to better help prepare hospitals and protect health care workers on the front line.

We are here today because we need answers to these questions. This will past August, the inspector general of the department of Homeland Security issued a report on personal protective equipment and antiviral-counter measures. They found that -- I'm quoting here -- "The Department of Homeland Security did not adequately conduct a needs assessment prior to purchasing pandemic preparedness supplies, and then did not effectively manage its stockpile of personal protective equipment and antiviral medical countermeasures." This just illustrates how unprepared that we are.

We have to get this right. I would like to yield the balance of my time to Ms. Blackburn from Tennessee.

REP. MARSHA BLACKBURN, (R), TENNESSEE: Thank you, Dr. Burgess. And, yes, indeed, welcome to all of our witnesses.

Everyone has mentioned we are here to work with you to protect Americans, and that includes the care givers. And -- and by that, I mean the men and women working on the front lines, the screaming eagles of the 101st from Fort Campbell. I will yield back my time...

MURPHY: Thank you.

BLACKBURN: ... and have further questions later (ph). Thank you.

MURPHY: The gentlelady yields back. The time expired.

I would now like to introduce the witnesses -- I'm sorry. No, first, I go to Mr. Waxman. I apologize.

REP. HENRY A. WAXMAN, (D), CALIFORNIA: Thank you, Mr. Chairman.

I'm pleased to have this opportunity to make an opening statement before we hear from the witnesses. I think we have to put all of this in perspective and not panic.

Everybody said not panic, and then they made statements like, we're going to get tough. We're gonna do something about it.

Well, what are we going to do? First of all, we've got a a problem in Africa. And this is a serious outbreak that could spiral beyond our control. On Tuesday, the World Health Organization estimated that soon there could be up to 10,000 new Ebola cases each week in West Africa. And CDC has warned that the outbreak could infect as many as 1.4 million people by the end of January.

So this is a humanitarian crisis in Africa, and we have a responsibility to help. Because if we don't help there, that outbreak is going to continue to spiral out to other places. And sealing people off in Africa is not going to keep them from traveling. They'll travel to Brussels, as one of the people did, and then it's the United States.

We can stop the epidemic from spreading in Africa or the United States if we isolate the patient and contact the -- and monitor the contacts of that patients. And if we do that, we can stop it there and we can stop it here.

So, in Africa, we need to know, are we moving fast enough? Do responders have adequate resources? Are we effectively coordinating our response with other countries and international organizations? But here, people are scared, and we shouldn't make them even more frightened.

Put this in perspective. We've had three recent cases of Ebola in this country. Thomas Duncan, who entered the U.S. while harboring Ebola, and who flew through Brussels to get here. Nina Pham and Amber Vincent, the nurses who became ill while caring for Mr. Duncan. We should be concerned about these cases, and we need to act urgently, but we need not panic. What we have to do is learn what we need to do, what mistakes we have made, and not repeat. We want to find out what happened in Texas Health Presbyterian Hospital, how CDC, state and local health officials can improve procedures moving forward.

We should also use this as a wakeup call to assure the adequacy of our own public health and preparedness safety net. We need to be prepared before a crisis hits, not scrambling to respond after the crisis.

In the past decade, the ability to fund research and public health programs has declined here in the United States. Since 2006, CDC's budget, adjusted for inflation, has dropped by 12 percent. Funding for the Public Health Emergency Preparedness Cooperative Agreement, which supports state and local health departments preparedness activities, has been cut from $1 billion in its first year of funding in 2002 to $612 million in 2014. All of these were also subject to the sequestration. And those who allowed that sequestration to happen by closing the government have to answer to the American people, as well.

We need to commit adequate funding to public health infrastructure. We need to hold public health systems accountable to standards of preparedness. Based on what we know, it appears that Texas Presbyterian would have not met those standards. Though, in fairness, I suspect that many, many hospitals all over the country would also have struggled to respond. This is a problem we have to solve.

Mr. Chairman, before I run out of time, I want to acknowledge the health care workers and volunteers, those treating Ebola victims in the U.S., and those who have traveled to West Africa to help during this outbreak. It's a dangerous work that they're doing. They're putting themselves in danger to save lives. They deserve our thanks and our praise.

I also want to thank all of our witnesses. You have my confidence. And I appreciate your joining us today to provide answers about how to stop the current Ebola outbreak in Africa, and to -- how to improve our public health systems to avoid the next crisis.

I'm ending my career at the end of this year, but I've been through so many hearings where, when there's a crisis, we have Congress would sit and point fingers. Well, let's point fingers at all of those responsible. We have our share of responsibility by not funding the infrastructure.

In Africa, they have no infrastructure. We have to help them develop it to deal with this crisis, but we shouldn't leave ourselves vulnerable by these irrational budget cuts.

MURPHY: The gentleman's time's expired. Thank you.

I would not like to introduce the witnesses on the panel for today's hearing.

Dr. Thomas R. Frieden is the director of the Centers for Disease Control and Prevention.

Dr. Anthony Fauci is the director of the National Institute of Allergy and Infectious Diseases within the National Institute of Health.

Dr. Robin Robinson is the director of Biomedical Advanced Research and Development Authority within the Office of the Assistant Secretary for Preparedness and Response at the United States Department of Health and Human Services.

Dr. Luciana Borio is the assistant commissioner for Counterterrorism Policy at the U.S. Food and Drug Administration.

Mr. John P. Wagner is the acting assistant commissioner of the Office of Field Operations within U.S. Customs and Border Protection at the U.S. Department of Homeland Security.

And joining us today on video conference from Texas will be Dr. Daniel Varga, who's the chief clinical officer and senior vice president at the Texas Health Resources. He'll be joining us in a moment.

I'll now join in the -- I'll now swear in the witnesses. You are all aware that the committee is holding an investigative hearing, and when doing so has had the practice of taking testimony under oath. Do any of you have any objections to taking testimony under oath?

WITNESSES: No.

MURPHY: The witnesses say so.

And, Dr. Varga?

DANIEL VARGA, CHIEF CLINICAL OFFICER AND SENIOR VICE PRESIDENT, TEXAS HEALTH RESOURCES: No.

MURPHY: Thank you.

The chair then advises you that under the rules of the House and the rules of the committee, you are entitled to be advised by counsel. Do any of you wish to be advised by counsel during your testimony today?

WITNESSES: No.

MURPHY: Dr. Varga?

VARGA: No.

MURPHY: Thank you. Everyone answers no.

In that case, would you all please rise and raise your right hand, and I will swear you in.

Do you swear the testimony you are about to give is the truth, the whole truth, and nothing but the truth?

WITNESSES: I do.

VARGA: I do.

MURPHY: Thank you, Doctor.

You are now under oath and subject to the penalties set forth in Section 18 -- in Title 18, Section 1001 of the United States Code.

We'll call upon you each to give a five-minute opening summary of your written statement.

Dr. Frieden, you are recognized for five minutes.

TOM FRIEDEN, DIRECTOR,CENTERS FOR DISEASE CONTROL AND PREVENTION: Thank you very much, Chairman Murphy, Ranking Member

Degette, Chairman Upton and Ranking Member Waxman. I very much appreciate the opportunity to come before you to discuss the Ebola epidemic and our response to it to protect Americans.

My name is Dr. Tom Frieden. I'm trained as a physician. I'm trained in internal medicine and infectious diseases. I completed the CDC Epidemic Intelligence Service training, and I've worked in the control of diseases -- communicable diseases and others since 1990.

Ebola spreads only by direct contact with a patient who is sick with the disease or has died from it, or with their body fluids. Ebola is not new, although it's new to the U.S.

We know how to control Ebola. Even in this period, even in Lagos, Nigeria, we have been able to contain the outbreak. We do that by tried and true measures of finding the patients promptly, isolating them effectively, identifying their contacts, ensuring that if any contact becomes ill, they are rapidly identified, isolated, and their contacts are identified.

But there are no shortcuts in the control of Ebola. And it is not easy to control it. To protect the United States, we have to stop it at the source.

There is a lot of fear of Ebola, and I will tell you, as the director of CDC, one of the things I fear about Ebola, is that it could spread more widely in Africa. If this were to happen, it could become a threat to our health system and the health care we give for a long time to come.

Our top priority, our focus is to work 24-seven to protect Americans. That's our mission. We protect Americans from threats. And in the case of Ebola, we do that by a system at multiple levels. In addition to our efforts to control the disease at the source,

we have helped each of the affected countries establish exit screening so that every person leaving has their temperature taken. In the two- month period of August and September, we identified 74 people with fever. None of them entered the airport or boarded the plane. As far as we know, none of them were diagnosed with Ebola.

But, that was one level of safety. Recently we've added another level of screening people on arrival to the U.S. That identifies anyone with fever here. And we've worked very closely with the Department of Homeland Security and the Customs and Border Protection to implement that program. And I would be happy to provide further details of it later.

We've also increased awareness among physicians throughout the U.S. to think Ebola in anyone who has fever and/or other symptoms of infection and who's been to West Africa in the previous 21 days.

We've established laboratory services throughout the country, so that not all laboratory tests have to come to the specialized laboratory at

CDC. In fact, one of those laboratories, in Austin, Texas, identified the

first case here.