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Live Congressional Hearing on Ebola

Aired October 16, 2014 - 13:30   ET

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


REP. MARSHA BLACKBURN, R-TENNESSEE: Now, Dr. Frieden, relying on self- reporting, and making certain that people tell us the truth before they leave, and then we catch the fever at the right time if they have a temperature, we've got to do better than this. We can do better than this. We are here to work with you. And we expect a better outcome.

I yield back.

REP. TIM MURPHY, R-PA: The gentlelady's time has expired. Now recognize Mr. Braley for five minutes.

REP. BRUCE BRALEY, D-IOWA: I'd like to thank the panel for joining us today.

Dr. Frieden, I was happy to hear you say we will consider any options to protect Americans. I think that's the purpose of everyone here in this room today. But I do want to ask you about Texas. Are you familiar with the concept of "sentinel event reporting"?

DR. THOMAS FRIEDEN, CDC DIRECTOR: Yes.

BRALEY: Has CDC done a root cause analysis of what happened at Texas Presbyterian, and come up with an action plan on what we learned from that incident?

We have the detailed hospital checklist for Ebola preparedness, which we have heard about here today. Have there been any recommendations on changing, modifying, or updated this in light of what happened at Texas Presbyterian?

FRIEDEN: We have a team of 20 of some of the world's top disease detectives in Texas now. We were there. We left the first day the patient was diagnosed. We identified three areas of particular focus.

The first is the prompt diagnoses of anyone who has fever or other symptoms of infection and travel history to West Africa. And Dr. Varga spoke about that issue.

The second is contact tracing. And the graphic that I provided earlier outlines what we are doing there very intensively, the state of Texas and the county are doing a terrific job, along with our staff, making sure that every single contact of the first patient, Mr. Duncan, is monitored.

The temperature taken by an outreach worker every day for 21 days, they're most of the way through that risk period. So, of the 48, none have developed symptoms, none have developed fever.

We are now looking at the contacts -- the health care workers who may have had contact, as the two individuals who became infected did, and our thoughts are with them. And we are delighted that NIH is supporting the hospital in Texas and also that Emory University is doing that as well.

And the third area is -- after identification and contact tracing, is effective isolation. And we are looking closely at what might possibly have happened to result in those two exposures.

BRALEY: And I assume if there are any new recommendations based upon that analysis, this protocol that was sent out will be updated and redistributed?

FRIEDEN: We always look at the data to see what we can do to better protect Americans.

BRALEY: Thank you.

Dr. Fauci, you are kind enough to share with us this graphic. And in it you mentioned a company in Ames, Iowa, called NewLink which working on one of the vaccines that just went into Phase I clinical trials this week, correct?

DR. ANTHONY FAUCI, DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES: That is correct.

BRALEY: And I had an opportunity to talk to two of their employees yesterday, and I know that they are working around-the-clock to help come up with a vaccine that will meet the protocol and the standards for scalability that I think everyone is looking for.

The WHO, the Department of Defense, HHS, and the Public Health Agency in Canada have called this vaccine one of the most advanced in the world.

And they have requested contracts with HHS to expand the manufacturing, to add a third site for manufacturing, to complete the scientific studies required to scale up manufacturing, and complete the additional safety study to provide newly manufactured vaccines that are equivalent to the original vaccines. And they have also identified companies to work as subcontractors.

Dr. Robinson, can you tell us what HHS is doing to make sure that those contracts are moving forward as quickly as possible?

ROBIN ROBINSON, DIRECTOR, BIOMEDICAL ADVANCED RESEARCH AND DEVELOPMENT AUTHORITY, HHS OFFICE OF THE ASSISTANT SECRETARY FOR PREPAREDNESS AND

RESPONSE: Yes. Thank you, sir.

We have renewed their proposal. It looks very favorable. And we will be over the next several weeks finalizing the negotiations with them. Prior to that we actually have been helping them with their submissions to the FDA, and providing assistance on-site and also at the manufacturing sites, and working with them to expand their production with other companies, including a very large company here in the United States.

BRALEY: Thank you.

FAUCI: And also, Mr. Braley...

BRALEY: Yes.

FAUCI: ... HHS is also involved on the other end of it, because the trials that were started were not only in collaboration with Department of Defense, but we admitted our first VSV patient at our clinical center in Bethesda for a Phase I trial.

So it is not only in the testing but in the ultimate production.

BRALEY: And it is my understanding, Dr. Fauci and Dr. Robinson, that the ultimate goal is to also expand this clinical testing into some of the affected regions in Africa as well once we have an understanding of some of the concerns that were identified earlier in your testimonies.

FAUCI: That is quite correct. In fact, when I was saying that after we get through Phase I on the trial, I was talking about both vaccines that GlaxoSmithKline and the NewLink, both, if they're safe and induce the response we feel is appropriate, we will expand both of them into larger trials in West Africa.

BRALEY: And then, Mr. Wagner, a question for you. We have heard a lot today about the issue of travel restrictions. Can you sort of walk us through the strengths and weaknesses of that approach from your standpoint in border security?

WAGNER: Well...

(CROSSTALK)

MURPHY: The gentleman's time has expired, so if you could hurry, give a quick answer.

JOHN WAGNER, ACTING ASSISTANT COMMISSIONER, CUSTOMS AND BORDER PROTECTION'S OFFICE OF FIELD OPERATIONS: Oh, so we have the ability to use the data that the airlines give us to be able to see where travelers are originating from. There are instances where travelers may go to different locations, and we might not see that, but through our questioning and our review of their passport, we can identify that they've been to these affected regions or if they come through one of the borders, if they fly to Canada or Mexico.

It is more difficult for us to do it, but the possibility is there. But the possibility is also greater that we would miss one.

So I do agree with what the experts, you know, say. It is easier to manage and control it when we know where people are coming from voluntarily, and not intentionally trying to deceive us.

MURPHY: Thank you. The gentleman's time has expired. The word is "voluntary." I now recognize Dr. Burgess for five minutes.

REP. MICHAEL C. BURGESS, R-TEXAS: Thank you, Mr. Chairman.

And I would like to stay with what Chairman Upton was talking about on the travel restriction. The secretary of health and human services, under the Public Health Service Act, has the authority to issue a travel restriction.

Under the pandemic plan that was adopted in 2005, the president has the ability to issue a travel restriction. 2005 was geared towards the pandemic avian influenza, but it was amended in July of this year to include the hemorrhagic fever.

So I believe that authority very clearly exists. Now the question is why the executive branch or why the agency will not exercise that authority.

Mr. Chairman, I think perhaps this committee should consider forwarding to the full House a request that we have a vote on travel restriction because people are asking us to do that. And I think it is -- they are exactly correct to make that request.

Dr. Frieden, the first nurse who was infected over the weekend is now being transferred away from Presbyterian. And yet her condition has been serially reported in the news media as she is stable and she has been improving.

So is the reason that she is having to be removed because the personnel are no longer rolling to stay at Presbyterian to take care of her?

FRIEDEN: Texas Presbyterian is really dealing with a difficult situation. They're working very hard. Because of the events of the past week, they are now dealing with at least 50 health care workers who may have potentially been exposed.

Management of those individuals, making sure that if any of them develop any symptoms whatsoever, even the slightest, they come immediately to be assessed so that if they develop Ebola, we hope no more will, but we know that is a possibility, since two individuals did become infected, others may, that makes it quite challenging to operate the hospital.

And we felt it would be more prudent to focus on caring for any patients who come in, any health care workers or others who might come in with symptoms effectively.

BURGESS: I don't disagree, and you and I have talked about this, and I am fully in favor of individuals who have been diagnosed that they do be taken care of in centers. And, Dr. Fauci, you know that if somebody wants to do research on the Ebola virus, they can't just go to a regular university setting and do that. They must go to one of the laboratories where they have the capability of protecting the personnel who are not only doing the experiments, but other personnel surrounding in the lab. Is it possible to get -- I had a picture from The Dallas Morning News

which had the CDC-recommended personal protective equipment. I think we have it there. And this not only shows the personal protective equipment, but it also details the order in which it should be put on and removed.

I would note that shoe covers are not included in this Graphic. But you do see a fair amount of exposed skin around the eyes and the forehead, and, of course, the neck.

Now, Dr. Frieden, this is going to be hard to see, but this is your picture in western Africa. And, as you can see, there is head- to-toe covering, and goggles. And I believe if I understand the circumstances correctly, you were just about to be dosed with a near toxic dose of chlorine, is that not correct?

FRIEDEN: Yes.

BURGESS: Well, and that is why you can't have skin exposed, because it is impossible to do the disinfection, if you will, after taking care of an Ebola patient or being in an Ebola ward. It is impossible to do the disinfection if there is skin exposed because exposed skin would be killed by the chlorine and that would not be good for the person delivering the care.

I mentioned this in my opening statement. I am so concerned. We know. We know the numbers in western Africa are going up on Ebola. We know the case rate is going to increase.

We know that 10 percent of those cases are health care workers. And we know that 56 percent of those health care workers in Western Africa will succumb to the illness. So that's a pretty dire warning for anyone who's involved in delivering health care.

And I would just submit -- well, Dr. Robinson, let me ask you, what kind of stockpile of this personal protective equipment do you have available to the health care workers who are on the front line? And bear in mind, no travel restrictions.

So a new patient could come in tonight and go to any hospital in this country, and present themselves. Are you going to be able to quickly deliver a stockpile of personal protective equipment like this?

ROBINSON: So we know from talking to the manufacturers, there are no shortages right now, and that they are willing to deliver within 24 hours or less.

BURGESS: Let me just ask this question, Dr. Frieden. You know, what did you think the first patient was going to look like? You knew you were going to have a patient zero at some point, or that it was a possibility. We had the gentleman who died in Nigeria at the end of July who could have gotten on a plane to Minneapolis. What did you think that was going to look like? What was patient zero going to look like? And now you've seen what it really looks like. What is the -- what is the matchup there?

MURPHY: You may go ahead and answer quickly. Thank you, Doctor.

FRIEDEN: Our goal has been to get hospitals ready. The specific type of personal protective equipment to be used is not simple, and there's no single right answer.

But there's a balance between protective equipment that's more familiar or less familiar, that's more flexible and less flexible, that can be decontaminated more easily or less easily. So the use of different types of protective equipment is something that obviously we're looking at very intensively now in Dallas in conjunction with the health care workers there.

MURPHY: Thank you. Now recognize Ms. Schakowsky for five minutes.

REP. JAN SCHAKOWSKY, D-ILL: Thank you, Mr. Chairman. I have so many questions. I just want to begin, though, by thanking the health care professionals that are on the front line.

And I would like to ask unanimous consent to put into the record, Mr. Chairman, a letter from Randy Weingarten (ph) from the American Federation of Teachers, which represents a bunch of nurses -- many nurses, into the record. I'd also like unanimous consent to put in the record the diary of Paul Farmer (ph) from Partners in Health, who has, among other things, said the fact is that weak health systems are to blame for Ebola's rapid spread in West Africa.

And we know that West Africa has 24 percent of global disease burden, 3 percent of world health workforce, one doctor in Liberia for 90,000 people. So I'd like to focus on what we're going to do to help that infrastructure.

But in my limited time, I want to focus on our infrastructure here. We have a vast infrastructure; hospitals, community health centers I want to point out, too, where people may present themselves, nurses, nurses' aides. No one better than the United States.

But do we have the ability to train and equip, as we talk about in military terms in Syria? Do we have the ability really to train and equip? But let me just put a couple things on the table.

In terms of the nurses, I still don't feel like we have a good answer of why nurse one and nurse two contracted Ebola. Is it because there was a problem with not following the protocols, or is there something wrong with the protocols? And how are we going to ensure that even if we have the best protocols in the world, that everybody knows how to use them?

Congresswoman Degette showed the various protective gear that our nurses are supposed to have. And yet, two days, apparently, went by when they were not wearing shoe covers, that their necks were not -- were not covered, that skin in fact, as Dr. Burgess was talking about, was in fact exposed, even as we knew that he had Ebola.

So how are we going to make sure, despite how we're going to check at the airports -- I'm from Chicago. I talked to our health director today. I know what we're doing. But there's still the chance that someone could present anywhere.

So how come the nurses in Dallas weren't protected, and how are we going to make sure that everybody can be?

FRIEDEN: So first, just to clarify one thing, those first couple of days -- the 28th, 29th, 30th -- were before his diagnosis was known. So he had suspected Ebola. The test was being drawn and assessed, but he had not yet been diagnosed with Ebola.

And in our team's review...

SCHAKOWSKY: Is that -- is that -- excuse me one second. Congresswoman, were you saying otherwise? Can I yield?

REP. DIANA DEGETTE, D-COLO.: The gentlelady will yield. But he presented with Ebola symptoms. He had been to the emergency room just a couple of days earlier saying he had been from Africa. And I believe the CDC protocols that were given to the Dallas hospital said that people should be wearing that protective covering, even before the official diagnosis.

I would certainly hope -- thank you for yielding, Ms. Schakowsky. Dr. Frieden, I would certainly hope that here going forward, if a patient shows up saying he's from Africa, and he's vomiting, and he has diarrhea, that you wouldn't say, "Well, we don't have the lab results in yet," you would start treating that person like they had Ebola.

FRIEDEN: Absolutely. I just wanted to clarify that those first couple of days, the 28th and 29th, he was being isolated for Ebola. The diagnosis was confirmed on the 30th. On the 30th we sent a team there.

And when we looked at the -- to answer your question of those first couple of days, there were some -- there was some variability in the use of personal protective equipment. The hospital was certainly trying to implement CDC protocol...

SCHAKOWSKY: I know. But going forward, how are we going to assure that just trying -- you know, how are we going to educate people, nurses? The nurses are saying they -- across the country, that they have not been involved, and that they are not trained properly, or have the equipment.

FRIEDEN: Three phases: First, think Ebola, anyone with travel history and symptoms; second, any time a patient is suspected, isolate them, contact us, and we will talk you through how to provide care while we get the test done. And if it's confirmed, we will be there within hours with the CDC Ebola response team.

SCHAKOWSKY: And my time is expired.

MURPHY: Just in response, when did you come up with that plan you just stated to Ms. Schakowsky, the plan in terms of training for nurses? When was that decided?

FRIEDEN: We look at our preparedness continuously. So awareness has been something that we've been promoting in extensive ways since the...

MURPHY: She was asking specifically for those nurses. When was the plan put in place for the Texas hospital that says, "You need to follow this protocol from this point on"?

FRIEDEN: The day the diagnosis was confirmed, we sent a team to Texas.

MURPHY: Thank you. Dr. Gingrey is recognized for five minutes.

REP. PHIL GINGREY, R-GA.: Well, first of all, I want to thank, of course, Chairman Murphy for calling the subcommittee back to Washington to hold today's hearing on our collective response to the ongoing Ebola outbreak, and commend my colleagues on both sides of the aisle your unanimous attendance to this hearing.

Since my time is very limited, of course, I'd like to get directly to my questions. And this is kind of a follow-on maybe to what Ms. Schakowsky was asking. I don't think we ever got around to an answer on that. And I'm going to direct the question to Dr. Frieden and to Dr. Varga, maybe first to Dr. Varga.

As we know from new reports yesterday, there's been a second health care worker who has contracted Ebola, Ms. Amber Vinson. Now that she's receiving isolated treatment at Emory University containment unit in Atlanta, we must examine the protocol breakdowns that resulted in the contraction of Ebola by these two nurses who were directly in contact treating Thomas Duncan.

Dr. Varga, in your written testimony, you say that the first nurse, Ms. Pham, to contract Ebola, was using full protective measures under the CDC protocol while treating Mr. Duncan. Has your organization in Texas identified where the specific breaches in protocol were that resulted in her infection, or alternatively, the inadequacies of the protocol? Dr. Varga, that question is for you.

VARGA: Thank you, sir. We are investigating currently the source of this obvious exposure and contraction of the illness. We've confirmed that Nina, through her care with Mr. Duncan, was wearing protective patient equipment through the whole period of time.

As Dr. Frieden already mentioned, with the diagnosis of the Ebola confirmed, the -- the level of personal protective equipment was elevated to the full hazmat style.

We don't know, at this particular juncture, what the source or the cause of the exposure that caused Nina to contract the disease was...

GINGREY: Dr. Varga, I'm going to interrupt you just for a second, because of limitation of time. I want to go to Dr. Frieden.

Dr. Frieden, as Dr. Varga just stated, healthcare personnel were following CDC protocols while treating Mr. Duncan, which include the use of so-called PPE, personal protective equipment.

Do the CDC guidelines, your guidelines, on the use of PPE mirror current international standards that, by the way, are being adhered to, those international standards, in West Africa in those three countries -- Sierra Leone, Guinea and Liberia?

FRIEDEN: The -- the international standards are something that evolve and change. We use different PPE in different settings. There's no single right answer, and this is something we're looking at very closely.

Our current guidelines are consistent with recommendations from the World Health Organization, is my understanding.

GINGREY: I would think that there need to be, Dr. Frieden -- and I commend you for the -- the job that you're doing, and I know this is -- these are tough times for all of us -- but I think some consistency is what we need.

And -- and that brings me to my next question and my last question, and again, it's to you, Dr. Frieden.

Does the issue of elevated temperature -- you know, is it -- it is 100.4, is it 101.5, is it 99.6?

I think there's some -- some great confusion, because initially, when -- when people were screening, Mr. Wagner, at -- at the airports in -- in West Africa, the temperature threshold was 101.5. And then I think now, the screenings that we're doing that these five major airports, including Hartsfield International in Atlanta, it's -- it's now 100.4.

When -- when Mr. Duncan came for the first time to the Texas Presbyterian Hospital, his temperature was, what, 100.1, and within 24 hours, of course, it was 103.

So when Mom and Dad are out there when a child has temperature, and there -- this fall is flu season, and they're going to the doctor, they're -- they're going to demand being checked for Ebola.

Give us some guidelines on what is elevated temperature and when should parents be concerned?

FRIEDEN: Well, first, parents should not be concerned about Ebola unless you're living in West Africa or the child has had exposure to Ebola. And right now, the only people who have had exposure to Ebola in the U.S. are people who either are providing care for Ebola patients or the contacts of the three Ebola patients, and I outlined those in this sheet. For our screening criteria, we're always going to try to have an additional margins of safety, and so we look at that, and we'd rather check more people and assess -- and so we're going to always have that extra margin of safety for our screening.

GINGREY: Thank you, and I yield back. Thank you.

MURPHY: I now recognize Ms. Castor for five minutes.

REP. KATHY CASTOR, D-FLA.: Thank y'all for tackling this important public health issue of the Ebola virus, and I want to thank the experts at the Centers for Disease Control and the NIH and medical professionals across the country, especially those at Emory University Healthcare, who have been proactive in containing and treating the virus.

I agree with President Obama and all of you. We have to be as aggressive as possible in preventing any transmission of the disease within the United States, and boosting containment in West Africa.

But I also think we need to pause here. This is a wake-up call for America that we cannot allow NIH funding to stagnate any longer.

Earlier this year in the Budget Committee, I offered an amendment to the Republican budget to restore the cuts to NIH, the budget cuts that have been inflicted over the past two years, and repair the damage of the government shutdown last year.

Unfortunately, it did not pass, on a party-line vote.

We will only save lives if we can robustly fund medical research in America and keep America as the world leader.

So I'd like to turn to some of that research that is going on now, because it's going to be research that will be our longer term response to Ebola. It will be the vaccines to prevent the disease and the drugs to treat it.

So I want to walk through a basic point here, that the development of vaccines and treatments for Ebola is different from the development of many other drugs. There's not a large private market for Ebola drugs, so the development requires leadership in our country.

And NIH, as -- as Dr. Fauci has testified, has been working on a vaccine for many years, and he reported today, they've now moved into some Phase I clinical trials.

Dr. Fauci, can you explain to us why government support is so important for developing Ebola vaccines and treatment?

FAUCI: Well, when you have a product that you want to develop, that it is not a great incentive on the part of the pharmaceutical companies, because of a disease whose characteristics is not a large market.

We have the experience when you're dealing with emerging and reemerging disease, be it influenza or be it a rare disease that could either be used deliberately in bioterror or a rare disease like Ebola that if you look prior to the current epidemic, there were 24 outbreaks since 1976. The total number of people in those outbreaks was less than 3,000; it was about 2500.

So we were struggling for years to get pharmaceutical partners -- ourselves, who were doing the fundamental basic and clinical research -- and then we did get some pharmaceutical partners, like we have now with GlaxoSmithKline and the NewLink Corporation, which is the reason why we're now moving along.

So that's one of the reasons why we have (inaudible). So I showed that slide, Ms. Castor, where the NIH and the research is at this end, and then you have to push the envelope further to the product to de-risk it on the part of the companies. Companies don't like to take risks when they don't have a...

CASTOR: So can you -- can you quantify a timeline for the Ebola vaccine to be on the market? Is it feasible for any vaccines to be approved in time to assist in the current outbreaks?

FAUCI: Well, your question has a couple of assumptions. The first is that the vaccine is safe and it works. The second is going to be how long is this outbreak going to last at its level?

If you look at the kinetics and the dynamics of the epidemic, it looks very serious. Our response to it -- when I say our, I mean the global response -- has not kept up with the rate of expansion.

If that keeps up, as the CDC has projected, we may need a vaccine to actually be an important part of the control of the epidemic itself, as opposed to what the original purpose of it was, was to protect healthcare workers alone.

But now, if you have a raging epidemic -- and to be quite honest with you, Ms. Castor, I cannot predict when that will be -- if you have a lot of rate of infection, a vaccine trial takes a much shorter time to give you the answer. If it slows down, it's a much longer time.

If you have a lot more people in your vaccine trial, it takes less time. If we have trouble logistically, which we might, of getting people into the trial, it might take longer.

So I'd like to give you a firm answer, but we can't right now.

CASTOR: Another, in addition to the vaccines, part of controlling the virus is -- is early diagnosis and treatment. I know there are some diagnostic tests that are being developed.

Can you speak to the prospect of improved diagnostics that can assist in this outbreak?

FAUCI: Right.

Well, there are couple of us -- when I say us, I mean agencies working on diagnostics -- Dr. Frieden's group at the CDC has actually played a major role in leadership. We have several grants and contracts out to try and get earlier and more sensitive diagnostics.

CASTOR: Thank you.

MURPHY: Thank you. I now recognize Mr. Gardner for five minutes.

REP. CORY GARDNER, R-COLO.: Thank you, Mr. Chairman, and I thank the witnesses for joining us today and the work that you are undertaking.

Dr. Frieden, I want to clarify something that you had said earlier. I believe you mentioned that there are approximately 100 to 150 people a day coming into the United States from the affected areas?

FRIEDEN: That's my understanding, yes.

GARDNER: And to Mr. Wagner, you had mentioned that we're screening 94 percent of those people?

WOLF BLITZER, CNN ANCHOR: We're going to take a quick break.

That's it for me. For our international viewers, "AMANPOUR" is coming up next. For our viewers here in North America, our coverage of this congressional hearing on Ebola will continue.