Transcripts For FOXNEWSW Outnumbered 20141016

Tom is here and when he is outnumbered on many thoughts on what is happening it ebola. I am with shepherd smith. His video is going viral telling everyone not to worry, it maybe overplayed and too much panic. I am with him. So many questions for americas Top Health Official as we await the start of the hearing. This is how we are learning ho two nurses possibly dbgot infected with the disease. And they are saying two days after the liberian man came to the hospital worked with procedures that changed on the fly and the cdc admitting vincent was allowed to fly across the United States after telling them she had a light fever possibly exposing dozens to the dangers. Angela do you believe we will get muchneeded answers . I am torn on this. It is important to Keep Congress in the loop and they hold the purse strings. There have been a lot of cdc failures. The un came out saying we have 60 days to con ain this. We cannot af two to have or three of thedays spent on a political dog an pony show. My advise because i know you have this on, i want you to make sure you have focused questions to get solution. And freidman better have specific requests so congress can fix whatever is going wrong. This cant turn into a situation where they use the camera for score election points there is no doubt it is going to get fiery and heated good luck. You dont th this will turn into a political standing . The last benghazi hearings didnt. I give credit to trey gowdy. If you start grandstanding, i would tell them im going to come down on all of you when i was in the media people dont have a lot of confidence we are being led through this mess right now. Well they look at what happened in dallas as a prime example of that. The cdc was overseeing the location and when her nurse called into the cdc to see if she should get on a plane and the fact she was treating an ebola patient and who knows if she took something to bring the fever down should have been enough to advise her get o on the plane. I want to mention this, nina pham is going to the National Health center in maryland. She has been speaking through statements to say how she is feeling. They say she is in good conditions. They are moving her, because the chief medical guy in dallas is going to be t the hearing and i would be asked about, the response in dallas and both have been moved. I would love to get your perspective i think i will get political. I think the republicans already are. And the democrats are not . No, because what is their motivation . We have watched ads about how republicans havent funded the cdc and that is why we are in this predicament. That is true. That is false the cdc is up 109 million since 2010. Nih has seen testing cuts. That is absolutely not true. Yes, it is. If that i true, why havent the democrat forked more money . I think they did just ask for more mun even with the money they have today, there is concern about the money they have being spent. I am on team she well as on this. I think it is as a tragedy this happened and we have had a couple cases in the country but i think we are having a lot of hysteria. Should the cdc be held accountable . Yes, but we are not seeing an epidemic or being threatened. I refuse travel restrictions on the people entering the country each month. A month ago obama said ebola reaching our shores is unlikely. Screening and selfreporting in airports have been a demonstrated failure. If the administration continues to advance the failed policy it doesnt make sense especially if pri priorty one is to control the health. They are cutting dies are democracy rather than protecting the health. This shouldnt be presented as an all or none choice. We can make a way to transport whatever goods are needs in africa. We dont have to leave the paths open while ebola is being transferred. The current passenger screening through temperature taking and selfreport is a determined infected traveler can mask the fever with mede or avoid one of the five airports. Let me be clear to all of the federal agencies responding to the outbreak, if resources are needed to st p ebola, tell us in congress because i pledge and the Committee Members pledge to do everything they can to keep it safe. 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 unemployi for modern times. The cdc predicts 1. 4 million west african will be affected by ebola and many more will die from treatable illnesses because of the infrastructure falling. This is a moral crisis. Ending the outbreak in africa is the best way to keep ebolau out of the United States. I was alarmed like all of you when Thomas Duncan flew to the united state and even more concerned about him being discharged from the texas hospital after having a fever and then learning two nurses contracted ebola. I know we join in sending thes women and their families their prayers. The Washington Post wrote that the texas ho total had quote learn on the fly how to control the deadly virus and the hospital wasfullye not prepared for ebola. We need to find out why this hospital was unprepared and if others are, too. And we need to make sure the cdc is filling the gaps. We should be concerned about the ebola in the United States and the transmission to two Health Care Workers but we should not panic. We know how to stop Ebola Outbreaks by isolating patients. The United States Health Care System can prevent isolated cases from becoming broader outbreaks. And that is why i am glad this hearing is taking place. It would be an understatement to say the response to first u. S. Based patient with ebola has been mismanaged causing risk to scores of people. I know they will tell us when another pers n shows up at the emergency room with these symptoms. I appreciate andcdc theator custom screenings and they are appropriate. And for those calling to cut off all travel this will not be reasonable to stop anyone with ebola coming into the United States. We dont want to take steps that would put americans in danger by interfering with the efforts in africa. The best way to stop ebola is going to be to stop this virus in africa. Experts from Doctors Without Borders told us a quarantine on travel would have catastrophic affects on w africa. And Francis Collins said if we had funded his agency adequately for over a decade we would have an ebola vaccine. The cuts have hampered the ability to respond to the crisis over the years. Six weeks ago when i asked if the hearing the scope of the problem in africa was coming into the focus. Now the situ ison dire. Let look to end this. With that, i give my time to lewis daily. 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 of those suffering from this horrible epidemic. I am proud o the work done by the american troops, nurses, doctors and others to combat the disease. Congress must come together and put aside partisan differences and stop the outbreak. I look forwahearing to what we are doing to stop the spread of the outbreak. I am concerned the administration didnt act fast enough responding in texas. We need to look at the options available to keep our family safe and move quickly to make changes at the airports. Gentlemens time is expired. We have a lot to do so we will keep going. Okay. Thank you. Now recognize the chairman of the full committee mr. Upton for five minutes. Let me start by thanking our witnesses and all of the republicans and democrats to be here. It is unusual to con vene a hearing in this matter but this capt cant wait. People are scared. We need all hands on deck. We need a st need and we to protect the American People first for foremost. It isnt a drill but the response so far has been unacceptable. As chairman of the committee, we want to tell the witnesses we sport you in any in keeping americans safe but we will hold your feet to one fire getting the job done and getting the job done right. They have failed to put in a strategy fast enough to combat the current outbreak. The cdc admitted more could have been done in texas. Two Health Care Workers have become affected wi ebola even as they suggest protocols are being developed on the fly. And none of us can understand how a nurse ho treated an ebola patient and had a was allowed to fly across the country. We sought de thes for preparedness and Response Plan here at home and it is clear whatever plan was in place was not sufficient but i believe we can and must do better now. We need a plan to treat those who are sick and train Health Care Workers who provide care and stop the disease here at home and in africa. This includes travel restrictions or bans from that region beginning today. S surely we can find other ways to get the countries ttools. We can no longer be reaccount reaccount reaccount reacting to each days situation. America is worried about the troops traveling and how they will be safe t. Isnt just the responsibility of the United States. The Global Health Community Bears the charge to get a head of the threat, develop a strategy, train all of those involved in combating the disease and get rid of the threat. People are scared. It is our responsibility to ensure the government is doing whatever it can to keep the public safe. We are getting together a 21st century Cure Initiative and a lot have been looked into on cancer and diabetes we need the same for the development of treatment for dead leo deadly viruses like ebola. Thank you. I think everybody agrees we must fix this. Americas response is a Public Health crisis and a dire one. We cannot guarantee the safety of our healtworkers on the frontline. It has been known they have the risk in west africa. 56 mortality ra those Health Care Workers who catch this disease. Two nurses have contracted ebola in the United States and we have to learn from the Current Situation in texas and use any information we can gather to better prepare hospitals and protect those on the front line. The Inspector General of Homeland Security issued a report on equipment and anti viral measures and they found they didnt assess a need assessment before purchasing and didnt managstockpile of the equipment and anti viral measures. We have to get this right. I would like to yie ms. O blackburn from tennessee. Thank you. And welcome to your witnesses. Everyone is here to support the men and wome on theng front lines. The screening eagles of the 101st from fort campbell. I will yield back time. I would like to introduce the witnesses no first, mr. Waxman. Thank you. I think we to put all of this in perspective and not panic. Everybody said not panic and then they made statements like we are going to get tough. We are going to do something about it. What do we need to do. We have a problem in africa and this is a serious outbreak that could spiral beyond our control. On tuesday t World Health Organization thatmated soon there could be up to 10,000 ebola cases each week in west africa and t cdc is warning the outbreak could infect as many as 1. 4 million by the end of january. This is a humanitarian crisis in africa. And we have a responsibility to help. If we dont help there, that outbreak is continue to continue and spiral out to other places. Sealing people off in africa isnt going to stop them from travelling. They will go to brussels and then the unistates. We can stop epidemic from spreading in africa and the United States if we isolate the patient and contact contacts of that patient. If we do that, we can stop there and we can stop it here. So in africa we need to know are we moving fast enough, responders have adequate resources, a we affectively coordinateing our efforts. But here people are scared and we should not make them more frightened. We have had three recent cases of ebola in the country. Thomas duncan who entered while harboring ebola and flew through brussels to get her and the two nurses that became ill while caring for m r. Duncan. We should be concern and need to act urgently but we should not panic. We need to learn what we did, the mistakes we made, an not repeat them. We want to find out what happened at the texas hospital and how cdc improve procedures mforward. We should use this as a wakeup call to insure our own adequate safety net. We need to be prepared before the crisis hits not scrambling to respond after the crisis. The ability to Public Health programs and research has declined in the United States. Since 2006, the cdcs budget adjusted for inflation dropped 12 . Funding for the Emergency Health preparedness agreement which provide state and local Health Departments has been cut from 1 billion in the first year of funding in 2002 to 612 million in 2014. They were also subject to the sequestration and those who allowed that to happen by closing the government have to answer to the American People as well. We need to commit Adequate Funding to Public Health infrastructu e and hold the systems accountable for preparedness. Based on what we know it appears that texas health didnt meet those standards but i suggest that several hospitals around the country would struggle with this. We have to solve this problem. I want to acknowledge the Health Care Workers in the United States and those going west africa who are helping during the outbreak. It is a dangerous work they are doing and they are put themselves in danger and deserve our praise. You have our confidence and i appreciate you providing information theow to stop out outbreak in africa and improving the crisis here. I am ending my career thes this year but i have been through so many hearing are people sit and point fingers. We have our fingers to point for cutting the funding. In africa they dont have the budget cuts but we are leaving our severals vulnerable because we cut ours. Dr. Thomas freidman is the director of the cdc. We have the direct of the the cdc. Allergy within the National Institute of health. We have the assistant for the preparedness and response at the cdc. We have the assistant commissioner at the Counter Terrorist food and drug instruction. We have the field operator within Border Protection at the office of homeland. And dr. Daniel varga is here from the texas Health Center joining us on the screen. I will swear in the witnesses. You are aware the committee is holding an investigative hearing and when doing so has the practice of taking testimony under oath. Any objection for taking testimony unoath . No. No. Under the house of the and committee you are entitled to be advised by council. Do any of you advise you would like hat . No. No. Everyone said no. In that case, rise and raise your right hand, do you swear the testimony you are about to give is the truth, the whole truth, and nothing but the truth . I do. You are under oath and subject to the penalty set forth in section 18 of the code. Dr. Freidman you are recognized for five minutes. Thank you very much chairman and Ranking Member. I appreciate the opportunity come before you and express the ebola epidemic. I am trained as a physician and i am trained in internal medicine and completed the training and worked in the control of diseases since 1990. Ebola sprout spreads only by direct contact with a patient who is sick from the disease, died from the disease or their body fluids. Ebola isnt new but it is new to the United States. We know how to control ebola even in this period. Even in nigeria we have been able to contain the outbreak. We do it by finding the patients quickly, isolating them, identifying their contact and insuring if any contact becomes ill they are rapid ily identified and put into isolation. There are no short cuts and it isnt easy to control it. To protect the we ed states have to stop it at source. If this could happen, it could be a threat to our health care. Our focus is to work 24 7 to protect americans. In the case of ebola, we do this by a system at multiple levels. In addition to our efforts to control the disease at the source, we h of helped each the affected countries establish exit screening so that every person leaving has their temperature taken. In a two month period of august and september, w identified 74 people are fire. None of them entered the airport or border the plane. As far as we know none of them were diagnosed with ebola. But that was one level of safety. Recently, we have added another level of screening people on arrival to the United States. That identifies anyone with fever here and we work closely with the department of Homeland Security and customs and Border Protection to implement that program and i would be happy to provide further details of it later. We have increased Awareness Among physicians to think ebola in anyone who has fever or other symptoms of infection and who has been to west africa in the previous 21 days. We established laboratories around the c oftry so not all them have to come to the special laboratory at the cdc. In fact, one of those cases in austin, texa , identified the first case here. We have fielded cal from concerned doctors and Public Health officials throughout the country. We found more than 300 calls and only one patient, mr. Duncan, had ebola. But that is many. O and we are open to ide for what we can americansp as safe as possible as long as the outbreak is continuing. We also have established Emergency Response team from cdc that will go within hours to any hospital that has an ebola case to help them provide affective care safely. To protect americans. Were always open to new ideas. Because the bottom line is using the most accurate data and information to inform our actions and protect health. Thank you. Thank you, dr. Frieden. I recognize dr. Fauci for five minute summary. Thank you, chairman murphy. Ranking members degette and Ranking Member upton and Ranking Member waxman. You heard ab the health aspectses of ebola virus disease from dr. Frieden. I appreciate the opportunity to speak to you this morning on the role of National Institute of allergy and Infectious Disease in research addressing ebola virus disease. Of note our activities started with the tragic events of 9 11, of 9 11, 2001, which were followed closely by the anthrax attacks which many of the members remember against the congress of the United States and the press. It was in that environment that a multifaceted approach towards bioterrorism was actually mounted by the ral government, one of which was the Research Endeavor to develop countermeasures. We soon became very aware, naturallyoccurring outbreaks of disease are as much of terror to the america and world public as deliberate bioterror. A number of what we call category a pathogens, anthrax, botulism, plague, smallpox, but look at the last bullet, viral hemorraghic fevers, ebola, marburg and lassa and others. They are fevers that are difficult because they have high degree of lethality a high infective on contact with body fluids. Therapy is the main supporter without specific interventions. We do not have a vaccine. So what is the role of the National Institutes of health . If we could advance the slide. The role of the National Instituteses of health in the Research Endeavor. As you can see on the slide we do basic and Clinical Research and importan apply and supply resources for researches in industry an academia to advance Product Development. The endgame of what we do are diagnostics, therapeutics and vaccines. Im sorry, could we get the slide back on the last slide . No the previous one. Im very sorry. Could we get it back . There, right there. This is a multiinstitutional endeavor. As you can see on the slide, the nih is responsible for fundamentally basic research and early concept development. Something that we did relatively alone because of the lack of interest on the Industrial Partners of making interventions. We partnered with bada who you hear from shortly with dr. Robin robinson. We partner with indus as weve done in a moment ill tell you to ultimately in collaboration with the fda to get the approval of products. Next slide. You heard a lot about therapeutic interventions. I would just like to spend a moment talking to you about a few of them. First it is realizet to theyre all experimental. None of them have proven to be effective. So when you hear about giving a drug that has a positive effect we do not know at this point, a, is it positive effect, or b, is it causing harm. That is the we needhy to study these carefully at the same time we rapidly make them available for the people who need them. The first one on the list is zmapp. You heard of it. That was given to dr. Brantly and nancy write bowl. It is got in the animal model. Still needs be proven in humans. You heard about the tekmira drug which was developed in support by the department of defense which is also being used and others that you will hear about since as brincidofovir. These are a few of those again that will go into Clinical Trials and actually being used in experimental way with compassionat approvalh from the fda in certain individuals. Let me turn slides here, which is an important one. Slides regarding a vaccine. We have been working on an ebola vaccine for a number of years. We did the original studies shown in an animal model to be quite favorable. We are now right at the phase where we are in phrase 1 trials some you made he started at nih september 2nd. A second vaccine was started couple days ago by the u. S. Military and in collaboration with nih when we finnish phase one trials, asking is it safe and does it induce response that you predict to would be protective . It is important to make sure it is safe. If those parameters are met, we will advance to a much larger trial in larger numbers individuals to determine if it is actually effective, as well as not having a paradoxical negative dell let tear russ effect. Deleterious effect. If we do not control the epidemic with pure Public Health measures, it is entirely conceivable that we may need a vaccine and it is important to prove that it is safe and effective. I would like to close by making announcement to this committee because im sure you will hear about it soo press. E this evening tonight we will be admitting to the clinical studies unit, special clinical studies unit at the National Institutes of health, nin pham, otherwise known as nurse number one. She will be coming to the National Institutes of health where we will supplier had to stateoftheart care in our highlittle containment facilities. Thank you very much, mr. Chairman. Thank you, doctor. I recognize dr. Robinson for five minute summary or statement. Good afternoon, chairman murphy, chairman upton, Ranking Members, degette and waxman and other distinguished members of this subcommittee. Thank you for the opportunity to speak with you today about our efforts by the government on ebola. I am dr. Robin robinson a former vaccine developer in the industry and last 10 years a Public Servant working on pandemic preparedness and many other bio threats. Barreda was prepared in 2006 for Government Agency supporting advanced development and countermeasures such as vaccines, therapeutic drugsings and medical devices for entire nation. Barda exists for the medical consequences of. We have developed man made threats on routine bas under project and responded to americaning threats, h1n1 and pandemic threat in 2009 and i have a very flu outbreak in china last year. Were responding to ebola with with issued department of homeland and security and emerging Infectious Disease. As you have said and my colleagues have said, when it comes to ebola as bio threat and emerging Infectious Disease the best way to protect our country to address the epidemic in africa, the worst on record. We work with the partners to have Early Development and dr. Fauci said and advance development fords ultimate fda approval. Since 2006 w advanced Development Pipeline of 150 medical Counter Measures, chemical, biological, radiological and Nuclear Threats and pandemic influenza. Seven products were fda approved in last two years and we have several promising and maturing ebola vaccines and therapeutic candidates from Early Development andr nih dod support into advanced development and insuring that commercial scale manufacturing capacity for these product candidates is available as soon as possible. Barda in concert with our federal partners uses Public Private partnerships within industry to insure we is countermeasures to protect our citizens. Over the past five years, barda with nih and cdc, fd the a and our Industry Partners built a flexible and Rapid Response ive infrastructure to develop and manufacture medical countermeasures. As a result of the pandemic and all hazard preparedness reauthorizat improved framework for Counter Measure development has been afforded to federal and Industry Partners and last year we mad newve vaccine candidates in record time for the china. Aks in were working currently with wider array of partners including small and large pharmaceutical companies, canada, u. K. , west of can countries World Health Organization and others to make and evaluate the safety and he have if can sy of these candidates. We have developed a infrastructure to assist Product Developers on daily basis in immediate public Health Emergency. Were using number of occur Services Systems program as Clinical Study network, centers for Innovative Development and manufacturing and field finish Manufacturing Network to make these products available as soon as possible. Additionally staff are on site at the manufacturer. People in plant. To provide t assistance and oversight to expedite product availability. Additionally were working with cdc and others across the federal government internationally with our modeling efforts to look at the Ebola Outbreak and as it becomes epidemic and also what possible impacts interventions may occur. Barda supports largescale production of medical countermeasures and response measure for Public Health emergencies like the h1n1 pandemic and h7 and 9 outbreaks. Were assisting ebola vaccine therapeutic manufacturers with scaled up production, spill were sporting the development in manufacturing zmapp, Monoclonal Antibody therapy studies at one manufacture. Expanding overall manufacturing capacity of zmapp with other toe back coat placed manufacturers. And other antibody candidates to expand production capacity. Pending outcome of on going animal challenge studies, we are prepared to support advanced development of promising therapeutic candidates dr. Fauci talked about on ebola patients. Were working to scale up manufacturing of three promising ebola vaccine candidates one weil make announcement today from pilot scale to commercial scale for clinical studies in africa next year. Addition to the barda efforts in Ebola Response and sponsoring activities supporting Health Care System preparedness and developing policies and guidance on patient movements repatriation, standards of care, clinical guidance, supporting logistical aspect of deploying Public Service officers to west africa and o coordination and communication with national an International Communities responding t threat. Finally we face significant challenges as have been discussed in coming weeks and months with the becoming ebola epidemic as medical countermeasures are manufactured and evaluated. Bottom line my colleagues here and our Industry Partners will use all of o collective capabilities here around approved to address todays ebola epidemic and be better prepared for future Ebola Outbreaks and bioterrorism events going forward. I want to thank the committee and subcommittee for your generous continued support over the past decade and opportunity to testify. Thank you. Thank you, dr. Robinson. Dr. Borio, for five minutes. Thank you, chairman murphy. Pull the microphone as close as possible. Thank you, chairman murphy, ranking memet ismiyati per degette and subcommittee. We want to respond to the ebola epidemic a tragic global event. My colleagues and i at fda are determined to do all we can to end it as quickly as possible. The desire and need fo andfe effective vaccines and treatments is overwhelming. Fdas taken extraordinary steps to be proactive and flexible. Were levera authorities and working diligently to expedite the development, manufacturing availability of safe and effective medical products for ebola. Were providing the fda with a unique, scientific regulatory advice to companies to guide their submissions. Were reviewing data as it is received. These action advance the development of and investigation of products as quickly as possible and for example, in case of two vaccines that dr. Fauci mentioned, fda took only a few days to review the applications and allow the studies to proceed. As a result the vaccine candidate being codeveloped by nid and glaxosmithkline began phase one clinical testing on september 2nd and vaccine candidate developed by newlink genetics began clinical testing on october this. Were partnering with u. S. Government agencies that support medical Product Development including naid, barda and department of defense. Because of fda longstanding collaboration with dod, fda was able to authorize use of ebola diagnostic t emergency authorization within 24 hours of request. We authorize twoe use of additional diagnostic tests developed by the cdc and these tests are essential for a Public Health response. In addition were supporting the World Health Organization. Our scientists are providing Technical Advice to the w. H. O. As it works to assess the role of convalescent plasma of treating patients with ebola. I recently participate ain consult attention focusing on ebola vaccines in geneva which included dozens of experts from around the world and affected neighboring countries in west africa. Participants agreed promising investigation of vaccines must be evaluated i scientifically valid Clinical Trials and a most urgent matter. Fda is working closely with our government colleagues and Vaccine Developers to support this goal. It is import while note we all want access to immediate therapies to cure or prevent ebola the scientific fact is that these investigational products are in the earliest stages of development. There is tremendous hope that some of these products will help patients but it is also possible that some may hurt patients and others may have little or no effect. Therefore actual investigation of products should be Clinical Trials when possible. They allow us to learn about product safety and efficacy and they provide equitable means for access. Nih working with the colleagues to have a Clinical Trial protocol to allow companies and clinicians to evaluate multiple investigatal ebola products under a common protocol. The goal to insure interpretable data to generate actionable results in the most expeditious manner. It is import for the Global Community to know the risks and benefits of these products as soon as possible. Until such trials are established well continue to enable access to these products when available and requested by clinicians. We have mechanisms such as compassionate use, which allow access to investigational products outside of Clinical Trials when we assess that the expected benefits outweigh the potential ri thefor patient. I can tell you that every ebola patient in the u. S. Has been treated with at least one investigatio product. Because fda is, ebola is such a serious and often rapidlyfatal disease fda approved such requests within a matter of a few hours and often times in less than one hour. There are more than 250 fda staff involved in this response and without exception everyone has been proactive, thoughtful, and adaptive to the complex things that have emerged. Were fully committed to sustaining d gaugement and aggressive activities to support robust response to the ebola epidemic in. Thank you an takeill your questions thank you, doctor. Mr. Wagner, youre recognized for five minutes. Thank you, chairman murphy, Ranking Member degette and distinguished members about subcommittee to discuss the efforts of u. S customs Border Protection to deer iting spread of ebola by ofns international travel. Each one one travelers arrive in the United States. 850,000 of t arrive at international airports. C. Travel and trade so vital to our nation ace economy. Within this broad responsibility our Priority Mission remains to prevent terrorist and terrorist weapons from entering the United States. However, we also play an Important Role in limiting the introduction, transmission and spread of serious Communicable Diseases from foreign countries. Weve had th role for over 100 years in coordination with cdc we had modern protocols i place for well over a decade guided response to have it roof Significant Health threats. Cbp officers at all ports of entry assess each traveler for overt signs of illness. In response the recent Ebola Outbreak in west africa, cbp in close collaboration with cdc is working to insure front line officers are provided information, training and equipment to identify and respond to International Travelers who may pose a threat to Public Health. All cbp offi are provided guidance and training identifying and addressing travelers with any potential illness including Communicable Diseases such as the ebola virus. Cbp officer training includes cdc Public Health training which teaches to identify through visual observation and questioning the overt symptoms and characteristics of ill travelers. Cbp provides Operational Training and guidance how to respond to travelers with potential illness including referring in whoduals display sign illness to cdc quarantine officers for secondary screening as well as training on assisting cdc with implementation of isolation and quarantine protocols. Additionally cbp provides training for the front line personnel covering key elements of cdc blood borne pathogens control plan, using personal protective equipment, other preventative measures and procedures to follow in potential exposure didnt. Were econom insuring that our field personnel have most uptodate Accurate Information since the outbreak began. They have be steadyide ad stream of guidance starting with initial information on the current outbreak at beginning of april this year with numerous and regular updates sie then. Information share something critical and continues to engage with health and medical authorities. Since january of 2011, ccd Crest Division of global migration and quarantine stationed Liaison Officer at national targeting tender to update requests for information between two organizations. Starting october 1st this year cbp began providing ebola information notices to travelers entering the United States from guinea, liberia and sierra leone. This sheet p traveler information and ininstructions should he or she have concern of possible infection. In addition to voice bring screen screening all passengers for overt signs of illness, starting october 11th, we began enhancing screening much travelers entering affected country entering jfk airport. We today expanded at dulles, chicago ohare, atlanta and newark. 94 of the travelers o affected countries en the United States through these five airports. These targets travelers are asked to com aete cdc questionnaire, provide Contact Information and have their temperature checked. Based on enhanced screening efforts, cdc public officers will make. Cbp conducted enhanced screening on 155 travelers identified in advance as being known to travel through one of these three affected countries. Additional 1 werevelers identified by cbp officers as needing additional screening during the course of our standard interview process that is applied at all ports of entry. A total of eight of these travelers have been sent to tertiary screening by cdc and it is important to note so far all passengers were examined and released. While cbp officers received training in illness recognition and response, if they identify an individual believed to be ill, cbp will isolate the traveler from the public in a designated area and contact the local cdc quarantine officer along with Public Health authorities to help with further medical assessment. Cbp officers are trained to employ universal precautions in Infection Control approach developed by cdc when they encounter in withuals overt symptoms of illness or contaminated items in examinations of baggage and cargo. When necessary, cbp personnel will take the appropriate Safety Measures based on level of propotential exposure. These proced designed to minimize risk to our officers and the to the public have been use lights collaboratively on both agencies on number of occasions with positive results. C about p wi monontinue to the ebola outbr provide timely information and guidance to our field personnel, work closely with the inneragency partners to develop and adopt measures as needed to deter the spread of ebola in the United States. Thank you for the opportunity to testify today and attention you give to this very important issue. I will be happen to answer any of your questions. Thank you. Well recognize dr. Daniel vagabond, chief clinical officer joining us f on texas videoconference. Dr. Vagabond. Good afternoon, chairman murphy, vicechair burgess, Ranking Member degette and members of the committee. My name is dr. Daniel vagabond. Im the chie clinical officer and Senior Executive Vice President for Texas Health Resources. Im boardcertified in internal medicine and 24 years in combined patient practice, medical education and health care administration. I am truly sorry that i could not be with you in person today. I appreciate the economist tease how to be here in dallas during this challenging and sensitive time. Texas Health Presbyterian hospital in dallas is 13 wholly owned acute Care Hospitals in the Texas Health Resources system. We are an 898bed hospital treating some of the most complicated texasin north in terms of, excuse me, in north texas. Texas Health Dallas is recognized as a magnet designated facility for excellence in Nursing Services by the American Nurses credentialing center and a leading nursing credentialing program. Texas Health Resources is one of the largest faithbased centers, notforprofit Health Systems in the u. S. And largest in north texas in terms of patients served. Our mission improve the health of th theople in communities we serve and we care for all patients regardless of their ability to pay. We serve a Diverse Communities and as such we provide one standard of care for all. Regardless of race, or country of origin. As the first hospital in the country to both diagnose and treat a patient with ebola, we are committed to using our experience t help other hospitals and Health Care Providers protect Public Health against this insidious virus. It is hard for me to put into words how we felt when our patient, thomas eric duncan, lost his struggle wi ebola on october 8th. It was devastating to the nurses, doctors, and team who tried so hard to save his life and we keep ourfamily in thoughts and prayers. Unfortunately in our initial treatment of mr. Duncan, despite our best intentions and a highly Skilled Medical Team we made mistakes. We did not correct diagnose his symptoms as those of ebola and we are deeply sorry. Also, in our effort to communicate to the public quickly and transparently, we inadvertently provided some information that was inaccurate and had to be corrected. No doubt that was unsettling to a community that was already concerned and confused and we have learned from that experience as well. Last week we, nurse nina pham, a member our hospital family who courageously cared for mr. Duncan was also diagnosed with ebola. Our team is doing Everything Possible to help her win that fight and on tuesday her condition was upgraded to good and as dr. Fauci mentioned earlier, ninas care continues to evolve. I can tell you that the prayers of the entire Texas Health System are with her. Yesterday as been noted we identify a second caregiver with ebola and i can also tell you that our thoughts and prayers well. With amber a lot is being said about what may or may not have occurred to cause nina and amber to contract ebola. The we know that they are both extremely sk nurses and were using full protective measures under the cdc protocols. So we dont yet know how or when they were infected and it is clear there was an exposure somewhere sometime and were pouring over records and observations and doing all we can to find the answers. Youve asked about the sequence of events with with regard to our preparedness for ebola and our treatment of mr. Duncan. Key events from our preparation timeline are attached to the our submitted statement. Here is brie overview, as ebola epidemic in africa worsened over the summer, Texas Health Hospitals and facilities began educating our physicians nurses, other staff on the symptoms and risk factors associated with virus. On july 28th an Infection Prevention Nurse Specialist at texas health received First Centers for Disease Control and Prevention Health advisory about ebola virus disease and began sharing it with other texas health personnel. The Health Care Advisory encouraged all Health Care Providers in the u. S. To consider ebd in the diagnose of febrile illness. In other words a fever. Persons who recently traveled to affected countries. Cdc advisory wa sent to all directors of Emergency Departments and signage was also posted in the eds. On august first texas Health Leaders including all regional and Hospital Leaders and ed leaders across our system received an email directing all hospitals have a hospital epdeem lodgic emerg policy in place how to care for patients with ebolalike symptoms. The email also drew attention to the fact that our Electronic Health record documentation in Emergency Departments including a question about travel history to be completed on every patient. Attachments to the email included a draft thr epidemiological emergency policy that specifi dressed ebd. Cdc based poster posted in the ed and cdc advisory from 7 28. Emergency department with a fever of 100. 1. Abdominal pain, dizziness, nausea and of 101. D he was examined and went over tests. In the time his temperature went to 103 and later went to 102. And he was discharged and we provided a time line on the notable events. Mr. Duncan was transported by