we have this under control, or it will never spread. it was not supposed to get over here either. >> a wonderful discussion right now on the ebola virus. that theen revealed and came left liberia from west africa over here. nobody checks him out. he goes right into the dallas , therety and as a result are people in quarantines. he is in the hospital. . >> i am proud to welcome him general rodriguez. he is here to interview an update on the u.s. military contributions against ebola in west africa. i will turn it over to you. i will moderate. we've got 30 minutes total. >> >> good morning. good to see you all again. i am glad to have the opportunity to talk to you about the u.s.-africa supportive competence of government effort to help contain the outbreak of ebola in west africa. as you know, the president considers this to be a national security priority that requires mobilizing our collective resources to enable the success of the international effort. recently, i discussed the progress of the response with the president. in support of the u.s. government effort, the military focus is on providing logistics, training, and engineering support in conjunction with the greater interagency effort. we stood up headquarters in command in liberia, regional coordination of u.s. military support to the u.s. and international relief efforts. finally, we placed two additional mobile medical labs into operation last week, significantly increasing the capacity for rapidly diagnosing ebola. we also enable health-care workers to safely provide direct medical care to patients. this is very important and i want you to help us to tell our families and the american public the health and safety of the teams supporting this mission is our priority. by providing pre-deployment training and adhering to strict medical protocols while deployed and carrying out carefully planned reintegration efforts, i have confidence we can ensure our service members' safety and the safety of their families and the american people. as we deploy america's sons and daughters in this effort, we will do everything in our power to mitigate the risk to our service members. that includes employees, contractors and their families . preventing the spread of ebola is the core of our effort. this applies to our own support efforts and our own people. the professionals of doctors without borders have a record of safe operation in their fight against the spread of ebola. we have looked at their procedures and consulted with the centers of disease control, the world health organization and others to develop our protocols based on known risks prudent planning. we are taking the following steps. we are implementing procedures to reduce or eliminate the risk of transmission to service members as they go through their daily missions while deployed including use of personal , hygiene equipment. let me assure you that, by providing the pre-deployment training, adhering to strict medical protocols, and carefully planned reintegration measures, i am confident we can ensure our servicemembers' safety and the safety of the american people. our equipment, training, and will help to ensure that our team accomplish and the mission without putting our mission and fellow citizens at risk. stopping the spread of this disease is the core mission. we are focused in all of our efforts to accomplish this by supporting the international effort and by keeping our own people as safe as we can. with that, i will take your questions. thank you. >> there have been some questions about whether the response to the overall crisis has been too slow. do the troops you have now -- are they enough to get the job done? or do you think, in order to move things along more rapidly, do you think you will need more troops there? do you have a cost estimate? >> first of all, one of the challenges is continuing to gain situational understanding over time because of some of the isolated places that is creating problems. we are supporting the usaid efforts to do that. right now, the leadership has approved up to almost 4000 people. admiral kirby talked to you about that. we have a lot of flexibility to put people in there as they are needed. the speed with which these things are done, it is not just one challenge. part of it is the ability of the host nation to absorb it. as you can imagine, their infrastructure and their capacity to house people, to feed people, is limited. so it will have to come in in a very carefully orchestrated -- based on the demand out front. at the same time, they are increasing their situational understanding of their situation at the same time. so these mobile labs are very important. as you can imagine, some people have malaria and some people have the flu and it is important to understand who you have to treat and who you don't. we already have two of more those in, and they are already having impact and we have more on the way to better adjust. that is not what we expected when we got the first mission. i think we have the right flex ability and the ability to adjust as needed. >> cost? >> the cost estimates right now are probably around $750 million for our efforts. that is in a six-month period. again the challenge with doing , that is that, those labs for example, they were not in the initial plan. so it will have to be a free-flowing, flexible on all of that. >> nbc. journal will any u.s. military , personnel be involved in the direct treatment of any ebola patients or in the training of health care givers? will they come into contact with any ebola patients? >> no. the mobile labs are different. but no for the majority of the force. the mobile labs are testing people so some of that will have the ebola virus. those are trained at the highest level of something like nuclear, biological, and chemical. so they are trained at a very high level. the one from walter reed has been operating there for many years, for example. and the two that we just deployed meet those standards of training. >> do you have any numbers of those who will be involved in the lab operations? what kind of protections or what kind of protocol will be observed? and if any u.s. military personnel should contract ebola, what is the protocol there? what happens? >> first, on the numbers in the labs, they are between a three and a four-person team. we have three labs deployed right now. we will probably deploy several others. so one lab adds three to four additional people. again, those people are trained at the highest level of nuclear, biological, chemical arena and they are testing all the people. they are the primary ones that will be contacting anybody. on the second point, if somebody does contract ebola and becomes symptomatic, they will be handled just like you have seen on the recent ones who came back on an aircraft that was specially designed to bring them back and they will go back to one of the centers that is specially designed to handle the ebola patients right now. >> so they will be returned to the u.s.? >> yes. >> fox news. will forces and personnel be working side-by-side with liberian troops as they build these emergency treatment units? i thought we had been told that they would be separate run the liberian forces. is there a risk of contamination by working closely with the partner nation's troops? first question. and do you have enough of the personal protective equipment that you need or is there a shortage of that? have you stockpiled any of the zmapp. >> we have people that will be working with and observing the other people that are building the etu's. our contractors will make sure they are meeting the standards and oversight. all the people who are doing that are tested and meet all the medical protocols and ensure they do not have the disease. then the continual daily checks are also a part of it. so all of the people we are working with go through those medical protocols. on the last point, the virus, we do not have that stockpiled. you have to get the expert opinion of the cdc, but that is still to be determined whether it is effective or not and they will be able to tell if that is effective or not. we have sufficient adjective equipment for ourselves and we will continue to make sure that is the way throughout the process. >> military times. can you tell us a little bit about where these three or 4000 medical servicemembers will be housed? and can you tell us about what kind of personal protective gear and what kind of hygiene protocols and monitoring will be done on a daily basis? >> for the majority of the people, they will be in places like the minister of defense or some of the military posts that are out there, some will be at the airfield and at the locations where people will be flown in. we will have trainers that are in a training facility. most of these places that are in and around monrovia are in buildings. the people will either live in the ministry of defense areas or they will live in tent city type procedures where everything will be taking care of them, including their food and water and all of those things. you have to watch all of that at these points. then the protocols that occur in the daily monitoring, malay, it -- mainly, it is built around the multiple washings with your hands and feet and everything else. when you go into one of these ebola treatment units, you will wash your hands and feet multiple times. you will have your temperature taken in and out. there is a checklist for each personnel on the virus or any other sickness that might be coming up. it is a self questionnaire and checklist. the personal protective gear, the majority of the people will with personalploy protective gear that includes gloves and masks and things like that. they don't need the whole suit as such because they will not be in contact with any of the people. >> cbs. understanding your point about the ability of liberia to absorb all the stuff, you have the feeling that, if the american embassy were under attack in liberia, it would not take weeks to get there. so what is it about this operation that makes it seem to be unrolling in a much slower pace than sending u.s. troops to protect americans first? >> the protect americans peace is a small number. we have five times that we have sent in to libya to protect the u.s. embassy in that situation. that infrastructure there, with all the ability to sustain themselves. the other challenge in liberia, as you can imagine, their whole nation is overwhelmed. their health facilities are overwhelmed. that is all broken down. we have to bring in everything at the same time. again, right now, they aren't even located in all the locations they want to be. those are some of the challenges we are being faced with that -- we just want to overwhelm them, and thrust things in their that they can't absorb. the airfield is the same way. >> foreign policy. can you tell us how the decision was made to not have u.s. medical personnel treat ebola patients directly, and do you have concerns about manning these ebola treatment units on the ground? there have been calls from doctors without borders that more people are needed, not just more facilities. both are needed. >> i'm not sure how the decision was made. the bottom line is, that is the position of the leadership area. it is the international community's role right now, that is where everyone is encouraging people to come forward to do that. that is where we stand until we -- and continually adapt to what is going on on the ground. we are filling in demands that the international community needs us to do. that is for command and control. it is for engineering support. it is for logistics. those types of things. that is where we are focusing our efforts. that is what they have asked us to do. >> do you believe that there is a scenario that you can see that would push you past 3900, and on the question of security, do you think the concerns in congress about the security of u.s. troops there for this decontamination risk, in a situation where people are trying to get into an area that was off-limits -- do think those concerns are overblown? >> i think we have -- service members wherever they go have the ability to defend and protect themselves. they will have that here. i think we will meet that standard, no matter where we go. we will do that here too. >> if the contaminated person is unarmed? >> we have the same rules of engagement everywhere we go. it is the approved rules of engagement. that is about protecting the self, self-defense. we want to make sure you understand that when people get infected, they are not capable of doing a mounted attack. the only one can get into you to -- the facilities are the sickest ones. they don't have the ability to move. they have had zero problems that i know of in the ebola treatment units right now, handling people at the gates. it's a very small element. >> 4000? >> the 4000 -- it depends how everything goes. i can't answer that question. i don't for see more than that right now. things can change. it is a fast-changing situation. we are still gaining understanding throughout the whole region. i think that would be the driving factor. >> litter go. politico. can you give us the latest estimate about how long it is going to take to get all the treatment centers and do the work you need to do, up and running? can you give us a sense of how long american troops will be on this mission? >> the treatment centers, to get the ones we have been tasked to build -- probably until mid-november. they are working on an effort there to get more people to build some of those at different times. we will just have to see how it flexes out. we will probably be able to continue to improve the speed with which we build them. after you get one done, the second set goes faster. that is the estimate to get all 17 done. what was the second question? >> how long will troops be doing this? >> the critical thing to this , based on cdc numbers is to get 70% of people infected into an infirmary. at that the curve will go down. point, it depends on how fast the curve goes down, and how the international community can pick up the requirements. we will stay as long as we're needed, but not longer. >> six months, a year? >> i do not. i am sure it will be about a year. that is just a guess. we will have to play that by ear. it is all about the transmission rates, and when that curve starts going down. >> could you give us a sense about your cooperation with regional countries in west africa, and you think other countries, other than log. , are safe -- other than liberia, are safe? >> sierra leone and guinea are also threatened by this. we are working with the french and the u.k., who are also doing some things like putting a hospital up, like a 25 person hospital. most of those efforts are being run and controlled by the united nations and the international community. we coordinate and communicate with them. we do not direct them or anything. >> about the cost -- can you tell us where the $750 million is coming from? is that coming out of the continuing resolution? do you anticipate the pentagon needing to request more money in 2015 for the response? >> you would have to ask the comptrollers for that. it is a reprogramming effort, i don't know what that is coming from. they were working got on the hill. osc policy is leading that effort. they could tell you where it exactly is coming from. >> thank you. i wanted to clarify one thing -- it is in fact service members who will be operating this testing labs in the field? >> correct. >> we have been told that service members are not going to come in contact with patients. now we are being told that is changing. >> the labs are a separate specialty element of the force. that is probably where that has come from. as far as the general population, they won't be coming in contact. these labs are trained to a specially skilled level. it is the highest level. they can operate in a nuclear, biological, and chemical environment. they are specifically trained to do that. that is their primary skill set. we had one in their that has been operating for several years in the country that works on infectious diseases. we have both the navy and the army with medical labs in many countries doing just that, to monitor these things. >> how many do you expect will be running these labs? >> three or four per lab. it is a testing facility. they test it in a full, biological, suited up -- they meet the highest standards of operating in that environment. >> a clarification on that -- will they be in contact with individuals or just specimens? >> they >> individuals. come into contact with individuals. it is a very high standard that these people have operated in all their lives. this is their primary skill. this is not medical guys just trained to do this. this is what they do for a living. >> and how many labs total with their -- >> there are three labs, and a request for four more labs. we are working to generate that. the testing really focuses who you need to treat, and who don't need to treat. malaria shows up with similar symptoms. they have had a major impact, and the more the better for the effectiveness of the effort. >> right you expect one general to replace the other general. >> the way that command-and-control is set for the component is that it has the ability to do small humanitarian things for a very short period of time. this is not a small effort. it is not a short period of time. we will get a headquarters from the united states out there to do that. general williams also has a significant job doing lots of other things everything will day that we need him working on in the rest of africa. that is the way the design structure of command and control is set up. >> when we get there? >> in the next three weeks. >> thanks, we appreciate you coming. [no audio] director and the texas health commissioner spoke with reporters today on the current ebola outbreak in the u.s.. this is 35 minutes. >> good morning. it afternoon. today is one week since the first nation was diagnosed. people begin to look back and think about it, what where right, what went wrong, implications for the future. i think we have to keep a couple of things in mind. this is going to be a long, hard fight. we can never forget that the enemy here is a virus. -- enemy is ebola. it is a virus that does not spread to the air. we do know how to control it. we do know how to stop it. isolating patients, contact tracing, and breaking the chains of transmission. weekend that there are real signs of progress. , not only in dallas, but also around the world. i will go through a few of them. in dallas, there are 10 definite and 30 of possible contacts being monitored. each and every one of them is having their temperature monitored. as of today, none of them are sick, none of them have a fever. we will continue to watch that berry closely in the coming days. the teams of the state and local level in dallas are doing a terrific job. they are dealing with what is an unprecedented situation. africa, we aret beginning to see some signs of progress as well. we have been talking about west africa, but the fact is, these are three different countries. have three different patterns of disease. even within each country, there are different patterns. in liberia, there are 15 districts. in those different districts, there are different patterns of disease. in sum, they have had buried two cases of ebola. in others, they are just beginning to have a big increase in cases. i will mention one particular district, which is in a remote, rural area. district, that was a district that is bordering syria lyons and ginny. in what has been the epicenter of the outbreak, that district, that area, had at times the most cases in all of iberia. over the past weeks, cases of plummeted. we are not sure of all of the reasons, but there were enough isolation areas. also, in those facilities, in that district, burial practices were being improved. we don't know that that decreases going to be maintained. we have seen waves of disease before. we do think that in that one community, it is real. even in west africa, even in a place that is the heart of the outbreak, we are seeing signs of progress. and though it has not been in the headlines, the outbreak in drc is still contained. the number of cases is relatively small. it has not spread beyond the remote, rural area. of ebola outbreak that we have seen in the past. it looks like it is well on the way to being contained in a country that has dealt with ebola many times in the past. one other sign of progress that has not been in the papers case in is a single a disease caused by the marburg virus. it is a lot like ebola, but there was no movie made about it. fatalitys a similar rate. it is spread in just about the way -- same way. it is controlled in the same way good one individual and you gone to -- uganda died. the cause of death was not immediately verified. we have done work in uganda to help them have a better laboratory network to find cases, have a response network with disease detectives and people who can follow up, and have an emergency operations center to track individual cases. as a result, we have identified context. those contacts include an individual who was the embalmer, the went back to kenya. that individual was trace and track to kenya, was tested, does not have marburg. and the context within a patient's family were also tested. i mention this because oftentimes of public health what gets notices what happens. it is hard to see what does not happen. if we stop the outbreak and role drc, there is progress. it gives us confidence that we will be able to control ebola in west africa. there is a lot that we are doing, based on what we have learned in the past week. for example, we have hospital awareness. we already work regularly with hospital associations. we have an intensive involvement in infection control, technical support. calls from doctors have increased tenfold since the first case was diagnosed. there is a lot of awareness. we are working to increase further. we are working closely with health departments, big city, state, and help the public associations. is a good example of a function health apartment. we want to make sure that the lessons that we learn from dallas are rapidly incorporated into the practice of health departments around the country. i know that people are eager for more information about travel. i want to adjust that. -- two address that. as the president said, we are looking at what we can do to increase the safety of americans, and, in the coming days, we will announce further measures to be taken. right now, i can get easily basic principles. we want to insure, and we will always be sure, that the health of americans is our top priority. we want to ensure that anything we do works and is workable. we recognize that whatever we do until the disease is controlled in africa, we cannot get the risk to zero here. we may be able to reduce it and we will look at every opportunity to do so. we also don't want to do anything that will backfire. in medicine, one of our cardinal rules is, above all, do no harm. if we do something that impedes our ability to stop the outbreak in west africa, it could spread further there. we could have more countries like liberia. and the challenge would be much greater and then go on for a much longer time. we know how to stop ebola. that is what is happening in dallas today. that is what is beginning to occur in parts of west africa. the signs of progress are there. but it is going to be a long, hard fight. and we should always keep in mind that the enemy here is a virus. and we, together, can stop that virus. i would now like to turn it over to the commissioner for the texas department of state health services. >> thank you, dr. frieden, and good afternoon to everyone. as he noted, one week ago today that a patient tested positive for ebola in dallas. even as we deal with the national and international issues related to ebola, we are dealing with this in dallas. here is a brief update about what is happening in texas. we are at a very sensitive time, when a contact could develop symptoms. we are monitoring with extreme vigilance. if a contact develops symptoms, we will tell you. we will also immediately isolate that individual, test that individual, and increased monitoring as we roll out and confirm ebola. the contact investigation is going exactly as it should. it is in constant motion. we are posting contact numbers daily. they have not changed since sunday. but that is always a possibility as we pursue every possible contact. the bottom line is anyone who needs to be monitored will be. i'm also mindful that the rest of texas and the fact that this one case has on our hospitals. hospitals are on high alert right now, because they don't want to miss anyone who present with a travel history and symptoms of ebola. if we get requests for testing, we will evaluate that in consultation with the centers for disease control. we are capable to do that testing safely and timely. i also want you to recall that the people we are monitoring are real people. i cannot think of anything more unnerving for them right now than this as they wait. but we can and will contain the spread of this disease and protect the public by following our core public health measures. that is what is going on right now in dallas as we fight against ebola. again, thank you dr. frieden, and thank you everyone for being a part of this conference today. >> thank you. we will not take questions, starting in the room. wait for the microphone. >> new york times. does the effort that have been started in the various countries explain the differences in cases in the district that you are mentioning? what explains the reduction in that area that had been a very hot area that now is not? >> there are big differences in the areas. some of them in urban areas, so it has an effect on the spread of the disease. urban areas are controlled activities. for example, in the capital of guinea, they have done such a good job of contact tracing that until recently, and we will see if that holds, that virtually every one of the cases that has arisen has been able to be monitored. that allows them to stop transmission. also, we have seen changes in caregiving and burial practices. as people learn about ebola, they learn the risks and they change their behaviors. usaid, the agency for international development, has contracted for burial teams throughout liberia. they have been ramping up to improve the proportion of burials that are done safely and respond to calls for assistance with burying of bodies. we have also improved infection control in health-care settings, although there is still a long way to go there. we do not know what the future will hold. there is no way to know in some ways what accounts for the progress and whether it will hold, but we are seeing some communities where we see progress. really, i would divide the communities in west africa into three types. there are communities that have very few or no cases of ebola. there, our focus is preparedness. such as what we have done in uganda. we have created an emergency operations center. we empower the county. we identify a way of testing for the virus. we train in contact tracing. we improve caregiving and funeral practices, so we can break the chains of transmission. and we try to keep those areas with lower events of ebola and having -- and prevent them from having widespread outbreaks. also, there are countries that do not have any ebola cases. and there, you want to make sure there is intensive preparation for the single possible case, so you prevent it from spreading widely. and finally, there are those that have lots of cases. and there, we break the true train of transmission. we get to patients probably, and if they die, we make sure that no one is effective in the process of burying them. and we've learned a lot about how to work with committees most sensitively in that process, for example, providing divinities -- providing communities with the opportunity to observe as they are burying their dead. and we respect traditions, in terms of certain faiths want only people of certain faiths to touch the body of someone who has died. learning those lessons has been really important, and working with health-care workers so that they keep in mind the incredible importance of rigorous infection control. yes? >> cnbc. we have been hearing a lot about experimental drugs on patients here in the u.s. can you give me guidance about how you're thinking about that and whether there is any centralize decision-making happening here in the u.s.? >> in terms of extremity drugs for patients with ebola, there is a lot of interest. right now, the two that we are looking at closely ,z-mapp, a combination of three different antibodies. it is promising. as far as we understand, there is none left in the world, and it takes time to make more. a second drug is also promising in animal models, although there may be challenges in using it in individual patients. and there are limited quantities of that as well. and the patient in texas is getting a third drug, which shows some promise in a test tube model of ebola. really, it's up to the doctors, the patient, the companies -- nih's very involved in drug development. parts of the u.s. government have been very supportive of that within hhs and the department of defense. it is an individualized decision, but i would step back a bit and say that what we have learned about ebola is how important it is to get the patient's basic care right. so that we are treating their fluid and electrolyte balance well. that is critically important to survival. let's take the next question in the room. and then we will go to the phone. >> abc. the texas patient did receive an example drug. as he had any reaction that? and what other treatments has he received other than supportive care? >> the hospital released a statement that he is intubated -- incubated he is on dialysis to support his kidney functions. and he is receiving experimental treatment. he remains in critical condition. >> in bc news. -- nbc news. there are members of congress urging the cdc to create new guidelines for screening for ebola at international airports. is this something you're working on? is this something you believe is needed, or is enough being done? >> we are working intensively on the screening process, as the president said, both in places of origin and on arrival to the u.s. and we are looking at at entire process to see what maybe done. i want to provide you with information about what is being done now in africa and here in the u.s. in west africa, in each of these three countries, cdc has had teams on the ground for several months training people within each country to take a questionnaire and take the temperature of every person getting on a plane to leave the country. and that is at the request of the governments of these countries. they absolutely understand that keeping travel going is vital to their ability to stop the epidemic, and to their ability to continue functioning as societies. they are willing to go through any procedures to make sure it is safe. in fact, all three of the presidents directly asked me, tell us what more we can do for screening people so we can make sure that the airlines keep flying? because about half of the airlines have canceled and stopped flights since the outbreak started. over the past two months, the staff we trained who are using thermometers that are calibrated and approved by the fda for use and do not require touch and can be used from a few inches away, we have overseen the screening of about 36,000 people who have been boarding planes. most of those, three quarters of those, do not come to the u.s. only a small proportion come to the u.s. of those, about 77 had either fever, in the case of or 74, symptoms that made us take them off the line in the case of the other three. that is roughly one in about 100 -- 500 travelers. as far as we know, none of those 77 people had ebola. many of them had malaria. that is a disease that is spread by mosquitoes. it cannot be spread from one person to another. it is extremely common in west africa and a major source of disease there. if you are finding fever in people from west africa, the most common single cause of that is going to be malaria. but we will absolutely look at every step that could tighten that process. screening at airports, of course, would not have found fever in the patient in dallas, because he did not have fever for four or five days after he arrived. but we will look at all the options. we are not today providing the steps that we plan to take, but i can assure you that we will be taking additional steps and making those public in the coming days once we can work out the details. let's go to the phone for a couple of questions. we will come back to the room if we have time. >> thank you. we will begin the question and answer session. if you would like to ask a question, please press star one on your phone. the first question comes from cnn. you may ask your question. >> thank you for taking my question. i'm sure you're aware of the case in spain where a nurse has become infected. i'm curious -- i know we don't know all of the details of this case, maybe this is more for dr. lakey and those involved in the treatment. how's this given anyone any cause about the protocols in the u.s. and elsewhere? could you detail the precautions that are taken and recommended? >> dr. lakey, why don't you start and i will add a couple of comments at the end. >> thank you. all of us saw that article and we are concerned about what is going on in spain right now. i looked at the protocols they are doing right now at presbyterian hospital, and they take this very seriously. they have a ward for this individual where they are caring , for him. they have policy and procedures that are mapped out. i would also say, as i went into the ward, i signed in. they have security there. they have the area where you gown, gloves, double gloves, put on the appropriate mask, and versatile protective equipment. and then you can see the individual and take care of the individual. and they have protocols when they are done to protect that individual, making sure that they take the equipment off appropriately and that they can shower before they come out of the ward. they take this really seriously. they have done so since the beginning. they are following meticulous practices. having said that, again, the unfortunate news going on in spain, it can't help but make -- increase some of the anxiety going on right now. but again, i want to say that they are doing their work very safely right now. and we continue to watch that. dr. frieden? >> thank you. what i would emphasize is that everything we are seeing in africa and elsewhere suggest that the way ebola is spreading has not changed. where we have seen health care worker infections, we have no additional information beyond what is in the media reports about what is happening in spain. there have also been recent infections in west africa that are very concerning. when we have seen problems, they have come in two different contexts. one, when it is a new situation and the health care team has not dealt with ebola before. and two, if the team is overburdened. if they are dealing with so many patients or have such a staff shortage, it's possible that even the best and most meticulous people may cut corners. that is why we have emphasized to global partners who are working in west africa that really four weeks or at most, six weeks is the maximum deployment time. then you need to rotate out and have another set of individuals there. i know of at least one infection that occurred in individual who is known to be very meticulous. we don't know how the infection occurred, but we do know that it occurred when he extended his stay past that six week time frame. and in the next two weeks that the individual wanted to provide care, the infection occurred. ensuring that we have meticulous, careful, well drilled situation is very important. i have said and i repeat that we know how to stop ebola from spreading in hospitals. but that does not mean it is easy. it is hard. it means you need meticulous attention to detail. you need a team working together. you need to make sure that every aspect of the protocol is rigorously and meticulously followed. in some of the ebola units in africa, one of the keys to success is having someone in charge of the unit who is very, very experienced and who is roving at all times, identifying anything that might possibly be a risk. there are many things that have to be checked carefully, from the concentration of bleach that is used, to the procedures for putting on and taking off protective equipment, to what actually happens in the ebola treatment area. next question on the phone. >> the next question comes from evan brown, fox's radio. >> dr. lakey and dr. frieden, thank you for doing this. there was an article in the newspaper today where they had interviewed some epidemiologists who worked on previous outbreaks of ebola. and they say that they cannot say with certainty that the virus would not mutate to other forms, including an airborne form, which would certainly change the dynamic of how it spreads. i would like you to take a moment to react to that, or at least give us your thoughts or opinions, or some technical explanation that the rest of us can understand. and i have a follow-up regarding that. >> ebola spreads by direct contact with someone who is sick, or with the body fluids of someone who is sick or has died from it. we do not see airborne transmission in the outbreak in africa. we don't see it elsewhere in what we have seen so far. the ebola virus itself has had a great deal of genetic stability, so between the beginning of this outbreak and more recent isolates, the isolates our about 99.9% similar. even the recent discoveries, the changes in the virus are less than 5%. furthermore, most viruses don't change how they spread. to do that would require a very large genetic change. if we look at ebola as a class of viruses, the subspecies here is ebola zaire. there are about 80 different sub species and they differ among them, but all of the also spread by direct contact, not by airborne route. that is not to say that it is impossible that it could change or be selected out for airborne transmission. that would absolutely be the worst-case scenario. and we would know that not so much from tracking genetic changes, but by looking at what is happening in africa. that is why we have teams of epidemiologists from cdc on the ground tracking that. one of the things we are doing at this point, i discussed earlier the heterogeneity, the differences within countries. we are now surging the cdc response to go out into the counties's most affected, the areas most affected, and provide intensive support there for the care of patients, for the tracking of the outbreak, and to see what has happened. everything we have seen until now does not suggest a change in how ebola spreads. >> if i may follow up. >> please. >> transmission is the ultimate bogeyman for a lot of people. especially here in the united states. a lot of the cases we've seen in the u.s. with regard to people being brought in, or with this dallas patient, they have been able to access a major urban center hospital. for those who live in suburbs, and even further out where they only have access immediately to smaller, acute care type hospitals, what is the protocol for them? are they equipped to handle this? and if not, how does someone who shows up at a small hospital who could potentially be in ebola case, what is the protocol for getting them to a more adept facility? >> the first point is to suspect ebola and diagnose it promptly. that is quickly important. in terms of the physical arrangements for infection control, you don't need a fancy facility for that. you need a private room with a private bathroom. in terms of the protocols to be followed, we would work with the state and local health departments to support any hospital to do that. it would not be easy, but can be done and can be done safely. next question on the phone. operator? >> our next question comes from bart jensen, usa today. >> hello, thanks for taking the call. senator schumer, among others, has called for greater screening of inbound travelers. he said after meeting with you that he suspects you are likely to follow his recommendations. i wonder, for lack of direct flights from these western african countries to the u.s., can you say how you choose the airport and the passengers? >> >> we are looking intensively at this and we anticipate announcing new measures in the coming days. what we can do, working with customs and border protection and with the department of homeland security, is identify people who arrived by indirect flights. >> thank you. >> next question on the phone. hi, thank you for taking my call. this question is for dr. lakey. response, what is your to work on the ground. have there been any other cases in texas at this time? >> there have been no other cases. hospitals are on high alert. a lot of conversations have taken place with emergency managers across texas. i did one of those earlier today , where we had emergency managers on the phone talking about the current situation. there are calls with all the hospitals in the state of texas. openve over 1000 lines talking about what is going on and making sure that we are prepared. we have one case. we have the case that is currently hospitalized at presbyterian. we have individuals that are being monitored. the contact tracing continues to go forward. they are being buried vigilant -- variant vigilant. they are chasing down numbers and making sure we are meticulous, and that every individual has been identified and as -- is being monitored we have the one case. thank you. >> is there any other contacts that you are monitoring who have tested positive? are you still waiting on those results? there is no other testing of any individual in texas right now. it would not be surprising if we have another patient from somewhere in africa or west africa that comes in. we have identified malaria on individuals, but there is no additional testing taking place in texas at this point. we could do that by quickly if we need to. we have that capability in our laboratory, but there is no other testing to my knowledge, and i have checked berry carefully, no additional testing in texas as of right now. thank you. >> just to reiterate, 10 contacts with definite contact. 38 context with possible contacted none have fever. none have symptoms. l have been monitored in texas. what dr. lakey described, working with health departments and hospitals throughout texas, those are steps that we are taking nationally. as i mentioned, we will have a call with health officers from all 50 states. i will be asking dr. lakey to share some of the key lessons from his experience on that call. we always look to learn from experiences. we want to see what more we can do to ensure we are consistently improving our ability to respond. next question in the room. >> new york times. the 36,000 is over what time? >> two months. will take two more questions from the phone. >> associated press. thank you for taking this. madrid officials have said they are seeking a court order to euthanize the dog of the nursing patient. can dogs transmit ebola to people? are there any other animals involved in the dallas patients case? >> there is one article in medical literature that discusses the presence of antibodies to ebola in dogs, whether that was an accurate text or whether that was relevant, we don't know. clearly, we want to look at all possibilities. we have not identified this as a means of transmission. we know in rural areas of africa it can infect animals. that is how it ticks handed. they may become infected by the blood. >> we are not monitoring any animals at this time. i have no knowe