Chairman for his tireless efforts on behalf of the weekend vulnerable. Week and vulnerable. I like to thank my good friend for pulling todays hearing together amid the escalating outbreak of ebola across west africa, countries including liberia, sierra leone, guinea, and now nigeria. Although i am not a member of the Foreign Relations committee, i do serve on the state and foreign operations appropriations subcommittee which funds the state department and foreign aid programs. I would also say to the witnesses that if you need extra money, ask for reprogramming. You should not wait for september, october you should ask for it immediately and him confident the appropriate committees will allow it. But if there is any doubt, there should be request for reprogramming. The current ebola epidemic has claimed over 900 people. It was detected earlier this year and is proving to be the worlds worst outbreak of the virus ever recorded. It now appears this alarming, contagious disease could be on the verge of spreading. On july 28, i received a call from ken isaacs. Let me say samaritans purse and Doctors Without Borders have done more to help the poor and suffering in many faces than almost any other group around. So i want to commend samaritans purse and Doctors Without Borders. Wherever you go in africa, they will either one other groups have long gone. Samaritans purse is on the front line, working to curtail the Ebola Outbreak. The outlook via absence of the United States was bleak. The Obama Administration underestimated the magnitude and scope of the epidemic. Despite wellintentioned efforts by local and International Aid workers, actors and nurses working on the ground, it seems the International Community in the u. S. Had been noticeably absent in helping these west african countries to get out in front of the spread of this epidemic. For the first part of the epidemic, the International Community led three of the most impoverished countries in the world deal with it ebola essentially on their own. It should be no surprise the Health Systems and night in liberia, guinea and sierra leone do not have the resources or capacity to deal with this epidemic on their own. Despite early warnings from ngos working on the ground, there was little action taken to get in front of this problem and now we are seeing the consequences. Nothing can bring back the lives that were lost and money and personnel deployed to help may not be enough to contain the epidemic. I spent much of last monday on the phone with the white house, state department, cdc, and aj just trying to understand what, if anything the u. S. Is doing to contain the out rate and prevent the spread of ebola to the u. S. I was concerned no one could tell me who was in charge within the administration on this issue. No one could explain what actions would be taken to ensure the u. S. Was prepared to respond. Although more progress has been made over the last week since these conversations, it is clear the government is still trying to catch up. This requires efforts from agencies and countries, france, great britain, many of the countries in europe who are experienced in africa should be brought in. It has also come to my attention that there seems to be deficiencies in the planning procedures and protocols in response to the ebola threat will stop as mr. Isaacs will share today and i have read his testimony when the Health Care Workers confirmed with ebola, getting guidance for returning Health Care Workers soon became apparent there were significant gap in existing procedures for dealing with this. The cdc had no available registry of medical facilities capable of treating ebola patients in the United States. There are no quarantines or travel restrictions in place and there was concerned the gaps in the protocols and how do you deal with them . I appreciate them very much. I appreciate dr. Frieden he took the cold call when his getting on the airplane. I hope you will talk about any deficiencies and how they can be addressed by the government and the congress of stop and the congress. I want to thank chairman smith for calling this hearing during the august recess and i also want to recognize the men and women of the cdc and other International Response groups who are on the ground and soon will be on the ground in africa as well as the doctors and nurses helping the two patients in atlanta. I want to thank them because this is very dangerous, what a will be doing all stop and people we do not know their names, will be doing. We nk we should tell them appreciate them. I want to thank the state department and department of defense for their invaluable assistance as this thing is taking place. This is important and serious work and i knew if the American People if they knew what was being done would appreciate their efforts. This should be a very top priority of the white house, the Political Leadership of the nation. You know with the career people are going to do, but the white house, the American People deserve to know what their government is doing to prevent the spread of this epidemic and keep the country safe. With that, mr. Chairman, thank ou and i yield back. I would like to now introduce our first panel of two panels. The getting first with dr. Tom frieden, who has been the director of the centers of Disease Control since june of 2009 and has worked to control Infectious Diseases in the United States and globally. He led new york citys program to control tuberculosis and reduced the multidrug resistant cases by 80 and worked in india for five years, helping to build a Tuberculosis Control Program that has saved nearly 3 million lives. Dr. Frieden founded programs that increased life expectancies and is the recipient of numerous awards and honors and has published more than 200 scientific articles and has previously testified before this committee on drugresistant diseases as well as other very Important Health topics. Thank you, dr. , for being here. We would like to introduce ariel pablo mendez, the assistant administrator for Global Health at usaid. Hes been in that position since 2011. He joined usaids Leadership Team to shape the bureau for Global Healths efforts to accomplish scalable, sustainable, and measurable impact on the lives of People Living in developing countries. He developed on mobile Health Strategy in the transformation of Health System and africa and asia and served as the director of Knowledge Management at the World Health Organization. He is a Board Certified internist and until recently was practicing as a professor of clinical medicine and epidemiology at columbia university. We will hear from ambassador williams, career member of the Senior Foreign Service with the of of minister consular Foreign Service and deputy of affairs at the department state. She serves as ambassador to the republic of niger and has served t the u. S. In montana france and guinea. Her postings have included director for International Organizations in National Security council at the white house and advisor at the u. S. Mission to the United Nations in new york. Ithout objection, fuller but they will be entered as part of the record. Dr. Frieden, the floor is yours. Inc. You very much for your interest in Global Health, your interest in ebola and calling this hearing at this critical and pivotal time. First, lets are member the lives and faces of the men, women and children who are affected by the Ebola Outbreaks in the four countries currently affected, especially the Health Care Workers who account for a substantial proportion of cases. Those are the people we must focus on. Those are the people we must support, and it is in africa we can stop this outbreak and protect not only this country but ourselves as well. We focus on what works and im incredibly proud of the staff of he centers for Disease Control and prevention. And i think every american who would know the expertise, dedication of the disease detectives, laboratory experts, disease and intervention specialists who have an on the ground in the past few weeks and months and you are now searching for our response would be proud to know what we are doing there. I want to start with the bottom line. Three basic fact. First, we can stop ebola. We know how to do it. It will be a long and hard fight and the situation in lagos, nigeria is particularly concerning, but we can stop ebola. Second, we have to stop it at the source in africa. That is the only way to get control. Third, we have to stop it at the source through tried and true means the Core Public Health interventions that work and i will go through in a few moments. By way of background, ebola is one of several viral hemorrhagic fevers. There are others, but ebola is the most feared in part because it had a movie made about it. There are others that are just as deadly. The first ebola virus was identified in 1976 in what is now the democratic republic of congo. There have been sporadic outbreaks since the natural reservoir is not known but is believe to possibly be that which pass it to primates and other forest living mammals and humans may come into contact with them by eating bush meat or contact with bats. That is a theory. Theres increasing evidence for but we are not certain of it. What we are certain of is when ebola gets into human populations, it spreads by two routes first, two people who are getting care to individuals who are sick with ebola. Ebola does not spread from people who have been infected but are not yet set. Its only sick people the transmitted. Second, its transmitted only by close contact with exchange of body fluid. So a Healthcare Worker or Family Caregiver who comes into contact with a patient who is very ill, maybe leading or have body fluids on the individual, that is how ebola spreads. In the outbreak in africa, there have been two main Drivers Health settings and other caregiving settings, including the family, and burial practices, where there may be practices that involve contact with the recently deceased person. Those are the drivers of ebola in africa. Ebola only spreads from people who are sick and only spreads through contact with infectious body fluids. It does not spread through asual contact. It is not an air borne disease, does not spread through water or food. And incubation time is usually between eight and 10 days from exposure to onset of illness. It can be as short as two days and possibly as long as 21 days. But in that time, it is essential any contact he closely monitored to determine if they have developed the symptoms of ebola and if they have, are followed up. We do know how to stop ebola. Meticulous case finding, isolation, Contact Tracing and management. We with our partners have been ble to stop every Ebola Outbreak to date. And i am confident that if we do what works, we will stop this one also. But it wont be quick and it wont be easy. It requires meticulous attention to detail. If you leave behind even a single burning ember, its like a forest fire. It flares back up. One patient not isolated, not diagnose, one Healthcare Worker not protected, one contact not traced, each of those lapses can result in another train of another chain of transmission. To control the outbreak, we have to work effectively. The challenge is not the strategy, its the mplementation. Mr. Chairman, we have provided how this can be controlled. Because il permit me, think it is important to get the fundamentals out there. First, to find the patients and diagnose them. That means fever or other symptoms. The only way to diagnosis ebola is with a laboratory test. We working with partners from the department of defense from the past with france, and from countries where the disease is present are scaling up the ability to diagnosis patients. So the first diagnosis is, suspect is with fever, test with blood, get it in the lab. Thats the first step. The steckedsfep is to respond to those cases. We do that by i getting them in isolation, eliciting their contact, and by following each and every contact every day for 21 days. If a contact develops fever, begin that process all over again. Isolate them. Find out who their contacts are. It is hard. It requires local knowledge and action, but it is how ebloa is stopped. Third, prevent it. Prevent it through Infection Control, health care, safe burial practices, and producing the consumption or unsafe consumption of bush meat and contact with bats. The Current Situation is a crisis and unprecedented. It is unprecedented in five different ways. First, it is the largest outbreak ever. In fact, at the current trend, within another two weeks, there will be more have been more cases in this outbreak than in all previous recognized together. Of ebola put continent. Is multi cases have moved between countries. One country gets control, and patients come in from another country. So that tricountry area is a particular challenge. Third, this is the worst outbreak in africa. This is a disease that was unknown in that area before. Because of this it has been a particular challenge. This also has been a challenge. Fourth, many of the cases have been in urban areas and there has been spread in urban areas. This is something we have not seen spread from this work before. This doesnt appear to be a change in the virus, but it is a new development in how and where the virus is spreading, and it makes control much more difficult. Fifth, it is the first time we are having to deal with it here in the United States. Thats not merely because of the two people that became ill caring for ebola patients and were brought back to the u. S. By their organization. Thats primarily because we are all connected. Inevitably there will be travelers who go from these countries or from lagos, if they dont get it under control, and appear here with symptoms. Those symptoms might be ebola or something else. So we have to deal with ebola in a way we have never had to deal with it before. The u. S. Is working to support partner governments and the World Health Organization. I have activated the c. D. C. Emergency Activation Center at level one for this outbreak. It doesnt mean there is an increased risk for americans, but it does mean we are taking an extensive effort to do everything we can to stop the outbreaks. E cant do it alone. Governments around the world as well as most importantly people in country will be key to stopping the outbreak. We will send the next week or two will have reached that 50 number. We are supported at our home base in atlanta by a much larger group. Even today before the full surge of activation, we have more than 200 staff working on this outbreak response. We will increase that number substantially in the upcoming days and weeks. We will hear more about the agency for development where we are using an unprecedented model to Work Together and rapidly identify and call in for reinforcements and assistance. I think it is important to we rstand that if didnt do this, we wouldnt we have more than 200 staff working on this outbreak. We dont have we have medications to care for it. You may have seen press coverage about experimental treatments. The plain fact is, we dont know if that treatment is helpful, harmful, or has any impact. We are unlikely to know from the experience of two or a handful of patients whether it works. We do know that Supportive Care for patients with ebola makes a big difference. Supportive care gives people saves peoples lives. Making sure they are not under their fluid balance. Treating other infections that occur, providing good Quality Health care. We are currently coordinating with n. I. H. , f. D. A. , the department of defense and others to see whether there can be new treatments and whether these treatments can be effective and treatable thrfment is a lot we dont know about that yet. It is important that we keep in mind that we do know, even without medicines specific to ebola or a vaccine, we do know how to control it and we can stop it. I want to spend a moment to discuss what we are doing to protect people in this country. First off, the single most important thing we can do is stop the outdaybreak break, stop it at the source. The second thing we are working on is to help these countries do a better job screening people who are leaving their countries so they will screen out people who are ill or who may be incubating ebola. Third, because we do recognize that we are interest connected, we are working with state and Health Workers throughout the United States so they are aware that there could be people who come through these three countries that come in with fever or other symptoms, they should think it could be ebola. Immediately isolate them in the hospital and get them tested at c. D. C. We have issued a level three travel advisory against all nonessential travel. We have issued a level two travel advisory about enhanced precautions on nigeria and we will reassess the nigerian ituation daily or as needed. There is strict Infection Control possible in the hospitals in the u. S. There has been some misconception about this. Ebola it not as infectious has the flu or the common cold. What is a concern is that a single lapse in control could be fatal. Thats why the key is to identify rapidly and strictly follow Infection Control guidance. It is certainly possible that we could have ill people in the u. S. Who develop ebola here while having been exposed elsewhere. It is possible they could spread it to close family members or Health Care Workers if their infection is not rapidly identified. But we are confident that there will not be a large Ebola Outbreak in the United States. We are confident we have the facilities to isolate patients, not only the highly advanced ones like at emery, but at every Major Hospital in the u. S. What is needed is not fancy equipment. Whats needed is standard Infection Control rigorously applied. Weve released guidance for doctors and other Health Care Providers in the u. S. On identifying, prodeviding, and treating patients, and guidance for flight crews, and cargo personnel. Fundamentally, to end here, we have three roads before us. We can do nothing and let the outbreak rage. I dont think anyone wants to do that. We can focus on stopping these outbreaks. Thats something we will ertainly do. We can focus not only on stopping outbreaks but putting in position response systems that will find and stop future outbreaks of ebola and other threats. We face in this country a perfect storm of vulnerability like emergence of ebola, intentionally created infections which remain a real threat. But we have unique opportunities to confront nem with stronger technology, more political commitment, and Success Stories on Real Progress from around the world. Earlier in year, the u. S. Joined with the World Health Organization and more than two dozen other countries to launch a Global Health security agenda. That Global Health security agenda is exactly what we need to make progress not only in stopping ebola, but preventing the next outbreak. The second document that weve provided for you, provides a summary of what the mapping is between what we launched back in february before this outbreak was joan or reported to have started and whats needed to stop the Ebola Outbreak, and they are closely aligned. The president s budget includes a request of 45 million to c. D. C. To l help with the detection and response. Former undersecretary of state for africa said to me citing his work that c. D. C. Is the 911 for the world. Though i was happy to hear that, i feel that what we manhattan to make sure is that every country or every region has its own Public Health 911. That will be good for us, it will be good for public safety. Expanding that type of work, strengthening Global Health security will not only help us stop this outbreak but also prevent future outbreaks and stop them faster if they occur. Thank you so much for your interest in this. Dr. Frieden, thank you for that comprehensive and insightful testimony. Would like to yield to dr. Pablos mendez. You for that introduction. Thank you for your longstanding support to stop ebola. Because this has never occurred in this region, and as we heard from tom, spreading to and beyond the region. I am, like many of you, sadened to see the loss of life by this outbreak but also by the broughter economic disruption this is inflicting in the region. What is really a series of fledgling democracies in western frica. The community has known how to deal with ebola. There have been 30 outbreaks in africa. Those situations have been contained. The conditions have to be per expect. Uganda has a track record that is worth noting. In the year 2000 they had 435 cases during that outbreak. The support we provided allowed the outbreak to be contained. Particularly outbreaks in 2008, only 149 cases. That is the last outbreak in the region. The number was only 32. We can deal with this outbreak. We have done it many times. And we know what to do. Usaid provides routine funding for the c d. C. To work in geneva and africa to have preparedness planning, response, and indeed that has been the machinery that is put in place here. We support about 22 laboratories in asia and africa where almost 500 new viruses have been detected in just the last five years. So there is a lot at c. D. C. Going on all the time. This particular virus, ebola, is familiar to us. And as far as we can tell from a biologicalgenetic point of view, it is really the same virus. It is not a muteant virus that has taken on new powers. It is the same virus we are familiar with, but it has entered a new reen region, and perhaps that because that was deputied in central africa. This he can logical dimension of the world has to be kept in mind. Because of the novelty of this, the News Business of the people in western africa, we are experienced in dealing with the outbreak as has been previous. Usaid has targeted in this year the in response to western africa, we started earlier this year, supporting a 2. 1 Million Investment to unicef and it has been supported now with 2. 4 million to support c. D. C. Indeed, it is important to note to chairman wolfs comments, that the outbreak in siera leone, in libera, we leon and this lie beer where in are retrospect on but theearlier cases where identified in late march and for a couple of weeks we had this outbreak that then springwn so this in the the initial outbreaks went down. Allowd out that if you one case in the remote areas one case can breed a whole thing and what we have seen with the secondary spine that has been truly difficult to control. This investment has allowed us allow toith uniref to deploy 30 or so technical experts and provide additional Operational Support including 35,000 sets of personal protective equipment and supplies. Also the basics, soap, water, is importantthing in this type of situation and we speak. Ce as services andman the defendant of defense as well lead in the. Has to the Ebola Outbreak but the coordination has been truly exemplary and i want to really point that out. It has been something the last thate of weeks that coordination has been working just to make sure that we countriesupport the to stop this outbreak. Addition has activated the Disaster Response that we have deployed in her emergencies from fukuself to haiti, earthquakes, and h provides the architecture for response of the u. S. Government once the u. S. Ambassador on the ground has declared emergency and this has, indeed, occurred and it is now deployed and the team leaders Deputy Team Leaders are in place. For is responsible thec. Is responsible for health and medical part of the response. But there is plenty of other activities and planning and on communications in not only in the government but with the local government and with partners that i mentioned before. I spoke with our mission havetor in liberia and we a large, a large platform for health work that works very closely with the minister of health. Ofhave only one or so health sierra leone. Working and taking the precautions to include the safety but also to work effectively against this outbreak. This preservation. Not only in the huge setting to thesethe growth of epidemic but also the global maintained so the viruses no bothered. In the shortterm it is a human many pairtive and National Security priority to contain this Ebola Outbreak as quickly as possible. It will take months to end it but i think we can turn around tables in the next couple of weeks if the response that is executeds deployed and as planned. The u. S. Government is fully engaged in the response and we we can stopt that the epidemic. As i sid it would not be ease where and might take several months. In the longterm we must assist developing countries in strengthening their own Health Systems, both those dedicated to Infectious Diseases like this but also the capability of the systems to deal because it is about the Frontline Health in primary care settings in commune kits and this time is africa, we have seen mexico we didnt expect mers coming from south africa. The path agains can jump anywhere and we have to be prepared to deal with these things as they occur. We are prepared to make this our priority in africa and also demonstration is working on the Global Health security aagain that for which we lock to work and in the plans because that would require future and we look forward to working with you on that. Thank you very much for giving me this opportunity and i look forward to your questions. It doctor, thank you very much for your testimony and leadership. Would like to note we have been joined by augustine who is the foreign minister of liberia. Usnk you for being with today. Most daunting the these can country vs. Faced. Today more than 1500 cases have been reported including over 900 total deaths. Although the affected countries are home to many heroic and dedicated Health Workers the rapid spread of the disease reflects the lack of capacity, particularly in the throw epicenter countries liberia, and see raria leone. Providing frontline medical care to patients is hardpressed to continue to provide care in all affected regions. Compounding the issue, affected lack ofons understanding of virus and wide it is spread mistrust of andthcare providers treatment methods have further efforts. Response in significant proportions of the affected regions local tradition such as public funerals and cultural mourning customs including preparing teased forbore riyal have contributed to the and led localss to block access to patients and ons some aces led to attacks Health Care Work hes. In one such incident in liberia, have begunproviders pulling out of the region to yoo for the safety of their staff. To proper medical care there is a critical need campaignsive health and Public Outreach as a crucial response of the efforts. We are reaching out to ensure coordinated with the w. H. O. And other countries that can assist both through at w. H. O. Sentatives Head Quarters in geneva and through directed discussion with governments. Liberia and sierra leone are still recovering from conflicts. This was especially acute in wherea and sierra leone the fighting went on forayers. He have taken important steps to heif hes tee tearor rakes and neglect. And other factors key to checking ebola spread also are challenging for the in the region. Aside from our interest in ebola virus does not spread to the United States or farther in africa, we do not want the virus to erode the capacity of of can countries to other Important National and regional challenges. We want to ensure these strong,s remain strategic ail highs to the United States. Sadly this virus already has peacekeeping in somalia. The African Union canceled a plan deployment of Peace Keeping force due to fears that the virus could be introduce inside the country. Given the critical importance of this issue we are fully doing Everything Possible to shore up each governments efforts to combat viral outbreak and controllity spread. We are county department that through the on certed and cord efforts of our government and our International Partners thisn contain and stop virus. In fact, mr. Chairman, the department has established a Monitoring Group on the humanitarian situation in west monitor and coordinate information. The tasks force may be reached at the following email address. Force5 state. Good gov. The department has maintaind coordination and and closely monitored operational plans to combat the outbreak. Ae sierra leone, set up president ial tasks force. In buinea improved messaging helped Healthcare Providers gain access to infected regions and liberia the president announced a National Task force to combat the spread of the vie rice. August 1, the three president s detailed their collective strategies for eradicating the virus in a joint communique following a meeting of the manu river union. We commend all three countries for taking the outbreak concrete and taking stepsteps to address it. A case ins news of maked need fora a National Plan and National Response more important than ever. Today with those who told mow that the Health Ministers of the throw affected states will meet again at the end of this week on august 11 through 14. Thethat following that Health Ministers of all of the states will meet on august 28. The intensified attention of the Health Ministers of the entire a good sign and dem monostruts that the whole region with this crisis. Assistant secretary greenfield president s ofthe and sierraeria leone. Department the hosted a moderated a meeting on webb on the sidelines of the summit toa leader discuss the next steps for controlling and ending the virus. Directsecretary, c. D. C. Toreor and n. I. H. Directors, assistant administrator for health and the lie minister and professor, nigeriandent of the academy of science participated in the meet. D. O. D. , andves from the world bank and private partners like the g. E. Foundation also joined. In addition to emphasizing the need to focus on tee textion, isolation and adequate training for Health Workers in the field our longtermized commitment to building the healthcare capacities of west african nations beyond this immediate crisis intervention. We continue to work with our International Partners and the neededto assess what is to properly treat patients and response. Sustainable such support has included providing financial and properly assistance to equip, Treatment Centers and supporting communication efforts Healthcare Workers assess affected communities. Communities. Ed the w. H. O. Sub Regional Coordination Center opened on july 23. And is coordinating all surveillance efforts, harmonizing Technical Support and mobilizing resources being provided to the affects countries. The organization has also launched a 100 million plan toy response search to mount a more effective response. We are in continuous discussions new ways to provide assistance. No higherment has priority than the protection of u. S. Citizens. Sympathies todeep the family of patrick sawyer, a sen who died in nigeria after contracting the virus in liberia. Additional citizens affiliated with the response organizations have been infected liberia and are currently undergoing treatment. We are in close contact with the sponsoring organizations of those two structurally deficient bridges and our thoughts and and to go out to them their families. U. S. Embassies in the affected disseminatede security messages including the resident andgs to traveling u. S. Citizens. We continue to take steps to educate citizens about the virus. And we also take the safety and wellbeing of our staff seriously. The departments chief of Infectious Disease traveled to west africa to Embassy Staff with assistance regarding Protection Measures and case recognition. Aally, embassies in the affected region have organized regular town Hall Meetings to questions and concerns of Mission Personnel and u. S. Citizens. Embassies in neighboring andtries like mali, senegal togo also held meetings and to plans forngency Embassy Personnel and resident citizens in the event of an outbreak. Closing, mr. Chairman, i would like to reiterate and assure this committee that the takes the of state ebola threat very seriously and we are fully dedicated to our governmental and nongovernmental allies, the Interagency Community and host governments in the affected countries to respond to this crisis, prevent its spread and to restore stability to the region. I thank you for your attention to this issue and look forward questions. G your thank you so very much. Ambassador williams. Questions toew pose. Beginning first as, doctor, frieden you said supportive with nois are important vaccine or drug threepoint you noted hydration and antibiotics to deal with some of the other coinfections. Disproportionallity in result when it comes to whether or not he would are talking about an elderly person, woman, a man, a child, a woman happens to be pregnant or someone who has a compromised immune system . What has been the m. O. Of that, if you could . Secondly, i know that treatment example in guinea there is three to four treatment but it is hard for people in that country as well liberia ands sierra leone to get to the Treatment Centers. A long trek. Not only the person is very others could come in context with him or her. There seem seems to be an overwhelming need. One of the points that i think that is be underscored underappreciated in many places dealing with someone especially in that part of the world there is a psychological trauma alone. Almost exacerbates the spread of the disease because people wasnt to be around, near, touchingnd what this person is highly infectious, that is when family members and others might if you could speak to that. The lack of testing. Testing areas, whether as part of the Treatment Centers, whether it is a testing lab, it is my understanding especially since this masks and parallels other looks like other things but it is ebola but you get this test back, how long tows it take to do the test . Ly through thel lu work with the bush program and theollowed up with obama, Building Health capacity and labs in africa is a very high seeingy and now we are where inadequate labs or lack of being sickto people and not even knowing it. The courage of the healthcare needs needs ec exclamation points. I know you go on the frontline you into contagious areas. But dr. Brantley and ms. Whitebol and others who put their live on the line motivated often by faith in the case of dr. Brantley. Hisd some of the things wife put out and the prayers offered up not just for him but for all of the victims. Liberia there have been 60 Healthcare Workers infected. Dead. Healthcare33 workers, infected, 20 dead. How does a country now attract or retain Healthcare Workers who arena thet to that prospects of me getting this are very real. Protectiveough equipment . The gowns, to mitigate the of transfer . And finally, and i do have other to myons but i yield colleagues. Promising drugs. Them. S one of the phase one trials and the f. D. A. Has a hold on it. They were contracted by the defense. T of from what i read, and it is only available data it was showing promise. Im not sure if there is any way to accelerate knowing that you want to obviously put something risky because is ebola is not 100 fatal, as we all mow. We dont want people getting sick from the remedy or supposed remedy. What about accelerating this . Is there an effort to do that. And my final we is about the of air flight. Many people have contacted my isice to as certain how safe it to fly perhaps next to somebody who maybe changed the unitedroute to states coming from liberia for example . Efforts at the airports, particularly where large population, i dont know if you have enhanced efforts there where there is africa are more likely to go, but are they up to task of detecting at point of embarkation passengers who be sick from ebola . Let me try to quickly give clear answers to all of those questions. The first is a relative case fatality rate of different groups and in the current tooreak the data is still foggy for us to give you clear data. The kind of robust will havewe eventually. Intriguinge historical fact which i think is worth mentioning. Laboratoryre was a accident in marburg, germany. Marburg virus was then identified. It was a similar fatality rate to ebola. If anything, a little higher, around 0 . Outbreaks in the 80 range in a africa. In germany it was 23 . That might have been because of Supportive Care. There was no specific antiviral treatment. Because have been people were healthier going in. It was interest mattically that is annd important point. Good supportive healthcare is a lives. Way of saving and we should never lose sight of that. Second, in terms of Treatment Centers you are correct that there is a challenge in getting to Treatment Centers and that is in fact the number one priority which u. S. A. Team id is convening and c. D. C. Is the med caglia Health Aspects of on the ground today liberia to assess. Challenge in the city of montori rovey and in the trihundredtry area. Facilityt whether one or multiple facilities a and where the facilities would be is a critical issue for us to coming days. The Treatment Centers as you point out are very important to support. With the american from sierra leone and speaking givingimple things like them cell phones to talk to their family or things that they can do while there was very important. And if patients dont believe that they will be well treated in the Treatment Centers they and may continue to spread it in the communities. Important. Y care is in terms of testing you are absolutely correct. As you know, mr. Chairman, with the c. D. C. Has represented crowiate the african sew tiety for laboratory and that has for the First Time Ever had high Quality Laboratories established all over africa. Countries have not been the focus countries so they have areaed activities in the a scaling up Laboratory Testing is important. In two ways. First, this isnt simple laboratory tests. P. R. R. Realtime the results back within a day possible positives are are not careful and that would be a real problem. We are workin working with International Partners involved Defense Department which has a very active program in sierra leone. Will also establish safe transport means. Rt we have done in in uganda. A lab out all over but quite possible to get transport into the lab and this is what we will establish in the days. In terms of the courage of Healthcare Workers i certainly agree with you and it is an for Healthcare Workers. For patients. We heard that with healthcare functional problems like malaria may become more deadly. Other conditions that arent treated because of ebola. So responding is so very and protecting the responders is so very important. Are see aspect that we working on with the world Health Countries andnd others is making sure there is protettive equipment there for ers. Thcare work we believe it the possible to evencare of ebola patients in africa safely but takes meticulous i tension to detail. I can assure you that the u. S. Government is looking at promising drugs and we will look at this as ways to eck podite development or production but i dont want any false hopes out there. Know if theydont work and we cant force we know have them in any significant numbers. The med sips used in the experimental cases as far as i not easy tot are use. They require infusion and may events and basic as artive care in place rerequisite to giving the treatments. We have to do the basics right might not have effective and available treatment in three months or six years or one year or five but we today have the means to stop the outbreaks. Airlinelly in terms of in the, we do have teams affected countries working with the equivalent of their Border ProtectionServices Helping them to do screening at the airports. Measure. A simple it is key first to reduce the number of cases. That is what is going to be the safe effort. And there are other things that can be done at airports in terms asked orons to be temperatures to be taken. Matched to be cross against known patients with known contacts. Procedures do take time to set up but we have teams now. On them if somebody is in proximity to a sneeze or a cough is that a transmission . In medicine we often say never say never. We haveneral the way seen the disease spread is by ille contact with very people. As you know, the individual who to lagosfrom liberia plane and ill on the we have assisted the countries to track the travel ares who have traveled with them and as now have not identified illness in any of them. Not from sneeze or a cough. In general, close contact with is very ill but we to have concerns there could be transmission from someone who is very ill. Fever stage, you are from obamato get it stage . Dy at fiver if they are just clearing their throat or sneeze original not have a fever and have not become ill with ebola they are not infectious to others. If someone became ill on the plane and was having fever or bleeding that might present a risk to those who came in contact with that and didnt appropriate precautions. Is there a way of advising airline personnel, particularly flight attendants who might be proximity to the plane. And the c. D. C. Advise them the airlines on numerous flights to the region . Provided detailed advice to the airlines. You spoke and i think it was insight about the handling for funeral arrangements and sensitivity to the culture. Publicit is part of the Information Campaign in guinea areexample, Text Messages being sent with a number of the red cross and one of the Text Messages are the bodies of ebola victims are very contagious, do not manipulate, call the red cross. Im wondering if there is any given. Being i remember after Operation Provide Comfort when the kurds border of way to the fleeing iraq after saddam hussein, i was there five or six days after that and the military using ground and they are cyops to educate and leafletting wet was done in a way that used in a not so benign situation in this case it was to meals ready tod eat and it was amazing how that kind of information made the kurds who were at great risk of starvation very aware of what they neede needed. Any thought with helping with a benign effort to make people aware. I know thi that radio is being. Needs to be done. I cant say that we moved to that point but i think you are very important issue which is that culture makes a difference and you have and dost the messaging the campaign according to the sensitivities and routines and culture. Per what was extremely effective in not only what you mentioned, mr. Chairman, but the fact this they started talking about survivors and the came on the radio and they went around and said look, ands sick but this and this this happened to mow and i did such and such and im still alive. Andet treatment and isolate make sure people know you have this. Important. Y, very waysilitary is helping in with logistics and making sure we can get in body bags and protective equipment for the islthcare providers and that where we are so far. We are relying upon the host to help explain to us one what are the sensitivities and what messaging needs to get out and then helpinhelping with the moans ofe communicate but not the means of the communication but not the message because they know best what they need. [captions Copyright National cable satellite corp. 2014] as you look at the 2014 senate race map on cspan campaign 2014 coverage you can see that there are just over seats. Dozen open 14 republican seats on the ballot. 21 democratic seats. A third of the senate up for grabs and, of course, a shift of six of those seats could also from the democrats to the republicans in 2015