You cant come into personal contact without having the proper protective equipment. Funerals are another way as well as preparing the bodies and the customs, the longrange traditions that go with the funerals. The mechanism of transmission, direct contact with body fluids explains what is going on in the west african countries. You are convinced no significant outbreak in the u. S. . The reason i say that let me reiterate it. The reason there is an outbreak now is because the Health Care Infrastructure and system in those countries is inadequate and uncapable of actually handling the kind of identification, isolation, rapid treatment, protection of the people who are coming into contact and Contact Tracing. Thats something that we have very, very well established here. So we have a case now and it is entirely conceivable there may be another case but its the reason we feel confident is that our structure, our ability to do those things would preclude an outbreak. Let me just take this gentlemans question here, the question of are we being notified of cases . This goes to what dr. Fauci just said we have an infrastructure in place. We have a Public Health alert system through which cdc has distributed information from and established a Laboratory Network for testing. When will are potential symptomatic individuals who present themselves in medical facilities the precautions are immediately taken. The tests are undertaken through a network of laboratories that cdc has validated and provided a clear guidance to. So we have the structure in place when we identify potential cases to resolve those and if there are actually confirmed ebola cases as we have seen one of in texas, we take the immediate steps, isolate them, provide the treatment and the Contact Tracing and our infrastructure works to make sure we are aware of those cases and take those steps. When secretary burwell said we have a case at howard but did not say a potential case but did not say we had one at shady grove adventist and the hospital put out a release. Are there only two or more than those two in the Washington Area . Nationwide . Right now youve indicated and youve talked about the potential case at howard. Well see the resolution of that as secretary burwell discussed. And at shady grove adventist. As the reports come in they will be addressed and reports undertaken. The Public Health infrastructure is reacting. I think perhaps, dr. Fauci will want to address this. Every hospital can isolate a patient, take the meshes put them in place to make sure they are isolated and the follow up steps are taken. Lisa, so to what degree have you debated internally and are you going to be prepared to recommend to the president what someone suggested today a travel ban from those countries from anyone who wants to come to the United States directly or indirectly. How do you think your deployed assets are as far as catching up to what you intend to do. And should military medical people be involved in the direct care as opposed to setting up the infrastructure . The travel ban question first. That has been something an issue that has been raised. Ive take note of dr. Friedens comments which is to say in fact right now we believe those type of steps impede the response. They impede and slow down the ability of the United States and other International Partners to get expertise and capabilities and equipment into the affected areas. And as weve said and stressed the most important and effective thing we can do is to control the epidemic at its source. So we want to ensure we are getting the assistance and expertise and we are getting the providers into the infected region and not impeding that. Before you go, Many Americans might say why not half a ban. Not getting there but exiting . Are you considering that . Let me just respond to that. As i mentioned as the measures are being taken to screen individuals who are departing from the infected countries, cdc professionals have provided the assistance and training and advice to airport officials in liberia, guinea and sierra leone. And as a result of those screening steps, many, many people, dozens of people have been stopped from traveling. So we see those issues those steps being effective. Sir, for us the speed we are moving out is focused on the ebola treatment units to get them going. That will take us several weeks. We are working with the armed forces of liberia and contractors and were working with a logistics chain of events to get the bill of materials there as fast as we can. It will take us several weeks to do that. And we are doing ones in isolated areas that are hard to support and get the equipment out there. Those will take the longest. Right now we are not anticipating that military personnel will be treating the people and that would be a decision made in the future. The International Community has said not right now. Thats not what we need. You do have folks capable of doing that, dont you . We do. And medical professionals there are three labs operated by military medical professionals right now identifying who has the disease and who doesnt, which is focusing on how they are able to treat the patients. Have you considered a waiting peter as josh would say i think were going to move around a little bit. Help me understand the stuff that you talked about in terms of preparedness here in this country, the conversations with the hospitals, the coordination with the local authorities and all, seems very disment that in the country for people who look at one of the first cases and see that the whole thing broke down every step of the way. It broke down as the person back there was saying when he lied on the form. It broke down when the hospital turned him away. It broke down when the materials that were in his apartment havent been thrown away. It broke down i mean, it feels like to americans like you guys are up here talking about we have this great and perfect system thats going to be able to you know, contain this virus because we have done all this preparation but it doesnt look like its working. How should the average person have confidence that whether its the case in howard or whether its some case somewhere else in the country at the moment that someone isnt being turned away there that their temperature was taken in africa but they are on a plane as we speak. So square the dissonance between your confidence and the fact that things dont seem to be working. I think the American People should be confident for all the reasons we have stated and the president has spoken to. Because the Public Health infrastructure we have is so expert and extensive and is considerable and as dr. Fauci has discussed and dr. Shah has mentioned the situation in liberia, sierra leone and guinea could not be more opposite in terms of the Public Health infrastructure and the ability of and the ability of officials there to isolate an individual case. What youre seeing in texas is the isolation of that patient, the Contact Tracing that is being down, meticulously by cdc and local health professionals. The other thing i would say to your question is we have a case in texas. The howard case that has been mentioned is a potential case. And i would defer to the medical professionals at howard to give the definitive view on that. But i think its very important to remember this outbreak began in march of this year. And since that time, and since the screening measures that weve discussed from this podium began over the summer, there have been tens of thousands of individuals who have come to this country from the effected region. And we have now seen one case and it is entirely possible we will see another case. However i would point you and others to the fact that we have now seen tens of thousands of people in the time since march to the country to the current day and we now have this isolated case in texas but we have a Public Health infrastructure and professionals in this country who are capable of dealing with cases if they present themselves and as dr. Frieden has said we are very confident we can stop this and other cases in its tracks. Can you explain within that Public Health infrastructure what the lines of authority are . Once you is a confirmed case, for example in dallas, does the cdc, does the nih, is there a federal authority . Is it up to the local Health Department . Who is in charge at that point . With regard to one of the things, when any test is done it is reported to cdc. So we have a network and we want the tests to go quickly. Part of the preparedness we did was created capability all around the country for the tests to occur. So they can occur quickly. However when that test occurs, cdc is alerted to the test occurring and the results of the test. With regard to who controls the patient i think is the question, that is done at the local level. And we support in that. And the ten people were on the ground from cdc immediately. I think you all know, in terms of supporting the local Health Departments and doing the Contact Tracing and any other issues they have. With their issues of the testing or the contact stras tressing we stand ready do that. While the local Health Officials because this is a local issue and that is a big part of how you do the Contact Tracing and they make the decisions on the ground. We are there hand in hand and had support with ten people on the ground and work hand in glove with that. On the Contact Tracing because some people in dallas are concerned about the Contact Group being isolated in a highly congested apartment area and i think that some of them there was an expression they should be moved. Is that something that could be repeated in other communities. If they are isolated for a period of time is that the best place to keep them in a place where it might be a high density apartment. That gets to the question of how local officials handle their situations specifically. I think dr. Fauci has gone over the way and the protocol what needs to happen is basic temperature taking two times a day on a regular basis. Hour a local official chooses to impment that we work in conjunction. We have given the guidance out but those are decisions made at the local level. Can you the this is the the ed show on msnbc. You are watching the white house officials briefing on the ebola outbreak. They emphasize that americans should feel confident about the United States response and Public Health infrastructure. Moments ago, Sylvia Burwell says that the cdc has been sending out diviguidelines. Cdc sent out our first guidance to state and local officials on july 28th and has been followed with six additional sets of guidance and the latest issued yesterday. The nurses on the ground say they arent getting that information. A National Nurses united survey found 80 of nurses say their hospital has not communicated on any policy on ebola patient admission and 87 say they have not provided the ebola education with the ability to ask questions and onethird of the nurses say their hospital has insufficient supplies of eye protection and fluidresistant gowns. The cdc says they will be able to stop ebola in the United States. That is good news. But the bottom line is, doctors, nurses and all Health Care Professionals need to be on the same page. Nurses need the proper gear and the resources. There has been a protocol like what dr. Nancy had outlined this morning, dr. Nancy snyderman who is been quarantined for 21 days. I want to bring in debra berger the co president of National Nurses united. Good to have you with us tonight. I appreciate your time. Thank you for taking the time. You bet. I want you to respond to what you heard at the White House Press conference in the last half hour. Anything that jumped out . What jumps out is they are still maintain they have this under control and we all should not worry because it wont come to a Community Near them. But the reality is our survey clearly shows that we are not ready in americas hospitals to deal with any kind of major Communicable Disease of this nature. Should there be a Standard Operating Procedure like dr. Nancy schneiderman outlined today . They need to have a standardized plan that is implemented in every sincele hospital. Currently our Health Care System allows for private hospitals to decide what protocols they choose to follow and what personal protection they choose to supplies and how they handle waste. And were saying we believe as nurses we can only provide safe care if we have safe staffing, if we have adequate resources and if we have adequate personal protection to protect the Health Care Providers from this Communicable Disease. So ms. Berger what im hearing is you cant leave it to local officials to get this right. There has to be some standards that are going to be met and National Protocol to deal with this ebola virus. Am i hearing that correctly . You are absolutely hearing it correctly. Whats happening now is our Health Care System is very fragmented. We have a privatized Health Care System. If we had a Public Health care system, which the cdc was referring to at the press conference, we would be in much better shape right now. But unfortunately, we have what is in place, which is aetna, kaiser, sutter and all these other Health Care Providers deciding what theyre going to implement and we think it should all be mandatory. And the other thing is this reliance on technology that theyre using for standardized protocols. Theres no standardized protocol in place currently for dealing with ebola. Thats what weve been shouting about for the last several months. Well, i want you to address this. 80 of the nurses in your organization say their hospital has not communicated any policy on ebola patient admission. Now, is it that they dont know what to communicate and theyre not sure exactly what their policy of isolation and protocol would be even on a local level . I think its all of the above. If you go to any hospital right now, i would bet that it would be very hard for any nurse to pull up a policy that they would be able to follow in their hospital on how to provide care for an ebola patient. The example i use is in california. We had an ebola patient in South Sacramento and they were scrambling to get the personal protection and tools they needed to get care for that patient. And that was just a suspected patient. It turned out not the be ebola. But had it been it would have been a mess. And of course, your Organization Also has concerns about proper equipment. How do you fix that . I mean it would seem to me that these forprofit hospitals are going to have to start investing and investing fast. If a third of your nurses say the hospital lacks eye protection and fluid resistant gowns. This is a National Health care crisis. And the federal government recently in 2006 spent 47 million on preparing for a pandemic, not even ebola. And their own report for department of Homeland Security indicated that theyre nowhere near ready for a pandemic. And what we think is there needs to be a National Priority to provide the personal protection for all Health Care Workers in this country. Debra berger, co president of the National Nurses united with us here tonight. I appreciate your time. Thank you for the nurses side of the story. I want to bring in Jim Mcdermott of washington who is a doctor. Good to have you on tonight. The cdc says there is no doubt that we will stop ebola from spreading here. But based on what were hearing, boots on the ground, the nurse and what they are hearing, how do you piece this together . Im a physician who has lived in west africa where the ebola virus was found or where it has been an outbreak. I have also lived in the congo where they have had many outbreaks of ebola virus. And i think whats important here is for us to take a deep breath and step back and think a little bit about this, not let our hair get on fire. There has been one case in the United States discovered that came in. If we look at our preparedness for any kind of catastrophe in almost any hospital we are not prepared for it. When you is a chemical outbreak or a machine break down and you spill chemicals all over the place and thousands of people effected by it. All those issues are being dealt with by the cdc very thoughtfully. They are sending ten people down to texas to look at this case and theyre going to get it under control there. People in texas dont have to run around and worry about the fact there is going to be a major outbreak there. There wont be one. They are dealing with it. Thats what Public Health is all about. Many of my colleagues thing that you know, how the Health Department a