Update on the U.S. Public Health Response to the Ebola Outbreak

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Congressional hearing summary provided by The Market Institute

The House Energy and Commerce, Oversight and Investigations subcommittee met on November 18, 2014 to receive the latest update on the ongoing outbreak of the Ebola virus and the government’s response. In his opening statement, Chairman Tim Murphy (R-PA) said that they will determine the lessons learned thus far in the fight against the Ebola virus outbreak and what the Administration plans to do with the $6.2 billion in funding it’s asking for. With no cure or vaccine available for the Ebola, he is recommending these steps to ensure a strong defense against the virus:

  • A ban on non-essential commercial travel;
  • A 21-day quarantine or isolation for those who have treated an Ebola patient
  • Upgrades and training for personal protective equipment
  • Designating specific Ebola-ready medical centers
  • Accelerate development of promising vaccines, drugs, and diagnostic tests;
  • Additional airplanes and vehicles capable of transporting American medical and military personnel who may have contracted Ebola back here for treatment;
  • Additional contact tracing and testing resources for public health agencies;
  • Information for Congress regarding any resources needed.

The first witness on the first panel, Dr. Thomas R. Frieden, Director at Centers for Disease Control and Prevention testified in his opening statement that there are some promising signs in parts of Liberia, but the epidemic continues to rage there and elsewhere in West Africa. Some of this progress could be attributable to the extensive work the United States Government and partners have done to increase treatment and isolation, and safe burials. The government has instituted layers of protections for Americans, starting with rigorous screening of passengers leaving the affected countries. Following the spread of the virus from the index patient in Dallas, TX, additional steps have been taken to increase the preparedness of hospitals. CDC is leading teams of public health infection control experts to assess the readiness of hospitals. This endeavor prioritized geographic locations around the hospitals where increased screening was occurring at airports and continues in a strategic manner. CDC’s top priority is to protect Americans from threats. In the case of Ebola, it means not only working here at home, but eliminating the risk to Americans by stopping this epidemic at its source in Africa.

The second witness on the first panel, Dr. Nicole Lurie, Assistant Secretary Preparedness and Response at HHS testified in her opening statement that ASPR has been uniquely successful in advancing the nation’s preparedness through its coordination and collaboration with a broad array of partners. These day-to-day activities, and the infrastructure put in place are key to responding to Ebola. The best way to protect America from Ebola is to support the response to the epidemic in West Africa and to get infection and spread under control as quickly as possible. They are mounting an aggressive whole-of-government response strategy to the Ebola crisis, focusing on controlling the epidemic; mitigating the secondary impact, including economic, social, and political tensions; coordinating the U.S. and broader global response; and reinforcing global health security infrastructure in the region and beyond.

The third witness on the first panel, Rear Admiral Boris Lushniak, M.D., Acting Surgeon General at HHS testified in his opening statement that officers from the USPHS Commissioned Corps are operating in both the U.S. and West Africa in clinical, management and liaison roles supporting the Office of the Assistant Secretary for Health and the CDC. Officers deployed to Liberia will have completed rigorous and intensive CDC-developed training in Anniston, Alabama prior to their deployment. Training includes didactic, situational, and hands-on advanced personal protective equipment (PPE) training to ensure officers possess sufficient knowledge of Ebola and transmission routes to work safely and efficiently in the well-designed Monrovia Medical Unit (MMU). Four overlapping teams of approximately 70 officers are scheduled for rotations of approximately 60-day deployments for an estimated six months of operations at the MMU. Officers will be returning into one of the five designated airports for enhanced screening just as all other individuals returning from patient-care-related activities in West Africa.

In response to questioning, Dr. Thomas Frieden said:

  • Funding will partly go to hospitals to increase their waste management capabilities
  • The main mechanism of spreading the virus is touching bodily fluids
  • They do not want to interfere with the current process of screening and tracking and inadvertently make the situation worse
  • The emergency funding request is essential to protect Americans at home and stem the crisis in West Africa
  • CDC is working with Customs and Border Patrol to monitor incoming air travel passengers

In response to questioning, Dr. Nicole Lurie said:

  • There are two Ebola vaccines in development; they are optimistic for the upcoming Phase 2 trials

The first witness on the second panel, Ken Isaacs, Vice President, Programs and Government Relations at Samaritan’s Purse testified in his opening statement that the media coverage on Ebola is already decreasing as if the disease itself is burning out, but we cannot assume that Ebola will now just go away because of the measures that have been implemented so far. The CDC is predicting that as many as 1.5 million people in West Africa will be affected by Ebola by mid-January. However, there appears to be improvement in Liberia. Data reporting on the disease has been grossly inaccurate from the outset, yet there is a noteworthy trend as evidenced by fewer burials, a substantial number of empty clinic beds, and fewer cases found in some of the early hottest spots of the epidemic. There must be more done than just screen departing passengers for fever. We have to be willing to consider implementing a policy of “essential” travel only that would be coordinated internationally.

The second witness on the second panel, Dr. Jeffrey Gold, Chancellor at University of Nebraska Medical Center testified in his opening statement that The University of Nebraska Medical Center (UNMC) and hospital partner, Nebraska Medicine, have successfully treated Ebola patients. He urges Congress to approve funding and policies supporting full reimbursement of the cost of care for these unique cases that are not recoverable from insurance policies. These are patients that federal government directed to UNMC and Emory. A mechanism to provide payment for the unpaid portions of the treatment seems fair. Guaranteeing financial sustainability for UNMC, Emory and future regional centers that may be designated to care for Ebola virus disease cases is critical to containing any future outbreak of an infectious disease.

The third witness on the second panel, Dr. David Lakey, Commissioner at Texas Department of State Health Services testified in his opening statement that the response to Ebola in Dallas, Texas, exhibited the strength of public health processes. No secondary cases of Ebola resulted from community exposure. The two secondary cases that occurred were associated with direct care by health care workers of an Ebola patient. Texas Governor Rick Perry has formed a Texas Task Force on Infectious Disease Preparedness and Response, the purpose of which is to assess and enhance the state’s capabilities to respond to outbreak situations.

In response to questioning, Ken Issacs said:

  • There are only two commercial airlines left that are flying to and from Monrovia and if they decide to stop that service it will create a commercial quarantine of Liberia
  • He fully supports the formation of an “air bridge” for humanitarian workers, medical workers, and volunteers

Hearing Website:
http://energycommerce.house.gov/hearing/update-us-public-health-response-ebola-outbreak

Hearing Video:
http://www.c-span.org/video/?322805-1/hearing-us-response-ebola

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