Examining the U.S. Public Health Response to the Ebola Outbreak


Notes from Jane M. Orient, MD on House Committee on Energy and Commerce Subcommittee on Oversight and Investigations hearing held October 16, 2014.

Subcommittee Chairman Tim Murphy noted in summary that the only person assuming responsibility for errors was Dr. Varga.

The CDC is still unable to state exactly how two nurses became infected. It is sticking to the narrative that transmission occurs only through direct contact with a symptomatic infected person or his bodily secretions. The possibility of airborne transmission would require far more elaborate precautions, such as use of powered air-purifying respirators (PAPRs). The CDC is disregarding evidence that Ebola virus can remain infectious for 90 minutes on droplet nuclei.

There is no test that can identify infection before symptoms develop, stated Dr. Frieden. The test is for the presence of the virus, and this is the reason for his confidence that asymptomatic persons are not contagious.

Subcommittee members said their constituents strongly favored restriction of travel from affected areas. Government witnesses said this would be harmful because travelers would evade it by departing from some other region, and then CDC wouldn’t be able to collect information from them.

Despite intense questioning, Frieden would not say whether CDC had recommended travel restrictions or specifically discussed them with the White House. The President has the authority to implement a ban.

Vaccines are in Phase I trials. Contracts are being let, and FDA is streamlining the approval process.

Rep. Blackburn’s question about a problem with our “porous borders” was taken by Frieden to refer to borders in Africa.

She also commented on the problem of dealing with infectious wastes. Hospitals can no longer incinerate them on-site because of EPA restrictions. What are the dangers in trucking them?

In response to her question about risk to our troops, Frieden said their temperatures were being monitored.

She quoted an earlier statement by Frieden about patients lying—was this not a problem with self-monitoring?

Rep. Griffith of Vermont referred to a 2005 CDC study showing antibodies to Ebola in dogs in countries that had had Ebola outbreaks. There is dog-to-dog transmission, and the possibility of dog-to-human transmission has not been ruled out. Should there be a travel ban on dogs, he asked. Customs had referred him to USDA, which referred him to CDC. Frieden will follow up.

Rep. Scalise asked whether Frieden had a “high level of confidence” that our troops are safe. Frieden said the risk is “not zero.”

Many pointed questions asked by subcommittee members were not answered directly. House Republicans will probably propose travel restrictions.

Live tweets from Dr. Jane Orient and Dr. Donald Palmisano are at #E&Cebov.

Testimony from the Oct 16 hearing on Ebola is posted at: http://energycommerce.house.gov/hearing/examining-us-public-health-response-ebola-outbreak.

Hearing Video: https://www.youtube.com/watch?v=FPAeGDciVGs

Witnesses included Dr. Thomas Frieden of CDC; Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Dr. Luciana Borio, Assistant Commissioner, Counterterrorism Policy, U.S. Food and Drug Administration; Dr. Robin Robinson, Director, Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services; Mr. John P. Wagner, Acting Assistant Commissioner, Office of Field Operations, Customs and Border Protection, U.S. Department of Homeland Security, and Dr. Daniel Varga, Chief Clinical Officer and Senior Vice President, Texas Health Resources.

Additional Summary Courtesy of The Market Institute

The House Oversight and Investigations subcommittee met this week to examine the ongoing situation involving the Ebola virus on U.S. soil. Subcommittee Chairman Tim Murphy (R-PA) said in his opening statement that the underestimating the severity of the initial Ebola outbreak has led to mistakes here and abroad. Rep. Michael Burgess (R-TX) said in his opening statement that Ebola policy should not be a political issue, rather an issue of public health. He said that the U.S. cannot protect front line healthcare workers. Rep. Henry Waxman (D-CA) said in his opening statement that they need to accelerate their response in Africa to stop the epidemic before it spreads in the U.S.

The first witness, Dr. Thomas Frieden, Director, Centers for Disease Control and Prevention testified in his opening statement that since the initial outbreak in West Africa, they have been preparing for this possibility by working closely with state and local partners and with clinicians and healthcare facilities so that any imported case could be quickly contained. They remain confident that Ebola is not a significant public health threat to the United States. It is not transmitted easily, and it does not spread from people who are not ill, and cultural norms that contribute to the spread of the disease in Africa – such as burial customs and inadequate public-health measures – are not a factor in the United States.

The second witness, Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases National Institutes of Health testified in his opening statement that In response to the Ebola public health emergency in West Africa, NIAID is accelerating ongoing research efforts and partnering with governments and private companies throughout the world to speed the development of medical countermeasures. Accurate and accessible diagnostics for Ebola virus infection are needed for the rapid identification and treatment of patients in an outbreak because the symptoms of Ebola can be easily mistaken for other common causes of fever in affected areas. They are still in the early stages of understanding how infection with the Ebola virus can be treated and prevented.

The third witness, Dr. Robin Robinson, Director Biomedical Advanced Research and Development Authority Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services testified in his opening statement that ASPR is supporting the Federal Government’s Ebola response effort through policy development, advancements in medical countermeasures, logistical support for deployed personnel, and broader community and healthcare preparedness and resilience through grant funding, dissemination of information to state and local partners, and communication with international partners concerning health security issues. With respect to vaccines, BARDA is working with industry partners to scale up the manufacturing of one of several promising investigational Ebola vaccine candidates to commercial scale with funds provided by the FY2015 CR.

The fourth witness, Dr. Luciana Borio, Assistant Commissioner Counterterrorism Policy, U.S. Food and Drug Administration testified in her opening statement that the FDA plays a critical role in helping to facilitate the development, manufacturing, and availability of investigational products for use against Ebola virus disease. They are reaching out proactively to multiple medical product developers to clarify regulatory requirements, provide input on pre-clinical and clinical trial designs, and expedite review of data as they are received from product developers. FDA also is collaborating with WHO and working with several of our international regulatory counterparts, including the European Medicines Agency, Health Canada, and others, to exchange information about investigational products for Ebola. This epidemic has placed incredibledemands on FDA, but staff is fully committed to responding in the most proactive, thoughtful, and flexible manner.

The fifth witness, John P. Wagner, Acting Assistant Commissioner Office of Field Operations, Customs and Border Protection, U.S. Department of Homeland Security testified in his opening statement that CBP works closely with CDC to recognize the signs and symptoms of international travelers who may be ill with a communicable disease of public health significance such as Ebola. CBP is continually providing updated guidance to its frontline personnel regarding Ebola, to include background on the current outbreak and impacted regions. DHS has executed a number of measures to minimize the risk of those sick with Ebola entering the United States, taking a layered approach to ensure there are varying points at which an ill individual could be identified

The last witness, Dr. Daniel Varga, Chief Clinical Officer and Senior Vice President,Texas Health Resources testified in his opening statement that as the first hospital in the country to both diagnose and treat a patient with Ebola, they are committed to using our experience to help other hospitals and healthcare providers protect public health against this insidious virus. They have taken all steps to maximize the safety of their workers, patients and community, and will continue to make changes as new learnings emerge.

In response to questioning, Dr. Frieden said:

They will consider all options to better protect Americans

DoD does not intend for U.S. soldiers to come in direct contact with Ebola patients

A ban on air travel from Africa into the U.S. would not necessarily prevent more Ebola patients from getting into the country, but it would remove an additional level of identification of the virus

In response to questioning, Dr. Fauci said:

Pharmaceutical companies have begun working on Ebola research and a potential vaccine

In response to questioning, Dr. Borio said:

They are expediting the process of developing a quick Ebola test

In response to questioning, John Wagner said:

It is easier to identify travelers with Ebola when they aren’t trying intentionally to deceive you

There are no direct flights from the affected countries into the United States

In response to questioning, Dr. Robinson said:

Manufacturers have said they are ready to deliver medical protective gear in 24 hours and have reported no shortages

In response to questioning, Dr. Varga said:

Healthcare workers at his hospital had received no direct Ebola training prior to the arrival of the first case last month

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