From the Pandemic Flu Forum, via Pixie a moderator: (snippage is Pixie's, I believe)
Congressional Seminar on the Ebola Outbreak in West Africa
Drs. Tom Frieden and Kejii Fukada were among the panelists who updated members of Congress on the Ebola outbreak in West Africa. They also discussed actions international organizations could take to curb the outbreak.
SEPTEMBER 24, 2014
http://www.c-span.org/video/?321685-1/congressional-seminar-ebola-outbreak-west-africa
[snip]
Frieden:
I WOULD ALSO LIKE TO RECOGNIZE THE UPN SEE CENTER FOR HEALTH SECURITY FOR HOSTING THIS EVENT. THAT YOU FOR THAT. I WOULD LIKE TO TURN IT OVER TO THOMAS INGLESBY, OUR MODERATOR TODAY TO INTRODUCE OUR DISTINGUISHED PANEL.
[snip]
FIRST, JEREMY KONYNDYK WAS THE DIRECTOR OF THE USAID OFFICE OF U.S. FOREIGN DISASTER ASSISTANCE. TOM FRIEDEN WAS THE CORRECT OF YOU CENTERS FOR DISEASE CONTROL, AND COFOUNDER OF ONE OR DECISION, AND ANDY WEBBER WAS THE ASSISTANT SECRETARY DEFENSE FOR NUCLEAR CHEMICAL AND BIOLOGICAL PROGRAMS.
WE ARE SORRY NOT TO HAVE KEIJI FUKUDA ON THE AGENDA. WE THOUGHT WE HAD KEIJI UNTIL 24 HOURS AGO WHEN HIS BOSS, W.H.O. CHAN SAID SHE NEEDED HIM IN NEW YORK TODAY.
[snip]
I'VE NEVER SEEN A PUBLIC HEALTH SITUATION WITH THIS MUCH NEED FOR IMMEDIACY. AS I'VE EXPLAINED TO PEOPLE, AND ADEQUATE RESPONSE TODAY IS MUCH BETTER THAN A GREAT RESPONSE IN A WEEK.
[snip]
THESE ARE EXTRAORDINARILY LARGE. AND THAT'S WHAT'S REALLY HARD TO GET OUR MINDS AROUND BECAUSE NOT ONLY ARE THE NEEDS LARGE TODAY BUT HE WILL BE TWICE AS LARGE IN LESS THAN ONE MONTH. AND IF WE'RE GOING TO BE SUCCESSFUL WE HAVE TO BUILD TO WHERE THEY'RE GOING TO BE IN A MONTH.
[snip]
W.H.O. IN THE PUBLICATION YESTERDAY RAISED THE POSSIBILITY OF EBOLA BECOMING ENDEMIC IN AFRICA, AND THAT WOULD MEAN FOR THOSE WHO ARE NOT IN THE PUBLIC HEALTH WORLD THAT THEY WOULD CONTINUE ON AN ONGOING LOW OR MEDIUM LEVEL INDEFINITELY. WE THINK THAT'S NOT INEVITABLE. WE THINK IF THAT WERE TO HAPPEN, IT WOULD BE AN ENORMOUS PROBLEM, NOT JUST WEST AFRICA AND AFRICA BUT FOR THE WORLD.
[snip]
WE NEED TO GET, TO SCALE AND THE SPEED THAT WILL MATCH THE EXPONENTIAL GROWTH OF THE OUTBREAK, TO ENSURE THAT AN IMMEDIATE RESPONSE, THAT PREVENTS THIS FROM BOTH HAPPENING WHERE IT'S NOT HAPPENING NOW AND FROM HAPPENING AGAIN ANYWHERE WHETHER IT'S EBOLA OR ANY OTHER HEALTH THREAT.
[snip]
Jospeh Fair, special adviser to Sierra Leone Health Minister:
WHAT WE ARE FACING IS INTENDED A CENTER LOCALLY OF BIBLICAL PROPORTIONS. AND FOR THE PEOPLE OF THOSE TWO COUNTRIES LARGELY FEEL ABANDONED BY THE INTERNATIONAL COMMUNITY. HOWEVER, THAT RESPONSE IS NOW STARTING TO TRICKLE IN AND THERE IS HOPE, THERE IS A LIGHT AT THE END OF THE TUNNEL
[snip]
WE HAVE COMPLICATING THIS FACTOR THAT EBOLA IS NOW OCCURRING IN THE HIGHLY MOBILE ENVIRONMENT, THAT IS WELL CONNECTED BY ROADS. WE ARE DEALING ONLY WITH COLONIAL BORDERS. THESE ARE NOT TRIBAL BORDERS.
[snip]
YOU CAN SEE WHY THERE IS A TENDENCY WHICH WE'VE ALL READ ABOUT THE PEOPLE FLEEING, RUNNING, NOT COMING INTO THE TREATMENTS AND. THAT'S LARGELY BECAUSE OF THE TREATMENT CENTERS ARE CONSIDERED A HOUSE OF DEATH. I THINK WE'RE TURNING THE CORNER IN KIND OF THAT OPINION, AND THE REASON WE SAW THAT EARLY ON WAS PART OF THE MESSAGING. MUCH OF THE MESSAGING WE GAVE EARLY ON IN THIS EPIDEMIC, WHICH WAS ACCURATE BUT NOT LOCALLY UNDERSTOOD, WAS IT IS THE LICENSED TREATMENT FOR EBOLA VIRUS. BUT WE HAD AS RESULT OF THAT IS A LARGE PORTION OF THE POPULATION, WELL, WANDA DIDN'T BELIEVE IN EBOLA VIRUS TO START, BUT TO COME WHY SHE WOULD REPORT TO A TREATMENT CENTER IF THERE IS NO TREATMENT FOR EBOLA? RATHER THAN HEARING THAT SUPPORTIVE CARE WILL INCREASE YOUR CHANCES, WHAT THEY HEARD WAS THERE'S NO TREATMENT FOR EBOLA. SO THAT LED ALMOST HALF OF THE POPULATION GENERALLY SEEK OUT TRADITIONAL HEALERS. A LOT OF THAT INVOLVES BLOODLETTING WHICH IS PROBABLY THE WORST THING YOU CAN DO DURING AN EBOLA OUTBREAK AND THAT IS ALSO GREATLY COUNTRY WOULD TO THE SPREAD OF THE VIRUS.
[snip]
I WANT TO CAUTION THAT, YOU KNOW, A PHENOMENON THAT WE'VE SEEN SINCE THE INTRODUCTION OF THINGS LIKE ZMAP AND THE INTRODUCTIONS OF EXPERIMENTAL VACCINES, WHAT THAT HAS RESULTED IN LOCALLY IS THE BELIEF THAT THAT IS GOING TO BE THE ANSWER TO THE OUTBREAK. THE LOCAL POPULATION THINKS WE HAVE THESE MIRACLE DRUGS, MEDICAL VACCINES ARE GOING TO STOP THIS OUTBREAK AND THAT'S HOW WE'RE GOING TO COME IN AND THAT'S WHAT WE'RE GOING TO HALT THE OUTBREAK. AGAIN I GO BACK TO THE NUMBER ONE PRIORITY IS EPIDEMIOLOGY. WE'RE GOING TO STOP THE OUTBREAK BY STOPPING THE TRANSMISSION CHAIN AND A PRETTY ARE INFECTIOUS CONTROL AND TREATMENT CENTERS. AND IN THE LONG-TERM WHAT THIS IS GOING TO REQUIRE IS ALMOST A REBUILDING OF THE PUBLIC HEALTH INFRASTRUCTURE OF THIS COUNTRY.
[snip]
TANKERS, INCLUDING OIL TANKERS HAVE NOT THREATENED TO STOP DOCKING IN SIERRA LEONE AND LIBERIA AND THAT WOULD CREATE A WHOLE OTHER SET OF PROBLEMS. NO FUEL FOR THE CARS THAT WE STILL DON'T HAVE
[snip]
I WILL SAY WE ARE FACING A VERY UNIQUE SITUATION, SPECIAL IN SIERRA LEONE AND LIBERIA TO A LESSER EXTENT GUINEA IN THAT THIS IS THE FIRST TIME ALMOST THAT WE HAVE HAD AN OUTBREAK OF HEMORRHAGIC FEVER IN AN AREA WHERE WE ALREADY HAVE A HYPERENDEMIC HEMORRHAGIC FEVER, LOSS OF FUTURE. AND AS OF LAST WEEK REALLY WE ARE STARTING TO INTO THE DRY SEASON OF SIERRA LEONE WHICH IS THE SEASON SO THE AREAS WHICH ARE THE MOST AFFECTED ESPECIALLY -- THE AREAS OF LIBRARY THAT HAVE BEEN INFECTED, THOSE HAPPEN TO BE OUR HYPERENDEMIC AREA FOR FEVER. SO VERY SHORTLY AND WE'VE SEEN THIS WE'RE GOING TO MULTIPLE HEMORRHAGIC FEVERS PRESENTING AT THE SAME TIME, AND RIGHT NOW THAT'S NOT EVEN A PLACE REALLY TO PUT ALL OF THE EBOLA PATIENTS. SO NOW WE'RE GOING TO BE THINKING ABOUT HOW DO WE SEPARATE THE PATIENTS BECAUSE THAT'S NOT SOMETHING WE WANT TO MIX. THE CHANCES OF SURVIVAL ARE MUCH GREATER THAN THOSE WITH EBOLA AND THEIR AS AN APPROVED TREATMENT
[snip]
I JUST WANT TO ASK ONE MORE QUESTION ABOUT THE CONSEQUENCES IF WE GET THIS WRONG. IF WE DON'T WRITE TO THE OCCASION AND YOU BEGIN TO PAINT THE PICTURE HERE, ALL OF YOU, ABOUT WHAT'S AT STAKE. BUT WE HEAR THINGS IN THE MEDIA OR ALONG THE WAY, ALONG THE LINES OF THIS COUNTRY HAS ENOUGH ON ITS PLATE, WE'RE TRYING TO DO WITH ISIS, WITH OTHER NATIONAL SECURITY THREATS. WHY IS IT IMPORTANT FOR US TO INVEST SO MUCH OF OUR TIME AND TALENT ON THIS PROBLEM? AND WHAT HAPPENS IF WE GET THIS WRONG? TO "USA TODAY," I THINK THE HEADLINE THE OTHER DAY WAS, COULD THE EBOLA EPIDEMICS GO ON FOR EVER? WHICH I THINK WAS ONE WAY OF SAYING ENDEMIC, WHICH TOM TALKED ABOUT. WHAT ARE THE CONSEQUENCES FOR US, FOR AFRICAN SECURITY, FOR HEALTH IF WE GET THIS WRONG?
[snip]
Frieden:
WELL, I THINK THE SAD FACT IS THAT THE WORST-CASE SCENARIOS ARE REALLY BAD. YESTERDAY CDC OUTLINED WHAT WOULD HAPPEN IF THE EXPONENTIAL GROWTH WERE TO CONTINUE AT THE RATE IT WAS GOING A FEW WEEKS AGO? WE DON'T THINK THAT WILL HAPPEN BECAUSE OF THE RESPONSE THE U.S. AND OTHERS, BUT THE WORST-CASE SCENARIO TOPS A MILLION CASES WITHIN A RELATIVELY SHORT PERIOD OF TIME. AND NOT ONLY WOULD AFFECT WEST AFRICA BUT WOULD INEVITABLY SPREAD TO OTHER COUNTRIES. WE HAD TO EXPORTATION DISEASE EXPORTATION EVENTS WITH THE FIRST COUPLE THOUSAND CASES. HOW MANY DEPENDS ARE WE GOING TO HAVE IF THERE ARE TENS OR AS THE PRESIDENT SAID, POTENTIALLY HUNDREDS OF THOUSANDS OF CASES? AND WHATEVER WE MAY THINK, IT'S NOT POSSIBLE TO SEAL BORDERS. IT JUST DOESN'T HAPPEN IN TODAY'S WORLD. IF IT DID, CONTROLLED DRUGS AND DIAMONDS AND PEOPLE WOULD BE MUCH EASIER BUT IT DOESN'T. AND IT'S NOT GOING TO HEAR. WHAT THAT MEANS IS WE REALLY ARE ALL CONNECTED. SO WHILE WE DO NOT THINK IT'S EBOLA CONTINUE TO SPREAD AS WE BELIEVE IT HAS BEEN SPREADING ALL ALONG, IT WILL PRESENT A SIGNIFICANT HEALTH RISK TO PEOPLE IN THE U.S. THEY COULD ABSOLUTELY CHANGE THE WAY WE WORK HERE. IT COULD CHANGE THE ECONOMY OF THE WORLD. IT COULD CHANGE THE WAY WE ASSESS ANYONE WHO MUST TRAVEL TO ANYWHERE THAT MIGHT AFFECT EBOLA.
[snip]
BUT THE OTHER KEY FINDINGS OF THE IN HIM WOR WE RELEASED THE OTHER DAY WAS THAT PROGRESS IS POSSIBLE. WHEN YOU ISOLATE ENOUGH PEOPLE, THE DISEASE BEGINS TO STOP SPREADING AND THEN AND DECLINE IN NUMBERS ALMOST AS RAPIDLY AS THE EXPONENTIAL GROWTH WE ARE SEEING NOW. BUT WHAT THE MODEL FOUND THAT I FOUND PARTICULARLY STRIKING WAS THE MATHEMATICAL DOCUMENTATION OF THE URGENCY WE ALL FEEL, THAT EVEN A DELAY OF ONE MONTH IN SCALING UP THE RESPONSE WILL RESULT IN A TRIPLING OF THE SIZE OF THE EPIDEMIC. AND THAT KIND OF SHOCKING INCREASE IS VERY HARD AS I SAID TO REALLY GET OUR MINDS AROUND AND TO ACT IN A WAY THAT WE'RE TRYING TO MAKE SURE THAT WE ARE ANTICIPATING WHAT ARE LIKELY TO BE THE NEXT PROBLEM, EVEN THOUGH WE RECOGNIZE THAT THE SITUATION ON THE FIELD IS FLUID ALMOST BEYOND DESCRIPTION. IT CHANGES DAY TO DAY, BUT OUR RESPONSE HAS TO BE WITH THE URGENCY THAT WE WILL TURN IT AROUND. AND I DO THINK WE CAN DO SO, BUT THE RISKS ARE NOT JUST WEST AFRICA AND AFRICA TO THEY ARE TO THE WHOLE WORLD.
[snip]
YOU CAN'T IGNORE THE FACT SOCIOECONOMICS OF THIS DISEASE. SO IT'S LIKE MOST TROPICAL DISEASES, DISPROPORTIONATELY AFFECTING THE POOR. AND I WOULD ARGUE AS JEREMY MENTIONED, THAT WE ARE EXPERIENCING A LEVEL OF MENTAL AND SOCIAL TRAUMA NOT SEEN SINCE THE CIVIL CONFLICT IN THIS AREA. AND A LOT OF US MAY QUESTION, GET A, WHY HAVE WE NEVER SEEN THIS RUN AND PLAY MENTALITY WITH EBOLA. THIS IS A DIRECT RESULT OF THOSE COMPLEX BECAUSE THAT WAS THE MENTALITY THAT WAS DEVELOPED AT THOSE TIMES. THE ONLY WAY YOU'RE GOING TO STAY ALIVE IS TO RUN, TO HIDE, TO STAY WITH YOUR FELLOW. THAT'S EXACTLY WHAT WE ARE SEEING RIGHT NOW. I BELIEVE WE'RE TURNING THE CORNER AND CONVINCING FAMILIES THAT BY HIDING SOME AND KEEPING THEM IN YOUR HOME, NOT ONLY ARE YOU GREATLY INCREASING THE CHANCE THAT THAT PERSON WILL PASS, BUT YOU ALSO WILL INFECT YOUR WHOLE FAMILY. THAT'S UNFORTUNATELY HAD HAPPENED MANY, MANY TIMES FOR THAT MESSAGE TO COME THROUGH.
[snip]
AND LASTLY I THINK EVERYONE ON THIS PANEL AT LEAST IS FAMILIAR THAT WE HAVE SPENT MUCH OF THE LAST 10 YEARS FOCUSING ON BIO TERRORISM SINCE 9/11, AND ANOTHER TERM WHICH WE USE BIO ERROR. SO THIS IS SOMEWHAT OF A WORST-CASE SCENARIO IN THE SENSE THAT WE LITERALLY HAVE THOUSANDS AND THOUSANDS OF THOUSANDS OF SAMPLES OF EBOLA VIRUS. I DO HAVE EXACT NUMBERS ON HOW MANY OF THOSE ARE POSITIVE GOING INTO VERY LOW RESOURCE LABS, TAKEN BY TECHNICIANS THAT ARE BASELINE PHLEBOTOMISTS WHO HAVE SEEN A NUMBER OF INFECTIONS OCCUR JUST BECAUSE OF NEEDLE STICKS, ET CETERA. AND THERE IS NO REAL GOOD TRACKING SYSTEM FOR THOSE SAMPLES.
[snip]
OFTENTIMES THE CHILDREN HAVE SURVIVED BECAUSE THE PARENTS WERE DISTANCING THEMSELVES FROM THEM BUT WE HAVE AN UNTOLD NUMBER OF ORPHANS NOW. AND IF YOU'RE COMING INTO A SYSTEM WHERE THE SOCIAL NET FOR THINGS, PEOPLE LIKE ORPHANS WAS ALREADY UNDER DEVELOPED. AND SO AGAIN, GOING BACK TO THE CIVIL CONFLICT WE ARE SEEING NUMBERS NOW ARE NOT EXACTLY EQUAL TO WHAT THEY SAW DURING THAT CONFLICT BUT IT'S REACHING THAT CATEGORY OF A NUMBER OF ORPHANS THAT WE'RE SEEING, ESPECIALLY IN THE MOST AFFECTED AREAS.
[snip]
THE QUESTION IS, WHAT IS THE CURRENT AND ONGOING EFFORTS TO UNDERSTAND THE DIRECTION IN WHICH THIS VIRUS IS GOING TO EVOLVE NOW THAT WE'VE SEEN MORE HOST THAN EVER BEFORE?
WE'RE IN AN UNPRECEDENTED SITUATION. WE HAVE TRACKED THE GENOME OF EBOLA FOR 40 YEARS AND WE'VE SEEN LESS THAN 5% GENETIC CHANGE, WHICH IS RELATIVELY SMALL FOR MOST PATHOGENS. I THINK THOUGH THE FACT THAT WE HAVE SEEN NOW 10, 20 DIFFERENT GENERATIONS, AND WE'RE SEEING IT IN THOUSANDS OF PEOPLE DOES PUT US IN A DIFFERENT ENVIRONMENT THAN WE HAVE BEEN IN BEFORE. WE'VE HAD SOME GROUPS LOOKING AT THIS, AND THERE IS A NEED TO TRACK THE GENETIC CHANGES IN THE VIRUS OVER TIME, AND THERE ARE INSTITUTIONS WORKING ON DOING THAT.
[snip]
WE DO NEED TO REALIZE THAT IT IS NOT IMPOSSIBLE THAT SOMEONE WILL COME INTO ONE OF OUR HOSPITALS OR HEALTH CENTERS WITH SYMPTOMS OF EBOLA. WE'VE ALREADY HAD 13 PEOPLE COME IN WITH SYMPTOMS THAT ARE CONSIDERED POTENTIALLY CONSISTENT WITH EBOLA WHO ARE FROM THE AREA THE PAST 21 DAYS THEY'VE BEEN TESTED AND THEY'VE ALL BEEN NEGATIVE SO WE HAVE RULED IT OUT MORE THAN A DOZEN TIMES.
[snip]
SPEAKING TO THE HOLISTIC ASPECT IS THAT IN ADDITION TO THINKING ABOUT STARTING THE OUTBREAK WE ARE NOW GOING TO HAVE TO START TALKING ABOUT THE FOOD SECURITY FOR THE AREA. HOWEVER GOING TO DELIVER FUEL TO THE AREA IF THE TINKERERS TINKERERS STOPPED AT SARAH'S WITH THE WE HAVE TO START THINKING ABOUT AID PACKAGES FOR THOSE COUNTRIES TO HELP THEM REBUILD AND WHERE THEY WERE BEFORE THE OUTBREAK AND HOPEFULLY THE SILVER LINING OF THE OUTBREAK WILL BE THAT AFTERWARDS THEY WILL HAVE STRENGTHENED HEALTH CARE SYSTEMS
[snip]
ONE OF THE SOMETIMES OVERLOOKED FACT IS THE TREATMENT ON THE UNITS BUT ACTUALLY THE HEALTH WORKERS MOST AT
RISK ARE THOSE WORKING IN THE NORMAL HEALTH SYSTEM BECAUSE WHEN SOMEONE PRESENTS A HEALTH FACILITY WITH THE SYMPTOMS THAT THAT FACILITY DOESN'T HAVE THE EQUIPMENT NEEDS AND THE STAFF PERSON DOESN'T HAVE THE TRAINING THAT THEY NEEDED AND THEY ARE EXTREMELY AT RISK
[snip]
THERE ISN'T AN EASY WAY FOR PEOPLE TO BE SHARING REAL-TIME INFORMATION AND LEARNING THAT'S BEING BUILT INTO THE SYSTEM SO WE ARE TRYING TO EXPERIMENT AT OUR CENTER THAT WE ARE CALLING THE SHARE AND EXCHANGE KNOWLEDGE FORUM FOR THE DOCTORS AND NURSES TO PUT ONLINE FIRST IMPRESSIONS AND ANECDOTES STORIES THEY ARE LEARNING IT COULD MAKE THEIR WAY TO FORMAL GUIDANCE BY THE ORGANIZATIONS THAT CDC AND HHS IF THEY PROVE TO BE USEFUL.
[snip]
