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Wednesday, October 15, 2014

WHITE HOUSE: NO SURGEON GENERAL, NO EBOLA CZAR, NO CHANGE IN CDC STANCE OR PERSONNEL, NO AIRLINE BANS

WHITE HOUSE PRESS BRIEFING DOMINATED BY EBOLA CONCERNS
October 14, 2014
James S. Brady Press Briefing Room

Questions asked to:
JOSH EARNEST - WHITE HOUSE SPOKESPERSON

EDITOR NOTE:  CRITICAL AREAS HIGHLIGHTED IN BOLD/RED BY FNN


Q    On Ebola, in this briefing room, on October the 3rd, Lisa Monaco said, “I want to emphasize that the United States is prepared to deal with this crisis both at home and in the region.  Every Ebola outbreak over the past 40 years has been stopped.  We know how to do this, and we will do it again.  With America’s leadership, I am confident, and President Obama is confident, [that] this epidemic will also be stopped.”  Do you believe that was -- considering what has happened since October 3rd -- a regrettable bit of over-confidence?
MR. EARNEST:  Not at all.  That continues to be true to this day.
Q    Everything that’s happened since then is consistent with the United States being able to handle and deal with this --
MR. EARNEST:  Absolutely.
Q    -- in a way that reassures the American public?
MR. EARNEST:  Absolutely.  What the CDC is doing is that they are working, consistent with the advice of our medical experts, to investigate exactly what happened in terms of the transmission of Ebola at that Dallas hospital.  They’re reviewing infection control procedures, including the use of personal protection equipment.  They are ensuring that hospitals and health care workers all across the country know and are actually following the protocols that are in place.  And the President has directed the CDC to examine what more the CDC and their experts can do to support hospitals who are currently treating Ebola patients.
That’s one of the reasons that this additional team of experts from the CDC went to the Dallas hospital over the weekend, is to assist -- to ramp up their assistance to the doctors who are treating this health care worker who did contract the virus.
But again, because of all of this -- because of the leveraging of these assets, we continue to believe that the risk of an Ebola outbreak here in the United States is exceedingly low.
Q    Does the President need an Ebola czar?
MR. EARNEST:  At this point, we have a structure in place in which the CDC and HHS are responsible for the efforts to contain Ebola here in this country.  They’re working closely with health care professionals all across the country to ensure that protocols are in place and they’re properly educated about what to do in the unlikely event that they’re presented with an Ebola case. 
We’ve got DOD and USAID and even CDC personnel that are on the ground in West Africa to try to attack this outbreak at the source.  They’re all performing different functions, but they’re all critical to the success of attacking this outbreak in West Africa.  That is the only way that we’ll entirely eliminate the risk to the American people, is by stopping this outbreak at the source.
And then you’ve also seen the Department of Homeland Security and their work with their partners to put in place these screening measures both in West Africa, in the midst of a transportation system, and five airports in this country, to also protect the American public.
So there are a lot of agencies that are involved.  Lisa Monaco is the President’s Homeland Security Advisor, and she is the one that from here at the White House continues to play the role of coordinating the efforts of all of those agencies.  But ultimately, each of those agencies understands exactly what they’re responsible for, and they have experts in this field that can ensure that the American people remain safe.
Q    So the President does not need one (Ebola "Czar")?
MR. EARNEST:  At this point, we have a very clear line of responsibility, and that’s what we’ve been using so far.
----> EDITOR NOTE:  NO DIRECT ANSWER WAS GIVEN TO THIS LINE OF QUESTIONING REGARDING THE EBOLA CZAR
Q    And if I could just move on to Ebola.  The CDC says that it has not established the exact number of health workers that were treating the patient in Dallas who died from Ebola.  And I’m just wondering how that is possible.  Wouldn’t that have been one of the first things you would have done, is had the CDC take inventory of all the people who came into contact with this man?
MR. EARNEST:  The CDC is working on an investigation to determine how exactly this transmission of Ebola occurred at the hospital in Texas.  This is the result of an order that the President gave in the context of the meeting that he convened on Sunday.  He ordered the CDC to expedite their investigation of how this specific transmission occurred.
What the CDC is also doing is they are also conducting a broader review of the infection control procedures that were in place at this Texas hospital, including the use of personal protective equipment.  And this will be part of the ongoing investigation to what’s happening there.
In terms of the status of that investigation, in terms of how many people they’ve identified, I’d refer you to the CDC on that.
Q    But they’re saying that they don’t have this exact tally, and I’m just wondering -- we keep hearing from officials about the urgency of this and how there’s no room for error, and then we’re told that there’s not an exact count of the number of health workers that were in contact with this man, health workers who presumably are treating other patients, who are going home to their families and having contact with other people.  How should the public feel about when they hear on the one hand that there’s urgency, and then on the other hand that we don’t exactly know how many people came in contact with this patient?  
--->  EDITOR NOTE:  THE QUESTION IS DIRECTED AT THE "MIXED MESSAGES" BEING SENT OUT FROM THE CDC AND WHITE HOUSE;  THIS IS AN AREA OF CONCERN FNN HAS HAD SINCE THE CDC STARTED DOING PRESS BRIEFINGS.
MR. EARNEST:  Sure.  I’m glad you asked the question that way, because it is important for people to understand the context here.  The thing that the CDC has been doing is they have asked the individuals who were in contact with what’s described as the “index patient” in Texas to -- they are actively monitoring their health conditions.  And the reason that that’s important is -- by actively monitoring their health, they’re taking their temperature.  The reason that’s important is because individuals are only contagious with Ebola if they are exhibiting symptoms of Ebola.  That is why we continue to be confident that based on the medical infrastructure that we have in place in this country, that the risk of an Ebola outbreak in America is exceedingly low. 
----> EDITOR NOTE:  BY "MONITORING" POTENTIAL EXPOSURES, TAKING A TEMPERATURE OR ANSWERING A QUESTIONNAIRE SEEMS TO BE THE HIGHEST-TECH METHOD THE CDC HAS IN ITS ARSENAL.
But at the same time, it’s important for us to put in place the necessary protocols to ensure that when Ebola cases do materialize, that health care workers can do the brave and courageous work that they already do to try to meet the needs of these individuals that have been stricken with Ebola, without putting themselves at great risk.  And it is clear that more needs to be known about what exactly happened in this Texas hospital, and that’s why you’re seeing the CDC conduct this investigation into this apparent incident, the transmission incident, but also looking more broadly at what sort of infection control procedures were in place to give additional advice to hospitals across the country about dealing with these circumstances.
Q    And, again, tying this into what else is going on and the questions raised by people like Gene Robinson about the effectiveness about ISIS, questions that are being raised about the response to Ebola, I mean, repeated assurances that American hospitals can safely treat Ebola and, of course, we know a nurse in Dallas was infected.  There’s a large set of examples in the New York Times today about Emory University and some of the problems that they have had in Atlanta.  Does this raise -- do these raise questions of competency in government? 
MR. EARNEST:  I’m surprised that you raised the Emory example, because this is an example of a medical facility that did safely treat and help at least two patients recover from Ebola.  So I think that’s actually a pretty good indication that the American people can have confidence --
Q    They faced a series of problems that were unanticipated, including --
MR. EARNEST:  Unanticipated.  But yet, Chris, this is the thing -- we’ve got to be focused on the results.  The fact that problems occur when we’re dealing with a deadly disease shouldn’t be a surprise to anybody.  The question is how do you respond to them.  And what you saw at Emory was you saw that two patients recovered from Ebola, thanks to the life-saving treatment they got from American doctors with the support of the federal government.  And what you’re seeing is a response in Dallas to ensure that the safety of this one health care worker who put her life on the line to try to treat one Ebola patient -- that is what makes America, America.  There’s no other country in the world that is taking the kind of efforts that we are to confront this outbreak at the source.  But yet, what you are seeing is that our involvement in that effort is galvanizing the international community to contribute more assets to dealing with that. 
And all of that is in pursuit of -- I mean, as I said, I started out this briefing by saying that the risks of an outbreak -- of an Ebola outbreak in the United States is exceedingly low.  But the fact is, we are ensuring that the United States continues to be a force for good in the world, so you’re seeing the significant commitment of resources in West Africa.  You’re also seeing a commitment on behalf of the United States, on behalf of this President, to ensure that we drive down the risk of an Ebola outbreak to zero.  And the only way we can do that is to attack this outbreak at its source.  And that’s why you’re seeing the United States make the most significant commitment to that.
This is something that, by the way, the United States government has been focused on since this outbreak occurred back in March.  So we’re not driven by the headlines here.  We’re not driven by the midterm elections.  What we’re driven by are results, and that’s what we’re focused on.
Q    Well, where are those results -- the WHO figures today that 70 percent is now the mortality rate and that the number of new cases could reach 10,000 per week by December?
MR. EARNEST:  That’s true, Chris.  You’re citing the problems again.  And these are significant problems.  And that’s what the administration is focused on.
Q    But you’re saying results, and you’re saying the importance is what happens at the source.  What’s happening at the source is that there’s a 70 percent mortality rate.
MR. EARNEST:  What’s happening at the source is that there’s a significant problem, and the United States of America is doing more than anybody else to confront it.
----> EDITOR NOTE:  JOSH EARNEST MANAGED TO DODGE ANSWERING THE QUESTION DIRECTLY.  THERE WERE NO ANSWERS GIVEN THAT SUPPORT AN ACTUAL PLAN BY THE CDC TO QUELL EBOLA.
Q    I want to follow up a little bit on that in terms of the global aspect.  Unfortunately, Mr. Duncan was the first to succumb to the Ebola virus here in the United States.  A little bit of geography: He got on a plane in Monrovia, in Liberia; he flew to Brussels, got on a plane to Brussels and flew to Dulles, right, close by across the river in Virginia. 
It is, to some, very comforting that the President was on the phone yesterday with President Hollande of France.  In Europe, there are many gateway cities that take individuals from the continent of Africa, they go through Belgium, they go through the Netherlands, France, U.K. and Germany.  Each of those leaders in those countries have a specific protocol -- some less stringent, some more stringent than others. 
Will the President be consulting with, discussing with other leaders -- as he has with President Hollande, including Chancellor Merkel who has put more strict protocols in place, and Prime Minister Cameron -- as to a coordinated effort as to the screening process of individuals who go through those gateways cities in Europe and come to the United States, and who are not so easily detected when they go through that particular process?
MR. EARNEST:  Well, let me say a couple things about that, J.C.  The first is, all indications are that the index patient, the one who unfortunately did succumb to this disease last week, was asymptomatic when he was travelingSo this is somebody who would not have been contagious, even though he had Ebola.  He would not have been contagious and did not pose a risk to the broader traveling public.  That’s the first thing.
The second thing is there are screening measures in place to protect cities around the world that start in West Africa.  That there is a training regimen that Mr. Shear’s colleague, Helene Cooper, wrote about over the weekend.  She talked about how many times her temperature was taken on the ground in West Africa before she was allowed to leave.  And that is indicative of the protocols that are currently in place under the supervision of international experts, including the CDC, to ensure the safety of the traveling public and to ensure that -- or at least minimize the risk of Ebola spreading.  So that’s the second thing.
The third thing is it’s the responsibility of all of these European leaders to decide for themselves what sort of protocols they want to have upon arrival in their countries.  But, fourth, there is a protocol for travelers who are arriving in this country -- that those individuals are screened once again, and we just announced at the end of last week some additional screening protocols that would be in place for those travelers who did originate or recently travel from countries in West Africa where there is an Ebola outbreak.
---->  EDITOR NOTE:  AGAIN, Mr. EARNEST IS ONLY REFERRING TO A QUESTIONNAIRE AND TEMPERATURE READING.
Q    May I just follow up?
MR. EARNEST:  Sure.
Q    And I don’t mean to -- well, I do actually mean it, so I’m going to say it.  (Laughter.)
MR. EARNEST:  You can belabor it, it’s fine.
Q    Just a tiny bit.  It is also a known fact that many individuals have dual passports.  Many individuals who come from Europe and may stay in those key cities for a length of time may not have particular instances where they have -- they’re presenting with a fever.  Others can take ibuprofen or other anti-inflammatories and lower the fever, get on the plane, and get to America where some, possibly, may think they’re going to get help.  So that’s just something else that is out there and in the discussion.
MR. EARNEST:  Well, again, I can’t speak to the medical veracity of what you’re describing, but the fact is we’ve had an outbreak for seven or eight months now, and the number of travelers who have gone through the system is obviously very small in terms of who made it to the United States.  That’s because of the protocols that are already in place on the ground in West Africa and on the ground here in the United States.  So we’ve got protocols in place.
I mean, the other statistic that I’ve seen is that there are dozens of people who have been denied boarding an aircraft in West Africa because they had a fever.  So that is an indication that these screening measures that take place before anybody gets on an airplane are having an effect.
---->  EDITOR NOTE:  THE QUESTION REGARDING COUNTER-MEASURES TO GET AROUND MEDICAL SCREENINGS WAS NOT ANSWERED DIRECTLY.
Jon.
Q    Josh, a couple quick ones.  One on Ebola.  Your statement on the President’s meeting yesterday referred to a “surge in personnel and other resources to Dallas.”  How many people are going to Dallas as a part of that surge?
MR. EARNEST:  I believe that so far there’s been a commitment of a team of individuals from CDC.  I’d refer you to CDC in terms of the number of individuals. 
Q    Because my understanding is it was nine people.  Is that what you consider a surge?  I’m just trying to get our terminology down. 
     MR. EARNEST:  Well, what we are focused on is ensuring that we have the necessary experts in place.  And that builds on the experts who are already on the ground in Dallas.  And one of the things the President did ask the CDC to focus on is to examine what additional resources and additional personnel they can mobilize to support hospitals that are treating Ebola patients.
----> EDITOR NOTE:  BASED ON THE ABOVE RESPONSE, A "SURGE OF PERSONNEL" BY THE CDC TO TEXAS MEANS A TOTAL OF 9 PERSONNEL.
Q    And on getting back to Ebola.  What is the President’s preference:  that people who contract Ebola just go to their neighborhood hospital, or should these people ultimately be treated at biocontainment centers, the CDC’s specialized biocontainment centers?  Should people with Ebola just be treated at any hospital in the U.S. when you might have hospitals with varying standards around the U.S.?
     MR. EARNEST:  Well, Jim, what I’d do is I would refer to the Centers for Disease Control, who can give you the best sort of assessment medically of what kind of treatment individuals can get.  What I have heard our medical experts indicate is that they do have confidence that many hospitals across the country, if not all of them, do have the modern infrastructure in place to diagnose and isolate individuals that they suspect may have Ebola.  And what they have -- what the President has asked the CDC to do is to figure out what more they can do to support hospitals who find themselves in that situation.
     Now, fortunately, at this point, we’ve only found one hospital that’s been in that situation.  But there certainly is the chance, even the likelihood, that there may be additional cases.  And we want to make sure that we have the protocols in place -- that those protocols have been accurately communicated to hospitals across the country, and that hospitals are actually following those protocols.  That’s a priority. 
     But, again, what the President has also asked the CDC to do is to figure out what more they can do to support hospitals that find themselves in a situation like that.
Q    So back to Ebola and Dr. Frieden.  Given the events of the last few days and the perception among some that the CDC has been kind of racing to catch up to events on the ground in Dallas and at the airports with the additional screening, does the President and the White House continue to have confidence that Dr. Frieden is both the right person to lead the CDC at this time but also the right person to be the public face of the response for the administration?
     MR. EARNEST:  Well, I think that there are a lot of people who have been involved in this effort to respond to the Ebola outbreak in West Africa and to respond to the isolated cases that we’ve seen in this country.
     Q    He’s doing the daily briefings every single day.  He’s the principal.
     MR. EARNEST:  He’s doing a lot of that.  I’ve seen Dr. Fauci from the NIH participate in a lot of briefings.  Lisa Monaco convened a briefing here at the White House.  This obviously is a prominent setting, as all of you can attest.  We’ve seen the Department of Defense talk publicly about their role.  Administrator Raj Shah has talked frequently in public about the role that they’re playing.
     So I think what I would describe as the -- in the context of this response are the many faces of members of the administration who are mobilizing assets in support of this important priority.  What we’re going to do is we’re going to be guided by the best scientific advice that we have, and we certainly are going to work closely with experts in other countries.  There are non-governmental organizations, like Doctors Without Borders, that have some expertise in this.  We’re going to continue to work closely with them as we design a response that both addresses the need to confront this outbreak at the source while also ensuring that protocols here in the United States are in place to keep the American people safe and healthy.
     Q    But can you specifically talk about Dr. Frieden?  Does he retain the President’s confidence and is he the right person?
     MR. EARNEST:  He does, and Dr. Frieden is a preeminent physician, somebody that has a lot of experience not just in the medical profession but also in the field of public health.  And he is somebody who in the last few months here has been working almost around the clock to ensure that our response is commensurate with the challenge that is posed here.  And the challenge that's posed is significant, as Chris was walking through the outbreak in Africa is distressing.  And the lack of a medical infrastructure in that country means that there are thousands of people who have died and thousands more who are suffering.
And that is tragic, it’s sad, but it’s also something that we are concerned about because of the more broader, destabilizing impact it could have on the region and because of the risk -- although it’s quite minimal -- that this poses to Americans around the globe.  So the United States is going to play the role that we have played many times, which is leading the international community to respond to an urgent international incident, and Dr. Frieden is playing a very important role in all that.
Q    And just one last clarification.  You had talked I think maybe in answer to Major about -- when you said that government doesn’t need a czar because there are clear lines of responsibility. 
MR. EARNEST:  Well, I don’t think I used exactly those words, but I did indicate that there are specific lines of responsibility in terms of who’s responsible for carrying out specific objectives in this.
Q    Right.  So who’s in charge?  Like, who does -- you listed all those people -- Raj Shah and the military and the CDC and the NSC and all the different pieces.  Who ultimately do you see in this who is leading the effort and who’s responsible for making sure that all the different pieces are doing what they should be doing?
MR. EARNEST:  Well, the interagency coordination effort is something that is being monitored and run -- very capably, I might add -- by Lisa Monaco, who is --
Q    So she’s --
MR. EARNEST:  She’s the President’s Homeland Security Advisor.  But again --
Q    So you would consider her to be the person that’s responsible for the effort globally?
MR. EARNEST:  She is the one that is responsible for coordinating among the varied -- the multifaceted effort that is currently underway by this administration; that we’ve got CDC, Department of Defense, and USAID playing their own very specific structured roles --
Q    And they all report to her, too?
MR. EARNEST:  Well, but again, they’re all playing their very specific structured roles on the ground in West Africa.  You have the CDC and HHS, and even some components of DHS who are responsible for various lines of effort here in this country.
And so they are all principally responsible for fulfilling their own task.  Ensuring that all of their efforts are integrated and coordinated is the responsibility of the President’s Homeland Security Advisor, Lisa Monaco.
----->  ***** EDITOR CRITICAL NOTE:  FROM THE ABOVE RESPONSE, THERE IS NO SINGLE AGENCY OR PERSON RESPONSIBLE FOR THE COORDINATED EFFORTS TO COMBAT EBOLA.  THE WHITE HOUSE OFFICIAL STANCE IS THAT THERE IS NOT A PERSON, NOR AGENCY, IN THE LEAD FOR THIS DISEASE OUTBREAK. *****
Scott.
Q    Josh, just to clarify that.  When we got briefed last week, it was explained that CDC and NIH work as advisors, but they’re still going through the state and local public health officials, right?  You have not nationalized this response?
MR. EARNEST:  Well, that’s correct, that there is still a very important role for state and local health authorities to play in all of this.  There obviously is an important role for medical professionals in communities all across the country and in hospitals across the country to play in all of this to ensure that protocols are updated and followed.
So again, this is a multifaceted effort that’s underway to ensure the safety and health of the American people.  And this is a difficult challenge, but one that our experts are guiding and are dedicated to succeeding in.
April.
Q    Josh, since the latest case of Ebola in Texas was discovered, is there 100 percent certainty that you’re getting still to the White House from health officials to include the CDC, as to how this disease is spread?
MR. EARNEST:  Well, are you talking about this in this one specific case in Dallas? 
Q    I mean, but this one specific case in Dallas could basically translate into other cases, as well.  Is there still a certainty as to how this disease is spread?  Because people were saying that you couldn’t -- after a certain period of time, you couldn’t live and what have you.  And they’re still trying to figure out how she contracted this disease.
MR. EARNEST:  Yes.  I think it’s important not to conflate the two, so let me separate these two things out.
The first is, the CDC is conducting an investigation to determine how the transmission occurred -- how was the virus transmitted from this Ebola patient into the system of this one health care worker who was working heroically to try to save his life.  And that is something that the CDC is still trying to figure out.  And what they’re going to do is they’re going to interview her, the patient; they’re going to interview the -- when I say the patient, I mean the health care worker who is now a patient -- they’re going to interview her colleagues and her coworkers who are also treating this individual.  They’re going to review all the protocols that were going to -- in place -- that were in place.  They’re going to review how all the protocols were implemented, and they’re going to try to determine how this individual, this health care worker contracted the disease.
Now, separate from that, it is very clear how the Ebola virus is spread.  It’s not spread through the air.  It’s not spread through the food and water here in the United States.  It is spread through close contact with the bodily fluids of an individual that is -- has symptoms of Ebola.  That is why we see so many cases involving health care workers, because it’s obvious that it’s health care workers who are, again, because of their courageous service, that they’ve put themselves in a position in which they’re coming into close contact with the bodily fluids of an individual that they know is sick.
-----> EDITOR NOTE:  IT IS NOT CLEAR WHY MR. EARNEST IS REFERRING TO "SO MANY CASES INVOLVING HEALTH CARE WORKERS".... I ASSUME HE MEANS WORLD-WIDE AND NOT JUST THE UNITED STATES.
They know they’re handling hazardous materials, but yet they put themselves at risk to try to meet the needs of this individual.  And I think that is -- it’s laudable, it’s heroic.  We want to make sure that health care workers -- nurses and doctors -- can do that in a way that doesn’t put themselves at significant risk.
Q    Does the White House believe that either the lack of a Surgeon General in place or budget cuts at the NIH and CDC have hurt the government’s response, or in any way materially impacted it?
MR. EARNEST:  Yes, I mean, as it relates to the Surgeon General, the President did nominate a highly qualified individual to that post quite some time ago, and we do believe that that person should be confirmed.  In terms of what role the Surgeon General would play in this specific response, I guess what I would say about that is it’s hard to imagine it would hurt, and that we would only benefit from a scenario where we had a dedicated public health professional who was involved in helping us communicate with hospitals and medical professionals all across the country to ensure that these protocols -- the proper protocols were in place and closely followed.
As it relates to funding, we’ve talked many times about the impact that sequestration and other tight budget caps have had on a range of critical health care programs.  That said, this administration continues to be focused on ensuring a focused and coordinated Ebola response both in West Africa and here in the United States.  There are some more statistics I can give you that relate to the efforts of this administration to try to ramp up funding, as we have for a number of years, to those programs within the CDC that are related to prevention and public health.
Q    So you’re saying that -- are you not -- it doesn’t sound like you’re saying whether it would have helped or hurt.  Lots of money has been cut; it’s becoming an issue where even Democrats are using it in ads against Republicans.  Does the White House think it would have had a different -- or would have benefitted if that money had not been cut?
MR. EARNEST:  Well, let me say it this way:  I think that what we can all agree is that the role that the CDC plays in preventing the outbreak of disease is critically important to the country, to our citizens, and to our broader economy.  And those are programs and those are efforts that are worth investing in.  And it certainly is disappointing that Republicans, at least to this point, haven’t shared that commitment to investing in those kinds of critically important programs. 
---->  EDITOR NOTE:  MR. EARNEST FALLS SHORT OF SAYING WHETHER OR NOT THE ABSENCE OF AN APPOINTED SURGEON GENERAL WILL HAVE MADE A DIFFERENCE IN FIGHTING EBOLA IN THE UNITED STATES.
Q    -- on funding, please?
MR. EARNEST:  Yes, we’ll move it around.
Q    -- Ebola and Malaria.
MR. EARNEST:  We’ll get you something.  Thanks, everybody.  Have a good day.