IDSA Media Briefing: Responding to Infectious Disease Threats

Jeanne Marrazzo: [00:00:00] Good morning everyone. I'm Dr. Jeanne Marrazzo and I am the chief executive officer of the Infectious Disease Society of America. 10,000 physicians, scientists and public health experts whose focus is the prevention, treatment and cure of infectious diseases. Today's briefing is co-hosted by IDSA and also the Society for Healthcare Epidemiology of America, or SHEA. Our experts today will discuss bio preparedness globally in the United States. And as you know right now, there are two disease outbreaks that the world is avidly watching. First, the Andes virus outbreak. As of this morning, the number of confirmed cases remains at 11. 18 American passengers from the ship have been repatriated and are at the University of Nebraska's national quarantine unit. Second, the Ebola outbreak. This is a rapidly growing outbreak, as we're going to hear there are now over 500 suspected cases and nearly 150 suspected deaths. As you know, likely a significant underestimate given the scope of what's going on. This morning we're joined by three terrific speakers. First will be Dr. Jay Butler, the dean of the College of Health at the University of Alaska Anchorage. Dr. Butler previously served as deputy director for infectious diseases at the U.S. Centers for Disease Control and Prevention. Next, we'll have Dr. Angela Hewlett. Angela is a professor in the Division of Infectious Diseases at the University of Nebraska Medical Center. She's also the medical director there of the Nebraska Biocontainment unit. Then finally, this third speaker will be Dr. Krutika Kuppali. Doctor Kuppali is an associate professor in the Division of Infectious Diseases at University of Texas Southwestern. She previously served as the medical director of an Ebola treatment center in Sierra Leone during the West Africa outbreak in 2014 to 2015. Following speaker remarks, we'll open the floor to questions. To ask a question, please click the raise hand button or for those on the phone, select star nine and you'll be added to the queue. I'll now turn it over to Dr. Butler.

Jay Butler: [00:02:18] Thank you doctor and good morning everyone. Let's set the stage for the discussion today by talking a bit about preparedness. By preparedness I mean the ability of clinicians, scientists, public health professionals and governments to respond to events like the outbreak of Andes virus on the MV Hondius and the current outbreak of Ebola in Africa. So I'd like to cover two areas about preparedness. First, it requires ongoing investment in our federal, state, tribal, and local public health infrastructure. Odds are that all of us have flown through a major U.S. airport in the past year. You may not have noticed fire and rescue vehicles in case of an emergency, but they were there and at the ready. Similarly, the U.S. public health infrastructure that supports our preparedness to respond to infectious disease threats is often invisible, but it's vital to our safety and to national security. No major airport is going to wait until there's a disaster to hire first responders and purchase fire and EMS equipment. And in health, we can't wait to invest in our ability to respond to emerging infectious disease threats until people are getting sick and dying. Time and resources are needed to establish the expert working force and laboratories that are required to identify new or emerging agents and to limit their health impacts. You'll be hearing more about how investments and preparedness are paying off right now to limit potential spread of infection and protect us from these current outbreaks.

Jay Butler: [00:03:54] The second point about preparedness is it's a team sport. It requires multinational collaboration and coordination to respond quickly and efficiently. This is particularly important in responding to outbreaks in resource limited or conflict torn areas, where preparedness infrastructure may be limited. One of the tools to foster a multinational collaboration is declaration of a public health emergency of international concern, sometimes called a fake or a PHEIC. I'm going to go with the latter just because it rolls off my tongue more easily. This step was taken last week to support the response to Ebola in the Democratic Republic of Congo and Uganda. A PHEIC is declared when a health event meets three criteria, defined in the International Health Regulations, that the event is serious, sudden, unusual or unexpected. Second, that it carries implications for public health beyond the initially affected countries national border, and 3rd May require immediate international action. I think it's clear from what has already been said, and you'll be hearing more about is the outbreak in DRC of Ebola clearly meets all three of these criteria. The PHEIC declaration highlights the seriousness of this current outbreak. This is only the ninth PHEIC that has been declared since the criteria were established in 2005, and only the third time involving an outbreak of Ebola.

Jay Butler: [00:05:26] I want to be very clear, though, a PHEIC is not a declaration of a pandemic. What a PHEIC does is it empowers the World Health Organization director general to make evidence based recommendations for prevention and control. It encourages organizations and governments to direct resources to the response, and it establishes a mechanism for governments to share epidemiological data and collaborate on cross border containment. Containment measures are quite broad, but they may include isolation and quarantine. These are terms that are frequently misused, so I'd like to clarify what they mean as we use them as infectious disease physicians. First of all, isolation is implementation of measures to prevent spread of infection from someone who is known to be infected. In general, these are people who have symptoms and require treatment. Isolation can be done at home, but oftentimes is done in a health care environment. Quarantine, on the other hand, has become a dirty word, but it is a very meaningful word. It includes measures to monitor someone who may have had a significant exposure to infectious agents, but is not yet ill or not yet known to be infected. Just to be clear, quarantine is not a societal measure, and it shouldn't be confused with what some call lockdown.

Jay Butler: [00:06:50] The intent of quarantine is to provide monitoring, which in some cases can even be provided at home and to prevent spread, which for some infections may occur early in the course of infection before symptoms become obvious. Also, quarantine provides rapid access to healthcare providers, and it's a safety step for people who have been exposed. Also, a Peck is not a public health emergency declaration for the US. That is the sole prerogative of the US government. Currently, there is no public health emergency declaration in the US related to these outbreaks because the risk to Americans in the US from either Andes virus or the Ebola outbreak is currently so extremely low. So I really appreciate the opportunity to be able to speak with you today. Before I turn it back to Dr. Marrazzo, though, I'd like us to remember that as we discuss numbers, People exposed people, sick people who have tragically died. But these numbers represent just that. People just like us, whose lives have been changed and sometimes tragically cut short by these viruses. The whole goal of prevention is to protect people, and that's why we're here today. With that, I'll look forward to your questions later in the discussion. But I'll turn it back to Doctor Marrazzo.
Jeanne Marrazzo: [00:08:25] Thank you. Sobering and moving reminder of who we're over to. Dr. Hewlett can you hear me? Yes, go ahead.

Angela Hewlett: [00:08:35] I've got you. Hi. So good morning. Um, as director of the Nebraska Biocontainment unit. I've cared for patients with Ebola virus disease. Some of the first Covid 19 patients in the United States, and we are currently monitoring 18 Americans who were exposed to Andes hantavirus on the MV Hondius cruise ship. These individuals were medically evacuated to Nebraska and are currently in the National Quarantine Unit, which is a federally funded quarantine facility here on our campus and the only facility of its kind in the United States. Given our unique facilities and expertise in the management of patients with high consequence infectious diseases, the University of Nebraska Medical Center is designated as a regional Emerging Special Pathogen Treatment center. However, we don't do this care alone. We're part of a network called the National Emerging Special Pathogens Training Education Center, or NETEC, which is a federally funded national leader for special pathogen preparedness and response in the United States. NETEC was established in 2015 after New York City Health and Hospitals Bellevue, Emory University and We at the University of Nebraska Medical Center treated patients with Ebola virus disease during the 2014 Ebola outbreak. NETEC serves as the coordinating body for the National Special Pathogen System, which is a nationwide tiered system of care designed to ensure that the U.S. can safely identify, manage and treat patients with high consequence infectious diseases.

Angela Hewlett: [00:10:04] Together, NETEC and NSPS form and maintain a coordinated national framework that strengthens healthcare readiness, response, coordination and access to specialized care across the country. The partnership ensures that the health care systems are best better prepared to respond rapidly and safely to emerging infectious disease threats. We're facing a difficult and volatile situation with the converging outbreaks of both Andes hantavirus and Ebola virus disease, both of which are presenting significant challenges. Although different, although the National Quarantine Unit is currently activated and we are caring for individuals exposed to Andes hantavirus from a worldview. I am particularly more concerned about the outbreak of Ebola virus disease that is occurring in the Democratic Republic of the Congo and neighboring countries. NETEC is ready to respond and support the health care system here in the United States, and we're also in close communication with international partners. These efforts require a significant amount of coordination and collaboration at all levels, including local, state and federal health authorities. The importance of sustaining these preparedness efforts through funding and support cannot be overstated, and the current scenario is evidence that we need to maintain both domestic and international preparedness to protect our patients, the health care workforce, our communities, locally, nationally, and worldwide. Thank you. I look forward to your questions.

Jeanne Marrazzo: [00:11:33] Thanks so much, Doctor Hewlett. Um, I just to let folks know, I turned my camera off because I have a little trouble with my connection. I am now going to turn it over to Dr. Kuppalli, who will bring us into a discussion of the outbreak and the global health perspective.

Krutika Kuppalli: [00:11:51] Great. Thank you. Good morning everyone, and thanks to IDSA and SHEA for hosting this, uh, uh, media briefing. Um, so the ongoing Ebola outbreak in the Democratic Republic of the Congo is a serious public health emergency that highlights both the progress the global community has made in responding to Ebola and the significant vulnerabilities that still remain. As of yesterday, there were almost 600 suspected cases and close to 200 suspected deaths reported. Um also affecting healthcare workers. While the world has gained substantial experience from prior Ebola outbreaks, including in West Africa and eastern DRC, this outbreak presents a unique and highly complex set of challenges. It also comes at a time when global health systems are under strain from funding cuts, workforce reductions, geopolitical fragmentation and weakening international public health infrastructure, as WTO Director General Tedros stated earlier this week. They are deeply concerned about the scale and speed of the epidemic, and took the unusual step of declaring a public health emergency of international concern prior to convening of the emergency committee earlier this week because of the urgency of the situation. The current outbreak is concerning for several reasons that distinguish it from prior Ebola outbreaks. First, this outbreak is caused by Bundibugyo Ebola virus, a different species of Ebola virus, than the Zaire species responsible for the large West Africa outbreak in 2014. Unlike Zaire Ebola virus, for which we have approved vaccines and therapeutics, there are currently no licensed vaccines or specific therapeutics approved for Bundibugyo Ebola virus disease. That significantly complicates the response and places even greater emphasis on rapid detection, infection prevention and control, supportive clinical care, laboratory capacity and community engagement.

Krutika Kuppalli: [00:13:37] The outbreak is also highly concerning because it occurs in a complex operational environment. The affected region includes areas impacted by insecurity and armed conflict, which can limit access for healthcare workers and public health responders. Current data estimates that there are over 100,000 newly displaced persons in this area due to conflict. In addition, the outbreak also involves highly mobile populations, including movement across borders and within mining communities, where people often travel frequently for work and trade. These dynamics make contact tracing, surveillance, and continuity of care much more difficult and increases the risk of wider spread of the outbreak, if not rapidly contained. W.h.o. and other experts have also highlighted concerns about spread into urban centers and across borders, particularly South Sudan, which is already experiencing the worst humanitarian crises and underscores how interconnected global health security is. The situations like this, the role of WHO is absolutely essential. Who serves as the central coordinating body that brings together governments, ministries of health, NGOs, regional partners, laboratories, clinicians, logisticians and many other partners. They help coordinate surveillance systems, lab testing, infection prevention and control, the development of clinical guidance and research strategies, along with helping to implement risk communication strategies. WHO also plays a critical role in ensuring countries are not responding in isolation, and that resources are directed where they are most needed. At this year's World Health Assembly, WHO leadership emphasized the need to reshape global health and build a new global health architecture fit for the future.

Krutika Kuppalli: [00:15:13] That message is particularly relevant now during outbreaks. Coordination is not just about logistics, it's about building trust, aligning strategy, avoiding duplication of efforts, and supporting countries with limited resources. The outbreak also underscores the importance of sustained global health investment, not only during emergencies but long before outbreaks occur. Outbreak preparedness depends on strong health care systems, trained health workers, surveillance infrastructure, supply chains and community relationships that are built over years. Many of these systems in Africa and globally have historically been supported through international partnership and funding streams, such as USAID supported programs and broader global health initiatives. Recent cuts to global health funding and the dismantling and reduction of preparedness programs have weakened some of these very systems designed to detect and contain outbreaks early. Across many regions, programs supporting disease surveillance, lab strengthening workforce training and outbreak response capacity have been scaled back or shut down entirely. Underfunded and weakened international cooperation are leaving the world increasingly vulnerable to infectious disease threats. We have seen firsthand during prior Ebola outbreaks that sustained investment in preparedness saves lives. The ability to rapidly identify cases and deploy trained personnel and engage communities is critical to the success of outbreaks, and it must exist long before these crises begin. These capabilities cannot simply be rebuilt overnight once an outbreak is already expanding. Ultimately, infectious diseases don't respect borders, so investing in global health preparedness, supporting international coordination through organizations like WHO and strengthening local health systems are not acts of charity. They are essential components of global health, security and collective strategy. Thank you.

Jeanne Marrazzo: [00:16:54] Thank you so much, Dr. Kuppalli very very, very important points. Um, so before we go to the Q&A, I'll just add a quick comment about the title 42 order, which I think, as you know, CDC issued on Monday. Uh, that's an order that places travel restrictions on citizens of other countries traveling to the United States from the DRC, Uganda, or South Sudan. You've heard, I think very strongly this morning that containing this type of outbreak requires all types of infection prevention measures, from individual acts to broader public health policies. For interventions to be effective, they need to be evidence based and informed by science. So policies that single out individuals, not for any scientific or medical reason, but because of their citizenship, won't prevent outbreaks from spreading. Finally, managing and treating outbreaks is complex, as you know, and requires the work of experts who are trained in infectious diseases and related fields. And I want to note that we don't have enough infectious disease physicians in the workforce and our workforce in general for infectious diseases, from basic science to practice, is really threatened. We do need policies that support our workforce, and also policies that support the ability to care for people in situations like this, like Dr. Hewlett managed. And that involves sustained investments in public health and research for preventing monitoring and responding to infectious diseases, both here and abroad. So that is all that I am going to say before we turn to questions. And our first question this morning is from Mike at The Associated Press. Mike, please unmute your line to ask your question.

Caller 1: [00:18:40] Hi. Thank you for doing this call and for calling on me. I have two questions about, um, the Ebola, uh, situation. Uh, first for Dr. Hewlett, um, the there was an American who's been reported to be infected and was transported, uh, to Germany as well as other people. I was wondering if you had any information about, uh, there's a question about why weren't they brought to the United States, perhaps to the University of Nebraska facility. I was wondering if you had any information about why that that didn't happen. And then I have a question for Dr. Butler. Should I pause or keep going?

Jeanne Marrazzo: [00:19:20] Uh, you can pause for a second. So let's, uh, let's let Doctor Hewlett take your first question.

Angela Hewlett: [00:19:26] Yeah. So I, I think we all need to recognize that there are multiple levels of decision making that go into this process and choosing the most appropriate place for an individual to receive care. Um, you know, the NETEC, uh, you know, centers, we have 13 biocontainment units here in the United States and all of those units are ready and available to care for individuals with Ebola virus disease or to monitor individuals potentially exposed to Ebola virus disease. So our network is ready. Those decisions were made at, um, at a high level. And my understanding is that they were looking for, uh, close access to care, um, a shorter plane flight. And the folks in Europe are very equipped to provide this type of care for individuals. So, you know, again, we're, we're ready from a network perspective, our Biocontainment units have been preparing for exactly this situation. Should we be called upon to care for patients or to monitor individuals that are exposed to Ebola virus?

Jeanne Marrazzo: [00:20:32] Thank you, Doctor Hewlett. Uh, why don't you go ahead, Mike, and ask a question for Doctor Butler. I do note that we have a lot of hands for questions. So.

Caller 1: [00:20:40] Uh.

Jeanne Marrazzo: [00:20:41] Uh, thanks.

Caller 1: [00:20:42] For Dr. Hewlett. Just at what level? And then for for Dr. Butler. Doctor, you you were at CDC, you led, uh, responses to SARS and Covid. I was just wondering if you could walk us through your understanding of the current, uh, CDC response to the Ebola situation. Um, there's a lot of, uh, discussion out there about the pace at which there was a response and people got in. We have a bilateral agreement with the DRC now, but we're not part of the WHO, could you just tell us your your understanding, your information about, uh, what, what maybe should have, would have happened in the past and what happened this time, and how the bilateral agreement and the WHO situation affected that. Thank you.

Jay Butler: [00:21:28] Yeah. Well, let me start by saying I'm not inside the CDC, so I really can't compare this response to prior responses. But what I can say is that I think the current response really highlights the importance of relationship in the global health security that the CDC and the scientists there have had ongoing relationship with scientists in the Democratic Republic of Congo. And that really that really helps to facilitate communications and set the stage for assistance to be able to support our colleagues in Africa in the response to this current outbreak.

Jeanne Marrazzo: [00:22:09] Thanks very much, Dr. Butler. We're going to now go to Helen from STAT. Please go ahead and ask your question. Helen.

Caller 2: [00:22:16] Thank you very much for doing this. And thank you for calling on me. My question is for Dr. Hewlett and it's a two part question. I'll ask the first part and then I'll which is short. And then I'll get to the second part. Um you were talking about the 13 NETEC, uh, facilities. Can you tell us how many, uh, beds or rooms, whatever the right unit is, are in the NETEC facilities in, um, D.C., Baltimore and New York City, please. And sort of what percentage of the total they are?

Angela Hewlett: [00:22:49] So we currently have two NETEC facilities in, uh, Baltimore, DC area. Um, and the number of beds in those facilities is actually dependent on the pathogen that we're dealing with. For something like a viral hemorrhagic fever, like Ebola, we're looking at our units essentially having a 2 to 3 bed capacity depending on, on the unit itself. Um, mainly that's because of the intensity of the care of those individuals, but also the waste stream and the fact that that waste is categorized where we're needing to perform special waste handling procedures like autoclaving, etc.. So, so the units in, in the DC Baltimore area typically have a 2 to 3 bed capacity. But as I, as I mentioned, that is really dependent on the, on the type of disease. For an airborne disease, without that same waste management strategy, then we typically can take up to ten patients at our facilities.

Jeanne Marrazzo: [00:23:49] Ellen, did you have a second question or was that-

Caller 2: [00:23:53] Yes, I definitely do. Thanks. Um, also, I had asked about New York and in the context of Ebola. But the second question was, has NETEC been told that Ebola patients will not be taken to the Baltimore DC area or New York City?

Angela Hewlett: [00:24:15] We have not been overtly informed of any geographic plans for where these individuals would be taken, should they, you know, should they need care. Um, you know, all of our facilities are ready and willing to care for these individuals. This is exactly what we've trained and prepared for, for all of these years. Um, they're, um, you know, there have been a lot of conversations about the, uh, the individuals and where they would potentially be placed. And that's part of our network, you know, determining the most important, you know, appropriate placement for those individuals should they need to return to the United States.

Jeanne Marrazzo: [00:24:52] Thank you very much. Uh, Doctor Hewlett, um, Leon from CBS News.

Caller 3: [00:24:59] Hi. Thank you all for doing this. It's very helpful. One question on Ebola and one on hantavirus, if I may. Um, Doctor Hewlett, for you on hantavirus, could you shed light on this 21 day period now that the patients in Nebraska are meant to stay. Why did that come down from 42? Um, and is it a matter of cost of transporting people back to their homes if they do want to quarantine now at home, is that prohibitive or is there a big, uh, concern about infection? And then I'll ask my Ebola question.

Angela Hewlett: [00:25:36] So the cost has not actually played into this scenario. Um, the government has been very willing to transport individuals back to their homes should that be necessary using, um, using private aircrafts and not, not flying commercial. The question about the length of quarantine. So that's something that has been addressed um on multiple levels. Um the individuals were initially asked to remain at the national quarantine unit for up to 72 hours for their initial assessments and monitoring period. But then the decision was made that they should remain longer due to the complexity of the assessments that were occurring. Most recently, last Sunday, the individuals were asked to stay in the quarantine unit until May 31st, so that would be a 21 day period. That doesn't mean that their quarantine period is over. It just means that they would remain in the national quarantine unit for that period of time. And at that point, decisions would be made regarding the need to continue in the national quarantine unit versus a potential home quarantine with appropriate transportation home.

Caller 3: [00:26:48] Thanks. And then my Ebola question, I'm sure you're all aware of the flight to Detroit that was diverted to Montreal and some concern and rightly or not. Could you shed light on how effective exit screening is, given that these are very long flights and someone may be asymptomatic in the boarding process and develop something in flight. Can you just kind of walk our viewers through how that works and what they need to be concerned about? Whoever's the most versed in that topic, please. Thanks.

Jeanne Marrazzo: [00:27:21] Dr. Kuppalli, Dr. Butler, would either of you like to take that one?

Krutika Kuppalli: [00:27:26] Doctor Butler take it since he's had experience with implementing it.

Jay Butler: [00:27:30] Yeah. I think you really describe the situation fairly well. The idea is to be able to identify people who are symptomatic to avoid the risk of transmission on the airplane. How effective it is depends on the type of infection we're talking about. Uh, and certainly there are certain types of infections where infectiousness can begin prior to the onset of symptoms. So it's very hard to like put a number in answer to that question. In the case of Ebola virus, the evidence is that the risk of transmission is really pretty, pretty much nil prior to onset of symptoms. So in this instance, screening for symptoms is likely to provide some degree of benefit.

Jeanne Marrazzo: [00:28:19] Thank you very much. That's that's very helpful. And I think that point about symptoms is really what I've been emphasizing to for people who are concerned about travel, um, a lot of people have, have had questions about that. Let's go to Meg now at ID special edition. And if you have more than one question, just go ahead and please ask them both at once and we'll decide who can answer them. But go ahead. Meg.

Caller 4: [00:28:44] Hi. Thanks so much for taking my question. Um, so my magazine goes to health care providers, uh, ID specialists specifically. And I'm just wondering, maybe, doctor, if you could talk to, um, to providers, you know, they might be fielding more questions from patients or, you know, thinking about like, you know, I can, you know, this is so far away from me, how can I help at all. And then also, if you have a comment for people who are on the ground treating patients today.

Krutika Kuppalli: [00:29:14] Great. Thank you. Um, so I think the first thing I would say to ID providers, particularly those in the United States, is that the risk here in the United States is very low. Right? And I want to reiterate that. That being said, I do think it's very important that with any patient that you are assessing to do an appropriate travel screen and follow up questions, as indicated, to ensure that you are not missing these patients. And I think that that is a very important thing that people need to remember, particularly as we are getting into the next few months with, um, many people potentially traveling to the United States for World Cup. So that is the information. That's what I would say to health care providers here in the United States. Um, in regards to the health care providers on the ground. I want them to know that we are thinking about them. We are worried about them. We are in solidarity with them. Working in an Ebola treatment center, working in that, um scenario is probably one of the most challenging things I have ever had to do in my entire life. I cannot imagine what it is like doing it in a place like the Democratic Republic of the Congo, where there is constant violence, where there's limited healthcare infrastructure and limited access to resources at this time. And so I just would like them to know that we are all thinking about them and here to support them in any way possible.

Jeanne Marrazzo: [00:30:37] Incredibly important reminder. Thank you so much. I really appreciate that. Let's go to Julie at Reuters. Julie. Go ahead please. Julie, are you muted? We can see your hand. Okay. We're going to come back to you. Just let us know when we're-[inaudible]

Jeanne Marrazzo: [00:31:22] So let's, let's hold on you. And if Anthony from Helio is available. Anthony. Go ahead.

Caller 5: [00:31:30] Hi. Thanks for taking my question. Um, and I don't know if anyone can specifically speak on this question, but here I go. Are any of you seeing or hearing about a negative impact from the administration's funding cuts, specifically the dismantling of USAID with this Ebola outbreak in Africa? Thank you.

Krutika Kuppalli: [00:31:51] Um, I guess I can speak to that. Um, so the short answer is yes. Funding cuts are impacting the outbreak response in Africa for many reasons. So some of the programs that were funded by USAID, they were used to transport lab specimens and to employ health workers. And those people are no longer around. We don't have that infrastructure intact anymore. Um, and so it is a complicated situation, but yes, definitely changes to the funding environment have impacted this outbreak and will continue to impact this outbreak, because now we're in this large Ebola response and we are going to need to deploy many people supplies. Um, we're going to need infrastructure and we're going to need funding for that as well. And it's unclear right now where that is going to come from. Uh, partners have stepped up, but it's still not going to be enough. And so, uh, and historically, the US has provided significant amounts of funding and it does not appear that that is going to happen at this time. And if we think back to the 2014 outbreak, um, the US ran the response in Liberia. And that took military. That took people that took CDC staff, that took NGOs. It's really unclear what's going to happen in regards to that. So many direct and indirect ways that the changes to funding are impacting this outbreak.

Jeanne Marrazzo: [00:33:13] Yeah. And Jay, please go ahead.

Jay Butler: [00:33:15] Yeah. I was just going to also add that not only is it an impact to this current outbreak, but it's going to become cumulative as time goes on. I think of support for preparedness as being like support for infrastructure such as buildings or equipment. It may not fail immediately after funding begins to fall, but when we start moving into the world of deferred maintenance, a building is going to have more and more leaks. It's going to have more and more problems until potentially there's a catastrophic failure. So what we're seeing now may be only the beginning of what may portend down the road if funding cuts continue, the impact that they're having now.

Jeanne Marrazzo: [00:33:54] Yeah. Thanks a lot to talk about here. Two things I'll quickly add. One is the distribution of PPE, or personal protective equipment. Krutika mentioned diagnostic tests, tests and other things. But that's critical to, to, to this effort and to containment. And I think that that infrastructure is very likely compromised. Uh, the other thing is that we know the recognition of this outbreak, at least from a global perspective, was really delayed. Right? We really didn't hear about this until there were significant numbers of cases and even deaths. And one can't help but wonder whether or not a syndromic outbreak of something this severe might have been picked up, um, if there were more health care workers in the region who were connected, there's great connections, even though this is a very remote place. Um, as, as, as Jay mentioned, um, a lot of the US government agencies have people on the ground with ears to the ground all the time. Um, you know, sort of when, whenever there's a cluster of something concerning, um, the sort of word goes out and people start to look into it. So that's another sort of aspect of surveillance for monitoring that I think we're all really concerned about. Um, okay. I think, uh, [inaudible] asked you to email your question, but if you have figured out your, um, your echo, please go ahead and come back on, um, in as we continue to wait for you. Um, let's go to Lauren from Politico. Lauren.

Caller 6: [00:35:26] Hi. Can you hear me? Thanks for taking my question. Great. Um, I wanted to see if any of you can comment. Um, just kind of generally like how the process in this kind of specifically for Ebola, um, how the process works, uh, for treating physicians, governments, um, what have you to, um, get experimental treatments and or vaccines to, um, to people who have been infected, uh, you know, particularly Americans that are, that may be getting treated by, um, by American physicians. And then if you have any specifics on what you may or may not know about what's happening in this current outbreak situation with that, in that regard, given this, uh, this Ebola virus species being not widely covered by what exists, that'd be helpful.

Jeanne Marrazzo: [00:36:24] So I'm happy to comment on that from my previous perspective at NIAID, but I'm wondering if Dr. Kuppalli has any information from your perspective on, on a global, um, global level.

Krutika Kuppalli: [00:36:37] Yeah. So a couple of things. I think WHO and partners have rapidly convened different technical advisory groups and different meetings to try and figure out where we stand with the, um, the therapeutics landscape and the vaccine landscape and trying to figure out what ones they're going to be moving forward. Trying to finish and continue to go through the clinical trials and regulatory processes. Um, in regards to facilitation of therapeutics to potential patients, um, I'm not exactly sure what the mechanisms are. Um, I did hear that, um, they may be shipping um, monoclonal antibody to Germany, um, for one of the patient there, but I'm not, I'm not sure what the mechanism is for that. I'm not sure if somebody else may be able to answer that.

Jeanne Marrazzo: [00:37:25] Yeah. So I'll just say that, um that we don't have any insight. Um, so whatever we say is, is, is speculative. Um, I will say that, um, in the past there have been really intensive, coordinated efforts to work between investigators who have emerging therapies that may just need to be pushed along the pipeline very, very quickly. So you can start to do some early investigative work or even compassionate use, uh, to, to try to treat, to try to treat people, you know, this is a very, very fatal disease as we, as we've been hearing. And so you don't want to withhold anything if there is a good chance that it's not going to do harm, and it might have even a relatively modest benefit. So it's unclear how that's happening right now. I will just point out, though, as we have been, you know, talking about that last year, key efforts to discover and to distribute and get these products out were defunded. For example, the NIH had funded for a long time the Centers for Research in Emerging Infectious Diseases, the CREIDs. Those were completely defunded. Anything that had to do with the investigation and development of antivirals that used the term coronavirus was also targeted. So we're really seeing, again, many reasons that we're behind the eight ball here in our ability to mobilize emerging therapies. And that's a very, very big concern in addition to the opacity, um, of, of what's going on. Um, so if I go ahead.

Jay Butler: [00:39:05] Yeah, I'm sorry, if I could, I could just add, this is a great example of where preparedness is a team sport. Domestically, the coordination between CDC, NIH, FDA, to be able to identify potentially efficacious agents, to be able to make them available is critical. And then being able to make that link into the World Health Organization and through that multilateral relationship, to be able to provide these agents, whether they're preventive agents, such as a vaccine or therapeutic agents to the people most in need, is just really critical. And right now, that's, uh, I worry it's compromised.

Jeanne Marrazzo: [00:39:47] Totally. And I'm going to go to Angela in a second because I want to ask her about the point of delivery, because two things. One, you may remember in 2014, ring vaccination and delivery of ZMapp actually two later. All of those things were really coordinated with NIH, CDC, everybody involved, global partners. And then I just want to ask you, Angela, from your perspective at the point of care of delivering these things to patients, having your infrastructure and your involvement and your expertise in caring for patients is so critical. So maybe you want to comment on, on your perspective in this, in this area. And if that's been discussed with the current outbreak.

Angela Hewlett: [00:40:29] Yeah. So these things are certainly being discussed. And as was mentioned, you know, a very sort of coordinated effort with a lot of different levels between different agencies as far as the most appropriate medical countermeasures to utilize for caring for patients. Here on the ground, you know, we have a process in place to acquire the most promising agents in the case, as is with, uh, with Bundibugyo, and that we don't have any FDA approved, you know, medications or vaccines at this point. Um, which that makes it distinct from Zaire ebolavirus, where now we do have two FDA approved medications, as well as an effective vaccine. And so we are able to typically acquire these products, but it's really through our relationships and preexisting relationships with multiple agencies, uh, you know, including the FDA, NIH, and CDC. But it is a complex process and definitely a lot of individuals are involved. And, and it is absolutely a team sport.

Jeanne Marrazzo: [00:41:29] Yeah. Thank you very much. I think it's important to have your perspective because you are the people who are actually administering the agents to the people who are affected. So I really appreciate that. Um, let's go to ping from, um, NPR.

Caller 7: [00:41:45] Hi. Thanks for doing this call and for taking my question. Um, I have two questions as well. The first one, um, Dr. Marrazzo, you mentioned title 42, you know, barring entry to some non-U.S. passport holders. Um, the Department of Homeland Security recently unveiled a new policy where they're going to be routing every traveler who's been to either of the affected countries in the past 21 days through a single U.S. airport. Um, that's Washington Dulles, um, Washington Dulles. And I'm wondering if you think that policy is helpful, if it's likely to increase security in any way. Um, my second question is more generally about World Cup preparedness. You know, you've all talked about how the risk to the US public is currently low. Does it rise with the super mixing event. Do you feel like the US is, um doing the right things to be prepared for that?

Jeanne Marrazzo: [00:42:36] Um I think that Dr. Kuppalli, has reacted um eagerly to your, to your question. So I'm going to I'm going to put that over to her, not to avoid it, because I think she's very well positioned to start answering.

Krutika Kuppalli: [00:42:48] Sure. So I think the question on airport screening. So, um, I don't think that funneling people through maybe one airport is going to help things. I think it causes actually more confusion and chaos. Now, do I think, you know, screening people is helpful? Yes. You can catch people who may be symptomatic. And again, figure out who your high risk contacts are and implement the appropriate measures. Right. And so I think that's important, but I'm not sure that funneling them all through one airport will actually make things easier and more efficient. Um, to your second question about World Cup preparedness. So this is something we've been working on a lot, um, in Texas because we have the most number of games. Um, and, um, we are also supposed to be hosting a game between DRC as well. So I think we've been thinking about the realm of possibilities of infectious diseases, especially when you have a large mass gathering like this, where there are estimates of as many as 5 million people entering the country for the games. So we're thinking about respiratory diseases, things like coronaviruses. And measles is probably the ones we're most worried about, the respiratory diseases and measles. But of course, we're going to be worried about some of these other diseases that we're seeing and hearing about, more like Ebola and other viral hemorrhagic fevers. And we're working to make sure that our local providers are prepared to be able to identify these things should they come through their doors. And then how to effectively work with local, state and national public health.

Jeanne Marrazzo: [00:44:29] Thank you so much. And I'll just also remind folks that, you know, screening involves public health personnel. And if you're going to set up screening at airports and not just have a central airport, which I agree is not going to be particularly effective. You need people to do it. And in the current environment, in the last five years in particular, we've seen decimation of local public health, regional, state public health, staffing, funding programs. So, you know, again, ideally you'd like to see more of a regional effort that would cover more airports, cover more places, but that takes resources and an infrastructure. And I don't know that we are as well prepared for that as we should be at those levels.
Krutika Kuppalli: [00:45:12] Can I just say one more thing?

Jeanne Marrazzo: [00:45:15] Yes of course.

Krutika Kuppalli: [00:45:16] Can I just say one more thing?

Jeanne Marrazzo: [00:45:17] Go ahead.

Krutika Kuppalli: [00:45:18] In 2014, they did this as well. They did airport screening. Right. But they had I think it was five airports where people would come through. And so it also helps decrease the bottleneck. If you have those airports spread out around the country, if you're going to do screening on people coming back into the United States. So having it at one airport also causes a lot of logistical challenges for people who are coming back into the country.

Jeanne Marrazzo: [00:45:44] Absolutely. The lines are even longer than they already are. Okay. We're coming towards the end. So I'm going to go ahead and ask the two questions from Julie at Reuters. The first question is, um and thanks for emailing these, Julie, can the experts compare the response to prior large outbreaks and the role of USAID to the current outbreak? I think we've touched on this before, but would anybody like to especially, um, Jay or, or any of you actually, I think could comment on this. Any additional points you'd like to make?

Jay Butler: [00:46:19] Maybe just to talk a little bit about the role that USAID and the Department of State plays in the response, they are the ones who are able to create the pathways to get the experts and the, uh, the medications and the test equipment into place. Uh, you know, as scientists, we are not necessarily good bureaucrats. Uh, but when I use the word bureaucrat, I mean that as a compliment. These are people who know how to use the bureaucracy to make things happen and to make a response be, uh, very fast and efficient. Uh, so right now, uh, USAID has basically been, uh, disassembled. So while I was hesitant to make any comparisons earlier regarding what's going on inside the CDC, we now have a response without USAID. So comparing it to when it was in place, I can say from experience, USAID was a vital partner to the response, uh, that was coordinated and oftentimes carried out logistically by other parts of the Department of Health and Human Services.

Jeanne Marrazzo: [00:47:29] Thank you. Jay. That's, uh, really appreciate that. And then, um, the second question, uh, from, uh, from Julie, uh, what's the total bed capacity for the US to care for symptomatic Ebola patients, especially something that Doctor Hewlett alluded to previously, given the waste management concerns, is there autoclave capacity? Um, and has that improved since the last time we were faced with this challenge. And I'm going to ask Doctor Hewlett to comment on that please.

Angela Hewlett: [00:48:01] So currently there are 13 regional emerging special pathogen treatment centers in the United States. All have waste management capabilities including category A waste, which is what the designation is for Ebola virus disease. Um, we within the network, you know, typically depending on pathogens, we usually can care for 2 to 3 individuals at each of these units. But that also is dependent on the acuity of the patient, whether the patient is requiring critical care interventions as well as the the staffing of the facility. So typically around two beds per facility is our our capacity. And so with that and the 13 regional treatment centers, we're looking at around 26 total beds in the United States at the level one regional treatment center, uh, facilities. Now, we do have a. Fortunately, we have we also have some level two facilities within the United States that are also capable of caring for individuals with high consequence pathogens. And so that bed capacity is expanded into those level two facilities as well. Um, but currently we're bringing up a number of those level two facilities so that we can increase our capacity. And that is something that we've been fortunate enough to receive funding for, uh, recently in order to, you know, to build that capacity here within the United States. But, you know, regardless of any of that capacity is still limited for, you know, for caring for patients with these types of diseases because of the very complex and, and intensive care that patients often require.

Jeanne Marrazzo: [00:49:41] Great. Thank you so much. Well, I think we're going to wrap up. That's the last question we have time for this morning. I really want to thank, uh, Drs. Kuppalli, Hewlett and Butler, um, for being available on short notice and from various time zones. Uh, so really, really can't thank you enough. Thank you for showing up. Um, those of you who ask questions, I want to let people know that IDSA will be holding a media briefing on another issue, the current state of measles outbreaks in the United States. And we'll be doing that next week. Um, Wednesday, May 27th. We will be sending out registration information on that later today. For more information on IDSA, please visit us at idsociety.org. And thank you for joining us today.