The National Governors Association appreciates the opportunity to comment on the nation's efforts to combat Ebola. States play a critical role in these efforts as the first line of defense against the spread of Ebola in the United States. As chief executives of their states, governors are responsible for maintaining public health and controlling the spread of disease within their borders. While the country is not currently facing an outbreak, the threat continues and governors are taking action to ensure that their states are prepared to respond.

Governors are implementing protocols based on the unique characteristics of their individual state's public health and safety infrastructure and in accordance with state laws. These policies are informed by federal guidelines and tailored to reflect specific state circumstances, including the number of people arriving from the center of the outbreak in West Africa, the prevalence of mass transit and the number and proximity of designated Ebola treatment centers. These and other factors underscore the importance of a strong, cooperative relationship between states and the federal government that preserves state authority and flexibility to tailor policies in a way that best meets the needs of their residents.

As efforts to prevent the spread of Ebola continue at home and abroad, there is an urgent need for stronger collaboration across federal, state and local government and additional resources to help states address this threat. Governors appreciate consideration of state and local needs in the Administration's November 5, 2014, request for emergency funding. With the Ebola outbreak still uncontained in West Africa, governors urge Congress to act on this request to ensure states have adequate resources to prepare for and respond to the near inevitability of new cases in the United States.

STATE PREPAREDNESS AND RESPONSE EFFORTS

Preparing for, responding to and treating potential new Ebola cases requires extensive planning and coordination across all levels of government and the private sector. Previous investments in the public health system have laid the groundwork to address current challenges, however, implementing and sustaining these efforts will require significant new investment and additional support.

As the Senate Appropriations Committee considers supplemental funding for Ebola, governors urge you to consider the additional expense states are incurring in order to protect the public health and safety of their residents, including the following:

Post-Arrival Monitoring and Other Safety Measures

  • Pursuant to federal guidelines, state and local health officials are closely monitoring individuals whose travel originated in the affected countries for 21 days following their last exposure. If current trends continue, state and local authorities will need to maintain direct daily contact with an estimated 80 to 150 people arriving each day—between approximately 1,700 and 3,000 people during any given 21 day period—for the duration of the crisis in West Africa.
  • States may need to quarantine and devote additional resources for individuals who have been exposed but remain asymptomatic, including those who do not comply with monitoring protocols. This may require deploying epidemiologists and other trained personnel, including law enforcement. In addition, states may need to provide housing, food and health care to some of the estimated 35 percent of travelers who do not reside in the United States. In one state, a 21 day out-of-home quarantine for one high-risk individual could cost an estimated $48,000 for meals and law enforcement overtime pay alone. That estimate does not including potential costs for other first responders, transportation and temporary housing for family members who need to be separated from the at-risk individual.
  • Out of an abundance of caution, some states are providing private transportation to lower the risk of transmission by removing at-risk individuals from crowded areas. States are also using contact tracing to identify others who may have been exposed.
  • Currently, all travelers from the affected countries must enter the United States through one of five federally designated airports. Seventy percent of those travelers will make their final destination in one of six states that began post-arrival monitoring on October 27. As Ebola continues to plague other parts of the world and additional at-risk travelers arrive with varied final destinations, all states will need to be prepared to implement these protocols.

Training and Equipment

  • States have been preparing for months by training health care workers to put on and take off personal protective equipment (PPE), conducting drills and working to ensure that their response plans are thorough and carefully designed.
  • In addition to health care and public health professionals, states are supporting training for law enforcement, the National Guard and others who may have a role in transportation, decontamination and waste disposal.
  • States are purchasing additional supplies and PPE—suits, face shields and gloves, among other items—to protect health care workers, first responders and others who may come into contact with suspected cases.

Hospitals

  • States are supporting hospital readiness, including increased training, new equipment and supplies and additional space in which to treat and isolate patients who have been diagnosed with Ebola. As part of this effort, states are working closely with hospitals to ensure that protocols are in place to safely identify and treat new cases at least until a patient can be transferred to a specialized treatment center.
  • To safely treat a single case of Ebola, as many as 50 health care professionals could be needed over a 24-hour period, and countless more may need to be trained and prepared to respond.
  • States are working to address concerns that many hospitals have expressed regarding the financial consequences that may result from their willingness to treat Ebola patients.

ENHANCED FEDERAL SUPPORT

Public health experts agree that until the Ebola outbreak in West Africa is brought under control, Americans here at home will continue to be at risk. Therefore, current preparedness efforts, such as enhanced monitoring of incoming travelers, will need to continue through the coming months or even years. Response and enforcement of Ebola-related measures fall on the shoulders of state and local governments. Governors urge Congress to ensure that states are not only reimbursed for their recent expenditures, but also have sufficient resources and flexibility to meet this ongoing challenge while maintaining support for other critical public health and safety functions. The following details several areas in which greater federal support will be critical to protecting public health and safety here at home:

Funding – States need adequate and stable funding to build capacity, implement new monitoring protocols and contain new cases of Ebola. While states are working to assess the level of additional funding needed to maintain their current efforts and respond in the event of a growing emergency, there is a clear need for Congress to reinvest in public health preparedness and provide immediate assistance to states already working on the front lines. The recent decline in funding for the Hospital Preparedness Program (HPP) and the Public Health Emergency Preparedness (PHEP) program has made it difficult for state and local entities to recruit and retain personnel, resulting in a loss of response capability.

Grant Program Flexibility –States are seeking additional federal guidance and flexibility with respect to their ability to reprogram existing grant funds to meet immediate needs. For instance, flexibility within the HPP, PHEP program, Homeland Security Grant Program and the Emergency Management Performance Grant program would help maximize and sustain preparedness and response efforts.

Information-Sharing –States rely on their federal partners to share timely information, such as new guidelines and information pertaining to the arrival and transport of at-risk or infected patients. States that first implemented post-arrival monitoring, for example, should have received adequate communication prior to the release of the Centers for Disease Control and Prevention's new guidelines. In addition, states responsible for monitoring 70 percent of incoming passengers from the affected countries should receive more advance notice of passenger manifests in order to appropriately monitor any potential Ebola cases.

Procurement of PPE –States urge their federal partners to help address supply chain issues that are preventing the purchase of additional PPE. Current backorders pose a major challenge as states work to ensure the safety of health care providers, first responders and other key personnel in the event of an outbreak. States may need dozens of protective suits a day to treat a single Ebola patient, depending upon the level of care needed and the type of suit.

Waste Transport and Disposal – States have encountered challenges with regard to the transportation and disposal of Ebola-contaminated waste. Federal rules require each facility and waste hauler to receive a special permit from the Department of Transportation, which leave states with few disposal options. States encourage the federal government to work with them to reevaluate these rules in order to avoid a potential buildup of contaminated medical waste.

Additionally, states encourage the federal government to work closely with airlines that are transporting passengers from affected countries in West Africa. Airlines should have clear protocols for isolating symptomatic travelers and notifying the appropriate local, state and federal authorities.

MOVING FORWARD

Governors are committed to working with their federal partners and other state and local organizations to prevent the spread of Ebola within the United States. While federal efforts are now focused on stemming the outbreak in West Africa, states must have adequate resources and support to prepare for and respond to new infections within their borders. Governors urge the committee to consider the immediate work that must be done here at home given the likelihood of new cases emerging in the coming weeks and months. Only with additional federal support and a renewed commitment to collaboration across all levels of government can states continue to protect the public from the threat of this disease.