Diary Prequel Package — page 362

There really is no command and control at a higher level. At my suggestion, Francis sent a note to SMB suggesting that we bump this up to the White House level (perhaps the VP) in order to get DoD, USAID, HHS, and NSC working together. She has not yet responded to him. I mentioned on the call today that Tom Frieden is dealing with Assistant Secretary Lumpkin of DoD. He is a good person, but nothing is happening with the promise for mobile hospital beds. They are still quibbling about a 25 bed hospital when they really need 1000 beds. Plans for 5 X 100 beds have gone nowhere. My experience with the DoD is that they are well-meaning, but the culture and chain-ofcommand is such that you never know when you are speaking with someone who really has the authority to actually do what they are talking about. Something strange about the military culture in that they will never say "you are speaking to the wrong person; I cannot help you". They will try to help (although they cannot) and all that happens is that time is wasted. I tried to make that point on the conference call. Importantly, WHO is saying that the epidemic could reach 20,000 cases. In fact, mathematical models that came out in ScienceInsider today from a physicist named Alessandro Vespignani showed that the curve is exponential, not linear, which means that there could be 10,000 cases by September 24. This is turning into a total catastrophe. Just spoke with Dawn O'Connell (Counsellor to SMB) and explained to her that the situation is out of control and that we need a higher command and control. I also explained to her the importance of the "exponential" curve of the epidemic. Dawn is really trying to be helpful. Sept. 2, 2014 - Tom Frieden back from West Africa, gives press conference and says that the situation is out of control and could result in 100,000 cases! HHS people concerned that he is being hyperbolic; I do not think that he is hyperbolic. Worrisome things - an American missionary M.D. got infected while got infected in Liberia in a hospital that was not for Ebola patients. Turns out he was doing an OB-GYN exam on a woman who was infected, but did not know it and did not tell the missionary that she had been exposed. Big problem - people are not telling the truth for fear of stigma. Epidemiological curves are now exponential. A lot of planning, but not much action. I am supporting Tom in the press and at HHS even though he still thinks that we should pre=position TKM drug (siRNA) and VSV vaccine for PEP for health workers in the ETUs even though they have not been in Phase 1 yet. Did Panel at CSIS on 1616 Rhode Island Avenue. Very hot muggy day. Panel on Global Health issues in the context of Larry Gostin's new Book of Global Health Law. Panel was me, Larry and Tim Evans of World Bank. Ebola was a major topic. Important - Secretary Sylvia Burwell called my cell phone at 2:30 PM to ask my opinion of whether we were not doing enough or were doing it wrong. I told her that quantitatively we are not doing enough. But as the epidemic grows exponentially, then the quantitative defect transforms into a qualitative defect and then we are doing it wrong since doing the same thing minimally while the epidemic grows, then becomes doing it wrong. She also tasked me to find out whether there are options to improve the tobacco