Ed Rouse

Edward N. Rouse

Q: Hello, this is Sam Robson here with Ed Rouse. Today is September 30th, 2016, and we are sitting here in the recording studio of CDC's [United States Centers for Disease Control and Prevention] Roybal Campus in Atlanta, Georgia. I have Ed here with me talking today about CDC's Ebola response, 2014 to 2016, and his role in it. Ed, thank you so much for being here. Would you mind pronouncing your full name for me, and telling me what your current position at CDC is?

ROUSE: Okay, it's Edward N. Rouse. I'm currently the deputy division director of the Division of Emergency Operations.

Q: Thank you. As briefly as possible, could you summarize your work as part of the Ebola response?

ROUSE: During Ebola, I actually had three functions. Initially, I was the Logistics Support Branch chief, or logistics section chief rather, in the 00:01:00incident management system. I also deployed to Liberia twice to do emergency management capacity development work, which essentially is helping the Liberian Ministry of Health [and Social Welfare] establish their own emergency operations center and emergency management program. Then, in the latter part of the response, I transitioned from being a Logistics Branch chief to the deputy division director, so it changed my focus a little bit.

Q: Great, thank you. Backing up drastically, can you tell me when and where you were born?

ROUSE: Hudson, New York, May, 1955.

Q: Thank you. Did you grow up in New York?

ROUSE: I did. I grew up and went to college in New York, and then after that, I went in the Army.

Q: Were you raised by your parents?

ROUSE: Yes.

Q: What did they do?

ROUSE: My dad was a salesman. My mom was a stay-at-home mom.

Q: How did you decide to go into the military?

ROUSE: Something I wanted to do since I guess late elementary school.

Q: Why was that?

ROUSE: I don't know. Somewhere along the line, I got an intense interest in military history and that sort of transitioned into serving.

Q: Gotcha. Can you tell me a little bit about the early years of being in the military?

ROUSE: Okay. My first assignment was in Germany in 1978. I was serving in one of the units that patrolled the east-west, the border between East and West Germany at the time. I did that for a few years. I had a follow-on assignment in El Paso. I went back to Germany for a couple of tours. I went to Desert Storm. I 00:03:00came back to the US and then retired. [laughter] That's kind of a thumbnail sketch, I guess.

Q: A lot of travel. You retired in what year from the military?

ROUSE: Nineteen ninety-eight.

Q: Nineteen ninety-eight, gotcha. Did you specialize in a certain area?

ROUSE: Yeah. I was in armored cavalry units, which for the Army, does reconnaissance and security missions, and then kind of functionally, in the operations field in general.

Q: Okay. If I could like trace your experience with logistics back, I would kind 00:04:00of see that pretty prominently in the military with operations?

ROUSE: Yeah. In the units I was in, a couple of times, I had duties that were as an executive officer, which included the logistical plans and activities for the unit. I also had a tour where I was the logistical planner, so [that's how I got into that].

Q: What tour was that?

ROUSE: That was one of the assignments in Germany.

Q: Gotcha, gotcha. I think you said 1998 is retirement from the military?

ROUSE: Right.

Q: What happens then?

ROUSE: I went to work for Fulton County government doing facilities management and emergency planning for them for about six years. Then I came here to CDC.

Q: Why Fulton County?

ROUSE: I guess happenstance. A friend of mine had a friend who was working there and was looking for somebody with my skill set.

Q: When you come to CDC, in what capacity did you come?

ROUSE: I was hired as a [contractor to be a] duty officer when the Division of Emergency Operations was in its early days.

Q: Do you remember what year that was?

ROUSE: Two thousand four.

Q: Two thousand four. What was it like here at CDC in 2004, the first few years?

ROUSE: In some ways, it's kind of like it is now. The pace was a little bit slower, but there were still a lot of emergencies going on. Things were growing. 00:06:00There were reorganizations going on. The Division of Emergency Operations, and in fact, the Office of Public Health Preparedness and Response, were both--I forgot the exact term for it, they're not ad hoc, but they were like provisional organizations awaiting approval. But there was always something going on in public health, so we were busy.

Q: And some of the earlier things that were going on in public health, some of those emergencies you were responding to?

ROUSE: The Indonesian tsunami took place not long after I got to work. We had a Marburg outbreak that we responded to. Then the hurricane season, Hurricane Katrina, Rita, Wilma all came in.

Q: Right, absolutely. Who were some of the people you worked with most closely?

ROUSE: Phil [Philip] Navin [Jr.] was the director of DEO [Division of Emergency Operations]. Bruce Burney was the deputy. Dr. Ralph O'Connor was the operations chief, public health officer. Mr. Steve Bice in the [Strategic National] Stockpile. A whole bunch of folks, many of whom have already retired.

Q: Do you transition to any other roles after the first few years, or how does it go?

ROUSE: Well initially, I was in the Operations Branch because that's where the duty officers sit.

Q: Can you tell me what a duty officer does?

ROUSE: The duty officers are responsible for providing supervision and oversight 00:08:00of the watch officers, who are the contract folks that are manning the phones 24/7 [twenty-four hours a day, seven days a week]. They field and triage all the calls that come in, whether they're coming from the public or another government agency or partners overseas. Duty officers are also responsible for reporting, so the daily report that goes out, any kind of incident-related or situation reports that have to go to leadership, just monitoring operations on a day-to-day basis.

Q: Gotcha. Sorry, and I cut you off about if you were making a transition from duty officer to any other positions.

ROUSE: Oh. Yeah, I was duty officer for about a year, and then I transitioned to 00:09:00an FTE [full-time equivalent staff] position and I became the deputy of the Operations Branch, and then did that for about four years. Then I became the Logistics Branch chief.

Q: In what year did you become Logistics Branch chief?

ROUSE: In 2009, the same week that H1N1 started.

Q: Wow, can you tell me about that?

ROUSE: It was interesting from a variety of perspectives. Of course, it was the first major response the agency had had since Katrina. It wasn't long after the governmental transition, so we had an acting CDC director, Dr. Rich [Richard E.] Besser. There was I think an acting HHS [US Department of Health and Human Services] director. The CDC was kind of doing a lot on their own, not only 00:10:00responding but dealing with the interagency. Of course, we'd been preparing for flu [influenza] for a number of years, and we thought it was going to be a different strain. We'd been preparing for H5N1 and it was H1N1. The thought process was it was going to come from Asia, across the Pacific. It came in through Mexico, across the border. But by and large, the same processes and procedures that we put in place--the exercising for flu served us pretty well during that response.

Q: So what happens after H1N1?

ROUSE: MERS [Middle East respiratory syndrome], H7N9, I mean, there's just--

Q: Just a constant flow.

ROUSE: Yeah.

Q: Gotcha. How did you originally get involved in the Ebola response?

ROUSE: Well, when we found out we were going to activate an incident management system and put it in the EOC [Emergency Operations Center] for the response, when that happens, the Logistics Branch chief in the Division of Emergency Operations becomes the logistics section chief in the incident management system. That wasn't--you know, it was kind of routine. We had been working with the folks in [Viral] Special Pathogens [Branch], Dr. Pierre Rollin, and Dr. Stuart [T.] Nichol, because in logistics, we typically supported them when they did response to the smaller scale outbreaks. In fact, we had helped them deploy to Guinea earlier in 2014 for what turned out to be the start of this response. 00:12:00So that was kind of routine.

The wrinkle was that Dr. [Thomas R.] Frieden wanted somebody to go to Liberia to try to help them put in an incident management system, or an IMS in place, and establish an emergency operations center. Dr. Kevin [M.] De Cock and Dr. Satish [K.] Pillai were already in Liberia and had been working with the Ministry. Both of them were kind of versed in incident management systems, so they recognized the need and were trying to work with the Liberian Ministry of Health, but they wanted an emergency management specialist to come and assist, so I got tapped to go do that. So that was the start of what became a series of relays of emergency 00:13:00management specialists from the Division of Emergency Operations going and doing rotational tours to try to get capacity established there.

Q: I remember when I talked with you several months ago now, you gave a really good breakdown of the incident management system, IMS, and the EOC, not--you know, those are not interchangeable terms. Can you kind of describe, define?

ROUSE: Yeah, so there's three three-letter abbreviations that people at CDC tend to treat as equivalent, but they're not. You have the Division of Emergency Operations, or DEO; you have the Emergency Operations Center, or EOC; and you have the incident management system, or IMS. DEO is an organization. We have an 00:14:00organization code, we've got a budget, we've got all the things that are associated with any other program. The EOC is actually just a room, you know, floor space with some rooms. It's not an entity in and of itself, and it doesn't have anything other than the physical space and equipment that sits in it. Then, you have the incident management system. The incident management system, or the IMS, is an ad hoc organization. It doesn't have an org [organization] code, it doesn't have a budget, it doesn't have an organizational structure, a formal one like with a MASO [Management Analysis and Services Office] package, but it has to do all those functions. Like I said, people tend to treat those three things as the same, when they're really different.

Q: Right. So there will always be a DEO, but whether the IMS gets activated 00:15:00depends on certain factors? I don't know.

ROUSE: That's true. DEO exists on a day-to-day basis. Hopefully, it will always be here. It's part of the day-to-day structure of the CDC. The incident management system gets stood up when there's a determination that a public health situation has exceeded the capacity of the program that normally handles that situation. In the case of Ebola, Ebola is a special pathogen. It's normally handled by the Viral Special Pathogens [Branch, in the Division of High-Consequence Pathogens and Pathology], I think. When the response exceeded the size and scope that the division could manage, they requested assistance from DEO and requested authorization from Dr. Frieden to activate an incident 00:16:00management system, an IMS structure.

Q: Gotcha. And an IMS structure means for them that they'll have what, like more resources dedicated to them, more people?

ROUSE: Generally, when you activate an IMS, then you have the ability to go outside the organic division or program for staffing, in this case, across the agency. Funding can be problematic because there's no funding that automatically comes with an IMS activation. An IMS activation normally starts out with funding from the program, so in this case, it would have been--actually, I think it was NCEZID [National Center for Emerging and Zoonotic Infectious Diseases] that provided the initial funding for the Ebola response. Then, it's up to the CDC director's office to find additional funding within the agency or to put in a request to go to HHS or OMB [Office of Management and Budget] for supplemental 00:17:00funding, and that of course happened later.

Q: Gotcha. So the rollout of the IMS when it came to Ebola, was that all pretty routine? Or were there some aspects of that that were unique?

ROUSE: I think probably a little of both. The activating of an IMS is--I mean, there's a process that's fairly established for that. Normally, we have what's called a preliminary assessment team meeting, a PAT, between the program and DEO to determine what the program needs are, what's the situation that's causing the request, and how activating an IMS, which brings essentially DEO assets to bear, is going to benefit the response. The request usually goes up through the OPHPR 00:18:00[Office of Public Health Preparedness and Response] director to Dr. Frieden, and that's normally kind of a formality. One of the things that was unique is that the Viral Special Pathogens folks had not been really in the EOC--operating in the EOC and incident management system structure before, so they were kind of new to that.

Q: Were there consequences that you saw from that?

ROUSE: Well, it's a growing process. They're not quite sure what support is available, or how to ask for it, so we end up having some meetings to try to explain okay, here's what Logistics can do for you, here's what Operations can do for you, here's what Plans, [Training, Exercises, and Evaluations Branch] can do for you, and they're trying to absorb that at the same time they're trying to respond. It's not always smooth, but we settled in and we're starting to 00:19:00operate. Most of our IMS activations are at a Level 3, which is the lowest level. This was no exception, although as things changed, we quickly escalated to a Level 2 and then a Level 1.

Q: Sorry, I appreciate your breakdown of all of these things. I know it's not focused exactly on your experience, but I just appreciate the definitions, etcetera. So you were tapped to go to Liberia and help set up the EOC. Kevin De Cock and Satish Pillai were already there. What were you told about this situation before going?

ROUSE: Well, we knew that there were a lot of cases, that there were cases in 00:20:00urban areas, which was new. We knew that neither Liberia nor the other two countries in the region had very strong or robust health systems, that there was limited embassy support. There was an embassy in Monrovia, Liberia. It's a relatively small embassy, so they had limited support. There was no CDC country office in any of those three locations, which is normally the plug-in point when we deploy staff to the field. We knew that none of the three countries had an operating public health emergency operations center and they didn't have any kind of emergency management program or incident management system, so all of 00:21:00those were going to be novel concepts that we were going to try to educate them on and implement in the middle of a major public health outbreak.

Q: What were your personal thoughts about the situation?

ROUSE: Well, timing is not good for trying to do something like that. There's an expression in the emergency management community that you don't want to be exchanging business cards on the first day of a response, but that's essentially what we're going to do. You couple that with the fact that, in my case, I was a new person to the Ministry. They didn't know me, I didn't know them, so you've got to establish that relationship and a trust there before you can do anything, and that's not something that happens overnight.

The one good thing was Liberia's an Anglophone country, so I didn't have to 00:22:00worry about a language problem, or a barrier, as they did in Guinea, which is a Francophone country. I knew the [CDC] director had a lot of expectations. I wasn't sure we were going to be able to meet them in a timely manner because establishing an EOC and establishing an emergency management program is not something that's done quickly.

Q: Sure. How does your deployment proceed? When do you get into Liberia?

ROUSE: It was around the 24th of August, I think. I was there for about a month. Part of the problem in my particular situation was we didn't have a deep bench 00:23:00in the Logistics Branch, so if I'm deployed, there's a hole in the log [logistics] structure. After I deployed the second time, I was sort of told you're not going back a third time, you've got to stay here and focus on the log stuff.

But by then, we established a rotation so there were three of us that were rotating through. One of the issues we were dealing with at the time that limited the rotation was the requirement that you have to have State Department medical clearance to deploy for over thirty days. Most of us didn't have that, so the starting point was the thirty-day rotation. Now, they subsequently waived that, but at the time, that was kind of a planning figure. We started out with thirty-day rotations, three of us taking turns, so at least if you're in the 00:24:00second rotation, it's like it's not a new person coming in, it's the same person who was here before, so you're not having to re-establish relationships. Not the ideal situation, but it worked.

We got to Liberia, got settled in. They were working seven-day weeks, so it was the next morning, I started going to meetings with Dr. De Cock and initially observing what they were doing. Then starting to work with the incident manager. They actually changed incident managers after I was there a week. The first person they had serving in the incident manager capacity was trying to do both incident management and day-to-day public health roles, so that impacted on the 00:25:00ability of the incident manager to focus on a response. So the minister of health split that, put a person in to be solely incident manager and let the original incident manager focus on day-to-day public health stuff. I was starting to work with the new incident manager, meeting with him early in the morning and late in the afternoon, communicating during the evening, because I think it was important not to be trying to dictate from a CDC perspective. Changes and things like that needed to come from the incident manager. He's establishing himself as the source, and the people are looking to him for decisions and not looking over his shoulder to CDC to see what CDC had to say. 00:26:00That was working pretty well, I think. By the time I rotated out, their meetings were starting to get a little more organized. They were starting to have some objectives and some follow-up. One of the problems they had early on was they would talk about a lot of things and they would identify a lot of actions, but there was no assignment of those actions to somebody to be accomplished, and then there was no follow-up. So we started a rudimentary task-tracking system, so if the IM [incident manager] said, "I need somebody to check on the status of the personal protective equipment in the warehouse," or "I need somebody to find out where these three ambulances are located," and identifying, tagging that to somebody, and then at the next IM meeting, having a list of do-outs, so the IM 00:27:00would go down the list and say, okay, so how much PPE [personal protective equipment] do we have and where are the ambulances, and those kind of things. Starting to get them into a rhythm.

Q: Right. And the incident manager, his name is Tolbert, is that right?

ROUSE: Yeah, Tolbert Nyenswah.

Q: Nyenswah, gotcha. Can you describe him a little bit?

ROUSE: Very intelligent guy, very caring and concerned about stopping Ebola, very much--because he was part of the Ministry, of course, he was attuned to the internal situations and which person needed to just be given direction, which 00:28:00person needed a little bit more schmoozing, if you will. He also had a number of folks on his staff, all technically proficient in their jobs, but almost all of them, I would say all of them, overworked because they didn't have a very deep structure, and a lot of them were doing it voluntarily because there wasn't a big budget for salaries and that. He was always concerned with resources, dealing with I guess intra and inter-ministerial conflicts. Good sense of humor, stayed pretty upbeat at least as far as I could tell, which was a challenge in 00:29:00those circumstances.

Q: Yeah, I would imagine. Wow. When you look back at that month, late August to late September, are there any vivid memories that come up for you?

ROUSE: A lot of the infrastructure was still fairly devastated from the last civil war, which ended in 2008, so five or six years is not a lot of time for an economy that's not real strong. There was still a lot of evidence of that, and people still talked about that, about things. You could tell that they were influenced by what had gone on.

One thing that--you know, when I first got there, I hadn't taken note before I 00:30:00left of what the Liberian flag looked like. I'm kind of groggy as we're driving around the first day and I'm seeing all these flags that look--and I'm thinking, there's a lot of American flags out. But when I stopped to look closer, it's really the Liberian flag. It looks very similar to the US flag, which is kind of interesting. They also have a CDC in Liberia. I learned right away not to use the abbreviation, CDC, outside of the Ministry or meetings with WHO [World Health Organization] or whatever, because I guess it's a political party that's prone to violence. When you tell somebody you are here with CDC, they kind of 00:31:00look at you funny.

People were friendly, very glad to have folks from the CDC there to help.

Q: [pause] Sorry, I'm just reflecting for a second. Who were the other two people that you were on rotation with?

ROUSE: Luis Poblano and Harvey Howard. Both of them were part of the Operations Branch of the Division of Emergency Operations.

Q: Did you have a chance to overlap with them at all when you rotated?

ROUSE: Yeah. We built in about a week overlap for each one of the rotations. I say about a week because one of the things that impacted on the deployments was 00:32:00airline schedules. At the beginning of the outbreak, there were multiple airlines flying into Monrovia, but I want to say September, maybe late September, everybody stopped except for Brussels Air. They were flying twice a week, so basically you built your handoff on somebody arriving on Tuesday and their replacement flying out on Friday or something. I forgot the exact timing of the flights, but it was something like that.

Q: What happens after you come back?

ROUSE: You just go into the EOC and pick up my duties as a log section chief in 00:33:00the IMS, making sure deployments are coordinated, shipments are made.

Q: What was your sense of the situation at that point, after having spent a month in Liberia? What I've heard is that Kevin De Cock was really important in raising alarm bells about the situation. When I imagine the mood, I imagine it to be--fast-paced and very tense. Is that how you would describe it?

ROUSE: We had a lot of long days and a lot of the meetings were pretty intense. The pace kind of varied because you're here in Atlanta and you're trying to 00:34:00influence actions that are thousands of miles away in a different time zone and you're working in a multinational environment, so you've got a sovereign nation that's got their own institutions and so you can't disregard those; you have to work with them and through them. We had WHO, which had an inconsistent presence and inconsistent effectiveness. We had US assets from other US government agencies, notably the Office of Foreign Disaster Assistance, and USAID [United 00:35:00States Agency for International Development]. They deployed a DART team, Disaster Assistance Response Team, I think, to Monrovia. Working with the DART team was a new experience for a lot of CDCers, and sorting out roles and responsibilities was a challenge in some respects. Both agencies operated very differently. CDC tends to operate in a decentralized manner in the field. USAID is more used to operating in a central manner. And later on, of course, DoD [US Department of Defense] showed up. I'm trying to remember when the--I think the 00:36:00DART showed up at the midway or toward the end of my first rotation, and DoD showed up second rotation.

One of the things that also changed during that timeframe was the Liberians' view on the need for an emergency operations center. Most of the countries have--their term for emergency management is disaster management. They would have a national disaster operations center, kind of like our FEMA [Federal Emergency Management Agency] equivalent, typically run by either the Defense or the Ministry of the Interior. Public health may or may not be invited in. It's actually not too different from situations that we faced here in the US some 00:37:00years ago. Telling them that they needed a separate emergency operations center for public health response with the space and money and staffing and all that entails is generally a hard sell. At the time this was going on, in late August or early September, I was in Liberia, and one of my colleagues, Mark Austin, was in Sierra Leone trying to do the same thing. Mark's from the Plans Section of the Division of Emergency Operations. CDC Foundation's head was arranging through donors to put EOCs in place in up to the three countries. At the time, 00:38:00there was some pushback from Liberia, so Mark was working with the Foundation, and they were going to provide a prefab [prefabricated] structure in Sierra Leone. Right after I came out, Dr. Frieden visited the three countries and was able to persuade them that they needed an emergency operations center. So I was gone about a week, and all of a sudden, I'm communicating with Luis and he's saying, we need some information here and we need to start planning an operations center. They established one in a building belonging to the Liberian telephone company, initially, while the Ministry was establishing or getting a site identified and the Foundation was working to get a prefab EOC constructed.

Q: Gotcha. So it was Dr. Frieden who ultimately made the sell on the EOC, would you say?

ROUSE: Yeah, he was able to talk to the president. She thought, okay, I've got this operations center here, and they were managing the responses they had typically done with a large committee of inter-ministerial representatives, which is not the most effective way to manage a response, but that's how they had done things. He was able to convince her that they needed to do something different.

Q: I know you mentioned the importance of going through the country for everything and not just imposing CDC's vision of how things should be on the country. What were some times, though, that some people were aggravated by the 00:40:00need to do that, and times when it seemed like it could have been just easier to bypass national systems?

ROUSE: I think there was a lot of frustration with the pace of things. I don't think there was any sector that was immune to that. I mean, the epi [epidemiology] folks, the lab [laboratory] folks, the risk communicators, the emergency management folks, it was all a process of trying to figure out, okay, who's the focal point that I need to convince, or get to, or work through to get things done? And it may have been the person with a title or it may not have been the person with a title. It's a resource-constrained country. You get 00:41:00outside the capital, there's not a lot of power, communication systems are iffy, road networks are poor to nonexistent. So all these things make anything a challenge.

Q: Yeah, yeah. So you came back to Atlanta and entered back into the EOC. It was late September, is that right?

ROUSE: Yeah.

Q: And is it December by the time you go back to Liberia?

ROUSE: No, I went back in October.

Q: Oh, back in October.

ROUSE: Luis kind of had September--let's see, August to September, September to October, October to November, yeah. So four--

Q: You followed Luis?

ROUSE: I get back after Labor Day, around Labor Day, so I guess it was mostly the month of August that I was in Liberia. It must have been the 24th or 25th I came--no. So me, then Luis, then Harvey, and then--so I came in behind Harvey, which was probably October-November timeframe, I guess. Then Louis and Harvey came back for their second rotations, and then I think we got another person, another couple of people wrapped in as we tried to have longer rotations. The problem is, at least for us is that this was a new mission for us. We had not 00:43:00typically deployed folks out during a response to do this concurrently with a response. You're resource-constrained.

Q: When you go back in October, what do you see? How has the situation changed or remained the same? Especially regarding the logistics piece that you were involved in?

ROUSE: When I went back the second time, WHO had activated the logistics cluster. For the WHO [World Health Organization] system, their clusters are analogous to our emergency support functions that we have in the [United] States. While FEMA has the logistics emergency support function here, the World 00:44:00Food Programme does the logistics cluster for WHO. So that was up and running. There were a lot of donated goods. There were donated--there were vehicles, cargo flights coming in. The Ministry of Health logistics guys were pushing stuff, or trying to push stuff out to the counties. I think there had been some improvement in reporting and monitoring and tracking cases.

One of the things that we were able to do, and Satish was very instrumental in 00:45:00this, was when I went out the first time, it was if you wanted an ambulance to pick up a sick person, you called one number. If you wanted an ambulance to pick up a dead body, you called a different number. If you were sick, you called a third number. It was very difficult to determine size and magnitude of the outbreak because you didn't know if you were counting one case three times or three different cases. So we were able to get a single call center, where you would call one number and then that call would get triaged inside the center to pick up a patient, recover a dead body, answer questions about Ebola, or whatever, so that, I think, was very helpful in the Ministry and partners being 00:46:00able to get a better grip on the outbreak.

Q: Absolutely. Sorry, were you going to--

ROUSE: I was going to say there was also establishing the labs in countries so that they were able to do faster analysis of specimens to determine whether or not it was actually an Ebola case, and if so, what was the linkage to other cases, so working between the lab guys and the epi folks to do the contact tracing and look at the chains of infection and those kind of things.

Q: Did you liaise at all with DoD during that second deployment?

ROUSE: Very little. The US Public Health Service folks, they had an advance 00:47:00party that came in. I did talk to them a little bit. We were trying to talk to DoD about using their aircraft for logistics. Their flights going in were full of their own stuff, and we were actually hoping to try to use their outbound flights to carry specimens back here to CDC for analysis, but they would not do that.

Q: Right. Yeah, I've talked about that with Dr. Joel [M.] Montgomery.

ROUSE: Yeah, so we ended up contracting aircraft to fly over there and bring them back.

Q: Were you involved in that part?

ROUSE: Mm-hmm.

Q: Which contractor did you find?

ROUSE: Phoenix Air.

Q: What happens after your second deployment?

ROUSE: Work on the Ebola response from this end.

Q: Any turning points that you look back and see?

ROUSE: Nothing that comes to mind.

Q: Sure. Sure.

ROUSE: When it became evident, as we were doing the daily and weekly meetings, the cases were starting to trend down. There were some discussions about whether the actions we were taking were having an effect, or if it was just the outbreak burning itself out.

Q: Interesting.

ROUSE: Typically, in previous outbreaks, I think the smaller ones, we didn't get 00:49:00there fast enough and there was only so much we could do, and because they were out in rural areas, I think the outbreaks tended to burn themselves out before they spread. Burial practices, I remember that being frustrating, trying to get control of that, and that causing some frustration in terms of a transmission method--that we could influence and could change that behavior, although change in behavior is complicated.

Q: You go back to Liberia at what time?

ROUSE: I'm thinking it was sometime in October. I'd have to go back and look, 00:50:00but it was--so I was done with both of my rotations, I think, by Thanksgiving.

Q: Oh wait, did you rotate twice or three times?

ROUSE: Just twice.

Q: Oh, just twice. Sorry, I was thinking there was a third time. Thank you. How did things proceed from there on your end?

ROUSE: Just kind of routine stuff back here.

Q: Yeah. When we, you know, Louise [E. Shaw] and I met with you several months ago now, you mentioned at one point that one issue that comes up--and maybe it's not unique to Ebola--is that at CDC, you have experts in many different fields. You have experts in emergency operations, you have people in CGH [Center for Global Health], you have the subject matter experts of viral hemorrhagic fevers, etcetera. You said that managing--having all of those different people 00:51:00interacting isn't always easy. That meshing experts from different areas doesn't always go completely smoothly. And you mentioned the importance of finding the right people for the pivotal roles in the response. I don't know if any of this is ringing a bell for you.

ROUSE: Well, CDC has got a lot of smart people and they've got a lot of subject matter experts. We're also not really deep in many of those areas, so we've only got one or two in some cases, a handful. I'm trying to recall the conversation, but I think it may have been that subject matter experts don't always make the 00:52:00best emergency, or incident managers.

Q: Yeah.

ROUSE: The incident manager has got to be able to step back and look across the whole response, and when you get a subject matter expert in the incident manager role, there's a tendency to dive into the area that you know best. Dr. [Inger K.] Damon did a good job of being able to--although she's clearly a subject matter expert in Ebola and hemorrhagic fever, of being able to step back and look across the response at the other areas. I think that was my point. She was a good example of that. We've had other examples that didn't work out so well, or worked out less well, because the conversations and the thought processes and 00:53:00the activities tend to hone in on the area that the subject matter expert knows. They're not comfortable dealing with, oh, we've got to deal with the White House; we've got to brief the Office of the Director; we've got to engage the national security staff; we've got to engage WHO. All that stuff requires a different skill set that everybody doesn't have.

Q: Right, absolutely. Not to name names or slam any individual in particular, but can you give me an example of a time when that happened in the Ebola response?

ROUSE: I can't think of something that would be a startling example of that. 00:54:00There's also examples, and there's some in the Ebola response where you've got a subject matter expert that acknowledges that they're not--this emergency management stuff, this incident management thing is not my forte, help me work through this. So you've got to have that partnership. We talk about the--"we" being the DEO, when we talk to visitors, we talk about the emergency management program here at CDC, which is the emergency management expertise from DEO and other emergency managers and the science expertise that we blend together to 00:55:00have an effective public health response. It's got to be a partnership. We can help provide staffing and resources and the ability to help work in the interagency because that's the national incident management system. The science part is the public health part, and you need to do the work in sync to have an effective response.

Q: Absolutely. Could you describe your continued work on Ebola in 2015?

ROUSE: It was mostly working out of the EOC as part of the incident management system. Coordinating deployment of staff, figuring out ways to get specimens back here, figuring out ways to get supplies in-country. We built up very large 00:56:00in-country components, so figuring out ways to get--we deployed logistics staff for the first time to provide logistics support on the ground to the teams in-country. Working with surge staff, and we actually had FEMA staff come here to CDC for the first time for, I think, about four months or so. A couple of rotations came in, where they brought their emergency management staff in to augment the DEO staff.

Q: Is that something that had been done before?

ROUSE: No, first time. Usually, FEMA runs a domestic response and they ask for public health support, and CDC provides it that way. This was the first time where they had come to participate essentially in the international response, 00:57:00but they worked in our Emergency Operations Center as part of the IMS.

Q: Right. So were you working a lot with the FEMA folk?

ROUSE: I had, I think, about six or seven people over the course of two rotations that were basically attached to my logistics section, and they did stuff that the rest of my team did: managing property, submitting requisitions, driving people to the airport, coordinating, tracking requisitions, all that logistical kind of stuff.

Q: I'm conscious of time, and I want to make sure that you can make your next meeting, but Ed, is there anything that we haven't talked about relating to your Ebola response that you think really should be on the record, or any memories that you have?

ROUSE: I've got lots of memories. I don't think anything is germane to this or would be of interest. I mean, it's--

Q: No? What kind of memories are they?

ROUSE: Well, the guy at the front desk at the hotel when I got back the second time, being happy to see me come back. It's seeing the progress that was made between the two rotations and, you know, getting pictures from other guys and seeing progress being made in establishing operations centers at a county level, and those kinds of things. Watching the case numbers go--seeing the curve trend 00:59:00down, finally. You were talking earlier about response after response, and they do tend to blur together. There's usually a few moments like that that stand out, personal significance.

Q: Absolutely. Thank you so much for being here.

ROUSE: Well, thanks for taking the time to ask the questions.

Q: Of course, of course.

END