THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTSPO Box 98129 | Atlanta, Georgia 30359 ph: 404/633-1866 | fx: 404/633-4896 | www.slcatlanta.orgSERVING THE SOUTHSOUTHERN LEGISLATIVE CONFERENCEOFTHE COUNCIL OF STATE GOVERNMENTS Copyright October 2014Lauren Greer, Policy AnalystStephanie Noble, Research and Publications AssociateSouthern Legislative ConferenceOctober 2014Photo courtesy of NIH NIAID via fickr Creative Commons LicenseSTATE OF PREPARATION:SLC STATES AND THE EBOLA VIRUSAN ISSUE ALERT FROM THE SLCTheWorldHealthOrganizationreportsthat thecurrentoutbreakoftheEbolavirusdis-ease (EVD), which is believed to have begun in March2014inWestAfrica,isthelargestand most complex outbreak of the virus since its discovery in 1976.1 It was not until August 2014, when two American missionaries were flown to Emory University Hospital in AtlantaaftercontractingthediseaseinAfrica,thatmost Americansbecameawareoftheoutbreak.Nearlytwo months later, the first diagnosis of Ebola was reported in the United States. Thediagnosisandsubsequentdeathofthispatienthas ledmanystatestoreevaluatetheiremergencyprepared-ness strategies. While the Centers for Disease Control and Prevention (CDC) has issued guidance and recommenda-tions for healthcare providers treating Ebola patients, and standards for public health preparedness in state and local emergencies, it lacks the authority to enforce them.2IncorporatingtherecommendationsfromtheCDC,ma-nystateshavetakenstepstoofferhealthcareproviders with the information and tools needed to care for suspect-ed Ebola patients, limit exposure to others, and to educate the public on the disease.The CDC recently announced it would establish a rapid-response team that will be deployed immediately to assist U.S. hospitals with a diagnosed case of Ebola.3However, it is important for states to remain proactive in emergen-cy response and vigilant in mitigating the risks posed by infected patients. Thefollowingprovidesabriefaccountofsomeofthe efforts SLC states have taken in reaction to the Ebola vi-rusdisease,asofOctober20,2014.Asgovernorsacross the nation continue to meet with health officials in their states,thepoliciesandeffortstocombatthisdisease,for whichthereisnoproventreatment,undoubtedlywill continue to evolve.AlabamaGovernorRobertBentleyheldapressconferenceon October8,alongsidetheAlabamaDepartmentofPub-licHealthandtheAlabamaHospitalAssociation,to announcethemeasuresthestateistakingtopreparefor possibleEbolacases.4 Inadditiontoissuingahealthcare providerbulletin,theDepartmenthassenttoolkitsto every hospital in the state, as well as paramedics and doc-tors offices.5 The toolkits include a list of questions to ask patients,informationonhowtoprotectstafffromthe disease,andsuggestionsontheadequatecareofpatients. Likewise,healthcareworkersarebeingtrainedonthe properprotocolforisolatingpatientsanddonningand doffing protective gear.6 The state also is working to en-sure every hospital has the basic gear necessary to stop the spreadofEbola,suchasface-shields,andmonitoringin-ternational students who return from West Africa. 2 STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUSFloridaGovernorRickScotthasmaintainedcommunication withTexasGovernorRickPerryastheirstateslearn lessonsonpropercontainment.GovernorScottsoffice alsoiscoordinatingpreparednesseffortswiththeDe-partmentofTransportation,theAgencyforHealthcare Administration,andDepartmentofHealth.Thestates DepartmentofHealthhasissuedguidelinestobusiness-es,colleges,healthcarefacilities,andemergencymedical services, while the Agency for Healthcare Administration hasidentifiedhospitalswiththeappropriatetreatment kitsandisolationfacilitiesandhasdistributedinforma-tion and training on containment protocols.7GeorgiaOnOctober20,GovernorNathanDealsignedanex-ecutiveordertocreatetheEbolaResponseTeam.The 14-member team, chaired by Public Health Commission-er,Dr.BrendaFitzgerald,comprisinghealth,education, andpublicsafetyrepresentativesfromaroundthestate, includingEmoryUniversityHospital.TheEbolaRe-sponse team is tasked with reviewing the states protocols, andassessingproceduresandbestpracticesinprepara-tion for the potential spread of the Ebola virus disease.8KentuckyThe Department for Public Health has developed a pack-age of materials, called Out of Africa, which is intended tohelphospitals,publichealthagencies,andhealthcare organizationswithEbolapreparedness.9,10Themateri-als include Guidelines for the Initial Management of Patients inEmergencyDepartmentswithSuspectedEbolaVirusDis-ease to help healthcare personnel manage suspected cases of Ebola and care for those patients in a manner that will limit further exposure to the virus by other patients and personnel.11LouisianaGovernorBobbyJindalmetwiththeUnifiedCommand Group*andtheGovernorsOfficeofHomelandSecurity and Emergency Preparedness (GOHSEP) on October 1 to discussthestatesreadinesstodealwithapossibleEbola outbreak. GOHSEP is coordinating efforts with the Coast * The state Unified Command Group (UCG) is a strategic decision-mak-ing body, established by executive order of Governor Bobby Jindal, to establishaunifiedandcoordinatedapproachtoemergencymanage-mentinthestateforemergenciesandinday-to-dayoperations.The role and duties of the UCG are codified in La. Rev. Stat. 29:725.6.GuardandDepartmentofTransportation.Meanwhile, the states Department of Health and Hospitals has distrib-utedinformationonidentifying symptomsofEbola,the Department of Education is circulating guides for schools, and the Department of Corrections is briefing wardens on identification, transportation, and containment.12OnOctober15,theBoardofSecondaryandElementary Educationapprovedemergencyrulesgrantinglocalsu-perintendents the authority to close schools in the event of any actual or imminent threat to public health or safety thatmayresultinlossoflife,disease,orinjury.13Astu-dent or staff member also may be removed from a school if reliable evidence or information suggests he or she has a communicable disease, which may be considered a threat to others in the school.MississippiThe Department of Health issued an Ebola virus hospital preparednessguideandtheheadoftheStateEmergen-cyOperationsCenterandstatehealthofficer,Dr.Mary Currier,briefedthegovernoronthestepstheDepart-ment has taken to prepare.14North CarolinaJoinedbyHealthandHumanServicesSecretaryAldona Wos, Governor Pat McCroy held a news conference Oc-tober 13, to discuss the steps the state has taken to prepare for a possible Ebola diagnosis. The Department of Health andHumanServicesDivisionofPublicHealthhasbeen working with public health partners and healthcare pro-viders since July to prepare for the possibility of Ebola in theirstate.15TheDepartmentisactivelymonitoringthe states largest hospitals for cases of Ebola using a network ofhospital-basedpublichealthepidemiologists.16The Carolinas Poison Center has established an Ebola hotline whereconcernedresidentscanreceiveinformationand ask questions about the disease.17OnOctober11,DurhamCountyDepartmentofPublic Health, in conjunction with Diaspora Alliance NC, held an EbolaeducationeventfortheWestAfricancommunity inDurham.18Theeventwasdesignedtoincreaseaware-ness and encourage communication and trust with public health workers. The community was updated on the cur-rent situation in West Africa and information was shared aboutwhatisknownaboutthedisease,itstransmission, and management. Discussions also included the prepared-STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS 3TIMELINE OF SELECTED EVENTS1976Ebolafrstdiscoveredinpresent-day Democratic Republic of CongoMarch 19, 2014Ebola outbreak begins in West Africa July 27, 2014 AmericanmissionariesDr.KentBrantly and Nancy Writebol are reported to have contracted the virus while while helping Ebola patients in Monrovia, LiberiaJuly 31, 2014Brantly and Writebol receive a dose of an experimental drug, which would later be named ZMappAugust 2, 2014BrantlyisfownfromLiberiatoAtlanta, Georgia, for treatment at Emory Univer-sity Hospital August 5, 2014Writebol is fown from Liberia to Atlanta, Georgia, for treatment at Emory Univer-sity Hospital August 19, 2014WritebolisdischargedfromEmoryUni-versity HospitalAugust 21, 2014BrantlyisdischargedfromEmoryUni-versity Hospital September 3, 2014AmericanmissionaryDr.RichardSacra isdiagnosedwithEbola,despiteonly treatingpatientsinamaternitywardin Monrovia, LiberiaSeptember 5, 2014Sacra is fown from Liberia to Omaha, Ne-braska, for treatment at Nebraska Medi-cal Center, where he will receive a blood transfusion from Dr. BrantlySeptember 9, 2014An unnamed patient arrives at Emory Uni-versityHospitalinAtlantaaftercontract-ingEbolawhileworkingfortheWorld Health Organization in Sierra LeoneSeptember 20, 2014ThomasEricDuncanarrivesinDallas, Texas, from LiberiaSeptember 25, 2014Dr. Sacra is released from Nebraska Med-ical Center after being deemed virus-freeSeptember 26, 2014Thomas Eric Duncan goes to Texas Pres-byterianHealthHospitalinDallaswith areportedfever.Heislatersenthome with antibiotics and TylenolSeptember 28, 2014DuncanreturnstoTexasPresbyterian Health Hospital by ambulanceSeptember 30, 2014The CDC confrms that Duncan has been diagnosed with Ebola October 2, 2014AmericancameramanAshokaMukpo contractsEbolawhileprovidingfree-lanceworkinLiberiaforseveralAmeri-can news outletsOctober 6, 2014Mukpo arrives at Nebraska Medical Cen-terinOmahaforEbola Treatment,fora blood transfusion from Dr. BrantlyOctober 8, 2014ThomasEricDuncandiesfromtheEbo-la virus at Texas Health Presbyterian Hos-pital in DallasOctober 12, 2014NurseNinaPhamisdiagnosedwiththe Ebola virus after treating Duncan at Tex-asHealthPresbyterianHospitalinDal-las; also for a blood transfusion from Dr. BrantlyOctober 15, 2014NurseAmberVinsonisdiagnosedwith theEbolavirusaftertreatingDuncan atTexasHealthPresbyterianHospital in Dallas and is fown from Dallas to At-lantafortreatmentatEmoryUniversity HospitalOctober 16, 2014PhamisfownfromDallastoBethesda, Maryland,fortreatmentattheNational Institutes of HealthSource: Ebola in America: Timeline of the Dead-ly Virus, ABC News Online, October 17, 2014, http://abcnews.go.com/Health/ebola-america-timeline/story?id=26159719 (accessed October 17, 2014).Facts about EbolaEbola virus is not spread throughCasual contactAirWaterFood grown or legally purchased in the U.S.How do you get the Ebola virus?Direct contact with1 sick with or has died from Ebola.(blood, vomit, urine, feces, sweat, semen, spit, other fuids)Objects contaminated with the virus(needles, medical equipment)Infected animals(by contact with blood or fuids of infected meat)Early SymptomsEbola can only be spread to others after symptoms begin. Symptoms can appear from 2 to 21 days after exposure.FeverHeadacheDiarrheaVomitingStomach painUnexplained bleeding or bruisingMuscle painEbola only spreadswhen people are sick.A patient must havesymptoms to spread the disease to others.MONTHS S F M T T W5 4 1 3 26 12 11 7 8 10 913 19 18 14 15 17 1620 26 25 21 22 24 2327 28 29 31 30After 21 days, if anexposed person doesnot develop symptoms,they will not becomesick with Ebola.4 STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUSnessmeasuresinplaceinNorthCarolina,theCDC,and DurhamCounty,andwhattodoifafamilymemberis visiting the United States from one of the affected areas.OklahomaGovernor Mary Fallin held a meeting with cabinet mem-bers, mayors, and public health, safety, and transportation officials at the state capitol to address the states ongoing preparations for a potential Ebola case. The states Depart-ment of Health has issued alerts and guidelines to hospitals in the state.19South CarolinaTheSenateMedicalAffairsCommitteeheldaspecial meetingOctober9,todiscussthestateslevelofpre-parednesstohandlethearrivalofapatientsuffering fromEbola,shouldthatoccur.20Legislatorsatthehear-ingheardaboutthestatesactionsandresourcesfrom CatherineTempleton,directoroftheDepartmentof HealthandEnvironmentalControl.21Duringthehear-ing,legislatorslearnedthathospitalsinSouthCarolina have begun conducting drills in all areas of the hospital, withpatientsreportingrecenttraveltoWestAfrica. Thedrillsareaimedatensuringtheproperprotocolis followedatallentrypointsintothehealthcaresystem, not just the emergency room. Additionally, local harbor pilots, who guide every ship into the Port of Charleston, havebeenbriefedontheproperprocedurestohandle shipscomingintothePortthathaverecentlyvisited West African countries.TennesseeTheDepartmentofHealthsEmergencyPrepared-nessProgramissuedasituationmanualwithscenarios, checklists, and resource guides, as well as instructions on donninganddoffingpersonalprotectiveequipment,to hospitals in the state.22 The Department of Health also has publishedexamplesofsuccessfulpublichealthprotocols used to contain Ebola in Nigeria and Senegal. TexasOnOctober6,GovernorRickPerryissuedanexecutive orderforthecreationoftheTexasTaskForceonInfec-tiousDiseasePreparednessandResponsetoaddressthe statesreadinesstohandlecontagiousdiseases,likeEbo-la.23The17-memberTaskForcecomprisesexecutives Emory University Hospital healthcare workers take in an Ebola patient. Photo courtesy of The Speaker via fickr Creative Commons License.STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS 5fromthehealthandhumanservices,environmental quality, housing and community affairs, emergency man-agement,publicsafety,transportation,andeducation departmentsanduniversityfacultyinthefieldsofpub-lichealthpreparednessandresponse,infectiousanimal diseases,immunology,epidemiology,virology,andbio-defense.24 The Task Force initially will focus on hospital preparednessandthepotentialroleofimprovedrap-id diagnostics. The Task Force is set to testify at the state capitol October 23, and will release its first report of rec-ommendationsbyDecember1,withasecondreportby February 1, 2015.West VirginiaTheKanawha-CharlestonandPutnamCountydepart-ments of health formed an Ebola preparedness task force to coordinate efforts among the counties and service pro-viders to handlethe potentialof an Ebola diagnosis. The taskforce,withrepresentativesfromlocalhospitals, emergencymedicalservices,andhealthandfiredepart-mentsaroundthearea,hasworkedtodevelopasystems approach to Ebola containment, identifying current prac-tices and needs in the event of an Ebola case in the state.25Research & Development: Current Progress in Ebola Detection and TreatmentBecausetherecurrentlyisnoproventreatmentforthe Ebolavirusdisease,thebestweapontocurtailtheout-break remains early detection and diagnosis. Tulaneprofessorofmicrobiologyandimmunology,Dr. RobertGarry,hasbeenawarded$2.9millionbytheNa-tionalInstitutesofHealthtodeveloparapiddiagnostic finger-pricktestfortheEbolavirus.26Currently,itcan take hours or days before being detected in humans. The finger-prick test will allow healthcare workers to quickly test patients for Ebola proteins and respond more quickly if isolation is needed. It also will reduce the risk healthcare workersfacebyeliminatingtheneedtouselong-nee-dledsyringeswhendrawingbloodfromEbloa-infected patients.InSeptember2014,theFDAgrantedemergen-cyauthorizationtotheDepartmentofDefensetousea similar finger-prick test, which examines viral genomes, inU.S.militarylabs.Dr.Garryexpectsthathisdevice, whichisstillintesting,alsowillbegrantedemergency authorization. The National Institutes of Health and the National Insti-tute of Allergy and Infectious Diseases (NIAID) are leading efforts to develop and expedite the testing and production of Ebola treatments and vaccines. KentuckyBioProcessinginOwensboro,Kentucky,has beencontractedbytheSanDiego-basedcompanyMapp Biopharmecuticaltoproducetheexperimentalmedicine ZMapp.27ZMapp,whichismadeusingatobaccoplant compound, has seen promising results in Canadian labo-ratory testing, but was untested on humans prior to being administered to the two American missionaries at Emory UniversityHospital.KentuckyBioProcessinghastem-porarilyhaltedallotherworktofocusentirelyonthe A Nicotiana benthamiana plant used to make ZMapp. Photo courtesy ofChandres via Creative Commons license.Colorized electron micrograph of Ebola virus particles. Photo courtesy of NIH NIAID.6 STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUSCDC Director Tom Friedan in full protective gear. Photo courtesy of CDC Global.The Economic Costs of the Ebola OutbreakCollectively, state actions and research developments also will help alleviate a secondary impact of the Eb-olaoutbreak,whichextendsbeyondthebordersof West Africa.Beyond the doleful consequences of the Ebolaoutbreakintermsofthelossoflifeandthose strickenbythedisease,fnancialanalystsandoth-erexpertshaveattemptedtostitchtogetheranes-timateofthepotentialimpactontheglobalecon-omy.AreportrecentlyreleasedbytheWorldBank estimatedapotentialworst-casescenarioeconomic cost of $32.6 billion to the global economy by the end of 2015, a staggering fgure by any standard.Experts also have honed in on the economic cost of fear as be-ing particularly pernicious, a development that might exceedactualmedicalcosts.Forinstance,theseex-pertsindicatethatseriouseconomicconsequences result whenconsumersandbusinessesreactbyre-ducingfightsonairplanes,changingvacationplans or altering business connections in a globally interde-pendent world.29 Notably, the stock prices of airlines, including United and American, dropped as investors became anxious about reduced air trafc.Hartsfeld-Jackson Atlanta International Airport. Photo courtesy of Dan Betts via fickr Creative Commons License.production of ZMapp and will hire more staff in an effort to expedite federal approval from the U.S. Food and Drug Administration.In addition to announcing an 18-month, $24.9millioncontractwithMapptoacceleratedevel-opmentofthedrug,theU.S.DepartmentofHealthand Human Services also is in talks with Caliber Biotherapeu-tics in Texas about producing ZMapp. TwoadditionaldrugsbeingconsideredbyNIAIDwere developedinNorthCarolina.BioCrystPharmaceuticals in Research Triangle Park plans to begin testing its drug, BCX4430, on humans early next year.28 Chimerix of Dur-ham has developed a second potential drug, brincidofovir, which has shown promising results with its ability to sup-pressEbolaviruscellsincultures.Limitedtestinghas indicated the drug is safe for humans; although a broader evaluation of the drug is expected in the coming months.ConclusionWhile the actions taken by these 12 SLC states are not ex-haustive of Ebola preparations in our region, they provide asnapshotofthefirststepsforpreventionofanation-alEbolaoutbreak.WithrecentreportsfromTexasthat two nurses have tested positive for Ebola, presumably af-ter providing medical care to the patient who became our nations first Ebola casualty, it is likely safe to assume that thesewillnotbethelastactionstakenbySLCstatesto combatthisdeadlyvirus.Aswecontinuetolearnmore about the disease and its treatment, SLC states will play a vital role in preventing the spread of infection and the ul-timate prospect of global eradication.STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS 7Endnotes1.World Health Organization, Ebola virus disease fact sheet, http://www.who.int/mediacentre/factsheets/fs103/en/ (accessed October 14, 2014).2.Centers for Disease Control and Prevention, Top 10 Ebola Response Planning Tips: Ebola Readiness Self-Assessment for State and Local Public Health Officials, http://www.cdc.gov/vhf/ebola/outbreaks/preparedness/planning-tips-top10.html (accessed October 14, 2014). 3.U.S. sets up rapid-response team for Ebola; Dallas nurse improves, Reuters, October 15, 2014, http://www.reuters.com/article/2014/10/15/us-health-ebola-usa-idUSKCN0I31Q620141015 (accessed October 15, 2014). 4.Ebola hasnt surfaced in Alabama but state ready, Gov. Bentley says, AL.com, October 8, 2014, http://www.al.com/news/index.ssf/2014/10/gov_robert_bentley_on_ebola_vi.html (accessed October 14, 2014). 5.Alabama Department of Public Health, Ebola Virus Disease: Healthcare Providers, http://www.adph.org/ebola/Default.asp?id=6785 (accessed October 14, 2014). 6.Governor Bentley explains Alabamas preparedness for Ebola, KAIT 8 Online, October 10, 2014, http://www.kait8.com/story/26741592/alabama-is-prepared-for-ebola (accessed October 14, 2014). 7.Florida Department of Health, Ebola Guidance: Public Health and Medical Providers, http://www.floridahealth.gov/diseases-and-conditions/ebola/guidance/medical-provider1.html (accessed October 14, 2014).8.Office of the Governor, Deal: Team to combat risks of Ebola should the need arise, October 20, 2014, http://gov.georgia.gov/press-releases/2014-10-20/deal-team-combat-risks-ebola-should-need-arise (accessed October 20, 2014).9.Kentucky Health Alerts, Ebola Information for Health Professionals, http://healthalerts.ky.gov/Pages/EbolaInformationforHealthProfessionals.aspx (accessed October 15, 2014).10.Kentucky health agency develops Ebola preparedness information for hospitals, others, Lexington Herald-Leader Online, October 12, 2014, http://www.kentucky.com/2014/10/12/3477665_kentucky-health-agency-develops.html?sp=/99/164/329/&rh=1 (accessed October 14, 2014). 11.Kentucky Department for Public Health, Guidelines for the Initial Management of Patients in Emergency Departments with Suspected Ebola Virus Disease, October 8, 2014, http://healthalerts.ky.gov/SiteCollectionDocuments/Ebola%20-%20Guidelines%20for%20EDs.pdf (accessed October 14, 2014). 12.Louisiana Department of Health and Hospitals, Ebola Preparedness in Louisiana, http://www.dhh.state.la.us/index.cfm/page/1974 (accessed October 15, 2014).13.BESE approves emergency Ebola policies for public schools, The Advocate Online, October 16, 2014, http://theadvocate.com/news/10532055-123/bese-approves-emergency-ebola-policies (accessed October 16, 2014). 14.Mississippi State Department of Health, Ebola Virus Disease Hospital Preparedness Resources Guide, October 3, 2014, http://www.msdh.state.ms.us/msdhsite/index.cfm/14,5979,389,154,pdf/MSDH_Ebola_Hospital_Preparedness.pdf (accessed October 14, 2014). 15.North Carolina Department of Health and HumanServices, NCDHHS Ebola Information, http://www.ncdhhs.gov/ebola/ (accessed October 15, 2014).16.Associated Press, McCrory, Wos outline NC preparations for Ebola, News & Observer Online, October 13, 2014, http://www.newsobserver.com/2014/10/13/4231405_mccrory-wos-outline-nc-preparations.html?sp=/99/102/105/135/&rh=1 (accessed October 15, 2014). 17.NC opens hotline for Ebola questions, 13 News Now Online, October 14, 2014, http://www.13newsnow.com/story/news/local/north-carolina/2014/10/14/nc-opens-hotline-for-ebola-questions/17237501/ (accessed October 15, 2014). 18.Durham public health officials address Ebola concerns, The Herald-Sun Online, October 11, 2014, http://www.heraldsun.com/news/localnews/x532296737/Durham-public-health-officials-address-Ebola-concerns (accessed October 15, 2014). 19.Oklahoma State Department of Health, Surveillance and Preparedness for Ebola Virus Disease in Oklahoma, http://www.ok.gov/health/Organization/Office_of_Communications/News_Releases/Situation_Updates/Surveillance_and_Preparedness_for_Ebola_Virus_Disease/ (accessed October 14, 2014). 20.How is SC prepared to deal with Ebola?, The State Online, October 9, 2014. http://www.thestate.com/2014/10/09/3734646/how-is-sc-prepared-to-deal-with.html?sp=/99/205/&ihp=1 (accessed October 14, 2014). 21.South Carolina Department of Health and Environmental Control, Health Alerts and Notifications: Ebola, http://www.scdhec.gov/Health/FHPF/HealthAlertsNotifications/ebola/ (accessed October 15, 2014). 22.Tennessee Department of Health, Information on Ebola Virus Disease, http://health.state.tn.us/Ceds/ebola.htm (accessed October 14, 2014). 23.Rick Perry, Relating to the creation of the Texas Task Force on Infectious Disease Preparedness and Response, Executive Order 79, October 6, 2014, http://governor.state.tx.us/news/executive-order/20193 (accessed October 15, 2014). 24.Office of the Governor, Gov. Perry Names Dr. Brett Giroir to Lead Texas Task Force on Infectious Disease Preparedness and Response, October 6, 2014, http://governor.state.tx.us/news/press-release/20194/ (accessed October 15, 2014). 25.Local health officials form Ebola task force, The Charleston Gazette Online, October 7, 2014, http://www.wvgazette.com/article/20141007/GZ01/141009410 (accessed October 15, 2014). 26.Tulane researchers race to develop rapid Ebola finger-prick test, The Times-Picayune Online, October 13, 2014, http://www.nola.com/health/index.ssf/2014/10/tulane_researchers_race_to_dev.html(accessed October 14, 2014). 27.Company puts sole focus on Ebola drug, USA Today Online, October 13, 2014, http://www.usatoday.com/story/news/nation/2014/10/13/ebola-zmapp-production-boosted/17204487/ (accessed October 14, 2014). 28.U.S. health experts consider Ebola treatments developed in NC, News & Observer Online, October 14, 2014, http://www.newsobserver.com/2014/10/14/4232943_us-health-experts-consider-ebola.html?sp=/99/102/105/135/&rh=1 (accessed October 14, 2014). 29.Calculating the Grim Economic Costs of Ebola Outbreak, New York Times Online, October 13, 2014, http://dealbook.nytimes.com/2014/10/13/calculating-the-grim-costs-of-ebola/?_php=true&_type=blogs&module=Search&mabReward=relbias%3Aw%2C%7B%221%22%3A%22RI%3A10%22%7D&_r=0 (accessed October 14, 2014). THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTSREGIONAL VIEW NATIONAL REACHThisreportwaspreparedbyPolicyAnalystLau-ren Greer with research assistance from Research and Publications Associate Stephanie Noble for the Human Services & Public Safety Committee of the Southern Legislative Conference (SLC) of The Council of StateGovernments(CSG),underthechairmanshipofstate Representative Joni L. Jenkins of Kentucky. The mission of The Council of State Governments Southern LegislativeConferenceistofosterandencourageintergov-ernmentalcooperationamongits15-memberstates.Inlarge measure,thisisachievedthroughtheongoingworkofthe Conferences six standing committees and supporting groups. Through member outreach in state capitols, policy research, memberdelegationstopointsofinterest,meetingsandfly-ins, staff support state policymakers in their work to build a stronger region.Foundedin1947,theSouthernLegislativeConferenceisa member-drivenorganizationandthelargestoffourregion-allegislativegroupsoperatingunderTheCouncilofState Governments and comprises the states of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Tex-as, Virginia and West Virginia.TheSLCssixstandingcommitteesprovideaforumwhich allowspolicymakerstoshareknowledgeintheirareaofex-pertisewithcolleaguesfromacrosstheSouth.Byworking together within the SLC and participating on its committees, Southernstatelegislativeleadersareabletospeakinadis-tinctive, unified voice while addressing issues that affect their states and the entire region.The Southern Office was opened in Atlanta in 1959. Initially charged with serving all three branches of state government, thedutiesoftheOfficehaveevolvedtoprovidingservices primarilytothemorethan2,400legislativemembersand staffofits15-stateregion.SLCmembersareappointedby theleadershipofthe30legislativechambersintheSouth. TheSLCAnnualMeetinghasgrowntobecomethelarg-estregionalgatheringofstatelegislatorsinthecountry andattractsthelargestaudienceofanyoftheCSGregion-al conferences.