Good morning.
Chairman Rubio, Ranking Member Menendez, and Distinguished Members of the Committee: Thank
you for the opportunity to testify on the Department's response to the recent health
attacks in Havana.
I will be describing the evolution of the medical response and what we currently know
about the health effects.
From the individual and public health perspective, managing this evolving situation is challenging.
Mission personnel describe a multitude of symptoms, many of which are not easily quantifiable
and not easily attributable to a specific cause.
The sharing of information that occurs in a small, tight-knit community has helped identify
more affected personnel, but, as typically is the case with any community outbreak, also
can complicate an epidemiological investigation.
However, the most challenging factor is the lack of certainty about the causative agent
and, therefore, the precise mechanism of the injuries suffered.
Individuals first visited our medical unit in Embassy Havana in late December 2016 and
January 2017 reporting various symptoms including headache, ear pain, dizziness, and hearing
problems.
They associated the onset of these symptoms to their exposures with unusual sounds or
auditory sensations.
Various descriptions were given: "a high pitched beam of sound"; an "incapacitating
sound"; a "baffling sensation" akin to driving with the windows partially open
in a car; or just an intense pressure in one ear.
Since the symptoms first reported primarily affected auditory functions, an otolaryngologist
at the University of Miami, highly experienced in evaluating acoustic injuries in military
personnel, was identified to perform additional assessments.
Between February and April of last year, this specialist evaluated eighty members of the
Embassy community.
Of the individuals evaluated in this initial tranche, sixteen were identified to have symptoms
and medically verifiable clinical findings of some combination similar to what might
be seen in patients following mild traumatic brain injury or concussion.
In early July, my office convened a panel of academic experts to review the case histories
and the test results gathered to date.
Although the assembled group identified that some of the symptoms and findings could be
caused by other things such as viral illnesses, previous head trauma, aging, and even stress,
the consensus was that the patterns of injuries that had so far been noted were most likely
related to trauma from a non-natural source.
In light of the emerging clinical parallels to mild traumatic brain injury, the nationally-recognized
brain injury center at the University of Pennsylvania was identified to provide detailed reevaluations
of employees with prior exposures and to evaluate Embassy community members who reported new
exposures.
As a result of further evaluations begun in late August, additional individuals with exposures
that occurred prior to April 24 were added to the list of confirmed cases.
Two other individuals who reported exposures that occurred in mid-August 2017 were also
medically confirmed as cases, bringing the total number of cases to 24.
I would like to now describe the health effects identified so far.
While the descriptions of the reported auditory sensations have varied, all medically confirmed
cases have described some combination of the following symptoms beginning within minutes
to hours of the event: sharp, localized ear pain; dull unilateral headache; tinnitus or
ringing in one ear; vertigo; visual focusing issues; disorientation; nausea; and extreme
fatigue.
In many of the patients, the acute symptoms resolved within days to weeks, but other health
issues emerged that were more persistent.
These have included: cognitive problems, including difficulty with concentration, working memory,
and attention; recurrent headache; high-frequency unilateral hearing loss; sleep disturbance;
and imbalance walking.
As in the acute phase, the duration and severity of these later symptoms have varied widely.
Defining the prognosis for the confirmed cases is extremely difficult since no precise analogue
for this possibly novel syndrome exists.
Some patients remain symptomatic months after their exposures.
The persistent symptoms have improved to varying degrees in all individuals, however, some
after extended rehabilitative therapy, some over time without treatment.
Ten of the 24 patients have returned to either full or part-time work, while others continue
to receive treatment with an anticipation of return to duty.
However, at this time we are unable to state whether or not the injuries may result in
adverse long-term consequences to the individuals' future health or functional abilities.
All government personnel who travel to Havana on official duty now receive a detailed medical
briefing and are encouraged to undergo pre-deployment screening including baseline audiograms and
neurocognitive testing.
We have formally requested assistance from the Centers for Disease Control for performing
a broader epidemiological evaluation and providing appropriate medical information to the American
public.
Discussions have also been held with the National Institute of Neurological Disorders and Stroke
at the National Institutes of Health regarding its participation in the ongoing medical investigation.
I look forward to your questions.
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