Secretary of Health and Human Services Sylvia Burwell said that despite the best efforts of health officials, Americans have to prepare for the reality that there may be more cases of Ebola in the United States.

“We had one case and I think there may be other cases, and I think we have to recognize that as a nation,” Burwell said at a media breakfast hosted by the journal Health Affairs and held at the Washington, D.C. offices of the Kaiser Family Foundation.

Burwell’s comments come as screening of travelers from Ebola-affected countries in West Africa has been stepped up at U.S. airports. On Wednesday, the first patient diagnosed with the virus on U.S. soil died in Texas.

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