Transcripts For CSPAN Federal Health Officials Testify On Coronavirus Response 20240713

Possible Treatment Options and vaccines and how to effectively protect yourself against catching or spreading the virus. This is about two hours 45 minutes. Minutes. Good morning. The committee on Health Education will come to order. I have one goal today and that is Accurate Information. Accurate information that can help americans understand what they can do and decide what else around the worl world is at f the multiple coronavirus is alarming. 90,000 cases and 65 countries, 3,000 deaths according to the World Health Organization and most people in the United States are at a low risk. Heres what the New York Times said on its front page todays ago on sunday in describing the situation in our country. Quote, much about the coronavirus remains unclear. Its far from certain that the outbreak will reach a severe see proportions in the United States or affect many regions that ones. With its topnotch scientists, modern hospitals and Public Health infrastructure, most experts agree the United States is among the countrys best prepared to prevent or manage such an epidemic. Thats from the front page of the New York Times two days ago describing where we are in our country. Today in our country while there are 90,000 cases around the world there is about 100,000 in the United States may be a few more in about half of those contracted the disease overseas have been brought back here to be quarantined and monitor. Thereve been six deaths in the United States. In addition to the human suffering the virus is causing disrupted the Global Economy according to the trade representative more than 20 of everything we import, not magazines, car parts, factories and walked down 16 cities where 760 Million People live. Think about that for a moment 760 million is more than twice as many as live in the United States and that theyve been locked down in china as china tries to grapple with this. In the short term this could disrupt the ability to buy and transport goods and materials in the longterm production of these materials could shift into direct implications on the jobs crisis. So the first goal of the hearing is to provide the American People with Accurate Information. Todays witnesses are respected professionals who have a lot of experience in what we are talking about today and who know what they are doing. I want to take a moment to emphasize their backgrounds. After Anne Schuchat spent 30 years at the center for Disease Control and prevention. She is the Principal Deputy director. Her work has been with these kind of epidemics through democratic and republican president s an in health emergens including the 2001 anthrax attacks, the 2003 sars outbreak and flin a flu pandemic. Doctor anthony fauci. Doctor fauci felt his position as the chief of Infectious Diseases at the National Institutes of health. Since president reagans time. So he worked for president reagan coming h. W. Bush, bush, obama and now trump. He led the response to hiv aids in the 80s and 90s and the west nile virus 99, sars in 2003, outbreaks in africa in 2014 and 2018. For his professionals, this is not their first radio. Third, 14 years ago and led by senator burr of this committee, congress created the position of assistant secretary for preparedness and response at the department of health and Human Services. Doctor Robert Kadlec helped draft the bill in holds the position. That was reauthorized by senator casey and senator burr. Not long ago, doctor kadlec had previously worked assisting the fbi and the United States air force and biological threats and finally, doctor stephen hahn is the newest to the federal government of these respected professionals. Hes had plenty of experience before becoming commissioner of the United States food and drug administration. The fda most recently chief executive of the university of texas, the Cancer Center of a Large Organization with 21,000 employees. So the reason i go through that is because if we are looking for Accurate Information, they support ought to be able to provide it. In addition to getting Accurate Information for the American People, they want to know what else we should be doing to limit the damage of the coronavirus to the American People and the american economy. Before we talk about what else needs to be done, i want to briefly summarize what we have already done. Lets start with congress. Its not the first Public Health threat we face. There are some senators and Staff Members who were here 20 years ago when the anthrax attack occurred. 2003, sars. Another coronavirus similar to the one we are seeking today. The 2009 2009 flu pandemic kiln estimated 151 to 575,000 people worldwide. Then there was the ebola outbreak. So following the anthrax attack in the bush administration, congress created project bio shield to develop and stockpile treatments and vaccines in after the sars attack in 2006, also in the bush administration, Congress Passed the pandemic and all hazards prepared this act. That guides the federal government and how it prepares for the response to Public Health emergencies. It gave the department of health and Human Services the authority fofor example they prioritized funding for the development of vaccines and treatments for Infectious Diseases and improve the Public Health Emergency Fund. As i said earlier the senator asked the most recent update of the law led by senator burr and senator casey. Senator blunt and senator murray and thin the work of the Appropriations Committee funded programs. We all know president s and their budgets into this includes all the president s that i know about, sometimes under fund these programs. Last Year Congress provided more than 4. 5 billion for Public Health preparedness programs. When a crisis occurs, we often need of money quickly. Thats why congress has created two funds, Public Health Emergency Fund and the Infectious Disease Rapid Response fund. For example, secretary azar already used some from the Rapid Response fund and using the Authority Congress has given him, hes transferring from other programs in his department to respond to the coronavirus. The trumpet administration has s requested an additional 2. 5 billion. Others in congress have made suggestions and we are likely to vote on it in the senate this week. In addition to what congress has done to get ready for pandemics like this, both democratic and republican president s over the last 20 years have used their executive authority during Public Health emergencies. President obama during the ebola outbreak. President bush said the cdc experts to investigate the epidemic. President trump similarly pointed a task force lynching tg with a 29. Keep the Vice President in charge. He moved ambassador from the state department to the years of experience in dealing with Infectious Diseases to be a Principal Deputy leading that effort. On january 302001, at the time when there were only six cases confirmed to the United States from the administration for the first time would quarantine americans exposed the virus while in china and impose travel restrictions on the foreign nationals to travel in the last 14 days. At the same time the state department warned americans not to travel to china and the cbc demands americans reconsider cruisers in asia. A couple days ago the state department added italy and south korea to the countries that americans should reconsider traveling in. Under the authority of the immigration and nationality act, the administration sent foreign nationalists have traveled to china in the last 14 days cant enter the United States. On saturday the president updated this to include travelers from iran. Doctor fauci said if we hadnt taken these steps, we would have had many more cases right now. A third example of executive action is developing the tested diagnosis of the coronavirus. The fda authorized on february 4 and its been made available to 46 laps and 38 states in the washington, d. C. They are working with 65 other privatesector developers including Academic Medical Centers and commercial labs to increase the availability of tests. For the doctor fauci said we are developing a vaccine for papillomavirus more rapidly than weve ever developed any other vaccine and drug benefit jurors met with the president yesterday to see if treatments and vaccines could be made available more rapidly. Scientists and laboratories are using super computing and imaging to try to understand the virus that are. In addition the impact on us and our individual lives theres the impact on the Global Economy. Trade representatives say about 20 of the imports comes from china as people get sick and cant go to work that slows down what is sent as an impact across the board. 13 of active ingredients for drugs are in china according to the fda. Some people said 80 of the ingredients for drugs are produced in china. We should evaluate that figure carefully. It appears to be based on a 1998 report that may not have a source that i discussed with the number of senators how we can inquire into whether we should explore that depended we now have on other countries not just china for medicine and health supplies. Most businesses in the United States that need supplies have more than one source for what they do and perhaps we need to take another look at that. Its not just medicines that are affected. In tennessee for reminding touring plans ceos said that phase one china deal caused workers to go up in the company but the virus caused them to go down and that has an effect on jobs in tennessee just as it does in other places todays hearing is an opportunity to listen to respected professionals who have decades of experience and are the right people to give the American People and members of congress Accurate Information about the coronavirus both with individuals can do and what else the federal government needs to do to respond. We will finish at noon so that doctor Anne Schuchat and doctor fauci can join the Vice President in briefing senators that the respective launches. Senator murray. Thank you mr. Chairman and to all of the witnesses today. I want to say at the top im grateful to all the women and men out there that are working to keep the country safe and i hope you pass this on to all of your team. Mr. Chairman and this is a frightening time. Six people in my home state have already died from the virus and im told we should expect more. We expect the number of infections continue to grow and people across my state and im sure across the nation are really scared. I am hearing from people who are sick and who want to gets tested are not being told where to go and even when people do get tested the results are taking way longer to get back to them. The administration had months to prepare for this and its unacceptable people in my state and nationwide cant even get an answer as to whether or not they are infected. To put it simply if someone in the white house or the administration is responding to the coronavirus it would be news to anybody in my state and ive been on the phone with all of our local officials for days n now. We are seeing the Community Transmissions of the virus. Families deserve to know when testing will be ready to scale up what they do families should be doing, and most importantly what they are doing. I have to say that while i am profoundly grateful for the work that Public Health officials are doing, im very frustrated at the steps the president has taken from repeatedly contradicting expert advice to downplay the seriousness of this threat and appoint a politician to lead the response so im glad today that they have the opportunity to hear today directly from the experts and get answers to the questions that i am hearing at home. I know people want answers and one of those days when are we going to scale the testing now that we are beginning to see the Community Transition in the United States. Its only after a long frustrating delay that we are finally able to Start Testing patients for this disease as the state labs across the country and the last few days seem to confirm the experts have been warning. There is a lot we are still learning there are a few things that are abundantly clear about how we need to respond. First of all we do need to be listening to the experts and making sure fact and science drive the response. They need to be able to trust the information they are hearing from experts in the federal government and is a political ideology and the policies being put in place are based on evidence about how to keep our families safe. I was heartened to hear your assurances, doctor fauci, but contrary to reporting you havent been muzzled by the administration. Its essential that continue to be the case. We cant have an Effective Response without active information and transparency from the administration and i will continue to be very focused on this. Second, weve got to provide adequate resources to meet the needs of our federal, state and local officials because we know resources that come through the cdc Public Health Emergency Preparedness programs are absolutely critical but also were never envisioned to be sufficient to respond to a threat like this so we have a lot more to do. Congress is working on a bipartisan supplemental agreement that will reimburse our state and local Public Health officials are costs theyve already incurred, combating the coronavirus and Additional Resources to the communities and it will guarantee resources are available. It will support vaccines and therapeutics to treat this virus and to keep us prepared to respond to future emergencies. I want to recognize all the democrats and republicans who came together to work quickly on this package and i urge the senate to pass it very quickly. Im very glad we are working on this agreement that goes well beyond what president trumps inadequate request for 1. 25 billion in new funding, and i urge the senate to take this up so that the house does get it passed and get it to our local communities. I am also very encouraged by strongmmittees bipartisan record in responding to Public Health emergencies as well. Last june, this can be strengthened and reauthorized the law underpinning so many federal efforts and resources were seeing today. I especially want to thank you, mr. Chairman, for our Work Together. Third, we have got to be sure we are not just responding to the latest developments, but staying ahead of this crisis by planning ahead because this is not likely going to end anytime soon. We are already seeing some of the challenges that will come next life the strain this will put on our Health Care System. We are seeing that in Washington State. We need to make sure hospitals have the capacity to address this virus without overwhelming their ability to provide health care that they need. We need to make sure that Health Care Workers are safe from the virus themselves. We need to manage our drug and medical device supply, especially considering we expect demand for some supplies already seeing that to skyrocket. And how many drugs and devices are manufactured in countries where an outbreak could interrupt production, something that we are already seeing. We also need to give adequate attention to our public Health Education. In the age where disinformation has been weaponize and rumors gain traction faster than ever, we cant let conspiracies stoke panic ur spur discrimination or disinformation or undermine our Public Health experts. We need to actively take steps to prevent and respond to bullying and harassment that is motivated by stereotypes and fears. And we also have to account for the ways that some of the Harmful Health care policies have undermined our ability to respond to Public Health threats. Our uninsured rate is going up again for the first time in years. Required toare not cover diagnostic tests or vaccines are expanding and those actions make it much harder for people to get the care they need to keep this crisis under control. So, we have to make sure that everyone who needs it has access to diagnostic testing going forward. And while a vaccine is still likely over one year away, we need to make sure cost is not a barrier for that as well. It is not just our Healthcare System we need to be considering as we work to stay ahead of this disease. Communities and families right now are facing difficult decisions. What measures should our schools take to keep students safe . What can parents do . When should schools close . Im sure others are facing similar questions about whether employees should go to work or whether they should stay open. I will be pressing secretary devoss about how her department is helping to prepare for these issues and i have written to secretary scalia about this as well. If this Public Health threat will have hidden and higher costs for those who are lowwage workers who dont have affordable job care, who dont have health insurance, and youre experiencing homelessness. In my home state, people are being told to stay home for two weeks if they are sick. There are not tests, so they cant get tested. Guess who cant stay home . If you dont have childcare, if you are a lowwage worker, if you dont have sick leave. When their basic needs are not met, they cannot make choices to protect themselves, which means they cant make choices that best protect others, because one person getting sick has repercussions for all of those around them. Situations like this remind us we are all a community in a very real sense. We all have a stake in what anothers wellbeing. We talk about the impact of this health risk. I want to be clear, this is not just about changes in the stock market, but we also need to develop lands responsive to the daytoday experience families actually have, and that is something i plan to raise today and will keep raising. I look forward to hearing from all of our witnesses about how we can best prepare our communities and i will continue to work with all of our Health Officials to give families in my state and across the country informed about what they should be doing, what we are doing, to keep them safe. And i will keep pushing to make sure that as the situation continues to develop, we keep listening to the experts, providing our Health Officials the research they need and planning for the longterm. Thank you, mr. Chairman. Andhank you, senator murray thank you for your cooperation which is typical of the way you work in dealing with this issue. Senator murray and i have posted four briefings for senators hosted four briefings for centers, several briefings for staff. Inhave one of our briefings a classified setting, so senators to be sure that there were not any secrets. And what we were saying in private with the same thing we were saying in public, and nothing came up that we are not able to say in public. And i agree with her that we should all listen to our professional, respected experts who are here today. Each one will have five minutes to get his or her testimony then we go to a round of questions. I gave each of them a pretty good introduction earlier, so i will shorten it here, except to principaloo is the director for the centers for Disease Control and prevention and she has had a variety of roles dealing with responses to anthrax, pandemic influenza blast 30 years. Dr. Tony is the top person at the National Institutes of health. He has been a position since 1984 and worked with six led thets, and efforts on hivaids, influenza, malaria, and ebola. Is assistantdlec secretary for preparedness and response of the department of health and Human Services which i mentioned earlier. Officer time as career and physician in the air force, special assistant to president george w. Bush, helped write the legislation that makes our country better prepared for pandemics. N wholy, dr. Stephen harp is commissioner of the u. S. Fda. Formally at the Cancer Center in houston. All of you are not getting much sleep these days. We thank you for your willingness to serve the American People in a way that you do and we were forward to your testimony we look forward to your testimony. Thank you very much, members of the committee. Whole ofe in this Society Response is built on decades of experience and pandemic influenza and other Emergency Preparedness planning. Our response is dependent on support for core Public Health capabilities at cdc and at a network of dedicated frontline Public Health workers at the state and local levels living in your communities. Two months into this response to a novel virus, cdc has learned a lot. We have acted nimbly in the United States and around the world, but we do so with humility about the work ahead. There are many things that each of us can do as individuals, businesses, communities, and organizations and we are thrilled to see the website posted behind the senators. Is responding with the following strategies. Our goal has been to slow the spread of this virus through a multilayreered aggressive containment, and mitigation effort. Were using evidencebased Public Health interventions that have improved early case recognition, isolation, and Contact Tracing. We have issued travel advisories and dealt with targeted travel restrictions as well as the use of quarantined for individuals returning from Transmission Hot zones including through funneling of lights from Mainland China to 11 airports. Tohave worked with the cdp get data to ensure that appropriate followup could happen through the state and local Public Health departments, and we have support of the quarantine of repatriated americans from the diamond princess cruise ship. Weve been working with the World Health Organization and ministries of health around the world, underscoring our leadership in global Public Health and the power of our investments in International Influenza surveillance and Global Health security. Staff at the0 centers for Disease Control and prevention have been responding to this outbreak. The situation today is evolving and dynamic. Thisst two months, outbreak has grown from a cluster in china in one city to affecting over 70 countries and territories around the world with more than 90,000 cases and about 3000 deaths. We are now in the United States seeing, in addition to the very small number of travel associated cases, Community Transmission in a few areas and tragic outbreak in a Health Care Facility or a longterm care facility in Washington State. Our hearts go out to the people affected by this virus directly or indirectly and to everyone who was working so hard to counter it. There are steps each of us can take. I want to recognize that people are concerned about this. As always, our number one priority is the health and safety of the American People, and we appreciate that americans are taking this threat seriously and continuing to seek information about how they can prepare. While the immediate risk to the general American Public remains low, and the u. S. Government is doing everything we can to keep it low, risk varies by exposure in some areas are now at your nsync community spread. State and local jurisdictions working near the spread of the virus is occurring are intensively investigating and assessing potential community interventions. Cdc has staff on the ground in washington, california, and elsewhere to provide technical assistance. Our role in this type of Community Measure is to develop principles and tools based on our updated pandemic planning playbook and based on what weve learned from other areas that have been experiencing the outbreak including singapore where they have done a very good job of managing it. A key planning principle is to protect the most vulnerable. Torust you as Senior Leaders help us with our mission to provide clear information to you and your constituents by urging people to get the facts from cdc. Gov and i want to say that i look forward to answering your questions. Thank you. Thank you very much. I appreciate the opportunity to spend a few minutes talking to you about one of the aspects of the government response to this emerging outbreak. That is in the realm of what we call interventions, both with regard to therapy, namely treatment of a person who is already in acted, and the others, in the area of vaccines or prevention of infections for those who are not infected. Its important to point out that the timelines for each of these are fundamentally different, and i would like to take a moment to explain why, when you talk about, and the American Public and the Global Public understandably want to know how quickly we can get interventions to them. Lets start off first with therapy. As we know from the data that has come out predominately from china, if you look at the 90,000 people who have been infected, and the number of deaths that have occurred, about 80 of individuals who get infected do quite well without any specific intervention. Namely, they spontaneously recover. However, up to 20 of individuals, usually those who are elderly and at risk, wind up getting serious disease, requiring supportive care. That could be oxygen, that could be intensive care, that can be integration or even more dramatic intubation, or even more dramatic interventions. There are a number of candidate therapies that literally as i speak today are being tested in randomized controlled trials. I the these was developed gilead by the gilead company. It is being tested in china and is also being tested here in the United States, in collaboration with gilead. Periodld know within a of a few months whether or not this particular drug works. Have thewe implementation of that would be almost immediate. I cant guarantee that it would work or that other drugs that are in the pipeline behind them, but the timetable for treatment is different than the timetable for a vaccine. Thats why i want to see if we can clear up any misunderstandings that are sometimes out there. Right now, the technology that we have has allowed us to go from the time, the sequence of the virus put in the public database, to the time we actually stick a candidate into has gone downeone to literally be the fastest that we have done. I expect at least one of those candidates will likely go into Clinical Trials in a phase one study within about two months or maybe even six weeks. That would be a record. However, that is not a vaccine, because it will take about three months or more to show that it is safe, and then if you show that it is safe, you have got to put it into what is called the phase two trial to show that it works. And the reason is there is a medical effort and other considerations, we would be getting this to normal people to prevent infection. So you must be sure the edict of medicine first, do no harm. We need to make sure it is safe and we need to make sure it works. That entire process will take at least one year, so when we hear talk about a vaccine that is going to be ready in a couple of months, it wont be ready to be deployed. Its going to take a while. We are going to have a multistep process. Public Health Measures that you ave heard about, kadlec. The issue is, in addition to those Public Health measures, interventions are going to be credible. We hope we will be able to get good news to you and that we will be able to say in the next x number of months that we have candidates, but there will be no guarantee of that and the only way to know that would be to do the kind of clinical testing is that im talking about testings that im talking about so we will have the opportunity to update you on a regular basis about where we are on that. Thank you. Thank you. Welcome. Thank you, chairman alexander, Ranking Member murray, and distinguished members of the community. I appreciate the opportunity to testify before you on how we are supporting the government response to the coronavirus situation. I think you heard very well in terms of the evolving domestic situation and this morning it will just take a couple minutes to give you an idea of how we are trying to address this problem from a point of strategic anticipation. Approacha four pronged to manage and support the domestic preparedness response, incident management, supporting the states and other entities, supporting the Health Care System of the United States, and also countermeasure development. In the medical countermeasure in developing, we are working very what kind ofe therapeutics and specifically diagnostics we can rapidly bring to this problem and how quickly we can field additional capabilities that the cdc has already fielded with commercial activities, specifically looking at areas that would allow us to do when of care diagnostics which i think senator murray has talked about and we had some very promising candidates that will take several months to bring online. But we also identify potential therapeutics. Were also working with the company on antibodies and looking at two potential vaccine candidates, one that was a product of the investment that congress made in preventing influenza with a vaccine licensed by the fda, and another that is a candidate developed for the ebolda crisis. Ebola crisis. Are looking at how we support americas Health Care Systems through the hospital preparedness program, working in coordination with Public Health Emergency Preparedness programs. Been looking at how we could basically work better to improve collaboration, coordination amongst hospitals and the Public Health sector and other entities like emergency medical services. I just want to highlight one area that congress was very crucial in developing and employing during the ebola crisis, the National Ebola treatment network. That has proved to be vital in terms of our ability to manage is not only through the repatriation of americans, but also from the diamond princess. That capacity and that capability and that education and training are vital in how we managed it at the locations in those military bases as well as in Washington Housing a number of people through the regional Ebola Treatment Network and that was vital. The other issue is around how were doing management. Since this started, weve been working with fema to put in place, and we have activated warmly, the Incident Management Network that really is based on the National Response framework. How can we bring the whole of government to respond . It under exercises, but it is a means by which we can leverage fema and all the Emergency Support functions that may be necessary by state when asked to basically employ responders to assist them in dealing with this crisis. And the last area i will highlight is really around the direct support to state government. I mentioned the repatriation efforts, 1100 americans brought back under very difficult circumstances from the diamond princess. First time that was ever done. Weve been working two years in advance with our japanese colleagues to actually prepare for such an event and we are actually supposed to have an exercise in march of this year to actually employ this as a test case. We actually got to do it for the real thing. More importantly, we are now focused on how we provide direct state aid. With the state of washington, weve used the Strategic National stockpile of personal protective employment to protect Health Care Workers. , we are very concerned about how we work proactively with Health Care Entities like longterm care facilities, like other areas where we know the most honorable populations reside, and had we shield them from the effects of this potential virus . Lastly, we are looking to employ and the boy some of our National Disaster medical system personnel as well as other federal Health Care Personnel to assist the longterm treatment facility. We are doing all these things together as a team to respond to this. With that, i will pause and yield back the rest of my time. Thank you. Thank you. Welcome. Thank you, chairman alexander , and other matters of the committee. I really appreciate the opportunity to speak to you today about the efforts on behalf of the 15,000 fda employees, our hearts go out to those who have been affected by this Novel Coronavirus and those who lost their lives. That is why we have deployed thousands of career men and women to address this and to proactively look at aspects of diagnostics as well as the medical supply chain. I will focus todays update on recentlyre we have mitigated new information, supply chain impacts and expediting availability of certain Laboratory Developed diagnostic test. Please remember that some of this information that i can share now does change quickly, but it is my hope that this information will help members of this committee is will of the American People have better visibility into the emerging situation. Regarding the drug supply, we have in and continue to be proactive in contacting manufacturers not only to remind them of the applicable reporting requirements, but also to ask them to assess their entire supply chain and much of what we are asking manufacturers, they are not required to tell us, but as you might expect, they have been very forthcoming in these discussions. 24, the fda has been in touch with more than 180 manufacturers of human drugs to assess whether they face any drug shortages due to the outbreak. As a result of this outreach, last week, one manufacturer did tell us about a shortage related to a Novel Coronavirus that was reported and immediately disclosed to the American Public through our drug shortage list. The good news about that, we are working very closely with that manufacturer and we expect that to be resolved in a very short time. The other good news is that there are alternatives to that drug to providers and patients. I know that there is interest in Additional Details surrounding this drug, but i can provide the name because it is confidential commercial information. I think this also highlights what weve put in on the budget proposals regarding the authorities of the fda has here. We do not have the authorities to actually require manufacturers of devices to tell us about shortages. Again, theyve been very cooperative with us, as have the Drug Companies with respect to getting up the information that we need. Please be sure that of other potential shortages or disruptions identified by the fda, we will be very transparent about this and we will quickly share that information with you. A Fast Breaking bit of information that we found out this morning is that india has of 20 six the export active pharmaceutical ingredients for export which represents about 10 of their exports capacity. We are working very closely to look at that list to assess how that will affect the medical supply chain. Regarding devices, we have been in touch with 63 manufacturers of essential medical devices. We have been aware of no shortages of these devices, although we understand on the demand side, particularly on personal protective equipment, that there is significant pressure and demand, particularly domestically. That someve found is of the manufacturers in china have reported disruptions in the workforce, as you might expect, particularly in the wuhan province. In an effort to mitigate any potential shortage of anything. Respirators, other personal protective agreement, the fda issued an emergency use authorization to allow the use of disposable filtering respirators and to allow some flex ability for Health Care Workers and to increase the supply within the nation. We have a lot of information we are communicating to hospitals and Health Care Workers about that, but that increase the capacity for the Health Care System. , thising diagnostic tests was mentioned by chairman alexander, the fda issued to enable Immediate Use of the diagnostic test that was developed by cdc and facilitating the ability for this test to be used by cdc qualified Public Health labs. On february 29, we also issued an authorization of testing for 19 and additional labs on the west coast and washington, california have also notified that they have begun using this emergency approach. We have had a lot of contact with both private and public Academic Centers with respect to the development of these tests. Ini mentioned yesterday, cooperation with the cdc, there was significant expansion and the ability to perform this test. We have one manufacturer working to expandth the cdc that over this upcoming week and we expect that to be available by the end of the week, and that expansion will continue. Thank you for the opportunity to update the committee on the fda response to this crisis and i look forward to answering your questions. Thank you. Attendance byood senators. Were going to continue the hearing until 12 30 in hopes that every senator will have a chance to ask questions. I know that the witnesses have been asked to go to lunch is with the Vice President , but that is us, so we would like for you to stay here until you answer our questions. Lunch with us, and answer our questions further and i think we can complete that by 12 30. Im going to ask senators to keep the total amount of time for each question and answer to five minutes each, so every senator has a chance to ask questions. Im going to ask a series of questions within my five minutes, and these are the kinds orquestions that i get home, sometimes here. Senator roberts asked me yesterday, what do we mean by Community Transmission . Immunity transmission means when there are cases that are in the community in which the original source is not known. If you get someone who travels from wuhan to the United States and you know they are a travel case and one of their contacts infected, you know the source. We are talking about persontoperson, that means we know who it is. Persontoperson, but you dont know what the original source is. In the state of washington i thought there was a difference between persontoperson and Community Transmission. Any transmission is from person to a person what if we do know who it is . If you are able to identify them, that is not community. If it is community, i understand that, but if senator murray has that and gives it to me, what do you call that . [laughter] that is persontoperson. And Community Means we dont know who caused it. Thats right. Ofwell, are we at the peak the season . Is likelyhe answer maybe all the way down. We are just over the peak . Down, now up and then it is starting to come back. About how Many Americans if you had to estimate, have the flu this year . Probably around 30 million infections, a couple hundred thousand hospitalizations. In the United States. And how Many Americans die every year from what we call the flu . It ranges from 50,000 to 20,000. The high year that we had in 2017 was about 70,000 people. About 70,000 people. In one of the worst years. The flu is a respiratory disease like coronavirus, is that correct . Thats correct. How do you know if you have the flu . As opposed to coronavirus . Would befinitive test to get a test of the flu or a test for the coronavirus. So you would need a test . There is overlap and symptoms. The situation with coronavirus is predominantly fever and a lower respiratory infection as opposed to an upper respiratory infection starting off with. And then you might get a pulmonary involvement, which is the flu. What is a lower respiratory . Prolongs, as opposed to sore throat. Your lungs as opposed to sore throat. You can get that with the flu, but usually it is upper respiratory and then lower. Fever and a cough . That can be for either of them. If you are in the middle of the flu season right now and you have fever and a cough, obviously it could be pneumonia, you should see a physician. Certainly if you are a person in a risk group, elderly or underlying conditions, during the flu season, you should see a physician because we do have antivirals for flu. Should be all the Wearing Masks . No. Why . There is not anything going around in the community that is calling for the broad use of masks in the community. Why do Health Care Workers wear masks . Because a Health Care Worker who is taking care of someone who is known to be infected with israns edible virus, that different from Walking Around in the streets. Are children getting the coronavirus . To a much lesser extent than adults. And for reasons that are still unclear. Maybe that they are getting infected but their symptoms are so low that they are not being recognized. But a number of reports that have come out from china, there are very few cases, less than 50 years old. You will always find the exception, but most of the cases are the mean age of about 50. What can we do or what can our family is to protect ourselves . What is the most effective way . Right now, and i think the question you asked is important, right now we are still in the flu season. What you can do to protect yourself against the possibility of coronavirus is the kinds of things he would do to protect yourself against the flu. Flu shot,you get a you can at least protect yourself against the flu. But also, it sounds simplistic but it is true, washing of hands , if possible, staying away from people who are coughing and sneezing. Infected, stay out of work, dont send your children to school. My time is up. Senator murray . Im going to yield the first questioning senator jones who has to leave for a flight. I will take the second round. Thank you. Id would like to followup on that real quickly. If somebody right now in alabama presents that they did not get their flu shot, so they have a fever and a cough, they get a good test, will that test, if they dont have the flu but have coronavirus, will that come back negative . Right. So they should be concerned of the present symptoms for the flu and that comes back negative . That, ip question to did not hear a lot about the testing. We have had some concerns in this country about testing. It is inadequate, to say the least right now. But i know there is efforts. What capacity do we have to do the testing as you sit here today, and how are we working to expand that, and when will that all happen . Thank you. The cdc is here to supply the Public Health labs with tests and we are rapidly doing so. Tests veryd the quickly, and detected some problems after the Quality Control steps were measured. By the end of this week, all of the state labs, the Public Health labs should be able to do testing. I think for context, its important to understand what the Clinical Labs do in respiratory testing. States,k in the united Clinical Labs tested 42,000 respiratory specimens for influenza and 11,000 of those were positive for influenza. So far this year, the Clinical Labs have tested almost one million respiratory specimens and about 200,000 were positive. Labs tested about 62,000. Public health labs are a tiny piece of the testing world. That said, most people that influenza dont actually get tested. We have about 30 Million People with influenza so far this year, and as i said, about one million tests. The Public Health issue is to detect early when there is emergence of this virus, recognize it in travelers or in the community, and right now, we are really keen to get those Clinical Labs up and running, that is really an fda issue. How will the testing, how much more capacity will be have by the end of this week versus two weeks, three weeks from now . Yes, senator. We worked with the cdc on their manufacturers, private companies are using the platform right now to further develop the test. Our expectation in talking to the company that its scaling this up is that we should have the capacity by the end of the week to have kits available to the laboratories to perform about one million tests. Great. One thing i would urge to please continue as i think of senator alexander and senator murrays, please get information out there. We are about to head into the allergy season as well and i can tell you people are so scared right now that the first time they sneeze with analogy, they are going to think of it got this. We need to make sure that we try to educate folks so that those limited tests that we have are for the right reasons. Second question i have, it concerns rural areas. In my sig. Alone, we have hospitals, another rural hospital closing this week in the state of alabama. Are there specific things that you guys are doing to make sure that rural hospitals who are living from paycheck to paycheck, almost, have the resources that they need, the Financial Resources and the tools that they need to make sure their communities are protected as well . Thank you for the question. And thank you, weve been monitoring the situation very carefully with our Health Care Coalition funded by the hospital preparedness program. Some recognize the risk areas of resources so we are investigating about medicine and how we can make that available. The majority of individuals with the coronavirus dont need care, but the critical thing is identifying those who can, and that is something the cdc has been working on to try to identify guidelines were individuals who may be at risk. We are looking at medicine options as one piece of the puzzle that would help us fill in the gaps. There needs to be a longterm solution. I appreciate that. I had a question, but i also would encourage you to get with cms and have them allow for reimbursements and they dont do that right now. That could be a really important factor. We are in conversation with them on that. Thats all i have. Thank you, senator jones. My five minutes starts, could i ask unanimous consent that i enter a statement into the record and what i asked on behalf of all members is that if they want to enter a statement, that they can . Members that in 2005 when senator kennedy and i passed papa, it was with this day in mind, that we would be faced with a pandemic, and we are close to that determination. And i would only say the temptations to do legislation are great. Before you do it, read what the statute says. Read what the latitude is. ,et them do their jobs emergency use authorization. That is part of the work of this committee. Lets not be too quick to go out and encumber them or micromanage what they do. We will go ahead and ask unanimous consent to put that in. Thank you, mr. Chairman. I heard you say that you are rapidly trying to reach testing. As of march 1, the cdc website had total tested up on their website, 472, even though secretary as are said 3600. I dont know which one is right. Is whyam curious about on march 2, did you take the total number tested off the website . You for that question, let me clarify. Theres a lot of numbers out there. There is a difference between persons under investigation who have been tested and all of the tests that we have run. For instance, the individual case, the first 12 cases that we saw here, we did testing on them to understand how long the virus was present and when it was safe for them to leave the hospital. When they no longer need isolation. We collected multiple specimens so we understood with this very new virus, is at the upper respiratory system or lower respiratory . We also collected other specimens from them. Tests run is000 correct. We have tested way more than the 500some persons under investigation. We have also tested some of the high risk cohorts like the repatriation individuals. About thisown potential threat since early january if not in december with what we are looking back at now. Diagnostics had to have been one of the things we were looking at. Weve got to be able to do this devote 150 million year to strengthen the surveillance capabilities at the state level. We have a situation Like Washington state where we have known for up to six weeks, reaching possibly 1500 experienced yet we what we have with this longterm care facility and clearly a cluster that we dont know the magnitude of . How can that happen when we have invested so much in being there early on an understanding that . The cdc there he rapidly system for aew completely new virus. We posted the instructions for that tcr on the website, so other academic labs, commercial labs, Research Labs could similarly developed test. There is a responsibility to work with the private sector to get commercial labs up and running, and the cdc has supplied the Public Health labs with the ability to do the testing. The situation in Washington State is tragic. An outbreak in a longterm care facility is one of the things we have been worried about from day one. We learn from the sars experience in 2003 that super spreading events or super spreading individuals could cause a very large amplifications rapidly. And so, the concern about Health Care Settings has been foremost in our minds. You, im only looking at, were we better prepared for this . It does not seem to be that we were. Reauthorization, direct hiring authority for 30 new employees in the cdc dedicated the development of surveillance systems. Of those 30 slots, how many of you feel . I dont have that information, but i can tiger that the Laboratory Activities for the coronavirus are not one of the larger parts of our program. We have really build our response around our influenza activities which have really grown with the generosity of the American People through congress. Our coronavirus capacities are relatively small. We built up a little bit, but we are not able to sustain that. We really appreciate the support from congress to strengthen that Public Health infrastructure. Shocked, andly was i like to think that i am fairly knowledgeable of everything that we instruct and provide for agencies, i was shocked to find out that in the normal appropriations, 650 million, that could also be used for im not sure with a 150 million line is, im going to need to get back to you on that. Renovationction and provisions are separate, i will need to get back to you on that. To cdc,ppropriations go there is an ability to move money from that to construction of facilities and i would encourage the appropriators on this committee. For god sakes, lets make sure it goes to response and not construction of a campus at this time. I yield back. Thank you, senator. Did you have Something Else . Just the followup to the Accurate Information. As you heard, i am very concerned about the delays and testing. I have people in my state who may have been exposed, who cannot get answers about where to go, Health Officials are telling us the breakthrough has been working for weeks undetected. We were relieved a month ago when the cdc began to shift but within days, many reported validation issues of those tests. Leading to inconclusive results in cdc and fda began to work on remedying that. 27 it was not until february that the cdc began distributing new test kits and at the same time, Academic Medical Centers across the country work raising concerns about the lack of availability of diagnostic testing and burdensome requirements the fda was imposing. For example, fda asked labs to submit information about 100 tests at a time when only 50 people were known to be infected. The fda has worked to address these issues, but press reports now indicate the publication of the guidance was delayed within hhs. I was glad to read last night that you now believe you are going to be able to do one million test by the end of the week, but frankly im hearing from professionals that that is unrealistic. So i wanted to ask you, first of all, what happened at the department that created these delays . How can you clarify that the estimate of one million tests is accurate . First of all with respect to the timeline and development of the test, cdc obtains a sequence of the virus, that is where it starts. They were able to develop a test based upon the identification of that sequence. They moved rapidly to develop this pcrbased test as it was just described. We received the validation information around that on february 3, and on february 4, we issued the emergency use authorization to allow that test to be used. During the scale of process which occurred in the week or so after sending it out as you mentioned, it was identified that some of the Public Health labs, not all of them, they were not able to reproduce and invalidate the tests. Cdc heard that information and we worked to correct that issue. Simultaneously, we were working with the private sector to actually scale up the use of the cdcbased test, and that is where we came in to the most recent estimate. What the publication delayed with an hhs, yes or no . No, it was not. It was not delayed . No. Do you really believe one million tests will be available by the end of the week . Let me explain that. The companies we are working with have the capacity to develop enough test kits to send out by the end of the week. Every day, we are hearing from additional manufacturers that they can do this. Week,y the end of the that should give us the capacity in the hands of laboratories once they validate to perform up to one million tests. 2500 kits . 500 tests per kit. I heard dr. Kadlec say that the point of where someone goes in to get a test, we are months away from that, correct . Yes, maam. I am hearing from a lot of people that are really concerned about what they should do a are theyted or if they know were within range of someone with coronavirus. Says now, the cdc website if you suspect you are infected, you should stay home except to get medical care. Right now, we know that 27 of privatesector workforce in the u. S. Do not have the ability to stay home from work. Or if theying pay have a loved one who is sick. In fact, one of only two countries that does not provide paid leave for personnel illness. If we are telling people to stay home, just think about the facilities that have been impacted. , all of them,kers are being told to stay home for two weeks. You, would it ask be beneficial for a Public Health reason right now to have policies in place that make it possible for people to stay home from work without losing a paycheck . Yes, absolutely. I think that is something we need to consider with this. Also, i amsk you very concerned about reports about hhs staff who are deployed to assist with potentially infected passengers returning from abroad, and despite facetoface contact with passengers, the staff are reportedly not appropriately trained to handle this type of Public Health emergency or in how to wear protective equipment. They were not quarantined, monitored, or tested the virus, and some have since taken commercial flights and returned to work. It is not clear to me that hhs took necessary steps to protect staff and the public either during this time or after concerns were raised with Senior Leadership about what happened. Is the situation i have just described consistent with protocol . And what should have been done once Senior Leadership were aware that front stein frontline staff may have been exposed . I can speak for cdc that we take the help of our work force very seriously, the health and safety, and have deployment guidance. This is a totally new virus, so were learning as we go. But when we identify problems, we want to resolve them quickly. Is what i described consistent with protocols . I dont have the full information of that, but i believe dr. Kadlec could say more. Said, weo what she has take the protection of our Health Care Workers in hhs very seriously. During that operation in particular, we are evaluating what may have been a breach and we owe it to you as well to identify the whistleblower to report back to you on that. That we needst say people to speak up when they see these situations. It is unacceptable if any of these workers on the front lines are intimidated into staying silent or believe that they are going to be retaliated against. We need to keep the protection minds,ic foremost in our and i want this looked at and i want to make sure that anybody was weeks of his protected. Think you, senator murray. Senator paul . Mentioned in medication, im intrigued that they say it is effective against sars in animal model. The you take that as a very encouraging sign as it may work in humans . I do. With regard to the children, i think its fascinating as there are not many cases. I would suspect it would be improbable if they are not being infected. Perhaps there is some blanket immunity. One important and may be putting this into perspective may be putting a better look on the overall outbreak, if we had numbers. I dont know if someone would suggest to china that they do some random testing where there is a huge number, because if we who are000 kits kids not being sick, i of fatality would go way down. There is some data about that, that rates may not be zero in children, but the data from a few places, they are looking at that. It is unlikely that they are not symptomatically i think we are going to get some data from the chinese. They have been quite cooperative and sharing data. We had a group that was under the auspices of the who that went to china. It was an individual from the cdc and an individual from the nih who have now returned and will soon get a good look at the report of what they have had. That was one of the questions we asked because as you mentioned, that is a very important issue. Theith regard to treating severe and potentially fatal cases, and bacterial or viral infections, sometimes it is drawn to fight off the cause of the infection as well of the bodys response to that. ,n some bacterial infections sometimes you actually get massive steroids, and some of these people survive. In the fatal cases, ive a finding that steroids, in someion, are they using steroid treatment in real severe cases . In aey have done it noncontrolled way, and there does not seem to be any difference that there is any effect, positive or negative. And a bacterial infection, we would never do it unless we were also giving out antibiotics. That might be a different scenario. Thank you, thats all i have. Thank you, senator paul. Sen. Casey in mark tanks very much. I want to thank the chairman and the Ranking Member for the hearing and obviously our andesses for the expertise the work by each individual here for many years. I think i will start today with what is the obligation of every elected official in the federal government . We got members of the house and the senate, both parties. We have two individuals in the executive branch, the president and Vice President. The obligation is real simple. By every elected official, every one of us is charged with working constructively to at least do the following. Slow the spread of the virus, taking sets to do that, working with all of you. Number two, support state and local preparedness efforts. Number three, provide complete and accurate always, always Accurate Information to the public to address their concerns about this challenge. Has workis committee in a bipartisan fashion on a range of issues for years. We are continuing that today. I appreciate it, especially the work for the last number of years in the Pandemic Alliance and the reauthorizations. But we have got to make sure that we do our job, even as we are indicating what should come next. With regard to the tragedy that has unfolded in the state of washington in Nursing Homes. Start withant to just that venue. We know that the early indications suggest that the poses a significant or even deadly risk to older adults and people with disabilities, and folks with Underlying Health conditions. The risk obviously is heightened in Nursing Homes for residents and workers who dont have the option to distance themselves. The residence, in particular, they are in their homes. There is no staying home to avoid it. Obviously, the workers have a challenge. Goending on who wants to first, tell me two things about what the administration is doing. What the administration is doing to protect both the residence workers, in longterm care settings. I think the key thing is, as we learn more about this outbreak and last thursday, the chinese posted a fairly significant report of their outpouring that included a record of 44,000 confirmed cases in china, which gave us a pretty good understanding to the points earlier. About 20 to 50 of people over the age of 70 in particular are at risk. They released guidelines on how we could basically worn and inform people of warner abilities, and we have actively worked to reach out to through massally calls and through briefings to inform them of those risks and guidelines they can follow, which are cdc guidelines. We have been very proactive and aggressively trying to respond to this as we learn more in a way that would ensure that we can warm proprietors of those facilities. But it is not just longterm care facilities. Potentially dialysis clinics. Other areas where we have cancer therapies, more people who are basically being taken care of and shielded from this virus. Just to say that the cdc has issued a number of guidance documents, and for the past several weeks, has been doing outreach with clinicians and health systems. Through the weekend, i spoke cms, and theth assets that cms has, including sectors and so forth is being directed to help us with this challenge. Obviously, individuals and Skilled Nursing facilities and acute hospitals have a lot of other things going on. The best we can do to protect acquired isfections really our responsibility. Just making a comment and then i have one question. We have had a debate about beenh care and ive working, as many have, to combat the use of these socalled junk plans. We have got a report where a guy got tested the flu to make sure he did not have coronavirus, he isds out that his insurance one of those shortterm limited duration plans, does not cover basic testing. You get the picture. These plans are problem. I hope this challenge we are facing will convince the administration that junk plans for the advancement of junk plans are really dangerous, especially when we face this kind of a threat. I hope they would rethink their regulatory strategies going forward. We are over time. Just one question on testing. How many people this week can be tested in the United States of america . That depends upon the deployment by the manufacturer to private companies, Academic Centers, etc. And the ability to validate and to the test. The capacity will be there by the end of the week, but those are the necessary steps to actually get a deployed to the American People. I hope we can get a number on people. The wall i have about seven or eight questions, so i ask you to be synced in your answers, but if i drop, it is not to be rude. If i interrupt, it is not to be rude. The guidelines have not been a strict for people returning from hubei province. God bless you, go home and dont infect anybody. We have mentioned that there is screening at the u. S. Canadian border. What percentage of those folks coming from canada into Washington State are actually being screened . I do my questionnaire at the travel industry and temperature, etc. . I dont have a percent, for we have worked closely with the teams in the u. S. Public Health Service can you give me a ballpark . Is a protocol that is assessing everybody who was crossing at the borders to alert it to where the flights are coming in, but i cant give you a percentage, sorry. But it could be as low as 5 . It could be. Secondly, is the cdc using location data or something similar in terms of tracking contacts . Not for contact. We are for travel pattern. So going to this nursing home in seattle, clearly somebody came who has been exposed to coronavirus. Law enforcement at the scene of a crime will ask google to give data and review on the statutes. Just to be clear, the cdc is not currently using that same sort of thing that Law Enforcement is to attract contacts . You have to recognize that right now, the chances that a person with fever and cough have coronavirus versus influenza, it is low. Is, if somebody went to that nursing home and you can follow their location data, and it turns out they had contact with somebody who had traveled to china, perhaps they had gone back and forth, they are obviously a candidate. Encourage, because i think the answer is no, that you do use that location data. It seems as if that would expedite the epidemiology of how this spreads among the community. Next, theres 26 apis that india is not allowing to be exported. Are any of those the active pharmaceutical ingredient for any of the candidate there. Drugs candidate therapeutic drugs . I dont know the answer to that question, we are going through that this right now. Next, one of the recommendations that senator murphy and i had was in west that was released last year, recommendation number two, to establish a Quality Supply train supply chain rating system. Should Congress Enact this quickly . Clearly if we have got supply chains overseas that we cant inspect or they are basically interdicting the flow of that to the u. S. , it could be one of these candidate drugs . Again, should be now an accident recommendation . We stand behind and we are working on the development of the rating system. We also have some legislative proposals as part of the president s budget. Ok. Next, we have a problem with antibiotics. If you have a really expensive antibiotic for some terribly resistant drug, it is difficult for it to currently pay for them with payments or hospitals. We are in the same situation with antivirals. The antiviral might be very expensive, and that would blow the lid off of the drg. You see where im going. Again, i would Like Congress to act upon this quickly to create some sort of carveout for the expensive drugs to develop. So, we have implement and the Authority Given to us to help with this, and we are very much facilitating the development of antibiotics. I think the payment policy on the part of cms, i think we would have to give them the authority to do that with the use of such drugs. We have a Pilot Project to bridge this gap and i do for the payment questions to cms. We are looking for quick diagnostics. Obviously, a pcr take a little bit longer than a swab or a blood test. To having ae we blood test that can be quickly turned around in a committed hospital . I think pretty close. It will be very important for both in surveillance and the company of exposed people. Need to know what authorities we need. We need expanded use authority, we need to give appropriate reimbursement. We also need Something Else. Got to send people home, i think we need to do something there. I think those are my questions. If you need authority from us, please let us know. We need to know what else you need. I yield back. Thank you. Senator murphy . Thank you. So much, thank you for being here today. Thank you for your very clear articulation about a realistic timeline for treatment and vaccines. I do think it is worth saying that it is pretty extraordinary that we have to have our medical and Health Professionals counter message the president of the United States, that they have to spend their time trying to correct the record. We have become normalized to this administration, the association with the truth, but it becomes particularly dangerous in the middle of a pandemic response. Thank you for being here and sharing the facts with us today. We all have lots of questions, so we will try to get in as many as we can. Senatorslow up on questions about new authorities. One of the things you said in your testimony was that you feel you have gotten good cooperation from the companies. They are not required to tell you when there is a shortage. Senator rubio and i sent you a letter to thank you for your response trying to catalog the shortage areas. Sounds like it would be helpful to have a legal requirement that they will alert you ahead of time when they see a shortage coming. Thinks the question. We have sent several legislative proposals as far as legend and i think one of the things that we learn from this and other veryages, it is a complicated supply chain. The most important thing is redundancy and effort around advanced manufacturing. We have had great cooperation, but this is complicated. The one drug that is currently insured is not actually related to an api for the final drug. That related to a chemical is before the active pharmaceutical agreement. Thisll supply chain is complicated. More information would be better. I think senator murray might have asked the question, the right information is key, but also setting realistic expectations as well. In your estimate by the end of the week, there are going to be one million test out there. That does sound a little aggressive, given the fact that we have only tested 3000 people and new york state is saying the goal is to do 1000 per day. Tell us why you think by friday of this week we are going to have one million test, when thus far we have only done 3000. I want to distinguish between the ability to get the test kits out to the laboratories and the ability of the labs to actually do the tests. We have been working very closely for the last three or four weeks with all manufacturers, private, academic, etc. To build on this platform that the cdc has developed. We have been in touch with this particular manufacturer over the last three or four days. We have reiterated this, we know them well. They have estimated that they are going to be able to scale up to deliver 2500 kits by the end of the week to providers of the test. Let me ask you, how do we make sure that those are in the right hands . Thanks. The cdc has been providing the Public Health labs with kits and expect by the end of this week that there would be sufficient for 75,000 people to be tested. As you say, not Everyone Needs a test. And we dont want to go through all our tests in low risk and not be able to really address the care and the context that is going to be critical. We have guidelines for this kind of thing for influenza about who needs to seek care and who can stay home. We have adapted them for this. Weve also broadened our definition of who we think is a person under investigation that really needs be tested, not just related to travel to china, but all the other areas. And also to say people with severe respiratory disease dont have the obvious diagnosis should be tested. We know that many of the cases in Washington State are detected through that because there was an outbreak being investigated. I think this question of where these tests end up and making sure they are in the right hands is going to be a really important one for us. Finally, let me ask you a question about protocols that we are recommending to School Districts. One of the biggest disruptions that can happen in a familys life is the closure of a school. Senator murray pointed out given the fact that many families have two parents working, that is really difficult. What are the recommendations and protocols that we are telling School Districts about what they should do if they have a child who tests positive, a family member, a teacher who test positive . Thank you. We absolutely recommend a child who is ill should stay home so that they dont spread. We have worked closely with local and state Public Health on this issue, and essentially, decisions about School Dismissal is very much locally driven, but we provide guidance. What is the guidance . The general principle is to minimize disruptions. You have this balance between the earlier you act, the more impact it can have in slowing the spread. You may remember in 2009, we saw hundreds of thousands of students at home in the first couple weeks of the pandemic. As we learn more about the virus and its spread, we learned that was too disruptive, the virus was relatively mild compared to what we were expecting, and weve dialed that back. Instead, staying home when cancelingk, assemblies, changing the patterns of what is done in class. Trying to keep classes going because so many depend on School Lunches and other services that are in schools. If theres too many people sick, it cant keep going, but really trying to protect the vulnerable and reduce the spread but not disrupt families and all those parents who will be staying home. That is such an important answer, but i hope everyone will try to stick to five minutes so that we can allow all senators to ask questions. Senator roberts . I think i can do that right off the bat. Senator james stole my rural question. Bob casey summed up where we ought to be. Look, we ought to get this money appropriated. Youpresident said whatever give me, i will take it, we will work with it. I just want to thank you both. We needed information. I think were doing that in this process. Largely because of the wonderful job that these witnesses do. I want to thank senator murray for that. This is a very unique committee. Along with a sometimes powerful Senate Agriculture committee, we are bipartisan. There is a lot of partisan elbows out there right now. We dont need to politicize a pandemic. I would recommend that we monitor what people say, and i would yield to the chairman for that decision along with the Ranking Member, maybe we ought to quarantine people for 14 days if they would just shut up about and tossing around partisan things. We can do better. We need to get funding to the president , and its get these kits lets get these kits out. I do want to underscore the rural areas. We have 83 critical access hospitals in kansas, probably that will be produced to simply what is going on. We are older. A lot of Nursing Homes, a lot of enterprises, that is just right for this kind of ring. Out in the senate, quite a few people have reached that age as well. I hope that we can follow the , i think it is an awfully good thing. Part of our job is to stand with you when you are taking the boos, and stand behind you when you are taking the bows. all of you should take it nob take a bow. We ought to have a situation where we have your back not to criticize, we are trying to work with you. We are going to get this done. In todays wall foret journal, last summer 7. 85, if you want to go to amazon today, it is 114 97 in spirit i will give it to you for 50. [laughter] is, itou bought a liter was 14, now it is 229. That is ridiculous. I guess that is just the supply and demand situation that amazon would be the case. I wanted to ask one other thing. Time that a lot of people are confused about his community spread. Spread is a verb, but it does not say that the whole community , that this disease will spread throughout the community. It just indicates there is one person where we dont know where the source was. Is that correct . Thats right. We are really differentiating from spread from a close contact or travel associated. It does not mean the whole community is affected and what were the means is that if we threw enormous resources, we could probably map out each of the links, but it is more important to go from man to man when you start to see that community recognition, to put the most effort where it can be the most impactful. Perhaps less on the individual Contact Tracing and more on writing the Health Care System, readying the schools. I thank you very much, i yield back. Senator roberts, you did a better job of asking your own western than i did, so thank you for doing that. You, i expressed condolences about the tornadoes in tennessee yesterday that were devastating. Thank you. I want to thank the witnesses, this committee has had a number of roundtable sessions and these witnesses have been here and presented to us. The first was on the 24th of january, that is positive. I will say when we had that briefing on the 24th and we have had briefings since, and won the white house appointed a special committee on the 29th, it made me surprised when i look at the president s budget that came to us on the 10th of february to see that in that budget there was a 52 proposed cuts to the World Health Organization and cuts between 5 and 10 to the nih, the cdc, and the overall hhs argent. It does not seem to me to be a wise time to take a scalpel to the Public Health infrastructure. I hope as we are looking at what we do from an appropriations standpoint, we are not only coronavirus, but also looking of the pieces of the budget that fund the Public Health infrastructure so that we dont do damage to that at this time similarly. The budget contains significant cuts to medicaid, and although it is describe someone euphemistically, it is pretty clear that the medicaid cuts are going to cut people in states that have adopted Medicaid Expansion under the Affordable Care act. And the administration is right eliminate the Affordable Care act, the Supreme Court announced yesterday it will take up a case later this year. It is not a good time. It is not a good time to take a meat axe or a scalpel to the Public Health infrastructure, it is not a good time to scare people about whether or not they are going to have health insurance. Im not sure there is a good time to do that, but you could not do it at a worse time when you are doing it as people are concerned about a pandemic. I want to ask you a question. Like senator alexander looking forward to the presentation today, during the middle of the searing, i got a notice that you will no longer be presenting at the democratic lunch, is that accurate . To my knowledge, no. Im planning to be at both lunches. Im just totally has changed, but i dont know why. I just want to be clear about it was notified yesterday that you and the Vice President would be presenting to both the democratic and republican lunches. I got a note from a democratic leader that came to all of us at about 9 25 it no longer be presenting. That is the first you have heard of this, right now . What you just mentioned to me is the first i have heard about. You have any reason why you have been disinvited . I dont know. Let me ask about a population, i would say that is not a confidence builder when the person who we have a lot of faith in really knowing this , who has worked with several president s of both parties for decades who is advertised as coming to it buys a lunch, we are now notified were not coming. Correction, that took me by surprise. Am i going . Im going. I thought your staff told you were not going 30 seconds ago. What is the answer to this . I am . I am invited, yes. Staff tellid your you that you were not invited and then 30 seconds later, change it . Am i that persuasive . Well see what happens. It is not a conferencebuilder, i would say, it is not a confidencebuilder. Let me ask about a population that is of significant concern in virginia. We do not have a dod person, but you must be working in tandem. We had a lot of virginians who are deployed. We have a lot of virginians are deployed in south korea. We have a lot of virginians deployed in sicily. Just thinking of other countries that have been mentioned as places where there is significant progress. My understanding is at least the families are being urged to stay on base. Talk a little bit about your interaction, any of you, your interaction with the dod. Are we likely to see more of this, is there a sort of quarantine in south korea . That is the last question. First of all, my direction with the dod is daily. We basically have a call at 12 00 with the entire enterprise , the department of defense, secretary of defense, joint staff. , obviouslyre doing these circumstances differ particularly overseas where you have the means to basically isolate the population. Please stay on base, i dont know the particulars of that, but we could certainly oblast to send the record. Page you conform with the cdcs guidelines. My time is expired. Senator romney. Thank you, mr. Chairman. I for she work is done in a country to delay the arrival of the virus in the United States. It is really quite remarkable to me that while other countries have seen so many cases, whether it is italy or iran, south korea, japan, that we have been able to delay it. Clearly, you cant keep it away forever, and we already have the Community Transmission predicted. I want to get to another issue, which is whether we as congress and administrations republican and democrat have done enough to prepare protective equipment for public at large. I dont want to point at anybody, this is not you, this is us. Given the fact that our medical professionals need masks, downs, gloves, and so forth, what percentage of what would be needed by medical professionals, if we were to have a fullblown pandemic, and i hope we dont, but if we were to have one, what percentage is in the Strategic National stockpile . I could give you a rough order of magnitude, it depends. Severe pandemic, 10 of what we need right now if it were to be a severe but, we would need 3. 5 billion. We have about 35 million. We are working actively in that. It strikes me that we should have substantially more than 10 of what we needed for a substantial pandemic. This isbelieve that congress appropriating and prior administrations as well. That should be in place. Do masks help for the general public . Lets say we have a major pandemic. Do masks actually help, do they prevent or reduce the likelihood of being exposed . It depends on the mask. In general right now, i think the question youre asking if we were to have a major outbreak of some kind . The most important thing for an mask would be if someone isnt that it, to prevent them from infecting others. The others are the health care providers, to protect them. The general public who could wear them, that could certainly prevent droplets going when someone sneezes on you, but it does not provide the kind of protection that people think it does. Therefore, there are some downsides, because people keep messing with the mask. Better than nothing. Do we have them in our Strategic National stockpile for the general public . We do not. Turn to aircraft. If someone on an aircraft is infected and sneezes, how many people are going to be exposed . Just a couple of people . The whole aircraft . Or this kind of virus, we are thinking just a couple rows around it. For other types of infections, it might be broader. Should our flight attendants flight attendants tell them you should cough into fabric or into your sleeve or whatever . I keep going onto airplanes, someone caught is, and i hear them barking out. In a condition like this, just the general flu going on, should be not be telling people on airplanes, you may not cough or sneeze unless you cover your mouth . I think i know the answer to that. [laughter] saynother question, lets we do get a vaccine that test positively and goes to phase one and phase two. To get majortake production . How long does it take to kick production up, and how long does that take . Who is doing the manufacturing what we know this is a vaccine that works . That is a really good question, it is one of the things that was discussed yesterday when the president and the Vice President brought the number of companies. That is really important. What i was talking about, if you dont have the Production Capacity to make tens of millions of dosages, it may take even longer. That are thecan do super companies. Do weal government have that capacity . I guess the question im looking for, legislatively, we should provide funding to have the cassidy to make large numbers of vaccines. We should have the capacity in the u. S. And have it ready to go in case this is not the pandemic we are worried about, is there something we should actually have ready to go . Yes, sir. Thisnly capacity we have introduction which would not be relevant to the vaccine or the candidates we are pursuing. There is longer than a sixmonth wait to produce vaccines on that scale. Thatwant to underscore that is an area we ought to consider making an investment in. I want to thank all of you for being here today please extend my thanks to your amazingly hardworking professional staff who i can only imagine have just been going nonstop for months. The misinformation and also in about the coronavirus that have been circulating. The misinformation and falsehoods for political reasons to the point of senator robert and others that we dont want to politicize this. What is the impact of this misinformation, and what should we do about it . It isnt there a sing to go through all of the things that have been set on National Media including honestly by the president. Not true, is it, that this is just like a common cold and we can expect this is going to be gone when the weather warms up. Is that true . In general, respiratory illnesses such as the prototypical influenza virus are seasonal, when the weather gets warmer, as will happen in march, april, and may, you will decreasey see a marked in influenza. The same is true for other respiratory viruses improving the common cold coronaviruses. This could happen, but we dont know. The reason we dont know is because this is a brandnew virus with which we have no experience. Thatthough the concept when warm weather comes, many respiratory viruses diminish, we have no guarantee at all that this is going to happen with this virus. And it might come back again. It certainly might. It is conceivable, given the degree and the efficiency of transmissibility of this virus, that we might have a cycle. It might come and be seasonal and come back. That is quite possible. We dont know that, but that is possible. The reason we have heard so much misinformation, this virus wageeveloped as a tool to economic war on the United States, that this is part of a strategy to try to bring down the economy, and it is ridiculous, and it is harmful. On why thismment makes it more difficult for us to address this epidemic should do to combat this kind of misinformation . I think we need to speak out often and loudly about how non nonsense this is. This is not new with coronavirus. There are always conspiracy theories when there is a new disease. I am thinking back now of 37 years ago i sat in this room trying to explain to the committee then that hiv was not a virus that was developed by the cia to eliminate certain population. Ot a virus that was developed by the cia to essentially eliminate certain population. Its crazy but this is what happens when you have outbreaks. Theres a lot of it misinformation. Theres consequences to this information that makes it more difficult for Public Health professionals to respond and take care the population in the ways that we need to. That is what worries me. I know dont how much time but i want to ask another issue thats extremely important, im very proud of minnesota health, we do great work and theyre very worried about whats going to happen, the capacity pressure they will be experiencing as they address the coronavirus on top of everything else. My question, its not only a question of getting the diagnostic test out so people can respond but the labs need to have the people in order to do the testing because its not like theyre sitting around with nothing to do. Absolutely the Public Health labs are shortstaffed on a good day so this is a very big challenge and thats one of the reasons we are keen to get Clinical Labs up and running with the test. I think you bring up the point it is not just the Laboratory Capacity for Public Health but all the other things that they do, they are very busy with contact tracy, following up on the people who traveled, who theyre supposed to follow, they are spread thin. It illustrates the principle in this evolving situation we need to put the most effort work and do the most good and not get distracted with smaller things. Its white so important as we work on the emergency appropriations making to the departments at the local level are reimbursed for the work theyve already done. Absolutely and they have sufficient dollars to do the work that they dont have the funding to do. Thank you, senator smith, senator scott. Thank you, mr. Chairman. In the panel for being here. The one thing im not concerned about frankly is whether or not congress will provide the necessary resources in a timely manner to deal with the challenges that we face as a coronavirus. Im not going to ask questions that are been asked several times by several different senators as relating to what will happen if. I do not think without a lot of conversation about putting the virus into context. Context for the average person in this nation can digest very quickly and understand the actual risks that are associated with the virus. So rather 2003 sars or 2009 swine flu or the current flu season and the number of americans have died because of the flu or rather overnight tennessee lost 19 people because of a tornado. I would appreciate if you would all take my time to help us to put in context what 80 of the people would experience if they were infected by the coronavirus which seems to be a favor and a cost that is downplaying. If it isnt please let me know. In the 20 folks who are elderly who may have disabilities and mobilitys that may be at a heightened risk. If you could use my three minutes and ill have left by the term and finish with my opening comment, help me and the rest of the folks in South Carolina who are seeing this issue on every screen and often times seen it from my perspective, hyped up in a way that is not helpful. I will close with this, those who are alarmist and really painting a picture that is very difficult to digest and those who are acting with a sense of urgency, i think the four of you are acting with urgency but not being alarmist at all. Now you have two minutes 48 seconds to help me figure out the situation. I address the regulatory issues, we worked with emergencies and facilitate mask and support of the Public Health colic. I will yield my time to doctor fauci in schuchat. My dog under jo job is to thinke main point. What you consider relative risk and how that relates to the unknown. Think about whats going on now, since it is a new virus, we dont really know exactly where it will go. If you look at the Disease Burden with immortality, every single year influenza does a significant amount of health damage, not only to our country but the rest of the world. The thing about influenza theres many things unpredictable. We know the bracket of how many people will get sick and how many people will die. It is tragic, death, suffering, we do not like it but we kind of know when youre in the area of the unknown, you have to walk a delicate balance of not overshooting and having panic but also not under shooting and being in a situation where you do not respond as aggressively as you should. A sense of urgency. Just to add in a Large Population most people who get infected will have very mild symptoms, some will have severe illness, pneumonia and be critically ill and what is unknown is what the total will be. Will we have been numerous cases a year end we have with flu which would be very difficult to handle or can we slow the spread and protect the Healthcare System. Its a balance that doctor fauci mentioned not overreacting but not under reactive because the risk of under could be that we have second third order complications. We dont want to have the Healthcare System flooded with people who do not need to be there but we need to build it up because it is going to be really bad flu we will need to build up the Healthcare System. Sense of urgency but not buy into this hysteria that will make it difficult for Healthcare Providers make it more difficult for Healthcare Providers that have the resources and equipment necessary for them to take care of the folks needing assistance. Thank you to the panelists and your entire teams you all have been working tirelessly and we know that and are grateful. I want to start to get at the issue with you of diagnostic Testing Capacity. I know the administration ordered an independent review of the cdc lab about problems that arose in the manufacturing of diagnostic testing kit. What is clear this point is the domestic Testing Capacity has been lower here in the United States are you confident the policies put in place by the cdc and fda over the past few days will allow states to test for coronavirus at a level come in third one of the things we are dealing with right now if you get a negative you will read texts next day and we still have the consent when we do then at the state level so when do you expect to reach the point when the cdc will no longer have to perform the testing on samples from state labs . That should be very soon as they verify if the procedures that work to expedite that there is a lack of ability to meet demand for diagnostic testing across the country. To doctor fauci and doctor kadlec, im concerned that the delays mean we dont yet have a full sense of the scope of the problem. If we cant test everybody that has these symptoms get, we may not know the full scope and having an accurate accounting is critical for your ongoing preparedness so how has the limited diagnostic Testing Capacity impacted your response efforts and what steps are you taking to mitigate those challenges . Thats not something im involved in but obviously you would want to be able to have as many tests as you need and at the cbc is ramping up in collaboration with the state and local health department. The first level is to get individuals in multiple states starting off with sex and it will probably be more as we improve and get better and better at that capacity we will have a much more accurate assessment of whats going on in the community. Doctor kadlec, briefly. There are two elements one is in terms of action how do you respond to the Early Warning and i think one of the things the cdc has been doing is using its influence into the tests they do to be able to test broadly to see surveillance so there is the trigger to respond and then the more important one in terms of understanding the circulating preference to understand that the pollinator that may be symptomatic as the both of those have a significant importance. We thought it would be funding commercial laboratories and basically try to develop the point of care diagnostics. I have another question to get to. We are doing that surveillance and hope to expand it broader so we will see what the tip of the iceberg really is. Thank you. I want to talk to commissioner stephen hahn for a moment. The fda has such an important wideranging role to pla role pe ongoing response efforts as you know your announcement last week regarding an unnamed drug shortage attributed to the disruptions in china due to the coronavirus caused confusion among publichealth experts and just now you said you couldnt name it and for those of us that either ourselves or have loved one to there is a shortage but thewe dont know if its ours ia difficult thing for the public. Yesterday you stated that they could perform up to 1 million tests this week while publichealth experts said they hoped to see them complete 10,000 tests per day. It becomes contradictory. Perhaps we can have the conversation offline to get a process in place so that you are making sure that your communications are clear to the public and integrated and i look forward to having that conversation with you a little bit later. Thank you chairman alexander, i want to express my condolences to the state in the tornadoes this morning and thank you for your time here today. If you look at where we are now in the capacity for the preparedness and response, weve come a long way however the Infectious Diseases means we need to continue to innovate. Your agencies have taken significant strides to improve the National Health security capacity. But in america much innovation comes from the private sector. I commend your steps taken with thibythis administration to adds this emergency. In these situations going forward, these can quickly reach the American People we are taking steps to reach out to the community looking at what the epidemic means to them and how they can help we met with the pharmaceutical industry and a member of the Big Companies about drugs and therapeutics. Those are a few areas to mention and you may want to go on i was very encouraged by the enthusiasm of the ceos in the pharmaceutical companies yesterday we met in the cabinet room at the white house. They want to do anything they could to help and as i mentioned in response to the previous question, we are not going to get the kind of production of interventions. The countermeasures for diagnostics to work on this and particularly on the supplychain issues. Weve been working with diagnostic companies with vaccine biologics and drug manufacturers around the shortages and Th Development of products to address this outbreak. Thank you all. Thank you, mr. Chairman. So, i want to start with the idea of the fact we have an emergency spending bill going through the congress quite rapidly and some of the issues that have been raised im hoping we will properly addressed those in the appropriation bill and also be able to follow up and make sure that the right policies are in place. So, let us start with the discussion weve been having about the Domestic Production in the epidemic. I remember in my former life as a member of the house of house f representatives in an instance where one of the manufacturers of the flu vaccine in england was the shutdown and a shortage and there was a lot of worry and we rationed flu vaccine that here, changed the standards of who should seek one in who should not. Iran also in the years we were fearing a very serious strain of the flu and inquiring about our domestic Production Capacity for the flu vaccine, and we had none. I might have even asked this of you all those years ago that should we assume if we put in an order with a foreign manufacturer for however many doses but there was a huge breakout in a country that they would commandeer that for their own Public Health purposes. The answer i got a thought at te was yes that would be a prudent and safe assumption on the part of policymakers. I hope that we assure we dont make those mistakes again. I think i heard all of you testify that having domestic capacity is very crucial in this, and i correct . The second thing i want to get into is we talked about labs and Testing Capacity in the u. S. I understand it to be chain reactionbased testing. And igg and iga and can we have that test soon it has a nasal swab and a blood sample . We recommend a throat and nose swab for that reaction. We have been developing the test of those antibodies that the senator was talking about and that is for the population level to understand how much disease has there been that didnt come to care. I want to get in a couple more questions. Can i assume we will have a test for a while . I want to get into the lab capacity we talked about the Clinical Labs and academic labs. If they need to search the capacity for testing and that is the veterinary labs that look at the same sort of tests but they are not usually looking at humans, they are looking at veterinary clinics, domesticated animals or the Wildlife Service that also studies the infections. If there were an emergency i dont know if you thought about tapping into that capacity but particularly of the skills and workforce that deals with level three labs etc. The media crazy idea. I hope you will discuss and think about it if we need to have a surge of the capacity to serve failed the transmission of this disease. Thank you mr. Chairman. I am going to follow up on the first question that senator baldwin raised with you. The fda reported its first coronavirus drug shortage last week and you indicated india restricted a number of active pharmaceutical ingredients. The fda testified previously that only 28 of the manufacturing facilities making apis to supply the market located in the country by contrast the remaining 72 of the manufacturers supplying our American Market are overseas and 13 are in china. Q. And i discussed the legislation that ive introduced with senator smith the mitigating emergency drug shortages which have been endorsed by more than 50 organizations and our bill contains new reporting requirements that would help the fda gain far greater visibility into the drug supply chain including where certain drugs are manufactured and manufacturing contingency and redundancy plans. Given the problems that we are already seeing, do you believe the concepts included in the legislation are in the drug shortage bill that ive introduced with senator smith would be helpful . Thank you for the question. We appreciate your leadership on the issue. This has been an ongoing problem prior to the outbreak and continues to be and is highlighted by what weve seen over the last few weeks. The agency totally shares your goal with mitigating increasing redundancy for manufacturing particularly in the areas of advanced manufacturing we look forward to working with you on that and with respect to the bill, we will be generating written response so we can provide the assistance and we very much look forward to working on a bill with you. With respect to the one drug that you mentioned that we announced last week was in short supply because of the corona virus outbreak, he mentioned this before and again this morning weve already listed that in the drug shortage list available. Thank you and i am hopeful that we might be able to move that bipartisan bill. The rate among older patients is significantly higher. The estimate ive seen 15 80 in order to survive compared to just over 2 in the general population of patients regarding the spread of the virus and longterm care facility. I represent the state that is the oldest in the nation into the aging committee i know senator casey brought this up generally with you as well. My question for you is what is the administration doing and what is the cdc doing in all aspects of response. Thank you for that question. They are sending a liaison to the Emergency Response and we are using our guidance adapted to the situation they are using their field staff to make sure practices around the country are best practices suited for this concern. Infection control is always an issue in the Different Levels of healthcare and the elderly are very vulnerable to the respiratory viruses. We see that same differentiation some are going to have lunch with United States senators and we will be able to finish by 1 12 30 and then we will wrap up by about 1230. Thank you for bringing the hearing we are so very grateful for the lifetime of work and care but i want to speak about the issue with access and capacity and how we can use tele health our response because many of our constituents are worried about the spread of coronavirus and if they have questions about their own health and since the symptoms can present like a cold or the flu, i can only imagine what people are seeing in the news that they are going to seek out care and people are a little nervous, needless to say. We have large areas of the population far away from the city centers and increase in those seeking care is not only hard on them creates a burden on the system. How can we use our health as a First Response to help people in their own home that could contain the virus relieved the Emergency Rooms and so what are your recommendations on the twopart question on addressing the barriers to access in tele health and do you have any plans potentially to operate a hotline or portal for initial screenings for some kind of hub and people could be returned to their local care if needed. Weve made a lot of progress. This was a huge issue getting developed in one state. We have more lawyers and most have actually worked out some of the king is and weve already been contacted by a number that are adapting their our triage wines. We also have been working with tell the Health Together with other parts of government to understand what kind of approaches are appropriate in the area as well as the coverage and that is one of the things cms is looking at now. One thing weve been doing we funded to pilo two pilot prograr regional Disaster Response system one at the university of nebraska and in nebraska in particular looking at the nuances how to use total health to expand outreach to not only nebraska but the other parts of the region and feel that evaluating both of the lega thed practical limitations to that. Can i ask a question because this book have to do with insurance considering that this could be a Global Pandemic or we have other issues. I wouldnt want insurance to be a barrier for someone able to access a hug or get the care because they do not care whether you are insured or not from a democrat, republican, will toward young so how do we address the issue of people feeling like they couldnt call or use this because of insurance on the patients . The strategy they are thinking through is trying to identify the right level of care for the right situation whether it is the nurse care line or Emergency Office and in the circumstances that we could see keeping people out of the Health Care System could be in everybodys interest to preserve it for those who need it most it would be somewhat different than it looks like doctor kadlec wants to Say Something there. In the declared disasters we have the opportunity to declare individuals and patients where they get reimbursed and it would be an interesting way to look at how you evaluate the pandemic to understand if that could be utilized in this way. That would be really impactful if we dont address this in the right way. So understanding that, what Additional Resources or what should we be looking at as we are going to be voting on the funding and resources hopefully this week, next week that you would need to address this issue . Can i get back to you on that . Thank you very much. Senator murray. First of all, thank you for having the hearing. I do have to ask each one of you because this is a very serious challenge we are seeing the impact in my state even though it may not be yes for each individual, it is absolutely critical so i think it is important right now and i am concerned that people trust the information they are hearing so they do the right thing for themselves and their communities in the country as this moves forward. Where do you turn for the information its the experts like all of you and that is for people need to be listening to. I think that you have heard the concern expressed here that the president has made some statements contradicting all of you. Our nations top experts may criticize the media for covering this, so i just think its important for us to hear from all of you yes or no can the American People count on you to be 100 transparent on the virus and response even if you have to contradict something someone says . Yes. Absolutely. We need to count on that because its moving quickly and we are seeing it in my state and we will see it in others. Families across the country watched the latest news and worry about the threat of the coronavirus. Im glad we are taking the opportunity in the committee to ask some of these questions that ive been hearing from home and we will all continue to hear and how we can prepare for the test. I will tell you since this started we learned the faithful closure of the facility committed to dh s. Center just closed a short time ago so its clear by the minute how serious this is for people in my state as well as the rest of the country and this administration as you will note those are some answers and they are going to keep hearing from me until i get the answers including apparently from Vice President mike ten and several of you. This is critical and we need to stay on top of it. I will say again thank you to senator alexander. Weve been holding bipartisan meetings on this and we want to continue to Work Together having that information i can talk you its so important for the people in my state. We need to get these tests out. There are real time decisions being made right now in my home state of School Closures and about whether to go to entertainment, what businesses should be telling people and as business grows it is only going to be more intense so we are counting on all of you. At a time that we are not in the middle of what they are now, i want to have some more discussion about the extent to which we rely on other countries for the medical supplies and medicines and what we should be doing about it that we are not. We have debates about importing prescription drugs and ive often thought that our the way we talk about that is all mixed up because we import a lot of drugs as we now see that the difference is they are manufactured under the supervision and have a supply line that the fda supervisors to make sure they are safe and when they do that we have lots of drugs made overseas so maybe the National Academies should do a study on this. I talked to other senators who are concerned about it and one of the areas the committee should look at and several senators mentioned it is we rely on other countries and the sole sources of supply, if chickfila sells mac and cheese it doesnt have one resource it has at least two to make sure it doesnt run out and we should certainly do the same with lifesaving drugs. Also want to endorse senator murray said about the appreciation for your telling us the truth into giving us Accurate Information about whats going on. Thats why we have such respect for you and your professionalism and thats why you are here today. The hearing has been about how to provide Accurate Information to the American People so they know what to do and how do we provide Accurate Information to congress so we know what else we need to do and we expect you to tell us that there is unpleasant news or not. Thank you for your professionalism and extra hours during this period of time. Thank you for coming today. I read at the beginning of the comment on the front of the New York Times sunday but said most experts agree the United States is among the countrys best prepared to prevent or manage such an epidemic. Your Performance Today suggests why that is true. The hearing record will remain open for ten days and members may submit information and thank you for being here the committee will stand adjourned. [inaudible conversations] [inaudible conversations] thehe federal response to coronavirus outbreak, go to cspan. Org coronavirus. You can hear briefings and the latest events anytime at coronavirus. Next q a, daughter of the former alabama governor and segregationist George Wallace talks about her father passes controversial career and his afterpolitical conversion almost being assassinated. She also talks about her friendship with john lewis of georgia. That is next sunday on cspan