The flu is a respiratory disease like coronavirus, correct . How do you know you have the flu as opposed to coronavirus . The definitive test would be a test for the flu or a test for the coronavirus. You need a test . There are overlapping systems symptoms. Coronavirus is predominantly fever and a low respiratory infection as opposed to an upper respiratory infection starting off with and you might get a pulmonary involvement, which is flu. What is lower respiratory . As opposed to sneezing. When you have lung involvement, you can get that with flu, but usually it is upper respiratory. Fever and a cough . Fever and cough, it can be either of them. What should you do if you have fever and cough . It depends on the circumstance. If you are in the middle of flu season right now and you have fever and cough, you should see a physician, certainly if you are in a risk group. With an underlying condition, during the flu season. We do have antivirals for the flu and you could be helped by doing that. Should we all be Wearing Masks . No. Isnte right now, there anything going around in the community, certainly not coronavirus, that is calling for the broad use of masks in the community. Why do Health Care Workers wear masks in the hospital . Workinglth care worker with someone with a known transmissible virus is different than someone Walking Around in the streets wearing a mask. Our children getting the coronavirus . To a much lesser extent than adults and for reasons that may still be unclear. Their symptoms are so low, they are not being recognized but in the number of reports that have come out from china, there are very few cases, less than 15 years old. Ill always find the exception, but most of the cases are a mean age of about 15 50. What can we do to protect ourselves . Right now, and the question about flu 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 flu. Obviously, you get a flu shot and you can at least protect yourself against flu, but also things like it sounds simplistic, but it is true. Washing of hands. If possible, staying away from people who are coughing and sneezing. If you are infected, stay out of work, dont send your children to work school if they are infected. The firstyield question to senator jones, who has to leave for a flight. I will take the second round. I would like to followup on that quickly. If someone in alabama presents and didnt get their fruit ashley scott their flu shot, will that test, if they dont have the flu but have coronavirus, will that test come back negative . They should be concerned if they present some symptoms for the flu and that comes back negative. Onlowup to the question that is about testing. I didnt hear a lot about the testing. Weve had some turns in this in this concerns country about testing. It is inadequate to say the least right now, but i know there are efforts. Dot capacity do we have to the testing, as you sit here today and how are we working to expand that and when will that all happen . The cdcs piece in this is to provide the Public Health labs with tests and we are rapidly doing so. We developed the test quickly problems. Ized by the end of this week, all the Public Health labs should be able to do testing, but for context, it is important to understand what the Clinical Labs do in respiratory testing. Last week in the united states, Clinical Labs tested 42,000 respiratory specimens for influenza and 11,000 of those were positive for influenza and so far this year, the clinical one have tested almost million respiratory specimens and about 200,000 were positive. Public health labs as opposed to one million so far this year tested about 62 thousand. Public health labs are a tiny piece of the testing world. That said, most of the people with influenza dont actually get tested. We have about 30 Million People with influenza so far this year a million tests. I think the Public Health issue is to detect early when there is an emergence of this virus and recognize it in travelers or the now, wey, and right arcade with the fdas assistance to get this clinical lab up and running and that was is an fda issue. Capacity willre we have by the end of this week versus two weeks, three weeks from now . Senator, we work with the cdc on their tests. But the outside manufacturers, outside companies are using their platform to further develop the tests. Our expectation in talking to the company 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. Toone thing i would urge please continue, as both senator alexander and murray said, we please hurry. In the allergy season and people are so scared that the first time they sneeze with an allergy, they are going to think they have got this and we need to try to educate folks so that the tests we have, the limited ones, are for the right reason. 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 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. Frankly, weve been monitoring that situation carefully with our Health Care Coalitions that are funded by the hospital preparedness program. And we do recognize there is a possibility in some areas of resources as well as absences in staff. As dr. Fauci said, the majority of individuals with the coronavirus dont need care. The critical thing is identifying people who can, and that is something that cdc has been working on messaging to kind of identify guidelines. One, individuals who may be at risk, particularly for severe disease, should seek hospital care. And if the doctor would like to follow on to that, we are looking at telemedicine options as one piece of the puzzle that would help us fill in the gap that there needs to be a longterm solution to that challenge. Get would encourage you to with cms and have them allow for reimbursements for telemedicine. They do dont do that right now and that would be important. We are in conversations. Thats all i have, thank you. Senator burr . Before my five minutes start, what i ask unanimous consent that i enter a statement into the record and ask on behalf of all members if they want to enter a statement into the record that they can . And just remind members in 2005 when senator kennedy and i pass sed papa, it was with this day in mind, that we would be faced with a pandemic and we are close to that determination. 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 that our responders have. Let them do their jobs. Dr. Hahn expressed he just did two emergency use authorizations. Thats part of the work of this committee. So lets not be too quick to go out and encumber them with micromanaging what they do. So ordered. Well go ahead and make unanimous consent to put that in and look forward reading it. Thank you, mr. Chairman. I heard you say youre rapidly trying to reach testing. As of march the first, the cdcs website had total tested up on their website, it was 472 even though secretary azar said last night 3600. Im not sure which is right. What im curious about is why on march 2 did you take the total number tested off the cdc website . Thank you for that question. Let me clarify. Theres a lot of numbers out there. Theres a difference between persons under investigation who have been tested and all of the tests that we have run. For instance, individual case, the first 12 cases we saw, we did serial testing on them to understand how long the virus was present and when it was safe for them to leave the hospital or when they no longer needed isolation. We collected multiple specimens so we understood with this very new virus, is it the upper respiratory respiratory, lower respiratory . Weve collected other specimens from them. Over 3,000 tests run is correct. Weve tested way more than the 500 some persons under investigation. Weve also tested some of the hot cohorts or hot risk cohorts like the repatriatation from the diamond princess. Weve known about this 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, saying weve got to be able to do this, and we devote, through papa, 150 million each year to strengthen the surveillance capabilities at the state level. How can we have a situation Like Washington state where weve known for up to six weeks, reaching possibly 1,500 individuals, yet we experienced what we have with this longterm care facility and clearly a cluster that we dont know the magnitude of. How can that happen when weve invested so much in being there early on and understanding it and being prepared . Cdc very rapidly developed a new pcr for a completely new virus. We posted the instructions for that pcr on the website so other labs, academic labs, commercial labs, research labs, could similarly develop tests. Barta has the 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 learned from the sars experience in 2003 that super spreading events or super spreading individuals could cause very large amplification rapidly. The concern about Health Care Settings has been foremost in our mind. Senator burr dr. Schuchat, i believe you. My question is, were we better prepared for this happening . It doesnt appear that we were. Papa required direct hiring for 30 new employees at cdc for development of a bio system. Of those 30 slots, how many have you filled . I dont have that information, but i can tell you that the Laboratory Activities for the coronavirus are not one of the larger parts of our program. We have really built our response around our influenza capacity, which has really grown with the generosity of the American People through congress. So, our coronavirus capacity is relatively small. We built it up a little bit after mers, but were not able to sustain that. So we really appreciate the support from congress to strengthen that Public Health infrastructure, both at cdc and the state. Sen. Burr i personally was shocked and i would like to think that im fairly knowledgeable of everything that we instruct and provide for agencies. I was shocked to find out that in the normal appropriations, this 150 million, that that can also be used for cdc facility construction. You know, its a little misleading to say this went for surveillance when the flexibility exists for some of it to go for facility construction. Do you know what portion of the 150 did not go directly to Fund Surveillance . Dr. Schuchat im not sure what the 150 million line is. I think im going to need to get back to you on that. Our construction renovation appropriations are separate. So i will need to get back to you on that. Sen. Burr if you check the appropriations in all appropriations go to cdc, theres an ability to move money from that to construction facilities, and i would encourage appropriators on this committee, especially as we look at emergency funding. For god sake, lets make sure it goes to response and not construction of a campus at this time. I yield back, mr. Chairman. Thank you, senator burr. Do you have Something Else . Dr. Schuchat no, just well follow up for the record with the accurate information. Senator murray . Thank you. Ray dr. Hahn, as you heard, im very concerned about the delays in testing. I have people in my state who may have been exposed. They cannot get answers about where to go and Health Officials are telling us that they fear that this virus has been circulating for weeks undetected. We were relieved a month ago when cdc began to ship diagnostic tests to our state and labs but within days many labs reported validation issues with those tests, leading to inconclusive results and cdc worked on remedying that. But it wasnt until 27 cdc began distributing new test kits and at the same time academic, medical Centers Across the country were raising concerns about the lack of ability of diagnostic testing. For example, fda asked labs to submit information about 100 tests at a time when only 15 people in the u. S. Were known to be infected. Fda has worked to address these issues with guidance on lab testing that had been issued this weekend, but press reports withine this was delayed hhs. I was glad to read last night you are going to be able to do one million tests by the end of the week, but im hearing from professionals that is unrealistic, so i wanted to ask you first of all, what happened at the department that created these delays and how can you clarify that estimate of one million tests is accurate. Dr. Hahn thank you, senator. So, first of all, with respect to the timeline and the development of the test, cdc obtains the sequence of the virus. Thats where it starts. And theyre 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 test on february 3 and on february 4, we issued the emergency use authorization to allow that test to be used. During the scaleup process, which occurred in the week or so afterwards and sending it out to the Public Health labs, as you mentioned, it was identified at some of the Public Health labs, not all of them, that they werent able to reproduce and validate the test. Cdc heard that information, came to fda and we worked to correct that issue. At the same time, simultaneously, we were working with the private sector to actually scale up the use of the cdcbased test and thats where we came into the most recent estimate regarding how we can scale up sen. Murray i understand that. What is the publication delayed, guidance delayed within hhs . Was it, yes or no . Dr. Hahn no, it was not. Sen. Murray it was not delayed . Dr. Hahn no. Sen. Murray do you really believe 1 million tests will be available by the end of this week . Dr. Hahn senator, let me just explain that one. The companies were working with on this, they have the capacity to develop enough test kits to send out by the end of the week. This is a dynamic process. Every day were hearing from additional manufacturers that they can do this. 2500 test kits by the end of the week. That should give us the capacity in the hands of laboratories. Once they validate to perform up to a million tests. Sen. Murray 2,500 kits . Dr. Hahn kits, and 500 tests per kit. Sen. Murray i heard it said the point of where someone goes in to get a test on a rapid we are months away from that, correct . Yes, maam. Sen. Murray im hearing from a lot of people in my state that are really concerned about what they should do if they are infected or if they know they were within range of someone with coronavirus. Right now, the cdcs website says if you suspect you are infected, you should, stay home except to get medical care. Well, right now we know that 27 of private sector workforce in the u. S. Do not have the ability to stay home from work without losing pay or if they have a loved one who is sick. In fact, the u. S. Is only one of two oecd countries that doesnt provide paid leave for personnel illness. If were telling people to stay home, just think about the facility thats been impacted. Its a senior center, lowincome workers there. All of them are being told to stay home for two weeks. Dr. Schuchat, i have to ask you, would it be beneficial for a Public Health reason right now while we combat this to have policies in place that make it possible for people to stay home from work without losing a paycheck . Dr. Schuchat yes, absolutely. Sen. Murray okay. Well, i think thats something we do need to consider with this. Dr. Schuchat, i want to ask you also, im very concerned by news reports about hhs staff who are deployed to assist with potentially infected passengers returning from abroad and, despite facetoface contact with passengers, the staff were 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 for the virus and some have since taken commercial flight and returned to work. Its not clear to me that hhs took necessary steps to protect staff and the public to, either during this time or after concerns were raised with Senior Leadership about what happened. Ill ask both. Does the situation i just described consistent with protocol and what should have been done once Senior Leadership were where frontline staff may have been exposed . Dr. Schuchat i can speak for cdc that we take the health of our workforce very seriously, haveealth and safety, and predeployment, deployment, and post deployment guidance. This is a totally new virus. We are learning as we go, but when we identify problems, we want to resolve them quickly. Sen. Murray was what i described to you consistent with the protocols . Dr. Schuchat i dont have the full information of that. I believe dr. Kadlik can explain more. K to echo what was said, we take the protection of our Health Care Workers very seriously and in that operation, we are evaluating what may have been the breach and we owe it to you and to report back to you on that report. Say that we need people to speak up when they see the situation. It is on acceptable if any workers on the front lines are intimidated into staying silent or believe they will be retaliated against in these issues, we have to keep the protection of public foremost in our mind and i want this look that and to make sure anyone who speaks up is protected. Thank you, senator murray. Senator paul . , they saidauci it was effective against mers and animal models. Do you think it is effective against humans . Dr. Fauci yes. Sen. Paul with regard to the children, its fascinating there arent many cases and i would suspect that it would be improbable theyre not being ininfected, that they have some sort of blanket immunity. One important thing of maybe putting this into perspective, maybe putting a better look on the overall outbreak is if we had numbers. I dont know if someone would suggest to china that they do random testing of kids in a hotbed to see if theres a huge number. If we have 10,000 kids not getting sick or 100 of kids. Dr. Schuchat there are some data about that that attack rates may not be zero in children, but they may be asymptomatic. Sen. Paul it seems more likely theyre asymptomatic or less symptomatic. Dr. Fauci i think were going to get some data from the chinese. They have actually now been quite cooperative in sharing data. We had a group that was under who thatces of the went to china. There was an individual from the cdc and an individual from the and will soon get a look at what was in the report. As you mentioned, senator, that is a very important issue. Sen. Paul with regard to treating the severe and potentially fatal cases in bacterial or viral infections, it seems sometimes its trying to fight off the cause of the infection as well as the bodys response to that. In some bacterial infections, steroids, like with the flesheating strep, sometimes you give massive steroids in the setting of an infection and some of these people survive. In the fatal cases, are they finding that steroids, in addition we dont really have an antiviral treatment. But are they using some steroid treatment in real severe cases and having some success . Dr. Fauci they have done it in an empiric noncontrolled way. ,sen. Paul i guess in method, it might be a different scenario. Thank you. Thats all i have. Sunday on book tv, reflections from watergate lawyer and the effect of a twoparty political system on democracy. At 7 50 pm eastern in her latest book the water gate girl, her role as one of the three assistant special prosecutors in the watergate case. At 9 00 p. M. On afterwards, new america senior fellow argues in his book breaking the twoparty that the twoparty system is damaging americas democracy. He is interviewed by George Washingtons university professor. Democracy is always going to involve conflict. Politics is conflict. Issues of consensus are not political issues. We need to have some system by which we can agree that some set of rules are fair and some procedures are fair and we can abide by those outcomes. Afterwards, sunday on book tv. Be sure to tune in next weekend for our two day live coverage of the tucson festival of books on book tv on cspan2. A state dinner at the white house. Vice president and mrs. Lyndon johnson are among those who joined the president and honoring his imperial majesty and the empress. On American History tv, the 1962 film from alliance. And firstjohn kennedy Lady Jacqueline kennedy. I speak on behalf of all of my fellow americans and welcoming you to the united states. The interest of both of us is the same. To maintain my freedom, to maintain our peace, and to provide a better life for our people. Real america, sunday at 4 00 eastern on American History tv. Cspans washington journal, live every day with news and policy issues that impact you. Coming up sunday morning, conservative activist Vernon Robinson discusses his book. Then we will talk about campaign 2020 and the democratic primary contest with bill press. Washingtonns journal, live at 7 00 eastern sunday morning. Join the discussion. On tuesday, treasury secretary Steven Mnuchin testified before the house ways and Means Committee on president andps 2021 Budget Proposal was asked about the governments response to the coronavirus outbreak as well as its economic impact. This is two hours and 40 minutes
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