Transcripts For CSPAN2 CDC Director Dr. Redfield Other Federal Officials Testify On Coronavirus... 20240713

[inaudible conversations] the subcommittee will come to order. First off, i appreciate the audience patience and given. We dont control the voting schedule so thank you and the witnesses. Without objection all members have five days to submit statements, extraneous materials for the record subject to lengthy and limitations in the world. I will now make an Opening Statement and then turn over to the Ranking Member for his Opening Statement and i want to thank the Ranking Member for his longtime friendship and partnership in this issue and also thank the members of the cbc and Senior State Department officials for taking the time to come up here. Obviously this is a very timely subject. This is our second hearing. A couple weeks ago we had the first hearing in congress on the coronavirus and this will be my second hearing. I think about this issue based on my background but more importantly, as the former chief medical officer for sacramento in charge of the system and as a faculty member by institutions the university of California School of medicine. The reason why i give that background is last night it became personal for me because it is hitting close to home. We put the first coronavirus case potentially persontoperson one transmission is in Sacramento County as we speak. That patient is being housed at uc davis and weve been in communication with former colleagues that are over there. There are a couple of concerning issues that as we go through the hearing im going to want to ask questions but i think about this particular case and it initially was close to where the Travis Air Force base is at one of the points of entry where we are quarantining patience as we evacuate them from overseas. Thus far we dont know, they didnt have any history and we are not aware of any contact they saying if it continues. The patient arrived at uc davis last thursday and was incubated at the time on a ventilator. At that juncture, the doctors at uc davis medical staff didnt have a concrete diagnosis and have requested testing for the coronavirus. It was determined that this patient did not fit the criteria for testing of coronavirus. This past sunday the doctors and medical staff insisted on the test and was performed last night and got the results back into the news spread that all of you have heard this is the first patient testing positive where we dont have contact. One thing i will want to talk about and perhaps with doctor redfield in questioning is the testing criteria. Also the testing capabilities quickly to every state in the distribution. Korea is testing 15,000 people a day right now, so whatever we can do to assist our scientists to get testing capabilities up and running is as quickly as possible. There is a couple areas i would like to focus on as well and i do applaud President Trump although i think it was delayed in announcing in identifying someone as the head czar who has direct access and vice President Trump. That said i do want to apply the appointment in announcing very well qualified and have our support. I also appreciate the administrations funding flexibility. I do think the initial amount of 2. 5 billion was not going to be sufficient. I know the senator suggested 8. 5. That may not be enough and in a bipartisan way we should be ready to make sure our scientists and the folks on the front line particularly the folks that are in Public Health systems have the resources and support the number one job is protecting Domestic National security at this juncture while we dont know this rapidly evolving Public Health threat weve got to be ready to make sure that our communities and Public Health infrastructure and Global Health leadership has the funds and ability to do their job. As we are thinking about the dollar amount we have to think about the infrastructure and assess thei the needs as well ae gaps. I know we run on shoestring. We dont potentially know how bad it will did we just have to be prepared for the worst and hope for the best. I also want to make sure and i talked about this with my colleagues on both sides of the aisle we need to keep politics out of this. This has to be a nonpartisan effort, this has to be looking at the science following the facts and doing what they have to do to keep the American Public safe to focus on the international community. That is going to be extremely important. In addition, we have to make sure in this era i its easy to put out false information. We do have a very concerned public we are all theaters as well as members of congress and have the ability to communicate effectively. So the more we can coordinate with the cdc and others to get information out there to make sure that the public is accurately informed and that we can quickly dispel any misinformation will allow us to do our job and allow you to do your jobs and our scientists to do their jobs better. And last, this is the Foreign Affairs committee and something we look very closely at. In this sense, American Leadership has to be central to how we approach this. I would be curious to get an update on how our scientists were doing in china if theyve accommodated. So we can get ahead of this. Again i appreciate the witnesses for taking their time to come down here and inform us as members of congress but also inform the general public on this rapidly evolving here and again appreciate the members here and with that but the turnover to the Ranking Member for your Opening Statement. Statement. Might appreciate those words. We had the opportunity to meet yesterday and opened up with the same thing about we are all on the same team and this is team america and we have to look forward to. You look around about the concern and that speaks loudly with the independenc attendance. We need to make sure that we are in that. Im a veterinarian by trade. Weve dealt with situations and that doesnt mean we should treat people like animals but we should make sure we put in more proper safeguards so that we protect our population. We have a bill we have sponsored which coordinates animal diseases with human disease and this is why seven out of ten originate with the animals. What comes out of this as we lived through the zika virus install the misinformation, the panic, the politics that got put into that and its a disaster. I hope we can do that in this hearing and help inform the American People other things we are doing we are putting appropriations for the nih and the research and development but also for organizations with the coalition for active epidemic preparedness they are looking at the new and upcoming diseases to have the model already her winsome like this happens. The collaboration with other countries we brought up with epidemiology at the last meeting we had epidemiologists and we looked at the origin of where this was supposed to come from with that of and it was the fish market and we asked the epidemiologists in its research was done and they felt it happened but the Chinese Government came and removed the market so they start raising questions and you look at the amount of response and severity of the quarantine people isolated and it sometimes doesnt match what we are looking at as a disease or what we are being told. But yet when we have the province that was under quarantine, its about 20 of the United States of america and then we produce over 100 Million People and we want to make sure we have a measure for accurate response and readiness to respond to this in the appropriate ways. Im proud of what the country has done. We appreciate that and then as i was talking about collaboration we want to make no countries are excluded, countries like taiwan that was so instrumental in the epidemic for a country like china to put pressure on others to exclude the process and the world health assembly. Viruses dont care what your political affiliation is. Thank you to the Ranking Member. We are joined by the excellent public servants. Jonathan serves as the Deputy Assistant secretary for the bureau of east asian and Pacific Affairs and will be followed by the principal Deputy Assistant secretary for the bureau of Consular Affairs. The final stage with us will be William Waters executive director, managing director for operational medicine at the bureau of medical services. Finally, we are honored to be joined by doctor Robert Redfield director of the centers for Disease Control and prevention. Please summarize your written statements to fivreturnstatemend without objection prepared return statements will be made part of the record. If you would like to begin. Thank you in the department of states response throughout this global Public Health emergency, the department has worked aroundtheclock on what has always been Mission Number onone focus ensuring the safety and security. The secretary and Senior Leadership team have been personally engaged in directing and supporting the u. S. Response to this outbreak including the cdc colleagues in the department of Homeland Security, department of defense and others. Utilizing the expertise and our diplomats and staff serving in the region executed plans, provide Consular Services, engaged Foreign Government and reported on Economic Issues arising in the outbreak. We simply couldnt have done so much to care for the citizens and personnel without a departmentwide effort. U. S. Diplomats in china, tokyo and elsewhere contribute to the efforts aided by the locally employed staff including those at the consulate general in wuhan. We engaged the people of china at the most senior levels including president of trumps february 7 conversation. Secretary mike pompeo spoke about the evacuation from wuhan protecting citizens in times of crisis is our number one priority. The ambassador to china, terry branstad, worked with is to facilitate evacuatious tofacilin the u. S. Delivery donated assistance. Our team was on the ground helping obtain permissions. It was instrumental evacuating citizens and even some of our allies. We face challenges from the quarantine and additional complexitiecomplexities supports on cruise ships. The department worked closely with our allies in japan to ensure the health and safety of its citizens on board the diamond princess ship. The u. S. Embassy tokyo coordinated closely with the japanese government of Carnival Corporation and cbc and other components. After a high number of cases were identified on board and out of consideration for japans already overburdened Health System, the department of health and Human Services made an assessment of u. S. Citizens and the crew on board were at high risk of exposure and should be repatriated to minimize risk Going Forward. In cambodia we organized Response Team to assist citizens on the cruise ship in the embassies of others on board the ship them to see teams included consular and logistic experts to facilitate Health Screenings and travel needs of more than 600 citizen passengers and also utilized its consular messaging platform accounts to provide timely updates to passengers. Iand coordination to usaid provided funding for effective anin that first countries to address critical gaps in the readiness including Risk Communication and engagement, Laboratory Detection enhanced surveillance and prevention and control. In addition, usaid to the selected countries and coordination with the World Health Organization. Our efforts continue. We are continually engaging with host governments in the asiapacific region to ensure they are informed of the policies and best practices to address the outbreak. We successfully encouraged beijing to assess the who mission to china and announced it is prepared to provide up to 100 million in existing funds to assist countries including china an and acted by and at rik from the virus. To content and conten continue e bilaterally through multilateral organizations. This commitment along with hundreds of millions generously donated by the private sector demonstrates strong leadership in response to the outbreak. Thank you mr. Chairman. I look forward to answering questions and to those of other members of the subcommittee. Thank you mr. Redfield, mr. Brownley. Thank you for the opportunity to testify. The mission has always been the safety and security of u. S. Citizens at home and abroad. We have worked in a recent weeks and in hand with our colleagues from the cdc, hhs, nih, dhs and others to provide critical information and travel alerts are citizens overseas to help arrange repatriation for u. S. Citizen than the two countries and to provide an inperson Consular Services to u. S. Citizens impacted by the outbreak and many other countries. In china the u. S. Embass u. S. Ed consulate staff made thousands of phone calls and corresponded tirelessly via email and various Online Platforms to reach u. S. Citizen in the province. We worked with the government to hold the grandmothers accompaniehelp the grandmothers accompanied a u. S. Citizen grandchildren on evacuation flights. As they walked down the wuhan, we coordinated to allow u. S. Citizens to travel to the airport to the evacuated. Using these flights and working with our interagency partners such as hhs, cdc and the dod we brought approximately 800 u. S. Citizens back to the United States. In japan, the u. S. Embassy staff created a dedicated webpage for u. S. Citizens quarantined on the cruise ship diamond princess and reached out to them individually by email and on the phone. As some citizens to Public Health problems, not all related how the consular officers worked with japanese hospitals to ensure patients receive appropriate medical care. In collaboration with our agent t. Partners, ththe partners coud over 300 citizens back to the United States on february 16. We remain in close coordination with japanese authorities and cruise line for those citizens who remained in japan after the evacuation. In cambodia, u. S. Embassy staff met the cruise ship in the port city. Our staff coordinated, provided key liaison roles and shortening u. S. Citizens were connected with appropriate cruiseship authorities we sent a team to provide Consular Services. Consular personnel in kuala lumpur and amsterdam worked late into tonight to help 91 of those stranded citizens get home last week. We are supporting the Public Health authorities efforts to contain the virus outside of the United States. These officers lamented the proclamation 9984 which suspends the entry into the United States of any aliens present in china accept hong kong during the 14 days before any attempted entry into the United States. The bureau of Consular Affairs is an idea of the feed from the end of most of those come from these applicants. Under the current authorities, we use these to cover most of the cost of providing services for citizens abroad such as those i just described. However, based on what we now know, we anticipate a loss of approximately excuse me, 98 million, loss of 98 million revenues this year as a result of covid 19. Despite falling these revenues i would ask you grante grant the department greater flexibility in spending existing fees. We remain committed to protecting the health and welfare of citizens overseas and working actively with the government and International Partners to achieve the goals of the crisis. Thank you mr. Chairman and i look forward to answering your questions and those of the members of the other and the otr subcommittee. Thank you mr. Brownley. Doctor walters. Chairman, Ranking Member of distinguished members of the subcommittee thank you for the opportunity to testified today. The department executed the most complex nonmilitary evacuation of u. S. Citizens in its history. From wuhan and the diamond princess cruise ship in japan is a testament to the agility proficiency and dedication of the workforce and interagency partnerships and others to accomplish the core mission advancing the interest of the American People. Following the sars outbreak, the Accountability Office recommended we work with interagency partners and private sector to develop capabilities to support the medical evacuation and transportation of u. S. Citizens and areas impacted by the sudden outbreak of Infectious Disease. The 2014 outbreak again served as a reminder. The citizens on emergency situations arise. Such a prompt the creation of u. S. Citizens from quarantined conditions couldnt have been possible had it not been for the bureau of medical services and aviation contract and solid corporate partners. The contract is the department only standing response aviation support capability and the u. S. Government only standing transport capability. Upon receipt of the mission, directives, we managed to configure and simultaneously choreographed the movement of five aircraft including the coordination of all clearances and other required logistics. The department of state personnel were trained and equipped to manage these operations. The department successfully directed and executed a total of seven flights over formation with those transported to five different locations within the United States equipped safely received evaluate and house persons exposed to the virus. This operation involved close coordination with our interagency partners including the federal Aviation Administration and the department of defense, health and Human Services, Homeland Security and others. We also coordinated with International Partners including the government of the peoples republic of china, japan, republic of korea. I was the lea pleased to officee second and Third Mission in wuhan. Some 41 countries and territories have reported cases of covid 19 infection. In these unprecedented times, the medical professionals are committed to doing everything we can for the health and safety of the workforce and u. S. Citizens overseas. We know that the bureau of medical services in particular has made this all possible and that your continued support will be critical in the months and years to come. Thank you. Thank you, doctor walters. Director redfield. Thank you members of the committee for the opportunity to speak of today. The cdc, the department of health and Human Services, state department and other u. S. Partners are fully committed to compound the Health Threat presented by the coronavirus 19. Cdc Public Health approach. For the pandemic influenza portal is to keep america safe and this new virus into the United States. Our response involves multilayered aggressive containment and potential mitigation measures. They prove these including early diagnosis and Contact Tracing. These Public Health interventions also include targeted restrictions as well as the use of quarantined for individuals returning from transmission hospitals such as china and the diamond princess cruise ship adopted in japan. Internationally the cdc is working with the World Health Organization and ministries of hope across the globe to continue to combat this outbreak. The cdc has deployed over 600 staff to the response including staff supporting japan, south korea and the Country Office in china. This outbreak underscores the National Leadership role on the global scale and at strengthening the global capacity to stop disease threats at the source before they spread. With this outbreak when it was first recorded in september, china reported a 27 cases of pneumonia linked to a seafood market. Today theres more than 78,000 cases and over 27 deaths. Over the past few months, weve seen confirmed cases reported in 46 International Locations including the United States and several of these countries now are reporting sustained community thread. In the United States, 15 cases have been confirmed by the nations Public Health and medical Community Based on clinical guidance provided to them by the cdc. On february 26 of the cdc confirmed an infection with the virus caused by covid 19 and a person who reportedly didnt have any relevant travel history or exposure to other covid patients. Its possible this could be an instance of Community Spread of covid which would be the first time this has happened in the United States. Three cases have been detect it among the americans repatriated from wuhan and another 43 who were confirmed on monday Cruise Ship Passengers that were repatriated from japan. We commend the efforts of the government in japan to institute a quarantine measure aboard the ship and appreciate the cooperation with the United States government to evaluate and care for american citizens. Cdc works in partnership with the state department to assist in this repatriation efforts of american citizens both in china and japan. All of the individuals repatriated by the state department charters have now been released from their mandatory quarantine. These individuals are not at risk of spreading a virus to others and should return to their normal lives. Passengers were in the process in several locations across the United States. We are grateful to all of the americans who have and are still undergoing quarantine for their patience and cooperation we also want to thank the department of defense or the military personnel, their families and the installations where the evacuees have been quarantined and service to the nation. To screen the rising passengers from mainland and to identify people at high risk exposure for the future travelers and where its spreading continues to post travel advisories and are now level three warnings that advised travelers against nonessential travel. As it remains low however we do anticipate new Community Cases we must be prepared to move to a blended containment approach. We recognize that you are trusted leaders in the communi community. Thank you and i look forward to your questions. I recognize you for the purposes of questioning the assist in my Opening Statement as well as you eluded to in your Opening Statement this potential is in my home county, Sacramento County at the patients hospital that i used to attend with students and in talking to my colleagues earlier today and getting the sense of the timeline of the patient, one thing is a bit concerning. Taking care of patients like this to get transferred through you dont have a sense of what the diagnosis is. Cultures are coming back negative, but in this case it does seem like the medical staff asked for a test of coronavirus and we are told they didnt meet meet the criteria and this wasnt a coronavirus patient and it does sound like there is an insistence and ultimately the patient did get tested and we know the results that came back 72 hours later as a positive test. The question i have maybe it is twofold. On the medical expertise and the folks trying to come from a diagnosis at a minimum with this new case we ought to rethink what those criteria are. To hear what criteria we are using today and the cdc is updating the criteria and the second component is the testing capabilities seem a bit slow at this juncture and i would be curious to hear what we are doing to increase availability of tests if we are getting testing to all 50 states as well as more broadly to cities and others and then it takes 72 hours from testing to get the results. If we could get the Testing Facilities at it closer. Im also told they produce a more rapid test and meet the ability to get some samples to confirm the specificity and sensitivity of the test and there are some privatesector Companies Working on the diagnostic tools as well. Mr. Chairman, thank you for the questions. First, i think you know when the outbreak started for better or worse even in china to expose to the sea market, food market so every confirmed case was from the market and in the discussions i had with the chinese cdc director i suggested they look with other people and of course they reported there were many cases that were not in the market. When the United States began, we had the epidemiological link where hubei where most of them came from and clearly what has been demonstrated in the recent cases that is no longer operational. I will tell you as soon as the case was recognized, we met and revised the Case Definition for persons under investigation. Today that has been posted with the new advisory recommendation should be when a clinician or Public Health individual suspects this we should be able to get a test for the coronavirus so that is the guidance that went out today. The second question is also critical how do we expand the availability of testing we think its an accomplishment within a week to develop the test and the cdc scientists that wasnt the take away and response ability for the private sector to be able to provide testing for them on Public Health community. We have had aggressive discussions about how to extend that. We had trouble with one of the controls. That has now been corrected and there are now 40 jurisdictions that have the ability to do the past modified with fda approval. And in the next, today, tomorrow we anticipate more that have been contracted by the cdc to get out. What you get at the root of it is what is the difference and i used to run a diagnostic lab and they have the ability for someone like me to develop a Laboratory Test and to deploy it. In order to get deployed and again im not criticizing the regulatory process. Im just saying thats the difference. And many labs in the country, many hospitals could stand up as you mentioned San Francisco and others because weve published the sequences and that is how that one company is now ready to sell a test which basically is a copy of the cdc test. So i do think we have to look at that because this is an example of where we were slowed in a sense because of the way we want to assure accuracy of the diagnostic test and i know the url wrestling with that. Later today they will be sent to the states in the state of california i talked with your secretary about this today because they were down to 200 tests and we are sending more. There are three in california that have the ability to do the test but both of your points are very important and we take them very seriously one of which we will not let happen again because we corrected it after the first case and the other we are working hard to get the tests out. The cdc develops them and we need the private sector to come in. This is th a situation we ned all hands on deck and take a look at speeding up the regulatory process. To quickly move through the process there is an accurate diagnostic test and this is the private sector can augment the ability especially now that there may be communities we have to stop the bottleneck and get these out to all parts of the country. To make the testing readily available and with the less we recognizmayrecognize the rankin. The variation of those i think along the lines should be provisional approvals quickly and if you are in a bottleneck where you cant get that, let us know and then do the testing and verification down the road you have to have a place to start and then when we get to the point that we have private manufacturing we need to make sure we are on the same page and we dont have a variation and sensitivity or specificity and we need to make sure that the other countries are doing the same. My concern is with so many of the api being created i look at it from a National Security standpoint or National Health standpoint of just in our countries but others have somebody needs and bill and you have a population of 1. 3 billion people, are they going to service their customers first and i think this is a wakeup call for american manufacturers and pharmaceutical companies not to be dependent on a company. What are your thoughts about that whoever wants to tackle it. Mr. Fritz. Hispanic thank you mr. Ranking member. There is going to be Economic Impacts of the outbreak and continues to develop. We are paying close attention not just to the general macroeconomic impact that are going to occur in the United States economy and others around the world but also to the impact on the supplychain and in particular supply chains that are importe important to the abo react to future instances and future outbreaks. I dont have anything i can share with you right now in terms of what this response will look like but its something we are looking at very carefully. We have people across the interagency process who are actively considering ways they can make sure we are able to make sure they have access to the necessary supply chain. Let me ask about the cooperation do you think it is adequate with the Chinese Government as far as transparency and working sidebyside where do you feel like its just the information we will give you and kind of card it . Let me take a shot on that with regards to personnel and american citizen. Very diplomatically and logistically challenging i would have to say that we where able to achieve a high level of coordination with the authority to make the five plates we got into wuhan. We were able to rely on their counterparts working with us to make sure they succeeded. Hispanic we heard reports they were not letting them out. I do know that they have worked well with other partners but ive heard similar reports about our friends from taiwan being treated differently regards to their evacuation plans. I would say in general they have generally made goodfaith efforts to help with other nationalities. Does anybody have reports about this being in north korea which i would assume it is, do we have any definitive proof . We dont have any confirmed reports. I think with you that im going to yield back and i appreciate everyone here. Im going to gather some more information. Thank you and i know working together as the water we will be prepared with this in the United States and hopefully we can be the ones that help the other countries the most. Thank you. The gentleman from michigan is recognized for five minutes. Thank you, mr. Chairman. On tuesday, nancy at the cdc said we expect we will see communities spread in the United States. Its not a question of if this will happen, but when this will happen and how many people will have severe illnesses. But National Economic director said we have contained this. I wont say its airtight but its pretty close to airtight and also this is all on tuesday. President of trump said the coronavirus in the United States is on her control and a problem that is going to go away. So that was all on the same day. Americans are scared of this situations and they want to know whats being done to keep them safe. And hearing mixed messages like this within a span of hours isnt reassuring. Doctor redfield, how can it be a problem going away and also not a question of if, but when. What should we be telling our constituents about what to expect . Thank you very much and i think its a very important question. Right now at this stage ive continued to say the risk to the American Public is low. We have an aggressive containment strategy that really has worked up to this time, 15 cases in the United States until the case we have in sacramento we havent had a new case in two weeks. We do believe we are going to continue to see new cases and we do believe now there may be the initial occurrence of community acquisition. Some countries this has moved very quickly what we saw in korea where we have more cases than the last 24 hours than in all of china. Weve seen in italy its moving faster, iran is moving fast. But other countries have really used the containment and blended Mitigation Strategy like singapore and hong kong and limited the spread after the initial introduction from china. We are at the point of view that we are still in aggressive containment mode dependent on the early recognition and Contact Tracing that now is going to be looking to identify the User Community reductions in practice publichealth to minimize them. But at the same time, we have done this to give us time and i think what doctor messonnier was trying to say that maybe it could have been done much more articulately promote the American Public heard, what she was trying to say is it is also a good time to prepare if we have to go. We are still committed to get aggressive containment. And i want the American Public to know at this point we are going to start identifying more cases like we did the other day. Im going to ask them to accelerate their own view of the standard dont go to school or work if you are sick and we have launched for the multilayered publichealth response is to know institute broad surveillance weve initiated it and we are planning it hopefully over the next four to eight weeks to actually make the Surveillance System the same nationwide so we can be quickly picking up when there was an introduction and a Community Going to try to stop it. I want to ask you to speak about the dangers of xenophobia in a situation like this. Cnn reported on examples from the sars outbreak when people of asian descent were treated like pariahs there were reports of people covering their faces in the presence of asian coworkers and Real Estate Agents who were told not to serve asian clients. During the 2014 outbreak ive heard reports of incidences like this around the coronavirus. I would like you to talk about why its so important to avoid stereotyping people as carriers and how incidences like these can be avoided and how dangerous for Public Health. I couldnt agree with you more. Ive always said the stigma is the enemy of Public Health in all of its forms. I think we have to proactively get that message out to the American People so that we dont harm the Public Health with stereotypes, dont you agree . I think you make an important point because we have seen those reports into the stigma has no role. Thank you and i yield back. You spoke specifically about the early diagnosis being a part of the positive thats going on. Can you discuss the early symptoms which lead to early diagnosis. Theres a lot we dont know and are learning more each day. That is of concern those of us confronting this. If it was the flu, we understand that theres a lot we dont know. Thewhat we have learned in the t eight weeks is that this virus caused asymptomatic, no symptoms. Over 50 of the individuals that are diagnosed in the process lack symptoms. There is evidence that individuals can transmit the virus also as the chairman knows from the publichealth point of view, that makes this more complicated. The other side can be as manageable as a scratchy throat. A dry cough and you can see that initially we had definitions that were pretty narrow because if all of a sudden everybody with a scratchy throat were a dry cough came, then we had some perplexities. At the severe end it can cause a significant compromise requiring critical care. Overall it does look like 5 of individuals are critical and other countries are starting to show similar but on the other end of the spectrum there could be symptomatic illness, so we are still learning. Its complicated. Obviously in the individual case we talked about with severe pneumonia and otherwise healthy individuals in light of what we now know that it will prompt the community to consider the virus in a differential diagnosis. Whawith a lot of individuals may present with a sore throat and a dry cough. Let me go to the other side of the table. 80 plus thousand cases diagnosed into the number that ive read is 33,000 recovered in Mainland China from having diagnosis. Can you say what has been the chief factor that has led to those that have recovered through it . Theres probably two major factors. Maybe three. One is age and one is comorbidity, so individuals that have diabetes or hypertension or chronic obstruction one disease and happen to be a much higher mortality. But the other issue that needs to be stressed is the effectivenesas theeffectivenesse system. So, in wuhan, the mortality right now is somewhere over 4 . Their Health System is beyond strange. Before this, they had 142 i think isolation and for Infectious Disease. Today they have over 20,000. You can go from 132 to 20,000 coming can build structures, but as the chairman knows, where are the doctors, nurses, the centiliters, the trained Healthcare Professionals . So we see a mortality and we believe it is the integrity of the Health System that is a major factor because if you just go to the rest of china, the mortality is probably about a half of a percentage. So i think the major factors i would say with comorbidity is age and theyre easily into the system that you happen to be in. If you dont have access to oxygen, mortality is going to be higher. This is why we are worried about pakistan, bahrain, all those that have come on her recently and any are going to be able to sustain life in the presence of the compromise. This is something you have a lot more faith in the system then wuhan or any of the other countries you listed off. I think that we are in a strong position we have an Effective Health care system. I think at this stage if we can continue what we are going to find these Community Cases and get our arms around them we can continue to respond. If the numbers get to the point that we cant control, then that is a totally different issue. My time is about to end. You mentioned something thats important to realize that our Health System has a different starting point then that system and many other places and certainly doesnt make us but its a better starting place to be. Thank you for your comments. Thank you. The gentle lady from pennsylvania is recognized for five minutes to question the witness. Thank you. I know its my obligation to ask the complicated questions about policy, but doctor redfield, i would like to start and lead off with the conversations about human beings who are at home and my kids, family members, Community Members to me you are the 18th director of the control prevention administrator that the agencof theagency for toxicd disease registry. In your capacity could you help me answer a few questions i frequently get asked t. At first it can be i dont know the answer im just asking on behalf of my community, should people be afraid . Thank you. Could you turn on your microphone . No. Should people engage in regular handwashing and coughing into this leaves . Absolutely. Should people be stocking up on cleaning supplies . No. Should people be stocking up on Prescription Medications that they have . Not at this time. Should people be stocking up on Food Supplies . Not at this time. Should you wear a mask if you are healthy . No. Is there a website coming and you can answer later if you dont know, where people can go to access information about these questions . The cdc. Gov we have all the information on this website and can take you to the coronavirus and where we are and any preparedness and recommendations. Is there anything else i should have asked that as a regular everyday person kind of question . The one comment i would make, because i do see people feeling the need to go buy masks, i would ask them and some people scoff at me when i say this we need to make sure those masks are available for the doctors and nurses that are going to be taking care of individuals to have this illness. And it really does displease me to find people going out there is no role for these masks in the community. They need to be prioritized for Healthcare Professionals as a part of their job that are taking care of individuals and or individuals that have this virus and are in home quarantine for those family members. I would like to prioritize the usage that we recommend and get people to realize that that is where these masks need to be reserved. I appreciate that and in the last couple of minutes of questioning i think it is for doctor fritz or doctor redfield i will followup on the line of questioning that has to do with prescription and pharmaceutical supply chains and begin saturday of a supplychain. Hhs in particular the fda and other relevant agencies are looking very carefully at this exact question to make sure the answer to that question Going Forward we have access to sustain ourselves from the current outbreak to make sure we are ready for future one. Is there a role the state department can play. Looking very closely at the outbreak on the Global Supply chain with those trade related agencies to map that out but with hhs and others how that impacts our abilities in the time of crisis. I am looking at this to be a bad Lesson Learned to make sure we know where the suppliers are so we dont have this type of exposure again. We are bound and determined to make sure whatever listens Going Forward. With the last half a minute i want to take off on something were happy the Health Care System but can you comment how we need to work with other nations to make sure all Healthcare Systems Work Together quick. Thank you for that question i would like to point out us foreign assistance over a number of years has focused in large part on helping countries around the world build Public Health systems to be resilient in the face of the crisis. That is a test in many instances, we can say would probably be much worse if not for our efforts to share best practices and make Resources Available at that capacity in this aspect and of course we have announced 200 million of assistance for partners around the world to respond to the crisis. I have run out of time. I yield back. Euro recognized for five minutes. I was one of the original founding cochairs of the congressional taiwan caucus now a cochair of that caucus and as we know china considers taiwan a breakaway province in taiwan for all intents and purposes conducts itself as and independent nation not necessarily recognized by the world as such in the people there are free and ought to be a model to other countries around the globe. So they have sought to be recognized with the who for many years. In my view they ought to be essentially fully recognized participant in the who its a gap of the world Health System not to recognize them more fully participate. But at this point china has still blocked them from participating. Would something as serious as the coronavirus and the origins of taiwan being right nextdoor with some of the top medical institutions with the doctors and medical personnel in the world, it seems to make no sense that china continues in this effort. China could be helpful taiwan could be helpful. So what gap does this create in the worlds response to the very serious situation quicks what is the problem with what china is doing relative to taiwan quick. Thank you for the question. As you said taiwan is a robust democracy and a reliable partner in Public Health and other concerns that we share and this outbreak only further underlines the unacceptability of taiwan to be excluded from the who assembly because the peoples republic of china blocks every attempt to do so. As you mentioned not only has the outbreak affected taiwan with 37 cases and to the extent they are unable to get timely information from the who that impacts Public Health on taiwan. But as you point out to have expertise with their own epidemiological track record to the extent it is not shared in a complete and timely fashion with other members that doesnt do anything with the rest of the community which is why the United States continues to push very hard for taiwan to have meaningful participation in the who granted world Health Observer status. Its worth pointing out the peoples republic of china was okay with i want to be the observer when a Different Party was in power. Through 2016 it did have observer status but only when the dpp party came into power 2016 china began blocking across the board taiwan participation we are pushing back very hard against that in our argument is now own the bolstered by this outbreak and that this is fully consistent with our us one china policy and the china relations act. And to be a friend of taiwan. Its a shame not only the people of taiwan and its own people but the rest of the world more at risk but not only observer status but a full member of the World Health Organization. Thank you for the courtesy. Just to follow up on the supplychain what are we doing that there is a sufficient supply to have a coordinating body in a serious way that will have access to the resources that we need. Thats not what i do so the secretary for preparedness response as the inter agency for group going through with the fda and in terms of the medical issues that in the broader issues that is ongoing there is leadership on that but there is the broader intergovernmental working group. You also made use to the cdc can you speak of the relationship and the chinese in particular as it relates to the Healthcare Worker transmission 1700 have been affected by corona violet on virus and if that is protecting Healthcare Workers. The cdc has a 30 year working relationship with china there is a reason they call it china cdc and i have a us cdc component affiliated with the embassy but it is attached to the china cdc the head and i have been in regular discussion since the very beginning when this happened on new years eve with very open scientific discussions about what he knew at the time to use that information and that continues to go directionally. At the beginning there was not a thought of human transmission they saw in the first week they didnt see any or the second week but again they were using a definition of those that were very severe one severely air one severely ill but then there has been extensive hospitalbased transmission one series was published shows that up to 40 percent of the cases were infected because they were Healthcare Workers or they went into a hospital where they were infected after they got there. Healthcare transmission is a high risk in particular in areas that are vigilant in the importance of Infection Control to date we have not had a Healthcare Worker this raises concern because people didnt see the setting. Give us a status on the Vaccine Development status. Nih doctor fauci has the lead on this but i can tell you what he has told us and others they do have a candidate product they are planning to move into phase number one trial in the next six weeks which will evaluate safety and assuming theyve already partnered with the private Sector Company and assuming that goes well they would move to expanded phase two trial. But in reality if everything goes really well and they get the Strategic Partners that they need it is one year or 18 months before we have it. Scientifically we believe it is a virus that should have a successful vaccine based on the coronavirus versus if we were doing this with hiv we would say we dont know that for this virus there is a lot of scientific reason to think it would be successful and the nih is moving aggressively to make that happen. Thank you mr. Chairman i yield back. Thank you to the witnesses for being here i am very concerned about the issue of this virus and across Central Virginia and our district i want to start by saying, thank you for what you said to my colleagues at they should not be afraid. That is incredibly important i appreciate you being here today because this is how we handle this with the outbreak is also determined how we communicate and the temperament on the groundwork i want to speak very briefly about local preparednes preparedness. The coronavirus is expected to put additional strain on Health Care System and Healthcare Providers are already near capacity how is the federal government assuring medical providers have what they need along with resources they need . What else could we be doing . A very important question. My Partnership Agency in hhs has been working and continues to work to see that hospitals begin to get prepared. That is their Central Mission for response and preparedness. We are going to that in great detail with we begin to see that because theres not a lot of packs in the Health System right now if you look at them they could be 95 or 96 or 97 percent capacity. This is why i stress the multilayer responses containmen containment, containment, contat to buy us time with the fruits of the labor of the private sector and doctor fauci that we will have a vaccine in a year and a half but they are working very aggressively to evaluate this to make sure they can build resilience into the system. Following up on containmen containment, in your written testimony you notice the Surveillance System so tell us how we apply existing systems to this virus and Public Health agencies specifically to the coronavirus. This is important. One of the most important components from the cdc perspective in the recently requested supplemental. Me have multiple Surveillance System. Rather than reinvent the wheel but we are adapting our respiratory systems and interfacing coronavirus 19. I am very hopeful in the next eight or 12 weeks we will be in a position with a flu Surveillance System and the National Corona virus system im more interested in this as im hope being is the canary in the mine that i can see when and if we get community at all have to wait to and tell an individual is hospitalized and on a ventilator i have to be honest. We know what we will find when we start this but we are anxious to get this using all the systems we have with respiratory as soon as possible. And that we are looking at in the state. And then with Public Health approach with that isolation contact. Do you have the Financial Resources into the future . That is one of the major components of the supplemental plant fourth to roll this out nationally. Thank you to the witnesses we appreciate your time and presence here today. The gentleman is recognized. Thank you for calling the supporting hearing chairman thank you doctor for your Public Service including us military. The Washington Post headline is a faulty cdc delays monitoring so the first question is does the patch test work. Yes. What is the error rate . We created a test very rapidly based on the sequence of the virus. And it measures three different component. I just need the error rate. One of those had a contaminant and it. The test of the cdc works fine given to the manufacturer. It has been corrected the first task works we test everyone in the country when we scale at the manufacturing scale it was inconclusive that they said we dont use that test and those were quite functional. So current test work is all i need. And south korea has about 70 cases where we only testing people that trifle one travel to china that doesnt make a lot of sense. When the outbreak originally occurred. Im talking about right now. Now there are coronavirus cases and other countries. We are continuing the travel restrictions. But testing people why dont you expand the test . There is people in Northern California basket mending to get the test and the cdc said no because we know the six dens beyond china every continent has this case we should be testing people not just those that travel to china can you commit to expanding the test if they have the symptoms . I mentioned earlier before you were here just so you know, know, we originally had a geographic description now there is not. But we made that change and posted it today. Thank you for making a change. As you said people should not be afraid that the coronavirus makes it hard to control there are two scientific studies that shows each passes the disease on between two or three other people then there is a long incubation. To have the exponential explosion of cases rather quickly. Is that correct. And those who travel to china who dont know could pass on to two more people and then two more people but as of yesterday. The current in the chairmans district is being led by the state we have a large number of contacts that are being isolated to really look at the fullest extent of the potential transmission around that case. There is an article on the daily beast saying the coronavirus may explode in the us overnight just like in italy. That the data contradicts what donald trump says but then i yield back. I can just say i commit the cdc to serve the organization so now i have to be in the science based data driven but service organization. So those who hid the disease in the beginning china tries to exclude taiwan from the who theres a number of things china could be doing. We need chinese cooperation to start Clinical Trials doctor, are we getting it . There is a drug now in Clinical Trials in china and japan and has been extended into the United States and to the repatriated individuals. The similarities to the flu it is often seasonal our president has said it will be gone by april. How confident are we that transmission will be substantially less when the winter is over . It is unknown. There are various treatments used for flu such as theraflu is there any reason to think there is a chance that would be helpful to reduce the effect of the disease . Not for coronavirus 19. And the sars vaccine with that provide any protection . It is unlikely but the methods they were used to develop that vaccine is the reason that doctor fauci has been able to accelerate this Vaccine Development. What is the earliest we could have a vaccine . Doctor fauci said about between one year and 18 months if everything goes well. How well are we cooperating with china today . Are they giving information they need . Are there people on the ground . I pointed out earlier we have good faith cooperation from chinese officials as we tried to get out. We had people on the ground at the epicenter of this epidemic getting information helping doctor redfield do his job. I will defer to the colleague. Are you getting what you nee need . I have regular discussions with my counterpart we do have a us cdc embedded into the china cdc so i do have a team of experts working there at a scientific level we have good dialogue. I would point out secretary pompeo and others have made it clear china allergy to freedom of speech and freedom of expression have been obviously had a negative impact. It was try to keep it under wraps with officials that is why this got going and now we are in a position that could have been avoided if china had a different policy of free expression. Versus hiding things and to keep them under wraps. Why does the administration request for additional funding rely on transferring funds from other disease fighting accounts . Doctor redfield do we need to spend money on ebola . Can we grab that money . Obviously have an ongoing Ebola Outbreak in the congo. Do you think it is wise to take all the money we had appropriated for ebola and not spend any money on ebola . I cannot comment on the budgetary decisions that were made. Are you doing useful work that may save lives with regard to ebola . If we leave the money in the budget will you spend it effectively . We have a current ongoing Ebola Outbreak with a number of cdc people deployed and if you will knock on wood we are finally close to winning. We are down really in the last week we had no single case. We now project based on the models we could and the outbreak by the end of june. But when instability happens we can be right back where we were two months ago. If this Ebola Outbreaks in eastern congo would that be a threat to the United States just as the chinese epicenter problem has been a threat to the United States . We have been fortunate with ebola there is very Little Movement from the eastern congo where this outbreak is but obviously we had to invest significantly as we have been in this outbreak now for almost over a year. If we dont fight ebola and africa does that mean americans are safe everything is fine and you assured me we could just not worry about ebola and we wont have a problem this year or next year . One of the most important things our nation can do is have our own Global Health security capacity to respond to these outbreaks and this is exactly what were doing with ebola the more we can expand that capacity i believe it is a coalition of the cdc to identify these threats and obviously we appreciate your continued support in that regard because what we seem at the coronavirus is another example why its so important to have global leadership. The outbreak of the coronavirus demonstrates the importance of your work and the folly to pull the plug on some of your work because of the unwillingness to fund the additional work we need to do for the coronavirus. I yield back. I would like to ask a couple questions. I appreciate your coming down but i appreciate you coming down. I hear your concerns we will continue an ongoing conversation about flexibility. I have been honest in my concerns with the administration announcing travel restrictions for individuals coming from china and i understand the rationale and have concerns if it will do with what it hope when we hope it does. But Going Forward, are we considering similar measures against other nations and if we are under what circumstances . As the cdc and issues what objective criteria are we using to make these determinations . Thank you for your question. With regard to further proclamations this is the prerogative of the white house they are gathering information from all available sources of further restrictions might be necessary to help contain the virus. As doctor redfield has noted we are still in the containment phase whether cdc or other authorities will recommend that is beyond my scope. With regard to travel advisorie advisories, this is something we revisit constantly looking at a variety of different issues health is one crime is another risk of terrorism is another or a natural disaster. Looking at information from a variety of sources the un provide some information on Health Issues the bureau with regard to the crime and terrorism risk and these sources the five likeminded countries we gather this information with a factbased matrix to decide if we will rank a country i hope that answers your question. The purpose of the cdc levels is for Public Health purposes only and we have three levels the first is just the alert to let the American Public know there is an ongoing Infectious Disease issue. Right now the alert for taiwan and vietnam. Once we see there is significant human to human transmission, we go to level one and that is hong kong. With the multiple clusters then we go to level two and that tells people particularly if you are older or any morbidity you should reconsider travel right now that is japan. This changes every day. Level three we tell people this is broad communitybased transmission to tell the public we recommend they dont travel. Based on the data that they see what is happening in the country at the time with human to human transmission. Right now in korea we have a very broad transmission throughout the country. But you should anticipate this will continue to change going up or down. Would not be surprised if we dont have changes in the next 24 or 48 hours. I know you are on a tight timeline we appreciate you being here if you have to leave the panel. Doctor walters i appreciate you coming down here and making yourself available. Thinking through the evacuation there were reports that positive testing patients and maybe those results were not communicated but some of those negative testing patients how that might have happened or how we avoid that in the future. Thank you for the question. The timeline matters. The decision to evacuate citizens from the diamond princess not because there was an outbreak of t10 but there was evidence of persontoperson transmission that was not Getting Better but worse and despite the best efforts of the government of japan. Once the decision was made it was safer to move these american citizens that were at greatest risk, we followed protocol this is the sixth flight we have done in two weeks. Each of those individuals the 329 we took off the ship were evaluated from the state department or hhs within the 24 hour period. The embassy in tokyo reached out that all that results be reported by 4 30 p. M. That afternoon. Evaluations were done the evacuees were handed to the care of the United States government disembarked and loaded onto buses this was to be one Single Movement from the ship to the airport. Only once and the minutes after midnight that the official from the government of japan approached Embassy Personnel with a list they had 16 names 14 were manifested in 15 different buses already and movement and the movement to the airport there was discussion thats only a 40 or 45 Minute Movement once they arrived at the airport 14 were identified in a way that was sufficient but protected privacy none of these individuals were not coughing or sneezing and did not have fevers of nobody were confirmed. They were removed from the bus. Morning is breaking at the airport. Rating. 161 6380 yearold american citizens hauled off buses put it into isolation area on the aircraft. The way the aircraft is set up airflow moves from the nose to the tail so the most at risk area is at the tail so they were partitioned off to protect other passengers from any contagion then the robust interagency discussion. At the end of the day we reached a consensus between our partners that we rely on from hhs state department and others that they were placed in the care of the Us Government and with that to receive the best care available. We heard over in china that we talk to the ambassador from cambodia said wide stellar response state department did working 24 7 and six different locations what kind of protections do we have for the personnel . Do you feel adequate. Thank you for the comments in the question. This is the International Emergency but in 220 locations we have a workforce of 75000 people some of whom are in countries of active cases we learned our lessons in 2004 and we are thankful for congress for the preparedness this is that every embassy in Healthcare Workers is almost 700 they are well educated and well prepared we continue to look at the resources and authorities not just the chief admission personnel but to protect americans. You feel confident if they would come down to get the supplies needed if thats an area thats more remote they dont have Good Health Care to get in sufficient numbers . There are two parts. First the contract that made these evacuations possible the critical of supplies possible the second part is a greater risk looking at the way of medical evacuation it comes back to the United States the Medevac Center established in the uk now they make that in a way you can understand to bring those citizens in. So working with the International Partners so that the teams have a place to work and still medevac the people home when the time comes. There is a cloud of a lack of transparency we keep getting from china if we see the real extent of damage the National Peoples congress thats a pretty strong signal to show that they are really that concerned about it as they should be but the people over there not getting that reliable information you are working more on a scientific platform do you feel comfortable with the information you are getting. Iam very comfortable with the american cdc in china so that the scientific level i really cant comment beyond that. It is worth noting with the most aggressive mitigation strategies we have ever seen. I would like to say that a reduced number of cases in chin china. Even then 434 people they have a major problem despite everything they have done. I dont expect an answer but as a veterinarian we have seen the syndrome broke out several years ago within one year it was in america we lost 300,000 fouls swine fever broke out 2018 we have not seen that here that can be transmitted it can resist heat and shipping from china to the United States in containers and through usda that will look at these things better than we ever have before thats port of entry and containers. The only comment i would make we are aggressively evaluating how long they can survive and be infectious. With copper and steel it is pretty typical it is about two hours. But other surfaces like cardboard or plastic, it is longer. We dont know i dont think it will affect cargo like what you have talked about but it may have contributed to the huge outbreak we saw on the diamond process diamond princess. So we are aggressively evaluating that to understand how it is in different conditions. Since we have been in the searing there is a breaking story with a Washington Post that is senior hhs official at the administration for children and families has a whistleblower report that they were sent to the airplane hanger to me evacuated americans at the air force base in riverside and were not given any protective equipment while interacting directly with those who are potentially impacted i raise this because the work we are doing today but it speaks to a general concern that there is a question related if the state Department Officers have what they need to stay safe and i would pose that question but i also want to make the point this is deeply concerning because as we are dealing with the second outbreak causing great fear in our communities with individuals we need to ensure our constituents have faith the government is doing Everything Possible there is already some concerns if that is the case and how people can keep themselves safe if they find out the Us Government might have put its own personnel in harms way is deeply concerning to me. Can you comment if your agencies are insuring their personnel are safe and how can we trust the government to keep us safe i would love your comments on tha that. Thank you for the question and concern. Ive been on those missions and certainly the first trip and then on diamond princess and the relationship i have had with hhs dating back to 2014 every precaution has been taken. So you did not witness any individuals who were not wearing ppe . Know unequivocally everybody in the evacuation was appropriately equipped and trained. But i have reading breaking news of the Washington Post but that is good to hear and specifically was state department officials. They take every precaution to do this safely. Do you care to comment . My colleagues in china and japan and elsewhere are working on the ongoing basis so in japan there are 100 plus us patients from diamond princess and are hospitalized we are regularly engaging in that same fashion taking professional advice some of these taking place in person was cumbersome because they had to suit up now it is telephonically i can give the chairman a copy that shows my colleagues standing as they were processing people coming off the diamond princess to be properly taken care of. I can see that photo from here. And the general concern with a report that is breaking news the veracity will be german be determined later but it is in the news people are reading this are there comments you would like to make related to ensuring the constituents have faith that we are handling this virus in the way it should be handled in light of what could be concerning news . The psychology is often worse than the pathology. We have the best medical care in the world whether ebola or corona virus the American Healthcare system is ready to receive and take care of Healthcare Workers and the state departments perspective we have a workforce on the front line. We are happy to be there to facilitate the relationships that are critical to contain this overseas with the exchange of technical information. What i tell my family you live in the best country in the world. And people who know how to do this are in positions to advise state and local and Healthcare Workers. Thank you for the indulgence of the second question mr. Chairman thank you for the work you are putting in on this. I truly appreciate it. I healed back. We recognize the gentle man from california. What is your best estimate as to the mortality rate among those who are healthy and under age 65 . The most important scenario if youre how the system is functional or not as we saw with the wuhan Health System Healthy Human and under age 65 . Again, we dont have the data but i suspect if you look at the mortality rate outside of china right now we are looking about half a percent. But we have to see more data to be clear on that. Seasonal flu has. One per thousand zero. 1 percent im sorry. The chinese are telling us there is a decline. Should we believe them . I think there probably is a decline. And the mitigation strategies are having impact in the wuhan area. I want to ask about masks i went on to amazon 50 masks is 50 bucks. They are not very heavy less than 1 pound and amazon wants to charge additional 400 for shipping and handling we will be in touch with amazon on this but i dont think they have ever charge 400 to ship a box and not even on a rush basis. Two weeks from now less than a pound 400 shipping and handling seems extraordinary but giving his need for food and necessities of life i can understand. We see pictures small over the world people wearing these masks who should wear the masks in the United States . As i mentioned earlier the mask really needs to be reserved for Healthcare Providers that are taking care of these patients as well is confirmed individuals that are in isolation to minimize the threat for inhome isolation. We would not recommend the American Public go out and get these masks. To protect the person wearing it to protect others from who is wearing it quick. The issue is to protect the individual who is exposed to someone who has the pathogen. We believe that is where the mask should be a lot of these people will not have a functional impact whatsoever the surgical mask you see people wearing in the city you people are Wearing Masks people may have a cold or an illness i would tell them to stay home that would be more effective that the cdc has good guidance and encourage people to look at it. The chinese have dealt with extraordinary lockdowns of entire areas. Should we be locking down in the neighborhood if we find someone cracks what type of lockdowns do we need, if any . The backbone of our response the important part of the multilayer response even though people dont recognize it because its not travel restrictions. The backbone is the american medical community. Of our 15 cases we diagnosed , 14 from the Public Health so i maintain confidence on early diagnosis as a major mechanism. To test is it sufficient just to take temperatures . Or is it contagious before it is symptomatic and should there be a blood test . The issue of how infectious is the symptomatology is still unknown but you can transmit before symptoms does that contribute meaningfully . We dont know thats what we are trying to learn. Clearly the cdc is working on another test which the chairman would understand trying to develop the extent in china right now what they are doing is administering the active virus and thats what were doing but that doesnt tell us the denominator of whos been infected we are currently working. The chairman understands what you are saying you want to test to see which people have been exposed and have the antibodies that dont know they have the disease. I yelled back. I just want to recognize thank you for the service to our country it is a fluid situation i want to make reference to the breaking story that was identified. And fully confident we can do everything to protect our personnel workers as we evacuated folks from china to put them on airplanes and bring our citizens back home. That i am commenting one fact its important for folks that see things to identify them and not fear retribution for coming forward. That is the way this process works. Doctor redfield, i appreciate you coming up and keeping us informed. We look forward to working closely with the cdc and from one doctor to another we work through the regulatory process and the availability of diagnostic tests throughout the country. We look forward to speeding up the process to make sure we get these tests help and are able to do it and appreciate updating the folks that we are testing and trusting the doctors on the front line but respec expect coronavirus being able to get back. Weve been working closely with the fda they are operating within the Regulatory Framework and i think the point that we want to make is the loss of Laboratory Development tests. Thank you and all three of you as well as your colleagues and Homeland Security for regularly coming up to brief members of congress and again to maintain close contact and dialogue and with that, the hearing is adjourned. 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