Transcripts For CSPAN2 Federal Health Officials Testify On Coronavirus Response 20240713

Good morning. The committee on Health Education will come to order. I have one goal today and that is Accurate Information. Accurate information that can help americans understand what they can do and decide what else around the worl world is at f the multiple coronavirus is alarming. 90,000 cases and 65 countries, 3,000 deaths according to the World Health Organization and most people in the United States are at a low risk. Heres what the New York Times said on its front page todays ago on sunday in describing the situation in our country. Quote, much about the coronavirus remains unclear. Its far from certain that the outbreak will reach a severe see proportions in the United States or affect many regions that ones. With its topnotch scientists, modern hospitals and Public Health infrastructure, most experts agree the United States is among the countrys best prepared to prevent or manage such an epidemic. Thats from the front page of the New York Times two days ago describing where we are in our country. Today in our country while there are 90,000 cases around the world there is about 100,000 in the United States may be a few more in about half of those contracted the disease overseas have been brought back here to be quarantined and monitor. Thereve been six deaths in the United States. In addition to the human suffering the virus is causing disrupted the Global Economy according to the trade representative more than 20 of everything we import, not magazines, car parts, factories and walked down 16 cities where 760 Million People live. Think about that for a moment 760 million is more than twice as many as live in the United States and that theyve been locked down in china as china tries to grapple with this. In the short term this could disrupt the ability to buy and transport goods and materials in the longterm production of these materials could shift into direct implications on the jobs crisis. So the first goal of the hearing is to provide the American People with Accurate Information. Todays witnesses are respected professionals who have a lot of experience in what we are talking about today and who know what they are doing. I want to take a moment to emphasize their backgrounds. After Anne Schuchat spent 30 years at the center for Disease Control and prevention. She is the Principal Deputy director. Her work has been with these kind of epidemics through democratic and republican president s an in health emergens including the 2001 anthrax attacks, the 2003 sars outbreak and flin a flu pandemic. Doctor anthony fauci. Doctor fauci felt his position as the chief of Infectious Diseases at the National Institutes of health. Since president reagans time. So he worked for president reagan coming h. W. Bush, bush, obama and now trump. He led the response to hiv aids in the 80s and 90s and the west nile virus 99, sars in 2003, outbreaks in africa in 2014 and 2018. For his professionals, this is not their first radio. Third, 14 years ago and led by senator burr of this committee, congress created the position of assistant secretary for preparedness and response at the department of health and Human Services. Doctor Robert Kadlec helped draft the bill in holds the position. That was reauthorized by senator casey and senator burr. Not long ago, doctor kadlec had previously worked assisting the fbi and the United States air force and biological threats and finally, doctor stephen hahn is the newest to the federal government of these respected professionals. Hes had plenty of experience before becoming commissioner of the United States food and Drug Administration. The fda most recently chief executive of the university of texas, the Cancer Center of a Large Organization with 21,000 employees. So the reason i go through that is because if we are looking for Accurate Information, they support ought to be able to provide it. In addition to getting Accurate Information for the American People, they want to know what else we should be doing to limit the damage of the coronavirus to the American People and the american economy. Before we talk about what else needs to be done, i want to briefly summarize what we have already done. Lets start with congress. Its not the first Public Health threat we face. There are some senators and Staff Members who were here 20 years ago when the anthrax attack occurred. 2003, sars. Another coronavirus similar to the one we are seeking today. The 2009 2009 flu pandemic kiln estimated 151 to 575,000 people worldwide. Then there was the ebola outbreak. So following the anthrax attack in the bush administration, congress created project bio shield to develop and stockpile treatments and vaccines in after the sars attack in 2006, also in the bush administration, Congress Passed the pandemic and all hazards prepared this act. That guides the federal government and how it prepares for the response to Public Health emergencies. It gave the department of health and Human Services the authority fofor example they prioritized funding for the development of vaccines and treatments for Infectious Diseases and improve the Public Health Emergency Fund. As i said earlier the senator asked the most recent update of the law led by senator burr and senator casey. Senator blunt and senator murray and thin the work of the Appropriations Committee funded programs. We all know president s and their budgets into this includes all the president s that i know about, sometimes under fund these programs. Last Year Congress provided more than 4. 5 billion for Public Health preparedness programs. When a crisis occurs, we often need of money quickly. Thats why congress has created two funds, Public Health Emergency Fund and the Infectious Disease Rapid Response fund. For example, secretary azar already used some from the Rapid Response fund and using the Authority Congress has given him, hes transferring from other programs in his department to respond to the coronavirus. The trumpet administration has s requested an additional 2. 5 billion. Others in congress have made suggestions and we are likely to vote on it in the senate this week. In addition to what congress has done to get ready for pandemics like this, both democratic and republican president s over the last 20 years have used their executive authority during Public Health emergencies. President obama during the ebola outbreak. President bush said the cdc experts to investigate the epidemic. President trump similarly pointed a task force lynching tg with a 29. Keep the Vice President in charge. He moved ambassador from the state department to the years of experience in dealing with Infectious Diseases to be a Principal Deputy leading that effort. On january 302001, at the time when there were only six cases confirmed to the United States from the administration for the first time would quarantine americans exposed the virus while in china and impose travel restrictions on the foreign nationals to travel in the last 14 days. At the same time the state department warned americans not to travel to china and the cbc demands americans reconsider cruisers in asia. A couple days ago the state department added italy and south korea to the countries that americans should reconsider traveling in. Under the authority of the immigration and nationality act, the administration sent foreign nationalists have traveled to china in the last 14 days cant enter the United States. On saturday the president updated this to include travelers from iran. Doctor fauci said if we hadnt taken these steps, we would have had many more cases right now. A third example of executive action is developing the tested diagnosis of the coronavirus. The fda authorized on february 4 and its been made available to 46 laps and 38 states in the washington, d. C. They are working with 65 other privatesector developers including Academic Medical Centers and commercial labs to increase the availability of tests. For the doctor fauci said we are developing a vaccine for papillomavirus more rapidly than weve ever developed any other vaccine and drug benefit jurors met with the president yesterday to see if treatments and vaccines could be made available more rapidly. Scientists and laboratories are using super computing and imaging to try to understand the virus that are. In addition the impact on us and our individual lives theres the impact on the Global Economy. Trade representatives say about 20 of the imports comes from china as people get sick and cant go to work that slows down what is sent as an impact across the board. 13 of active ingredients for drugs are in china according to the fda. Some people said 80 of the ingredients for drugs are produced in china. We should evaluate that figure carefully. It appears to be based on a 1998 report that may not have a source that i discussed with the number of senators how we can inquire into whether we should explore that depended we now have on other countries not just china for medicine and health supplies. Most businesses in the United States that need supplies have more than one source for what they do and perhaps we need to take another look at that. Its not just medicines that are affected. In tennessee for reminding touring plans ceos said that phase one china deal caused workers to go up in the company but the virus caused them to go down and that has an effect on jobs in tennessee just as it does in other places todays hearing is an opportunity to listen to respected professionals who have decades of experience and are the right people to give the American People and members of congress Accurate Information about the coronavirus both with individuals can do and what else the federal government needs to do to respond. We will finish at noon so that doctor Anne Schuchat and doctor fauci can join the Vice President in briefing senators that the respective launches. Senator murray. Thank you mr. Chairman and to all of the witnesses today. I want to say at the top im grateful to all the women and men out there that are working to keep the country safe and i hope you pass this on to all of your team. Mr. Chairman and this is a frightening time. Six people in my home state have already died from the virus and im told we should expect more. We expect the number of infections continue to grow and people across my state and im sure across the nation are really scared. I am hearing from people who are sick and who want to gets tested are not being told where to go and even when people do get tested the results are taking way longer to get back to them. The administration had months to prepare for this and its unacceptable people in my state and nationwide cant even get an answer as to whether or not they are infected. To put it simply if someone in the white house or the administration is responding to the coronavirus it would be news to anybody in my state and ive been on the phone with all of our local officials for days n now. We are seeing the Community Transmissions of the virus. Families deserve to know when testing will be ready to scale up what they do families should be doing, and most importantly what they are doing. I have to say that while i am profoundly grateful for the work that Public Health officials are doing, im very frustrated at the steps the president has taken from repeatedly contradicting expert advice to downplay the seriousness of this threat and appoint a politician to lead the response so im glad today that they have the opportunity to hear today directly from the experts and get answers to the questions that i am hearing at home. I know people want answers and one of those days when are we going to scale the testing now that we are beginning to see the Community Transition in the United States. Its only after a long frustrating delay that we are finally able to Start Testing patients for this disease as the state labs across the country and the last few days seem to confirm the experts have been warning. There is a lot we are still learning there are a few things that are abundantly clear about how we need to respond. First of all we do need to be listening to the experts and making sure fact and science drive the response. They need to be able to trust the information they are hearing from experts in the federal government and is a political ideology and the policies being put in place are based on evidence about how to keep our families safe. I was heartened to hear your assurances, doctor fauci, but contrary to reporting you havent been muzzled by the administration. Its essential that continue to be the case. We cant have an Effective Response without active information and transparency from the administration and i will continue to be very focused on this. Second, weve got to provide adequate resources to meet the needs of our federal, state and local officials because we know resources that come through the cdc Public Health Emergency Preparedness programs are absolutely critical but also were never envisioned to be sufficient to respond to a threat like this so we have a lot more to do. Congress is working on a bipartisan supplemental agreement that will reimburse our state and local Public Health officials are costs theyve already incurred, combating the coronavirus and Additional Resources to the communities and it will guarantee resources are available. It will support vaccines and therapeutics to treat this virus and to keep us prepared to respond to future emergencies. I want to recognize all the democrats who came together to work quickly on this package and they urge the senate to pass it quickly. Im glad we are working on that agreement that goes to lunch with president trumps request was for 1. 25 in new funding and i again urge the senate to take this up as soon as they get it passed to the local communities dealing with this. I also encouraged by the committees strong bipartisan record in responding to Public Health emergencies as well. Just last year the committee strengthened and reauthorized federal efforts and resources we have seen employed today so i especially want to thank you mr. Chairman for the Work Together senatorworkedtogether d further efforts will not weve got to be sure we are not just responding to the latest developments by staying at of this crisis, by planning ahead because this is not likely going to end anytime soon. They are already seeing some of the challenges that will come next like the strain this will put on the Healthcare System. We are seeing that in Washington State. We need to make sure hospitals have the capacity to address this without overwhelming the ability to provide other care people need. We need to made sure the Health Care Workers caring for coronavirus patients are safe from infections themselves including by making sure we have a sufficient supply of protective equipment. We need to manage the drug and medical device supply especially considering we expect demand for some supplies and are already seeing that to skyrocket. They also need to give adequate attention to the public Health Education in the age where disinformation has been organized and rumors are getting traction as we all know faster than ever we cant let conspiracies panicked whisper discrimination or spread dangerous misinformation or undermine our Public Health experts. We need to actively take steps to prevent and respond to bullying and harassment that is motivated by stereotypes and fear and also account for the ways that some of the policies have undermined our ability to respond to Public Health threats. Our uninsured rate is going up again for the first time in years. The plants that are not required to cover diagnostic tests or vaccines are expanding and those actions make it harder for people to get the care they need to keep this crisis under control so we have to make sure everyone who needs it has access to diagnostic testing Going Forward and while that is still likely over a year away we need to make sure the cost is not a barrier for that as well but its not just the Health Care System we need to be considering as we work to stay ahead of this disease. Communities and families right now are facing difficult decisions. What measures should the schools take keep students safe and what can parents do, when should schools close, employers and workers in a state and others are facing similar questions about whether employees should go to work or whether they should. I will be pressing of the department is working to prepare for these issues and i printed secretary scalia about this as well. And if as it is often the case this publichealth threat will have hidden in higher cost for those who are lowwage workers who dont have affordable childcare, who dont have Health Insurance and who are experiencing homelessness. In my state people are being told to stay home for two weeks if they are sick. There are enough tests so they cant get tested. If you dont have childcare and if you are a lowwage worker or dont have sick leave. When basic needs are not met, they cannot make choices to protect themselves which means they cant make choices that best protect others because one person getting sick has repercussions for all of those around them. Situations like this remind us we are all a community in a very real sense. We all have a say i stake debate state in one anothers wellbeing. I want to be clear this isnt just about changes in the stock market. We need to develop plans and that is something i plan to raise today and will keep raising. I look forward to hearing from all of our witnesses about how we can best prepare the communities and i will continue to work with all of you and Health Officials to keep families in my state and across the country informed about what they should be doing. I will keep pushing to make sure as the situation continues to develop, we keep listening to the experts providing Health Officials the resources they need and planning for the longterm. Thank you, mr. Chairman. Thank you senator murray and thank you for your cooperation which is technical o typical oft they work and dealing with this issue. We have hosted for briefings for senators. Several briefings for staff and the suggestion we have one of the briefings in a classified setting so senators can be sure that there are not any secrets and nothing came up in the meeting we were quite able to say in public and i agree that we should listen to our professional respect of experts today. Each will have five minutes to give his or her testimony. I gave each of them a pretty good introduction earlier, so i will shorten it except to say doctor Anne Schuchat is the Principal Deputy director for the center of Disease Control and prevention and she has had a variety of roles dealing with responses to sars, anthrax, pandemic influenza over the last 30 years. Doctor fauci is the top person at th the National Institute of health and Infectious Diseases. He served this position since 1984 and worked with six president s and led the institutes efforts on hiv aids influenza, malaria, ebola and other Infectious Diseases. Doctor Robert Kadlec is the assistant for preparedness response of the department of health and Human Services. As i mentioned earlier, he spent time as a career officer and a physician and air force special assistant to president george w. Bush working with senator burr they helped write the legislation that makes our country better prepared for pandemics and finally, doctor stephen hahn who is the commissioner of the u. S. Food and Drug Administration formerly the chief executive of the university of texas Cancer Center. All of you are not getting much sleep these days. We thank you for your willingness to serve the American People in the way you do and we look forward to your testimony. Thank you so much, chairman alexander, Ranking Member murray and members of the committee. Cbcs role in this whole of government pull of Society Response is built on decades of the Infectious Disease experience and pandemic influenza and other Emergency Preparedness planning. Our response is dependent on support for the core publichealth capabilities and a network of dedicated frontline publichealth workers at the state and local level living in your communities. Two months into this response to a novel virus, the cdc has learned a lot. Weve acted nimbly in the United States and around the world, but they do so with humility about the work ahead. There are many things each of us can do as individuals, businesses, communities and organizations and we are thrilled to see the website thae posted the highend of the senators. Cdc is responding with the following strategy. The goal has been to slow the spread of the virus through a multilayered aggressive containment and as needed, mitigation effort. We are using evidencebased publipublichealth interventiont have included early case recognition and weve issued travel advisories and adult with targeted travel restrictions as well as the use of quarantine for individuals returning from funneling of flights from Hubei Province to 11 airports. We worked with cbp to get the data to ensure that appropriate followup could happen through the state and local Public Health departments and weve supported the quarantine of repatriated americans from Hubei Province and that the princess diamond cruise ship. We worked with ministries of health around the world underscoring the leadership and global Public Health and the power of the investments in International Influenza surveillance and Global Health security. More than 1500 staff at the centers of Disease Control and prevention has been responding to this outbreak. The situation today is evolving and dynamic. In just two months this outbreak has grown from a cluster in one city to affecting over 70 countries and territories around the world with more than 90,000 cases and about 3,000 deaths. We are now in the United States seeing in addition to the small number of travel associated cases or close contact we are seeing Community Transmission in a few areas and tragic outbreak of the healthcare facility longterm care facility in Washington State. Our hearts go out to the people affected by the virus directly or indirectly and everyone working so hard to counter it. There are steps each of us can take. I want to recognize people are concerned about this. As always our number one priority is to health and safety of the American People and we appreciate that americans are taking the threat seriously and continuing to seek information about how they can prepare. While the immediate risk to the general American Public remains low and the u. S. Government is doing everything we can to keep it low, risk varies by exposure in somand some areas are now experiencing community thread. Where it spread they are intensely investigating and assessing potential community interventions. Cdc has staff on the ground in washington, california and elsewhere to provide technical assistance. Our role in this type of Community Measure is to develop principles and tools based on the updated pandemic playbook and based on what weve learned from other areas that have been experiencing the outbreak including singapore where theyve done a good job of managing it. The key planning principle is to protect the most vulnerable. To help us with the mission to provide clear information to you and your constituents by urging people to get the fact from cdc. Gov which you can see up there and i want to say i look forward to answering your questions. Thank you. Doctor fauci, welcome. Thank you mr. Chairman, members of the committee i appreciate the opportunity to spend a few minutes talking to you about one of the aspects of the government response to this emerging outbreak and that is in the realm of what we call intervention both with regards to therapy, namely treatment of a person whos already infected and the other is in the area of vaccine prevention of infection and those that are not infected. And its important to point out that the timelines for each of these are fundamentally different and id like to take a moment to kind of explain why when you talk about in the American Public and the Global Public understandably they want to know how quickly we can get interventions to them. So lets start off first with therapy. As we know from the data that has come out of predominantly from china, if you look at the amount of people infected and the number that have occurred, about 80 of individuals who get infected do quite well without any specific intervention. Namely they spontaneously recover. However, about 15 of the 20 of individuals usually those who are elderly and atrisk groups wind up getting serious disease requiring supportive care. That could be oxygen, intensive care, education for even more dramatic interventions. So we want to have a therapy for these individuals. There are a number of candidates to appease that literally as i speak to you today are being tested and randomized control trials one of these was developed by the Gilead Company we should know within a period of a few months, several months whether or not. If it does the implementation of that would be almost immediate. Now i cant guarantee that well work or other drugs which were iare inthe pipeline a little bid them. But ththe timetable for treatmes different than the timetable for the vaccine. I want a clear opinion on to become his understandings out there. The technologies have allowed us to go from the time to the sequence of the virus put in the public database to the time they actually stick a candidate into the arm of someone has gone down probably the fastest. We are likely going to Clinical Trials in a phase one study within about two months or maybe even six weeks. That will be a record however it doesnt vaccine because it would take about three months or more to show that it is safe and then if you show that its safe youve got to put it into the trial to show that it works and the reason is there is a medical, ethical and other considerations that we would be getting this. We need to make sure that it works. That entire process will take at least a year or a year and a half so when we hear the talk about the vaccine ready in a couple of months, it wont be ready from being deployed. Its going to take a while so we will have a multistep process. We have the Public Health measures youll hear from doctor stephen hahn and doctor kadlec, but the issue is in addition to those measures the interventions are going to be critical so we hope that we will be able to get good news to you and we will be able to say in the next number of months we have candidates and the only way to know that would be to do the kind of clinical testing that im talking about so hopefully we will have the opportunity to update you on a regular basis about where we are with the. Thank you, doctor fauci. Doctor kadlec, welcome. Distinguished members of the committee, i appreciate the opportunity to testify before you today on how they are supporting the hhs whole of government response to the coronavirus situation. I think you heard very well in terms of the evolving rapidly evolving domestic situation and this morning we will take a couple minutes to give you an idea how we are trying to address the problem from a point of strategic anticipation incident management direct support to the states and other entities and supporting the Health Care System of the United States and also the counter development. In the countermeasure we are working very closely with doctor fauci and dod colleagues to see what kind of therapeutics and specifically diagnostics we can rapidly bring to bear to the problem and see how quickly we can fill additional capabilities with commercial activities. Specifically we are looking at areas that would allow us to do the point of care diagnostics which i think senator murray has talked about and we have very promising candidate that will take several months to bring online. Doctor fauci has talked and we are working with a company on antibodies and looking at two potential vaccine candidates one that was a product of the investments congress made independent methods when the end of the vaccine that is licensed by the fda and another one that is a product developed for the crisis. So those are very important and active activities and second we are looking at how we support americas Healthcare Systems through the Hospital Preparedness Program working in coordination with the Public Health program the cdc administers weve been looking at how we can work better to improve collaboration and coordination among hospitals and the Public Health sector and other entities like the medical services. I want to highlight one area that again congresbutagain congl in developing during the crisis which is a reTreatment Network has proven to be viable only for the repatriation of americans taken from wuhan but also the diamond princess. That capacity and capability in education and training is vital in how we manage it at the locations of those military bases that house the number of people through the regional Treatment Network and that was vital in terms of how we could do that. The other issue is around how are we doing in incident management. Since it started weve been working to actually put in place and activated as of yesterday and Incident Management Network that is based on the National Response framework how can we bring the whole of government to respond. This is the first time weve done this under exercises but its the means by which we can leverage all of the support functions that may be necessary by state to employ responders to assist them in dealing with the crisis into the last area but i will highlight is around the state and other entities. I mentioned at the repatriation efforts at 1100 americans brought back under very difficult circumstances from wuhan at the diamond princess. The first that was ever done that weve been working two years in advance and with our japanese colleagues to prepare for such an event and we are supposed to have an exercise in march of this year to employ this as a test case that we got to do it for the real thing so more importantly we are focused on how to provide direct state aid so with the state of washington we used a strategic stockpile for personal protective equipment to protect healthcare workers, to highlight what doctor Anne Schuchat said, its how we work proactively with longterm care facilities and older care areas where we know the most vulnerable populations reside in how we shield them from the potential virus and we are looking to employ some of the personnel as well as other to assist the longterm Treatment Facilities that we are doing all these things together as a team to respond to this. With that i will pause and yield back the rest of my time. Thank you chairman alexander, Ranking Member mary and other members i appreciate the opportunity to speak today about the efforts. Our hearts go out to those that have been affected by the coronavirus and those that have lost their lives. Thats why weve deployed thousands of men and women to address this and to a loo look e aspects of diagnostics in the supplychain. In the supplychain impact expediting the availability of certain Laboratory Developed tests. Please remember some of this information i can share now does change quickly and its my hope this information will help the members of the committee as well as the American People have their visibility into the emerging situation. Regarding the drug supply, weve been and continue to be proactive in contacting manufacturers. Not only to remind them of the applicable reporting reporting t also to ask them to assess their entire supply chain. As you might expect, theyve been forthcoming in the discussions. Since january 24, the fda has been in touch with more than 180 manufacturers of human drugs to assess whether they face any drug shortages due to the outbreak. As a result of this outreach last week one manufacturer reported it immediately disclosed to the American Public through the drug shortage list. The good news is we are working closely with the manufacturer and expect that the result in a very short period of time. The other good news is there are alternatives to the providers. I know that there is interest in additionaadditional detail surrg the spy cant provide the name because i its confidential, commercial information. I think this also highlights what we have put in the budget. We do not have the authority to actually require the devices to tell us about the shortages as have the information that we need. Please be assured of other potential shortages are identified by the fda we would be very transparent about this and we would share that information with you. India has restricted the export of 26 active pharmaceutical agreements for experts which represents about 10 . Look at the list and how that will affect the medical supply. Weve been in touch with 63 manufacturers of essential medical devices. Weve been aware of no shortages of the devices also we understand on the demand side on personal protective equipment that there is significant pressure and demand particularly domestically but they are working closely with the manufacturers and what we have found is that some of the manufacturers in china reported a disruption in the workforce as you might expect particularly in wuhan province. To mitigate any shortage of anything respirators and other protective agreement for healthcare as you know he issued an emergency use authorization to allow the use of the approved disposable filtering respirators so masks basically to allow flexibility for healthcare workers and to increase the supply with an a nation. We have a lot of information we are communicating to hospitals and healthcare workers that should increase the capacity for the Health Care System. Regarding diagnostic tests on february 4 as was mentioned, the fda issued Immediate Use of a diagnostic tests developed by cdc and facilitating the ability for the test to be used in the classified Public Health labs. February 29 we also issued to authorize testing for the conv19 have to labs in new york and since that time, additional labs on the west coast, washington and california notified that theyve begun testing using this approach. Weve had contact with both private and Academic Centers with respect to the development of the test and as i mentioned yesterday in cooperation with cdc and the significant expansion in the ability to perform to test we have one working closely with the cdc to expand over this upcoming week and we expect that to be available and by the end of the week that will continue. Thanks for the opportunity to update the committee on the agencys response to the crisis and i look forward to answering questions. We are going to continue the hearing until 12 30 in hopes every senator will have the chance to ask questions. I know that the witnesses have been asked to go to senators lunches with a Vice President at us, so we would like you to stay here until you answer our questions and then go to lunch with us and answer our questions further and i think we can conclude that fateful 30. Im going to ask senators to keep the total amount of time for each question and answer to five minutes each to every senator has the chance to ask questions. Doctor fauci, im going to ask a series of questions. Senator roberts asked and i couldnt get the exact answer what do we mean by Community Transmission . Cases which the source is not known. If you get someone who travels lets say from wuhan to the United States and cuba know they get infected. That means we know who it is. Intin the state of washingto. Any transmission persontoperson. What if you do know who it is . If they were able to identify them, you might have a cluster in the community. What do you call it if they havent given it to me what do you call that . If i get it we dont know who caused it. Are we at the peak of the flu season . It went up and about how Many Americans have you had to estimate have the flu this year . Spinnaker from 30 plus million a couple hundred thousand hospitalizations. How Many Americans die each year from what they call the flu . 15 to 20,002 the year that they had in 2017 and 20 team which is 70 plus thousand peop people. How do you know if you have the flu as opposed to coronavirus . Is connected with the ticket a test for the flu or for the coronavirus. There is overlap in the symptoms. The situation with coronavirus is predominantly fever and a lower respiratory infection as opposed to an upper respiratory infection starting off and then you might get a pulmonary involvement which is the flu. What is a lower respiratory when you have your lungs involved, you can get that with the flu but usually it is upper respiratory. Fever and cough can be either of them. What should you do if you have a fever and cough . If you are in the middle of a flu season right now and if you have a cough i that could be pneumonia and you should see a physician. If you are a person and a risk group you should see a physician because we do have antivirals. Should we all been Wearing Masks . Know because there isnt anything going on in the community certainly the coronavirus for the broad use of masks in the community. Why do Health Care Workers wear masks . Because they are taking care of someone that is known to be infected with a transmissible virus. Thats different from Walking Around in the streets wearing a mask. Or children getting the coronavirus . To a much lesser extent than adults and for the reason its unclear but the symptoms are so low they are not being recognized at the number of reports that have come out from china there are few cases. You will find the exception that most of the cases are about 50. What can we or our families do to protect ourselves . Right now we are still in the flu season. What you can do to protect yourself against the possibility of coronavirus is the kind of things he woul they would do tot against the flu. Obviously you get a flu shot and you can protect yourself against the flu but things like we always say if it sounds simplistic but its true washing of hand hands as possible stay y from people that are coughing and sneezing. If you yourself are infected, dont send your children to school if they are infected. Thank you mr. Chairman. Im going to yield the first question over and i will take the second round. I would like to followup on that quickly. So, if somebody right now in alabama presents they didnt get their flu shot will that test if they dont have the flu but they have the coronavirus, would it come back negative . They should be concerned if they have symptoms and it comes back negative. Followup question on that its about testing. I didnt hear a lot about the testing. We had some about testing. Its inadequate to say the least right now but i know theres efforts. What capacity do we have to do the testing as you sit here today and how are we working to expand and when will that all happen . The cdc peace is to provide the Public Health lab with tests and we are rapidly doing so. We developed the test very quickly and detected some problems after about Quality Control steps were measured so by the end of this week they should be able to do testing but i think that for context its important to understand what they 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 so so far this year the Clinical Labs have tested almost a million respiratory specimen and about 200,000 were positive. Public health labs as opposed to a million tested about 62,000. They are a tiny piece of the testing world that said most people with influenza dont actually get tested. We have about 30 Million People with influenza so far this year and as i said, about a million tests so i think the Public Health issue is to detect early when there is emergence of the virus recognize it and travelers or the community and right now with the fda assistance to get the clinical lab up and running. How much more capacity will we have by the end of this week versus two or three weeks from now . We worked with the cdc on their test and outside Manufacturers Private companies are using their platform right now to further develop test. Our expectation in talking to the company that is scaling this up is that we should have the capacity by the end of the week to have kids available to the laboratories to perform about a million tests. One thing i would urge, so please continue as both have, get information out there. We are about to head into the allergy season and people are so scared out there right now that the first time they sneezed they are going to think theyve got this and we need to make sure we educate folks so that the tests we have are for the right reason. Second question that concerns rural areas in my state alone weve got hospitals, we have another hospital closing this week in the state of alabama. Are there specific things you are doing to make sure that rural hospitals that are living from paycheck to paycheck have the resources they need, the Financial Resources and tools . I will ask. Thank you for the question and weve been monitoring the situation very carefully with our Healthcare Coalition funded by the Hospital Preparedness Program. You may be at risk for severe disease should seek hospital care. If doctor would like to follow up on that. We are looking at that is one peaceablpiece of the puzzle to n the gap. In that regard i had a question but i would recruit you to get with cns to get medicine for that. They dont do that right number that can be an important factor. Thank you. That is all i have. Thank you, senator jones. Senator burr. Can i ask a unanimous consent to enter a statement into the record and ask on behalf of all members if they want to enter a statement that they can and just remind members in 2005 when senator kennedy and i passed it was with the stay in mind. That would we be phased with the pandemic and were close to that determination. I would only say that ten team chooses to do legislation are great, before you do it read with the statute says. Read what the latitude is, what are responders have. Let them do our job. Doctor just said he did to emergency use authorizations for 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. We will go ahead and make a unanimous consent to put that in look forward to reading it. I heard you say you are rapidly trying to reach testing. As of march the first, cdcs website had total tested 472 even though secondary azar said 3600 printer military. Why on march the second did you take the total number tested off the cdc website . Thank you for that question. There is a lot of numbers out there, there is a difference between persons under investigation who have been tested and all of the test that we have run for instance an individual case, the first 12 cases that we saw here, we did serial testing 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 we understood with his fiery virus the upper respiratory and lower respiratory we also collected other specimens from them. So over 3000 test run is correct, we have tested way more than the 500 some persons under investigation and weve also tested the hot risk cohorts like the individuals the potential threat in early january if not in december with what we look back at now. Diagnostics had to been one of the things we were looking at saying we have to be able to do this and we devote 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 1500 individuals yet we experience what we had with this longterm care facility in clearly a customecluster that we dont kne magnitude of. How can that happen when we invested so much in being early on an understanding that. Cdc very rapidly developed a new pcr for completely new virus when posted the instruction for the pcr on the website so other labs, academic, research could similarly develop test, barta has been a responsibility to work with the private sector to get commercial up and running in the cdc has supplied the Public Health lab with the ability to do the testing. The situation in Washington State is tragic, and outbreak in a longterm care facility is one thing we have been worried about from day one, we learned from sars in 2003 that the spreading of events or super spreading individuals could cause very large amplification rapidly so the concern about healthcare setting has been foremost in her mind. I believe you, im only looking if we were better prepared for this happening and it does not seem that we were. Also in the reauthorization provided authority for 30 new employees at cdc dedicated to development of our Surveillance System at cdc. Of those 30 how many have you filled. I dont have information but the laboratory activity for the coronavirus are not the larger parts of our program, we have both a response around the influenza capacity which is really grown with the generosity of the American People through congress. So the coronavirus capacity is relatively small, we bolted up after murders but were not able to sustain that. We really appreciate the support from congress to strengthen the cdc in the state. I was shocked and i like to think i am fairly knowledgeable of everything that we instruct and provide for agencies. I was shocked to find out that in the normal appropriation, this 150 million can also be used for cdc, facility construction, its a little misleading to say this went for surveillance when the flexibility exist for some of it to go to facility construction. You know what portion of 150 did not go directly to Fund Surveillance . Im not sure what the hundred 50 is, i will have to get back to on that. Our construction, renovation is separate. I think if you check in all appropriations go to cdc, there is an ability to move money from that to construction facilities and i would encourage the appropriators on this committee as we look at the Emergency Funding lets make sure goes to response and not construction of a campus at this time. I yield back. Thank you, senator burke on as you have 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 they fear the virus has been circulating for weeks undetected. We were relieved a month ago when cdc began to ship diagnostic test to state and local labs but within days many labs reported and validation issues with the test leading to inconclusive results in cdc and fda began to work on gravity not but it was not until february for breach 27 that cdc distributor new test kits and at the same time Academic Centers across the country were raising concerns about the lack of availability and diagnostic fda was imposing. For example fda asked labs to some information about 100 tested a time when only 15 people in the u. S. Were known to be infected. Fdas work to address the issues with the testing that issued this past weekend but press reports indicate the publication of the guidance was delayed within hhs, i was glad to read last night that you will be able to do 1 million test by the end of the week but frankly am hearing from professionals that that is unrealistic. I wanted to ask you first of all, what happened at the department that created these delays and how can you clarify that the estimate of 1 million test is accurate . First of all with respect to the timeline of the development of the test, cdc obtains sequence of the vibrance, thats where it starts and theyre able to develop a test based upon the identification of the sequence. They moved rapidly to develop the pcrbased test as it was just described. We received the validation information around the test on fiber third and on for break for three issue the emergency use authorization to allow the test to be used, during the scala process which is last week, it was identified that some Public Health labs, not all that they were not able to reproduce and validate the test. Cdc heard the information, came to fda and we worked to correct the issue. At the same time simultaneously we were working with the private sector to scale up the use of the cdcbased test. Thats where we came into the most recent estimate regarding how we can scale up. Was the publication delayed within hhs . Was it yes, sir no. No it was not. Do you really believe that a million test will be available by the end of this week. Let me just explain that, the company that we are working with have the capacity to develop enough test kits to send out by the end of the week, this is a dynamic process, every day we hear from additional manufacturers that they can do this, 2500 test kits by the end of the week, that should give acidic capacity once they validate to perform up to 1 million test. 2500 kids. 500 test per kit. I her doctor say that the point where someone goes into get a test, were months away from that. I am 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 their within range of coronavirus, right now cdcs website says if you suspect you are infected you should stay home except to get medical care. Right now we know 27 of private sector 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 one of two countries that dont provide paid leave for personnel. If we are telling people to stay home, think about the facility thats been impacted, the Senior Center lowincome workers, all of them are being told to stay home for two weeks. I just have to ask would it be beneficial for a Public Health reason where we combat the step policies in place that make it possible for people to stay home from work without losing a paycheck . Yes, absolutely. I think that is something that we need to consider. I want to ask you, i am very concerned by news reports about hhs staff who were deployed to assist with potentially infected passengers returning from abroad and despite facetoface contact with passengers the staff reportedly not appropriately trained to handle this type of Public Health emergency or how to wear protective equipment. They were not quarantined, monitored or tested for the virus and some have taken commercial flights and return to work. It is not clear that hhs took necessary steps to protect staff in the public either during this time or after concerns were raised with Senior Leadership about what happened. I will ask both doctors, is a situation i just described consistent with protocol . And what should have been done once his Senior Leadership was aware that frontline staff may have been exposed . I speak for cdc, we take health of our workforce very seriously, the health and safety and have deployment guidance, this is a totally new virus and were learning as we go but when we identify problems we want to i dont have the full information of that, but i believe the doctor could say more. I will just assume were looking at it closely, to echo with the doctor, we take the protection of her healthcare workers and hhs very seriously during operation of particular evaluating what may have been a breach and we owe it to you as well been identified by the whistleblower report to report back. I would just say we need people to speak up when they see these situations, its unacceptable if any of the workers are intimidated and staying silent or believe the be retaliated against the issues. We have to keep the protection of public and first and foremost in our minds and i want this book that in a want to make sure anybody who speaks up is protected. Senator paul. Doctor fauci im intrigued by the fact that they said its against mars, sars in animal models. With regard to the children, i think its fascinating that there are many cases and i would suspect it would be improbable but that there not been infected, somehow they have blanket of immunity. Thinking of putting this into perspective of putting a better look on the overall outbreak if we had numbers, i dont know someone would suggest to china that they do random testing of kids in a real hotbed when theres a huge number because we have 10000 kids that were not getting sick or 100,000 kids or the percentage of fatality would go down. There is data about that and maybe 0 in children but it may be asymptomatic, the data from a few places looking at that. Is more likely that there asymptomatic or less symptomatic. I think we will get data from the trainees, they have been quite cooperative in sharing data. We have a group that was under the offices of the w. H. O. That went to china, there is an individual from the cdc an individual from the nih who have now returned and will get a good look at the report of what they had, that was one question we asked. As you mentioned, that is a very important issue. With regard to treating the severe and fatal cases in bacteria or viral infections, is seems its trying to fight off the cause of the infection as well as the bodys response to that. Some bacterial infections, steroids with the flesh eating, sometimes you get a massive steroid in the setting of an infection and some people survive. In the fatal cases, their findings steroids in addition when we dont have an antiviral treatment, are they using steroid treatment in severe cases and having any success . Theyve done in a noncontrolled way and it does not seem to be any different that it affects positive or negative. We would never do it a most forgiving antibiotics if we had an antiviral plus steroid it might be a different scenario. Thank you, senator paul, senator casey. I want to think the chairman in the Ranking Member for the hearing and obviously our witnesses and the expertise and the work by each individual for many years. I will start by what is the obligation of every elected official in the federal government. We have members of the house, senate and both parties and we have two individuals and the executive branch the president and Vice President , the obligation is real simple. But every elected official, every one of us is charged with working constructively to the following, slow the spread of the virus, taking steps to do that, working with all of you and number two, support state and local preparedness efforts in three provide complete and accurate, always, always Accurate Information to the public to address their concerns about this challenge. I know this committee has worked a bipartisan fashion on a range of issues for years, were continuing that today, i appreciate the work that senator berg is done working with him as theyve done with the last number of years to prepare for the reauthorization spring but we have got to make sure that we do our job even as we are indicating what should come next. I want to start with regard to the tragedy that is unfolded in the state of washington in Nursing Homes. I guess i want to start with just the venue for this challenge, we know the early indications suggest that the virus opposes a significant and even deadly risk to number one, older adults and people to under with disabilities and folks with Underlying Health conditions. The risk is heightened in Nursing Homes and residents of workers dont have the option to distance themselves the residents in particular are in their home. So there is no staying home to avoid it. And the workers have a challenge. Tell me two things about what the administration is doing, what is the administration doing to protect both, number one the residence and number to the workers in longterm care setting. I will start and turn it over to doctor, the key thing is, as we learn more about the outbreak and last thursday the chinese posted a fairly significant report of their outbreak that included a record of 44000 confirmed cases in china which gave us a good understanding of what are the relative risks to doctor faucis point about 15 20 of people over the age of 70 are at risk. And that, i think saturday, i wont steal doctors thunder, they released guidelines how we can mourn and inform people with vulnerabilities and weve actively worked to reach out to them specifically through mass calls and through briefings to inform them of the risks and guidelines they can follow with cdc guidelines. Weve been very proactive in aggressively trying to respond as we learn more that would ensure that we can mourn proprietors of those facilities but is not just longterm care facilities, its potentially dialysis clinics and other areas where we have Cancer Therapies given where people are immunology at risk and being children from the virus. Just to say cdc has issued a number of guidance documents and for the past several weeks is doing outreach with health systems. Through the weekend i spoke many times with cms in the assets that cms has including sectors and so forth is being directed to help us with this challenge. Obviously individuals in the nursing facilities and hospitals have a lot of other things going on in the best that we can do to protect them from infections acquired there is really our responsibility. Just to make a and then one question for doctor hawn. We had a debate about healthcare in a been working as many half to combat the use of the junk plants. We have a report where a guy got tested for the flu to make sure he did not have coronavirus, he finds out his insurance is a shortterm plan it does not cover basic testing. You get the picture, these junk plans, i hope this challenge we are facing will convincing administration that junk plans or the advancement of junk plans are really dangerous especially when we face this threat. I hope they would rethink their deregulatory strategy Going Forward. Doctor hahn. We are over time. One question on testing. How many people this week can be tested in the United States of america . That depends upon the deployment by the manufacture to private companies, Academic Centers, et cetera in their ability to validate and do the test, the capacity will be there by the end of the week but those of the necessary steps to get that deployed to the American People. I hope we can get a number of people. Thank you all, i have about seven or eight questions so please think about your answers, if i interrupt is not to be ru rude. Cdc, beforehand, i discovered the canadians have not been as strict in terms of people returning from Hubei Province. If you have been there god bless you, go home and dont infect anybody. You mentioned there screening at the u. S. Canadian border, i 1 of those folks coming from canada and Washington State are actually being screened either by a questionnaire as a travel history exposure and temperature et cetera. I dont have the percent but we work closely with doctor stephen the u. S. Public health system. Can you give me a ballpark, 10 , 15 . There is a protocol that is assessing everybody who is crossing at the key borders alerted to where the flights are coming in and so forth. But i cannot give you a percentage. It could be as low as 5 . It could be. Secondly, are you using google location data or any similar tracking contacts . Not for context, we are for travel pattern. Going to the nursing home in seattle, clearly somebody came who was exposed to coronavirus. Law enforcement on the scene of a crime will give data in reviewing the statutes. So just to be clear, cdc is not currently using the same that Law Enforcement is to contact. You have to recognize the chances that a person with a fever and a cough have coronavirus versus influenza are very similar. If somebody went to the nursing home and you can follow their location and it turns out they had contact with somebody who had traveled to hubei perhaps in canada than there obviously a candidate in the factor. So i would encourage because they think the answer is no that you do use that location data, it seems it would expedite how its been spread among the community. Next doctor hahn, those 26 apis that india is not allowing to be exported, are any of those active pharmaceutical ingredient therapeutic drug . Senator, i dont know the answer, we are going through the list right now to assess the medication. Next, one of the recommendations that senator murphy and i had and requested on the report which was released last year, the recommendation number two was to establish a Quality Supply chain rating system, now should Congress Enact as quickly, clearly if we got the supply chains overseas that we can expect and basically interdicting the flow of the pharmaceutical ingredient to the u. S. And it could be one of the candidate drugs, should we now enact the recommendation number two . We stand behind them working on the development of the rating system. It also has legislative proposal. As regard we have a problem with antibiotics. In which if you had a really expensive antibiotic for some terribly resistant drug to pay for them with capitated payments with drg hospitals, we couldve the same situation with antivirals, where the antiviral might be very expensive and that would blow the lid off the drg you see where im going. Again i would Like Congress to act on this quickly to create a carveout for these espress expee drugs. We have implemented the authorities given to us and we are very much facilitating the development of antibiotic. This would be a payment policy on cms. We have to give them authority for the use of such drugs. We have a Pilot Project to bridge this gap and differ the payment to cms. Doctor fouci were looking for quick diagnostic in a pcr takes longer than a swab or a blood test for an idm or igg, how close are we to having those test to be turned around in a Community Hospital . I think pretty close because thats one thing we want to get and expose people who come to the medical care. I want to shut off by saying this, we want to know what authorities we need, we need home health. She was saying that we have to keep people home, i think we need to do something there and those are my question, if you need authority from us, please let us know, we need to know what else you need. I yield back. Senator murphy. Thank you very much mr. Chairman. Thank you so much for your service, thank you for being here today. Doctor fouci thank you for your clear articulation about a realistic timeline for treatment and vaccine, i do think its worth saying is pretty extraordinary that we have temper medical and Health Professionals counter message of the United States that they have to spend their time to correct the record that we become normalized to this administration to the super hesitant in truth when it becomes particular dangerous in the middle of a pin democrat spots. Thank you for being here ensuring facts. We all have lots of questions so will try to get in as many as we can. Doctor hahn, let me followup on senator cassidys question on new authority, one thing you said in your testimony while you feel you have good cooperation from the medical device, they are not required to tell you when there is a shortage. Senator rubio and i sent you a letter and thank you for your response, trying to catalog the shortage areas. It sounds like it would be helpful to have a legal requirement that they alert you had a time when they see a shortage coming. Thank you for the question. We have sent several legislative proposals as part of the budget, one thing we learned from this is a very complicated supply chain. The most important is redundancy and effort around advanced manufacturing. Weve had great cooperation that this is complicated, the one drug that is currently is related to an api or the final drug form, is related to chemical before the pharmaceutical agreement. The whole supply chain is complicated and more information would be better. I think senator murray asked you a question that you might not of got to answer. The information is key but also setting realistic expectations as well. Your estimate by the end of the week there will be 1 million test out there, those sound a little aggressive given the fact weve only tested 3000 people in new york state is saying their goal is to do 1000 today, tell us why you think by friday of this week we will have 1 million test when this for weve only done 3000. I want to distinguish between the ability to get the kids out to the laboratory with the ability of the labs to do the test that we have been working very closely with the last three or four weeks with all manufactures private, et cetera to build on the platform the cdc has developed, weve been in touch with this manufacturer over the last three or four days, we read iterated, we know them well, they have estimated it will be able to scale up 2500 kits by the end of the week to providers of the test. How do we make sure those are in the right hands. Cdc has been providing the Public Health law with kids and expect by the end of this week they would be sufficient for 75000 people to be tested but as you say not Everyone Needs a test and we dont want to go through all of her test and low risk situations and not be able to address the care and context that are critical we have guidelines for influenza of who needs to seek care and stay home. And weve adapted them for this. We broaden our definition of who we think is a person under investigation that needs to be tested not just related to travel but all the other areas and is a people with severe respiratory disease who dont have an obvious diagnosis should be tested and we know many of the cases in Washington State are detected through that or because there was an outbreak. I think the question of where the test and up and making sure theyre in the right hands will be important. Let me ask you a question about protocols that were recommending to School Districts. One of the biggest disruptions that can happen in a families life is the closure of a school. Senator murray pointed out given the fact that many families have two parents working that is difficult for a day nevermind a week. One of the recommendations and protocols were telling School Districts about what they should do if they have a child who test positive, a family member, teacher, what is the best protocol . We absolutely recommend a child who is ill should stay home so they dont spread but we have worked closely with local and state Public Health on this issue and essentially decisions about school dismissal, School Closures and changes are locally driven but we provide guidance. The general principle is to minimize disruption, you have a balance between the earlier you act the more impact it can have in the soul of the spread and then orvis disruption was School Closures. You may remember 2009, we saw hundreds of thousands of students at home in the first couple weeks of the pandemic. As we learn more about the virus we learned that was too disruptive, it was relatively mild and compared to what we are expecting and we dialed her back instead shift to stay home when youre sick, canceling assemblies, changing the patterns of whats done in class, keep classes going because so many depend on School Lunches and other services at school. Its a local decision, if theres too many people sick you cannot keep going but try to protect the vulnerable and reduce the spread but not disrupt families and all the parents who will be staying home if their kids are home. Thank you. I have to go on because thats an important answer but i hope everyone will stick to five minutes so we can allow all senators to answer the question. Senator robert. Thank you, mr. Chairman. I think i can do the off the bat, you asked my question. I have a pretty good answer, senator jones stole my role question, bob casey summed up he said we are to get this money appropriated and the president said whatever you give me ill take it will work with it. I just want to thank you both, you indicated we need information, i think we are doing that in this process, largely because of the wonderful job they do. I want to think senator murray for that. This is a very unique committee along with a sometimes powerful agriculture committee, we are bipartisan there is a lot of elbows out there, we dont need to politicize epidemic. I would recommend we monitor what people say and i would yield to the chairman for that decision along with the Ranking Member that maybe we ought according to people for 14 days if they shut up about the politics and bipartisan. We can do better, i think we need to get the funding to the president and get these kits out, 1 million within the week thats good progress. Doctor schuchat, i want to underscore again rural areas. We have 83 critical access hospitals in kansas, that will probably be reduced simply because whats going on. We are older, a lot of Nursing Homes, longterm care, that is just right for this kind of thing. I might point out in the senate we have quite a few people that have reached that age as well. I hope we can follow the chart that good senator cassidy has suggested. I think its been a good thing. One other thing, part of our job is to stand with you when you take the blues and stand behind you when you take the bows. All of you should take about. I think we ought to have the situation where we have your back, not so much criticize, were trying to work with you. We are going to get this done, i would say mr. Chairman, in todays wall street journal, last summer for 7. 85. You can get this for 7. 85. If you want to go to amazon is 114. 97 today. Ill give it to you for 50. [laughter] if you bought a leader of this it was 14 bucks, announced 229. That is ridiculous. I guess thats supply and demand amazon thinks it would be the case. I wanted to ask one other thing, the term that a lot of people are confused about his community spread, it does not say the whole community that this disease will spread throughout the community, it indicates its one person we dont know where the source was, is that correct. That is correct. We are differentiating from a close contact or travel associated. It does not mean the whole community is affected and what it means if we throw enormous resources we need to map out the links its more important to go for mantoman to zone to zone to see the recognition and put the most effort where it will be the most impactful and less on the individual Contact Tracing in the more ready in Healthcare System i think of her much i yield back. Senator kaine i express condolences about the tornadoes, those are devastating. I want to think the witnesses and the chair and ranking, this committee has had a number of roundtable sessions and these witnesses have been here and presented on the 24th of january, positive. I will say when we had the briefing on the 24th and rican sensed and when the white house appointed the special committee on the 29th it made me surprised when i looked at the president s budget they came to us on the tenth of february to see in the budget there was a 52 cut of the World Health Organization and cuts between 5 10 of the nih, cdc and overall hhs budget, it does not seem to be a wise time to take it to the Public Health infrastructure. As a help as we look at what we do from an appropriation standpoint, we are not only coronavirus but also the pieces of the budget that fund the Public Health infrastructure so we dont do damage to that at this time similarly. The budget contains significant cuts to medicaid and although described euphemistically, its pretty clear the medicaid cuts will cut people in states that have adopted Medicaid Expansion or early for the book it care act in the administration is in courts as a been every day trying to eliminate the Affordable Care act, the Supreme Court announced yesterday it will take out the case later this year. It is not a good time to take it to a scuffle for the Public Health infrastructure, its not a good time to scare people about whether or not they would have Health Insurance. Im not sure theres a good time to do that but you cannot do it at a worse time when people are concerned about epidemic. I was looking toward your presentation at the lunches today. But during the middle of this hearing, i got a notice and i dont know its accurate but you will no longer be presenting at the democratic lunches, is accurate . To my knowledge, no, i am planning being here and beat on both lunches. Im just told its change but i dont know why. I just want to be clear about this it was notified yesterday that you and the Vice President would be presenting the democratic and republican lunches, i got a note from the democratic leader that came in and 925 the said you would not be presenting, thats a first report of this right now . What you just mentioned is the first ive heard of it. Dear of any idea why you been disinvited. I dont know. Let me ask a question about a population thats not a confidence builder when the person the person we have a lot of faith in knowing the stuff whos done it for president s, both parties for decades and advertise coming to advise at lunch, we are now notified youre not coming. Correction, it took me by surprise, am i going . I am going. I thought your staff said you were not going 30 seconds ago. What is the answer . I am invited. So why did your staff tell you that you are not invited in 30 seconds later changed . We will see what happens tomorrow. Is not a confidence builder. Let me ask about a population that is a significant concern which is military, we dont have a dod person but you must be working, we have a lot of people who are deployed in italy, a lot of virginians employed in south korea, just thinking to countries that mightve been mentioned were there significant coronavirus. My understanding at the base, families are being urged to stay on base, talk about your interaction with a dod, are we likely to see more of this, is there quarantine are we likely to see in germany . Thatll last question i have. My direction for dod is daily, we have a call at 12 00 oclock with the department of defense and office of secretary of defense, joint staff, the logistic agency, what theyre doing is abiding by cdc rules and guidelines in these circumstances, obviously it is different overseas rehab then needs to isolate the population. Are we doing please down base other than i dont know the particular particulars they do conform with cdcs guidelines and what should be done to protect. My time has expired. Thank you, senator kaine. Thank you, mr. Chairman, i appreciate the work that has been done by the Public Health community to delay the arrival of cobra 19, its really quite remarkable that while other countries have seen too many cases where the italy, i wrong, south korea, japan that weve been able to delay it, we cannot keep it away forever and we already have the Community Transmission which you predicted, i want to turn to another issue whether we as congress and Administration Republican or democrat have done enough to prepare protective equipment for medical professionals. I wont point at anybody, this is also responsible for funding. Given the fact that the medical professionals need masks, gowns, gloves and so forth, what percent of what would be needed by medical professionals if we were to have a fullblown pandemic. I hope we do not, what percentage will we need for medical professionals in the Strategic National stockpile. It depends whether a severe pandemic, 10 of what we need, if it were to be severe we would need 3. 595 billion respirators, we have about 35 we are working actively and that. Thats an area where i been concerned, we should have substantially more than 10 of what would be needed for substantial pandemic. We should have that in stock, congress, not the administration, congress is appropriating an prior as well. Do mask help for the general public . Lets say we have about enter major pandemic and going to the grocery store, do masks help, do they prevent or reduce the likelihood of being exposed to the disease . It depends on the mask, if you look at the n95 mask much better than the floppy masks, in general right now, the question you are asking. If we would have a major outbreak. The most important thing for mask would be if someone is infected to prevent them from infecting others, the Healthcare Provider to protect them, the general public who could wear them, that could prevent when someone sneezes and coughs. But it does not provide the protection that people think it does. Therefore there is downside because people keep fussing with the mask. Better than nothing. Do we have masks in the stockpile for the general public . We do not. Return to aircraft, someone on air fo aircraft is infected and sneezes, how many people will be exposed to the disease, just a couple of people, the next people sitting next them, the whole aircraft . This virus we are thinking a couple rows around it and for other types of infection and might be broader. Should verify intendants tell them not just to fasten their seat belt but if you cough or sneeze should cough or sneeze into your sleeve, i going through an airport and people cough or sneeze barking out in a condition like this the general flew, should we not be telling people on airplanes you may not cough or sneeze unless youre covering your mouth. I think i know the answer to that. [laughter] let me ask another question, lets say we get a vaccine that test positively and goes through phase i and phase ii clinical trial. What does it take to get a major production done. How long does it take to kick the production up and how long does that take in whos doing it once we know it works. A very good question. That was the thing that was discussed yesterday when the president and Vice President broaden the ceo as the number of companies, what is really important, i was talking a year, year end half, if you have the Production Capacity to make tens and tens of millions of doses it may take even longer, the ones that can do that essentially are the pharmaceutical companies, the federal government will not be able to make hundreds of millions of doses, its going to have to be partnership with the private sector. Do we have the capacity or capacity outside the u. S. . Whether legislatively or procreation standpoint, we should provide funding to have the capacity to make large numbers of vaccines, we should have the capacity in the u. S. And have it ready to go this is not the pandemic, if it comes down the road, should we have this ready to go . Yes, the only capacity we have is a production which should not be relevant to the axing candidate or the candidate were pursuing a longer than a sixmonth wait to produce vaccines on scale. I want to underscore thats an area where we ought to consider making an investment. Thank you very much, chair alexander and Ranking Member, i want to thank you for being here and please extend your thanks here amazingly hardworking professional staff who i can only imagine have been going nonstop for months, thank you. I want to ask a question about the misinformation and flat out falsehoods about the coronavirus that has been circulating and amplified. I worry its been amplified for political reasons that senator robertson asked dont want to politicize. What is the impact of the misinformation which we do about it, i am looking at schuchat and doctor fauci in particular. Its embarrassing to go through all the things that have been set on National Media including buyer president. Doctor fauci, its not true that this is a common cold and we can expect this will be gone when the weather warms up, is that true . In general respiratory illnesses such as the prototypical influenza virus is seasonal. When the weather gets warmer as will happen in march, april and may you will inevitably see a marked diminution in influenza. The same truth other respiratory viruses including the common cold, coronavirus. This could happen but we do not know. The reason we do not know is because this is a brandnew virus with which we have no experience. Even though the concept that when warm weather comes, many respiratory viruses diminish. We have no guarantee that this will happen with this virus. It might come back again. It certainly might. It is conceivable given the degree and the efficiency of transmissibility of this virus that we might have a cycle, and may come and be seasonal and come back. That is quite possible, we do not know but its possible. We have heard so much misinformation, its been said that this virus was developed of a tool to economic war on the United States, its been said that this is part of a strategy to bring down the economy, its ridiculous and harmful. Could you as Public Health professionals comment on why this makes it more difficult to address this epidemic and what we should do to combat this misinformation. I think we need to speak out often and loudly about how much nonsense this is. This is not new with coronavirus. There is always conspiracy theories when there is a new disease that people are afraid of and that is really novel to them, i have to say im thinking back about 37 years ago, i sat in this room trying to explain to the committee then that hiv was not a virus that was developed by the cia to essentially eliminate certain population. Its crazy but this is what happens when you have outbreaks. Theres a lot of it misinformation. Theres consequences to this information that makes it more difficult for Public Health professionals to respond and take care the population in the ways that we need to. That is what worries me. I know dont how much time but i want to ask another issue thats extremely important, im very proud of minnesota health, we do great work and theyre very worried about whats going to happen, the capacity pressure they will be experiencing as they address the coronavirus on top of everything else. My question, its not only a question of getting the diagnostic test out so people can respond but the labs need to have the people in order to do the testing because its not like theyre sitting around with nothing to do. Absolutely the Public Health labs are shortstaffed on a good day so this is a very big challenge and thats one of the reasons we are keen to get Clinical Labs up and running with the test. I think you bring up the point it is not just the Laboratory Capacity for Public Health but all the other things that they do, they are very busy with contact tracy, following up on the people who traveled, who theyre supposed to follow, they are spread thin. It illustrates the principle in this evolving situation we need to put the most effort work and do the most good and not get distracted with smaller things. Its white so important as we work on the emergency appropriations making to the departments at the local level are reimbursed for the work theyve already done. Absolutely and they have sufficient dollars to do the work that they dont have the funding to do. Thank you, senator smith, senator scott. Thank you, mr. Chairman. In the panel for being here. The one thing im not concerned about frankly is whether or not congress will provide the necessary resources in a timely manner to deal with the challenges that we face as a coronavirus. Im not going to ask questions that are been asked several times by several different senators as relating to what will happen if. I do not think without a lot of conversation about putting the virus into context. Context for the average person in this nation can digest very quickly and understand the actual risks that are associated with the virus. So rather 2003 sars or 2009 swine flu or the current flu season and the number of americans have died because of the flu or rather overnight tennessee lost 19 people because of a tornado. I would appreciate if you would all take my time to help us to put in context what 80 of the people would experience if they were infected by the coronavirus which seems to be a favor and a cost that is downplaying. If it isnt please let me know. In the 20 folks who are elderly who may have disabilities and mobilitys that may be at a heightened risk. If you could use my three minutes and ill have left by the term and finish with my opening comment, help me and the rest of the folks in South Carolina who are seeing this issue on every screen and often times seen it from my perspective, hyped up in a way that is not helpful. I will close with this, those who are alarmist and really painting a picture that is very difficult to digest and those who are acting with a sense of urgency, i think the four of you are acting with urgency but not being alarmist at all. Now you have two minutes 48 seconds to help me figure out the situation. I address the regulatory issues, we worked with emergencies and facilitate mask and support of the Public Health colic. I will yield my time to doctor fauci in schuchat. My dog under jo job is to thinke main point. What you consider relative risk and how that relates to the unknown. Think about whats going on now, since it is a new virus, we dont really know exactly where it will go. If you look at the Disease Burden with immortality, every single year influenza does a significant amount of health damage, not only to our country but the rest of the world. The thing about influenza theres many things unpredictable. We know the bracket of how many people will get sick and how many people will die. It is tragic, death, suffering, we do not like it but we kind of know when youre in the area of the unknown, you have to walk a delicate balance of not overshooting and having panic but also not under shooting and being in a situation where you do not respond as aggressively as you should. A sense of urgency. Just to add in a Large Population most people who get infected will have very mild symptoms, some will have severe illness, pneumonia and be critically ill and what is unknown is what the total will be. Will we have been numerous cases a year end we have with flu which would be very difficult to handle or can we slow the spread and protect the Healthcare System. Its a balance that doctor fauci mentioned not overreacting but not under reactive because the risk of under could be that we have second third order complications. We dont want to have the Healthcare System flooded with people who do not need to be there but we need to build it up because it is going to be really bad flu we will need to build up the Healthcare System. Sense of urgency but not buy into this hysteria that will make it difficult for Healthcare Providers make it more difficult for Healthcare Providers that have the resources and equipment necessary for them to take care of the folks needing assistance. Thank you to the panelists and your entire teams you all have been working tirelessly and we know that and are grateful. I want to start to get at the issue with you of diagnostic Testing Capacity. I know the administration ordered an independent review of the cdc lab about problems that arose in the manufacturing of diagnostic testing kit. What is clear this point is the domestic Testing Capacity has been lower here in the United States are you confident the policies put in place by the cdc and fda over the past few days will allow states to test for coronavirus at a level come in third one of the things we are dealing with right now if you get a negative you will read texts next day and we still have the consent when we do then at the state level so when do you expect to reach the point when the cdc will no longer have to perform the testing on samples from state labs . That should be very soon as they verify if the procedures that work to expedite that there is a lack of ability to meet demand for diagnostic testing across the country. To doctor fauci and doctor kadlec, im concerned that the delays mean we dont yet have a full sense of the scope of the problem. If we cant test everybody that has these symptoms get, we may not know the full scope and having an accurate accounting is critical for your ongoing preparedness so how has the limited diagnostic Testing Capacity impacted your response efforts and what steps are you taking to mitigate those challenges . Thats not something im involved in but obviously you would want to be able to have as many tests as you need and at the cbc is ramping up in collaboration with the state and local health department. The first level is to get individuals in multiple states starting off with sex and it will probably be more as we improve and get better and better at that capacity we will have a much more accurate assessment of whats going on in the community. Doctor kadlec, briefly. There are two elements one is in terms of action how do you respond to the Early Warning and i think one of the things the cdc has been doing is using its influence into the tests they do to be able to test broadly to see surveillance so there is the trigger to respond and then the more important one in terms of understanding the circulating preference to understand that the pollinator that may be symptomatic as the both of those have a significant importance. We thought it would be funding commercial laboratories and basically try to develop the point of care diagnostics. I have another question to get to. We are doing that surveillance and hope to expand it broader so we will see what the tip of the iceberg really is. Thank you. I want to talk to commissioner stephen hahn for a moment. The fda has such an important wideranging role to pla role pe ongoing response efforts as you know your announcement last week regarding an unnamed drug shortage attributed to the disruptions in china due to the coronavirus caused confusion among publichealth experts and just now you said you couldnt name it and for those of us that either ourselves or have loved one to there is a shortage but thewe dont know if its ours ia difficult thing for the public. Yesterday you stated that they could perform up to 1 million tests this week while publichealth experts said they hoped to see them complete 10,000 tests per day. It becomes contradictory. Perhaps we can have the conversation offline to get a process in place so that you are making sure that your communications are clear to the public and integrated and i look forward to having that conversation with you a little bit later. Thank you chairman alexander, i want to express my condolences to the state in the tornadoes this morning and thank you for your time here today. If you look at where we are now in the capacity for the preparedness and response, weve come a long way however the Infectious Diseases means we need to continue to innovate. Your agencies have taken significant strides to improve the National Health security capacity. But in america much innovation comes from the private sector. I commend your steps taken with thibythis administration to adds this emergency. In these situations Going Forward, these can quickly reach the American People we are taking steps to reach out to the community looking at what the epidemic means to them and how they can help we met with the pharmaceutical industry and a member of the Big Companies about drugs and therapeutics. Those are a few areas to mention and you may want to go on i was very encouraged by the enthusiasm of the ceos in the pharmaceutical companies yesterday we met in the cabinet room at the white house. They want to do anything they could to help and as i mentioned in response to the previous question, we are not going to get the kind of production of interventions. The countermeasures for diagnostics to work on this and particularly on the supplychain issues. Weve been working with diagnostic companies with vaccine biologics and drug manufacturers around the shortages and Th Development of products to address this outbreak. Thank you all. Thank you, mr. Chairman. So, i want to start with the idea of the fact we have an emergency spending bill going through the congress quite rapidly and some of the issues that have been raised im hoping we will properly addressed those in the appropriation bill and also be able to follow up and make sure that the right policies are in place. So, let us start with the discussion weve been having about the Domestic Production in the epidemic. I remember in my former life as a member of the house of house f representatives in an instance where one of the manufacturers of the flu vaccine in england was the shutdown and a shortage and there was a lot of worry and we rationed flu vaccine that here, changed the standards of who should seek one in who should not. Iran also in the years we were fearing a very serious strain of the flu and inquiring about our domestic Production Capacity for the flu vaccine, and we had none. I might have even asked this of you all those years ago that should we assume if we put in an order with a foreign manufacturer for however many doses but there was a huge breakout in a country that they would commandeer that for their own Public Health purposes. The answer i got a thought at te was yes that would be a prudent and safe assumption on the part of policymakers. I hope that we assure we dont make those mistakes again. I think i heard all of you testify that having domestic capacity is very crucial in this, and i correct . The second thing i want to get into is we talked about labs and Testing Capacity in the u. S. I understand it to be chain reactionbased testing. And igg and iga and can we have that test soon it has a nasal swab and a blood sample . We recommend a throat and nose swab for that reaction. We have been developing the test of those antibodies that the senator was talking about and that is for the population level to understand how much disease has there been that didnt come to care. I want to get in a couple more questions. Can i assume we will have a test for a while . I want to get into the lab capacity we talked about the Clinical Labs and academic labs. If they need to search the capacity for testing and that is the veterinary labs that look at the same sort of tests but they are not usually looking at humans, they are looking at veterinary clinics, domesticated animals or the Wildlife Service that also studies the infections. If there were an emergency i dont know if you thought about tapping into that capacity but particularly of the skills and workforce that deals with level three labs etc. The media crazy idea. I hope you will discuss and think about it if we need to have a surge of the capacity to serve failed the transmission of this disease. Thank you mr. Chairman. I am going to follow up on the first question that senator baldwin raised with you. The fda reported its first coronavirus drug shortage last week and you indicated india restricted a number of active pharmaceutical ingredients. The fda testified previously that only 28 of the manufacturing facilities making apis to supply the market located in the country by contrast the remaining 72 of the manufacturers supplying our American Market are overseas and 13 are in china. Q. And i discussed the legislation that ive introduced with senator smith the mitigating emergency drug shortages which have been endorsed by more than 50 organizations and our bill contains new reporting requirements that would help the fda gain far greater visibility into the drug supply chain including where certain drugs are manufactured and manufacturing contingency and redundancy plans. Given the problems that we are already seeing, do you believe the concepts included in the legislation are in the drug shortage bill that ive introduced with senator smith would be helpful . Thank you for the question. We appreciate your leadership on the issue. This has been an ongoing problem prior to the outbreak and continues to be and is highlighted by what weve seen over the last few weeks. The agency totally shares your goal with mitigating increasing redundancy for manufacturing particularly in the areas of advanced manufacturing we look forward to working with you on that and with respect to the bill, we will be generating written response so we can provide the assistance and we very much look forward to working on a bill with you. With respect to the one drug that you mentioned that we announced last week was in short supply because of the corona virus outbreak, he mentioned this before and again this morning weve already listed that in the drug shortage list available. Thank you and i am hopeful that we might be able to move that bipartisan bill. The rate among older patients is significantly higher. The estimate ive seen 15 80 in order to survive compared to just over 2 in the general population of patients regarding the spread of the virus and longterm care facility. I represent the state that is the oldest in the nation into the aging committee i know senator casey brought this up generally with you as well. My question for you is what is the administration doing and what is the cdc doing in all aspects of response. Thank you for that question. They are sending a liaison to the Emergency Response and we are using our guidance adapted to the situation they are using their field staff to make sure practices around the country are best practices suited for this concern. Infection control is always an issue in the Different Levels of healthcare and the elderly are very vulnerable to the respiratory viruses. We see that same differentiation some are going to have lunch with United States senators and we will be able to finish by 1 12 30 and then we will wrap up by about 1230. Thank you for bringing the hearing we are so very grateful for the lifetime of work and care but i want to speak about the issue with access and capacity and how we can use tele health our response because many of our constituents are worried about the spread of coronavirus and if they have questions about their own health and since the symptoms can present like a cold or the flu, i can only imagine what people are seeing in the news that they are going to seek out care and people are a little nervous, needless to say. We have large areas of the population far away from the city centers and increase in those seeking care is not only hard on them creates a burden on the system. How can we use our health as a First Response to help people in their own home that could contain the virus relieved the Emergency Rooms and so what are your recommendations on the twopart question on addressing the barriers to access in tele health and do you have any plans potentially to operate a hotline or portal for initial screenings for some kind of hub and people could be returned to their local care if needed. Weve made a lot of progress. This was a huge issue getting developed in one state. We have more lawyers and most have actually worked out some of the king is and weve already been contacted by a number that are adapting their our triage wines. We also have been working with tell the Health Together with other parts of government to understand what kind of approaches are appropriate in the area as well as the coverage and that is one of the things cms is looking at now. One thing weve been doing we funded to pilo two pilot prograr regional Disaster Response system one at the university of nebraska and in nebraska in particular looking at the nuances how to use total health to expand outreach to not only nebraska but the other parts of the region and feel that evaluating both of the lega thed practical limitations to that. Can i ask a question because this book have to do with insurance considering that this could be a Global Pandemic or we have other issues. I wouldnt want insurance to be a barrier for someone able to access a hug or get the care because they do not care whether you are insured or not from a democrat, republican, will toward young so how do we address the issue of people feeling like they couldnt call or use this because of insurance on the patients . The strategy they are thinking through is trying to identify the right level of care for the right situation whether it is the nurse care line or Emergency Office and in the circumstances that we could see keeping people out of the Health Care System could be in everybodys interest to preserve it for those who need it most it would be somewhat different than it looks like doctor kadlec wants to Say Something there. In the declared disasters we have the opportunity to declare individuals and patients where they get reimbursed and it would be an interesting way to look at how you evaluate the pandemic to understand if that could be utilized in this way. That would be really impactful if we dont address this in the right way. So understanding that, what Additional Resources or what should we be looking at as we are going to be voting on the funding and resources hopefully this week, next week that you would need to address this issue . Can i get back to you on that . Thank you very much. Senator murray. First of all, thank you for having the hearing. I do have to ask each one of you because this is a very serious challenge we are seeing the impact in my state even though it may not be yes for each individual, it is absolutely critical so i think it is important right now and i am concerned that people trust the information they are hearing so they do the right thing for themselves and their communities in the country as this moves forward. Where do you turn for the information its the experts like all of you and that is for people need to be listening to. I think that you have heard the concern expressed here that the president has made some statements contradicting all of you. Our nations top experts may criticize the media for covering this, so i just think its important for us to hear from all of you yes or no can the American People count on you to be 100 transparent on the virus and response even if you have to contradict something someone says . Yes. Absolutely. We need to count on that because its moving quickly and we are seeing it in my state and we will see it in others. Families across the country watched the latest news and worry about the threat of the coronavirus. Im glad we are taking the opportunity in the committee to ask some of these questions that ive been hearing from home and we will all continue to hear and how we can prepare for the test. I will tell you since this started we learned the faithful closure of the facility committed to dh s. Center just closed a short time ago so its clear by the minute how serious this is for people in my state as well as the rest of the country and this administration as you will note those are some answers and they are going to keep hearing from me until i get the answers including apparently from Vice President mike ten and several of you. This is critical and we need to stay on top of it. I will say again thank you to senator alexander. Weve been holding bipartisan meetings on this and we want to continue to Work Together having that information i can talk you its so important for the people in my state. We need to get these tests out. There are real time decisions being made right now in my home state of School Closures and about whether to go to entertainment, what businesses should be telling people and as business grows it is only going to be more intense so we are counting on all of you. At a time that we are not in the middle of what they are now, i want to have some more discussion about the extent to which we rely on other countries for the medical supplies and medicines and what we should be doing about it that we are not. We have debates about importing prescription drugs and ive often thought that our the way we talk about that is all mixed up because we import a lot of drugs as we now see that the difference is they are manufactured under the supervision and have a supply line that the fda supervisors to make sure they are safe and when they do that we have lots of drugs made overseas so maybe the National Academies should do a study on this. I talked to other senators who are concerned about it and one of the areas the committee should look at and several senators mentioned it is we rely on other countries and the sole sources of supply, if chickfila sells mac and cheese it doesnt have one resource it has at least two to make sure it doesnt run out and we should certainly do the same with lifesaving drugs. Also want to endorse senator murray said about the appreciation for your telling us the truth into giving us Accurate Information about whats going on. Thats why we have such respect for you and your professionalism and thats why you are here today. The hearing has been about how to provide Accurate Information to the American People so they know what to do and how do we provide Accurate Information to congress so we know what else we need to do and we expect you to tell us that there is unpleasant news or not. Thank you for your professionalism and extra hours during this period of time. Thank you for coming today. I read at the beginning of the comment on the front of the New York Times sunday but said most experts agree the United States is among the countrys best prepared to prevent or manage such an epidemic. Your Performance Today suggests why that is true. The hearing record will remain open for ten days and members may submit information and thank you for being here the committee will stand adjourned. [inaudible conversations] [inaudible conversations] National Institute of health in bethesda maryland for an update on the coronavirus. You heard from health and Human Service secretary azar, doctor francisco in and other Health Officials. This is about 25 minutes