Transcripts For CSPAN2 Hearing On Interagency Coordination On Coronavirus 20240713

Next, a hearing on how federal agencies are working in response to the corona Virus Outbreak. Ken cuccinelli as acting deputy Homeland Security secretary and doctor Robert Kadlec is assistant secretary of Human Services. Topics include supplychain management, sick pay support and travel issues. Specifically how the coast guard is working with cruise line. This is just over two hours. This hearing will come to water. I want to thank the witnesses first and foremost for the efforts as related to the current i guess we have to call it a pandemic at this point in time with conv19, the corona virus. I do think its important we put everything in perspective and i would ask my Committee Members to include my pretend Opening Statement in the record. But we often times. Let me rattle off a couple figures here. Ebola total cases worldwide ended up being less than 29,000. I remember in a crisis we were talking about it spreading and could be a Million People which would have been a huge problem because ebola had a mortality rate of 40 , but in the end because of effective action on the part of the world health organization, the Obama Administration and resources we prevented it from spreading some less than 29,000 contracted it and about 11,000 died. Weve had other outbreaks where we are Getting Better and weve developed some relatively effective vaccines to help protect Health Workers and we will talk a little about that in tha Senate Briefing as we pointd out that is a finite resource. The next deadliest virus weve been dealing with is the 2012 mers outbreak. Total cases are less than 2500. 850 people died as the mortality rate of 34 . 2003 week of the sars. 8,000 people affected, 774 people died. The mortality rate of 9. 6 . The average flu, the seasonal flu if these numbers are a wide dispersion of what happens, nine to 45 million a year catch it and 800,000 are hospitalized with it. Obviously anyone with Underlying Health conditions, the elderly are most affected by it and we will lose, there will be 12 to 67,000 fatalities per year justh just seasonal flu. Another virus that will reach pandemic levels that sounded scary is the end one each one virus and this diplomat of 61 million americans caught h1n1 it was over 200 million worldwide. 150 to 575,000. But the fatality rates were not that high. Even thousands die in the u. S. , but weve dealt with these things in the past so as far as i have them, we know about 81,000 individuals have contracted and tested positive for conv19. Close to 3,000 deaths. This is definitely more virile and. A higher mortality rates but i would caution everybody in terms of the mortality rate this as more deaths from people than we have tested and we dont have the type of test kit yet reducing the regulatory burdens in terms of testing and we will talk about that. We do want to clarify that situation. But my guess is when all is said and done and we have a sense of how many people contract this and do not display symptoms or they are mild i would think would probably come down to it but nobody knows. Theres an awful lothere is an e disease that nobody knows so what im hoping we can accomplish in todays hearing is talked about the administrations response which by the way i think has been almost immediate from what ive seen my interaction and the accessibility whether its acting secretary wolf, mr. Ken cuccinelli, id have access to them. I have and have used that access because you working to mitigate this problem, but i dont know how many briefings ive already attended. I appreciate we have two individuals here and you see why dont we have everybody representing every agency, i want them to work. They have a job to do and thereve been a lot of hearings. I think youve taken the whole of government approach. As ive said repeatedly i dont see the administration under responding. In fact, you take unprecedented steps, travel bans, corny quara, unprecedented steps so we havent under reacted, but i think this administration is fully aware in the cockpit of the cost of overreacting. The basic fact of the matter is the chance of the administration getting it just right reacting perfectly is zero. But again from my own introduction what weve seen with the interaction of the senate or the house, this is in all of the government approach and all hands on deck for this and being ignored i you see the eight billiondollar response as opposed to 2. 5 billion funding request funds will not be an issue. They will make sure the administration has the fun. We know the extent of what the outbreak is and i really want to talk about the regulatory issues, just the basic science issues. We talked to doctor kadlec in the front room. Theres a reason they collect ct medical practice. Its a whole new virus may be three months ago you are saying so tha but takes time to develoe test so they dont produce false positives and then you have to manufacture them. So i am heartened by what im hearing and we want to delve into those in terms of what testing kits are available and how they will be distributed throughout the nation and kind of what the priority is so we do get a sense because right now its been limited with high criteria. We want to talk about the role how you are cooperating with the cbc and with the measures are into the data. We talked about that so we can trace travelers that we have come in contact with people so we want to talk about those issues as it relates to the department of Homeland Security. Again, testing is a top priority that we also want to talk about the Current Issues with the supplied chain, but also in the future once we have this wall stabilized and we know where we are at hopefully this will prove to be somewhat seasonal. Once weve taken care of this and vaccines are developed and accessible which will be quite sometime in the future, we do need to take a look at the future stockpile and could supply chains and ask ourselves in a manufacturing process that isnt laborintensive, why are so many of these precursor chemicals for drugs produced in india which is now blocking export of some of these as well. I see no reason for the manufacturing of drugs approved for u. S. Use that those things should be manufactured overseas. I just dont. We have to learn from these types of situations and put in place either regulations or laws so we are better prepared for the next pandemic because there will be. I rattled off the ones weve already had to deal with so i really want to thank the witnesses and i hope this is a good discussion. I hope that its a clarifying discussion. Its about transparency and recognizing you dont have all the answers because there are things right now that are unknowable but thank you again for your work and for appearing before the committee and with that i will turn over to the ranking and are, senator peeters. The top priority is to keep americans safe and to be clear, the corona Virus Outbreak is incredibly widespread but nevertheless, it does pose a significant threat to the Public Health and homeland securit homd we have to take it seriously. Im grateful for the efforts of your agency and Public Health officials across the country to limit the spread of the contagious virus. While we have seen growing numbers of cases in the United States we have thankfully not seem widespread outbreaks yet in this country it is the job of this administration to work with congress. Its clear to me that we should also prepare for a worstcase scenario and widespread infections. Assessing information about the virus has been a significant challenge for the public today. The American People have a lot of questions. They want accurate, reliable information about the virus spread and what the government is actually doing to protect their health and safety. As we have learned from past epidemics and pandemics can outbreaks like this require aggressive coordinated and comprehensive response as well as timely and trusted useful guidance from Public Health officials as well as security officials. In the coming weeks and months your agencies will play a Critical Role in containing the outbreak, educating americans about the virus and protecting Public Health. Whether the response is timely and effective it will truly be a matter of life and death. I appreciate you joining us today my kids to wins in michigan and the American People want clear answers to the most pressing questions that they have right now. I look forward to hearing what steps the department are taking to ensure we have the right plans and they do have adequate resources. If you would both stand and raise your right hand. Did you swear the testimony you will give before the committee will be the truth, the whole truth and nothing but the truth, so help you god . So be seated. A senior official performing the duties of the department of Homeland Security. Mr. Ken cuccinelli served as the acting director of the citizenship and Immigration Services and served as the attorney general for the commonwealth of virginia. Chairman johnson, Ranking Member peeters and distinguished members of the committee it is my honor to appear to testify about the work of dhs and what we are giving to respond t doine outbreak of the corona virus known as covid19. Our department and health and Human Services and across the government are giving to contain the spread of disease slow the spread of the disease and to prepare for the domestic response to safety and security of the American People and we are working on a proactive role of government response in fulfilling that mission as required by congress in 2018, President Trump signed the firstever bio Defense Strategy to build upon the ability to rapidly respond to and limit the impact of bio incidents like the ones we are facing now. We are seeing the strategy paid dividends in the response to this disease. Dhs is taking action at the airports of entry and slowing the spread of the novel virus and working to decrease the workload of Public Health officials, expedite the processing of u. S. Citizens returning from china and above all ensuring resources are focused on the health and safety of the American People. Dhs including Customs Border protection transportation security administrations continue to work very closely with our partners and the cbc to route all admissible persons have been in Mainland China and iran in the previous 14 days to one of 11 designated airports of entry where the federal government has focused on Public Health resources. Any admissible person whos iran in the previous 14 days undergoes corrective entry at one of the airports and if they are asymptomatic to 14 days of self monitoring to ensure they did not contract the virus and dont pose a them ended up 95 on duty at any given time and for those that are medical screening are identified as particularly at risk they are then referred to the personnel that are onsite and made on sie arrangements with local Health Authorities. This has involved over 53,000 air travelers to date. We realize these actions could prolong the travel times for some individuals however Public Health and Security Experts agree these measures are necessary to contain the spread and protect th to protect the an people. To minimize disruption, the air carriers are working to identify the passengers before the scheduled flights. Dhs costs the wmd is screening efforts through agreements with state, local, private Public Health and First Responder personnel thats where the contractors come from. They established the capability in response to the virus that was emerging last summer to deploy the cbc with screening operations at the dhs was able to adapt t adapt the capabilityo quickly address the 19 threat. They are also the providing direct support to collect passenger information at all airport allowing the cdc to provide that information at the officials to facilitate Contact Tracing efforts. The efforts have significantly increased the accuracy of the data collected. The cbp and the coast guard continue to work to recognize the individuals arriving through the land ports and waterways who may be carrying the virus. All in coordination with the cbc. The coast guard continues although distant offenses of arrival this is one they get you for any ship comes through the american port. The medical status of anyone on the ship captain of the port will communicate any concerns stemming from the crew or passengers to the coast guard chain of command and the cosmos and quarantine station who will coordinate with local Health Authorities to ensure continued facilitation of International Trade coming on th come in on tr commercial vessels that have been in china or in work crew members have been in china or iran in the previous 14 days with no septembers, reload and depart the port. My time is up i will stop and im happy to answer your questions. The next witness is doctor Robert Kadlec the secretary for prepared to send response for the department of health and Human Services prior to joiningg in 2017 he served as the staff director for the select committee on intelligence and special assistant to president george w. Bush for the defense policy. He served in the u. S. Air force for over 20 years and was in u. S. Air force Flight Surgeon in the year 1986. They were expanded, i want to read a little bit more. Doctor kadlec was instrumental in drafting the pandemic signed a law. Conducting the bio defense assessment that culminated in drafting the policy for i appreciate it very much and that is a nice way of saying im a one trick pony. [laughter] Ranking Member peeters and numbers of the committee of the hhs is supporting the whole of hhs an and u. S. Government respe to the 2019 corona Virus Outbreak. Im this morning jus just want to take a few minutes to discuss how we are addressing this from the point of strategic anticipation. Working with my colleagues on supporting state and local authorities working hard to contain and mitigate the Virus Outbreak to save lives and protect americans. As for the four pronged approach to the domestic response this includes Countermeasure Development, supporting the Health Care System, incident management and direct support to the state and local entities. In the Countermeasure Development we are rapidly establishing the Department Counter or task force that includes partners across hhs, the department of defense and other federal agencies and private sector to identify therapeutics diagnostic vaccines that could be readily brought through the pipeline to address the coron coronavirus. They are looking at rapid detection and treatment and the therapeutic state and support of the affected persons. We are also working closely with nih combined all of the efforts pushing platforms as fast as possible for the overall response. How do we separate the Public Health system through the Hospital Preparedness Program in coordination with the Public Health emergency Preparedness Program we have improved coordination and collaboration between hospitals and Public Health sector and other entities like the medical services. Services. Weve also leveraged the national evil of treatment which was an idea created by congress and establishes the response of the 2014 people ebola as the Health Care System discredits the coronavirus this network has and will continue to link technical experts with quarantine to the treatment efforts of the state and local level. Shifting to the overall response structure since repatriation neighbors began, weve been working with the federal Emergency Management agency to put in place based on the National Response framework this is the first time that we have implemented a structure though we have practiced activating the structure in previous exercises, we are doing it for now and that means we can leverage the capacity. I want to end with a few brief update for we are providing direct support to state and local entities. I mentioned the repatriation where we brought approximately 1100 american from wuhan into the diamond princess cruise ship. There are no planned repatriation efforts at this time that show that there needed to be we are standing ready to support the state department or any other authority to provide direct support in the states weve used the stockpile to protect healthcare workers in a second shipment is arriving today to help with before they sent it this weekensend it thiso planning 28 of our Commission Corps Public Health Service Officers and team members to support them as well. We are concerned about the facilities where we know the most vulnerable populations reside and are working proactively with cms and cdc to provide information on the best practices and when possible help them shield the more older populations from the impact of the coronavirus. With that i would be happy to yield the rest of my time and would be happy to answer any questions that you may have. Thank you, doctor kadlec. I do want to ask questions. Normally i yield desk later that i just want to get some clarity on a few thing things because iw this has been confusing. Lets talk about the testing kits. My understanding is 2500 test kits will be distributed the end of this week, which is like tomorrow. Each test kits can perform 500 tests so if you do the numbers on it, that is 1. 25 million individual tests. Senator haskins was remarking yesterday that each to be sure should be tested twice and that is about 600,000 americans. Is that an accurate assessment or where are we at in manufacturing the test kits within a week or ten days of when the sequence for the ofe virus was boosted by the chinese again to work on the reaction test which has been a genetic test to look for the presence of dna gets to do a proof of concept and also prototype and then begin to produce that at the cdc and shifted it to the commercial manufacture. They are the individuals that are basically making the 2500 test kits that include 500 tests per kit to 1. 2 million. Those would be going out to how many Different Centers . Connect to 190 places around the country and the cdc already distributed 75,000 already. Its to maximize the number of tests that can be performed. This puts reasonable expectations behind this these are test kits that will be served around the country and have to basically validate for ththetest procedures and train e personnel so they will become immediately available or increasingly available over the next week or two to basically test americans which is another part of this critical function thereve been several things to basically enhance the testing posture. To ensure they are validated and thereve been things that have been done to increase the use of the test by indicating people that fit the Case Definition for the possible coronavirus can relax so we can test more people and thats been a significant ability of doctors in firstline primary care physicians and nurses if they suspect the virus so theres a lot of us play as well as falsepositives than it takes time to manufacture the first test kit into time and allow to validate the labs at the personnel they need to be trained that they were thinking within a couple of weeks would e would be a capability of testing about 1. 25 million tests and then my guess is that ken ramp up pretty quick. Theres an expectation for the company to expand the manufacturing and also a parallel being done to engage a commercial laboratory testers so that would proliferate across the domain. There will be plenty of opportunity for testing and what they are focusing on is being able to ge the point of care diagnostics to support the positions on the front line in their offices and the sweetest people in offices to decide whether or not someone has to coronavirus. What will happen if it is going to be public based and commercial laboratorybased. This takes time. Everybody recognizes how important this is because we really cannot get a game plan until we know the extent of the problem. It sounds like we are developing a vaccine in a rapid pace so we will make sure that its safe when . They believe it can be done in a couple of months and even after that its period of time for the safety data. I want to create the expectation to develop one dot then we have to validate the safety and validate that it will take a couple of months, so now we are four or five months out. That is the study that will look at that so it will take how many months . You are r. A year before we really have a vaccine that we think is safe and that will be effective i think it was up to a year an and a half to moderate e expectation. Lets say we have a vaccine that is safe and effective but youre not going to be able to mass produce the yet. Would you be able to produce enough to provide to the response to doctors, nurses i think he would prioritize who will have access to the general population. In the generous funding it is the manufacturing for this particular virus is limited and we could use much of the eggbased production so for these new technologies like synthetic or genetic vaccines we have a limited capacity so we would be somewhat constrained to get the vaccine for everyone but it would be prioritized for those who need it most. This will use one of those sophisticated techniques. If you are talking 18 months before you start to manufacture we will mix next years flu season and you are not going to have a vaccine available until 2022 flu season. Thats why we are putting a lot of emphasis on the diagnostics and therapeutics. I did mention in my Opening Statement that screaming and approved drugs activity to basically do that in the supplemental so we are looking at thousands as well as the candidates. But quite frankly the only thing we really have. The vaccines in the future turn to how do you mitigate this and that will be how do you screen and get your arms around what this is. We will talk further about other actions should this become a far more significant outbreak but my time is up. Senator peters. This information is important as i mentioned in my opening comment is important to get this information out to the American People one thing i called for yesterday as we look to find out where information is in the public theres good information. There is no one coordinated a place where people can go to find out exactly what the government is doing, with the agencies that whole of government approach coming forward so my suggestion is we have a website that is trusted and talks about of what the cdcc puts out with the travel restrictions or implement Security Department to read all of this where people can go to because people are just actively searching and i get this back home they are searching for information and theres all sorts of websites that are not accurate and they try to create fear and theres a lot of stuff happening right now. To have one coordinated site that makes sense. Mr. Cuccinelli. We have used our websites at the Department Level to describe what we are doing but it is a whole of government approach and it is a complicated interaction at the government level. I would also note and well talk more about it i am sure they preponderant gold local and state officials play in this response and then coordinating between Different Levels of government as well. I saw your letter, senator, was glad to see it and it makes an awful lot of sense particularly in a circumstance like this where doctor kadlec for instance has the lead federal agency theres an awful lot of us working on the subject which is why the president convened a task force so its definitely something we heard you loud and clear. Im looking at the cbc website putting out facts about the disease and last night the president was being interviewed into some of the comments caused confusion so im going to take an opportunity at this hearing it says here if you are sick to keep from spreading respiratory illness you should stay at home when sick. Is that accurate . I know theres some confusion. Part of the best thing is self isolation there are some reports that some foreign nationals have traveled to china the past 14 days are actually coming into canada which doesnt have the same restrictions and they are crossing the land ports of entry from the northern border obviously michigan has an active border but all across the northern border. Are you aware of these reports and is the cdc conducting reports to try by way of exampld then crossed into the United States. The three largest land ports of entry for the chinese nationalsy at the airport it wasnt advertised necessarily. That wasnt advertised necessarily. I would note that the proclamation of flies and land as well as airports and we have excluded over 304 in nationals. . Because of their travel history the cbp does have some access to this at the border depending on how the individual or family. If they come through air travel recently that is a fairly straightforward determination but they are also doing interviews essentially. If you think of the airport arena, the cbp folks do a travel interview. Where have you been, who did you encounter, etc. And then the next you get more of a medical interview, but that first one is the location that is the first and biggest flag and predating the virus situation, cdp has always had access to the cdc when people present in front of them with the appearance of illness. Of course the danger here you can be asymptomatic with this particular virus tha but that hs been vigorously engaged in both borders north and south. Is even more complicated when someone is coming across we have two of the three busiest border crossings. Lots of vehicle traffic. How are you doing that . The main screen that is the first filter and biggest filter is the travel screen so we are using the data systems we have available to the officers and that interview which while they were always doing it, theres obviously a heightened focus on china and iran but also korea, italy, japan, etc. Theres not a proclamation barring those but if you get a yes answer to those areas of the world, you will still pay closer attention it medically trained individuals but if theres anything that they suspect, then those individuals will be pulled to the secondary screening and contact made with the cdc and it becomes a consultation with genuinely medically trained folks that are not physically present. It is a far from foolproof system. That is a really important point, mr. Chairman. This has never been from day number. It would be unbelievably costly. To be able to mitigate it and you are buying this time of the borders and thank you for having that. Again which is what they said in a private briefing it definitely delayed us and was contrary to the models so it wasnt necessarily predicted to work that way. Our analysis in the past so now we can monday morning quarterback ourselves not as clearly. But it bought us time. Senator carper. Doctor kadlec given the potential for the fairly rapid spread of this virus we cant afford for coronavirus screening. What are you and your staff doing to ensure that the screenings and treatments are lowcost and affordable and how do you ask your insurers to remove the financial barriers to the screenings . That was appreciated and that is why the head of cms is part of the task force to focus in on part of the problem. One is about the accessibility of healthcare for people who may have the coronavirus as well as affordability issues hes been engaging with Insurance Companies and its not surprising that someone they be taking advantage of this but shes nosheis not someone to beh and i have confidence shes going to engage on this fully. To talk more about that concern and accessibility. There is a Bipartisan Commission on coyotes and. I think doctor kadlec, you may have been the founding staff director for the end it is now cochaired by tom ridge, former governor, former secretary, and Joe Lieberman whose wife is a chairman of the committee as you may recall. In 2015 the group issued a report that included 33 recommendations to improve the nations preparedness for intentional or naturally occurring biological threats. Im pleased to know the president has told one of thosef those recommendations by centralizing the response efforts at the highest level of government with advice to the president. Many of the recommendations remained unfulfilled. As the founding staff director, could you speak for a minute or so about the recommendations that still remain to be completed and what stands in our way . There was a second when completed ionecompleted in the o Defense Strategy to understand what is the whole of government we need to do quite frankly that is Unfinished Business and i think that is the intent of the study panel to evaluate what needs to be done so Broad Strokes in the Health Care System we have a Healthcare System that spend 95 prioritized. Thats one area in terms of the system prepared us into the other infrastructure which is about the people of the state and local level and give us serious issues around the number of people willing to get involved in that business. I call it the Rodney Dangerfield of medicine. They get no respect because when they do everything right, nothing happens and it is a circumstance that really does require a little more nuance effort to promote and incentivize that. Third is a different infrastructure and that is for medical Countermeasure Development. We talked a little bit about the Domestic Production of vaccines and that is a good thing because we could expand back its only making sure we have the right of vaccines that they have jobs for americans and many parts of the country and enhance innovation in healthcare that is the fourth element. We are doing some of that to address the issues related to the supply chain that have to be addressed as things like active pharmaceutical ingredients if much of it is overseas and a great vulnerability as we learned through this experience. So there are things in Broad Strokes but i would suggest talking about additional steps the administration has taken all of the recommendations of the other 30 some that maybe has not been. We talk about the bio Defense Strategy and one thing on the pandemic influenza which talks about relevant to this issue quite frankly how we manage the potential pandemic of the flu and again a lot of that is about speed, speed up action which is a fundamental issue in this event and its moving faster than sometimes we cant even sing and second is about the capacities and stockpile that have to be maintained over time. I would point out one of the findings in the bio Defense Strategy as we invest about 8 billion in this kind of activity each year. Sounds like a lot of money but when we consider an Aircraft Carrier costs 17 billion we have 12 of them as a country that gives you some kind of scale of what we invest in one volume of the National Defense but we probably want to in testing a National Health security. As you know, pharmaceutical companies that exist and were founded and operated exclusively in the country often times with part pharmaceutical companies and others in the world would try to solve alzheimers disease and parkinsons. What kind of collaboration should be encouraged with respect to developing vaccines to address the virus . A group with an International Consortium that involves the Gates Foundation to focus on major disease areas to address e harder problems and also understand that in many of the cases its the greatest at risk so to make it affordable and more accessible so those models are very helpful. They can be better positioned to help themselves and that was the success of the western congo outbreak of ebola where a small amounamount helped build the infrastructure as well as the availability of the affected vaccine and its sort of different story but those are some of the examples. Thank you so much. Thank you mr. Chair and both of the witnesses not only for your presence here. Thank you for Public Health labs and now we are searching up on the commercial side to test capacity and part of the process is going to be once the commercial lab did the testing, theyve got to validate them. So how long does the validation process take . Im trying to get a timeline so people understand when this will be making a difference in their experience. I think the key thing is based on the availability of the tests now and the delivery they are being delivered now in the Public Health lab they will be increasing by the end of next week. You probably see that capacity capabilities. So then you can imagine the commercial laboratories will be lacking about a week behind them give it a how long does the validation process take . A couple days to do that. Basically its for the machine and validating the test into the people that have to work a test kit. I dont want to belabor this but if they would put down a timeline and see the writing on the website, you dont have to promise and accept date but when it would be reasonable to expect the commercial labs to perform the testing if the doctors suggest you get it i think that would be very helpful. I wanted to move on to another issue as you know the disaster medical system and other programs play a Critical Role in insuring the uninsured and underinsured patients receive care during emergencies by helping to reimburse hospitals. I know that you mentioned earlier that this issue was under discussion. Can you provide an update on the conversations and more broadly with the administration is doing to help ensure. I do know that in the supplemental there is money to basically support tha that and t would basically expand things about a billion dollars so you were generous in that application and i think that will be money that can be used for that purpose to ensure we can take care of anyone afflicted with this. There are stockpiles of equipment such as masks but they recognize the stockpiles may be quickly used up and weve already had at least one confirmed case in new hampshire. Based on your testimony earlier this week i am concerned for National Strategic stockpile wont be sufficient to meet demand. What is the timeline for getting the equipment and how would you advise people to protect themselves in the interim . The strategy to basically address what is your point is if you have it offhand immediately yowill have to face some challenges. One is we have a stockpile or limited stockpile right now as masks, surgical masks, and we are in the midst of procuring more and it was released as of yesterday the request for proposals for 500 million respirators to basically be provided for the next six to 12 months. So that will ramp up. And it provides funding so the manufacturers know they will get paid. Do you have a plan in place to ensure firefighters, Public Health officials and responders are appropriately prioritized . Weve met with manufacturers yesterday and i think i that is one of the conversations we are having. In the course of just the given year only 10 of the Health Care Professionals and First Responders so much of it is used by construction mining and manufacturing the fda has given authorization to allow on medical masks to be used by the population, First Responders included and we are going to work to see if we can get an allocation to make sure that they are covered. That is helpful to know. In addition to the states meeting these supplies, its going to be important to provide training to the responders that will be tasked with this treating coronavirus. What efforts are underway to in sure the responders and providers can Access Training on the use of personal protective equipment . One of the critical things and again the product is the national evil of treatments that work and wish that it was more generous than them now to basically address not only the ten Regional Centers of excellence, but they also in the north new england area started the regional disaster with the General Hospital thats working with your area to basically train and prepare people so that would be one mechanism we could get training out and specific management on how to manage these experts and when you use some of the people from the general and repatriation from diamond princess. I think its going to be an important something thaimportand secretary wolf yesterday because it is the proposed budget is actually cuts to programs that train First Responders so i want to make sure we are focused on that. I am just about out of time so i think you both. Thank you mr. Chair and for being here. I know youve been to a lot of hearings and i appreciate the around the clock work. The virus is moving fast and reported the first case of the virus today. Ive been in close contact with officials, the Governors Office and i wanted to size and stressed the importance like the other senators here how important it is to keep those clear lines of communication open with good data that they can respond to the boots on the ground. The federal assistance for the impact of individuals is larger quarantine measures are needed and justified what plans are in place who may miss work due to the government imposed quarantine but not necessarily to their illness, any folks live paycheck to paycheck the loss of a few days work as a hardship but alone staying home. This could lead to people losing their homes, not being able to a food afford food or other essentials. What can you do to help alleviate this in the short term, what do you need from us to help with that . Fema has been in touch for almost a month now and assisting in bringing expertise to the Disaster Response to this effort. Still with the lead federal agency of course. People naturally look to the act and this is a disaster for inst, so there is a base found where governments, governors can make requests. Can you speak to that . I believe that secretary as are has the ability to expand aid, welfare programs under these circumstances but fema nor dhs have dollars available that are legally fitting the description of the relief you are describing senator meant to be covered and addressed in the supplemental and that is the appropriate vehicle. I would note more generally that referring to the Planning Efforts that have gone before we operate off that plan and it was envisioned the financial vehicle to deal with an outbreak of this nature was be a supplemental so we are sticking with that plan we would come to the congress and it includes the kind of things you are describing. You are mixing two things. If the supplemental includes money to address the type of financial shortcomings you are describing, then the answer would be yes but there is nothing in place that fema has available to fulfill the need your describing. So we may have to look to that in the future to take care of those vulnerable populations. The next thing i would like to ask you is immigrants seeking care nevada is diversity and strength and living in households with immigrants and are undocumented as he worked to contain the coronavirus that there is timely access to medical care for everyone that needs it regardless of their status it is a Public Health and safety issue. Living left but its all communities at risk. No one should be afraid to seek care and as the coronavirus spreads putting counties at risk would you refrain apprehension of vehicles of the immigration status while seeking care . Much like the cdc relationship to preexist the virus i. C. E. Also has it already in place the sensitive location policy they do not do enforcement in Healthcare Facilities with single case circumstance. There is no reason anyone should expect. But what about the intimidation factors such as placing vans outside of Community Centers where people may go . That would be consistent with the policy. Thank you. I yield back. Very quickly we discussed this looking at the supplemental zero dollars for dhs and we talk about this can you describe the thinking of congress and how dhs needs the funding to do the things that you need to do in the situation . So the starting point is that fema is in the Office Every Day assisting hhs. That is financed by hhs so there is interagency agreements in place so the dollars that flow to hhs to address the challenge they do flow to dhs when we provide those supportive efforts from any agencies or components. There is a mechanism in place . So you are not concerned when you look at the supplemental . Where are our support or resources . You get those through hhs this request two. 5 billion we will give them eight resources should not be a problem. Exactly how this will work Going Forward as it has for the last month or so. Thank you for being here and the excellent work you are doing to address this outbreak very concerned about the spread of the virus and what this has exposed. And the fragility of the vulnerable one the vulnerability that you address this too many drugs or pharmaceuticals themselves are manufactured in other places and now we have seen reports about drug shortages because the chinese factory closures this is something we have to scramble to address now that if this outbreak continues we dont have severe medical shortages but also Going Forward to take this action. So let me start with you, can you describe the actions of the task force are taking to ensure Healthcare Providers providers of an act one uninterrupted access . We have been working with the Key Manufacturers in the United States with distributors and again it is a delicate balance to ensure what is made available to the stockpile not only ours but distributors to provide for private healthcare workers and institutions. Many do have a limited stockpile and for those materials as we did in the state of washington what is available commercially so they dont run out in the emergency of this nature. But this stockpile works handinhand with partners to monitor shortages. Can you elaborate . Basically again if not daily or weekly conversations with major suppliers respirators three m or honeywell to basically understand their allocations to the private sector and the needs for the federal government as well. There are Many Department agencies so we can moderate to ensure we have enough in the pipeline. Its my understanding the fda is working with the manufacturers to monitor the shortfalls so to what extent are they complying . They do this through a confidential business arrangement i do believe it is entirely appropriate. But the doctor would be an excellent source to come in and brief you what they are doing. At this point there is only one drug that has been identified as a potential shortfall and there isnt any that could be substituted. But he monitors that like a hawk with his team but with those longerterm risks. My own view we have to give the fda more authority to see where they come from and then give the authority by speeding up approval of alternative devices of drugs manufactured with this legislation. Do we need to look at travel restrictions as the virus spreads . The short answer is yes but thats because we were literally considering on a daily basis. The driving factors would include how they weigh in each country. First the transparency of the nation under consideration compare chinas transparency to korea that is a rather dramatic difference. The ability of their own Health Care System to respond to the outbreak in their country. And the capacity remaining after they do so. So the state departments warnings early on about china were not because of the outbreak but also directed to keeping all us employees safe because if you got in a car accident completely unrelated to the coronaviru coronavirus, there was not a doctor to take care of you. So they have systems in parts of their country were and are overwhelmed. That is another consideration. China on the other hand has a very different consideration and they are neighbor mongolia if you compare the Healthcare Systems, mongolia close they are border very fast with the rationale they do not have the ability to respond we are talking in this committee about strengths and weaknesses of what we can do better in the future but those factors weigh in on those other countries. So your testimony is you are talking on a daily basis. It is the interagency process were using to scales to warn americans both the state Department Travel advisory scale between one and four and cdc health scale the alert up through three and the numbers are off by one as we go up or down. But we have found that i dont think we have ever seen such responsiveness to their travel advisories. Weve never seen such consumption by the American Public of 500,000 downloads of the Business Advice and guidance over the last 48 hours. That all has a real meaningful effect without government mandates the tsa issued security directives effective yesterday regarding italy. But the minimal impact in wake of the value and credibility. Let me just come back to you before my time completely expires. To see the other countries like south korea with 10000 diagnostic tests per day where citizens can go and be tested. Why are we not at scale for Something Like that and while were at this topic what about the defective kits . I cannot give you that reason cdc does a brief you but with those earlier conversations we are scaling up now with commercialization and what is used in Public Health laboratories and to engage the commercial labs to do large volume of testing. That will roll off the line in the next week or two to expand the opportunity not only testing in hospitals and clinics and doctors offices to use commercial laboratories. That would be rapidly turned around. We may not get the drivethrough swab if you call it that but you do have to do that with some precision and you could risk somebody if youre not careful and get a false negative i wouldnt think jackinthebox would be swabbing anytime soon. I havent seen anyone talking about pregnant women is there any precautionary terms . There needs to be a better understanding for a vulnerable population as well as the different physiological effects so this report the coronavirus report for a case of a newborn in china thats the only anecdotal case that is our only major issue and concern. Nothing else as of yet we are not getting case reports. And the millions of people so what did advice are you giving to the airports and the seaports that we know they have coronavirus what options are you putting in place . First of all the coast guard tsa in particular have very regular communication with the cruise lines in the airlines and in fact i have been doing that as well you will have noticed for the First Time Ever talking about travel advisory specifically related to crew ships not a country or a location but to the cruise ship from a standpoint. And in terms of those responses with the cruise ship industry and the diamond princess was a viral disaster and to avoid a repeat of that series of mistakes that will take a long time to understand that has driven a lot of that response we are seeing. 2. Declins but korea has declined maybe by half urge opinion 25 percent by way of example and there are good reasons for that the crew ships themselves in my discussions are themselves trying to bring on passengers from the hot zones to avoid a repeat of the results to quarantine a ship. And you do have many ports in florida the captain of the port the coast guard person is an absolute control. We hold the ships off shore where needed and throughout this entire time to be associated with cargo shipping we have tried very hard with supply chain to keep the cargo flowing because of the interconnected nature of the supply chain. We have taken special steps to keep the ship cruise on ships to allow the reloading without the usual coming to shore in the passenger context that is much much more difficult we continue to contend with these senator harris coming in from San Francisco literally as we speak that is being dealt with directly. The captain of the port will work directly with the regional cdc head to address these on a casebycase basis with dealing with the passengers. Having been governor of florid florida, if we were to try to use the Healthcare Facilities to deal with the entire cruise ship we would swamp the Healthcare System locally so that is our counterbalancing challenge for the cdc to make those local arrangements with the coast guard has all the time we are handling them one at a time but it is with the eye not to bring ashore virus spread that is why weve warned americans not to g go. We have a lot of international flights. What would it take for you to do the same thing to restrict travel out of china . Of course that was taken literally in the worlds epicenter still the largest number of cases in the world we dont see anything like that developing to that scale korea and italy are picking them up very fast because when you take a snapshot of todays cases it is a threeweek lagging indicator of what was already there. We are operating with this virus that hasnt existed for three months a lot of areas we lack knowledge that hurts you right now and that will keep hurting you for a little while. We dont know how long but obviously the challenge is to try to keep americans. I dont believe any information coming from china. So do you have any inclination to open up travel from china . That is not on the discussion table. We are not even talking about it right now. It would be important for my state. But the cruise industry will you get to a point you will Start Testing everybody . That is casebycase however right now literally as we are speak throwing one sending out test kits off of california with the coast guard dropping onto the ship and bringing kids with a very large number coming to the ship so we have full information when the captain of that port talks to the local cdc authority they have already been working on the action group with the cruise line themselves we have been working this for days. Real quick i word think that because its such a unique situation that would be one of the priorities to get a test ki kit. Thank you mr. Chairman. As you know my state home of 40 Million People with the largest number of cases 52 the governor declared a state of emergency for the entire state. This is an interesting convergence between Public Health concerns and equities specifically two thirds of low income workers do not have paid sick leave. As we know we have been encouraging people to stay at home. Often people in that category are in the Service Industry they work in restaurants, hote restaurants, hotels, child care and come in contact with a lot of people. For them to stay at home in the interest of Public Safety means they may not be able to put food on their table. Understanding this is a very real issue what is the administration doing to encourage employers to have paid sick leave for employees so they will stay at home and not have to make that decision whether it is Public Safety or put food on the table. I will speak first to the communications with people across the private sector in addition to accelerated communications we have been talking to on Healthcare Private enterprises encouraging them in this direction as well that recognizing that burden for employees to stay home on the employee. You identified certain businesses its important for everyone else, not just coworkers for them to stay home if you are serving food then if they dont want you to come to work. And how we support you talking with the private sector. We already have a standing Sector Consortium they are talking to and this is one of the subjects they talked about supporting employees who were asked to stay home were also asking businesses in those lines of work where its possible to make telework arrangement so they can keep working and keep getting paid you dont function as well but you could still earn money for families. My concern is for the majority of low income workers who do not have paid sick leave they are in the Service Industry and its not an option so perhaps we could follow up how we can support your effort to figure out ways these employees dont have to make a decision between paying their rent. And there is money available but i would refer to hhs. On the White House Task force mr. Kudlow and secretary of addiction one secretary minutia and talk about Small Business to support those individuals and how they can do that im sure they will welcome the opportunity to support individuals were facing this problem who are challenged. We have many federal employees who again their job does not allow them to telecommute like tsa or postal workers so what is the administrations plan for those workers in terms of what is soon to be enumerators for the 2020 census what is the administrations plan to deal with those federal workers who do not have the ability. One of the subgroups in the task force is dealing with the federal workforce and of course to use the department of Homeland Security as an example we have a building in Washington State unfortunately we had an employee test positive. That is one setting dhs operates Border Patrol station or a tsa desk were a bunch of people go by in close proximity each day. For those it would apply the cbp and others we have made tpp available to them the medical guidance does require appropriate to use that is advantageous. I have been out to dollars air one airport when the china flights for coming i observe the difference of the employees that when i arrived have their uniform on looking like you and me but when the china flight arrived gloves and masks were on and that is available for the frontline folks that is closely studied and we are pulling down unnecessary travel for the general public. As a followup of the undocumented the reality is there are many undocumented immigrants and we also recently had an announcement from i. C. E. They would increase enforcement. It is legitimate and real concern that undocumented immigrants in particular their family members are in fear of or discouraged to go to Public Health facilities if they are sick. I heard what you said about the policy. Would you be willing to issue a Public Statement that during the crisis we are now facing that there will not be i. C. E. Enforcement whether hospital or medical clinics . We issued a statement yesterday obviously the statement was based off the existing policy. And for both witnesses theres been a lot of discrimination against asian immigrants and Asian Americans Public Health experts agree coronavirus does not focus or target any group by race or ethnicity but we are seeing many reports of intimidation and profiling and threats to the Asian American community. What is the administration prepared to do to dispel this information about this issue . It is very real and we already have enough fear about the Public Health crisis but to calm pound that with friends and neighbors with fear to be profiled as real. Obviously we are trying to convey calmly lots of different information about a virus and much of which is unknown and we have woven into our remarks at every level of government the same concern that you have just voice because periodically, we do it candidly when we have instances brought to our attention so that now the department of Homeland Security and other places, with her soon thereafter Public Statements is when we try to knock that back but we want to be very clear as you said the task force without question there is no difference this virus shows black or white or asian or hispanic or anything else. The dangers starts to the same people regardless of race or ethnicity and our responses should be irregardless of their skin color or ethnicity and thats how the federal government is responding to it if you talk about the northern border with china with that proclamation or canadians have been barred on the northern than chinese because of that proclamation because it was travel base not because you are chinese but you were in the hot zone in the targeted time period of 14 days we will continue to operate that way and to make efforts to knock down storylines or narratives that say anything different from that. Thank you to the witnesses for participating today. I represent arizona with confirmed cases the Arizona State lab and Maricopa County a Public Health and Arizona State university took swift action to mitigate exposure to those in the community. We need to see that same level of cooperation on the federal level those that were quarantined on air force base received little or no information about going home another individual who has been released doesnt of a test positive now they are on their way home some are still in quarantine and this lack of communication is unacceptable our constituents deserve straight answers under the guidelines and the efforts with the vaccine and treatment must be driven by evidencebased Public Health expertise. My first question, Innovative Companies large and small are working to develop vaccines and therapeutics that are diagnosti diagnostic. Johnson Johnson Sanofi and merck and others are included with the all hands on deck effort new innovators like the phoenix biometrics have submitted information to the cdc to evaluate the biocentric technology to detect airborne virus one viruses but once approved what is the prior to rosacea and strategy for deployment to target those vulnerable populations of seniors with Underlying Health conditions and also what about frontline workers like Border Patrol at ports of entry or healthcare workers in servicemember stationed abroad in hardhit countries . I will take the first and quite frankly yes, we are actively reaching out to Innovative Companies we actually have met with 1500 commercial entities and universities and the like we would be delighted to receive white paper readies suggestions from your folks on this. I would be happy to provide that information as well. The key thing here is we look across the domain. My director is behind me. Basically they put out a broad area announcement to look for innovative ideas for countermeasures so again so to engage in that area so with the area of vaccine as a possibility from earlier conversations its more like 18 months when we would have something and the scale of that availability is dependent on the kind of vaccine that would be developed primarily there are three candidates that are considered Johnson Johnson has one and sanofi is the third. So much that will be determined on the prior to rosacea that you identified clearly there is a National Security component to protect the forces is how we protect the people like healthcare workers and then the vulnerable populations which are significant so that all has to be factored in those are answers yet to be determined with those answers that we can come up within the time that we have. With respect to the prior to rosacea and you can expect to see when we reach that point, what i would call a traditional high risk categories the mortality rate if you are over 60 with a secondary condition is much higher than if you are under 50. So limited supply will be funneled to the priority categories as that typically happens already. We also have to work through exactly the kind of challenges you describe of force protection as well as frontline and First Responders the people who come facetoface and healthcare workers i am sure you are familiar with the first doctor in china to speak publicly about this has passed away otherwise a healthy 34 yearold but healthcare workers are a limited resource in the sense that nothing any of us will do here will make more healthcare workers to fight this battle. So they get priority to care for them because we need them to care for everyone else. And that priority will go forward and will be similar for First Responders so you can fully expect to see that play out in your state as a border state that does include Border Patrol agents to man those post and deal with those that dont come in with documentation or medical history and we have to be very very cautious in the circumstances. And frankly people can wipe that out for utility purposes. My second question recently announcing more types of respirators to be used as part of the response to address shortage concerns. We introduce the Healthcare Workforce protection out to address liability concerns by mending the preparedness act to include respirators that are certified by the National Institute of Occupational Safety and health can you talk about the coordination efforts to ensure adequate supply including efforts to incentivize manufacturers to increase production . That is a critical issue to be addressed. I happened to be on the Health Committee at the time when that was originally considered and enacted i have firsthand experience one thing we didnt consider at that time was the situation we have right here right now because we thought influenza would be the principal threat so we focused on the idea of countermeasures that would be necessary to protect the Frontline Health care workers like vaccines or therapeutics like antivirals. So to be focused and did not include respirators that was 15 years ago. Little bit of oversight and has significant implications for today so thank you for introducing that bill that the house companion bill and i hope that congress would take action on that we did try to take an effort to put that in the supplemental but this is vital to the producers of these products if you point out the fda gave the authorization that allows nonmedical to be used by the Healthcare Industry that is vital. We have a requirement for healthcare workers depending on how severe the outbreak is for a couple billion respirators there was no physical way we can produce those, in particular the medical ones that are important in the operating room and those that are resistant but we could use the public ones by industry that are not resistance to be used in other Healthcare Settings as we expand the ability for the Frontline Health care workers. Right now the only thing we have is that protective equipment and First Responders so thank you. Thank you mr. Chairman. I appreciate this very much mr. Chair and i appreciate the witnesses stamina i know you started at 8 00 oclock this morning with all senators. I just want to circle back to something you had talked about on the cruise ship issue. We learned from the princess the first positive test on that ship it took several days at least before a quarantine was implemented at the end of the day 3700 people on board, 700 tested positive, six death, i thought we determined it was not a good idea if there is a positive result on a cruise ship to keep everybody on the cruise ship together. Now a little bit of what you said we are hearing the very same cruise ship off of california has 40 Million People were there is military bases and facilities but yet we dont seem to have a protocol to get them off the ship into quarantine in a way to minimize the spread of infection. So i am curious and concerned given the example of the diamond princess we dont seem to have a protocol in place right now that is clear. First of all, lets be clear about what we learned. That was a bad quarantine. It was not a successful quarantine situation. And not just because the virus spread but because that was a secondary effect of a bad quarantine. The lessons we learned were negative im sure that doesnt surprise you. But thats my point and from news reports it sounds like what happens on the diamond princess is repeated on the ship. The initial assessment with the diamond princess before the spread accelerated the safest thing for all passengers was to bunker down and isolate in place and because the quarantine was not maintained effectively that did not hold. If it was done well it would have been the right course. We obviously dont want to use one bad example to set the rule for Everything Else and that is why we have flown test kits out to the ship literally as we are speaking that is going out so we have greater clarity what we are contending with. You may remember the cruise ship out of new jersey when that one came back basically we investigated the circumstances on the ship and had an offload strategy for that ship the captain of the port working smoothly with the head of cdc and then last brought those suspected of infection off separately to a prearranged local healthcare facility. We could do that because it was for people if you start putting zeros on that number with a heavy suspicion of positive you could overwhelm local healthcare. I dont want to belabor the point except to say that it is not as if we have to take all the positive people those that have tested positive and send them to one local healthcare facility we have lots of them some states are hitting on being hit more than others so i think its important we have protocols in place. I understand the importance of factual case based determination but it seems like there is confusion is just an observation i appreciate the response but we have the whole country available to us we dont have to worry about or one overwhelming a single point. If i could, we dont. There is a misconception about the capacity we can put together for a quarantine. Frankly the doctor is better positioned than i but this is an important misconception. Then why dont you address that because if we dont have the capacity for a couple of months at least the highly contagious virus was headed our way in the likelihood what is our quarantine capacity what do we need to do to increase that . I know in my state we can when we need to. Will have the capabilities to manage these things even though weve made arrangements really it is a singledigit event. Unfortunately we had that capacity only a couple of dozen isolations that we could use we maxed out that capacity at the university of nebraska where they have 12 beds they expanded to 16 for us to help take care of the most seriously at risk personnel from the diamond princess. So that is another area for congress to consider, how do we do this in the future given the nature of what we experience into the chairmans point this is in the last one there will be another one behind it. And how do we ramp up now if we need to . We are americans we know how to do things. We do hard things we can ramp up capacity. We have a lot of resources and smart people and good people who want to take care of each other so lets figure this out. Another question is to follow up that senator harris was touching on, as we know a lot of people who should stay home get sick and they cant stay home and still feed their families and pay rent. So want to follow up on a question i posed earlier this week in a briefing, sometimes the federal government invokes authority to help those in need during a Natural Disaster by providing snap benefits are temporary assistance for needy families to go beyond the typical eligible. We know many a citizens cannot afford to stay home and they face a real financial burde burden, have you considered providing similar support . Hhs is exploring all of these options and to see who could receive this assistance and if there is through a supplemental he has the authority to do these other things. When will we have a determination . Because again we have a virus spreading people know if they have snap benefits if they have to stay home now they are more likely to self quarantine if we need them when will the answer come . I will get you an answer i will take it back. It has been asked already this weekend needs to be answered they sent you here to us today so i would appreciate it as quickly as possible. I want to go back first to the definition of quarantine. My guess is we are talking about something strictly defined in terms of its capabilities, medical facility for very sick people, and if we have to and it becomes more significant, there are things we can do maybe not a perfectly defined facility but we can still do things defined when you say we have limited capacity i dont deny that but in what ways is a limited . Traditional quarantine we have limited capacities to accommodate individuals to disrupt their activities. So basically having door rooms or places to put people the best place you can quarantine is their home but with the diamond princess it wasnt feasible when you try to move a large group of people across the nation and then realize they are risk it could be a risk to society have to monitor over time. Talk about the distributed approach, cdc has been working with state and local authorities for those who are identified at airports to get them to at the home of record to be in familiar settings. This all depends on this ramping up to a certain level of significance but the issue of home quarantine if some kid went to a party and should have been self quarantined now a lot of people are coming in contact with him. In the ebola experience smaller numbers and then if you look at the number of people at those funneling airports and that is it 42000 people in only 11 communities but they are not unlimited in the healthcare capacity and in the logistics of just getting that person safely and they must remain safe. To be very substantial. And to be enormously expensive with the logistical undertaking to just move a Single Person from point a to point b becomes a real challenge and you have local authorities because of the fear factor. Thats just the beginning so that word contemplate to be self quarantine i guess there would have to be some kind of penalty. Assuming it becomes far more significant. But you noted earlier we use federal quarantine here in the scale over 50 years remember smallpox it has been that long the Real Authority that expectation is local and state authorities she has the most knowledge about their community the Legal Authority travels from state to state and to have an example what one of your colleagues talked about is at an airport and wonders about the economic exceptions of cargo pilots going into town and to have the Legal Authority and to force the company and with the coast guard with the state authority they can make that decision and with all those other impacts that we word rather not impose at the federal level on local authorities and to make those informed decisions and thats why i was talking to the attorney general and health commissioner. And certainly we will be providing resources but in some of these cases. And that they dont have all the requisite information and passengers only provide of phone number or email are there holes in that data by what is provided by the airlines and what they provide to the cdc . We both have elements to speak to on this and there has been a 15 year battle going on with the cdc to get a regulation in place to get what they would say are the five key pieces of data they need to effectively do Contact Tracing if the need arises. So to deal with that final rule to direct the airlines to provide this piece of information now there is a logistical gap and when they can have the systems in place to do this. It has to happen at the point of Ticket Purchase many people have bought tickets already. Airlines are not the only ones that sell tickets it could be orbits or travelocity and they provide even less information to the airlines then if we went to the website so when this broke out cbp went through the database pulling back manifest information from the preexisting wuhan flight so 7000 passengers over the course of two weeks roughly. It took cdc time to process to use that information to contact those individuals and they found they could ultimately only reach 25 percent of them. And with those Public Health officials we mentioned how important they are so what has happened talking in the midst of the changes and then to bring on more with that dhs personnel. Their computers and then to go straight into the system but since that time they have been able to contact well over 95 percent they were trying to contact in this situation its heavily weighted to Public Health authorities that to get the information. Cdc works with them to pull the oars so that has changed dramatically you can expect when the ifr is functionally in place and the airlines are collecting the information immediately, we should maintain that level of performance above 95 percent contact rate. This is the prime example the administration has been responsive. I was not getting fast actors at of the cdc so im talking to ken in a rapid period of time you are already on the case so you could capture that information. Thats why i say from my own personal experience this administration has been on top of these issues with the gaps correcting them as rapidly as they can. As we talk about the cooperation between government and industry but the supply chain we have to have data where things are in the chain. So information sharing is important so talking about the interagency counterparts from data from the counterparts in so what more should we be doing . And to have the authority to have that information i look for the doctor to give me that analysis. He is part of the team and to have the inside authority. And anything that is arrived. And with those needles and syringes that would be important but hhs what steps do they take that is a way to respond to the outbreak . Allied of that material is the ability to provide with the pandemic influenza with 800 million needles and syringes. Thats a lot of needles and syr syringes. Syringes. Intend to build some capacity to do that using that kind of innovative approach as well as other innovative approaches Like Administration of vaccines. Theyve been very successful in their endeavors. My apologies. The point is it is trying to look at innovation to help solve some of these supplychain issues we dont just have to do it the old way we can do it more cheaply as well. Mr. Cuccinelli is that department issuing a declaration given what happened maybe you can walk me through that a little bit it would allow the government to deploy the disaster medical teams, management teams, hospitals or transportation support weve done that with west nile virus etc. Walk me through the thinking about that. The answer to the first part of the question is no but the center for close. To give you an idea of some of the work weve been doing, you are familiar with our team and they are sizable numbers of people. We have reshuffled them down to four and five person teams that we provided additional training to deal with a virus situation say hurricane, tornado and the reason we did that is because the impact can be everywhere at once. We created enough standalone team as we could help all 50 states into smaller degree with the kind of support in terms of experience and so forth so again those are the kind of changes weve been making to the structure so we are responsive to whats out there today but the stafford act doesnt envision a circumstance like this. I mentioned the availability of the base fund that i think you have to go back to the 90s it was new york and new jersey to get ahead up and alleviate if you help us now we can help. It is designed to avoid when a community or state has its Healthcare System and threatened Health Care System and threatened to be overwhelmed because they are getting paid harder than other parts of the countriecountry so there is somy available for that purpose. I would say it isnt really designed for this and its sort of backwards and forward so they would reimburse us and that is how the budget piece would work for the deployment just as they are for the team supporting them right now. I need to close this out pretty quick but who is in control of the strategic stockpile . To basically managed this event. How many are inventoried in the stockpile flex about 8 billiondollar enterprise. 8480 . Eight. Hundreds of vaccines, therapeutics, supplies, what can we afford to buy as well as what we may need. To have the required inventory now. I would have to give you a detailed kind of answer. Its something that looks at what we need to do it so if you look back at the last five years at what should be those levels of funding that reflect those requirements. The point wasnt to get the answer to the question but to raise the issue from my standpoint in terms of supplychain and what we need at the stockpile of the situation about what we need now and how are we going to procure it so if this continues to get worse and worse, weve got the supplies and recognize again to create Unrealistic Expectations it takes time to manufacture things and if it isnt in the stockpile now there will be some issues. That is a finite amount and so we need to protect them first. Within longterm we need to take a look at how we fill the stockpile. What things should be inventoried. I certainly want to use this committee and i would imagine you are the person to do it in terms of what we need to pass legislatively to make sure that we are better prepared next time. Learn the lessons from this episode and be better prepared. I am a manufacturer and when we have an fda approving drugs for use in america, the fact that weve put ourselves in position i think about 77 comes from india. Thats not a laborintensive process i wouldnt believe. There is no reason i dont believe the fda approved drug here it needs to be manufactured here. We do need to take a look at these things and be smart about this. Really want to work with you when the dust settles i think its going to require legislation and appropriation but thoughtful analysis comes close us out i want to thank all of the Committee Members that are not here for the respectful questions and attendance and i want to thank you. I hope the press and the American People are listening to the thoughtful responses. It would give them a fair amount of confidence. We dont where this is going to go but having dealt with members in the administration, first of all thank the men and women in your agencies, but this is being carefully considered. We are working through this process in a very uncertain situations within thank you and i really do appreciate the members of this committee being respectful and thoughtful of their questions as well. The record will remain open for the submission of statements and questions for the record in this hearing is adjourned. [inaudible conversations] [inaudible conversations]