Transcripts For CSPAN2 Hearing On Interagency Coordination On Coronavirus 20240713

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 there s doctor kadlec as the lead federal agency, theres a lot of us working on this which is why the president can have the task force. It is something we heard loud and clear on your letter and taking back to the task force. I am looking at the cdc website, last night the president was being interviewed in some of the comments he made has caused some confusion. It says here if you are sick, to keep from spreading respiratory illness, stay at home when sick. Is that accurate . There is some confusion now. We have one trusted source that is the best thing, isolation if you have a respiratory illness and not sure what it is. If it is coronavirus better reason to stay home but it is good practice. Thank you. Mister cuccinelli. There are reports that some foreign nationals have traveled to china. And they are crossing the port of entry from the northern border and all across the northern border are you aware of these reports, to try to accept folks using canada as port of entry to come to the United States . It is not uncommon for chinese nationals to fly to tijuana or vancouver or montreal by way of example, cross to the United States, but three largest land ports of entry for chinese nationals are blame washington, buffalo, new york. As you know in detroit they are not the only ones. The numbers are sufficiently high the we staged medical personnel at the airport, not widely advertised, the proclamation applies, we have excluded 300 foreign nationals, the largest excluded group are canadians and it is canadians who travel to china in the previous two weeks. The next largest are chinese nationals. And it drops substantially, 90 chinese nationals. The china challenge you poses real. We have been aware of it and confronting it head on and turning those folks back. You screen passengers in vehicles across the land and how do you deal with passengers in the vehicle and have the opportunity to screen. The most important scream, travel screening. Because of the travel history, cvp has access to this at the border depending how the individual or family in front of them came to be there. If they came through air travel recently that is a fairly straightforward determination, also doing interviews essentially for people at ports of entry in addition. If you think of the airport arena the cvp folks do a travel interview. Where have you been, who did you encounter . The next layer you get a medical interview. The first one, the location that has been the biggest flag predating this situation, has always had direct access to cdc with the appearance of illness. The danger is we can be asymptomatic with this particular virus but this process was vigorously engaged in. It is more complicated when someone is coming across, address that are coming across the vehicle. Two of the busiest border crossings in america, lots of vehicle traffic. How are you doing that . The main screen that is our first filter and biggest filter, we are using the data systems available to our officers and the interview, and and china and iran. There is not a proclamation barring those. If you get a yes answer to those areas of the world, you will pay closer attention in these are not medically trained individuals but anything they suspect those individuals will be pulled to secondary screening, contact will be made with cdc and it becomes a consultation at that point with genuinely medically trained folks who are not physically present. Thank you so much. A foolproof system and and this was never intended to be a hermetically sealed process. We are trying to reduce and delay the biggest peak in the virus wave hit on the United States of america and all these steps reduce and delay. They do not stop the virus and we never suggested we were capable of doing that and viruses dont care about boundaries. It is an obvious point to try to provide extra safety to the American People but by no means. It is not a criticism, just creating realistic expectations. If it was hermetically sealed, overreacting would be costly. The ability is slowing down. To buy time to mitigate it. You are buying us time at the border which is what doctor fsuci said, the travel ban definitely mitigates to this. Contrary to the models. It was not necessarily predicted to work that way. Our analysis and the task force we came to a different conclusion and now we can monday morning quarterback ourselves, that is clearly been effective, doesnt mean perfectly but but us time, bought us time. Senator carper. Thank you for joining us and for your testimony and your work. Given the potential for rapid spread of this virus we cant afford for patients to delay screening because of affordability with respect to insurance deductibles and copays. The news media documented one shortterm Health Insurance plan billing a patient more than 3,000 for his coronavirus screening. Test. What are you and your staff doing to ensure coronavirus treatment is lowcost and affordable. Have you asked Health Insurers and employers to remove barriers to coronavirus screenings. That was appreciated and that is why doctor seema verma is part of the task force to focus on that part of the problem. The accessibility of healthcare for people who have the coronavirus and the affordability issues she has been engaging with Insurance Companies and it is not surprising someone may be taking advantage of this but this is not someone to be fooled with and clearly have confidence that she is going to engage on this really but we can certainly have her available for briefing for members if that would be helpful to talk more about what cms is doing to address that concern, accessibility and affordability. That would be well received, thank you. There is a Bipartisan Commission on bio defense, it is carried by tom ridge, former governor, former secretary and joe lieberman, in 2015 the group issued a report that included 33 recommendations to improve our nations preparedness for intentional or naturally occurring biological threats. Pleased to know the president , centralizing response efforts at the highest level of government in this case, many reclamations however remain unfulfilled. As staff director of that commission would you speak for a minute or so about the recommendations that still remain to be completed and what stands in our way . Broadly there was the national bio Defense Strategy, the foundational document or effort to understand what we need to do. A lot of great Work Congress did with the administration in 20056 and that is Unfinished Business and that was the intent of the study panel to evaluate what needs to be done. Broad strokes in the Healthcare System. We have a system that is 90 privatized, running on limited margins in terms of probability, limited surge, that Surge Capacity will be tested to the limit but that is one area in terms of hospital Health Care Systems, a major vulnerability. The other one, critical infrastructure, really about the people at the state and local level land serious issues in terms of the number of people willing to get involved in the business. I call the Rodney Dangerfield of medicine, they get no respect. When they do everything right nothing happens. A circumstance that does require a little more nuance effort to promote, incentivize that. The third is a different infrastructure for medical Countermeasure Development. We talked about domestic reduction of vaccines. If we could expand that lets make sure we have the right vaccines, great jobs for americans in many parts of the country, innovation in healthcare. We are doing some of that to address issues related to the supply chain that have to be addressed, things like active pharmaceuticals and where that is manufactured, much of it is overseas, great vulnerability as we learned through this experience. Four quick things in Broad Strokes i would suggest the study panel has done to raise awareness and focus our efforts to do that. Take another minute to talk about additional steps the administration has taken to fill other recommendations. The other 30 some that have not been. In Broad Strokes the bio Defense Strategy, the executive order on pandemic influenza which talks relative to this issue how do we manage a potential pandemic of lou, a lot of that is about speed of action which is a fundamental issue for this event, the virus is moving faster than we can even think and act and the second thing is about domestic capacity and supplies, things like the Strategic National stockpile that have to be maintained over time. One of the findings of the bio Defense Strategy was we invest 8 billion in this kind of activity each year. Sounds like a lot of money but when you consider Aircraft Carrier cost 17 billion and we have 12 of them that gives you scale of what we invest in one arm of our National Defense that we want to invest in our National Health security. As you know, pharmaceutical companies that exist and operate exclusively in this country often times to partner with pharmaceutical companies in other parts of the world in order to try to solve alzheimers disease, parkinsons disease, ms, what collaborations are being encouraged with respect to shortening the Development Time for the vaccines . There are some examples, a group that an International Consortium that involves the gates foundation, several european governments to focus on major disease areas. Coronavirus is one of them and wahlberg virus and hemorrhagic fever and those initiatives are valuable because if you consolidate small resources and get bigger opportunities and tap into the wealth of innovative thinking to address these problems and understand in many of these cases the underdeveloped world is the most at risk, to make it affordable and more accessible. The models are very helpful and the security agenda is another thing that was created in the Obama Administration, perpetuated in the Trump Administration to address how to build capacity to be better positions to help themselves, the success of the western congo outbreak of ebola to build infrastructure and availability of effective vaccines and it is a different story. These are the examples. Thanks to both of our witnesses not only for your presence this morning but to you and your teams thank you for your service and thanks to everybody on the front lines. Doctor kadlec, i want to follow up on senator johnsons line of questionings about what to communicate to our constituents about the timing of testing availability. You went through, Public Health labs, now we are surging up on the commercial side. We talked about 1 million plus test capacity, a part of the process is going to be once the commercial labs get these kits theyve got to validate them. How long does the foundation process take . Im trying to get to a timeline so people understand when this surge will make a difference. The key thing is the availability test being delivered now. In Public Health labs, you will see very high capacity and capability. And then the commercial laboratories will be lagging a week behind that. How long does the validation process take . A couple days. For each kit . The machine validating the test itself on the machine and the people who work the machines. I think it would be helpful and i want to move on to other questions and not belabor this but if the administration would put down a timeline so people could see in writing on a website when you dont have to promise an exact date but when it would be reasonable to expect commercial labs to perform this test that would be very helpful. I want to move on to another issue. As you know, the National Disaster medical system and other programs play a role in ensuring uninsured and underinsured patients receive care by helping members, you mentioned earlier a discussion in the administration. Can you provide an update on those conversations and more probably what the administration is doing to ensure that underinsured and uninsured patients receive the Emergency Care they need . I am not the best one to answer that. I know that in the supplemental there are moneys to support that, about 1 billion, you were very generous and that our location. The money will be used for that purpose to assure that we can take care of everyone afflicted with this. Eiffel i will follow up. It is an important issue and if we need more resources to make sure people are not only getting the care they need but the tests they need so they will not be affecting other people. Earlier this week, doctor kadlec, i met with Public Health officials who having state stockpile the protective equipment like masks but they recognize their stockpiles may be used up and we have had one confirmed case in new hampshire. Public Health Officials attempted to order more supplies and they were told supplies were on back order until may. Based on your testimony, i am concerned the National Strategic stockpile wont be sufficient to meet the demand. What is the timeline for getting the equal it in the field and how would you advise people to protect themselves in the interim. The strategy to address your point which is unless you have it on hand immediately you will have challenges. We have a limited stockpile of masks, respirators and we are in the midst of procuring more immediately meaning tens of millions and introduced or released as of yesterday a request for proposals for 500 million, 95 respirators to provide the next 612 months. The manufacturers know they will get paid. Do you have a plan in place to ensure that firefighters, Public Health officials and other First Responders are appropriately prioritized . We met with manufacturers and it is one of the conversations, they are making a locations on their own but in the course of that in a given year only 10 is used by Healthcare Professionals and First Responders so much is used by construction, mining and manufacturers but the authorization to allow nonmedical math and First Responders including working to get an allocation to ensure that those First Responders are covered. That is helpful to know. In addition to states needing these supplies it will be important to provide training to any responders or providers tasked with treating coronavirus patients. What efforts are underway at the federal level to ensure responders and providers can Access Training on the use of protective equipment . One of the critical things, a product of congresss work has been the National Ebola Treatment Network that was created with that there was more generous money then than now to address not only ten regional centers, National Centers of excellence, we have also in the new england area started regional disaster at mass General Hospital working with your area to train and prepare people so that is one mechanism, we can get training out in specific information how to manage coronavirus experts and using people from mass general and repatriation of people. It is going to be important, something i asked about yesterday. There are cuts to programs that train First Responders in this kind of work. Im just about out of time so i thank you both and thank you, mister chair. Thank you for being here. We have had you a lot of hearings and appreciate your aroundtheclock work. No surprise the virus is moving fast, nevada reported its first case of the virus today. I have been in close contact with state officials, the Governors Office and i want to emphasize the importance like the other senators have how important it is to keep those clear lines of communication with really good data they can respond with boots on the ground. I would like to address federal assistance for the impact that individuals. If larger quarantine measures are needed or medically justified what plans are in place to provide relief to those americans who may miss work due to government imposed quarantines but not necessarily to their illness . Many live paycheck to paycheck, loss of a few days work as a major hardship let alone staying home for a few weeks, this could lead to people losing their homes, not being able to afford food or other essentials. If we have situations like that on the ground what can fema do to alleviate this in the short term . What do you need to help with that . Fema has been in place with hhs for almost a month now assisting them, bringing the expertise fema brings to Disaster Response to this effort. The lead federal agency, people naturally look to stafford act, this is a disaster of sorts but the response mechanisms are not the same. It is not currently anticipated that you would see a stafford act declaration. The intensity of the problem will be different in nevada than it will be in virginia. There is a base fund where governments, governors can make requests when elements of their systems are overwhelmed for funding. There is a 5 million that is waivable for that and this is not the Disaster Relief fund, the 34 billion this is a base fund that has 640 million or so in it. We know that around the country some places are reporting school closures. We could anticipate closure of Senior Centers. Many kids across this country, many in our state, on free or reduced lunch, we have Senior Centers where those seniors are reliance on those meals every day. How do we ramp up if there is a school closure, Senior Center closure, meals on wheels, and their families, can you speak to that . I believe but it is believed, secretary azar has the authority to expand age, welfare programs under the circumstances but fema and dhs do not have dollars available that are that would legally fit the description of the relief you are describing. That is something being covered and addressed in supplemental and that is the appropriate vehicle. I would note more generally, doctor kadlec referred to the Planning Efforts that went before this all arose and we operate off of the 2018 plan. In that plan, it was envisioned the financial vehicle to deal with an outbreak of this nature was via supplemental. We are sticking with this plan. As was said six weeks ago if we need dollars we will come to the congress. We are here now and that discussion is going on and it is including the kind of things our governors could request this invalid to communities that need it. Now, you are mixing two things. If the supplemental includes moneys to address the shortcomings you are describing then the answer would be yes. Theres nothing currently legally in place that fema has available that would fulfill the needs you are describing. We may have to look to that in the future, what we have to do to take care of those vulnerable populations. The next thing i would like to ask you is about immigrants seeking care. Nevadas diversity is its strength, one in five nevadans born outside the United States, many more living in households with immigrants, some of whom are undocumented. As we work to contain the coronavirus we need to make sure theres timely access to medical care for everyone who needs it regardless of their status. This is a Public Health and safety issue. Anything less put all of our communities at risk. Mister cuccinelli, no one should be afraid to seek care, will the department refrain from apprehending individuals based on their immigration status when they are in the process of seeking care . Much like the cdc cbp relationship exists this virus, it is something that has stood before, ice also has an already in place policy, sensitive locations policy, they do not do enforcement in Healthcare Facilities absent single case negligent circumstances. There is no reason anyone should expect that will they refrain from potential intimidation factors like placing vans outside Community Centers or Health Centers where people may go to seek these tests . That would be consistent with the policy. I yield back. We discussed this, senator portman brought this up yesterday. 0 for dhs. We talked about this in the cloakroom. Can you describe, how dhs will get the funding to do the things you need to do . The easiest starting point is what is already going on so fema is in the Office Every Day with doctor kadlec assisting hhs, that is financed by hhs. Those agreements are in place so dollars that flow to hhs to address the virus challenge, the source of the lead federal agency do flow to dhs when we are providing those supportive efforts from any of our agencies or components. The most obvious one day today being fema. Theres a mechanism between agencies. You are not concerned when you look at that supplemental, where is our support . Where are our resources . The administration requested 2. 5 billion, we will give him eight. Resourcing should not be a problem. That is exactly how this will work Going Forward as it has as i noted for the last month or so. Thanks to both of you for being here in the excellent work you are doing to address this outbreak. It is very concerning, the spread of the virus nationwide. Im concerned about what this is exposed. One of the things is the fragility, the vulnerability of our medical supply chains. He recognized this a moment ago, medical devices too many of our drugs or pharmaceuticals are manufactured in other places, china in particular and we have seen early reports about potential drug shortages because of chinese factory closures. This is something weve got to address, so that we are not cut with severe medical shortages but also Going Forward that we take necessary action. Let me start with you on this. Can you describe the actions the task force have taken to ensure that our Healthcare Providers have uninterrupted access to personal protective equipment like masks and gloves . The key thing is we are thing working with key manufacturers, distributors and it is a delicate balance to ensure that what is made available is available to the stockpile and not only our stockpile but distributors so they can provide for private healthcare workers as well as institutions. Many states have a limited supply, limited stockpile and our intent is to provide, support the state by providing the materials as we did in the state of washington to supplement what they have on hand to ensure they dont run out in an emergency of this nature. You wrote about the Strategic National stockpile working handinhand with commercial supply chain partners to monitor shortages. Can you elaborate on that . If not daily, weekly conversations with major suppliers, respirators, honeywell and others to understand what their allocations are to the private sector and what are the needs for the federal government as well and there are many departments and agencies that have needs so we are monitoring actual needs to ensure theres enough in the pipeline for the private sector to meet their personal needs. My understanding is the fda is working with manufacturers to monitor shortfalls for drugs and devices. To what extent are they complying with requests . The fda does this to a confidential business arrangement. I dont have disability entirely is appropriate in this case to know what the particulars are but doctor hahn could brief you on what they are doing but theres only one drug, prescribed drug that has been identified as being a potential shortfall. There are alternative products available in the us market that could be substituted so the impact of that limitation doesnt seem to be great but he is monitoring that like a hawk to ensure they not only identify nearterm but longerterm risks to our medical pipeline. My own view is we need to give them more authority to look under the hood and find out where the devices come from with supplychain vulnerabilities and give them the authority by speeding up approval of alternative devices or drugs manufactured in various areas and i introduced legislation to do that. Mister cuccinelli do we need to consider expanded travel restrictions and how do you evaluate that . The short answer is yes but it is yes because we have been considering them on a daily basis and the driving factors would include how they weigh in each country. First, the transparency of the nation under consideration. You compare chinas transparency to korea, dramatic difference. The ability a own Healthcare System to respond to the outbreak in their country and the capacity remaining after they do so, so i will give you an example. The state departments warnings early on about china were not just because of the outbreak. But also they were directed at keeping employees safe. If you get into a car accident and related to the corona virus there wasnt a doctor to take care of you. In that part of the country they were and are overwhelmed. That is another consideration. China on the other hand would be a difficult consideration than their neighbor, mongolia. Mongolia closed the border very fast. Part of the rationale is they dont have the blue to respond. We are talking about this committee, they have no ability. Those factors weigh in on other countries. Your testimony is reevaluating this on a daily basis . An interagency process, using two scales to warn americans, the state departments travel advisory scale that is 14 and the cdc health scale which is alert to 3, and they are the top respectively. The deputy secretary in the task force i dont think they have seen such responsiveness to their travel advisories. Much like cdc, 500,000, their business guidance in the last 2448 hours. That is a meaningful effect without mandates. There is a 212 proclamation with china, the tsa issued security directives effective yesterday with respect to korea and italy but a minimal legal impact come more advice and wait of the advice. Before my time completely expires and 10,000 diagnostic test today. And why are we not at scale to do that and on this topic can you explain the precise reason for the defective kids we lost earlier. They need to have cdc brief you on that but in terms of scaling in the earlier conversations, they were scaling up by commercialization, test kit in Public Health laboratories, engaging the private sector and commercial labs doing largevolume testing and rolling off the line in the next week or two that would expand the opportunity and hospitals and clinics in doctors offices with commercial laboratories. We dont need to do that. I want to comment on that point but you need to do with some precision, with nasal a swab so the risk is you can swab somebody if youre not careful and get a false negative. It gets a little training and i dont think jackinthebox will be swatting anytime soon. Senator scott. A lot of information, is there increased risk . There needs to be better understanding, a vulnerable population for a lot of reasons, two lives in different physiological effects of pregnancy on women and the baby, the earliest reporters coronavirus report, but it is an anecdotal case, a major issue. Nothing has come out of south korea or japan. We are getting highlevel statistical data. Secretary cuccinelli, in florida we have 150 million, and they go to the cruise ships. What advice do you give airports and seaports to deal with, so many people all over the world, we know countries have coronavirus. What precautions are you putting in place . The coast guard, tsa in particular have regular communication, i have been doing that as well. You will have noticed for the First Time Ever talking about travel advisories, we issued a travel advisory, Todd Department of state related to cruise ships, not a country, not a location but to cruise ships, proven to be a risky venture from a health standpoint, that was unique and effective, and the cruise ship industry, it is a viral disaster. And avoiding a repeat of a series of mistakes that will take a long time to understand, has driven a lot of their response was on the airline front, we are seeing point to point declines in traffic, i have data on that if you like, chinas flights have gone to the floor and korea has declined maybe by half, japan by 25 by way of example. There are good reasons for that. With some of the representatives, they are themselves trying to avoid bringing on passengers from these hot zones. To avoid a repeat of the result of quarantining a ship. As it works in the ports and you have many of those in florida, the captain, the coast guard person in command is in absolute control and we hold ships offshore. We have done that through this entire time, that has primarily been associated with cargo shipping and we have tried hard through some of the discussion of supply chain to keep the cargo flowing not for dollar reasons but because of the interconnected nature of our supply chain and we have taken special steps allowing offloading and reloading of ships without the usual coming ashore. In the passenger context that is much more difficult and we have to contend with these. Sitting next to senator harris, in San Francisco, as we speak, that is being dealt with directly, the port will work directly with the regional cdc head to address these on a casebycase basis in terms of how to deal with passengers. Having been governor of florida you can appreciate if we were to use the Healthcare Facilities to deal with an entire cruise ship we would immediately swamp the Healthcare System locally. That is counterbalancing challenge to make those state and local arrangements, though they are conversations the coast guard has all the time. We are handling them one at a time but with an eye to not bringing ashore virus spread. That is the priority and that is why we warned americans not to go on them. Lots of International Flights in florida. What will it take to do the same thing we did restricting travel out of china. That step was taken in the worlds epicenter, still the largest number of cases in the world. We dont see anything like that developing to that scale. They are kicking case numbers up and it is important to remember when you take a snapshot of todays cases, that is a two or three week indicator. And might exist in humans for three months. They try to air on the side of in the cruise business, that is hurting you right now and that will keep hurting you for a little while. We dont know how long. Obviously our challenge i dont trust any information of china. I dont believe they are transparent country, a communist country run by the communist party. Any inclination to open up travel from china anytime soon . That is not on the discussion table. We are not even talking about it. Clearly it would be important for my state but on the cruise industry will you get to the point you Start Testing everybody that will come on . That would be a casebycase. We wont be able to for at least a few weeks. However, we are right now literally as we speak flying test kits to a cruise ship off San Francisco, off california moving up to San Francisco with coast guard hilos, dropping onto the ship and bringing kids and we will test if not everybody a very large number of individuals relative to the ship so that we have full information when the captain of that board in San Francisco is talking to their local cdc authority and they have been working as an action group with the cruise line so this is not popping up on us. We have been working on it for days. I would think in terms of availability testing, such a unique situation that would be one of the priorities in terms of getting test kits. As you know my state is home to 40 Million People every have a large number of cases, 62. Yesterday our governor declared a state of emergency for the entire state. The coronavirus is a convergence between Public Health concerns and pay equity concerns. Two thirds of low income do not have paid sick leave. As we know we have been encouraging people who are sick to stay home. Often people in that pay category also are in the Service Industry. They work in restaurants, hotels, childcare, contact with a lot of people. For them to stay home in the interest of Public Safety means they may not be able to put food on their table. My question is understanding this is a very real issue. What is the Administration Planning to do to encourage employers to provide paid sick leave for sick employees so they will stay home and not have to face that awful decision about whether they stay at home and be a minister Public Safety or dont put food on the table for their family . I will speak first to the comedic asians with people we have had across the private sector. In addition to accelerated communication with local and state level officials we have been talking to nonhealthcare private enterprises and encouraging them in this direction recognizing the burden asking employees to stay home imposes on the business and the employee. You identified certain businesses where it is important for everyone else, not just coworkers, for the person to stay home. If you are serving food, customers in that restaurant dont want you to come to work. What can we do to support you talking with the private sector providing paid family leave . Already standing sector consortiums they are talking to and this is one of the subjects, supporting employees who are asked to stay home and we are asking businesses in those lines of work where it is possible to make the telework arrangement so people can keep working and get paid and you dont function as well but they can still earn money for their families. My concern, the majority of low income workers, dont have paid sick leave. They are in the Service Industry so teleworking is not an option for them. We can follow up to determine how to support your effort to figure out ways to make sure these employees dont have to make a decision between paying their rent or contributing theres more money available and i would be for 2 doctor kadlec because that is out of hhs. Another area on the White House Task force, mister kudlow, Mister Mnuchin and the National Economic council are involved in this and looking at ways, small businesses, very credible part of supporting individuals. Im sure they will work with congress to figure out how to support individuals who are facing this problem, were challenged. Federal employees. We have many federal employees whose job does not allow them to telecommute, tsa for example, coastal workers. What is the administrations plan for those workers in terms of also soon to be in numerators for the 2020 term which starts april 1st. What is the administrations plan for federal workers who do not have the ability to telework and do their job. One of the subgroups in the task force is dealing with the federal workforce and to use that to permit of Homeland Security as an example we have the building in Washington State where we unfortunately had an employee test positive, that is an Office Building setting, one sitting dhs operates, a lot different from Border Patrol station or a tsa desk where a lot of people are going by you in] every day. For those folks, people like the tsa example, apply the cvp and others, we have made it available to them, the medical guidance requires appropriate training to use correctly in a way that is advantageous to the where. When china flights were coming i observe the difference in the employees, the cvps, when i arrived with no flights, had a uniform on, looked like you and me. Gloves and masks were on and that is available to all our employees and that is true for the frontline folks across the federal government but that is closely studied and we do things like cooling down necessary travel. Other things where we dont create risks for employees or the general public. Following up to immigrants and undocumented immigrants, the reality is we have many and document it immigrants in americas workforce and we recently had an announcement from ice that they are going to increase enforcement. It is a legitimate and real concern that undocumented immigrants in particular and their family members are in fear of and discouraged from going to Public Health facilities to receive treatment if they are sick. I heard what you said about policy. Would you be willing to issue a Public Statement that during the crisis we are facing around the coronavirus, there will not be ice enforcement and Public Health facilities. We should a statement in response, our statement was based we restated that yesterday. There is discrimination against asian immigrants. Public Health Experts agree. And we are seeing many reports, from intimidation and profiling about threats. What is the administrative prepared to do committing to actively. It is very real. We have enough fear about the Health Crisis and to compound that with what friends and neighbors have, being profiled. We are trying to convey lots of information about a virus about which much is unknown. And we have remarks from every level of government and the same concern you just voiced. When we have instances brought to our attention. In our soon thereafter Public Statements to knock that back. That is when we talk about that, i will say clearly the task force is without question, since youre black, white, asian, hispanic, anything else. The dangers are the same people regardless of race, ethnicity and our responses should be regardless of peoples skin color, ethnicity and that is how the federal government and how we are responding to it. I use the northern border, canadians have been barred from the United States on the northern border van chinese, to that proclamation it is because we are travel based, wasnt just you are chinese but you have been in the hot zone in the targeted time period and we will continue to operate that way and make efforts to knock down storylines. Thank you for participating in this important hearing. A stay with confirmed coronavirus cases. And the Arizona State lab, Maricopa Department of Arizona State university for swift action to secure those individuals and mitigate exposure to those in community. We need to see that coordination on the federal level. We quarantines at lapland air force base received little to no information when they would be able to go home after another individual tested positive for the coronavirus. Many of them are on their way home to their loved ones, some are in quarantine. This lack of communication is on acceptable. Our constituents bear straight answers from the federal government on quarantine guidelines to develop a coronavirus and Public Health expertise. My first question is directed to both of you. Companies large and small are working to develop vaccines, therapeutics, better diagnostics and lending their expertise from previous pandemics, moderna, jfk, cicada, gilead and others are included in this all hands on deck ever. Arizonas own phoenix biometrics minute information to the cdc to evaluate Biosensor Technology to detect airborne viruses. Once a vaccine is approved what will the prioritization strategy before its deployment . Specifically targeting vulnerable populations like seniors and those with Underlying Health conditions and frontline workers at our Border Patrol stations, ports of entry or healthcare workers, servicemembers stationed abroad in hardhit countries . I will take the first shot at this. We are actively reaching out innovative countries and we have met with 1500, engaged 1500 universities and the like. We have been delighted to receive suggestions from your folks. I will be happy to provide this information as well and the key thing is were looking across the domain. The director behind me, still behind me, they put out a broad announcement to look for innovative ideas across the spectrum of medical countermeasures. There is a way to do it and electronically engage in that area. The issue of the vaccine, that is not an imminent possibility from earlier conversations, 12 months, more like 18 months, we would have something in the scale of that availability will be dependent on the kind of vaccine to be developed and right now there are primarily three candidates, moderna is one, Johnson Johnson is another and santa fe as well as a third. Much of what will be available will be determined on the prioritization you identified. There is a National Security component, to protect forces, there is a critical how do we protect people on the front lines like healthcare workers and as you highlighted the vulnerable populations which are significant in our country, has to be factored into that and those are answers yet to be determined based on the best evidence and Scientific Answers we could come up within the time we have. With respect to the prioritization you can expect to see when we reach that point what i call a traditional prioritization, you mentioned high risk categories, the mortality rate if youre over 60 and have a secondary condition is much higher than if you are under 50. And so limited supply will be funneled to the priority categories as typically happens already. We are also going to have to work through the kind of challenges you describe in force protection and Frontline Law enforcement and First Responders. E 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 limited resource incense that nothing in of us are going to 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 it will be similar for First Responders. So you can fully expect to see that play out in your state as a border state, thatta will inclue Border Patrol agents and so forth the man those posts and deal with people who dont come in with documentation, who dont come in with medical histories, and we have to be very, very cautious in the circumstances. And, frankly, one or two people in the facility like that can wipe that facility out for utility purposes. Thank you. My second question is for dr. Kadlec. It was announced you a lot more type of respirators to be used by healthcare personnel as part of the group of viruses but concerns. This week senator fischer by introducing the Health Care Workforce protection act. It amends the preparedness act to include respirators that are certified by the National Institute for Occupational Safety and health. Could you talk about some of the coronationon efforts office is leading to ensure adequate supplies to protective equipment including efforts to incentivize manufacturers to increase production . You for the question. Thats a critical issue that has to be addressed. I happen to be on the h. E. L. P. Committee of the time the prep act was originally considered and and acted so i have firsthand experience and one thing that we didnt consider at that time quite frankly is the situation we have here right now, which is then we thought a pandemic of influence would be the principal threat weou would have to confront. With that weve focused a lot on the idea of medical countermeasures that would minister to protect our Frontline Healthcare workers in vulnerable populations, vaccines, therapeutics and diagnostics and the like. The prep act was focus on those particular things 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. Of the supplemental monies we intend to actually kind of work to build theui capacity to that using that kind of innovative approach. Other approaches like transdermal application or administration of vaccines. Doctor brighton who leads barda here has been very successful in their endeavors, 53 54. My apologies. The point is really getting, trying to look atat innovation o basically help solve some of these 30 difficult supply chain issues. We dont just have to do the old way. We can find new ways to do it just as effectively and likely more cheaper as well. Final question. Is the department considering issuing an Emergency Declaration under stafford act am given what happened we have to see what happens as adults. Maybe you can walk me through that, to issue a declaration that would allow the government to deploy disaster medical teams, incident management teams, mobile hospitals or transportation sport . We done that and a variety of times in the past with west nile virus and ebola, et cetera. Walk me through that. So the answer to the first part of the question is no, but that does not foreclose the use of the i met. To give you an idea of some of the work weve been doing with the time, we bought with the strategies we been using, youre familiar with our teams that fema and they are sizable numbers of people. We have reshuffled them down to four and five person teams who we provide some p additional training to deal with a virus situation versus hurricane, tornado in tennessee right now were dealing with right now. And the reason we dad that is we did that is unlike a weather event, can be everywhere at once in a worstcase scenario. We created enough standalone teams that wee can help all 50 states in smaller degree with the kindes of support that fema brings in terms of experience and so forth. So again not sitting idly. Those of the changes weve been making to our structure so we are responsive to whats out there today. But the stafford act doesnt envision act circumstance like this. I mentioned earlier the availability of the baseline, not the Disaster Relief fund, that really i think you to go back to the 90s, and it was i think west nile, it was in new york and new jersey, if memory serves, made request of the base fund to get ahead of, allevia, these example is a forest fire. If you help us now we can keep this thing from getting bigger. It has a 5 million cap, away a waivable cap and it is designed to avoid rolling damage to a system. In this circumstance you probably looking when a community or a state has its Healthcare System threatened to be overwhelmed because theyre getting hit harder than other parts of the country. There is some money available for that purpose. I would say the stafford act is not designed for this. Not surprising to you we have analyzed it for this purpose sort backwards and forwards. So you are seeing even those teams are typically be deployed alongside hhs here and in support of them, and hhs would reimburse us. Thats of the budget would work for their deployment, just as it are for thefo pink fema team tht is supporting them right now. Thank you. Real quick, i really need to close this out pretty quick, but dr. Kadlec, who is in control of the strategic stockpile . The secretary is really the overall if you will, i was a Incident Manager but hes a person in charge at hhs. So how many items are inventoried in the stucco . Its about 80 billion enterprise. Eight or 80 . Ri eight. How many items . Hundreds of vaccines, therapeutics come all kinds of supplies, masks. So who and how are the inventory levels set . We have requirements that are set that are based on requirements process. Some of it has been fixated on the basis of what can we buy our what can we afford to buy as much as what we may need. 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 i hope the American People areth listening to the thoughtful, responses. It would give them a fair amount of confidence. This is uncertain. We dont know where this is going to go t but from my standpoint having dealt with members of the administration of people throughout these agencies, percival thank the men and women of your agencys, but this is being carefully consider. We are thoughtfully working our way through this process in a very uncertain situation. So again thank you. Thank the men and women in your agencys. Again ind really do appreciate e members of this committee being very respectable and thoughtful in the questions as well. The hearing record will remain open for 15 days for the submission of statements in question for the record. This hearing s is adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] today, the director for the centers of Disease Control and prevention dr. Redfield testifies before House Appropriations subcommittee on the governments response to the coronaVirus Outbreak. Watch live at 10 a. M. Eastern on cspan3, online cspan. Org, or listen live on the free cspan radio app. If they if it comes out to ba campaign in which we have one candidate who is standing up for the working class and the middle class, were going to win that election. For those, those who have been knocked down, counted out, left behind, this is your campaign. The president ial primaries and caucuses continue tonight for six states, including idaho, michigan, mississippi, missouri, north dakota, and washington. Watch our campaign 2020 coverage of the candidates speeches and results. Tonight live on cspan, cspan. Org or listen from wherever you are with the free cspan radio app. The National League of cities held a briefing at the annual congressional city conference in washington. They spoke about local government leadership priorities and coordination between cities and the federal government in response